Why I Love South Africa

South Africa bubbles with wonderful, culturally diverse people. A colourful array of different foods, religions, beliefs and traditions are blended together to make up the amazing nation of the republic of South Africa It is, arguably (and ironically), one of the most liberal, free, and constitutionally healthy democracies in the Western World – and, most certainly, in Africa. To have achieved this after hundreds of years of the most brutal repression and trashing of human rights – 15 years of true democracy, is nothing if not a monumental achievement. Then there are the challenges – yes, South Africa has many. But that’s what makes it exciting to be here. To be part of facing these challenges and (re)building a country . The people – ALL the people – are just great. There are simply no sacred cows in South Africa any more. Anything and everything can and is being discussed openly. Only once you have been to a South African braai, the beach in December, the bustling cities zig-zaged by taxis, a game park and met our vibrant inhabitants can you under. Where else in the world can you go from Oceans and Mountains, through beautiful vinyards and into arid desert, from open bushveld, to tropical forest. Where else can you find such a diversity of people that 11 official languages are required. South Africa is a country rich with resources, cultures and geographies and few countries the size of South Africa can boast such diversity. But none of this matters, if it doesn’t feel like home, and thats why I love SA. Its home. This is the home of ubuntu. For those of you who don't know, it basically means a spirit of community and sharing and kindness. Here’s to the glorious South African sunsets and the great blue African skies. Here’s to the rich wildlife and the friendly, happy people. Here’s to melktert and koeksusters, mampoer, bobotie, sosaties, amasi, isidudu, chutney and bunny chow, vetkeok and malva pudding. Here’s to a melting pot of cultures, coming together in one home under one roof – Indians, Chinese, Zulu, Xhosa, Pedi, Sotho, Tswana, Afrikaans, the San bushmen, English†¦ Here’s to Shaka Zulu, Nelson Mandela, Charlize Theron, Freek Robinson, Riaan Crywagen, Natalie du Toit, Makhaya Ntini and the man on the street. Here’s to the Drakensburg, Table Mountain, The Tsitsikama forests in Knysna, the Garden Route, the warm Indian ocean intermingling with the cool Atlantic, the dry escarpment of Gauteng and the Great Karoo. Here’s to every different season and landscape contained in one immensely beautiful country.

British Petroleum “Bp” Oil Spill

British Petroleum â€Å"BP† Oil Spill On April 20th 2010, British Petroleum better known as BP had an extremely destructive impact on the environment and the livelihood of those in Gulf Coast area of Louisiana, Mississippi and Florida. BP’s Deep-water Horizon oil rig was located offshore, 52 miles off the southeast coast of Venice, Louisiana. An explosion on the Deep-water Horizon oil rig caused a massive fire that claimed the lives of eleven BP workers. After 36 hours of burning, the Deep-water Horizon oil rig sunk to the bottom of the ocean and during this time there were different accounts of how much oil was leaking, if any.Within two weeks, estimates ranged from 8,000 barrels a day to none, back up to 1,000 and some even estimated at 60,000 barrels a day, this made it clear that no one really knew how much oil was being released into the ocean. Initially, besides the deaths, BP made it appear as if it was a mild disaster for the organization. However, the reality o f this disaster was that eleven people lost their lives, an estimated 4. 9 million barrels of oil leaked in the Gulf of Mexico for five months and only approximately 800 million cleaned up. As a result, sea animals lost their lives, many fisherman lost their livelihood, and even the tourism suffered.In the end, BP was fined four billion dollars by the government of the United States, agreed to pay $525 million in civil penalties and has already paid billions in civil claims to all who were impacted by the spill. In addition, three BP employees were indicted on criminal charges and BP CEO Tony Hayward stepped down four months after the spill. The above summary about the tragic BP oil spill was as a result of nbcnews. com website. The article detailed the result of the BP Oil spill of 2010. After two and a half years, the US government and BP agreed on a settlement of 4. billion and the plea of guilty of eleven manslaughter charges. The payments will be paid out in a span of 5 years. This is the largest such penalty ever to an organization. This settlement does not include civil cases that are pending against them from their workers. BP had also agreed in March of 2012 to pay 7. 8 billion to more than 100,000 businesses that were directly affected by the oil spill. The positive aspect of this massive oil spill is that BP took responsibility for the oil spill by pleading guilty and paying billions of dollars for clean-up to businesses, fisherman, families, etc. and committing o getting the coast line back to the way it was before the industrial accident. In addition, BP dedicated a section of their website to the Gulf oil spill in an effort to keep the lines of communication open. BP even used television commercials to communicate the progress of the clean-up efforts and BP employed thousands of people for the clean-up efforts. However, there is a fundamental belief that had BP had not been so greedy and negligent, this environmental disaster could have been avoi ded. BP made many cost saving decisions that increased the risk of a spill and did not closely monitor their contractors.There were so many negative effects of this spill to include the loss of lives, fisherman who lost their livelihood, tourism suffered, wildlife and their breeding grounds were displaced, oil prices skyrocketed, oil rig workers lost their jobs and worst of all, no one will ever truly know the future affects this disaster will cause for the wildlife and environment. In the end, BP continues to rake in billions (last quarter 93 billion) in revenue. The 4. 5 billion BP had to pay to the US government pales in comparison to their profits every year.

Reneging on a Promise Essay

Billy Tushoes recently received an offer to join the accounting firm of Tick and Check LLP. Billy would prefer to work for Foot and Balance LLP but has not received an offer from the firm the day before he must decide whether to accept the position at Tick and Check. Billy has a friend at Foot and Balance and is thinking about calling her to see if she can find out whether an offer is forthcoming. Question 1. Should Billy call his friend? Provide reasons why you think he should or should not. Is there any other action you suggest Billy take prior to deciding on the offer of Tick and Check? Why do you recommend that action? Billy should call his friend to ask how the recruiting process is going, but not specifically ask if he got the job offer or not. I believe that it will give him an unfair advantage than the other applicants because the other applicants are still waiting as well. I think that it’s reasonable to call to ask when he should be expecting a call from the Foot and Balance LLP, but not to ask if he got an offer from the firm. Part B Assume Billy calls his friend at Foot and Balance and she explains the delay is due to the recent merger of Vouch and Trace LLP with Foot and Balance. She tells Billy that the offer should be forthcoming. However, Billy gets nervous about the situation and decides to accept the offer of Tick and Check. A week later he receives a phone call from the partner at Foot and Balance who had promised to contact him about the firm’s offer. Billy is offered a position at Foot and Balance at the same salary as Tick and Check. He has one week to decide whether to accept that offer. Billy is not sure what to do. On one hand, he knows it’s wrong to accept an offer and then renege on it. On the other hand, Billy hasn’t signed a contract with Tick and Check and the offer with Foot and Balance is his clear preference because he has many friends at that firm. Questions 1. Do you think it is ever right to back out of a promise you gave to someone else? If so, under what circumstances? If not, why not? I don’t think breaking any promises is right to do but I think some promises are more important than others. I feel that people feel obligated to keep promises with certain people based on their importance. For example, a boss or a best friend, a person can feel obligated to keep their promises with those people instead of others who are not as significant. †¨Ã¢â‚¬ ¨2. Identify the stakeholders and their interests in this case. The partner at Foot and Balance is definitely a stakeholder in this case because he is interested in Billy and wants to hire him. Billy is a stakeholder because of his interest in Foot and Balance LLP. And Tick and Check LLP is a stakeholder because they are interested in Billy as well. 3. Evaluate the alternative courses of action for Billy using ethical reasoning. What should Billy do? Why? I believe that Billy should stick with Tick and Check LLP. Billy already knows that he it is wrong to renege on a commitment. Even though he did not physically sign a contract, he did verbally accepted the offer. It would be unprofessional of him to accept the offer and then take it back a day later just because he got an offer from Foot and Balance. A verbal commitment is just as significant as signing the contract.

Commercial contracting Essay Example | Topics and Well Written Essays - 6000 words

Commercial contracting - Essay Example For advising Transco regarding these issues, the following discussion, relating to the terms used in the letters from Minerva and Hedge Plc have been taken up for discussion. Essay 1 Subject to Contract The formation of contracts is a process that is subject to continual change. This process has gradually acquired considerable intricacy and involves much higher stakes. Nevertheless, some features of this process have remained unchanged. For instance, the negotiators are interested at reaching an agreement and are keen to gain the maximum profit from it. These objectives are inherently contradictory; because, a party that is interested in effecting an agreement might be required to behave in a manner that diminishes its profits.1 It has been a long standing practice to employ the device of subject to contract in contractual negotiations. This expedient prevents the emergence of contractual liabilities, during contractual deliberations. Its use in correspondence that transpires before a contract is formed connotes the absence of contractual liability till such time as a contract is formed.2 The subsequent conduct of the parties to an agreement, primarily determines the outcome of the condition subject to contract. ... Furthermore, this term cannot be employed to indicate that no binding contract can be formed. In addition to the written words and negotiations the conduct of the parties also determines the existence of a binding contract.4 As a result, any instruction to commence work, prior to arriving at a final agreement, should be dealt with great care. In Regalian Properties plc v London Dockland Development Corpn [1995] it was held that an offer that had been accepted, subject to contract was not binding in nature. In this case, the plaintiff was a property developer who made its offer via a letter entitled subject to contract. 5 Due to difficulties envisaged in acquiring the land by the defendant and other reasons, the contract proved difficult to materialise. The plaintiff claimed heavy damages, which the court rejected, as the work had been undertaken on the basis of subject to contract, which implied the absence of a contract betwixt the plaintiff and the defendant. The plaintiff had incu rred considerable expenditure, in the anticipation of procuring the contract. The court held that the plaintiff’s actions had been at its own risk, as there was no binding contract between the plaintiff and the defendant.6 Thus, subject to contract provides a stratagem for circumventing liability in such claims. In Confetti Records v Warner Music UK Ltd [2003], it was ruled by the court that the inclusion of a track from the album did not constitute an infringement of copyright. The inclusion of the term subject to contract indicates that the party has no intention to confer a binding nature on deal memo. However, the act of sending the track and invoice by the claimants was to be considered a valid offer. If the defendant had

Analysis of a drama film-The Truman Show Essay Example | Topics and Well Written Essays - 2750 words

Analysis of a drama film-The Truman Show - Essay Example The protagonist of the film, Truman Burbank, is the main character of a longest nonstop live broadcast catering to a global audience. He is unaware that his life, activities and emotions are being filmed and that all those who are with him are acting their roles well for the success of the show. His mundane life in the seaside town of Seahaven is being captured by more than 5,000 hidden cameras. Most parts of the film appear as if the audience is watching "The Truman Show" rather than a film based on a reality show.         The film opens on the broadcast day 10,909 when Truman is nearly thirty years old. Until this day, Truman has not realized that he is living in an artificial world that Christof has created for him. Omnicom Corporation had adopted Truman from the day he was born and turned his life to a reality show where â€Å"his wife Meryl, his best friend Marlon and his mother † (Niccol 1998) are actors who are performing in front of Truman to convince him that hi s life is real. As in the words of the master architect of the Show, Christof, "We’ve become bored with watching actors giving us phony emotions. We’re tired of pyrotechnics and special effects. While the world he inhabits is in some respects counterfeit, there is nothing fake about Truman himself. No scripts, no cue-cons. It’s not always Shakespeare, but it’s genuine. It’s a life†¦Louis Coltrane and Hannah Gill (Meryl) also stresses the originality of Truman's life by saying that "It's all true, it's all real.

An essay which explores and analyses a particular issue in the field

An which explores and analyses a particular issue in the field of interpretation - Essay Example This author will assess the interpretation of war and the multiple factors that dictate the many perspectives on the topic. In Carol Acton’s article Diverting the Gaze: The Unseen Text in Women’s War Writing, she talks about the difference in how women perceive war verses the way men see it. She notes that, â€Å"while womens war writing from the First World War has received much critical attention over the past ten or more years that has established its authenticity as witness to war, scant attention has been paid to how women see the trauma of frontline combat nursing and how, consequently, such seeing or not seeing influences the narrative (Acton, p54).† The author focuses on the perception of how women perceive the trauma of war specifically nurses who aren’t necessarily fighting on the frontline, but who are providing medical care for soldiers and often caring for them right up to their last living moments. Acton notes how writings produced by women of the first World War and Vietnam were very similar, she goes on to point out that, On a general level, the striking similarity in the narratives of these two wars seems to arise from the compulsion to bear witness to the trauma of combat nursing. More specifically, British writers from the First World War and American writers from the Vietnam War were both concerned with carrying what Jane Marcus has called "a terrible knowledge" to a civilian population that seemed completely removed from any understanding of the war experience (Acton, p54) The contrast Acton makes between the women nursing the soldiers, both American and British, in both World War I and Vietnam, with the civilians reveals how there is a major difference in interpretation of war when one is on the frontline verses just assessing it when it’s far away. Acton goes on to point how

Personalized Marketing Essay Example | Topics and Well Written Essays - 1750 words

Personalized Marketing - Essay Example Recent research has confirmed that most firms have several tiers of customers in terms of profitability and that these tiers often have different service expectations and needs. According to Valarie Zeithaml, Roland Rust and Katharine Lemon (2001), it's critical that service firms understand the needs of customers with different profitability tiers and adjust their service levels accordingly. So more and more marketing led organizations are moving towards personalized/customized relationship marketing to know and filfill the actual needs of the customers. This new orientation has its roots in American (Berry, 1982) and Nordic (Gummensson, 1987) concepts. Supporters of this new form of marketing argue that in order to survive in the markets which has become more competitive and more turbulent, organizations must move away from managing transactions and instead focus on building long lasting customer relationships ( Webster,1992). Research by Kevin Gwinner, Dwayne D. Gremler and Mary Jo Bitner (1998) suggests that relationships create value for individual customers through such factors as inspiring greater confidence, offering social benefits and providing special treatment. Piyush Kumar (1999) emphasizes that relationships strengthen in a business to business are dependent largely on the quality of the interactions between individuals at each of the partnering firms. As r elationships strengthen over a period of time, he observes the service provider's personnel often assume the role of outsourced departments and make critical decisions on behalf of their clients. In the process of developing relationship with customers, personalization has been preceded by mass customization. Mass customization emphasized on satisfying a specific segment of the customers from a production perspective (Pine II et al., 1995) whereas personalization specifically depends on satisfying the needs of an individual. So reaching out to an individual customer, knowing the needs of the customer and then providing product or services required is all about personalizing the marketing. In the hyper competitive situation and advent to interest and database about individual customer has equipped companies to customize their product or services according to individual customer. Prior to advent of electronic/internet communication, personalization was available only to selected few for selected product or services at premium prices (Mattilla, 1999). Personalization of marketing has taken place due to emergence of internet technology and providing opportunities to the organization to have one to one relationship with the customer. Riecken (2000) states, personalization is about building meaningful one to one relationship; by understanding the needs of each individual and helping satisfy a goal that efficiently and knowledgeably addresses each individual need in the given context. Personalization of product or services increases the differentiation and helps in positioning of the product or services. Customizing the product or services to the needs of single customer has been facilitated by the modern information technologies. More and more information about customers and their needs of services and products is the basic requirement of personalization. Differe nt methods of data gathering about customers i.e. customers profile give an insight of new

Human Rights in Islam Essay Example | Topics and Well Written Essays - 1000 words

Human Rights in Islam - Essay Example The purpose of this paper is to explore the UDHR and compare it to the stipulations of Islam, finding similarities and differences between the two. This will show that, whilst the majority of the articles represent facets of Islam, there are a number of areas in which the UDHR fails to represent this religious tradition. One of the most obvious similarities between Shariah law and the UDHR is that they both oppose discrimination based on race, gender, language, nationality or religion. The Quran suggests that ‘when the Trumpet is blown, no ties of kinship will exist between them on that day, nor may they question one another’ (The Quran, 23:101). This essentially makes reference to the fact that Allah will not discriminate based on these things on judgement day. The Cairo Declaration on Human Rights in Islam (CDHRI) is essentially an Islamic version of the UDHR, and also includes this sentiment as the very most important thing, which suggests that there is a high amount of compatibility between the two. Islam itself is seen to be a very all-encompassing religion, as it encourages people of all races to convert to the religion, again suggesting that the UNDR and Islam are similar in content in this department. Another element that is common to both the UNDR and Islam is the focus on women’s rights and equality between genders. For example, the CDHRI suggests that women have ‘equal human dignity’ (Hashimi, 1997) and therefore should be treated as well as men are. Islam and the CDHRI also both place emphasis on the fact that men and women both have the right to choose their own spouses regardless of race or pressure from outside parties. The UDHR also expresses this, suggesting that ‘Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution’ (United Nation s, 2012, Article 16). The reference to dissolution is also important, as Islam is well-regarded for being one of the first religions to allow women the right to divorce their own husbands by choice (Hashimi, 1997). Both Islam and the UDHR place an emphasis on living quality. It seems sensible to both parties to encourage living standards to be the best possible, as all humans have the right to live cleanly and safely. The Quran puts this sentiment very nicely, suggesting that ‘he who saves a life will be as if he had saved the lives of all humankind’ (The Qur’an, 5:32). There are further quotes which support the fact that Islam is for the preservation of human life, rather than destroying it, and saving a life is incredibly important in the religion. The aim of Islam is to ensure that everyone lives a long and happy life (Hashimi, 1997). Similarly, the UDHR suggests, in article 25, that ‘everyone has the right to a standard of living adequate for the health and well-being of himself and of his family’ (United Nations, 2012). This is yet more evidence for the fact that the UDHR and Islam stand for several similar principles in a number of matters. There are, however, a number of times in

Germany and the Germans class Essay Example | Topics and Well Written Essays - 250 words

Germany and the Germans class - Essay Example Although honesty is considered a good quality in America, it is often the case that conversations lack directness, because Americans do not want to appear blunt and impolite. Environmental awareness is a second stereotype that I believe to be accurate and good. Germans have strict rules about recycling trash and biodegradable packaging. Moreover, their cars are fuel-efficient. I picked this trait, because protecting nature is a positive characteristic. Even though there seems to be a change in America towards a more environmentally friendly culture, I still think that Germans are more advanced in that field. The third and last stereotype that I believe to be accurate and positive is that Germans are often portrayed as rule abiding. For example, many German pedestrians respect traffic rules and will not cross the street, when the traffic light is red, even if there are no cars in sight. This is a positive trait, because it makes everyday life more civilized and safer. Americans also respect laws; however, I am of the opinion that Americans sometimes have a tendency to ignore certain laws if they believe that it does not make sense to follow the rules, such as waiting at a red light, even though the street is

Gender, Globalization and Aesthetic Surgery in South Korea Essay

Gender, Globalization and Aesthetic Surgery in South Korea - Essay Example is influenced by a hybrid of intersecting factors like negotiation between national and global standards of beauty, national identity, official and unofficial religious discourses, caring for oneself, aging, quest for social status and traditional attributes as opposed to the generally held notion that cosmetic surgery is only two-fold; as a feminist issues and as undesired effect of influence from westernization. The authors present this argument by questioning the previous research done on the field of cosmetic surgery. The author has used different types of evidence to support his central argument. The major types of evidence used are statistical and judgment evidence. Statistical evidence is used to annul the notion that cosmetic surgery is a feminine issue. Drawing from official statistics, the author reveals that male patients make 10% of the total cosmetic surgery patients. Furthermore, according to Morgan (1991:30), the number is higher ranging between 30 and 40%. The most interesting thing with the convectional research is that, despite the increased number of male patients seeking the services of cosmetic surgeons, men have been left out of the discussion making the issue sound solely feminine. Judgment evidence has been used to dispel the notion that Korean cosmetic patients are exclusively influenced by western effects. The authors have been able to make concrete inferences by drawing on the official facts and figure. Cosmetic surgery has been taken to signify a strong sense of indigenous identify as an individual has a mixture of both global and national beauty attributes. Furthermore, taking a few beauty aspects from different cultures demonstrates access to wider cosmopolitan identify with a more global perspective also informed by the local knowledge of concepts and beauty. The authors have presented a well-researched and coherent piece of work. This work is well informed and largely avoids cases of bias by many instances of statistical evidence.

Deinstitutionalization Capstone Project Research Paper

Deinstitutionalization Capstone Project - Research Paper Example s that health behaviour is determined by one’s personal beliefs or perceptions regarding a disease or disorder and the available strategies one can access to prevent it. The four perceptions, namely: perceived seriousness, perceived susceptibility, perceived benefits and perceived barriers can be used to explain why a person behaves the way he does when it comes to health. All four perceptions affect an individual’s health and well-being so these must all be kept positive in order to achieve optimal health. Pedersen, P.B. and Kolstad, A., 2009, De-institutionalisation and trans- institutionalisation – changing trends of inpatient care in Norwegian mental health institutions 1950-2007, International Journal of Mental Health Systems, 3:28 This article chronicles trends in Norwegian mental health institutions from the 1950’s to the present that leads to current trends of deinstitutionalization and trans-institutionalization of inpatient care. It concludes wit h the observation that deinstitutionalization may mean fewer beds available in mental health facilities but not necessarily fewer patients treated since they are just transferred to other mental health services. It also identifies the factors behind deinstitutionalization in Norway as the expansion of welfare state; increased professional focus on active treatment and increased focus on patients’ preferences. Thompson, P., Lang, L. & Annells, M., 2008, A systematic review of the effectiveness of in-home community nurse led interventions for the mental health of older persons, Journal of Clinical Nursing Journal Compilation, Blackwell Publishing, Ltd. This article is a systematic review of the literature on in-home community nurse-led interventions for elderly adults with mental health issues. Main findings... Community care centers need to adopt a health promotion program to guide the health workers with a firm philosophy of health and wellness. A commonly used health promotion model is the Health Belief Model (HBM) which proposes that health behaviour is determined by one’s personal beliefs or perceptions regarding a disease or disorder and the available strategies one can access to prevent it.   Another good health promotion program is one by Ewles & Simnett (2005).   It   takes a holistic health care approach, taking into account all dimensions of a person’s development.   A study on how these two health promotion programs can be integrated to come up with the most appropriate program that would best suit elderly adults with mental illness would be interesting.a. Purpose statement for a Quantitative Study:   This study will compare the Health Belief Model (HBM) and the Holistic Health Care approach   as to its principles and features using a likert-scaled ques tionnaire to be distributed to nurse practitioners working in a hospital facility. It purports to determine the best features of each model and integrate it into one effective health promotion program.b. Purpose statement for a Qualitative Study:   The purpose of this study is to develop a sustainable community care health promotion program for the elderly with mental illness.   Input from families of residents in a psychiatric facility will be interviewed as to their preferences for their family members.

Living As If God Does Not Exist Essay Example for Free

Living As If God Does Not Exist Essay Since ancient times, alongside society’s development is the widespread proliferation of the religious consciousness of mankind. Although primitive small-scale societies had always been depicted as animists and polytheists, the concept of the High God is a common theme that has already been discovered. Studies of ancient societies have revealed in the belief of a Supreme Being, although this was also coupled with worship of lesser spiritual entities since the Supreme God seems distant and uninvolved in daily concerns of men. Compared with modern men, people of the ancient past were mainly agricultural communities. They are basically more aware of their natural surroundings and the different forces which affect his sustenance and survival. Many of these forces are beyond his control and understanding. Early man was therefore more inclined to acknowledge the existence of a Great Being who is responsible for the existence of the world and the one who is in complete control over all. Worship, whether to God or lesser spirits, has often been closely associated with receiving favour and positive results, or to ward off negative conditions like sickness. But current mode of attitudes and perspectives that pervade modern men has increasingly being held under the spell of beliefs that exclude God and the invisible world from the realm of reality and day to day living. Such an approach to life however, is not entirely exclusive in modern times. This was already present in the distant past where there were critics of religious beliefs for instance among some of the ancient Greek philosophers and the Roman Lucretius; in India, where most see it as a rich place of religious practices, materialism has already flourished at the time of the Buddha and for many centuries afterward which basically rejected all belief in a transcendent world; and in China, rationalist Confucianism often involved a rejection of religious doctrine. But these protests against the existence of and reliance of a Supreme Being or of spirituality in general, are only sporadic and never gained majority allegiance during its time. But this is now greatly pronounced in the modern period than ever before, since the powerful restatements of atheism and agnosticism have found a wide success in acceptance and following. The rise of the scientific discoveries and inventions, as well as the increase of intellectuals has made it more ideal to reject the existence of God and other religious values. Man sees himself as the ultimate controller of his destiny, as he experiences more control of the things that affect him. As greater understanding of the world around him is achieved, man sees a greater lack of importance in relying on an unseen and somewhat ‘distant’ God. Modern man is also pressed with many concerns. The large masses of manual workers that were born of out of industrialization in the big cities of northern Europe have caused them to become largely alienated from the faith of their fathers. It is both the social and intellectual forces which have thus combined to promote a widespread practical atheism. There are mainly anti-religious ideologies of modern man which has come to influence modern day thinking. First, was the growth of liberal humanism that principally influenced the western world. This philosophy is rooted in the scepticism of the eighteenth century; it received a greater momentum from the religious controversies of the nineteenth century. Second, was the spread of German type of atheism which were popularized by the writings of Feuerbach, Marx, and Nietzsche. Nietzsche even pronounced the death of God in one of his writings. He announced the death of God, as man is ‘awakened’ to the ‘reality’ that God is only a creation of the human mind. Today’s society is very much influenced, although mostly indirectly, by the banner of humanism that fiercely denounces the existence of God and His requirements. Humanism passionately proclaims that the acknowledgement of God is a declaration of war against life, against nature, against the will to live; and that Christianity is the formula for every slander against this present world and guilty of proliferation of ‘lies’ of a world beyond or afterlife. Out of this, came the atheistic Communist ideologies, which for some time in the past, has pronouncedly divided the world. Then, there were also the philosophical movement known as Existentialism, which ironically had Christian origins through the work of Kierkegaard, has nurtured within it a newer type of atheism, popular since the Second World War. Such a deluge of assault on the Christian faith would seem overwhelming and puzzling to those who profess faith in it. God and Christianity seem to have often called down upon strong denunciations. But it is not entirely out of reason. There has been the spectacle of inter-denominational strife, the growing cynicism towards the authenticity of those who were key figures of the Christian faith as against their extravagant lifestyles, memory of persecutions, and the political conservatism of many Christians all these must be taken into consideration. However, what could be considered a more major reason for rejection is because of the more common association of Christianity with Puritanism. There have, indeed, always been pronounced ascetic elements in the Christian experience, although they are considerably less than in most other of the world religions. It can be said though, that Puritanism and ascetism obviously have important place in certain kinds and phases of different religions. Puritanism demands the population at large to conform to it. Central to the Christian belief is the submission to the Supreme Being, and His instructions. The world, as symbolized by Nietzsche, continuous to express a strong reaction against such beliefs. God and his laws are often received as restrictive, since man’s experience show that he possess desires and instincts which often goes in conflict to what God approves, and must therefore contend with it for most of his time. For most men, this seems to constitute a kind of conspiracy to confine human self-expression and freedom. It is not surprising then, to see an abundance of decay in wide areas of society, since unwillingness to submit to God’s authority is more appealing in order to gratify the self. God is therefore seen as an enemy against the fulfilment of the desires and plans of the self. In addition to this, many simply suspect that those â€Å"kill-joy† Christians, do make those impositions on others condemning jollification and gaiety, as an unconscious repressions and anxieties which stems from Freudian influence. The rejection of the divine and supernatural is not just a mere intellectual scepticism about the truth of God and Christian beliefs; it has also been an emotional rebellion as well. Social factors have contributed. As we have seen, the dislocations caused by industrialism in many Western countries, have produced the alienation of much of the working masses from Christianity. In addition, social forces have brought a distrust of the older forms of authoritarianism. This was already demonstrated between the World Wars, the rejection of being ruled by a higher force. Moreover, this has been heightened after the war where many younger folks have opportunities of work and spending that often creates a sense of being relatively independent. This new found independence rewards man’s desire to be the sole controller of his own life. Such an attitude was already displayed since man’s creation. Self-rule, the rebellion against God’s authority has become the norm. With this development, the traditional forms of Christian teaching and preaching and the presentation of the ethical side of Christianity as something fixed and God-given have not had a widespread effectiveness. What is more popular in many folks of today’s generation is the adherence to anti-authoritarianism and which continuous to stimulate anti-Church feeling, even to the political level. Various advocacies that are being presented with much militancy and following today (i. e. same sex-marriage) run in complete opposition to God- declared laws. It is therefore not an unexpected condition that those who support such advocacies will reject God’s authority and existence. God’s ‘in-existence’ would mean that man can do whatever seems right in his own eyes. Truth and right is therefore relative. Also, aside from the agnostics and anti-religious atheism, are those within the so-called Christian societies, are a large number of people who simply do not attend church or religious ceremonies (Smart, pp. 558-573). They are not necessarily lacking in religious belief, but nevertheless they do not feel themselves called upon to belong to any religious organization. They are people who live in a large, gentle twilight zone between religiousness and agnosticism. They have inherited much of the humanist movement, but they do not share the intellectual presuppositions. They include many, therefore, who, when asked, profess belief in God or more vaguely in a Power which controls the cosmos. But they are not convinced of actively participating in worship of such a Being as something essential of one’s existence. They are not inclined to pray, seek God, read the Bible, though they might possibly do so in times of stress or great danger. They are, for the most part, alienated from the fellowship with God and the fellow believers. They are aware of the differences of teachings in different denominations, and are thus mistrustful of dogma. They have no wish to deny God’s existence outwardly, but they do not desire to seek and know Him. They have reverence for a Creator; but they feel that God is distant and detached. They respect Christian moral values, but they reject Puritanism. They do not have much sense of sin, but they admire saintliness. They are worried by death, and they hope to live for a better afterlife. But the division between heaven and hell they do not feel. Such people far outnumber the committed atheists and the explicit agnostics. For many members of society today, science possess greater prestige derived from the practical benefits of technology and the awesome mumbo-jumbo surrounding the expert, has superseded that of religion. The current civilization can be depicted in such a state. Although the blatant atheists and agnostics have been relatively few, the influence of their thinking has been formidable. Despite the ‘advancement’ in knowledge, man has generally been ignorant of God and His ways. What is generally esteemed as ‘wise’, those who reject God, does not see the pointlessness of their argument. Creation itself speaks as a witness to His superiority and existence. What is evident in creation is the presupposition of a Creator. If the world and the universe came out of chaos, scientific discoveries show that everything in it has a purpose and held with much order, which could not basically flow in congruence with the ‘accident’ theory. Also, the amazing functions of the human body, also defy such a premise that man was created by chance. For man to reject his Creator and His authority is one of the most miserable and worse thing that has occurred to man. Man indeed is very much in need of redemption from the futility of his own way of thinking. Reference: Smart, Ninian. (1984). Contemporary Religious Experience. The Religious Experience of Mankind. New York: Charles Scribner’s Sons

Preventing Deliberate Self Harm in Prison: Review of Methods

Preventing Deliberate Self Harm in Prison: Review of Methods Systematic review of the efficacy of methods  of preventing deliberate self harm in prison In delving into an examination of a ‘Systematic review of the efficacy of methods of preventing deliberate self-harm’ it is important to understand that the scope of the examination takes in a broad range of considerations, views and methodologies that are aligned with the main subject matter. Thus, having a clear understanding of what self-harm is represents a necessary facet in order to be able to determine the context within the scope of this examination. Hawton (1) states that â€Å"deliberate self-harm† entails â€Å"intentional self-positioning or self injury, irrespective of the apparent purpose of the act†. The most common forms, and or actions usually entail self-poisoning, overdosing on drugs, and the cutting of oneself (2). The preceding, self-harm, in a prison environment represents â€Å"a significant problem† that â€Å"requires the coordinated input of a number of agencies†, which includes â€Å"acute medical and psychiatric ca re (3)†. The subject of deliberate self-harm represents a broad subject area that includes alcohol abuse, deliberate self-injury by means of cutting, and other techniques. It also entails drug use, starvation, and other means via which individuals seek to harm, and or damage themselves. Harrison and Sharman (4) advise that self-injury represents a manner in expressing deep distress as represented by the cutting, burning, or other injury to oneself. They continue that frequently individuals do not know, or understand why they inflict harm upon themselves, and add that it is frequently a means to communicate what one cannot put into either words or thoughts (4). Harrison and Sharman (4) indicate that self-harm can be described â€Å"as expressing an inner scream†, which after the harm has been inflicted, then individuals are frequently able to cope with life, for a period of time. The preceding is expressed by many studies and articles that self-harm and self-injury represents a broad se t of acts that can, and does emanate from one not looking after their own needs from either an emotional and or physical standpoint (4). The infliction if self-injury can include cutting oneself, scratching, burning, hitting oneself, swallowing, and or putting harmful things inside one’s body, as well as the use of drugs to hide, and or mask distress, for escapism, and or relief (4). Self-harm also can include becoming involved in as well as staying in a relationship that is abusive, taking unneeded and unnecessary risks, eating disorders such as anorexia and bulimia, and as mentioned drugs, along with alcohol abuse (4). The preceding are manifestations of excess that almost all individuals exhibit in some limited form or another as also represented by overeating. Overwork is an illustration of the foregoing whereby one attempts and or tries to lose themselves in an activity as opposed to being alone with their thoughts, and or feelings (4). The foregoing explanation of self-harm, and self-injury spans a broad range of descriptions, and has been utilized to draw attention to the depth of methods that a systematic review of the subject matter entails. In equating a ‘systematic review of the efficacy of methods for preventing deliberate self-harm in prison, it is critical to understand the terms utilized in the preceding title, focusing first on ‘efficacy’ as the core word defining the context. The Merriam-Webster online dictionary (5) defines ‘efficacy’ as â€Å"the power to produce an effect†. This definition is mirrored by Houghton Mifflin (6) that states it, efficacy, is the â€Å"power or capacity to produce a desired effect; effectiveness†. The foregoing represents a significant contribution to the understanding of the range this examination will cover in terms of its systematic review. The core of the problem represent identification, treatment, and follow up, which is r eferred to as interventions at varying stages in the process of uncovering and dealing with individuals exhibiting the traits, and or recorded histories of self-harm. The primary objectives concerning intervention is to identify, and manage self-injurious behaviour, enacting where possible improvement in the individual’s mental state, behaviour patterns, and functioning over the short, medium and long term. The preceding is manifested by less than six weeks, six weeks to six months, and more than six months respectively. The typical manner in which the foregoing is handled in a prison environment is via: the utilization of conventional as well as newer antipsychotic drugs, use of non-pharmacological interventions as represented by dialectical behaviour therapy, and the removal of identified individuals to safe cells whereby they can be placed under close observation. The secondary objectives represent the determination of the invention(s) that might have a beneficial effect. Such also entails understanding the diagnosis of treatable illnesses as evidenced by: severe depression episodes that include psychotic symptoms, as well as post-schizophrenic depression, and the diagnosis of individuals suffering from emotionally unstable disorders of the personality that are borderline This examination shall delve into the understanding of self-harm, and self-injury as it relates to individuals that are incarcerated, along with treatments, evaluation of intervention methodologies, common treatments, strategies in treatment and the efficacy of the methods utilized in prevention of the condition of deliberate self-harm. Jackson and Waters (7) inform us that there is no singular method that provides the necessary scope to answer the broad array of questions concerning â€Å"†¦ public health, health promotion problems and interventions†. They point to Pettigrew and Roberts (8) who advise that when the problem is known, then the types of studies to answer, and hone in on the problem can be deduced. The preceding thus sets the parameters for this examination concerning a ‘systematic review of the efficacy of methods of preventing deliberates self-harm in prison’. Garner (9) advises that in general, â€Å"people who deliberately hurt themselves do so because they feel that they need to, and that the act itself makes them feel better for a while, and more able to cope†. She adds that â€Å"People report overwhelming feelings of misery, emotional distress and hopelessness which lead them to the apparent solution of inflicting pain on their bodies†, and thus harming themselves. For a great many individuals, the preceding, self-harm, represents the solution, but however, it is in the reality a facet of the problem that is unresolved within themselves (9). Harrsion (10) advises that in the â€Å"strictest terms† Deliberate Self-Harm represents the general terminology describing activities that are self-damaging. The foregoing includes activities such as alcohol abuse along with bulimia to add to the other manifestations thus far mentioned. He also advises that Self-Injury makes more specific reference to the activities entailing the utilization of cutting, positioning, bruising, burning, and over-dosing with the intent of suicide as well as other activities directed at self-injury (10). In the preponderance of instances, it has been observed that the infliction of self-injury often means self-protection as opposed to self-destruction, representing a â€Å"way of copping †¦ when things get really bad (11).† Bywaters and Rolfe (11) continue that â€Å"People deal with things in different ways and, unfortunately or not, this is my way†. The preceding is an important understanding in the issue, which is highly com plex. The phenomenon, deliberate self-harm, represents a subject that has, and is entailing â€Å"extensive sociological, epidemiological, psychological, biological and clinical study† along with research as well as speculation as to its causes, reasons and roots (12). Jackson (13) published a set of guidelines which added to the ‘Handbook’ that provide â€Å"a working framework to conduct a systematic review of health promotion or public health intervention† to be utilized in conjunction with other source materials in the conducting of reviews concerning health interventions. There are two types of ‘reviews’ referred to by Jackson (13), which consist of: â€Å"traditional literature reviews/narrative reviews†, and â€Å"systematic reviews (with or without) meta-analysis† The first, â€Å"traditional literature reviews/narrative reviews† is generally conducted as well as interpreted by experts in the field utilizing â€Å"informal, unsystematic and subjective methods †¦ which is often summarised subjectively and narratively† (13). Jackson (13) explains that such processes representing â€Å"searching, quality appraisal and data synthesis are not usually described and as such, they are prone to bias†. The advantage of the preceding is the participation by said experts â€Å"who may have a thorough knowledge of the research field†, however it is also pointed out that the disadvantage is represented by the fact that these individuals and or authors â€Å"may have preconceived notions or biases and may overestimate the value of some studies† (13). In conducting a ‘systematic review’ of an individual with the condition of self-harm and self-injury, Jackson (13) defines the process as one that is â€Å"a review that is â€Å"very much driven†, in today’s terms, â€Å"by the evidence-based medicine movement†. She continues that a systematic review is thus defined as â€Å"a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research† (13). She adds that said systematic review is utilized to â€Å"extract and analyse data from the studies that are included in the review†(13). A meta-analysis represents when two or more studies are combined statistically â€Å"to produce a single estimate of the effect of the health care intervention under consideration† (13). Jackson (13) cautions us that the preceding, a meta-analysis, represents simply the statistical combination conc erning the result from the studies utilized, and that as such the final estimate concerning the effect might not necessarily represent the result found in the systematic review as done via the literature. Accordingly, the preceding should thus â€Å"not be considered as a type of review† (13). The following represents a comparison of the varied types of reviews: Table 1 – Different Types of Reviews, A Comparison (13) The Department of Health, under its â€Å"Delivering the Future† guidelines concerning self-harm (14) state that in many instances, acts of self-harm are not connected with attempts to commit an act of suicide. It states that such may represent instead an attempt to either influence, and or secure aid and help from others as well as a means to obtain relief from what is an unpleasant, and or overwhelming emotional state and or situation (14). Chapter 2 – Clinical Guidelines and Interventions As advised by Jackson and Waters (7), there is no singular method that provides the scope of information, and or definitions to answer the broad array of questions concerning interventions. As indicated by Pettigrew and Roberts (8), the foregoing requires a determination of what the problem is as a means to select the types of studies and information needed to hone in on the problem so that answers can be deduced. Therefore, in order to reach a determination, and or closer approximation of the potential type, or types of intervention needed, a â€Å"preliminary scooping search† (7) represents a means aids in gaining familiarity with the type(s) in interventions. This entails utilizing the questions that are asked, and answered in the interview session as the basis for the preceding. Jackson and Waters (7) in referring to Popay et al (15), as well as Dixson-Woods and Fitzpatrick (16) argue â€Å"†¦ qualitative research should have a role in systematic reviews†. Spen ser et al (17), as cited in Jackson and Waters (7), advises that the purpose of qualitative research is to provide a deeper understanding of the experience that individuals have, along with their experience factors, histories and importantly, their perspectives within their individual settings, and circumstances in an attempt to glean why people behave in the manner they do. The preceding represents the attempt to understand behavioural patterns, and social actions. In a study conducted in the United States representing a small group of just 21 adults that were receiving aid for deliberate self-harm, it was found that the most promising intervention methodology entailed ‘problem solving therapy’ (18). The preceding found that the most promising type of intervention entailed short-term problem solving therapy, that was cognitively oriented psychotherapy. The foregoing, as represented in five studies versus that standard aftercare indicated a trend that showed decreasing self-harm, with the treatment time varying among all five participants (18). In another set of interventions conducted that entailed twenty adults in each study group indicated a reduction concerning the repetition of self-harm incidents (18). The methodology utilized represented what is termed ‘dialectical behaviour therapy (DBT), which is a treatment program that is comprehensive, and was developed to see to individuals with severe dysfunctional problems. It a lso was designed to uncover those who exhibit borderline personality disorder along with recent incidents of deliberate self-harm (18). In addition, the study revealed that the â€Å"administration of antipsychotic flupenthixol† was shown to significantly reduce the percentage of repeated incidents of deliberate self-harm among individuals that had a prior history of at least two previous suicide attempts as opposed to testing the preceding on another trial group whereby a placebo was used (18). Hogg and Burke (19) advise that self-harm represents more in the attempt to relieve distress and or tension than anything else. Clinical Guidelines Nationally, in the United Kingdom, there are ‘clinical practice guidelines’ as represented by what are termed systematically developed statements developed to assist clinicians, and patients in making decisions concerning the appropriate treatment as represented by differing specific conditions (14). And while the aspects of conditions, circumstances, and related criteria differ in a prison environment, it is important to understand that there are national clinical practice guidelines in place that have some applicability. The preceding guidelines have been devised from available research, and evidence that utilized both predetermined as well as systematic methodologies for the identification, and evaluation of evidence concerning the varied specific conditions (14). In those instances whereby sufficient evidence is either lacking, or not compiled in meaningful numbers, and or conclusions, the guidelines incorporate recommendations as well as statements that have been ba sed upon a consensus as arrived at by the development group responsible for the guidelines (14). The National Institute for Clinical Excellence (20) approach the subject of intervention by stating that the management of self-harm calls for the utilisation of both primary as well as secondary care services in order to provide a complete assessment of the individual’s mental health as well as social needs, along with factors that precipitated the situation, and the factors of risk entailing future and further self-harm incidents. This approach is also supported by Green and Sinclair (21) who add that the appropriate treatment methodologies should be sensitive in terms of the differences that exist between patients exhibiting self-harm characteristics, therefore interventions must be mindful as well as acknowledge the diverse needs as represented by differing circumstances. Thomas and Faulkner (22) add that what is termed as â€Å"user led† evidence is increasingly being recognized in both policy making as well as research, and that perspectives of self-harm treatment following incidents should be investigated thoroughly to correlated findings to further establish care pattern guidelines based upon similar lines of historical facets. Such, however has not been the case, as present evidence relies strongly upon patient studies based upon preventing, and managing self-harm based on a medical perspective. The National Institute for Clinical Excellence (20) in its NICE guidelines, recommend that such a study should be implemented whereby qualitative methodology is applied in a rigorous fashion to examine user experiences, and results. The utilization, and importance of clinical guidelines has been devised as a means via which to improve the outcomes along with processes for the treatment, and intervention of individuals demonstrating a tendency, and or actual history of self-harm and self-injury. It is important to understand that the reasons, and causes for self-harm as well as self-injury are not entirely understood, and that each case and instance represents its own unique set of causes, histories, backgrounds, and rationales. As such, the Department of Health in developing said guidelines has cautioned that the preceding does not represent a substitution for either clinical judgment, or professional knowledge (14). In addition, the guidelines indicate that they are not meant to replace, and or supercede the responsibility of qualified health professionals in their rendering of decisions with respect to their patients. The purpose of the guidelines are to aid professionals in good practice points as well as recommendations for medical treatment, along with psychosocial ,and interventions, with the aims to (14): reach an evaluation of the specific medical as well as surgical interventions undertaken during the first forty-eight hours following an episode reach an evaluation, where possible, of risk assessment for the individual involved make an evaluation of the utilization, and role concerning the psychological as well as pharmacological interventions utilized in said episode reach an evaluation concerning the role as represented by service delivery systems, along with service-level interventions regarding the treatment and care of individuals who have committed self-harm acts to integrate all of the preceding to reach a determination of best practice representing the care, and treatment of those persons whom have committed an act or acts of self-harm. The following guidelines are intended to focus upon those individuals that have committed act(s) of self-harm representing an expression that demonstrates personal distress, along with those situations whereby an individual specifically intends to injure themselves (14). It should be noted that the prison systems fall under the guidelines of the NHS, and the guidelines are applicable to these types of situations as such falls under what are termed statutory services (14). Guidelines The HM Prison Service (23) set forth a â€Å"Prison Drug Treatment and Self-Harm† â€Å"to introduce new procedures†¦Ã¢â‚¬  devised to â€Å"minimize the risk of self-harm† from occurring as a result of â€Å"reaction to the stresses† associated with certain drug treatments. It further stated that compliance with the guidelines requires (23): appropriate information sharing to ensure that proper treatments are being conducted as well as to gather database information on treatment effectiveness inventions. That under ‘Mandatory Action’ That the Directors along with Governors ensure: That managers and staff in drug treatment positions are informed of the treatment guidance contents, and are following the prescribed outlines, That case history information shall be detailed, including prior drug treatment as well as mental state, and such provided to a CARAT team while the assessment is being conducted. The preceding is also to be shared with other intervention treatment programs to further the informational base of how differing case histories, and approaches fair in terms of effectiveness to build the historical base of improved interventions in the future. That prisoners under treatment are monitored for emotional as well as mental well being during the drug treatment process. That providers administering drug treatment must have familiarity concerning the ‘multi-disciplinary risk management process’, termed ACCT, or F2052SH, as well as invoking these procedures upon the identification of someone found as being at risk concerning self-harm, and or suicide. Lastly, drug treatment as administered by providers needs to actively promote as well as facilitate healthcare services access, along with the broad array of support services that are in prisons. The national guidelines for prison treatment of self-harm and drugs, as set forth in â€Å"Prison Drug Treatment and Self-Harm† (23), advises that there are a number of important considerations which must be taken into account during the assessment of the potential utilization of treatment for individuals being treated for self-harm as well as the types of support needed. It advises that the management of the process for self-harm, and suicide represents a multi-disciplinary process that must include CARAT, ACCT, and or F2052SH in the risk management process after the identification of an individual with suicide, and or self-harm tendencies as well as a demonstrated history (23). The treatment of self-harm entails the inclusion of any and all prior treatment, and event histories that should be sought concerning the informational basis for the engagement of intervention (23). The intervention process needs to be cognizant of the individual’s prior treatment along with so cial, mental, and family problems as the concerns underlying the issue may lie in these areas. The guidelines, and information as set forth under â€Å"Prison Drug Treatment and Self-Harm† (23) specify that the treatment programs as represented by CARATs, clinical services as well as Intensive Rehabilitation I are collectively the responsibility of the UK Prison system. CARAT represents the care coordinators for prisons with drug problems, and this agency maintains contact with each prisoner identified in their database. CARAT also maintains contact those instances whereby prisoners are transferred between institutions as well as treatment intervention transfers. Increased effectiveness under the shared informational context is seen as a result of the availability of prior history on prisoners, thus providing data on the path(s) taken, and the results achieved. The preceding also aids in the implementation of more effective intervention techniques. A mandatory facet of the guideline calls for the opening of an ACCT, and or F2052SH as soon as they are aware of an individ ual’s suicide, and or self-harm tendencies and or past actions (23). Under the â€Å"Prison Drug Treatment and Self-Harm† (23), the former treatment, medical, and personal histories of individuals represent an important aspect in continuing as well as prescribing new treatment as it aids those in delivering care to build upon past information. Continuity of care is a vital facet in the setting forth of treatment and allied routines, and it also adds that the delivery of treatment, and intervention in isolation is unacceptable (23). Information with respect to the preceding historical aspects can be obtained by those administering treatment from (23): Oasys assessments, LIDS records that record prior episodes as contained in the ACCT or F2052SH database, Healthcare services The â€Å"Prison Drug Treatment and Self-Harm† (23) document states that prisons need to ensure that a written as well as observed policy on the institution’s â€Å"substance misuse service† that covers the following (23): the clinical services that are provided as a result of healthcare, the guidelines for detoxification for opiates, alcohol as well as bebzodiazepines, that information representing assessment, the setting for treatment and overdose, along with essential observations are in keeping with the guidelines as set forth by the Department of Health, that the health care treatment has been and is being administered in accordance with CARAT drug care plans, as well as the fact that an NHS specialist is involved in the guideline preparations. The foregoing procedural guidelines have been devised to reduce incidences associated with self-harm behaviour. The use of drugs is also considered as a self-harm behavioural pattern. As such, clinical assessment concerning the misuse of substances represents an area definable through the first reception into the prison system as represented by initial medical examines as well as screening of the individual’s personal medical files, and sentencing records (23). The foregoing also applies to incidents of self-harm. Identified individuals that have self-harm, and drug use problems are thus referred for clinical misuse assessments (23). Under the â€Å"Prison Drug Treatment and Self-Harm† (23) guideline, prison systems have the responsibility to provide the appropriate settings for clinical interventions that permit unrestricted observation for patients that exhibit complex needs, with such observation available at all times (23). The â€Å"Prison Drug Treatment and Self-Harm† (23) also provides for healthcare and CARAT teams to work jointly on protocols concerning the referral of individuals that exhibit self-harm risk as well as suicide, and other mental health facets. The preceding, protocols, require in addition to prison referral concerning the aforementioned to CARAT teams, that an ACCT, and or F2052SH must be opened concerning any case that has these symptoms (23). The CARAT assessment framework contains elements that are utilized to provide detailed information concerning individual records of treatment as well as health areas as such relates to self-harm. The following specifies the drug intervention record asks and or records the following under the: A. Treatment Section (23): If the individual is presently receiving drug use treatments, under section 5.12 This aspect represents the opportunity to determine the type(s) of treatment administered to the prisoner, and whether such prior treatment records should be obtained. If the individual has had any drug use over the past two years, under section 5.13 Under this segment of questioning the CARAT worker should determine the type(s) of treatment the prisoner received, from the individual themselves as well as the treatment agency. Such data is useful in determining the treatment intervention(s) utilized and how such affected the prisoner, in addition to identifying if the individual had and or has any problems related to coping and related areas. Has the individual had any treatment for drug use in prison, under section 5.13 Details representing prior treatment, help options and other relevant contact details, under section 5.15 B. Health Section (23): If the individual has any mental and or physical health issues, under section 6.2 Under this facet, the CARAT worker seeks information from various agencies as well as healthcare concerning if prior treatment has either caused, and or raised any problems that might contribute to the prisoner’s physical, and or mental health areas. C. Disclosure Form (23): Informed Consent Under the disclosure form, it is indicted clearly that the prisoner’s consent is not a requirement if the CARAT team thinks that the prisoner may be at the risk of committing self-harm. The consent form also permits that information can be shared between agencies, as well as disclosing the treatment the prisoner is receiving. D. Referral Form (23): This form is devised to allow for any other relevant information, such as risk to the prisoner as well as others, access problems, and related areas, to be recorded as part of the assessment, thus resulting treatment formulation. E. Comprehensive Substance Misuse Assessment (CSMA) (23): Under the ‘National Treatment Agency Model of Care’, a Comprehensive Substance Misuse Assessment (CSMA), along with the preparation of a corresponding care plan must be concluded before the administration of drug treatment. However, the foregoing is noted as to potentially not being possible for those individuals whose stay inside the prison system is relatively short. History of Substance Abuse – Under section 1 Under this segment, the CARAT worker’s responsibility is to seek detailed information concerning the prisoner’s prior treatment through asking direct, and informed questions. In the exploration of the preceding, the CARAT worker needs to be mindful of as well as to take into consideration the processes utilised to achieve said outcomes as discovered

Client Based Care Case Study: Elderly with Diabetes

Client Based Care Case Study: Elderly with Diabetes 215479 Client Based Care Study Introduction In this essay, the author will explore the care of a single patient, encountered in clinical practice, examining the impact on quality of care, and on the health and wellbeing of the individual, of key aspects of care. Case studies allow nurses to reflect on practice, examine critical elements of case and of clinical decisions made and actions taken, and to examine areas of care in more detail. This essay will explore the care of one patient, who shall be called Molly, an older, community dwelling adult with Type 2 diabetes, who was admitted to a medical admissions ward having been found unconscious at her home by neighbours. The essay will examine the aspects of her care that relate to the management of her condition, the assessment and management of her social, care and personal needs, and the planning of her future care and support needs. Reference will be made to governmental guidelines and policies, and to interprofessional working as a fundamental component of meeting patient needs in this case. Discussion Diabetes is a chronic disease which is known to impact significantly on the health, wellbeing and prosperity of individuals, of families, and of society as a whole[1]. More than 1.4 million in the UK are affected by diabetes[2]. Because of the great impact that this disease has on public health and on the use of NHS and social care resources and services, the Department of Health has published a National Service Framework for diabetes, which not only sets standards for management and diagnosis of the disease, but outlines best practice in the light of the latest available evidence on the condition[3]. There are two types of diabetes, Type 1 and Type 2, both of which are signified by a persistent high level of circulating blood glucose, due to a lack of insulin or a significantly impaired response to insulin, or to a combination of both factors[4]. Type 1 diabetes is due to the insulin-producing cells in the pancreas, called the Beta Cells, located in the Islets of Langerhans, failing to produce insulin, because the body’s own immune system has destroyed them[5]. Type 2 diabetes is usually caused by a reduced amount of insulin production by these cells, and by a degree of insulin resistance within the body, wherein the body’s metabolic responses to insulin are not as sensitive[6]. Type 2 Diabetes is the condition which Molly, the patient in this case study, has been affected by. Molly is a 66 year old woman who has had Type 2 diabetes for 17 years. She is treated by twice daily insulin, and, living independently still in her own home, she is visited once weekly by a district nurse to monitor her glycaemic control and check her insulin stocks and her general wellbeing. Molly has a BMI of 35, and also has a history of hypertension which is controlled by medication. She has her blood pressure checked weekly as well. Molly lives alone, never having married, and has no children. She has an active social life, attending a local book group, taking part in a local history and re-enactment society, and volunteering at a community library. She is known by the district nurses to be competent in administering her own insulin and measuring her own blood sugar, but she does not always adhere to her regimen and her recommended diet, because it can interfere with her social life. Molly was found unconscious by one of her neighbours at 9 pm, and the ambulance was called. Paramedics attending were told of her history by her neighbour, who waited with her, and suspected either Diabetic Ketoacidosis or hypoglycaemia. Diabetic ketoacidosis is a condition which can be life-threatening, and is usually due to a lack of insulin, which means that the cells of the body are unable to use glucose for energy, and so instead convert fat reserves to energy, which can produce ketone bodies which can adversely affect brain function[7],[8]. Hypoglycaemia can be caused by an overdose of insulin, or inadequate carbohydrate intake in a person who is taking insulin, or by the patient taking too much exercise, thus using up glucose, or by a combination of these Paramedics found her blood sugar to be 1.1 mmols, and administered glucagon to reverse the hypoglycaemia. She recovered consciousness quickly once her blood sugar improved, but was also given facial oxygen, and had full observations taken. Molly remained confused after insulin administration. She was taken to the medical admissions unit for a full assessment and, if necessary, in-patient admission and review of her diabetes. According to emergency care principles for the diabetic patient, the priorities are to save the patient’s life, alleviate their symptoms, prevent long-term complications of the disease and their current risk factors, and then to implement care that will help to reduce risk factors for their health, such as hypertension obesity, smoking, and hyperlipidemia, along with providing ongoing education and support for self-management of their condition[9]. In Molly’s case, the team evaluated her condition, because although the initial diagnosis was hypoglycaemia, suggested by her self-reported history of missing meals that day and being very busy, the differential diagnosis was diabetic ketoacidosis, which can be precipitated by physical or biological stress, including changes in endocrine function or other diseases, such as myocardial infarction[10]. Molly is pale as well, a finding suggestive of hypoglycaemia, along with her elevated blood pressure and dilated pupils[11]. As Molly was conscious, her Glasgow Coma Score was 13, and she had responded well to glucagon, according to established diabetic protocols, she needed to be stabilised and undergo a range of investigations to determine any other disease or factors precipitating her condition[12]. Blood pressure, temperature, pulse and respiration rate were monitored recorded via continuous telemetry, and an ECG was carried out, which ruled out myocardial infarction. Molly had blood sent for Full Blood Count, Liver Function Tests, Urea and Electrolytes and Glucose, as well as insulin levels, prothrombin time, clotting factors[13]. Prothrombin Time and Clotting Factors may also be tested, due to the risk of disseminated intravascular coagulation. Bloods were also sent to test HbA1c; Fructosamine; Urinary albumin excretion; Creatinine / urea; Proteinurea; and Plasma lipid profile[14]. Urine was dipped with reagent strips to test for glucose, protein (suggestive of kidney problems) and ketones. Because of her presentation, Molly was put on a continuous IV infusion of insulin, titrated hourly using a syringe driver against blood glucose, with an infusion of 5% glucose running in a different IV port. IV fluid therapy, and fluid balance, were also monitored closely[15]. Diabetes can cause kidney damage and impaired urinary function, so monitoring kidney function was an important part of care[16]. Once Molly was stabilised, ongoing care related to supporting her health and wellbeing, and minimising complications of her diabetes, became an important part of care. Diabetes is a significant public health issue, because it is not only associated with the ‘social’ disease of obesity, but also because as a disorder it is associated with a number of serious health implications[17]. These complications include macrovascular complications, including atherosclerosis and cardiovascular disease[18], [19], [20]; diabetic retinopathy and sight loss due to vascular damage which weakens the walls of the blood vessels in the eyes, causing microaneurysms and leakage of protein into the retina, vascular damage and scar tissue [21], peripheral neuropathy, peripheral vascular disease and gastrointestinal dysfunction, gomerular damage, and kidney failure[22]. The impact of this disease on public health relates to the fact that many people of working age are diabetic, and because the co ndition is chronic as well as serious, with acute exacerbations and so many complications, it presents a serious drain on health and social care resources. Therefore, it is imperative that individuals with diabetes are identified as early as possible, and are educated and supported in good self-management, and provided with ongoing care to maintain good glycaemic control[23]. Molly’s status as an older adult is also a public health issue, because older adults constitute the largest patient group in the UK, and the ones which consume the biggest proportion of healthcare services[24]. However, it was also important to avoid stereotyping Molly as an older person, and making assumptions about her needs and her health. Although she was obese and hypertensive, and had Type 2 diabetes, she was very active and had a very important social life, and was usually independent and self-caring. It was important to consider the social support that she had, and to ensure that she was aware of any services or support she might be able to access if she felt it necessary. However, some members of the multidisciplinary team, in particular, some of the medical staff, did appear to act in a way that suggested they were stereotyping Molly based on these factors (age, weight, health) and were discussing her case without really making clear reference to her as a whole perso n. This leads on to the need to evaluate the multidisciplinary input in Molly’s case, and the quality of the interprofessional working that took place, which is discussed below. As can be seen from the list above, diabetes can affect the individual and the body in complex ways, and so requires an holistic approach to care[25]. Care should also be based on evidence based, collaboratively agreed care pathways[26], as suggested by the NSF for diabetes[27]. Molly may need a comprehensive review of her management and her lifestyle, the patterns of care and the ongoing monitoring of her condition[28]. The National Institute for Clinical Excellence recommends a patient-centred approach to ongoing patient education and management, and also suggests a number of options for patients who might require different forms of insulin administration, such as continuous sub-cutaneous insulin[29], [30]. This, however, was not suitable for Molly, because it is usually for people with Type 1 diabetes. Health promotion and education is an important part of Molly’s care at this point, which is related to the fact that her current hospital admission is due to mismanagement of her condition herself. It was important to determine what factors about her lifestyle and behaviours had led to the lapse and the serious hypoglycaemia. Ongoing care, health promotion and education involved multi-professional collaboration and integration of care into a complex, detailed care plan. The aim was to provide Molly with the information, support and guidance that would allow her to view her diabetes management as a means of achieving a better quality of life, rather than viewing her diabetes as something which interfered with her quality of life. It was also important to view Molly in terms of supporting her to continue with her normal social activities. Research shows that making changes in lifestyle, and providing good, effective health education, helps to contribute to reducing rates of diab etic complications[31]. However, the kind of health education and support used is important, because different approaches have different levels of effectiveness. Some research examines the differences between health education that tries to persuade patients to be compliant with regimes and activities designed by health professionals, approaches which are usually generic, and health education that is client-centred[32]. Client centred approaches are usually more effective, as they are individualised. Research shows very clearly that patients with diabetes need to understand their disease fully, and be supported and empowered to make the lifestyle and behavioural changes that will enhance their wellbeing whilst enabling them to control their condition[33]. In this case, a diabetic nurse specialist was involved with Molly’s case, and a plan for health education and support drawn up, with clear guidelines and a tailored plan for managing her social life around her diabetes. Diabetes UK recommends a struc tured, tailored education programme for people with the condition[34]. Interprofessional and multidisciplinary working is a fundamental component of care for a patient with diabetes like Molly[35]. This means that diabetic patients should experience seamless care, addressing all needs, with access to all the professionals necessary to support her care[36]. Specialist involvement, including diabetic nurse specialists, was a feature of this care, and helped with a client centred focus[37]. The literature suggests that it is important for a lead professional to take charge[38], but in Molly’s case, her lead nurse was not present for the majority of her inpatient stay, and there was a lack of effective coordination of the complex number of professionals involved. In relation to multidisciplinary, interprofessional working Molly was referred to ophthalmic services for a check-up, to ensure that there was no diabetic retinopathy or glaucoma. She was referred to a dietician to support her in managing her dietary intake. She was also referred to a social worker. Diabetic specialist doctors were involved, and a report was sent to the diabetic nurse at her local surgery, as well as to her GP. Molly ended up staying in hospital, however, on a medical ward, for two weeks, even though her condition was stabilised rapidly, and she experienced no further complications. In this case, interprofessional working was not effective, because although the said referrals were made, or were recorded to have been made, Molly was not seen by the dietician or a social worker for over a week, and only when she began to threaten to take a discharge against medical advice did the dietician and social worker arrive and get involved. The doctors in charge of Mollyâ€℠¢s case however appeared to make judgements about plans for discharge and ongoing care without involving the nursing team and without considering some aspects of her social situation and Molly’s own preferences and wishes. It is apparent, from this case, that while Molly’s immediate medical needs were met, the interprofessional working element of her ongoing care failed in some way. There are a complex range of professionals and support workers who provide healthcare[39]. Because of this complexity, interprofessional education has become part of healthcare education programmes[40]. Interprofessional working is supposed to help with the provision of true patient-centred care, and the highest quality of care[41]. However, experience in this case, and some of the literature, cites ongoing problems with interprofessional working in a number of contexts. Some of this is to do with the professional boundaries and hegemonies which persist in healthcare professions, which continue to be defended rigorously by each profession[42]. Some literature shows that elitism, professional isolationism and professional defensiveness can have negative effects on health professionals themselves as well as on the qual ity of care delivery[43]. Yet there is ample government guidance, particularly from the Department of Health, which aims to improve service provision, and the NSF for Older People[44], identifies the most important elements of care and service provision which must be improved upon. Standard 2 of the NSF, ‘Person-Centred Care’, requires that health and care services are designed around the needs of the older patient (and their carers)[45]. However, this kind of needs-based care then demands . â€Å"an integrated approach to service provision†¦ regardless of professional or organisational boundaries, [which is] delivered by clinical governance, underpinned by professional self regulation and lifelong learning† .†[46] In Molly’s case, the fundamental role of the nurse in providing leadership and coordination for her care was not acknowledged or supported. Some researchers suggest that this can be due to medical hegemony[47]. Current approaches to offsetting such ingrained hierarchical thinking are very much focused on initial education of healthcare professionals, overcoming historical professional boundaries[48], [49], [50]. The research shows that there is a difference between multiprofessional working, which does not transcend the traditional hierarchies and boundaries , and inter-professional working, which is built on the desire to share care, support each other, and value each others’ expertise[51]. Government drivers continue to underpin strategies for better, ‘joined up working.’[52],[53]. The failures which occurred in Molly’s care were clearly linked to poor communication between the healthcare professionals, a lack of joined up working, and a lack of recognition, perhaps, of the importance of the social aspects of Molly’s case, and the health-education aspects, based on her individual needs. On reflection, the author believes that had there been better, collaborative working, then none of these needs would have been overlooked and they would have been dealt with more speedily. But another aspect of her care that could be improved upon was related to her own involvement in her case. Molly was not fully involved in her case discussions and in the medical decisions made about her care. While this can be a product of the medical hegemony mentioned before[54], it constitutes a serious oversight and is not in line with governmental guidance[55]. Research shows that the patient voice is the most important one in terms of collaborative care planning and manage ment[56]. Conclusion This case study has identified the case of Molly (a pseudonym), an older patient with Type 2 diabetes who received good quality clinical care in meeting her acute care needs and managing her medical condition and its potential consequences, but for whom interprofessional working failed in relation to ongoing care and multi-discinplinary involvement. Diabetes is a significant public health issue, and a range of governmental guidance and research evidence informs care for patients with the condition. The public health issues surround the serious morbidity and mortality associated with diabetes, and the fact that good management and glycaemic control can minimise these complications. In this case, the patient’s needs were prioritised medically, but interprofessional communication broke down. While the appropriate referrals were made, proper joined up working did not take place. Similarly, Molly was not fully involved in her case, and should have been. 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[5] Watkins, P.J. (2003). [6] Watkins (ibid) [7] DoH (ibid) [8] Hankin, L.(2005) p 67. [9] Watkins (ibid). [10] Turina, M., Christ-Crain, M. Polk, H.C. (2006) p 291. [11] Guthrie, R.A. Guthrie, D.W. (2004) p 113. [12] Edge, J.A., Swift, P.G.F., Anderson, W. Turner, B. (2005) p 10005. [13] Hankin (ibid) [14] Reinauer, H. (2002) [15] Guthrie (ibid) [16] Guthrie (ibid) [17] DoH (2002); Department of Health, (2001). [18] Guthrie (ibid) [19] Bloomgarden, Z.T. (2006) [20] Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) [21] Guthrie (ibid) [22] DoH (2002). [23] DoH (2002) [24] Department of Health, (2001) [25] Collis, S. (2005) [26] Pollom, R.K. Pollom, R.D. (2004) [27] OBrien, S.V. Hardy, K.J. (2003) [28] Snow, T. (2006) [29] NICE (2003) [30] Diabetes UK (2006) [31] Anthony, S., Odgers, T. Kelly, W. (2004) [32] Skinner, T.C., Cradocl, S., Arundel, F. Graham, W. (2003) [33] Antony (ibid) [34] Diabetes UK (2006) [35] DoH (2002) [36] Keene, J., Swift, L., Bailey, S. Janacek, G. (2001) [37] Keen, H. (2005) [38] Scott, A (2006) [39] Masterson, A. (2002) [40] Pollard, K.C., Miers, M.E. Gilchrist, M. (2004) [41] Kenny, G. (2002) [42] Colyer, H.M. (2004) [43] Price (ibid)

An Argument for the Use of Due :: essays papers

An Argument for the Use of Due Due to a lack of attention or understanding of English grammar, many Americans have, for several generations, used the adjective due as part of a prepositional phrase to introduce adverbial elements- to the disapproval of some strict grammarians. Although I prefer their prescription, for reasons of style, I must oppose their claim to correctness, on the pragmatic grounds of logic and sensibility. The most shakily grounded argument against the adverbial use is one of etiquette or style. Wilson Follett considers this use as "poor workmanship" which is "loose and lawless....rare in writers other than those who take advantage of every latitude." (Follett). H. W. Fowler also reveals a negative bias in his statement that "due to is often used by illiterates" ( Qtd. in Morris). But, as Bergen Evans said, "it is used to qualify a verb millions of times every day. And it is used in this way in very respectable places." So, if we are to devise and enforce laws of grammar based on usage by a particular social class or the preference of some who disapprove of its workmanship-who I might add are a minority-then we should sharpen our pencils, and prepare our oratories, for the battle we've begun hardly ends with this issue and is certain to be long and arduous. A second argument, best stated by Follett, that not every locution is right by virtue of its existence, appears to highlight the noble defense of language from the deterioration caused by uneducated and uncouth use. If this were the case here, I would heartily applaud Follett and Fowler for their defense. But it is not the case. For example, engraved tablets adorning the Philadelphia state house read, " Here sat the Continental Congress...except when...it sat in Baltimore, and in...Lancaster and in...York, due to the temporary occupation of Philadelphia by the British army." (Qtd. In Evans). And in 1957 Queen Elizabeth II opened her addressed of the Canadian parliment with, "Due to inability to market their grain, prairie farmers have been faced for some time with a shortage of sums..." (qtd. In Morris). The wide spread, public and formal use of due to for adverbial elements hardly qualifies it as uneducated or uncouth and actually contradicts the definition of locution. In fac t, if precise usage is the issue, I think it would be more accurate to call the grammarians substitution of other phrases in adverbial uses a locution.