Assumption Paper

Rio Salazar Professor Kampa English composition 122 August 15, 2012 Assumption Paper Music history is the easiest way to appreciate the craft no matter genre, instrument, sound, or origin. It also gives one a chance to get an understanding of what life is like in a different country by the way they dance to their music, or how they react when their music comes on. One thing that should be learned in music history is the appreciation of music.The second thing that should be learned is how music influences people all over the world no matter the language, whether it is an instrumental or acapella, all people will react different. The last thing that should be learned is the different time periods of all music to see how it has changed over the years. Clearly you can understand that these are the main points of music history. Music appreciation is an important aspect because it allows one to gain knowledge about many genres of music. It teaches the origins of different types of music. I t shows one how to expand their range of music.Music appreciation also allows one to find out the origins of the genres. In many ways music appreciation allows people to expand their taste in music. Music history will teach people how music influences people all over the world. It will help people understand how the music people listen to makes them feel in everyday life, and how it influences the way they dance to the music they hear. Lastly how the different regions influences the music and its style. All in all this is how it would teach the music’s influences on people in their everyday lives.The different styles that have been developed over the years would be the next thing taught in music history. First off there would be so many different styles of music as the years go on because, things tend to expand, and music expanded quickly. Also as the years went by music expanded and so did the use of different instruments. Lastly this is how music has changed due to new styl es developing over the years, and the use and construction of new instruments. Music is the sauce of life and without it would be bland and very boring with nearly nothing for entertainment.

Comm 399

Instructor: Daniel Ding COMM 399-204 Due: 13pm Mar 20, Wednesday Assignment 3 Analyze Hewlett-Packard – Supply the DeskJet Printer in Europe Case (CJA chapter â€Å"Inventory Control†; see the course package). Answer questions 1, 3, and 4 given at the end of the case (question 2 is not required). Discussions are permitted within a group of at most 3 students, but everyone has to submit their own assignment and it cannot be an identical copy! Paperversion is preferred. For your convenience, I have prepared a spreadsheet (Assignment3_HP. ls) in the assignment folder on connect. It may save lots of your time if you work on the excel. If you choose to use excel, be sure to include the excel spreadsheet when you submit your assignment. Please use hints that are provided below. †¢ In comparing different options (localization of a generic printer at DCs or not), you need to quantify the benefits from each. The best way to do that is to use the inventory models to calculat e the total cost of inventory per unit (for all DeskJet models) under different options. †¢ Use demand data from the exhibit 13. 16.For your convenience, the monthly and weekly mean and standard deviation for six models as well as generic printers have been calculated in the spreadsheet Assignment3_HP. xls †¢ Assume 1 month = 4. 33 weeks †¢ Assume a 98% service level. The z value to ensure a 98% Service level is 2. 06. †¢ Note that this is a fixed time period (R,T) model with review period T= 1 week. †¢ Lead time for ocean transit = 5 weeks †¢ While calculating annual inventory costs, remember to include pipeline (in-transit) inventory, safety stock, and cycle stocks (because in this case, HP is responsible for all these costs). The annual average inventory cost is computed as follows: Annual Average Inventory Cost = (Safety Stock + Average In-Transit Inventory + Average Cycle Inventory) ? (unit cost) ? (percent carrying cost). Note that in a fixed time period model, the ordering cost is fixed and can therefore be ignored. †¢ We can find the average inventory cost per printer by dividing the annual average inventory cost by mean annual demand (mean monthly demand ? 12). The total supply chain cost per printer sold is given by (unit cost) + (average inventory cost per printer) + (transportation cost per printer). †¢ For question 4, your recommendation to HP should use the option that minimizes total supply chain cost per printer. Suggested length: If you use excel (Recommended Approach), then submit the spreadsheet plus one-page report that briefly explains your result; otherwise, you may submit a report which includes 2-3 page solution details.

First case study assignment Example | Topics and Well Written Essays - 750 words - 1

First assignment - Case Study Example the purpose of this brief analysis is to briefly discuss the seduction theory, analyze its contents, and seek to infer a rational for why Sigmund Freud chose to abandon such a theory only one year after mentioning the high probability of its existence. As a way to do this, the author will examine Freud’s own admissions with regards to the lack of therapeutic success, unlikely number of sexual deviants in the Vienna population, the nature of unconsciousness, and the Oedipus Complex. Firstly, with regards to the Seduction Theory, this was ultimately a theory put forward by Sigmund Freud around the year 1895-1896 in which he sought to link the prevalence of hysteria and obsessional neurosis to repressed memories of childhood sexual assault. In the theory, the repressed sexual assault was ultimately internalized and manifests itself as a function of a type of neurosis or other form of mental issue. Naturally, within the constructs of the times and within the scientific body of knowledge, Freud published a paper on the topic in 1896 and prior to this performed a long set of clinical trials in which he was able to elicit confessions of repressed sexual abuse upon his patients, generally taking place before the age of 4 years; i.e. in infancy. However, for one reason or another, Freud soon abandoned this theory as he evidently thought it to be ultimately untenable within the realm of extant science and experience he had witnessed (Blum 2008). Although many of Freud never detailed the reasons for why he chose to distance himself from the Seduction Theory, one can infer a great deal based upon his 1897 letter to Wilhelm Fliess. Within this personal correspondence, the four factors which were listed in the introduction of this analysis with regards to why Freud may have ultimately chosen to abandon the theory are iterated. Firstly within the letter Freud complained of the â€Å"inability to bring a single analysis to a real conclusion† (Freud 1985). This of course

The Logistics Activities of a Organization or of a Business Research Paper

The Logistics Activities of a Organization or of a Business - Research Paper Example In order to understand the particular challenges of the food retail business environment thoroughly, a good place to start is by examining the logistics activities of a supermarket chain. It is possible to establish how a business is able to create a profitable record by effective logistics and concentration on the delivery of desirable products in a â€Å"no-fuss† way and at competitive prices, to the average consumer.   In Ontario, Canada, a particularly well-known and widely supported brand of the supermarket is the Food Basics stores. The stores offer lower cost products across a wide range of products, with the particular focus on foodstuffs. National and international brands are carried as well as private in-store brand labels and offered in 117 stores across Ontario. Food Basics is owned by Metro, Inc. a major Canadian food and pharmaceutical company, which also owns Metro, Metro Plus, and Super C brands.   The central topic of this paper is the logistical activitie s involved in the retail sale of vegetable oil by Food Basics. Within the wider examination of â€Å"logistics† Demand Forecasting, Quality Control and Site Location with being looked at with a narrower focus. Vegetable oil will be considered on two levels: locally and internationally prepared canola oil; and internationally produced olive oil, as stocked by Food basics stores, and carried under their in-store labels.  Food Basics aims to provide lower-cost, high-quality food stuff to their customers.

Current Events Essay Example | Topics and Well Written Essays - 250 words - 1

Current Events - Essay Example However, the company has had to make many changes since it acquired Zain Africa in a deal that involved more than ten billion dollars (Campbell 416). The main reason was the existence of established mobile operators in individual countries and across regions. One of examples is the West African region where MTN has acquired a considerable stake of the market. However, apart from this, the high operating costs, a low-income market, political instability, and restrictive government policies have been among the major reasons for Airtel Africa reengineering. Despite the numerous changes that have faced this company the short-term achievements are exceptional (Campbell 417). The incentives the company has offered, such as low calling, texting, and Internet rates, have ensured the constant rise of the number of its subscribers. Moreover, the recent roll out of 3G Internet speed for its users has been its most successful promotional methods so far. The success achieved in the African market has established it among the five top mobile operators in the world. In conclusion, Bharti Airtel reengineering has been beneficial not only for the company but also for the African people. In a general business outlook, it is one of the main contributors to making Africa one of the fastest growing telephone markets in the world (Pan 14). Consequently, as shown by Bharti Airtel, reengineering is one of the most effective methods to expand, increase profits, and accelerate the growth of a

Speech Made in the Conference, Concerning Japan's Aggression Essay

Speech Made in the Conference, Concerning Japan's Aggression - Essay Example Japan is such a country that can best be described as aggressive, with its acts being tantamount to belligerence, especially towards China. Some of the acts of aggression that Japan has carried out may be illustrated forthwith. It is open knowledge that Japan on September 18th, 1931 sent its army and some of its political leaders to invade Manchuria, which is the eastern seaboard of China. The worst part of this problem is not merely personified in Japan’s acts of aggression, but on Japan’s lack of goodwill to being accountable for its actions. For instance, in 1933, after the Manchuria crises ended, Japan’s delegate walked out of the League of Nations when the findings by the Lytton Commission were being read out and mooted. In so doing, Japan was not only excising itself from the rest of the international community, but also parading unwillingness to take responsibility. Arrogance was also the driving force behind Japan’s walk out since Japan had already pacified Manchuria from China and singlehandedly made Manchuria a puppet state, Manchukuo. Japan even had the audacity to make Emperor Pu Yi as the head of Manchukuo who was a stooge in every respect. Similarly, Japan’s aforementioned willingness to take responsibility is underscored by the fact that the tabling of the Lytton Commission’s findings was supposed to be accompanied with discussions on China’s appeal for an interstate approach towards Japan’s aggression (Christensen, 75). Japan’s bellicose stance was further shown in it engaging the Chinese army near Peking, at the Marco Polo Bridge in 1938, following the ‘China Accident.’ It is important to note that Japan’s problem is one which is heavily embedded in wrongful thinking and attitude. For a fact, ever since Japan won the Sino-Japanese War which took place between 1894 and 1895, Japan has become increasingly stubborn throughout the orient, after it knew that it had a stranglehold in the Asian continent. China’s compelled recognition of the Korean independence and its forced concessions on Liaotung Peninsula and Taiwan were to serve as Japan’s reassurance and propitiation. Unfortunately, Japan grew into a bully. It is important to note that with much power comes, responsibility in lieu of belligerence. Japan, other developed and developing countries ought to realize this. It is important that Japan appreciates the fact that when it joined the Allies in World War I, it gained a lot when the League of Nations granted it, the Asian colonial territories that had been being controlled by Germany in the 1919 Treaty of Versailles. That these territories were rich, is a matter that is underscored by the inclusion of the Shantung Peninsula and Micronesian islands which had been under the tutelage and ownership of China and Germany, respectively. Thus, the citing of Japan’s landlocked status as a reason behind its unbridled antagonism cannot wash. How the U.S. Plans To Handle the Situation There are several measures that America has considered as tenable solution to the problem of Japan’s aggression. The measures are both short and long term. One of the long term approaches to the problem is the reevaluation of economic policies with Japan. It is well known that since 1920s, Japan got less interested in western model of economic liberalism. This is because, while reeling from the

Reflection on my Cofacilitation Group Skills Demonstration Essay

Reflection on my Cofacilitation Group Skills Demonstration - Essay Example etings were scheduled and attended by the members and that each member completed their parts on time so that we could merge all the sections before acclimatizing to them to foster further understanding on us. With regard to my facilitation partners, I have to commend them, despite residing in different areas I fond working with them quite cordial as no one missed even a single meeting. They all played their parts thoroughly without being pushed and took the initiative to update the rest of the group about their finding so that we could share a common grounding. I must say I enjoyed doing business with them, it was a flexible group, eager to learn, time conscious, and with unique contributions. Even though every event was successful in the group work, my most well done duty was the actual presentation-how I engaged and controlled the audience within the provided time. My presentation was more of interactive and I think this significantly contributed to the understanding of my facilitation. Though the presentation was good, I had the feeling that I have to improve on time management, it is important that after the facilitation, the audience get time to ask questions and this was not the question with my presentation. Time was well managed but I did not allocate time for questioning and clarifications from the audience. The feedback from peers and the instructor was positive, they all commended my contribution and confessed they did not expect such a well-organized and articulated presentation form me. The instructor went ahead and said that I must have had adequate preparation for the presentation, which was true. I also came to realize that with commitment, hard work, and dedication to duty, everybody could improve on their ability to deliver n anything. My contribution to the group was enormous, having been proposed the leader; I had to ensure that all the prerequisite preparations are done on time. I scheduled meetings, delegated duties to the group members,

How to Criticize Up and Down Your Organization and Make It Pay Off Essay

How to Criticize Up and Down Your Organization and Make It Pay Off - Essay Example That said, Weisinger points out that criticism is necessary for growth. For instance, Weisinger (1989) states that the Romantic period in philosophy, politics and the arts came about because the individuals involved with the Romantic period criticized the neoclassical period, and because criticism of the neoclassical followers had their criticism suppressed. Weisinger (1989) further point out that Louis the XIV suppressed criticism, and the response to this was the American and French revolutions. In other words, when criticism is stifled a cataclysm might develop which changes the status quo. Moreover, Weisinger states that criticism from the likes of Galileo, Darwin and Freud changes societies in general. Criticism is necessary for growth, and criticism cannot be suppressed without consequences. Therefore, according to Weisinger (1989), criticism, being necessary for growth and change, and being necessary to influence, motivate and change behavior, must be expressed in a positive w ay so that the criticism can be accepted and useful, as opposed to simply negative and demoralizing. Weisinger further states that there are barriers to individuals accepting criticism and applying the criticism to their lives to makes themselves, and the organization, better. There are psychological hurdles which must be overcome. Weisinger talks in terms of cognitive appraisal, which means that individuals have a mental framework with which they receive information like criticism, and this framework dictates how the criticism will be processed. The framework is built through classical conditioning – criticism in the past has produced a negative response, so present criticism, even if tactfully presented, will also present the negative response. Moreover, since criticism is often portrayed in the media as negative – such as headlines which link criticism to failure – the mind links the two concepts together. Criticism equals failure. Modeling is another psychol ogical force at work, and this means that how one’s family criticized one another is what is known to the individual. If one’s parents responds to criticism by yelling, making retaliatory comments, or leaving the room, the individual is likely to do the same. The modeling focuses upon how one criticizes, as well as how one reacts to criticism. Operant learning is also a force at work, and this is when an individual does X, he gets the result of Y. A worker responds to criticism with anger, so the supervisor backs off. This reinforces the angry response, so that the worker continues to use this response when criticized. Since criticism is obviously necessary, because there can be no growth and change without it, and individuals are hard-wired either to not accept criticism gracefully or to give criticism in a counter-productive manner, what can be done? This question is the focus of Heidringer’s book and and analysis. The bulk of the analysis is that criticism mu st be redefined in a manner that it is not seen as tearing somebody down, but, rather, giving them information which they can use to improve. This is an important message to myself and my future career growth, not just because it is inevitable that I will be criticized, so I need to know how to handle this criticism and apply it so that it is not negative but positive, but also because it will help me learn how to criticize so that any team that I

The reality of arms trade compared to its depiction in popular Essay

The reality of arms trade compared to its depiction in popular Hollywood Movie - Essay Example Arms Trade has impeded the prosperity of this world and its negative effects are just increasing as it has become a nuisance for the well-being of the people.The global arms industry comprises of various governments and individual commercial companies who manufacture and sell weapons and other advanced form of military technology and equipment. This industry has grown in both volume and its reach. Now more and more developing countries are being served by these arms producing entities. A huge sum of cash is being spent on research, development, manufacture and supply of military equipment to the developing world. These defense contractors produce guns, ammunition, military aircraft, missile and other defense related equipment. Experts estimate that nearly 1.5 trillion dollars are wasted on the various military expenditures worldwide. Although the percentage has come down from 4% in 1990 to 2.7% at present, the volume has increased significantly and the sale has been focused more towa rds the economically deprived countries. (Shah, World Military Spending) These countries lack enough funds to provide for the well-being of its people but somehow they manage to spend a substantial amount of their GDP on defense budgets. The movie Lord of War does portray a true picture of the global arms industry existing in the world. Nevertheless, it can be argued that the degree of its reality is different since these things are hidden from the general public. The incidents depicted in this movie clearly highlight how in real life certain factors push one to pursue the worst of jobs. The life story of Yuri portrays him as a person caught up in a situation where he has to deal in arms trade in order to give others a chance to protect themselves. His initial intention is to provide the people with a necessity of life, but later on he turns into an arms dealer who builds contacts and uses his networks to sell arms and ammunition without caring for the lives of others. The way the t rade has been shown, where force and power has been used to get hold of weapons, is a true picture of reality. Arms trade is one of the deadliest causes of chaos in the world. It not only allows military dictators to rule ruthlessly over the population but also gives them the power to continue their suppression and oppression over the suffering population. The deal that is struck between the arms lord and the dealer is usually of millions of dollars and both parties are completely unresponsive to the effects such transactions would have over the future of their nations. The use of such arms is highly questionable; on one end these deals are struck to protect the people from the ruthless rule of their dictators, and on the other it is seen as a source of strengthening the grip of evil doers over the sufferers. For instance, the movie story shows that it was apparent that the deal between the African military ruler and the arms dealer would bring about a massacre of nearby villages an d loss of thousands of lives, but still the deal was carried out. It is likely that the dealer is rarely concerned about the interests of the people who will suffer as a result of these weapon deals. It has been debated also depicted in the movie that after the collapse of the Soviet Union in 1991, thousands of AK-47 and other Russian weaponry flowed into the hands of arms dealers. Since it was lying idle in warehouses and military depots, Russian military generals illegally sold them to arms dealers around the globe in order to make their personal gains. This surely resulted in the availability of one of the best assault rifles of all times and was soon seen in the hands of mobsters and warlords on all continents. It is astonishing to know that around 76% of world’s total expenditure is accounted on defense budgets. This amounts to a humungous $1.22 trillion, out of which 42.8% comes from the United States. (Sipri, Recent trends in military expenditure) This reveals that no matter what

Increased gas prices in the US compared to the Middle East Essay

Increased gas prices in the US compared to the Middle East - Essay Example The high prices are mainly caused by the supply and demand factor. The demand for crude oil has immensely increased which directly affects the gasoline prices at pumps of USA. The supply has not been increased in that proportion. The consumption of gasoline in developing countries like China and India has been significant as the automobile industry is skyrocketing in these countries. The gasoline consumption in USA is about one quarter of the world’s total production. However supply and demand is not only the factor but the additional cost which includes taxes, cost of refining crude oil, transportation cost, and the profit to the gasoline dealer is also the reason and contributes about increasing the cost less half then cost of gasoline in United States. Rising gas prices is a matter of concern for the USA car manufacturing companies. It is expected that the use of Subways will be increased in the future. This may result in weakening the USA economy as car manufacturers are one of major stakeholders. Last but the most important factor is recent unrest in the Arab World. Although the countries like Egypt, Syria, Jordan are not the major crude oil producers but they play significant role in determining the world oil prices. President Obama has put aside the interest shown by some Companies willing to explore oil in Alaska and other areas. The aim of these people was only to increase the domestic exploration. This action of him has resulted in complete shutting down of the present oil drilling infrastructure in USA. It is reported that about 103 permits are in waiting list for review. But the Obama administration has not renewed any single exploratory drilling plan in the Gulf of Mexico. Moreover Obama administration has also put â€Å"7 year ban† on the oil exploration in the coastal waters in Atlantic and Pacific coasts and the Eastern Gulf of Mexico. According to the experts

Plato and the Concept of Knowledge Essay Example for Free

Plato and the Concept of Knowledge Essay Plato’s Theaetetus is a dialogue that discusses and attempts to find a definition of knowledge. The two characters, Socrates and Theaetetus, approach the argument with the initial idea that knowledge is the addition of a true judgment and an account. However, Socrates raises some concerns regarding the fundamental aspects that make the definition true. Ultimately, the two characters find that their original definition of knowledge is not as accurate, nor as simple as they once believed. The article opens with Theaetetus recalling a definition of knowledge he once heard, which stated â€Å"true judgment with an account is knowledge [and is therefore knowable], and the kind without an account falls outside the sphere of knowledge [and is therefore unknowable]† (126). Socrates begins to question one’s ability to determine whether something is or is not knowable, and he demonstrates the concept using the relationship between elements and complexes. In doing so, he explains a recent dream of his, which, in turn, is actually an explanation of Dream Theory. Dream Theory states that â€Å"the primary elements, of which we and everything else are composed, have no account. Each of them itself, by itself, can only be named† (126). In other words, as elements cannot be broken down further, elements cannot have an account because that would require the determining of whether or not the said elements exist. The addition of that information onto the original element itself results in something that is no longer in its simplest form. Therefore, no elements can have accounts, nor can they be knowable; elements can only be perceived. Consequently, this poses the question as to whether or not complexes are knowable given that their elements are not. When complexes are viewed as the sum of all their elements, it is safe to conclude that the complexes are unknowable, as their elements are unknowable. This idea allowed Socrates to then consider whether complexes were mere sums or if they should instead be viewed as wholes that cannot be dissected into parts. However, the problem with this idea is that, when viewed as a whole that cannot be separated, the complex is then no different than an element, and therefore cannot have an account. After failing to determine what does and does not have an account, Socrates decides to turn his attention to determining what constitutes an account. First, he defines it as stating one’s judgment through speech. Immediately, this manifests flaws in the sense that any true statement could then be considered an account. If this were the case, there would be no differentiation between an account and a true judgment. Next, he defines an account as listing the elements of the things known. Again, this must be incorrect because the possibility exists that one could simply memorize the elements without actually understanding them. Without understanding, one cannot have knowledge. Finally, he defines an account as differentiating the known thing from everything else. This would require knowledge of the differences, and ultimately would again be a reiteration of the true judgment. Additionally, one would be defining knowledge as true judgment plus knowledge, which would be considered a fallacy. This marks the final turning point in Socrates’s and Theaetetus’s overall definition of knowledge, where the two characters decide that their initial definition could not be considered correct. Through their attempts to dissect the supposed explanation of knowledge, Socrates and Theaetetus finally reach the conclusion that knowledge is â€Å"neither perception, nor true judgment, nor an account added to true judgment† (133).

The red scare and the crucible

The red scare and the crucible The term Red Scare indicates two marked periods of strong and great anti-Communism in the United States of America. The first Red Scare took place from the year 1919 to 1920, and the second Red Scare, occurred between 1947 and 1957. The first Red Scare related to worker or socialist, political and radicalism revolution, while the second Red Scare focused on issues relating to foreign and national communists who infiltrated the society or influenced the federal government. The beginning of the first Red Scare was due to the Bolshevik Russian Revolution of 1917 and the greatly patriotic World War I year, as the left-wing political violence, anarchist and social agitation worsen national political and social. Mr. Murray B. Levin a former member of the Communist Party and a political scientist noted that the Red Scare was a national wide rebellion against radical hysteria, which was provoked by a buildup of fear, anxiety and intimidation that Bolshevik revolution was forth coming in America was forth coming. The revolution would give a new look to the home, civility, Church, home, marriage, and the entire American Lifestyle (Burnett).The media and Newspapers translated the political anxiety and fears into xenophobia, solely because an array of radical anarchism were seen to be the answers to poverty. Recent European immigrants were often the advocates and, the World Industrial Workers supported several strikes, organized by labor in 1916 and 1917. The pre ss portrayed the strikes as radical threats to US society and as being instigated by some foreign agents provocateurs, and the left wing. The press media misrepresented genuine labor strikes as being Communism establishment plots, crimes against society, and anti-government conspiracies. Transformations in public views and opinion lead to the loosing of many members by the left-wing organizations like the Industrial Workers of the World, communist and the Communist Party America. Several American states enacted a law known as the criminal syndicalism laws, which outlawed advocating of unrest and violence between the years 1919 and 1920. This was done in an effort to secure and effect social change in the states. The restrictions and regulations in the law included limitation of free speech. Aggressive investigation by police took root after the passing of these laws. Irrespective of ideological gradation, Red Scare failed to distinguish between socialism communism, and social democracy. The Second Red Scare took place after World War II, and coincided with the increased fear of communist espionage consequent, the Chinese Civil War, the Korean War, the acknowledgment of intelligence work for the Soviet Union given by several high-ranking American government officials, the Berlin Blockade, and Soviet Eastern Europe. The occurrences of the late 1940s, the court trial of Julius Rosenberg, and Ethel, the Iron Curtain between 1945 to 1991 around Eastern Europe, and the Soviet Unions nuclear weapon creation surprised the American public (Miller). The influencing popular opinion about America national security, in turn, connected to fear of the ability of the Soviet Union, carrying out an atomic-bombing on its territories, and fear of the United States of America Party of Communist contributed largely to the Red Scare. Whittaker Chambers, Elizabeth Bentley, former CPUSA members and NKVD spies, testified at the House Un-American Activities Committee, that communist sympathiz ers and Soviet spies had made penetration into the government of the United States and this happened prior to and even after World War II. Out of pride, other United States American citizen spies confessed, to their activities of espionage in instances where the statute of limitations on their prosecution had run. In the year 1949, fear of American traitors and anti communist, was mounted by the winning of the Chinese Civil War by the Chinese Communists against the Western supported Kuomintang, one of the founders of the Peoples Republic of China, and later the intervention of the Chinese in the Korean War against American ally nation of South Korea (Eaklor 87). The Second Red Scare greatly changed and aggravated the temper of U.S society. The societys later identification as anti-intellectual may be have been seen as a contributed by factors such as escalating popularity of anti-communist espionage like â€Å"My Son John† and science fiction movies such as â€Å"The Thing from another World† of 1951. Such resources contained themes and stories of the invasion, infiltration, destruction, and subversion, of United States society by non-American sentiments and inhuman individuals. The animosity even lead to a baseball team, originally known as Cincinnati Reds to , temporarily change their   name to Cincinnati Red legs to avoid the loose of money and their career ruining legacy consistent in being ball playing Reds. As an indication of the ability of the American government to curry out intelligence gathering, it released details of the Venona Project for the Soviet Union from 1940 through 1980 in 1995. In the duration of the McCarthy era, many Americans were accused of being members of the Communists movement or of being communist sympathizers and therefore becoming the objects and subject of aggressive interrogations and questioning by the private industry panels, or government, committees and special agencies. Government employees, individuals in the showbiz and entertainment industry, teachers, union activists and instructors, were the primary targets of such victimization and suspicions (Bowers 19). Despite questionable evidence or inconclusive findings, the suspicions continued to be given credence. There was also a great exaggeration of level of threat presented by a persons real or supposed leftist interactions or beliefs. A great number of people went through the pain of losing employment, career destruction, and even long-term imprisonment. Most of the punishments issued were because of trial verdicts and convictions based on laws that would be later declared unconstitutio nal. The most famous and well-known examples of McCarthyism during the Red Scare are Sen. McCarthys own personal trial hearings, speeches, and communists investigations. The Hollywood blacklist, associated with the House Committee on Non-American Activities hearings, and a range of anti-communist behavior of the Federal Bureau of Investigation (FBI), are key examples of McCarthyism. The cultural and social widespread phenomenon had an immense effect on all levels of society. Furthermore, it was seen as the source of a great debatable issues and conflict in the United States of America. The Crucible is known to be a tale of the Salem witch-hunts that was practiced during the preceding days before the institution and founding of the United States (Bloom 197). Arthur Miller, a play writer, wrote that story. It is an allegorical presentation of Joseph McCarthy and the hunt for Communists in the 1950s during the Red Scare. The intention of the play was to depict that McCarthy, as being the wit ch hunters, and that he was making profits from public hysteria by persecuting innocent people. The soviet archives along with the data of the Venona Project released by the U.S intelligence, later suggested that some of McCarthys targets were actually guilty of becoming enemy agents. During the Red Scare and the Crucible United States citizens, were in apprehension of communism in the same manner in which people were in witchcraft trepidation in the Salem witch trials. Distinguishing attributes of the two occurrences are can be compared between that of Arthur Millers Crucible narrative and the Red Scare occurrences that took place in American history. During the time when the witch trials were conducted in The Crucible, people were forced to either agreeing or confessing to having committed the witchery crime or direct the blame towards another suspect or a different person. Part of the crucible story, records that trouble in The Crucible started when Abigail Williams blamed Tituba for the actions of the girls who used to dance among the trees or woods. She replied that, she made him not to do it, but instead made Betty to do it. The statement given against another person generated the emergence of pandemonium in Salem. Such quotes are perfect example that leader s like Miller presented in his dialog relating to the way people conducted themselves during the duration of the Red Scare. Another example of an instance of how people behaved during the Red Scare is Mary Warren story. She states that John Proctor is worked in the company and together with the devil. Arthur Millers vividly illustrated the thought that everyone must agree to confess or face death, and that being against the court meant also being against the church in The Crucible narration. The achievements by Sen. McCarthy to United States are undeniable to the historians and those who look at history with impartial eye. At a time when agents of the most murderous empire in human history were infiltrating America, McCarthy was the only voice that stood against victimization and tyranny (Senator McCarthy Inc.). He managed to expose hundreds of agents who were determined to destroy Unite States. If Sen. McCarthy never got the nerve to express what he knew, the possibilities that the USSR might still have been in existence today would be true. Senator Joseph McCarthy is on record as having been the first one who indicated that communism had come over to the United States of America and their spies were letting out Americans secret intelligence information. Lies seemed to be the grounds upon which America was governed, from its very commencement of Salem with trial to the Sen. McCarthy occurrences. A considerable number of people of the Eastern Europeans descent, who once lived under the ruler ship of the Soviet, owe their freedom to Senator McCarthy today. The patriotism of Sen. McCarthy did not fail to come with a price. It cost him his work and finally his life. Having determinate his willingness to protect and defend United States freedom, Senator Joseph McCarthy is without a doubt an American patriot and hero. Although he ruined several lives and led to the downfall of many careers, McCarthy is the man who changed the landscape of American politics. His speech proved that America adhered to the tenets of the constitution of freedom of expression and speech. His acts of free speech, hunting for communist proposers and liberals who were thought to be pro-communist led to the downfall of President Harry S.S. Truman and several other Democrats from the Congress and the White House. His actions also led to the fanning of the cold war hatred embers that went on for several years up until the early 90s. McCarthy also changed the atomic bomb focus of the world through the Red Scare. He broke through the ranks of communism, ensured that the formulae for making atomic bombs has not been spread by Communist spies in the U.S. This somehow contributed to the curtailing of the number of countries and people who can make bombs that are of a powerful nature. McCarthy is a man who reduced the communist stance and existence around America and in the Globe!

Nursing Discipline Overview and Reflective Account

Nursing Discipline Overview and Reflective Account NURSING DISCIPLINE MENTAL HEALTH BRANCH From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950s. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were put away. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as muffling or being put in a swing chair. In the 1960s, inadequacy and cost resulted in mental health hospitals closing and care moving to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003), where most people with mental health problems are cared for today (NHS 2010). Legislation such as the 1959 and subsequent 1983 Mental Health Act, and the Care Community Act (1990) are relative to modern community mental health nursing. In 1999 the Government confirmed mental health was a top priority in the Health Service (Jackson Hill 2006). Since then guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson et al 2006) have been introduced to reform and improve services for people with mental health problems and their carers. The Department of Health have also investing significantly in inpatient mental health settings due to issues such as a not enough beds being available, the lack of privacy and dignity of patients and wards not supporting provision of self care (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been dev eloped, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009). Mental health nurses will work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to care for people in a fair and anti-discriminatory way and deliver care holistically, mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and personality and human behavior (Hannigan et al 2003). One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention (Mind 2010). Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they cant cope with, such as depression following the death of a partner (NHS 2009). Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan et al 2003). Care is person-centered and mental health nurses will work within a professional multi-disciplinary team which will include GPs, psychiatrists and social workers and other health care professionals. A mental health nurse will require good interpersonal and communication skills. They will to demonstrate sensitivity when caring for patients, for example there is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010). Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill a nurse will be required to have is to recognise building tension and diffuse it when necessary to maintain the patients and others safety (NHS 2010). Sometimes nurses may find themselves faced with awkward situations, and be required to apply ethical principles, such controversial issues which cannot be disclosed and where confidentiality needs to be maintained (NMC 2008). On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan et al 2003). Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them (Hannigan et al 2003) . In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision. Nurses need to support patients to take responsibility for their own well-being and make informed decisions by providing information which is accessible and understandable (Mind 2010). This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the clients best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983) (Hinchcliff et al 2003). To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential. NURSING DISCIPLINE LEARNING DISABILITIES BRANCH People with learning disabilities have been treated as second class citizens for many years, once being seen as possessed by evil spirits or being punished by God for a sin they may have committed. In the 19th century they were removed from their families and lived in purpose built institutions, treated as sick and in need of treatment (Brown Benson 1995). During the 1970s care moved to the community (Brigden Todd 1993) where it largely remains today. Approximately 1.5 million people have a learning disability, the majority of which live at home with their families or in community care settings (Mencap 2009). Relatively few live by themselves or with a partner (Emerson, Davies, Spencer, Malam 2005). Turnbull and Chapman (2010) describe a learning disability as being a lifelong condition, which may be genetic or environmental and vary in degree of impairment. Sowney (2006) suggests all learning disabilities have common features including impaired intelligence and social functioning which has a lasting effect on development. According to Mencap (2009) people with learning disabilities live an average of 50-55 years and sometimes up to 70 years old. A learning disability nurse can therefore expect to nurse a range of patients from birth to the elderly and will need to demonstrate a patient centred approach and work in partnership with the patient to help them meet their health, social, emotional, developmental and behavioral needs ( NHS 2009). Although a learning disability is not an indication of a physical disability or ill health, people with learning disabilities generally have more complicated problems and require more nursing interventions than the general population. In the young person some of the more common problems include respiratory problems, epilepsy, sensory and motor impairments, hypertension, thyroid disease and cancer and in elderly adults common problems include loss of hearing, vision and mobility, heart conditions, diabetes, fractures and osteoporosis (Davis 2008). Generic issues include communication difficulties, conditions relating to specific syndromes, challenging behavior and delayed development (University of Nottingham 2010). A learning disability nurse needs the skills to work within both simple and complex health areas. Communication is a vital skill for the learning disability nurse, hospitalisation for a patient with a learning disability can be very distressing and it is important to build therapeutic relationships based on trust and understanding. In the past access to healthcare services for patients with learning disabilities has sometimes unintentionally been denied. A learning disability nurse can help to overcome these prejudices by ensuring people with learning disabilities are not discriminated against and have the same opportunities as the rest of the population (Brittle 2004). People with learning disabilities are the most vulnerable and socially excluded in our society (DOH 2001). A learning disability nurse works in partnership with both the patient and family carers to provide healthcare, and should recognise each persons uniqueness, individuality and differing abilities. The learning disabilities nurses main aims will be to support the well-being and social inclusion of people with learning disabilities, their rights, choices and independence by improving or maintaining their physical and mental health so they can pursue a fulfilling life whatever their ability (DOH 2009). For example teaching someone the skills needed to find work can help them lead an independent life with equal opportunities (NHS 2009). Many complex issues working with patients with learning disabilities relate to ethical aspects of care, and may be related to an individuals rights and welfare, public welfare or inequality. For example a learning disability nurse may need to assess the capacity and ability of a person to consent to treatment (Hinchcliff, Norman Schober 2003). Every effort should be made to provide information in a format the patient can understand, which might be in the form of pictures, alternative communication methods, using short sentences, repeating explanations and giving them time to make a decision (Brittle 2004). Previous experience may mean a person with a learning disability has not been given the opportunity to make their own choice regarding their individual treatment and care (Turnbull et al 2010) and involving family, friends or an advocate, where possible may help them understand the care and treatment offered to enable them to make their own decision (DOH 2001). In some situations people with learning disabilities may have the capacity to consent to straightforward nursing activities but may lack capacity to consent to more complex procedures (DOH 2001). Other ethical issues may involve the family or carer, for example, a person with learning disabilities may receive some benefits which they may wish to have control over and decide how it is spent. The carer on the other hand may see it as part of the household income and wish to control of it. Or maybe the parents or carers, due to ill health are unable to continue with full time care of a person with learning disabilities in their own home. Nurses will require good negotiation skills to support individuals and carers through dilemmas such whilst working within ethical guidelines, with the person being supported remaining the central focus (Thomas Woods 2003). Other ethical issues might involve psychosocial and lifestyle issues such as overeating or drug abuse which might raise concerns about control and freedom of choice (Davis 2008). Opportunities for learning disabilities nurses exist in both hospital environments and the community. They will specialise in many areas which might include education, sensory disability or the management of services (NHS 2009). They will work within the multi-disciplinary team of their preferred environment, for example a learning difficulty liaison nurse will work with other staff, patients and carers to develop therapeutic relationships and ensure people with learning disabilities have a positive healthcare experience (Brittle 2004). To conclude people with learning disabilities have very similar health issues to that of the general population. However it is important that the learning disabilities nurse exercises a person centered approach, develops a therapeutic relationship and understands a person with learning disabilities personal needs in order to support their wellbeing and promote social inclusion, rights, choices and independence to enable them to enjoy the same health care rights as everyone else. NURSING DISCIPLINE CHILDRENS BRANCH The Childrens branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood childrens individual needs but it wasnt until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard Trig 2000). Sick childrens rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving childrens services and recent statute law has given children increased rights (Hubbard et al 2000).The Childrens Act (1989 2004) highlights their rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents (Chambers Licence 2005). These policies give direction today and will shape the future of childrens nursing. Nurses need to understand how they apply and what implications there might be when caring for children. For example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and phys ical or mental child abuse is suspected, the nurse will have an ethical duty to work with other agencies and professionals such as the Child Protection Services (Hubbard et al 2000). Childrens nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers et al 2005). In order to provide care in a fair and anti-discriminatory way they need to understand the effect age and development has on a childs health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when assessing medication the weight and development of a child, will need to be taken into consideration as well as which drugs come in a form which can be easily administered. Appropriate care plans will need developing and updating for evaluation and referrals made as necessary for Doctors to review (Robertson South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may the refore take more than one attempt (Robertson et al). The DOH (2006) promotes optimal care for young people who have illnesses which previously wound have been fatal in childhood but are now surviving. Childrens nurses work in both hospital and primary care settings such as schools, GPs surgeries and in the community. Childrens nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al). Childrens nursing is very much centred on the family (NMC 2008). Nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family (Hinchliff, Schober Norman 2003) and support both children and their families to make informed decisions regarding treatment and care options (Chambers et al 2005). Hubbard and Trig (2000) declare the family is central to a childs wellbeing, and whilst respecting and promoting the rights of a child, should also be sensitive to the needs and views of the parents wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a childs welfare. A nursing model often used to assist the nursing process is the Casey Model of nursing which focuses on working in partnership with both children and their families (Smith 1995). Lansdown, Waterston and Baum (1996) suggest childrens nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig (2000) agree and suggest that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the childs age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange. Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (2005) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the childs wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al 2005). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Childrens 1989 Act, childrens nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 2005). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless the y lack capacity, for example in emergency situations (Dimond 2005). Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958) (Hubbard et al 2000). Increasingly children are being cared at home by their parents supported by the community childrens nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al). NURSING DISCIPLINE ADULT BRANCH Prior to the influences of Florence Nightingale, hospitals were often unclean and contaminated by infection and nurses were seen as the ones to do the Doctors dirty work. Nursing schools were set up in the 1880s, although it wasnt until the 1950s that the nursing profession was governed by the regulation body, UKCC. Today nurses are accountable to the NMC (2008) and must work within the code of conduct, demonstrating that they are able to deliver, manage and develop an excellent standard of evidence based nursing care (Abel-Smith 1960)(NMC 2008). Adult nurses primarily nurse sick and injured adults back to health and have a prominent role in the provision of health care, whilst working closely with other professionals, patients and their families (NHS 2010). Traditionally nursing was task oriented and patient care focused on specific illnesses and conditions. Today nursing is much more patient centred. An adult nurse will provide holistic care to number of patients 18 years and above at any one time to meet their physical, psychological, social and spiritual needs, using the nursing process which will include assessing, planning, implementing and evaluating the care delivered (NMC 2008). Adult nurses care for adult patients with a wide range of acute and long term illnesses and are involved in many different health arenas such as health promotion and disease prevention or they may specialise in specific diseases or disorders, such as diabetes, respiratory problems or cancer care. Others may specialise in accident and emergency, practice nursing or care of the elderly (NHS 2010). Although purposely trained to nurse adults, adult nurses will almost certainly be required to care and treat other groups of patients such as children, people with learning difficulties and patients with mental health issues, for example if they present in an accident and emergency unit, or are admitted to a ward with diabetes issues (Hinchcliff, Norman Schober 2003). Adult nurses will work within a multi professional team to deliver care to patients, which will include other health professionals such as doctors, pharmacists, healthcare assistants, physiotherapists, occupational therapists and radiographers (NHS 2010). Adult nurses work in a range of settings which can be hospital based or in the community where more and more health care is being delivered such as GP surgeries, clinics, occupational health services, schools, nursing and residential homes and voluntary organisations such as hospices. The government is driving health care towards a primary health care led service within which nurses roles are expanding and developing (DOH 2010). Opportunities are also available in the armed forces, prisons, and leisure, eg cruise ships (NHS 2010). Adult nurses all cover the same programme even though their work destinations differ considerably and it has been suggested that it is time to consider a new branch of nursing that equips people to work in primary care (Smith M 2003). Adult nurses will need to demonstrate many skills such as problem solving, flexibility, caring, counselling, managing, teaching and interpersonal skills to maintain and improve the quality of patients lives, sometimes in difficult situations (NHS 2010). They may find themselves caring for patients who are the same age as their family, friends or themselves and it is important not to get too personally involved with patients or they may find themselves in discussions regarding ethical issues such as euthanasia where clearly legally it is unlawful but the patient may feel it is in their best interest (Hinchcliff et al 2003). To assist the nursing process, nursing models are used such as the Roper, Logan and Tierneys (2000) 12 activities of daily living, often used in acute settings and the Orems model (1985) which promotes self care, particularly useful in rehabilitation setting. An adult nurse must comply with legislation and obtain consent before any treatment can be given, this may be verbal for routine nursing procedures, or written for more complex ones. Nurses must allow the patient to have autonomy when making decisions regarding care and treatment, respect that decision and always act in the patients best interest (Dimond 2005). The governments agenda and The Human Rights Act (1998) have had significant impact on how adult nursing has evolved to meet peoples needs in an ever changing environment. New jobs are being created to extend the nurses role and get them involved in advanced procedures such as the modern matron, consultant nurses, nurse practitioners and chief nursing officers. The DOH strategy for nursing recommends consultant posts, for example care of older people and pain management taking nursing to another level (cited by Sines, Appleby Frost 2005). According to the NMC (2007) nurses now carry out roles previously carried out by Doctors, for example theatre nurses now perform surgery and community care nurses co-ordinate packages. Changes in the way care is delivered has taken place in accordance with the government directive which laid down a plan to make primary health care accessible to people in the community, at work and at and home (Hinchcliff et al 2003). New opportunities are being created to meet the needs of older people. Older people are living longer and are the largest group of people using health services (Hinchcliff et al 2003). Common health issues for elderly patients are strokes, falls and mental health problems. The NHS Plan (2000a)(cited by Sines et al 2005) promotes independence and encourages them to have support in their home environment rather than residential homes. The government also recognises the need to increase and improve services for young adolescence patients to address their individual needs. For example as child moves into adulthood they may take risks, take part in anti-social behaviour, or they might be vulnerable and frightened (Hinchcliff et al 2003). Nurses have a role to play providing care, treatment and information to help them stay safe and healthy. To conclude adult nurses work with a wide range of patients with many different health issues across numerous health arenas. Nursing has developed considerably since it was first regulated and as patient care is a key government priority todays adult nurses need to have the necessary skills to deliver appropriate care and treatment in an ever changing environment whi Reflective Account The Role of a Rehabilitation Nurse Introduction This reflective account will discuss the role of a rehabilitation nurse in a community hospital. I am going to use the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my knowledge of nursing practice and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the NMC Code (2008) and maintain confidentiality all names have been changed. Description On my second week of my placement, I met my associate mentor for the first time. She asked if she could look at my placement documentation and personal development plan. We then discussed the skills and knowledge I want to achieve during the placement which is on a community rehabilitation ward. After our discussion, my mentor suggested to that I spend some time reflecting on the role of a community hospital rehabilitation nurse. Thoughts and Feelings Although my associate mentor did not require a formal piece of reflection, I thought it would be good to document my reflection for my personal development. When she asked me if I would reflect on the roles of nurse in a community hospital, I had already been thinking how different is was from that of a nurse in an acute hospital during my first week so I welcomed the challenge, although I had some reservations about what I could say on a positive note about community nursing. From what I had seen during my first week I was skeptical about the skills of nursing in a community hospital as the pace seemed much slower with less opportunity to practice clinical skills than in my previous acute placement. I was feeling quite disappointed and whilst I appreciate personal health care is an important nursing skill, the majority of my first week I had been left to work with nursing assistants and not invited by my mentor to be watch or carry out any clinical skills, who as a sister spends les s time than staff nurses on hands on nursing and more time on office tasks. This really worried me as I dont want to just cruise through my nursing training, I want to take every opportunity to broaden my knowledge and skills in all aspects of nursing. However I was now feeling more positive as my first impression of my associate mentor was that she was extremely knowledgeable, committed and caring and I hoped I would find her inspirational as I got to know her. Evaluation Being left for a whole week working without any real mentorship was demorilising for me and having no support or guidance the first week resulted in me having a negative view of the rehabilitation ward and community nursing in general (Taylor 2008). However, meeting with my associate mentor for the first time was a good experience. She was interested in me and committed to developing my knowledge and skills and by the end of our conversation had a good understanding of what I wanted to achieve from the placement and was able to challenge my knowledge on the current placement. Taylor (2008) states an inspirational mentor is a necessity to assist student nurses with their learning and development needs and nurture them to become first-class nurses. Understanding the skills and knowledge required by a community hospital rehabilitation nurse will build on my current knowledge which has been in the acute sector and be good for my personal development and future nursing career. Analysis Rehabilitation is an important aspect of any nurses role, but more prevalent for nurses working with the elderly in community hospitals (Brooks 2010). It is the nurses role to promote independence and to empower patients to carry out the activities of daily living adopting new skills and knowledge where necessary. Many different models of nursing are used for rehabilitation purposes, two popular ones are the Roper, Logan and Tierneys (2000) 12 activities of daily living and the Orems (1985) model of self care. Sinclair and Dickinson 1998 define rehabilitation as: A process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users and their family carers. Many patients find themselves on a rehabilitation ward as a result of a traumatic incident or disease and rehabilitation nurses will work with the patient, family and other member of the multi disciplinary team to support and encourage patients to maximise their independence with physical functioning (White and Johnstone 2000). They are very often the coordinators of a patients care as they are the ones in contact with patients 24 hours a day. Nursing interventions will include supporting and reinforcing the care devised by other health care professionals such as occupational therapists and physiotherapists (Low 2003). They will need to have underpinning knowledge about adjusting to life changes and understanding of anatomy and physiology, health promotion and illness prevention (Chilvers 2002). To provide holistic care for the patient, nurses will be required to apply their knowledge and skills through the nursing process. The first stage of this process is assessment to identify a patients impairments and disability in order to develop care plans. Identifying emotional effects is as important as physical disabilities, as these are likely to have an effect on patients rehabilitation progress (Vohora and Ogi, 2008). These may include anxiety, grief, depression, frustration, and anger (Stroke Association, 2008). Many of the care plans aims will be to increase a patients independence so that they can resume responsib Nursing Discipline Overview and Reflective Account Nursing Discipline Overview and Reflective Account NURSING DISCIPLINE MENTAL HEALTH BRANCH From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950s. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were put away. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as muffling or being put in a swing chair. In the 1960s, inadequacy and cost resulted in mental health hospitals closing and care moving to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003), where most people with mental health problems are cared for today (NHS 2010). Legislation such as the 1959 and subsequent 1983 Mental Health Act, and the Care Community Act (1990) are relative to modern community mental health nursing. In 1999 the Government confirmed mental health was a top priority in the Health Service (Jackson Hill 2006). Since then guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson et al 2006) have been introduced to reform and improve services for people with mental health problems and their carers. The Department of Health have also investing significantly in inpatient mental health settings due to issues such as a not enough beds being available, the lack of privacy and dignity of patients and wards not supporting provision of self care (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been dev eloped, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009). Mental health nurses will work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to care for people in a fair and anti-discriminatory way and deliver care holistically, mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and personality and human behavior (Hannigan et al 2003). One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention (Mind 2010). Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they cant cope with, such as depression following the death of a partner (NHS 2009). Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan et al 2003). Care is person-centered and mental health nurses will work within a professional multi-disciplinary team which will include GPs, psychiatrists and social workers and other health care professionals. A mental health nurse will require good interpersonal and communication skills. They will to demonstrate sensitivity when caring for patients, for example there is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010). Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill a nurse will be required to have is to recognise building tension and diffuse it when necessary to maintain the patients and others safety (NHS 2010). Sometimes nurses may find themselves faced with awkward situations, and be required to apply ethical principles, such controversial issues which cannot be disclosed and where confidentiality needs to be maintained (NMC 2008). On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan et al 2003). Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them (Hannigan et al 2003) . In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision. Nurses need to support patients to take responsibility for their own well-being and make informed decisions by providing information which is accessible and understandable (Mind 2010). This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the clients best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983) (Hinchcliff et al 2003). To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential. NURSING DISCIPLINE LEARNING DISABILITIES BRANCH People with learning disabilities have been treated as second class citizens for many years, once being seen as possessed by evil spirits or being punished by God for a sin they may have committed. In the 19th century they were removed from their families and lived in purpose built institutions, treated as sick and in need of treatment (Brown Benson 1995). During the 1970s care moved to the community (Brigden Todd 1993) where it largely remains today. Approximately 1.5 million people have a learning disability, the majority of which live at home with their families or in community care settings (Mencap 2009). Relatively few live by themselves or with a partner (Emerson, Davies, Spencer, Malam 2005). Turnbull and Chapman (2010) describe a learning disability as being a lifelong condition, which may be genetic or environmental and vary in degree of impairment. Sowney (2006) suggests all learning disabilities have common features including impaired intelligence and social functioning which has a lasting effect on development. According to Mencap (2009) people with learning disabilities live an average of 50-55 years and sometimes up to 70 years old. A learning disability nurse can therefore expect to nurse a range of patients from birth to the elderly and will need to demonstrate a patient centred approach and work in partnership with the patient to help them meet their health, social, emotional, developmental and behavioral needs ( NHS 2009). Although a learning disability is not an indication of a physical disability or ill health, people with learning disabilities generally have more complicated problems and require more nursing interventions than the general population. In the young person some of the more common problems include respiratory problems, epilepsy, sensory and motor impairments, hypertension, thyroid disease and cancer and in elderly adults common problems include loss of hearing, vision and mobility, heart conditions, diabetes, fractures and osteoporosis (Davis 2008). Generic issues include communication difficulties, conditions relating to specific syndromes, challenging behavior and delayed development (University of Nottingham 2010). A learning disability nurse needs the skills to work within both simple and complex health areas. Communication is a vital skill for the learning disability nurse, hospitalisation for a patient with a learning disability can be very distressing and it is important to build therapeutic relationships based on trust and understanding. In the past access to healthcare services for patients with learning disabilities has sometimes unintentionally been denied. A learning disability nurse can help to overcome these prejudices by ensuring people with learning disabilities are not discriminated against and have the same opportunities as the rest of the population (Brittle 2004). People with learning disabilities are the most vulnerable and socially excluded in our society (DOH 2001). A learning disability nurse works in partnership with both the patient and family carers to provide healthcare, and should recognise each persons uniqueness, individuality and differing abilities. The learning disabilities nurses main aims will be to support the well-being and social inclusion of people with learning disabilities, their rights, choices and independence by improving or maintaining their physical and mental health so they can pursue a fulfilling life whatever their ability (DOH 2009). For example teaching someone the skills needed to find work can help them lead an independent life with equal opportunities (NHS 2009). Many complex issues working with patients with learning disabilities relate to ethical aspects of care, and may be related to an individuals rights and welfare, public welfare or inequality. For example a learning disability nurse may need to assess the capacity and ability of a person to consent to treatment (Hinchcliff, Norman Schober 2003). Every effort should be made to provide information in a format the patient can understand, which might be in the form of pictures, alternative communication methods, using short sentences, repeating explanations and giving them time to make a decision (Brittle 2004). Previous experience may mean a person with a learning disability has not been given the opportunity to make their own choice regarding their individual treatment and care (Turnbull et al 2010) and involving family, friends or an advocate, where possible may help them understand the care and treatment offered to enable them to make their own decision (DOH 2001). In some situations people with learning disabilities may have the capacity to consent to straightforward nursing activities but may lack capacity to consent to more complex procedures (DOH 2001). Other ethical issues may involve the family or carer, for example, a person with learning disabilities may receive some benefits which they may wish to have control over and decide how it is spent. The carer on the other hand may see it as part of the household income and wish to control of it. Or maybe the parents or carers, due to ill health are unable to continue with full time care of a person with learning disabilities in their own home. Nurses will require good negotiation skills to support individuals and carers through dilemmas such whilst working within ethical guidelines, with the person being supported remaining the central focus (Thomas Woods 2003). Other ethical issues might involve psychosocial and lifestyle issues such as overeating or drug abuse which might raise concerns about control and freedom of choice (Davis 2008). Opportunities for learning disabilities nurses exist in both hospital environments and the community. They will specialise in many areas which might include education, sensory disability or the management of services (NHS 2009). They will work within the multi-disciplinary team of their preferred environment, for example a learning difficulty liaison nurse will work with other staff, patients and carers to develop therapeutic relationships and ensure people with learning disabilities have a positive healthcare experience (Brittle 2004). To conclude people with learning disabilities have very similar health issues to that of the general population. However it is important that the learning disabilities nurse exercises a person centered approach, develops a therapeutic relationship and understands a person with learning disabilities personal needs in order to support their wellbeing and promote social inclusion, rights, choices and independence to enable them to enjoy the same health care rights as everyone else. NURSING DISCIPLINE CHILDRENS BRANCH The Childrens branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood childrens individual needs but it wasnt until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard Trig 2000). Sick childrens rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving childrens services and recent statute law has given children increased rights (Hubbard et al 2000).The Childrens Act (1989 2004) highlights their rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents (Chambers Licence 2005). These policies give direction today and will shape the future of childrens nursing. Nurses need to understand how they apply and what implications there might be when caring for children. For example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and phys ical or mental child abuse is suspected, the nurse will have an ethical duty to work with other agencies and professionals such as the Child Protection Services (Hubbard et al 2000). Childrens nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers et al 2005). In order to provide care in a fair and anti-discriminatory way they need to understand the effect age and development has on a childs health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when assessing medication the weight and development of a child, will need to be taken into consideration as well as which drugs come in a form which can be easily administered. Appropriate care plans will need developing and updating for evaluation and referrals made as necessary for Doctors to review (Robertson South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may the refore take more than one attempt (Robertson et al). The DOH (2006) promotes optimal care for young people who have illnesses which previously wound have been fatal in childhood but are now surviving. Childrens nurses work in both hospital and primary care settings such as schools, GPs surgeries and in the community. Childrens nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al). Childrens nursing is very much centred on the family (NMC 2008). Nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family (Hinchliff, Schober Norman 2003) and support both children and their families to make informed decisions regarding treatment and care options (Chambers et al 2005). Hubbard and Trig (2000) declare the family is central to a childs wellbeing, and whilst respecting and promoting the rights of a child, should also be sensitive to the needs and views of the parents wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a childs welfare. A nursing model often used to assist the nursing process is the Casey Model of nursing which focuses on working in partnership with both children and their families (Smith 1995). Lansdown, Waterston and Baum (1996) suggest childrens nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig (2000) agree and suggest that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the childs age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange. Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (2005) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the childs wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al 2005). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Childrens 1989 Act, childrens nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 2005). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless the y lack capacity, for example in emergency situations (Dimond 2005). Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958) (Hubbard et al 2000). Increasingly children are being cared at home by their parents supported by the community childrens nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al). NURSING DISCIPLINE ADULT BRANCH Prior to the influences of Florence Nightingale, hospitals were often unclean and contaminated by infection and nurses were seen as the ones to do the Doctors dirty work. Nursing schools were set up in the 1880s, although it wasnt until the 1950s that the nursing profession was governed by the regulation body, UKCC. Today nurses are accountable to the NMC (2008) and must work within the code of conduct, demonstrating that they are able to deliver, manage and develop an excellent standard of evidence based nursing care (Abel-Smith 1960)(NMC 2008). Adult nurses primarily nurse sick and injured adults back to health and have a prominent role in the provision of health care, whilst working closely with other professionals, patients and their families (NHS 2010). Traditionally nursing was task oriented and patient care focused on specific illnesses and conditions. Today nursing is much more patient centred. An adult nurse will provide holistic care to number of patients 18 years and above at any one time to meet their physical, psychological, social and spiritual needs, using the nursing process which will include assessing, planning, implementing and evaluating the care delivered (NMC 2008). Adult nurses care for adult patients with a wide range of acute and long term illnesses and are involved in many different health arenas such as health promotion and disease prevention or they may specialise in specific diseases or disorders, such as diabetes, respiratory problems or cancer care. Others may specialise in accident and emergency, practice nursing or care of the elderly (NHS 2010). Although purposely trained to nurse adults, adult nurses will almost certainly be required to care and treat other groups of patients such as children, people with learning difficulties and patients with mental health issues, for example if they present in an accident and emergency unit, or are admitted to a ward with diabetes issues (Hinchcliff, Norman Schober 2003). Adult nurses will work within a multi professional team to deliver care to patients, which will include other health professionals such as doctors, pharmacists, healthcare assistants, physiotherapists, occupational therapists and radiographers (NHS 2010). Adult nurses work in a range of settings which can be hospital based or in the community where more and more health care is being delivered such as GP surgeries, clinics, occupational health services, schools, nursing and residential homes and voluntary organisations such as hospices. The government is driving health care towards a primary health care led service within which nurses roles are expanding and developing (DOH 2010). Opportunities are also available in the armed forces, prisons, and leisure, eg cruise ships (NHS 2010). Adult nurses all cover the same programme even though their work destinations differ considerably and it has been suggested that it is time to consider a new branch of nursing that equips people to work in primary care (Smith M 2003). Adult nurses will need to demonstrate many skills such as problem solving, flexibility, caring, counselling, managing, teaching and interpersonal skills to maintain and improve the quality of patients lives, sometimes in difficult situations (NHS 2010). They may find themselves caring for patients who are the same age as their family, friends or themselves and it is important not to get too personally involved with patients or they may find themselves in discussions regarding ethical issues such as euthanasia where clearly legally it is unlawful but the patient may feel it is in their best interest (Hinchcliff et al 2003). To assist the nursing process, nursing models are used such as the Roper, Logan and Tierneys (2000) 12 activities of daily living, often used in acute settings and the Orems model (1985) which promotes self care, particularly useful in rehabilitation setting. An adult nurse must comply with legislation and obtain consent before any treatment can be given, this may be verbal for routine nursing procedures, or written for more complex ones. Nurses must allow the patient to have autonomy when making decisions regarding care and treatment, respect that decision and always act in the patients best interest (Dimond 2005). The governments agenda and The Human Rights Act (1998) have had significant impact on how adult nursing has evolved to meet peoples needs in an ever changing environment. New jobs are being created to extend the nurses role and get them involved in advanced procedures such as the modern matron, consultant nurses, nurse practitioners and chief nursing officers. The DOH strategy for nursing recommends consultant posts, for example care of older people and pain management taking nursing to another level (cited by Sines, Appleby Frost 2005). According to the NMC (2007) nurses now carry out roles previously carried out by Doctors, for example theatre nurses now perform surgery and community care nurses co-ordinate packages. Changes in the way care is delivered has taken place in accordance with the government directive which laid down a plan to make primary health care accessible to people in the community, at work and at and home (Hinchcliff et al 2003). New opportunities are being created to meet the needs of older people. Older people are living longer and are the largest group of people using health services (Hinchcliff et al 2003). Common health issues for elderly patients are strokes, falls and mental health problems. The NHS Plan (2000a)(cited by Sines et al 2005) promotes independence and encourages them to have support in their home environment rather than residential homes. The government also recognises the need to increase and improve services for young adolescence patients to address their individual needs. For example as child moves into adulthood they may take risks, take part in anti-social behaviour, or they might be vulnerable and frightened (Hinchcliff et al 2003). Nurses have a role to play providing care, treatment and information to help them stay safe and healthy. To conclude adult nurses work with a wide range of patients with many different health issues across numerous health arenas. Nursing has developed considerably since it was first regulated and as patient care is a key government priority todays adult nurses need to have the necessary skills to deliver appropriate care and treatment in an ever changing environment whi Reflective Account The Role of a Rehabilitation Nurse Introduction This reflective account will discuss the role of a rehabilitation nurse in a community hospital. I am going to use the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my knowledge of nursing practice and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the NMC Code (2008) and maintain confidentiality all names have been changed. Description On my second week of my placement, I met my associate mentor for the first time. She asked if she could look at my placement documentation and personal development plan. We then discussed the skills and knowledge I want to achieve during the placement which is on a community rehabilitation ward. After our discussion, my mentor suggested to that I spend some time reflecting on the role of a community hospital rehabilitation nurse. Thoughts and Feelings Although my associate mentor did not require a formal piece of reflection, I thought it would be good to document my reflection for my personal development. When she asked me if I would reflect on the roles of nurse in a community hospital, I had already been thinking how different is was from that of a nurse in an acute hospital during my first week so I welcomed the challenge, although I had some reservations about what I could say on a positive note about community nursing. From what I had seen during my first week I was skeptical about the skills of nursing in a community hospital as the pace seemed much slower with less opportunity to practice clinical skills than in my previous acute placement. I was feeling quite disappointed and whilst I appreciate personal health care is an important nursing skill, the majority of my first week I had been left to work with nursing assistants and not invited by my mentor to be watch or carry out any clinical skills, who as a sister spends les s time than staff nurses on hands on nursing and more time on office tasks. This really worried me as I dont want to just cruise through my nursing training, I want to take every opportunity to broaden my knowledge and skills in all aspects of nursing. However I was now feeling more positive as my first impression of my associate mentor was that she was extremely knowledgeable, committed and caring and I hoped I would find her inspirational as I got to know her. Evaluation Being left for a whole week working without any real mentorship was demorilising for me and having no support or guidance the first week resulted in me having a negative view of the rehabilitation ward and community nursing in general (Taylor 2008). However, meeting with my associate mentor for the first time was a good experience. She was interested in me and committed to developing my knowledge and skills and by the end of our conversation had a good understanding of what I wanted to achieve from the placement and was able to challenge my knowledge on the current placement. Taylor (2008) states an inspirational mentor is a necessity to assist student nurses with their learning and development needs and nurture them to become first-class nurses. Understanding the skills and knowledge required by a community hospital rehabilitation nurse will build on my current knowledge which has been in the acute sector and be good for my personal development and future nursing career. Analysis Rehabilitation is an important aspect of any nurses role, but more prevalent for nurses working with the elderly in community hospitals (Brooks 2010). It is the nurses role to promote independence and to empower patients to carry out the activities of daily living adopting new skills and knowledge where necessary. Many different models of nursing are used for rehabilitation purposes, two popular ones are the Roper, Logan and Tierneys (2000) 12 activities of daily living and the Orems (1985) model of self care. Sinclair and Dickinson 1998 define rehabilitation as: A process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users and their family carers. Many patients find themselves on a rehabilitation ward as a result of a traumatic incident or disease and rehabilitation nurses will work with the patient, family and other member of the multi disciplinary team to support and encourage patients to maximise their independence with physical functioning (White and Johnstone 2000). They are very often the coordinators of a patients care as they are the ones in contact with patients 24 hours a day. Nursing interventions will include supporting and reinforcing the care devised by other health care professionals such as occupational therapists and physiotherapists (Low 2003). They will need to have underpinning knowledge about adjusting to life changes and understanding of anatomy and physiology, health promotion and illness prevention (Chilvers 2002). To provide holistic care for the patient, nurses will be required to apply their knowledge and skills through the nursing process. The first stage of this process is assessment to identify a patients impairments and disability in order to develop care plans. Identifying emotional effects is as important as physical disabilities, as these are likely to have an effect on patients rehabilitation progress (Vohora and Ogi, 2008). These may include anxiety, grief, depression, frustration, and anger (Stroke Association, 2008). Many of the care plans aims will be to increase a patients independence so that they can resume responsib