Irony Essay Example for Free

Irony Essay Both â€Å"The Necklace† and â€Å"The Gift of the Magi† have plots that depend in large measure on the use of situational irony to create a surprise ending. â€Å"The Necklace† tells the story of Madame Mathilde Loise, a lowly clerk’s wife, who, in an effort to appear more debonaire than she is, borrows expensive jewels from Madame Jeanne Forestier, a wealthy friend. After the inevitable loss of the jewels, Madame Loisel and her husband secretly replace the jewels. Years later, Madame Loise, now impoverished, encounters Madame Forestier on the streets of Paris and admits to the secret. Madame Forestier, shocked by the change in Loise, explains that the necklace was merely costume jewelry. The situational irony that both the reader and Madame Loise experience simultaneously is the twist, the unexpected turn of events that is both a perfect example of irony and the very element that makes the plot so original and memorable. Similarly, â€Å"The Gift of the Magi† employs irony to provide the unexpected ending. A young couple, barely able to feed and house themselves, sells their most valuable possessions to buy presents for each other. In an ironic catch typical of O’Henry, Della sells her hair to buy a watch fob for Jim, her husband. Jim, in turn has secretly sold his watch to buy the tortoise-shell combs Della dreamed of running through her long, dark hair. The story makes use of both dramatic irony and situational irony to create the literally-doubly ironic ending: both â€Å"sacrifice for each other the greatest treasures of their house. †

Infection Control Practices in Nursing Homes

Infection Control Practices in Nursing Homes Introduction Literature review on the infection control practices in the Nursing Homes most particularly in the United Kingdom. It is well known that the elderly population has a substantially increased incidence and severity of many infectious diseases (Hampton, 2003). The student will focus on the infection control and prevention issues most specifically to person- to-person transmission and a little regarding food -borne transmission. In fact, the Centres for Disease Control and Prevention (CDC) estimates that 1.5 million nosocomial infections occur in long-term care residents per year, which translates to an average of one infection per resident per year (Williams, 2008). Between February and May 2006 infection control staff across the United Kingdom and Ireland completed the third national survey into health care associated infection. A prevalence rate of 7.6% broadly supports the results that were reported in the first and second national surveys (Cole, 2007). According to Knoll and Lautenschlaeger (2010), the rate of healthcare-associated infections (HCAIs) is listed for the United Kingdom at approximately 50 thousand cases in every year. Among these are the elderly people, which are the most vulnerable hosts (Aitkenhead, 2009). According to Nazarko (2007b), infection control in UK care homes does not yet receive the same level of scrutiny as in hospitals. People requiring care in nursing homes may have infections, or may be at risk of picking up infection from other people. Staff and visitors may also be at risk since they are the ones who are in direct contact with the clients. As being observed by the student, infections spread rapidly between the residents in the Nursing homes. Standard precautions aim to eliminate sources of infection whenever possible and to prevent the spread of infection (Nazarko, 2007). Controlling the spread of the infection may be difficult for some workers due to lack of education on infection control and prev ention. This is the main reason why the student came up with several sources that may sum up the problems and makes solutions that may be helpful to health personnel. The number of people in care homes will continue to expand as the population ages. Today, according to Hampton (2003), residents in care homes have more complicated medical conditions than they did 5 years ago, as they become even more elderly and the trend continues towards shorter and shorter hospital stays in acute care facilities. This literature review was made by the student to emphasize the importance of compliance of infection control procedures in the care home. The students experiences and knowledge gained from work based studies and broad sources of reading materials greatly contribute in making the substance of this paper. This paper may help readers to gain knowledge on the ideal infection control procedures that applies mainly in the healthcare setting. Common mode of transmission in a nursing home facility Infection control is described by the National Health Service Executive as a managed environment, which minimises the risk of infection to patients, staff and visitors (Health Protection Agency, 2006). Standard precautions are directed towards breaking the chain of infection by preventing the transmission of infection (Cole, 2010). According to El-Kadiki and Sutton (2005), compliance of infection control may provide high quality and safe services among individuals. It may also prevent cross contamination among staff member and may lower the costs of health care services since prevention is more economical than treatment (Eriksen et al, 2007). From the article by Nazarko (2005), the spread of infection within health care requires three elements: 1. a source of infecting organism (bacteria, viruses, and fungi), 2. a susceptible host and, 3.a route of transmission of the organism from one person or site to another. In relation to the nursing home environment, the source may be a resident, a staff member or a visitor. That certain individual may have signs of infection, or may be colonized and does not show any symptoms (Knoll, 2010). The source may also be inanimate objects within the environment that have become contaminated such as equipments. The host is the resident or client that is on the nursing home facility. According to Williams (2008), resistance to pathogenic microorganisms may vary greatly from each individual. Microorganisms can be transmitted by variety of routes and the same organism can be transmitted by more than one routes. According to Cole and Lai (2009), there are common modes of transmission of infecti on in the nursing homes that every staff can prevent by just executing correct infection control procedures. However, the student has chosen the most common types that were being noticed in the workplace. These are 1. Person-to person, 2. Food-borne, and 3. Hospital Acquired Infections (HAIs). Cole and Lain (2009) briefly describe person-to person spread as a conveyance of a certain disease condition to another individual. Person-to-person spread of infections may be airborne, faecal-oral, blood-blood or skin-to-skin. The most common infectious diseases the student noticed over the past few months were colds and flu. The spread of the infection to each person was so massive despite flu vaccination several months before the onset. The residents that were affected with the viral infection were treated with several courses of antiviral medications and antibiotics. Aitkenhead (2009) indicated that anti-viral medication is currently under-used for older people in care homes in the UK. Isolation was also done to severely affected residents. According to Cole and Lai (2009), isolation may be done to residents if they acquired infectious or communicable disease; they may also be place on isolation if a certain individual has been suspected of any infectious disease. Despite doing procedure, flu virus was able to spread on few of the residents and staff. False handing or poor infection control procedures must have caused the break in isolating the resident with infection. Food borne infection had also been very common among care homes. With this, according to Ashurst (2007a) on her article, nursing homes and hospitals in the United Kingdom are now subject to strict environmental health inspections to monitor the premises, and making sure that foods that are served are safe for consumption. As being observed by the student in the workplace, all kitchen staffs are handlers of basic food hygiene certificate as part of their induction programme. Kitchen staffs were taught about the principles of food hygiene with emphasis being placed on high standards of personal hygiene, including hand washing. As stated in Ashurst (2007b) in her second article, food safety should never be taken for granted, as people may lost their lives as direct result of the staff failure to follow agreed policies and procedures. This matter is to protect both the residents and staffs from potential harm. Food poisoning, according to Ashurst (2007a), is caused by poor hygiene and, in particular, is caused by the contamination of ready-to-eat food with food poisoning bacteria. From the students basic knowledge, poor temperature control of ready-to-eat food may also cause of bacteria to multiply in large numbers. The best environment for most bacteria to grow and increase in number is a moist environment between 5 °C and 60 °C. This range of temperatures is known as the growth or danger zone (Fisher and Hartshorn, 2005). Undercooking may also cause poisoning since this enables food poisoning bacteria to survive. Hospital acquired infections, according to Gaspard et al (2008), is an infection acquired during hospital care which was not present or incubating prior to admission. Among reported case of nosocomial infections on the students work place, MRSA or Methicillin-resistant Staphylococcus Aureus is the most common. Common types of person to person infection in Nursing Homes in the UK There have been a number of outbreaks on infection in the Nursing Homes in the UK, according to Nararco (2005). Few of these infective diseases are Flu, gastrointestinal conditions, pneumonia, urinary tract infection, and scabies. Wound infections had also been very common in residents, especially those who developed decubitus ulcers or bed sores. Each of these infectious conditions will be discussed by the students. Influenza is defined by Daniell (2004) in his journal article as an acute viral, respiratory infection causing the temperature to rise quickly, with profound malaise, headache, myalgia, congested nose, cough and breathing difficulties. For otherwise healthy individuals, influenza is an unpleasant but usually self-limiting disease; this normally resolves in 7-14 days. Flu continues to cause outbreaks in care homes and in the community (Benison, 2006). The student was able to observe that influenza outbreaks occur readily in elderly care homes. They strike rapidly and are frequently associated with widespread severe illness and deaths. Eleven years ago, According to Nguyen-Van-Tam (2000), in Britain, outbreaks are frequently detected too late in their course when the options for effective intervention are few. Flu vaccinations are being given to staffs and clients during outbreaks. Vaccination against flu must also be given to staffs considering they are exposed in both setting inside and outside the care home. Whilst this cannot be applied to all situations it is advisable in some circumstances. It should always be combined with other infection control efforts however to ensure complete protection. In conjunction with vaccination is post exposure prophylaxis, this is used where vaccines do not exist after contact with infection has occurred (Booker, 2004).  Staff spend a lot often time with residents, and can infect vulnerable residents inadvertently. If staff have flu vaccinations they are very unlikely to bring the flu virus into the home, therefore reducing the risk of older people getting flu (Daniell, 2004). The flu immunization season, which is the beginning of winter season, is a busy time for the nurses but its preventive value cannot be overestimated. If an outbreak of flu does occur, anti-viral medication can be used (Eriksen et al 2007). According to Benison (2006), the combined use of immunization and targeted treatment with antiviral agents can e ffectively control the serious impact of seasonal influenza on vulnerable communities of residents in care. Scottish researchers found that giving flu vaccinations to nursing staff working in nursing homes reduced death rates (Booker, 2004). Flu Vaccination can highly reduce death rates and prevents vulnerable older people who develop flu from becoming increasingly disabled. Second condition that had been known to be very common is gastroenteritis or diarrhoeal problems. According to Ashurst (2007a), this condition is very common and extremely infectious and affects approximately 1 in 5 people are affected by the condition in England every year. In which at least 50% of cases of gastroenteritis are due to  foodborne illness  are caused by  norovirus. This can be acquired from contaminated foods and water. However, this can easily be prevented by frequent and correct execution of hand hygiene since bacteria can be transferred this way through poor hygiene. For example, if someone does not wash their hands after going to the toilet. For this reason, staffs and residents are encouraged to perform hand hygiene after using the bathroom or changing incontinence pads. Any viruses or bacteria on their hands will be transferred to whatever they touch, such as a glass, kitchen utensil or food. As per Doctors recommendation every time a resident experiences this kind of condition, nurses in the workplace, including the manager, must assure that food be properly cooked and stored to prevent gastroenteritis. It has also been encouraged to thoroughly wash both hands before eating and after. Bleaching soiled laundry and household surfaces may also help prevent spreading bacteria caused by gastroenteritis (Parker, 2004). Based on the students observation, Pneumonia has also been common to the clients in the nursing home. According to Booker (2004), pneumonia in nursing and residential care homes may be different from that found in the general population. Mortality is also higher this group. According to Metha (2009), pneumonia vaccine is important since there had been reported outbreaks of pneumonia in unvaccinated clients in some nursing homes within the UK and even in United States of America for people who are aged 65 years and above. According to Roberts (2004), the bacteria that cause pneumonia can become extremely resistant to any types of antibiotics in nursing homes, and when the disease occurs, it can be difficult to treat. As being observed in the workplace, nurses determine new residents vaccination records to determine the need of the vaccine and the risks. As the student involves himself in the caring of residents with Pneumonia, good, general nursing care is vital. Adequate rest had bee n encouraged and smoking- discouraged. The patient may well be agitated and fearful and will need plenty of reassurance. Urinary incontinence is one of the most common and disabling conditions affecting a frail elderly individual (Hampton, 2004); this can also lead to the use of indwelling catheters for some. According to Nazarko (2009), urinary tract infection (UTI) is the most common healthcare-acquired infection in the UK. So far, based on the students observation in the workplace, UTI due to long term indwelling catheterization has the highest rate of prevalence and reoccurrence. With the general knowledge the student has, patients should be monitored at regular intervals; communication between carers and relatives should be effective to promote understanding how and why long-term catheters should be maintained. Catheter care is a nursing procedure and its importance is sometimes overlooked. According to Harvey (2007), it should be addressed by education and self-directed learning. Practices such as routine catheter irrigation should be avoided and the NICE guidelines recommend that bladder instill ations or washouts must not be used to prevent catheter associated infection (Brown, 2006). However, if necessary, perform appropriate catheter care and consistently use appropriate infection control guidelines while maintaining a closed drainage system. In the workplace, the use of bubble bath/oils, perfumed soaps and talc around the genitals should be avoided as they break down the bodys natural protective flora. Also, common tradition on the workplace to prevent or treat UTI is to offer cranberry juice to the residents. However, frustratingly, a study of Hampton (2004) concluded that there was no good quality or reliable evidence for the effectiveness of cranberry juice in prevention and treatment of UTI and that more research is needed. It was also confirmed in the study by Harvey (2007) that claims that Cranberry juice, on a daily basis, will not have any effect greater than that water in preventing UTI. If an older person becomes suddenly confused, its not an indication that the elder must be developing Alzheimers Disease (Brown, 2006). It has also been observed by the student in the workplace that some staffs may mistakenly assume that confusion is normal for all older people. Staff seeking advice from a healthcare provider regarding a quick onset of confusion may be surprised if the doctor orders a urine specimen. Actually, a urine specimen is not a bad idea since urinary tract infections are a common cause of delirium in the elderly (Goldrick, 2005). Scabies had also been one of the causes for outbreaks in the UK nursing homes (Nazarko, 2005). This can easily be spread by staffs, relatives, visitors, and residents since close prolonged contact causes the transmission. In this case, the student ensures all staffs must wear gloves and aprons upon dealing with infected individual. The infected individual must also be taken for a bath or shower everyday with the aid of medicated soaps and shampoos. Bed bathing is still a nursing skill that is greatly appreciated by patients but it can be associated with cross-infection. According to Parker (2004), bowls used to bath patients are often stacked inside each other in the sluice and poorly cleaned. Infection control nurses have tried to have this practice changed so that individual bowls are kept at each bed space and cleaned after use. Wound infection had also been one of the most common infections found in the nursing homes. However, as the student able to perceive, it the less common among all of those infective diseases mentioned earlier. There is little information on the development of wound infection within the nursing and residential care settings. Wound infection can be a huge burden on the patient and relatives in terms of pain and suffering, with the added threat of a resultant systemic illness (Russell, 2006). Skin had been considered as the first line of defence. In healthy people it is intact and even if a person has contact with microorganisms, they can be removed by washing. The treatment of wound infection has been and still is a subject which is debated within literature (Timmons, 2003). Based on the students basic understanding, in order to help prevent wound infection in any care setting, it is vital that basic infection control protocols are followed. Correct hand-washing technique is essential to avoid the transfer of bacteria from staff to a resident. As a protocol on the nursing home where the student works, residents with infected wounds should be isolated if possible, and wounds should be reassessed regularly to avoid further complications. The principles of aseptic technique should be followed in order to avoid cross-contamination among residents. Preventing pressure sores in the vulnerable elderly is complex. The literature written by Russel (2006) clearly highlights the importance of early and continual assessment of the individuals risk of pressure sore development and implementation of preventive strategies. As being observed by the student, senior nurses and managers of the home regularly inspect and ensure proper training of the staffs since lack of knowledge is a contributing factor that should be addressed by the provision of education and training so that all staff possess and implement evidence-based practice. This should be supported by strategies to provide guidance on the prevention of pressure sores. Skin care ha d been part of the daily routine for nurses and carers in the nursing home. The skin should be kept clean and dry, perfumed soaps and cleansing agents must be avoided because they cause excessive dryness and irritation (Timmons, 2003). In cases of incontinence or if the area is contaminated with urine or faeces, it is best to wash the area with warm water and pat dry with towels or soft tissues. Impact of poor infection control practice Having robust policies and procedures in place for infection control is fundamentally important. However, each organization has to go a step beyond this (Flanagan, 2009). As care homes fill with increasingly vulnerable elderly, control of infection within long-term care facilities becomes a daunting problem (Cole, 2007), with residents developing similar infections to acute care facility. Elderly patients are at particularly high risk of contracting infection because of reduced innate immunity, malnutrition, and the presence of chronic medical conditions (Roberts, 2004). According to Maudsley (2004), poor infection control practices may lead to common infections such as urinary infection, respiratory infection, and skin and soft tissue infections, resulting in increased costs to the health service, extended durations of care and substantial morbidity. Aside from that, infections acquired by infected residents or individuals may spread to other, which cause a serious problem on contro lling and containing. People requiring care in hospitals, care home clinics, doctors surgeries and their own homes may have an infection or may be at risk of picking up infection from other people (Cole, 2007). Staff and visitors are also at risk of infection. Staffs in a healthcare facility may also be considered as the main transporter of the disease itself. According to Hampton (2003), education in infection control and attention to employee health is essential to enable staff to care appropriately and prevent the spread of infection for todays care home population. Antimicrobial Resistance According to Brown (2006), overuse of antimicrobials may lead to increase resistance in many pathogenic bacteria of viruses. As observed by the student during every consultation, General practitioners usually prescribe oral broad-spectrum agents such as cephalosporins. Although many antibiotics initially prescribed are broad-spectrum, which is capable of killing a wide range of bacterial types, each antibiotic has limited effectiveness against certain types of bacteria (Goldrick, 2005). If an infection does not resolve, the antibiotic being taken may not be compatible with the bacteria causing the infection. Antimicrobials are specific as to the type of organism they work for and they should not be used for a purpose that is different from that for which they were prescribed (Nazarko, 2005). In line with El-kadikis (2005) article, unwarranted use of antimicrobials can partially mask symptoms and delay the exact diagnosis and recovery. Unless directed by the prescriber, antimicrobials should not be administered before the service user has symptoms (prophylactic treatment) because that increases the risk of resistance developing. According to the General Health Protection-Department of Health (2006), nurses must ensure that General practitioners (GP) do not prescribe antibiotics unnecessarily for the residents. It is important that antimicrobials are administered appropriately to ensure successful treatment and reduce the development of resistance. Policies and Procedures According to Nazarko (2007b), there are several policies that the National Health board formulated to implement healthy practice within the care home setting. These policies are implemented in every Nursing Home; as observed, the manager also ensures that these policies and procedures are made available to the staffs for all the time. This may ensure that written policies, procedures and guidance for the prevention and control of infection are implemented. The manager also engages staff throughout the care home to promote and secure the implementation of best practice in the prevention and control of infection. In the nursing homes, there are several infection control procedures. On where the student works, hand hygiene, disinfecting, personal protective equipment, and safe use and disposal of sharps are the very common practices. These practices are beneficial to both the residents and the staff. The practice of these procedures can also be found in the Infection control manuals that are located in all units in the nursing home. As mention on the previous section, the manuals are placed in a certain area of the institution to make it accessible to all the staffs. From the manual, aseptic techniques based from the UK standards were identified. There are 3 aseptic techniques that are commonly identified by the UK healthcare system. These are 1. Hand hygiene, 2. Personal Protective equipment and 3. Safe use and disposal of sharps. The student will discuss briefly on the later part of this essay. Hand Hygiene The most basic aseptic technique found to be the most common is Hand hygiene. On the study made by Knoll and Lautenschlaeger (2010), demonstrates compliance of the staffs in the nursing home with regard to hand hygiene guidelines can be significantly influenced by a number of factors. According to the research article by Rickard (2006), the link between hand hygiene and the infection rate in healthcare establishments is not in doubt. Research articles and reviews have demonstrated the evidence that increased hand-hygiene performance reduces the infection rate. Careful infection-control practice, including frequent hand washing, will remain critical for limiting the spread of infection. Also, very importantly, is the availability of soap, hand towels, disinfectant and disposable cleaning cloths. Infection control is an extremely important aspect of health care. Based on the research by Gould (2001), cold and flu may also be acquired by failing to perform hand hygiene. The cause of the increase of incidence of flu in the nursing homes must be from noncompliance of basic hand hygiene. It was also reported that improper or failure to perform hand washing can cause pneumonia in older people and in people who are diagnosed with chronic illnesses (Stanwell-Smith, 2008). Based on what the student found out, several journals that discuss about the cause infections in the health care setting were mostly from the staffs poor hygiene practices. Although these measures are all important in the prevention of cross-infection, they are not likely to be used appropriately without education and monitoring of hand washing and cleaning practices of all staff. Personal Protective Equipment Infection control is also concerned with personal protective equipment or PPE. Personal protective equipments in the workplace are also used such as disposable gloves and plastic aprons. By definition by Williams (2008), Personal protective equipment or PPE is a specialized protective covering worn by an employee for protection against infectious materials. The use of PPE is essential when working in a healthcare setting. The purpose of PPE is to prevent the worker from coming into contact with infection. Usage of PPE promotes health and safety upon working with clients (Brown and Nay, 2006). From the students basic experience, the most basic principle of infection control based from the infection control manual is to work from clean to dirty. In this instance, this refers to getting in contact with clean body sites or surfaces before touching dirty or heavily contaminated areas. This method prevents any debris from spreading toward the cleaner surface. This principle had been compet ently practiced by the staffs on where the student works. Safe Disposal of Sharps Safe disposal of sharps is the third most practiced infection control procedure in the healthcare setting. Ideally, the contaminated syringe needles, scalpel blades, and other sharp devices should be thrown away in a sharps bin (Aitkenhead, 2009). As being observed by the student, sharps bin are located in a protected room in the nurses station where residents with mental incapacity, such as dementia, will not be able to gain access on the bin. Based on the article by Trim (2004), numerous staffs sustain sharps injury. In his definition, sharps injury is an injury where a sharp material contaminated with body fluids, penetrates the skin. Majority of the sharps injuries are avoidable and happen when they are handled or disposed in an unsafe manner. Aside from these three main techniques to prevent spread of infection in the nursing home, there are some other protocols the students workplace implements. Among these are provision of yellow bins, plastic bags and red hampers. Waste Segregation, Use of Bins, and Laundry Waste segregation had also been part of infection control. According to Conrardy and Hillanbrand (2010), the safe and effective disposal of waste starts with the healthcare professionals or practitioners. Staff in the nursing homes had been instructed to dispose infectious waste such soiled dressings, catheter bags, incontinent bags, etc. in the yellow bin and domestic waste on the black bin. Nappies and incontinence pads however are thrown in black bins. The protocol of pads disposal on where the student works is being followed by staff. Soiled nappies and incontinence pads are being wrapped with plastic bags prior to disposal on the black bin. Aside from that, instructions are given to staffs to be familiar with the waste management policy and procedures for health care waste management. The policies and procedures manual for waste management is accessible to everybody as it is together with the infection control manual. According to Ashurst (2010), it is part of the Care Quality Commissions responsibilities to ensure that care homes meet the requirements of the national agenda for infection prevention and control; this includes monitoring laundry facilities. Based on the practice on where the student works, soiled linens are placed on a special kind of bag before placing in to red hampers. Dirty linens are being handled with extra care paid to the potential spread of infection. It is also stated on the manual that gloves and disposable plastic apron should be worn upon handling of soiled garments. It is impossible to avoid all contact with infected tissue or potentially contaminated body fluids, excreta, and secretions. Appropriate barriers such as gloves should be used when handling potentially contaminated linen followed by hand hygiene after removal of the gloves. If a certain material is reusable, transmission of infective agents is prevented by cleaning and by appropriate disinfection or steril ization. All staffs have a responsibility to prevent and control the spread of any infection that may threaten a care home with vulnerable older people in residence. Laundry services also have the potential to set a positive impression for visitors. Staffs working tirelessly behind the scenes in the laundry are sometimes in danger of being forgotten, so their major role in ensuring safety through infection control and securing the homes reputation must be acknowledged. It is not just about utilising the most efficient chemicals and cleaning solutions in order to prevent infection. The training of staff can also be seen as an important preventative measure. If workers can understand and appreciate the issues concerned with infection control and management it is more likely they will follow procedures. Application to Practice It is not just prevention that makes up infection control, the process of surveillance and investigation can also be involved. Fundamentally this is the detection of infection origins and symptoms in order to develop efficient preventative measures. The student has gathered information regarding infection control and may also be helpful to some staffs, residents, and even relatives. On the recent learning that the student was able to gain upon the composition of this paper, he may be able to share the knowledge regarding infection control towards other staffs, especially those who involve in direct care to the clients. Ideal procedures and latest evidence-based practices may also be implemented when students knowledge will be shared. The basis of infection prevention and control is the attention to hygiene. Microorganisms can be found everywhere and the cleanliness of individuals, equipment and the environment is essential in reducing the risk of infection. Paying attention to the ba sics of nursing practice such as bed bathing, oral hygiene, nutrition and elimination is not only part of the caring aspect of nursing, but also necessary for preventing cross-infection. The Infection Control Nurses Association devised a tool to determine of certain. According to the NHS Chief Medical director, Mr. Donalson (2005), this infection control audit tool for primary and community care settings builds on previous work for acute Trusts and provides a standardised method for monitoring both clinical practice and the environment. The feedback may enable the staff to know and systematically identify the points where improvement is greatly needed. Thus, enables them to give minimize infection and give quality care for the residents. However, this type of tool was never implemented by the manager on where the student works. Perhaps, knowing the existence of this tool may be very helpful to the company when introduced

Asher Levs Crucifixion Paintings as an Act of Disrespect Towards His P

Asher Lev's Crucifixion Paintings as an Act of Disrespect Towards His Parents Asher Lev paints against the values of his family and community. He disregards Jewish traditions and observance by pursuing his passion for art. His individuality has him disobeying the Rebbe, the mashphia, his mythic ancestor as well as his parents. Asher does not intend for his artwork to be harmful, but that they convey truths and feelings. Yet, the Brooklyn Crucifixions cause shame for his observant Jewish parents. In that way, he disrespects their teachings and wishes. He challenges the Jewish belief on modesty in creating nude works and disturbs the Hasidic community in his Christian imagery. Worst of all is the reflection of the life-like representation of his family in the paintings. This causes a shocked and angry reaction from the public. The climax evolves towards the last chapter of My Name is Asher Lev, when Asher's parents react hurtingly after the paintings are exposed to them in the New York Museum. Chaim Potok writes their reaction as happening slowly in a step-by-st ep movement; in silences; building up readers' expectations of a negative outcome. Guilt and fear of disobedience induces a silence from Asher. "They're not the truth, Papa; but they're not lies either". Asher appears to be speaking in his mind while thinking of the memories that the pictures portray. He disregards his father's lesson on how 'one Jew can cause the rest of the Jews to suffer'. Asher feels his disrespect as a son and justifies himself in his mind, but does not speak to his parents about the Cruxifixion paintings at all. Disrespect for his parents makes Asher scared. He anticipates their disappointment and hurt. Readers sympathize in acknowledging his inner suffering as he struggles to communicate freely with them. Asher fears his father's reaction more than his mother's reaction for it is his father that disapproves of Asher drawing in the first place. The father appears to be the one who should be feared the most. Other characters suggest this, for example, Asher's teacher who says,"What will your father say if he saw this?" in regards to the picture of the Rebbe Asher drew in his Chumash. His mother is more supportive of Asher and just wants him and his father to get along. After finishing their journey for the Rebbe, she says " I want you and your father to be friends", The te... ...an ugly sickening picture of the boy at school. Asher and his art is an ultimate form of disrespect towards his parents and perhaps the Jewish community. They warn him of the day of hurt and resent like the opening day of Asher's paintings in the New York Museum. Asher's father returns from Russia, and says "Do not forget your people Asher" It is the same as if one Jew aches, the whole community hurts, Asher's mythic ancestor haunts him in his dream, and indicates that his art is a waste of time at the end of Chapter 4. It is Asher's 'gift' that separates him from the Jewish community. He causes so much pain for his parents and the community that the only resolution is too send Asher away, which the Rebbe does at the end. Like the father and the mother, Asher is journeying for him to prevent Jews from suffering. The conclusion ends with Asher's parents watching in silence as Asher's cab pulls away. Similarly, at the museum, he had watched his parents, who did not utter a voice or a glance at him, pull away in a cab. In his parents' eyes, Asher has crossed the boundary of obedience and disrespect, with such immense rage and hurt that it causes a deadly silence between them.

Judicial Activism :: essays research papers

Judicial Activism: A Necessary Action   Ã‚  Ã‚  Ã‚  Ã‚  Judicial activism is rarely needed, but when it is employed, it is only in the most dire of circumstances. It is the broad interpretation of the constitution of the United States by the Supreme Court. Some argue that this should not be done, but if it had not been, slavery would still exist in America. It is obvious that in some cases, it is necessary to expand civil rights beyond what the constitution explicitly states. This was the case in Brown v. Board of Education. 9 black students were allowed into a white school, previously segregated. This was the landmark case in the battle for black civil rights. The judicial activism displayed by the Supreme Court led to an end to segregation, social equality for blacks and allowed them to reach respected positions in the American society.   Ã‚  Ã‚  Ã‚  Ã‚  A major effect of the Supreme Courts decision was the desegregation of schools everywhere. Integration became federal law, and schools could no longer bar applicants based on race alone. By enforcing this law, the Court allowed blacks to recieve the same education as whites and effectively removing their status as second-class citizens. They were one step closer to being fully accepted by the white majority. The integration of children's schools was a controversial step, and many southerners opposed it with extreme prejudice. There were riots to oppose this move, but eventually the chaos was subdued and after order was restored, schools were fully integrated. Black children were now on equal footing with white children and could no longer be called less intelligent, as they would recieve the same education. Also, this case led to the 15th amendment, giving blacks the right to vote. This was an important event, effectively making them complete citizens, legally equal to white men in every way. They could now vote for the president, a key part of the representative democracy present in the United States. They became able to directly affect the law, by voting.   Ã‚  Ã‚  Ã‚  Ã‚  Social equality was a major gain for the blacks. As a result of this case, and others after it, they became increasingly accepted in a previously white-dominated society. With any form of discrimination outlawed and punishable by law, there was no way they could be kept from their rightful position as equals in every respect. Lawsuits against discriminators became increasingly common, and the mindset of the common American was one of tolerance and compassion for

Chemistry Coursework †Fuels Essay -- GCSE Chemistry Coursework Invest

Chemistry coursework – Fuels Planning ======== Aim --- In this investigation I will have to find out which of the alcohol fuels: methanol, ethanol, propanol and butanol, is the best. The ‘best’ one will be the one which creates the most energy whilst burning. Introduction and prediction --------------------------- A fuel is a substance burned for heat or power. The best type of fuel is one that: can be transported safely without the worry of it catching on fire, gives out a lot of heat for a certain mass, does not cost very much, lights quickly, burns slowly, is safe to use and does not give off any form of polluting gases. When burning alcohols, as I am going to do in this investigation, the reaction is exothermic as heat is given out. Breaking the bonds of the original alcohol by burning requires energy-it is endothermic, making the bonds of the new products of burning the alcohol ie carbon dioxide and water gives out energy-it is exothermic. I predict that Butanol will require the most energy as it has the most bonds holding the carbon, oxygen and hydrogen atoms together. Propanol will require the second largest amount of energy, Ethanol the third and Methanol the least amount of energy to break these bonds. Methanol CH3OH Ethanol C2H5OH Propanol C3H7OH Butanol C4H9OH Pentanol C5H10OH Therefore I predict that Methanol will be the ‘best’ fuel, followed by Ethanol, then Propanol and the worst fuel will be Buta...

Artists and Self Portraits

Why would someone take the time to create a work of art that merely resembles themselves? To answer this, one must understand the famous artists of the past, both visual and literary. When analyzing a self- portrait, one notices that it often goes beyond the visual characteristics of the author. Minute details that can be easily overlooked frequently delve into the artist's personality and can sometimes make the viewer look deeper Into themselves. To answer the why of self-portraiture, one must understand the how.By comparing the tertiary elements of Portrait of the Artist as a Young Man, by James Joyce, to the artistic techniques utilized by legendary artists In their self-portraits, one learns the reason of why someone would create a portrait of themselves. When making a self-portrait, It takes much more than simply looking In the mirror and copying what one sees either In text or through art. To make a self-portrait, the artist must look Into themselves and select their most Impor tant qualities that they want to show to the world. Jockey's original version of Portrait of the Artist as a YoungMan, known as Stephen Hero, was comprised of over nine hundred pages and his siblings were major characters. In the revision that made it his portrait, he decided to get rid of a few hundred of those pages and to focus exclusively on the psychological growth of his alter ego, Stephen Deals. While it must have been difficult for Joyce to completely take out a majority of his work from the published product, the more precise version gave readers a true sense of Joyce and what moments in his life affected his process of growth from a young poet to an accomplished writer.The selective process is one of the most important elements of elf-portraiture. Another important aspect of self-portraits is the use of color; in literary portraits, the use of diction. The best way to describe the importance of the two was explained by Vincent van Gogh, â€Å"Instead of trying to reproduc e exactly what I have before my eyes, I use color more arbitrarily, in order to express myself, more forcefully. † Van Gogh understood the importance of colors and how they can affect the overall message off self-portrait.In a portrait that he painted right after being admitted Into a psychiatric hospital (image 1), the background is dark blue and his shirt Is almost the same color. Because the shirt does not have a definite outline, It gives the Illusion that he is fading into the dark abyss of the background. After spending more time In the hospital, he painted another portrait (Image 2). Even though the actual Image of him is almost identical to the previous portrait, It evokes a completely different set of emotions because of the lighter colors he used.The light blue tones make the painting feel relaxed and calm whereas In the previous painting, the dark color makes It feel ominous and depressing. Van Sago's quote can also be applied Joey's writing. In the years after Step hens childhood, he never Just states what Is going on In the world around him; his Dalton and perspective always affect It. The Dalton he uses not only describes his surroundings, but It describes him as well. HIS choice of diction gives the reader Insight Into his personality and his opinion without directly stating it. When talking about prostitutes, he has two very different views.In rebellion, his encounter with the prostitute is very emotional and almost loving. He refers to her as â€Å"a young woman dressed in a long pink gown† and uses phrases like warm and lighthouse,† â€Å"embraced him gaily,† and â€Å"tears of Joy and relief shone in his delighted eyes† to show his happiness and comfort in the presence of the woman. In the third chapter, when Stephen is beginning to close himself off emotionally, he calls prostitutes â€Å"whore's† and describes them using words like â€Å"squalid,† â€Å"yawning lazily,† and â€Å"cluste rs of hair† which accentuates his hardened opinion towards them.Easily overlooked, the use of color and diction changes the overall meaning of self-portraits by conveying feelings that otherwise would have been missed. In addition to color ND diction, small details are another vastly important aspect of portraiture that usually go unnoticed. An artist who understood how small details could express personality and advertise oneself was Judith Leister. She knew how to make people feel as if they knew her when they looked at her portrait.Her self-portrait emphasizes the importance of small details and what they can add to the message of the final product. In her portrait (image 3), her posture alone says many things about her personality. She is leaning back with her elbow on the chair facing towards the ewer which shows that she is confident in what she is doing and takes pride in her work, eager to show it off to any who interrupt her when she is at work. Her facial expression shows that she is happy, outspoken, and has a warm, welcoming attitude towards people.The other miniscule details that she included in her portrait may have been a clever form of self-promotion. The painting she is working on in the picture is of a man playing the violin; she was known for painting lively, happy scenes so by having it in her self-portrait, she is saying that painting these scenes is an important part of her. She is holding eighteen brushes in one hand which shows that she is a talented artist and the clothes that she painted herself in show that she is wealthy and successful.These details could be used to entice potential patrons to hire her because by seeing her portrait, they believe that she is a talented artist who is confident in her work. Like Leister, James Joyce also understood the weight that small details carry. When describing people, Stephen only gives the person's description and actions; he never gives his actual opinions of them. The details that e in cludes shows what stood out to him in the moment and which features of the person were the most important. One character that Joyce gives a personality to through details is Vincent Heron.Heron and Stephen had been competing in school for as long as the two can remember yet Joyce never outright says Stephens opinion of him- it is blatantly stated through the details that are included. The first thing that Heron says is â€Å"Noble Deals' in a high throaty voice. † He then lets out a â€Å"soft peal of mirthless laughter,† and brandishes his cane. Beside him, he has an intimidating yet intelligent friend who agrees with everything Heron says. From these few details, much can be said about what Stephen feels is Heron's personality.From the way laughs and the fact that he carries a cane with him, it is obvious that he is arrogant and believes himself to be better than those around him. It also shows that Heron is a powerful manipulator. His fake laugh, the way he addresse s Stephen and the fact that a more powerful man is his inferior shows that he knows how to interact with people in a way that results in him always having the upper hand in a situation. Small details can have on self-portraits. In addition to these elements of self- portraiture, motifs are significant as well. Might not a painter's choice of lines and colors give an indication of his character, whether it is noble or common? † Paul Gauguin believed that the way in which a person makes their portrait says the most about them. In his Self-portrait from 1889 (image 4), he paints himself among many different symbols. The halo above his head symbolizes him as almost being an angelic figure yet he is holding the snake of temptation between his fingers. He is also within reach of the apples of the Tree of Knowledge which means that when he as painting this, there was a temptation that he had to refrain from.The fact that he only painted his head in the portrait may symbolize that he felt lost in this battle of good and evil and that he felt out of control. The bright red of the background also adds to the chaotic feeling. By painting himself interacting with all of these symbols, it may be his way of conveying his battle between good and evil into a portrait. His painting of the motif showed that he felt there was a hectic struggle going on in his life that affected how he saw himself. Joyce also put emphasis on the power of outfits.In Portrait of the Artist as a Young Man, a major motif that is applied throughout the story is that of temperature. When Stephen was happy and comfortable, Joyce did not have to say it; he made a reference to something that was warm that was a signal of Stephens happiness. When Stephen was depressed and felt lost, something about the situation felt cold. While at Clones, a boarding school that he hated, he always felt cold and uncomfortable and when he thought of being at home to comfort himself, he would feel a wave of warmth wash over him.The motifs that artists use to further their self-portraits often elevate them to a level that takes deep comprehension to understand. So why would one choose to make a self-portrait? Some may say that self-portraiture is a selfish act; merely a way for one to immortality themselves, a way to have a representation on earth long after they are gone. However, James Joyce describes how his self-portrait came to be the best, â€Å"Think you're escaping and run into yourself. † When Joyce first started to write Stephen Hero, he was attempting to distance himself from his embarrassing, poetic sat.Yet as he began to put more into the work, he began to delve deeper into himself, realizing what made him the man he was and what he contributed to the world around him. Self-portraits force the artist to embark on a Journey of self- discovery. They make it possible for the artist to warp the person that the outside world sees into the person that they see themselves as or the pe rson they wish to be. While self-portraiture may have selfish results, the process of creating a self-portrait is the artist's way of understanding themselves, inside and out.

Brief Literature Review

Pelvic examination is an important component of the primary care of women especially by internists. This study conducted an internist-run education program that consisted of 4 weekly patient-care sessions with 2-3 patients under a resident internist. They supervised each pelvic examination and gave real-time feedback and used a skills-assessment checklist during the first and last exam of the program to yield a comprehensive and formative feedback.Number of questions used in the questionnaire was not distinctively discussed, though it was stated the questionnaire was administered twice, first prior to the program, then the second questionnaire was administered after 3 months. With regards to the questionnaire, a 5-point Likert Scale was used in this study to asses results. Based from the results, the patient’s self-assessed competencies have improved and it may help increase the likelihood of residents performing pelvic examination in primary care.(Goldstein C. E. , 2005) The second study evaluated the effects of an in-service program on the perceptions, knowledge and concerns of nursing faculty members about students with disability. 112 faculty members were trained in 8 nursing programs. The number of questions utilized in the study was not specifically stated, though it a definite Likert Scale of 6-point was used.The areas aspects which the Likert Scale dealt with were legal issues, classroom strategies, clinical teaching strategies and accommodations Likert Scale was administered to the faculty members to rate their awareness of whether people with disabilities could succeed as nursing students or professionals. The results of the questionnaire were reported in terms of an average value or the mean ratings, which was defined or found out to be approximately 4.From this result, it was concluded that there was a big significance on the faculty members’ perception before and after the training. The results of this study suggest that faculty membe rs’ perceptions, knowledge and concern can be positively affected through training. (Sowers J. A. , 2004) The third study utilized a modified Course Experience Questionnaire (CEQ) to assess the teaching of medical communication skills. First year college students completed a CEQ that would be potentially useful in evaluating innovative programmes and securing support for their development.In this study, a course experience questionnaire (CEQ30) having 30 questions was used, which was an innovation of the course experience questionnaire (CEQ25) (Broomfield & Bligh, 1998) having 25 questions only. In this questionnaire, five items were devoted specifically to on medical communication skills teaching. The questionnaire which was administered used a Likert Scale of 5-points. The developed questionnaire was employed to test whether it’s applicable or not in evaluating the medical communication skills teaching Measures: In 1997 to 1998.Results were reported using average val ues, stating the number of principal components factor analysis of responses equal to 165. From the results, it was found out that the CEQ30 was a reliable instrument to evaluate a course design. (Steele G. , 2003) The fourth study is about the perceived efficiency of teaching methods used for health services management education. The study was conducted to bring into consideration the challenges of establishing an experimental link between teaching methods and the outcome of education in a classroom.Program directors from the AUPHA graduate programs were surveyed in 1998 regarding the supposed success of a wide range of teaching methods employed. No definite number of questions or items in the questionnaire was mentioned, and it the Likert Scale used was not specifically mentioned, only that its range varies from very effective to not very effective. The results were not reported quantitatively, but rather qualitatively, whereas the highest and the lowest ranked teaching method was elaborated.Based from the results, the authors they suggested a research agenda for measuring the education outcomes in a classroom. (Hilberman D. W. , 2000) The fifth study is about the participation in continuing nursing education programs by staff development specialists. Staff development specialists were surveyed regarding their reasons for their participation in continuing nursing education programs. Hospital-based staff development specialists from the American Hospital Association member facilities responded to the Participation Reasons Scale (PRS).No definite number of questions was mentioned in the study, though it was mentioned that a Likert Scale with a rating of 1 to 7 was used. The Likert Scale was used to determine if it was effective or not, where results were presented in terms of mean scores. It was found out that the average scores of the Hospital-based staff development specialists in the Likert Scale was 3. 52 to 6. 40. Results were also reported that there wer e significant differences in the responses. Furthermore, the results showed a statistically significant difference in the responses of certified and noncertified staff development specialists.It was stated that the result scans help continuing education professionals make decisions and programming, though further studies were still recommended. (Aucoin, J. W. , 1998) The last study investigated whether physiotheraphy students’ attitudes towards physiotheraphy changes during training in what way. Literature and studies on this topic is limited and there is controversy about the process of professional socialisation and attitude changes that occur during the training in health care professions. In the study, no exact number of questions used in the questionnaire was stated.Though in it was mentioned that there were 52 respondents, wherein a Likert Scale, of no definite scale mentioned, was used. The results were presented using frequencies of respondents on a particular aspect or subject which the questions tackled. The result showed no significant difference in the attitudes of the first, second and third year students. This study provides useful information which could be used to help in the selection of students and in the planning of the future courses. Also, recommendations for further studies are made.(Wadsworth, S. J. , 1991) References Goldstein C. E. , H. I. , Foldes C. , et al. . (2005). Internists training medical residents in pelvic examination: impact of an educational program. (Publication. Retrieved August 22, 2007, from The Chartered Society of Physiotherapy Library and Information Services: http://www. csp. org. uk/director/libraryandpublications/libraryandinformationservices. cfm Hilberman D. W. , D. P. L. , Andersen R. M. , et al. . (2000). Perceived effectiveness of teaching methods for heath services administration education.(Publication. Retrieved August 22, 2007, from The Chartered Society of Physiotherapy Library and Information Se rvices: http://www. csp. org. uk/director/libraryandpublications/libraryandinformationservices. cfm J. W. , A. (1998). Participation in continuing nursing education programs by staff development specialists. (Publication. Retrieved August 22, 2007, from The Chartered Society of Physiotherapy Library and Information Services http://www. csp. org. uk/director/libraryandpublications/libraryandinformationservices. cfm S. J. , W. (1991).A study to show changes in physiotherapy students' attitude to physiotherapy during training Addenbrookes Hospital Cambridge School of Physiotherapy. (Publication. Retrieved August 22, 2007, from The Chartered Society of Physiotherapy Library and Information Services: http://www. csp. org. uk/director/libraryandpublications/libraryandinformationservices. cfm Sowers J. A. , S. M. R. (2004). Evaluation of the effects of an inservice training program on nursing faculty members' perceptions, knowledge, and concerns about students with disabilities. (Publicati on.Retrieved August 22, 2007, from The Chartered Society of Physiotherapy Library and Information Services: http://www. csp. org. uk/director/libraryandpublications/libraryandinformationservices. cfm Steele G. , W. S. , Simeon D. . (2003). Using a modified course experience questionnaire (CEQ) to evaluate the innovative teaching of medical communication skills. (Publication. Retrieved August 22, 2007, from The Chartered Society of Physiotherapy Library and Information Services: http://www. csp. org. uk/director/libraryandpublications/libraryandinformationservices. cfm