Personal Responsibility Essay

Practicing personal responsibility in every aspect of our lives is the safest way to guarantee personal success. Personal responsibility is as simple as managing our life and making our own decisions without giving others the opportunity to dictate the outcome of our future. As the architects of our academic future, we must understand that only we can lay the foundation for our success. It is also important to recognize that having a strong preliminary plan to practice personal responsibility in our education is essential in achieving our academic goals. Dr. Ron Haskins with the Annie E. Casey Foundation defines personal responsibility as â€Å"the willingness to accept both the importance of standards that society establishes for individual behavior and to make strenuous personal efforts to live by those standards†. According to Dr. Haskins â€Å"personal responsibility also means that when individuals fail to meet such expected standards, they do not look around for some factor outside themselves to blame†. Dr. Haskins is saying that by accepting our role in society we are accepting the responsibilities that come with that role. That if our responsibilities become overwhelming, we will make the necessary sacrifices or changes to fulfill those responsibilities and we will not blame our faults on others. When it pertains to your education, you must understand that it is your responsibility to always seek improvement in order to become a valuable member of our society. Personal responsibility and college success will always go hand in hand. The moment we decide to seek an education we make a huge commitment to ourselves and others. We become part of a small group of individuals who believe that self-improvement and the pursuit of excellence are the keys to achieving success. As we embark on our educational journey we will be faced with many obstacles that can prevent us from achieving our academic goals.  It is important to identify these obstacles and find balance in our lives by setting priorities and limitations. Always seek help when needed and use your family and career aspirations as motivation rather than challenges in the path towards academic success. Remember that your academic success will always be the result of your work and determination. In 2009 President Barak Obama gave a speech on the importance of education at the Wakefield High School in Arlington, Virginia. In his speech President Obama stated that â€Å"we can have the most dedicated teachers, the most supportive parents, and the best schools in the world and none of it will make a difference, none of it will matter, unless all of us fulfill our responsibilities†. I believe President Obama was highlighting the importance of fulfilling our responsibilities if we wish to achieve academic success. President Obama was trying to teach the students of Wakefield High School that although you can be provided with a blank canvass and supplies, it is up to you to create the master piece. Having a preliminary plan to fulfill your responsibilities and achieving your goals is essential if you wish to create that master peace. You need to manage your time by setting periodic goals and making responsible decisions. You must also recognize your limitations and ensure that your expectations are realistic. Never put more than you can eat on your plate and do not hold other people accountable for your decisions. By following these steps you will ensure a smooth process through your academic journey. Personal responsibility can perceive differently by many people. Your background, culture or morals can be key influential factor in your interpretation of the term. However, although there are several factors that can influence the decisions we make in life, personal responsibility lays with each individual. We must embrace our failures and learn from our past to ensure a better future. We must also ensure that our personal and academic choices are responsible and guided by firm principles, and we must always strive towards excellence in every aspect of our life. Most importantly, we must understand that the choices we make today will follow us for the rest our lives. References Barack Obama’s speech on education. 2009. President Barack Obama. Retrieved from http://www.upi.com/Obamas-speech-on-importance-of-education. The Sequence of Personal Responsibility. 2009. The Brookings Institution. Retrieved from http://www.brookings.edu/research/articles/2009/07/09-responsibility-haskins.

How to Write a Nursing Research Critique Paper

How to Write a Nursing Research Critique Paper While writing a Nursing critique paper, attention should be paid to the qualitative and quantitative figures in the findings, in order to analyze the context of such findings. This aspect of critiquing nursing research is crucial, in that it enables nurses to provide the highest quality care to their patients. There are various approaches used in the critique of a nursing article. For instance, the best approach requires an individual to begin with an introduction where the purpose of critiquing such an article is stated. They then state the job together with other details of the author of the nursing study. This is done in order to prove whether, or not, the given author has credibility in the nursing world. The next step followed in writing a nursing critique paper is commenting on the title of the article. This gives a clear outline of the topic, depending on whether it properly characterizes and covers the presented content, together with the subject matter. This step could also include details on whether the presented research is supporting a particular need in the health sector. If such an article is able to meet the key points stated above, then it will make a high quality nursing document. The third step followed, in order to write a good nursing critique paper, is ensuring that all the stated case studies have participants with great records and achievements in the medical sector. The other step that is followed, in this case, includes judging the abstract on the basis of whether it is sufficient for the research paper presented. In the absence of an introduction in the research document, observe whether the literature review presented serves the purpose of an introduction. Generally, different procedures could be used in order to analyze and separate a quality nursing critique paper from one of poor quality. This is because various nursing research papers differ from the others, depending on how a particular nurse participated in the research. This, then, determines the quality of output such an individual can present. Nursing critique is crucial in that it improves the overall working of the medical sector, where various nurses struggle to attain excellent nursing research papers. You can also make use of ordering the  Nursing research critique paper online. This will greatly save your time and money, once you place the order at the official web-site of a custom writing agency. What is more, the complete privacy of your ordering process is guaranteed by the company – they will never disclose your name and address to your tutors, or parents. Do not hesitate and order professional written help with your papers online, right now, to benefit from the competency of eminent writers.

Evidence-based Interventions for a Patient Suffering from Dementia The WritePass Journal

Evidence-based Interventions for a Patient Suffering from Dementia Introduction Evidence-based Interventions for a Patient Suffering from Dementia ). This is done to ensure that interventions are supported by current evidence in healthcare and have been found to be effective for most patients (Pearson et al., 2009). The use of evidence-based practice is rooted in the belief that patients should only receive quality care (Pearson et al., 2009). The same approach is used when caring for patients with mental health conditions. In the policy, No Health without Mental Health (Department of Health, 2012), the NHS has emphasised that patients suffering from mental health conditions should receive quality and evidence-based care. This brief aims to critically discuss the case of an 80-year old woman who is suffering from dementia and the different forms of interventions that could be applied to the case. Consistent with the Nursing and Midwifery Council’s (NMC, 2008) code of conduct, a pseudonym will be used to hide the identity of the patient. This brief discusses the purpose of evidence-based practice in managing patients with a progressive condition such as dementia. An investigation on the different forms of evidence-based interventions and their potential impact for promoting inclusion would also be presented. A discussion on interventions as means to develop a shared understanding of the patient’s needs would also be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process. Using Evidence-based Interventions for Patients with Dementia The Nursing and Midwifery Council’s (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised that the past model of evidence-based intervention relies only on current evidence from literature to support clinical decisions. Current studies that are of high quality are often used to inform current practices. Fitzpatrick (2007b; 2007c) exmphasised that nurses and other healthcare professionals should have the skills to critically assess the quality of a study and determine whether the findings are applicable to one’s current and future practice. Evaluating the strength of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has included best practices, personal experiences of healthcare professional on providi ng care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a; 2007b, 2007c; Greenhalgh, 2010). This new definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care. Communicating evidence from published literature is also essential in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthened first. Kizer (2002) observe that, â€Å"this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient† (p. 117). In the UK, The National Institute for Health and Clinical Excellence (NICE, 2006) and the National Collaborating Centre for Mental Health (2007) have provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues’ experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patient’s name is Laura (not her real name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, aggressive behaviour and agitation (Department of Health, 2009). A psychiatric consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and psychiatrist are discussing alternative drugs to reduce her anxiety level and regulate her sleeping patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. While she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion. Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the Mental Health Act 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patient’s immediate family members or appointed guardian (Depart ment for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patient’s case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will include the patient’s carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise. Evidence-based Interventions and Potential Impact for Promoting Inclusion A number of studies (Casartelli et al., 2013; Monaghan et al., 2012; Ewen et al., 2012) have shown that exercise could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patient’s mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise intervention to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking e xercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012; Hopper et al., 2013) has also been shown to be effective in reducing anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis. It should be noted that the psychiatrist and the GP in the healthcare team are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side effects on the cognition of patients (Porsteinsson et al., 2013; Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Laura’s case, she is pro gressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura. Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Laura’s case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patient’s case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. Similar to animal-assisted therapy, there is also strong evidence on the e ffectiveness of music therapy in managing anxiety, depression and aggression amongst patients with dementia (Sakamoto et al., 2013; Wall and Duffy, 2010). Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patient’s end-of-life care. All these realisations could influence the carer’s own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013). The patient in my care is also suffering from type 2 diabetes. Pharmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in hospitals, the new environment and lack of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital stay could be influenced by changes in her behaviour. It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have sufficient diet. This is seen as a challenge in Laura’s case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Laura’s type 2 diabetes through proper feeding would be an added challenge to her care. Legal, Ethical and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary admission to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. Apart from the legal aspects that influence the delivery of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and other healthcare practitioners should ensure that the interventions would be benefici al to the patient (Beauchamp and Childress, 2001). In Laura’s case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patient’s behaviour. In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Laura’s case, her autonomy would be respected. Allowing patients to participate in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. Justice will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patient’s background, religion, race, gender, ethnicity, she should receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Laura’s healthcare needs. While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive sufficient funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007). Role of the Nurse in the Intervention Process On reflection of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMC’s (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Laura’s family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful stage in the patient’s disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient is experiencing. Since nursing is a continuing process, I have to inform the family members that the patie nt will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage. Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her dignity would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will attend courses on how to conduct end-of-life care for patients with dementia. Through Laura, I realised that a patient’s dignity should always be observed. It is recommended that in my future and present practice, I will continue to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patient’s experiences on how to choose and deliver interventions. Conclusion Evidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patient’s rights, act as her advocate and ensure her safety during the trajectory of the condition. For future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patient’s preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions. References Baillie, L. Gallagher, A. (2011). ‘Respecting dignity in care in diverse care settings: Strategies of UK nurses’. International Journal of Nursing Practice, 17, pp. 336-341. Beauchamp, T. Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. Casartelli, N., Item-Glatthorn, J., Bizzini, ., Leunig, M. Maffiuletti, N. (2013). ‘Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-moth postoperative comparison’. BMC Musculoskeletal Disorder, 14:176 doi: 10.1186/1471-2474-14-176. Croker, J., Swancut, D., Roberts, M., Abel, G., Roland, M. Campbell, J. (2013) ‘Factors affecting patients’ trust and confidence in GPs: evidence from the national GP patient survey’, BMJ Open, 3(5). Pii: e002762. Doi: 10.1136/bmjopen-2013-002762. Department of Health (2012). No Health Without Mental Health. London: Department of Health. Department of Health (2009). Living Well with dementia: A National Dementia Strategy. London: Department of Health. Department for Constitutional Affairs (2007). Mental Capacity Act 2005 Code of Practice. Norwich: The Stationery Office. Ewen, A., Stewart, S., St Clair Gibson, A., Kashyap, S. Caplan, N. (2012). ‘Post-operative gait analysis in total hip replacement patients- a review of current literature and meta-analysis’. Gait Posture, 36(1), pp. 1-6. Filan, S. Llewellyn-Jones, R. (2006). ‘An animal-assisted therapy for dementia: a review of the literature’. International Psychogeriatrics, 18(4), pp. 597-611. Fitzpatrick, J. (2007a). ‘Finding the research for evidence-based practice: Part one- The development of EBP’. Nursing Times, 103(17), pp. 32-33. Fitzpatrick, J. (2007b). ‘Finding the research for evidence-based practice: Part two-selecting credible evidence’. Nursing Times, 103(18), pp. 32-33. Fitzpatrick, J. (2007c). ‘How to turn research into evidence-based practice: Part three- Making a case’. Nursing Times, 103(19), pp. 32-33. Greenhalgh, T. (2010). How to read a paper: the basics of evidence-based medicine. West Sussex, UK: John Wiley and Sons. Hopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. Schooling, T. (2013). ‘An evidence-based systematic review on cognitive interventions for individuals with dementia’. American Journal of Speech and Language Pathology, 22(1), pp. 126-145. Kizer, K. (2002). ‘Patient centred care: essential but probably not sufficient’. Quality and Safety in Health Care, 11, pp. 117-118. Kurz, A., Thà ¶ne-Otto, A., Cramer, B., Egert, S., Frà ¶lich, L., Gertz, H., Kehl, V., Wagenpfeil, S. Werheid, K. (2012). ‘CORDIAL: Cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: a multicenter, randomized, controlled trial’. Alzheimer Disease and Associated Disorders, 26(3), pp. 246-253. Monaghan, B., Grant, T., Hing, W. Cusack, T. (2012). ‘Functional exercise after total hip replacement (FEATHER): a randomised control trial’, BMC Musculoskeletal Disorder. 13:237 doi: 10.1186/1471-2474-13-237. Moncrieff, J. Cohen, D. (2009). ‘How do psychiatric drugs work?’. British Medical Journal: 338 [Online]. Available from: bmj.com/content/338/bmj.b1963#alternate. Morrissey, J. Callgahan, P. (2011). Communication skills for mental health nurses. Maidenhead: Open University Press. National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell and Social Care Institute for Excellence and NICE. National Institute for Health and Clinical Excellence (NICE) (2013). Falls: assessment and prevention of falls in older people: NICE clinical guideline 161. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2008). Type 2 Diabetes: The Management of type 2 diabetes. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2006). Dementia: Supporting people with dementia and their carers in health and social care. London: NICE. Nursing and Midwifery Council (NMC) (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Pearson, A., Field, J., Jordan, Z. (2009). Evidence-Based Clinical Practice in Nursing and health Care. Assimilating Research, Experience and Expertise. Oxford. Blackwell Publishing. Polit, D. Beck, C. (2010). Essentials of nursing research: appraising evidence for nursing practice. 7th ed. London: Lippincott Williams and Wilkins. Popp, J. Arlt, S. (2011). ‘Pharmacological treatment of dementia and mild cognitive impairment due to Alzheimer’s disease’. Current Opinion in Psychiatry, 24(6), pp. 556-561. Porsteinsson, A., Drye, L., Pollock, B., Devanand, D., Frangakis, C. Ismail, Z., Marano, C., Meinert, C., Mintzer, J., Munro, C., Pelton, G., Rabins, P., Rosenberg, P., Schneider, L., Shade, D., Weintraub, D., yesavage, J. Lyketsos, C. (2013). ‘Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial’. JAMA, 311(7), pp. 682-691. Repper, J. Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. London: Balliere Tindall. Sakamoto, M., Ando, H. Tsutou, A. (2013). ‘Comparing the effects of different individualized music interventions for elderly individuals with severe dementia’, International Psychogeriatrics. 25(5), pp. 775-784. Smith, G., Greogry, K. Higgs, A. (2007). An integrated approach to family work for psychosis. London: Jessica Kingsley Publishers. UK Legislation (2007) Mental Health Act 2007 [Online]. Available from: legislation.gov.uk/ukpga/2007/12/contents (Accessed: 13th May, 2014). Wall, M. Duffy, A. (2010). ‘The effects of music therapy for older people with dementia’. British Journal of Nursing, 19(2), pp. 108-113. Wright, N. Stickley, T. (2013). Concepts of social inclusion, exclusion and mental health: A review of the international literature. London: SAGE. Wright, J., Turkington, D., Kingdon, D. Basco, M. (2009). Cognitive-behaviour therapy for severe mental illness: An illustrated guide. USA: American Psychiatric Publishing Inc.

Fireflies, Family Lampyridae

Fireflies, Family Lampyridae Who hasn’t chased a blinking firefly on a warm summer night? As children, we captured their luminescence in glass jars to make insect lanterns. Unfortunately, these beacons of childhood seem to be disappearing due to habitat loss and the interference of manmade lights. Fireflies, or lightning bugs as some call them, belong to the family Lampyridae. Description: Fireflies are usually black or brown, with elongate bodies. If you handle one, youll notice they feel somewhat soft, unlike many other kinds of beetles. Hold it gently, as its quite easy to squish. When viewed from above, the Lampyrids seem to conceal their heads with a large shield. This feature, an extended pronotum, characterizes the firefly family. If you examine the underside of a firefly, you should find the first abdominal segment is complete (undivided by the hind legs, unlike in ground beetles). In most, but not all fireflies, the last two or three abdominal segments look quite different from the others. These segments are modified as light-producing organs. Firefly larvae live in moist, dark places – in the soil, under tree bark, and even in swampy areas. Like their adult counterparts, larvae glow. In fact, fireflies produce light in all stages of their life cycles. Classification: Kingdom – AnimaliaPhylum - ArthropodaClass – InsectaOrder – ColeopteraFamily – Lampyridae Diet: Most adult fireflies do not feed at all. Firefly larvae live in the soil, preying on snails, grubs, cutworms, and other soil-dwellers. They inject their prey with digestive enzymes that paralyze and break down the bodies, and then consume the liquefied remains. Some fireflies eat mites or even pollen. Life Cycle: Fireflies typically lay their eggs in damp soil. Eggs hatch within weeks, and larvae overwinter. Fireflies may remain in the larval stage for several years before pupating in the spring. In ten days to a few weeks, adults emerge from the pupal cases. Adults live just long enough to reproduce. Special Adaptations and Defenses: Fireflies are best known for their coolest adaptation – they produce light. Male fireflies flash their abdomens in species-specific patterns, hoping to attract the attention of a female hiding in the grass. An interested female will return the pattern, helping guide the male to her in the darkness. Some females use this behavior for more sinister means. A female of one species will purposefully mimic the flash patterns of another species, luring a male of another kind to her. When he arrives, she eats him. Male fireflies are rich with defensive chemicals, which she consumes and uses to protect her eggs. Most females dont practice cannibalism, though. In fact, since females live just a few days spent waiting in the grass for a mate, some dont even bother to develop wings. Firefly females may look just like larvae, but with compound eyes. Many fireflies use foul-tasting defensive compounds to deter predators, like jumping spiders or even birds. These steroids, called lucibufagins, cause the predator to vomit, an experience it wont soon forget when it next encounters a firefly. Range and Distribution: Fireflies live in both temperate and tropical climates throughout the world. About 2,000 species of Lampyrids are known globally.

FTAA and its effects on latin america Research Proposal

FTAA and its effects on latin america - Research Proposal Example A growing world economy will also enhance our domestic prosperity. (Hakim )Free trade and increased economic integration are key factors for raising standards of living, improving the working conditions of people in the Americas and better protecting the environment." This paper seeks to discuss the negative effect that the FTAA would have on Latin American countries. Although the FTAA agreement was meant to be in force by the 1st January 2005 by the time senior American and Brazilian officials met in Switzerland to try to breathe fresh life into the deal the talks had been stalled for more than a year and the deadline had already been missed.The United States and Brazil are co-chairs of the FTAA negotiations but have had vastly different views of what the final agreement should look like. There has been very little consensus among the participating countries about either the timing or the scope of the FTAA. The United States, along with 12 other nations (those with which the United States either already has or is negotiating bilateral trade deals), is pushing for the completion of an "ambitious" and far-reaching accord on schedule for implementation by 2005. The countries of the Mercosur, the South American common market led by Brazil and Argentina, on the other hand, are advocating a "possible" FTAA, with drastically scaled-back goals. (FTAA)Venezuela and many Caribbean countries have also expressed misgivings about the timing of the negotiations and their scope. (Hakim) For the time being the final workable form of the FTAA remains to be thrashed out at the negotiating table. Will further the effects that NAFTA had on American jobs. Companies are lured progressively south in search of cheaper wages. Companies who have not moved abroad are closing plants because they cannot compete with cheaper imports. Governments

A real story happened in my life Essay Example | Topics and Well Written Essays - 1000 words

A real story happened in my life - Essay Example This essay explores how an opportunity to study in the US changed my life and gave me an opportunity to give back to society back at home. I was born in the outskirts of the beautiful city of Valparaiso that is known to Chile’s business and tourist hub. At this time, times got tough and my parents had to move in the city in search for better paying jobs and improved quality of life for my siblings and I. My parents did their best to give the best education for my siblings and I. My education experience in Chile was difficult as anticipated. I can confidently say that I wasted three years of my life going round in circles. When I was two years old, I enrolled in a special class for students with disabilities. Although this class was meant to form a solid foundation for my education, it turned out to be a huge disappointment to my parents, as I could not read a single word in Braille. I spent two years in regular kindergarten and one and a half years in first grade. My education was not getting any better and the oral lessons offered were of no use to me. My parents started looking for ways for me to access the kind of education I needed. We got a few rejections but eventually, the Arkansas school for the blind accepted my application. This was the first time I was away from my family and friends and I felt so lonely and scared. I had seen my parents try their best to give me a better education and was not going to disappoint them in any way. At the time I enrolled in the school, there were a few international students and we were treated better than the natives were (Isibor 73). The institution had excellent facilities for study and play and I felt that life had given me the chance to discover my talents and be an inspiration to children in Chile. As other children played during recess, I sat alone on the bench. The teachers were concerned and often encouraged me to join my peers in play. There has been a constant increase in the number of foreign student s seeking to pursue education in the US and this trend is likely to increase in future as shown in the graph below. Changes in the U. S. Population (U.S. Department of Labor) When I first came to the institution, I had to learn and adjust to new experiences. My former education experience was oral and I thought this would continue. In my first year, I learnt to write and read Braille. The teacher in charge was stern and firm and I quickly adjusted to her teaching style. She taught me some of the most valuable lessons that I have applied to date. I had not interacted with children from ethnic and cultural backgrounds and this opportunity enabled me to interact with them (Isibor 74). It also gave me the chance to make new friends away from home. I had never given much thought to being able to move around and carry out my routine activities independently. At the end of my first week in the institution, I was assigned a mobility instructor and I was presented my first cane after complet ing my first mobility test. The mobility instructors taught me on how to move around independently. Over time, my mobility skills improved immensely as I could walk around the school alone and handle activities including play better. My teacher helped me draft letters to my parents who were amazed at my progress and this encouraged me to be better every day. The greatest disappointment occurred during the holidays when the school social worker notified me that I would not be going home, as my parents could not

Cosmetic Industry Advertising Analysis- Prime focus on L'Oreal Essay

Cosmetic Industry Advertising Analysis- Prime focus on L'Oreal - Essay Example L’Oreal is one such cosmetic company who with their effective advertising campaigns is able to attract consumers from various cultures from all the over, thereby achieving sizable profits and in the process becoming the largest cosmetics and beauty company of the world. Among the many industries, the cosmetic industry is an ever expanding one, as the desire of the people to look as well as feel good has been increasing, irrespective of gender, age, culture, etc. L’Oreal Group is able to cater to these segments of consumers by offering products for hair care, hair colouring, skin care as well as beautifying products in three international brands, namely L’Oreal Paris, Garnier and Maybelline. One of the key as well as successful branding cum advertising strategy adopted by L’Oreal and missed by its competitors is the reaching out to the customers of different countries of the world, across different income ranges and cultural patterns. (finance.mapsofworld.c om). That is, instead of focusing on one country or even a particular continent and one target customer base, L’Oreal has and is still expanding to newer markets with various products as part of differentiation strategy. â€Å"L'Oreal uses different brands to attract different markets†¦shows no desire to create the world in its own, singular image† (Haig 2006). Importantly, in their operations worldwide, L’Oreal comes up with advertisement campaigns which cater to the local population, even while maintaining an international look. International look in the sense, even if L’Oreal come up with advertisements catering to the local population featuring local celebrities or models, they make sure that the celebrity or even the model has an non-ethnic international facial features. On the other hand, some international advertisements with international celebrities are also showcased in other countries, with the language or voice over dubbed in the local la nguage. In addition, the advertisements are shot by International advertising agencies to give that look. This can be seen in the key market of India, where L’Oreal advertisements although have local celebrities like Former Miss World and Indian actress Aishwarya Rai, it projects an international look. â€Å"Cosmetics major L’Oreal uses international advertising for its brands like the hair.† (Jacob 2002).Thus, it is clear that as â€Å"a result of this transnational approach, L'Oreal is apparently able to maintain a similar image for all its brands wherever they are sold.† (Bogucki and Kredens 2010). While its competitors are now only following L’Oreal’s path and are diversifying and entering various markets. That is, these companies mainly catered to the local market and people of particular ethnicity and race, and so their advertising campaigns had a certain market centric ‘look’. For example, Shiseido, Japan’s number one cosmetics company and fourth largest in the world, exhibited this behaviour as they mainly focused on the Asia-Pacific region and thereby came up with advertising campaigns that predominantly featured Asian models. However, following the model set by the L’Oreal, Shiseido also wants to become a global player by showcasing international advertisements as well as local advertisements with international look. â€Å"We want to become more of a global company like L'Oreal,'' says Yoshikuni