Sustainable Management Futures Essay Example | Topics and Well Written Essays - 3000 words - 7

Sustainable Management Futures - Essay Example Hence, there was considerable opposition from developers of the resort as the scenic splendour The company can adopt the policy of maximum pollution, which can be evaded under the law of South Carolina, in order to maximise the company’s revenues as well as create adequate job opportunities in the concerned area. Then again, this policy will affect aesthetic quality of the environment and hamper business of the resorts in Hilton Head by way of attracting lesser visitors (Taylor, 2011). Long-term effects of pollution are very hard to determine and BASF’s past experiences in other countries, where they had polluted rivers, did not help them with a buoyant feeling. As a result, development of the factory had become more of a moral issue than a business one. In order to solve the moral issue, the researcher proposes that the BASF’s manager had three options. He can either build the factory with the least pollution control or maximise the pollution control or further still, he can choose to not build the factory at all. The first option will yield a tolerable amount of water pollution, huge company profits, satisfied shareholders and extremely antagonistic resort developers as well as greater employment opportunities. The second option, on the other hand, would yield low profits for the company, unsatisfied shareholders, minimal pollution, welcoming developers and high costs incurred so as to implement pollution control measures. The third option would have approval of the developers, yield no profits, incur costs so as to search for a new location and also disappoint the local residents who were in support of the industrialisation. The best course of action in such a case would be to weigh all the options, analyse the environment and organisational benefits and come up with the best possible or optimal solution that would benefit all. Both the manager and the company were confronted with a number of duties and obligations. The organisation management

Electronics Coursework Example | Topics and Well Written Essays - 2500 words

Electronics - Coursework Example The gain of an amplifier is usually given in decibels or its unit less if the input and output variables are the same (all current, voltage or power. The power gain of an amplifier depends on the sources and load resistances used and its voltage gain. The amplifier should be linear in most cases hence its gain should be constant. Electronic amplifiers find their applications in Radios, Television Transmitters, Receivers, and high-fidelity stereo equipments, Microcomputers, and other electronic digital equipments. The 1Mï â€" and 10kï â€" potentiometer/decade boxes were used to set VCE and VBE to the values shown in table 1 to give the input characteristics of the BJT. The voltages across RB were measured and recorded for all measurements of VCE and VBE. The 10kï â€" potentiometer/decade box was s3et to its maximum value so that the output characteristics could be determined. The 1Mï â€" potentiometer/decade box was adjusted to set Ib to 10ï  ­A, and the desired values of RB were calculated using the measured values of RB. the value of 10kï â€" potentiometer/decade box was adjusted for all values of VCE in table 2 of the results analysis while Ib was kept constant. The voltage across the 100ï â€" resistor was measured and recorded for each combination of VCE and IB. In common emitter configuration, the input is connected between the base and the emitter while the output is taken between collector and emitter. The emitter is the common terminal as shown in the above figure. Emitt er base voltage is the input voltage, base current flows in the circuit and then the in the output resister, hence there will be high power and voltage gains and its output and input voltage ratio is moderate hence this configuration is commonly used. Increasing the supply voltage causes the base current to be lower for a given value of base-emitter voltage; this implies that higher values of supply voltage leads to greater collector-base junction reverse bias, hence greater depletion region

Suez Crisis Essay Example for Free

Suez Crisis Essay Lee states, ‘There was no internal split in the Conservative party’. Kilmuir agrees with this, and goes onto talk about, ‘Our most lost party workers, although dismayed by our handling of the situation were consumed with the hatred of the Labour party. ’ Which means even though they were going through a tough situation the Conservatives kept a strong front and were all in it together against Labour; even the media gave publicity in which spread the disgust to the public about the Labour party. Overall it shows Labour actually had it worse off; they weren’t popular with the public at the time, this later shows at the 1959 general election as Macmillan takes a victory for the Conservatives. On the other hand, Kilmuir was a member of the Conservatives at the time and he might have wanted to give the public the idea that the situation wasn’t as bad as it seemed as his party just caused a major international tensions with our allies. Although he does admit that, ‘Even the most hostile critics of the Conservative party’ had their doubtful moments in the party giving the idea that the party had nothing to hide and that its members knew there would be some slight internal tensions. Opposing the statement, in Source 4, Rowe tells us that after the Suez Crisis, ‘†¦there as a sharp economic crisis’ and that, ‘Politically, Eden was finished. ’. This was true about the economy as there was a international run on sterling, which threatened Britain with economic collapse with no hope of the USA willing to bale Britain out. There were further large withdrawals of deposits by international investors which lead to a major fall in Britain’s currency reserves. This of course damaged the Conservatives greatly as Britain was still trying to recover economically from WWII and this crisis set Britain back about 4 years economically according to an account from Gaitskell; being from the Labour party he may of exaggerated some of these numbers as he produced no evidence of his findings. It also did finish Eden apparently; as he was removed from the party but in Source 5 it says it was because of ‘ill health’ not because of the Crisis itself. People expected R. A. Butler to take over but as he wasn’t much help during the crisis when he took over from Eden. It was actually Macmillan who took control of the Conservatives. Showing the Conservatives they had to change their party structure because they had been damaged by leading Britain into this crisis. Overall, to a certain extent I disagree with the statement because I think that Eden was damaged significantly by the Suez Crisis as he lead Britain into some economic problems which left him politically finished. However, to a larger extent I agree with the statement that it did no damage to the fortunes of the Conservative party even though it had some short term damage at the beginning for example, Eden was removed and they had to shuffle the party leadership, Macmillan then saved the party and won the later 1959 General election with the increasing of public consumption resulting in a period of affluence whilst Labour was left in the gutter constantly in internal party feuds leaving the Conservatives victorious and prosperous.

Individual Learner Differences In Second Language Acquisition English Language Essay

Individual Learner Differences In Second Language Acquisition English Language Essay Introduction Language is defined by scholarly linguists as a part of growing up (Cook 2001, p. 46). It is an element of culture regarded as providing motivation to individuals in its own right. It has also been identified as necessary for effective communication and integration into a particular environment. I noted that second languages are different from the primary languages. Second language learning involves some form off acquisition. This is a process by which an individual can effectively learn a second language also known as an additional language. Cook (2001, pp. 41 48) argued that learning second languages requires some form of motivation (2001, p.43). Motivation in this context involves encouraging the individual to overcome all challenges in pursuit of learning another language. Mostly, individuals undergo the hustles of learning a second language for them to conform to the immediate environment. In this paper, I explore Individual learner differences in Second Language acquisition (SLA). I apply Gardners socio-educational model in discussing second language acquisition. The paper also details the significance of motivation and its impact on learning second languages. It applies motivation as the learners orientation regarding learning a second language. The paper divides motivation into two basic types including integrative and instrumental. It relates integrative motivation as being dependent on the positive attitudes of the learner. On the other hand, it relates instrumental motivation as being influenced by a reward in learning second languages. Both forms of motivation in this paper are analyzed and researched to establish the impact of motivation on second language acquisition. The essay will be structured into subsections with a flow expounding on the relevance of motivation as one element that explains individual learner difference in second language acquisition. The first part explains a general overview of individual learner differences. The second part integrates the models of motivation including the works conducted by Gardner and clement in analysing motivations impact on SLA. The last subsection is an overview of the Chilean cultural setting and its impact of motivation for second language learners. This is followed by some suggestions and recommendations of how motivations can be cultivated within such a cultural setting. Individual learner differences in SLA There are diverse learner differences in learning a second language. For one, in learning a second language, there must be the involvement of a second or even a third party. The second party assists in disseminating the knowledge to the individual who wants to learn the language. However, The process of second language acquisition is dependent on what the learner does and very little on what teachers does (Schmitt 2002, p.50). The goals of the individual also bring out the individual learner differences. In learning a second language, some individuals go for communicative competence. This might include basic communication skills, which is the main goal of the individual. I am of the view that the goal of an individual learner is critical because it determines what level the individual has the will to go in learning a second language. My analysis of current debates on SLA reveals that they have embarked on individual differences. Doman (2006) contributed vast literature on this topic asserting that not a single individual is similar to the other physically, psychologically or mentally. Therefore, these differences reveal the reason why individuals learn second languages differently. He supports Piagets theory of cognitive development, which asserts that the human mind is different from the other even in the process of learning. Therefore, I argue that problems, frustrations and challenges as being part of SLA affect the individuals differently. The individuals differ in the way they handle such issues, which ultimately determines how they learn a second language. Generally, Individual learner differences are evident in SLA, explanations have been provided by major scholars in this context. However, the ideal way to explain these differences is through developing an understanding of some of the models espoused by scholars on motivation and SLA. Conversely, second languages are difficult to learn, which has been a huge challenge for many individuals. Motivation is therefore defined as critical in the entire process. Motivation is defined by major scholars including Hedge (2000, pp. 17 28), Ellis (2005, pp. 305-352), McDonough (2007, pp. 369-371) and Celce-Murcia (2002, pp. 119-134) as the psychological quality essential for fostering individual goal achievement. Therefore, I can argue that in second language acquisitions, language proficiency is the main goal. The individuals desire to master a language is the main goal, which motivates him or her to work towards its achievement. Scholars have supported this argument by asserting that coaches can motivate learners and vice versa in the process of learning. With such assertion, there is a clear view that motivation varies between individuals. An individual is therefore unique in his own way depending on his or her stipulated goal of learning the second language. Motivation is also a transitive concept. In this context, the coach motivates the learners and their reception also motivates the coach to teach the language. Gottlieb (2006, pp. 56) asserted that the long-drawn out process of learning a second language is the reason why individual differences exist in SLA. In his article on Teaching and Researching Motivation, Dornyei (2001, pp. 28 30) argued that people have diverse cognitive behaviours. In this case, individuals respond differently to diverse environments. Therefore, it is arguable that individuals always differ in their reception to language learning situations. The book by Lightbown Spada (1993, p.135) also supported this notion asserting that individuals have diverse preferences. The environment in itself is a great determinant of the diverse response by individuals, and this has a great impact in language learning. Conversely, I argue that both intrinsic and extrinsic motivation determines the level of individual learning. Intrinsic and extrinsic motivations subject the individual to a particular level of acceptance in second language acquisition. In the same light, individuals handle intrinsic and extrinsic pressures differently, which makes them different in the way they learn a second language. Ellis (2005, pp. 305-352) supported these arguments by writing an article on individual differences in second language learning. He was of the view that an individual is subjective to internal and external pressures even in the process of learning a language. Earlier, Skehan (1991, pp. 12 19) had written a book on Individual differences in second-language learning. He was of the same view. It is therefore notable that the way the individual handles these pressures is what determines the level of success in second language learning. Models of Second Language Acquisition For decades, studies of motivation as a factor of SLA have covered issues related to reasons for learning. Empirical evidence from major case studies reveals that most of the people strive to acquire a second language in order to integrate with the speech an identified community. Research over the last thirty years has ignored the role of motivation in SLA (Mitchell and Myles 2004, p.71 85). However, other scholars have concentrated on motivation as a determinant factor in SLA. I therefore note that motivation is viewed as being affected by various issues in the process of SLA. Some of these issues include demands of self-instruction, overwhelming requirements, and challenges of coping with the new materials and personal progress assessment, inadequacy of feedback, among other frustrations. In this context, the individual is either motivated or de-motivated into learning a second language. Mitchell and Myles (2004, pp. 71 85) identified Gardners model of SLA as covering major issues in the area of motivation. Gardners works were influenced by Mowrer (1950) who had earlier discussed more on first language acquisition. My argument draws that the success of learning a language is attributed to the desire to learn it. A child struggles to learn a language to gain identity within the family. The objective is similar to Gardners argument who asserted that acceptance into the wider language community fosters the need to learn a new language. Using this argument Gardners model aimed at investigating second language acquisition and how motivates influences the same. Before examining motivation as an element that has an impact on second language learning, Gardner acknowledged that it is a single variable that is subject to other factors. My point is that motivation alone does not affect the SLA process. The socio-educational model as espoused by Gardner identified several facto rs that also influence language learning. Gardners model identified a structured classroom setting as the main setting for learning a second language. He prefers the foreign language classroom as compared to a natural setting arguing that the earlier is dependent more on motivation. Second Language acquisition is therefore pertinent to many issues and factors. Like Gardner argues, his model interrelate second language acquisition with at least four features including individual learner differences, social and cultural milieu, the setting in which learning process is facilitated and the linguistic outcomes (Gardner 1982). The social or cultural milieu is the immediate environment where the learner is situated. Cook (2001, pp. 41 48) was of the view that, the learners environment subjects him or her to beliefs about a particular language or culture. I also analyze that beliefs impact the way and individual perceives the language and his or her willingness to learn a new language. Gardner gave an example of Britain as a monocultural setting. In this context, the British have a notion that they are the superior culture. Therefore, they do not acknowledge learning another language as critical. Rather, they have a notion that other minority cultures should learn thei r language and assimilate into the system. This culture instils these believes in the context of becoming the dominant language of the country. Larsen-Freeman (2001, pp. 12-24) noted that there are many cultures across the globe, which regards themselves as mighty cultures. In this context, they tend to influence other cultures other than assimilating into them. Therefore, individuals within the majority culture are lowly motivated to learn new languages. Patsy and Nina (2006, pp. 86 102) regarded these cultures as monocultural communities. However, Gardners social and cultural milieu applies differently in other countries. I have come to note that in some countries such as Canada and Australia, bilingualism and biculturalism is encouraged among the people. The society is therefore motivated into acquiring new languages. On the other hand, Gottlieb (2006, pp. 52 76) supported this notion noting that the social settings develop certain attitudes towards learning another language. I assume that these attitudes are the basis of an individuals motivation towards learning another language. The second phase of the model discusses individual differences including intelligence, motivation variable, language aptitude, and situational anxiety (Giles and Coupland 1991). These variables differ from one setting to the other and are closely interrelated. Mitchell and Myles (2004, pp. 71 85) argued that it is critical for second language teachers to set the learning places appropriately for effective learning to take place. Two contexts are identified in discussion the setting. They include formal instruction and unstructured language acquisition. The identified variables have diverse impacts depending on the context. For instance, intelligence and aptitude influence the formal setting within a classroom. On the other hand anxiety and motivation are variables which have an impact on both the formal and informal setting. Gardners model explains the final phase of SLA as linguistic and non-linguistic outcomes. The linguistic outcomes are regarded as the actual language including the skills and knowledge acquired. Hurd, Beaven, and 2001, pp. 341-355) supported the definition by giving examples of linguistic outcomes as including test indices such as proficiency tests. On the other hand Dornyei (2001, pp. 28 30) defines non-linguistic outcomes as the attitudes, which an individual develops towards the language. This is subject to the values and beliefs of the individual. Therefore I can argue that integrating both the linguistic and non-linguistic outcomes develops success in SLA. It develops a form of motivation and an individual can develop a higher degree of L2 proficiency. Gardners model asserted that motivation is composed of three elements. The identified elements include effort, affect and desire. He describes effort as an individuals devotion in terms of time and resources used. Desire on the o ther hand is the willingness to acquire L2 proficiency. Finally, effect includes the response of the individual pertinent to the emotional reactions with regard to SLA. An almost similar model of SLA is espoused by Clement. Clementss Model of motivation espouses that self-confidence is the most critical element in motivation of SLA. The model asserts that, it is critical for individuals to develop self-confidence when learning a second language. Therefore learning a second language is hugely challenging. Conversely, any level of success is dependent on how much an individual is willing to commit him into the process. In this context, it depends with the level of sacrifice that an individual can sustain in order to achieve a desired goal. In a book titled how languages are learned Lightbown Spada (1993, p.135) argued that self-confidence motivates an individual to achieve the ultimate goal of learning a new language. The individual is successful in learning a new language by developing own initiatives. These initiatives develop from the individuals confidence to learn a language and the persistence even with the challenges involves. The individual is therefore the determinant of how he or she learns a language. I have come to value the assertion that the level of persistence and confidence in learning the second language structures the trend of learning a new language. Having understood the models of motivation in SLA, it is critical to develop this context and apply it within a cultural setting. Applying the models brings out the real sense and understanding of the types of motivates and the existent challenges. It also gives an opportunity to understand how these challenges can be overcome to support second language learning. The Chilean cultural setting has been identified in this discussion as critical for assessing motivation as a critical element of language and acquisition. Chilean Cultural Setting and SLA The Chilean cultural setting is evident of low attendance in classes. In this context, the students are lowly motivated to learn English as a second language. Low attendance in classes means that the individual students do not ascribe to the goal of learning second languages. They are not motivated to attend classes, which challenges the process of learning a second language. In the same line of argument teachers are also lowly motivated by the students behaviour. They are therefore tired of devoting their time to teaching in these classes. A Chilean teacher works for over 44 hours a week in front of a class, which is quite tiring because they do not have enough time to rest. The teachers therefore are unmotivated in delivering class lessons. Therefore, they do not have the zeal to motivate students in learning. The huge classes in Chilean contexts are also a huge challenge for both teachers and students in the process of learning. The class population is between 38 and 45 students p er class, which is a huge number that a single teacher can handle. In this context, both teachers and students are unmotivated in the learning process. In considering learning English as a second language, the Chilean context is quite difficult. Within the system, English classes take only 90 minutes per week. This is less time compared to other lessons and the time assigned for the same. The time assigned for learning English as a second language is not enough to deliver effective learning. Time therefore, limits both the teachers and the students in the process of learning a second language. It is also a big challenge for students to learn English as a second language because they have low levels of interest. The learners also portray a negative attitude toward English learning, which is an indication that learners are hugely challenged. Students within this culture do not consider English as a useful tool for everyday life. They tend to value their local language more to English, which is an aspect that challenged the process of learning a second language. The remote geographical location of the country is also a huge challenge f or SLA because the Chileans cannot access other English-speaking countries easily. They are therefore entrenched into the same culture without external influences, which could provoke a need for SLA. Types of Motivation in SLA There are diverse forms of motivation which can be applied within the Chilean context in handling the issue of second language acquisition. The three mostly identified types of motivation include integrative, instrumental motivation and integrative vs. instrumental motivation. Integrative Motivation Mitchell and Myles (2004, pp. 71 85) identified motivation as the learners orientation regard his or her goal of learning a second language. In this line of argument, it was identified that students who develop interest in learning a second language become more successful. There is need to develop huge interest among Chilean students in learning a second language. Celce-Murcia (2002, pp. 119-134) argued that the idea is to enforce an integration of cultures in order to provoke need for learning a second language. The students need to be provoked to admire another culture for them to develop an interest of learning another language. The students would also be provoked to integrate into the wider society and this entails learning a second language. This is what Doughty (2001, pp. 206-257) regards as integrative motivation. Integrative motivation assists the learner to develop and increase language proficiency for him or her to integrate into the system. This kind of motivation forces the individual to operate socially and become a part of the vast community. In an EFL setting such as Chile it is critical to develop an understanding of the term integrative. As Hudson (2000, pp. 18 25) suggests, integrative motivation develops when an individual desires to become bilingual in nature. This is the same as becoming bicultural and living within the limits of the two cultures. Skehan (1991, pp. 12 19) argued that the ultimate result is to add another language to the identity of the learner. As Chile is more of a monocultural society, the biggest challenge is to engage integrative motivation in order to overcome the challenges involved in (L2) acquisition. Instrumental Motivation Doughty (2001, pp. 206-257) concentrated more on explaining instrumental motivation. He argued that this type of motivation is in contrast to integrative motivation. The major characteristics of this kind of motivation are individual desires to obtain something practical after learning a second language (Mitchell and Myles 2004, pp. 71 85). In the Chilean context, this type of motivation can be applied diversely. Within this culture, globalization has led to the introduction of new companies. Within these companies, most of the employees have to be outsourced locally. With English being mandatory as a requirement when applying for these jobs, the Chileans can be motivated to learn it as a second language. Hedge (2000, pp. 17 28) noted that instrumental motivation is provoked by issues such as job application, graduation in various institutions and other work related issues including pay rise. It might be the desire of individuals to learn a second language but circumstances force t hem to do it and even equip them to handle challenges. With students in the Chilean context not willing to learn a new language, the introduction of English as a requirement for graduation would be a motivating factor to learn it as a second language. It is my view that this type of motivation is ambitious in nature and compelling. The individual learner has a choice to avoid it but external pressures are too strong and compel him or her to learn the second language. Conversely, integrative and instrumental motivation has been identified as both applicable in different context. When applied appropriately, both types of motivation lead to certain levels of success. However, integrative motivation is regarded by Ehrman and DÃ ¶rnyei (1998, pp. 34 41) as ideal for long-term success in second language learning. Integrative motivation works best in both formal and informal situations. Within the natural setting and the classroom situation, integrative motivation is better compared to instrumental motivation. Dornyei (2001, pp. 28 30) identified instrumental motivation as weak because it sometimes does not reflect the individual will to learn. Individuals in this case rely more on circumstances than their will to learn. It is a short term type of motivation and thus not very effective. Conclusion Various scholars have identified that there are individual learner difference in second language acquisition. As part of culture, language is described as an element of growing up. Language is also regarded as an element of culture that provides motivation to individuals in its own right. Just like any other cultural element, language is acquired differently from one individual to another. A similar case has been identified for second languages. In learning second languages, motives, goals and motivation have been identified and developing differences among individuals. In learning second languages integrative and instrumental types of motivation influence the individual differently. On the other hand, individuals conceptualize these types of motivation differently. Gardners socio-educational model, Clementss Model of motivation and Piagets theory of cognitive development, explain into detail how motivation influences SLA. The broad argument is that there is a great correlation betwe en SLA and motivation. Motivation is a variable that determines the level and success of learning a second language.

Communication Skills in Nursing | Reflection

Communication Skills in Nursing | Reflection This essay will present a reflective account of communication skills in practice whist undertaking assessment and history taking of two Intensive Care patients with a similar condition. It will endeavour to explore all aspects of non verbal and verbal communication styles and reflect upon these areas using Gibbs reflective cycle (1988). Scenario A Mrs James, 34, a passenger in a road traffic collision who was not wearing a seatbelt was thrown through the windscreen resulting in multiple facial wounds with extensive facial swelling which required her to be intubated and sedated. She currently has cervical spine immobilisation and is awaiting a secondary trauma CT. Mr James was also involved in the accident. Scenario B Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and orientated but currently breathless and requiring high oxygen concentrations. Patients who are admitted to Intensive Care are typically admitted due to serious ill health or trauma that may also have a potential to develop life threatening complications (Udwadia, 2005). These patients are usually unconscious, have limited movement and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invasive procedures for the purpose of monitoring and regulation of physiological functions. Having the ability to effectively communicate with patients, colleagues and their close relatives is a fundamental clinical skill in Intensive Care and central to a skilful nursing practice. Communication in Intensive Care is therefore of high importance (Elliot, 1999) to provide information and support to the critically ill patient in order to reduce their anxieties, stresses and preserve self identity, self esteem and reduce social isolation (Joà £o: 2009, Alasad: 2004, Newmarch:2006). Effective communic ation is the key to the collection of patient information, delivering quality of care and ensuring patient safety. Gaining a patients history is one of the most important skills in medicine and is a foundation for both the diagnosis and patient clinician relationship, and is increasingly being undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is crucial (Carr, 2005). Often the patient is transferred from a ward or department within the hospital where a comprehensive history has been taken with documentation of a full examination; investigations, working diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this admission if it was not appropriate to do so. Where available patients medical notes can provide essential information. In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective communication is restricted and obtaining a comprehensive history would be inappropriate and almost certainly unsafe (Carr, 2005). The Nursing Midwifery Council promotes the importance of keeping clear and accurate records within the Code: Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). Therefore if taking a patients history is unsafe to do so, this required to be documented. Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy person is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has often been accompanied with other injuries such as traumatic brain injury and complications such as airway obstruction. This may have been caused by further swelling, bleeding or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. Within scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for over half of the thoracic injuries from non-penetrating trauma (Middle ton, 2003). When ribs are fractured due to the nature and site of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is pain. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effectively. These combined increase the risk of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003). A key component of Intensive Care is to provide patients and relatives with effective communication at all times to ensure that a holistic nursing approach is achieved. Intensive care nurses care for patients predominantly with respiratory failure and over the years have taken on an extended role. They are expected to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a physical assessment and collect the patients history in a systemic, professional and sensitive approach. Effective communication skills are one of the many essential skills involved in this role. As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history taking process (Appendix A) and the physical assessment process. Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/Examination (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to blood cells and the oxygen cannot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid asses sment, continuity of care and the reduction of errors. Communication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, messages, opinions and thoughts are transferred by different forms. Basic communication is achieved by speaking, sign language, body language touch and eye contact, as technology has developed communication has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication: Verbal and non verbal. Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, understood and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Baron:2005, Zastrow:2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and orientated and had some ability to communicate; he was breathless due to painful fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions can allow breathless patients to communicate without exerting themselves. Closed questions such as is it painful when you breathe in? or is your breathing feeling worse? can be answered with non ver bal communication such as a shake or nod of the head. Taking a patients history in this way can be time consuming and it is essential that the clinician do not make assumptions on behalf of the patient (Ashworth, 1980). Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal communication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al:2000, Alasad:2004). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and crossed legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Alt hough Mr. James could verbally communicate, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles. A patients stay in Intensive Care can vary from days to months. Although this is a temporary situation and many patients will make a good recovery, the psychological impact may be longer lasting (MacAuley, 2010). When caring for the patient who may be unconscious or sedated and does not appear to be awake, hearing may be one of the last senses to fade when they become unconscious (Leigh, 2000). Sedation is used in Intensive Care units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony between the patient and ventilator. Poor sedation can lead to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. Over sedation can lead to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care delirium. Derlerium can be distressing for both the relatives andthe patient, who may have some recolection after the deleium epsiode (Mclafferty, 2007). Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation (Page, 2008). Within this stage of sedation or delirium it is impossible to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological status would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore im portant to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch when a patient is being moved, washed or having a dressing changed and secondly a caring touch holding Mrs James hand to explain where she was and why she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of talking to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been (Baron, 2005). If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of communication process as the Intensive Care environment in itself can cause communication barriers. Intensive Care can be noisy environment (Newmarch, 2006). Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength (Newmarch, 2006). Weakness of patients can affect the movement of hands and arms making gestures and handwriting frustration and diff icult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The University of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care. This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overall research (Alasad: 2004, Leigh: 2001, MacAuley, 2010: Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further education within Intensive Care may be requ ired to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contributions that others offer, to improve patients care and the overall patient experience. Appendix 1, The History Taking Process: The questions are the key to a good interview. You need to use a mix of open ended questions and close ended questions. Open ended questions leave the door open for the patient to tell you more. Questions like when it this problem start?, have you had any recent health problems?, and can you show me where it hurts? are open ended. The patient feels free to provide additional information. While questions like does it hurt here?, did you have this pain yesterday?, and have you had the flu in the past month? are close ended. Close ended questions seek very specific, often yes or no responses from the patient and dont encourage the patient to provide any additional information. Good interviews are a mixture of both kinds of questions. (Secrest, 2009) Basic Elements: 1. Greeting a. Introduction b. Identification of patient and self c. Assessment of the patients overall appearance and demeanor 2. Personal history a. Age b. Occupation c. Sex d. Height / Weight e. Marital / Family status i. Children 3. Chief complaint (CC) or Presenting complaint a. Why is the patient seeking care? b. What other problems concern the patient? 4. History of present illness a. Location and radiation of complaint b. Severity of complaint c. Timing of onset d. Situation (setting) of onset e. Duration of complaint f. Previous similar complaints g. Exacerbating and relieving factors h. Associated symptoms i. Patients explanation of complaint 5. Past medical history a. Systematic questioning regarding previous adult illnesses i. Neurological/Psychiatric ii. Eye, ear, nose, throat iii. Skin/Hair/Nails iv. Musculoskeletal v. Cardiovascular/Respiratory vi. Genital-urinary vii. GI tract b. Childhood illnesses c. Surgeries, injuries or hospital admissions d. OB/GYM i. Birth control ii. Pregnancies / Births iii. Menstrual periods iv. Pelvic exams / Pap smears e. Psychiatric f. Immunizations g. Screening tests h. Allergies 6. Family history a. Disease history b. Parental health c. Childrens health 7. Drug history a. Current medications i. Prescription ii. Over-the-counter b. Drug allergies 8. Lifestyle (social history) a. Alcohol b. Smoking c. Recreational drug use d. Sexual life style/orientation e. Reproductive status f. Occupational issues (Secrest,2009)

Galactosemia: A Rare Milk Sugar Disorder :: essays research papers

Galactosemia: A Rare Milk Sugar Disorder   Ã‚  Ã‚  Ã‚  Ã‚   Galactosemia is a rare congenital disorder which affects the body’s inability to convert galactose into glucose. Galactose is a type of sugar, which is a breakdown product of lactose. Lactose is found in milk and milk products, including breast milk. Given that the galactose can not be broken down, it builds up in the body and acts as a poison that can cause serious damage to it‘s carrier(â€Å"galactosemiaâ€Å"). â€Å"As milk is important to a baby’s diet, early diagnosis is essential to avoid lifelong problems from this potentially fatal disorder â€Å"(Chung). This research paper provides information about the genetic part of Galactosemia, the cause, symptoms, diagnosis, treatment.   Ã‚  Ã‚  Ã‚  Ã‚  The first trace of information that was brought to light about galactosemia was in 1908 by Von Ruess. He composed an article of his findings in an infant with many of the symptoms we now relate to galactosemia. This work has widely been accepted by scientists as the first reported case of galactosemia. However, at this time the diagnosis of galactosemia was not yet possible. It would be nine years before a similar diagnosis of galactosuria was largely accepted by scientists as a hereditary disorder.   Ã‚  Ã‚  Ã‚  Ã‚  In 1917, galactosuria was treated by eliminating dairy products from an individual’s diet. (â€Å"galactosemiaâ€Å") The discovery of galactosemia was published by Manson and Turner in immense detail. Although this disease was recognized earlier, it was not until 1956 that scientists discovered the mutated gene that causes galactosemia. It is know that the mutated gene is found encoded on chromosome 9. In 1963, a major break- through was unearthed. Galactosemia was the second disorder found to be detectable through newborn screening. Finally, in 1970 galactosemia was acknowledged as a metabolic disease. Today scientists largely accept the notion that galactosemia is a rare metabolic disorder (disease).   Ã‚  Ã‚  Ã‚  Ã‚  This disorder comes in two different variations. Though there is more than one type, it is still rare, having only 1 in 100,000 births being affected by the disorder (Feinbloom). Classic Galactosemia is the first and more common form of the disorder. This is the form when the affected has a complete loss of the enzyme. Both parents must contribute a galactosemic gene for a child to receive the disorder. Since the accumulation of galactose behaves as a toxin in the body, serious complications such as an enlarged liver, kidney failure, cataracts, and brain damage may occur.

College Essay :: essays research papers

As I thought of this article, many of the issues I have faced as a single Hmong woman in her mid-twenties came to mind. Should I discuss the functional reasons why marriage is so important in the Hmong culture, especially for women? Or do I talk about the lack of eligible, older Hmong men? Better yet, should I complain about the attempts by my relatives to find me a good husband as if it were an unfortunate circumstance that I was single instead of a conscious choice? Thinking it over, though, I decided that all those questions boiled down to one fundamental truth – the Hmong community is still trying to learn how to treat the increasing number of Hmong women who, like me, are making the choice to stay single in their mid-twenties. Today, single Hmong women in their mid-twenties are living on their own, sometimes in different cities, earning their own income, and making decisions independent of both their parents and clans. However, in a community where marriage defines the moment an individual becomes an adult, these successes still have not allowed them to be treated or perceived as adults by the family and clan. Furthermore, in a culture where a woman’s role continues to be defined by the dominant male in her life – either her father or her husband – the independence of Hmong women in their mid-twenties has led to a displacement of traditional roles. My sister coined the term â€Å"Christmas Tree Age† when someone told her that in order to be able to find a good husband, a Hmong woman needed to be no older than twenty-five years old. Just like a Christmas Tree which is discarded after the 25th of December, the Hmong community seems to disregard women older than twenty-five as in-eligible marriage material. At twenty-five years of age, I’ve attained many of the goals I set for myself as a young girl, starting a successful career in Corporate America, gaining financial freedom and traveling the globe. Yet, to many of my relatives, it seems my life is still lacking the most critical ingredient – a husband. While in college, my single status seemed more acceptable. However, as I have continued to focus on my career instead of a husband and as I have reached the magic twenty-five, the choice to remain single has become an increasing concern for my family.