New York Wicks Law Essay Example | Topics and Well Written Essays - 500 words

New York Wicks Law - Essay Example Studies have demonstrated that the effect of Wicks Law has been to expand the expense of development by a normal of 10%. Alongside this come postponements and bothers for organizing the sub contracting work and all things considered Wicks Law goes about as an obstruction for school development work other than the expense over runs. Once more, gauges are that 10% of the $3.7 billion spent on government funded school development was by virtue of the expense over runs because of Wicks Law and this squandered cash could have been used for instruction programs. That there is truth in these attestations can be seen from the way that the specialists every once in a while have thought about methods of getting rid of Wicks Law and have given exclusions to it. Resistance particularly from the sub-temporary workers have made the specialists avoid the annulment of Wicks Law and search for available resources to revise the Law with the end goal that there is a decrease of its effect on developmen t. The sub contractual workers themselves are unobtrusively tolerating that Wicks Law is out dated and setting themselves up for the progressions that can be normal soon, with even the chance of the annulment of Wicks Law. (Phillips, Mathew. â€Å"Wicks Law finally might be ready for repeal this year†). Changes: The cancelation of Wicks Law not the slightest bit recommends that the method of reasoning wasn't right and it just should be changed on top of the evolving times. That there ought to be a partition of the sub-contracting work despite everything stays a prerequisite, however it ought not be commanded, that different agreements be granted for the work.

What were the aims of Gregory of Tours 'History of the Franks' Essay

What were the points of Gregory of Tours 'History of the Franks' - Essay Example As a young, Gregory lived with his uncles Nicetius and Archdeacon Avitus who later became priest of Lyons and religious administrator of Clermont individually. His training was in chapel schools and fundamentally constrained to an investigation of the sacred text. Truth be told, he was taught by his own uncle Gallus, who was the Bishop of Clermont. 1Platts calls attention to that â€Å"Gregory separated himself such a great amount by his learning and temperance, that in 573, he was picked priest of Tours†. Gregory had just been appointed an elder by 565. He was picked to succeed Eufronius, his mother’s cousin as the nineteenth minister of visits in 573. Subsequent to being picked cleric of Tours, Gregory went to Rome where he visited the burial chambers of different Apostles and developed fellowship with Gregory the Great. Gregory’s life being a religious administrator was difficult. Notwithstanding being the site of the fourth-century priest of Tours, it was an additionally an area acclimated with clashes between the lords of Frank, for example, Sigibert and Chilperic. In 585, Gregory was contradicted by an alliance framed by an area of the Touraine church, the foes of the Austrasian family and the tally of the city. During this time Touraine was being questioned by Merovingian sovereigns. In spite of being an individual who regarded authority, Gregory engaged in these political squabbles as he endeavored to guard the privileges of Saint Martin. Nonetheless, he had all the more very relations with replacements of Chilperic. In spite of the fact that he was unable to keep up his clout in a territory isolated among various realms, he did new things in Tours and delayed Saint Martin’s authority. Gregory kicked the bucket in Tours on November 17 of every 593 or 594. When of his passing, he had made numerous achievements among them being crafted by modifying Tours church building just as improving its assortment of relic materials. There have been different discussions in the past on Gregory’s target composing the historical backdrop of the Franks. In any case, the title ‘history of the Franks’ gives a feeling that his work is basically founded on history. Any individual who peruses the title will accept that the rule behind the work is the historical backdrop of the Merovingian and Frankish realms, their lords and replacements. Indeed, the points go from endeavors by Clovis to take out Frankish rulers who were his adversaries. He likewise gives records of catastrophic events that portrayed his conditions such as the calamitous floods. Be that as it may, Gregory’s aim was not to compose a political history yet rather to interlace both clerical and mainstream history so as to pass his message. The word history is in opposition to what Gregory needed to pass on in his work the historical backdrop of the Franks. Yet, for Gregory and other old journalists, for example, Herodotus the word Hist oriae is utilized to allude to a record of saw occasions instead of occasions knew about. Truth be told, six among the ten books Gregory composed rotate around his own occasions. In book one, Gregory returns to the production of man, a few occasions in the Old Testament and closures with the demise of priest Martin of Tours. In book two he talks about the questions that occurred between early Frankish lords and finishes with Clovis’s passing. In book three, he talks about the fortunes of Clovis’s children and from the fourth book; he examines his initial life, family and occasions during his occasions. Gregory composed the historical backdrop of the Franks; the lives of the holy people among different works. He stays one of the most skilled and imaginative scholars of the medieval times. He is likewise one of the most conspicuous early medieval sacrosanct biographers. Through his work, the historical backdrop of the Franks Gregory uncovers the political turmoil’

Letters Assignment Example | Topics and Well Written Essays - 1500 words

Letters - Assignment Example At the point when I endeavor to toast a bagel or some other sort of food, the toasting units just become somewhat hot. As opposed to gleaming red as they normally do, the toaster can't even tolerably toast the most slender cut of bread. Despite the fact that this is a significant bother, it additionally speaks to an interesting wellbeing danger because of the way that it expects me to hold down the toasting mechanical assembly until such a period, that the bits of bread or bagel are adequately toasted. As needs be, I attempted to restore this unit to Target just to be informed that I should contact the first maker as a methods for accomplishing a fix or a substitution. I’m totally willing for your firm to either fix or supplant the toaster, in any case, I would prefer not to be liable for the vital postage expenses this may acquire. As needs be it is my expectation that you will have the option to fix this circumstance in the most brief time period conceivable. Genuinely, Jame s Smith 123 Main Street Anytown USA April 28, 2013 Mark Witte Human Resources Department CKLB Radio Station 111 Bush River Road Columbia, SC 29201 Dear Mr Witte It is become obvious that there is as of late been posting for position of statistical surveying expert for CKLB Radio station. In like manner, I might want to communicate my enthusiasm for this position and quickly present myself as a profoundly qualified applicant who could properly fill such a position. As of now, I’m utilized with TV6 as a lead specialist and their promoting office. I’ve been working in this situation for a time of around three years and have increased an important system of people inside the neighborhood network that I accept would be useful inside the position that you are right now promoting. At last, the position that you depicted gives off an impression of being of common advantage both for myself and for your firm. I speak to a person who is capable, spurred, and profoundly devoted. M y references will be connected to this letter should you have need of presenting upon any expert sources to a test to my degree of commitment to work. In spite of the fact that I’m happy with the present degree of work that I’m playing out, the opening for work that you have as of late posted is appealing and speaks to a one of a kind open door for me to stretch out and look to use a portion of my gifts concerning distributing the undertakings that would fundamentally be a piece of the activity. I truly value your time and thought this issue and anticipate your reaction sooner rather than later. Truly Tom Jones March 15, 2001 Mr. John Smith, Director of Operations SomeGroup Group SomeStreet Drive Sometown, GA 30815 Dear Mr. Smith I am composing with respect to a bike buy that occurred from Maritime Sports Equipment on April first of 2013. In spite of the fact that I have appreciated the bike incredibly, the explanation this provoked me to compose this letter is with re spect to a cheat that occurred when the request was put. At the point when I settled on the choice to buy the bike, the rundown cost was $185 in addition to $25 postage charge. Appropriately, this speaks to the complete use of $210. In any case, when I got my bicycle and my bill from Maritime Sports Equipment, it became obvious that I was being charged $22.10 notwithstanding the $210 which has just been noted. After looking at my receipt to a closer degree, I have been not able to figure out what the starting point of this extra charge may be. Appropriately, I would mercifully demand that your firm respect the first understanding that existed by means of

indias earthquake essays

indias quake expositions Occupants in the Gujarat State of western India went through the night outside Friday, too frightful to even think about going go into their harmed homes after India's most impressive tremor in 50 years. The 7.9 size tremor slaughtered upwards of 2,000, harmed in any event 2,000, and left 4,000 missing. The majority of the missing are believed to be covered under rubble, and salvage laborers burrowed wildly with pieces of machinery, scoops, sticks even uncovered hands attempting to discover them. The quake is a cataclysm of national greatness, said Indian Prime Minister Atal Bihari Vajpayee, who arranged an excursion to the zone to review harm. We have chosen to meet the crisis on a war balance, he said. This is the ideal opportunity for individuals to lift up. The quake shook skyscraper towers 600 miles away in the capital, New Delhi. The tremor could be felt similarly as 1,200 miles away in Calcutta and beach front Bangladesh. The shake struck at 8:46 a.m. the same number of urban areas were starting festivals for India's 51st Republic Day, which honors the selection of the nation's constitution. In Ahmadabad, Gujarat's business capital and a rambling city of 4.5 million, helmeted salvage laborers utilized iron bars to pry chunks of concrete and metal, looking for survivors. Ladies sobbed and shook to and fro, looking as the couple of accessible pieces of machinery and cranes pushed through the heaps of stone that once had housed families and shops. Beds, youngsters' toys and garments lay surrendered in the garbage, light posts and electric arches were curved and numerous structures were left inclining problematically. After night fell, with temperatures at 55 degrees, survivors spread covers and clustered around pit fires. There is an incredible frenzy among the individuals and they have spilled out onto the lanes, said Haren Panya, home clergyman of Gujarat. In view of the consequential convulsions, We have solicited individuals to move out from old structures. Bodies were accumulated on the verandah of the N.S. Hospital,... <!

Expected Value of a Binomial Distribution

Anticipated Value of a Binomial Distribution Binomial dispersions are a significant class of discrete likelihood circulations. These sorts of conveyances are a progression of n free Bernoulli preliminaries, every one of which has a consistent likelihood p of accomplishment. Likewise with any likelihood circulation we might want to realize what its mean or focus is. For this we are truly soliciting, â€Å"What is the normal estimation of the binomial distribution?† Instinct versus Verification On the off chance that we cautiously consider a binomial circulation, it isn't hard to establish that the normal estimation of this sort of likelihood appropriation is np. For a couple of fast instances of this, think about the accompanying: On the off chance that we flip 100 coins, and X is the quantity of heads, the normal estimation of X is 50 (1/2)100.If we are stepping through a various decision examination with 20 inquiries and each question has four options (just one of which is right), at that point speculating haphazardly would imply that we would just hope to get (1/4)20 5 inquiries right. In both of these models we see that E[ X ] n p. Two cases is not really enough to arrive at a resolution. In spite of the fact that instinct is a decent apparatus to manage us, it isn't sufficient to frame a scientific contention and to demonstrate that something is valid. How would we demonstrate completely that the normal estimation of this circulation is in reality np? From the meaning of expected worth and the likelihood mass capacity for the binomial dissemination of n preliminaries of likelihood of progress p, we can exhibit that our instinct matches with the products of numerical thoroughness. We should be to some degree cautious in our work and agile in our controls of the binomial coefficient that is given by the recipe for blends. We start by utilizing the recipe: E[ X ] ÃŽ £ x0n x C(n, x)px(1-p)n †x. Since each term of the summation is increased by x, the estimation of the term comparing to x 0 can't avoid being 0, thus we can really compose: E[ X ] ÃŽ £ x 1n x C(n , x) p x (1 †p) n †x . By controlling the factorials engaged with the articulation for C(n, x) we can revamp x C(n, x) n C(n †1, x †1). This is genuine in light of the fact that: x C(n, x) x n!/(x!(n †x)!) n!/((x †1)!(n †x)!) n(n †1)!/((x †1)!((n †1) †(x †1))!) n C(n †1, x †1). It follows that: E[ X ] ÃŽ £ x 1n n C(n †1, x †1) p x (1 †p) n †x . We factor out the n and one p from the above articulation: E[ X ] np ÃŽ £ x 1n C(n †1, x †1) p x †(1 †p) (n †1) - (x †1) . A difference in factors r x †1 gives us: E[ X ] np ÃŽ £ r 0n †1 C(n †1, r) p r (1 †p) (n †1) - r . By the binomial equation, (x y)k ÃŽ £ r 0 kC( k, r)xr yk †r the summation above can be revised: E[ X ] (np) (p (1 †p))n †1 np. The above contention has taken us far. From starting just with the meaning of expected worth and likelihood mass capacity for a binomial appropriation, we have demonstrated that what our instinct let us know. The normal estimation of the binomial appropriation B( n, p) is n p.

Write Your College Essay in 10 Days. Take the Challenge.

Write Your College Essay in 10 Days. Take the Challenge. You Can Write Your College Essay in 10 Days. Take the Challenge. You Can Write Your College Essay in 10 Days. Take the Challenge. With early decision deadlines inching ever closer, the rush to get those college essays written is real. But fear not, dear applicants! Our Uncommon Essay Approach, will help you can craft  winning essays in just 20 minutes a day for 10 days! (Or condense the process and get it done in even less time!) Just follow these easy steps: 1. Find your essay’s purpose. The essay plays a different role than your grades or test scores. It is your one opportunity to speak to admissions in your own voice â€" and to jolt them awake from their application-reading-induced slumber. What do you want your essay to tell admissions that they couldn’t learn anywhere else on your application? How will you grab and hold their attention? 2. Review the Common App Prompts. Even if you have other essays to write for your early decision or early action school of choice, the Common App essay is the place to start. Read through this year’s prompts and wrap your brain around what the questions are really asking. Then, hide them away and don’t look at them again until you have written a draft. At the end of the day what is most important is the story you want to tell. You can almost always back into one of the Common App prompts once you have honed your topic to perfection. 3. Brainstorm your topic. Stop waiting for divine inspiration. Go out into the world and look for clues. Whether you create lists, take notes on your daily habits, or call up your grandma for ideas, devoting time to brainstorming is the only sure way to uncover your magic topic. 4. Freewrite your heart out. Once you have brainstormed your way to a magic topic, set aside some time (perhaps three different times throughout the day) to freewrite on what that subject means to you. Get your first thoughts on the page in full and without judgment. Dig for details. You’ll never know what’s inside your brain until you allow it to come out on the page. 5. Sculpt your story. Review your freewrites and you’ll probably start to notice patterns. What particular moment or individual sticks out in all of your notes? Is there a word or image that seems significant? Use these clues to organize your story into a preliminary outline. We bet you can even pull complete sentences and paragraphs from your freewrites into your first draft. 6. Edit, edit, edit. How can you make sure that first draft is transformed into a mind-blowingly memorable essay? Read it over at least three times. Edit for story. Then edit for clarity at the sentence level. Finally, edit for grammar. 7. Organize those supplements. Most supplemental essays fall into one of a few classic categories, so organization is key. If you are applying early to just one school, make sure you do your research thoroughly so you can fill your essay with relevant details. If you are applying to more than one school, group similar assignments together and work on those essays from longest to shortest. 8. Manage your writer’s block. We know you know that feeling. Your mind is fuzzy. You’re not really feeling like yourself. Every time you sit down in front of the computer your head hurts and your fingers cramp. You can cure this horrible feeling with a few small mental changes. For starters, lower your standards. Not like, forever. Just for the beginning of the process. You will raise your expectations of yourself later as you refine and polish. When you start, quality is not the issue. The issue is that you turn that scary blank page into one filled with ideas. 9. Refer to example essays in moderation. Poring over dozens of sample college admissions essays immediately before sitting down to write your own can be a debilitating exercise because you may feel compelled to compare your earliest ideas to these final, polished essays. That doesn’t seem fair! That said, we do think that it can sometimes be helpful to read through a few (just a few) to help direct your brain towards the style of the personal narrative. 10. Call for help! After all of your hard work, if you are still wondering if your topic is worth its weight in hamburgers; if you’re not sure whether your story structure is strong enough to support your big idea; even if you’re just wondering whether or not your overall story will create enough fireworks to hold the attention of an admissions advisor for your allotted two minutes of admissions essay fame, CALL US! Or email us: info@collegeessayadvisors.com. We will personally extract the winning ideas from your noggin with our magic powers (of conversation). About Thea HogarthView all posts by Thea Hogarth » Want a step-by-step guide? Take the 10-step course. WATCH ACADEMY CHAPTER 1 FOR FREE »

New Considerations When Applying to Kellogg

The Kellogg School of Management at Northwestern University has recently released its â€Å"Facts and Figures†Ã‚  statistics for the new Class of 2018, and boy is it impressive! With record numbers across the board, it is important for prospective MBA candidates to understand what some of these key facts and figures are, as well as what strategic insights about  the school can be  uncovered from the new numbers. Record GMAT Score The first and most prominent metric that jumps out in Kellogg’s â€Å"Facts and Figures† is the school’s impressive GMAT average, which  has climbed to 728! To put this in context, Kellogg’s 2012 â€Å"Facts and Figures† listed their  average GMAT score as 708 20 points lower than it is today, less than five years later. Kellogg’s average GMAT score has been rapidly rising every year. In fact, its current  number is 2 points higher than Harvard’s last reported average GMAT score, representing a significant change in the schools approach to admissions  as more  Ã¢â‚¬Å"numbers driven†. Historically, Kellogg has used a much more  holistic approach to admissions, often admitting candidates who may have been â€Å"soft† in their GPA or GMAT numbers. While Kellogg remains holistic,  it is  clear that key quantitative data points, like GMAT scores, have increased in importance. Record Gender Diversity Kellogg has always placed an emphasis on gender diversity, both in admissions and within the student community, consistently boasting one of the most active Women’s Business Association and strongest female alumni networks. So Kellogg’s record percentage of women in their program represents a strong actualization of the school’s mission. I suspect Kellogg will continue to take a leadership role in this category and aim to grow their 43% women closer to a 50/50 ratio. Shrinking the Two-Year Class Since taking over the helm at Kellogg, Dean Sally Blount has sought to re-balance the school’s two-year and one-year programs the goal with this approach is to shrink the two-year class and increase the one-year class. This plan is not only a strategic one to attract specific audiences (those for whom the two-year  program may not be the best fit) but also, potentially, a functional one that will allow the school to improve the statistics of its two-year  program, which is reflected most notably in the advertised class profile. Interested candidates should use these trends to identify the best program type for their unique profile. Candidates with â€Å"softer† data points and a strong business background may want to consider the one-year program as a potential option, given the increasing competitiveness of Kelloggs  two-year  program. Kellogg’s â€Å"Facts and Figures† are always a great representation of trends at the school. Use the factors  above to develop the optimal strategy for your own application to Kellogg. And for more information on Kellogg, check out Veritas Preps Essential Guide to Top Business Schools. Applying to business school? Call us at 1-800-925-7737 and speak with an MBA admissions expert today, or take our free MBA Admissions Profile Evaluation  for personalized advice for your unique application situation! As always, be sure to find us on  Facebook,  YouTube,  Google+  and Twitter. Dozie A.  is a Veritas Prep Head Consultant for the Kellogg School of Management at Northwestern University. His specialties include consulting, marketing, and low GPA/GMAT applicants. You can read more articles by him  here.

Personal Philosophy of Nursing Essay - 621 Words

Running head: Philosophy of Nursing Philosophy of Nursing Nancho DeChirico University of Phoenix Philosophy of Nursing For as long as I can remember, nursing was a profession that I longed to be a part of because nurses represented the very essence of caring and compassion. After realizing my dream, I found myself working in a Neonatal Intensive Care Unit (NICU) where I developed a personal philosophy and core set of values regarding nursing. â€Å"Philosophies of nursing are statements of beliefs about nursing and expressions of values in nursing that are used as bases for thinking and acting† (Chitty Black, 2007, p.319). Everyone has values, ideas and beliefs that are unique and different from others. One great†¦show more content†¦I will treat my patients and their families in the manner that I would expect for myself and my family. To live out my philosophy of nursing, every day I must remember my patients are individuals and entitled to privacy, respect, and dignity. The families of my patients are experiencing one of the most stressful experiences of their lives. I will strive to promote an environment that is family-centered. I must remember that my co-workers may have different values and beliefs than my own but are also deserving of my respect, support and encouragement. With the intention of providing excellent care to my patients I will strive to take care of myself physically and emotionally. I understand that my philosophy of nursing may change as I continue to grow in my profession. I look forward to the journey but will continuously remember that the core of my profession is caring and all that it encompasses. Chitty, K., Black, B.P. (2007). Professional nursing: Concepts and Challenges. Retrieved from University of Phoenix E-Book Collection. References Kubsch, S., Hansen, G., Huyser-Eatwell, V.. (2008). Professional Values: The Case for RN-BSN Completion Education. The Journal of Continuing Education in Nursing, 39(8), 375-84. Retrieved September 21, 2009, from ProQuest Health and Medical Complete. (Document ID: 1533055471). National League for Nursing. (n.d.). Core values. Retrieved September 20, 2009, from www.nln.org/aboutnln/corevalues.htmShow MoreRelatedPersonal Nursing Philosophy : My Personal Philosophy Of Nursing1475 Words   |  6 PagesPersonal Philosophy of Nursing When one thinks of a nurse they often think of a caring, compassionate, knowledgeable individual. They don’t often think that every nurse comes from different situation, past experiences, and life changing events that make nurses who he or she is. Everyone on this earth is unique and has something to contribute. The same goes for patients. Each patient has a different background and have different interests which make them who they are. In order to give the optimalRead MorePersonal Nursing Philosophy : My Personal Philosophy Of Nursing1190 Words   |  5 PagesPersonal Philosophy of Nursing Megan A. Farrell Moberly Area Community College Introduction I, Megan Farrell, am currently a Licensed Practical Nurse at a treatment center that works with prisoners. I accepted a clinical positon here as a graduate, but plan to work in a hospital setting once I have become a Registered Nurse working in the Intensive Care Unit. I quickly worked my way up the latter from the clinic nurse to the Chronic Care nurse and I am quite passionate about furtherRead MorePersonal Philosophy of Nursing1500 Words   |  6 PagesPersonal Philosophy of Nursing Personal Philosophy of Nursing Pamela Metzger September 11, 2011 Jacksonville University Personal Philosophy of Nursing Nursing Philosophy What is nursing, what does nursing mean to me? After much thought I have put together a few ideas of what the term nursing means to me, along with some supporting ideas from references I have read. Jacksonville University School of Nursing Philosophy One of the primary foundations of the philosophy of JacksonvilleRead MorePersonal Nursing Philosophy1432 Words   |  6 PagesPersonal Philosophy Nursing and Application of Orem’s Theory to Practice A typical nursing philosophy includes the concepts of patient, environment, health and nursing. Likewise, examining theory is part of the doctoral prepared nurse’s journey into practice. In this preparation, theory plays an important role in guiding and exploring the advanced practice nurse’s role with respect to practice. The following paper will discuss a personal nursing philosophy, including if and how it has changedRead MorePersonal Nursing Philosophy1055 Words   |  5 PagesPersonal Nursing Philosophy My personal definition of nursing would be getting your patient to the highest level of health you can in your time with them while incorporating their family, environment, and beliefs/culture with a high level of critical thinking at all times. The American Nursing Association defines it as â€Å"the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of humanRead MorePersonal Philosophy of Nursing682 Words   |  3 PagesPersonal Philosophy of Nursing Rosenald E. Alvin Florida Atlantic University A journey of 1000 miles begins with a single step, a Chinese proverb that I have come to live by through my journey of nursing. I never thought in a millions years that I would have become a nurse. When I was younger nursing was the only profession my mother pushed. It was as if everyone in our family had to be a nurse. Honestly, I think I rebelled from the thought of being a nurse simply because it was my mothers desireRead MorePersonal Philosophy of Nursing810 Words   |  4 Pages12, September 2012 Personal Philosophy of Nursing The American Nurses Association defines nursing as, â€Å"protection, and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of the individuals, families, communities, and populations.† (American Nurses Association, 2004, p. 7) There is a lot of work in nursing. There are lot of cores, focuses, visions, and philosophies of nursing. In my opinion thereRead MoreNursing Philosophy : My Personal Philosophy Of Nursing932 Words   |  4 PagesMy Philosophy of Nursing My personal philosophy of nursing began at an early age watching my mother volunteer for 25 years on the local rescue squad, following in the footsteps of her mother. I learned that helping others in a time of need should always be a priority. Respect and dignity should always be shown to people, no matter the who they are or where they are from. I have and will continue to show compassion for others while administering professional holistic care, guided by the AmericanRead MorePersonal Philosophy of Nursing1021 Words   |  5 PagesPersonal Philosophy of Nursing I believe that balance is necessary to living a healthy lifestyle. Fun and pleasure are a necessity of life. When you are living healthy, you are building up your immune system, strengthening your body and mind, fueling yourself with nutrients that will help you to grow and progress, and becoming stronger, quicker, confident, conscious, and bettering yourself all-around. Personal Philosophy on Personal Health I aim to eat as little processed foods as possibleRead MoreThe Personal Philosophy Of Nursing1642 Words   |  7 PagesThis paper is aimed at addressing the personal philosophy of nursing (PPN) in caring for the people, their-health and their-environment. PPN is defined as the way of navigating true about understanding individual or people living situation in according to their values, beliefs, health and surrounding (Whitman, Rose, 2003). This PPN has reflected many times in my previous works as an assistant in nurse, with the ACT agents known as Rubies Nursing. In this role, I have cared for both moderate and

Cross-Price Elasticity of Demand

Cross-Price Elasticity of Demand (sometimes called simply Cross Elasticity of Demand) is an expression of the degree to which the demand for one product -- lets call this Product A -- changes when the price of Product B changes. Stated in the abstract, this might seem a little difficult to grasp, but an example or two  makes the concept clear -- its not difficult.   Examples of Cross-Price Elasticity of Demand Assume for a moment youve been lucky enough to get in on the ground floor of the Greek Yogurt craze. Your Greek yogurt product B, is immensely popular, allowing you to increase the single cup price from around $0.90 a cup to $1.50 a cup. Now, in fact, you may continue to do well, but at least some persons will revert back to the good old non-Greek yogurt (Product A) at the $.090/cup price. By changing the price of Product B youve increased the demand for Product A, even though theyre not highly similar products. In fact, they can be quite similar or quite different -- the essential point is that there will often be some correlation, strong, weak or even negative between the demand for one product when the price of another one changes. At other times, there may be no correlation. Substitute Goods The aspirin example shows what happens to the demand for good B when the price of good A increases. Manufacturer As price has increased, demand for its aspirin product (for which there are many substitute goods)  decreases. Since aspirin is so widely available, there probably wont be a great increase in each of these many other brands; however, in instances where there are only a few substitutes, or perhaps only one, the demand increase may be marked. Gasoline vs. electric automobiles is an interesting instance of this. In practice, there really are only a few automobile alternatives: gasoline automobiles, diesel, and electrics. Gasoline and diesel  prices, as youll remember, have been extremely volatile since the late 1980s. As U.S. gasoline prices reached $5/gallon in some West Coast cities, the demand for electric cars increased. However, since 2014 gasoline prices have fallen. With that, demand for electrics fell with them, putting automobile manufacturers in a peculiar bind. They needed to sell electrics to keep their fleet mileage averages down, but consumers began buying gasoline trucks and larger gasoline autos again. This forced manufacturers --Fiat/Dodge  is a case in point -- to lower the price of electrics below their actual production cost in order to keep selling gasoline-powered trucks and muscle cars without triggering a federal government penalty.   Complimentary Goods A local Seattle band has a breakthrough hit -- millions and millions of streams, many, many downloads and a  hundred thousand albums sold, all in a few weeks. The band begins touring and in response to demand, ticket prices begin climbing. But now something interesting happens: as the ticket prices increase, the audience becomes smaller -- no problem so far because whats happening essentially is that the band is playing smaller venues but at greatly increased ticket prices -- still a win. But then, the bands management sees a problem. As the audience grows smaller, so do the sales of all those high mark-up collectibles -- band T-shirts, coffee mugs, photo albums and so on: the  merch. Our Seattle band has more than doubled the ticket price at $60.00 and is still selling about half as many tickets at each venue.  So far so good: 500 tickets times $60.00 is more money than 1,000 tickets times $25.00. However, the band had enjoyed robust merch sales averaging $35 a head. Now the equation looks a little different: 500 tix x $(60.00 $35.00) is less than 1,000 tix x ($25.0035). The drop in ticket sales at a higher price created a proportionate drop in merch sales. The two products are complementary. As the price increases for band tickets, the demand for band merch drops.   The Formula You can calculate the Cross Price Elasticity of Demand (CPoD) as follows: CPEoD (% Change in Quantity Demand for Good A)  Ãƒ · (% Change in Price for Good A)

A Clinical Case Study On Mild Cognitive Impairment Essay

Why is it that some seventy year olds cannot recall memories from their twenties or find it hard to follow along with a conversation? As people age they tend to change, physically and mentally. Just like our bodies, our brains change as we age. Our thinking becomes slower and we cannot remember certain things. However, memory loss, confusion and other major changes in the way our brains work may be signs of cognitive changes. This essay showcases a clinical case study on Mild Cognitive Impairment. It describes the process of cognitive development according to theorist Jean Piaget. It overviews the three basic cognitive function of the brain. It explains several cognitive impairments related to the elderly. Last, it details cognitive assessment used to detection and measurement of cognitive impairments in the elderly. Case Study A 78-year-old woman presented to her primary care physician for a routine examination, the results of which indicated that her previously diagnosed chronic disease conditions-smoking-related emphysema and high blood pressure-were being effectively managed. After scheduling an upcoming appointment, the patient pulled aside the office s physician assistant. I didn t want to bring this up with the doctor because I don t know whether it s anything to be concerned about or not, she confided. But I m worried about my memory. I seem to be forgetting where I ve been putting things lately-my keys and important paperwork, like my bankShow MoreRelatedMr. Wilsons Symptoms With Bipolar Affective Disorder1703 Words   |  7 Pagescomorbidities of diabetes and hypertension. The third cluster related to cognitive impairment is correlated to his social isolation, memory problems, loneliness and a sense hopelessness. Each of these clusters are interrelated one problem causing another problem for Mr. Wilson. To start with this case study, Mr. Wilson presents a recurrent bipolar depression, for his welfares, the recovery model will be beneficial to manage Mr. Wilson’s clinical management within advanced nursing care. The three relevant symptomRead MoreCognitive Impairment With Older Age1553 Words   |  7 PagesCognitive Impairment With Older Age Many times, we hear our older generation complain that their memory is failing. Is it really failing or is there something else causing the memory to decline? With many studies in the area of cognitive impairment during aging, it was shown that often times it the decline is due to aging, but there are signs and symptoms that those entering their older years may want to look for, as well as those who love and care for them (National Institute on AgingRead MoreNeurological Disorder : Parkinson s Disease992 Words   |  4 Pagesnumber of new cases but what is even more startling is the fact that thousands of cases go undetected each year as well. PD is a clinical diagnosis with no definitive diagnostic test to identify the disease. The question may arise, what exactly is Parkinson’s disease? Parkinson’s disease is a progressive degenerative neurological disorder, which means that it gets worse over time. PD is more common with increasing age affecting 1% of the population above 55, with 4-10% of cases having early onsetRead MoreExample Of Research Studies On Alzheimers888 Words   |  4 PagesThis weeks paper is quite a challenge but one that can sure be conquered, herein we will discuss a research study on Alzheimers. Alzheimers is a disease that is devastating and had symptoms that are similar to amnesia, however amnesia is sudden and Alzheimers comes on slowly. Subsequently, in Anterograde amnesia which is normally cause from brain trauma, in this form you cannot remember new information, but your memory before the event is intact(Spielman et al., 2014, p. 275). Moreover, RetrogradeRead MoreAlzheimer s Disease And Disease935 Words   |  4 Pagesto more severe cases that is leading to Alzhe imer’s disease. Many patients can forget how to eat, get dressed, brush their teeth, or fail to comprehend situations that are straightforward. Patients are unaware this is happening to them. (Alzheimer’s Disease Fact Sheet, 2015). This disease is unpredictable and is not entirely understood; therefore, it has been tested and studied on a great amount of people. One of the many tests for Alzheimer’s disease is the ADNI study.This study was created asRead MoreDifferences In Behavior And Performance In Frontotemporal Dementia Essay793 Words   |  4 Pagesdifferences in behaviour and performance in basic clinical presentation Alzheimer’s patients are presented with a problem of forgetfulness, orientation, difficulty with doing complex daily activities such as planning and they have insights to their deficits at early stages and less likely to have distinctive language or behavioural problems but in case of FTD patients they have changes in behaviours and personality and usually they have not insight about their behaviour changes and referred byRead MoreAlzheimer s Disease ( Ad )1244 Words   |  5 Pagesdementia, particularly those who are sixty-five or older, have brain impairments. All through the numerous periods of Alzheimer s disease, people appear to show any indication, yet harmful changes are occurring in the cerebrum. An unnatural deposit of proteins structure amyloid plaques and tau tangles all through the brain, and once the active neurons quit working, they lose contact with different neurons, and they eventually die. Studies have also shown to slow down the rate of the developing, e volvingRead MoreSymptoms And Symptoms Of A Concussion1312 Words   |  6 Pagesproduce concussions. Players of these types of sports are at a significantly higher risk for developing long-term brain damage and cognitive impairment later in life. A concussion is a subset of a Traumatic Brain Injury (TBI) and results from shaking the brain within the skull. The American Association of Neurological Surgeons (the â€Å"AANS†) has defined a concussion as â€Å"a clinical syndrome characterized by an immediate and transient alteration in brain function, including an alteration of mental status andRead MoreDementia With Lewy Bodies ( Dlb ) Essay1551 Words   |  7 Pagesbodies (DLB), when cognitive symptoms appear within a year of movement problems, is a complex and challenging neurodegenerative disorder. (Pervin, Edwards Lippa, 2016). It is complex because the DLB pathology and its impact on certain brain regions are unclear. The pathology includes Lewy bodies, senile plaques a nd neurofibrillary tangles. It is challenging because its many core features make it difficult for individuals to perform activities of daily living. The core clinical features compriseRead MoreWilliams Syndrome As A Neurodevelopmental Disorder Essay892 Words   |  4 Pagesyears old (Morris, Demsey, Leonard, Dilts Blackburn, 1988). People with WS usually show a developmental delay at the early age and are affected all life long. Williams Syndrome is characterised by some abnormalities in physical, behavioural, and cognitive. Individuals with WS will suffer various cardia, vascular and gastrointestinal problems (Wessel et al. 1994, Hallidie-Smith et al., 1998,). They also have some distinctive facial features, including a small upturned nose, long philtrum, wide mouth

Analysis of Desert Rose Essay examples - 1206 Words

For my analysis essay, I chose the song Desert Rose written and performed by Sting. Cheb Mami also wrote and performed the Arabic part of the song. The genre of the song is pop and â€Å"Desert Rose† was released in 1999 but it was well known around 2000 due to its music video which was used in a Jaguar auto mobile commercial. I chose this song because Sting and Cheb Mami speak of longing and desire which is what every human being feels at some point in their lives. In life people always want something they cannot have, which makes the person or object of one’s desire more intriguing because of the struggle to obtain it. I for one can relate to this song and know people who can feel what the lyrics are expressing through love, lust, and desire†¦show more content†¦The metaphor of the veils are connected to the petals of the rose which is usually compared to a woman’s beauty. In love and or an act of seduction it usually takes steps to get into a womanâ⠂¬â„¢s heart as compared to the veils. Sting is singing of finding the woman of his dreams and getting inside her heart. In the last verse, â€Å"This memory of Eden haunts us all...†(A-Z Lyrics). In this line Sting is be referring to the Biblical reference of the Fall of Man from the Garden of Eden in which â€Å"...the patterns of desire and seduction have been hardwired into us since ancient times.† (Douglas). It is natural for humans to long for things that are unattainable. As John Donne wrote in his poem, â€Å"If ever any beauty I did see, Which I desird, and got, twas but a dreame of thee.† (Donne, 45). Since ancient times, everyone dreams of the perfect mate. This song can relate to personal situations as well as beliefs. Some people think that this song is a good dance song, but if any type of dance could suit this song, I believe slow dancing fits â€Å"Desert Rose†. Slow dancing brings people together and can also spark attraction between the partners. The mood of the song is slow and intoxicating in a sense because for me, it relaxes me and ignites my imagination. When people dance one on one they tend to stare into each other’s eyes. Some say that eyes are the windows to your soul and its true when youShow MoreRelatedBlack Boy And The Grapes Of Wrath Analysis1728 Words   |  7 PagesThe bible is a pretty exhilarating book; tales of bearded men crossing deserts, talking snakes, talking bushes, forbidden fruits, floods, adultery, and pregnant virgins. What more could you want? Well, you might want to escape poverty. Logically, your next question is: can religion accomplish this task? And according to Richard Wright and John Steinbeck, the answer is a resounding â€Å"no.† Wright and Steinbeck, pump their books, Black Boy and The Grapes of Wrath, respectively, full of biblical allusionsRead MoreBob Marley And The Wailers1654 Words   |  7 PagesAmerican rhythm and blues. Reggae contains many references Rastafarianism, which many consider the result of Bob Marley’s practice of integrating reggae with Rastafarian ideology. This paper serves to examine reggae, with special emphasis on a lyric analysis of Jamaican reggae band Bob Marley and the Wailers. The major question this paper addresses the social context that led to the dominance of social criticism in the lyrics of reggae songs, the importance and significance of Rastafarianism, as wellRead MoreAuthor of A Rose for Emily, William Faulkners Nobel Prize Essay707 Words   |  3 PagesAll I have to say about A Rose for Emily is that she was a crazy person! Faulkner is a really worthy and famous writer that has a lot to say in his writings and I think that he accomplishes that when he writes. â€Å"On December 10, he delivered his acceptance speech to the academy in a voice so low and rapid that few could make out what he was saying, but when his words were published in the newspaper the following day, it was recognized for its brilliance; in later years, Faulkner’s speech would beRead MoreThe Gulf War Strategy Essay1235 Words   |  5 Pagesperception that the United States was no longer a major military power. In actuality, the United States had not lost power but military authority. The difference between the two is explained in the following excerpt from On Strategy II: A Critical Analysis of the Gulf War by Col. Harry G. Summers: Simply stated, military power, based on physical factors that can be counted and computerized, is the aggregate of the size of a nations armed forces; the strength of its weaponry, arms, and equipment;Read MoreWilliam Faulkners A Rose for Emily Essay1382 Words   |  6 Pages Emily’s Downward Spiral: An Analysis of â€Å"A Rose for Emily† In William Faulkner’s short story â€Å"A Rose for Emily,† the main character of the story is Miss Emily Grierson. To analyze and examine her character, it is almost impossible not to look at the psychological aspect of it. Through the narrative of Faulkner’s â€Å"A Rose for Emily,† Miss Emily’s behavior and character is revealed as outright strange from any average standard of characters. A few days after they lay Miss Emily’s body to restRead MoreLiterature Review Retributive Justice: The Case of Justin Wolfe1838 Words   |  7 Pagespower between criminal justice officials, victims and offenders and imprisonment provides offenders with skills likely to reduce recidivism. Literature Review Retributive Justice Moore (1993) indicates that retributive justice is based on just deserts. Society punishes offenders because offenders deserve to be punished, regardless of if any other good comes from the punishment. Retributivists consider punishment on an individual basis. Every offender must be punished; one offender cannot escapeRead MoreEssay on The Nature and Role of the Ocean in the Medieval Imagination1525 Words   |  7 Pagesinfluencing the medieval view of the ocean is the ideology of the Desert Fathers. The desert fathers were holy men that lived in the near east, who became disillusioned with the materialistic culture of the time and wandered out into the desert as hermits. They were seen as heroes in their time and were revered as wise men. They were sought out by people wanting guidance and gradually became famous for their way of life. They went out to the desert for solitude, to be `warriors of God and test themselvesRead MoreSummary Of A Plague Of Sheep By Elinor Melville1558 Words   |  7 Pageshuman choice that caused the ecological degradation of the Valle del Mezquital. She outlines the environmental characteristics of the valley in Mexico before and after the colonial conquest of the region. Melville furthers her argument through the analysis of another region in Australia and the stratification of the conquest process. The study is focused on the decades between 1500 and 1600. A cogent book, â€Å"A Plague of Sheep† does well to deliver information pertinent, but sometimes irrelevant, toRead MoreThe Greek And Roman Religion943 Words   |  4 Pagesabout Hebrews. This was called, the Law, or the Torah. On 1250 B.C.E., Moses contemned the pharaoh in Egypt then directed his people out of Egypt towards the Sinai Desert. There, on Mt. Sinai, Moses was given the Decalogue, or Ten Commandments. The Decalogue contained religious ancient laws and a â€Å"basis for moral reflection and analysis,† which influenced many Hebrews from the begin ning to present day. In early Christianity, the belief was that the Messiah would come down to earth to help the humansRead MoreThe Debate On Global Warming1239 Words   |  5 Pages In a recent study, based on analysis of temperature variations over time and geomagnetic activity, researchers concluded that the sun will continue to play a significant part in climate change in coming decades. Another often cited natural cause of climate change is orbital change. Scientists believe that the earth’s orbital tilt varies between 22 and 250 every 41,000 or so years. Such orbital change is said to be responsible for the development of the Sahara desert in Africa. For some time, the

A New Turning Point in My Life Free Essays

Have you ever heard someone says that life is never quiet and peaceful likes a river? And, have you ever faced a difficult challenge that influenced your life? My life has changed a lot and I have faced many complexities since I came to the United States. Like most foreign students, I have almost the same problem about adapting into a new environment while I am studying abroad due to English limitations. It is not easy for me to fully understand what everyone says at the beginning, and it is hard to adapt into American culture. We will write a custom essay sample on A New Turning Point in My Life or any similar topic only for you Order Now Discrimination and miscommunication are the biggest issues and they always exist for people who immigrate to a new environment. Most foreign students do not get respect from others, and blend into their classmates’ society, that was my thought at first in the new community. However, after almost two years learning in America, I have discovered some valuable experiences about how to manage to be proficient in English, as well as more self-assured and I feel at ease in my life. I always try to keep moving forward, grabbing every chance to improve myself and never give up making my dream come true. Regardless, communication and discrimination are strenuous challenges for me to integrate into the new environment. I believe that I can surmount these predicaments and achieve success through hard-work and determination. Initially, communication was one of the universal issues for me to encounter when I came to America, because that is the basic step to integrate into a new life. Language differences greatly increase communication problems, even if the speakers have some knowledge of the others’ language. Language is so much more than words. As a result, accurate translation, How to cite A New Turning Point in My Life, Papers

Music and Text Questions Review Essay Example For Students

Music and Text Questions Review Essay What are the basic elements of music? Pitch, Tempo, Dynamic. 2. What is pitch? Pitch is the frequency of a sound, and it relates to the highness or lowness of a tone that we hear. 3. What is syncopation? A symphony is a musical piece that has been scored for a full orchestra; it is often an extended composition. What types of music use syncopation? Concerto and Sonata 4. What are three examples of forms of music? 12-bar blues is a chord progression that is common in many popular forms of music. The common meter, which consists of four lines of a particular number of, beats that end in the rhyming pattern of a-b-a-b. 5. What is form in music? The Form is the arrangement of large musical sections within a composition. Critical Thinking Questions 1. Music has sometimes been referred to as a universal language. Why has this description been applied to music? The reason for this is because the type of music there is and the message they contain. Do you agree or disagree with this assessment? Yes. Why? I agree because of how there are a wide variety of music here is in the world. . Why is musical notation important? Musical Notation is important because it shows how the music will sound. What benefits do musicians and others receive from being able to write down and note aspects of a musical piece? The benefit is that they wont forget how it was supposed to sound. 3. In the first part of the module, we discussed how music is everywhere in society. What are some of the ways that we use music? People use music for everything they put in movies, TV shows, and in they put it in malls. How do you use music in your own life? I use music when Im doing work, working out, playing games, and when Im in a competition. 4. Music can help influence the mood or feeling in a place by the way in which it is played. What is a specific example of this that you have experienced? When I was going through a bad relationship and we broke up I felt so bad I cried but one day I was Just listening to random music on the computer and I started to feel better and better about myself. The song was Vitamin R(Leading Us Along) by Chevrolet Music and Text Questions Review By Jambalaya

Nursing Methodology and Reports of Systematic Reviews

Question: Discuss about the case study Nursing for Methodology and Reports of Systematic Reviews. Answer: Introduction: This assignment aims to provide a short summary regarding the relevancy of the reviews. The two references that are selected for this task are: In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review. Methodology and reports of systematic reviews and meta-analyses: A comparison of Cochrane reviews with articles published in paper-based journals. Being a health professional, I have analyzed these online articles, and this has helped me to change my practice. The reviews in the first article are relevant because by going through the first article, I came to know regarding the management of lifestyle and glycemic control in the adolescents and children suffering from type 2 diabetes who seek assistance from the professionals of healthcare for managing their conditions of health. I came to know about the quality assessments that are associated with this illness (Johnson et al., 2010). The reviews in the second article are relevant as the comparison of the Cochrane reviews with the articles published in the journals that are based on papers have revealed that Cochrane reviews are methodologically more appropriate and are commonly updated in comparison to the meta-analysis or reviews that are published in the journals that are based on papers. Hence, I will be referring this to my practice in an efficient manner to make decisions regarding the type of care that should be provided to the individuals and maintain the consistency of my profession (Jadad et al., 1998). References Jadad, A. R., Cook, D. J., Jones, A., Klassen, T. P., Tugwell, P., Moher, M., Moher, D. (1998). Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals.Jama,280(3), 278-280. Johnson, S. T., Newton, A. S., Chopra, M., Buckingham, J., Huang, T. T., Franks, P. W., ... Ball, G. D. (2010). In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review.BMC pediatrics,10(1), 1.

Writing Sample Essays: Your First Draft

Writing Sample Essays: Your First DraftWhile many of the writing sample essays that you have encountered are from college students, the problem with these, as with most samples is that they lack structure. There is no editor guiding your prose and there is no attempt to make the sentences flow in a straight line. To take the approach to writing a sample essay that we will look at in the next few paragraphs, you need to start off by structuring the content, not to add more content to an already crowded page, but to create a structure that will guide the reader through the essay without them being distracted.You do not need to spend a lot of time on the sample essay to get your writing style right. Most college students will spend at least three or four hours writing the first draft of their essay, not counting the revision time that is necessary once it has been accepted for publication. So the time that you spend reading your sample essays is not wasted. You are less likely to turn u p with an essay that is completely unfocused and open ended.First of all, make sure that you format your sample cover sheet correctly. This means that you do not use the word 'cause' where there is a complete sentence. Make sure that the sample document uses proper grammar and spelling. If you find that your essay is in any way difficult to read, make sure that you proofread it again, to check that the spelling and grammar are correct.The first thing that you should do, when you are doing a look at your sample essay, is to make sure that you have an editor who is giving you input on the content of the document. If your editor does not give you any input on the content, this could be a red flag that you have a complex idea about the way to format the cover sheet. Also make sure that your editor has not yet delivered his/her own note to you on what should be included.The next step is to learn the structure of the sample and how you can add structure to it. We know that it is better to have a structure in your essay, than to have nothing at all. The process of building structure into your sample essay, could not only make the sample more enjoyable to read, but it will also help in writing a more coherent essay. You should also consider making changes to the structure of the sample document.We are confident that you will get some satisfaction when you compare your sample to the final version of the document. You will then understand why you did not receive a higher grade when your sample was compared to the final version. The structure will help you to make the proper corrections that you need to make to the document to make it as effective as possible. When you come to edit your work, your editing partner will also be able to spot some of the mistakes you made.After you have completed your essay, the best thing to do is to send it to as many different editors as you can find. This will make you feel much more comfortable that your essay will be judged on its meri ts. You can send your cover sheet to a large number of editors, and you will be well on your way to finishing your paper.

5 Super Tips On How to Get Your Resume Noticed

5 Super Tips On How to Get Your Resume Noticed You’ve come of age in the era of social media. Which probably means you assume everything can be done online: networking, socializing, job applications. And that’s more or less true. But there’s one vestige of the old world that will still be crucial to you in finding yourself a satisfying job: a resume. Don’t be fooled into thinking you don’t need one. Everybody does. Do concern yourself with making sure your resume gets in the right hands. It doesn’t have to be perfect; you’ll likely tinker with it for the entirety of your career. But you need to start somewhere. Here are five tips for how to get your resume noticed and read, so you can get that job and get your start.1. Think like a computerYour cover letter and your interview need to be geared towards the human recruiters who’ll be reading it. Your resume, on the other hand, will probably be read first by a search engine. Keep that simple fact in mind and gear your document to get through the machines.2. OptimizePart of this strategy means using the right words to get through the computer programs that will sort your resume. Part of it is simply making sure you’re showing a hiring manager that you can do the job. Start by reverse-engineering the job description and peppering your resume with the keywords necessary to showcase your skills. You can also create a â€Å"core competencies† section at the top and listing your most valuable skills there. And if you have to cheat, and include keywords for skills you don’t quite have, you can try putting them in in white font, so computer searches will pick up on it, but human recruiters won’t see that text.3. Make it easyMake sure to get all the basics covered: school, major, GPA, objective. When writing your objective, err on the side of specifics. Don’t just say you want a great job doing great things; make sure to let the recruiter know you mean business. Be clear about th e location and the industry you’re looking for. Take the guess work out of it.4. Go electronic with your cover letterMore often than not, you’re going to need to email a cover letter rather than sending the traditional hard copy. Again, there’s no guarantee a human is going to see it. But you shouldn’t cut any corners all the same. Start with as personal an opening as possible- whether a friend referred you, or you have a mutual acquaintance, or you have a particular affinity for this particular position. Then use the rest of the message to contextualize the bullet points on your resume. Again, be as specific as possible.5. Think â€Å"means to an end†Your resume doesn’t have to be perfect. It doesn’t have to do everything. But it does need to be attention-grabbing. And it needs to present your brand clearly and effectively to the people who will hire you. Be honest and showcase your unique qualities and talents and you’ll do f ine.

Five Views on Sanctification Essay Example

Five Views on Sanctification Essay Example Five Views on Sanctification Paper Five Views on Sanctification Paper All Christians in a process of their spiritual development realize the need of living a holy or sanctified life. However, there is no one uniform view on how sanctification can be achieved. â€Å"Five Views on Sanctification† comprises a gathering of studies of five major Protestant views on sanctification. Each author presents his own understanding of sanctification, and responds to the opinions of others. Melvin Dieter summarizes the Wesleyan View, Anthony Hoekema explains the Reformed view, Stanley Horton presents the Pentecostal view, McQuilkin presents the Keswick view, and John Walvoord explores the Augustinian-Dispensational view.In this book Protestant theologians address such topics as possibility of success in sanctification, the way to achieve it, crisis experience after a person’s conversion, as well as other issues connected with the concepts and processes of sanctification. The book is written in a counterpoints manner, which allows reader to examine stren gths and weaknesses of each view and make reasonable conclusions.The Wesleyan View derives its name from John Wesley, an English theologian and evangelist. Dieter summarizes that Wesley saw the final goal of sanctification as a renewal of â€Å"mens and womens hearts in (Gods) image† (Dieter 15). The achievement of this goal could be implemented on practice in a person’s physical existence. His understanding of connection to God was through love, which was the key factor in gaining Christian maturity and achieving sanctification. In his opinion, a person’s heart turns to God after acquiring â€Å"a faith that works by divine love in the crucible of everyday life† (Dieter 12).Wesleyan view strongly supports the idea of the original sin, and as a key factor in purification process on the way closer to God it points out â€Å"prevenient grace†, which is the initial step in the process of sanctification and â€Å"the beginning of the process by which God begins to lighten the darkness of the Fall for all men and women; it will bring those who faithfully receive it to saving grace, sanctifying grace, and grace for the life of love (Dieter 25). Wesley believed that the process of sanctification has no limits; there is no point where a Christian could stop his development. He also believed that regardless a person’s Christian maturity, there is always a possibility of committing a sin. As for the law, Wesley believed that it was enclosed in the Sermon on the Mount, saying that â€Å"the Ten Commandments are renewed in the Sermon on the Mount in their sanctifying purity and spirituality and†¦Ã¢â‚¬  (Dieter 26).Under the Reformed view sanctification can be achieved under three main conditions: experience of a growing union with Christ, sanctification by truth, sanctification by faith. The concept of sanctification according to the Reformed view is describe as â€Å"that gracious operation of the Holy Spirit, involving our responsible participation, by which He delivers us as justified sinners from the pollution of sin, renews our entire nature according to the image of God, and enables us to live lives that are pleasing to Him† (Hoekema 61). There are two outcomes of sanctification according to Hoekema: the proximate and final goals of sanctification. The final goal of sanctification is the glorification of God, and the proximate result is perfection, or likeness of Christ.Positional sanctification concept from the Pentecostal Perspective is similar to the Reformed view. This type of sanctification occurs at the moment of belief, involves the believer being set apart from the world to follow Christ, puts believer in perfect relationship with God, and sets Christians free to do Gods will. According to Horton, in order to achieve sanctification Christians demonstrate a complete obedience to the God’s will. Pentecostals reject the possibility for Christian to achieve a perfect sinless s tate, leaving space for an opportunity of a believer being weakened by sin. On of the most unique features of this view is baptism by Holy Spirit, which occurs after a Christian reached salvation and it empowers through the filling of the Spirit (Horton 130).According to the Keswick view, Christian life should be based on the forcing progress and victory, such as overcoming temptation, growth in obedience, improvement of self-control, resulting in the increased joy. The followers of the Keswick movement were represented by theologians with different persuasions and beliefs, and therefore the Keswick view does not have a well-defined concept of sanctification. However, McQuilkin summarizes sanctification as a setting apart for service to God. Those who achieve sanctification receive holiness and separate from sin. McQuilkin points out three main kinds of sanctification: positional, experiential, and permanent. The first is realized after a Christian’s conversion and results in justification in front of God. Experiential sanctification can be compared to the progressive sanctification of the Reformed view, and the author describes it as the outworking of ones official position in daily life† (McQuilkin 153). Transformation to the new life and the achievement of the likeness of Christ of the believer marks the occurrence of permanent sanctification, which results in a departure of a person from sin. McQuilkin summarizes Keswick view as a balanced opinion on different Biblical ideas of sanctification appeared through the development of the Christian culture.The dispensational view is researched by John Walvoord, who emphasizes one factor generating differences in concepts of sanctification. He believes this factor to be the rate of a person’s transformation after achieving sanctification. The other views argue whether a person completely changes or some aspects from the previous experience still remain. Walvoord concludes this difference in the presence of â€Å"sin nature.† He defines â€Å"sin nature† as â€Å"The concept of a sin nature can probably best be summarized as a complex of human attributes that demonstrate a desire and predisposition to sin† (Walvoord 206). Dispensational point of view states that choices made in people’s life shorten or extend the way to sanctification, which eventually be achieved and a sanctified Christian will reflect Christ’s glory and perfection. Complete God’s perfection cannot be achieved through the sanctification process though; rather it gives an increasing assurance of a believer’s salvation through Holy Spirit. The result of this process is that a mighty work for God can be accomplished† (Walvoord 222).

Critically discuss being drinking among women and particularly among Literature review

Critically discuss being drinking among women and particularly among asian women - Literature review Example This is because they are the largest group between the two that is experiencing rapid growth in binge drinking. This paper seeks to explore the theoretical implication of binge drinking while focusing on Asian women. As a modern phenomenon, binge drinking is more of a problematic form of drinking as opposed to pleasurable drinking. There has been numerous instances of debate on binge drinking in the media, especially in the TV and the newspaper with shameful representations captioned by examples such as â€Å"Binge Britain’s Night of Shame†, â€Å"Booze Britain† and â€Å"Ladette to Lady†. From these contexts, it is clear that the people being described in the TV and the newspaper are young people who engage in unacceptable behavior after alcohol intoxication. There are also alcohol policies put in place by the government to promote sensible behavior when drinking (Nicholls 2009). In academic studies, there are misconceptions about the phenomenon of binge drinking being a new manifestation of the 21st century. What is also questionable is its mere existence and how exactly it is presented in practice because most of the people who go out drinking on weekends are painted by the media and the government as being binge drinkers when they do not overtly comprehend the nature of their drinking themselves (Haydock 2009). Academic accounts also identify a problem with the fact that binge drinking is considered a new phenomenon, given that there are numerous aspects that influence the â€Å"newness† and they vary with race, culture, age, gender among others. For instance according to Measham and Brain’s (2005), the â€Å"culture of intoxication† is a representation of â€Å"determined drunkenness† which is a calculated and deliberate attempt made by a person to get drunk (Measham & Brain 2005). However, according to Hall and Winlow’ s (2006), binge drinking is considered a means by which people engage more in broader friendship

Carbon Price Mechanism Essay Example | Topics and Well Written Essays - 1500 words - 1

Carbon Price Mechanism - Essay Example The main goal of this essay is to comprehend the importance of this plan to the household economies and forecast the impacts of its implementation on these economies from the consumer behaviour perspective. It is crucial to overview main features of the proposed program before going into the discussion on its impacts. This program involves four major areas including the energy consumption, carbon price mechanism, increasing the efficiency of the energy consumption units and the management of the energy resources. The focus of this essay will be the mechanism for carbon price that has direct effects on the household economies and patterns of consumption of energy. This mechanism accompanies a list of various measures to explain its expected consequences on the business and households and methods for reducing the harmful effects by providing assistance in the form of increased cash payments and the reduction of taxes. Beyza reported that changes in the prices and income impacted the consumer behaviour, the proposed plan suggest two phase strategy for the implementation of carbon price mechanism. The first will continue for three years and during these years the carbon prices will remain fixed for at different levels for each year. For the first year the prices will be set at $ 23, for the second year the price will remain at $ 24.5 and during third year it will be increased further and will be fixed at $ 25.4. It shows that the prices will continuously increase during the first three years. The second phase is referred as the flexibility phase in which the prices remains flexible and will be determined with the help of emission trading scheme. The government will issue permits for the certain amount of carbon emission to various industries and the fees obtained from these permits will be used for the assistance of the household, small scale industries and for the promotion of alternate sources of energy which involve less carbon emission. Deborah (2010) described that the carbon price mechanism and assistance program by the government will have a combined impact on the household economies. The impact of both these factors on the economy of the household is explained below. Q. 1: What is the effect of rising energy prices for the economic wellbeing of households? Household is responsible for loads of carbon emission by consuming conventional sources of energy in large amounts. The economic reform program introduced by Austrian government aims to control the emission of carbon, change the energy consumption patterns of the

Impact of Aphasia on Health and Well-being

Impact of Aphasia on Health and Well-being Abstract This discussion paper considers the impact of aphasia on health and well-being, and following an in-depth exploration of relevant literature, provides suggestions for appropriate nursing interventions in respect of this relatively common condition following stroke. The introduction states that effective communication is essential to holistic care and positive outcomes for individuals affected by aphasia. However, when verbal communication is absent, nurses fail to adequately utilise alternative strategies so that the standard of nurse/patient communication is frequently poor. The discussion introduces the Theory of Human Scale Development. This theory emphasises that quality of life depends as much upon self-actualisation and relation-building as on physical health. The theory is used as a framework within the discussion in order to highlight the significance of communication to quality of life, and how its loss has profound psychological and social consequences. By utilising the theory, the discussion demonstrates that nursing care delivery must address loss of self-actualisation and relationship-building abilities, as well as physiological communication skills. The discussion reflects upon how aphasia results in loss of self, and how the situation is exacerbated by inadequate healthcare communication strategies such as nurse-controlled conversation, talking-over, and elderspeak. Suggestions are offered regarding more appropriate strategies. Efficacy of family input is considered; nursing competence regarding language practice therapies is discussed, and the quest approach is explored. Next, the discussion reflects upon the impact of aphasia on relationships. Aphasia denies access to support networks and results in isolation, stress, and loneliness. The individuals predicament is worsened by negative nursing responses such as communication filtering and avoidance tactics. The discussion reflects upon positive nursing strategies, which alleviate effects of aphasia on individuals social health. Concept analysis and self-awareness exercises as methods of enhancing compassion skills are explored. The social model of disability is discussed in order to highlight the benefits to individuals of environmental adaptations. Also, the social benefits of aphasia-group affiliation are discussed. The discussion concludes by emphasising that fundamental human needs involve social and psychological as well as physical aspects. Nursing interventions must therefore address all needs in order to provide holistic care in its fullest sense. Key Words Aphasia: nursing: relationships: self: Theory of Human Scale Development Summary Statements What is already known about this topic Good communication between nurses and patients is essential to the provision of quality healthcare that protects patients rights, autonomy and choice. Aphasia compromises nurse/patient communication leading to discrimination in health services, suboptimal care, poor long-term outcomes, and restricted rights. Communication difficulties faced by individuals with aphasia risks loss of self, and diminishes the beneficial impact of social integration on health. What this paper adds The multifarious impact of aphasia on the lives of individuals with the condition must be recognised and acknowledged by nurses. During their day-to-day nursing activities, nurses can facilitate the immediate communication needs of individuals with aphasia. Nurses can initiate aphasic individuals abilities to function independently and autonomously in the wider world via supporting the maintenance of personal identity and social integration. Introduction It has long been acknowledged and purported that good communication is essential to the provision of quality healthcare as it is integral to effective clinical assessment, health promotion, and patient choice and autonomy. Models of communication and research studies (Peplau, 1952; Fosbinder, 1994; Charlton et al, 2008) suggest that care delivery and health outcomes are improved when nurses use communication as a reciprocal interaction to express concern and commitment, and in return invite trust and human connection. These texts demonstrate that proficient interpersonal skills transform patients from objective clinical tasks to individuals meriting empathic, holistic care. However, because most communication strategies depend upon speech, the expediency of interpersonal relationships becomes severely compromised for individuals who experience aphasia as a consequence of stroke. Indeed, although the World Health Organisations (2001) definition of communication impairment encompasses verbal, non-verbal and graphic abilities, Finke et als (2008) systematic review finds that nurses continue to focus on stroke patients inadequate ability to verbally meet communication needs. Non-verbal messages are assigned a secondary, supporting role, and are therefore not adequately exploited as legitimate alternative strategies. The subsequent poor standard of professional/patient communication, described as appalling in the United Kingdoms National Sentinel Stroke Audit (Intercollegiate Stroke Working Party, 2009, p.12) has serious ramifications. O Halloran et als (2008) literature review suggests that health professionals inability or unwillingness to effectively enga ge with individuals affected by aphasia leads to discrimination in stroke services, suboptimal care, poor long-term outcomes, and restricted rights. Theory of Human Scale Development To avoid the suboptimal care of patients with aphasia, nurses must realise the necessity of effective communication to health and well-being. If nurses are to be motivated to explore, improve and exploit communication strategies as therapeutic tools, they must, in the first instance, understand the devastating impact of aphasia on quality of life. An analysis of aphasia in relation to the Theory of Human-Scale Development (Max-Neef et al, 1991) helps to illustrate its effect on the individual. According to the Theory of Human-Scale Development, quality of life depends upon the satisfaction of nine classes of interrelated ontological fundamental human needs (figure 1). Of these, only subsistence relates to physical health, the others being concerned with psychological and social issues associated with the sense of self and relationships. Because quality of life correlates with the number of satisfied needs, if a synergic satisfier (one satisfier that satisfies multiple needs) such as the ability to fluently verbally communicate, is removed, the impact on life quality is devastating (figure 2). Charmaz (1983; 1995; 1999) symbolic interactionist perspective reaches similar conclusions. These grounded theory studies of chronic illness demonstrate that the self is developed and maintained via self-actualisation and social relationships. Where illness reduces individuals participation in society, and prompts negative reactions from others, feelings of discreditation and loneline ss follow. Individuals beliefs that they are encumbrances on society rather than valuable contributors, lead to suffering and the loss of self. It is essential, therefore, that rehabilitative therapies should result in a synergic effect so that self, relationships, and thus quality of life are improved and maintained to the highest possible level (figure 2). However, many individuals with aphasia bemoan the fact that health professionals consistently focus on physical, biomedical definitions which view the condition as synonymous with physiological stroke events, rather than separate aphasia disability experiences (Liechty and Heinzekehr, 2007; Shadden et al, 2008; Wertheimer, 2008). This leads to the dismissal of psychological and social aspects of communication impairment and a thwarting of attempts to address them. Thus, the biomedical perspective, which defines aphasia as an inability to use or comprehend language as a consequence of injury to the cerebral cortex, results in the comment, I have aphasia, generating the response, You mean you had a stroke (Liechty and Heinzekehr, 2007, p.316). But, as Liechtys autobiographical account illustrates, aphasia is not an objective condition but a subjective reality, and focusing on the physiological brain damage both de-emphasises the pain that aphasia causes and denies the continual struggl es faced (p.316). Liechtys experience suggests that a psychosocial definition is more appropriate to describe the full extent of the consequences of aphasia to the individual. Sundin et als (2000) wider definition describes the condition as a defect in the use of language which causes extensive damage to psychological and social well-being resulting in isolation and depression. This study suggests that understanding the meaning of the illness for the individual rather than concentrating on the underlying physical causes, is the true initiator of holistic healing. O Halloran et al (2008) agree. This systematic review proposes that a biomedical perspective impoverishes care delivery because attributing communication breakdown to the disease process reduces nurses responsibility and motivation to develop ongoing communication strategies. The review suggests that a psychosocial perspective where nurses view communication impairment as an illness experience as well as a medical phenomenon, promotes the ide a that difficulties result from impaired interaction between nurse and patient. This increases nurses feelings of responsibility to overcome communication barriers and seek out the individual behind the disease. It is apparent, then, that reference to the Theory of Human-Scale Development helps to illustrate how a professional attitude which attempts to satisfy all fundamental human needs, not just the physical need of subsistence, subsequently leads to richer, more meaningful outcomes. Although fundamental human needs are to an extent, interrelated (figure 1), they are broadly split into three categories. The discussion paper will explore the impact of aphasia by focusing on self-actualisation and relationship needs. Self-Actualisation Needs Impact of Aphasia on the Self Rogers (1967) personality theory states that self-concept and self-perception are fundamental components of personal identity. He proposes that because life-meaning and behaviour are essentially purposeful, individuals require freedom to make choices, and create and develop their own personalities, in order to construct a valid presence in the world. Of course, language is the core of this process of self-construction. Without language, the ability to narrate lived experiences is lost. The individual cannot inform the world who and what he/she is, or understand who and what others are, hence is unable to find an appropriate place in the scheme of things. Shaddens (2005) literature review describes this predicament as identity theft, a state of affairs in which individuals with aphasia are ignored and invisible. However, Kagans (1995) masking of competence model refutes this, proposing that the individual is transformed rather than rendered invisible by aphasia. The model states that because communication impairment makes it difficult to perceive the individuals functional mind, it becomes difficult to envisage capacity. With capacity hidden, the individual is transformed from a person to a mere physical presence and is often viewed as a burden with little social value. According to Charmaz (1983), witnessing ones former self-image crumbling away is itself a fundamental form of suffering (p.168). Time and again, autobiographical narratives refer to the pain experienced when the self is reduced by an assumption that language loss is synonymous with the loss of intellectual and cognitive abilities (Neal, 1988; Bauby, 2008; Liechty and H einzekehr, 2007). Bauby (2008) summarises the feeling thus, [They] left no doubt that henceforth I belonged on a vegetable stall and not to the human race (p.90). Buber (1958) refers to this objectivising of people as an I-It relationship (as oppose to an I-Thou relationship defined by its reciprocal and mutually respectful nature). Aphasia renders the establishment of a nurse/patient I-Thou therapeutic relationship particularly challenging, because sharing and understanding become difficult to achieve. Unfortunately, this often results in I-It communication within the healthcare arena, which in nursing, is intrinsic to detached task-orientated care. According to Gordon et al (2008), this denies individuals with aphasia the freedom to control and direct their own lives. Gordon et als (2008) observational study concludes that staff control conversations and focus dialogue on their own nursing-task goals. The studys use of conversation analysis demonstrates that patients rarely initiate conversations and therefore have little influence over topics. In addition, due to heavy reliance on the sequential context of dialogue in order to maximise unde rstanding, individuals with aphasia find it difficult to alter the course of conversation to suit their requirements. Such asymmetrical, task-orientated communication is neither therapeutic or responsive to holistic needs. This results in a reduction of the self and a denial of individuals rights to participate in their own care or in the creation of their own future. According to Wertheimer (2008), curbing the freedom to express the self commonly leads to feelings of entrapment. Wertheimers (2008) detailed analysis of post-subarachnoid haemorrhage experiences suggests that language difficulties and loss of control during hospitalisation contribute to depression, and dreams and hallucinations, which frequently involve images of imprisonment and dictatorial authoritarianism. The negative impact of nurse-controlled conversation is exacerbated further by persistent occurrences of talking over patients. Flegels (2008) short article acts as a reminder that talking over is unethical because it contradicts health professionals codes of conduct that stipulate patient autonomy is paramount during care delivery. Quoting Kants (1785) argument that autonomy depends upon the hypothesis that all individuals have unconditional worth, Flegel (2008) believes that talking over signifies to patients that their presence is of no consequence and therefore they are not autonomous. Elderspeak also diminishes autonomy. This speech style is generally used as a means to communicate with elderly patients, but research confirms that it is commonly used by nurses when encountering individuals with physical, cognitive and communication disabilities (Kemper et al, 1998; Williams et al 2004; Melton and Shadden, 2005). Williams et al (2004) describe elderspeak as a demeaning mode of communication similar to baby talk that features exaggerated, simplified, repetitive language. Because elderspeak stereotypes elderly and disabled patients as incompetent and incapable, individual potential and progress may be ignored, thus reducing control and the sense of self even further. Reactions to Loss of Self Unsurprisingly, individuals with aphasia struggle to instigate the fight to rescue the self, and often surrender to discreditation. Charmaz (1983) explanation that self-concept depends upon reflected images of the self by others is confirmed by Simmons-Mackie and Damico (2008). This study of communication therapy sessions suggests that external negative responses to individuals with aphasia leads to internal negative perceptions of the self and a silencing of the voice. Poor nurse communication techniques based on task-orientated conversation, elderspeak and talking over compound this internalisation process. According to Ryan et als (1986) seminal literature review and subsequent theory of dependency over-accommodation, implications of incompetence and diminished capacity which arise from such condescending speech styles lower individuals confidence and self-esteem. This increases dependency and passive acceptance of care, and consequently promotes feelings of worthlessness and powe rlessness. Parr et al (2003) agree. This literature review reports that individuals faced with inadequate communication attempts of service providers, feel so diminished that they often apologise for their own existence. By reflecting on the impact of aphasia on self-actualisation needs, it seems that the nursing role in care delivery should involve supporting the individual to both recover the pre-aphasic self and connect this self to the new disabled identity. In order to achieve this, the nurse must firstly get to know the patient as a person, then secondly, empower that person to regain the creativity, confidence and freedom required to control his/her own life. Nursing Implications Use of Family Liaschenko and Fisher (1999) identify person knowledge as integral to the establishment of effective therapeutic communication and holistic care. The acquisition of this knowledge involves knowing the patients private biography with a view to revealing the unique individual. Where aphasia inhibits direct verbal interaction between nurse and patient, family and friends can relay information and re-construct much history, therefore contributing to the satisfaction of a range of fundamental human needs. According to Williams and Davis (2004), this indirect narrative is invaluable as it allows the nurse to participate in individualised communication when speaking directly to the patient. This deters any tendency for task-focused interaction or elderspeak, which in turn, reinforces the individuals sense of self. There are barriers to implementing such interaction however. Paradoxically, despite, for example, British Government calls for improved professional/patient/carer communication (Intercollegiate Stroke Working Party, 2009), some studies report that nurses efforts to personalise care by informal chat with patients and families are thwarted by sociopolitical systems that prioritise task completion over person knowledge. (McCabe, 2004; Speed and Luker, 2004). Also, Fairburns (1994) study of attitudes to visiting hours reports that nurses often feel patients and relatives resent staff presence as an intrusion upon their private time together. Perhaps the use of patient diaries can help overcome these barriers. Combes (2005) introduction of diaries in the intensive care setting demonstrates that by encouraging families to produce ongoing written narratives, which are left at the patients bedside, readily accessible relevant information concerning what is significant and individual to the patient is made available. This data can be utilised and built upon in later nurse/patient interactions. Research into the use of diaries in aphasia care should therefore be undertaken. Families are also useful when nurses are trying to ascertain the individual with aphasias immediate concerns and opinions. Goodwins (1995) well-cited case study illustrates that needs are more easily interpreted when relatives, familiar with the individuals gestures, facial expressions and idiosyncrasies, and who share common social contexts with him/her, are on hand to translate. Indeed, Finke et als (2008) systematic review finds that, where nurses are prepared to ask families for suggestions, or written directives, regarding the meanings of the individuals non-verbal strategies, communication is much more efficacious. In terms of advocacy, Hedberg et als (2008) study of multi-disciplinary care-planning meetings demonstrates that an in-depth knowledge of the individual with aphasias life and views, equips family members to act as advocates in the negotiation of care needs and future plans. The research therefore concludes that nurses require training in how best to involve relatives in the decision-making process in order to ensure individual needs remain salient. While the recommendation to involve families in the communication process is essentially sound, much of the proposing nursing literature quoted above nevertheless fails to fully explore the potential risks to patient autonomy of relying heavily on alliances with relatives. Translation literature (Englund-Dimitrova, 1997; Bradby, 2001; Leininger and McFarland, 2002) confirms that any form of interpretation via a third person amplifies the chances of misinterpretation. However, the risk is further heightened by relatives conscious or subconscious propensity to distort, omit or add to the patients messages and opinions in order to address their own concerns. Shadden et als (2008) review of autobiographical narratives reports that, while the well-being of patients is the central concern of most families, disability caused by stroke has a significant negative impact on the lives of all close family members. This may result in the interpretation of aphasic communication being influenced by the intermediarys own slanted perspectives. Thus, relatives feelings of guilt, fear, stress, and fatigue may filter out some of the true messages that the individual with aphasia is trying to express. Ryan et al (1986) offers a more cynical consequence to family advocacy by suggesting that it may undermine the individuals power to control situations, and can even disguise the sense of self by recreating and redefining elements of the individuals history, personality and wishes during the advocacy process. Hence, although it is helpful to use family knowledge to obtain patient information, nurses must recognise that individuals needs may not be adequately supplied by biased intermediaries. Nurses must therefore be able to use their own disinterested objective strategies to reach an understanding of the individual with aphasias meaning. Nursing Implications Competence Theory and research which explores the meaning of caring (Halldorsdottir and Hamrin, 1997; Brilowski and Wendler, 2005; Chang et al, 2005) states that a fundamental strategy when nursing any illness is the alleviation of the patients fear that nothing can be done to treat the condition. This literature reveals that while patients appreciate expressive caring behaviours, competence when performing instrumental therapies, is considered imperative to a secure caring base. As Halldorsdottir and Hamrin (1997) assert, caring without competence is meaningless (p.123). It is apparent that in aphasia, where preservation of the self is at stake, the nurse needs to convey competence and confidence in attitude and execution of language practice therapies, so that the individual with aphasia feels secure in the knowledge that recovery of identity is possible and in hand. Nystroms (2009) phenomenological study of interviews and biographies finds that such provision of security via nursing competence encourages patient hope, motivation, and fighting spirit (p.2509). Finke et al (2008) believes that nursing competence in language practice therapy requires training in basic speech therapy, familiarity with augmentative and alternative communication, and regular consultations with speech and language therapists. However, currently, none of these schemes are widely implemented. Hemsley et al (2001) suggests this is due to individual and organisational attitude barriers, which view specialised communication techniques as both too time-consuming and beyond the remit of nurses. Finke et al (2008), proposes that time and resources spent on enhancing nurses communication competence may prove more efficient than relying on minimal task-orientated interactions. This is because ineffective interactions are at high risk of misinterpretation, ineffective at meeting individual needs, result in frustration, fear and despondency, and may contribute to depression. Also, Nystrom (2009) finds that extended time periods required for personal care support, provide ideal opportunities for skilled practitioners to simultaneously offer language practice (thus reducing rehabilitation time and resources), while allaying patient fears. A participant in the research is quoted thus, One nurse talked to me while helping me to eat and get dressed†¦that made me feel calm and secure (pp.2507-8). Nursing Implications Quest Approach Aphasia traps individuals in the present. Struggling to express details of past achievements, individuals situations are worsened by an inability to shape the future. In effect, individuals have lost both identity, and the freedom and creativity to restore it. They have lost their place in the world. Nystrom (2009) believes that the optimal method of regaining place is to defer to individuals pre-stroke identities. An awareness of individuals previous competencies, allows the nurse to personalise language practice, communication strategies and conversation by basing subject matters on familiar contexts of family, work, interests, and achievements. This enables individuals with aphasia to grasp meanings more easily, but it also helps to maintain a sense of the old valued, accomplished self, thus providing a structure on which to base rehabilitation goals. This method, defined by Moss et al (2004) as a restitution approach, is fundamentally flawed because it overlooks the fact that for many individuals, aphasia remains a permanent disability. Preoccupation with the old self could therefore lead to a painful mourning for what is lost. It could even exacerbate feelings of worthlessness by highlighting comparisons between past abilities and present inabilities. Moss et als (2004) exploration of online illness narratives purports that a quest approach is more psychologically healthy. Here, individuals are encouraged to accept their changed circumstances, and envisage and create a different future. For the nurse, this involves using the individuals history, not as a source of goals, but a source of interests on which new modified goals can be built. This requires strong multi-disciplinary co-ordination skills to bring patient, nurse, speech therapist and occupational therapist together in order to fully explore interests, resources, potential and progress. Furthermore, according to Vickery et als (2009) quantitative analysis of self-esteem scales, the nurse must kindly but firmly guide individuals to a realisation of their limitations so that the risk of disappointment is reduced. However, simultaneously, the nurse should demonstrate motivating and commendatory attitudes that elicit a sense of pride from individuals in their gains and success es, which ultimately increases confidence, self-worth and a sense of freedom. Relationship Needs Impact of Aphasia on Relationships Berkman et als (2000) review of social integration theory demonstrates that relationships and affiliations are formidable influences on physical and psychological health. The study explains that relationships provide informational, instrumental (practical), appraisal (decision-making) and emotional support, as well as opportunities for social engagement. All these aspects are essential to the endorsement of meaningful roles, the reinforcement of participation and belonging, and the promotion of affection and pleasure. Charmaz (1983; 1999) reiterates that these factors add to the sense of self as a valuable entity. Any process or condition which leads to alienation, separation or disconnectedness from society, adversely impacts on mental well-being and mortality (figure 2). Generative studies by Durkheim (1952) and Bowlby (1991) suggest that relationships serve to buffer detrimental influences of stressful events. These texts illustrate that when consistent, reliable relationships are absent or damaged, psychological stability is weakened and the risk of depression increases. Berkmans (1988) hypothesis takes this concept further by suggesting that social isolation is itself a chronic stressor resulting in persistent heightened hypothalamic-pituitary-adrenal (HPA) axis responses which consequently accelerate physiologic aging and functional decline. Because conversation is pivotal to interaction and relationship building, aphasia inhibits individuals from exploiting the health benefits of social integration. Pound et al (2006) believe that conversation is primarily transactional, enabling individuals to participate within a supportive society consisting of mutually supportive relationships. Aphasia therefore, results in an inability to access support strategies resulting in isolation and stress. For example, appraisal support is compromised because individuals with aphasia are unable to talk problems over with friends. Likewise, informational and instrumental support may be inaccessible if individuals cannot express their opinions and needs, nor comprehend disseminated messages. While Laver (1975) acknowledges the transactional element of conversation, he also emphasises its interactional nature, which allows the development of social connections. He explains that it is a bonding ritual, which explores and categorises social position, conveys intimacy, conspiracy, affection and belonging, and as such, its loss can lead to a devastating sense of loneliness. For individuals with aphasia, whose health is already severely impaired by stroke, it is imperative that nurses are able to support the relationship-building process, and hence, diminish risks of further health problems associated with social isolation. Ramos (1992) research concludes that this is best achieved by establishing reciprocal or connected nurse-patient relationships which involve the development of emotional and cognitive bonds that persuade the individual to feel the nurse is taking on part of the burden (p.503). Reciprocation also encourages nurses to perceive coping with illness as a shared responsibility. Pound et al (2006) agree, stating that if professionals acknowledge patients are not solo performers, but part of a company of players (p.18), then this idea of joint responsibility is accentuated. However, poor therapeutic relationship development in aphasia remains a common problem. Perhaps this can be explained by Hindles (2003) suggestion that any phenomenon, which undermines nurses competence as communicators, leads to the implementation of communication filter barriers, such as rationalisation and projection. Sundin et al (2000) believe aphasia is a relationship leveller because both nurse and individual with aphasia have difficulty being understood by, and understanding, each other. This situation is uncomfortable for nurses working in a healthcare social construction that is founded upon competency achievement and proficient practice. Balandin et als research (2007) validates this idea. This small qualitative study finds that the undermining of competence and power results in rationalisation and projection in the form of defensive attitudes such as its not my job or the patient doesnt need to communicate (p.58). These avoidance tactics have been so widespread that Stock well (1972) included individuals with aphasia in her list of unpopular patients. Reactions to Diminished Relationships Charmaz (1983) research, confirmed by Davidson et als (2008) case study, reveals how unwillingness or inability of family, friends and professionals to establish effective relationships with individuals affected by aphasia leads to feelings of rejection. This in turn erodes patients perseverance to pursue support and comfort, often resulting in retreat and the seeking of solitude. Lyon (1998) refers to this behaviour as constructive because it provides a protective cocoon (p.12) in which individuals can rest and quietly contemplate their situation. Likewise, Shadden et al (2008) believe solitude-seeking is beneficial as it allows individuals to recapture the self which appears to bolster self-esteem. The authors quote from a patient interv