Environmental Examples Essay

The lamentable condition of the Amazon River is featured in the You Tube video â€Å"The Amazon Dries Up†. It shows major portions of the river drying up with boats stranded, fish dying because of lack of oxygen, and people traveling far in search of clean water to drink. Going through this video brought up feelings of sadness and anxiety at the same time because of the deplorable status of the environment in the area, and the apparent hopelessness of the situation. Forests have been denuded for the benefit of a few but with a predictably great impact in the offing. It is scary to think about the future basing from this video especially since this video was done in 2006 yet. The emphasis of the film is against deforestation and more emission of greenhouse gases which are said to be the culprits behind the drought in the Amazon. Environmental degradation (Ferris & Stein, Ch. 15) has emerged to become one of the world’s major social problems as humans have acknowledged its effects like global warming (Ferris & Stein, Ch. 15) and climate change. The problem is actually one that is of a major dimension because many people will be affected if these problems continue to worsen. As we feel the effects of global warming, not a lot of the world’s inhabitants may survive and some species may become extinct. Furthermore, climate change can bring about devastations of unknown magnitudes. Just the recent flooding and earthquakes which occurred this year are some typical examples of unexpected destruction to the environment, to man and property. Furthermore, ongoing extinction of species may cause ecological imbalance which may also result to other unanticipated results which are still unknown, and may never be reversed. The environment needs to be everyone’s concern. Taking things one step at a time will not bring anyone to the goal immediately, yet slowly but surely, the goal can be reached. Small simple steps like the 3 Rs : Reduce, Reuse, Recycle, making use of car pools, conserving electricity will all add up to make the goal of making the environment more habitable an attainable possibility. The worst case scenario is one where the leaders we look up to seem to be passive in their stance regarding these issues. Nevertheless, it is still a conglomeration of efforts which will be the best way to address these environmental issues. Works Cited Ferris, Kerry & Stein, Jill, The Real World: An Introduction to Sociology New York: W. W. Norton & Company, 2009. Print.

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I have been offered constructive feedback and the opportunity to improve my work. Assessor I declare that I have issued the relevant resource material. I ensured that the student understood the requirements for the completion of this course. The student named above completed the work that is submitted and the work is their own. Student Signature Assessor Date Assignment 1 brief Qualification BITE Level 3 National (90-credit/Extended) Diploma in Applied Science Assignment title Work in the Science Industry Start date 01/09/14 Interim Deadline date Final Deadline date N Walters / D Miracle Learning Outcome(s) 1.Be able to use mathematical tools in science Mathematical tools: SSL units (length, mass, time, area, volume, density, force); conversions, egg imperial to metric and vice versa; prefixes, egg gig, mega, kilo, decide, cent', mill', micro, Anna, Pico; accuracy of data (decimal places and significant figures); fractions; percentages; ratios; standard form; use of scientific calcul ators Scientific problems involving algebra: transposition of formulae; substitution of equations; simple linear equations, egg involving force and mass (F =ma), speed and distance (v =s/t), mole calculations (n =m/Mr.), voltage and current (V =IR), density and illume (p =MN) Menstruation: standard formulae to solve surface areas, egg total surface area of a cylinder = nor + nor, surface area of a sphere = nor; volume of regular solids, egg volume of a cylinder = Teller, volume of a sphere = 4/nor, volume of a cone = 1/north Scenario You work for a pharmaceutical research company; the company would like to offer assistance and training for a new intake of employees who might find the mathematical demands of their new Job challenging.In addition to providing helpful guides and resources for these employees you need to produce some assessment trials that will be used to assess whether employees require additional training. The assessment materials you produce will need to include ques tions and the answers to these questions so that they can be marked and assessed. Criteria Pl : Carry out mathematical calculations using suitable mathematical tools UP: Carry out mathematical calculations using algebra MI: Use standard form to solve science problems MM: Use menstruation to solve scientific problems ODL : Use ratios to solve scientific problems DO: Use algebra to solve scientific problems Tasks for Assignment 1 Completed? Pupil Teacher TASK 1. 1 -(PI) Produce a poster showing commonly used imperial units with examples of their conversion into SSL units.Include specific examples covering units used in biology, chemistry and physics. Your poster should contain instructions on how to convert these units from imperial to metric and vice versa. Produce a guide to using standard form in science. Use examples relating to the use of standard form in measurements using microscopes in biology measurements of concentration in chemistry distance in physics using the wavelengths of different forms of radiation from the electromagnetic spectrum. In your guide present each example as a problem showing how the solution can be found using standard form. Task 1. 3 – (UP) Produce the 1st of 4 Question Papers that will be used to assess a new employees' mathematical capability.In this first paper write 10 questions requiring the use of algebra to solve mathematical problems. Having written the paper you need to write a mark sheet showing the answers and full working out for each question. Task 1. 4 – (MM) The next question paper for assessing employees is based on the use of menstruation. You need to write at least 10 questions in which employees are squired to solve problems involving shape and volume. You must include; 3 Biology, 3 Physics and 3 Chemistry-based questions. Again you should produce a mark sheet in which you clearly show the answers and working out for each question. Task 1. 5 – (ODL) with ratios. 10 Questions should be writte n covering problems in Biology, Chemistry and Physics.Genetics, chemical reactions and moments are topics that lend themselves to questions based on ratios. A mark sheet needs to be produced showing the answers and working out for each question. Task 1. 6- (DO) In the final question paper you should write one Biology, one Physics and one Chemistry problem requiring employees to find a solution using algebra. These three questions should be more complex than previous questions and involve a number of stages in which algebra is needed to find a solution to the problem. A detailed mark sheet is required for this paper showing the solutions to the problems including the working out for each stage of the problem.This could be from any subject in science but must be collected by the learner. You should include a brief statement stating how the data was collected, as well as a table of results for the data. The table should have borders and show quantities along with the correct units. Tas k 2. 2 – (MM) Provide a detail description of the stages undergone in the data collection process applied for UP. This description should be for both secondary and primary data. Task 2. 3 – (DO) Compare the different methods of data collection applied in UP and MM (both primary and secondary); The advantages and disadvantages of the methods should be clearly highlighted.TASK 2. 4 -? (UP) Identify any errors associated with collecting scientific data within an experiment (ideally the experiment used for UP). This could be in the form of a list or a statement. It should include any random and/or systematic errors. Task 2. 5 – (MM) Detail and show how errors were calculated in UP from the experiment conducted in Task 2. 6 – (DO) reduced. It is expected that the errors mentioned in DO will be linked to errors encountered during the same experiment mentioned in UP and MM and ideally linked to UP. Include also a mention of how errors encountered in UP were mini mized. Assignment 3 brief Displaying Data 10/09/14 3.Know about laboratory information management systems Charts: data represented by statistical diagrams (bar charts, pie charts); histograms (continuous and discrete variants) Type of graphs: linear graphs, egg distance time graphs, graphs obeying Ohm's law (voltage against current); non-linear graphs, egg ate of catalytic reaction against temperature, hydrogen gas given off against time, radioactive decay, bacterial growth Interpretation of data: random data, patterns in data; calculation of the arithmetic mean, mode and median; continuous data, egg rate of production over time, population count of invertebrates or plants; discrete data, egg fingerprint type, shoe size; raw and derived data, egg measure time and distance traveled by a car and calculate (derive) the speed Interpretation of graphs: calculating the gradient of a straight line graph; calculating the area under a straight nine graph; taking tangents of non-linear graphs in order to determine the gradient at a point; explaining trends in both linear and non-linear graphs Scenario You are a trainee microbiological scientist displaying data from an experiment to grow organisms; you will need to show your superiors your competence at handling and comparing collected data with reinforced reliability through including detailed references of error calculations.Criteria AS: Select the appropriate formats for displaying the scientific data that has been collected UP: Interpret scientific data MS: Interpret the trend in the scientific data collected in an experiment ADS: Calculate scientific quantities from linear and non-linear graphs Tasks for Assignment 3 TASK 3. 1 – (AS) Select an appropriate format of displaying a primary and a secondary set of data. (you may use data collected from UP) Ensure that any plots on your scatter grams and line graphs are accurately plotted on graph paper. In all cases, you should include correct labeling of axis and an appropriate title for your graph. Task 3. 2 – (UP) Provide an interpretation of your collected data (both primary and secondary)

Financial Reporting Essay Example | Topics and Well Written Essays - 2500 words - 2

Financial Reporting - Essay Example Here the items are specific and these are compared over a specific accounting period. This method can further be classified into two sub categories, namely absolute dollar and percentage comparison (Edmund, et.al., 2006). b) Vertical Analysis: The vertical analysis on the other hand is when the analysts use separate figures to one specific figure of a financial report. This comparison is generally performed in percentages. Here unlike the horizontal analysis, the analyst use one certain item and compare several different items with it, in the same accounting period. This is generally used to gather enough data to build a trend. This method is also divided into two main styles, income statement analysis and balance sheet analysis (Edmund, et.al., 2006). Narrative reports in annual reports are a very useful tool. These often cover a number of different aspects of the annual report. The narrative reports have been taking up higher portions of the annual reports. It has been noted by Deloitte research that these take up as much as 54% of the total annual reports (Reed, 2008). The role of the narrative reports is very clear, it is mainly present in the annual reports to provide the readers with a clear knowledge of the history of the company, a brief analysis of the changes made in the year, future plans of the company and also the illustrations and photographs that are relevant. This forms a source of information for the readers and to some extent can be considered to be a monologue. The role is to provide for a complete overview of the company. In terms of the analysing the financial statements, these reports provide the analysers with straight forward information. It includes a five to ten years of financial summary which proves to be very beneficial especially if the analyser aims at gaining comparative information over a few years of historical data of the company (Bear,

Examine how a labor agreement is administered Essay

Examine how a labor agreement is administered - Essay Example The allotted time frame under step 2 is 10 workdays. After which, if the issues still remain unresolved, the matter is elevated to the chief steward (to represent the grievant) and the immediate supervisor elevates the concern to the department manager, who is the authorized personnel to review and evaluate the matter. The time allotted for step 3 is 15 days. Step 4 is being addressed by local union president and the vice president for industrial relations. A total of 30 workdays is allotted to mediate the matter. Finally, step 5 already calls for arbitration when the issues still have not been resolved (Chapter 14: The Dynamics of Labor Relations, 2012). â€Å"Thousands of Greeks walked off the job on Thursday in the third general strike of the year, this time called by labor unions to protest a surprise decision by the conservative-led government to close the state broadcaster and put about 2,900 employees out of work† (Kitsantonis, 2013); Personally, I strongly believe that unions are formed to serve the best interests of employees or members of the labor force, especially those whose voices could not be aptly heard and duly represented in an organization. Thus, unions’ effectiveness could be measured in terms of their ability to forge a congenial agreement with management (or authorized representatives of the organization) and with the employees (who are members of the union) regarding labor relations issues and concerns. When clear conditions and stipulations have been clearly set by both parties and have been properly evaluated and agreed upon, it would be an indication that the needs and concerns of the employees are effectively represented and served. Thus, unions’ success in serving the labor relations needs of these employees (and that which are acceptable to management) are the standards of measurement for their

(Elements of Drama) - Drama imitates reality through representation Essay

(Elements of Drama) - Drama imitates reality through representation rather than imitation - Essay Example During the analysis we will look for evidences that can prove our original idea. We’ll overview the tragedies without retelling their plots and going into details. Both pieces of literature belong to the field of tragedy. Let’s briefly remind us of the main requirements to the tragedy proposed by the Aristotle in his famous â€Å"Poetics† and later by the representatives of the Enlightenment. According to Aristotle, tragedy is the imitation in dramatic form of an action which is serious and complete, with occurrences that evoke sympathy and fear /Aristotle, 1999/. Aristotle believes that the writer should use pleasant language that must fit the situation in which it is used. The main characters of a tragedy are noble and well-off people, performing noble actions. Aristotle also made a statement in his work â€Å"Poetics† that tragedy should lead to the catharsis of the audience when they experience and share emotions of the characters and sympathize to their suffering /Aristotle, 1999/. Enlightenment writers proposed that according to its structure tragedy should be composed of five acts and involve three main characters which should be noble and famous. The author should begin the tragedy in the middle of the action, make use of noble language and refrain from the scenes of horror on the stage. From the Aristotle times it was considered that the ideal piece of tragedy should consist of two main parts. They are complication and unraveling. Those incidents that are inessential to the development of the plot are mostly combined with of the action proper in order to mould the complication. So we can say that the complication is the whole amount of actions from the beginning to that part of the play where the course of events changes either for good or for bad. The unraveling then is all that remains. It begins with the end of the complication and extends to the end of the tragedy / Wikipedia/. According to the structure,

The knowledge level and attitudes of pregnant women in passing on Research Paper

The knowledge level and attitudes of pregnant women in passing on sickle cell disease - Research Paper Example The paper tells that sickle cell anemia is an inherited blood disease where the body makes sickle-shaped red blood cells containing abnormal hemoglobin. Sickle cells are stiff and sticky and tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow causes serious infections, pain, and organ damage. Patients are born with it. People who inherit a normal gene from one of the parent and sickle hemoglobin gene from the other parent exhibit a sickle cell trait. People with a sickle cell trait do not have Sickle cell anemia but have one gene that causes the disease. Approximately 2,500 people have sickle cell anaemia. This disease is now prevalent among pregnant women. A study on sickle cell anaemia in pregnant women is very significant for it will impart knowledge on this condition in relation to the woman’s and the in-born child’s health. However, the study is challenging as people have very little knowledge on this disease. The study seeks t he relevance between the level of knowledge and the attitudes of pregnant women with the sickle cell trait from the Mississippi Delta and the sickle cell disease. To achieve this, the researcher will rely on an interview done in Mississippi Delta on Africa-American pregnant women and other relevant literature. Age, marital status, economic status, occupation, and level of education are some of the demographic variables the researcher used. According to the interview, only 20% of the respondents have enough knowledge about the sickle cell trait. ... This implies that there is very little knowledge on the sickle cell trait hence the increased spread of sickle cell anaemia from pregnant women to their inborn children. Contents Contents 4 Background 6 Problem Statement 7 Purpose 8 Research Questions 8 Philosophical Basis 8 Definitions 10 Summary 11 Introduction 12 Concept Development 14 Major Related Studies 15 Summary 17 Study Design 19 Sample 19 Inclusion criteria 19 Interviews 20 Data Collection Plan 20 Ethical Considerations 21 Data Analysis Plan 22 Stage 1 22 Stage 2 22 Stage 3 22 Stage 4 23 Stage 5 23 Stage 6 23 Stage 7 23 Strategies for Rigor and Validity 24 Summary 25 REFERENCES 26 Introduction 32 Demographics of the Sample 32 Major Themes 33 Summary 35 Introduction 37 Limitations 39 Summary 41 REFERENCES 43 DEMOGRAPHIC TOOL 44 INTERVIEW QUESTIONS 46 CONSENT FOR PARTICIPATION IN RESEARCH STUDY 47 ASSENT TO PARTICIPATE IN RESEARCH STUDY 49 CHAPTER 1 INTRODUCTION Background Sickle cell disease is a disorder of the blood that is genetic in nature. Defective hemoglobin molecules that aggregate to form sickle-shaped, elongated, and inflexible rod-like structures that are unable to pass through small blood vessels (Papadakis et al, 2006) characterize it. As they are unable to pass through these small vessels, these sickle-shaped cells pile up together leading to blockages and starving tissues and organs of oxygenated blood. This results in regular periods of pain and is associated with damage to important body organs and tissues and can cause serious medical problems. Blockage may cause problems such as vaso-occlusive, hemolytic, splenic sequestration, and aplastic crises. Other medical conditions that may result include infections, stroke, priapism,

Quality Management Case Study Example | Topics and Well Written Essays - 3750 words

Quality Management - Case Study Example The objective of any business organisation is to generate profit. Quality Management System (QMS) ensures improvement in business situation and for attaining long term growth. In the today's competitive world, quality is crucial factor for survival in any type of organisation. QMS mainly focus on ensuring Quality Assurance and Quality Control. Quality assurance focuses on overall process and to verify that it is carried out in required manner. Quality control is the accepting or rejecting the product. QC is mainly product oriented approach. QMS involves QC, QA and overall business management process. ISO 9001:2000 is a Quality Management Standard. ISO (International Organisation for Standardisation) is established to develop international standard for management or product or services. They used to conduct auditing process for acquiring ISO certification. This can be applied in all kinds of organisation irrespective to its size and type of business. In the today's shipping service sector, ISO 9001:2000 is crucial for meeting customer satisfaction and thus for ensuring profitability. ISO 9001 is the most suitable standard for quality assurance in shipping sector. Shipping sectors are pressurised to provide a proof of quality management system by their clients as well as by authorities. ... Customer Satisfaction usually determines the growth of the company. Customer satisfaction can be attained by quality of products or services. Dissatisfaction of the customer is mainly arises due to failure in meeting their expectations and demand. IDO is providing more sophisticated services to its passengers and this reflected in their in number of customers increased over the years. Generation of profit is the main objective of shipping companies and so they mainly focused on reducing the daily operational expenses rather than providing efficient services. Cost cutting measures can be seen at everywhere but International Maritime Organisation has made rules and regulations. Cost cutting measures might affect the company in the long run. In the short run it may bring additional income. It is not practical to adopt cost cutting on customer service and maintenance of efficiency. 2 Company Profile: Istanbul Deniz Otobusleri (IDO-Istanbul Seabuses and Fast Ferries Inc.) was established in the year 1987 by Istanbul Metropolitan Municipality mainly with the emphasis on public transport by sea. Firstly they started with 10 seabuses and now they are grown into world's largest seabuses and Ferry service provider. Today they are carrying about 90 million passengers and 5 million vehicles yearly. It has been seen that they are continuously developing year by year. Seabuses are reliable and comfortable for passengers of Istanbul and Marmara Sea. Each seabuses has a capacity of about 500 passengers. In addition, they are allocating more funds for investment and development of vessels. There was tremendous increase in the number of passengers travelling over the last few years. IDO

Essay 2 Example | Topics and Well Written Essays - 750 words - 1

2 - Essay Example Type II diabetes makes up 90-95% of diabetes cases. It is caused by a combination of lifestyle and genetic factors. Predisposing factors of this disease include old age, obesity, physical unfitness, genetic factors and sometimes previous gestation diabetes. Obesity is considered to be the primary cause of type II diabetes, with increased cases among children and the youth. Factors such as diet and obesity can be controlled while others like increasing age, gender, and genetics are not. Lack of sleep has also been linked to type II diabetes, believed to have effect on metabolism. High sugar and starch foods and uptake of saturated fats are associated with an increased risk. Genetically there is increased risk of offspring becoming diabetic if parents were diabetic. The abnormal genes can be passed to offspring. The main symptoms of the disease are excess thirst, constant hunger, and frequent urination. Other symptoms include weight loss, blurred vision and slow healing of wounds. Vari ous complications have been associated with type II Diabetes. Diabetes II has been associated with heart disease and stroke, increasing chances by almost twice. Diabetic people are more likely to suffer them at an earlier age than other people. High glucose levels in the blood increases the deposition of fats and cholesterol in blood vessels narrowing them, affecting blood flow and increasing blood pressure. It has also been related with neural disorders. This is when nerve cells are damaged leading to lack of sensation. Most diabetic patients have some form of nerve problem, which can occur in any organ. It has been associated to abnormal cholesterol levels in blood, and the poor absorption of insulin. When blood vessels narrow due to fat deposition, the nerve cells suffer blood supply and may be damaged. Symptoms of nerve damage include numbness, tingling or muscle wasting. Diabetic neuropathy may be peripheral, autonomic, proximal and even focal depending on the nerves affected. Diabetes II can also cause eye damage such as cataracts and glaucoma. The high glucose levels in blood and increased blood pressure can damage various parts of the eye- retina, vitreous, lens, optic nerve. Symptoms of damage to any of this affected include blurred vision, flashing lights, pain or pressure in the eyes, even total blindness. Diabetes II has also been associated with sexual problems such as erectile dysfunction in men. This is the inability to sustain an erection or having no erection at all. Vaginal dryness, painful intercourse and decreased libido in women can also occur in women suffering Diabetes type II. These problems occur due to nerve damage, hormonal changes or reduced blood flow to the genital and vaginal tissues, associated with diabetes. There are various ways of preventing diabetes II. For genetically predisposed individuals, it is critical to maintain proper lifestyles and reduce exposure to risk factors. Weight is a major risk factor of this disease and prevention concentrates on maintaining proper body health. Constant blood sugar testing and monitoring enables early detection of any problem. Blood sugar levels can be tested using home-kits or at a doctors clinic. Overweight people should work on weight reduction in healthy ways. This involves a diet change from high starch and sugars to low starch foods. Their meals should be made using unsaturated fats or even no fat at all. Reduced proportions of starch served and increases proteins and vegetables also ensure

Electronic and mobile commerce solutions Essay Example | Topics and Well Written Essays - 1000 words

Electronic and mobile commerce solutions - Essay Example The service is operational twenty four hour a day everyday across the year. Nevertheless, consumers face challenges of no instant gratification so, delivery may take a while. There is limited consumer service because they have no one to attend to their questions hence can only see the goods without touching them. Bespoke is service offered to a consumer after the consumer has given order for it to be made. The bespoke products include; clothes, vehicles or furniture. This service is good because a consumer is assured of an original and new product of their choice unlike ready to use items on sale. On the other hand, there is lack of supervision by the consumer when their products are made therefore omission errors are inevitable (Andrew et.al, 1997). Consequently, since it is business on the internet, the choice of materials used may not be satisfactory to the ones requested by the consumers. An example is bespokemoda.com An online software solution is an ecommerce website solution that allows selling online by providing software that creates an online store. An example of online software is Shopify solutions. It is easy to set up and synchronizes the store’s products, inventory, orders and consumers between ecommerce site and retail stores. Open sources like magneto and e-commerce solutions is a platform that uses latest web technologies offering professional features, flexibility and controls the activities like shopping online for example Word Press. An Open Source establishes an e-business with convenient product and catalogue browser options, extended consumer management and has an intuitive interface of administration well rated with an extensive network support. Magneto can be used on PHP and MySQL installed in any web server because they are available as free software therefore is prone to hacking and virus attacks (Awad, 2006). In line with electronic commerce is the mobile commerce technology. Mobile commerce is an online commercial transactions

Stem Cell in the Philippines Essay Example for Free

Stem Cell in the Philippines Essay As time goes by, there seems to be a gradual influence of modern sensibility on the way humans perceive the concept of health. In fact, nowadays, there seems to be a blurring of the line between health and wellness. Because of this, it is inevitable that in a modern society, people are now being more conscious with their body and their health is now being a worrisome for them. Thus, science, especially the field of medicine and health sciences, has permeated popular culture in a sense that people have already treated health as a â€Å"religion†. A perfect example of this phenomenon is the rising popularity of stem cell technology because it has already become a transnational activity and issue. Because of this technology’s transnational influence, governments around the world have been very supportive of it. And now, this transnational activity has entered the Philippine healthcare and medical discourse, and issues in its funding are arising. Although stem cell technology is a relatively new and promising technology which will help address health concerns in the country, the federal funding of this technology will only be a burden for the government for it is not a necessity, has questionable benefits, and is impractical and not practicable. This paper, then, seeks to determine the origin of how the concept of stem cell entered the Philippine health and medical discourse as well as issues regarding the federal funding of stem cell research and technology in the country. Furthermore, the writer wants to state that although this paper is arguing that the government should not fund stem cell research in the country, this paper is not trying to argue on the necessity, beneficiality, practicality, and practicability of stem cell research and technology in general, or should it be implemented in the country without federal funding. Also, although some issues of bioethics are going to be tackled in this paper, the writer does not intend to side on certain beliefs of some culture or religion. The discussion on the ethical issues affiliated with the federal funding of stem cell research and technology are entirely made on a social, political, and economic basis. But before the paper begins on enlisting the arguments against the federal funding of stem cell research and technology in the country, it will first provide a background of how it came to the Philippine context. Starting now from what was stated in the introduction, that modern sensibility has gradually influenced people’s perception of the concept of health, it is important to note that with modern technology it has provided an avenue for medical research to continuously uncover new facts and principles that build upon existing knowledge to modify the way we think about biological processes (Trounson xix). In relation to this, throughout the age of medical research, it can be inferred that the reason why there is a continuous activity regarding medical research is because there is a growing interest among scientists in the discovery of new and revolutionary methods of treating certain illnesses that are difficult to be treated in the present like cancer, diabetes, and other degenerative illnesses. It is true that after the nineteenth century, it was thought that â€Å"germs† are the main causes of death among Americans in terms of health-related deaths. But with the birth of the twentieth century and the booming twenties, there has been a paradigm shift in trying to find out the causes of health-related casualties. It was believed then that as generations come, people will be more conscious to degenerative illnesses than that of infectious diseases. Since then, there have been many studies that try to give cure to these degenerative illnesses like cancer, diabetes, etc. And yes, there have been successful discoveries, and there are some failures or â€Å"still ongoing† studies like the attempt to find the cure for diabetes. These then, can be the rationale behind the endless string of studies in the field of medicine and health sciences. However, it is also without doubt that the reason why scientists are so interested with medical research is that, in a social context, the field of medicine and health sciences tries to give pertinent solutions to the people’s needs, wants, and interests in having a healthy lifestyle, being safe from diseases, and in having a beautiful and healthy body. It is intriguing, though, to know that medical research is also being influenced by the interest of the people, of the mass to be more specific. From this, we can then assume that health has been popularized already. In fact, after the first half of the twentieth century, in the final phase of the popularization of health, masses of Americans took a special interest in health as shown in their willingness on spending dramatically increased amounts of money for their health, not only on medical care but gymnasium and similar group memberships and paraphernalia as well to be able to have a healthy lifestyle, thereby blurring the line between health and wellness (Burnham 67). It is then without doubt, according to Trounson that â€Å"in the history of science, certain discoveries have indeed transformed our thinking and created opportunities for major advancement, and so it is with the discovery of stem cell technology†¦Ã¢â‚¬  (xix). Indeed, if there is to be an example of how the field of health and medicinal sciences became popularized, it is the rise of the stem cell. It was November of the year 1998 that stem cell came to the scene of health in popular culture. There were separate announcements in this time by two groups of medical researchers, lead by James A. Thomson of the University of Wisconsin and John Gearhart of the John Hopkins University School of Medicine, about the isolation of the human stem cell. That’s why recently there has been an increased interest among professionals and the public for the stem cell technology other than any fields in biology. But why is there such an interest in stem cell? The ability of the stem cell to provide an in-depth understanding of the biology of the cell and its promising abilities in the field of medicine are the reasons why stem cell is what getting the imagination of the scientists. They are interested in the stem cell because of its property of self-renewal (the ability to produce cells identical to the mother cell) and the ability to make differentiated cells (daughter cells that have limited and focused potential) (Melton and Cowen xxiii). It is a relatively new and promising technology that can lead to the cure for diabetes and more advanced treatment of cancer and other degenerative illnesses. Furthermore, there is a possibility that through regenerative medicine that makes use of stem cell, cancer and heart disease can now be cured. But what makes stem cell technology a buzz among the public is because it has been a hit in the field of cosmetology for stem cell technology can prevent body aging. Also, through the popularization of the stem cell, there have been certain hypotheses that stem cell technology can prolong someone’s life span compares to the average human life span. Because of the popularization of stem cell, it is without doubt that it will become a global issue. Its impact has made transnational influence already. It is because presently, science is a transnational activity – the work and research of scientists have no national boundary (Savulescu and Saunders c3). However, the regulation of science is still being placed under national jurisdiction. It is often that there are different laws and ethical standards in each country, and of course, transnational studies in science are being affected. This implies that there are â€Å"some fundamental cultural, social, [political], and economic forces that drives controversy and conflict, not only in the United States, but in Europe and elsewhere† (Green 265). Due to this, there have been suggestions from different groups from the scientific community specializing in stem cell research and technology that there should be a regulation of stem cell research in different countries because of the potential of this technology especially if the administrations will give importance for the politics of public health (Savulescu and Saunders c3). Later on, because of this transnational influence, there has been a steadfast support from governments all over the world for stem cell technology and in the effort of making stem cell research and technology a transnational activity, also due to the transnational collaboration of scientists from different countries to impart among themselves knowledge about stem cell technology. One of these countries is the United States which pioneered research in this field, where modern medical techniques were developed using this technology. In fact, stem cell research has a long history already in the US. There have been debates regarding the ethical issues associated with stem cell technology, specifically the use of human embryonic stem cells, and issues regarding the federal funding of stem cell research and technology. Only last 2009, US President Barack Obama approved the bill amending the federal funding of stem cell research and technology in the US. It is also important to note that other countries in Asia and other third world countries have been influenced by this transnational activity. In 2004, three private stem cell banks were established in South Africa. Even though, these banks were private, the government has shown interest and support for these private research entities and stem cell research as well because of the Human Tissue Act that allows the use of human embryos that are not more than 14 days old in their research projects. Last March 2012, a group of scientists from the Council for Scientific and Industrial Research in South Africa was able to produce pluripotent stem cells – a feat and a first from a third world country. Meanwhile in Asia, legislation was passed in China that allows the stem cell research and India, another third world county in Asia, has now launched programs using stem cell technology. Singapore is now known as Asia’s Stem Cell Center, where more than forty groups of researchers are to be found, some of it are funded by the government. The Philippines is no exception. A third world country from South East Asia, the country has proved that we are not to be left behind in terms of medical development. Stem cell technology was introduced to the Philippines as a technology used in the medical field of cosmetology. A few examples of the usage of this technology in this field are the alteration or surgery of certain body parts like the nose or breasts and the age-defying medications that fight off skin or body aging. However, discoveries that are exchanged through transnational studies brought to the Philippines some breakthroughs in the use of stem cell technology. That’s why some groups of specialists from the country has already joined the transnational activity that is collaborative stem cell research and used the discoveries in stem cell research in other medical fields other than cosmetology. The group of specialists from the National Kidney and Transplant Institute pioneered the use of stem cell in transplantation in 1990. From then on, the institution has strived to raise the standards of stem cell technology through providing modern facilities and continuous research in the field especially in its usage in Dendritic Cell Vaccine Therapy in collaboration with the Lung Center of the Philippines. Another spearheading group in the field of stem cell technology in the country is the group from The Medical City where they used their discoveries to be the pioneers in the medical technique of personalized molecular medicine in the country through their Regenerative Medicine Program that is lead by Dr. Joyce Bernal. Other groups that have explored stem cell technology in the country are the groups from St. Luke’s Medical Center, Eye Institution, and the Makati Medical Center. Notice that all of the institutions mentioned are private institutions. It is with no doubt that the government might have an interest in a public stem cell center. The interest was then materialized on September 13, 2011 when House Bill No. 5287 or the Stem Cell Center of the Philippines Act of 2010 was passed to the congress. The house bill, introduced by Rep. Carmelo Lazatin, states that a government-run stem cell center has to be established in the country that will be the premier center for research and technology applications of stem cell which will be, in essence, funded by the government. However, we need not to follow the United States in federally funding stem cell research and technology in the country. That although stem cell technology will help address health concerns in the country, the federal funding of the technology will only be a burden fir the government for it is not a necessity, has questionable benefits, and is impractical and not practicable. Firstly, the federal funding of stem cell research is not a necessity. The government has more pressing concerns that should be prioritized first in the health care system. Instead of building new facilities for a single stem cell center, why not improve the infrastructures of public health institutions? We need more public hospitals, especially in the provinces and rural areas where access to medical assistance is scarce, that are also well-equipped with modern advances in medicine and have competitive health workers. This way, we’re already hitting two birds with one stone. Not only that the government is providing more health facilities for the people, but it is also providing jobs for practitioners in medicine like doctors, nurses, midwives, and etc. as well. Through this, the government is making a small step towards lessening underemployment in the country and the number of health professionals that have to work abroad. Also, the government has to address issues regarding the PhilHealth system. According to the Philippine Health System Review, although estimates of PhilHealth coverage of the population vary, there are legitimate concerns that the amount of financial protection provided by the county’s largest insurance program is actually small, at least relative to its infrastructure and available resources (Romualdez et al. 36-39). In addition to this, the government has to financially support instead research in the advanced treatment of epidemic diseases that are more rampant in the country especially among the poor. Secondly, the federal funding of stem cell technology has questionable benefits. The fact the government will fund stem cell research will do ensure that stem cell treatment may be open to the public at a lower price. However, stem cell treatment is not the same for anyone, thus, there will be different processes such that because stem cell treatment must be a personalized treatment, but this will require a lot of costs because specialists will then have to prepare different treatments for different patients. Even so, that the treatment may be open to the public at a lower price might affect the quality of the treatment because (1) price tag may limit potential scope of stem cell treatment, particularly if treatments are individually customized, which may be necessary and (2) such limitations might lead to further problems and will have to require financial support again. Furthermore, Evert and Zavarzadeh argue that: â€Å"†¦[B]ut public funding is itself the immediate form of surplus labor in conducting stem cell research†¦Those who use the excuse of the usefulness of stem cell research for curing illnesses argue that public funding (the social surplus) but privatize its cost of new research (funding it through people’s taxes) but privatize its profits. The new procedures/medicines that will be developed will then be patented by these companies and sold at a high profit back to the people who have provided the funding (through their taxes) for these discoveries.† (116) Indeed, since the government will have to fund a costly research, there will be no choice left than to spend a considerable part of the taxes collected from the public for stem cell research which then raises the question: Who are the actual beneficiaries of federal funding of stem cell research then? Thirdly, the federal funding of stem cell technology is impractical and not practicable because the facilities and technology required in making sure that an advance science like stem cell technology meets high standards are definitely going to be of high maintenance and expensive value. According to a press release of the Department of Health last September 4, 2012 in its website, DOH Secretary Enrique T. Ona announces the proposed 2013 budget of the department. He announces that there is an increase for this year’s healthcare budget. Furthermore, he emphasizes that the budget is allotted in line with the administration’s effort to alleviate poverty, thus the imperative implementation of the Kalusugan Pangkalahatan by the department. He further broke down the components of the budget. He emphasized that 69% of the budget will be used for priority projects, and that the budget will ensure the enrolment of indigenous families under the healthcare system. Moreover, part of the budget is to address concerns regarding the improvement of current medical facilities and work force from the barangay up to the regional level especially in rural areas. Concerns regarding immunization and infectious diseases will be addressed by the budget as well. Ona ends the press release by stating that the budget will help the nation achieve its Millennium Development Goals, and further suggests that to further bolster the sustainability of the budget, the Senate has to pass into legislation the tobacco and alcohol excise tax reform bill and the reproductive health (RH) bill. Ona emphasized in the press release that 69%, a big part of the budget, will be used to address priority projects, activities, and programs in support of KP of the DOH. The following programs are as follows: Subsidy for Health Insurance Premium payment of indigent families to the National Health Insurance Program, Health Facilities Enhancement Program, Implementation of the Doctors to the Barrios and Rural Health Practice Program, Family Health including Responsible Parenting, Expanded Program on Immunization, National Pharmaceutical Policy Development including provision of drugs and medicines, medical and dental supplies to make affordable quality drugs available, Tuberculosis Control, the elimination of diseases as public health threats such as malaria, schistosomiasis, leprosy and filariasis, other infectious diseases and emerging diseases including HIV/AIDS, dengue, food and water-borne disease, and Rabies Control Program. Notice that the programs that are to be prioritized by the majority of the budget are the timely concerns in the health sector in the country. The researcher argues that the remaining percentage of the budget will be unable to financially support the implementation of the Stem Cell Act, and that to include the proposal to the priority programs will be impractical for the research itself is quite inconclusive and will be not practicable for it is an expensive technology. Furthermore Ona said at the press release that, â€Å"It is imperative for us to support the proposed DOH 2013 budget in order to build on the health gains of 2010-2012 and continue the direct, immediate, and substantial health benefits for our people, especially the poor.† Thus, the current proposed budget for the Department of Health is already spot-on on addressing the priorities of the government for the health sector. Without a doubt, stem cell technology is a high maintenance and expensive technology, thus efforts on trying to keep up with certain standards will significantly diminish the budget. However, as Ona said that â€Å"it is an imperative†¦to support the proposed DOH 2013 budget,† with the remaining percentage of the budget in support of other projects, federal funding of stem cell technology seems not practicable. Moreover, stem cell technology has yet inconclusive results that doesn’t address the more pressing concerns in the context of the Philippine health setting – that is, it cannot cure epidemic diseases like malaria, dengue, and typhoid fever which are more rampant in the country. Further on, there are a few select professionals that specializes in stem cell technology, thus the government still need to provide training for certain health professionals so that they can specialize in stem cell technology and treatment for the proposed public stem cell center which, in essence, is an additional expenditure. In the end, the conditions and standards set by stem cell research and technology do not fit in the context of the Philippine health setting. Besides, with the rising protest against stem cell technology because of it not being in tune with the established norms and ethical standards in the country, it will be better off that the government should not fund it because the country is still amidst debates between the implementation of certain bills that go against the foundations of moral standards in the country. Works Cited Burnham, John C. How Superstition Won and Science Lost: Popularizing Science and Health in the United States. New Brunswick: Rutgers, the State Univeristy, 1987. Print. Department of Health, Republic of the Philippines. DOH 2013 Budget Promises Better Health for All Filipinos. Department of Health. Department of Health, Republic of the Philippines, 4 Sept. 2012. Web. 28 July 2013. . Ebert, Teresa L. and Mas’ud Zavarzadeh. Class in Culture. Boulder: Paradigm Publishers, 2008. Print. Green, Ronald M. â€Å"Embryo as Epiphenomenon: Some Cultural, Social, and Economic Forces Driving the Stem Cell Debate.† Global Bioethics: Issues of Conscience for the Twenty-First Century. Ed. Ronald M. Green, Aine Donovan, and Steven A. Jauss. New York: Oxford University Press Inc., 2008. 265. Print Melton, Douglas and Chad Cowen. â€Å"Stemness: Definitions, Criteria, and Standards†. Essentials of Stem Cell Biology. By Robert Lanza, et al. 2nd ed. Toronto: Elsevier Inc., 2009. xxiii. Print. Republic of the Philippines. Cong. House. Rep. Carmelo Lazatin. An Act Establishing Stem Cell Center of the Philippines and Strengthening Research on Stem Cell Technology. 15th Cong., 2nd Sess. HR 5287. Quezon City: Philippine Congress, 2011. Print. Romualdez, Alberto G., Jr., et al. â€Å"The Philippines Health System Review.† Health Systems in Transition 1.2 (2011). 36-39. Print. Savulescu, Julian and Rhodri Saunders. â€Å"The Hinxton Group Considers Transnational Stem Cell Research.† Hastings Center Report 36.1 (2006). c3. Print. Trounson, Alan. â€Å"Why Stem Cell Research.† Essentials of Stem Cell Biology. By Robert Lanza, et al. 2nd ed. Toronto: Elsevier Inc., 2009. xix. Print.

Describing The Assessment Process For Hospital Ward Patient Nursing Essay

Describing The Assessment Process For Hospital Ward Patient Nursing Essay The purpose of this assignment is to describe how a nurse assesses a patient admitted to a hospital ward. It will discuss the history of the patient, any pre-existing medical conditions and the reason they were admitted to the ward. It will also describe the hospital setting, the nursing model used, the risk assessment tools and the information collected from the assessment including the needs identified and what can be and will be done. For the purpose of this assignment the patient, healthcare professionals and the trust must remain anonymous, and will be referred to by pseudonyms. This is in accordance with the Nursing and Midwifery Council (NMC) code, where it clearly states you must respect peoples right to confidentiality (NMC Code, 2008). The patient receiving assessment and care will be referred to as Mrs Ethel Morris. Mrs Ethel Morris was admitted to an orthopaedic trauma ward within the North West. Orthopaedics is the correcting of deformities to the skeletal joints and bones, which have been caused by damage or disease (McFerran, 2008). The ward consisted of many staff, including, nurses, health care assistants, a house officer, medical consultants and physiotherapists. It had three bays, 2 being female, with 8 beds in each and one ten bedded male bay. Also, there were 4 side rooms for patients that needed to be isolated. This was an acute setting with various Orthopaedic conditions, including fractures of all types. The ward admits patients twenty-four hours a day from Accident and Emergency (AE) and transfers from other hospitals. Many of the patients admitted have pre-existing medical conditions, which have to be taken into account alongside their fractures. Ethel was an 82-year-old lady who had fallen whilst she was out shopping with her daughter. She usually walked with a walking stick to aid her balance, but with a previous history of dementia she had forgotten it. Dementia is a progressive deterioration of the brain, caused by structural and chemical changes within the brain. Symptoms include, memory loss, disorientation and changes in personality (Ouldred, 2007). Ethels friend had called an ambulance immediately after the fall, and she was admitted to the ward through accident and emergency. Ethels fall had resulted in a fracture to the neck of femur in her left leg. Marieb (1998) states that the femur is the strongest and largest bone in the body. It consists of a ball, which is known as the head of the femur, which is carried on the neck of femur to the long bone. The neck is the weakest part of the femur. Elderly people are more at risk of falls as their muscles become weaker they become less flexible. This then interferes with their movement and balance, they become more inactive and this increases the risk of falls. (Skelton et al, 1999) Ethel also has osteoporosis, which may have contributed to her fracture. Liscum (1992) states this is the formation of the bone having decreased. Elderly women suffering from osteoporosis, who subsequently sustain a fractured neck of femur, face a fifty percent chance of not walking again. Ethel appeared confused when she arrived on the ward, not knowing how she had come to be in hospital, apart from being aware of the pain and discomfort she was suffering with her hip. The nursing staff reminded Ethel what had happened and checked her drug kardex immediately for pain relief. The doctor who had seen Ethel in AE had written her up for 5ml of oromorph every three hours to control the pain. As oromorph is a controlled drug the nurse checked the dosage with another registered nurse and give it to Ethel orally. Once Ethel was comfortable, the nurse in charge of the bay began the nursing assessment. An assessment is the collection of information from an individual, to establish their needs and develop a clear prospective of their situation. The nursing process relies upon complete and thorough assessments to be a success. A key nursing skill is observing a patient, using all five senses, from listening to gain information, to touching them, assessing their temperature and the condition of their skin (Brooker and Waugh, 2007) Holland et al (2008) also states that an assessment identifies the priority amongst the problems. Data can be collected in a number of different ways, from observing a patient, communicating with them and through their clinical notes. Collection of information can also be made through a secondary source (a relative), if, for example, the primary source (the patient) was unconscious. A named nurse approach was used on the ward; this provides individualised care for the patient from admission to the point of discharge. Named nursing has been developed from primary nursing and is very closely connected to team nursing. (Dawe, 2008) The ward follows a philosophy of care to meet individual needs. Providing patient centred care, meeting individual needs whilst respecting their privacy, dignity, religious and cultural beliefs. They strive to provide high quality care and aim to maximise the potential of individuals to adapt and cope with their conditions. The wards philosophy reflects the National Service Frameworks (NSFs) quality of care. NSFs are in place to improve care in twelve specific areas, including blood pressure, diabetes and mental health. The standards have been implemented nationally and they have all been set certain time scales. (Department of Health (DOH), 2008) The ward uses most of the NSFs depending on which patient they are dealing with. In Ethels case the main ones being blood pressure and older people, which has eight different standards of its own. The nurse firstly recorded Ethels clinical observations, and her saturations appeared to be very low at only 89%. Oxygen saturations are monitored through an electronic device called a pulse oximeter. This reads the oxygen levels of haemoglobin in the arteries and is updated with each pulse (Jevon, 2000). The nurse immediately put her on four litres of oxygen through a nose cannula. A Nose cannula is two small plastic tubes that are inserted into each nostril to administer oxygen. This allows room air to be breathed in at the same time and is secured by tubing over the ears, which fits onto the oxygen cylinder (Brooker and Waugh, 2007). The nurse carried out Ethels assessment by her bedside with the curtains drawn to respect her privacy. As Ethel had dementia her daughter was present for the assessment, to confirm details and help with the process. Barrett et al (2009) states that nurses who carry out disorganized, incomplete assessments, may fail to notice a major concern, or recognize an underlying problem. Nursing models are used in the assessment process in most care settings. They are in place to establish the information that is required, ways it can be gathered for the best results, and the detail that is likely to be more helpful. (Aggleton and Chalmers, 2000) Roper et al (2000) says that models are used to help organize thinking by creating theory. They are global views that have been summarised into systems. There are many different Nursing Models used in clinical settings from Orems self care model to Hendersons model of nursing. Nursing models are used to provide a distinctive framework, to highlight what the patients needs are (Fawcett, 1989). The nursing model used on this ward was Roper Logan and Tierney, Activities of living model. Roper et al (1996) activities of living consists of twelve activities that ensure survival, these are, maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling of body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying. These activities are all as important as each other and one cannot be done without another. The impact of illness will affect more than one of these activities. Roper et al (2000) activities of living was first written in 1980 for nursing practice to be introduced to students. At this time there were five concepts in the model that included activities of living, lifespan and individuality in living. The model became the United Kingdoms most popular model and was also widely used throughout Europe. The nurse used a number of risk assessment tools when assessing Ethel. These were, the malnutrition universal screening tool (MUST), waterlow score, falls risk assessment score for the elderly (FRASE) and the Abbey pain scale. The MUST tool is a nutritional screening tool that recognises over nutrition (obesity) and under nutrition (BAPEN, 2008). The MUST tool was developed so nutritional care would improve in all care settings, by the malnutrition advisory group (MAG) of BAPEN. This tool can be applied to all adult patients, even those who are bed bound (BAPEN, 2008). As a result of the MUST screening tool, Ethel was commenced on a fluid balance chart. This measures the quantity of liquid intake, including Intravenous (IV) fluids and drinks, against the total urine output. Also to be monitored was Ethels food intake, this was to be done on a food chart. This needed updating after every mealtime to show how much was being eaten at different times. The waterlow score is to determine whether a patient is at risk of developing a pressure ulcer (Waterlow, 2005). This tool uses a scoring system, based on patients data. The categories include skin type, age, and continence. (Thompson, 2005) Ethels score was sixteen and she was at high-risk of pressure sores, this was due to her age and mobility. Waterlow (2005) first designed this tool for students use in 1985. It is the most frequent risk assessment tool in the United Kingdom (UK), and is used throughout hospitals, nursing homes and within the community. Pressure ulcers are most common in people with bony surfaces, thin skin and an unhealthy diet. Ethel was found to be a high risk of developing a pressure sore, as she was immobile and had tissue paper skin. The nurse commenced her on a turns chart so she would be rolled or moved every three hours to check and relieve her pressure areas. Also a pressure-relieving mattress was ordered for Ethel, this alternates the body areas under pressure by rotating the air throughout the mattress. (Collins, 2004) The FRASE assessment tool is to assess if a patient is at risk of a fall, taking into account their history and their current state. (Bolton NHS, 2003) Connard developed a fall risk assessment for the elderly in 1996; this was then adapted into a hybrid tool, known as the FRASE tool. It is in similar context to the waterlow score as they both use a points scale to assess the patients level of vulnerability (Kinn and Hood, 2001) The nurse carrying out the assessment began Ethel on a falls care plan, as she was at high-risk from having another fall. A member of staff was to update the care plan each day, noting any unsteadiness or falls. This was going to play a greater part after Ethels operation, as for the time being she was bed bound. The Abbey pain scale was developed in Australia to assess patients pain levels. It was used for individuals who had trouble communicating effectively and who suffered from dementia (Turner-stokes and Higgins, 2007). Abbey (2004) researched and developed the abbey pain scale between 1997 and 2002, and wanted it to be a straightforward and effective tool, used by all health care staff. It consisted of six scales to measure pain including physiological changes to changes in body language. Ethels score was seven and her pain level was acute to chronic during the assessment. The nurse had previously administered 5ml of Oromorph, and because of this the abbey scale was to be updated every hour to monitor the success of the pain relief. During the assessment the nurse collected various information from Ethel, including objective and subjective data. Newson (2008) states that objective data is information collected that can be measured such as temperature and blood pressure. The MUST tool was used to measure Ethels weight, and other observations were recorded, including blood pressure which was 142 systolic and pulse of 84; these were all in satisfactory limits. Any data collected outside the normal range would have been given an early warning score. A doctor and the outreach team need informing if a score totals three or above (Baines and Kanagasundaram, 2008). Also collected was Ethels details that included her, address, date of birth, and her medical history. This can be obtained through medical notes. as original records cannot be tampered with and all records made must be clear and accurate (NMC Code, 2008). Subjective data is information that cannot be measured, for example, information that the patient has given about him or herself, or the nurses insight on the patient (Newson, 2008). The nurse asked Ethel questions to gain this information, if she felt nauseas, or in pain and how she felt about what had happened. Also observed was Ethels behaviour to see if she was agitated or frightened, closed body language showed she was as her arms were wrapped around herself. The nurse also looked at and noted the condition of her skin, nails and hair. Due to Ethels dementia she didnt understand very much of what was going on and didnt know how she had ended up on a hospital ward. Short-term memory is affected alongside some long-term memory loss. This affects the ability to communicate with people and can result in the patient asking the same question repeatedly (LEHR, 2006). The nurse had to keep reassuring Ethel about what had happened, how she ended up on the ward and what her plan was. Communication is a key skill in nursing and it is an essential part in building the patient-nurse relationship. The nurse has to gain lots of information from the patient so it is important to know whether there is a communication barrier, such as a hearing problem or if the patient cannot read or speak the same language. They may need to speak more loudly or slowly so the patient can lip-read (Holland et al 2008). McCabe and Timmins, (2006) states that communication should be focused on the patient, rather than task centred. Listening, empathy and support are essential communication skills in nursing, but the main being to develop a relationship with the patient, and nurses should make time to spend with them. Ethels daughter stayed during the assessment process to help the nurse gain accurate information and communicate effectively with Ethel. The nurse had to speak slowly so she understood, and if she looked confused the nurse would reassure her and repeat the question. This process took a long time but it was necessary so Ethel could gain trust in the nurse. This made her feel more relaxed and comfortable as she could feel the warmth that had developed between them. This assignment has shown how a nurse has an important role in assessing, planning and the implementation of patient care. It has shown that nurses have to obtain data by using a various number of different sources, from assessment tools to observing patients behaviour. The nurse must also use a nursing model to help complete full and accurate assessments of patients and their needs. If there is a communication barrier, nurses must be able to overcome it by using an interpreter or picture cards. The needs identified during the assessment process have to be implemented and care plans introduced. Nurses then have a responsibility to keep regularly updating the care plans by re-assessing the patient on a regular basis.