Critical Analysis of Patient Care Utilising John’s Model...

Introduction The aim of this assignment is to reflect on the management of a patient with multiple organ dysfunction syndrome (MODS). Reflective practice is associated with learning from experience, (Johns Freshwater 1998) and viewed as an important strategy for health professionals who embrace life long learning (Department of Health 2000). Engaging in reflective practice is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice (Benner 1984; Johns Freshwater 1998). Central to Johns’ idea of reflective practice is the goal of accessing, understanding and learning through direct experience. It is this that enables the practitioner to†¦show more content†¦Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He also began to appear grossly oedematous. Mr Cox’s sedation was stopped (Midazolam and Morphine) following the insertion of a tracheostomy. However, due to encephalopathy he never regained consciousness. Despite many attempts he was difficult to wean from the ventilator and eventually there was reduced base entry. Mr Cox’s abdomen became increasingly distended and his jejunostomy feed was stopped and TPN was commenced. Due to an increase in sepsis he returned to theatre for a laparostomy washout, it was discovered that his bowel loops were necrotic. An Endoscopy following a further GI bleed confirmed an arterial bleed, and it was deemed he was still unstable for any further surgical intervention. Mr Cox continued to deteriorate with sepsis and MODS, consequently at this point, it was decided to withhold and withdraw treatment. Renal replacement therapy (RRT) was withdrawn as he was still profoundly acidotic with no improvement, and surgical intervention withheld due to instability. All other treatment was continued, but he was ‘Not for resuscitation’ in the event of cardiopulmonary arrest. Mr Cox died after 30 days in ITU. Aesthetics Aesthetical knowing is defined by Johns as the intuitive nature of grasping, interpreting, envisioning and responding (Johns 1995). Nurses’ aesthetic qualities are sometimes referred to as the ‘art of nursing’Show MoreRelatedEssay on Mental Health Care Assessment1321 Words   |  6 PagesFor confidentiality (NMC, 2008) purposes, patients’ real names will not be used. Introduction Within this essay, I will reflect and critically analyse an OSCE which has increased my awareness, or challenged my understanding, in assessing the holistic needs of a service user (John), referred by his GP, whilst incorporating a care plan using the Care Programme Approach (CPA). By utilising this programme and other sources of current literature, I hope to demonstrate my knowledge and understandingRead MoreA Reflective Account of Valuing Diversity and One Aspect of Anti-Discriminatory Practice Which Relates to a Client from Clinical Placement.4442 Words   |  18 Pagesorganisation and its patients. The Nursing and Midwifery Council (2002) incorporates the idea of non-judgemental care into its code of professional conduct by maintaining clause 7 of the UKCC Guidelines for Professional Practice (1996, pp25) who instructed â€Å"as a registered nurse, midwife or health visitor you are personally accountable for your practice. In the exercise of your professional accountability you must recognise and respect the uniqueness and dignity of each patient and client and respond

The Relationship between Organizational Management and Unions

Management and Unions The relationship between unions and organization is a touchy one. Dating back to the start of unionization in the 19th century, the two bodies have held opposing viewpoints. Unionization was formed from the opinion that organizations took advantage of workers and some form of a negotiating agreement was needed. There were documented events of workers working long taxing hours for insignificant pay; no healthcare coverage; dangerous working conditions; and gender and or racial discrimination. Companies believed that unionization caused less productivity which endangered profits. Companies also believed that unions interfere in daily processes, and limits the employer’s say over compensation and benefits. The†¦show more content†¦Prior to the arrival of unions in the workplace, conditions were considered unsafe and workers continuously moaned about poor wages and benefits. Unions pursued to improve the working conditions for members through fair and reasonable wa ges, quality healthcare and benefits; and safe working conditions and quality of life. The union represented the workers and through a collective bargaining process negotiated the interests of the workers. Collective bargaining helps work through tribulations with the organization. Collective bargaining is the process between employers and employees to reach an agreement regarding the rights and responsibilities of employees. This tool used to come to a collective agreement which concentrates on different things such as employees working hours, their pay their rights, rules and details of how to participate in company affairs. (Lewin, 2012) Unions have had their share of developing troubles. The joining of two power house unions in 1955, American Federation of Labor (AFL) and Congress of Industrial Organization (CIO), reportedly had a collective membership of fifteen million. 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Role of Nurses in Gestational Diabetes Free Essays

The role of nurses in gestational diabetes. (DIABETES CARE)(Brief Article) Journal of Diabetes Nursing | May 1, 2003 | Assignment 2 Research studies, recently conducted in America, have found that diet and exercise play an important role in predisposing a woman for gestational diabetes (GD). This study compared the rate of insulin treatment and perinatal outcome in women with gestational diabetes under endocrinologist-based versus diabetes nurse-based metabolic management. We will write a custom essay sample on Role of Nurses in Gestational Diabetes or any similar topic only for you Order Now A total of 244 participants received endocrinologist-based care and 283 participants received diabetes nurse-based care. A retrospective analysis was carried out comparing maternal characteristics, rate of insulin treatment and perinatal insulin requirements, in comparison with those who had used diet and exercise as a controlling factor for their diabetes. Pregnancy imposes a great amount of stress on most bodily functions and it is certain that glucose metabolism is no exception. Gestational Diabetes Mellitus is a type of diabetes, which occurs during pregnancy, distinct from the condition that already existed. It is defined as a glucose intolerance of variable degrees with onset or first recognition during pregnancy; it will generally develop in the latter half of the pregnancy and will improve after delivery (Colman, 2004). Gestational Diabetes is generally not dangerous to either mother or fetus. The disease itself is usually mild and even asymptotic; however there is an increased incidence of foetal and perinatal complications (Guthrie amp; Guthrie, 2004). In addition, if an unreasonable amount of sugar is allowed to circulate in the mother’s blood and then to enter the fetal circulation, potential problems for both mother and baby are serious. The mother’s pancreas work’s overtime to produce insulin, but it is not enough to lower blood sugar levels. Glucose will then cross the placental barrier, increasing work on the pancreas of the fetus, which uses insulin to convert the glucose into energy. The baby has more energy than is required so it converts this energy into fat stores, resulting in large birth weight babies and all the problems that can be associated with that (http://diabetes. org). At each visit to the doctor a sample of urine is taken, this is then tested for glucose levels. Sugar in the urine may be the first indications of Gestational Diabetes. Also, during the fifth month a glucose tolerance test is now a routine test for pregnant women. A Glucose Tolerance Test is when the women provide a blood sample taken before and after consuming a glucose drink, glucose levels gt;9. 0mmol/l indicate Gestational Diabetes is present. However this may be performed earlier on someone who is considered as being at risk (Colman, 2004). The incidence of gestational Diabetes has increased a significant amount, between35% and 59%, over the past ten years (http://diabetes. rg). Studies have found that the figures have shown an alarming incline in the amount of women being diagnosed with this gestational Diabetes. It is now believed that between 2 and 12% of pregnant women suffer from Gestational Diabetes (Guthrie amp; Guthrie, 2002). Testing has now become routine for pregnant mothers, so it is being discovered earlier in the pregnancy and as a result is now being treated much sooner. Because of this routine testing the chance of miscarriage and perinatal loss has been greatly reduced. The survival rate of these infants has increased from less than 70% a few years ago to nearly 98% now, a figure which has only come about through care specializing in diabetes in pregnancy, routine testing of all pregnant women and the best care available (Guthrie amp; Guthrie, 2002). Even though gestational Diabetes is now being discovered more often and being medically controlled a woman who has had Gestational Diabetes will have a much higher chance of developing diabetes later in life. If insulin was required as treatment, there is a 50% chance of diabetes within 5years, and even if the diabetes was dietary controlled there is still a 60% chance of developing diabetes within 10-15 years (Australian Bureau of Statistics, 2007-08). With these alarming figures it is obvious that further understanding of the treatment and control of gestational diabetes is necessary. From the whole number of applicants, researchers then divide participants into stratified samples; containing those who were at risk for gestational Diabetes and those who had no known predisposing factors. Each of these strata was then further divided into halves, with one half continuing their usual daily activities and progress through the pregnancy with current medical assistance available. The other half of the group was required to stick to a strict regime of healthy diet and exercising at least once a week, more if they wish. There was an initial interview conducted between the 6-12 week period of pregnancy, during the first trimester, to ensure that the required information is collected and any information can be supplied and ensure that is understood. The interview incorporated data from the year prior to conception and continued until 2 months following the births of the children. All participants were required to test daily their Blood Glucose Level (BGL) and also test their urine for sugar and record their findings. While there would be an occasional increase in glucose levels during pregnancy, persistently high levels would indicate Gestational Diabetes and a Glucose Tolerance Test was conducted. Weekly follow ups were conducted to ensure all information was recorded accurately, and also permitted time for the participant to discuss any concerns that had arisen. However pregnancy requires a number of checkups, increasing towards the later trimester, so data was also collected through the ante natal clinics. After delivery another Glucose Tolerance Test was performed to evaluate for preexisting Diabetes and it also allowed time for any complications for the newborn to arise. For the purpose of this study I feel that a larger number would be required to make certain that there would be women who are at risk, have had gestational diabetes and have never suffered from this condition before, and would also allow for the inevitable elimination of some of the participants. This was a quantitative research process, there was a need to interview, assess and gather personal information on the study participants. Some participants may deem this an invasion of privacy. To ensure that no emotional or psychological damage occurs to the participants it would be extremely important to ensure that there would be the strictest confidentiality with the information provided and that it would only be shared with those who require the data. The aim of this research is to understand whether gestational Diabetes can be avoided all together, or whether it can be treated more effectively, providing a better health outcome for the fetus and mother. By providing conclusions, which benefit society, the principle of Beneficence can be achieved (Roberts and Taylor, 2002). An even more critical consideration is the health and well being of the participants. All women are naturally concerned that their baby will be healthy and normal; a researcher must be able to ensure that no harm will come to the mother or child. The principle of non-malfeasance, makes certain that no injury will occur to either mother or fetus, that the participants are not exploited in any way and that the benefit to the community outweighs any risk that may be present (Roberts and Taylor, 2002). At all times, the participants were treated with respect, confidentiality and their physical and mental welfare was maintained. The most important point to remember here is effective communication, the participants understood exactly what was being researched, and they received accurate information on when, where, how, why and who. They were given education sessions on how to use any of the equipment that had been supplied. The equipment used were Urine dipstick and BGL machine, requiring only a small amount of training to make sure they were used properly. As the researcher, it is important to be precise and clear about this information to ensure that participants show up, on time and at the right place. (Roberts and Taylor, 2002). By incorporating the interviews and research into their ante- natal care visits, which would normally take place; the researchers avoided any complications arising from data collection. Participants were required to provide accurate, detailed and correct information on their experiences for the research to be valid and have any true meanings. This requires a great amount of trust on the researcher behalf. By ensuring that the participants understood the importance of this study, for their own health as well as the wider community, it would be hoped that the participants would record precise information. For many people, being diagnosed with gestational diabetes can be upsetting. Treatment for gestational diabetes substantially reduces adverse perinatal outcomes and improves maternal quality of life. Optimal proven treatment for gestational diabetes includes review by a diabetes educator, dietitian and physician, with insulin used if glycaemic targets are not achieved with dietary control alone. Screening for gestational diabetes should be offered to all pregnant women. Maternity service providers should ensure that adequate resources are devoted to the detection and treatment of gestational diabetes. References Australian Bureau of Statistics. National Health Survey, 2007-08 http://www. abs. gov. au 10/04/10 Colman, M. 2004, Diabetes and you: An owner’s Manual, Diabetes Australia, Melbourne. Diabetes Australia. Diabetes and Pregnancy, http://diabetes. org/gestational-diabetes 05/04/10 Guthrie, D. A. amp; Guthrie, R. A. , 2004, Nursing Management of Diabetes Mellitus: Fifth Edition, Springer Publishing Company, New York. Roberts, K. L. amp; Taylor, B. J. , 2002, Nursing Research Processes: An Australian Perspective, 2nd Ed. , Nelson Thomas Learning, Southbank, VIC. The role of nurses in gestational diabetes. DIABETES CARE, Journal of Diabetes Nursing, May 1, 2003| How to cite Role of Nurses in Gestational Diabetes, Papers

Death Of A Salesman Symbolism Essay Example For Students

Death Of A Salesman: Symbolism Essay Many symbols are incorporated into the play Death of a Sales man andthey in turn relate to both character and theme. The hose, tape recorderand th e seeds are some of these symbols. The hose in Millers drama directly relates to the theme of d eath. The hose is a line attached to the gas main in Willys house which allowshim to snif f the gas. This action can be seen as Willys suicide wish, andescape from the realities of life. As seen in the loss of his job and hisfailure to succeed. The hose also represents grief and deception. For whenLinda, Willys wife, finds the hose, she is distraught over its in tendedpurpose. The deceptive nature of the hose is apparent when Willy isconfronted about it by Biff his son and Willy denies its existence. Asimilar denial is also evident when Willy is confronted with the taperecorder in Howards office. The tape recorder signifies the change in Willys life throug h theadvancement of technology. It also represents the end of Willys career. This is brought about when Howard, Willys boss and godson, shows the taperecorder to Willy and appe ars to be more interested in the sound andtechnology of the machine instead of Willy, who i s fighting for his job. Howard no longer need s Willys services and without concern fires him. This , to Willy, was like, eating the orange and throwing away the peel. However, Willy is partly to blame, as he does not accept change and wantsto remain in the pas t. This is foreshadowed in the scene where Willy isleft alone with the tape recorder and is unable to shut it off. Willybelieves in using his old techniques and style to succeed. N evertheless,in hi job, it is not what you know, but it is who you know. Willy is not upto date with the business nor technology. Yet, Willy still has hope, andwishes to leave some fo rm of support behind for his family as illustratedin his planting of the seeds. Willy feels that he must leave something behind something for Biff. InWillys imaginary world he wants Biff to be magnificent and he symbolically plants seeds in his garden. In spite of such an action he is doomed tofail. Willy sta rts planting the seeds at night, but at night there is nosun shining and this seems very od d as seeds require light to grow. Whatelse is strange is the fact that Willys house is boxed in between largeapartment buildings and is covered by the shadows cast by them. It iseviden t that no light will fall on Willys garden. Willys attempt toplant and grow seeds is futile, but he persist in his attempt to seekreconciliation and forgiveness. Thus the hose, tape record er and the seedsare all symbolic of Willys dreams gone sour, and his inability to live inthe present. His death is inevitable and is mirrored by his life.

Legalities of School Personnel Administration free essay sample

Examines tort liability of schools teachers, federal intervention, examples, testing, discrimination, special education, teacher rights responsibilities, tenure, reforms. This research paper summarizes the legal aspects of personnel administration in the American public school system. It focuses primarily on the legal problems which arise out of the actions of school districts, administrators, teachers and students and their impact on those groups and on parents and the community. The public school system has become much more legally intensive because it is operating under very severe pressures and is undergoing significant changes. For the personnel or human relations function, the most important areas of concern are the following: (1) the tort liability of school districts, administrators and teachers under state law; (2) the effects on school liabilities and school discipline of the recent upsurge of

Young Adult vs. Middle Grade Fiction Which Are You Writing

Young Adult vs. Middle Grade Fiction Which Are You Writing Young Adult vs. Middle Grade Fiction: Which Are You Writing? Jamie Evans is an editor and writer based in Atlanta. Her passion is young adult and middle grade lit, and she also specializes in romance and new adult fiction. In this post, she reveals 4 key differences between writing for YA and MG readers. Lastly, we arrive at word count. Middle grade fiction will generally be shorter than YA fiction, but again, there are exceptions.As a general idea:Middle grade fiction is generally 30,000–50,000 words (though fantasy can run longer to allow for adequate worldbuilding).Young adult fiction is generally 50,000–75,000 words (with the same note for fantasy).Of course, there are numerous exceptions (hey there, J.K. Rowling!), but as a debut author, this is still your time to be the rule and not the exception. Do you know how long your MG and YA novels should be? By highlighting the basic differences between YA and MG, I hope this serves as a helpful guide as you draft your stories!Jamie Evans is a Reedsy editor who is ready to help you with your manuscript. Share your thoughts and questions in the comments below.

How effective are Business Intelligence (BI) tools for supporting Essay

How effective are Business Intelligence (BI) tools for supporting decision-making - Essay Example Includes database and application technologies, as well as analysis practices. Sometimes used synonymously with "decision support," though business intelligence is technically much broader, potentially encompassing knowledge management, enterprise resource planning, and data mining, among other practices. ...† (csumb, 2011) Trying to interpret the actual meanings of the term ‘intelligence’ and how it is evolved would give us a better understanding into the terminology of business intelligence itself. Generally, intelligence refers to the ability to understand, learn and evolve. Intelligence develops with every learning experience and input of every kind of information. Basic intelligence, when deployed in business environment is referred to as business intelligence. THE DISCUSSION: The capacity of human beings to incorporate prior instinctive and experience based knowledge to execute processes in order to achieve a particular objective is termed as intelligence. It ’s a virtual entity that encompasses all logical horizons. Business is also one of the natural and logical processes. Logic can be defined as a set of rules that governs executions. To discriminate a process as being logical or illogical one needs to be intelligent. This new perspective about intelligence gives a much understandable definition of Business Intelligence. BI would now be defined as, the capacity that enables businessmen to differentiate logical and illogical executions in a business.. This definition presents Business Intelligence as an umbrella that covers almost all the tasks performed under the tag of ‘businesses’. This paper emphasizes on the same notion with the discussion of multiple top notch business terms namely... The capacity of human beings to incorporate prior instinctive and experience based knowledge to execute processes in order to achieve a particular objective is termed as intelligence. It’s a virtual entity that encompasses all logical horizons. Business is also one of the natural and logical processes. Logic can be defined as a set of rules that governs executions. To discriminate a process as being logical or illogical one needs to be intelligent. This new perspective about intelligence gives a much understandable definition of Business Intelligence. BI would now be defined as, the capacity that enables businessmen to differentiate logical and illogical executions in a business.. This definition presents Business Intelligence as an umbrella that covers almost all the tasks performed under the tag of ‘businesses’. This paper emphasizes on the same notion with the discussion of multiple top notch business terms namely sales forecasting, market research and knowledg e management. The association of business intelligence with sales forecasting, knowledge management and Market Research brings new meanings to this seemingly simple business term. It is attempted to take a general look at the basic definitions of each of the above mentioned terms before looking at their comparative involvements and meanings.

The helping process Essay Example | Topics and Well Written Essays - 500 words

The helping process - Essay Example Assessment is the basic step in the development of a helping process. It involves a comprehensive evaluation of the situation to identify the problem and give insights of the possible remedy (Poulin, 2010. Moreover, the professionals get the overview of the skills and capability of the people in need of help. Therefore, I can be observed that assessment stage lays the foundation for the helping process development. However, some ethical considerations must be followed when conducting the assessment process. For instance, the people involved in the assessment exercise should be informed fully about the practice to eliminate ignorance. In addition, the rights of individuals, as provided for in the constitution, must be followed appropriately.PlanningThis phase focuses on putting the necessary structures and strategies in place to facilitate a smooth process of helping those in need. In essence, the planning stage facilitates the collection of the required resources to enhance a success ful process. During the planning stage, the people to be helped are prepared for the projected activities to improve their efficiency. Barsky (2010) states that the planning stage must follow certain ethical principles to ensure that social and constitutional rights of individuals are not infringed. For instance, the professionals organizing the helping process should ensure that the budgeted expenses are with the reach of institutions responsible for implementing the new developments.

Ritz Carlton Case Studies Essay Example | Topics and Well Written Essays - 750 words

Ritz Carlton Case Studies - Essay Example In Malaysia, McBride, the general manager, introduced the practice of extending a welcome to passengers at the airport by giving discount coupons and mimosas, amongst others, not to mention the presence of a fully furnished room of Ritz-Carlton in the airport. All these were totally novel and unique concepts of marketing that go on to fortify the hotel’s image as a leader in the realm of customer care.† (1) Another vital factor contributing towards the hotel’s success story is the tremendous amount of importance that is accorded to people associated it – both employees and also the customers. The consistent growth of any organization is heavily dependent on the manner in which the people associated with it are treated. This very factor is all the more relevant for entities operating in the sphere of hospitality. â€Å"It is the firm conviction of Ritz-Carlton that when a customer stays in its premises, for the entire duration, the hotel is the home for them. Hence, the hotel’s 7 Day Countdown Orientation program for new recruits is predominantly aimed at making them fully understand the relevance of this concept. One of the first precepts communicated to the new employees is â€Å"We all are ladies and gentlemen serving ladies and gentlemen†. This speaks volumes about the friendly and amicable treatment that Ritz-Carlton gives to its employees. Additionally , it is in this very cordial atmosphere that the skills of the employees are honed, ensuring that they run the extra mile in addressing the all-important aspect of customer service. Last but not the least, the various things inclusive in the orientation program such as The Credo, The Employee Promise and The Twenty Basics, to cite a few, go a long way in making sure that employee efficiency would invariably lead to customer satisfaction.† (1) At this juncture, it would be worthwhile to understand as to what actually is being sold by Ritz-Carlton. The answer to that resulting from a mere

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2 Research Paper Related to Prevention of Diabetes Mellitus Type 2 Beginning in the 1990s, the number of cases of Diabetes Mellitus Type 2 (DMT2) began increasing. This increase occurred alongside an increase in obesity, poor diet choices, and a decrease in exercise among the American population. DMT2 is the most common form of diabetes and is particularly affecting the younger population. With one in five children now said to be overweight, some studies indicate that the number of young people with DMT2 has quadrupled in recent years. This paper will examine the complexity of DMT2 and its rising incidence among the United States (US) population as well as demonstrate that community education and prevention are key components to controlling this disease (American Diabetes Association, 2007). It will consider six dimensions: 1) pathophysiology, 2) incidence and prevalence, 3) audience, 4) survey and other research, 5) disease prevention, and 6) teaching plan with final conclusions. Dimension One: Pathophysiology DMT2 is a chronic disease previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes. It is caused by several complex metabolic disorders which can lead to high levels of sugar in the blood. These disorders result from defects of multiple organ sites including insulin resistance in muscles and tissues, a decline in insulin secretion from the pancreas, unrestrained hepatic glucose production or secretion, and/or declining ÃŽ ²-cell function. Patients who have DMT2 are not able to regulate the glucose levels in the body. If glucose is not able to reach cells in the body, the body is not able to use it for energy and the glucose will stay in the blood causing the main symptoms of diabetes (Barr, Myslinksi, Scarborough, 2008). ÃŽ ²-cell dysfunction is thought to be partly genetic and contributes to the onset of glucose intolerance in DMT2. It is characterized by impairment in the first phase of insulin secretion during glucose stimulation. The endocrine pancreas is unable to compensate for insulin resistance that could lead to hyperglycemia and the onset of diabetes. ÃŽ ²-cell dysfunction along with glucotoxicity, lipotoxicity, and other inflammatory agents on pancreatic insulin production all play a contributing role in the development of DMT2 (Rizvi, 2004). Tissue resistance to glucose uptake is also recognized as a major cause of DMT2. Insulin resistance has been linked to elevated levels of pro-inflammatory cytokines that trigger endothelial cell dysfunction and promote vascular abnormalities. These mechanisms may lead to atherosclerosis and coagulation tendencies which can also be present with DMT2. Although these causes are not linked to diabetes alone, they are found in other chronic diseases such as dyslipidemia and hypertension which are known risk factors of diabetes. (Rizvi, 2004). Dimension Two: Incidence and Prevalence DMT2 accounts for 90 to 95 percent of all diagnosed cases of diabetes and usually begins as insulin resistance. It is often associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. In the US, the populations most affected are Native Americans, Hispanic-Americans, and Asian-Americans. According to the National Diabetes Information Clearinghouse (NDIC) (2007), there are approximately 798,000 new cases of diabetes annually in the US, which is an estimated 1 in 340 people per year. Broken down even further, this is about â€Å"66,499 per month, 15,346 per week, 2,186 per day, 91 per hour, and 1 per minute† cases (NDIC, 2007,  ¶6). In 2002, there were 150 million people affected with DMT2 worldwide and 15.7 million people in the US, with an estimated 5.4 million of those undiagnosed. DMT2 affects approximately 1 in 16 people (NDIC, 2007). Dimension Three: Audience Student nurses at Southwestern Community College recently hosted a health fair discussing various diseases and concerns amongst the community. To present the information, student nurses used a demographic audience analysis in order to identify the population attending the health fair. This type of audience examination described the qualities of a group of people by considering several aspects, such as the size of the audience, diversity, captivity or circumstances, as well as the audience composition (Outloud Online, n.d.). The size of the audience determined the way of presenting information; for instance, the large audience would likely have a wide variety of characteristics whereas the smaller audience may have fewer differences. Consequently, presenting information to a large group of people required a more formal approach (Outloud Online, n.d.). On the other hand, small audiences allow for a more personal and informal presentation. Because the health fair was designed to attract a large group of people from three different counties the student nurses concluded that the formal way of presenting information during the health fair would be more appropriate. The second component of the audience analysis referred to the diversity of people attending the health fair. Generally, the larger audiences are more diverse and require a broader approach (Outloud Online, n.d.). On the other hand, special occasions such as health fairs attract a variety of people who are interested in health and wellness. Consequently, the student nurses decided to address the topic of increasing incidence of diabetes during the health fair in a non-judgmental way with the consideration for cultural variations among people. The next element of the audience analysis was related to circumstances of presenting information. For example, people who chose to listen on their own were more receptive than the people were forced to hear something. The term captive described the audience who may resent a speaker; therefore the speaker needed to exert an extra effort to get the audiences attention (Outloud Online, n.d.). Generally, an assumption can be made that the audience is captive and works hard to show the importance of the topic. In order to capture the attention of the audience, the student nurses decided to utilize variety of visual, tactile, auditory, as well as psychomotor teaching methods to present the information about diabetes during the health fair, which will be explained further below. The last component of the demographic audience analysis was related to the composition of the audience. The student nurses considered the factors, such as age, race or culture, gender, as well as education level of the community population. Although the composition of the audience was important, the simplifying peoples interest and beliefs could have easily led to stereotyping (Outloud Online, n.d.). In order to avoid stereotyping of audience, the student nurses decided to provide information without cultural and ethnical preconceptions as well as in a non-judgmental way. Dimension Four: Survey and Other Research In prior years, much research has been conducted on the incidence and prevalence of DMT2. This research validates the increasing rate of diabetes amongst the US population. It was estimated that in 1999-2002, 19.3 million Americans (about 9.3 percent of the total population) had diabetes. By 2005, approximately 1.5 million new cases of diabetes were diagnosed in the US and at this rate, it is estimated that more than 25 million people in the US will have diabetes by the year 2025. According to research conducted by the Tufts-New England Medical Center (2007), the rise of DMT2 anticipated over the next few decades can be attributed to the changes is diagnostic criteria, increased awareness which leads to increased diagnosis, the aging population, increase the prevalence of obesity, and decreasing mortality. Although the prevalence of diagnosed diabetes from 1980-2004 increased in all age groups, it is similar to other chronic conditions and affects the older population. It is estimat ed that over 22 percent of the elderly population (age 65 and older) make up almost 40 percent of those diagnosed with diabetes. In 2005, there were 575,000 new cases of diabetes among those 60 years and older (Balk, et al., 2005). Other research has shown that DMT2 may be described as a new epidemic in the American pediatric population. In 1994, DMT2 accounted for up to 16 percent of new pediatric diabetes cases, and by 1999, it account for 8-45 percent of new cases. This increase coincided with the increased prevalence of childhood obesity. In 2000, the prevalence of diabetes for all ages worldwide was estimated to be 2.8 percent. Based on current research, it is predicted that 4.4 percent will be diagnosed with DMT2 in 2030, which will be an estimated total number of 366 million (Balk, et al., 2005). Results from a Pan American Health Organization survey conducted in 2007 along the Mexico-US border can be found in Appendix A. Another survey on the rising prevalence of obesity among the younger population can be found in Appendix B. Dimension Five: Disease Prevention Although the need to prevent DMT2 was recognized in the 1920s, little has been done in the area of prevention in the decades following despite the technological advances. This lack of implementing a prevention plan was also due to the lack of evidenced-based studies. Several clinical trials were conducted, but many were flawed in design and most studies used anti-diabetes drugs as the only intervention. Fortunately in the intervening years, positive results from several controlled trials using lifestyle changes have become available. More recent trials show it is possible to reduce the rate of DMT2 in high-risk clients through lifestyle modifications such as diet and exercise (Tuomilehto, 2007). Pre-diabetes is a condition in which a clients blood glucose level is higher than normal, but not yet high enough to be termed diabetes. Either the impaired fasting glucose or impaired glucose tolerance tests will be higher. If a client shows increased test results with these two tests, however, progression to diabetes is not inevitable. Losing weight and increasing physical activity has been shown to reduce the blood sugar levels to a more normal range and delay the onset of diabetes. These lifestyle interventions are attainable and much more cost-effective and it is proven that lose 5-10 percent of body weight can reverse pre-diabetes symptoms. (Adams, 2009). Physical activity increases the bodys use of insulin which in turn lowers blood glucose levels. Reducing the amount of time sitting in front of a television is an effective way to increase physical activity. A study in 2007 showed a direct link between television watching and an increased risk of diabetes. Those with a two-hour increase in television viewing had a 23 percent increase in the risk of obesity, leading to a 14 percent increase risk of DMT2 (Tuomilehto, 2007). Nutrition recommendations for prevention of diabetes include high intakes of dietary fiber and low-glycemic-index foods. Eating a well-balanced diet with adequate amounts of protein and carbohydrates with lower amounts of saturated fats and sugars has proven to be effective in the prevention of DMT2 (Mann, 2006). Dimension Six: Teaching Plan A health fair was recently held on the campus of Southwestern Community College. Each group attending the health fair was given one table to present information in a systematic manner that would be beneficial to those passing by. The authors of this research paper, who are also student nurses, chose to concentrate on basic DMT2 pathophysiology and prevention. To effectively present the material to a varied audience, the student nurses came up with strategies to teach the materials that would appeal to various learning styles. For those who may learn visually, the student nurses provided visual aids including a large display board along with two posters. These materials included written information, pictures, and diagrams of DMT2s effects on the body as well as descriptions of the pathophysiology and causes. For the audience to take with them or look through while browsing, the student nurses provided tactile objects such as pamphlets about diabetes and exercise, diabetic cookbooks, diabetic desserts from the cookbooks, and three factual information sheets about DMT2 from a local diabetes educator. For those who were audio-style learners, several student nurses stayed near the information table and were available to answer questions and speak with those interested and/or concerned they may be at risk for developing DMT2. Also available to the audience as reinforcement of this information was a video which spoke of signs and symptoms of pre-diabetes as well as preventative strategies. To further test for symptoms of pre-diabetes, student nurses were available with a glucose monitor to check glucose levels when requested. Overall, the health fair seemed to be quite effective and pleasing to the audience present based on review.

Shirley Jacksons The Lottery and Kate Chopins The Story of an Hour Es

Shirley Jackson's The Lottery and Kate Chopin's The Story of an Hour "The Lottery" by Shirley Jackson, and "The Story of the Hour" by Kate Chopin, both have similarities and differences when it comes to the elements of literature.   Particularly, when the authors use foreshadowing to manipulate the moods of the stories and add irony to cleverly deceive the reader. Both of these stories possess similarities and differences when it comes to their components of the story, specifically the authors' usage of elements of mood and the tone of irony.   Ã‚  Ã‚  Ã‚  Ã‚  In Shirley Jackson's 'The Lottery,' irony is a major theme. This story is about a town full of elitist snobs that are stuck on their tradition of a lottery, even though it is a grim ritual and rather detrimental to the people in the town. The characters are honoring a tradition that is handed down to them from former generations. The reader is led through the outwardly normal and charming little village, and is taken on a ride of ironic horror as they slowly grasp the annual fate of one the village?s inhabitants. The title ?The Lottery? implies a contest with a winner of some kind, like a sweepstakes. When in reality the winner is actually the loser or person that will die by stoning. At the beginning of this story, the main character, Mrs. Hutchinson, is in favor of the lottery. The atmosphere of the town is casual yet anxious. Mrs. Hutchinson arrives late because she ?clean forgot? what day it is. This seems quite impossible to any reader that anyone would forge t a day like lottery day. Her procrastination is reasonable but her excuse is lame. Mrs. Hutchinson complains that her husband, Bill, ?didn?t have enough time to choose.? And that the results of the drawing were not fair. In these statements, she is implying that the other villagers had more time to choose, and in fact given an advantage over the Hutchinson family. In reality, time had little to do with the drawing of the ?slips of paper.? As soon as they hold the second drawing, Mrs. Hutchinson is chosen. This is the climax of irony of this story. Mrs. Hutchinson is chosen for the lottery. She is shocked and astounded, having believed that she couldn?t possibly be chosen for the lottery. She begs or mercy, but the townspeople are strict with keeping to their traditions and her pleas of mercy fall on deaf ears and she is stoned to death.   Ã‚  Ã‚  Ã‚  Ã‚  ?... ...the mention of her health. However, in ?The Lottery? the reader knows that something bad will eventually happen, but the reader has no idea who the ill-fated winner is going to be.   Ã‚  Ã‚  Ã‚  Ã‚  I feel that ?The Story of an Hour? is a better example of the elements of irony and foreshadowing than ?The Lottery.? In ?The Story of an Hour? the author uses a writing style that is easy to follow and simple to understand. The plot is orderly and follows a sequential order of events. The imagery is vivid, but is it easy to understand and doesn?t confuse the reader. ?The Lottery? was not an adequate story. The foreshadowing was presented in an irksome fashion, and the language confused and baffled me. ?The Lottery? was difficult to follow, and I was unable to understand anything about it until I had completed the story. In closing, I feel that Kate Chopin did a superb job with ?The Story of an Hour? in reaching her audience on a level that made it simple to understand her story and to have a sense of perceptive knowledge of how the story would end.   Ã‚  Ã‚  Ã‚   Works Cited: Jackson, Shirley. "The Lottery." The Harper Anthology of Fiction. Ed Sylvan Barnet. New York: HarperCollins, 1986. 862-868