Napoleon Bonaparte Essay -- Papers

Napoleon Bonaparte Napoleon saved France from a horrible situation. He extended the French territory to bring hope to the French people, and brings revolution to Europe. Napoleon Bonaparte never gave up hope for France. Napoleon Bonaparte was born on August 15, 1769. No Bonaparte except for Napoleon became a professional soldier or was good at war. His father Carlo fought for Corsican independence, but after the French took over the island he served. He became prosecutor and judge and entered the French aristocracy. Napoleon had a good education and exceptional military training. His father secured a scholarship for him to go to the French military school at Brienne. When he was in school he a lot of his time and effort into his studies. Then in 1794,when he was 15,he graduated 42nd in his class of 58. He wanted more education after he graduated. He spent a year at the Military Academy in Paris. Then he was commissioned a second lieutenant in artillery. Napoleon was the head of an artillery brigade at the siege of Toulon where there was a British fleet. The British were driven out, and Napoleon was given a promotion to General of Brigade. In February of 1794 Napoleon was assigned to the French army in Italy. In October 5, 1795 a revolt broke out in Paris because of protesting the new constitution introduced by the Convection. Napoleon was ordered to defend the convection and was helped by Joachim Murat cannons. He was able to stop the revolting within four months. The Directory rewarded him with the appointment as commander of the army of the interior. In March of 1796 Napoleon began operations to divide and defeat the .. ... to navigate rivers that formed boundaries between states. Also the congress reestablished the balance of power among the countries of Europe. Napoleon never really abused his power he remained a fair leader to the people of France all of his life. Napoleon has been referred to as the "first modern dictator," because he didn't abuse his power compared to other leaders in western civilization. Napoleon cared more about the well being of the French people, and didn't care about getting money from the government. Napoleon's achievements and goals should be evaluated in a good way. Because he wasn't a tyrant, he achieved those most of his goals in a civilized way. Napoleon was one of the more fair, and better leaders than the ones that came earlier in historyà ¢Ã¢â€š ¬Ã‚ ¦.. But his wife was a whore! (Had to throw that in jokingly)

Stroke Care Management and Pressure Ulcer Assessment Tool

Student Number: 21127187 Module: Assessment and Therapeutic Care Management Module Code: AN 602 Assignment Title: A Case study: Stroke Care Management and Pressure Ulcer Assessment Tool Word Count: 3296 Date Submitted: 11th January, 2012 This academic work aims to present a clinical case study of a patient who is diagnosed of cerebrovascular accident (CVA), also called â€Å"stroke†, achieve a deeper understanding of debilitating post-stroke complications using an assessment guide and nursing interventions to the nursing diagnosis of impaired skin integrity.This essay aims to incorporate the utilisation of a pressure ulcer grading assessment tool to establish baseline assessment data and facilitate ongoing wound care management in relation to pressure ulcers (PrUs) as one of long term problems encountered in the care of a stroke patient. A holistic assessment of the patient will be required, identifying activities of daily living to enable the nurse to devise a plan involving the therapeutic team in line with identified nursing diagnoses.Due to limitation on word count, the essay will focus more on the present health status in relation to areas pertinent to PrUs management during the rehabilitation process. For the purpose of this academic work, the patient will be protected by the Nursing and Midwifery Council (NMC) Code of Conduct (2008) by use of a pseudonym, ‘Mr. X’. Mr. X, is an 87 year-old elderly obese patient, with long-term diagnosis of Hypertension (HPN) and Non-Insulin Dependent Diabetes Mellitus (DM), on maintenance medications, who was recently diagnosed of Cerebrovascular Accident (CVA).Mr. X was transferred to a nursing home after the acute hospitalisation for long-term care. Brunner (2008) defines CVA, Ischemic Stroke, or â€Å"Brain Attack† as sudden loss of neurologic functioning resulting from blood flow disruption in cerebral blood vessels. Stroke has two main types, Ischaemic and Hemmorhaegic: the former is caused by an infarct of blood clot in brain artery and accounts for 80 % of all stroke cases; while the latter is caused by bleeding into the brain tissues accounting to 20 % of stroke occurrences (Feigin et al, 2003).Stroke is the third leading cause of death and is a major cause of adult neurological disability which affects approximately 130,000 people a year in the UK (National Audit Office, 2005). Mr. X was diagnosed of having left middle cerebral artery (MCA) infarct 7 months ago resulting to neurological deficits on the contralateral side of the body. The extent of deficits following stroke depends upon the affected cerebral artery and subsequent areas of brain tissue compromised of blood supply by the damaged vessel (Porth, 2007). Upon assessment, Mr.X has right side hemiplegia, contralateral sensory impairment, dysphasia, bowel and bladder incontinence, and an existing Category I PrUs on both heels. The hemiplegia is explained by Brunner (2008) that because motor neurons decussat e, a disturbance of motor control on one side of the body may reflect damage to the motor neurons on the opposite side of the brain. Williams et al (2010) states that following a MCA infarct, there is alteration of the brain’s ability to process and interpret sensory data which results in Mr. X’s sensory impairment.Porth (2007) defines aphasia as a general term with varying degrees of inability to comprehend, integrate, and express language. Porth (2007) further states that a stroke on the MCA territory is the most common aphasia-producing stroke. It is then imperative to understand the pathology of affected areas of the brain to anticipate presence of motor, sensory, and speech deficits where the nurses and entire therapeutic team can intervene. For the purpose of data gathering and assessment, Gordon’s Functional Health Pattern (1987) is utilised as a framework of this essay.The model presents 11 functional health patterns categorized systematically for data c ollection and analysis, and is used as a guide in the development of a comprehensive nursing data base ( Gordon, 2000). The nurses can identify functional patterns as the clients’ strengths and dysfunctional patterns as the nursing diagnoses, which assist the nurse in developing the care plan (Gordon, 1994, 200). The assessment guide is particularly chosen because it gives the nurse a full opportunity to examine not only the physical aspect f human functioning but includes physiological and psychological disturbances experienced by the patient. Nursing diagnoses can then be derived from the wide-range of assessment data collected. The Gordon’s assessment tool is thereby used a framework for ensuring that all aspects of an individual’s patient’s life are considered. However, this essay will only focus on the following health patterns: Cognitive – Perceptual, Nutritional-Metabolic, Activity and Exercise where nursing problems were identified and ther eby require therapeutic care management.The Agency for Healthcare Policy and Research Guideline for Post-Stroke Rehabilitation (AHCPR, 2005) recommends that initial assessment of stroke patients should include a complete history and physical assessment with emphasis on medical co-morbidities, level of consciousness, skin assessment and risk of PrUs, mobility, and bowel and bladder function. Moreover, the following areas of assessment contribute to the development of PrUs: impaired sensory perception or cognition, decreased tissue perfusion, nutrition and hydration status, friction and shear forces, skin moisture, mobility, and continence status (Brunner, 2008; Porth 2007).The specific areas mentioned above will be of greater emphasis due to its contribution to PrU management in post-stroke Mr. X. Based upon history taking, Mr. X has been living with Hypertension (HPN) and DM for 12 years and has been insulin dependent for 5 months now after the occurrence of stroke. Past medical his tory must be taken into essential consideration especially in chronic conditions to ascertain levels of compliance to medical interventions, perception towards illness, and impact on patient’s lives (Crumbie, 2006).Establishment of rapport and consequently gaining trust from the patient thereby enables the nurse to create a good baseline history assessment and attain patient’s cooperation through the entire rehabilitation process. The nursing process first step is assessment which involves collecting data to help identify actual and potential health problems and patient needs. In order to develop appropriate nursing diagnoses, accurate assessments should be made to guarantee allocation of appropriate resources in the planning stage to achieve expected outcomes. Potter and Perry, 2008). It could be suggested that nurses in this stage of nursing process should employ opportunities for holistic assessments and use critical thinking in determining focus areas to be include d in the database. The cephalo-caudal principle of assessment is incorporated as a guide for presenting the health patterns, which sets the Cognitive – Perceptual pattern as the first to be approached highlighting assessments on cognition, perception, sensory, pain, and language.Williams et al (2010) states that post-stroke damage to the brain can result to cognitive and sensory impairment which often includes a decrease in thinking, effective decision-making, memory, and perception. Mr. X’s assessment of this health pattern reveals communication difficulty between patient and healthcare team. If communication problems arise, nurses conduct referrals to the Speech and Language Therapy (SLT) who diagnoses presence of aphasia. However, the type of aphasia has not been established yet since Mr.X has been reportedly uncooperative to therapies. It could be suggested however, that basing on research, the Frenchay Aphasia Screening test (Enderby et al, 1987) can be utilised b y the SLT to administer a quick language measure. Another recommendation is the participation of nurses in an interview (Inpatient Functional Communication Interview, McCooey et al, 2004) by the SLT to describe how Mr. X communicate at bedside to help the SLT diagnose communication problems, if any.The limitation on data gathering and assessment process can be compromised at this stage because of problems on communication between the nurse and the patient. It could be suggested that a referral to a speech pathologist can be made to evaluate the patient’s speech, language and ability to understand by testing verbal expression, writing ability, reading, and understanding of verbal expression (Barker, 2002). A nursing diagnosis identified is Impaired verbal communication related to effects of dysphasia.It may be suggested that nurses should provide patients with aphasia a constant way of communicating, through hand gesture, tone of voice, facial expressions and verify responses with family members when warranted ( Holland et al, 2003). It may also be necessary to talk slow, clear, in simple terms and render the patient ample time to understand the information given (Barker, 2002). Family members of aphasic stroke survivors may also experience difficulty in various roles of care giving since the patient cannot communicate effectively (Christensen and Anderson, 1989; Draper and Brocklehurst, 2007).Therefore, it is also necessary to include the family, caregivers, and the nurses at bedside during therapies to maximise nursing care (Intercollegiate Stroke Working Party, 2008). Mr. X’s perception of pain is assessed periodically at varying times of a day to ensure pain relief. Mr. X cannot verbalise pain, but most of the time shows facial grimaces while pointing to right shoulder and hand where pain are felt. Brunner (2008) says that as many as 70 % of stroke patients suffer severe shoulder pain that prevents patients to perform balance and perform self- care activities.Mr. X upon physical assessment has painful shoulder, swelling and stiffness on right hand, defined by Brunner (2008) as shoulder-hand syndrome which causes a frozen shoulder and subcutaneous tissue atrophy, and is always painful. However, according to Edwards & Charlton (2002), it cannot be a cause of pain if managed correctly with appropriate limb support. In this regard, pain assessments should always be subjective and be backed up with objective data gathered. Nursing diagnosis identified is Chronic pain related to immobility secondary to disease process (Heath, 2008).Mr. X has been prescribed with pain relief, Piroxicam gel onto pain areas three times a day and Tramadol tab daily. Piroxicam Gel is a non-steroidal anti-inflammatory drug that inhibits the enzyme prostaglandin thereby reducing pain and swelling whereas Tramadol is an Opiod analgesic (British National Formulary, 2010). Moreover, Mr. X has been receiving Amitryptiline HCl to help in the management of post-stroke pain but it causes cognitive problems and sedation (Brunner, 2008) thereby requiring safety nursing measures.However, non-pharmacological nursing interventions should be employed first hand before medical interventions. Brunner (2008) suggests elevation of the hand and arm to prevent edema. National stroke guidelines recommend any patient whose range of motion at a joint is reduced should undergo passive stretching of all affected joints on a daily basis, and furthermore, taught to carers (Carter & Edwards, 2002) provided that pain relief is achieved at all times.Referrals to physical therapy or occupational therapy are suggested to evaluate physical debilitations relating to functional mobility to promote pre-morbid independence and subsequently enhance quality of life (Barker, 2011). The second health pattern to be presented is Nutritional – Metabolic. Stroke can present a wide range of deficits which can affect ability to eat and predispose a post-stroke patien t from malnutrition (Williams et al. , 2010).It is supported by Shelton and Reding (2001) who integrates associated weakness and sensory loss on arm and face more than the leg in patients who has had occlusion of the MCA. Barker (2002) states that nearly one third of stroke survivors have dysphagia and chewing difficulties which prompts nurses strategies to liaise aspiration risk with SLT and nutritionist or dietitian. Special diet and caloric calculations may also be needed for Mr. X due to daily insulin management, not to mention daily blood glucose monitoring.Waterlow (1985) emphasizes that those with eating difficulties are likely to eat less, thereby slowly predisposing to poor nutritional intake, so efforts should be directed at creating good balanced diet, is well-presented, and if possible, assistive devices are provided such as adapted cutlery for ease in eating, plate guards, non-slip pads and beakers for drinking. Monitoring of nutritional deterioration of post stroke pat ients is essential during rehabilitation phase thereby giving attention to nutritional intake, weight, gastrointestinal function, and general health condition (NICE, 2005).Weekly weighing has been advocated and utilization of nutritional screening tools that are validated and reliable are recommended by NICE (2005). Review of systems provides skin assessment in nutritional metabolic health pattern which revealed presence of pressure ulcer on heels. The European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) (2009, p7) defines, ‘ A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence , as a result of pressure, or pressure in combination with shear’.Waterlow (1996) emphasizes that excessive weight increases pressure on a bony area thinly covered by tissue such as the sacrum, heels, and trochanters. Pressure ulcers (PrUs) on the heel is a very common site of PrUs, ranking second fro m the sacrum (Bennett & Lee,1985; Hunter et al, 1985; Wong & Stotts, 2003) and is often painful (Black, 2005). Krueger (2006) in her study, stated that 25% of heel PrUs are related to diabetic neuropathy and peripheral arterial occlusive disease.PrU classification systems describe how severe the tissue damage is through progressive numbers or categories (Dealey, 2009). Given that all professionals utilize same system, logic dictates that all PrUs will be objectively assessed, however, Ousey (2005) debates that many grading systems available are rather subjective in nature giving professionals varying assessment interpretations. Grading systems assists healthcare professionals identify the severity of PrUs and serve as a baseline for care plans. However, careful clinical judgement by the nurse s essential in ensuring that the classification systems are used only as a guide, professional skills in assessment are needed to ascertain objective assessment data. In conclusion, grading sys tems serve as valuable tools to determine pressure sore severity in clinical practice, audit, and research ( Beeckman, 2007). Moreover, consistency in the use of classification system will enable the professionals to define progress of healing, allow evaluation of goals of treatment, and revise plans as deemed necessary.Based on the European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) (2009) Pressure Ulcer Classification System, Mr. X has a Category I PrU and is defined as an area of intact skin with non-blanchable redness of a localized area, usually on a bony prominence, which may present as painful, warm, and edematous. The NPUAP and EPUAP classification system was designed to provide commonality in the definition and grading / categorization / staging of pressure ulcer, which is applicable in international settings.It has four categories, Category I to IV, each defining level of skin injury and adding physiologic descriptions, which i s recommended by NICE (2005). Terms such as unclassified or unstageable and deep tissue injury (DTI) which are classified as category IV is discussed separately in the new guideline (NPUAP and EPUAP, 2009). Ousley (2005) stated that Surrey system of classifying PrUs is the simplest tool available, presenting same four levels in plain terms, however, warns professionals of its relative subjectivity due to its simplicity.The EPUAP (2007) grading system is almost similar to NPUAP (2007), describing four grades, each is described in detail. However, according to a study done by Beeckman (2007), the EPUAP system of classification has a low inter-rater reliability because of complex details in the definition, leading to a low commonality of professionals identifying the categories of PrUs, jeopardising audit of prevalence rates and affectivity of wound management.The Torrance grading system involves five stages, each stage described simply and is easy to use, however it was not widely uti lised because of its number of categories (Ousey, 2005), which may impose confusion against four categories, rather than achieving consensus. Healey (1995) in her study, revealed that Surrey, Torrance, and Stirling systems do not have a high level of reliability. Similarly, the Stirling Pressure Sore Severity scale (SPSSS) tool is argued by Healey (1995) to have the lowest reliability rate because of its most complex subscales under each category.There are four stages starting from 0 where there is no evidence of pressure ulcer, then each category has subsections, describing the level of skin injury, wound bed, and presence of infection parameters (Ousley, 2005). However, Waterlow (1996) in her work on pressure sore prevention established the use of SPSSS as the standard classification system to be implemented because she argues that specialists and researchers need to define pressure ulcers in greater depth whereas the other systems’ relative simplicity is regarded as weakne ss in lieu of its use on clinical audit.In this regard, the NPUAP and EPUAP guideline is considered useful because it provides evidence-based assessment as it is proven to be an effective and reliable tool in every healthcare setting. This will enable the healthcare team to improve the care required for pressure ulcer due to a common baseline assessment of the ulcer, thereby requiring a specified care management depending on its stage. Nurses can then devise a care plan based on ulcer grading, identify appropriate treatment, allocate care resources, implement the plan, and do continual evaluation of the care plan with its goal directed at wound healing.However, to achieve this level of patient assessment and care, every nurse should possess the necessary knowledge and skills which can be achieved through continuing education and trainings in pressure risk assessment and PrUs management, an interdisciplinary collaboration ( NICE, 2005). Nursing diagnosis identified is Impaired skin i ntegrity related to immobility and decreased sensory perception secondary to disease process (Heath, 2009). Nursing management employed were repositioning Mr.X every 2 hours avoiding positioning on pressure area (EPUAP and NPUAP, 2009) and taking weight off the mattress by placing a pillow or a folded blanket under entire length of the leg and not under the Achilles tendon to protect the knee as well (Waterlow, 1996; NPUAP and EPUAP, 2009, Langermo et al, 2008). There are marketed devices for heel protection but needs constant care giver assessment since these devices are found to not keep the heels off the bed better than pillows do (Tymec et al, 1997).Relieving the pressure off the heels is often all that is needed to recover the tissues in category I Heel PrUs (Langemo et al, 2008) and if offloaded continuously hastens recovery time (Black, 2005). Periods of frustration and depression are sporadically experienced by 40 % of stroke patients throughout the recovery process or as a new phase in the trajectory of a chronic illness and is often underdiagnosed (Barker, 2002).Ideally, a psychiatrist or a clinical psychologist diagnoses depression, but according to Intercollegiate stroke Working Party (2008) a healthcare professional with mental health training can diagnose using a clinical interview. It can also be suggested to use brief screening tools to identify patients at risk of depression such as the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) or the Geriatric Depression Scale GDS ( Yesavage et al, 1982) which are validated tools to assess mood in stroke populations (Williams et al, 2010). Amitryptiline HCl, a Tricyclic antidepressant (BNF, 2010) is prescribed for Mr.X, and is taken daily. Duncan (2005) sets the prevention of stroke recurrence as the highest priorities in stroke rehabilitation and is therefore the responsibility of the nurse to understand stroke risk factors and apply contemporary evidence based lifestyle changes after pr oper training (Lawrence et al, 2011). Barker (2002) reports that stroke survivors have 30% probability of recurring stroke within a year and 50% can suffer fatal strokes in 5 years. It could then be suggested that a Stroke Risk Screening Tool (Barker, 2002) be utilised to decrease risk of death and evaluate risk factors of Mr.X such as HPN which is managed at present with antihypertensives, DM managed with Insulin injections, Hypercholesterolemia managed with Antilipidemics, advancing age, obesity, and diet. Therefore, an important aspect of nursing care is health education whereby nurses promote lifestyle change and supportive behavioral approach towards long-term health modification. In conclusion, nurses’ role in the care of post-stroke patient is multi-faceted, one that requires interprofessional linkage and deep understanding of contemporary evidence based interventions to address issues.DH (2007) further suggests that post stroke patients and their carers should receive support from varying range of services made available locally. Most importantly, though nursing interventions are standardized as guidelines, it could be suggested that it may not be all applicable in every patient interaction and care should be individualized as needed (Landers & McCarthy, 2007). Therefore, it is of prime importance for nurses to understand that healthcare decisions are based from patient’s individual choices derived from rational decision-making and the objective and rofessional advice of every member of the therapeutic team. Reference List Agency for Health Care Policy and Research. (1992) Pressure ulcers in adults: prediction and prevention. Clinical practice guideline no. 3. AHCPR, Public Health Service, US Department of Health and Human Services. Rockville, MD: US Department of Health and Human Services. Barker, E. (2002) Neuroscience nursing: a spectrum of care. 2nd ed. Missouri. Mosby. Beeckman, D. , and Schoonhoven, L. (2007). EPUAP classification s ystem for pressure ulcers: european reliability study. Journal of Advance Nursing. 60 (6), 682-691. Bennett L, & Lee, BY. 1985) Pressure vs. shear in pressure sore causation:Chronic ulcers of the skin. New York. McGraw Hill. Black, J. (2005) Treating heel pressure ulcers. Nursing. 35:68. British national formulary. (2010) British national formulary:March 2010. London. BMJ group. BNF. org Carter, P. & Edwards, S. (2002) General principles of treatment. Neurological Physiotherapy: A problem solving approach. 2nd ed. Edinburgh. Churchill Livingstone. Christensen, JM. and Anderson, JD. (1989) Spouse adjustment to stroke:aphasic vs. non-aphasic partners. Journal of Communication Disorder. 22 (4), 225-231. Crumbie, A. 2007) Assessment and management of the patient with chronic health problems : Watson;s clinical nursing and related sciences. 7th ed. Edinburgh. Dealey, C. (2009) Skin care and pressure ulcers. Advances in Skin and Wound Care. 22 (9), 421-428. Department of health (2007) The national stroke strategy for England. Department of health. [online]. Available from:http://www. stroke. org. uk/campaigns/stroke_policy/the_national_stroke. html [14 November, 2011] Draper, P. and Brocklehurst, H. (2007) The impact of stroke on the well-being of the patient’s spouse: an exploratory study. Journal of Clinical Nursing. 6 (2), 264-271. Duncan, P. , Zorowitz, R. , Bates, B. , Choi, J. , Glasberg,J. , Graham, G. , Katz, R. , Lamberty,K. , and Reker,D. (2005) Management of adult stroke rehabilitation care:a clinical practice guideline [online]. American heart association. Available from: http://stroke. ahajournals. org/content/36/9/e100. full. [Accessed 12 October 2011]. Edwards, S. & Charlton, PT. (2002) Splinting and the use of orthoses in the management of patients with neurological disorders. Neurological Physiotherapy: A problem solving approach. 2nd ed. Edinburgh. Churchill Livingstone. Enderby, P. , Wood, V. , and Wade, D. 1987) Frenchay Aphasia Screening Test. NFER-Nelson. Windsor. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. , (2009) Pressure ulcer prevention: quick reference guide [online]. Available from: www. eupap. org [Accessed 20 November 2011]. Feigin, V. , Lawes, C. , Benett, D. , Anderson, C. (2003) Stroke Epidemiology: a review of population-based studies of incidence, prevalence, and case fatality in the late 20th century. The Lancet Neurology. 2 (1) 45-53. Gordon, M. (1994). Nursing diagnosis: Process and application. 3rd ed. St. Louis: Mosby. Gordon, M. (2000). Manual of nursing diagnosis: 1995-1996.St. Louis: Mosby. Healey, F. (1995) The reliability and utility of pressure sore grading. Journal of Tissue Viability, 5 (40), 111-114. Heath, H. (2002) Potter and perry’s foundation in nursing theory and practice. London. Elsevier science limited. Heather, H. (2009) North American nursing diagnosis association international nursing diagnoses. Oxford. Wiley-blackwell. Holland, K. , Jenkins, J. , Solomon, J. and Whittam, S. (2003) Applying the roper logan Tierney model in practice. London. Elsevier limited. Hunter, SM. , Langemo, DK. , and Olson, B. (1995) The effectiveness of skin care protocols for pressure ulcers.Journal of Rehabilitation Nursing. 20 (2), 50-55. Intercollegiate Stroke Working Party. (2008) National clinical guideline for stroke. 3rd edition. London. Royal college of physicians. Kelly, J. (1994) The aetiology of pressure sores. Journal of tissue and viability. 4(3), 77 Krueger RA. (2006) Pressure relieving support surfaces: a randomized evaluation. Poster presented at the 9th European Pressure Ulcer Advisory Panel Conference. Berlin, Germany. Landers, M. and Mc Carthy, G. (2007) Person-centred nursing practice with older people in Ireland. Nursing Science Quarterly. 20 (1), 78-84. Langemo, D. , Thompson, P. Hunter, S. , Hnason, D. , Anderson, J. (2008) Heel pressure ulcers:stand guard. Advances in Skin and Wound Care. 21 (6), 282-292. Lawr ence, M. , Fraser, H. , Woods, C. , and McCall, J. (2011) Secondary prevention of stroke and transient ischemic attack. Nursing Standard. 26 (9), 41-46. Maklebust, J and Magnan, MA (1994) Risk factors associated with having a pressure ulcer: a secondary data analysis. Advances in Skin and Wound Care. 7 (27), 31-34. Maklebust, J and Magnan, MA (2005) Preventing heel pressure ulcers in immobilized patients. Advances in Skin and Wound Care. 18 (1), 22 McCooey, R. , Worrall, L. , Toffoko,D. Code, C. , and Hickson, L. (2004) Inpatient functional communication interview. Singular publishing. National audit office (2005). Reducing brain damage – faster access to better stroke care. The stationary office. London. National institute for health and clinical excellence (2005) CG29 Pressure ulcer development:quick management guide [online]. Available from: http://publications. nice. org. uk/pressure-ulcers-cg29/guidance [Accessed 26 October 2011]. National pressure ulcer advisory panel ( NPUAP). (2007). Pressure Ulcer Definition and Stages. NPUAP. Available from: www. npuap. org [Accessed: 16th December 2011).Nursing and Midwifery Council. (2008). The code Standards of conduct, performance and ethics for nurses and midwives. London. Nursing and midwifery council. Ousey, K. (2005) Pressure area care. Oxford. Blackwell. Porth,C. (2007) Essentials of pathophysiology:concepts of altered mental states. 2nd ed. London. Lippincott Williams & wilkins. Shelton, FN. and Reading, MJ. (2001) Effect of lesion location on upper limb motor recovery after stroke. Stroke. 32 (1), 107-112. Smeltzer,S. , Bare, B. , Hinkle, J. , and Cheezer, K. (2008) Brunner & suddarth’s textbook of medical-surgical nursing. 11th ed. London.Lippincott williams & wilkins. Tymec AC, Pieper B, Vollman K. (1997) A comparison of two pressure-relieving devices on the prevention of heel pressure ulcers. Advances in Skin and Wound Care. 10(1), 39-44. Waterlow, J. (1996) Pressure sore prevention manual. Taunton, Somerset Williams, J. , Perry,L. and Watkins, C. (2010) Acute stroke nursing. Chichester. Wiley-blackwell. Wong, VK. , Stotts, NA. (2003) Physiology and prevention of heel ulcers: the state of science. Journal of Wound Ostomy and Continence Nursing. 30 ( ), 191-198. Yesavage, JA. , Brink, TL. , Rose, TL. , Lum, O. , Huang, V. (1982) Development

Hamlet’s Psychological Aspect Essay

I decided to do this research work because I have enjoyed a lot reading this play: Hamlet. The inner motivations and psyche of this character have captured my attention. Therefore, the aim of this research is to depict Hamlet’s attitudes during the play. I will try to approach to his real feelings on life and death taking into consideration what critics and researchers have said about Hamlet. In order to clarify Hamlet’s personality and behaviour, I will provide some aspects of the historical context in which Shakespeare was inspired to write this play, and a brief summary of it to take into account the plot. Finally, I will make a conclusion in which I will try to summarise the most important impressions of this research. Historical Context of the play Shakespeare wrote Hamlet in the last years of the reign of Queen Elizabeth 1, who had been the queen of England more than forty years. As she had no children the question of who would succeed her was a situation that provoked anxiety at that time. Due to this fact, researchers agree that many of Shakespeare’s plays from this period concern transfers of power from one monarch to the next. Another important issue dealt with in his plays is the general sense of anxiety, fear, uncertainty, betrayal and revenge. For instance, Hamlet displays all the themes mentioned above. Shakespeare was able to sum up the most impotant values of the Renaissance. Cultural phenomenon that began in the fifteenth-century and proclaimed the humanism: a new thought that revalued the social and popular aspect of life. People who belonged to the Renaissance period claimed that human beings lived in a world of appearances, in which they tried to hide their realities, that is to say, their deepest desires and what they actually were. Hamlet had to face one of the most difficult realities: injustice. A task that presents a dilemma to him: â€Å"to be or not to be†. While pointing out questions that cannot be answered, the play as a whole chiefly demonstrates the difficulty of knowing the truth about other people: who are guilty or innocent, which their motivations and feelings are. Brief Summary of the play Shakespeare begins the play with the death of the King of Denmark and the possession of the throne by the King’s brother Claudius, instead of the King’s son, that is to say the prince Hamlet, who was supposed to be the next in line. What is more, the new king Claudius suddenly married Gertrude, the dead king’s widow. Thus, the prince Hamlet got depressed by the unexpected situation. One night, Hamlet’s father appears as a ghost to tell Hamlet that he had been murdered by his own brother Claudius, that is to say, Hamlet ´s uncle. In his anger, Hamlet decides to fulfill his father’s request, which is to avenge his death. In order to confirm what the ghost has said, Hamlet organizes a play in which he represents the assessination scene. While the play is being performed, Claudius stands up and goes out feeling guilty. At the moment, Hamlet confirms the truth and discusses the situation with his mother. As Hamlet notices that someone is spying on them behind the curtains, he stabs his sword without checking who this person is. As a result, he kills Polonius, Claudius’s chief councillor. When Ophelia, Polonius ´s daughter, is informed about her father’s death she reacts with madness and eventually falls in a stream and drowns. After that, Laertes, Ophelia’s brother, is told that Hamlet is involved in Polonius’s death and Ophelia’s madness. Therefore, he wants to avenge his father’s and sister’s death trying to eliminate Hamlet. As Claudius promised Laertes to help him with the revenge, they plan to kill Hamlet as if by accident with a poisoned sword in a fencing match. Claudius also plans to offer Hamlet a poisoned drink during the fight. When the fencing contest begins, Hamlet’s mother Gertrude drinks the poisoned drink before Caludius can stop her and she dies. Hamlet turns away and Laertes wounds him with the poisoned sword, but Hamlet goes on fighting. During the struggle, they exchange swords and Hamlet wounds Laertes, who confesses the plan telling Hamlet that he is also sure to die from the effect of the poison. After hearing the truth, Hamlet stabs Claudius with the poisoned sword and forces him to drink the poison, too. Finally, while Hamlet is dying by the effect of the poison, he orders one of his friends called Horatio to tell the terrible story of the happening to everyone.

Australian women in WW2 essays

Australian women in WW2 essays The coming of World War II in 1939 saw almost 800 thousand Australian men and women leave the country serving the Australian Armed Forces. For the many women left behind this created vast opportunities for them to develop their economical and social status. Their patriotism was targeted in many areas, including paid work, romance and motherhood. They became highly independent parents and in the work force and many Australian women found romance in the visiting American soldiers. With hardly any men left in the country Australian women's patriotism was called upon, the work that they had traditionally done in the home was seen as unnecessary, and they were called upon to enter the 'real work force', or jobs that had previously been seen as men's work.. The government and private industry had realised the enormous potential of a mobilised work force of women. Many of the tasks undertaken by women initially caused surprise and some open debate, but it was not long before scenes of women working in factories and with heavy machinery ceased to be unusual. Women were encouraged to fill the gap that the men had left in the work force and enter areas of work including munitions, factory work and other auxiliary services. Many women undertook intensive training on machinery and production procedures to ensure the supply of products essential to Australia's war effort. Women working in the jobs classified as men's were receiving 90% of the male wage, while women who stayed in work that could not be left, like clothing and textiles remained at only 65% of the male wage. There was great concern about the introduction of women to the work force, particularly their suitability and whether or not they would maintain their femininity. There was also fears that women in uniform would develop lesbian tendencies and cause men to be obsolete. This, ofcourse, was untrue and it was also proven that women were just as worthy in the work place a ...

Essay on A Classic Case of Separation of Powers

Essay on A Classic Case of Separation of Powers Essay on A Classic Case of Separation of Powers Essay on A Classic Case of Separation of PowersThe federal and state budgeting process is to a significant extent similar but still they have differences that make them distinct from each other and, thus, contribute to the development of different approaches to budgeting.The main difference between the federal and state budgeting is the larger authority of Governors compared to the US President in terms of forming the budget of states or the US respectively. Pataki vs. Assmebly and Silver vs. Paraki cases and respective court’s ruling has proved the authority of governors to play the key part in the formation of the budget, while legislatures have limited opportunities to change the budget since they have to have two-thirds votes to overcome a governor’s veto or change the budget.In this regard, the authority of the US President is more limited compared to the authority of governors because the US President has to coordinate the budget with legislators in both houses of the Congress. In fact, the US Presidents just makes the proposal, whereas is the Senate and the House of Representatives have to vote for the proposed budget but they also have the right to introduce changes in the proposed budget to introduce changes, which they consider to be essential. In such a way, the US President should have the support of the majority of the Congress to introduce the budget without significant changes.Thus, cases Pataki vs. Assmebly and Silver vs. Paraki contributed to the enhancement of the position of governors in budgeting at the state level, whereas the federal budget is different from state budget since the President is more dependent on legislatures than governors.

7 Excel Hacks That Will Make Your Life Easier

7 Excel Hacks That Will Make Your Life Easier A whopping 67% of middle-skill jobs require experience in Excel. Just because you hate numbers and the thought of spreadsheets make you nauseous doesn’t mean you can’t add this valuable skill to your resume with confidence. Here are a few tricks to make you an Excel wizard.  1. ChartsThese are not just for the know-it-all in grade school. Charts are a great way to make your data visual, and a great way to impress the bigwigs. Once you’ve entered your data, simply click Insert Chart  Chart Type   and you’re on your way.2. Conditional FormattingThe possibilities here are endless. Want to show off profit margins? Or efficiency? Simply click Home  Ã‚  Conditional Formatting  Ã‚  Add and make your magic. Low numbers (say those below 70%) or profits under 3% could be set to automatically highlight in red, while excellent numbers could be highlighted in green.3. Quick AnalysisHave a smaller data set? You can skip to the fancy chart and table stage by u sing this tool. Just highlight your data and click on the icon in the bottom right corner of your highlight field to open the Quick Analysis menu.4. AutofillWhy enter the same thing in every row when you can have Excel do it for you? Just type in the datum you need repeated, then click and drag the lower right-hand corner of the cell all the way down the column.5. Power ViewHave a larger data set? Power View can collate and make sense of your data for you, generating visual, interactive reports for you to present directly to the boss. Just click Insert  Ã‚  Reports and start exploring.6. Pivot TablesThey sound really fancy, but they’re super useful. You don’t have to write a single formula, but you can summarize all of your data into impressive and informative tables and lists. Just click Insert  Ã‚  PivotTable, select your data range, use the drop-down menu to select your fields, then make your table!7. VLOOKUPIf you’re working in a database with multiple s heets and tabs, VLOOKUP is a great way to bring them all together and pull coherent information from the entire data set. Under the Formula menu, select VLOOKUP and enter the cell that contains your reference, then the range of cells to pull from, the column number, and either â€Å"true† or â€Å"false.†These few tricks are handy for everyone, but will make you stand out among your colleagues- even if you’re â€Å"bad at numbers.†Once you have these done, step up your game and learn these 7 advanced Excel Tricks. It might even get you a raise or promotion.7 Excel Tricks Thatll Make Your Life a Lot Easier (Especially if Youre Not a Numbers Person)

Theory, Research, and Evidence-Based Practice Research Paper

Theory, , and Evidence-Based Practice - Research Paper Example behind the origin of this theory was to encourage motivation among patients in making healthy decisions concerning the most appropriate health services to be adopted. The success of this theory depends on some four conditions. The person must first develop a belief he or she can undergo some risks occasioned by particular ailments conditions. The patient must also believe that the risks linked to the development of the disease are not desirable at all. Additionally, the patient must also have a belief that the particular behavior change can change the magnitude of the disease. Finally, the patient must also believe that the existence of some barriers that tend to hinder behavior change can be managed (Buchanan, 2008). The HBM follows a condition of perceived threat. In this regard, a behavior related to health care must ignite a stimulus action to avert a life threatening disease. For instance, a person who practices sunbathing everyday but not aware that he is exposing himself to skin cancer, will just continue with the behavior. This brings up perceived threats of two kinds. These are perceived vulnerability and perceived sternness. In susceptibility, a person considers the level of risks that he has while in severity, a person considers the outcomes of the perceived risks. An individual needs to belief in both severity and susceptibility as a condition of changing his health behaviors effectively. The nature of severity and susceptibility presents real dangers to individuals. As a result, they will adopt behavior changes such as performing exercises, losing weight, stopping drinking, and giving up smoking in a bid to reverse their health conditions. However, many of these behavior changes are not easy to accomplish. For instance, stopping smoking may take a long time and the benefits may not be accomplished immediately (Buchanan, 2008). The knowledge of health belief model to determine the patient’s rejection and acceptance possibility for an intervention