Men of Honor Essay Example for Free

Men of Honor Essay Cosby, B. and Robertson, S. (Producers) Tillman, G. (Director). (2001). Men of Honor [Motion Picture]. United States of American: Twentieth Century Fox Film Corporation The movie begins by introducing Master Chief Leslie W. (Billy) Sunday (Robert DeNiro), a US Navy Diver, who has recently gone AWOL. The movie then flashes back 25 years, where an African-American boy named Carl Braschear is watching his father work the plow on their farm. Carl wants to quit school so that he will be able to help work and then prevent the farm from ruin. Carl’s father is against his son being like him and stuck working on a farm. As time passes Carl (Cuba Gooding Jr. ) decides to join the Navy. On the day Carl is leaving for the Navy, Carl’s father gives his son a custom-built portable radio as a memento of home, and tells Carl to be the best, even if it means breaking the rules. Carl winds up working in the kitchens on the USS Hoist in the South Pacific. He and the other African American officer’s joke about the so-called bright future the Navy promised them. Afterwards, Carl and his friends go up on deck where the white officers are swimming (the black crew members are assigned a specific day when they can swim). Carl, tired and hot, decides to jump in the water. The white officers try and chase him down, but Carl out-swims all of them. The ships captain meets with Carl and, impressed with the boys speed, decides to transfer Carl to the search rescue swimmers, a group assigned to rescue anyone who falls overboard on ship. A few days later, the ship is rocked by an apparent crash. Carl assists the others on deck in raising a Navy Diver from the sea floor with the wounded pilot. The Diver is Master Chief Sunday. Carl, having seen Sundays actions as heroic, is inspired and vows to become a Navy Master Diver. Two years later, Carl is reporting for Diving School. Despite the harsh treatments, Carl performs admirably in his training, assembling machinery and adapting to the diving suit with much greater results than a large number of his classmates. Unfortunately, Carl is falling behind in the academic requirements-scoring only a 37 on his first exam. If he fails again, Carl will be kicked out of the program. One weekend, on leave, Carl comes to a library in the hopes of getting a tutor to help him. He meets a young woman named Jo who is studying medicine. Carl stays the entire night at the library reading and learning more about the Navy program. Next morning, Jo is so impressed by his progress that she agrees to help Carl. After diligent studying Carl passed his next exam allowing him to remain in the navy dive program. The time has come and Carl has passed his final exam with a 94, Chief Sunday has been instructed by the Senior Officer at the training to school to do whatever is necessary to prevent Carl from passing the final test. Most of the other recruits are able to complete the project in about 2 hours. Carl remains in the water for 9 hours after having to find all of his components in the excruciatingly cold water; Carl Brashear has passed his final and essentially graduated with honors from Diving School. After waiting several years as a stand by divers, Carl finally is assigned to a ship allowing him to dive. An accident on the ship’s deck causes the lines to snap. Carl shoves several other deck hands aside, but his own leg is caught by the snapped wire. Carl realizes his diving days are over but refuses to give up, he request his leg be amputated. He begins the difficult process of learning to move and act with a prosthetic. Master Chief Sunday pays Carl a visit while in the hospital and encourages him to not give up and they will train together. Two months later, after completing all the difficult tasks Naval Personnel placed before him, he was reinstated to full diving duty. Carl became the first African-American amputee to be on active Navy diving duty, and be promoted to Master Chief. Carl continued in his Naval career for another nine years before finally retiring. Personal Reflection Men or Honor is a movie which offers the viewer a great deal of emotion. Even though I previously watch the movie some years before, I felt this would be the perfect movie based on our studies. Carl, the main actor in the movie was determined to succeed in life. Because of his father’s confidence and determination, Carl wanted a better life. Society consistently provides roadblocks for everyone even those with some type of disability. In each segment of the movie, my feelings bounced between crying and laughing. Each time Carl was faced with an adversity, I found myself getting mad Critical Thought This week’s discussion dealt with Individuals and Disabilities. Over the years, people who have a â€Å"disability have been subjected to prejudice and more. And the first way to diminish someone is through language, by using words or labels to identify a person as less-than, as the others—not like us, and so forth. Once a person has been identified this way, it makes it easier to justify prejudice and discrimination. One of many concepts which caught my attention this week was the importance of putting a person first before the disability. This allows the disability to be in the background while the focus is on the person. Often times, people with disabilities are fighting society to let them know they are not their disabilities. People are not victims due to their disability; people are victims of attitudes and discrimination.

The Integration Of Core Concepts And Frameworks In Health Studies Nursing Essay

The Integration Of Core Concepts And Frameworks In Health Studies Nursing Essay Introduction This assignment attempts to explore the integration of core concepts and frameworks in health studies. The purpose of the assignment is to analyse the writers current professional practice, focusing on the outcomes of reflection, models of health, focus for learning, methods of enquiry and occupational mode of practice. Where reflective accounts are used to demonstrate a relationship to current practice, the author will make these entries in the first person (Webb, 1992, Hamill, 1999). The author is a senior staff nurse within an acute and emergency care facility in the North West of England. To ensure anonymity and confidentiality no reference is made to either patients or staff (NMC, 2004). During the last three decades, many professional groups have taken up reflective practice. Bulman Schutz (2004) argue that this enhances learning and promotes best practice within nursing. It is seen as an appropriate form of learning and a desirable quality amongst nursing staff (NMC, 2002). There have been many attempts to define reflective practice, however, Atkins Murphy (1993) argue that the whole concept is poorly defined. Reflection and reflective practice is a process allowing the practitioner to explore, understand and develop meaning, highlighting contradictions between theory and practice (Johns, 1995). Moon (1999) defines reflection as a set of abilities and skills, to indicate a critical stance, an orientation to problem solving or state of mind. Reflection is a window through which an event or situation is broken down and evaluated upon in an attempt to understand what has happened, to improve practice and aid learning and development (Reed, 1993, cited in Burns Bulman, 2000). Kolb (1984) states that reflection is central in theories of experiential learning and argues that within nursing, this form of learning is the most dominant. Platzer, Blake Ashford (2000) state that there are many benefits to learning through reflection, however, they are critical of individual reflective accounts and acknowledge the barriers to this form of learning. They explain how group reflection is more potent when attempting to understand complex professional issues and believe that through sharing, supporting and giving feedback in these sessions will facilitate learning with greater effectiveness. Wilkinson Wilkinson (1996) share this view, but highlight the importance of respecting and maintaining confidentiality. Schon (1983) describes reflection in two ways: reflection in and reflection on action. The differences in these types of reflections are reflecting whilst the situation unfolds and reflecting retrospectively on an event (Greenwood, 1993, Fitzgerald, 1994). Atkins Murphy (1994) improve upon this and suggest that for reflection to make a significant difference to practice, the practitioner must follow this up with a commitment to action, as a result. Interestingly, Greenwood (1993) also states that reflection before action is an important preparatory element to reflective learning as it allows the practitioner to formulate plans ahead of situations arising. There are other writers on reflective practice and conflicting arguments exist about when best to reflect. (Wilkinson, 1999). There are some critics of reflective practice, these highlight issues including the surveillance and self-regulation of reflective practice (Taylor 2003). Bulman Schutz (2004) suggest that when bringing personal feelings and emotions into the public domain that this can act as a barrier to reflection. They also acknowledge other limitations to the reflective process, including a lack of effective tools for assessment, political and financial pressures and the knowledge and skills required by facilitators. Taylor (2003) proposes that due to the confessional nature of reflection, debate can be raised over the legitimacy and honesty of the process. Schutz (2007) states that insufficient research has taken place to assess the benefits of reflection in nursing, leaving some debate about its appropriateness. Taylor (2003) argues however, that reflective practice is considered a positive approach to learning and is an important educational tool. There are many models to guide a practitioner through the reflective cycle. Reflection was first explored by Dewey (1933), Boud et al (1985) Cooper (1975) Powell (1989), Jarvis (1992), Atkins and Murphy (1994), Reid (1993) and others. More recently, models used to guide reflective practice, include Gibbs (1998) Johns (1995), Bortons (1970), Smyth (1989) and others. Health is a broad concept and can embody a variety of meanings, of which there is no particular right or wrong answer. There is no ideal meaning of health, making it a highly contested topic (Aggleton, 1993). The word health derives from the old English word to heal (hael) meaning whole (Naidoo and Wills, 2000). This statement suggests that health relates to the individual and concerns their holistic well-being. However, the literature suggests that opinions vary and that some perspectives disagree. Health is defined in many ways, generally divided into two types of understanding; official and lay perspectives. The main difference between the two, is that one is the view held by professionals and the other represents the views of lay people (non professionals). Official definitions of health have two common meanings in every day use; positive and negative (Cribb 1998, Aggleton 1993). The positive view represents a state of well being and the negative view surrounds absence of disease. The World Health Organisation (WHO) (1946) encapsulated a holistic view of health, Health is a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. Whilst setting high targets to be achieved, this definition has been criticised for being too idealistic and impossible to attain (Aggleton, 1993). In view of the criticism, the WHO changed its definition: health is the extent to which an individual or group is able to realise aspirations, to satisfy needs and to change or cope with the environment. Health is therefore seen as a resource for everyday life not the object of living. Health is a positive concept emphasising social and personal resources as well as physical capabilities (WHO, 1986). This suggests that more recent definitions see health not as a state, but as a process towards the achievement of each individuals potential (Seedhouse, 1986). Negative definitions focus on the absence of disease or illness (Aggleton 1993, Naidoo Wills 2000). One definition of health suggests that people are healthy so long as they show no signs of bodily abnormality (disease). This definition fails to take into account how the person feels about themselves. The individual may feel ill in situations where health professionals are unable to find any underlying pathology (Aggleton 1993). Alternatively, an individual may have a disease and feel perfectly well. The main point being made here is that subjective perceptions cannot be overruled or invalidated by scientific medicine (Naidoo Wills 2000). The negative meaning of health is utilised by the medical model, which is explored later in the text. Whilst in the workplace, it is apparent to me (who is also a Registered Nurse) that both positive and negative meanings of health are used. Doctors focus on health from the negative viewpoint e.g. a doctor may review a patient and whilst not being able to find evidence of an acute illness, decides that the patient is fit to be discharged. Alternatively, I may focus on the positive view. In this context, a holistic approach to the patients health and social well-being is being explored, and therefore a comprehensive assessment of these needs are being made prior to discharge. As previously mentioned, lay beliefs are the views of those who are not professionally involved in health issues (Aggleton 1999). Whilst this is so, they must not be totally discounted as they can be as important as official definitions. They often influence the behaviour and understanding of an individual, and ultimately, the way they respond to health issues. An example of this can be demonstrated when reflection takes place after an incident e.g. a gentleman was admitted to the assessment area complaining of chest pain. After investigation, he was diagnosed with a myocardial infarction. Immediately after diagnosis, he remained on bed-rest for twenty-four hours, then after this period, the patient stated (when asked how he felt), that he felt well and had infact never felt better. At this point the patient proceeded in an attempt to get out of bed and mobilise locally. Thus, it was his belief (a positive view) that because he felt well (he had no symptoms of feeling unwell) then th is was a signal for him to carry on, in his normal manner, which was not the case. If the patient had been told he needed to rest, then it is likely that his behaviour would have changed. Beliefs about health can also vary from place to place (Aggleton 1993). Having nursed in various locations throughout the United Kingdom, my experience of this is first hand and from this experience, I share the views of Aggleton. There seem clear distinctions between health needs and health interpretations between different social class groups. e.g. in deprived areas, beliefs of health are that you just get by, however, in more affluent areas, health is not seen as merely being free from ill-health, but looks at other dimensions too, like keeping fit, eating healthily and being active. According to Jones (1994), health is subject to widely variable individual, social and cultural expectations, produced by the interplay of individual perceptions and social influence; suggesting that individuals create and re-create meanings of health and illness. This is done by our lived experiences. This view is supported by researchers, who have identified social class differences in concepts of health (Blaxter 1990, Calnan 1987). Their findings concluded that middle class respondents had a more positive view of health and found this to be linked to perceptions such as enjoying life and being fit and active. Through the same research, working class groups viewed health as functional and avoiding ill health. One explanation for these findings is that compared to working class people, middle class groups have greater control over their lives, due to income thresholds and job security, generating higher standards of living. According to Naidoo Wills (2000), this leads to people in different social classes holding different beliefs about autonomy and fatalism. These views are confirmed by my experiences in the workplace. The majority of patients I see are from working class backgrounds. This information is obtained from the patient during admission, when asked about their occupational status. It must be acknowledged however, that someones occupation doesnt necessarily denote their social group. These patients do have a tendency to view health as functional and this further supports the explanation offered by Naidoo Wills (2000). The United Kingdom is undoubtedly classed as a multicultural society, therefore it could be argued that a range of cultural views about health co-exist (Naidoo Wills, 2000). Alternative practitioners offer therapies such as acupuncture, reflexology and massage, which are based on cultural views of health and disease and run in conjunction with therapies offered by the National Health Service, which focuses on scientific medicine. The use of complementary alternative medicine (CAM) is largely unregulated but due to recent government pressures, a regulatory body to govern the use of some of these practices is to be set up (Hawkes, 2008). It is also evident that differences in chronological age and lifestyle also play a key part in influencing our views about health. For many young people, health may be seen as the ability to take part in sporting activities or being at the peak of their fitness (Blaxter 1990, Aggleton 1993). Alternatively, health for the older person is more likely to relate to the ability to cope and to be able to undertake a more restricted range of actions (Williams 1983, Aggleton 1993). It is clear from this discussion, that there are a variety of forms that can be taken from a concept. It is felt therefore that it would be useful to use an analytical framework which brings together defining features of concepts of health and demonstrates their relationship to each other. One such framework is by Alan Beattie (1987, 1993). Beattie (1987, 1993) suggests that concepts of health can be characterised by a focus on health as the property of individuals through to the property of people collectively, on a continuum. Further concepts can be seen as open to authoritative definition (or scientific principles), or alternatively as socially negotiable within the context of people concerned. This lead Beattie to set out two interlocking axis the horizontal and vertical axis. The horizontal axis represents individual people to families, groups and whole communities. The vertical axis represents a stance from expert led (authoritative usually represented by expert knowledge) to client led (negotiated using peoples own interpretations of their health and viewing them as experts in their own right) interventions. From this, the four quadrants of Beatties concepts were born. Biopathological models of health are related directly to the individual, them being the focus for treatment and free from illness or disease. Health is proclaimed in an authoritative manner through investigation and diagnosis. This model relates closely to the medical model of health. Biographical models of health focus on the individual subjective experience of health. Health is seen as part of everybodys life story and is therefore seen as being linked to our individual biographies. Health is not established through science but the personal opinion of the individual in the context of their lived experience. Environmental models view health as a property of populations as opposed to individuals. The emphasis is on the use of statistical data to describe epidemiology, in order to determine the health of the population. The communitarian concept states that health is the property of the social contexts of peoples lives in their communities. Health is seen to be influenced by how people respond to their material and cultural circumstances of their lives and not being shaped by authoritative monitoring of patterns of health. Beattie (1987, 1993) suggests that these models are not mutually exclusive. They can co-exist in differing circumstances, however, the emphasis may be more or less dominant. Having explored these models, it becomes evident that within my practice the Biopathological model is the most dominant between the members of the health care team e.g. a patient is admitted to the assessment unit with complaints of chest pain. The medical team (or the technician as Beattie would refer) would see the individual as the focus for treatment and will carry out expert, scientific led investigations. The diagnosis would then be proclaimed in an authoritative manner. This model has been criticised for being too narrow and it can be argued that medicine is not as effective as it is often claimed (Naidoo Wills 2000). The twentieth century has seen a reduction in mortality and increased longevity in developed countries and it is often assumed that medical advances have been responsible for this. McKeown Lowe (1974) would argue that this is not necessarily the case. In their historical analysis they concluded that social advances in general living conditions had been responsi ble for most of the reduction in morbidity, whereas the contribution of medicine had played a much smaller role. However, within the professions and institutes of medicine, mechanistic approaches to analysis are still dominant (Beattie et al 1993). In practice, the biopathological model of health is usually adopted when dealing with the nominated patient group, but it must be acknowledged that sometimes, due to the nature of nursing (even in an acute area), I may utilise other models within Beatties framework, particularly the biographical model of health. Here, the focus is still individual, but the care is negotiated as opposed to prescribed. Interestingly, the NMC (2004) code of professional conduct also advocates that patients be treated individually, with respect and with their best interests in mind. An example can be given to the reader of when this overlap occurs. A patient is admitted to hospital, following an acute exacerbation of chronic airways disease. The individual is seen by the doctor and in an authoritative manner prescribed a course of treatment, which included smoking cessation. The patient did not respond well to this demand. He believed that because he had been smoking for most of his adult life, that this did not contribute to his current health breakdown. Utilising previous experience in this area, I talked through the issues of smoking cessation and gave a rationale for the proposed treatment. I listened to the patient, with their concerns and anxieties and found that previous attempts at stopping smoking had been unsuccessful. The patient highlighted that no help had been offered previously from the health care team and that he had no financial compensation for his treatment. After a discussion about the support and available services, the patient accepted my offer to a free and confidential stop smoking service and agreed to a referral being sent. According to Beattie (1987, 1993) the focus for learning concerns the type of knowledge a health care practitioner needs in order to practice within their setting. Within the biopathological model of health, the focus for learning is that of essential knowledge applied by the competent worker (the technician). This is consistent with my focus for learning and is utilised frequently in every day practice. It is the most dominant over other focuses suggested by Beattie (1987, 1993) within other models of health. An example of when I might use this form of knowledge could be when managing a deep vein thrombosis (DVT) clinic. I assess the patients risk of having a DVT, then, by following the trusts protocol decide the patients management plan. To ensure the effective running of the clinic at a competent level requires me to have essential knowledge about the diagnosis and treatment of DVT including a thorough understanding of the anatomy and physiology involved, the treatments, radiologi cal investigations, complications and side effects to treatment. Carper (1978), suggests that there are four fundamental patterns or types of knowing in nursing. These are known as his taxonomys of knowing and include, the empirics, aesthetics, personal knowledge and ethical domains. The empirics element of his taxonomy relates to the science of nursing and having the ability to describe, explain and predict. The aesthetics dimension relates to the art of nursing. Personal knowledge relates to the knowledge that an individual has from their past experiences in nursing and the ethical component of Carpers taxonomy relates directly to the decision making, the rights and wrongs, holding values and applicating. A method of enquiry, concerns the formal ways in which knowledge is generated and used by practitioners (Beattie 1987, 1993), often referred to as research and is vital in informing practice (Rolfe 1996). Research has two main paradigms for which there are different terms. Here, they shall be referred to as positivism and interpretivism. Positivist research is concerned with facts based on objective information, which is tested and systemised e.g. a randomised controlled trial. Interpretivist research deals with meanings based on subjective information e.g. a patient satisfaction survey (Parahoo 1997). Previously, I have identified that the predominant method of enquiry in the workplace is the positivistic approach, directly relating to the biopathological model of health. In nursing, the use of evidence-based practice is prevalent and Naidoo Wills (2000) agree is firmly established. This is consistent with the use of randomised controlled trials to establish what forms of treatment are most effective for most people. Sackett, Rosenburg, Muir Gray, Haynes Richardson (1996), describe evidence based practice to be a conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This suggests that evidence based practice is crucial to the effective delivery of care and to the role and status of the nursing profession (Hardey Mulhall 1994, Roper, Logan Tierney 1996). An example of positivistic research, used within my practice, would be the use of diabetes mellitus, insulin glucose infusion in acute myocardial infarctio n (digami regime) (see appendix 1, for summary of research findings). Following these findings, the digami regime has been implemented throughout the NHS Trust in which I am employed, and is now standard procedure for staff to use on the appropriate patients. The data to support the use of the digami regime evolved from randomised controlled trials, which Hardey Mulhall (1994), maintains provide high reliability. Further more, the randomised controlled trials have been described within evidence-based practice as the gold standard (Naidoo Wills, 2000). On the negative side, Parahoo (1997) argues that positivistic research studies human beings as objects and does not provide knowledge of the patients views of the treatment. Conclusion It is undoubtedly clear that health is a complex and multi-faceted area for discussion. There are many meanings and definitions to health with no simple answers. It has become clear that lay and professional views should be regarded equally due to their equal stature. The practitioner has always regarded these as so, but the essay has highlighted this important area and has increased my awareness of this for future clinical practice. The practitioner will continue to view health positively and holistically and will endeavour to promote this practice amongst other members of the multi-disciplinary team. The practitioner has learned that using an analytical framework is a useful tool when mapping concepts of health in particularly Beatties framework. The framework was easy to follow and relates well to practice. The focus for learning was found to be predominantly around applying essential knowledge. The method of enquiry that informs practice was dominantly positivism which linked closely with Beatties biopathological model. Not surprisingly, this model prevails as the most dominant in my clinical practice. From this module, I feel that I have developed both personally and professionally. The knowledge gained through the undertaking of further study has helped me bridge the theory practice gap and has made me more aware of issues surrounding this complex area of health. Appendix 1 This study was initiated to test the hypothesis that rapid improvement of metabolic control in diabetes patients with acute myocardial infarction by means of insulin glucose infusion decreases the high initial mortality rate and that continued good metabolic control during the early post infarction period improved the subsequent prognosis of myocardial infarction (Malmberg et al 1995, Malmberg et al 1994, Malmberg 1997). Conclusions from this study, support the immediate use of insulin glucose infusion followed by multi-dose insulin in diabetic patients with acute myocardial infarction (Malmberg et al 1995, Malmberg et al 1994, Malmberg 1997) References Aggleton. P. (1993) Health Routledge. London. Atkins. S., Murphy. K. (1993) Reflection: a review of the literature. Journal of advanced nursing. 18(8) 1188-1192. Atkins. S., Murphy. K. (1994) Reflective practice. Nursing Standard, 8(39) 49-56. Beattie. A., Gott. M., Jones. L., Sidell. M. (eds) (1993) The changing boundaries of health. The Macmillan press Ltd. Hampshire. Beattie. A. (1987) Making the curriculum work inAllan. P, Jolley. M. (eds) The curriculum in nursing education. Chapman Hall. London. Blaxter. M. (1990) Health and lifestyles. Routledge. London. Borton. T. (1970) Reach, teach and touch. McCraw Hill. London. Boud. D., Keogh. R., Walker. D.(1985) Reflection: turning experience into learning. Routledge falmer. London. Bulman. C., Schutz. S. (2004). Reflective practice in nursing (3rd ed). Blackwells publishing. Oxford. Burns. S., Bulman. C. (2000) Reflective practice in nursing: The growth of the professional practitioner. Blackwell Science. Oxford. Calnan. M. (1987) Health and Illness. Tavistock. London. Carper. A. (1978) Fundamental patterns of knowing in nursing. In Nicholl L H (Ed) Perspectives on nursing theory. Lippincott Company. Philadelphia. Cooper C. L. (1975) Theories of group processes. John wiley Sons. London. Cribb. A. (1998) The philosophy of health in nursing practice and health care a foundation text. Arnold. London Dewey. J. (1933) How we think: a restatement of the relation of reflective thinking to the education process. DC Heath co, Massachusetts. Fitzgerald. M. (1994) Theories of reflection for learning. in Reflective practice in nursing, A. Palmer. S. Burns. (eds). Blackwell scientific. Oxford. Gibbs. G. (1998) Learning by doing: a guide to teaching and learning methods. FEU. London. Greenwood. J. (1993) Reflective practice: a critique of the work of Argyris Schon. Journal of Advanced Nursing. 19. 1183 1187. Hamill. C. (1999) Academic essay writing in 1st person: a guide for undergraduates. Nursing Standard. 13 44 38-40. Hardey. M. Mulhall. A. (1994) Nursing research Theory and practice Chapman Hall. London. Hawkes. N. (2008) New laws to govern alternative medicine. TimesOnline http://www.timesonline.co.uk/tol/life_and_style/health/article3134337.ece (accessed 6th January 2008). Jarvis. P. (1992) Reflective practice and nursing. Nurse education today. 12. 174 181. Johns. C. (1995) Framing learning through reflection with Carpers fundamental ways of knowing in nursing. Journal of Advanced Nursing. 22. 226-234. Johns. C. (1995) Achieving effective work as a professional activity. In Schober. J. E., Hinchcliff. S. M. (eds). Towards advanced practice: key concepts for healthcare. Arnold. London Jones. L. J. (1994) The social context of health and health work. Macmillan press. Basingstoke. Kolb. D. A. (1984) Experiential Learning: Experience as the source of learning and development. Prentice Hall. New Jersey. Malmberg. K. A., Efendic. S., Ryden. L. E. (1994) Feasibility of Insulin-Glucose Infusion in Diabetic patients with acute myocardial infarction Diabetes Care 17(9) 1007-1014 Malmberg. K. A., Efendic. S., Ryden. L. E., Herlitz. J., Nicol. P., Waldenstrom A., Wedel. H., Welin. L. (1995) Randomised Trial of Insulin-Glucose Infusion followed by Subcutaneous Insulin treatment in Diabetic patients with Acute Myocardial Infarction (DIGAMI Study) : Effects on Mortality at 1 year Journal of American College of Cardiology 26(1) 57-65 Malmberg. K. A. (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus British Medical Journal 314, 1512-5 McKeown. T., Lowe. C. R. (1974) An introduction to modern medicine Blackwell scientific publications. Oxford. Moon. J. (1999) Reflection in learning and development. Theory and practice. Routledge Falmer. Oxon. Naidoo. J., Wills. J. (2000) Health promotion foundations for practice (2nd ed). Balliere Tindall. London. New York. NMC. (2002) Requirements for pre-registration nursing programmes. NMC publications. London. NMC (2004) The code of professional conduct: standards for conduct, performance and ethics. NMC publications. London. 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A study on narrative therapy being emotionally focused

A study on narrative therapy being emotionally focused When one imagines a spouse coming home from work there is usually a question asked in the scenario, how was your day? Now in the household I grew up that question was usually responded to with a story or anecdote as oppose to a simple fine or bad. My family has always been emotionally open, but generally withdrawn from using the emotion words like happy or sad instead explaining their days through the events. I think that narrative therapy has much potential to be emotionally focused, and still accept the social constructs we all are inundated with from birth. In many ways narrative therapy celebrates life as two stories intertwine with one another and the therapist is not the expert, but an interested collaborator. Rather than look for pathology or flawed functioning couples the therapist works to develop awareness of problematic discourse and offer couple the opportunity to describe and evaluate the effects of those discourses on their relationship. (Freedman Combs, 2008) I full-heartedly agree with narrative therapies take on goal setting. By being too specific in any goals life possibilities are eliminated and single-mindedness tends to reign supreme in ones mind. Life has a fluidity that presents and eliminates obstacles. Goals do not always account for these variations. The goal setting of narrative therapy is to help the narrative remain fluid from moment to moment and what positive emotions can be reached. (Freedman Combs, 2008) I think that objectivity is a key component to solving dysfunction and once two people become too enmeshed in a conflict, objectivity disappears. Working with narratives is an excellent way to separate oneself from a conflict and see a perspective without as much irrationality. The couple in the provided scenario is losing objectivity in their current worldview of soon to be married professionals. Narrative therapy is not a concrete process with a list of events that have to occur before the next step can occur. It is a more cyclical process that allows the therapist and couple the ability to move back and forth between the processed goals. That does not mean a regression in thinking will not happen, but narrative therapy is based on building forward a story that has its own ebbs and flows. It is the role of the therapist to guide and advise the client in ways to construct the narrative. (Brimhall, Gardner, Heline, 2003) I thought of narrative therapy when I started thinking about the couple in the scenario, because with only three months before the wedding I feel that constructing a narrative would work with the time period available. Narrative therapy has a free structure that has a distinct jumping off point, but overall a structure that has chapters that include emotions one can return to. I would personally be weary of how many sessions I would be able to have with this couple with their wedding being so close. The first thing to do in the initial session and assessment with the couple in the scenario is have them identify their problem. Ask them to give a name to the problem, associate the emotions with the problem, and identify the alteration in each member of the couples lives and relationships due to the problem. The couple stated that the problem is constantly getting into fights and cannot discuss anything without being angry and defensive. For the sake of brevity the problem will be shortened to fighting. The next thing is to construct the narrative that leads up to the anger, fights, and defensiveness. While the narrative approach is based on the clients being the experts on their own lives, a therapist must still assess disorders, dysfunctions, and negative thoughts. The therapist is also responsible for making the dialogue progress so that all the necessary emotions and cognitions about the relationship emerge. It is easy to see one side of the couple dominate the narrative. Each member of the couple should have equal time to present their own narrative and the therapist should make sure of this. One member of the couple tells his or her narrative of the relationship to the therapist while the other partner listens. The therapist reiterates it back to make sure everything is clear. This gives the therapist the chance to reframe the narrative structure and encourages the listening partner to understand the narrative from an objective viewpoint. Then the same process happens with the other partner. Each partner must feel that their own story has been heard. One partner should not dominate the session. After each partner has shared his narrative then the therapist has a clear vision of all the problems which in this couples case are anger and defensiveness. Ultimately, I think there should be a completely shared narrative also, but that is idealistic. The couple spins the narrative in the sessions a greater understanding of the relationship between couple and problem presented in the narrative. By mapping the influence understanding of the problem a therapist can begin to trace back where and when the fighting started. (Corey, 2009) This couple does not have an enormous history of fighting, so the historical precedent can be traced to an origin point. I would also work on preferred points in the relationship. Both members of the couple could benefit from positivity with questions such as what initially attracted you two to one another? What kinds of things do you like to do together? What do you most appreciate about your partner? Exploring the narratives of the successful times of the couples relationship can be just as much a positive benefit as looking at their problems. The therapist can begin to see the patterns that emerge in each narrative where the named problem is present. From this point, hopefully with rapport built, it will be time to start externalizing the narrative the couple has presented. Externalization means a new and more objective perspective and the ability to re-author the narrative into alternative meanings. The externalization of conversations is the key to an objective attitude when in an emotionally charged situation. Part of externalization is the need to know their relationship with the problem. How does the fighting start? What makes the fighting worse? What makes the fighting stop? These are all questions each partner should address when looking at the relationship with the problem. There is a very good chance that the couple will each have their own answers to these fighting relationship questions, but it is of the utmost importance to note both partners have a relationship with the problem. (Freedman Combs, 2008) The co uple should then start seeing each others narratives and the attached emotions. It is really important to monitor each clients emotions and follow them up with additional emotionally focused questions. Just because the couple has a better emotional understanding does not mean hurt feelings and negativity cannot appear, especially in early stages. If needed returning to positive questioning and the preferred time could be part of the strategy. The next step is the search for unique outcomes. This is to search for moments during the problem that point to success regarding the problem. (Corey, 2009) What are the exceptions to the problem? I like to think of the lessons learned of unique outcomes is like capturing lightning in a bottle. Is there anything that this couple can do to recreate the incident that stopped the fighting? These unique outcomes often are accompanied by events that cannot be recreated. When that unique outcome is found a new story can be formed. With this unique outcome solutions are starting to materialize amongst the couple. More history should be evaluated amongst the clients. After restructuring clients start determining the pattern of negativity and they have the ability to team-up against the problem that is sabotaging their relationship. (Johnson, 2004) It is important to see all members of the counseling party united against a common goal now. After progress with the couple and successful externalization of narratives the couple will talk directly to each other instead of dialogue being filtered through the therapist. The therapist still acts as the guide and monitors the dialogue to avoid or counter-act the relational problems and the regressions from the prefered story. Hopefully, the couple has moved past the strict turn based structure initially presented amongst the first sessions, but still respects each others dialogue. (Brimhall, Gardner, Heline, 2003) With the scenarios couple the therapist has to monitor awareness of anger and defensiveness and point out the problem when it arises. When a couple is aware of the path their narrative is takin g they actively try to avoid the problem and restructure the dialogue of the narrative. The therapist is trying to pursue unconditional positive regard between the partners without having them discount their emotions. After they have finished the therapist guided sessions the clients should have created a mutual preferred narrative and start complete non-turn based dialogue based on a solution focused result. The positive regard is more apparent in the couple and they are able to focus on unique outcomes.The couple now has new interactions and alternative stories. The couple is in the last stages of their therapy and have an awareness of their problems and strategies for coping with regression back into the problem. The narrative is now ready to be solidified. This stage is close to termination with the couple. The couple now has a unique preferred narrative that both partners have contributed to. This story contains positive outlooks and more objective views. This concrete preferred narrative is also fused with positive emotions and noticeable cooperation attacking the problem from both partners. Bringing in an outside party to share the completion of the new narrative is an improtant activity for the client to participate in. This shows the client has completed a goal. I believe external validation away from therapy couch is necessary to promote growth in any problems, whether individual, conjoint, or group. This demonstrates self-confidence in the client as well and shows they are self-reliant when facing their problems. (Brimhall, Gardner, Heline, 2003) The only step left for the couple now is to prepare for the future. The couple can now circumvent their problems of anger, defensiveness, and can use externalizing questions to explore emotions and attain an objective perspective on their problems. There are steps that this couple learned that they can use for the rest of their relationship. The theory of narrative couples therapy has many diverse skills a couple can learn to help them through relationship problems and prepare them for the future. The therapist can combine many aspects of different theories in narrative, including emotionally focused therapy so they can attack client problem from many different angles.

Prejudice and Racial Segregation on Campus Essays -- Sociology Racism

Racial Segregation on Campus      Ã‚  Ã‚   The practice of ethnic separation and segregation is common on every college and university campus. Since this practice has happened through history, it is remarkable that this has only been recognized recently as a true problem (Jacobs, 2). Segregation has hampered America as long as it has existed. Ethnicity and segregation was nearly the cause of this country splitting apart during the Civil War. Since then reformation and hard work has attempted to bring unity to this country. Though today, college students have regressed, university pupils are "standing by" their own and are not branching out to those who are unlike them in ethnicity. People in general, but more specifically college students are segregated in their lives ( Kramer, 12). From the way they act, what they do or do not do, the type of people they socialize with, to where people sit - students are split. College students group together as a result of ethnicity at events and establishments or locations on university campuses.    Let me explain where I am coming from,so you may understand my aim in writing this article. In order for people to understand or realize the issue at hand, I first wanted to explain the explain the problem. Because these happenings effect you the reader along with most people in our society. Then I would like to give you examples of the issue in ways you can relate to it. I wanted to put the issue on a real level for you, which I initially attempted in the opening paragraph. Following that I will attempt to illustrate why this subject is relevant to our society and important to you. This is a topic in which I feel very deeply about, so what I am writing is real, worth reading, and is for you. ... ...: McGraw - hill, 1997. * Higher Learning. Videocassette. John Singleton. Columbia Pictures, VHS. 120 min., 1994. * Howe, Jeff. " Race Divides...". Link, The College Magazine. New York : College Television Network., pg 18-25. 1998. * Jacobs, Jerry A. "Gender, Race, and Ethnic Segregation Between and within Colleges." Pennsylvania : University of Pennsylvania, Department of Sociology, 1996. Available: http://av.yahoo.com/bin/query?p=ethnic+segregation+in+colleges&b=21&hsO * Kramer, Martin, and stephen S. Weiner. Dialogues for diversity : community and ethnicity on campus. Phoenix, Ariz. : Oryx Press, 1994. * Orfield, Gary. Dismantling desegregation : the quit reversal of Brown vs. Board of Education. New York: W.W. norton & Company, 1996. * Myers, Samuel L. Desegregation in higher education. Washington, D.C. : University Press of America, 1988.

What A Day! :: Computers Internet Papers

What A Day! Pamela, Pamela, Pamela, what can I say she is a typical modern day mother. At work she is the woman who takes care of everyone else, she is the one who brings cookies and cakes everyday to share with everyone. I can see her now in her maroon 2001 Chrysler Mini van with vinyl interior so that the children don't mess up the seats! Driving along with her flowered dress, hair band, flat sandals, loads of jewelry and too much blue eye shadow, which by the way doesn't match her out fit, accompanied by her bulging purse that is filled with everything including the kitchen sink. This morning was a good one; she had orange juice with coffee, blueberry pancakes with butter and syrup. She isn't up in time very many mornings to make a full breakfast for herself, her three children and her husband; well you might as well say her four children. She just got her red hair permed and teased just the way she likes it a few days ago. Pamela is just so stylish in her everyday attire. Somehow s he finds the time to read her favorite book The Client, by John Grisham, and every once in awhile she even gets to watch her favorite movie Where the Heart Is. After a long day in the office as a secretary she is comforted to know that only four more weeks and she off to Disney World for a week of summer vacation with her kids. Pamela just got home from work. Each day after she gets home she reads her emails from her friends, which usually are about the most recent gossip. Today Pamela got an email that was quite frightening. The email was a forward from her friend Danielle and it contained a link to a website which was about a deadly chemical called dihydrogen oxide. This awful chemical is odorless, colorless, and tasteless, but it kills thousands of people each year. Pamela became scared and called her three children in the room with her to read about this terrible chemical. She continued to read her email aloud: â€Å"Most of the deaths caused by DHO are by accidental inhalation. Prolonged exposure to the chemical in its solid form can cause severe tissue damage.

MRSA infection in neonatal intensive care units

Methicillin-resistant S. aureus strains increased in the U.S. from 2.4% in 1975 to 29% in 1991. Once established, MRSA is very difficult to eradicate. One of the biggest challenges is preventing cross-transmission of these organisms. Certain patients are more prone to infection and colonization by MRSA, and neonates in NICUs are a high-risk group (Finkelstein, 1999, 24). Risk factors for acquiring MRSA include prolonged hospitalization; a stay in an ICU or burn unit; previous antimicrobial therapy; surgical site infections; and exposure to colonized or infected patients. The majority of MRSA infections in neonates are primary bacteremias and pneumonias. MRSA infections have also been associated with increased morbidity and mortality, and greater hospital costs than those due to methicillin-sensitive Staphylococcus aureus (MSSA). Why are neonates more prone to MRSA infection? With regards to skin infection it has been shown that an infant's gestational age has a great impact on epidermal barrier function as measured by transepidermal water loss. Preterm infants younger than 28 weeks show decreased functioning of the epidermal barrier, placing them at risk for cutaneous bacterial infection (Kalia, 1998, 323). The skin barrier attains full function, similar to adult skin, by 2 to 4 weeks of age but can take as long as 8 weeks in extremely premature infants. Mandel et al. (2004, 161) conducted a retrospective analysis of the role of cutaneous abscess in sepsis. They found that in 22% of the newborn infants with nosocomial sepsis, cutaneous abscess was the underlying cause. Additionally, their immune systems are underdeveloped, with white blood cells-neutrophils in particular-moving more slowly than adults'. It's suspected that neonates become colonized with S. aureus soon after being placed in a nursery, with the umbilical stump as the site of initial colonization. Factors identified with MRSA outbreaks in NICUs include high infant-to-staff ratios and infection transmission through hand carriage by health care workers (AAP, 1997) Spread of MRSA Infection and prevention MRSA is found on the anterior nares, groin, and perineum, S. aureus is a normal part of the body flora. It's also a common pathogen, causing major infections in both compromised and uncompromised patients. The normal immune response of the body can overcome any MRSA attempt to infection, but in the intensive care due to reduced immune response, and bacterial resistance, these organisms van create havoc. In a report from Australia quoted by Park (2007, 26-27), it was shown that from 1992 to 1994, methicillin-resistant S. aureus (MRSA) infections caused only 8% of staphylococcal infections but from 1995 to 1998, there was an outbreak of MRSA infection in two Melbourne hospitals. Methods to halt the spread of MRSA outbreaks include reducing overcrowding and improving staffing patterns, treating umbilical cords with triple-dye, and bathing full-term infants with hexachlorophene. But unless strict adherence to infection control is maintained, it is not possible to control this infection. Handwashing is most important. The American Academy of Pediatrics recommends that neonatal nursery staff perform a three-minute handwash at the start of each shift, cleansing up to the elbows with an antiseptic soap and sponge brush (AAP, 1997). Infected neonates should be placed on contact precautions. Here the infant must be handled with gloves, and if possible, depending on the spacing available and the acute status of the infant, they should be assigned to isolated chambers (Larson, 1995, 259, 262). Hitomi etal (2000, 127), advocate the use of mupirocin as a nasal spray to control nasal carriage of MRSA in the hospital staff, which act as the greatest source of spread of this infection. Effects of Nosocomial MRSA infection According to the NNIS (2002), In 2000, 55.3% of S. aureus isolates causing nosocomial infections among patients hospitalized in intensive care units in hospitals reporting to the National Nosocomial Infection Surveillance System were resistant to methicillin. Nambiar etal(2003, 224) give an interesting account of the complications MRSA can cause in an intensive care setting. They describe an outbreak of MRSA, in which neonates had meningitis, blood stream infection (with its complications – soft tissue abscess, shock and a right atrial thrombus, suppurative thrombophlebitis, osteoarthritis of the distal femur and knee joint). Masanga (1999, 169) reported colonic stenosis after MRSA enterocolitis. The predisposing factors for neonatal MSSA enterocolitis include breast feeding from a mother with staphylococcal mastitis,an indwelling feeding catheter   and malnutrition. The clinical picture of MSSA enterocolitis in the neonate is characterized by acute onset of diarrhea and ileus. Necrotizing enterocolitis. intensive care including mechanical ventilation, indwelling feeding catheter, the use of antibiotics, the delay of feeding causing the lower acidity of gastric contents, hypoactive peristalsis and the change of bowel flora, conditions similar to those seen in postoperative patients most likely predisposed to abnormal MRSA growth and resultant enterocolitis. toxic shock syndrome (combination of erythema and thrombocytopenia, low-positive C-reactive protein (CRP) value, or fever), (Richtmann etal, 2000, 88-89, Takahashi, 2003, 234-35). Effect on parents The illness in the neonate is a great source of stress to the parents. Not only is the child separated from the mother, which leads to anxiety for the mother, and nursing problems. There occur problems of lactation, with breast engorgement and galactorrhoea. In addition, the mother is at a greater risk of catching infection from a septicemic child with pneumonia and exanthemas. Skin infection can spread via contact. Thus parents are at an increased risk from a child affected with MRSA infection. Treatment Prevention is the best treatment. This infection can be rapidly fatal in the neonates, particularly the preterm infants. Prompt recognition of the symptoms and active measures to prevent spread can reduce the morbidity and mortality. Cultures should be obtained for susceptibility determination in any child with a presumed S. aureus infection that is moderate to severe. The choice of empiric therapy, before susceptibility testing, and the choice of definitive therapy will depend on the local antibiotic resistance patterns, the tissue site and severity of infection, and the toxicity profile of the antibiotic. Vancomycin has been the traditional antibiotic employed for the treatment of MRSA pneumonia. It has been found, however, that problems with lung tissue penetration may limit the effectiveness of vancomycin   Similarly, daptomycin has been shown to have limited activity for pneumonia due to limited lung penetration and inhibition by surfactant. Linezolid has also recently been evaluated as a specific treatment for MRSA pneumonia, and found to have good lung tissue penetration capability (Bradley, 200575-77) Conclusions MRSA infection in the neonatal intensive care setting is associated with exceptional morbidity and mortality. Preventive measures are the key to victory against MRSA. Each unit has to chart out effective protocols of infection control and adhere to it with a strong will. References 1 Finkelstein LE etal(1999MRSA in NeonatesAm J Nurs, Volume 99(1).January.24 2   Kalia YN, Nonato LB, Lund CH, et al(1998) Development of skin barrier function in premature infants. J Invest Dermatol; 111:320-326 3 Mandel D, Littner Y, Mimouni FB, et al.( 2004) Nosocomial cutaneous abscesses in septic infants. Arch Dis Child Fetal Neonatal Ed; 89:F161-F162 4 American Academy of Pedaitrics and American College of Obstetricians and Gynecologists (1997)Guidelines for Perinatal care, 4th ed. Elk Grove Village, IL, The Academy, 5 PARK CH etal(2007). Changing trend of neonatal infection: Experience at a newly established regional medical center in KoreaPediatr Int, Volume 49(1).24–30 6 Larson, E. L(1995). APIC guideline for handwashing and hand antisepsis in health care settings. Am.J. Infect.Control 23:251-269. 7   Hitomi S, Kubota M, Mori N, et al(2005): Control of methicillin resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment. J Hosp Infect; 46: 123–129 8 National Nosocomial Infections Surveillance (NNIS) System Report. Data Summary from January 1992 to June 2001. Issued August 2001. Available at: http://www.cdc.gov/ncidod/hip/NNIS/members/members.htm #nnisreports. Accessed Mar 5 2007 9   Nambiar S, Herwaldt LA, Singh N (2003). Outbreak of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med, Volume 4(2).220-226 10 Masanga K etal (1999). Colonic Stenosis After Severe Methicillin-Resistant Staphylococcus Aureus Enterocolitis In A Newborn. Pediatr Infect Dis J, Volume 18(2).169-171 11 Richtmann R etal.(2000) Outbreak Of Methicillin-Resistent Staphylococcus Aureus (Mrsa) Infection On A Neonate Intensive Care Unit (Nicu): The Key Role Of Infection Control Measures. Am J Infect Control, Volume 28(1).February 88-89. 12 Takahashi N (2003). Neonatal toxic shock syndrome-like exanthematous disease (NTED). Pediatr Int, Volume 45(2).233–237 13 Bradley JS (2005). Newer antistaphylococcal agents Curr Opin Pediatr, Volume 17(1).71-77                           

Invention of the Laser Printer

The presentation Mr. Starkweather gave touched upon many points of entrepreneurship and perseverance. As we have learned, Mr. Starkweather’s major accomplishment was the invention of the laser printer. In today’s world this might not seem like that big of a deal, but there were many obstacles standing in the way of this invention. The idea of building a printer based on laser technology was foreign for the time period. When the idea was first proposed not one company wanted to put money towards the development.This rejection came with a great deal of defeat and a sense of hopelessness for Mr. Starkweather. Not only did he not let the critics drag him down, but he also had the determination to keep pushing the idea onto different printing companies. Kodak finally stepped up to the plate and offered a patent but no funding. Although the money wasn’t there, this was still a big step in the right direction. After much perseverance and experimentation the laser printe r was finally developed in 1959.Being able to prove all the companies that doubted the idea was an overwhelming feeling of accomplishment for Mr. Starkweather. This new technology was able to print original copies straight from your computer. This machine was ground breaking for the time period and was able to significantly improve the functionality of offices across America. After being able to reflect upon Mr. Starkweather’s presentation I realized that even though people might not accept your ideas at first it is important not to give up.The rejection you receive should only be an indication to further your research and prove how your idea can be practical and advantageous. By giving up on your own idea due to someone else’s reaction, we are falling into peer pressure and tricking ourselves into thinking we are failures. Mr. Starkweather not only risked his pride but he also risked his employment. Not only was he able to prove what was thought to be the impossible p ossible, but he was able to jump start a new way of life.In today’s world we are now able go to our local Wal-Mart and pick up one of these laser printers for under $100. It is very ironic how something we take for granted today, took so much time and rejection 50 plus years ago. This presentation was not only important for the business majors but it could have also done a great job at inspiring the rest of the school. After finding out how much rejection Mr. Starkweather endured and how much of a success his idea became, I was very impressed and caused me to reflect upon how I would act if I was put into a similar situation.