Health Visitor Reflective Essay

Health Visitor Reflective Essay I attended a core group meeting for a family with complex needs. Parents Poppy and Richard had struggled to overcome a class A drug addiction and that there were grave concerns about the wellbeing of the 4 children in the family home. I sat opposite Poppy across a small table as this was the last available seat in the room. Richard was unable to attend but it had a very positive start for Poppy who discussed some of the improvements since the last official meeting. She appeared content and motivated to ensure things continued to improve. I was aware that an important discussion was going to take place about a serious incident which had occurred within the family and had been observed by a health visitor visiting the family next door. The purpose of the discussion was to support Poppy to understand the risks of leaving children unattended in the car and readdress the on-going issue of smoking around the children in confined spaces. The issue was broached by the social worker and Poppy immediately expressed unease. She denied having been involved until Poppy was informed it had been witnessed by another health visitor. Poppy became very angry, very quickly and made reference to the name the health visitor (her name had not been disclosed in the meeting). Her anger was then directed at my community practice teacher and me as the health visitor/student in the room. Poppy maintained intense eye contact with me and when I glanced away she noticed and it escalated her anger. Amongst the shouting and swearing Poppy was asking why Health visitors always interfere with her family and she was expressing that there was nothing wrong with what she was alleged to have done. As the main receiver of Poppys upset I tried to put active listening skills in to practice. Chosen Reflective Model and Rationale: Reflection is described by Boud et al (1985 p43) as a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to a new understanding and appreciation . It is deemed a particularly valuable tool within the health profession for many reasons. Reflection is a tool which can be used at all levels within the health care setting and is arguably imperative within practice (Ralphe et al 2011). It facilitates critical thinking (Cotton 2011) and by scrutinizing experiences professionals are then able to decipher the evidence within their own practice. Moreover it supports practitioners to make more sense of difficult and complex situations (Driscoll and Teh 2001). The collection of knowledge of individuals and groups through the form of refelction helps people to look not only at the situation but at how to understand it enough to be able to commit to improve similar situations which may arise again. Thus leading to improved practice (Ghaye and Lillyman 2010) Examples of reflective models include Gibbs (1988), Johns (2004) and Driscol (2000). Johns model is recommended for more complex reflection and decision making (REF). On one hand this would work well as a basis for this assignment however the model looks at the situation which has been resolved and it could be argued that it does not consider how the situation can be taken forward (Rolfe 2001). Although this could be adapted the Gibbs model of reflection (Gibbs 1988) has been chosen as a guide for this assignment. Despite being a fairly straight forward model, it is favourable because it aids a clear description of the scenario, analysis of feelings, evaluation of the experience, analysis to make sense of the experience and conclusion for each point that will be reflected upon. This enables careful consideration on what I would do if the situation occurs again. Communicating in Difficult Circumstances and Relevance to Health Visiting: According to the Department of Health (2007) one of the key elements to health visiting practice is to deliver the healthy child programme (Department of health 2009). This outlines the role of the health visitor and this includes the need for the health visitor to reduce health inequalities and protect children at risk (Department of Health 2009). The distressing conversation for Poppy was aimed to protect the children from potential harm caused by cigarette smoke and also to protect the children from the harm of being left unattended in a smoky car. It was acknowledged that smoking cessation had been suggested to Poppy but denied with such ferocity that the idea was to put things in place to protect the children from being harmed as a result of her smoking. After all as professionals we have to remind ourselves that Poppy has a right to smoke if she chooses to. The safeguarding of the children is paramount and therefore despite it being a tricky issue to address, it was an issue wh ich was vital to work with in order to safeguard the children. It is important to recognise that delivering these messages set out in the healthy child programme (2009) are not always straight forward. The people at highest risk of poor health are often those who have a lesser understanding of the consequences of their actions on the health of themselves and their families. They are perhaps less likely to comprehend the information which is delivered to them and the fact that this information is often changing (Knai 2009). Good communication is therefore crucial. Communication is defined by Porche (2004 pp266) as The transfer of Information and the understanding of the information from one individual another. It is the process through which individuals share thoughts, ideas, facts, beliefs, values and traditions. The department of health (2012) recently published Developing the Culture of Compassionate Care, which highlights Communication as one of the 6 Cs (Care, Compassion, Competence, Communication, Courage, Commitment) required to maximise compassionate care. It acknowledges that good communication skills contributes to better listening which results in people receiving care feeling valued and therefore happier with the service they receive (Department of Health 2012). Focusing on communication in difficult situations is very relevant to Health visiting practice as there are frequent barriers which can effect delivering the public health messages. In this case the barrier was Poppys resistance as a loving Mother to acknowledge the risks which her actions may have on her children and the emotions this consequently provoked creating a difficult situation in which to communicate not just the public health messages but to support Poppy in de-escalation. Resistance to accept information and support from health visitors is an on-going issue (REF) so having the opportunity to critically reflect on the situation will support me to ensure better practice in futur Eye Contact Initially Poppy seemed calm and positive about the progress she had made with her children avoided eye contact. However when angry, Poppy maintained strong eye contact with me in particular. I was surprised at how intimidated I felt, not by the shouting and verbal abuse but by the intense way in which Poppy was looking at me. I glanced away and looked towards my community practice teacher. This move that for me seemed quick and subtle had a profound effect on Poppy and she demanded I look at her when she is talking to me and this was followed with a threat. As specialist community public health nurses it is important to recognise that communication goes way beyond the verbal conversations that we have with people. Nonverbal communication plays a very strong role in the impressions that we give to people therefore having an understanding of what happened with Poppy is key to furthering my communication skills and awareness in future. Non-verbal communication is profound. Eyes and eye contact are a major part of non-verbal communication and many messages are consequently sent and received by the eyes (Sieh and Brentin 1997). The person who is listening holds eye contact with the speaker in order to express that they are listening and taking on board what the speaker is saying. The speaker holds eye contact with the listener so that they will know that the conversation is being directed at them (Lerner 2002). It is a real challenge to define normal eye contact as it differs from person to person depending on personal preference and aspects such as culture. (REF something on culture). It is not possible to create a text book advising when to look and how long for (Rungapadiachy 1999). Therefore responses to eye contact are open to interpretation and could lead to confusion within communicative situations (Sieh and Brentin 1997). Eye contact can have a positive impact on people. A good level of eye contact from the listener can make the person speaking feel as if they are being listened to and listener is interested and focused (Rungapadiachy, 1999). Alternatively, any form of eye contact can cause some people to feel uncomfortable, self-conscious and threatened (Rungapadiachy, 1999). Minimal eye contact may indicate lack of interest (Sieh and Brentin 1997) but it is important to acknowledge that eye contact may be less prominent when engaging in difficult or intimate topics (Rungapadiachy, 1999). Knapp (1978, cited in Rungapadiachy, 1999, pp206) recognises that when a person is disapproving of something it can be displayed in aggressive and intimidating eye contact. Furthermore early signs of anger can be shown via intense and threatening eye contact (Neild-Anderson et al 1999). Poppy initially avoided eye contact. She may have felt self-conscious being surrounded by professionals and despite the discussion being originally very positive, the subject matter was also intimate and personal. Similarly possible that she was able to anticipate what was about to be said. As Health visitors the heart of what we do is safeguard children physically and emotionally. The information discussed was vital within our role but it was not easy for her to deliberate and acknowledge. The intimidating eye contact displayed could have been because she was feeling intimidated or she was not accepting of the information being given to her. Moreover, I broke the eye contact momentarily and this may have upset the foundation of the conversation. For Poppy this could very easily be construed as non-compliance to listen on my part (Kidwell 2006). If we feel that something is unacceptable then it is likely that our eye contact will decrease (Rungapadiachy 1999). I acknowledge that I looked away from Poppy whilst she was communicating with me. Consciously I feel this is because I felt intimidated. However perhaps subconsciously I was not accepting of what she was saying. I attempted to communicate to Poppy through non-verbal communication that I do care and I appreciate that the situation was not an easy one for her. This is much like the view of Chambers and Ryder (2012 p106) who acknowledge that many nurses have become very skilled at communicating messages and meaning without words. However in this case, either I was not portraying myself in the manner that I intended, or it went un noticed as a result of Poppys heightened state of anxiety and upset. At the time I did not consider that Poppy could have misinterpreted my eye contact for staring. Poppys behaviour was intimidating but this did not exempt her from feeling intimidated herself. It is possible she felt under attack as a result of the raised concerns and prolonged eye contact on my part could have been threatening (Duxbury, 2000).Moreover, averting my gaze suddenly, may also have signalled fear in me which could also have distracted Poppy from getting her point across (Manos and Braun 2006). Alternatively I acknowledge that eye contact is also natural process and the anger which Poppy displayed did frighten me thus triggering a fight or flight reaction (Manos and Braun 2006). I did not escape physically but there was a shift in my gaze in order to avoid a threatening glare and it could be argued that this does not assist good listening. Although it was not possible in this situation because of the room space, I understand the importance of positioning within a meeting. I was positioned directly opposite Poppy which meant that I was the centre of her vision and she of mine. This meant that where less intrusive peripheral eye contact may have worked better, I was holding what could have been construed intimidating contact (Duxbury, 2000). My Community Practice teacher fed back that my expressions and levels of eye contact were acceptable and skilled. She viewed the reaction as unavoidable because of Poppys nature and the topic of the conversation. I acknowledge that there were a number of factors which triggered Poppys anger and it is because I deem eye contact so important that I have prioritised it. It is very difficult to know whether it directly correlated with the escalation of her emotions and if it did which of the above discussions applied to her. However as a result I am more aware of different personalities and how communication methods can be interpreted and it is this which is so vital for future practice. Seih and Brentin (1997 p5) reinforce this by stating Being sensitive to your own eye contact patterns and the patterns of those with whom you communicate will help you be more perceptive of what is occurring in the communication process, Active Listening I was aware that Poppy needed support to deescalate. I was not confident addressing this myself despite having had years of experience deescalating distressed people who displayed challenging behaviour. This was different. There was pressure on me as Poppy had targeted me and I was feeling increasingly intimidated by what was happening. Whilst Poppy was shouting I nodded a few times so she would feel listened to. She made some unpleasant threats to my community practice teacher and me and was suggesting that there was no problem with leaving children unattended in a smoky car or in smoking with them on her lap. I was equally careful as I did not want to give the impression that I was condoning what was being said. When active listening was used Poppy did respond calmly on occasion. Verbal contributions which I made in response to Poppy included: Am I right in thinking that you feel that your privacy has not been respected? Are you saying you feel health visitors dont think you are a good mother? Active listening is central to good interpersonal skills (Wondrak 1998). Where listening may be deemed passive when a person is talking and another listening it is in fact very active. Active listening is defined by Arnold and Boggs (2007 pp201) as a dynamic, interactive process in which a nurse hears a clients message, decodes its meaning, and provides feedback to the client based on their understanding of what has been said. It is deemed an empathetic means of communication where the listener understands and shares the feelings of the person talking whilst recognising they are not their own feelings and opinions (Balzer-Riley 2008.) A significant advantage of active listening is that it prevents misunderstanding. By relaying back to the person what they say they are feeling it ensures that there is no guess work and thus confusion over what is being said (Balzer-Riley 2008). Active listening is therefore a useful tool in attempting to defuse situations involving conflict (Reznic et al 2012). It allows the individual to communicate and get a response when conversation is not appropriate. In these instances the use of active listening enables the person talking to feel like they are being engaged with but without bombarding them with information they are not in a position to receive (McBride and Maitland 2002). Actively listening gave me the opportunity to be proactive. I was embarrassed and threatened and felt that it was my fault that Poppy was upset (as a result of me diverting eye contact). I had a personal battle because on one hand I felt sad for Poppy as she was clearly distressed and I understand that she has a lot of difficulties in her life. On the other hand I was shocked that she said that she did not care about the issues in hand. It could be argued that she was being defensive because she felt uncomfortable in the situation; however the issued in hand were very real and reflected what she was saying. As theory suggests, active listening in this instance was useful. It enabled Poppy to feel that she was being listened to and perhaps even understood. Although Poppy appeared fraught, the fact that I was relaying to her what she had just told us seemed to gradually calm the situation. It was my hope that by actively listening we would eventually get to a point where Poppy was ready to talk and receive advice and information. I acknowledge this was perhaps naÃÆ' ¯ve but Poppy was empowered enough to make the decision to walk away to calm down. Despite the challenging situation there was no obvious misunderstanding to be resolved, more a serious issue which needed to be addressed. I would like to have been able to offer Poppy some space to calm down but this would not have fitted in with the core group. I was very conscious that there were a room full of people watching and that this would not have supported Poppy to deescalate. It was a relief that by actively listening to Poppy, my CPT was able to encourage her to make the decision. In contrast to the recommendation I made for future practice regarding eye contact, it is recommended that the listener sits squarely in front of the person talking and maintains good eye contact when engaging in active listening (Duxbury 2000). I would agree that this is the case when the conversation is calmer however I learnt that in this scenario this was not appropriate as I was sitting directly in front of Poppy. The verbal communication I contributed through the active listening process had a more positive impact than the way in which I was sitting. Linking in with the above reflection about eye contact, it is recommended to maintain good eye contact with the person talking if it is within their cultural boundaries (McBride and Mailtland 2002). Active listening will be a dynamic part of my communication methods in future and I aim to learn more about the effects of active listening on people who receive care. I would like to attend further training in this area as I now see it as a vital aspect of communication and I acknowledge that active listening skills can be improved. As an active listener, sensitivity is a key concept and I believe it is a method which could be particularly beneficial when communicating with women who are suffering with post natal depression. The concept of active listening is consistent however the ease in which we do it will vary from case to case as will the outcome. The situation described above was tense and it took self-discipline for all those involved not to engage in a conversation which could have caused the incident to worsen further and the non-verbal communication methods varied from what is recommended. In future I will be aware of adaptations which may be required rather than solely facing them at the time. Ultimately active listening will be valued as much as any other forms of communication. Leadership As previously established, communicating in difficult circumstances and communicating information which may be difficult for families to acknowledge is not unique in health visiting. As health visitors embrace new leadership challenges it is important to acknowledge the above reflection and consider how what has been learnt can be disseminated through teams. Throughout the SCPHN course communication skills such as active listening are taught and these skills are useful not only in communicating with families but also with teams. Building relationships and having the ability to communicate and negotiate successfully are key skills in leadership and being able to gage appropriate eye contact and active listening both come under the umbrella of communication (Adams 2010). Effective communication is a core competence in good leaders (Sobieraj 2012) and this is demonstrated in the NHS Leadership Framework (REF) which prioritizes communication as a key component. Recommendations for future Practice as a leader: Further training in non-verbal communication skills needs to be available to teams as this will benefit communication used with families and further professional relationships. Non-verbal communication skills should be discussed with all of the team regularly for example in team meeting s or supervision and used as a measure for understanding and success. Critical reflection on various scenarios should be carried out in order to further understanding in these areas and support the application of evidence based practice. Empower team members to communicate effectively and understand the importance of non-verbal communication strategies As a leader I will take what I have learnt with regards to this reflection and use the skills in communicating with both families and team members. When making recommendations be sure it doesnt start to sound like a shopping list balance this with the demands and pressures of the real world. Maybe find examples of where these suggestions have been put into practiceà ¢Ã¢â€š ¬Ã‚ ¦this helps to justify your recommendations etc. The above recommendations support the notion of leading with compassion. Offering team members with the compassion we want them to provide enables each individual to feel empowered to give effective and compassionate care of which non-verbal communication is so important (Sobieraj, 2012).

Being Single or Being Married Essay

There are many differences between life as a single person and life as a part of a married couple. some of these differences are obvious, while others are more subtle. The key to make the dicision is the answer of the following question: Do you prefer life of going home to an empty house and a cold bed alone, but which seems easier; or do you prefer life of coming home with considerate family and warm atmosphere, but which seems more complicated? Sometimes, the soceity favors marriages. Because in traditional opinions, a marriage adds happinesses and fulfilments to one’s life. A reseaches also shows that married people are more likely than those who are not married to be very happy: forty-three percent of people who say they are very happy they are married, versus twenty-four percent of unmarried people saying they are very happy[1]. What is more, in a marriage, there is always someone to talk to or listen to you. It is good to have someone there to have a conversation, to bounce idea of or to have a witty exchange of remarks. The companionship between the couple also offer supports and can be particularly important at time of trouble and stress. Partners of a marriage which lasts long are usually assured a certain basic level of emotional sustence. Marriages also result in consistent expression of sexual desire for one’s spouse through the life course. People who are married reported the highest levels of well-being, regardless of whether they were happily married or not. â€Å"Even when controlling for relationship happiness, being married was associated with high-esteem, greater life satisfaction, greater happiness and less distress.† The heavier commitment of marriage brings long-term concerns over a spouse’s future well-being. Marriage is a motivation of fighting for better financial supports. Some people prefer being single. In many people’s dictionaries, being single means being free. Single people can make decisions follwing their hearts without asking for any others’ approval. Their time is their own and their money is their own, so they can dominate the life by themselves. They may occasionally feel that thet have too much empty time on their hands, but thet can fill that time any way they want. Being single makes people really focus on their careers, education, and life goals. Put in long hours, work toward advancement or job hop until they find ideal positions which give them personal satisfaction. Dreams can be pursued freely, life can be shaped discretionarily. Being single may relate to less responsibilities. Besides freedom, another advantage to many people of being single is travalling. From weekend jounts to summer resort vacations, traveling alone is the time in one’s life of getting away and relaxing. On many practical levels, being single has additional advantage, a single person can often snag the odd single seat for otherwise sold-out performance. Without â€Å"wearing a ring†, single people have opportunities to choose their favorite partners among all the pursuers. For myself, I would like to choose the life of being married, rather than the life of being single. First of all, companionship and stabability is much more important to me than freedom. True love and marriage is a companionship. Secondly, as a person who likes struggling emotionally, I do not expect to live in my own emotional world. Thirdly, even though traveling alone is a wonderful experience, traveling with one’s partner will be an unforgettable journey. Visiting the places you both dream of will accomplish your common expectations. The same experience will make you closer. As to the question of being single or being married; people come and go and walk away, but I am not going anywhere. Being married cannot make life easier, but I will have someone to suffer this hard life with me, that is the marriage all about for me.

Amundsen and scott

The chilling tundra ot the antarctic restrained anyone trom exploring antarctic tor years. Amundsen and Scott, two very brave men chose to attempt to reach the south pole. The prowess in both men was incredibly heroic. Amundsen and Scott knew It was a treacherous journey but were up for the task. Only one man could be the first, and Amundsen was most definitely the successor. Amundsen had prepared for this journey all his life. While Scott flew by the seat of his pants, going on this expedition was Just one of many things he had done without lan.It was a provisional job. Scott knew he wouldn't be able to keep up with it for that long. Scott was temerltly. Scott didn't think twice about his adventure, thus leading to him being unprepared on his trip. Scott was physically prepared but not fully prepared mentally. Amundsen on the other hand examined every detail of his expedition piece by piece, ensuring that he would have the best of the best and be fully prepared. Always planning ever y move he made. The equipment they brought and the obstacles they faced were definitely a huge part of their trip.Obstacles including weather and the natural environment. Of course Scott and Amundsens trip differed between what exactly happened but Scotts body obviously couldn't procure the harsh weather the arctic had In store for him. Yet Amundsen still had trouble handling the weather he could still cope with it. Also, equipment was what saved Amundsen. Amundsen brought around a hundred dogs. He was well prepared bringing everything he would ever need and then some on the trip. While scott packed light rather than packing what he needed. Luck and fate played a large part In the story.Just because Amundsen was stopped when he was so close to the pole doesn't mean he tailed. He had the experience, the Journey and the lesson that Is Irreplaceable. Scott may of got to the pole, but whats it worth if he died. He's not alive to be a success. Considering Scott was completely unprepared it was luck that he made it to the pole. Knowing he was oblivious to what was really happening out in the abject temperatures. Yet it was fate that he didn't make It home safely. Amundsen on the other hand had fate on his side, he hadn't made it to the pole. ich must of been meant to be. because If he made It he very well could of died. It was fate that he got to come home to keep on living a life rather than Scott who died an inexpedient death along side his team out in the icy cold. Making it to the pole and dying doesn't make you a hero nor does it make you smart. You are both stupid and unheroic. Yes Scott died trying to be a success, but he tOf2 naa Tallea. I ne Tame deserves to go to Amundsen. Amundsen was smart enougn to know what he was doing and how it could drastically change the outcome of his trip f he kept on going.Amundsen is the hero because he turned back. He was able to say i tried, and i my not of made it but i got extremely close and I am alive to tell a story. Th at is a true successor. In the end the successor is Amundsen no doubt. He dreamed of the day for years and years. It would be cruel if you took the rightful fame away from him. He knew what he wanted to do for years and years. Scott Just decided one day on a whim. Amundsen deserves to be remember Just as well if not greater than Scott.

The Efficacy And Safety For Smoking Cessation Treatment

A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY TO EVALUATE THE EFFICACY AND SAFETY OF NICOTINEX (NiX) COMPARED TO PLACEBO FOR SMOKING CESSATION Product: NiX Protocol Number: A6012890 US IND Number: 76, 224 Development Phase: II Created by: Manoj Amaraneni 1. INTRODUCTION 1.1 Indication NiX is indicated as an aid to smoking cessation treatment. 1.2 Background and Rationale Currently, about half of the 1 billion people smoking will eventually die from smoking related diseases1. Less than 5% of the smokers are able to stay abstinent for one year after a quit attempt, due to lack of effective therapies2. Nicotine†¦show more content†¦Antibody levels were boosted by a second injection, and the vaccine was well tolerated. Based on these encouraging results, we are now planning to perform an exploratory phase II randomized trial in smokers between the ages of 18 and 70 years. 2. STUDY OBJECTIVES AND END POINTS 2.1 Objectives The objectives of this phase II trial are †¢ To compare the clinical efficacy of NiX to placebo in smokers willing to quit. †¢ To evaluate the safety of NiX in healthy smokers. †¢ To determine the immunogenicity of NiX. 2.2 End points Efficacy †¢ Continuous abstinence will be assessed at 6 months (week 24) after the prime dose. Assessment will be based on the measurement of exhaled carbon monoxide (CO) and urinary cotinine at each visit and self-reported number of cigarettes smoked during that time interval. A participant with a CO level of 10 ppm at screening. †¢ Individuals with negative urine screening tests for drug addiction (Opiate, Cocaine, Cannabinoids, Alcohol, Methamphetamines). †¢ Subjects who are willing and able to comply with scheduled visits, treatment plan, laboratory tests and other study procedures. †¢ Females who are not of childbearing potential and who are not nursing can be included. Females who are of childbearing potential may be included provided that they are not pregnant, not nursing, and who meet all of the following criteria: ïÆ' ¼ Are instructed and agreed to avoid pregnancy through 30 days after the lastShow MoreRelatedChronic Obstructive Pulmonary Disorder ( Copd )966 Words   |  4 Pagesinfections, socio-economic status and exposure to second hand smoke (SHS). , However, the main factor responsible for the development of this disease is tobacco smoking where almost 90% of those who smoked tobacco developed COPD. Tobacco smokers are nearly 12 to 13 times at higher risk of death from COPD than those who are non-smokers.9 Tobacco smoking itself is the single largest preventable cause of disease and death in the United States (US) leading to more than 480,000 deaths every year and more thanRead MoreSmoking Cessation Of Pregnancy : Review Of Current Strategies9414 Words   |  38 Pages SMOKING CESSATION IN PREGNANCY: REVIEW OF CURRENT STRATEGIES Boitumelo A Nkoane-Kelaeng1, Claire M Lawley1,2, Gemma A Figtree1 Cardiovascular Research, Kolling Institute, Royal North Shore Hospital, Sydney, Australia Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia Corresponding Author: Professor Gemma A Figtree MBBS DPhil (Oxon) FRACP FAHA North Shore Heart Research Group Kolling Institute of Medical Research Royal NorthRead MoreQuit Smoking Case Study Essay4989 Words   |  20 Pages Case study- Quit Smoking A young adult man met his primary care physician for the first time, during which his prior military history came to light. The young man recalled the anxiety he experienced when he received his military orders for deployment to Iraq. Prior to the notice of deployment, he smoked cigarettes only occasionally, maybe 1 or 2 cigarettes a day. As the time for deployment approached, he started smoking more cigarettes and by the time he arrived in Iraq was up to a full packRead MoreLiving Life with Heart Failure Essay869 Words   |  4 Pagesmore hospitalizations than all forms of cancer combined. It is the number 1 cause of hospitalization for Medicare patients and this process can begin early in adulthood from poor diets and smoking habits.† HF may go undetected by the client months after the disease starts, which leaves little options for treatment when symptoms are prevalent. As with any disease process early teaching from a healthcare professional could make the difference betwe en an active lifestyle to one that is hindered by severalRead MoreHypertension Is Characterized By Chronic Elevated Blood Pressure11247 Words   |  5 Pagesalso important in understanding the cause and extent of hypertension. Initial treatment involves lifestyle and diet modifications such as exercise, smoking, cessation, and limited sodium intake. Patients unresponsive to lifestyle and diet modification or have a blood pressure greater than 160/100 mmHg are recommended by the American Heart Association to begin drug therapy. Current JNC-8 guidelines dictate the goal of treatment to reduce blood pressure below 150/90 mmHg for patients 60 years or olderRead MoreA Short Note On Obstructive Pulmonary Disease ( Copd )1200 Words   |  5 Pagesleast two successive years when other causes of chronic cough have been excluded. Chronic obstructive pulmonary disease is associated with major morbidity and mortality such as cardiovascular disease, muscle wasting, type 2 diabetes, and asthma. Smoking cessation will probably have the most important effects on COPD as a public health problem in Europe and the world as it slows disease progression and lowers mortality. Chronic obstructive pulmonary disease progresses over many decades and tends to presentRead MoreSmoking and Brain Tumors in Women3727 Words   |  15 Pagesï » ¿Policy On Smoking And Brain Tumors In Women Name Institution Date Smoking and Brain Tumors in Women 1.0 Description of the Public Health Issue The prevalence of tobacco use among women has increased rapidly in the past century. This increase has resulted to an increase in smoking-related diseases, like lung cancer, brain tumors, and chronic obstructive pulmonary disease. There is growing literature suggesting that women are more susceptible than men are to the effects of smoking. This rapidRead MoreHepatitis C Is A Blood Borne Pathogen1448 Words   |  6 Pageschronic HCV infection, 20% of patients will get cirrhosis which usually takes 20-25 years to develop.1, 2 The HCV virus itself is not lethal, but the progression to the other diseases it causes like cirrhosis of the liver is lethal. The goal of the treatment is to eliminate the HCV infection and stop chronic infection, cirrhosis, and death.2 Hepatitis C therapy is designed for patients that have not been treated before and have evidence of HCV RNA, high ALT levels, compensated liver disease, or chronicRead MoreA Brief Note On Patients With Diabetic Lower Leg Ulcers With Activated Protein C ( Apc )1119 Words   |  5 PagesQuantitative Article Treatment of chronic diabetic lower leg ulcers with activated protein C (APC). This quantitative â€Å"study was designed to assess the efficacy, safety and tolerability of a topical APC on lower leg ulcers in patients with diabetes in a small randomized, placebo-controlled, double blind pilot trial† (Kaley et al., 2013, p. 2). The sample used for this study was twelve patients randomly assigned to receive APC or the placebo (saline), both topically applications. The treatment was administeredRead MoreThe Joint Commission On Accreditation Of Healthcare Organizations2121 Words   |  9 Pageseducation resulting in follow-up appointments, left ventricular performance or left ventricular systolic (LVS) function, treatment medications, and smoking cessation programs. Nurses provide an important role in the education of patients with HF. The Nurse is integral in providing documentation in relation to LVS. Nurses play an important role in the administration of HF medication. Smokin g, a major cause of HF, requires special nursing intervention. Nursing results in improved quality of care if HF core

War Message On Congress, By Woodrow Wilson - 843 Words

In the document, â€Å"War Message to Congress†, by Woodrow Wilson, discusses his message, the way he feels towards the war. He couldn’t believe that the government could accomplish so much, such as providing hospital ships. He believes â€Å"The present German submarine warfare against commerce is a warfare against mankind† (1, Wilson). It is a war against every nation, according to him. He believes the government should not take this action of the German as anything less than a war. This war will require the Navy as well as armed forces. The purpose of this action is to indicate the principles of peace and justice in the life of the world against selfish and autocratic power†¦Ã¢â‚¬  (3, Wilson). The point of the war is to achieve a better world. This document is a primary source, since it is raw material and is not written after the event took place. The document is written by Woodrow Wilson. The purpose of the article is to express the war and why it happened. Peace and justice is the goal and should not be forgotten. In the article, â€Å"Fourteen Points Speech†, Woodrow Wilson, delivers this speech in Joint Session of Congress, on January 8, 1918. He discusses why we entered the war, the war itself, and ending the war. If the men fighting might lose their lives in it, he wanted to explain the purpose of what they were fighting for. He summarized those reasons in fourteen points. Wilson acknowledges, â€Å"An evident principle runs through the whole program I have outlines. It is theShow MoreRelatedThe United States and World War I Essay1703 Words   |  7 PagesInvestigation When the First World War erupted in Europe on July 28, 1914; President Woodrow Wilson formally proclaimed that the United States would remain neutral on August 4, 1914. However, the United States did not stick to this proclamation, and eventually became involved in the war efforts. This investigation aims to evaluate the reasons the United States violated their neutrality in order to join the war. In inquiring into the reasons of the United States’ entry into the war, the Zimmermann telegramRead MoreRealism Vs. Realism Of The United States889 Words   |  4 Pagesperson who believes that we can solve our conflicts without wars. They believe that war is the failure in human evolution and that we should not turn to it to solve our problems because â€Å"all war is a symptom of man’s failure as a thinking animal† (John Steinbeck). Woodrow Wilson is an example of an idealist presedent Afred Thayer Mahana was a great realist, a U.S naval officer and a historian. Mahan was also a professor in the Naval War College and lectured on naval history and naval strategy. OutRead MoreThe War I Was The United States Become A Super Power959 Words   |  4 Pages World War I was the war that shaped the future of the 20th century and is what helped make the United States become a super power. Since its Independence the United States had taken a stance of isolationism from conflicts in Europe and Asia. To further assert their stance on isolationism the United States passed the Monroe Doctrine in 1823 which stated that any attempt by a European nation to colonize or interfere with North and South American would be seen as an act of aggression. The United StatesRead MoreWoodrow Wilson s War Message1405 Words   |  6 Pages Woodrow Wilson s War Message A Rhetorical Analysis Paper Cesar Gerardo Fragoso Texas AM International University Abstract On April 2, 1917, President Wilson wrote and spoke one of his famous speech: War Message. President Wilson wants to ensure the people s hope and faith from the war. As President Wilson (1917) stated in his speech Each nation must decide for itself how it will meet it... Our motive will not be revenge or the victorious assertion of the physical might of the nation, but onlyRead MoreWorld War I And The United Policy Of Strict Neutrality931 Words   |  4 Pagesa chain of events that would lead to the start of World War I. When the war began the United States proclaimed a united policy of strict neutrality. After multiple U-boat attacks that killed hundreds of American civilians and the transmission of the â€Å"Zimmerman Telegram†, America declared war on Germany in 1917. In an address before a joint meeting of Congress, U.S. President Woodrow Wilson discusses the aims of the United States in World War I and outlines his famous â€Å"Fourteen Points† for achievingRead Mo reThe First World War ( Wwi )920 Words   |  4 Pagesthey unite masses for the best for the humanity and others for the worse. The First World War (WWI) left leaders that implementing strategic messages dedicated to the people made a paradigm shift by that time causing a revolutionary change and â€Å"a tragic and unnecessary conflict,† as Keegan describes the Great War. Leaders in WWI such as David Lloyd George, the Liberal chancellor of British, Thomas Woodrow Wilson, 28th President of the United States, and later Adoft Hitler during WWII, are rememberedRead MoreThe United States Into World War I855 Words   |  4 PagesFirst World War was once one of the most harmful and deadliest wars of all time. A few countries participated within the battle together with Russia, Great Britain, Germany, and France. When the European nations went to war, Americans wanted nothing to do with the war. The twenty-eighth U.S. president Woodrow Wilson, led America through World War I. Wilso n was a college professor, university president and Democratic governor of New Jersey before winning the White House in 1912. Woodrow Wilson asked CongressRead MoreWoodrow Wilson s Vision For A League Of Nations1321 Words   |  6 Pages Woodrow Wilson sought out the future of America, as he understood that the liberty that underlined democracy was starting to look vulnerable in the current world s state. It was at the address at Independence Hall, that Wilson defined the position of liberty and its place in the world when he said; â€Å" I earnestly believe in the democracy not only of America but of every awakened people that wishes and intends to govern and control its own affairs. â€Å" His perspective of the ownership of libertyRead MoreZimmerman Telegram1099 Words   |  5 PagesOn April 2, 1917 the United States entered WWI declaring war against Germany and its allies. The deciding factor for the U.S. to enter the war is due to one document, the Zimmerman Telegram. The document was sole proof to many Americans that Germany’s intentions were not only causing harm on European soil but bringing it across the seas to American soil. It stated that Germany had no intentions on slowing down its submarine w arfare to which they hoped to keep the Americans neutral, but if they failedRead MorePresident Woodrow Wilson s First Modern Ministry For Propaganda1470 Words   |  6 Pagespromise to keep America out of war, President Woodrow Wilson created the first modern ministry for propaganda in the West suppressed dissent and resistance. As the 28th President of the United States of America, Woodrow Wilson served two terms from March 1913 to March 1921. He was nominated by his party at the 1912 Democratic Convention where he â€Å"campaigned on a program called the New Freedom, which stressed individualism and states rights† (Freidel). Once elected, Wilson faced the decision of the nation’s

A Guide to Essay on American Dream Topics

A Guide to Essay on American Dream Topics A good thesis statement will help you produce a focus for your paper. Draft a thorough outline of the critical points you will contain in your paper. This paper may be true nightmare, that's true. It's possible to approach it like a classical research paper. This sort of essay is a lot more than only a simple telling of the story. If you don't have sufficient time and you're worried that the submission date is close. Alternatively, you might concentrate on the form of narration used. To begin with, you could explain the kind of narration. The Appeal of Essay on American Dream Topics Selecting the most suitable topic is essential for writing an expository essay, since it can influence your writing. Conduct thorough research on the topic utilizing credible and dependable sources. Consider the next list of helpful suggestions. As an example, schools are totally free to everybody. Education too many people is the American dream as it may give you a job and it might provide you Knowledge. In spite of the fact that college is largely costly and resorting to student loans may be the sole way, most individuals think that it's well worth it, seeing since they can find a better Job once they're out of college. There are many choices to select from, thus don't feel that if your teacher has assigned you the American dream essay you will need to write only about equality or liberty. Therefore, it would be confusing and hard for students to compose an essay. The essay topics within this lesson help students approach the American dream from an assortment of angles, deepening their knowledge of the concept and their capacity to take part in critical reflection. Many students often earn a mistake within this sort of writing in which they may pour out their ambitions residing in America without due consideration of the elements that would produce the essay interesting. Therefore, many students and employees decide to purchase cheap essay rather than writing it themselves. Anyhow, there's a standard comprehension of the notion of the American Dream. Based on the class difference, one's dream may differ from others. A few of these dreams are made by humane hearts while some are worked out as a result of human interactions. Typically, this sort of essay includes five paragraphs. The social classes within this novel also boost the inequality among different folks. Define the expression American Dream from popular perspectives and pick the right topic to work on. Today it is known as a sub-culture within the overall state culture. African American's did not have the chance to prosper in society or have an opportunity to take on their personal desires. Last, folks say America is a spot of dream since they can reach their goal by hard work. It's easy here in America to boost your standard of living with time and energy. The Good, the Bad and Essay on American Dream Topics You'll receive your high quality plagiarism-free paper based on your deadline! Whichever goal, make certain you do not become unrealistic. To begin with it means the liberty of choice. Everyone has different jobs which may control how successful they are, or wish to be. One is proper education that may force you to secure a great job. It is not even essential to attend any college.

Second Generation and Children of Immigrants Longitudinal

Question: Discuss about the Second Generation and Children of Immigrants Longitudinal. Answer: Introduction Cultural Dissonance is an uncomfortable feeling of conflict, discord, misunderstanding, or argument faced by individuals in the middle of transform in their cultural surroundings (Mumford and Chaudry, 2010). These transforms are usually unforeseen, unsolved or not logical because of different kinds of cultural forces. Usual conflicts consist of: moral, religious, or even instances on the level of distinctiveness, like trend, entertainment and verbal communication (Karasz, Dempsey and Fallek, 2007). Cultural dissonance is generally annoying, baffling, captivating, and difficult altogether (Lai and Surood, 2011). It is regularly experienced as there is an innate distinction in perspectives, morals and practices connected with those. It can be seen when a person from a small town comes to the big city, he feels the cultural dissonance (Lee, 2004). Likewise a white individual from rural Alberta can feel cultural dissonance when hes in rustic area of Nova Scotia, a Chinese human being born in Canada can feel cultural dissonance as he is in China, a female can also feel cultural dissonance in a male-controlled place of work. Personal experience of cultural dissonance I am fond of the meal times. As I grew up with my family, dinner was my much-loved. It was as I get to be seated at table with my family: my mother and father, my grandmother, grandfather, aunties and uncles, cousins, siblings. I was trained with table- etiquette from a small age. Being a child, I was all the time moving from a relatives house to a different. The technique that the table which was put at every relatives house was different one utilised a fork as well as spoon, one more utilised chopsticks, other one utilised their hands. At all times, I was aware of how to munch at these tables, manoeuvring proficiently my tools or my hands in a culturally suitable way. The expenditure of it, though, was that come what may the arrangement of table arrangement was, under no circumstances I felt I was part of any single culture particularly. While at home, at the dinner table I learnt that we always have to wait for everyone at the dinner table, prior to begin eating. We always started with serving the elders and after that- the youngsters. While serving, we would never let anyone have an empty glass, quickly fill it without even their asking for it. There was no need to revolve the dishes, yet the dishes were placed at the centre so that all could have food collectively. In my family, we also never stuck chopsticks in the rice bowl while standing. For eating the food, sitting on table- chair was mandatory. Being located in any other circumstance was mystifying and difficult, and as per my cultures tendency I did not get disheartened in any situation. Yet, it was upsetting to notice my friends stare at me shocked as I was not familiar with stuff (although they didnt show any hard feelings towards me). My attempts in the kitchen made me suffer worthlessness because I had to struggle with the entire stuff. Even my dinner table manners were snubbed by my own friends. In the end, I had to find out how to squeeze in. Even though, I still fill other persons glasses prior to my own, however I feel that I now I have come over the passing of dishes and plates. I have adapted to the new culture, and now I can also eat rice with chopsticks while I am standing. Cultural values or dimensions that were causing the dissonance There has been a huge cultural change which led to the dissonance. Until I grew up, I had just learnt to adapt, however then also I was not accepted by my friends easily. With the passage of time, it was me only who had to change. I always thought that whatever culture my family and my relatives followed was the most appreciated one. However, people used to stare at me when I did the same, thinking that I was pretending to be over-lovable. Ways applied to overcome the dissonance experienced To live in a situation not quite of my own is overwhelming. It means that I still try helping in the kitchen and I still wait for everybody to come, before starting the meal. Although sometimes people make fun of me and sometimes I am being criticized. Yet, very few people accept the same and thus I learn how to intermingle with other people in customs different to myself yet known to their cultures. Consecutively, my friends have also got to know of our customs in the manner of understanding. I accept that finally the cultural dissonance takes place due to the inadequacy of readily-obtainable information regarding the one culture that people from other cultural backgrounds can get. Conclusion (Lessons taken from this experience) The kitchen and meal-areas are places of serving, intended to bring in individuals collectively, into camaraderie and society. thus herein, I think that each one has it correct in own way; the meal-table is the primary place to reconcile, and I believe that, by this way, God plans for His table to be the unchanged, where each person of every background can arrive and have meals in group of people and as one. The cultural dissonance could be one of the causes of added stress on the youngsters who try to fit into the new cultural ideals. As stated by Portes and Rumbaut (2015), there is a desire for self-government and steadiness among family, hope, and sacred duties that bring about the thoughts of guiltiness and dejection, which might then be observed as a behavioral issue. Being grown up in a different culture and adapting to other culture was difficult for me, as I was always questioned of my values and traditions and why these differed from others. This made me feel isolated and a lways struggling to fit in. I always felt that I never belonged to the group of my friends, yet I always wanted to. At last, the challenge was accepted and I just had to fit in. References Karasz, A., Dempsey, K. and Fallek, R. (2007). Cultural differences in the experience of everyday symptoms: A comparative study of South Asian and European American women. Cultural Medicine Psychiatry, 31: 473-497. Lai, D. W. L. and Surood, S. (2011). Predictors of depression in aging South Asian Canadians. 138 Journal of Cross Cultural Gerontology, 23: 57-75. Lee, S. (2004). Engaging culture: An overdue task for eating disorders research. Culture, Medicine and Psychiatry, 28: 617-621. Mumford, D. B. and Chaudry, I. Y. (2010). Body dissatisfaction and eating attitudes in slimming 140 and fitness gyms in London and Lahore: A cross-cultural study. Portes, A. and Rumbaut, R. (2015). Introduction: The second generation and the children of immigrants longitudinal study. Ethnic and Racial Studies, 28 (6): 983-999.