Analyse Maria Edgeworths treatment of one of the following themes in Castle Rackrent history or politics or society Essay Example

Analyse Maria Edgeworths treatment of one of the following themes in Castle Rackrent: history or politics or society Essay It has been debated over the years that Castle Rackrent by Marie Edgeworth, published in 1800, was the first regional novel in Britain and certainly the first novel to use the vernacular for the voice of the story. In effect the narrative structure is carefully organized, the vernacular medium plays a significant part in the organisation and the novel has a political purpose which the organised text seeks to serve. To publish an Irish story in January 1800 was definitely a political act. In Castle Rackrent Edgeworth adopts the voice of the native Irish, Thady Quirk is Catholic and Irish born, whose family have worked under several generations of an Anglo Irish family, the Rackrents. Castle Rackrent was written during a turbulent period in Irish history. The 1790s was the decade of the defenders and the united Irish men and the book was published on the eve of the union. This was hugely significant not only for the old Irish but also the Anglo Irish as they were now viewed by the New English as lowly as the Irish. The novel can be read as a tortuous struggle for Irish independence against the English ascendancy. We will write a custom essay sample on Analyse Maria Edgeworths treatment of one of the following themes in Castle Rackrent: history or politics or society specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Analyse Maria Edgeworths treatment of one of the following themes in Castle Rackrent: history or politics or society specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Analyse Maria Edgeworths treatment of one of the following themes in Castle Rackrent: history or politics or society specifically for you FOR ONLY $16.38 $13.9/page Hire Writer It is the minor effects in the book that point to political unstableness, and change, including the title itself. Castle Rackrent This was an abuse that existed for centuries in Ireland. As we can see in the text castle rackrent was totally mismanaged leading to inefficient use of resources. In the text we know that Sir Kit Stopgap was the definition of an absentee landlord, spending most of his time in Bath. It is he who adopts the dreaded middle men who were dreaded in Ireland, as they look large farms on long leases, and set the land again in smaller portions to the poor, as under tenants at exorbitant rates. This led to awful mismanagement and in later years led to the call for Home Rule. In the text, Thady describes this, The agent was one of your middlemen, who rind the face of the poor, and can never bear a man with a hat upon his head- he ferreted the tenants out of their lives-not a week without a call for money-drafts upon drafts for Sir Kit. It is also worth noting that Ra ckrent was a form of torture, this could be noted as a torture on the native Irish people, through their possession of their land. The last couple of lines of the preface contain a very prophetic musing. That is, in my opinion, still as relevant today as it was on the eve of the act of union. Nations as well as individuals gradually lose attachment to their individuality, and the present generation is amused rather than offended by the ridicule that is thrown upon their ancestorsWhen Ireland loses her identity by an Union with Great Britain, she will look back with a smile of good humoured complacency on the Sir Kits and Sir Condrys of her former existence.1 With the continuous growth in Ireland and greater integration into Europe this statement definitely rings through today. The current generation of young Irish no doubt look back to past decades, with perhaps a since of amusement and bewilderment at old Ireland and how she was. One of the key political messages in the book, (which does contain some bit of irony which I will later talk about) is to combat English prejudice against the Irish and to create an understanding between the two peoples. Brian Hollingworth in his book Marie Edgeworths, Irish Writings says she uses two separate and contradictory strategies. Firstly, in her narrative, she allows the English their customary laughter at Irish behaviour, but then she emphasises that such behaviour is now an anachronism. So the English grow more tolerant of the Irish and view the Union positivelySecondly, by the tropes and by the allusions which she employs, she identifies the social problems which exist in Ireland and the difficulties which face the Union. 2 (1997 pg75) Concerning her first tactic, a peculiarity which leaps from the title page is her emphasis that events described in Castle Rackrent predate 1782An Hibernian Tale, Taken from the facts, and from the manners of the Irish squires, before the year 1782 Brian Hollingworth concludes that a political message, both private and public is intimated here.1782 coincides with the beginnings of the Grattanite period and the slender years of political self confidence. However I think its Edgeworths display of social degeneration though various mannerisms of the Rackrent family themselves and also the use of the Castle Rackrent as a simile. This can be seen throughout the whole novel, the jovial disposition of the Rackrent family can be seen as condescending to the native Irish at times, on PG19 Sir Kit casually throws Thady a guinea, money to him was no more than dirt, this would be in stark contrast to the native Irish. Another relevant factor is the incessant carelessness and apathy to the Castle Rackrent and its business interest by several generations of the Rackrent family. The Rackrents are famous for their parties and their exuberant spending, this fickleness, however costs them everything. The irony been is that Thadys son Jason ends up buying the Castle and its lands. Jason a proper native Irish, through hard work ends up acquiring the castle through Sir Condys carelessness. This could be seen as warning to the ruling classes of Ireland, that if this continuous mistreatment of the Irish continues, then the Irish could rise up. We know this period was very unstable with many uprisings because of land ownership. Another example of politic unstableness can be seen through the Castle itself. The Castle at the start seems to be a place of great entertainment and joy. The castle begins large, it then falls into ruins and diminishes in size, this in stark contrast to the earlier part of the story when carriages come thundering up to the great hall door and improvements are being made to the house. After Sir Condrys marriage to a spendthrift wife, and his corrupt election to parliament, however, the house deteriorates rapidly. There was then a great silence in Castle Rackrent, and I went moping from room to room, hearing the door clap for want of right locks, and the wind through the broken windows that the glazier never would come to mend, and the rain coming through the roof and the best ceilings all over the house for want of the Slater whose bills were not paid. It is clear that through political corruptness and mismanagement that thing between the Irish and the English ascendancy cannot conti nue on. Mistreatment of the Irish has led to deterioration of not only the Irish themselves but also the English world. Marriage is also used in the novel to describe the political divisions in Ireland. The Rackrent males are dominating and abusive of theirs wives, especially in the sense of possessions and wealth. The best example of this is Sir Kit who marries a wealthy Jewish heiress in order to get his hands on her money. The scenes where she is shut away in the castle, are actually quite amusing, with Sir Kit condescending her at every turn, answering every question with yes sir. Perhaps the funniest incident in the film is, when Sir Kit demands bacon every morning for breakfast. After five years of this treatment she looks to be dying. During this time she has been wearing a valuable cross, which Sir Kit has been trying to get his hands on. The irony of the situation is that she recovers and Sir Kit dies. Directly she bursts into tears, and pulling her cross from her bosom, she kissed it with as great devotion as ever I witnessed, and lifting her eyes to heaven uttered some ejaculation,. Sir Con dys also marries a girl of vast wealth, although not as a calculated as his predecessor (He flips a coin) he still forfeits true love, which also ends in disaster. These acts of Union all end in failure and can be seen as a metaphor for the Union of Ireland and Great Britain, which also ends in failure. Marriage is meant to be a holy alliance, yet if the reason behind marriage is wrong, then it is an act against God. Ireland and Britain were never meant to be, it was a sin against God

Rappaccinis Daughter Quotes

'Rappaccini's Daughter' Quotes Rappaccinis Daughter is a short story by Nathaniel Hawthorne. The work centers around a young man, and a beautiful young woman (with her brilliant and inventive father entering the scenes periodically). The work (and author) are famous for being representation of American Romantic literature (Hawthorne is also famous for The Scarlet Letter). The story is also sometimes the subject of study and discussion in American literature classes, as it explores the definition of beauty, emotion/love versus intellect/science, and an exploration of Creator/creation. Here are a few quotes from Rappaccinis Daughter. Which quote is your favorite? Quotes From the Story Nothing could exceed the intentness with which this scientific gardener examined every shrub which grew in his path; it seemed as if he was looking into their innermost nature, making observations in regard to their creative essence, and discovering why one leaf grew in this shape, and another in that, and wherefore such and such flowers differed among themselves in hue and perfume.Every portion of the soil was peopled with plants and herbs, which, if less beautiful, still bore tokens of assiduous care; as if all had their individual virtues, known to the scientific mind that fostered them.He was beyond the middle term of life, with grey hair, a thin grey beard, and a face singularly marked with intellect and cultivation, but which could never, even in his more youthful days, have expressed much warmth of heart.But now, unless Giovannis draughts of wine had bewildered his senses, a singuolar incident occurred†¦a drop or two of moisture from the broken stem of the flower descende d upon the lizards head. For an instant, the reptile contorted itself violently, then lay motionless in the sunshine. Beatrice observed this remarkable phenomenon, and crossed herself, sadly, but without surprise; nor did she therefore hesitate to arrange the fatal flower in her bosom. And must I believe all that I have seen with my own eyes? asked Giovanni pointedly, while the recollection of former scenes made him shrink.They stood, as it were, in an utter solitude, which would be made none the less solitary by the densest throng of human life. Ought not, then, the desrt of humanity around them to press this insulated pair together? If they should be cruel to one another, who was there to be kind to them?Created it! created it! repeated Giovanni. What mean you, Beatrice?Miserable! ... What mean you, foolish girl? Dost thou deem it misery to be endowed with marvelous gifts, against which no power nor strength could avail an enemy? Misery, to be able to quell the mightiest with a breath? Misery, to be as terrible as thou art beautiful? Woudst thou, then, have preferred the condition of a weak woman, exposed to all evil and capable of none?To Beatrice-so radically had her earthly part been wrought upon by Rappaccinis skill-as poison had been life, so the powerful an tidote was death. And thus the poor victim of mans ingenuity and of thwarted nature, and of the fatality that attends all such efforts of perverted wisdom, perished there, at the feet of her father and Giovanni.

Assessment item 1 - Individual assignment Essay

Assessment item 1 - Individual assignment - Essay Example Though times have changed and organizations getting less hierarchical, yet importance of understanding legal requirements in employment relationship remain intact. The only difference is while earlier, they were transactional in nature, now they have turned more relational today. However, laws still guide the managers through their way to recruitment, selection, labor and procedural justice, compensation and other human resource functions. Legislation in employment does not follow at the time of recruitment and selection alone; they pave the way for successful and hassle-free work bargain and also extend after the human resource selection in maintaining the informal relationship according to the formal regulations. These legislations span across aspects such as providing equal opportunity rights, diversity management, accounting for health and safety of employees, relations at workplace, wage and child-related laws and illegitimate discrimination (Nankervis et al. 2009:153). Gillilan d (1993:696) assert that inclusion of laws into recruitment and selection process imparts fairness and objectivity to the entire function. Serving as a means to establish tenets of equity, laws put in place provide for substantial distributive and procedural justice in the organization which helps develop the attitude of employees and also infuse motivation in them. Evidence of fulfillment of labor and compensation laws discards the feeling of inequity between inputs and outputs and establishes symbiotic relationship between employers and employees. Elaborating further on the positive perception, implementation of procedural justice gains more grounds if legal requirements are duly complied within an organization. In the presence of proper regulations, employees tend to believe that they have a voice and an equal opportunity in affecting the decision making process and use of procedures to arrive at conclusions or verdicts. In exercising the procedural justice, if laws are in place, it obligates employers to account or justify for any of the repercussions. Legal provision of creating a two-way communication channel and justification lowers down the negative effect associated with the negative consequence. As such, laws also help develop interpersonal relations between employers, employees and related parties as they tend to involve the components of procedures, decision making and communication in recruitment and selection. Realizing the importance of legal requirements in work place settings, HR managers are now making increased use of psychometric tests in selecting apt candidates from applicants’ pool. Wolf & Jenkins (2006:201) opine that this exercise is guided more on a defensive note than a pre-requisite staffing practice. Use of different tests do provide equal opportunity rights to applicants of varied intellect, education and capabilities, but more importantly, these tests serve as evidence that organization had been fair and justified in its r ecruitment process when there were no clear job descriptions or specifications. External environment and

Theodore Roosevelt's Main Contributions to American History Essay

Theodore Roosevelt's Main Contributions to American History - Essay Example This paper will discuss the main contributions of Theodore Roosevelt to American history. â€Å"Theodore brought modernism to the American government† (Woods 2010, 1). He was properly suited for this responsibility. Philosophically, Roosevelt was an expert who was determined to bring effectiveness and intelligence to fight against spoilers of the natural environment, as well as international disorder. Roosevelt was as historians put it, "the first great leader who changed America to the modern industrial age" (Woods 2010, 1). Roosevelt had little endurance with federalism and also with a majority of the constitutional barriers that stood between him and the establishment of a fresh American state. Politically, Theodore was a dedicated nationalist. He, therefore, could hardly bring himself to address Thomas Jefferson, whom he detested. Moreover, as late as the 1880s, Roosevelt was still criticizing Jefferson Davis as a traitor. Roosevelt was angered by The Confederate cause bec ause it denied a large united nation its own justification. â€Å"Roosevelt took to the presidential office a consistent and thorough philosophy of a government† (Woods 2010, 1). What a former leader might have done without fanfare or hesitatingly, Theodore Roosevelt formed a much better principle. ... They all echo the president's self-belief in proficient commissions and his stewardship assumption of the executive branch. As one historian put it, these acts, put together, "may well be regarded as the dawn of a modern regulatory nation, the great America" (Woods 2010, 1). Not all American leaders were confident at this view. One traditional Republican stated that Roosevelt was â€Å"unconsciously or consciously trying to focus all power in Washington, to eliminate state lines, as well as to govern the people by bureaus and commissions." Roosevelt was a natural publicist. â€Å"He offered an astonishing heritage to the American citizens of a variety of resources and lands in public ownership† (Bedford/St Martin's 2009, 16). He used the Presidency's "bully pulpit" successfully to stimulate public interest in conservation matters. Theodore’s key contribution to the conservation movement was "wielding his presidential status to craft an alliance of people from civic lea ders and naturalists who favored conservation to useful resource specialists, as well as users" (Woods 2010, 1). No success shows this better than the Governor's Conference of 1907. At this meeting, Roosevelt conveyed all the country’s governors and several other leaders together and, using his own eagerness for conservation, he ignited policies, discussions and proceedings that still echo today at many levels of the American government. â€Å"Theodore Roosevelt also assumed that he had a duty to spread American interests and ideas across the globe† (Roosevelt 2006, 1). As the leading world power, the U.S. had an apparent chance to remake the global system in a manner that would eradicate the old ruins of war, as well as corrupt alliances. Roosevelt

Bad marketing, bad budgeting, and bad customer service can lead to the Research Paper

Bad marketing, bad budgeting, and bad customer service can lead to the failure of a business - Research Paper Example (Mercer, David. 1996; Shim, Jae. K, Siegel, Joel.G, Shim, Allison.I. 2011) A good and healthy business needs a perfect alignment and coordination of these components in order to be profitable. Organization can not exist without its market; all its strategies are based on winning the market. Marketing focuses and revolves around customer’s needs and demands. To any organization customer- i.e. the consumers of its product are everything. They are revenue generating and are the reason for which the organization exists. Marketing emphasizes on a long term perspective of building strong and long term relationships with the customers. The aims of marketing is to reduce down the dissatisfied customers, identify reasons for their dissatisfaction and work on strategies and products that fulfill their demand and needs, keep them satisfied and brings customer loyalty as increased customers lead to increased revenues and profitability. (Mercer, David. 1996) Market research and advertisement are important aspects of marketing. Market research helps the organization to gain an understanding about the environment it operates in and gives an in-depth knowledge about the opportunities and risks which helps the organization in formulating its future strategies for success. Advertisement and promotion on the other hand are other tools to develop or increase brand recognition and increase market share. Other strategies of marketing like after sales services, promotional offers etc. are all ways to win customers for growing revenues and profitability. (Mercer, David. 1996) Budgeting is a tool and technique used for systematic and productive management. Budgeting allocate funds and set targets to achieve a desired outcome. Budgets are created after determining the over all strategies of the company, then these strategies are translated into long tem and short term goals and objectives which provides the basis of budgeting and allocating resources.

Nurse-led Clinics in Respiratory Care: a Literature Review

Nurse-led Clinics in Respiratory Care: a Literature Review INTRODUCTION 1. What is a nurse-led clinic? As the coined term suggests, a nurse-led clinic is a health care centre in which nurses are involved in high level specialist procedures and assessments. In such centres, nurses are the critical decision makers, being involved in patient care at the micro-, meso-, and macro-levels. While the role of the physician in the provision of health care is undisputable, the deity-like status that medical practitioners typically have in the mind of patients, coupled with the limited time available for individual patient consultations, make it hard for these group of health care professionals to tackle the ‘softer’ side of patient care. Nurses, on the other hand, defined by the Oxford Medical Dictionary as health care professionals that are trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines, are better placed to provide this essential follow-up, especially in the care of patients with chronic dise ases. According to Hatchett (2003), a nurse-led clinic is a clinic in which nurses have their own patient case loads of whom they take complete charge. Hatchett broadly describes the components of such a clinic. There would be an increase in autonomy associated with the nursing role in the nurse-led clinic, with the power to admit, discharge or refer patients, as appropriate. In Hatchett’s own words, the roles which nurses adopt in these revolutionary settings can be broadly classified as follows (Hatchett, 2003): Education Psychological support Patient monitoring The initiation of nurse-led initiatives probably owes its origins to the rise in nursing specialties in the United Kingdom. Throughout primary and secondary care, nurses are taking senior positions in health care institutions, such as nurse specialists, nurse practitioners, nurse consultants, nurse prescribers, etc, leading to a marked change in service delivery and the profile of the nursing profession. In addition to the usual registered nurse training, nurses working at higher levels of practice receive training to acquire a range of other medical skills such as physical examination and medical history taking in order to recognise abnormal clinical findings. In a two-phase exploratory study to evaluate the domains of structure, process and outcome of nurse-led clinics in supporting intermediate care after the acute phase of disease, Wong et al (2006) interviewed nurses from 34 clinics and 16 physicians and observed 162 nurse-led clinic sessions. Their findings demonstrated the high level of skill and experience of the nurses who ran the clinics. Their work involved skills such as adjusting medications and initiating therapies, and diagnostic tests according to protocols. Interventions included assessments and evaluations, and health counselling. All patients studied showed improvement after the nurse clinic consultation, with the best rates reported in wound and continence clinics; satisfaction scores for both nurses and clients were high. However, although physicians valued their partnership in care with the nurses, they were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. Ultimately, nurse-led clinics provide an integral and invaluable patient-centred approach to the management of chronic disease which build upon skills such as counselling, teaching and health promotion which are key to contemporary nursing practice, as well as newly acquired medical skills. The advent if nurse-led clinics provides an opportunity for nurses to develop enhanced roles in which they can achieve more autonomy in their practice. This can be made a reality if adequate training and education, as well as effective leadership are in place (Wiles et al, 2001). 2. The general roles of nurses in chronic care management The chief nursing officer, Sarah Mullally has proposed ten key roles for nurses in autonomous patient care. These are outlined below as cited by Hatchett (2003): Order diagnostic interventions: just like a medical practitioner would, the present-day nurse is able to ask for laboratory or clinical diagnostic tests to aid the process of diagnosis. Furthermore, a well-trained nurse will also be able to read and interpret laboratory results effectively Make and receive referrals directly: while the all-important roles of nurses are recognised, the need for a multidisciplinary approach to patient care remains key in order to optimise patient outcomes. Accordingly, nurses should be able to recognise the patients’ needs and refer them to the appropriate health care service as required. Similarly, nurses should be ready to accept referrals from other health care disciplines as necessary. Admit and discharge patients for specified conditions, within agreed protocols: in order to make the best use of the often limited hospital resources, a nurse should have the power to recommend patients for hospital admission and subsequent discharge Manage patient case loads: in nurse-led clinics, nurses are also responsible for managing their individual case loads. It is important to delegate patient cases to other members of the team, when necessary to ensure that patients receive the best care possible. Run clinics: the autonomous role of the nurse in a nurse-led clinic includes all aspects of the management and day-to-day running of the clinic. Prescribe medications and treatments: nurse prescribers are able to advise patients on appropriate treatment, based on diagnosis of ailment and individual characteristics and laboratory findings. Carry out a wide range of resuscitation procedures, including defribillation Perform minor surgery and outpatient procedures: especially in injury clinics. While nurses are probably not equipped to carry out full-fledged surgical operations alone, they are trained to conduct emergency processes as appropriate. Triage patients, using the latest information technology, to the most appropriate health care professional Take a lead in the way local health services are organised and in the way they are run Nurses have always been considered as a supplement to the fundamental care provided by medical doctors. In fact, in some geographical regions, nursing roles are limited to menial tasks such as changing bedpans etc. In the new age, the nursing role as we know it is becoming increasingly important with nurses taking on infinitely more clinical roles. This has led to controversial debates with critics arguing that nurses cannot replace doctors in the provision of health care services. As Richard Hatchett very astutely pointed out (2003), the increased autonomy being acquired by nurses is not a bid to compete with medical doctors. Instead, â€Å"it is a case of considering who can provide the most appropriate service to the patient† (Hatchett, 2003). Thus, it is clear that the roles of nurses in chronic care management is very diverse and can be integrated into any nurse-led clinic intervention to the utmost benefit of the patient and all stakeholders. There have been numerous studies on the role of nurses in the care of patients with chronic diseases. In addition, and more specifically, the feasibility and benefits of implementing nurse-led clinics in practice have also been investigated to some extent. In the subsequent sections, we will review the evidence to support these innovative nursing interventions in an attempt to make the best use of health care resources. 3. Nurse-led clinics in the management of chronic care diseases: the evidence The World Health Organization (2002) defines chronic diseases as health care problems that require ongoing management over a period of years or decades. The nature of these disease conditions make it necessary to provide long term care and follow-up for the afflicted patients. Nurse-led interventions have been investigated a wide range of chronic diseases. It could be a logical, user-friendly, cost-effective and practical approach to improving long-term patient outcomes and should be explored fully to maximise the contributions of nurses to the chronic care management. Although this review aims to analyse the effectiveness of nurse-led clinics in the treatment of respiratory diseases, a prior look at the role of these interventions in the management of other chronic care diseases will provide an insight to the general contributory roles of nurses and will serve as a foundation for complete understanding of this state of the art intervention. 3.1 Nurse-led interventions in the management of diabetes Numerous studies have evaluated the benefits and practicalities of nurse-led clinics in the long-term management of diabetes. The renal diabetic nurse specialist is described as an â€Å"essential player† in organising the management of, and to meet, all aspects of need of this group of patients (Marchant, 2002). An unintended benefit of a nurse-led clinic to reduce cardiovascular risk is improved glycaemic control, HbA1c (Woodward et al, 2005). In particular, nurse-led diabetic clinics have been shown to benefit specific ethnic groups. Matthias et al (1998) identified the needs of diabetic patients from minority ethnic groups, such as blacks and Asians and postulated that nurse-led clinics were of particular benefit in this patient group. As epidemiological data show that diabetes is most common in minority ethnic groups (Carter et al, 1996), the importance of these innovative interventions is further emphasised. 3.2 Nurse-led interventions in the management of cardiovascular disease Care of patients with cardiovascular diseases is broad and involves many aspects, from risk factor management (non pharmacological interventions), primary and secondary prevention of clinical events, pharmacological therapy, surgical procedures, etc. Through a large well-designed randomised controlled trial in Scotland, Campbell et al (1998) showed that nurse-led clinics were practical to implement general practice and led to an significant increase in various aspects of the secondary prevention of coronary heart disease. Significant improvements were noted in aspirin management, blood pressure management, lipid profile management, diet and physical activity, regardless of the individual patient’s baseline cardio performance or status. However, surprisingly, there was no recorded improvement on smoking cessation, which would have been a beneficial intervention in most acute and chronic disease states, including respiratory diseases. In addition to the apparent effectiveness of the nurse-led clinics in the long-term primary and secondary prevention of coronary heart disease, the optimal use of nurses in the care of these patients has been shown to be cost-effective in terms of quality adjusted life years (QALYs) (Raftery et al, 2005). In this large cost-effectiveness analysis, although the cost of the nurse-led clinic intervention was  £136 higher per patient, the differences in other National Health Service (NHS) costs was not statistically significant. Furthermore, there were 28 more deaths in the non-intervention group leading to a gain, in the intervention group, in mean life-years per patient of 0.110 and of 0.124 QALYs. 3.3 Nurse-led interventions in rheumatology The role of clinical specialist medical doctors in the care of their patients is unquestionable; however, the role of nurses in the therapy area of rheumatology (i.e. in patients with rheumatoid arthritis) is also well documented. Hill and colleagues (1994) clearly demonstrated the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Although this was a small study with a sample size that only included 70 patients, the statistical significance of the findings of this randomised controlled trial cannot be ignored. In patients managed in the Rheumatology Nurse Practitioner clinic, pain, morning stiffness, psychological status, patient management and satisfaction all improved significantly (p = 0.001; p = 0.028; p = 0.0005; p In addition, patient satisfaction is frequently higher in patients who are allocated to nurse care than those allocated to standard medical care (Hill, 1997). In yet another study by Dr Jackie Hill, a registered nurse at the Academic and Clinical Unit for Musculoskeletal Nursing in the Chapel Allerton Hospital in Leeds, the researchers concluded that a nurse-led clinic is effective and safe and is associated with additional benefits, such as greater symptom control and enhanced patient self-care, compared with standard outpatient care. 3.4 Nurse-led interventions in cancer care The effectiveness of nurse-led care in different common cancer afflictions has been researched variously. An extensive review article by Loftus and Weston (2001) discussed the patient needs that could be met by nurses working in nurse-led clinics and highlighted the experience and skills of advanced nursing practice that make such innovative care a reality. The types of nurse-led interventions are as varied as the different types of cancers for which they are used. These range from nurse-led telephone clinics in patients with malignant glioma (Sardell et al, 2001); nurse-led follow up in patients receiving therapy for breast cancer (Koinberg et al, 2004); and nurse-led screening programmes in Hong Kong Chinese women with cervical cancer (Twinn and Cheung, 1999). In a randomised controlled trial in a specialist cancer hospital and three cancer units in southeastern England, Moore et al (2002) assessed the effectiveness of nurse-led follow-up in the management of patients with lung cancer. The findings of the study showed high levels (75%) of patient acceptability. This negates the possibility of patients’ reduced confidence in nurses’ ability and preference for standard medical doctor care. Clinical outcomes were also greatly improved as shown by less severe dyspnoea at three months (p=0.03), better scores for emotional functioning (p=0.03), and less peripheral neuropathy at 12 months (p=0.05). 3.5 Nurse-led interventions in the management of HIV infection Using a rigorous model of comprehensive care nurse-led clinic in genitourinary medicine to compare nurse-led and doctor-led clinics at a central London medicine clinic, Miles and colleagues (2003) reported reliable and valid results to support the use of the nurse-led variety as an acceptable alternative to the existing doctor-led clinics. More specifically, the British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) advocate the benefits that can be accrued from a nurse-led educational intervention in the care of patients with HIV infection (Poppa et al, 2003). A small pilot study that investigated the effects of a 6-month nurse-led educational programme reported that improved virological responses were seen in treatment-experienced patients (Alexander et al, 2001). While a majority of the studies on nurse-led clinics in other chronic diseases can be broadly applied to nurse-led care in patients with respiratory diseases, differences in the nature of these diseases and the necessary care pathways mean that the extent to which these tested interventions can be applied to other therapy areas is, in actual fact, limited. Government policies that advocate the clinical and economic effectiveness of nurse-led interventions frequently pool together evidence from all therapeutic areas. Indeed, it can be hypothesised that, if nursing interventions are shown be practical alternatives for medical care in complex diseases with poor prognoses, such as cancer, HIV and coronary heart diseases, care of patients with respiratory diseases which generally have better prognoses should be easily, effectively and safely undertaken by qualified and well-trained nurses. Nevertheless, these findings of the effectiveness of nurse-led interventions in the numerous chronic diseases explored in previous sections, should be applied to the different patient population with respiratory diseases. As much as possible, research findings from similar patient groups should be applied in clinical practice in order to ensure that evidence-based practice in this case is relevant. 4. Government policies influencing the establishment of nurse-led clinics Government health policies in the United Kingdom actively support the extension of nurses’ skills into areas such as nurse prescribing and the development of nurse practitioner posts (NHS Plan 2000; Department of Health). Government initiatives that that strive to reduce consultation waiting times and optimise the use of medical practitioners indirectly support the establishment of nurse-led clinics. The Government has endorsed the implementation of nurse-led clinics as a means of increasing access to specialist health care and treatment more quickly and also as an effective way to manage chronic conditions (Hatchett, 2003). In the Department of Health (1999) document, ‘Making a difference’, government plans for strengthening nursing contribution to health care is presented. The Government has launched an ambitious programme of measures to improve the National Health Service and the health of the public, and the role of the nursing profession in this initiative cannot be overemphasised. The key nurse-related points of the document are outlined below: To extend the roles of nurses, midwives and health visitors to make better use of their knowledge an skills – including making it easier for them to prescribe To modernise the roles of school nurses and health visitors in supporting the new health strategy and other policies To see more nurse-led primary care services to improve accessibility and responsiveness The document highlights numerous nurse-led initiatives that have been effectively implemented all around the United Kingdom. A nurse-led minor injury service in rural Cornwall has provided patients with a number of benefits: easier accessibility, reduced waiting times, reduced need for on-site medical; attendance, increased patient satisfaction and reduced need for transfers to local Accident and Emergency departments. Similarly, a nurse-led rapid response team in Peterborough responds to acute crisis cases and allows patients to be nursed at home. Evaluation has shown that 71% of patients referred to this ‘hospital at home’ service would have been admitted to hospital if the service did not exist. Other effective live nurse-led services include a nurse-led rheumatology service in Merseyside and a nurse-led intermediate care unit in Liverpool. Furthermore, several nurse interventions are advocated in the document for contributing to the management of cardiovascular disease. Several of these are also applicable to respiratory diseases; these include: Smoking cessation clinics using national smoking cessation guidelines Healthy lifestyle clinics in collaboration with other health professionals to address factors such as diet, nutrition and exercise, thus improving overall health Care for patients with congestive cardiac failure under ‘home-based’ initiatives Nurse-led chest pain clinics or risk factor screening and reduction clinics Nurse-led blood pressure clinics to identify and help manage blood pressure disorders and medication adherence 5. Review objectives The objectives of this review are: To briefly summarise various studies on effectiveness and cost-effectiveness of nurse-led interventions in common respiratory diseases To critically appraise the methods employed by these studies To evaluate, interpret, and where possible, compare the findings of the various studies To explore the applicability and generalisability of the results to practice in the appropriate patient population To make suggestions for future studies in this area. METHODS Literature search A search of two major databases, MEDLINE and EMBASE, was conducted to identify articles published from 1990 through 2008. Search terms that were used include nurse, nurse-led clinic, nurse-led interventions, respiratory diseases, asthma, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis, cystic fibrosis, cost-effectiveness analysis, cost-benefit analysis, and economics. A secondary search of the reference lists was then conducted to identify relevant articles, editorials, and other unoriginal reports that may have been missed in the primary search. Some studies were excluded based on the following criteria: They were not conducted in patient populations with respiratory diseases Independent nurse-led interventions were not investigated The study populations being investigated were mixed in terms of diagnosis, which would affect the integrity of the study findings for respiratory diseases The methodology and/ or statistical analysis methods were not clearly elucidated 6. Nurse-led clinics in the management of respiratory diseases: a review of the evidence The role of the specialist respiratory nurse has evolved since the early 1980’s with the support of the Royal College of Physicians (RCP 1981). The possible complexity of respiratory patients’ regimens necessitates support with various aspects of their care plans, such as: Supervising nebuliser and inhaler techniques Monitoring progress, i.e. by periodical assessment of lung function and exercise capacity Education on the specific disorder, medications, potential adverse events, etc Counselling and education on positive lifestyle, or non-pharmacological, changes Adherence support and monitoring The role has developed further with nurses providing nurse-led clinics in chronic obstructive pulmonary disease (COPD) and asthma along with nurses providing early supportive discharge and ’hospital at home’ for patients with COPD (French et al, 2003). Some schools of thought argue that nurse-led clinics would culminate in the neglect of the more traditional nursing roles, as nurses focus on a more medical-focused aspect of patient care. However, research in other therapy areas, such as rheumatology (Hill et al, 1994) and mental health (Reynolds et al, 2000) shows that nurses can effectively combine the medical role with the traditional nursing approach. Nursing care strives to provide a holistic approach to care through practical management of disability, education and counselling and referral to other health care services as required (Rafferty and Elborn 2002). 6.1 Bronchiectasis Nurse-led clinics have been evaluated, compared with regular doctor-led clinics, in a single randomised controlled trial in patients with bronchiectasis, a respiratory condition in which there is widening of the bronchi or their branches (Sharples et al, 2002). The study was a randomised controlled crossover trial including 80 patients in a bronchiectasis outpatient clinic. Patients received 1 year of nurse led care and 1 year of doctor led care in random order, and were followed up for 2 years. Various outcome indicators were used in the comparison, including lung function and exercise capacity, infective exacerbations, hospital admissions, quality of life and cost-effectiveness of the intervention. The results of this study are illustrated in Table 1 below. Table 1: Nurse-led and doctor-led care in care of patients with bronchiectasis (Sharples et al, 2002) Measurement outcome Nurse-led Doctor-led Mean difference (95% CI) p-value Forced expiratory volume in one second (FEV1) (%) 1.87 1.86 0.01 (-0.04 to 0.06) Forced expiratory volume in one second (FEV1) (L) 69.7 69.5 0.2 (-1.6 to 2.0) Forced vital capacity (FVC) (%) 87.6 87.6 -0.02 (-1.5 to 1.4) 12 minute walk distance (m) 765 746 18 (-13 to 48) Infective exacerbations (patient years of follow up) 262 (79.4) 238 (77.8) 0.34 Hospital admissions attributable to patient’s bronchiectasis 43 23 0.22 As the table above clearly shows, there was no statistical difference in FEV1/FVC percent predicted or distance walked between nurse led and doctor led care in the two treatment periods. Furthermore, 262 episodes of infective exacerbations were recorded by patients in the nurse practitioner-led care group in 79.4 patient years of follow up, compared with 238 in 77.8 years in the doctor-led care group. Thus, nurse practitioner-led care is associated with a relative rate of exacerbations of 1.09 (95% CI 0.91 to 1.30), p=0.34. Using the St Georges Respiratory Disease questionnaire to assess differences in health-related quality of life between the two groups, there was no statistically significant differences in each of the scores for Symptoms, Control, Impact or total score. Also, the study showed that nurse-led care resulted in significantly higher costs per patient compared with doctor-led care; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs. The authors concluded that nurse practitioner-led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. This study has several potential limitations which could invalidate the findings. As the study relied on patient report to record the prescriptions issued by general practitioners, these may have been underestimated and could grossly affect the cost analysis. Conversely, the nurse practitioner was required to record prescriptions and tests issued at the clinic, and thus these records are probably more reliable and she would be more likely to have ensured that patients left with supplies of routine treatment. Another possible drawback of this study is the use of a crossover design in the methodology. Unless a wash-out period is incorporated in the study design, there is the possibility of a carryover effect with crossover study designs, with the danger that the effects of the earlier treatment is falsely attributed to the final experimental treatment. In this study, there was no allowance for a washout period and thus this could affect the reliability and validity of the study results. This order and time effect needs to be checked for within the analyses but it can rarely be excluded as potential biasing factors (Pocock 1983). However, as recruited patients received the interventions in random order, this may negate the carryover effect. Despite the possible limitations of the study that could potentially hinder its applicability in practice, the findings support the implementation of a nurse-led clinic in patients with chronic cases of bronchiectasis as an alternative to the standard rigid medical care. 6.2 Asthma Similar to the findings in the study by Sharples and colleagues (2002) in patients with bronchiectasis, Nathan et al (2006) more recently compared the effect of follow-up by a nurse specialist with follow-up by a respiratory doctor following an acute asthma admission. In a single centre prospective randomised controlled trial, 154 patients admitted with acute asthma were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. The intervention comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse, and all patients were asked to attend a 6-month appointment. Despite hospital outpatient follow-up, there was a significant proportion of patients in both groups who had exacerbations. However, there was no statistically significant difference between the two groups (Table 2). In the same manner, there was no statistically significant difference in quality of life assessed with two different validated questionnaires, the Asthma Questionnaire and the St George Respiratory Questionnaire. Mean change in peak flow at 6 months was similar between the two groups, probably indicating equivalence of the two tested interventions. Nathan et al (2006) concluded that follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that traditionally provided by a doctor practitioner. Table 2: Nurse-led and doctor-led care in follow-up care of patients admitted with acute asthma (Nathan et al, 2006) Measurement outcome Nurse-led Doctor-led Odds ratio (95% CI) Mean difference (95% CI) p-value Change in peak flow 1.39 (-3.84 to 6.63) 0.122 Infective exacerbations (%) 45.6 49.2 0.86 (0.44 to 1.71) 0.674 Quality of life 87.6 87.6 -0.02 (-1.5 to 1.4) Asthma Questionnaire 0.78 (-0.64 to 2.19) 0.285 St George Respiratory Questionnaire 1.08 (5.05 to 7.21) 0.891 The possible limitations associated with this study is the large amount of missing data for some outcomes, especially peak flow and quality of life

Drugs Essay -- essays research papers

Drugs   Ã‚  Ã‚  Ã‚  Ã‚  Drugs have always been a big part of our society. Many issues arise with whether or not some of them should be legalized for medication purposes or if they all should just be kept as illegal. Drugs are a very interesting topic to learn about and discuss. There is so many things that people don’t know and maybe they should. Not everyone is aware of all the risks or what can happen to you if you get caught with them. If you’re ready to hear about five illegal drugs, then I’m ready to share what I have found out about them.   Ã‚  Ã‚  Ã‚  Ã‚  Marijuana, also known as: â€Å"cannabis, pot, weed, herb, green, Mary Jane, joints, bong toke, and reefer† (Drug Use, www.druguse.com/definitions.html), is probably one of the most controversial drugs. People don’t know if they want to legalize it to help cancer patients or if they want to keep it illegal so that it doesn't get abused by other people. Marijuana is classified as a â€Å"class B drug. It is illegal to have, sell, or give away. The maximum sentences you can receive in a magistrates court is 3 months in jail and a $500 fine† (Illegal, www.impington.cambs.sch.uk/work/illegal.html). Also if you are caught you will have a record and it will keep you from getting jobs like a teacher and working in a bank, so watch out.   Ã‚  Ã‚  Ã‚  Ã‚  Most of the time marijuana is smoked. The users like to mix it with tobacco and roll it into a cigarette. After smoking it, it will leave a sweet herbal smell behind, which is hard to describe but easily recognizable (Illegal, www.impington.cambs.sch.uk/work/illegal.html). Not only can marijuana be smoked it can also be eaten or inhaled. Any way you do it you still get the same effects.   Ã‚  Ã‚  Ã‚  Ã‚  The only things that will change the effects you will receive are according to your mood or the atmosphere in which it is smoked. A lot of the people will become relaxed, but then you have those who will become very giggly. Smoking marijuana can also cause you to get the munchies, so you need to be prepared to eat just about anything. Many times the people who smoke marijuana become lazy and seem to put things off; they also get a loss in memory. The biggest danger comes from the actual smoking. â€Å"Like tobacco, marijuana has a high tar factor, so smoking it can cause bronchitis and cancer† (Illegal, www.impington.cambs... ...r writhe on the floor, terrorized by grisly visions, or imagine himself so indestructible that he walks into a moving car† (Modell and Lansing, 42). When on LSD many people experience a â€Å"bad trip†. When having a trip you can become very frightened and have panic attacks and feel anxious. Sometimes they forget it is the drug and they then think that they are going mad. â€Å"People don't usually get dependent on LSD, but someone who does use too much too often can feel out of touch with the real world† (Illegal, www.impington.cambs.sch.uk/work/illegal.html).   Ã‚  Ã‚  Ã‚  Ã‚  So, like I stated before, drugs are a very interesting topic to learn about. I think that anyone that is taking drugs or considering using drugs should really read up about them and I know that they might just change their mind about what they are doing. Drugs are very dangerous and if you want live your life being addicted to them and ruining your body then go right ahead and do that. Damaging my brain and my liver just doesn’t sound very cool to me. All I can say is never do drugs, unless you want to live a life that will always be effected by the drugs you are taking.   Ã‚  Ã‚  Ã‚  Ã‚