Wise Judgment Scenario Essay Example for Free

Wise Judgment Scenario EssayThe wise judgment scenario that I have chosen to deliver on is the adolescent girlin love. The teenaged girls boyfriend that she is in love with is encouraging her to have sex he is adage he leave derive sure they only have protected sex. Older woman quite a little usually relate to situations like this, because we were all in one case young. I have personally dole outt with this wise judgment situation but at a younger age. When coming to situations like these one must make a wise judgment, this will take place with in the perception of the person. There atomic number 18 several questions the young girl needs to find or so am I archaic enough, do I really love him, is it worth it, or is he worth it. The person needs to look with in her emotional perception. This is the persons ability to identify emotions and recognize them in others. The teenage girl needs to think, does he really salute emotions for me as I do for him. She thinks that sh e is in love, but how does she know she is not experiencing lust for the boy?Maybe the couple spends too much time together, and she cannot decipher her emotions because she is constantly with him. If she was to go hang erupt with friends maybe then she could open up and realizes if this is something she should avoid at this age. Mood changes sometimes enable people to appreciate contrasting and to a greater extent points of view. This scenario is almost a hard factor for a lot of people to try and make judgments towards. I think this is because we do not know how old the teenage girl is, and we do not know her or the boy friends back ground. Now in our present time, teenage pregnancy is very frequent now, and most of them our in their very low teens. I think this should have a lot to do with decisions making when it comes to unprotected sex. If the boy friend says he will make sure, it is also in her wise judgment to make sure as well, not just him. Wise judgment has been hypnot ized into cardinal components, to better help people understand.The first component is factual knowledge about matters of lifespan. This means this includes knowledge about human nature, interpersonal relations, and social norms (Ch 4, pg94). The teenage girlneeds to get more information about interpersonal relation and human nature. This will help her understand how relationships work, and she can find out if she is in love with him or is it lust. If this is her first relationship it is more than likely going to be lust. As teenagers hormones kick in they like whoever is the first persons to show them the attention they like. This could also be another factor in her having sex with this boy. He could be using her because he knows she is irritable. The next component is procedural knowledge, this deal with weighing goals, methods of handling conflict, and ways of offering advice. The teenagers can use this knowledge by weighing goals that they wish to have as they get older.For ex ample if they pauperism to go to college, or even get married in a couple years, what if they have kids. All these need to be thought about when they be being sexual active because having protected sex does not always 100% prevent births. So they need t think, what happens if we do get pregnant, will I still be able to achieve the goals that I had before hand, like finishing school. Handling conflict is also a strategy they can think about, what if they have sex and they end up breaking up. Questions like where would we go from there? The third component is lifespan contextualism, this is knowledge about different roles and contexts of life and how they may change in life. The teenage couple may not realize that as they grow older and mature that there skill be someone else out there for them. If they can learn to wait and enjoy being teenagers and not have to possible deal with the risk and responsibilities of life, they skill find more friends and things to do.In a life we com e in contact with so many people, making so many friends along the way. flavour is to enjoy and not grow up to fast, live and learn. Next is the fourth component of wise judgment and it is recognition and management of uncertainly. This is that the future cannot be to the full known in advance and that life is unpredictable. This should be a very bear-sized component in talking about sexual relations, especially amid young people. Having a child at a young age is something that cannot be predicted. Even protected sex can go wrong the exceed protection is not having sex until parent hood is ready. The last component to wise judgment is relativism regarding solutions.This is to acknowledge individual and cultural differences in values and life priorities. This brings us back to goals. Setting goals as a younger person is vary valuable in life, it can help you reach what you want to be in life.The teenagers need to be aware of their goals and not only a couple but as individuals. They need to be fully aware of the personal effects that teen sex can cause. They need to think what happens if she does get pregnant are they financially responsible to take care of another life.Based on the five components of wise judgments the decision that I have made regarding this scenario is that they should wait. I have chosen to make this decision because all the facts make sense. If the teenagers are in love then I believe that they should be able to wait a little bit longer. They need to wait and make sure they are finished with school and both have reliable jobs. I think these are important to look at because if she happens to get pregnant she will not have to quit school or fall behind on school work, since she will be graduated.Also having jobs and an established place is a big deal. They do not want to have the burden of having a baby and not having anyway of raising the baby. Also it says that he is encouraging her into having sex, and I think that this is a form of peer pressure and on his behalf is not fair. Younger teenage girls are very vulnerable when it comes to having a boyfriend interested in being with them. So I think waiting is the true test of their relationship.

Hematologic Discussion Essay Example for Free

Hematologic Discussion EssayQuestion 1 genus Anemia is a condition of the neckcloth in which the human action of healthy red blood cells is very low to meet the oxygen requirements of body tissues. It is mainly categorise on the basis of erythrocyte morphology, physiology and probable etiology. The classification based on morphology of red blood cells takes into account the size of erythrocytes. Under this category microcytic genus Anemia occurs if the red blood cells are smaller than normal.Normocytic anemia is present if the red blood cells have the normal size but lower in number whereas macrocytic anemia occurs when the red blood cells are larger than normal. Based on etiology, various conditions are considered which result in either blood loss, excessive destruction of red blood cells and decreased or impaired production of red blood cells. On the same note, the physiological classification is based on haemoglobin level and occurs in three st periods. These include th e mild stage in which the Hb level is 110-90g/l, moderate stage in which Hb level is 90-70g/l, and mischievous stage in which Hb level is Laboratory criteria (Makama, 2010).The three types of anemia are iron-deficiency anemia caused by blood loss such as in cases of heavy or prolonged menstrual periods, insufficient iron supply or underutilization of iron in the body. Aplastic anemia is caused by inability of the bone essence to produce enough erythrocytes, platelets and white blood cells. Sickle-cell anemia is caused by a hereditary defect which affects Hb production in which the red blood cells sop up an abnormal crescent shape.It is worth noting that the most common type of anemia in the United States is iron-deficiency anemia since most women are of child bearing age and experience excessive blood loss during menses. Similarly, the signs and symptoms of this type of anemia are pale skin, fatigue, headache, dizziness, gastrointestinal disturbances, and dry mouth. Its treatment involves intake of iron rich nutriment including iron supplements (bodyandhealth. potentiometerada.com, 2009).Question 2DIC is an acronym that stands for disseminated intravascular coagulation. It is a serious disorder in which proteins which control blood clotting become abnormally active resulting in composition of blood clots within blood vessels. The clogging of blood vessels cuts off blood supply to various organs such as the brain, liver and kidneys. DIC can be caused by certain types of blood cancer, blood infection by fungus or bacteria and blood transfusion reactions. Clinical manifestations include excessive hemorrhage, hypertension, and blood clots. DIC can be treated by using plasma transfusions to replace blood clotting factors. Also heparin may be used to prevent blood clotting (nlm.nih.gov, 2010).

The Strategies of Ryanair

The St setgies of RyanairRyanair Holdings is Europes lead-in low-fare scheduled rider airline, carrying roughly 34 gazillion passengers per year, across 19 countries (Ryanair, 2006). The comp both operates short-haul, point-to-point routes amid Ireland, the UK and Continental Europe, and the companys leading market position provides the company with the ability to leverage its market position to further augment its operating network a key part of its current operating strategy. However, the predicted decline in the domestic European air travel market (Global commercialise Information Database, 2005) is likely to decrease the demand for the companys services and thus harm its resultant revenues, and so the other key aspect of the organisations strategy is to reduce its pic to these external threats. (Johnson et al, 2005). Hence this work aims to examine the interplay between these two strategies, critically analysing both their current, and potential future, success.Leveraging m arket position to drive revenueRyanair has the leading market share on most of scheduled routes between Ireland and provincial cities in the UK, carrying approximately 43% of all scheduled passenger traffic between Dublin and London. Additionally, the company has more than 45% market share on scheduled routes from Dublin, which include London, Manchester, Glasgow and Edinburgh, and London, which include Venice, Rome, Milan, Hamburg, Valencia and Gothenburg, as of January 2005. (Datamonitor, 2005) Ryanair has also been voted as the airline with the outstrip punctuality highest frequency which, combined with the companys leading market position, provides the company with the ability to leverage its market position to further expand its operating network.Ryanair has also been insurance c everyplaceage strong revenue growth since fiscal 1999, and the company reported revenues of 1336.6 million Euros during the fiscal year ended March 2005, an increase of 24.4% over 2004. (Ryanair, 200 6) The increase was earlier attributable to an increase in passenger volumes, which increased by 19% over 2004, and the companys revenues increased at a compound annual growth rate of approximately 28.6% from 1999 to 2005, despite the overall fall in air travel during that period (Global Market Information Database, 2005). Additionaly, Ryanairs net income increased at a intensify annual growth rate of 29.1% from 1999 to 2005. Thus, the companys strong consistent financial strength provides its operations with financial stability and the ability to fund its expansion strategies.Ryanair thus has an exceedingly strong and aggressive business strategy, which is focused on its objective to firmly establish itself as Europes leading low-fares scheduled passenger airline. The company offers low fares intentional to stimulate demand, particularly from fare conscious leisure and business travellers. (Ryanair, 2006) The company favours secondary airports, as they are generally less congest ed than major airports and great deal be expected to provide higher rates of on-time departures the company can thus achieve faster turnaround times and fewer terminal delays and shed swingy on competitive handling costs. (Datamonitor, 2005) The strategy has enabled the company to have a better on time performance record, than its bigger competitors. In addition, Ryanair enters into agreements with third party contractors to address passenger and aircraft handling, ticketing and other services, and the company fixes its contracts on competitive terms by negotiating multi-year contracts, at prices that are fixed or subject only to periodic increases united to inflation. Ryanairs strong business strategy thus enables the company to synchronize its operational strategies in accordance with the market requirements, thereby enabling the company to maintain a cost effective business strategy.Hedging against external threats.Crude oil prices are at an all time high in March 2005, ligh t crude oil prices climbed to $55.40 per barrel after peaking at $56.1 per barrel. Additionally, jet kerosene prices have increased by over 80% from 2004. In order to hold dear their operations from significant volatility, airlines have fairly robust hedging positions, as the volatility in oil price and availability of jet fuel importantly affects operations. Although its European competitors have traditionally been sufficiently well hedged against volatile oil prices, Ryanair has always been unhedged. As of April 2005 the company was not covered by any hedging protection against oil prices however, as of November 2005, Ryanair hedged 90% of its estimated demand for the second half of its fiscal year, at prices corresponding with oil averaging $49 per barrel. take off of the carriers strategy is now to build hedges forward, and its financial prowess means it has the cash position to succeed. (Fiorino, 2005)The companys revenues are also highly dependent upon revenues from the UK a nd Irish market historically the company has generated over 50% of total revenues from the UK. For fiscal 2003 and 2004, passengers on Ryanairs routes between Ireland and the UK accounted for 35.9% and 28.6% of total passenger revenues respectively, with Dublin and London accounting for approximately 13.4% and 10.7%, respectively. Additionally, total passenger revenues, and the Dublin-London route accounted for approximately 7.6% and 6.0%, respectively. (Datamonitor, 2005) The companys dependence on Ireland and the UK, could significantly impact the companys revenues receivable to regional factors, and thus although Ryanair is also attempting to increase its market share as a whole, it is specifically attempting to do this into more diverse areas, such as Eastern Europe, in an attempt to reduce its exposure to the demand changes in the UK and Irish market. shutdownRyanairs primary business strategy has always been to fly as many passengers at as low a cost as possible (Ryanair, 200 6). condescension the fact that passenger numbers are generally not increasingly significantly (Global Market Information Database, 2005) and the fact that Ryanair has been forced to divert some of its resources to hedging, due to market conditions (Fiorino, 2005), this strategy still forms the core of the airlines business model, and is often viewed as the companys core competence (Johnson et al, 2005) Given that revenues, profits and passenger numbers have soared over the past few years, despite the uncertainty in the external environment (Datamonitor, 2005), this analysis concludes that, not only are Ryanairs current strategies hugely successful, but they allow for continue to be for the foreseeable future.

Fall of Malacca Empire

Fall of Malacca EmpireFALL OF malacca EMPIREThe golden age of Malacca ended in 1511. Empire Malacca who called to an end after the Portuguese attack Malacca under the rule of Sultan Mansur Shah.Internal FactorsWEAK LEADERSHIP OPPRESSIVE garbage disposalWeak ruling government is the root cause to the pin tumbler of the Malacca Sultanate. They were overdependence on Tun Perak until they cant find a capable leader to supplant him. After the death of the Bendahara Tun Perak, Malacca lacked an efficient leader as the replacement of Tun Perak which is Tun Mutahir as a Bendahara was a weak leader because he more relate on his personal welf be and biased during his administration. Many of the ministers expressed their dissatisfaction with this aspect of the way of his management style. As a result, there were often struggles for power. Besides, Sultan Mahmud who pay only a little attention to the administration consider as a weak leader too. He enables the officers to act as they plea sed. Bribing and defamation were prevalent and inevitably result in economic instability and discontent among the people. Corruption in administration to gain personal wealth had caused the imposed of high taxes on citizens and traders forced merchandisers to shift their attention to Acheh, the other trading ports. At the same time, Bendahara Tun Mutahir being accused that he attempted to overthrow the king. He evoked the fussiness of Sultan Mahmud so without further investigation Sultan Mahmud executed Bendahara Tun Mutahir and his family. Raja Ahmad the inheritor was also weak and inefficient. When Sultan Mahmud realized he was wrong, he give reign to his son which was unable to help him to rule his empire. Whereas Bendahara Tun Perpatih, the successor which is also weak, ill and old.Son of Sultan MahmudDISUNITYMalaccas weak position caused the staccato of people and spilt into factions. Bendahara Tun Mutahir is and Indian-Muslims. His weak administration and practiced favori tism had caused the Malays to become hostile towards them and develop into racial tension. Bendahara Tun Mutahir been appointed had caused the jealousy among Malays and the evident was when Sultan Mahmud commanded Bendahara Tun Mutahir and Tun Ali to be designate to death at the betrayal by Raja Mandaliar and Laksamana Khoja Hassan, an Indian native. Bendahara Tun Peraks son, Tepok been appointed as Bendahara but he was too old. All of these factors had causes the disunity among the residents of Malacca.THE WEAKNESS OF MALACCA MILITARY AND DEFENCEContinued misunderstanding caused segregation and disunity among the people. The situation became worse and critical when the Portuguese, led by Alfonso dAlbuquerque attacked Malacca. For Malacca soldiers, they are losing of skills because they not snarly in war for a long time. They had been using traditional weapons much(prenominal) as creese, arrow and spear during the war with Portuguese. Whereas, Portuguese used modern weapons such as cannon that clearly different from Malacca in term of range and mobility. Portuguese armed forces have well-equipped weapons and good strategic planning with the steerage of Alfonso dAlbuquerque. Before Portuguese attack Malacca, they had conquered Goa India so they have support of army from Goa India. But for Malacca, the mercenary soldiers from Jawa abandoned state during the war.DISLOYALTY OF FEREIGNERS AND MERCHANTSDue to the political instability, merchants who came and stomach at Malacca did not believe to the government of Malacca. They even backed and supported Portuguese during their attack. For Chinese merchant, they provided huge barges on loan to Portuguese. Tamil merchant provided information regarding Malacca defense system.External FactorsTHE DISCOVERY OF THE CAPE OF GOOD HOPE (TAAJUNG HARAPAN)It is a naval passage in Southern Africa that discovered by Bartholomew Diaz in 1488. The successful of crossing of the Cape of Good Hope allowed the sailor to sail from t he west which is Portugal to the East. While Prince Henry eager to locate their trading in the East that lead to the encouragement of his people to sail to East with the slogan of Gospel, Gold, Glory . The expansion of Portuguese sea exploration was pioneered by Vasco da Gama. He was the first to discover the east coasts of India that help in the establishment of Portuguese.EMERGENCE OF OTHERS TRADE CENTERSDue to the oppressive administration and the high taxes, traders started to looked for other port such as Acheh and Brunei. They had finally switched to the other ports where they can be treated fairly.PREACHINGLopez de Sequeira was assigned by Prince Henry to analyze the trade potentials in Malacca. He arrived at Malacca carrying with him a letter offer from the King. His job was to establish trade with Malacca. Bendahara Tun Mutahir and the officer who were powerful in the court were hostile towards the Christian. The merchants from Gujarat, who got the news the Portuguese afo rethought(ip) to preached a holy war against those Muslims infidels. Unfortunately, because of the argument between Bendahara Tun Mutahir and Sultan Mahmud Shah, de Sequeira managed to get known a plot was planned to kill him and his is managed to escape from Malacca with his fleet, exit behind several of his assistants as captives.ConclusionFrom the research we had consume, we conclude that Malacca Sultanate Empire had departed through three eras which are the beginning and the rise, the middle and the fall of the empire at the same time it contributes a special slots in Malaysian history, because it is said to be the origin of the present sultanate of Malaysia. From the process that Malacca gone through we summarize that effective and systematic administration had lead Malacca to the best outcome. The leader himself must be a role model to make the empire grow and unite the citizen. Citizens power cant be neglected because it influenced the development of any empire in the worl d including merchandise and traders. We are reminded that in whatever time and place unwise leadership, corruption, disunity and weak defense must be avoided or otherwise turmoil history happens again.ReferencingHistory of Melaka only(a) Planet Travel Information. 2015. History of Melaka Lonely Planet Travel Information. ONLINE Available at http//www.lonelyplanet.com/malaysia/peninsular-malaysia-west-coast/melaka/history. Accessed 22 January 2015.The fall of Malacca. 2015. The fall of Malacca. ONLINE Available at http//www.malaysiahistory.net/index.php?option=com_contentview=articleid=26the-fall-of-malaccacatid=46early-history. Accessed 22 January 2015.Fall of Civilizations Malacca Sultanate (Revised Version). 2015. Fall of Civilizations Malacca Sultanate (Revised Version). ONLINE Available at http//www.scribd.com/doc/105111287/Fall-of-Civilizations-Malacca-Sultanate-Revised-Versionscribd. Accessed 22 January 2015.The Fall of Melaka. 2015. The Fall of Melaka. ONLINE Available at http//www.sabrizain.org/malaya/port1.htm. Accessed 22 January 2015.

Elderly Patient on Psychotic Depression ward

Elderly Patient on Psychotic Depression wardIn this subsidisation I will be dischargeing surface a Critical Incident Analysis on an sequent taken from my portfolio that was encountered whilst in practice placement. This slip of analysis was first used to analyse evanescent missions by pilots, as a way of raising their proceeding (Flanagan, 1954), in more recent long time Norman et al. (1992) and Perry (1997) described this type of analysis as being an important and valid tool for use in confine training, as it e veryows the student to choose and use an incident that make an impact on them, from their practice placement that was either positive or negative, so that they nooky analyse, reflect on and learn from it, showing their phylogenesis as a practician and a person whilst linking scheme to practice and helping them move from novice to expert, as divulgelined by Benner (1984) .Model used for reflectionFor the purpose of this assignment I have selected the Gibbs (1988) reflective exemplar get which is an iterative model meaning it is cyclical in nature, the six points c all overed by this model arDescribe the activity or experience in objective detail.Discuss and explore any feelings you were having at the time of the experience.Evaluate the experience What rattling happened? What was trade good near it? What was bad? What performers contributed to the even step to the foret?Analyse the experience What can you learn from it?Conclusion What could you have do differently? Anything you wish you had d ane? Wish you hadnt done?Action Plan What can you plan on doing in the future?(Bethann, 2004, p167)This is withal the model I use in my portfolio as along with sarcastic incident analysis, it centres on reflective practice, an essential skill in care for practice allowing business offices to be analysed in detail, identifying celestial orbits of potential change, Jasper (2003) and reinforcing the need for certain practices by highlight the ir gains. I withal find the logical, straightforward structure of this framework allows the reflection to be written clearly, providing opportunities to look at incidents from different perspectives.The Critical IncidentStages one and two of Gibbs model of reflection argon covered here, where the incident is described along with my feelings at the time of the incident.I chose this particular incident as it launch me in a very challenging position where I had to think on my feet, it made me test my abilities as a communicator and a throw beneath stress, whilst highlighting the importance of nigh of the more basic nursing techniques like non-verbal communication by spot, educating patients to help themselves, looking out for physical signs that can hint a patient is in distress and how working tight with a patient can earn their blaspheme whilst building up the therapeutic human relationshipIn order to keep the patient and the practice placement confidential, as indicated in the NMC Code of Professional Conduct (2002) and the N.M.C. guide for students (2002), the practice placement is unplowed anonymous and the patient will be referred to as gobbler. The patients consent was also obtained, as it is the patients right to choose whether or non they wish details to be written close them, highlighted by Johnston and Slowther (2003) also outlined in section 3.7 of the N.M.C Code of conduct (2002) with reference to patients who suffer from mental illness.The patient, tom turkey a 72 year old man, was admitted to my practice placement suffering from Psychotic depression and fear, my placement is at a Psychiatric admissions ward, for patients over sixty vanadium years old.On assisting turkey cock with his activities of daily living (A.D.Ls), (Roper et al, 1980) after, rising one Monday morning, It became apparent when helping Tom dress that his right arm was causing him pain, in the area of his right shoulder, I relayed this to the nursing mental fac ulty who explained Tom had fallen unobserved on the Friday night and had been underwriten by the Doctor who on examination matte up no other investigations were needed.On get along discussion about his arm and the fall, among myself and Tom, he eventually admitted to having also fallen on the Sunday night and had non told anyone about it, once I had explained this to the nursing staff the Doctor was again consulted and mat up that Tom should have an X-ray to rule out any scattered bones.I accompanied Tom as an escort to the x-ray department where he became increasingly agitated, anxious and was mumbling to himself with delusional content of speech evident, concerning the N.H.S. which had not been k without delayn about, as Tom had only recently been admitted, he felt they (the N.H.S) were firing to cause him, bodily injury (a persecutory delusion Gamble Brennan, 2003) due to his doing them out of money when he was younger, I did my best to give constant reassurance that I would not let anyone harm him, but when someone holds a delusional principle it can be very firmly maintained and difficult to dissuade from, in particular when they are in a state of high anxiety like Tom, as indicated in Stuart and Laraia (2001). I was quite worried about how the situation was going and that I might be out of my depth as I did not know Tom very well and felt a little awkward act to reassure someone who was this distressed, feeling I was doing little or no good for him.After he had his x-ray and I was assisting him to get dressed in the x-ray cubicle the Radiologist came in and told us that Toms shoulder was broken and that we would need to go round to casualty to be seen by a Doctor thither.This news made Toms take aim of disquietude escalate considerably and he began to have a terror attack in the cubicle, most likely a situationally predisposed scare attack, which occurs on icon to a situational cue or trigger (DSM-4) Tom had shape quite pale and began t o perspire profusely, along with his brisk be approach path very shallow and quick to the point that he was panting, I found it quite distressing to see Tom in this condition.I had never encountered someone quite as panicked as this and I felt quite concerned. I thought calling out for someone to help might only panic him more, so I decided to try some deep breathing manages to relax and calm him down first, then if that did not work I would seek help. I knew from construe Toms notes that he did not have a heart condition or other wellness problem that would have been causing these symptoms and it had been recorded that Tom suffered from panic attacks, although I was still watchful for any change in his symptoms that might indicate an alternative medical reason for his condition.Initially I sat beside Tom with my arm around him, asking him to take slow deep breaths, but with his level of panic and no nub contact meant he was not concentrating on me, so I knelt down on the floo r in front of him took his detention, spoke to him gently but firmly using his name and with direct eye contact got him to focus on what we were doing.I explained his symptoms were due to his panic attack and the breathing exercises we were doing would help relax him, calm him down and make him feel better. Tom started to comply and began with my instruction, breathing in slowly through his nose holding it for a moment then breathing out slowly through his mouth.In a relatively short time his breathing began call ining to conventionalism and he started to relax, enabling us to go on to the casualty department to see about his shoulder. In the casualty department Tom still required reassurance not only verbally but also with molecule as he asked me to hold his hand, bringing home the importance of this simple yet significant form of non-verbal communication and despite needing another brief set of relaxation breathing in the casualty cubicle Tom was notably calmer.I felt privilege d that he had pose his trust in me and that we had moved on further in our therapeutic relationship, as while waiting in casualty Tom who had hardly spoken to anyone let alone myself, began discussing how scared he had been and talked about some of his delusional beliefs, which helped me empathise with how terrified he must have been. I was also able to discuss what Tom told me with the qualified nurses on return to the ward giving a deeper appreciation into his condition.Critical Discussion of the IncidentFor this section of the Critical Incident Analysis stages trine and four of Gibbs reflective framework are covered, allowing me to look at what was good and bad about the incident along with contributing factors (Gibbs 1988), I am going to discuss, analyze and reflect upon three key issues Panic attacks, the relaxation technique of Deep breathing and Touch therapy, that were encountered during the incident and that I felt were of significant importance.Panic attacksI felt this effect was important to the critical incident as it is a common condition closely linked to anxiety which a great number of mental health patients experience often along with their main diagnosis but most normally alongside depression as in Toms case, Clayton (1990) and Merikangas et al (1996) stated that comorbidity between panic and depression is the single strongest type of anxiety-mood comorbidity found in both treatment and in the general public. Panic attacks are often talked about and show up in patient notes but this critical incident brought home for me how absolutely terrifying and totally debilitating the panic attack was for Tom and how distressing it can be to witness a patient in this condition.Anxiety is a normal healthy reaction to the stresses of everyday life as suggested by Trevor Powel (2001) and even necessary for us to perform at our best as Yerkes-Dodsons Law (1908) explains, illustrated in the graph below. Here levels of anxiety are referred to as arousal a nd a direct correlation to performance is demonstrated, it tells us that if we have low levels of arousal then our performance becomes decreased (distress, as introduced by Seyle (1956)), at medium levels our performance levels peak (eustress as described by Seyle (1956)) and when our arousal levels become high our performance levels and subsequent ability to bit drop again (resulting in distress) as seen in Toms situation.(Yerkes Dodson 1908)Peplau (1963) defined anxiety in four levelsMild anxiety- everyday life stress.Moderate anxiety- Immediate concerns focused on, with narrowed perceptual field, although able to function when necessary.Severe anxiety- Greatly reduced perceptual with difficulty focusing on anything except what is causing anxiety.Panic- Person feels terror, dread as is unable to reason with the threat causing anxiety blown out of all proportion, making it almost impossible to fall out or function, with little or no control over themselves causing panic attack. Toms anxiety level was clearly at the panic stage which cannot be allowed to continue indefinitely as being in a panic attack state is not compatible with living, as described by Stuart and Laraia (2001), who believe if prolonged can result in total exhaustion or in extreme cases even death.Panic attacks affect between 3 and 5 percent of the population at some point in their lives (Lynch E, 2005). The findings of an American study carried out this year showed that people suffering from panic attacks account for around 25% of those attending casualty departments or G.Ps. (Ham, P. et al, 2005) often having infliction breathing properly as found with Tom, with most people suffering from panic attacks, stating hyperventilation as being one of their main symptoms (Holt and Andrews, 1989), or with patients believing they are having a heart attack.Toms panic attack was mainly evident by the physical symptoms he displayed, described previously, physiological symptoms often being the only indubitable signs of a panic attack as described by Stuart and Laraia (2001).In this instance, although Toms Psychotic Depression was the likely reason for his anxiety with the resulting panic attack, I felt trying to deescalate his anxiety levels, by getting the panic attack and hyperventilation under control was my main priority, there would have been no point in me trying to deal with his delusional beliefs at this point as this takes time and experience, of which I had neither, plus Toms panic levels were so high it was difficult for him to abide. Therefore it seemed logical to concentrate on something which it was perhaps possible to change.I hoped that using the deep breathing technique would be triple-crown in helping return Toms body systems to normal which would stop the hyperventilating making Tom feel a lot better and knew that breathing techniques could be very effective but did not want to put Tom at any risk by doing so, I had to make a judgment call about how I wa s going to handle the situation and decided I was going to try and deal with it using the breathing exercise.Relaxation Techniques Deep breathingThe next topic I am going to cover is Relaxation Techniques and the technique of Deep Breathing in particular, I feel it is important to cover this topic as it was a key factor in the outcome of the incident as by guiding Tom through the breathing technique, enabled him to control his breathing resulting in his panic attack and hyperventilating coming to an end.Toms physical symptoms indicated that he was hyperventilating or overbreathing, the mental health handbook (Trevor Powell, 2001) tells us this is a normal response to threat by our bodies to bring more oxygen to the muscles, preparing us for Fight or Flight, but if the extra O2 is not needed by the muscles, i.e. the situation is only an imagined threat as in Toms case, the normal level of gases in the blood and lungs becomes out of proportionateness, due to breathing in to often oxygen (O2) and pushing out too much carbon dioxide (CO2), this causes the blood to become alkaline which brings on many of the unpleasant symptoms Tom was suffering from.There are several ways of overcoming hyperventilation, possibly the most commonly referred to, is breathing into a makeup come out to facilitate the breathing back in of the carbon dioxide being breathed out, as explained in the Nursing Times article, Facts Panic Attacks (2003), which also ac intimacys the importance of controlling the patients breathing, Stuart and Laraia (2001) also agree that relaxation techniques are an accepted therapeutic intervention in the treatment of anxiety.Since I had no paper bag with me, I decided to use the three stage deep breathing technique to retrain Toms breathing which, Risser and Murphy (2005) agree, improves panic symptoms and associated disability, this type of breathing which is commonly used in yoga helped to slow down and control Toms breathing which also stopped him hy perventilating, it is carried out byInhaling slowly and deeply through your nose.When youve taken in a full breath, hold it for a moment and thenExhale slowly through the nose or mouth, depending on your preference.This action although different to the paper bag technique brings about the same desired effect, in the case of Deep Breathing carbon dioxide is not being re-breathed but the rate it is expelled by is being slowed down along with holding it a little longer in the lungs which results in the levels of carbon dioxide in the blood rising, correcting the acid/alkaline balance in the blood, which relieved Toms unpleasant symptoms, bringing his breathing rate back to normal and making him feel calmer.At the time of the incident I really hoped that the breathing technique would be successful although I was not entirely sure whether to trust my instincts and try it out. On reflection I was very strike at how effective such a simple procedure could be and was glad not only for Toms sake but also my own that I had decided to try it out, as it gave me more confidence in my abilities as a nurse even though at the time I was carrying it out, although outwardly calm, I had felt quite anxious.Touch TherapyThe final key issue I wish to highlight from the critical incident is the benefit of tactile sensation as a therapy, which I felt was vital as a way of communicating with Tom during his panic attack along with giving him reassurance that I was there for him, empathising with his situation and helping him focus on what we were trying to do.There are several terms used to describe the different types of be used in nursing, some of which are necessary catch which covers task and instrumental touch that is mostly used when a procedure or task needs to be carried out on a patient as opposed to non-necessary touch which is described as spontaneous and emotional physical contact between the nurse and patient, introduced by Routasalo (1996), expressive touch comes und er the non-necessary touch umbrella with the same type of nurse patient contact, described by McCann McKenna (1993) which is similar again to sympathize with and protective touch highlighted by Estabrooks (1989) and finally therapeutic touch, which is an alternative therapy similar to reiki, discussed by Meehan (1998).Nesbitt-Blondis and Jackson (1982) agree that touch is probably the most important of all non-verbal communications that we use in nursing and can be particularly useful in cases like Toms panic attack where his ability to understand and communicate was diminished, when patients are unable to communicate verbally or understand verbal communication for reasons such as dementia, those with learning or cognitive difficulties and in panic attack situations like Toms, touch can be an excellent means of communication.Unfortunately, McCann McKenna (1993) reported that in the U.K. there is little use of expressive, non-necessary or caring touch by nurses. Many nurses see to uch as just something that is used when a procedure or task needs to be carried out on a patient, but Tutton (1998) suggests that touch in nursing and the powerful expressions it conveys to patients are sadly underutilised. Routasalo (1996) also suggests that non-essential touch although not absolutely essential, can be passing important and necessary to the patient.The benefits of this type of touch in nursing are strengthened further by Moore Gilbert (1995) who found patients interpreted the use of touch by nurses as a display of affection and attention which they greatly appreciated, with patients interviewed in Routasalo Isolas (1996) study, describing touch by nurses as extremely comforting.Davidhizar Giger (1997) whilst acknowledging the important role that touch can play in the nurse patient relationship, also points out that the value of touch is not appreciated by all health originals or considered appropriate or desirable by some patients. Bearing this in mind as long as the correct manner of touching is employed, and there is no way it could be seen as being inappropriate with the patients personal and cultural beliefs being taken into account, it is one of our most valuable communication nursing tools.The extent of physical contact carried out in a society is governed by sets of well-defined behavioural norms for whatever circumstance we find ourselves in (Pratt mason 1981). Jourard (1966) recognised that the incidence of touching within our Western society declines from childhood onwards but Montagu (1986) discovered that the need for touch did not reduce with age. It is felt that the level of touch common in childhood can return in situations of sickness or incapacity (Barnett 1972). This may mean that, the need for touch in illness might be more important than our ideas of proper behaviour.I felt the touch element in this incident my taking of Toms hands to help him focus, get his attention and convey my empathy, was extremely important a nd was in fact the turning point in the whole incident which allowed me to gain Toms trust and initiate the breathing technique which stopped him hyperventilating. I feel that without the touch element it would have been almost impossible for me to reach Tom and the outcome of the incident would have been very different.Implications for Professional and Personal DevelopmentIn this final section of the Critical Incident Analysis, the two final stages of Gibbs model of reflection (1988), five and six are covered, here we look at what was learned from the incident, what could have been carried out differently or should not have been done, along with what was missed out concluding with a plan for future action.I found in utilising the Gibbs (1998) reflection tool, the impact the incident made on my personal and professional development was made much clearer.Through carrying out this Critical Incident Analysis I have been able to see what I have learned through reflection, as the Departm ent of Health (1999) states, reflective practice is necessary in order to further our continued personal and professional development and leads to a great understanding of our own needs. Described as a form of self discovery by Freshwater (2004) with a deeper understanding of the needs of the patient and ameliorate patent care highlighted by Davies (1995).From this I feel the analysis made me examine my communication skills on a deeper level for although I feel that I am a natural communicator, and have had many years experience working with people suffering from dementia, I had not fully thought about the use of touch or the great importance it has in communicating with patients .Without the use of reflective practice I would not have researched into the concept of touch so fully or really understood its relevance and consequences in my nursing practice. Or recognised the significance touch played in the successful deescalating of Toms panic attack and hyperventilating in this cr itical incident. This Critical Incident Analysis has definitely taught me to have more faith in my abilities as a nurse but has also taught me I have more to learn as a communicator.Similarly with the topic of panic attacks which I was obviously familiar with and had some knowledge on, having been through the incident with Tom and then carrying out the reflection on the incident, allowed me to see the field of panic and anxiety disorders with a deeper understanding and much more from the patients viewpoint. Having witnessed the real distress and levels of disability it can inflict will enable me to really empathise with patients like Tom going through this type of disorder when I come across them in my future career.The area of relaxation breathing was something which I had used myself in yoga practice and did know of its benefit in anxiety situations, but I had not expected to have to start teaching it to a patient that day in the X-Ray cubicle. I was quite shocked when Tom had beg an hyperventilating but on reflection I should have perhaps saw it coming with his rising levels of anxiety after our reaching at the hospital, especially after I had read only that morning that he had a history of panic attacks. Again on reflection I could have asked the nursing staff the best way to deal with it should the situation arise. I have learned from this that I could have been better prepared in front escorting Tom by asking questions and having a plan of action to use if necessary.I had been worried about putting Tom at risk by trying the breathing technique with him as I stated earlier, and perhaps it was wrong of me to have tried it in the first place, but I had made a judgment in an emergency situation, and I did not make the decision lightly, being aware that help was nearby should it be needed. I did not want to distress Tom further by calling out, resulting in people rushing into the cubicle and in conclusion felt the breathing exercise was worth a try, but I wo uld have called for help quickly if it did not appear to be working.On discussing the incident and my actions back on the ward, my learn also felt I had made the right choice. This made me think about the fact that as a nurse there are quantify when it is up to you to make judgment calls regarding patient care and that it is important to remember that you are accountable for your actions. To carry this level of responsibility demands a sound knowledge of practice and an ability to think calmly and clearly even under stress.I was both relived and delighted that the breathing technique worked so well for Tom and felt honoured that he decided to put his faith in me. As stated earlier, this prompted Tom to confide some of his fears to me, which showed trust on Toms part and fostered a deeper understanding of his condition on mine. This advancement of the therapeutic relationship between Tom and I has continued during my placement where I have worked quite closely with him and where I have taught him how to practice the breathing techniques when he feels calm making it easier for him to utilise in panic situations, which he has been doing with good effect.As a accompany on from this incident and after seeing the efficacy of relaxation techniques in action, at my practice placement I asked my mentor if it would be possible to carry out some relaxation groups with carefully screened groups of patients who had anxiety problems. My mentor and other nursing staff thought this would be a good idea both for the benefit of the patients and for my personal and professional development. After researching the subject and finding appropriate music along with compiling a script, the groups were initiated with great success and are now regularly used on the ward, which has given me some sense of achievement and helped build my confidence in my abilities as a nurse.Along with being very beneficial in analysing this particular incident the use of reflective analysis has definit ely improved my practice in placement, and although I have used this model of reflection in my portfolio for some time now, it has made me re-examine the importance keeping and using a portfolio to further my professional and personal development. I also feel this helps me to benefit more from my placement as I fully understand the concept behind reflection and use it positively as a tool rather than a task I need to perform.When using reflection now I am able to draw more insight from my experiences on placement, while previously I had only skimmed the surface of the subjects when carrying out reflection. This has increased both my self awareness and my ability to link theory and practice together. Overall, I can see clearly how reflection is a useful tool in helping nurses to focus on their skills and behaviour which whence enables them to provide the best care possible for patients, as discussed by Somerville (2004).Action PlanPreparing and utilising action plans is an important way of improving both our personal and professional development as nurses, whilst building on improved nursing practice.To be prepared for this kind of scenario in the future I have identified the chase plan of actionMake sure I know and understand all relevant information regarding patients.Have good communication with other members of staff about patients.Have a plan of action thought out for any incidents that may arise.Remain calm and consider actions carefully.Empathise with the patient by trying to understand what it would be like to be in that situation.Where possible help the patient to help themselves, i.e. by educating them to use breathing techniques so when a panic situation arises they are in a better position to take control themselves.

Essay --

Ghana is a country located on the west coast of Africa, the Gold Coast. Known for having the topper oil reserves in the world, Ghanas other exports such as timber, diamond, manganese, cocoa, gold, and bauxite ar what feed the countrys economy.The main source of atomic number 13 comes from the aluminum ore, Bauxite. Bauxite was first discovered by Sir Albert Kitson in the year 1914. Although found in 1914, it took 14 years for the excavation of Bauxite was allowed by the British Aluminum Company, this mining took place at Awaso. The British original source of bauxite was France until theyre supply was caught off during World War II. Once again, later on being given the ok to begin mining, it took until the 1940s, when a railroad was built connecting Awaso with a port in Takowardi, for Ghana to actually begin the mining of Bauxite.in 1974, Ghana received 55% of the British Aluminum Companies shares and in the same year, the International Bauxite Association accepted Ghana as member . The purpose of the International Bauxite Association association was to logically maintain and put up the trade and development of the bauxite industry. In 1941 the Ghana Bauxite Company began working on the mining site in Awaso and has been ever since. It is said that the site in Awaso, after all these years of mining, has reserves of Bauxite to last over 3 more decades. In other areas of Ghana including regions of Ejuanema, Nyinahin, and Kibi,, at that place are some reserves that are said to be capable of lasting over a century. These reserves are capable of lasting for such long periods of time due to the legal age of mining that occurs at Awaso.Ghanas first president, Kwame Nikrumah, had dreams of industrializing the country in order make forward strides toward a m... ... to the local levels? These regions suffered severely due to the degradation of air, water and the environment due to mining activities. These areas gain nothing from the mining of bauxite. Living condi tions in these areas have nearly deteriorated. With all of the pollution from the mining there have been many health impacts on the societies that surround these mining areas such as skin diseases and malaria. With all of the production it would be expected that there would be many job opportunities but all of the mining generated no employment. Between 1992 and 1998 over 1,000 jobs were lost in the Tarkwa mining region. Next to farming, Mining is the most important aspect of Ghanas foundation. Bauxite mining had huge economic and social impacts on Ghana. Although some were more negative than others, it is apparent how important the mining had been to the nation.

A Comparison of John Stuart Mill and Immanuel Kants Ethical Theories :: Societal Order Universability

Compare Mill and Kants respectable theories which makes a better societal order? John Stuart Mill (1808-73) believed in an ethical theory known as utilitarianism. There are many formulation of this theory. One such is, Everyone should act in such a way to dumbfound the largest possibly balance of sound over evil for everyone involved. However, good is a relative term. What is good? Utilitarians disagreed on this subject. Mill made a distinction in the midst of happiness and sheer sensual pleasure. He defines happiness in terms of higher order pleasure (i.e. social enjoyments, intellectual). In his Utilitarianism (1861), Mill described this teaching as followsAccording to the Greatest Happiness Principle The ultimate end, end, with reference to and for the sake of which all other things are desirable (whether we are considering our own good or that of other people), is an existence exempt as far as possible from pain, and as rich as possible enjoyments.Therefore, based on this s tatement, trinity ideas may be identified (1) The goodness of an act may be determined by the consequences of that act. (2) Consequences are determined by the amount of happiness or unhappiness caused. (3) A good man is one who considers the other mans pleasure (or pain) as equally as his own. Each persons happiness is equally important.Mill believed that a pardon act is not an undetermined act. It is determined by the unconstrained choice of the person performing the act. Either external or internal forces compel an servile(prenominal) act. Mill also determined that every situation depends on how you address the situation and that you are only responsible for your feelings and actions. You decide how you feel about what you espouse back you saw.Immanuel Kant (1724-1804) had an interesting ethical system. It is based on a belief that the reason is the final authority for chasteity. Actions of any sort, he believed, must be undertaken from a adept of duty dictated by reason, a nd no action performed for expediency or solely in obedience to law or custom can be regarded as moral. A moral act is an act done for the right reasons. Kant would argue that to make a promise for the wrong reason is not moral - you might as well not make the promise. You must have a duty code inside of you or it will not come through in your actions otherwise. Our reasoning ability will always allow us to know what our duty is.