Nursing Discipline Overview and Reflective Account

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

Farehnheit 451 Essay

Fahrenheit 451 is a novel about how the world would be without feelings, emotions, and knowing what you want in life. Mildred Montag and Clarisse McClellan are two different characters in the novel that act in very diverse ways. The main distinctions between Mildred and Clarisse is that, their personalities are different, they have different views on life, and their feelings toward Guy are completely dissimilar. Mildred Montag is one of the main characters in Fahrenheit 451. Mildred has many struggles and difficulties. She is unrealistic, cares only about herself, and doesn’t show any real emotions. Guy Montag is her husband, but yet it doesn’t feel that way in the novel. No emotions are showed between the two, they sleep in different beds, and their views are both very different. Mildred’s main hobby is watching television. She is unexciting, vacant, and obsessed with television. Throughout the novel nothing new is said about Mildred, her character doesn’t change and nor do her feelings. In one part of the novel, Guy asks her how she feels about life, is she satisfied, is she happy? â€Å"I’m proud of it (Bradbury 26) † she says, and she convinces herself to be content even though she is not. Clarisse McClellan is one of the characters that have an immense impact in Montag’s life. Clarisse has an independent mind; she has intellect and shows feelings and emotions. Innocence is her strength and is one of the realistic characters in the novel. Clarisse has a short part in the novel but made a full impact on the main character; Montag. Something that she shows is being normal and just enjoying the fine things in life. In one part of the novel she says to Montag, â€Å"Isn’t this a nice time to walk? I like to smell things and look at things, and sometimes stay up all night, walking and watch the sunrise (Bradbury, 7).† It shows how she appreciates what she has, she isn’t afraid of anyone, and she know how to just be herself. Clarisse’s feelings towards Montag in the book make a big influence on him. When she first meets him she isn’t afraid to express herself. She walks along him as he goes home and says, â€Å"Do you mind if I walk back with you? I’m Clarisse McClellan (Bradbury, 6).† This just shows how different she is and how she is not afraid to act the way she does.

Top Tips of Self Introduction Essay

Top Tips of Self Introduction Essay It is preferable to begin writing as soon as you're assigned the undertaking. Self introduction truly is a very hard endeavor. Introducing yourself in a fashion which is both creative and memorable isn't always such a simple undertaking. Even if you're experienced professional, aside from your subjective abilities, your communication will likewise be assessed. The Principles of Self Introduction Essay You Can Benefit From Starting Immediately You're not writing for yourself here, but instead for quite a specific type of reader. Add individual snippets based on your requirements and you're ready to go. One of my favourite things about my novel is it s completely accessible. Make sure your character will likewise be highlighted by writing a brief information regarding your work ethics and personal character in the job atmosphere. Write a couple of things that you know more about the work position that you're applying for. If you're at wo rk, for example, you may want to inform your work title or who your boss is. What you should do is summarize and highlight the experiences and achievements that you desire the interviewer to understand about. Somebody works part-time and doesn't have sufficient time to do each of the assignments. In any expert industry in which you need to submit an application for a work position, there'll always be competition. Every work description provides details about the kind of job and the candidates' requirements within the work description. Moreover, all of the necessary information concerning the preceding job profile needs to be explained in a positive way. Now, job interview has gotten more comfortable and communicative. Finding the Best Self Introduction Essay Therefore sort of behavior is unacceptable in the specialty of professionalism. Self Introduction Letter is written through a person to introduce himself formally in the job place. Business Introduction Letter A business introduction letter is part of the company ethics that should be maintained. Begin by stating your complete name clearly and your individual particulars. The 30-Second Trick for Self Introduction Essay As soon as you have answered that question, you're ready to go. Still, it's extremely crucial as it provides you a fantastic first impression which will have a huge effect on how folks perceive you. Self-actualization is the expression used to refer to how individuals go their whole lives attempting to reach their entire potential. It's likely the person that you're introducing yourself to feels somewhat nervous and awkward too. A self-introduction essay outline can be simple to write, since all you need to do is to introduce yourself. You are able to pick any myself essay given below depending on your need and requirement. A self-introduction essay might be among the easiest essays to get started. Second, the introduction sample essay must be written in the right style. Many times, you'll be requested to prepare one as an English essay assignment again at the start of the year. You want to understand how to compose an effective essay as it is a typical foundation for a student's grade. Students have to compose essays based on the teacher's instructions or their preferred style in writing. There's no ideal solution on how best to compose an effective essay. At did you consider the book. The principal question of all students who must compose a reflective or private essay is whether it's possible to think of such sort of academic paper without sounding too egotistical. As soon as you inform us about all of the paper information, we'll begin trying to find an ideal writer for your paper. The Battle Over Self Introduction Essay and How to Win It The revisions are unquestionably free! Lastly, you're want to close your introductory paragraph. Writing an introductory paragraph is simpler than it might seem. A Startling Fact about Self Introduction Essay Uncovered Be sure you can provide, show, and implement the items which you have written in your letter of introduction as the corporation would expect that you could deliver all the things which you have written. You overlook t have to commit money in buying the product. Hospitality business is normally considered being a service business, which it is definitely not. Use the assistance of true academic experts and receive the service you have earned!

Ife, Efe and Cpm Matrix - 1375 Words

Google Case Study EFE (External Factor of Evaluation) S. no | Opportunities | Weight | Rating | Weighted Score | 1. | In future Google expand their coverage of universe with alliance LSST. | 0.05 | 2 | 0.1 | 2. | Google may explore new businesses in future related to telescope. | 0.1 | 2 | 0.2 | 3. | After implementing of LSST telescope build up-to-the-minute image of internet, which will give him competitive advantage. | 0.02 | 2 | 0.04 | 4. | After Acquiring YouTube; it can start new services for the business point of view or explore new talent. | 0.03 | 1 | 0.03 | 5. | Google can offer their professional services; for research and market trend to china mobile. | 0.02 | 1 | 0.02 | 6. | Google can alliance with other†¦show more content†¦| Economical, political and law in order situation uncertainty and influence | 0.10 | 4 | 0.40 | 5. | New programs offers from competitive universities | 0.15 | 3 | 0.45 | 6. | Old conventional universities values and standards | 0.10 | 2 | 0.20 | | | | | | | | | | | | | 1.00 | | 2.95 | Conclusion: KASBIT has a total weighted score of 2.95 indicating that the firm is above average in its efforts to pursue strategies that capitalization on external opportunities and avoid threats. IFE Internal Factor of Evaluation S. no | Strength | Weight | Rating | Weighted Score | 1. | Recognized with HEC in â€Å"W† category | 0.15 | 4 | 0.60 | 2. | Member of AACSB and Certified by URS | 0.05 | 3 | 0.15 | 3 | Located in center of the city | 0.10 | 3 | 0.30 | 4. | M. Phil PhD Programs | 0.05 | 3 | 0.15 | 5. | Four Campuses over different locations in Karachi | 0.10 | 4 | 0.40 | 6. | Renowned as KASB Group | | | | | Weakness | | | | 1. | Condition and atmosphere of Cafeteria | 0.10 | 3 | 0.30 | 2. | Administrative staff | 0.10 | 3 | 0.30 | 3. | Visiting Faculties selecting criteria | 0.10 | 4 | 0.40 | 4. | Space and Collection of Literature is limited in Library. | 0.10 | 3 | 0.30 | 5. | Students inquiries, registration and Announcement procedure is online instead rigid and conventional | 0.15 | 4 | 0.60 | 6. | Only expend their campuses in Karachi instead all over Pakistan. | 1.00 | | 3.35Show MoreRelatedHarley Davidson case analysis -- with IFE, EFE, CPM, and TOWS matrix...1588 Words   |  7 Pages ·Independent distributor in Sweden has developed a floating store and restaurant  ·Spanish local distributor is adding some new dealers to meet the increasing demand Corporate Culture: - Competitive - Goal-Oriented - Creative Internal Evaluation Matrix Internal Strengths WeightRatingWeighted Score 1. 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EXTERNAL AUDIT Competitive Profile Matrix (CPM) No | Critical Success Factor | | Macy’s | Dillard’s | Nordstorm | | | Weight | Rating | Weighted score | Rating | Weighted score | Rating | Weighted score | 1 | Advertising | 0,12 | 4 | 0,48 | 3 | 0,36 | 3 | 0,36 | 2 | Financial Position

Should We Learn About It - 852 Words

Introduction There are many issues today involving genetics and inheritances; therefore, I want to introduce this subject to students and allow them the opportunity to learn about it. Before students begin this genetics unit they should have a basic understanding of DNA, cellular reproduction, and the process of mitosis and meiosis. Additionally, this unit will contain activities that require students to employ critical and higher order thinking skills; I believe these skills can prepare students for the kinds of issues they may encounter in the world in the future. According to the Next Generation Science Standards which are endorsed by the National Science Teachers Association, students should be able to analyze and interpret data to provide evidence that plants and animals have traits inherited from parents and that variation of these traits exists in other organisms. Moreover, students should be able to ask questions that clarify the role DNA and chromosomes have in coding the instructions for characteristics passed from parents to offspring (NGSS, 2016). Recognizing that even the simplest genetic cross requires combining inferences about two complex processes which are how genetic traits are inherited through meiosis and mating and how these traits interact to produce the external differences that are seen in parents and offspring. Additionally, students should have opportunities to learn the basic concepts of genetics that provide an increased understanding ofShow MoreRelatedWhy Should We Learn About It?849 Words   |  4 PagesSTATEMENT OF PURPOSE Introduction There are many issues today involving genetics and inheritances; therefore, I want to introduce this subject to students and allow them the opportunity to learn about it. 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Education Analysis Paper Free Essays

â€Å"The popular notion of what it’s like to teach in urban America is dominated by two extremes† (Michie, 1999, p. xxi). Gregory Michie succeeds admirably in rendering his teaching experiences in the complicated reality between two extremes in his book Holler If You Hear Me: The Education of a Teacher and His Students. We will write a custom essay sample on Education Analysis Paper or any similar topic only for you Order Now Many people hear about the horror stories, portrayed by the media mainly, that schools in urban America are nothing short of chaos; uneducated and uninterested kids. Then there are other stories that are rarely heard of, about the one teacher who makes the difference in such a school. Michie’s account in his book skillfully avoids the simplification either extreme would demand. Holler if You Hear Me touches on a variety of the fundamental challenges of teaching: classroom discipline, teacher frustration, racial and ethnic differences, student apathy, relationships with students and with other teachers, and the list goes on. Throughout the book, Michie balances his tales of struggle with moments of joyous success. Not surprisingly, the successes are often related to the development of deeper connections between teacher and student. This aspect is so detrimental to the educational system. As teachers we need to make that connection with our students. To not do so would be taking away from their experience as a student as well as ours as teachers. Isn’t this why we teach to begin with? This goal may seem high considering you have to add on top of curriculum, standards, rowdy students, the personal connection of teacher and student. It may seem this way, but if it’s not set, then everything else does not seem worth the trouble at all. Esme Codell states my beliefs on this topic beautifully: â€Å"The goal is not necessarily to succeed but to keep trying, to be the kind of person who has ideas and sees them through† (Codell, 1999, p. 5). I may not succeed in reaching every student I teach, but if the effort is made on my part, if I set this goal and try to see it through, then at least I know I did not give up. There are so many situations that Michie was in where I felt he should just let it go, don’t try because it’s not going to work out, especially so in the story where Reggie was attacked by a local police officer, but he didn’t (Michie, 1999, p. 46). As I was thinking about this, I wouldn’t have gone through the trouble of seeing this man brought to justice, although in the end he wasn’t. Michie wasn’t even there, but he knew if something wasn’t done, this would affect the way Reggie grew up and viewed life. It is this kind of dedication that inspires me to keep going to classes and writing papers. I want to help students to see our world in a different light. Joel Spring stated in his book, American Education, â€Å"the school will continue to be used in efforts to solve social, political, and economic problems† (Spring, 2004). The purpose of public schooling is to prepare today’s children for tomorrow’s problems. It is important not only to teachers and students, but also to the community as a whole. If the communities where these children are being raised see the teachers that teach their kids really do care, the implications are endless. Things could change, especially so for urban American communities. I know these are high hopes, but again, if I don’t set them, how will I even begin to see them through. Being a teacher means I must strive to connect with my students. I have to see beyond my basic responsibilities as a teacher and bring the students to the fore-front of my life. It is the little moments of success that will bring such a connection to our relationships with our students. â€Å"It’s a teachable moment that got away, just one of many that I’ve knowingly let slip through my fingers† (Michie, 1999, p. 102). Michie presents his victories with a genuine modesty that comes from the experience of other, less effective teaching moments, but these moments are not always successful. Michie’s reported mistakes and difficulties are some of the most instructive parts of the book. As a prospective teacher, I have to understand the reality of life that not all teachable moments are going to be seen through. Sometimes they are lost and Michie has opened my eyes to such an existence. The only difference is that I hope I do not â€Å"knowingly† allow this to happen. At times, though, I wanted to hear even more introspection from the author about the reasoning behind his actions or why he thinks a particular moment worked well or did not work at all. It was frustrating when there was no follow up on something as important as â€Å"a teachable moment being lost† (Michie, 1999, p, 102). It is apathy such as this that makes going into the teaching field frustrating. The Corridor of Shame is a prime example of a cold detachment of interest. Nobody really cares for the students who live out there along the highway, but who is suffering? The students are. Do people even know what’s going on in our state? I didn’t until I watched this film. What kind of message is this sending to our nation? What’s behind the motives of leaving schools such as these left out to die? Politics? Hidden agendas? Who knows? What is important is that we ask these questions and put forth an effort to find the answers. We need to find out why teachers, administrators, parents, etc. allow schools to be lost. Essentially these schools are if you think about it. A school that is neglected is an entire lifetime of teachable moments being lost. Holler If You Hear Me contains powerful stories of Michie’s first years as a teacher in public elementary and middle schools on Chicago’s South Side. Each chapter begins with a story told by Michie, followed by the reflections of one of his former students who were at the fore-front of each story. Michie’s purpose in this alternating format is to â€Å"shed light on the education of a teacher† and â€Å"to allow space for my students to speak their minds, tell their stories, raise their voices† (Michie, 1999, p. xxi). I really enjoyed these first-person reflections because it made Michie’s students come alive for me regardless of how insightful and caring the author’s descriptions might be. It was different and refreshing. As I was reading this book, I was able to empathize as well as sympathize with both teacher and student. This type of narration allowed me to see past the words written and see the person behind the font. Since Michie’s book does not follow one classroom or group of students throughout its entirety, the student reflections serve to deepen my understanding of certain students but also to encourage me to wonder about the future lives of each student that Michie mentions. This part was actually where I was disappointed. I felt that I was ‘left hanging,’ there was no resolution. Some of the stories did not need this, but I felt that if he thought the student’s story was significant enough to be talked about, then he should have let us readers have a clue as to how they ended up. Michie’s concern for and commitment to his students shines in Holler If You Hear Me, and his questioning, wonderment, frustration, passion, and humor pulled me along this journey of embodied education. Michie was in fact the miracle-worker that no one hears about in a world where chaos is synonymous with life in general for those who went to school in urban Chicago. Although he lived in such extreme realities, his ability to clearly display his experiences in no way was diminished in his book. While many of the issues raised are familiar, Michie’s book is one of ordinary inspiration that will appeal to both teachers and students. Works Cited Codell, E. (1999). Educating esme: Diary of a teacher’s first years. In A. S. Canestrari B. A. Marlowe (Eds. ) Educational foundations: An anthology of critical readings (pp. 3-7). Sage Publications. Michie, G. (1999). Holler if you hear me: The education of a teacher his students. New York: Teachers College Press. Documentary from class: Corridors of Shame Handout from class: Joel Spring: The Purposes of Public Schooling How to cite Education Analysis Paper, Papers

Growing Up Wired Social Networking Sites †Myassignmenthelp.Com

Question: Discuss About The Growing Up Wired Social Networking Sites? Answer: Introducation Life transitions are their related human relationships have always been under focus for nursing research. The reason is that there is a wide scope for finding new methods by which nurses can integrate elements of human relationships in their care delivery (Feldman, 2016). As highlighted by the authors, each stage of life span is to be analysed on the basis of its set of milestones to come up with appropriate care delivery. The different theories of human development are crucial in this regard. The essay written in here discusses the social and cognitive developmental milestones of the three-year-old child Jack who is enrolled in day care unit for twice a week for five hours. The works of theorists Jean Piaget and Erik Erikson are the basis of this essay. The importance of understanding life stages for a nurse is also highlighted in the paper. The first theory of human development that is considered in this discussion is the theory of cognitive development that had been put forward by the famous psychologist Jean Piaget. Through this theory, Piaget aimed at analysing the development of human intelligence (Jehan Butt, 2015). The theory, also known as development stage theory goes on to explain how humans develop their knowledge and apply them for the carrying out regular activities. Kail (2015) highlight that a child of three years falls under Preoperational Stage that revolves around children of age between two and seven years. In this stage, a child is starting to develop cognitive skills and language skills develop properly at this stage only. A child is seen to demonstrate the ability to speak in complete sentences, thereby expressing his feelings and thoughts to a better degree. Language development is perhaps the most distinct feature of this stage. At this conject of life span, a chid is capable of symbolising thing s as they tend to be more mature. The authors further highlight that a child who is more than two years old can create an identity for himself and engage in a make-belief action. Caution is to be taken while dealign with the child and helping him to understand the differences between his caregiver and those who are not as a chid might become egocentric and not respond desirably to all individuals. Concerning the present case study, the concern that comes into the light is that Jack has not been able to achieve adequate language development as per the milestone mentioned in the Preoperational Stage. This is evident from the fact that Jack speaks in sentences that have two to three words and no longer than that. He is also found to be babbling most of the time, indicating that he wants to express himself but is not able to do so due to certain constraints. The other factor that might be related to babbling is growing egocentric nature. The child might be suffering from feelings of rejection and loneliness, in the absence of his mother, Vanessa. The second theory of human development that is considered in this discussion is the theory of social development that had been put forward by the famous psychologist Erik Erikson. As per this theory, the lifespan of an individual is divided into eight stages, of which the stage involving children aged between two and four years is concerned about the high calibre of will. At this stage, the power to socialise is strong, and an enhanced sense of imagination puts the child in a position to understand and perceive the surrounding environment. A childs social and emotional development includes an emerging awareness of self and others (Shapiro Margolin, 2014). As opined by Sigelman and Rider (2014) a child at this age is capable of controlling his eliminative function and other similar motor abilities. The only criteria for this development is a strong care support from parents, especially mother. In the continual presence of the mother, children gain their own autonomy. Learning is cont inual if support is also continual and not hampered by physical separation. A child would be ready to explore the world if there is a foundation of encouragement from the mother since a child perceives the mother to be the prime source of care. In relation to the present case study, it is seen that Jac, though has attained the age of three years, has still not in a position to showcase appropriate toileting skills, unlike others. The fact of the case is that Vanessa, Jacks mother, puts him into day care for two days in a week, creating physical separation from him. The impact of this has been constraints in the development of toileting skils for Jack. The death of support and encouragement from his mother has limited the development of this social skill. Jack has not become self-sufficient in the absence of his mother and is not confident about demonstrating the skills his mother had been trying to teach him at home. Chances are high that Jack is lacking social skills to communicate with the nurse at the care unit and therefore the care received at the unit is of less significance pertaining to his development. The interrelationship between cognitive and social development has been much studied in the literature. A childs experiences when he is between thee age of two and five years effects profoundly his actions in a consequent manner. The manner in which children respond to the environment, and the ability and eagerness to form trusted relationships are driven by both social and cognitive development. Cognitive development and social development are interlinked, with each impacting different actions of the child. As language skills develop and the child is better able to express himself, he is able to demonstrate his social skills in a better manner. In addition, if a child has learnt to think in a complex manner, he might be altering the social skills he had learnt (Bremner, 2017). Olds (2016) threw light upon the importance of a nurse to understand human relationships and life transitions. While caring for a child, it is imperative that the nurse has complete knowledge of the transition phase the child is in. The age of 2-6 years has been indicated to be crucial for a childs development as major changes in physical, social and cognitive abilities are witnessed at this stage. for a nurse to care for a child at this age group the essence of safe care delivery lies in his ability to allow the life transition theories guide the nursing practice. In a fast-paced day care unit, the goal of care would be to provide personalised care, and this is possible only when there is an increased understanding of the benchmark that the child had to attain. As human relationships are of prime importance in every childs life, a nurse must explore the perception of the child about such relationships in order to care for him. The above essay draws the attention of the readers onto the role of nurses in caring for children who aim to achieve certain cognitive and social milestones according to their age. Human development is explained through a number of theories, of which the theory of the social development of Erikson and theory cognitive development of Piaget are of prime importance. For a nurse to deliver optimal quality care for the child, it is imperative that these theories are understood adequately. References Bremner, J. G. (2017).An introduction to developmental psychology. John Wiley Sons. Feldman, R. S. (2016).Development across the life span. Pearson. Jehan, S., Butt, M. N. (2015). Attainment of conservation ability among primary school children in the light of Piagets cognitive theory.VFAST Transactions on Education and Social Sciences,5(1). Kail, R. V. (2015).Children and their development. Pearson Higher Ed. Olds, D. (2016). Building evidence to improve maternal and child health.The Lancet,387(10014), 105-107. Shapiro, L. A. S., Margolin, G. (2014). Growing up wired: Social networking sites and adolescent psychosocial development.Clinical child and family psychology review,17(1), 1-18. Sigelman, C. K., Rider, E. A. (2014).Life-span human development. Cengage Learning.