Application of Evidenced

Introduction Sackett et al (1996) defined Evidenced-based practice (EBP) based on medicine as, â€Å"the conscientious, explicit, and judicious use of current best evidence based in making decisions about the care of individual patience, furthermore EBP involves integrating individual clinical expertise with the best available external clinical evidence from systematic research† (cited in Social Work Resources, 2010).Advertising We will write a custom essay sample on Application of Evidenced-Based Practice in Autism specifically for you for only $16.05 $11/page Learn More Individual clinical expertise constitutes those adeptness and judgmental aspects a professional clinician builds over time as a result of field experience and practice. While on the other hand, external clinical evidence constitutes precise research built from the sciences of medicine but reflecting patient-focus clinical research that largely involves, â€Å"correct and meticul ous diagnostic tests, the power of prognostic markers and the efficacy and safety of therapeutic rehabilitative and preventive regimens† (Social Work Resources, 2010, p.1; Curtin, 2008). Autism is a disorder that affects a child’s social and communication skills. In many instances, these children have a problem in interpreting the usual messages and signals, experience difficulty in social relationships, have problems in development of play and imagination, always appear resistance to change in routine, and lastly, these children normally demonstrate to possess unique skills and talents in art, music and even science (Autism Reality, 2007). Demonstrating numerous social problems and with no particular specific medicine available to treat the disorder, this paper tries to answer a question that arises as to how well can Autism children be clinically and ‘socially’ treated based on a communication intervention program in an effort to integrated them properly in the society. Treating disability based on Evidence-based practice Debate has persisted for a long time about how mental health problems have manifested themselves in those individuals with different degrees of disability. Broad consensus is that individuals who manifest mild learning disability can be diagnosed by adopting criteria usually used for the general population. These criteria include, International Classification of Disease-10, adopted by World Health Organization in 1993 and the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) adopted by the American Psychiatrist Association in 1994 (Raghavan and Patel, 2005). These treatments have been a challenge to victims who demonstrate severe to profound learning disabilities.Advertising Looking for essay on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Individuals with such disabilities have problems that are more individualized in form manifested as behavioral disorder, and for them to have better forms of treatment, there is need for assessment that is qualitative in nature, case study approach using person-centered planning models and behavioral approaches such as functional analysis. When there is no adequate recognition of the mental health problems specifically to those with learning disabilities, the victims experience major effect on their general well being, personal independence, productivity, and quality of life. At the same time, the family of the victim gets affected together with other caregivers. When learning disabilities combine with mental ill health, victims may always experience stigmatization and prejudices that sometimes lead to social exclusion. Treatment for the victims has generally involved differential diagnosis of challenging behavior and mental health disorder which in turn has resulted in numerous and serious consequences with regard to understanding the therapeutic needs of these people with disabilities. Du al diagnosis has become complex and sometimes confusing in nature whereby, various practitioners have not understood the form and types of needs of people with learning disabilities and sometimes who experience mental health disorders (Raghavan and Patel, 2005). Evidence shows that people with dual diagnosis have intricate needs, which in most cases are poorly identified, and in most cases, these people receive fruitless therapeutic services. Providing therapeutic care in addressing mental health problems and learning disabilities requires in-depth understanding of the biopsychosocial dimensions of learning disability (Raghavan and Patel, 2005). This has led to search and identification of a systematic process of identifying needs and providing appropriate interventions to meet the needs. Further, providing care for these people needs to be undertaken with professional integrity, respecting the individuality, rights, and choices of the people.Advertising We will write a custom essay sample on Application of Evidenced-Based Practice in Autism specifically for you for only $16.05 $11/page Learn More More so, there is a need for thorough assessment of the problems and needs of the people, and this calls for the use of structured assessment processes using standardized screening tools, interview schedules, rating scales and checklists. Treating Autism using evidence-based practice Autism victims demonstrate greater disability with regard to communication skills. They tend to have problem in communication skills, which in general affect their associative social world (Glicken, 2009; Gordon, 2010, p.1). Practitioners adopting and utilizing the broad definition of the EBP have integrated it into communication assessment and intervention for the Autism victims. In general, EBP process takes place based on the following steps: asks a well-built question; search for research evidence; appraise the evidence; apply the evidence; and evaluate the effectiveness of the application (Matson, 2009; Neville and Horbatt, 2008). At the same time, to effectively carry out this evidence-based practice process, the practitioner requires to: assess and incorporate stakeholder perspectives into the communication assessments and interventions; identify and select the most relevant, adequate and effective empirically validated procedures and adapt the procedures to suit the unique elements of individual children; and gain and apply the requisite clinical expertise to effectively apply and evaluate assessment and treatment procedures (Matson 2009; Olszyk 2005). Evidence-based practice puts much emphasis on incorporating stakeholders’ perspectives in the implementation of assessment and intervention. Stakeholders in this context include direct stakeholders, who are recipient of the intervention; indirect stakeholders, who may involve family members of the child; immediate stakeholders, comprising peers and teachers; and extended s takeholders, the various people the child may interact with (Matson, 2009).Advertising Looking for essay on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Incorporating stakeholders plays a significant role in communication intervention since these are the people who constitute the child’s frequent communicative partners. At the same time, inclusion of stakeholders will result into a collaborative interaction between the stakeholders and practitioners in implementing the intervention. When the participation and commitment of stakeholders is effective, then there is likelihood of experiencing successful treatment outcomes and maintaining treatment gains. Moreover, evidence-based practice advocate for incorporation of stakeholders from the beginning when the intervention process is initiated. Selection of appropriate target behaviors and negotiation of stakeholders’ involvement during the initial stages of designing communication intervention programs for Autism children is important. Critical decisions to make during this stage include the methods and modes of communication that the child will be taught to use and the ini tial communicative skills to target for acquisition (Matson, 2009). In addition, stakeholders need to be taught the full range of speech and non-speech communication modes that include speech, gestures, manual sign, picture communication, and a range of communicative functions that largely involve verbal behavior (Matson, 2009). Evidence-based practice further requires practitioners to utilize procedures that have precise establishment or that are empirically supported. To do this, the practitioner will need to evaluate the nature of the encountered problem; the time constraints; and the level of expertise. In a communication intervention program of Autism children, EBP postulate that there should be flexible use of well-established techniques. In selecting the best empirical procedures for the communication intervention program, practitioners are required to select procedures that: suit the child’s unique attributes and characteristics; practitioners should also collect and use learner-generated performance data to determine if the intervention is fruitful; then the practitioner is further required to understand the fundamental principles that underlie the empirically validated procedures(Matson, 2009). The third aspect of evidence-based practice is that practitioners should utilize relevant educational and clinical expertise in generating and foster an assessment or intervention. The overall requirement of this element is that practitioners should demonstrate exemplary skills in implementing empirically supported procedures and working within a high degree of treatment fidelity (Matson, 2009). At the same time, practitioners are required to constantly update themselves with the new and emerging evidence that characterize the evidence-based practice. Conclusion Autism largely is connected to communication abilities of a child, a situation that later results into the child experiencing disability problems in effectively encoding and decoding communicati ve messages. These communicative disabilities further affect the quality of the child’s life. To effectively address this issue, evidence-based practice has come out as the intervention method that appears holistically to address the needs of the Autism children. Evidence-based practice is seen to integrate the numerous available researches with relevant educational and clinical expertise (Boswell, Gatson, Baker and Vaughn, 2008) without forgetting the key stakeholders in generating effective assessment and intervention decisions that are efficient in treating Autism children. Reference List Autism Reality. 2007. AutismPro-â€Å"Somewhat† Evidence Based Internet Autism Intervention or Not Evidence Based At All? Web. Available from: http://autisminnb.blogspot.com/2007/11/autismpro-somewhat-evidence-based.html . Boswell, C., Gatson, Z., Baker, D. and Vaughn, G., 2008. Application of Evidence-Based Practice through a Float Project. Nursing Forum, Vol. 43, No. 3. Web. Avai lable from: http://proquest.umi.com/pqdweb?index=64did=1549949831SrchMode=1sid=7Fmt=3VInst=PRODVType=PQDRQT=309VName=PQDTS=1288348111clientId=29440 . Curtin, L. J., 2008. The Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. The Journal of Continuing Education in Nursing, Vol. 39, No. 9. Web. Available from: http://proquest.umi.com/pqdweb?index=57did=1550210641SrchMode=1sid=7Fmt=3VInst=PRODVType=PQDRQT=309VName=PQDTS=1288347364clientId=29440 . Glicken, M. D., 2009. Evidence-Based Practice with Emotionally Troubled Children and Adolescents. CA, Academic Press. Web. Available from:http://books.google.com/books?id=PpF1yVncGDACpg=PA233lpg=PA233dq=evidenced-based+practice+in+treating+autismsource=blots=j92JXWtuFUsig=ptccFylkpK2nsv6L1u-Sp2gJAEYhl=enei=06HKTO6fENTNjAeFza3TDwsa=Xoi=book_resultct=resultresnum=7ved=0CDIQ6AEwBg#v=onepageqf=false . Gordon, M., 2010. New program helps autistic students transition into ‘real world’ after high school. McClatchy-Tribu ne Business News, Washington. Web. Available from: http://proquest.umi.com/pqdweb?index=1did=2160184831SrchMode=1sid Fmt=3VInst=PRODVType=PQDRQT=309VName=PQDTS=12883487 0clientId=29440 . Matson, J. L., 2009. Applied Behavior Analysis for Children with Autism Spectrum Disorders. NY, Springer. Web. Available from: http://books.google.com/books?id=gUlW1gA3yyACpg=PA122dq=Evidence+Based+Practice+%28EBP%29+and+Autismhl=enei=BnPKTO_cFYKQjAe7z8HRDwsa=Xoi=book_resultct=resultresnum=1ved=0CCkQ6AEwAA#v=onepageq=Evidence%20Based%20Practice%20%28EBP%29%20and%20Autismf=false . Neville, K. and Horbatt, S., 2008. Evidence-Based Practice: Creating a Spirit of Inquiry to Solve Clinical Nursing Problems. Orthopaedic Nursing, Vol. 27, No. 6. Web. Available from: http://proquest.umi.com/pqdweb?index=50did=2140407801SrchMode=1sid=7Fmt=3VInst=PRODVType=PQDRQT=309VName=PQDTS=1288347363clientId=29440 . Olszyk, R. K., 205. Change in symptomatology and functioning of preschoolers with autism in the context of the DIR model. Pace University. Web. Available from: http://proquest.umi.com/pqdweb?index=1did=885699711SrchMode=1sid=11Fmt=2VInst=PRODVType=PQDRQT=309VName=PQDTS=1288349666clientId=29440 . Raghavan, R. and, Patel, P., 2005. Learning disabilities and mental health: a nursing perspective. Wiley-Blackwell. Web. Available from: http://books.google.com/books?id=5LGzTQPdvAECpg=PA2dq=general+issues+of+evidence+based+practice+in+disabilityhl=enei=EXzKTKfkF4ztOempgIwBsa=Xoi=book_resultct=resultresnum=1ved=0CCcQ6AEwADgK#v=onepageq=general%20issues%20of%20evidence%20based%20practice%20in%20disabilityf=false . Social Work Resources. (2010). Evidenced Based Practice. Web. Available from: http://sophia.smith.edu/~jdrisko/evidence_based_practice.htm . This essay on Application of Evidenced-Based Practice in Autism was written and submitted by user Shatterstar to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Medicines management †an introduction to non-medical prescribing 2000 word case study The WritePass Journal

Medicines management – an introduction to non-medical prescribing 2000 word case study 1. INTRODUCTION Medicines management – an introduction to non-medical prescribing 2000 word case study 1. INTRODUCTION1.1 . MEDICINES MANAGEMENT1.2 . NON-MEDICAL PRESCRIBING1.3 . CASE STUDY2. PATIENT OVERVIEW3. DIAGNOSIS3.1 . DIAGNOSTIC TOOL3.2. TREATMENT RECCOMENDATIONS4. MEDICATION  4.1. GALANTAMINE4.2. MIRTAZAPINE4.3. LORAZEPAM5. LEGAL, ETHICAL AND PROFESSIONAL ISSUES5.1. ADHERENCE5.2. MENTAL CAPACITY5.3. ETHICAL CONCERNS6. REFERENCESRelated 1. INTRODUCTION 1.1 . MEDICINES MANAGEMENT Medicines management can be defined as; â€Å"†¦a system of processes and behaviours that determines how medicines are used by the NHS and patients.† (National prescribing centre,2002, P1). According to Dr Michael Dixon chair of the NHS alliance, Medicines management services are the processes for designing, implementing, delivering and monitoring patient-focused care, based on need, and include all aspects of supply and therapeutic use of medicines within healthcare settings. â€Å"Poor medicines management within organisations can lead to low public confidence in health services, unaddressed health needs and unsatisfactory patient outcomes and can lead to unscheduled emergency admissions or failure to maintain independence in the community leading to re-admission to hospital and other acute care settings. It can also lead to organisational issues such as, unmet targets, inappropriate allocation of resources, inefficient services, and risk.† (Calderdale pct, 2004) â€Å"Good medicines management means that patients receive better, safer and more convenient care. It leads to better use of professional time and enables practitioners to focus their skills where they are most appropriate. Effective medicines management also frees up resources which means that NHS money can be used where it is most effective. Good medicines management benefits everyone.† (npc.co.uk/mm/index.htm) 1.2 . NON-MEDICAL PRESCRIBING â€Å"Non-medical prescribing is prescribing by specially trained nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers, working within their clinical competence as either independent or supplementary prescribers.† (npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf) The Department of health recognised that non-medical prescribers are a large and growing workforce. They found that by the end of 2009 there were over 14,000 nurse prescribers, 1700 pharmacist and supplementary prescribers and many community nurse prescribers and allied health professional prescribers that had qualified to prescribe within their competence. (DOH, London, 2009). 1.3 . CASE STUDY This piece of work is a case study of a service user from the authors practise placement area at the time of writing. The case study incorporates three key elements within it; The service user Three medications prescribed to them The legal and professional issues surrounding the above The case study will look at these three elements in detail within the report. 2. PATIENT OVERVIEW (In order to uphold confidentiality, during this report the service user in question will be referred to as ‘Mary’. (NMC, Code, 2008) Mary is a seventy three year old lady who was admitted to the inpatient practise placement area on the 02/04/2011. Mary has a diagnosis of Alzheimers Dementia and was presenting with increased confusion and according to her care givers (Mary was a resident in a nursing home) had been showing signs of depression and aggression over the last few months culminating in a series of aggressive outbursts which ended in a serious attack on a member of her care home staff. The decision had been made that a hospital admission to the organic illness assessment ward (Older people’s services) was necessary to manage risk, assess the progression of Mary’s condition and reassess her package of care. Mary was initially resistant to all interventions from the ward team and displayed high levels of agitation and aggression. The consultant and nursing team felt that medication would play an important role in the management of Mary’s initial presentation. However Mary’s resis tance to any therapeutic interventions meant that alternative approaches were felt to be the only option at the start of treatment. John was also given a capacity assessment and found to lack capacity which allowed the ward staff to treat Mary effectively in her best interests. (For Mary’s pen story see appendix 1) 3. DIAGNOSIS Mary has a diagnosis of Alzheimers   Dementia. The Alzheimer’s society explain the term dementia describes a group of symptoms these include a decline in memory, reasoning and communication skills a gradual loss and decline in the skills needed to manage the individuals activities of daily living , confusion and a change in behaviour or personality. These symptoms are caused by the physical impact of disease or injury on the brain. There are a number of different conditions that lead to dementia including Alzheimers disease. (alzheimers.org.uk/site/scripts/documents_info.php?documentID=160) 3.1 . DIAGNOSTIC TOOL â€Å"Making a diagnosis of dementia is often difficult, particularly in the early stages The time it takes to make a diagnosis can vary. If scans and other investigations are required, it could be 4-12 weeks. If the person is in the early stages of dementia, a 6-12 month period of monitoring may be required before a diagnosis can be made.† (alzheimers.org.uk/site/scripts/documents_info.php?documentID=121) â€Å"The Mini Mental State Examination (MMSE) is the most commonly used test when a diagnosis of Dementia is being considered The MMSE is the test that the National Institute for Health and Clinical Excellence (NICE)  recommends for deciding whether a drug treatment for Alzheimers Disease should be prescribed.† (http://guidance.nice.org.uk/DT) However NICE do stress it should not be relied on as the only means of assessment alone as diagnosing dementia involves careful monitoring and assessment. 3.2. TREATMENT RECCOMENDATIONS â€Å"Treatment for Dementia should only be initiated and supervised by a specialist experienced in the management of Dementia.† (BNF, 2009, P280) 4. MEDICATION â€Å"Being prescribed a medicine is arguably the most frequent intervention in the NHS† (Shepherd, 2002). Mary’s medication was reviewed on admission to the inpatient ward due to her aggressive and volatile presentation. For the purpose of this report three of the medications Mary was prescribed will be discussed in detail.   4.1. GALANTAMINE â€Å"Acetylcholinerase inhibiting drugs are used in the treatment of Alzheimers disease, specifically for mild to moderate disease.† (BNF, 2009, P280) Galantamine is a medication used to treat moderate Alzheimers dementia disease. Alzheimers occurs as a result of atrophy of the cerebral cortex. The disease causes changes in central neurotransmitter function especially the cholinergic system. It is linked to a lack of sufficient acetycholine levels. Evidence also points to raised levels of glutamate (a neurotransmitter). Galantamine is one of the centrally acting inhibitor of acetylcholinerase. It is a reversible acetylcholinerase inhibitor medication which works by increasing levels of acetylcholinerase in the synaptic cleft of central nervous system neurons. Galantamine is used to ‘slow’ neuronal degeneration by impeding further atrophy of the cerebal cortex. Evidence for the drug relates to an individual’s cognitive enhancement, however there is no cure for Alzheimers dementia and so medication is purely palliative. (Aarbakke, J et al, 2006) Interactions of Galantamine from a patient safety perspective include:- Warfarin effects are enhanced. Antipsychotics and barbiturates effect is reduced (Johns dose of Zuclopenthixol increased to counteract this) Muscle relaxants effects are modified. Dosage of Galantamine must be carefully considered and the individual’s renal functioning and Creatinine levels must be checked prior to treatment. Side effects of Galantamine include:- Nausea Sleep disturbance Headache Dizziness Drowsiness and fatigue Depression (Treated with Mirtazapine in Mary’s case) (BNF, 2009, P281) Mary was prescribed Galantamine Hydrobromide (Reminyl XL) a prolonged release medication. The Scottish medical consortium state Reminyl XL is recommended for the treatment of moderate Alzheimers dementia and allows a reduction in dose frequency and is as cost effective as immediate release forms of Galantamine. (scottishmedicines.org.uk/files/reminyl_XL_Summary_Advice__FINAL__for_website.pdf) 4.2. MIRTAZAPINE Mirtazapine is a medication used to treat depression. Theories explain the cause of depression as a neurobiological change resulting in too little Noradrenaline and 5HT in some central nervous synapses. Mirtazapine is an Atypical antidepressant. It is a presynaptic alpha2 adrenoreceptor antagonist and increases central noradrenergic and serotonergic neurotransmission which then increases the release of noradrenaline. Mirtazapine has an antihistamine effect with sedative effects and so is beneficial to Mary due to her agitation and restless presentation. Mirtazapine is also suitable for older adults due to its anticholinergic effect. (Aarbakke, J et al, 2006) Interactions of Mirtazapine from a patient safety perspective include:- Alcohol – Sedation increased Warfarin – Enhances anticoagulant effect Anxiolytics and hypnotics – Sedation increased. Mary is also prescribed Lorazepam at present and this is monitored closely when given for over sedation. Withdrawl from Mirtazapine must be staggered due to side effects of withdrawing. (medicinenet.com/mirtazapine/article.htm) Dosage – Mary is on a titrating dose of Mirtazapine and so may be experiencing side effects which she is not used to and may cause her further distress. It was important that Mary be monitored closely and reassured during this time. Side effects of Mirtazapine include:- Increased appetite and weight gain (regular weight assessed and diet chart commenced) Oedema Sedation (Mary is monitored closely for over sedation due to her other medications sedative effects) Dizziness and headache Postural hypotension (Mary’s blood pressure is checked daily) â€Å"Mirtazapine causes few antimuscarinic effects and is therefore recommended over Trycyclic antidepressants† (BNF, 2009, P215). 4.3. LORAZEPAM Lorazepam is an Anxiolytic. Benzodiazepine anxiolytics are indicated for use short-term in anxiety states. However they are also used as an adjunctive therapy at the beginning of anti-depressant treatment to ease the initial worsening of symptoms, as in Mary’s case. Interactions of Lorazepam from a patient safety perspective:- Respiratory Depression- (Mary was monitored and physical obs taken post dose) Sleep apnoea syndrome (Mary was on arms length observation levels anyway) Severe hepatic impairment Myasthenia Gravis Side effects of Lorazepam include:- Drowsiness Lightheadedness Confusion Ataxia Headache Hypotension (Mary’s bp was taken on a daily basis) Confusion and Ataxia may be particularly apparent in elderly and should be closely monitored. (BNF, 2009,P189) 5. LEGAL, ETHICAL AND PROFESSIONAL ISSUES Therapeutic interventions which involve the prescribing and administration of medications have legal, professional and ethical implications. In Mary’s case these included the following issues. 5.1. ADHERENCE One of the problems with medication administration as part of planned care was Mary’s resistance to all interventions from the ward staff. â€Å"People with dementia often have problems taking prescribed medication. They may forget to take it without prompting or supervision, and can lack awareness of their health problems. Some believe they do not need medication as they think there is nothing wrong with them.† (Stapleton, L. 2010) Medication adherence can be improved by applying some simple measures:- Ensure patients know what drugs they are taking, why they are taking them, and when.   Also check that they are aware of any possible side effects, and what to do if they experience them. Check that all patients with dementia are able to take their medication safely by organising dosette systems, and ensure carers can help patients where necessary. Give all patients and their families’ information about how to contact the clinic nurse by providing verbal information and written leaflets. Ensure patients have a written treatment plan. (Stapleton, L. 2010) According to Cheesman (2006), adherence is an approach to achieving the best use of medication involving the sharing of information between healthcare professionals and patients. The prescriber can promote an effective therapeutic relationship by building a patient’s confidence in their ability to self-manage their condition. 5.2. MENTAL CAPACITY â€Å"The Mental Capacity Act 2005 provides a statutory framework to empower and protect people aged 16 and over who lack, or may lack, capacity to make certain decisions for themselves because of illness, a learning disability, or mental health problems. The act was fully implemented in October 2007 and applies in England and Wales. If someone is unable to make a decision for themselves at the material time because of an impairment of the mind, then that person can be said to lack the mental capacity to make that decision.† (Alzheimers society, 2011). According to the law, a person is defined as being unable to make decisions for themselves if they are not able to undertake at least one of the following: understand information given to them retain that information long enough to be able to make a decision weigh up the information available to make a decision communicate their decision by any possible means, including talking, using sign language, or even through simple muscle movements such as blinking an eye or squeezing a hand. (Rethink, 2010) Mary was found to lack capacity as she was unable to retain or weigh up the information given to him to make a decision. Mary lacked any insight into her recent worsening of symptoms, changes in behaviour and aggression. This is often the case with dementia disease. â€Å"The act encompasses five main principles: 1   A presumption of capacity − Every adult has the right to make their own decisions and must be assumed to have capacity to do so unless it is proved otherwise. 2   The right for individuals to be supported to make their own decisions − All reasonable help and support should be provided to make their own decisions. 3   It should not be assumed that someone lacks capacity simply because their decisions might seem unwise or eccentric. 4   If someone lacks capacity, anything done on their behalf must be done in their best interests. 5   If someone lacks capacity, before making a decision on their behalf, all alternatives must be considered and the option chosen should be the least restrictive of their basic rights and freedoms.† (Warren, L. 2010) â€Å"When considering a persons views and wishes it is important that they are given weight, and are carried out, unless the effects would be detrimental to that person.† (National archives, 2010) The multi-disciplinary team worked to all these principles in Mary’s case by:- 1. Presuming capacity by letting Mary make decisions until the capacity assessment had been done and a formal plan of care put in place. Mary was also supported to continue to make decisions on a daily basis which she was deemed to have capacity to make e.g. what to wear that day. 2. Support was provided in the form of an Independent mental health advocate (IMHA). 3. Mary was found to have capacity to make certain decisions even if they seemed strange to the ward staff. Staff supported her in this. 4. Mary had a best interest assessment and the findings were used to formulate a comprehensive care plan for Mary. 5. The MDT sought input from the deprivation of liberty safeguarding team (DOLS) around the intervention decisions with Mary to ensure they were applying the least restrictive care. 5.3. ETHICAL CONCERNS When working with people with dementia ethical practise should be considered as dementia is a long-term illness with no cure. Treatment is purely palliative and the evidence for the benefit versus drawbacks to treatment is not fully understood. (www.mind.org.uk) Foot Anstey solicitors explain that Advance directives and lasting power of attorneys put in place can ensure that the service user receives the treatment and care they want when they are no longer able to voice their requirements themselves. (www.repod.org.uk) Healthcare professionals must make the service user the centre of care decisions in the service user’s best interests to uphold ethical practise. 6. REFERENCES Aarbakke, J et al, (2006) Illustrated Pharmacology for nurses. Hooder Arnold, London. Alzheimers society (2011). Diagnosis and assessment. [Internet] Available from: alzheimers.org.uk/site/scripts/documents_info.php?documentID=260 [Accessed on 5/4/11] British National Formulary (March 2009) Galantamine, pg 281-282, BMJ and RPS, London. British National Formulary (March 2009) Mirtazapine, pg 215-216, BMJ and RPS, London. British National Formulary (March 2009) Lorazepam, pg 188, 190 BMJ and RPS, London. Calderdale pct, (2004) Improving health, improving lives: commissioning strategy for Calderdale. [Internet] Available from: calderdale.nhs.uk/fileadmin/files/Public_Information/Publications/Strategic_Plan_Appendix_1.pdf [Accessed on 6/4/11] Cheesman S (2006) Promoting concordance: the implications for prescribers.Nurse Prescribing; 4: 5 205-208. Dixon, M (2010) Modernising medicines management. A guide to achieving benefits for patients, professionals and the NHS, Executive summary. National prescribing centre, (2001) [Internet] Available from: npc.nhs.uk/developing_systems/intro/resources/library_good_practice_guide_mmmexecutive_summary_2002.pdf [Accessed on 10/4/11] Fittock, A. (2010) Non-medical prescribing by nurses. National prescribing centre [Internet] Available from: npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   [Accessed on 6/4/11] MedicineNet.com, Mirtazapine index. [Internet]   Available from: medicinenet.com/mirtazapine/article.htm [Accessed on 30/1/11] Modernising Medicines Management. A guide to achieving benefits for patients, professionals and the NHS. National Prescribing Centre, (2001). [Internet]   Available from: npci.org.uk/medicines_management/medicines/medicinesintro/library/5mg_intro_to_mm.php [Accessed on 6/4/11] The National Archives (2010) Mental Capacity Act, 2005. [Internet] Available from: legislation.gov.uk/ukpga/2005/9/part/1 [Accessed on 10/4/11] National prescribing centre (NHS) Medicines management [Internet]. Available from: npc.co.uk/mm/index.htm [Accessed on 9/4/11] Non-medical prescribing programme, (2009) DOH, London. [Internet] Available from: dh.gov.uk//TheNon-MedicalPrescribingProgramme/index.htm [Accessed on 5/4/11] Nursing and Midwifery Council. (2008). The code: Standards of conduct, performance and ethics for nurses and midwives. [Internet].   Available from: nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/   [Accessed on 10/4/11] Rethink National Advice and Information Service. (2010). Mental Capacity Act 2005. [Internet] Available from: rethink.org/living_with_mental_illness/rights_and_laws/laws_you_need_to_know_about/mental_capacity_act.html [Accessed on 12/4/11] Scottish medicines consortium (2004) NHS Scotland, Treatment for Alzheimers dementia [Internet] Available from: scottishmedicines.org.uk/files/reminyl_XL_Summary_Advice__FINAL__for_website.pdf [Accessed on 13/4/11] Shepherd, M. (2002). Medicines. Nursing Times,   VOL: 98, ISSUE: 15, PAGE NO: 43 [Internet] Available from: nursingtimes.net/nursing-practice-clinical-research/medicines/206461.article [Accessed on 12/4/11] Stapleton, L (22 Nov, 2010) Can nurse prescribing improve medication concordance in people with dementia?. Nursing Times, 106:46 [Internet] Available from: nursingtimes.net/nursing-practice/clinical-specialisms/prescribing/can-nurse-prescribing-improve-medication-concordance-in-people-with-dementia/5022174.article [Accessed on 11/4/11] Warren, L (2010) Mental capacity Act, 2005 Factsheet. [Internet] Available from: alzheimers.org.uk/site/scripts/documents_info.php?documentID=354 [Accessed on 5/4/11]

You can choose the topic Essay Example | Topics and Well Written Essays - 1500 words

You can choose the topic - Essay Example These finding are alarming and it is a clear call to revisiting safety and health measures at work places. However, work related risks are different in the various sectors with some holding higher risks than others are. This implies that some of the safety and health measures and conditions may differ and hence all organizations should ensure that safety and health measures provided are in line with the risks related to the specific sectors. Therefore, it is the responsibility of every organization to ensure the safety and health of its entire workforce at all times. For instance taking a scenario of a company manufacturing high tech composite components for the US defense department, there are a number of measures that can be taken to ensure safety and health of its workforce. Such companies as the one in reference require significantly many safety and health measures due to the nature of activities carried out in the organization. For starters, the company should ensure to have a well written safety program addressing all the common accidents in relation to the company’s activities. Additionally, the safety program should address all necessary steps that should follow in case of an accident. In manufacturing industries, accidents are prone to happen from time to time therefore it is important to identify some of the most common accidents prone to happen. In a bid to ensure accessibility and frequent revision of these particular accidents, the company can produce some printed copies and attach them on various appropriate sites within the company. Furthermore, it is necessary that the company keeps on updating the written safety program as new accidents occur. With such a program, the entire workforce including new recruits can be alerted on these a ccidents thereby becoming more cautious in dealing with equipment or events attributed to these accidents. In line with the Occupational Safety and Health Administration (OSHA) safety and health

The Traditional Pedagogical Method of Learning Assignment

The Traditional Pedagogical Method of Learning - Assignment Example Teachers have to provide motivation and further encourage the student to continue exploring and questioning the matter. It is important for the students to learn to apply what the teacher has delivered as information. This educational goal can be achieved if they learn how to think abstractly. The teacher has to equip them with the tools to critically evaluate situations and problems and then determine by themselves the solution. This happens when the teacher uses strategies and concepts that build skills required for productive collaboration. Students have to construct their own meaning despite the directions and teaching methods of the teachers (Science for all Americans 1990). Through the principles of learning and teaching, the learning environment also encourages students to develop their independent and interdependent learning abilities. The teachers should establish an atmosphere where the students can learn both individually and with each other. Such tasks can be beneficial especially for young students who still orient themselves in the educational setting. Learning usually occurs when students have the opportunity not only to express their ideas but also to get feedback both from their peers and teachers (Science for all Americans 1990).

I Have a Dream Essay Example for Free

I Have a Dream Essay Martin Luther King Jr. was born in Atlanta, Georgia on January 15th 1929. He was a pastor, activist and the prominent leader in the African American civil rights movement and is often presented as a heroic leader in the history of modern American liberalism. He is most famous for his speech called â€Å"I have a dream†. It is about not being segregated or discriminated against and to have equal rights between white and black people. It is now recognized as one of the greatest speeches in history. Martin Luther King used a number of rhetorical devices in his speech. The main rhetorical device used throughout the speech is repetition and parallelism. In each paragraph he repeats different sentences to emphasize what he is saying. He repeats phrases such as ‘one hundred years later’, ‘we can never be satisfied’, ‘I have a dream’ and ‘now is the time’ to make the listener remember the parts he wants to emphasize. It is effective because the people are anticipating it so then they can join in. Also later on in life people will look back at the speeches and remember it for certain phrases because of the repetition. Martin Luther King also uses inclusive pronouns in his speech, for example we, our and addressing the audience as brothers and sisters. ‘The sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood.† He makes the audience feel as though it is there duty as well to overcome the discrimination and try and make all the southern states of America united and equal. He also makes the audience feel like it is their dream too and not just his. Martin Luther used different parts of the English language to enhance the meaning of his speech and bring out the details. The different rhetorical devices, allusions to historic documents, and metaphors seemed to have brought about the emotions that King was trying to arouse in his listeners. This helped him influence his listeners towards wanting equality for all and changing what was happening in the present so they didnt repeat things in the past.

A Brief Analysis of The Steel Industry Essays -- Industry

Steel Industry In the early part of this century was a time when industry was booming with growth around the installation of major railroads. With this growth came the transatlantic cable, the telegraph, and a whole lot of steel. Steel would be needed in the construction of these new transportation systems and communications were now possible between businesses and industries. (Wren, 2005) This paper will first discuss the development of the steel industry. Next, it will examine steel, and in the impact it had on the transportation industry. Finally, it will discuss systematic management practices of this time and how they gave birth to the scientific approach that is still in use today. Steel The steel industry was needed for almost everything. Alfred D Chandler Jr. could see the potential market value early on. According to Wren: Chandler traced the history of various firms and delineated four phases in the history of the large U.S. enterprise: 1. The initial expansion and accumulation of resources 2. The rationalization of the use of resources 3. The expansion into new markets and lines to help assure the full use of resources; 4. The development of a new structure that rationalized the renewal of growth. For many companies, the phases started and ended at different times, depending on the state of technology and the firm’s ability to react and capitalize on market opportunities. Chandler further noted two facets of industrial growth: 1. Horizontal growth from 1879 to 1893- which occurred when producers of similar fields combined through mergers, pools, or trusts to gain economies of scale, and 2. Vertical growth from 1898 to 1904- which occurred when firms moved backward or forward in ter... ...vents/pande01.html English Online. (Ed.). (n.d.). The Industrial Revolution. Retrieved April 23, 2012, from English-online.com Web site: http://www.english-online.at/history/industrial-revolution/industrial-revolution-manufacturing.htm History.com. (Ed.). (n.d.). Andrew Carnegie. Retrieved April 23, 2012, from History.com Web site: http://www.history.com/topics/andrew-carnegie Kernsanalysis.com. (Ed.). (n.d.). An Overview of Management. Retrieved April 24, 2012, from Fredrick Taylor Scientific Management Web site: http://www.kernsanalysis.com/sjsu/ise250/history.htm Vectorstudy.com. (Ed.). (2008). Henri Fayol Management Gurus. Retrieved April 25, 2012, from Vector Study.com Web site: http://www.vectorstudy.com/management_gurus/henri_fayol.htm Wren. (2005). The History of Management Thought (5th ed.). Danvers, MA: Wiley & Sons. (Original work published 1976)

A Look Into The Arts Essay

Art is one aspect of the past that has carried on for decades. Art in any form may it be poetry, novels, and playwright, sculpting as well as painting, has been an outlet for generations and continues to be an outlet and a means for expression. This paper will discuss â€Å" The Mona Lisa† one of Da Vinci’s most famous paintings, as well as another great painting, Antonio Veneziano’s â€Å"Virgin and Child†(c. 1380). Both paintings focus on the human form and exhibit many variations of styles from lines, shading, color and possible meanings behind the work. The first piece of artwork that will be looked is from the Renaissance Era. Da Vinci’s â€Å"Mona Lisa†(c. 1519) a painting that is known around the world, which has been known to cause skepticism as to who is this woman. Did she really exist? Or is this merely a self-portrait that Da Vinci was able to show his private devotion for the female form? The second piece of artwork that will be discussed is from The Middle Ages. Antonio Veneziano’s â€Å"Virgin and Child†(c. 1380) both pieces of art work stem from different eras but share many commonalities as well as shows the transformation of art techniques from Sfumato, to perspective, as well as linear perspective, Humanism, foreshortening and more between each era. In the Early Renaissance Era, artists from Da Vinci, Michelangelo, Raphael Sanzio, Piero della Francesca, Sandro Botticelli and more, developed a passion and ability to create art that could capture a moment may it be a beautiful moment or tragic moment. These artists were also able spark creativity and question in the human mind as to what is or was and why. Much like the middle Ages, art from both eras focused on religious forms, humanism, from the finite details of a lock of hair to the muscle tone. The Renaissance era developed the linear perspective to create; depth and angles in work, though the Middle Ages opened the door for linear perspective to be created. Most depictions from the Middle Ages showed a human form that was stiff and schematic, like a rough draft that was never completed. However art from the Renaissance Era had a profound effect on European art. Lilian H. Zirpolo (SNHU. â€Å"Chapter 8.† 2012 FAS 201, Introduction to Humanities I.) Stated â€Å" The outburst of creativity of the era, resulted in the most influential artistic revolution ever to have taken place.† There was so much depth and thought put into Renaissance art that it was the stepping-stone for all who dared to create. Da Vinci’ s the â€Å"Mona Lisa†(c.1519) holds Miss. Zirpolo’s statement to be true. When viewing the piece, one can see the exquisite line work and Foreshortening, to linear perspective. This art form shows his attention to detail and his passion for his work. The â€Å"Mona Lisa† (c.1519) is a small piece of artwork that became very popular. To this day the â€Å"Mona Lisa†(c.1519) still triumphs over Michelangelo’s â€Å"Creation Of Adam† (c.1511), which became a part of the â€Å"Sistine Chapel.†(C.1512) When one views â€Å"The Mona Lisa† they can see the dark color scale that is used, perhaps to depict an unhappy time. Da Vinci through out this piece is able to use an aerial perspective within the background of this portrait. Da Vinci was the first artist to successfully depict an aerial perspective. Da Vinci also uses Sfumato in his negative space by blending, blurring and softening the landscape, this technique is used to create a gradual transition between areas of different color, avoiding sharp outlines, to which I believe was done as to not take away the focal point in his positive space of the canvas. Another great aspect to the â€Å"Mona Lisa† is that is demonstrates the art of science discoveries that came to fruition in the Renaissance period, which is that they were able to acknowledge how the eye perceives light, thusly how light reacts with colors and how the human eye adapts to the change in color and light. So why is that of any significance in art? Well when one takes a painting such as the â€Å"Mona Lisa† once can see how the color gradation changes to separate the neck and face from her clothing. It creates more of a realistic feel to the art. The Middle Ages on the other hand focused on two-dimensional compositions, their depictions of humans were frail and stiff, and the human art form was inert. (SNHU. â€Å"The Middle Ages.† 2012 FAS 201, Introduction to Humanities I.) Like art from the Renaissance, they also focused a lot on Religion, saint hood and humans. In fact it depicted the importance of humans based on the size they were painted or sc ulpted. It focused on women and God, as the two were of major importance at the time. Woman we scared and givers of life and love, their beauty was unfounded and they were cherished. God was the almighty and the one who created a life form that woman were there to carry on the tradition, so to speak. Is it believed through the Bible and studies that Jesus was born into this world as a miracle from a virgin. So Antonio Veneziano’s â€Å"Virgin and Child†(c. 1380) upholds that belief and leaves room for discussion. In the early times of God and Mary and the birth of Christ it was believed that Immaculate Conception was possible, as pre-martial sex was a sin. So to have depictions of such a scene may make one wonder if it was at all possible at one point in time. This picture depicts a Virgin mother coddling her newborn, both are pictured with a â€Å"halo† above their heads which signifies the importance of their religion and the acceptance of religion into not only their life but into Gods life. As you can see here as well as in the â€Å"Mona Lisa† there is a contrast between light and dark as to separate the two bodies and distinguish the Virgin from the Child. In a personal opinion in the color choice of the Virgin as compared to the Child, I would say that light colors are used for the child because he is born pure and free from sin, where as the Virgin is with sin and thusly wears a dark robe. Art from the middle ages depicts religious events, because it was the basis of life at the time. Most art from that time were done by artists who either choose to or had to be anonymous, they we for the most part two dimensional pieces of art work with a single color background, which when looking at Antonio Veneziano’s â€Å"Virgin and Child†(c. 1380) one can see how this, the background is primarily one color, it has been shaded to show detail in the halo and architect, but holds close to the standard for Middle Aged era art. Though the painting is set fourth to show a natural pose of a mother and child, the line work and attention to detail in the human form lacks. This painting though a well painted, blends the line work of the bodies making the figures seem almost uncomfortable in their poses. The colors used in this painting may foreshadow an unhappier time for the two, as dark colors tend to represent tragic, mournful and displeased events. As one can see the â€Å"Mona Lisa† from the Renaissance and the â€Å"Virgin and Child† from the Middle Ages, share many similarities in terms of their impressions of humans. Both eras focus their art on humanism, religious, two and three – dimensional works of art, the hatching used to create depth and more dimensions. Both the Renaissance and the Middle Ages have very different ways of executing the precision of the human form. The Renaissance paid very close attention to detail, the line work that is depicted in the human form is natural and lifelike, and where as artists from the Middle Ages who painted humans were stiff and motionless. Though both Eras have great works of art, it was the Renaissance that had more of a well-rounded and idealistic way of executing their work, thusly making it one of the better Eras for art. Resources Page: SNHU. † Chapter Seven The Middle Ages.† 2012 FAS 201, Introduction to Humanities I. SNHU. † Module Eight The Renaissance, Reformation and Age of Exploration.† 2012 FAS 201, Introduction to Humanities I.