Tuesday, August 6, 2019
A declaration of war justify behaviour Essay Example for Free
A declaration of war justify behaviour Essay Whether or not the declaration of Just War justifies behaviour that is morally or legally unacceptable in peacetime depends firstly on the sort of behaviour we are talking about. There are a number of behaviours that are legally permitted in peacetime that many people would and do reject as morally unacceptable. This includes abortion, euthanasia and animal rights. The legal acceptability of these issues depends on the government, and varies from state to state. In this country, during peacetime it is acceptable to kill in self defence for instance, if ones house is being robbed and the burglar threatens the owner, the owner would not be penalized for shooting and killing the burglar. Pacifists object to all kinds of killing in both war and peacetime, whereas just war supporters try to draw parallels between civil justice and international justice in the attempt to justify certain behaviour. There are also behaviors such as propaganda, espionage and deliberate infringement of human rights that are more doubtful and are usually seen as unacceptable in peacetime. Certain examples of violent behaviour in peacetime in hindsight appear unacceptable, yet at the time those guilty were not prosecuted. There have been a number of incidents when armed Police officers have shot dead suspects who were not carrying a weapon. None of the police officers who killed those people were convicted. This is because killing in defence of innocent life is acceptable in peacetime, and the boundaries and conditions can be bended to suit the individual. Pacifists believe that therefore no killing can be acceptable on deontological grounds. Some religious people argue for the absolute sanctity of human life; they would say that ideally no incidental killings would take place if all killing was prohibited. Thus, this position would assume that a declaration of war does not justify any kind of killing either. Christian absolutists believe they are following the example of Jesus Christ by refusing to resort to violence, even if they have been treated cruelly. Therefore a declaration of just war would not be able to justify any unacceptable behaviour such as murder and violence this would only further divide men, who are already divided by sin. Nevertheless, those who support the Just War theory believe that killing in the name of resisting an unjust oppressor is justifiable. The declaration of just war must be a proportionate response, and must discriminate between the guilty and the innocent. Oliver ODonovan suggests war is an act of armed judgment and must be carried out by an unbiased judge to ensure its fairness. This judge must have a clear perspective on the gains and losses this act would entail and the final aim must be to bring about peace. In theory, military aggression is not defined by killing and violence. For instance, British troops that entered Iraq do not kill unless attack. Therefore killing is still self defence and this is no different to peacetime. Walzer thinks killing in self defence is justifiable and supports the theory of legalist paradigm. This means interstate justice basically reinforces the civil legal system, but on a larger scale it is analogous. The right of a given state to defend itself must be accepted, just as an individual has the right to do the same. Walzer believed whichever side begins aggression to be automatically in the wrong. There is also the question of propaganda and whether it becomes appropriate to mislead people into thinking in a certain way in order for them to support the supposedly just war movement. In a healthy and functioning democracy during peacetime it is prohibited to lie to citizens or conceal the truth of political work. Some would argue that in wartime morale need to be boosted However, when a nation is at war, its citizens are often indoctrinated via mass media with the sort of messages that would disorientate their judgment and evoke hatred for the enemy. Propoganda can lead to disproportionate warfare and killings, therefore it cannot be justified. Human rights have always been an issue, for it is no certain whether it is morally right to deny someone the right to life in favour of another objective. From a utilitarian perspective, it would depend on whether the war was successful. If more people than soldiers killed are able to lead happy and fulfilled lives after the war ends, then it is acceptable to justify military confrontation in wartime. However, The High Court has recently decided that it soldiers human rights should not be overlooked either. This means the Ministry of Defence has to ensure the soldiers are not subjected to combat in intolerable heat or cold, and have functioning equipment. Certain equipment would be forbidden entirely, such as Nimrod planes. Of course, this would affect the damage potential of British troops, and possibly extend the war and subsequently take more lives. A utilitarian critic would ask whether in the long term this court order is going to cause more death and pain.
Monday, August 5, 2019
The Structure Of Protein P53 Biology Essay
The Structure Of Protein P53 Biology Essay Protein p53, encoded by gene Tp53, is known as a tumor suppressor. Discovered in 1979 as a transformation-related protein (DeLeo et al., 1979) and protein which accumulates in the tumor cells binding with simian virus 40 (SV40) large T antigens (Lane et al., 1979), p53 was regarded as an important protein in the regulation of an apoptosis and cancerization. During the last 30 years, a large amount of studies was taken in p53 and its related mechanisms in cellular process. In 1980s, researchers cloned the Tp53 gene and determined the role of p53 as a tumor suppressor. However, the structure of p53 protein was uncertain until 2006, in which William and his colleagues determined the DNA binding core domain of protein p53 (William. C. Ho. et al., 2006). Plenty of researches focus on the regulatory mechanism of p53 and hundreds types of targets and regulators of p53 were found, e.g. MDM2, Cyclin H, ATR, ATM, etc. These molecules can interact with p53 and regulate the life process collecti vely. P53 plays a very crucial role in cell cycle regulation and apoptosis induction, the mutation of p53 would lead to the cancerization in cells and induce cancer. Bai and Zhu (2006) reported that the mutation or loss of p53 gene and protein can be found in over 50% of tumor cells in human all around the world. For these reasons, the application of cancer therapy through protein p53 and Tp53 gene is a very potential aspect in cancer treatment. This review will describe the structure and function of p53 protein, examine its role in natural and tumor cells and focus on the cancer therapy application through p53. The Structure of P53 Human protein p53 is a 53KDa phosphoprotein encoded by a 20Kb-gene; it has an intricate structure which is closely related to its function. Wild-type P53 protein contains five major domains. The N-terminus of p53 is a transcription-activation domain (TAD), with a major one at residues 1-42 and a minor one at residues 55-75 (Venot et al., 1998). The basic function of this domain is involvement in the regulation of the pro-apoptotic transcription. Following the TAD is a proline-rich region which plays an important role in apoptotic activities. The central core of p53 protein is a DNA binding domain which can bind and interact with special DNA sequence that contain 2 copies of 10bp motif 5-PuPuPuC(A/T)-(T/A)GPyPyPy-3 (Kern et al., 1991). This region is also responsible for binding with LMO3, which is an essential co-repressor of p53 (Larsen et al., 2010). A nuclear localization signaling domain (NLS) is located beside the C-terminus of central core. The C-terminus domain of p53 protein, called negative regulatory domain is involved in the down regulation of DNA binding in central core (Chen, et al., 2005), and is also an essential part for the induction of cell death. A homo-oligomerisation domain (OD) located between the negative regulatory domain and NLS. This part is involved in tetramerization, which is a main activity for p53 in vivo. The different domains of p53 protein have their functions respectively, nevertheless, they constitute an inseparable entirety to play the role as a tumor suppressor. The function of p53 As a cancer suppressor, the main function of p53 is the anticancer function. P53 plays a vital role in apoptosis, gene stability and DNA damage through a series of complex mechanisms. First, p53 can respond to DNA damage through activating the DNA repair protein. For example, upon DNA damage, p53 gets activated and initiates the transcription of repair protein XPC and DDB2. The complex of p53-XPC-DDB2 can repair the DNA damaged by UV (Adimoolam and Ford, 2003). In addition, p53 can arrest the cell cycle at S, G1, and G2 phase (Agarwal et al., 1995), which can provide sufficient time for proteins repair to fix the damaged DNA. Induction of apoptosis, the programmed cell death, is also the essential and most important anti-cancer function of p53. If DNA damage is irreparable, p53 can activate the expression of pro-apoptosis genes like p21, Gadd45 (growth arrest and DNA-damageinducible protein 45), Bcl-2 family, etc. Moreover, p53 can bind and interact with hundreds of protein to regulate the cellular process and apoptosis. P53 can also restrain the cell cycle by repressing the expression of genes include bcl-2, bcl-X, cyclin B1, MAP4 and survivin (Bai and Zhu, 2006). The physiological functions of p53 are to maintain the genetic stability and regulate the normal cell cycle through a complex regulatory network. The mutation of Tp53 gene would lead to the loss of function of p53 protein, resulting in a cellular canceration. Consequently, the essential function of p53 is preventing the cancerization of cells by repairing genes or inducing apoptosis, in order to achieve these function, p53 can interact with a n umber of downstream targets. The Regulation in P53 Level A large amount of cellular response and process is induced by p53 through a series of complex biochemical mechanisms. P53 achieves its function through activating, binding, interacting with myriad kinds of downstream target molecules including kinase, enzymes, etc. Generally, p53 interacts with its target by phosphorylation of transcription-activation domain in N-terminus. The most well-known target of p53 is a cyclin-dependent kinase (CDK) p21. P53 would initiate the transcription and transduction of p21 in response to cellular stress, p21 is necessary in G1 control, the increase of p21 arrest the cell growth and induce cell death (Yin, et al., 1999). P53 and p21 contribute to a cell-cycle check point in G1 phase. The damaged genes would not be allowed to express until they are repair. If most damaged genes cannot be repaired, the accumulation of p21 regulated by p53 would induce apoptosis. Another important target of p53 is MDM2 (also called HDM2 in human body). MDM2 is a p53 inducible gene and its product can bind and interact with p53. The product of MDM2 gene, called p90 or p95, can bind with p53 and combine with ubiquitinate which can induce the degradation of p53 (Buschmann, et al., 2000). MDM2 is the killer of p53 which can keep the amount of p53 proteins into an appropriate level. However, a series of cellular stress would cause the overexpress of MDM2 and result in the over degradation of p53, the cell would lose ground and transform to tumor cell. P53 has plenty of other regulation pathways that cannot be listed in detail. The hundreds of pathways regulated by p53 have two mutual purposes: repair genes and induction of apoptosis. Therefore, the core of the p53 regulation levels is to maintain the stability of genes and accelerate the death of damaged or diseased cells. The Role of p53 in Normal and Tumor cells In natural human cells, the wt-p53 protein can be regarded as a guardian of the cell and genome. It can monitor the vital process, repair the gene indirectly through interaction with repair protein and induce apoptosis when necessary (Hofseth, et al., 2004). P53 plays a crucial role in numerous cellular processes which are related to cell cycle and cell death. If Tp53 gene mutated, the tumor suppression function in the cell would partly reduce. As a result, people whose Tp53 gene was mutated are more susceptible to suffer from cancer. Tp53 gene is mutated in over half of tumor cells; the mutation would alter the structure of p53 protein, thus p53 would lose its function partly or completely. The p53-mutated cells can not die programmatically, and become tumor cells. The mutated p53 protein tends to accumulate in tumor cells because the mutated p53 lose its function to induce the express of MDM2, which can degrade p53 proteins in the cell. The accumulation of p53 protein is a significant feature for the tumor cells. In cancer treatments, tumor cells can be detected through the accumulation of p53. However, mutated p53 can also be an obstacle of the therapy because mutant p53 can inhibit the function of wide-type p53 (Blagosklonny, M. V., 2002). If the treatment strategy is transferring the wide-type p53 into tumor cells, how to eliminate the effect of mutant p53 is the problem which has to be solved first. Consequently, p53 plays crucial roles both in normal cells and tumor cells; it is a gatekeeper in normal cells and a marker for tumor cells; it is an effective target for cancer treatments, nevertheless it can also become a barrier in cancer therapy. Conclusion P53 is the best-known transcription factor and cancer suppressor plays multiple roles in the cell. In healthy cells and, it is a gatekeeper to monitor the cell cycle and prevent the mutation of gene. If some mutations happen in the genome, p53 serve as a doctor to activate the repair process of damaged genes. When cells suffer from an irreversible damage or oncogenic stress, p53 can become a killer of cancerous cells. P53 participates in a number of biochemical pathways which can respond to the stress, arrest cell-cycle, repair gene and induce apoptosis. In the 30 years after the discovery of p53, plenty investigation was devoted into this essential protein and received a number of great achievements. A large amount of downstream targets has been identified and the regulatory network of p53 levels became clearer. Although plenty of details about p53, such as the relationship between each pathway, are still unknown. There is still a potential application through p53 in cancer treatmen ts.
Sunday, August 4, 2019
The New Testament :: Bible Religion Christian Christianity
The New Testament I.     The Primary Source of the Knowledge of Jesus a.     Proclaims the Incarnation -- the Word made Flesh -- Jesus becomes Man b.     Fulfillment of the Promise of the Old Testament II.     Collection of books (proclaiming the fulfillment of God’s promises through His Son, Jesus) a.     Gospels i.     Written by the evangelists – Matthew, Mark, Luke, John     ii.     CCC 125 = Gospels are the heart of all the Scriptures as they are the primary source of life and teaching of Jesus iii.     Main sources of information about the historical Jesus iv.     Faith testimonials announcing the good news of salvation; evangelists are not primarily interested in the historical details of Jesus’ life -- primary interest in the good deeds he performed, the words of salvation he taught, and the meaning of his passion, death, resurrection and glorification v.     Not all alike 1.     Mark – suffering servant 2.     Matthew – humanness of Jesus 3.     Luke – Gospel message is for all 4.     John – emphasizes the symbolisms within Jesus’ life vi.     Synoptic Gospels 1.     how Jesus lived 2.     Matthew, Mark and Luke vii.     John’s Gospel – what Jesus meant b.     Acts of the Apostles i.     Written about the time following Pentecost (for abt 30 yrs) ii.     Luke’s sequel to his Gospel c.     Epistles – letters i.     Pauline (13 books) – dealt with particular problems faced by the early Church and continued proclaiming faith in Jesus to be its central focus 1.     7 of the books directly attributed to Paul; the others were probably written by disciples of his ii.     Epistle to the Hebrews – defines the priesthood of Jesus iii.     Catholic Epistles – encouraged the universal church to keep the true faith and live Christ-filled lives d.     Revelation (The Apocalypse) – another book full of symbolisms written to aid Christians under persecution to remain loyal to Jesus and His teachings. III.     How did the writing of the Gospels come to be? – 3-stage process a.     The life and teaching of Jesus ------ period of time from Jesus’ birth until his death ------- what he did and taught b.     Oral preaching about Jesus ------ from Pentecost until the actual written form of the Gospels c.     Written Gospels ---- written over a 35 yr period ------ Mark around 65AD, Matthew and Luke between 75-85AD and John during the last decade of the first century. Each evangelist adapted his materials keeping in mind the circumstances of the particular audience for whom he was writing†¦.each had different audiences. i.     Most of what we know about Jesus’ early life comes from Matthew and Luke --- birth, Magi, Flight to Egypt, circumcision, Slaughter of the Innocents, boy Jesus in the Temple, Joseph ii.     Catholic Church maintains the dogma of the virgin birth --- no brothers or sisters ------ the text that refers to Jesus’ brothers and sisters uses a word that also means cousins
Saturday, August 3, 2019
The Outsiders :: essays research papers
Chapter Five/Six/Seven 12. Ponyboy liked his hair so much because it looked like Soda's and it also made him look tuff. 13. Johnny thought that Dally was gallant because Dally just takes what comes his way. Like when Two Bit broke the school windows and the fuzz thought it was Dally, Dally just took the rap and never ratted on his friend. 14. Ponyboy understood the way Johnny felt and that was the best way to emphasize it. I think the poem ment everything must change and that good and bad doesn't last forever. 15. Ponyboy, Johnny and Soda were the only ones of the gang who understood things like that and appreciated them. 16. Dear Pony      I don't understand whats going on, but I miss you and I am very sorry about hitting you the other night. The fuzz is after you and Johnny they think you guys killed a socs. Is it true? Dally seems to be the only one who knows what's going on, but you know him, he wont even tell us. Please come home Ponyboy I miss you. 17. It made things more intense so the Greasers had to walk in groups so they wouldn't be jumped by the socs. 18. Johnny didn't want to spend his life running from the cops just because he defended himself. 19. Juvenile Delinquents Turn Heroes      Ponyboy Curtis and John Cade were brought into hospitals yesterday after making an heroic rescue of several young school children in a burning abandoned church. The police have been looking for these two boys for about a week because they are wanted for the murder a wealthy boy named Bob. The two young men were returning to the church they had been hiding out at when they saw the smoke and all the kids outside. They heard that there was still some kids in it and they ran inside and heroically rescued them. Ponyboy is now out of the hospital with non serious burns, but John is still in the hospital under serious condition. As for the murder charges, they have been dropped. After talking to John, Ponyboy and friends that Bob was with at the time, We have come up with this; John and Ponyboy were in a park during the middle of the night when Bob and several of his friends arrived in their car, drunk. They were angry because Ponyboy and John were hanging out with their girlfriend's. They assaulted Ponyboy and John and
Role of Female Characters in Fidelmans Epiphany in Naked Nude :: Naked Nude Bernard Malamud
Role of Female Characters in Fidelman's Epiphany in Naked Nude Word Count Includes Outline   Thesis: In his picturesque short story, "The Naked Nude", Bernard Malamud uses the female characters to develop, enact, and resolve Fidelman's epiphany and to bring about the protagonist's final, artistic self-understanding. Bernard Malamud, a leading contemporary Jewish author, skirts between fantasy and reality in his almost allegorical short fiction, teaching the reader a lesson through coinciding elements of beauty and comedy. Venturing away from his usual, inner-city Jewish element, Malamud tackles new challenges of subject and setting in his novelistic collection of short stories, Pictures of Fidelman   Malamud develops his protagonist through a series of six, interrelated short works, each of which may function entirely independent from the others. In "The Naked Nude," for instance, Fidelman comes to a new, artistic maturity through his attempt to copy the famous painting "Venus of Urbino" by Titian Tiziano. Malamud's recurring theme of self-knowledge through suffering permeates this short work. Scarpio and Angelo, as primary antagonists, provide the bulk of this suffering for Fidelman. It is his own mental captivity concerning the female nude, however, that gives cause for Fidelman's eventual epiphany as an artist and as an individual. His relationship to the women in the work shapes his ability to capture the form of the "Venus" and to come to grips with his own self-worth. In "The Naked Nude," Bernard Malamud uses the female characters to develop, enact, and resolve Fidelman's epiphany and to bring about the protagonist's final, artistic self understanding.            At the story's outset, Fidelman is forced to act as janitor and manservant to a group of ill mannered prostitutes under the employment of the padrone, Angelo. These offensive characters establish the first of a series of mental obstacles in the imprisoned protagonist's attempt to copy Titian's nude. They torment Fidelman with cynical laughter and exploit his demeaning position. His sexual insecurity is established at the beginning of the story when he ponders his violent guillotine sketch, asking "A man's head or his sex?...either case a terrible wound" (Malamud 318). The limited omniscient narrator, revealing Fidelman's thoughts and feelings, also suggests that he could gain "no inspiration from whores," and that "maybe too many naked women around made it impossible to draw a nude" (Malamud 325).  This illustrates Fidelman's early accreditation of his artistic impotency to desensitization. He soon recogn izes, however, that the way in which he views the "Venus" also interrupts his progress.
Friday, August 2, 2019
Long Term Illness Essay
In this assignment a focus on an individual with the long term illness/ condition of a stroke will be undertaken, examining the impact of the condition/illness from the perspective of the individual and their family and also the impact of person centred care upon nursing practice. The Nursing and Midwifery Council (NMC, 2008) Code of Professional Conduct Guidance has been maintained throughout this essay and therefore, all names have been altered for the purpose of confidentiality and anonymity. Currently there are around 1.2 million stroke survivors in the UK, which is every year an estimated 152,000 people. More than half have been left with disabilities that affect their daily life. Stroke can affect anyone, no matter what their age. Around a third of all strokes happen to people under the age of 65, and around 400 children (0-18) have a stroke each year. Furthermore stroke is the largest cause of complex disability in adults. (Stroke Association 2012). A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue (WHO 2012). Mary is a 75 year old white British lady who suffered from a Cerebrovascular Accident (Stroke) approximately five years ago. She is a divorced lady who lives alone in a two storey house, however she has three children and numerous grandchildren who live within walking distance and whom visit on a daily basis. Mary was admitted to hospital as she had sustained a fall, fortunately nothing was broken, but she had suffered with severe bruising to her face and left side of her body resulting in loss of confidence. Mary currently takes medication for hypertension and hypercholesterolemia which her G.P monitors quite closely. On assessment it was identified that Mary has been finding it hard to accept her diagnosis, she was hoping that she would return to the same quality of life that she had before the stroke as she had never been poorly or took medication prior to this happening. CHSS (2012) state that denial initially protects you from being overwhelmed by the changes in your life. Some people may become ‘stuck’ in denial. The author has chosen this condition/illness as her grandmother suffered from a stroke 10 years ago and fights everyday with her disability, because of this experience the author decided to join the nursing profession and possibly work on a stroke unit or neurology department. This assignment will help to support, educate and contribute to patients ability to care for themselves after being diagnosed with any long term illness and will be part of life long learning, the Royal College of Nursing explain that nurses are committed to lifelong learning and continuous professional development (RCN 2012). Clinical reasons for choosing this condition/illness are that on this placement the author was allocated with the stoma nurses which gave her the opportunity to work on the wards of her choice on the final two weeks of the placement, she chose the stroke unit which also allowed her to complete many achievements and outcomes for example proficiency 2.4 was met which involved working with patients and families in order to use their strengths to achieve their goals and aspirations. As a nurse it is vital that patient centred care is met in today’s NHS and the care management of patients with a long term condition meaning putting the patient and their experience foremost, through communication, discussion of treatment options, potential outcomes and possible psychological effects also empowering the patient and allowing them to make choices about their healthcare (Nursing Standard 2011). As Mary was admitted with a fall investigatory questions needed to be asked to find out whether trips and falls are a common occurrence within Mary’s life and whether any member of the multi disciplinary team has implemented any changes to prevent these from happening. Through engaging in a therapeutic relationship allowing us to gain mutual respect and collaboration to develop with Mary she informed us that she has had many trips in her own home and only this one major fall outside, along with her worries and concerns which were listened to attentively. Nicol, J (2011) explain that as a nurse managing risk and promoting health and wellbeing whilst aiming to empower choices to promote self-care must be a priority therefore certain referrals need to be put in place. Firstly a referral to the physiotherapist was made within the hospital in order to improve posture and balance and make sure it is safe for Mary to return home to her own surroundings, as this was not managed post stroke admission and it is within the nurses role to make sure the patient and family are comfortable with there discharge. It is known for stroke suffers to have problems such as weakness, clumsiness or paralysis usually to one side of the body or loss of balance (Stroke Association 2008) which is why Mary has not received any further treatment from a physiotherapist after her stroke five years ago as treatment is stopped when it is no longer producing any marked improvement to your condition (NHS Choices 2012). Although from this admission it is recommend from the physiotherapist that a cane will be useful to Mary in order for her to gain more strength and move about more freely when walking outside within her limitation. A lot of time and advice was given to Mary and her family through discussion, education and effective communication, in order to help her in the decision making process and allowing Mary to realise that regaining independence requires patience (National Stroke Association 2011). Furthermore from a staff nurse’s experience in the past a referral to the Falls clinic was also put in place which was deemed successful from previous stroke survivors who have been left with similar disabilities to Mary and found this useful in the rehabilitation pathway. The Falls Clinic, (2011) aims to reduce your risk of falling and falls-related injuries and review your progress every two months for the first year. From this it enables Mary to be followed up in others ways apart from the GP ensuring that nothing significant is being missed in her care. Good engagement and collaboration allows the patient to gain full confidence and allows the nurse to develop a therapeutic nurse patient relationship providing care in a manner that enables the patient to be an equal partner in achieving wellness, which Mary had never felt before. However the family stepped forward at this point and informed the nursing team that they felt that Mary is starting to struggle around her usual housing environment and made it clear that they had no knowledge of any movement aids or assistive device until this hospital visit and talking to other families with the same problems. A referral to the Occupational Therapist was then put in place to assess and treat the physical condition using specific, purposeful activity to prevent disability and promote independent function in all aspects of daily life (NHS Careers 2012). From this referral it was decided that assistive grab bars, shower seats, supportive hand rails were put in place for easier movement around her home and further safety. This helped put her family at ease as she lives alone and copes by herself. Many stroke survivors continue to improve over a longer time in many different ways. Their recovery is in fact a long period of rehabilitation, as they learn to deal with the effects the stroke has had on them, however the psychological impact of living with a long term condition are very popular such as 30% of patients will suffer from depression at some point post-stroke (British Psychological Society 2010) and a significant proportion these remain undiagnosed or inadequately treated ( Hackett ,Yapa, Parag & Anderson 2005). Therefore as a nurse it is vital all the common problems after a stroke are investigated in depth. Upon Mary’s admission these psychological issues were assessed, Mary revealed that she had a feeling of hopelessness as she was unable to look after her younger grandchildren, worrying all the time and unable to sleep furthermore she felt like a burden to her family as they now had to do her housework and her weekly shop. Feelings of loss of energy were also described and a feeling of being isolated from her friends .As this attitude from a nurses perspective is not seen as a positive one the signs and symptoms of depression after stroke were researched. Stroke Association (2012) suggest that it is vital to seek help if four or more symptoms are present which include feeling worthless, avoiding people, feeling anxious or feeling blue and patients with long term conditions being more likely to develop depression, A Two Question Screening Tool was used which also determined that depression was a strong possibility NICE (2009) recommend a two question screen tool to determine who may have depression. These questions link to the key symptoms required for a diagnosis to be made and with both questions answered yes it meant things can be put in place to manage this. However this diagnosis for Mary and her family was hard to accept as she had felt like this for numerous years and nothing had been done about it. The nursing referral to GP for further screening in the community was put in place which has to include the diagnosed stage of depression which for this patient is mild disorder and the treatment and management needed. Then it is the GP’s responsibility to set up an active review which includes self help, cognitive behavioural therapy and exercise (CSIP 2006) NIMH (2011) suggest cognitive behavioural therapy (CBT ), a type of psychotherapy, or talk therapy, that helps people change negative thinking styles and behaviours that may contribute to their depression, from this as a nurse a recommendation of a day hospice was suggested to Mary, as similar patients from the nurses experience had thoroughly enjoyed there time visiting a hospice weekly. This form of empowerment allows Mary to take greater control over decisions and actions affecting her health facilitating choice, self care and self management. Using Gibbs model of reflection (1988) it was clear to me from a student nurse perspective that Marys psychological needs were not adequately addressed, as it took six years to pick up on this adjustment in her life the healthcare in this case was not acceptable. It was upsetting to observe the patient and her family feel frustrated that nothing was done as continuing health care in stroke is a primary need and stroke survivors are eligible for NHS funding for all the individuals assessed needs ( Department of Health 2009) In order to improve nursing the stroke patient the nursing role should involve preventative care which includes providing adequate information on stroke, risk factors and any lifestyle modifications, followed by curative care which involves accurate assessment’s, planned care that is person centred, physiological monitoring and risk assessment. Finally Rehabilitative/ promotive care which entails the carry on role (therapies), safe discharge planning and excellent communication with family/carers in which most of these steps should involve depression awareness and the importance of it as those people who have a Stroke and become depressed, failure to treat results is a less than optimal rehabilitation outcome (Stroke Recovery Association 2010). In addition to this nursing staff should aim to facilitate psychological adjustment and to support understanding of the emotions associated with recovery as the interaction of psychologists and nurses provides an opportunity to normalise patients’ reactions to post-stroke difficulties also they can exchange evidence-based and patient knowledge with each other (Vohora & Ogi 2008). In Mary’s case I found that this aspect of her care was dealt with very well as Mary found it a challenge to accept this change in her life the and nurses spent endless amounts of time and dedication to help Mary come to terms with her disabilities. It may be argued that staff nursing levels were a relating factor to Mary’s poor post stroke care, from working on a stroke unit previously the workload is very heavy and consists of many clinicians with appropriate levels of expertise in medicine, nursing, occupational therapy, physiotherapy, speech- language pathology, social work and clinician nutrition. Additional disciplines may include pharmacy, (neuro) psychology and recreation therapy, however it is within the nurses role to ensure all of these clinicians see there patient. In which some cases this maybe missed therefore implementing higher staffing levels may avoid this and signs of Marys depression could have been picked up amongst all of the reviews. In 2005 Lankshear published a systematic review of international research since 1990 that looked at relationships between nurse staffing and patient outcomes. Across the 22 studies covered the report stated that, †[The results] strongly suggest that higher nurse staffing and richer skill mix (especially of registered nurses) are associated with improved patient outcomes, although the effect size cannot be estimated reliably (Royal College of Nursing 2010). This would also be applied when the patient returned to there own home as people who have had a stroke and their carers value continuity, being kept informed, being included and having a clear, consistent point of contact with all the clinicians and services available.(Department of Health 2007). Another implementation that could be put in place not only for Mary’s psychological needs but also her physical needs is that Stroke specialist professionals could be involved in application and review of eligibility for Continuing Health Care in the community so that complex or hidden post stroke deficits which may be missed by generic staff can be considered. This could be included in the six week, six month and annual stroke reviews, and form part of the joint health and social care plan. (Department of Health, 2009). With this put in place Mary’s fall may have been prevented and her home could have become safer for her earlier putting her family at ease and allowing Mary to become more independent and less reliant on help. If the situation arose again and these changes were implemented then Holistic care, which is essential in nursing skills would be successful taking into consideration the psychological, environmental and spiritual needs of the patient, as well as the physical so that people are treated as whole human beings and the impact of the illness on their quality of life is met.(Nursing Standard, 2011). To conclude the role of the nurse in the management of care delivery for the patient and their family is to share their skills and knowledge with patients and their carers, acting as a key resource and providing a route to other services and professionals ( DOH 2005). As a person centred approach was used on this admission for Mary and her family it was clear that she was discharged more aware of services available to her in the community and the care given was beneficial in her life long rehabilitation process, leaving the Multidisciplinary Team confident they have done all they can for the patients individual needs.
Thursday, August 1, 2019
Culturally Competent Nursing in an Ever Changing Diverse World Essay
In nursing and healthcare the issue of culture is more pronounced than anywhere else. This is because many people various ethnic, religious, racial and cultural backgrounds come forth to hospitals and healthcare centres in search of health solutions. Due to these cultural disparities, patients often fail to receive quality services because of practices that are lacking in cultural competence. Cultural competence in nursing and healthcare refers to the efficiency with which a healthcare provider is able to offer quality service in a cross-cultural setting thus enhancing the system’s or institution’s capacity to function in effective manners (Dolhun, E. P. et al 2003). Culture influences an individual’s values, perceptions, beliefs and opinions. It influences how patients respond to healthcare givers and the medication prescribed to them. Therefore it is very important that nurses and other medical practitioners seek to improve their awareness towards the issues raised by cultural diversity in order to improve on service delivery. This paper examines ways in which a nurse can be more culturally competent. It also examines the opportunities in the work place and nursing school that requires culturally focused health practices. Additionally the paper discusses the issues of self-assessment and client assessment that is geared towards the delivery of culturally competent health solutions. Importance of Culture to Nursing. The US is comprised of the most culturally diverse population. A big percentage of the world’s ethnic, religious and cultural groups are represented in this population. This has created a most unique opportunity as well as challenge to many organizations in the service delivery sector. This is because people from all cultures get ill at one point in time and they have to seek treatment. Nurses are thus presented with patients from very diverse cultural backgrounds. Culture influences how different people will respond to the different ways of health service delivery, interventions and treatment (Dolhun, E. P et al. 2003). It is therefore important for nurses to move towards achieving cultural competence in order to effectively deal with the challenges that come with the cultural reality. Because of the demographic situation in America service providers are under pressure to provide more culturally correct services. The nursing profession cannot be left behind and therefore the need to comply with the changing needs is overwhelming. Language limitations are also another issue of concern in attaining cultural competence. Ethical Factor One ethical principle that guides nurses in their endeavour to provide culturally appropriate care is the appreciating that everyone regardless of their cultural persuasion is entitled to receive quality health care. Cultural differences can influence the caregiver’s prejudices and bias towards a patient (Galanti G. A. 1997). In a similar way a patient can misconstrue the caregiver’s actions and words. This can serve to lower the quality of care given to this particular patient. Professional ethics require that there be no form of discrimination in the provision of health care but in a situation where there is prejudice on either party, then the quality of care is compromised. Similarly what is considered ethical may have serious consequences when viewed from a cultural context. A fitting example is when the doctor feels obliged to divulge some information to a patient or a certain member of the family, because in some cultures it is believed that giving certain information to a sick person is unacceptable, the doctors ‘ethical’ actions may be viewed in very bad light Nurse’s responsibility Nurses are usually supposed to care for the general well being of a patient, they ought to be able to understand and empathize with the patient in order to cater for their physical and emotional needs. On an individual level, a nurse has a responsibility to learn the practices that are in accordance to cultural competence. It is important that nurses should have an attitude that goes further than just learning acceptable cultural behaviours. Nurses must be motivated by compassion to the patients and driven by moral responsibility (Tervalon M. Murray-Garcia J. 1998). This allows them to display a genuine concern and is thus motivated to internalize harmonious attitudes towards achieving cultural competence. In a hospital setting a nurse is required to be able to anticipate the issues that may arise due to cultural disparities and lack of proficiency in certain languages. They are also to understand the others’ points of view as well as appreciating the strengths and weaknesses of these points of view. In addition to this, respecting the cultural differences is key to the ability to provide culturally appropriate care. Since the issues raised by cultural diversity are multi-faceted in nature, they require a holistic approach that calls for a total overhaul in the nurses’ ways of thinking. There is no one culture that is the standard of what is good or bad and therefore an open mind is important as nurses move towards delivering health care that exemplifies cultural competence. Achieving this kind of competence is only possible if one comes to self-awareness and recognizes their own values, beliefs, opinions, prejudices and biases (Dolhun, E. P. 2003). From here, they can be able to understand how they respond to different points of view from other. Inorder to come to self-awareness one needs to examine their own cultural and environmental backgrounds. An underlying ethnocentricity is part most people where one is protective and to an extent defensive when it comes to cultural differences (Switzer, G. E et al 1998). However in the nursing practice each nurse should be flexible and work towards developing skills of responding to varied cultural settings and situations. Nursing Schools Similarly in nursing schools one is required to meet most of the aforementioned standards. In addition to that communication skills are developed in school. Learning to communicate effectively in a cultural context entails being open-minded, respectful and shunning any form of prejudice or bias (Robins, L. et al 1998). It is a great opportunity to learn form and about other cultures. Other communication skills that are essential are listening skills that enable one to establish a rapport with the others. Language skills also play an important role in communication and as such each student nurse has a responsibility to learn other languages. Ofcourse it is not possible to learn all the languages there are but one can do their best and that is what is required of them. In the same way nurses should have skills that would enable them to assess the patient in a cultural context. This would entail finding out as much detail on the patient as possible. It would help to understand their ethnic background, socio-economic class, religion, age group and other social entities that they identify with. Learning about their experiences could also aid in establishing biases. Impact of culture on health care In the year 2010 more than 45% of all patients in the US will come from minority cultures. This is due to immigration that is the greatest contributor to the cultural diversity (Tervalon M. Murray-Garcia J. 1998). The health sector has realized the reality of these facts and medical practitioners are now given incentives to encourage them to take up learning on cultural diversity. This is changing the entire medical profession. Many initiatives have been put in place in order to bridge health differences that exist between minority groups and the white Americans. The existence of cultural difference may impact negatively on the care given. Cultural factor do affect the response to the different methods of treatment and diagnosis. Some ideas are perceived differently in different cultures and in some extreme cases family members can react in ways that may seem bizarre in the western world. Conclusion The issue of culture is increasingly attaining great importance with the ever-changing cultural mixture. The provision of healthcare is now taking cognizance of the effects of culture on the delivery of these vital services. It has been realized that cultural differences have been an impact on the quality of care given. Nurses and other medical practitioner are now under increased pressure to attain cultural competence in order to achieve high standards of quality. This paper opines the achievement of an all round cultural competence is a long journey. It will take a collective as well as an individual effort to achieve. Nurses have a personal responsibility to seek to understand the cultural factor. Additionally each one of them needs to appreciate their moral duty to seek self-awareness inorder to understand their own behaviour in response to other people with a differing opinion. Respect and a non-judgemental attitude are important if one is to overcome the ethnocentricity that is part of every human being. This awareness cultivates interest and inquiry. Once this point has been reached cultural differences will be viewed as learning opportunities that will spur personal growth. Reference Dolhun, E. P. Munoz, C. and Grumbach, K. (2003). â€Å"Cross-cultural education in U. S. medical schools: Development of an assessment tool. †Academic Medicine. Galanti G. A. (1997). Caring for Patients from Different Cultures: Case studies from American hospitals. 2nd ed. University of Philadelphia Press. Philadelphia, PA. Riddick S. (1998). Improving access for limited English-speaking consumers: A review of strategies in health care settings. J Health Care Poor Underserved. Supp vol 9: Robins, L. S. Alexander, G. L. , Wolf, F. M. , Fantone, J. C. , & Davis, W. K. (1998). â€Å"Development and evaluation of an instrument to assess medical students’ cultural attitudes. †Journal of the American Medical Women’s Association, Switzer, G. E. Scholle, S. H. , Johnson, B. A. , & Kelleher, K. J. (1998). â€Å"The Client Cultural Competence Inventory: An instrument for assessing cultural competence in behavioral managed care organizations. †Journal of Child and Family Studies, Tervalon M. Murray-Garcia J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved.
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