Sample Common Application Essayâ€Topic of Your Choice

Alexis chose option #7 for her Common Application essay. This is the popular topic of your choice option on the 2018-19 application. The question asks, Share an essay on any topic of your choice. It can be one youve already written, one that responds to a different prompt, or one of your own design. The other six essay options on the Common Application give applicants so much flexibility that it is rare for a topic not fit elsewhere, but in some cases the topic of your choice is indeed the best choice. This is true for Alexiss essay below. Sample Essay on the "Topic of Your Choice" Option My Hero Harpo In middle school, I took part in an essay competition where we had to write about one of our strongest role models—who they were, what they did, and how they had influenced us. Other students wrote about Eleanor Roosevelt, Amelia Earhart, Rosa Parks, George Washington, etc. I, the youngest of five sisters and one of the quietest people in the school, chose Harpo Marx. I did not win the competition—to be honest, my essay wasn’t very good, and I knew that, even at the time. I had bigger, better things to worry about, though. I was taking swimming lessons, and was terrified of discovering a shark in the deep end. I was making little hats for my dog Alexa, which she did not appreciate. I was busy working on a clay chess set in art class, and learning how to garden with my grandmother. I’m getting off-topic, but my point is: I didn’t need to win a competition or write an essay to feel validated. I was learning who I was, and what was important in my life. Which brings me back to the Marx Brothers. My great-uncle was a big old-movie buff. We’d go over to his house most mornings during summer vacation, and watch Philadelphia Story, The Thin Man, or  His Girl Friday. My favorites, though, were the Marx Brothers’ films. Duck Soup. A Night at the Opera (my personal favorite). Animal Crackers. I can’t logically explain why I found these particular movies so hilarious and entertaining—there was something about them that not only made me laugh, but made me happy. Now, of course, watching those movies again, I’m reminded of those summer mornings, and of being surrounded by the people I loved, unconcerned with the world outside, that adds another layer of appreciation and joy. The brothers each brought their own unique humor to the pictures, but Harpo—he was perfect. The hair. The wide ties and crazy trench coats. The way he doesn’t have to say anything to be funny. His facial expressions. How he offers people his leg when they try to shake his hand. The way you can see the change in him when he sits down at the piano or the harp. The subtle shift from comedian to musician—not a complete shift, of course, but in that moment, you know just how talented and hard-working he must have been. I love that rather than being a full-time, professional musician, which he certainly could have done, Harpo (known as Adolph off-screen) instead devoted his time and energy to entertain, to make people laugh, to be a big goof with a bicycle horn and a killer whistle. I identified with him—and still do. Harpo was quiet, funny-looking, not the most outgoing or famous performers, silly, and still insanely dedicated and a serious artist. I don’t plan on going into show business. I mean, never say never and all that, but I don’t see myself as ever really getting bitten by that particular acting or performing bug. But the lessons I’ve learned from Harpo (and Groucho, Chico, Zeppo, etc.) are the kind that can transcend careers. It’s ok to fall down (a lot.) Learn to laugh at yourself. Learn to laugh at your family. Making faces is a perfectly good way to express yourself. Wear the weird clothes. Don’t be afraid to show off your talents when given the chance. Be kind to children. Have a cigar, if you want. Make up a silly song, or a goofy dance. Work hard at what you love. Work hard at what you don’t love, but what is still necessary. Don’t shy away from being the strangest, brightest, wildest, wackiest, passionate you you can be. And also carry a bicycle horn with you, just in case. A Critique of Alexis's "Topic of Your Choice" Essay With the topic of your choice essay option, one of the first issues to consider is whether or not the essay should have been presented under one of the more focused Common Application prompts. Its easy to be lazy and simply choose topic of your choice to avoid thinking too hard about the most appropriate fit for an essay. For Alexiss essay My Hero Harpo, the topic of your choice option does, in fact, work well. The essay could potentially fall under Common Application essay option #5 on a realization that sparked a period of personal growth. Alexiss experiences watching Marx Brother movies did lead to an understanding of personal identity and life balances. That said, an essay on comedic actors doesnt quite fit the general seriousness of the option #5 prompt. Now lets breakdown some of the important elements of Alexiss essay: The topic. Harpo Marx is a rather unusual focus for an admissions essay. This can be a good thing, for Alexiss essay wont be a clone of other essays the admissions office receives. At the same time, one could argue that Harpos slapstick comedy is a rather superficial focus for an application essay. This certainly could be true if the subject matter were handled poorly, but Alexis manages to turn an essay focused on Harpo Marx into an essay that is really about much more than Marx. Alexis identifies with Harpo, and she explains why she identifies with him. In the end, the essay is as much about Alexis as it is Harpo. It is an essay that reveals Alexiss self-awareness, analytical skills, and sense of humor.The tone. Many applicants wrongly assume that an application essay needs to shine a bright light on a writers accomplishments while hiding any warts. The reality, however, is that were all quirky, flawed, complex people. Revealing an awareness of this fact is a sign of maturity, and it will often play well in an admissions essay. Alexis succeeds admirably on this front. The overall tone here is conversational and slightly self-deprecating. Alexis identifies with Harpos goofiness and his decision to focus on bringing happiness to others rather than personal prestige. We finish Alexiss essay with a sense that she is reserved, silly, able to laugh at herself, yet quietly confident. The overall impression is certainly a positive one.  The writing. Alexiss language is clear and engaging, and she avoids common stylistic errors. The essay has a strong voice and personality. The essay does, in fact, have several sentence fragments, but these are clearly used deliberately for rhetorical punch, not because Alexis is a grammatically inept writer.  The impact. Its always important to step back from an application essay and consider the big picture: what will a reader take away from the essay? Alexiss essay doesnt present any remarkable accomplishment or impressive tale nt. It does, however, present a student who is thoughtful, self-aware, generous, talented, and quietly ambitious. Does Alexis come across as someone who the admissions folks would want to join their campus community? Yes. Make Your Essay as Strong as Possible If a college requires you to submit an essay with the Common Application, it is because the school has holistic admissions—the admissions folks want to get to know you as a whole person, not as a simple compilation of numerical data such as grades and standardized test scores. Along with extracurricular activities, letters of recommendation, and in some cases an interview, the essay can plan an important role in the admissions process. Make sure yours is as strong as possible. As you write your own essay, be sure to avoid the bad essay topics,  and follow these tips for a winning essay. Most of all, make sure that your essay makes a good impression. Does it present a dimension of your personality and interests that isnt obvious from other parts of your application? Does it present you as someone who will contribute to the campus community in a meaningful way? If yes, your essay is performing its purpose well.

mood, substance, and personality disorders Essay - 1729 Words

Mood, Substance, and Personality Disorders nbsp;nbsp;nbsp;nbsp;nbsp;Do you know a person that has sudden mood swings? Do you wonder why they act like they do? Their actions could be a result of a type of mood disorder. Mood disorders are part of the Axis One disorders that are found in the DSM IV. Axis One is all categories of disorders except for personality disorders. People who have mood disorders are diagnosed to have a pattern of severe depressive and manic episodes. One major mood disorder that will be discussed is bipolar disorder. People who are bipolar tend to have episodes of both mania and depression, sometime by themselves or sometimes mixed. Some of the symptoms are a very active social life, rapid speech, racing†¦show more content†¦The movie showed just how difficult it is to live with the disorder and how drastic manic and depressive episodes can be. However, in the movie Dr Brown falls in love with the charming and talented Mr. Jones. She then stopped treating him because it was not professional; she later resigned from her job completely. This is the only part of the movie that was not accurate because if that relationship occurred in every day life, Dr. Brown would have been disciplined farther. She probably would have lost her license. Overall, I thought the movie was excellent and it was cast perfectly. nbsp;nbsp;nbsp;nbsp;nbsp;Substance-related disorders include several diagnoses. Substances are used to change a person’s mood and consciousness which usually leads to addiction. The main concerns of this disorder are drinking problems, nicotine problems, marijuana problems, stimulants problems, and hallucinogen problems. Alcohol is the most commonly used drug in the United States: 18% of men and 8% of women have alcohol related disorders. There are three different kinds of disorders caused by alcohol: alcohol dependence, alcohol abuse, and alcohol induced disorders. 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HND Business Supply Curve & Demand Curve

Question: Describe about the HND Business? Answer: Samsung responds at whatever point the amounts of their item move to one side or to right half of their financial matters adds up to a harmony between what we need and what we can manage. Due to this fix, every individual must pick the amount of cash to spare and the amount to spend. We should likewise settle on all the products and administrations going after our consideration. Assume you needed to buy a PDA (Herman, Richard. Power Curve). You'd need to browse a mixture of brands and models. You'd likewise need to choose where you needed to go to purchase one. In the wake of looking, you may choose you didn't need a PDA whatsoever. An interest bend gives the most extreme value shoppers will pay for an extra unit of a decent or administration. The interest bend is the maximum furthest reaches of the value shoppers will pay for an extra unit. Every point on the interest bend can be considered a man, or persons, and their most extreme cost. Samsung dependably attempt best to attain to the force objective and be a main brand and they got the achievement. Samsung demonstrate his supply in the force of each states and work for social exercises which make him driving in creating to instruction field. We have the case of South Africa where the supply of the Samsung leaded and build up a training division where the interest of Samsung climbs and permit him to be the main and creating brand. We realize that when the supply builds then the interest abatements however we can't overlook that when interest expands then supply diminishes, we generally attempt to take after the law which is identified with the main brand and taking after the arrangements to cover the long separation and be the main brand. Supply Curve Demand Curve References Borjas, George J. The Labor Demand Curve Is Downward Sloping. Cambridge, Mass.: National Bureau of Economic Research, 2003. Print. Herman, Richard. Power Curve. New York: Avon Books, 1997. Print. Oswald, Andrew J. Efficient Contracts Are On The Labour Demand Curve. Centre for Labour Economics, London School of Economics, 1987. Print. Reid, Gavin C. The Kinked Demand Curve Analysis Of Oligopoly. Edinburgh: Edinburgh University Press, 1981. Print.

Health Informatics In Dallas Health And Hospital System

Question: You are the Vice President of the Dallas/Fort Worth Health and Hospital System. Your system includes 1800 bed-hospital and 30 community-based clinics throughout the metroplex. You and your interdisciplinary team (Quality Improvement, Health Information Management, Pharmacy, and Report/Analytics) are charged with the task of assessing the appropriate clinical, business, and specialty systems applications for the entire hospital system. Provide an assessment for the following applications: administrative, clinical decision support systems, electronic health record and computer-based health record systems, nursing, ancillary service systems, patient numbering systems at master and enterprise levels. Requirements For each application assessment (1) select the appropriate clinical setting (inpatient and/or outpatient), (2) explain database architecture and design, and (3) decide which components of an e-health delivery system would be appropriate. Your assessments should be a minimum of 6 pages. Answer: Introduction: The study consists of designing databases of various aspects of Dallas Health and Hospital System. The patient and the authorities will access the stored information through the proposed architecture (Go et al., 2013). The architecture of different aspects varies from each other. The team will design the main database in the central part, but the other systems will make use of that tables with additional required tables. The study also indicates the similarities between the Dallas's systems and E-health delivery system. The organization has 1800 beds and 30 clinics. Health Care Administration: It is a field that relates to management, leadership and administration of hospitals, public health care system, hospital networks, and health care systems (Kongstvedt, 2012). Clinical Settings: For in-patient the clinical settings regarding administration of the Dallas Health and Hospital System are managing beds, keep supervision on the scientific research, following legislations, distribution of doctor and nurses in each ward and recruiting doctors, nurses and administrative (Crapo et al., 2015). For out-patient the administrative manages the thirty community-based clinics, doctors at each clinic and maintain clinical quality. Database Architecture and Design: The administrative of Dallas Health and Hospital Management System have to maintain the quality of the service while managing one hundred beds and thirty clinics. The purpose of the clinics will be handling the out-patient. The entities of the community clinics are placed, id (unique identification number), time, doctor-id and patient-id. The last three components will store that at what time which doctor checked which patient. The individual doctor and patient table will consist of their information. The ward table will be composed of the bed number, nurse-id, doctor-id and patient-id and time. The patient table will include the admission, discharge and visiting time. Each component is atomic (Coronel Morris, 2016). So the team can move onto the 2nd and 3rd normal form. Through using different tables for patients, doctors and nurses the system will prevent the repetition of groups. The entities of nurse and doctor table will be same. One patient can get admitted or appointed various times. On the other hand, the various patient can get admitted in the same day. The service date depends more on the services than patient so using normalization the team will separate the service dates (O'Leary-Driscoll, 2015). The primary key service_id will serve as the foreign key in the patient table. The Bed table will consist of all the primary keys of other tables. This way the administration department can see all the information regarding a bed. Doctor Table Doctor_id Name Ph. Number Address Date of birth Start service Nurse Table Nurse_id Name Ph. Number Address Date of birth Start service Patient Table Patient_id Service_id Name Ph. Number Address Patient Service Dates Table Service_id Appointment Admission Discharge Payment Clinic Table Clinic_id Address Contact Doctor_id Patient_id Ward Table Ward_id Location Incharge Bed Table Bed_id Ward_id Patient_id Doctor_id Nurse_id Figure 1: Database Architecture of Dallass Administrative (Source: Created by author) Components of E-health Delivery System: The viewer, provider information, and public health information are the various elements of electronic health delivery system that is compatible with the administrative database system (Kongstvedt, 2012). The administrative watches over all the operations, observes provider information for future decisions. Clinical Decision Support or CDS Systems: The term refers to an essential aspect of the field of the clinical knowledge management technologies using the gathered information to treatment and long-term care for supporting the use of knowledge and clinical processes (Musen, Middleton Greenes, 2014). Clinical Settings: Thus, the settings are. Administrative: Supporting authorization, clinical coding, referrals and authorize procedures. Handling clinical details and complexity: Tracking orders, chemotherapy protocols and keeping the patient on research (Go et al., 2013). Capital control: Preventing unnecessary tests and monitoring medicine orders. Supporting decisions: Offering support to treatment plan processes and clinical diagnosis (Musen, Middleton Greenes, 2014). Database Design and Architecture: The database design will consist if mainly on the information of the patients and the services they get. In addition, the various information management tools will assist in analyzing the data that the database stores (Coronel Morris, 2016). The architecture will be smooth enough to provide all the relevant information to authorized personnel at a single place. The Diagnosis table will assist in finding all the relevant information like which patient did which diagnosis from which clinic or the patient was an inpatient (O'Leary-Driscoll, 2015). The Clinic_id and Bed_id will be nullable as either one or both can have data. Using the foreign key, Patient_id the authorities can access every information regarding the patient. Diagnosis Diagnosis_id Name Patient_id Clinic_id Bed_id Resource Resource_id Name Type Resource_provider Provider_id Address Contact Resource_id Figure 2: Database Architecture of Dallass CDS (Source: Welch Kawamoto, 2013) Components of E-health Delivery System: The elements of E-health delivery system that are associated with the Clinical Decision Support Systems are as following. E-stakeholder community (Kongstvedt, 2012). Potentiality to predict future features. Electronic Health Record: It refers to a system that holds the whole information of the patients of the Dallass for the use by the organization (Weiskopf Weng, 2013). Clinical Settings: Efficient, organized and well documentation of the administrative process. Well, establishment regarding reporting and data collection (Crapo et al., 2015). Database Design and Architecture: The database will consist of the information of Dallas's patients. The admiration of the organization will utilize this information for constructing a good documentation. The documentation further provides support for better patient treatment (Bright et al., 2012). The patient will give feedback that will store in the system. The administration will examine which doctor and nurses were associated with the treatment of the patient (Rosland et al., 2013). Through the analysis of subscribed drug Dallass administration can track the effect of the drug on the various types of patients. Customer_feedback Patient_id Ward_id Clinic_id Feedback Drug_use Drug_id Name Patient_id Figure 3: Sample Database Architecture of Dallass EHR (Source: "Electronic Health Records-Based Phenotyping | Rethinking Clinical Trials", 2016) Components of E-health Delivery System: The components of the E-health delivery system are as following. E-health service model entities (Kongstvedt, 2012). Potentiality to predict future features. Nursing: Critical Settings: The nursing system will primarily focus on the in-patients. The nursing system will provide the medicines prescribed to the patients by the doctors. It will assign the nurses to the patients using the electronic health record. The system will try to find which patients feel better under whose supervision and thus improve patient satisfaction (Oshima Lee Emanuel, 2013). For out-patent the system will try to assist the organization to help the patient how to follow the doctor's advice. Catch the patient's reaction toward the assist Dallas provider in the clinic. Database Design and Architecture: The database will have an additional table called nurse_shifts. This way Dallas will be able to keep track of the nurses duty period and provide the best hospitality to patients. Nurse_shifts Nurse_id Patient_id Duty_start Duty_end Week_off Figure 4: Database Architecture of Dallass Nursing System (Source: "Electronic Health Records-Based Phenotyping | Rethinking Clinical Trials", 2016) Components of E-health Delivery System: Core value proposition. The accommodations for future features (Kongstvedt, 2012). Ancillary Service Systems: Critical Settings: For an in-patient, critical settings are the treatment of critic patients and diagnostic services. For an out-patient the settings are home health services and occupational therapy, physical therapy (Rosland et al., 2013). Database Design and Architecture: The database will consist of extra two tables Therapist and Home_service_in_charge. The Home_service_in_charge table will give Dallas the ability control the process of providing services to the home. Home_service_in_charge In_charge_id Name Address Contact Home_service Service_id In_charge_id Name Type Patient_id Therapist Therapist_id Name Address Therapist_service T_service_id Therapist_id Patient_id Location Figure 5: Database Architecture of Dallass Ancillary Services (Source: Created by author) Components of E-health Delivery System: E-health service model entities (Crapo et al., 2015). E-stakeholder community involvement. Patient Numbering Systems: The Master Patient Index (MPI) or patient numbering system at master and enterprise levels is very vital for Dallas. Dallas will implement independent MPIs within their facility (Crapo et al., 2015). Critical Settings: It has a big responsibility of taking care of the patient while they are admitted to the hospital (Kongstvedt, 2012). For an out-patient the system will ensure the patient satisfaction by providing all the available facility. Database Design and Architecture: The database will consist of an additional table that will keep track of the payments of the patient. Payment Pay_id Patient_id Service_id Ward_id Clinic_id Amount Figure 6: Database Architecture of Dallass MPI (Source: Created by author) Components of E-health Delivery System: The ability of processing the critical mass of transaction. Core value propositions (Rosland et al., 2013). Conclusion: The study concludes that the various aspects of the hospital are somehow related to each other. The clinical services are a lot different from the hospital services. The critical settings describe the various important aspects and functions of different systems. The databases may assist different systems for analyzing and storing data, but the core of the databases are all same. The various architecture supports the organization provide services to the patient and put tight control over their services and processes. One simple mistake in designing the database can cause a major issue at the real time experience. References: Bright, T. J., Wong, A., Dhurjati, R., Bristow, E., Bastian, L., Coeytaux, R. R., ... Wing, L. (2012). Effect of clinical decision-support systems: a systematic review.Annals of internal medicine,157(1), 29-43. Coronel, C., Morris, S. (2016).Database Systems: Design, Implementation, Management. Cengage Learning. Crapo, J., Coyle, D. M., Owen, C. L., Pearson, P., McRae, K. (2015).U.S. Patent No. 8,949,137. Washington, DC: U.S. Patent and Trademark Office. Establishment of a Quality Program for the Master Patient Index. (2016).Library.ahima.org. Retrieved 23 March 2016, from https://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_039331.hcsp?dDocName=bok1_039331 Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W. B., ... Franco, S. (2013). On behalf of the American Heart Association statistics committee and stroke statistics subcommittee.Heart disease and stroke statistics2013 update: a report from the American Heart Association. Circulation,127(1), e1-e240. Kongstvedt, P. R. (2012).Essentials of managed health care. Jones Bartlett Publishers. Musen, M. A., Middleton, B., Greenes, R. A. (2014). Clinical decision-support systems. InBiomedical informatics(pp. 643-674). Springer London. O'Leary-Driscoll, S. (2015). Database/Resource Acronyms. Oshima Lee, E., Emanuel, E. J. (2013). Shared decision making to improve care and reduce costs.New England Journal of Medicine,368(1), 6-8. Rosland, A. M., Nelson, K., Sun, H., Dolan, E. D., Maynard, C., Bryson, C., ... Schectman, G. (2013). The patient-centered medical home in the Veterans Health Administration.The American journal of managed care,19(7), e263-72. Thomson, R. (2016).Clinical Decision Support Systems.Openclinical.org. Retrieved 23 March 2016, from https://www.openclinical.org/dss.html Weiskopf, N. G., Weng, C. (2013). Methods and dimensions of electronic health record data quality assessment: enabling reuse for clinical research.Journal of the American Medical Informatics Association,20(1), 144-151. Welch, B., Kawamoto, K. (2013). The Need for Clinical Decision Support Integrated with the Electronic Health Record for the Clinical Application of Whole Genome Sequencing Information.Journal Of Personalized Medicine,3(4), 306-325. https://dx.doi.org/10.3390/jpm3040306

Banking Industry Analysis Essays - Banking, Bank,

Banking Industry Analysis Graham Mavar Mgmt. 415 Sec 6 Industry Analysis: Banking The banking industry has come under increasing pessimism of late because of rising short and long-term interest rates. The banking industry's market capitalization made a substantial decline. Most investors are concerned with whether the industry can sustain continued profitability as a result of these factors. Banks have responded in recent years to these problems by diversifying away from interest sensitive products and services. But interest rates are the fundamental aspect of any financial services. Therefore, I believe the financial services industry will be deeply affected by rising interest rates. Banks have experienced good business factors over the past two years. Interest rates were low, credit quality was good, and inflation was low. These factors are usually predictive of the types of earnings banks should report. But good times can't continue because interest rate hikes cause reduced lending activity, damaged credit quality, and reduced values of bond portfolios. Porter's Five Forces Analysis: 1. Rivalry among competing sellers: The banking industry is continuing to restructure and position itself for our changing economy as a result, many mega-mergers have occurred in recent years. Citicorp and Travelers Insurance agreed to merge in April 1998 at a value of $70 billion. Bank of America and Nation's Bank also agreed to merge shortly afterwards which became the largest bank in the United States. Bank mergers are usually consummated as a cost-cutting measure but also to compete with non-bank providers of financial services. Bank rivalries are very strong, and as we've seen many of the largest banks are merging to increase their power. In fact, Charlotte, NC is practically owned by Bank of America and First Union. 2. Potential entry of new competitors: There is virtually no chance of a new entrant significantly affecting the major banks' market share. The only place that new entrants may have a chance in the industry is through Internet banking, because of its low cost. 3. Firms offering substitute products: This is not really an issue within the banking industry, because there aren't really any legal alternatives, except buying a safe and borrowing from a loan shark 4. Competitive pressures stemming from supplier and buyer bargaining power: I grouped these two categories together because in the banking industry the buyers are the suppliers and vice versa, so I might as well just discuss the situation as a whole. Interest rates are the single most important aspect of bank profitability they are the bargaining power. Most bank profits are derived from net interest income. This is interest income received on loans minus interest expense for borrowed funds. Interest rates determine the amount of money a bank can earn. Another measure is a banks' net interest margin which is a bank's net interest income divided by its average earning assets. This is a common measure of a bank's ability to squeeze profits from its loans. When interest rates fall, they have a positive effect on a bank. First, net interest margin can expand. Second, the value of a bank's fixed rate of investment portfolio is enhanced by declining rates, since a bond with a higher stated interest rate becomes more valuable as prevailing rates drop. Third, falling rates lower the cost of credit, which stimulates loan demand and reduces delinquency rates. Opportunities: 1. Because of the increasing amount of technology Internet banking will begin to replace traditional banking, thus cutting personnel costs. 2. Incorporating investment banking into the banking industry, as some major companies are doing, lets the bank increase profits and promote economic growth while improving company image. Threats: 1. An increase in interest rates causing a decline in bank activity. 2. A collapse of the Fed leading to bank failures, a repeat of the crash of 1929. 3. A decline in the US economy leading to a fall in the value of the dollar, thus causing an instable economy. From there the US banking system would be less secure in terms of dollar values that many people would move their money overseas into a more stable economic situation. Similar to the situation in many South American countries. (a little far-fetched, but possible) Key Success Factors: ? Capability to use the internet for banking, investing, and general e-commerce ? Size of company, name recognition, innovative local marketing ? Best rates (loans, checking, savings,

Free Essays on A Whole Lot Of Cheatin Going On - Critique

Mark Clayton, the author of â€Å"A Whole Lot of Cheatin’ Going On,† states that cheating has become a huge problem throughout schools and that schools are trying to stop it. At least 80% of students have admitted to cheating one or more times in their educational careers, says the Center for Academic Integrity in Nashville. Schools are trying many things to try and prevent cheating. Schools and students definitely disagree on the definition of cheating; so how can anything be done until cheating can be clearly defined? Clayton uses a lot of sources for his evidence. Each and every student, teacher, and educational reference gives opinions on cheating based on their own, individual knowledge and bias. The main evidence he lacks is the actual definition of cheating. His evidence backs up the fact that cheating is going and that schools are trying to fix the problem, but he never once gives a concise definition of the problem so it makes it hard for the reader to make his own opinion of the issue. I agree with Clayton’s points about cheating. Being a college student, I know from experience just how common cheating is. The internet makes it so much easier for students to cheat because when you search for a topic, papers are offered to you right away whether you want them or not. I believe that colleges think that enforcing honor codes and educating students on cheating will stop it, but it will only stop a small amount. So many students have cheated their entire life, through everything, without ever getting caught, so being threatened by an honor code will not stop them now. They believe it is the easy way to get through life and no one has taught them any differently yet. In high school, cheating was so easy because the teachers just gave you your work and didn’t care what happened from there so, of course, students took the easy way by cheating. As teachers continue to not care each day in the classroom, students are going to c... Free Essays on A Whole Lot Of Cheatin Going On - Critique Free Essays on A Whole Lot Of Cheatin Going On - Critique Mark Clayton, the author of â€Å"A Whole Lot of Cheatin’ Going On,† states that cheating has become a huge problem throughout schools and that schools are trying to stop it. At least 80% of students have admitted to cheating one or more times in their educational careers, says the Center for Academic Integrity in Nashville. Schools are trying many things to try and prevent cheating. Schools and students definitely disagree on the definition of cheating; so how can anything be done until cheating can be clearly defined? Clayton uses a lot of sources for his evidence. Each and every student, teacher, and educational reference gives opinions on cheating based on their own, individual knowledge and bias. The main evidence he lacks is the actual definition of cheating. His evidence backs up the fact that cheating is going and that schools are trying to fix the problem, but he never once gives a concise definition of the problem so it makes it hard for the reader to make his own opinion of the issue. I agree with Clayton’s points about cheating. Being a college student, I know from experience just how common cheating is. The internet makes it so much easier for students to cheat because when you search for a topic, papers are offered to you right away whether you want them or not. I believe that colleges think that enforcing honor codes and educating students on cheating will stop it, but it will only stop a small amount. So many students have cheated their entire life, through everything, without ever getting caught, so being threatened by an honor code will not stop them now. They believe it is the easy way to get through life and no one has taught them any differently yet. In high school, cheating was so easy because the teachers just gave you your work and didn’t care what happened from there so, of course, students took the easy way by cheating. As teachers continue to not care each day in the classroom, students are going to c...

The Power of Images - Television and Film Research Paper

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Clinical Remit

Clinical Remit Teaching and Nursing Practice 1 A Learning Needs Assessment 1. Clinical Remit. As a nurse working within a clinical specialty it is within the remit of my job to promote the stoma care service and maintain high standards of care. It is also the responsibility of the stoma care department to meet the training and educational needs of ward based nursing staff to ensure high quality care which is evidence based and kept updated. Prior to coming into post my teaching experience had been limited to mentorship of students and informal ward based seminars. My only formal teaching experience had been as a student when attending lectures and courses. My teaching remit includes patients, relatives, carers, colleagues and students. It provides me with the opportunity to pass on my clinical skills, knowledge and experience to junior staff. This not only allows them to develop their own practice but influence the surgical unit and their patients. There is allocated placement time to the stoma team for students and we also teach students who have placements within the colorectal and general surgery unit. Teaching is often done in an informal, ward based environment where learners are able to observe and study with patients. Patients are carefully chosen and their consent obtained before the introduction of the learner. These patients are vulnerable therefore it is important that the patient is comfortable with any change or addition of another person to teaching sessions. Patients and their stoma nurses develop a special bond and it is important that this relationship remains strong. It is through this unique relationship that the patient gains the skills and knowledge needed to equip them for life with a stoma. The stoma care nurse is a facilitator, he/she empowers patients to optimise quality of life and adjust to their new circumstances. My principle clinical role is in the teaching and support of patients who are about to have or have undergone surgery to create a stoma. Fulham (2008) acknowledged that nurses play an important role in helping patients adjust both physically and psychologically to a new stoma. Research (OConnor, 2003; Metcalf, 1999; White, 1998) has shown that early teaching of practical skills and coping strategies help new stoma patients have a more favourable outcome. Early education helps prepare them for surgery and allows patients to adapt more positively to the stoma (Burch, 2005). I have chosen to focus on one particular aspect of teaching within stoma care, namely the changing of a one piece stoma pouch. The reason for my choice is that this is a fundamental part of the stoma care process. It is the focus of many patients anxieties and is key to many patients feeling of wellbeing; it is one area where they feel they still have some control. Bekkers et al (1996) saw self-efficiency as crucial to adjusting to a stoma and as a result saw fewer psychological problems post- operatively. Commonly, the assumption is that teaching stoma management is someone elses responsibility (Turnbull, 2002). The principles of a pouch change are simple to follow to achieve success, yet it is generally carried out poorly at ward level. This could be due to a number of reasons. Pouch changing is a practical skill not widely practiced at university; it is often passed on through experiential learning and reflective practice while on placement. This indicates that the current university curriculum does not adequately equip students with the skills needed to support these vulnerable patients (Simmons et al, 2007). It is a specialised skill that has to be practiced to become proficient. Some nurses approach changing a stoma pouch merely as a task to be carried out rather than an integral part of individualised patient centred care (Mitchell, 1995) or a teaching opportunity. Lacking knowledge or confidence in stoma care my lead to a reluctance to become involved with patients with a stoma. Norris and Spelic (2002) reported that many nurses do not feel competent enough to support patients adapting to altered body image. Stoma care is not an integral part of all healthcare areas therefore many nurses lack the opportunity to practice learned skills which then become redundant. Hollinworth et al (2004) highlighted the importance of enabling all practitioners who regularly care for patients with a stoma the opportunity to develop professionally. It is with this in mind I have chosen to carry out a learning needs assessment on a small group of nurses who work within the surgical directorate who regularly care for patients who have a stoma. The group consists of 3 nurses; 2 trained staff and 1 untrained. The rationale being that it is often untrained staff who carry out patient care due to time constraints and workload pressure on their trained colleagues. I thought it would be interesting to compare these groups; to establish strengths and weaknesses and where improvements can be made that is patient centred, individualised and of the highest standard. Learning Theories Conducting a learning needs assessment is critical to the educational process. This can lead to change in practice and forms the cornerstone of continuing professional development (Grant Stanton, cited in Grant, 2002). Evidence based practice has become the focus of NHS policy over recent years with emphasis on cost effectiveness. This ensures patients receive the most efficient care based on evidence from the most up to date research (Upton, 1999). Turnbull (2002) highlighted that ostomy teaching starts at the patients bedside often by non specialised staff; therefore it is important that staff have the necessary knowledge and skills to be able to support these patients. It is also important that patients receive the best possible care and advice no matter who is giving it. Prashnig (2006) discussed the responses of teachers to the varying learning needs of students when the teachers are aware of their teaching styles. I use a combination of styles. My approach is initially pedagogy as particular skills and information is being taught as the learner is often a new stoma patient. It then develops into an andragogical approach as the teacher learner relationship changes to guide and empower the learner towards independence through discussion and problem-solving rather than just instruction (Jarvis, 1985 as cited in Smith 1996; 1999). This can be illustrated through many of the learning theories used in education today. Banduras (1977) social learning theory shows learning comes form observing and copying behaviour before adopting it and adopting his ‘role model when teaching practical skills and giving advice. Skinners (1954) conditioning theory of positive reinforcement can be applied to stoma pouch changing. Reinforcement in the form of repeated p ractice helps to form a habitual pattern and the necessary skills to perform the task. The nursing process model of assess, plan, implement and evaluate can also be applied to this theory. Kolbs experiential learning cycle (1984) has influenced nurse education for decades (Quinn, 2000). The learner moves around the cycle through the four adaptive abilities of concrete experience; reflective observation; generalisation and application from action to observation through the learning process. Ausubels (1978) assimilation theory enables the student to build on their existing knowledge. I teach in small, easily managed sections. Revising what was learned previously and ensuring it is understood before continuing with the next stage. Rational for carrying out a learning needs assessment. Identifying a learning need is the first step in planning any education programme (Dyson et al, 2009). This ensures that the programme is appropriate for all, regardless of knowledge and experience and forms the basis of the objectives and content (DeSilets, 2007). In this case the assessment will be carried out on a small group of healthcare professionals but the principle can be used on a larger scale. A learning needs assessment forms a baseline; it identifies what is already known and what is needed to fill in gaps in knowledge or experience. The need to carry out a learning needs assessment in this clinical area was identified through casual observation of interactions between ward staff and new stoma patients. The poor uptake of stoma patient education was highlighted by a disappointing lack of documentation within patient records and limited assessment of the stomas function, the local skin condition and the patients independent progress. This has an impact on the patients psychological adjustment and ultimately their satisfaction regarding quality of care. Nursing is based on holistic, individualised needs; if a fundamental part of a new stoma patients wellbeing is not being addressed it can increase length of hospital stay, delaying independent stoma management prior to discharge with evident associated financial implications. Employers too have expectations of their staff. The NMC codes (2008) states knowledge and skills should be kept updated; and healthcare professionals should attend education which maintains and develops competence. A learning needs assessment enables the setting of goals benefit not only the learner (through improving practice) but also benefit the patients and ultimately the organisation. There are however drawbacks with carrying out a learning needs assessment. Learners often concentrate on positive aspects of their practice and do not highlight areas that need refining or further work. Teachers may focus on the negative aspects and may not give the learner credit for what they do well. Identify an area of learning A review of ward notes and patient questioning identified a poor uptake of patient teaching in stoma care. When questioned staff answers ranged from time constraints, lack of confidence when dealing with stomas and feeling that it was the responsibility of someone else to take charge. Some staff when questioned thought responsibility lay with the specialist stoma nurses. CNSs were carrying out the majority of teaching and support in the minimum amount of time, with little support from other members of the multi-disciplinary team. This identified an area of learning and an opportunity to address some of the issues through an education programme. This would re-empower ward staff and give them the skills and confidence to work with new stoma patients. This will also have a positive impact on time management. An initial increase in time spent teaching and supporting patients to manage their stoma would be rewarded when the patient was independent and more confident in their own ability. Staff are encouraged to observe, work and participate in teaching patients along with the Stoma Care CNS on the ward where she is available to answer any queries and offer assistance. Discussion with ward staff has shown that although stoma care is carried out regularly in a general surgery unit there are staff members who a greater interest and subsequently are more confident when providing stoma care. Nursing staff from the colorectal ward were informally approached and asked if they would participate in a stoma care education programme. Three members of staff expressed an interest and agreed to participate. It was decided that this would form a pilot study group. Like other forms of research a pilot study should be carried out to ensure validity and reliability (Burns and Grove, 2005). The group consisted of 2 qualified and 1 unqualified nurse. This was to attempt to determine the varying strengths and weaknesses of the grades of staff (Hesketh and Laidlaw, 2002). In accordance with the Nursing and Midwifery Council Code Standards of conduct, performance and ethics for nurses and midwives (2008), to maintain client confidentiality, all names have been changed and no reference has been made to vocation. Kate- Qualified for 3 years. Worked initially as a bank nurse but recently joined the staff of the general surgical ward full time. She has been in post for 6 months. Amy- Qualified for 5 years. Worked in a medical ward for 1 year but has worked in the general surgical ward for 4 years. Janet- Worked as a health care assistant for 14 years, all within the general surgical ward. She had aspirations to train as a nurse but never pursued this after having a family and now feels she has missed the opportunity. She is a part-time member of staff. It was decided that the teaching session should include other aspects of stoma care for which patients often need extra support e.g.; skin assessment and simple remedies, measuring a stoma and template cutting. Some common but relatively simple problems such as sore skin can be improved or resolved by prompt and correct treatment (Burch and Sica, 2008). With this in mind it was decided that the education should contain a practical session; to revise and practice pouch changing, using stoma measuring tools, cutting out templates and dealing with simple problems. Methods of assessing the learning needs. To assess learning needs it is first necessary to choose a method for gathering information. As learning needs are individual; based on knowledge, understanding, attitudes and self-assessment (McKimm, 2009; Norman et al, 2004; Grant, 2002). It was hoped the results would reveal the individual learning needs of each participant. Vaughan (1992) discussed that a learners competency can be assessed through direct observation. It identifies the learners performance level and capability. Bee and Bee (2003) also discussed the value of observation as a tool to determine strengths and weaknesses in learners practice. Quinn (2000) however identified that observation can be subjective, so to prevent observer bias a checklist or rating scale should be used. Following the example of Bee and Bee (2003) Observation can be subdivided into Direct observation, Work samples and Simulations. Direct Observation Enables assessment in real time. It quickly identifies good practice and areas requiring work. This was carried out by the Stoma Care CNS. It was decided that as she was a familiar face in the wards the nursing staff would be relaxed in her presence and would not alter their practice when â€Å"on show† and results would be accurate. It was seen as an efficient use of time/resources by ward staff and the CNS as she was available to advise and help patients and staff. Work Samples- Assessing current work practice can be difficult to assess accurately, particularly as ward staff and the CNS have individual commitments and priorities. Assessing competed work does not give the assessor a true reflection. If the CNS is unavailable to offer advice on potential issues then a vulnerable patient can be put at unacceptable risk of stoma or skin complications. Therefore this method was excluded on moral and ethical issues. Simulation- Allows the observation of the learners when dealing with different situations e.g. the availability of a simulator mannequin for practice. Interchangeable pieces replicate differing shapes and sizes of stomas which assess basic pouch changing skills but would not allow assessment of any complication or teaching of the patient. It does however, not encourage the learner to consider the psychological needs of the patient further and see that changing a stoma pouch and disposal of the pouch is more than merely completing a task (McKenzie et al, 2006; Rust, 2007). Heskth and Laidlaw (2002) discuss other tools when assessing learning needs. These include: Practice Testing- Routine review of notes and charts. This can give an indication of good practice and areas requiring improvement. Informal Testing- Will establish the knowledge and current practice of the group by carrying out a simple test prior to the teaching session. This would enable the teacher to gear the education to the specific needs of the learner group. Reflective Practice- Discussing a memorable situation or experience whether it was memorable for good or bad reasons. This allows the individual to recognize their own strengths and weaknesses and identify learning needs. This can be carried out on a one-to-one basis or within a group as in individual or group supervision. It gives an opportunity to share feelings, attitudes and knowledge with their peers and is itself a valuable learning experience. The use of questionnaires and structure interviews are commonly used measuring tools used in needs assessment (Mailloux, 1998; Hopkins, 2002; Bee and Bee, 2002) Using different types of questions within the questionnaire will gain the information required. Classification questions check how representative the sample is. It enables respondents to be put into or ‘classified in a group e.g. gender, race or age. Coded/Structured questions measure knowledge and attitudes. Open questions allow respondents to expand on their answers; it gives the opportunity to express their views. Semantic- differential questions also ask for opinion using a numerical scale. Lickert-type questions ask the respondent to express their opinion against a specified rating scale. Grant (2002) warns that reliance on formal needs assessments when planning education can restrict the learning process instead of encouraging it. To ensure learning needs are appropriately measured a questionnaire using a combination of question types was used (Appendix 1). Time was assigned for simulated practice using the mannequin and direct supervision of 10 pouch changes by the Stoma Care CNS. This would be the starting point for teaching stoma care. Learning needs assessment To assess the learning needs of the chosen group the questionnaire was given out two weeks prior to the teaching session. It was hoped that an education programme would address some anxieties and encourage some deeper understanding of stoma care so the questionnaire include all aspects of stoma care including skin assessment and simple treatment, measuring a stoma and preparing patients for discharge. This required the participants to have a basic knowledge of stomas and the principles of changing a stoma pouch. The questionnaire was made up of a combination of coded/structured; open and Lickert- type questions. This will gain information on the learners knowledge on the subject and an indication of knowledge on particular aspects which they may have limited or no experience. The Lickert-type question was used to identify knowledge and opinion on a specific skill used when caring for patients with a new stoma. One week later a second needs assessment was carried out. This took the form of ward based direct supervision. Time within the teaching session was also allocated for simulated practice using the mannequin. This included template measuring and cutting and treating minor complications using stoma care accessories. Questions were encouraged and following the simulation the group reflected on what they had learned. Due to close links with the nursing process model (Rolf, 1998; Masters, 2009) this needs assessment was based on Kolbs experiential learning theory (1984). Kolbs Learning StylesKolb (1999) The needs assessment is reflected within the learning cycle. The questionnaire and simulated practice reflected the learners knowledge and identified their learning needs Concrete experience. Group reflection and simulation exercise Reflective observation. Identifying topics for inclusion in the education Abstract conceptualisation. The learners application of new knowledge to practice when performing and teaching stoma care- Active experimentation. Williams (1998) advises a combination of three methods of assessing learning needs. A triangulation approach addresses the limitations and assumptions of each (Robson, 1993). A Lickert-type assessment tool was developed as the third method of assessing learning needs when observing the learners during their supervised practice and using the mannequin (Appendix 2). These methods provide valuable qualitative and quantitative date, as it provides both concrete knowledge and opinion from the learners (Moule and Goodman, 2009; Polit and Beck, 2008). Analysis of the Results of the Learning Needs Assessment To analyse the questionnaire and ward observation each participants results are examined in turn and a personalised learning need will form a conclusion. The questionnaire was divided into four parts: 1. The Stoma (5/5=25%) 2. Pouch management (4/4=10%) 3. Skin assessment and treatment (6/6=40%) 4. Prep for home (5/5=25%) Analysis of Kates results Kate showed a good basic knowledge of what a stoma and the importance of assessment and treatment of the parastomal skin. These results would indicate that the theoretical component of the education programme will re-enforce Kates good knowledge base. The results do however show that Kate does need to improve her knowledge with management of the stoma, namely the draining and timing of pouch changing and in the teaching and support of patients as the aim for self care of the stoma. Analysis of Amys results Amys results have shown that she has a sound knowledge of stomas; there management; skin assessment and treatment of common simple problems. This would reflect the experience Amy has within the colorectal specialty. Her single wrong answer reflects only that there is still room to learn. Experience is important but as technology and approaches change it is important to keep up with current trends and techniques. Analysis of Janets results Janets results were also impressive, particularly as she has had no formalised nurse training. She showed a good basic knowledge of the stoma, although was unable to identify specifics. She did know the picture was an ileostomy but not that it was a loop-ileostomy. Janets assessment skills also reflect good practice. She can identify changes in the stoma and has the knowledge and skills to adjust treatment to minimise minor setbacks like sore skin. She showed a patient centred approach to teaching and supporting patients towards stoma self care; this may reflect that as a healthcare assistant Janet has greater patient contact and therefore has more ‘hands-on experience. Analysis of direct observation The information obtained from the Lickert-type observation study carried out during direct observation by the teacher was transferred onto a bar chart. This was compiled while the learners were practicing stoma care skills on the mannequin. It compares the learners practical skills and highlights areas of good practice and where further practice is required. The Lickert-type scale used documents each learners current level of competence. The range 1-5 was used, 1 (very poor) 5 (very good). The bar chart illustrates the strengths and weaknesses of each learner and makes comparisons among the group. The chart reflects that Amys knowledge on stomas and management is better than her practical management skills. Kate requires further practice with both theory and practice. Janet has shown consistency with theory and practice, scoring well in both. It is hoped that Kate, as the least experienced nurse will improve in time as her knowledge and skills increase as reflected by Benner (2001). Reflection the learning needs assessment. Learning needs assessment is a specific form of educational research (Williams, 1998) and conducting a learning needs assessment requires careful planning. It forms a vital element of teaching within continuing professional development (McKimm, 2009). It is important to address a need rather than a preference for learning that benefits the organisation and enhances the practice of health professionals. Grant (2002) reported only limited evidence of educational effectiveness as a result of needs assessment alone, therefore it should be used in context within a wider learning plan which must be relevant to practice. Learning needs assessments focus on identified need and often fails to address needs not looked for, therefore it requires flexibility (Hicks and Taylor, 2002 as cited in Dyson et al, 2009). It re-enforces that the needs of individuals are different. No single needs assessment is effective. Using a variety of assessment methods provides a comprehensive picture of an individuals performance (Hesketh and Laidlaw, 2002). SWOT analysis is an auditing tool developed by a research team from the Stanford Research Institute in the 1960s, led by Albert Humphrey. It is built on the use of four dimensions: Strengths, Weaknesses, Opportunities and Threats which enables pro-active thought. Strengths and weaknesses are internal factors; Opportunities and threats are external. Strengths * LNA produced information required to address a gap in knowledge and practice. * Observation of small sample identified individualised needs. Weaknesses * Only small sample used, Is this representative? * Is practice under observation reflecting everyday practice? * Time consuming. * Limiting due to design and response subjectivity. Opportunities * Address the knowledge gap through education. * Identify individuals with skills to act a link nurses. Threats * Response to survey may be poor. * Time and financial barriers to effective education. Needs assessments should be an ongoing process which facilitates learning to ensure practice and knowledge are kept up to date (Hicks and Hennesy as cited in Dyson et al, 2009).It would be useful to carry out the needs assessment on a larger scale, perhaps initially throughout wards to ascertain knowledge and skills of all nurses within the surgical area References 1. Ausubel, D. (1978) 2. Bandura, A. (1977) Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall. 3. Bee, F. and Bee, R. (2003) Learning Needs Analysis and Evaluation. 2nd Edn. London: Chartered Institute of Personnel and Development. 4. Bekkers, M. J. T. M., van Knippenberg, F. C. E., van den Borne, H. W. and van Berge-Henegouwen, G. P. (1996) Prospective evaluation of psychosocial adaptation to stoma surgery: The role of self-efficiency. Psychosomatic Medicine. Vol.58(2), pp183-191. 5. Benner, P. (2001) From Novice to Expert. Commemorative Edn. New Jersey: Prentice-Hall. 6. Burch, J. (2005) Exploring the conditions leading to stoma forming surgery. British Journal of Nursing. Vol.14(2), pp94-98. 7. Burch, J. and Sica, J. (2008) Common peristomal skin problems and potential treatment options. The British Journal of Nursing. Vol.17(17 Stoma Care Supplement), ppS4-S11. 8. Burns, N. and Grove, S. (2005) The Practice of Nursing Research: Conduct, Critique and Utilization. 5th Edn. St Louis, MO: Elsevier/Saunders. 9. DeSilets, L. D. (2007) Needs Assessment: An array of possibilities. The Journal of Continuing Education in Nursing. Vol.38(3), pp107-112. 10. Dyson,L., Hedgecock, B., Tomkins, S. and Cooke, G. (2009) Learning needs assessment for registered nurses in two large acute care hospitals in Urban New Zealand. Nurse Education Today. Vol.29(8) November, pp821-828. 11. Fulham, J. (2008) A guide to caring for patients with a newly formed stoma in the acute hospital setting. Gastrointestinal nursing. Vol.6(8), pp14-23. 12. Grant, J. (2002) Learning needs assessment: assessing the need. British Medical Journal. Vol.324(7330), pp156-159. 13. Hesketh, E. A. and Laidlaw, J. M. (2002) Needs Assessment. [Online] Available URL: http://www.nes.scot.nhs.uk/Courses/ti/NeedsAssessment.pdf. (Accessed 18th November 2009). 14. Hollinworth, H. et al (2004) Professional holistic care of the person with a stoma: online learning. British Journal of Nursing. Vol.13(21), pp1268-1275. 15. Kolb, D. A. (1984) Experiential Learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall. 16. Kolb, D. A (1999) Experiential Learning Cycle. In: Kolbs Learning Styles and Experiential Learning Model. (2008) [Online] Washington: Donald Clark. Available from: http://www.nwlink.com/~donclark/hrd/styles/kolb.html. (Accessed 14th December 2009). 17. Masters, K. (ed.) (2009) Role Development in Professional Nursing Practice. Massachusetts: Jones and Bartlett Publishers. 18. McKenzie, F., White, C. A., Kendall, S., Finlayson, A., Urquhart, M. And Williams, I. (2006) Psychological impact of colostomy pouch change and disposal. British Journal of Nursing. Vol.15(6), pp308-316. 19. Metcalf, C. (1999) Stoma Care: empowering patients through teaching practical skills. British Journal of Nursing. Vol.8(9), pp593-600. 20. Mitchell, A. (1995) The therapeutic relationship in health care: towards a model of the process of treatment. Journal of Interprofessional Care. Vol.9(1), pp15-20. 21. Mailloux, J. P. (1998) Learning Needs Assessment: Definitions, Techniques, and Self-Perceived Abilities of the Hospital-Based Nurse Educator. The Journal of Continuing Education in Nursing. Vol. 29(1) Jan/Feb, pp40-45. 22. Norman, G. R., Shannon, S. I. And Marrin, M. L. (2004) Learning in Practice. The need for needs assessment in continuing medical education. British Medical Journal. Vol. 328 April, pp 999-1001. 23. Norris, J. and Spelic, S, S. (2002) Supporting adapting to body image disruption. Rehabilitation Nursing. Vol.27(1), pp8-13. 24. Nursing and Midwifery Council (2008) The Code. Standards of conduct, performance and ethics for nurses and midwives. London: NMC. 25. OConnor, G. (2003) Discharge planning in rehabilitation following surgery for stoma. British Journal of Nursing. Vol.12(13), pp800-807. 26. Polit, D.F. and Beck, C.T. (2008) Nursing Research: Generating and assessing evidence for nursing practice. 8th ed. Philadelphia: Lippincott Williams and Wilkins, pp206-209. 27. Prashnig, K. (2006) Learning Styles in Action. London: Network Continuum Education. 28. Quinn, F. M. (2000) Principles and Practice of Nurse Education. 4th Edn. Cheltenham: Nelson Thornes. 29. Robson, C. (1993) Real World Research: A Resource for Social Scientists and Practitioner-Researchers. Oxford: Blackwell Publishing. 30. Rolfe, G. (1998) Beyone Expertise: Reflective and Reflexive Nursing Practice. In: Johns, C. and Dreshwater, D. (eds.) Transforming Nursing through Reflective Practice. Oxford: Blackwell Science. 31. Rust, J. (2007) Care of patients with stomas: the pouch change procedure. Nursing Standard. Vol.22(6) July, pp43-47. 32. Skinner, B, F. (1954) The science of learning and the art of teaching. Harvard Educational Review. Vol.24(2), pp86-97. 33. Simmons, K.L., Smith, J.A., Bobb, K-A. and Liles, L.L.M. (2007) Adjustment to Colostomy: stoma acceptance, stoma care self-efficacy and interpersonal relationships. Journal of Advanced Nursing. Vol.60(6), pp627-635. 34. Smith, M. K. (1996; 1999) ‘Andragogy, The Encyclopedia of informal education, http://www.infed.org/lifelonglearning/b-andra.htm. (Accessed 6th November 2008). 35. Turnbull, G.B. (2002) The importance of coordinating ostomy care and teaching across settings. Ostomy/Wound Manag

Has Feminism Benefited the American Society? :: Gender Roles, Womens Right

Feminism has transferred an impact on the American society. Some of the benefits include restructured views on careers, schooling, and privileges women obtain. The women’s movement was the main triumphant movement of the 1960s and 1970s (Epstein 125). However, without the victory of the movement nothing would be the same as it is these days. In conclusion, women vision themselves differently now then what they did thirty years ago (Epstein 125). For instance, women pursue infinite amounts of career options that they would have been deprived of in the past. For example, in 2008, Governor Sarah Palin was running as Senator John McCain’s vice presidential candidate (Baxter Paragraph 1). Because of the women’s movement, women like Sarah Palin strive to make the most of it. Possibly someday, in the future, the president could be a female. Women make up four-teen percent of the active duty military force (Velasquez 7).Without that four-teen percent the armed forces could be outnumbered. Women worked their way up to being able to shield their county in a benefitting way. On the other hand, there are more women applying for positions in medical schools all across the country (Chambers Paragraph 1). Any career can be possessed by women these days. In other words, the movement allowed men and women the option to follow their career preferences. Without the women’s movement, women would have been deprived of a prosperous future in a fascinating profession of their choosing. Additionally, over the years women have progressed in their educational studies. For instance, women currently make up fifty-seven percent of all college students (Marklein Paragraph 2). This proves that women are competent of succeeding and accomplishing more than men. As a result, women have gained the freedom to be able to strive for a degree and be able to be independent. Almost one in four women earns a bachelor’s degree compared to one in seven men (Hechinger Paragraph 2). Women have traveled along way from not even being able to attempt working for an education. Without working women America would have a hard time advancing and keeping up with work demands. Besides, women compromise forty-six percent of the total United States labor force (Perkins 1).This is a testament that women are no longer being discriminated against in any aspect of life.

Anatomy and Physiology Cells

This essay will outline the functions of the main cell components, these consist of the nucleus, nuclear membrane, mitochondria, lysosomes, Golgi apparatus, cell membrane, ribosomes, cytoplasm and endoplasmic reticulum both rough and smooth. Images: [3] Every human body has billions of microscopic units called cells. Cells carry out numerous of chemical reactions and processes that make up the essence of life. The structure of cells varies in size and shape and has different functions.There are four main features with in a cell and these consist of the cell membrane also known as the plasma, the cell nucleus which contains mature red blood cells, the cytoplasm and the organelles which is a â€Å"various component of a cell with a distinct structure and their own functions and can be likened to miniature organs. Organelles include mitochondria, the endoplasmic reticulum the Golgi apparatus and lysosomes† [1] The nucleus is usually the largest structure inside the cell which con tains chromosomes which contains deoxyribonucleic acid (DNA), this is the genetic coding material which determines difference characteristics.The nucleus main function is to contain instructions for growth, work and maintenance of the cell, it controls nearly all the activities of the cell. â€Å"A smaller, darker sphere is often visible, the nucleolus, this is a source of ribonucleic acid (RNA) one of the nucleic acids† [2]. When a cell is not dividing (known as resting) this is called the chromatin network and the nuclear material appears like a thick, triangle mass. When a cell is in the process of dividing, the chromatin network separates into distinct black threads known as chromosomes and there are 23 pairs of chromosomes in a human cell. The nuclear membrane is made up of 2layers, each composed of a lipid bilayer. It has holes all over which are called nuclear pores, to facilitate and regulate the exchange of materials, for example, proteins and RNA, between the nucleu s and cytoplasm. The outer membrane is continuous with the endoplasmic reticulum. The inner membrane is linked with a network of intermediate filaments called nuclear lamina acts as a site of attachment for chromosomes. It also acts as a shield for the nucleus†. [4] The mitochondria are rod shaped or spherical shaped, they are very energy active cells.Each mitochondrion has a double layered membrane but the inner layer is folded at intervals, producing a series of ridges known as cristae which is where the enzymes responsible for the end stages of cell respiration. â€Å"The energy released from glucose is stored until it is needed by a chemical battery called adenosine triphosphate (ATP). When energy is required for building complex molecules or doing work like contracting muscles, ATP breaks down to adenosine diphosphate (ADP), releasing energy to build chemical bonds.The ADP is recycled, to be built up once more into ATP, using the energy released from glucose. â€Å"[3] The number of mitochondria in a cell depends on the amount of energy it needs to perform its function, for example the muscle cell will have a large amount because it needs a lot of energy. Images: [4] Lysosomes are very small vesicles produced by part of the Golgi apparatus. They contain powerful enzymes that destroy bacteria, protein, nucleic acids, carbohydrates, lipids and other foreign materials and they release it outside the cells. ysosomes travel freely within the cell and by releasing their contents they can destroy old or damaged organelles and in some cases entire cells, like the clean-up crew of the cell that eliminate anything that has outlived their usefulness. The Golgi apparatus packages protein to deliver to other organelles or outwards from the lysosomes. This appears to look flattened, fluid filled sacs which are stacked upon each other. Images: [2] â€Å"The cell membrane is a thin semi-permeable membrane that surrounds the cytoplasm of a cell, enclosing its con tents.Its function is to protect the integrity of the interior of the cell by allowing certain substances into the cell† (for example, gases and liquids), â€Å"while keeping other substances out† [6]. The cytoplasm is semi-fluid, gel like substance that gives shape to the cell. This where metabolism takes place and this accommodates cell organelles such the mitochondria and the endoplasmic reticulum. There are two types of endoplasmic reticulum (ER), rough and smooth.The rough ER is studded with tiny black bodies called ribosomes and its functions are to manufacture cell proteins and act as a temporary storage area. Sometimes sugars are added to protein (glycoprotein) in secretions like mucus. The smooth ER has no attached ribosomes and is involved in the metabolism. â€Å"Smooth ER is important in the synthesis of lipids and membrane proteins. Rough ER is important in the synthesis of other proteins. Information coded in DNA sequences in the nucleus is transcribed as messenger RNA. Messenger RNA exits the nucleus through small pores to enter the cytoplasm.At the ribosomes on the rough ER, the messenger RNA is translated into proteins. These proteins are then transferred to the Golgi in â€Å"transport vesicles† where they are further processed and packaged into lysosomes, peroxisomes, or secretory vesicles† [5] The reticulum network fills the cell interior and channels passage ways for transporting materials to and from parts of the cell. Images: [1] Ribosomes what are studded all over rough ER. â€Å"A ribosome is a biological molecule made of ribonucleic acid (RNA) and proteins (ribosomal proteins).The structure of a ribosome is complex, and it is responsible for making the millions of proteins that are needed by cells. Think of a ribosome as a small protein biosynthetic factory that translates the DNA genetic information into an amino acid sequence (the primary structure of proteins). † [7] A ribosome may be located in ma ny places within the cell. Some are in the cytosol and others are bound to cellular membranes. Membrane-bound ribosomes are responsible for the characteristic roughness of the endoplasmic reticulum when seen under a microscope.Reference: Images: 1. Anon. (undated) http://www. cellsalive. com/cells/er. htm [online] 2. Anon. (undated) http://micro. magnet. fsu. edu/cells/golgi/golgiapparatus. html [online] 3. Anon. (undated) http://scienceaid. co. uk/biology/cell/structure. html [online] 4. Michael W. Davidson (2000) http://micro. magnet. fsu. edu/cells/mitochondria/mitochondria. html [online] Books and internet: 1. Stretch B. (2010) Health & Social Care Level 3 Book 1: Anatomy and physiology for health and social care 2. Stretch B. 2010) Health & Social Care Level 3 Book 1: Anatomy and physiology for health and social care 3. Stretch B. (2010) Health & Social Care Level 3 Book 1: Anatomy and physiology for health and social care 4. Anon. (2008) www. biology-online. org/dictionary/Nuc lear_membrane [online] 5. Anon. (undated) www. cellsalive. com/cells/er. htm [online] 6. Regina Bailey (2012) www. biology. about. com/od/biologydictionary/g/cell-membrane. htm [online] 7. Paul Arnold (2009) www. brighthub. com/science/genetics/articles/22938. aspx [online]

The Novel A Christmas Carol Essay Example

The Novel A Christmas Carol Essay Example The Novel A Christmas Carol Essay The Novel A Christmas Carol Essay at acquaintance with the spectre Scrooge primarily passes it off as an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato in fear of insanity seeping into him. However instead of insanity setting in, the ghost Jacob Marley was genuinely visiting the tenacious Scrooge. In life I was your partner, Jacob Marley The words spoken from beyond the grave consume Scrooge and start him of onto the path he should have taken a long time ago. Scrooge is foretold of the three ghosts that await him. Without their visits, said the ghost, you cannot hope to shun the path I tread. We leave this stave with Scrooge in a deep sleep, anticipating his destiny of amendment. The opening to any book is arguably the most important part, as it has to hook the reader with a small section of writing into continuing to read the story and the author hasnt fallen short on this occasion. The book starts strangely with Marley was dead which although seems rather bizarre, it grabs the readers attention and sidetracks their thoughts to trying to understand; who is Marley? How did he die? Why is he dead? What is the relevance of this information? However the fact that someone has died [fictional, but nonetheless] the author is in fret to conjure up a few quirky jokes. Old Marley was as dead as a door-nail. Mind A might have been inclined, myself, to regard a coffin-nail as the deadiest piece of ironmongery in the trade. But the wisdom of our ancestors is in the similie; and my unhallowed hands shall not disturb it, or our countrys done for. You will then permit me to repeat, emphatically, that Marley was as dead as a door-nail. This is a good example of how Dickens finds humour in even in a persons death even if the joke isnt really that funny, it still lightens up the mood and by adding this paragraph to the story just emphasised Marleys death so that the appearance of the ghost later on adds a more eerie aura to the epic saga. Because Scrooge knows that Marley is dead for sure, the whole incident sparks of a whole chain reaction, before he didnt care what others thought, wasnt scared of anything and believed in nothing [even love]. But after seeing Marleys faced envisaged into his door knocker, Scrooge became afraid and looked all around his house every room and even under the beds! After all the nasty things Scrooge has done, it is amusing to see him put into this situation and revenge taking place. Every action has an equal and opposite reaction, and Scrooges reaction to the ghost of Marley surely is a humorous one. The first ghost to visit was ghost of Christmas past. Its appearance is rather peculiar It was a strange figure like a child: yet not so like a child as an old man, viewed through some supernatural medium, which gave him the appearance of having receded from the view, and being to a childs proportions. Its hair, which hung about its neck and down its back, was white as if with age; and yet the face had not a wrinkle on it, and the tenderest bloom was on the skin. The arms were very long and muscular; the hands were the same, as if its hold were of uncommon strength. Its legs and feet, most delectably formed, were, like strength those upper members bare. This strange description carries on for quite a while, but from what weve seen so far the ghost is very strong. It most likely uses this strength to hold on to Scrooges past that he himself tries to forget. She looks old because she is Scrooges past, and Scrooge himself is old, therefore she looks old. But she looks young because the young are often looked upon as innocent, which may suggest Scrooge used to be nice. The scene I want to talk about is that at Fezziwigs party. During this whole time, Scrooge had acted like a man out of his wits. His heart and soul were in the scene, and with his former self. This visit unveils the true Scrooge that actually enjoys things and knows how to have fun. Scrooge gets so caught up in the moment he even forgot the ghost was there. This definitely shows us that Ebenezer Scrooge once had a heart. The Second ghost visiting Scrooge was that of Christmas present. Heaped up on the floor, to form a kind of throne, were turkeys, geese, game, poultry, brawn, great joints of meat, sucking-pigs, long wreaths of sausages, mince-pies, plum-puddings, barrels of oysters, red-hot chestnuts, cherry-cheeked apples, juicy oranges, luscious pears, immense twelfth-cakes, and seething bowls of punch, that made the chamber dim with their delicious steam. In easy state upon this couch, there sat a jolly Giant, glorious to see, who bore a glowing torch, in shape not unlike Plentys horn, and held it up, high up, to shed its light on Scrooge, as he came peeping round the door. This description beautifully shows us the shear amount of food there is. And the representation of the 2nd ghost is quite intriguing. It was clothed in one simple green robe, or mantle, bordered with white fur. This garment hung so loosely on the figure, that its capacious breast was bare, as if disdaining to be warded or concealed by any artifice. Its feet, observable beneath the ample folds of the garment, were also bare; and on its head it wore no other covering than a holly wreath, set here and there with shining icicles. Its dark brown curls were long and free; free as its genial face, its sparkling eye, its open hand, its cheery voice, its unconstrained demeanour, and its joyful air. Girded round its middle was an antique scabbard; but no sword was in it, and the ancient sheath was eaten up with rust. This ghost takes Scrooge to many places, and in each place people still celebrates Christmas. Scrooge is also shown how unpopular he really is when people make fun of him at a party. The final ghost, the ghost of Christmas yet to come is a very dark and mysterious character. Lead on! said Scrooge. Lead on! The night is waning fast, and it is precious time to me, I know. Lead on, Spirit! this is different from how we saw Scrooge in the sense that at first he was scared by his own business partner Marley, and now he is talking confidently to a ultra scary ghost. Unlike the previous two, this phantom seems to drain all happiness from its surroundings. It shows Scrooges grave stone covered in rubbish and moss. And then he sees Tiny Tims grave stone immaculate and clean. And to round things off, Scrooge is shown businessman laughing over a dead man [obviously himself]. He moves on to see all his belongings on sale at market. If he wanted to keep them after he was dead, a wicked old screw, pursued the woman, why wasnt he natural in his lifetime? If he had been, hed have had somebody to look after him when he was struck with Death, instead of lying gasping out his last there, alone by himself. . This gives Scrooge an even better view of peoples opinions of him, because now that hes dead they arent afraid to speak their mind. It also is different from stave 1 because then people were scared just by the very presence of Scrooge. And because they think Scrooge deserves all his things being stolen from him. The final scene shows Scrooge looking at his own grave. This hammers home the idea that if Scrooge carries on with his bad ways hell be remembered as the selfish man he is. His conscience is as filthy as his grave. I will honour Christmas in my heart, and try to keep it all the year. I will live in the Past, the Present, and the Future. The Spirits of all Three shall strive within me. I will not shut out the lessons that they teach. Oh, tell me I may sponge away the writing on this stone! . Stave 5 ends the novel with applauded content. Scrooge has been liberated from his wicked ways of malevolence. His pleasant counterpart has been salvaged from his mercilessness exterior. I dont know what day of the month it is. said Scrooge. I dont know how long Ive been among the Spirits. I dont know anything. Im quite a baby. Never mind. I dont care. Id rather be a baby. Hallo! Whoop! Hallo here! . This act of unconcern and rather giddiness has pushed the boundaries that held people back from even being on the same sidewalk as Scrooge. Now his act of blissfulness is being extended to others in the environs of him. He now abides by the knowledge Treat others as you would like to be treated. His life of cruelty and indecency has therefore revoked his right to be treated with the courteous ways in which he ceases to yield. However this encounter of ethereal events has cast him to the path of righteousness. Running to the window, he opened it, and put out his head. No fog, no mist; clear, bright, jovial, stirring, cold; cold, piping for the blood to dance to; Golden sunlight; Heavenly sky; sweet fresh air; merry bells. Oh, glorious! Glorious! These weather conditions deeply contrast those unambiguously dramatic circumstances revealed in stave 1. Foggier yet, and colder. Piercing, searching, biting cold. If the good Saint Dunstan had but nipped the Evel Spirits nose with a touch of such weather as that, instead of using his familiar weapons, then indeed he would have roared to lusty purpose. This is another way in which the author lightens the ambience. He had a momentary idea of knocking Scrooge down with it, holding him, and calling to the people in the court for help and a strait-waistcoat. That just shows how people genuinely cant believe that Scrooge has changed and that instead he has just gone insane, which was ironically Scrooges thought as he first laid eyes upon the spirit of his former business partner, Jacob Marley. At the end of the novel, Scrooge discovers his new passion for Christmas and understands how his ways of skimping on money and overall cruelty has hauled others around him into a descending spiral of misery. And in utter contrast to his former self Scrooge seized the ruler with such energy of action, that the singer fled in terror. into a happy and grateful for everything kind of person Its Christmas Day! said Scrooge to himself. I havent missed it. The Spirits have done it all in one night. They can do anything they like. Of course they can. Of course they can. Hallo, my fine fellow! . The novel ends with a perpetual sense of being and archetypal joy. And so, as Tiny Tim observed, God bless Us, Every One! In conclusion, I believe this novel was written to not only show the inequality of treatment throughout society forced labour in work houses for poor, slave wages, but also to show that people like Scrooge are not overly popular and wont live a good life. Moreover, it is never too late to change your ways.

Essay on Whistle-blowing the EnvironmentEssay Writing Service

Essay on Whistle-blowing the EnvironmentEssay Writing Service Essay on Whistle-blowing the Environment Essay on Whistle-blowing the EnvironmentOften times companies will do things that they are not supposed to knowing that they can get away with it. One problem with this is that if someone finds out and does something about it, it can be extremely detrimental for the company. This was the case with Avco Environmental Services who have a contract with a local hospital. Avco is a company that deals with toxic-waste disposal and it was discovered by one of their employees (named Chantale Leroux) that they were disposing of some of this medical waste in a local municipal landfill. This is not only an illegal action, but it could be very harmful to the health of the workers and the public in general.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Chantale Leroux is faced with a very loaded decision. She could either say something about it and risk falling out of favor in the company or allow this activity to continue in hopes of maintaining good standing in the company. Chantale takes the fo llowing course of action. Initially she goes to her immediate superior and is told to drop it because it is neither the concern of her or her superior. Not being satisfied with this, Chantale takes her issue to a higher ranking employee the very next day. When Chantale brings up the issue, her superior is clearly irritated and tells Chantale things like â€Å"this isn’t your concern†, â€Å"everyone knows that the regulations in this area are overly cautious†, and that there is no real danger and that the matter should be considered closed.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   After Chantale had taken the previously mentioned, she was unsure of what to do. Her supervisors had both been extremely clear that they thought she should just drop her concerns, but she was hesitant to drop it. One the one hand, she knew that it was a completely illegal act and that it could be potentially harmful to the unsuspecting public. On the other hand though, if she were t o take this fact public, she fears that she could jeopardize her job. She is especially fearful of this because she is new and has a promising future with the company. Chantale thinks that the management of the company is honest and trustworthy and generally has faith in them. She is, however, unsure of what to do. She looks up the phone number of an old friend who worked for the local newspaper in case she wants to tell the story, but has still yet to decide.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Corporations have moral obligations in a multitude of ways including obligations to people and obligations to the environment. Corporations are not to harm the people or environment around them especially if it is not of a significant cost. In this sense, cost can mean many things including the obvious money, but also includes things like lives, the well-being of people, and surrounding areas. What is being questioned is whether Chantale has a moral obligation to do as much as she ca n to prevent her company from harming others even if it may cost her job.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Whistle-blowing is essentially just a name used to describe the act of somebody making information public that was secret and intended to be kept secret. There are multiple kinds of whistle-blowing, but for this specific case, we will focus on what is called internal whistle-blowing. â€Å"[T]he term refers to disclosures made by employees to executives in a firm, perhaps concerning improper conduct of fellow employees or superiors who are cheating on expense accounts, or are engaging in petty or grand theft.† (DeGeorge 300) It is referred to as internal whistle-blowing because it is done by somebody inside of the company which is the exact situation that Chantale finds herself in. â€Å"Generally (when one whistle-blows), one believes an investigation will follow and a sanction will be imposed.† (DeGeorge 300) This would be the case for Chantale as wel l because she would only whistle-blow in order to potentially reduce harm to her surroundings.Whistle-blowing can be viewed three different ways: prohibited, permitted, and mandatory.Prohibited – This is the most widely held view of the three. DeGeorge states that â€Å"[t]here is a strong tradition within American mores against †ratting† or telling on others.† (303) Due to this common viewpoint, it is typical for a whistle-blower to be seen as someone who went against the firm and therefore the people in the firm.Permitted – Permitted whistle-blowing â€Å"involves an employee somehow going public, revealing information or concerns about his or her firm in the hope that the firm will change the product, action, policy, or whatever it is that the whistle-blower feels will harm, or has harmed, and needs to be rectified.† (DeGeorge 306) Whistle-blowing is typically not seen as something done with the permission or consent of the company and will often do the company harm. For this reason, for whistle-blowing to be permitted, good must come of it and enough to where it outweighs the bad.Mandatory – This is the case when a person has a moral obligation to whistle-blow because of certain conditions including, but not limited to, the concern for the health of others and the concern for the environment.As long as there are activities going on, goods being made, or really anything else where companies are acting immorally, there will be some sort of whistle=blowing that not only will happen, but really in some cases, should happen. â€Å"The need for moral heroes shows a defective society and defective corporations. It is more important to change the legal and corporate structures that make whistle-blowing necessary than to convince people to be moral heroes.† (DeGeorge 316) When speaking about whistle-blowing one must understand that it can on the one hand lead to troubling times for a company, but on the other, i t can make companies work toward a higher standard. DeGeorge states, â€Å"[w]histle-blowing should also alert corporations to what can and should be done if they wish to be both moral and excellent.† (317) Overall, whistle-blowing should be see looked at in a case-by-case basis because it can be both wrong and right.Chantale finds herself in a situation that is far from enviable, but she is trying to decide whether or not to blow the whistle on her company. There are positives and negatives to both sides, but armed with the previous information, she should be able to make a decision. What should Chantale do?