Miller Associated Communications

1. How does Miller fit the profile of the average fraud perpetrator? How does he differ? How did these characteristics make him difficult to detect? Miller fit the profile of the average fraud perpetrator is that he has seem to look like everyone else in the business world who is well liked and seem to be an ideal employee. Purpose of Miller is trying to gain the trust of his employer and colleagues. That’s why Miller works so hard on the constant energetic attempt to conceal his fraud. Miller differed from other fraud perpetrators because he was a sensible person. He has realized that embezzle he done was not right. When he caught by the employer, he promised will pay back all the money that he had stolen from earlier fraud. These characteristics made it difficult to detect Miller because he was trusted by his employer and colleagues. He would dedicate and put more effort on his job, and said to do outstanding work. This added by Miller being a very likeable person simply proved to make his evildoings very hard to detect. 2. Explain the three elements of the opportunity triangle (commit, conceal, convert), and discuss how Miller Associated Communications. What specific concealment techniques did his actions? Miller accomplished the three elements of the opportunity triangle in embezzling funds from Associated Communications by stealing money from his employers through forged checks. He would trick colleagues into signing their names to checks requiring two authorizing signatures. He would do this by asking them to sign the checks just in case the company needed to authorize a payment while they were on vacation. Miller concealed the fraud by intercepting the bank reconciliation and destroying the cancelled checks he used to siphon money. He then wrote off the amount to an expense account in order to balance the company’s book balance. Since Miller converted the checks he had written into his personal account to convert the funds into personal gain. 3. What pressures motivated Miller to embezzle? How did Miller rationalize his actions? Pressure is a person’s incentive or motivation for committing fraud. In this case, Miller faced a pressure vanity of his lifestyle which motivated Miller to continue to commit fraud. This is because he needs to buy luxury goods and lavish lifestyle. Miller rationalized his actions by saying he was not a bad person and he promised to all victim companies he would paid back the money that he stole. 4. Miller had a framed T-shirt in his office that said, â€Å"He who dies with the most toys wins. † What does this tell you about Miller? What lifestyle red flags could have tipped off the company to the possibility of fraud? Miller’s framed T-shirt showed that he was extremely motivated by material things and needs a lot of money to support his motivation. The lifestyle red flags could have tipped off the company were that Miller was spending his salary most likely could have supported, such as buying a lavish suburban home, expensive suits, diamond, ruby, a new car, and others. 5. Why do companies hesitate to prosecute white-collar criminals? What are the consequences of not prosecuting? How could law enforcement officials encourage more prosecution? Companies hesitate to prosecute white-collar criminals because they will be going to worry that fraud perpetrators will continue to exploit a company if they going to be prosecuted the fraud perpetrators. Fraud perpetrators will be going to revenge those companies who prosecute them as they are clearly about the weakness of the internal controls of their existing companies. So that, they can easily to sabotage each companies. Law enforcement Officials could encourage companies to report and prosecute fraud and hold them responsible if they know about the fraud committed. This would prevent more fraud acts happen in the future because employees know they will be prosecuted for committing fraud. 6. What could the victimized companies have done to prevent Miller’s embezzlement? Wheeling Bronze could have better enforced proper authorization and approval controls over access to cash and bank checks and to the means of writing and signing checks. Crest Industries could have been prevented or at least detected by better control over monthly bank statements and their reconciliation. In all but the first fraud, a more thorough background check of Miller may have revealed his past fraudulent activities and the company could have avoided the problems that arose after he was hired.

Selecting Employee

Learn how to select and hire the best employees for your open positions. Selection and evaluation techniques are explored that help you pick among qualified candidates. Employee selection processes are critical to hiring a superior staff. Learn to improve your employee selection methods. 10 Tips for Hiring the Right Employee Top Ten Tips for Selecting and Hiring the Right Employee Hiring the right employee is a challenging process. Hiring the wrong employee is expensive, costly to your work environment, and time consuming. Hiring the right employee, on the other hand, pays you back in employee productivity, a successful employment relationship, and a positive impact on your total work environment. Hiring the right employee enhances your work culture and pays you back a thousand times over in high employee morale, positive forward thinking planning, and accomplishing challenging goals. This is not a comprehensive guide to hiring an employee. But, these are key steps to hiring the right employee. 1. Define the Job Before Hiring an Employee Hiring the right employee starts with a job analysis.  The job analysis enables you to collect information about the duties, responsibilities, necessary skills, outcomes, and work environment of a particular job. The information from the job analysis is fundamental to developing the job description for the new employee. The job description assists you to plan your recruiting strategy for hiring the right employee. Job HiringEasy Search & Posting: AyosDito Free Job Posting, No Sign Ups! www. AyosDito. ph Interview Strategy GuideGet a Free interview strategy for HR professionals. hr. mcleanco. om/interview-guide Employment ScreeningInternational Background Checks No hidden fees or minimum orders 2. Plan Your Employee Recruiting Strategy With the job description in hand, set up a recruiting planning meeting that involves the key employees who are hiring the new employee. The hiring manager is crucial to the planning. At this meeting, your recruiting strategy is planned and the execution begins. Teams that have worked together frequently in hiring an employee can often complete this step via email. 3. Use a Checklist for Hiring an Employee  This checklist for hiring an employee will help you systematize your process for hiring an employee. Whether it's your first employee or one of many employees you are hiring, this checklist for hiring an employee helps you keep track of your recruiting efforts. The checklist for hiring an employee keeps your recruiting efforts on track and communicates progress to interested employees and the hiring manager. 4. Recruit the Right Candidates When Hiring an Employee You can develop relationships with potential candidates long before you need them when hiring an employee.  These ideas will also help you in recruiting a large pool of candidates when you have a current position available. The more qualified candidates you can develop when hiring an employee, the more likely you are to locate a qualified potential employee. Read on to discover the best ways to develop your talent pool when hiring an employee. 5. Review Credentials and Applications Carefully The work of reviewing resumes, cover letters, job applications, and job application letters starts with a well-written job description.  Your bulletted list of the most desired characteristics of the most qualified candidate was developed as part of the recruiting planning process. Screen all applicants against this list of qualifications, skills, experience, and characteristics. You'll be spending your time with your most qualified candidates when hiring an employee. And, that is a good use of your time. 6. Prescreen Your Candidates The most important reason to prescreen candidates when hiring an employee is to save the interviewing and selection committee time.  While a candidate may look good on paper, a prescreening interview will tell you if their qualifications are truly a fit with your job. Additionally, in a prescreening interview, you can determine whether their salary expectations are congruent with your job. A skilled telephone interviewer will also obtain evidence about whether the candidate may fit within your culture – or not. 7. Ask the Right Job Interview Questions The job interview is a powerful factor in hiring an employee. The job interview is a key tool employers utilize in hiring.  The job interview questions asked are critical in magnifying the power of the job interview to help you in hiring the right employee. Interview questions that help you separate desirable candidates from average candidates are fundamental when hiring an employee. Job interview questions matter to employers. Here are sample job interview questions. 8. Check Backgrounds and References When Hiring an Employee Effective background checks are one of the most important steps when hiring an employee. You need to verify that all the presented, sterling credentials, skills, and experience are actually possessed by your candidate.  The background checks must include work references, especially former supervisors, educational credentials, employment references and actual jobs held, and criminal history. Other background checks when hiring an employee, such as credit history, must be specifically related to the job for which you are hiring an employee. 9. Extend a Job Offer The job offer letter is provided to the candidate you have selected for the position. Most frequently, the candidate and the organization have verbally negotiated the conditions of hire and the job offer letter confirms the verbal agreements about salary and benefits.  The more senior the position, however, the more likely the job offer will turn into a protracted negotiation about salary, benefits, employment termination, bonus potential, severance pay, stock options, and more. 10. Use Effective Employment Letters These sample employment letters will assist you to reject job candidates, make job offers, welcome employees, and more when hiring an employee. Use these sample employment letters to develop the employment letters you use in your organization when hiring an employee. New Employee Orientation: Employee Onboarding New employee orientation is the process you use for welcoming a new employee nto your organization. New employee orientation, often spearheaded by a meeting with the Human Resources department, generally contains information about safety, the work environment, the new job description, benefits and eligibility, company culture, company history, the organization chart and anything else relevant to working in the new company. New employee orientation often includes an introduction to each department in the company and training on-the-job. New employee orientation frequently includes spending time doing the jobs in each department to understand the flow of the product or service through the organization. Tips for a Better New Employee Orientation When we orient new hourly (non-exempt) employees, we provide a standard HR couple of hours on policies, procedures, company history, goals, culture, punching in and work rules. We give a company tour and hourly employees then train and cross-train on the job. Managerial and salaried (exempt) employees participate in an orientation that is custom-designed for them. It includes the above information that is received by all employees. Additionally, their orientation may last one to two weeks and it enables them to meet the whole organization, their direct reports and more. They should leave this orientation with a clear picture of the organization, its challenges, its goals and their opportunity to assist with progress. It is challenging to make sure salaried employees have the chance to do the orientation while also beginning their new job. Neither can be put on hold. My current new director spent the morning helping to write an RFP for a potential customer rather than attending his scheduled meetings. This is okay, but I don't want his orientation to get off track. It provides fundamental information he needs to succeed in this organization. From an HR perspective, this may not be ideal for making sure he gets the organization overview, but it is ideal for helping him integrate quickly into the working business of the company – and that's the point. Right? The best orientation I have ever known was instituted at Edgewood Tool and Manufacturing. Every manager who hired a new employee was required to write a 120 day orientation for the new employee. It involved one action a day. Actions included meeting the Director of Quality, calling on a customer and having lunch with the CEO. You can bet that new employee was thoroughly welcomed and integrated into the organization after 120 different orientation events. Orientation and Training of New Employees New employee orientation effectively integrates the new employee into your organization and assists with retention, motivation, job satisfaction, and quickly enabling each individual to become contributing members of the work team. New Employee Welcome Letter-A welcome letter to a new employee who has accepted your job offer confirms the employe's decision to accept the position. The welcome letter helps the new employee feel wanted and welcomed. Depending on the goal of your new employee welcome letter, these sample welcome letters will give you a template. See sample welcome letters for new employees. Onboarding-Onboarding is the process of acquiring, accommodating, assimilating and accelerating new team members, whether they come from outside or inside the organization. Effective onboarding of new team members is one of the most important contributions any hiring manager or HR professional can make to long-term success. Onboarding done right drives new employee productivity, accelerates results, and significantly improves talent retention. Yet few organizations manage the pieces of onboarding well. Purposes of Orientation Employers have to realize that orientation isn't just a nice gesture put on by the organization. It serves as an important element of the recruitment and retention process. Some key purposes are: * To Reduce Startup Costs: Proper orientation can help the employee get â€Å"up to speed† much more quickly, thereby reducing the costs associated with learning the job. To Reduce Anxiety: Any employee, when put into a new, strange situation, will experience anxiety that can impede his or her ability to learn to do the job. Proper orientation helps to reduce anxiety that results from entering into an unknown situation, and helps provide guidelines for behavior and conduct, so the employee doesn't have to experience the stress of guessing. * To Reduce Employee Turnover: Employee turnover increases as employees feel they are not valued, or are put in positions where they can't possibly do their jobs. Orientation shows that the organization values the employee, and helps provide the tools necessary for succeeding in the job. * To Save Time for the Supervisor: Simply put, the better the initial orientation, the less likely supervisors and co-workers will have to spend time teaching the employee. * To Develop Realistic Job Expectations, Positive Attitudes and Job Satisfaction: It is important that employees learn as soon as possible what is expected of them, and what to expect from others, in addition to learning about the values and attitudes of the organization. While people can learn from experience, they will make many mistakes that are unnecessary and potentially damaging. The main reasons orientation programs fail: The program was not planned; the employee was unaware of the job requirements; the employee does not feel welcome. Employee orientation is important – orientation provides a lot of benefits, and you can use feedback to make your orientations even better. Use Training and Development to Motivate Staff Building Your Employee Training and Development Program Want to keep your staff motivated about learning new concepts? The quality and variety of the employee training you provide is key for motivation. Reasons for employee training range from new-hire training about your operation, to introducing a new concept to a workgroup to bringing in a new computer system. Whatever your reason for conducting an employee training session, you need to develop the employee training within the framework of a comprehensive, ongoing, and consistent employee training program. This quality employee training program is essential to keep your staff motivated about learning new concepts and your department profitable. Essential Components of Employee Training Programs A complete employee training program includes a formal new hire training program with an overview of the job expectations and performance skills needed to perform the job functions. A new hire training program provides a fundamental understanding of the position and how the position fits within the organizational structure. The more background knowledge the new associate has about how one workgroup interrelates with ancillary departments, the more the new associate will understand his or her impact on the organization. Another aspect of a comprehensive employee training program is continuing education. The most effective employee training programs make continuing education an ongoing responsibility of one person in the department. This is an important function that will keep all staff members current about policies, procedures and the technology used in the department. New Hire Training A solid new hire training program begins with the creation of an employee training manual, in either notebook format or online. This manual acts as a building block of practical and technical skills needed to prepare the new individual for his or her position. In order for the department to understand current policies and procedures, a manager must ensure the department manuals or online employee training are kept current. This includes any system enhancements and / or change in policy or procedure. In addition, keep the user in mind when designing training manuals or online training; keep the employee training material interesting for the learner. Use language that is not â€Å"corporate† and include images and multi-media. Much of this employee training and reference material belongs online these days in a company Intranet. But, if your organization is not ready to embrace the online world, keep the manuals up-to-date and interesting. When possible, in computer training, incorporate visual images of the computer screen (multi-media screen capture) to illustrate functions, examples, and how tos. On the Job Training Another form of new hire training includes having the new associate train directly next to an existing associate. Some call this On the Job Training (OJT) or side-by-side training. This type of employee training allows the new associate to see first hand the different facets of the position. Also, OJT allows the new hire the opportunity to develop a working relationship with an existing associate. This type of employee training reinforces concepts learned in the initial training and should be used to reinforce and apply those same learned concepts. Continuing Education in Employee Training A continuing education program for a department is just as important as the new hire training. When training a new associate, I have found that they will only retain approximately 40 percent of the information learned in the initial training session. Therefore, a continuous effort must be placed on reminding the staff about various procedures and concepts. This continuing education can be formal or informal. (The author’s preference is always with a more informal approach. ) The formal, or traditional approach, to employee training often includes a member of management sending a memo to each associate. The informal, and often more appealing approach to a visual learner, is to send a one-page information sheet to staff. This information sheet, called a training alert, should be informative and presented in a non-threatening manner. Therefore, if the policy or procedure changes, the informal approach would better prepare the department to receive this presentation. New Employee Training – Is It Worth The Investment Getting off on the right foot Many companies provide some sort of introductory training or orientation for most of their new employees. It may take the form of an older employee assigned to show the new employee â€Å"the ropes. † Or it may be left to the HR department or the individual's new supervisor to show them where the coffee pot is and how to apply for time off. Many organizations, especially in government and academia, have created new employee training that is designed, exclusively or primarily, to provide mandated safety familiarization. Yet some companies in highly competitive industries recognize the value in New Employee Orientation (NEO) that goes much farther. They require several weeks or even months of training to familiarize every new employee with the company, its products, its culture and policies, even its competition. There is a measurable cost to that training, but is it worth it? Let's look at some of the issues. Some Background Facts The technology in the workplace is changing very rapidly and companies that can't keep up will drop out of competition. A survey by the Ontario (Canada) Skills Development Office found 63% of the respondents planned to â€Å"introduce new technology into the workplace that would require staff training. A third of the respondents included â€Å"improving employee job performance† and â€Å"keeping the best employees† as desired outcomes. The American Society for Training and Development (ASTD) reports that less than $1500 per employee was spent for training in 1996. The largest part of that (49 percent) was spent for technical and professional training. Only two percent was spent for New Employee Orientation and three percent on quality, competition and business practices training.

Analysis of Prompt and Utter Destruction

He contends that because of their lack of knowledge of the actual damage that the force of the explosion would cause, that American politicians including President Truman made a decision based on certain assumptions. Now to address the query, was the assault on Japan with atomic bombs necessary? Samuel J. Walker had always been intrigued by the history surrounding the decision to assail Japan with the use of the atomic bombs. He was so fascinated that he made it a personal assignment to conduct research on the issue in his own time. Walker did not do so as part of his obligation as the historian for the United States Nuclear Regulatory Commission. His research reveals that President Truman came into presidency without any absolute knowledge of what was occurring on the part of the United States in the war effort. In addition, the Manhattan Project (the title given to the engineering team that was developing the atomic bomb by Roosevelt) was almost a complete enigma to Truman when he entered his term as President (13). As President, Truman was concerned with ending the war as soon as possible in order to reduce the loss of American troops. It is logical to conclude that any leader would be concerned with the sacrifice of life affecting their country; however, abiding by moral principles must also be considered. The bomb was considered by the American government to be the quickest and most effective way to end the war at the time, in addition to lowering the cost of American lives (36). The reason that the atomic bomb was considered to be very effective was because it had the capability to wipe out an entire city, including troops, men, women, and children. Would an act of this capacity be considered as moral? Scholars dispute the morality of Truman’s decision, some arguing it was warranted by Japan’s aggression and refusal to surrender, and other scholars suggesting that the assaults were the moral equivalent of the Nazi holocaust (109). I postulate that to annihilate an entire city of people in one fell swoop is something that neither man nor nation should be able to decide, even if they conceive the other party to be deserving of such a punishment in retribution for their actions. In addition to the desire to end the war and thus the casualties to the American troops, Truman had other reasons for considering the approval of the atomic attacks. Truman was enlightened by Secretary of War Henry L. Stimson in a meeting on April 25, 1945 on the capability of the bomb, and the enormous expense incurred in developing it. This was one reason that Truman’s conclusion was to use the bomb against Japan, as there had to be a justifiable explanation for the expense incurred. Also, if he had not employed the use of the atomic bomb, he would not be able to justify to the American people why he had chosen not to do so, as there were so many American lives lost. It was alleged after the atomic assaults on Japan the decision to carry out the attacks was made in order to prevent as many as 500,000 to 1 million American casualties or deaths. However, there has been no proof provided that Truman received any information that an invasion on Japan would cause that number of casualties (39). Learning that the presentation of the number of estimated casualties was skewed to ensure a favourable opinion from the majority of the American public solidifies my opinion that the atomic assaults were unnecessary. If they had been necessary, why not be forthcoming about the lesser estimation of casualties? Yet another reason that Truman and his cabinet decided to attack is that American relations with the Soviet Union during that time were becoming strained. It was important to the American government to strengthening the United States’ ties to the Soviet Union. The desire for amicable relations with the Soviet Union was a factor in the conclusion to use the bombs against Japan (95). At the time, the Soviet Union was preparing to declare war against Japan, and joining them or preceding them in the war would apparently strengthen the relationship between the Soviet Union and the United States. The opinion was that the United States was a stronger power and that the Soviet Union would not be able to defeat Japan without U. S. intervention (41). However, with the Soviet Union and the United States working together, Japan would most likely be defeated in a short amount of time, making the atomic assaults on Japan even more unnecessary. Regardless of the option to partner with the Soviet Union, the United States decided to act alone in their attacks. Finally, the most pressing reason that the government and Truman argued that they had to use the bombs was the sentiment of outrage that the American public harboured over the attack on Pearl Harbour and their resulting fury if something had not been done in retaliation to that horrific event (20). In all honesty the American public would have been assuaged with a victory no matter the means by which it was achieved. The American government was fully aware of the fact that there would be civilian casualties, in addition to the soldiers and sailors of Japan (62). Preservation of the lives of the innocent is of the utmost importance. The American government had pronounced that there would be hundreds of thousands of American lives saved due to the bombings, but later statements by Truman stated the numbers to be in the â€Å"thousands†, which coincided with actual estimates from the military in the summer of 1945 (93). Truman and the government opted to save thousands of American soldier’s lives, and kill hundreds of thousands of innocent Japanese men, women and children. In addition to all of the reasons the American government had for dropping the bombs on Japan, they came to the conclusion that there were not any viable reasons presented against doing the atomic assaults which outweighed the reasons in favour of dropping them. However, there were other options for the American government to proceed with in order to secure a victory. There was a planned invasion on Kyushu as well as continued aerial bombings and blockades (36). It is understandable that the American government would want to appease the American public, secure relations with the Soviet Union, justify the expense of developing the bomb, and reduce the cost of American lives, however; the dropping of the atomic bombs on Hiroshima and Nagasaki was horrendous and morally detestable. The sheer volume of innocent lives lost due to the bombs, as well as the agony caused by the radioactive material, was most assuredly not justified. There would have definitely been many more American troops lost if the bombs were not dropped, but I do not agree that it justifies killing innocent men, women, and children on such a large scale. I particularly enjoyed the way that Walker states it -â€Å"The fundamental question that has triggered debate about Trumans decision since shortly after the end of World War II is, Was the bomb necessary? In view of the evidence now available, the answer is yes . . . and no. Yes, the bomb was necessary to end the war at the earliest possible moment. And yes, the bomb was necessary to save the lives of American troops, perhaps numbering in the several thousands. But no, the bomb was probably not necessary to end the war within a fairly short time without an invasion of Japan. And no, the bomb was not necessary to save the lives of  hundreds  of thousands of American troops† (97). Bibliography Walker, Samuel J. Prompt and Utter Destruction: Truman and the use of atomic bombs against Japan. 1997. eBook.

Health of Family Business Essay Example | Topics and Well Written Essays - 2750 words

Health of Family Business - Essay Example The organisation with the assistance of quality and homemade ingredients is facilitated in providing fresh products, which have assisted in performing business operations in a financially stabilised manner. The marketing activities have also aided the organisation in creating better awareness amid customers in the market segments. However, certain limitations are identified in the area of financial operations, investment procurement and management structure. In this regard, recommendations are made which include online business operations, external investments and developing business relationship with external business consultants in order to ensure that business operations are conducted sustainably. Subsequently, it can be stated that the business operations of the organisation are performed moderately in the market segment of the UK. Family business is a kind of business domain which is conducted based on the prevailing ethos of a family. Family business is recognised as an importa nt backbone responsible for the development of an economy. The concept of family business has assisted in generating wealth along with job opportunities in a community. A business is identified to be a family business if an individual, who has developed the firm, possesses the majority of the rights in making decisions. Additionally, in circumstances when the business operations are managed by family members, it is recognised as a family business correspondingly, a very close family friend operates .

Criminal Justice Essay Example | Topics and Well Written Essays - 250 words - 13

Criminal Justice - Essay Example In an example, the Muslims living in United States feel that the government has failed to protect them from the aggression emanating from the local population. Initially, the society has been instrumental in ensuring that young generation is guided according to the rules and regulations set by the community. The old people were acting as a guide to the young people in the society. However, with some communities being marginalized, the young people have become an easy target by terrorists groups which recruit them with promises of making money. These are groups that train the youth on how to shoot and bomb people. They convince the youth that they will be rewarded or they are doing according to the teaching of their religion. The young people are learning how to shoot from violent video games. Currently, they are spending a lot of their time watching simulations of how to shoot and bomb. This is making them to look for guns and bombs in order to have a firsthand experience. Religious programs can be used by religious leaders to train the young people on how to resolve conflicts. In addition, conflict resolution programs, e.g. through encouraging the youth to work in diverse groups can be initiated in the society in order to train the young people on how to resolve conflicts without using violent

Manchester United Take Over Case Study Example | Topics and Well Written Essays - 3500 words

Manchester United Take Over - Case Study Example Acquiring the Man United brand means more than just owning a trademark. Brand acquisition gives an opportunity for brand exploitation. And nowhere is brand exploitation more rampant and unrestrained than in the United States. As a hunting ground to further the Man United brand image, the US holds vast potential, and this is where Glazer's extensive marketing skills and resources come into play. But the US market is very competitive. Soccer has to contest with traditional American sporting pastimes like baseball, American Football and basketball. Soccer's rising popularity though, over the past ten years due in part to the 1994 World Cup held in the states could make Man United a household name as is the case in other countries around the globe. Even in Asia where Man United has a huge base of fans who neither speak English nor know where Britain is, brand image has rooted itself in the public mindset. Contrary to popular perceptions, Man United already has a fan following in the US, albeit a small one. When they played the Champion World Tour of exhibition games two years in a row the average crowd attendance was over 65,000 for each game, exceeding that of some NFL games. Americans know about the club through soccer telecasts and the products available on the streets. Merchandising had also made business there but in a small way, yet better than all the US Major Soccer Leagues put together (Chris Isidore). With more co-coordinated marketing efforts in the media (cable and DTH), wider coverage of soccer games, increased media exposure to star players and a retelling of past glories and successes, the Man United brand can further cement itself into the American collective conscience, reaching iconic status in a few short years. The mere purchase of the club puts the Glazers half way towards making Man United a household name. But there is still some way to go. There are other advantages in associating with a brand as well known as Man United. It gives Glazer's other businesses better commercial prospects. When a brand publicly joins forces with a marketing juggernaut, the value of both, in terms of market exposure and business opportunities multiplies. For Glazer whose diverse business portfolio at least in the US include food service equipment, packaging and supplies, marine protein, broadcasting, health care, real estate, banking, natural gas and oil protection, Internet publications, stocks, government securities and corporate bonds, the introduction and expansion of these businesses in Britain as a result of this acquisition gains importance (Bill Hutchison). Glazer's ventures may unhesitatingly attract investment in the hopes that the new businesses will pay rich dividends in the future. But these ventures may suffer if Man United's brand persistence is challenged by rivals. Sustaining the brand position therefore requires the footbal l team to maintain a high success rate. The business side of the club must take a back seat to allow team management to

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Cultural tourism in Newcastle UK as a part of Urban tourism Essay

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Ukraine joining the EU - Essay Example Although the European Union has always considered Ukraine as a partner based on its principle of the European Neighborhood Policy (ENP), many western countries currently support the establishment of closer ties with Ukraine going beyond co-operation to gradual political and economic corporation and eventual integration of Ukraine into both the European Union and the NATO umbrella (Umland, 2011, 36). On the other hand, the Russia has always opposed the idea of Ukraine joining the European Union arguing that such moves would be incompatible with the Russia’s national interests as well as the good relations between Russia and Ukraine as former members of the Soviet Union. This is particularly in view of the fact that the Ukrainian population is made up of more than 20% ethnic Russians and Russia is fears losing this population in the event that Ukraine joins EU. This paper critically analyzes the current issue of Ukraine joining the European Union with particular focus to the background of the issue, current developments, different viewpoints and the major obstacles that have prevented the integration. Ukraine became an independent state in 1991 following the collapse and dissolution of the Soviet Union. The newly independent state was premised on three important goals namely, self determination, free market economy and democracy. However, the Ukraine together with Belarus and Russia soon formed a regional economic integration block that was named the Commonwealth of Independent States (CIS). The organization particularly sought to improve the economy of the former members of the Soviet Union by ensuring common trade policies and customs between the member states (Oudenaren, 2004, 277). Prior to the collapse of the former Soviet Union, Ukraine had a stronger economy in comparison to most regions of the Soviet Union. However, the country experiences serious economic problems between 1991 and 1999, resulting in the loss of up to

German Bundestang Essay Example | Topics and Well Written Essays - 3250 words

German Bundestang - Essay Example It has been argued that the use of mobile phones during the driving is not safe and can cause serious safety issues for the drivers therefore German Government should be implementing regulations such that they teach and educate the drivers to avoid using the mobile phones during the driving. This education should emphasis on the possible consequences of the use of mobile phones during driving on the lives of the drivers and others who can fall victim of reckless driving because of this fact. Further through the implementation of this new regulation, drivers, using the mobile phones during driving, should be penalized for not only breaking the law but putting at risk the lives of others besides and themselves. This report intended to pursue the government to not only sanction funds for the public awareness but also for the creation of proper regulations in the country so that the use of cell phones during driving can be avoided. Technology has made our lives easier and efficient as technology has been the most important variables which have virtually revolutionized our daily lives. However, its use can be harmful if technology is not used properly. The use of mobile phones during driving is one such example which is causing many deaths as drivers of the cars sometimes lose concentration and resultantly causes accidents to them. Though its use during the driving is prohibited in many countries however still many motorists tend to ignore the restrictions and use the cell phones during their driving. A survey by AA Trust reported that motorists across the Europe know about the restrictions on the use of cell phones during the driving however the fines and penalties imposed by various governments are different in each country. (IMA, 2008). However it must be noted that drivers are partially aware of the use of the cell phones during the driving is limited too as many considered that they can use the mobile phon es during the driving whereas many believe that the use of hands free during the driving is permitted and hand-held sets are not. The issue is not whether the drivers are aware of the same or not, what is most important is the fact that governments need to take proactive measures in order to ensure that drivers during driving take care of the fact that their lives may be in danger if they continue to talk on cell phones during their driving period. This report will pursue a case to the German government- German Bundestag needs to take proactive

Dalman Swot Essay Example for Free

Dalman Swot Essay Dalman and Lei are considering a large-scale expansion for their business, Sandwich Blitz. In order to come to the right conclusion they need to do a SWOT analysis which means finding a strength, a weakness, an opportunity and a threat in regards to the operations of the business. By performing a SWOT analysis Dalman and Lei will be able to find factual information about their internal and external business environment. Then they will be able to take advantage of opportunities presented to them by playing on their strengths, correcting their weaknesses and counter acting threats, or those items or actions of competitors deemed potential threats. The first part of doing the SWOT analysis is to identify one strength and one weakness in regards to Sandwich Blitz’s internal resources. Sandwich Blitz’s strength is that they have a positive cash flow and Lei knows that they have enough money to open two new locations. Even though she mentions that there has been a decrease in traffic in the stores near the office parks they are still making a profit. Their weakness is their internal structure is not functioning correctly at the moment. Dalman and Lei are spending the majority of their time helping the managers with budgeting and the daily accounting process. These are things the managers should be doing themselves without Dalman and Lei’s help. The second part of doing the SWOT analysis is to identify one opportunity and one threat in regards to Sandwich Blitz’s external environment. Sandwich Blitz currently has eight locations but they are all within one metropolitan area. So, an opportunity for Sandwich Blitz is that they could expand into another city. The threat that Sandwich Blitz faces is that competitors are entering the market because they have shown to be profitable. Lei mentions that there are two new franchise operations emerging into the market that offer similar food products as Sandwich Blitz. In short, Dalman and Lei need to put together a strategic plan to solve the issues that the business is currently facing before they jump feet first into the idea of expanding and opening new locat ions.

Biography of Pope John Paul II Essay Example for Free

Biography of Pope John Paul II Essay I. Early Life The Pope John Paul II was born Karol Jà ³zef WojtyÅ‚a, before his papacy in October 1978 .He was born in the Polish town of Wadowice, a small city 50 kilometers from Krakow, on May 18, 1920. Karol Jà ³zef WojtyÅ‚a was then the youngest of the three children born to Karol WojtyÅ‚a and Emilia Kaczorowska. His mother died in 1929 while Edmund, his eldest brother who was a doctor, died in 1932 and his father who was a non-commissioned army officer died in 1941. A sister, Olga, had died before he was born. Fr. Franciszek Zak baptized Karol Jà ³zef WojtyÅ‚a on The 20th of June in 1920 in the parish church of Wadowice. He was nine (9) years old when he took his First Holy Communion and was a confirmed Catholic at the age of eighteen at eighteen (18). â€Å"Upon graduation from Marcin Wadowita high school in Wadowice, he enrolled in Krakows Jagiellonian University in 1938 and in a school for drama.† (Short Biography, 2005) A year after, the university was closed by the Nazi forces. The young Karol instead had to work in a quarry from 1940 until 1944 and after in the factory of chemicals, Solvay, to earn his living and to keep away from being deported to Germany. Karol was always aware of his religious callings, and it was in 1942 when he started courses of becoming a priest in the clandestine seminary of Krakow, managed by Cardinal Adam Stefan Sapieha, the archbishop of Krakow at that time. â€Å"At the same time, Karol WojtyÅ‚a was one of the pioneers of the Rhapsodic Theatre, also clandestine.† (Short Biography, 2005) II. Post World War II Life with the Church Karol Jà ³zef WojtyÅ‚a pursued his studies in the major seminary of Krakow when it had reopened after the Second World War. At the same time he was a faculty of theology of the Jagiellonian University. It was in 1946, at the first day of November when he was ordained to the priesthood in Krakow. Archbishop Sapieha did the honor to ordain him. Thereafter, the same cardinal sent Father Karol WojtyÅ‚a to Rome to work under the direction of the French Dominican, Garrigou-Lagrange It was in 1948 when Father WojtyÅ‚a finished his doctorate in theology having a thesis on the â€Å"subject of faith in the works of St. John of the Cross (Doctrina de fide apud Sanctum Ioannem a Cruce)†. (Short Biography, 2005).   Even then, he was a good catholic and a person because that time after having his doctorate degree, while he was on vacations, he applied his pastoral ministry among the Polish immigrants of France, Belgium and Holland. During the same year he returned to his home country and became a vicar of many parishes in Krakow as well as chaplain to young students in the university and these roles and activities lasted until 1951. Beginning 1951 he pursued his studies again to widen his knowledge on philosophy and theology and two years after he was to defend a thesis on evaluation of the possibility of founding a Catholic ethic on the ethical system of Max Scheler at Lublin Catholic University.† (Short Biography, 2005) After this event he became a professor teaching about moral theology and social ethics in the key seminary of Krakow as served as a Faculty of Theology of at the same time. He was appointed as a titular bishop of Ombi on the 4th of July in 1958. The Pope Pius XII also appointed him as an auxiliary of Krakow on that same moment. On the 28th of September of the same year he was consecrated as a bishop by Archbishop Eugeniusz Baziak in Wawel Cathedral located in Krakow. Bishop WojtyÅ‚a had a lot of meaningful religious activities before he became the pope in October 1978. Among these are the publication of his dissertation in 1960, Evaluation of the Possibility of Constructing a Christian Ethic based on the System of Max Scheler† and the publication of Love and Responsibility; and in 1965 he made his Letter of Reconciliation of the Polish Bishops to the German Bishops, containing the famous words We forgive and ask forgiveness (Pre-Pontificate, 2005) III. And He Became the Pope John Paul II It was October 16, 1978 when Cardinal Karol WojtyÅ‚a  was elected successor to Pope John Paul I, the 264th Pope of the Catholic Church and takes the name  John Paul II. (Pontificate, 2005) During his election as the pope, â€Å"there were three surprises: that the new pope should be so young 58; that he should be a non-Italian; and that he should come from an Eastern European country. Though there has been noticeably less talk about the Holy Spirit, once again the cardinals have said how satisfied they are with their choice.†Ã‚  (Hebblethwaite 3) During his first year in the papal seat in 1978, he made numerous and notable activities and encouragement to the whole Catholic world. Among these are the Urbi et Orbi  radio message, John Paul IIs historic embrace of Cardinal  WyszyÅ„ski, the visits  to the Shrine of the Blessed Virgin Mary at Mentorella, Rome and to  Assisi  to venerate the tomb of St. Francis, patron of Italy, and to the Basilica of Santa Maria sopra Minerva to venerate the tomb of St. Catherine, patroness of Italy, The preceding year of his papacy and the years after it, Pope John Paul II simply inspired the whole Catholic community with his leadership. In 1979, the Pope accepted the request made by  Argentina  and  Chile  for the Holy See’s mediation in solving the controversy that was on going between the two nations. He also made the Pastoral Visit to  Santo Domingo in Dominican Republic, to Mexico  for the Third General Conference of the Latin American Bishops and the Bahamas  on January 25th to February 1st 1979 for his 1st Apostolic Voyage. (Pontificate, 2005) This voyage was succeeded by the second, third and fourth, all happening in the same year, 1979. These were the visits or voyages to Poland in June, in  Ireland, the U.N.  and the  United States of America  in September and in Turkey in November. During his voyage to his homeland, he had a very specific message to his countrymen. â€Å"The popes letter on the purpose of his visit, in which he stressed that he hoped to serve the unity of the Poles. (Hebblethwaite 3) During the 1980s, among the outstanding activities of Pope John Paul II involve Pastoral Voyages to  Zaire, Republic of Congo, Kenya, Ghana, Upper Volta  and  Ivory Coast, France, Brazil, and West Germany. His pastoral visit to Naples, Potenza, Balvano  and  Avellino was made after the earthquake. The apostolic voyages, which obviously result to greater acceptance among the Catholics of the respective visited nations, also serve as reminders to each and every one to restore their faith and be better followers of God. The pope never missed in reinstating this message anywhere he visits. At the year 1980 was ending the pope made his Apostolic Letter  Egregiae virtutis  in which he proclaimed Sts. Cyril and Methodius, together with St. Benedict, Patrons of Europe. As the leader, teacher and model of millions of Catholic followers, John Paul II made and performed his papal responsibilities dutifully. The Popes 1988 encyclical,  Sollicitudo Rei Socialis,  which is about social justice threading a middle ground between the sides of capitalists and socialists and putting arguments on both economic developments and placing the needs of those millions of poors over the wants of the selected wealthy. This Sollicitudo Rei Socialis is in fact believed to be â€Å"one of his most substantial documents.† (John Paul II) A new catechism was approved by Pope John Paul II in 1992. This contained comprehensive statements of devotion meant to unify the entire Catholic It was in October of this year when the Pope was able to publish a large encyclical on moral issues fairly â€Å"inspired by the pedophilia or the sexual attraction of adults to children crisis† (John Paul II) that was rampant in the United States. It was called Veritatis Splendor  or The Resplendence of Truth. In 1994 the Pope was with the Special Assembly for Africa  of the Synod of Bishops on the theme:† The Church in Africa and Her Evangelizing Mission Towards the Year 2000: You Shall Be My Witnesses. On that same year however, on the month of April the Pope had an accidental fall on the evening of the 28th causing a fracture on his right femur. Thereafter the Holy Father recovered at the Gemelli Polyclinic Hospital and undergone an operation and was hospitalized until the 27th of May. (Pontificate, 2005) Fulfilling the promise of his apostolic letter  Tertio Millennio adveniente  (As the Third Millennium Draws Near, 1994 the pope entered the year 2000, which he greeted by a proclamation of this year as the year of the Great Jubilee.   The Pope carried on this year â€Å"with a series of epoch-making activities calling for dialogue and brotherhood among the faiths.† (Pope John Paul) In February of the new millennium, John Paul II was the first pope to make a visit to Egypt, where he celebrated a mass in Cairo, stirring on discrimination against Christians in Egypt and other countries of Africa. On March 12, 2000, the pope also asked for forgiveness for many of the Catholic Churchs past sins, such as its treatment of Jews, heretics, women, and native peoples. â€Å"This was believed to be the first time in the history of the Catholic Church that one of its leaders sought such a sweeping pardon.† (John Paul II Biography) In the beginning of 2004, the Pope made his appeal to everyone regarding World Peace. â€Å"All of you, hear the humble appeal of the Successor of Peter who cries out: today too, at the beginning of the New Year 2004,  peace remains possible. And if peace is possible,  it is also a duty!†(John Paul II, 2004) A year before his death, Pope John Paul II was conferred the  International Charlemagne Prize, a prestigious award given annually by the city of Aachen, Germany, in recognition â€Å"of the Pope’s personal commitment, and that of the Holy See, in favor of unity among the peoples of Europe on the basis of the values rooted in the common human nature and efficaciously promoted by Christianity† (Pontificate, 2005) On February, at least a month before his death the Memory and Identity was published. This book was all about the Pope John Paul II, his life, and his legacy to the world. With his great contribution to the Catholic Church and in humanity in general, Pope John Paul II died in Vatican on April 2, 2005 at 9:37 in the evening. He was a great pope, leader, teacher and a person who gave much inspiration and teachings to his followers.

Persona, salud, entorno y enfermeria

Persona, salud, entorno y enfermeria Estamos ante un articulo de titulo Persona, salud, entorno y enfermeria, que pertenece al volumen Enfermeria Comunitaria. Metodos y Tecnicas. S.21.Edit.DAE.2 ° ed.2008 de autores Dora Espinar Gonzalez e Hipolito Delgado Rodriguez. Lo que viene a clarificarnos este articulo, en toda regla, es que el modelo biomedico se orienta exclusivamente a la practica asistencial, que se orienta a la enfermedad y deja a un lado el modelo holistico, el cual se centra en todos los aspectos de la persona. Como el sistema sanitario actual se centra en el modelo biomedico, su objetivo final y prioritario es buscar el tratamiento y la curacion de la enfermedad. Lo que conseguimos con esto, es centrarnos en los aspectos fisicos ignorando al paciente, ya que se deja a un lado toda comunicacion con el. Tenemos que tener claro que a la hora de contactar con un paciente, no solo nos ha de importar la causa fisica o las anomalias bioquimicas para el diagnostico de la enfermedad, sino que el estilo de vida de la persona y su susceptibilidad biologica influyen en una futura enfermedad, asi como el entorno que nos rodea, la sociedad en si, el medio natural donde yace, etc. La enfermera es la que cuida de la persona en todas sus dimensiones, comunicandose con el, entendiendo sus preocupaciones, preguntandole por su forma de vivir para asi ayudar a que tome sus propias decisiones y recupere por tanto, su autonomia para mejorar o recuperar su salud. Es verdad que los profesionales medicos son mas habiles para conocer y explicar las razones de las enfermedades, pero no son habiles para aplicar habitualmente la prevencion y la promocion de la salud para conservar y mejorar la salud de la persona y en general, de la comunidadcosa que si hacen o deberian hacer los profesionales de enfermeria. Los profesionales de enfermeria deben promocionar la salud, pero deben hacerlo colaborando con la poblacion, pero no trabajando para ella. Para obtener la promocion de salud se debe estimular, motivar, orientar a los lideres informales para que la poblacion desarrolle sus propias habilidades para con su salud. Sabemos que las enfermedades dependen de los grupos sociales en las que se de, es decir, no es lo mismo una enfermedad tratada en un pais desarrollado que en un pais en vias de desarrollo. De todas formas, nunca debemos aislar la enfermedad de la persona que esta enferma y sin lugar a dudas el modelo actual del sistema sanitario se centra solo en la enfermedad y se olvida totalmente del paciente, que en muchas ocasiones ayuda incluso al diagnostico y a su curacion. Otro factor que afecta al ser humano es el entorno, es decir, todo aquello que le rodea. Es el ser humano el que se debe adaptar al medio natural en el que vive y esto se debe hacer mediante la socializacion y el aprendizaje y para ello se debe contar con la ayuda de la familia, puesto que es un agente de salud potencial, porque es la familia la que ayuda a desenvolvernos en la sociedad ante cualquier tipo de problema, sea de salud o no. Por lo tanto, las personas dependemos de nuestra familia para adoptar un estilo de vida y unas formas de enfrentarnos a la enfermedad que pueden ser buenas o malas. Naturalmente, para eso estan los profesionales de la salud, para promocionar un estilo de vida sano y una manera de enfrentarse a la enfermedad adecuada para preservar o mejorar asi la salud. Como resultado, habra que potenciar las buenas actuaciones en la familia para conseguir una serie de objetivos que ayuden a la socializacion y al aprendizaje de los hijos y que como consecuencia esto s lo hagan con las futuras generaciones. Quizas el papel de enfermeria se ha ido alejando de lo que realmente es, puesto que lo que se debe hacer no es lo que realmente se hace. Se debe cuidar tanto a las personas sanas como a las enfermas para educar en salud, para que ademas, se reconozca a los profesionales de enfermeria por el cuidado de la salud y no exclusivamente por el cuidado de la enfermedad. Tambien se debe garantizar a la poblacion de que seran atendidos por el profesional adecuado y de forma personalizada porque cada persona es diferente, por lo tanto sus cuidados deben ser distintos. Y ademas, se debe garantizar la ayuda para que las personas que han mermado una de sus capacidades por cualquier tipo de enfermedad, vuelvan a recuperarla para asi poder conseguir la autonomia que toda persona debe poseer. Como el sistema sanitario se ha vuelto incapaz de realizar los cuidados y las atenciones especificas para la poblacion, los servicios sanitarios necesitan incorporar nuevas ideas y visiones para afrontar los objetivos que se deben cumplir y que ya existian. Para ello, nos ayudaremos de las construcciones socio-culturales de cada comunidad para asi integrarlos en la participacion para la obtencion de salud y su conservacion. En base a todo lo escrito antes, para un correcto entendimiento en el que las enfermeras hagan lo que deben de hacer, deberiamos recuperar viejas ideas que se centren en todos los ambitos del paciente como hacen muchas medicinas tradicionales, por ejemplo el Ayurveda, que es una medicina tradicional tipica de la India. El Ayurveda es un sistema holistico en el que sus objetivos son tener en cuenta tanto la mente, las emociones y la constitucion fisica del paciente. No obstante, el modelo que persiste actualmente en occidente es todo lo contrario, pues se centra en curar la enfermedad dejando actuar al paciente de forma pasiva. El Ayurveda se centra en 5 elementos fundamentales como son el aire, la tierra, el eter, el fuego y el agua que conforman las tres Doshas (Kappa, Vata y Pitta), segà ºn vayamos teniendo desequilibrios en estas Doshas, el Ayurveda nos aconseja una serie de alimentos sanos para asi mantener una dieta sana y equilibrada que acompaà ±ada de ejercicio fisico, que equilibra mente y cuerpo, como la yoga, podamos asi mantener un estilo de vida sano orientado a la conservacion o la mejora de la salud. Sabemos ademas, que la mente ejerce mucho poder sobre nuestro cuerpo por lo que Mens sana in corpore sano tal y como dijo un celebre poeta romano llamado Decimus Iunius Iuvenalis, el c ual instruia que se debia dejar las cosas vanas a un lado e implorar a los dioses por una salud integral de la mente, el cuerpo y el alma. Por lo tanto, se puede llegar a la conclusion de que si mantenemos nuestra mente sana, mantendremos nuestro cuerpo sano y por tanto nuestra salud sera la adecuada. Tanto el ejercicio fisico, como una mente sana y un estilo de vida correcto, ayudaran a sentirnos bien, para poder asi mejorar o mantener nuestra salud. En resumidas cuentas, todo lo que conforma nuestro cuerpo es muy importante, puesto que debemos tener en cuenta las emociones, la mente y la constitucion fisica a la hora de hablar con un paciente, ya que no solo las anomalias bioquimicas importan, sino que tambien es importante lo que piensa el paciente o aquel rasgo subjetivo de la enfermedad que solo el puede expresarnos. Todo profesional de la salud, debe centrarse en el modelo holistico, para asi atender a todas la dimensiones que conforman la persona y como ejemplo, la medicina ayurvedica es bastante completa. Con este articulo, queda bastante claro cual debe ser la mision de cualquier personal sanitario, pero en concreto el del profesional de enfermeria. Ademas, esta muy bien estructurado ya que en ningà ºn momento la tesis se contradice y el objetivo del articulo queda bastante evidente.

The Freudian Model in Conrads Heart of Darkness Essay -- Heart Darkne

The Freudian Model in Heart of Darkness  Ã‚         In my essay I intend to prove Joseph Conrad's use of the Freudian model of the human mind, as portrayed in his characterization of Marlowe, Kurtz, and the "wilderness". Further, using that model I will explicate Conrad's ambiguous tone in Heart of Darkness. First, I must define each figure in Conrad's novel with its appropriate Freudian psyche. These psyche are defined in an essay by Ross C. Murfin's essay, "Psychoanalytic Criticism in The Awakening": "the human mind is essentially dual in nature. He called the predominately passional, irrational, unknown, and unconscious part of the psyche the id, or "it". The ego, or "I", was his term for the predominantly rational, logical, orderly, conscious part. Another aspect of the psyche, which he called the superego, is really a projection of the ego. The superego almost seems to be outside of the self, making moral judgements, telling us to make sacrifices for good causes even though self-sacrifice may not be quite logical or rational."(Murfin 219) We see the characteristics of Freud's "id" in the descriptions of Kurtz's savage actions as well as Marlowe's analysis as to why he acted this way: "I want you to clearly understand that there was nothing exactly profitable in these heads being there. They only showed that Mr. Kurtz lacked restraint in the gratification of his various lusts, that there was something wanting in him-some small matter which when the pressing need arose, could not be found under his magnificent eloquence. Whether he knew of this deficiency himself I can't say. I think the knowledge came to him at last-only at the very last. But the wilderness had found him out early, and had taken on him a terr... ...y the memory of gratified and monstrous passions." (Conrad 132) It is the connection between Kurtz, Marlowe and their inability to figure out the "wilderness" that we are left with Kurtz's chilling last words: "The horror. The horror." This quote is significant because of it ambiguity. Conrad keeps the readers curiosity by having us searching for "meaning" in what the heart of darkness is. The feeling of eerie confusion we get from Kurtz and Marlowe's fear and bewilderment of the wilderness is symbolic of the human mind's inability to realize the unconscious. Conrad uses the "wilderness" as Marlowe's symbol of the unconscious. Works Cited Murfin, Ross C.. "Feminist Criticism and The Awakening." in Chopin, Kate. The Awakening. Boston: Bedford Books, 1993. Conrad, Joseph. Heart of Darkness and The Secret Sharer. New York: Signet Classic, 1997.   

The Harlem Renaissance, Jazz and Billie Holiday Essay -- Billie Holida

The Harlem Renaissance, Jazz and Billie Holiday In Harlem, the people sit on their front porches in protest of the summer Sunday sun, fanning themselves with the morning paper as the day slides away. Out on the streets, neighbors call to each other. A woman’s voice is audible from an open window, singing nonsensically as she scrubs. Her melodies tumble out the window and intertwine with the trembling harmonica rising from the heat of the pavement and venture into the store on the corner. The boisterous laughter of men on the porch mixes with the skip of the jump rope slapping the sidewalk and the shrieking of children. All the faces on the streets, inside the houses, and emitting the shrieks are not the same ones to be found along Fifth Avenue, across town. This small portion of Manhattan is entirely black, except when the sun sets. Dusk somehow radiates calm to the slightly jittery Whites that pour into the city for an evening of entertainment. Only in darkness is when the Whites feel safer in making the pilgrimage to Harlem. Differentiating skin color isn’t a chore when pedestrians are only a possibility-- when the sun doesn’t make lightness or darkness so apparent. People parade into the city dressed up to the nines, out to hear the latest style of music, dance the latest dance, or see the latest revue. Creation spewing from this cultural Mecca is insatiably sought after and people of all ethnicities wish to embrace it as their own. High heels and wingtips carry stocking feet into various downtown dumps and dives for a change of pace, clamoring for Black artists to whom they would never give the time of day if the sun were out. Yet the patience of nighttime is incontestable. The rhythms and rhymes coinciding with th... ... to break into show business at all. The great "Lady Day" lived her whirlwind life, making decisions that would have made any mother’s head spin. But her unbelievable life helped pave the way for other Black female artists, so that they had a strong female example that didn’t back down in the face of Racial and Sexist tensions and worked so hard to overcome them that the stress was too much, and she sought solace in narcotics because the pressure was too great. Today, the legacy of Billie Holiday lives on. People are continuously intrigued by her life, inspired by her music, and impressed with the difficulties she faced. Armed with her music, Billie Holiday faced the world on the offensive, constantly battling those who presented her with obstacles. Though she did not fight flawlessly, her ambitions and her dreams carried her through life as best they could.

I loved the book To Dance With The White Dog, by Terry Kay. When I firs

I loved the book To Dance With The White Dog, by Terry Kay. When I first started reading, I was afraid this was going to be another depressing book about old people and I wasn't looking forward to reading it. I loved the book To Dance With The White Dog, by Terry Kay. When I first started reading, I was afraid this was going to be another depressing book about old people and I wasn't looking forward to reading it. However, I was soon taken in by the sweet, humorous Sam Peek and couldn't put down the book. I was moved by the strong love he had for his beloved wife Cora and even more so by his strength to carry on after her death. I think it was wonderful how Sam's family came together, even in the days after Cora's death, to look after him. I thought it was funny how his daughters worried about him and questioned his sanity at times while the whole time Sam knew exactly what they were thinking of him and how they fretted. I really enjoyed Neelie and even though she seemed to get on the children's nerves you could tell that having her there helped ease their minds. The children knew Neelie had their father's best interest at heart even if she did tend to nit pick and talk too much. I really envied the closeness of the Peek family and their love and concern, even if they did go a bit overboard at times. It was not only heartwarming, but truly amusing as well, in the way that Sam Peek dealt with them. He would play into their worries and concerns. Sam Peek went from being a pretty independent man to what appeared to his children as fragile, senile and helpless overnight with the death of Cora. From the moment his wife died Sam's ability to take care of himself immediately came into question, at least by ... ...of their lives. Unfortunately, that is not always possible due to financial reasons, failing health or lack of family to help out. Sam was lucky that his family lived close by and could look out for him. This enabled him to stay home until the very end and in essence probably prolonged his life. He was also lucky that he stayed pretty healthy for as long as he did. Many elderly people aren't so lucky and must totally rely on someone else to help them with their daily needs much like a toddler needs their mother. It is sad for many to lose their independence and even harder to have to rely on their children for care when they are the parent, but that's what families are for, to be there for one another. Our parents raised us to be who were are today and the least we can do in return is to be sure that they are given the best care possible in their old age.

Go Ask Alice Analysis Paper Essay

In the book Go Ask Alice (1971) By an Anonymous author, a teenager struggling with drugs tragically succumbs to her problems. There has been a lot of Controversy revolving around whether the author is real or if this book was just written to draw attention to drugs. Regardless of whether the supposed author actually existed, the fact that remains is that identity issues and drug addiction are very real problems for millions of teenagers. In the beginning of the book a teenage girl talks about herself and how she wants to change her image. She describes very adamantly that she is unhappy with her body and her own personality. â€Å"I want to be someone important, maybe the new me will be different† (page 4). Many Teenagers have an identity crisis, some more drastically than others. The task of being confident isn’t an easy one; teens seem to always want to be someone better. But by focusing only on the thought of becoming advanced instead improving what is already good, it causes a stalemate. The mind wants to improve but all it does is think about ameliorating, the actual action that must be taken never happens. This is what the girl in the book goes through, she is always thinking about becoming better, but as she finally starts to improve and stop just thinking about it, she accumulates a mindset of becoming better. Now this girl has a constants need to be progressive, giving her no true identity except the thought of wanting a better one. Later in the book the young girl runs away from her home and makes a new life for herself in California. She acquires a job at a department store and after a few days of working the owner of the store invites her to a party at her loft. While at the party the girl is exposed to drugs, she had been trying to stay away from the demon pills, but it didn’t work. â€Å"One of the men passed me a joint and that was it. I wanted to be ripped, smashed, torn up as I had never wanted anything before. This was the scene, and I wanted to be part of it† (page 76). This girl was exposed to drugs without her knowledge but after being exposed she needed the high. She sought out the pills. After finally getting clean she is exposed again, while she could have rejected the ‘joint’ she isn’t confident enough in herself to do so in front of others. Her uncertainty allows her judgment to be influenced, which makes her addiction grow vigorously. Teenagers of this age see drugs as a way to escape from their problems. Which is half the predicament with this generation, we are all about avoiding issues rather then facing them head on.

Characteristics of Gothic Literature Essay

The Gothic In 1798 an anonymous author published a commentary that revealed exactly how some writers received the Gothic during this time: â€Å" Take—An old castle, half of it ruinous A long gallery, with a great many doors, some secret ones. Three murdered bodies, quite fresh. As many skeletons, in chests and presses. An old woman hanging by the neck; with her throat cut. Assassins and desperadoes, quant. suff. Noises, whispers, and groans, threescore at least. † (1-7) After reading many of the selections in the anthology, I found this poem on a Gothic’s â€Å"recipe† to be quite true (602). However, in the case of this anonymous writer, he considers all of these characteristics to be negative. I, on the other hand, find it very intriguing that this type of novel developed in a time ruled by writers whose main focus was politics and poetry. Many influential writers including Coleridge and Wordsworth criticized the characteristics, morality, purpose, and significance of these novels; however, I believe many of the features they disliked actually broadened the scope of literature. The Gothic novel was often attacked for being too formulaic. Although the specifics of the plot changed from novel to novel, the characteristics were often similar, which is something that is pointed out repeatedly by the Gothic’s critics. The similarities encountered in the characteristics of these novels include the setting, mystery, and characters to name a few. The setting of this type of novel is usually in a castle of sorts, or in some other mysterious place that produces suspense and terror within the reader. Although these settings were often alike, they â€Å"exist to convey the atmosphere† and are used â€Å"for ends that are fundamentally psychological† (Hume 286). This characteristic is one that set up the entire feeling of the novel, one of suspense, horror, and mystery. The setting of various novels was not uniform because it was the easy or obvious choice like many critics believed, but because it created a certain atmosphere that was needed for the plot. If the story had been set on a sunny beach, the atmosphere would have been much different and the reader would not get the same affect. Like the settings, the mysteries that develop within Gothic novels are usually somewhat similar. From what I have come across, many include a murder or deep, dark secret that is unraveled by an ordinary person. While this may support Wordsworth’s claim that these novels are â€Å"sickly and stupid German tragedies† because of their straightforward plot, I find them to be quite interesting (266). These mysteries create suspense, and were the first â€Å"page-turners† that were ever written. Readers no longer had to decipher long and complicated meanings from pieces such as the â€Å"Lucy Gray† poems; instead, they could sit back, relax, and enjoy these novels that created an escape into a mysterious world. Another piece of the â€Å"formula† that was important to the genre were the characters that were used throughout the novels. The characters were often simple people who were thrown into a situation that required extraordinary actions. While the simplicity of the characters was often criticized by writers who considered themselves to be â€Å"high culture,† these characters had the ability to â€Å"involve the reader in special circumstances† (Hume 286). Unlike the pieces that came before them, the Gothic novel had the capacity to draw the reader in, and put them in the shoes of the main character. For me, it was very hard to feel for the personas in earlier poems that we came across. I think the main reason for this is that the characters tended to be somewhat generic, but interesting. They allowed for anyone to understand the character and immerse themselves within the character’s thoughts. They also allowed for people to sink in to a particular character and feel the terror that they were feeling. Another aspect of the Gothic that was often called into question was the morality of the characters and authors. There are many instances in which these novels incorporated grotesque scenes that included rape and murder among many other things. In The Monk by Matthew Lewis the main character, Ambrosia, is a virtuous and ethical man who seduced by the demon Matilda. In one scene â€Å"his desires were raised to that frantic height by which brutes are agitated†¦ and [he] hastily proceeded to tear off those garments which impeded the gratification of his lust† (598). Ambrosia is obviously an immoral character, and he is criticized for not being so. To me, it seems like critics were getting to the point where they were trying to find anything and everything to criticize about the Gothic novel. While this genre may involve some unseemly characters, they are needed in order to create an interesting plot. Having some sort of villain is necessary in any type of writing that has a mystery or murder involved. Without villains, we cannot have heroes, and both are very important aspects of literature. Coleridge, for example, not only attacked The Monk as a novel but also attacked Lewis as a person for having the ability to create such an immoral character. He believed that â€Å"the merit of a novelist is in proportion†¦ to the pleasurable effect which he produces (604). I highly disagree with this statement because I believe controversy affects change, and change is needed in order to forward society. Novelists and poets were no longer writing poems that had the sole purpose of making a person feel good or empowered; instead, they were writing for entertainment. Also, many of the writers before The Monk addressed political issues that were not considered pleasurable, but controversial and hard to confront. Coleridge’s statement seems to contradict everything that literature stands for. Authors and the literature they create are unpleasant at times, and that is not wrong—it is merely a necessity for the forward movement of society and evolution of literature. Another important issue to address when it comes to these novels is their specific purpose. It seems that every literary movement in history had some sort of motive or driving force behind them. For the Gothic, this driving force or purpose seems to be to induce terror while entertaining. Before this movement, we never really encountered works of literature that were straightforward, suspenseful, and enjoyable all at the same time. In an essay by Aikin and Aikin, they claimed that people would â€Å"rather chuse to suffer the smart pang of a violent emotion than the uneasy craving of an unsatisfied desire† (584). By this, they mean that terror is pleasurable, and that is exactly what these novels delivered to their readers. It was not an emotion that was regularly produced when readers came into contact with the typical works of this time. For a piece of literature to induce such error was something novel and interesting that affected many of their readers. Because terror is an emotion that is hard to come by, these novels were, like I said, an escape for readers. Terror is not something that a person wants to encounter in their real life, but is something they can enjoy and acquire through reading these novels. Their purpose was not to confuse the reader with complicated meanings full of allusions. Instead, these terrifying novels have the ability to â€Å"render the poorest and most insipid narrative interesting when once we get fairly into it† (584). Although many of the authors of Gothic novels may not have been the best composers compared to standards during this time, they were still able to draw in a huge audience because they gave the people what they wanted. I would not consider the narratives â€Å"insipid,† but compared to the works that came before them, they were much simpler and used language that was not considered to be as articulate. This simplicity that is encountered when reading a piece of Gothic work, though criticized, says much about how society was changing during this time. These novels significantly altered the way in which literature was composed and whom it was available to. Instead of being read by the elite few, it was accessible to pretty much anyone who could read. During this time, the percent of literate people was rising rapidly, especially in the middle class. These books appealed to these people, and sold millions upon millions of copies because of this. I think that much of the distaste that so-called â€Å"high culture† writers had for these novels is because of their success. They were extremely popular, more so than the most popular of the poets during this time. For example, Wordsworth was said to be a commercialized version of â€Å"real† poetry because it was easier to understand than many other pieces out during this time. However, he never even came close to selling as many copies of Lyrical Ballads as the Gothic writers did with their own works. For Wordsworth to criticize a genre that feeds off of the readers’ ability to comprehend seems to be extremely hypocritical of him. Also, I think that when something appeals to the masses, it is a good thing. Change cannot occur unless everyone is on the same page, and that is what the Gothic provided to the people. Finally, I would like to confront just how significant this movement is to the literature we have today. This was the first time we encounter a genre that is similar to the types of genres we see today. The Gothic genre was criticized because the novels were too alike—but that is exactly what a genre is, according to today’s standards. One could argue that the novels that are published today are not of the same caliber as novels published 50, 100, or 200 years ago. And maybe that is true, but is it necessarily bad? In my opinion, having novels that are more accessible to more people makes for a better, more unified society. Having works of literature that are too complicated, wordy, or abstract leads to more ambiguity, and eventually creates a divide among social classes. I am not saying that all written works should be easy to understand, but I do think that the Gothic novel was the first in a wave of works of literature that helped society grow more literate. Finally, scholars and everyday people were able to read and talk about the same kinds of things. Although scholars who thought they were better writers were constantly criticizing it, they could not appeal to the masses. Gothic literature had the ability to do this, and you can still see its influence in novels on shelves today. It has a definite place in literary history, and should not be overlooked. It may not have had the deepest plots or the most complicated characters, but the genre had an impact during the 18th century, and continues to have an impact today.

Paul’s Case

In Willa Cather’s story â€Å"Paul’s Case,† the main character Paul is a troubled young man, who is seeking an escape from reality. Paul’s way of escaping his troubled life is through a day dream. For the most part Paul’s safe place is in New York City. That is until Paul’s father comes looking for him. This is when Paul’s reality then takes form in his imaginary world. If Paul uses an imaginary escape world to get away from his troubled life, then why does it include him committing suicide? I have one reason to explain his suicide. Before, Paul supposedly enters his imaginary world, the story leaves off with Paul sitting in the cellar of his house. At this point in time, Paul starts to wonder if his father heard him entering. In the darkness of the cellar, Paul fears that his father may think Paul is a burglar, and shot him. (pg. 127) The though of death and Paul’s senseless running from a troubled life collide. In result creating Paul’s suicide, when his father comes looking for him. I believe Paul’s suicide serves as an epiphany. Paul’s epiphany relates to his struggling life, and how he has more to live for than just music. As a result of Paul’s epiphany, he begins to fade back into reality. As the audience, you are lead to believe that Paul was dreaming the whole time. The last sentence in the story â€Å"Paul dropped back into the immense design of things,† confirms the audience’s beliefs. (pg.133) Therefore I find it hard to believe that Paul ever actually traveled to New York. Due impart that Paul was a middle class kid from Pittsburg. Paul absolutely resented his lower and middle class upbringing. His resentment of his upbringing leads him to believe that New York is where the upper class lived. I find it hard to believe that he actually went to New York, because most of New York is slums. I find it hardly plausible or even possible that Paul actually lived most of the story, but rather that he imagined it all. The first problem that comes to mind when believing the story is the fact that Paul was able to get away with smoking cigarettes and drinking wine publicly. Paul was but a teenager with large sums of cash. How is it that Paul was able to live such a luxurious life for as long as he did, without being questioned about anything? The story â€Å"Paul’s Case,† was all about Paul seeking freedom from his personal life. Even though Paul was able to find some peace of mind, somehow his personal problems follow him into is dream land. Throughout Paul’s dream he encounters situations very similar to the ones he’s running from in reality. Nonetheless Paul can not escape his reality.

Sepsis and Barbara

This portfolio will provide evidence of my experience in an acute care setting. I will provide an appendix giving a brief summary of a patient I cared for whilst undertaking a placement in an acute setting. This portfolio of evidence will be based on a patient diagnosed with sepsis secondary to her chest infection. I will discuss extensively the aetiology, pathophysiology and clinical features of a patient presenting with sepsis treated in an acute care setting.I will explore the role of the different healthcare professionals that were involved in the care of the patient describing how they contributed to her holistic care. I will incorporate evidence base supporting the approach used by the doctors, nurses and microbiologists in the diagnosing and caring for the patient. I will equally evaluate practice using findings from contemporary research policy and practice on the care of the adult with acute care needs.I will also discuss the value of our practice in accordance with professi onal, ethical and legal frameworks that ensure the privacy of the patient’s interest and well-being. Finally, I will conclude by summarising this portfolio of evidence in relation to acute care practices and focus on identifying my future learning needs in developing myself personally and my professional practice. It is indicated by Latto (2011) that a meeting between The American College of Chest Physicians and the Society of Critical Care Medicine in 1991 brought about the use of systemic inflammatory response syndrome (SIRS) to define sepsis.SIRS being manifestation of two or more of certain medical signs including, a temperature of less than 36 degrees Celsius or greater than 38 degrees Celsius, a heart rate of over 90 beats per minute, respiratory rate of over 20 breaths per minute and white blood cells count of greater than 12000 or less than 4000. Further on to recognise sepsis, a patient has to have at least two signs of SIRS as well as a documented infection. Sepsis, as defined by Matot and Sprung, (2001) â€Å"is the systemic inflammatory response to infection. In addition to this definition, Herwald and Egesten (2011) indicate that sepsis could also be defined as the existence of bacteria or other micro-organisms in the blood, hypotension or shock. Rello, Diaz and Rodriguez (2009) emphasise that there is a difference between sepsis and systemic inflammatory response syndrome (SIRS) as sepsis is systemic inflammatory response to  infection  while systemic inflammatory response syndrome is a tool used to simplify the diagnosis of sepsis.Sepsis occurs as a result of the body fighting infection that has spread though the body via the blood stream as defined by Sepsis Alliance UK (2012). Barbara presented with low blood pressure, a high temperature, tachycardia and an increased respiratory rate. Patients who present with sepsis can progress to severe sepsis which is defined by Marini and Wheeler (2010) as â€Å"a syndrome caused by infection and defined by the presence of vital sign abnormalities and new organ system failure caused by the ensuing inflammation and coagulation. Associated with severe sepsis, there are three integrated responses as explained by Kleinpell, R. (2003) which are; activation of inflammation, activation of coagulation, and impairment of fibrinolysis. As the body detects infection, its natural response is inflammation. â€Å"Inflammation is a response of a tissue to injury, often injury caused by invading pathogens. It is characterized by increased blood flow to the tissue causing increased temperature, redness, swelling, and pain. † Kleinpell (2003).Ball (2011) in describing the process of inflammation in the body explains that inflammation occurs due to the white blood cells releasing pro-inflammatory mediators called cytokines these are proteins, peptides, or glycoproteins which include tumour necrosis factor alpha, interleukin-1 and interleukin-6, the white blood cells also releases a platelet-activating factor which is a lipid mediator that is well-known for its ability to cause platelet formation. The work of these mediators is to repair damages caused and prevent further damages from occurring.Normally, the body’s response in order to prevent damage by the release of these pro-inflammatory mediators is to release anti-inflammatory mediators which are interleukin-4 and interleukin-10 these are also cytokines which are a type of protein. In severe sepsis, there are excessive pro-inflammatory mediators which are not regulated by the anti-inflammatory mediators which results in overwhelming inflammatory reactions causing impaired tissue function and organ damage. Due to the pro-inflammatory mediators being released and unregulated by anti-inflammatory mediators, coagulation is promoted which is the clotting of blood.This happens in the capillaries which obstructs the flow of blood into the tissues causing hypoxia which then leads to the dysfunction of orga ns. Hypoxia is defined by Wiebe and Machulla (1999)  as â€Å"reduction of oxygen supply to tissue below physiological levels. † The activation of coagulation then causes fibrinolysis to be activated. Fibrinolysis is the process of breaking down of blood clots as defined by Leslie, Johnson, and, Goodwin (2011). This happens because the levels of plasminogen rapidly reduce.Plasminogen is a protein that when activated by enzymes transforms into plasmin which promotes dissolving of blood clots. Though the plasminogen levels fall rapidly, the antiplasmin levels remain normal which causes an end result of a decrement in the fibronolytic response. â€Å"The imbalance between inflammation, coagulation, and fibrinolysis that occurs in severe sepsis results in systemic inflammation, widespread coagulopathy, and microvascular thrombosis, conditions that can lead to multiple organ dysfunction†Ã‚  Kleinpell (2003)   Severe sepsis if not properly treated can then lead to septic shock.Septic shock is defined as sepsis with hypotension which is unresponsive to fluid resuscitation as well as abnormal perfusion that may include lactic acidosis, oliguria or alteration in mental status, Sepsis Alliance UK. (2012). In relation to the care that Barbara received whilst being treated for sepsis, there were different health care professionals involved throughout her stay in the hospital. An inter-professional team worked together to ensure that she was given holistic care taking into consideration the social aspect of her life, her spiritual values, her emotional and mental state of mind and full physical care.On recording Barbara’s clinical observations, we passed on our results to the doctors as Barbara was scoring a mews of seven. Guidelines on the Modified Early Warning Signs chart advices that if a patients’ scores a MEWS of four or more, the patient must be referred for urgent medical review, NHS Outer North East London Community Services (2011) The doctors immediately ordered for blood cultures to be taken. The blood cultures were used to investigate the reason why Barbara had an increased temperature as an increased temperature is a sign of infection as described by Hegner, Acello and Caldwell (2009).The blood tests and cultures taken were also to test for the serum lactate level, white blood cell count, tests to check how the liver and kidneys were functioning. The doctors then prescribed fluids to help in increasing Barbara's blood pressure. Working collaboratively to enhance the care that Barbara received, the microbiologists were involved in the diagnosis and care she received through the involvement by the doctors requesting for blood samples to be taken and investigating the reason why Barbara had an elevated temperature.By collecting a sputum sample from Barbara, the microbiologists were also involved in looking for the medication sensitive to the bacteria causing Barbara’s chest infection. The microbiologis ts also took blood for arterial blood gases test. They were very efficient in delivering the results of the blood tests showing that Barbara had an increased white blood cell count. Her serum lactate levels were 3. 4mmols/l. An increased white blood cell count along with an elevated temperature proved to the doctors that Barbara had an infection.The doctors commenced Barbara on the sepsis six bundle. The sepsis six bundle is a guideline within the Surviving Sepsis Campaign which gives information on what should be done in the first 6hrs that sepsis is diagnosed in a patient in order to aid safe recovery. The nurses ensured that from the moment Barbara was admitted, it was a duty to monitor her clinical observations. With the use of the Modified Early Warning Signs (MEWS) chart, we recorded her observations which enabled us to monitor changes in her blood pressure, respiratory rate, temperature, heart rate and oxygen saturation.This was also a way for us to assess her consciousness l evel checking to see if she was alert, responsive to voice alone, responsive to pain alone or unconscious. This enabled us to check for signs of improvement in her health or for deterioration. Our duty as nurses was to provide 24hr care to Barbara. With a blood pressure of 85/42 mmHg we ensured that Barbara got enough fluids as were prescribed by the doctors. These fluids were given intravenously to increase Barbara’s blood pressure.In a patient with sepsis, due to vasodilation as an inflammatory response to the infection, arterial circulation is ineffective therefore; intravenous fluids are required as advised by Institute for Healthcare Improvement (2011) Apart from receiving care from the nurses, we referred Barbara to the occupational therapist. The role of an occupational therapist as defined by Institute For Career Research, (2007) is to help in the development, recovery and maintaining of daily living and work skills of people with conditions that are disabling mentall y, physically, emotionally and developmentally.Institute For Career Research (2007). They ensured that on returning home, patients will have everything needed to make them comfortable. If need be, they will get their houses modified with a stair lift, a ramp or any additional equipment needed for them to make living at home easier. In relation to Barbara, the occupational therapist focused on her personal care, they assessed how easy or difficult it was for her to wash and dress herself and if she could manage cooking her food in the kitchen.This enhanced collaborative working as this enabled the nurses to be aware of what steps needed to be taken to provide optimum care to Barbara. We were informed by the occupational therapist that she would need all care in the area of her personal hygiene and assistance in most areas of her activities of daily living. With the information derived from the occupational therapist, we were able to refer Barbara to the social services to ensure that when she was fit for discharge, extra measures were taken to provide her with care in her own home.Barbara also received care from the physiotherapist. The role of the physiotherapist is to work as part of the multidisciplinary team to assess the patient and then provide treatment. Treatment would include exercise, movement, hydrotherapy, electrotherapy, massages and manipulation. A physiotherapist is also involved in providing health education this is elaborated by NHS Scotland (2002). In relation to Barbara, after we had referred her to the physiotherapy, they ensured that she received physiotherapy for her chest which was a series of claps on her chest, back and under her arms.This was very helpful to Barbara as due to her chest infection, she had a lot of mucus in her breathing passages and with treatment from the physiotherapist; she managed to cough it up. This positively enhanced the care that Barbara received as through collaborative working, the physiotherapist encouraged the loosening of mucus from her breathing passages which enabled us as nurses to acquire a sputum sample to send to the microbiologist to test for what antibiotics were suitable to treat Barbara’s chest infection.In addition to having lung cancer, Barbara also had liver and bone metastasis. With her consent, we involved the Macmillan nurses in her care. They focused on the social, emotional and practical impact cancer had on Barbara. They also gave her information on different support groups which were accessible to her and meetings where she could share her experience and listen to others experiences. Involved in the care of Barbara was the church priest.As Barbara was too ill to attend the hospital Sunday services as were her wishes, we invited a priest who could give her communion, emotional and spiritual support through her stay in the hospital. Barbara had a reduced appetite so we commenced her on a food diary in which we recorded everything that Barbara ate and how much of it she ate. After three days of commencing Barbara on the food diary, we showed it to the dietician. Barbara was quite ill and did not have the strength to take part in most of her activities of daily living including feeding herself.The dietician came to the ward to review Barbara and then prescribed ensure drinks and little cups of procal shots. These are nutrient supplements which provide protein, fat and carbohydrate in the body. All healthcare professionals worked together to enhance the quality of care that Barbara received although because Barbara had been diagnosed with sepsis, the decision of the dietician to provide Barbara with medication to boost her nutrition arguably caused deterioration in Barbara’s health.Studies show that when treating a patient with sepsis, permissive underfeeding is required to ensure that recovery is enhanced as encouraging a lot of dietary intake would cause lipogenesis which would result to excess production of carbon dioxide and res piratory overload, hyperglycaemia and over usage of energy which would lead to stress for the patient. Vincent, Carlet and Opal (2002).In supporting the doctors’ decision to prescribe intravenous fluids for fluid resuscitation on Barbara, Evidence has shown from the Surviving Sepsis Campaign (2011) under the sepsis resuscitation bundle that patients who are suspected of being in septic shock should be commenced on fluid resuscitation immediately. Guidelines on the Surviving Sepsis Campaign states that, â€Å"In the event of hypotension and/or lactate ;gt; 4mmols/L (36 mg/dL) deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent). † As explained by Winters and Glatter (2009), serum lactate levels are used to identify patients who have sepsis.They explain that an elevated serum lactate level is a method of forewarning of an increased mortality in patients with sepsis or septic shock. This proves that ordering for blood tests to check the serum lact ate level of Barbara was a positive step in treating Barbara by identifying the diagnosis of Barbara’s condition. Current evidence from the Surviving Sepsis Campaign (2011) indicates that analysing serum lactate levels in septic patients is not conclusive as â€Å"a number of studies have suggested that elevated lactate levels may result from cellular metabolic failure in sepsis rather than from global hypo perfusion.Elevated lactate levels can also result from decreased clearance by the liver. Although blood lactate concentration may lack precision as a measure of tissue metabolic status, elevated levels in sepsis support aggressive resuscitation. † This gives reason to why the doctors ordered for blood tests to be taken so as to measure Barbara’s serum lactate level. Through continuous input of intravenous fluids, Barbara’s blood pressure increased to 99/55 and remained stable and she was now scoring a MEWS of 3 as her respiratory rate was still elevate d at 24 breaths per minute and a heart rate of 105 beats per minute.Barbara’s temperature was still a little bit elevated at 37. 4? C but not scoring on the MEWS chart. The MEWS chart played a very important role in helping us evaluate Barbara’s health status. Although different studies show that there are pros and cons of using the MEWS system to evaluate patients’ health status. Studies show that the modified early warning scoring systems in the accident and emergency department or an acute care setting can help healthcare professionals identify patients that are at risk of deterioration.Though, concerns have been raised questioning the sensitivity of this system as a risk assessment tool in comparison with the early modified warning score (EWS). Griffiths and Kidney (2011), in their survey assessing the use of MEWS in the UK’s acute care departments found out that over 90% of respondents in the survey supported the use of the Early Warning Score in hel ping identify deterioration or improvement in patients who are admitted to the acute care departments to the use of the Modified Early Warning Score.This is evidence that supports the practice of nurses in monitoring Barbara’s condition through the use of modified early warning score. On the other hand, another study shows that many issues arose in implementing the MEWS chart in recording patients’ observation. The problems encountered with the MEWS chart include complaints of font size, size of the boxes provided to write in and due to this, some staff members have been reluctant to engage with the process making it difficult to monitor deterioration in acutely ill patients.NICE (2011) I think that the MEWS chart was very effective in helping us monitor Barbara’s condition because we were able to use the information recorded on it as a means of communication with other healthcare professionals involved in her care. In caring for Barbara, we ensured that her con fidentiality was optimised. This is a professional requirement for every nurse by the Nursing and Midwifery Council (2008). Through the use of a model called ‘Situation – Background – Assessment – Recommendation’ (SBAR), we ensured that communication between all health care professionals were detailed and solely on a need to know basis.This model did not only protect the confidentiality of Barbara, it also encouraged assessment skills helping to provide all information to health care professionals in a manner that makes it difficult to omit any information. In communication with other bodies involved in Barbara’s care, SBAR stood as a guideline in divulging information. Stating the situation Barbara was in, giving background information only in relation to her present condition, providing results of assessments carried that would relate to their function in the care of Barbara and finally getting the recommendation from the other body.This wa y, disclosure of information is kept to a minimum. Confidentiality is a key concept in protecting people that are vulnerable. Apart from being an ethical requirement, confidentiality also is a legal requirement. The legal principle of confidentiality lies within the Data Protection Act (1998), which simplified by Mind (2005) states that â€Å"Confidence is breached by the unauthorised use or disclosure of confidential information. † This act emphasises the principles that define confidentiality one of which includes sensitive personal data.This has to do with matters relating to a persons’ ethnicity, religious and political beliefs, physical and mental health, sexual orientation as well as criminal offences. In relation to Barbara, whenever we received a phone call from people claiming to be family members, in order to protect Barbara’s confidentiality, we never disclosed results of tests or doctors’ orders. We always gained consent from Barbara before gi ving information out to other parties involved in her care.Timing when caring for critically ill patients is a valuable commodity which makes it important to be able to identify when a patient is in need of urgent medical attention. In the course of looking after Barbara through her admission in the hospital, I realised that prioritising care was the main issue surrounding her treatment. Observing my mentor who was in charge of Barbara’s care as well as nine other patients, using the ABC technique she was able to prioritise the care that Barbara received.Ensuring that she had open Airways, Breathing with addition of oxygen therapy, Circulation through constant monitoring of her blood pressure. Prioritising of care is a skill that is essential in a care setting because if it was decided that all patients would be cared for in respect of their bed position on the ward, that would have had a negative impact on Barbara because she would not have received the urgent attention that she needed which could lead to a tragedy.Through prioritising care, my mentor was able to organise herself in caring for the other patients she was in charge of placing Barbara on the top of her list because she was in constant need of urgent care as when it was time for her intravenous fluids to be commenced because she had organised her time accurately she was able to meet up with demands placed by Barbara’s condition as well as demands of her duty to the other patients.In conclusion, this portfolio of evidence has defined the different stages of sepsis. It has explored the causes, pathophysiology and clinical manifestations. Fluid resuscitation was highlighted as the most important step to take in recognising a patient with sepsis. I described the different roles of the healthcare professionals in relation to the care that Barbara received.Using information from the surviving sepsis campaign, I explained the guidelines used in the treatment of sepsis and related it to the steps taken by the doctor to treat Barbara. I identified the key strength of my mentor in working under pressure by prioritising care. This is an area that I will need to develop myself in the course of attending placement in the future. I will research on techniques of prioritising patient care and research on the process of triage in relation to a care setting.