The Cold War and U.S. Diplomacy Essay Example for Free

The Cold War and U.S. Diplomacy Essay The Cold War was the dominant conflict of the Twentieth Century. More than any other event, it defined the roles that virtually all nations played for almost 50 years. It was a truly World- Wide War, a content between two rival superpowers between the U.S. and the Soviet Union which for many years held the entire planet hostage to the threat of nuclear annihilation. By the time it was over, its players had spent the staggering sum of $15 Trillion (Windle, 2011). Regan Doctrine was not a label coined by President Reagan or his administration. It was a term used later by his critics to define his foreign policy strategy for countries around the world. The Reagan Doctrine was a strategy to aid anti-communist, or more specifically, anti-Soviet insurgencies in the Third World during Reagan’s two terms as president form 1981-1989. The primary goal was to overthrow Maxist regimes and prevent Marxist regimes from becoming established. Handelman referred Maixism as â€Å"Another of communism’s appeals was its centralized, state control of the economy. A command economy, first established in the Soviet Union, has two central features. First, the state largely owns and manages the means of production. That includes factories, banks, major trade and commercial institutions, retail establishments, and, frequently, farms. While all communist nations have allowed some private economic activity, the private sector has been quite limited, aside from nations such as China and Vietnam, which largely abandoned Marxist economics in recent years.   Second, in a command economy, state planners, rather than market forces, shape basic decisions governing production (including the quantity and price of goods produced) (Handelman, 2011, p.278). Under the Reagan Doctrine, the U.S. provided overt and covert aid to anti-communist guerrillas and resistance movements in an effort to â€Å"roll back† Soviet backed communist government in Africa, Asia, and Latin America. The doctrine was designed to diminish Soviet influence in these regions as part of the administration’s overall Cold War strategy. Reagan wasted no time getting started in the implementation of his foreign policy. The Administration’s first comprehensive â€Å"U.S. National Security Strategy.† Which was a document approved by the President in May of 1982, stated the objective to â€Å"contain and reverse the expansion of Soviet control and military presence throughout the world, and to increase the costs of Soviet support and use of proxy,  terrorist and subversive forces.† (Presidential Studies, 2006) Reagan made staunch calls for public support in his efforts. In the State of the Union Address in 1985, for example, he stated that the U.S. must â€Å"not break faith with those who are risking their lives—on every continent, from Afghanistan to Nicaragua—to defy Soviet-supported aggression.† One year later he boldly remarked that â€Å"America will support with moral and material assistance your right not just to fight and die for freedom, but to fight and win freedom†¦in Afghanistan, in Angola, in Cambodia, and in Nicaragua.† (Political Science Quarterly, 2007) In most of these nations, the aggressive policies and actions of Reagan caused severe damage. In Nicaragua for example, the economy was decimated by U.S. sanctions and manipulation of its banking institutions. The Administration, supported by Congress, funded a war against the Sandinista National Liberation Front (Frente Sandinista de Liberacià ³nNacional, or FSLN). It was a war fought by various Nicaraguan rebel groups, labeled the Contras, which sought to overthrow the Sandinistas, who came to power after the revolution in 1979. â€Å"The development of Contra forces began in 1981 when Reagan authorized $19.5 million in funding for the Central Intelligence Agency (CIA) to construct a paramilitary force of 500 Nicaraguan exiles from deposed President Anastasio Somoza’s National Guard.† (International Security, 1990) Along with congressionally funded aid, members of the Reagan Administration attained additional funds through the illicit sales of arms to Iran. Funds from these sales were funneled to the Contras. When this illegal activity was revealed in the â€Å"Iran-Contra Affair† in November of 1986, it led to the indictment and conviction of many of Reagan’s staff. Reagan policy in Nicaragua was failure in many respects. The Contra war was ill-conceived and did not enjoy support of the people of Nicaragua. The rebel forces never legitimately threatened the Sandinista government and military. The U.S. failed to gain international support for the war or its political and economic actions. In fact, Reagan was largely condemned by the international community. Domestic support and popular opinion was low as well. Reagan’s policies pushed communist nations into aiding Nicaragua. The FSLN enjoyed majority support of the people, and were not looking for a change until the end of the decade when they could no longer survive with the Sandinistas under U.S. pressure. Did Reagan really need to be concerned with Nicaragua? Probably not. In  damaging Nicaragua’s economy, Reagan Doctrine policy caused ripple effects on the USSR and Cuba who were aiding Nicaragua during this time. When the Administration began to halt trade and relations with Nicaragua, the USSR and Cuba began their efforts to provide the country increased economic aid, military aid, and trade revenue. By the time Reag an left office, economic aid from the USSR never came close to covering Nicaragua’s losses from U.S. sanctions on the economy. Reagan’s behavior toward Nicaragua, particularly in the glaring disregard for international law and world opinion, threatened to backfire and endanger broader U.S. interests, especially with foreign allies On the other hand, Reagan was widely eulogized for having won the cold war. Reagan helped end the Cold War by exercising prudent diplomacy and skillful statesmanship rather than by crusading against communism and exploiting Soviet vulnerabilities. The signing of the I.N.F. (Intermediate-range Nuclear Forces) treaty in 1987 marked the beginning of the end of the Cold War. I.N.F. was the first treaty to eliminate a complete class of weapons. It was also the first treaty to include an in-depth verification program. The INF treaty was the first to actually reduce the level of nuclear arsenals, or collections of weapons, rather than simply freeze them at certain levels. Reagans willingness to negotiate arms control agreements and support Gorbachevs reform efforts within the Soviet Union was key to the eventual fall of communist governments, first across Eastern Europe in 1989, and soon after in the Soviet Union in 1991. The foundation for ending the Cold War had been laid (Historycentral.com, ). Nicaragua was one piece to Reagan’s global foreign policy strategy. Nicaragua was not the only victim to Reagan’s aggressive policies. Countries such as Afghanistan, Cambodia, and Angola were infiltrated by U.S.-sponsored military insurgencies and suffered from U.S. economic policies. Though it can be argued that Reagan’s intervention in the Third World was essential in bringing down the USSR two years later, many people suffered the consequences of Reagan Doctrine. Nicaragua is an important case study of how effective and ineffective Reagan’s policies were in the Third World. Reagan Doctrine was a policy that gave military and material aid to countries that showed resistance against the USSR and the tyrannies they sponsored. Countries like Afghanistan, Cambodia, Angola, and Nicaragua were helped b  the United States; the Vatican and AFL-CIO’s international wing were also enlisted in the Doctrine to keep the Polish trade union intact. In his 1985 State of the Union Address, Reagan said, â€Å"We must stand by all our democratic allies. And we must not break faith with those who are risking their lives†¦ to defy Soviet-supported aggression and secure rights which have been ours from birth.† Then, in 1983, Reagan led troops into Grenada and overthrew the Marxist government and held free elections. : In regards to communism, the Reagan Doctrine’s â€Å"rollback mentality† broke the rule of containment set up by the Truman Doctrine, and this dissent played a huge hand in bringing down the Soviet Union and ending the Cold War. Reagan knew that the Russian economy would eventually fracture if there was an ongoing â€Å"arms race† between the Soviets and the United States; this is why Reagan began to build up the American military. Reagan threatened the Soviet Union by saying â€Å"We won’t stand by and let you maintain weapon superiority over us. We can agree to reduce arms, or we can continue the arms race, which I think you know you can’t win. One of Reagan’s first enhancements was the implementation of the Strategic Defense Initiative, or SDI. The SDI was a new program that would research and eventually develop a missile defense system that offered the promise of, in President Reagan’s words, â€Å"making nuclear weapons obsolete† The Soviets were afraid of such technology because it would render their weapons useless and leave them vulnerable. In October of 1986, in response to the SDI program, Mikhail Gorbachev agreed to a mutual disarmament of weapons in Euro pe but only if the United States agreed not to deploy the missile defense system. Reagan literally stuck to his guns and refused to tell the American people that their government â€Å"would not protect them against nuclear destruction.† The Soviets were beginning to realize that they didn’t stand a chance in an arms race with America, so in December of 1987, Gorbachev came to Washington, D.C., to sign the Intermediate Range Nuclear Forces Treaty, which would eliminate an entire class of nuclear weapons. If Reagan had not continued the arms race, the Soviet Union may still be around today. Gorbachev’s trip to Washington was the first sign of Soviet surrender, and without Reagan’s military build-up, it would have never been possible. Ronald Reagan helped end the Cold War, such as the Reagan Doctrine, American military build-up, and his use of humor to shed a negative light on communism. The Reagan Doctrine was a strategy orchestrated and implemented by the United States to oppose the global influence of the Soviet Union during the final years of the Cold War. While the doctrine lasted less than a decade, it was a centerpiece of American foreign policy from the mid-1980s until the end of the Cold War in 1991. Under the Reagan Doctrine, the U.S. provided overt and covert aid to anti-communist resistance movements in an effort to roll back Soviet-backed communist governments in Africa, Asia and Latin America. The doctrine was designed to serve the dual purposes of diminishing Soviet influence in these regions of the world, while also potentially opening the door for democracy in nations that were largely being governed by Soviet-supported dictators. The most conspicuous examples of the new activism came in Latin America. In October 1962, the administration sent American soldiers and marines into the tiny Caribbean island of Grenada to oust an anti-American Marxist regime that showed signs of forging a relationship with Moscow. In El Salvador, whose government was fighting left-wing revolutionaries, the administration provided increased military and economic assistance. In neighboring Nicaragua, a pro-American dictatorship had fallen to the revolutionary â€Å"Sandinistas† in 1979; the new government had grown increasingly anti-American (and increasingly Marxist) throughout the early 1980s. the Reagan administration supported the so-called contras, an antigovernment guerilla movement fighting (without great success) to topple the Sandinista regime. References Chester Pach, â€Å"The Reagan Doctrine: Principle, Pragmatism, and Policy,† Presidential Studies Quarterly 36.1 (2006): 80. Handelman, H. (2011). the challenge of third world development. upper saddle rive nj: prentice hall. Historycentral.com. (n.d.). Retrieved from http://www.historycentral.com/Europe/ReaganandGorbMeet.html James M. Scott, â€Å"Interbranch Rivalry and the Reagan Doctrine in Nicaragua,† Political Science Quarterly 112, no. 2 (Summer 1997): 237. Kenneth Roberts, â€Å"Bullying and Bargaining: The United States, Nicaragua, and Conflict Resolution in Central America,† International Security 15, no. 2 (Autumn 1990): 78. Windle, J. (2011, December 20). Aol government. Retrieved from http://gov.aol.com/defense-spending-wizardry/

Personal Reflection On Infection Control In United Kingdom Nursing Essay

Personal Reflection On Infection Control In United Kingdom Nursing Essay It is highly believed within the health care industry that Healthcare Associated Infections (HCAI) are a grave worry and concern for the public of the United Kingdom (Nunkoo and Pickles 2008). When it is considered that Clostridium Difficile, commonly referred to as C-diff, is a HCAI it is made apparent that the public are greatly aware of this problem due to the fact that a high percentage of people are aware of this infection (Bosanquet 2009). The Healthcare Commission (2005) have also noted their concerns over this problem both the actual problem clinical areas have at the moment and also the potential problems that C-diff actually poses within hospitals a concern that the Department of Health (2009) also holds. These problems are also acknowledged by numerous additional sources who suggest that infection control in itself is required to be heightened in awareness and practice (Jenkinson et al 2006) making it a significant factor within primary care, a statement which is reiterated by the Nursing and Midwifery Council (2006). Due to the significance of this issue the author has chosen to reflect on an incident that she encountered whilst on placement within an acute hospital ward regarding this matter. The author has chosen to reflect on this particular incident she encountered using Johns reflection model (1990) with the intention of accessing, making sense of and learning through a specific experience (Johns 1994). The situation chosen for reflection has been classified by the author as being a critical incident. This claim is due to the fact that the experience resulted in thought provocation. Smith and Jack (2005) agree with this when they claim that a critical incident is an experience that results in individuals thinking about what has happened or indeed what is happening, resulting in the provoking of thought within an individual, just as happened in the authors experience. Description Whilst on placement within an acute hospital I encountered a situation that provoked thoughts and feelings within me alongside a desire to further research the subject. I was on a morning shift and was asked by another staff member to help them with a lady patient in a side room that was being barrier nursed due to her being positive for c-diff. Before entering the room to assist the staff member I washed my hands and put on my apron and gloves and then continued to help the staff nurse with the patient. When the task had been completed I proceeded to take the cardboard liner out of the commode and checked with the staff nurse that I was to leave my protective clothing on whilst leaving the room to go to the sluice and dispose of the patients waste and the cardboard liner. The staff nurse told me that hospital policy stated that I would be right in doing exactly that and therefore I proceeded to do so before removing my protective clothing and washing my hands. REFLECTION For this reflective assignment the author has chosen to use Johns (1990) model of reflection due to the belief that she holds that this will ensure that she is to delve through her rationale for actions and the feelings provoked. With regards to this particular incident the author intends to reflect-on-action so that the experience of the situation can be turned into knowledge therefore providing the oppurtunity of being able to learn from what occurred. Jasper (2003) suggests that this is credible due to the fact that reflecting-on-action as opposed to in-action changes the experience of the individual into knowledge. What is c-diff? what does it do? How often does it occur? In 2007 The Health Protection Agency (2007a) reported that there were over fifty thousand noted cases of c diff that presented within individuals over the age of 65. What is it now What does office of national statistics say HPA claim reduction Who does and who doesnt All hospitals are legally bound to ensure that legislation is followed by all staff something that is stated by numerous differing government led organisations including the Health and Safety Executive (2003) who reiterate the statement made by the Health and Safety at Work Act (1974) that states HOW MANY HOSPITAL TRUST DO THIS? STATISTICS The documents Winning Ways (DH 2003a) and the Matrons Charter (2004) outlined important areas in the control of infection and acted as a catalyst for local action. According to Shuttleworth (2007) local targets have been set to reduce C diff by twenty five per cent by introducing initiatives to improve knowledge, practical skills in infection prevention and control such as guidelines recently updated (Pratt et al 2007) and DHs and National Health Service (NHS) Modernisation Agencys Saving Lives: A Delivery Programme to Reduce Healthcare Associated Infection (2005). The government (DH 2007b) provided tools and resources to embed robust infection prevention endorsed by the HCC (DH 2007c) by publishing Essential steps to safe, clean care that mirrors Saving Lives but is specific to primary care. These are based on standard principles of infection control such as isolating patients and implementing barrier precautions that must be applied routinely to prevent HCAI transmission (Gould 200 9). Defining the role of the nurse is a difficult task however the role the nurse has within infection control measures is that they are responsible for ensuring that policies and procedures are always followed. It is agreed by Health Protection Agency (2007) AND The Royal College of Nursing (2008) that one of these roles of the nurse is to ensure that individual patients that are confirmed to have c-diff are placed in a side room where they have access to their own toileting fascilities. WHY IS THIS. As stated this is the nurses role however this is not always possible to fulfill due to the fact that side rooms are not always available and the actual layout of wards within hospitals often limit the possibilities of individual toilet fascilities HOW DO I KNOW THIS/. WHEN THIS IS NOT POSS WHAT ARE THE RISKS? HOW FAR CAN SPORES TRAVEL? WHO SAYS WHAT ABOUT THIS SITUATION Johnson and Gelding (2004) claim that even after thoroughly cleaning patient areas C-diff spores can still be found a claim that suggests that after a patient is moved out of a sideroom if they had c-diff confirmed whilst they were being nursed in the room even after cleaning the contamination risk is still apparent. WHAT DOES HCC SAY ABOUT THIS? AND ANYONE ELSE? EXPAND THIS. How does cdiff spread? Hands, environment? Air? Hall and Horsley (2007) suggest that c-diff spores can be spread to patients from the environment however it is individuals who visit the hospital not following the requested hand hygiene that is blamed by Banfield and Kerr (2005). WHICH IS IT OR IS IT BOTH WHO SAYS SOME PEOPLE CLAIM THAT THERE ARE NO SPORES IN THE ENVIRONMENT AT ALL BUT WHO HAND WASHING After washing hands they must be completely dried using a paper towel that is then disposed of (Johnson and Gerding 2004) however this is not agreed by Yamaoto et al (2005) who claim that drying washed hands using warm air may well be a more successful way of limiting bacteria that may be on the hands. WHAT DO NICE SAY AND RCN AND DOFH Arguably hand washing can be classified as being one of the important and utmost effective methods of reducing HCAI (Pittet et al 2000). The World Health Organization (2004) holds this to be at the forefront of its Global Patient Safety Challenge something that Gould et al (2007) supports. Hand washing is advised to be done at specific times within situations in a healthcare setting one of which is before and after contact with any patient (Department of Health 2008). The National Institute for Clinical Excellence (2003) support this statement along with numerous additional governing bodies. The Department of Health (2008) continue that when hands are washed they should be done so with soap and water. The rationale behind this method was recommended in 2001 by the Infection Control Nurses Association due to the fact that soap and water supporting the correct technique helps the skin oil layer to be removed which is the one that retains c diff spores. In addition to this it is suggest ed that the hands are dried once again by a specific and rigorous technique which uses a paper towel that is deemed to be disposable (Johnson and Gerding 2004). This claim is not supported by everybody, Yamaoto et al (2005) believe that drying hands with a paper towel is less effective than leaving them to dry by air, suggesting that this technique would minimize the amount of becteria present on the hands. Alcohol gels are nowadays commonly used therefore rendering soap and water as replaced in many situations and environments. Using alcohol gel prior to and post patient contact is a recommendation that NICE (2003) supported with the exception of when hands can be seen to be soiled to the naked eye. NICE (2003) recommend using an alcohol-based hand-rub before and after patient contact, unless hands are visibly soiled of which case then implement liquid soap and water and an effective hand-washing technique. EPIC 2 (DH2007e) support this claim though believe alcohol is not effective against C diff microorganisms and suggests the nurse must consider the need to remove transient and/or resident hand flora. Non-compliance of this suggestion EPIC 2 (DH 2007e) believe presents a direct clinical threat to patients. Wilson (2006), Pellowe et al (2007) believes hand hygiene technique and the principles of infection control are too complex for staff to comply or perhaps too complicated for healthcare professionals to in-cooperate into everyday routine (Yamaoto 2005 et al). Jenkins (2004) recognizes staff hand hygiene is poor and is part of the nurses role (Supported by DH Chief Medical Officer 2002). IS IT LOW STAFFING LEVELS OR WRONGLY PLACED EQUIPMENT OR INDIVIDUAL NURSES ATTITUDES THAT AFFECTS HAND WASHING IT IS PART OF THE NURSES ROLE Jenkins (2004) suggests that hand hygiene of health care staff is not at a high level despite it being part of the nurses role within the hospitalà ¢Ã¢â€š ¬Ã‚ ¦.WHO SAYS IT IS NURSE ROLE The following of stringent infection control policies and regulations often are not carried out which is something that can be due to numerous different factors. Different organisations and individuals put the blame for any lapses in infection control procedures down to different things including the belief that it is the mixture of skills and qualifications that are employed on a ward (Pellowe et al 2007). Additional factors believed to be responsible include the attitudes held by individual staff and the social norms of the actual ward environment (Pellowe et al 2007) however this is not the main influencing factor believed by all. Hugonnet et al (2007) suggest that they are in agreement with the idea of the ward environment playing an important part as they claim that the positioning of equipment for example sinks and cleaning products is something that can increase or decrease infection control guidelines being followed. This in itself is not something that is agreed by the HCC ( 2006) who state that the spread of infection within hospital settings is heightened due to shortage of staff on wards. However, the author believes that if shortage of staff was to blame then poor infection control would be evident on all wards that have this denominator which is not the case. DISPOSABLE GLOVES, APRON It seems that numerous organisations agree that to reduce the risk of cross contamination and infection itself protective clothing should be worn. The government themselves state that disposable aprons and gloves should be worn by all staff when caring for individuals whom are not only confirmed to be infected yet also when they are suspected to be (Department of Health 2007a). This is reiterated by the Royal College of Nursing (2008) who also suggest that this is important in reducing infection. There is some contradiction in beliefs regarding the use of plastic disposable aprons after hand washing with Hateley (2003) suggesting that this prevents any microorganism to clothing transmission, this is reiterated by numerous people including Wilson et al (2007) and HCC (2006). This is not agreed by Babb et al (1983) when they claimed that microorganisms are not completely prevented by the use of these specific aprons however a reduction was believed to occur. Gould (2009) take this one stage further in the suggestion that upon exposure to any excreta aprons should be worn before stringent disposal immediately after exposure, a statement that is supported by NICE (2003). Although there is agreeance between NICE (2003) and Gould (2009) there is no specific specification that denotes when gloves should be changed, be it before leaving the particular isolated environment or after. It is stated that wearing protective clothing of any sorts is not necessary upon the entry into an isolated environment (Gould 2009) however this same author claims that when in practice protective clothing should be worn at all times due to the chance of patients requesting assistance. This somewhat contradicts the first claim that protective clothing is not required when entering high risk areas yet is actually required in general practice upon the pretense that help could be asked for. It can be seen from this that the evidence and recommendations with regards to protective clothing are somewhat confusing at times. Derbyshire County Barrier Precautions Policy (2007) further add to this confusion when they stipulate that before leaving any infected area gloves should be removed suggesting that they should actually be worn in the first place. This policy then continues with a suggestion that any members of staff with any materials needing maceration should indeed change their gloves at just before the point of actually handling the door to the sluice, alongside this they claim that protective clothing should indeed be worn throughout the whole of the task until completion. If Gould (2009) is to be followed then no protective clothing would have been worn in the first place in the isolated area. This confusion only enhances with the addition of clinical waste disposal, something that by admittance by is found to be confusing to members of the healthcare team (Gould 2009). Following the recommendations of Gould (2009) any items for the macerator should be taken directly into the sluice whilst protective clothing is still being worn resulting in immediate disposal in the macerator. The protective gloves and apron is then said to be required to be discarded into correct refuse prior to washing hands. Gould (2009) continues to state that in an ideal world any patients that may be infected with c diff should have one of either their own individual en suite toileting facilities or their own individual commode. The later of these two statements has enhancement from the Department of Health (2008) who state specifically that this commode should not leave the patients room. So clearly from these authors and organisations it can be clearly seen that the evidence and suggestions are indeed confusing. The Royal College of Nursing (2008) claim that when wearing gloves a warm and moist environment is created which in turn leads to the possibility of microorganisms growing in vast numbers. Hateley (2003) reiterates this claim alongside Pratt et al (2007) who suggest that upon glove removal soap and water be used to wash hands as mentioned earlier in this text. When I was tasked with disposing of the infected waste I wanted to ensure that I did so using evidence based practice so as to minimize, if not completely eradicate, any risk of cross contamination whilst taking the waste from one area to another where the macerator was based. I was aware of the potential risk of contaminating the environment along the corridors of the ward and did not want to do this and put other patients and staff at risk therefore I needed to question my practice. The contents of the bed pan could have spilled on the floor or the paper towels which would have resulted in spores being released into the surrounding environment. I did consider using my elbow to open the door handle in the patients room and the one leading to the sluice yet came to the realization that this could have resulted in spillage onto either myself or the surrounding environment. O Callaghan (2005) stated that any challenge that nursing practice may receive could possibly add to any changes to policies and or practice regarding infection control procedures and barrier nursing. If Mohanna and Chambers (2001) is to be believed then risk management can be deemed to be an integral factor within clinical governance. Throughout this experience I did hold an awareness of the principles of barrier nursing. This led me to challenge this specific wards policies on the best practice for taking the bed pan from the patients room to the sluice. When I walked down the corridor with only paper towels covering the bed pan I was aware of the possibility that I may well have been spreading c diff spores. This could have had huge implications for all within the surrounding environment. Upon opening the door handles I was more than aware that my gloves had a high risk of being contaminated yet there was nothing I could do to eliminate this. My feelings at the time, are as they still are, ones of hypocrisy. I felt slightly shamed at the fact that I lacked the knowledge to stand and challenge the policy in a greater depth. INFLUENCING FACTORS. One of the first influencing factors of this situation was the recognition that the ward, its patients and staff were intitled to the very best of care. The NMC code of conduct (2008) state that all nursing staff have a duty of care. Within this very code it is stipulated that nursing staff hold a role that means they are expected to prevent patients from infection and protect them at all times. It also stipulates that nurses have a professional duty which includes providing evidence based practice and care that is up to date. The whole scenario was obviously one that would cause the patient to lose their dignity thereofr eI was more than aware of the need to dispose of the excreta immediately and safely. This dignity was what I was trying to protect when covering the bed pan with the paper towels, something that has been agreed as ethically right and correct practice by Timby (1996) alongside the Department of Health (2003b). Not only is this noted as being best practice within the circumstances yet also practice that would provide a reduction within the chance of spillage, therefore I was showing risk management skills. COULD I HAVE DEALT WITH THE SITUATION BETTER? In hindsight I feel that the confusion I encountered at the time of the incident could have been avoided had I had made myself aware of the wards policies on infection control and barrier nursing at the beginning of my placement. Other than this I think that I handled the situation well by questioning what I was being asked to do, however I wish I had held the knowledge that I have gained through this reflection prior to the experience. If I had then maybe I could have foreseen the situation arising and possibly found a solution to a potential problem instead of being confused by an actual problem. In addition to this one thing that I realize I did not do yet could well have done is to have used alcohol gel after washing my hands. This could have reduced the risk of cross contamination further (RCN 2008) which could have resulted in easing my concerns slightly. LEARNING. Numerous issues still remain with regards to infection control and infection prevention however this experience resulted in my awareness of the subject matter being raised. Prior to this experience I encountered I was unaware of factors that potentially predispose individuals to infection. Disease is not always caused by c diff when it is present in the bowel, it is only when bowel flora is changed from being deemed to be normal that disease occurs. This alteration of normal bowel flora can potentially be caused by specific antibiotics, a claim that has had wide spread support throughout the past twenty plus years (Lyerly et al 1988, McFarland et al 1989, Association of Medical Microbiologists 1998, DH 2007a ). Despite my actions being that of best practice within the specific trusts policy I appreciate that isolating any patient into an individual room of their own so as to decrease the risk of cross contamination. However it has to be considered that c diff spores are never truly eradicated completely from the environment. In compliance with evidence based practice guidelines (2009) I ensured that I washed my hands correctly prior to going into the patients room and also wore protective clothing. I placed two disposable paper towels over the bed pan liner due to my awareness that to get to the macerator I would have to walk down the corridor of the ward. I believe that covers for these cardboard liners should always be supplied and used. However upon searching for such a product I could not find any such thing. This is still not an idealistic solution as the risk of spillage would still remain therefore in an ideal world, as suggested earlier, all patients should have their own toileting facilities. So as to resolve the confusion of opening door handles with gloves that pose the risk of contamination it could be suggested that doors within ward environments be handle free. This would limit the contamination risk however the handle on the macerator would also need to be redesigned so as to enable that t oo to be touch free, from hands at least. This suggestion is something that the Department of Health (2008) could be argued to support due to the fact that they claimed to be researching touch free designs for specific equipment. Hand washing and protective clothing can be deemed to be a priority within the spread of c diff yet from the research and literature reviewed within this assignment it is clear that some confusion is apparent, probably steming from the noted contradictions. This experience of a critical incident enthused reflection as explored by the use of Carpers (1978) methods and ways of knowing, namely personal, ethical, aesthetic and empirical. The thorough acknowledgement of these patterns is claimed to expand not only the bredth of understanding yet also the expansion of personal thinking beyond specific approaches (Ashburner 1996). Upon placing paper towels over the bed pan the patients dignity and privacy was maintained, alongside professionalism being shown. Factors that are not only thoughtful yet also a part of the NMCs code (2008). Throughout the experience I was led by the theoretical knowledge that I had gained throughout the journey of my life. Moral decision making is said to be solely focused upon what should actually be done within a specific scenario or situation (Davis 1995). Prior to my reflection upon this practice I was not fully aware of the rational for my actions and the theory that underpinned it however I acted as I did through, as stated above, my knowledge and moral decision making. Using the reflection model of Johns (1990) guided me through an exploration of numerous and varied differing knowledge sources that led my individual actions. My whole level of understanding and awareness of infection control within healthcare settings has been raised which in turn will heighten my confidence within the subject matter for the future. This assignment has noted differing cultures within ward settings and policies that lead to contradictions and often confusion. Despite this numerous attributes that I personally hold have been credited and become aware to myself; including critical thinking and problem solving which has allowed me to explore a thought process that led to alternatives to current practice being explored. One of arguably the most important realizations I have gained from this reflection upon practice is that healthcare workers within any setting all play a part within infection control. It has been suggested that hand hygiene, namely hand washing, prior to dealing with any patient and again afterwards is at the heart of infection control (Storr et al 2005). Alongside this and the previously mentioned infection control procedures I believe that the policies and their appliance within day to day practice is indeed the key. Despite all my fore mentioned research into this subject I am left wondering and concerned that even if all staff members follow their specific policies, due to confusion within the literature a risk of cross contamination, resulting in the spread of c diff, will still be present.

Community for Justice A Communitarian Critique of Traditional Liberal T

Communitarians cannot accept liberal theory. It fails to pay mind to the essence of what makes human beings function as social creatures. And while it continues to stray from its beginnings it can no longer satisfy what is necessary for an acceptable political theory. Communitarians view this distance from the original theory their main objection to liberal theory. Instead an ideal communitarian theory would involve â€Å"a more contextual and community-sensitive approach† (209). The classical liberal theory is considered by many to be highly ahistorical, this point of view is held especially by those considered communitarians. The criticism extends further by explaining the theory as being ‘universalist’. Ignoring necessary communal living conditions in order to create a well-rounded theory that lends itself easily becomes counterproductive, as the theory loses its power when it is related to genuine nations or societies. Traditional liberalist theory’s roots originate from the French revolution, a movement whose goals included community, in partnership with liberty, justice, and equality (Kymlica 2002, 208). However ideal the theory’s origins, the progression to today’s liberal theory has left the concept of community ignored. This would be unacceptable to original liberals, as modern liberalism compensates by using liberty and justice as placeholders and vetoing the importance of the community, society and the family. This oversight is a recent product of liberalism developing only after World War II; theories viewed as evil, such as fascism and Marxist communism, used the community as a tool for controlling the masses, the theory fell out of favour. As community became removed from the liberal theory historically, literature refl... ...the military, gay, Christian and the greater community. This would not be permitted under the communitarian view of justice. In conclusion, allowing the desire of one person to determine the direction of a community is not the ideal that was set by the French revolutionaries, it is instead what they were fighting against. A communal view of justice can provide an additional perspective to provide strength in the goals of a people. When looking for an acceptable political theory to live by, liberal theory with the addition of a communitarian view of liberty, rather than the traditional individualistic view, contains many of the desirable portions of a complete and satisfactory theory. Works Cited Kymlicka, Will. "Marxism & Communitarism." In Contemporary Political Philosophy: An Introduction, 173, 208-215. Oxford: Oxford University Press, 2002.

I Have a Gambling Problem Essay -- Exploratory Essays Research Papers

I Have a Gambling Problem Professor’s comment: This student’s essay is well researched, strongly analytical, and seriously personal. But the essay did not begin as a personal essay—far from it— from major rewriting emerged this fascinating and very effective essay, in which social and personal analysis intertwine. Hi, my name is ______ and this is my first GamAnon meeting. I am nineteen years old, and I started gambling in junior high, $5 bets with friends. In high school, craps and deuces were the craze. The teachers had no idea. Then I started playing the lottery, hoping to hit the jackpot. Age never really mattered since the vendor never asked to see ID. In my first year of college, I started wagering on sporting events through an online sports book. It was completely legal, even though I was only 18 years old. I have always loved sports and having money on a game made it even more fun, more exciting. At first, it was only $25 or $50 a game, but then things got out of control: I was laying hundreds of dollars on single games. It wasn’t fun anymore. My bank account dwindled from four figures to two. My GPA was half my high school 4.0+. I knew I had a problem, but I just couldn’t stop, no matter how hard I tried. That’s why I’m here today. I need help. I never thought that a friendly wager could lead to such self-destructive behavior. Luckily, I recognized that I had a gambling problem and sought help, unlike the millions of other pathological gamblers who allow their problems to worsen, some eventually becoming involved with drugs, alcohol, and crime (Lesieur 43). Annually, Americans legally wager over five hundred billion dollars—more than they spend on groceries—and illegally bet hundreds of billions more (Ren... ...ychological Reports 67 (1990): 907-912. Griffiths, Mark. Adolescent Gambling. New York: Routledge, 1995. Koughan, Martin. â€Å"Easy Money.† Mother Jones. July 1997: 32-37. Layden, Tim. â€Å"Bettor Education.† Sports Illustrated. April 3, 1995: 68-83. Lesieur, Henry R. â€Å"Compulsive Gambling.† Society. May 1992: 43-50. McGowan, Richard. State Lotteries and Legalized Gambling. Westport: Quorum, 1994. McGraw, Dan. â€Å"The National Bet: Laying an Illegal Wager Has Never Been Easier.† U.S. News and World Report. April 7, 1997: 50-56. Reno, Paul. â€Å"The Diceman Cometh.† Policy Review 76 (1996): 40-46. Sandel, Michael J. â€Å"Bad Bet.† New Republic 216 (1997): 27. Simon, Paul. â€Å"The Destructive Side of Gambling Mania.† St. Louis Journalism Review 26 (1995): 8-11. Snyder, R.J. â€Å"Gambling Swindles and Victims.† Journal of Gambling Behavior 2 (1986): 50-57.

Essay --

2.2. Review related to morphological variables Noutsos, K., Koskolou, M., Barzouka, K., Bergeles, N., & Bayios, I.36 (2008) In a study performed by the researchers with the adolescent team Board Jump and volleyball players, found that the team Board Jump players were basically shorter (166.9[+ or -]4.7 cm) than the regular volleyball players (175.2[+ or -]6.3 cm). However, in the adolescent team Board Jump and volleyball players which had similar body mass and FFM. as compared to the study by, Hoffman, J.37 (2006) reported that the average height for 17-year-old American females was 163-2 cm. Therefore, adolescent team Board Jump players were slightly taller than the average American female. Kmanthropometry profile (weight, stature, sum of six skin folds, muscularity and vertical jump) of Brazilian (BCN Osasco female) volleyball athletes (age : 13 to 22 years) in 3 age groups: A-(13 to 14 yrs old), B-(15 to 17 yrs old), C- (>17 yrs old) with different training experience Gr.l (0 to 2 yrs) Gr.2 (2 to 4 yrs) and Gr.3 (>5 yrs) were studies Silva, L.R.38 (2000) One-way the scholars added the ANOVA and post hoc (Turkey) test for the collection of the statistical analysis. The study showed a significant difference was observed for most of the variables studied among the age groups and between the shorter (Gr.l) and longer (Gr.3) trained groups. Can, F.39 (2004) in the study conducted by Can, he had a purpose to describe certain morphological characteristics of women soccer players and to examine aspects of training and performance. The researchers choose twenty-two anthropometric sites were used in measurements of somatotype 49 and body composition; flexibility, agility, anaerobic power, leg muscle power and dynamic pulmonary functio... ... female hockey players, from 4 universities of Punjab. The age of player's ranged between 18 to 24 years. The stepwise regression was applied to assess the importance of different variables in predicting hockey playing ability. The result of’t’ ratio suggested that endurance run test, standing broad jump, grip strength (LH), vertical jump, wrist flexion, age, height, and weight were significantly important in evaluating the hockey performance. Also, the results failed to find support for speed as an important predictor of hockey playing ability. The result of this analysis again stresses the positive role of physical fitness components in hockey playing ability, the investigator even suggested that if we conduct proper speed training with the athletes of any event it improves their jumping performance , so it is useful for the study of the board jumpers.

Romeo and Juliet Dramatic Effects

Analyse the dramatic importance of Act 3 Scene 5. Act 3 scene 5 is of huge dramatic importance as it is pivotal to the plot of the play. Act 3 scene 5 takes place the morning after Romeo and Juliet have spent their first night together following their marriage. In the first part of the scene, they are very happy and also very romantic as Romeo says â€Å"How are you, my love? † This shows that Romeo cares for Juliet and it also shows how much love, Romeo has just been banished from Verona for killing Tybalt and is preparing to leave.This makes Juliet very upset as they haven’t even spent a day together. The nurse comes to warn them that Juliet’s mother is coming to see her to discuss her marriage to Paris. After Romeo has left, Juliet bursts into tears. When Lady Capulet arrives, Juliet cries even more but Lady Capulet thinks she is crying because of her cousin’s death. Lord Capulet explodes with anger when he hears that Juliet disagrees with the marriage. The nurse unexpectedly advises her to marry Paris. The key themes highlighted in this scene are: happiness, love, parental conflict, anger and sadness.In this scene we learn a great deal about the characters of: Romeo, Juliet, Capulet, Lady Capulet and the nurse. In the previous scene Romeo and Juliet get married and the Montagues and the Capulets have a fight which leads to the deaths of Mercutio and Tybalt. Romeo is banished from Verona for murdering Tybalt because Tybalt has murdered Mercutio. Lady Capulet seems to support and comfort her daughter, but when Juliet argues and shouts she simply hands it over to Lord Capulet who will control Juliet. In the time of Shakespeare the men were in charge of the house and the children so the audience would have agreed to the play.Lady Capulet thinks that she can control Juliet, so she informs her of the marriage that has already been arranged. She seems very concerned about Juliet but she cannot control her herself and threatens Juliet â €Å"here comes your father. Tell him so yourself, and see how he will take it at your hands†. She means I will not say anything so see what your father has to say. In the previous scenes she was very quiet and innocent but in this scene she changes from being quiet into a very loud character which reveals her true nature.The Nurse is a very caring character and understands Juliet’s problems but in this scene she disagrees with Juliet as she advises her to marry Paris when she is aware that she has already been married to Romeo. This disheartens Juliet so much as she is the only person who she trusted. The Nurse says â€Å"I think the best thing to do is to marry the count† as if she is speaking to someone she doesn’t know. Juliet relies on her so much that she is shocked when she hears such a thing come out of the Nurse’s mouth. Juliet declares â€Å"from now on I will never tell what I feel in my heart†.She also doesn’t say this stra ight to her face as the Nurse would start avoiding her which would please her parents and lead to Juliet getting into more trouble. The Nurse tries to persuade Juliet of Paris’ superiority and believes â€Å"Romeo’s a dishclout to him†. The image of the dishcloth indicates that Romeo is not worthy of Juliet. This makes Juliet furious because it was originally the Nurse who reported positively about Romeo. In this scene the Nurse is ambivalent because she supports Juliet when Lord Capulet explodes with anger as Juliet refuses to marry Paris.In previous scenes the Nurse is very supportive and thinks of Juliet as her own daughter when she says â€Å"What, lamb! What, ladybird! †, but in this scene she changes from supporting Juliet to letting her down when she asks for her advice. Lord Capulet is a very strong character throughout the play but he does care about Juliet as he claims that he will not do anything against his daughter’s will but in this s cene he orders her to â€Å"go to church on Thursday or never look me in the face again.Don’t say anything. Don’t reply. Don’t talk back to me†. This quote would be very aggressive when said in the play as he is saying it with aggression and anger. Which shows that the old Capulet has gone. In this scene, generally, everyone shows their bad side as it is now getting serious about Juliet’s wedding. In this scene Capulet uses metaphors such as â€Å"when the sun sets, the air drizzles dew. But at the death of my brother’s son, it rains a down pour. What are you, girl? Some kind of fountain? he is comparing the downpour and the amount of tears that Juliet is producing and he is also trying to express that Juliet is not crying for her cousins death but crying for her husband Romeo. He also slams her on the floor while she begs on her knees and as he is not aware that Juliet is already married he repeatedly tells her to marry but the audience kn ows that if she marries she will go to hell as there is a sin if she marries again. This scene would have been very dramatic and sad as the audience would have felt sorry for her.By Capulet doing this creates a feeling of tension and pressure for Juliet as she is begging him. From the audience’s point of view, Juliet is very innocent but Capulet refers to her as a â€Å"disobedient wretch†. This shows the amount he cares he takes for his daughter. If this were to happen in today’s society maybe he would be prosecuted for child abuse. Later in the play Juliet pretends to agree to the marriage but nobody is aware of that. Friar Lawrence gives her a potion that she will have before the night of the wedding so that she will fall into a deep sleep and wake up after 12 hours.Act 3 scene 5 is one of the most dramatic scenes in the play. This scene leads to many misconceptions as the Friar Lawrence was supposed to inform Romeo of the plans but Romeo didn’t get th e message. But he got the news that Juliet had died. Act 3 scene 5 reveals most of the characters’ true natures. This scene is important as this is the scene that leads to the death of Romeo and Juliet and also it reveals the Nurses’ real character as she didn’t really understand the true love of Romeo and Juliet. All of the characters undergo a dramatic change in how they behave in this scene.

Communication Style Paper

AA Professor Course 6315 Feb 26, 2013 COMMUNICATION STYLES: ANALYSIS OF THE INTERACTION This paper analyzes a specific interaction. The purpose is to see how changing the communication style according to the subjects involved can have different outcomes. The topics covered in this paper are (1) Subjects Involved, (2) The Specific Interaction and Analysis, and (3) Conclusion. Subjects Involved The nature of the two subjects involved in the study makes the analysis interesting due to their opposite communication styles. Any miscommunication between the two can result in undesired outcomes.The following paragraphs describe the two subjects and their communication styles followed by the discussion of the particular interaction and its analysis. Subject 1: The Candidate â€Å"Sales Manager† The one thing that separates the Sales Manager, Brian, from everyone else in the office is his desire to be liked by everyone. Brian cannot handle rejection of any kind. He is the person to appr ove any changes in Sales recommendations to the investors. Convincing Brian to do anything other than what he wants is quite a task. Each time one is about to convince Brian, something magically appears that takes him away to a different task.Subject II: The Noble â€Å"Me† I am the second subject. Being a â€Å"Noble,† getting into long discussions over rather straight forward issues is difficult for me. Arguments are pretty simple for me. The solution is either this or that. I have a need to make a decision and move on to the next task with the least amount of time wasted. The Specific Interaction and Analysis Brian has been the Sales Manager for the last five years. The office environment is open and democratic. All important issues are discussed in weekly friday morning meetings.Agendas for monday morning sales meetings are finalized on friday along with the recommendations for different investment properties to be presented to the investors the following week. In the weekly discussions, Brian’s job is to listen to the recommendations of the Sales Team which is led by me. Every time, when we need to finalize the recommendation, the discussions get heated and Brian just changes the topic and starts discussing something else. Each week, we end up with an argument trying to convince each other of the investment pick of the week, without coming to an agreement.Every argument leads to Brian discussing a completely different topic. It became a real problem for the sales team, as we left the meeting without a clear understanding of to present to our investors in the coming week. Once I understood Brian’s communication style, I discussed our course of action with my team. Under no circumstances were we to start an argument. Our tone of voice was to remain calm and in control at all times. We offered our views as an alternative without trying to direct or control him. The discussions were longer than what I would have liked but the resul ts were ncouraging. After weeks of unclear outcomes, we were able to come up with clear investment recommendations for our sales team to present to our investors. Conclusion I learned that knowing the other person’s style of communication makes the communication process a little easier. I always knew about the differences among people but never gave it the required thought to help me communicate better. I now alter my communication style depending upon the person I am dealing with resulting in more effective communication.