The Most Disregarded Fact Regarding Best Mba Essay Samples Uncovered

The Most Disregarded Fact Regarding Best Mba Essay Samples Uncovered Lies You've Been Told About Best Mba Essay Samples Your essays can play a crucial function in communicating to the admissions committee why they ought to consider you over thousands of different applicants. Admissions officers would like to know who you are. They want to know what excites you. Admissions committee officers are on the watch for the finest possible candidate profiles. The Little-Known Secrets to Best Mba Essay Samples More to the point, the essays that follow are most likely to supply comfort, that there's no formula or singular means to craft a thriving answer. To successfully answer the question, there are a couple of things you will need to continue in mind. After editing is done, your thoughts, voice, and style stay intact. You should have your reasons, and our principal concern is that you wind up getting a great grade. 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Argumentative Essay on Banning Cigarettes Do You Support It

One of the most debated topics on the globe is smoking and the movements for banning it. You’re a lucky student once you’re assigned with the task to complete an argumentative essay on banning cigarettes! The thing is that this topic can be approached in many different ways and it’s up to you to decide which one you’d like to choose. Let’s imagine like you’re one of those cigarettes anti-fans eager to ban this harmful habit once and for all. What kind of arguments one can suggest to prove that smoking should be banned in bars, restaurants and all other public places? No more second-hand smoking! It is a well-known fact that second-hand smoking is one of the cancer causes. Second-hand smokers receive the same amount of harmful nicotine and other chemicals as the real smokers. Once smoking is banned, the amount of people who suffer from second-hand smoking will be reduced. Make sure to support your viewpoint with the statement that second-hand smoking reduction will also minimize the risk of cancer. Cigarettes banning will help smokers to quit Each smoking ban leads to a decrease in the number of cigarettes. With every banning law more and more smokers make a decision to quit altogether. In accordance with the information provided by the Mayo Clinic Nicotine Dependence Center representatives, the number the brain receptors that are longing for nicotine increase from the inhalation of tobacco. Once the number of receptors begins to decrease the need to have â€Å"just one more cigarette† decreases too, which, in turn, results in no smoking. All the bans also give smokers one more reason to quit smoking for it is really inconvenient to spend hours searching for a place where smoking is allowed. No more heart attacks! In accordance with the Journal of the American Heart Association, the cities where smoking in public places is banned have less heart attacks in comparison with the areas where smoking is allowed everywhere. Make sure to give enough space for statistics within your essay. It is recommended to mention that almost 225  000 cases of heart attacks (per year) can be prevented by means of smoking bans. Provide real-life examples of the fact that smoking bans tend to lower the risk of heart attacks not only among smokers, but also among the people who do not have this habit. Samples Download this sample Paper title: Argumentative Essay: â€Å"Learning To Save Energy† Academic level: College (3-4) Discipline: Sociology Paper Format: APA Sources: 0 Pages: 4 Download this sample Paper title: Argumentative Essay: â€Å"The Problem of Consuming Resources† Academic level: College (3-4) Discipline: Environment Paper Format: MLA Sources: 0 Pages: 2 Download this sample Paper title: Argumentative Essay: â€Å"Graduating University and Further Recruitment† Academic level: College (3-4) Discipline: Education Paper Format: APA Sources: 2 Pages: 4

The Doctrine Of Freedom Of Contract - 1504 Words

The particular focus of this essay is on how terms are implied. This is central because the courts intervene and impose implied terms when they believe that in addition to the terms the parties have expressly agreed on, other terms must be implied into the contract. Gillies argued that the courts have become more interventionist in protecting the rights of contracting parties thereby encroaching upon the notion of freedom of contract. The doctrine of freedom of contract is a prevailing philosophy which upholds the idea that parties to a contract should be at liberty to agree on their own terms without the interference of the courts or legislature. Implied terms can be viewed as a technique of construction or interpretation of contracts. It has been argued that the courts are interfering too much in their approach to determine and interpret the terms of a contract. The aim of this essay is to explore this argument further and in doing so consider whether freedom of contract is lost due to courts imposing implied terms. The essay will outline how the common law implies terms. The final part of the essay will examine whether Parliament, by means of a statute, or terms implied by custom restrict freedom in a contract. An overall conclusion on the issue will be reached. On the one hand it is evident that terms implied at common law can be ‘implied in law’ or ‘implied in fact’. Terms implied as a matter of fact are said to give effect to unexpressed intentions of theShow MoreRelatedThe Business Law Short Essay1215 Words   |  5 PagesUnfair Contract Terms) Act 2015 ()will affect from 12 November 2016. it has changed some sections to the Australian consumer law. Last version of this law only applicable to the individual consumer, Act 2015 extend the scope to the small business that employs fewer than 20 persons. This thesis will discuss the following questions; ï  µWhat is an unfair term under the new law and when will it apply? ï  µWhat is the legal effect if a court decides a contract term is unfair? ï  µExplain the doctrine of freedomRead MoreEssay about The Criticism of Social Contract Theories1232 Words   |  5 Pagesï » ¿Tatum Schneidmiller Justice Theory Assignment #1 Ward Churchills criticism of social contract theory clearly applies to classic social contract theories that we discussed.   However, Rawls adds the veil of ignorance concept to his more modern social contract theory.   A) Explain the basics of Rawls and Churchills arguments and how they each criticize classic social contract theories.   B) Discuss whether or not Churchills argument applies to Rawls modification and explain how and why it doesRead MoreThe Rules Of Law Must Be Prepared1632 Words   |  7 Pagesbind itself by contract. A sufficient reason to enforce a promise is based on a free will of exchange between the parties. The orthodoxy on the doctrine of consideration is described as incoherent, uncertain in scope and inconsistent with the intention of the parties. Lord Goff observed in White v Jones that[ [1995] 2 AC 207, at 262 - 3.]: Our law of contract is widely seen as deficient in the sense that it is perceived to be hampered by the presence of an unnecessary doctrine of considerationRead MoreAt Will Employment Law1374 Words   |  6 Pagesto cancel the contract at any time without consequence. â€Å"Employment at-will means that employers are able to terminate ones employment at any time, for any cause - with or without notice†, Rogers, S. 2012. By the late 1800’s the doctrine â€Å"At Will Employment† was established in the United States. The principle was valued at first by the employers because it allowed the employers to have exclusive freedom as to how they could operate their companies. The principle of this doctrine also gave theRead MoreAffirmative Action On Equal Rights1655 Words   |  7 PagesUniversal Human Rights declaration states that all human beings have a natural right to equal freedoms thereby providing the basis for proactive measures to guarantee the enjoyment of equal rights in employment. Discourse on the controversial employment edicts of affirmative action and exceptions to the at-will employment doctrine signify the ambiguity in the implementation of the declaration on equal freedoms. White-male employees feel that the preferential treatment of women and racial minorities atRead MoreThe Racial Contract And Sexual Contract Affect Poverty1495 Words   |  6 Pagesthey are inferior, u nequal to men. How do the racial contract and sexual contract affect poverty? Using Howard Zinn or other class readings, provide specific examples of what Mill calls: An expropriation contract An exploitation or slavery contract a domination or colonial contract Some ways that the racial contract affect poverty is the ?color-coded distribution of wealth?.1 Most of the worlds wealth is controlled by whites.1 The sexual contract can correlate with poverty in which some societies areRead MoreThe Law Of Obligation Is A Private Law1672 Words   |  7 PagesIntroduction Throughout history, the law of obligation has held such prodigious value in the face of private law. Being the heart of both Contract and Tort law, it is a pervasive phenomenon of our social life. Both Tort and Contract law protect the rights, and ‘that protection cannot be legitimately compromised to achieve the aim of just distributing’ . This proposition may be true in the late 19th century, in the present time, however, the law of obligation has been ‘built on the law of its predecessorsRead MoreMonetary Compensation For A Loss, Detriment, Or Injury? Essay1488 Words   |  6 Pagesdefined as ‘Monetary compensation for a loss, detriment, or injury to a person or a person s rights or property, awarded by a court judgment or by a contract stipulation regarding breach of contract’ (1). Also referred to as liquidated and ascertained damages, liquidated damages are damages whose amount the parties agreed upon during the formation of a contract which the injured party can claim as compensation upon a specific breach, unlike unliquidated damages which are not specified in detail in theRead MoreAssignment 2 – Employment-At-Will Doctrine. Forsha Anderson.1586 Words   |  7 PagesEmployment-At-Will Doctrine Forsha Anderson LEG500 – Law, Ethics and Corporate Governance Professor Lori Baggot April 28, 2017 Introduction The employment At-Will doctrine is in place to allow employment relationships to be restricted. It allows employers and employees to terminate a relationship at any time without cause. The doctrine will allow employees to quit without any fear of being held liable for any inconvenience or disruption to the business at the time of quitting. This doctrine also allowsRead MoreThe Extent and Location of Collective and Individual Bargaining in Britain and USA1435 Words   |  6 Pagesrepresentatives negotiate a contract with the management regarding wages, hours, benefits, and other terms and conditions of employment, such as protection from termination of employment without just cause. Once the contract is agreed to by the workers committee and management, it is then put to a vote of all workers at the workplace. Primary means of addressing American workers’ needs is through individual bargaining. In contrast to the UK, two facets of the system of individual contract rights in the United

Abcd free essay sample

In Parsons Journey the children are the only hope for Afghanistan s future. Do you agree? Children are the only hope for the future of Afghanistan because Varian and the others used to live differently than the other people in Afghanistan. One day Varian found a baby inside a bombed house and she took the baby girl along with her so that she doesnt get bored. Varian found ASPI in a cave who couldnt walk because he lost his leg in the war, ASPI scared Varian by saying that he Is holding a gun towards her and if she comes any further he will be shooting her.Still Varian as not angry or was not offended. Later on when they were friends she took care of ASPI she never use to make fun of ASPI as he Is not having a leg. Varian was a kind of girl who use to take care of everybody throughout the Journey through the villages. We will write a custom essay sample on Abcd or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page When Varian was going through villages, one day she saw a baby crying In a house where his mother was lying beside she said the boy you are Like my brothers height. This shows that Varian was a caring natured girl even If she Is having to many hurdles in her own life. ASPI was rude. E used to shout at Varian by saying bring some food by throwing the pot towards dont like people throwing things to me. .. If you want food go get it by yourself Varian said.. . Again he shouted back saying L cant walk cant you see that? How stupid you are, even though ASPI was rude she never used to be upset about that and still took him with him as he was all alone. Moreover when use to say her plans to ASPI about how she will be escaping from Afghanistan. He said that he was coming with her, Just to annoy her, but that was not the only reason for coming with her. This character shows that she was all et that she will take ASPI and Hosannas along with him to live a better life. Her imagination keeps them going. They found a girl named Leila, she takes them to her house and she also teaches them how to get food from the mines. They decided to stay for a while Varian use to educate ASPI what she knows. When they were out of food and were all hungry she was the one to go to the village and ask for job in change of food. Her dream was to live forever happily in green valley where there will be no bombs or no mine and they will live happily ever after.

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