Movie Review: The Abnormal in Normal

Normal is a spectacular characterisation which encompassed both a war and unity of emotions, standards, and ideologies. It showcased the play of sexuality, understanding, anger, variation, ostracism, and most especially, fare, depicted in the lives of the temperaments that allay the film. How all of them owned a different perception of Roys transsexualism and how these perceptions seemed to be intertwined dramatically revealed the key element that make up Normals core.Personally, I found the movie very moving and inspiring. It is non usual that films like these are produced in the industry for the obvious fact that transsexualism, not to mention heterosexuality and bisexuality, is still on the process of h senileing a secure, firm, and properly recognized position in society. Normal was successful in its attempt to disband stereotypes regarding deviant behavior and twisted genders. It portrayed how adoption and manage serve as the briny dissolving agent in breaking norms in response to the changes that occur in time.Roy, one of the main characters, was extremely daring and determined to stimulate comeed strength to face much(prenominal) an immense transformation and survived the critical judgment of his family, peers, and community fellows. Containing his desire to be a wo manhood fixly to himself for that length of time is something not firm people could ever put up with.The weight was even graver, however, on her wife Irma. In my opinion, she was the one who suffered most with what had happened. After 25 old age of marriage, two teenage offspring, and a healthy relationship which was supposedly homosexual-to-homosexual, her preserve tells her that he is a fair sex trapped in a mans tree trunk and that he wanted to live like a lady for good through gender reassignment. Discovering that the man she fell in love with was replaced by someone with a heart of a woman would have been the key struggle in Ruth and Irmas marriage.Eventually, nonethele ss, Irma versed to embrace Roy for who he isthe man he loved yet promptly with earrings, perfume, make-up, and even breasts. This was a affectionate proof that true love does enamour all and breaks differences. The occurrence tested if Irma was really willing to stay with Roy and to love him with all her heart, through sickness and health, for richer or poorer, with death as the sole wall that could separate them. The relationship of the touch evidently changed, but the love was still the same. This served as their starting point to both reliving an old chapter of their liveliness and opening a new one together.Patty Ann and Wayne, the couples children, were also affected by Roys revelation. Albeit their reactions were of opposite sides of the spectrum, these showed that they importantly cared about what happened to their bugger off. Dealing with his kids, however, remained as another struggle for Roy.Patty Ann took his fathers transformation in a positive light since she, to o, was having a puberty and femininity crisis of her own. On the other hand, Wayne was infuriated. Being older, cosmos the son, and being a hardcore rock music enthusiast, it was not peculiar that Waynes mind seemed to be very narrow when it came to gender issues.The main characters father also played a weighty leave-taking in Roys family struggle. analogous Wayne, Roy Sr. strongly disagreed with what occurred to his son. During Roys earlyish years, his father had already begun beating Roy to stop his feminine tendencies. His paternal influenced continue until Roys adulthood but failed to maintain his sons manliness.in concert with his wife Irma, Roy struggled to face another conflict with an influential and important torso outside their marriage society. His revelation to the parish counselor initiated the ostracism that Roy encountered from the religious sector. This banishment was in line with the Vati potbellys dissent for gender changes.Though international to the scope of the movie, the Papal government most likely inspired the historys plot. According to Asher (2003), gender reassignment shall not in any counsel change the gender of an individual in the vision of the church. Moreover, Catholics who underwent this kind of transformation shall not be eligible to wed, be ordained to the priesthood or project religious life (par. 2). Gender reassignment merely changes the surface quality of the someone and not his/her inner attributes and personality. These were the strong bases of Roy and Irmas gradual but fixed exclusion from the religious sector.Roy also had problems in his control. He served almost his firm life as an employee in a farm machinery factory. Going to work one day all womanized expectedly brought in mockery from his coworkers. Roys boss, Clancy Brown, was pity enough to transfer him to a safer and more considerable work section. However, he developed affection for Irma, which pushed Roys work struggle to a high notch. Fortun ately, Roys wife realized that he was in love with no man other than his beloved husband.This dedication, loyalty and commitment of Irma to Roy were what captivated me to the movie the most. These same attributes of Roys wife are the reasons why she is my favorite character. Like what I have mentioned before, Irma exemplified the power of true and powerful love. More than that, however, is Irmas commendable courage to continue to walk with his husband, no matter how things have changed.Remarkable courage was also exhibited by Roy. Personally accepting that he was a woman in a mans body is already a valiant feat. Adding his revelation to his family and community during the period of his life when all was settled for him as a man can be considered a lifetime accomplishment. Not everyone who is gay, lesbian, or both can muster the willpower and inner strength that Roy depicted. Not all irregularly gendered can face life with the truth that they know deep within them. at that place is t his strong feeling inside of me that the movie Normal will always hold a special place in my life. It taught me so numerous things about accepting changes and living with what and who matters in your life. Just be strong and all things will follow.ReferencesAsher, J. (2003, January 16). Vatican Will Not Endorse Gender Changes. Retrieved April 7, 2008 from http//www.planetout.com/pno/ news show/article.html?2003/01/16/3

Religious and Ethnic Diversity

Religious and Ethnic variety show ETH125 Lavetta Hayes 3/24/2013 The Mormons believe that there were Jews in the States and that Jesus came to the States and non the ticker Eastern holy land. They in addition believe that the giveer of their faith learned this information and other presentation values of the Mormon religion based off of some flourishing tablets that came d suffer to him from heaven. Person eithery, I see that those particular beliefs ar kind of crazy. However, whizz of the more interesting beliefs that the Mormons hold is that when they die and go to heaven.They go out be reunited with all of their family, including past family members. Because of this particular belief, the Mormons reserve truly meticulous genealogical records of their families, so that when they do enter heaven they will manage who their family members be. thither is a genealogical library in e real Mormon perform and followers of these churches will often spend hours at a era in these libraries researching their families. To my knowledge, no other mainstream Christian religion view ass such thoroughly track of all possible family ties. * The LDS (Latter- solar twenty-four hours Saints) church has seen a swarm of wrong against their beliefs.Even from the beginnings of the religion, m any(prenominal) societies begin disagreed with their views. Because of this disagreement and over all dread and misconstrue of the religion, the followers of the religion have been asked to leave many presents. In oneness particular case, there was actually a war between the state of Missouri and the followers of the church. * Throughout history, only until the 20th century, or so of what the Mormons see with other religions was ostracization and fear. Even after the war that had occurred in Missouri, they calm d suffer shew persecution to the places they emigrated to until they finally settled in Utah.Because of all of the mistreatment, this has caused Morm ons to be a very tightly knit community that is very secretive to outsiders. many an(prenominal) Mormons keep their religion to themselves and their church congregation. * One of the approximately recognizable things that the Mormons have brought us is their incredibly famous, and very talented Mormon Tabernacle Choir. This choir has win multiple awards including a Grammy and Emmy for their performances. They have performed for multiple presidents and even at the Olympics.They have rel freed multiple albums of famous hymns and toured all over the world. This choir has played an beta role in helping the overall image of the church. * The Latter Day Saints overly boast one of the best genealogical libraries in the pastoral, collectible to their beliefs roughly family, and are major(ip) supporters of The Boy Scouts of America. Many BSA troupes across America are funded by a local Mormon church and the subject church service awards BSA money every year so that they may watch their efforts. The major genealogical libraries of the LDS churches are constantly growing.The Mormons are also cognize for building and maintaining extremely gorgeous churches in major LDS communities, many of which are in Utah, skillful there are also large, glorious churches in Las Vegas, New Mexico, and various areas in Southern California. The Mormons have seen a survey of persecution in Ameri toilette history. When the religion was originally founded, most communities conception that they were unusual and like other religions before them (Judaism in Germany, Paganism in the phantom Ages, and what some places in America are trying to do to sharia Law), the religion was ostracized.This led to a great migration of the Mormon commonwealth to Utah, their Zion. They found peace there for many years, alone as the meters changed and nine changed, heap once again questioned the Mormons for their oddness. People today inactive mean the Mormons are odd but on the grander scheme of things, they have non take place in to light since the 70s. The world has bigger things to be preconception against today so there is no point in currently questioning a religion that, in the end, does believe in Jesus.In the 60s and 70s the Mormon Church got a band of attention because many people were non at ease with the Mormon Churchs view on marriage and polygamy. This caused a rift in the Mormon culture and created two sects of the church The fundamentalistic LDS and the we know now as just Jesus Christ Church of Latter-Day Saints. The Fundamentalists were pressured to leave the traditional Mormon cities, and have since campaignd and founded their own communities across the Northern and Southern Sierra Nevada. No commencements are wholly clear on wherefore the Mormons have seen as frequently inconsistency as they have.Though I believe that a basic understanding of homosexual nature would show that the reason this religious group has seen so much persecut ion is because many people fear what they do not understand, and do not seek to understand what it is they fear. The Mormons have a some, even myself, would consider to be strange beliefs. Their original stance on polygamy, their strict health code, and their recurring belief to dress and behave modestly. In todays day in age the latter seems nearly impossible but they still manage to dress contrastingly, which I am sure is a source of discrimination for those that venture outside of their communities.The Mormons have long been ruling to be polygamists, in where one man has many wives know as babe wives. duration this was true at one point, and in some cases still is, the majority of the churches no longer practice this. Still, this has permanently marred their semipublic image. Devout Mormons, even today, still follow strict health practices. Many of them do not consume or drink sugar, caffeine, tobacco, or alcohol, and keep their food natural and free of modern chemicals. Le arning about this religion was interesting, to say the least.I am one of the few people I know that knows my ancestral line so well, and that is because of my grandmother on my fathers side. When I asked her why I know this, and why she knows this, she told me about the Mormons belief of their families in heaven. And small-arm I am a fan of natural foods, and live a relatively substance free life in terms of alcohol, caffeine and sugar, to think that I could not have them as a Mormon would incur me sad, because I love chocolate. I cannot say that I in full understand the Mormon religion, or that I ever will, or that I ever want to.They are a nonviolent people, and when they come to my penetration and I tell them that I am happy with the religion I am, they smile and tell me to have a nice day and move on. All that I am concerned about is that they are peaceful and do not hate me for being a unalike religion from them. Knowing that they are means that I can continue to think th em a bit odd, but not hate or accuse them for it. I will forever understand that they are different, and because of that I will not ever hold their religion against them because I am different, and in that itinerary, we are the homogeneous.I might not ever understand more than that, but what is important is that there is peace for them and me. * The people we know as the Asiatics are many and varied, in looks, culture, and religion. The term of Asian refers to anyone that looks Japanese, Chinese, or, to put it more bluntly, has a rounder face and slanted eyes. Many people forget that India is a part of the Asian continent, as well as what we know as the middle east, the bucolic made famous in the movie Borat, Kazakhstan, and my personal favorite, RussiaThere are over 40 different accepted major lyrics in Asia, and this is not including smaller dialects and over 15 different recognized religions and spiritual beliefs, some of which we are familiar with, and some of which we ar e not. A few of these recognized languages are Russian, Vietnamese, Korean, and Arabic, among many others. We are familiar with the religions of Christianity, the views of Atheism, and Judaism. other major religion in Asia, specifically Japan is Shinto. Confucianism is popular in Korea and Islam is the largest religion of Asia. * Many races from Asia have been greeted here in America with fear and disdain.Even though we are the great melting pot, each group of people that has immigrated here has seen their fair share, and sometimes more than their share, of hate, no matter what discolor their skin is or where they are from. In modern days it is light-colored for us to recognize the tenuous relationship that Americans have had with Muslim Americans. While the discrimination of the Muslim Americans is in the decline, there is still a lot of fear amongst the American people of this particular group at this time in history. * The country of Asia has been very war torn within their ow n borders as well.Many Jews within Russia are still prejudice against, the wars in the Middle East, the war and continued disdain between China and Japan, the North Korean and South Korean divergence, the list goes on. America may be funny of immigrants throughout the years, but there has been and always will be conflict amongst countries within their own borders that will encourage them to come here or elsewhere for a better life. * One of the first things I horizon of after reading this question in regards to the Asian people is Chinese New Year. It might sound racist, but I love the Chinese New Year so much.It is a fun and unique jubilation that brings back great memories from my childhood, and I believe that many Americans enjoy that rejoicing as well. While it is something that is distinctly Chinese/Japanese, it has become part of American culture as well. I think that is only one display case of the other holidays that have been brought over from Asia, and only one of th e things that the Asian people have contributed to our culture. * I think more than just Holidays and fun languages, any group of people that has come to America has brought an overall understanding of their culture.While all immigrant groups in America have seen discrimination and prejudice, their persistence brings an understanding and ultimate peace to their settling here. One of the most prevalent and frightening displaces of prejudice and discrimination against Asian people occurred during World War II, after the approaching on Pearl Harbor from the Japanese. After that attack, due to fear of Asian spies within the countrys borders, many Asian-Americans of Japanese or Chinese decent were mandatory to move into internment camps located across the country.While these camps were not like the working class camps into Germany, they were not any less bad. While interred in these camps, the prisoners were coerce to read and learn American propaganda, they were not fed well, their sleeping conditions were poor, and the nutrition conditions were filthy, and just sad. Many of the inmates at the camps had their homes foreclosed on and all of their property repossessed by federal and local governments. After the prisoners were released from these camps, they did not have homes to go to, and had been apart(p) from their families.They were also not welcome at many places to eat, live and work. If we become further back in history, any Chinese immigrant that came to America in the 1880s was not treated very well. They were often beaten in the streets. Lynching and murder of a local Chinese immigrant was often looked over. They were hire as cheap, fast, and replaceable workers, so if one died, no one very cared and the work continued because it was understood that there would be a shift very soon. In the case of the internment camps during World War II, that was something that was do out of fear.The American people were afraid and as a result, a terrible thing happened that we all try to politely ignore, but that can never be erased. In the case of the great Chinese immigration in the 1880s, well that was a different time. We were a much jr. country then, and fear, discrimination, and prejudice were much more common place. It was very well-heeled for any duster American to distrust any person that wasnt the same color as them, and there was a belief then that white people were better than the other races.But with all prejudice and discrimination, along with that thought of superiority, it comes down to fear, ignorance and misunderstanding. As the country has matured, as has our understanding of the world. Different cultural groups still see prejudice and discrimination, but there is a lot less killing than there was in days past, and we see things in a different way than what we did in centuries past. From what I know about the many peoples of Asia, I understand that like us, they are a country (many countries). Like us, they have th eir religions, their cultural views, their languages, and their lives.They hold different views on personal responsibility, familial responsibility, school, family values, and religion. Asia is an incredibly vast continent, and there are many different cultures on that continent. I know that each country is different in its own way and I respect that. I do not greet people from that continent with any kind of disdain or prejudice. The Mormons, the Chinese, and the Japanese as well as other Asians have seen similar discrimination in that at some point in American history, on American soil, they have been beaten, killed, pressured, and taken out of their homes.They have also seen religious persecution. There was a time where any religion that was thought to be Asian was celebrated in a major way here in America. Though now these cultures are well assimilated into American culture, they were once feared and ostracized. Even other cultures from the continent of Asia have seen prejudice and detestation at the hands of the Americans, but I am of the opinion that everyone that has come to America has, even the pilgrims, it has all just come at a different time in history and been enacted out in different ways. Times may change, but hate never really does.The major difference between the two groups is that one is recognized as a religious group, and the other, while having varied religions, is recognized mainly as face different from white people. The Mormons were Americans that were hated and feared by other Americans. Many Asians are recognizably different from a traditional American, even if they are not what we typically think of when we think of Asians. The other difference is that the Mormons saw their persecution not because of the way they looked, while Asians, because they looked different, were looked down upon. Both have seen physical nuisance, but I would venture to say that theAsians have seen more physical pain than the Mormons have. After the Mormo ns came to Utah, most of the violence was over, but there are crimes move against non-whites even to this day. And since Mormons have fallen off of the great radar of plague for America, there are still many very racist areas of the country that are acutely aware of the difference between whites and non-whites, and tend to make a big deal about it. America, while being known as the land of opportunity and the great melting pot, is a very scared, hateful country. Yes, there are many places within America that are very tolerant and peaceful, such as where I live.But there are also other places that are still very prejudice towards authentic ethnic groups. As our country has matured, the hate towards different ethnic groups has been explicit in a different ways, but hate is still hate. perhaps someday in a perfect world, America will just stop caring and realize that in the end it doesnt matter what language we speak, what religion we are, or what color we are, but instead realize that the most important thing is that we are all people. We are all military personnel beings on the same planet and that is, and should be recognized as the most important unifying factor in us all.

Gender Roles in “Their Eyes Were Watching God” Essay

During the 1900s, wowork force, specifically black women, were take uped to be property of men in the coupled States, especially down south, in states such as Florida and Georgia. Legally, women had no voice. For example, if a wo musical composition was abused by her economise, the court system would not allow it even if it did really happen. In the article Sexism in the Early 1900s, Becca Woltemath states that a womans job is to constitute care of the dwelling house and to bear children.Shes no good for anything else. Shes vertical a simple thinker. Women were forced into submission and there was nothing they could do around it. In the novel Their Eyes Were Watching god, Zora Neale Hurston shows the issue of gender business offices by dint of the story of a young woman named Janie, who struggles through an arranged unification. finished multiple characters, as well as the plot, sexism beds to the surface.As soon as the novel begins, it is evident the roles of men and women play a very man-sized part in this novel Ships at a distance bear all mans wish on board. For some they come in with the tide. For others they sail foreverNow, women forget all those things they dont want to remember, and remember everything they dont want to forget (Hurston 1). In this opening paragraph of Their Eyes Were Watching God, Hurston compares the wishes and dreams of men and women in a particularly interesting way.By using the sea as a symbol, she is saw that men can never really control their dreams, just wait for them to come true. While women on the other hand, can take their dreams into their own hands, molding them as they see fit. Making this comparison establishes the floor of gender divergency throughout the novel, and ultimately foreshadows the fact that Janie is going to struggle, n iodintheless go away stop at nothing to achieve what she sets her mind to. aft(prenominal) first setting the tone, nurse is introduced. Her traditional values of woman ly roles such as cooking and cleaning lead us to believe that Janie will be the same way. But when Janie kisses Johnny Taylor, her view of men changes by and by seeing a dust-bearing bee sink into the sanctum of a bloom the kilobyte sister-calyxes arch to meet the love embrace and the ecstatic shiver of the channelize from root to tiniest branch creaming in every blossom and frothing with delight. So this was a marriage She had been summoned tobehold a revelation (Hurston 11).This paragraph is one of the most important, if not the most, in the whole book. Comparing love to the birth between a bee and its flower, Janie suddenly craves, love, passion, and above all, someone she can consider her equal. Unfortunately, though, equality was a foreign concept during this time period. Men were seen as all-powerful, considered the sole providers and the only ones allowed to hold any sort of say-so or high-status job.Women, on the other hand, were the complete opposite. In an article in dite by Dorothy W. Hartman, a historian, she states Womens God-given role, it stated, was as wife and mother, keeper of the mansion Womens God-given role, it stated, was as wife and mother, keeper of the household Many people, including blacks, believed in this sort of household the men being on top, with the women considered far inferior.In Janies first relationship, it is clear this is not the equality she has hoped for. Logan Killicks- an elderly, black man her grandmother has arranged for her to marry- treats Janie want a servant and not like a wife at all. There is no love present, and every day is a chore.Even though Nanny knows Janie is not happy, she insists the marriage is a good one Heah yo is wid de onliest organ in town, amonst colored folks, in yo parlow. Got a house bought and paid for and sixty acres uh land by rights on de big roadLawd have mussy Dats de very prong all us black women gits hung on (Hurston 23).In Nannys speech, Hurston is trying to emphasize that t he females only role is to marry and look good, and let the man do all the work. similarly in her article, Hartman says that due to the fact that the man was almost always functional, bittie room was left to develop a connection between husband and wife love was a foreign concept., which describes what Janie and Logan have together exactly. in spite of being given all she should want, Janie seeks more.When Joe Jody Starks appears out of nowhere, Janie feels like her dreams have at last come true. But after a while, the marriage turns out to be little more than the stint with Killicks. Starks, like Killicks, treats her as property and not as someone he actually loves. One example is how Jody makes Janie induct her hair up in a wrap while working in the store, ratherthan leave it down.Another is when he publicly criticizes her appearance, saying she is starting to show her age, when he is clearly at least ten dollar bill years older You aint no young courtin gal. Youse uh old woman, nearly fourty (Hurston 79). Joe feels the need to tear down Janie, in hunting lodge to make himself feel more important, which was an important part of being a man during this time.By reading the novel Their Eyes Were Watching God by Zora Neale Hurston, one could immediately pick up on the difference gender played during the late 1800s and into the early 1900s. While women were evaluate to stay at home and clean and take care of children, men worked to provide for their families and were considered far superior.While these prejudices have slowly gotten better over time, most of them still exist to a small extent in todays society. Through the characters attitudes and narratives, especially Janies relationships, and the societys feelings as a whole, Their Eyes Were Watching God clearly displays the kindly issues of sexism and gender roles.Works CitedHartman, Dorothy W. Womens Roles in the Late 19th Century. Conner Prairie interactional History Park. Conner Prairie, n.d. W eb. 24 Mar. 2013. Hurston, Zora Neale. Their Eyes Were Watching God. New York Perennial Library, 1990. Print. Woltemath, Becca. Sexism in the Early 1900s.Worldbook Encyclopedia. Worldbook, 11 Dec. 2012. Web. 29 Jan. 2013.

Of Mice and Men on the American Dream

Of Mice and Men The Ameri mess stargaze Quote 1 I remember about the rabbits, George. The blaze with the rabbits. Thats all you can ever so remember is them rabbits. (1. 18-19) This is the first workforcetion we wear of the American intake. Even from the introduction, it seems Lennie is more provoke than George about the prospect. Georges easy dismissal of them rabbits makes it seem as though he phones the whole thing is silly. This result liquidate more difficult as we realize that George might be as excited about the dream as Lennie it seems he is just more wide-awake about that excitement, given that hes more fill inledgeable than his companion.Quote 2 Well, we aint got all, George exploded. Whatever we aint got, thats what you necessity. divinity a mighty, if I was alone I could animated so easy. I could go lay a job an work, an no trouble. No mint candy at all, and when the end of the month come I could take my litre bucks and go into t feature and get whate ver I want. Why, I could occlusion in a cat put forward all night. I could eat every drive I want, hotel or any commit, and order any unredeemed thing I could think of. An I could do all that both damn month. Get a gallon of whisky, or ensnare in a pool room and play cards or rouse pool. Lennie knelt and looked over the fire at the angry George. And Lennies face was force in with terror. An whatta I got, George went on furiously. I got you You cant go forward a job and you lose me ever job I get. Jus conceal me shovin all over the boorish all the time. (1. 89) George explodes at Lennie and rattles off what he imagines to be the dream-life of a travelling worker without any burdens ( standardised Lennie). George dreams of a slaphappy life and is careful to emphasize that Lennie is the barrier. What George outlines for himself here is strangely predictive, given what will come to him later in the story.Quote 3 GEORGE O. K. Somedaywere gonna get the jack together and were gonna have a little house and a couple of acres an a cow and some pigs and An live off the fatta the lan, Lennie shouted. An haverabbits. Go on, George Tell about what were gonna have in the garden and about the rabbits in the cages and about the rain in the winter and the stove, and how thick the cream is on the milk like you can hardly cut it. Tell about that George. Whynt you do it yourself? You know all of it. Noyou tell it. It aint the same if I tell it. Go onGeorge. How I get to tend the rabbits. Well, express George, well have a big vegetable berth and a rabbit hutch and chickens. And when it rains in the winter, well just say the hell with goin to work, and well build up a fire in the stove and set around it an listen to the rain comin down on the roof wild (1. 119-123) This seed is one of the foundational pieces of the whole play, perhaps its most important. at that place are numerous bits to analyze in this passage, ranging from its reflection of the American Dream during theDepressionto the fact that the dream is so repeated among the two men that even dull Lennie has memorized some of it.For our purposes, its very important that this trounce of the bring on is talked about wildly throughout the play it seems like the farm is a dream to George, a hope for Lennie, and (eventually) even a intend for Candy. Its especially interesting that sometimes it seems the farm is the dream that keeps them going, and sometimes it is just a reminder of the lack of usefulness of dreaming. Quote 4 Lennie watched him with wide eyes, and old Candy watched him overly. Lennie express softly, We could live offa the fatta the lan. Sure, said George. All kins a vegetables in the garden, and if we want a little whisky we can sell a few ball or something, or some milk. Wed jus live there. Wed die there. There wouldnt be no more runnin round the country and gettin fed by a Jap cook. No, sir, wed have our own place where we belonged and not sleep in no bunk hous e. (3. 202-203) The arsehole line of the dream for George is not the absence of work, or the easy living, or even having a surge of money. It is simply grounded in having some place to belong to him and Lennie and Candy.Quote 5 When Candy spoke they both jumped as though they had been caught doing something reprehensible. (3. 212) Dreams are delicate things in the real world, and George and Lennie have always carefully kept their plan a secret. Faced with the gaze of someone from the immaterial world, the men seem ashamed. The real world they live in would neer allow or look kindly upon such a relieve oneself as their dream, precious as it is to them. Quote 6 They fell into a silence. They looked at one an early(a), amazed. This thing they had never actually believed in was approach path true. (3. 221) On one hand, this could be amazing.On the other hand, were suddenly force to ask whether the dream isnt better off as a dream, something they can believe and imagine thats b igger and better than any reality. One might argue that when Candy gets close to George and Lennie, he spoils the dream of the farm by making it a genuine possibility (and ironically, something that could be a disappointment), rather than an ongoing and eternal hope. Quote 7 Crooks hesitated. If you guys would want a hand to work for naughtjust his keep, why Id come an lend a hand. I aint so crippled I cant work like a son-of-a-bitch if I want to. (4. 88) Dreams are almost infectious. Even Crooks, whom weve barely come to know for his not the person to believe up to now, he seems ready. Its at this point we feel like this thing is really going to happen or that it might just be too good to be true. Quote 8 Crooks called, Candy Huh? Member what I said about hoein and doin odd jobs? Yeah, said Candy. I remember. Well, jus forget it, said Crooks. I didn mean it. Jus foolin. I wouldn want to go no place like that. Well, O. K. , if you feel like that. Goodnight. (4. 148-153) Crookss hope is broken.He can bear on to live on the ranch, seemingly happy to be aloof, but we know from this episode that he stays on the farm because he has no dreams of anything better anymore. He had that dream for a moment again with the other guys, and was quickly pulled back into the vicious world of those with no hope. When you cant even dream, you really dont have anything, and it seems Crookss lot in life is to be resigned to some pitiful nothingness. Quote 9 George said softly, I think I knowed from the very first. I think I knowed wed never do her. He usta like to cop about it so much I got to thinking maybe we would. (5. 78) Ironically, in the case of the dream farm, it is Lennie who is the main threat to the dreams success, and it is as well Lennie who makes the whole idea worthwhile. Quote 10 Lennie said, George. Yeah? I make another bad thing. It dont make no difference, George said, and he fell silent again. (6. 34-37) It seems now that George has given up o n the dream, nothing much matters. Lennies bad thing obviously makes a great difference, but within the fact of Georges concerns (making their dream a reality), what Lennie did or didnt do doesnt matter. The dream is over.

Actions and context of social Essay

Hale arrives in Salem and begins to interrogate Abigail. He is very steer and soon Abigail realises that she cannot avoid his questions any more. She knows she must escape his attention altogether she cannot run otherwise she will look suspicious. Instead, she cleverly implicates Tituba. Abigail constructs her involvement to generate the leader of the proceedings, trying to force the other little girls and her into following her lead. After confession, Tituba is told to sound out the name of people seen with the d criminal. Mrs Putnam asks whether her past midwives had been in clash with the devil.Abigail soon says the label of Sarah Good and Goody Osburne as she quickly reveals that they are in contact with the devil. By satisfying her interrogators suspicions, despite their untruthfulness she can depart attention away from herself. Her intelligence and unique deflect is demonstrated as she does so and sends the professional men of the court into a frenzied excitement, as they believe they have found someone in touch with the devil. By being the first and shouting out names, she has power and trust with the court. She thence begins to call out more names, adding to Titubas list.This excites Betty whom immediately rises and joins in the cantillate of names. She is described to be calling out hysterically and with great patronage. Then their ecstatic cries turn into a gleeful tone, adding an evil edge. Abigail has spoilt her way out of trouble and Betty has picked up on the plan, assured that she is honorable from punishment and joins Abigail. They are now beyond accusation or insecurity and happy to call names out. Betty is following Abigail, but Abigail has no film to continue as she has already said Elizabeths name.The other names of people, she has no involvement with and most importantly, people who bear no immenseness in Salem and are vulnerable to prosecution. It is a fiendish scene, as if the girls are possessed by evil. They are not how ever and that leaves only one reason, that Abigail is wreaking her specific revenge for her parents deaths. It is one of her more evil actions in the play, as it cannot be accounted for. This shows that she does not hate and have power everywhere people she wants revenge for, but everyone of human society. In my opinion, she is a excited guinea pig. She is initially perceived as being wild bright and proud.Her character then develops a ghastly quality that becomes a large influence over everybody in the village of Salem. She abuses this ability to turn things to her advantage and others fate. She develops an evil insensitive, which would seem to be her character, however occasionally she shows different emotions in moments of violent passion and fear. Abigail is the hidden secret of the play. She covers behind her sweet little girl innocence and manipulates it between the characters, which brings up many truths from the past. Her quest however, soon becomes an dependency as she has people killed and blames anyone to get back John Proctor.

Nurse Manager Paper

control Manager Paper NUR 4301 Nursing Seminar The shield director I selected to interview is a Baccalaureate degree nanny and has attended some(prenominal)(prenominal) in-house training sessions related to her position within the hospital. She attended Lenoir Rhyne University to obtain her BSN and has been occupied with the institution for 13 years and has been in nursing for nearly 20 years. She is currently certified as a Certified Emergency Nurse (CEN) and is also a Sexual Assault Nurse Examiner.The Hospital that she is active with is a cloistered hospital she manages a 15 bed emergency department and 6 bed express care facility, which also holds several involuntary commitments for several hours at a time waiting on placement. This nurse double-decker oversees 62 persons within the emergency department of this private medical center. She whole caboodle full-time, generally from 900am until 530pm, Monday-Friday.The nurse manager must work closely with the emergency depa rtment Administrative theatre director to reinforce and disseminate information important to the nursing provide, she must inflict policies and carry out plans, and she must handle disciplinary problems that may build up in the absence of the Administrative music director. She is responsible for insuring that the ER flows smoothly with the attention of the dilute nurse. She ensures that supplies and equipment are available, she is involved in the interview process for new(a) hires and must perform evaluations on current employees after probation and then annually.The nurse manager I interviewed considers herself to be a democratic leader and delegates a huge portion of the day-to-day operations to the charge nurse, however she is non above performing actual clinical duties, especially in multiplication of disaster or overcrowding. She considers her unit to flow smoothly and feels that teamwork is a tell component to that success. This nurse manager considers herself to be a very legal leader, who encourages communication. She wants her employees to voice their concerns and ideas without fear of retaliation and the hospital is very supportive of that mindset.She has an open(a) door policy and considers her employees to be like family. She expects her employees to maintain a controlling attitude and if they do not have one she helps them to achieve a positive attitude. The major challenges that she expressed to me were understaffing and constant bickering between trusted female co-workers. With regard to understaffing, corporate has not offered any viable solutions, delinquent to non-peak times in the ER. This means at times it is either bedcover or famine. The staff knows this and tends to simply suck it up and pull in concert when it gets busy.When co-workers come to her with a complaint she takes time to discuss the matter in depth and non-judgmentally with the employee, surprisingly in most cases she state that after the discourse it turned out that the problem originated with the one filing the complaint. She further works with the person on strategies to be a more effective interpersonal communicator and soon the problems lessen or resolve entirely. The nurse manager stated that her vision for her unit was to have her entire staff be clinically sound and function confidently under adverse client load.She expects topmost teamwork from her staff and expects the unit to operate efficiently with upmost regard for staff and client safety. She went on to add that she was initially unsure about beingness a nurse manager, she was encouraged to apply by her the Administrative Director and once promoted, she was given little direction in how to perform her job. She met with the charge nurses and basically took their group input on how the unit would operate effectively and fine-tuned it, the result has been very effective and had excellent feedback from her employees as well as upper management.She did add that managing peo ple is far more tiring and unenviable than managing patient care. She also expressed to me that she did miss working on the horizontal surface and dealing directly with the clients regularly. I felt that based on her feedback the nurse manager that I interviewed was a very effective unit manager she applied fundamental concepts to the management of her staff which primarily focused on effective communication and teamwork. These concepts also support her own theory that she is a democratic leader. References Huber, Diane. (2010). Leadership and nursing care management. Maryland Heights, MO Saunders Elsevier.

“a Contemporary View on Health Care System in Bangladesh.”

CHAPTER 1 Introduction 1. 0 origin and backcloth of the name The report A Contemporary view on easyness disquiet System in Bangladesh is the outcome of Internship programme which is a precondition for acquiring MBA horizontal surface. Only curriculum activities ar not enough for handling the real(a) business environment, so it is necessary to get the better loveledge around the real scenario. The report is a requirement of the internship programme for my MBA Degree. Conduction of Internship/ disquisition started on 20th December cc9 and ended on 12th February 2010.My internship supervisor at International Islamic University Chittagong, capital of Bangladesh Campus, Mr. R M Nasrullah Zaidi ap engineer me the topic of my report. The reason behind choosing this topic is getting a ca-ca picture of the wellness sector of Bangladesh. Working on this topic gives me an chance to down the stairsstand the Problem and prospect of health cautiousness arranging in Banglad esh. In todays world of globalization Thiland is seeking to advance health tourist to its inelegant below the banner of Thailand Centre of elegant wellness Cargon of Asia, India is building an e-health industry and Singapore is building infirmarys abroad.When scenarios atomic number 18 want that where the health sector of Bangladesh ? Here we try to get a idea roughly what is the real scenario of divers(prenominal) cogitate issues like entrance fee to health-relate knowledge and technology, the provision of new hospital and aliened health organization and the handiness of health professionals. 1. 1 objectives of the report The objective of my study divided into cardinal instalments 1. 1. 1 primary feather Objective The old objective of this report is to work the requirements of the course, OCP 5900, Internship. 1. 1. 2 Secondary ObjectiveThe subaltern objectives atomic number 18 * To confer a illumine picture of inside health senario. * To know just ripel y list and efficiency of existing infirmary & clinic * To know near manpower supply talent and requirement * To know about Morbidity and its rate * To know about Available alternative or traditional aesculapian wield system. * To know about health education of mass hatful * To know about government twist- health system * To know about demographic structure of population * To know about role of diametric institution in respect of wellness C atomic number 18 1. methodology I kick in mean to perform the task in four microscope phases Step 1 formulation of the work Step 2 Data collection Step 3 Analysis and showation of entropy Step 4 Drawing conclusions and testimonys The world-class st advance is the most cardinal stage. I have anyocated enormous term for this stage. I am emphasizing on thorough and detailed preparation. intend includes detailed methodology and scheduling of the re of importing triplet stages. I am to a fault emphasizing on documenting detai led planning which would serve as a guideline and performance measure for the whole report.The second stage is the information collection stage. I have planned to collect data in three main phases. * Collect data from internet, different books and medical journals. * Conduct interviews with selected re establishatives from different train of health professionals. This phase actu bothy concent place on clarification and elaboration of data collected from the start-off phase. * Conduct interviews and fall with health go forthrs who are in the front line. This phase actually concentrates on accumulating data for the overall scenario. The third stage is the analysis and interpretation of data.In this stage I would use around statistical and graphical analysis tools to interpret the relationship among different variables and factors. The fourth stage is the stage for drawing conclusions and prescribing recommendations. In this stage the results from the previous stage would be used to draw conclusions about different aspects of concerned matters within the organization and prescribe some recommendation for future improvement. The project is base on both primary and secondary information. Primary Source * Informal discussion with employees of UHL. Observation plot running(a) in different desks * Interview with health sell pass onrs. Secondary Sources * appointed Web Site of UHL * Annual Reports of Ministry of health * Various Manuals and Brochures of DG wellness * Different normalations of WHO. 1. 3 scope This report solely deals with the health related information of Bangladesh. Here we try to accumulate information from various topics that have role with the health system of a sphere. The project is base on both primary and secondary information. wellness system is a real vast area to work thousands of issues are related here.Here we make some major(ip) segment to discuss like national health status, health care de perchry system, facility based h ealth service, leading domain health problems and health education. 1. 4 limitations 1. The major limitation faced in preparing this report is the enormous number of parameters that have relationship to the health care system of a country. 2. Less approachability of data at all tiers of service providing especially in the private sector. 3. Less entrywayibility to data due to shortage of time and proper arrangement and at the analogous time the authenticity of data not beyond questions. 4.Health sector requires fewer specified expert foul knowhow for better down the stairsstanding. Being a non medical background some time face some problem to understand technical terminology and frequently needed explanation and further study. CHAPTER 2 Bangladesh subject Health side 2. 0Location and Geography Bangladesh was emerged as an independent and sovereign country in 1971 following a nine calendar months war of liberation. The country is unmatchable of the largest deltas of the wo rld with a total area of 147,570 sq km. Being a sea-level country it stretches latitudinal amidst 20? 34 and 26? 38 north and longitudinally between 88? 01 and 92? 1 east. It is by and large surrounded by Indian Territory (West Bengal, Tripura, Assam and Meghalaya), except for a puny strip in the southeast by Myanmar. Bay of Bengal lies on the south. The exemplification time of the country is GMT +6 hrs. 2. 1History Bangladesh has a glorious score and rich heritage. Once it was known as Sonar Bangla or the prosperous Bengal. The territory now constituting Bangladesh was under the Muslim feel for over flipper and a half centuries from 1201 to 1757 AD. Subsequently, it came under the British rule following the strike of the sovereign ruler, Nawab Sirajuddaula, at the battle of Plessey on 23 June 1757.The British ruled over the Indian subcontinent including this land for nearly 190 old age from 1757 to 1947. During that occlusion, Bangladesh was a part of the British Indian provinces of Bengal and Assam. With the termination of British rule in August 1947, the sub-continent was partiti singled into India and Pakistan. Bangladesh was a part of Pakistan and was called East Pakistan. 2. 2Physiography With about half of its surface below the 10 m contour line, Bangladesh is located at the lowermost r distri saveivelyes of three mighty river systems -the Ganges-Padma river system, Brahmaputra-Jamuna river system and Surma-Meghna river system.Coinciding with the division of the country based on altitude the land can be divided into three major categories of physical units Tertiary hills, Pleistocene uplands and Recent plains (formed in upstart epoch). The heavy monsoon rainfall coupled with the low altitude of major separate of the country makes floods an yearly phenomenon in Bangladesh. Quaternary (began about 2 angiotensin converting enzyme thousand million years ago and behaves to the present) sediments, deposited mainly by the Ganges, Brahmaputra (J amuna) and Meghna rivers and their numerous distributaries, cover about three-quarters of Bangladesh.The physiography and the drainage pattern of the vast alluvial plains in the central, blue and western regions have gone under considerable alterations in new-fangled times. In the context of physiography, Bangladesh whitethorn be classified into three clear-cut regions (a) floodplains, (b) terraces and (c) hills, each having distinguishing characteristics of its own. The physiography of the country has been divided into 24 sub-regions and 54 units. 2. 3Climate Bangladesh has a tropical monsoon-type climate, with a hot and rainy summer and a wry winter.January is the coolest month with temperatures averaging near 260 C (780 F) and April is the agileest with temperatures from 330 to 360 C (910 to 960 F). The climate is one of the wettest in the world. Most places receive more than 1,525 mm of rain a year, and areas near the hills receive 5,080 mm). Most rains occur during the mon soon (June-September) and little in winter ( nary(prenominal)ember-February). Bangladesh has w gird temperatures without the year, with relatively little variation from month to month. January tends to be the coolest month and May the warmest.In capital of Bangladesh, the mean(a) January temperature is about 19C (about 66F), and the average May temperature is about 29C (about 84F). 2. 4Administration From the administrative point of view, Bangladesh is divided into 6 Divisions, 64 dominions, 6 city Corporations, 308 Municipalities, 482 Upazilas and 4498 Unions. The half dozen administrative divisions are that is to say, Dhaka, Chittagong, Rajshahi, Khulna, Barisal and Sylhet. The country is governed by the Parliamentary Democracy and it has a one(a) discipline Parliament, nameBangladesh Jatiya Sangsad. at that place are 40 Ministries and 12 Divisions.The Ministry of Health Family well-organism is one of largest ministries in the country. At the national level, the Ministry oHealth Family wellbeing (MOHFW) is responsible for policy, planning and conclusion fashioning atmacro level. Under MOHFW, in that respect are four directorates, viz. , board of directors normal of Health function, Directorate massively distributed of Family supply, Directorate of Nursing Services and Directorate of Drug Administration. Beside, there are a separate matter Nutrition Proje(NNP)and Construction, Maintanance and Management Unit (CMMU). . 5Economy Bangladesh has an agrarian economy, although the share of agriculture to gross domestic product has beendecreasing over the last few years. Yet it dominates the economy accommodating major rural labour force. From marketing point of view, Bangladesh has been following a immix economy that operates on allow market principles. The GDP of Bangladesh is 6. 21% and per capitincome is US$ 599. The principal industries of the country include readymake garments,textiles, chemical fertilizers, pharmaceuticals, tea process ing, sugar, leather goods etc.Theprincipal mineral includes Natural gas, Coal, white clay, glass sand etc. 2. 6Communication The transport system of Bangladesh consists of roads, railways, inland waterways, two sea ports, maritime shipping and civil line catering for both domestic and international traffic. Presentlythere are about 21,000 km of paved roads 2,706 route-kilometres of railways (BG-884km and MG -1,822 km) 3,800 km of perennial waterways which additions to 6,000 km durinthe monsoon, 2 seaports (Chittagong and Chalna) and 3 international (Dhaka, Chittagong andSylhet) and 8 domestic airports. . 7Religion and Culture The majority (about 88%) of the people are Muslim. Over 98% of the people speak in Bangla. English, however is roomyly spoken. Bangladesh is heir to a rich cultural legacy. In two thousand or more years of its chequered history, many illustrious dynasties of kings and Sultans ruled the country and have left their mark in the shape of magnificent cities and m onuments. The people of Bangladesh are very simple and friendly. A beautiful communal harmony among the different religions has ensured a very sympathetic atmosphere.More than 75% of the population pull rounds in rural areas. Urbanization has, however, been rapid in the last few decades. 2. 8Population and Demography Bangladesh is now Asias fifth and worlds eighth thickly settled country with an estimated population of about 146 million. Density of population is around 979 per solid kilometer, the gameest in the world. Rural population comprises about 76% while urban constitutes about 24%. Adult literacy rate is 54% (2006). Census of 2001 reveals that 43 per cent of the population is below 15 years of age.This young age structure constitutes built-in population momentum. Also urban population is change magnitude quite fast. Though Bangladesh has made progress in cut destitution and per capita income has been creeping up, a substantial number of population are poor. processi on made in improving Bangladeshs Human Development Index (HDI) has displace her among the medium-ranking HDI countries. Strong policy interventions led to continuous reduction in the annual growth rate of population from the level of 2. 33 % in 1981 to 1. 54 in 2001 and further to 1. 48 (2007). The amountFartility Rate (TFR) also went down from 3. 4 in 1993-94 to 2. 2 (2007). The CPR (any method) addd from 44. 6% in 1993-94 to 58. 1% in 2004, but again fell down to 55. 8% in 2007. Life expectancy at birth has continuously been rising, and is now 65 years (2007) from the level of 58 (1994). Reversing past trends, women now live nightlong than men. The country, however, is over shoot downed with about two million new faces both year creating extra pressure on food, shelter, education, health, employment, etc. , and thus making the anticipated economic growth difficult. . 9Health Status Since independence Bangladesh has made meaningful progress in health outcomes. Infant and Ch ild mortality rates have been markedly reduced. The underfive mortality rate in Bangladesh declined from 151 deaths per thousand live births in 1991 to 65 deaths/ deoxycytidine monophosphate0 live births in 2007 and during the same percentage point infant mortality rate reduced from 94 deaths per carbon0 live births to 52. EPI coverage extended its reach from 54% in 1991 to 87. 2% in 2006. The MMR reduced from 574/ ampere-second,000 live births in 1991 to 290 in 2007.Deliveries attended by virtuoso(prenominal) birth attendants increased from only 5% in 1990 to 20% in 2006. The prevalence of malaria dropped from 42 cases /100,000 in 2001 to 34 in 2005. Bangladesh has also achieved noteworthy success in halting and reversing the spread of tuberculosis (TB). Detection of TB by the Directly Observed Treatment Short-course (DOTS) has more than doubled between 2002 and 2007, from 34 to 92%. The successful treatment of tuberculosis has progressed from 84% in 2002 to 91% in 2007. Polio and leprosy are virtually eliminated. HIV prevalence is still very low.Development of countrywide internet of health care base of motions in overt sector is remarkable. However, availability of drugs at the health facilities, deployment of nice health professionals along with maintenance of the health care facilities remain as crucial issues, impacting on optimum utilization of public health facilities 2. 10Nutrition Status There has been considerable progress in reducing mal sustenance and micro nourishing deficiencies in Bangladesh. According to BDHS, partage of U5 underweight (6-59 months) has reduced to 46. (2007) from 67 (1990) and that of U5 boney (24-59 months) from 54. 6 (1996) to 36. 2 (2007). Percentage of electric shaverren 1-5 years receiving vitamin-A supplements in last six months has increased from 73. 3 (1999-00) to 88. 3 (2007). The rate of night blindness has reduced to 0. 04 per special K people (IPHN, HKI 2006). However, in spite of efforts taken by th e government, high rates of malnutrition and micronutrient deficiencies along with gender discrimination remain common in Bangladesh. 2. 11Urban Health ServiceThe urban areas exit a contrasting picture of availability of different facilities and operate for secondary and tertiary level health care, while primary health care facilities and services for the urban population at large and the urban poor in particular are undermanned. speedy influx of migrants and increased numbers of people living in urban slums in large cities are creating continuous pressure on urban health care service tar. Since the launching of two urban primary health care projects, the services have been delivered by the city corporations and municipalities through contracted NGOs in the projects area.Rest of the urban areas and services are being cover by MOHFWs facilities. Moreover, 35 urban dispensaries under the DGHS are providing outdoor forbearing services including EPI and MCH to the urban population . 2. 12Organizational Setup of MOHFW The Ministry of Health & Family Welfare is one of largest ministries in the country. At the national level, the ministry of Health & Family Welfare (MOH&FW) is responsible for policy, planning and decision making at macro level. 2. 12. 1Executing Authorities of MOHFWUnder MOHFW, there are four Directorates General or Directorates, e. g. , Directorate General of Health Services, Directorate General of Family Planning, Directorate of Nursing Services and Directorate of Drug Administration. 2. 13Directorate General of health Services (DGHS) The Directorate General of Health Services (DGHS) is entrusted for the death penalty of the policy decisions of the Ministry of Health and Family Welfare (MOHFW) as regards health service delivery to all the people under the jurisdiction of the Government of the Peoples Republic of Bangladesh.It provides technical guidance to the ministry. DGHS carries out its activities through different directors, line directo rs, project directors, institution betokens, district and upazila health managers and union health plys. 2. 14Health, Nutrition Population sector weapons platform (HNPSP) The constitution Bangladesh mandates for basic health care services for its people as one of the fundamental responsibilities of the state. Towards this goal, the government has taken different endeavors to extend health facilities to the population.The broader policy document of the Government of Bangladesh that shapes direction of health care is the Poverty Reduction Strategy Paper (PRSP) although the current government has indicated that it forget go for Five Year Plan. The Government of Bangladesh is running a program through which the health care services are provided to the people from the potentiometer root to the central level. The program is entitled Health, Nutrition and Population firmament class for the period of July 2003 through June 2010 (HNPSP 2003-2010).The Ministry of Health and Family We lfare (MOHFW) designed the Program Implementation Plan (PIP) in accordance with the PRSP to implement its sector wide program popularly known as Health, Nutrition and Population heavens Program (HNPSP). The HNPSP covers 38 Operational Plans (OP) to be implemented by 38 Line Directors and 14 stands/Programs. The Government has recently decided to outride HNPSP until 2011. The detail of the program are well documented in the form of Program Implementation Plan (PIP) duly endorsed at the highest policy level of the government, the executive Committee for National Economic Council (ECNEC).The Implementing Agency of the program is Ministry of Health and Family Welfare (MOHFW) with its attached departments. The financial involvement is estimated to be around Taka 324,503 million which includes contributions for jak (Government of Bangladesh) and DPs (Development Partners). 2. 15Priority Objectives and Goal One of the important goals of PRSP and HNPSP is attainment of Millennium Devel opment Goals (MDGs). The health sector is specially striving for attainment of health related MDGs.The precedency objectives of HNPSP are (i) reducing MMR (ii) reducing TFR (iii) reducing malnutrition (iv)reducing infant and under-five mortality (v) reducing the burden of TB and otherwise diseases and (vi) prevention and control of noncommunicable diseases including injuries. The consignment of the government targets towards reaching the goal of sustainable improvement in health, nutrition and family planning status of the people by the end of the program period. It may be mentioned here that HNPSP deals with health care service delivery of the public sector.Nevertheless, it strives to maintain a strong cooperation and coordination with the efforts of the Private Sector as well so as to ensure the overall well-being of every citizen of the country. Of the 38 OPs, 7 are under MOHFW, 19 under Directorate General of Health Services (DGHS), 9 under Directorate General of Family Plann ing (DGFP), 1 under Directorate of Nursing Services (DNS), 1 under Directorate of Drug Administration (DDA) and 1 under National name of Population look for and Training (NIPORT) and.Of the 14 projects/programs, 1 is under MOHFW, 9 under DGHS, 1 under DGFP, 2 under DNS and 1 under NIPORT. The Health bulletin 2009 is an attempt of Management Information System (MIS) of DGHS to provide an overview of the current health profiles of Bangladesh. CHAPTER 3 Health care delivery systems of Bangladesh diffusion of public health care services and facilities follows similar pattern of administrative tiers, viz. national (mostly capital-based in Dhaka), regional (in divisions), district, upazila, union and ward. The country has 7 divisions, 64 districts, 482 upazillas and 4,498 unions.As the Ministry of health and family Welfare deploys health workforce according to the senior(a) ward system, which divides each union into 3 wards. Therefore, number of MOHFW wards is 13,494. Primary health care (PHC), which includes family planning services in the urban area (city corporations and municipalities), is provided by Ministry of Local Government and in rest of the country by Ministry of Health and Family Welfare (MOHFW) provides health care service. Provision of secondary and tertiary care, in both urban divisional directorates with necessary staff. and rural areas, is the sole righteousness of MOHFW.The MOHFW delivers its services through two separate executing authorities, viz. Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP). The name calling explain their functions. PHC services of both DGHS and DGFP begin at the ward level through a set of companionship health staffs, at least one in each ward (Table). To supervise these sphere staffs, there is one assistant health quizzer (for DGHS) and one family planning inspector (for DGFP) at union level. There are several hundred non- hunch community facilities to provide outpati ent services (1466 for DGHS and 3500 for DGFP). overly DGFP also operates additional 97 maternal and child welfare centers (MCWCs) (union 23 upazila 12 district 62), 471 MCH-FP clinics (upazila 407 district 64), 177 NGO clinics (upazila 68 district 104 national 05), 08 model clinics (national 02 regional 06) and organizes 30,000 makeshift satellite clinics per month. The public sector hospital care in Bangladesh is mainly provided by DGHS. Primary level hospital care Secondary level hospital care Tertiary level hospital care Begins through Upazila Health complicated (31 to 50 Bed) existing in 418 upazilas. The district hospitals (50 to 375 bed), one each district, provide secondary level hospital care in several differentiation areas. The regional hospital are multidisciplinary tertiary care hospitals (250 to 1700 beds) mostly machine-accessible with teaching institutes. At the national level, there are postgraduate and narrow down hospitals (100 to 600 beds) 3. 0divisional lev el health organization At the divisional level, there is a divisional Director for Health. S/he is the head of a Divisional Directors supervise the activities of the civil operating surgeons. 3. 1District level health organizationAt the district level, Civil Surgeon is the health manager. S/he has own administrative office back up by various categories of staff. There is either a Sadar hospital or a General infirmary in each district head quarter. The hospital provides services under the management of Civil Surgeon with a view to render out-patient, in-patient, emergency, laboratory and imaging services to the people. The in-patient services internal medicine, general surgery, obstetrics and gynecology and other common specialist clinical services. It is the secondary level referral facility of health services of Bangladesh.Currently there are 59 Sadar district hospitals and 2 General hospitals in the country each having 100-250 bed. 3. 2Upazila level health organization Upazil a Health Complex (UHC) is another unbending service delivery point next to district level hospital. It provides the first level referral services to the population. In each UHC, there are posts for 9 (nine) doctors including one Upazila Health and Family Planning incumbent (UHFPO). UHFPO is the Chief Health Officer of upazila and also Head of the UHC. Other doctors of UHC are Junior Consultants-4, Resident checkup Officer-1, Assistant Surgeons (MO)-2 and Dental Surgeon-1.There are 418 Upazila Health Complexes (UHC) in the country of which 153 are 50bed and rests are 31-bed. UHC provides out-patient, in-patient and emergency services, limited diagnostic and imaging services, emergency obstetric care, contraceptive services and dental care. 3. 3Union level health organization There are four types of static health facilities in the union level. These are Rural Health Centers (RHC, 10-bed hospital), Union Sub-centers (USC), Union Health and Family Welfare Centers (UHFWC) and fratern ity Clinics (CC). There are 22 RHCs, in each of these, there are O.K. posts of 20 staffs.RHC provides both out-patient and inpatient services. In an USC, there is sanctioned posts for one medical officer, one medical assistant, one pharmacist and one MLSS. Number of USC is 1,362 that for UHFWC is 87. Under HPSP, Government planned for establishing one Community Clinic for every 6000 rural populations. Number of CCs so far built is 11,883. But, these were not made functional. Recently Government has decided to start the CCs again. The total number of CCs volition be 18000. The existing UHCs and Union level facilities will also provide services of CCs in the respective communities.So,13,500 additional CCs will be required. The main health workforce in the union level is the domiciliary staff called health assistants. They are placed in each ward, which is the lowest and smallest administrative unit of the health sector. They visit the homes of the local people for providing primary health care services and collection of routine health data. The health assistants routinely organize satellite clinics for immunization services. Besides there are other small to large hospitals and special purpose hospitals spread across the country both in rural as well as in urban areas.Under the DGHS, there are altogether 40 teaching/homework institutes and 589 small to large hospitals. In Family Planning sector, there are one national research-cum-training institute, two hospital-based training centers, and 32 other training centers (national 12 regional 20). Nearly six hundred health managers under DGHS and a similar number under DGFP, from national to upazila levels, play roles in administering the health and family planning services (1,17). This figure does not include the institute and clinic/hospital heads. CHAPTER 4Facility Based Health Services infirmary service is one of the important activities of health sector, which is the most visible health service also. This chap ter of the Health Bulletin 2009 will provide an overview of the hospitals and their bed capacity as well as utilization based on the information from January through December of 2008. 4. 0 hospitals by bed capacity There are 585 hospitals ranging from 10 beds to 1,700 beds under DGHS currently. each of these hospitals provide a total of 37,090 beds. The table below gives a detail profile. No. f hospitals by bed capacity and total beds under DGHS Sl. No. Bed capacity No. of hospitals in this type intact beds 1 1700 beds 1 1700 2 1010 beds 1 1010 3 900 beds 1 900 4 800 beds 1 800 5 600 beds 5 3000 6 500 beds 3 1500 7 414 beds 1 414 8 375 beds 1 375 9 250 beds 19 4750 10 200 beds 2 cd 11 150 beds 3 450 12 100 beds 53 5300 13 80 beds 1 80 14 56 beds 1 56 15 50 beds 158 7900 16 31 beds 271 8401 17 30 beds 1 30 8 25 beds 1 25 19 20 beds 43 860 20 10 beds 22 220 constitutional = 589 3817138171 Type o f hospitals Following list gives an overview of the type of hospitals currently in operation under DGHS Type of hospitals No. of hospitals center bed capacity postgraduate institute hospital 7 2014 Dental college hospital 1 20 Hospital for alternative medicine 2 200 checkup college hospital 14 8685 Mental hospital, Pabna 1 500 Shekh Abu Naser Specialized Hospital 1 250 Narayanganj 200 bed Hospital 1 200 Specialized Health center (Asthma Burn unit) 2 150 Sarkari karmochari hospital 1 100 Chest hospital 12 566 Infectious disease hospital 5 180 Leprosy hospital 3 130 District Level Hospital 60 8100 50 bed hospital(Tongi, Saidpur) 2 100 100 bed hospital (Narsingdi) 1 100 25 bed hospital (Jhenidah) 1 25 Bangladesh korea moitree hospital 1 20 Upazila health complex 421 15958 Health complex (31 bed) 3 93 20 bed hospital 28 560 10 bed hospital 22 220 graduate(prenominal) take Hospitals all are national level hospitals an d are located in Dhaka) Total = 7 No. of beds Total Revenue Develop. Proposed Beds will Increase 1. National Institute of Chest Disease and Hospital (NIDCH) 600 600 0 0 0 2. National Institute of Cardiovascular Disease (NICVD) 414 250 164 0 0 3. National Institute of Traumatology and Rehabilitation (NITOR) 500 500 0 0 0 4 National Institute of Cancer Research and Hospital (NICRH) 50 50 0 250 200 5 National Institute of Ophthalmology (NIO) 250 250 0 0 6.National Institute of Kidney Disease and Hospital (NIKDU) 100 0 100 0 0 7. National Institute of Mental Health (NIMHR) 100 50 50 0 Total = 2014 1700 314 250 200 Medical College Hospitals of Teaching Hospitals of equivalent level (Regional hospitals and are used as undergrad and postgraduate teaching hospitals). Division District Name of hospital (Total = 17) No. of beds Beds Revenue Develop. Proposed Bed will increase Barisal Barisal Sher-e-Bangla Medical College H ospital 00 600 0 1000 400 Chittagong Chittagong Chittagong Medical College Hospital 1010 1010 0 0 0 Comilla Comilla Medical College Hospital 250 250 0 500 250 Dhaka Dhaka Dhaka Medical College Hospital 1700 1700 0 2000 300 Sir Salimullh Medical College Hospital 600 600 0 0 0 Shahid Suhrawardy Hospital, Dhaka 375 375 0 0 0 Homoeopathic Degree College Hospital 100 100 0 0 0 Unani Ayurvadic College Hospital 100 100 0 0 0 Dental College and Hospital, Dhaka 20 20 0 200 180 Faridpur Faridpur Medical College Hospital 250 250 0 0 0 Mymensingh Mymensingh Medical College Hospital 800 800 0 1000 200 Khulna Khulna Medical College Hospital 250 250 0 500 250 Rajshahi Bogra SZR Medical College Hospital 500 500 0 0 0 Dinajpur Dinajpur Medical College Hospital 250 250 0 500 250 Rajshahi Rajshahi Medical College Hospital 600 600 0 0 0 Rangpur Rangpur Medical College Hospital 600 600 0 1000 400 Sylhet Sylhet MAG Osmani Medical College Hospital 900 900 0 1000 100 Total = 8905 8905 0 7700 2330 Specialized Centers under DGHS with bed capacity (Year 2008) Division District Name of hospital (Total = 2) No. of beds Beds Revenue Develop. Proposed Bed will increase Dhaka Dhaka 1. National Asthma Center at NIDCH 100 0 100 0 0 2. Burn Unit 50 0 50 200 150 Total = 150 0 150 200 150 4. 1BSMMU Bangabandhu Sheikh Mujib Medical University (BSMMU) is the premier Postgraduate Medical Institution of the country. It bears the heritage to Institute of Postgraduate Medical Research (IPGMR)which was established in December 1965.In the year 1998 the Government converted IPGMR into a Medical University for expanding the facilities for higher medical education and research in the country. It has an desirable reputation for providing high quality postgraduate education in different specialties. The university has strong link wi th other professional bodies at home and abroad. The university is expanding rapidly and at present, the university has many departments weaponed with modern technology for service, teaching and research. Besides education, the university plays the vital role of promoting research activities in various discipline of medicine. Since its inception, the university has also been delivering general and specialized clinical service as a tertiary level healthcare center.The university provides patient care services on various disciplines like Psychiatry, Physical medicine, Pediatrics, Neonatology, Pediatric neurology, Pediatric surgery, Clinical pathology, Dermatology, Colorectal surgery, Nephrology, Urology, Neurology, Neuro-Surgery, inner euphony, Gastroenterology, Hepatology, Ophthalmology, ENT, Obstetrics gynecology, Surgery, Hepatobiliary Surgery, dentistry, and blood transfusion services. It provides different treatment services like Intensive burster, Lithotripsy, Pain manageme nt and diagnostic services like radiology, endoscopy, CT scan MRI and a one-stop laboratory service. BSMMU runs Institute of Nuclear Medicine (INM). INM is a joint project of Bangladesh Atomic Energy Commission and BSMMU. The INM has modern diagnostic and therapeutic facilities including computerized ultrasonography, gamma camera and a well equipped radioimmunoassay (RIA) laboratory.This is considered to be the best center for noninvasive diagnoses. 4. 2SmilingSunFranchiseProgram (SSFP) The Smiling Sun Franchise Program is a project funded by the United States Agency for International Development (USAID). It is intended to complement the wide network of healthcare facilities set up by the Government of Bangladesh resorting to an advance(a) approach to health care franchising. SSFP is committed to improve the quality of life of all Bangladeshis by providing superior, friendly and affordable health services in a sustainable manner. To achieve relevant health outcomes, SSFP is joint ly working with partnering NGOs to convert the existing network into a viable social health system.SSFP objective is to strengthen partnering organizations quality of care while helping them to evoke their financial sustainability, thus enabling them to continue serving an important segment of the Bangladeshi society, including the poorest of the poor. Currently 29 NGOs are providing health care services to women, children and through 319 static and 8,500 satellite clinics in 61 districts of Bangladesh. 34 clinics of this network are providing Emergency Obstetric Care (EmOC) services. This network will continue to expand the volume and types of quality health care under ESD provided to the able-to-pay customers as well as underserved and poor clients. 4. 3Urban Primary Health Care Project (UPHCP-II) About 35 million people representing almost 25 percent of the population of Bangladesh live in urban areas, a large equipoise of whom are slum dwellers.The health knowledge of the urb an slum dwellers and their access to essential basic health services are low. Children living in urban slums are deprived of education and health care, and vulnerable to violence, vitiate and exploitation. On the other hand, high rate of mortality and morbidity exists among women who remain neglected in terms of meeting their basic health inescapably and ensuring their rights. The Government of Bangladesh is committed to put in place strategies to address the issues of improving the health status of the urban population. This is to be done through alter access to and utilization of efficient, effective and sustainable Primary Health Care Services.The provision of public health services in urban areas is the responsibleness of Local Government Bodies by dint of City Corporation ordination of 1983 and Pouroshova Ordinance of 1977. For primary health care services delivery, the public sector flora in partnership with NGOs and the local government institutions such as the City Corp orations and Pouroshovas. The health service delivery mechanism in urban areas involves diverse roles of the government (MOLGRD&C and MOHFW), NGOs and the private sector. CHAPTER 5 Leading Public Health Problems 5. 0Communicable disease The prevention and control of communicable diseases represent a satisfying challenge to those providing health-care services in Bangladesh.Sound knowledge on the disease epidemiology is a must for the health service providers in various levels. The Bangladesh population is namely affected by diarrheal diseases, cholera, hepatitis A & E, Malaria, Mycobacterial Disease like tuberculosis and Leprosy, Dengue, Japanese encephalitis, Nipah virus contagious disease, etc. Crowding, poor access to safe water, inadequate hygiene and toilet facilities, and unsafe food preparation and handling practices are associated with transmission. Cholera is endemic Bangladesh, between 800 and 1000 cases are usually being recorded daily at the hospital of the ICCDR, B in Dhaka. Hepatitis A and E levels are usually high in the country.Malaria risk exists passim the year in Bangladesh. Thirteen out of 64 administrative districts are high malaria endemic areas. 98% of all malaria cases reported are from these districts, which are mainly located in the border areas of India and Myanmar. Tuberculosis still stay as a major public health problem, which ranks Bangladesh fifth among the high-TB burden countries in the world. The present revised National Tuberculosis Programme (NTP) was launched and field implementation of DOTS (Directly Observed Treatment short course) was started in 1993. Kala Azar or leishmaniosis or is endemic in Bangladesh and has an incidence of 175 per 100,000 per annum.It is caused by a protozoa which is transmitted from the bite of infected sandfly and may present in cutaneous or visceral forms (particularly common in Bangladesh). Filariasis is a mosquito borne parasitic disease causality urogenital organs, breast, etc. with lon g arm disability. In Bangladesh, it is endemic in 23 districts, mostly the bordering ones. About 20 million people are already infected, most of whom are incapacitated. Leprosy has been a major health problem in Bangladesh for a long time. Bangladesh was considered a high endemic country and was listed among ten countries with high case alloy (1992). Leprosy situation has changed globally after 1981 when the Multi Drugs Treatment (MDT) were introduced.Hepatitis A virus infection is common in Bangladesh with a prevalence of about 2% to 7%. Prevalence of hepatitis C virus infection is less than 1%. infrequent outbreak is often seen caused by hepatitis E virus infection but presence of hepatitis D infection is not exactly known. Polio free status prevailed from 2001 until now (June 2009) except a small window period in 2006 when 18 cases of child polio were seen in boarder areas of Bangladesh. it is off-key that these cases were imported from India. Dengue fever/Dengue hemorrhagic fe ver (DF/ DHF) is a viral disease transmitted by the Aedes aegypty mosquito. It is on the increase in South East Asia. Bangladesh reported 100, 000 cases in 2005.However case want rate (CFR) remained

Marshal Mcluhan Essay

What he elbow room with the phrase the intermediate is the message is simply that the formulate of a medium embeds itself in the message, because the medium forges how the message is perceived and creates a symbiotic relationship between the two. Mass mediamedia itself, non the content it carries, should be the focus of study. He said that a medium affects the society in which it forges a role not only by the content delivered each over the medium, but also by the characteristics of the medium itself.McLuhan believed that print media was the greatest influence in society. It similarlyk us from a primarily oral society, where the only means of spreading news or information was by means of verbal interaction with another person. When print media came ab start, this all changed. Suddenly information and news was printed, and all that necessary to be d unmatchable, was read. As print media heightened our visual senses, our verbal dialogue and interaction declined, leaving flock far to a greater extent than private. This caused individualism to blossom, as social skills declined.With the introduction of the electronic age, we were acquainted with an audiovisual environment and addicted the probability to interpret the information in more than star way. With this, McLuhan indeed stated that different medium provoke different levels of fellowship from the individuals who pour down it. He coined these differences as Hot and Cool Media. According to McLuhan, technology is an filename extension service of the body. It improves, and helps us perform at a better rate, and does what the body provokenot do on its own, be it some means of tran enjoyment that is an improvement on walking, or something as primitive as a shovel too help us dig.Every extension is based on one before, and is normally seen as an improvement on its predecessor. However, when technology is over-extended, and parachutes to tip the musical scale more in a negative favour, it is referred to as an amputation. McLuhan comprised a quaternary of questions that, when asked, helps decide if the technology is merely an extension or if it is in accompaniment an amputation. Hot and Cool Media In Understanding the Media, McLuhan stated that different media march on different levels of participation.If you look at a photograph for example, very piddling participation is needed from the viewer in outrank to complete the photographers range of view or message. Because we single out one sense, and stimulate it above all the other, we would refer to this as toothsome Media. In contrast to this, McLuhan used the example of a Comic, which gives us very itty-bitty information, and encourages the readers participation to fill out the blanks in pasture to actually fully understand and enjoy the content. This is known as coolheaded Media Because Hot Media does not encourage as much participation, McLuhan states that more could be learned from Cool Media.He used t he difference between a Lecture and a Seminar as another example. Seminars and Workshops normally encourage participation from its attendees, where a lecture is truthful based on a classroom environment where there is a teacher and students. According to McLuhan, we argon leading(p) more and more into a society dominated by HOT media because the extensions of technology argon becoming more independent of human feat and interaction. Many of these extensions aid in our everyday life in order to give birth it easier for us.However, are we at the point where technology almost does not need US anymore? This is where McLuhans Tetrad comes into play. Many of our everyday activities have now been replaced with virtual and interactive counterparts. Shopping, for example, has now manufacture as simple as going online and selecting what you need from a list, and the company delivers your purchases to your bet door. We are now able to go on virtual tours through existing buildings as wel l as those that are yet to be built. The most common and accessible of these interactive replacements is the Nintendo Wii.The Wii is a gaming console table that has reached the point where is has wireless operation and reacts to and with human motion. Its games range from common play station gaming resembling world of warcrafts and tactical gaming, to fitness and sport orientated games and programs with which you can play virtual matches or have simple workouts. Marshalls Tetrad If you take something like the Wii gaming console, you can explain what he means by this in far simpler way. The questions are What does the Technology extend? The Wii is essential on the same principle as of an Xbox and other gaming consoles.A form of interactive media that has extended to the point where it now has virtual exercise and sporting games you can play in your living room. With means of a wireless power plate and choke held cordless remote, Nintendo has virtually compiled almost every sport or physical activity one can do. So what does it extend? The Wii and its programs have been developed to stimulate its users physically and mentally, therefore it extends the entire body. Nintendo also have acquirement games, which can help improve your memory, general knowledge and other literacy skills. What does it make obsolete?Instead of doing physical sport outside or in a more social environment like a gym, hoi polloi can now exercise in the comfort of their own home. And for those that didnt do sports or any general form of exercise imputable to embarrassment, inconvenience of any other reason now have the opportunity to get active. It has also changed video gaming in a large way. Players now actually needs to physically get involved in the game when playing, and the cordless remote makes movement easier and gives the player more freedom. With the educational games, Wii has made learning easier, and more entertaining.By making it rewarding, people are more eager to actua lly know the information and get the answers right. They start asking questions like what they would get if they actually have the right answer, which misses the total point of purely being educated. What is retrieved that use to be obsolete? The Wii encourages fitness, interaction and participation. With the digital era, fewer people are as active as they use to be a few years prior. We depend more on technology than ever, and seem to do fewer and fewer things for ourselves.Games like the Wii fit encourages physical activities for some that would not normally do it out of their own, by rewarding them for what they do. The educational and general knowledge games challenge people mentally, which general society doesnt do as frequently as it use to, due to the fact that technology does most of our work for us. What does the medium reverse into when over-extended? This gaming console encourages more interaction than most. The most perspicuous progression would be virtual interactive gaming, where player step into a world in which they play.They lead be entirely involved in the dynamics and progression of the game. It will create a hyper genuinelyity that mimics a real word. The educational system could also lapse over into a media based development, where children learn via virtual tutors. Only problem is that they are perpetually stimulated and entertained, and in the end, this could simply lead to shorter concentration spans rather than dependable more accessible knowledge. Conclusion Therefore, if one looks at the Wii, many will argue that it is a step forward in technology and that it is needed to keep up with our ever-changing world.It teaches us skills that are needed in everyday life, as everyday life is becoming more and more technologically dependant, and that this is our future in its simplest form. Others might argue that we are become less and less self-efficient and more and more dependable on the technology around us. We cannot function without computers and cellular phones anymore, and because of this, we have become more open without even realizing it. Technology has become such a great extension in our lives, that is has actually become our lives and our reality.

Effects of Corruption on Economic Growth Essay

Corruption has been around for a very long time and will be around in the future unless governments can figure out effective ways to attack it. This is not going to be easy. Corruption in any class is treated as an incurable disease cause of many kindly and scotch evils in the society and it damages the moral and ethical fibers of the purification .Indisputably, it is correct that degeneration breeds many evils in the society & once rot start study place ,slowly and gradually whole country passes done its net and it becomes after some time incurable diseases .from the economic guide on of view ,there seem to be no clear cut correlational statistics between foul upion and the economic harvest-home of a country. There may be some social maladies like inequality of income among the people ,moral adulteration of people due to the prevalence of corruption ,the parameter of economic growth which are taken on percentage or an average posterior are entirely differentTo begin with, in the presence of corruption, business community are often made aware that an up-front bribe is required in the lead an enterprise can be started and that afterwards corrupt officials may identify claim to crack up of the proceeds from the investment. Businessmen therefore interpret corruption as a species of taxthough of a particularly evil nature, given the need for secrecy and the uncertainty that the bribe-taker will fulfill his part of the bargainthat diminishes their incentive to invest. Empirical evidence suggests that corruption lowers investment and retards economic growth to a significant extent.Moreover, when it takes the form of tax evasion or claiming improper tax exemptions, corruption may bring about passing game of tax revenue.What is more, the allocation of exoteric procurement contracts through a corrupt system may lead to lower quality of infrastructure and public services.Then, Corruption may distort the composition of government expenditure. Corru ption may tempt government officials to choose government expendituresless on the origination of public wel farawaye than on the opportunity they provide for extorting bribes. Large projects whose need value is difficult to monitor may present lucrative opportunities for corruption. A priori, one might expect that it is easier to collect substantial bribes on ample infrastructure projects or high-technology defense systems than on textbooks or teachers salaries.So far Indian economic is concerned the slow progress is the result of inadequacy of decision making at higher level .Many politician who take money but could not enforce their will because of powerful third house of bureaucrats at many place and a democracy like India ,voice of media ,voice of opposer could suppress the wish of the leader .Indias economic growth on an average 6 % GDP despite considerable corruption is because of the perceptual constancy and the liberalized stripe taken by the present govt., gradual pr ivatization of various sector, cut back bureaucratic intervention in routine work & other measure adopted by govt.In brief it can be cogitate that corruption and economic growth has no clear correlation .strong institution, policy-making stability, fast and reasonability in decision taking are some of the fate for fast economic growth.

Holistic Care Nurse Essay

The name and other identifying information about the affected role of included within this piece of work have been changed to protect confidentiality, as conveyd by The Code of Professional Conduct (Nursing and Midwifery Council, 2008). For this reason, the patient included in this case study forget be presumptuousness the pseudonym of surface-to-air missile Jones.The purpose of this assignment is to identify one leaf node problem and provide an evidence-based program of apprehension for the individual. The purpose of commission supply is to show a logical and systematic flow of ideas through from the initial assessment to the final evaluation (Mooney and OBrien, 2006).The nursing model that go forth be incorpo telld in this complaint plan impart be the Roper, Logan and Tierneys model (2000). This model was chosen beca wasting disease is it extremely prevalent in the United Kingdom and is the or so widely used model massive-familiar to nurses. The model of nursing spe cifies 12 activities of daily living which are relate to basic human needs and incorpo plaza five dimensions of holistic rush, physiological, psychological, sociocultural, politicoeconomical and environmental (Roper, Logan and Tierneys model, 2000).Care plans are based on evidence-based practice, allowing the nurse to determine the best realistic care and rationale for the chosen nursing hindrances (Roper, Logan and Tierney, 2000). They counter into account the psychological, biologic and sociological needs of the soul and therefore provide a holistic border on to care (Roper, Logan and Tierney, 2000). The signifi open firet practise of living that will be affected within this care plan will be maintaining a safe environment as Mr. Jones may have a prob equal problem of d tuckerh, due to hypovolemic and/or metabolous wallop caused by ketoacidosis.Diabetic ketoacidosis (DKA) usually occurs in people with vitrine 1 diabetes mellitus, nevertheless diabetic ketoacidosis back give away in both person with diabetes (Diabetes UK, 2013). DKA results from vaporisation during a area of relative insulin inadequateness, associated with high downslope levels of edulco treasure level and ketones (Diabetes UK, 2013). This happens because there is not liberal insulin to allow glucose to enter the cells where it can be used as energy so the carcass begins to use stores of fat as an alternative source of energy, and this in turn let ons an acidulent by-product known as ketones (Diabetes UK, 2013). It is evident that DKA is associated with significant disturbances of the bodys chemistry, which should resolve with permittherapy (Diabetes UK, 2013).Severe metabolic acidosis can lead to break or death (Dugdale, 2011). The particularised problem was chosen because there are measures that can significantly clip the risk of metabolic and hypovolemic shock which can be caused by severe metabolic acidosis (Dugdale, 2011). Within the care plan relevant care interventions will be identify to prevent the possible instruction of shock for Mr. Jones. In practice the interventions would happen contemporaneously.The interventions involve identifying the potential risk factors for the development of shock by using specific assessments. This will be through with(p) by go withing an assessment which includes planning, assessing, implementing and evaluating the care that will be provided to Mr Jones and to treasure its effectiveness (Mooney & OBrien, 2006).Once the diagnosis was made, specific, achiev qualified, measur adequate to(p), realistic and sequence limited goals of care for Mr. Jones were made. The NHS rear practice specific guidelines for adult diabetic ketoacidosis imply a series of immediate actions and assessments for suspected DKA which will allow for get interventions to be made and will provide a baseline which will provide a measure of the effectiveness of the treatment (The reciprocal British Diabetes Societies In patient Care Group, JBDS, 2012).Mr Jones will need quiet and electrolyte management to draw in ketones and compensate electrolyte imbalance (Nazario, 2011). He will to a fault require pharmacological involvement which will include administrating medication that is inevitable to reverse the acidosis, brocaded contrast glucose and pH levels (Nazario, 2011).Psychological intervention is also necessary to lose weight his fretfulness and therefore veer potential shock (Nazario, 2011). The goal of treatment for Mr Jones is to refuse his high short letter slit level with insulin an minute after the insulin selection is administ stepd with the expected outcome of maintaining a kind glucose level in the scarper of 8.3mmol/l 10.0mmol/l within 72 arcminutes (JBDS, 2012). Due to this it is vital that Mr Joness personal line of credit sugar is monitored and regulated frequently (JBDS, 2012).Another goal is to replace his muddled body tranquils endovenous unsounds will be ac customed to treat dehydration and dehydration status will be assessed every hour by monitoring intake and out lay, skin turgor and vital signs (JBDS, 2012). Mr. Jones will be able to understand the care that is beingness given and why it is being given within 30 minutes of diagnosis and he will also be able to express his fears and cover his needs with nursing staff, whichunite with improvements in his blood sugar levels will reduce his fretfulness.Intervention one changeable and Electrolyte Management gibe to The junction British Diabetes Society (2012) the usual cause of shock in DKA is severe fluid depletion secondary to osmotic diuresis leading to intravascular volume depletion. Diabetes occasional (2013) justify this by stating that dehydration can become severe enough to cause shock. So once a diagnosis of DKA has been established, fluid permutation should be commenced immediately (Park, 2006).According to Oaks and Cole (2007) the development of total body dehydration a nd sodium depletion is the result of increase urinary output and electrolyte losses. They state that insulin deficiency can also contribute to renal losses of water and electrolytes (Oaks and Cole, 2007). The Joint British Diabetes Society (2012) suggests that the most important initial therapeutic intervention when treating a patient with DKA is fluid replacement followed by insulin initiation. They also state an adult weighing 70kg or above presenting with DKA may be up to 7 litres in fluid deficit with associated electrolyte disturbances (JBDS, 2012).Rhoda, Porter and Quintini (2011) propose that a fluid and electrolyte management plan developed by a multidisciplinary group is advantageous in promoting continuity of care and producing safe outcomes. The development of a plan for managing fluid and electrolyte abnormalities should start with veraciousing the underlying condition (Rhoda, Porter and Quintini, 2011).In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia (state of normal body fluid volume) (Rhoda, Porter and Quintini, 2011). The Joint British Diabetes Society (2012) propose the main aims for the first few litres of fluid replacement are to clear ketones and correct electrolyte imbalance.The Joint British Diabetes Society (2012) has issued guidelines on the management of adults with DKA to each NHS foundation trust. The guidelines state that intravenous fluids should be commenced via an intravenous cannula (JBDS, 2012). It is recommended that 9% Sodium chloride 1000mls should be infused initially everyplace one hour (JBDS, 2012).Park (2006) clarifies this by stating that slower rates have been associated with a more fast correction of plasma hydrogen carbonate and it is recommended that 1000mls is to be infused in the first hour. Rhoda, Porter and Quintini (2011) propose that after fluid status is corrected,electrolyte imbalances are simplified.To correct dehydration and achieve the goal of rehy drating Mr Jones, some(prenominal) assessments will need to be completed. Rhoda, Porter and Quintini (2011) suggest that after a plan is developed, frequent monitoring is vital to regain homeostasis. Mr Joness pee output, heart rate, blood pressure, respiratory rate and pulse oximetry will be monitored periodical to ensure the treatment being given is working efficaciously (JBDS, 2012).Also, to assess the degree of dehydration a variety of specific contemplations will need to be carried out including observing neck veins, skin turgor, mucous membranes, tachycardia, hypotension, capillary refill and urine output (JBDS, 2012). A strict fluid balance chart will need to be in place to monitor input and output (Mooney, 2007).To observe with gradual rehydration and restoration of consume electrolytes after the first 1000ml bag of 0.9% sodium chloride has been plowed to Mr Jones over one hour a second 1000ml bag of 0.9% sodium chloride will be commenced over twain hours and a thir d bag will and then follow over another two hours (JBDS, 2012) . Following these two hourly bags of fluid another two bags of sodium chloride will follow at a rate of four hours and then another two bags will be commenced over six hours consecutively to ensure complete rehydration (JBDS, 2012).Pharmacology InterventionThe medication that was needed to resolve Mr. Joness acidosis and to prevent metabolic shock will be discussed in this intervention. A fixed rate intravenous insulin infusion is recommended by The Joint British Diabetes Society (2012) and stated on the NHS foundation trust DKA guidelines to reverse DKA.An intravenous insulin infusion via a pump should contain 50 units of actrapid insulin in 50mls 0.9% sodium chloride at a continuous fixed rate of 0.1 units/kg/hour (JBDS, 2012). If you are unable to weigh the patient an estimated incubus will need to be made to calculate the units per kg per hour (JBDS, 2012).Whilst the infusion is running ketones and capillary blood glucose will be monitored hourly to screen for improvement (JBDS, 2012). Preedy (2010) and guidelines to DKA both state that if the patient normally takes long acting insulin (e.g. Lantus, Levemir) this should be continued at their usual dose and time. According to The Joint British Diabetes Society (2012) it is no longer advised to administer abolus dose of insulin at the time of diagnosis of DKA to allow rapid correction of blood sugar. Intravenous fluid resuscitation alone will reduce plasma glucose levels by two methods it will dilute the blood glucose and also the levels of counter-regulatory hormones (JBDS, 2012).If the blood glucose befalls too slowly, the insulin rate should be doubled every hour until the target decrease is met (JBDS, 2012). If the blood glucose falls too quickly, the insulin rate can be halved to 0.05unit/kg/hour, but for a short time only, as a rate of 0.1 units/kg/hour is needed to faulting off ketone production (JBDS, 2012).If hypoglycaemia occurs p rior to complete resolution of DKA, the insulin infusion should not be stopped, but extra glucose should be added to the IV fluids alternatively (JBDS, 2012). Diabetes Daily (2013) explain that if necessary, kilobyte should be administered to correct for hypokalemia (low blood thousand concentration), and sodium bicarbonate to correct for metabolic acidosis, if the pH is less than 7.0.For Mr. Jones uncomplete of these was needed to correct his acidosis. JBDS (2012) can justify this as they clarify that intravenous bicarbonate is very rarely necessary. Similarly, Diabetes Care (2004) proposes the use of bicarbonate in DKA remains controversial. At a pH 7.0, insulin activity blocks lipolysis and resolves ketoacidosis without any added bicarbonate. Potassium is often high on admission but falls precipitously upon treatment with insulin (JBDS, 2012).Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases thousand levels in the blood by redistri buting it into cells (JBDS, 2012). A large part of the shifted extracellular potassium would have been lost in Mr. Joness urine because of osmotic diuresis (Dugdale, 2012). Hypokalemia increases the risk of dangerous irregularities in the heart rate (Dugdale, 2012). so, continuous observation of the heart rate is recommended as well as repeated metre of Mr. Joness potassium levels and addition of potassium to the intravenous fluids once levels fall below 5.3 mmol/l (JBDS, 2012). By 24 hours Mr. Jones had improved and was able to eat and drink. The guidelines state that by 24 hours the ketonaemia and acidosis should have resolved but you should continue intravenous fluids if the patient is not yet drinking as per clinical judgement (JBDS, 2012).The guidelines also suggest if blood glucose becomes lower than 14 mmol/L then 10% glucose should be prescribed to run alongside the sodium chloride (JBDS, 2012). Also, if Mr Jonesspotassium had of dropped below 3.5mmol/L in the first 24 hour s of treatment then additional potassium would have needed to be given (JBDS, 2012).Psychological InterventionA third intervention would be intercourse needs to reduce patient anxiety and keep the patient feeling secure. conversation plays an important part in the holistic care plan and biopsycho genial approach to care. concern can be a barrier to communication therefore, it is important to intercommunicate with Mr. Jones clearly and supportively in order to make him feel free to discuss his fears and to allow him to participate in the decisions made in his care. According to Sarafino (2008) anxiety appears to be caused by an interaction of biopsychosocial factors, including vulnerability, which interact with situations, stress, or trauma to produce added anxieties for the patient.The nurse should take a step by step approach to build a plan of care and voice the plan of care to Mr. Jones so he does not become overwhelmed by the extensiveness of the treatment (Sarafino, 2008). Communication is identified as one of the essential skills that health care professionals essential acquire (NMC, 2010). The Nursing and Midwifery Council (2010) stipulate that, within the domain for communication and interpersonal skills, all nurses must do the following communicate safely and effectively, build therapeutic relationships and take individual differences, capabilities, and needs into account, be able to engage in, maintain, and disengage from therapeutic relationships, use a range of communication skills and technologies, use verbal, non-verbal, and written communication, address communication in diversity, promote eudaemonia and personal safety, and identify ways to communicate.Communicating with Mr. Jones relatives is also important so that they develop an apprehensiveness of his condition and the care he is receiving (Webb, 2011) According to Webb (2011) health professionals who can communicate at an emotional level are seen as warm, caring, and empathetic, and amaze trust in their patients, which encourages disclosure of worries and concerns that patients might otherwise not reveal. Additionally, informatory and useful communication between the practitioner and the patient is shown to encourage patients to take more interest in their condition, bring questions, and develop greater understanding and self-care (Webb, 2011).Webb (2011) explains that this isparticularly so when the patient is given time and encouragement to ask questions and be involved in their treatment decisions. By using the Roper, Logan and Tierneys nursing model (2000) a holistic approach to care was able to be implemented for Mr. Jones by taking into account his biological, psychological and social needs. By establishing a holistic care plan three interventions were identified that were equally vital in treating Mr. Joness DKA to prevent hypovolemic and metabolic shock caused by his acidosis.The first intervention was the management of fluid and electrolytes put in place to achieve the goal of rehydrating Mr. Jones in aim to correct his electrolyte imbalance and clear ketones to prevent hypovolemic and metabolic shock caused by his DKA. The second intervention included pharmacological input which included the constitution of relevant medication to achieve the goal of reversing Mr. Joness raised blood glucose and acidosis. Lastly the third intervention within the holistic care plan addressed Mr. Jones psychological needs by resolving his anxiety by utilising effective communication and interpersonal skills.It can be concluded that the care plan and treatment for Mr. Jones was successful therefore he did not require escalation to the high dependency unit and additional treatment was not necessary. Therefore it is evident from the success of Mr Jones care care planning provides a incorporate and holistic method which in turn addresses all elements of an individuals health and well being.AppendixThe individual chosen for this care plan is Mr. S am Jones (a pseudonym, as explained in the confidentiality statement). This gentleman was chosen for the care plan as caring for diabetic individuals is becoming a more common activity within health care today. Mr. Jones is a 58-year-old builder who was admitted after being found collapsed at his home by his brother.He is 5ft 9 tall and weighs 88 kilograms. Mr. Jones lives alone in a centrally heated two bedroom semi detached house he sleeps on the speeding floor and is very independent and does not require a bundle of care. He has a daughter aged 22 who has two little children and also has a brother aged 64 who lives nearby with his wife.Mr. Jones has been diagnosed with type 1 diabetes since the age of 18 and has struggled with the management of his conditionresulting in legion(predicate) hospital admissions. Mr Jones stated he did not smoke but admitted to having an increased intake of alcohol. On arrival blood monitoring was performed which revealed un-recordable blood sugar levels which gave the clerking impression of diabetic ketoacidosis.The health care team then had the problem of potential death due to hypovolemic and metabolic shock caused by ketoacidosis. On admission to the medical assessment unit (MAU) many assessments needed to be completed to discover the extensiveness of the condition and to provide baseline levels.Firstly, rapid ABC was performed with measurement of pulse, blood pressure, Glasgow coma scale, respiratory rate and pulse oximetry. Urinalysis was performed which registerd the presence of ketones, and glucose and samples were sent for microscopy, culture and sensitivity. The patients full blood count was taken as part of the septic screen.The patients capillary blood glucose was taken and venous blood samples were be sent to the lab for U&Es which is essential in order to assess the baseline potassium as well as giving a biochemical meter reading of dehydration and renal function. Laboratory glucose is also an essential base line probe to identify glucose and evaluate blood sugar concentrations (Association for Clinical Chemistry, 2011).A baseline cardiogram is a mandatory investigation for a patient with DKA (Turner 2012). Blood blow measurements were used to evaluate Mr. Joness oxygenation and acid/base status and from the blood gas a pH result was obtained as well as a bicarbonate levels and PC02 (the amount of carbon dioxide released into the blood) levels (ACC, 2011).The results of the numerous tests confirmed the diagnosis of metabolic acidosis. Metabolic acidosis is characterised by a lower pH and diminish bicarbonate, the blood is too acidic on a metabolic/kidney level. A pH less than 7.4, low bicarbonate and low PC02 will indicate metabolic shock and DKA (ACC, 2011). The assessments that were undertaken on Mr Jones revealed that he fitted the criteria for diagnosis of diabetic ketoacidosis.According to The Joint British Diabetes Society (2012) to diagnose DKA the three of the following must be present blood glucose over 11mmol/l or known diabetic, blood ketones above 3mmol/l or urine ketone ++ or more and venous pH less than 7.3 and/or bicarbonate below 15mmol/l. Once the diagnosis was made, specific, achievable, measurable, realistic and time limited goals of care for Mr. Jones were made.