Solving assignment Term Paper Example | Topics and Well Written Essays - 750 words

Solving assignment - Term Paper Example (Apology, Plato) He thought that people who examined their lives were more virtuous than people who did not. Here he makes a convincing argument that if one did not know the rationale behind one’s actions one will not know whether the actions are right and justified and whether these actions can be repeated. Socrates also believed that a virtuous life meant examining the views of society on what is right. A man desirous of leading a virtuous life must examine views other than his own. According to Socrates a virtuous life meant focusing on the way things should be or could be and not on the way things are. If one had the knowledge of what is good he will not make mistakes. Lack of knowledge often makes men to consider bad things as good. One should exercise reason to understand what is good. To Socrates virtuous acts came from knowledge. He always associated virtue with wisdom Socrates views on death can be found in Apology and Crito (Plato). Socrates believed that fear of death should not act as a factor in decision making. One’s decisions must be based on examining one’s live and determining what is good and just. Our aim in life must be to place goodness and justice above everything else. If some acts are performed because of fear of death it means one is trying to preserve life and this according to Aristotle is not our primary concern. Our concern is to examine what is right and act virtuously without fearing death. Here too his argument is convincing. According to him no one knows exactly what happens after death whereas it is known that death results in a better condition for the human being as it means a complete loss of consciousness and a dreamless sleep. Hence there was no need to fear death. Many are of the opinion that where there is fear there is shame.. Here Socrates disagrees. In Euthyphro (Plato) Socrates explains that we fear many things like poverty and disease. But this does

Womens Roles Then and Now Essay Example for Free

Womens Roles Then and Now Essay Abigail said she was born November 11, 1744 in Weymouth, Massachusetts to the Reverend William and Elizabeth Quincy Smith. She stated that she married John Adams on October 25, 1764 and they moved to Braintree, Massachusetts where she gave birth to six children. She cared for her children at the Braintree home while her husband was an accomplished lawyer. She was left largely alone for ten years during the American Revolution to run the household. Women running a family home were also running a family business. The family homes were centers of production; households often had to produce their own food, clothing, and many of their own supplies. Women were often in charge of coordinating and producing these materials and, thus, were an essential part of keeping the family alive and well. Catherine the Great said that she was born May 2, 1729 in Stettin, Prussia to Christian Augustus and his wife, Johanna Elizabeth of Holstein-Gottorp. She said her baptismal name was Sophia Augusta Frederica. In accordance with the custom then prevailing in German princely families, she was educated chiefly by French governesses and tutors. In 1744 she was taken to Russia, to become the fiancà © to the grand duke Peter, the nephew of the empress Elizabeth, and her recognized heir. They married on August 21, 1745 at St. Petersburg. Unlike Abigail, Catherine did not have to do the day to day chores of raising a family and running a home. She had servants to do that job. The historical status for women in general during the 18th century in America changed from the previous years. Married women’s lives revolved to a large extent around managing the household, a role which in many cases included partnership in running farms or home businesses. Even those women whose social standing afforded increased leisure took up spinning and other activities to replace imported goods. They prepared food for militia musters and made cartridges. War, when it came, touched everyone. Abigail stated that she joined her diplomat husband in Europe in 1784 where they spent eight months in Paris. In 1785, she filled the role of wife of the first U.S. minister to the Court of St. James in London. They returned in 1788 to a house known as the â€Å"Old House† in Quincy, Massachusetts which she set about vigorously enlarging and remodeling. When John was elected President of the United States, Abigail continued a formal pattern of entertaining. With the removal of the capital to Washington in 1800, she became the first â€Å"First Lady† to preside over the White House. She told Catherine that she took an active role in politics and policy. She was so politically active; her political opponents came to refer to her as â€Å"Mrs. President†. Catherine said that once she married her husband she set about winning the hearts of the Russian people. She learned the language of the people and made up her mind to do whatever had to be done, and to profess to believe whatever she was required to believe, in order to be qualified to wear the crown. Being raised in the Lutheran faith she declined the religious services of a Protestant pastor, and sent for an orthodox priest who had been appointed to instruct her in the Greek form of Christianity. On June 28th, 1744 she was into the Orthodox Church at Moscow, and was renamed Catherine Alexeyevna. Catherine was emphatically a sovereign and a politician who was in the last resort guided by the reason of state. Her foreign policy was as consistent as it could be considering the forces she had to content against. It was steadily aimed to secure the greatness and the safety of Russia. She stated that she loved her adopted country and had affection for her people. She incorporated Enlightenment ideas into her politics, commissioned art, and created s successful foreign policy. She also expanded the Russian Empire to the Black Sea by defeating the Ottoman Empire in two major wars. Catherine’s empire spanned over three continents: Europe, Asia, and part of North America. It stretched form the Arctic Ocean to the North, the Black Sea to the South, Alaska and the Pacific to the East, and the Baltic Sea to the West. She reformed the system by creating a legislative commission in 1767, introducing a system of local self-government in 1775, and issuing the Charter to the Nobility in 1785. Russia became the largest producer of iron, cast iron and copper. She had more than 200 factories and workshops. Industrial production had doubled the value of domestic and foreign trade tripled. Though she had mounted the throne by a military revolt and entered on great schemes of conquest, she never took an intelligent interest in her army. She neglected it in peace, allowed it to be shamefully administered in war, and could never be made to understand that it was not in her power to improvise generals out of her favorites. Each of the women had opinions on the role women should play in society during their lifetimes. Abigail told Catherine that she was an advocate of married women’s property rights and more opportunities for women, particularly in the field of education. Women, she believed, should not submit to laws not made in their interest, nor should they be content with the simple role of being companions to their husbands. She said that women should educate themselves and thus be recognized for their intellectual capabilities, so they could guide and influence the lives of their children and husbands. Abigail along with her husband believed that slavery was evil and a threat to the American democratic society. Catherine stated that she was kind to her servants, and was very fond of young children. She was rarely angry with people who merely contradicted her or failed to perform their service in her household. Her renowned toleration stopped short of allowing the dissenters to build chapels, and her passion for legislative reform grew cold when she found that she must begin by the emancipation of the serfs. She saw no reason to emancipate the serfs because there would be no one to do the work. Abigail Adams would greatly admire the current roles of women today. Condoleezza Rice, the first African-American woman to become the U.S. Secretary of State advising the leader of the world largest superpower, Hillary Rodham Clinton, a U.S. Senator for the state of New York and then the Secretary of State, and Sandra Day O’Connor, the first woman appointed to the U.S. Supreme Court. Catherine the Great would also greatly admire the current roles of women today. Indira Gandhi, the Prime Minister of India from 1966-1977. This was the highest position in the world’s most populous democracy and was especially significant for Indian women, who had traditionally been subservient to men. Benazir Bhutto, Prime Minister of Pakistan from 1988-1990 and 1993-1996, the first female leader of a Moslem country and Golda Meir, Prime Minister of Israel form 1969-1974. Both Abigail Adams and Catherine the Great would approve of the fact that women have the right to study and become doctors, lawyers, scientists and even politicians. No longer are women confined to the home raising children. Today’s modern woman has a home, works a full time job and takes care of her children and some even decide to continue their education. Women have come a long way since the beginning of time. Reference http://www.bookrags.com/printfriendly/?p=essaysu=2005/5/23/231755/036 http://ezinearticles.com/?How-the-role-of-Women-Has-Changesid=3602156 http://www.forbes.com/lists/2005/11/DFBA.html http://www.forbes.com/lists/2005/11/DZTZ.html http://www.forbes.com/lists/2005/11/MTNG.html http://www.123helpme.com/american-womens-changing-roles-in-society-view.asp?id=15 http://en.wikipedia.org/w/index.php?titlr=Abigail_Adamsprintable=yes http://fr.wikipedia.org/w/index.php?title=Catherine_11_de_Russieprintable=yes

Nursing Discipline Overview and Reflective Account

Nursing Discipline Overview and Reflective Account NURSING DISCIPLINE MENTAL HEALTH BRANCH From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950s. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were put away. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as muffling or being put in a swing chair. In the 1960s, inadequacy and cost resulted in mental health hospitals closing and care moving to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003), where most people with mental health problems are cared for today (NHS 2010). Legislation such as the 1959 and subsequent 1983 Mental Health Act, and the Care Community Act (1990) are relative to modern community mental health nursing. In 1999 the Government confirmed mental health was a top priority in the Health Service (Jackson Hill 2006). Since then guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson et al 2006) have been introduced to reform and improve services for people with mental health problems and their carers. The Department of Health have also investing significantly in inpatient mental health settings due to issues such as a not enough beds being available, the lack of privacy and dignity of patients and wards not supporting provision of self care (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been dev eloped, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009). Mental health nurses will work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to care for people in a fair and anti-discriminatory way and deliver care holistically, mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and personality and human behavior (Hannigan et al 2003). One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention (Mind 2010). Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they cant cope with, such as depression following the death of a partner (NHS 2009). Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan et al 2003). Care is person-centered and mental health nurses will work within a professional multi-disciplinary team which will include GPs, psychiatrists and social workers and other health care professionals. A mental health nurse will require good interpersonal and communication skills. They will to demonstrate sensitivity when caring for patients, for example there is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010). Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill a nurse will be required to have is to recognise building tension and diffuse it when necessary to maintain the patients and others safety (NHS 2010). Sometimes nurses may find themselves faced with awkward situations, and be required to apply ethical principles, such controversial issues which cannot be disclosed and where confidentiality needs to be maintained (NMC 2008). On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan et al 2003). Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them (Hannigan et al 2003) . In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision. Nurses need to support patients to take responsibility for their own well-being and make informed decisions by providing information which is accessible and understandable (Mind 2010). This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the clients best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983) (Hinchcliff et al 2003). To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential. NURSING DISCIPLINE LEARNING DISABILITIES BRANCH People with learning disabilities have been treated as second class citizens for many years, once being seen as possessed by evil spirits or being punished by God for a sin they may have committed. In the 19th century they were removed from their families and lived in purpose built institutions, treated as sick and in need of treatment (Brown Benson 1995). During the 1970s care moved to the community (Brigden Todd 1993) where it largely remains today. Approximately 1.5 million people have a learning disability, the majority of which live at home with their families or in community care settings (Mencap 2009). Relatively few live by themselves or with a partner (Emerson, Davies, Spencer, Malam 2005). Turnbull and Chapman (2010) describe a learning disability as being a lifelong condition, which may be genetic or environmental and vary in degree of impairment. Sowney (2006) suggests all learning disabilities have common features including impaired intelligence and social functioning which has a lasting effect on development. According to Mencap (2009) people with learning disabilities live an average of 50-55 years and sometimes up to 70 years old. A learning disability nurse can therefore expect to nurse a range of patients from birth to the elderly and will need to demonstrate a patient centred approach and work in partnership with the patient to help them meet their health, social, emotional, developmental and behavioral needs ( NHS 2009). Although a learning disability is not an indication of a physical disability or ill health, people with learning disabilities generally have more complicated problems and require more nursing interventions than the general population. In the young person some of the more common problems include respiratory problems, epilepsy, sensory and motor impairments, hypertension, thyroid disease and cancer and in elderly adults common problems include loss of hearing, vision and mobility, heart conditions, diabetes, fractures and osteoporosis (Davis 2008). Generic issues include communication difficulties, conditions relating to specific syndromes, challenging behavior and delayed development (University of Nottingham 2010). A learning disability nurse needs the skills to work within both simple and complex health areas. Communication is a vital skill for the learning disability nurse, hospitalisation for a patient with a learning disability can be very distressing and it is important to build therapeutic relationships based on trust and understanding. In the past access to healthcare services for patients with learning disabilities has sometimes unintentionally been denied. A learning disability nurse can help to overcome these prejudices by ensuring people with learning disabilities are not discriminated against and have the same opportunities as the rest of the population (Brittle 2004). People with learning disabilities are the most vulnerable and socially excluded in our society (DOH 2001). A learning disability nurse works in partnership with both the patient and family carers to provide healthcare, and should recognise each persons uniqueness, individuality and differing abilities. The learning disabilities nurses main aims will be to support the well-being and social inclusion of people with learning disabilities, their rights, choices and independence by improving or maintaining their physical and mental health so they can pursue a fulfilling life whatever their ability (DOH 2009). For example teaching someone the skills needed to find work can help them lead an independent life with equal opportunities (NHS 2009). Many complex issues working with patients with learning disabilities relate to ethical aspects of care, and may be related to an individuals rights and welfare, public welfare or inequality. For example a learning disability nurse may need to assess the capacity and ability of a person to consent to treatment (Hinchcliff, Norman Schober 2003). Every effort should be made to provide information in a format the patient can understand, which might be in the form of pictures, alternative communication methods, using short sentences, repeating explanations and giving them time to make a decision (Brittle 2004). Previous experience may mean a person with a learning disability has not been given the opportunity to make their own choice regarding their individual treatment and care (Turnbull et al 2010) and involving family, friends or an advocate, where possible may help them understand the care and treatment offered to enable them to make their own decision (DOH 2001). In some situations people with learning disabilities may have the capacity to consent to straightforward nursing activities but may lack capacity to consent to more complex procedures (DOH 2001). Other ethical issues may involve the family or carer, for example, a person with learning disabilities may receive some benefits which they may wish to have control over and decide how it is spent. The carer on the other hand may see it as part of the household income and wish to control of it. Or maybe the parents or carers, due to ill health are unable to continue with full time care of a person with learning disabilities in their own home. Nurses will require good negotiation skills to support individuals and carers through dilemmas such whilst working within ethical guidelines, with the person being supported remaining the central focus (Thomas Woods 2003). Other ethical issues might involve psychosocial and lifestyle issues such as overeating or drug abuse which might raise concerns about control and freedom of choice (Davis 2008). Opportunities for learning disabilities nurses exist in both hospital environments and the community. They will specialise in many areas which might include education, sensory disability or the management of services (NHS 2009). They will work within the multi-disciplinary team of their preferred environment, for example a learning difficulty liaison nurse will work with other staff, patients and carers to develop therapeutic relationships and ensure people with learning disabilities have a positive healthcare experience (Brittle 2004). To conclude people with learning disabilities have very similar health issues to that of the general population. However it is important that the learning disabilities nurse exercises a person centered approach, develops a therapeutic relationship and understands a person with learning disabilities personal needs in order to support their wellbeing and promote social inclusion, rights, choices and independence to enable them to enjoy the same health care rights as everyone else. NURSING DISCIPLINE CHILDRENS BRANCH The Childrens branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood childrens individual needs but it wasnt until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard Trig 2000). Sick childrens rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving childrens services and recent statute law has given children increased rights (Hubbard et al 2000).The Childrens Act (1989 2004) highlights their rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents (Chambers Licence 2005). These policies give direction today and will shape the future of childrens nursing. Nurses need to understand how they apply and what implications there might be when caring for children. For example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and phys ical or mental child abuse is suspected, the nurse will have an ethical duty to work with other agencies and professionals such as the Child Protection Services (Hubbard et al 2000). Childrens nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers et al 2005). In order to provide care in a fair and anti-discriminatory way they need to understand the effect age and development has on a childs health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when assessing medication the weight and development of a child, will need to be taken into consideration as well as which drugs come in a form which can be easily administered. Appropriate care plans will need developing and updating for evaluation and referrals made as necessary for Doctors to review (Robertson South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may the refore take more than one attempt (Robertson et al). The DOH (2006) promotes optimal care for young people who have illnesses which previously wound have been fatal in childhood but are now surviving. Childrens nurses work in both hospital and primary care settings such as schools, GPs surgeries and in the community. Childrens nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al). Childrens nursing is very much centred on the family (NMC 2008). Nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family (Hinchliff, Schober Norman 2003) and support both children and their families to make informed decisions regarding treatment and care options (Chambers et al 2005). Hubbard and Trig (2000) declare the family is central to a childs wellbeing, and whilst respecting and promoting the rights of a child, should also be sensitive to the needs and views of the parents wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a childs welfare. A nursing model often used to assist the nursing process is the Casey Model of nursing which focuses on working in partnership with both children and their families (Smith 1995). Lansdown, Waterston and Baum (1996) suggest childrens nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig (2000) agree and suggest that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the childs age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange. Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (2005) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the childs wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al 2005). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Childrens 1989 Act, childrens nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 2005). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless the y lack capacity, for example in emergency situations (Dimond 2005). Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958) (Hubbard et al 2000). Increasingly children are being cared at home by their parents supported by the community childrens nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al). NURSING DISCIPLINE ADULT BRANCH Prior to the influences of Florence Nightingale, hospitals were often unclean and contaminated by infection and nurses were seen as the ones to do the Doctors dirty work. Nursing schools were set up in the 1880s, although it wasnt until the 1950s that the nursing profession was governed by the regulation body, UKCC. Today nurses are accountable to the NMC (2008) and must work within the code of conduct, demonstrating that they are able to deliver, manage and develop an excellent standard of evidence based nursing care (Abel-Smith 1960)(NMC 2008). Adult nurses primarily nurse sick and injured adults back to health and have a prominent role in the provision of health care, whilst working closely with other professionals, patients and their families (NHS 2010). Traditionally nursing was task oriented and patient care focused on specific illnesses and conditions. Today nursing is much more patient centred. An adult nurse will provide holistic care to number of patients 18 years and above at any one time to meet their physical, psychological, social and spiritual needs, using the nursing process which will include assessing, planning, implementing and evaluating the care delivered (NMC 2008). Adult nurses care for adult patients with a wide range of acute and long term illnesses and are involved in many different health arenas such as health promotion and disease prevention or they may specialise in specific diseases or disorders, such as diabetes, respiratory problems or cancer care. Others may specialise in accident and emergency, practice nursing or care of the elderly (NHS 2010). Although purposely trained to nurse adults, adult nurses will almost certainly be required to care and treat other groups of patients such as children, people with learning difficulties and patients with mental health issues, for example if they present in an accident and emergency unit, or are admitted to a ward with diabetes issues (Hinchcliff, Norman Schober 2003). Adult nurses will work within a multi professional team to deliver care to patients, which will include other health professionals such as doctors, pharmacists, healthcare assistants, physiotherapists, occupational therapists and radiographers (NHS 2010). Adult nurses work in a range of settings which can be hospital based or in the community where more and more health care is being delivered such as GP surgeries, clinics, occupational health services, schools, nursing and residential homes and voluntary organisations such as hospices. The government is driving health care towards a primary health care led service within which nurses roles are expanding and developing (DOH 2010). Opportunities are also available in the armed forces, prisons, and leisure, eg cruise ships (NHS 2010). Adult nurses all cover the same programme even though their work destinations differ considerably and it has been suggested that it is time to consider a new branch of nursing that equips people to work in primary care (Smith M 2003). Adult nurses will need to demonstrate many skills such as problem solving, flexibility, caring, counselling, managing, teaching and interpersonal skills to maintain and improve the quality of patients lives, sometimes in difficult situations (NHS 2010). They may find themselves caring for patients who are the same age as their family, friends or themselves and it is important not to get too personally involved with patients or they may find themselves in discussions regarding ethical issues such as euthanasia where clearly legally it is unlawful but the patient may feel it is in their best interest (Hinchcliff et al 2003). To assist the nursing process, nursing models are used such as the Roper, Logan and Tierneys (2000) 12 activities of daily living, often used in acute settings and the Orems model (1985) which promotes self care, particularly useful in rehabilitation setting. An adult nurse must comply with legislation and obtain consent before any treatment can be given, this may be verbal for routine nursing procedures, or written for more complex ones. Nurses must allow the patient to have autonomy when making decisions regarding care and treatment, respect that decision and always act in the patients best interest (Dimond 2005). The governments agenda and The Human Rights Act (1998) have had significant impact on how adult nursing has evolved to meet peoples needs in an ever changing environment. New jobs are being created to extend the nurses role and get them involved in advanced procedures such as the modern matron, consultant nurses, nurse practitioners and chief nursing officers. The DOH strategy for nursing recommends consultant posts, for example care of older people and pain management taking nursing to another level (cited by Sines, Appleby Frost 2005). According to the NMC (2007) nurses now carry out roles previously carried out by Doctors, for example theatre nurses now perform surgery and community care nurses co-ordinate packages. Changes in the way care is delivered has taken place in accordance with the government directive which laid down a plan to make primary health care accessible to people in the community, at work and at and home (Hinchcliff et al 2003). New opportunities are being created to meet the needs of older people. Older people are living longer and are the largest group of people using health services (Hinchcliff et al 2003). Common health issues for elderly patients are strokes, falls and mental health problems. The NHS Plan (2000a)(cited by Sines et al 2005) promotes independence and encourages them to have support in their home environment rather than residential homes. The government also recognises the need to increase and improve services for young adolescence patients to address their individual needs. For example as child moves into adulthood they may take risks, take part in anti-social behaviour, or they might be vulnerable and frightened (Hinchcliff et al 2003). Nurses have a role to play providing care, treatment and information to help them stay safe and healthy. To conclude adult nurses work with a wide range of patients with many different health issues across numerous health arenas. Nursing has developed considerably since it was first regulated and as patient care is a key government priority todays adult nurses need to have the necessary skills to deliver appropriate care and treatment in an ever changing environment whi Reflective Account The Role of a Rehabilitation Nurse Introduction This reflective account will discuss the role of a rehabilitation nurse in a community hospital. I am going to use the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my knowledge of nursing practice and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the NMC Code (2008) and maintain confidentiality all names have been changed. Description On my second week of my placement, I met my associate mentor for the first time. She asked if she could look at my placement documentation and personal development plan. We then discussed the skills and knowledge I want to achieve during the placement which is on a community rehabilitation ward. After our discussion, my mentor suggested to that I spend some time reflecting on the role of a community hospital rehabilitation nurse. Thoughts and Feelings Although my associate mentor did not require a formal piece of reflection, I thought it would be good to document my reflection for my personal development. When she asked me if I would reflect on the roles of nurse in a community hospital, I had already been thinking how different is was from that of a nurse in an acute hospital during my first week so I welcomed the challenge, although I had some reservations about what I could say on a positive note about community nursing. From what I had seen during my first week I was skeptical about the skills of nursing in a community hospital as the pace seemed much slower with less opportunity to practice clinical skills than in my previous acute placement. I was feeling quite disappointed and whilst I appreciate personal health care is an important nursing skill, the majority of my first week I had been left to work with nursing assistants and not invited by my mentor to be watch or carry out any clinical skills, who as a sister spends les s time than staff nurses on hands on nursing and more time on office tasks. This really worried me as I dont want to just cruise through my nursing training, I want to take every opportunity to broaden my knowledge and skills in all aspects of nursing. However I was now feeling more positive as my first impression of my associate mentor was that she was extremely knowledgeable, committed and caring and I hoped I would find her inspirational as I got to know her. Evaluation Being left for a whole week working without any real mentorship was demorilising for me and having no support or guidance the first week resulted in me having a negative view of the rehabilitation ward and community nursing in general (Taylor 2008). However, meeting with my associate mentor for the first time was a good experience. She was interested in me and committed to developing my knowledge and skills and by the end of our conversation had a good understanding of what I wanted to achieve from the placement and was able to challenge my knowledge on the current placement. Taylor (2008) states an inspirational mentor is a necessity to assist student nurses with their learning and development needs and nurture them to become first-class nurses. Understanding the skills and knowledge required by a community hospital rehabilitation nurse will build on my current knowledge which has been in the acute sector and be good for my personal development and future nursing career. Analysis Rehabilitation is an important aspect of any nurses role, but more prevalent for nurses working with the elderly in community hospitals (Brooks 2010). It is the nurses role to promote independence and to empower patients to carry out the activities of daily living adopting new skills and knowledge where necessary. Many different models of nursing are used for rehabilitation purposes, two popular ones are the Roper, Logan and Tierneys (2000) 12 activities of daily living and the Orems (1985) model of self care. Sinclair and Dickinson 1998 define rehabilitation as: A process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users and their family carers. Many patients find themselves on a rehabilitation ward as a result of a traumatic incident or disease and rehabilitation nurses will work with the patient, family and other member of the multi disciplinary team to support and encourage patients to maximise their independence with physical functioning (White and Johnstone 2000). They are very often the coordinators of a patients care as they are the ones in contact with patients 24 hours a day. Nursing interventions will include supporting and reinforcing the care devised by other health care professionals such as occupational therapists and physiotherapists (Low 2003). They will need to have underpinning knowledge about adjusting to life changes and understanding of anatomy and physiology, health promotion and illness prevention (Chilvers 2002). To provide holistic care for the patient, nurses will be required to apply their knowledge and skills through the nursing process. The first stage of this process is assessment to identify a patients impairments and disability in order to develop care plans. Identifying emotional effects is as important as physical disabilities, as these are likely to have an effect on patients rehabilitation progress (Vohora and Ogi, 2008). These may include anxiety, grief, depression, frustration, and anger (Stroke Association, 2008). Many of the care plans aims will be to increase a patients independence so that they can resume responsib Nursing Discipline Overview and Reflective Account Nursing Discipline Overview and Reflective Account NURSING DISCIPLINE MENTAL HEALTH BRANCH From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950s. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were put away. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as muffling or being put in a swing chair. In the 1960s, inadequacy and cost resulted in mental health hospitals closing and care moving to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003), where most people with mental health problems are cared for today (NHS 2010). Legislation such as the 1959 and subsequent 1983 Mental Health Act, and the Care Community Act (1990) are relative to modern community mental health nursing. In 1999 the Government confirmed mental health was a top priority in the Health Service (Jackson Hill 2006). Since then guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson et al 2006) have been introduced to reform and improve services for people with mental health problems and their carers. The Department of Health have also investing significantly in inpatient mental health settings due to issues such as a not enough beds being available, the lack of privacy and dignity of patients and wards not supporting provision of self care (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been dev eloped, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009). Mental health nurses will work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to care for people in a fair and anti-discriminatory way and deliver care holistically, mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and personality and human behavior (Hannigan et al 2003). One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention (Mind 2010). Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they cant cope with, such as depression following the death of a partner (NHS 2009). Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan et al 2003). Care is person-centered and mental health nurses will work within a professional multi-disciplinary team which will include GPs, psychiatrists and social workers and other health care professionals. A mental health nurse will require good interpersonal and communication skills. They will to demonstrate sensitivity when caring for patients, for example there is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010). Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill a nurse will be required to have is to recognise building tension and diffuse it when necessary to maintain the patients and others safety (NHS 2010). Sometimes nurses may find themselves faced with awkward situations, and be required to apply ethical principles, such controversial issues which cannot be disclosed and where confidentiality needs to be maintained (NMC 2008). On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan et al 2003). Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them (Hannigan et al 2003) . In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision. Nurses need to support patients to take responsibility for their own well-being and make informed decisions by providing information which is accessible and understandable (Mind 2010). This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the clients best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983) (Hinchcliff et al 2003). To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential. NURSING DISCIPLINE LEARNING DISABILITIES BRANCH People with learning disabilities have been treated as second class citizens for many years, once being seen as possessed by evil spirits or being punished by God for a sin they may have committed. In the 19th century they were removed from their families and lived in purpose built institutions, treated as sick and in need of treatment (Brown Benson 1995). During the 1970s care moved to the community (Brigden Todd 1993) where it largely remains today. Approximately 1.5 million people have a learning disability, the majority of which live at home with their families or in community care settings (Mencap 2009). Relatively few live by themselves or with a partner (Emerson, Davies, Spencer, Malam 2005). Turnbull and Chapman (2010) describe a learning disability as being a lifelong condition, which may be genetic or environmental and vary in degree of impairment. Sowney (2006) suggests all learning disabilities have common features including impaired intelligence and social functioning which has a lasting effect on development. According to Mencap (2009) people with learning disabilities live an average of 50-55 years and sometimes up to 70 years old. A learning disability nurse can therefore expect to nurse a range of patients from birth to the elderly and will need to demonstrate a patient centred approach and work in partnership with the patient to help them meet their health, social, emotional, developmental and behavioral needs ( NHS 2009). Although a learning disability is not an indication of a physical disability or ill health, people with learning disabilities generally have more complicated problems and require more nursing interventions than the general population. In the young person some of the more common problems include respiratory problems, epilepsy, sensory and motor impairments, hypertension, thyroid disease and cancer and in elderly adults common problems include loss of hearing, vision and mobility, heart conditions, diabetes, fractures and osteoporosis (Davis 2008). Generic issues include communication difficulties, conditions relating to specific syndromes, challenging behavior and delayed development (University of Nottingham 2010). A learning disability nurse needs the skills to work within both simple and complex health areas. Communication is a vital skill for the learning disability nurse, hospitalisation for a patient with a learning disability can be very distressing and it is important to build therapeutic relationships based on trust and understanding. In the past access to healthcare services for patients with learning disabilities has sometimes unintentionally been denied. A learning disability nurse can help to overcome these prejudices by ensuring people with learning disabilities are not discriminated against and have the same opportunities as the rest of the population (Brittle 2004). People with learning disabilities are the most vulnerable and socially excluded in our society (DOH 2001). A learning disability nurse works in partnership with both the patient and family carers to provide healthcare, and should recognise each persons uniqueness, individuality and differing abilities. The learning disabilities nurses main aims will be to support the well-being and social inclusion of people with learning disabilities, their rights, choices and independence by improving or maintaining their physical and mental health so they can pursue a fulfilling life whatever their ability (DOH 2009). For example teaching someone the skills needed to find work can help them lead an independent life with equal opportunities (NHS 2009). Many complex issues working with patients with learning disabilities relate to ethical aspects of care, and may be related to an individuals rights and welfare, public welfare or inequality. For example a learning disability nurse may need to assess the capacity and ability of a person to consent to treatment (Hinchcliff, Norman Schober 2003). Every effort should be made to provide information in a format the patient can understand, which might be in the form of pictures, alternative communication methods, using short sentences, repeating explanations and giving them time to make a decision (Brittle 2004). Previous experience may mean a person with a learning disability has not been given the opportunity to make their own choice regarding their individual treatment and care (Turnbull et al 2010) and involving family, friends or an advocate, where possible may help them understand the care and treatment offered to enable them to make their own decision (DOH 2001). In some situations people with learning disabilities may have the capacity to consent to straightforward nursing activities but may lack capacity to consent to more complex procedures (DOH 2001). Other ethical issues may involve the family or carer, for example, a person with learning disabilities may receive some benefits which they may wish to have control over and decide how it is spent. The carer on the other hand may see it as part of the household income and wish to control of it. Or maybe the parents or carers, due to ill health are unable to continue with full time care of a person with learning disabilities in their own home. Nurses will require good negotiation skills to support individuals and carers through dilemmas such whilst working within ethical guidelines, with the person being supported remaining the central focus (Thomas Woods 2003). Other ethical issues might involve psychosocial and lifestyle issues such as overeating or drug abuse which might raise concerns about control and freedom of choice (Davis 2008). Opportunities for learning disabilities nurses exist in both hospital environments and the community. They will specialise in many areas which might include education, sensory disability or the management of services (NHS 2009). They will work within the multi-disciplinary team of their preferred environment, for example a learning difficulty liaison nurse will work with other staff, patients and carers to develop therapeutic relationships and ensure people with learning disabilities have a positive healthcare experience (Brittle 2004). To conclude people with learning disabilities have very similar health issues to that of the general population. However it is important that the learning disabilities nurse exercises a person centered approach, develops a therapeutic relationship and understands a person with learning disabilities personal needs in order to support their wellbeing and promote social inclusion, rights, choices and independence to enable them to enjoy the same health care rights as everyone else. NURSING DISCIPLINE CHILDRENS BRANCH The Childrens branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood childrens individual needs but it wasnt until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard Trig 2000). Sick childrens rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving childrens services and recent statute law has given children increased rights (Hubbard et al 2000).The Childrens Act (1989 2004) highlights their rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents (Chambers Licence 2005). These policies give direction today and will shape the future of childrens nursing. Nurses need to understand how they apply and what implications there might be when caring for children. For example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and phys ical or mental child abuse is suspected, the nurse will have an ethical duty to work with other agencies and professionals such as the Child Protection Services (Hubbard et al 2000). Childrens nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers et al 2005). In order to provide care in a fair and anti-discriminatory way they need to understand the effect age and development has on a childs health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when assessing medication the weight and development of a child, will need to be taken into consideration as well as which drugs come in a form which can be easily administered. Appropriate care plans will need developing and updating for evaluation and referrals made as necessary for Doctors to review (Robertson South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may the refore take more than one attempt (Robertson et al). The DOH (2006) promotes optimal care for young people who have illnesses which previously wound have been fatal in childhood but are now surviving. Childrens nurses work in both hospital and primary care settings such as schools, GPs surgeries and in the community. Childrens nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al). Childrens nursing is very much centred on the family (NMC 2008). Nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family (Hinchliff, Schober Norman 2003) and support both children and their families to make informed decisions regarding treatment and care options (Chambers et al 2005). Hubbard and Trig (2000) declare the family is central to a childs wellbeing, and whilst respecting and promoting the rights of a child, should also be sensitive to the needs and views of the parents wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a childs welfare. A nursing model often used to assist the nursing process is the Casey Model of nursing which focuses on working in partnership with both children and their families (Smith 1995). Lansdown, Waterston and Baum (1996) suggest childrens nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig (2000) agree and suggest that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the childs age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange. Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (2005) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the childs wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al 2005). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Childrens 1989 Act, childrens nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 2005). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless the y lack capacity, for example in emergency situations (Dimond 2005). Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958) (Hubbard et al 2000). Increasingly children are being cared at home by their parents supported by the community childrens nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al). NURSING DISCIPLINE ADULT BRANCH Prior to the influences of Florence Nightingale, hospitals were often unclean and contaminated by infection and nurses were seen as the ones to do the Doctors dirty work. Nursing schools were set up in the 1880s, although it wasnt until the 1950s that the nursing profession was governed by the regulation body, UKCC. Today nurses are accountable to the NMC (2008) and must work within the code of conduct, demonstrating that they are able to deliver, manage and develop an excellent standard of evidence based nursing care (Abel-Smith 1960)(NMC 2008). Adult nurses primarily nurse sick and injured adults back to health and have a prominent role in the provision of health care, whilst working closely with other professionals, patients and their families (NHS 2010). Traditionally nursing was task oriented and patient care focused on specific illnesses and conditions. Today nursing is much more patient centred. An adult nurse will provide holistic care to number of patients 18 years and above at any one time to meet their physical, psychological, social and spiritual needs, using the nursing process which will include assessing, planning, implementing and evaluating the care delivered (NMC 2008). Adult nurses care for adult patients with a wide range of acute and long term illnesses and are involved in many different health arenas such as health promotion and disease prevention or they may specialise in specific diseases or disorders, such as diabetes, respiratory problems or cancer care. Others may specialise in accident and emergency, practice nursing or care of the elderly (NHS 2010). Although purposely trained to nurse adults, adult nurses will almost certainly be required to care and treat other groups of patients such as children, people with learning difficulties and patients with mental health issues, for example if they present in an accident and emergency unit, or are admitted to a ward with diabetes issues (Hinchcliff, Norman Schober 2003). Adult nurses will work within a multi professional team to deliver care to patients, which will include other health professionals such as doctors, pharmacists, healthcare assistants, physiotherapists, occupational therapists and radiographers (NHS 2010). Adult nurses work in a range of settings which can be hospital based or in the community where more and more health care is being delivered such as GP surgeries, clinics, occupational health services, schools, nursing and residential homes and voluntary organisations such as hospices. The government is driving health care towards a primary health care led service within which nurses roles are expanding and developing (DOH 2010). Opportunities are also available in the armed forces, prisons, and leisure, eg cruise ships (NHS 2010). Adult nurses all cover the same programme even though their work destinations differ considerably and it has been suggested that it is time to consider a new branch of nursing that equips people to work in primary care (Smith M 2003). Adult nurses will need to demonstrate many skills such as problem solving, flexibility, caring, counselling, managing, teaching and interpersonal skills to maintain and improve the quality of patients lives, sometimes in difficult situations (NHS 2010). They may find themselves caring for patients who are the same age as their family, friends or themselves and it is important not to get too personally involved with patients or they may find themselves in discussions regarding ethical issues such as euthanasia where clearly legally it is unlawful but the patient may feel it is in their best interest (Hinchcliff et al 2003). To assist the nursing process, nursing models are used such as the Roper, Logan and Tierneys (2000) 12 activities of daily living, often used in acute settings and the Orems model (1985) which promotes self care, particularly useful in rehabilitation setting. An adult nurse must comply with legislation and obtain consent before any treatment can be given, this may be verbal for routine nursing procedures, or written for more complex ones. Nurses must allow the patient to have autonomy when making decisions regarding care and treatment, respect that decision and always act in the patients best interest (Dimond 2005). The governments agenda and The Human Rights Act (1998) have had significant impact on how adult nursing has evolved to meet peoples needs in an ever changing environment. New jobs are being created to extend the nurses role and get them involved in advanced procedures such as the modern matron, consultant nurses, nurse practitioners and chief nursing officers. The DOH strategy for nursing recommends consultant posts, for example care of older people and pain management taking nursing to another level (cited by Sines, Appleby Frost 2005). According to the NMC (2007) nurses now carry out roles previously carried out by Doctors, for example theatre nurses now perform surgery and community care nurses co-ordinate packages. Changes in the way care is delivered has taken place in accordance with the government directive which laid down a plan to make primary health care accessible to people in the community, at work and at and home (Hinchcliff et al 2003). New opportunities are being created to meet the needs of older people. Older people are living longer and are the largest group of people using health services (Hinchcliff et al 2003). Common health issues for elderly patients are strokes, falls and mental health problems. The NHS Plan (2000a)(cited by Sines et al 2005) promotes independence and encourages them to have support in their home environment rather than residential homes. The government also recognises the need to increase and improve services for young adolescence patients to address their individual needs. For example as child moves into adulthood they may take risks, take part in anti-social behaviour, or they might be vulnerable and frightened (Hinchcliff et al 2003). Nurses have a role to play providing care, treatment and information to help them stay safe and healthy. To conclude adult nurses work with a wide range of patients with many different health issues across numerous health arenas. Nursing has developed considerably since it was first regulated and as patient care is a key government priority todays adult nurses need to have the necessary skills to deliver appropriate care and treatment in an ever changing environment whi Reflective Account The Role of a Rehabilitation Nurse Introduction This reflective account will discuss the role of a rehabilitation nurse in a community hospital. I am going to use the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my knowledge of nursing practice and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the NMC Code (2008) and maintain confidentiality all names have been changed. Description On my second week of my placement, I met my associate mentor for the first time. She asked if she could look at my placement documentation and personal development plan. We then discussed the skills and knowledge I want to achieve during the placement which is on a community rehabilitation ward. After our discussion, my mentor suggested to that I spend some time reflecting on the role of a community hospital rehabilitation nurse. Thoughts and Feelings Although my associate mentor did not require a formal piece of reflection, I thought it would be good to document my reflection for my personal development. When she asked me if I would reflect on the roles of nurse in a community hospital, I had already been thinking how different is was from that of a nurse in an acute hospital during my first week so I welcomed the challenge, although I had some reservations about what I could say on a positive note about community nursing. From what I had seen during my first week I was skeptical about the skills of nursing in a community hospital as the pace seemed much slower with less opportunity to practice clinical skills than in my previous acute placement. I was feeling quite disappointed and whilst I appreciate personal health care is an important nursing skill, the majority of my first week I had been left to work with nursing assistants and not invited by my mentor to be watch or carry out any clinical skills, who as a sister spends les s time than staff nurses on hands on nursing and more time on office tasks. This really worried me as I dont want to just cruise through my nursing training, I want to take every opportunity to broaden my knowledge and skills in all aspects of nursing. However I was now feeling more positive as my first impression of my associate mentor was that she was extremely knowledgeable, committed and caring and I hoped I would find her inspirational as I got to know her. Evaluation Being left for a whole week working without any real mentorship was demorilising for me and having no support or guidance the first week resulted in me having a negative view of the rehabilitation ward and community nursing in general (Taylor 2008). However, meeting with my associate mentor for the first time was a good experience. She was interested in me and committed to developing my knowledge and skills and by the end of our conversation had a good understanding of what I wanted to achieve from the placement and was able to challenge my knowledge on the current placement. Taylor (2008) states an inspirational mentor is a necessity to assist student nurses with their learning and development needs and nurture them to become first-class nurses. Understanding the skills and knowledge required by a community hospital rehabilitation nurse will build on my current knowledge which has been in the acute sector and be good for my personal development and future nursing career. Analysis Rehabilitation is an important aspect of any nurses role, but more prevalent for nurses working with the elderly in community hospitals (Brooks 2010). It is the nurses role to promote independence and to empower patients to carry out the activities of daily living adopting new skills and knowledge where necessary. Many different models of nursing are used for rehabilitation purposes, two popular ones are the Roper, Logan and Tierneys (2000) 12 activities of daily living and the Orems (1985) model of self care. Sinclair and Dickinson 1998 define rehabilitation as: A process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users and their family carers. Many patients find themselves on a rehabilitation ward as a result of a traumatic incident or disease and rehabilitation nurses will work with the patient, family and other member of the multi disciplinary team to support and encourage patients to maximise their independence with physical functioning (White and Johnstone 2000). They are very often the coordinators of a patients care as they are the ones in contact with patients 24 hours a day. Nursing interventions will include supporting and reinforcing the care devised by other health care professionals such as occupational therapists and physiotherapists (Low 2003). They will need to have underpinning knowledge about adjusting to life changes and understanding of anatomy and physiology, health promotion and illness prevention (Chilvers 2002). To provide holistic care for the patient, nurses will be required to apply their knowledge and skills through the nursing process. The first stage of this process is assessment to identify a patients impairments and disability in order to develop care plans. Identifying emotional effects is as important as physical disabilities, as these are likely to have an effect on patients rehabilitation progress (Vohora and Ogi, 2008). These may include anxiety, grief, depression, frustration, and anger (Stroke Association, 2008). Many of the care plans aims will be to increase a patients independence so that they can resume responsib

Self Discovery in Dostoevskys Crime and Punishment and Camus The Outs

Self Discovery in Dostoevsky's Crime and Punishment and Camus' The Outsider      Ã‚  Ã‚   In every society, it is important for individuals to adhere to a set of principles in order to maintain order. In Dostoyevsky's Crime and Punishment and Camus' The Outsider , however, both protagonists ignored the values of their society. Raskolnikov and Meursault felt their own beliefs were significant, and through their actions they were able to express them. As a result, one man was judged as a social deviant, while the other man suffered psychologically. Through dealing with this strife, Raskolnikov and Meursault gained a better understanding of their values and personal worth.      Ã‚  Ã‚  Ã‚  Ã‚   In the beginning both men rejected the fundamental values of society and formed their own ideologies. Raskolnikov, for instance, believed that "we have to correct and direct nature. But for that, there would never had been a single great man"1. In fact, he had written an article titled "The psychology of a criminal before and after the crime". It stated that 'ordinary' men live according to the law and exist only to reproduce the human race, yet 'extraordinary' men may break laws "if in his own conscience it is necessary to do so in order to better mankind"2. Raskolnikov believed that indeed, he was an "extraordinary man"3, but like Meursault, his beliefs were untested. As a result, he murdered an old pawnbroker women in order to prove himself. Meursault, as well, acted against the social norm. For example, even though it was expected of a son, he did not show sorrow at his mother's funeral4. He did not think this was shallow, however, he just refused to falsel... ... was finally able to declare them. Raskolnikov and Meursault were not afraid to cross the boundaries their societies had set for them. They were free-thinkers, and although they were seen as heretics, men like these play an important role in the growth and improvement of any society.    Works Cited and Consulted: Akeroyd, Richard H. The Spiritual Quest of Albert Camus. Alabama: Portals Press, 1976. Camus, Albert. The Stranger. New York: Random House, Inc., 1988. Dostoevsky, Feodor. Crime and Punishment. Trans. Jessie Coulson. Ed. George Gibian. New York: Norton, 1989. Frank, Joseph. Dostoevsky: The Miraculous Years, 1865-1871. Princeton: Princeton University Press, 1995. King, Adele. Camus. Oliver and Boyd Ltd. 1964. 120. McCarthy, Patrick. The Stranger. University of Cambridge: Cambridge University Press, 1997.

Boston Beer Company Case Essay

Background Information_: The Boston Beer Company, which was founded in 1984, had a very diversified thriving product line which entailed about twenty different kinds of beers. Their product was available in over nineteen various countries and used a network of around four hundred distributors. Revenues grew from 21 million dollars to 210 million dollars from inception to 1997. _Problem and Opportunity Identification_: As a result of the company’s product line and its variety, the company encountered issues sustaining and upholding of their products such as Lightship – which has been withering in recent years and which doesn’t have the volume like other products to sustain distribution. Since the light beer business that Lightship belonged to was one that was rapidly growing, the Boston Beer Company felt the need to investigate its products disappointment. The research to do so took place in different forms such as competition, market, and financial analyses, customer surveys, and finally deep emotional analysis using the ZMET technique. _Alternatives_: One option the research team is considering is introducing a new light beer into their product line. It is understandable that since the high-priced light beer industry is one of the biggest and rapidly growing field in the beer industry, the Boston Beer Company wants to occupy and take advantage of this field to further enhance its name and maintain its market share and its standing. However, there are issues in terms of positioning and marketing of this product. The product needs to be communicated as a light, rich, fun beer and targeted at a different audience that entails women. In addition to the fact that this option might cause conflict in terms of the brand image being a macho rough beer brewer, using it doesn’t solve the problem for Lightship if Lightship is going to be kept in the market offerings. Another option the research team considered was repositioning Lightship and throwing in more effort and investment into the marketing of the product. It was obvious that, compared to one of their biggest competitors Heineken, the Boston Beer Company has had trouble and sort-of failed to build a unique brand identity for this product. The product was not successfully differentiated and positioned in the market in order for it to build market share and improve standings. This failure could make it difficult for the company to reposition itself and change consumer perceptions to gain their interests and so it might be a waste of time and efforts. Finally, the last option is the dreaded one of not competing in this realm of the industry. This is a very extreme option since this realm is a huge and growing segment of the market and they would be missing out on a lot if they decide to pull out it. The failure to fit into this field, however, might have proved that the Boston Beer Company is not competent enough and ready to compete in this segment. _Critical Issues_: There are two main critical issues that the company should consider when making the decision about their situation in the light beer industry. One critical issue concerns the brand image – the company has an umbrella brand image of being a premium masculine macho craft beer brewer and shaking that could be seen to influence consumer perceptions. The second critical issue relates to the field study and the results it yielded – do they answer our questions about how to position the light beer product or on whether we should even introduce/keep products in this segment of the market. _Conclusion and Recommendation_: After reviewing the results of the various research techniques, the recommended option would be to introduce a new high-end light beer into the market (while probably retiring Lightship). Making use of the ZMET research results, this new product should be positioned in a manner that represents an active, refreshing, and healthy lifestyle. Having a new product instead of improving Lightship is best in order to avoid the difficult efforts of having to change stubborn consumer perceptions. Also, in terms of the umbrella brand image of BBC being a macho tough image, having a separate offering targeted at other audiences will probably add to the image of having two instead of eroding the existing image.

Chapter 32 Ap World History Outline Essay

A. Postcolonial Crises and Asian Economic Expansion, 1975–1990 I. Revolutions, Depressions, and Democratic Reform in Latin America 1. The success of the Cuban Revolution both energized the revolutionary left throughout Latin America and led the United States to organize its political and military allies in Latin America in a struggle to defeat communism. 2. In Brazil a coup in 1964 brought in a military government whose combination of dictatorship, use of death squads to eliminate opposition, and use of tax and tariff policies to encourage industrialization through import substitution came to be known as the â€Å"Brazilian Solution.† Elements of the â€Å"Brazilian Solution† were applied in Chile byte government of Augusto Pinochet, whose CIA-assisted coup overthrew the socialist Allende government in 1973 and in Argentina by a military regime that seized power in1974. 3. Despite reverses in Brazil, Chile, and Argentina, revolutionary movements persisted elsewhe re. In Nicaragua the Cuban-backed Sandinista movement overthrew the government of Anastasia Somoza and ruled until it was defeated in free elections in1990. In El Salvador the Farabundo Marti National Liberation Front (FMLN) fought guerrilla war against the military regime until declining popular support in the 1990s led the rebels to negotiate an end to the armed conflict and transform themselves into a political party. 4. The military dictatorships established in Brazil, Chile, and Argentina all came to an end between 1983 and 1990. All three regimes were undermined by reports of kidnapping, torture, and corruption; the Argentine regime also suffered from its invasion of the Falkland Islands and consequent military defeat by Britain. 5. By the end of the 1980s oil-importing nations like Brazil were in economic trouble because they had borrowed heavily to pay the high oil prices engineered by OPEC. The oil-exporting nations such as Mexico faced crises because they had borrowed heav ily when oil prices were high and rising in the 1970s, but found themselves unable to keep up with their debt payments when the price of oil fell in the 1980s. 6. In 1991 Latin America was more dominated by the United States than it had been in1975. This may be seen in the United States’ use of military force to intervene in Grenada in 1983 and in Panama in 1989. II. Islamic Revolutions in Iran and Afghanistan See more: what is essay format 1. Crises in Iran and Afghanistan threatened to involve the superpowers; the United States reacted to these crises with restraint, but the Soviet Union took a bolder and ultimately disastrous course. 2. In Iran, American backing and the corruption and inefficiency of Shah Muhammad Reza Pahlavi’s regime stimulated popular resentment. In 1979 street demonstrations and strikes toppled the Shah and brought a Shi’ite cleric, Ayatollah Ruhollah Khomeini, to power. The overthrow of an ally and the establishment of an anti-western Islamic republic in Iran were blows to American prestige, but the United States was unable to do anything about it. 3. In the fall of 1980 Iraqi leader Saddam Hussein invaded Iran to topple the Islamic Republic. The United States supported Iran at first, but then in 1986 tilted toward Iraq. 4. The Soviet Union faced a more serious problem when it sent its army into Afghanistan in 1978 in order to support a newly established communist regime against a hodgepodge of local, religiously inspired guerilla bands that controlled much of the countryside. The Soviet Union’s struggle against the American-backed guerillas was so costly and caused so much domestic discontent that the Soviet leaders withdrew their troops in 1989 and left the rebel groups to fight with each other for control of Afghanistan. III. Asian Transformation 1. The Japanese economy grew at a faster rate than that of any other major developed country in the 1970s and 1980s, and Japanese average income outstripped that of the United States in the 1990s. This economic growth was associated with an industrial economy in which keiretsu (alliances of firms) received government assistance in the form of tariffs and import regulations that inhibited foreign competition. 2. The Japanese model of close cooperation between government and industry was imitated by a small number of Asian states, most notably by South Korea, in which four giant corporations led the way in developing heavy industries and consumer industries. Hong Kong and Singapore also developed modern industrial and commercial economies. All of these newly industrialized economies shared certain characteristics: discipline and hard-working labor forces, investment in education, high rates of personal savings, export strategies, government sponsorship and protection, and the ability t o begin their industrialization with the latest technology. 3. In China after 1978 the regime of Deng Xiaoping carried out successful economic reforms that allowed private enterprise and foreign investment to exist alongside the inefficient state-owned enterprises and which allowed individuals and families to contract agricultural land and farm it as they liked. At the same time, the command economy remained in place and China resisted political reform, notably when the Communist Party crushed the protests in Tiananmen Square in 1989. B. The End of the Bipolar World, 1989–1991 I. Crisis in the Soviet Union 1. During the presidency of Ronald Reagan the Soviet Union’s economy was strained by the attempt to match massive U.S. spending on armaments, such as a space-based missile protection system. The Soviet Union’s obsolete industrial plants, its inefficient planned economy, its declining standard of living, and its unpopular war with Afghanistan fuel dean underground current of protest. 2. When Mikhail Gorbachev took over the leadership in 1985 he tried to address the problems of the Soviet Union by introducing a policy of political openness (glasnost) and economic reform (perestroika). II. The Collapse of the Socialist Bloc 1. Events in Eastern Europe were very important in forcing change on the Soviet Union. The activities of the Solidarity labor union in Poland, the emerging alliances between nationalist and religious opponents of the communist regimes, and the economic weakness of the communist states themselves led to the fall of communist governments across Eastern Europe in 1989 and to the reunification of Germany in 1990. 20. The weakness of the central government and the rise of nationalism led to the dissolution of the Soviet Union in September 1991. Ethnic and religious divisions also led to the dismemberment of Yugoslavia in 1991 and the division of the Czech Republic in 1992. III. The Persian Gulf War, 1990–1991 1. Iraq invaded Kuwait in August 1990 in an attempt to gain control of Kuwait’s oil fields. Saudi Arabia felt threatened by Iraq’s action and helped to draw the United States into award in which American forces led a coalition that drove Iraq out of Kuwait but left Saddam Hussein in power. 2. The Persian Gulf War restored the United States’ confidence in its military capability while demonstrating that Russia—Iraq’s former ally—was impotent. Cather Challenge of Population Growth I. Demographic Transition 1. The population of Europe almost doubled between 1850 and 1914, and while some Europeans saw this as a blessing, Thomas Malthus argued that unchecked population growth would outstrip food production. In the years immediately following World War I Malthus’s views were dismissed as Europe and other industrial societies experienced demographic transition to lower fertility rates. 2. The demographic transition did not occur in the Third World, where some leaders actively promoted large families until the economic shocks of the 1970s and 1980sconvinced the governments of developing countries to abandon the pronatalist policy. 3. World population exploded in the twentieth century, with most of the growth taking place in the poorest nations due to high fertility rates and declining mortality rates. Tithe Industrialized Nations 1. In the developed industrial nations of Western Europe and Japan at the beginning of the twenty-first century, higher levels of female education and employment, the material values of consumer culture, and access to contraception and abortion have combined to produce low fertility levels. Low fertility levels combined with improved life expectancy will lead to an increasing number of retirees who will rely on a relatively smaller number of working adults to pay for their social services. 2. In Russia and the other former socialist nations, current birthrates are lower than death rates and life expectancy has declined. III.The Developing Nations 1. In the twenty-first century the industrialized nations will continue to fall behind the developing nations as a percentage of world population; at current rates, 95 percent of all future population growth will be in developing regions, particularly in Africa and in the Muslim countries. 2. In Asia, the populations of China and India continued to grow despite government efforts to reduce family size. It is not clear whether or not the nations of Asia, Africa, and Latin America will experience the demographic transition seen in the industrialized countries, but fertility rates have fallen in the developing world where women have had access to education and employment outside the home. IV. Old and Young Populations 1. Demographic pyramids generated by demographers illustrate the different age distributions in nations in different stages of economic development. 2. The developed nations face aging populations and will have to rely on immigration or increased use of technology (including robots) in order to maintain industrial and agricultural production at levels sufficient to support their relatively high standards of living and their generous social welfare programs. 3. The developing nations have relatively young and rapidly growing populations but face the problem of providing their people with education and jobs while struggling with shortages of investment capital and poor transportation and communications networks. D. Unequal Development and the Movement of Peoples I. The Problem of Growing Inequality 1. Since 1945 global economic productivity has created unprecedented levels of material abundance. At the same time, the industrialized nations of the Northern Home to enjoy a larger share of the world’s wealth than they did a century ago; the majority of the world lives in poverty. 2. Regional inequalities within nations have also grown in both the industrial countries and in the developing nations. II. Internal Migration: the Growth of Cities 1. Migration from rural areas to urban centers in the developing world increased threefold from 1925 to 1950 and accelerated rapidly after 1950. 2. Migrants to the cities generally enjoyed higher incomes and better standards of living than they would have had in the countryside, but as the scale of rural to urban migration grew, these benefits became more elusive. Migration placed impossible burdens on basic services and led to burgeoning slums, shantytowns, and crime in the cities of the developing world. III. Global Migration 1. Migration from the developing world to the developed nations increased substantially after 1960, leading to an increase in racial and ethnic tensions in the host nations. Immigrants from the developing nations brought the host nations the same benefits that the migration of Europeans brought to the Americas a century before. 2. Immigrant communities in Europe and the United States are made up of young adults and tend to have fertility rates higher than the rates of the host populations. In the long run this will lead to increases in the Muslim population in Europe and in the Asian and Latin American populations in the United States, and to cultural conflicts over the definitions of citizenship and nationality. E. Technological and Environmental Change I. New Technologies and the World Economy 1. New technologies developed during World War II increased productivity, reduced labor requirements, and improved the flow of information when they were applied to industry in the postwar period. The application and development of technology was spurred by pent-up demand for consumer goods. 2. Improvements in existing technologies accounted for much of the world’s productivity increases during the 1950s and 1960s. The improvement and widespread application of the computer was particularly significant as it transformed office work and manufacturing. 3. Transnational corporations became the primary agents of these technological changes. In the post-World War II years transnational corporations with multinational ownership and management became increasingly powerful and were able to escape the controls imposed by national governments by shifting or threatening to shift production from one country to another. II. Conserving and Sharing Resources 1. In the 1960s, environmental activists and political leaders began warning about the environmental consequences of population growth, industrialization, and the expansion of agriculture onto marginal lands. Environmental degradation was a problem in both the developed and developing countries; it was especially severe in the former Soviet Union. In attempting to address environmental issues, the industrialized countries faced a contradiction between environmental protection and the desire to maintain rates of economic growth that depended on the profligate consumption of goods and resources. 2. In the developing world population growth led to extreme environmental pressure as forests were felled and marginal land developed in order to expand food production. This led to erosion and water pollution. III. Responding to Environmental Threats 1. The governments of the United States, the European Community, and Japan took a number of initiatives to preserve and protect the environment in the 1970s. Environmental awareness spread by means of the media and grassroots political movements, and most nations in the developed world enforced strict antipollution laws and sponsored massive recycling efforts. 2. These efforts, many of them made possible by new technology, produced significant results. But in the developing world, population pressures and weak governments were major obstacles to effective environmental policies.