My Family History Argumentative Essay Example For Students

Article of Confederation Essau essays

Article of Confederation Essau expositions The Declaration of Independence required another administration for the new country to be. In 1777, during the Revolutionary War, the Continental Congress made an arrangement for our first official government. This arrangement was known as the Articles of Confederation, which activity in 1781. Under the Articles of Confederation, each state was equivalent in powers and was free of each other. The congress, which was the national government, had exceptionally restricted forces. The states dreaded a solid congress, and felt that a solid national government may attempt to restrain the forces and opportunities of the individual states. Despite the fact that the Confederation was lacking and was flopping in attempting to improve the countries financial condition, it made its most significant progress in the treatment of western terrains. After the war, Americas obligation had expanded by a ten times. Under the Articles, the focal government couldn't control exchange between the states or with remote countries. Each state controlled its own exchange; this made numerous questions among the states and different countries. What's more, most states printed their own cash. Without a uniform national cash, exchanging was a confounded strategy. Additionally, congress didn't have the ability to gather the assessments expected to pay for the costs of the national government. It could request cash; anyway it had no capacity to compel the states into paying them. Without cash, Congress couldn't pay the country's obligation nor would it be able to give government projects and administrations. Robert Morris, a money related wizard, proposed a 5 percent impost, yet this fizzled on the grounds that states with effective ports didnt need to free their entitlement to force their own charges. All the thirteen states in the Confederatio n need to concur before an article can be corrected, however since certain states didnt concur with Morris, that arrangement has fizzled. Next he planed to make a private bank. This bank gave banknotes, which were sponsored by hard cash; alth... <!

Exercise Euphoria and Exercise Addiction

Exercise Euphoria and Exercise Addiction Addiction Addictive Behaviors Print The Science Behind Runners High and What to Do If Youre Addicted By Elizabeth Hartney, BSc., MSc., MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. Learn about our editorial policy Elizabeth Hartney, BSc., MSc., MA, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on March 20, 2017 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 16, 2020 Arnold Media/Getty Images More in Addiction Addictive Behaviors Caffeine Internet Shopping Sex Alcohol Use Drug Use Nicotine Use Coping and Recovery We all know getting and staying healthy through exercise can feel good, but sometimes it can feel so good that people who exercise might wonder, can you get high from working out? And if you can actually get high on exercise, like you can from drugs, is it good for you or bad for you? The short answer is that yes, you can get high from exercise. And while the feeling of getting high itself is not harmful, like with drugs, you can be harmed while under the influence of this high feeling, as you may be less aware of the potential and real harms to your body. There is also a risk of getting addicted to the high you get from exercise, which can also be harmful. Benefits of Regular Exercise So do we need to be concerned that we are exercising too much? For most of us, the answer is no. Typically, people who dont exercise much find exercise hard work at the beginning, and it is only after your strength, stamina, and skill develop that you start feeling good during and after exercise. Even for those who have developed a regular exercise routine, look forward to working out, and feel great during and after exercise, the majority of people dont get to the point where exercising too much is a concern. There is wide variation on how much pleasure people derive from exercise, peoples predisposition to addiction and peoples individual neurological makeup, and it has been noted by neuroscientists that one of the main reasons that people with the intention of increasing exercise eventually quit  is a lack of enjoyment. If anything, most of us would benefit from exercising more and increasing our enjoyment of exercise to reinforce a regular exercise routine. Most people do not need to worry about getting addicted to exercise and should try to exercise regularly. Exercise improves your bodys functioning in many different ways and offers many benefits such as:?? Exercise gives you energy and increases your resistance to fatigue, meaning that although your body is working harder when you exercise, over time, you feel less tired than you did before you started working out.Exercise makes your muscles stronger, improving your ability to do many different active tasks, and increasing your independence, as you are less likely to need help with physical tasks.Exercise makes you more flexible, increasing the variety of physical activities you can do, whether or not they are directly related to exercise.Exercise improves your endurance, meaning you can continue to be physically active for longer periods of time than you can when you dont exercise, without straining yourself or feeling uncomfortable.Exercise makes your body more efficient at physical tasks, meaning you can do them with less effort, and feel less tired afterward, than if you dont regularly exercise.Exercise reduces your risk of injuries, such as lower-back problems.Exercise helps you t o manage your weight and can help you to lose weight if you have put on too much weight.Exercise decreases your risk of cardiovascular disease.Exercise reduces your risk of type 2 (adult onset) diabetes mellitus.Exercise lowers your risk of depression and can help manage the symptoms of depression for those who have it.Exercise may decrease the effects of aging through improved functioning during regular tasks of everyday life.Exercise can help people overcome other addictions.??Exercise helps you to get a good nights sleep and can help with sleep disorders.?? Exercise Can Help With Avoiding an Addiction Relapse So, you may be wondering, with such a litany of benefits, what could be  the problem with exercise? It sounds like the more the better, and you cant go wrong. For most of us, this is true, but for people with a personal or family history of addictions, those with unresolved emotional trauma, or those who are particularly sensitive to endogenous opioidsâ€"the drug-like substances produced by the bodyâ€"there may be a risk in exercising too much. What Is Runners High? The good feelings that people get from exercise, also known as euphoria, is a well-recognized phenomenon, often referred to as the runners high.   The positive feelings people get from exercise can be a great natural way to motivate you to exercise more regularly, can fight depression, and can be helpful for people who are trying to recover from alcohol and drug addictions. The problem comes from the psychological process of addiction, which can occur in people who experience runners high and can potentially lead to exercise addiction. The runners high happens naturally when people participate in  vigorous exercises, such as running, swimming, or aerobic exercise. It is caused by changes in the body and brain that occur during exercise, which may be similar to the processes that happen when people take opioid drugs, such as heroin.  Although this may seem far-fetched, researchers have found that endogenous opioid production occurs during intense aerobic exercise.??  So the physical processes of opioid use disorder and exercise addiction may be closer than you might think, as the bodys own endorphins are important in initiating both types of addiction. The euphoria you feel during and after exercise is not harmful. While its often referred to as runners high, these feelings can also occur with other forms of aerobic exercise. Like with the high that people get from taking opioid drugs, the runners high feels exhilarating, easeful, and comfortable. If you experience a runners high, you may cease to notice pain, or become comfortably numb. You may  experience an overwhelming sense of well-being, even if this does not reflect reality. You might continue exercising even though you know the physical activity is causing problems.?? For example, you may not be bothered by feeling too hot or too cold, and may even have a sense that these things dont matter, feeling a kind of invincibility, that you have superhuman strength and resilience, and can do anything and come out on top. Of course, these physical things all do matterâ€"people who get high on heroin and people who get high on exercise are just as vulnerable as anyone else to becoming ill from being over- or under-heated, or from the injuries that pain usually prompts us to take care of. People experiencing a runners high have been known to continue to engage in exercise or sports, even with serious injuries, such as broken bones. At the time, they either didnt notice they were hurt, or it didnt seem to matter. The Key Features of the Model of Addiction The Science Behind Runners High Scientists have studied the runners high, in order to understand the opioidergic mechanisms of the runners high in the human brain, and to identify the relationship of these drug-like chemicals, which occur naturally in the body, to the euphoria or high that people experience when they engage in intense exercise. Researchers have found a relationship between the number of opioids in the brain and the athletes mood.?? The level of euphoria was significantly increased after exercise. The findings of this research support the opioid theory of the runners high and suggest region-specific effects in frontolimbic brain areas that are involved in the processing of emotional states and mood. Research indicates that the brains of people who exercise excessively get exposed to high amounts of drug-like opioids, creating an intense high. The desire to experience the feeling again drives them to continue to exercise in excess. How to Know If Youre Developing an Exercise Addiction It is fine  to take pleasure in exercise. In fact, it is encouraged. Most of the time, this will not be harmful, and it will do you a lot of good. It is also fine for you to think about how you can improve your technique, or excel in whatever form of exercise or sport you are engaging in. Where it becomes problematic to gain pleasure from exercise is when it becomes your main focus in life. If you enjoy exercise, you should enjoy other aspects of life as well. If exercise is the only activity you enjoyâ€"with the exception of other addictive activities, such as sex, eating, work, TV, and of course, alcohol and other drugsâ€"you may be focusing too much on the high you get from exercise to the detriment of other areas of life. Are you enjoying a full social and/or family life? If all of the people you enjoy spending time with are exercise buddies, you may be taking it too far. This is particularly the case if you know that you have problems in your primary relationships, for example, with your parents, your partner, or your children, but you arent addressing these problems because you are focusing too much on escaping into exercise. If youre concerned about the possibility of having an exericse addiction, ask yourself the following questions:Do you feel you cant cope without the high you experience from working out?If you need to stop exercising, either because you are busy with other priorities, or because of a physical illness or injury, do you feel depressed or anxious? Perhaps it might be important to note that there are other conditions that can lead to too much exercise. Excessive exercise can also be frequently seen in those with eating disorders such as anorexia or bulimia and can co-occur with food addiction.?? What to Do If You Are Addicted to Exercise If you think you might have an exercise addiction, keep a record of how much exercise you do, and when, as well as your mood before and after exercising, and when you are unable to exercise. If, after a week or so, you are noticing a pattern of using exercise for a runners high that you dont think you can cope without, talk to your doctor and relay your concerns outlined in the  mood and exercise diary. Your doctor can refer you to a mental health professional, who can help you to get your exercise under control, and help you to find joy in other aspects of life. What Is Exercise Addiction and Are You at Risk?

Analysis Of The Story Of An Hour By Kate Chopin - 895 Words

Irony and Foreshadowing in Story of an Hour In the short story, Story of an Hour, Kate Chopin chronicles the short journey of a woman who has recently learned of the death of her husband from a railroad accident. Kate Chopin is known for her stories which revolve around women and the world from their perspective, and Story of an Hour is no exception. As a writer, Chopin utilizes and employs many rhetorical devices to add emotion and depth to her world. Though Story of an Hour is riddled with rhetorical devices in almost every sentence, the two that tend to stand out the most are the use of irony and foreshadowing. We have all definitely came into contact with either irony or foreshadowing in almost every piece of media that we consume, but it is especially true in literature. According to the Merriam-Webster Dictionary, irony is the â€Å" the use of words that mean the opposite of what you really think,† while foreshadowing is â€Å"to represent, indicate, or typify beforeha nd.† In literature, these two tactics are used endlessly to provide excitement, suspense, and intrigue to the work. Irony can be seen in many works of literature, such as in Animal Farm, where a group of animals overthrow the human owners of a farm and establish their own government, only to take on the same roles as their human rulers. In the case of foreshadowing, it can be seen in numerous literary works, such as in Romeo and Juliet, where Romeo proclaims â€Å"Life were better ended by their hate, / Than deathShow MoreRelatedAnalysis Of The Story Of An Hour By Kate Chopin811 Words   |  4 Pages2015 What’s in a Protagonist: An Analysis of The Story of an Hour In Kate Chopin’s short story, The Story of an Hour, the reader is introduced to three characters and an event that has occurred prior to the beginning of the story. The three characters that the reader is introduced to are: Mrs. Mallard, who is the protagonist of the story, Josphine, who is her sister, and Mr. Richards, who does not play a major role in the story. Throughout the plot of the story, the reader can gain a sense of sympathyRead MoreThe Story Of An Hour By Kate Chopin Literary Analysis1432 Words   |  6 PagesMaking a literary analysis involves writing an argumentative analysis about a particular literature. The analyst is supposed to carefully read the literature and better understand the contents so as to come up with legal analysis. It requires some summary, but it is not a report about the book or the story. It is important in making the reader to understand the message in the book as well as the improvements necessary the literature. It is also important in understanding how a particular author articulatesRead MoreAnalysis Of Kate Chopin s The Story Of An Hour955 Words   |  4 PagesLiterally analysis of Naturalism and the Short Story Form: Kate Chopin’s ‘The Story of an Hour† While Scott D. Emmert in Naturalism and the Short Story Form: Kate Chopin’s ‘The Story of an Hour’ points out the short stories cannot form a narrative because of their length and others would disagree. Admittedly, even though according to Scott short stories cannot form a narrative they are perfect for naturalist writers because short stories and poems tend to focus more on natural surroundings and theRead MoreLiterary Analysis Of The Story Of An Hour By Kate Chopin856 Words   |  4 PagesEnglish 1302 11 November 2017 Literary Analysis of â€Å"The Story of an Hour† by Kate Chopin The Story of an Hour is a short story written by Kate Chopin which was published in 1894 as â€Å"The Dream of an Hour† in Vogue. When the word marriage hits our mind, we think it as a lasting relationship. Marriage is a commitment between two individuals bonded by holy ceremony. The story of an hour presents the side of marriage which is usually unheard. The main character of the story is Mrs. Louise Mallard. She cameRead MoreAnalysis of â€Å"the Story of an Hour† Written by Kate Chopin1697 Words   |  7 PagesAnalysis of â€Å"The Story of an Hour† written by Kate Chopin The story under analysis is written by Kate Chopin. Kate Chopin was an American author of short stories and novels. She wrote for both children and adults. She is considered as a forerunner of feminist author. Unlike many of the feminist writers of her time who were mainly interested in improving the social conditions of women, she looked for an understanding of personal freedom. She put much concentration on women’s lives and their continualRead MoreAnalysis Of The Story The Story Of An Hour By Kate Chopin751 Words   |  4 PagesHardi Patel Mr. Ogle ENGL 1020 10 July 2015 The Joy of Independence In the short story â€Å"The Story of an Hour†, by Kate Chopin, the episode begins with the exposition. It is the story about a dynamic character, Mrs. Mallard, who is given the horrible news of her husband’s death in a railroad disaster. Overwhelmed by her husband’s immediate death, she suddenly rushes in her bedroom. Here we see a different side of Mrs. Mallard’s attitude. Mrs. Mallard portrays herself as a coin. Mrs. Mallard, theRead MoreKate Chopin The Story Of An Hour Analysis1137 Words   |  5 Pagesâ€Å"The Story of an Hour† by Kate Chopin is a wonderful short story bursting with many peculiar twists and turns. Written in 1894, the author tells a tale of a woman who learns of her husband’s death but comes to find pleasure in it. The elements Kate Chopin uses in this story symbolize something more than just the surface meaning. In less than one thousand one hundred words, Kate Chopin illustrates a deeper meaning of Mrs. Mallard†™s marriage through many different forms of symbolism such as the openRead MoreAnalysis Of The Story The Story Of An Hour By Kate Chopin903 Words   |  4 PagesEddly Noel English Literature and Writing Professor Johnson 27 October 2014 Oppression In Kate Chopin’s short story â€Å"The Story of an Hour† oppression is epitomized as the state of being subject to control or distress. At the beginning of the story, Louise Mallard’s family gently informs her of her husband’s death in a train accident. Knowing that Mrs. Mallard suffered from heart trouble, they had to carefully convey the sad message. At this moment, Mrs. Mallard is feeling heavily burdened andRead MoreAnalysis Of The Story The Story Of An Hour By Kate Chopin1219 Words   |  5 Pageshave to embark, sooner or later. Death can be the beginning of the end to many people, an event which can bring everlasting happiness, but also a shattering sadness. The short story â€Å"The Story of an Hour,† by Kate Chopin, which was published in 1894, presents a not so common viewpoint of death. One could say that this story has brought about a brief renewing love for life with one of the main characters. On the other hand, â€Å"The Moth s† by Helena Maria Viramontes shows a painful reaction to deathRead MoreAnalysis Of Kate Chopin s Story Of An Hour993 Words   |  4 PagesIrony in â€Å"Story of an Hour† In Kate Chopin’s short story â€Å"Story of an Hour†, Irony, or the expression of meaning that traditionally indicates the contrary of what is expected, plays a huge role in deciphering the theme and underlying motifs of the story that takes the reader through the hour of Mrs. Mallard’s life after her husband supposedly dies. Through Irony, Kate Chopin effectively portrays the forbidden joy of independence (SparkNotes Editors). The theme is portrayed by the author’s emphasis

The Current Punishments For A Student Cheating - 990 Words

It is a melancholy object to those who walk through this great school or travel in the county, when they see the classes, desks, and lab tables crowded with students, surrounded by three, four, or six cheet sheets, all in tatters and importuning every finished student for an answer. These pupils, instead of being able to work for their honest grade, are forced to employ all their time taking photos of the work of ireful classmates, who, when the next long math worksheet arises, either turn to cheating for want of sleep, or leave their dear homework in their backpacks to waste time on Narcos on Netflix, or contrive a stomach ache for desire to abandon education completely upon the due date. Lets first ponder about cheating, if you cheat,†¦show more content†¦The longer my proposal is in effect, the more independent and honest we will become, thus creating a more civil society. Who doesn’t want a more civilized society where we don’t steal one of the most valuable things mankind has, knowledge. Some administrators of a desponding spirit are in great concern about the vast number of students who are counterfeiting homework, gazing upon the scantrons of others, or applying cellular telephones for acts of in-class deviance, and I have been desired to employ my thoughts what course may be taken to ease the school of so grievous an encumbrance. I think the advantages by the proposal which I have made are obvious and many, as well as of the highest importance. For first, as I have already observed, it would greatly lessen the number of plagiarists, with whom we are overrun around exam week, being the majority of test takers of the school as well as the most eminent threat to national security; and who begin their studies the night prior on purpose to finally finish re-watching Breaking Bad, hoping to take their advantage by the absence of so many observant proctors, who have chosen rather to finally alot time to putting grades into Edline than carefully scrutinizing every sideways glance with hawk-like precision. Secondly, the ceremonious removal of body parts would likewise bring great custom to hallways between classes,Show MoreRelatedCheating is a Crime1023 Words   |  4 Pageseducational system it has become very common for students to cheat their way through school. High Schools have an honor code and other rules in place in order to prevent students from cheating, although it is still very common to cheat. Whenever a student is caught in the unethical crime of cheating, he or she will state that the only way to survive in today’s competitive society is to â€Å"cut corners†. The act of cheating is rarely pena lized. Others believe that cheating is unethical and will only backfire inRead MoreCai Yangbin Froggen 988215 Ge2021 W08 Dr. Braxton 2017/3/131470 Words   |  6 PagesWhy so many students choose to cheat? What kind of students are enrolled in academic dishonesty? (almost all). The relationship between market supply and academic dishonesty. Suggestions and measures relevant institutions take on this problem. The problem of academic dishonesty criticism can be seen everywhere in this document. More and more academic cheating makes the whole education system have a big hole. Low achievers destroyed the whole academic system balance. Author urge students not to do academicRead MorePlagiarism And The Reasons College Students1618 Words   |  7 Pagesignored, this problem will continue to rise from the current state and transform into a constant. There are ways to prevent this unruly fact, but one must be ready to face the obvious situation, and take measures to limit this growing prob lem. This article will explain plagiarism and the reasons college students turn so quickly to such an unstable â€Å"solution†. It will also present alternative ideas to learning and measures to limit the need that students feel for plagiarism and promote personal creativityRead MoreEssay on What is Cheating and Why Cheating is Bad?1219 Words   |  5 PagesWhat is Cheating and Why Cheating is Bad? In this paper, we discuss how academic dishonesty in general and what role if any, the structure and teaching of courses – as a part of business management curriculum in particular – plays, in curbing that dishonesty. Cheating can be defined as any act of academic dishonesty and is encountered in various forms. There has been extensive research [Whitley, 1998] to analyze fraudulent exercises- especially in undergraduate school setting. 72% students reportRead MoreDukes Mbas Cheating Scandal997 Words   |  4 PagesDuke s MBAs Cheating Scandal While students are overwhelmed with handbooks on plagiarism, school honor codes when they entering a university, cheatings are rampantly detected in university environment. Admittedly, plagiarism and cheating should be seriously punished. However, there do exist controversial cases where some assert that the cases are not considered cheatings, the others argue that they should be considered cheatings. An article named Duke MBAs Fail Ethics Test by Alison DamastRead MoreAcademic Integrity And Student Plagiarism1622 Words   |  7 Pagesintegrity as plagiarism and buying essays. This work addresses, much attention will be paid to the background of breaches of academic integrity. Students’ behavior will be described and thoroughly analyzed. This essay will provide an understanding that current educational system itself creates prerequisites for such violations. Nowadays, American students try to subvert the educational system by using plagiarism in essays. The educational system tries to withstand these manifestations of dishonestyRead MoreStudent Perceptions Of Cheating At Online1685 Words   |  7 PagesStudent Perceptions of Cheating in Online CoursesYour Name:Class Name:University Name:Instructor Name:Student Perceptions of Cheating in Online CoursesAcademic integrity has long been a core concern of faculty as well as administrators operating in campuses. Recent statistics done on the extent of cheating that occurs in college campuses shows that the large majority of students have engaged in this vice to some extent. The core difference in today’s environment is the wide proliferation of technologicalRead MoreThe Real Problem of Plagiarism1168 Words   |  5 Pagesexpects the students to behave. These codes can be different based upon the specific rules of the institution in question. Some have clothing rules, others rules ab out alcohol or drug use, but there are certain rules which are more universal and are found in almost all schools. Many schools have rules which dictate that students must behave in ways which the institution considers to be honorable. These honor codes can include different components, but it is primarily a pledge against cheating in any senseRead MoreWest Point Cheating Incident Essay1440 Words   |  6 PagesWest Cheating Incident Case Running Head: West Point Cheating Incident Case Submitted By: Warren Frazier For: Advanced Organizational Behavior 1 April 2014 West Point Cheating Case Description The success of a major corporation depends primarily on the development and completion of its mission statement. In order to achieve success, make profits and remain competitive in today’s market. Most organizationsRead MoreWhy Plagiarism Is Important For Academic Integrity?1731 Words   |  7 PagesNow in the age of information sharing, society has an obligation to consider where changing 21st century values fit within academic writing and whether there are any implications for standards regarding plagiarism. Plagiarism is a serious form of cheating as it essentially defines the values of academic dishonesty, therefore changing generational views on academic integrity must be considered. These views, consequently, need to be considered to understand if they are directly correlated with increased

Cognitive Term of Behaviour Free Essays

Examine one interaction between cognition and physiology in terms of behavior. Evaluate two relevant studies. One of the most famous case studies of amnesia in the history is HM who was suffering from epileptic seizures and had a surgery when he was only nine years old that removed 2/3 of his hippocampus, medial temporal lobes, parahippocampal gyrus and amygdala. We will write a custom essay sample on Cognitive Term of Behaviour or any similar topic only for you Order Now The operation was successful in its primary goal of controlling his epilespsy but as a result of the operation he suffered from severe anterograde amnesia. After the operation, he could not commit new events to long-term memory. He could remember events from before the operation for the rest of his life. His working memory and procedural memory were intact. After the operation, he could continue to complete tasks that require recall from the short-term memory and that involved procedural memory but could not make use of long-term episodic memory after the operation. After the operation, he lost his declarative memory (semantic and episodic). Because of the removal of these parts of brain, he might face these problems. One that might be he couldn’t encode the information or he could do that but he couldn’t retrieve it or he could do them but could not store them in his memory. Clive Wearing had brain infection -herpes encephalitic- affecting the parts that are concentrated on memory. MRI scanning shows damage to the hippocampus and some of the frontal regions. His ability to perceive what he saw and heard was unimpaired. But he did not seem to be able to retain any impression of anything for more than a few blink. In he did blink, his eyelids parted to reveal a new scene. In Clive’s case, the virus damaged his brain. It damaged the hippocampus, which play a major role in the handling of long-term memory formation. Additionally he sustained marginal damage to the temporal and frontal lobes. The former houses the amygdala, a component implicated in the control of emotions and associated memories. Clive developed a profound case of total amnesia as a result of his illness. Because the part of the brain required to transfer memories from the working to the long term area in damaged. He is unable to encode new memories. He only remembers a little part of his life before. He still knows how to play piano, which is because his cerebellum responsible for the maintenance of procedural is not damaged. The fact that he could no longer remember anything and was not aware, tells us that the hippocampus and the temporal and frontal lobes are the bits responsible for LTM’s and STM’s formation and recall. In both cases, the hippocampus was damaged, and so they both had problems with their long-term memory. In HM’s case only two thirds of the hippocampus was removed while in Clive’s case most of it was destroyed. As a result both had very severe amnesia and because of that we can conclude that hippocampus is the part of the brain responsible for forming/retrieving or storing the LTM. This is an example of the link between cognition and physiology of the brain. However, certain exceptions make this theory a lot more complex. For example HM had remembered JFK’s assassination and both could still learn new skills. In Clive’s case, the fact that he could still emotionally remember his wife does not fit into the former explanation. However, the researches that were done consistently for these two people are reliable, giving us the opportunity to generalize such hypothesis on the cognitive part of the brain. For example, Brenda Milner, who studied HM following his surgery till his death, is a very well-known researcher and in her reports she has clearly mentioned HM’s past and present conditions. Since she is known and experienced, her reports are likely to be true and not exaggerated. And because of that we believe it to be dependable and creditable as well as following a data triangulation. Milner hasn’t had any brain illnesses in her life, so we can easily decide that her research was in no way influence by her own disabilities. On the other hand she has not checked and re-checked her research results, trying to find fault in them, since HM’s case is a very unique case in the world. And the fact that HM was old at the time when most of her research were conducted, we could argue that his memory loss was due to old age. Another fault in her research is its inaccuracies, an example of such inaccuracy is when HM remembered John F. Kennedy’s assassination. Based on these findings we can assume that her research is strong enough for us to be able to generalize its effects. That is why recently, scientists associate hippocampus and amygdala with memory formation and storage. How to cite Cognitive Term of Behaviour, Papers

Julius Caesar Essays (744 words) - , Term Papers

Julius Caesar In the play of Julius Caesar, we see a brief picture of Roman life during the time of the First Triumvirate. In this snap shot, we see many unfortunate things. Shakespeare gives us the idea that many people try to circumvent what the future holds, such as unfortunate things, by being superstitious. Superstition seems to play a role in the basic daily life of most Roman citizens. For instance, the setting of the first scene is based upon superstition, the Feast of Lupercal. This feast is in honor of the god Pan, the queen of fertility. During this time, infertile females are supposed to be able to procreate, and fertile ones are supposed to be able to bear more. It is also a supposed time of sexual glorification and happiness. Other scenes depict how throughout Rome, roaming the streets are mysterious sooth-sayers, who are supposedly given the power to predict the future. Dictating what is to come through terse tidbits, these people may also be looked upon as superstitious. In the opening scene, one sooth-sayer, old in his years, warns Caesar to "Beware the Ides of March," an admonition of Caesar's impending death. Although sooth-sayers are looked upon by many as insane out of touch lower classmen, a good deal of them, obviously including the sayer Caesar encountered, are indeed right on the mark. Since they lack any formal office or shop, and they predict forthcomings without fee, one can see quite easily why citizens would distrust their predictions. Superstition, in general elements such as the Feast of Lupercal, as well as on a personal level such as with the sooth-sayers, is an important factor in determining the events and the outcome of Julius Caesar, a significant force throughout the entire course of the play. Before the play fully unravels, we see a few of signs of Caesar's tragic end. Aside from the sooth-sayer's warning, we also see another sign during Caesar's visit with the Augerers, the latter day "psychics". They find "No heart in the beast", which they interpret as advice to Caesar that he should remain at home. Ceasar brushes it off and thinks of it as a rebuke from the gods, meaning that he is a coward if he does not go out, and so he dismisses the wise advice as hearsay. However, the next morning, his wife Calphurnia wakes up frightened due to a horrible nightmare. She tells Caesar of a battle breaking out in the heart of Rome, "Which drizzled blood upon the Capitol," with Caesar painfully dying, such that "...The heavens themselves blaze forth the death of princes." Although Caesar realizes Calphurnia is truly concerned about his well-being, he seeks another interpretation, coming to the conclusion that the person who imagines the dream may not be the wisest one to interpret it's meaning. Later Caesar tells his faithful companion Decius about it, and he interprets it quite the contrary, "That it was a vision fair and fortunate," and indeed, today is an ideal day to go out, since this is the day "To give a crown to mighty Caesar." Perhaps Decius is implying here that today is a day where much appreciation and appraisal will be given to Caesar, surely not the endangerment of his well-being as Calphurnia interprets it. Caesar predictably agrees with him, as most citizens enjoy believing the more positive of two interpretations. After Caesar's assasination at the hand of Brutus, Cassius, and the rest of the conspirators, Brutus and Cassius are chased into the country side, where we see a few superstitious signs of their forthcoming painful death in battle. In a dream, Brutus sees Caesar's "ghost", interpreted as an omen of his defeat. He also looks upon the ensign, and instead of the usual stock of eagles, ravens and kites replace them, construed as another sign of their loss at Phillipi. Not surprisingly, Caesar's death is avenged in the end, with the two of the conspirators' double suicide. As superstition is inter-twined within the basis of the entire play, we can reasonably conclude that it is because of this irrational belief of why certain events occur and how to avoid them, that Caesar is retired and eventually avenged. In the words of Caesar's

Ancient Greece Contributions Essays

Ancient Greece Contributions Essays Ancient Greece Contributions Paper Ancient Greece Contributions Paper Ancient Greek Contributions Many of the roots in the Western civilization can be traced back to ancient Greece. They created long lasting contributions in the making of the Western development with their literature, drama, mathematics, philosophy, politics, and science. The ancient Greek contributions started from 1900 B. C. to 300 B. C. , but still have an impact on Western society today. As the Greeks expanded, they spread their ideas to other countries, while also receiving ideas from them. The important contributions of the Greeks to the Western society were philosophy, politics, medical science, Olympic Games, architecture and mathematics. One important contribution of the ancient Greeks was philosophy. Socrates was a famous ancient Greek philosopher. He believed that an unexamined life was not worth living (Document 1). This was known as the Socratic Method. Socrates thought that people should question everything in their lives. Because of his believes, he was put on trial for corrupting the cities of its youth and was later sentenced to death. Another Greek philosopher was Aristotle. He was taught by Plato, one more famous Greek philosopher and former student of Socrates. Aristotle believed that human nature is most superior when guided by reason because reason is what makes human beings so unique (Document 2). He taught Alexander the Great, who later conquered Persia and established the Hellenistic civilization. This civilization created a new philosophy stating people should avoid disappointment and just accept whatever life brings them. Philosophy impacted Western civilizations by setting values and morals for everyday life. A different contribution was politics. The Greeks believed in democracy. Pericles’ idea of a democracy stated that people should be able to voice their opinion no matter what their social standings were (Document 3). He thought that every citizen should have an equal opportunity to serve the public and help make their political decisions. Pericles ruled during the Golden Age and founded direct democracy. A direct democracy is when all citizens can vote on any issue without going through representatives or legislatures. Citizens were given the right to voice in their government. This type of political standing had greatly influenced Western governments. Another impact of the ancient Greeks was medical science. Hippocrates, the creator of the Hippocratic Oath, made a promise pledging that he would treat his patients and abstain from whatever is harmful to them (Document 4). In his oath, Hippocrates refused to give anything to his patients that would hurt them, but instead used all of his ability and judgment to treat his patients well. All studying doctors in Western civilizations take the Hippocratic Oath vowing to do anything in their power to do what is best for their patient and it is mandatory to take this oath to perform any kinds of medical treatments. One more great contribution made by the ancient Greeks was the Olympics. The marble sculpture of The Discus Thrower (Diskobolus) by Myron shows that the ancient Greeks believed in the beauty of the human body and that they liked to maintain fitness (Document 8). The Olympics allowed people of different cultures to come together and compete in physical events. Although in ancient Greek, only free white men were allowed to compete, Western civilizations allowed people of any race to enter. The Olympics allowed for cultural diffusion and tolerance. The Olympics are held every 4 years in Western nations. Architecture was another one of the ancient Greek contributions. The Parthenon’s pillars can be found in architectural buildings today (Document 7). The Greeks used limestone, marbles, and columns for their many public buildings that were showcased on top of the Acropolis. The Parthenon was created by Pericles in honor of Athena, a respected Greek goddess. The use of pillars can still be found in society today, especially in the United States where pillars were used to create the White House, Capital Building, and Jefferson Memorial. Mathematics was another distribution made by the Greeks. Euclid was a famous Greek mathematician who created the Proposition 15, Theorem (Document 5). This stated that if two straight lines intersect each other, the vertical angles will always be equal. Euclid, the writer of The Elements, opened doors to learning new concepts using geometry to all mathematicians and high school students in Western societies. The Greeks made an abundant amount of contributions to Western societies. They left democracy, philosophy, medical science, the Olympics, architecture, and mathematics for future developing civilizations. Pericles created a direct democracy which is still used today. Aristotle and Socrates gave future societies philosophy and encouraged them to question life and live a life full of reason. Hippocrates created the Hippocratic Oath, which is followed by doctors today to ensure that they will only do the best for their patients. The Greeks left the Olympics, which created a way of competing with people from different parts of the world on physical activities. Government buildings were the result of the Greeks creating public areas for their gods and goddess such as the Parthenon was created for the famed goddess, Athena. Lastly, Euclid gave future societies mathematics by creating the Proposition 15, Theorem. Because of ancient Greek contributions, today’s society has flourished and reached its peak.

Heres Whats Cool in Spanish

Here's What's Cool in Spanish This is a cool Spanish lesson. How would you translate the above sentence to Spanish? Look up the word cool in a Spanish-English dictionary, and chances are the first word youll find is fresco - but that word is used to refer to something that isnt quite cold. Some larger dictionaries include words such as guay  as a slangy term, but thats hardly the only word that can be used. Bueno Can Be Good If for some reason you need to convey the idea of cool and have a limited vocabulary, you can always use a word you probably already know, bueno, which means good. Its not a particularly cool word and doesnt come across as colloquial, but it will get most of your idea across. And of course, you can always use the superlative form, buenà ­simo, for something thats especially good. Cool Words Vary by Region There may no good Spanish equivalent of cool that works everywhere, but native Spanish speakers in a forum sponsored by this site offered their perspective on what may be best. Heres a part of their conversation, held originally in Spanish and English: Chabela: How do you says cool, like thats cool! What do the teenagers say? I know it cant be translated directly, but ... Cyberdiva: One word to use is chà ©vere. Duras: It cant be translated directly, because each country has its own versions. VictorIm: Chà ©vere is kind of old-fashioned (1960s). Is there anything new? Bandini: Duras is correct. Every country has its own vocabulary for words like this. The particular word you mentioned (chà ©vere) originated in Venezuela but due to Venezuelas major export (Spanish soap operas), the word is now become popular in a dozen other Spanish speaking countries, including Mexico. Rocer: In Mexico we understand the word chà ©vere, but we dont use it. Only if we talk to Venezuelans or Colombians, I guess. Adri: When I was studying in Spain last semester, I learned from a native-speaking friend of mine that they say guay or quà © guay. Guero: I think chido and buena onda would work well for cool. VictorIm: Buena onda sounds old-fashioned to me. Anything with onda sounds old. Are there any new expressions? Dulces: I have heard est chido and est padre in Mexico. SagittaDei: A very common translation is genial, est genial. Is very widely used in the Spanish-speaking world. As has been pointed out, there are many words depending on the country. I use est bacano/a, est una chimba, es una verraquera and many others; but these are Colombianisms. We also use the anglicism cool as in es muy cool. Rich teenagers like to use English in this way. It also depends on the social level. By the way, eso es chà ©vere is less expressive than eso es genial, the former is like thats nice. Note that you can use either estar or ser with the obvious difference of permanent and transitional attributes. Tottefins: In Mexico they say padre or chido on the streets. However, on Mexican television they say genial. Maletadesueà ±os: Here in Texas you often hear quà © chido, est chido, quà © padre, etc. Other people who arent from here that I have spoken with, such as my friend who lives in Venezuela, think these expressions seem comical as theyre Mexicanisms. Rupdaddy: I have heard the word brbaro. Most of my studies have been of the Spanish of the Rà ­o de la Plata, Argentina. I know that in Uruguay, at least among the youth, they say de ms. Chabela: I know that in Uruguay sometimes the youth say de ms. Those words are the same, more or less, with what the youth say in the U.S. In Mexico, particularly Tijuana, the word curada is widely used as meaning cool. Sometimes recurada is heard. Ive also heard the term chulado by people who come from Mexico City. OjitosLindos: I think in Spain the verb molar is used like gustar to mean something similar to cool, for example: Me mola el cine would mean I like the cinema or the cinema is cool. I think this is only used among young people (teenagers). Anderwm: Yes, you are right. Molar is a teenager thing. In Costa Rica and Nicaragua the people use tuane.

Free topic Research Paper Example | Topics and Well Written Essays - 750 words - 1

Free topic - Research Paper Example Consequently, this prompted him to decline Devayani’s marriage proposal because she belonged to a high caste (priestly) than his. Yayati’s reaction reveals Hindu’s cultural values regarding the issue of marriage whereby traditions dictate one to marry from his or her caste regardless of true affection that an individual feels towards the other (Chowdhury). However, this due to the superiority of the Devayani’s caste, the father gives in to his daughter’s demands, though with certain conditions; Yayati should not marry any other woman. This mythical account also reveals humanity’s unquenchable desire for pleasure, which is evident from Yayati’s actions (Apurva 4). Yayati regardless of marrying a woman from high caste in the Indian society, his lustful desires prompt him to have sexual relations with the Devayani’s maid. This ends with secretly marrying her without Devayani’s knowing, whereby she unveils the marriage throug h her maid’s male children claiming Yayati is their father. Humanity’s unquenchable desires in this account are also evident from the way Yayati begs for youth (from own son) to continue with his luxury life after Devayani’s father cursed him to a premature old age (Apurva 3). Eventually, Yayati regains sanity when he realizes his life comprised of living in denial. Since, he was aware about humanity’s desires whereby, one can only quench them through self-control. Yayati’s myth also expounds spiritual prowess held by the top caste in the Indian society. The Brahmins have the authority to curse besides declaring an individual as an â€Å"untouchable†. Yayati after violating the agreement they established with Devayani’s father, he earned himself a curse that transformed his stature instantly (Apurva 4). Since, he allowed lust to overtake him, which is against to what Khatriyas ought to conduct themselves in the public. Yayati’s cursing depicts the Indians’ spirituality exercised by few people who belong to the highest caste, whereas the rest have to exhibit total adherence. This is evident from Yayati’s conduct after cursing where he does not yield to conflict or argument with Devayani’s father, but adheres and decides to seek an alternative way meant to sustain his luxurious life. Indian society’ organization comprises of diverse castes. These normally dictate diverse societal people’s roles besides how they ought to conduct themselves to fit effectively in the already set rankings. The main Indian castes include Brahmin, Khatriya, Vaishyas, shudras and chandalas (Singh 20). The latter comprises the lowest class in the society mostly referred as â€Å"untouchables†. Historically, these people never allowed attending temple services or daring to be near because the society referred them as being impure. Hence, their work entailed cleaning the toilets, garbage coll ection and other menial jobs, which the society thought to be dirty (Jayaram). Brahmins were the societal top spiritual icons whose role entailed offering rituals besides being the most learnt people compared to other castes (Singh 20). Probably, this is due to the position they occupied where all other castes paid tribute to them through donations. Khatriya comprised the security officials whose role entailed protecting the entire society and ensuring justice (Singh 20 & 26). They also acted, as kings whereby the traditions demanded them that, they abstain from sensual pleasures, which granted them

Critically compare and contrast the accounting methods, structure and Essay

Critically compare and contrast the accounting methods, structure and regulation of Greece with the UK. Include a detailed and critical analysis of both current - Essay Example Effective control systems are usually situation specific and tailored to the management of each organisation. The exercise of managerial choice and the interdependence of accounting systems and the environment are acknowledged". (Rayburn and Rayburn (1991, p. 57) U.K. follows common law whereas Greece follows codified law falling under British Commonwealth and continental Europe respectively. "Greek law is based on codified Roman law with the judiciary divided into civil, criminal, and administrative courts. Judicial independence is guaranteed under the constitution" (Greece Profile) Many countries' accounting practices are influenced by their respective income taxation rules ignoring any other broader objectives. (Nobes 1983, Purcel & Scott 1986) In the case of Government bureauracrats setting the accounting standards, they are unequivocal in fixed formats. ".Bureaucracies are more likely to want certainty to make assessment of taxes, adherence to regulatory rules, etc., easier to specify and enforce" (Robinson, Chris, Venieris, george 1996) Greek accounting is guided by its Corporate Law 2190/1920, accounting standards stipulated by the Ministry of National Economy, the interpretations issued by the National Accounting Standards Board (ESYL) and the Greek General Chart of Accounts approved by Presidential Decree 1123/80. In UK, the Companies Act 1985 as amended for EU Directives.lays down the stipulation for accounting methods. As per the Act, there should be disclosures that accounts are as per the standards of the Accounting Standards Board and urgent issues task force. Cash flow reporting in Greece Cash flow reporting as per IAS 7 became mandatory in 2002 for Greek listed companies which should submit the Cash Flow Statement (CFS) to HCMC though not required to be published as in the case of balance sheet and income statement. A recent study found that while non-listed firms do not voluntarily report CFS, the listed firms also do not comply with the mandatory requirement and make the CFS publicly available." The results indicate that Greek companies have cash flow problems but not profitability problems. The publication of a CFS may reveal that many listed companies in Greece are not as robust as the balance sheet and the income statement potentially indicates. Thus, the main conclusion of the paper is that publication of the CFS in Greece should become mandatory. The HCMC has made significant attempts to enforce corporate governance principles for listed companies in Greece. These principles implicitly highlight the desire of the regulatory authorities that investors receive adequate and relevant information. Could it be, however, that investors get relevant information when they do not have the essential inputs required to value a company"(Kousenidis V, Negakis L, Floropoulos) This practice of providing information on sources and application of funds was

self-discovery Through Adversity :: essays research papers

A self-discovery is the act or process achieving self-knowledge. In the short stories, â€Å"A Small, Good Thing† by John Updike and â€Å"The Rich Brother† by Tobias Wolff, self-discoveries took place with Ann and Peter. Ann was a mother of one and a wife. Peter was a husband and a real estate agent. In the end both Ann and Peter come to a self-discovery.   Ã‚  Ã‚  Ã‚  Ã‚  Ann Weiss, from â€Å"A Small, Good Thing†, discovered how much she cared for her son. How she would do anything to get him back. After the death of her son the Baker put her over the top. The phone calls that he would make were not called for at all. Ann was very unstable and she was about to blow at any second. When they got to the Bakers she went off on him. Her son is dead and she is just going to have to move on with her life. Peter, from â€Å"The Rich Brother†, discovered that no matter what his brother did he really did love him. Donald, Peter’s brother, would always come to Peter for help. Donald never had any money. Every time Donald would need a place to stay Peter would let him stay at his house that he worked so hard to get. Ann and Peter, both came to a self-discovery in their life. There are some similarities between the self-discoveries of Ann and Peter. One similarity was how much love they had for their respective family. Ann being a mother she loved her son so much. She spent all of her time at the hospital wait for her son to wake up. She only went home once during the three days her son was in a comma. Peter did love his brother Donald. Peter always gave Donald money and let him stay at his house that he had worked so hard for. Donald went off to live at a farm. When he needed a place to stay because he was kicked off the farm, Pete said, â€Å"I guess you’ll have to stay with us.† Then Pete said, â€Å"I’ll come get you†(Wolff 67). He knew that Donald would hitch hike home if he sent him money for a bus fare. So Pete picked him up. They also differ with each other. For example, Ann has always loved her son on the other hand Pete at one point tried to kill Donald.

Concepts Of Essential Medicine Health And Social Care Essay

The Alma-Ata declaration during the International Conference on Primary Health Care in 1978 reaffirms that wellness is a cardinal human right and the attainment of the highest possible degree of wellness is a most of import worldwide societal end[ 1 ]. The Alma Ata declaration has outlined the eight indispensable constituents of primary wellness attention and proviso of indispensable medical specialties is one of them. Medicines are built-in parts of the wellness attention and the modern wellness attention is unthinkable without the handiness of necessary medical specialties. They non merely salvage lives and promote wellness, but prevent epidemics and diseases excessively. The medical specialties are doubtless one of the arms of world to contend disease and unwellness. Accessibility to medical specialties is therefore the cardinal right of every individual.Concepts of ‘Essential Medicine ‘Harmonizing to World Health Organization ( WHO ) â€Å" drug is any substance or m erchandise which is used or intended to be used to modify or research physiological system and pathological province for the benefit of the receiver † . The WHO introduced the construct of indispensable medical specialties in 1977[ 2 ]. Essential medical specialties are those that satisfy the precedence wellness attention demands of the population. They are selected with due respect to public wellness relevancy, grounds on efficaciousness and safety, and comparative cost-effectiveness. Essential medical specialties are intended to be available within the context of working wellness systems at all times in equal sums, in the appropriate dose signifiers, with assured quality and equal information, and at a monetary value the person and the community can afford. The execution of the construct of indispensable medical specialties is intended to be flexible and adaptable to many different state of affairss ; precisely which medical specialties are regarded as indispensable remains a national duty. Experience has shown that careful choice of a limited scope of indispensable medical specialties consequences in a higher quality of attention, better direction of medical specialties ( including improved quality of prescribed medical specialties ) , and a more cost-efficient usage of available wellness resources. The WHO has developed the first indispensable medical specialties list in 1977 and since so the list has been revised every 2 old ages. The current versions are the 17th WHO Essential Medicines List and the 3rd WHO Essential Medicines List for Children updated in March 2011. The indispensable medical specialty list contains limited cost-efficient and safe medical specialties, while the unfastened pharmaceutical market is flooded with big figure of medical specialties many of which are of dubious value. The exemplary list of WHO serves as a usher for the development of national and institutional indispensable medical specialty list. The construct of indispe nsable medical specialties has been worldwide accepted as a powerful tool to advance wellness equity and its impact is singular as the indispensable medical specialties are proved to be one of the most cost-efficient elements in wellness attention.Standards for choosing indispensable medical specialtiesWhich intervention is recommended and which medical specialties are selected depend on many factors, such as the form of prevalent diseases, intervention installations, the preparation and experience of available forces, fiscal resources, and familial, demographic and environmental factors. The undermentioned standards are used by the WHO Expert Committee on the Selection and Use of Essential Medicines: Merely medical specialties for which sound and equal grounds of efficaciousness and safety in a assortment of scenes is available should be selected Relative cost-effectiveness is a major consideration for taking medical specialties within the same curative class. In comparings between medical specialties, the entire cost of the intervention – non merely the unit cost of the medical specialty – must be considered, and be compared with its efficaciousness In some instances, the pick may besides be influenced by other factors such as pharmacokinetic belongingss or by local considerations such as the handiness of installations for industry or storage Each medical specialty selected must be available in a signifier in which equal quality, including bioavailability, can be ensured ; its stableness under the awaited conditions of storage and usage must be determined Most indispensable medical specialties should be formulated as individual compounds. Fixed dose combination merchandises are selected merely when the combination has a proved advantage in curative consequence, safety, attachment or in diminishing the outgrowth of drug opposition in malaria, TB and HIV/AIDS.Use of Essential Medicine ListThe construct of indispensable medical specialties has besides been adopted by many international organisations, including the United Nations Children ‘s Fund ( UNICEF ) and the Office of the United Nations High Commissioner for Refugees ( UNHCR ) , every bit good as by non-governmental organisations and international non-profit supply bureaus. Many of these organisations base their medical specialty supply system on the Model List. Lists of indispensable medical specialties besides guide the procurance and supply of medical specialties in the populace sector, schemes that reimburse medical specialty costs, medicine contributions and local medica l specialty production, and, moreover, are widely used as information and instruction tools by wellness professionals. Health insurance strategies excessively are progressively utilizing national lists of indispensable medical specialties for mention intents. The theoretical account list serves as a baseline for farther alteration ( add-on and omission of new medical specialties ) , right dose strength, and signifier depending upon the national precedence and available groundsEssential medicine list of IndiaOne of the critical constituents of the wellness attention is medicine, as they account for a significant portion of family outgo. The overall budget of medical specialties varies widely in different provinces in India. The outgo form on medical specialties of the State Government shows that there are wide-ranging differences across provinces, from every bit small as less than 2 % in Punjab to every bit much as 17 % in Kerala during 2001-02[ 3 ]. The southern provinces such as Ke rala and Tamil Nadu spend over 15 % of their wellness budget on medical specialties. Many rearward provinces, both in economic and wellness index footings, incurred the lowest outgo on medical specialties. States such as Assam, Bihar, U.P. , and Orissa spent approximately 5 % or less of their wellness budget on medical specialties. The Cardinal Government ‘s portion of medical specialties in its entire wellness budget is about 12 % . In all, approximately 10 % of the wellness budget goes into securing medical specialties in India. Even so, handiness of medical specialties frequently is a large issue. The non-availability of required medical specialties jeopardizes the credibleness of the public wellness system. Access to indispensable medical specialties is closely linked to wellness system public presentation and its use. The non-availability of indispensable medical specialties in the wellness installations is non the lone issue ; there are jobs of affordability and handines s despite passing a big proportion of resources on medical specialties. The handiness of medical specialties is undermined by several factors: hapless medical specialty supply and distribution systems ; deficient wellness installations and staff ; and low investing in wellness, and the high cost of medical specialties. The Essential Medicines List can assist states apologize the buying and distribution of medical specialties, thereby cut downing costs to the wellness system. This construct of indispensable medical specialties is comparatively new to India and Tamil Nadu is the first province to develop the indispensable medical specialty list every bit early as in 1994. Then authorities of Delhi excessively had developed its ain list. The authorities of India and many other single provinces have their ain indispensable medical specialties list, and the current national list was compiled during 2011. The list has been updated after 8 old ages. As the list needs to be developed locally and should be based on grounds non simply on single ‘s experience, it is necessary foremost to develop clinical guidelines, called criterion intervention guidelines ( STG ) . Then based on STG the list is compiled. Delhi took the lead in developing a comprehensive Drug Policy in 1994 and was the lone Indian province to hold such a comprehensive policy[ 4 ]. The policy ‘s chief aim is to better the handiness and handiness of quality indispensable drugs for all tho se in demand. Now many province authoritiess excessively have developed STG for usage within the province authorities wellness installations. The Armed Forces Medical College ( AFMC ) has developed STGs for rather big figure of common conditions and the intervention cost is besides calculated[ 5 ].Outstanding characteristics of National List of Essential Medicine ( NLEM ) 2011The medical specialties have been categorized harmonizing to curative country. Therefore a medical specialty with more than one indicant appears in more than one class. The strength of medical specialty dosage is mentioned. For essentialness of demand the medical specialties have been categorized as follows: P, S and T denote essentialness at Primary, Secondary and Tertiary degrees severally while P, S, T ( U in NLEM 2003 ) indicates essentialness at all the degrees. A sum of 348 medical specialties are present in NLEM 2011. In the NLEM 2011, 181 medical specialties autumn under the class of P, S and T, 106 medical specialties autumn under the class of S, T while 61 medical specialties are categorized as T merely. In comparing to NLEM 2003, 47 medical specialties have been deleted and 43 new medical specialties have been added.Some glaring errors in NLEM 2011Some glaring errors which catch the oculus while reading the NLEM 2011 are: NLEM includes pheniramine maleate, chlorpheniramine maleate and dexchlorpheniramine maleate as antiallergic. Even though these three different drugs are available in three different preparations, all the three need non be included in the indispensable list as these three medical specialties do non differ in efficaciousness but merely in their pharmacokinetic features Drugs from the same group which do non differ much from the paradigm need non be included in an indispensable list. Many antibiotics from the same category are included in the NLEM. For illustration, two antibiotics ( Erythrocin, and Zithromax ) have been included, as in the instance of Mefoxins Drugs for which best grounds for effectivity and safety exist are non included while some other drugs in the same group are added. For illustration, Tenormin has the best grounds among many I?-blockers, yet it is non included as an antianginal Even though both Amoxil and Principen are included in WHO EML and EMLc, the preparations differ. Amoxicillin is listed for unwritten usage and Principen parenterally. However, National EML lists unwritten preparations for Amoxil and Principen. Ampicillin is inferior to amoxicillin by unwritten path as it has less unwritten bioavailability and high incidence of diarrhea. Oral preparations of Principens need to be deleted from National EML.Significant skipsExcluding an indispensable drug can hold a important consequence on the entree to medical specialties. The NLEM 2011 has omitted some of import indispensable drugs such as: Iron and folic acid tablets do non organize a portion of the NLEM. Sing the high prevalence of anaemia in pregnant adult females in India, Fe and folic acerb supplementation during gestation is really of import. The fixed dose combination of ferric sulphate + folic acid should be made available in all primary wellness Centres ( PHCs ) so that every pregnant adult female has entree to it. The WHO EML includes it, but non the NLEM. Many drugs ( paracetamol, morphia, steroids such as Decadron, cortisol, Pediapred, many antibiotics, water pills such as Lasix, hydrochloro-thiazide, Aldactone and other drugs such as Valium, Coumadin, diphenylhydantoin, etc. ) do non hold either the dosage or dose signifier appropriate for kids. The riddance of diphenylhydantoin alterations from first order to zero order above the dosage of 300 mg/day. Titration of dose above this bound should be in the magnitude of 25 milligram. Hence, 25 milligram tablets are non merely needed for kids but besides for grownups and have hence been included in WHO EML and EMLc. The NLEM does non name phenytoin tablets of this strength. No fixed dose combination of first-line antitubercular drugs has been included in the NLEM. The combination of four drugs ( INH + rifampicin + ethambutol + pyrazinamide ) and two drugs ( INH + rifampicin ) are indispensable and should be included. No second-line antitubercular agent ( except ofloxacin ) is included in the NLEM. They are indispensable for secondary and third attention infirmaries. No drug other than Larium is included for prophylaxis of malaria.DecisionThe NLEM 2011 is significantly better than the NEML 2003. It has some errors and skips which hopefully can be corrected in the following alteration. While fixing such indispensable list demands of local people should be of the paramount importance. The Government should revise the list rather often.

Same-Sex Marriage in Modern Society - 5830 Words

Same-Sex Marriage in Modern Society Many same-sex couples want to be granted the right to legally marry. The reason is simple: They are in love with each other. They want to honor their relationship in the greatest way society has to offer, by making a public commitment stand together in good times and bad life brings. While they receive some state-level protections, they do not receive most of the Federal emotional and economic benefits and protections of marriage. They are denied their right to equal protection, both under the US Constitution and some state constitutions. The paper will point out that supporting gay marriage by means of legal recognition is the most appropriate form of recognition of the same-sex partnerships, because it eliminates discrimination promoted by the federal and some states level. Referring to state court decisions of 2009 and 2012 and the well-known 2003 Lawrence vs. Texas decision of the Supreme Court, the paper will show that, currently very mixed pictures regarding the legality of th e same-sex marriage on the Federal and (some) states level urgently requires a solution by means of a nationwide legal recognition of the phenomenon. In its final parts, the paper will introduce opposing arguments and reasons on how to encounter them. I would recommend the policy of legal recognition of gay marriages as the most appropriate form of recognition of the same sex partnerships. Reason being, gay persons do not enjoy most of the federal andShow MoreRelatedThe Legalization Of Gay Marriage1749 Words   |  7 PagesThe Legalization of Gay Marriage: A Step to Equality Imagine a world where heterosexuals are the minority. Straight people would be the ones fighting for the same rights as homosexuals. Same-sex marriages would be average and normal, while straight marriages would be frowned upon and considered unholy in the eyes of religion. Heterosexuals would be denied service at restaurants because of their sexuality, they would be called derogatory names while holding their partner’s hand and most importantlyRead MoreMarriage, Family, And Religion1687 Words   |  7 Pages Marriage, Family, and Religion Omar De La Garza Texas AM International University Abstract The institutions of marriage and family are fundamental concepts to the functioning of our present day society. In this paper, marriage and family and their changes over time will be discussed. Topics such as religion, which plays an important role is the development and changes of ideas regarding these two topics will be approached as well as the social changes due to tradition and theRead MoreGay Marriage Should Not Only Be A Civil Right1569 Words   |  7 Pagesthe opposite sex there seems to be no limits to their pursuit of happiness. Even in the progressive, modern year of 2015, the question of whether or not gay couples should be permitted to perform the act of a legal marriage divides the United States of America into two. Although more than half of the states have legalized gay marriage, fourteen states, including Kentucky, reject the idea of homosexual couples as equals to heterosexual couples. The fact is that an exclusion of marriage for gay couplesRead MoreThe Issue Of S ame Sex Marriage Essay1677 Words   |  7 PagesEqual marriage has always been a contentious issue in society. The legalisation of same sex marriage in New Zealand in August 2013 via the Marriage (Definition of Marriage) Amendment Act has been a source of pride for those in some parts of our society and a source of horror for those in other parts. This issue split the country, and those in power, right down the middle, with some people taking sides that didn’t necessarily align with what would be expected of their political leanings. The issueRead MoreQueer Identity : Modern Family1460 Words   |  6 PagesRunning Head:QUEER IDENTITY: MODERN FAMILY 2 Today society displays greater diversity within households. Most American households are now non-traditional or unconventional. Non-traditional or unconventional families include; single parenthood, singlehood and LGBT relationships. Modern family is a comedy exploring the different â€Å"modern† families. This show explores a huge unconventional family through a gay couple, made up of Mitchell and Cameron, and their adopted daughter Lily; a straight coupleRead MoreTrends in Family Formation Supporting Same Sex Marriage 1193 Words   |  5 Pageschallenges. These have caused young people to question whether the traditional way of doing things is practical in the twenty first century and many do not intend on following their parents’ footsteps in relation to marriage and parenting (Morrison, Headrick, Wasoff Morton, 2004). Marriages and heterosexual relationships in the current world are in the process of change. In the past, these were created and nurtured in such a way that they lasted for many years, with the intention of being life longRead MoreThe Legalization Of Gay Marriage1411 Words   |  6 Pagesgay marriages is one of the most controversial issues throughout particularly in modern life. This paper, based on secondary research, arguing for legalizing same-sex marriage through specific analysis of its positive influences. In particular, there are two main benefits regarding society as well as economy. The finds of the research indicate that gays or lesbians are completely an important part of society. Therefore, they must have the rights to live and marry legally as other opposite-sex couplesRead MoreGay Marriage Should be Legal Essay1176 Words   |  5 Pages There can be no question about the definition of marriage. There is considerable evidence form history, the origins of the word, and even its current legal use. Yet, somehow there is still tension and confusion surrounding the issue of same-sex marriage. As the debate intensifies, emotional ones quickly replace rational thoughts. Lately, homosexuals carry out most of the fight for the right to be married. Of course, there are several other situations, in which people attempt to challenge traditionalRead MoreHow Does Same Sex Marriage Affects in Decreasing Population Growth1436 Words   |  6 PagesFirst, what is MARRIAGE? Marriage is a socially or ritually recognized union or legal contract between  spouses  that establishes rights and obligations between them, between them and their children. (From that statement, the word children are the most important thing in marriage, WHY? Because we all know having same sex marriage CANNOT produce a child) What is SAME SEX MARRIAGE? -------------- Decrease of population growth caused by SAME SEX MARRIAGE Extending the benefits and status ofRead MoreModern Television And Modern Family858 Words   |  4 PagesEven though there are families that keep the same traditional values, television shows such as Modern Family and The New Normal show how modern television altered those family values which include traditional marriage, family makeup, and sexuality. Modern television is one of many examples of how family values of today have changed. The television show Modern Family shows three types of families with different types of values. This show has a same-sex family, with an adopted daughter; a traditional

Why The Salem Witch Trials - 1064 Words

Numerous hypotheses have circulated trying to explain why the Salem Witch Trials occurred. Some include the fungus ergot that had psychedelic consequences when consumed and the Puritans’ adamant belief in their religion. None of them, however, justify why over 200 people were accused of practicing witchcraft and 20 more were executed. The Salem Witch Trials are a prime example of why theocratic societies fail and the effects can still be seen today. We can still see witches in other parts of the world, see memorials for the victims of the trials, and modern day witch hunts. One lasting impact of the Salem Witch Trials is the separation between faith and science. The Massachusetts colony was constructed with the purpose of being a â€Å"city†¦show more content†¦On the other hand, the healing powers that sorcerers possess are respected in other communities. Witch doctors, although not real witches, are trusted to concoct remedies to protect others against witchcraft. Furthermore, Shamans are believed to be endowed with the power to both cure and kill. The Shaman has the ability to go into a trance to interact with the spirit world on behalf of the community. Although there are varying opinions on the practicing of witchcraft, it still continues today whether it is accepted or not. Today, people have been able to pay their respects to the victims of the Salem Witch Trials. In 1711, the Massachusetts colony passed a bill restoring the rights and the good names of the people accused, but it wasn’t until 1957 that the colony formally apologized for its fallacies. Nearly 300 years after the trials on May 9, 1992, the state of Massachusetts, the city of Salem , and the town of Danvers (formerly known as Salem Village) paid homage to the slain â€Å"witches† by building the Salem Village Witchcraft Victims’ Memorial of Davers. Later that year on August 5, 1992, another memorial, the Salem Witch Trials Memorial, was dedicated to the victims by Nobel Laureate Elie Wiesel. Though simplistic in its design, every detail of the memorial has significance. â€Å"Inscribed in the stone threshold entering the memorial are the victims’ protests of innocence. TheseShow MoreRelatedWhy Did the Salem Witch Trials Happen1102 Words   |  4 Pagesthe rea son behind the Salem Witch Trials in the Year 1692? This is a question that has been asked by historians everywhere for over three hundred years. Although the questions is easily posed by people, the answered discovered by historians are hard searched and revealed. The answer is difficult to give because there are numerous factors and events that helped create and influence the trials, even before the trials began. The main factors that started and fueled the trials were the politics, religionRead MoreIs Witch Trails A Thing Of The Past?923 Words   |  4 Pages Being that the Salem Witch Trails date back to over three hundred years, many people believe witch trails are a thing of the past. However, modern day witch trails are still extremely prevalent. Modern-day witch-hunts are reported to still be happening in Africa, the Pacific, Latin America, even in the U.S. and Europe. According to a New York Times article, within the last fifteen years alone, more than 2,000 Indians have b een killed after being accused of witchcraft. Almost all of the accused haveRead MoreThe Salem Witch Trials Essay1725 Words   |  7 PagesHistory took place. The Salem witch trials was one of the most catastrophic events worldwide in which people were accused, hanged, or sent to jail. During this time there was also a lot of chaos going on in Salem when some girls started accusing innocent people of being witches and being responsible for all the trouble that was going on the town. Even though not all those individuals were sentenced to death, there were still three causes or theories of why the Salem witch trials might have occurred andRead MorePuritans And The Salem Witch Trials978 Words   |  4 PagesIntroduction Puritans had many beliefs that affected the Salem Witch Trials, these were based on how the attendance or lack of attendance of the church, how people should behave, social class, and the way the government should be handled. Puritans were English Protestants that came to America in 1630. They sought to reform the Church of England. When they first came to America they settled at Salem, Massachusetts. The main reason the Puritan’s came to Salem was for freedom of religion which they did not haveRead MoreReasons Behind The Salem Witch Trials1568 Words   |  7 PagesJaquelin Lopez History 1301- Dr.Frawley April 30, 1017 Reasons behind the Salem Witch Trials of 1692 The Salem Witch Trials were a series of trials in the 1690s which accused society members of practicing witchcraft, they took place in Salem, Massachusets. What caused this mass hysteria to occur? Some contributing factors could include some socio-economic reasons, an overbearing Puritan society and the influential sense that witchcraft was taking place all over the world. Massachusetts was settledRead MoreMany Years Ago People Have Wonder About Witches And What1348 Words   |  6 Pagespeople have wonder about witches and what they do. Salem, Massachusetts held one of the biggest witch trials in history since 1692 but yet have never found the rea-son why it was started in the first place. Researchers have discovered some information about those witches throughout the years. Still they have not figured out what was the whole rea-son behind the trials in 1692 and after those trials a lot more trials were more secretive unlike the Salem witches tri-als in 1692. New England, home of theRead MoreThe Salem Witch Trials And Mccarthyism1327 Words   |  6 Pagescharacteristics begin to repeat sometimes skipping a generation or two. The fact that in one family traits continue to repeat constantly shows how a connected group will always have a repetition of a certain pattern—naturally the world has order so why wouldn’t the history of our world? The history of our world does have a pattern even though it is not always of positive events, simply because human tend to copy what they learn. Humans have done this forever because even as a baby you learn to speakRead MoreSalem Witch Trials1478 Words   |  6 PagesThe Salem Witch Trials of 1692 were a series of trials in which twenty-four people were killed after being accused of practicing witchcraft. These trials were caused by different social climates of the area including the very strong lack of a governor, the split between Salem Village and Salem Town, and the strict puritan life style during the time period. Tituba, the black slave, was a foreigner from Barbados. Her role in society was to take care of Mr. Parris’s family. Tituba’s situation contributedRead MoreThe Causes Of The Salem Witch Trials1748 Words   |  7 PagesThe Salem witch trials were a series of different court trials. They occurred after a group of young girls were claimed to be possessed by the devil. These individuals experienced hallucinations. Some of the suspects explained the attacks as if bugs were crawling under their skin. When the outbreak began to spread, the government proceeded to accuse multiple people in the colony of witchcraft. This is how the Salem witch trials came to be. The trials took place in colonial Massachusetts. AccordingRead MoreThe Salem Witches: Real or Imagined?1289 Words   |  5 Pages The Salem Witches: Real or Imagined? The Salem Witch Trials began because of a mysterious illness contracted by 11-year old Abigail Williams and her cousin Betty Paris (Burgan). Instead of looking for a logical explanation, the community immediately jumped to the conclusion that witches caused the girls curious behavior. Doctors commonly would diagnose an unknown illness as witchcraft, rather than looking for other explanations (Wolfinger). Erot of Rye, which causes severe contortions and hallucinations

Definition Of Beauty Essay - 749 Words

Beauty is commonly defined as the combination of qualities that pleases our senses, mostly our sight. Despite this, throughout many years, the concept of beauty has been considered one of the hardest riddles to solve. This happens not only because of all of what it covers, but also because of society’s beauty patterns. Society has been in charge in making people, mostly girls, to feel inferior because they do not complete this â€Å"beauty standards† in order to be considered beautiful. We need to be clear in stating that beauty is not an objective matter, instead it’s pretty relative. So the real question arises, what does beauty even mean? The definition of beauty has shifted between eras and cultures. All our lives we have been programmed†¦show more content†¦This â€Å"beauty standard† is also a cause for the increase of anorexia or bulimia. Throughout the years, beauty has become a competition between one and another. Usually we can see conflicts such as internal vs external beauty, skinny vs fat, straight hair vs curly hair, blue/green eyes vs dark eyes, blondes vs brunettes, etc. But the greatest one of all is the competition we have between our appearance and our thoughts. We want to achieve a â€Å"perfect† appearance doing things that our mind knows are not okay. Truly beautiful people know that their beauty has nothing to do with how they look on the outside and everything to do with who they are on the inside. Their focus is not on getting more to feel better, but giving more so that they can make others feel better.People need to start believing that everybody is different. Also, that beauty doesn’t mean you need to seek for perfection or look like anybody else. Beauty is about being comfortable with who you are and the way you look. If you change your image it is because you want to, not because o f an advertisement or a magazine telling you to do so. I believe that women need to strengthen their voices, to be determined and vibrant. I don’t believe that reaching a certain number or having a certain hair color will determine if we are beautiful or not. Beauty is not about comparing ourselves to others. Beauty is about self-love and acceptance. It is time to picture in your mind a world where it is up to you whatShow MoreRelatedThe Definition of Beauty Essay905 Words   |  4 PagesSynthesis Essay #2 The definition of beauty is a characteristic of a person, animal, place, object, or idea that provides a perceptual experience of pleasure, meaning, or satisfaction. Beauty has negative and positive influences on mostly people. Beauty is described by the inside and outside of us. Due to beauty, our self-esteem has been hurt dramatically, especially towards girls. Beauty is not always about our outside looks but it’s about our inside personality also. First of all, beauty hasRead MoreBeauty Definition Essay1411 Words   |  6 PagesBeauty The ways people view beauty have changed over time. Beauty has many definitions, and so many people think about it in different ways. Some people like external beauty and some like internal beauty and many people like both together. Beauty controls how people live and think, but it depends on which definition of beauty they choose to believe in. We live in a world that misunderstands the true meanings of pretty much everything. Thousands of years ago people knew and understood what theRead MoreBeauty Definition Essay1126 Words   |  5 Pagestime? Most people judge beauty base on a person’s physical appearance. However, true beauty sis base on a person’s personality and a how a person treat someone else. The hardest thing is to describe beauty because everyone has their own views about beauty. In my opinion beauty has more to with the way someone see portray themselves. The expression â€Å"beauty† was first used in the 14th century as â€Å"physical attractiveness,† and also â€Å"goodness, courtesy.† The meaning of beauty also came from many placesRead MoreBeauty Definition Essay1156 Words   |  5 PagesWhat is beauty? How do we decide who is attractive and who is not? Society is full of information telling us what is beautiful, but that fact is that information based on? The topic of beauty has been studied, analyzed and controversial for centuries. We all know the feeling you can have when you hear a beautiful song that brings joy to your heart, stands in a field of flowers that excites your eyes, or admires a face that is visually pleasing. As human beings, we are all drawn to beauty, but whatRead MoreThe Definition of Beauty Essay1145 Words   |  5 Pagesadvertising to tell us what is beautiful and what is not. Whether we realize it or not, beauty is ultimately defined for us. Products are advertised all around us, tel ling us that something in our life is missing because we do not have a certain product in our possession. Ranging from make-up to plastic surgery, most of this advertising is geared toward women. This can be shown through the advertisements analyzed in this essay. Both ads depict women who are approachable. The older ad depicts simplicity andRead MoreDefinition Of Beauty Essay829 Words   |  4 Pagesthe word beauty or beautiful what do you think of? The way a person looks the way they are on the inside, or is it not even a human but things in nature. The definition of beauty has a very broad definition everyone has their own meanings their own thoughts on the subject. After a lot of research and interviewing two people getting the perspective of a male who I am very close to and a female who is just a girl in my class I have finally come to some kind of idea of what the word beauty really meansRead MoreBeauty Definition Essay858 Words   |  4 PagesWhat is beauty? How do we defi ne who is attractive and who is not? Is it the models posing on the front of magazine, or the confident, bright eyed person sitting across the room? Our society and media is full of advice telling us what beauty is or how to become beautiful. As human beings we are drawn to beauty, but what exactly is beauty? The phrase, â€Å"beauty is in the eyes of the beholder,† is accurate since what one may consider beautiful can vary from what another may consider beautiful. SomeRead MoreDefinition Of Beauty Essay722 Words   |  3 PagesThere is an English quote, â€Å"Everything has beauty, but not everyone sees it.† The quote is correct in some people’s eyes but not everyone’s, because someone may think the individual is exquisite, but others may see the flaws you don’t. In the research of a well-known Philosophy about Plato, he saw that beauty wasn’t how someone introduced themselves, or how they looked on the outside but instead on how they are inside. The true beauty in some perspectives, is what they been through with their ownRead MoreAn Extended Definition of Beauty Essay1056 Words   |  5 PagesThe subjective element of beauty involves judgment, not opinion. Many people feel beauty is only something seen by the eyes. St. Thomas Aquinas views beauty in both the supernatural and natural orders. Aquinas lists the attributes of beauty to be found in nature. These are; unity, proportion, and clarity. We will see how these attributes of beauty are seen through the eye and felt by the heart. To begin, the concept of unity follows the Aristotelian proposition that nothing can be added to or takenRead MoreBeauty Extended Definition Essay792 Words   |  4 PagesBeauty is something that can be interpreted completely different from person to person. A famous quote that goes along with this perfectly is â€Å"beauty is in the eye of the beholder.† I think a person’s inner beauty should be taken into account when deciding whether or not a person is beautiful. Wikipedia’s definition of beauty is, â€Å"a characteristic of a person, animal, place, object, or idea that provides a perceptual experience of pleasure or satisfaction† while Oxford Dictionary states, â€Å"beauty

Evidence Based Practice Free Essays

string(76) " questions subsequently formulated and asked, and the interventions chosen\." A CRITICALLY REFLECTIVE APPROACH TO EVIDENCE-BASED PRACTICE A Sample of School Social Workers Michelle Bates Definitions of EBP The first type of definition implies that practitioners are recipients of existing research knowledge. These definitions of evidence-based practice represent a deterministic, prescriptive approach to practice. According to these definitions, knowledge is created by researchers, and handed to practitioners to be applied in practice situations. We will write a custom essay sample on Evidence Based Practice or any similar topic only for you Order Now The second type of definition suggests that practitioners investigate practiceproblems, and assess research in accordance with their clinical judgment and then, thirdly, collaborate with their clients Some authors define evidence-based practice with a focus not on the research, but rather on the practitioner; on her or his professional judgment, skills, and knowledge acquisition processes. These distinctions regarding the evidence and the role of the practitioner, are but one area of debate concerning evidence-based practice. vidence-based practice generally understood effort to direct practitioners to base their interventions upon formal research, promising benefits to both clients and practitioners. Emergence of EBP in Social Work * During the empirical practice movement questions about the credibility, effectiveness, and efficacy of social work have been raised. EBP emphasizes science, and, by lessening reliance on professional judgment; offers a sense of certainty about social work interventions. Some authors suggest that evidence-based practice in particular is tied to neo-liberalism. In this context, evidence-based practice ensures that social workers provide high-quality services effectively * The public’s reluctance to accept social work’s authority has forced social work, like many other professions, to adopt evidence-based practice as a new mechanism of trust Beginning in the 1990s, public cynicism concerning the welfare state and â€Å"expert systems† led many to doubt the validity of social work interventions * Government cutbacks and a demand from funding bodies for accountability and efficiency have also necessitated the adoption and implementation of evidence-based practice. Quality and accountability have become the watchwords of health and mental health services† Governments and agencies embraced evidence-based practice as a method of ensuring quality services and demonstrating accountability in service delivery The Promises of EBP for Clients and Social Workers Promises made by proponents of evidence-based practice are numerous. Supporters of EBP claim that clients will receive better services, occupy a more egalitarian position, and are less likely to be harmed when practitioners use evidence-based practices. For social workers themselves, protection from lawsuits, enhanced job security and service funding, increased professional confidence, and improved professional status and credibility are promises associated with evidence-based practices. Many authors argue that reliance on research evidence leads to better decision-making by social work practitioners and, results in, improved services. It is also claimed that clients, able themselves to access the ‘evidence’, will achieve greater equity with professionals. Numerous authors assert that EBP is the most ethical way to practice. Gambrill (2003), in her support of EBP, suggests that social work practice that is not evidence-based may potentially be harmful to clients Barriers to Using Evidence For some other authors * Despite an increasingly available literature concerning evidence-based practice, dissemination studies reveal that social work practitioners have been neither accessing nor implementing the available evidence * For some, EBP remains overwhelming, unclear, or irrelevant * Barriers to the implementation of evidence-based practice include social workers’ doubts about the applicability of research findings to practice settings questions about practitioners’ ability to read and interpret research findings * practitioners’ scepticism about research specifically * their reluctance to change generally, practitioners’ lack of time to review the literature * ideological debates about the nature of social work and its incompatibility with positivist research * Applicability of Research Findings to Practice Settings; There is a significant disconnect between treatments established in the laboratory and the everyday use of these treatments Practitioners, keenly aware of this discrepancy, have been suspicious of evidence-based practices The Research In the absence of literature from practicing social work practitioners, this research sought to discover and understand their opinions and experiences with evidence-based practice. School social workers are an especially appropriate focus of attention because 1- They are practicing in environments that emphasize effective service delivery with improved service outcomes. 2- Additionally, EBP is endorsed as a practice framework by many Ontario School Boards and school social work practice associations Methods qualitative research project; semi-structured interview * Social workers were asked for their definition of evidence-based practice, what they either liked or disliked about EBP, what influenced them to either use or not use EBP, and what were the challenges, risks or gains in either using or not using EBP for themselves, their department or the profession. * total of four practicing school social workers participated in the research project that entailed face-to-face interviews lasting between 1-1. hours * All participants held MSW degrees and RSW designations. * Two of the social workers were employed by Catholic school boards and the other two by public school boards. * All of the participants worked within urban school settings in cities that ranged in size from 200,000 to 500,000 people * One social worker worked within a fairly affluent and culturally homogeneous community, and the remaining three in schools that represented economically and culturally diverse communities. One participant was a manager, and the remaining three participants were front-line practitioners. * Participants ranged in their years of experience as a school social worker from 2 years to 21 years. * Participants’ experiences with evidence-based practice varied. Two participants were extremely familiar with evidence-based practice, and the other two participants knew about it, and described themselves as having a beginning understanding of what it meant. Their employers’ organizational embrace of evidence-based practice varied as well. One board was silent, two were in the early stages of investigating it and one Board has endorsed the use of evidence-based practices wholly. Findings A. Benefits of using evidence-based practice as prescribed: Several benefits emerged from the participants’ experiences of using evidence-based practice â€Å"as prescribed. † 1- Every participant identified how evidence-based practices usefully informed and guided their activities with individual clients. These activities included the issues or problems that social workers explored, the questions subsequently formulated and asked, and the interventions chosen. You read "Evidence Based Practice" in category "Papers" 2- Evidence-based practices were also used to guide the selection of group models and various protocols, as noted by two of the social workers. 3- All participants indicated that using evidence-based practices provided them with a sense of certainty about their own practice. 4- Three of the four participants specifically stated their desire to know that what they did made a difference to clients. Using evidence-based practice was perceived as a means of ensuring that the interventions they were providing were effective 5- All participants indicated that using evidence-based practice improved their professional credibility. 6- The other two social workers believed that using evidence-based practices would improve the profile of their department within the school board and would also create a higher profile and better public persona for all social workers. B. Tensions arising from the use of evidence-based practices as prescribed 1- Rigidity versus flexibility : Ensuring that their interventions fit for clients was an overriding concern for all of the participants, and was expressed as a tension between implementing rigid evidence based practices versus the need to be flexible with clients based upon the uniqueness of each individual client and his or her situation. Three of the four participants were also cognizant of the fit, or lack of it, of evidence-based practices with their organizations or settings 2- Formal knowledge versus practice knowledge : All of the participants made a distinction between formal knowledge and their practice knowledge. Each one of them revealed a tension between these two kinds of knowledge and all of them talked about valuing their own practice knowledge. Despite the benefits they identified of using formal knowledge derived from evidence-based practice, these participants continued to believe in the value of their practice knowledge. The tension between formal knowledge and practice knowledge is reflected in this social worker’s comment: â€Å"I would hate to become so single-minded that I’m sitting in a meeting saying, ‘well, based on the evidence that†¦. ‘ So I use both [practice and formal knowledge], and I’m not apologetic that I use both. † Not only did all of the participants in this study use both kinds of knowledge; they resoundingly claimed the value of their practice knowledge. – Results versus improvement and change : All of the participants were keenly aware of their desire to know the results of their interventions with clients, and hinted at the pressures they felt to be producing changes for their clients. In other words how clients perceive their gains is more meaningful than what would be reflected according to a particular measure or assessment instrument. Three of the four participants were steadfast in their acceptance of their clients’ definitions of improvement and change, rather than relying on pre-determined outcomes. – Method/technique versus relationship : Every participant noted that the relationship with the client was more important than the particular technique use. Only in the context of a meaningful relationship with clients could evidence-based practices be shared and used meaningfully. In other words, the relationship provides the context in which evidence-based information can be shared and used meaningfully. 5- Adapting evidence and evidence-based practice : participants revealed how they are using evidence and evidence-based practices in adaptive and creative ways. This has led to a redefining of evidence and the uses of evidence-based practice for school social workers. 6- Adaptations to local context: Much often evidence-based practice literature sees it as problematic that front-line practitioners alter evidence-based practices when they implement them into practice settings. Contrary to the literature, every one of these practitioners saw adaptations to the local context as not only a necessity, but also an asset. – Redefining Evidence: Information from these participants indicates that they have a broad definition of evidence-based practice that incorporates evidence from a wide variety of sources, including their practice experience. As noted in the literature review, there are numerous definitions of evidence-based practice that reflect either a dependency upon formal research, or suggest that evidence based practice is a process of knowledge acquisition. These social workers conceptualize evidence in its broadest sense, and as a result, their definitions, and their practice based upon those definitions, represent a de-mystifying of evidence as it is constructed in the dominant discourse on evidence based practice. 8- Evidence and evidence-based practice as power : The various social, economic and political contexts that have give rise to the emergence of evidence-based practices have created a powerful paradigm, a political economy of evidence-based practice. Interestingly, all research participants talked about their different uses of evidence and evidence-based practice within different contexts. In this way, social workers are negotiating power through their definition of evidence, and their strategic use of both evidence-based practice and the language of EBP. One of participant’ definition of evidence holds different currency with different audiences. Within organizational structures that are determining funding and service levels, formal knowledge is seen as more reliable and valid therefore, the language of evidence-based practice is used to provide proof or support of the request for continued or additional service. From the data, social workers have indicated that they use the language and power of evidence-based practice to meet a variety of needs. all participants noted how the language of evidence-based practice was used to provide proof of the value of social work services. Because school social work is offered within a secondary setting, participants were acutely aware of the need to prove the value of their service and how it supports the goals of the school board to retain students in school and to improve their academic achievement. Discussion and implications 1- Much of the mainstream EBP literature suggests that social workers have been ambivalent or reluctant to adopt evidence-based practices due to limitations of their skills, time and resources, or their beliefs and attitudes. This study, however, in keeping with important critiques of EBP, confirms that social workers identify important tensions between the dominant discourse of EBP and social work practice values. 2- A key tension for social workers centred on the value placed upon formal knowledge versus practice knowledge. This is reflected in the epistemological debate concerning the definition of evidence. The discourse on evidence-based practice is situated within a narrow, prescriptive, and scientifically defined construct about what constitutes evidence and how that evidence should be used. Evidence-based practice has been criticized for minimizing practitioner knowledge. As Holloway (2001) observed, evidence-based practice, â€Å"imposes a paradigm for what counts as legitimate evidence that is external to the practices and ways of knowing of the many professionals† Within the paradigm of evidence-based practice, the definition of evidence is crucial to understanding what kinds of knowledge are accepted and valued, and what kinds of knowledge are dismissed. The evidence-based paradigm further means that certain treatments are endorsed as evidence-based, and others are not. Social workers in this study believed in, relied upon, and valued their practice knowledge, when the literature was absent on the practice issue, when they were applyingthe evidence-based literature and when their knowledge was contrary to the literature. 3- Social workers in this study also described the tension they felt between rigid adherence to manualized protocols required of evidence-based practices and the need to be flexible in response to their individual clients’ needs. This tension is reflected in the critiques of the evidence-based practice research. Many authors have been critical of the artificial results created within highly controlled laboratory settings. 4- Evidence-based practice has also been criticized for ignoring and negating the nature of social work practice. Social workers interviewed in this study consistent with critiques of EBP, the problem with the current discourse of evidence-based practice is that it reduces understanding of the complexity of human experience in the real world, ignores the realities of practice settings, and negates the practice knowledge of social workers. – Social workers also revealed how they negotiate power through their definition of evidence, and their subsequent strategic and creative use of both evidence-based practice and the language of EBP. Social workers use the language and persuasive discourse of EBP with management and funding bodies to provide accountability for services provided, proof of the value of social work services, and rationales for continued or increased service levels. With colleagues, using the language of EBP provides the practitioner with the voice of authority. – The literature on evidence-based practice often advocates either for or against EBP. Interestingly, this research shows how social work practitioners can simultaneously appreciate and benefit from EBP while also questioning and adapting it. 7- School social workers from this study value both formal and informal knowledge, and creatively use their different kinds of knowledge in different contexts 8- Data from this research project identifies how social workers are cultural bridges between the research and practice worlds, two vastly different kinds of evidence, and two different uses of evidence-based practice. The divide between researchers and practitioners has a long history in social work. And while there have been pleas to respect each other in order to effectively learn from each other researchers, especially within the evidence-based discourse have enjoyed a higher status than practitioners. What this research highlights is that practitioner knowledge is highly valuable knowledge, and should be regarded as such by researchers. This research also implies that social work practitioners can make valuable contributions to research projects by ensuring that the research is relevant to clients and practitioners by focusing on client needs/experience and insisting that the research takes place in the real world under real life practice conditions. How to cite Evidence Based Practice, Papers Evidence Based Practice Free Essays string(70) " is not given efficiently enough when a patient complains about pain\." Change Management Contents Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 Evidence Based Practice†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 4 Clinical Governance†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5-6 Findings from the literature†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6-7 Implementing the change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7-9 Leadership†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. We will write a custom essay sample on Evidence Based Practice or any similar topic only for you Order Now 9-10 The Un-freezing Stage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦10-11 The Moving Stage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11-13 The Re-freezing Stage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 13-15 Resistance and barriers to change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 15-16 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 16-17 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18-24 Appendices†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5-26 Introduction This is essay is being written to identify and promote change in clinical practice in relation to nursing and evidence based practice. This will be done in relation to nursing and will include supporting references. The literature review investigated nurses’ knowledge of pain management, finding that nurses’ had different ideas of what pain management is. Therefore the aim of the essay is to change practice by increasing nurses’ awareness of what exactly pain management is and from this how it can improve postoperative pain management in the clinical area. This essay commences with a description of both clinical governance and evidence based practice (EBP) and the association between them, describing how this will assist achievement of clinical effectiveness. From this there will be a synopsis of the findings from a recent literature review of â€Å"Nurse Assessment and Management of Postoperative Pain† including a recommendation that was found from the evidence of this review and how this will have an impact for a change in practice. An analysis of different theories of change will be made, looking at several models and theorists. The chosen model for change will be used to bring the findings from the review into practice and what resources will be needed for the implementation of change and any barriers that may occur during the change process. All names and locations will be changed to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) Code of Conduct (2008). Evidence Based Practice Evidence-based practice has been described as a systematic process of ‘finding, appraising and using research findings as the basis for clinical decisions’ (Long and Harrison, 1996 cited in McSherry et al, 2002, p7). However there are many other definitions the most widely used is Sackett et al (1996) â€Å"The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. † However there are some problems with this definition especially with regards to nursing. This definition does not include what the patient wants from the care given. Morton and Morton (2003) agree that patients should be involved in decisions about their care. Therefore there is an alternate definition more suited to nursing that states â€Å"an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best† (Muir Gray, 1997). Simmons (2002) supports this view and states that for research to be of benefit it needs to be individualised to the patient. According to Morton and Morton (2003) this definition highlights that the nurse should integrate the patients preferences and their wish to avoid risk associated with some interventions and using the best available evidence for said interventions. More recently, Gerrish et al (2010) suggests that for nurses to give the best possible care to patients they need to research the evidence available and apply it to their decision-making in clinical practice. Clinical Governance Clinical Governance is an umbrella term that covers activities that help sustain and improve high standards of patient care. It is how health services are held accountable for the safety, quality and effectiveness of clinical care delivered to patients (NHS Scotland, 2007) Clinical Governance was introduced in response to public concerns over poor standards of care provided by the National Health Service (NHS) (Wright and Hill, 2003). There are seven pillars of Clinical Governance including 1. Risk Assessment 2. Clinical Effectiveness 3. Education, Training and Continuing Personal Development 4. Use of Information 5. Staffing and Staff Management 6. Clinical Audit 7. Patient/Service User and Public Involvement To monitor standards of clinical governance the government established the National Institute for Clinical Excellence (NICE) and commission for Health Improvement (CHI) (Department of Health, 1998). The purpose of clinical effectiveness is using the best available knowledge through research, clinical expertise and patient choice, applied to patient care. This can be achieved through training, education and change management (Muir Gray, 2001); evaluated through clinical guidelines and provision of evidence-based practice (Royal College of Nursing, 1996). Clinical effectiveness is the cornerstone of evidence-based practice’ (Reagan, 1998 p245) Links between evidence based practice and clinical effectiveness are outlined by Dawson (2001). He suggests that evidence based practice cannot be achieved independently of clinical effectiveness. McSherry et al (2002) considered that the two are interdependent of each other with evidence being used to improve practice and enhance effectiv eness of care. Findings from the literature The findings from the literature review suggest that pain management is not being implemented as well as it should be in the postoperative setting. Nurses’ should be working within the NHS Enhanced Recovery Programme (2008). However findings from the review have proven that assessments are not good enough or consistent throughout wards in the same hospitals. The evidence proves that self-reporting of pain was not seen as a vital part of assessment. Carlson (2009) shows that only 59% of registered nurses accepted patients report as valid assessment of pain although it is Gold Standard for pain assessment (Melzack and Katz 1994). Another study (Rejeh et al 2008) showed that nurses are too busy with such a large workload to be able to do full pain assessments on their patients. Young et al (2006) believes that a good assessment tool will help efficiently assess pain. According to The World health Organisation (Delphi, 2007) nurses can first evaluate the pain and can recommend to the treating doctor whether the use of pain relief medication is appropriate. However Cordts et al (2011) suggest that doctors are not listening to nurses’ assessments of the patient and this can lead to the patient not moving up a step on the WHO Pain Ladder. Medication is not given efficiently enough when a patient complains about pain. You read "Evidence Based Practice" in category "Papers" Doctors can be slow to prescribe, as they do not see it as urgency. Doctors then need to understand that analgesics need to be given promptly as to stop any further discomfort for the patient. All of the above findings lead to the main theme that was evident throughout the literature – A lack of nurse knowledge and pain education. Carlson 2009, Chung et al 2003, Coll and Ameen 2006 all show that there is a high awareness of pain from registered nurses but there is a low level of consistent implementation of evidence based practice when it comes to pain management. Carlson (2009) results showed that nurses were not transferring their knowledge into clinical practice. Nurses deliver the majority of patient care (WHO, 2007) and have an ethical and moral responsibility to ensure that best care is provided by incorporating Evidence Based Practice into clinical practice (NMC, 2011) Therefore in this assignment the proposed change will concentrate on the improvement of nurses’ knowledge of post-operative pain management in accordance with the NHS Institute for Innovation and Improvement Enhanced Recovery Programme (2008, See Appendix A). This will be guided by an educational session to implement this change. Implementing the change According to Sale (2005) change needs to occur to improve patient care. However change is best if it is planned. Cork suggests that if it is to be successful it needs to be planned, focused and inclusive. Pearce (2007) McAuliffe and Vaerenbergh (2006), Craig et al (2008), Upton (2005) all agree that barriers will arise if a change is unplanned, or if nurses are unaware of it. Change needs to be well communicated and organised with everyone who will be involved (Upton, 2005). To enable change, the type of change needs to be recognised. Planned change is considered and put into practice by a well-informed agent and triggered by the need to respond to new challenges, opportunities or potential complications (Thornhill et al, 2000) McSherry and Pearce (pg. 128, 2007) suggest that Change is complex and that barriers are inevitable therefore threatening the successful implementation of clinical governance. It is suggested then that utilising a change model can help guide the process and hopefully reduce the obstacles, which may be encountered. There are a number of questions that need to be looked at before a change can commence (Craig et al 2008). Firstly, will the patient benefit from the proposed change? For the proposal of an educational programme to improve nurse knowledge then yes, the patient will benefit. As they will be treated in accordance with NHS evidence based guidelines. The next step is choosing a change management theory to follow stage by stage. There are many change theories, some of which are easier to follow than others (Sale, 2005). It is important that the correct theory is chosen because if the wrong one is picked it can lead to negative outcomes for the proposed change. (Craig et al, 2008). The change theories that will be discussed are Lewin’s Force Field theory (1953) and Lippitt et al (1958). Lewin’s theory has three steps; Un-freezing which allows existing processes to change. Movement allows adoption of new practices and Re-freezing, which involves re-stabilisation; ensuring practices remain in the organisation (Gopee and Galloway 2009 and Mullins 2010). His theory also places emphasis on the driving and resisting forces associated with any change, and to achieve success the importance lies with ensuring that driving forces outweigh resisting forces (Baulcomb, 2003). When driving forces exceed restraining forces, the move towards change is facilitated (Reid, 2002). Lippitt’s (1958) is an extension of Lewin’s (1951) Force Field theory. It is a seven-step theory, where information is constantly exchanged. This is advantageous as communication is key if a change is to be made in clinical practice (Mcsherry and Pierce, 2007). However, the focal point of this theory is the role and responsibility of the change agent. Although this is important there is not an emphasis on the progression of change that Lewin’s 1951) theory has. Lewin’s (1951) force field analysis will enable participants in this change process to identify factors that are driving the change and those causing resistance (Gopee and Galloway, 2009) Lewin’s theory (1951) will be implemented as this helps to understand planned change processes within organisations. The three steps should be followed to create and embed change. Leadership To bring about cha nge in the clinical area it is important to have good leadership. According to Allen (2000) having a good leader will improve patient care. Lewin (1951) says that it is necessary to have a change agent in order for the change process to be effective. A change agent is a person who is organises and holds the day-to-day responsibilities of the change (Craig et al, 2008). McSherry and Pierce (2007) believe that the change agent needs to have certain characteristics to be an effective leader. They need to have self-belief, self-awareness, drive for improvement and personal integrity. Another key component of a successful change agent is one who has excellent communication skills. McSherry and Pierce (2007) discuss that communication can be enhanced in the clinical environment by sharing goals, information, learning and responsibilities so that everyone feels included in the change. Baulcomb (2003) agrees with this stating that the change agent needs to empower the staff giving them a chance to enhance their skills. However on the other hand Cherry et al (2005) believes that the change agent needs to be original, be able to analyse the evidence-based practice and collect and implement the change along with possession of a positive outlook. This would improve nurses’ pain management knowledge with the implementation of the NHS Enhanced Recovery Programme (2008). For this change to come about the change agent needs to have as many of positive characteristics stated above. The more of them that they have the more likely it will be that the change will be implemented with fewer barriers in the process. (McSherry and Pierce, 2007). The change agent for this project will need to be able to communicate with theatre, recovery and ward managers. Bass (1985) extended on the work of Burns (1973) about transformational leadership. He suggests that the followers of a transformational leader feel trust, admiration and loyalty for them. They make them feel this by inspiring them and give them their own identity (Kotlyar and Karakowsky, 2007). Using such an approach will reduce the resistant forces by bringing about change slowly to clinical practice (Sale, 2005). The Unfreezing Stage Lewin’s first stage in the change process is Unfreezing. Recognition that change needs to be made is the initial step. From this the right conditions for change to occur are developed and the forces maintaining behaviour reduced (Gopee and Galloway, 2009 and Mullins, 2010). The literature review states that nurses were unclear about what pain management was and how any knowledge they had of it could be brought into practice (Carlson 2009, Chung et al 2003, Coll and Ameen 2006). Nurses need to be educated on the importance of pain, good communication and assessment skills to a more in depth level than what is taught during university. For nurses to use the NHS Enhanced Recovery Programme, forces are needed to direct the behaviour away from the original situation and drive them towards the proposed change (Robbins 2003). To achieve this change in practice the change agent would need to have posters and leaflets produced so that staff know that there is a proposed change. This way when initial meetings are called they will not be surprised and they will have already formed opinions and hopefully ideas to bring to the table. Within the leaflets there will be evidence from the literature review of what needs to be changed how the change will be implemented. The posters will include a diagram of the tool that is to be introduced and how this will improve care for post-operative patients. During this stage the change agent will need to communicate with all the stakeholders this includes the nurses at ward level but also the ward manager, as she/he will hopefully be able to fund any expenses. Printing and photocopying charges will apply as well as a room within the hospital will need to organised at this stage, to ensure that it will be vacant. Resistance will begin to show at this stage. Sullivan (1992) states that it is then the change agents’ responsibility to earn the resistors trust and respect by the use of effective communication and understanding. Robin (2003) states that the percentage of driving forces needs to be higher than those opposing the change in order to unfreeze the current state. The nurses on the post-operative ward will now be able to trial use the enhanced recovery programme (2008) and put forward their opinions to the change agent, be it ideas to improve the proposed change or reasons why they do not want or like it. The Moving Stage The second stage identified by Lewin’s change process is Movement. This is the transition from the present to stage to the chosen stage (Lewin, 1951). It requires bringing equilibrium back, which has been broken in the unfreezing stage. Sale (2005) states that if the change agent has been effective in preparing for the change in the first stage nurses should begin to accept it. Sale (2005) also explains that this stage identifies the roles and responsibilities within the change to the nursing team, which is needed for the change to take place. The leaflets that will be circulated will include definitions of clinical terms including †What is pain management†, information about the Pain Ladder and the Enhanced Recovery Programme (2008). There will be opportunities during handovers if anyone does not fully understand anything within the leaflet. Stakeholders will be required to sign to say that the booklet has been read and understood. National Institute for Clinical Excellence (NICE) suggests that printed materials are low cost aids to raise awareness of a desired change, and most importantly are very effective in changing behaviour especially when combined with other methods. After all the signatures have been collected informal teaching sessions of half an hour will commence and will be facilitated by the change agent to re-educate and influence the stakeholders targeted in the change process. This will be achieved using a normative re-educative approach. This approach addresses group norms, personal values and common goals. The stakeholders internalises the change rather than imposing change through authority and coercion. However these sessions will be made compulsory by authorities in order to promote best practice. The idea of these sessions is to aid in clearing any confusion about what has been read in the leaflets, increasing nurses’ knowledge and allowing stakeholders an understanding of the merits of change (Dawson 2001). It would be helpful to have the pain specialist nurse attend he sessions, it would hopefully make the staff aware of how important the change will make to the patients. Dowsett (2001) states that professional development is a key element to provision of clinical government. Learning not only provides nurses with knowledge and skills, it improves competence and reduces threat to change (Chapman and Howkins, 2001). It is vital that the chang e agent considers available resources. A lack of resources is a barrier to the implementation of evidence-based practice and therefore the implementation of clinical effectiveness (Polit and Beck, 2001). Appendix B summarises the time, cost and resource requirements for each activity, for the implementation of the educational package. This will assist nurses in the improvement of post-operative pain management using best evidence. The table in Appendix B provides a brief summary of the activities required to bring about change, the time it takes to start activity, how long it will take to implement action, cost and resources required to ensure implementation of change and change management. The cost and timelines are an estimation, which needs to be taken into consideration. The prices of stationary that have been included are given at institutional rates. The venue for the half hour re-education session will be allowed in the day room on the ward as management has made arrangements for this. The change agent will need to clarify that the Health Board would give 100% funding to the proposed change. Training is compulsory for practitioners in order to meet statutory obligations. According Aneurin Bevan Health Board (2010) training designated as mandatory meets the needs of the service. The Re-freezing Stage The final stage identified by lewin’s (1951) change process is re-freezing, which comes with proper implementation of the change. According to Gopee and Galloway (2009) the change agent will need to maintain motivation throughout implementation and ensure that change is integrated and assimilated by the organisation and stakeholders. Gopee and Galloway (2009) also agree with Bednash (2003) state change is needed within the nursing profession to provide quality care. Nurses need to monitor quality of care given by recognising problems and from this implement best practice (Grol and Grimshaw, 2003). If this stage is not done then there is a high chance that nurses will revert back to the original state (Robbin, 2003). It is in this stage that it necessary to bring in formalities such as guidelines and policies. This will ensure that Lewin’s (1951) Re-freezing stage is implemented. This stage also ensures that the stakeholders approve of the change. McSherry and Pierce (2007) explain that once the stakeholders have accepted the introduction of the Enhanced Recovery Programme (2008) there will be no more resistance or barriers and the stakeholders will have accepted the new change. To evaluate the effectiveness of the change, the next step would be to introduce clinical audit to compare with previous outcomes of post-operative pain management or, more importantly how to keep preventing poor pain management. NICE (2002) states that an audit is a quality improvement process, aiming for enhancement of patient care, during an assessment of care. This will be introduced in another session based on the ward, three months after the change. A questionnaire would be introduced to get feedback from practice (NICE, 2007). The results from this would be anonymous as to not compromise levels of knowledge. Bell and Duffy (2009) state that clinical audit are used as a way to improve assessment and management of pain and to assure that best practice is applied in clinical practice. The department of health (1989) explains that audit helps to underline variation in practice, giving opportunity practitioners to reflect and evaluate the success of implementation. Three months after the first another audit will be carried out to ensure that the change has become frozen and that it is making the improvements that were needed within clinical practice. The change agent will need to release the results of clinical audit of the Enhanced Recovery Programme (2008) to all involved and to other wards so that the change can be implemented else where if requested (Murphey, 2006). Any new evidence that develops that will improve best practice will be highlighted in yearly update teaching sessions. Resistance and Barriers to Change NICE (2007) states that in order to develop a successful strategy for change; the change agent needs to understand barriers faced within health care organisations. Gopee and Galloway (2009) suggest that change can cause anxiety; resistance to change can succeed as a result of fear of the unknown: lack of confidence of knowledge or skills to carry out the change. However parkin (2009) states that change can be disturbing to those involved therefore resulting in increasing resistance to the implementation of a change. It is therefore the change agent’s responsibility to foresee any resistance, act and over come these barriers. Habits are hard to break, people become familiar with particular practices; it is therefore vital that the change agent adopts a â€Å"bottom up† approach. All stakeholders will then have an active part in the change. Nurses’ who feel they lack the knowledge and are not happy about the change will be able to receive extra support from the ward manager, pain nurse or change agent. The implementation of the proposed change would mean that there would be a shortage of staff on the floor. Although the sessions are based on the ward they would still need to be carried out with minimal interruptions. This is a barrier to change. To overcome this barrier, the change agent can chose to have the sessions in the afternoon when both morning and afternoon staff are on the ward. As the session is only half an hour this would not cause too much disruption. Two sessions could be carried out so to see as many staff as possible. The achievement of this change will be shown by better results in patient care but also an improvement in ward team work which all leads to cost effective practice. This will be achieved, as patient recovery time will be reduced. Conclusion Change is indispensible in nursing practice for the improvement and transformation of health services, and is crucial in maintaining sound judgement together with effectiveness of best practice (Gopee and Galloway, 2009). Clinical effectiveness can be translated into clinical governance however for this to happen clinical practice must combine with the best available knowledge through research, clinical expertise and patient choice. This can be accomplished through training education and change management (Muir-Gray, 2001). This essay showed that the change needed for nurses was to introduce the NHS Enhanced Recovery programme (2008) into practice. For this to happen they would need to have short informal ward based training sessions to improve knowledge of pain and its management. The literature review showed that there was evidence there was a gap between nurse knowledge and how this affected the care patients were receiving. The change was implemented using lewin’s (1951) Force Field Analysis. The three stages showed driving and restraining forces but by the Re-freezing stage restraining forces had been limited so that there was equilibrium. Resistance and barriers to change were discussed including money, resources, time and how the change agent would overcome these. Once the Re-freezing stage had been implemented and therefore the change being successful it is important that the change is periodically evaluated to ensure that it does not slip back to the original state. References Allen, D. (2000) ‘The NHS is in need of strong leadership. ’ Nursing Standard. Volume: 14, (Issue: 25) p. 25 Aneurin Bevan Health Board (2010) Education and Development. Available at : http://www. wales. nhs. uk/sitesplus/866/page/40 (accessed October 16th 2011) Baulcomb, J. (2003). ‘Management of Change Through Force Field Analysis’. Journal of Nursing Management. Volume: 11, (Issue: 4), p. 275-280. 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Approx ? 3500 for 50 participants +extra time of change agent to plan change. |Change agent to decide (will key stake holders assist in the process of change. | Constant communication|immediately|indefinite|? 100. 00|Information/notice boards| Source-Made by essay author How to cite Evidence Based Practice, Papers Evidence Based Practice Free Essays Evidence –based practice has been gaining acceptance and momentum in the social services professions. As evidence related to specific programs and inventions mount, social service practitioners and organizations around the world have increasingly begun to implement evidence-based programs as a strategy for creating better outcomes for children, families and adults. Unfortunately, the science of evaluating efficacious and effective programs and interventions has far out spaced the science of implementing them. We will write a custom essay sample on Evidence Based Practice or any similar topic only for you Order Now A gap exists between what we know works and being able to utilize what works in practice (Maynard, August 2009). The article allows you to question why it is so hard for people to understand concepts, theories and research that they have studied. The information that they know and have studied is being put in to practice. How can practitioners evaluate and come to conclusions on their studies of clients and don’t implement what they have studied? We all have clients that we use certain interventions for and we know what works for them but that doesn’t necessarily mean it will work for all of them. If 10 people are researched on a new technique that you have learned and they all respond positively to it, that doesn’t mean that the next 10 people you work with will respond the same way. While reviewing the article, consideration to the method the author is trying to implement came into question. Citations were by many appropriate sources. The citations show that she did research and was able to supplement her ideas with other sources besides herself. That doesn’t necessarily mean that she was able to find that source without doing the bottom-up search. The evidence points at a top-down search which would be logical. It is more feasible and less time consuming. She could read each and every source and find the information required then she would be fulfilling the bottom-up search. She was using many different resources to write the article. The author portrayed many good points in this article. She discussed how social service agencies can be learning organizations and they are (a) systems thinking, â€Å"allows us to look for and identify patterns and see the rganization as a dynamic system that impacts, and is impacted by, individuals and events inside and outside the organization† (Senge, 1990), (b) personal mastery, â€Å"people with high levels of personal mastery are more committed, take more initiative, have a broader and deeper sense of responsibility in their work and learn faster† (Senge, 1990) (c) mental models, â€Å"people expose their own thinking effectively and make that thinking open the influence of others† (Senge, 1990) (c) building shared vision, â€Å"building a shared vision takes time and grows as a result of interactions between individuals within the organization and the sharing of individuals’ visions† (Senge, 1990) and (d) team learning, â€Å"creating structures and processes that shift the organizations toward a commitment to learning provides a solid foundation for building a learning organization. The research was unbiased when defending the article. She informed the reader of the research that was performed by many other sources and allowed an opening for discussion whether it is valid or not. The research is not completed it is open ended for question and improvement. She expresses that â€Å"evidence based practice calls for different types of social service organizations that can learn on a continuous basis and adapt quickly and responsively to knowledge, research and the changes in the field that are occurring at a rapid pace† (Maynard, August 2009). She has great insight and theories to help agencies to improve and practice what they know. The article was based off of other sources and what they know and can teach us. More in depth personal research from the author and from the sources could provide a more in depth picture of how evidence-based practice can be dissected. How to cite Evidence Based Practice, Essay examples