Act According to Your Real Nature Essay Example | Topics and Well Written Essays - 750 words

Act According to Your Real Nature - Essay Example One monkey pretended that it was about to faint, but in reality, its health condition was not that tragic. But another young monkey that began to cry, invited the attention of all. â€Å"I saw some flies land on my banana and I am sure that they are the agents of dengue. I suggest that we lodge the bananas in our mouth, one on each side, for the safety of our health. We are certainly not eating the bananas.† The suggestion was accepted and the monkeys complimented the young one for his foresight and concern. Some time passed by. â€Å"Since the health issue has cropped up, I need to say something,†. I stay on a tree adjacent to the private hospital of a reputed doctor. I have heard doctors often discuss with nurses and patients that the food items need to be chewed properly, to assist the process of digestion. Why not chew the bananas and keep the stuff ready to swallow, the moment the fast is terminated?† They chewed and chewed, and they did not realize when the food reached their stomach through the food pipe. The entire exercise was over in minutes, and all the monkeys, including the senior citizen, had a hearty laugh. â€Å"Never attempt anything that which is not in your real nature,† the senior citizen repeated the advice. I recall what Ronald R. Sims argued, â€Å"Human Resources management is particularly concerned with all the activities that contribute to successfully attracting, motivating, and maintaining a high-performing workforce that results in organizational success.†

Critical Thinking - Inductives & deductive reasoning Essay

Critical Thinking - Inductives & deductive reasoning - Essay Example The argument builds on likelihood of commonness between acquaintances in order to include an additional train that could be common for the two. The premise of this argument is the statement that gives details the close relationship involving the two ladies. The premises try to establish the commonness of the two girls. In this case, the girls are friends and moreover, both of them like fishing and climbing rocks. This argument is inductive because the premises present some evidence to support the truthfulness of the conclusion. Furthermore, nobody can determine its validity or invalidity. Only a comparison can be used to challenge the argument. The conclusion needs not to be certain. According to Teitelbaum & Wilensky (2013), this is a process of reasoning based on one or more statements in order to arrive to a logically certain conclusion. These types of reasoning need to connect premises with conclusion. Deductive reasoning relies on clear and true rules of logic to reach a necessarily true conclusion. In the argument, ‘’ there must be something incorrect with the engine of my truck’’ is the premise that needs to be ratified as true. In deductive logic, this premise will require to be supported with a conclusion that can either be validated or invalidated. In the argument, the conclusion is the fact that the truck’s engine failed to start. In this case, there are two outcomes of the logic: if the car fails to start, it implies that the premise is true, on the other hand, if the engine starts, therefore the premise is untrue. The reasoning illustrated above is a deductive reasoning. This is because the certainty of the conclusion can be established in order to validate or invalidate the premises. In this, someone just requires starting the car’s engine and thus the truth is

OUR CLASSIFICATION AND DIVISION ESSAY Example | Topics and Well Written Essays - 750 words - 2

OUR CLASSIFICATION AND DIVISION - Essay Example Moreover I have watched churchgoers closely even from my childhood. â€Å"Division is the process of breaking a whole into parts; classification is the act of sorting individual items into categories† (Kirszner &Mandell) During the course of my school studies I forced to study in different schools which were distant from my home. So I stayed in school hostels and got lot of opportunities to interact with different types of people; Extrovert persons will always talk too much and will comment on any subjects even if they don’t have any idea of what they were talking about or the subject they were talking about. Extroverts always try to prove others that they were exceptionally smarter than others. They will quiet often jump into troubles because of their over smartness. On the other hand the introvert persons always talk little and they will never interfere in other’s personal matters. They will concentrate on what they were doing and will never make unnecessary comments on others. Moreover most of the introvert people I observed were intelligent people. â€Å"We readily accept labels like introvert and extrovert as immutable descriptions of ourselves† (You can change from introvert to extrovert - when you want to) Fat ones always eat too much and sleep too much. Most of them will never participate in physical activities like sports and games which needs physical hard work. They will mostly concentrate on passive games like video games, card games, chess, caroms etc. On the other hand thin ones always exhibit better stamina and enthusiasm in participating in sports activities. They will always go for active games like football, cricket, tennis, badminton etc. â€Å"Simply being thin does not automatically qualify us as fit. As a matter of fact, the world is full of skinny fat people.† (Skinny Fat People) I am a sport loving person and hence a close observer of

Control cycles-a general model Essay Example for Free

Control cycles-a general model Essay A general model of organizational control includes four components that can operate in a continuous cycle and can be represented as a wheel. These elements are: 1. Setting a goal. Project goal setting goes beyond overall scope development to include setting the project baseline plan. The project baseline is predicated on an accurate. Work Breakdown Structure (WBS) process. Remember that WBS establishes all the deliverables and work packages associated with the project, assigns the personnel responsible for them, and creates a visual chart of the project from highest level down through the basic task and subtask levels. The project baseline is created as each task is laid out on a network diagram and resources and time durations are assigned to it. 2. Measuring progress. Effective control systems require accurate project measurement mechanisms. Project managers must have a system in place that will allow them to measure the ongoing status of various project activities in real time. We need a measurement system that can provide information as quickly as possible. What to measure also needs to be clearly defined. Any number of devices allow us to measure one aspect of the project or another; however, the larger question is whether or not we are getting the type of information we can really use. 3. Comparing actual with planned performance. When we have some sense of the original baseline (plan) and a method for accurately measuring progress, the next step is to compare the two pieces of information. A gap analysis can be used as a basis for testing the project’s status. Gap analysis refers to any measurement process that first determines the goals and then the degree to which the actual performance lives up to those goals. The smaller the gaps between planned and actual performance, the better the outcome. In cases whe re we see obvious differences between what was planned an what was realized, we have a clear-cut warning signal. 4. Taking action. Once we detect significant deviations from the project plan, it becomes necessary to engage in some form of corrective action to minimize or remove the deviation. The process of taking corrective action is generally straightforward. Corrective action can either be relatively minor or may involve significant remedial steps. At its most extreme, corrective action may even involve scuttling a nonperforming project. After corrective action, the monitoring and control cycle begins again. The control cycle is continuous. As we create a plan, we begin measurement efforts to chart progress and compare stages against the baseline plan. Any indications of significant deviations from the plan should immediately trigger an appropriate response, leading to a reconfiguration of the plan, reassessment of progress, and so on. Project monitoring is continuous, full-time cycle of target setting, measuring, correcting, improving, and remeasuring. MONITORING PROJECT PERFORMANCE As we discovered in the chapters on project budgeting and resource management, once we have established a project baseline budget, one of the most important methods for indicating the ongoing status of the project is to evaluate it against the original budget projections. For project monitoring and control, both individual task budgets and the cumulative project budget are relevant. The cumulative budget can be broken down by time over the project’s projected duration. The Project S-Curve: A Basic Tool As a basis for evaluating project control techniques, let us consider a simple example. Assume a project (Project Sierra) with four work packages (Design, Engineering, Installation, and Testing), a budget to complete of $80,000, and an anticipated duration of 45 weeks. To determine project performance and status, a straightforward time/cost analysis is often our first choice. Here the project’s status is evaluated as a function of the accumulated costs and labor hours or quantities plotted against time for both budgeted and actual amounts. We can see that time (shown on the x, or horizontal, axis) is compared with money expended (shown on the y, or vertical, axis). The classic project S-curve represents the typical form of such a relationship. Budget expenditures are initially low and ramp up rapidly during the major project execution stage, before starting to level off again as the project gets nearer to its completion. Cumulative budget projections for Project Sierra have been plotted against the project’s schedule. The S-curve figure represents the project budget baseline against which budget expenditures are evaluated. Monitoring the status of a project using S-curves becomes a simple tracking problem. At the conclusion of each given time period (week, month, or quarter), we simply total the cumulative project budget expenditures to date and compare them with the anticipated spending patterns. Any significant deviations between actual and planned budget spent reveal a potential problem area. Simplicity is the key benefit of S-curve analysis. Because the projected project baseline is established in advance, the only additional data shown are the actual project budget expenditures. The S-curve also provides real-time tracking information in that budget expenditures can be constantly updated and the new values plotted on the graph. Project information can be visualized immediately and updated continuously, so S-curves offer an easy-to-read evaluation of the project’s status in a timely manner. (The information is not necessarily easily interpreted, however, as we shall see later.) Our Project Sierra example can also be used to illustrate how S-curve analysis is employed. Suppose that by week 21 in the project, the original budget projected expenditures of $50,000. However, our actual project expenditures totaled only $40,000. In effect, there is a $10,000 budget shortfall, or negative variance between the cumulative budgeted cost of the project and its cumulative actual cost. In the table it shows the track of budgeted expenditures with actual project costs, including identifying the negative variance shown at week 21. In this illustration, we see the value of S-curve analysis as a good visual method for linking project costs (both budgeted and actual) over the project’s schedule. S-CURVE DRAWBACKS When project teams consider using S-curves, they need to take the curve’s significant drawbacks into consideration as well as their strengths. S-curves can identify positive and negative variance (budget expenditures above or below projections), but they do not allow us to make reasonable interpretations as to the cause of variance. Consider the S-curve shown. The actual budget expenditures have been plotted to suggest that the project team has not spent the total planned budget money to date (there is negative   variance). However, the question is how to interpret this finding. The link between accumulated project costs and time is not always easily resolved. Is the project team behind schedule (given that they have not spent sufficient budget to date) or might there be alternative reasons for the negative variance? Assume that your organization tracks project costs employing an S-curve approach and uses that information to assess the status of an ongoing project. Also assume that the project is to be completed in 12 months and has a budget of $150,000. At the six-month checkup, you discover that the project S-curve shows significant shortfall; you have spent far less on the project to date than was originally budgeted. Is this good or bad news? On the surface, we might suppose that this is a sign of poor performance; we are lagging far behind in bringing the project along and the smaller the amount we have spent to date is evidence that our project is behind schedule. On the other hand, there are any number of reasons why this circumstance actually might be positive. For example, suppose that in running the project, you found a cost-effective method for doing some component of the work or came across a new technology that significantly cut down on expenses. In that case, the time/cost metric may not only be misused, but might lead to dramatically inaccurate conclusions. Likewise, positive variance is not always a sign of project progress. In fact, a team may have a serious problem with overexpenditures that could be interpreted as strong progress on the project when in reality it signals nothing more than their inefficient use of project capital resources. The bottom line is this: Simply evaluating a project’s status according to its performance on time versus budget expenditures may easily lead us into making inaccurate assumptions about project performance. Milestone Analysis Another method for monitoring project progress is milestone analysis. A milestone is an event or stage of the project that represents a significant accomplishment on the road to the project’s completion. Completion of a deliverable (a combination of multiple project tasks), an important activity on the project’s critical path, or even a calendar date can all be milestones. In effect, milestones are road markers that we observe on our travels along the project’s life cycle. There are several benefits to using milestones as a form of project control. 1. Milestones signal the completion of important project steps. A project’s milestones are an important indicator of the current status of the project under development. They give the project team a common language to use in discussing the ongoing status of the project. 2. Milestones can motivate the project team. In large projects lasting several years, motivation can flag as team members begin to have difficul ty seeing how the project is proceeding overall, what their specific contribution has been and continues to be, and how much longer the project is likely to take. Focusing attention on milestones helps team members become more aware of the project’s successes as well as its status, and they can begin to develop greater task identity regarding their work on the project. 3. Milestones offer points at which to reevaluate client needs and any potential change requests. A common problem with many types of projects is the nature of repetitive and constant change requests from clients. Using project review milestones as formal â€Å"stop points,† both the project team and the clients are clear on when they will take midcourse reviews of the project and how change requests will be handled. When clients are aware of these formal project review points, they are better able to present reasonable and well-considered feedback (and specification change requests) to the team. 4. Milestones help coordinate schedules with vendors and suppliers. Creating delivery dates that do not delay project activities is a common challenge in scheduling delivery of key project components. From a resource perspective, the project team needs to receive supplies before they are needed but not so far in advance that space limitations, holding and inventory costs, and in some cases spoilage are problems. Hence, to balance delays of late shipments against the costs associated with holding early deliveries, a well-considered system of milestones creates a scheduling and coordinating mechanism that identifies the key dates when supplies will be needed. 5. Milestones identify key project review gates. For many complex projects, a series of midterm project reviews are mandatory. For example, many proj ects that are developed for the U.S. government require periodic evaluation as a precondition to the project firm receiving some percentage of the contract award. Milestones allow for appropriate points for these review. Sometimes the logic behind when to hold such reviews is based on nothing more than the passage of time (â€Å"It is time for July 1 review†). For other projects, the review gates are determined based on completion of a series of key project steps (such as the evaluation of software results from the beta sites). 6. Milestones signal other team members when their participation is expected to begin. Many times projects require contributions from personnel who are not part of the project team. For example, a quality assurance individual may be needed to conduct systems tests or quality inspection and evaluations of work done to date. The quality supervisor needs to know when to assign a person to our project, or we may find when we reach that milestone that no on e’s available to help us. Because the QA person is not part of the project team, we need to coordinate his or her involvement in order to minimize disruption to the project schedule. 7. Milestones can delineate the various deliverables developed in the work breakdown structure and therefore enable the project team to develop a better overall view of the project. You then are able to refocus efforts and function-specific resources toward the deliverables that show signs of trouble, rather than simply allocating resources in a general manner. For example, indications that the initial project software programming milestone has been missed allows the project manager to specifically request additional programmers downstream, in order to make up time later in the project’s development. Problems with Milestones Milestones, in one form or another, are probably the simplest and most widely used of all project control devices. Their benefits lie in their clarity; it is usually easy for all project team members to relate to the idea of milestones as a project performance metric. The problem with them is that they are a reactive control system. You must first engage in project activities and then evaluate them relative to your goal. If you significantly underperform your work to that point, you are faced with having to correct what has already transpired. Imagine, for example, that a project team misses a milestone by a large margin. Not having received any progress reports up until the point that the bad news becomes public, the project manager is probably not in a position to craft an immediate remedy for the shortfall. Now, the problems compound. Due to delays in receiving the bad news, remedial steps are themselves delayed, pushing the project farther behind. EARNED VALUE MANAGEMENT An increasingly popular method used in project monitoring and control consists of a mechanism that has become known as Earned Value Management (EVM). The origins of EVM date to the late 1960s when U.S. government contracting agencies began to question the ability of contractors to accurately track their costs across the like of various projects. As a result, after 1967, the Department of Defense imposed 35 Cost/Schedule Control Systems Criteria that suggested, in effect, that any future projects procured by the U.S. government in which the risk of cost growth was to be retained by the government must satisfy these 35 criteria. In the more than 30 years since its origin, EVM has been practiced in multiple settings, by agencies from governments as diverse as Australia, Canada, and Sweden, as well as a host of project-based firms in numerous industries. Unlike previous project tracking approaches, EVM recognize that it is necessary to jointly consider the impact of time, cost, and project performance on any analysis of current project status. Put another way: Any monitoring system that only compares actual against budgeted cost numbers ignores the fact that the client is spending that money to accomplish something-create a project. Therefore, EVM reintroduces and stresses the importance of analyzing the time element in project status updates. Time is important because it becomes the basis for determining how much work should be accomplished at certain milestone points. EVM also allows the project team to make future projections of project status based on its current state. At any point in the project’s development we are able to calculate both schedule and budget efficiency factors (the efficiency with which budget is being used relative to the value that is being created) and use those values to make future projections about the estimated cost and schedule to project completion. We can illustrate the advance in the project control process that Earned Value represents by comparing it to the other project tracking mechanisms. If we consider the key metrics of project performance as those success criteria discussed in Chapter 1 (scheduling, budget, and performance), most project evaluation approaches tend to isolate some subset of the overall success measure. For example, project S-curve analysis directly links budget expenditures with the project schedule. Again, the obvious disadvantage to this approach is that it ignores the project performance linkage. Project control charts such as tracking Gantt charts link project performance with schedule but may give budget expenditures short shrift. The essence of a tracking approach to project status us to emphasize project performance over time. While the argument could be made that budget is implicitly assumed to be spent in some preconceived fashion, this metric does not directly apply a link between the use of time and performance factors with project cost. Earned value, on the other hand, directly links all three primary project success metrics (cost, schedule, and performance). This methodology is extremely valuable because it allows for regular updating of a time-phased budget to determine schedule and cost variances, as identified by the regular measurement of project performance. Terminology for Earned Value Following are some key concepts that allow us to calculate Earned Value and use its figures to make future project performance projections. PVPlanned value. A cost estimate of the budgeted resources scheduled across the project’s life cycle (cumulative baseline). EVEarned value. This is the real budgeted cost, or â€Å"value,† of the work that has actually been performed to date. ACActual cost of work performed. The cumulative total costs incurred in accomplishing the various project work packages. SPISchedule Performance Index. The earned value to date divided by the planned value of work scheduled to be performed (EV/PV). This value allows us to calculate the projected schedule of the project to completion. CPICost Performance Index. The earned value divided by the actual, cumulative cost of the work performed to date (EV/AC). This value allows us to calculate the projected budget to completion. BACBudgeted cost at completion. This represents the total budget for a project. Creating Project Baselines The first step in developing an accurate control process is to create the project baselines against which progress can be measured. Baseline information is critical regardless of the control process we employ, but baselines are elemental when performing EVM. The first piece of information necessary for performing earned value is the planned value; that is, the project baseline. The PV should comprise all relevant project costs, the most important of which are personnel costs, equipment and materials, and project overhead, sometimes referred to as level of effort. Overhead costs (level of effort) can include a variety of fixed costs that must be included in the project budget, including administrative or technical support, computer work, and other staff expertise use (such as legal advice or marketing). The actual steps in establishing the project baseline are fairly straightforward and require two pieces of data: the Work Breakdown Structure and a time-phased project budget. 1. The W ork Breakdown Structure identified the individual work packages and tasks necessary to accomplish the project. As such, the WBS allowed us to first identify the individual tasks that would need to be performed. It also gave us some understanding of the hierarchy of tasks needed to set up work packages and identify personnel needs (human resources) in order to match the task requirements to the correct individuals capable of performing them. 2. The time-phased budget takes the WBS one step further: It allows us to identify the correct sequencing of tasks, but more importantly, it enables the project team to determine the points in the project when budget money is likely to be spent in pursuit of those tasks. Say, for example, that our project team determines that one project activity, Data Entry, will require a budget of $20,000 to be completed, and further, that the task is estimated to require 2 months to completion, with the majority of the work being done in the first month. A ti me-phased budget for this activity might resemble the following: Activity| Jan| Feb| †¦| Dec| Total| Data Entry| $14,000| $6,000| | -0-| $20,000| Once we have collected the WBS and applied a time-phased budget breakdown, we can create the project baseline. The result is an important component of earned value because it represents the standard against which we are going to compare all project performance, cost, and schedule data as we attempt to assess the viability of an ongoing project. This baseline, then, represents our best understanding of how the project should progress. How the project is actually doing, however, is, of course, another matter. Why Use Earned Value? Assume that it is now week 30 of the project and we are attempting to assess the project’s status. Also assume that there is no difference between the projected project costs and actual expenditures; that is, the project budget is being spent within the correct time frame. However, upon examination, suppose we were to discover that Installation was only half-completed and Project Testing had not yet begun. This example illustrates both a problem with S-curve analysis and the strength of EVM. Project status assessment is only relevant when some measure of performance is considered in addition to budget and elapsed schedule. Consider the revised data for Project Sierra. Note that as of week 30, work packages related to Design and Engineering have been totally completed, whereas the Installation is only 50% done, and Testing has not yet begun. These percentage values are given based on the project team or key individual’s assessment of the current status of work package completion. The question now is: What is the earned value of the project work done to date? As of week 30, what is the status of this project in terms of budget, schedule, and performance? Calculating the earned value for these work packages is a relatively straightforward process. We can modify the previous table to focus exclusively on the relevant information for determining earned value. The planned budget for each work package is multiplied by the percentage completed in order to determine the earned value to date for the work packages, as well as for the overall project. In this case, the earned value at the 30-week point is $51,000. We can compare the planned budget against the actual earned value using the original project budget baseline. This process allows us to assess a more realistic determination of the status of the project when the earned value is plotted against the budget baseline. Compare this figure with the alternative method, in which negative variance is calculated, with no supporting explanation as to the cause or any indication about whether this figure is meaningful or not. Recall that by the end of week 30, our original budget projections suggested that $68,000 should have been spent. Instead, we are projecting a shortfall of $17,000. In other words, we are not only showing a negative variance in terms of money spent on the project, but also in terms of value created (performance) of the project to date. Unlike the standard S-curve evaluation, EVM variance is meaningful because it is based not simply on budget spent, but value earned. A negative variance of $10,000 in budget expenditures may or may not signal cause for concern; however, a $17,000 shortfall in value earned on the project to date represents a variance of serious consequences. Steps in Earned Value Management There are five steps in Earned Value Management (EVM): 1. Clearly define each activity or task that will be performed on the project, including its resource needs as well as a detailed budget.As we demonstrated earlier, the Work Breakdown Structure allows project teams to identify all necessary project tasks. It further allows for each task to be assigned its own project resources, including equipment and materials costs, as well as personnel assignments. Finally, coupled with the task breakdown and resource assignments, it is possible to create the budget figure or cost estimate for each project task. 2. Create the activity and resource usage schedules. These will identify the proportion of the total budget allocated to each task across a project calendar. Determine how much of an activity’s budget is to be spent each month (or other appropriate time period) across the project’s projected development cycle. Coupled with the development of a project budget should be its direct linkage to the project schedule. The determination of how much budget money is to be allocated to project tasks is important. Equally important is the understanding of when the resources are to be employed across the project’s development cycle. 3. Develop a â€Å"time-phased† budget that shows expenditures across the projects life.The total (cumulative) amount of the budget becomes the project baseline and is referred to as the planned value (PV). In real terms, PV just means that we can identify the cumulative budget expenditures planned at any stage in the project’s life. The PV, as a cumulative value, is derived from addin g the planned budget expenditures for each preceding time period. 4. Total the actual costs of doing each task to arrive at the actual cost of work performed (AC).We can also compute the budgeted values for the tasks on which work is being performed. This is referred to as the earned value (EV) and is the origin of the term for this control process. 5. Calculate both a project’s budget variance and schedule variance while it is still in process.Once we have collected the three key pieces of data (PV, EV, and AC), it is possible to make these calculations. The schedule variance is calculated by the simple equation: SV = EV – PV, or the difference between the earned value to date minus the planned value of the work scheduled to be performed to date. The budget, or cost, variance is calculated as: CV = EV – AC, or the earned value minus the actual cost of work performed. USING EARNED VALUE TO MANAGE A PORTFOLIO OF PROJECTS Earned Value Management can work at the portfolio level as well as with individual projects. The process simply involves the aggregation of all earned value measures across the firm’s entire project portfolio in order to give an indication as to the efficiency with which a company is managing its projects. Other useful information contained in the Portfolio Earned Value Management table includes the total positive variances for both budget and schedule, as well as determination of the relative schedule and cost variances as a percentage of the total project portfolio. The use of Earned Value Management for portfolio tracking and control offers top management an excellent window into the firm’s ability to efficiently run projects, allows for comparisons across all projects currently in development, and isolates both the positive and negative variances as they occur. All of this is useful information for top-level management of multiple projects.

The Assessment Process Of Patients In Intensive Care

The Assessment Process Of Patients In Intensive Care This essay will present a reflective account of communication skills in practice whist undertaking assessment and history taking of two Intensive Care patients with a similar condition. It will endeavour to explore all aspects of non verbal and verbal communication styles and reflect upon these areas using Gibbs reflective cycle (1988). Scenario A Mrs James, 34, a passenger in a road traffic collision who was not wearing a seatbelt was thrown through the windscreen resulting in multiple facial wounds with extensive facial swelling which required her to be intubated and sedated. She currently has cervical spine immobilisation and is awaiting a secondary trauma CT. Mr James was also involved in the accident. Scenario B Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and orientated but currently breathless and requiring high oxygen concentrations. Patients who are admitted to Intensive Care are typically admitted due to serious ill health or trauma that may also have a potential to develop life threatening complications (Udwadia, 2005). These patients are usually unconscious, have limited movement and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invasive procedures for the purpose of monitoring and regulation of physiological functions. Having the ability to effectively communicate with patients, colleagues and their close relatives is a fundamental clinical skill in Intensive Care and central to a skilful nursing practice. Communication in Intensive Care is therefore of high importance to provide information and support to the critically ill patient in order to reduce their anxieties and stresses. Effective communication is the key to the collection of patient information, delivering quality of care and ensuring patient safety. Gaining a patients history is one of the most important skills in medicine and is a foundation for both the diagnosis and patient clinician relationship, and is increasingly being undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is crucial. Often the patient is transferred from a ward or department within the hospital where a comprehensive history has been taken with documentation of a full examination; investigations, working diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this admission if it was not appropriate to do so. Where available patients medical notes can provide essential information. In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective communication is restricted and obtaining a comprehensive history would be inappropriate and almost certainly unsafe. The Nursing Midwifery Council promotes the importance of keeping clear and accurate records within the Code: Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). Therefore if taking a patients history is unsafe to do so, this required to be documented. Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy person is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has often been accompanied with other injuries such as traumatic brain injury and complications such as airway obstruction. This may have been caused by further swelling, bleeding or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. Within scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for over half of the thoracic injuries from non-penetrating trauma (Middle ton, 2003). When ribs are fractured due to the nature and site of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is pain. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effectively. These combined increase the risk of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003). The key issue of Intensive Care is to provide patients and relatives with effective communication at all times to ensure that a holistic nursing approach is achieved. Intensive care nurses care for patients predominantly with respiratory failure and over the years have taken on an extended role. They are expected to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a physical assessment and collect the patients history in a systemic, professional and sensitive approach. Effective communication skills are one of the many essential skills involved in this role. As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history and assessment taking process (Outlined in Appendix A). Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/Examination (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to blood cells and the oxygen cannot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid assessment, co ntinuity of care and the reduction of errors. Communication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, messages, opinions, speech and thoughts are transferred by different forms. Basic communication is achieved by speaking, sign language, body language touch and eye contact, as technology has developed communication has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication: Verbal and non verbal. Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, understood and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Zastrow, 2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and orientated and had some ability to communicate; he was breathless due to painful fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions can allow breathless patients to communicate without exerting themselves. Closed questions such as is it painful when you breathe in? or is your breathing feeling worse? can be answered with non verbal communi cation such as a shake or nod of the head. Taking a patients history in this way can be time consuming and it is essential that the clinician do not make assumptions on behalf of the patient. Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal communication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al, 2000). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and crossed legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Although Mr. James could verbally communica te, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles. A patients stay in Intensive Care can vary from days to months. Although this is a temporary situation and many patients will make a good recovery, the psychological impact may be longer lasting (MacAuley, 2010). When caring for the patient who may be unconscious or sedated and does not appear to be awake, according to Sisson (1990) hearing may be one of the last senses to fade when they become unconscious. Sedation is used in Intensive Care Units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony between the patient and ventilator. Poor sedation can lead to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. (Ramsey et all, 2000). Over sedation can lead to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care delirium. Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has be en associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation. Within this stage of sedation or delirium it is impossible to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological status would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore important to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch when a patient is being moved, washed or having a dressing changed and secondly a caring touch holding Mrs James hand to explain where she was and why she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of talking to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where ther e is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been. If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of communication process (Kirby, 1997). The Intensive Care environment in itself can cause communication barriers. Intensive Care can be noisy environment with monitor and ventilator alarms and general movement of patients and staff, ensuring effective communication with explanations of the alarms at all times can alleviate any anxieties the patient and relatives may have. Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength. Weakness of patients can affect the movement of hand s and arms making gestures and handwriting frustration and difficult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The University of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care. This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overall research (Alasad: 2005, Leigh: 2001, MacAuley, 2010: Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further education within Intensive Care may be requ ired to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contribution that others offer to improve patients care.

Suicide Or Ambicide Of Nella Laurens Passing English Literature Essay

Suicide Or Ambicide Of Nella Laurens Passing English Literature Essay The ending of Nella Larens Passing is famous for its ambiguity and obscurity; the death of Clare Kendry is never clear defined and vaguely stated. Despite this deliberate equivocation on the authors part, there is definitive evidence hidden within the text that Clares death is in fact a homicide. Clare Kendrys death was not a suicide; the one person who had constant and progressive reason for the murder Clare was her supposed friend, Irene Redfield. One of the main suspects in the death of Clare Kendry is her longtime childhood friend, Irene Redfield. Although they have known each other since they young, they drifted apart as they aged; it had been twelve years since she à ¢Ã¢â€š ¬Ã‚ ¦ had laid eyes on Clare Kendry (18). It is only through chance that these two were reunited, something that Irene would have rather left unchanged; Irene has repeatedly displayed a increasing desire to break ties with Clare, making many attempts à ¢Ã¢â€š ¬Ã‚ ¦ to tell Clare Kendry at once, and definitely, that it was of no use, her coming, à ¢Ã¢â€š ¬Ã‚ ¦ (64). These tactics ranged from not replying to Clares mail or phone calls, though it à ¢Ã¢â€š ¬Ã‚ ¦ rung like something possessed (32) to lying about her schedule and how she is à ¢Ã¢â€š ¬Ã‚ ¦ filled upà ¢Ã¢â€š ¬Ã‚ ¦ [and]à ¢Ã¢â€š ¬Ã‚ ¦ so sorry (23) that her could not be with Clare. Irene could have been avoiding Clare because she is envious of her looks and of how Clare is à ¢Ã¢â€š ¬Ã‚ ¦ exquisite, golden, fragrant, [and] flauntingà ¢Ã¢â€š ¬Ã‚ ¦ [how]à ¢Ã¢â€š ¬Ã‚ ¦her glistening hairà ¢Ã¢â€š ¬Ã‚ ¦ [and] à ¢Ã¢â€š ¬Ã‚ ¦ eyes sparking like dark jewels (74). Irene often à ¢Ã¢â€š ¬Ã‚ ¦ felt dowdy and commonplace (74) when compared to Clare. Another reason Irene wanted Clare to leave her controlled life was that she suspected Clare to be pursuing and infatuating with Brian, Irenes husband. As time passed, Brian à ¢Ã¢â€š ¬Ã‚ ¦ looked on à ¢Ã¢â€š ¬Ã‚ ¦ with the same tolerant amusement that marked his entire attitude toward Clare (79). Because of this, Irene often wondered what did it mean? [and] how it would affect her and the boys? (93) and often feared that à ¢Ã¢â€š ¬Ã‚ ¦ she didnt count, she was, to him, only the mother of his sons à ¢Ã¢â€š ¬Ã‚ ¦ [and that] à ¢Ã¢â€š ¬Ã‚ ¦ she was nothing. Worse. An obstacle (93). Regardless of Irenes reasons, her thoughts were steady turning darker, frequently questioning if Clare should die! Then Oh, it was vile! To think, yes, to wish that! (101). During the confrontation at the end of the novel, Clare Smiled a à ¢Ã¢â€š ¬Ã‚ ¦ smile that maddened Irene. She ran across the room, her terror fringed with ferocity, and laid a hand on hand on her Clares bare arm. [and that] She couldnt have her free (111). This quote showed Irenes determination and desperation for Clares disappearance, yet even though she acted in this murder, she stated that it was an accident, a terrible accident à ¢Ã¢â€š ¬Ã‚ ¦ [that] it was. This phrase confirms Irenes guilt in this homicide, by the act of denying any fault, solidifies her as the prime suspect in Clares murder. Even though there is substantial evidence the other character had a hand in Clares death, she has shown a rather unpredictable and melancholy state of mind; such a state of mind could lead to irrational thoughts such as suicide. She passed for white and abandoned her black heritage for monetary value; she believes that in fact, all things considered, I think Rene, that its even worth the price (28). Yet Clare feels trapped by her husband, John Bellows, racist views; even though she is black herself, John believes Clare to be white. He has made it clear that he à ¢Ã¢â€š ¬Ã‚ ¦ [drew] the line at that. No niggers in my family. Never have been and never will be (40). Despite the fact that she is in such a precarious position, she sought to be with Irene with reckless abandonment à ¢Ã¢â€š ¬Ã‚ ¦ to get the things I want badly enough, Id do anything, hurt anybody, throw anything away (81). Clare continues to visit Irene, requesting to accompany Irene to her various social parties and thro ugh her, to the black part of society that Clare abandoned long ago. Yet she à ¢Ã¢â€š ¬Ã‚ ¦ would if I could, but I cant à ¢Ã¢â€š ¬Ã‚ ¦ you cant realize how I want to see Negros, to be with them again, to talk with them, to hear them laugh (71). All of these lead to a volatile mixture of recklessness, desperation, loss of identity, and a sense of being trapped. These could have lead to her eventual suicide, when John Bellow discovered and confronted her about her race: Clare stood at the window, as composed as if everyone were not staring at her in curiosity and wonder, as if the whole structure of her life were not lying in fragments before her. She seemed unaware of any danger or uncaring. There was even a faint smile on her full, red lips, and in her shining eyes. (111) This quote exemplifies Clares increasing sense of detachment from the world around her; when she was confronted by her husband at the end of the novel, she felt trapped and chose to escape rather the face the reality of her situation. Yet all of this is merely speculation. The motives and thoughts of Clare Kendry are unknown and can only be interpreted through Irenes perception of Clares actions. On the other hand, Irenes mental process it often displayed through her own narrations and has show on numerous occasions to have entertained the idea of ridding herself of Clare.

Political Cartoons and Republicans :: essays research papers fc

Introduction   Ã‚  Ã‚  Ã‚  Ã‚  The Republican Party was founded by a coalition in 1854 and was comprised of former members of the Whig, Free-Soil, and Know-Nothing parties. The slavery issue shattered America’s established political landscape and catapulted the Republicans from what seemed like nowhere straight into the White House in 1860. After Fremont’s attempt at winning the presidency in 1856, Lincoln won the election four years later, cementing the Republican Party’s desire for executive power. In the aftermath of the Civil War, the United States found itself politically gridlocked. Neither the newly formed Republicans nor the Democrats were able to gain much traction. The decades after the Civil War saw some of the closest and most controversial races in American history. The Rutherford B. Hayes commissioned election victory is a great example as he had fewer popular votes than Sam Tilden, but won the election under the guise of the Electoral College. The 1888 electi on was also very close, as less than 100,000 votes separated the leading candidates; Benjamin Harrison again won by the rules of the electoral process but lost the popular vote. During the Gilded Age of American history, the mainstream political scene was superficial and intensely partisan, but the regular Joe loved it. â€Å"Despite the lack of issues,† writes Morton Keller, â€Å"balloting – and straight ticket voting – in the 1870’s and 1880’s was at or near the highest level in American history.† He also contends that policy had become subordinate to â€Å"the sumptuous display† of parades, bonfires, and pep rallies. Accompanying this era of political advertisement and propaganda, the political system itself depended upon a spoils and patronage allowance, which gave rise to political corruption.   Ã‚  Ã‚  Ã‚  Ã‚  Political cartoons and mass media grew up with the end of the Civil War as well. As Harper’s weekly, Judge, Puck, and the New York World all competed for popular acceptance, they helped reform the political corruption of the time. After the critical election of 1896, the nature of party conflict changed. The close competition between the parties in the post Civil War period was replaced by Republican dominance. Mckinley’s defeat of William Jennings Bryan in 1896 and 1900 was followed by Republican victories in every presidential election until 1932, except for Woodrow Wilson’s victories in 1912 and 1916. This will be explored later. As the Republicans also controlled Congress from 1896 to 1930, except for during Wilson’s tenure, they were dominant everywhere but the South.