Burnout Prevention Program for Nurses Essay

Burnout Prevention Program for Nurses Essay Burnout Prevention Program for Nurses Essay Example Burnout Prevention Program for Nurses Essay Example The nursing profession is one of the most demanding in terms of responsibilities to be performed and the working environment. The high pressure in the nursing profession makes nurses vulnerable to burnout, which affects their ability to deliver quality services to patients. Accordingly, burnout among nurses is possible when they start experiencing an increased prevalence of depression and anxiety. Their levels of commitment to their respective duties and responsibilities decline with the increasing levels of burnout. Burnout among nurses increases the annual turnover rates, as many nurses opt out of the practice to relax. Such situation is worrying and needs urgent intervention through proper coping strategies that would help them handle the numerous stresses they experience in their respective areas of work. One of the most notable examples of programs that have been successful in preventing burnout among nurses was the Resilience Training Program for Intensive Care Unit. According to Mealer, et al. (2014), the American Association of Critical-Care Nurses (AACN) was in charge of the program and it was based on the cognitive behavioral therapy sessions, regular exercises over a 12-year period, expressive writing and mindfulness-based stress-reduction techniques. The strategies played an instrumental role in giving participants the opportunity to express themselves, hence releasing their stresses and other concerns in the best possible way. They were taught to be stronger and resilient in the stressful field. Therefore, it is vital for hospitals to understand the different challenges that nurses face in their work environments, as it would offer the opportunity to assist them in coping with burnout. Burnout prevention programs are only successful in instances where the needs of nurses are keenly evaluated and addressed in the most significant manner. The training program suggested in current essay would be crucial in addressing diverse challenges, inclu ding family problems, work structure, remuneration, interaction with patients and workplace relationships among nurses and their bosses. Current essay explicates the concept of burnout among nurses and suggests an effective program for burnout prevention for nurses. What is Burnout? Burnout refers to the long-term exhaustion and diminished interest in work among professionals in different field. Ceslowitz (1988) opines that burnout is always common among highly pressured professionals, such as those in the field of nursing. Specifically, burnout is a condition that emanates from the chronic occupational stresses, such as work overload and pressures relating to the completion of different jobs at the workplace. However, further evidence reveals that the etiology of burnout is multifaceted in nature as dispositional factors also tend to play a role in its occurrence. Lambie (2006) informs that burnout is widespread among professionals, but it is not recognized as a distinct disorder in the DSM-5 due to its closeness to other depressive disorders. In the ICD-10, burnout could be found under problems related to life management difficulties. Overall, a burnout could be defined as the unending feeling and exhaustion among professions in their respective areas of work. The Interpersonal Impact of Burnout When the concept of burnout was first described in the 1970s, it was originally linked to interpersonal stressors on the job. Falck and Kilcoyne (1984) inform that the concept of burnout was originally observed in the context of human services, such as healthcare, hence easily revealing its interpersonal impacts. In line with such understanding, the first significant interpersonal impact of burnout is the syndrome of emotional exhaustion. It emanates from a person’s emotional demands in the course of interacting with others at the workplace. Moreover, there is a high possibility that nurses will develop a reduced emotional attachment to other people at work due to the exhaustion caused by the workplace stressors. The individual feels exhausted in terms of responding to emotional demands in respect to others in the workplace. The second vital interpersonal impact of burnout is depersonalization. Ericson-Lidman and Strandberg (2007) are of the view that it is the cynical and negative response to patients and losing interest with oneself. For instance, nurses would lose interest in offering the required care to patients. Moreover, they tend to feel that patients are a bother to them and offer services that do not meet the required criteria due to burnout. The last crucial interpersonal impact of burnout is reduced personal accomplishment. It is believed that due to it a worker cannot work in the most effective manner with the clients. In the hospital setting, nurses tend to feel that they cannot work effectively with patients due to the frustrations they experience in the workplace. Symptoms of Burnout According to Brake, Gorter, Hoogstraten, and Eijkman (2001), burnout exhibits numerous symptoms that are easily noticeable from the behavior of workers. The first symptom is the unique feeling of tiredness. It is when a worker experiences tiredness coupled with aches and pains in different parts of the body. The second symptom of burnout is the loss of interest to work. Most people find their work a fun experience. However, they reach the level, at which they perceive their work a burden rather than a fun experience. The third notable symptom of burnout is the feeling of loneliness emanating from the decision to isolate oneself from others in the workplace. Such detachment tends to lead to depression among workers. Balk, Chung, Beigi, and Brooks (2009) assert that the fourth symptom of burnout is emotional exhaustion. The emotions of individuals tend to be blunted, and they may negatively react to co-workers. They lose that passion of working effectively with other employees and fail to realize the goals of the hospital in terms of service delivery. The last significant symptom of burnout is anxiety and continuous instances of worry among individuals. The workers tend to be anxious about everything occurring in the workplace. Some of them become frustrated with their own job performance and all other activities taking place within the work environment. Stages of Burnout Burnout develops in 12 diverse phases/stages among individuals. Wang, Liu, and Wang (2015) affirm that before explaining each of the stages, it is crucial to point out that burnout is not categorized as a distinct disorder in the DSM-5 because it is problematically closer to depressive disorders. Therefore, such stages are perceived the onset of depressive disorder from the perspective of DSM-5. The relevant stages theorized by Herbert Freudenberger and Gail North are summarized below. Stage 1: The compulsion to prove oneself. According to Falck and Kilcoyne (1984), it refers to the excessive ambition adopted by employees. The pressure to prove oneself at the workplace leads to compulsion. They want to be above everyone in terms of performance in their areas of work. Stage 2: Working harder. It emanates from the desire to prove oneself at the workplace. The employee develops higher expectations and sets higher targets compared to everyone. With the desire to prove themselves, they engage in any work at the workplace. Stage 3: Neglecting their needs. Such individuals place all their focus on work, while forgetting their personal needs. For instance, a worker might forget to eat, spend time with the family or friends. They perceive such activities unnecessary and prioritize work at any given time. Stage 4: Displacement of conflicts. Kushnir and Milbauer (1993) agree that at current stage the individuals convince themselves in the fact that what they are doing is not right. However, the individuals fail to recognize the cause of the problem leading to an individual crisis. Physical symptoms begin appearing at current stage among most individuals. Stage 5: Revision of values. In line with current stage, the individual prefers isolating himself/herself from others. Schaufeli, Leiter, and Maslach (2009) hold the view that individuals avoid conflicts and find themselves in a state of self-denial about their basic needs with the changing perceptions. They develop a new value systems focusing on job performance and become emotionally blunt. Stage 6: Denial of emerging problems. Current stage is characterized by intolerance as individuals are not social. Social relationships are extremely unbearable for them due to their intolerance. At this stage, outsiders are always able to identify aggression and aspects of sarcasm among such individuals. They blame their problems on the way they have changed rather than on their work and other organizational pressures. Stage 7: Withdrawal. It is when the social contacts reduce to the lowest level almost leading to isolation. Individuals tend to minimize their stresses using alcohol and cigarettes. Stage 8: Obvious behavioral changes. Ericson-Lidman and Strandberg (2007) reiterate that changes in the behavior of the person become so apparent that friends, co-workers and family members cannot overlook them. They begin fearing and shying away from other people due to the rapid changes in behavior and aggressive tendencies. Stage 9: Depersonalization. Individuals tend to lose contact with themselves, as they perceive themselves worthless. They also forget their own personal needs and they view their lives from a narrow perspective. They mostly focus on the present, forgetting the future. Stage 10: Inner emptiness. Individuals feel extremely empty on their inside and resort to the activities such as sex, overeating, alcohol and other drugs to overcome their stresses. Their engagement in such activities is always exaggerated. Stage 11: Depression. Smith (1999) informs that depression develops with time, as the individuals become hopeless, exhausted and develop the belief that they do not have a future. They see no meaning in their own lives as a result of the lost hope. Stage 12: Burnout syndrome. The emotions and physical status of such individuals collapses to the lowest level. At this stage, there is always a need for urgent medical attention for individuals. Suicidal ideation might occur in some instances caused by extreme depression. However, only a few people commit suicide. What is Not Burnout? In numerous instances, burnout has always been confused with stress. Specifically, individuals tend to confuse the symptoms of stress with burnout without understanding that they are two distinct disorders. However, stress is different from burnout because it is usually characterized by over-engagement, while burnout is associated with disengagement. A person would not be termed to be experiencing a burnout when he/she over-engages in a particular activity. Additionally, Schaufeli, Leiter, and Maslach (2009) point out that instances of emotional overreaction are not reflections of burnout, but stress. Goetz, et al. (2013) hold the opinion that burnout develops as a result of emotional bluntness among individuals, as they forget their own needs, family and friends. More so, stress might lead to premature death among individuals, while a burnout only makes individuals feel worthless in their lives. It does not necessarily have to lead to suicidal ideations. Therefore, incidences of sui cidal ideations may not necessarily reflect the presence of a burnout among individuals. Again, burnouts mostly tend to occur from the job, hence differing from stress, which might occur from any other causes. A burnout is not a feeling that arises from any other life event, but pressures in the work environment. Analysis of the Real Situation and Background MacKusick and Minick (2010) indicate that The American Association of Colleges of Nursing (AACN) indicates that the shortage of registered nurses in the country exceeds 500,000 registered nurses by 2025. It occurs due to the fear of starting the practice influenced by the associated workplace pressures. MacKusick and Minick (2010) emphasize that the study by AACN also indicated that an estimated 30%-50% of registered nurses leave their practices three years after starting their work. The longer working hours have contributed to burnout among such nurses, as they have to be involved in the routine of taking care of patients on a daily basis. Kalliath and Morris (2002) state that the increasing burnout levels lead to patient dissatisfaction with negative outcomes, which occur in the healthcare environment. Nobody wants nurses to leav the practice due to the increasing burnout levels. Again, everyone wants to experience a situation where patients are satisfied with the services delivere d to them by nurses. Such situation needs to improve to promote the ability of nurses to cope with such challenging environment. Therefore, the burnout prevention program was designed that would enhance the ability of nurses to cope with the pressures in their workplace. The program is specifically dedicated to decrease the pressures that nurses are exposed to and help them cope with their work. For instance, it focuses on encouraging hospitals to reduce the working hours for nurses, hence allowing them maximum time to rest. Even with the shortage of registered nurses, it is possible to deliver shifts that accommodate rest for nurses. The review of the work structure to manageable levels would play an instrumental role in leading to reduced burnout levels. One significant element that makes such burnout prevention program important is that it would involve the identification of a need assessment for nurses before tackling their issues in respect to factors contributing to their burnout. Balk, Chung, Beigi, and Brooks (2009) agree that the identification of needs is crucial because it leads to a more focused approach in the execution of the prevention program. In tandem with the program, the need was expressed to prevent burnout levels among nurses. Therefore, it has been planned to conduct surveys or questionnaires with nurses to identify their needs prior to helping them cope with workplace pressures. As Wang, Liu, and Wang (2015) explain, everyone with a burnout level higher than 4 on both the frequency and the intensity scale of the Maslach Burnout Inventory would need to be involved in such burnout prevention program. It is important as these are moderate levels of burnout as experienced by each person. It is noticeable, hence lead ing to the loss of interest in work and undesirable patient outcomes. Such burnout prevention program would start with involvement of individuals at the moderate to the high levels of burnout to facilitate future coping among them. Such strategy is developed accordance with the research conducted from the daily lives of nurses in the hospital setting. Program Aims and Goals The program will have both general and specific goals to guide its purpose in helping nurses prevent incidences of burnout by dealing with different matters they face. General Goals The first general goal is to train nurses on the best techniques to prevent burnout, while facing different issues at their workplaces; The second general goal of the program would be increase awareness, hence helping nurses identify symptoms easily as they face diverse challenges in their work environments. Specific Goals To promote the understanding of common signs of burnout among nurses; To improve resilience among nurses through in-depth training on relevant coping strategies relating to different challenges in the workplace; To ensure that nurses know the antecedents of burnout, hence enabling them deal with it effectively as they start experiencing it; To help nurses learn how to manage time to avoid finding themselves in working situations that expose them to burnouts. Appropriate time-management skills eliminate overworking; To decrease their burnout levels measured on the Maslach Burnout Index; To help nurses understand themselves in terms of their strengths and limitations; To help nurses learn how to manage their private and job life to avoid overindulgence in one area, while foregoing the other one; To enable nurses to learn how to reveal themselves. It relates to adopting the best strategies to communicate feelings and thoughts to other people, and being able to say â€Å"no† in some cases. Target Population and Location The participants in the program will be nurses from a hospital in the United States. The reason for it is that the nursing profession is one of the occupations that are exposed to numerous pressures, which lead to burnout. Smith (1999) asserts that while working in the hospital environment, nurses face different events, such as suffering cancer patients, dying patients and long working hours. Others have personal financial and family problems that expose them to burnouts, hence the need for the effective coping strategies. As noted earlier, the program would consider nurses who exhibit a burnout level higher than 4 on the Maslach Burnout Index, as they are at a high risk in terms of the burnout level. Such prevention program would only accommodate 15 nurses. Such number is perceived ideal because it is easier to work more efficiently with this number of people compared to working with a large number, for example 30 participants. Moreover, the number is ideal because it enhances perso nal contact with all participants, hence giving them the opportunity to benefit from the prevention program. The most significant thing to indicate here is that everyone will participate voluntarily without being coerced. The inclusion criteria is as follows: A person must be a nurse; A person must be participating in the delivery of healthcare services at a hospital; Should be working in shifts; Must be in a high responsibility area; Must have a social attitude as they help others all the time; Must be experiencing difficult working conditions, such as experiencing death, dealing with cancer patients and other suffering patients all the time; Has to be friendly and needs to have a large base of social contacts; Could be either male or female; Nurses with family and money problems would also be accommodated in such burnout prevention program. Exclusion Criteria: Exhibiting zero levels of burnout; Low responsibility area. Location The burnout prevention program will take place in a hospital in City X. Most of the sessions will take place outside the hospital setting to give the nurses a new experience that would help them relax and learn effectively. Skovholt, Grier, and Hanson (2001) are of the view that learning outside the hospital environment would be the most ideal way of helping them understand the best strategies of preventing burnout, while offering their services to patients in their respective high responsibility areas. Again, they would be able to express themselves better in any other environment away from the hospital. In addition, it may lead to the success of the intervention program in terms of enabling them prevent incidences of burnout, as they work in the future. Timetabling The prevention program is scheduled to take 12 weeks (3months) to accomplish its mission of helping nurses prevent burnout in the future. Participants would engage in similar activities with three sessions every week. There will also be an open forum session where participants have the opportunity to express themselves and receive instant feedback from facilitators. Balk, Chung, Beigi, and Brooks (2009) opine that such approach to learning would be significant in achieving the desired outcomes among the nurses. As a result, it will help improve their resilience and coping strategies in their challenging work environments.

When Should I Ask for a College Recommendation Letter

When Should I Ask for a College Recommendation Letter SAT / ACT Prep Online Guides and Tips I remember worrying about the perfect time to ask for recommendation letters. Too early, I thought, could seem like over-planning; maybe my teachers would even forget by the time deadlines rolled around! Too late, though, would suggest a lack of preparation or could even offend my recommenders. It seemed like the stars had to align just right. If you’ve had any of these same concerns, you don’t have to wonder anymore. This guide will discuss the best times to ask for recommendations, plus why it’s important to have good timing in the first place. To start, what should you consider as you figure out when to ask? What Matters As You Decide When to Ask? There are a few main factors that influence when you should ask for recommendation letters, each of which I’ll talk about in more detail below. In a nutshell, these factors include the following: your college deadlines your teachers’ preferences your school's policy the year in which you had your teachers Some of these factors are easy to define - like your college deadlines - while others may offer a little more flexibility. Read on to figure out which ofthese scenarios applies to you, as well as what it means for your rec letter request schedule. Let’s begin with the general (though not necessarily definitive) golden rule: Ask At Least a Month Before Your College Deadlines Unless your school or teachers set other policies, you should ask for recommendation letters about four weeks before your college deadlines. If your deadlines vary, then ask four weeks before your earliest one. What exactly does this look like? If you’re applying to meet a November 1st early action or early decision deadline, then you should ask your teachers by October 1st. If your deadline’s November 15, then ask by October 15th. You get the idea. If your deadlines are regular decision, then they might be around January 1st or January 15th. In this situation, you could ask by the time December rolls around. However, consider everything that goes on in December. December is full of midterms, which means lots of grading for teachers, plus manydays off from school. You can also assume that most students have made their rec letter requests earlier in the semester. For regular decision deadlines, I would suggest asking by mid-November at the latest, to take into account the busy scheduleandvacation daysin the winter months. You may be wondering why teachers need a month to write a letter. For one thing, they’re not just writing you a letter - some teachers have dozens of letters to write, and most counselors have hundreds! Besides that, rec letters take time and thought to do well. You don’t want a rushed, subpar letter because you waited too long to ask for it. While giving your teachers about a month before your deadlines is generally a safe rule, it’s not the end-all, be-all answer. Your teachers and school might tell you to ask even earlier. Let’s consider what policies teachers set, followed by what your school guidance department might tell you to do. Everyteacher might have their ownpersonal preference. Ask According to Your Recommenders’ Preferences Teachers are busy. They have to teach several classes a day for hundreds of students, not to mention all the planning and grading that goes on behind the scenes. Plus, despite what we may have believed in elementary school, they don’t live at the school. They have lots going on in their personal lives, too. My point is that recommendation letters are another task on top of an already packed schedule. Just as you should give your teacher plenty of time to write your letter, your teacher might set certain policies to make the workload more manageable. She might set a rec letter request due date, or set a cap on how many letters she’ll write. It’s your job to find out what your teachers’ policies are. If you can’t find out from older students or through word of mouth, then you should ask your teacher when she prefers to get requests. Find out if she sets a deadline or limit. If she sets a cap, try to get a sense of how popular a recommender she is. If you know your English teacher, for instance, gets inundated with requests, get yours in early. Ask her in September or, better yet, in the spring of junior year. You don’t want to ask a month before your deadlines only to find that your teacher’s too busy or has stopped accepting requests. Generally speaking, your teacher will appreciate that you’re being thoughtful, proactive, and giving her plenty of time. Along similar lines, your guidance department may give you instructions about when to ask. Ask According to Your Guidance Department’s Instructions While individual teachers may set their own policies, your guidance department may also have a blanket rule for all college-boundstudents. Some schools, for instance, have students ask in the spring of junior year. Others tell students to submit three teacher preferences to their college counselors, who will then assign everyone two (and thereby balancethe numbers more evenly). Other high schools tell students to ask in the fall of senior year, and still others have no particular guidance - they leave it up to each student to figure it out. If you haven’t received directions, visit your school counselor and ask her about the general expectations. They may determine whether you ask in Aprilof 11th grade or September of 12th. Finally, there’s one more consideration that may alter your request timeline: the grade in which you had your recommenders as teachers. Don't wait so long that your teacher forgets who you are! Also, just keep swimming. Ask Your Teachers At the End of their Class or School Year Remember that classic first day of school assignment,"Write about what you did over the summer"? Well, what if your teacher asked you to write in vivid detail about what you did three summers ago? Just as you might have trouble remembering the specifics, your recommenders mightnot be able to produce the clearest memories if they had you in class years before you make your request. While it’s advisable to ask your junior year teachers, some students reach back further and have their freshman or sophomore year teachers recommend them. If you had a great connection with a 9th or 10th grade teacher and feel they might make a strong recommender, then you should ask them sooner rather than later. Instead of waiting until senior year, you should ask them at the end of the year you had them, ie, at the end of 9th or 10th grade. Similarly, you could ask your junior year teachers at the end of 11th grade, rather than waiting until after summer break. Even if you don’t ultimately use the letter, you can have it on file just in case. Plus, asking early helps in any of the other scenarios mentioned above: you give your recommenders (more than) a month before your deadlines, you beat the rush of requests, and you get your request in before any ofyour teachers’ or guidance department’s deadlines. Win-win-win. If you’ve learned about the rec letter process, then you know more goes into it than simply asking your teacher to write you one. You additionally want to provide a resume and a thoughtful brag sheet. If you’re asking especially early, then you could make the request and follow up later with all this info. You’ll show your recommenders that you’re proactive and goal-oriented; then you can send along your recommendation packet once you’ve prepared it. Now that you have a sense of when students typically ask for recommendations and why, how can you figure out when exactly YOU should ask? So When Should You Ask for Your Recommendations? To determine when you should ask your recommenders for a letter, you need to do your research. Make sure you know all your college deadlines, for starters. Then figure out whether your school has any guidance about when to ask, like in April of 11th grade or September of 12th grade. Figure out who you're going to ask in junior year, so you can find out if your teachers set any deadlines for or caps on requests. If you're a younger student, you should think about whether any of your teachers would make for strong recommenders. If so, then consider asking them at the end of the school year. The latest that you should ask for recommendations is October of senior year for early deadlines and November to December of senior year for regular deadlines. To be safe and proactive though, as well as to keep yourself fresh in your teachers' memories, you'd do well to ask in March, April, or May of junior year. Asking early will not only give your teachers the time they need to write a well-crafted letter, but it will also give you peace of mind. Apart from following up with a reminder and thank you note, your work on recommendation letters will be done! Then it will be up to your recommenders to upload their letters, and you can focus on finishing up the rest of your college application. What's Next? As you can tell, a lot of planning and strategy goes into your recommendation letters. Why are rec letters important in your application? Whatdo admissions officers look for when they read them?Find out more about the role of rec letters in admissions decisions in these guides. There are lots of other steps that go into applying for college, like scheduling your SAT/ACT and writing your personal essay. Check outour complete guideto applying to college, from 9th grade up until senior year. Want to improve your SAT score by 160 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now:

A Normal C Reactive Protein and Significant Bacterial Infection in Literature review

A Normal C Reactive Protein and Significant Bacterial Infection in Children with Fever - Literature review Example One of the most common reasons for Emergency Department (ED) visit is the fever. Fever accounts to approximately 10 – 35% of admissions in children younger than three years of age (Nuttall, 2003; Andreola et al., 2007; Behjati 2008; Liu et al, 2008). In this age group, severe bacterial infections or SBI represents to about 10 – 25%; however, Andreola et al (2007) noted that this diagnosis is frequently confusing especially with the absence of localising findings. Hence, a need for specific and sensitive laboratory markers for infection is required because of the presence of clinical findings such as body temperature. More than a decade ago, an algorithm which incorporates with laboratory findings, such as white blood cell count and absolute neutrophil count was published and was proven to be useful in the medical practice especially in the identification children who are at higher risk of severe bacterial illness. Additional markers such as C – reactive protein ( CRP) and procalcitonin (PCT) are maybe useful (Nuttall, 2003; Andreola et al, 2007). In 1930, CRP is discovered by Tillett and Francis as C – Polysaccharide fraction called as fraction C from the sera of an acutely ill patient. In 1941, fraction C was found to be a peptide instead of a polysaccharide, thus renamed as C reactive peptide. In 1950, it was reported that CRP can be detected in more than 70 types of disorders. Carlan added that CRP can be normal in invasive bacterial disease, and produces the largest, the most rapid, and most quantifiable acute response to inflammation and infection.

How Far Should Pornography Be Regulated in the 21st Century Essay - 1

How Far Should Pornography Be Regulated in the 21st Century - Essay Example FÐ ¾r exÐ °mple, MÐ °rshÐ °ll Ð °nd BÐ °rbÐ °ree (1984) stÐ °ted thÐ °t "there hÐ °ve been drÐ °mÐ °tic increÐ °ses in the Ð °mÐ ¾unt Ð ¾f viÐ ¾lent sex in bÐ ¾th sÐ ¾ft cÐ ¾re . . . Ð °nd hÐ °rd cÐ ¾re pÐ ¾rnÐ ¾grÐ °phy. . . Ð °vÐ °ilÐ °ble in Western sÐ ¾cieties". BÐ °rry (1979) stÐ °ted, "The mÐ ¾st prevÐ °lent theme in pÐ ¾rnÐ ¾grÐ °phy is Ð ¾ne Ð ¾f utter cÐ ¾ntempt fÐ ¾r wÐ ¾men . . . (whÐ ¾) Ð °re rÐ °ped, ejÐ °culÐ °ted Ð ¾n, urinÐ °ted Ð ¾n, Ð °nÐ °lly penetrÐ °ted, beÐ °ten, Ð °nd, with the Ð °dvent Ð ¾f snuff films, murdered in Ð °n Ð ¾rgy Ð ¾f pleÐ °sure". Russell Ð °nd Lederer (1980) Ð °lleged thÐ °t  «pÐ ¾rnÐ ¾grÐ °phy usuÐ °lly cÐ ¾mbines sÐ ¾me sÐ ¾rt Ð ¾f viÐ ¾lence with sex ». DwÐ ¾rkin (1981) in describing pÐ ¾rnÐ ¾grÐ °phy stÐ °ted, "reÐ °l wÐ ¾men Ð °re tied up, stretched, hÐ °nged, fucked, gÐ °ng-bÐ °nged, whipped, beÐ °ten, Ð °nd begging fÐ ¾r mÐ ¾re". SimilÐ °rly, Grif fin (1981) described pÐ ¾rnÐ ¾grÐ °phy Ð °s "usuÐ °lly Ð ° wÐ ¾mÐ °n, sÐ ¾metimes Ð ° mÐ °n, Ð ¾ften Ð ° child, is Ð °bducted by fÐ ¾rce, verbÐ °lly Ð °bused, beÐ °ten, bÐ ¾und hÐ °nd Ð °nd fÐ ¾Ã ¾t Ð °nd gÐ °gged, Ð ¾ften tÐ ¾rtured, Ð ¾ften hung, his Ð ¾r her bÐ ¾dy suspended, wÐ ¾unded, Ð °nd then murdered". Ð °ll these clÐ °ims Ð °s fÐ ¾r pÐ ¾rnÐ ¾grÐ °phy Ð °nd its negÐ °tive impÐ °ct Ð ¾n sÐ ¾ciety hÐ °s evÐ ¾ked cÐ ¾ntrÐ ¾versiÐ °l Ð °pprÐ ¾Ã °ch tÐ ¾ the regulÐ °tiÐ ¾n Ð ¾f pÐ ¾rnÐ ¾grÐ °phy Ð °nd subsequent viÐ ¾lence in 21st century. FrÐ ¾m Ð ¾ne side the demÐ ¾crÐ °tic system is believed tÐ ¾ hÐ °ve freedÐ ¾m in mÐ °ss mediÐ ° Ð °nd thus expÐ °nd different kinds Ð ¾f infÐ ¾rmÐ °tiÐ ¾n, frÐ ¾m Ð °nÐ ¾ther side the Ð ¾bscentity by which the wÐ ¾rld hÐ °s been filled with respect tÐ ¾ pÐ ¾rnÐ ¾grÐ °phy mÐ °kes it impÐ ¾rtÐ °nt tÐ ¾ regulÐ °te Ð °nd cÐ ¾ntrÐ ¾l the infÐ ¾rmÐ °tiÐ ¾n Ð °vÐ °ilÐ °ble fÐ ¾r the peÐ ¾ple Ð ¾f different Ð °ges. The pÐ ¾rnÐ ¾grÐ °phy cÐ ¾ntrÐ ¾versy is Ð ° cÐ ¾mplex Ð ¾ne, spÐ °nning persÐ ¾nÐ °l, technicÐ °l Ð °nd public Ð °rgument (see GÐ ¾Ã ¾dnight) Ð °s it invÐ ¾kes sÐ ¾ciÐ °l, mÐ ¾rÐ °l, legÐ °l, Ð °nd ethicÐ °l clÐ °ims. It Ð °lsÐ ¾ rÐ °ises interesting theÐ ¾reticÐ °l questiÐ ¾ns  Ã °bÐ ¾ut the wÐ °y persÐ ¾nÐ °l testimÐ ¾ny Ð ¾perÐ °tes in public Ð °rgument. PriÐ ¾r tÐ ¾ Ð °ll Ð ¾f these cÐ ¾nsiderÐ °tiÐ ¾ns, hÐ ¾wever, is hÐ ¾w the cÐ ¾ntrÐ ¾versy is distinguished by the primÐ °ry rÐ ¾le plÐ °yed by definitiÐ ¾nÐ °l Ð °rgument.

The secret life of bees Essay Example for Free

The secret life of bees Essay T-Ray, Lilys father comes to collect Lily but leaves Rosaleen in the cell; alone to be with her thoughts and come to terms with what has actually just happened. Youre lucky I got you out he yelled. But she cant stay there She dumped sniff juice on three white men! What the hell was she thinking? Lily is grateful for her father coming and getting her out of jail, but is upset that Rosaleen has been left behind. But Rosaleen has to learn her lesson and that is the impression that the reader gets from her father, youre lucky I got you out' tells us that he might have even left his own daughter in the jail cell for longer than he did, I think that Rosaleen and Lily had no real reason to be in jail in the first place the way the writer describes the incident is that Rosaleen was paying back the man for deeds he had done in the past that severely damaged her family. There is a great turning point to this novel, when Rosaleen and Lily run away together. They went to South Carolina and found a house that they seemed very interested in. Lily wants to run away because the situation with her father is getting too much for her and she also wants to find much more about her mother. The woman moved along a row of white boxes that bordered the woods beside the pink house, a house so pink it remained a scorched shock on the back of my eyelids She looked like an African bride. This was when they first seen the house and where watching the beekeeper go about her duties, which was amazing to them. Lily has a connection towards bees and this is what brought her and Rosaleen towards this house, as if the bees were calling her and showing her the right path in her life. As they watch this woman they feel as if they are getting to know her more and more just by watching her go about her duties. At this house they meet three black calendar sisters: May, June and August, August is the beekeeper who tells Lily the secrets of the Black Madonna mother to thousands. Its from August that Lily unexpectedly receives the keys to her mothers mystery and learns the secrets of beekeeping. This is where I spent my summers, she said Big Mama kept bees; too, right out there in the same spot theyre in today She liked to tell everyone that women made the best beekeepers. This felt like home to Lily the girls were almost her sisters she never had and August was like that special mother that she had always wanted, Rosaleen took on that figure but was more like a best friend than a mother to Lily. As the turning point develops Lily does think back to what life at home was like and whether her Dad is ok, but she knows there will be trouble down the line and will see her father again. Towards the end of the novel Lily starts to realise how important real family is and what they are there to do. Looking back to the old days Lily realises how much she really misses her mother and once told stories of her by August is reminded of her charming nature. August telling Lily the stories of her mother really does trig her memory of having great fun with this special person and makes her look back with Rosaleen at those great days everyone enjoyed with her and how great she really was. Lily loved her mother very much and still does she is reminded of this as she reflects back onto her childhood past and thinks of all the great times the family had together. When T. Ray finds Lily it is an unfortunate yet tragic event at the same time, she wants to see him but doesnt feel love for him. This is the autumn of wonders, yet every day, every single day, I go back to that burned afternoon in August when T. Ray left. and there they were. All these mothers. I have more mothers than any eight girls off the street. They are the moons shining over me. This is when Lily realises although she cannot remember meeting her biological mother she has many other mother figures in her life that will almost fill those shoes until she grows up. I also think that her father leaving her is a very stupid and selfish thing of him to do. Lily goes from having so much sympathy from me to being a young woman who can understand that once something so tragic as your mother dying has happened there really is nothing that you can do about it and all you can do is look for new or replacement mothers for the time being. Lily I feel is a very heroic child dealing with what she does as a main character she develops dramatically changing from very vulnerable to extremely strong and courageous. This is evident through her relationship with her father and Rosaleen. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Miscellaneous section.

Lack of Forgiveness in Lucille Cliftons poem Forgiving My Father

The title of Lucille Clifton's poem, "forgiving my father", seems to be in sharp opposition with the poem itself. There seems to be no forgiveness, yet the title claims that it is there. The entire poem focuses on the debt of the author's father. "it is Friday." she says, "we have come to the paying of the bills." (1-2). But perhaps it doesn't necessarily mean that it is literally Friday, perhaps she just means it is the end, and maybe the debt isn't one of money, but of love. Clifton is using a monetary debt to symbolize a debt of love and affection. She uses this symbolism to show that by the end of the poem, she has forgiven her father, but it is not forgiveness as we would normally think of it. The poem begins by talking about how it is payday, but the father, as a ghost, is asking for more time to pay. How can a ghost pay anything? Even if he could get the extension, he would never be able to pay anything because he is dead. So why does she say it is payday? Perhaps the answer lies in lines 7 and 8 when she says, "my mother's hand opens in her early grave and I hold it out ...

Pre-operative assessment Essay

Pre-operative assessment (POA) and planning, carried out prior to treatment, ensures that the patient is fully informed about the procedure and the post operative recovery, is in optimum health and has made arrangements for admission, discharge and post operative care at home. POA and planning is an essential part of the planned care pathway which enhances the quality of care in a number of ways. * If a patient is fully informed, they will be less stressed and recover more quickly * A health check ensures good medical health before anaesthesia and surgery * Planning admission and discharge individually ensures that patient and carers know what to expect facilitating earlier post operative care at home * Cancellations due to patient ill health or DNAs are reduced * Admission on the day of surgery and early discharge are more likely By improving the planned admission process, you also enhance the patient experience and the clinical process, as well as the efficiency and productivity of the trust. POA and planning should form a natural part of the process for all planned surgery. You may wish to match the intensity of the process to the patient’s level of fitness and complexity of the procedure. The key areas covered in the National Good Practice Guidance on Pre-operative Assessment for Inpatient and Day Case Surgery include: * The objectives of pre-operative assessment  * Who should undergo pre-operative assessment * When and where pre-operative assessment should take place * Who should perform pre-operative assessment * The risks, benefits and informed consent * What should happen after pre-operative assessment * What information should be given to patients * How records should be kept * How the pre-operative assessment service should be audited * Training in pre-operative assessment * Examples of effective practice