Infection Control Essay free essay sample

This reflective essay is based upon my experience working alongside the Infection Prevention and Control Support Nurses at the general hospital. As part of my learning experience as a 2nd year student nurse is to accompany the infection control nurses when visiting the wards The role of the IPCSN involved teaching, educating and advising all disciplines across the Trust, monitoring outbreaks and daily surveillance. I will structure this essay using Gibbs Model of Reflection (Gibbs 1988). Reflective learning helps practitioners analyse their experiences and how they think and feel about them before deciding whether they would approach the situation in a different way next time. In order to maintain confidentiality at all times for the patient and of any staff members I will adhere to the NMC Code of Professional Conduct (NMC 2008). Therefore any names used in this essay are fictional. The Health Act states: ‘Effective prevention and control of Health Care Associated Infections (HCAIs) have to be embedded into everyday practice and applied consistently by everyone’ (Department of Health [DH], 2006). We will write a custom essay sample on Infection Control Essay or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Hospitals and other care providers are legally required to implement this code of practice within their organisations. Most common infections occur as a result of people taking various antibiotics and being in close contact with each other, such as hospitals and nursing homes (NHS 2010). Attention to good hand hygiene measures should be observed during outbreaks. It is very important that staff and patients wash their hands with soap and water Health Protection Agency (2010). Compliance with hand hygiene is only maintained by constantly reminding staff of it and monitoring their performance. The ayliffe technique is recommended for nursing staff especially after direct contact with patients who are ill (Ayliffe 2000) and the use of wearing protective clothing of disposable apron and gloves making sure they are changed and hands washed between patients. The infection prevention and control protocol’s include the use of protective clothing, environmental cleaning and decontamination and disposal guidelines for items that have been in contact with the patient. Risk assessment is also important (Coia et al 2006). The infection prevention and control team (IPCT) was informed by a medical ward that several patients had had episodes of diarrhoea and vomiting. Norovirus is a common form of viral gastroenteritis that occurs during winter month’s and is highly infectious (NHS 2010). The symptoms of norovirus include nausea, vomiting, diarrhoea and high fever (NHS 2010). This alerted the IPCT therefore there was a need to investigate and assess the situation fully and a ward visit was required. I went along to the affected ward to observe the assessment with my mentor Helen, where two patients there may have developed norovirus the symptoms they present with diarrhoea and vomiting which has escalated during the last six hours, the IPCSN asked the staff nurse if samples had been obtained for collection of the suspected patient’s faeces and vomit the nurse was not aware of the policy. Patients with norovirus are usually isolated in a single room as they are classed as contagious the incubation period is 24-48 hours. Patients need to remain isolated for 72 hours after symptoms have subsided. Hense, in this case there were no single rooms available therefore the suspected patient’s are nursed in the affected bay and a caution is put on that bay to any new admissions NHS (2010). Following the next episode of diarrhoea and/or vomiting samples are required to detect Norovirus and once collected they must immediately be sent to the virology laboratory for investigation. Helen gave the nurse a norovirus resource pack put together by the IPCT which contains an outbreak action plan and checklist to be implemented and for other staff to read which will advise staff of the isolation precaution and give guidance on managing the infection and the affected patients were given information leaflets about the illness. Staff were advised to encourage fluids especially with the patient’s suspected with nurovirus and commence them on a Bristol stool chart in order to monitor the diarrhoea a food chart and fluid balance chart to keep a record of the input and output. By documenting the information correctly enables nurses adhere to the NMC code for good record keeping (NMC 2009) who recommend that stating the date, time, signing and printing alongside is good practice. On reflection I have learned by being with the IPCT the importance of sending samples off when the first episode of diarrhoea and vomiting occurs leasing with team members. The IPCT emphasises prompt screening of suspecting patients for a norovirus as early detection of the signs can prevent an outbreak on the ward. I have become aware that the mode of transmission of norovirus means it is not always possible to avoid becoming infected (Nursing Times 2011). The trust provides mandatory training to inform nursing staff on the most recent infection control measures in practice. Hence, good hygiene and the isolation of infected individuals can limit the spread. Good communication is important with all visitors and staff, including cleaners. However, everybody who has contact with the patient or the environment is entitled to relevant information that will enable them to reduce the risks of transmission to themselves or others. I can now see that this situation could have been avoided if samples had been sent for screening earlier. However, the results of screening tests take some time becoming available on the database and failure in communication can prevent the results reaching the wards promptly. During my nurse training I have learned about the common hospital acquired infections (HCAI) meticillin-resistant staphylococcus aureaus (MRSA), clostridium ifficile  (c-diff) and norovirus, but now I know that there are many more micro-organisms that the IPCT have to record and monitor when arise at times the IPCT have to report the situation to the department of health. I have gained a lot of experience from this placement regarding Infection control and I now have a broad range of knowledge of which I will pass on to future colleagues and junior staff.

Abraham Maslow Essays

Abraham Maslow Essays Abraham Maslow Paper Abraham Maslow Paper Abraham Maslow- Maslows Hierarchy of Needs  Maslows theory mainly revolved around psychology and stated that,  As humans meet basic needs, they seek to satisfy  successively higher needs that occupy a set hierarchy.  This is Maslows hierarchy of needs:  Maslow believes that when the first stage is completely fulfilled only then will an employee be motivated enough to step up to the next level and complete it. For example only when an employee has basic needs such as food drink and sleep will they then be able to progress onto their safety needs such as security, limits and protection. In terms of Burger King Maslows theory wouldnt largely affect them. However for all people to work well certain needs need to be fulfilled such as sleep, food and drink. For Burger King Employees I believe that they only really need to concentrate on the first two stages as many employees do not stay long and are only there for the short term. Burger King does provide good hygiene conditions and security.  Belonging and Love needs arent really met as although they work in teams Burger King do not provide team building activities such as weekends or any social events. This theory mainly addresses the needs of employees.  Frederick Winslow Taylo  Taylors primary idea was that workers are mainly motivated by pay. Therefore his theory was that if you break down production into a set of small tasks and only pay for the amount of product each employee produces, this would motivate staff and increase productivity. At the beginning this seemed like a good idea as productivity increased and workers were only paid for how hard they worked. They began to build specialised skill for the specific area and businesses were more efficient as less staff were needed. However, employees soon became to dislike Taylors approach to motivation as they were given boring, repetitive tasks and were being treated no better than human machines. Certain aspects of this theory do apply to Burger King. Burger King pays their employees hourly, not piece rate, and has set areas in which people work- these can either be tills or kitchen staff. This provides competition between the two areas which can build motivation as to which area can work the best. However Burger King wouldnt realistically be able to pay employees on their productivity as each area has different tasks, some of which cant be measured, such as working on the tills. This theory addresses mainly the performance of employees.  Frederick Herzberg  Herzberg believed in a two-factor theory of motivation.  Job Enlargement- Workers would be given a greater range of tasks to perform (not essentially more challenging) which should make the work more interesting.  Job Enrichment- Involvement of workers being given a wider variety of more intricate, interesting and demanding tasks surrounding a complete unit of work. This should then give a greater sense of achievement. Herzberg used a survey to investigate what people liked and disliked about their jobs and with these results he put them into two categories; motivators and Hygiene Factors. His two factor theorem is shown below:  Working Conditions  For Burger King they need to ensure that all hygiene factors are covered so that workers feel safe and happy to be working in a clean environment. For example clean work surfaces and floors. Burger King does already achieve highly good hygiene factors however theyre not providing the best motivation. With this they dont have any achievement within their working days and simply work for pay. This lacks fun and could mean that employees would work better if they had something to look forward to. This theory addresses both the needs and performance of employees.  In this section I am going to explain how PEST affects the recruitment process in Burger King. From identification of a role to managing change inside the company PEST influences how Burger King plans and responds to these influences as it effects the entire recruitment cycle.  Pest analysis is concerned with the environmental influences on a business.

The Work and the Sadness - Freewrite Store

The Work and the Sadness - Freewrite Store This is a guest post by  Lancelot Schaubert. Schaubert is the author of the forthcoming novelFaceless, and lives in Brooklyn with his wife and attack spaniel.The City of Joplin, Missouri commissioned him to write and direct a photonovel that fictionalized and enchanted the history of their town. He has sold articles to Writer's Digest (one forthcoming and one in the 2016 Poet's Market), the World Series Edition of Poker Pro, McSweeney's, Bernie Sanders' campaign site, and others. His fiction or poetry has appeared or is forthcoming in The Misty Review, Carnival, Encounter (who has purchased a dozen or more) and many others. He loves soup. Send him soup. You can learn more about him athttp://lanceschaubert.org/ orlet him directly send you his best work. ________________________________ Do you believe in writer's block? I don't. But perhaps not for the reason you think. The fantasy writer Patrick Rothfuss has said ten thousand times that plumbers don't get plumbers block. I like that, especially since my plumber was also my sensei for shoto jitsu the man was brilliant at both and invested time heavily in both, both black belt of the year and your local handy man. Ed Daniels. Ed Daniels never got â€Å"blocked.† Rothfuss elaborated on this during one of his Worldbuilders Twitch streams last fall. He believes what some people attribute to writer's block is clinical depression. You could say further that plumbers don’t get plumbers block unless, as a human, they’re clinically depressed. Let’s break that down. Writer's block, in my estimation, comes down to one of two things: laziness or depression. We'll talk about depression first. Rothfuss was right to bring up the number of writers who have committed suicide, passively or actively, in history. A deep sadness runs parallel to the writing gene because we spend so much time in our headspace. Some believe that depression is an evolutionary trait that helps us reevaluate our situation: we go into a quiet place to reassess, to come to a better understanding of our current predicament, and then move forward stronger and more agile. The monks? They might have called it silence and solitude the prayerful posture of one who uses meditation to remain present in â€Å"this, my Father's world.† Wherever you sit on that spectrum, you can't deny that spending so much time imagining other worlds can leave you drained of your happy-happy joy-joy juices. And you get stuck. You're stuck not because you're a writer. You're stuck because you're a human. My buddy T. A. Giltner who teaches religion at St. Louis University says to all of his freshman on the first day of class, â€Å"Raise your hand if you want to be a good doctor. A good lawyer. A good scientist.† They raise their hands. â€Å"Keep your hands up if you think this class is pointless as a means to that end.† They lower their hands. â€Å"This class is not about religion. It's about becoming a decent human being. You want to be doctors and lawyers and scientists but you don't want to be good human beings? Good luck with that.† The phrase â€Å"good doctor† has the assumption of a â€Å"good human† built in. Writers too. Without a healthy, patient, joyful, kind humanity there ain't a one of us who's going to become a good writer. Let alone a great one. And that includes this awful disease that hit even me as a high school student and sometimes hits me even now: depression. To tackle this form of writer's block, you must do what all humans do. You must become whole by seeking help. I have a counselor who has helped me dig my way out of the hellhole that was my 2015 and my writing has improved. But again, that’s not specific to writers. As for laziness, I'm convinced that those who minimize their own depression by glorifying it with labels like â€Å"writer's block† make it easier for sluggards to scoot along. I know, I was one. I was a lazy teenager who had little reason to be lazy, considering the poverty of some of my early years. For one reason or another, perhaps because they follow the exact opposite trajectory of those professional football careers that blossom early and fade as fast, the careers of writers take a long time to marinate, cure, and hibernate. Coupled with wealth and privilege whether you're a trust fund kid or simply whiter than your neighbor writers have invented the most absurd methods of procrastination on the market all the way down to writing about not writing about not writing on social media. And then they hijack this term that has been used to minimize the clinical depression found in the pros or the greats and they say, â€Å"I have writers block.† Are you depressed? If that's the case, seek help and support, but it has nothing to do with being a writer.   If you're not depressed, then you're lazy. I am convinced that most writers need spend their time learning how to write at first. I'm convinced most writers must begin by learning how to work their asses off to survive and then thrive. That probably means some low-wage job or finding a way of generating passive income yourself rather than inheriting it or shoving it off to some future generation through debt. It might mean finding simple joy in trimming the verge or taking out the trash. If this is you, you don't have writer's block, sorry. You have an aversion to hard work. And only through learning how to work, how to enjoy your work, how to thrive even in an environment that's cursed and stacked against you, will you be able to write well. Stephen King has a high output precisely because he worked his ass off in a laundromat, as a teacher, and as a chimney sweep and then applied those skills to writing. Once you’ve learned to work, then apply that work to your study and practice. Then you read the "On Writings" and the "Elements of Style" of the world. Then you literally re-write your drafts over from scratch. Then you tap into the thing you've always wanted to do and bring it to bear upon the Earth. But let's not call it block anymore. If you're depressed, seek help. And if you're lazy, shut up and get to work. I should mention that I wrote the first draft of this on a Freewrite I'm testing it today because I've followed this team from the day they started taking contributions. I've been known to jack out of the matrix more than my peers and head to upstate New York or to Northwest Arkansas to duck into some hobbit hole and type away on my Smith Corona or scribble on whatever scraps I find. Perhaps the Freewrite will help me with that.   But the typing itself? Hell it took thirty minutes hunched over this metal coffee table in the lobby of their offices here in the Flatiron district. My back hurts, I have a headache, and I'll have to revise this before they post it. And yet somehow it wasn’t as bad this time around because for once I wasn’t focused on the machine, the sound, the internet, or the reloading of paper and ribbon. Me and the words, baby, me and the words. Was it worth it? The sky was grey when I began, but the sun's reflecting off of the windows of this high rise next door. And I've taken pleasure in my work. I am not worried about future awards. I have no delusions of grandeur in this moment. In my mind right now, there hides no phantom of any high school sweetheart or bully or hardass teacher I must now impress. There is only the work and the pleasure I take in it.   Lancelot took pleasure not in winning tournaments. Not in the wreath or the prize. It was the virtue he sought, virtue as an end in itself. He took pleasure in drawing back the bow and shooting the arrow, in dehorsing other knights, and in running the gauntlet faster and with fewer bruises than the time before. The discipline itself brings the joy.

Battle of San Jacinto Essay Example | Topics and Well Written Essays - 750 words

Battle of San Jacinto - Essay Example The researcher states that many American immigrants had migrated to Mexican Texas with full backing by the Mexican government near the beginning of the Mexican Independence. These immigrants started to rise up against the Mexican government in 1835 when the government of Santa Anna declared dictatorship rule over the country. Gradually, Texans formed a provisional government and started a movement for independence. This movement for independence was supported by many Americans, who volunteered to help the Texans in this movement. An army was formed by the help of these volunteers. In 1836 Santa Anna entered Texas with his army to take back its territory and put it back under the control of Mexico. Two battles were fought at Alamo and Goliad. Both of these battles were won by the Mexican army and a large number of Texan army was slaughtered brutally. After these two battles general Houston led his army against the army of Santa Anna near the river of San Jacinto in Texas. General Hous ton proved to be a very sharp and far sighted leader. The number of men in the Mexican army was already more than that of the Texan army and Houston did not want to give time to Santa Anna to call for more troops. Due to this reason he decided to execute a surprise attack against the Mexicans. This was a major risk on General Houston’s part because in this plan most of his army would be exposed to the Mexicans. On the other hand a critical mistake was made by the Mexican leader Santa Anna, in his confidence gained by the last two wins; he did not pay much attention to this battle and failed to post lookouts for any surprise attacks by the Texan army. This surprise attack by the Texan army was conducted in the evening of 21st April. The Texan army moved forward without getting caught by the Mexican army because their approach was hidden by trees and the uneven ground. Havoc reigns on the enemy as the Texian cavalry attack their stunned counterparts with slashing sabers (McDona ld, McCord & Haas 2008). This thing worked in the favour of the Texans because Santa Anna had not sent any men for lookouts. The bridge on the river was cut off by the Texans so that no retreats or reinforcements were possible. This was for both the armies because now the only way out of this was the ten feet deep water. The Texan infantry was led by General Houston himself. It was a well planned attack and the Mexican army was completely surrounded by the attackers. The Texan army had two artillery weapons called the twin sisters which were given to them by the city of Cincinnati. These weapons were placed in the battle and were of great help. It was a completely silent attack and the Texan forces did not reveal themselves until they were a few yards away from the Mexican army camps and then charged. They charged while shouting different slogans of â€Å"Remember Goliad† and â€Å"Remember Alamo†. The Texan army started firing at the surprised Mexicans. The Mexican ar my was not prepared for this kind of attack by its opponents and was completely taken by surprise. Most of the Mexican army was resting or asleep after building fortifications. Some of them were gone to gather woods while some of the others were fetching water at the time of the attack. The unarmed Mexicans had no choice but to ran and a complete chaos was created in the Mexican

Learning Needs Assessment Essay Example | Topics and Well Written Essays - 1250 words

Learning Needs Assessment - Essay Example For example, in areas involving complex surgical procedures, the volume of interventions and procedures is maintained at a high level in order to improve the outcome. In addition, it was observed that most of the activities are channeled towards the large units of the hospital in a bid to improve the quality of healthcare care. The following table shows the volume of activity and outcome. Number Percentage Surgical procedures 179 86.4% Cancer related procedures 84 40.3% Cardiovascular procedures 68 32.5% Orthopaedic procedures 19 8.7% others 11 4.9% In-patient 21 9.7% Traumatology 11 4.9% Cardiology 4 1.5% emergencies 3 1.0% Pneumology 3 0.5% Intensive care 2 0.5% Nephrology 2 0.5% Mixed (all types of care) 2 0.5% Obstetrics 6 2.4% Safe deliveries 2 0.5% High-risk births 1.0% neonatal intensive care 3 1.0% Outpatients 4 1.5% Total 206 100.0% d) Levels of nursing care staff employed Out of all the respondents that participated in the study, approximately 49% tendered their responses, excluding the wrong addresses. The total of the surveys that were completed was 65, which was 27% of the sample size. The survey revealed that the majority of the nurses worked in regular, full-time basis (60%) or regular and part-times basis (30%). The remaining 10% worked on casual contracts. Also, information was collected regarding the employment settings and status of respondents. Most of the nurses (70%) worked in a hospital setting. There was a good representation from other settings including nursing homes / Long Term Care (LTC) (16%), Home Care (14%), Community Health (8%) and other settings (14%). Most nurses worked in regular, full-time employment (67%) or regular, part-time employment (23%) compared to 10% who worked in casual positions. The level of education for the nursing staff that was interviewed was very diverse, of which 81 % of the staff held diplomas and 24 % held post diploma certification. Of these, 10% had oncology certification from different nursing associ ations, in addition to other oncology courses. Another 5% was found to have completed palliative care certificate courses (Bailey & Corner, 2009). More than 30% of the nurses were holding university degrees with specialization in different medical disciplines. Forty two percent were holders of bachelor degrees while 5% were holders of graduate degrees. Eighty one percent were working in the capacity of staff nursing role while another 7% worked in other roles such as nurse education, nurse consultation, nurse coordination, administration, family practice nursing, research coordination and executive directorship. When the level of nursing care was investigated, it was found that 69% cared for chronic patients, 70 % cared for palliative patients and 65% cared for acute patients. It was also found that a few of the nurses who were interviewed cared for emergency (21%), preventative (29%), and intensive care (16%). As shown in figure 2, these nurses were extensively experienced in cance r care. A good proportion (53%) of them had been employed in a cancer care environment for at least 11 years. Figure 2: The amount of cancer care experience A summary of the results of the educational needs assessment and analysis Identification of the highest priority educational need When the nurses were asked to rate their fields of experience in different fields classified into four types,

Free

Free philosophy Essay In philosophy, the â€Å"self† is used to refer to the ultimate locus of personal identity, the agent and the knower involved in each person’s actions and cognitions. The notion of the self has traditionally raised several philosophical questions. First, there are questions about the nature and very existence of the self. Is the self a material or immaterial thing? Is the self even a real thing or rather a merely nominal object? Second, is the self the object of a peculiar form of introspective knowledge, and if so, what does this tell about its ultimate nature? Third, what is the relation between the nature of the self and the linguistic phenomena of self-reference, such as the use of the first-person pronoun ‘I’? In this course, we will investigate these and related questions with a special focus on the issue of the unity of the self. In the first half of the course, particular attention will be devoted to recent works on the relation between the nature of the self, the unity of agency and the process of self-constitution by authors such as Korsgaard, Velleman, Dennett In the second half of the course, we will discuss some of the peculiar features of self-knowledge and consider whether the idea of self-constitution can shed light on them. The self does not really exist as something truly real because: it is not available to introspection (Hume); it is not a thing (Existentialists); it is a soluble fish in a sea of general meanings or representations (postmodernists); and/or it cannot be found in the brain or its activity (neurophilosophers). There are many other lines of attack but these examples are sufficient to illustrate what is wrong with these autocides: they are looking for the wrong kind of entity or in the wrong place or both.

Lee Harvey Oswald: Killer or Scapegoat? :: history

Lee Harvey Oswald: Killer or Scapegoat? On November 22, 1963 in Dallas, Texas, "the Crime of the Century" took place. President John F. Kennedy was shot in Dealey Plaza while touring through the city in his open-roof limousine. After the shots were fired, police began looking for suspects. One hour after the shooting, Lee Harvey Oswald was arrested for murdering a police officer. One hour after that he was charged with killing the President. Was Lee Harvey Oswald the real killer, or was he merely the scapegoat hired by some agency outside of the United States, to take the blame. There are a lot of known and unknown facts about this case. Many people believe that there were more people than Lee Harvey Oswald firing the shots even though the Warren Commission will deny any possibility that there was more than one assassin. The purpose of this paper is to state the facts about this case and let you decide for yourself whether or not Lee Harvey Oswald was quilty. Early in the morning, on November 22, 1963, Julia Ann Mercer was driving past the Texas School Book Depository on her way to work. Just past the Depository, about half-way from the railway overpass, she saw a green truck parked illegally on the side of the road. Because it was blocking traffic, she had to stop and wait for the other lane to clear before she could go. She noticed that there were two men in the truck. The back of the truck said "Air-conditioning. The passenger of the truck got out and pulled out of the toolbox, located on the back of the truck, what appeared to be a gun case. The many pulled the gun case out and started walking towards the grassy knoll just up the hill. As she drove on, she noticed three policemen standing a little ways down the road talking apparently not seeing the man with the gun case. Miss Mercer wrote out a full report on what she saw and gave it to the Warren Commission, however, none of it was spoken of or even mentioned in the Warren Commission's Report. There is the possibility that the gun case was empty, but the policemen should have taken more precaution considering that they know the President would be visiting the city that day. That same day, a Mr. Lee Bowers Jr., a railroad tower man for the Union Terminal Company, was on duty and had the best view of the area directly behind the fence on the grassy knoll. Lee Harvey Oswald: Killer or Scapegoat? :: history Lee Harvey Oswald: Killer or Scapegoat? On November 22, 1963 in Dallas, Texas, "the Crime of the Century" took place. President John F. Kennedy was shot in Dealey Plaza while touring through the city in his open-roof limousine. After the shots were fired, police began looking for suspects. One hour after the shooting, Lee Harvey Oswald was arrested for murdering a police officer. One hour after that he was charged with killing the President. Was Lee Harvey Oswald the real killer, or was he merely the scapegoat hired by some agency outside of the United States, to take the blame. There are a lot of known and unknown facts about this case. Many people believe that there were more people than Lee Harvey Oswald firing the shots even though the Warren Commission will deny any possibility that there was more than one assassin. The purpose of this paper is to state the facts about this case and let you decide for yourself whether or not Lee Harvey Oswald was quilty. Early in the morning, on November 22, 1963, Julia Ann Mercer was driving past the Texas School Book Depository on her way to work. Just past the Depository, about half-way from the railway overpass, she saw a green truck parked illegally on the side of the road. Because it was blocking traffic, she had to stop and wait for the other lane to clear before she could go. She noticed that there were two men in the truck. The back of the truck said "Air-conditioning. The passenger of the truck got out and pulled out of the toolbox, located on the back of the truck, what appeared to be a gun case. The many pulled the gun case out and started walking towards the grassy knoll just up the hill. As she drove on, she noticed three policemen standing a little ways down the road talking apparently not seeing the man with the gun case. Miss Mercer wrote out a full report on what she saw and gave it to the Warren Commission, however, none of it was spoken of or even mentioned in the Warren Commission's Report. There is the possibility that the gun case was empty, but the policemen should have taken more precaution considering that they know the President would be visiting the city that day. That same day, a Mr. Lee Bowers Jr., a railroad tower man for the Union Terminal Company, was on duty and had the best view of the area directly behind the fence on the grassy knoll.

Developing Communication and Interpersonal Skills: Continuing Professional Development ?

Introduction The Nursing and Midwifery Council (NMC) has set out at least four domains of competencies for entry to the register in Adult Nursing. In this brief, I will focus on the second domain of communication and interpersonal skills. Communication plays a crucial role in addressing the needs of the patients. Adult nurses are expected to communicate effectively, listen with empathy and advocate for their patients (Department of Health, 2012a, 2012b). Specifically, the Department of Health (Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser, 2012) has introduced the 6 Cs of nursing, which encompasses compassion in nursing practice. Compassion in care is only possible when patients feel that their nurses understand their feelings and show empathy (Chambers and Ryder, 2009). Communication is essential in helping patients articulate their needs (Hall, 2005). Similarly, poor communication could result to misunderstanding, anxiety for the patients and poor quality of care (Chamb ers and Ryder, 2009). In this brief I will focus on the domain of communication and interpersonal skills since these form the foundation of my relationships with my patients. Developing my competency in this domain would help me identify both verbal and non-verbal messages of the patients and address their needs accordingly. Meanwhile, effective communication is needed when I communicate with my colleagues and other healthcare practitioners. A focus on my communication skills with my patients will be made in this reflective brief. Communicating effectively with my patients and other health and social care professionals would help improve the care received by my patients. Benner’s (1984) stages of clinical competence would be used to underpin my development from novice to competent. Gibb’s (1988) reflective model will be utilised to reflect on my experiences in the last three years from novice to competent. Professional Development from Novice to Competent Level Reflective practice (Gibbs, 1988) allows healthcare practitioners to improve current practice by learning from incidents and one’s own experiences. Pearson et al. (2009) explains that one’s own experiences are another form of evidence in healthcare. With the focus on patient-centred care, the NHS (Department of Health, 2012b) has encouraged evidence-based care when addressing the needs of the patients. I will use Gibbs (1988) model in reflecting on my communication experiences in years 1 to 3. This model starts with a description of an incident followed by analysis, evaluation, conclusion and action plan. An incident during my year 1 exemplifies how I developed my communication and interpersonal skills as a novice. I was assigned to the mental health ward and assisted an elderly patient with dementia who was admitted for pneumonia. During his first day in the hospital, my senior nurse performed a nutritional assessment and informed me that I should assist the patient during feeding time. This was consistent with the Patient Mealtime Initiative (PMI) (NHS, 2007) implemented in our ward. As a student nurse, I would be assist the patient to self-feed and make his environment comfortable and uncluttered. During mealtime, I talked to the patient and informed him that I would assist him in eating his food. He stared at the wall and did not respond. I gently asked him if he was ready to eat. When he turned to me, I informed him that he could now start eating. He only stared at his food and did not seem to understand my instructions. I placed the utensils near his hand so he could grab it and eat. When he did not respond, I asked him if he wanted me to help him eat. After a few minutes, he got his spoon and held it for a few minutes. I began to realise that he did not seem to understand my instructions so I started to place the spoon with food in his mouth and gently touched his chin to remind him to chew his food. My senior nurse passed by and informed that I have to put some pressure on the patient’s chin and make some chewing motions to help remind him that he needs to chew his food. It took me an hour to feed my patient. On reflection, communicating with older patients with dementia could be a challenge. Most of these patients suffer from cognitive impairments, which make it difficult for them to communicate their feelings and concerns (NICE, 2006). A significant number of older patients with dementia who are admitted in hospital wards are underweight (World Health Organization, 2014). Jensen et al. (2010) explain that many of these patients have forgotten how to eat and chew their food while others lack cognitive abilities in understanding instructions on feeding. Hence, the National Institute for Health and Clinical Excellence (NICE, 2006) guideline on nutrition for older patients highlights the importance of assisting the patients during feeding. For patients in the advanced stages of dementia, the main aim of nutrition is to maintain hydration and comfort feeding. Meanwhile, some patients could also suffer from swallowing problems, making it more difficult to ingest food (Lin et al., 2010). The hospital ward environment is also new to older patients with dementia and might trigger anxiety and fear (Lin et al., 2010). Since patients are in unfamiliar surroundings with unfamiliar people, they might express their fears and anxieties through aversive behaviours (NICE, 2006). It is shown that nurses react negatively to aversive behaviours of older patients with dementia (Jensen et al., 2010). On reflection, the incident taught me to be more patient and to understand both verbal and non-verbal messages. It took some time for me to realise that I have to feed the patient since he appeared confused. I was also unprepared on how to communicate with an older patient with dementia. As a novice nurse, my feelings and apprehensions are normal and are also shared by other nurses (Cole, 2012; Murray, 2006). Best and Evans (2013) have shown that nurses feel unprepared to communicate and care for older patients with dementia. On reflection, I should continue with my professional develop ment by joining training and seminar on how to communicate with older patients with dementia and address their nutritional needs. When faced with a similar situation in the future, I am better prepared and would not need more supervision from senior nurses on how to communicate with older patients with dementia and address their needs. For instance, I am now aware that these patients have difficulty verbalising their needs and I have to be sensitive of non-verbal cues and interpret aversive behaviour as possible signs of distress, anxiety or fear (Best and Evans, 2013). The second incident occurred during year 2 in my placement in the Urology Department. At this stage, I already considered myself as an advanced beginner (Benner, 1984). I was assigned to care for a 45-year old male patient who was admitted due to testicular pain. I introduced myself to the patient and informed him that I was part of a team that would be caring for him during his hospital admission. I noticed that he was uncomfortable communicating with a student nurse and asked for a more senior nurse. I gently informed him that my senior nurse was supervising other student nurses and he was left to my care. I tried to communicate and noticed that he had difficulty with the English language. I asked him if he needed a language interpreter. Once an interpreter was identified and assisted me with communicating with my patient, I noticed a change in his behaviour. He began to open up and was willing to take his prescribed medications. I slowly understood that he was anxious about his co ndition and wanted a male nurse with the same ethnic background to be his nurse. When he realised that most of the nursing staff are composed of female nurses, he began to accept me as his nurse. On reflection, this incident illustrates the importance of taking into account individual differences and using communication strategies to understand the patient’s needs. Specifically, I became aware that he had difficulty with the English language. The act of getting an interpreter greatly improved our communication. One of the competencies stated under communication states that nurses should be able to use different communication strategies in order to identify and address the patient’s needs (Nursing and Midwifery Council, 2010; National Patient Safety Association, 2009). It was apparent that the patient was self-conscious that a female nurse was addressing his needs. It is shown that a patient’s perception about his condition is also influenced by their cultural beliefs and ethnicity (Department of Health, 2012b). He was uncomfortable that a female nurse was providing care when he was suffering from testicular pain. However, the patient shares similar ethnic background as the interpreter and only became comfortable when the interpreter assured him that he could trust me. I realised that patients with different cultural background could be anxious about their treatment and might have difficulty communicating. On evaluation, I felt that I was able to address the immediate language barrier gap by getting an interpreter to help me communicate with the patient. My experiences during my first year in placement with patients who have different ethnic backgrounds and have difficulty expressing themselves in English helped me prepare for this situation. As Benner (1984) stated, nurses develop competency through experiences. I felt that I have improved on my communication skills and have achieved the advanced beginner level during year 2. Being sensitive to the communication needs of my patient is also consistent with the 6 Cs of nursing (Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser). In this policy paper, nurses are encouraged to show compassion in caring through effective communication. On analysis, I could have improved my communication skills by learning how to communicate with patients with different cultural beliefs about human sexuality. The patient was shy that a female nurse is part of the healthcare team managing his testicular pain. As part of my professional development and action plan, I will participate in training and seminars on how to communicate about health issues, such as testicular pain, that are considered sensitive and may carry some cultural taboo. The third incident happened during year 3, in my placement in the surgical ward for orthopaedic patients. At this stage, my previous experiences in communicating with patients during year 1 and 2 have helped me develop important communication skills. These included recognising non-verbal messages, understanding how culture influences my patients’ perceptions of nurses and the care they receive. Culture plays a crucial role in how patients place meanings on the words and symbols I use when communicating (Funnell et al., 2009). Apart from culture, I realised that the patient’s own perceptions of the illness and pain they are experiencing could also influence the quality of our communication. In the incident, I was assigned to assess the level of post-operative pain of a patient after surgical operation. He was a 32-year old male and was unable to communicate even after four hours of surgery. I tried to communicate with him to help assess his level of pain. Since he could not verbalise his level of pain, I used the visual analogue scale (VAS) to identify the level of pain. On analysis, I felt that I have done the right thing and have fulfilled one of the competencies under the domain of communication. Specifically, the NMC (2010) states that nurses should be able to use different communication strategies to support patient-centred care. The use of the VAS helped the patient articulate his level of pain. The VAS is often used as a tool in healthcare practice when assessing the patient’s level of pain. This tool is reliable and has been validated in different settings (Fadaizadeh et al., 2009). On analysis, my personal experiences in the last three years helped me be come acquainted with current guidelines on pain assessment. It also helped me identify a simple but valid and reliable tool in assessing patient’s level of pain. Pain perception in post-operative patients is highly subjective and could be influenced by several factors (Gagliese and Katz, 2003). These include age, gender, prior pain experience, medications and culture (Lavernia et al., 2011; Grinstein-Cohen et al., 2009; Gagliese and Katz, 2003). Regardless of the factors that influence pain, nurses should be able to assess the patient’s pain accurately and communicate with the patient strategies on how to control pain (Clancy et al., 2005). Hence, communication is crucial in ensuring quality post-operative care. On reflection, I was aware that the patient has difficulty communicating. Hence, choosing a more complex tool in assessing pain could add to more distress and anxiety for the patient (Gagliese and Katz, 2003). I realised that choosing a simple assessment tool helped calm down the patient since I was able to deliver care appropriately. On reflection, I would follow similar procedures in the future. However, I would improve my knowledge on pain assessment by participating in pain education nursing classes in university or in the hospital where I am assigned. This would form part of my continuing professional development and action plan. Abdalrahim et al. (2011) argue that nurses with high knowledge on patient education are more likely to accurately assess patient pain, leading to earlier relief and management of the patient’s pain. However, Francis and Fitzpatrick (2013) express that despite high levels of knowledge on pain management, there are some nurses who have difficulty translating this knowledge into actual practice. One of my roles as a nurse in an orthopaedic surgical ward is to manage post-operative pain of my patients. Failing to manage pain could lead to chronic pain, longer hospital stays and poorer health outcomes (Grinstein-Cohen et al., 2009). I also realised that effective communication with patients is needed to ensure that the patient’s needs are addressed. Conclusion In conclusion, the three incidents portrayed in this reflective brief demonstrate how I evolved as a nurse practitioner from novice to competent. Specifically, my communication skills have developed from year 1 until Year 3. In the first incident, I had difficulty communicating with older patients with dementia. Beginner nurse practitioners have no experience in the situations they find themselves in. This was true in my experience with the older patient with dementia. It was my first time at communicating with a patient with cognitive impairment and feeding him. I lacked confidence in carrying out the task and only improved after several meetings with the client. However, in year 2, my communication skills improved. For instance, I was able to immediately identify the needs of the patients by depending on verbal cues and non-verbal messages of the client. I was able to get an interpreter and communicate with him. However, I also realised that I still need to improve by participating in classes and training on how to communicate effectively with patients with different ethnic background. Finally, in year 3, I was now more competent in communicating with patients. Even when the patient in post-operative care could not communicate, I was aware that he was in pain. I was also able to use an appropriate assessment tool that is consistent with the guidelines in our hospital. I realised that I possess more confidence in communicating with the patient and identifying his needs. My previous experiences in communicating with different groups of patients helped me become competent in identifying the needs of the patients. Importantly, care was delivered promptly since I was able to appropriately assess the level of pain of the patient. All these three experiences show that I could hone my skills in communication. My communication experiences in nursing will help me become more competent and ready as a future nurse registrant. References Abdalrahim, M., Majali, S., Stomberg, M. & Bergbom, I. (2011) ‘The effect of postoperative pain management program on improving nurses’ knowledge and attitudes toward pain’, Nurse Education in Practice, 11(4), pp. 250-255. Benner, P. (1984) From Novice to Expert: Excellence and power in clinical nursing practice, Menlo Park: Addison-Wesley. Best, C. & Evans, L. (2013) ‘Identification and management of patients’ nutritional needs’, Nursing Older People, 25(3), pp. 303-6. Chambers, C. & Ryder, E. (2009) Compassion and caring in nursing, London: Radcliffe Publishing. Clancy, C., Farquhar, M. & Sharp, B. (2005) ‘Patient safety in nursing practice’, Journal of Nursing Care Quality, 20(3), pp. 193-197. Cole, D. (2012) ‘Optimising nutrition for older people with dementia’, Nursing Standard, 26(20), pp. 41-48. Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser (2012) Compassion in Practice, London: Department of Health. Department of Health (2012a) The Power of Information, London: Department of Health. Department of Health (2012b) Bringing clarity to quality in care and support, London: Department of Health. Fadaizadeh, L., Emami, H. & Samii, K. (2009) ‘Comparison of visual analogue scale and faces rating in measuring acute postoperative pain’, Archives of Iranian Medicine, 12(1), pp. 73-75. Francis, L. and Fitzpatrick, J. (2013) ‘Postoperative pain: Nurses’ knowledge and patients’ experiences’, Pain Management Nursing, 14(4), pp. 351-357. Funnell, R., Koutoukidis, G., and Lawrence, K. (2009) Tabbner’s nursing care: Theory and practice, 5th Edition, Chatswood, London: Elsevier. Gagliese, L. and Katz, J. (2003) ‘Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients’, Pain, 103(1-2), pp.11-20. Gibbs, G. (1988) Learning by doing: A guide to teaching and learning methods, Oxford: Further Educational Unit, Oxford Polytechnic. Grinstein-Cohen, O., Sarid, O., Attar, D., Pilpel, D. and Elhayany, E. (2009) ‘Improvements and Difficulties in Postoperative Pain Management’, Orthopaedic Nursing, 28(5), pp. 232-239. Hall, L. (2005) Quality work environments for nurse and patient safety, London: Jones & Bartlett Learning. Jensen, G., Mirtallo, J., Compher, C., Dhaliwal, R., Forbes, A., Grijalba, R., Hardy, G., Kondrup, J., Labadarios, D., Nyulasi, I., Castillo Pineda, J. & Waitzberg, D. (2010) ‘Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee’, Journal of Parenteral and Enteral Nutrition, 34(2), pp. 156-159. Lavernia, C., Alcerro, J., Contreras, J. & Rossi, M. (2011) ‘Ethnic and racial factors influencing well-being, perceived pain, and physical function after primary total joint arthroplasty’, Clinical Orthopaedic and Related Research, 469(7), pp. 1838-1845. Lin, L., Watson, R. & Wu, S. (2010) ‘What is associated with low food intake in older people with dementia?’, Journal of Clinical Nursing, 19(1-2), pp. 53-59. Murray, C. (2006) ‘Improving nutrition for older people’, Nursing Older People, Vol. 18, No. 6, pp. 18-22. National Institute for Health and Clinical Excellence (NICE) (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. London: NICE. National Patient Safety Association (2009) Being open: communicating patient safety incident with patients, their families and carers, London: NPSA. NHS (2007) Protected mealtimes review: Findings and recommendations report, London: NHS. Nursing and Midwifery Council (2010) Standards for pre-registration Nursing education, London: NMC. Pearson, A., Field, J., Jordan, Z. (2009) Evidence-Based Clinical Practice in Nursing and health Care. Assimilating Research, Experience and Expertise. Oxford. Blackwell Publishing. World Health Organization (2014) Nutrition for older persons [Online]. Available from: http://www.who.int/nutrition/topics/ageing/en/index1.html (Accessed: 1 February, 2014).

Review of Anxiety Scales for Children and Adults Essay

Abstract   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Psychology testing is very abstract form of testing.   It needs to be based on good research and solid evidence in order to be considered effective.   This review goes in depth to examine the use of this test and how valid it is at proving the existence and level of anxiety in children and adults.   There are many items and aspects of the test reviewed herein, including, the normative sample group, the construction of the test and the overall effectiveness of the test to come to a plausible conclusion and diagnosis.  Ã‚  Ã‚   This review should serve as a good guide in how to best use this test and what aspects may need to be revised in order to provide a more efficient and useful test. Test Name: Anxiety Scales for Children and Adults. Author: Battle, James Publication Date: 1993 Publisher Information: PRO-ED, Inc., 8700 Shoal Creek Blvd., Austin, TX 78758-6897 Prices as of 1994: $84 per complete kit including examiner’s manual, 50 Forms Q, 50 Forms M, scoring acetate, and administration audiocassette $31 per examiner’s manual $19 per 50 Forms Q or 50 Forms M $6 per scoring acetate $14 per administration audiocassette. Online Availability:   This test is only available in written form or a tape recorded form. The test, ‘Anxiety Scales for Children and Adults’, is intended to show if a person has anxiety and, if so, at what level they have anxiety.   It seeks to show the presence and level of anxiety through a series of questions that relate to symptoms of anxiety.   The test is only arranged based upon age with one group for grade nine and under and the second group being grade 10 and above.   There is a different test form for each group.  Ã‚   However, the test does not separate out by gender or using any other factors except the two age groups.   The test could be described as being both unidimensional and multidimensional.   This is based upon the fact that the only differential is the basic age group. â€Å"No factor analyses, internal consistency coefficients, or empirical-criterion keying (item scores for anxious versus non-anxious persons or treatment effects studies) are reported. No controls for faking are indicated. Although developmental differences between elementary (second through sixth grades) and junior high (seventh through ninth grades) students were reported, no other age changes are indicated. Particularly important would be an examination of high school students versus adults and age changes through each elementary grade. A face/content examination indicates the majority of items relate to generalized anxiety and physiological symptoms, with some attention to setting and stimulus triggers. up. â€Å" (Oehler-Stinnett,2007)   There are no distinguishing points made for gender, race or even specific age, as mentioned in this quote from the Oehler-Stinnett review of the test.   As far as theoretical and empirical foundations, this test is very limited.   The test development was not sufficiently reported to allow for any hypothesis to be made.   Additionally, the lack of sub-scales and any rationale support for the procedure is a great default for deciding if the test has any clinical application. There is also a problem with the actual use of information in the test.   The questions are not properly defined as to what, if anything, makes them an anxiety trigger and worthy of being used to determine if a person suffers from anxiety.   Ã‚  It is only stated that they are symptoms commonly reported by people with anxiety.   As this analysis of the test reports, this leads to questions about the validity of the test:   Ã¢â‚¬Å"The specific sources of the item pools from which the author selected the items are unknown. It is merely stated the items represent symptoms typically reported by individuals experiencing anxiety. The final items that appear on the scales apparently have never been subjected to item analysis, internal consistency analysis, and factor analysis, all of which are standard scale construction procedures.† (Merenda,2007) The test manual does not caution nor imply that such limitations exist and the catalog actually reports erroneous information as to the size of the sample group.   The test is intended to be used for the diagnosis, treatment and research of anxiety.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The test is in two different formats.   The children’s, Form Q, and the adult’s, Form M are both designed to reach the same outcome, however, they are designed to be easy to complete for the different age groups.   Form Q is a simple yes or no choice test and has 25 questions.   Form M is a rating system test where individuals will choose from one to five, with one being always and five being never, and is comprised of 40 questions. There are no subscales to this test.   The only scale for the test was constructed without analysis of item, internal consistency and factor.   Each test has its own scale.   The scales are both pretty basic with the only outcome being if the individual has anxiety and if so, the intensity of the anxiety.   There is no allowance for faking or the possibility of conditions of a similar nature, such as depression.   The total testing time is ten to fifteen minutes.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The administration procedure is straightforward in nature with instructions for Form Q to be answered with a yes or no answer and Form M is to be based upon the 5 point scale given.   The tests are in written, paper and pencil format with the questions to be read by the individual taking the test.   There is an allowance for oral administration and other modifications, if necessary to assist the administration of the test.   The test can be given individually or in a group setting.  Ã‚   The test administrator is expected to have knowledge and familiarity with psychometrics and understand the standards of good test evaluation and use.    The manual specifically points out that the administrator should have knowledge of the American Psychological Association’s published standards of good test development and use from 1954.   There is no reference to special circumstance or any special considerations that should be made in the test administration.   There is the recommendation that the test interpretation should be conducted under the supervision and assistance of a psychologist or other professionally trained individual. The type of scoring for Form Q is based upon the amount of yes or no answers.   Form M scoring is based upon the rating given to each question.   The raw scores are totaled and used to determine the level of anxiety based upon a classification table that goes from very low to very high.     There are tables to help convert the percentile ranks and T-scores. The actual instructions for interpretation of the raw score, classification, percentile rank and T-score is very limited.   In fact, the conversion tables for each type of score are not in complete agreement with each other.   This insinuates that only one type of score should be used to score the test, not a combination of the different scoring options.   There is also a question as the reliability of the scoring system used for this test. â€Å"†¦ for the scale to be acceptable as a measure of treatment effects, all coefficients should be in the .90s. As noted, no internal consistency coefficients (alpha) were reported; therefore consistency of the scales in measuring the construct of anxiety cannot be examined. Standard error of measurement was also not reported in the reliability, scoring, or interpretation sections.† (Oehler-Stinnett,2007) The tables and scoring instructions are included in the manual. The technical evaluation of this test reveals numerous flaws.   The manual does not give a full explanation of the normative sample.   The description is rather simplified and gives the overview that the normative groups and reliability/validity groups overlap.   The data was collected in 1987 or 1988 and consisted of 247 adults for Form M, ages 15 to 63, and for Form Q it was based on 365 children of elementary school age and 433 children of junior high school age.   Both groups were from the Midwest. The children group was equal in the ratio of males to females.   The adult group had about twice the number of females as males.   There is no information given as to the demographics of the groups in terms of minorities and no representation of SES levels, clinical populations or the exact ages of participants.   There was distinction given for gender.   The limited information makes it difficult to fully evaluate the sample groups effectiveness in standardizing this test. The reliability of the test is based upon two testing, the original test and then a 2 week retest.  Ã‚  Ã‚   The retest rate was at .84 for elementary age, .86 for junior high age and .96 for adults, which are all acceptable rates.   The short retest period, however, does not allow for sufficient confirmation of a hypothesis and does not meet standards that are acceptable for the measuring of treatment effectiveness.   Additionally, there is not enough consistency in the scales to allow for an accurate measurement of anxiety levels between the original test and retest. The validity of the test, Form Q, is given based upon comparison to the State-Trait Anxiety Inventory for Children and the Nervous Systems subtest of the California Test of Personality.  Ã‚   The scale, however, is compared to the North American Depression Inventory for Children and the Culture-Free Self-Esteem Inventory.   Form M is compared to the Taylor Anxiety Scale for Adults and the Nervous Symptoms subscale of the California Test of Personality.   Constructs were as high or higher in correlation.   However, this is not discussed in detail in the manual.   The validity coefficients according to gender showed similar patterns. The T-tests showed no major difference in the scores of Form Q, according to gender. For M showed a higher score for females than males, but there must be consideration for the fact that there were twice as many females as males taking this test.   When looking at the mean, the difference was not major.   The lack of validity evidence can not be overlooked.   There are no studies that indicate the scale can accurately prove the difference between someone who is experiencing anxiety and someone who is not.   Additionally, there is a lack of supporting evidence for the use of this test in diagnosis and treatment of anxiety. A practical evaluation of this test shows no major indications of a problem.   The use of two separate forms for different age groups allows for the test to be easy to use and understand for each group.   Additionally, the availability of oral administration ensures those with limited reading abilities will be able to take the test and understand it.   The actual image of the test is rather plain and simple. It is presented in a straight forward, non-confusing manner. Form Q is presented in a yes or no format and Form M gives a scale that allows a rating from one to five with one clearly labeled as always and five as never.   There is nothing that stands out about the appearance of the test.   It is acceptable in terms that it is easy to use and understand for the participant. The straightforward nature of the test makes it easy to comprehend.   Form Q is a choice of two answers, which is well suited for the intended age group.   Form M gives a scale that allows for a more descriptive analysis of answers.   The test is intended to be taken by the participant reading and answering on their own, but the availability of oral administration allows for the test to be easy to take for all levels of comprehension.   The administration directions are quite clear and leave no room for question as to how it is to be done.   The test is to be given in a ten to fifteen minute time period.   It is manually administered, taken and scored.   Scoring is based upon the scales given in the manual.   It is advised that scoring be done under the supervision of a professional trained in psychology. This test has many weaknesses.   It is not fully backed by research and is not completely validated.   It lacks major aspects of an acceptable test, including the fact that scoring results are often inconsistent.   The scoring scales are not consistent with each other and there are no sub-tests to give an in depth look into the results.   Additionally, the lack of a reliable normative sample group is very concerning to a professional who is in need of a test that is reliable and valid.   The major strengths of the test is the actual make up of the test.   It is easy to understand and easy to score. This test would be best used for a general idea of a person state of anxiety.   It should be used in combination with other diagnostic measures and not as a sole source of diagnosis.   In order to make this test more effective and useful to a professional, it should be updated with more normative sample group tests, a better scoring system and more definition as to the age levels for each test.   Additionally, it would be helpful to include more differentiating information based upon specific age and race.   If updated, it should also be closely examined to fit into standards for tests of this nature. Reference Merenda, Peter F. (2004). Review of the anxiety scales for children and adults. University of Rhode Island. Oehler-Stinnett, Judy. (2004). Review of the anxiety scales for children and adults. Oklahoma State University. Wood, Richard J. and Zalaquett, Carlos P.(ED). (1998). Evaluating Stress: A book of resources, Volume I. Scarecrow Press.

Wedding Blessings and Quotations for Newlyweds

Wedding Blessings and Quotations for Newlyweds Till death do us part. This section  of the wedding vows, or something like it, is the highlight of many wedding ceremonies. As you exchange rings with your beloved, you feel a sense of oneness, a union of souls. For the newlyweds, the journey has just begun. If you want to bless the young couple with a lifetime of happiness, here are some special wedding blessings. John Lennon: 1940-1980; English singer-songwriterwith the Beatles and solo Love is a promise, love is a souvenir, once given never forgotten, never let it disappear. Oscar Wilde: 1854-1900, Irish poet and playwright Keep love in your heart. A life without it is like a sunless garden when the flowers are dead. The consciousness of loving and being loved brings a warmth and richness to life that nothing else can bring. Antoine de Saint-Exupry: 1900-1944, French poet, journalist, and aviator Life has taught us that love does not consist in gazing at each other but in looking outward together in the same direction. Aristotle: 384 B.C.-322 B.C., Greek philosopher and scientist Love is composed of a single soul inhabiting two bodies. Oliver Wendell Holmes Sr.: 1809-1894, American physician, writer, and humorist Love is the master key that opens the gates of happiness. Helen Keller: 1880-1968,American author, political activist, and lecturer. The best and most beautiful things in this world cannot be seen or even heard, but must be felt with the heart. Leo Buscaglia: 1924-1998, Americanprofessor, author, andmotivational speaker The life and love we create is the life and love we live. Mignon McLaughlin: 1913-1983, American journalist and author Love is the silent saying and saying of a single name. Andre Maurois: 1885-1967, French author A successful marriage is an edifice that must be rebuilt every day. Amy Grant: 1960- present, American singer-songwriter The more you invest in a marriage, the more valuable it becomes.

List of US Presidents With Beards

List of US Presidents With Beards Five  U.S. presidents wore beards, but its been more than a century since anyone with facial hair served  in the White House. The last president to wear a full beard  in office was  Benjamin Harrison, who served from March 1889 to March 1893. Facial hair has all but disappeared from American politics. There are very few bearded politicians in Congress. Being clean-shaven wasnt always the norm, though. There are plenty of presidents with facial hair  in U.S. political history. Where did they all go? What happened to the beard? List of Presidents With Beards At least 11  presidents had facial hair, but only five had beards. 1. Abraham Lincoln was the first bearded president of the United States. But he might have entered office  clean-shaven  in March 1861 were it not from a letter from 11-year-old Grace Bedell of New York, who didnt like the way he looked on the  1860 campaign trail  without facial hair. Bedell wrote to Lincoln before the election: I have yet got four brothers and part of them will vote for you any way and if you let your whiskers grow I will try and get the rest of them to vote for you you would look a great deal better for your face is so thin. All the ladies like whiskers and they would tease their husbands to vote for you and then you would be President. Lincoln started growing a beard, and by the time he was elected and began his journey from Illinois to Washington in 1861 he had  grown the beard for which he is so remembered. One note, however: Lincolns beard was not actually a full beard. It was a chinstrap, meaning he shaved his upper lip. 2. Ulysses Grant was the second bearded president. Before he was elected, Grant was known to wear his beard in a manner that was described as both wild and shaggy during the Civil War. The style did not suit his wife, however, so he trimmed it back. Purists point out the Grant was the first  president  to wear a full beard compared to Lincolns chinstrap. In 1868, author James Sanks Brisbin described Grants facial hair this way: The whole of the lower part of the face is covered with a closely cropped reddish beard, and on the upper lip he wears a mustache, cut to match the beard. 3. Rutherford B. Hayes was the third bearded president. He reportedly wore the longest beard of the five bearded presidents, what some described as  Walt Whitman-ish. Hayes served as president from March 4, 1877 to March 4, 1881. 4. James Garfield was the fourth bearded president. His beard has been described as being similar to that of Rasputins, black with streaks of gray in it. 5. Benjamin Harrison was the fifth bearded president. He wore a beard the entire four years he was in the White House, from March 4, 1889, to March 4, 1893. He was the last president to wear a beard, one of the more notable elements of a relatively unremarkable tenure in office. Author OBrien Cormac wrote this of the president in his 2004 book  Secret Lives of the U.S. Presidents: What Your Teachers Never Told You About the Men of the White House: Harrison may not be the most memorable chief executive in American history, but he did, in fact, embody the end of an era: He was the last president to have a beard. Several other presidents wore facial hair but not beards. They are: John Quincy Adams, who wore mutton chops.Chester Arthur, who wore a mustache and mutton chops.Martin Van Buren, who wore mutton chops.Grover Cleveland, who wore a mustache.Theodore Roosevelt, who wore a mustache.William Taft, who wore a mustache. Why Modern Day Presidents Don't Wear Facial Hair The last  major-party candidate with a beard to even  run for president  was Republican Charles Evans Hughes in 1916. He lost. The beard, like every fad, fades and re-emerges in popularity. Lincoln, perhaps Americas most famous bearded politician, was the first president to wear a beard in office. But he began his candidacy clean-shaven and only grew his facial hair at the request of an 11-year-old schoolgirl, Grace Bedell. Times have changed, though. Very few people beg political candidates, presidents or members of Congress to grow facial hair since the 1800s. The New Statesman summed up the state of facial hair since then: Bearded men enjoyed all of the privileges of bearded women. Beards, Hippies, and Communists In 1930, three decades after the invention of the safety razor made shaving safe and easy, the author Edwin Valentine Mitchell wrote, In this regimented age the simple possession of a beard is enough to mark as curious any young man who has the courage to grow one. After the 1960s, when beards were popular among hippies, facial hair grew even more unpopular among politicians, many of whom wanted to distance themselves from the counterculture. There were very few bearded politicians in politics because candidates and elected officials did not want to be portrayed as either Communists or hippies, according to Slate.coms Justin Peters. For many years, wearing a full beard marked you as the sort of fellow who had Das Kapital stashed somewhere on his person, Peters wrote in 2012. In the 1960s, the more-or-less concurrent rise of Fidel Castro in Cuba and student radicals at home reinforced the stereotype of beard-wearers as America-hating no-goodniks. The stigma persists to this day: No candidate wants to risk alienating elderly voters with a gratuitous resemblance to Wavy Gravy. Author A.D. Perkins, writing in his 2001 book One Thousand Beards: a Cultural History of Facial Hair, notes that modern-day politicians are routinely instructed by their advisers and other handlers to remove all traces of facial hair before launching a campaign for fear of resembling Lenin and Stalin (or Marx for that matter).  Perkins concludes: The beard has been the kiss of death for Western politicians ...   Bearded Politicians in Modern Day The absence of bearded politicians has not gone unnoticed. In 2013 a group called the Bearded Entrepreneurs for the Advancement of a Responsible Democracy launched a political action committee whose aim is to support political candidates with both a full beard, and a savvy mind full of growth-oriented policy positions that will move our great nation towards a more lush and magnificent future. The BEARD PAC claimed that individuals with the dedication to grow and maintain a quality beard are the kinds of individuals that would show dedication to the job of public service. Said BEARD PAC founder Jonathan Sessions: With the resurgence of beards in popular culture and among today’s younger generation, we believe the time is now to bring facial hair back into politics. The BEARD PAC determines whether to offer financial support to a political campaign only after submitting the candidate to its review committee, which investigates the quality and longevity of their beards.

Two Questions of international banks Essay Example | Topics and Well Written Essays - 500 words

Two Questions of international banks - Essay Example When it is time to pay back the load, the Venezuelan company may not be able to repay in dollars because of exchange controls imposed by the government of Venezuela. Thus, the borrower could not fulfill the demand of contract because of transfer risk (Smith 112). The government policies do not allow the transfer of currency of the opponent country. The local currency is not allowed to be converted into forex so that it may be sent out of the host country. Likewise, forex can not be acquired from the outside. The tangible assets of banks are susceptible to confiscation by the local agencies. The contract between the investor and the government bodies is likely to experience a breach. Other risks are of significantly minute nature that include but are not limited to financial crisis in the host country, local people’s boycott of the bank on the grounds of religion, and delays in currency exchange and transfer because of external influences. Conclusion: International banks suffer a lot because of political risks. Political upsets are both a cause and effect of distorted international banking system. Growth of international banking and role of supply and demand conditions: Introduction: Value of a particular stock upsurges as its demand increases.