The Landlady by Roald Dahl Essay Example for Free

The Landlady by Roald Dahl Essay Slightly shocked from the answer to the question just asked, Billy took another sip of his tea frantically trying to think of something to say. Placing the cup of Tea onto the coaster he took a gasp complementing on the tea, the landlady smiling as he did so. And then without warning he just blurted a question out, So why the others not joining us from upstairs. The landlady took a grin and answered his question well Gregory and Christopher, have not been feeling well recently, so I have been looking after them, they are ever so polite much like you. The way she said it made it sound like she was there mother! Giving a giant yarn, Billy stood up and stretched. I am awfully sorry but best be off to bed now, I have a long day tomorrow. I bet you do, she smirked. All of a sudden she began to lift up he heavy skirt show off her stockings and in the side was a giant curved knife, Billy stood back in shock. She stood up with the knife, the blade reflecting the wall light. What you doing with that? Billy squeaked. All of sudden she launched like a speeding bullet, and with lightening reactions Billy chucked his burning turning in the landladys eyes. Billy ran for his life and at the same time he could hear the landladys frantic screams as he climbed the landing stairs, racing up to his room. He closed the door and locking it behind him. Silently he moved swiftly to his briefcase, and started cramming all his possession into it. And then he heard a thuder of the landlady charging up the stairs like a possessed elephant, he hid behind the door And has he looked over he saw an old mop, not been used for years he took hold of it, Dust left a heavy trail behind it, And waited behind the door he could hear her breathing heavy and droopy like she was ready to swipe someones head off! He heard the lock click and the door swung open hitting him in the face, slightly dazed but still conscious Billy saw the landlady walk in knife first, he didnt give her anytime to think he swung the mop and smashed the landlady around the head she fell to the ground like a sac of spuds. Billy looked closer at the sick and twisted face of the evil witch, Billy had never knocked anyone out before the sudden sensation made him feel proud but hed never guess in a million years he would knock out a fifty-year-old woman! Billy eyes caught hold of the ring of keys around her belt, discreetly he unclipped them, grabbed his case and walked out of the room again locking it (permanently) behind him. Dazzled and tired of the ordeal Billy put his briefcase down and sat on it, looking at the 3rd floor stairs in mystery. Then he remembered what the landlady had said about Gregory and Christopher who was upstairs because they werent feeling very well, if she had tried to knife him, Imagine what she has done to them! With his decision made Billy started to climb the gloomy stairs. Dust was on the railing he wiped it off as he went up. When he got to the top he found himself gazing at two rooms, he decided to take the one closeted on the right. Billy edge open the door a dirt musty smell Hit is face it smelled like vinegar. He walked in and looked around the room in confusion Billy wasnt expecting what he was going to find in here. The room was exactly like his except of the horrendous smell, and as he look at the bed he noticed it was occupied! Hello Billy shouted, it was as silent as it were when he comes in shot to the bed and slowly lifted the covers 2 dead bodies were laid there. It made Billy nearly be sick in his mouth, they defiantly not feeling well he thought! No sain human being could have done this, he thought to himself. The bodies were like to pickles. Billy stared at the crackling fire in the room. Thing of nothing but hate for the landlady. Malice and hate built up inside. And with no warning or control Billy threw a burning hot ember glowing log from the fire to the bed of stuffed men. Within minutes the bed was completely on fire the smell of burning flesh was touching his nostrils, Black smoke was collecting on the ceiling Billy decided to take his exit. Billy closed the door behind him the heat of the handle scolding his hands; he walked down the landing stairs hammering his feet down every step. When he reached the bottom it appeared the landlady had awoken and was screaming at the top of her voice Smoke, smoke wheres it coming from What ever you have done you will regret it, you will regret this Billy Wilkins! Hey hag!, its weaver get it right. Billy stormed down the rest of the stairs with a satisfied grin on his face. He entered the front room, and walked next to the fire were she had revealed the knife at him. He spread the fire out around the front room with the smell of the smoke going thicker and thicker. Billy exited the creepy BB locking it behind him, then chucking the keys in the bin. Billy watched the burning inferno until he felt the tiredness reach him again, and went to go and find the bell and dragon. 50 years later. It had been 50 years to the day that Billy had that terrible encounter with landlady but he can still remember what had happened yesterday, it had left a mental scar on his mind. Billy was on his way to bath of all places for the last meeting before his official retirement suddenly the train stopped and the announcer announced that they where at bath. Billy got off the train and like he had done 50 years ago made his way down the path that had led him to such a cruel place. He walked down the empty street many of the houses were bordered up and rusting away, allot had changed in 50 years Billy thought to himself. Then he got to the place of the terrible BB and has Billy looked up the building had been rebuilt exactly has it had fallen he walked across the road to get a better look at it. Then a young man was walking down street a lot like he had done all them years ago he look at the sign and knocked on the door. The door swivelled open straight away, and with a horror Billys past there stood the un aged unchanged, Landlady! Shivers crawled up Billys legs as she greeted the young man. It was like a Ghost from Billys past that wont go away, the young man walked in and as he passed in Billy saw the landlady licking her lips, and slamming the door!

Behavioral Systems Theory Utilization and Application

Behavioral Systems Theory Utilization and Application A body or collection of knowledge that is of most use in giving definitions and explanation to the profession of nursing is referred to as a nursing theory. Theories are based on assumptions made up of models, concepts, definitions, and propositions. Croyle (2005) defines a good theory as one that is logical, supported by a past research in the same field, consistent with everyday observations. Florence Nightingale is seen as the forerunner of nursing theories although she never really came up with any theory in action today. She wrote a book about her nursing experiences giving way to numerous nursing theories. This paper is about the utilization and application of a nursing theory in addressing a clinical issue. Of particular interest is Dorothy Johnsons Behavioral systems model (Johnson, 1980). This paper attempts to identify a clinical problem in the society and apply the principles of Johnsons theory in finding the solution to the problem. The issue identified is aggressive beha vior in the elderly living in long-term care nursing homes. In the nursing profession, theories form a very vital part of the system. The main aim of nursing theories is description, explanation, and prediction of nursing phenomenon. A good theory in this field therefore ensures better patient care, professionalism, and better communication between nurses and above all provides guidance on further research and education in the field. A good theory has provisions for foundations of the nursing practice to help in the generation of further knowledge and giving good direction to the field. A theory shows what we already know and what we need to find out thus in nursing, it plays a central role in caring for patients. Theories thus go a long way in the development of the profession. Dorothy Johnson is the proponent of the Behavioral Systems model. Born in Georgia on the 21st of august 1919, she received her A.A in 1938 from Armstrong Junior College. In 1942, she graduated from the Vanderbilt University with a B.S.N. she got her M.P.H. from Harvard University in 1948. She was involved in teaching pediatric nursing at Vanderbilt University before joining the University of California in Los Angeles. Johnson (1980) states that the eight subsystems of behavior are interdependent, interactive and integrated at the same time. According to her, humans are behavioral systems made up of the following seven subsystems: the achievement deals with setting and attaining goals while the affinitive forms relationships with others. The aggressive/protective has the function of responding to threats and providing protection to ones self while the dependency subsystem obtains necessary feedback about the self and goes ahead to recognize the need to depend on others. Whereas the eliminative part expresses feelings to the outside world and is involved in the elimination of wastes from the body system, the ingestive is involved in the intake of the ever so valuable nutrients and acquiring knowledge. The sexual subsystem is for recreation, development of gender based identity and having sexual relationships with others. In other words, the seven subsystems need to be in good conditions and in actio n for a normal healthy human being. Interaction between the seven subsystems is in turn interrelated and connected such that they influence each other in delivering their various duties. However, the seven subsystems do not go it alone as they are also acted on, significantly, by external factors. For Johnson, the environment is the main external factor as it includes anything and everything outside the person in question. The physical, socio-cultural and to some extent even the economic factors form part of the external actors on the subsystems. Aggressive behavior is a social issue and the society forms the major part of the external environment. The main role played by nurses is thus helping the affected individual return to the normal balance of the seven subsystems. To achieve the possible ultimate functioning behavior, the nurses at the care facilities have to make the social environment of the patients comfortable so they feel at ease. When the subsystem fails to develop fully and/or does not get sufficient supply of something, it easily falls out of balance. At other times there is discrepancy meaning that the subsystem is not doing enough to attain the end goal, which is being in the best state. Conflict between the components of the subsystem is not good for the body just as much as one of the subsystems being dominant in action over the rest. They are the major causes of imbalance in the subsystem that results in people not feeling well and consequently falling ill. In the case of aggressive behavior, the aggressive subsystem is dominant over the other subsystems. When this energy is not channeled in the right direction clinical issues arise. These can be witnessed in form of violence, or aggressive language (Croyle, 2005). Regulation of behavior is the best way for the person to get back the balance hence is well again. The nurses at the care facilities for the elderly have to pay attention to any changes in the behavior of their patients. Alteration of the internal as well as external environment while n some cases stimulation of the recovery process goes a long way in aiding the patient to return to the normal balance. The unfamiliar environment in the facilities sometimes causes aggressive behavior, especially amongst the elderly in the care facilities. Elderly people at the facilities need the nurses to help with the aggressive behavior (Croyle, 2005). It is Johnsons belief that the basic responsibility of the nurse is to support the patient restore balance when lost and in case of imbalance then, achieve the status quo, which would mean return to normal balance. Nurses, therefore, need to be patient with patients with aggressive behavior if they are to get to the cause of the problem. Most aggressive behavior is caused by anger and emotional stress. It is thus upon the nurse to create conducive external environment for the patient to open up. Thanks to research and the advancement of science, it is now easier to identify and pinpoint where the problem comes from. In her analysis and development of the theory, Johnson did not fail to mention the contribution and effects of the environment to the body. Here the environment is divided into external and internal, the internal being the subsystems while the external include anything outside the body. On health, the theory holds that a healthy person is one with a perfect balance and stability in the operations of the seven subsystems. The nurse has a role to play in the regulation of the balance whenever there is instability in the system. External and internal environments are the main causes of aggression or aggressive behavior. Various parts of the body contribute differently to aggressive behavior. The brain is the major controller of aggressive behavior. The brain is in charge of controlling expression of both automatic and behavioral components of aggression. This includes violent behavior and vocal expression. The brain picks up signals from both the external and internal environments and expresses them in form of aggression. Whenever the individual feels threatened or uncomfortable, they become aggressive in their talk, throwing insults, and demeaning words. It becomes worse when they turn violent to release the anger they have inside. By elderly people, we mean those from the age of 65 and above, most of which have retired. These people are normally seen as a bother to their loved ones as their needs increase from the normal. They thus need more care which cannot be provided at home so they are often taken to nursing homes where they can get the proper care. Because of old age and stress from retirement. These people have difficulty coping with the changes around them and their behavior changes. Some become aggressive while others develop mental problems making long-term nursing homes the best to take proper care of these individuals. There are numerous long-term care facilities ranging from mental institutions for the mentally handicapped to nursing homes where there are available facilities to assist them in their daily livelihoods. Most of these facilities are homes to the elderly and those with terminal illnesses. Of the seven subsystems, the aggressive part of their systems is more active than the rest. They thus face life-changing issues and try their level best to deal with the emotional as well as mental challenges. Nurses in these facilities are particularly faced with dealing with mental issues that come with aggression. Behavioral problems often arise from the patients effort to deal with his emotions or simply express them. The behavior ranges from repeating questions or phrases, humming, pacing up and down, to repetitive behavior. Aggressive behavior includes throwing things, punishing language and even hitting (Parker, 2001). Nurses in these institutions have to pay keen attention to such aggressive behavior and identify which of the seven subsystems is not functioning properly thus help these patients restore balance in their systems. It could be dependence, the attachment, or the aggressive causing a change in behavior. The dependence in the sense that the patient who was used to taking care of himself now finds it frustrating when he has to rely on others for all his needs. The attachment comes in when the patient struggles to form new relationships at the care facilities and being kept away from the existing relationships. Normally the patient plays a role in the behavioral system model of treatment but in dealing with mental complications, especially the ones accompanied by aggressive behavior. Most of the effort is required from the part of the nurse who has to be patient with the patient. Ones the subsystem causing the change in behavior has been identified, the nurse goes ahead to ensure conducive external environment to aid the patient to full recovery. The patient has to feel comfortable in the care facility because any irritation or discomfort agitates them. The patient is incapable of controlling their feelings or emotions and may be aggressive in expressing what they feel. The nurse therefore has a duty to stimulate the internal environment to be peaceful through the external. It is not easy to take care of mentally ill patients because the problem lies within their minds. The best way to help the patient is by finding out what changed in their past behavior. What happened before they became ill is crucial in determining the problem and adjusting the environment in an attempt to direct the patient to recovery of the balance in the subsystem. Depression is one of the commonest common mental-health problems in health facilities. Loneliness, fear of death, helplessness, frustration, anger, and hopelessness are some of the challenges of post-retirement faced by the elderly. Depression has many symptoms one of them having trouble falling asleep (Parker, 2001). These symptoms are often seen as complications and most people try treating them instead of observing change of behavior in the individual and restoring balance. Depression can be solved by improving the external environment of the patient. Mavis et al (2011) states that anti-depressants are available and can be used to treat depression. He continues to state that the elderly always have difficulties with their carers thus adding more problems to the recovery process. The nurse should involve the patient in support groups; give medication to stimulate recovery of the internal environment, and involving them in activities that spark their interests. Individual therapy and interaction with loved ones is vital for the recovery of these patients. Depression is a mental complication and just like others, it affects the mind. The nurses have a responsibility to try to stimulate the mind in the right direction to encourage quick recovery and development of the mental system. Mavis (2011) confirms that some of the causes of depression include illness, loneliness, an adverse life-event, and even some medication. According to him, depression is an insight to more cognitive problems that the elderly have to deal with. This is where the environment comes in. the internal, (subsystems), have to be kept in balance. The external environment helps the patient fit in properly and be free with the nurses. The patient opens up easily to discuss problems when the surrounding is to his comfort. Nurses have to help them fit in to the care centers. In conclusion, the behavioral system theory is very useful in the treatment of mental illnesses. The mind is affected by the bodys subsystems and ensuring restoration of balance in the subsystems will go a long way in treatment of mental illnesses especially among the elderly. Not being able to express their feelings to the carers is a big problem to the resolution of aggressive behavior. Improving their environment and making the patient comfortable calms them down and thus improve the internal environment as well.

Reflection On Communication In Experiencing Mental Illness Nursing Essay

Reflection On Communication In Experiencing Mental Illness Nursing Essay The purpose of this assignment is to critically reflect upon on aspect of my professional practice and development that arose whilst out in clinical practice. The paper will show emphasise based on communication. This reflection has been chosen to highlight the need for nurses to have therapeutic communication skills in order to provide holistic care and encourage a good nurse-patient relationship. Gibbs (1988) reflective cycle has been chosen as a framework for this paper. To satisfy the requirements of the Data protection Act (1998) as well as the NMC (2007) code of professional conduct, all names have been changed to protect identity in concordance with confidentiality purposes. Reflection is a way of analysing a past incident in order to promote learning and development. Gibbs (1988) reflective cycle can be seen as cyclical in nature which incorporates six stages to enable me to continuously improve my learning from the event for better practice in the future. The six stages are: 1. Description 2. Feelings 3. Evaluation 4. Ananlysis 5. Conclusion 6. Action plan. Description Whilst out in placement I witnessed both positive and negative communication. During handover I was informed Maisey has dementia, deafness, aggression and short term memory loss. During handover Maisey approached the nurses int he office who appeared to look very anxious and upset. The staff nurse raised her voice and in a fixed tone told Maisey to return to her bedroom, shouting we are to busy now, go back to your room. The nurses and health care assistants present in handover giggled amongst themselves, exchanged knowing glances and mimicked Maiseys voice saying she can be such a nuisance. Having not previously met Maisey I offered to assist her with her personal hygiene needs and to make her bed. I knocked on her bedroom door to which I then entered. Maisey stood up defensively and appeared to be very agitated and irate. She shouted that she wanted answers. I explained that I came to help her and would do my best to help her. Maisey then explained that no one had explained to her why she was in hospital nor did she know the where abouts of her daughter (main care giver). Reviewing Maiseys care plan I found out she had a fall at her daughters (Barbara) house and her son informed me that Barbara was away on holiday for a week. After the discussion with Maisey I documented it in her notes so that other members of the Multi-disciplinary team would acknowledge that Maisey was uncertain about the situation she was in. After speaking to my mentor and being more knowledgeable on Maiseys situation, I returned to her with my mentor close by. I pulled up a chair next to her and in a calm, reassuring, comforting manner explained the reason why she was in hospital. However Maisey appeared to look confused and asked me to speak to her in her left ear as she was deaf. I patiently repeated what I had said, she looked brighter after I mentioned her daughters name. Maisey asked a few more questions and I tried to answer them accurately and confidently. Maisey smiled and confided she is aware that she can be forgetful but feels that she is being ignored and that no one cared to what she had to say. She also said she could not sleep as other patients were disturbing her. After the discussion I gave Maisey assistance with her personal hygiene needs to which she thanked me for taking the time and just talking. Maisey had said she felt a lot better that someone took the time to listen to her concers and explain wh at was going on instead of being ignored and left in the dark. Feelings I felt very angry and disappointed that the staff easily agreed as a team that Maisey was just confused and describing her a as nuisance, without investigating as to why she seemed upset. I was in complete shock that as nurses they could be so quick to dismiss Maisey the way the did. I was highly annoyed that they all felt it was alrite to mimic and laugh at a patient. I felt a bit disheartened how no one took the time to explain what was going on to Maisey. Once I helped Maisey I felt happy that I took the time to get to know her and in turn see a different side to things. I felt proud I was able to reassure and relax Maisey so she could rest properly. Evaluation I feel I have learnt a lot from this experience with Maisey and how the nurses responded to her when she was at a very vulnerable time. It was not a nice encounter as I feel things like this should not happen in practice, however in terms of a learning prospective it was good as it taught me that it is paramount to be sensitive towards a patient who is feeling distressed. It went well as I have learnt how important it is to be patient, to take the time to listen to a patient as this can have cumulative effects on that persons well being and the outcome as to how they are feeling. The way the staff nurses reacted was not in the best interests of the patient. I did not like their approach, as they did not make an effort to show support or any understanding as she was known as a difficult patient. Stockwell (1972) wrote the infamous book The Unpopular Patient where she explains that studies of communication in nursing demonstrate inadequacies in nursing practice.   Stockwell (1972) de scribes the nurse-patient interaction, insisting that such interaction is not always satisfactory, especially when dealing with a difficult or unpopular patient. I feel the nursing team were ignorant to the fact that Maisey had difficulty in hearing which must have made it irritating for staff to keep repeating themselves. This could have been part of the reason as to why Maisey was considered an unpopular patient as she was seen as demanding. Analysis There was no interaction between nurse and patient as Maisey approached the nurses station, and to be mocked then dismissed must have been a terrible experience for her.   Davis (2008) explains how hectic times of the day such as handover, mealtimes and ward rounds leave insufficient time to help patients who need it.   However, if the nursing team had engaged in a little conversation with Maisey, she might have felt valued and understood, instead of upset and belittled.   The NMC Code (2008) clearly states many standards of conduct which a registered nurse should be trusted to do, these including You must treat people kindly and considerately and You must listen to the people in your care and respond to their concerns and preferences.   If as nurses we should comply with The Code (2008), a lot of work is required to raise the awareness of the importance of communication in the delivery of care.   In 2007 the NMC introduced Essential Skills Clusters.   These Essential Ski lls are to be delivered by all registered nurses, one of these clusters containing Care, Compassion and Communication.   The NMC introducing these clusters show the importance of interpersonal skills in nursing care, and significance of communication in the nursing profession.   On this occasion, the nursing team did not show care or compassion for Maisey, and certainly did not engage in therapeutic conversation.   As a student nurse I felt I had the knowledge and skills to approach the patient to appropriately calm and reassure her.   Heyward and Ramsdale (2008) explain that a patient who thinks his nurse is not listening to them will lose faith in the service a nurse provides, and in the nurses willingness and ability to do as they have promised.   They explain that sympathising with a patient shows willingness to understand their anxieties and make the patient feel more comfortable.   As I entered the room the patient stood up with a defensive posture, which I assumed was using non-verbal communication to inform me that she was suspicious and distrustful of me.   This was caused by the nursing teams disability to make the patient their first priority and to listen and respond to her concerns.   Santamaria (1993) tells us that nurses must deal with the full range of human behaviour, and at the same time deliver the highest quality of care.   I acknowledged that Maisey was upse t and gave her the opportunity to ask questions and voice her concerns, and in turn made her feel special by giving her my time.   As Maisey asked me to speak loudly into her right ear I wondered if her history of deafness had been accurately assessed, as she was definitely not deaf but having communication difficulties.   Eradicating this problem with help of a speech and language therapist or a hearing aid would have helped Maisey and the impatient staff enormously in this situation.   Although I had been informed that the patient could be aggressive, I managed the situation by relating to her position and understanding her point of view.   Leadbetter and Patterson (1995) explain the prevention and management of aggression should be dealt with by showing empathy and respect for the patients individuality and being genuine, utilising an open and honest manner.   Finally, integrity, and being aware of ones own competence to handle the situation.   Egan (1990) considers non-verbal communication to prevent violent situations such as considering body posture, nodding to show interest and making eye contact, but not as though to threaten the patient in any way. Fortunately, empathy and respect for Maisey helped her to trust and confide in me.   The reason for analyzing this particular section of the scenario was to answer the question, Why did the nurse not feel efficiently equipped to approach the patient herself, instead leaving the potentially aggressive situation with an unsupervised student?   In the NMC Code (2008), advice for a registered nurse is to recognise and work within the limits of your competence, but also to have the skills and knowledge for safe and effective practice.   I believe communication skills within the nursing team must be rigorously developed and maintained as one professional alone cannot meet a patients requirements.   We need to work collaboratively to provide maximum care delivery.   Maisey felt more relaxed, valued and safe, after we identified and resolved her concerns.   Older people generally have more barriers to communicating effectively.   These barriers are worth investigating, as the acquisition of a little understanding and basic skills is a simple and rewarding exercise. (Myerscough, 1992)   The barriers Maisey faced, was the time the nurses had to spend with her, and the fact that she was deaf.   Myerscough (1992) explains that this is overcome by speaking loudly and clearly, using clear lip movements to assist lip reading.   Through actively listening to the patient and encouraging conversation we managed to focus on the problem that was causing unease.   I do believe that Maisey was discriminated against because of her conditions and illness, as she was not given the time and energy that was given to other patients.   The Human Rights Act (1998) Article 14 explains that every person should be treated equally without any discriminat ion on any ground.   This section of the act was broken when the staff failed to treat Maisey as they would the other patients.   Maisey was confused and upset that she had not been given time to adapt to her surroundings, and was in fear due to the separation from her main caregiver.   Most patients do suffer a degree of anxiety and apprehension and admission to hospital is in particular a disturbing experience for anyone. (Lloyd and Bor, 1996)   They offer explanations for these anxieties, such as being in an unfamiliar environment and separation from family and friends.   Loss of personal space is a factor mentioned, as is loss of independence and privacy.   One that closely relates to the scenario is uncertainty of diagnosis and management.   Maisey was uncertain of what was going on.   By providing her with the information she required, she could understand a purpose for her admission and the decisions being made.   Conclusion The reason for Maisey being upset, and the nursing teams reluctance to help her, all stem from the same thing.   As we have discovered communication and ones ability to reflect on practice have enormous effect on the capability to provide the highest possible quality of care.   Additionally time and commitment to our patients is priceless as it can never be taken away from them.   We also need to realise that ones own values have effects on interaction with our patients, so appreciating that our client has different values and beliefs to ourselves help us gain insight into the reasons they think and behave as they do.   Some consider interacting with others as hard work, but we as nurses need to understand that communication is the gateway to successfully helping our patients and improving our skills.   Action Plan On reflection I saw first-hand how easily communication can break down, if not between nurse and patient, then within the multi-disciplinary team.   I will take the experience with me throughout my nursing education, remembering the importance of effective communication, and also the ability to look back at an experience and break it down to discover what really happened.   Taylor (2000) defines how reflection on action occurs perfectly.   He explains that only when details of events are recalled and analysed, unpicked and reconstructed considering all aspects of a situation, can one gain fresh insights and amend actions.   He quotes Critical thinking is essential for safe practice.   (Taylor, 2000)   This should be an ongoing and extensive process for all nurses in practice.   I will be more aware of my interaction with others and will constantly reflect on my experiences to see the whole package of care delivery.   REFERENCES Becker, E.L. (1991) Churchills Illustrated Medical Dictionary. 3rd Edition. USA: Churchill Livingstone Data Protection Act 1998 London: HMSO Davis, C. (2008) Tea and Empathy: discussing a project focusing on patient centred care. Nursing Standard. Vol 22, no. 32,   p.18 Elliss, R.., Gates, B., Kenworthy, N. (2003)   Interpersonal communication in Nursing.   2nd Edition. London: Churchill Livingstone Egan, G. (1990) The Skilled Helper: A systematic approach to effective helping.   4th Edition.   USA: Wadsworth Gibbs, G. (1988)   Learning by doing: a guide to teaching and learning methods. London: Further Education Unit Human Rights Act 1998 London: HMSO Heyward, T. Ramsdale, S. (2008) Interpersonal Skills. Chapter 1 IN Richardson, R. (Editor) (2008) Clinical Skills for Student Nurses.   UK:   Reflect Press Lloyd, M. Bor, R. (1996)   Communication Skills for Medicine.   New York: Churchill Livingstone Myerscough, P.R. (1992) Talking with Patients: A Basic Clinical Skill.   2nd Edition.   Oxford: Oxford University Press Nursing and Midwifery Council (NMC) (2007) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives.   London: NMC Nursing and Midwifery Council (NMC) (2008) Essential Skills Clusters for pre-registration nursing programmes.   London: NMC Santamaria, N. (1993) The Difficult Patient: An Important Educational Need of Registered Nurses. Unknown Stockwell, F. (1972) The Unpopular Patient.   London: Royal College of Nursing Taylor, B.J (2000) Reflective Practice: A guide for nurses and midwives. Buckingham: Open University Press p.64 Timby, B.K   (2009)   Fundamental Nursing Skills and Concepts.   9th Edition.   London: Lippincott, Williams and Wilkins Weller, B.F (2002)   Baillieres Nurses Dictionary.   24th Edition. London: Elsevier

Free Billy Budd Essays: Billy Budd as Christ :: Billy Budd Essays

Billy Budd as Christ In this novel, Billy Budd, Melville acts as a "Creator", in that he gives Billy Budd certain superhuman qualities, which allows him to posses the traits of a servant of God. Billy Budd appears Christ-like, because of his peace-making abilities. Although, he is a peacemaker whom will fight for what he believes in and to keep peace. In the beginning of the novel, when Red Whiskers gives Billy Budd problems, he strikes him with a powerful blow and does not have any more problems with him or the crew again. Melville then foreshadows how Billy will use the same tactics the next time he runs into a bully like Red Whiskers. It seems ironic of the names of the ships as we go along in the story. Billy Budd goes from the Rights-of-Man to Bellipotent, it seems then he makes a change like a minister being ordained to a Bishop. Bellipotent signifies a good ship, in that belli- means kind, and -potent means strong and powerful. Melville seems to want his audience to think of the ships as Christ-like symbols also. As in another story, Young Goodman Brown by Hawthorne, a young man is too eager to meet his destiny. Billy Budd is not at the least hesitant, when Lieutenant Ratcliffe wants him for service to King George Ill. Billy Budd goes from a peaceful merchant ship, to a ship at war, full of guns and military discipline. Me lville is suggesting here that Billy will most like endure many problems and hardships entering this service. Billy Budd acts as the foretopman on this ship, which leads the audience to wonder is he doing it out of the grace of God, to make a change on the ship, or is he toying with fate. At the time this novel took place, wars were going on, which was later called the Great Mutiny (a time when sailors rebelled against their own). That explains most of the story Melville is attempting to display. Melville introduces Captain Vere as a dedicated officer who only permits obedience to duty and is very strict with discipline. The author has already foreshadowed many things for the audience. He lets us see how Billy is bound to run into a confrontation with at least one shipmate, and may possibly be accused of mutiny, since the thoughts are already on many officers' minds.

Sabiduría y enseñanza en la ciudad en crisis (Platón, Apología 18a7-20c3) :: Spanish Essays

"Sabidurà ­a" y "enseà ±anza" en la ciudad en crisis (Platà ³n, Apologà ­a 18a7-20c3) ABSTRACT: Con Platà ³n se produce el reconocimiento de la educacià ³n como el lugar en que una comunidad mantiene su peculiar instalacià ³n en la realidad y por ello como el terreno de la accià ³n politica eficaz. La problemà ¡tica, presente ya desde los textos socrà ¡ticos, es ubicada en el pasaje de la Apologia de Sà ³crates en que la mencià ³n de las ‘acusaciones antiguas’ permite ver el juego de distintos elementos-la paideà ­a, la opinià ³n pà ºblica, el saber-en un momento de crisis. Esta crisis, tanto de la base polà ­tica tradicional como de la polà ­tica pragmà ¡tica, se traduce en un oscurecimiento de que lo que son el hombre y la pà ³lis que da lugar a Sà ³crates y a su tarea como consciencia de la quiebra del mundo polà ­toco. Se desarrolla el alcance ontolà ³gico de ella y sus-paradà ³jicos-consecuencias polà ­ticas y educativas. Una usual caracterizacià ³n sociolà ³gica de la educacià ³n la define como los modos de reproduccià ³n de una sociedad. En el fondo, la educacià ³n està ¡ exigida por el hecho de que una comunidad determinada (asà ­ sean las grandes sociedades contemporà ¡neas) resulta el lugar primario del encuentro del hombre con la realidad, y esta apertura del mundo, por ser siempre concreta, es histà ³rica y finita, y por ello tiene que esforzarse permanentemente para mantenerse abierta, ya que en cualquier momento puede oscurecerse y quebrarse. La educacià ³n es parte decisiva de este esfuerzo. El nombre de Platà ³n parece ligado a una concepcià ³n que, lejos de encontrar un fundamento en la finitud, lo encuentra—si vale la palabra—en lo 'absoluto', dejando a lo finito en una regià ³n ontolà ³gicamente là ­mite. Y sin embargo esta comprensià ³n de la realidad—que el Platà ³n maduro traducirà ¡ en la doctrina de las Ideas—està ¡ ligada al intento de rescatar a su particular comunidad de un naufragio (rescate que Platà ³n cree todavà ­a desesperadamente posible, aunque en realidad ya era tarde). Ya los textos "socrà ¡ticos" (la Apologà ­a de Sà ³crates y el Crità ³n) marcan, en la compleja relacià ³n de Sà ³crates con su ciudad, el reconocimiento, a la vez, del carà ¡cter fundante de lo comunitario-polà ­tico y de la quiebra interna de ese fundamento; y es justamente esta quiebra la que permite reconocerlo como tal. Estos textos tambià ©n marcan el comienzo de la reflexià ³n platà ³nica sobre la educacià ³n, que el drama socrà ¡tico signa inicialmente de violencia. Sà ³crates es la và ­ctima ilustre de una realidad social fallida que se opone con toda su fuerza a quien seà ±ala esa quiebra de sus fundamentos y que aparece asà ­ como 'subversivo' mucho antes de cualquier propuesta de replantearlos o cambiarlos.

Deductive and Inductive Methods of Research Essay

In the quest for logical, supportable and verifiable scientific answers there are two basic methods of reasoning used to approach the subject matter to be studied. These are known as the deductive and the inductive approaches. The two approaches provide quite different lines of attack when attempting to prove or disprove social theories. The information that is gathered is used by social work researchers as supporting evidence to establish connections between theories and empirical data. Rafael Engel and Russell Schutt, The Practice of Research in Social Work, explain â€Å"Theories help us understand how social problems emerge; they guide us in the design of interventions to help individuals, groups or communities†(Rafael. Schutt. 2005. p. 39). In the case of deductive reasoning studies the research is begun from a theoretical basis, focused on a topic, and then narrowed to an; ‘If-Then’ hypotheses that can be tested. Research is conducted to gather data through observations, to confirm or disprove the hypotheses. Inductive reasoning is in a sense a reverse study, as it is through observations made that have initially picked up on certain trends, or established regularities that the hypotheses or theory is developed. In the field of Social work research it is not at all uncommon to utilize both methods of research, and Engel and Schutt refer to this as the â€Å"Research Circle† (2005. p. 45). Research often involves variables, and hypotheses often must stand up to multiple studies to arrive at a conclusive answer. The authors cite the Sherman and Berk’s, 1984, study of domestic violence â€Å"as an example of how the research circle works†(2005. p. 43). They said that first based on data regarding spousal abuse a hypothesis was developed regarding arrest rates. After data was researched that corresponded with the theory, the study was then followed up with inductive research based on the statistics of the data gathered. As noted often the researchers will go around the circle a number of time, as Sherman and Berk’s study did, adjusting variables and methods, to test a multitude of hypotheses. According to Engel and Schutt the â€Å"Inductive research process is more often the strategy used in qualitative methods† (2005. p. 38), and that deductive is â€Å"Most often used in quantitative methods† (2005. p. 38).

Effects of Smoking

Effects of Smoking According to the Clinical Respiratory Journal an average of five million people will die globally every year from effects of tobacco smoke. The number of people that dies is shocking. Smoking has many terrible effects on the human body from effecting the lungs, heart, and even causes cancer if you did not know that already. Why do people smoke? Some people might ask. Well there is nicotine in tobacco which causes your muscles to relax and thus causing that relaxing non stressful feeling that people who smoke feels while â€Å"enjoying† a cigarette.The feeling can be eally strong for a first time smoker causing a â€Å"buzz†, since their body has not built up a tolerance to the nicotine. When people do start to build up their tolerance level, the feeling of the pleasurable â€Å"buzz† or relaxation lessens to where you must smoke more than one cigarette to feel relaxed or even a slight â€Å"buzz†. But there is a drawback nicotine is a hi ghly addictive substance. So addictive in fact that according to heart. org compares it to hardcore drug addictions like cocaine and heroin.So once people start they are caught in a trap. Heart. org states that approximately sixty-eight ercent of smokers want to quit, but are unable to stop because of the high amounts of nicotine in his/her body. But what happens to those who cannot quit? Well let me start with the place smoke gets inhaled to: The Lungs. The harmful smoke from the cigarette causes immediate life threatening damage to the lungs the second the smoke enters. According to Lung. org cigarette smoke has over 4,800 chemicals with sixty-nine known chemicals to cause cancer.Even with Just one inhale all of those chemicals will enter the lungs. Cigarette smoke has been also connected to chronic obstructive pulmonary disease (COPD) such as chronic ronchitis and emphysema. On top of COPD, cigarettes also cause the lungs to shrink and turn black, thus causing inability to breath e deeply and less oxygen in the blood stream. That is way when smokers exercise they feel very light headed and out of breath, because there is not an ample supply of oxygen in the blood stream.How bad would that be to past out from lack of oxygen while playing with your grandkids? I would feel terrible to lead that kind of example of its 0k to smoke and cause that kind of harm to the lungs to where a person can't even spend quality family time with them. I have wondered why the lungs Just don't clean all of those nasty chemicals out, or why do smokers cough. I have found out that these two things are related. Everybody has these little hairs in their longs called cilia that help clean out mucus and harmful substances in the lungs.The smoke from a cigarette paralyzes these hairs causing mucus to build up in the lungs which gives people terrible coughs by trying to hack the mucus out of the lungs. Which if the person coughs for long enough and hard enough, the cough will cause major irritation in the throat making the person cough up blood. Now back to the chemicals, the cilia cannot clean the chemicals out of the lungs because it is the chemicals that immobilize them and will eventually all will die out and stop working if the smoker smokes long enough.Which if that happens the persons lungs will be almost beyond repair with all of the mucus build up, the chemicals causing harm, and the lungs not being able to clean out the natural substances that could already cause harm to the lungs. All in all t i is one highly deadly trio. The lungs are one of the part of the body that most people think get harmed when a person smoke, but people do not think about the heart. Almost twenty percent of people that pass away due to cardiovascular disease are directly related to smoking.That is saying that if a hundred people died from heart disease twenty of them died because of smoking, and not of high cholesterol or some other reason. That number is scary because of the fact of instead of harming one major organ the body the person is harming two. Smoking causes the heart to increase its rate of speed causing the resting heart beat to be considerably higher than the average nonsmoker. With each cigarette a person smokes the chances of artery disease goes up. Which means that also the chances of heart failure and having a heart attack goes up substantially.In some cases the threat of heart failure has a greater chance of happening than lung failure. Taking all of these factors into consideration people still smoke because it is their body and they are only harming themselves well may I say that statement is false. Secondhand smoke kills a number around 70,000 of nonsmokers a year. That's 70,000 people that care about their body day because of somebody else's stupidity and no awareness of how their choices impact others. Some smokers say that econdhand smoke is harmless, but that is a complete lie.Secondhand smoke can cause the same exact health concerns from the lungs, to the heart, and can even cause cancer. Yes, smokers are not the only ones who get cancer; it is also the people who they are around. Kids are extremely vulnerable to secondhand smoke from smokers. The kid's immunity system has not fully developed yet to even attempt to fight off the diseases from the smoke. Kids are already experiencing heart failure due to their parents' cigarettes. I have personally known a sweet kid who had trouble with his heart because his parents smoked.It is truly heart wrenching to watch it happen. If you are reading this please remind people to all of the health risks that smoking can impose. Such as cancer, lung disease, cardiovascular disease and along with telling them that smoking not only harms them but also their loved ones. Citations Carter, Charleata A. , Manoj Misra, and Robert R. Maronpot. â€Å"Tracheal Morphologic And Protein Alterations Following Short-Term Cigarette Mainstream Smoke Exposure To Rats. † Journal Of Toxi cologic Pathology 25. 3 (2012): 201-207. Academic Search Complete. Web. 3 Dec. 2013. ello, Francescopaolo D', et al.Question –  ALCOHOL, MARIJUANA, COCAINE, AND A WIDE VARIETY OF OTHER CHEMICAL AGENTS THAT ALTER PERCEPTIONS AND MOODS ARE CALLED?Answer at  https://donemyessay.com/unit-5-review/