Developing practitioner The WritePass Journal

Developing practitioner Introduction Developing practitioner IntroductionReflection in nursingConclusion ReferencesRelated Introduction Reflection has increasingly become an essential element of nursing professionalism. However, the term ‘reflection’ is not clearly defined in the literature and most definitions could be described as complex or vague (Atkins and Murphy 1993). Williams and Lowes (2001) define reflection as; ‘.a way of exploring and evaluating previous experiences and appreciating their value on personal practice and self.’ (pg. 1) Reflection is important to student nurses as it enables us to look at ourselves and our practice objectively. However, Mackintosh (1998), as well as other authors, are dubious that reflection can do all that it claims to do. What is agreed by nursing writers is that we can grow and mature as both a professional and a person by integrating our theory and knowledge into practice. The process of reflection can help move us from a student, to a nurse, and later to a competent and expert practitioner (Benner 1984). As nurses we should have the competencies to identify and respond to issues and make decisions that are informed and based on knowledge. All healthcare professionals make daily decisions that have ethical implications. Ethics for student nurses can be challenging as many of these decisions are emotive and students find these feelings hard to dismiss and difficult to rationalise (Clarke 2003). In their study, Ellis and Hartley (2001) found that student nurses expressed concerns over ethical problems and their ability to deal effectively with them. With the focus on a legal and ethical issue which I encountered whilst on clinical placement, I will reflect upon and critically analyse the issues raised in the incident using a recognised model of reflection. The model which I have chosen for this purpose is Borton’s Reflective Framework (1970, in Jasper 2003) which is increasingly being used by healthcare professionals as an approach for reflection. Jasper (2003) describes Borton’s model as simple and pragmatic, which meets the needs of practitioners to describe, make sense of and respond to situations. Howev er, the model has been criticised and Rolfe et al (2001) suggest it does not include the finer details of reflection and offers no prompts as to how reflection is to be conducted within each stage of the process. Even so, Rolfe et al (2001) do state that in comparison to Gibbs’s (1988, in Jasper 2003) and Johns (1998, in Johns 2005) models of reflection, it can be seen that the activity of reflection leads to action being taken in Borton’s framework, rather than just proposed, therefore moving from the realms of ‘maybe’ back into the reality of practice. The simplicity of the model and the proposal of action being taken in future situations prompted me to consider this model for this assignment purpose. Also, when reviewing the literature around reflective models, I found evidence by Burrows (1995) to suggest that nursing students under the age of 25 do not have the cognitive abilities and experience to reflect and alter their practice. Bulman and Schutz ( 2004) reiterate this perspective by implying that less mature students are more inclined to use more descriptive models such as Gibbs rather than more advanced, as these may not be of any use to them. As I would consider myself a mature student and want to develop my knowledge beyond that of a novice practitioner, taking into account the simple structure of the model as discussed, I feel that Borton’s Reflective Framework (1970) is an appropriate choice to use as a guide to my reflective account. The incident I have identified to reflect upon involves the refusal of further treatment by a patient who is terminally ill. With a view to gaining new knowledge, insights and to further develop as a nurse practitioner, I will reflect upon the ethical and legal issues that arose from this encounter. These include autonomy, beneficence, capacity and informed consent, as well as my own feelings and preconceptions. I will maintain confidentiality throughout this assignment by changing the names of those persons involved incompliance with the Nursing Midwifery Council (NMC) ‘Code’ (2008). Reflection in nursing Reflection is not just about adding to our knowledge; it is about challenging the concepts and theories as we try to make sense of that knowledge (Burton 2000). Kim (1999) argues that constructing knowledge from clinical practice is not enough and that nurses must also reflect on how that knowledge can lead to intentions to act. Several authors distinguish a gap between theory and practice in nursing (Conway 1994; Lauder 1994) and suggest that reflective practice may be the process with which to alleviate this. However, these authors do not support their claims with any evidence and are only offering opinion. The question still remains as to whether reflective practice produces better patient care as intended as there is very little research evidence on the benefits of reflective practice in nursing (Hargreaves 1997). Burton (2000) further reiterates this point by recognising that reflection relies entirely on information from patients and claims to be to their benefit, but is resear ched solely in the terms of the effects on practitioners. Reflective practice is also a fundamental concept of nurse education, with students encouraged to challenge their clinical practice and widen their knowledge base. However, Mackintosh (1998) stated that; ‘The implementation of reflection for students is as uncertain as its definition, with no guidelines or uniform method of application available.’(pg. 7) This criticism is evident in more recent literature, with Ireland (2008) and Hong and Chew (2008) both recognising that there are no definite guidelines on how to structure reflective practice in education. Writing reflective journals is one way reflective practice is encouraged in education as it allows students privacy and also to look back at previous entries to see how they have developed as nurse practitioners. However, Hargreaves (1997) suggests that reflective journals can be repetitive and time consuming, leading to boredom for the student. Hargreaves (1997) also proposes that when students are required to reflect in groups, this can lead to low self esteem as there is a lack of privacy. Also, when reflecting-on-action for assessment purposes, students may feel anxious about writing open and honest accounts in case of bad marks, leading to them writing what they think others want to hear and not the truth (Teekman 2000). When reflecting-on-action for this assignment purpose, I have been aware of these issues and this has encouraged me to reflect a true account of the incident, regardless of how difficult I may have found it to expose myself in such a way. Ethical issues relating to confidentiality also arise when reflecting, both for the person writing them and for the patient, as writing ‘stories’ about them without their consent can been seen as bad practice. However, Hargreaves (1997) argues that nurses have always ‘used’ patients and it is these experiences with patients that shape practice and it can be proposed that if a patient’s case is discussed but she has no knowledge then it can cause no harm and may actually benefit the patient directly or indirectly (Hargreaves 1997). Despite these criticisms, as opposed to giving care uncritically, reflection allows nurses to examine, question and learn from their experience and Andrews et al. (1998) recognise a danger of nursing care becoming ritualistic if it is not challenged. Using the three basic starting points in Borton’s Reflective Framework (1970) as a guide to the structure of my account, I am now going to reflect on the ethical and legal issue which I encountered recently whilst on clinical placement. What? It is important to recognise before recounting the incident, that as well as students being inclined to alter the scenario when reflecting-on-action as acknowledged, hindsight bias (Jones 1995) is also a concept by which a person’s recollection of events is influenced once they know the final outcome of the situation. Factors involved in hindsight bias are the desire to appear correct, maintain self esteem and to enhance feelings of competence (Jones 1995). Also stressful situations can affect attention and Saylor (1990) concluded in his study on recall, that for novice nurses and students in difficult interpersonal situations, such as topics on death, these are likely to cause stress resulting in less important issues being remembered. I had been involved in Mrs Jones’s care for a number of weeks and I was aware that she had returned from theatre the day before where she was to have had a secondary tumour removed. I was also aware, as was she, that she was terminally ill. I was in the room with Mrs Jones and her husband and we were chatting as I did her clinical observations. She was telling me that she was not afraid of dying and that she had been very lucky and had had a wonderful life. I felt very saddened by this and can clearly remember thinking to myself that I must remember what they told us in University about communicating with the dying patient, as I didn’t know what I was going to say once she finished speaking. In the end I decided that it was best if I say nothing rather than saying something inappropriate. This made me feel guilty at my own incompetence. The consultant then entered the room with my mentor and I asked my mentor if I should leave, but Mrs Jones insisted that I stay. The consultant then told Mrs Jones that they had been unable to remove the tumour. Mrs Jones nodded at this and said that she thought that would be the case. I suddenly felt out of my depth and wished I could just leave the room. The consultant continued by saying that he could offer Mrs Jones radiotherapy to try and shrink the tumour and prolong her life. He told her the side effects of the treatment, the frequency and also that it would not cure her, only ‘give her more time’. Mrs Jones stated that she did not want any more radiotherapy and just wanted to be pain free. I felt quite upset at this point and was trying not to make eye contact with anyone else in the room as I knew I would probably cry. The consultant continued by saying that although radiotherapy had side effects, it could add months to her life, and that there were options avai lable to help counter the side effects and that it might be worth considering. I remember thinking that Mrs Jones will probably decide on the radiotherapy if the doctor says it is the best thing to do, I couldn’t make sense of why she wouldn’t. Mrs Jones stated again that she did not want any further treatment, that she had discussed it with her family and that all she wanted was for her kids to see that she was happy, pain free and peaceful. Mrs Jones’ husband was crying at this point but told the consultant that they had talked about it and that he respected his wife’s decision and they would now like some time alone. At that the consultant, myself and my mentor left the room. The incident played on my mind immediately afterwards and although I wanted to talk with someone about it, I knew if I opened my mouth to speak I would cry so I busied myself with other things. So What? I had nursed Mrs Jones for a number of weeks and felt personally affected by her prognosis and her refusal of treatment to prolong her life. Mrs Jones was the same age as my own mother and had similar family dynamics to myself. I felt guilty that I could not offer some sort of comforting response when talking with her and during her interaction with the consultant. The feeling of guilt elevated as I felt inadequate to respond in what I felt was an appropriate manner. A study carried out by Kelly (1991) found that feelings of guilt are evident in students and appear more frequently as students gain experience. These findings are similar to those of Smith (1998) who concludes that guilt feelings in students are associated with a perceived inadequacy of personal responses and ethical dilemmas. The more experience gained, the more students felt fearful and guilty as they worry about what will be expected of them. I can relate to this evidence having worked in the health care setting for a number of years prior to starting my nurse training and now being in my second year, I have high expectations of myself and my practice. I feel that if I don’t match up to these expectations, and what I believe other people expect from me, I am letting myself and others down. Smith (1998) recognises that students develop coping mechanisms such as detachment and adopt these when they are in situations that are difficult for them. I tried to detach myself from the situation by not making eye contact or speaking as I felt out of my depth within the situation. Although detachment can be seen as a threat to the nurse-patient relationship, Smith (1998) concluded that some degree of detachment is necessary for students to maintain the ability to function and prevent breakdown. I adopted this coping mechanism to prevent myself from crying and upsetting the situation further, which appears to support the findings proposed by Smith. However in a study carried out by Kralik et al (1997) on patient’s experiences in hospital, the participants stated that, when cared for by nurses who appeared detached, it was a negative experience and they felt vulnerable and insecure. I am aware that if I allow detachment to become embedded within my future practice it may aff ect my ability to offer compassionate care to patients. Although I was aware of the knowledge around communication with the terminally ill, I was unable to reflect-in-action and apply this knowledge to practice. Schon (1983) describes reflection-in-action as the way that nurses think and theorise about practice whilst they are doing it. This is seen as an automatic activity that occurs subconsciously in practice. According to Street (1992), students experience difficulty connecting theory with the realities of practice. However, Street does suggest that there are indications that students are able to integrate theory gained in the classroom with practice, but at first it is deliberate and conscious. This evidence suggests that reflection-in-action is developed through experience. I felt upset that Mrs Jones did not want any further treatment and I kept thinking that if it was my own mother I would want her to stay alive as long as possible. I may have felt like this as I did not want to experience the grief that comes with death, which appears now to be a selfish act. The refusal of treatment with a view to end of life can sometimes be associated with voluntary euthanasia. This term involves the deliberate intervention or omission with the intent of ending an individual’s life at their request (Saunders and Chaloner 2007). Despite a Bill passing before parliament on assisted dying or assisted suicide, existing laws remain unchanged and euthanasia of any sort is illegal in the UK. However a person’s right to refuse treatment is legal in the UK and is supported in the NMC ‘Code’ (2008) which states; ‘You must respect and support peoples rights to accept or decline treatment and care’. Although the consultant was persistent in his offer of further treatment, he did not at any time disregard Mrs Jones’s decision to refuse treatment. UK law goes to great lengths to protect a person of full age and capacity from interference with personal liberty. In the case of Sidaway v Bethlem Royal Hospital (1985) it wa s stated that; ‘a capable adult has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to their own death.’ (Lord Scarman 1985 pg. 3) This absolute right has been upheld in more recent cases such as Re T (adult: refusal of medical treatment) (1997) and Re B (adult: refusal of medical treatment) (2002). The courts also recognise that in law there is a distinction between letting die (refusal of treatment) and killing a person (euthanasia), even though this is not accepted by some philosophers (Dimond 2005). Saunders and Chaloner (2007) question whether there is a moral distinction between withholding life sustaining treatment at the patients request and actively taking steps to end the patient’s life at their request. However, a concept that is shared amongst UK law, literature and philosophers is the respect for a person’s autonomy. This makes me consider whether the consultant, despite his persistence, did not disregard Mrs Jones’s decision as he was respecting her right to be autonomous. Buka (2008) proposes that to be autonomous means to be able to choose for oneself and involves individuals being able to formulate and determine the course of their own life. Autonomy consists of values and beliefs that are unique to the individual and that change with circumstances, so what Mrs Jones considered to be of value to her prior to her illness could well have changed at the time of the incident. Also what Mrs Jones believed to be of value to her could very well be different to what I would consider to be of importance. Begley (2008) acknowledges that dying well involves living well until the end of life and living well throughout the dying process depends on the responses of each unique person to the conditions in which they find themselves. Mrs Jones spoke about wanting her kids to see she was happy, pain free and peaceful, which appeared to me to be her main priority. Mrs Jones also spoke about how she was not afraid to die and that she had had a wonderful life. In their study of patients with incurable cancer, Voogt et al. (2005) found that while approximately a third of the participants strove for length of life, a third wanted quality of life. Mrs Jones’s values and beliefs may have been intertwined with an autonomous decision to die with dignity. Radley and Payne (2009) suggest that when people refuse treatment later on they want to spend quality time with their family without the side effects of treatment. Tingle and Cribb (2007) also recognise that although medicine can now provide the means of staving off death, the cost to the individual may be too high. Some may not want to spend their last days or weeks attached to tubes and drips. Tingle and Cribb further reiterate their point by proposing that it needs to be recognised that even if the pain of those who are terminally ill can be controlled, what they may fear the most is the technology that potentially leads to a loss of self-respect and self esteem. The concept of dying with dig nity is supported in UK law, and Article 3 of the Human Rights Act (1998) states that ‘no-one shall be subjected to torture or inhuman or degrading treatment or punishment’, an article which can be used to support cases of withdrawal of treatment. An autonomous person is also defined by Beauchamp and Childress (2001) as an individual who has the capacity to make decisions for themselves, as well as being competent to evaluate and deliberate information in order to reflect their own life plan. Capacity in the law is defined as the ability to understand information and make a balanced decision (Griffith 2007). Capacity is a fundamental component of autonomy and the Mental Capacity Act’s (2005) starting point is the presumption that a person has the capacity to make decisions for themselves unless it can be shown that they are incapable. Mrs Jones had been involved in decisions to do with her care throughout her treatment and the consultant knew her well. However, Tingle and Cribb (2007) suggest that patients are not very good at saying when they don’t understand and Pellegrino (2004, in Harrison et al. 2008) found in his study that patients suffering from cancer are on a negative spiral of events which may diminish their clinical competence and result in feelings of ‘powerlessness’. This evidence could suggest that Mrs Jones may have felt that she did not have the power to not only make a competent decision, but to tell the consultant that she did not understand what he was saying. The decision of whether a person has capacity is to be made at the time of the decision making (MCA 2005) and Larcher (2005) acknowledges that clinical competence may fluctuate, depending on the circumstances and compounding factors such as pain. Mrs Jones had regular analgesia to control her pain and did not before, during or after the encounter make any complaints of discomfort. She had support from her husband and was familiar with her surroundings as well as the staff present in the room. All these factors indicate to me now that Mrs Jones had the capacity to evaluate and deliberate the information given to her and make a decision that reflected her own life plan. The main principle of the Mental Capacity Act (2005) stresses that a person’s right to autonomy must be respected and can be further supported by requiring steps to be taken to maximise decision making capacity. One of these steps is informed consent. The Mental Capacity Act (2005) states that information given must include the nature of the decision, the purpose for which it is needed and the likely effects of any decision made. The need to weigh the information as part of the process of making the decision has been described by the courts as; ‘The ability to weigh all relevant information in the balance as part of the process of making a decision and then use that information to arrive at a decision.’ (Re MB Caesarean section 1997, in Griffith 2007). The consultant gave Mrs Jones information about her prognosis and treatment in compliance with the Mental Capacity Act (2005) as well as other health care policies (DOH 2007; 2008). He disclosed the factual details such as the advantages and disadvantages of the treatment and the potential side effects of undertaking further radiotherapy. However questions still arise as to how much information needs to be disclosed to the patient before consent can truly be said to be informed. As a moral matter it has been suggested that you should disclose whatever information a reasonable person would want to know plus whatever further information the actual individual wants to know (Radley and Payne 2009). However, research carried out by Clarke (2003) does suggest that patients demonstrate poor levels of knowledge and comprehension, particularly where bad news has been given. When the consultant told Mrs Jones that they hadn’t been able to remove the tumour she had replied that she had t hought that might have been the case. This indicates to me that Mrs Jones had already taken the time to consider her options and the possibility that the tumour may not be removed, prior to the encounter with the consultant. Seymour (2001) proposes that the informed decision to refuse treatment may be about regaining control in a situation where there may be few desirable options. Radley and Payne (2009) suggest that the decision to refuse treatment, is not a rejection of medicine but a rejection of false hope or an acceptance of another sort of hope in which quality of life is preferred over quantity of life. Mrs Jones had undergone intensive treatment in the months leading up to this final prognosis and I now consider that the finality of this diagnosis may have given her not the opportunity to ‘give up’ but to spend quality time with her family without the side effects of a treatment which was not going to cure her. Therefore Mrs Jones was taking positive steps to safeguard the death she wanted. After Mrs Jones initially refused the treatment the consultant went on again to say that ‘it could add months to her life’. I thought at the time that Mrs Jones may take time to consider this again given that the consultant was to me the ‘expert’. From a medical viewpoint, death is seen as a failure, rather than as an important part of life (Smith 2000), so there may be a conflict when a patient chooses to make a decision that is likely to end in death. Physicians who are unable to keep patients alive may struggle to avoid experiencing an inevitable sense of failure (Clarke 2003) as it is widely accepted that medicine’s primary goal is to restore a person’s health (Heaney et al. 2007). By offering Mrs Jones a treatment to delay the inevitable the consultant was acting in a beneficent manner and tension can arise when beneficence and autonomy are in conflict. With advanced medicines today life can be sustained for longer periods, however Van Kle ffens et al (2004) found in their study that for the patients who refused the treatment, their decision was not based on the pros and cons of treatment from a medical perspective but a ‘circumstantial basis’. In a further study by Van Kleffens in 2005, the patients who decided not to accept further treatment said it was based on their own experiences, values and meanings in life. Voogt et al (2005) also proposed that physicians do not engage sufficiently with the world of the patient that extends outside of medicine. So although the consultant knew Mrs Jones well and had been involved in her care for many months, he had only been associated with her in the medical concept. Contemporary opinion suggests that where there is tension between autonomy and beneficence, autonomy should take precedence (Dimond 2005). Now What? Mrs Jones passed away how she wished, in hospital surrounded by her family. Consideration of the ethical and legal principles discussed required a depth of knowledge that I as a student did not hold for this particular situation which was to me personal, complex and difficult to define. From reflection on this incident I recognise now that I have gaps in interpreting theory into practice. Benner’s (1984) work proposes that nurses move from novice to expert as a result of both experiences and training. By analysing the situation with reference to theories and concepts, I have come to realise that only through experience, greater knowledge and confidence will these gaps begin to close. I now know that no one solution was correct nor was it incorrect. Nurses have a legal and moral duty to act in a beneficent way which at times may conflict with the autonomy of the patient. However, providing the patient is of age and has the capabilities to make informed and balanced decisions, in cases of conflict the law will favour autonomy over beneficence. I have come to appreciate that the patient is the only one who can decide what matters to them and what is good based on the information given and as a nurse I am in a position to recognise when patient autonomy is at risk of not being respected and help to restore it. This would then result in the principles of autonomy and beneficence working in partnership rather than in conflict, with the act of beneficence being the action that increases the autonomy of the patient. The process of reflection can bring up painful emotions again but if followed properly and supported appropriately, it can help the reflector to come to terms with their emotions and move on. I now know that the feelings I expressed were natural for a novice like me. Should this particular situation arise again I know I would be able to take this new knowledge with me but am unsure as to whether it would diminish my feelings of sadness, I am however confident that I could now put them to one side. Conclusion Reflection is an important aspect of nurse education and can assist student nurses in linking theory and practice and in developing self-awareness skills. Borton’s (1970 in Jasper 2003) reflective framework has assisted me in both reflecting on what was to me a difficult and personal experience and being able to structure an academic assignment based on it. Even though critics claim that Borton does not include the finer details of reflection or any guide as to how reflection is to be conducted within each stage of the process, I found that these omissions allowed me a wider scope and more freedom to analyse and challenge the situation and my own feelings. Had I used a model such as Gibbs (1988 in Jasper 2003), which consists of prompt questions, it may have restricted my reflection as I tried to answer the specific questions. I am aware of the negative elements of reflection but feel that by acknowledging these within my assignment I was able to conduct a reflection that was an honest and true account. The ethical and legal issues that arose in the incident were autonomy, beneficence, capacity and informed consent. All these issues are interlinked and have an impact on each other and I now understand that each must be considered both as individual components and together in order to gain an accurate perception of a situation and provide patient centred care. My professional knowledge and understanding of these issues and the importance of reflection in nursing has increased considerably by completing this reflective assignment. I understand that by reflecting on situations that occur within clinical practice I will gain new insights, knowledge and understanding therefore empowering me in my practice. This will enhance my nursing practice in future in variety of ways, in particular by assisting me in conti nuous professional development throughout my nursing career, as required by the NMC (2008). References ANDREWS, M.; GIDMAN, J., and HUMPHREYS, A., 1998. Reflection: does it enhance professional nursing practice? British Journal of Nursing 7, 413-417 ATKINS, S.; MURPHY, K., 1993. Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192 BEAUCHAMP, T.L.; CHILDRESS, J.F., 2001. Principles of Biomedical Ethics, 5th edition. Oxford: Oxford University Press BEGLEY, A.M., 2008. Guilty but Good: Defending voluntary active euthanasia from a virtue perspective. Nursing Ethics 15(4), 434-445 BENNER, P., 1984. From Novice to Expert. California: Addison-Wesley BORTON, T., 1970. Reach, Touch and Teach. London: Hodder Arnold cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD B, RE (adult: refusal of medical treatment).; 2002. 1 FLR 1090. Available from: bailii.org/ew/cases/EWHC/Fam/2002/429.html (Accessed 14th May 2011) BUKA, P., 2008. Patients’ Rights, Law and Ethics for Nurses: A practical guide. London: Hodder Arnold BULMAN, C.; SCHUTZ, S., 2004. Reflective Practice in Nursing, 3rd edition. Oxford: Blackwell Publishing LTD BURROWS, D., 1995. The nurse teacher’s role in the promotion of reflective practice. Nurse Education Today 15, 346-50 BURTON, A.J., 2000. Reflection: nursing’s practice and education panacea? Journal of Advanced Nursing 31(5) 1009-1017 CLARKE, J., 2003. Patient centred death. British Medical Journal 327, 174-175 CONWAY, J., 1994. Reflection, the art and science of nursing and the theory-practice gap. British Journal of Nursing 3, 114-118 DEPARTMENT OF HEALTH., 2007. Cancer reform strategy. London: Crown Publications DEPARTMENT OF HEALTH., 2008. End of life care strategy. London: Department of Health DIMOND, B., 2005. Legal Aspects of Nursing, 4th edition. London: Pearson Education Limited ELLIS, J.R.; HARTLEY, C.L., 2001. Nursing in today’s world: Challenges, Issues and Trends. Philadelphia: Lippincott GIBBS, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Blackwell Publishing cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD GREAT BRITAIN. Human Rights Act 1998: Elizabeth ll. Chapter 42. 1998. London: The Stationery Office. Available from: legislation.gov.uk/ukpga/1998/42/contents (accessed on 14th May 2011) Great Britain. Mental Capacity Act 2005: Elizabeth II. Chapter 9. 2005 London: The Stationery Office. Available from: legislation.gov.uk/ukpga/2005/9/contents (Accessed on 15th May 2011) GRIFFITH, R., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 HARGREAVES, J., 1997. Using patients: exploring the ethical dimension of reflective practice in nurse education. Journal of Advanced Nursing 25, 223-228 HEANEY, M.; FOOT, C,. and FREEMAN, W., 2007. Ethical issues in withholding and withdrawing life-prolonging medical treatment in the IC U. Current Anaesthesia Critical Care 18, 5-6, 277-283 HONG, L.P.; CHEW, L., 2008. Reflective practice from the perspectives of the bachelor of nursing students in International Medical University (IMU). Singapore Nursing Journal 35(3), 5-6,8-10,12-15 JASPER, M., 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD JOHNS, C., 1998. Opening the Doors of Perception. Oxford: Blackwell Science cited in C. Johns and D. Freshwater, 2005 (eds), Transforming Nursing through Reflective Practice. Oxford: Blackwell Science JONES, P.R., 1995. Hindsight bias in reflective practice: An empirical investigation. Journal of Advanced Nursing 21, 783-788 KELLY, B., 1991. The professional values of English undergraduates. Journal of Advanced Nursing 16, 867-872 KIM, H.S., 1999. Critical Reflective inquiry for knowledge development in nursing practice. Journal of Advanced Nursing 29(5), 1205-12 KRALIK, D.; KOCH,T., and WOTTON K., 1997. Engagement and detachment: Understanding patients’ experiencing with nursing. Journal of Advanced Nursing 26(2), 399-407 LARCHER, V., 2005. Consent, competence and confidentiality. British Medical Journal 330, 7487, 353-356. LAUDER, W., 1994. Beyond reflection: practical wisdom and the practical syllogism. Nurse Education Today 14, 91-98 MACKINTOSH, C., 1998. Reflection: a flawed strategy for the nursing professional. Nurse Education Today 18, 553-7 MB, RE (Caesarean Section)., 1997. 2 F.L.R. 426 cited in R., Griffith., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 NURSING MIDWIFERY COUNCIL, 2008. The code: standards of conduct, performance and ethics for nurses and midwifes. London: NMC PELLEGRINO, E., 2004. Ethical considerations in head and neck cancer. California: Addison-Wesley cited in L, Harrison., R, Sessions., W, Hong., 2008 (eds). Head and Neck Cancer: A Multidisciplinary Approach, 2nd edition. Philadelphia: Lippincott Williams Wilkins RADLEY, A.; PAYNE, S.A., 2009. A sociological commentary on the refusal of treatment by patients with cancer. Mortality 14(4), 309-24 REID, B., 1993. ‘But we’re doing it already!’ Exploring a response to the concept of Reflective Practice in order to improve its facilitation. Nurse Education Today 13(4), 305-309 ROLFE, G.; FRESHWATER, D.; and JASPER, M., 2001. Critical Reflection for Nursing. Hampshire: Palgrave Macmillan SAUNDERS, K.; CHALONER, C., 2007. Voluntary euthanasia: ethical concepts and definitions. Nursing Standard 21(35) 41-44 SAYLOR, C.R., 1990. Reflection and professional education: art, science and competency. Nurse Educator 15(2), 8-11 SCHON, D., 1983. The Reflective Practitioner: How professionals think in action. London: Temple Smith SEYMOUR, J.R., 2001. Critical moments: death and dying in intensive care. Buckingham: Open University Press SIDAWAY V BETHLEM ROYAL HOSPITAL.; 1985. AC 871, 1985 1 All ER 643, 1985 2 WLR 480. Available from: bailii.org/uk/cases/UKHL/1985/1.html (Accessed 14th May 2011) SMITH, A., 1998. Learning about reflection. Journal of Advanced Nursing 28(4), 891-898 SMITH, R., 2000. A good death: an important aim for health services and for us all. British Medical Journal 320, 7228, 129-130 STREET, A.F., 1992. Inside nursing- A clinical ethnography of Clinical Nursing Practice. New York: Albany TEEKMAN, B., 2000. Exploring reflective thinking in nursing practice. Journal of Advanced Nursing 31(5), 1125-1135 TINGLE, J.; CRIBB, A., 2007. Nursing Law and Ethics, 3rd edition. Oxford: Blackwell Publishing LTD VAN KLEFFENS, T.; VAN BAARSEN, B., and VAN LEEUWEN, E., 2004. The medical practise of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective. Social Science Medicine 58, 2325–2336 VAN KLEFFENS, T.; VAN LEEUWEN, E., 2005. Physicians’ evaluations of patients’ decisions to refuse oncological treatment. Journal of Medical Ethics 31, 131–136 VOOGT, E.; VAN DER HEIDE, A.; RIETJENS, J.A.C.; VAN LEEUWEN, A.F.; VISER, A.P.; VAN DER RIJT, C.C.D., 2005. Attitudes of patients with incurable cancer towards medical treatment in the last phase of life. Journal of Oncology 23, 2012-2019 WILLIAMS, G.R.; LOWES, L., 2001. Reflective practice. Reflection: Possible strategies to improve its use by qualified staff. British Journal of Nursing 10(22), 1482-8

Dont Be Despondent Over Slough and Slew

Dont Be Despondent Over Slough and Slew Don’t Be Despondent Over Slough and Slew Don’t Be Despondent Over Slough and Slew By Maeve Maddox The spelling slough represents two meanings and two distinct pronunciations. 1. slough (rhymes with now) noun: soft, miry, muddy ground. This is the kind of slough that John Bunyan describes in his allegory, The Pilgrim’s Progress: Now I saw in my dream, that, just as they [Christian and Pliable] had ended this talk, they drew nigh to a very miry Slough that was in the midst of the plain; and they, being heedless, did both fall suddenly into the bog; the name of the Slough was Despond. Here, therefore, they wallowed for a time, being grievously bedaubed with the dirt; and Christian, because of the burden that was on his back, began to sink in the mire. 2. slough (rhymes with muff) noun: of a serpent or similar reptile, the cast-off skin. verb: to cast or shed the skin. Often used figuratively: Putin, like Yeltsin, is constantly looking for ways to  slough off responsibility  for  his  decisions and their consequences- RussiaLost in Transition, by Liliia Fedorovna Shevtsova. Slew, sometimes spelled slue, has more than one meaning. The verb slew originated as a nautical term meaning â€Å"to turn a thing round upon its own axis, or without shifting it from its place. Slewed became nautical slang for â€Å"drunk† and a slew-foot was â€Å"a clumsy person who walks with feet turned out.† In Texas folklore, Pecos Bill marries a woman named â€Å"Slue-Foot Sue.† The usual modern meaning of slew as a verb is â€Å"to turn a thing around on its own axis.† Here’s an example from fiction: Near the top of the ramp a motorist in a gray Toyota panicked, slamming into the car behind it. Chrome and plastic hanging from its front, it  slewed around  blocking both lanes, effectively cutting off the Aviator. Robert Ludlums (TM) The Bourne Betrayal, Eric Van Lustbader. As a noun, slew means â€Å"a very large number† or â€Å"a great amount.† For example: Baltimore City legislators  prepare  for new Annapolis session with  a slew of  bills.  City Paper, Baltimore. A less common use of slew (also spelled slue) is in reference to â€Å"a marshy or reedy pool, pond, small lake, backwater, or inlet,† as in this description of a journey along the upper Mississippi River: A continual variation of scene now opened to the view, marred only by an occasional ungraceful slew or marsh Some American speakers conflate the spelling and pronunciation of the words slough (miry ground) and slew (wetlands). They take their cue from Merriam-Webster whose entry for slough lumps the following definitions together: 1a. a place of deep mud or mire. 1b. a small marshy place. 1c. also slew or slue, a side channel or inlet I’ll give the last word on the spelling and pronunciation of these words to The Chicago Manual of Style: slew; slough; slue Slew is an informal word equivalent to many or lots (you have a slew of cattle). It is sometimes misspelled slough (a legitimate noun meaning â€Å"a grimy swamp† and pronounced to rhyme with now) or slue (a legitimate verb meaning â€Å"to swing around†). The phrase slough of despond (from Bunyan’s Pilgrim’s Progress [1678]) means a state of depression. This is etymologically different from slough (/slÉ™f/), meaning â€Å"to discard† (slough off dry skin). Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:20 Computer Terms You Should KnowEmpathy "With" or Empathy "For"?Types of Plots

Alkaline phosphatase enzyme Essay Example | Topics and Well Written Essays - 1250 words

Alkaline phosphatase enzyme - Essay Example The enzyme acts by splitting off phosphorous creating an alkaline pH. Even though the physiological function of the alkaline phosphatase enzyme is not clear it still plays a vital role in the phosphate metabolism. A gene known as ALPL gives instructions for making the alkaline phosphatase enzyme. The role played by alkaline phosphatase enzyme is very important. It helps in the growth and development of bones and teeth. It is active in many other tissues in the body such as liver and kidneys. The enzyme plays an important role in the growth and development of bones and teeth. It is also active in many other tissues, particularly in the liver and kidneys. This enzyme operates as a phosphatase; it means that helps in removing clusters of oxygen and phosphorus atoms from other molecules. This enzyme is also important for recycling phosphate in the living cells. It is common in tissues that transport nutrients including intestine and kidney. In addition to the above mentioned function, alkaline phosphatase is one of the essential elements for the process of mineralization. In this process, minerals such as calcium and phosphorus are deposited in the developing teeth and bones. The process of mineralization is important for the formation of teeth which can endure chewing and grinding and for formation of bones that are strong and rigid. According to a research undertaken by Prof. Herbert Fleisch and Prof. Gideon Rodan in an article published under the name of â€Å"In searching a bone quality marker. What about Bone Mineral Density?† the biological role of alkaline phosphatase enzyme in mammals includes the following: The first three are articulated in a tissue-specific manner. The last one is ubiquitous but is abundant in liver, bone and kidney. The gene sequence of isoenzymes of alkaline phosphatase shows that the nascent polypeptide has a short signal sequence of 17 and 21 residues of amino-acid and at its c terminal site a hydrophobic

Functions of Re-appropriation in Contemporary Texts About Historical Essay

Functions of Re-appropriation in Contemporary Texts About Historical Events - Essay Example However, reviewing the horrific events there are two sides of the coin. The perpetrators justify their actions while the victims are forced to fight for justice. Any form of violence such as genocide should not be justified but the account of the perpetrators should be considered when trying to understand the motive and the influencing factor leading to a horrific event. Regardless of the accounts of the victim and the perpetrator, the legal framework within which a horrific event occurred should also be evaluated. In the text by Philip the re-appropriation of these legal documents should be done on each and every horrific account to enable the neutral members of the society to understand the psychology of both the victim and perpetrator. This paper will highlight the major horrific events in the modern era. Additionally, the paper will evaluate the legal framework responsible for these events. The accounts of both the victims and perpetrators will be analyzed and how the re-appropriation of specific legal documents may help understand the vents leading to a horrific event. The paper will be compiled in consideration of the works by Heimrad Backer and Nourbese Philip on their different accounts on the modern day horrific events. The main function of re-appropriation of legal documents is to minimize the risks of a repetition of a particular horrific event. For instance, after the occurrence of the holocaust the rivalry between the Jews and the Nazis become more serious. The holocaust was an event where thousands of Jews were massacred in the hands of the Nazis. From this point, the common Jew and the Nazi were mortal enemies. Additionally, the publication and legal address of the events did not ease the pressure between the two functions. In an argument by Backer major publications and legal definitions on the holocaust has

Why Britain reduced its Empire between 1939 and 1964 Essay Example for Free

Why Britain reduced its Empire between 1939 and 1964 Essay Assess the reasons why Britain reduced its Empire between 1939 and 1964 In 1945 the Second World War ended, the next thirty years were to see rapid disintegration of the European empires and the creation of many new independent states. In this essay I will attempt to explain for what reasons Great Britain decolonised, and the effects this decolonisation had for those countries decolonised. As a result of victory after WWI several former German territories in Africa and Asia were added to the British Empire. The British Empire was among the largest Empires the world had ever seen. It consisted of various territories conquered or colonised by Britain from about 1600. The British Empire was at its largest at the end of WWI, consisting of over 25% of the worlds population and area; including countries such as India, Malaya, Kenya, Ghana, Cyprus, Greece, New Zealand. World War I brought the British Empire to the peak of its expansion, but in the years that followed came its decline. Britain had growing economic problems and couldnt afford to continue governing its enormous Empire. There were threats of Civil War in countries such as India; the threat of the spread of Communism from China into Malaya and the increasing problem of racism and prejudice in Britains African colonies. The Empire faded gradually into the Commonwealth from the 1930s onwards as one by one former British colonies and protectorates gained independence but retained this last link with the Crown. It was incredibly important for Britain to retain its trade links with countries that were/had been part of its Empire. Britain needed to change the face of its Empire, one reason for such a change was due to the view of the U.S they were opposed to Empires and Britain did not want the Anglo-American relationships to even slightly grow apart. At the beginning of end of the Second World War Britain had the largest empire, which spanned the whole of the globe. But in the next thirty years this was dramatically reduced in size. The first country to seek independence from Britain at the end of the Second World War was India. India was seen as the Jewel in the crown of the British Empire and was of key significance to Britain. Even before WWI it was evident that the Indian desire for freedom would prove increasingly difficult for Britain to contain and control. Although British officials dominated the key posts in the civil service, barely one per-cent of the civil population was British. There were many disturbances and large unrest throughout India, the British government made some concession to the demand for a greater share by Indians in the local affairs. It was too late by now and this offer was no longer sufficient; the total withdrawal of British rule was now the aim of Nationalists. The Indian society was made up of varying and often conflicting races, castes and religions India had no single nationalist voice. Until some sort of unity could be achieved Indian aspirations would be frustrated, this frustration found outlet in increasing violence. This came to an end and then it was non-violence that now became the chief factor in the advance of Indian Nationalism. The move was called Civil Disobedience and was thought up by an Indian man named Gandhi. Gandhi was the single most important influence in the growth of Indian Nationalism. Gandhi was a devout Hindu although he sought mutual respect and tolerance between all religions and races. Gandhi became a type of figurehead and identified with all castes. For a time he was even able to gain Muslim support. Although fearing that independence gained on Gandhis terms would lead to the subjection of interests in favour of the Hindu majority, the Muslim Nationalists preferred separate to collective action. It became a question of not whether Britain should withdraw but when they would withdraw. The Japanese War effort by Britain interrupted the Indian problem. Many Indians, during the war effort, tried to overthrow British rule but the police and the army remained loyal and British control was unbroken. At the end of the Japanese War it was obvious to see that to keep control of India against the wish of her peoples would stretch Britains resources too far, Britain could no longer afford to do so and the will to do so had largely gone. The Muslim League, led by Jinnah, was increasingly suspicious of the Hindus, represented by the Congress Party and its leader Nehru, an upper class Anglophile. A sizeable Sikh minority was equally apprehensive of being swamped in an independent India. To such groups, federation within a single sovereign state was not acceptable. Partition seemed to be the only solution that would make the dominant religious groups happy. After much haggling and arguing the Hindu Congress and Muslim League agreed to the partition proposals: India, the sub continent, was to be divided into two distinct states; India, overwhelmingly Hindu; Pakistan and East Pakistan predominatly Muslim. The British method of partition was to set a date for British withdrawal 1947, and then work up until this date to achieve a peaceful partition. When the partition was created making India a Hindu state and Pakistan a Muslim state many people found themselves in the wrong area and there was a lot of mass movement of peop le between the two areas. To Britain the most valuable dependency of all was Malaya, which is an example of what the British were willing to do where the Empire remained worth while. In the latter half of the 19th century Malayas economy assumed many of the major aspects of its present character. The output of tin, which had been mined for centuries, increased greatly with the utilisation of modern methods. Rubber trees were introduced (Indian labourers were imported to work the rubber plantations), and Malaya became a leading rubber producer. In 1948 its net dollar earnings amounted to à ¯Ã‚ ¿Ã‚ ½170 million and it provided over half the USAs imports of rubber and nearly all imports of tin. In the difficult days after WWII Malayas exports were vitally important in keeping the Sterling Area solvent. The Sterling Area was formed in 1939 to maintain the pound sterling as an international currency. It included the whole of the British Empire and Commonwealth, with few exceptions. This meant that Malaya had to buy goods from within the Sterling Area, meaning their money was tied up in the Empire. Malayas economic character, as well as its geographic position, gave it great strategic importance. The British built their fortifications accordingly at Singapore. The Malayans, anxious to regain their independence, had first to face an unexpected challenge from Communist Guerrillas, mainly Chinese, who were anxious to acquire control of the many raw materials in Malaya. The Chinese were a minority in Malaya and not popular. The Malayans didnt want to fall under the control of their great neighbour, Communist China. They were willing to accept the assistance of British forces and the Guerrillas, after about five years were expelled. After the defeat of the communists Malaya moved quietly to independence. The Malayans united behind Rahman. Rahman was the kind of courteous conservative with whom the British had always felt able to do business. The federation of Malaya became an independent state within the Commonwealth on 31st August 1957. Britain controlled many countries in Africa including the following; Ghana, Nigeria, Zambia, Uganda and Kenya. Kenya was one of the most important of the African countries. Strategically the Naval Base at Mombasa Port near to the Suez Canal was priceless. If the port fell into the hands of the Communists it would prove devastating. Climatically it was suitable for European settlement and the British saw it as a New Australia. British settlers went out in small numbers before and after WWI and in rather large numbers after WWII. Those that moved out there successfully introduced plantation farming of crops such as coffee and tea, the land was very rich. The British settlers believed that the country belonged to them and expected to evolve a government like that of Canada or Australia. Due to the large European population Britain didnt want to upset them, it was said that there would be an all white Kenyan Government. Despite this, the settlers received a major set back when they were told; Primarily Kenya is an African territorythe interests of the African natives must be paramount by the Duke of Devonshire, Colonial Secretary. Other than the European community there was another outside community within Kenya, an Asian community. The Asians were prosperous and sometimes became money lenders. They were hated by the Africans. Britain saw themselves and America as being superior to the Asian world and then again that the Asian world was superior to the Africans. The British did not think that the Africans were intelligent enough to be able to run their own country, this was seen as being a very racist and prejudiced viewpoint and there was a loss of confidence. The Kikuyu were farmers in the region where the capital of Nairobi had been established. They were more disturbed in the possession of their land than other tribes and they also came into contact with European ideas and European education. Jomo Kenyatta, later the leader of the Kikuyu, was first educated at a Presbyterian mission school. The first African organisation, the Kikuyu Association was formed in 1920 but was a very moderate body made up of the elders and the chiefs. In 1921 the Young Kikuyu Association was founded by the younger men, educated like Kenyatta himself in the mission schools, and was much more radical in temper. Kenyatta was abroad from 1929 to 1946. When he returned he found that the Kikuyu Central Association had been condemned as trying to undermine the Government during the war and that very little constitutional progress had been made. Only in 1952 were Africans elected to the Council and then by a complicated indirect system. The early 1950s saw the terrorist outbreaks known as the Mau Mau. With their fearsome oaths and occasional atrocities, they spread terror among the European community, although in fact most of the atrocities were against other Africans. It was unknown whether Kenyatta had any connection with the Mau Mau, he was arrested and banished to a northern part of the colony. The white colonists could not conquer the Mau Mau on their own and had to ask for troop reinforcements from Britain. This need for outside assistance ended any remaining thoughts that settlers might have had that they would be capable of running an independent state. During the Mau Mau troubles a new constitution was introduced into Kenya called the Lyttleton constitution. This was an extremely complicated system designed to allow the Africans to gain some ministerial experience. Many of the more die hard Europeans didnt like this at all. A new European Party was set up, the United Country Party, to work for a society which would be multi-racial yet would safeguard both the political and land rights of the Europeans. This was doomed, the tide was now firmly in favour of making Kenya an independent African country, although there were seats reserved in the Legislative Council for minority groups, including Europeans. There were now two main African parties, the K.A.N.U which drew its strength from the Kikuyu and Luo tribes and favoured a centralised system of government, and the K.A.D.U, supported by the Masai and a number of smaller tribes who wanted a more federal system of government. K.A.N.U, led by Kenyatta, won the 1963 election, the last before Kenya got independence on the 12th of December 1963. Economically Britain could not possibly to afford to maintain an Empire. It could not afford to defend its countries from outside attacking forces, let alone from enemies within. The threats of civil war, in terms of India, was a very dangerous one, it would have been impossible for Britain to control the entire population of India with its army. Britain without a doubt relied heavily on the trade links within its Empire, it couldnt afford to lose these links but it could not afford to keep them at the way things were going. By creating the Common-Wealth it made it possible for Britain to hand over Independence to countries, making them happy, as well as keeping them within a trading circle. Most of the countries in the Empire wanted Independence, Britain wanted the trade to remain, it was the best solution.

Predicted Impact of Environment on Psychological and Social Development of a Human Clone :: Human Cloning Essaysw

Debates continue to haunt the subject of human cloning, and will continue to do so for some time. Among the debates: How will the clones’ personalities develop? Would it be humane to create clones if they are going to be considered inferior, or if they are going to have a difficult time acclimating to society? Identical twins are essentially clones because they share indistinguishable copies of the same DNA. Due to the similarity between the two genetic situations, it has been suggested that clones will develop much as twins do. By looking at psychological studies that have been conducted on identical twins, scientists can predict how a clone will mature and how they will react to their world. Controversy and science have walked hand-in-hand through many discoveries and inventions. Cloning is no exception, as debates whirl around the various ethics, risks, and possibilities of creating human clones. Philosophers, religious leaders, scientists, and politicians continue to argue amongst each other, trying to determine how cloning will affect future generations of society and medicine. A few psychiatrists, sociologists, and other developmental scientists have focused less on the effects of cloning on modern society, and become more concerned with the effects cloning will have on the psychological development of the clones that may be created. These social scientists worry that clones might experience difficulties developing a healthy personality or functioning happily in society. In order to accurately project possible conflicts, scientists have resorted to the study of today’s natural clones: identical twins. Identical twins possess exact copies of each other’s DNA, and are essentially clones of each other. As such [clones], they may help us to understand some aspects of human clones (Levick, 2004). Trends in the psychological development of twins suggest that a person’s environment influences an individual and can alter their personal growth. By further exploring the psychological impact of having an identical twin, scientists hope to discover how clones will mature. Multiple studies and observations have indicated that the varying genes and environments of each twin can influence many aspects of psychological development such as falling in love, aging, personality development, talents and abilities, body characteristics, health, and physiological responses (University of Minnesota). If an identical twin is so affected by their environment, it is possible that clones will be just as influenced by their surroundings, perhaps even more so than twins if clones are subjected to discrimination. How a clone is regarded, treated, and taught will affect changes in the manner that the clone reacts to their world.

Bluffing

HUMN 330 Values and Ethics Online Course Syllabus Credit Hours: 3 Delivery Method: Online (Internet / Blackboard) Required Textbook Rosenstand, N. (2013). The moral of the story: An introduction to ethics (7th ed. ). New York, NY: McGraw-Hill. ISBN: 978-0078038426 Course Description This course focuses on the process of practical ethics as a way of resolving moral conflict and of understanding professional responsibility in a multi-culturally diverse society without devaluating specific viewpoints of ethical or metaphysical theory, ideology, or religion.Students will use proposals, value judgments, observation statements, assumptions, and alternate-world assumptions in arguing contemporary issues of moral importance. With this basic moral logic, students will resolve issues in terms of rights, responsibilities, and the community of rational beings; in terms of consequences and contingencies; and in terms of habituated virtues and character. Free and unrestricted discourse will be enc ouraged so as to let students find common ground in diversity. Course Goals This course is designed to help students: 1. Understand the basic vocabulary and fundamental theories of ethics. . Discover life's values and determine which values are the most worthwhile. 3. Relate the textbook theories to actual life situations. 4. Find greater personal peace by choosing more constructive values. 5. Apply understanding of ethics to personal lives. 6. Understand the relationship between attitudes, values and moral conduct. Learning Outcomes This syllabus was developed for online learning by Dr. Moseby HUMN 330 Online Syllabus 0712 Upon course completion, students will be able to: 1. Judge the role and importance of ethics and evaluate moral behavior based on the criteria of value and self autonomy. . Assess the psychological, sociological, historical, and philosophical background of ethics. 3. Relate the nature and role of reason in understanding values. 4. Relate the nature and characteri stics of freedom when responding to values. 5. Distinguish and apply ethical principles in ethical situations. 6. Explain the various arguments for and against the major contemporary ethical issues. 7. Discuss one’s options for identifying and replacing inferior values. 8. Explain the role, nature, and characteristics of responsibility. 9.Defend the value of and the process of foreseeing the consequences of an individual’s conduct. 10. Defend the choice of a viable ethical theory in solving an ethical problem. 11. Utilize the principles of critical thinking to enhance learning skills and to increase intellectual and moral growth. 12. Evaluate their conduct in the light of constructive ethical expectations. Grading Your final grade will be based on the following evaluation items: Grade Scale 90 – 100% 80 – 89% 70 – 79% 60 – 69% 0 – 59% A B C D F Evaluation Items and Weights Weekly Assignments Discussions Midterm Exam Group Project Fina l Exam Total 5% 30% 15% 15% 15% 100% Activities and Assignments Activities Each module, excluding Module 9, contains various assignments related to the respective module, such as: ? Chapter and Lecture Notes. This activity consists of reading the text and the lecture notes that are posted in each module. ? Reading and Reflection. This activity contains a reading activity that is assigned to stimulate additional thinking and some discussions within the topic area. This syllabus was developed for online learning by Dr. Moseby HUMN 330 Online Syllabus 0712 ? ? Research and Critical Thinking.This activity varies with each module; however, they are typical outside readings with associated discussion questions of short essay-type answers to the topic area. Application. This activity varies with each module and is integrated into the learning modules to help you apply and reinforce the concepts that each module introduces. Weekly Assignments The assignments vary from module to module and a re based on the activities that were contained within the module. Each includes a combination of threaded discussions, short essays, or study questions based on text or outside readings.The weekly assignments comprise 25% of your grade. Discussions The Discussion Board is an integral part of your learning in this course. You are encouraged and expected to participate in online discussions. Regular and meaningful discussion postings are part of your final grade. Each module, excluding Module 9, contain Discussion Board topics or questions that will help sharpen your critical thinking and written communication skills as you study the theories and concepts related to values and ethics.Thirty percent of your course grade will come from your original responses to module discussion prompts and responses to classmates submitted to the appropriate Discussion Board forum in response to these module discussion activities. Please refer to the Checklist for Meaningful Discussions and Discussion Rubric in Module 1. Discussions account for 30% of your grade. Exams Both the Midterm and Final Exams are time-limited online tests. The Midterm will cover Modules 1 through 4 (Chapters 1-6) and is to be taken in Week 4. The Final is comprehensive (Modules 1-4 and 5-9, Chapters 1-13) and is to be taken during Week 9.The Midterm and Final are each worth 15% of your grade. Group Project Module 8 is devoted to the group project. The Instructor will divide the class into four virtual groups to discuss a case involving an ethical issue. ? ? ? ? Group 1: Media Ethics Group 2: Theory of Just War Group 3: Animal Welfare and Animal Rights Group 4: Death Penalty Each group will have its own private group discussion forum. Accessing this private forum is a little different from reaching the public discussion forums. You will need to click the Groups menu item, not the Discussion Board.After clicking Groups, you will see the four groups listed but you will only have access to the group you hav e been assigned to. Click your group link to see a list of the other members of your group and then the Group Discussion Board link to access the discussion forum. This syllabus was developed for online learning by Dr. Moseby HUMN 330 Online Syllabus 0712 Work with your assigned group members on the ethics case for your group in your private discussion forum. Identify ethical or moral justifications to support your arguments from the text or additional sources as necessary.Use the Internet to research any additional information you would like to use in your group's discussion. After groups have had time to review and discuss their cases and reach a consensus on the topic, one member of each of group will post its findings to the appropriate thread in the public Module 8 – Group Presentations forum. As individuals, each student will then comment on at least two other group presentations. The group project makes up 15% of your grade. Additional Information Library Embry-Riddle Aeronautical University has one of the most complete library collections of aviation-related resources in the world. ? ERAU Libraries: http://library. erau. edu/ Hunt Library Worldwide: Information, Services, Help o Worldwide Library: Basic Training o Worldwide Library: Ask-a-Librarian o Reference: Research Request Contact Information ? Hours: Monday – Friday 8:00 a. m. – 5:00 p. m. Eastern Time ? Telephone: 1-800-678-9428 or 386-226-6947 ? Email: [email  protected] edu RefWorks RefWorks is an online database tool that can manage references and citations from almost any source. It provides specific guidance in how to collect and use references, create bibliographies, and write research papers.You may access it through this ERAU organizational login link when signed in to ERNIE or directly from the RefWorks website (http://www. refworks. com). A different link must be used for off-campus access (see these instructions). RefWorks requires users to create a RefWorks-spe cific username and password. Please contact the Hunt Library if you have any questions. Online Sources There are many websites that offer current information on values and ethics and any search engine (Google, etc. ,) will get you to both historic and current information that is relevant to the content of this course.In addition, many links are provided within the online learning modules. APA Format ERAU students should master the American Psychological Association (APA) editorial style format for research papers and other written assignments. Two good websites to bookmark for help citing references used in your assignments and discussion posts are listed below. (See the Academic Resources folder in the Resources area of the course for additional sites on APA style. ) This syllabus was developed for online learning by Dr. Moseby HUMN 330 Online Syllabus 0712 The OWL at Purdue, APA Formatting and Style Guide APA Style. rg Course Policies Academic Integrity Embry-Riddle is committed t o maintaining and upholding intellectual integrity. All students, faculty, and staff have obligations to prevent violations of academic integrity and take corrective action when they occur. The adjudication process will involve imposing sanctions which may include, but are not limited to, a failing grade on the assignment, a failing grade in a course, suspension or dismissal from the University, upon students who commit the following academic violations: 1. Plagiarism: Presenting the ideas, words, or products of another as one’s own.Plagiarism includes use of any source to complete academic assignments without proper acknowledgement of the source. Reuse or resubmission of a student’s own coursework if previously used or submitted in another course, is considered self-plagiarism, and is also not allowed under University policy. 2. Cheating: A broad term that includes, but is not limited to, the following: a. Giving or receiving help from unauthorized persons or material s during examinations. b. The unauthorized communication of examination questions prior to, during, or following administration of the examination. . Collaboration on examinations or assignments expected to be, or presented as, individual work. d. Fraud and deceit, that include knowingly furnishing false or misleading information or failing to furnish appropriate information when requested, such as when applying for admission to the University. Online Learning This course is offered through ERAU Worldwide Online (Blackboard) and runs nine (9) weeks. The first week begins the first day of the term and ends at midnight EDT/EST (as applicable) seven days later.Success in this course requires in-depth study of each module as assigned, timely completion of assignments, and regular participation in forum discussions. Late work should be the exception and not the rule and may be downgraded at the discretion of the Instructor, if accepted at all. Unless all work is submitted, the student co uld receive a failing grade for the course. Extensions may be granted for extenuating circumstances at the discretion of the Instructor and only for the length of time the Instructor deems appropriate. The most important element of success in an online course is to communicate with your Instructor throughout the term.Conventions of â€Å"online etiquette,† which include courtesy to all users, will be observed. Students should use the Send Email function in Blackboard for private messages to the Instructor and other students. The class Discussion Board forums are for public messages. It is highly recommended that students keep electronic copies of all materials submitted as assignments, discussion board posts and emails, until after the end of the term and a final This syllabus was developed for online learning by Dr. Moseby HUMN 330 Online Syllabus 0712 grade is received.When posting responses in a discussion forum, please confirm that the responses have actually been posted after you submit them. Course Schedule Module Title Understanding Values, Morals, and Ethics Activities / Assignments 1. 1 – Introductions 1. 2 – Read Chapter 1; View Morality Video 1. 3 – Reading and Reflection: Morality and Ethics 1. 4 – Application: Current News Search 1. 5 – Discussion 1: Ethical Behavior 1. 6 – Discussion 2: Moral Issues 2. 1 – Read Chapter 2 and 3 2. 2 – Research and Critical Thinking: Haroun and the Sea of Stories Study Questions 2. – Discussion: Understanding the Past 2. 4 – Application: Moral Dilemma 2. 5 – Discussion: Ethnicity vs National Identity 3. 1 – Read Chapter 4; 3. 2 – Research and Critical Thinking â€Å"The Ethics of Emergencies Study Questions† 3. 3 – Reading and Reflection: Altruistic Behaviors 3. 4 – Application: Essay on Rand’s Ideas 3. 5 – Discussion: Understanding Altruism 4. 1 – Read Chapters 5 and 6 4. 2 â €“ Reading and Reflection: Utilitarianism and Deontology 4. 3 – Research and Critical Thinking: Flight 93 and Utilitarianism in Times of Crisis 4. – Discussion: Ends and Means 5. 1 – Review Modules 1 through 4 Learning Objectives 5. 2 – Discussion: Midterm Q & A 5. 3 – Midterm Exam 6. 1 – Read Chapters 7 and 8; Listen to â€Å"I Have a Dream Speech† 6. 2 – Reading and Reflection: Walmart Employment Practices 6. 3 – Application: Education Equity and Social Justice Awareness 6. 4 – Discussion 1: Person vs. Human Being 6. 5 – Discussion 2: Rights and Responsibilities 6. 6 – Research & Critical Thinking: The Trial of Socrates 6. 7 – Application: Resolving Ethical Dilemmas 6. 8 – Discussion 3: Socrates’ Trial 7. – Read Chapters 10 and 11 7. 2 – Research and Critical Thinking: â€Å"Either/Or† Study Questions 7. 3 – Reading and Reflection: Philosophers 7 . 4 – Application: â€Å"Why Courage Matters: The Way to Braver Life† Study Questions 7. 5 – Discussion: Politics 7. 6 – Group Project Preview 8. 1 – Read Chapters 12 and 13; View Gender and Ethics Video 8. 2 – Reading and Reflection: Group Case 8. 3 – Research and Critical Thinking: Group Case 8. 4 – Application: Group Findings 9. 1 – Review Modules 1 through 8 Learning Objectives 9. 2 – Discussion: Final Q and A 9. – Final Exam 1 2 Moral Lessons Through Time and Ethical Relativism 3 Exploring Psychological and Ethical Egoism 4 Utilitarian Reasoning and Universal Law 5 Midterm Exam Week 6 Human Rights, Justice and the Concept of Virtues 7 The Contemporary Perspectives and Case Studies in Virtue 8 Feminism, Virtue, and the Exploration of Ethics in a Global Context 9 Final Exam Week This syllabus was developed for online learning by Dr. Moseby HUMN 330 Online Syllabus 0712 This syllabus was developed for onl ine learning by Dr. Moseby HUMN 330 Online Syllabus 0712

Biblical Allusions Throughout of Mice and Men Essay

â€Å"He calls Of Mice and Men a parable that illustrates the biblical conflict between the brothers Cain and Abel† (Goldhurst 48). Therefore the people who have read the story Of Mice and Men can automatically see the resemblance between the two stories. Of Mice and Men is a novelette by John Steinbeck, it is about two men who are migratory workers that works on farms. Of Mice and Men contains many Biblical allusions including the Story of Cain and Abel, the longing for Eden, and facing temptation. In Of Mice and Men and the Old Testament the themes are similar. It is stated in the â€Å"A Parable Curse of Cain.† â€Å"Of Mice and Men is a story about the nature of man’s fate in a fallen world, with particular emphasis upon the question: is man destined to live alone, a solitary wanderer on the face of the earth, or is it the fate of man to care for man, to go his way in companionship with another? This is the same theme that occurs in The Old Testament† (Goldhurst 49). This proves that Of Mice and Men and The Old Testament have a similar theme. One reoccurring theme in Of Mice and Men and The Old Testament is loneliness will always follow man and innocence keeps ideas alive. The curse that the Lord placed upon Cain was that agricultural labor was going to be difficult, and he will be lonely while being a fugitive (Genesis 4:12). In Of Mice and Men George and Lennie are fugitives that are migratory workers but George at times feels lonely even though he has Lennie because he doesn’t have a romantic partner. This shows how these two stories are similar within their themes. Worked Cited Goldhurst, William. â€Å"A Parable of the Curse of Cain.† Readings on John Steinbeck- Of Mice and Men. Ed. Jill Karson, Bruno Leone, Brenda Salcup, and Brenda Szumski. San Diego, CA: Greenhaven Press, 1998. 48-58. Print The New Oxford Annotated Bible. Ed. Bruce M. Metzger, Roland E. Murphy, and Bernhard W. Anderson. New York: Oxford University Press, 1994. 2-7. Print. Owens, Luis. â€Å"Of Mice and Men: The Dream of Commitment.† Modern Critical View John Steinbeck. Ed. Harold Bloom. New York: Chelsea House, 1987. 145-149. Print.

In what ways and to what extent did constitutional and socia essays

In what ways and to what extent did constitutional and socia essays Any Revolution can usually be credited to some sort of constitutional and/or social development. Between 1860 and 1877, constitutional and social developments contributed to the revolution in many, many ways including The South Carolina Declaration of Causes of Secession, The Reconstruction Act, and the Freedmens Bureau. The South Carolina Declaration of Causes of Secession helped to start the revolution, as stated in Document A. Being the first to secede, South Carolina led an example, and other states followed. As stated by John Sherman in Document B, It has been a principle of states rights, that bad sentiment that has elevated state authority above national authority, that has been the main instrument by which our government is sought to be overthrown. (Meaning that the government has been overthrown as a result of giving the states too much power.) Sherman also believes that the policy of this country ought to be to make everything national as far as possible. The Reconstruction Act also contributed to causing the Revolution. The angered the South because it placed too many restrictions (such as registering new electorate voters) on it, helping the revolution to be well on its way. In Document F, Senator Lot Morrill thinks the Civil Rights Act of 1866 is revolutionary. However, he believed that there was already a revolution taking place, but no one realized. A third leading cause of the Revolution was The Freedmens Bureau. As represented in Document E, the Bureau was meant to give Homesteads to the freed slaves, but the promises made by the government were not kept. Document Is picture represents how the freedmen felt that having no rights was even worse than slavery. Of course, there were more constitutional and social developments that contributed to causing the Revolution such as the Emancipation Proclamation, the Ku Klux Klan, and the Black Codes. ...

History of USS Intrepid World War II Aircraft Carrier

History of USS Intrepid World War II Aircraft Carrier The third Essex-class aircraft carrier built for the US Navy, USS Intrepid (CV-11) entered service in August 1943. Dispatched to the Pacific, it joined in the Allies island-hopping campaign and took part in the Battle of Leyte Gulf and invasion of Okinawa. In the course of the World War II, Intrepid was hit by a Japanese torpedo and three kamikazes. After serving with the occupation forces at the end of the war, the carrier was decommissioned in 1947. Fast Facts: USS Intrepid (CV-11) Nation: United StatesType: Aircraft CarrierShipyard: Newport News Shipbuilding CompanyLaid Down: December 1, 1941Launched: April 26, 1943Commissioned: August 16, 1943Fate: Museum ShipSpecificationsDisplacement: 27,100 tonsLength: 872 ft.Beam: 147 ft., 6 in.Draft: 28 ft., 5 in.Propulsion: 8 Ãâ€" boilers, 4 Ãâ€" Westinghouse geared steam turbines, 4 Ãâ€" shaftsSpeed: 33 knotsRange: 20,000 nautical miles at 15 knotsComplement: 2,600 menArmament4 Ãâ€" twin 5 inch 38 caliber guns4 Ãâ€" single 5 inch 38 caliber guns8 Ãâ€" quadruple 40 mm 56 caliber guns46 Ãâ€" single 20 mm 78 caliber gunsAircraft90-100 aircraft In 1952, Intrepid commenced a modernization program and rejoined the fleet two years later. The next two decades saw it serve in a variety of roles including as a recovery ship for NASA. Between 1966 and 1969, Intrepid conducted combat operations in Southeast Asia during the Vietnam War. Decommissioned in 1974, the carrier has been preserved as a museum ship in New York City. Design Designed in the 1920s and early 1930s, the US Navys Lexington- and Yorktown-class aircraft carriers were built to meet the limitations set forth by the Washington Naval Treaty. This agreement placed restrictions on the tonnage of different types of warships as well as capped each signatorys overall tonnage. These types of limitations were affirmed through the 1930 London Naval Treaty. As global tensions became more severe, Japan and Italy left the agreement in 1936. With the collapse of the treaty system, the US Navy began creating a design for a new, larger class of aircraft carrier and one which drew from the lessons learned from the Yorktown-class. The resulting design was wider and longer as well as included a deck-edge elevator system. This had been used earlier on USS Wasp (CV-7). In addition to carrying a larger air group, the new design mounted a greatly enhanced anti-aircraft armament. Construction Designated the Essex-class, the lead ship, USS Essex (CV-9), was laid down in April 1941. On December 1, work commenced on the carrier that would become USS Yorktown (CV-10) at Newport News Shipbuilding Dry Dock Company. That same day, elsewhere in the yard, workers laid the keel for the third Essex-class carrier, USS Intrepid (CV-11). As the US entered World War II, work progressed on Intrepid and it slid down the ways on April 26, 1943, with the wife of Vice Admiral John Hoover serving as sponsor. Completed that summer, the carrier entered commission on August 16 with Captain Thomas L. Sprague in command. Departing the Chesapeake, the Intrepid completed a shakedown cruise and training in the Caribbean before receiving orders for the Pacific that December. Island Hopping Arriving at Pearl Harbor on January 10, Intrepid commenced preparations for a campaign in the Marshall Islands. Sailing six days later with Essex and USS Cabot (CVL-28), the carrier began raids against Kwajalein on the 29th and supported the invasion of the island. Turning towards Truk as part of Task Force 58, Intrepid took part in Rear Admiral Marc Mitschers highly successful attacks on the Japanese base there. On the night of February 17, as operations against Truk were concluding, the carrier sustained a torpedo hit from a Japanese aircraft which jammed the carriers rudder hard to port. By increasing power to the port propeller and idling the starboard, Sprague was able to keep his ship on course. On February 19, heavy winds forced Intrepid to turn north towards Tokyo. Joking that Right then I wasnt interested in going in that direction, Sprague had his men construct a jury-rig sail to help correct the ships course. With this in place, Intrepid limped back to Pearl Harbor arriving on February 24. After makeshift repairs, Intrepid departed for San Francisco on March 16. Entering the yard at Hunters Point, the carrier underwent full repairs and returned to active duty on June 9. Proceeding to the Marshalls in August, Intrepid began strikes against the Palaus in early September. After a brief raid against the Philippines, the carrier returned to the Palaus to support American forces ashore during the Battle of Peleliu. In the wake of the fighting, Intrepid, sailing as part of Mitschers Fast Carrier Task Force, conducted raids against Formosa and Okinawa in preparation for Allied landings in the Philippines. Supporting the landings on Leyte on October 20, Intrepid became embroiled in the Battle of Leyte Gulf four days later. USS Intrepid (CV-11) during the Battle of Leyte Gulf, 1944. US Naval History and Heritage Command Leyte Gulf and Okinawa Attacking Japanese forces in the Sibuyan Sea on October 24, aircraft from the carrier mounted strikes against enemy warships, including the massive battleship Yamato. The following day, Intrepid and Mitschers other carriers delivered a decisive blow against the Japanese forces off Cape Engaà ±o when they sank four enemy carriers. Remaining around the Philippines, Intrepid sustained heavy damage on November 25 when two kamikazes struck the ship in the course of five minutes. Maintaining power, Intrepid held its station until the resulting fires were extinguished. Ordered to San Francisco for repairs, it arrived on December 20. Repaired by mid-February, Intrepid steamed west to Ulithi and rejoined operations against the Japanese. Sailing north on March 14, it commenced strikes against targets on Kyushu, Japan four days later. This was followed by raids against Japanese warships at Kure before the carrier turned south to cover the invasion of Okinawa. Attacked by enemy aircraft on April 16, Intrepid sustained a kamikaze hit on its flight deck. The fire was soon extinguished and flight operations resumed. Despite this, the carrier was directed to return to San Francisco for repairs. These were completed in late June and by August 6 Intrepids aircraft were mounting raids on Wake Island. Reaching Eniwetok, the carrier learned on August 15 that the Japanese had surrendered. Postwar Years Moving north later in the month, Intrepid served on occupation duty off Japan until December 1945 at which point it returned to San Francisco. Arriving in February 1946, the carrier moved into reserve before being decommissioned on March 22, 1947. Transferred to Norfolk Naval Shipyard on April 9, 1952, Intrepid began an SCB-27C modernization program which altered its armament and updated the carrier to handle jet aircraft. Re-commissioned on October 15, 1954, the carrier embarked on a shakedown cruise to Guantanamo Bay before deploying to the Mediterranean. Over the next seven years, it conducted routine peacetime operations in the Mediterranean and American waters. In 1961, Intrepid was redesignated as an anti-submarine carrier (CVS-11) and underwent a refit to accommodate this role early the following year. USS Intrepid (CV-11) recovers Gemini 3, March 23 ,1965. NASA NASA and Vietnam In May 1962, Intrepid served as the primary recovery vessel for Scott Carpenters Mercury space mission. Landing on May 24, his Aurora 7 capsule was recovered by the carriers helicopters. After three years of routine deployments in the Atlantic, Intrepid reprised its role for NASA and recovered Gus Grissom and John Youngs Gemini 3 capsule on March 23, 1965. After this mission, the carrier entered the yard in New York for a Fleet Rehabilitation and Modernization program. Completed that September, Intrepid deployed to Southeast Asia in April 1966 to take part in the Vietnam War. Over the next three years, the carrier made three deployments to Vietnam before returning home in February 1969. USS Intrepid (CVS-11) in the South China Sea, September 1966. US Naval History and Heritage Command Later Roles Made flagship of Carrier Division 16 with a home port of Naval Air Station Quonset Point, RI, Intrepid operated in the Atlantic. In April 1971, the carrier participated in NATO exercise before beginning a goodwill tour of ports in the Mediterranean and Europe. During this voyage, Intrepid also conducted submarine detection operations in the Baltic and on the edge of the Barents Sea. Similar cruises were conducted each of the following two years. Returning home in early 1974, Intrepid was decommissioned on March 15. Moored at Philadelphia Naval Shipyard, the carrier hosted exhibits during the bicentennial celebrations in 1976. Though the US Navy intended to scrap the carrier, a campaign led by real estate developer Zachary Fisher and the Intrepid Museum Foundation saw it brought to New York City as a museum ship. Opening in 1982 as the Intrepid Sea-Air-Space Museum, the ship remains in this role today.

Blog Essay Example | Topics and Well Written Essays - 250 words - 9

Blog - Essay Example Janissaries were a formidable fighting force of the Ottomans which gave the Ottomans enormous advantage over the European forces. Gradually, firearms, infantry drill, muskets, grenades and hand cannons were introduced which further strengthened the Janissary corps. However, the original organization was strong enough to adopt these advancements. There were infantry and cavalry soldiers. The infantry was divided into seven groups: janissaries, recruits, armorers, artillerymen, artillery carries, bombardiers and sewermen. All of these groups, formed by Turkish yongmen, were strong enough to provide the military with a tough corps. Hence, it is concluded that the military should have a robust organizational structure first of all, so that it is resilient enough to adopt newer ways, tools and equipment. Although, it is also true that without the introduction and adoption of firearms, muskets, and etcetera, the Janissaries would have ended up much sooner than they did, however, the import ance of organizational structure cannot be denied as with any other field of