Government Assistance on Welfare Programs

S. B. 311 will reform the current system of welfare. The reform of the national system is based on the Wisconsin Works or W-2 bill. The bill makes it necessary for people receiving financial, medical, and other various types of government assistance to work for what they receive. The goal of this bill is to eventually get everyone off of the current welfare system. This bill requires everyone who is currently receiving welfare to find employment or enter a job training program. The part of the W-2 bill that will be included is the part that deals with job location. Every participant would have to meet with a financial and employment planner, who would help develop a money and time management program for that person. They would also determine which level of employment or training the participant is ready for. Here are the levels from top to bottom: Unsubsidized Employment: People entering at this level will be offered the best available and immediate job opportunity. If the job does not provide a high enough income to support oneself, income credits, food stamps, Medical Assistance, and child care may be accessible for 6 months. This period of time is given to the participant to locate a higher income job. Trial Jobs: These jobs are designed for people who are not able to locate unsubsidized work. The bill would cover added costs to the employer for training an employee which might need extra support in job training for the first 3-6 months. These trial jobs should result in permanent positions. While a participant is working at a trial job the would be eligible for all of the current assistance programs. If a person quits a trial job they will be ineligible for any further financial or any other type of assistance. Community Service Jobs: This category is reserved for people who do not have the job skills necessary to be hired by a regular employer. CSJ workers would receive $700 per week for up to eight months. During this period, a participant would have to work 30 hours a week and have 10 hours of educational training a week. After the eight months, the participant would be transferred to a trial job. Transition: Transition jobs are only for those people unable to perform self-sustaining work. These participants would receive up to $700 a week for up to a year. During this period, a participant would be required to have 30 hours of work and/or developmental training a week and 10 hours of educational training a week. Participants would be eligible for all assistance programs and would be required to move to the CSJ category after a year. These are the measures that would be taken to help people find employment and permanently get them off of welfare. The current national system that is being used for work requirements is TANF. TANF stands for the Temporary Assistance to Needy Families. The required number of monthly hours of participation in the program is 25 hours for 1999. Job skills ttraining, education related to employment, and secondary school or GED completion does not count towards the first 20 hours of participation. They can be in the program for up to 24 months and can receive all of the current welfare benefits. Then job searching is allowed for an additional 3 months, while participants still receive benefits. The only punishment this programs implements for able adults that do not work is that the adult would only receive foods stamps for 3 months out of a three year period. However, the person would still be eligible for other assistance benefits. The current national system seems like a joke. It is practically encouraging people not to work. It has a basis for some practical ideas, but the requirements are far too small and there is virtually no motivation for a person to work. Everyone is not given an equal chance to get a job growing up, but that does not mean working Americans should have to support them. S. B. 311 proposes a practical working plans for unemployed citizens and also has rigid standards. The expectations are high of the participants, but it is time that unemployed people have to work for what they receive. The bill proposes a plan which provides adequate assistance for people receiving job training and assistance to those who are starting unsubsidized work. On the other hand, the guidelines of the bill were designed not to tolerate an unwillingness to work. If a person chooses not to work, or to go through the levels of job training, they will receive no government assistance. This seems harsh, but who wants to support someone who refuses to work? The participants of this program are given more than a fair chance to find employment and if they choose not to work, they will suffer the consequences.

Three Ways of Being with Technology

Three Ways Of Being-with Technology by Carl Mitcham Introduction: Mitcham talks about the relations between technology and humanity. He starts with the chicken-and-egg question â€Å"Which is primary-humanity or knowledge? † What exactly is happening? Is it that we influence the technology or is it so happening that the technology is shaping our morals and us? At this point he quotes one of the Winston Churchill quotations that â€Å"We shape our buildings and thereafter they shape us â€Å".Then he tries to answer this question by saying it is a mutual relationship in between these two but even the mutual relationship take different forms. He then proposes a three ways of being with the technology and takes the whole document on structural analysis of the three forms. Ancient Skepticism: The articulation of a relationship between humanity and technics in the earliest forms when stated boldly is â€Å"technology (that is, the study of technics) is necessary but dangerousâ⠂¬ .Technics, according to these myths, although to some extent required by humanity and thus on occasion a cause for legitimate celebration, easily turns against the human by severing it from some larger reality – a severing that can be manifest in a failure of faith or shift of the will, a refusal to rely on or trust God or the gods, whether manifested in nature or in Providence. Ethical arguments in support of this distrust or uneasiness about technical activities can be detected in the earliest strata of Western philosophy.Socrates considered farming, the least technical of the arts, to be the most philosophical of occupations. This idea of agriculture as the most virtuous of the arts, one in which human technical action tends to be kept within proper limits, is repeated by representatives of the philosophical tradition as diverse as Plato, Aristotle, Thomas Aquinas, and Thomas Jefferson. Socrates argues that because of the supreme importance of the ethical and political issues, human beings should not allow themselves to become preoccupied with scientific and technological pursuits.Socrates argues that human beings should determine for themselves how to perform their actions and therefore should not depend on god for help in â€Å"counting, measuring or weighing† whose consequences are nonetheless hidden. In the Intellectual Auto Biography of Socrates, he explained how he turned away from natural science because of the cosmological and moral confusion it tends to engender. Never did he speculate on the ‘cosmos ‘of the sophists or the necessities of the heavens but declared those who worried about such matters were foolish.The classical greek culture was shot through with a distrust of the wealth and the affluence that the technai or arts could produce if not kept within strict limits. Socrates explains what is important is moderation. He explains that under the condition of affluence human beings tend to become accustomed to eas e and thus to chose less over the more perfect. He explains â€Å"Once drugs are available as palliatives, for instance, most individuals will choose them for the alleviation of pain over the more strenuous paths of physical hygiene or psychological enlightenment. Which is very true in the modern con text than to that current in athens that scarcely need to be mentioned. Another aspect of this tension between politics and technology is on the dangers of technical change. In the words of Adeimantus, with whom Socrates in this instance evidently agrees, once change has established itself as normal in the arts, â€Å"it overflows its bounds into human character and activity and from there issues forth to attack commercial affairs, and then proceeds against the laws and political orders†.Technological change, which undermines the authority of custom and habit, thus tends to introduce violence into the state. This should be taken more serious with the experience in the 20th centu ry. Eros or love, by contrast, is oriented toward the higher or the stronger; it seeks out the good and strives for transcendence. â€Å"And the person who is versed in such matters is said to have spiritual wisdom, as opposed to the wisdom of one with technai or low-grade handicraft skills† It’s the person with the spiritual wisdom that the love is oriented to.The ancient critique of technology thus rests on a tightly woven, fourfold argument: (1) the will to technology or the technological intention often involves a turning away from faith or trust in nature or Providence; (2) technical affluence and the concomitant processes of change tend to undermine individual striving for excellence and societal stability; (3) technological knowledge likewise draws human beings into intercourse with the world and obscures transcendence; (4) technical objects are less real than objects of nature.This pre-modern attitude looks on technics as dangerous or guilty until proven innoce nt or necessary – and in any case, the burden of proof lie’s with those who favor technology not those who would restraint it, because this way of being with technology views it with skepticism. Enlightenment Optimism: This is a radically different way of being with technology; it shifts the burden of proof from those who favor to those who oppose the introduction of inventions in the name of enlightenment.Aspects of this idea or attitude are not without pre-modern adumbration. This idea is first fully articulated in the writings of Francis Bacon at the time of renaissance. Unlike Socrates Bacon maintains that God has given humanity a clear mandate for the change i. e. the technical change. Technical consequences are all cut loose with an optimistic hope and the consequences of such actions are treated as mere accidents. We all deemed to form in the image of god are all expected to create and the art plays the primary role in this.Formed in the image and likeness of Go d, human beings are called on to be creators; to abjure that vocation and pursue instead an unproductive discourse on ethical dilemmas. Bacon indeed claims that not applying new remedies must expect new evils. The kingdom of man founded by sciences is none other than the kingdom of heavens. It is important to understand that Bacon and Socrates relates to each other in pro- and anti- technology partisans. Technical action is circumscribed by uncertainty or risk.Bason doesn’t evaluate technical projects on their individual merits, but simply asserts/affirms the technology. It is important to pursue technological action irrespective of the dangerous consequences. The uncertainty of the technological actions is jettisoned in the name of revelation. Bacon argues that the inventions of printing, gunpowder, and the compass have done more to benefit humanity than all the philosophical debates and political reforms have done to the human kind throughout history.The distinctly modern w ay of being-with technology may be articulated in terms of four interrelated arguments: (1) the will to technology is ordained for humanity by God or by nature; (2) technological activity is morally beneficial because, while stimulating human action, it ministers to physical needs and increases sociability; (3) knowledge acquired by a technical closure with the world is more true than abstract theory; and (4) nature is no more real than artifice – indeed, it operates by the same principles.Romantic Uneasiness: The pre modern way of being with technology effectively limited the rapid technical expansions in the west for approximately 2000 years. The proximate causes of this radical transformation were, of course, legion: geographic, economic, political, military and scientific and the author questions then what brought all such factors together in England to engender a new way of life. Romanticism is what came out from this yelling for change.This paved the way for the new way of being with the technology, one that can be identified as with ancient skepticism or modern optimism but tries to be neutral by accepting change but showing uneasiness towards the change. Mitcham argues that the Romanticism is a form of questioning. On the ancient view, technology was seen as a turning away from God or the gods. On the modern view, it is ordained by God or, with the Enlightenment rejection of God, by nature. With the romantics the will to technology either remains grounded in nature or is cut free from all extra-human determination.In the former instance, however, nature is reconceived not just as mechanistic movement but as an organic striving toward creative development and expression. William Wordsworth tries to demonstrate the same thing through his poems. In which he first shows exult over intellectual mastery and inventions and then in the following poems looks back and grieves over the great change that happened because of inventions and the outrage done t o the nature. Then he writes how unpropped are these arts and high inventions.Rousseau argues the need for actions, not words, and approves the initial achievements of the Renaissance in freeing humanity from a barren medieval Scholasticism. He argues that the destruction is better than inaction. He then points out to a paradox that: turning against technology – but in the name of ideals that are at the heart of technology. In with the way of romantic way of being with technology, there is a paradox. There is a certain ambivalence built in to this attitude. The attitude itself has not been adopted whole-hearted way by the modern culture.

Policy Analysis on Dementia Care

Abstract The policy ‘Improving Care for People with Dementia’ aims to increase diagnosis of dementia, improve health and care services in hospitals, care homes and communities, create dementia-friendly communities and widen research on dementia care. This brief aims to analyse only the aspect of improving health and care services in communities and the patients’ homes and relate this to the district nurse’s role of bringing care to the patient’s home and community. With an ageing population, the London Borough of Hackney, and the rest of the UK, is experiencing increased incidence of dementia. The costs associated with dementia care are approximately ?23bn annually in the UK. As a district nurse, this policy is important since it seeks to improve the care received by patients in community settings or their own homes. My caseload demonstrates a disproportionate number of patients suffering from dementia and the resources channelled to their care. Dementia is a chronic and complex condition and requires interventions from different health and social care professionals. However, informal carers bear most of the burden of caring. As a district nurse, I have to address the patients and the carers’ needs. Patients need to receive interventions to improve their nutrition, health and wellbeing. Carers need to receive training on how to feed their patients, ease their anxiety, regulate their sleeping habits or improve their mobility and independence. Meeting all these needs require additional training and collaboration between the district nurses and other health and social care professionals. The Department of Health and the Royal College of Nursing have a cknowledged the district nurses’ role in meeting the needs of patients with dementia in hospital settings. These nurses are tasked to prevent admission of patients and promote positive experiences for families during end of life care. However, the politics and economic context of this policy could all influence the care received by the patients. Ethics also play a role in delivery of care. The state’s apparent withdrawal of minimum service and delegating most of the task to home care could have ethical implications. Safeguards to quality care most commonly seen in wards or hospitals are missing in home care. This might do more harm for the patient than good. However, district nurses still have to weigh if choosing to provide care at home would be more beneficial for the patient or otherwise. Finally, this brief shows that community care for patients with dementia is possible if district nurse teams are dedicated and the workforce increased to respond to the increasing workload. Introduction The Department of Health Public Health Nursing (2013) has recognised that care for patients with long-term conditions often continue in their own communities and in the people’s homes. This type of care would require sustained relationships with district nurses (DN), who are responsible for managing the patient’s healthcare conditions. This brief aims to critically analyse the policy Improving Care for People with Dementia (Department of Health, 2013) and will relate this with the Department of Health Public Health Nursing’s (2013) Care in Local communities- District Nurse Vision and Model. The Department of Health Public Health Nursing (2013) has acknowledged that this new vision is a response to the growing needs of the ageing population in the UK. Specifically, it has recognised the growing incidence of dementia amongst the elderly population and this vision sets out the contribution of DNs and other healthcare teams in meeting the challenge of dementia. The first part of this brief justifies the choice of this policy and the focus on dementia care. A community in Hackney is chosen in this brief to represent my nursing caseloads of dementia. The second part discusses political, economic and philosophical context of the policy. The third part critically appraises the ethical and moral implications of this policy for practice. Policy on Dementia Care and the Community of Hackney With an ageing population, the London Borough of Hackney, like the rest of the UK, is faced with a rising incidence of the long-term conditions associated with old age (Office for National Statistics, 2013). According to the Alzheimer’s Research UK (2013), more than 820,000 elderly individuals are affected by dementia. The rate of dementia in Hackney is four times higher than that of the general population’s rate (Public Health England, 2013). In 2010, approximately 1,350 elderly people were living with dementia in Hackney (NHS, 2012). This policy aims to increase diagnosis rate, improve health and care services in hospitals, care homes, communities and homes, create dementia-friendly communities and widen research on dementia care. This brief will only focus on improving health and care services in communities and homes and relate these to the DNs role in providing care to patients in their own communities and homes. Implications of the Policy on Current Practice The policy on dementia care has an important implication in my practice as a district nurse. Providing holistic interventions to improve the quality of care in community settings require collaborative efforts of health and social care professionals (National Collaborating Centre for Mental Health, 2007). As a district nurse, I take the lead in provision of healthcare in community settings. On reflection, patients with dementia have complex needs that require collaborative care from nurses, physical and occupational therapists, dieticians, social care workers and other healthcare professionals. My role extends from planning care to coordinating care with other professionals. The King’s Fund (2012) explains that multidisciplinary teams are needed to provide quality care to patients. However, the quality of care could be affected if there are fewer nurses caring for patients. I observed that the number of registered nurses in my practice is declining. This observation is similar in a survey conducted by the Royal College of Nursing (2011), which reported that almost 70% of district nurse respondents claimed that registered nurses in their staff have dropped out. In my current caseload, a third of my patients in our team suffer from dementia. The incidence of dementia in Hackney is four times higher compared to the UK’s average (Public Health England, 2013). However, due to the nature of the condition, the care of this group of patients requires a disproportionate amount of time and resources. One of the duties of DNs in addressing the policy on dementia care is to ensure that carers also receive appropriate support. Carers have the right to h ave their needs assessed under the Carers and Disabled Children Act 2000 (UK Legislation, 2000). In my experience, CBT has been show to be effective not only in reducing anxiety in my patients but also depression in the carers. It has been shown that joining support groups has been associated with reduced incidence of depression (NICE, 2006). Implications of the Policy on Future Practice With the increasing focus on community care, there is a need to strengthen the district nurse workforce. Based on my experiences and observation, the quality of care could be compromised due to the decreasing number of DNs (Queen’s Nursing Institute, 2010). There is increased pressure to provide quality care at the least cost and with reduced number of nurses (Queen’s Nursing Institute, 2010). Establishing a therapeutic relationship is difficult when the continuous decline of healthcare workforce in the community is not addressed. Sheehan et al. (2009) argue that a positive relationship between healthcare professionals and the patient is needed in order to make healthcare decisions that would dictate the future of the patient. Based on these observations, the policy on dementia care would require additional workforce of registered nurses who would be willing to work in community settings. At present, the issue of sustainability of the DN workforce in meeting the present and future demands of elderly patients has been raised (Royal College of Nursing, 2013, 2011). Unless the issue of reduced workforce is not addressed, meeting the demands of the dementia policy would continue to be difficult. The policy would also require additional education and training for nurses. The Royal College of Nursing (2013) has acknowledged that the present DN workforce is highly qualified. Many have met the qualifications of nurse prescriber or district nurse while the rest of the staff either have completed qualifications for nursing first or second level registration or at least hold a nursing degree. However, the Royal College of Nursing (2013) also notes that the workforce number is still low. A small workforce could not adequately meet these needs. Further, the ageing population in the UK would mean that the NHS would continue to see a rise in the incidence of dementia in the succeeding years. The issue of recording performance data is also raised with the recent policy on dementia care. This would be a challenge since a community or a home does not present any safeguards commonly found in a controlled environment such as wards in hospital settings (Royal College of Nursing, 2013). There is also a need for DNs to be trained on how to give education and training to caregivers. In a systematic review conducted by Zabalegui et al. (2014), suggest that the quality of care of patients with dementia living at home could be improved if caregivers receive sufficient education and training from healthcare providers. Political, Economic and Philosophical Context The Alzheimer’s society (2014) states that in the UK, approximately ?23 billion is spent annually to manage patients with dementia. However, the same organisation is quick to observe that a large portion of this cost is borne by carers of the patient rather than social care services or the NHS. To date, there is only one study (Alzheimer’s UK, 2007) that investigated the cost of managing patients with dementia in community settings. The report shows that in 2007, the cost of managing one patient with mild dementia within one year in a community setting amounts to ?14, 540. For an individual with moderate dementia, the annual cost is ?20,355. This increases to ?28,527 for a patient with severe dementia. If a patient is sent to a care home, the annual cost of managing the condition amounts to ?31,263. It should be noted that all these costs were calculated almost 7 years ago. The individual cost of treatment is now higher. The same survey also shows that majority of the costs of dementia care is channelled to the carers. However, these costs do not account for the informal carers. Alzheimer’s UK (2007) estimates that the number of hours informal carers devote to caring run up to 1.5bn hours each year. This translates to ?12bn in cost, which is higher than the combined health and social care cost for dementia. Patients with severe dementia living in their homes or communities need at least 46 hours of paid carer support within a week (Alzheimer’s UK, 2007). However, the changing dynamics of families, with children living far from their parents or loss of spouse due to divorce or death could limit the pool of family carers. This issue could all influence the impact of the service provided by informal carers of dementia. The ageing population of the UK (Office for National Statistics, 2013) could further drive up the cost of caring for patients with dementia. The policy on dementia care increasingly depends on homes and communities to support the care of patients with dementia. Since many informal carers manage patients with dementia, the burden of caring is now channelled to the patient’s family. The main stakeholders then for this policy include informal carers, patients, DN staff and multidisciplinary team. This increasing reliance on home care and management could even be viewed as a strategy of the NHS to reduce the cost of caring for patients with dementia. There is also a concern on whether the quality of care is maintained at home, especially with fewer DNs supervising the care at home. Apart from the economic cost, politics could also influence DN practice. As with other policies, the policy on dementia (Department of Health, 2013) bring care close to home and care at home. These gradual changes are projected to empower patients, lower costs of healthcare while empowering communities to take care of their own health (Department of Health, 2013). The withdrawal of the state in providing minimum services for patients with dementia in favour of care at home should be evaluated on whether this would cause harm to the patient. If care at home would be possible with supportive carers, my role as a DN would focus on coordinating care with other healthcare professionals. However, if the patient does not receive sufficient support, the Mental Health Act 2007 (UK Legislation, 2007) mandates the appointment of a carer for the patient. The consequences of the political context of moving care closer to home for patients with dementia would be felt in the succeeding years. On re flection, making this policy work would require DNs to provide adequate support to the informal carers. The philosophical underpinning of this policy focuses on tackling health inequalities. Social determinants of health (NHS, 2012) have long known to influence the health outcomes of many individuals. In the London Borough of Hackney, incidence of dementia is higher amongst the older black elderly compared to the general white population (Office for National Statistics, 2013; Public Health England, 2013). Yaffe et al. (2013) argue that genetics do not account entirely on the disparity of incidence between black and white older populations in the UK. Instead, Yaffe et al. (2013) maintain that socioeconomic differences appear to have a greater influence on the higher incidence of dementia amongst black older people. Related risk factors for dementia such as poorer health, less education and literacy are higher in the black elderly and might account for the variation in dementia incidence. A number of earlier studies (Haas et al., 2012; Thorpe et al., 2011) have pointed out the relationsh ip between socioeconomic status and cognitive outcomes. The dementia policy not only brings care closer to home but also addresses socio-economic disparities of patients with dementia by allowing DNs to provide care in home settings. However, this is still challenging since carers and family members would provide care on a daily basis. The limited financial capacities of families with lower socio-economic status could have an effect on the nutritional status and physical health of the patients (Adelman et al., 2009). It has been stressed that poor nutrition and health could increase the risk of cognitive decline (Adelman et al., 2011). Ethical and Moral Implications of the Dementia Policy for Practice Approaches to ethics include the Deontological approach, Justice, Virtue and Consequentialism. Fry (2010) explain that in deontology, individuals should perform an action because it is their duty to do so regardless of the consequences of the action. The Dementia Policy in the UK is underpinned by ethical approaches. Using deontology, it is moral for nurses and carers to provide care for patients with dementia. In rule-deontology, decisions regarding the care of patients become moral when these follow the rules. Fry (2010) emphasise that the actions of individuals following deontology is usually predictable since it follows set of rules. A second approach to ethics called the Results of Actions (Fry, 2010) is opposite to deontology. In this ethics approach, an action becomes moral when its consequences produce more advantages for the patient than disadvantages. The third approach to ethics or the virtue approach states that there is an ideal that should be pursued by individuals in order to develop their full potential (Jackson, 2013). This approach is more encompassing than the deontological approach since it seeks to make a person moral by acquiring virtues. A review of the policy reveals that the virtue approach is followed since it seeks to provide holistic care to the patients. The policy emphasises providing psychological, social and emotional support not only to patients but also to their carers. Meanwhile, Beauchamp and Childress (2001) have set out four principles of ethics. These are autonomy, non-maleficence, beneficence and justice. The Nursing and Midwifery Council’s (NMC, 2008) code of conduct has stressed that patient autonomy should always be observed in all healthcare settings. A review of the dementia policy reveals that allowing patient’s to be cared in their home settings would likely increase patient autonomy. Patients in the early stages of dementia or those with moderate forms of the condition could experience cognitive impairments but still have the capacity to decide for themselves (Department of Health, 2009). The Mental Capacity Act 2005 (UK Legislation, 2005) states that only when patients suffer significant cognitive impairments should representatives of the patients be allowed to make decisions in behalf of the patient. Since the policy focuses on patient-centred care even in home settings, patients or their family members are allowed to decide on the best treatment or management for the patients. District nurses are encouraged in the policy to always seek for the patient’s interest. The emphasis of the policy on allowing patients to decide about their care is consistent with the ethical principle of autonomy. It is also important that nurses should first do no harm to the patients as embodied in the ethics principle of non-maleficence (Beauchamp and Childress, 2001). The policy supports this principle since DNs are available to provide support and lead the care of patients in home settings. However, there are several barriers in implementing the full policy. Although the policy specifies that DNs should rally the support of patients in home settings, there is the growing concern that the standards of care seen in hospital settings might not be transferred in home settings (King’s Fund, 2012). For instance, DNs could not regularly supervise carers on a daily basis on how they provide care to individuals with dementia. These patients need to receive sufficient nutrition, engage in exercises that increase their mobility or regularly receive pharmacologic medications for their conditions (Casartelli et al., 2013; Hopper et al., 2013; Cole, 2012; Bryon et al., 2012). It would be difficu lt to determine on a regular basis if all these tasks are carried out according to standards if patients are cared in their own homes. In a recent King’s Fund (2013) report, the quality of care received by patients from their nurses is highlighted. This report observes that not all nurses are compassionate to their patients and often, basic care such as feeding or giving water to the patients are often neglected. While this report was based on a study in only one hospital setting, the results are important since it showed that basic care might not be observed. In contrast, DNs would only visit the patients in their homes and would not be around to provide long hours of care. If patients receive poor quality care, this could result to poorer health outcomes and faster deterioration of the patient. The ethics principle of non-maleficence might not be observed if the volume of DN staff in the community remains low. There has been an association of high volume of work and low staffing amongst nurses with poor quality care (King’s Fund, 2013, 2012). The policy also observes the principle of beneficence since its primary outcome is to improve the quality of care received by older patients with dementia in their own homes. Although providing care in home settings would drastically reduce healthcare costs for dementia care, it is still unclear if this would benefit the family more. The cost of informal carers remains to be high, and yet is often discounted when approximating the cost of care for dementia (Alzheimer’s Society, 2014). This policy might put undue burden on families who lack the capacity to provide care for patients in advanced stages of dementia on a 24 hours basis (Alzheimer’s Society, 2014). Despite this observation, the policy is beneficial to patients with moderate dementia. A home setting might provide them with the stability and familiarity that is absent in hospital settings (Sheehan et al., 2009). It has been shown that when patients are admitted in hospital settings, they often manifest aggressi ve behaviour that is suggested to be a response to the changes in environment (Sheehan et al., 2009). The ethics principle of justice is also observed since the policy requires all patients, regardless of race or gender and socio-economic status, to receive equitable healthcare (Department of Health, 2013). On reflection, the moral implications of the policy might come into conflict with the state’s increasing reliance on informal carers or family members to provide care for patients with dementia. The issue lies on whether it is moral to delegate most of the care to informal carers who might also need additional support when caring for patients with progressive chronic conditions. The National Collaborating Centre for Mental Health (2007) stress that informal carers also need support to help them manage depression, stress or burnout from providing care to patients who would never recover from their condition. While the NHS continue to practice innovation in delivering care, an evaluation on whether there are enough resources to implement the innovation should be made. Conclusion In conclusion, the recent policy on dementia in the UK sets the direction of care in community or home settings. District nurses are in the position of following this direction since they lead patient care at home and in the community. However, this brief highlights some issues that should be addressed. These include the decreasing workforce of DN and their staff and their need for additional training and education. The political and economic context influencing the dementia policy should also be taken into account. Finally, this brief illustrates the role of DNs in providing quality care to patients in community and home settings. They could lobby for the patient’s rights and coordinate collaborative care between healthcare professionals and those involved in social care. References Adelman, S., Blanchard, M., Rait, G., Leavey, G. & Livingston, G. (2011). ‘Prevalence of dementia in African-Carribean compared with UK-born white older people: two-stage cross-sectional study’, British Journal of Psychiatry, 199, pp. 119-125. Adelman, S., Blanchard, M. & Livingston, G. (2009). ‘A systematic review of the prevalence and covariates of dementia or relative cognitive impairment in the older African-Carribean population in Britain’, International Journal of Geriatric and Psychiatry, 24, pp. 657-665. Alzheimer’s Society (2014). Financial cost of Dementia [Online]. Available from: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=418 (Accessed: 12th March, 2014). 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Hopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. & Schooling, T. (2013). ‘An evidence-based systematic review on cognitive interventions for individuals with dementia’. American Journal of Speech and Language Pathology, 22(1), pp. 126-145. Jackson, E. (2013) Medical law: Text, cases, and materials, Oxford: Oxford University Press. King’s Fund (2013). Report of the Mid Staffordshire NHS Foundation trust Public Inquiry by Robert Francis QC. London: The King’s Fund. King’s Fund (2012). Integrated care for patients and populations: improving outcomes by working together. A report to the Department of Health and the NHS Future Forum, London: King’s Fund [Online]. Available from: www.kingsfund.org/uk/publications (Accessed: 12th March, 2014). National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. 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District nurse is becoming an endangered species (press release, issued 26 March 2010), London: QNI [Online]. Available from: www.qni.org.uk (Accessed: 12th March, 2014). Royal College of Nursing (2013). District Nursing- harnessing the potential: The RCN’s UK Position on district nursing. London: RCN [Online]. Available from: www.rcn.org.uk/publications (Accessed: 12th March, 2014). Royal College of Nursing (2011). The Community nursing workforce in England, London: RCN [Online]. Available from: www.rcn.org.uk/publications (Accessed: 12th March, 2014). Sheehan, B., Stinton, C. & Mitchell, K. (2009) ‘The care of people with dementia in general hospital’, The Journal of Quality Research in Dementia, Issue 8 [Online]. Available from: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1094&pageNumber=5 (Accessed: 12th March, 2014). Thorpe, R., Koster, A., Kritchevsky, S., Newman, A., Harris, T., Ayonayon, H., Perry, S., Rooks, R. & Simonsick, E. (2011). ‘Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition Study’, Journal of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(10), pp. 1114-11123. UK Legislation (2007). Mental Health Act 2007 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2007/12/contents (Accessed: 12th March, 2014). UK Legislation (2005). Mental Capacity Act 2005 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2005/9/contents (Accessed: 12th March, 2014). UK Legislation (2000). Carers and Disabled Children Act 2000. [Online]. Available from: http://www.legislation.gov.uk/ukpga/2000/16/notes/contents (Accessed: 12th March, 2014). Yaffe, K., Falvey, C., Harris, T., Newman, A., Satterfield, S., Koster, A., Ayonayon, H. & Simonsick, E. (2013). ‘Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study’, British Medical Journal, 347: f7051 [Online]. Available at: http://www.bmj.com/content/347/bmj.f7051 (Accessed: 22nd March, 2014). Zabalegui, A., Hamers, J., Karrison, S., Leino-Kilpi, H., Renom-Guiteras, A., Saks, K., Soto, M., Sutcliffe, C. & Cabrera, E. (2014). ‘Best practices interventions to improve quality of care of people with dementia living at home’, Patient Education and Counseling, pii: S0738-3991(14)00044-5. doi: 10.1016/j.pec.2014.01.009 [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24525223 (Accessed: 12th March, 2014).

One Hundred Years of Solitude Essay Example | Topics and Well Written Essays - 750 words - 1

One Hundred Years of Solitude - Essay Example These occurrences befall all the Buendia family generations, who are unwilling, sometimes unable, to run from these misfortunes that are often self-inflicted. Eventually, the town of Macondo is destroyed by a hurricane, a further highlight on the inherently cyclical turmoil that characterizes Macondo. As the story ends, a descendant of Buendia is able to decipher a cipher that many of Buendia’s descendants had found unable to, foiled by its encryption. The message contained in the cipher reveals all misfortunes, and fortunes, that the Buendia family had lived through over the generations. This paper aims to discuss the various varieties of love, a recurring theme in the novel, with particular emphasis on Amaranta and Jose Arcadia (ІІІ). Love exists in a variety of forms in the novel. However, because this love is born in a society afflicted with solitude, it is rarely happy. Doomed love permeates the novel as seen in the curious and tragic saga of the beautiful Remedies (Fox 49). Any man who strives to pursue her ends up dead. Another form of love is one that breeds animosity and jealousy, especially among siblings. An example of this is the rivalry that exists between Amaranta and Rebecca as they both fall in love with Pietro Crespi, who eventually decides to marry Rebecca leaving Amaranta with a feeling of animosity towards Rebecca. There also exists genuine love in the novel (Fox 50). The two most obvious examples are the love between Meme and Mauricio Babilonia, and Aureliano and Amaranta Ursula. Their love, however, does not end well, with intervention that is unexpected, horrific, and even gratuitous. Simple passion also exists between Aureliano Segundo and his mistress, Petra Cotes. This passion is productiv e as it brings wealth and fertility to the Buendia family (Bloom 99). Love triangles in the novel also exist. Colonel Aureliano and Jose Arcadio (ІІ) are involved in an affair with Pilar Tenera, whose result is two sons by each

Lab. report Essay Example | Topics and Well Written Essays - 750 words

Lab. report - Essay Example A service request of the C-STORE is done by the invoking modality (SCU) to the PACS gateway (SCP) and thereafter, upon the reception of this C-STORE request, the gateway proceeds to produce to the response of the C-STORE’s inducing scanner. The third step of this intricate procedure involves the sending of the first image’s first information packet by the imaging modality to the gateway followed by execution of the requested C-STORE service by the gateway and eventual storage of the packet. The modality then receives a confirmation from the gateway upon this service completion and after this confirmation on the success of the storage packet from the gateway has been delivered from the gateway, the next packet is sent to the PACS controller by the scanner. The process from the gateway performance of the elicited service of the C-STORE to archive the packet to the sending of the consequent packet to the PACS controller repeats itself till that time that all the image packets shall have been sent from the gateway to the modality. This is followed consequently by the modality providing a second request of service, to the PACS’ gateway, stemming from the C-STORE that elicits the sending/ transmission of the second image. At this point, all the steps from the initial issuance of a request of the service of the C-STORE to the gateway of the PACS by the SCU to the transmission of the second image are repeated till that time that all the study images’ transmission shall have been completed. Thereafter, the ‘dropping association request and response’ communication command of the DICOM is issued by the PACS gateway and the modality which leads to a disconnection. Databases of the ePR and RIS/ HIS/ PACS are formulated, using artificial keys, to recover data. This data includes things such as hospital name and patient identification details, and so on. This operation design is enough for operations of

Engineering Environmental Sustainability- Take Home FINAL EXAM Assignment

Engineering Environmental Sustainability- Take Home FINAL EXAM - Assignment Example been subjected to uniform surcharge of 50kPa applied on the surface of soil deposit, which was later removed causing both the sand and clay layers in the current states to be over consolidated. For a 15-m- long, 500-mm drilled shaft and a geometrically identical closed-end steel pipe pile, calculate (a) the shaft capacity due to the clay layer ( divide the clay into ten sub layers of equal thickness in your calculations), (b) The shaft capacity due to the sand layer, (c) the total shaft capacity, (d) the ultimate base capacity, (e)the ultimate load capacity of the pile, (f) the allowable load based on a suitable factor of safety (without consideration of the strength of the pile cross-section), and (g) the allowable load if the compressive strength of the concrete is 15 MPa. Let us first divide the clay layer into 10 sub layers. The current vertical effective stress at each layer and past maximum vertical effective stress for each sub layer can be calculated from given data. The allowable axial load for the drilled shaft from geotechnical consideration is less than the allowable structural load, so, integrity of the cross section is not a concern. Therefore, the final allowable load of drilled shaft is obtained as We can now calculate the fundamental soil properties (undrained shear strength for clay and relative density for the sand layers.) Let us first calculate undrained shear strength of the clay layers. Following

IP1 ECON Essay Example | Topics and Well Written Essays - 750 words

IP1 ECON - Essay Example The price could fall as the A-phone is trying to clear the stock of the current models while developing new models to compete with the promegranate. The curve is likely to move to the left due to a fall in demand. If there is an increase of the price of A-phone due to a flaw found in the promegranate, demand is likely to fall if there are other competitors, but if there is little or no competition, the demand is going to rise (Bernanke and Abel, 2000). The movement is going to move according to the change in demand. If there is a new type of walkie-talkie that has unlimited range, and is basically free, demand for the A-phone is likely to fall. The rate in the fall in demand will depend on how many unique features the A-phone has. There is large number of people interested in the unique features such as cameras, and mp3 players. The price must fall in order to attract buyers even when the walkie-talkie is free, therefore, the curve will shift to the left due to the fall in demand. If it is discovered that there are health concerns when using cell phones, there is will be a drastic fall in the demand and price, since few people w ill be willing to use the phone. In this case, the curve is likely to move to the left due to the fall in demand. If there is a baby boom, there will be an increase in customers and therefore demand is likely to increase, and the price is also going to increase. In this case, the curve is going to shift to the right. If the price of the A-Phone and the Pomegranate both go up, demand is likely to remain the same, however, if the other brands in the market do not raise their prices, the demand may fall. The graph is likely to remain the same if the demand remains the same. If the market price of cell phones goes up, the demand will go down. The supply will outweigh the demand. Therefore there will be excessive supply in the market. If it becomes more expensive to

Explain the role of the judiciary in developing common law. Does this Essay

Explain the role of the judiciary in developing common law. Does this role assist with law making Explain the law making proces - Essay Example Customs were codified in the period of William the conqueror and this is said to be the basis of common law. With time, the king’s courts started to be used as a forum for dispute resolution of individuals, thus making it the common law and was subsequently said to be distinct from customs. However, the judges of that based their decisions on the customs and when a situation arose where no custom could be found new laws were formed. The procedure used at that point in time was by way of issuance of a writ, however, problems arose, as writs were fixed and only Parliament could approve a new writ, for a problem, which did not come under the existing writs. This caused a lot of problems thereby creating a rigid legal system and in lieu of this a practice of petitioning to the king was developed whereby individual cases were dealt with by the Chancellor. In turn a Court of Chancery was established whereby a new rule of ‘equity’ was established, which was contrary to t he common law of the ordinary courts. 1 The Court of Chancery was effective in respect of rectifying injustices but the existence of a parallel system was a problem, one of the problems being the existence of two separate procedures and was bought to an end by the Judicature act 1873-1875 whereby a unified system was established. 2 Thus the important aspect of the English Legal System has been its development by way of precedents, which the courts followed by way of the hierarchy of the courts. Furthermore, the fact that the House of Lords did not till 1966 have the power to overrule its own decision has also played an important role in this respect. The hierarchy of the courts has played an important part in respect of development of the common law and therefore the doctrine of binding precedent has led to such development. 3 The decisions of the judges are based upon the ratio decidendi and obiter dictum. The ratio of a judgment is the binding decision and the reasons for deciding , however, obiter dicta are the things that have been said by the way.4 The advantages of the hierarchy of the courts and judicial precedent is the consistency of decisions, certainty of decisions, efficiency of time and last but not the least flexibility of judges to mould common law.5 The disadvantages can be uncertainty by stare decisis, fixity by way of unjust precedent and unconstitutionality in respect of separation of powers.6 Thus the judges have played an important role in respect of developing the common law as can be seen by the historical developments. The judges now also play an important role by way of statutory interpretation. The next issue that would be looked into is the law making process of the Westminster Parliament and whether or not it’s effective. The Houses of Parliament are House of Commons and House of Lords. The laws of Parliament also known as Acts of Parliament are also called statutes or legislation. These acts can originate via party manifestos ; national emergency, crisis or new development; Royal Commissions; the Law Commission; or Private Members’ Bills.7 There are different types of Bills and these can be classified as Private Bills; Private Members’ Bills; or Public Bills. Public Bills are the common form of bills introduction of which is usually done by a Government minister. This is the most common type of Bill. Public Bills deals with matters which affects the public generally. As far as Private Members’

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Issues, Challenges and Strategies in Successful Implementation of an HRIS Project - Essay Example This article presents a critical analysis of the need for HRIS, features required in HRIS, design & acquisition issues, cost benefits, implementation issues and acceptance issues. Gardner and Lepak et al. (2003) presented that the new role of HR professionals is more of "strategic partners to the business" whereby they are expected to understand the business objectives of the organization and align the HR practices with the business goals defined to fulfil the objectives. Hence the business objectives expand into the HR objectives & related goals that are essentially defined to enhance employee contribution by providing them essential guidance, resources & support and to manage essential transformations & changes required in maintaining the fundamental culture of the organization. The authors argue that IT systems act as the catalyst for human resources professionals in achieving HR goals. Enterprise Resource Planning systems integrate various functional (departmental) information systems across the company such that the information from all departments can be integrated and organized for unified MIS reporting to the senior management enabling them to take quick & effective decisions (Gupta & Kohli. 2006). Human Resources is one of the key departments of an organization and hence HRIS need to be an integral part of ERP. The key result areas for all employees are defined by their respective functional managers but closely monitored by the HR function by virtue of key performance indicators. Kaplan and Norton (1996) developed the balanced scorecard system that helps organizations to design & implement a performance measurement system in such a way that individual performance measures can be tangibly mapped with organizational performance. The author hereby argues that such an integrated framework requires the performance management system to be an integral part of the E RP such that performance appraisal cycles can be carried out by respective supervisors of the employees but human resources function can closely monitor the KPI metrics and map with other soft aspects of the individual in terms of punctuality, knowledge & skill enhancement, trainings, additional certifications achieved, etc. The integrated information of functional KPIs and soft aspects can help the HR function to assess the overall performance of the employees and identify employee development needs as well as take decisions on promotions, increments, rewards & recognitions. 3.0 Requirement Analysis for an

Video game genres Essay Example for Free

Video game genres Essay Today, video games have become the most popular means of entertainment throughout our world. More than three-quarters of American youths have video-game consoles, and on a typical day at least 40 percent play a video game. Moreover, recently there has been a wide range of studies by professors throughout the world all focusing on the idea of whether or not video games are causing the youth to become a more illogical violent society in the future. Moreover, some people believe they are just a waste of precious time. However, they have been proven by many scholars that they are not only the best means of entertainment, but also one of the best sources of learning and improving brain performance and strategies, speed of alertness and decision making, and problem solving skills. Coming up with good strategies can be very handy for our lives whether it be in business, learning, teaching, etc. Nowadays video games have been proved to make people smarter towards creative strategy thinking. For example, it has been stated that â€Å"While there are many games that place a premium on strategy, most set an overall goal and give the gamer numerous ways in which he or she can achieve that goal. † Vila, Monica. 7 Reasons Why Your Son Should Play Video Games. http://www. babble. com/. N. p. , 04 Feb 2013. Web. 4 Nov. 2013. Video games teach kids to think objectively about both the games themselves and their own performance. In addition, players also get instant feedback on their decisions and quickly learn their own strengths and weaknesses through try and error since they get unlimited lives in a video game. Video games have a great effect on the youth regarding decision making. Some researchers compared action video-gamers and non-gamers with a series of simple decision-making experiments. Gamers devoted at least five hours weekly in the year before the experiment to playing action video games, such as Grand Theft Auto: San Andreas and Halo 2. They presented volunteers with arrays of dots, asked them to identify which way the dots were moving, and varied the number of dots moving in the same direction to make the task easier or harder. Video games get kids to think. There are dozens of video games that are specifically geared towards learning, but even the most basic shooter game teaches kids to think logically and quickly process large amounts of data. Rather than passively absorbing content from, say, a TV show, a video game requires the player’s constant input to tell the story. Moreover, well known sources such as the video games CQ research proved this characteristic about video gaming â€Å"Games stress taking your knowledge and applying it. That’s pretty crucial in the modern world,† says University of Wisconsin Professor of Reading James Gee. † Glazer, Sarah. Video Games. Congressional Quarterly, 2006. 939. Print. Indeed, the argument that video and computer games are superior to school in helping children learn as gaining currency in academic circles. Claimed benefits include improved problem-solving, mastery of scientific investigation and the ability to apply information learned to real-life situations. In conclusion, as you have seen, there is more than just killing and violence in video games. Our future children should be more exposed to video games not only for ways of entertainment, but also for the sake of improving their intelligence whether it be in creating new strategies, enhancing problem solving skills, or even allowing them to make better life decisions.

Anaemia During Pregnancy: Case Study

Anaemia During Pregnancy: Case Study ANAEMIA DURING PREGNANCY The wonder and joy ofpregnancyis matched by the bodys ability to adapt to looking after the growing baby. In addition to the mothers physiologic needs, there is the additional need to provide the building blocks for optimal growth of the baby. All this construction requires energy and oxygen as the fuel that helps drive the engine. Oxygen in the air that we breathe is delivered to the cells of the body by haemoglobin, a protein molecule found in red blood cells. When the blood lacks level of healthy red blood cells or haemoglobin it leads to a condition called anaemia. The main part of red blood cells is haemoglobin that binds to oxygen. If red blood cells is too few or the haemoglobin is abnormal or low , the cells in the body will not get enough oxygen. The body goes through significant changes when a woman is pregnant. Anaemia is a common disorder in pregnancy, which affect 20 to 60% of the pregnant women. About 20 to 30% of blood increases in the body, which increases the supply of iron and vitamins which are required in the production of haemoglobin. Most of the mothers lack adequate amount of iron during the second and third trimester of pregnancy. A mild anaemia is normal during pregnancy due to increase in the blood volume, but however a severe anaemia can put the baby at high risk of iron deficiency later in infancy. There are different types of anaemia that can develop during pregnancy such as fotal-deficiency anaemia vitamin B12, deficiency anaemia and iron deficiency anaemia. According to Cashion Alden, Perry (2009) In pregnancy, ladies need extra folate to make the red blood cells to transport oxygen to tissues throughout the body. Folate deficiency can directly contribute to certain types of birth defects. Folate-deficiency anaemia, folate which is also called folic acid, is a type of vitamin which is needed for the body to produce new cells, including healthy red blood cells. Iron-deficiency anaemia is when the body does not have enough iron to produce adequate amounts of haemoglobin, and is the most common cause of anaemia in pregnancy. To form healthy red blood cells the body needs vitamin B12 from her diet, the body would not be able to produce enough healthy red blood cells. Ladies who do not eat meat, poultry, dairy products, and eggs have a risk of vitamin B12 deficiency, which can lead to birth defects. Severe or anaemia which is untreated can lead to preterm or low-birth-weight baby, postpartum depression, baby with a serious birth defect of spine or brain, prenatal mortality or maternal death. . Some of the symptoms of anaemia during pregnancy are pale skin, lips and nail, feeling tired or weak, dizziness, shortness of breath, and rapid heartbeat. Antenatal care refers to care given to a pregnant woman from the time of conception is confirmed until the beginning of labor. Risk factors for anaemia in pregnancy can be woman pregnant with more than one child, two pregnancies close together, vomiting a lot because of morning sickness, teenager who is pregnant, not eating enough foods that are rich in iron and heavy periods before became pregnant In nursing process Assessment is the first stage in which nurse carries out a complete and holistic nursing assessment. Normal ward routine of nursing care procedures in antenatal unit at booking and important nursing focus areas is followed. Antenatal booking appointment, which provides the midwife with the valuable background information. The subjective and objective data is collected. The purpose of the visit is to bring together the woman to the maternity service. The information is shared between the mother and the midwife in- order to discuss, plan and implement care for duration of the pregnancy, the birth and postnatal period. During my attachment in antenatal clinic a mother came in for antenatal booking. Collecting her personal history, she is Mrs X, Indian married female. Her date of birth is 22th January, and is now 23 years old. , she is a high school graduate, is able to read and write and follow instructions, able to maintain eye to eye contact and is married to a 25 years old taxi driver named Mr Y. She is staying with her husband, his parents, two brother’s and a sister. They live in a wooden house near the copra mill. The mother is from Waibula but lives with relatives in Namara. Her emergency contacts were of her husband xxxxxxx and cousin sister xxxxxxx. Her family history, Mrs X mother is diabetic and her sister had twins. Mothers medical history was occasionally complains of migraine, and heavy menstrual bleeding. The husband and his elder brother are driving taxi and also they do a casual job in the timber mill. Mrs last normal menstrual period was on 25th of September 2012, her expec ted date of delivery is on the 7th of January 2013. She missed her period for two months. There was no gynaecological history present. Starting with her examinations, the height is 6 feet and 4 inches (1.65m) and is 66 kilograms. The urine test was normal, blood pressure was 80/40mmHg, temperature of 37.5 °C,pulse rate: 114 bpm, respiratory rate: 28 bpm skin: (+) pallor, (-) jaundice, (-) cyanosis, head:, EENT: pale palpebral conjunctiva, negative cervical lymp adenpathy chest, lungs: symmetrical chest expansion, (-) retractions heart: adynamic precordium, tachycardia, (-) thrills, (-) murmur abdomen: globular, soft, normal and active bowel sounds, non-tender extremities: pale nail beds, cold upper and lower extremities (-) cyanosis, weak peripheral pulsesneurological: No found neurological deficits rectal exam: No haemorrhoids, no fissures, no masses, palpated, no tenderness, intact rectal vault, good sphincter tone. In the blood test, the full blood count was done and was low an d proven to be anaemic. In order to ensure that the outcome of the pregnancy is the best for mother and baby, a routine is undertaken which is embraced by the term â€Å" antenatal care†. Fraser and Copper (2009) stated â€Å" the aims of antenatal care is to monitor the progress of pregnancy to .maternal and fetal health, developing a partnership with the woman, providing a holistic approach to the woman’s care that meets her individual needs, promoting an awareness of her public health issues for the woman and her family, exchanging information with the woman and her family, enabling them to make informed choices about pregnancy and birth, being an advocate for the woman and her family during her pregnancy, supporting her right to choose care appropriate for her own needs and those of her family, recognizing complications of pregnancy and appropriately referring woman to the obstetric team or relevant health professionals or other organizations, facilitating the wom an and her family in preparing to meet the demands of birth, making a birth plan, facilitating the woman to make an informed choice about methods of feeding and giving appropriate and sensitive advice to support her decision and offering parenthood education within a planned programme or an individual basis†.(P.g 265). During booking the mothers blood was sent in the laboratory for tests. The haemoglobin level 12g/dL or if it is the haematocrit less than 30% in a pregnant woman. Then it proves that the woman is anaemic. Mrs X haemoglobin level was 8.7g/dL and hemocrit was 25% , so it proved that she is anaemic. It is the risk to the mother and the fetus., So the nursing problem was diagnosed to Mrs X that she was suffering from Iron Deficiency Anaemia. Fraser et al. (2009) stated â€Å" iron deficiency anaemia is the most common hematologic disorder in pregnancy, it affects approximately 15% to 25% of pregnant woman, depending on the ethnic and socioeconomic groups being studied†.(P.g 872). After the diagnosis of iron deficiency anaemia Mrs X was referred to the doctor. The body produces more blood to support the growth of the body. The existence of a hematologic abnormally increases the pregnant women’s risk for developing more complication such as infection or preterm delivery If the mother not getting enough iron or certain other nutrients, the body might not be able to produce the amount of red blood cells it needs to make this additional blood. Taylor, Lillies, Lemone Lynn (2011) stated â€Å" carbohydrates, protein and fats are potential sources of energy for the body†.(P.g 1158). Mrs X presented with symptoms of pale skin, lips and nails, feeling tired or weak, dizziness, shortness of breath, rapid heart rate and trouble concentrating. It is very important to assess the wellbeing of the fetus. This was done by checking the fetal movement and listening to the fetal heart sound using a fetal cardio graph machine. The bloods were performed to see the changes that may indicate worsening of anaemia. The nurses has its own independent role scope of practice to ensure that the mother and fetus are healthy. The nurses role in managing the pregnant woman in this case of Mrs X are as follows. Nurses can be councillor, collaborator and advocator. The role of the nurse at first step will be taking or monitoring vital signs of the mother and thefetal heart rate. To assess the fetal heart rate, fetal heart sound and fetal kick count was monitored. Urine check is another important role of nurse in monitoring an anaemic mother. The mother will be asked to bring along a urine sample for glucose and protein level. In early pregnancy if protein level will be high it can be sign of problems including urinary tract infection, a kidney disorder , high blood pressure or diabetes. If in later pregnancy protein of high level is found is sign of pre-eclampsia. Taking of height and weight measurements is another role of a nurse, also to work out body mass index. Potter, Perry, Stockert Hill (2013) st ated â€Å" body mass index (BMI) measures weight corrected for height and serves as an alternative to traditional height-weight relationships†.(P.g 56). Since the nurse knows the diagnosis of Mrs Mrs Xshe can advise on what kind of foods to consume .She was advised to take foods that are rich in iron examples are red meat, egg yolks, dark leafy vegetables, dried fruit, iron-enriched cereals, grains, chicken giblets, beans, lentils, and liver. Establishment of quiet and peaceful environment to promote rest. During her hospitalization Mrs X was served with full diet. The nurse also taught to the woman on correct positioning while resting.The nurses also did health education with the husband on health. Nurses need to follow the physicians orders in giving the prescribed medications on time.They also advised on personal hygiene. In antenatal care the nurse needs to collaborate with other health care professionals, such as dietician, the obstetric, doctor, haematologists and physiotherapist. To enablepeople to make informed and practical choices about food and lifestyle in health and disease, the role of a dietician comes in, dietetics is the interpretation and communication of nutrition science. The role of a dietician was to prepare a food guideline for Mrs X. Obstetric team works with patients who are wanting to become to become pregnant, is pregnant or have recently delivered. The obstetricnurse have plenty roles in managing an anaemic mother. Mrs Narayan was admitted, reviewed, history taken, vaginal examination, fetal heart tones, and duration and intensity of contractions was done by an obstetric nurse. Paediatrician doctoradvised on healthy and successful delivery of Mrs Narayan, also advised on diet and medication compliance. Paediatrician doctor also took blood and urine test. The roleof midwife is to provide pregnancy care to woman during pregnancy and during birth. The midwife took Mrs X medical history and explained in detail the limitations and risks associated with pregnancy while being anaemic. The midwifealso checked urine for protein and heart beats for the developing baby. Health education was also provided by the midwife. The doctor was also responsible to prescribe medications, examination and to consider delivery if the condition of mother gets worse and fetus gets distressed. The physiotherapist taught Mrs X on exercise that was helpful to her. There are rationales behind the nurses independent roles in ensuring the well-being of the mother and the fetus. As stated earlier monitoring of vital signs, it is very important because to see if Mrs X condition is stable or not. Also same for the fetal heart rate and fetal sounds to see if everything is normal or not. Monitoring fetal heart rate and fetal sound to ensure that the fetus is not distressed. Urine checkis also important factor, it is done by the nurses to see if the glucose and protein level is normal or requires attention. Taking of height and weight is also important to see if mother is healthy and gaining weight since she is pregnant.Also to calculate the body mass index of the mother. The nurse providing health education on her diet, encouraging her to take iron rich foods to prevent or stop Mrs X from getting anaemic. The nurse administers medication as prescribed by the doctors to make Mrs X to improve on her health.Personal hygiene is really important because th e way mother keeps her self affects or reflects the fetus as well. There are rationales behind the professionals collaborative roles in establishing or giving quality care to the pregnant mother. Taking of history from the mother is to know whether she had any past medical problems, such as gynaecological issues or any surgeries that can hinder her present pregnancy. Doctors or paediatricians take samples of blood to see if mother is seriously anaemic or requires attention, or to see if there could be any complications.The rationale of doctors doing vaginal examination is to see cervical dilation or any complications which can arise. Counselling by the doctors of having proper diet or dieticians, to improve the condition of the mother and avoiding complications. Obstetric team was to ensure that if emergency develops there could be urgent need to conduct delivery in caesarean section, because they have knowledge on when and how to conduct delivery in emergency situation. Doctors presenting medication to increase iron level in the blood. Physiotherap ist needed to educate mother on exercise to help her in delivery. During the end of the antenatal clinic, the strengths and weakness of Mrs X was found and identified, it was recorded in evaluation. Mrs X was adjusted to what the plan was ruled out for her. Her strengths were that she followed her diet to what the dieticians planned for her. The health education was really effective to her and her husband supported on her diet and growing fetus. The family support was also there and she was in happy environment, free of fear and anxiety. Mrs X also took her tablets on time and gained weight. Another blood test was done and was found out that her haemoglobin level was normal. The benefitsof maternal iron supplementation on these outcomes are unclear, even for woman who develop anaemia during pregnancy. There is vivid evidence that maternal iron deficiencyanaemia increases the risk of preterm delivery and low birth weight. Iron supplementsimprove the iron status of the mother during pregnancy and during the postpartum period, even in woman who enter pregnancy with reasonable iron stores. Through my point of view, the mass of evidence supports the practice of routine iron supplementation during pregnancy, even though iron is most common and important for woman who have anaemia. ( Approx: 2443 words.) Reference Potter, P, A., Perry, A, G., Stockert, P, A., Hill, A, M. (2013). Fundamentals Of Nursing (8th ed.). United States Of America: Mosby. Fraser, D, M., Copper, M, A. (2009). Myles: Textbook for midwives (15th ed.). Edinburgh: Churchill Livingstone. Lowdermilk, D, L., Perry, S, E., Cashion, K., Alden, K, R. (2012). Maternity Women’s Health Care ( 10th ed.). United States Of America: Mosby. Taylor, C, R., Lillis, C., Lemone, P., Lynn, P. (2011). Fundammentals Of Nursing: The art and science of nursing care (7th ed.). Philadelphia: Lippincott. Reeder, S, J., Martin, L, L., Martin, L, L. (1997). Maternity Nursing: Family, newborns, and women’s health care (18th ed.). Philadelphia: Lippincott. 1

Treatment Of Cirrhosis Of The Liver Nursing Essay

Treatment Of Cirrhosis Of The Liver Nursing Essay Jo is a 23-year-old undergraduate student. She is very sociable and admits to enjoying a drink fairly frequently. Six months ago she got involved in a scuffle while out and ended up in her local AE department. While there she had a blood test which showed abnormal liver function. Follow up tests revealed she had cirrhosis but with only a small part of the liver affected at present. Consequently, Jo has been advised to quit drinking completely and has been referred to her local community alcohol team. However, she has not attended any sessions with them. She did go to one session with the AA which she found out about on the Web but did not return as she felt the people attending were so unlike her Im not an alcoholic. Recently, Jo has been to see her GP and said that, as her condition is so mild, and is not causing her any problems at present, she doesnt see why she should totally give up drinking. She claims to have reduced her drinking slightly going out only 4 nights a week and reducing the alcohol she drinks at home, and believes that this is enough. She admits to not telling any of her family or friends about her diagnosis. Her GP has now referred her to her local psychology service to see if you can make her see sense. How might a health psychologist go about helping Jo? Issues Jo has been diagnosed with having cirrhosis of the liver and has been advised by her GP to stop drinking alcohol. During early stages of cirrhosis there can be very few symptoms (Wright, 2009), and Jo does not seem to have experienced any physical aggravation that would indicate problems with her liver function. Therefore her diagnosis initially seemed inconceivable for Jo to comprehend. After a chronic disease is diagnosed, patients can be in a state of crisis and psychological disequilibrium (Taylor, 2006). Moos and Schaefer (1984, cited in Bennet, 2000) suggested that following a diagnosis of a chronic illness an individual can feel that their future plans, social identity and support network is threatened. She has decided not to tell her friends or family, and is avoiding the implication of her health through denial (Taylor, 2006) until she is more accustomed to the diagnosis. After prolonged inflammation of the liver due to excessive alcohol abuse Jo has cirrhosis on the liver. This is when normal healthy liver cells are damaged and replaced by scar tissue, reducing the number of cells remaining to perform its many important functions (Wright, 2009). Cirrhosis is the final stage of alcoholic liver disease, which is an incurable, progressive and potentially fatal (Wright, 2009). Alcoholic cirrhosis is a multi-factorial disease and is not only a result of high dependency to alcohol (alcoholism) (Addolorato et al, 2009; Day, 2009). Research have found a low dependency of alcohol in patients with cirrhosis (Smith, 2006 cited in Addolorato et al, 2009), and it is known that gender, genetic and nutritional factors can influence the disease progression to cirrhosis (Addolorato et al, 2009). Therefore alcoholic cirrhosis could develop in susceptible individuals whose life style of heavy alcohol abuse has predisposed them to their illness. Jos dependency to alcoho l will be established and considered throughout her treatment process, as this could affect the length and stringency of the treatment approach to achieve the best response (Kadden, 1998). Due to the progressive nature of liver cirrhosis in is imperative that Jo eliminates her alcohol intake, as this would worsen her condition (Wright, 2009). The ability to maintain abstinence from alcohol requires a change in lifestyle, accepting the responsibility of ones actions and being aware of the consequences of drinking behaviour (Farid, Clark Williams, 1997). Once Jo establishes this belief and takes responsibility that her behaviour influences her health, she will hold an internal locus of control (Farid et al, 1997). However currently believing that she has reduced her alcohol consumption to an adequate level, and doesnt believe her behaviour has an influence on her health status, she currently ender an external locus of control. Without acknowledgment of this link to her health, Jo might lack the motivation to stop drinking (Farid et al,1997). To alter and educate Jos current beliefs the information and advice given will need to match the appropriateness for her needs (Br unt, 1993). After her diagnosis Jo could be feeling a great deal of anxiety, fear and uncertainty (Berry, 2003), which would make the processing of advice and treatment information difficult. There is a danger that the individual can be left uneducated, which then adversely affects her coping methods and adherence to treatment (Silverman, 2005). Careful consideration must be made to their treatment of individuals who suffer from alcohol related illness as they tend to differ in their ability to function due to depression (Bianchi et al, 2005), raised anxiety (Bolden, 2009; Kim et al, 2005) and fatigue (Blackburn et al, 2007; Sogolow et al, 2007). There are also multiple psychological factors that contribute to this difference such as elevated levels of stress, inadequate coping mechanisms and reinforcement of alcohol use from other drinkers (Bolden, 2009; Bianchi, 2005; Constant, 2005). Psychological support could help Jo overcome any avoidant coping style and associated psychological distress p reventing adverse response to illness (Taylor, 2006). As this could have a detrimental effect on the progression of liver disease (Jin-Cai Xu-Ru, 2002) and act as a predictor for depression (Bianchi, 2005). Majority of the side effects for cirrhosis are treatable with adequate medical management of the patients affected by alcoholic cirrhosis (Addolorato, 2009). Despite damage to the liver, the liver can still perform some of its functions. Jo currently only has a small part of her liver affected and complete abstinence of alcohol is the only way to prevent further damage that could lead to the gradual recovery of liver function (Addolorato, 2009). However it is likely that end-stage liver failure will result in the patient being assessed for a liver transplant (Georgiou, 2003). Therefore, it is imperative that Jo has documented evidence of the length of time she has been abstinence from alcohol, has sound psychological wellbeing and a strong support network, imperative whilst on the waiting list for a replacement liver (Georgiou, 2003; Pereia, 2000) all in which are considered to reduce the risk of relapse both before and after the liver transplantation. A health psychologist can help Jo to employ effective strategies into different aspects of her life to prevent further alcoholic liver damage. Her current psychological wellbeing will be considered as she is adapting to various lifestyle changes, and therefore psychological intervention will help avoid or reduce psychological suffering (Blackburn, 2007; Kim, 2005). A health psychologist will educate Jo to tackle her current beliefs and develop effective coping mechanisms (Taylor, 2006). Having a wider support network would greatly benefit her treatment process (Georgiou, 2003), which would require her to involve family and friends for extra social support. Together with suitable nutritional advice (Merli et al, 2009) and exercise programme (Petrides et al, 1997) could reduce the effect of liver cirrhosis and could lead to the gradual recovery of liver function. Intervention From the start of the intervention it is important that Jo feels like she is being treated like an individual and that her health psychologist understands the impact of having diagnosed with liver cirrhosis will have on her life (Kadden, 1995), and that they may feel that their identity will be defined by their disability (Charmaz, 1995). A good patient-doctor relationship is important for the adherence and success of the intervention (Kadden, 1995). To establish a good rapport Jos health psychologist must display empathy and belief with good interpersonal skills (Kadden, 1996). He or she must be familiar with the material and function as an active teacher to import the skills successfully (Kadden, 1995). To further strengthen a positive patient-doctor relationship Jo must be encouraged to be involved in the decision-making of her treatment, as this could increase the likelihood of Jo being motivated to comply (Longabaugh, 1999). Jo will complete a Patient Knowledge Questionnaire (PKQ) to assess the knowledge of her disease, and also a CAGE screening test for alcohol dependence (Kadden, 1995), which will set a guide line for the health psychologist of the problems being addressed. Her current beliefs and perceptions of how her illness will affect her life can be further be explored by using open-ended questions (Kadden, 1995). Together with constant emotional support (Kadden, 1995) would improve her psychological wellbeing. Once Jos beliefs have been established, meaningful information can be given and educational programs can be incorporated. Jo requires learning necessary skills to change her problem behaviour, for this reason the information should be given alongside cognitive behavioural therapy (CBT), which views alcohol abuse as a learned behaviour which can be reversed (Lonabaugh Morgenstern, 1999). Jo will need to be aware that any negative feelings towards the diagnosis are normal and reassured that following the intervention she will learn adequate coping skills that will help her take control of her illness (Taylor, 2006). The first part will gain acceptance of the purpose, content and plan of the therapy. Information will be presented about the severity of her liver disease, and abstinence of alcohol clearly identified as the desired goal. The patient should elect a person (family member, friend) willing to act as a source of support. A motivational interviewing style should be used to throughout to promote self-efficiency and better understanding in a nonthreatening fashion (Georgiou et al, 2003). Secondly it is important to identify and develop sufficient coping skills and plan how they can occupy their time with social activities that do not involve alcohol. Potential high-risk situations for drinking will have been identified, and the third part of the therapy would req uire the individual to identify how they will avoid and cope with relapse. Jos psychologist should use the PKQ and CAGE results as a guideline to predict the length and stringency of the treatment (3-12 weeks), depending on level of alcohol dependence (Kadden, 1995), which should be constantly reviewed. Jo has shown positive response to cope with her diagnosis by looking for support on the internet. This provides support for the CBT approach as the success of this therapy will require active participation from the patient (Kadden, 1995). Jo did not enjoy the AA meeting she attended, and may have had difficulty comprehending their belief that an individual is unable to alter their drinking behaviour without the aid of religious intervention (Longabaugh Morgenstern, 1999). This would provide further support for the CBT approach having an underlying assumption that it is within the individuals power to change (Longabough Morgenstern, 1999). Attendances to alternative support group will be encouraged as researches have associated this with positive drinking o utcomes (Longabough, 1999). Jo might benefit from a group who share the underlying assumption that alcohol is learned maladaptive behaviour that they can change (SMART cited in Longabough, 1999). Total alcohol abstinence represents the most effective strategy for alcoholic patients affected by cirrhosis (Tilg Day, 2007 cited in Addolorato, 2009). Even low doses of daily alcohol intake are associated with increased risk of cirrhosis. Continuing alcohol abuse can lead to compilations such as hepatocellular carcinoma (Addolorato, 2009). Consequently, achieving total alcohol abstinence should be the main aim in the management of Jos liver cirrhosis. This could become complex if Jo is diagnosed with alcohol dependence (Sussman, 2004). Medical recommendations and/or brief interventions may not be sufficient to achieve and maintain alcohol abstinence when a diagnosis of dependence is present. There may be a need to add pharmacological approaches, like naltrexone, acamproste and bacolfen which have been shown to reduce alcohol craving and intake (Addolorato, 2009), to prevent relapse and further damaging Jos liver. Malnutrition is frequently present in cirrhotic patients, and considered to be a predictive factor for increased morbidity and mortality (Merli et al, 2009). Exercise and nutritional intervention could improve and prevent inter-related conditions such as obesity, diabetes and insulin resistance (Catalano, 2008), which may worsen her condition. Good nutrition has been shown to improve liver regeneration, recommending an intake of about 2000 calories per day to correct deficiencies and promote hepatic repair (Addolorato, 2009). It is generally assumed that patients with chronic liver disease should be encouraged to engage in exercise, as this will maintain or improve their physical well-being. This could have beneficial effects on body composition, muscle strength (Andersen et al, 1998) and glucose tolerance (Petrides, 1996) and may reduce symptoms of depression (Rot et al, 2009) and fatigue (Blackburn, 2007; Sogolow, 2008). However strenuous exercise is not recommended as this might i ncrease risk of internal bleeding (Petrides, 1996). There arent many researches available on the long-term functional outcome of nutritional and physical well being, however malnutrition (Merli, 2009), depression (Bianchi, 2005) and fatigue (Blackburn, 2007) have been shown to increases complications in liver disease. In conclusion forming a good report with the health professional throughout the sessions will promote the underlying success of the intervention. Jos determinants and high risk situations that are likely to lead to alcohol will be assessed. It is important to incorporate healthy interests to her lifestyle and involve her friends and family throughout the cognitive behavioural treatment, where Jo will learn the necessary coping-skills to unlearn old habits associated with alcohol abuse. She should receive psychological support counselling for a long as required and be encouraged to maintain nutritional and physical well-being, which will overall reduce disability and psychological distress.

My Place by Sally Morgan, The Road Not Taken by Robert Frost, The Trans

The Journey as Depicted in My Place by Sally Morgan, The Road Not Taken by Robert Frost, The Transall Saga and Pay it Forward The inner journey is a concept that has always been debated, and so has its meaning. The word ‘inner’ has the alternative meaning of personal. Moreover, the word journey has an alternative meaning of movement. So, the concept of the inner journey, customarily, has the meaning of a personal movement. Inner journeys have often been described as the metaphor behind a physical journey. The statement ‘Journey is the reward’ and the idea of a personal movement are depicted in the texts, My Place by Sally Morgan, The Road Not Taken by Robert Frost, The Transall Saga and Pay it Forward. ‘My Place’ is the autobiographical story, in which Sally Morgan’s family refuses to accept their aboriginality. It was the persistent attitudes of the family which prompted Sally to commence on her journey of self discovery. The poem ‘The Road Not Taken’ by Robert Frost also revolves around the theme of the inner journey. The poem is based of a manâ⠂¬â„¢s recollection of decision that he once made and its ramifications. The novel ‘The Transall Saga’ by Gary Paulson, is the fictional survival story about ‘Mark’ and his adventure after he was transported to a foreign world by a mysterious blue light. Finally, the film, ‘Pay It Forward’, is about a boy named Trevor McKinney and new found thoughts about the world after having been given a social studies assessment. This essay will highlight how all four texts portray the truth in the statement ‘The Journey is the reward.’ My Place is an autobiographical story by Sally Morgan. Sally was raised in an Aboriginal family which always denied their Aboriginality. Sally is the one who goes on a physical journey in order to discover her true family heritage and identity, which leads to a much more intricate inner journey. The road to enlightenment was not easy. She came across many obstacles and most of those came from her own family. Throughout the story the respondent is left wondering the reason behind the family’s silence towards each other. This statement only reinforces the idea that the core text, My Place, clearly depicts how the journey is the reward. Sally Morgan uses a wide range of different techniques to convey her physical and internal movement to disclose her family heritage and her own identity. The book it... ...which brought his family back together. In conclusion, My Place, The Road Not Taken, The Transall Saga and Pay It Forward, are all texts which connote the message that there is truth in the statement, ‘The journey is the reward’. My Place shows how Sally was able to discover her heritage, and more importantly, her identity. For Sally her journey payed of by meeting a whole new set of relatives and past family friends. The Road Not Taken, is a poem which vividly and subtly shows the respondent that all of lifes choices are important. The poem also tells us that he ‘should never come back’ to change his decision. Sally is under similar circumstances, for she cannot go back on some of her decisions. The Transall Saga told us how Mark changed his personal perspective on life and his physical appearance. The reward that Mark received while on his journey was meeting people, and then receiving respect from these ‘savages’. Pay it Forward, was the movie which enlightened the respondent into basic human nature, and to some extent what is wrong with the world. Trevor’s inner journey enabled him to discover that people can change and that the world may not be such a lost cause after all.

Essay --

"I feel at home wherever I go" . This is what a person who's not place-bound would say . This is what a person whose love is not confined to family and friends, but is spread everywhere and to everyone would say. This is what a global citizen would say. It is surprising how someone can be away from home but still feel like at home. A global citizen has cultivated his/her abilities to achieve this in a couple of ways. Let me tell you how . A global citizen has realized that we are all interconnected no matter where we come from or what religion we follow. No matter what our race or nationality is we are all part of a larger process which is human life. A global citizen has become aware that everyone on this planet is a brother or sister. The global citizen has read a lot about different countries , has learned different languages,has been interested in what's going on across the oceans , has found a connection between his daily life and the lives of others who live far away. I take my hat off to a such person . One of the global citizen's characteristics that I admire most ,i... Essay -- "I feel at home wherever I go" . This is what a person who's not place-bound would say . This is what a person whose love is not confined to family and friends, but is spread everywhere and to everyone would say. This is what a global citizen would say. It is surprising how someone can be away from home but still feel like at home. A global citizen has cultivated his/her abilities to achieve this in a couple of ways. Let me tell you how . A global citizen has realized that we are all interconnected no matter where we come from or what religion we follow. No matter what our race or nationality is we are all part of a larger process which is human life. A global citizen has become aware that everyone on this planet is a brother or sister. The global citizen has read a lot about different countries , has learned different languages,has been interested in what's going on across the oceans , has found a connection between his daily life and the lives of others who live far away. I take my hat off to a such person . One of the global citizen's characteristics that I admire most ,i...

Behavior Modification Project

I don’t remember exactly when I took to smoking or how the habit had developed in me. However I remember well that my pattern of smoking has been fairly consistent, at least for the last couple of years, smoking about six cigarettes a day. There are of course days when I have smoked a couple of cigarettes more or less too. Most of my friends don’t smoke and they don’t like smoking in their presence, although they wouldn’t object it on the face. I am aware of the risks of smoking, its association with cancer and strokes, and had long decided to abandon it.I had convinced myself that I need to give up smoking. However I didn’t have a plan or deadline for it; not that I was ignorant of this fact. I knew that to get rid of any habit, one should have a concrete plan and an anticipated schedule. In my mind, I believed I would soon be implementing one for myself. Unfortunately I did nothing in an effort to quit smoking, only compensating it with a feeling that I have a strong untested will power and can easily quit whenever I wanted. It never struck me that the quitting should start now.It so happened, that I had an opportunity last month to attend a seminar on ‘Modern lifestyle trends and its impact on health’. Here the speaker emphasized that habits like smoking, alcoholism, drugs, sexual attitudes can only be reversed when it is within a reversible range. He said it was his personal opinion that chronic addicts cannot come out of it, no matter what the de-addiction programs he or she goes through. He then went on to give scary facts that awaited the pursuers of these habits. This was when I got really scared, and decided to call it a day.I knew I was not a chronic smoker although I thanked God; he didn’t define a chronic smoker. I realized and accepted the fact that I had not made even the slightest attempt, to give up smoking. I took a resolution that quitting efforts would start right here and right now. I wa s careful enough not to fall back on Behavior Modification Project 3 my will power and put it through an acid test, by deciding to quit immediately. I began to plan a way of achieving a no smoking state in a gradual way. I was happy that although my efforts to quit smoking had been late, it was being done cautiously.Had I taken an unplanned and arbitrary decision, like stopping instantly; and if it had rebounded, there were chances that I would probably never get out of it. For the first week, I had decided that I would smoke no more than six cigarettes a day, so as to average about six or lesser number per day. For the second week, I had planned a reduction of two cigarettes a day, so as to average about four or less per day. Then the most important third week, where I further reduced the number of cigarettes to just two per day. Then the hopefully successful fourth week, where I would be a non-smoker.Although I was confident, I was apprehensive of the possibility of achieving thes e goals. I recollected the times when I didn’t have a cigarette and desperately needed one, and to the extent I went, to get one. As my goal to quit smoking is to be achieved only in stages, I thought it necessary to reward myself whenever I reach the goal, for the week. This would not only be an encouragement for me, but also an acknowledgement of meeting target for that week. I decided to treat myself to a half hour, either in a flight simulator or with friends.This was my roadmap to quit smoking, planned in detail. The first week wasn’t difficult as it was almost like any before; the only difference being that it should not exceed six any day. However, I considered this week as a crucial one because this was the first week I was ever under smoking conditions. I smoked only about five for most days of this week. The second week was more difficult, as I could smoke only four or less. Here too I tried to restrict to the least possible and I smoked less than the target. I smoked only about three per day for most days, touching four only twice that week.I allowed and enjoyed the treat I promised myself, after each week. Then came the ultimate third week Behavior Modification Project 4 where I had to be more resistive to temptations; just two cigarettes a day. It was indeed difficult but I was determined, and knew it was worth it. On the third day of the third week, I had a feeling that things might become extremely difficult, and even impossible in the fourth week. Third week looked achievable, but I feared the fourth ultimate week, where I had to be without cigarettes.I realized, I needed any possible help to keep me off cigarettes. I joined a meditation class by the mid of the third week. By the time fourth week started, I felt I could comfortably keep off cigarettes for the week. I didn’t feel the urge to smoke one that entire week. In fact, I would say, the fourth week was the most comfortable and a confident one as I felt that smoking w as no longer a problem with me. When I went for my treat that weekend, I sensed the feel of being a non-smoker, for the first time. Behavior Modification Project Working out is something I really enjoy doing, but I almost always find some excuse as to why I cannot exercise more than going to Zumba twice a week. It’s not that I don’t care about losing weight or staying in shape; it’s just that the outcome of working out is too small to control my behavior. The contingency for working out is ineffective. Ineffective contingencies fail to control our behavior because the outcomes are either too small (though of cumulative significance) or too improbable.I have a given level of health, I work out twice a week for 60 minutes, and then I have an infinitesimally greater level of health. Although my level of health increasing is small and cumulative, I know neither my body image nor my weight will change by working out one time. I know getting my butt to the gym several times per week will reduce my body fat, but there are several competing contingencies that prevent me from doing so. For example, E. R. is one of my favorite T. V . shows that I love to watch if I have some spare time in my day, I would much rather watch Dr.Carter put in a chest tube to save a little girl’s life than sweat through two tank tops at the gym. If I go to the gym I will lose the opportunity to watch E. R. My performance objective is to workout at least five days a week for at least 40 minutes. The type of exercise does not matter; it can include cardio, aerobics classes, toning exercises, or any combination. I did not specify exact days I had to work out, just that I have to work out five of seven days a week. For my intervention I implemented an avoidance of loss contingency.An avoidance of loss contingency is the response contingent prevention of the removal of a reinforcer resulting in an increased frequency of the response. Each time that I missed any of the five days or working out for 40 minutes I have to pay my classmate and workout buddy Michelle $3. By working out for 40 minutes I would avoid the loss of a reinforc er (money). By setting up a performance contract I know exactly what is expected of me. I am completely aware of the behavioral contingency: the occasion for the response, the response, and the outcome for that response.Since Michelle and I go to the same gym, she holds me accountable and checks with me daily if she does not see me at the gym. I report to Michelle each day before boot camp at 3:00pm. My weeks run Monday-Sunday, and I pay out for each instance of a missed workout Monday before class. Having to give Michelle money that I would have otherwise spent at the vending machine during the class break is very aversive. I keep track of my performance of working out on a week at a glance graph, which I present to my boot camp classmates every Friday.The graph has different shapers of data points indicating the type of exercise I did. For example, I use circles for cardio, stars for weight training, and hearts if I did both cardio and toning. My benefits measure is my body fat pe rcentage. I did not choose to use weight loss as a benefit measure because as I do more toning exercises, muscle is gained so my weight may not fluctuate a whole lot. Body fat is what I really want to focus on because I could care less how much I weigh if my body looks tight and toned!So far the performance management intervention has been overall pretty successful. I am making time to workout many more times per week than I have in a long time. My performance manager Michelle really motivates me to stay on top of my game, and since we go the same gym, our workout buddy system works really well. I began the intervention on June 11, 2008 and I am currently still implementing. My body fat percentage decrease quite a bit at first, then increased slightly (due to poor eating habits).So far I have only paid out $6, which is much less than I ever thought I would have paid out at this point. I made a goal with my performance manager to hit my goal for the rest of boot camp. If I hit my goa l for the remaining 3 weeks at 100% Michelle and I are treating ourselves to pedicures! I have hit my goal of five days a week several times, and only had a few weeks when I did not reach five workouts per week. The first week of the intervention I started on Wednesday, so I missed a couple days to workout. Also, in week 5 I had a migraine so I excused myself from working out.I am currently in the middle of week 9 and so far have worked out three times. The only thing I would revise about this intervention is the diet aspect. I did increase my exercising; however, my results were not phenomenal. I think I need to put some performance management contingencies on healthy eating as well as exercise. I feel great working out more, but I am still eating Twinkies and Taco Bell! This really prevents me form losing optimum body fat! Through behavior analysis (the study of the principles of behavior)