Nursing Evoluations Health Care Policy Article Example | Topics and Well Written Essays - 500 words

Nursing Evoluations Health Care Policy - Article Example The survey was in 2014. The Commonwealth Fund statistics and analysis ranks the U.S. last among seven nations they did their statistics in health care. Debate the possible consequences of the health care delivery system of adding millions of new enrollees. How would this policy impact schools, medical practices, clinics, hospitals and outpatient diagnostic centers? What role would advance practice play in accommodation of new enrollees? The Patient Protection and Affordable Care Act have led to millions of new enrollees to the healthcare and insurance systems. The act has implications for Public Health Policy and Practice. New enrollees on the systems, however, might slow down operations (PPACA, 2010). The new law would, however, strengthen the already existing forms of health insurance coverage. It would also build a new and affordable health insurance market for families as well as individuals (Department of Health and Human Services, 2010). The policies would cover people who do not have affordable employer coverage. The impact of value-based performance has an echo across many professions especially nursing practice. The impact is that it has made people have evidence-based quality improvement on their services. There has also been an increase in healthcare transformation. Another impact is in the need for redesigning the care that we give to the patients. We ensure that is safe, effective, and efficient. Nurses have a response of launching initiatives that give to the maximum valuable contributions that nurses can make, have made, and will make, to fully deliver on the patients. I had a visit to the hospital policy committee meeting at my Hospital. The issues on the discussion at the meeting were how to improve the services at the hospital to be fast and efficient for our clients. Our hospital also considered

Judaism, Christianity, Islam Essay Example for Free

Judaism, Christianity, Islam Essay The three oldest religions are Judaism, Christianity and Islam. Judaism is a one of the oldest religions known to people. Judaism is a monotheistic religion, which means that Jewish people pray to only one g-d. There weren’t too many religions like this when it originated which made Judaism very unique at the time. Moses was one of the most famous Jewish prophets. He led the Jewish people out of slavery, led them to Mount Sinai and received the Ten Commandments, a set of rules that people even today still follow. The Jews have many customs and traditions. Among them are circumcision, bar or bat mitzvah, special rituals and prayers to be said during a wedding and during death and mourning. Circumcision is the removal of the foreskin of the penis. The rite of circumcision is one of the most ancient practices of Judaism. Circumcision is done because of a Commandment by God to Abraham as it is written in the Torah and as a sign of commitment of Jewish people. The Torah is Judaism’s most important text. It contains the Five Books of Moses and is the source of the Ten Commandments. Bar or Bat mitzvah’ is when a child reaches the age of maturity, 13 for boys, and 12 for girls, and is ready to become an adult their community. At that age, a child becomes responsible for his actions and is obligated to observe the commandments. This ceremony is incorporated into an ordinary Sabbath service. During a Jewish wedding, the bride and groom get married under a special cloth called a â€Å"chuppah† or special canopy. Another tradition that is followed during a Jewish wedding is the breaking of a small glass at the end of the ceremony. This is to symbolize that even though this is a happy event, people should still remember the hardships that were faced before the Jewish people got to that place in time. During death and mourning, a Jewish family will sit â€Å"shiva† which is sitting in mourning for seven days after the death of a loved one. Some other customs are wearing a kippah on the head in a synagogue or wearing a tallit, a prayer shawl, while praying. Christianity is one of the world’s major monotheistic religions. Christianity takes the beliefs and practices very seriously. The central figure in Christianity is Jesus Christ. As the Son of God, he came to earth to teach about love and fellowship. He represents the person that all Christians must strive to be. Christians believe that he is the only one that ever lived on earth that can be called perfect from all worldly sins. The important thing to understand was that Jesus was God. He was here on earth to teach of God’s plan for all of humanity and to save the people of the world from their transgressions. In Christianity, God is almighty and rules over all of heaven and earth. He is the one that created the earth and one day will cast judgment over the entire earth. Christians understand that through Jesus Christ, people can be saved from this judgment. By believing that Jesus Christ is Lord and Savior, the Spirit of God is exists in all believers, and that God is almighty in power. A person can be saved from this judgment. Christians believe in heaven and hell. Heaven is the place where believers would enjoy the presence of God and other believers and freedom from suffering and sin. Hell is where unbelievers and sinners are punished for their sins committed during the course of their lives. Baptism is one of the most important sacraments in Christianity. It involves application of or immersion in water, a blessing, and the pronouncement, I baptize you in the name of the Father, the Son, and the Holy Spirit. Most Christian churches baptize both infants and adults, but some believe that baptism is only rightly performed on adults. Views of baptism vary, but common views of the rituals include: it grants or symbolizes salvation, commemorates Christs death and resurrection, fulfills the command of Jesus to baptize, cleanses away sins, confers grace, and publicly expresses ones faith. Christianity also teaches about the importance of attending Holy Mass. It’s important for Christians to keep their Sabbath according to the commandments. It is observed on the seventh day which usually falls on a Sunday or Saturday and is considered a weekly day of rest from work. The day is spent fasting and praying and attending Holy Mass. At Mass, followers are taught about the teachings in the bible through scripture readings. The celebration of Mass would conclude with the sharing of communion. Communion represents the Passover that Jesus celebrated with his twelve disciples on the eve of His death. It is an integral part of Christian worship. It causes Christians to remember the Lord’s death and resurrection and to look for His glorious return in the future. Holidays, feasts and fasts are a significant part of Christian religious practice. The feast days celebrate joyous and sorrowful historical events such as the birth, death and resurrection of Jesus Christ, while the fast days provide a special opportunity to focus on self-reflection, self-discipline and repentance. Christmas is the celebration of the birth of Jesus Christ. Lent starts on Ash Wednesday and it runs for forty days. During the forty days Christians fast and pray which represents the forty days Jesus spent in the wilderness fasting and praying. Lent is followed by Easter which represents the return of Jesus from the wilderness. Easter starts from Palm Sunday. His death and resurrection is observed during Easter. Special Services are kept in the church during this week and ends with Easter Sunday, the day that Jesus rose from the dead. Islam is a simple and practical religion. It has established, clear, and easily understandable beliefs and laws that any follower or student of the religion can easily understand. Islam affirms belief in a decent, civilized society. Islam also does not demand impossible goodness of its followers, but it recognizes that all human beings make mistakes and sin. No one is exempt. Islam preaches peace, mercy, justice, tolerance, equality, love, truth, forgiveness, patience, morality, sincerity and righteousness. Islam is the religion that preaches the Oneness of God, the Oneness of mankind and the Oneness of the Message. Muslims believe that there is only one supreme God, Allah. In Islam to believe in Allah is not only to believe in Allahs existence but also to believe in all Allahs attributions, to worship Allah alone, and to obey all Allahs commands. Islam teaches about the five pillars: Shahada, Salah, Seyam, Zakat and Hajj. Shahada is the verbal commitment and pledge that there is no God but Allah, and Muhammad is the messenger of Allah. It is the duty of every Muslim, male and female, after reaching the age of puberty, to perform five Salats or prayers at specific times during the day and night. These five specific times are: Dawn, Noon, Afternoon, Sunset, and Night. A ritual called Wudu, which is the cleaning several parts of the body with water, is a prerequisite to Salat. Fasting during the month of Ramadan, the ninth month of the lunar calendar, is from sun up to sun down only and is an obligation on every healthy adult Muslim, male or female. Fasting is total abstinence from eating, drinking, smoking, gum chewing, intimate relations, and taking anything into the body. If a person is ill and needs to take medication, he/she cannot fast. Fasting is also a time to discipline ones self from bad behaviors, such as; arguing and saying mean things. Those who are ill or unable to fast for health or reasons of age are exempt from fasting. However, they should feel the poor one meal for every day they miss of fasting. Women who are pregnant, menstruating, or nursing, or any who are traveling, are also exempt from fasting. However, when their situation changes, they make up the days of fasting or feed the poor one meal for each day of fasting they missed. Zakat is an annual obligatory charity on every Muslim, male or female, who possesses over the last year money or property that exceeds their minimum needs. The requirement is 2. 5% of ones excess wealth. The performance of the pilgrimage to Mecca, Saudi Arabia is required once in a lifetime of every Muslim, if financially able, as well as physically able. Hajj begins every year during the month of Dul Hejja. Dul Hejja is the 12th month of the Islamic calendar year. The Hajj is a spiritual journey where a Muslim forgets all worldly things and devotes his/her attention and time to Allah alone. Islam looks at the woman as an equal, mature and capable partner of a man, without whom a family cannot exist and teaches that men and women are all the creation of Allah, existing on a level of equal worth and value. In some societies women are treated according to ancestral customs and tribal tradition, but in Islam they are treated with full respect and honor. Islam preserves womens honor and dignity, and requires that she must be treated with respect and honor. Her femininity should not be exploited in any way, rather she is to be regarded and treated as human individual whose sexuality does not enter into her relationship with any person other than her husband. In Islam marriage cannot take place unless the female freely agrees to it and a dowry is given to her. Islam puts priorities for the husbands and wives. The responsibility for providing for the family is on the husband, while the responsibility to care for the house and raising the children is on the wife. These are the main priorities, but cooperation between the husband and the wife is required and highly recommended.

Chaucers Canterbury Tales - Comparing Dishonesty in The Physicians a

Dishonesty and Hypocrisy in The Physician's and Pardoner's Tales      Ã‚   Chaucer presents characters in the Physician's and Pardoner's Tales who are very similar to each other in one important way. Although the characters seem on the surface to be mirror images of each other, they have an important underlying similarity: both the physician and the pardoner are not what they appear to be to most people. Both are hypocritical, although they show this hypocrisy in different ways.    One way of seeing this hypocrisy, in the case of the physician's tale, is to examine the way the similarities and differences between the knight Virginius and the physician himself in terms of what he sees as moral actions. It seems fairly clear that the physician identifies himself with Virginius during the telling of the tale. One of the main ways in which the physician identifies with Virginius is by sharing his concern for Virginia's future state of virtue. He shows his concern with Virginia's future by speculating on whether she will continue to be "a thousand foold moore vertuous" than she is beautiful -- as she is at the beginning of the tale -- when she "woxen is a wyf" (VI.40; VI.71). Virginius shows his concern for his daughter's virtue by killing her rather than allowing her chastity to be compromised; the physician shows that he believes it necessary for a father to guard his daughter's virtue in a long comment (VI.71-104) describing a father's duty to have his daughter w atched over by governesses, or "maistresses" (VI.71).    The most important way in which Virginius differs from the physician -- and the physician clearly does not see this -- is in the moral application of the tale. The physician clearly intends for the ta... ...uthority or to skim beneath the surface of the tale, as is shown by the hostility of the host. Harry Bailly does not respond to the pardoner's accusation that he is "moost envoluped in synne," but merely appeals to force in threatening the pardoner.    Neither achieves the result that he wants, and the reason for this failure in each case is his general failure to be honest, either with others (in the case of the pardoner) or with himself (in the case of the physician). For this reason, Chaucer pokes fun at both of them in subtle ways throughout their tales.    References Benson, C. David. Explanatory Notes to "The Physician's Tale" in The Riverside Chaucer. General Ed. Benson, Larry D. Boston: Houghton Mifflin, 1987. Chaucer, Geoffrey. The Canterbury Tales in The Riverside Chaucer. General Ed. Benson, Larry D. Boston: Houghton Mifflin, 1987.

Comparison Between Hinduism and Budhism

Comparison of Two types of Pagan Religion i. e. Hinduism and Buddhism South Asian people have a well-defined amalgam of Abrahamic and Pagan religions. Two of the Pagan religions of this region are well-known in this region because their birth place South Asia. These two religions are â€Å"Hinduism† and â€Å"Buddhism†. Hinduism refers to the principal and most ancient religious tradition of India: in it the lives of the believers are governed by the doctrines of â€Å"Dharma† or universal law, â€Å"Karma† or the cumulative effects of personal actions, and â€Å"Samsara† or the cycle of rebirth, liberation from which is the first goal of life; [similarly] Buddhism is a religion and philosophic system, founded in India in the 6th cent. By Buddha: it teaches the right thinking and self-denial will enable the soul to reach Nirvana, a divine state of release from misdirected desire† (â€Å"Dictionary definitions you can understand-†).Altho ugh the birth place of both religions is South Asia and thus they stem from a similar Philosophy and culture, as S. Radhakrishnan says â€Å"Buddhism, in its origin at least is an offshoot of Hinduism† (qtd. In  Ã¢â‚¬Å"Buddhism & Hinduism, Comparative Study of Buddhism & Hinduism, Compare Contrast Buddhism & Hinduism. â€Å"); yet there is also a prominent difference in the major ideational elements of Doctrine of both; which includes â€Å"Concept of God†, â€Å"Reincarnation† and â€Å"Caste system†. In each and every religion of the World, the word â€Å"God† generally refers to designate a supreme power, who is the ultimate creator of the entire universe.In Hinduism there is also such definition for God. â€Å"Neither the multitude of gods nor great sages know my origin, for I am the source of all the gods and great sages. A mortal who knows me as the unborn, beginning-less great lord of the world is freed from all delusion and all evilsâ⠂¬  (â€Å"Bhagavad Gita: Chapter 2 – Verses 9 & 10. †). But the thorough study of Hinduism reveals it a polytheistic religion; indeed most of Hindus attest it by their worship of God. As they consider the many of living and non-living things to be divine and sacred.For example they consider the trees, the sun, the moon, the monkey, the snake and the human beings as manifestations of God. While in Buddhism, the designation of God is same as in Hinduism. As Gospel of Buddha says â€Å"There is, O monks, an unborn, unoriginated, uncreated, and unformed. Were there not, O monks, this unborn, unoriginated, uncreated, and unformed, there would be no escape from the world of the born, originated, created, formed. Since, O monks, there is an unborn, unoriginated, uncreated, and unformed, therefore is there an escape from the world of the born, originated, created, formed† (â€Å"The Gospel of Buddha†).But there appears difference in the belief in gods and godly manifestations of both religions; because in Buddhism there is no such entailment of godly figures in the original Buddhist doctrine, except in few sects. â€Å"Buddha was once asked by a disciple whether God exists. He refused to reply. When pressed, he said that if you are suffering from a stomach ache would you concentrate on relieving the pain or studying the prescription of the physician. â€Å"It is not my business or yours to find out whether there is God – our business is to remove the sufferings of the world† (â€Å"Concept of god in Buddhism†).Doctrine of Buddhism says that all these are the ways, by which people soothe themselves. â€Å"Gripped by fear, men go to the sacred mountains, sacred grooves, sacred trees and shrines† (â€Å"The Dhammapada 188†). But also Buddhists do not condemn the concept of gods and also they do not regard the believers of gods as sinners. Hinduism is considered as the complex mixture of religious philosoph ies and schools; but the soul of all this is â€Å"Reincarnation† i. e. the journey of the â€Å"soul† (atman) from one body to another body(cycle of birth and death).This cycle of birth and death (also known as â€Å"Samsara†) is summarized in the following verse of The Bhagavad Gita: â€Å"Just as a man discards worn out clothes and puts on new clothes, the soul discards worn out bodies and wears new ones. † (Chapter 2-Verse 22). As we profoundly glance over both the religions: â€Å"Buddhism shares some concepts of Reincarnation with Hinduism but on the major there appear differences. For example Theravada Buddhism emphasizes in the doctrine of â€Å"Anatta†, or no soul, which states there is no enduring entity that persists from one life to the next.While in Hinduism, â€Å"Karma† determines the circumstances of subsequent lives, so there is continuity between personalities but not persistence of identity. For this reason, Thervada Budd hist prefer the term â€Å"Rebirth† to â€Å"Reincarnation†. That is why in Buddhism, the law of â€Å"Karma† is viewed as naturalistic, akin to the laws of physics. Thus Buddhists do not consider the circumstances of â€Å"Rebirth† as rewards or punishment handed out by a controlling God, they simply regard it the natural result of various good and bad deeds.Thus contrary to the infinite cycle of â€Å"Reincarnation†: â€Å"Rebirth† inevitably involves suffering and ends when all carvings are lost and â€Å"Nirvana† is achieved† (â€Å"Does Hinduism Believe In Reincarnation. â€Å"). So Buddhists lead their lives in a way (negating the concept of infinite cycle of births and deaths), which leads them to their ultimate destination i. e. Nirvana Some of the teachings of every religion of the world provide the guidelines in order to secure the basic social rights of the people.But the there are some religion in which â€Å"Cast e system† has deprived the people from their basic social rights. â€Å"During the Buddha’s time â€Å"Brahmanism† was the predominant religion in India, in which all humans were divided into four castes i. e priests, warriors, traders and laborers. Later on this â€Å"Caste system† was absorbed into â€Å"Hinduism†, given religious legitimacy and sanction and has continued to function right up till the present. This has made the Social contact between each cast minimal and has provided the lower ones with the less opportunities, the less freedom and the less rights.Outside the caste system there are the outcast’s people, who are considered so impure that they are hardly counted as humans. On the other hand Buddha himself was born into the warrior caste, but he severely criticized the caste system. He ridiculed the priests’ claims to be superior, he criticized the theological basis of the system and he welcomed into the  Sangha  p eople of all castes, including outcasts. His most famous saying on the subject is: â€Å"Birth does not make one a priest or an outcaste. Behavior makes one either a priest or an outcaste†Ã¢â‚¬  (â€Å"Buddhist Studies: Caste System. â€Å").In summary to the religious beliefs, philosophies and social teachings; Buddhism provides an ultimate concept for an ultimate Power, similarly it gives the fascinating hope for ultimate destination â€Å"Nirvana† and also it maps a just society on the golden rules of equity. While Hinduism limits the ultimate concept of God to worldly figures, similarly the concept of â€Å"Reincarnation†, negates the ultimate destination; which indirectly, is the negation of God and also the caste system in it makes the life of its follower’s worldly punishment, because deprivation of basic social rights leads the people to inferiority complex. Bhagavad Gita: Chapter 2 – Verses 9,10 &22†³Ã‚  Bamboo Wisdom. Web. 19 Oct. 2011.   Ã¢â‚¬Å"Buddhism & Hinduism, Comparative Study of Buddhism & Hinduism,Compare Contrast Buddhism & Hinduism. †Ã‚  Buddhist Tourism,Travel Buddhist Sites,Buddhist Tourism in India, Japan, Tibet, China. Web. 19 Oct. 2011. http://www. buddhist-tourism. com/buddhism/religion/buddhism-hinduism. html â€Å"Buddhist Studies: Caste System. †Ã‚  BuddhaNet – Worldwide Buddhist Information and Education Network. Web. 19 Oct. 2011. . Does Hinduism Believe In Reincarnation? †Ã‚  Personal Development on a Deeper Level – Tyler Hardy. Web. 19 Oct. 2011. . â€Å"Reincarnation – World, Body, Life, History, Beliefs, Time, Person, Human, Hinduism, Buddhism, Shiite Muslims, Judaism and Christianity, Ancient Greece, West Africa. â€Å"Encyclopedia of Death and Dying. Web. 19 Oct. 2011. . â€Å"South Asia – Definition | WordIQ. com. †Ã‚  Dictionary, Encyclopedia and Thesaurus – WordIQ Dictionary. Web. 19 Oct. 2011. â€Å"The Dhammap ada: Verses and Stories.   Tipitaka Network: Bringing Dhamma Studies to You. Web. 19 Oct. 2011. . â€Å"The Gospel of Buddha. †Ã‚  The Reluctant Messenger of Science and Religion: Science and the World's Religions Are Pieces to a Puzzle That Need Each Other to Form a Complete Picture. Web. 19 Oct. 2011. ;http://reluctant-messenger. com/gospel_buddha/chapter_20. htm;. â€Å" Concept of god in Buddhism-by Dr. Zakir Naik† Dictionary Definitions You Can Understand – YourDictionary. Web. 19 Oct. 2011. ;http://www. yourdictionary. com;. http://saif_w. tripod. com/interfaith/general/god/inbuddhism. htm

How to Respect Your Parents

How to respect your parents? There are many days set aside in non-Islamic societies to honour and appreciate special people; examples of these are Father's Day, Mother's Day, Memorial Day and Labour Day. In Islam, however, respecting, honouring and appreciating parents is not just for a single day of the year, but rather for each and every day. Parents in the Quran: A Muslim child should respect and appreciate his or her parents on a daily basis. Allaah mentions that human beings must recognise their parents and that this is second only to the recognition of Allaah Himself.Throughout the Quran, we notice that parents are mentioned with appreciation and respect. In the Quran, there is a very beautiful description of how parents are to be treated; Allaah Says (what means):  Ã¢â‚¬Å"And your Lord has decreed that you not worship except Him, and to parents, good treatment. Whether one or both of them reach old age [while] with you, say not to them [so much as] ‘uff' [i. e. , an ex pression of irritation or disapproval] and do not repel them but speak to them a noble word. And lower to them the wing of humility out of mercy and say: ‘My Lord!Have mercy upon them as they brought me up [when I was] small. ‘†Ã‚  [Quran 17:23-24] The recognition and respect of parents is mentioned in the Quran eleven times; in every instance, Allaah reminds children to recognise and to appreciate the love and care that they have received from their parents. One such example is when Allaah says what means:  Ã¢â‚¬Å"And We have enjoined upon man goodness to parents†¦Ã¢â‚¬ Ã‚  [Quran 29:8 & 46:15] 3. In Chapter Al-An'aam, Allaah reemphasises that people should be kind to their parents; He says what means:  Ã¢â‚¬Å"Say: ‘Come, I will recite what your Lord has prohibited to you. He commands] that you not associate anything with Him, and to parents, good treatment†¦ ‘†Ã‚  [Quran 6:151] Mother First Among parents, it is usually the mother who makes the most sacrifice and endures the most hardship in the care of her children. She gives birth and looks after them. Islam recognizes this fact, offering more honor to the mother as a parent. Muhammad once said, â€Å"Paradise is placed at the mothers' feet,† so high is their status and regard. The Qur'an reminds people of the sacrifices and hardships that mothers face on behalf of their children. â€Å"And e enjoined upon mankind concerning parents: his mother carried him in weakness upon weakness, and his weaning is two years. Therefore show gratitude to Allah and to your parents† (Qur'an 31:14). On another occasion, some people asked the Prophet Muhammad, â€Å"To whom should we show kindness first? † He answered, â€Å"Your mother. † Then he was asked again, â€Å"And after that, then whom? † Muhammad again replied, â€Å"Your mother. † He was asked yet again, and he gave the same reply again: â€Å"Your mother. † Only af ter that, when he was asked one more time, did he answer, â€Å"Then, your father. Duties to Parents Our life would not be possible without the sacrifice and hard work of our parents, who cared for us and met all our needs when we were young. The Qur'an addresses this point in one touching verse: â€Å"And your Lord has decreed that you worship none but Him, and that you be kind to parents. If one or both of them attain old age during your life, say not to them a word of disrespect, nor repel them. But address them in terms of honour, and lower to them the wing of humility, out of mercy, and say, ‘My Lord!Bestow on them Your Mercy, as they did bring me up when I was young’† (Qur'an 17:23–24). Muslims are advised to treat their parents gently and respectfully. They should always strive to please them and never become impatient or rude with them. Muslims consider it an honour and a blessing to be able to care for their parents in old age. After all, it's th e least we can do to repay them for all of their hard work and sacrifice. Nursing homes and hospice care are new phenomena in the Muslim world, and they are not widely accepted.Elderly and ill family members almost always remain in the homes of children or relatives, cared for and respected until death. Muhammad encouraged his followers to treat their parents well and to be mindful of their needs. Once, a young man came to him and wanted to join the Muslim army on the battlefield to defend the community from attack. Muhammad asked him if his parents were living. When the young man said they were, he told him: â€Å"Then go back to your parents, serve them, and deal with them kindly.This is as good as fighting for God's sake. † Muslims consider their parents' opinions about important matters, such as choosing a career path, spouse, or place to live. As a Muslim gets older, any income she earns is partially used to support her parents and meet their needs. A Muslim prays that a fter their deaths, God will forgive her parents and show mercy toward them. Also, you should always listen and obey to the commands that your parents have told you to do. Always take care of them afterall to have them is a big gift.

Copernicus Studies essays

Copernicus' Studies essays Nicholas Copernicus was never supposed to be a revolutionary in the field of revolutions. This Polish merchants son, groomed to be a church canon, was not the sort of man to be running around changing the world; he was not even published until near his death, in 1543. Copernicus had been preceded by over a thousand years of contentment with the universal model, as Europe had been riding Ptolemys system with the full support of the Catholic Church. Few people had given serious question to breaking Ptolemys crystal spheres; in fact, they were so firmly established as the methods by which planets revolved around the earth that Dante had written about them in his Divine Comedy and John Milton, several years later, wrote them into his epic, Paradise Lost. Copernicus himself was quite loyal to the precise, circular motion set in place by Aristotle; the major difference between his system and the Ptolemaic is that the Earth revolves around the Sun and turns on its own axis. Because of this, some believe that Copernicus was not a revolutionary thinker, but a thinker of revolutions (Henry, 10). However, Copernicus himself harbored beliefs other than that of the Catholic Church, and this would prove to be the driving force behind his overwhelming discoveries. He would eventually get the last laugh, as his discoveries launched the Scientific Revolution. Nicholas Copernicus was born in 1473 in Thorn on the Vistula. His father died early, but Nicholas was tutored and protected by his maternal uncle, Lukasz Watzenrode, who eventually became bishop of Ermeland (Sarton, 55). He studied at the Krakow Academy in Poland for four years, reading several astronomical texts under the tutelage of Albert Brudzewski, which was as good an astronomical education as was available anywhere (Sarton, 57). Copernicus may have been dissatisfied with the Ptolemaic model even before he arrived in Bologna. Copernicus went to B...

Free Essays on Computer Market

Introduction The computer market is considered to be one of the fastest growing and rapid changing markets , due to the fact that technology develops continuously and alternates the business environment in which the computer manufacturing companies have to operate . The majority of these companies have to adapt to the continuous changes and even more forecast the blurry forefront in order to survive and make profits . A commonly used tool to predict the changes and the potential of expansion is the Market Opportunity Analysis . More specifically Market Opportunity analysis or MOA is the systematic method for gathering and organising the information about a believed market opportunity ( Cadotte, 2003 ) . A useful tool like the MOA can even apply to a virtual marketplace like marketplace 6 which simulates with remarkable realism the rapid changes at a virtual computer market . By using the MOA we will try to identify the factors that form the business environment , the strategies that the vir tual company , Tech – Edge , follows and the strategic position of the company and finally we will try to see the potential of growth and expansion of the company’s activities to different market segments . The Business Environment It’s really quite difficult to distinguish and analyse the factors that shape a fluid business environment, like the computer industry environment . In order to achieve a slight approach , we will use the PEST analysis , which is a tool that is usually used from companies when they want to establish their strategic position in the market that they operate . A PEST analysis includes the study of Political , Economical , Social and Technological factors that affect the operation of the company and through which we can understand better , which factors trigger the changes and alter the present forefront . Although the information about the factors that shape the virtual marketplace are limited... Free Essays on Computer Market Free Essays on Computer Market Introduction The computer market is considered to be one of the fastest growing and rapid changing markets , due to the fact that technology develops continuously and alternates the business environment in which the computer manufacturing companies have to operate . The majority of these companies have to adapt to the continuous changes and even more forecast the blurry forefront in order to survive and make profits . A commonly used tool to predict the changes and the potential of expansion is the Market Opportunity Analysis . More specifically Market Opportunity analysis or MOA is the systematic method for gathering and organising the information about a believed market opportunity ( Cadotte, 2003 ) . A useful tool like the MOA can even apply to a virtual marketplace like marketplace 6 which simulates with remarkable realism the rapid changes at a virtual computer market . By using the MOA we will try to identify the factors that form the business environment , the strategies that the vir tual company , Tech – Edge , follows and the strategic position of the company and finally we will try to see the potential of growth and expansion of the company’s activities to different market segments . The Business Environment It’s really quite difficult to distinguish and analyse the factors that shape a fluid business environment, like the computer industry environment . In order to achieve a slight approach , we will use the PEST analysis , which is a tool that is usually used from companies when they want to establish their strategic position in the market that they operate . A PEST analysis includes the study of Political , Economical , Social and Technological factors that affect the operation of the company and through which we can understand better , which factors trigger the changes and alter the present forefront . Although the information about the factors that shape the virtual marketplace are limited...

ACT Admission Requirements The Importance of the ACT

ACT Admission Requirements The Importance of the ACT SAT / ACT Prep Online Guides and Tips Getting ready to apply to college? If you are, I’m sure you’ve heard of the ACT and/or SAT. If you’re unfamiliar with the basics of the ACT, make sure to learn about what the ACT is before continuing reading this article. Just how important is the ACT for your college applications? It is one of the most important pieces of your college application (if not THE most important piece). In this guide, I'll explain why test scores are a key part of your application and how todetermine the ACTadmission requirements for your targetschools. Why Is the ACT Important to Colleges? There are two main reasons for the importance of the ACT. #1: Your ACT Score Is How Colleges Compare You to Other Applicants While all college applicants come from different backgrounds, attend different high schools, took different high school classes, and did different extracurricular activities, all applicants will have taken the SAT and/or ACT (at least at non-test optional schools). Since all students have taken the ACT (or SAT), admissions officers use it as a sort of normalizer.Your ACT score shows college admissions officers if your GPA and transcript are accurate representations of your academic ability.If your GPA is high but your ACT score is low, admissions officers may think your grades were inflated.However, if you have a 4.0 GPA with a perfect 36 SAT score, admissions officers will likely be impressed and think your GPA is reflective of your academic potential. A high ACT score can also make up for a lower GPA.If you have a 3.0 GPA with a perfect 36 score, a college admissions officer may think your classes were too hard or that you simply matured and are now college ready as indicated by your ACT score. The ACT helps colleges compare you to other applicants. #2: Colleges Are Judged by Their ACT Score Ranges The ACTis so important to universitiesbecause admissions officersuse it tojudge your academic preparedness for college. However, yourACT score is also important to universitiesbecause if you're admitted, your ACT score will be incorporated into their annualACT statistics. Every year, colleges publish their freshman admit profile (see an example of Princeton's freshman admit profile).In this profile, colleges provide data on their admitted students.The data always includes either the 25th/75th percentile SAT/ACT scores (sometimes referred to as the middle 50%) or the average SAT/ACT scores of admitted students. However, more often, the 25th/75th percentile is provided instead of average score.The 25th percentile score means that 25% of admitted students scored at or below that score (and therefore 75% of admitted students scored above).The 75th percentile score means that 75% of admitted students scored at or below that score (and therefore 25% of admitted students scored above).The average score is just what it sounds like, an average of all the admitted students scores. The general public usesthis data to make judgments aboutthe selectivity of the school (the higher the ACT score range, the more competitive or â€Å"better† the public may think the college is). When you think of Ivy League schools such as Harvard, Dartmouth, Yale, you likely think, "Wow, those are good schools!" Why do you think they are good schools? You might think of their alumni or campuses. However, many lower ranked schools such as Denison have beautiful campuses and famous alumni like billionaire Michael Eisner. You might think Ivies are prestigious due to their low admit rates, but there are othercolleges with comparable admit rates tothe Ivies. The reason you most likely associate Harvard, Stanford and other top colleges with excellenceis due totheir published ACTscore ranges and their ranking. When doing research on applying to colleges, you likely sawthe US News World Report ranking of US colleges. Every year, US News World Report assembles their rankings based on several categories including the ACT scores of the college’s students.If you attend that college, your ACT score will be factored into that college’s overall national ranking in US News World Report. Top colleges such as Brown, Princeton, and Columbiawant your ACTscores to be top notchso that it reflects well on their school. Even "second tier college" such as Vanderbilt, USC, and Emory care about your ACT score for this reasonbecause these universities hope to continue to rise in theUS News World Reportrankings. How do you find out if your ACT score is good enough? Keep reading! What Does This Mean for You? Because schoolsvalue your ACT score so muchin their admissions process, you needto make sure that you have an ACTscore that fits their expectations. How canyou figure out what that ACT score expectation is? Do you rememberthose ACT score percentiles I mentioned earlier?As a quickreminder, schools publish an admit profile every year with either the 25th/75th percentile SAT/ACT scores (sometimes referred to as the middle 50%) or the average SAT/ACT scores of admitted students. Admissions officers use this ACT score percentile data as the score standard for applicants.Universitieswillbe looking to acceptapplicantswho are in or above this range (or at or above the average).That way the school is always getting the same or better caliber student (which means their rankings will either stay the same or increase). At PrepScholar, we recommend trying to get your score at or above the 75th percentile score for your target school to give yourself the best chance of admission. How To Find a Specific School's ACT AdmissionRequirements? Where can you find the 25th/75th percentile ACT score for your target colleges?I suggestchecking outour guide to finding your ACTscore for your target school first.The simple route is to Google Search for â€Å"[College Name] ACT PrepScholar.†That will bring you to our admissions page along with ACT score for your target school. You’ll be able to read about the average ACT score, along with the 25th/75th percentile ACT scores of admitted students, and you’ll be able to use our nifty admissions calculator to determine your chances of getting into that school based on your GPA and SAT score. Write downthe 75th percentileACTscore listed onour admissions page for your target college.That should be your target ACTscore. What Can You Do To Improve Your ACT Score? Now that you’ve found out your target ACT score, what can you do to reach it?If you haven't yet started preparing for the ACT, start with our complete study guides for ACT Science, ACT Math, ACT Reading, and ACT English. The first step to reaching your score is practice! If you’ve already started preparing but are still seeing no improvement, consider changing your ACT strategy.We’ve prepared many great ACT strategy guides. Read them hereand make sure you’re incorporating these strategies.NOTE: not all strategies will work for everyone. Try out these strategies on your ACT practice tests. Try to figure out what works for you and what doesn't work for you. If you’ve tried all of the strategies and are still seeing no improvement, you should consider hiring a tutor or trying PrepScholar’s program.Don’t worry! With the appropriate amount of time and effort dedicated, you should be able to reach your ACT score goal. Here at PrepScholar, we offer a 4 point increase guarantee. Do you not have time for a prep program? Are you taking the ACT this month?Check out our ACT 10-day cramming guide.NOTE: I highly recommend against cramming as time spent studying is important to help you achieve your score goal! What’s Next? Not sure where you’d like to go to college? Figure out how to find your target school. Worried about the rest of your college application? We’ll help you write a great personal statement and get excellent letters of recommendation. Still not sure whether the SAT or ACT is right for you? Let’s help you pick the right test for you! Want to improve your ACT score by 4+ points? Download our free guide to the top 5 strategies you need in your prep to improve your ACT score dramatically. Have friends who also need help with test prep? Share this article! Tweet Dora Seigel About the Author As an SAT/ACT tutor, Dora has guided many students to test prep success. She loves watching students succeed and is committed to helping you get there. Dora received a full-tuition merit based scholarship to University of Southern California. She graduated magna cum laude and scored in the 99th percentile on the ACT. She is also passionate about acting, writing, and photography. Get Free Guides to Boost Your SAT/ACT Get FREE EXCLUSIVE insider tips on how to ACE THE SAT/ACT. 100% Privacy. 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Health Economics Essay Example | Topics and Well Written Essays - 3500 words

Health Economics - Essay Example But the thing is quite different in healthcare sector of any economy. In healthcare sector, policymakers are quite reluctant to put a value on life due to a lot of ethical reasons. Until recently there has been huge disagreement on the method of measuring life. Over the years, researchers have tried to measure returns on different heath care interventions or programs using economic analysis framework. In last few decades several indicators have been developed for making economic evaluation of different healthcare interventions. Among those indicators, the two most important and widely used indicators are quality adjusted life years (QALY) and disability adjusted life years (DALY). These two composite indicators are being increasingly used by researchers and policymakers of health care sectors of most of the countries across the world. The paper makes an attempt to critically evaluate each of these composite indicators which are helping policymakers in the healthcare sector to decide which intervention should be made available to the patients. The paper will first discuss the definitions and underlying concepts of each of these two indicators along with their uses, then it will move on to discussing the method of calculation for each of them and examine advantages and disadvantages of them, and finally look into their applications. (Prasad et al. 2009; Morrow and Bryant, 1995; Harron, Burnside and Beauchamp, 1983) QALY – One of the most important composite indicators used for assessing the effectiveness of healthcare interventions QALY was devised during the period of 1980s (Hirskyi, 2007) by economists, healthcare researchers and psychologists for conducting cost effectiveness analysis. QALY offers the policymakers of the healthcare sector an economical framework through which they become able to make an efficient allocation of scare health care resources. The QALY is actually based

'The principle of binding precedent is too inflexible and stifles the Essay

'The principle of binding precedent is too inflexible and stifles the development of the law. It should be abolished.' Discu - Essay Example Similarly if the binding precedent was one that allows for same sex marriages the judge would have to rule in favour of that statute regardless of their own personally held belief to the contrary2. This principal has been followed in jurisprudence in all of the countries that follow the precepts of common law3. There are a couple of situations that must obtain where the Binding Precedent has to be followed. The first is that the courts accept the hierarchy that is in place and the superiority of the court or judge that ruled in the binding precedent. The level of the court can also be the same as the one hearing the latter case. The second situation is that the material facts of law in the latter case must be similar or be based on the same principle as the matter in the original precedent. Binding precedents, as a whole, are usually covered by the doctrine or principle of the Latin maxim: Stare Decisiset Non QueitaMovere which in its most literal translation means â€Å"stand by th e decision and do not unsettle the established†. ... The first of such reasons is for the efficiency that the use of device of binding precedentaffords as well as the savings in time and resources in the deliberation and ruling on a matter at hand. The binding precedent does not stifle the development of law but rather improves the efficiency of the application of law. The main principle here being that if each and every judgement was made as a â€Å"fresh† or â€Å"new† ruling, without relying on an kind of precedence then it would result in an arbitrary and unnecessary delay in the judicial decision-making process. The use of the binding precedent therefore results in a much faster and more efficient administration of justice and employs this time-saving device in a way that results in a faster and more efficient legal process. If a similar matter has been heard and determined during a previous time and most probably by a court of higher authority there really is no reason why a lower court should not dispense of the de cision in quicker fashion by accepting the precedent. The binding precedent also provides the administration of justice with a certain degree of certainty. It allows litigants to approach the courts with a certainty that all things being equal then the balance of justice would be the same regardless of the time and place of its actual implementation4. The binding precedent means that lawyers can advise their clients with confidence and certainty on matters of legal principle knowing that the previously existing authorities will be able to bear them out and results in a greater confidence in the law by those that pursue claims through the court process. Binding precedent ensures that the lesson learnt in previous judgements and ruling is therefore consistently and similarly applied in future and that

Consumer's Shopping Experience Essay Example | Topics and Well Written Essays - 1250 words

Consumer's Shopping Experience - Essay Example Thus from the discussion we can arrive at the definitions of the three types of purchases. The low involvement purchase implies the buying process where the purchasers do not perceive the product to be crucial enough and do not relate with it strongly (staff.uny.ac., n.d.). In this type of purchase decision the customer puts the least effort in browsing, comparing and selecting activities. Example of low involvement purchase could be purchasing casual daily wear t-shirts. The medium involvement purchase implies the purchase of products like the grocery items like toothpaste and newspaper etc. that requires medium level of information gathering endeavor and the buyer attaches themselves with the product to a medium level. For a medium level product the buyer puts a moderate level of effort towards the browsing, comparing and selecting procedure. The high involvement purchase deals with high level of involvement of the customer with the product or service they are planning to purchase. These types of products or services are way more expensive than the medium and low involvement products. The time spent on the decision making process is the longest for the high involvement products. ... Among these categories chocolates, dairy products and ice-creams will be categorized as the high-involvement products, while the Purina pet care will be considered as the medium involvement purchase and the bottled water will be the low involvement purchase. Marketing strategies undertaken by the makers of Nestle would encourage the consumer to search for all the information regarding low involvement purchases, medium involvement purchases and high involvement purchases since the operations and activities of Nestle are quite transparent and all the information are available online. The consumers have the option to make the purchase online through the Nestle nutrition store. For a high involvement purchase the marketer must present some information regarding the product or service which the help the creation of an encouraging attitude for the brand that will consequently result in a purchase. The advertisements in this case should be focused on the factual significance. The problem re cognition state in this case reflects the doubt in the mind of the consumer regarding the purchase decision which can only be answered by the availability of detailed information related to price, quality and material of the product. The problem in the case of medium involvement purchase requires an adequate amount of information and a good amount of time for comparing the similar products. In this case the marketer must come up with effective promotional campaigns to influence the decision of the purchasers. The low involvement purchase decision gives rise to the issue of lack of loyalty. In this case the marketer requires creating and maintaining brand reliability among

E-commerce in Arab countries ,what is the benefits Article

E-commerce in Arab countries ,what is the benefits - Article Example Relationships among individuals and organisations have been revolutionized by the massive application of information technology. Such massive use of information and communication technologies has resulted to simpler processes, enhanced productivity, increased customer participation, and reduced costs. As a result large numbers of organisations have shifted from the traditional business platform to the online platform of running business. All these factors have greatly influenced the economies of almost all the developed and developing countries over the past few years. The effects are more prominent in case of developing countries like Arab countries. Generally the list of Arab countries includes Algeria, Djibouti, Bahrain, Iraq, Egypt, Lebanon, Kuwait, Jordon, Mauritania, Libyan Arab Jamahiriya, Palestinian Autonomous Territories, Oman, Qatar, Morocco, Saudi Arabia, Syrian Arab Republic, Sudan, United Arab Emirates, Yemen and Tunisia. Economies of all these countries especially Saud i Arabia, United Arab Emirates, Egypt, Oman, Sudan and Kuwait are found to be growing fast. As a result use of internet and other related technologies in these countries has increased over the past year and most importantly this use is expected to increase at a faster rate than it was ever before. This paper focuses on e-commerce activities in Arab countries. The paper also contains the benefits of e-commerce having on the economies of Arab countries. The report includes a brief overview of the main concepts of e-commerce. Commercial activities, as we all know, comprise those that are required to carry out trade between different parties. Generally the exchange of products and/or services is settled as per conditions that are mutually acceptable by the parties and hence the objective of any commercial transaction is to ensure that all the parties

Exchange rate systems Essay Example | Topics and Well Written Essays - 1250 words

Exchange rate systems - Essay Example The traditional debate on exchange rate systems focused on insulating properties of flexible exchange rates as in Friedman (1953) and Meade (1955). The subsequent literature showed that insulating properties depend on some structural characteristics1 (e.g., openness, capital mobility), as well as the types and the sources of shocks impinging on the domestic economy. The monetary theory of the balance of payments emphasized the differences in macroeconomic adjustment under fixed versus flexible exchange rates. One consequence of fixed exchange rates is that nations may not be able to pursue independent monetary policies. Specifically, an external imbalance has to be offset by a change in the net reserve position which can affect the domestic money supply. Commitment to a fixed rate also entails buying or selling domestic currency in exchange for foreign currencies at declared parities to satisfy autonomous changes in currency demands, which unless successfully sterilized, makes the mo ney supply endogenous.Another aspect of the exchange rate system is the different operating procedures of macroeconomic policies under alternative exchange rate systems. The Mundell-Fleming framework compares the effectiveness of monetary and fiscal policy under fixed and flexible exchange rate systems. The textbook version of the model (e.g., Mankiw, 1997, pp. 308-323; Blanchard, 1997, pp. 250-267) predicts that under high capital mobility, fixed exchange rates render fiscal policy powerful in altering aggregate demand while monetary policy is impotent.

E-commerce in Arab countries ,what is the benefits Article

E-commerce in Arab countries ,what is the benefits - Article Example Relationships among individuals and organisations have been revolutionized by the massive application of information technology. Such massive use of information and communication technologies has resulted to simpler processes, enhanced productivity, increased customer participation, and reduced costs. As a result large numbers of organisations have shifted from the traditional business platform to the online platform of running business. All these factors have greatly influenced the economies of almost all the developed and developing countries over the past few years. The effects are more prominent in case of developing countries like Arab countries. Generally the list of Arab countries includes Algeria, Djibouti, Bahrain, Iraq, Egypt, Lebanon, Kuwait, Jordon, Mauritania, Libyan Arab Jamahiriya, Palestinian Autonomous Territories, Oman, Qatar, Morocco, Saudi Arabia, Syrian Arab Republic, Sudan, United Arab Emirates, Yemen and Tunisia. Economies of all these countries especially Saud i Arabia, United Arab Emirates, Egypt, Oman, Sudan and Kuwait are found to be growing fast. As a result use of internet and other related technologies in these countries has increased over the past year and most importantly this use is expected to increase at a faster rate than it was ever before. This paper focuses on e-commerce activities in Arab countries. The paper also contains the benefits of e-commerce having on the economies of Arab countries. The report includes a brief overview of the main concepts of e-commerce. Commercial activities, as we all know, comprise those that are required to carry out trade between different parties. Generally the exchange of products and/or services is settled as per conditions that are mutually acceptable by the parties and hence the objective of any commercial transaction is to ensure that all the parties

International Business Essay Example | Topics and Well Written Essays - 1500 words - 1

International Business - Essay Example Among these is the fact the assumption that the problem with Greece is based on liquidity instead of solvency. While there might be a problem with liquidity in Greece, the problem that is affecting it most is solvency, something that is not being considered. Instead, the IMF and the European Union are treating the crisis as one of liquidity and they have taken steps to counter it as such. This has not helped Greece recover and may, in fact have made the problem worse than it already was. A second issue about how financial markets work that has been ignored is the fact that the Greek debt will be sustainable in the future and that the economy will eventually absorb all the debt that it currently has. What has not been considered is that financial markets do not work well with uncertainties (such as future sustainability) and instead, they only gain confidence if action and their results are seen immediately. The third issue that has come to affect the Greek economy is that its governm ent was given loans way before a plan on how to spend the money given was made. This ensured that there would be a problem with how the money was spent, because it ended up being lost because of unplanned spending. The fourth issue discussed in the article is that fact that while Greece has been promised enough financial support to end its crisis effectively, it has become almost impossible to implement its recovery program because most of the money has yet to be received. Instead, most of the money received has been given in bits and this has made it impossible for the economy to recover. This has made the financial markets wary of taking part in the Greek economy as its future has become uncertain. When one considers the points brought up in the article, one concludes that the Greek financial crisis is something that can be solved if only the people and organizations involved would work faster than they already are to end it. The only way through which this crisis can be solved is if the financial markets can regain the confidence they once had in the Greek economy. The support of these markets would ensure that the flow of money into Greece would become stable and that its liquidity and solvency problems would end. The only way open for the Greek economy to be saved is for all the money that was promised to be made available at once to ensure stability in the financial markets. International monetary systems The article by Jack Ewing discusses the international monetary systems, dealing specifically with the Eurozone, which has for the last few years had to deal with various economic crises. Among these is that fact that many of the countries in this zone have are in either recession or are about to enter one. This has seriously threatened the Euro and until recently, many had even questioned if this monetary system was viable. There had been fears that because of the financial crisis encountered by Greece, then this country would withdraw from the Eurozone , thus leading others into abandoning the currency. However, this was not the case, and in fact, the year 2012 saw a recovery in confidence for this monetary system as it continued to perform well. The countries whose economies were expected to collapse such as Spain and Italy did not turn out as expected despite remaining deep in recession. This encouraged the continued confidence in the Euro and the belief that things would be much worse if this monetary

Care Delivery & Management Essay Example for Free

Care Delivery Management Essay The purpose of this assignment is to reflect upon my personal and professional development. It will consider the quality of the care I provided, the skills I developed in my specialist placement, plus my learning since the commencement of my nurse training. Personal learning and self-reflection will be identified. I shall be using Gibbs (1988) Reflective Cycle to consider my practice. Gibbs (1988) Reflective Cycle looks at six aspects which include the following; what happened, what were my thoughts and feelings, what was good or bad about the experience, what sense can I make out of the situation, what else could I have done and if it arose again what would I do? Findings will be supported or contrasted by relevant literature. A conclusion will be offered to evaluate findings. I shall also include an action plan, which will address future professional and personal development needs and any factors that may help or hinder this. I will also consider why I have selected these issues for my action plan, what my goals are and how I aim to achieve them. At the beginning of my nurse training we were asked to write on a piece of piece what our definition of nursing was. I wrote ‘It’s about being human’. At the time these words were based on my gut feeling and personal belief. Now, two and a half years later, I would write the same thing, but this time my definition would be based on the skills, knowledge and experiences I feel privileged and grateful to have had during my training and not just on gut feeling and personal belief. How does this knowledge impact on me in terms of practice? I can now put my definition of nursing into a framework and relate the theory of it to practice, for example I can identify when I am actively undertaking anxiety management with a patient. This is quite an achievement for me. What else have I learnt? I have gained knowledge of illnesses and understand how bio-psycho-social aspects of mental illness impact on the individual, their family and their life. I have also developed a good basic knowledge of practical skills such as: counselling, anxiety management, assessment, nursing and communication models, problem-solving and psychotherapy. This knowledge and development of practical skills has enabled my self confidence and self esteem to grow. What things have had the most influence on my personal and professional learning? These things are what ‘It’s about being human’ means to me as a nurse. They include a humanistic care philosophy. Evidence suggests that patients have found the humanistic care philosophy to be positive and helpful to their well-being (Beech, Norman 1995.) Humanistic care believes in; developing trust, the nurse-patient relationship, using the self as a therapeutic tool, spending time to ‘be with’ and ‘do with’ the patient (Hanson 2000,) patient empowerment, the patient as an equal partners in their care (Department Of Health 1999,) respect for the patient’s uniqueness, recognition of the patient as an expert on themselves (Nelson-Jones 1982, Playle 1995, Horsfall 1997). Equally important to me is person-centred care, Roger’s (1961) unconditional positive regard, warmth, genuineness and empathy, recognition of counter-transference, self-reflect ion and self-awareness. I was on placement with Liaison Psychiatry also known as Deliberate Self Harm. The team consisted of my mentor and myself. In this placement we would assess patients who had deliberately self harmed. Patients would be referred via AE only. We would see patients whilst they were still in AE or after they had been transferred to hospital wards for medical treatment for their injuries etc. We would only see patients once they were medically fit to have a psychiatric assessment. The purpose of the assessment was to find out what was happening for the individual and see if we could offer any help via mental health services to the individual, this is done via implementing ‘APIE’ the nursing process (Hargreaves 1975). The main focus was to consider what degree of risk we felt the patient was in. Therefore we needed to establish what the individuals intent was at the time of the deliberate self harm, and if suicidal, whether they still had suicidal intent after the incident. We also held a weekly counselling clinic. I considered Gibbs (1988) Reflective Cycle. How did I feel about this placement? At first I was apprehensive as to how I would feel dealing with patients who do not necessarily want to live. I belong to a profession that saves lives, so I felt an inner conflict. This is an anxiety that is recognised in most nurses (Whitworth 1984). In my first few weeks I felt distressed by the traumatic events that these patients were experiencing. I felt guilty that I have a family who love me, a fulfilling career, a lovely home and no debts, then each day I talk to people who may have no home, no money, no one to love them and no employment. It was hard for me to make sense of these things when life circumstances, such as class, status, wealth, education and employment create unfairness. I felt a desire to help try and improve the quality of these patients’ situations. Midence (1996) has identified that these feelings are a normal response when dealing with others less fortunate that oursel ves. Patients’ who attempt suicide have lost hope (Beck 1986). I felt more settled and positive once I was able to make sense of the situation (Gibbs 1988). I realised that could help by listening to these patient’s and help to restore hope, develop problem solving ideas to tackle some of their problems or referring them to gain the emotional help and support they needed from appropriate mental health services. Patients find help with problem solving extremely valuable and can help them feel able to cope (McLaughlin 1999). Generally, after most assessments, I learnt that listening, giving emotional support and problem solving helped restore enough hope in the previously suicidal patient enable them to feel safe from future self harm. In only a handful of cases did my mentor and I need to admit patients to any inpatient facility under the Mental Health Act (1983). This was because they still felt at risk of future self-harm. Through using Gibbs (1988) Reflective Cycle to consider my special placement area I feel I have been able to change my nursing practice in a positive way, initially from feeling anxious, guilty and helpless when dealing with suicidal patients to feeling useful, constructive and positive. I’ve learnt that by confronting my own feelings of guilt and discomfort I was able to help in a very positive, practical, constructive and empowering way. My mentor identified that one of my strengths is that I can generally combine common sense, logic and practicality in terms of risk assessment and problem solving and still build up a sensitive and caring, therapeutic relationship when dealing with patients whose circumstances are in crisis and complicated and they themselves are emotionally and mentally vulnerable. Nurses not only need good communication skills (Faulkner 1998) but they also need to have an environment conductive to open communication (Wilkinson 1992). Social barriers such as environment, structure or cultural aspects of healthcare can inhibit the application of communication skills (Chambers 2002) Utilising Gibbs (19988) Reflective Model, in retrospect; I feel our interview with some patients could have been done differently. On occasions when my mentor and I were in the A E department the two rooms that we had available for our use were occasionally both in use. This meant that we would conduct our assessment interviews in the Plaster Room, if it was empty. This room was where medical patients would have plaster-casts applied. This was a very clinical room. However, due to limited room availability this was sometimes the only option we had at the time, it was not a welcoming or appropriate setting and would not have helped patients feel relaxed or valued. In reflection, I believe it was actually demeaning as we were asking patients who had attempted suicide to sit on a hard chair in a clinical workroom and share their despair with us. I am sad that this happened and I feel as though we were giving the patients the impression that a cold clinical work room is all they were worth. If this arose again (Gibbs 1988) I would suggest to my mentor that we wait for one of our allocated rooms to become available, where the rooms were relaxing, with soft armchairs and a feeling of comfort. Using Gibbs (1988) Reflective Model I shall describe a situation with a patient to highlight my learning. What happened (Gibbs 1988)? Neil had been bought to AE by his son after he made an attempt to take his own life. His son explained that Neil’s wife had terminal cancer and had died the day before. Neil was unable to engage in conversation other that to repeat over and over again â€Å"I don’t want to live without my wife.† However the more disturbed and difficult to communicate a patient is the less interaction they receive therapeutic or otherwise from nursing staff (Cormack 1976, Poole, Sanson-Fisher, Thompson 1981, Robinson 1996a, 1996b). I found this too be true in Neil’s situation as some A E nurses did not wish to approach him because of his disturbed state and unresponsiveness to verbal cues. What were my thoughts and feeling (Gibbs 1988)? After spending twenty minutes in the assessment interview Neil had remained unresponsive to our approaches and had remained distressed, distant and uncommunicative for the entire time. I had past experience of recent bereavement within my immediate family and I realised that counter-transference was at play and was a reason for my strong emotional reaction to Neil’s distress resulting in me having an overwhelming desire to ease his suffering. Even though another part of me understood the need for him to experience this extreme pain as a normal part of grieving. What was good or bad about the experience (Gibbs 1988)? This was not a good experience for me because as a compassionate person, I found it extremely hard to suppress my own feelings of wanting to protect him from such devastating distress, although I recognised that I was over-identifying with him due to my own grief. I considered that he might have been embarrassed by the emotional state he was in and his inability to control his grief; he could not speak, maintain eye contact or even physically stand. What sense could I make of the situation (Gibbs 1988)? We adjourned for a few minutes so that my mentor and I could assess the situation. I thought it might be appropriate to utilise Heron’s Six Category Intervention Analysis (1975) cathartic intervention as a therapeutic strategy to enable the patient to release emotional tension such as grief, anger, despair and anxiety by helping to (Chambers 1990). I hoped it would facilitate the opportunity for Neil to open up and express his full feelings in a safe and supportive environment. I initially planned to sit quietly with him and briefly put a reassuring hand on either his hand, arm or shoulder. My mentor supported this action. I was aware that I ran a risk of misinterpretation by choosing therapeutic touch. Therapeutic touch may be criticised because it is open to misinterpretation by the patient and abuse of power by staff. The patient may view holding another’s hand as a sexual advance, violation or abuse, so nurses should always consider patient consent, appropriateness, context and boundaries. Clause 2.4 of the Nursing and Midwifery Council (2002) Code Of Professional Conduct says that at all times healthcare professionals must maintain appropriate boundaries with patients and all aspects of care must be relevant to their needs. Therapeutic touch appeared acceptable given his situation and seemed appropriate to the context it would be performed in, given that my mentor would supervise me. As per Gibbs (1988) Reflective Cycle I considered what else I could have done especially if the situation arose again and mentor not been there. I would may have chosen to utilise Hanson’s (2000) approach of ‘being with’ whereby I use therapeutic use of self through the sharing of one’s own presence, and not involved any form of touch, avoiding any misinterpretation or breach of boundaries. I was anxious because I felt concerned that my nursing skills would be inadequate to address his needs due to his acutely distressed state. In reflection my mentor helped me acknowledge that this was about my own anxiety rather than being accurately reflective of my nursing ability. I approached Neil and explained that if it was acceptable with him I would like to sit quietly with him so that he was not alone in his distress. â€Å"It is likely that the nursing process is therapeutic when nurse and patient can come to know and to respect each other, as persons who are alike and yet different, as persons who share in the solution of problems† (Peplau 1988). I gently placed my hand onto his. Neil reacted by given the impression that he physically disintegrated, he become extremely distressed and crying loudly, squeezing my hand tightly. This continued for several minutes. Neil became calmer and started to talk about his situation. This was a good outcome. I was able to utilise Herons (1975) cathartic strategy with positive effect via empathising with Neil’s situation and using myself as a therapeutic tool through the use of touch, thus enabling Neil to express his emotions and activate a nurse-patient relationship. Studies have shown that nurses can express compassion and empathy through touch, using themselves as a therapeutic tool (Routasalo 1999, Scholes 1996) and this has a cathartic value, enabling the patient to express their feelings more easily (Leslie Baillie 1996). The therapeutic value of non-verbal communication and its harmfulness is overlooked (Salvage 1990). Attitudes are evident in the way we interact with others and can create atmospheres that make patient care uncomfortable (Hinchcliff, Norman, Schoeber 1998) On one occasion, one nurse privately referred to Neil as a â€Å"wimp† because he was having difficulty coping with the death of his wife. I wondered whether her body language had transmitted her bad attitude towards Neil, contributing to his distress and difficulties in communicating with staff. Again using Gibbs (1988) Reflective Cycle, I shall provide another example to highlight my learning in practice. What happened (Gibbs 1988)? Cycle On one occasion my mentor and I received a phone call from A E asking us to review an 18-year-old girl called Emma who had taken an overdose. They said she was medically fit to be assessed. When we arrived they claimed that she was pretending to still feel unwell and described her as â€Å"milking it†. We found her to be vomiting and discovered she had been left in a bed in the corridor of A E for 8 hours. McAllister (2001) found that patients who had self-harmed were ignored, had exceptionally long waits and suffered judgemental comments. What were my thoughts and feelings (Gibbs 1988)? I felt very angry towards A E staff as I felt that she was being unfairly treated because she had caused harm to herself, she had been labelled as a troublemaker by staff and I do not believe she had received good quality care. Emma explained that in the last month her father had died, she had miscarried her baby, discovered that her partner was having an affair, and she had been made redundant leaving her with debts that she couldn’t pay. As I looked at her, I saw a vulnerable young woman at the end of her tether. I felt saddened and disappointed by the judgemental attitudes of the A E staff who had not even taken the time to talk to Emma or ask her why she had taken an overdose, instead they describe her as an â€Å"immature and attention seeking kid†. As per Gibbs (1988) Reflective Cycle, I felt this was a very bad experience of poor care, bad attitudes and unacceptable moral judgement being made by A E staff. Cohen (1996) and Nettleton (1995) identify that social status; age, gender, race and class contribute to stereotyping and judgemental attitudes. I noticed that people who self-harmed were judged differently dependent upon their age and the younger they were the worse the attitude of A and E staff. Interestingly ageism towards youth is an area that I could find no research on. I believe ageism towards younger people is overlooked and is really only identified in the elderly. During the assessment I was aware of how my physical presence can impact on the care given. However, I have learnt about the importance of considering how one can communicate to the patient via body language. By attending to patients in a non-verbal or physical way it is another method of saying, â€Å"I’m interested, I’m listening and I care.† To do this during Emma’s assessment I utilised Egan’s (1982) acronym S.O.L.A.R. This meant that I sat facing Emma Squarely, with an Open posture, Leaning towards her, whilst making Eye contact and Relaxing myself, to give her the feeling of my willingness to help. This client centred care recognises her equality in the nurse-patient relationship. What sense did I make of the situation (Gibbs 1988)? I was very unhappy about the attitude of A E staff but recognised that they had a lack of understanding and knowledge. In one study looking at self-harm admissions it was discovered that patients who deliberately self-harm are often deemed as unpopular patients, being labelled and judged as time wasters by A E staff. Apparently 55% of general nurses perceived these patients as attention seekers and disliked working with them, 64% found it frustrating, 20% found it depressing and almost a third found it uncomfortable (Sidley, Renton 1996). What else could I have done (Gibbs 1988) After reflecting upon the experience with my mentor, I was able to realise that part of my role is to act as a representative for mental health. If this happened again what would I do (Gibbs 1988)? If staff were to make judgemental comments again it is part of my role to educate and inform them so they can have a positive understanding of the needs of the mental health patient and learn to address any judgemental comments made. This is a view supported by Johnstone (1997), who says that if we are made aware of our actions when we are judging and labelling people it is our responsibility to correct this. Medical staff need to be aware of mental health promotion, and need further training and education in respects of helping to care for and understand of this vulnerable patient group (Hawton 2000). This is a view supported by the Department of Health (DOH 1999a) who have recommended closer liaison between mental health and A E services in an effort to address the poor understanding and negative attitudes of A E staff. I have also learnt that I must look at both sides of each situation and should show more understanding towards the A E staff’s feelings, as they are often confronted with shocking and distressing acts of self infliction which can make them feel despair, helpless and unskilled to deal with these sort of patient. I believe nurses negative attitudes develop because we all intuitively apply own our values and views to everyday situations, people, experiences and interactions. It may be the staff member’s own coping mechanism to keep their distance from the patient or to label them as attention seeking in order to make sense of the situation for themselves. This is a view supported by Johnstone (1997). In reflection, following the assessment and planning of care for Emma my mentor and I reflected upon the care I provided for her. I recognised that I felt nervous because it was my first experience of conducting an assessment. Having my mentor there to observe me made me feel secure because I trusted my mentor and could rely on her expertise to ensure that I provided safe practice for Emma. However, I still felt anxious as I was faced with an unknown situation. This made me realise how difficult and intimidating the assessment process may have felt to Emma. I had the security of feeling safe in the relationship with my mentor. Emma didn’t know either of us. This highlighted the huge value of the nurse-patient relationship and how the importance of utilising Rogers (1961) theory of client-centred care involving unconditional positive regard, warmth, genuineness and empathy towards patients. My mentor said that I provided evidence based care and I appeared to have a good humanistic approach, sensitively providing client centred care. She joked that I was so keen to ‘get it right’ that I was practically sat on Emma’s knee in my efforts to non-verbally show to Emma that I was attentive and listening to her. I think that whilst this was a joke, I will endeavour to continue to be keen but will relax a bit more, hopefully as I gain more experience myself. I will also use the insight and understanding from these experiences to benefit my future practise and the care I provide for patients. Boyd Fales (1983) suggest, â€Å"Reflective learning is the process of internally examining an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in a changed conceptual perspective.† Self-reflection helps the practitioner find practice-based answers to problems that require more than the application of theory (Schon 1983). I have discovered this to be true, especially in mental health nursing where problem solving may be in the realm of religious, spiritual or cultural beliefs, emotional or intuitive feelings, ethics and moral ideals, which sometimes cannot be theorised. With one patient I couldn’t understand his unwillingness to engage in therapy even though he turned up for a weekly appointment. Once I reflected on this with my mentor I realised that I was not considering his strict religious and cultural background, which complicated his care. I realised that I had been completely ignorant of his needs and had in-fact lacked self-awareness otherwise I would have recognised these issues sooner. According to Kemmis (1995) a benefit of self-reflection is that it helps practitioners become ‘aware of their unawareness’. I have learnt that there are barriers to reflection. On occasions after seeing a patient my mentor may interpret events in a slightly different way to myself. Newell (1992) and Jones (1995) criticize the idea of reflection arguing that it is a flawed process due to inaccurate recall memory and hindsight bias. Another criticism of refection is that it aims to theorise actions in hindsight therefore devaluing the skill of responding intuitively to a patient (Richardson 1995). I considered that my thought to hold Neil’s hand may have been intuitive but because we must use evidence based practice and appropriate frameworks of care, I theorised my care and utilised Heron’s (1975) framework. I believe self-reflection helps me to become self-aware. Self-awareness is achieved when the student acknowledges there own personal characteristics, including values, attitudes, prejudices, beliefs, assumptions, feelings, counter-transferences, personal motives and needs, competencies, skills and limitations. When they become aware of these things and the impact they have on the therapeutic communication and relationship with the patient then they become self-aware (Cook 1999). I have learnt through these experiences that reflection can be a painful experience as I have recognised my own imperfections and bias. I have felt angry with general nursing staffs attitudes towards mental health patients and have now been able to realise that this emotion is unhelpful and instead I should be more tolerant and understanding and help them to understand the patients needs. It is also difficult especially if one is experiencing strong emotions such as anger, frustration and grief (Rich 1995). At times I have over-identified with my patients and personalised their situation to similar situations of my own. This is known as counter-transference and has blinded my ability to address their care needs. Counter-transference is the healthcare professionals emotional reaction to the patient, it is constantly present in every interaction and it strongly influences the therapeutic relationship, but is often not reflected upon (Slipp 2000). Counter-transference can be defined as negative as it can create disruptive feelings in the clinician, causing misguided values and bias (Pearson 2001). I have learnt that it is crucial for me to consider how my reactions to a patient’s problem can impact on the care I provide. Whilst I endeavour to always give 100% best and unbiased care to each patient, I have realised I respond more favourably to patients that I like or identify with. For example I was extremely compassionate and biased towards both Emma and Neil and I feel that my personal life experiences influenced me because I could really empathise with them both. However, I realised that I am only human and that as long as I recognise the impact of counter-transference then I can use it positively as my self awareness of the fact that the process is occurring will enable me to address and challenge my own thoughts, feelings and responses. To conclude, I have been able to highlight my learning over the last two and a half years, both personally and professionally. This has enabled me to look at the areas that I am good at and the areas that I can improve on. I have been able to look at the quality of the care I have given patients and considered what I have achieved, how I felt, how I could have done things better, what was successful and unsuccessful, what issues influenced me and what understanding I had of the experience. I have also been able to recognise my role as a representative for mental health nursing and how I can promote it to other healthcare professionals. I have also identified the value of the role of my mentor in helping me to develop as a nurse. I will use the insight and understanding from these experiences to benefit my future practice and the care I provide for patients. ACTION PLAN Word Count 1086 What are my goals? My mentor and I discussed the areas that I want to improve on. We identified that my stronger points are common sense, logical approach and practical ability in terms of things like risk assessing and problem solving. I am also competent in the building of a therapeutic relationship, utilising a humanistic care philosophy, person centre approach, empathy, genuineness, unconditional positive regard and honest. I also have a good knowledge in respect of mental health promotion, anxiety management, basic counselling skills, understanding of the fundamentals associated with nursing, assessment and communication models and the basic principles of psychotherapy. I feel I have come a long way in two and a half years and have accomplished a lot. However, there are areas that I recognise that I can improve on and I am happy that I can address these as I hope this will improve my learning, skills and competency as a nurse in the future, providing better patient care. The areas I need to gain more knowledge and experience of include: understanding the religious, cultural and spiritual needs of the patient and how this impacts on their care and quality of life, recognising and working with counter transference and my tendency to feel the need to over protect patients as this does not help the patient to utilise choice, be responsible for themselves or empower themselves. I want to continue developing my own self awareness through self reflection. Finally I wish to develop my academic abilities and to train further so that I have more knowledge. Why have I chosen these issues? I have chosen to improve my knowledge and understanding of patients religious, cultural and spiritual needs and how this impacts on their care and quality of life, because by doing this I hope to be able to address their needs holistically. To successfully undertake a thorough assessment the healthcare practitioner needs to identify the holistic needs of the patient, failure to do so would neglect the patients physical, psycho-social and spiritual needs (Stuart and Sundeen 1997.) At present I feel I am unable to fully comprehend or provide best care as I feel I lack the skills and knowledge to do so. I also wish to further consider the impact of counter transference and my tendency to feel the need to over protect patients. I feel that if I gain more understanding and recognition of how counter-transference can change my reaction to a patient then I will be able to address it and have more control and choice over my nursing and my responses. In practice, I have experienced strong emotional reactions to some patient’s, perhaps because I could identify with some of their issues. However, this can result in my wanting to over protect them, which may disempower them, and this is unhelpful. Different characteristic in patients can influence the emotional reaction of the nurse (Holmquist 1998). I need to be able to recognise these characteristics in the patient and be self aware of the way I am responding. I want to continue developing my own self-awareness through self-reflection, as I will need to be able to exercise autonomous and expert judgement as a qualified nurse. The ability to use self-reflection as a learning tool to becoming self-aware will help me achieve this. This is a view supported by (Wong 1995). Boud, Keogh Walker (1995) believe self reflection is an important human activity, essential for personal development as well as for the professional development of the nurse. By being able to mull over my experiences will help me challenge my beliefs and behaviour as an individual and a nurse. Finally I wish to develop my academic abilities and to train further so that I have more nursing knowledge. Experience alone is not the key to learning (Boud et al 1985). I wish to gain further qualifications so that I may further my career and knowledge, as this will provide a sense of achievement and fulfilment for me. How am I going to achieve my goals? I intend to develop my portfolio and keep an open reflective diary (Richardson 1995) to show evidence of my learning and prepare for my PREPP. Portfolios are seen as a collection of information and evidence used to summarize what has been learnt from prior experience and opportunities (Knapp 1975), and acknowledges professional and personal development, knowledge and competence, providing nurses with evidence of their eligibility for re-registration every three years (NMC 2002). I believe maintaining my portfolio helps with one’s self-assessment and will help me to develop my strengths, plus identify and critically evaluate my weaker areas, this is a view supported by Garside (1990). However in contrast Miller Daloz (1989) suggest there is no evidence to suggest that self assessment contributes to enhance self awareness. A barrier to one’s ability to self-reflect may be time constraints and socio-economic factors such as high staff and management turnover, low staff morale and staff illness (Bailey 1995) I hope to overcome this by being a supportive team member to my colleagues and maintaining a positive mental attitude. I am happy to work on my portfolio and diary in my own time as I think it is a valuable learning tool. I will use my preceptorship, learning in practice, observation in practice and clinical supervision to help achieve my goals. Reflection on action is considered to be an essential part of clinical supervision (Scanlon Weir 1997). I will continue to use Gibbs (1988) Reflective Model to help me develop my learning through reflection. I will need to feel confident that by sharing my portfolio, diary, reflection or seeking advice via preceptorship and supervision that this will not reflect negatively on me and effect my ability to feel able to trust my mentor. Students and staff sometimes feel unable to fully express themselves or belittled by the power relationship if supervision is not in a trusting relationship feeling it could be open to bias, personality clashes, counter-transference or could disadvantage them in terms of career development (Richardson 1995 Jones 2001). However, good clinical supervision enables nurses to feel better supported, contributing to safer and more effective nursing (Teasdale 2001, Jones A 2001). I hope to continue with life long learning and would like to be able to study for a degree in nursing. I shall do this by apply for funding once I am employed and hope that whoever my employers are they will support me in my goal to become better qualified. 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