Subsidies are also one form of social services as the Government Essay Example for Free

Subsidies are also one form of social services as the Government Essay With the increasing diversity and complexity in which services are facilitated by the United States Social Welfare system, it needs to be elaborated and reviewed accordingly so as to help benefactors get the best of what they have and necessitate the optimum available alternatives on their part. One important example given in the text is the power over decisions. This initiative enables and evokes the â€Å"right to make decisions that serve self-interests of a particular group with which decision maker is affiliated† (Chambers and Wedel, 2005, p.   94). This example can best serve if for example the healthcare department of one state agrees to place a qualified professional to make decisions on what programs need to be tackled for a particular period. On the other hand, this initiative can be costly to individuals and groups if the decision making process is tainted with a subjective purpose. For instance, a designated man may advocate a particular scheme because his company or service can benefit more in the process while disregarding the needs of other groups. Subsidies are also one form of social services as the Government tries to shoulder various expenses incurred in some aspects mandated by law (Chambers and Wedel, 2005). In here, the positive aspect of such facet can be the government reaching out to starting sectors in the economy and giving them the needed boost to succeed. On the other hand, one negative aspect of this is that not all sectors are given subsidies. Due to this, only selected and limited parties benefit from the process. Lastly, positive discrimination is a form of social service that tries to provide individuals and groups who have been treated harshly or unequally by the government (Chambers and Wedel, 2005). It is a form of setting restorative justice for those individuals discriminated by the old system. This connotes a positive attitude because it the Government tries to reach out and provide the necessary changes in their lives. For example, an African American was not given a good job despite his credentials has the option to apply for this. Contrary to these, it also brings about the question of its legality and notion of the action to create restorative justice. Due to this, limited people receive this kind of service and are primarily determined by court. Reference Chambers, D. E. and Wedel, K. R. (2005) Chapter 5: Who Gets What: Analysis of Types of Benefits and Services in Social Policy and Social Programs: A Method for the Practical Public Policy Analyst. 4th ed. Allyn and Bacon; Pearson Education 90-108.

Pip and Magwitch Essay Example for Free

Pip and Magwitch Essay Throughout the novel Great Expectations the reader will find that Magwitch plays a significant role to the plot of story. Not only does Dickens use Magwitch to form the main foundation of the story he also uses the character to convey Dickenss view on important themes such as crime, punishment, social status and betrayal. In this presentation I will explore the ways in which Magwitch is presented and talk about and his significance in the novel. We are first introduced to Magwitch in chapter one. The reader becomes familiar with the character Pip; we learn he is a child who is alone in the graveyard and is mourning over the death of his family. The reader knows that not only would this upset Pip, it could make him feel frightened because as a child you are dependant on your family members to keep you safe. He makes it sound as if Pip was recalling what it felt like to be a child, like when we get the impression that he could have been exaggerating about wilderness and so on before him. An image is described, such as the low leaden line beyond and this then is revealed as what it actually is; the river. This gives the effect that not only Pip is confused and lost by his surroundings but also and therefore scared and intimidated by them. Dickens delivers Pips emotions cleverly because there is no direct reference to how he is feeling at first. This is very good building up to the shock of first meeting Magwitch. The writer uses direct speech for his first words, which come out suddenly, at no particular starting point and with impression that they are loud! He says Hold your noise. which sounds at first so abrupt it could be almost like he is trying to save Pip, that he fears for Pip too. We then read on to see how Magwitch is presented physically. He is wet and muddy, and is described as being stung by nettles, so he obviously does not look after himself properly. He is shivering and limping, so he may be unwell as well as cold. His shoes are broken and he has no hat or proper clothes which shows he cannot afford them. He has a very informal way of speaking, and is eager to see the scrap of food he finds on Pip, so this also shows that he is poor and working class. This could be because, or the results of being a criminal. The first chapter is important; we now know exactly what Magwitch looks like and how he is presented. As mentioned in the introduction, Magwitch is significant in the plot. The fact that he appears in the very first chapter makes us assume he is a main character, even though he does not reappear until later in the book when the reader either has completely forgotten about him or thinks it is very unlikely that he will appear again with the current story line, especially as at the end of chapter three it says the last I ever heard of him. When he does make his unexpected reappearance in Chapter thirty-nine, he reveals news that causes him to become the centre of almost every aspect of the story line. By the end of Chapter fifty-four and when mysteries are revealed and loose ends tied we come to realise that Magwitch is somehow connected to every character. Pip, obviously because of the money he gives that cause him to become wealthy and middle-class. His lost past with Molly and Estella, his daughter, who was adopted by Miss Haversham. Also he is connected to Joe because it was his whittles and file he used to set him free. Perhaps he is connected to Mrs Joe because he murdered her. When Magwitch dies during chapter fifty-six, it impacts the plot and the characters, especially Pip. Magwitch influences other characters, especially Pip and sometimes they influence him too. Had it not been for Magwitch the way people behaved may have been very different! We do not know much about Pip before he meets Magwitch, but afterwards we find him to be cautious, for example how nervous he was when he meets Miss Haversham. This could have been a lasting effect from his fears upon first meeting Magwitch. Pip may have been so shocked by the way that the poor lived that he becomes even more determined to become a gentleman. It gave him an insight to the lives of the very poor. In chapter three Magwitch seems to wait all night just for the food Pip has brought him. Pip may have recognised his determination and perhaps used this will when he is seeking Estella as his wife later during the book. Magwitch may have been so grateful towards Pip that it made him feel like he should try and become a better person. Both Pip and Magwitch taught each other that you should not always be judgmental. For Pip, it was that he was at first very afraid of Magwitch and thought he was going to be scary. Later on he realises that he only was behaving in a threatening way because he was hungry and desperate for food.

Importance Of Needs Assessment In Nursing Practice Nursing Essay

Importance Of Needs Assessment In Nursing Practice Nursing Essay Confidentiality and anonymity must be maintained at all times to protect the identity of the service user, carers, families, healthcare settings and other professionals involved. Any breach of confidentiality will result in an automatic fail. This essay will discuss the importance of needs assessment in nursing practice. In relation to case study 2 about a 68 years old Afro Caribbean retired bus driver male called Carl, who has being married for 45 years with 5 grown up children and 8 grand children. He smokes 20 a day and enjoys nightcap before sleep. His latest vital signs observation are respiratory 20 rpm, blood pressure 168/105, pulse 92bpm, Spo2 95% and BMI 32kg/m2 and he is on statin, betablocker, aspirin, frusemide medication. Currently his wife has notice Carl seems to have forgetfulness, he couldnt remember his way home from the super market and keep losing items. He is getting frustrated and taking it on his wife and grand children, especially when he cannot read them a story. This essay will discuss the importance of needs assessment in nursing practice. It will identify a service users needs base on a scenario and the appropriate assessment tools required for his care. And from the tools identified, one will be prioritised and apply on his condition. Finally the essay will summarise the experience of using the assessment tool and how it will help in future learning. Patients assessment is the collection of data about an individuals health state that identifies and defines patient problems in order for solutions to be planned and implemented in line with their preferences (Roper el at 2000 p 124). Therefore, a clear idea about health is important because this determines which assessment data should be collected. The world Health Organisation (WHO) (2001) defines health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. Whiles this is a broad definition, it implies that the nursing approach to health care is holistic in nature and therefore health assessments should reflect that philosophy with it focus on the whole person and their context. Nurses are obliged to take in to consideration patients physical, emotional, spiritual, social and intellectual needs when making an assessment (Department of Health 2004). ` Therefore, when nurses are conducting health assessment on a person it may requires acknowledgement of techniques of collecting and analysing subjective data which is what the person says about them selfs during history taking. And objectives data which is what nurses observe by inspecting, percussion, palpating, and auscultation during physical examination (Department of Health 2003). Potter and Berry (2005) argue that if inaccurate, incomplete or inappropriate data is recorded then the overall care of the patient may be affected, including wrong diagnosis and even wrong treatment. NMC (2002), code of professional conduct, urged all nurses to work in a professional manner and abide by the policies set out by the trust they work in. it suggest that the recording or documentation of information is essential and any deviation could lead to potential consequences for the individual if their standards are not met. The purpose of health assessment is to make judgement or diagnosis because all health treatments and decisions are based on the data gathered during assessment; it is paramount that the assessment is factual and complete, providing the foundation for clinical decision making (RCN, 2007). This gathered information provides a comprehensive description of the patient. It focuses on the patients needs at that moment in time and possible needs that may need to be addressed in the future (NMC, 2007). Its a fair and accurate account of the individual and their life. Overall assessment is a way of delving deeper into a patients illness and preventing more problems from arising. In relation to case study 2 about a 68 years old Afro Caribbean retired bus driver male called Carl, who has being married for 45 years with 5 grown up children and 8 grand children. He smokes 20 a day and enjoys nightcap before sleep. His latest vital signs observation are respiratory 20 rpm, blood pressure 168/105, pulse 92bpm, Spo2 95% and BMI 32kg/m2 and he is on statin, betablocker, aspirin, frusemide medication. Currently his wife has notice Carl seems to have forgetfulness, he couldnt remember his way home from the super market and keep losing items. He is getting frustrated and taking it on his wife and grand children, especially when he cannot read them a story. Newson (2001) suggests that, for a process to commence a model of assessment is utilised and this model needs to be holistic in all aspects of patients needs. Therefore proper attention needs to be paid to the biological, psychological and social situations of the patient. It is important that the health assessment includes a thorough examination of the patients activities of daily living (Department of Health, 2002) .The twelve activities of daily living (ADL) are communication, safe environment, breathing, eating and drinking, elimination, washing and dressing, temperature, death and dying, mobility, working and playing, sexuality and sleep (Roper, Logan and Tierney model 1985). Although, the Roper Logan Tierney model has being criticized for the use of activities of living as a simple checklist and emphasis only on the physical aspect of patient care( Reed and Robins 1991). This contrasts with Newton (1991) who suggests that the description of the Roper Logan Tierney model (1985) have been varied over the years and describe the model as a system model. Also Pearson (1983) describes it as a systems/development-based model incorporating certain concepts of Dorothy Orems model and the conceptual framework of Hendersons model (Henderson, 1969). It is important to remember that all ADLs about our individual life activities are interlink and when one or more activities is affected due to illness then most of the activities can become compromised. (REF) After a thorough nursing assessment, the ADLs that are appropriate to meet Carls needs are communication breathing, eating and drinking, elimination, safe environment, mobility, working and playing. Communication is essential for building nurse patient relationship (Robinson, 2002). For Carl due to his state of forgetfulness, memory loos, out of character behaviour and frustration especially when he cannot read for his grand children, he may need referral to see opticians for eye check, and the MMSE tool can be use to assess his state of dementia. Breathing is the first sign every health professional look for during patient assessment. Being able to breathe normally ensures that we can attempt other activities without any difficulties for example running. For Carl his breathing can be affected by smoking for 20 pack years as well as his higher BMI can cause shortness of breath. Referral to the NHS stop smoking service or radiographs for chest x-ray to check for infection will be essential. Also regular vital signs check up and the use of the peak flow meter for checking oxygen level in the lungs or nebuliser will help. Ensuring adequate hydration and nutrition is essential if health is to be maintained and in Carls case he has a higher BMI and he is in a state of confusion. There is a difference between dying from nutrition and dying with nutrition. And in Carls case he is dying with nutrition as being over nourished with higher cholesterol level. Fanning H, (2003) suggests that Dehydration as well as UTI can contribute to his state of confusion. Both the (MUST) tool and the (MMSE) tool for assessment of possible dementia can be used (NICE 2012). Referrals can be made by nurses for Carl to see the dietician and also physiotherapist for physical exercise regime and dipstick for UTI. Elimination is very important, and in Carls situation review of his medications will be important since some may cause constipation or frequent urination e.g. furosemide. Higher BMI as a result of being Obese as well as chronic chest problems and constipation can cause urinary incontinent (Kamm, MA1998). Also In male, disease of the prostate may lead to the obstruction of the flow of urine (Abrams el at 2002). The Bristol stool chart can be use to assess constipation, the dipstick tool can also be used to check for infection or UTIs and the fluid balance chart can be use to assess for dehydration by checking input over output. Mobility can be a problem since Carl has a history of forgetfulness and the need to urinate frequently. Fear of not being able to find his way home, been incontinence in public and even fear of falling in a new environment may but him off from mobilising. Human assistance will be needed as well as the assessment of risk of fall. Carl may need assessment on Working and playing since he is retired, have memory impairment and get upset when he cannot read for his grand children. Socialisation seems impossible for him now due to his condition. Referral to psychologists for self worth exercise and also going to day centres to meet other people will help. According to the RCN (2004), nurses will always need an assessment tool to guide their daily nursing practice in terms of their professional accountability and responsibility. For any tool to be effective it must be integrated into daily activity as a standalone initiative it is unlikely to have a significant impact. In Carls condition the as human beings the capacity to sustain life is dependent on our ability to address biological needs including breathing, maintaining blood flow to all our major organs, eating and drinking, elimination waste, protecting ourselfes from injury or disease, exerciseing and resting. All these activities can be monitored through nursing observations of patient in our care, enabling us to decide whether any intervention is necessary to help them maintain their vital functions. In order to make accurate observations we need to learn the correct techniques and how to use relevant equipment. To appreciate the significance of the observations, we need a good understanding of relevant anatomy and physiology, and how to distinguish normal from abnormal functioning. We then have to decide whether our observation require further action, which might include double checking results, increasing the frequency of observations, reporting changes to the clinical managers, Universal Screening Tool (MUST) will be appropriate for his health. The reason being that, been over weight or having a higher BMIcontribute to a whole range of health problems such as heart conditions, high blood pressure, type 2 diabetes, stroke, sleep apnoea, cancer, gallstone, weak pelvic muscles and osteoarthritis (Department of Health, 2004). Heart disease for instance, is one of the most widespread main health risks of being overweight. Being overweight increases the probability of heart malfunction and blood circulation problems and may result in congestive heart failure (Miller el at 2006). He continued that, losing weight in this situation may not only avoid the above-mentioned ailments but as well assist normalize blood pressure, cholesterol levels and triglyceride and diminish inflammation in the body. According to Elia, (2003) MUST is a screening tool that has been devised for application to all adult patients across all health care settings. Malnutrition adversely affects physical and psychological function (Elisa, 2000; Stratton et al. 2003b) and impairs patients recovery from disease and injury, thereby increasing morbidity and mortality. BMI (body mass index) is an easy, inexpensive method of predicting the percentage of your body weight that is due to fat mass. BMI is found by dividing your weight (in lbs.) by your height squared (in inches) and then multiplying by 703. In adults, a BMI below 18.5 is considered underweight, 18.6 to 24.9 is considered healthy, 25.0 to 29.9 is considered overweight and above 30.0 is considered obese. Respiratory function has been studied extensively in relation to BMI. For those with lung diseases, including emphysema, chronic bronchitis, asthma, and interstitial and vascular lung diseases, respiratory function is moderately to severely compromised. This compromise can be exacerbated by being overweight or having a BMI over 25.0. However, even in those with normal airway function, high BMI can impair respiratory function. Obesity and Chronic Obstructive Pulmonary Diseases (COPD) Chronic Obstructive Pulmonary Diseases include emphysema, chronic bronchitis and asthma. COPD causes a decrease in elastic recoil of the lungs so that excess air becomes trapped in the chest. This stretches the muscles involved in respiration and compromises their function. The respiratory muscles must then work harder even at rest, increasing oxygen demand on an already taxed respiratory system. At a certain point during physical activity, COPD patients reach a level when increased effort does not further increase the amount of air that they can expire. Having a high BMI means having more weight for your muscles to support during mobility. Thus, if you have COPD, the level at which increased effort no longer provides an increase in expiration comes much faster since you are working harder to support your own weight. In addition, having a high BMI means having more weight on the chest for the respiratory muscles to work against. Sponsored Links Lose 2 Stone in 4 Weeks?Mom reveals the shocking truth  About the UKs hottest dietwww.constant-fitness.com/diet Underweight and COPD Although a high BMI can further impair respiration in those with COPD, once COPD progresses to a severe level, weight loss becomes problematic. Because of lower oxygen levels in the blood, blood becomes shunted from the abdomen into the heart and lungs. This causes malnutrition because the gut is not getting enough blood flow to properly digest foods. Additionally, severe impairment of the lungs causes the respiratory muscles to work so much harder that metabolism greatly increases, even at rest. Typically, severe COPD patients who are underweight have a worse prognosis than those who are overweight because they are essentially starving. High BMI in Healthy Individuals According to a 2005 study by Jones et. al., high BMI can severely impact respiratory function even in non-diseased individuals. The study found that both Functional Residual Capacitythe volume of air in your lungs after passive exhalationand Expiratory Reserve Volumethe volume of air you can expire after passively exhalingdecreased exponentially as BMI increased. Subjects who were morbidly obese were actually breathing close to their Residual Volumesthe amount of air in your lungs after forced exhalation. Another 2005 study by Medarov et. al. Supports Jones findings and also found that Total Lung Capacitythe maximum amount of air you can inhaledecreased with increasing BMI. According to the American College of Sports Medicine, being overweight has mechanical effects on respiration, due to increased weight on the chest wall and diaphragm. Being overweight also causes an increase in energy use at the same workload compared to a leaner person, so the respiratory muscles fatigue at lower intensities in heavier people. These effects may contribute to the decreases in Functional Residual Capacity, Expiratory Reserve Volume and Total Lung Capacity. Lung Diseases Caused by Obesity There are two types of lung disease for which obesity is a primary cause. The first is Obesity Hypoventilation Syndrome, also known as Pickwickian Syndrome. Obesity Hypoventilation Syndrome involves chronic hypoxemiatoo little oxygen in the bloodand hypercapniatoo much carbon dioxide in the blood. The second lung disease obesity can cause is Obstructive Sleep Apnea. This disease involves periodic airway collapse and increased airway resistance during sleep. As both of these diseases progress, pulmonary hypertension may occur and eventually cause cor pulmonalefailure of the right side of the heart. Domino Effect Because high BMI decreases lung function in both diseased and healthy individuals, an unfortunate domino effect often occurs. Since being overweight makes it harder to breathe, those with respiratory problems may become less physically active. Decreased physical activity causes your muscles, including your respiratory muscles, to weaken and break down, which in turn makes breathing even more difficult. A downward spiral begins, in which inactivity begets further respiratory problems and respiratory problems beget more inactivity Read more:  http://www.livestrong.com/article/84685-bmi-respiratory-function/#ixzz2I54s1yvb The Health Risks of Overweight and Obesity Dr Jeremy Sims  MB BS MSc MRCGP FRIPH FRSH PGDipHI DipNH MRNT Obesity isnt just a cosmetic problem; its very much a health problem as well. You may be reading this today because you are, or have been, very unhappy about your physical appearance. However, losing weight isnt just about looking good, it is about feeling good; its about being healthy and living a productive and comfortable life. Above all, it is about avoiding the terrible health consequences of carrying around excessive weight. The growing evidence shows that if you are overweight you are more likely to develop health problems, such as heart disease, stroke,  diabetes, certain types ofcancer, gout (joint pain caused by excess uric acid), and gallbladder disease. Being overweight can also cause problems such as sleep apnoea (interrupted breathing during sleep) and osteoarthritis (wearing away of the joints); and the more overweight you are, the more likely you are to have these health problems. In comparison, healthy and steady Weight Loss can help improve the harmful effects of being overweight. The latest studies show that by losing as little as 10 to 20 pounds you can dramatically improve your overall health status, whilst significantly diminishing your risk of disease. The Risks To Your Health Heart Disease and Stroke Heart disease and stroke are the leading causes of death and disability for both men and women in the Western World. Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, than people who are not overweight. Very high blood levels of  cholesterol  and triglycerides (blood fats) can also lead to heart disease and often are linked to obesity. Being overweight also contributes to angina (chest pain caused by decreased oxygen to the heart) and sudden death from heart disease or stroke without any signs or symptoms. The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. See dietitian, Juliette Kellows  Healthy Heart Diet  feature. Reducing your weight by 10 percent can decrease your risk of developing heart disease by improving how your heart works, reducing your blood pressure, and reducing the levels of blood cholesterol and triglycerides. Diabetes Noninsulin-dependent diabetes mellitus (type 2 diabetes) is the most common type of diabetes in the Western World. Type 2 diabetes reduces your bodys ability to control blood sugar. It is a major cause of early death, heart disease, kidney disease, stroke, and blindness. Statistically, overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. You can reduce your risk of developing this type of diabetes by both losing weight and by increasing your physical activity. Furthermore, if you have type 2 diabetes, losing weight and becoming more physically active can help control your blood sugar levels. If you use medicine to control your blood sugar, Weight Loss and physical activity may make it possible for your family doctor to decrease the amount of medication you need Mohammed, MA (2009) Improving accuracy and efficiency of early warning scores in acute care. British Journal of Nursing. 18(1) 18-24 This article is a report on an experimental study to compare the effectiveness of hand held early warning computer system with the traditional pen and paper method Article 2. Johnstone C, Rattray J and Myers L (2007) Physiological risk factors, early warning systems. British Association of Critical Care Nursing. 12(5) 220-231 This article is a general article that provides background information on the topic of why early warning systems can improve patient care Article 3. Hughes LL (2009) Implementing a patient assessment framework in acute care Nursing Standard 24(3) 35-39 This article describes a service improvement initiative to improve patient assessment using an early warning score system over a4 month period at a Hospital in Birmingham Artcicle 6 Wheatley I (2006) The nurses practice of taking level 1 patient observations. Intensive Critical Care Nurse 22(2) 115-21 This was a survey conducted to discover the nurses practices of taking clinical observations in acute settings. It uses an observation data collecting tool (words 470) Read more:  http://www.ukessays.com/essays/nursing/examining-use-of-early-warning-scores-in-assessment-nursing-essay.php#ixzz2I5R87ePn Read more:  http://www.ukessays.com/essays/nursing/examining-use-of-early-warning-scores-in-assessment-nursing-essay.php#ixzz2I5QcaLAr Weight-control Information Network.  Do You Know The Health Risks Of Being Overweight?. Nov. 2004. U.S. Dept. of Health and Human Services. 23 Oct 2006 Diabetes Statistics.  Total Prevalence of Diabetes Pre-diabetes. 2005. American Diabetes Association. 23 Oct 2006 The Nutrition Source.  Healthy Weight. 2006. Harvard School of Public Health. 25 Oct 2006 Obesity causes many of the most common diseases in the world. Being overweight can cause insulin resistance, which leads to Type II Diabetes. A diet high in fat and lack of exercise causes cardiovascular disease and congestive heart failure. Excess weight can cause sleep apnea and respiratory illnesses. Many top scientists believe the increase of average weight directly corresponds to the increase of cancer cases, including kidney, breast, colon and prostate cancers. Read more:  Effects of Being Overweight | eHow.com  http://www.ehow.com/about_4596213_effects-being-overweight.html#ixzz2I57jKX6t Advances in the recording of vital signs make it possible for nurses to monitor patients continuously, be it their heart function, arterial blood pressure, central venous pressure or oxygen saturations. The recordings generated by this equipment must be interpreted according to the patient and in conjunction with other observations. The concern is that nurses may become too reliant on using technology to carry out assessment. Burman et al (2002) describe how staff who are used to equipment can feel insecure assessing patients without this equipment to validate their findings. Within the competencies are skills such as venepuncture, cannulation, arterial blood gases (obtaining and analysing), and recording and obtaining ECGs. Docherty (2003) identifies the recording and interpretation of the 12-lead ECG as being pivotal in the assessment and management of patients who are experiencing chest pain. This is further supported by Harvey (2004) who discusses the assessment and management of patients suffering from angina. However, it is further complemented by accurate physical assessment of the patient. Basic is a term that is frequently used to describe blood pressure, pulse, respiratory rate and temperature. However, I would argue that this undervalues these observations. Breakell (2004) identifies respiratory rate as one of the most important signs and yet one of the most frequently omitted clinical observations. Carberry (2002) also found this to be a problem in clinical practice. The objective of observation is to monitor patients progress, thus ensuring the prompt detection of adverse events or delays in recovery (Stevenson, 2004). Respiratory rate is pivotal to assessment. Many scoring systems incorporate respiratory rate, such as: APACHE Acute Physiology and Chronic Health Evaluation Score; SIRS Systemic Inflammatory Response Score; Assessment tools Neiderhauser and Arnold (2004) identify the importance of assessing the health risk status of patients, and the indications for intervention. A wide variety of assessment tools are in use to facilitate assessment and ensure the reliability of the process. For example the EWAS/MEWS tool can be use to check vital signs and avoid patients deterioration. EWAS is use for the assessment of unwell hospital patients, using 5 simple physiological parameters, mental response, pulse rate, systolic blood pressure, respiratory rate and temperature. It scoring system can be calculated at the patients bedside, using a simple and inexpensive equipment to measure any parameters. Of all the parameters respiratory rate is said to be the most sensitive indicatory of a patients physiological well being. Breakell (2004) identifies respiratory rate as one of the most important signs and yet one of the most frequently omitted clinical observations. Carberry (2002) also found this to be a problem in clinical practice. This is logical because respiratory rate reflects not only respiratory function as in hypoxia or hypercapnia, but cardiovascular statusas in pulmonary oedema, and metabolic imbalance such as that seen in diabetic ketoacidosis (DKA)( REF). Department of Health (1999b) Making a Difference: Strengthening the Contribution of Nurses, Midwives and Health Visitors. DH, London the health problems that stem from being overweight go way beyond the ones we usually hear about, like diabetes and heart disease. Being overweight can also affect a persons joints, breathing, sleep, mood, and energy levels. So being overweight can impact a persons entire quality of life. Dangers of being Overweight Some of the dangers of being overweight include developing: High Blood Pressure:  When you have excess body fat, your body retains sodium. When your body retains sodium, blood volume increases and blood pressure rises. High blood pressure causes your heart to work harder, which is dangerous for the heart. Diabetes:  Obesity is the leading cause of type 2 diabetes. Excess fat makes your body resistant to insulin. When your body is resistant to insulin, your cells cant get the energy they need. Stroke Abnormal blood fats:  A diet high in saturated fats increases the level of LDL (bad) cholesterol. Osteoarthritis:  Excess weight adds pressure to joints and wears away at the cartilage that protects them. Sleep apnea:  The more overweight a person is, the greater more severe the sleep apnea will be. Cancer:  Men and women who are overweight have a higher risk of developing many different kinds of cancer. Gallstones:  Gallstones are more common in people who are overweight. The connection between gallstones and weight is unclear. Weak Pelvic Muscles Physical Discomfort: As fat accumulates, it crowds the space occupied by yourorgans. People who are overweight may have difficulty breathing, walking or sitting. Heart disease is 1 of the most widespread main health risks of being overweight. Being overweight to a great extent increases the probability of heart malfunction and blood circulation problems and may result in congestive heart failure, heart attack, angina (chest pains), abrupt cardiac arrest or unequal heartbeat. Weight loss in this situation may not only avoid the above-mentioned ailments but as well assist normalize blood pressure, cholesterol levels and triglyceride and diminish inflammation in the body. Cancer is one of the foremost causes of death in the United States, and is frequently a result from fat cells that affect cell growth and multiply beyond capacity. Colon, esophagus, and the kidney are the most affected regions of the body. Being obese has also contributed to uterine as well as postmenopausal breast cancer in females. Sleep apnea, Osteoarthritis plus other Health Difficulties In sleep apnea the sufferer experiences short lapses of breaths during nighttime. This in turn makes the person tired right through the day, making it hard for him to concentrate on work. In some cases, heart failure has also been noted in patients suffering from this ailment. The lapse of breath happens due to the increased size of the cells of the neck, obstructing the windpipe at certain intervals. Dropping weight may decrease the size of the neck and diminish the pressure on the windpipe and make breathing easy. Osteoarthritis is another health risk of being overweight. In this particular ailment, the joint bone and the tissue that protects joints (cartilage), wear away. The joint bone of numerous parts of the body like the hip, knees, plus lower back are the main targets of Osteoarthritis. Being overweight places a lot of heaviness on the joints, which might lead to this condition in the long run. Dropping  weight  will let down the  body fat  and lessen the aches and pains. Excess fat accumulates in the liver cells and causes the organ to inflate, leading to injuries. This results in Fatty Liver diseases. This disease can lead to severe liver injury, built-up of scar tissue that blocks the proper blood flow to the liver (cirrhosis), and complete liver breakdown. It is relatively similar to alcoholic liver damage but does not inevitably mean that it cannot affect those who do not consume alcohol. Taking communication for instance, it is essential for building nurse patient relationship (Robinson 2002). It is important, for example for nurses to know during assessment whether a patient can hear, understands the language in which a question is being asked or can answer by speaking or sing language. And if they cannot hear, do they wear hearing aids, if so in which ear. Language barrier can be a major problem during assessment, but interpreters, family and friends can contribute and help. However, very often accurate information will not be given, preventing full assessment of patients needs. The use of braill and flashy lights is also important during assessment for patients who are blind or deaf. Newton (1991) suggests that descriptions of the Roper, Logan and Tierney model (1985) have been varied over the years. The model has been described as a system model (Aggleton Chalmers, 1987), as a model that incorporates multiple theories (Thibodeau, 1983) and as an activities of living model based on human needs (McFarlane, 1980). Farmer (1986) has described it as having a functional approach. Pearson (1983) describes it as a systems/development-based model incorporating certain concepts of Dorothy Orems model and the conceptual framework of Hendersons model (Henderson, 1969). It seems fair to suggest that the Roper, Logan and Tierney model has had criticism over time. Indeed, the model has been criticized for the use of the activities of living as a simple checklist (Reed Robbins 1991), the emphasis on solely the physical aspects of patient care (Minshull et al 1986, Walsh 1989), and the simplicity of the model (Walsh 1991). Bellman (1996) suggests that the first two problems indicate an inappropriate introduction and implementation of the model in practice. We have done nursing assessment and for Carl the ADLs that are a

Journey Theme in Whitman’s O Captain! My Captain! and Tennyson’s Crossi

Journey Theme in Whitman’s O Captain! My Captain! and Tennyson’s Crossing the Bar A man’s journey at sea has always been romanticized as an individualistic struggle against the backdrop of the cruel elements of nature. Paradoxically, though, within that same journey, the sea possesses an innate sense of timelessness that can become a man’s quest for God. In â€Å"O Captain! My Captain!† Walt Whitman describes the narrator’s sense of aimlessness at sea after his beloved Captain dies. In Lord Alfred Tennyson’s â€Å"Crossing the Bar,† the speaker is beckoned by the sea and its soundlessness even though he senses foredoom there. And so, although both Whitman and Tennyson employ a voyage at sea as the predominant image and metaphor within similar structural frameworks, they do differ in how they represent the journey and depict the tone of the poem. In â€Å"O Captain! My Captain!† uses the ship, the voyage at sea, and the Captain, within the poem to describe the mood of the United States in the immediate aftermath of the Civil War. The â€Å"fearful† voyage at sea, then, is an appropriate metaphor for the arduous Civil War, which has finally ended, but ironically, the Captain of the ship, Abraham Lincoln, has fallen dead (Line 2). Whitman uses extensive imagery to describe the North, awaiting the ship to dock, â€Å"exulting,† and â€Å"their eager faces turning† (Whitman, Lines 3, 12). But at the same time, there are underlying burdens of grief that the war brings. Whitman describes the postwar era with a pervading irony within the poem; although â€Å"the prize we sought is won,† the true reality of the situation reflects a phyrric victory (Line 2). The narrator’s â€Å"mournful tread† on the deck of the ship becomes symbolic for the United States, as the Sout... ...orates the death of the Captain, Tennyson discusses crossing into the realm of the afterlife with a stoic calmness, which ultimately leads a solitary death. However, both poets seem to realize their own mortality and that death is an indestructible force. While Tennyson’s everyday narrator treats â€Å"crossing the bar† as another symbolic stage of the human existence, the beloved Captain is ironically unable to defeat it despite what horrors he may have overcome at sea. Death, then, transcends the social divide; no one, from the common man of Tennyson’s poem to a brave, revered Captain, who has survived the perils at sea, can conquer it. Works Cited Tennyson, Alfred Lord. Alfred Lord Tennyson: Selected Poems. New York: Penguin Books , 1992. Whitman, Walt. Leaves of Grass. 1892 ed. New York: Bantam Books, 1983. PID 0062 1 Marlow Engl. 12 Sect. 37

Shakespeares King Lear - The Redemption of King Lear Essay -- King Le

The Redemption of King Lear It is said that no other playwright illustrates the human condition like William Shakespeare. Furthermore, it is said that no other play illustrates the human condition like King Lear. The story of a bad king who becomes a good man is truly one of the deepest analyses of humanity in literary history; and it can be best seen through the evolution of Lear himself. In essence, King Lear goes through hell in order to compensate for his sins. Lear's relationship with his three daughters, Goneril, Regan and Cordelia, is, from the beginning, very uncharacteristic of the typical father-daughter relationship. It's clear that the king is more interested in words than true feelings, as he begins by asking which of his daughters loves him most. Goneril and Regan's answers are descriptive and sound somewhat phony, but Lear is flattered by them. Cordelia's response of nothing is honest; but her father misunderstands the plea and banishes her. Lear's basic flaw at the beginning of the play is that he values appearances above reality. He wants to be treated as a king and to enjoy the title, but he doesn't want to fulfill a king's obligations. Similarly, his test of his daughters demonstrates that he values a flattering public display of love over real love. He doesn't ask "which of you doth love us most," but rather, "which of you shall we say doth love us most?" (I.i.49). It would be simple to conclude that Lear is simp ly blind to the truth, but Cordelia is already his favorite daughter at the beginning of the play, so presumably he knows that she loves him the most. Nevertheless, Lear values Goneril and Regan's fawning over Cordelia's sincere sense of filial duty. ... ...e and determination to repair his life is evident at this point, and continues to show for the duration of the play. Perhaps Lear's most difficult moment to endure is when he discovers his youngest and most prized daughter, Cordelia, dead. His initial reaction is of unbearable pain, but, being in his current state of madness, some of the anguish is alleviated when he "realizes" that she is alive. The king overcomes his earlier mistakes only after losing the one daughter who truly loved him. It's debatable whether Lear is completely conscious of his loss, but more plausible to suspect he is not fully affected by it as he is no longer in his right mind. Finally, Lear has dealt with the consequences of his decisions and is redeemed. Work Consulted: Halio, J. The Tragedy of King Lear. Cambridge: Cambridge University Press, 1992.

Profile of the Self Essay -- Decision Making Personality Essays

Profile of the Self  Ã‚   â€Å"You are requested to close the eyes.† This urging that Sigmund Freud experienced in a dream helped to unlock repressed feelings, and gave him insight into his personality. Fortunately, there are now tests available to help us to understand ourselves. Our behavior can be determined and understood by analyzing different aspects of ourselves. The four main aspects are: Decision Making, Self-Concept, Interpersonal Relationships, and Affect. Decision Making is very important.   Ã‚  Ã‚  Ã‚  Ã‚  Making decisions is really much more complicated than it seems. When I make decisions, my Id, Ego, and Superego decide my fate. Unfortunately for me, my Id wins far too often, as I often do not study enough. Other personality traits, such as my tendency to over-think and analyze too many things, also play a role. This can influence my other behaviors by making me seem cold and distant with others because I’m too busy thinking. My self-concept is also important.   Ã‚  Ã‚  Ã‚  Ã‚  Self-concept is how I view myself. This affects me in a number of ways. My self esteem and role expectations are all based off of my self-concept. My self-concept also can be a self-fulfilling prophecy. If I think that I have low self discipline, then I may subconsciously change my behavior to achieve what I think I am or should be. My real self still does not meet with my ideal self, which could potentially cause problems, or cause things to go well. My inadequacies in orderliness can never improve as long a...

Theme of Pastoralism in Shakespeare’s as You Like It

William Shakespeare’s ‘As You Like It’ is probably one of the most famous pastoral comedies of all times. Written around 1599 and published in 1623, its plot was derived from Thomas Lodge’s pastoral romance ‘Rosalynde’. But what is interesting about this play is how Shakespeare, using the features and tropes of a pastoral comedy, undercuts the idea of the pastoral. The pastoral, as a genre, can be said to have had its beginnings with Theocritus’ ‘Idylls’. Other notable works in this genre are Virgil’s ‘Eclogues’ and Longus’ ‘Daphnis and Chloe’. Artificiality and lack of realism are the chief characteristics of this tradition.When the Elizabethans wrote in this tradition, they more or less followed the set conventions. The shepherds with which they peopled their rural landscape were metaphors for amorous lovers, scholar-poets and aristocrats in exile. These poets gave the primacy to cou rtiers who led a shepherd-like existence or merely treated the rural environment as a background to the amours of shepherds and shepherdesses who in their love-behaviour resembled the refined noble-men of the court. ‘As You Like It’ also has these love-lorn figures in characters such as Silvius and Phebe.Yet, it can be clearly seen from their marginalized status in the play that Shakespeare has clearly departed from the convention of ‘pastoralisation’ of the courtly people. 1. The people in Shakespeare’s pastoral are not the dainty shepherds and shepherdesses of the golden world. They are uneducated, plain-spoken, not much concerned with romance, poetry and etiquette. The reason for this far-away-from-reality portrayal of the country people in pastoral romances and poetry was the fact that the authors/poets were a part of a class belonging to the town and court.Their anxieties and pre-occupations with their own socio-politico-economic conditions nece ssitated the construction of an idyllic space, free from all the troubles and tensions. And it was to fulfil this need to escape that they created an almost Eden-like rural world. The pastoral, therefore, became one of the literary forms best suited for an expression of disgust with the court and an admiration for the ‘simple pleasures’ of the country. 2. â€Å"They say he is already in the Forest of Arden, and many a merry men with him; and there they live like the old Robin Hood of England.They say many young gentlemen flock to him every day, and fleet the time carelessly as they did in the golden world†, says Charles in Act 1, Scene 1 of the play. This sure raises our expectations about the Forest of Arden as a place where life is like a never-ending holiday. In Act 2, Scene 1, Duke Senior also describes the Forest as a place where he finds â€Å"good in everything† and compares it to the Garden of Eden. But in the very same dialogue, he refers to the à ¢â‚¬Å"icy fang/ And churlish chiding of the winter’s wind†. This brings to our notice the less-than-perfect nature of life in Arden.Even when away from the strifes of courtly life, the courtiers and the duke have to bear the â€Å"penalty of Adam†. Each of the character that enters the Forest of Arden considers it as a refuge from the iniquity, restriction, oppression and corruption of the life at court. Rosalind and Celia run away from the court to escape the patriarchal domination of the tyrant Duke Frederick. Orlando and Adam come to the Forest in search of a new life away from the injustice meted out to him by his own brother. Duke Senior and his courtiers remain in the Forest as exiles, having been wronged at the hands of Duke Frederick.But even here Shakespeare inverts this notion by giving each one of them their share of trials and tribulations. It certainly is not an escape into a utopian world as we would like it to be. Each of them reaches the Forest in a state of physical exhaustion and it is not the end of their troubles, what with hunger, extreme weather conditions and struggle for survival staring them in the face. The play also deals with the idea of old world-new world order and uses pastoral as a medium to resolve serious socio-political problems.The society at this point in time was in a state of flux and the aristocracy came to be divided into two categories – One that still set much store by the notions of blood lineage, loyalty and a golden, feudal society where everyone knows his place and the other that adopted the Machiavellian idea of rampant individualism and gain of power for selfish purposes. Shakespeare presents this split in the society in terms of familial conflict between Oliver and Orlando & Duke Senior and Duke Frederick.In denying Orlando his share in his fathers’ fortune and mistreating Adam, Oliver violates the moral law of the traditional order which required the lord to fulfil the patriar chal commitment of ensuring a harmonious social order on his estate. Sir Rowland de Boys is depicted as the epitome of the ideal lord. By virtue of being morally akin to his father, Orlando is loved by everyone. He embodies traditional values of the old feudal order, â€Å"the antique world†. Oliver, being all that his father was not is representative of the new world order.Duke Frederick, similarly, is put in the same moral category when he says, â€Å"The world esteemed [Sir Rowland] honourable/But I did find him still mine enemy. † Not only this, he is an anomaly in the law of primogeniture because he overthrows the rightful inheritor, Duke Senior, who also loves Sir Rowland and thus we hold him in the same light as Orlando. Oliver violates moral law, Duke Frederick violates social law. It is in the Forest of Aden that this violation is corrected and we see the ultimate re-uniting of the Orlando and Oliver when the wronged younger brother saves the life of the very elder brother who had plotted to kill him.And it is after entering the Forest that Duke Frederick realises his folly in usurping the rightful position of his brother and Duke Senior is thus reinstated as the king. The Forest, more importantly the idea of countryside, then works as a place which provides resolution to the conflicts and restores harmony. There is a constant contrast being drawn between the court and the country in the play which undoubtedly presents the country as a better and superior alternative.The move by the characters into the Forest of Arden is seen as a retreat into nature where they are physically and spiritually rejuvenated. It is also a source of learning for the Duke Senior, for he â€Å"Finds tongues in trees, books in the running brooks/Sermons in stones, and good in everything†. Their stay in the Forest re-instils a sense of confidence in them and they also acquire a degree of self-knowledge. But in spite of this idealization of the country we do not see even one character that completely identifies with it.The pastoral is just a temporary refuge and never a permanent haven. As soon as the familial and social conflicts are resolved, the inhabitants leave the place about which they had eulogised. In Act 1, Scene 1, talking to Adam about Oliver’s unjust behaviour towards him, Orlando describes his gentility against the coarseness of the country people. In saying â€Å"You have trained me like a peasant, obscuring and hiding from me all gentleman-like qualities†, Orlando gives vent to an inherent prejudice against the country folks as uncivilized people.Even when in the Forest, Orlando thinks of the country dwellers as incapable of any civility and the prejudice in him remains intact when he says â€Å"I thought that all things had been savage here†. Duke Senior refers to his days at court as â€Å"better days† with an evident sense of nostalgia in the same scene and draws a contrast between the ord erly life at court and the almost anarchical existence in the Forest when he recalls the â€Å"holy bell [that] knolled to church/ And [when he] sat at good men’s feasts†. This distinction between the court and country is brought out most tellingly in the characters of Touchstone and Corin.Touchstone’s description of himself as a courtier not only parodies the courtiers and their ways but also provides a contrast with the simplicity of Corin, representative of the rural fraternity. We notice a misplaced sense of elitism and superiority seeping in in the behaviour of Touchstone as soon as he enters the Forest when he calls out to Corin as â€Å"you clown† in Act 2, Scene 5 and refers to himself as his â€Å"betters†. The conversation between the two in Act 3, Scene 2 shows the yawning fissures that separated the two classes and precluded any possibility of a democratic exchange of ideas. 3.Touchstone’s answer to Corin’s inquiry about h is feelings for shepherd life underlines the conventions of the pastoral life-â€Å" Truly, shepherd, in respect of itself it is a good life; but in respect that it is a shepherd's life, it is naught. In respect that it is solitary, I like it very well; but in respect that it is private, it is a very vile life. Now, in respect it is in the fields, it pleaseth me well; but in respect it is not in the court, it is tedious. † Corin himself continues this realistic tone when he points out the obvious differences between life in the court and life in the country.The best truce between the two diametrically opposite worlds comes in Corin’s sagacious analysis-â€Å" Those that are good manners at the court are as ridiculous in the country as the behaviour of the country is most mockable at the court† thus establishing that one place is not necessarily better than the other, just different. The relationship that the court people establish with the Forest and the forest- dwellers is almost exploitative in nature. Despite being away from the court physically, they can never really leave behind the court mannerisms and prejudices.We see a new court order being established in the Forest. The Duke and his courtiers are refugees in the forest, but still they become tyrants and usurpers of the place rightfully belonging to the inhabitants. They kill the animals, the natives i. e. , for their own convenience and pleasure. Broken feudal loyalties are strengthened when Duke Sr. meets Orlando and recognises him to be the son of his favourite, Sir Rowland. We see the creation of a social hierarchy when Rosalind and Celia, by virtue of their socio-economic position in the society, enter into a business arrangement’ with Corin and offer to buy his land. Although, he is a native of the Forest and should be economically prosperous, going by the conventions of the pastoral, we are informed that he does not even â€Å"shear the fleeces [he] graze[s]† a nd is servant to a â€Å"churlish master†. Thus unlike the traditional pastoral relationship between the courtier and shepherds which is that of good-natured equality, in Shakespeare’s play the shepherd can only become a host to the ladies by becoming their servant. . Some critics have also read this usurpation of the rights of the natives as a critique of the systemic enclosure of the commons in 17th century England. As mentioned earlier, the retreat into the Forest is not an escape into a utopian world. Rather than simply being an idyllic, innocent site to escape to, Arden is constructed as a neutral space where people are allowed to be themselves, free to create alternate identities and perhaps this is from where the title of the play, ‘As You Like It’, derives. 5.Each character that enters the Forest projects his own personality on to it. So while Duke Sr finds it to be â€Å"idyllic golden world†, almost Eden-like, Orlando calls it â€Å"deser t inaccessible†. Rosalind and Celia meet a pleasant sheepcote â€Å"fenced with olive trees† on entering the Forest while Oliver is greeted by a snake with drawn fangs and a lioness ready to kill him. So a retreat into Arden can be seen as a metaphor for the retreat into ones soul. It becomes the mirror of their minds, reflecting their thoughts onto their situations.Rosalind and Celia escape the unpleasant and restricted atmosphere of the court and don new identities in the Forest. While Celia chooses the name Aliena, representative of her state of mind, Rosalind forges an altogether new identity for herself by choosing to dress up like a man as Ganymede. By doing this, Rosalind draws upon the latent courage and resilience of her character. She becomes a working woman, independent of all male control, something which the orderly and patriarchal world of the court would not have permitted.A subversion of the gender stereotypes is also happening in the relationship of Orl ando and Rosalind in the Forest where Orlando roams about looking for her and inscribing eulogies as proof of his love for Rosalind on tree barks and she tests his love in the garb of Ganymede. Orlando, whom we had seen as a man who knows his worth and potential but is unable to actualise it due to his situation in society, transforms into a most ardent lover as he is given the freedom to express his love. The loyal courtier in him is accorded its true worth when Duke Sr recognises him as the son of Sir Rowland de Boys.Thus the entry into Forest can also be seen as a symbolic quest to determine one’s identity. In so far as all the action of the play takes place in the Forest of Arden, it is of prime importance. But as we have noticed, the retreat into Arden is not a permanent move on the part of the court dwellers. The stay in the Forest is a means to and not the end itself, the end being resolution of all social and familial conflicts. And Shakespeare very well uses the past oral tradition to achieve this resolution.