Nuclear Power: Problem or Solution

Nuclear power is complicated. A nuclear power plant provides energy that does not contribute to global warming. Climate concerns have seen a rise in the construction of new reactors to address growing demands of electricity worldwide. Currently the United States and Canada receive 20% of their electric power from nuclear plants. The rest of the world is at 6% but rising. The benefits drive the nuclear energy movement and continue to do so and the proponents of nuclear power see this as an indispensable solution in reducing the consumption of conflict-ridden fossil fuels. Opponents of nuclear power also make a strong case citing cost, safety and justified global concern of waste storage and the potential for nuclear weapons in areas where terrorism is a major concern. These plants provide the uranium and plutonium regarded as critical components of nuclear weapons. This will be discussed in depth in this paper. This paper will also detail the benefits and detriments of the future growth of nuclear power plants across the globe. The first uses of nuclear technology were the bombs dropped in Japan in the 1940’s. In the 1950’s physicists and engineers harnessed this power and presented it as a less costly and an alternative form of energy. Nuclear power plants were built with an eye to safety; this was the main concern early on. The 103 reactors in the U. S. today supply 25% more electricity than 109 reactors did a decade ago. This has been achieved through improvements in management, reliability and productivity. In 2010, Taking Sides, Clashing Views on Environmental Issues states that favorability to nuclear energy was running at 67% of Americans in favor of using this technology. The gap of people against this was closing. These companies were being seen as valuable and all operating licenses were being renewed. Impressive gains in output and reliability at many nuclear power plants have the industry looking to build more plants. Nuclear power is being accepted as the core strength of the U. S. electric supply. And in this â€Å"green† era, nuclear is seen as the main source of assisting the U. S. in meeting clean air goals. The Clean Air Act of 1970 set out to improve air quality and nuclear power plants are credited as one big reason that compliance was met. Electric vehicles and hybrid electric vehicles are becoming more in demand and the clean electricity from nuclear power is driving policymakers to continue to support nuclear technology. These vehicles reduce carbon emissions, noise, maintenance and reduced oil usage and reliance on foreign oil. Clean energy is paramount to a sustainable development globally. As the population continues to grow, the demand for energy increases and harnessing wind and solar should increase because they are good options and do not contribute directly to air or water pollution. These renewable fuels contribute in a positive way to a sustainable world but they just don’t produce enough electricity yet, they are considered good alternate options in conjunction with nuclear energy. The nuclear age started with the thought of this form of generating electricity being less costly. That did not prove to be the case, in the beginning, but today nuclear energy is once again being heralded as a value proposition. The volume of electricity that can be produced and done so in a clean and safe way is looked at as a way to provide environmental attributes and price stability. The Department of Energy’s Nuclear Power of 2010 program created a partnership between government and industry and ensured adequate funding for the building of new plants. The planned investment was $650 million dollars over several years and assists with the need of program stability and resources necessary to ensure future viability. The U. S. faces an imminent energy crisis and even though electric power is only 3 to 4 % of our gross domestic product, the other 96 or 97% depends on that to fuel our $11 trillion dollar economy. Nuclear energy will remain a front runner because of the reliable and continuous source of energy it provides and it allows us, as a nation, to lead the world in decreasing our dependence on fossil fuels. Coal is abundant across many parts of the globe but contributes to global warming (there is research and development in developing a â€Å"clean† coal and this has been proven viable but bringing it to market at a competitive price has not happened). Natural gas is also fairly abundant but unsustainable in power generation and makes little sense. This being said enhances the argument for nuclear energy plants to assume that the future plants being built will continue to grow worldwide and that as this continues, the industry will strive to address cost and bolster safety. The other side of this issue sheds a different light on the same subject. The expense of nuclear energy is measured differently. Financial expense is a factor but fear is the most major concern. Nuclear energy has no pollution or emissions but the by-products of the process namely waste, and how it is stored, transported and discarded is regarded by many as the downside of nuclear energy. The safety of power plants was the original concern but as these expanded across our country and the world, the waste has come to be a mightier concern from the holding and containing in plants, to the transporting over highways and ultimately the storage of these toxic materials, with a half-life of a thousand years. The potential harm of radioactive waste is to humans, wildlife and the environment. This waste contains plutonium, uranium and other elements along with parts of atoms. Nuclear waste needs to decay following a cooling process. Even after the waste has been out of the reactor for 10 years, a human coming within a meter of it would die in three minutes. Waste from the first generation of reactors has not been successfully dealt with and that said, this leaves all reactors that followed looking toward a solution and the prediction of over a 100,000 metric tons of waste by 2035 that needs to be completely isolated from the environment for tens or even hundreds of thousands of years because it is so deadly. Sendai, Japan had an 8. 9 earthquake on March 11, 2011 that was followed by a tsunami of immense proportions. There was a nuclear power plant in operation called Fukushima-Daiichi that continues to be in the news more than six weeks after the disasters and the story continues to unfold. The first thing to point out, in fairness, is that these were unlike Three Mile Island and Chernobyl because the problems that resulted were not the result of human error. The built in safety measures detecting an earthquake worked and as soon as the quake was detected, the plant started an automated, preprogrammed shut down and all the safety elements were working to achieve a cooling and treatment of the decay heat. Diesel generators provide the power to drive the pumps for the water coolant necessary to circulate through the reactors, removing the decay heat but when the tsunami hit, the diesel generators that were necessary to provide power necessary for the pumps was lost. There were other backup systems but they too were lost and the fear of melt down and radiation being spewed into the atmosphere ensued. Heat removal could have continued indefinitely if there was power but that was not the case due to the tsunami. Radiation levels are high and more than 6,000 families in surrounding cities have been told to leave the area. Minor traces of the radiation were found in the drinking water in my state, Massachusetts and this drives home the point of how small our world has become and why we all need to be better informed of the world around us. Radiation and its side effects are nasty and can take years to manifest illness and cancers. There are also some discrepancies on how much area should be evacuated and there are many varying reports. The U. S. cientists seem to share a common number of 50+ miles, Japan is saying 12. The Fukushima-Daiichi nuclear plant problems echo most people’s concerns about nuclear safety and have started a concentrated look at nuclear power plants that are built in earthquake prone areas. This concern has spread to Germany where more than 60,000 protestors have been assembling outside the major nuclear plants in that area. The IAEA (International Atomic Energy Age ncy) is trying to assure people around the world that new safeties were already on the drawing board addressing issues like the one in Japan. Nuclear energy had been enjoying resurgence with relative calm before the tragedy in Japan. India and China had a plan to add a thousand new nuclear sites in the next two decades. Japan nuclear facilities have withstood many earthquakes; the tsunami is what brought this one down. Opponents are still focused on the long term and the storage, handling, transporting and long term storage of the hazardous waste that is a lethal by-product of nuclear energy. The following is from www. wagingpeace. org and states the risks in a succinct way: ?Nuclear Waste ?Nuclear waste is produced in many different ways. There are wastes produced in the reactor core, wastes created as a result of radioactive contamination, and wastes produced as a byproduct of uranium mining, refining, and enrichment. The vast majority of radiation in nuclear waste is given off from spent fuel rods. ?A typical reactor will generate 20 to 30 tons of high-level nuclear waste annually. There is no known way to safely dispose of this waste, which remains dangerously radioactive until it naturally decays. ?The rate of decay of a radioactive isotope is called its half-life, the time in which half the initial amount of atoms present takes to decay. The half-life of Plutonium-239, one particularly lethal component of nuclear waste, is 24,000 years. ?The hazardous life of a radioactive element (the length of time that must elapse before the material is considered safe) is at least 10 half-lives. Therefore, Plutonium-239 will remain hazardous for at least 240,000 years. ?There is a current proposal to dump nuclear waste at Yucca Mountain, Nevada. ?The plan is for Yucca Mountain to hold all of the high level nuclear waste ever produced from every nuclear power plant in the US. However, that would completely fill up the site and not account for future waste. ?Transporting the wastes by truck and rail would be extremely dangerous. ?For a more detailed analysis of the problems of and risks incurred by the plan, see Top Ten Reasons to Oppose the DoE’s Yucca Mountain Plan ?Repository sites in Australia, Argentina, China, southern Africa, and Russia have also been considered. ?Though some countries reprocess nuclear waste (in essence, preparing it to send through the cycle again to create more energy), this process is banned in the U. S. due to increased proliferation risks, as the reprocessed materials can also be used for making bombs. Reprocessing is also not a solution because it just creates additional nuclear waste. ?The best action would be to cease producing nuclear energy (and waste), to leave the existing waste where it is, and to immobilize it. There are a few different methods of waste immobilization. In the vitrification process, waste is combined with glass-forming materials and melted. Once the materials solidify, the waste is trapped inside and can't easily be released. The final concern for the purpose of this paper goes back to the second to last point from wagingpeace. org. The U. S. is banned from reprocessing nuclear waste because those materials are necessary components when making a bomb. There is a volunteer group called the National Supplies Group (NSG) and they enforce guidelines to members and oversee exports to ensure that the technologies and materials are treated properly and are not being used to contribute to proliferation. The NSG has 46 member states but Israel, India and Pakistan are not among them. This is frightening and makes one question why it is not mandatory to be part of this NSG. It seems that the rules should be the same for each state or country when dealing with nuclear energy and makes one wonder what the IAEA contributes. Nuclear energy is complicated. If I was writing this before the March 11, 2011 disasters in Japan, I would be impressed by how far the industry has evolved. Natural disasters are just that, natural and occurring more and more. The strength of Hurricane Katrina was blamed on global warming and makes me wonder if we had more nuclear energy would the storm have been less severe. I don’t know that I gave a lot of thought to nuclear energy before this course and it seems that many movies I have seen over the years usually involves smuggling of components necessary for use in weapons of mass destruction. It now appears that this is a very real threat and one that needs full worldwide regulation. I think nuclear energy is here to stay and that the growth will be immense to keep up with the population and to decrease emissions. This product is a bit of an enigma to me. It strives to do good but has the potential to create so much evil. Nuclear energy and all it’s by-products are very complicated.

Boeing 737

PRANSAC ASSIGNMENT 1 ‘Using the B737 as an aircraft type, you are required to research on the inventions and Innovations that have made this particular aircraft impact the development of Commercial airplane. ’ Boeing 737 Introduction A. Aircraft The Boeing B737 is a short to medium wide range narrow body twin-engine body jet airliner. Originally designed in 1964, initially had its first maiden voyage in 1967 and joined into professional service in 1968. B. Company Boeing had been the number one professional plane company.This company controls 60% of a competitive commercial market and its professional aircraft goods and services account for more than 70% of Boeing's income. Boeing's products symbolize a complete family of jetliners in the variety of travellers and freight adjustments and wide ranging abilities. The B737 has developed different series such as B737 Original, B737 Classic, B737 New Generation, and the newest series 737 MAX. The Boeing 737 is the best-sellin g jetliner in aviation history. A. Idea In 1958 Boeing had a design research for â€Å"A twin engine feeder airliner to complete the family of Boeing passenger jets†.In Feb 1965 the first purchase was placed and the project went ahead. The 737 has since become the best-selling professional planes in planes record with more than 5,900 purchases from 225 clients so far. < Chris Brady. 1999. > B. Design Boeing wanted to design a real short-haul jet to compete with its competitors like the Caravelle, BAC One-Eleven & DC-9. However they are way behind them. The DC-9 was about to fly, the One-Eleven was well into its flight test program and the Caravelle had been in service for 5 years.They had some catching up to do. Designers Joseph Sutter and Jack Steiner began work on the 737 in November 1964. The original 1964 specification was for a capacity of about 60-85 passengers, an economical operating range of between 100 and 1000 miles and to be able to stay equal at a 35% load factor . As a result of final design talks with launch customer Lufthansa the capacity was increased to 100, but the range and load factor figures still remains the same. < Chris Brady. 1999. > Invention/Innovation of the aircraft A. Placing the Engines i.Wing Mounted Engines The wing mounted engines provided the key benefits of decreased interference drag, a better C of G position, less noisy cabin, more useful cabin space at the back, front & aft side doors, easier access to engines for servicing and required less pipework for fuel & bleed. The bodyweight of the engine also provides twisting comfort from the rise of the wings. Apparently this benefit was over-estimated and a set of wings were unsuccessful in static tests at 95% of max load so the side had to be remodelled. ii. DisadvantageThe disadvantage of wing-mounted engines was that the size of the fin had to be increased for engine-out operation over centerline thrust aircraft. Also, due to the reduced ground clearance, the engines had to be almost an essential part of the wing, which in turn using a short chord. The engines extended both forward and aft of the wing to reduce aerodynamic interference and straighter top line of the nacelle formed a streamline flow over the wing to further reduce drag. iii. Advantage Overall, the wing-mounted layout had a weight saving of 700Kgs over the equivalent â€Å"T-tail† design and had performance advantages. v. Thrust Reversers Thrust reversers were taken from B727 were found to be inefficient when used by the B737. Therefore B737’s thrust reversers were greatly improved, allowing the aircraft to land on shorter airstrips. B. Type Of engine The CFM56-3B-1 turbofan engine was chosen to power the aircraft, which yielded significant gains in fuel economy and a reduction in noise, but also posed an engineering challenge given the low ground clearance of the 737 and the larger diameter of the engine over the original Pratt and Whitney engines which were used f or the earlier models such as the -100 and the -200.However, overtime noise became an issue and many users opted for an alternative engine. As a result, Boeing and engine supplier CMFI solved the problem by placing the engine ahead of the wing, and by moving engine accessories to the sides of the engine pod, giving the engine a distinctive non-circular air intake. C. Fuselage The B737’s fuselage was especially one of its best-selling points. Its cross-section had been taken from the B727. v. More Space, more passengers This made the B737 to hold 6 wide abreast seats, because this way it could take more passengers per load on board than its competitors.In the B737 Classic series and the B737 Next Generation Series, the fuselage was lengthened to fulfil the demand for space in the aircraft and also help Boeing sustain its competitiveness in the aviation industry. vi. Even More Space, more passengers In the B737 Original series, the fuselage was only able to contain a highest po ssible of 130 passengers in 737-200 while the B737 Classic series were improved and enhanced to provide for bigger and more economical aircraft. As such, the aircraft’s fuselage was prolonged to allow about 170 passengers on board. vii. B737 Next GenerationThe B737 Next Generation series had even more changes to its uses. In commercial flying, the airplane’s fuselage was prolonged to allow a highest possible of 215 passengers on board. The B737 Next Generation also had its own business jet, BBJ1 and BBJ2 series and military aircraft, C-40 and AEW&C, series. The BBJ was regularly used by personal jet entrepreneurs, and organizations, because of its small dimension and fuel efficiency. The military series of the B737 encompass the AEW&C that is used for monitoring and radar operations, and the C-40, P-8 Poseidon, which assisted in military operations.D. Wings Changes had been made to the wings and the flight controls of the B737. Many improvements result in greater perfo rmance of the aircraft by generating more lift, increase in fuel efficiency, and reduce drag while most importantly being more economical. i. Wings Extended The B737-100 and B737-200 created too much drag for the aircraft, making it very costly to fly. Thus, the front flaps of the wings were extended towards the fuselage, providing greater lift and shorten the distance for the aircraft required to take off. The wing’s leading edge and span were also extended.This is because when the leading edge is being extended, the upper camber will be pushed forward towards the leading edge and thus makes the air flow on the upper camber have a higher airspeed and as a result create more lift, due to the decrease in static pressure. ii. Composite Material The B737’s flight controls were mostly made of composite material instead of aluminium alloy to reduce the weight of the aircraft. To generate more lift and greater performance during cruising iii. Winglets Winglets were added fro m the B737-700 model onwards and the B737-300. Winglets reduce induced drag caused by the vortex on the wingtips. v. Fly-by-wire system control In the B737 MAX, it has integrated the new fly-by-wire system control to allow for more efficient performance of the aircraft. Fly-by-wire (FBW) is a system that replaces the conventional manual flight controls of an aircraft with an electronic interface. The movements of flight controls are converted to electronic signals transmitted by wires. The fly-by-wire system also allows automatic signals sent by the aircraft's computers to perform functions without the pilot's input, as in systems that automatically help stabilize the aircraft. v. ConclusionThus the B737 is able to generate more lift and reduce drag on the aircraft. Therefore the B737 is able to move faster and increase on fuel efficiency, reducing cost and fuel. Allowing Boeing to have a greater advantage in the competitive Aviation Industry. Conclusion Over the years, Invention an d Innovation of the aircraft such as the fuselage, wing, engine, and nacelles, the B737 was able to have a sustainable growth. This allowed Boeing to stay ahead of its competitors. These results in having more Boeing planes chosen by airlines compared to other domestic carriers.Currently Boeing faces significant competition from their rival Airbus A320. While trying hard not to lose out, Boeing made improvements such as the new B737 Max series, which combines the use of more high-tech devices to help Boeing compete with the Airbus bus latest series, the A320 Neo. However the B737 MAX is only due in 2017 and it is in its last levels of examining. As such, this gives Boeing the time to enhance and completely improve the abilities of the B737 MAX to help improve on its durability later on improvements. Deliveries are scheduled to begin in 2017. References Chris Brady. History & Development of the Boeing 737. †Ã‚  History & Development of the Boeing 737. N. p. , Sept. 1999. Web. 2 7 June 2012. . â€Å"Fly by Wire. † Wikipedia. Wikimedia Foundation, 23 June 2012. Web. 28 June 2012. . â€Å"Boeing 737 – American Flyers. † Boeing 737 – American Flyers. N. p. , n. d. Web. 28 June 2012. . â€Å"Boeing 737RE. † Wikipedia. Wikimedia Foundation, 27 June 2012. Web. 28 June 2012. .

Finnc nd Growth Strtgy Essay Example | Topics and Well Written Essays - 1750 words

Finnc nd Growth Strtgy - Essay Example Of cours ths findings dpnd on th sctor nd th typ of M& tht ws don. Mny fctors ply n importnt rol in th furthr succss of th compnis, nd th on, myb th most importnt cn b th knowldg nd bility to crt vlu ftr. Mrgrs nd cquisitions, two forms of rstructuring, rprsnt both strtgic opportunitis nd thrts for compnis, s ownrship chngs hnds. Mrgrs nd cquisitions crry on stting nw rcords in both volum nd siz. cquisitions probbly r not th quickst wy to grow comprd to othr options nd, from th prspctiv of top mngrs, thy r stimulting nd oftn finncilly rwrding. Howvr, by most ccounts, cquisitions r pron to filur, with som hving disstrous consquncs. Studis of th short-trm ffcts of M&s point out tht M&s gnrt vlu, vn though most of this vlu ccrus to th trgt firm. Rsrch in th US nd UK indicts tht th shrholdrs of th trgt firms xprincd gins of btwn 16% nd 45%. cquiring firms' shrholdrs, on th othr hnd, xprincd bnorml rturns rnging from -1.1% to 7.9%. Th combind firms' bnorml rturn ws btwn 1.8% nd 3.5%. (S Jnsn & Rubck 1983; Frnks & Hrris 1989; Bchr 2000; Mulhrin & Boon 2000; Kohrs & Kohrs 2000; ndrd t l. 2001.) Th long-trm ffcts of M&s in th US nd th UK hv bn xmind xtnsivly (S grwl, Jff & Mndlkr 1992, Brns 1984, Frnks, Hrris & Titmn 1991, Grgory 1997, Knndy & Limmck 1996, Limmck 1991, Lodrr & Mrtin 1992, Loughrn & Vijh 1997, Mitchll & Stfford 2000, Ru & Vrmln 1998). Ths studis, lthough criticisd th mthodology, ll indict tht th shrholdrs of th cquiring firms in most instncs los vlu. Th ngtiv typicl rturns wr s high s -20%. Th crtion of ngtiv typicl rturns holds tru spcilly whn th mthod of cquisition ws othr thn by mns of tndr offrs. Th min rson for M& to tk plc is xpctd synrgis, mngril hubris, nd promising solution of gncy problms. Synrgis r th prim motivtion for th bid nd s rsult for th trgts nd th biddrs tht shr th wlth gins. lthough most bidding compnis mk th sttmnt bout th potntil synrgis from th mrgrs nd cquisitions, frquntly th forcstd bnfits r not obtind. This cn b rsult of ovr optimistic forcst by th bidding mngmnt or simply th fct tht th mrgr for inititd for nothr rson, such s gncy problms. So ths thr tkovr motivs hv diffrnt outcom on th wlth crtd ftr mrgrs nd cquisitions. If synrgy is th primrily motiv for th mrgr, thn th trgt's nd biddr's shrholdrs should gin nd th distribution of wlth should only dpnd on th brgining powr of th biddr nd th trgt. If th scond motiv tks plc nd it mns tht gncy problm is worsning, th min slf-intrst of th biddr's mngmnt is th prim rson for th mrgr or cquisition. In such cs, mngrs just focus on growth rthr thn on th shrholdrs' vlu. For xmpl, Conyon nd Murphy (2002) show tht for th UK, siz (nd not th prfomnc) is th min dtrminnt of th mngril slris. This fct cn xplin why mngrs r so tmptd to us fr csh flow to furthr build th mpir tht hopfully will rsult in highr slris nd bonuss. No wondr tht ftr such circumstncs, th totl vlu ftr mrgrs nd cquisitions ctully gos down. Mngrs who r ggrvtd by prsonl intrsts, (.g. mximiz th siz of th firm nd thir fild of control) r mor pron to sk out lrg, wll known compnis s cquisition trgts - nd usully ovrpy in th bidding procss. This is n doubtful motiv for th cquisition of rltivly smll nd unknown privt compnis. Th cquisition of privt compny mor sily fits th motiv of mximiztion of shrholdr wlth. nd th third motiv of M& cn b th

Strategic Financial Management(business report) Essay - 1

Strategic Financial Management(business report) - Essay Example According to Kanter (1995) such an action will not constitute an adequate response. This is so because success is based on an organisation’s ability to create, rather than predict the future by developing those products that will literally transform the way the world thinks and view it self and the needs (Kanter 1995:71). This paper is aimed at analyzing the case study of Amazon.com. In an attempt to implement a strategic and management turn around strategies by the CEO Jeff Bezos. The objectives of this paper can be examined from three dimensions. In the first instance, the paper seeks to outline, analyse and discuss the main issues concerning the case study Amazon.com. The first part of the paper provides the background while looking into the market in which the company is operating. The section also highlights the profitability and liquidity position of the company. Part two of the paper looks at the marketing strategies of the company by utilising the four Ps. The section further looks at the Human resource management strategies, operations analysis, the SWOT, PESTLE with respect to the case Amazon.com. The last part of the paper provides the conclusion and recommendation through the development of the strategic direction for the company. Amazon .com worldly known as Amazon is a key and strategic player in the field of electronic commerce. Being a worldwide brand selling virtually everything through its online shopping experience with customers. Today, Amazon serves customers in more than 200 countries through its several retail websites. Its e-commerce business model has become a benchmarking platform for other businesses to develop their e-business. Through its online shopping access webpage customers can shop virtually everything from financial services to diamond rings. Thus, to sum up, while operating as an online and e commerce supermarket,

Motivation at work Essay Example | Topics and Well Written Essays - 1250 words - 1

Motivation at work - Essay Example Thus the organization is able to increase the amount of profits it makes since it increases its level of customer satisfaction and retention (Pinder, 2008). From the article, it is a clear fact that motivation plays a significant role in fulfilling the promise for personal improvement as well as that of the organization. It is shown in the way that the employees at the WestLake Computing Corporation (WCC) are provided with diversity training programs that help them to know how to work within a workforce that is highly diverse. Usually the small problems that are identified within an organization serve as a greater revelation of the main issues that are affecting the overall performance of the organization. One of this is motivation, which although may appear to be a minor issue is a very relevant component towards the success of the organization. It thus reveals that there is a lot of motivation that still needs to be offered below the surface hence an indication of the high capability contained in each individual to perform extraordinarily. For instance, the employees in this organization are given the details, case applications or exa mples and regulation to provide employment regulations with which they raise their capabilities in dealing with different situations within an environment with multiple cultures (Pinder, 2008). The article provides a lot of insight regarding the need for motivation at the workplace in relation to the total organizational performance. It is also encouraging in the sense that it is written on a positive perspective and not with the intention to offer criticisms. In relation to the case, it helps to speed up most important issues within the organization that include the expansion of sales to international levels. According to the author, it is the organizational behavior class that helps individuals to point out towards some of the solutions

Law and policy for social work practice Essay Example | Topics and Well Written Essays - 1500 words

Law and policy for social work practice - Essay Example 2012, p. 1423). To provide better health and safety services to the children require all stakeholders to work together according to the laid down policies. It is important for the organizations and individuals to understand their roles in protecting and sustaining the interests of the children. Every action and decisions made should also be aimed at achieving the intended outcomes for the benefit of the child and the entire family (Johnson and Cahn, 1995, p. 16). Case Study Rochdale Child Abuse Case: Exploited Girls Faced ‘Absolute Disrespect† In Williams (2012, Rochdale Child Abuse Case) there is a case of an institution that deals with sexually abused adolescent girls in United Kingdom. The institution was faced with a situation in which some young girls were discriminated by the people who were supposed to take care of them. For instance, there were nine guys who had jointly slept with five girls after enticing them with material things and then added drugs in their in their foods (The policy, Ethics and Human Rights Committee. 2012, p.17). However, the protection council assumed that the young girls had submitted to the sexual molesters out of their own accord. Among the council members who were assisting the victims, three of them left their jobs. Most of the cases handled by the Rochdale were not adequately solved as was discovered by a Local Safeguarding Council. On contrary to the reasoning of the Rochdale council, the Crisis Intervention Team believed that the girls were abused by the rapists. Most cases are now transferred to Sunrise group who are presently assisting 106 teenager girls (Williams (2012, Rochdale Child Abuse Case) This case was faced with several quandaries, with one being the inability to distinguish the issue of young girls and those of adult ladies. For example the assumption that the young ladies had contended to sexual performance out of their own accord yet they were below majority age (The policy, Ethics and Human Rig hts Committee. 2012, p.13). These adolescents needed protection of the law under child Act which never happened. Also most of the staff members working with the group had left the organization before the issues were settled. Therefore, there was no one to confess in favour of the victims thereby resulting to injustice of the young girls. Consequently, the justice for the victims was delayed as the team sought for vital information to help them convict the suspects as anyone who have not attained the age of 18 years (Williams (2012, Rochdale Child Abuse Case). The 1989 and the 2004 children Acts refers to a child Section 17 of the Children’s Act 1989 define â€Å"children in need† as those who are not able to achieve a satisfactory level of health or development, those development has been impaired, those who lack service. Under section 17(10) of the Children Act 1989, the disabled are also referred to a children in need (Oxford Journals, 2012, p.1437). The various poli cies set out in the children act 2004, indicates that the child should be health, stay safe, enjoy and achieve, make a positive contribution to the society and be able to sustain themselves economically in future. Children need to feel loved, valued, and supported by a chain of individuals who are reliable and shows affection. They also need to feel respected, understood, listened to and to have their emotional feelings being considered and attended to. In the case of Rochdale, the institution neglected children who had been victims of rape

Follow-up Questions for 2nd Writing Assignment Example | Topics and Well Written Essays - 250 words

Follow-up Questions for 2nd Writing - Assignment Example oved from Montgomery to Hampton to look for green pastures and mostly because park had disagreements with King and other heads of the civil rights movement. Parks got a new job in Hampton as a hostess in a hotel and after a short while they moved again to Michigan (Parks and Reed 2006, 44). Until in 1965, Park labored as a seamstress when the American-African diplomat for U.S, J.Conyers employed her as a secretary. In 1970, Parks experienced the worst of her live when illness struck her, her husband, brother and mother causing her to admit donations from well-wishers (Weidt 2003, 76). Later on Parks was involved in a fall accident while she was walking on an icy sidewalk and she was hospitalized with broken bones. It was a big blow when she lost her family members within a short span of time (Weidt 2003, 81). In 1980 she devoted herself to founding and raising finances for communal rights and learning associations. In 1992 she published her autography named Rosa Park-my story which was aiming the youthful generation and there after her memoir-Quiet Strength and points out the significance role her faith played in her life (Weidt 2003, 84). In 1994, she was attacked by a drug addict an ordeal that traumatized her for long. She made her last appearance on the film in 1999 after participating in a movie called Touched by an Angel (Weidt 2003, 91). In 2000 her health deteriorated and was almost evicted from her apartment when a Baptist church came to her rescue due to high accumulation of rent debts (Weidt 2003, 91). She was honored and received many awards due to her achievements and later died on October

Pintex Organics London Ltd Assignment Example | Topics and Well Written Essays - 750 words

Pintex Organics London Ltd - Assignment Example The first problem emerged when the company entered into a contract with Mixurs Ltd to supply it with equipment, but the equipment was found not to be compatible with the installations in the company’s premises, hence, cancellation of the contract. The second major problem concerning the contracts occurred when the negotiations for a contract under which the company would provide catering services to members of the International Olympics Committee collapsed because the parties could not agree on the contract terms. As a result, the company lost the contract and the financial benefits that could have arisen out of it. Therefore, the company needs to ensure that its interests are in tandem with the English contract law. Also, there is need for the company to review its terms of agreement to avoid a situation such as that of Miah where the former director of the company enters into contract with the immediate potential client of the company. In regard to the cancellation of contra ct offered to Mixurs Ltd, it was in order as the company was exercising the right to cancel a contract stated on the Cancellation of Contracts made in a Consumer’s Home or Place of Work Regulations 2008 Act Article 8(1-6) (The National Archives, 2008). However, it would be advisable that the company should exercise caution when entering in contract with other companies when intending to purchase. This will be crucial in ensuring that the company does not incur losses or get substandard equipments (Taylor, 2009, p. 101). Concerning the second scenario where the negotiations between the company and the International Olympics Committee collapsed, it is important that such occurrences should be avoided or minimized in the future. It is no doubt that such a contract would have not only offer the company financial benefits but boost its quest to becoming the leading provider of catering services in the forthcoming 2012 Olympic games. Losing such a contract was not desirable for the company’s business prospects. The company should know that it should not necessarily bid the adequate price but, rather, the consideration should be of sufficient value in the eyes of the law (Keenan, 2006, p. 29). As the Chappell & Co Ltd v Nestle Co Ltd (1960) AC 87 showed, the offeror needs to make a consideration that is sufficient and not necessarily adequate (Sealy and Worthington 2010, p. 45). Applying this in the contract might not have afforded Pedro’s company the financial rewards they intended but would have provided them with the opportunity to maintain International Olympic Committee as a client for future services, especially in the forthcoming 2012 Olympics games, hence, more revenues in the future. Apart from that, hosting of such high profile clients would have boosted the reputation of the company thus attracting more clients which will translate to more revenues. It can be argued strongly that Miah was not comfortable with the contract terms of the POL Ltd to International Olympics Committee which he may have seen to cost the company both the revenues and the reputation. He was, thus, convinced that it was more worth to resign from the company’s directorship and open his own restaurant in order to gain benefit from providing services to International Olympics Committee both at that time and in the future. As noted, the company’s other problem arise from the terms of agreement for the

Comparing poems Essay Example for Free

Comparing poems Essay Salome turns out to be an evil and very disturbed character; she gets pleasure by beheading people. In this poem it turns out that Salome has removed few other heads previously and she would doubtlessly do it again. She does not even know whos head it is that is next to her, but it seems like that she does not care at all. This makes her sound like a whore. As the maid walks in this makes her feel more comfortable and better for some reason. Hitcher: The man seems really stressed and tired, and when he receives the phone call from his boss that is his final straw. He seems very jealous of the hitcher this is because he is free of stress and is a free spirit. He seems very frustrated. The Man He Killed: This poem is very interesting. It turns out that they dont want to kill each other but because they are at war with each others country. One of them says youd treat if met where any bar is or help to half-a-crown. He is saying if I met you in any other circumstances I would take you to a bar and buy you a pint. My Last Duchess: She is very very jealous, in fact she is so jealous that she wants to poison he and watch he die very slowly. She makes the poison sound like something that is rich and luxurious. Salome: There is some alliteration on line 18-19 where the sound of maids clanging makes Salome happy. Throughout the poem the tone of it makes the poem sound like a young girl who is spoiled and self-indulgent. In this poem there are quite a few clichi s e. g. and aint life a bitch. Hitcher: In this poem the first stanza has some typical rhymes which binds the poem together tired, fired, hired. Can you see the effect of this? He is tired and then his boss threatens to fire him then he hires a Vauxhall Astra. A lot of clichi s are used in this poems here are some examples The truth he said was blowin in the wind, or around the next bend. hed said he liked the breeze to run its fingers/ through his hair. The Man He Killed: There are colloquialisms such as off-hand like which provide an earthy realism along with the rough sounding meter. The Laboratory: This poem uses consolation irony. It also uses some alliteration here is an example Grind away, moisten and mash up thy paste and here is another example Brand, burn up, bite into its grace-. It also has some ambiguity in it here is an example If it hurts her, beside, can it ever hurt me? . Salome: The first verse describes how she is trying to figure out whose head is on the pillow next to here. The second verse describes how she started to feel less hangover when the maid rough in her breakfast. The third verse discusses how she is trying to dissolve the life of the booze and the fags and the sex. Then she decides to turf out the blighter from her bed. Hitcher: This poem has five stanzas and a regular five line shape with the third line being the longest in all of them. If you look at each third line you will see some sort of a pattern occurring. The shape of the stanza is very interesting. The Man He Killed: This poem has a simple but formal structure of five short stanzas all rhyming ABAB. The last tow stanzas remind the men that they could be friends if they met in any other situation. Stanzas two and three: set out the qualifying circumstances that change everything for the mens fate: they are soldiers in opposing armies and therefore enemies. The laboratory: The title in this poem gives us a big hint on where the scene takes place. The speaker is a woman; she takes a lot of pleasure watching the procedure. In the second verse we cab see why the woman wanted revenge, she wanted revenge because the speaker has been betrayed by her lover. In verse three she watches the apothecary at work and is fascinated by what he is doing. She is in no hurry. She takes pleasure in the preparation. This is better than dancing in the kings palace.

Sachin Tendulkar Essay Example for Free

Sachin Tendulkar Essay Sachin Ramesh Tendulkar (Listeni/ËÅ'sÉ™tÊÆ'É ªn tÉ›nˈduË lkÉ™r/; born 24 April 1973) is a former Indian cricketer widely acknowledged as one of the greatest batsmen of all time, popularly holding the title God of Cricket among his fans. Some commentators, such as former West Indian batsman Brian Lara, have labelled Tendulkar the greatest cricketer of all time. He took up cricket at the age of eleven, made his Test debut against Pakistan at the age of sixteen, and went on to represent Mumbai domestically and India internationally for close to twenty-four years. He is the only player to have scored one hundred international centuries, the first batsman to score a double century in a One Day International, the only player to complete more than 30,000 runs in international cricket. and the 16th player and first Indian to aggregate 50,000 runs or more in all forms of domestic and international recognised cricket. In 2002 just half way through his career, Wisden Cricketers Almanack ranked him the second greatest Test batsman of all time, behind Don Bradman, and the second greatest ODI batsman of all time, behind Viv Richards. Later in his career, Tendulkar was a part of the Indian team that won the 2011 World Cup, his first win in six World Cup appearances for India. He had previously been named Player of the Tournament at the 2003 edition of the tournament, held in South Africa. In 2013, he was the only Indian cricketer included in an all-time Test World XI named to mark the 150th anniversary of Wisden Cricketers Almanack. Tendulkar received the Arjuna Award in 1994 for his outstanding sporting achievement, the Rajiv Gandhi Khel Ratna award in 1997, Indias highest sporting honour, and the Padma Shri and Padma Vibhushan awards in 1999 and 2008, respectively, Indias fourth and second highest civilian awards. After a few hours of his final match on 16 November 2013, the Prime Ministers Office announced the decision to award him the Bharat Ratna, Indias highest civilian award. He is the youngest recipient to date and the first ever sportsperson to receive the award. He also won the 2010 Sir Garfield Sobers Trophy for cricketer of the year at the ICC awards. In  2012, Tendulkar was nominated to the Rajya Sabha, the upper house of the Parliament of India. He was also the first sportsperson and the first person without an aviation background to be awarded the honorary rank of group captain by the Indian Air Force. In 2012, he was named an Honorary Member of the Order of Australia. In December 2012, Tendulkar announced his retirement from ODIs. He retired from Twenty20 cricket in October 2013 and subsequently announced his retirement from all forms of cricket, retiring on 16 November 2013 after playing his 200th and final Test match, against the West Indies in Mumbais Wankhede Stadium. Tendulkar played 664 international cricket matches in total, scoring 34,357 runs.

Nursing Discipline Overview and Reflective Account

Nursing Discipline Overview and Reflective Account NURSING DISCIPLINE MENTAL HEALTH BRANCH From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950s. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were put away. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as muffling or being put in a swing chair. In the 1960s, inadequacy and cost resulted in mental health hospitals closing and care moving to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003), where most people with mental health problems are cared for today (NHS 2010). Legislation such as the 1959 and subsequent 1983 Mental Health Act, and the Care Community Act (1990) are relative to modern community mental health nursing. In 1999 the Government confirmed mental health was a top priority in the Health Service (Jackson Hill 2006). Since then guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson et al 2006) have been introduced to reform and improve services for people with mental health problems and their carers. The Department of Health have also investing significantly in inpatient mental health settings due to issues such as a not enough beds being available, the lack of privacy and dignity of patients and wards not supporting provision of self care (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been dev eloped, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009). Mental health nurses will work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to care for people in a fair and anti-discriminatory way and deliver care holistically, mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and personality and human behavior (Hannigan et al 2003). One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention (Mind 2010). Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they cant cope with, such as depression following the death of a partner (NHS 2009). Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan et al 2003). Care is person-centered and mental health nurses will work within a professional multi-disciplinary team which will include GPs, psychiatrists and social workers and other health care professionals. A mental health nurse will require good interpersonal and communication skills. They will to demonstrate sensitivity when caring for patients, for example there is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010). Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill a nurse will be required to have is to recognise building tension and diffuse it when necessary to maintain the patients and others safety (NHS 2010). Sometimes nurses may find themselves faced with awkward situations, and be required to apply ethical principles, such controversial issues which cannot be disclosed and where confidentiality needs to be maintained (NMC 2008). On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan et al 2003). Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them (Hannigan et al 2003) . In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision. Nurses need to support patients to take responsibility for their own well-being and make informed decisions by providing information which is accessible and understandable (Mind 2010). This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the clients best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983) (Hinchcliff et al 2003). To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential. NURSING DISCIPLINE LEARNING DISABILITIES BRANCH People with learning disabilities have been treated as second class citizens for many years, once being seen as possessed by evil spirits or being punished by God for a sin they may have committed. In the 19th century they were removed from their families and lived in purpose built institutions, treated as sick and in need of treatment (Brown Benson 1995). During the 1970s care moved to the community (Brigden Todd 1993) where it largely remains today. Approximately 1.5 million people have a learning disability, the majority of which live at home with their families or in community care settings (Mencap 2009). Relatively few live by themselves or with a partner (Emerson, Davies, Spencer, Malam 2005). Turnbull and Chapman (2010) describe a learning disability as being a lifelong condition, which may be genetic or environmental and vary in degree of impairment. Sowney (2006) suggests all learning disabilities have common features including impaired intelligence and social functioning which has a lasting effect on development. According to Mencap (2009) people with learning disabilities live an average of 50-55 years and sometimes up to 70 years old. A learning disability nurse can therefore expect to nurse a range of patients from birth to the elderly and will need to demonstrate a patient centred approach and work in partnership with the patient to help them meet their health, social, emotional, developmental and behavioral needs ( NHS 2009). Although a learning disability is not an indication of a physical disability or ill health, people with learning disabilities generally have more complicated problems and require more nursing interventions than the general population. In the young person some of the more common problems include respiratory problems, epilepsy, sensory and motor impairments, hypertension, thyroid disease and cancer and in elderly adults common problems include loss of hearing, vision and mobility, heart conditions, diabetes, fractures and osteoporosis (Davis 2008). Generic issues include communication difficulties, conditions relating to specific syndromes, challenging behavior and delayed development (University of Nottingham 2010). A learning disability nurse needs the skills to work within both simple and complex health areas. Communication is a vital skill for the learning disability nurse, hospitalisation for a patient with a learning disability can be very distressing and it is important to build therapeutic relationships based on trust and understanding. In the past access to healthcare services for patients with learning disabilities has sometimes unintentionally been denied. A learning disability nurse can help to overcome these prejudices by ensuring people with learning disabilities are not discriminated against and have the same opportunities as the rest of the population (Brittle 2004). People with learning disabilities are the most vulnerable and socially excluded in our society (DOH 2001). A learning disability nurse works in partnership with both the patient and family carers to provide healthcare, and should recognise each persons uniqueness, individuality and differing abilities. The learning disabilities nurses main aims will be to support the well-being and social inclusion of people with learning disabilities, their rights, choices and independence by improving or maintaining their physical and mental health so they can pursue a fulfilling life whatever their ability (DOH 2009). For example teaching someone the skills needed to find work can help them lead an independent life with equal opportunities (NHS 2009). Many complex issues working with patients with learning disabilities relate to ethical aspects of care, and may be related to an individuals rights and welfare, public welfare or inequality. For example a learning disability nurse may need to assess the capacity and ability of a person to consent to treatment (Hinchcliff, Norman Schober 2003). Every effort should be made to provide information in a format the patient can understand, which might be in the form of pictures, alternative communication methods, using short sentences, repeating explanations and giving them time to make a decision (Brittle 2004). Previous experience may mean a person with a learning disability has not been given the opportunity to make their own choice regarding their individual treatment and care (Turnbull et al 2010) and involving family, friends or an advocate, where possible may help them understand the care and treatment offered to enable them to make their own decision (DOH 2001). In some situations people with learning disabilities may have the capacity to consent to straightforward nursing activities but may lack capacity to consent to more complex procedures (DOH 2001). Other ethical issues may involve the family or carer, for example, a person with learning disabilities may receive some benefits which they may wish to have control over and decide how it is spent. The carer on the other hand may see it as part of the household income and wish to control of it. Or maybe the parents or carers, due to ill health are unable to continue with full time care of a person with learning disabilities in their own home. Nurses will require good negotiation skills to support individuals and carers through dilemmas such whilst working within ethical guidelines, with the person being supported remaining the central focus (Thomas Woods 2003). Other ethical issues might involve psychosocial and lifestyle issues such as overeating or drug abuse which might raise concerns about control and freedom of choice (Davis 2008). Opportunities for learning disabilities nurses exist in both hospital environments and the community. They will specialise in many areas which might include education, sensory disability or the management of services (NHS 2009). They will work within the multi-disciplinary team of their preferred environment, for example a learning difficulty liaison nurse will work with other staff, patients and carers to develop therapeutic relationships and ensure people with learning disabilities have a positive healthcare experience (Brittle 2004). To conclude people with learning disabilities have very similar health issues to that of the general population. However it is important that the learning disabilities nurse exercises a person centered approach, develops a therapeutic relationship and understands a person with learning disabilities personal needs in order to support their wellbeing and promote social inclusion, rights, choices and independence to enable them to enjoy the same health care rights as everyone else. NURSING DISCIPLINE CHILDRENS BRANCH The Childrens branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood childrens individual needs but it wasnt until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard Trig 2000). Sick childrens rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving childrens services and recent statute law has given children increased rights (Hubbard et al 2000).The Childrens Act (1989 2004) highlights their rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents (Chambers Licence 2005). These policies give direction today and will shape the future of childrens nursing. Nurses need to understand how they apply and what implications there might be when caring for children. For example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and phys ical or mental child abuse is suspected, the nurse will have an ethical duty to work with other agencies and professionals such as the Child Protection Services (Hubbard et al 2000). Childrens nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers et al 2005). In order to provide care in a fair and anti-discriminatory way they need to understand the effect age and development has on a childs health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when assessing medication the weight and development of a child, will need to be taken into consideration as well as which drugs come in a form which can be easily administered. Appropriate care plans will need developing and updating for evaluation and referrals made as necessary for Doctors to review (Robertson South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may the refore take more than one attempt (Robertson et al). The DOH (2006) promotes optimal care for young people who have illnesses which previously wound have been fatal in childhood but are now surviving. Childrens nurses work in both hospital and primary care settings such as schools, GPs surgeries and in the community. Childrens nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al). Childrens nursing is very much centred on the family (NMC 2008). Nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family (Hinchliff, Schober Norman 2003) and support both children and their families to make informed decisions regarding treatment and care options (Chambers et al 2005). Hubbard and Trig (2000) declare the family is central to a childs wellbeing, and whilst respecting and promoting the rights of a child, should also be sensitive to the needs and views of the parents wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a childs welfare. A nursing model often used to assist the nursing process is the Casey Model of nursing which focuses on working in partnership with both children and their families (Smith 1995). Lansdown, Waterston and Baum (1996) suggest childrens nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig (2000) agree and suggest that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the childs age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange. Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (2005) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the childs wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al 2005). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Childrens 1989 Act, childrens nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 2005). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless the y lack capacity, for example in emergency situations (Dimond 2005). Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958) (Hubbard et al 2000). Increasingly children are being cared at home by their parents supported by the community childrens nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al). NURSING DISCIPLINE ADULT BRANCH Prior to the influences of Florence Nightingale, hospitals were often unclean and contaminated by infection and nurses were seen as the ones to do the Doctors dirty work. Nursing schools were set up in the 1880s, although it wasnt until the 1950s that the nursing profession was governed by the regulation body, UKCC. Today nurses are accountable to the NMC (2008) and must work within the code of conduct, demonstrating that they are able to deliver, manage and develop an excellent standard of evidence based nursing care (Abel-Smith 1960)(NMC 2008). Adult nurses primarily nurse sick and injured adults back to health and have a prominent role in the provision of health care, whilst working closely with other professionals, patients and their families (NHS 2010). Traditionally nursing was task oriented and patient care focused on specific illnesses and conditions. Today nursing is much more patient centred. An adult nurse will provide holistic care to number of patients 18 years and above at any one time to meet their physical, psychological, social and spiritual needs, using the nursing process which will include assessing, planning, implementing and evaluating the care delivered (NMC 2008). Adult nurses care for adult patients with a wide range of acute and long term illnesses and are involved in many different health arenas such as health promotion and disease prevention or they may specialise in specific diseases or disorders, such as diabetes, respiratory problems or cancer care. Others may specialise in accident and emergency, practice nursing or care of the elderly (NHS 2010). Although purposely trained to nurse adults, adult nurses will almost certainly be required to care and treat other groups of patients such as children, people with learning difficulties and patients with mental health issues, for example if they present in an accident and emergency unit, or are admitted to a ward with diabetes issues (Hinchcliff, Norman Schober 2003). Adult nurses will work within a multi professional team to deliver care to patients, which will include other health professionals such as doctors, pharmacists, healthcare assistants, physiotherapists, occupational therapists and radiographers (NHS 2010). Adult nurses work in a range of settings which can be hospital based or in the community where more and more health care is being delivered such as GP surgeries, clinics, occupational health services, schools, nursing and residential homes and voluntary organisations such as hospices. The government is driving health care towards a primary health care led service within which nurses roles are expanding and developing (DOH 2010). Opportunities are also available in the armed forces, prisons, and leisure, eg cruise ships (NHS 2010). Adult nurses all cover the same programme even though their work destinations differ considerably and it has been suggested that it is time to consider a new branch of nursing that equips people to work in primary care (Smith M 2003). Adult nurses will need to demonstrate many skills such as problem solving, flexibility, caring, counselling, managing, teaching and interpersonal skills to maintain and improve the quality of patients lives, sometimes in difficult situations (NHS 2010). They may find themselves caring for patients who are the same age as their family, friends or themselves and it is important not to get too personally involved with patients or they may find themselves in discussions regarding ethical issues such as euthanasia where clearly legally it is unlawful but the patient may feel it is in their best interest (Hinchcliff et al 2003). To assist the nursing process, nursing models are used such as the Roper, Logan and Tierneys (2000) 12 activities of daily living, often used in acute settings and the Orems model (1985) which promotes self care, particularly useful in rehabilitation setting. An adult nurse must comply with legislation and obtain consent before any treatment can be given, this may be verbal for routine nursing procedures, or written for more complex ones. Nurses must allow the patient to have autonomy when making decisions regarding care and treatment, respect that decision and always act in the patients best interest (Dimond 2005). The governments agenda and The Human Rights Act (1998) have had significant impact on how adult nursing has evolved to meet peoples needs in an ever changing environment. New jobs are being created to extend the nurses role and get them involved in advanced procedures such as the modern matron, consultant nurses, nurse practitioners and chief nursing officers. The DOH strategy for nursing recommends consultant posts, for example care of older people and pain management taking nursing to another level (cited by Sines, Appleby Frost 2005). According to the NMC (2007) nurses now carry out roles previously carried out by Doctors, for example theatre nurses now perform surgery and community care nurses co-ordinate packages. Changes in the way care is delivered has taken place in accordance with the government directive which laid down a plan to make primary health care accessible to people in the community, at work and at and home (Hinchcliff et al 2003). New opportunities are being created to meet the needs of older people. Older people are living longer and are the largest group of people using health services (Hinchcliff et al 2003). Common health issues for elderly patients are strokes, falls and mental health problems. The NHS Plan (2000a)(cited by Sines et al 2005) promotes independence and encourages them to have support in their home environment rather than residential homes. The government also recognises the need to increase and improve services for young adolescence patients to address their individual needs. For example as child moves into adulthood they may take risks, take part in anti-social behaviour, or they might be vulnerable and frightened (Hinchcliff et al 2003). Nurses have a role to play providing care, treatment and information to help them stay safe and healthy. To conclude adult nurses work with a wide range of patients with many different health issues across numerous health arenas. Nursing has developed considerably since it was first regulated and as patient care is a key government priority todays adult nurses need to have the necessary skills to deliver appropriate care and treatment in an ever changing environment whi Reflective Account The Role of a Rehabilitation Nurse Introduction This reflective account will discuss the role of a rehabilitation nurse in a community hospital. I am going to use the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my knowledge of nursing practice and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the NMC Code (2008) and maintain confidentiality all names have been changed. Description On my second week of my placement, I met my associate mentor for the first time. She asked if she could look at my placement documentation and personal development plan. We then discussed the skills and knowledge I want to achieve during the placement which is on a community rehabilitation ward. After our discussion, my mentor suggested to that I spend some time reflecting on the role of a community hospital rehabilitation nurse. Thoughts and Feelings Although my associate mentor did not require a formal piece of reflection, I thought it would be good to document my reflection for my personal development. When she asked me if I would reflect on the roles of nurse in a community hospital, I had already been thinking how different is was from that of a nurse in an acute hospital during my first week so I welcomed the challenge, although I had some reservations about what I could say on a positive note about community nursing. From what I had seen during my first week I was skeptical about the skills of nursing in a community hospital as the pace seemed much slower with less opportunity to practice clinical skills than in my previous acute placement. I was feeling quite disappointed and whilst I appreciate personal health care is an important nursing skill, the majority of my first week I had been left to work with nursing assistants and not invited by my mentor to be watch or carry out any clinical skills, who as a sister spends les s time than staff nurses on hands on nursing and more time on office tasks. This really worried me as I dont want to just cruise through my nursing training, I want to take every opportunity to broaden my knowledge and skills in all aspects of nursing. However I was now feeling more positive as my first impression of my associate mentor was that she was extremely knowledgeable, committed and caring and I hoped I would find her inspirational as I got to know her. Evaluation Being left for a whole week working without any real mentorship was demorilising for me and having no support or guidance the first week resulted in me having a negative view of the rehabilitation ward and community nursing in general (Taylor 2008). However, meeting with my associate mentor for the first time was a good experience. She was interested in me and committed to developing my knowledge and skills and by the end of our conversation had a good understanding of what I wanted to achieve from the placement and was able to challenge my knowledge on the current placement. Taylor (2008) states an inspirational mentor is a necessity to assist student nurses with their learning and development needs and nurture them to become first-class nurses. Understanding the skills and knowledge required by a community hospital rehabilitation nurse will build on my current knowledge which has been in the acute sector and be good for my personal development and future nursing career. Analysis Rehabilitation is an important aspect of any nurses role, but more prevalent for nurses working with the elderly in community hospitals (Brooks 2010). It is the nurses role to promote independence and to empower patients to carry out the activities of daily living adopting new skills and knowledge where necessary. Many different models of nursing are used for rehabilitation purposes, two popular ones are the Roper, Logan and Tierneys (2000) 12 activities of daily living and the Orems (1985) model of self care. Sinclair and Dickinson 1998 define rehabilitation as: A process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users and their family carers. Many patients find themselves on a rehabilitation ward as a result of a traumatic incident or disease and rehabilitation nurses will work with the patient, family and other member of the multi disciplinary team to support and encourage patients to maximise their independence with physical functioning (White and Johnstone 2000). They are very often the coordinators of a patients care as they are the ones in contact with patients 24 hours a day. Nursing interventions will include supporting and reinforcing the care devised by other health care professionals such as occupational therapists and physiotherapists (Low 2003). They will need to have underpinning knowledge about adjusting to life changes and understanding of anatomy and physiology, health promotion and illness prevention (Chilvers 2002). To provide holistic care for the patient, nurses will be required to apply their knowledge and skills through the nursing process. The first stage of this process is assessment to identify a patients impairments and disability in order to develop care plans. Identifying emotional effects is as important as physical disabilities, as these are likely to have an effect on patients rehabilitation progress (Vohora and Ogi, 2008). These may include anxiety, grief, depression, frustration, and anger (Stroke Association, 2008). Many of the care plans aims will be to increase a patients independence so that they can resume responsib Nursing Discipline Overview and Reflective Account Nursing Discipline Overview and Reflective Account NURSING DISCIPLINE MENTAL HEALTH BRANCH From the 16th Century mental health patients were contained in asylums until mental health hospitals were introduced during the 1950s. Sometimes people who were a disruptive or were only reacting in a normal way to difficulties in their lives were put away. Often patients were excessively medicated and subject to treatment which would be totally unacceptable today such as muffling or being put in a swing chair. In the 1960s, inadequacy and cost resulted in mental health hospitals closing and care moving to general hospitals. Patients who were allowed home at the weekends recovered more quickly and therefore care increasingly moved to the community (Hannigan and Coffey 2003), where most people with mental health problems are cared for today (NHS 2010). Legislation such as the 1959 and subsequent 1983 Mental Health Act, and the Care Community Act (1990) are relative to modern community mental health nursing. In 1999 the Government confirmed mental health was a top priority in the Health Service (Jackson Hill 2006). Since then guidelines such as the Department of Health guidance (2003), the National Service Framework for Mental Health (1997) and the NHS Plan (2000) (cited in Jackson et al 2006) have been introduced to reform and improve services for people with mental health problems and their carers. The Department of Health have also investing significantly in inpatient mental health settings due to issues such as a not enough beds being available, the lack of privacy and dignity of patients and wards not supporting provision of self care (DOH 2009). As a result many new opportunities have been created for mental health nurses over the last few years, for example the modern matron and nurse consultant, and new skills have been dev eloped, such as nurse prescribing and psychosocial interventions (Brimblecombe 2009). Mental health nurses will work with children and adults who suffer with various mental health problems. The primary role being to form therapeutic relationships with patients (sometimes called clients) and their families to help them recover from their illness and promote independent living (NHS 2010). Mental health nursing is varied and complex, for example treatment may include conventional nursing interventions such as administering drugs and injections or it may be to encourage patients to take part in art, drama or occupational therapy. In order to care for people in a fair and anti-discriminatory way and deliver care holistically, mental health nurses need to have good knowledge of the theories of mental health and illness, psychological and biophysical sciences and personality and human behavior (Hannigan et al 2003). One in four people will suffer with a mental health illness at some point during their life and one in twelve will require medical intervention (Mind 2010). Women are 1.5 times more likely to suffer with anxiety and depression whilst men are more likely to suffer from substance abuse and anti social personality disorders. For some patients a mental illness is triggered by a crisis in their life, which they cant cope with, such as depression following the death of a partner (NHS 2009). Some of the more familiar mental health illnesses are anxiety, depression, schizophrenia, eating disorders, drug and alcohol addition, personality disorders and impulse control such as gambling. Some of these illnesses will require treatment in hospital but many will be treated in primary care settings, such as outpatient clinics, schools, community mental health centres, residential facilities, prisons and day treatment centres (Hannigan et al 2003). Care is person-centered and mental health nurses will work within a professional multi-disciplinary team which will include GPs, psychiatrists and social workers and other health care professionals. A mental health nurse will require good interpersonal and communication skills. They will to demonstrate sensitivity when caring for patients, for example there is still some stigma attached to people with mental health problems and it is important for a nurse to help the individual and their families deal with this (NHS 2010). Dealing with the human mind and behavior is not an exact science and sometimes people with mental health problems can be violent, one skill a nurse will be required to have is to recognise building tension and diffuse it when necessary to maintain the patients and others safety (NHS 2010). Sometimes nurses may find themselves faced with awkward situations, and be required to apply ethical principles, such controversial issues which cannot be disclosed and where confidentiality needs to be maintained (NMC 2008). On the other hand if someone is at risk of serious harm, have an infectious disease or criminal activity is involved they may have to inform the appropriate bodies (Hannigan et al 2003). Nurses may find themselves giving care or treatment which is against their beliefs, for example someone addicted to drugs may request a supply even though medically it is not in their best interest or an anorexic patient might protest when food when the nurse tries to care for them (Hannigan et al 2003) . In practice, mental health nurses will come across difficult situations were an assessment of the capacity and ability of a person to consent will be required. People with mental health disorders have the same rights to consent or refuse treatment as those with physical illnesses unless some mental health issue means they are unable to make a decision. Nurses need to support patients to take responsibility for their own well-being and make informed decisions by providing information which is accessible and understandable (Mind 2010). This may mean working with the clients, advocates and carers to ensure it happens. Although giving certain treatments might be in the clients best interest it not enough to impose treatment without consent. In some circumstances a small number of people with mental health problems will be detained under the Mental Health Act (1983) (Hinchcliff et al 2003). To conclude mental health care has developed considerably over the last few years. Mental health nursing is not an exact science but is varied and complex and is about building therapeutic relationships with people and understanding and reacting appropriately to individual circumstances and needs to promote recovery and maximise life potential. NURSING DISCIPLINE LEARNING DISABILITIES BRANCH People with learning disabilities have been treated as second class citizens for many years, once being seen as possessed by evil spirits or being punished by God for a sin they may have committed. In the 19th century they were removed from their families and lived in purpose built institutions, treated as sick and in need of treatment (Brown Benson 1995). During the 1970s care moved to the community (Brigden Todd 1993) where it largely remains today. Approximately 1.5 million people have a learning disability, the majority of which live at home with their families or in community care settings (Mencap 2009). Relatively few live by themselves or with a partner (Emerson, Davies, Spencer, Malam 2005). Turnbull and Chapman (2010) describe a learning disability as being a lifelong condition, which may be genetic or environmental and vary in degree of impairment. Sowney (2006) suggests all learning disabilities have common features including impaired intelligence and social functioning which has a lasting effect on development. According to Mencap (2009) people with learning disabilities live an average of 50-55 years and sometimes up to 70 years old. A learning disability nurse can therefore expect to nurse a range of patients from birth to the elderly and will need to demonstrate a patient centred approach and work in partnership with the patient to help them meet their health, social, emotional, developmental and behavioral needs ( NHS 2009). Although a learning disability is not an indication of a physical disability or ill health, people with learning disabilities generally have more complicated problems and require more nursing interventions than the general population. In the young person some of the more common problems include respiratory problems, epilepsy, sensory and motor impairments, hypertension, thyroid disease and cancer and in elderly adults common problems include loss of hearing, vision and mobility, heart conditions, diabetes, fractures and osteoporosis (Davis 2008). Generic issues include communication difficulties, conditions relating to specific syndromes, challenging behavior and delayed development (University of Nottingham 2010). A learning disability nurse needs the skills to work within both simple and complex health areas. Communication is a vital skill for the learning disability nurse, hospitalisation for a patient with a learning disability can be very distressing and it is important to build therapeutic relationships based on trust and understanding. In the past access to healthcare services for patients with learning disabilities has sometimes unintentionally been denied. A learning disability nurse can help to overcome these prejudices by ensuring people with learning disabilities are not discriminated against and have the same opportunities as the rest of the population (Brittle 2004). People with learning disabilities are the most vulnerable and socially excluded in our society (DOH 2001). A learning disability nurse works in partnership with both the patient and family carers to provide healthcare, and should recognise each persons uniqueness, individuality and differing abilities. The learning disabilities nurses main aims will be to support the well-being and social inclusion of people with learning disabilities, their rights, choices and independence by improving or maintaining their physical and mental health so they can pursue a fulfilling life whatever their ability (DOH 2009). For example teaching someone the skills needed to find work can help them lead an independent life with equal opportunities (NHS 2009). Many complex issues working with patients with learning disabilities relate to ethical aspects of care, and may be related to an individuals rights and welfare, public welfare or inequality. For example a learning disability nurse may need to assess the capacity and ability of a person to consent to treatment (Hinchcliff, Norman Schober 2003). Every effort should be made to provide information in a format the patient can understand, which might be in the form of pictures, alternative communication methods, using short sentences, repeating explanations and giving them time to make a decision (Brittle 2004). Previous experience may mean a person with a learning disability has not been given the opportunity to make their own choice regarding their individual treatment and care (Turnbull et al 2010) and involving family, friends or an advocate, where possible may help them understand the care and treatment offered to enable them to make their own decision (DOH 2001). In some situations people with learning disabilities may have the capacity to consent to straightforward nursing activities but may lack capacity to consent to more complex procedures (DOH 2001). Other ethical issues may involve the family or carer, for example, a person with learning disabilities may receive some benefits which they may wish to have control over and decide how it is spent. The carer on the other hand may see it as part of the household income and wish to control of it. Or maybe the parents or carers, due to ill health are unable to continue with full time care of a person with learning disabilities in their own home. Nurses will require good negotiation skills to support individuals and carers through dilemmas such whilst working within ethical guidelines, with the person being supported remaining the central focus (Thomas Woods 2003). Other ethical issues might involve psychosocial and lifestyle issues such as overeating or drug abuse which might raise concerns about control and freedom of choice (Davis 2008). Opportunities for learning disabilities nurses exist in both hospital environments and the community. They will specialise in many areas which might include education, sensory disability or the management of services (NHS 2009). They will work within the multi-disciplinary team of their preferred environment, for example a learning difficulty liaison nurse will work with other staff, patients and carers to develop therapeutic relationships and ensure people with learning disabilities have a positive healthcare experience (Brittle 2004). To conclude people with learning disabilities have very similar health issues to that of the general population. However it is important that the learning disabilities nurse exercises a person centered approach, develops a therapeutic relationship and understands a person with learning disabilities personal needs in order to support their wellbeing and promote social inclusion, rights, choices and independence to enable them to enjoy the same health care rights as everyone else. NURSING DISCIPLINE CHILDRENS BRANCH The Childrens branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood childrens individual needs but it wasnt until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard Trig 2000). Sick childrens rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving childrens services and recent statute law has given children increased rights (Hubbard et al 2000).The Childrens Act (1989 2004) highlights their rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents (Chambers Licence 2005). These policies give direction today and will shape the future of childrens nursing. Nurses need to understand how they apply and what implications there might be when caring for children. For example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and phys ical or mental child abuse is suspected, the nurse will have an ethical duty to work with other agencies and professionals such as the Child Protection Services (Hubbard et al 2000). Childrens nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers et al 2005). In order to provide care in a fair and anti-discriminatory way they need to understand the effect age and development has on a childs health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when assessing medication the weight and development of a child, will need to be taken into consideration as well as which drugs come in a form which can be easily administered. Appropriate care plans will need developing and updating for evaluation and referrals made as necessary for Doctors to review (Robertson South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may the refore take more than one attempt (Robertson et al). The DOH (2006) promotes optimal care for young people who have illnesses which previously wound have been fatal in childhood but are now surviving. Childrens nurses work in both hospital and primary care settings such as schools, GPs surgeries and in the community. Childrens nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al). Childrens nursing is very much centred on the family (NMC 2008). Nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family (Hinchliff, Schober Norman 2003) and support both children and their families to make informed decisions regarding treatment and care options (Chambers et al 2005). Hubbard and Trig (2000) declare the family is central to a childs wellbeing, and whilst respecting and promoting the rights of a child, should also be sensitive to the needs and views of the parents wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a childs welfare. A nursing model often used to assist the nursing process is the Casey Model of nursing which focuses on working in partnership with both children and their families (Smith 1995). Lansdown, Waterston and Baum (1996) suggest childrens nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig (2000) agree and suggest that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the childs age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange. Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (2005) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the childs wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al 2005). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Childrens 1989 Act, childrens nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 2005). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless the y lack capacity, for example in emergency situations (Dimond 2005). Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958) (Hubbard et al 2000). Increasingly children are being cared at home by their parents supported by the community childrens nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al). NURSING DISCIPLINE ADULT BRANCH Prior to the influences of Florence Nightingale, hospitals were often unclean and contaminated by infection and nurses were seen as the ones to do the Doctors dirty work. Nursing schools were set up in the 1880s, although it wasnt until the 1950s that the nursing profession was governed by the regulation body, UKCC. Today nurses are accountable to the NMC (2008) and must work within the code of conduct, demonstrating that they are able to deliver, manage and develop an excellent standard of evidence based nursing care (Abel-Smith 1960)(NMC 2008). Adult nurses primarily nurse sick and injured adults back to health and have a prominent role in the provision of health care, whilst working closely with other professionals, patients and their families (NHS 2010). Traditionally nursing was task oriented and patient care focused on specific illnesses and conditions. Today nursing is much more patient centred. An adult nurse will provide holistic care to number of patients 18 years and above at any one time to meet their physical, psychological, social and spiritual needs, using the nursing process which will include assessing, planning, implementing and evaluating the care delivered (NMC 2008). Adult nurses care for adult patients with a wide range of acute and long term illnesses and are involved in many different health arenas such as health promotion and disease prevention or they may specialise in specific diseases or disorders, such as diabetes, respiratory problems or cancer care. Others may specialise in accident and emergency, practice nursing or care of the elderly (NHS 2010). Although purposely trained to nurse adults, adult nurses will almost certainly be required to care and treat other groups of patients such as children, people with learning difficulties and patients with mental health issues, for example if they present in an accident and emergency unit, or are admitted to a ward with diabetes issues (Hinchcliff, Norman Schober 2003). Adult nurses will work within a multi professional team to deliver care to patients, which will include other health professionals such as doctors, pharmacists, healthcare assistants, physiotherapists, occupational therapists and radiographers (NHS 2010). Adult nurses work in a range of settings which can be hospital based or in the community where more and more health care is being delivered such as GP surgeries, clinics, occupational health services, schools, nursing and residential homes and voluntary organisations such as hospices. The government is driving health care towards a primary health care led service within which nurses roles are expanding and developing (DOH 2010). Opportunities are also available in the armed forces, prisons, and leisure, eg cruise ships (NHS 2010). Adult nurses all cover the same programme even though their work destinations differ considerably and it has been suggested that it is time to consider a new branch of nursing that equips people to work in primary care (Smith M 2003). Adult nurses will need to demonstrate many skills such as problem solving, flexibility, caring, counselling, managing, teaching and interpersonal skills to maintain and improve the quality of patients lives, sometimes in difficult situations (NHS 2010). They may find themselves caring for patients who are the same age as their family, friends or themselves and it is important not to get too personally involved with patients or they may find themselves in discussions regarding ethical issues such as euthanasia where clearly legally it is unlawful but the patient may feel it is in their best interest (Hinchcliff et al 2003). To assist the nursing process, nursing models are used such as the Roper, Logan and Tierneys (2000) 12 activities of daily living, often used in acute settings and the Orems model (1985) which promotes self care, particularly useful in rehabilitation setting. An adult nurse must comply with legislation and obtain consent before any treatment can be given, this may be verbal for routine nursing procedures, or written for more complex ones. Nurses must allow the patient to have autonomy when making decisions regarding care and treatment, respect that decision and always act in the patients best interest (Dimond 2005). The governments agenda and The Human Rights Act (1998) have had significant impact on how adult nursing has evolved to meet peoples needs in an ever changing environment. New jobs are being created to extend the nurses role and get them involved in advanced procedures such as the modern matron, consultant nurses, nurse practitioners and chief nursing officers. The DOH strategy for nursing recommends consultant posts, for example care of older people and pain management taking nursing to another level (cited by Sines, Appleby Frost 2005). According to the NMC (2007) nurses now carry out roles previously carried out by Doctors, for example theatre nurses now perform surgery and community care nurses co-ordinate packages. Changes in the way care is delivered has taken place in accordance with the government directive which laid down a plan to make primary health care accessible to people in the community, at work and at and home (Hinchcliff et al 2003). New opportunities are being created to meet the needs of older people. Older people are living longer and are the largest group of people using health services (Hinchcliff et al 2003). Common health issues for elderly patients are strokes, falls and mental health problems. The NHS Plan (2000a)(cited by Sines et al 2005) promotes independence and encourages them to have support in their home environment rather than residential homes. The government also recognises the need to increase and improve services for young adolescence patients to address their individual needs. For example as child moves into adulthood they may take risks, take part in anti-social behaviour, or they might be vulnerable and frightened (Hinchcliff et al 2003). Nurses have a role to play providing care, treatment and information to help them stay safe and healthy. To conclude adult nurses work with a wide range of patients with many different health issues across numerous health arenas. Nursing has developed considerably since it was first regulated and as patient care is a key government priority todays adult nurses need to have the necessary skills to deliver appropriate care and treatment in an ever changing environment whi Reflective Account The Role of a Rehabilitation Nurse Introduction This reflective account will discuss the role of a rehabilitation nurse in a community hospital. I am going to use the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my knowledge of nursing practice and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the NMC Code (2008) and maintain confidentiality all names have been changed. Description On my second week of my placement, I met my associate mentor for the first time. She asked if she could look at my placement documentation and personal development plan. We then discussed the skills and knowledge I want to achieve during the placement which is on a community rehabilitation ward. After our discussion, my mentor suggested to that I spend some time reflecting on the role of a community hospital rehabilitation nurse. Thoughts and Feelings Although my associate mentor did not require a formal piece of reflection, I thought it would be good to document my reflection for my personal development. When she asked me if I would reflect on the roles of nurse in a community hospital, I had already been thinking how different is was from that of a nurse in an acute hospital during my first week so I welcomed the challenge, although I had some reservations about what I could say on a positive note about community nursing. From what I had seen during my first week I was skeptical about the skills of nursing in a community hospital as the pace seemed much slower with less opportunity to practice clinical skills than in my previous acute placement. I was feeling quite disappointed and whilst I appreciate personal health care is an important nursing skill, the majority of my first week I had been left to work with nursing assistants and not invited by my mentor to be watch or carry out any clinical skills, who as a sister spends les s time than staff nurses on hands on nursing and more time on office tasks. This really worried me as I dont want to just cruise through my nursing training, I want to take every opportunity to broaden my knowledge and skills in all aspects of nursing. However I was now feeling more positive as my first impression of my associate mentor was that she was extremely knowledgeable, committed and caring and I hoped I would find her inspirational as I got to know her. Evaluation Being left for a whole week working without any real mentorship was demorilising for me and having no support or guidance the first week resulted in me having a negative view of the rehabilitation ward and community nursing in general (Taylor 2008). However, meeting with my associate mentor for the first time was a good experience. She was interested in me and committed to developing my knowledge and skills and by the end of our conversation had a good understanding of what I wanted to achieve from the placement and was able to challenge my knowledge on the current placement. Taylor (2008) states an inspirational mentor is a necessity to assist student nurses with their learning and development needs and nurture them to become first-class nurses. Understanding the skills and knowledge required by a community hospital rehabilitation nurse will build on my current knowledge which has been in the acute sector and be good for my personal development and future nursing career. Analysis Rehabilitation is an important aspect of any nurses role, but more prevalent for nurses working with the elderly in community hospitals (Brooks 2010). It is the nurses role to promote independence and to empower patients to carry out the activities of daily living adopting new skills and knowledge where necessary. Many different models of nursing are used for rehabilitation purposes, two popular ones are the Roper, Logan and Tierneys (2000) 12 activities of daily living and the Orems (1985) model of self care. Sinclair and Dickinson 1998 define rehabilitation as: A process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users and their family carers. Many patients find themselves on a rehabilitation ward as a result of a traumatic incident or disease and rehabilitation nurses will work with the patient, family and other member of the multi disciplinary team to support and encourage patients to maximise their independence with physical functioning (White and Johnstone 2000). They are very often the coordinators of a patients care as they are the ones in contact with patients 24 hours a day. Nursing interventions will include supporting and reinforcing the care devised by other health care professionals such as occupational therapists and physiotherapists (Low 2003). They will need to have underpinning knowledge about adjusting to life changes and understanding of anatomy and physiology, health promotion and illness prevention (Chilvers 2002). To provide holistic care for the patient, nurses will be required to apply their knowledge and skills through the nursing process. The first stage of this process is assessment to identify a patients impairments and disability in order to develop care plans. Identifying emotional effects is as important as physical disabilities, as these are likely to have an effect on patients rehabilitation progress (Vohora and Ogi, 2008). These may include anxiety, grief, depression, frustration, and anger (Stroke Association, 2008). Many of the care plans aims will be to increase a patients independence so that they can resume responsib