Role of a Palliative Care Nurse

Role of a Palliative Care Nurse Palliative Care The role of the expert palliative care nurse is complex and unique. The nurse functions as an integral part of a Multidisciplinary team, providing expert skilled assessment and nursing care, supporting the patient and the family to make informed choices thereby encouraging the patient to continue to make autonomous decisions about their care towards the end of their life. However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope with the many dilemmas she must be well armed. The complex needs of the terminally ill patients and their families make the multidisciplinary team approach the most effective method of care Staff from a range of disciplines including medical, nursing, social work, dietitian, physiotherapist, pharmacist and others bring diverse and unique skills. As a team they provide an excellent sounding board for ethical dilemmas thereby hopefully- enhancing ethical practice. (Latimer, 1998) The Nurse in her role is required to act as patient advocate and ensure that the patients rights are respected. Unfortunately this advocacy is sometimes perceived negatively as a threat or implied criticism of medical care. Doctors need to listen to the nurses more accurate perspective of patient concerns. Consistency across the team leads to better outcomes for patients. Reinforcing the same information by both medical and nursing staff help to allay patient anxiety far more than conflicting views on such things as symptom control. (Jeffrey, 1995) The members of the Multidisciplinary team sometimes make decisions regarding treatments, which they may perceive to be of the most benefit to the patient whilst in fact the patient, does not perceive the benefits in quite the same way. Nurses have more prolonged contact with the patient than most other members of the team due to the hands on patient care that they do. They often establish a close rapport with the patient and the family and are most likely to be aware of the patients likes, dislikes, hopes and dreams and are privy to often delicate and very private details of the patients life. The very fact that the nurse spends so much time with the patient makes them more likely to have knowledge of this kind of information. Doctors rounds in a Palliative Care Unit enable the doctor to spend perhaps 30minutes maximum per day in talking to the patient. In the community, appointments times with Doctors are restrictive and Home Visits limited. Patient Nurse dependency ratios in hospit als and palliative care units mean that Nurses are spending approximately four hours per day on one to one patient contact. Again, other team members are very limited in the amount of time they spend with patients due to the number of clients/patients they may have. A dietitian for example may spend 15 minutes with a patient twice during their six-week stay in a Palliative Care Unit or 30 minutes as an outpatient during the course of the Terminal illness. Social workers often spend long periods at a time with patients and/or their families in lengthy discussion however these discussions may only take place a couple of times over the period of the illness. Therefore the Nurse is far more likely to be aware of issues affecting patient care. There can be many difficulties for the Nurse expert providing high quality care to palliative patients whilst respecting their right to autonomy in the setting of the Palliative Care Unit, the role of the Nurse is to painstakingly assess the needs of patient and family. These needs may be constantly changing and there is no room for the Palliative Care Nurse to become complacent in her patient care. Symptoms may be physical such as pain, nausea, and dyspnoea or psychosocial or spiritual. In identifying care needs the nurse must be able to determine who is the most appropriate team member to refer to provide optimum management of these needs. E.g. although the expert nurse will have counselling skills, she must be aware of her limitations and refer on where appropriate to counsellors, psychologist or social worker. Mount (1993) suggests that we must first attend to physical needs and that to do this we need a detailed knowledge of therapeutics. Skilled listening and attention to detai l are paramount in Palliative Care. Our listening skills not only apply to what the patient is saying, but what they may be leaving unsaid. Nonverbal cues such as facial expressions and demeanour, the need to keep the door to their room open at all times or to constantly keeps the curtains drawn. In order for patients to make choices they need to be accurately and appropriately informed, yet Vachon (1993) suggests that whilst caregivers sometimes decide not to tell patient and family what is likely to happen, at other times they may give too much negative information not allowing the patient and family to have any hope. Patients need to know at what stage their disease is and their prognosis in order to choose where to spend their remaining time. The ethical communication of information should be timely and desired by the patient, accurate and given in words understandable to the patient and family and conveyed in a gentle, respectful and compassionate manner. (Latimer, 1998) An example of such communication would be that when asked by my patient (speaking about his fungating tumour) When will this thing on my neck stop leaking? I need to gently but truthfully explain that it will most likely continue to leak blood and fluid until he dies but also that we will continue to con tain the fluid and minimise the discomfort and attempt to disguise the drainage appliance as best we can. To not advise him of the eventuality of the fluid discharge continuing is to encourage him to have false hope and expectations and further disappointment when the discharge continues and probably worsens. However, the nurse needs to recognise that some patients do not wish to have information relayed to them e.g. a patient who did not want to talk about her illness future and continued to deny that her disease was terminal. Dont tell me that, I dont want you to say those words! Yet respect for patient autonomy demands that patients be given honest answers to their questions. Without this, patients become more uncertain and unable to make decisions about their future. Dying patients are by virtue of their physical and emotional situation, frail and vulnerable their treatment and management during this final phase of their life must be of a high standard both professionally and ethically. The Nurse and other members of the team should seek to do the best for the patient and their family. This includes respecting autonomy, through the provision of truthful information and helping them to set realistic goals while providing genuine attentive care during the full course of the illness. Provision of symptom control hinges on accurate assessment. McCafferty and Beebe (1989) suggest that we dont always make assessment easy by the fact that sometimes we dont readily believe what the patient tells us or the patient may deny having pain or refuse pain relief although they may be hurting. The expert Nurse should remember that the person with the pain is the authority- they are the one who is living the experience and we must believe them if they tell us they have pain. It is all too easy to allow ones own values and beliefs to cloud our judgement Unfortunately I have seen it happen where a nurse usually not experienced in Palliative nursing will make a statement such as He says he has pain rated 8 out of 10 but he doesnt look distressed or She was laughing and talking with her visitors 5 minutes ago and now shes buzzing for pain relief. Such comments display the Nurses ignorance and lack of understanding of pain. It seems apparent that they do not understand about adapta tion or distraction or that laughter stimulates the relaxation response throughout the body systems by lowering blood pressure, deepening breathing and releasing endorphins. Also of great importance is the need for the nurse to explore further if a patient denies pain despite indications that they are in fact suffering pain. There may various reasons for denial for example; sometimes our language when asking questions about the patients pain may be inappropriate. Some patients may not consider a dull constant ache as pain but an ache. Others may feel sore. Other words such as discomfort and pressure may be used instead of Pain We as nurses need to avoid misinterpretation by using such other words. The Nurse needs to explore the issue of pain and help to identify the source. Location. Intensity, and Quality of the pain help to identify the source. Eg. Bone, visceral or nerve pain. Identifying the source aids in determining the appropriate treatment method. The expert Nurse will be aware that nerve pain will not respond as well to opiates and that neuroleptic agents need to employed. As suggested earlier, as Nurses spend the most time with the patients they are able to obtain the most information on the patients response to pain management plans, they are able to educate patients on the need to take regular analgaesia; and they can be the most influential in management of pain (Lindley, Dalton and Fields, 1990). Of course we as nurses in Palliative Care need to be aware that not all pain will respond well to traditional or orthodox treatments. Seeing a patient in pain and trying all pharmacological methods without success is distressing for staff as well as the patient and it is then that nurses should further attempt to employ other methods such as relaxation, distraction and music. Studies have shown that that listening to music disrupts the chronic pain cycle. Laughter, Massage and relaxation therapies have also been shown to interrupt this chronic pain cycle (Owens Ehrenreich, 1991) and massaging a dying patients back or feet with oil blends incorporating lavender instils in many cases a feeling of peace, contentment and lessening of pain. Heat and cold packs are also said to be beneficial in the treatment of chronic pain however heat applications are said to be contraindicated in patients with poor vascular supply and in malignancy. Most institutions have policies related to the use of thermal applications. As most nurses working with palliative patients will know, bowel management is of MAJOR importance! The Narcotics we administer to alleviate the symptom of pain have the side effect of causing the symptom of constipation. Vigilant monitoring of a patients bowel status is essential but it is of great importance that patients are not quizzed about their bowel actions in front of visitors or during meal times. Privately and quietly please! Cameron (1992) describes the types of constipation, these being primary and secondary due to pathology or iatrogenic. The goal of bowel management should be the prevention of constipation rather than treatment of constipation and appropriate assessment, regular administration of aperients, appropriate diet and fluids and provision of conditions favourable to bowel evacuation should all be part of the nurses management plan and patient education is paramount here for without the knowledge that opioids will contribute to constipation but that regular ap erients will counteract this symptom, the patient is unable to make informed choices about his symptom control. Nausea and vomiting are other symptoms the nurse can provide valuable assistance in controlling again through adequate assessment and intervention. The nurse needs to be aware of possible causes of nausea and vomiting such as hypercalcaemia, disseminated carcinoma, renal failure and vestibular stimulation particularly in patients with primary brain tumours or secondary cancer deposits. Constipation and radiotherapy, urinary tract infection and chemotherapy- the causes are many and varied. Hogan (1990) suggests that an understanding of the various pharmacological and non-pharmacological interventions is the foundation of symptom control but that the nurses commitment to alleviate the symptoms is the most important variable. Simple techniques like minimising cooking smells, presenting small meals and ensuring offensive odours such as foul linen bags from the vicinity can all be employed in conjunction with pharmacological methods to minimise nausea and vomiting. Successful management r equires an understanding of the cause of the symptoms. Other symptoms that may prove troublesome for the terminally ill patient include oral thrush and stomatitis, diarrhoea, lethargy and insomnia. Dyspnoea can be the cause of great distress and the expert nurse will be aware of the need to employ techniques to minimise discomfort. These may include reducing exertion by the patient, positioning them to allow maximum comfort when breathing and improving air circulation by use of fans or open windows. Humidification by methods such as nebulised saline may also be helpful. Pharmacological methods such as morphine either orally, subcutaneously or as a nebulised solution have also been found to decrease the perception of breathlessness (Chater, 1991) and anxiolitics such as Lorazepam s/l are quite helpful. Reassurance and providing a calm environment are also helpful techniques to employ. Distressed relatives around the bedside can further increase the patients respiratory distress and it is at such times that the nurse needs to take them asi de and explain to them what is happening and how they can help by remaining calm and distracting the patient or helping them to relax. For the terminally ill patient, being in control is vital and the nurse must appreciate that the patient though suffering an illness from which he will eventually die must be allowed to keep his self respect. This self respect can be eroded enough by the nature of the disease its symptoms and suffering, sorrow and emotional pain. There are times when we as nurses see patients admitted to hospital who have already had their autonomy undermined. Whilst it may have been their wish to stay at home longer or until the end, families may feel the burden of care is too great and that they can no longer cope. This is usually when a new symptom presents that the family feel unable to manage. Nurses in the community may sometimes be able to prevent this situation arising by offering a more frequent or higher level of care supported by a Palliative Care Service, education of the family about the patients symptoms and how to help manage them. Sometimes admission is not what the patient wishes but the service is unable to provide appropriate management in the home. There is then an onus upon those providing the care to look at all options to enable the patient to achieve his goal of returning home. To be autonomous means to have choice and control in our own lives yet we must accept that total autonomy is hardly ever possible. Sometimes there are circumstances in which it is not possible to challenge on the patients behalf- times when the patient may wish to have their autonomy eroded. There are times when the patient may not want our advocacy and times when we may not be able to give it- for example controversial ethical issues such as euthanasia. (Coyle, 1992). The nurse may sometimes develop feelings of helplessness and insecurity because of her unrealistic expectations of herself. The complex role we play in management of the terminally ill sometimes may lead the nurse to think she should be all things to all people the doctors handmaiden the patients advocate, the families sounding board. Sometimes nurses can become over involved, infringing on the autonomy of the patient and the family (Scanlon, 1989) and must be aware of when to withdraw. At times when caring for a patient with uncontrollable physical or emotional pain the nurse may feel herself to be a failure. Add to this the likelihood of inadequate resources and staffing, staff conflict and role conflict and there is a pretty good recipe for stress. Abraham and Shandley (1992) list five main sources of work stress. These being: 1. Work overload, 2. Difficulties relating to other staff, 3. Difficulties involved in nursing critically ill patients 4.concerns over patient treatment an d 5. Nursing patients who fail to improve. This again emphasises the fact that nurses specialising in palliative care are likely to suffer high levels of stress. CONCLUSION To help cope with these high demands and continue to maintain the delicate balance between what the patients want and what the health professionals think the patient needs, nurses need to arm themselves with expert knowledge of symptom control, and be well aware of ethical issues related to palliative care. Nurses also need to maintain open active communication with their peers and other members of the facility. We must also realize that even if we do not influence a situation or supply an answer to all needs and if our patients do not maintain total autonomy, it is enough that we have been with them, supporting them as best we can in their journey to the end of their life. Bibliography:

Impact of EU Fixed Term Work Directive: Scientific Research

Impact of EU Fixed Term Work Directive: Scientific Research Employment/Policies for Scientific Researchers: Is the EU Fixed Term Work Directive of any Assistance to Scientific Researchers in the UK? Introduction This dissertation proposal proposes to examine the impact of the new EU Fixed Term Directive on contract researchers throughout the UK. Its scope and potential for impact is quite wide, yet its workability and prospective effectiveness remains to be seen. Its aim is to increase levels of stability, consistency and equality among employees within Europe, which are employment conditions, from which scientific researchers on short term contracts in the UK have arguably been distanced from due to the nature of their employment. Also, the legislation is aimed at making research work between member states easier to access for EU citizens. The legislation also aims to make the EU a more attractive work destination, for, for example Chinese scientists who have a lot to contribute to European academia. The legislation applies to both private and public sector actors, and will also impact firms and universities employing researchers. The wider socio-political environment, the continued concentration of power with the European Commission and the growing influence of European Institutions upon actors operating at member state level will be examined in the writer’s proposed research, as this will ultimately contextualise both the final recommendations of the research and the processes of the proposed research as it unfolds. The proposed research will examine the research question from a primary data collection angle, and accordingly data will be collected in relation to how many individuals in the UK work as scientific researchers, and these individuals will be asked to contribute to the research by articulating their views on the potential workability and usefulness of the Directive. Also, employers, such as universities, public laboratories and firms will be approached in an effort to gather information from a wide variety of actors who will experience the impact of the new legislation. Data will be collected from other actors with expertise on the issues which relate to the employment of scientific researchers within the EU. The Research Question The research question will address the potential workability and usefulness of the new EU Fixed Term Directive; how it may be critiqued and how it may be improved. The research question will be addressed using primary and secondary research. The research question will be assessed qualitatively, and quantitatively, in an approach known as methodological pluralism. The next section will examine the background and aims of the EU Fixed Term Work Directive in a more in depth way, and it will give details on what literatures will be used and why. Review Literatures which give detailed background on the new Directive and literatures which provide background on the wider role of the EU will be used to create a point of reference for the study, and as they will help the guide the writer in identifying where gaps in the literature exist, and where research will best be concentrated. The literature which has been relied upon by the EU to gather background information in relation to the situation of scientific researchers on short term contracts is not an exhaustive body of research, and it is anticipated that this proposed research will add to this literature. The European Commission has become a deeply influential body[1]. Accordingly, its proposals in terms of legislation and social policy within the sphere of employment law have become fundamentally important for both employees and employers operating within Europe[2]. Therefore, the European Commission’s recent indications that it wished to address what it termed the ‘abuse’ of fixed term contracts, ‘through their continued use’ had many legislative and political consequences for employers and employees operating within the European Union[3]. In terms of operationalising their concerns, the Commission has recently called for all European Union member states to desist from what the Commission regarded as ‘short-term’ contract misuse through engaging in collective bargaining or through the implementation of domestic legislation. Many of the UK’s estimated 40000 researchers[4] will be impacted by the new EU Fixed Term Directive which proposes to ensure that fixed term contracts, under which many of these employees work, are made permanent after a period of four years. Also, the Directive requires that employers offer contract researchers equal terms of employment, compared with those enjoyed by permanent staff, in relation to departmental committees and maternity leave provisions[5]. However, the Directive allows employers to extricate themselves from having to implement the Directive, in circumstances where they can show specific and objective reasons for doing this[6]. Other criticisms of the new legislation are that it does not go far enough to prevent or discourage the ‘misuse’ of short term contracts, since contractual periods of any length are still legally enforceable under the legislation. Also, as the chairman of the Association of Researchers in Medicine and Science, Stephen Hopkins has commented, contracts may be terminated before the expiration of the four year period[7]. Also, it is unclear how much of an impact the legislation would have upon scientific researcher’s whose contracts are tied to external sources of funding and are therefore terminable upon the expiration of funds. However, the functions and circumstances of scientific researchers within the UK remain understudied and obscure. For example, there is little data which tells us what the exact number of researchers who are working on short term contracts, in the academic community is, and accordingly the extent of the impact of the new legislation is unclear. It would therefore be sensible to attempt to gauge these figures, and accordingly the proposed research will address this gap in the literature on this subject. Also, since the legislation is relatively new, little literature is available on the viewpoints of individual scientific researchers, and due to this, in particular the relevance of the proposed research can be seen to be even more sharply defined. These perspectives will allow the new legislation to be evaluated with reference to the views of those who are constrained and impacted by it. Ogbonna and Noon (2001) gives us further insight into the concept of ‘equality’ and equal opportunities with the context of the European Union: ‘There are two separate aspects to evaluating the effectiveness of equal opportunities policies†¦The liberal approach aims to provide equality of opportunity, and relies on fair procedures, bureaucratic processes, and a sense of justice being seen to be done. The emphasis is on the principle of recognising individual merit, rather than on any notion of providing social justice in relation to under-represented or disadvantaged groups. The radical approach is interested in equalising outcomes, and thus emphasises the fair and equal distribution of rewards, and positive discrimination†¦[8]’. As we have seen explained in previous sections, the new Directive is predicated upon a desire to offer contract researchers working within universities greater job security and more equal rights compared with other categories of professionals, like veterinary surgeons and doctors whose rights have been embodied prescriptively through EU legislation, particularly within the last five years. The research will therefore, also address literature on how the new legislation will impact upon the concepts of equality and equal opportunities within the EU. Research Design As has been explained, the focus of the research will be methodologically pluralistic in nature. This means that both qualitative and quantitative methods[9] will be relied upon to implement the proposed research. Qualitative research regards reality as a subjectively evolving social construct, whereas quantitative research is more specific and confirmatory. The meaning and application of both disciplines can be illustrated with reference to these two quotations: ‘Historians have always analysed documentary evidence, much of it non-quantitative data such as correspondence, as their primary source material, and through oral history methods have added in-depth interviewing to their repertoire†¦Organisational theory has been based largely on case studies created from an amalgam of observation, documentary material and interviews†¦[10]’. ‘Quantitative research is frequently referred to as hypothesis-testing research (Kerlinger, 1964)†¦Characteristically, studies begin with statements of theory from which research hypotheses are derived†¦[11]’. Therefore, the research design of this project will draw from both of these disciplines to construct the research framework, and gather primary information. Qualitative data will be primarily relied upon to gather the primary data needed for the operationalisation of the research. Semi-Structured interviews (this involves information exchange usually on a one to one basis) and focus groups[12] (these are groups interviews, usually led by the researcher) will be used to gather the qualitative data from research scientists working within the UK and surveys will be used to gather data in respect of the numbers of individuals the new legislation is likely to affect. Experts such as representatives of the European Industrial Research Managers Association, and the Association of Researcher in Medicine and Science will be interviewed. Within the qualitative arm of the study, semi-structured interviews will be mainly relied upon for practical reasons, since logistically, conducting focus group interviews, when dealing with a niche community like scientific researchers, and representatives from those actors who employ them like universities might be difficult to organise. The research design is pluralistic in nature, since this will provide a holistic context from which to examine the topic of employment law and policy in the context of scientific researchers. GANNT Chart/Discussion of Implementation The project will be implemented over approximately a three month period. The writer anticipates that they will implement the project alone. Various resources will be needed, such as access to libraries, equipment and respondents. The implementation of the research, and the time-scales which certain aspects of the research design must accord with may be represented diagrammatically in the following way: Chapter Headings Introduction: Background to the Study Literature Review: The EU Fixed Term Directive and the Role of the EU Commission Methodology Results and Discussion: New Models for Evaluating the Employment Circumstances of Scientific Researchers Conclusion Evaluation of Possible Problems and Barriers to Completion. The research project will be limited and constrained in many ways, as is the case with every research initiative. Resources with which to implement this project are finite and there is a very limited time scale to work within. Accordingly, the project design must be cogent and well-organised if the implementation of the research is to run smoothly. The writer does anticipate that the problem of representation may be a barrier to the implementation of the research design. Any research which claims to survey a group of individuals, and then seeks to comment upon the situation of a group of individuals in similar circumstances, imputes that the research is representative of those individuals and of that group, yet, there can be problems with the concept of representation. Therefore, the writer must ensure that representation bias is not introduced within the research design by over-reliance on the views of any particular age, gender or ethnic group. Also, a relatively large sample must be taken to ensure that trends which are discerned are not just random occurrences or anomalies[13]. Observance of ethical research methods will help to facilitate the research, since respondents are more likely to be willing to participate if they know that the information they impart will be used ethically. Therefore, matters such as confidentiality and informed consent will need to researched in detail and absorbed within the research design. However, these barriers to completion and potential problems will only thwart the prospective research if they are not addressed and recognised before the research is conducted. Also, they will need to be made reference to in the writing up of the research since to ignore potential barriers to completion in the write-up of one’s research is to, by default, suggest that they have been eliminated or are not relevant. This could therefore lead to the research indirectly being biased. Therefore, the writer will give an honest account of how problems have been identified and addressed throughout the research. Also, if the writer needs to travel to conduct research, journeys will be planned in advance and cost will therefore be minimised. Overall, therefore this proposed research will evaluate the usefulness and prospective workability of the EU Fixed Term Work Directive, by gauging the opinions of those most likely to be affected by it. Bibliography Books Benz, C. and Newman, I. (1998) Qualitative-Quantitative Research Methodology: Exploring the Interactive Continuum. Publisher: Southern Illinois University Press. Place of Publication: Carbondale, IL. Darlington, Y. and Scott, D. (2002) Qualitative Research in Practice: Stories from the Field. Publisher: Allen Unwin. Place of Publication: Crows Nest, N.S.W.. Frankfort-Nachmias, C. and Nachmias, D. (1996) Research Methods in the Social Sciences. Publisher: Arnold Publishers. Place of Publication; London. Noon, M. and Ogbonna, E. (2001) Equality, Diversity and Disadvantage in Employment. Publisher: Palgrave. Place of Publication: Basingstoke, England. Roberts, I. and Springer, B. (2001) Social Policy in the European Union: Between Harmonization and National Autonomy. Publisher: Lynne Rienner. Place of Publication: Boulder, CO. Article Payne, D. (2002) New Job Security for UK Researchers on Short Term Contracts? The ELSO Gazette. Issue 12. 1 Footnotes [1] P151. Roberts, I. and Springer, B. (2001) Social Policy in the European Union: Between Harmonization and National Autonomy. Publisher: Lynne Rienner. Place of Publication: Boulder, CO. [2] P16. Noon, M. and Ogbonna, E. (2001) Equality, Diversity and Disadvantage in Employment. Publisher: Palgrave. Place of Publication: Basingstoke, England. [3] P1. Payne, D. (2002) New Job Security for UK Researchers on Short Term Contracts? The ELSO Gazette. Issue 12. [4] P1. Payne, D. (2002) New Job Security for UK Researchers on Short Term Contracts? The ELSO Gazette. Issue 12. [5] P1. Payne, D. (2002) New Job Security for UK Researchers on Short Term Contracts? The ELSO Gazette. Issue 12. [6] P1. Payne, D. (2002) New Job Security for UK Researchers on Short Term Contracts? The ELSO Gazette. Issue 12. [7] P1. Payne, D. (2002) New Job Security for UK Researchers on Short Term Contracts? The ELSO Gazette. Issue 12. [8] P16. Noon, M. and Ogbonna, E. (2001) Equality, Diversity and Disadvantage in Employment. Publisher: Palgrave. Place of Publication: Basingstoke, England. [9] See Chapters One and Two of: Frankfort-Nachmias, C. and Nachmias, D. (1996) Research Methods in the Social Sciences. Publisher: Arnold Publishers. Place of Publication; London. [10] P2. Darlington, Y. and Scott, D. (2002) Qualitative Research in Practice: Stories from the Field. Publisher: Allen Unwin. Place of Publication: Crows Nest, N.S.W.. [11] P19. Benz, C. and Newman, I. (1998) Qualitative-Quantitative Research Methodology: Exploring the Interactive Continuum. Publisher: Southern Illinois University Press. Place of Publication: Carbondale, IL. [12] P19. Benz, C. and Newman, I. (1998) Qualitative-Quantitative Research Methodology: Exploring the Interactive Continuum. Publisher: Southern Illinois University Press. Place of Publication: Carbondale, IL. [13] P19. Benz, C. and Newman, I. (1998) Qualitative-Quantitative Research Methodology: Exploring the Interactive Continuum. Publisher: Southern Illinois University Press. Place of Publication: Carbondale, IL.

Haydn :: essays research papers

Josef Franz Haydn   Ã‚  Ã‚  Ã‚  Ã‚  The composer that we chose to do are report on is Josef Franz Haydn. Josef Franz Haydn was born on March 31, 1732. Haydn was born in Rohray, Austria. His parents were both peasants. His Father was Mathias Haydn, who was a wagoner. Haydn’s mother was Elizabeth Haydn.   Ã‚  Ã‚  Ã‚  Ã‚  Haydn’s father was a musical person. He could play the piano, and he could play the harp too. His mother could also play the piano very good. His father and mother would sit around in their house and play music, and Haydn was interested and wanted to learn how. By the time Franz Haydn was six years old, he could play the piano, violin, and the harpsichord. He could also sing very well. When Haydn was seven years old he joined the St. Stevens Church choir. He had success in the choir until he was seventeen.   Ã‚  Ã‚  Ã‚  Ã‚  When Haydn was seventeen years old his voice broke and he could no longer sing for the choir. He didn’t have any money, any home, and he didn’t have any friends or family that would help him. He was living on the streets for a few months. After a while one of his friends from the St. Stevens choir let Haydn stay with him because he felt sorry for him.   Ã‚  Ã‚  Ã‚  Ã‚  All Haydn did in his free time was study music, mainly works done by Bach. He composed music for masses and started to make a living on music.   Ã‚  Ã‚  Ã‚  Ã‚  When Haydn was twenty-three years old he composed his first string quartet. He also married his wife, Maria Anne Keller. She was the daughter of a wig maker. They had troubles in their marriage and in a few years, they separated permanently. Haydn gave her money to live until his death. Haydn met Wolfgang Mozart for the first time in 1785 and a year later he composed his first symphony. Wolfgang Mozart said about Haydn,† He alone has the secret to making me smile, and touching me to the bottom of my soul.† Haydn and Mozart met often throughout his life.   Ã‚  Ã‚  Ã‚  Ã‚  In 1970, Prince Ester Hazy died, letting Haydn take his place as a conductor of an orchestra in London. While he was conducting the London Orchestra, he composed six new symphonies, during this time he also composed some of his best and most famous works. This is what really helped his career.

Pros and Cons of Abortion Essay -- Religion Christianity Abortion Ethi

Pros and Cons of Abortion Should a list of pros and cons of abortion really be necessary for Christians...or human beings for that matter? I mean, have we really reached a point where we cannot tell that abortion is murderous no matter how you color it or try to paint it as compassionate? Apparently so. Thirty plus years after the infamous Supreme Court decision in Roe versus Wade and thirty one years after my own timely birth, I sit in awe at the ignorance of a great portion of society...their lack of understanding, their selfishness, and their brazen support of such a horrendous practice as abortion. I guess I should not be surprised that the unregenerate world can support abortion, but what shocks me most is that professing Christians need to consider some sort of pros and cons of abortion list so that they can "make an informed decision". It is a crying shame that we have reached a day when the Bible is not sufficient enough of a guideline for Christians that they feel they must hear the "pros and cons of abortion". Well, since this seems to be the case, let’s look at some pros and cons of abortion. Lets evaluate them in light of the scriptures and in light of our conclusions based on the whole of scripture and the impecable character of our God and His expectations for us. I recently viewed a site with one of these lists with the "pros and cons of abortion". I would like to review their statements with my evaluation of them below: Pros of Abortion "*Laws against abortion kill women. Even though abortion may be illegal doesn't mean that women won't go through with the abortion. Look at the case of Becky Bell for example. She was an innocent girl that did not want her child and died because of an illegal abortion." ***My Assessment: Yes, people will continue to sin, but we should never sit band condone theirs inn by either verbal support or merely apathy. We certainly should not use the dumb excuse of: "Well, they are just going to do it anyway and at least if abortion is legal, they won't be doing them in dirty back alleys." It is always tragic when a human being loses their life, but if abortion is once again outlawed (as it should be), these people would always be losing their lives in violation of a good, common sense, and compassionate law. If they die breaking the law, then they will die the death of a criminal. But, please keep... ...ortion you will always wonder what if, and feel guilty for the rest of your life about the child you could have had." Biblical pros and cons of abortion: Isa 44:24 Thus saith the LORD, thy redeemer, and he that formed thee from the womb, I [am] the LORD that maketh all [things]; that stretcheth forth the heavens alone; that spreadeth abroad the earth by myself; Biblical pros and cons of abortion: Isa 46:3 Hearken unto me, O house of Jacob, and all the remnant of the house of Israel, which are borne [by me] from the belly, which are carried from the womb: Biblical pros and cons of abortion: Isa 66:9 Shall I bring to the birth, and not cause to bring forth? saith the LORD: shall I cause to bring forth, and shut [the womb]? saith thy God. Now I shall leave you with some very key scriptures as you consider the pros and cons of abortion... Jer 1:5 Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee, [and] I ordained thee a prophet unto the nations. Isa 49:15 Can a woman forget her sucking child, that she should not have compassion on the son of her womb? yea, they may forget, yet will I not forget thee.

Labelling Theory

Labeling theory had its origins in Suicide, a book by French sociologist Emile Durkheim. He found that crime is not so much a violation of a penal code as it is an act that outrages society. He was the first to suggest that deviant labeling satisfies that function and satisfies society's need to control the behavior. As a contributor to American Pragmatism and later a member of the Chicago School, George Herbert Mead posited that the self is socially constructed and reconstructed through the interactions which each person has with the community. The labeling theory suggests that people obtain labels from how others view their tendencies or behaviors. Each individual is aware of how they are judged by others because he or she has attempted many different roles and functions in social interactions and has been able to gauge the reactions of those present. This theoretically builds a subjective conception of the self, but as others intrude into the reality of that individual's life, this represents objective data which may require a re-evaluation of that conception depending on the authoritativeness of the others' judgment. Family and friends may judge differently from random strangers. More socially representative individuals such as police officers or judges may be able to make more globally respected judgments. If deviance is a failure to conform to the rules observed by most of the group, the reaction of the group is to label the person as having offended against their social or moral norms of behavior. This is the power of the group: to designate breaches of their rules as deviant and to treat the person differently depending on the seriousness of the breach. The more differential the treatment, the more the individual's self-image is affected. Labeling theory concerns itself mostly not with the normal roles that define our lives, but with those very special roles that society provides for deviant behavior, called deviant roles, stigmatic roles, or social stigma. A social role is a set of expectations we have about a behavior. Social roles are necessary for the organization and functioning of any society or group. We expect the postman, for example, to adhere to certain fixed rules about how he does his job. Deviance† for a sociologist does not mean morally wrong, but rather behavior that is condemned by society. Deviant behavior can include both criminal and non-criminal activities. Investigators found that deviant roles powerfully affect how we perceive those who are assigned those roles. They also affect how the deviant actor perceives himself and his relationship to society. The deviant roles and the labels attached to them func tion as a form of social stigma. Always inherent in the deviant role is the attribution of some form of â€Å"pollution† or difference that marks the labeled person as different from others. Society uses these stigmatic roles to them to control and limit deviant behavior: â€Å"If you proceed in this behavior, you will become a member of that group of people. † Whether a breach of a given rule will be stigmatized will depend on the significance of the moral or other tenet it represents. For example, adultery may be considered a breach of an informal rule or it may be criminalized depending on the status of marriage, morality, and religion within the community. In most Western countries, adultery is not a crime. Attaching the label â€Å"adulterer† may have some unfortunate consequences but they are not generally severe. But in some Islamic countries, zina is a crime and proof of extramarital activity may lead to severe consequences for all concerned. Stigma is usually the result of laws enacted against the behavior. Laws protecting slavery or outlawing homosexuality, for instance, will over time form deviant roles connected with those behaviors. Those who are assigned those roles will be seen as less human and reliable. Deviant roles are the sources of negative stereotypes, which tend to support society's disapproval of the behavior. [edit]George Herbert Mead One of the founders of social interactionism, George Herbert Mead focused on the internal processes of how the mind constructs one's self-image. In Mind, Self, and Society (1934),[1] he showed how infants come to know persons first and only later come to know things. According to Mead, thought is both a social and pragmatic process, based on the model of two persons discussing how to solve a problem. Our self-image is, in fact, constructed of ideas about what we think others are thinking about us. While we make fun of those who visibly talk to themselves, they have only failed to do what the rest of us do in keeping the internal conversation to ourselves. Human behavior, Mead stated, is the result of meanings created by the social interaction of conversation, both real and imaginary. [edit]Frank Tannenbaum Frank Tannenbaum is considered the grandfather of labeling theory. His Crime and Community (1938),[2] describing the social interaction involved in crime, is considered a pivotal foundation of modern criminology. While the criminal differs little or not at all from others in the original impulse to first commit a crime, social interaction accounts for continued acts that develop a pattern of interest to sociologists. Tannenbaum first introduced the idea of ‘tagging'. [3] While conducting his studies with delinquent youth, he found that a negative tag or label often contributed to further involvement in delinquent activities. This initial tagging may cause the individual to adopt it as part of their identity. The crux of Tannenbaum's argument is that the greater the attention placed on this label, the more likely the person is to identify themselves as the label. Kerry Townsend writes about the revolution in criminology caused by Tannenbaum's work: â€Å"The roots of Frank Tannenbaum’s theoretical model, known as the â€Å"dramatization of evil† or labeling theory, surfaces in the mid- to late-thirties. At this time, the ‘New Deal' legislation had not defeated the woes of the Great Depression, and, although dwindling, immigration into the United States continued (Sumner, 1994). 4] The social climate was one of disillusionment with the government. The class structure was one of cultural isolationism; cultural relativity had not yet taken hold. ‘The persistence of the class structure, despite the welfare reforms and controls over big business, was unmistakable. ‘[5] The Positivist School of Criminological thought was still dominant, and in many states, the s terilization movement was underway. The emphasis on biological determinism and internal explanations of crime were the preeminent force in the theories of the early thirties. This dominance by the Positivist School changed in the late thirties with the introduction of conflict and social explanations of crime and criminality†¦ â€Å"One of the central tenets of the theory is to encourage the end of labeling process. In the words of Frank Tannenbaum, â€Å"the way out is through a refusal to dramatize the evil†, the justice system attempts to do this through diversion programs. The growth of the theory and its current application, both practical and theoretical, provide a solid foundation for continued popularity. [6]: [edit]Edwin Lemert It was sociologist Edwin Lemert (1951) who introduced the concept of â€Å"secondary deviance. † The primary deviance is the experience connected to the overt behavior, say drug addiction and its practical demands and consequences. Secondary deviation is the role created to deal with society's condemnation of the behavior. With other sociologists of his time, he saw how all deviant acts are social acts, a result of the cooperation of society. In studying drug addiction, Lemert observed a very powerful and subtle force at work. Besides the physical addiction to the drug and all the economic and social disruptions it caused, there was an intensely intellectual process at work concerning one's own identity and the justification for the behavior: â€Å"I do these things because I am this way. † There might be certain subjective and personal motives that might first lead a person to drink or shoplift. But the activity itself tells us little about the person's self-image or its relationship to the activity. Lemert writes: â€Å"His acts are repeated and organized subjectively and transformed into active roles and become the social criteria for assigning status†¦.. When a person begins to employ his deviant behavior or a role based on it as a means of defense, attack, or adjustment to the overt and covert problems created by the consequent societal reaction to him, his deviation is secondary† [7] [edit]Howard Becker While it was Lemert who introduced the key concepts of labeling theory, it was Howard Becker who became their champion. He first began describing the process of how a person adopts a deviant role in a study of dance musicians, with whom he once worked. He later studied the identity formation of marijuana smokers. This study was the basis of his Outsiders published in 1963. This work became the manifesto of the labeling theory movement among sociologists. In his opening, Becker writes: â€Å"†¦ social groups create deviance by making rules whose infraction creates deviance, and by applying those roles to particular people and labeling them as outsiders. From this point of view, deviance is not a quality of the act the person commits, but rather a consequence of the application by other of rules and sanctions to an ‘offender. ‘ The deviant is one to whom that label has been successfully applied; deviant behavior is behavior that people so label. [8] While society uses the stigmatic label to justify its condemnation, the deviant actor uses it to justify his actions. He wrote: â€Å"To put a complex argument in a few words: instead of the deviant motives leading to the deviant behavior, it is the other way around, the deviant behavior in time produces the deviant motivation. â€Å"[9] Becker's immensely popular views were also subjected to a barrage of criticism, most of it blaming him for neglecting the influence of other biological, genetic effects and personal responsibility. In a later 1973 edition of his work, he answered his critics. He wrote that while sociologists, while dedicated to studying society, are often careful not to look too closely. Instead, he wrote: â€Å"I prefer to think of what we study as collective action. People act, as Mead and Blumer have made clearest, together. They do what they do with an eye on what others have done, are doing now, and may do in the future. One tries to fit his own line of action into the actions of others, just as each of them likewise adjusts his own developing actions to what he sees and expects others to do. [10] Francis Cullen reported in 1984 that Becker was probably too generous with his critics. After 20 years, his views, far from being supplanted, have been corrected and absorbed into an expanded â€Å"structuring perspective. â€Å"[11] [edit]Albert Memmi In The Colonizer and the Colonized (1965) Albert Memmi described the deep psychological effects of the social stigma created by the domination of one group by another. He wrote: â€Å"The longer the oppression lasts, the more profoundly it affects him (the oppressed). It ends by becoming so familiar to him that he believes it is part of his own constitution, that he accepts it and could not imagine his recovery from it. This acceptance is the crowning point of oppression. â€Å"[12] In Dominated Man (1968), Memmi turned his attention to the motivation of stigmatic labeling: it justifies the exploitation or criminalization of the victim. He wrote: â€Å"Why does the accuser feel obliged to accuse in order to justify himself? Because he feels guilty toward his victim. Because he feels that his attitude and his behavior are essentially unjust and fraudulent†¦. Proof? In almost every case, the punishment has already been inflicted. The victim of racism is already living under the weight of disgrace and oppression†¦. In order to justify such punishment and misfortune, a process of rationlization is set in motion, by which to explain the ghetto and colonial exploitation. â€Å"[13] Central to stigmatic labeling is the attribution of an inherent fault: It is as if one says, â€Å"There must be something wrong with these people. Otherwise, why would we treat them so badly? † [edit]Erving Goffman Perhaps the most important contributor to labeling theory was Erving Goffman, President of the American Sociological Association, and one of America's most cited sociologists. His most popular books include The Presentation of Self in Everyday Life,[14] Interaction Ritual, [15] and Frame Analysis. [16] His most important contribution to labeling theory, however, was Stigma: Notes on the Management of Spoiled Identity published in 1963. [17] Unlike other authors who examined the process of adopting a deviant identity, Goffman explored the ways people managed that identity and controlled information about it.

Phase 1 – Intro to Economic Thinking

Phase 1 – Intro to Economic Thinking ECON202-1302A-02: Microeconomics Colorado Technical University Joseph Keller 4/14/13 As prices increase, should health economists advocate giving something up (opportunity costs/trade-offs)? I feel that health economists should promote giving something up in as prices rise. The reason I feel this way is because as the prices increase a lot of people would not be able to pay for the services . So in this case I believe that they should consider lowering the prices, this in return should encourage people to continue to receive the services.The tradeoff probably would be lowering the salaries of some of the health providers. As the quantity of health services provided goes up, does the benefit of each additional unit of service become smaller (marginal analysis)? If the number of services goes up the benefit of each service would become smaller, because using marginal analysis every addition is considered less value. So if you use marginal ana lysis it will help you figure if generating different services will benefit your company (Cliff's Notes, 2013).Discuss the issue of health care in the context of the following microeconomic concepts: Marginal analysis Marginal analysis in the health care industry for example would be if you were spending $1000 for 5 units of health service, sold in $200 increments, marginal analysis would work like this, if you were to buy another $200 you would get 1/2 units, if you bought another $200 you would gain 1/4more ,another 1/8 . So as you can see you could get to a point were buying more units would work negatively because you would no longer be gaining anything (Cliff's Notes, 2013). Trade-offs /Opportunity costsTrade-off in the industry would be if a facility badly needed to add another unit, the trade of could be to lower some of the workers’ salaries in order to compensate for that extra money being spent. The opportunity cost is the money lost from the employees in order to g et the extra unit needed. (Hubbard, G & O’brien, and T 2013). Normative versus positive economics Normative economics deals with what the economy ought to be like or what particular policy actions ought to be suggested to attain a necessary goal. Positive economics is the part of economics that concentrates on realities and cause-and-effect relationships. Hubbard, G & O’brien, and T 2013). . Should this decision be made in a centrally planned economy or a market economy? I think that health care in particular should be controlled by a centrally planned economy. These I think will promote a more fairly run system and decisions basically are made for the greater good. The reason that I feel this way is because if you let the market control the economy then they most likely would do what’s best for their self’s instead of what is best for all. If it was a market economy we would probably have the same problem that we have with the gas industry, prices steady rising until it is unbearable .People would still need the service but it would be on a must have basis (Hubbard, G & O’brien, T 2013). At least now there are plans in affect to insure that everyone has affordable health insurance, along with things like Medicaid and Medicare. Is health care a macroeconomic or microeconomic issue? I think that healthcare is both because you have to look at it from both perspectives, on one hand healthcare is a microeconomic issue because it is the study of individual firms and their economics .I think the micro part of health care comes into play when you’re talking about individual offices and hospitals . Then it can be viewed as macroeconomics when you look at health care in the bigger sense, meaning health care as a whole. The macro part comes into play when you look at health care and government assistance laws etc. How would this affect production efficiency? Healthcare offers a unique subject, because if a person is having a lif e threatening issue, people will still obtain the services no matter the cost if they can afford it.If the health issue is not that serious then a person may shop around for trying to find the best deal available, or if they don’t have medical insurance they may choose to forego the procedure needed altogether. References Cliff's Notes. (2013, April 14). Economic analysis. Retrieved from http://www. cliffsnotes. com/study_guide/Economic-Analysis. topicArticleId-9789,articleId- 9726. html Hubbard, G ; O’brien, T. (2013). Microeconomics. Upper Saddle River, NJ: Pearson Education, Inc

Two Reviews of Angela Davis

Two Reviews of Angela Davis’ Women Race and Class (1983) By: Brittany Turnbull I. The Reviews a. Amy Winter [Women Race and Class] Off Our Backs, January-February Issue (2005) pp48-49 b. Ann Russo [Book Review]Women Studies International Forum, Volume 6, Number 2 (1983) pp249 II. Summary of Reviews a. Winter, Off Our Backs The reviewer focused on the different parts of history of the African American woman as well as the history of all women as a whole. She broke up the review by discussing each chapter to coincide with Davis’ break up of her book and focused on the important details of each chapter that she found Davis had brought out. Winter doesn’t offer much opinion within her review because she mainly sticks to the fact that the book is written about oppression of African American women and African American people and she mainly describes exactly what Davis wrote. However, Winter did offer some criticism when Davis had written about how women working in the factories and doing hard labor was more interesting than doing house work. Winter found that there was no difference because either way something needed to be cleaned. One just reaped the benefits of a paycheck while the other did not. This was a good and thorough review because not only did it look at the whole book but it looked at each individual chapter and the main points within each chapter. b. Russo, Women Studies International Forum There is a different approach to this review because it is basically an analysis of what Davis’ theme or overall meaning of the book was. Russo described the book in the sense that the book wasn’t about oppression of Black women or Black people. It was about comparing the Black women to White women the overall sexist oppression that they both had to overcome and still are overcoming. Russo described this book as a being a feminist book about feminism as a whole and the revolution of all women. There was no discussion about the history of oppression that Black women had to live with over time or anything along those lines. There was not mention of historical figures as well. This review was good in the sense that it was an analysis of the overall idea of the book, however I feel that Russo was completely wrong in her analysis. She failed to realize the exact struggles and the exact differences between White and Black women. She also failed to realize that the use of White women within the text was to compare how much more difficult Black women had had it over White women in terms of the sexual and racial discrimination that Black women have had to encounter and attempt to overcome throughout history.