Internet of things for Dubai Electricities and water authority (DEWA) Essay

Internet of things for Dubai Electricities and water authority (DEWA) - Essay Example DEWA is one of the first local authorities in the emirate of Dubai to get completely enabled and has a website reflecting its effort towards effective communication with its clients. In this paper, I am going to look at how robots usage can benefit the organization with the unique ideas and devices that can get used internally and externally. In the artificial power generation field there exist three modes of major power plants that can get used for the purpose of generating massive electric power, which can meet the high electrical demand of the vast Dubai population. They include the thermal power plants, tidal power plants, and the nuclear energy plants. For the all these cases, mobile monitoring by the application of robots can get used, and efficiently perform the expected roles with lots of efficiencies. The concept of mobile surveillance entails the power systems entails the control as well as the maintenance of plant by some automated means, robot, from a very safe distance (Everett, 1995). The robotic usage solve this task through high levels of sensing, processing of signals, control performance, the relay of information accordingly and the optimization theory. The sensing mechanisms by the robots get enhanced by the use of various sensors such as sensing of acoustic, field sensing, and also the infrared sensing among others. This sensing is advantageous since it substitutes human workforce for dangerous and highly specialized operations, including the live maintenance of high-voltage transmission line, by the DEWA, which is a long-standing initiative in the Dubai electric power. In the process of monitoring the internal electric power usage by different households and companies, DEWA is applicable with the use of line scout robot. Line scout robot is a triple axis robotic arm, which has gotten designed in a manner that it can attain the four principal conductors of a transmission line. The

Retirement vs. Strife in Old Age Essay Example for Free

Retirement vs. Strife in Old Age Essay A man that spends many years in active service be it for himself or for a more noble reason such as his country or people, would more certainly than not find retirement a disorienting prospect once he faces it. Retirement means stopping whatever has kept one alive and working for most of his healthy years. It means realigning his goals, getting used to other, more leisurely and less strenuous habits as befitting old age, and preparing to face death with peace and resignation. In Lord Alfred Tennyson’s poem â€Å"Ulysses†, the mythical hero of Homer’s epics expresses his anxiety about coming back home to Ithaca to reclaim his old responsibilities as king after years of traveling overseas and fighting the Trojan war, and his desire of undertaking a new adventure, instead. The poem begins with Ulysses dreading his return to resume the job of â€Å"an idle king† (Tennyson 1). He could not imagine the relevance of staying home â€Å"with an aged wife† (Tennyson 3) and to â€Å"mete and dole† (Tennyson 4) rewards or punishments to the people he governs—most of whom he does not know nor they of him but for his position as king. Ulysses does not like his former life of idleness and monotony even if it was a life of comfort and wealth. He prefers to travel and seek for adventures, testing life to its limits. For Ulysses, traveling means enjoying and suffering unpredictable moments. The sea and foreign lands, unlike a kingdom, presents varied and new experiences. Those that he had experienced so far have given him â€Å"a hungry heart† (Tennyson 12). His voyages have brought him to strange places, allowed him to interact with different peoples, customs and cultures, and meet creatures unimaginable if one simply stayed in one place all his life. Moreover, he has experienced the â€Å"drunk delight† (Tennyson 16) of war in Troy. Nothing in his kingdom could equal the things he did and witnessed. All that Ulysses saw and did made him what he has become and has produced a kind of restlessness or thirst upon his soul that cannot now be satiated by ruling a kingdom. This past life as king has become dull in comparison to his life as a voyager and soldier. According to him, a person who is contented with his present life is like rusting and acknowledging that the only purpose of life is to breathe. Ulysses wants to â€Å"follow knowledge like a sinking star/ Beyond the utmost bound of human thought† (Tennyson 31-32). He would like to keep exploring and test the boundaries of the capacities of an ordinary mortal, even one who is already old and less agile. He believes that one’s age is not a factor to consider because â€Å"old age hath yet his honor and his toil† (Tennyson 50). Only death can stop and end the possibilities that life has to offer. In the end, Ulysses appoints his son, Telemachus, to take his place as king, leaving him â€Å"the scepter and the isle† (Tennyson 34). Meanwhile, he prepares to embark on another journey. The speaker’s exhortations to his former companions in the final stanza may well be read as words that any man should well take heed as a personal advice, especially those who are contemplating a sedentary retirement in their senior years. The lines encourage everyone to not worry about the physical limitations that old age imposes upon every individual because the weakness of the body can easily be overcome when one is â€Å"strong in will† (Tennyson 69). This is also how a heroic life is lived.

Screams :: essays research papers

In my mind, it never ends. I can hear myself screaming and begging him to stop. My two year old son is hiding under his bed and shaking because he knows that Daddy is hurting Mommy again. My daughter is crying helplessly in her crib. At six months of age, even she knows that something is wrong. As I stare at the gun through my swollen eyes, I realize that if I make it through the night, I have to get us out of this house. I have to find a safe place for us to hide. I know the police will not help me. They never have. All I can do as I wait for his fists to tire is to think back on my life and wonder where it had gone wrong. As a child, I was enrolled in the Gifted and Talented program, which is the Texas version of Advanced Placement courses. The Daughters of the American Revolution gave me an award for a genealogy project and my team was the only one in the district that made it to the Odyssey of the Mind state-level competitions. I also competed in numerous spelling bees. Between drama class and the National Honor Society, my middle school and junior high school years were busy, but fun. In my junior year of high school, I was informed that I was in the Who’s Who high school edition. I worked after school and enjoyed volunteering at the hospital in the cancer center in my free time. I found myself inspired by their courage and it helped to keep me grounded in my priorities. In 1993, those priorities took a different turn. I realized that I was pregnant. After I got married, I found that the school district frowned upon pregnant students, married or not. I elected to receive my GED and begin college. I was on both the President’s and Dean’s List every semester. I was happy with the choices that I had made. Being a wife was a joy and I had a wonderful son. My husband’s job took him out of town occasionally for a week or two. One day he came home from a trip, and everything had changed. He was acting irrationally and being verbally abusive. He would stay out all night and, when he was at home, nothing could make him happy. I did not know it then, but he had become addicted to drugs and other women.

Mcdonalds vs Kentucky Fried Chicken Essay

Kentucky Fried Chicken (KFC) and McDonalds, which one do you prefer? Actually, they both serve delicious fast food. McDonalds focuses primarily on hamburgers and fried chicken but KFC does wraps, salads or sometimes pies and kebabs. they are hazards to health. In the Middle East they sell halal food. McDonalds and KFC have similar types of food, popularity and history. McDonalds and KFC both are global fast food chains but they have a really different history. Harland Sandors known as Colonel Sanders founded KFC. Ray Kroc created McDonalds However, McDonalds logo is smiling clown where’s KFC logo is the founder of KFC. McDonalds and KFC both serve fast food. McDonalds most common items are hamburgers, cheeseburgers, chicken nuggets, fries, salads, and shakes they also serve breakfast items and children’s meals. however, KFC chicken are crunchy and it is delicious. The chicken comes in original and spicy flavor. McDonalds burgers it consist of the Big Mac, Chicken Burger, double Beef burger and others. Both KFC and McDonalds are international companies. they are worldwide and have their own market. As you can see McDonalds and KFC are obviously really popular Still McDonalds operate their businesses for 24 hours for local consumers. As KFC doesn’t yet KFC and McDonalds had been broadcasted through television, newspapers and magazines. However, McDonalds and KFC actually have many similarities like their polite attitude and their extremely fast food. Be it McDonalds or KFC, you will surely have a great meal. But they both are hazardous to health. The ministry of health had been experimenting both McDonalds and KFC and they discovered that they discovered that they have a lot of oil and fats in it, so people have been debating about it the fats and oil that are in both the restaurant. Besides I prefer McDonalds because there is more choice on the menu, and its better value than KFC. McDonalds is cheaper than KFC and McDonalds tastes much better than KFC and some people have other opinion about that.

Paying college football athletes Essay

The Coach of a football team is just as important as any player performing on the field. In fact his power over the team surpasses that of any one single player, the coach can determine whether an entire season is a victory or a loss. Perhaps this is why Colleges justify paying a coach millions of dollar a year, but the players who are out there beside him next to nothing. Although a lot of the players that perform on the field week by week do get scholarships to help their tuition fees, food, and housing, this pales in comparison to the millions of dollars that the schools will bring in every season of football. It is wrong for colleges to use athletes to make money and not pay them or allow them to earn money in anyway involving their sport. Any coach of a successful college football team makes somewhere between 900,000 dollars and 5 million dollars annually. These are the coach’s of the big 10, big 12, SEC, ACC and many other conferences. For our top two college football teams in Michigan alone we have some of the highest paid coach’s. Brad Hoke the coach of our Michigan wolverines made 3. 25 million in 2011 and was the eighth top paid coach in college football. Mark Dantonio, coach of the Michigan state Spartans, made 1. 9 million according to USA Today. This is a small portion of what the whole industry of college football will make for a single college every year. It is wrong to not pay the ones who are even making all of this entertainment possible. It is one thing that colleges do not provide contracts for these players that compete so hard for the slim possibility of glory making it to the National Football League, but these colleges students are not even allowed to sell their signature for a profit. Colleges have prohibited the right of players to sell anything with their signed name on it to make a small some of money to fill their pockets. Now this does not affect every player in the NCAA, but it certainly does to the superstars of the league. An athlete can also be disciplined for selling their tickets to someone on game day, yet how much money do the directors of the NCAA earn as a result of the efforts of the student athletes? The truth is that the college athletes pay for a large portion of the salaries of every person employed by the NCAA. It only further demonstrates how colleges are abusing their control and power over their football players and more importantly what goes into their wallets. Another exploit in college football is the sale of jerseys by colleges. The NCAA wont allow colleges to sell football jerseys with a players name on the back of it, so the colleges resorted to selling it with a players number on the back. The number of a superstar football player is easily recognized locally in a college town. The schools are allowed to sell these jerseys, while the player who has worked hard to earn the right to play the game with it on never seeing a single penny of the profits earned. This does in theory put an idea of how much a single player can earn a school annually, but does go further than that, because a star can pull hundreds of fans in to a stadium that might not have filled up the year before. The money a school will makes from selling tickets to games is minuscule though in comparison with the money they will earn every when football starts in the fall with television contracts. Colleges setup contracts with major television networks so the whole nation can keep up with their fantasy football teams or enjoy the weekend flipping back and forth between games on TV. These contracts that school write up with networks earn millions of dollars every year and between actually airtime and all the advertisement that goes into it. Schools will also earn millions of dollars from sports booster donations. It is true that there does need to be money to cover cost of traveling, hotels, staff and maybe the college would even expect to earn back the 15-25,000 dollar yearly scholarship’s that a lot of athletes receive, but when you compare the amount of revenue that student athletes generate for their colleges, what they receive in return is very small. Most people already think of colleges as being greedy for their outrageous tuition fees and everything else that goes along with needing to live on campus and attend classes. That they will hire students to teach classes so that professors do not have to, while the large majority of students who are attending these classes are paying thousands of dollars to be there. Their greed reaches beyond all that when it comes to college level sports at school that have competitive teams. These astonishing facts about the amount of money a season of college football produce yearly surprise and upset most fans. It’s the same as taking a test for someone only to let them turn it and receive an A on the exam, It is constantly debated about whether or not starting and back up players on college teams should get a yearly salary, considering the time and effort they put in does not always lead to a deal into the NFL. However it has not changed yet and does not seem to be heading that way anytime soon. It is corrupt, it is unjust, but most of all robs the hard working players who go out their every weekend to make everyone else Saturday that much more enjoyable.

What Can You Do With a Philosophy Degree †Pro-Academic-Writers.com

What Can You Do With a Philosophy Degree Why study Philosophy? Many students see no reasons for obtaining a degree in this subject. They associate this science with something outdated and unpromising. In fact, Philosophy is not a science. We would rather say that it’s art. It’s an art of telling the truth to people so that it makes them think. It is an art of discussing our life values in a special manner. It’s an art of making other people hear you. Such skills are required in many professional fields. Thus, once you graduate from your university with a Philosophy degree, don’t worry about your profession. Most university graduates wish to work in the field of business or IT as these are two most promising directions for the future. Business and technologies are closely related, but many graduates ignore the fact that Philosophy is connected with business too. This discipline and advertising are a partnership made in heaven. So, we can say that Marketing, for instance, cannot survive without good knowledge of humanities, especially philosophy and psychology. Business majors believe that Marketing is a philosophy of selling. Any prestigious business university like Harvard Business School dedicates enough attention to studying issues in philosophy, even though they may not have it as a separate subject. In the age of unemployment, graduates fear to stay without well-paid careers. Fear not if you graduate with a Philosophy degree from your college or university! Such majors usually possess a unique set of skills developed over the course of their education that will pique the interest of the recruiters in many fields. A list of possible careers is much longer than you used to think. Also, you can read about other university majors and their opportunities. Find a Workplace Thanks to the Unique Set of Skills Research conducted by prospects.ac.uk found that Philosophy graduates are working  Ã¢â‚¬Å"for almost every type of employer in public, private and not-for-profit sectors.†Ã‚  Perhaps, the only place where you cannot work with your Philosophy degree only is Information Technologies (IT) as this field requires a solid knowledge of computer. All law, education, and business-related careers, including jobs in advertising, welcome university graduates with Philosophy degrees. It is much easier to work with the philosophy-trained mind from the very beginning than paying for the additional training in corresponding humanities school. So, what are those good skills that help Philosophy graduates win their dream careers? Analytical thinking:  Many careers today require advanced communication skills necessary to target proper audience as well as work in a team to come up with the mixed problem-solving experience. Philosophy degree guarantees perfect ability to evaluate any case objectively, study all existing opinions, conducting research to develop new and left-field ideas, and assuming the pros and cons of all options. Effective communication:  Graduates with Philosophy degrees in their pockets can answer any questions and share ideas in a concise and well-constructed way. No one would defend his personal point of view better than a Philosophy University graduate. Research and investigation:  Conducting in-depth research, placing and interpreting large amounts of information, and offering innovations are valuable skills for all types of careers possessed by the Philosophy degree holders. Moreover, such graduates are able to write down their thoughts in a well-organized manner. If you still have problems with writing experience, visit special websites which can help develop corresponding skills These are the arguments for employers to choose Philosophy degree owners to perform any careers. If you are about to graduate from your school, college, or university with a Philosophy degree, study your work opportunities below. Potential Careers for University Graduates with a Philosophy Degree Careers in Education As a rule, a position of a high school teacher is not the best option for the applicant with Philosophy degree. It is better to work as a university professor. University professors get paid much higher than school tutors. Besides, Philosophy is studied at the more advanced level when it comes to college or university. Teaching careers are perfect for graduates who like to communicate and write a lot. If you wish to share your knowledge and skills like critical thinking with the growing generation, teaching jobs are right for you. However, careers in education may require a professional teaching qualification, so you may want to take an extra course in university. Masters and Ph.D. degrees are preferred. Careers in Legal Environment Philosophy is closely related to the Law. These are two ancient sciences that have formed our community. Majors often join the field of law by choosing one of the possible legal careers (e.g. lawyer or advocate). You have to be able to investigate, conduct research, write legal documents, defend your arguments, and be aware of all legal issues with respect to the particular state. A philosophy degree is a good foundation for careers in law in case an applicant has also worked in the field of law. At least, extra training or education is a must because you still need to know the laws. Careers in Media Under media, we mean service like publishing rather than role play. Philosophy degree holders are effective in both preparing written materials and giving public speeches. Being a university graduate with a Philosophy foundation, you may want to work in the production of printed media such as books, newspapers, and more. Also, there are many opportunities for those who would like to write remotely. You can highlight any subject of your interest in the shape of blog posts. If you like to deal with research and write lengthy articles, careers in journalism may be your solution. Careers in Public Fields Every year, hundreds of thousand professional philosophers join public services. A Philosophy degree graduate feels comfortable when working for some government-issued organizations or medical services. If you would like to research various societal issues and propose your alternatives, public careers are good for you. Police and armed forces are hiring university graduates with Philosophy degrees on a regular basis as well. If you still think whether to study Philosophy or not, look at the life of at least one famous person with this degree: Bill Clinton, Rashida Jones, Ricky Gervais, Stone Phillips, and other university graduates who have chosen Philosophy degree. No matter if you want to join the business, education, or medical careers, Philosophy degree may be your lucky ticket! Ready to join? Order college or university admission essay from the professional writing service to get the place in short!

Explore reflective accounts of the mentor’s developing role using a recognised framework The WritePass Journal

Explore reflective accounts of the mentor’s developing role using a recognised framework Introduction Explore reflective accounts of the mentor’s developing role using a recognised framework IntroductionDefinition of mentorshipDescription FeelingsEvaluation/ AnalysisConclusion/ Action planEvaluation/ AnalysisReferencesRelated Introduction The purpose of this assignment is to review and explore reflective accounts of the mentor’s developing role, using a recognised framework.   Ely and Lear (2003) suggest that following a mentorship preparation course, a mentor should have sufficient information to increase their knowledge base in relation to a student’s learning needs; the effectiveness of role-modelling and effective learning environments.   The ability to examine and reflect upon issues relating to; course development and facilitation and assessment of learning should also be developed.   In order to achieve such; a portfolio of learning in collaboration with a reflective critical analysis and evaluation of five learning outcomes will be completed: supported by available literature, this will demonstrate the integration of theory and practice.   Burns and Grove (1999) believe that a literature review should contain only current research from the last five years.   However, as both mentorship and the reflective process are evolving phenomenon, it was felt significant to include reference to material, both recent and classic.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Although research into the effectiveness of reflection is extremely limited, anecdotally it does appear evident that there are multiple advantages to reflective thinking (Burton 2000). These will be discussed in more detail in outcome 2, but briefly reflection can be regarded as innovative (Pierson 1998), dynamic (Burns and Bulman 2000) and as Burnard (1989) proposes, promotes feelings, thoughts and beliefs to be challenged.   Although reflection is believed by some to be an essential part of professional education and development (Atkins and Murphy 1993), it does however have its critics.   The lack of research into the value of reflection has been noted by Newell (1994) and Macintosh (1998).   Burnard (2005) criticises the point that reflection requires an accurate recollection of an incident.   However, this would not appear to apply during reflection-in-action. To direct the reflective process throughout this assignment, an adapted version of Gibbs reflective cycle (1988) has been implemented.   As the reflective process entails a recognition of an experience and a subsequent description of such (Powell 1989), it is justifiable to incorporate the use of the first person when discussing related feelings.   Hamill (1999) considers the use of first person to be suitable when writing an assignment that requires an element of personal reflection.   He also believes it to be appropriate when developing personal and professional qualities of self-awareness, reflection, analysis and critique. In accordance with the Nursing and Midwifery Council’s (2004) guidelines relating to confidentiality, the mentored student will be named Amy.   Throughout the assignment, the author will be referred to as a mentor (although in reality the role was more of an associate mentor since the official requirements for mentorship had not yet been met).   All paperwork and formalities were agreed and countersigned with a recognised ‘mentor’ who had previously undertaken the former 998 course.   This nurse also acted as the authors mentor throughout the preparation course. Definition of mentorship Phillips et al (1996) note a lack of clarity in the term mentorship.   A variety of definitions have been offered for the term ‘mentor’, and so for the purpose of this assignment, a considered clear-cut definition provided by a well-regarded source will be applied. ‘Mentorship is a role undertaken by a nurse midwife or health visitor who facilitates learning and supervises and assesses students in the practice setting’ (Department of Health/ English National Board 2001a). In a longitudinal qualitative study undertaken by Gray and Smith (2000), it was again revealed that students identified a good mentor as a good role model, encompassing skills such as being organised, caring, confident, enthusiastic and professional.   A bad mentor, however, was thought to have a lack of knowledge, expertise and structure in their teaching, who was unfriendly, unapproachable and intimidating.   Although this study provides an insight into the effects of mentorship on student nurses, it can only really be applied to the small sample size employed, as to generalise to a wider population, the sample must be well-defined (Cormack 2000) Outcome 1 Description I was not on duty on Amy’s first shift; however, the ward manager introduced her to the nursing team, orientated her around the ward and explained the emergency procedures.   During the first week of Amy’s placement, I ensured that time was allocated to discuss all her learning objectives.   These had been set by the school of nursing, by Amy herself, and included objectives that I felt she would be able to achieve during her 9 weeks on the unit.   Although Amy’s allocated placement was specifically the surgical assessment unit, it was agreed that as the qualified nurses rotated between this unit and the main ward, it would be beneficial for her to do the same, thus ensuring consistency of mentorship and also a broader range of experience. The course documents were attained from the link educator, and these were discussed with Amy to ensure all outcomes were appropriate to the course module.   It was agreed that although allocated time would be available to discuss her progress, both Amy and I would state any concerns or difficulties that were identified, as and when they arose. Feelings During this initial interview Amy appeared extremely enthusiastic to learn, and despite having just entering the second year of her training, she seemed knowledgeable in many significant areas of nursing.   Amy’s enthusiasm had a direct impact on my desires to become a good mentor.   Despite feeling extremely nervous that I may let her down by not encompassing the necessary knowledge and experience to assist her through her placement, I felt eager to prove my capability and to learn more about the mentorship process. Evaluation/ Analysis Ely and Lear (2003) state that an initial discussion between the mentor and student should take place at the earliest opportunity, ideally during the first shift of the placement (Gray and Smith 2000).   Phillips et al (2000) believe that the discussions regarding a students assessment, should pre pre-arranged and prioritised, to avoid the student feeling like an added burden.   Time should be spent to ensure a thorough assessment is made, as hurried meetings have been suggested to be of less value (Bedford et al 1993). Price (2005a) states that during this initial interview, the mentor should make it clear that any developing problems or concerns should be addressed as they arise.   He also suggests that this initial interview act as a reference point for future discussions regarding progression.   Neary (2000a) recommends clearly identifying outcomes at this point to aid the relationship between theory and practice.   These objectives should express the needs required by the individual student (Gray and Smith 2000), the learning opportunities that the placement can provide (Stuart 2003) and as Price (2005b) advocates, meet the module outlines set by the school of nursing.   Rogers (1961) maintains that students are more likely to succeed once they have identified, individual needs and feel confident in their ability to achieve them.   He also states the importance of the student feeling comfortable to ask for advice and express their limitations.   Oliver and Endersby (1994) agree, sug gesting that the identification of the student’s individual needs during the initial orientation facilitates their perception of security. A number of authors have suggested the use of a learning contract as part of the continual assessment process and as a guide to learning (Stuart 2003, Quinn 1998, Priest and Roberts 1998).   Ely and Lear (2003) believe the implementation of a learning contract specifying individual evaluative criteria and outcomes, can promote the individual to take control of their own learning.   This contract is thought to provide a structured plan for ongoing formative assessment, therefore assisting the learning process and providing continuity (Wallace 2003). Although this form of self-directed learning does appear to be advantageous (Hewitt-Taylor 2002), Darbyshire (1993) suggests that mentors may find it difficult to gain control over a learning situation. Hutchings Sanders (2001) highlight a study commenced in the Northern Devon Healthcare Trust in 1999, in which a regional project bid was placed to develop formalized, multi-professional learning pathways. The overall aim was to prepare and provide a learning environment that was dynamic and enjoyable and promoted high quality care. A learning pathway was developed in order to ensure equity and consistency in the quality of student practice place. It comprised of three steps: preparation for each placement, induction before each placement and the learning experience.   The study was piloted in 6 clinical areas over 3 months, attempting to evaluate the effectiveness of the model.   A baseline qualitative analysis of the perceptions of service staff and students was completed prior to the study. The results of this were to be compared to a similar evaluation on completion of clinical placements in the pilot areas.   Although suggested that the model will have a positive effect on the quality of the students experience, it was noted that the pilot had not yet been completed, and subsequent results have not yet been published. Conclusion/ Action plan Following the above reflection and analysis, it would appear that most of the issues highlighted in the literature were actually met in the initial meeting with the student.   It is however noted that my area of practice does not typically implement learning contracts unless a student is repeating a placement.   With this in mind, I devised a form of agreement in conjunction with Amy, which would aim to meet her individual learning needs.   This has been included in appendix1. The main presenting challenge was that of a time constraint.   Working on an unpredictable assessment unit, it is very difficult to prearrange a discussion. To overcome this problem, Amy and I agreed to stay behind at the end of assigned shifts and to utilise any ‘quiet’ time that arose during the placement. Outcome 2 Description In order to be an effective role model, I first needed to ascertain how I was perceived by others.   In order to gain an honest insight, I asked my family, friends, and chosen colleagues that I felt would not be afraid to be truthful.   The outcome was that although I was considered caring and enthusiastic to teach others, I sometimes appeared impatient when under stress.   I identified similar attributes when compiling my own list.   With the assistance of my mentor, I compiled a list of self improvements and asked her to observe my behaviour to notice if they were being achieved. Feelings I felt very aware and anxious, that my actions and attitudes would be observed by Amy and possibly imitated in her work.   I was therefore conscious of how I acted in front of her, and realised I needed to remain professional, not only when dealing with patients but also away from the clinical area. Evaluation/ Analysis It has been suggested that nurses should use self assessment and reflection as part of their professional work and learning (Thorpe 2004).   The Department of Health/ English National Board (2001b) profess that qualified staff should provide good role-models for best practice, valuing learning and encouraging reflection.   Boud et al (1998) emphasise the importance of reflection as both a learning and teaching tool, believing it to facilitate the integration of theory and practice and develop a nurses’ capacity to contextualize knowledge to meet patients’ needs.   Burrows (1995) highlights the effectiveness of reflective thinking for both enhancing clinical practice and affirming the value of practice and knowledge-in-action to the profession. Burrows (1995) does however point out that research suggests students under the age of 25 may not encompass the cognitive readiness or experience required for critical reflection.   Although the student discussed in this a ssignment is 34 years old, the majority of pre-registration student nurses are in fact included in this category. The term role modelling has been defined by Bandura (1977) as a process that teaches students to learn new skills from others, that does not involve their personal trial and error.   Donaldson and Carter (2005), consider it to be of such importance, that they advise the value of role modelling to be discussed in the preparation for mentorship module.   Effective role modelling involves competence, enjoying the profession and providing excellent nursing care, and using these qualities when interacting with students and structuring their learning environment (Wiseman 1994).   Murray (2005) lists the behaviours of a positive role model as; listening and responding appropriately, displaying warmth and sincerity, maintaining eye contact and asking questions.   The problems with role modelling, however, can be if the student observes bad practice and consequently mimics such (Charters 2000), or as according to Lockwood and Kunda (1999), if the student feels dampened and de-motivate d when unable to achieve high standards set by a high-achieving, outstanding mentor. Watson (1999) undertook a qualitative ethnographic study to investigate the mentoring experience and perceptions of pre-registration student nurses.   Interviews were conducted within the clinical setting, with 35 students on a common foundation programme, and 15 allocated mentors.   The semi structured interviews, lasting between 20 and 30 minutes, were conducted privately and recorded by the researcher.   The results from the students and mentors were very similar; all saw the mentor’s role as assessor, facilitator, role model and clinical support, although the students identified an additional key role as planning.   This study highlighted some important issues; however, it is not without its drawbacks.   Although a small sample size is often acceptable within qualitative research (Thompson 1999), in order for the results to be generalized Dempsey and Dempsey (2000) explain that the selection of subjects must be thought to be a representation of the target populat ion.   The researcher stated using purposeful sampling, but it was not felt that 35 students at the beginning of their training from 7 ward areas met such requirements.   As the researcher only used one form of data collection (Appleton 1995) and did not ask the subjects to verify the results (Nolan and Behi 1995), the results can not be deemed to hold credibility.   The fact that the researcher undertook the interviews herself, the results could also have encompassed interviewer bias (Carr 1994). Brereton (1995) believes that a mentor’s insight and understanding of the mentoring role is the most effective bridge over the theory-practice gap.   A number of mentorship roles have been discussed by Thompson (2004) including; sharing personal thoughts, feelings and intuitive practice, being aware of own strengths and weaknesses and their effects on others, and being sensitive to a students needs. Conclusion/ Action plan Having read and internalised the literature, I would hope that I am a ‘good’ role model.   To confirm the opinions held by the students, I have encompassed an anonymous questionnaire within the student booklet discussing the strengths and weaknesses of the placement area and feedback regarding their mentor.   I have also learnt to reflect more in and on-action to improve on my own self-awareness and gain further insight into my actions and feelings. Outcome 3/6/7 Description My ward area currently has access to the trust intranet and internet, hospital policies and protocols, a small selection of books and journal articles and a welcome pack, notice board and information file designed and intended for student nurses.   Students also have access to lockers, kitchen facilities and the staffroom.   Whenever possible, a student’s off duty is planned around that of their allocated mentor and associate mentor. Feelings Although I feel that A6 generally meets the needs of student nurses, some of the resources are very out of date, and many of the books have ‘disappeared’ from the unit.   The absence of an allocated teaching room makes it difficult to discuss a student’s outcomes and/ or progress. Evaluation/ Analysis Price (2005a) emphasizes that the learning environment must be fit for practice and conducive to learning.   The ENB DOH (2001a) state that a clinical setting must be planned, structured, managed and coordinated, in order to provide unique learning experiences and opportunities, to enable the development of competencies for professional practice. In a quantitative study undertaken by Hart and Rotem (1995), it was significantly verified that the clinical learning environment has a considerable impact on nurses’ perceptions of their professional development.   The 516 questionnaires returned from across five metropolitan teaching hospitals suggested that; autonomy and recognition, job satisfaction, role clarity, quality of supervision, peer support and opportunities for learning all had an effect on professional development.   The statistical significance of p0.001 would suggest that the results are significant (Couchman and Dawson 1990).   However over a quarter of the questionnaires were not completed in full and for a quantitative study, the sample was still relatively small, and therefore questionable for generalisability to a wider population (Fetter et al 1989). Price (2004) believes a learning environment should address four issues; practical experience, practice resources, an approach to education and learning support.   These have been individually discussed by a number of authors.   The practical experience should provide sufficient supervision, ensure a range of patient/ clients and procedures, implement the nursing process and practices consistent with local protocols, policies and philosophies (Price 2004).  Ã‚   Myrick and Yonge (2002) advise students to work alongside various members of the multidisciplinary team (MDT) and to seek relevant opportunities from other practice areas to ensure exposure to a variety of clinical experience and expertise. The availability of a variety of resources, including journals, books and relevant articles has been suggested by Stengelhofen (1993).   Oliver and Endersby (1994) recommend access to policies, procedures and protocols, product and department information, health education literature and a list of contact names.   Ely and Lear (2003) advise the implementation of a dedicated teaching area, believing the use of patient day room, staff rooms and nursing stations to be unsuitable for structured teaching.   Mentors should be knowledgeable of learning centres and resources and take the time to inform students of their availability (Myrick and Yonge 2002). Characteristics of a good clinical learning environment are said to include a humanistic approach to students in which they are treated with kindness and understanding and encouraged to feel part of the team (Quinn 2000).   Quinn (2000) also emphasises the importance of an efficient management style, encompassing nursing practice that is consistent with that taught in university.   The National Audit Office (2001) strongly encourages partnerships between the school of nursing and the clinicians applying learning in practice to improve the quality of practice placements. To ensure students are adequately supported, Eaton (1999) insists staff must be dedicated and adequately prepared to undertake the role of the mentor.   The off duty must be carefully planned to coincide a student’s shifts with those of their mentor, and arrangements should be made to ensure other members of staff will ‘look after’ them in their mentor’s absence (Gray and Smith 2000).   Although Landers (2000) suggests that the supernumerary status of students can accentuate their insecurities if they are lacking direction and guidance, Ferguson and Jinks (1994) insist that student allocation should be for the purpose of learning rather than service needs.   Spouse (2001) believes that the ideal situation for learning is an environment encompassing good staffing levels of active learners engaged in problem solving, where there is a knowledge transmission, together with trust and companionship. Conclusion/ Action plan On examining my ward area as a conducive learning environment, the literature appears to support the conclusion that it holds many positive aspects, with staff members attempting to make the student experience enjoyable and informative. During recent weeks, the area was audited by the university as a positive learning environment, with no recommendations given for improvements.  Ã‚   Although this is extremely encouraging, it is felt that there are areas that could be improved.   Following discussion with the ward manager, I have devised a teaching system within the ward, which entails a monthly update of a teaching board and a short presentation for the junior staff members, including students.   This is maintained by the link nurse for each speciality and has received excellent feedback for the two months it has been implemented.   I have also updated the student booklet and have suggested providing the students with these prior to the placement with an invitation for them to visit the unit in advance, should they wish to do so.   The ward manager and I have also ordered a selection of books suitable to the ward area and are now continuously updating the policies and protocols on the ward. Outcome 4 Description As discussed in the previous outcome, my ward area does currently discuss relevant issues and ideas to ensure practice is evidence based.   On gaining a password from the IT department, all staff has access to the trust intranet, and at the discretion of the ward manger, internet access is also granted.   All staff members, including students, have access to the library. This ensures access to a variety of sources of research. Feelings Although relevant and up to date literature is accessible, it is felt it would be beneficial for my ward to hold more recent books and articles on surgical nursing.   Although I do feel that students are relatively well supported in my area of practice, I think they could be more involved in decision making and the planning of patient care. Evaluation/ Analysis Sams et al (2004) identify three largely unresolved problems within the healthcare setting: an existing gap between evidence and practice; unnecessary variations in practice and an increasing cost of healthcare.   They explain that these factors are changing nursing practice from routines and opinions to critical appraisal and practices substantiated by evidence.   In doing so; quality and safety of patient care is ensured through the nurse performing the right thing, the right way, the first time (Caramanica et al 2003).   Sackett et al (1996) describe evidence-based health care as the conscientious utilisation of clinical experience and current best evidence in decision making and patient care.   Evidence-based guidelines have been said to include three sources: clinical expertise, patient preferences and most importantly scientific findings (Hinds et al 2003) Webster (1990) advises clinical staff to keep up to date with current practice to ensure that what is carried out relates to what is taught in university.   Krichbaum (1994) believes student learning in the clinical setting is related to their mentors’ behaviours, including using objectives, providing practice opportunities and asking effective questions.   It has also been argued that teaching methods reflect what the student perceives as most effective (Burnard and Morrison 1991).   Thomson (2004) advises a mentor to transmit their view of nursing into the student’s mind in order for them to understand and evaluate practice from their perspective.   To maximise the benefits of a clinical placement, mentors should teach from the experience the student is having through a combination of a teacher driven approach and the reflective process (Thomson 2004).   The use of reflection has been discussed further in the facilitation of learning, to demonstrate an under standing of concepts, knowledge, skills and attitudes (Dix and Hughes 2004).   Neary (2000a) explains that to reflect in a way that enables them to understand and learn through their experiences, students will need advice and guidance from their mentors. Craddock (1993) suggests teaching students to process information in a way that becomes more meaningful to them, enabling the integration of theory and practice.   Self directed learning has been proposed as an effective method of achieving such, providing a foundation for practice based on evidence (Burnard and Chapman 1990). Students should be encouraged to participate in clinical knowledge by sharing ideas on practical issues, facilitated with time to visit the library (DOH/ENB 2001). Andrews and Roberts (2003) suggested that a mentors’ role was that of support, and to ensure students received adequate teaching within the clinical area, a clinical guide should be employed.   They undertook a study consisting of self-report questionnaires administered to 239 first year students and 450 clinical guides across eight NHS trusts.   They indicated that the students valued the clinical guides’ impartiality, gained further insight into the practice experience and became more proficient in problem solving.   The level of confidence that can be placed in the results is however extremely limited.   Only 65% of students and 21% of clinical guides responded to the questionnaires, the subject’s demographic characteristics were not described (Ryan-Wenger 1992), and no reference was made to the sampling method, (Parahoo 1997) the validity and reliability of the data collection (Mathers and Huang 1998) or the study’s credibility (Carter and Port er 2000). Conclusion/ Action plan Following the above literature review, I now understand the importance of involving a student in the assessment, planning and evaluation of a patients’ care as well as the implementation.   I try to involve students in all aspects of the nursing process, explaining our rationale for all decisions.   I have also implemented a self-directed learning approach, asking Amy to briefly research and feedback issues that have arisen.   She seemed to enjoy, and benefit from this style of learning, and in the process I also gained further insight into current evidence. Outcome 5 Description I used the outcomes set in the initial discussion as a benchmark for Amy’s learning and assessed her competency on how well I thought she achieved these outcomes.   Amy would observe a task, we would research it where appropriate and I encouraged Amy to ask questions.   When we mutually decided Amy was ready, and on gaining the patient’s consent; I allowed Amy to perform a task, such as completing an admission, administering an injection or redressing a wound. Feelings I was extremely nervous of misjudging Amy’s level of competence and consequently allowing her to administer care she was not capable of or restricting her learning. Evaluation/ Analysis Myrick and Yonge (2002) emphasize the importance of assessment and evaluation of a student’s learning in facilitating their experience.   Effective assessment is vital in judging a student’s competence to practice (ENB/DOH 2001a).   Watson et al (2002) noted a lack of clarity surrounding the term competence.   However, the NMC’s (2004) definition describes ‘possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision’. Rowntree (1987) identifies reasons for assessment as; motivating students, establishing progress and providing feedback, identifying strengths and weaknesses and establishing the level of achievement.   To uphold the reputation of nursing, Price (2005c) considers it vital to assess a learners’ ability to practice in a professional, sensitive and safe manner.   Watson et al (2003) believe that having the competency to practice involves having the competence to learn.   This involves having a positive attitude to learning, taking initiative, recognising learning needs, seizing learning opportunities and understanding how to reflect on; analyse and critique practice.   Benner (1984) advises skilful teaching in the practice setting to ensure students pass through five levels of proficiency from novice to expert. Calman et al (2002) undertook a study in Scotland to determine the methods, preparation of assessors and student views relating to the assessment of students’ practice. A combination of postal questionnaires, review of programme documentation and interviews with key stakeholders were completed.   They concluded that students had little confidence in competence assessment methods, there is a lack of consistency in the training of student assessors in the clinical areas and a limited number of approaches to clinical assessment are used.   Credibility was ensured through presenting the results to the subjects to verify (Nolan and Behi 1995) and by the implementation of a triangulative data collection method (Appleton 1995). Wilkinson (1999) states that to ensure an assessment is reliable; student’s abilities should be consistent and the assessment should be made over a period of time and agreed by others.   Validity can only be assured when a students’ performance involves an integration of cognitive, affective and psychomotor skills (Wilkinson 1999).   A vital part of clinical assessment is direct observation, which must involve sufficient time to observe, an awareness of observer bias and the observer effect, and the incorporation of a checklist (Hull 1994).   Greenwood and Winifreyda (1995) devised a model to aid teaching and assign which the use of direct observation with diagnostic questioning of students.   This elicits a students understanding and performance and should be followed up with constructive feedback including; instructions, revisions, encouragement and guidance.   A study by Watson (2002) supports the use of reflective learning contracts as an assessment tool a lthough this has been criticised on ethical grounds. As no single procedure is adequate for assessing clinical competence, a continuous assessment incorporating a variety of methods should be employed (Neary 2000b). Conclusion/ Action plan On reviewing the literature, I feel that I now have a deeper understanding of the methods of assessing a students’ competence and will attempt to implement such in the future.   I will also try to provide feedback and constructive advice whenever possible to assist a student in meeting their initial outcomes. References Andrews, M. and Roberts, D. (2005).   Supporting student nurses learning in and through clinical practice: the role of the clinical guide.   Nurse Education Today, 23: 474-481. Appleton, J.V. (1995).   Analysing qualitative interview data: addressing issues of reliability and validity.   British Journal of Nursing, 14 (10), 587-590. Atkins, S. and Murphy, K.   (1993). Reflection: a review of the literature.   Journal of Advance Nursing, 18: 1188-1192. Bandura, A. (1977).   Social Learning Theory.   New York: General Learning Press. Bedford, H, Phillips, T, Robinson, J and Schostak, J. (1993).   Assessment of Competencies in Nursing and Midwifery Education and Training.   London: The English National Board for Nursing, Midwifery and Health Visiting. Benner, P. (1984).   From novice to expert.   Menlo Park: Addison Wesley. Boud, D, Keough, R. and Walker, D. (1998).   Reflection: Turning experience into learning.   London: Kogan Page. Brereton, M.I. (1995).   Communication in nursing: the theory-practice relationship.   Journal of Advanced Nursing, 21: 3114-3324. Bulman, C. (2000).   Exemplars of Reflection: A chance to learn through the inspiration of others. IN. S Burns and C Bulman (eds).   Reflective Practice in Nursing: The growth of the professional practitioner.   2nd edition.   Oxford: Blackwell Science. Burnard, P. (1989).   Developing critical ability in nurse education.   Nurse Education Today, 11 (2): 271-275. Burnard, P. (2005).   Reflection on reflection.   Nurse Education Today, 25: 85-86. Burnard, P. and Chapman, C. (1990).   Nurse Education the way forward.   London: Scutari Press. Burnard, P. and Morrison, P. (1991).   Preferred teaching and learning strategies.   Nursing Times, 87 (38): 52. Burns, N. and Grove, S.K. (1999).   Understanding Nursing Research. 2nd edition.   Philadelphia: WB Saunders Company. Burrows, D.E. (1995).   The nurse teacher’s role in the promotion of reflective practice.   Nurse Education Today, 15: 346-350. Burton, A.J. (2000). Reflection: nursing’s practice and educational panacea? Journal of Advanced Nursing, 31 (5): 1009-1017. Caramanica L. Cousino JA. Petersen S. (2003) Four elements of a successful quality program: alignment, collaboration, evidence-based practice, and excellence. Nursing Administration Quarterly, 27 (4): 336-43. Carr, L.T. (1994).   The strengths and weaknesses of quantitative and qualitative research: what method for nursing? Journal of Advanced Nursing, 20: 716-721. Carter, D.E. and Porter, S.   (2000). Validity and Reliability.   IN. D.F.S. Cormack. (ed).   The Research Process in Nursing.   4th edition.   London: Blackwell Science Limited. Charters, A. (2000).   Role modelling as a teaching method.   Emergency Nurse, 7 (10). Cormack, D.F.S (2000) The Research Process in Nursing.   4th edition.   Oxford: Blackwell Scientific Publications. Couchman, W. and Dawson, J. (1990).   Nursing and Health Research.   London: Scutari Press. Craddock, E. (1993).   Developing the facilitator role in the clinical area.   Nurse Education Today, 13: 217-224. Darbyshire, P. (1993). In defence of pedagogy: a critique of the notion of androgogy.   Nurse Education Today, 13 (5): 328-335. Dempsey, P.A. and Dempsey, A.D. (2000).   Using Nursing Research: Process, Critical Evaluation and Utilization.   5th edition.   Maryland: Lipincott. Department of Health/ English National Board (2001a).   Preparation of Mentors and Teachers: A new framework of guidance.   DOH/ENB: London. Department of Health/ English National Board (2001b).   Placements in Focus.   Guidance for education in practice for health care professionals.   London: Department of Health/ English National Board. Dix, G. and Hughes, S.J. (2004).   Strategies to help structure students learn effectively.   Nursing Standard, 18 (32): 39-42. Donaldson, J.H. and Carter, D. (2005). The value of role modelling: Perceptions of undergraduate and diploma nursing (adult) students.   Nurse Education in Practice, 5: 353-359. Eaton, A. (1999).   Assessing learning needs.   IN. S Hinchliff (ed).   The Practitioner as Teacher.   2nd edition.   London: Baillià ¨re Tindall. Ely, C. and Lear, D. (2003).   The Practice Learning Experience.   IN. S Glen and P Park (eds.) Supporting Learning in Nursing Practice.   Hampshire: Palgrave MacMillan. Ferguson, K.E. and Jinks, A.M. (1994).   Integrating what is taught with what is practiced in the nursing curriculum: a multi-dimensional model.   Journal of Advanced Nursing, 20: 687-695. Fetter, M.S, Feetham, S.L, D’Apolito, K, Chaze, B.A, Fibk, A, Frink, B.B, Hougart, M.K, and Rushton, C.H. (1989).   Randomized clinical trials: issues for researchers.   Nursing Research, 38 (2): 117-120. Gibbs, G.   (1988).   Learning by Doing: A guide to teaching and learning methods.   Oxford: Oxford Polytechnic. Gray, M.A. and Smith, L.N. (2000).   The qualities of an effective mentor from the student nurses’ perspective: findings from a longitudinal qualitative study.   Journal of Advanced Nursing, 32 (6): 1542-1549. Greenwood, J. and Winifred, A. (1995).   Two strategies for promoting clinical competence in pre-registration nursing students.   Nurse Education Today, 15: 184-189. Hamill, C. (1999).   Academic essay writing in the first person: a guide for undergraduates.   Nursing Standard, 13 (44): 38-40. Hart, G. and Rotem, A. (1995).   The clinical learning environment: nurses’ perceptions of professional development in clinical settings.   Nurse Education Today, 15: 3-10. Hewitt-Taylor, J. (2002).   Teachers and students views on self directed learning.   Nursing Standard, 17 (1): 33-38. Hinds PS. Gattuso JS. Barnwell E. Cofer M. Kellum L. Mattox S. Norman G. Powell B. Randall E. Sanders C. (2003). Translating psychosocial research findings into practice guidelines. Journal of Nursing Administration, 33 (7/8): 397-403. Hull, C. (1994).   Assessment in Learning (i) Understanding assessment issues.   Teaching and learning in practice.   Nursing Times, 90 (11): 1-8. Hutchings, A. and Sanders, L. (2001).   Developing a learning pathway for student nurses.   Nursing Standard, 15 (40): 38-41. Krichbaum, K. (1994).   Clinical teaching effectiveness described in relation to learning outcomes of baccalaureate nursing students.   Journal of Advanced Nursing, 33 (7): 306-316. Landers, M.G. (2000).   The theory-practice gap in nursing: the role of the nurse teacher.   Journal of Advanced Nursing, 32 (6): 1550-1556. Lockwood, P. and Kunda, Z. (1999).   Increasing the salience of ones best selves can undermine inspiration by outstanding role models.   Journal of personality and social psychology, 76 (2): 214-218. Macintosh, C. (1998).   Reflection: a flawed strategy for the nursing profession.   Nurse Education Today, 18: 553-557. Mathers, N. and Huang, Y.C.   (1998).   Evaluating methods for collecting data in published research.   IN. P A Crookes and S D Davies (eds).   Research Into Practice. London: Baillià ¨re Tindall. Murray, C.J. (2005).   Role modelling as a teaching method for student nurses.   Nursing Times, 101 (26): 30-33. Myrick, F. and Yonge, O. (2002).   Preceptor behaviours integral to the promotion of student critical thinking.   Journal for Nurses in Staff Development, 18 (3): 127-133. National Audit Office (2001).   Educating and training the future health professional workforce for England.   London: National Audit Office. Neary, M.   (2000b).   Teaching, Assessing and Education for Clinical Competence, a practical guide for practitioners and teachers.   London: Stanley Thornes. Neary, M. (2000a).   Responsive assessment of clinical competence: part 2.   Nursing Standard, 15 (10): 35-40. Newell, R. (1994).   Reflection: art, science or pseudo-science.   Nurse Education Today, 14 (2): 79-81. Nolan, M. and Behi, R. (1995).   Alternative approaches to establishing issues of reliability and validity.   British Journal of Nursing, 14 (10): 587-590. Nursing and Midwifery Council.   (2004). Code of Professional Conduct. [World Wide Web].   Available:   nmc-uk.org/aFramedisplay.aspx?documentID=201  Ã‚  Ã‚  Ã‚  Ã‚   [2005, October 17]. Oliver, R and Endersby, C. (1994).   Teaching and Assessing Nurses.   London: Balliere Tindall. Parahoo, K. 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Price, B. (2005b). Placement goals and etiquette.   Nursing Standard, 19 (26). Priest, H. and Roberts, P. (1998).   Assessing student’s clinical performance.   Nursing Standard, 12 (48): 37-41. Quinn, F.M. (1998). Teaching and Learning in Practice Placements. IN. CM Downie and P Basford.   Teaching and Assessing in Clinical Practice: A reader.   London: University Press. Quinn, F.M. (2000). Principles and Practice of Nurse Education.   4th edition.   Cheltenham: Nelson Thornes. Rogers, C. (1961).   On Becoming a Person.   London: Constable. Rowntree, D. (1987).   Assessing Students: how shall we know them?   London: Kogan Page. Ryan-Wenger, N.M. (1992).   Guideline for critique of a research report.   Heart and Lung, 21 (4): 394-401. Sackett DL, Rosenberg W, Gray J, Haynes R. and Richardson W. (1996) Evidence-based medicine: what it is and what it isn’t. British Medical Journal, 312 ( 7023): 71–72. Sams L. Penn BK. Facteau L (2004). The challenge of using evidence-based practice. 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Draconian Implies Cruelty

Draconian Implies Cruelty Draconian Implies Cruelty Draconian Implies Cruelty By Maeve Maddox During the recent Congressional gridlock regarding the federal budget, the word draconian has become a common epithet used to preface the words budget cuts, in the way the epithet powerful usually precedes Ways and Means Committee. How appropriate is the use of draconian to describe budget cuts? It depends. Asking the Pentagon to cut some of its $463 billion non-war related expenditures is not the same as cutting off a thiefs hand for stealing. Eliminating programs that are keeping people alive, on the other hand, might appropriately be called draconian. Apart from budget cuts, draconian is often used in contexts in which official procedures are seen as unnecessarily cruel or tyrannical: Over the past week, the unrest in the Middle East deepened, with growing protests in Bahrain and Libya, and more draconian measures by the countries’ leaders to quash the opposition. A new report this week from Human Rights Watch peers into Chinas Draconian and ineffective incarceration of people struggling with drug addiction. We are not going to take the draconian police measures necessary to deport 11 million people. Draconian new measure requires police to arrest anybody who cant prove they are a US citizen. Since 2005, a rather draconian law has been adopted to deal with offenders. Failure to pay a ticket results in the revocation of driving privileges in Quebec. Somali women complain of draconian Sharia restrictions. Draconian [drÄ -kÃ… nÄ“-É™n ] is an eponym, a word derived from a persons name: draconian (or draconic) of, pertaining to, or characteristic of Draco, archon at Athens in 621 B.C., or the severe code of laws said to have been established by him; rigorous, harsh, severe, cruel. OED Although draconian has come to mean unreasonably harsh, Dracos written code in which punishments were spelled out was seen at the time as being more just than arbitrary punishments inflicted by the local authority figure. According to legend, Dracos code prescribed death for most offenses. Plutarch passed along this much-quoted anecdote: It is said that Drakon himself, when asked why he had fixed the punishment of death for most offenses, answered that he considered these lesser crimes to deserve it, and he had no greater punishment for more important ones. I say according to legend because Ive read that in the only fragment of Dracos code that survives, exile (not death) is the punishment for homicide. Dracos name could have something to do with the fact that his code of laws entered Greek memory as being really really cruel: Greek dracon means dragon or serpent. Bottom line: draconian is a strong word that conveys disregard for the humane treatment of others. Its wasted as a mere synonym for extreme. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:7 English Grammar Rules You Should KnowWhat is the Difference Between Metaphor and Simile?Preposition Mistakes #1: Accused and Excited

The Culture of Zulu Research Paper Example | Topics and Well Written Essays - 2000 words

The Culture of Zulu - Research Paper Example Zulus placed a lot of importance on their ancestors and their spirits. These ancestors were supposed by them to be living in Unkulunkulu which was considered as the world of the spirits. The ancestors were the link between the living and the spirits. For this reasons they needed to be remembered by the family members, praised regularly and also appeased by making offerings to them. In case a family failed to do so, the spirits are said to have visited them in the form of troubles. These troubles can be solved only if the mistake of the family is rectified and the spirits of the ancestors are pacified by some offerings and by showering of praises on them. The Sangoma was the spiritual healer and the priest of the Zulus. In the case of a mishap such as failure of crops, the death of livestock, drought or any other natural calamity the Sangoma was the one who declared the reasons for the calamity. The calamity could have been caused by the unhappy spirits or by witchcraft. If it was the former, the family was supposed to appease the ancestors but if it was the latter a witch-hunt and the elimination of the witch responsible was carried out. Another important religious person among the Zulus is the Inyanga. The Inyanga can be said to be the doctor of the Zulu tribe. He mostly used local plants and animals in order to find a cure of the common diseases like cuts, bruises. The cure was usually followed by religious rituals in which the spirits were praised and pacified and asked to restore the health of the person who is sick.

African emerging markets as a potential destination of efficiency Essay

African emerging markets as a potential destination of efficiency seeking investment - Essay Example However, the Asian continent serves as Africa’s greatest threat in terms of foreign investment as the continent has intense aspects by European countries and other grown economies. For this reason, the Asian continent experiences rapid growth in terms of infrastructure and the economy unlike in Africa. On the other hand, investments in African countries by foreigners attributes to maintained peace while the countries that do not have peace experience minimal international investment. Therefore, this essay will indulge on why Africa has steadily been an emerging market as a potential investment destination by foreign investors. In the global population index, Africa boasts of having at least one billion inhabitants spread across the continent. Essentially, this figure comprises of all fractions of the population that include age, gender, among many other factors. However, the literacy levels are average with the percentage standing at sixty two. This means that the elite population is slightly above the half percentage meaning that it is not enough to sustain employment and investment. By 2008, the collective gross development profit for the continent combined was at least two million trillion dollars making it high, but with minimal income. In addition, the overall expenditure levels for the continent were eight hundred and sixty billion US dollars as at 2008. Despite these visible trends, analysts predict that Africa would increase profits and gross spending income by 2020. However, the achievement of these desired results squarely laid with the investments levels if made at a steady rate. For instance, the population of Africa will be at one point four billion people by 2020. Further, analysts predict that the gross development profit will also increase to at least two point six trillion US dollars by the same time. In excess, the levels for consumer spending will also go up to almost one point four trillion dollars.

Esaay Essay Example | Topics and Well Written Essays - 500 words - 1

Esaay - Essay Example Kant comes up with another theory of mind. Here, Kant vividly rejects limitations posed by Hume on human knowledge claiming that mathematics gives us more knowledge regarding the empirical world. He also says that knowledge of facts is along the cause and effect relationship. The manner in which Kant circumvents the challenge by Hume is through coming up with new ways of embracing the workings of the mind. For this reason, Kant observes that human mind transforms information from noumena through turning it into substantial phenomena in help the mind process pure concepts regarding understanding. Copernicus adopted the alternative after seeing the impossibility of explaining the motion for heavenly bodies with reference to the supposition that such bodies moved across the earth as the immovable center (Gupta 78). This also included the supposition of all components to go around the sun. For this reason, Kant supposed on the contrary other than supposing man into moving around objects. He considered himself as the center where all other things moved round him. According to Kant, both empiricism and rationalism are wrong in claiming that human beings can possess all knowledge of things within themselves. Further, rationalists go wrong in not trusting senses within in the phenomenal world where senses form part of decision-making processes. Rationalists are in order are well within â€Å"innate ideas† even though not in sense of forms by Plato similar to the argument of the wax in Descartes. Hume is inaccurate as claims of self-concept are unsupported by senses (Lawhead 63). The experiencing self remains one of the pre-conditions in engaging such experiences (this way, Descartes was right). Kant adds that Hume was wrong in the perspective that the future resembles the past solely due to â€Å"habit and custom†. This way, morality provides the crucial linkage to the phenomenal worlds and noumenal. Kant is for the opinion that if morality is acceptable,

Native American Culture Essay Example | Topics and Well Written Essays - 1000 words - 1

Native American Culture - Essay Example Vocals were very important and were the anchor of the Native American music (Pritzker, 1998). Singing and percussion was crucial and songs ranged from solo to responsorial and multipart singing (Barreiro, Akwe: kon Press. & National Museum of the American Indian ,2004). Music was mainly done by groups of people and hence there was no musical harmony and the rhythms were irregular. The people who sang songs were very passionate and spiritual and when they sang, they did it to involve spirits, make rain or heal the sick. Music form different tribes differed in terms of vocals and dancing styles. A common characteristic in all Native American music is that while dancing, men danced round in circles while the women danced in one place. Native American music is very intricate and complex due to the combined vocals and varying sounds from drums and flutes. The music began at a lower note and gradually grew faster and more emphatic both in vocals and sounds from the musical instruments. The natives were from very many tribes ad each tribe had a unique dancing style and hence the Native American culture in music is so rich. Tribes such as the Eskimos produced simple music and simple dancing styles while other tribes such as the Zuni and Hopi are characterized with very complex music comprising of different vocals and many dancing styles. The Native American music has not been replicated in the modern music, but the folk dances of the present day resemble those of the past. Music played a vital role in the Native American communities was simply unavoidable (Barreiro, Akwe: kon Press. & National Museum of the American Indian ,2004). Music was played for historical purposes, for education and for passing of information from one generation to another. Most songs contained information that the different tribes wanted to keep and hence such songs were often played. Ceremonial music was respected since it was said that they originated

Laboratory Assignment Essay Example | Topics and Well Written Essays - 750 words

Laboratory Assignment - Essay Example The overlying volcanic islands (arcs) chains marks in the subduction zones. The ocean floor spreading is believed by geologist to result from the mantle convention and lower crust that results into less dense, hotter, and plastic material that move towards the surface. The cold dense rock sinks towards the mantle resulting into convective forces that tear the ocean crust within the midocenic ridge. This brings in the rift valley formation that is marked by high angle faults high heat flows and basaltic lavas. The mid oceanic ridges separates regions and comprises of foot tall mountain peaks that lie a mile below the ocean surface. Boundaries within the tectonic plate could be convergent divergent, or transform. In the divergent boundaries the extension of the crust within is thinned and mainly fractured by an upwelling hot mantle material. The relationship that exist between the islands can be explained in terms of divergent, convergent and transform boundaries. In the case of divergent boundaries, pulling of the adjacent plates is evident for example, at mid- Atlantic ridge separating North and South America plates from Africa and Eurasia. The ocean floor is formed as a result of the pulling apart forces. Another relationship exist under the context of convergent boundaries. In this case two plate’s moves towards one another where one is sub ducted and are typified by the Aleutian Trench. Good examples include; Mount St. Helens and Mount Fuji (Japan).Finally, the transform boundaries which results when a plate slides horizontally past another. For example, the earthquake-prone San Andreas Fault Zone in California. The labeled boundaries in this case represents the Earths shifting plates. Approximately all of the worlds renowned active volcanoes and earthquakes takes place along these plates, however, they are predominantly frequent within the

Native American Culture Essay Example | Topics and Well Written Essays - 1000 words - 1

Native American Culture - Essay Example Vocals were very important and were the anchor of the Native American music (Pritzker, 1998). Singing and percussion was crucial and songs ranged from solo to responsorial and multipart singing (Barreiro, Akwe: kon Press. & National Museum of the American Indian ,2004). Music was mainly done by groups of people and hence there was no musical harmony and the rhythms were irregular. The people who sang songs were very passionate and spiritual and when they sang, they did it to involve spirits, make rain or heal the sick. Music form different tribes differed in terms of vocals and dancing styles. A common characteristic in all Native American music is that while dancing, men danced round in circles while the women danced in one place. Native American music is very intricate and complex due to the combined vocals and varying sounds from drums and flutes. The music began at a lower note and gradually grew faster and more emphatic both in vocals and sounds from the musical instruments. The natives were from very many tribes ad each tribe had a unique dancing style and hence the Native American culture in music is so rich. Tribes such as the Eskimos produced simple music and simple dancing styles while other tribes such as the Zuni and Hopi are characterized with very complex music comprising of different vocals and many dancing styles. The Native American music has not been replicated in the modern music, but the folk dances of the present day resemble those of the past. Music played a vital role in the Native American communities was simply unavoidable (Barreiro, Akwe: kon Press. & National Museum of the American Indian ,2004). Music was played for historical purposes, for education and for passing of information from one generation to another. Most songs contained information that the different tribes wanted to keep and hence such songs were often played. Ceremonial music was respected since it was said that they originated

Marketing Essay Example | Topics and Well Written Essays - 2750 words - 8

Marketing - Essay Example According to Walker (2009), in 2012, over 20,000 e-bikes were sold in United Kingdom. Support for greener transport continues to grow thus making e-bikes become a trend, and giving a higher advantage to the stockers of e-bikes. This is a marketing plan in the field of sustainable mobility. The success factor in electric bicycle is that it has several benefits in comparison to conventional forms of individual mobility. E-bikes business has been selected because electric bicycles mitigate accessibility problems and reducing energy use and most relevant emissions of commuter traffic. These issues are the success factors of Manchester e-bikes Inc. because e-bikes will reduce environmental degradation, as well as offer cheap transport options. This plan focuses on the company’s growth strategy, suggesting ways in which Manchester e-bikes Inc. can build a large customer base, develop products that are differentiated from the already existing brands in the market. This plan will also provide information regarding the external environment in which the Company will operate in order to provide it with a good startup strategy. Since Manchester e-bikes Inc. will market its products directly to its customers, it is considered a business-to-customer (B2C) marketer. This marketing plan seeks to promote consumer awareness of the e-bikes and to motivate and entice them to purchase e-bikes. An outline of the strategies through which the e-bikes will be marketed will be given in this marketing plan. A substantial research will be undertaken in order to develop viable assessments that will help Manchester e-bike Inc. to determine the marketing and image branding direction for their products. Every business is rooted in a particular macro environment. An instrument that is used to scan the macro environment is the PESTLE analysis (Andler 2008, p. 197-198). This analysis will be conducted in consideration of the political environment, economic

Survey of Mathematical Methods Essay Example for Free

Survey of Mathematical Methods Essay I chose problem number 6: 6. In an ad for moisturizing lotion, the following claim is made; â€Å"†¦ it’s the # 1 dermatologist recommended brand. † What is misleading about the claim (Bluman, 2005)? Suspect samples, detached statistics, and implied connections are all used in this misleading claim. Companies use a variety of different techniques to help promote and sell their products. Marketing firm’s advertisings can be very persuasive to buyers. This claim is very misleading because there is not enough data given to back up their statement that the lotion is the # 1 dermatologist recommended brand. There was no information on how many dermatologists were involved in the testing, or how many other brands were actually tested. Was the sample random? How many other brands were in the testing? Were the other brands tested a high quality? How many dermatologists participated in the testing? Were the dermatologist used in the testing familiar with all the lotions available and tested this particular lotion against the most well-known for skin problems? What feature or result of the lotion was the most impressive? The texture? It’s longevity? The perfume smell? The size or amount? The price? The lotions functionality? Was this testing for one function of the lotion or for the lotions overall qualities? Without a side to side comparison or at least data showing the differences between this lotion and others I would say buyer beware. b. Select one even problem from exercises 11 through 22 on pages 811-812. As you answer the questions above, identify what types of misrepresentation or misuse have been demonstrated by referring to the bold blue headings in the â€Å"Chapter 12 Supplement† (e.g., Suspect Samples, Asking Biased Questions, Misleading Graphs, etc.). The assignment must include (a) all math work required to answer the problems as well as (b) introduction and conclusion  paragraphs (Bluman, 2005). a. Your introduction should include three to five sentences of general information about the topic at hand (Bluman, 2005). b. The body must contain a restatement of the problems and all math work, including the steps and formulas used to solve the problems (Bluman, 2005). c. Your conclusion must comprise a summary of the problems and the reason you selected a particular method to solve them. It would also be appropriate to include a statement as to what you learned and how you will apply the knowledge gained in this exercise to real-world situations (Bluman, 2005). I chose problem number 14: 14. How often do you run red lights? I think that this is a great example of a biased and misleading question. The question looks simple enough if an individual does not really think about it. Several people might even answer the question without giving any thought to it even people who do not drive might answer this question. Individuals who do run red lights might be tempted to lie. The way this question is phrased seems to state that the person answering the question runs red lights. When a question is phrased this way there is generally multiple choice answers like: every day, once a week, every two weeks, once a month, once every three months, twice a year, etc. The answers to this question could be used to draft different laws, and to change the fines for running red lights, or it can be used to increase the insurance rates for the individuals. The question should be more direct like: â€Å"Have you run red lights† or â€Å"Do you run red lights†. Reference Bluman, A. G. (2005). Mathematics in our world (1st ed. Ashford University Custom). United States: McGraw-Hill

Reflection on Critical Care of COPD Patient

Reflection on Critical Care of COPD Patient Foundations of critical care. Introduction The aim of this essay is to present a situation in describing my experiences caring for am identified female patient, and reflecting upon the issues which arose during one shift in a Critical Care unit. The reflective analysis will be carried out using Johns model of reflection (1995) which incorporates Carpers fundamental ways of knowing. This includes aesthetic, personal, ethical and empirical knowing and re flexibility. The purpose of the reflection is to understand better the ways of knowing applied to the situation, and to build upon this knowledge to improve future practice. Case Description. The chosen patient is a 59 year old female with a history of COPD and asthma. For the purposes of this essay, she will be called Jane. Jane had a severe infective exacerbation of COPD, which resulted in PEA Cardiac arrest in the admission medical unit secondary to type 2 respiratory failure, although it was a brief period of output loss only. Jane was intubated and transferred to the critical care unit, and since then she has had difficulty being ventilated due to bronchospasm/air trapping. At the time that I took over care for this patient, she had been on the critical care unit, on ventilatory support, for 12 days. Reflection (based on John’s Model and Carper’s Fundamental Ways of Knowing). AESTHETIC KNOWING: As I came on shift, the ventilation mode was on BIPAP, ASB 15, PEEP 10, I:E 1:3, FIO2 .65 via tracheostomy tube. Upon assessment at the beginning of the shift her BP 110/40, map was 60mmhg despite of noradreanline, and core temperature was 38.6 with improving markers of inflammation. The CVP had fallen to 8, but there was good urine output, 45-70 mls per hour over the previous four hours, with hourly urine measurements continuing. There was an intercostal drain in situ for a pneumothorax which developed post subclavian line insertion. Jane was sedated on midazolam and morphine sulphate infusion. She wass also paralysed with Vecuronium infusion to optimise ventilation, in the light of the previous difficulties. Jane was also on noradrenaline and actrapid insulin infusion, both of which aimed to maintain homeostasis. She was fed via nasogastric tube with Osmolite 60mls/hr with water 50 mls/hr, the latter because her sodium level had been rising when the serial U+Es were reviewed. I als o noted also her heart rate rising up to 148b/m, and was aware that she had had an episode of SVT on the previous day, with a loading dose of amiodarone having been given on that day. Having noted these findings, I reported to the Doctor that the patient may be dehydrated and need significantly increased fluids, perhaps an IV fluid challenge, as it had been noted that her CVP was declining, that she was hypotensive, and that urine output had started to tail off . This finding was supported by the fact that the patient was tachycardic. In response, the doctor prescribed 500mls of Gelofusin and an amiodarone infusion for 24 hours to be restarted. The care of this patient involved frequent, close observations, and these were what initially alerted me to the changes in the patient’s condition. The reduced central venous pressure was the first indicator, which was accompanied by consistently low blood pressure readings. This was despite the patient being medicated with noradrenaline, which should have brought about an increase in blood pressure and CVP. These, accompanied by the tachycardia, made me wonder whether the patient might be dehydrated, quite severely. The plan for the shift then became to give the patient a fluid challenge, in the form of the Gelofusin infusion, and to optimise her electrolyte levels, monitor and correct her pc02, and improve her positioning to improve V/Q mismatch. It was my responsiblity to report to the doctor or nurse co-ordinator if there were any untoward changes with the patients observations. There were a lot of issues surrounding the care of such a patient, and I believed that I was making decisions based upon previous experiences, a degree of previously developed innate knowledge, and other knowledge, including empirical knowledge. However, I also felt that it was hard to combine all the observations, results, care plans, orders and the like into an overall consciousness of the patient’s current condition. This leads into the next section of the reflection, that of personal knowing. PERSONAL KNOWING: The personal knowing relates to some innate knowledge, and this is based on experience. I have in past practice previously looked after patients who were haemodymically unstable and needed prompt intervention. In fact, I felt a degree of confidence with this kind of patient. However, this was different to having to look after a long term complicated case, a woman who had demonstrated such difficulty to ventilate (due to broncho- spasm/air trapping), was challenging. The fact that the patient was paralysed, with a vecuronium infusion was something entirely new to me, which caused concern and a little distress. However, from my previous experience I felt very strongly that thei patient might require fluid challenge due to the observations already discussed. I was concerned that day if it was left untreated for much longer, Jane patient might develop metabolic acidosis, and potentially acute renal failure due to hypoperfusion and hypovolaemic shock due to the decrease in circulating volume. I identified this as an opportunity to be proactive, and although everyone around me seemed more concerned with oxygen pressures and ventilation, I felt that it was important to consider other aspects of the patient’s condition as well. ETHICAL KNOWING Ethical knowing in this case was very acute, because of the level of dependence of the patient, who was dependent on nursing and medical staff for every one of her activities of daily living. Addressing one of these needs that I sensed other staff may have overlooked meant that I was able to be proactive. Discussing with the doctor that the patient might need a fluid challenge made me feel that I had acted as an advocate for my patient, but also that I had made good use of the knowledge I already had, even if I did not feel I had enough specialist knowledge to address some of the patient needs. The patient’s social and emotional needs were also an important part of ethical knowing. Jane lives alone, and her sister is her next of kin. Her sister kept calling the unit for any changes, although she was already updated by the medical team every day, and talking with the sister helped to ensure that I was aware of Jane as a person, and also able to make sure that those who needed t o know were involved as much as possible in her care. EMPIRICAL KNOWING. I was aware that institution of high level of PEEP in the ventilator decreases blood return to the heart and cardiac output as the PEEP ventilation generates positive intrathoracic pressure. However, the symptoms persistently suggested hypovolaemia (Kelly, 2005). I was also aware of other issues, such as the need to increase oxygen pressure, but the ABG tests carried out every six hours demonstrated good oxygen pressures. However, I had to learn about the implications of ventilation on the cardiovascular system. â€Å"Ventilation can profoundly alter cardiovascular function via complex, conflicting, and often opposite processes. These processes reflect the interaction between myocardial reserve, ventricular pump function, circulating blood volume, blood flow distribution, autonomic tone, endocrinologic responses, lung volume, intrathoracic pressure (ITP), and the surrounding pressures for the remainder of the circulation†. (Pinsky, 2005 p 592s). One of the most significant issues surrounding empirical knowing in this case was the need to understand all the potential complications of having a patient in such a condition, paralysed and receiving the high levels of PEEP in order to maintain ventilation. The literature shows that there are a number of issues surrounding mechanical ventilation. For example, Putenson et al 2006) state that mechanical ventilation generates an increase in airway pressure and, therefore, an increase in intrathoracic pressure, which may decrease systemic and intra-abdominal organ perfusion, which may have significant effects on homeostasis an organ function. Critically ill patients can therefore develop a systemic inflammatory response that culminates in multiple-organ dysfunction syndrome and death, which suggests that the symptoms that Jane was displaying, and the findings from the electrolyte levels, could have been related to a more serious bodily response to mechanical ventilation. I did not know about this possible response to mechanical ventilation, until I carried out a literature search, and so would not have been aware that the findings were possibly linked to this kind of serious response. Kollef (2004) suggests that for all patients who are intubated/ventilated, there are a number evidence-based interventions which focus on the prevention of aerodigestive tract colonization which can result in one of the serious complications of ventilation, that of ventilator-associated pneumonia. These include avoidance of unnecessary antibiotics, stress ulcer prophylaxis, chlorhexidine oral rinse, selective digestive decontamination, short-course parenteral prophylactic antibiotics in high-risk patients, and the prevention of aspiration of contaminated secretions, with preferred oral intubation, appropriate intensive care unit staffing, avoidance of tracheal intubation with the use of mask ventilation, application of weaning protocols and optimal use of sedation to shorten the duration of mechanical ventilation, semirecumbent positioning, minimization of gastric distension, subglottic suctioning, avoidance of ventilator circuit changes/manipulation, and routine drainage of ventilat or circuit condensate (Kollef, 2004). Obviously a key element of empirical knowing for me in this situation is about the haemodynamic monitoring, which has been so important in assessing this patient (Pinsky, 2003). The literature says that ongoing and dynamic haemodynamic monitoring is important in judging the response to the treatment, including the fluid challenge (Hadian and Pinsky, 2007). Michard (2005) states that â€Å"mechanical ventilation induces cyclic changes in vena cava blood flow, pulmonary artery blood flow, and aortic blood flow. At the bedside, respiratory changes in aortic blood flow are reflected by â€Å"swings† in blood pressure whose magnitude is highly dependent on volume status.† ( p 419). Another element however that is very important is the administration of the fluid challenge. Fluid challenges are common in a range of nursing situations (Vincent and Weil, 2006). According to Michard (2005), â€Å"the expected hemodynamic response to a fluid challenge is an increase in cardiac preload and, according to the Frank-Starling mechanism, an increase in stroke volume and cardiac output† (p 423). This should be evident in a blood pressure increase and a reduced heart rate. However, there is the danger of fluid overload, and therefore administering a fluid challenge must be carried out carefully. Vincent and Weil (2006) propose that fluid challenges should follow a protocol should include four variables: the type of fluid administered; the rate of fluid administration; the critical end points; and the safety limits. The choice of fluid was gelofusine, which is a colloidal fluid useful for volume replacement because of its unique properties (Vincent and Weil, 2006), Vincent and Weil (2006) state that using a structured approach to fluid challenges would be best, in order to correct fluid deficits and minimize the risks associated with fluid overload. It is important to monitor patient response closely (Vincent and Weil, 2006). When gelofusine was given her CVP increased and blood pressure and urine output improved. Her potassium, magnesium sulphate and Phosphate were topped up during my shift, and electrolyte levels were stable. Her heart rate went down to 110bpm since amiodarone infusion was restarted. She was on a few other medications, which potentially affect the potassium levels such as hydrocortisone, insulin actrapid infusion, salbutamol nebuliser and theophyline via NGT, which in addition can also cause arrrhythmias. REFLEXIBILITY. I learned a lot about basic nursing care activities, and in particular, the importance of time management. Time management is an important element of managing such a complex case, because it requires specific measurements, observations and recordings at specific times, whilst also managing emergent issues, maintaining records, and liaison with other members of the multidisciplinary team. Good patient assessment also emerged as a key learning point, and promoting a safe working environment, particularly in relation to all the aspects of care that posed challenges, such as managing drains, lines, infusion machines, monitoring morphine as a controlled substance, and also keeping contemporaneous records. These were all very challenging and made me feel under pressure to somehow keep juggling all the different tasks and demands, and still have time to reflect and think about the overall picture. Record keeping helped with this, but it seemed that critical care of such a patient requires t he development of specific capabilities, which must mean that such multi-tasking and multi-awareness gets easier over time. The level of vigilance required in order to anticipate and be ready for any emergent changes in Jane’s condition was significant, and required a great deal of concentration and focus. I also learned that it was important to work with confidence and collaborate with the multidisciplinary team. However, maintaining communication with the team was very difficult given all the demands on my time. One of the issues here was also whether or not Jane still needed mechanical ventilation, and during this shift, there was no discussion of when or whether she would be weaned off the ventilator. As she was paralysed, there was no indication of whether or not she would be trying to breathe with the ventilator, and how good her respiratory function might be. 12 days on the ventilator is a significant amount of time, and some literature suggests that earlier weaning from ventilator support may be possible in a lot of cases (Dasta et al, 2005). However, there was no indication of this, but similarly, there was no indication that this was a palliative care case (Mularski et al, 2006). If I had had more knowledge and understanding of this kind of nursing, and in particular, of the details and implications of Jane’s condition, I might have considered whether or not, as her advocate, I should be asking about the continued need for ventilation, particularly in the light of other possible approaches, such as non-invasive ventilation (Don et al, 2007). My discussions with other, more experienced members of staff, however, showed that the kinds of knowledge that most informed their care in this situation were experiential knowledge developed over a significant period of time. Therefore, it seemed to me that the empirical knowledge discusses above needed to be tempered with experience, which includes the experiences that come from working with more experienced and knowledgeable colleagues. Another issue which arose was about learning how much of my nursing practice is based upon good communication skills and developing a relationship with the patient, neither of which were useful or appropriate in this case. Although communication with ventilated patients is a focus of critical care nursing (Bergbom-Engberg, and Haljam, 1993), in this case I found it strange to work without including the patient in my care, whilst I also realised that the patient needed my advocacy more than any other, because they could not be involved or speak for themselves. However, the role of the critical care nurse in managing mechanical ventilation is something which became very apparent during this experience. The literature shows that critical care nurses have high levels of autonomy and responsibility in relation to mechanical ventilation, and that â€Å"critical care nurses were responsible for the majority of the decision episodes that resulted in a change to ventilator settings, ranging in complexity from the simple titration of FIO2 to a decision to commence weaning† (Rose et al, 2007 p 440). CONCLUSION This reflection has looked at the care of a client in the critical care nursing sector, who, after an infective exacerbation of COPD had to have a tracheostomy and be ventilated. I identified potential markers of dehydratrion, and presented these conclusions to the doctor in charge, who prescribed regulatory medication and a fluid challenge with Gelofusine. I administered the fluid challenge, infusing at the prescribed rate of 500 mls over 2 hours, and noted an improvement in central venous pressure, blood pressure and mean arterial pressure. An improvement in hourly urine output was also noted. It was also important to monitor electrolyte balance, and arterial blood gases, all of which improved with therapeutic intervention. The care of the client highlighted a number of issues for me as a nurse. The first is the value of this kind of reflection in highlighting my knowledge and my learning processes. Gustafson and Fagerberg (2004) highlight how important structured reflection is to professional development, and in this case, using a structured process of reflection has highlighted my knowledge base, learning needs, learning process, and the application of nursing knowledge which is more than empirical knowledge, to a specific clinical scenario. Jones (1995) suggests that reflection is a part of the development of true nursing expertise. This has proved to be correct in relation to the learning that has occurred during this reflection. It has shown that understanding the effects of mechanical ventilation required more than simply monitoring observations and test values, but understanding that ventilation can affect cardiovascular function, and that this can be affected by haemodynamic status. Although pre vious knowledge and experience indicated that the patient’s condition was likely due to hypovolaemia (potentially secondary to dehydration), there were a number of other mechanisms that might have affected this. It also became apparent that the role of the nurse in this situation is more than to simply monitor vital signs and infusions, ventilator functions, urine output and general wellbeing, attending to the activities of daily living. When a patient is paralysed and ventilated, unconscious due to sedation, the role of the nurse is to act in their stead, in their best interests, to be their advocate and to ensure plans of care are implemented which not only meet patient needs but anticipate them. Rolfe (2005) describes reflective practice as a deconstructive process, which allows nurses to question practice and ways of working. This process has identified a range of nursing issues related to this case, and shown that nothing is a simple matter of managing one condition in critical care nursing, it is part of an overall focus on patient-centred care. References Bergbom-Engberg, I. and Haljam, H. (1993) The communication process with ventilator patients in the ICU as perceived by the nursing staff. Intensive and Critical Care Nursing 9 (1) 40-59. Bridges, E.J. (2008) Arterial Pressure-Based Stroke Volume and Functional Hemodynamic Monitoring. Journal of Cardiovascular Nursing. 23(2):105-112. This article is not included in your organizations subscription. However, you may be able to access this article under your organizations agreement with Elsevier. Dasta, J.F., McLaughlin, T.P., Mody, S.H. and Piech, C.T. (2005) Daily cost of an intensive care unit day: The contribution of mechanical ventilation. Critical Care Medicine. 33(6):1266-1271. Don, D.S., Wong, E., Mayers, I. et al (2007) Effects of nocturnal non-invasive mechanical ventilation on heart rate variability of patients with advanced COPD. Chest 131 156-163. Gustafsson, C. and Fagerberg, I. (2004) Reflection: the way to professional development? Journal of Clinical Nursing 13 271-280. Hadian, M. and Pinksy, M.R. (2007) Functional hemodynamic monitoring. Current Opinion in Critical Care. 13(3):318-323. Jones, P.R. (1995) Hindsight bias in reflective practice: an empirical investigation. Journal of Advanced Nursing 21 (4) 783–788. Kelley, D. (205) Hypovolemic Shock: An Overview. Critical Care Nursing Quarterly. 28(1):2-19. Kollef, M.H. (2004) Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Critical Care Medicine. 32(6):1396-1405. Michard, F. (2005) Changes in arterial pressure during mechanical ventilation. Anesthesiology 103 419-428. Mularski, R.A., Curtis, J.R., Billings, J.A. et al (2006) Proposed quality measures for palliative care in the critically ill: A consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Critical Care Medicine. Improving the Quality of End-of-Life Care in the ICU. 34(11) Suppl:S404-S411. Pinsky, M.R. (2005) Cardiovascular Issues in Respiratory Care. Chest 2005;128 592-597. Pinsky, M.R. (2003) Hemodynamic monitoring in the intensive care unit Clinics in Chest Medicine 24 (4) Pages 549-560 Polanco, P.M. and Pinsky, M.R. (2006) Practical Issues of Hemodynamic Monitoring at the Bedside Surgical Clinics of North America 86 (6) 1431-1456 This article is not included in your organizations subscription. However, you may be able to access this article under your organizations agreement with Elsevier. Putensen, C., Wrigge, H. and Herin, R. (2006) The effects of mechanical ventilation on the gut and abdomen. Current Opinion in Critical Care. 12(2):160-165. Rolfe, G. (2005) The deconstructing angel: nursing, reflection and evidence-based practice Nursing Inquiry 12 (2), 78–86. Rose, L, Nelson, S., Johnston, L. and Presneill, J.J. (2007) Decisions made by critical care nurses during mechanical ventilation andweaning in an australian intensive care unit. American Journal Of Critical Care, 16 (5) 43-54. Vincent, J-L. and Weil, M.H. (2006) Fluid challenge revisited. Critical Care Medicine. 34(5):1333-1337.