Enteral and Parenteral Nutrition Essays

Enteral and Parenteral Nutrition Essays Enteral and Parenteral Nutrition Essay Enteral and Parenteral Nutrition Essay Which critically ill patients should receive TPN? Prof R D Griffiths in conjunction with Fresenius-Kabi Why are these guidelines required? In the critical care setting, nutritional support influences the outcome for critically ill patients. This guideline seeks to outline the important role of parenteral nutrition in the critically ill patient. Enteral and parenteral nutrition The enteral route for nutrition delivery is preferred where it can be safely delivered in the absence of gastrointestinal intolerance. For a small proportion of patients enteral feeding is not possible but in addition for a larger proportion of patients research consistently shows that enteral nutrition does not always cover the total nutritional needs of intensive care unit patients. There has been a reluctance to use parenteral nutrition (PN) or to supplement enteral (EN) or oral nutrition with parenteral nutrition (PN) for the perceived risk that to do so increases the infection and mortality risk. Systematic review evidence acquired from studies in the critically ill shows that while there may be an increased risk of infection there is no added mortality risk [ 1 ]. Parenteral nutrition has changed considerably over the last forty years and many of the complications were a feature of historical PN practice associated with its inappropriate use, unbalanced formulations and liberal overfeeding. Even the risk of infection may be more related to the underlying patient disease and indication for PN rather than modern PN formulations and delivery in ICU. Malnourishment It has been estimated that around 40% of all patients in hospital are undernourished and this is associated with further complications. Acute critically ill patients lose on average approximately 5-10% of skeletal muscle mass per week during their ICU stay [ 3 ]. Complications such as septicaemia in these patients are to a large extent caused by malnutrition and impaired immunological function [ 2 ]. Complications versus choice of nutrition route When correctly applied, the complications of PN are less likely to result in death compared with those of EN. Recent studies conclude that PN compared with early EN is risk-neutral overall [ 3 ]. It is reassuring that in critically ill patients, when used with EN in the ICU as a supplement, PN has been confirmed to be risk-neutral or may even offer benefits. However from current data it is not possible to justify the extra cost of supplemental PN when started concurrently with EN at the start of an ICU admission [ 1 ] but more importantly there are no studies where it has been started in the more appropriate situation after EN has been shown to fail in already malnourished ICU patients. It has been demonstrated that nutritional goals were reached in 22% of ICU patients fed via EN compared with 75% with PN [ 2 ]. It must be remembered that under nutrition is a debt that must eventually be repaid and this is also worse if it is compounded! The ACCEPT study showed that survival from intensive care was improved when an evidence based guideline for nutrition was followed and more nutrition delivered more consistently. This was achieved by earlier introduction and more complete enteral nutrition delivery without any decline in the use of PN alone or in supplementation. Using the guidelines These guidelines have been developed using a step-by-step approach as follows: Step 1ASSESSMENTDoes the patient require nutritional support? Step 2ADMINISTRATIONWhich route(s) should be used? Step 3ACHIEVEMENT (REVIEW)Are nutrition goals being met? Step 1 Nutritional Risk Screening (adapted from NRS 2002 ESPEN) Does this patient require nutritional support? Initial screening of patients is recommended in these guidelines but it is assumed that ALL patients fulfill the criteria for requiring a final screening assessment which follows. The adaptation assumes an affirmative answer to the question â€Å"Is the patient severely ill? (e. g. in intensive care) Impaired nutritional statusSeverity of disease (increase in requirements) Score 0Normal nutritional statusScore 0Normal nutritional requirements Score 1 Wt loss 5% in 3 months or foodScore 1Hip fracture. Chronic patients in (Mild)intake below 50-75% of normal particular acute complications of requirements in preceding weekcirrhosis, COPD. Chronic diabetes haemodialysis, oncology. Score 2Wt loss 5% in 2 months or BMIScore 2Major abdominal surgery, stroke, (Moderate)18. -20. 5 + impaired general condition orsevere pneumonia, haematologic food intake 25-60% of normal requirement malignancy. in preceding week. Score 3Wt loss 15% in 3 months or BMI Score 3Head injury, Bone marrow transplant (Severe)18. 5 + impaired general condition orIntensive Care Patients (APACHE 10) food intake 0-25% of normal requirement in preceding week SCORE+ SCORE= TOTAL SCORE AGE ADJUSTMENT (IF PATIENT ? 70 YRS ADD 1 TO TOTAL SCORE)= TAAS SCORE INTERPRETATION SCORE ? 3The patient is nutritionally at risk and a nutritional plan should be initiated. SCORE 3Weekly re-screening of the patient. If the patient is scheduled for a major operation a preventative nutrition plan should be considered to avoid associated risk status. Step 2Administration route(s) Nutritional support does influence the outcome of critically ill patients and evidence suggests that the consistent achievement of nutritional goals is important and this should if feasible be through the enteral route [ 7 ]. Evidence suggests that for most patients this is just as effectively and safely delivered through a naso-gastric tube compared to tubes sited after the stomach [ 1 ]. It must be recognized that problems do occur with all forms of enteral delivery and that delivery is more often attained by the parenteral route3 and this is apparent in critically ill patients where enteral nutrition is inappropriate, contraindicated or has failed. Parenteral nutrition should be used when the GI tract is not functional or cannot be accessed or when the patient’s nutrient needs are greater than those which can be met through the GI tract. However it should not be commenced in the non-malnourished as a supplement until approaches to enteral delivery have been optimized [ 1 ]. Assess the integrity and function of the bowel using the following prompts: IF THE ANSWER IS â€Å"NO† TO EITHER QUESTION – TIME TO CONSIDER PN Is the digestive tract functioning? Is the patient well nourished and recovery of gut function expected within 3 days? IF THE ANSWER IS â€Å"YES† TO EITHER QUESTION – TIME TO CONSIDER PN While using an enteral feeding protocol does the presence of excess gastric aspirates (e. g. persistently 150mls after measures to improve gastric emptying) lead to reduced enteral intake. Does the nutrition equirements of the disease or injury exceed that which can be delivered safely via the enteral route? Some patients with an intact GI tract do not tolerate enteral feeds or do not receive sufficient intake enterally or orally to meet their energy and protein requirements. The reasons for poor gastric emptying should be considered. Simple measures such as turning to the right side or reducing opiate intake may be tried along w ith short trials of either Metoclopramide or Erythromycin if other causes have been excluded. However gastrointestinal intolerance is an important and worrying sign and is associated with increased pneumonia and risk of death independently of illness severity . The supine posture is also associated with increased risk of aspiration pneumonia and if patients cannot be nursed in the semi-erect position parenteral nutrition may be a safer option whether it is used as a supplement or as the sole source of nutrition in these patients [ 6 ]. Choice of feed and amounts In the critical care setting estimation or measurement of precise requirements is fraught with error. A target of 25 kcal/kg/day for the first week is acceptable. Protein intake is the central component as this cannot be stored metabolically. Most evidence supports 1. 5 gm/kg/day as a reasonable target. Requirements change during an illness and generally increase in the second week and when patients become more active. Simple methods using patient size bands based upon accessible measures of body size (height or weight) should be used to calculate target amounts. More sophisticated individual patient calculations have not been shown to be any more accurate. Polymeric complete enteral feeds should be used for most patients and infused continuously. Evidence for the use of specific formulations is lacking, except that the immunonutrition cocktails that contain extra arginine should NOT be given [ 1 ] outside of the peri-operative setting where evidence exists. An all-in-one complete balanced parenteral formulation should be used and evidence based recommendations suggests where practical these should contain glutamine [ 1 ]. They should be delivered continuously through a dedicated lumen that should not be used for any other access. Some of the energy should come from lipid sources but there is paucity of evidence to suggest any particular lipid formulations although this may change as more advanced formulations come on the market. Caution should be applied when other lipid containing infusions are also in use (e. g. propofol). Lipid infusion is safe at rates up to 1. 5 gm/kg/day, and glucose should be given at 3-4 gm/kg/day. Use simple standardized regimens for most patients. Within ICU acute electrolyte management (e. g. potassium and phosphate) is more readily managed by separate infusions if safe systems exist. Patients on renal support will have increased nutritional losses so maintain on full feeding. Important when using either EN or PN Nutrition should be commenced at reduced rates especially in the malnourished until metabolic tolerance established. Increase to full target over a 3 day period and monitor for re-feeding syndrome. It is possible to overfeed with PN but unless glucose intake exceeds 4-5 gm/kg/day hyperglycaemia indicates peripheral insulin resistance and the need for additional insulin and not reduction in feed volume. Step 3 Are nutrition goals being achieved? Set targets and check nutrition intake daily and act upon the findings. It is recommended that calorie (and nitrogen) intake is calculated daily in addition to the fluid balance. Has the patient received the amount of nutrition prescribed over previous days? Nutritional support, once instigated, should be monitored to confirm the safety of treatment. The following guide illustrates the type of monitoring required. The tests required will depend upon duration and method of feeding. The frequency of testing will vary depending on the illness severity. Fluid balance and calorie intake and if possible weight. Urea and electrolytes daily (watch K+ as feeds may have only a modest K+ content) Blood glucose monitored frequently and preferably as part of a tight glycaemic control. Phosphate (This should be monitored closely especially when starting feeds in the malnourished) Plasma lipid clearance or triglycerides Full blood count Liver function tests, Calcium Magnesium Calculation or measurement of nitrogen balance is not reliable in the routine setting. Nutrition support algorithm summary ASSESS Is nutritional support required? 40% of patients admitted to hospital are undernourished REASSESS Supplemental PN? ADMINISTER Which route? Is enteral feeding practical and safe? If not consider PN ACHIEVE and REVIEW Are you satisfying the nutrient needs of the patient? N Y WEANING STRATEGY If on EN can oral intake be started? If on PN can EN be started?

Women rights Essay Example | Topics and Well Written Essays - 500 words

Women rights - Essay Example Despite making such a big portion of the human race, only about seven million women are employed while the rest do domestic work in their homes. This means that while women do an equal amount of work as men, they get less pay considering that only a small portion of them are employed (Dudden 87). This can be changed through the ballot to ensure that women get equal pay for equal work with men. The Senator also argues that there should be representation for those who pay taxes. Mrs. Jones argues against this case by saying that if that was to be the case, it would mean that other parties such as the aliens and the minors should be eligible to vote. It is, however, worth treating each of these groups individually and looking at the reasons why each of the group does not deserve a representation through the ballot. Treating all these groups wholesomely will not give the real picture as each group has its own varying reasons restricting them from being represented. As noted by Senator Owen, the woman ballot has the potential to revolutionize the world. In Colorado for instance, it ensured that political parties induced morally upright men as their candidates since women could not stand corrupt men. This shows the vital role of cleaning up the society the woman ballot had played. Mrs. Jones in her speech argues that granting the ballot to women in the suffrage states had not brought any significant benefits. The social challenges experienced before granting the ballot to women are still there. By stating so, Mrs. Jones fails to realize that the task of fighting social challenges faced by any society is a collective duty. This cannot be solely left to women just because they have been granted the ballot. Women cannot purify politics on their own. Men should equally have a hand in it (Dudden 88). Senator Owen concludes by noting that although women have been granted the ballot in Colorado, the bad women do not vote. However, the

Constitution cafe Essay Example | Topics and Well Written Essays - 1000 words

Constitution cafe - Essay Example The discussions are based on Thomas Jefferson, a radical who held the belief that there was the need to keep on revising the Constitution. As outlined in the book, periodic amendment of the Constitution can be regarded as essential since it keeps the constitution in line with the changing times. Phillips contends that the Constitution has become an immutable as well as a sacred text, which needs some shaking up or some review (Phillips 1–336). In the book, Phillips argues that respect of the United States’ Constitution forms a key phenomenon of modern political life in America. According to Phillips, the Constitution is the basis upon which the rights of the U.S. citizens can be understood. Across the political spectrum, it has become the last argument of politicians and the secular scripture has it as the moral gravity. The book explains the desire of the third American president, Thomas Jefferson, that Americans should rewrite the Constitution after every twenty years in order to enable them to meet their needs. The radical ideas of Jefferson are put to the test by Phillips, who asks Americans to create a new Constitution that will serve their needs (Phillips 1–336). Throughout the book, the main idea that Phillips strives to pass focuses on how the American public could rewrite the United States’ Constitution. The book involves a series of discussions, which engage various groups coming together and focussing on various Articles and Amendments. For example, there are teenagers who talk about the amendment of age at which people should vote, and lawyers discussing the patent clause. Each of the groups involved comes up with new Articles, which have the aim of redressing problems of the existent Constitution. The author also discusses the historical interludes regarding the conflicts among the Founding Fathers; this highlights the compromises as well as difficulties that were needed in 1783 (Phillips 1–336). In the book, Phillips portrays

A View from the Bridge by Arthur Miller | Analysis

A View from the Bridge by Arthur Miller | Analysis A View from the Bridge is a play set in Brooklyn in the 1950s and was written by Arthur Miller. He wrote this play based on different aspects in his life as he lived in Brooklyn as a child and worked in the Brooklyn shipyards like Eddie and befriended the Italians he worked with. Miller heard a story of some men coming over to work illegally and being betrayed which inspired him to write A View from a Bridge. It was originally a one act play, but he changed it into a two-act play later on. The play includes ideas from Greek tragedies, which is where the character of Eddie links into. Alfieri, another main character acts as a Greek chorus, a vital role in a Greek tragedy and he watches the action, comments on it and talks to the audience directly, like a narrator. We see him in many different roles throughout the play and each role adding to the dramatic impact of the play. The first role Alfieri takes on is as a narrator, which is at the start of the play. You wouldnt have known it, but something amusing has just happened. You see how uneasily they nod to me? Alfieri uses the word you to include the audience and to make them feel involved. Also, as the narrator he highlights the importance of certain scenes and actions, as after the scene when Marco and Rodolpho arrive, Alfieri starts to talk again saying Eddie Carbone had never expected to have a destiny implying that because Beatrices cousins have come to stay, something will change. Alfieri also mentions that we settle for half and uses repetition as in the first speech and the very last speech after Eddie has died he says that it is better to settle for half, it must be. By using the word we Alfieri is again involving the audience and making them think that they should settle for half as well as Eddie, and is therefore offering moral guidance to the audience. Furthermore by saying it must be better to settle for half, and using an imperative, Alfieri is trying to convince the audience and even himself that appreciating what youve got must be better than dying like Eddie did. When Alfieri is narrating the play, Arthur Miller uses dramatic devices for example using stage lights to focus on Alfieri, so the audience know what he is saying is very important. The title of the play A View from a Bridge has many different meanings, as it could be seen as Alfieris view from the bridge, as he is the one narrating the events and telling his view on the events that unfold. Furthermore the title is literally the play, which is set in Brooklyn Bridge and is about the community around the area and the actions that happen which Alfieri tells as a narrator. Also the bridge could be a metaphor for the differences between Alfieris view on justice and Eddies differing opinions and can also incorporate Alfieris view that we should settle for half as to do this you may need to compromise and meet in the middle, like the middle of the bridge. Another interpretation on the title is that the bridge is like a bridge between Eddies community in Brooklyn and Marco and Rodolphos community in Italy and they both have to understand each others way of life by using this bridge to help them. Another role Alfieri takes on is a character in the play as a lawyer. He gives Eddie advice on how to deal with Rodolpho and Catherine: Let her go. Thats my advice. You did your job, now its her life; wish her luck and let her go. The audience trust Alfieri, because of his character as a lawyer as more often then not they are seen to be trustworthy and reliable. As well as advising Eddie, he also warns him when he feels Eddie is going too far. Because of Alfieris narration running through the play, the audience can see that there is a theme of law and justice running through the play. He explains these themes by giving more information about the different communities telling the audience that the law has not been a friendly idea since the Greeks were beaten, implying that the Americans of Red Hook do not really believe in the law. Alfieri attempts to explain the law to Eddie and Marco, telling them that the law is nature. The law is only a word for what has a right to happen. So when Eddie chooses to find justice by his own means, Alfieri feels that he cannot get involved and he cant do anything to stop Eddie. In the first scene when Alfieri meets with Eddie as a lawyer he describes Eddies eyes like tunnels. This simile gives the impression of a dark journey ahead of Eddie and gives the audience an image that Eddie cannot escape his fate that has been predicted by Alfieri as the audience already know its going to happen. It could also suggest that Eddie was thinking deeply or that he had many dark feelings rushing around his head. In this scene Alfieri is powerless to prevent what is going to happen and this creates tension and suspense because the audience want to know what is going to happen next. I could see every step coming, step after step. Alfieri also acts as a warning sign, by preparing the audience for events that are about to happen. You wont have a friend in the world, Eddie! By using the phrase you wont Alfieri is warning Eddie that something is definitely going to happen and that he should be careful. As the weeks passed, there was a future; there was a trouble that would not go away. By using repetition, Alfieri is emphasizing the point that something is going to happen and is making the audience think through what will happen and why and therefore keeps them hooked. Arthur Miller uses dramatic irony as the audience and Alfieri know something is going to happen, however the characters in the play are oblivious to this. Alfieri informs the audience that his customers are prepared to settle for half, however in the final paragraph he tells the audience that something else is going to happen by using the phrase and yet. Alfieri uses the quote bloody course to paint an image in the audiences head of blood and violence and the images that are left in the audiences mind leaves them curious about the rest of the play which creates dramatic tension. It also shows Alfieris importance in the rest of the play, as it shows he is predicting the play and Eddies fate. In the last sentence of Alfieris first speech, he links to his past saying every few years there is still a case to tell the audience that this story will definitely be tragic. He then introduces Eddie: This ones name was Eddie Carbone, and the fact that Alfieri immediately mentions Eddie after talking about that culture of Red Hook and also speaks about him in the past tense shows that his fate has already come to an end and gives another indication that Eddie will die at the end of the play so the audience are left wondering not what will happen to him but how it will happen. The way in which this quote is presented shows that Eddie is one of many of Alfieris clients whose tragic story is like many others in Italy that die of unfair causes. The setting of Red Hook is a poor community and Alfieri creates the atmosphere of Red Hooks by describing it as the slum that faces the bay seaward side of Brooklyn Bridge. There is a lot of cultural context linked into the story as Alfieri comes from the same Italian background as Eddie; therefore he understands both American and Italian lifestyles and he helps the audience to understand the 1950s Brooklyn society in which the characters live. Alfieri also explains how the rich and the poor are divided in their community by their jobs and states that Eddie has a hard job as a longshoreman working on the docks. I often think that behind that suspicious little nod of theirs lie three thousand years of distrust. This is a quote that Alfieri says at the beginning of the play which gives the audience an insight into what Red Hook is like and suggests that there is a lot of dishonesty in the area. He mentions the characters Al Capone and Frankie Yale who were former Italians that had a history of crime and violence, In those days, Al Capone the greatest Carthaginian of all was learning his trade on these pavements, and Frankie Yale himself was cut precisely in half by a machine gun, he uses this quote to emphasise the case that he is about to handle which shows that it will be of violent nature and he also uses this quote to show that the play will end tragically. The audience sees Alfieri as a character in the play when Eddie goes to see him for advice. However Alfieri feels that he cannot help Eddie as he knows about the disaster that is going to happen at the end of the play so he feels powerless over Eddie as his friend and his lawyer and cannot prevent the decisions Eddie is choosing to make. Another role Alfieri takes on which is a very important part in the play is as a moral commentator. Alfieri gives his own views and opinions on the characters and their actions and this guides the audience rather than allowing them to make their own minds up. The audience has the same opinion of the narrator because Alfieri talks directly to them affecting their view on the situation and characters and they believe everything he says. Alfieri comments on Eddies moral character saying he was as good a man as he had to be in life that was hard and even, and he explains that Eddie is neither entirely good nor entirely bad. Alfieri only guides the audien ce influencing their opinion, but sometimes gives two differing opinions on Eddie allowing the audience to make up their own minds. In the play there are only two acts, which is unusual for a play; however there is many different things that happen in these two acts. As an audience we see that Alfieri is very important to the structure of A View From A Bridge as he is the character that opens the play and ends the play with his two dramatic speeches therefore adding to Alfieris dramatic impact to the play. Finally Alfieri acts as the Greek chorus in the play, explaining the events on stage to the audience without actually participating in them. He has to know a lot about each of the main characters and actions to be an effective chorus; however he communicates with the audience more thoroughly than with the characters, to inform them of the actions and thoughts of the characters. The idea of the narrator was developed in the Greek tragedies of the 5th century called the chorus who commented on the actions of characters in the play which is like Alfieri. A Greek Tragedy was originally a play that consisted of tragic events with a main character (like Eddie) whos fate would soon come to an end and usually die at the end. A View from a Bridge uses the conventions of a Greek Tragedy, as Arthur Miller used a final climax in the play where Eddie Carbone (one of the main characters) tragically dies, which suggests his play is based on a traditional Greek tragedy. In conclusion Alfieri helps contribute to the dramatic impact of the play in many different ways, because of his different roles but also because as an audience we know that what is going to happen as Alfieri predicted the events to come which adds tension and suspense. Throughout the play Alfieri keeps emphasizing that we should settle for half, which shows that Arthur Millar was trying to give a moral message to the audience and also society saying that they should settle for half, and always bring justice to the world as otherwise we might end up with Eddies fate. Bibliography www.bbcbitesize.co.uk www.sparknotes.co.uk

Self-awareness: Health Care Worker

NMIH101 Self-awareness This essay will explore some of the aspects of self-awareness, with description and definition for use to the health care worker in the health care setting from various educators in all fields of health care from various aspects of evidence-based practice that involves, includes and is open to developmental learning for continuous improvement with Client-Health Care Worker outcomes. Self-awareness is the mental, psychological and physical attributes that are ingrained into the human psych to manage society with encompassing emotional intelligence and empathy by acknowledging one’s own feelings and thoughts.Multiple amounts of literature regarding client care is available to the beginner and the practising health care professional specifically to teach and revise the learning process for current and future education (Unal 2012). The medical field is vast and ever-changing from evidence-based practices for all medical fields and employees for optimum clien t care (Unal 2012). Learning through life and education stems from communication. The health care worker has to draw on their personal interactions and education for the positive and professional setting (Charney 1994).For a health care worker to establish any form of communication with a client is to put their own self-awareness into action at the first introduction to consultation by being introspective (Cumbie 2001). The ability to express genuine empathy with emotional-intelligence is intrinsic to the health care worker in every health care field (Atkins 2008). The initial health care worker introduction and the client with health concerns begin with the introduction of eye contact.Depending on the cultural background of the client, eye contact holds a welcome message from clear and concise conversation, their expressions of interest and understanding, with professionalism and compassion to invite acknowledgment and to invoke trust and respect. This is the health care workers fi rst step for the client onto the path of the therapeutic relationship from competence and confidence of the health care worker all contributing to the levels of communication that encourage trust with the client (Atkins 2011).The basic human trait to be apprehensive when engaging in the need for medical assistance brings forth all aspects of self-awareness with compassion, understanding and support to the health care worker, thus alleviating stress to the client to ensuring the path to the client and health care worker’s overall homeostasis. These characteristics of the health care worker are to stabilise the client to begin their journey to wellness (Atkins 2011).In the health care setting we are faced with self-awareness on a daily basis with a broad spectrum of clients with diverse health issues from diverse cultural backgrounds. The health care worker learnings from specialised educator teachings from their many health care fields covers an abundance of information to ass ist the health care worker from evidence-based practices that are to promote and encourage both client and health care worker inner health and well-being (Cabe & Timmins 2003).When there is the cultural diversity of the client another aspect of care is approached by the health care worker to enlist their abilities to disperse congruent practice (Dewey 1933). Clients differing socio-economic backgrounds may be of concern but the health care worker is taught to absorb self-awareness and professionalism. The health care workers discretion with awareness of their emotions will encourage the clients comfort and ease.For the health care worker role to be professional, ethical, objective and non-judgemental they must use self-awareness to monitor their thoughts, beliefs, strengths and weaknesses. Assertiveness from emotional expression (Ellis & Hartley 2005) and all facets of self-esteem will allow for better health care worker and client interaction (Battle 1990). It is known and document ed the people with high self-esteem are more sensitive, tolerant and patient toward fellow human beings (Sherwood & Freshwater 2005).It has long been considered that interpersonal processes of the health care worker is a founding aspect of client care to open the doorways with an emotional and effective connection by influencing better client health outcomes (Peplau 1952). As client conditions and circumstance varies, communication awareness and skills that come from one’s life experiences may be brought into effect when dealing with particular cases. Critical analysis at first observation may show client emotions to then commence the duty of care by the health care worker.These ideas are demonstrated in the ANMC National Competency Standards for the Registered Nurse. For example, the nurse must practice within a professional and ethical nursing framework (ANMC 2006). Without these principles there is minimal chance of effective communication as the prospective relationship c ould be blurred with bias (Australian Nursing & Midwifery Council (AMNC 2006). In conclusion, self-awareness is crucial to all health care workers so as to aid in identifying and implementing appropriate behaviours when dealing with clients from diverse backgrounds.Numerous and varied amounts of literature are constantly being updated for integral implementation. Health care workers need to draw on their own personal perspectives so as to apply self-awareness and emotional intelligence with empathy. Applying self-awareness will foster better relationships with the client which will assist in overall better health outcomes, thus enabling the client to heal and the health care worker to consciously acknowledge the clients progression.Direct results of self-awareness will enhance better communication channels, further improving the health status of the client. References: * Atkins, K Britton, B & de Lacey, S 2011, Ethics and law for Australian nurses, Cambridge University Press, New Yo rk. * Australian Nursing & Midwifery Council 2006, National Competency Standards for the Registered Nurse, Australian Nursing & Midwifery Council, viewed 1 April 2013, www. nursingmidwiferyboard. gov. au/documents/default * Battle, J 1990, Self-esteem: the new revolution, James Battle & Associates, Canada. Cabe, CM & Timmins, F 2003, ‘Teaching assertiveness to undergraduate nursing students’, Nurse Education in Practice, vol. 3, no. 1, pp30-42. * Crisp, J Taylor, C Douglas, C & Rebeiro, G 2013, Potter & Perry’s fundamentals of nursing, 4th edn, Mosby Elsevier, Australia. * Ellis, J & Hratley, C 2005, Managing and coordinating nursing care, 4th edn, Williams and Wilkins, Philadelphia. * Fawcett, J 1995, Analysis and evaluation of conceptual models of nursing, 3rd edn, Davis, Philadelphia. McQueen, A 2000, ‘Nurse-patient relationships and partnership in hospital care’, Journal of Clinical Nursing, vol. 9, no. 5, pp723-731. * Peplau, HE 1952, Intraperso nal relations in nursing, Putnam Sons, New York. * Sully, P & Nicol, M 2005, Essential communication skills for nursing, Elsevier Mosby, London. * Unal, S 2012, ‘Evaluating the effect of self-awareness and communication techniques on nurses’ assertiveness and self-esteem’, Contemporary Nurse, vol. 43, no. 1, pp90-98.

Our Duties to the Environment Essay

Technology, unfortunately, has two-faces; while it can aid the human race in easing tasks, curing countless diseases, and even lengthening life spans, it can also destroy the earth and its inhabitants. There is much good to be said about the development of the human race when it comes to technology, but it cannot be denied that insofar as Mother Earth is concerned, there were countless of damages inflicted through the process of development. There is a need to evaluate the costs and problems that will be met whenever new developments arise, as well as find means to finally minimize these problems. In order to come up with the information on how such problems may be minimized, there needs to be an analysis of the literature regarding such issues (Pojman and Vaughn 895). Despite the fact that various literature has been written about the problem, the human race cannot escape the fact that they might have not done enough to address such issues. Our Duties to the Environment shows that in order for such problems to be solved, there is a need for humans to acknowledge the fact that technology and development can cause as much harm as good to everyone. Work Cited Pojman, Louis, and Lewis Vaughn. â€Å"Our Duties to the Environment. † The Moral Life: An Introductory Reader in Ethics and Literature. , Louis Pojman and Lewis Vaughn. Oxford: Oxford University Press, 2006. 893-895. Print.

The Importance of Early Childhood Education and What it...

â€Å"At what age should I enroll my children in school? Why are we pushing our children at such an early age? I just want my children to be children. Will Pre-K really prepare them for Kindergarten?† These are all questions that parents ask themselves as their children start approaching school age. Parents have to face the decision about whether or not to send their children to pre-k before kindergarten, or if they will just send them to kindergarten. Some parents do not realize just how important early childhood education is. Early Childhood Education begins at birth. The first stage, birth to age three, focuses on skill development, which includes tasks such as sitting, walking, feeding themselves, toilet training, and enough†¦show more content†¦The next step is four-year old Kindergarten. Here, parents still have the options of Head Start or church/privately run preschools, but also have the option of a public school program. Through different funding, many public schools have started offering four-year old preschools. In my district, the four-year old program is funded through Title 1. Title funds are awarded to schools based on the number of students that receive free and reduced meals at school. There are three title funded pre-k classrooms in my district, which are free for families. In order to be placed in these classrooms, families must meet certain criteria such as low income or a low score on the Peabody Picture Vocabulary Test (PPVT). We also offer a paid class for families that do not meet the criteria for the free class. In this class, families pay $175.00 a month. Many preschools, like Head Start, are socially based. In our district, our pre-k is academically based. We go by the Common Core Early Learning Standards for classrooms serving four-year old children. The pre-k Common Core standards are very similar to the kindergarten Common Core standards. My pre-k classroom is centered on a quote by an unknown author: â€Å"Play, Learn, and Grow Together.† Children learn by doing. There should be a lot of playing in Early Childhood classes. The following is my classroom schedule. 7:30 – 8:00 Morning Work 8:00 – 8:15 Morning Message 8:15 – 8:30 Breakfast/Bathrooms 8:30 –Show MoreRelatedSuccessful Leadership As A Leader1179 Words   |  5 Pagesfollowers who believe in the leader† What would one call successful leadership, would it be controlling others around you, or having followers who believe in their leader. The quote that Successful leadership is having followers who believe in the leader, will be analysed through this essay. Piece by piece you will find that leadership is not only about taking a stand, not only about controlling others but by having the support of everyone around you to believe in what you are leading. 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