Analysis Of John Steinbeck s Of Mice And Men - 849 Words

â€Å"Wha’s the matter with me?’ she cried. ‘Ain’t I got a right to talk to nobody? Whatta they think I am, anyways?† (Steinbeck 87) In the novella Of Mice and Men by John Steinbeck, Curley’s wife is discriminated against because she is a woman living in the 1930s when few females could live economically independent of men. By choosing not to name her, Steinbeck reinforces her insignificance on the ranch and her dependence on Curley. While a misfortunate victim of isolation, Curley’s wife exerts unexpected power attempting to mask her pain. While Crooks, a victim of racial prejudice, expresses his isolation openly, he also socializes with the other workers on the job and while playing horseshoes with them. Curley’s wife, on the other hand, cannot talk to anyone without suffering the consequences of a jealous husband: â€Å"I get lonely,’ she said. â€Å"You can talk to people, but I can’t talk to nobody but Curley . Else he gets mad. How’d you like not to talk to anybody?† (87) More specifically, Curley’s wife is experiencing homesickness for the first time, because not only did she leave home at an early age to marry Curley, a man whom she does not even like. In fact, she only married him to spite her mother. Not only is Curley hostile and disrespectful towards his wife, he also is controlling. Knowing of Curley’s jealously, the other men fear Curley’s wife and the consequences of taking to her: â€Å"Listen, N****,’ she said . â€Å"You know what I can do to you if you open your trap?† (80)Show MoreRelatedAnalysis Of John Steinbeck s Of Mice And Men 2778 Words   |  12 PagesLiterature 15 October 2014 Author Study: John Steinbeck John Steinbeck, born in February 27, 1902, worked as a manual labor worker before achieving his success as a well renowned American writer. A compassionate understanding of the world s disinherited was to be Steinbeck s hallmark. The novel In Dubious Battle (1936) defends striking migrant agricultural workers in the California fields. In the novel Of Mice and Men(1937; later made into a play), Steinbeck again utilizes the hardships of migrantRead MoreRhetorical Analysis Of John Steinbeck s Of Mice And Men 1406 Words   |  6 PagesRhetorical Analysis Essay John Steinbeck, writer of the novel, Of Mice and Men, uses many different rhetorical devices and appeals to unravel the essence and truth of the American Dream, while revolving around the world of these characters, George and Lennie. Written during the great depression, the novel itself shares the lives of many different people during that time period. It explored how everyone was treated through that time due to skin color, disabilities, and gender. Life during thisRead MoreAnalysis Of John Steinbeck s Of Mice And Men 1199 Words   |  5 Pages Alaura Lopez Period 4 December 18, 2014 Mrs. George Of Mice and Men Final Paper John Steinbeck’s book Of Mice and Men presents the story of two men trying and struggling to find the â€Å"American Dream†. In southern Salinas, California during the 1930’s the main characters Lennie, a giant man with a childlike aura and George, the opposite of Lennie, a small man with strong features are displaced migrant ranch workers, that travel from town to town together in hunt of new work opportunitiesRead MoreAnalysis Of John Steinbeck s Of Mice And Men 926 Words   |  4 Pages In the literary work Of Mice and Men by John Steinbeck,the reader is introduced into the depression era where this takes place.This set takes place in the Depression era where everybody is out of a job , the bank crashes , the Stock market crashes. Every man is struggling, trying to find work. Steinbeck teaches the reader about the struggle of working hard for their dreams, having hope, and never giving up. A prime example of this is George, who tells his dream and creates dreams for other peopleRead MoreAnalysis Of John Steinbeck s Of Mice And Men839 Words   |  4 Pages Joe Cetrone Response to setting Of Mice and Men Along with the market crash of 1929, the United States underwent an economic calamity. Millions out of work, families destroyed and dreams crushed. Not only this, a solution to this disaster was nowhere in sight. Human existence was in question. And inevitably, the American Dream. With so many out of work, how would it have been possible for people to protect and serve their families? There was not enough money to go around, making it near impossibleRead MoreAnalysis Of John Steinbeck s Of Mice And Men 1367 Words   |  6 Pagesworth. Living life with whom a person loves greatly increases happiness and trust between those in the relationship. But this unity may come at a cost; true friendship requires sacrifice. Friendship and loyalty in the novella, Of Mice and Men, by expression through John Steinbeck’s interpretation, brings greater understanding to their importance of each. Loyalty, protecting and standing by someone who a person respects or loves, as Lennie and George illustrate. Loyalty does involve a treacherousRead MoreAnalysis Of John Steinbeck s Of Mice And Men 1020 Words   |  5 PagesWeak Do opposites really attract? Can two people, with no similarities, share a close bond? It proves to be so in the novel Of Mice and Men , written by John Steinbeck. A novel which tells the story of two men, George and Lennie, and their journey of a new job working on a ranch. A novel with a different but interesting style of writing. A novel where John Steinbeck utilizes how powerful George is over Lennie, to signify how people believe they are dominant over others, because of their greaterRead MoreAnalysis Of John Steinbeck s Of Mice And Men Essay1320 Words   |  6 Pagestowards women have been a problem in society since men foolishly decided to give women the stereotype of being housewives and only good for breeding children. Those who refuse to follow the stereotype are considered promiscuous, or unfaithful towards their significant other. This stereotype was highly expected of women during the early twentieth century, and was also exhibited in John Steinbeck’s Of Mice an d Men towards Curley’s wife. Of Mice and Men took place in the 1930s, and the plot follows twoRead MoreAnalysis Of John Steinbeck s Of Mice And Men 1564 Words   |  7 PagesThe Life of John Steinbeck By: Alex Moses Mrs. Seymour 11/20/14 Dear Reader, I chose to research John Steinbeck for the Mulitgenre Research Project. I chose this American author because he has written many old timey American classics that signify the growth of the Untied States, which is exemplified in his novel, â€Å"Of Mice and Men†. This author is important to American literature because â€Å" Ideas are like rabbits. You get a couple and learn how to handle them, andRead MoreAnalysis Of John Steinbeck s Of Mice And Men 1453 Words   |  6 PagesIn the novella Of Mice and Men, John Steinbeck portrays the characters as pathetic victims of society, each of them pathetic in their own ways. Yet all of them are lonely, in need of companionship, in need of a relationship and in desperate need to make their dreams come true. Specifically, Steinbeck uses the two main protagonists George and Lennie to convey the theme of the American dream. At the beginning the two men get a job working on a farm together after fleeing from their last jobs at a

Rhetorical analysis “The Hardest of the Hardcore” Free Essays

It is believed that the United States allocates approximately 316 billion dollars a year on these groups. Distant from securing companies, they also provide security for the police, and government officials. Most of them are ex-special forces, and veterans. We will write a custom essay sample on Rhetorical analysis â€Å"The Hardest of the Hardcore† or any similar topic only for you Order Now Some are ex-cons. Some people refer to them as mercenaries, and some people call them builders. Others would describe the mission as training other soldiers. They are used all around the world, providing different services in support of the United States Military. What is their role? Student, Dylan Fujitani in his research policy argument, â€Å"The hardest of the hardcore† writes an article suggesting the removal of private contractors from the Middle East. It suggests that there is a common misconception that people are confused between the difference of civilian contractors, mercenaries, people in the military, and that civilian contractors should not adopt a military role. He adopts a serious tone in order to clutch the attention of his audience. There are a lot of misconceptions to what some may believe the key objectives of the support staff/private contractors/ mercenaries are in the Middle East, and Congress must swiftly act to level the playing field between US military personnel and private security contractors. Most of the writer’s points in the essay seem relevant, and consistent with my past experiences in dealing with private contractors. I agree that there is a common misconception about the role of the private contractor/mercenary. Historically, the mercenary is a soldier for hire, however, the private contractor also has different dignitary support roles. Fujitani successfully uses pathos in his essay to persuade his audience particularly when he suggests that the use of mercenaries circumvents public, and congressional scrutiny of some aspects of war (Fujitani 374). The writer’s purpose here is trying to persuade people, by giving an emotional appeal that civilian contractors (who have questionable prior backgrounds) are armed, are given essentially given legal immunity. Another example of Fujitani using pathos is when he said that placing more contractors in the theater of war is a good way to keep US troops numbers down, but politically it’s more expensive. Here he is suggesting that the United States is trying to mask the severity of war. Even though he provided examples from both sides of the case, he’s extremely ineffective in this area because it seems he was not concerned with presenting the counterargument fair-mindedly. Although the writer uses pathos in this particular section part of his essay, most of this paper is logos heavy. These styles of comparison help the writer convey to his audience a sense of importance by using the language that is quite familiar to the military. He indeed uses language that was easy for military, and nonmilitary personnel to understand. The writer seems very prejudiced, however, uses citations to support his opinion. I agree with the writer on the information that was presented, and how he was able to break down the concepts. I understand what he proposes when he references the role of civilian mercenaries. The writer was able to convince readers that his opinion was truly legit using ethos by referencing several published articles from credible sources. The reference New York Times article also gives good examples to support his reasoning. In contrast to what the writer believes, I believe that there is a position that supports the private contracting business overseas. The writer clearly overlooks some important points that should be noted on the contrary. In my experience, I believe civilian contractors provide essential support services to the United States military. It is imperative that the military should not waste valuable resources, and manpower on support positions. To the contrary of what most people think, war is not always shooting at people, capturing prisoners, and kicking down doors 24 hours a day. A lot of essential jobs are in support. The use of private contractors help with convoys, logistics, and food services help free up essential manpower for the military to concentrate on high mission profile assignments. In conclusion, the writer’s essay was ineffective because I believe that his essay appeals to one type of audience. The writer seems to not have any knowledge of how wartime operations are drawn out and conducted. Although not perfect, I believe that the use of private contractors are essential and should not be completely weeded out the process. On the contrary, he was effective because I think he used mostly logos to appeal to his audience. He references essentially six principles on why private contractors/mercenaries should be extremely downscaled. He starts off by reference in how mercenaries disguised the true cost of war. Here he explains how civilian contractors actually disguise the number of deployed troops. He goes on and references how civilian contractors have no loyalties, and ultimately answer only to their employers and not the military. He again uses logos by citing a report on how mercenaries assigned in Saudi Arabia left their post indefinitely, because they were not comfortable. Fujanti then moves to tie the two points together making a clear contrast on how the US military, and civilian mercenaries are accountable to the Geneva Convention. He describes how civilian mercenaries have no accountability to the law to whereas the US military does. The mercenaries are considered â€Å"noncombatants† and therefore it is difficult for them to fall within the Uniform Code of Military Justice (UCMJ). The writer closes his argument by expressing how private contractors frequently hire employees with questionable backgrounds. He appeals to his audience by citing an article from the New York Times how 1500 S. African mercenaries are now in the Iraqi area. He expresses that many of the people that are participating admitted to being former apartheid mercenaries. Fujanti is clearly frustrated knowing that these kinds of practices are frequently carried, nothings done about it, and moves to propose his solution by conveying that the problems that were discussed earlier needs to be addressed by Congress swiftly, and immediately to protect the legitimate uses of war from market forces, lawlessness, and the abuse of power. How to cite Rhetorical analysis â€Å"The Hardest of the Hardcore†, Papers

Childbirth and Midwife free essay sample

Midwives are autonomous professionals who are responsible for delivering high quality and holistic care for women during the antenatal, intrapartum and postnatal period’s . This involves working in close partnership with women to enable the provision of all necessary support, care and guidance (ICM, 2011). The midwife also has the important task of providing woman -centred care whilst always striving to promote normal birth (midwifery 20 20). The royal college of midwives (RCM, 2010a) describes normal childbirth as one where a woman begins, continues and completes labour physiologically at term without intervention. However it must be recognised that normality is a hazy subject in health care and there are many different theories making it difficult to define. This essay will discuss the role of the midwife in the provision of normal midwifery care during the intrapartum period, specifically in relation to up-right positioning and mobility during labour and birth. It will analyse the essential skills a midwife must acquire to allow the provision of normal midwifery care, the main components include; becoming an advocate for the woman, empowering the woman to make informed choices by providing evidence based information and the importance of continuous support and effective communication. The importance of mobility will also be examined and the role of the midwife in enabling mothers achieve effective mobility during labour will be discussed. There are also numerous different positions that women can adopt during the intrapartum period , there are various advantages for different positions therefore the role of the midwife in helping mother’s to accomplish these positions will also be considered. An imperative role that midwife must adopt in the promotion of mobility during labour and birth, is the role of an educator (Dunkley, Bent, 2012 Mayes book ref). It is important that the woman has been provided with all of the relevant information regarding mobility and positioning. Antenatal classes can be very beneficial and discuss labour in great detail. However not every woman will attend these classes and it is therefore the role of the attending). midwife to educate the woman of the benefits and ensure that the woman understands all of the information, enabling her to make an informed decision. Any information must derive from evidence based practice as stipulated by the Nursing and Midwifery Council (NMC, 2011 In order for a midwife to be able to inform her practice it is essential that she keeps up to date with the latest research, guidance, policy changes and statutory training. This is why midwives are described as lifelong learners (Mayes PG 47). The (RCM, 2005) emphasises the importance of a midwife’s knowlegde of anatomy in the understanding of how adapting different positions in labour can aid the physiological processes. One of the benefits that the mother should be made aware of is that remaining mobile during labour can aid the descent of the fetus (Midirs, 2008). Despite more women being educated on the benefits of mobility and positioning, the majority of women in the United Kingdom continue to labour and give birth lying down on a bed. A survey carried out by the (RCM, 2010b) concluded that a massive sixty three per cent of the women surveyed gave birth in a recumbent position. It is ultimately the mother’s decision to decide what position she may want to adapt during labour and birth however the midwife has a duty of care to ensure that she possess the adequate knowledge to make an informed choice (NMC, 2011). It is important that the midwife develops a quick rapport with a woman in her care if the woman is to actively listen and take in any information that is being offered. According to (Midirs, 2006) a qualitative study in the Netherlands concluded that the dominating factor in influencing the women’s choice of birthing positions was the advice she had been given by her midwife. A Cochrane review carried out by(Hodnett et al 2011) also mirrors these findings and suggests that the length of time in labour may even be reduced and there may also be fewer interventions if a supportive care giver (the midwife in this case) is present. To be able to build an effective and trusting relationship, one to one care is essential, furthermore the National Institute for Clinical Excellence (Nice, 2007) guidelines state that all women should be provided with one to one care while in labour. This care should ideally take place in a warm and welcoming environment The birthing environment plays an integral role in the provision of women-centred care. It is therefore the responsibility of the midwife to ensure the environment is safe, hazard free and suitable for mobilisation in the aim to provide normal midwifery care (Midwifery matters, 2010 ref 5). In the hospital setting, the bed tends to be the central feature in the delivery room , the midwife should consider moving the bed to the side prior to the woman’s arrival and maybe provide a comfortable chair( The Practising Midwife, 2003 REF 9). The (RCM, 2010a) campaign for normal birth also recommends the use of low lighting, removing any unnecessary equipment and minimising interruptions. Midwives should also be sensitive to the importance of respecting a woman’s privacy and helping to maintain her dignity at all times. Suggests that women are encouraged to adjust the environment to meet their own individual needs during labour and delivery, this helps to empower women and give them a sense of self-control. The midwife is obliged to facilitate the woman’s needs to the best of her ability and could maybe suggest bringing in some aids such as bean bags or a birthing ball that can enhance a woman’s comfort while also promoting mobility and upright positioning ( The Practising Midwife, 2003 REF 9). Mobility is especially important in early stages of labour as this can aid the descent of the fetus through the pelvis (British Journal of Midwifery, 2010 REF 18). The first stage of labour, in particular the Latent phase can be a particularly confusing and worrying time for women as they often believe themselves to be in established labour. How the woman’s care is managed at this stage is vitally important and can have implications for the remainder of the birthing experience. The midwife has a huge part to play in supporting the mother through this stage by listening to her, remaining positive and providing constant reassurance (RMC, 2010a). A recent Cochrane review found that offering continuous support to a woman during labour can reduce the use of pharmacological analgesia, shorten labour, and increase the likelihood of a natural birth while enhancing the woman’s birthing experience (Hodnett et al, 2011). Supporting a woman in labour can be both mentally and physically demanding for a midwife, therefore involving the birthing partner can be beneficial to both the midwife and the woman and can improve the overall quality of care (TB page 10). During this early stage the midwife should encourage the woman to be as mobile as possible and maybe suggest that she walks up and down stairs as this can maximise the pelvic outlet allowing the fetus to descend into the birth canal. A Cochrane review from (Lawrence et al, 2009) found that remaining mobile and adopting upright position can shorten the first stage of labour by about one hour. It is also well recognised that adapting up-right positions during labour and birth have many other advantages for both woman and fetus. The fetus is more inclined to have a better alignment and contractions tend to be more effective help to reduce the risk of; episiotomy, assisted delivery, fetal distress and less severe pain (Gupta and Hoffney, 2006). Women who choose to labour in an up-right position also have a reduced risk of aorto-caval compression , which is when the aorta is constricted and can cause hypotension and loss of consciousness in the Woman (Midirs, 2008 final report). However a review carried out by (Lawrence et al, 2009) implied that there is a link between upright positions and increased blood loss, but a reason for this could be the fact that the woman is in an upright position could the loss more obvious. However research suggests that Giving birth in a recumbent or flat position can have the potential to be more harmful to the fetus and carries a higher risk of an instrumental delivery or a caesarean section (RCM 2010b). It is the role of the midwife to ensure that the woman is aware of all of the evidence on both the benefits and potential risks of labouring and giving birth in an up-right position. She must also confirm the woman’s understanding of the information given.

Influence of Team

Goal accomplishment can be regarded as a primary objective of any team in an organization that works on a specific task. Most of organizations resort to team-based pay structure to encourage employees work harder because their salaries depend largely on the success of the goals accomplished. The point is that all members of the team receive similar incentive pay with no reward assigned to individual members for their greater contributions (Heneman, 2008).Advertising We will write a custom essay sample on Influence of Team-Based Pay Structures on Team Members’ Performance and Motivation specifically for you for only $16.05 $11/page Learn More Therefore, team-based pay is often criticized by both employees and their organizations for many reasons. To begin with, the given program can alleviate the spirit of competition, as well as discourage employees to work efficiently for reaching the company’s objectives. As a result, the competition insi de the organization can be lost and the productivity level will also be reduced significantly (Heneman, 2008). Social pressure and incentives for improvement will also be dismissed because each employee will impose some responsibilities on others because he/she will have to achieve similar goals (Heneman, 2008). Incentives for improvement will also be lost because of the absence of proper reward systems for individuals. In this respect, specific guiding principles should be implementing to strike the balance between the given pay system and the corrections to be introduced. In order to restore the spirit of competition, Gross’ certain guiding principles should be used for instituting pay and reward structures. This is of particular concern to the second guiding principles, which runs â€Å"Balance the mix of individual and team-based pay† (Thompson, 2011, p. 54). In particular, there should be a reasonable balance between group and individuals incentives to arrange a c ompetitive environment and provide a basis for further inspirational and motivated work. For instance, there should a bonus scheme for employees to feel that their work is appreciated and there is always an opportunities for personal self-improvement and determination. For instance, organization should implement additional bonuses for group members, along with group rewards. More importantly, there should two groups working under competition to encourage group goals accomplishment. The third methods postulates, â€Å"Consult with the team members who will be affected† and it should be introduced to provide a decision-sharing atmosphere in a team (Thompson, 2011, p. 55). In addition, managers should inform the team members about the actual process of project fulfillment so as they have an exact idea of how the pay structure is organized. Finally, principle 8, which reveals â€Å"Determine how target levels of performance are established and updated†, is also indispensib le to guaranteeing a high level of performance (Thompson, 2011, p. 57). In this respect, managers should define the correlation between goals accomplishment and its influence on team performance.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More American teams are extremely task-oriented. However, their focus on task fulfillment does not always lead to successful project accomplishment. In order to achieve the highest results, team members should examine opposing ideas in a cooperative context to increase the team effectiveness and quality of problem solving and decision making (West, 2012). In the majority of cases, task orientation does not contribute to adequate distribution of roles and positions. In this respect, failure to allocate resources and responsibilities can prevent from the goal accomplishment. Hence, West (2012) argues, â€Å"team members should attempt to influence their col leagues towards a solution based on shared, rational understanding rather than attempted dominance† (p. 143). Task-orientation often prevents team members from establishing active decision sharing and open-mind way of expressing ideas. As a result, introvert orientation does not always contribute to high level of performance and effective teamwork. Following the idea presented in Thompson (2011), that â€Å"team performance should focus on collective performance† (p.70), we can state that this â€Å"collective performance† leads to development of the adequate knowledge among the team members, which, in its turn, helps them develop the necessary skills and abilities. The adequate knowledge, skills and abilities are one of the most essential conditions that contribute to productive performance and successful cooperation. Knowledge-based performance of the team creates more collaborative work and mutual understanding among the group members. It makes the group more productive and motivated. As a result, such a collaborative environment ensures that each member of the team is able to support or substitute another one provided one of them is not able to perform his/her responsibilities. Interaction and active participation on goals accomplishment should not depend on the analysis of task performance. With regard to the above-highlighted problems and conditions, specific solutions should be implemented. In order to eliminate excessive task orientation, team members should be provided with bonuses for providing decision where the priority is made on a specific task fulfillment, but on the degree to which this task fulfillment contributes to the overall goal accomplishment (Salas et al., 2001). Second, to encourage communication between members, top leaders should engage task that are distribution for more than one person (Salas et al., 2001). As a result, team members will increase the level of goal adherence. Finally, there should a distinguished distribution of roles and responsibilities where each team members should be involved in various level of project accomplishment. This is of particular concern to the necessity to introduce only one position for accomplishing a task.Advertising We will write a custom essay sample on Influence of Team-Based Pay Structures on Team Members’ Performance and Motivation specifically for you for only $16.05 $11/page Learn More Equal distribution of members for task accomplishment and goal orientation can solve the problem of extreme task management that is not always beneficial for project management in an organization. In such a manner, it is possible to keep track of the larger picture of event within a group (Salas et al., 2001). There should also be a person who will be responsible for coordinating the process between two groups (Salas et al., 2001). Thus, expending a spectrum of responsibilities and positions can provide the team members with new opportunities for effective project management and group cooperation. References Heneman, R.L. (2008). Strategic Reward Management: Design, Implementation, and Evaluation. US: IAP. Salas, E., Bowers, C. A., Edens, E. (2001). Improving Teamwork in Organizations. US: Taylor Francis. Thompson, L.L. (2011). Making the team: A guide for managers (4th ed.). Upper Saddle River, New Jersey: Pearson Education, Inc. West, M. A. (2012). Effective Teamwork: Practical Lessons from Organizational Research. US: John Wiley Sons. This essay on Influence of Team-Based Pay Structures on Team Members’ Performance and Motivation was written and submitted by user Artur0 to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Shrouded Christianity essays

Shrouded Christianity essays The Bible is a roadmap that shows how one ought to live their life. It contains the mind of God and gives Christians moral guidelines and examples of which to abide by. Although the oppressors in both Incidents in the Life of a Slave Girl written by Harriet Jacobs and Our Nig written by Harriet E. Wilson, claim to be of the Christian faith, there is a disparity between their religious values and how they actually treat their slaves. Jacobs and Wilson show how this hypocrisy leads to physical abuse, limitations, and mental anguish. Both Incidents in the Life of a Slave Girl and Our Nig are replete with an insubordination of Christian values and the authors use this to exemplify the wrong doings towards slaves. The word of the Lord says, Whatever you want men to do to you, do also to them.(Matthew 7:12) This scripture, however, was not one of the Christian values that Dr. Flint and Mrs. Flint abided by in Incidents in the Life of a Slave Girl. Throughout her story, Harriet Jacobs describes the many hardships that Linda Brent went through. Dr. Flint had sworn that he would make me suffer, to my last day...(223). These are not the words that would come out a Christian mouth, for God wants no one to suffer like he had to, until his last day on the cross. Linda Brent also suffered physical abuse in the form of whippings or beatings. Dr. Flint and Mrs. Flint would not impose these types of punishments on their own children, so why was it acceptable to impose them on Linda Brent? It is the double standard that the Flints hold. God views all of his children as equal but the Flints do not share the same views, even though they claim to. Harriet Wilson also includes countless instances of physical abuse in her story about a young girl growing up. The indentured servant, Frado, is forced i ...

African American and Body Paragraphs

Instructions: Copy and paste the following text into a document or create a document that contains the same information. Writing Prompt What stylistic elements does King use to influence his readers? After reading and analyzing Letter from Birmingham Jail, write an essay in which you answer the question and analyze structure and language in his text, providing 3 or more examples to illustrate and clarify your analysis. What conclusion can you draw about the power of this text? 1. Copy and paste the introduction of your essay. If your instructor suggested any revisions to your introduction, please make your revisions and include in the space below. â€Å"Its unjust treatment of Negroes in the courts is a notorious (well-known) reality. There have been more unsolved bombings of Negro homes and churches in Birmingham than any city in this nation. These are the hard, brutal, and unbelievable facts. † Unfortunately, he was right. Those were â€Å"hard, brutal, and unbelievable facts† at that time. During the time he wrote the â€Å"Letter from Birmingham Jail† the African-American Civil Rights Movement was happening. People were protesting to get equal rights for â€Å"colored people†, to outlaw racial injustice in the USA and Martin Luther King Jr. was a big part of it. He was one of the leaders of this movement; this letter that he wrote was from jail because he was given a penalty for parading without a permit. Martin Luther King shows this power through similes, rhetorical questions and imagery which creates a bigger more important picture in the readers mind. Write 2. Using what you have learned about evidence, explanation, quotations, and paraphrase, write your body paragraphs in the space below. You will need to include at least one of each of the following: †¢a direct quotation introduced with a complete sentence and a colon †¢a direct quotation introduced with a signaling phrase and a comma †¢a direct quotation that is introduced and explained in one sentence †¢a paraphrased example †¢an embedded quotation Locate 3. Within the body paragraphs of your essay, locate a direct quotation that is introduced with a complete sentence and a colon. Copy and paste it here. Be sure to include the entire sentence that contains the quotation as well as the explanation sentence(s) that comes after it. 4. Within the body paragraphs of your essay, locate a direct quotation that is introduced with a signaling phrase and a comma. Copy and paste it here. Be sure to include the entire sentence that contains the quotation as well as the explanation sentence(s) that comes after it. 5. Within the body paragraphs of your essay, locate a direct quotation that is introduced and explained in one sentence. Copy and paste it here. 6. Within the body paragraphs of your essay, locate one paraphrased example and copy and paste it here. 7. Within the body paragraphs of your essay, locate one embedded quotation and copy and paste it here. Reflect 8. What are you most proud of in this draft of your body paragraphs? 9. What questions do you have about how to use examples or explanations in your writing? [ Close ]

TQM Strategy & Toolkit Essay Example | Topics and Well Written Essays - 2500 words

TQM Strategy & Toolkit - Essay Example rts as it can be used for identifying organizational procedures, ideas, cause and effect matters and business statistics that are related to the business organization. This piece of research work is an attempt to examine the relevance and organizational significance of Total Quality Management with relation to the case of Financial Collection Solutions and Services (FCSS). This paper identifies most appropriate TQM tools that can help the company develop its software based business of credit cards and other payment solutions. The concept of Total Quality Management and its importance in the business and economy have dramatically increased in recent years because it has been considered to be an effective strategy that can help managers to become accustomed to the changes in both technology and changing customer attitudes as well customer demands. When the business contexts continue changing and are challenged by innovative and technological advances, the business must be able to adjust with changes and to provide goods and services according to the changing business contexts. Customers, competitors, employees and stakeholders all are putting maximum pressure on managers to quickly innovate and change the business route. Total Quality Management is one approach that has emerged to meet these changing forces. This approach also has been termed as Continuous Quality Improvement (CQI) and Leadership Through Quality (LTQ) (Brown and Harvey). One of the very basic tasks and objectives of the management is to achieve quality in the business. According to Peter F Drucker, a business must be able to create a customer in a way that it can satisfy him by providing some product or services that he wants (Burril and Ledolter, 1999). A business can be said to have achieved the required ‘quality’ when it provides excellent products or services with required attractiveness, with no defects, and with reliability and long term dependability. Customers demand high value and

Feasibility of Foreign Retail Firms Entering India Case Study

Feasibility of Foreign Retail Firms Entering India - Case Study Example While formulating the strategies, the organizations’ leader and the management team will firstly look at the factors that may aid them to make a successful entry. After analyzing the positive factors, the firms will or should have to analyze the challenges that may impede their entry. As every foreign market or country will have different political, social, economic and legal conditions as well as different customers, competitors, prospective employees, etc, etc, there will be many challenges, which will block the firms’ success. Also, there will be country specific challenges as well as industry-specific challenges in those foreign markets. For example, the Asian country of India has some distinct aspects, which will surely act as an advantage as well as a challenge for the new firms, who are planning to enter it. Likewise, the retail industry in India also has some inbuilt favourable factors as well as impediments particularly in the political, social, legal and economic spheres, which may facilitate or impede foreign-invested retail firms’ entry. This paper will analyse India and the opportunities and risks, it presents for the retail firms. Globalization is having major impacts on the economic sphere of many developing countries like India, working as a catalyst for economic development. Globalization turned out to be a godsend opportunity to these countries. That is, these countries opened up their markets and invited foreign companies with a slew of schemes and benefits. India has also become part of the global plans of many organizations mainly due to globalization. That is, when globalization or liberation made its entry into in the early 1990s, it opened the door for foreign companies including retail firms (but with caps) to reach India, benefiting both the Indian people and the companies. India has been pursuing the Mode 1 globalization strategy since the economic reforms began under P.V. Narasimha Rao and Manmohan Singh in 1991. Despite several changes of government and difficulties in implementation, the essential aspects of this international economic strategy have been maintained (Sen 2000).  

Information system development life cycle models Essay Example for Free

Information system development life cycle models Essay Health information managers must understand the components of information systems and how information systems affect the organization, individuals within the organization, and interested publics outside the organization. Information systems provide opportunities to improve internal operations, create competitive advantage in the marketplace, improve patient-care delivery, enhance research, and provide better service. Information system risk occurs when the systems are not well integrated, are poorly managed, or do not support the goals of the organization. In order to exploit information system opportunities and minimize threats and risks, a thorough understanding of information system components and how these relate to the organization is necessary. An information system is composed of a group of components (people, work processes, data, and information technologies) that interact through defined relationships to accomplish a goal. Information systems must be able to adapt to environmental change. A good example of a health-related information system is an order entry system. The goal of the system is to process physician orders. The system is composed of a group of components including people (nurses, physicians, unit secretaries, laboratory personnel), data, work processes, and information technologies. Each of these components interacts through defined relationships. fails to accommodate the environment or if the interactions among its component parts fail, the system becomes nonfunctional and disintegrates. Thus, a system must be composed of a group of components that: ï‚ · Interact through defined relationships ï‚ · Work toward accomplishing a goal ï‚ · Self-adapt and respond to environmental changes Figure 2-1 provides an example of the relationship of these characteristics. An information system is composed of a group of components (people, work processes, data, and information technologies) that interact through defined relationships to accomplish a goal. Information systems must be able to adapt to environmental change. A good example of a health-related information system is an order entry system. The goal of the system is to  process physician orders. The system is composed of a group of components including people (nurses, physicians, unit secretaries, laboratory personnel), data, work processes, and information technologies. Each of these components interacts through defined relationships The peoples enter orders in a predefined way through a data entry terminal (hardware) and through interaction with software. Through the predefined interactions between the hardware and software, the order is processed. The order entry system is self-adapting and able to accommodate environmental changes such as order volume. The example depicted in Figure 2-2 demonstrates the characteristics of a system as applied to an information system: component parts working in predefined relationships that can self-adapt to environmental changes to accomplish a common goal. As the bidirectional arrows depict in Figure 2-2, at any given time there is a potential three-way interaction between all system components. People interact or are affected by work practices, data, and information technologies. Work practices affect people and may be impacted by data availability and information technologies. Information technologies may affect work practices, people, and the input, processing, or dissemination of data. Thus, we see that information components are highly interrelated. Recognizing these interrelationships is very important, since a problem with one component will likely adversely impact all other components within an information system. When information system problems arise, it is crucial that all information system components and their relationships be examined System Elements Systems have three principal elements: inputs, processing mechanisms, and outputs. Figure 2-3 depicts their simple relationship. In the order entry example given previously, inputs include physician orders such as laboratory, radiology, or pharmacy orders that are entered in a computer terminal on the patient-care unit. The orders are subjected to several processing mechanisms that check their consistency and completeness before they are routed to the appropriate department. The output of the system is a requisition for a specific type of test, procedure, or pharmaceutical. In addition to inputs, processes, and outputs, most systems also have a  feedback loop. Feedback provided by the system influences future inputs. In the order entry example, feedback regarding nonavailability of an ordered drug in the pharmacy department inventory might be provided to the physician. In this case, the system might suggest what alternatives or substitutes are available Information System Components All definitions of an information system must embody the essence of the four system characteristics that were previously presented. Thus, an information system is a group of interrelated and self-adapting components working through defined relationships to collect, process, and disseminate data and information for accomplishment of specific organizational goals. The components of an information system should be broadly interpreted. For example, information system components should be viewed to include people, work procedures, data, and information technologies (Alter, 1992). Although organizational goals may not be specifically included in the components of an information system, they must be viewed as the driving force for the development, design, implementation, and evaluation of information systems. Each information system must be evaluated in terms of its contribution to meeting the goals of the organization Information System Types In Chapter 2, six types of information systems are discussed: transaction processing systems (TPS), management information systems (MIS), decision support systems (DSS), executive information systems (EIS), expert systems (ES), and office automation systems (OAS). Early systems in health care were principally transaction processing systems. These systems automated operational functions such as accounting, payroll, inventory, and admission/discharge systems. Later, other transaction systems, such as order entry, were added to the capabilities. Management information systems emerged in the late 1970s and gradually became more sophisticated during the 1980s. One factor influencing the growth of MIS during this period was the introduction of the national prospective payment (diagnostic-related groups or DRGs) system for Medicare patients. Because of DRG implementation, hospitals needed information systems that provided better filtered and formatted data for making managerial and strategic decisions. The  implementation of DRGs also revealed the weaknesses of current information systems in linking and integrating data. Weaknesses associated with the proliferation of stand-alone systems and the historical emphasis on financial systems became magnified during the 1980s coiera When the same kind of decision is made on a regular basis, it will require access to the same kind of data and may use the same knowledge. In these circumstances, one can develop a regular process or information system to accomplish the task. An information system could thus be anything from the routine way in which a clinician records patient details in a pocket notebook, the way a triage nurse assesses patients on arrival in an emergency department, through to a complex computer-based system that regulates payments for healthcare services. An information system is distinguished from other systems by its components, which include data and models. Recall from the last chapter that there are several different kinds of information model, including databases and knowledge bases. These different information components can be put together to create an information system. For example, consider a calculator that can store data and equations in its memory. The data store is the calculator’s database, and the equation store is its knowledge base. The input to the calculator becomes the equation to be solved, as well as the values of data to plug into the equation. The database communicates with the knowledge base using a simple communication channel within the device, and the output of the system is the value for the solved equation (Figure 3.6). There are many potential internal components that could be included within an information system, including a database, a knowledge base, an ontology, and decision procedures or rules of inference. The different components of an information system are connected together with input/output channels, which allow data to be shifted between the components as needed. A patient record system is a more complex example of an information system. Its purpose is to record data about particular patients in some formalized fashion to assist in the control Wager2009  An information system (IS) is an arrangement of information (data), processes, people, and information technology that interact to collect, process, store, and provide as output the information needed to support the organization (Whitten Bentley, 2005). Note that information technology is a component of every information system. Information technology is a contemporary term that describes the combination of computer technology (hardware and software) with data and telecommunications technology (data, image, and voice networks). Often in current management literature the terms information system and information technology are used interchangeably. 6.1.1 What Is a System?shortliffe Until now, we have referred informally to health information systems and computer systems. What do we mean when we refer to a system? In the most general sense, a system is an organized set of procedures for accomplishing a task. It is described in terms of (1) the problem to be solved; (2) the data and knowledge required to address the problem; and (3) the internal process for transforming the available input into the desired output (Figure 6.1). When we talk about systems in this book, we usually mean computer-based (or just computer) systems. A computer system combines both manual and automated processes; people and machines work in concert to manage and use information. A computer system has these components: ââ€"  Hardware: The physical equipment, including processing units (e.g., the central processing unit (CPU)), data-storage devices, comunication equipment, terminals, and printers ââ€"  Software: The computer programs that direct the hardware to carry out the automated processes—i.e., to respond to user requests and schedules, to process input data, to store some data for long periods, and to communicate informative results to the users; at times the software will prompt the users to perform manual processes System Design and Engineering in Health Care 235 ââ€"  Customers: The users who interact with the software and hardware of the system, issue requests, and use the results or forward them to others; there will be other users who are concerned with providing input, system operations, backup, and maintenance The role of a computer is, broadly speaking, the conversion of data into information. Every piece of data must be supplied by a person, by another computer system, or by data collection  equipment, as seen in patient monitoring (see Chapter 17). Information that is output is delivered to health care professionals or becomes input to another computer system. In other words, a medical computer system is a module within the overall health care delivery system. The overall health care system not only determines the need for the computer system (e.g., which data must be processed and which reports must be generated) but also the requirements for the system’s operation (e.g., the degree of reliability and responsiveness to requests for information). Acquisition and operation of a computer system has implications for the organization of an institution. Who controls the information? Who is responsible for the accuracy of the data? How will the system be financed? The installation of a computer system has sociological consequences as well. The introduction of a new system alters the work routines of health care workers. Furthermore, it may affect the traditional roles of health care workers and the existing relationships among groups of individuals—e.g., between physicians and nurses, between nurses and patients, and between physicians and patients. Important ethical and legal questions that arise include the confidentiality of patient information, the appropriate role of computers in patient care (especially in medical decision making), and the responsibility of developers and users for ensuring the correct operation of the system (see Chapter 10). Although the technical challenges in system development must be met, organizational factors are crucial determinants of the success of a computer system within the institution. These factors can differ greatly among institutions and can make the transfer of a well-functioning system to another site difficult. 6.1.2 Functions of a Computer System Computers have been used in every aspect of health care delivery, from the simple processing of business data, to the collection and interpretation of physiological data, to the education of physicians and nurses. Each chapter in Unit II of this book describes an important area for the application of computers in biomedicine. The unique characteristics of each problem area create special requirements for system builders to address. The motivation  for investing in these applications, however, is the computer’s ability to help health professionals in some aspect of information management. We identify eight topics that define the range of basic functions that may be provided by medical computer systems: 1. Data acquisition and presentation 2. Record keeping and access 3. Communication and integration of information 4. Surveillance 5. Information storage and retrieval 6. Data analysis 7. Decision support 8. Education .

Health Matters :: Healthy Lifestyle Essay

Health Matters In 1991, fewer than one percent of Americans felt that health care was an important issue. Just two years later, President Clinton urged Congress to help him fix a health care system that "is badly broken" (Collins 78). Is the health care system badly broken? The health care reform debate has captured the attention of all Americans. What brought health care reform into the public spotlight? Although our medical care in this country is of the highest quality, our access to that care is waning due to higher and higher costs. Our health care system needs fundamental reform. Currently, there are dozens of reform packages in Congress, yet three packages offer significant recommendations toward health care reform: President Clinton's Health Security Act, Representative Jim Cooper's Managed Competition Act, and Senator John Chaffee's Health Equity and Reform Access Today Act. The final health care reform package must include the choice aspects of all three of these proposals. One aspect which must be included in health care reform is the elimination of insurance bias. Too many Americans are uninsured because of pre-existing conditions. Insurance providers should no longer be allowed to cover only the healthiest persons. Never again should an employer feel the need to fire a worker because of an illness which raises health insurance premiums. There are two important steps toward eliminating insurance bias. The first step is making portability of insurance a reality. Right now in this country, 28% of working Americans are unable to change jobs because they would lose their coverage and be denied coverage with another company due to pre-existing conditions (U.S. Health 56). For example, Marcia and Mark Callendar both had good jobs with good benefits. They thought their family was well-protected by the insurance provided by Mark's employer. Then their son, Matthew, got sick. Mark lost his job, and the Callendars lost their insurance. When they tried to apply for coverage through Marcia's job, they were turned down because of Matthew's pre-existing condition. Matthew finally qualified for coverage through disability, but Mark had to take a lower-paying job to be eligible for coverage (Health Security 6). Hence, increasing portability of policies is fundamental to reform. No longer should an individual lose health insurance coverage with the loss of employment. Secondly, insurance providers must stop cherry-picking individuals. People should not be denied health care coverage because they have been sick. Denial of insurance coverage only forces these patients to use expensive emergency room services rather than obtaining regular treatment.

In Oedipus the king Essay

Fate is an unavoidable part of a person’s life that may control who we are, what we do and what will happen to us. So, regardless of human actions and regardless of emotions and wishes, fate upon each humans being will occur. Fate can be undeserving and cruel, awesome and unchangeable, so much so that no one can change its course. Even when others try hard to help, fate will have its way. Certainly, in Sophocles’ tragedy, Oedipus the king was such an individual for even though exercising free will to determine the course of his destiny, fate ultimately had its way in that he is to kill his father and to marry his mother. An individual life is governed by the forces of fate that takes away autonomy and only leaves destiny as the road an individual will travel on. Despite Queen Jocasta’s individual effort to change her destiny, that she could stop her son from murdering his father and herself will marry her son, she was unable to do so. Even though she gives up her son to death in the useless hope to avoid fate, the oracle seals her destiny. However, later on, she herself admits that â€Å"chance rules our life†, for she realizes that all that efforts are not enough to change the predestined course of her life. Jocasta’s calm and reasonable brother, Creon, also support the philosophy that simple mortal do not control life, but gods control human’s destiny. Calm and in control, he announce to Oedipus before his self-proclaimed banishment, by saying that, â€Å"god will decide not I. † therefore, it shows that no one can predict their own future because what happenings in our life are decided by a greater force than humanity that is the control of the gods and human beings have little say in their destiny. Even when others interfere in one’s life, fate will in the end have its way. Jocasta and Laius try to escape the horrible prophecy set down by the god by giving up their new born son to a terrible death. However, the control of the god reign and the baby does not die, but lives. Oedipus, like his real parents tried to exercise free will in determining his destiny rather than that control by the gods. Once Oedipus hears of his fate from the oracle that he is to murder his father and marry his mother , Oedipus flee from Corinth to save his â€Å"parents† lives and so shows that he is willing to do anything, including giving up the throne, to make sure the prophecy does not come true. Yet, this very act leads him directly towards his fate, it is fate that drives him towards Thebe, the place where his destiny began. As well as placing him on the three crossroads where he angrily killed his real father laius. in addition, the efforts of the shepherd further add to the belief that humans cannot escape the control of the Gods, in his claim that â€Å"I hadn’t the heart to destroy it,† thereby ultimately allowing fate to continue in its path. Some humans, however, are able to exercise free will and control their own life; their lives have not been predetermined by destiny from the gods. Teiresias exercise free will to determine his own destiny, as such circumstances have not been imparted on him. Although cursed with blindness for he â€Å"lives in perpetual night†, Teiresias may exercise his own wish in his actions and is not restricted in his ultimate fate by the workings of the gods. Creon, jocata’s brother and Oedipus’ brother in law and uncle, has all the rights of a royal couple with none of the kingly responsibilities, for he claims that â€Å"who in his right mind would rather rule and live in anxiety than live in peace, mainly if he enjoys the same authority. † Unlike Oedipus who has had his fate set out for him from birth, Creon has not been give with such a tragedy, and so allows â€Å"chance to rule his life,† â€Å"living each day as best he can. † Likewise. Since human beings often suffer great pains in order to discover their true selves, it is ultimately the powerful and dominant Oedipus, whose â€Å"name is known afar,† who pays a very high cost for such revelations. At the same time as demonstrate free will to show himself to be a king with little self knowledge, his passionate and dogmatic nature leads him on this path of self- discovery. However, fate also has its way, for ultimately he suffers the indignity of a man who has committed the most dreadful of crimes.

Police officers Essay

Have you ever been in a situation where you find yourself stuck between facing consequences for things you haven’t done and giving in to someone who seems to be on a power trip and is taking advantage of their superiority over you? Whether it be a manager taking advantage of his power in the work place or a police man or woman doing unnecessary and over the top things to you. Abuse of power seems to be a common thing in some police officers every day life and this is not okay. It is very apparent what a police officers job is and that is to protect and serve the community and make sure that real criminals are being served justice, however; some may come across police officers that use the fact that they have badges and weapons to their advantage in order to basically become a bully instead of a hero. Of course not all police officers are corrupt, most are actually doing their job and are concerned with the safety of all people and not just their own but those few that are corr upt need to be stopped and be punished for their police brutality and/or abuse of power. So the question is, are police men and women being evaluated thoroughly enough so as not to hire corrupt officers? Are police officers being punished and or brought to justice because of their wrong doings? In this paper I will bring some cases of police brutality and or abuse of police powers to your attention as well as if and how police are being punished because of their illegal or down right cruel behavior. Becoming a police officer is far from an easy task as it should be, but why is it that after so much questioning and tests of integrity and moral values citizens are becoming more and more victimized by police officers? In my opinion police officers are not being as extensively tested for a corrupt mind set as we are led to believe they are. Possible police officers are asked questions on a polygraph test that mostly tie in with the questions asked in the application process so as to get details and obviously the truth out of anything remotely suspicious on the application. These questions mostly having to do with drug use or theft and anything that may prove an officer to be dishonest about questions already asked prior to the polygraph. These questions however rarely have to do with how officers view a citizens race, religion, gender, levels of class, etc. For example, a police officer is not asked in a polygraph test if he does not like Muslim people or if he is disgusted by gay individuals.

Career Choice Project †Information Systems Current Issues Essay (300 Level Course)

Career Choice Project – Information Systems Current Issues Essay (300 Level Course) Free Online Research Papers Career Choice Project Information Systems Current Issues Essay (300 Level Course) After completing the Career Choice application provided by the Internship and Career Center, I was given many choices of jobs that would suite to my lifestyle as well as was able to choose jobs and research what I was interested in. Once Career Choice was completed, and it provided jobs that â€Å"suite to my lifestyle†, I disagreed with what was originally given. Once slowly working through it, and more data was taken from me, information on what jobs I would be interested in matched much more consistently to my ideas. The three jobs I found to most suite what I am interested in are Computer Network Telecommunications Technician, Computer Network Systems Administrator, and Engineer, Computer Systems. A Computer Network Telecommunication Technician (CNTT) includes the assistance to a network administrator dealing with hardware, software, or infrastructure to an information system. As this career does not require a bachelor’s degree, it would be just a start to moving up the chain of command. As the skills needed in this job are Technical, Computer literacy, and diagnosing I believe I am well prepared to do this job. As the work conditions are nearly equal to an eight to five job, not many overtime hours, but this comes with the basic salary of 30 – 35 thousand dollars per year. A Computer Network Systems Administrator (CNSA) is the knowledge to know what and when to install in an information system, as well as the capability to install and maintain. This career requires a bachelor’s degree in some type of information systems degree. Skills needed in this occupation would include Information Handling, Computer Literacy, and diagnosing. These three jobs also are included in what I believe I am capable of. As this position is a bit more time consuming, as well as the knowledge needed to take this position is more than the previous, the pay is higher. The salary for this occupation is 35 to 42 thousand a year. An Engineer of Computer Systems also known as a Systems Analyst is the occupation I am aiming for as a lifetime career. In this career, you would be in charge of handling the information data needs of users, inside and outside of your company. This position in today’s economy is growing rapidly. According to Career Choice, it is neither as high paying, nor as in demand as it really is. I am currently enrolled in a class on this subject of the information systems market. This is a very interesting subject, learning how to design and put in place everything from business processes to new technology. As this job is very much in demand in today’s economy, it is also not an easy one. Once the skill sets used in this occupation is part of my skill set, which I plan to retrieve from the first two previously described occupations. This occupation according to Career Choice requires knowledge in number computing, technical, computer literacy, and diagnosing. Each of the se skills are definitely needed, yet only real world experience can get you the skills needed to complete this occupation. The CNTT position as well as the CNSA position are very similar, and are very close in the chain of command, they both are jobs I consider to have at some point before I attempt at an Systems Analyst position. I do not believe I can fulfill my duties needed to be a Systems Analyst without the real world experience first. As I have been associated with the Information Systems world for years, I believe the base salaries given by Career Choice are low balled, and are much higher, especially with information systems degree. As the skill sets between the first two are similar, they are both similar to the third occupation. Luckily Career Choice came to the same conclusions of what I wanted to do with my life. Research Papers on Career Choice Project - Information Systems Current Issues Essay (300 Level Course)Open Architechture a white paperIncorporating Risk and Uncertainty Factor in CapitalRiordan Manufacturing Production PlanBionic Assembly System: A New Concept of SelfThe Project Managment Office SystemMoral and Ethical Issues in Hiring New EmployeesThe Effects of Illegal ImmigrationResearch Process Part OneAnalysis of Ebay Expanding into AsiaPETSTEL analysis of India

IP 1 Essay Example | Topics and Well Written Essays - 750 words

IP 1 - Essay Example It may be just a movie but helped me settle the argument if everything around me is just an idea or predetermined but finally concluded that everything has physical existence and that nothing is predetermined. Real for me meant a tangible existence that could be verified by my senses. Since everything around me is verifiable by my senses, everything I see is real and that we have free will. There two main thoughts about the source of knowledge. One is the idea of tabula rasa that the mind is empty and it gets its knowledge from sensory experience and study. There is also another thought that posits that the mind already contains some ideas such as conscience and the predisposition to believe the existence of a Supreme Being. For me however, I am more incline to believe that knowledge is a product of study and experience more than a predetermined idea. And this knowledge is subjective. What I experience and learn may differ from other person and as a result, we will have a different kind of thinking but we may have agree on some truths such as existence of a Supreme Being, to be a moral person, to serve society, etch. Traditional thinkers hold that faith conflicts with reason. They posit that to be faithful, one must abandon reason and to be reasonable, one must not have faith. My position however is that each complements the other. Reason through science supports faith. By knowing the wonder of nature and the universe, I became more convince of the supreme intelligence and power of God and thus, fortified my faith more. Human understanding can also never fathom the eternal wisdom of God. Ethics, which is doing the right thing to differentiate from morals, which means to be a good person in a way that ethics only requires following a certain standard of right whereas morals is not subjective. Moral is universal regardless of culture, norm or society. Simply put, being good does not mean following certain rules which ethics

Amputation Mishap Negligence Essay Example | Topics and Well Written Essays - 1000 words

Amputation Mishap Negligence - Essay Example A malpractice on the other hand occurs when a doctor, a hospital, or any other medical professional, causes an injury through omission or negligence to a patient. Malpractice can also be viewed as professional negligence, where a surgeon or any other professional testifies that his colleagues would regard his practice as not proper. All malpractice may involve negligence, although all negligence may not be malpractice. If a nurse fails to present medications as prescribed, and consequently the patient’s condition gets worse or results in death, the nurse will be indeed negligent. In cases where a nurse fails to pay attention to his or her tasks or has inadequate skills, it may lead to a suit of negligence to one who does not give approved care standards (Helm, 2003). Good nurses know their obligations and communicate well with their patients and physicians. Such nurses are aware of board practices and regulations within legal guidelines. Most nurses have no issues with committ ing negligent acts provided and they adhere to the confines of required practices, protocols, and legal hospital guidelines. I do agree with the article that what was practiced by the doctor, the hospital management, and the neighboring staff is total negligence. It is man’s nature to make errors at times, but mistakes that lead to harm on individuals could be perceived as negligence. In the Neighborhood newspaper, Mr. Benson’s amputation was an irreversible act. The doctor amputated the wrong leg, a fact that still remains a dream to Benson. The dilemma is whether the doctor was negligent in his practice or not. Here, the doctor was definitely negligent. This is due to the reason that the surgeon did not act exactly the way any other surgeon would have acted if in the same practice. Worse of all, not all the measures were considered to make sure that the right leg be amputated. Several cases of the same type have happened in history and procedures invented so this mis take would not occur again. Surgery is to be carried out after the right procedures have been put in place. Staff members in the operating room have to take time in ensuring that the correct patient is in the room awaiting the right surgery. In Benson’s case, the nurses at the neighborhood hospital kept quite on the case. If the nursing staff and the doctors in the operating room were keen on the practice, then this incident could not happen (Oberman, 1996). Quality documentation is vital in providing care and due to the present healthcare system; patients who claim to have sustained psychological or physical harm resulting from the negligence of their health providers can bring their lawsuits and claims to recover damages. A medical record acts as a legal document to be used by the injured patient for other legal proceedings or against other personnel since it is a permanent record. Correct documentation in the medical records develops legal data which completely and accurat ely reflect the care offered to the injured patient. In a court of law, it acts like a witness who gives facets about the events. If there is no evidence from the records then it is assumed that the negligent act never happened. Documentation is also important to the health providers; especially in civil litigation where there is alleged nursing malpractice or negligence it can

Medication Errors Research Paper Example | Topics and Well Written Essays - 500 words - 1

Medication Errors - Research Paper Example Nurses make errors when giving medications in any of these stages with most of the errors being done at the prescribing stage. Most errors that nurses do however are the administering errors that make up 26-32% of total medication errors (Unver et al, 2012). The most unfortunate thing about these errors is that they have not been intercepted by anyone but recent technological advancements focus on reducing them. It can be argued that most nurses do not conduct these errors knowingly as there are many factors that contribute to the medication errors. One factor that makes nurses make errors in administering medication is having wrong patient details. It is essential for a nurse to have all the information about a patient as it determines things like the dosage he or he is given. A patient can conceal to a nurse that he or she is allergic to various medication and in the event the nurse prescribes to the patient a medicine that would trigger an allergic reaction, a case of medication errors arises (Lan et al, 2014). Environmental factors also make nurses make medication errors. A nurse is likely to make a mistake in administering medication in working environments that are not conducive. There are high chances that a nurse working in a cluttered environment will make a medication error when administering or preparing drugs. If a nurse is preparing a drug in a poorly lit place, he or she will certainly make a mistake. The extensive learning that nursing students go through when learning does not make them be in a position where they can recognize and differentiate every drug in the market and this makes them confuse some drugs. There are incidents where nurses mistake certain drugs that have the same packaging and recommend them to innocent patient (Cheragi et al, 2013). To help reduce this confusion, the companies making these medicines should differentiate the drugs as much as

Innovation course PowerPoint Presentation Example | Topics and Well Written Essays - 1750 words

Innovation course - PowerPoint Presentation Example ter is to improve the delivery of quality health care conforming to the strict standards of the Joint Accreditation Commission of Health Organizations (JACHO). It basic strategy to attain its vision and mission is to manage innovation through governance and leadership skills. The first strategy is to employ non-nurse managers to head their nursing units. It is strategic move to enable nurses to focus on patient care and not be bogged down with administrative work. This move paved the way to increase morale and productivity in the units, and increased patients’ satisfaction with regard to the delivery of efficient and effective healthcare. The second strategy was an innovative structure necessitating building a two-tower structure which stands on a 1.6-hectare property. This move would capture a more extensive clientele thereby improving their market share. The third move was to institute actions which are â€Å"firsts† in the industry. First to invest in advanced medical equipments to cater to more patients not only in the local market but in the neighboring Asian nations. Further, this strategy puts SLMC in the top spot among the medical institutions in the Philippines. Innovative companies have well defined goals, vision and mission. The vision defined 2010 as the year to achieve its being one of the top 5 hospitals in Asia and would be achieved through highly competent and caring professionals and with the use of world class technology and research. Leadership is essential in managing innovation. The appropriate leadership skills are matched with personalities, characteristics and behavior of its human resources to motivate them into achieving organizational goals. Company’s resources must be maximized. Human resources are acknowledged as their most important asset. Property, equipment, and processes are continuously updated. And management has made a commitment to invest in technologically advanced medical equipments to compete with other top health

People Suffering Mental Disorder Auditory Hallucinations

People Suffering Mental Disorder Auditory Hallucinations Auditory hallucinations for some people suffering mental disorder are frequently experienced as alien and under the influence of some external force. These are often experienced as voices that are distressing to the individual and can cause social withdrawal and isolation. Although auditory hallucinations are associated with major mental illnesses such as schizophrenia, they also occur in the general population (Coffey and Hewitt 2008). The annual incidence is estimated between 4-5 percent (Tien 1991), with those experiencing voices at least once, estimated between 10-25 percent (Slade Bentall 1988).The standard professional response to voice hearing has been to label it as symptomatic of illness and to prescribe anti-psychotic medication (Leudar Thomas 2000). An alternative is suggested by Romme and Escher (1993), who view the hearing of voices as not simply an individuals psychological experience, but as an interaction, reflecting the nature of the individuals relationship with h is or her own social environment. In this way, voices are interpreted as being linked to past or present experiences and the emphasis is on accepting the existence of the voices. Romme and Escher (1993) see hallucinatory voices as responsive to enhanced coping and found that those who coped well with voices had more supportive social environments than those who found it difficult to cope. This dissertation will aim to discuss the experience and management of auditory hallucinations in schizophrenia looking into therapeutic relationship, helping approaches, and working towards the ending of a therapeutic relationship discussing discharge. First chapter will aim to explain what schizophrenia is, the cause of schizophrenia, its symptoms and types with particular focus on auditory hallucinations. The chapter will then discuss what auditory hallucinations are in the diagnosis. Therapeutic relationship between service user and the nurse is paramount in mental health nursing and is seen to prove long term outcome such as social functioning (Svensson and Hansson 1999). Chapter two will aim to discuss the building of therapeutic relationship in the management of auditory hallucinations using Peplaus interpersonal relations model (1952). The importance of holistic assessment using a variety of tools, scales and questionnaires that will identify symptoms, risks, management of risk and address the service users needs will be discuss in chapter three. Chapter four of this dissertation will discuss helping approaches. Gray et al (2003) states that pharmacological and psychosocial interventions have been heavily researched to find the most up to date literature and recommendations for the management of auditory hallucinations in schizophrenia with medication and Cognitive Behavioural Therapy (CBT).. The final chapter will aim to discuss the ending of the therapeutic relationship between the nurse and the service user looking into discharge planning process and conclusion. Chapter one What is Schizophrenia and Auditory Hallucinations? Introduction to chosen topic Schizophrenia is one of the terms used to describe a major psychiatric disorder (or cluster of disorders) that alters an individuals perception, thoughts, affect and behaviour. Individuals who develop schizophrenia will each have their own unique combination of symptoms and experiences, the precise pattern of which will be influenced by their particular circumstances (NICE 2010). Allen et al (2010) define schizophrenia as a chronic and seriously disabling brain disorder that produces significant residual cognitive, functional and social deficits. Schizophrenia is considered the most disabling of all mental disorders (Mueser and McGurk, 2004), it occurs in about 1% of the world population, or more than 20 million people worldwide (Silverstein et al., 2006). The DSM -IV TR (APA 2000) defines schizophrenia as a persistent, often chronic and usually serious mental disorder affecting a variety of aspects of behaviour, thinking, and emotion. Patients with delusions or hallucinations may be described as psychotic. However, Tucker (1998) argues that the system of classification developed by the DSM-IV does not actually fit many patients as a whole; the syndromes outlined in DSM-IV are free standing descriptions of symptoms. He said unlike diagnoses of diseases in the rest of medicine, psychiatric diagnoses still have no proven link to causes and cures; Tucker argues that there is no identified etiological agents for psychiatric disorders. Schizophrenia is characterized by clusters of positive symptoms (e.g. hallucinations, delusions, and/or catatonia), negative symptoms (e.g. apathy, flat feet, social withdrawal, loss of feelings, lack of motivation and/or poverty of speech), and disorganized symptoms (e.g. formal thought disorder and/or bizarre behaviours). In addition, individuals with schizophrenia often experience substantial cognitive deficits including loss of executive function, as well as social dysfunction (Allen et al., 2010). It is estimated that nearly 75% of people with schizophrenia suffer with auditory hallucinations (Ford et al., 2009). Positive and negative symptoms are mentioned briefly because the dissertation is primarily focused on auditory hallucinations. Auditory hallucinations in diagnosis Auditory hallucinations are often considered symptomatic of people diagnosed as suffering from schizophrenia (Millham and Easton, 1998). APA (1994, p.767) defines hallucinations as a sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Auditory hallucinations range from muffled sounds to complete conversations and can be experienced as coming either from within or from outside ones self (Nayani David, 1996). However, Stanghellini and Cutting (2003) argue that APA definition of hallucinations is false, they believe an auditory hallucination is not a false perception of sound but is a disorder of self consciousness that becomes conscious. Hearing voices is not only linked to a persons inner experience but can reflect a persons relationship with their own past and present experiences (Romme and Escher, 1996). Beyerstein (1996) suggests that voices are anything that prompts a move fro m word based thinking to imagistic or pictorial thinking predisposes a person to hallucinating. Auditory hallucinations, or hearing sounds or voices are the most common and occur in nearly 75 percent of individuals diagnosed with schizophrenia (Ford et al., 2009). Auditory hallucinations are often derogatory or persecutory in nature, and can be heard in the third person, as a running commentary, or as audible thoughts. Some individuals with schizophrenia also experience useful or positive voices that give advice, encourage, remind, and help make decisions, or assist the person in their daily activities (Jenner et al., 2008). Voice hearer can work with their voices and either choose what to listen to or can completely ignore them (Romme et al., 1992). Sorrell et al (2009) states that some individuals experience positive voices which do not affect the way they function or go about their daily living, these hearers also find that their voices may offer advice and guidance. The hearers voice can be reported as a little distressful or some go on to report no distress at all (Honig et al., 1998). However Nayani and David (1996) argues that individuals who experience a constant negative voice found them less difficult to control, they found the voice more powerful and attempt to ignore the voice. Chadwick et al (2005) said that those who resist voices or feel the need to argue or shout back are termed malevolent, those who think voices are good and engage with them are benevolent, they see voices are helping them so they tend to listen and follow advice. Swanson et al (2008) suggests that people who hear voices are more likely to be victims of violence than be violent themselves. However Soppitt and Birchwood (1997) argue that voices are more commonly linked to depression, voice hearers can also have a history of suicidal thoughts, paranoia and abuse. Not all auditory hallucinations are associated with mental illness, and studies show that 10 to 40 percent of people without a psychiatric illness report hallucinatory experiences in the auditory modality (Ohayon, 2000). A range of organic brain disorders is also associated with hallucinations, including temporal lobe epilepsy; delirium; dementia; focal brain lesions; neuro- infections, such as viral encephalitis; and cerebral tumours intoxication or withdrawal from substances such alcohol, cocaine, and amphetamines is also associated with auditory hallucinations (Fricchione et al., 1995) The phenomenological characteristics of auditory hallucinations differ on the basis of their etiology, and this can have diagnostic implications. People without mental illness tend to report a greater proportion of positive voices, a higher level of control over the voices, less frequent hallucinatory experiences, and less interference with activities than people who have a psychiatric illness (Lowe, 1973). There is also evidence that delusion formation may distinguish psychotic disorders from non clinical hallucinatory experiences. In other words, the development of delusions in people with auditory hallucinations significantly increases the risk of psychosis when compared with individuals who have hallucinations but not delusions. Auditory hallucinations may be experienced as coming through the ears, in the mind, on the surface of the body, or anywhere in external space. The frequency can range from low (once a month or less) to continuously all day long. Loudness also varies, from whispers to shouts. The intensity and frequency of symptoms fluctuate during the illness, but the factor that determines whether auditory hallucinations are a central feature of the clinical picture is the degree of interference with activities and mental functions (Waters, 2010) The most common type of auditory hallucinations in psychiatric illness consists of voices. Voices may be male or female, and with intonations and accents that typically differ from those of the patient. Persons who have auditory hallucinations usually hear more than one voice, and these are sometimes recognized as belonging to someone who is familiar (such as a neighbour, family member or TV personality) or to an imaginary character (God, the devil, an angel). Verbal hallucinations may comprise full sentences, but single words are more often reported. Voices that comment on or discuss the individuals behaviour and that refer to the patient in the third person were thought to be first-rank symptoms and of diagnostic significance for schizophrenia (Schneider, 1959). Studies show that approximately half of patients with schizophrenia experience these symptoms (Waters, 2010). Waters (2010) says a significant proportion of patients also experience non verbal hallucinations, such as music, tapping, or animal sounds, although these experiences are frequently overlooked in auditory hallucinations research. Another type of hallucination includes the experience of functional hallucinations, in which the person experiences auditory hallucinations simultaneously through another real noise (e.g., a person may perceive auditory hallucinations only when he hears a car engine). The content of voices varies between individuals. Often the voices have a negative and malicious content. They might speak to the patient in a derogatory or insulting manner or give commands to perform an unacceptable behaviour. The experience of negative voices causes considerable distress. However, a significant proportion of voices are pleasant and positive, and some individuals report feelings of loss when the treatment causes the voices to disappear (Copolov et al., 2004). The exact processes that underlie auditory hallucinations remain largely unknown. There are two principal avenues of research: one focuses on neuro anatomical networks using techniques such as positron emission tomography and functional Magnetic Resonance Imaging (MRI). The other focuses on cognitive and psychological processes and the exploration of mental events involved in auditory hallucinations. A common formulation suggests that auditory verbal hallucinations represent an impairment in language processing and, particularly, inner speech processes, whereby the internal and silent dialogue that healthy people engage in is no longer interpreted as coming from the self but instead as having an external alien origin. There is support for this language hypothesis of auditory hallucinations from neuro imaging studies. These show that the experience of auditory hallucinations engages brain regions, such as the primary auditory cortex and broca area, which are associated with language c omprehension and production. This suggests that hallucinatory experiences are associated with listening to external speech in the absence of external sounds (Waters, 2010) An explanation of why these experiences are not perceived as self-generated posits that auditory hallucinations arise because persons who have the hallucinations fail to distinguish between internal and external events. This arises because of deficits in internal self-monitoring mechanisms that compare the expected with the actual sensations that arise from the patients intentions. This abnormality also applies to inner speech processes and leads to the misclassification of internal events as external and misattribution to an external agent (Frith, 2005).However, Bentall and Slade (1985) suggest that individuals with hallucinations use a different set of judgment criteria from healthy people when deciding whether an event is real, and they are more willing to accept that a perceptual experience is true. This bias essentially involves a greater willingness to believe that an event is real on the basis of less evidence. According to the context memory hypothesis of auditory hallucinations, the failure to identify events as self-generated arises because of specific deficits in episodic memory for remembering the details associated with particular past memory events. These specific deficits in memory cause confusion about the origins of the experience (Nayani and David, 1996). Patients with auditory hallucinations tend to misidentify the origins and source of stimuli during ongoing events and during memory events (Waters et al., 2006). The lack of voluntary control over the experience is a key feature of auditory hallucinations, which might explain why self-generated inner speech is classified as external in origin (Copolov et al., 2003). Hallucinations are experienced when verbal thoughts are unintended and unwanted. Because deficits in cognitive processes, such as inhibitory control, are thought to render people more susceptible to intrusive and recurrent unwanted thoughts, studies have linked audit ory hallucinations with deficits in cognitive inhibition (Waters et al., 2006). Recent advances in the neurosciences provide clues to why patients report an auditory experience in the absence of any perceptual input. Spontaneous activity in the early sensory cortices may in fact form the basis for the original signal. Early neuronal computation systems are known to interpret this activity and engage in decision-making processes to determine whether a percept has been detected. A brain system that is abnormally tuned in to internal acoustic experiences may therefore report an auditory perception in the absence of any external sound (Deco and Romo, 2008). Ford et al., (2009) suggested that patients with auditory hallucinations may have excessive attentional focus toward internally generated events: the brains of persons who have auditory hallucinations may therefore be over interpreting spontaneous sensory activity that is largely ignored in healthy brains. Cognitive impairments are not the only factors responsible for auditory hallucinations. Psychological factors such as meta-cognitive biases, beliefs, and attributions concerning the origins and intent of voices also play a critical modulatory role in shaping the experience of hallucinations. The role of environmental cues and reinforcement factors through avoidance strategies must also be incorporated in any explanations of auditory hallucinations. These factors do not explain how hallucinations occur in the first place, but they have strong explanatory power when accounting for individual differences in how the voices are experienced (Baker and Morrison, 1998). Patients suffering from auditory hallucinations sometimes can not distinguish between what is real and what is not real, it is very important to build a trusting therapeutic relationship with the sufferer. This dissertation will go on to explore the importance of building a therapeutic relationship with a patient; To explore the extent of auditory hallucinations a patient may be experiencing it is important that an appropriate assessment and risk management are carried out, exploring the need for assessment and risk management in auditory hallucinations, It will also look into helping approaches discussing pharmacological and psychosocial approaches in the management of auditory hallucinations and how to end the therapeutic relationship between a service user and the nurse, looking into discharge planning. CHAPTER TWO DEVELOPMENT OF THERAPEUTIC RELATIONSHIP Development of the Therapeutic Relationship Peplaus theories laid the ground for ascendancy of the relationship as the key context for all subsequent interventions with patients (Ryan Brooks, 2000). Although the idea of the relationship endures as the paradigm for psychiatric nursing (Barker, Jackson, Stevenson, 1999a; 1999b; Krauss, 2000; Raingruber, 2003), it does not appear there is any universal consensus on exactly how to frame this relationship. The nurse-patient relationship can be defined as an ongoing, meaningful communication that fosters honesty, humility, and mutual respect and is based on a negotiated partnership between the patient and the practitioner (Krauss, 2000, p. 49). Peplau describes nursing as a therapeutic interpersonal process that aims to identify problems and how to relate to them (Peterson and Bredow 2009). Forster (2001) defines therapeutic relationship as a trusting relationship developed by two or more individuals. However, Jukes and Aldridge (2006) says at first sight therapeutic nursing and the therapeutic relationship may seem relatively easy to define, but once we scrape the surface we find a complex range of ideas and concepts that stem from philosophies, ideologies and individual therapies. Sometimes there are difficulties in applying these definitions to our own work. Not least of these difficulties is the relevance of the concept of therapy as healing to nursing. This begs the question of whether a therapeutic relationship always entails the use of a therapy, or whether there is something more universal and fundamental in therapeutic relationships. It seems important therefore to attempt a workable definition of the therapeutic r elationship that has currency within nursing as a whole. Additionally, it seems that therapeutic nursing has two facets. The first of these, and probably the most apparent, is the emotional and interpersonal aspect, which we might call therapeutic nursing as an art. The second is the more logical and objective aspect, which we might call The therapeutic nursing as a science. Arguably, there is a synergy between the two that leads to a gestalt, and therefore a need to address both aspects if our nursing is to be truly therapeutic in a holistic sense. Peplaus theory focuses on the nurse, the patient and the relationship between them and is aimed at using interpersonal skills to develop trust and security within the nurse-patient relationship. Therapeutic relationships are the corner stone of nursing practice with people who are experiencing threats to their health, including but not restricted to those people with mental illness (Reynolds 2003). The relationship of one to one of nurse patient has potential to influence positive outcome for patients. Hildegard Peplau interpersonal relations overlap over four phases namely: Orientation, Identification, Exploitation and Resolution. Peplau also identify that during the four overlapping phases nurses adopts many roles such as- Resource person: giving specific needed information that aids the patient to understand his/her problem and their new situation. A nurse may function in a counselling relationship, listening to the patient as he/she reviews events that led up to hospitalization and feeling connected with them. The patient may cast the nurse into roles such as surrogate for mother, father, sibling, in which the nurse aids the patient by permitting him/her to re-enact and examine generically older feelings generated in prior relationships. The nurse also functions as a technical expert who understands various professional devices and can manipulate them with skill and discrimination in the interest of the patient (Clay 1988). The orientation phase is the initial phase of the relationship where the nurse and the patient get to know each other. The patient begins to trust the nurse. This phase is sometimes called the stranger phase because the nurse and the patient are strangers to each other (Reynolds 2003). Peplaus (1952) suggest that during this phase early levels of trust are developed and roles and expectation begin to be understood. It is important that during this time that the nurse builds a relationship with the patient by gaining their trust, establishing a therapeutic environment, developing rapport and a level of communication expectable to both the patient and the nurse. During the orientation phase trust and security is supposed to be developed between the nurse and the patient. Co-ordination of care and treatment of patient while using an effective communication between the MDT is a nurse role. The nurse also acts as an advocate/surrogate for a patient and promotes recovery and self belief. Essential communication skills are deemed to be listening and attending, empathy, information giving and support in the context of a therapeutic relationship (Bach and Grant 2009). Building a therapeutic relationship needs to focus on patient -centred rather than nurse-task focus. Bach and Grant (2009) say interpersonal relationship describes the connection between two or more people or groups and their involvement with one another, especially as regards the way they behave towards and feels about one another. Communication is to exchange information between people by means of speaking, writing or using a common system of signs or behaviour. Faulkner (1998) suggested that Rogers (1961) client centred approach conditions can be seen as important factors that contributes to a therapeutic relationship. Rogers (1961) three core conditions are: congruence, empathy and unconditional positive regards. Congruence means that the nurse should be open and genuine about feelings towards their patient. Having the ability to empathise with the patient would show that the nurse has the ability to understand the patients thoughts and feelings about their current problem. Unconditional positive regards is viewing them as a person and focusing on positive attributes and behaviour (Forster 2001). The orientation phase also gives the nurse the chance to asses the patients current health and once the assessment has been carried out the can then move the relationship forward to the identification phase. The identification phase is where the patients needs are identified through various assessment tools. Assessment will be discussed in detail in the next chapter. Butterworth (1994; DH 1994a; DH 2006a) says that during the identification phase the nurse and the patient will both work together discussing the patients identified needs, needs that can be met and those that cannot be met. They will al so identify risks and how to manage the risks and aim to formulate a care plan. Butterworth said the care plan should focused on the patients individual needs, long and short term goals and their wishes, whilst being empowered at all times to make informed decisions and choices that matter in their care. Collaborative working between multi-agencies ensures the needs of the patient are being met through appropriate assessment and treatment under the Care and Treatment Plan (CTP). The Care and Treatment Plan is one of a number of new rights delivered by the Mental Health (Wales) Measure (2010). The Measure also gives people who have been discharged from secondary mental health services the right to make a self referral back for assessment and it extends the right to an Independent Mental Health Advocate to all in-patients. A care co-ordinator must ensure that a care and treatment plan which records all of the outcomes which the provision of mental health services are designed to achieve for a relevant patient is completed in writing in the form set out (Hafal, 2012). The Sainsbury Centre for Mental Health (Rose 2001) found that patients are often not involved in the care planning process and many service users were not even aware of having a care plan. The exploitation phase is where interventions are implemented from the needs and goals set out in the identification phase which enables the service user to move forward, these interventions will assist in managing auditory hallucinations, whilst educating the patient and family members about the illness. Helping approaches will be discussed in detail in the next chapter looking at various up to date interventions available for the management of auditory hallucinations. A trusting relationship can help with recovery and during these interlocking phases is what the nurse and the patient are aiming for (Hewitt and Coffey, 2005). Building of a trusting therapeutic relationship is essential for nursing interventions to work (Lynch and Trenoweth, 2008). Nurses need to be sensitive, show compassion at all times and understanding to a patients needs. Nursing interventions needs to address physical, psychological and social needs; this involves having holistic approach (Coleman and Jenkins, 1998). Nurses need to work with the best evidence based therapeutic treatment available, this then being a positive approach to care (NMC 2008). The Chief Nursing Officer (CNO) review of the Mental Health Nursing (2006) noted that to improve quality of life, service users risks need to be managed properly, whilst promoting health, physical care and well being. However, Hall et al., (2008) argues that the CNO review does not take into consideration the great pressure nurs es are under and also the complex needs of the service user. Therapeutic interventions are an important aspect of recovery (Gourney 2005). Recovery can be described as a set of values about the service users right to build a meaning life for themselves without the continuous presence of mental health symptoms (Shepherd et al., 2008). The purpose of recovery is to work towards self determination and self confidence (Rethink 2005). National Institute for Mental Health in England (NIMHE, 2005) described recovery as a state of wellness after period of illness. Nurse need to provide a holistic view of mental illness with a person centred approach that can work towards the identification of goals and offer the patient appropriate support through interventions like CBT, family therapy and coping skills, this will enable the patient to be at the centre of their own care, thus taking responsibility for their own illness and improve quality of life. Service user who have a full understanding and accept their illness can engage more with therapies and in terventions with the necessary support from professionals, this then leads to self determination and better quality of life (Cunningham et al., 2005). However, Took (2002) says it is important to remember that with a service user experiencing auditory hallucinations, their mood and engagement can fluctuate and also the side effect of prescribed medication can affect this which may slow down the recovery process. Early intervention is also recognised to improve long term outcomes of auditory hallucinations in schizophrenia (McGorry et al., 2005: NICE 2009). However, not all service users will seek advice when first experiencing symptoms, due to stigma attached to mental illness and fear of admission to hospital (French and Morrison 2004). Some service users have also complained that the hospital has a non therapeutic environment and that they also feel unsafe and in an orison like setting (SCMH 1998, 2005; DoH 2004b). Drury (2006) says that service users felt that some professionals lacked compassion. Mental health nurses are encouraged to adopt a client centre approach, some research suggests nurses lack empathy and have general uncaring attitude (Herdman 2004). The final phase of Peplaus theory is the resolution phase. This is where the nurse and the service user will end their professional relationship. The relationship can end either through discharge or death. For the purpose of this dissertation the ending of the relationship that will be discussed at a later chapter will be discharge. Therapeutic relationship is seen as paramount during these interlocking phases of peplaus interpersonal relations theory, nurses needs to promote the service users independence whilst treating them with respect, privacy and dignity. By identifying treatment goals, implementing and evaluating treatment plans the service user can move on to interventions that will help them manage and cope with auditory hallucinations. Chapter 3 Assessment of a patient with Auditory Hallucinations Assessment of Auditory Hallucinations Assessment is the decision making process, based upon the collection of relevant information, using a formal set of ethical criteria, that contributes to an overall estimation of a person and his circumstances (Barker 2004). Hall et al (2008) described assessment as one of the first steps to the nursing process; it is also part of care planning and a positive foundation for building a relationship and forming therapeutic alliance. It is an ongoing process that enables professional to gather information that allows them to understand a persons experience. Most assessments have similar aims. However, how assessments are conducted can vary enormously. Such differences are very important and can influence greatly the value of the information produced (Barker 2004). In Wales CTP was introduced under the Mental Health (Wales) Measures 2010. CTP means a plan prepared for the purpose of achieving the outcomes which the provision of mental health services for a relevant patient is design to achieve and ensures service users have a care plan, risk assessment and a care co-ordinator to monitor and review their care (see appendix one). NICE (2010) suggest that assessment should contain the service users psychiatric, psychological and physical health needs and also include current living arrangements, ethnicity, quality of life, social links, relevant risk and other significant factors that may affect the service users quality of life. Assessment of a patient relies upon the collection of information through interviewing: the patient, member of their family, direct observation of the nurse, questionnaire, rating scales, and previous history (Previous records). However, Barker (2004) argues that despite the importance of the history, if relied upon as the sole method of assessment, not only may the final picture of the patient be of a doubtful accuracy but it may also lack the fine detail necessary for the planning o