Relationship Centered Model of Care in Dementia and the Six Senses Framework Essay

Anticipating and enhancing the health and wellbeing of the older person with dementia in hg HWOP02 A1 Alzheimer’s Scotland (2014) estimate that there are 88,000 people in Scotland with dementia and two thirds of these people live in the community with support from family carers. Therefore, providing sensitive and appropriate support for people with dementia and their carers is one major challenge facing the health care system in supporting quality care. Firstly, this assignment provides a definition of dementia, then identifies Relationship Centred Care (RCC) and the six senses framework. Furthermore this assignment discusses the development of relationship centred care and it’s relevance to dementia. Extending on this, my assignment will cover the use of the senses framework by Nolen et al. (2001) to develop relationship centred care. My assignment will then discuss what the individual six senses mean to the individual with dementia, as well as their family and carers when developing  RCC. The second and final section of my assignment will use a case study to discuss the application of the relationship centred care model using the three senses of; purpose, continuity and security recognised within the six sense framework for a person with dementia who has family support at home. To be able to put this assignment in context, an understanding of dementia is needed in order to define what Relationship Centred Care (RCC) and the senses framework means to individuals diagnosed with dementia. Dementia is defined by the Department of Health as a ‘syndrome which may be caused by a number of illnesses in which there is a progressive decline in multiple areas of functioning, including decline in memory, reasoning, communication skills and the ability to carry out daily activities’ (2009 pg.15). Alzheimer Scotland (2011) have developed ten warning signs of the disease, these include symptoms such as; memory loss which disrupts daily life, challenges in planning, difficulty completing familiar tasks and confusion over time and place. It is therefore not surprising dementia can severally affect quality of life and relationships. Due to dementias progressive nature, a person with dementia gradually loses the ability to act autonomously and must therefore rely on the decisions and support of others, primarily their relatives when living at home (Hughes et al. 2001). Beach and Inui (2006) suggests that RCC can simply be defined as care in which all participants appreciate the importance of their relationship with one another. Nolan et al. (2001) Senses framework identifies the subjective and perceptual dimensions related to caring relationships. Within this Nolan et al. (2001) incorporates the interpersonal and intrapersonal elements of giving and receiving care to ensure the highest quality. The framework is centred on six themes which all individuals involved in RCC should experience, this includes; security, belonging, continuity, purpose, achievement and significance. Over the past decade, there has been much written about the notion of patient centred care, however, it has been argued for some time that care giving can only be understood within the context of relationship (Nolan et al. 2004). The national dementia strategy (Department of Health 2009) identifies providing person centred care as one of the key standards of living well with dem entia. Kitwood (1993) changed the focus of care for people experiencing dementia from a biomedical approach to an approach he labelled ‘person centred care’. For an  individual with dementia person centred care is characterised by the need to value people with dementia, to treat them as individuals, to view the world from their perspective and to create a positive environment (Brooker 2004). Sheard (2004) review on health services found that often services consider the needs of people with dementia and their carers separately. Kitwood’s (1997) approach offers all health care professionals a way to care for an individual with dementia, however it does not take into consideration the importance of the interaction among people as the foundation of any therapeutic or healing activity in health care. Post (2001) supports this statement and suggests that living with dementia is not about quality of life but rather about quality of lives. Wadensten and Carlsson (2003) suggestion that the most common models of nursing dementia patients provide little more than guidance on how to work positively with older adults. Sheard (2004) therefore called for a development of an approach where an individual with dementia is seen within the context of important and significant relationships. Nolan et al. (2004) therefore argues that RCC is one of the most comprehensive ways of doing this in order to promote a more holistic vision of health care to include; social, economic, environmental and culture into care practice. RCC was developed by the Pew-Fetzer Task Force (1994) who examined how relationships formed between patient and practitioner, practitioner and community and practitioners and practitioners. Pew-Fetzer task force (1994) argued that although the patient centred care model promotes personhood it is not inclusive enough to embrace the relationships formed during illness. To establish RCC, Pew-Fetzer (1994) united the biomedical with the psychosocial element of care to conceptualise health care and recognise that the nature and the quality of relationships is necessary to broaden the health care delivery system. Beech and Unui (2006) Founded four principles of successful RCC, these included; relationships in health care should include the personhood of the individuals, that affect and emotion are important components of relationships in health care, that all healthcare relationships occur in context of reciprocal influence, and finally that RCC should have moral foundation This in relevance to dementia care is important, as often the family play a pivotal role in the care of an individual with dementia with support from many different health professionals. However many researchers  have found that little is known about how to develop and sustain such relationships in a health care environment (Dewar and Nolan 2013). Nolan et al. (1999) considered ho w positive relationships can be created and sustained and developed the ‘senses framework’. Nolan et al. (2001) suggests that individuality certainly shouldn’t be ignored in dementia care, but rather that for most people relationships are crucial in determining quality care. This framework comprises of the six senses; security, continuity, belonging, purpose, achievement and significance. The fundamental premise of Nolan et al. (2001) vision of relationship centred care, is that these senses need to be experienced by all groups involved in order to deliver good care based on relationships. Arksey et al. (2004) in his systematic review concluded that trusting and supportive relationships with staff are essential in dementia care, where good relationships are supported by communication with staff to draw on carers’ expertise and views of what is best for the person with dementia. Due to a lack of time to establish RCC Baillie et al. (2012) suggests that the senses framework in dementia care is very difficult to achieve in an acute ward, where the turnover of patients is often very high. The 8 pillar model of community support (Alzheimer Scotland 2012) provides a case example of how ‘supportive relationships’ form and develop into dement ia care triads. RCC in dementia care provides a complementary philosophy of care, uniting the biomedical approach with the psychosocial of health care, recognising that the nature and quality of relationships are central to the health and care of individual and can be achieved when all participants appreciate the importance of their relationship with each other (Beach and Unui 2006). The senses framework recognises six senses which should be experienced during RCC, three of these are; security, belonging and continuity. Nolan et al. (2004) suggests that continuity creates a subjective sense of security and belonging for older people with dementia. To a person with dementia a sense of security, belonging and continuity is essential in RCC and often involves open negotiation of the service they would like with attention to the physiological and psychological needs with the same support worker (Nolan et al. 2008). Alzheimer’s Scotland (2011) five pillar model of post diagnostic support suggests that individuals with newly diagnosed dementia who receive personalised and flexible support, which is delivered proactively and  sensitively over the course of a year by a skilled and well-trained person will feel these senses. Froggatt et al. (2006) in relation to the need for information developed a welcome booklet for care homes to capture what was special about the care home environment and what was available to residents and their careers. This resulted in a perceptual sense of security for carers and individuals, as they felt they knew something about the environment and the staff working there. When looking at a sense of security, belonging and continuity from a health professional’s view, it is suggested that it involves having a positive experience working with an individual with dementia, being free from physical threat, rebuke or censure and to have secure conditions of employment and their emotional demands recognised (Nolan et al. 2008). Many studies have looked into health professionals and stress in providing dementia care, it is suggested that many people leave the profession due to lack of security and continuity (Dupluis et al. 2014). Through education about the senses Nolan et al. (2004) found that in training staff in effective management of dementia care, the greatest reward comes from witnessing carers and nurses realise that compassionate communication is at the heart of supporting RRC. Hobbs (2009) suggests that workshops and role-play establish ‘steps’ that enable people to meaningfully connect with their environment, feel more supported via discussion groups and ultimately creates a sense of belonging amongst staff. For family and carers, these senses mean being confident in the knowledge that they are providing good care without detriment to their own personal wellbeing and ensures the standard of care is maintained to a high standard. Olsson et al. (2012) study recognised that relatives of people with dementia often struggle to create a situation of security in daily life for themselves and the individual with dementia. Flynn and Mulcahy (2013) suggest that to do this, family and carers need support not only in meeting their physical needs but also their emotional and social needs. The Alzheimer’s Scotland (2012) 8 pillar model of community support recognises that security and continuity can be achieved through personal support, environment aids and the use of health professional’s knowledge in dementia care. Through using Nolan et al. (2001) senses framework a sense of purpose achievement and significance can be created for carers, people with dementia and staff supporting RCC. For people with dementia these senses can be  achieved through purposeful activity, to work towards therapeutic goals and valuing the person’s wellbeing (Barker and Board 2012). A workshop by Nolan et al. (2004) suggests that that these senses highlight the important aspects of care, which are often taken for granted in a care home. For a support worker achieving these senses means they can improve car e for the individual by having direction and a clear set of goals and to feel that their expert opinion matters. In Brown et al. (2012) study they found that the sense of significance can be fulfilled through staff taking an interest in the individual. For instance Brown et al. (2013) study found that when staff got the family and individual in care involved in creating memory boxes, participants felt a sense of perceptual significance, through reminders of who the person is. This also helped to initiate more meaningful conversations and acted as a reminder for the individuals about their life achievements. Nolan et al. (2008) model suggests that for the family carers the sense of purpose achievement and significance can be achieved through, maintaining their dignity and wellbeing through support of their emotional needs such as recognising the time and effort they have committed to the individual with dementia. Often a carer can feel that their best isn’t good enough (Dupluis et al. 2014). Family relationships may already have become strained with the sufferer hiding their memory proble ms. These are often already strained because all of the participants are adjusting to living with dementia (Steeman et al. 2006). However through a RCC approach Nolan et al. (2008) suggests that family carers can feel achievement and significance through support from health professionals to establish their needs in the care process. Alzheimer’s Scotland (2012) suggests that family carers often need to communicate their concerns with a trained professional to overcome any hurdles they face and seek reassurance. Carers need to be recognised as individuals with their own needs. In taking on the identity of a carer, a person often risks losing aspects of what it meant to be themselves (Ter Meulen and Wright 2012). Alzheimer’s Scotland (2012) also recognise the importance of family carers and work with the family to incorporate their needs such as seeking respite or creating a package of care for the individual with dementia so that the family member can take time out for themselves. The Senses framework often reminds health professionals involved in the RCC about the family carers as well as the  in dividual in creating good care. Ben is a 75 year old retired engineer, living with his 70 year old wife, Mary. They live in Perth, Scotland, in a semidetached house, purchased when they were first married 60 years ago. Ben received diagnosis of mild Alzheimer’s a month ago, after being referred to a neurologist by his GP. On a mini mental examination he scored 22/30. Being diagnosed was a fraught time, for Ben and his wife. Ben and Mary have two children and four grandchildren who all live close by, but are not aware of his diagnosis. Over the past year Mary had become concerned about Ben as his mood appeared to become low and his anxiety increased. She also noticed that his short term memory and ability to perform daily activities had declined. Ben has difficulty performing household tasks, such as preparing meals, which he had previously enjoyed doing. On several occasions he has left dinner on the cooker and forgot all about it, leaving it to burn. Mary feels scared to leave Ben alone because of this so very rarely leaves the house. Mary used to enjoy going to choir practice in the evening, however, with Bens decline in cognitive function she hasn’t felt able to do this. Mary is a retired receptionist who at present has no significant medical conditions and describes herself as Ben’s only carer. Mary also feels that their relationship isn’t as close as it used to be. Ben avoids answering questions or talking to her, and often loses his tempter when he doesn’t understand. Ben used to be a keen motorist and often entered his prize winning beetle into many vintage car shows with his old work colleagues. Since his diagnosis, he has been told not to drive and has neglected his car. He is still able to perform basic activities of daily living, such as personal hygiene and dressing, and with prompting from Mary do instrumental activates like emptying the dishwasher. Ben has become increasingly worried about what will happen to himself and Mary as his condition deteriorates, however, wishes to stay at home as long as possible. Ben is also worried about legal and financial affairs. Ben’s only past medical history is osteoarthritis which he takes regular painkillers for. For his newly diagnosed Alzheimer’s, his GP has also prescribed three acetylcholinesterase (AChE) inhibitors Donepezil, Galantamine and Rivastigmine. Ben presently feels uncertain about the future for him and his wife. Ben has an appointment with a dementia  practice co-ordinator in a couple days and is keen to seek advice and help for them both. Nolan et al. (2001) suggests that security for Ben can be achieved through RCC. In Ben’s case, security is recognising his physiological and psychological needs and to feel safe from harm and pain (Ryan et al. 2008). From the case study, some of the issues Ben and his wife are experiencing, in being able to develop a sense of security are; fear of diagnosis, finical worries, safety at home and the future. For Ben, becoming aware that something is wrong, has affected his sense of security with in his relationship with Mary and friends. His relationships have declined because of his insecurity. It is not uncommon for someone newly diagnosed with dementia to feel fear, depression, disbelief and uncertainty which in turn puts stress on their interpersonal relationships (Pratt and Wilkinson 2001). Social interaction can be used in the transitional phase involved in coping with dementia to support all individuals involved in care and friends, often peer support groups, can improve wellbeing (Steeman et al. 2006). Interactions with professional caregivers such a dementia care support workers can often build a relationship where education about dementia can be given and discussions had to make Ben and Marys opinions heard. The information should help individuals to understand what is happening and how disease changes can be modified so they can live a fulfilled life (Olsson et al. 2012). However, it is suggested by Young (2002) that health professionals may silence the person with dementia and the carer. Therefore the use the 5 pillar model can prove beneficial in structuring care around everyone’s needs (Alzheimer Scotland 2011). Advice can be given on how to create security in the home to ensure Ben’s safety and about sorting out finical and legal affairs whilst Ben is still able to do to so. A lasting power of attorney enables Ben to nominate Mary as his attorney. This means when Ben is no longer able to make decisions for himself about his health care or finances, Mary will be able to act on his behalf. This ensures security for Ben and Mary through ensuring the right choices are made for Ben and that Mary still has a home (Ouldred and Bryant 2008). In this case study, Mary is concerned about Ben’s security in their own home, as he regularly leaves the cooker on. Georges et al. (2008) conducted a large survey, which found relatives of people with dementia often spend 10 hours or more a day caregiving. However, it is acknowledged  by Wimo et al. (2002) that a great deal of a relative’s time has been reported to concern supervision/surveillance. Olsson et al. (2011) study suggests that technology could be used in managing daily life. For instance, smoke detectors could be installed to make Mary aware sooner of fire and ensure Ben’s safety when cooking. Also home improvements could be made to help Ben as his condition progresses, such as good lighting to prevent falls and the use of clocks and calendars as a reminder of time and date. Enhancing security can often be linked to continuity in RCC, which can be used to ensure everyone’s wellbeing. Continuity, as described by the six senses, recognises the person with dementia as an individual and offers a chance for family to maintain shared pursuits with constant care, whilst maintaining a positive experience of work for health care professionals. In this case study, Ben is worried about future care. The support needs of Ben and Mary will become evident through discussion. These range from concerns about maintaining their home, continuing to live on their own, or w anting to continue to do the things that they enjoy (Cook et al. 2012). Through discussion of care, all individuals involved in Ben’s care can put a plan in place to support these needs. The care plan should enable constant and stable staffing which allows RCC to form thorough knowledge of each other (Cook et al. 2012). Continuity of Ben’s care should recognise his medical history of osteoarthritis and offer ways to manage his pain (Buffum and Haberfelde 2007). As Ben’s Alzheimer’s progresses, he may not be able to communicate his pain as effectively, this is when pain assessment tools such as the abbey pain scale could be used to ensure he gets adequate pain relief (Buffum and Haberfelde 2007). It may be necessary to educate Mary on these tools so she feels able to asses Ben’s pain and give competent care. Despite Ben’s diagnosis, his daily routine should maintained where possible to promote personhood. This for professional carers means respecting Ben and Mary’s daily routine and home environment. At pre sent Mary feels she can cope at home with Ben, so enforcing home care services at this point may disempower Mary. Support services should be made easily available to Mary when required (Ouldred and Byrant 2008). It is suggested by Van De Steen (2012) that mental health care is particularly well served by continuity of management and co-ordinating health services. Continuity of health professionals involved in Ben’s care means Ben and Mary do not have to  repeat themselves over and over again and a health professional who knows Ben can easily recognise any changes. There are many tools a health professional could use to assess the effect that Ben’s Alzheimer’s is having on him and his care needs, including tools such as the care needs assessment package (Cameron and O’neil 2005). This assessment helps to establish goals for everyone involved in care, especially the health care assistant as they can prioritise needs and create continuity. Mary wants to ensure that Ben is well cared for weather it be by her or another carer, therefore her involvement in the decision ab out where Ben is cared for and how, is crucial in creating a sense of continuity. RCC can support Ben, Mary and his carers in feeling a sense of purpose (Nolan et al. 2004). In this case study, Ben and Mary’s social lives have both been affected by his dementia, they have also yet to establish a relationship with a health care professional. Ben can be supported in many ways to engage in purposeful activity, including the pursuit of his hobbies. In most localities, there are community-based services that can support people to maintain their independence and fulfil their aspirations (Cook et al. 2012). However Cook et al. (2012) often states that there is a lack of information on support in the community. Alzheimer Scotland (2013) funds local Dementia Advisors, who support people with dementia, their partners, families and carers within the local community to access services. The support workers are highly trained to work with each person at home, to support a purposeful relationship where goals can be met. The support worker can suggest local community groups which have been created to offer a dementia friendly place for people like Ben and Mary to meet up for a chat. Support workers also attend this event and it is a chance to really get to know the people involved in care outside of the home. Dementia often affects the sense of purpose for all individuals involved in care (Nolan et al. 2001). Alzheimer Scotland (2013) offers a wide range of welcoming community activities across Scotland, such as singing groups, football memories groups, walking groups, cinema groups and much more. If Mary wishes, she can arrange for a personal assistant to come to the house to be with Ben so she could go to choir practice. Whilst the personal assistant is with Ben, he can be supported to do the things he likes to, like clean his car and take part in meaningful conversation about his interests. The most important support an informal carer can have  regarding the feeling of purpose, is the recognition that they are partners in the care of the dependent person (Ter Meulen and Wright 2012). Driving is closely associated with an adult’s personal identity and self-perceived role in family and society. An individual’s inability to drive can therefore affect their sense of purpose (Alder 2007). Taking the car keys away from Ben is a life-changing event, both for him and Mary that crystallises the devastating impact of the diagnosis. However, through support, Ben can still be encouraged to pursue his love of vintage cars via car rallies and show visits. This can be done in a number of ways using RCC, a carer could support this for example or family members, who are educated about Ben’s needs, could enjoy pursing such events as a family outing, providing a sense of purpose in fulfilling Ben’s personhood. In conclusion, as the number of people with dementia is on the increase, the provision of sensitive and appropriate support for all individuals involved in caring for people with dementia, is needed. This assignment identified the RCC model and the six senses framework in relation to dementia care. Making connections with the senses that are often involved in everyday activity for all individuals involved in care, to promote RCC. This assignment also concluded t hat recognition of the six senses; security, continuity, belonging, purpose, achievement and significance, reflect the varying dimensions necessary for quality dementia care. The senses framework captures the subjective and perceptual dimensions of caring relationships in order to create tailored and seamless care. When using RCC and the senses framework model in a case study, it allowed a biographical approach of care planning structured through ensuring the six senses are met. A greater understanding of the person with dementia can be achieved through using the six senses accurately. However if the future of care is going to change from patient centred care to RCC, more education on the subject is needed. Reference list ADLER, G., 2007. Intervention approaches to driving and dementia. Health & social work, 32(1), pp. 75-79. ALZHIEMER SCOTLAND, September 2011, 2011 – last update, The five pillar model of post-diagnostic support [Homepage of Alzheimer Scotland], [Online]. Available: http://www.alzscot.org/assets/0001/1226/Getting_post_diagnostic_support_right View as multi-pages

Macbeth †Closing Address to the Jury, Prosecution. Essay

Good morrow esteemed lords and ladies of the court, it is within my regrets to tell you that our â€Å"noble† thane (of both Glamis and Cawdor) and King Macbeth has murdered our fair (late) King Duncan for his own traitorous and greedy purposes. Macbeth has betrayed his country and committed regicide, the highest form of sacrilege. The prosecution has found Macbeth guilty beyond a reasonable doubt, with several accounts of murder, manslaughter, attempted murder, one account of regicide and conspiring to murder. (accessory to murder) 😛 Macbeth is a murderous heathen, whom sought to heighten himself to the rank of King by betraying the country (already stated this), his King and god. An earlier witness; one of Macbeth’s â€Å"Loyal† servants, (the gentle woman) stated that he had heard Macbeth whispering â€Å"I go, and it is done. The bell invites me. Hear it not, Duncan, for it is a knell that summons thee to heaven or to hell.† Obviously scared of Macbeth’s murderous mind, the servant stayed quiet until now. There were more witnesses as of yesterday, as a cutthroat hired by Macbeth told the jury of the atrocities he had performed, before being dragged off to be executed. To quote; the murderer said â€Å"Macbeth threatened me with a certain death if I were to betray him. That was just a shimmer of the murderer within him.† The prosecution would also like to point out that straight after Duncan’s body was found, Macbeth killed the two intoxicated guards, blaming these poor innocent men for the murder, and also dispatching of two possible witnesses. Macbeth did also state â€Å"O, yet I do repent me of my fury, that I did kill them.† In stating â€Å"them†, Macbeth could have been referring to both the murdered slaves and our fair King Duncan. Macbeth also insinuated that the drunken guards murdered Duncan in his sleep, but if you look and think, and I am sure you are all intelligent Lords and Ladies, a drunken guard cannot harm more than a fly (people who are drunk are more likely to become very aggressive), as they would not be able to stand. In an earlier testimony, we called upon Lady Macbeth, who, when confronted with the evidence and questioning, cracked under pressure and confessed her hand in murdering Duncan. Lady Macbeth acknowledged Macbeth and herself plotting to murder Duncan, Banquo, and MacDuff’s wife and children. Macbeth also attempted to murder Fleance and MacDuff. A servant came forth and stated that Lady Macbeth had whispered to Macbeth â€Å"Infirm of purpose! Give me the daggers. The sleeping and the dead, are but as pictures. ‘Tis the eye of childhood, that fears a painted devil. If he do bleed, I’ll gild the faces of the grooms withal, For it must seem their guilt.† Lady Macbeth obviously did not know she was whispering loud enough for the Servant to hear. Unfortunately, Lady Macbeth has passed away now, taking her life before more answers arose. The defence earlier tried to state Macbeth was acting under the influence of three evil witches. They stated that the witches had told him â€Å"All hail, Macbeth, that shalt be king hereafter!† According to the defence, this justifies treason, heresy, murder and plotting against the crown. The court was lucky (luck is not a part of their nature) enough to get one of the Witches (Weird Sisters and they don’t listen to petty human demands and/or requests) in the room, whom stated that â€Å"Macbeth sought to murder King Duncan on his own accord; we witches merely stated he would be King.† The Witch denied fuelling Macbeth’s murderous tendencies. MacDuff, slayer of the late Macbeth, retold the account of his family’s murder, which was issued by Macbeth. He stated to the court that his wife and son were in the midst of talking when a murderer ( he wasn’t there when they were murdered he had heard news of it but never witnessed it ), sent by Macbeth shook the residence by declaring that he was a traitor. He stated that his son, a brave young lad, meant to protect his father’s name. His honourable son screeched at the Murderer, â€Å"Thou liest, thou shag-eared villain!† This was followed by a fatal stab to his son, in which Lady MacDuff ran, shouting murder. The villainous murderer sought after Lady MacDuff, who could not outrun the murderous lunatic. MacDuff was severely shaken during this testimony, for reasons obvious to the court. He also recounted the end of Macbeth, in affirming â€Å"I held his head†¦ I held the head  of the treacherous king. I had to do it; he slaughtered my family, my life! I regret to say I enjoyed it, enjoyed taking back what he took from me.† If this does not prove the guilt of Macbeth, I do not know what does. As the court can see, the mind inside of Macbeth was a sickening one, as he ordered the slaughter of innocent people, to secure his position as King. In all these dishonourable acts, I believe it is in the interest of the court to say that Macbeth is guilty of multiple accounts of treason, murder, attempted murder, manslaughter, regicide and heresy. I thank you, esteemed lords and ladies, for your time in this period of turmoil. May King Duncan rest in peace, and the wicked Macbeth burn for his crimes.

Email vs. Snail Mail

Throughout history people have communicated with each other in various ways. For instance, some used birds to transfer their messages while others used the smoke of fire to signal their friend who were far from them. Lately postal mail was used as a mean for correspondence, which was referred to as snail mail afterword. And with the invention of telegraph and development of civilization a new tool came in known as e-mail. There are significant discrepancies between snail mail and e-mail along with some common points.First of all, both tools are uses for communication in society, and they are both under risk in terms of confidentiality, but for different reasons. For instance, you cannot be secure that all post offices are safe enough to send your messages that are too personal or contain secret information about your work†¦ etc. E-mails suffer from the same problem but for different reasons. For example your computer can become a victim of hacking and a hacker can get your whole archive in a few seconds. Finally, once they are delivered to the wanted place there is no way going back.Although they share some common points, snail mail and e-mail are tremendously different in many ways. Firstly, e-mail is way a lot faster than snail mail, it enables you to delivers your message in the blink of an eye, whereas it might take days for a snail mail to receive the place you want. Secondly, for sending an e-mail all you need is an internet connection and you can send it to hundreds of people at once, nonetheless, you can send a snail mail once at a time and you have to pay for it respectively.Moreover, there are many options for editing an e-mail and sending different types of media files along with it, in contrast to snail mail with which you can only send text messages. In addition, nowadays people are very busy to memorize the address of all of their acquaintance, e-mail solves this too, you can save all of those confusing addresses in your account without any e ffort, for snail mail this option is not present.The last and most important difference is that using snail mail we actually use up our natural resources like paper and ink, yet e-mail is a tool the encourages sustainability because you neither use resources nor throw it away after using it. As a conclusion, we can say that although both e-mail and snail are similar to each other to some extent it’s clear that all ways lead to using e-mail and regarding snail mail as an obsolete way for communication.

The Epic Of Gilgamesh as Translated by Andrew George Essay

The Epic Of Gilgamesh as Translated by Andrew George - Essay Example ace in the world’s literature, wrote Nancy Sandars (1972), not only because it precedes the Homeric epic by at least one and a half thousand years, but also because of the quality and character of the story that they tell - a mixture of pure adventure, of morality, and of tragedy. (p. 7) According to Kenneth Rexroth (1986), the Epic of Gilgamesh is a highly developed fictional narrative, stressing that: It is not a myth. Even to call it an epic requires a stretching of the definition. It is more like a novel of modern, individualistic hero than it is like Homer’s Iliad. It is spiritual adventure, a story of self-realization, the discovery of meaning of the personality, of a type that would never change down the four-thousand-year-long history of human imagination†¦ It is modern because it is like a dream of a modern man. (1) This paper will examine this highly significant work and determine how it reflects the society in which it was created and in how it reveals the economic, political, cultural, religious and social structures that defined the Mesopotamian society. There are several variations to the Epic of Gilgamesh particularly in the literature of the Hittite, Hurrian, Canaanite, Sumerian and Assyrian. One could even find a hint of Gilgamesh’s repute in the Islamic Koran. The most complete chronicle of the epic was found in Assurbanipal’s library, formed just before the destruction of Nineveh in the seventh century B.C. The story is divided into several chapters or episodes: a meeting of friends, then the forest journey, the flouting of a fickle goddess, the death of Enkidu and the quest for an ancient wisdom and immortality. These episodes demonstrate a single theme that reflects the permeation of pessimism in the Mesopotamian thought, which, according to Sandars, lay partly in the precariousness of life in the city-states. (p. 22) The city-states which are dependent on the vagaries of flood and drought as well as turbulent neighbors; then on

Riding around Denver Essay Example | Topics and Well Written Essays - 1250 words

Riding around Denver - Essay Example The city’s economy is based on the geographical position as a major connector of the transport system. This paper will determine the roles of minority groups played in the urban society, the aspects of technology that interact with an urban environment and how various aspects of Denver city change from the centre to the periphery. Denver is a city that is fast growing in Colorado. The local government has estimated that, by 2025, the metropolitan area is estimated to have about one million people. This is from the current population of 2.5 million. This is the most popular city within a radius of 550 that is centered within the city. According to American community Survey, that was conducted in between 2006-2008, depicted different percentages of racial composition. Whites make a larger percentage of the population of about 63.1% and Hispanic or Latino take 34% of the Denver population. The minority groups in this city include Asian, African American and Native America who take up a small percentage of Denver’s population. While the minority groups continue to form a growing portion of the population, especially in urban areas, these groups have not been included in the decision making process thus, leaving them under represented. The poverty statistics that have been associated with minority groups have affected their contribution towards the urban society. However, racial tolerance is becoming a clear trend in the American society.

Prepare a report for an employee in the hospitality industry sector Essay

Prepare a report for an employee in the hospitality industry sector analysing the impact of the London olympics 2012 on at least three policy areas in the manag - Essay Example This is a marathon effort but an excellent opportunity for the Human Resources department in UK. The role of the head of HR will have to be strategic and influential, and focused on delivery (Karen Dempsey). It is estimated that 12,000 new jobs will be created because of the development of the Olympic Park area (People 1st). The two main areas that will have an impact are the hospitality sector and the construction sector. Employment in the hospitality industry is growing at a rate faster than overall employment in the UK (People 1st). The hospitality sector has been behind the games bid but the shortage in this industry has always existed because it is either tough or underpaid for the British. Besides, the unemployment is very low (Encore Personnel) and with baby boomers retiring soon, there will be an increased gap between the demand and supply. Training for the skilled workforce has to start now to ensure smooth operations. In view of the above, the greatest challenge before the HR department will be recruitment of the skilled personnel, and retention and motivation of the existing personnel. The success of the Olympics depends entirely upon the skills and the commitment of the people involved. Hence, the three core areas where HR has to concentrate are recruitment and retention, motivation, learning and development. The hospitality sector comprises of hotels, providers of holiday accommodation, pubs and bars, restaurants and take away food outlets (Low pay Commission Report 2005). It is probably the world’s fastest growing, job-creating profession (Hospitality: As it is). The hospitality industry exhibits tremendous diversity both with respect to the types of jobs on offer and the workers required. (Migration: A Welcome Opportunity). There is a huge shortage in the hospitality sector and it is estimated that the industry will require 30000-35000 trained people by 2010 at the management and supervisory

Being a leader Essay Example | Topics and Well Written Essays - 1250 words

Being a leader - Essay Example What matters, are the characters and attitudes toward any adjustments to be able to survive the tests of undesirable circumstances. Deciding how to respond to unrealistic expectations, and the problem people who so often plague the administrator's credibility and integrity has to have founded principles in doing so. According to James A. Davey and Warren Bird on "Handling Expectations", the following are suggested: 1. know yourself - Stripping away the accretions of the years - those layers of expectations others have laid upon us and we have willingly assumed. We should never underestimate the power of others to make us dishonest with ourselves. Change, which is dominant nowadays, is a part of the different strategies implemented to attain the peak of success of any kind of endeavor. However, it doesn't materialize completely until all the concerned people within its scope are prepared and ready most especially for its unexpected consequences. Though change without conflict is rarely possible, there is still much to do to limit conflict and overcome resistance to change. The potential influence of such technology on all aspects of communication is tremendous. As it is apparent in the advances of computer networks, communication satellites, data handling devices, electronic information exchange adapted to convey voice, vision, and graphics as distinct and separate types of communication. Communication, which is the building block of any relationship, plays a major role in the success of any organization aspiring to compete in this competing generation. It serves as a bridge to transport vast excellent inputs and highly competent outputs that marks an organization in gaining respect and prestige. Thus, the problem regarding communication tops the priority list to be addressed. Every individual communicates differently depending on a combination of personal and environmental factors. As such, a Court Administrator needs to learn to communicate at the level of the recipient, since communication is complete only when both parties understand what is being said, and as Peter Drucker puts it, "Enable performers to perform their way - not your way." Since communication plays such central roles in any organization, the key issue is not whether administrators engage in communication or not, but whether administrators communicate effectively or poorly. Communication is unavoidable to an organization's functioning. In other words, people must exchange information. However, to develop shared meaning requires positive efforts by administrator and other participants. Outputs should be made clear, understood, and agreed upon by all as goals and objectives should also be well-communicated and meet certain expectations. Highlighting priorities is equally important, and in the interest of clarity, a job description

News analysis and Advertising Essay Example | Topics and Well Written Essays - 1000 words

News analysis and Advertising - Essay Example Nonetheless, the most significant question to be asked is: what brand of truth and in what form and hue does today's television news tell Obviously, 20th century news on television either blow up and amplify or curb and restrict what is being presented on the air. Most often, it leaves out too much of what should have been dished out. Many of the subject matters on TV news today are worthless to the viewer simply because they focus on incidents that affect only a small sector of the audience (e.g. police-blotter accidents or petty crimes.) Are these events really so important to most people Most probably they're not. However, they get so much attention and focus and are allotted so much air time. But how can that be if they offer no real meaning to most people Yes, the conflict between Lebanon and Israel has in seconds (after its initial broadcast) become a global event but does it really have a direct effect on the poverty-stricken citizens of Haiti or Bangladesh Years back, the affair and eventually the "painful death" of Princess Diana and her supposed lover occupied the airwaves to no end, but how do these occurrences concern the war-torn Iraq or the destitute children of Somalia Evidently, these efforts denote a crack at putting in entertainment to an otherwise boring broadcast. These stories on the news are encouraged by the mounting pressure of the trash news programs which are extremely damaging to the sense of worth of the viewing public and the nation as a whole. Ratings are all that matters now. As a rejoinder to this kind of programming, John J. O'Connor of the New York Times broached a compelling question, "What kind of people do we want to be Are we a society that is driven to topics appealing to our pocketbooks and/or curiosity about celebrities" Most of what is being seen and heard on TV is fantasy and entertainment. As a consequence, the power of television journalism leaves its viewers with imprecise notions and feelings which often devastate its function to inform. Yes, the news of today still answers the basic questions of what makes NEWS. The who, what, when, why and how's still there, however, supplementary to these functions, the need to entertain has been added. Unfortunately, it has become the most important. Advertising Selected commercials - VISA MasterCard (Pierce Brosnan/Catherine Zeta-Jones); Channel (Nicole Kidman); Nike (Michael Jordan); Close-Up (unknown) !) Which commercials seem to be the most effective Least effective For the commercials selected, the use of celebrity endorsement as a strategy is quite effective. These advertisements can surely achieve "recall" from their viewers simply because they are using named stars which appeal to most people. In the case of Channel, at first glance, it looks ineffective in the sense that it looks "too rich," and the not-so-rich citizens may not easily identify with it (obviously, it is a product that may not be a household name for the masses) but the employment of someone possessing classic beauty like Nicole Kidman and the way the whole campaign has been packaged and presented can still appeal to

Case report review Essay Example | Topics and Well Written Essays - 500 words

Case report review - Essay Example This just shows that when a group people agree on certain norms and communicate effectively, almost any endeavor is possible. Also, we observed that aside from playing different roles, we developed deeper relationships as friendships. We also understood the meaning of individual differences and tried to work around it. There were many times that some members expressed their different opinion and we have to find a way to compromise. Although we had difficulty in resolving conflicts, the more important thing is that we realized in a hard way that we need one another ( interdependence) to be able to achieve the goals. The worst experience that we had is not finding the right time to meet. This has been a struggle since we all have different schedules. The windows live messenger was helpful in aiding us when communicating but the scheduled live meetings were difficult. Most of the time, one group member was not available due to other commitments. This was hard for all of us since we agreed at the start to prioritize the group meetings. Another unpleasant experience was when a group member cannot perform his tasks as expected. Actually, this was a consequence of not being able to attend meetings since the absent member has no idea how to keep up with the pace of the group. It is very important that group members work together as a team since one member’s absence affects the other group members in performing their assigned tasks. Because of this, we have to scold the group member and make him realize the importance of agreements. Honestly, I became a matured person because of this experience. I used to do things in my own style and time before but I realized that when one is a member of a group, he must conform to certain rules that the group agreed upon. One of the challenges for me was coming on time for all meetings which was hard to do but I was able to manage my time well. I also learned to sacrifice some personal activities

Narrative Argument About Education Religion Essay Example for Free

Narrative Argument About Education Religion Essay Considering the gift of computers Bill Gates bestowed upon libraries for students, I’m sure his intentions were for the students to excel and keep abreast of the ever changing world of technology, not to replace reading with surfing the web. I agree with Judith Levine when she stated, â€Å"It’s important for students to read books, magazines, newspapers, history, poetry, politics and listen to people who know what they’re talking about.† Reading books and other literature teaches students the past, present and future, not only for things happening in the world today but facts about things past. Dating myself, I think back to the days of the sixties and seventies when reading was fundamental to education. Literacy was important and the only choice we had was to read a book because there were no computers. Teachers took us to the library weekly, and we were required to check out at least one book and read it. There was also time set aside during class for us to stand up and read a portion of your book aloud. Most of our books had no pictures to stimulate the imagination, so you felt a sense of accomplishment when the book was finished. Teachers took education very serious, and they knew reading was essential to be successful in life; therefore, they made sure we took it serious as well. When we read a story for a writing assignment, our first resource was the encyclopedia, which was neatly stacked inside the bookcase in almost every home. There were no short cuts to obtaining information. Reading is more empowering than one-click learning; you develop increased discernibility and critical thinking skills. Computers are a great tool. I use one every day for my online college courses and I know how important it is to question everything I retrieve on the internet. Computers, however, have made students slack  and lazy. From a very young age children have developed the attitude of not liking to read and with computers supplying all the answers for them, they don’t have to. As I sit and look at my blank computer screen, and time is ticking away until my essay is due, I read my story once again. I also head for the web, but only to get ideas and something to assist me with my starting point. Nothing takes the place of old fashioned reading. I know my subject is education and my story is talking about computers, so I google education using computers. One site Using Technology: Ways to use Computers/Education.com catches my eye, but after accessing the site I soon find this is not the site or the data that’s going to help me prepare a creditable paper. So I reread my story and the instructions, put my critical thinking cap on and choose not to one stop shop for my assignment. I begin writing everything I can think of and soon the ideas surface. This is unlike inexperienced users, like our children and grandchildren, who rely heavily on data they retrieve from the internet without considering how much weight the site is going to hold, and what kind of argument the data will present to their readers who may feel they did not provide enough information about the topic. Our students have become accustom to presenting data found on the web as fact, giving no thought to how bias the information might be. Some even portray the data as their own, without verifying its validity. Parents need to share some of the responsibility, because we are not teaching our children the difference between working hard and hardly working. From a Biblical perspective Deuteronomy 6: 4-9 states: â€Å"Hear, O Israel: The Lord our God, the Lord is one! You shall love the Lord your God with all your heart, with all your soul, and with all your strength. And these words which I command you today shall be in your heart. You shall teach them diligently to your children, and shall talk of them when you sit in your house, when you walk by the way, when you lie down, and when you rise up. You shall bind them as a sign on your hand, and they shall be as frontlets between your eyes. You shall write them on the doorposts of your house and on your gates†. This command from God explains why education is important, and why it is our responsibility as parents to educate our children, both academic and Biblically. My eighty-three year old Uncle Mike was a prime example of why getting an education is important. He only had about an eighth grade education and virtually no Biblical  knowledge. Because of his limitations, he was never able to make a decent living throughout his life. He also had no knowledge of who God was and expressed no desire to be saved. His soul was doomed to hell; however, I never gave up on Uncle Mike. I knew it was God’s will that everyone be saved, and on July 28th, 2013, his eyes were opened, and his heart soften as he accepted Jesus Christ as his Lord and Savior two days before he passed away. In conclusion, computer use has caused us to no longer read books or utilize our critical thinking skills. Our students have become slack and lazy and collect unreliable data to present as facts. We must guide and teach them how to surf the web and to become better readers, which in turn, will make them better writers. References Levine, J, â€Å"I Surf, Therefore I Am†, in To the Point, Reading and Writing Short Arguments, 2nd, 222-224. Pearson Education, Inc. 2009 MacArthur Study Bible NKJV (1997) Word Publishing, a division of Thomas Nelson Inc. Narrative Argument about Education Thesis/Outline Topic: Education and Computers Thesis Statement: The everyday use of computers has caused us to become slack and lazy. We no longer read or utilize our critical thinking skills. The inexperienced user collects unreliable data, and presents them as fact. Outline: I. Introduction Reading vs Computers II. Body Paragraphs A. Author argument B. Education Importance C. Alternative to Computers D. Biblical Perspective. Conclusion Computer use has caused us to no longer read or utilize of critical  thinking skills.

Billy Elliot Film Summary

Billy Elliot Film Summary The background of the film Billy Elliot was set in the context of the 1984 Miners Strike in England, where both Billy s father and older brother were miners participating in the strike. In the history of England, this was an important event for the governing party of England at that time, the Conservative Party led by Margaret Thatcher. The event set a strong political and ideological standing for the United Kingdom (UK) with regards to the ideas accepted by the people today. The 1984 Miners Strike was an intense period for the miners, who made up a significant proportion of the working class in England at that time. The reason behind the strike was the intended shutting down of twenty coal mines by the government, which would in turn result in the massive loss of jobs by as many as twenty thousand people. This led to the uproar by the miners in opposition to such a decision. Billy s family was heavily involved in this strike, with his brother Tony as the union leader. Essentially, this was somewhat a symbolism of a class struggle because such a decision affected mainly the working class only in terms of employment. In the film, Mr. Wilkinson, the husband of Billy s ballet teacher, was a figure representing the upper middle class with a rather cynical attitude towards the lower middle class i.e. the miners as well as the strike. Similarly, at the end of Billy s audition and interview together with Billy s father, the panel of judges, a representation of t he upper class, offered his father a patronizing and perhaps sarcastic, good luck with the strike (Blandford, 2007). Despite all the heavy-hearted circumstances Billy and his family were going through, the beginning of the film, together with the dancing along the way, was a surprisingly light-hearted scene. With upbeat rock music playing, Billy s jumping revealed a certain uncontained and unrestrained soul that seemed free. As the story developed however, the contradiction was the fact that Billy s life, at the age of 11, was hardly so. This somewhat likened to the period after the French Revolution, stepping into the Romantic Ages, where light-hearted, happy and fun ballets, often fairytales, were seen as a form of escapism from the harsh reality of people s lives. In another segment of the film, when Billy s father finds him dancing on Christmas night at the gymnasium with his friend, instead of succumbing to his father s objections, Billy bursts into a powerful segment of dancing, which was strong, uplifted, together with jumps and turns. This was almost like an open confrontation between Billy and his father, except not verbally. That dance segment portrayed a two-sided representation of Billy s emotions, one of frustration, with the circumstances and with not being able to dance fr eely, and at the same time, one that seemed to help him express what he could not through words, his love for dance. This was shown through his movements which were heavier and more grounded than when he was dancing to I love to boogie , his inspiration for the audition piece. Though there were jumps in the sequence, they were executed with a strong intention of frustration and desired release from being bound to his father s expectations of carrying on family traditions as a boxer and objections of being a ballet dancer. The unwillingness of Billy s father also revealed something intriguing about the situation, in relation to the political climate at that time. The governing party of England at that time was the Conservative Party, led by Margaret Thatcher. The ideology that followed with such a leadership was conservatism. Conservatism is a political and social ideology that promotes the maintenance of traditional institutions as well as to limit change, or at its best, allow minimal and gradual change in society. This ideology could be seen to have set its roots in the lives of the characters in the film. The strike was an obvious resistance to a significant impending change, the closing down of 20 coal mines and causing the massive loss of jobs. This philosophical idea also had its social impacts on the characters in the story. One of the core reasons for the objection of Billy s father to him dancing was the notion that male dancers were poofs , or simply put, homosexual. Billy s friend Michael w as such a representation, who began showing signs of cross-dressing and homosexuality at a young age. However, the important thing to note was that Michael was not a dancer, placing an immediate call to relook this so-called social phenomenon. This phenomenon, or rather, broad generalization of male dancers, had painted a negative image of males doing this art form and coming back to the ideology of conservatism, Billy s father was simply not ready for a change in mindset about such a phenomenon that had already been etched in his mind. The influence of Fred Astaire was another aspect that had an impact on the choreography of Billy Elliot s dance segments in the film. Rock was the main genre of music popular at that time but Billy Elliot was influenced more by Fred Astaire, who was popular among Billy s mother and grandmother s generation. Fred Astaire was a broadway dancer and choreographer. Though there were no details about how Billy Elliot knew how to tap dance, in many segments where he was dancing, whether out of frustration, happiness or the desire for freedom, his steps incorporated a certain jazzy and broadway style to it. The film, Billy Elliot, was put in the context of many issues that would have surrounded someone who lived in a middle class family, even more so if they were miners and involved the 1984 Miners Strike. The governing party of England at that time played an important role in shaping the mindset of people with the ideology of conservatism, the social and cultural influences revealed its impact on Billy Elliot s dancing as a young boy and ultimately, Billy was motivated by a desire for freedom, breaking away from social norms and standing out as an individual. All of these ideas displayed in Billy s behaviour were formed and passed on from predecessors such as Aristotle, who believed in a society open to ideas and disagreements, as well as John Locke, who was an important figure in the history of freedom. It is through the embodiment of such ideas through the characters in the film, including Billy s father, his brother and even his ballet teacher s family, that gives us a glimpse of th e life and thoughts of those living during the Miners Strike.

Position Of Women In India

Position Of Women In India Chapter-1 Introduction: Status and Social Position of Women The women are the soul of our community and they are self build and self trained human responsible for the morale development of their children, inspiration for the family and an example for the community to follow. As a wife, woman is his best friend and inspiration. The history conveys that, Each successful man has an inspiring woman responsible for success. According to Swami Vivekananda- That country and that nation that do not respect women have never become great, nor ever be in future. According to Historian Romilla Thapper- Within the Indian sub-continent there have been infinite variations on the status of women diverging according to culture malice, family structure, class, caste, property rights and morals. Tagores said, Womens are the ornaments of society. The society was male dominated and he ruled mainly by ethics and morals. But now a days womens are enjoying the topmost supremacy and these have won over intelligence and mental capacity of the men. Today if it was that the society was Male-Dominated then india wouldnt have produced highlighting examples such as P.T.Usha-The Women Athlete, Lata Mangeshkar-The Nightingale and the Singer, Sonia Gandhi-Political and Klpana Chawla-The Indian Astronaut. Today the proverb given above has proved true. A woman is the pillar of a family, and concussively that of a nation. The statue of liberty which is symbol of peace and liberty is none other than that of a woman. Therefore, respect women and every life. In spite of fifty percent of the population on the world wide, women were not in equal status with men. This differential position causes socialization raises from boys and girls are different roles. As a traditional form, the status and social role of the women in every society, specific Indian society have been women are weaker than men. Women are the teachers of the society and they are not competitors. Woman as the mother is the best friend and teacher for the child, especially girl child (Firestone, Catlett, 1993, the Mother-Daughter Bond). Woman as friend is an inspiring support for any task. Woman as wife is a best friend and supportive partner for the husband. Woman as a family member is a best family manager and care taker of family values and traditions. Women as a community member are an example of love, friendliness, inspiration and the best worker. These are the common roles and responsibilities performed by the women community around the world. Woman is an all-round pla yer in the game where, playground is family. The only difference is that, woman is an all-round player at almost all such play grounds around the world. In family, woman is an excellent manger cum worker. The social stratification of women in-India however leaves them as a second rate citizen. This is no more evident than the violence to which a woman is subjected in her domestic setup. Violence against woman is present is every society cutting boundaries of class, culture, education and age. Even though most societies proscribe violence against woman, the reality is that she is tortured physically, psychologically, sexually and economically, the right to equality, security dignity and self worth are denied to woman. At times the place where a woman seeks love, safety, security and shelter, becomes a place of terror and violence at the hands of somebody close to them whom they trust. If we visualize the multiple view of the, woman from various families working for her children, family and herself; we will find that there several women working for the development of their respective families. In broad sense, they are working for collectively development of the family, community and society in which they live because; community is the united from of varied families. A woman is never appreciated for her indirect contribution in this strong development and in the progress of her children, family or external community. She can be said as a silent and selfless leader. We take woman as a strong pillar on which the progress of the family and community depends. If she is educated enough to utilize and manage the family resources in smart manner and every woman does so, than such community will definitely progress irrespective of the variations in the religion, tradition, culture and financial background that are present in any community around the world. There can be many situations that can prevent woman from performing at her best. It can be lack of peer support, illiteracy, lack of knowledge, lack of resources or lack inspiration to name few. Crime, atrocity and violence against woman is a manifestation of the historically unequal power relations between man and woman, which led to the domination of a womans fuller advancement. Violence in the domestic spare is usually committed by them who are or who have been, is position of trust and intimacy and power-husbands father, brother, uncle sons or other relatives. It does not mean that women are not violent but their actions account for a small percentage of domestic violence. Such as outside homes these type activity boy friend and unknown person. The criminals, atrocious abuser and the abused are tied together because of emotional, physical, biological, familial, residential and financial ties, and are often their intimate partners.  Perpetrators of domestic violence seek power and control over their survivors. The factors which contribute to the continued prevalence of violence are mainly the womens lack of access to legal information, aid or protection and also the lack of laws that effectively prohibit violence against women.  There is also failure to reform existing laws and the efforts made on part of public authorities to promote awareness of and enforce existing laws are also inadequate. The absence of educational and other means to address the causes and consequences of violence is also the reason behind prevalence of violence. The Universal Declaration of Human Rights (UDHR) declares that Motherhood and childhood are entitled for special care whether born in or out of wedlock shall enjoy the same protection.  The Indian constitution enshrines in Art.14, 15, 39(a) (d) and (e) that the state shall ensure a just social order for women based on equality and dignity. In spite of all these, and on the sacred land of Sita, Sabitri and Damayanti it found that women are being seduced, tortured, and enjoyed and betrayed. In spite of Constitutional guarantees and legal protection there is a rise on the trend of committing offenses against women and the domestic violence is one of them. Women have always played a specific and crucial role which has been veiled in society and history. Traditionally, the Indian woman has been the keystone of the family and society in general. She creates life, nurtures it, guards and strengthens it. In her task as mother, she plays a vital role in the development of the nation.   Status and social position of women in India Women in India have been always topics of concern since ancient period. They can as a exact example of perfect home-makers. With their incomparable quality of the calm ness of mind they easily handle even toughest situation as well. The Indian women are fully devoted to their families. They are preached in the names like as Goddess Durga, Goddess Saraswati, Parvati and goddess Kali.  The evolution of the status and social position of women in India  has been a continuous process of ups and downs throughout history. For the purpose of depicting a brief survey of the changing position and role of women in India throughout history, four broad periods are considered: Ancient Period Medieval Period Modern India Period British-India Period. After Independence Period Brief described each period on following as:- A) Ancient Period Many women have comforted themselves with a view of many scholars that women were greatly honored in the ancient India from Vedic times. They enjoyed freedom good status and learning opportunities. In those days women must have had certainly freedom it appears that the Vedic women were probably comparable to modern women. Recently some women historians have attempted different interpretations of the original Brahmanical Texts. On the one hand Scriptures have glorifies womanhood. They have treated women as the equals of men. On the other hand some sacred texts held women not only disrespect but even in a positive hatred. There are contradictions and generalizations, which can be interpreted in either way. Women held very important position in ancient Indian society. It was a position superior to men. There are literary evidences to suggest that woman power destroyed kingdoms and mighty rulers.Elango Adigals Sillapathigaram mentioned that Madurai the capital of Pandyas was burnt when Pandyan ruler Nedunchezhiyan killed a womans husband by mistake. Veda Vyasas Mahabharata tells the story of fall of Kauravas because they humiliated queen Draupadi.Valmikis Ramyana is also about the wiping away of Ravana when he abducted and tried to marry Sita forcibly. The plethora of Goddesses in ancient period was created to instil respect for women. Ardhanareeshwar, which called God is half-man and half-woman, was highly worshipped. Women were allowed to have multiple husbands. For example:- 1. Manu has told that where women are honoured the Gods are leased but where they are not honoured, no sacred rite yields any reward. But it is as clear as day light that the same Manu has formulated the theory of sacred tutelage of women when he said that a woman has to depend on her father in her childhood, on her husband in youth and on her sons during her old age and no woman is fit for freedom. Pita rakshathi Kaumare Bhartha rakshathi yavvane Rakshanthi Putrah Stavire, na Sthree svatantram arhati. 2. Yagnavalkya had told that women are the embodiment of all divine virtues on earth. Soma has bestowed all his purity on them. Gandhrva has given them sweetness of speech and Agni has showered all his brilliance to make them most attractive. She is the goddess (Devata as well as a lurer (pramada). Manu says women are able to lead astray not only the ignorant but also even the learned men and make him a slave of lust and anger. Such lofty ideals about women have been repeated in Ramayana and Mahabharata also. B) Medieval Period Medieval India has not womens age it is supposed to be the dark age for them. Medieval India saw many foreign conquests, which resulted in the decline in womens status. When foreign conquerors like Muslims invaded India they brought with them their own culture. These period women was the sole property of her father, brother or husband and she does not have any will of her own. This type of thinking also crept into the minds of Indian people and they also began to treat their own women like this. One more reason for the decline in womens status and freedom was that original Indians wanted to shield their women folk from the barbarous Muslim invaders. As polygamy was a norm for these invaders they picked up any women they wanted and kept her in their harems. In order to protect them Indian women started using Purdah, (a veil), which covers body. Due to this reason their freedom also became affected. They were not allowed to move freely and this lead to the further deterioration of their status. These problems related with women resulted in changed attitude of people. Now they began to consider a girl as misery and a burden, which has to be shielded from the eyes of intruders and needs extra care. Whereas a boy child will not need such extra c are and instead will be helpful as an earning hand. Thus a nasty circle started in which women was at the receiving end. All this gave rise to some new evils such as Child Marriage, Sati, Jauhar, devdasi, restriction on widow marriage, Purdha system and restriction on girl education. Sati: Sati is known as the ritual of dying at the funeral pyre of the husband. According to some of the Hindu scriptures dying at the funeral pyre women of her husband go straight to heaven so its good to practice this ritual. Initially it was not obligatory for the women but if she practiced such a custom she was highly respected by the society. Sati was considered to be the better option than living as a widow as the plight of widows in Hindu society was even worse. Some of the scriptures like Medhatiti had different view it say that Sati is like committing suicide so one should avoid this. Jauhar: It is also more or less similar to Sati but it is a mass suicide. Jauhar was prevalent in the Rajput societies. In this custom wives immolated themselves while their husbands were still alive. Jauhar are also known to place a high profile on honour. When people of Rajput clan became sure that they were going to die at the hands of their enemy then all the women arrange a large pyre and set themselves afire, while their husband used to fight the last decisive battle known as Shaka, with the enemy. Thus are defending the sanctity of the women and the whole clan. Devadasis: Devadasi system is a religious practice in some parts of southern India, in which women are married to a deity or temple. The ritual was well established by the 10th century A.D. In the later period the illegitimate sexual exploitation of the Devadasis become a norm in some parts of India. Child Marriage: It was a norm in medieval India. Girls were married off at the age of 8-10. They were not allowed access to education and were treat as the material being. The plight of women can be imagined by one of the shloka of Tulsidas where he writes [r1] Dhol, gawar, shudra, pashu, nari, ye sab tadan ke adhikari. Meaning that are animals, illiterates, lower castes and women should be subjected to beating. Thus women were compared with animals and were married off at an early age. The child marriage along with it bring some more problems such as increased birth rate, poor health of women due to repeated child bearing and high mortality rate of women and children. Restriction on Widow Remarriage: The condition of widows in medieval India was very bad. They were not treating as human being and were subjected to a large number of restrictions. They were imaginary to live religious life after their husband died and were not allowed entry in any celebration. Their being there in any good work was considered to be a bad omen. Sometimes heads of widows were also shaved down. They were not allowed to remarry. Any woman remarrying was looked down by the society. This cruelty on widows was one of the main reasons for the large number of women committing Sati. In medieval India living as a Hindu widow was a sort of a curse. Purdah System: Purdah system is the practice among some communities of requiring women to cover their bodies so as to cover their skin and conceal their form. It imposes restrictions on the mobility of women, it is curtails their right to interact freely and a symbolic of the subordination of women. It does not reflect the religious teachings of either Hinduism or Islam, contrary to common belief, although misconceptions are occurred due to the ignorance and prejudices of religious leaders of both are faiths. Girl Education: The girls of medieval India and above all Hindu society be not given formal education. They were given education related to household chores. But a famous Indian philosopher Vatsyayana write that women were supposed to be perfect in sixty four arts which included cooking, spinning, grinding, knowledge of medicine, recitation and many more. C) Modern India Period Modern India witnessed some developments in the status and social position of women. There were many reformers in India who worked for the betterment and upliftment of their other female counterparts. The Begum of Bhopal discarded the purdha and fought in the revolt of 1857. Many reformers measures to eradicate social stigmas from the society. Sir Sayyid Ahamad Khan established the Aligarh Muslim University for the spread of education among the Muslims. Among many the Widow Remarriage Act of 1856 was important. The education system was also elevated. English was introduced in this period. Various female English writers like Sarojiini Naidu, Kamala Das made their presence felt in this period. In the modern times, women in India are given freedom and right such as freedom of expression and equality, as well as right to get education. Women in Contemporary India are doing the same what a male can do. Various prestigious positions are held by Indian women. They are enjoying the ladies first facility in various fields. But still problems like dowry, female infanticide, sex selective abortion, health, domestic violence, crime and atrocities are prevalent in the society. Several acts have been passed to demolish all these problems. But illiteracy and lack of awareness are the obstacles in the path of Indian women to stand against these follies. British India Period Womens Struggle and Reforms Though women of India are not at par among her counterpart in Western world but she is struggling hard to make her mark in mens world. We can count on certain names from the British India where women put the example of extraordinary bravery which even men might not be able to show. Rani Lakshmi Bai of Jhansi was the one such woman. She was the one who put even British rulers to dishonour with her extraordinary feat in battle. She fought for her kingdom, which Dalhousie, British Governor General, had unlawfully annexed. She was in a true sense the leader of uprising of 1857. There are certain men who took the cause of women in India. There have been social reformers like Raja Ram Mohan Roy, Ishwar Chandra Vidyasagar, Swami Vivekanand, Swami Dayananda Saraswati who have helped women gain their previous status in society. Raja Ram Mohan Roy Born on 22nd may 1772 he was the torchbearer of social reforms for the women. He was strictly against the evils prevalent in society in his time. He is the one who has done women a great favour by abolishing Sati lawfully. It was due to his efforts that Lord William Bentinck banned the custom of Sati in 1829. Though this law was not a great deterrent but it changed mindset of people to some extent. Ram Mohan Roy also did great work in the field of women education. He was against child marriage and favoured widow remarriage. He himself married a widow thus setting the example for the whole society. Along with Dwarka Nath Tagore he founded Brahmo Samaj for the reform of Indian society and emancipation of women. Ishwar Chandra Vidyasagar Ishwar Chandra Vidyasagar was popularly well-known as Vidyasager, which means sea of knowledge. Testifying to his name he was truly the sea of knowledge. He was a pillar of social reform movement of Bengal in 19th century. He broadly read ancient Hindu scriptures and came to know that the gender divide which was prevalent in Bengal was not encoded in our ancient texts instead it is the politics to keep women subordinate to men. He strongly supported women education in Bengal and went door to door to persuade people to send their girl child to school. He also did a lot in the field of widow remarriage. He opened many schools for girls. Mahatma Jyotirao Phule Born on April 11, 1827, Pune, Jyotirao Govindrao Phule was a genuine philanthropist. He was the one to open first girl school in India. He is also credited with opening first home for widows of the upper caste and a home for newborn girl children so that they can be saved from female infanticide. Swami Dayanand Saraswati He was the founder of Arya Samaj and gave a cry, back to Vedas. He translated Vedas from Sanskrit to Hindi so that a common man can read it and understand that the Vedic Hindu scriptures gave utmost importance to women. He emphasize for the equal rights for women in every field. He tried to change the mindset of people with his Vedic teachings. Mahatma Gandhi The social reformers of 19th century laid down the stage for the emancipation of women but it was Mohan Das Karam Chand Gandhi under whose influence these reforms reached masses. He was the one who liberated Indian women from the rule of Purdah and other social evils. He brings them from their confinement and asked them to participate in the struggle for independence. According to him women should survive liberated from the slavery of kitchen only then their true potential could be realized. He said that liability of household is important for women but it should not be the only one. In fact she should arrive forward to share the responsibilities of nation. When Gandhi come to the step of Indian struggle for independence then the average life span of Indian women was 27 years and only 2%women were educated this shows what a Herculean task it was to bring the women of India who was not getting her basic rights to fight for the cause of the nation. But it was due to his efforts that so a lot of women like Sarojini Naidu, Vijayalakshmi Pandit, Aruna Asaf Ali, Sucheta Kriplani and Rajkumari Amrit Kaur came forward. He spread the message of equality of the gender to the masses and criticized the desire of Indian people to have male child instead of a female. Gandhiji was strictly beside the child marriage and favoured widow remarriage. He urged the youth to come forward and accept young widows as their life partner. He said that the girls are also capable of everything boys can do but the need of the time is to give them opportunities so that they can prove themselves. It was mostly due to his efforts that when India get independence right t o vote came naturally to Indian women whereas in other developed nations like England and America women got this right very late and that too after lot of protest. Spread of Education The idea of imparting education to women emerged in the British period. Earlier, it was almost universally hailed that since women need not earn their livelihood, there was no need of education for them. After the Bhakti Movement, the Christian Missionaries took interest in the education of the girls. The Hunter Commission too emphasized on the need for female education in 1882. The Calcutta, Bombay and Madras institutions did not permit the admission of girls till 1875. It was only after 1882 that girls were allowed to go for higher education. Since then, there has been a continuous progress in the extend of education among females. Though the number of girls studying at various levels was low, yet there has been a marked increase in the number of female students at every level from 1941 onwards. After Independence Period The status of women in modern India is a sort of a paradox. If on one hand she is at the peak of ladder of success, on the other hand she is mutely suffering the violence afflicted on her by her own family members. As compared with past women in modern times have achieved a lot but in reality they have to still travel a long way. Their path is full of roadblocks. The women have left the secured domain of their home and are now in the battlefield of life, fully armoured with their talent. They had proven themselves. But in India they are yet to get their dues. The sex ratio of India shows that the Indian society is still prejudiced against female. There are 933 females per thousand males in India according to the census of 2001, which is much below the world average of 990 females. There are many problems which women in India have to go through daily. These problems have become the part and parcel of life of Indian women and some of them have accepted them as their fate. The main problems of Indian womens are includes:- Malnutrition, Poor Health, Maternal Mortality, Lack of education, Mistreatment, Overworked, Lack of Power, Marriage, Dowry, Female infanticide/foeticide. Malnutrition Generally in India, women are the one who eat last and least in the whole family. So they eat whatever is left after men folk are satiated. As a result most of the times their food intake does not contain the nutritional value required in maintaining the healthy body. In villages, sometimes women do not get to eat the whole meal due to poverty. The UNICEF report of 1996 clearly states that the women of South Asia are not given proper care, which results in higher level of malnutrition among the women of South Asia than anywhere else in the world. This nutritional deficiency has two major consequences for women first they become anaemic and second they never achieve their full growth, which leads to an unending cycle of undergrowth as malnourished women cannot give birth to a healthy baby. Poor Health The malnutrition results in poor health of women. The women of India are prejudiced from the birth itself. They are not breastfed for long. In the want of a son the women wants to get pregnant as soon as possible which decreases the caring period to the girl child whereas the male members get adequate care and nutrition. Women are not given the right to free movement that means that they cannot go anywhere on their own if they want and they have to take the permission of male member of family or have to take them along. This results in decrease in womens visit to doctor and she could not pay attention to her health as a result. Maternal Mortality The mortality rate in India is among highest in the world. As females are not given proper attention, which results in the malnutrition and then they are married at an early age which leads to pregnancies at younger age when the body is not ready to bear the burden of a child. All this results in complications, which may lead to gynecological problems, which may become serious with time and may ultimately, lead to death. Lack of education In India women education never get its due share of awareness. From the medieval India women are debarred from the educational field. According to medieval awareness women require just household education and this perception of medieval India still persists in villages of India even today. Girls are supposed to fulfil domestic duties and education becomes secondary for them whereas it is considered to be important for boys. Although scenario in urban areas has changed a lot and women are opting for higher education but majority of Indian population residing in villages still live in medieval times. The people of villages consider girls to be curse and they do not want to waste money and time on them as they think that women should be wedded off as soon as possible. The main reason for not sending girls to school is the poor economic condition. Another reason is far off location of schools. In Indian society virginity and purity is given extreme importance during marriage and people are afraid to send their girl child to far off schools were male teacher teach them along with boys. The lack of education is the root reason for many other problems. An uneducated mother cannot look after her children properly and she is not aware of the fatal diseases and their cure, which leads to the poor health of the children. Uneducated people do not know about hygiene this lack of knowledge of hygiene may lead to poor health of the whole family. Mistreatment In India violence against women is a common evil. Not just in remote part but in cities also women bear the brunt. They are subjected to physical and mental violence. They are the one who work most but are not given their due. Women are safe anywhere neither at home nor at workplace. An hour a woman is raped in India and every 93 minutes a woman is burnt to death due to dowry problem. There are a lot of laws such as The Hindu Marriage Act of 1955, The Hindu Succession Act of 1956, The Hindu Widow Remarriage Act of 1856, The Hindu Women Right to Property Act of 1937, The Dowry Prohibition Act of 1961, to protect women and punishment is severe but the conviction rate of crime, atrocities and violence against women is very low in India. Overworked Indian women work more than men of India but their work is hardly recognized as they mainly do unskilled work. Their household chores is never counted as a work, if a woman is working in a field to help her husband it will also be not counted as a work. A study conducted by Mies in 1986 states that in Andhra Pradesh a woman works around 15 hours a day during the agricultural season whereas a male on an average works for around 7-8 hours. Lack of Power In India a large percentage of women do not have power. They cannot take decisions independently not even related to their own life. They have to take permission of male members for each and every issue. They dont have any say in important household matters and not in matter of their own marriage. Marriage The family mainly fixes the marriages in India. The scenario in villages is very bad. The girl is not consulted but is told to marry a guy whom her family has chosen for him. They are taught to abide by the whims and fancies of their husbands. Going against the wishes of husband is considered to be a sin. In marriage husband always has the upper hand. The groom and his parents show as if they are obliging the girl by marrying her and in return they demand hefty dowry. Dowry Its a serious issue. Courts are flooded with cases related to death due to dowry harassment by husband and in laws. In ancient times women were given Stridhan when they departed from the house of their parents. This amount of money was given to her as a gift which she can use on her and her children but her in-laws did not have any right on that amount. This amount was supposed to help the girl in time of need. Slowly this tradition became obligatory and took the form of dowry. Nowadays parents have to give hefty amount in dowry, the in laws of their girl are not concerned whether they can afford it or not. If a girl brings large amount of dowry she is given respect and is treated well in her new home and if she does not bring dowry according to expectations of her in laws then she has to suffer harassment. Due to this evil practice many newlywed women of India have to lose their lives. Female infanticide/foeticide As women were supposed to be and in some areas of India are still considered to be curse by some strata of society their birth was taken as a burden. So in past times they were killed as soon as they were born. In some of the Rajput clans of Rajasthan newly born girl child was dropped in a large bowl of milk and was killed. Today with the help of technology the sex of the unborn baby is determined and if it is a girl child then it is aborted down. In all this procedure women do not have any say they have to do according to the wish of their husbands even if she does not want to abort she have any choice. Divorce The divorce rate in India is not accordingly high compared to western countries but it does not mean that marriages are more successful here. The cause behind low level of divorce rate is that it is look down by the society. It is regard as the sign of breakdown of marriage, especially of women. She is treating as but she has committed some crime by divorcing her husband. In some community like Muslim women did not have the right to divorce their husband they were divorced at just the pronouncement of I divorce you by their husband thrice and they could not do anything except to be the mute spectator. Recently Muslim Law Board has given right of divorce to women. After divorce women is entitled to get her Mehr for herself and her childrens sustenance. In Hindu society women obtain maintenance for themselves and their children after divorce. WOMENS MOVEMENT That is evident fr

Comparing Composed Upon Westminster Bridge by William Wordsworth and Lo

Comparison between William Blake and William Wordsworth’s Views of London William Blake grew up in the slums of London and this is shown in his poem, he wrote his poem in the slums and back alleys of London as he never had very much money. He describes London as being â€Å"charter’d†, this gives us the impression that everything has rules and boundaries in London, and that there is no mystery to be discovered. Also chartered means on a map, almost as if it is owned, by the king perhaps. The line in which the word is on, â€Å"I wander through each charter’d street, near where the charter’d Thames does flow,† makes us feel as if every thing is owned and nothing is natural, like all the people in London are prisoners of society The ending line of stanza two tells us, â€Å"The mind-forg'd manacles I hear†, this is Blake’s way of showing to us that there are no free minds in London. Everyone had been brainwashed by society and they could not think for themselves because of that. In the next stanza Blake describes the corruption of the Church of England by mentioning, â€Å"Every black'ning Church apalls† this shows the dirtiness of the buildings and shows us that there is a possibility that he is a strong catholic. This line ties in very well with the line directly above it â€Å"How the chimney-sweeper's cry†, both of the lines are discussing how dirty and filthy London is. We could also think of these lines in a different way Blake could be telling us that the priests are corrupt and dirty rather than just physically dirty. In the final line of this stanza, Blake states. â€Å"And the hapless soldier's sigh, runs in blood down palace-walls.† This could be considered as an other sign of corruption, and that monarchs are to blame for the death in London a... ...f London, but they only do this because of their life before they wrote the poems. One poet grew up in the rich area outside London and moved there later, whereas the other poet grew up in the slums of London. They never had the chance to see London through each others eyes, if they had they may have thought differently of London. Both poets grew up and wrote about what each thought of the same place, London is a city that is magnificent and beautiful to the people who know it like that. Whereas it is filthy and dirty to the people who have grown up in those filthy dirty areas. In my opinion London is a place that is somewhere between these two extreme versions of it, a place where there is magnificent splendour but also a place where there is filth and poverty. Theses poems where written two hundred and six years ago and London has not changed that much since then.

The Role of Background Knowledge in Reading Essay -- Education

1. Introduction With the passage of time and the spread of technology wider than ever, there is a vast amount of knowledge and information which require from individuals faster response to these developments around the globe. One of the most effective ways for individuals to be up-to-date with the world around is to read. Reading is a skill which any learner needs along with other skills. Reading, as defined by Macmillan Dictionary, is the process of recognizing written or printed words and understanding their meaning. For reading to be most effective, readers need to read in their area of interest and have prior knowledge of what is going to be read. For more clarification, prior knowledge is background knowledge about certain topics. In other words, what a reader already knows about the topic he is about to read. This prior knowledge has great impact on the reading and the reader. 2. Description 2. A. Terms Used for Background Knowledge Moreover, background knowledge is fundamental in reading comprehension. It is defined by The Free Online Dictionary as â€Å"Information that is essential to understanding a situation or a problem.† The terms background knowledge and prior knowledge are generally used interchangeably (Strangman and Hall, 2010). Background knowledge and prior knowledge are parent terms for many more terms such as: conceptual knowledge, metacognitive knowledge, subject matter knowledge, strategy knowledge, personal knowledge, and self-knowledge (Strangman et al., 2010). Though scholars’ definitions and names of prior knowledge are different, they typically describe the same concept. 2. B. Factors Shape Background Knowledge Furthermore, there are many factors that background knowledge could b... ...NHUAvgCy4-HuRIoUF7y2b07jddLKA&cad=rja Spires, H.A. & Donley, J. (1998). Prior knowledge activation: Inducing engagement with informational texts. Journal of Educational Psychology, 90(2), 249-260. Strangman, N. & Hall, T. (2010). Background Knowledge. Curriculum Enhancement Report. U.S. Special Office of Education Program. National Center on Accessing the General Curriculum. Retrieved October 28, 2011 from : http://www.google.com/url?sa=t&rct=j&q=the%20role%20of%20background%20knowledge%20in%20reading&source=web&cd=7&sqi=2&ved=0CEYQFjAG&url=http%3A%2F%2Fsoar.wichita.edu%2Fdspace%2Fbitstream%2Fhandle%2F10057%2F256%2Ft06002.pdf&ei=O0WmTsvILdK2hAeU-pSeDg&usg=AFQjCNHearmwQCdk6JpPpDZEtGg7jiCG8Q The Free Online Dictionary. (2011). The entery â€Å" background knowledge†. Retrieved October 26, 2011 from http://www.thefreedictionary.com/background+knowledge

Analysis of Middle Range Nursing Theory Essay

Complex physiological changes during pregnancy have a significant impact on almost every organ on the body system including the oral cavity — these changes are due to hormonal changes. Estrogen causes increased blood flow to the oral cavity, making the gums friable and easy to bleed, contributing to gingivitis. Pregnancy-associated gingivitis is highly prevalent. It affects approximately 30%-75% of pregnant women and resolves after delivery. Nausea and vomiting during pregnancy can also increase the risk of extensive erosion (Varney, Kriebs, & Gegor, 2004; Barak, Oettinger, Machetie, Peled, & Ohel, 2003). In addition, changes in diet, such as increased consumption of carbohydrates, increased acid from vomiting, and changes in oral hygiene may increase the risk of tooth decay during pregnancy (Russel & Mayberry, 2008). Current research and evidence shows the importance of maintaining good oral health during pregnancy. Evidence supports that periodontal infections during pregnancy increases the risk of adverse birth outcomes such as premature deliveries, low birth weight, still birth, miscarriage, and pre-eclampsia (Russell & Mayberry, 2008; Jeffcoat, Geurs, Reddy, Cliver, Goldenberg & Hauth, 2001). Preterm birth is a significant public health problem, as the prematurity rate at in the United States was 12.7% in 2007. Preliminary data for 2008 indicates a slight decline to about 12.3% (Martin, Hamilton, Sutton, Ventura, Mathews, Kirmeyer, & Osterman, 2010). Behrman & Butler (2007) reported that annual societal preterm births cost more than $26.2 billion in 2005, or $51,600 per infant born preterm, including maternal delivery, medical care, early intervention services, and loss of household and labor market productivity. As a midwife, one main goal during antenatal care is to improve pregnancy outcomes. Part of this can be accomplished is by promoting oral health care and healthy  behaviors. It is important to provide oral health education before and during the current pregnancy, as well as educate our clients about the association between poor maternal oral health and adverse pregnancy outcomes. In addition, we must encourage them to see a dentist during pregnancy. Theory To choose a theory to apply to the practice problem, relevant theories must be critically evaluated based on a set of criteria. The author used the three questions posed by Fawcett and Associates (1992) as described by Kenny (2006): â€Å"(1) Does the theory or model address the client problems and health concerns?; (2) Are the nursing interventions suggested by the model consistent with client’s expectations for nursing care?; and (3) Are the goals of nursing actions, based on the model or theory, congruent with the client’s desired health outcomes?† (Kenny, 2006, p.305). Several middle range theories can be used and applied to maximize oral health during pregnancy, as well as the prevention of adverse outcome related to oral problems. The Theory of Reasoned Action and Theory of Planned Behavior focuses on and explores the relationship between behavior and beliefs, as well as attitudes and intention (Montano & Kasprzyk, 2008). The Diffusion of Innovations Theory has been used to study the adoption of health behaviors and programs (Tiffany & Lutjens, 1998). The Precaution Adoption Process Model has been applied to behaviors which require deliberate action and initiating new behaviors (Weinstein, Sandman, & Blalock, 2002). The Transtheoretical Model and Stages of Change are used to guide the individual through the stages of change to action and maintenance (Prochaska, Redding, & Evers, 2002). The Health Belief Model is used to predict and explain health behaviors and promote individuals in engaging health behavior (Champion & Stretcher & Janz, 2002). The best theory that fits this practice problem and author’s values and beliefs about client, health and nursing practice is Health Belief Model. Health Belief Model The Health Belief Model (HBM) was developed by a group of social psychologists at the U.S. Public Health Service in the 1950s in an attempt to understand â€Å"the widespread failure of people to participate in programs to prevent and detect disease.† It was later applied to patient responses to  symptoms and to compliance with prescribed medical regimens (Champion, Stretcher, & Janz, 2002, p. 46). The HBM has four major constructs: Perceived susceptibility, perceived severity, perceived benefit, and perceived barriers. The model has been expanded to include cues to action and self efficacy (Champion, Stretcher, & Janz, 2002). ‘‘Perceived susceptibility† refers to â€Å"one’s subjective perception of the risk of contracting a health condition.† (Champion, Stretcher, & Janz, 2002, p.48). â€Å"Perceived severity† refers to â€Å"feelings concerning the seriousness of contracting an illness or of leaving it untreated includes evaluations of both medical and clinical consequences (death, disability and pain) and possible social consequences (such as effects of the conditions on work, family life, and social relations).† (Champion, Stretcher, & Janz, 2002, p.48). â€Å"Perceived benefits† are beliefs and opinions of the value regarding the effectiveness of the various actions available in reducing the disease threat.† (Champion, Stretcher, & Janz, 2002, p.48). â€Å"Perceive barrier† is a person’s perception of both the difficulties in performing the specific behaviors of interest and the negative things that could happen from performing those behaviors.† (Champion, Stretcher, & Janz, 2002, p.49). â€Å"Cues to action are strategies to activate the one’s readiness.† And finally, â€Å"self efficacy† is â€Å"one’s confidence in one’s ability to take action.† (Champion, Stretcher, & Janz, 2002, p.49). The Health Belief Model is one of the conceptual frameworks for understanding health behavior. Also, the HBM is used for explaining and predicting acceptance and adherence to medical care recommendations (Champion, Stretcher, & Janz, 2002). The Model hypothesis â€Å"that an individual’s decision to change behavior is determined by two elements: (1) One’s perception of a threat to personal health which is determined by two underlying belief, namely perceived susceptibility of the disease and the perceived severity and seriousness of the disease. And (2) Ones perception of the efficacy of treatment proposed to reduce the threat†. (Ramseier, Suvan, 2010). This theory is indicated as a mid-range theory because it is narrow in scope, less abstract, and more applicable directly to practice for explanation and implementation. The early applications of HBM were focused on tuberculosis screening test, and then MBM extended to lifestyle behavioral changes such as condoms use, obtaining vaccination against infectious disease such as  influenza vaccine (Baranowski, Cullen, Nicklas, Thompson, & Baranowski, 2003; Janz & Becker,1984). The HBM model also has been used on screening behaviors such as: mammography screening behaviors for detecting breast cancer, screening program for Tay Sachs disease, as well as in AIDS and high-risk behavior research (Janz & Becker, 1984) Plan for Practice Integration To initiate the use of the Health Belief Model in promoting and maximizing oral health during pregnancy, we might begin with distributing a survey or questionnaire for each woman during the prenatal visit. The purposes of questionnaire are: (1) To explore oral health practices and utilization of dental care; and (2) To examine women’s use of dental service and frequency of dental visits during pregnancy. The questionnaire includes demographic data (i.e., age, marital status, educational level, annual house hold income, and dental insurance). It also includes questions regarding oral health hygiene practices (i.e., frequency of brushing and flossing). In addition, the frequency of dental visits before and during pregnancy, reason for dental visit, questions regarding any instructions received from health care providers about oral health care, safety of oral treatment during pregnancy, knowledge of common oral health problem during pregnancy, and associations between poor matern al oral health and adverse pregnancy outcomes would also be covered. Questions about barriers to dental care or reasons they do not visit the dentist would be explored. After collecting the survey from the women, the midwife or health care provider should discuss and provide teaching about oral health practices, the importance and safety of dental visits, and provide knowledge of oral health and pregnancy outcomes associated with poor oral health. This information should be provided at every prenatal visit. The Health Belief Model would be explained in an educational session for midwife and health care provider (MD and dentist) using visual aids, including posters and handouts of the HBM construct. This educational session includes information about the theory in general, constructs and its relationships, also how this model was used in research and practice previously, and then how this model might be used and applied in maximizing and promoting oral health during pregnancy. A better understanding of the HBM from the midwife will  enable them to use it in predicting and screening a patient’s oral health and related behaviors. In-person counseling could address each woman’s baseline belief regarding susceptibility to oral infection (i.e., gingivitis, peridonitis and dental caries), as well as benefits and barriers to the dental clinic visit and screening. By the end of the educational session, certain outcome objectives should be assessed. These outcome objectives would be: (1) By the end of the session, 100% of the midwives and health care providers will be able to describe the HBM and its constructs in their own words; and (2) By the end of the session, 100% of the health care providers and midwives will be able to assist individual clients to develop and maintain oral hygiene behaviors. These objectives could be measured by assessing learner expectations regarding the sessions, asking questions, and having each one state their answers, as well as provide effective feedback to each answer from the participants. Several factors influencing the practice issues were understood by using the HBM in this practicum situation. The concept of â€Å"perceived susceptibility† includes all pregnant women because of the hormonal fluctuations that occur during pregnancy, in addition to personal characteristics related to income, poor habits, inadequate dental hygiene and related behaviors. The concept of â€Å"perceived severity† is important in that if woman are made aware of poor pregnancy outcomes related to poor oral health, they may be more inclined to engage in healthy behaviors. The concept of â€Å"perceived benefits† are instrumental and correlate with healthy behaviors and healthy outcomes, which is the desire of most pregnant women. The concept of â€Å"perceived barriers† is important to address. While the cost of dental care may be discouraging and many may fear the pain involved in dental health (i.e., injections, fillings), the cost and disappointment of poor pregnancy outcomes may far exceed these perceived barriers. â€Å"Cues to action† are employed through education and counseling the patient regarding the many benefits and risks regarding adequate and a lack of oral hygiene, as it affects their pregnancy outcome. The concept of â€Å"self-efficacy† is important, as women become empowered to make positive life-style behavioral changes which positively impact their pregnancies. References Barak, S., Oettinger, B., Machetie, E., Peled, M., & Ohel, G. (2003). Common oral manifestations during pregnancy: A review. Obstetrical and Gynecological Survey, 58(9), 624-628. Baranowski, Cullen, K., Nicklas, T., Thompson, D., & Baranowski, J.( 2003). Are current Health behavioral change models helpful in guiding prevention of weight gain efforts? Obesity research; 11. Janz & Becker. (1984). The Health Belief Model: A decade later. Health education quarterly.11 (1):1-47. Jeffcoat, M., Geurs, N., Reddy, M., Cliver, S., Goldenberg, R., & Hauth, J. (2001). Periodontal infection and preterm birth: Results of a prospective study. Journal of the American Dental Association,132, 875-880. Behrman, R., & Butler, A. (2007). Preterm birth: Causes, consequences and prevention. National Academic Press, Washington, DC. Retrieved on November 3, 2011 from http://www.nap.edu/openbook.php?record_id=11622&page=398. Martin, J., Hamilton, B., Sutton, P., Ventura, S., Mathews, T., Kirmeyer, S., & Osterman, M. (2010). Births: Final data for 2007. National Vital Statistics Reports. 58(24), 1-88. Montano, D., & Kasorzyk, D. (2008). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In K. Glanz, B. Rimer, & K. Viswanath (Eds.). Health Behavior and Health Education Theory Research and Practice (4th ed.), USA: Jossey-Bas, pp. 67-95. 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