Thursday, October 31, 2019

EMBA Essay Example | Topics and Well Written Essays - 500 words

EMBA - Essay Example My career path is perfectly aligned with the skills and abilities that I developing by being a part of Ivey advanced business education. I founded an Information Technology company which is currently considering launching an IPO to become a publicly trading company. Once this shift occurs my company will move into new territories such as international expansion plans. An MBA degree will provide me with the practical experience through business simulations and other scenarios that will expose me to comprehensive business environments. In order to be successful in the global marketplace companies need leaders that can synthesize information in order to make the optimal decisions. A higher level of knowledge of business will allow me to understand and manage business issues such as diversity in the workplace and how boost sales despite recessionary forces. Along with the technical and analytical tools I will learn in my journey towards obtain an MBA degree my goal is to improve my interpersonal skills by working side by side with my fellow student peers. Talking and sharing professional experiences with dynamic people helps develop a person’s communication skills and comprehension of different business scenarios. An MBA degree means a person is joining a select group of individuals since in the United States 6.8% of the population achieve a Masters degree. Studying in the Executive MBA program at Ivey will help my personal development by exposing me to a great network of people with similar interest that reached the same development path while coming from different

Tuesday, October 29, 2019

Scandal and controversy Essay Example for Free

Scandal and controversy Essay Scandal and controversy are a true recipe for commercial success. And with the format of the Big Brother being such that everyone in the world can see what a person does in private, the people get naturally interested. The commercial success of any program depends on the number of users it gets and the public debate it generates (read: media coverage)-more so for a reality TV program like Endemol’s Big Brother. Since its inception in Netherlands, the show has spread into many other countries, which has introduced the cultural element to it. How different people react when two different people with different backgrounds, ideas, perspectives and interests are forced to live together under one roof for a considerable period of time provides entertainment to the masses. And the figures show this. From 3 million in the first week, the show had 8. 8 million viewers at its peak for the recently-concluded, controversy-marred Celebrity Big Brother in UK. The Big Brother brand earns 10 percent of the revenues of Channel 4 which broadcasts Celebrity Big Brother. With Big Brother open for public debate, controversy is created for the smallest of reasons, since the participants are treated as minor celebrities by the masses. Sometimes, the views included racism, gender bias, sex, etc. which have again led to media activism and public debate regarding the views of the bourgeoisie and subsequent problems. The format is suited for the masses, because on the one hand, you see how a person reacts in public, while on the other, you see how they actually feel through the ‘Diary Room’. The housemates have to work according to the orders of the ‘Big Brother’, which makes it doubly interesting to see how these people live under stressful conditions. And with the voting being done both by the public and the participants on whom to evict from the house, the interest level of the masses automatically goes up, since their decision influences the eviction. That the show is a commercial success is proved by the fact that continuous video streaming facility is available on the Internet, where the people can see 24-hour feeds of what the housemates were actually doing, and people were actually ready to pay to get these feeds. The show is also used for psychological studies by scientists. German scientists even discovered that the participants are likely to suffer from Post-Traumatic Stress Disorder, generally seen in those who leave armed forces. A lot of interest also goes into the fact that even in this age of liberalization and globalization, the state of race, gender and class relations is primeval. And it comes out in the open due to the realistic nature of the show. The fact that such problems exist even in democratic, egalitarian societies increases the interest of the viewer and makes the program commercially successful. The show has been criticized by experts from everything ranging from the concept of the program to how problems like racism are used to maximize profits. Yet the fan following of these programs belies the wildest of imaginations. Also with the media available today, it is easy to vocalize opinion across the borders. And the program is benefiting commercially from all this hype. The success of the program in some countries may well be because it challenges the ways in which the society operates, in an honest and real manner rather than being acted out as in a soap opera. And being inherently different from the soap opera gives the masses something different to watch, something to which they can relate more. It gives a platform to the audience to evaluate and contemplate the existing societal order. Big Brother is about interacting with the audience-and getting people to decide the fates of participants. Interactive TV provides such incentives to the general public and is responsible for making the show such a commercial success. References: 1. Big Brother (TV series) Available on http://en. wikipedia. org/wiki/Big_Brother_(TV_series) 2. When the Whole World is Watching: The Case of Celebrity Big Brother Available on http://flowtv. org/? p=247 3. November 2002, Celebrity Big Brother Offers Even More Interaction Available on http://www. bbc. co. uk/pressoffice/bbcworldwide/worldwidestories/pressreleases/2002/11_november/audiocall_celebrity_bb. shtml 4. Hanks Robert, January 2007, First Night: Celebrity Big Brother, Channel 4 Available on http://news. independent. co. uk/media/article2124296. ece 5. Big Brother Available on http://www. bigbrother. com/big-brother. php 6. Big Brother International: Formats, Critics and Publics Available on http://www. wallflowerpress. co. uk/publications/television/big_brother. html

Sunday, October 27, 2019

The Abuse Of Native Americans

The Abuse Of Native Americans The white colonizers of the past helped turn the once New World into the United States of America, a dominating world power that prides itself on being a fair, non-discrimatory and liberal country. What has been long forgotten is how they made their progress, that is, the destruction, torture, and unfair treatment of the first inhabitants of America, and how these people are treated to this day. Early Colonization The colonization of the Americas is dated all the way back to the 11th century when the Vikings (the Norse) settled in Greenland and Newfoundland. The contact they had with the indigenous people, the Inuits, was hostile, something that could have been taken as a sign of forewarning of the later contact between the natives and the European colonizers. These Norse colonies were not long-lived and they eventually disbanded in the 15th century.  [1]   In 1492, Columbus headed the expedition to America in the name of the Spanish. Colonization and exploration grew very popular and soon most of the islands in the Caribbean had been colonized.  [2]  By 1494, the Spanish and Portuguese had made the treaty of Tordesillas which divided the New World between themselves. The Portuguese took all of what is now present-day Brazil while the Spanish pushed onward with conquering as much as possible. Spanish Conquistadors Spanish conquistador, Hernan Cortes, had overthrown the once very powerful Aztec Empire in Mexico who had thought him to be Quetzalcoatl, an Aztec god who had come to destroy their empire. He slaughtered thousands and people and burned some of the city.  [3]  Pizzaro, a second cousin to Cortes, overtook the Incas in Peru, also massacring thousand and ransacking the entire empire. What is astonishing is the pure cruelty of these men in the name of Spain who had been welcomed with open arms.  [4]  In an account by Waman Poma, the Incan emperor, Atahualpa, sent gifts to the Spanish. Poma wrote, The presents consisted of male servants and sacred virgins. Some of the virgins were also offered to the Spaniards horses, because, seeing them eat maize, the Peruvians took them for a kind of human being. Until that time, horses were unknown to our people and it seemed advisable to treat them with respect.  [5]   Continued Colonization Colonization continued on, with Spanish Florida, the English colonies of Virginia and New England, the French colonies of Acadia and Canada, the Swedish colony of New Sweden, and the Dutch New Netherland. By the 18th century, Denmark-Norway revived their colonies in Greenland and Russia took Alaska.  [6]   It is quite obvious that with the onset of so many foreigners, the Europeans, clash was eminent. What wasnt so easily seen was what the Europeans brought with them-disease. Smallpox, typhus, influenza, diphtheria, and measles wiped 10 to 20 million of the indigenous population.  [7]  Before these plagues, the natives had been used as servants and slaves but once they started dying out, Africans were brought to the Americas to take their place. White Overtaking and Manifest Destiny As more and more Europeans came to the Americas, the more land they wanted to cultivate and occupy. By the 17th century, for every one Native American, there were three white Europeans.  [8]   During the 1800s, John L. OSullivan, the New York newspaper editor used the phrase Manifest Destiny.  [9]  He had created a term for a long-held belief that the whites of America had the right to expand their territory to the West, that it was their duty and was approved by God in every way. People started making advertisements, paintings, and pictures to encourage the expansion.  [10]   What all this did was cement the idea of white supremacy over the Native Americas. None of this was a good thing for the Native Americans because now the whites had even more a reason in their minds to continue their expansion and to continue their efforts for civilizing them which meant making them live as Whites. This meant they must be Christian, must build homes and practice private property, and educate their children in a way that the dutiful White Christians saw fit.  [11]   Indian Removal Act and the Trail of Tears What was one of the biggest steps taken to move Native Americans so the Whites could have all access to the land was the Indian Removal Act of 1830, which was signed by President Andrew Jackson.  [12]  Though this act was supposed to be voluntary on the side of the Native Americans, community and tribe leaders were made to feel a great deal of pressure to sign the treaties that would move them from their ancestral homes to the West. This was a very controversial act and many white people were opposed to it because of how unfair it was to the Native Americans. There was definitely greater support of the Indian Removal Act though, especially by the South because they wanted access to lands where different tribes were occupying.  [13]  These tribes were called the Five Civilized Tribes which consisted of the Cherokee, Choctaw, Muscogee-Creek, Chickasaw, and the Seminole.  [14]   The pressure grew and chiefs finally gave in. First to sign a treaty to move with promise of new land and money was the Choctaws in Mississippi. The treaty the Choctaw chief signed was called the treaty of Dancing Rabbit Creek and when interviewed by the Arkansas Gazette, he said the removal was a trail of tears and death. Five years after the initial passing of the Indian Removal Act, the Cherokee signed the Treaty of New Echota.  [15]   The removal of the Cherokee, Muscogee-Creek, Seminole, and Choctaw was called the Trail of Tears. These tribes were moved to Indian Territory and experienced exposure, disease, and starvation during their journey. 4000 of the 15000 Cherokee that made the journey died on their way to the Indian Territory.  [16]   Resistance, Victories and Defeats Though many Indians cooperated with the American government, some fought back and tried resisting. Indian Wars broke out and they did win some, such as the Battle of Little Bighorn. The greatest victory by the Native Americans was when Tecumseh, a Shawnee leader of a multi-tribal group, allied with the British and defeated the White Americans in Detroit St. Claires Defeat.  [17]   Although they won sometimes, the Native Americans lost quite a few battles, such as the Creek War, the Sioux Uprising, the Sand Creek Massacre, and Wounded Knee. Times were very hostile and by 1872, the United States government went by a policy that meant the extermination of all Indians unless they moved to reservations so as to be more civilized and become Christianized.  [18]  Paul Wellman describes quite accurately in his 1934 book the pure torture and disregard of Native Americans during this time: The Indian [was thought] as less than human and worthy only of extermination. We did shoot down defenseless men, and women and children at places like Camp Grant, Sand Creek, and Wounded Knee. We did feed strychnine to red warriors. We did set whole villages of people out naked to freeze in the iron cold of Montana winters. And we did confine thousands in what amounted to concentration camps.  [19]   Americanization Once the federal government had gotten most Native Americans onto reservations, they started the process of Americanizing them. The federal government was able to treat them almost as if the Indians were their wards because, in fact, they were. This was so because in 1871, the Indian Appropriation Act was passed which stated that the government no longer viewed the Indians land as separate countries and their communities as separate nations but that the land would belong to the government and the Native Americans would become wards of the United States government.  [20]  This is what the Indian Appropriation Act said: That hereafter no Indian nation or tribe within the territory of the United States shall be acknowledged or recognized as an independent nation, tribe, or power with whom the United States may contract by treaty: Provided, further, that nothing herein contained shall be construed to invalidate or impair the obligation of any treaty heretofore lawfully made and ratified with any such Indian nation or tribe.  [21]   Once this was done, the government passed more laws which constricted the Native Americans even further. These laws forced them to give up their old way of life, such as moving from their traditional places of inhabitation to more Americanized homes. They were also made to change their appearance and their names. Men were often made to cut their hair and whole communities were made to abandon their old religious practices in favor of Christianity.  [22]   Schools were created for the Native American children so as to get them used to their new lives and to also quickly Americanize the youth. They were forced to choose American names and to only speak English, abandoning their native tongue. Doing this to the Native Americans was very damaging to their tribal identity and also basically stripped them of all they had once known in favor of the strange American way.  [23]   The General Allotment Act of 1887 (The Dawes Act) The Dawes Act was enacted in 1887. What this did was it took once tribally-owned land and fractioned it off to the Native Americans. Families received about 80 to 160 acres while unmarried adults received about 40 to 80 acres. The rest of the land that had not been allotted was opened to railroad development and settlers not of Native American descent.  [24]   The Dawes Act was enacted so as to better assimilate the Indians into American society which meant getting them to learn how to farm and eventually support themselves. Though it seemed like this act had good intentions, the biggest reason it was enacted was unspoken, but the most important at the time. The dividing of land was to break up the Native Americans sense of culture and unity. Along with this negative aspect was the fact that the land allotted to them was not sufficient for living off of.  [25]   Though this was obvious, in 1906 the Burk Act was passed which meant that all allot tees were deemed competent and capable and could be taxed. If they were determined incompetent by the Secretary of the Interior the land could be taken away and leased by the federal government. In total, the Dawes Act was manipulated and executed in a way that negatively affected the Native Americans, robbing them of their land and resources.  [26]   The Indian Citizenship Act of 1924 (The Snyder Act) Life was a bit easier for Native Americans if they had status as an American citizen. They could acquire citizenship if a woman married a white man, through military service, if they had allotments, or through special treaties.  [27]  This was unfair because they had to go through special and unusual processes to even be considered citizens of the county they lived in while any white man had full American citizenship the day they were born. People realized this fact and in 1924, the Indian Citizenship Act (also called the Snyder Act) came along. It was proposed by Representative Homer P. Snyder of New York and was signed into enactment by President Calvin Coolidge on June 2.  [28]   The biggest reason though for this enactment was to, once again, better assimilate the Native Americans into American society. They had already proven themselves possible good members of society by being part of the military during World War I. This act did not include citizens born before the enactment date but did include all Native Americans that were born after.  [29]   Native Americans in WWII Once World War II broke out, the Native Americans joined in just as they had during World War I. This earned them more respect than they had had before. Because they had always had the image of the mighty and brave Indian warrior, non-Native Americans often called their Indian comrades chief which could have been seen as a token of respect.  [30]  The movement of the Native Americans to go to war was the largest scale exodus since the Indian Removal Act during the 1800s. The war had a huge impact on the Native Americans and their lives back home. Seeing the outside world change their perspective on life. Also, they were able to find well-paying work because of the wartime labor shortages because of the men away at war.  [31]   What also brought added respect and boosted the reputations of the Native Americans was that the military used Navajo code talkers to communicate secret information in the Pacific. This code was never decoded by the Japanese.  [32]   Further Racism and Discrimination Though Native Americans had moved further up in status over time, it was not by much, Native Americans were still highly discriminated against and were not seen as equals in American society. Because of this, the American Indian Movement (AIM) was formed and was very much active during the 1960s and 1970s.  [33]  They worked to better the quality of Native American life and men and women leaders became powerful in doing so. One leader was a woman named Anna Mae Pictou Aquash. She put her own beliefs and demands for equality before her own safety. Because of this she was often involved in plots which led to her being in and out of jail. One plot, though, led to her being in much more serious trouble then her usual short jail sentence. She had been arrested in South Dakota for being an FBI killer. Two agents had been killed by members of AIM and because Aquash was a prominent leader, it seemed likely by the police for her to be somehow involved and deserved to be under suspicion. She was released on bail. Aquash was caught in Oregon and fled once again, fearing for her own life and safety. Sadly, she was found dead in 1976 on a Lakota ranch. She was not identifiable by police so her hands were cut from her body to possibly identify her.  [34]   The death of Aquash made Native Americans even more aware of their status in American society because she had only stood up for her beliefs, and she had been killed for it. Her people later found a bullet hole in the back of her head and found it suspicious that the police had cut off her hands to identify the body which they saw as being unnecessary and a sign that they may have been covering up Aquashs murder.  [35]   Indian Reservations Today Though the Indian Reservations were created so long ago, the quality of life has barely changed. It is extremely poor. So poor, in fact, that they are likened to developing countries.  [36]  60% of children are born out of wedlock and Native Americans are the third highest group in the country for teenage pregnancy. The suicide rate of Native American teenagers is three times that of the rest of America.  [37]   Alcoholism is a big problem of reservations. Native Americans are four times more likely to die of alcoholism and 17 times more likely to die in an accident involving alcohol. In addition to this, they are twice as likely to be involved in an arrest concerning alcohol.  [38]   One of the worst reservations is the Pine Ridge Reservation in South Dakota. It is one of the poorest in the nation. The unemployment rate is 35% to 45% and homelessness is 30%. The average income for those living on this reservation is $6100 a year.  [39]   Because of these terrible statistics, the reservations in the nation have the right to run casinos to bring in revenue through attracted tourists. They were given this right in the 1987 case, California v. Cabazon Band of Mission Indians. In the Indian Gaming Regulatory Act of 1988, their right was formally recognized.  [40]   Conclusion The Native Americans of the Americas have been through so much since the colonization that began hundreds of years ago. The treatment of them has been cruel and inhumane in all regards. Luckily, some acts have been taken to fix the problems these people face everyday. Hopefully in the future, they will have a better life for themselves and will experience less racism and poverty. With the help of the rest of American society, this is 100% possible.

Friday, October 25, 2019

Various Learning Disabilities Essay -- Diseases, Disorders

Learning Disabilities Unlike other disorders an individual may have, there is no quick way and easy way to confirm or deny a learning disability. There is no x-ray, blood tests, easy and quick surveys to help educators determine whether a learning disability exists. Many of the problems with identifying and assisting children with learning disabilities are to have knowledge of the various learning disabilities and how they affect students. The lack of information available to parents and teachers causes the students to continue to struggle in school and diagnosis for any disabilities to be postponed even further in their schooling. Finding reliable sources of information for learning disabilities is difficult. The subject is broad and many of the individuals offering information on the subject are doctors or professionals within the field of education. Similarly to the medical field, the opinions and research findings of the educational field very greatly between the researchers and what those researchers are attempting to discover or reveal. The term â€Å"learning disability† applies to a multitude of different disabilities. This term can refer to a specific disorder, specific disability, or a specific weakness within a student. Using the term learning disability is similar to grouping all people living in the United States as Americans. An important point of learning disabilities is they can occur with other disorders such as ADD or ADHD. This does not mean they occur with every disability, but can be present or contribute to a learning disability (Horowitz, Ed. D and Golembeski, Ed. M. par 9). The common learning disability in reading is called dyslexia. Reading problems occur in a student when they have difficulty unders... ...basics. 16 March 2012. Kemp, M.A, Gina, Melinda Smith, M.A and Jeanne Segal, Ph.D. HelpGuide.org. January 2012. http://www.helpguide.org/mental/learning_disabilities.htm. March 2012. Pilgrim, Fionna. dysTalk. 24 July 2009. http://www.dystalk.com/talks/85-the-7-causes-of-dysgraphia. March 2012. Pirotte, OD, FCOVD, Patrick J., Brandon R. Fisher, OD and Andrea J. Baker. Children's Vision Information Network. January 2011. http://www.childrensvision.com/. March 2012. Tian, Stan. Health Guidance, Health Guidance for better health. 2012. http://www.healthguidance.org/entry/12786/1/The-Causes-of-Dyspraxia.html. March 2012. Welding, Dr, Robert. MedicineNet.com, We Bring Doctors' Knowledge to You. 2011. http://www.medicinenet.com/aphasia/page2.htm. March 2012. Wilson, Dr., Anna. About Dyscalculia. May 2007. http://www.aboutdyscalculia.org/causes.html. March 2012.

Thursday, October 24, 2019

Are Parents Really to Blame for Their Kids’ Behavior?

Vanessa Olson Mrs. Novak September 17, 2012 Final Draft Are Parents Really to Blame for Their Kids’ Behavior? Watching how children, or even teenagers my age, act, I wonder how or why their parents let them get away with their behavior. What causes some kids to talk disrespectful to others or throw temper tantrums for the littlest reasons? My parents would tell me how, when they were my age, no one acted out like how children do today; that parents do not have the morals or values that the earlier generations have.After all, I personally would never allow my children to act in such ways. I started to research if parents were really to blame for the way their children act, or if kids act in their own ways no matter how their parents raised them. At first I searched through Google to see if I could find articles debating whether parents were really to blame for how their children behave. Most of the results came out to be that parents were responsible and that children acting ou t is usually because there is little discipline at home.I was not satisfied with only these results; I felt that there are exceptions to how children behave that are not solely in result of how they were raised by their parents. School, location, ethnicity, age, and religious factors all influence how we behave. Children are like sponges-they model everything a parent does and incorporate what they see into their own lives (Erikson 5). Reading this article, I was almost convinced that parents were actually really the main reason for children to act in the ways they do.After all, negative examples can be unhealthy as a child will mimic these and lead them to bad behavior. I continued to read on what types of factors would influence negative behavior. I found out social skills, stress, discipline, fighting, and child abuse are all major factors that children are exposed to that result in their behavior. Social skills, such as a simple â€Å"please† or â€Å"thank you†, c an be positively influential to kids; they will model what they witness their parents doing.According to the website More4Kids info, a parent’s reaction to stress affects the way a child reacts to stress (Erickson 6). If they believe they are the reason for yelling or lashing out, the child will sometimes shut him or herself down. Discipline, such as spanking or physically harming one’s child, does not teach that child how to modify their behavior; time-outs are alternate forms of punishment that can change their behavior in a calm manner. Verbal and physical fights are extremely hard on kids.Children may develop low self-esteems and may even behave violently toward other children (Erickson 6). Sometimes when children are abused, they shut down and try to understand why they are getting abused. Reading through this article on how all these factors really influence how children act, I started to believe that mouthy children are the result of bad parenting. Still questio ning if there were any other reasons for children to act out I continued to look at other articles online. According to Oxford University, poor parenting is not the reason for increased problem behavior in kids.They found out that there is no general decline in parenting. Parents and teenagers are choosing to spend more quality time together than in 25 years ago (Oxford 3). The most recent studies show how parents now a-days are more likely to know where they children are compared to what they are doing in the 1980s. I found this information to be particularly surprising because I feel that parents were much stricter in earlier generations then compared to now. The most interesting article I found on who is to blame for children’s behavior is on The New York Times website.Dr. Richard A. Friedman, M. D. , talked about a patient he had that dealt with depression and anxiety due to the fact that her son that had been a generally rude and unkind person his entire life. â€Å"I h ate to admit it, but he is unkind and unsympathetic to people,† said his patient (Friedman 1). When tested, the results came back saying he was in the intellectually superior range and that there was no evidence of any learning disability or mental illness. These same parents raised two other children who were socially and intellectually normal.How do parents raise two other well-behaved children while their other one turned out to be so misbehaved? When I read this, I felt that this was the truth. As I began to read the article Accepting That Good Parents May Plant Bad Seeds, part of me agrees with Dr. Friedman; sometimes good parents do have toxic children. Reading multiple articles arguing why parents are to blame for how their children act or how other factors can influence kids, I feel that both are to blame. On one hand, parents are to blame if their kids have no self-control and get away with acting out.But on the other hand, I feel that some kids are just bad kids; the y choose their own path to follow. For better or for worse, parents have limited power to influence their children. This is why they should not be so fast to take all the blame or credit for everything that their children become (Friedman 3). Vanessa Olson Mrs. Novak Annotated Bibliography 22 September 2012 A Selected Annotated Bibliography on Parents Influence on Kids’ Behavior Friedman, Richard A, M. D. Accepting That Good Parents May Plant Bad Seeds. 12 July   Ã‚   2010. Web. 13 July 2010. http://www. nytimes. om/2010/07/13/health/13mind. html? _r=0 This article was published in the New York Times and Richard Friedman, M. D. , explains the experience he had with one of his patients. She claimed to be depressed due to her son’s behavior. He talks about how their one son is not a nice person but they managed to raise two other well-adjusted children. I think this article is helpful; it explains how parents are not always the reason for how every child behaves. Also there is information of another set of parents who have been ignored by his son, having no phone calls or e-mails returned.The best part of this article is that it says that not everyone will turn out nice and loving, and that it is not necessarily because of parental behavior or their environment that they grew up in. Erickson, Rose. Parents Effect on Child Behavior. 21 Jan. 2010. Web. 14 Sept. 2012. http://www. livestrong. com/article/75282-parents-effect-child-behavior/ In this article, parents are to blame for how their children act. It states how negative examples from parents have a great effect and can cause children to develop bad behavior. The author gives particular topics in day to day life that influence how one behaves.I think this article is useful because out of all the articles about children’s bad behavior being a result of their parents, this has the best reasons why. I like how she used examples to show how each topic is the cause and that she backs up her statements. Also I like this article because Rose does not use words that exceed the average reading level. Oxford University. Today’s Parents ‘Not to Blame’ for Teenage Problem Behavior. 31 July 2009. Web. 14 Sept. 2012. This website talked about how most people believe that parents are much worse now than they were in earlier generations.It has statistics on how even though most believe it to be the other way around, teenagers and parents are much closer now than in earlier generations. Parents are more likely to know where their kids are and what they are doing. I found this article to be useful because it talks about how there are other factors, such as cell phones, television, and the internet, that can influence one’s actions no matter how they were raised. I like this article mainly because it talks about what most articles do not; the comparison between earlier generations and this current one.

Wednesday, October 23, 2019

Assessment and Care Planning: Holistic Assessment

Introduction This essay deals with the holistic assessment of a patient who was admitted onto the medical ward where I undertook my placement. Firstly, the relevant life history of the patient will be briefly explained. Secondly, the Roper, Logan and Tierney model of nursing that was used to assess the care needs of the patient will be discussed, and then the assessment process will be analysed critically. Identified areas of need will be discussed in relation to the care given and with reference to psychological, social, and biological factors as well as patho-physiology. Furthermore, the role of inter-professional skills in relation to care planning and delivery will be analysed, and finally the care given to the patient will be evaluated. Throughout this assignment, confidentiality will be maintained to a high standard by following the Nursing and Midwifery Council (NMC) Code of Conduct (2008). No information regarding the hospital or ward will be mentioned, in accordance with the Data Protection Act 1998. The pseudonym Kate will be used to maintain the confidentiality of the patient.The PatientKate, a lady aged 84, was admitted to a medical ward through the Accident and Emergency department. She was admitted with asthma and a chest infection. She presented with severe dyspnoea, wheezing, chest tightness and immobility. Kate is a patient known to suffer from chronic chest infections and asthma, with which she was diagnosed when she was young. She takes regular bronchodilators and corticosteroids in the form of inhalers and tablets. Kate lives on her own in a one bedroom flat. She has a daughter who lives one street away and visits her frequently. Her daughter stated that Kate has a very active social life; she enjoys going out for shopping using a shopping trolley.Assessment of the PatientAssessment TheoryIn this ward, the Roper, Logan and Tierney model of nursing, which reflects on the twelve activities of living, is used as a base for assessing patients (Alabaster 2011). These activities are â€Å"maintaining safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, controlling body temperature, mobility, working and playing, sexuality, sleeping, and dying† Holland (2008, p.9). Elkin, Perry and Potter (2007) outlined nursing process as a systematic way to plan and deliver care to the patient. It involves four stages: assessment, planning, implementation and evaluation. Assessment is the first and most critical step of the nursing process, in which the nurse carries out a holistic assessment by collecting all the data about a patient (Alfaro-Lefevre 2010). The nurse uses physical assessment skills to obtain baseline data to manage patients’ problems and to help nurses in the evaluation of care. Data can be collected through observation, physical assessment and by interviewing the patient (Rennie 2009). A complete assessment produces both subjective and objective findings (Wilkinson 2006). Holland (2008) defines subjective data as information given by the patient. It is obtained from the health history and relates to sensations or symptoms, for example pain. Subjective data also includes biographical data such as the name of the patient, address, next of kin, religion etc. Holland defines objective data as observable data, and relates it to signs of the disease. Objective data is obtained from physical examination, for example of blood pressure or urine. Before assessment takes place, the nurse should explain when and why it will be carried out; allow adequate time; attend to the needs of the patient; consider confidentiality; ensure the environment is conducive; and consider the coping patterns of the patient (Jenkins 2008). The nurse should also introduce herself to help reduce anxiety and gain the patient’s confidence. During assessment, the nurse needs to use both verbal and non-verbal communication. Using non-verbal communication means that she should observe the patient, looking at the colour of the skin, the eyes, and taking note of odour and breathing. An accurate assessment enables nursing staff to prioritise a patient’s needs and to deal with the problem immediately it has been identified (Gordon 2008). Documentation is also very important in this process; all information collected has to be recorded either in the patient’s file or electronically (NMC, 2009b).Carrying out the AssessmentKate was allocate d a bed within a four-bed female bay. Her daughter was with her at the bedside. Gordon (2008) stated that understanding that any admission to hospital can be frightening for patients and allowing them some time to get used to the environment is important for nursing staff. Kate’s daughter was asked if she could be present while the assessment was carried out, so that she could help with some information, and she agreed. Alfaro-Lefevre (2008) recommended that nursing assessments take place in a separate room, which respects confidentiality, and that the patient be free to participate in the assessment. Although there was a room available, Kate’s daughter said it was fine for the assessment to take place at the bedside because her mother was so restless and just wanted to be next to her. The curtains were pulled around the bed, though William and Wilkins argued that it ensures visual privacy only and not a barrier to sound. NMC (2009a) acknowledges this, along with the n eed to speak at an appropriate volume when asking for personal details to maintain confidentiality. The assessment form that was used during Kate’s assessment addressed personal details and the twelve activities of living. A moving and handling assessment form was also completed because of her immobility. First, personal details such as name, age, address, nickname, religion, and housing status were recorded. Information was also recorded about any agency involved, along with next of kin and contact details, and details of the general practitioner. Holland (2008) stated that these details should be accurate and legible so that, in case of any concerns about the patient, the next of kin can be contacted easily. The name and age are also vital in order to correctly identify the patient to avoid mistakes. Knowing what type of a job the patient does or the type of the house she lives in helps to indicate how the patient is going to cope after discharge. Holland also insisted that religion should be known in case the patient would like to have some privacy during prayers, and thi s should be included in the care plan. The second assessment to be done focused on physical assessment and the activities of living. Barrett, Wilson and Woollands (2009) suggested that when enquiring about the activities of living, two elements should be addressed: usual and current routines. Additionally, identifying a patient’s habits will help in care planning and setting goals. During physical assessment, when objective data was collected, Kate demonstrated laboured and audible breath sounds (wheezing) and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: blood pressure 110/70; pulse 102 beats /min; respirations 26/min; temperature 37.4 degrees Celsius; oxygen saturation 88%; peak flow 100 litres; weight 60kg; and body mass index 21. Taking and recording observations is very important and is the first procedure that student nurses learn to do. These observations are made in order to detect any signs of deterioration or progress in the p atient’s condition (Field and Smith 2008). Carpenito-Moyet (2006) stated that it is important to take the first observations before any medical intervention, in order to assist in the diagnosis and to help assess the effects of treatment. Kate’s initial assessment was carried out in a professional way, taking account of the patient’s particular circumstances, anxieties and wishes. After the baseline observations were taken, the twelve activities of living were analysed and Kate’s needs were identified. Among the needs identified, breathing and personal hygiene (cleansing) will be explored.Identified Care NeedsBreathingWilkinson (2006) states that a nursing diagnosis is an account about the patient’s current health situation. The normal breathing rate in a fit adult is 16-20 respirations/minute, but can go up to 30 due to pain, anxiety, pyrexia, sepsis, sleep and old age (Jenkins 2008). In old people, muscles become less efficient, resulting in increasing efforts to breathe, causing a high respiratory rate. On assessment, Kate’s problem was breathing that resulted in insufficient intake of air, due to asthma. She was wheezing, cyanosed, anxious and had shortness of breath. Wilkinson (2006) explained that a goal statement is a quantifiable and noticeable criterion that can be used for evaluation. The goal statement in this case would be for Kate to maintain normal breathing and to increase air intake. The prescription of care for Kate depended on the assessment, which was achieved by monitoring her breathing rate, rhythm, pattern, and saturation levels. These were documented hourly, comparing the readings with initial readings to determine changes and to report any concerns. The other part of the plan was to give psychological care to Kate by involving her in her care and informing her about the progress, in order to reduce anxiety. Barrett, Wilson and Woollands (2012) stated that it is very important to give psychological care to patients who are dyspnoeic because they panic and become anxious. Checking and recording of breathing rate and pattern is very important because it is the only good way to assess whether this patient is improving or deteriorating, and it can be a very helpful method for nurses to evaluate whether or not the patient is responding to treatment (Jamieson 2007). Mallon (2010) stated that, if the breathing rate is more than 20, it indicates the need for oxygen. Blows (2001), however, argued that this can happen even after doing exercise, not only in people with respiratory problems. Griffin and Potter (2006) stated that, respirations are normally quiet, and therefore if they are audible it indicates respiratory disease. Nurses needs to be aware of these sounds and what they mean, for example a wheezing sound indicates bronchiole constriction. Kate’s breathing was audible and the rate was also above normal and that is why breathing was prioritised as the first need. Oxygen saturation level was also monitored with the use of a pulse oximeter. The normal saturation level is 95-99% (British National Formulary ((BNF)) 2011a). Nevertheless the doctor said that 90-95% was fine for Kate, considering her condition and her age. Kate was started on two litres of oxygen and she maintained her oxygen saturation between 90 and 94%. The peak expiratory flow was monitored and recorded to identify the obstructive pattern of breathing that takes place in asthma (Hilton, 2005). This is another method that is used to assess the effectiveness of the medication (inhalers) the asthmatic patient is taking, and this test should be carried out 20 minutes after medication is administered. It is the Trust’s policy to do hourly observations on patients who have had one, two or three abnormal readings, until readings return to normal. Kate was observed for any blueness in the lips and tongue and for oral mucosa as this could be a sign of cyanosis. All the prescribed nebulisers, inhalers, bronchodilators, corticosteroids, antibiotics and oxygen therapy were administered according to the doctor’s instructions. Bronchodilators are given to dilate the bronchioles constricted due to asthma, and corticosteroids reduce inflammation in the airway (BNF 2011b). Kate was also started on antibiotics to combat the infection because, on auscultation, the doctor found that the chest was not clear. Kate was nursed in an upright position using pillows and a profiling bed in order to increase chest capacity and facilitate easy respiratory function by use of gravity (Brooker and Nicol, 2011). In this position, Kate was comfortable and calm while other vital signs were being checked. Pulse rate and blood pressure were also being checked and recorded because raised pulse can indicate an infection in the blood.CleansingDue to breathlessness and loss of mobility it was difficulty for Kate to maintain her personal hygiene. Hygiene is the practice of cleanliness that is needed to maintain health, for example bathing, mouth washing and hair washing. The skin is the first line of defence, so it is vital to maintain personal cleansing to protect the inner organs against injuries and infection (Hemming 2010). Field and Smith (2008) stated that personal cleansing also stimulates the body, produces a sense of well-being, and enables nurses to assess the patient holistically. Personal hygiene is particularly important for the elderly because their skin becomes fragile and more prone to breaking down (Holloway and Jones 2005). Therefore this need was very important for Kate; she needed to maintain her hygiene as she used to, before she was ill. The goal for meeting this need was to maintain personal hygiene and comfort. The care plan prescribed involved first gaining consent from Kate, explaining what was going to be done. Hemming (2010) recommended that identifying the patient’s usual habit is very important because each individual has different ideas about hygiene due to age, culture or religion. Identifying usual habits helps individuals to maintain their social life if things are done according to their wishes. Though Hemming said all human beings need personal hygiene, Holland (2008) argued that it is important to ask patients how they feel about being cleaned, especially in private areas. Kate indicated that she didn’t mind being assisted with washing and dressing. She preferred washing daily, shower and a hair wash once a week, and a mouth wash every morning and before going to bed. Kate was assisted with personal care 5-10 minutes after having her medication, especially the nebuliser. Individuals with asthma experience shortness of breath whenever they are physically active (Ritz, Rosenfield and Steptoe 2010). After having medication Kate was able to participate during personal hygiene. According to NMC guidelines on confidentiality (2009a), privacy and dignity should be maintained when giving care to patients. Therefore, whenever Kate was being assisted with personal care, it was ensured that the screens were closed and she was properly covered. Field and Smith (2008) suggested that assisting a patient with personal hygiene is the time that nurses can assess the patient holistically. Since Kate was immobile, it was very important to check her pressure areas for any redness. She was also checked for any pallor, jaundice, cyanosis or dry skin that needed attention. The care was always carried out according to her wishes.The Role of Inter-Professional SkillsConsi dering Kate’s age and condition, she needed multi-professional teamwork. NMC (2008) encourages teamwork to maintain good quality care. Kate was referred to the respiratory nurse who is specialised in helping people with breathing problems. Since Kate was on oxygen since admission, the respiratory nurse taught her the importance of healthy breathing and taught her some breathing exercises to help wean her from oxygen. Kate was also referred to the physiotherapist who did breathing exercises with her. Kate was not able to walk without aid so she was also referred to the occupational therapy department to assess how she was going to manage at home, or if she required aids to help her manage the activities of living. Upon meeting together, all the multi-disciplinary team agreed that Kate needed a care package, as she could no longer live without care. She was referred to social services so that they could assess this aspect of Kate’s future. After one week Kate was medically fit but could not go home because she was waiting for the care package to be ready. Her nurse shared information with the multi-disciplinary team in order to establish continuity of care for Kate. The team prepared for her discharge: the occupational therapy staff went to visit her home to check if there was enough space for her walking frame; social services arranged for a care package; and her nurses referred her to the district nurse to help her with her medication and make sure it did not run out.OutcomeKate responded well to the medication she was prescribed; normal breathing was maintained, her respirations became normal, ranging from 18 to 20 respirations per minute, and her oxygen saturation ranged from 95% to 99%. Kate was able to wash and dress herself with minimal assistance. She was discharged on a continuous care package comprising care three times a day, and the district nurse helped her with the medication to control her asthma.Evaluat ionThe model of the twelve activities of living was followed successfully on the whole. The nurse collected subjective and objective data, allowing a nursing diagnosis to be formulated, goals to be identified and a care plan to be constructed and implemented. Privacy is very important in carrying out assessments, and this was not achieved fully in Kate’s assessment. However, this lower level of privacy has to be balanced against causing anxiety to the patient. Kate’s daughter thought that the bedside assessment would be more comfortable for her mother, and therefore cause least anxiety. This was very important because of the effects of potential panic on breathing; therefore, this was the correct balance to strike. A multi-disciplinary team was involved in meeting Kate’s care goals. This is a good example of the use of inter-professional skills, as a number of different departments were involved in creating and implementing the care plan. However, the system was not as efficient as it should have been: Kate spent unnecessary time in hospital after recovery because the care plan was not yet in place. Assessment can also take a long time, especially with the elderly who are usually slow to respond. Therefore, more time is needed to be sure that the necessary progress has been achieved before taking further steps. However, poor staffing also affects performance in this area, an observation supported by the Royal College of Nursing (2012). In conclusion, the assessment of this patient was completed successfully, and the deviation from best practice recommendations (the lower level of privacy) was justified by the clinical circumstances. Progress from assessment to care goals was good, and at this point an inter-disciplinary team was used successfully. However, the one flaw in this process was delays, caused partly by the difficulties of working across different departments, and partly, it seems, by staff shortages. 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