Nursing research Essay Example | Topics and Well Written Essays - 750 words - 12

Nursing research - Essay Example Other areas that will improve my capacity as a professional include career assistance, availability of information on databases and targeted products and resources, including newsletters and online CE. Through exposure to these informative resources, professionals and knowledge areas, I will improve my knowledge base and the capacity to offer quality care. As a professional in the medical profession, I am required to offer my entire work time – and in some cases my personal time – towards the delivery of healthcare services, which are the source of my livelihood. Therefore, as a permanent employee in this sector, almost all my time is spent on work – particularly patient care. However, there are other professional activities that I am required to take, either for certification or for personal development. These include attending professional seminars, educational conventions, professional examinations, assisting other professionals and contributing to the knowledge-base available at professional associations. Balancing between the career and these other professional activities is difficult, as they improve my career and professional development, but at the same time – I am required to execute my duties as a professional, to the fullest. Through evaluating the activities that must be taken and those that req uire my continued physical and mental presence has helped me give priority to my services at the hospital. After completing my service dues, I am able to engage in the other activities, most times during my free time, and when I have work breaks. Through prioritizing, I have been able to balance between my career and the other professional activities. From a personal point of view, being a member of an organization is beneficial to a nurse. These benefits include that the nurse is exposed to educational programs, organizational conventions and seminars, and they are able to network for help and information with other members

Computer System Infomation Essay Example | Topics and Well Written Essays - 500 words

Computer System Infomation - Essay Example It is constantly upgrading its search engine. Apart from this it has constantly tried to add value to its Google search users like Google alerts, Google news. Till now Google's main raw material has been in the domain of free content, whereas the new business it is entering requires partnerships and networking for content. For doing the new business the organization will require new skills in customer service, negotiations and networking. Meeting customers' expectations and partners needs will become very important. As an organization it has been leveraging its technical skills to drive the company. As of now, as an organization, it has not been able to adequately respond to problems related to customer satisfaction. Many of its customers have suffered using their AdWords product. Some of its products have created conflict with its partners in copyrights and other Intellectual property related aspects, which have not been adequately resolved. This is an area which Google does not seem to have identified as a problem area and looked for solutions. Google has attracted a large pool of talent in the IT sector to develop innovative products for its growth. Now it needs to translate organizational needs to be met through human resources.

Dead Poets Society Essay Example for Free

Dead Poets Society Essay Both The Mosquito Coast and Weir’s next feature, Dead Poets Society (1989), foreground fathers myopically invested in misguided personal aspirations. A significant critical and commercial success, Dead Poets Society is a period piece set in the 1950s in Welton College, a private boys school, at the heart of New England’s establishment. It is a study in the mechanisms with which the ruling class absorbs and expels rebellious influences before proceeding undeterred in its primary mission of reproducing itself. As in Picnic, Weir introduces eager young lives both oozing potential and straining under expectation. In both period pieces Weir deftly establishes the restrictive weight of the institution’s traditions through repeated interior, constricted compositions. Here, however, the challenge to the status quo, far from being a mysterious force, is an enthusiastic, unconventional teacher, John Keating (Robin Williams), who nevertheless will play a role in leading the boys to a traumatic awakening. Keating’s passion for literature moves his students to personal quests of self-expression: â€Å"Make your lives extraordinary†, he pleads. The film evokes the American spirit of democratic self-actualisation, as epitomised by the poet Walt Whitman, a portrait of whom Keating displays in his classroom and gestures toward when inciting the boys to emulate his free spirit. Inspired by Keating, the boys re-establish the â€Å"Dead Poets Society†, a club that Keating himself had participated in when a student at Welton. They convene at night in the romantic setting of a nearby cave and share poetry. Keating’s encouragement proves most successful with one of the â€Å"Dead Poets†, Todd Anderson (Ethan Hawke), a teenager so neglected by his parents that he is fearful of human interaction, and petrified of public speaking. Weir subtly conveys the evolving effect Keating’s presence has on Todd, through dexterous camera placement in a series of scenes. In the initial scene, Todd chases his roommate, Neil Perry (Robert Sean Leonard), around their dorm room, trying to retrieve a poem he was composing as an assignment for Keating, which Neil is now playfully reciting aloud. The camera captures the action in a continuous spiralling, pan shot of the boys running in circles within their confined space, creating a spirited, flowing sense of movement. Later, in a long take (28 seconds), the static camera observes Todd, again in his room, as he reads his poem to himself while walking in circles. He is initially pacing at a steady rhythm and smiling to himself, animated by his work, but he then gradually slows and begins to look less sure, before ultimately stopping and despondently tearing up his poem. A cut transfers us to the boys’ classroom the next day, where they are reading their compositions. Todd cowers, insisting he did not prepare a poem, but is encouraged by Keating to usher forth inspiration from Whitman’s portrait for an improvised composition in front of the class. As Keating covers Todd’s eyes, eliciting poetry from the student, the two walk around in continuous circles, followed by the camera, which in turn circles around them in a continuous shot. The effect is a vertiginous one of dizzying movement, which captures the moment of release and rupture for Todd, as he overcomes his inhibitions and spontaneously recites a heartfelt creation, eliciting impressed silence, followed by applause from his classmates. This series of circular movemen ts, suggesting Todd’s burgeoning capacity for self-expression, represents Weir at his most subtle and sophisticated. Todd’s ability to spontaneously compose and recite is rendered all the more persuasive by the almost subliminal referencing of the previous moments of circular movement. Keating’s influence holds different consequences for Todd’s roommate, the kind and charming Neil Perry (Robert Sean Leonard). When Neil’s father learns that his son has discovered a passion for theatre, he forbids him from performing in the local production of A Midsummer Night’s Dream. Neil defies him, only to be informed after the performance that his father is removing him from Welton the next day and sending him instead to military academy, after which he will attend medical school. The news constitutes a ten-year sentence for the artistically inclined teenager, who cannot bear the prospect. That night, in a haunting sequence of elisions, we learn through his parent’s distraught, slow motion reactions that Neil has killed himself. John Keating is indirectly blamed for Neil’s death and the school authorities coax some of the boys Keating had taken into his trust into condemning his unconventional teaching. Rather than presenting a facile depiction of a repressive establishment’s collapse against the ultimately victorious seekers of self-expression (a favourite American tale), Weir explores the scapegoating mechanism through which the establishment responds to a challenge to its symbolic order. As Keating’s class sits sheepishly, listening to droll instruction from the school principal who orchestrated Keating’s dismissal and who is now teaching his poetry class, their former teacher enters the room to collect his belongings. Before Keating leaves, Todd, previously unable to talk in front of a group, boldly stands on his desk (a position Keating had occasionally encouraged them to assume in order to â€Å"change their perspective†) and turns in one last circular motion, this time to face Keating and address him with the teacher’s favourite Whitman address, â€Å"Oh Captain, my Captain†. Rousing music builds to a crescendo as the school principal repeatedly orders Todd to get down or risk expulsion. The boy stands firm, looking more composed than ever before, as various other students follow his lead. A high angle point of view shot reveals Keating, with eyes watering, from Todd’s vantage point. With this final scene of defiance, Weir suggests that the seeds of discontent that will usher in the counter-culture of the 1960s have been sown.

Definition of lifespan development or lifespan psychology

Definition of lifespan development or lifespan psychology The definition of lifespan development or lifespan psychology is implicit in the term itself. Lifespan developmental psychology or lifespan psychology deals with the study of individual development from conception into old age (Baltes et al 1980). This definition implies the notion that an individual progresses through various developmental stages or phases throughout his or her lifetime. The theories that present the development of an individual in stages is known as stage theories. In analyzing the stages of an individuals lifespan, many theories have been posited by a number of psychologists who have studied particular aspects of the lifespan. Some of these theorists are Jean Piaget, who posited the cognitive developmental theory. During the 20th century, he was one of the most influential researchers in the area of developmental psychology, and posited that individuals progress through four stages of development in mental and reasoning capacities. There is also a psychosexual theory, posited by Sigmund Freud, the father of psychology. He believed that the individual progresses through five stages of sexual development, each of which has a relating psychological principle. Freud believed that if each stage of sexual development was handled well, the individual would evolve into a mature, well-adapted person. A few other theorists are Erik Erikson, who posited the psychosocial theory of development; Lawrence Kohlberg, who posited the theory of moral development ; and James Fowler who posited the psycho spiritual theory of human development. The study of Lifespan Development is of extreme relevance and importance to the Counselling and Consulting Psychologist. The theorists, through years of research, provide a sound basis for understanding the individuals progression through the lifespan. As can be seen from the preceding paragraph, various theorists pay attention to specific aspects of human development, for example, Erikson primarily studied the psychosocial development of the individual. In this way, they were able to spend much time in observation and preparation, thus making the theory reliable. The theories provide a guide as to the developmental stages and expectation of each stage across the lifespan. Therefore, being aware of each theory and its basic tenets will arm the psychologist and give him a birds eye view into the functioning and capabilities of the client. The theory will assist the psychologist to easier detect what may be the clients presenting problems. As with all theories, the theories of Lifespan Development should not be accepted as laws, but simply as guides to the developmental stages through which an individual may progress. The constant nature-nurture debate is ever present in the study and practice of Lifespan Psychology. The individuals nature, that is, his or her genetic make-up and biological predispositions; as well as nurture, which is the environment in which he or she exists, (and there can be several environments, such as school, home, church) contribute to the individuals development. Because of this, the theories cannot be taken as rigid and inflexible boundaries in the psychologists practice. This paper, will discuss the application of lifespan psychology to two cases that may be faced by a counselling psychologist. I will also include discussions on how my own experiences and development would influence my counselling ability and technique in relation to the two scenarios. The first scenario describes a 16 year old girl whose biological mother migrated to England when she was 5 years old. She is now living with her grandparents. Her father is unknown, and her mother has made contact three times since she migrated. There has been no visitation. The 16 year old is suffering from symptoms of withdrawal, tearfulness, and anxiety. Immediately, attachment issues spring to my mind. Attachment may be defined as the strong affectional tie between infants and their caregivers (Baron, 2001). John Bowlby did much research on attachment in humans (1969, 1973, 1977, 1980). His theory holds that the early experiences of infants attachment become cognitively represented in the form of internal working models of the self and others. These models take in expectations about self-worth, and the extent to which others are reachable and responsive in providing support and protection. These models continue to develop over time. He found that attachment does not emerge suddenly, but rather, develops over four phases. Based on this theory, Schaffer (1996; cited in Santrock, 2008) identified four stages of attachment: Phase 1: Birth to 2 months. At this stage, infants instinctively turn their attachment to humans. Even strangers are likely to elicit crying or smiling from the infant. Phase 2: 2 to 7 months. At this stage, attachment becomes focused on a single figure, which is usually the primary caregiver, and the baby gradually learns to distinguish between familiar and unfamiliar people. Phase 3: 7 to 24 months: Here, specific attachments develop. With increased locomotor skills, babies actively seek contact with regular caregivers. Phase 4: 24 months onward. Children become aware of the feelings of others, as well as others goals and plans, and they begin to take these into account in forming their own actions. In one research known as the Strange Situation done by Ainsworth (1979), based on Bowlbys attachment theory, she identified four types of attachment. Most infants show secure attachment, which means that they freely explore new environments, using the caregiver as a secure base. They may or may not cry when the caregiver leaves the room, and later when she returns, the babies actively seek contact with her, stop crying quickly, and soon return to previous activities. Another group of infants, based on Ainsworths test, displayed insecure/avoidant attachment. These infants do not cry when caregivers leave the room, and react in much the same way to strangers as to their caregivers. They do not usually reestablish connection on her return. If contact is established, the infant usually leans or looks away. A third group of infants displays a pattern described as insecure/ambivalent attachment. These babies usually cling to the caregiver and then resist her by fighting against the closene ss. In the research, these infants often cling anxiously to the caregiver, cry loudly when she leaves, and push away if she tries to comfort them on her return. The final group of babies was described as having insecure/disorganized attachment. These babies were shown to be disorganized and disoriented. They may also appear dazed, confused and fearful. Early attachment to a caregiver is important and relates to a childs social behaviour in later development. In one study conducted by Alan Stroufe and his colleagues (2005; cited in Santrock, 2008), it was found that early secure attachment (occurring between 12 and 18 months) was linked with positive emotional health, high self-esteem, self confidence and socially competent interactions with peers, teachers, and romantic partners through adolescence. According to Santrock (2008), consistently positive parenting over a number of years is likely an important factor in connecting early attachment and the childs functioning later in development. It can be assumed that the young lady in the presented case, whom we shall call Ana, had formed an insecure attachment to her mother in her infant years. Based on the research and the presented information, Ana would more likely be socially competent, had she formed a secure attachment. This is not to rule out other factors which may have been present in her environment. However, it could be argued that her mother was not sensitive to Anas signals as an infant, and so, Ana may have developed this insecure attachment. Further to that insecure attachment, is the fact that she was left with her grandparents at the tender age of five years. Along with all of that trauma, Anas father is unknown to her and the subsequent parent-child contact with her mother was woefully insufficient. It may be that Anas mother was busy trying to manage the stresses that come with single parenthood, including how to create a financially stable environment, in the years following childbirth. The result: Ana is now withdrawn and experiences tearfulness and anxiety which may mark the beginning of a depressive disorder. Based on the information presented in this theory, the therapy session with Ana, , would lead me, the therapist, to ask questions about the relationship she had with her mother, prior to her leaving, and also that which she has with her grandparents. Are the grandparents supportive? I would also like to know how Ana views herself now. What kinds of activities is she involved in? And how does she handle these activities, and even social relationships? These questions would give insight into her feelings of self-worth and self-esteem? As therapist I would ask what changes have occurred in Anas recent life. It may be that a particular situation, such as a romantic relationship, (whether starting or ending) has brought on the feelings of anxiety and the reactions of tearfulness. Obviously, knowledge of Bowlbys theory of attachment would be helpful in managing this particular case. Another theory which may be useful in assessing Anas case is Eriksons psychosocial model. Eriksons theory is a cumulative stage theory. This means that successful completion of each stage is a prerequisite for completing the subsequent stages. Each stage is recognized as a psychological crisis which needs to be solved, with each of these crises having a positive and a negative outcome. A healthy resolution of each crisis, that is, where the outcome is positive, will lead to a mature, healthy, and emotional competent individual. For the purposes of responding to the case, I will focus only on the first and fifth stages. Trust vs. mistrust is the first psychological crisis to be resolved by the individual and focuses on age zero to 1 year old. This first stage centers around the infants basic needs being met by the parents as it depends on them, especially the mother for food, sustenance, and comfort. The infants relative understanding of society comes from the parents and their interaction with the child. If the child is exposed to warmth, regularity, and dependable affection, the infants view of the world will be one of trust. If this does not happen, and the caregivers fail to provide a secure environment, a sense of mistrust will result. Erikson believed the major developmental task in infancy to be learning whether or not other people, especially primary caregivers, regularly satisfy basic needs. If caregivers are consistent sources of food, comfort, and affection, an infant learns trust that others are dependable and reliable. If they are neglectful, or perhaps even abusive, the infant instead learns mistrust that the world is in an undependable, unpredictable, and possibly dangerous place. This early stage in development sets the pace for subsequent victories in development across the lifespan. If Ana had learned trust The fifth stage of Eriksons theory is identity vs. role confusion which spans the adolescence years about 10 to 20 years of age. It is at this stage, according to Erikson, that adolescents are faced with the task of deciding who they are and where they are going in life. These questions become especially important as the adolescence years are reached because adolescents face an overwhelming number of choices. As a therapist, I cannot overlook the fact that there might be situations in therapy that would remind me of some of my own issues, and my own history. As I look at Anas case, I am concerned about what she has faced as a child in being left by her mother, not knowing her father, and now suffering from feelings of anxiety and tearfulness. It would be lovely if every mother could be like mine. I remember my mother saying to me years ago, when a serious issue arose with a child we know, that she had had the opportunity when her children were quite young to go abroad and make a better life. However, as a young, (first child born at 16) unemployed mother, she understood the importance of mother being present and active in the lives of her children, and chose to stay. As I ponder Anas situation I would need to be mindful that not everyone will, or can make the choice that my mother did. Actually, there are many success stories involving a single parent living abroad, while their children live in Jamaica. I do know my strengths, though, and despite the fact that this case would arouse some memories for me, I would be able to maintain clarity of thought and principle. Good professional ethics would have to win out as I would be careful not to let my values overshadow the counselling relationship, so that Anas situation can be dealt with as quickly and efficiently as possible. In the second scenario, a 25 year old male has been referred because of three counts of sexual harassment in the workplace over a 6 month period. He has inappropriately touched three women, two on the breast and one on the bottom. He expresses no remorse and believes the women are overreacting. He is a university graduate and is still living at home with his parents.

Mother Loves Me :: essays papers

Mother Loves Me Children usually form a powerful and unseparable bond with their family. These fortunate angels get all the love and attention they call for. But for children less fortunate, they are also in need of love and care. For example, Jerry, a twelve year old orphan in the short story A Mother in Mannville by Marjorie Kinnan Rawlings, had experienced his young life without a family. He was sent to the orphanage at the age of four. However, as he started to spend time with the writer who lived in a cabin below the mountains, Jerry felt a great maternal affection towards her. They became very close and, hence, developed a strong relationship between them. For Jerry and all children, a child's true wish is for their mother's love. A period of time after Jerry had been with the writer, he developed a strong affection towards her. One night, sitting with the woman in front of the warm fire, Jerry became sentimental, telling her that she looked a little like his mother. He told a moving story about his mother, who lived in Mannville, and how she always sent gifts to him on Christmas and on his birthdays. But the story was later revealed that Jerry never had a "mother in Mannville." He fabricated the lie because he loved the writer just as much as he would love his own mother. Jerry felt that the woman was very close to him, and being with her gave him a warm feeling-a feeling like home. Even the writer's dog, Pat, was intimate and never barked at him. To Jerry, the writer and Pat were a part of his life. If Jerry never felt this kind of motherly love from the woman, he would not have lied about his "mother in Mannville." In other words, if the writer was not as nice and understanding, Jerry would not have lied. He would never want a mother who does not care about him. When Jerry lied about his mother, he wanted the writer to realize that he was really referring to her as his "mother." There was no distance between them and Jerry always felt safe and comfortable to talk to her. But if Jerry never sensed the passion and

Social Control Essay -- Sociology, Crime

Society is possible through social control. Without social control society would be left in anarchy. Social control is the â€Å"concerted efforts to constrain and direct the conduct of people by inducing conformity and preventing non conformity (Welch, Lecture, 2011).†Ã¢â‚¬Å"Social control is any action, either deliberate of unconscious, that influences conduct toward conformity, whether or not the person being influenced are aware of the process (Hemmens, Walsh, 2011, p.224).† Social control aims at creating a peaceful coexistence that allows society to live in a predictable manner. To the degree that members of a society abide by group rules and expectations, they will be able to know with some degree of certainty what others will do in a variety of situations (Hemmens, Walsh, 2011, p.224).† Society could not function with out a large amount of predictability. For example, drivers know not to drive through red lights because they have been socialized to understa nd the consequences of doing so. This allows the drivers crossing through the green light to predictable know that they can do so safely. To ensure predictability, social control also works to minimize non-conformity and deviance. Non-conformity challenges society’s sense of safety, security, propriety, and freedom (Hemmens, Walsh, 2011, p.224). Social control is exerted through formal social control and informal social control. Formal social control is â€Å"efforts by official agencies, acting in their designated capacity, to constrain and direct the conduct of people (Welch, Lecture, 2011).† Formal social control uses codified rules and regulations, or laws, which are punishable if violated. The criminal justice system uses formal social control in its practice. When individuals vi... ...ast as they could. If the police were more concerned with protecting Ron’s due process rights, Ron would have been protected from such an overzealous investigation and prosecution. Due process is the â€Å"equal treatment before the law; the constitutional mandate that criminal proceedings, from police to corrections, follow established rules or principles, that similar cases be handled in a similar fashion, and that a no person shall be adjudicated guilty without sufficient safeguards against state power (Welch, Lecture, 2011).† If Ron’s investigation and trial took the time to ensure that his rights were not being violated, and also weren’t tainted by police malpractice, Ron wouldn’t have been convicted of a crime he didn’t commit. An innocent man was put through a corrupt criminal justice system, and almost died because his due process rights were violated.

Effective communication for and about individuals Essay

Promote effective communication for and about individualsExercise HSC031A) What are the legal requirements on equality, diversity, discrimination and rights, relating to: individuals language and communication preferences?Equal treatment for language and communication. When completing records?As I work within the NHS, the ICU follows the National Institute for Clinical Excellence Equal Opportunities (2000) policy it states that“It is the policy of the Institute to work towards ensuring that no recipient of its services, present or future employee or job applicant receives less favourable treatment on the grounds of:- age, colour, creed, disability, ethnic origin, marital status, nationality, race, religion, sex, sexual orientation, social status, trade union membership” (NICE 2000)This affects communication as it states that we must do everything in our power to provide equal service levels to everyone. For example if a patient speaks a foreign language, there is a communication barrier, so we must provide any information to them in their native language, whether that be through an interpreter or translated leaflets. The trust recognises that promotion and regular communication of the policy is important to ensure that individuals understand their commitment to equal opportunity and are aware of their own responsibility regarding equal opportunities and know how to raise concerns or make complaints and are confident that these will be handled effectively. E) What is the code of practice and standards and guidance relevant to your role, responsibilities and accountability, and duties of others when communicating difficult, complex and sensitive issues and reporting and recording?As a health care assistant the official code of practice and standard that I should follow and understand are laid down by the General Social Care Council in the Codes of practice: for social care workers and employers (2002) this covers most of the core standards which as a care worker I must follow. But I am also under the guidelines set down by the Nursing and Midwifery Council (NMC 2005). To ensure that I gain the trust of my patients, I should recognise them as equal partners, use language that is familiar to them and make sure that they understand the information you are  giving. As far as record keeping goes, I should make sure that any records I make must be clear, legible and accessible to the patient or client, as outlined by the NMCÂ’s document Standards for Records and Record Keeping (NMC 89346) and under the terms of the Data Protection Act (1984) and the Access to Health Records Act (1990). Both these documents state that all communication about patients whether written or verbal are completely confidential. F) Where can you seek advice from regarding an individuals communication and language needs, wishes and preferences?When a patient has communication and language needs the first person I would ask would be the patient, to access for myself the communication needs. I would then look at the patients notes and finally I would ask the staff nurse looking after the patient or the district nurse if they are in the community. If I still need more advice or there are still communication difficulties, I could refer the patient to the speech and language therapy department. If the difficulty is a language barrier I could try to contact a language and interpretation service. It is vital to understand that wherever possible the patientÂ’s wishes should take priority in the decision taking over communication needs. G) How can you and were can you access information and support to update your knowledge and gain further assistance to meet the individuals communication needs. There are several places that you can access information to update your knowledge both on a personal level and on an individual client basis. You can update your communication knowledge by keeping up to date with all the guidelines surrounding communication, such as the journals on new communication methods and studies or spend time with the speech and language therapy unit to improve your communication skills. On an individual client basis, the first place to look for information on  improving your communication with the client is from the client themselves. By checking for responses and reactions, both verbal and non verbal you can judge whether your communication methods are effective. Then to further gain knowledge and understanding, you can refer them to a specialised service to meet their needs depending on what the communication need is. For example there may be a language barrier, in this instance, first see if there are members of family who could translate (where appropriate with patients understanding) as patients often feel more comfortable with a relative translating for them, if this was not available or inappropriate, I would track down the translators service and refer the case to them. H) What are the theories relevant to the following:-Specific conditions in your area of practice that can affect communication skills, abilities. In Intensive care effective communication can be difficult for a number of reasons, they can be environmental problems, physical or mental problems, like the patients consciousness levels could be effected, either drug induced or pathologically based, there may be visual and hearing problems and environmental problems, such as poor lighting or a noisy situation. The patient may not be able to make sense of the communication, they may use a different language or dialect or may not understand the jargon or professional terms used. Many of the patients on Intensive care are heavily sedated, so effective two way communication with then is almost impossible, also most of the patients that are not sedated are on high levels of medication, which can cause drowsiness and confusion. Of the patients that are lucid enough to communicate coherently, the most common communication problems are the problems of those who have ventilation support, either they have a tracheotomy tube in place, which means that air does not pass through the voice box so they have no voice, or they have a BiPAP mask to assist with breathing, which restricts the ability to speak and be heard. How can communication and language differences affect the identity, self esteem and self image of those you work with?“Self-esteem means  Ã¢â‚¬Ëœappreciating your own worth and importance’ – and it helps you to cope better with the challenges of life” (Tracy Turner BBC)In ICU patients that have a Glasgow coma score (GCS) of 14 or 15 and are on little or no sedation, in other words able to understand where they are and what is happening to them. Communication problems can have a huge influence on identity, self esteem and self image. Especially in ICU as the communication difficulties are usually new problems for the patient due to illness and the treatment. For example a person has a tracheotomy, firstly they loose their voice, which many people feel is part of them, it make who they are, so this detracts from self image and identity. But the main factor is that they loose the ability to express themselves with ease, so they can loose self-esteem. One of the major thing is, as they canÂ’t express themselves in the way they are used to, so a person whose self-esteem is low, will tend to feel that what happens to them is beyond their control. Studies have suggests that self-esteem is likely to have a major effect on their mental and physical health. How can power be used to abuse people when communicating on difficult, sensitive and complex issues?One major thing that people with communication difficulties experience, is loss of power. The person/carer who is looking after someone with communication difficulties, whether they be sensory deficits or other difficulties, is that they ( the carer ) is acting as interpreter and has the power to interpret the patients needs and wishes in their own way, even ignoring the persons wishes and carry out tasks that they want to. This is why training is essential for effective two-way communication. An example of this would be the situation of a stroke patient with paralysis down one side, so was unable to feed themselves and has mild dysphasia. In a lot of cases the care giver thinks they know what is best for the patient, with no consideration for the patients wishes, In many cases all the carer wants to do is feed the patient so they have a full diet but the patient may not like the “mashed carrot” but because time is tight and the carer just wants to get the plate cleared, they pretend not to understand the patients attempts to communicate that they would prefer the  Ã‚“mushy peas”. A lot of abuse is not actually intentional, much of this comes from lack of proper communication skills and the carer not taking the time to listen or try to understand the patient. They have a job to do and a set amount of time to do that job in and in most cases think they know what is best for the patient. Often when patients do try to communicate their unhappiness the are treated to a barrage of patronizing ‘awwsÂ’ and ‘come on dears you need to do thisÂ’, orÂ’ arenÂ’t you being silly todayÂ’ almost treating patients like children, they can even be labelled as trouble makers. It is much different for the patient who can communicate fully, they state their discomfort in a clear and concise way, it is much harder to make somebody do something if they say straight out ‘no I donÂ’t like thatÂ’. On ICU the situation is slightly different as a lot of our patients are on medications which will affect their mental capacity and perception so their communication difficulties are harder to resolve. So to determine if someone is of sound mind we use assessment tools to determine how able a patient is to make there own decisions (GCS & Sedation score). I) What factors can affect communication skills, abilities and development of those you support?In the ward environment there are many factors that can affect communication with the patient, they can be broken down into two main categories, environmental factors and personal factors. Trying to talk to someone in a noisy environment where there are continual interruptions leads to frustration, lack of understanding and poor concentration. Similarly individuals are often disinclined to discuss personal information or express strong emotions if they can be overheard or seen. Other environmental factors may relate to time available to talk. Carers often feel under pressure to ‘get the job done’ and their workloads may either inhibit clients ‘I don’t want to bother the nurses they’re so busy’ or result in the carer communicating poorly because of pressure of work. VanCott (1993), Identified some of the personal factors that can effect patient communicationIndividual Carers may lack the knowledge, experience and skills to promote effective communication. Also in health care medical jargon is common, but can appear as a foreign language to someone receiving care. Use of words that are not within the client’s own vocabulary generally results in misunderstandings and poor communication. There is also a tendency to use vague, ambiguous or unclear questions or statements along with failing to verify their own understanding of the other person’s statements. A communication failure that often occurs is completing tasks with little or no explanation behind purpose behind actionsM) What conflicts and dilemmas may be created by difficulties in communication in your workplace?Moving away from patient/career conflict, one of the main sources of conflict in ICU it that of conflict between families and friends and ICU staff. As with any ward and care situation the next of kin debate comes up regularly and what is best for the patient. The law around patient consent and advocacy is a massive topic and very hazy in some areas as to whether the doctor has the right to decide treatment or whether a next of kin should be involved. Also there is visitation rights who can come in and who canÂ’t and who decides. N) What procedures do you follow when dealing with conflict?In most of the cases where conflict arises there are strict procedures to follow this usually means reporting the problem to a higher level of responsibility. A good example of this it the case of Luke Winston-Jones (BBC 2004) there was direct conflict between the doctors and parents over the best case of action for the child. In the end the problem was passed to the highest responsibility the courts. This would be the same in my workplace so far I have only had to report minor conflict up to my line manager. R) What is the difference between factual, opinionated and judgement? Why is this important when completing records?It is important when completing records to only fill in what actually happened or what your clinical  judgement was, not what your opinion is. An example of this would be when documenting what dressing you applied, you would state that in your clinical judgement what the best dressing would be and a factual account of applying that dressing. It is not good practice to document opinions unless your opinion clashed with that of somebody else, then you would state in the records that that was your opinion. A Factual account is something that is known to have happened or to exist, especially something for which proof exists, or about which there is information. Opinionated means having and expressing very strong feelings and beliefs, and believing that your own ideas are the only correct ones. Whereas an opinion is a person’s ideas and thoughts about something. It is an assessment, judgement or evaluation of something. An opinion is not a fact, because it is not possible to prove (or disprove) an opinionJudgement is the act or process of judging; the formation of an opinion after consideration and deliberation especially a formal or authoritative decision