House of Bernarda Alba- Elements of House

â€Å"Bernarda’s house serves on a number of levels as the central image in the play. How does Lorca use the house to convey his ideas? † In order to arrive at the central idea in Federico Garcia’s last play, â€Å"House of Bernarda Alba†, the title is the first factor to be reflected on. Lorca has not presumably named the play â€Å"Bernarda Alba†, or â€Å"Day of Bernarda Alba†. He had named the play â€Å"House of Bernarda Alba† because it will let the reader draw attention both to Bernarda’s ‘house’ in the sense of Bernarda’s family and to the physical space of house itself, which functions as the central image of the play. The play employs number of themes which are supported by the central image of house. The state of house such as colour, size, temperature, condition and props, which are nonverbal elements all link with the theme which Federico is trying to convey. These features will aid to provide the audience with information about the setting of the play and give insight to the underlying ideas such as dictatorship, purity, fate and choice, freedom, confinement, and sexual oppression. The play commences with the brief description of the house, which aid to communicate the central idea of purity, and fate and choice to the audience; â€Å"Very white inner room in Bernarda’s house. Thick walls. Arched doorways with jute curtains trimmed with black beads and ruffles. † These descriptions are the important elements of the house. Readers are able to obtain the associated idea from the play by having a general understanding of the setting. From the description, first, colour is the element to consider. The walls of the house are all painted white. Because the play is set in Spain, this is the characteristic of homes in the country, since white reflects the sunlight and prevents house from heating. Though, the â€Å"white† colour in a deeper meaning, symbolises the purity and virginity. All the daughters in the house have not married yet, and after the funeral of the second husband, they are not allowed to look at men. Therefore, â€Å"white† also represents the restriction of freedom and choice, where the restriction of choice is derived from evidence that all the rooms are coloured white. The girls have no choice; they cannot choose their destiny. Moreover, the family name ‘Alba’ means white. This colour is seen as a contrary to the black dress of the women in the mourning as they enter the house. The colour black symbolises death and have an effect of foreshadowing the death of the character Adela, a victim of Bernarda’s tyranny. The decoration, props and set of the room also aids in obtaining the idea of dictatorship and confinement. The â€Å"Thick walls† indicates difficulty for the girls to escape the confinement of Bernarda’s control, again suggesting the idea of restriction of the girl’s freedom. From the description of the house,â€Å"Arched doorways with jute curtains trimmed with black beads and ruffles. † the jute curtains are described as being tied with black beads and ruffles. The jute is used for making rope and rough fabric, which symbolises men as ropes are generally used for men’s labour. Therefore it is symbolic for male presence in the home, likely from Bernard’s husband. Though, the black beads indicate the stage of mourning the house is in due to death of Bernarda’s husband. The decoration, â€Å"Pictures of nymphs or legendary kings in improbable landscapes† depicts imaginary places, but it is an alternate reality which girls wish to escape to. In the form of picture and being hung on the white wall emphasise that the fantasy is in place where it is out of reach for the girls. The kings serve as an idea of dictatorship in the house, which in this play, Bernarda is the â€Å"king†, the ruler and the house is her castle. Through the symbolism of heat we see that Lorca makes the reader realise the tension heightening within the characters, which conveys the idea of sexual oppression. At the beginning of the play, Bernarda locks her daughters into the house, away from the outside world. â€Å"There are eighty years of mourning ahead of us. While it lasts not even the wind will get into this house. † Since Bernarda’s husband died, she does not want her daughters to be open to the outside world. Bernarda, trying to be helpful, wants her daughters to be pure and safe. But since the house is locked, no wind will come in the house and therefore heat will build up in the house. If the wind is symbolised as the men, the daughters who are not exposed to the wind (men) builds up their sexual desire. Characters who are not victim of this heat are the male characters that are shown outside the house. They are cooler in the patio or in the fields, suggesting symbolically that they do not suffer from sexual frustration. â€Å" Is the lemonade ready?†¦ Give some to the men. They’re having some on the patio. † The symbolism of what is inside the house and what is outside is also illustrate the idea of freedom and dictatorship. The doors and windows serve as a both barriers and bridges. To the daughters, the outside represents freedom, new life, and sexual fulfilment. Throughout the play, the daughters number of times runs to the window and look at the outside world: the crowd leaving the funeral, men going to work in the fields, and arrival and departure of Pepe el Romano. â€Å"Since he’ll be coming around the corner, you can see him better from the window in your room. [ The Maid exits. Adela hesitates for a moment, then she, too, rushes off towards her room. ] Bernarda strikes Angustius for looking out through the cracks of the back door, maintaining the idea of no freedom and choice for the girls. To Bernarda, the outside of the house represents threat to the reputation of her family name. She does not want her privacy to be spread in public, from her urge to protect her daughters. Bernarda’s power in the house means that sexual activity takes place outside the house as the house is completely under her control. This is evident when the Maid says, â€Å" Rot away, Antonio Maria Benavides, stiff in your woven sit and your high boots! Rot away! Never again will you lift up my skirts behind the back corral! † The back corral is outside the house, which illustrates the lack of restrictions out of the house. Another example is when Pepe and Adela meet. They do not meet at the house, but at the corral. accentuate Lorca was successful in portraying the idea of the play through the central image of house, which included; dictatorship, purity, fate and choice, freedom, confinement, and sexual oppression. Bernarda’s house thus functions as a central image in Lorca’s final play by the use of colour, symbolism and other element of scenic design. The readers are able to obtain the various ideas Lorca is trying to inform, and we also get an idea of how some households were like in Spain during the civil war time. Moreover, this play was written during the Franco’s regime of Spain, which there were fascism involved. Women were treated unfairly in the society, such as their pay. Women could not make choices of their own including marriage. This point reflects the idea of daughters not being able to marry due to commanding power by Bernarda. The fact that these nonverbal elements of the house contributing to the central idea of the play makes the reader think deeply, which let us gain true appreciation for a work Lorca has done for his final moments of life. Words: 1257

Crj 100

Assignment 1 Robert D. Brown Professor Aprille W. Campbell Lithonia Campus CRJ 100 April 13, 2013 STRAYER UNIVERSITY [pic] The criminal justice system is a group of component agencies, which consist of the police, followed by the courts, and the corrections. Each component supports each other to achieve the overall success of the criminal justice system. The system begins with the police where the law is enforced, if a crime is committed it is the policeman duty to investigate and apprehend the criminals for questioning.These are not the only functions of the police according to; Frank Schmalleger Criminal Justice Today Eleventh Edition â€Å"the police enforce the law, investigate crimes, apprehend offenders, reduce and prevent crimes, maintain public order, ensure public safety, provide emergency and related community services, and protect the fundamental rights and freedom of individuals. Many individuals look at the policeman as the â€Å"BAD GUY† but this is a very impor tant job and is critical to the criminal justice system. The criminal courts system is the second phase of the criminal justice system.Is very important to maintain professionalism at all times, fairness, integrity, and impartiality is expected of all criminal justice personnel at every stage of the criminal case processing. During this process it is the duty of the courts to ensure that the highest standards and expectations are met and maintained during the entire criminal courts process. The criminal courts must conduct fair and impartial trials, decide criminal cases, and ensure due process, the idea that laws and legal proceedings must be fair.The Constitution guarantees that the government cannot take away a person's basic rights to ‘life, liberty or property, without due process of law. ‘ Courts have issued numerous rulings about what this means in particular cases, (According to www. lectlaw. com). The courts system must determine guilty or innocent, and only imp ose sentences on guilty personnel. The criminal justice system is charged to uphold the law and be fair throughout out the justice process. Protect the freedom and rights of anyone facing processing by the justice system, and must provide a check on the exercise of power by other justice system agenciesThe third and final stage of the criminal justice system is the correctional agencies, once an offender has been sentenced, the corrections stage begins. Once in the correctional system there are many local procedures and the individual are assigned to confinement facilities and treatment facilities. All correctional facilities are charged to provide safe and humane custody and supervision of offenders. Some criminals with minimal offenses are housed in lower security facilities and have many more privileges. Those with more serious crimes such as rape, killers, and organized crimes are housed in the maximum security facilities.The purpose of the correctional facility is to punish cri minals for their crimes and depending on the charge try to rehabilitate the individual, followed by reform, and reintegrate convicted offenders back into the community. The rehabilitation phase is a lengthy process, which includes counseling, and many different classes that are designed to help the convicted offenders make better choices in life. The correctional facility often has repeat offenders; some of these crimes are Murder, Rape, Robbery, Aggravated Assault, Burglary, Larceny-theft, and Motor Vehicle Theft.While serving time in a correctional facility, the legal and human fights of the convicted must be treated with respect at all times. The criminal justice system is a long and drawn out process, that has many steps to ensure that everyone is entitled to fairness and equal treatment. Without following the correct procedures, in the criminal justice system there could be errors that could include false imprisonment, and could create many other problems for the criminal justi ce system. References Frank Schmalleger Criminal Justice Today Eleventh Edition, Retrieved April 13, 2013 www. lectlaw. com

Asian history Essay Example | Topics and Well Written Essays - 1500 words

Asian history - Essay Example There are three meanings of Tao (Taoism) that Lao-tzu describes in is teachings and philosophical ideas. In the teachings of Taoism, the universe and everything in it follows a mysterious and unidentified force referred to as Tao which is translated plainly as â€Å"The way.† There are three meanings that assist in the understanding of the â€Å"way† described by Lao-tzu. The first meaning is that Tao refers to the ultimate reality in which its diversity cannot be conceived or understood by human nature. The Tao is not equal to anything, but this undefined and superior Tao is the basis for everything; moreover, it is a way that is above all in the universe and a mystery to human beings. In all the things of the world, Tao is definitely the greatest and its existence cannot be denied by anyone or anything. This concept for instance, perceives that Tao is only comparable to God from the Old Testament who is indescribable (Oldmeadow 96). The second meaning of Tao is that i t is definitely immanent in that it is the driving force for all existence and the way that people should follow. The Tao in this case clarifies that the being takes the form of â€Å"flesh† guidance to ever which gives guidance to everything in the world. It is like an intense spirit, assumes a complete being, defeats even the most glittering existences, and exists like dust or spirit. The Tao is like a sprit and not a substance that can be exhausted and it flows forever. The Taoism bible, Tao Te Ching indicates that everything is one regardless of the appearances. It gives life to all things and therefore, Tao is the Mother of the Universe that ensures the existence of everything in it. Smith gives an example that Tao is â€Å"Graceful rather than abrupt, flowing rather than hesitant†¦flows with purpose† (Oldmeadow 96). The third meaning of Tao describes it as the path of human life that is related to the ruler of the universe. This indicates that human beings l ive in accordance with the universe and therefore, living in Tao. In addition, it means finding a balance between negative and positive energies within the universe. Nature should not be damaged or abused but rather humans should strive to maintain naturalness in all things (Oldmeadow 96). The three approaches to Daoism are intellectual (Philosophical), Psycho-physical, and spiritual (religious). Philosophical Daoism is an approach that aims at conserving â€Å"te† or power with teachers focusing of coaching. This philosophical idea was generated by Laozi and Zhuangzi in a concept that focuses on the idea of â€Å"wu wei.† Wu Wei is a term that means Quite Creativity that advocates for preserving life liveliness by ensuring that one does not spend uselessly. The concept advocates for minimal friction or conflicts within interpersonal relationships and in relation to the natural world (Haldan 10). The psycho-physical Daoism approach is the essence of enhancing the level of â€Å"Ch’i† (breath or crucial energy) through proper diet (food and herbs), martial arts (discipline), and meditation (Yoga). Ch’i is increased by ensuring consumption of necessary supplements nutritionally. In addition, absorption of ch’i is achieved from the universe and allowing inner flow through efficient body movements. Physical exercises are necessary in Daoism through activities like Yoga to

Principles of Marketing Report Essay Example | Topics and Well Written Essays - 500 words - 192

Principles of Marketing Report - Essay Example Millennials are diverse and optimistic and are aged between 18 and 36. This generation account for 24 percent of the U.S population only 21 percent of this age group are married meaning their finances are less committed, and they are likely to buy a new product. The income of this demographic is between $25k and $48k. With the younger Millennials aged between 18 and 27 earning $25k and the older ones aged between 27 and 36 earning $48k (Nelsien, 2014). This is a diverse generation composed of Hispanics who make 19 percent, African Americans 14 percent and Asians 5 percent. They are also bilingual, and two-thirds were born in the US. Millennials are also tech-savvy and are likely to visit the company’s website before making an actual visit to a retail store. The company will have to engage them both online and in the media. Millennials like city life and are less likely to live in suburbs. They are social and do not fancy the picket- fence mythology that is associated with the suburbs. With this in mind, the company will target the urban areas of the state (Nelsien, 2014). The targeted areas also have the some highest concentration of Millennials in the state. In their research on Millennials, Nielsen found that three cities in California were in the top ten markets where the concentration of Millennials was high in the US. The areas are San Diego, Los Angeles, and San Francisco. Since San Diego ranks the highest of the three it will be the company’s area of focus in the state (Nielsen, 44). San Diego is also ranked third in the country making it an ideal location for the company to achieve the greatest distribution. These demographics are ideal for the company as a target group because they live in urban environments and live mostly in Western states that make California, an ideal place for the company (Kotler, 2009). Millennials have become influential in America.  

How would George Fredrickson explain Sherman Alexies essay

How would George Fredrickson explain Sherman Alexies - Essay Example Manifest destiny is an idea held by most Americans that America would expand its boundaries throughout the continent. However, slavery and the existence of many tribes hindered the realization of the idea of manifest destiny. Fredrickson uses four models to explain how different ethnic and racial groups that people view as different should relate with one another. However, this essay focuses on one of the models, which is assimilation. The essay will examine Sherman Alexie’s essay and how Sherman applies Fredrickson’s model of assimilation. Assimilation is one of the best models of explaining the racial and ethnic differences between different tribes living in America. Assimilation is an exemplary model of explaining gender identity and the best approach to unite different social groups in the world. The main aim of assimilation is to establish a stable American culture where all ethnic groups are equal. Good understanding of the model requires one to know some terms that the model uses. Some of these terms include dominant cultures, inferior cultures and out-groups among other terms. The model does not call for a racist approach to ethnic and racial integration but rather considers the plight of all cultures involved, including the inferior cultures. However, the dominant culture has some characteristics of superiority and purity. Assimilation involves invitation of minority cultures to join the American culture through ethnic integration. In most cases, few aspects of the minority culture are preserved or passed on to the new integrated American culture. American has applied this model throughout its history. For instance, in the twentieth century, the model applied to large numbers of European immigrants who had migrated to America (Fredrickson 102). Other social theories can apply this model. For instance, equality of men and women can apply the model of assimilation in trying to understand the basic facts surrounding it

The impact of culture on international marketing Essay

The impact of culture on international marketing - Essay Example However it is observed that the new emerging markets have socio-cultural contexts much different from the parallel contexts in western countries. Such cultural differences present themselves both as an opportunity and threat to those organizations expecting to find niche in these markets. If properly researched and read into the cultural dimensions of the foreign market can be woven into the international marketing mix and help establish the global supplier as a trustworthy supplier who understands the local realities. Inadequate research into these aspects and thereby deficient weaving of cultural dimensions in the international marketing mix can prove to be an expensive marketing mistake. This paper takes up a substantive literature review of the impact of cultural dimensions in international marketing mix before taking up a library based approach to examine major arguments in respect of culture, its dimensions, international marketing mix and the impact of cultural dimensions on i nternational marketing mix. A hypothesis that international marketing mix was made more effective by conscious in building within such mix cultural dimensions and their implications was tested through the analysis of major arguments presented in the researched library material. The analysis also found support in some case studies examined from the library resources.

Reflective Paper Essay Example | Topics and Well Written Essays - 2000 words - 3

Reflective Paper - Essay Example The biographical study approach was leveraged in the effort to analyze the entrepreneurship process from the point of view of Spreckels’ life as an immigrant and the evolution of his business enterprises. There are three steps to the method. The first step relates to the analysis of the family and ethnicity of Spreckels. The second step relates to the evolution of his business interests. The third step relates to how his immigrant status shaped his business life (Spiekermann 1-21). The article is well-written and makes use of the biographical study in a very structured fashion. It is informative and allows the reader to glean insights into the entrepreneurship process in general and its demonstration in the life and times of Spreckels (Spiekermann 1-21). The paper details the results of a case study involving the introduction of information technology into Fairfield University, detailing those aspects of the introduction relating to impacts on management and on the economic considerations relating to the acquisition and rollout of a vital pieces of IT, including computing hardware and networking infrastructure. Those two aspects, management impacts from the perspective of faculty use and economic considerations relating to the demand for the IT resources relative to supply and adequacy of the computing investments. The findings include that such exercises require extensive planning, and can be justified from the point of view of learning and efficiency improvements that offset the costs of the investments in IT (Tellis). The researcher detailed the study methodology within the paper in straightforward fashion, and that methodology had four steps. One is the design of the case study. Two is the undertaking of the case study itself. Three is the analysis of the data. Four is the derivation of conclusions and implications, and the crafting of recommendations for next steps (Tellis). The paper relied

Why did I closed down my business Personal Statement

Why did I closed down my business - Personal Statement Example Therefore, lack of focus led to closure of the business. Second reason behind the closing down of the business is lack of trust on the individual skills which are required to run the business to greater heights. Successful entrepreneurs are goal oriented and have internal interest towards the tasks that they undertake (Nieuwenhuizen 2009, p. 9). Business has a varying results and it’s the mandate of the manager to know how to deal with the situations when they arise. Fear of failure is the reason behind the closure of the business as there was a mentality of personal failure in the future. When managing a business that a person does not own a manager is shielded from losses as they go to the stockholders rather than the management (Nieuwenhuizen, 2009, p. 17). Business needs planning and forecasting for it to prosper. An individual entrepreneur who poorly plans for his/her business is likely to be attracted to other opportunities that make him lose focus towards the main goal of achieving success in running the business (Nieuwenhuizen, 2009, p. 9). This was the case as there was poor planning for the future which made you to lose focus when an enticing opportunity

Legal Issues-Business Law Essay Example | Topics and Well Written Essays - 750 words

Legal Issues-Business Law - Essay Example The medium of transaction in the online world may not satisfy the existing legal requirements like a contract should be in writing. Like in the conventional business transactions, there are concerns to regulate online commerce. However, the nature of traditional business and online commerce differ significantly. It is these differences that lead to legal issues to arise. The legal issues relating to online commerce is further compounded by the fact that the existing law is territorial. This implies that the existing law is limited in its application to the persons or activities within the boundaries of a region or a state. Unlike the usual business transactions, online commerce does not occur within the precincts of one physical location. It is crucial that the law should adapt to the online commerce needs, as well as respond to the differences between traditional commerce and online commerce. The law must adapt to online commerce realities by providing a clear guidance for parties engaging in electronic communication and online commerce. This is particularly important in simulating online commerce to reach its full commercial potential. I agree with the article that the law needs to evolve in order to address emerging issues in online communications and particularly online commerce. It is important that the law should be designed to accommodate the traditional aspect and online commerce as well. The book titled â€Å"Code† written by Lawrence Lessig provides insights into the whole concept of online commerce. In order to have a better understanding and its implications, particularly legal perspectives, this paper will highlight what is important in chapters 1, 2 and 3 of the book. In chapter one, the book provides historical background of the advent of online commerce. The chapter discusses the beginning of a new political society after the collapse of communism in Europe. It further points out to the fact that a

Global warming Essay Example | Topics and Well Written Essays - 500 words - 1

Global warming - Essay Example And as the temperature in our waters heats-up, it harms and kills the algae which serve as food to other living organism in the ocean. When that happens, it inadvertently destroys the ecosystem and balance in the ocean. Carbon dioxide emission from our use of fossil fuels like gas, oil and coal has been the primary culprit of global warming as it traps heat to remain in our atmosphere that makes it warmer. Much of carbon dioxide emission comes from our energy use ranging from the electricity that lights our houses to the to the carbon emission of our cars and industrial plants. Fossil fuel has been the primary source of energy as it is cheap and constitutes 85% of the world’s primary energy source. A very significant portion of the greenhouse gas emission in the atmosphere comes from the developing countries. As they are trying to develop their economy and improve their living condition, the construction of industrial plants, warehouses, offices and other implements of production and development consumes unusual amount of energy that contributes to global warming (http://www.globalwarming.org). Such, this comes to fore the debate of whether it will be appropriate to de-carbonize the source of energy considering its greenhouse emission in the atmosphere. Such measure is debated and at odds with the energy requirement of the world especially with the developmental efforts of developing countries that needs tremendous amount of energy. For decarbonizing energy source will make energy expensive and will take toll on the growth of developing countries. Such, it is often argued that the measure of decarbonizing energy source is anti-poor as it stunts the efforts of developing countries to improve its living condition. But everybody agrees that the environment has to be protected and that the continuous warming of our atmosphere will have a serious consequence on the environment; weather pattern changes,

The Color of Water Essay Example for Free

The Color of Water Essay The Color of Water by James McBride was a story about a young boy trying to figure out his racial identity but his mother would not talk about her past or what race she was. All James knew was that she was white living in a black power neighborhood and that fact terrified him. He thought that to grow up he had to know his racial identity but through all the trouble and hard times he went through he learned that his race did not matter. It was his education that was the most important. Ruth attitude about her race effected James through his childhood and as a young adult, she negatively affected his racial development, and Ruth eventually clears up his questions that he has been dying to get answers from. Ruth McBride’s attitude toward her own race affected her son, James McBride, as both a child and as a young adult. Ruth mainly looked down on her race because of her father. All he care about was money and the store, he did not care about his own wife or family. He also molested Ruth when she was a young girl. When James was a young boy he always questioned her about race. He wanted to know if he was black or white and he also asked what color Jesus was. James mother would not completely answer his question. She responded saying that James was a human and education was all that mattered, and that Jesus was the color of water. As a kid, James knew that his mother was white, and that terrified him. He knew that a white lady living in a black neighborhood, also with black kids, was living in danger. James really realized his mother’s danger when Ruth and James were walking home and a man came up and stole Ruth’s purse. James figured out how strong and brave or crazy his mother was when she did not fight the theft back and all she told James was that it was just a purse and it did not matter. When James grew up, he thought that Ruth was going crazy, and he didn’t respect her like he did in the past. If James would have known about his mother’s past, it wouldn’t have change much. He might have been more apologetic for her but that would be about it. Ruth’s impact on James’s racial development is negative, but she had good intentions. James never knows what his racial background is and that bothers him throughout his life. If he would have known what his mother’s background was maybe then he would understand himself in his eyes, but it does not take your race to figure out yourself, it takes learning who you are on the inside. Ruth was trying to make it a positive impact on his racial development. Ruth knew that race did not matter, it was about what was on the inside of the person, but James did not understand that concept. Race never concerned him by saying he was not going to associate himself with a person because of their background but he want to know about their race, and Ruth had no cares about their race, which is a better way to go at it. Ruth offers James confusion as he grapples with his racial identity as a younger boy, but she offers him clarity as a young adult. When James was young, Ruth would answer any of her questions and that bothered him but he knew not to push her to her limit or he would get the belt. He does not know what half of his race is, he know he was black from his father but knew nothing about his mother’s race. Ruth was not ashamed to be a Jew, but she did not support Judaism because of her father, Tateh. She was not hiding the fact that she was a Jew from James but she did not want to think about everything that she ran away from when she left Suffolk, Virginia and her family, more importantly her mother, Hudis Shilksy. When James turns into the young adult he finds out that knowing your race does not help you in life like a good education does. Even though he has learned this Ruth starts to explain his questions about race to him. In the story The Color of Water, James has unanswered questions as a child. At the end of the book James learns about Ruth’s race and he finds out his racial identity. James also finds out God’s color, He is the color of water and water is neither, black or white. Ruth had harmful memories when she was a Jew because of her father and when he might her first husband, Dennis, she changed her faith and found happiness. Ruth’s race affected Ruth which later on affected her son James negatively. Her angry about her past led to James’s confusion about his own racial identity, but later on got all his questions answered.

Care, rationale and outcome in Coronary Care Unit

Care, rationale and outcome in Coronary Care Unit Nurses are required to continue education and upgrading of skills to ensure their patients receive the best possible nursing care. Cardiac nursing is a dedicated nursing practice that gives focused and precise nursing interventions, that are governed by the best practice nursing standards using latest research based facts. Nurses need to have good technique and skill when performing health history and physical assessments to enable them to look after the person as a whole. When nursing patients, nurses need to understand the care they give and reasoning of why they deliver the cares in a certain way. A sound knowledge of assessment and observations help nurses plan, initiate and deliver health care. Without knowledge and rationales the nurse may not deliver cares in the correct manner or have the ability to know when to initiate them. Myocardial infarction is a common cause for admission into the Coronary Care Unit and this case study follows cares, rationales and outcomes in this se tting. Mr Smith (synonym for confidentiality) is a retired 58 year old man that was admitted to a Coronary Care Unit (CCU) via the Emergency Department (ED) of the Atherton Hospital. His admission diagnosis was an Anterior ST Elevated Myocardial Infarction (STEMI), which had already been treated with thrombolytic therapy. On the morning of his admission, he drove himself to the ED with chest pain. He presented with left sided chest pain that radiated to his left jaw and left arm which he scored 10/10 and described as crushing. He was diaphoretic and hypertensive with nausea and vomiting. An ECG showed sinus bradycardia, rate of 60 bpm with hyperacute T waves in V2-V4, that progressed to ST Elevation. Thrombolytic therapy was administered 1 hour of his presenting to ED and within 2 hours of the initial chest pain that commenced at home. His ST segment was elevated approximately 8mm and continued to increase until 70 minutes post thrombolytic when he had 50% resolution of the ST elevation. When he presented to the ED he was given oxygen, morphine, anginine, aspirin, clopidigrel and enoxaparin as first line pharmaceutical treatments. He was transferred that afternoon to Townsville. Mr Smith was not managed in Atherton due to the lack of cardiac catheter services and was transferred for a Percutaneous Coronary Intervention (PCI) the next day where he had a stent placed in his proximal area of his Left Anterior Descending Coronary Artery (LAD). Anterior MIs affect a large surface of the heart, thrombolytic therapy and PCI are the most effective way to treat them (Evans-Murray, 2008 ). His medical history includes a previous STEMI and PCI in 1997, hypercholesterolemia, depression, a ruptured bowel and neck injury from a Motor Vehicle Accident in 1977. Upon further questioning Mr Smith admitted to recently becoming very short of breath whilst mowing the lawn. His risk factors include ex-smoker ceasing in 1993, hypercholesteremia, and stress of brother dying 3 weeks previous. His current medications were aspirin 100mg daily, atorvastatin 20 mg daily and zoloft 200mg daily. Upon arrival to a Townsville Coronary Care Unit (CCU), Mr Smith was pain free. He was connected to continuous cardiac monitoring and admission workup was attended, this includes admission paperwork, ECG, vital signs, mobile Chest x-ray and pathology tests. He was ordered and given stat doses of aspirin, clopidigrel and IV lasix. Mr Smith had an IVT running in his Left hand and an IVC in his Right hand. During the next few days Mr Smith remained febrile 37.6 ° with only a small elevation in white cell count (Huszar, 2007). Four days post infarction, Mr Smith became short of breath (SOB) in the shower and felt light headed; he was monitored in Sinus Rhythm with SaO2 of 95% on 3lpm via nasal cannula. On auscultation, crackles were heard in his lower bases. He was commenced on lasix 20mg daily. This was an indication that his Left Ventricle may not have been functioning adequately. An Echocardiogram was performed to see if the heart wall motion and valves were performing to their best ability (Kern, 2003). The report showed extensive akinesis of the septal, anterior and apex left ventricle wall. His Left Ventricle Ejection Fraction (LEVF) was 35%. Normal values for (LVEF) are 60-65% (Moser Riegel, 2008). He was commenced on a Beta Blocker Cavedilol 6.25mg and Ramipril, which was commenced post PCI and decreased from 2.5mg to 1.25 mg. Use of these medications follow the criteria of the Reducing Risk in Heart Disease (Heart Foundation, 2007). He was sent to the cardiothoracic unit on day 5 with telemetry, to monitor for any changes in his cardiac condition (Jayasekara, 2009) and discharged two days later. A systematic approach should be taken when attending to health history and physical assessment. Throughout the assessment, skin temperature, body odour, mood and appearance are observed. Patients need to feel comfortable with nurses so Mr Smith had the physical assessment explained to him and the reasons for performing it. (Brown, 2007) Mr Smiths physical assessment was completed in the morning prior to his PCI. He seemed relaxed with a jovial manner but at times did appear nervous. He was of a clean well kept appearance and looked younger than his 58 years. Neuro intact. Orientated to time, person and place, GCS 15 and PEARLA. He had a good memory of the event. Cardiovascular monitored in sinus rhythm with frequent PVCs and runs of bigeminy. ECG attached. Febrile- low grade 37.4  °, Pulse 70 bpm, blood pressure 102/69, no peripheral oedema. Jugular venous pressure was approximately 4 cms. Initially I could not palpate the apical pulse but when patient positioned onto his left side it was felt 5th ICS MCL. The reason it is felt is due to the apex of the heart comes into contact with the chest wall (Marieb Hoehn, 2010) No thrills or heaves heard. Mr Smith was warm to touch but not diaphoretic. Upon auscultation of the carotid arteries no bruits were heard. Normal S1 and S2 heart sounds were heard upon auscultation. Good radial, carotid and femoral pulses, Normal 2+ according to pulse volume scale (Lewis, 2007). Mr Smith did look pale and his haemoglobin was 121g/L. Respiratory rate of 18 per minute. Sao2 94% on 2lpm via Nasal cannula. Inspection of the thorax area revealed equal shape, size and symmetry of chest with nil use of accessory muscles. Trachea was midline. Lips and nail beds showed no signs of cyanosis. Diaphragmatic excursion was equal at 4 cms. Anterior, lateral and posterior areas revealed equal air entry, bilaterally in high and mid thoracic zones. Basal zones of thorax areas were bilaterally dull. No adventious sounds heard. Chest X-ray noted that some consolidation in bilateral bases which corresponds to the decreased air entry heard in the bases (Wang, Baumann, Slutsky, Gruber, Jean, 2010). Gastrointestinal revealed an old scar midline under the umbilicus from previous MVA. Bowel sounds heard in all 4 quadrants. Abdomen was soft with no distension. Mr Smiths upper and lower limbs and nail beds showed no signs of cyanosis or clubbing, ulceration or varicose veins. Capillary refill was normal less than 3 seconds in all limbs. Range of motions and strength were bilaterally equal and normal in all 4 limbs. Dorsalis pedis and posterior tibial veins were felt on palpation and scored 2+ bilaterally (Lewis, 2007). Acute coronary syndrome is a common cause of death. Myocardial infarction can have a good mortality rate if treated early. Treatment can be as basic as oxygen, ECG, observations, nitroglycerine through to thrombolytic therapy or a rescue angiogram/angioplasty (Overbaugh, 2009). One is not more important than the other and the patients prognosis is the main concern. Patients complain of chest pain due to myocardial oxygen demand and supply mismatching. The coronary arteries supply the myocardium with blood supply, if the supply is interrupted by a clot, spasm or atherosclerotic plaque the myocardial oxygen requirement (demand) is not met which causes myocardial cells to starve for oxygen supply. This causes the depolarization of the cells to be interrupted and changes will occur on the ECG. (Woods, 1995) Ischemia is shown on the ECG by ST segment elevation. This is primarily an emergency situation as the first 6 hours post infarction is when myocardial damage becomes irreversible (Thelan, 1994). In this time many interventions can be attended to resupply the myocardium with oxygen enriched blood supply. Oxygen is administered for at least the first 48 hours post MI so that tissue hypoxia does not become evident. At times chest pain can be relieved by applying oxygen.(Swearingen Keen, 2001) Vital signs are attended to frequently in CCU, usually hourly, which enables nurses to see any changes in hemodynamic monitoring. Complications of infarctions are heart failure and arrhythmias, due to the large area of heart wall damaged. When Mr Smith suddenly became SOB and adventious breath sounds were heard on auscultation, it alerted medical staff that his left side of the heart was congested and not efficiently pumping. Early indications of Left ventricular failure are shortness of breath (SOB) and intolerance of beta blockers, nitrates, or ACE inhibitors. Mr Smith showed signs of SOB and lightheadedness, which may be due to Ramipril ( ACE inhibitor) that was then decreased in dose (Schell Puntillo, 2006). Continuous cardiac monitoring enables nurses to keep constant checks on heart rates and rhythms, it gives nurses the ability to act on any life threatening rhythms immediately or enables them with the knowledge of impending problems that could arise (Drew, 2004). Premature Ventricular Contractions (PVC), Ventricular Tachycardia (VT) or Ventricular Fibrillation(VF) are the most likely rythyms to be noted due to the scarring or necrotic myocardial tissue (Aehlert eInstruction Corp., 2011). Mr Smith was noted to have occasional PVCs that became more frequent until he was monitored in bigeminy, which can lead to runs of VT (Huszar, 2007). Monitored patients can be observed in pulseless VT/ VF via the central monitor at the nurses station and can be immediately defibrillated, whereas if a ward patient collapses a monitor needs to be attached before the heart rhythm can be established and treatment given (McDonough, 2009). ST Segment monitoring shows significant changes in monitoring that can indicate ischemia or infarction. Central monitors should have regular nurse surveillance, will alarm if there is a significant change to the ST segment. Changes occur with or without complaints of chest pain or shortness of breath, indicating myocardial oxygen mismatch (Smith, 2008). Patients need to advised to tell staff of chest pain whilst being monitored. Some patients assume nursing staff know from the monitor when they are experiencing chest pain. (Swearingen Keen, 2001) An ECG can be performed to show any significant changes of the heart. Mr Smith showed ST segment changes in his anterior /septal (V3 V4 position) aspect of his left ventricle. This area is supplied by the Left Anterior Descending Coronary Artery. Treatment does not differ depending on which area of the heart is affected. All areas require oxygen supply. While in hospital Mr Smith was ordered serial ECGs, these are taken daily to show any changes. Expected changes expected post MI are the development of a pathological Q wave. Q waves indicate the necrosis of myocardial tissue and specifically in V1 to V4 indicates anteroseptal infarction (Dubin, 2000) Mr Smith was initially given morphine, an opioid that relieves pain by decreasing myocardial oxygen demand by decreasing the Autonomic Nervous System and decreasing anxiety (Lewis, 2007). Nitro-glycerine, was ordered as a smooth muscle relaxant that vasodilates the vessels to restore blood supply if the mismatch is due to a coronary spasm(Yassin, 2007). Aspirin is given daily indefinitely as it is a antiplatelet aggregation inhibitor that Hung, 2008 states is proven for secondary prevention of myocardial infarction, stroke and cardiovascular death in both men and women. He also discusses the combined use of clopidigrel and aspirin to reduce subacute stent thrombosis after PCIs (Hung, 2008). Thrombolytic therapy is given within the first 6 hours of chest pain.(Levin, 2008) Tenecteplase 90mg was given. Thrombolytic Therapy is given to dispel the clot and allow blood flow to the affected area. It can take up to 90 minutes for full resolution to occur (Goldberger,2010). There are certain considerations that medical staff must ensure prior to administration of this therapy, these include an absence of CVA/TIAs or surgery in the last 12 weeks (Gibson, 2009). Once administered ECGs are taken in 15-30 min intervals to see changes of ST segment, showing that myocardial blood supply and depolarization being restored. Cardiac markers are Pathology tests that also give evidence of myocardial damage. When cardiac cells are damaged the membrane walls leak these substances into the blood stream (Aehlert eInstruction Corp., 2011). Myoglobin, Creatine kinase (CK), Troponin T and Troponin I are myocardial specific and along with ST elevation can be evident of a STEMI. Ëarly in ischaemia the ST segment may lose the ST-T wave slope and appear straight. Then as the T wave broadens and the ST segment rises, the segment loses its concave form and becomes upwardly convex with elevations (Moser Riegel, 2008). Non STEMI do not have a significant change on the ECG only cardiac markers alter. These markers usually peak between 15-24 hours post infarction and remain elevated for 2-3days (Huszar, 2007) Creatine Kinase has normal value of 45-250 U/L and Mr Smiths on admission was 4290 U/L decreasing to 800 U/L, 2 days post. Troponin T normal values are à ¢Ã¢â‚¬ °Ã‚ ¤0.03ug/L but Mr Smiths ranged from 14.20ug/L at 2200hours on the day of MI, to 4.39ug/L 2 days later. Serial pathology tests are taken usually every 6 hours for the first 24 hours. Mr Smith was taken for a PCI the day after his MI. He had a stent put in his proximal area of his Left anterior descending coronary artery (LAD) in the Cardiac Catheter Lab. Mr Smiths had a PCI even though his blood supply looked like it had been reinstated, the stent will prevent clot formation again and reocclussion (Cannon, 2010). He was then transferred back to CCU and remained RIB overnight. He had a femoseal deployed into his groin to occlude the opening of the femoral vessel used for this procedure. Nurses need to do regular neurovascular and pedal pulse observations to check for bleeding or vessel occlusion (Shoulders-Odom, 2008). Mr Smith needed to be educated on his procedure pre and post operative. He has previously been for this procedure but needed re-education. It must be a daunting experience to be given twilight sedation whist having the PCI. Mr Smiths last procedure was 13 years ago which would see many new techniques being practiced that he was not familiar with. His post op education included the importance of keeping his affected leg still and care of his affected groin.(Moser Riegel, 2008) Myocardial Infarction education can be given to him at the same time but this is information that needs to be reiterated continually during his hospitalization(Lewis, 2007). He and his family need to be aware of the risk of reinfarction especially in the next 2 weeks post MI as the heart muscle is still weak and irritable and increase in activity can cause another MI. This is the time that patients start to resume their normal daily activities after hospitalization and are at the most risk. (Douglas, 2010) Documentation is very important and needs to be filled out correctly as it is a legal document (Lewis, 2007). The CCUs clinical pathway for infarction indicated strict rest in bed with commode privileges for the first 48 hours, this decreases the need for myocardial oxygen. This is difficult for active patients but it needs to be strictly followed. Due to immobility other medical complications can arise, pneumonia and decreased gas exchange, deep vein thrombosis or emboli are common. To prevent these patients are encouraged to attend to hourly Deep Breathing Exercises (DBE), leg exercises and triflow. Patients can also be sat in an upright position which increases venous return (Thelan, 1994). Anticoagulants prevent clot formation therefore Mr Smith was administered daily Clexane 90mg post PCI until discharge and administered Abciximab (Reopro) for 12 hours post PCI. To test the adequacy of anticoagulants, INR and APPT are taken to check patients dose is therapeutic. Problems with ad ministering the anticoagulant after thrombolytic therapy is bleeding (Yassin, 2007). Mr Smith was noted to have large traces of blood in his urinalysis and was sent for a Pelvic Ultrasound to be sure there was no other complications, the ultrasound was NAD. Prior to discharge Mr Smith was educated on his new regime of medications and the importance of medication compliance to decrease his risks of further cardiac complications (Albert, 2008). Nurses if experienced and up to date with current research and practices can work alongside medical staff and initiate nursing cares that are in the best interest of patients. Coronary Care Units must have confident and competent nurses to run the ward as most times they make significant decisions on implementation of nursing care. When Doctors have confidence in the nurse looking after their patients they will respect and listen to nurses opinions because they know they are educated and empowered with knowledge.

Consequences of child abuse and neglect

Consequences of child abuse and neglect Introduction Child abuse and neglect are an unfortunate reality for many children in our community. The past thirty years have witnessed a growth in our awareness of and attention to the problems faced by children exposed to violence in their homes. The consequences of maltreatment can be devastating. For over 30 years, clinicians have described the effects of child abuse and neglect on the physical, psychological, cognitive, and behavioral development of children. Physical consequences range from minor injuries to severe brain damage and even death. Psychological consequences range from chronic low self-esteem to severe dissociative states. The cognitive effects of abuse range from attentional problems and learning disorders to severe organic brain syndromes. Behaviorally, the consequences of abuse range from poor peer relations all the way to extraordinarily violent behaviors. Thus, the consequences of abuse and neglect affect the victims themselves and the society in which they live. REVIEW OF DEFINITIONS A 1989 conference convened by the National Institute of Child Health and Human Development recommended that maltreatment be defined as behavior towards another person, which (a) is outside the norms of conduct, and (b) entails a substantial risk of causing physical or emotional harm. Behaviors included will consist of actions and omissions, ones that are intentional and ones that are unintentional (Christoffel et al., 1992). The term child maltreatment refers to a broad range of behaviors that involve risk for the child. Four general categories of child maltreatment are now generally recognized: (1) physical abuse, (2) sexual abuse, (3) neglect, and (4) emotional maltreatment. Each category, in turn, covers a range of behaviors. Physical abuse includes scalding, beatings with an object, severe physical punishment, and a rare form of the abuse called Munchausen by proxy, wherein an adult will feign or induce illness in a child in order to attract medical attention and support. Sexual abuse includes incest, sexual assault by a relative or stranger, fondling of genital areas, exposure to indecent acts, sexual rituals, or involvement in child pornography. Child neglect is the presence of certain deficiencies in caretaker obligations (usually the parent, although neglect can be found in residential centers or foster care homes) that harm the childs psychological and/or physical health. Child neglect covers a range of behaviors including educational, supervisory, medical, physical, and emotional neglect, and abandonment, often complicated by cultural and contextual factors. Several authors (Mrazek and Mrazek, 1985; Zuravin, 1991) have noted the relative lack of attention to definitional issues of child neglect, particularly given its greater reported prevalence (NCCAN, 1981, 1988b; Wolock and Horowitz, 1984). Emotional maltreatment, a recently recognized form of child victimization, includes such acts as verbal abuse and belittlement, symbolic acts designed to terror ize a child, and lack of nurturance or emotional availability by caregivers. Effects of child abuse and neglect Physical Health Consequence The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe (broken bones, hemorrhage, or even death). In some cases the physical effects are temporary; however, the pain and suffering they cause a child should not be discounted. Meanwhile, the long-term impact of child abuse and neglect on physical health is just beginning to be explored. According to the National Survey of Child and Adolescent Well-Being (NSCAW), more than one-quarter of children who had been in foster care for longer than 12 months had some lasting or recurring health problem (Administration for Children and Families, Office of Planning, Research and Evaluation [ACF/ OPRE], 2004a). Below are some outcomes researchers have identified: Shaken baby syndrome: Shaking a baby is a common form of child abuse. The injuries caused by shaking a baby may not be immediately noticeable and may include bleeding in the eye or brain, damage to the spinal cord and neck, and rib or bone fractures (National Institute of Neurological Disorders and Stroke, 2007). Impaired brain development: Child abuse and neglect have been shown, in some cases, to cause important regions of the brain to fail to form or grow properly, resulting in impaired development (De Bellis Thomas, 2003). These alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities (Watts-English, Fortson, Gibler, Hooper, De Bellis, 2006). NSCAW found more than three-quarters of foster children between 1 and 2 years of age to be at medium to high risk for problems with brain development, as opposed to less than half of children in a control sample (ACF/ OPRE, 2004a). Poor physical health: Several studies have shown a relationship between various forms of household dysfunction (including childhood abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults who experienced abuse or neglect during childhood are more likely to suffer from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers (Springer, Sheridan, Kuo, Carnes, 2007). Psychological Consequence The immediate emotional effects of abuse and neglectà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬isolation, fear, and an inability to trustà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬can translate into lifelong consequences, including low self-esteem, depression, and relationship difficulties. Researchers have identified links between child abuse and neglect and the following: Difficulties during infancy: Depression and withdrawal symptoms were common among children as young as 3 who experienced emotional, physical, or environmental neglect (Dubowitz, Papas, Black, Starr, 2002). Poor mental and emotional health: In one long-term study, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts (Silverman, Reinherz, Giaconia, 1996). Other psychological and emotional conditions associated with abuse and neglect include panic disorder, dissociative disorders, attention-deficit/ hyperactivity disorder, depression, anger, posttraumatic stress disorder, and reactive attachment disorder (Teicher, 2000; De Bellis Thomas, 2003; Springer, Sheridan, Kuo, Carnes, 2007). Cognitive difficulties: NSCAW found that children placed in out-of-home care due to abuse or neglect tended to score lower than the general population on measures of cognitive capacity, language development, and academic achievement (U.S. Department of Health and Human Services, 2003). A 1999 LONGSCAN study also found a relationship between substantiated child maltreatment and poor academic performance and classroom functioning for school-age children (Zolotor, Kotch, Dufort, Winsor, Catellier, 1999). Social difficulties: Children who experience rejection or neglect are more likely to develop antisocial traits as they grow up. Parental neglect is also associated with borderline personality disorders and violent behavior (Schore, 2003). Behavioural Consequences Not all victims of child abuse and neglect will experience behavioral consequences. However, behavioral problems appear to be more likely among this group, even at a young age. An NSCAW survey of children ages 3 to 5 in foster care found these children displayed clinical or borderline levels of behavioral problems at a rate more than twice that of the general population (ACF, 2004b). Later in life, child abuse and neglect appear to make the following more likely: Difficulties during adolescence: Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen pregnancy, low academic achievement, drug use, and mental health problems (Kelley, Thornberry, Smith, 1997). Other studies suggest that abused or neglected children are more likely to engage in sexual risk-taking as they reach adolescence, thereby increasing their chances of contracting a sexually transmitted disease (Johnson, Rew, Sternglanz, 2006). Juvenile delinquency and adult criminality: According to a National Institute of Justice study, abused and neglected children were 11 times more likely to be arrested for criminal behavior as a juvenile, 2.7 times more likely to be arrested for violent and criminal behavior as an adult, and 3.1 times more likely to be arrested for one of many forms of violent crime (juvenile or adult) (English, Widom, Brandford, 2004). Alcohol and other drug abuse: Research consistently reflects an increased likelihood that abused and neglected children will smoke cigarettes, abuse alcohol, or take illicit drugs during their lifetime (Dube et al., 2001). According to a report from the National Institute on Drug Abuse, as many as two-thirds of people in drug treatment programs reported being abused as children (Swan, 1998). Abusive behavior: Abusive parents often have experienced abuse during their own childhoods. It is estimated approximately one-third of abused and neglected children will eventually victimize their own children. Societal Consequences While child abuse and neglect almost always occur within the family, the impact does not end there. Society as a whole pays a price for child abuse and neglect, in terms of both direct and indirect costs. Direct costs: Direct costs include those associated with maintaining a child welfare system to investigate and respond to allegations of child abuse and neglect, as well as expenditures by the judicial, law enforcement, health, and mental health systems. Indirect costs: Indirect costs represent the long-term economic consequences of child abuse and neglect. These include costs associated with juvenile and adult criminal activity, mental illness, substance abuse, and domestic violence. They can also include loss of productivity due to unemployment and underemployment, the cost of special education services, and increased use of the health care system. Possible Treatment Strategies Descriptions of treatment for child sexual abuse, physical abuse, and neglect have been reported separately within the literature, with much more attention paid to treatment of child sexual abuse. In fact, there are relatively few studies or reports of individual treatment of the physically abused or neglected child. In practice, however, treatment programs often address individual needs of children. The emphasis here is cognitive behavioral treatments, as these have shown the greatest effects in controlled studies. General Issues for Treatment First and foremost, it is important that the child be safe from potential harm from the offender as well as from non-believing or unsupportive family members. In addition to ethical issues of treating a child within an unsafe environment, treatment of abuse related problems is not likely to be effective if the child is living in such conditions. The targets for treatment are determined to a large degree by the childs presenting symptoms and are defined following the initial assessment. There are, however, certain overriding goals that should guide the treatment process. Treatment should be directive and focused on the abuse or trauma itself. Treatment approaches: Help and encourage the child to talk and think about the abuse/neglect without embarrassment or significant anxiety. Help the child to modulate and express feelings about the abuse; Reduce the intensity and frequency of behavioral and emotional symptoms; Clarify and change distorted, inaccurate, or unhealthy thinking patterns that might negatively affect the childs view of self and others; Help the child develop healthier attachments; Strengthen the childs coping skills Enhance social skills, and Educate the child regarding self-protective strategies. An additional goal, accomplished specifically through group therapy is to reduce the childs sense of isolation or stigma through exposure to other victims of abuse. Group treatment for victims of child physical abuse can have positive effects but may also be associated with increased behavior problems. Therefore the therapist should be cautious and monitor group participants behavior closely (Kolko Swenson, 2002). Treatment strategies Strategies for treating the abused child are varied and are used as appropriate to the childs presenting problems. Recommended treatment approaches include (Finkelhor Berliner, 1995): 1) cognitive-behavioral strategies, 2) graduated exposure to aspects of the abusive experience, 3) relaxation training , 4) education regarding abuse process and effects of abuse, 5) skills training, 6) supportive strategies teaching self-protective strategies, 7) behavioral strategies/parent training. Strategies for treating abuse victims which have received some scientific support, have been those derived from a cognitive behavioral perspective and which focus on the abuse itself. Cognitive behavioral strategies typically address the childs thinking patterns, affective response, and behavioral reactions to the abuse. In particular, the childs attributions of blame and responsibility for the abuse should be addressed. That is, the child should be helped to recognize that it is adults rather than children who are responsible for healthy parent-child interactions (Finkelhor Berliner, 1995). Gradual exposure or discussion of abuse experiences helps to reduce the childs anxiety and embarrassment and provides opportunities to modify inaccurate or self-defeating thinking processes. Relaxation training further addresses the childs fear or anxiety reaction to abuse-related cues and can facilitate more effective affect regulation. Educational approaches facilitate clarification of misperc eptions developed in response to the abuse. Skills training are used to teach the child coping strategies to manage negative emotions and to improve social/interpersonal functioning. Supportive techniques also are required, as the child may be coping with non-supportive family members, upcoming court proceedings, and/or negative reactions from peers. Education in the use of self-protective strategies is important for minimizing the likelihood that the child will be abused/neglected again (Finkelhor Berliner, 1995). It is important to establish a safety plan within the home, delineate danger cues, and identify support persons in the childs environment to decrease the secrecy within previously abusive/neglectful families. This, in turn, is expected to minimize the risk of repeated abuse. Age-related issues The treatment approach should be appropriate to the age of the child. For example, a four year old child should not be expected to come into a therapist or counselors office, sit on a couch, and recount the details of her abuse. The therapist can utilize a variety of play techniques to encourage the young child to communicate about his or her abuse. Many cognitive behavioral strategies which are used with adolescents and adults can be modified or simplified for use with young children (Kolko Swenson, 2002). For example, there are numerous scripts for relaxation training which are humorous and which engage the child in the therapeutic process. Puppets and drawings are useful as well for helping children to tell of their experiences, learn strategies for coping with negative emotions, and behaving in a more organized and directed manner. In contrast, older children and adolescents are more able to directly communicate their thoughts and feelings about their abuse experiences. It is recommended, however, that the therapist be flexible in method of approach. Drawings, therapeutic stories, and therapeutic games can be very helpful for engaging children of all ages. Treatment duration There are no clear guidelines regarding the length of treatment for the abused or neglected child, although most studies of treatment effectiveness have examined short-term interventions. Clinical experience suggests that while some children can resolve their negative reactions to the abuse in a relatively brief period (i.e., 12 16 sessions), many will require more extended treatment. Typically, treatment length will be determined by the nature of the childs social, behavioral, or emotional difficulties. That is, the child who is experiencing a wide array of problems of a serious nature is likely to require more intensive treatment over a long period of time. In addition, the quality of support that the child is receiving from the non-offending caregiver or other family members will affect treatment length. That is, child problems are typically more significant if there is no support coming from the non-offending caregiver, and, therefore, treatment of the child whose non-offending parent is disbelieving or non-supportive is likely to be more extensive than that of a child who has the support of a non-offending parent. Additional treatment approaches Family involvement in treatment Children should not be treated in isolation of intervention with their family and/or current living situation. Thus, many in the field recognize the importance of incorporating family members, particularly parents or primary caregivers, into treatment addressing abuse and neglect (Kolko Swenson, 2002). The goal of family work is to reduce the risk of recurring abuse, increase safety, and promote healthy growth and development of all family members. Family approaches address the needs of all family members while also targeting the interactions between them. However, it is difficult to specify the precise structure of therapeutic work addressing family issues. The specific approach with the family will vary; depending upon the childs living context and the level of acknowledgement of abuse by offender(s) and non-offending caregiver(s). For example, a child who has been placed in foster care due to parent-child abuse and lack of a supportive non-offending caregiver will be addressing d ifferent issues than the child who is receiving support from a non-offending caregiver and/or whose abusive parent is acknowledging abuse and is committed to treatment. Family work is not indicated if the child is in out-of-home placement and there are no plans for reunification. Treatment involving the entire family and that has as a goal family reunification is generally of a much longer duration than individual treatment of the child. Initial stages involve the child, offender, and non-offending caregiver in individual treatment, allowing members to first address individual issues related to the development and outcomes of the abuse. In addition, marital work is recommended to address relational issues between the childs caregivers prior to any reunification efforts. If early work with caregivers is successful, family therapy may ensue. The clarification session can serve as the bridge between each family members individual treatment and treatment addressing the entire familys needs. Therapeutic interventions with caregivers typically begin with individual sessions addressing the abuse itself, as well as the specific needs of family members. These stages of treatment encourage assumption of responsibility by the offender and non-offending caregiver(s). An alleged perpetrator who is denying having abused the child or a non-offending parent who does not believe that abuse has occurred cannot fully benefit from abuse-specific treatment. Therefore, initial treatment efforts focus on reducing denial. If such efforts fail, family treatment is contraindicated. If the offender is acknowledging having abused and/or neglected the child, then he or she can engage in abuse-specific treatment that addresses faulty thinking patterns, behavioral actions, emotional responses, and physiologic reactions. Sexual abuse offenders will be targeting their sexual arousal to children, thought patterns which allow them to justify perpetrating sexual abuse, and examining the behavioral repertoire that lead up to abuse. Physical abuse offenders will learn strategies for managing anger, parenting skills, and non-physical means of discipline. Caregivers who are neglectful will receive assistance in securing basic goods and resources, will learn parenting strategies and be taught skills which facilitate independent management of the children and familys needs. In the treatment of all forms of abuse it is important to address attributions of blame. Invariably child abuse/neglect offenders minimize their own responsibility for the abuse/neglect and project blame on other family members, most often the victim. The abuse clarification process (Lipovsky et al., 1998), which addresses such attributions, should be included in treatment if at all possible. The abuse clarification involves an acknowledging offender who has proceeded through treatment to a sufficient degree to be able to clarify the nature of the abuse, assume responsibility for the abuse, demonstrate empathy for the childs responses to the abuse, and begin to participate in the development of a family safety plan. The abuse clarification process is addressed in the offenders individual or group treatment and is ongoing, often for many months before an abuse clarification session is possible. The abuse clarification session provides the opportunity for the offender to read a letter written to the child victim that focuses on the offenders assumption of responsibility, empathy for the child, and commitment to developing the family safety plan. This session is likely to occur some months after the abuse are disclosed, allowing the offender sufficient opportunity to engage in and progress in his/her own treatment. Ideally, at least one supportive adult should be included in the treatment process. Several programs around the country have targeted non-caregivers parents in their approach to treating child sexual abuse and have found success with such an approach.16, 32, 50 Treatment with non-offending caregivers also must also be built upon a foundation of acknowledgement that abuse has occurred. In most cases, where non-offending caregivers believe and support their child, family work addresses the caregivers individual needs. Early treatment strategies must address denial if it is present. Treatment of the non-offending caregiver(s) addresses his/her emotional responses to the abuse and individual mental health needs. In addition, treatment includes focus on the caregivers responses to the childs abuse, education regarding the childs symptoms and provides assistance for developing strategies for reducing these symptoms. It is recommended that the non-offending parent be involved in an abuse protection clarification (Wilson Ralston, 1995). This process is similar to the abuse clarification conducted with the offender. The protection clarification involves clarification of the abuse, commitment to protection of the child, and participation in the development of a family safety plan. The protection clarification may be initiated relatively early in treatment, especially if the non-offending parent believes and supports the child from the time of disclosure. Long-term family resolution of parent-child abuse is a life-long process and involves changing many aspects of family functioning. Some type of resolution must occur in all cases, regardless of whether the child or offender has been removed from the home. Resolution may take the form of helping a child adjust to permanent foster care and cope with a non-supportive family or may involve reunification of the family following the successful completion of individual/group treatment, the clarification process, and family therapy which addresses a safety plan, alteration of family members rigid patterns of thinking and behaving (Saunders Meinig, 2000). Home-Based Services and Family Preservation Services Home-based services and family preservation services address the overall needs of families, include both children and parents, and focus directly on contextual factors, such as poverty, single parenthood, and marital discord, that increase stress, weaken families, and elicit aggressive behavior (Kolko, in press). These programs target functional relationships among diverse individual, family, and systemic problems by combining traditional social work with various therapeutic counseling approaches. The use of home-based services has been advocated in response to the multiple problems found among abusive and neglectful families, difficulties in providing services in a traditional format, and interests in reducing the number of children placed in foster care. The breadth of potential family dysfunction has encouraged hands-on approaches that address risk factors at multiple levels of the family system, such as financial problems, disruption, social isolation, and behavioral deviance (Frankel, 1988). Self-Help Services for Abusive Adults Self-help support and treatment programs are based on the premise that individuals can benefit from learning about the victimization experiences of others. These programs have attracted popular support in a wide range of health services, including the treatment of alcoholism, weight loss, and rape counseling programs, and they have also been applied in the treatment of both physically and sexually abusive adults.. A self-help component has also been integrated into treatment programs for intra-familial sexual abuse (Giaretto, 1982). Parental Enhancement Most parental enhancement programs focus on training abusive parents in child management (e.g., effective discipline), childrearing (e.g., infant stimulation), and self-control skills (e.g., anger control). Programs for neglectful parents typically focus on areas such as nutrition, homemaking, and child care. Parental enhancement programs may help some families who experience child management problems when a sexually abusive father is removed from the home. In these cases, child management skills help develop positive child- parent interaction in sexually abusive families. The efficacy of parent training approaches for physically abusive parents has been supported by various single-case studies, one study using repeated measures, and group design studies (Azar and Twentyman, 1984; Crimmins et al., 1984; Gilbert, 1976; Jeffrey, 1976; Reid et al., 1981; Szykula and Fleischman, 1985; Wolfe et al., 1981a,b, 1982). Studies of multiple approaches and diverse populations have provided consistent evidence that parents can acquire behavioral skills and use them in interactions with their children, at least in clinical settings (Golub et al., 1987). Some evidence suggests that training has reduced parental distress or symptomatology and, in some instances, improved child functioning (Wolfe et al., 1988) and reduced the likelihood of child placement (Szykula and Fleischman, 1985). Efforts to expand the scope of parental enhancement programs have fostered attention to parents cognitive-attributional and affective repertoires (see Azar and Siegel, 1990). Therapeuti c directions highlight the need to incorporate diverse skills and to evaluate the effectiveness of individual approaches (see Azar and Wolfe,1989). Psychopharmacologic treatment for child victims Medications may be used with child victims of abuse and neglect who are experiencing post-traumatic stress disorder (PTSD). A number of medications may be of use, though the state of our knowledge about which are most appropriate for use in children is limited. Some have recommended that the use of medication may be reserved for those children who do not show improvement with cognitive-behavioral treatments for PTSD. Children experiencing other types of behavioral or emotional difficulties, including depression, anxiety, or attentional problems also can benefit from pharmacologic treatment. In all cases, the choice of medications is determined by psychiatrist through a careful assessment. Family Income and Supplemental Benefits The relationship of poverty to child maltreatment, specifically child neglect, is thought to be significant. Several government programs designed to alleviate or mitigate the effects of poverty on children are often part of a comprehensive set of services for low-income, maltreating families. Such programs include Social Security supplemental income programs, Aid to Families with Dependent Children (AFDC), Women with Infants and Children food supplement program (WIC), Head Start, rent subsidy programs, and school lunch programs, among others. Gil (1970) has stated that almost 60 percent of families reported for incidents of abuse and neglect received aid from public assistance agencies during or prior to the study year. However, while national and local child welfare programs designed to improve the well-being of all poor families may provide food, shelter, and other necessary resources, for children in households characterized by neglect or abuse, the relationship between income support, material assistance, and the subsequent reduction of maltreatment has not been systematically addressed. CONCLUSIONS Medical, psychological, social, and legal interventions in child maltreatment cases are based on assumptions that such interventions can reduce the negative physical, behavioral, and psychological consequences of child abuse and neglect, foster attitudes and behaviors that improve the quality of parent-child interactions and limit or eradicate recurrences of maltreatment. Interventions have been developed in response to public, professional, legal, and budgetary pressures that often have competing and sometimes contradictory policies and objectives. Some intervention services focus on protecting the child or protecting the community; others focus on providing individual treatment for the child, the offender, or both; others emphasize developing family coping strategies and improving skills in parent-child interactions. Assumptions about the severity of selected risk factors, the adequacy of caretaking behaviors, the impact of abuse, and the steps necessary to prevent abuse or neglect from recurring may vary given the goals and context of the intervention. Little is known about the character and effects of existing interventions in treating different forms of child maltreatment. No comprehensive inventory of treatment interventions currently exists, and we lack basic descriptive and evaluative information regarding key factors that influence the delivery and outcomes of treatment for victims and offenders at different developmental stages and in different environmental contexts. A coherent base of research information on the effectiveness of treatment is not available at this time to guide the decisions of case workers, probation officers, health professionals, family counselors, and judges. Investigations of child maltreatment reports often influence the development and availability of other professional services, including medical examinations, counseling, evaluation of risk factors, and substantiation of complaints. References Administration for Children and Families, Office of Planning, Research and Evaluation. (2004a). Who are the children in foster care? NSCAW Research Brief No. 1. Retrieved August 9, 2007, from the National Data Archive on Child Abuse and Neglect website: www.ndacan. cornell.edu/NDACAN/Datasets/Related_Docs/NSCAW_Research_Brief_1.pdf A

Essay --

Introduction Children of the 21st century are facing brand new health challenges. We are witnessing epidemic levels of new childhood disorders within the most recent generation of U.S. children. These children are also experiencing a higher percentage of familiar diseases and disorders, such as obesity, diabetes, cancer, asthma, attention-deficit diagnoses, intestinal problems, and even mental disorders, than any other generation of the past. There is certainly a health crisis in America, one that can make or break the very foundation of our health as a nation of capable citizens. As our country prepares to launch the Affordable Care Act, with the government entering into managing part of the health care industry, the time is now to take matters into our own hands to ensure the well-being of our families. America’s kids are in a full-blown crisis; they are under attack, losing out on their quality of life before they can even enter adulthood. The U.S. infant mortality rate has worsened significantly. In 2009, the mortality rate ranking dropped from 28th in the world to 41st in the world. More of our children are dying during the first four weeks of life than ever before. At 4.3 neonatal deaths per 1,000 live births, the U.S. now shares the 41st spot with Croatia, Qatar, and the United Arab Emirates. There is a huge rise in the number of children affected with these conditions: ADD/ADHD, autism, asthma, digestive problems, and anxiety and general â€Å"mood disorders.† A report released in 2012 revealed that one in every 54 boys in the U.S. has been diagnosed with autism, and the number of children with autism is expected to double every five years. A health epidemic is no longer on the horizon; clear evidence reveals that it is here... ... quickly, and his coloring is healthy, not pallid and grey. He thinks more clearly and sleeps more deeply. He is no longer malnourished. He is relaxed, and he smiles a lot. Had no one corrected the core problem, the allergy to wheat, the boy would’ve been facing a lifetime of discomfort and crippled health. A proper diet is critically important for the body’s rapid growth that occurs throughout each year of childhood, when a person is developing the intricate systems that must last them for a lifetime. You can easily establish a solid base of well-being for your child, knowing that this gift will last them for a lifetime. Even during such challenging and busy times, the solution for optimum wellness is within your reach, you just need to know where to start. It’s time to build them up! You’ve got the power and the ability to change the world, one child at a time.

Illusion and Delusion in Conrad’s Lord Jim : A Tale Essay -- Joseph Co

Don Quixote Rides Again: Illusion and Delusion in Conrad’s Lord Jim: A Tale â€Å"‘You are an incorrigible, hopeless Don Quixote. That’s what you are.’† (Conrad 1946b, 44) Fifteen-year-old Konrad Korzeniowski (Joseph Conrad) heard these admonitory words from the lips of his tutor, a Krakowian college student instructed by his maternal uncle (Tadeusz Bobrowski) to talk his nephew out of his eccentric desire to become a seaman. The link between young Conrad’s desire to become a sailor and the renowned knight of La Mancha is not a casual one. In his writings, Conrad generalises the particular case of his vocation for the sea by pointing to the reading of romances of adventure as the cause prompting young men to join the maritime profession. Thus, for instance, in the autobiographical work in which the words of dear tutor are quoted (A Personal Record) Conrad refers to Victor Hugo’s Toilers of the Sea as his â€Å"first introduction to the sea in literature.† (1946b, 72) In â€Å"Tales of the Sea† (1898) ––an earlier piece written at a period in which he was already engaged in the composition of Lord Jim: A Tale–– Conrad speaks of how Frederick Marryat and James Fenimore Cooper, the creators of sea fiction, â€Å"influenced so many lives and gave to so many the initial impulse towards a glorious or a useful career†. (1949, 56) Later essays like â€Å"Well Done† (1918) or â€Å"Geography and Some Explorers† (1924) highlight the role played by romances and books of exploration in triggering young men’s desire for a life of adventure at sea, Conrad’s included. In the latter he calls Nà ºÃƒ ±ez de Balboa, Tasman, Torres, Cook or Franklin â€Å"the first grown-up friends of my early boyhood† and states that their nautical feats were an inspiration for him. ... ...Facts! They demanded facts for him [Jim], as if facts could explain anything!† (Conrad 1946c, 29) This disavowal of the value of facts sounds is an anomalous one to hear coming from a third-person narrator which, traditionally, was supposed to occupy the objective position of a view from nowhere specifically. It is important to add that such a statement is made in Chapter 4, at the end of which the third-person narrator gives the floor to Marlow, a first-person narrator subjectively involved in the story he is telling. 11 Needless to comment on the connection between hepatic diseases and alcoholism. 12 It may be argued that the doctor’s irony and laughter are a sign of nervousness and a symptom of the loss of consistency of his self-representation as derived from a scientific practice whose solidity is equally eroded by the engineer’s atypical hallucinations.

Mad Genius: A Look into Bipolar Disorder and Creativity Essay examples

Augustus Saint-Gaudens once said, â€Å"What garlic is to salad, insanity is to art.† This quote summarizes the stereotype of the creative world as being whimsical and a bit loony; furthermore, one must consider if there is any merit to this opinion. Much debate is focused around this topic. Specifically, this paper will focus on the merit of a connection between bipolar disorder and creativity. Irwin G. Sarason and Barbara R. Sarason (2005) define bipolar disorder as a mood disorder classified by an alteration between a state of mania and depression. In addition, Albert Rothenberg, M.D. (2001) gives insight into the scientific definition of creativity. He believes januvial processes (brain’s ability to conceive multiple opposites simultaneously) and homospatial processes (conceiving two or more discrete entities occupying the same space, which results in a conception leading to the articulation of new identities) are necessary in creativity. The New York Times ques tioned the general populations’ definition of this potentially lucrative trait. The writers questioned, â€Å"What separates humans from animals and ever more advanced machines?’ and [it] gives the answer: ‘We make art† (as cited in Rothenberg, 2001). With these general definitions of bipolar disorder spectrum and creativity, this paper will look into the history, causes, and effects of the disorder on creativity. Curiosity dating back to the Greeks involving this connection has prompted a fair amount of research. Three dominant figures in the psychological field, Jamison, Andreasen, and Richards, are key researchers in the relation of bipolar disorder and creativity. These three psychologists have differing beliefs on the subject, but unanimously agree on the genetic co... ...cts of the disorder can be marked positively in the work artists of all fields produce, but devastating results are also a reality. Therefore, we must as a society remember the critical disadvantages of this disorder before focusing on how society as a whole may benefit. References Richards, R., Kinney, D. K., Lunde, I., Benet, M., & Merzel, A. C. (1988). Creativity in manic-depressives, cyclothymes, their normal relatives, and control subjects. Rothenberg, A. (2001). Bipolar illness, creativity, and treatment. Sarason I., & Sarason B. (2005) Abnormal Psychology: The proglem of maladaptive behavior. Eleventh edition. Schlesinger, J. (2009). Creative mythconceptions: A closer look at the evidence for the "mad genius" hypothesis. Shapiro, P. J., & Weisberg, R. W. (1999). Creativity and bipolar diathesis: Common behavioural and cognitive components.

Applying Theory Essay

Healthy aging is positively correlated with continued psychological and social participation of senior citizens with activities that may not be very similar to those that they have been used to, but substitutes them to accommodate their age and limited capabilities. Building a senior citizen’s center would allow them to participate in modified activities that they have pursued in middle age. The community would be creating a venue by which the elderly could get educational training, physical and leisure activities suited to their age to reduce boredom. The center would encourage them to stay active, less depressed about aging. In the long-term, the center would promote a positive well-being among the elderly. Exchange Theory Building a senior citizen’s center would benefit the senior citizens in many ways but on the part of the community, the project would have benefits as well as incur costs. A center would provide senior citizens a productive means by which to spend their retirement years. It would make them more active and social than they would if they simply spend most of their time at home or a retirement home. On the part of the community, the monetary cost of the project might make it impractical if the amount could be better spent in a much more needed community project. Then again, the elderly is as much a part of the community as much as the younger members and constructing a center would provide a psychological benefit for both age groups. To the elderly, a center is a reassurance that the community values them in spite their old age. To the younger generation, the center equally reassures them that they are doing something right for the elderly. Functionalism Every age group needs to belong to an institution which would foster a sense of their membership in the larger community. Furthermore, to survive as a whole, all members should work together and slip into roles aimed towards fulfilling the needs of society. A senior citizen’s center would make the retirees a sense of belonging in the community as it would serve as their institution now that they have lost membership in their former workplaces. They would form into a social group which could organize activities to benefit the entire community. It would make the cohesion of the community stronger as an organized group of senior citizens means that even the elderly are contributing towards the stability and constant activity of the community, factors which characterize a healthy, working community. Continuity Theory Senior citizens would continue to seek for the same activities, relationships and lifestyles they had in younger years. A senior citizen’s center would be a good way by which the elderly members of society can organize, assemble and socialize—just like when they were younger. Since they all belong to the same age group, members would develop a distinct culture and this would give everyone a sense of stability and support system. A center with activities and programs geared for the elderly would help ease the difficulties of adjusting to old age. The community, in turn, would have less of the stereotyped bitter and bad-tempered elderly members because it has a place which helps the elderly experience aging as a positive, supportive and gently-sloping experience. Theories that would argue against the senior citizen’s center. Conflict Theory Building a senior citizen’s center would benefit the elderly, however it would acknowledge their continued worth in society and their influence in terms of policy-making. The senior citizens have passed their prime, and the younger generation controls public administration including the budget and planning. The latter would disapprove the spending of $3M for a center that would not be profitable to the community. The community could maximize its spending by allocating the budget for other projects and simply put the care of the elderly under their respective families or elderly homes. This way the family or home would be spending only for the necessary expenses to support the survival needs of the elderly without funneling the community’s financial resources. Political economy of aging The corporate interest precedes personal interest of the market. A senior citizen’s center would surely not justify the $3M that the community would be spending towards constructing and running it. A center for the elderly would simply be a place for them to engage in pursuits like physical activities, entertainment, seminars conducted by volunteers and other non-profitable, self-serving endeavors. If the aim is to spend the money in a project that would benefit the aging population, a wiser idea would be to revert the funds towards the construction of a managed care institution. To be profitable in the long run, this institution could give the elderly the same services and activities as the proposed center, but at certain prices. Recreation for the elderly should be a privilege instead of a charitable act. Disengagement theory The elderly and society engage in mutual separation. A senior citizen’s center is impractical because it would mean integrating the elderly into the community when they should realize that they have to withdraw from social activities they have been used to prior to retirement. A center would give the elderly a false sense of importance regarding their role in the community. It would pose a burden to the community which has to constantly bear with the expenses incurred by the center and its useless programs. The elderly cannot anymore contribute to society and compete with its standards of excellence; therefore, for the benefit of society, they should interact with the community and with each other less. Social Competence/Breakdown Theory Building a senior citizen’s center would create greater dependency on the part of the already vulnerable senior citizens. If the center is realized the elderly would feel self-important, ask for extra services and special privileges. If the demands are refused, it would cause emotional distress. To show sensitivity to the elderly, they should be allowed to face the challenges in life, without spending $3M to build a center especially for them. They should not be doled out with charity. They should be left to find the means to be happy and productive in their late years. The community would be doing them well if they are made to feel like they have worked hard to accomplish something.

Debate Team paper on Obamacare

Our team’s debate topic covers a controversial issue within the Affordable Care Act in America, known as Obamacare. Obamacare is the universal health care in the United States that provides Americans access to affordable, quality health insurance, with a goal of reducing growth in healthcare spending. This universal health plan is technically a mandate or tax, in which non-compliers may be penalized through their federal return. Our topic debates whether Americans should be forced to pay this ‘shared responsibility fee’ for not complying with Obamacare. Arguments for Pro’s The United States of America is a rich and powerful country.The way we handle political, social, and ethical issues are closely watched by the entire world. We are a free democratic society who has entrusted our government to make the best, most appropriate decision for each individual in this country, even if that means we have to pay a little more. Obamacare is one of many policies that illustrate the American people’s willingness to help one another.According to â€Å"Obamacare Facts† (2013), Health and Human Services (HHS), the department in charge of implementing and overseeing the Affordable Care Act, reported that in the first two months of open enrollment nearly 1.2 million Americans had selected a health plan. With so many people utilizing these policies, it sends a positive message to other countries demonstrating how, through democracy the American people’s concern for and willingness to help one another is evident. In countries like Japan, the government has been working together with its citizens to help with healthcare costs without any hesitation. According to â€Å"The Lancet† (2011), â€Å"In healthcare the government overtime succeeded in changing the basis of medical practice from Chinese to Western medicine.Moreover the transition was achieved without minimal cost and limited social disruption [ The same social compli ance can be achieved through Obamacare, even with the tax mandate in place. Throughout history, the American people has overcome tremendous social hardships (9-11 and Sandy Hook/Connecticut to name a few), by coming together and supporting one another, exemplifying our tenacity, resilience and dedication to each other] Arguments for Con There is another side of the coin that should be addressed.With the tax penalty and the implementation of Obamacare not being as smooth as our government would have liked, many Americans who were in favor of Obamacare are quickly rethinking their stance. For Americans to fully utilize the Obamacare healthcare system, Americans must accept responsibility and pay the tax for non-compliance. Obamacare offers healthcare packages specific to ones’ needs along with many added benefits. Due to a significant amount of Americans who need or want to obtain health insurance, the cost of these plans must be covered.For Americans who are experiencing an in crease in healthcare expenses due to the unacceptable regulations of insurance companies and the rising costs of prescription medications, Obamacare seems to be a perfect solution. Yet, some Americans insist that the tax is unfair and feel they should not be forced to pay anything. According to the â€Å"ARC† (2007), â€Å"Observe that all legitimate rights have one thing in common, they are rights to action not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone.The system guarantees you the chance to work for what you want not to be given it without effort by somebody else. † Ethical, Moral, Legal, and Technical Issues There are many ethical, moral, and legal issues that lie within the Affordable Care Act. Ethical issues like younger American’s being relied upon to cover the benefits of the older, sicker Americans. The moral issues like the fact that other countries with uni versal healthcare- Japan for example, strictly regulates cost to keep insurance affordable yet, Obamacare does not guarantee affordability for its citizens; and legal issues like the â€Å"fix† on grandfathered health plans.Americans who will consume healthcare less frequently are â€Å"needed to subsidize the cost of older sicker ones† (Oliphant, 2013). In order to achieve affordable health insurance and include the benefits of the packages, not only must Americans actively participate in the healthcare law but younger Americans especially. â€Å"In theory, the law would create large pools of younger, healthier participants whose premiums would help offset the cost of providing care for older policyholders who use the health care system more† (Cohen, 2013).As the  deadline approaches for Americans to shop and purchase healthcare packages, the desperate need for compliance by young Americans has increased and has been communicated to the People. According to C NN News reporters, President Obama encouraged young supporters to recruit their peers to sign up for healthcare on Wednesday December, 4th 2013 (Cohen, 2013). Americans who will be depending on their healthcare more, will also depend on Americans who are healthier, to comply and pay into the plan as an attempt to maintain affordability in Obamacare.Affordability in Obamacare is not however guaranteed. â€Å"The ACA was enacted with the goals of increasing the quality and affordability of health insurance [and] lowering the uninsured rate by expanding public and private insurance coverage† â€Å"Wikipedia/Affordable Care Act† (2013). As Americans shop, some are experiencing significant rate increases. Obamacare offers many rights, protections and benefits including, â€Å"improvements to women health services†, â€Å"better care and protection for seniors†, â€Å"no annual or lifetime limits† (Obamacare Facts, 2013), and acceptance of pre-existing c onditions.In order to include these essential additions, some Americans are facing increases in their premiums or, for Americans who were not covered before, experiencing higher than expected insurance costs. â€Å"Several studies on insurance premiums expect that with the subsidies offered under the ACA, more people will pay less (than they did prior to the reforms) than those who will pay more, and that those premiums will be more stable (even in changing health circumstances) and transparent, due to the regulations on insurance† â€Å"Wikipedia/Affordable Care Act† (2013).Even though many Americans will notice a discount, when compared to health care in Japan, Obamacare communicates a stance of quality over affordability. The Japanese Government strictly regulates health care to ensure its consumers are paying as little as possible out of pocket. The affordability of Japanese healthcare may be a factor in utilization that is 4x that of the United States. This govern ment regulation guarantees affordability for the Japanese causing an increase of usage of health care.Not to mention,â€Å"people who live in Japan can expect to remain in good health longer than anybody else in the world, according to the World Health Organisation(WHO)† (BBC news, 2000). Legal issues like the â€Å"grandfathered plan† fix have impacted the roll-out of Obamacare. Confusion raised when already insured Americans experienced significant increases in costs of current premiums. This confusion was due to the promise of President Obama to Americans, â€Å"if you like your plan you can keep it†; that Americans who were already insured would experience no change in premium costs.After further review, Grandfathered plans (plans in effect before March 23, 2010) now remain effective until 2015. President Obama’s statement â€Å"if you like your plan you can keep it† still stands. Previously insured Americans can take advantage of their current plans that â€Å"don't have to follow ObamaCare's rules and regulations or offer the same benefits, rights and protections as new plans† (Obamacare Facts, 2013). The issues that exist within the healthcare law require the American people to develop skills that aid in the execution of complying with Obamacare guidelines.Despite these issues, all Americans share a responsibility to obtain the means and abide by the healthcare law Career Competencies Obtaining health insurance requires many Americans to develop a skill-set of research, evaluation, critical thinking, decision making, and also coping with pressure due to the many inconsistencies of the roll-out and progression to deadline. Too short paragraph. One’s competence in assessing and shopping for plans provides him or her (or business) the incentive to choose the package that fully covers all specific needs.Creating an understanding of information on plans and details within the package, along with applying these expertise to shop and choose the perfect plan, allows consumers to take an active role in achieving health insurance. Whether you are shopping for individual, family, or employee coverage, paying attention to the qualifications, offers, and costs of each package will allow one to find quality health insurance while remaining aware of the benefits of Obamacare. Americans who choose not to shop for healthcare packages must also achieve competence in evaluating fees.â€Å"The individual mandate goes into effect January 1st, 2014. The penalty will be applied to your annual taxable income for each month you do not have health insurance. The fee for not having insurance in 2014 is $95 per adult and $47. 50 per child or 1% of your taxable income (up to $285 for a family), whichever is greater† (Obamacare Facts, 2013). For employers who have over 50 fulltime equivalent employees and wish not to provide insurance, competence in calculating the fee is also important.â€Å"The annual fee is $2,000 per employee if insurance is not offered. The fee is a per month fee due annually on employer federal tax returns starting in 2015. So the per month fee is 1/12 of the $2,000 or $3,000 per employee† (Obamacare Facts, 2013). Americans who choose to shop, as well as those who make the decision not to comply must obtain the necessary skill-set to remain informed and be prepared of how Obamacare will affect their finances and life beginning January 1st, 2014.In times of non-compliance, web-site flaws, the need to become familiar with new information, and fighting the clock to deadline, Americans must also cope with pressure. Maintaining a positive outlook and working productively to choose a plan, despite the circulating flaws that may arise, will promote healthy mental processes that will guide one to successful decision making. Keeping emotions under control during difficult situations will help individuals, families, and businesses obtain quality health insurance while remaining stress free and open-minded.Making the decision to pay tax rather than comply with standards of Obamacare may also increase stress. Americans making this tough decision must think critically on the matter yet remain level-headed to ensure valid and sound arguments against the insurance of their health. Conclusion American’s may feel stripped of their â€Å"freedom of choice† when forced to either pay more taxes on private health insurance or enroll in the Affordable Care act, better known as Obamacare.Many years Americans have gone without having health insurance which has increased the cost of insurance, as well as increased the cost of hospitals, medications, health insurance premiums, and other medical related costs. Over the past few decades, health in American people had deteriorated due to lifestyle choices. One of the initiatives of Obamacare is geared towards young people also known as â€Å"get covered†. â€Å"It also seeks to nudge you ng adults into action by portraying insurance as a social responsibility, and encouraging peers and parents to put pressure on the uninsured† (Bohan,2013).After many years of this continued practice and still increasing costs, we are indirectly paying for the people who go to receive treatment and do not pay their medical bills. It could be argued that Obamacare will force Americans to reassess and accept responsibility of their healthcare. Obamacare allows Americans to make a conscious decision to carry the cost for being provided quality health insurance, whether it is choosing to pay the â€Å"penalty tax† or enrolling in a healthcare plan.Life expectancy has increased over the past decades and unfortunately, this means more people have utilized Medicaid over a longer period of time. Instead of being reactive when diagnosed with heart disease, diabetes, or other long term conditions which are very costly over time, Obamacare will make Americans proactive in awareness of their health by having set parameters of the requirements in coverage, i. e. , â€Å"requiring a physical†. Having a healthy nation that helps young Americans understand the importance of health is something we all must contribute to.The mentality of why Americans must pay penalties, follow requirements, and how freedom of choice will change is the first reaction to the unknown. Obamacare provides access to a market of quality and affordable health insurance for Americans. Obamacare mandates that anyone who can afford it must provide themselves, family, or employees with quality health insurance. To ensure a more healthy nation and align with the notion of shared responsibility and a willingness to help each other, Americans must abide by the mandate or pay the shared responsibility fee.