EXPERIENCES OF NURSES WORKING IN PALLIATIVE CARE Dissertation

EXPERIENCES OF NURSES WORKING IN PALLIATIVE CARE - Dissertation Example (Harris, Flowers, Noble, 2011) In a qualitative study by (Brajtman, Higuchi, McPherson, 2006) they looked into the matter related to the challenges the nurses face in palliative care, to explore their experiences in caring for patients with terminal delirium and their families. This qualitative research will emphasize the importance of qualitative interviews as most powerful method for understanding the experiences and meanings related to the topic. This study was conducted in a palliative care unit located in a large Canadian city hospital for 5 nurses working in an interdisciplinary palliative care unit and 4 nurses form palliative home care nursing team located in the same city. Few interview questions have been generated for the nurses to proceed with the qualitative study. Based on the questions results which has been found are like most of the participants said that they experience distress while caring for palliative care patients. They said that if they gather convenient skil ls and knowledge in the identification and diagnosis they can help to support the patient in better way and family during disturbed conditions. Understanding the unique nursing experience is very much important in the process of providing the nurses with required support to make them strong and help them to provide care in challenging situations. Nurses also identified their team members as most major source of support. They also mentioned that effective teamwork would help them to deal with palliative care patients and their families more efficiently. There is need for proper education and training for the nurses to face challenges with palliative care patients. Lack of education may experience in serious stress for these nurses in care of the dying people and their families. It is important to check that nurses should receive appropriate knowledge, skills and support to care for this patient (Brajtman, Higuchi, McPherson, 2006, pp.6-7). Thus from this study we can understand that proper opportunities should be provided to the nurses so that they can face challenges confidently. The support of organization, teammates and family will enhance the quality of care. The number of sample chosen here is very small. A primary research should contain minimum 20 samples to carry on with a proper research. But here amount is very small which is not very good to conduct a research. A larger sample would have been beneficial to obtain greater depth of data as there was no clear evidence to overcome the challenges. White, et al (2004) found similar trends in his study. He explored with qualitative descriptive study using semi structured interviews with nurses caring for palliative care patients. Here 9 experienced palliative care nurses were interviewed. The participants here explained about their experience and challenges they face regularly. The nurses reported that they have enormous impact on their work and personal lives. The nurses here describe about two types of su fferings, physical and emotional or psychological. Most of the nurses reported here that they try their best to relieve a patients suffering and when they cannot help the patient with such condition they get a feeling of helplessness, distress, frustration and a sense of failure. Some of the nurses also mentioned that they did not want to dwell with those things and thus tried to go back home with a fresh

Breaking Dawn Edwards Pov Essay Example for Free

Breaking Dawn Edwards Pov Essay â€Å"I miss you already.† â€Å"I don’t need to leave. I can stay†¦Ã¢â‚¬  â€Å"Mmm.† It was the eve of our wedding and Bella and I were lying in her narrow bed together, as was our habit. Though it was August, she was wrapped in her usual swaddling blanket, a protection against the chill of my skin. The bulky afghan did not prevent Bella’s hands from wandering about, exploring the unclothed parts of my body. If she had her way, both of us would be even less clothed. I found shirtless to be challenge enough. With Bella’s fingers probing the outlines of each muscle and bone above my waistband, her lips on mine, I was both awash in pleasure and sinking into concern. Some might call it performance anxiety and I could not deny it. When one’s performance was a matter of life and death, there was no shame in that. Bella dragged her tongue across my top lip and a surge of desire shot through me. It was all I could do to remain still and let the sensation fade. If she were a vampire, I would have rolled on top of her, stripped off the bulky afghan and pressed my entire body into hers. I would have kissed her passionately, tasting her lips, her tongue, and pulling her as close to me as the laws of physics would allow. Ahhh†¦ I groaned and retreated from her caressing hands and her delicious, warm tongue. â€Å"Wait,† Bella murmured, clutching my arms. I watched as she kicked her right leg free from the blanket and wrapped it around my waist. â€Å"Practice makes perfect.† I chuckled. I’d heard that one before. Numerous times. â€Å"Well, we should be fairly close to perfection by this point, then, shouldn’t we? Have you slept at all in the last month?† â€Å"But this is the dress rehearsal,† she protested, â€Å"and we’ve only practiced certain scenes. It’s no time for playing safe.† Playing safe. My body froze as I considered how easy it would be to break Bella’s arm, or tear out a handful of her beautiful hair, or snap her spine, or†¦ â€Å"Bella†¦Ã¢â‚¬  â€Å"Don’t start this again. A deal’s a deal.† â€Å"I don’t know. It’s too hard to concentrate when you’re with me like this. I—I can’t think straight. I won’t be able to control myself. You’ll get hurt.† â€Å"I’ll be fine.† â€Å"Bella†¦Ã¢â‚¬  â€Å"Shhh!† Bella put her hands on either side of my face and pressed her lips against mine. I would like to have been distracted by that, but it was too late. My mind was already elsewhere, drifting from the thousand-and-one ways I could harm Bella to enumerating all she was giving up for me†¦her family, her friends†¦her chance to be a mother, to grow old, to become something more than what she was right now. It was too much to sacrifice just to be with me. In my mounting distress, I revisited an argument that Bella and I had had repeatedly. I’d never convinced her before; I don’t know why I thought she might change her mind now. â€Å"It’s not right! I don’t want you to have to make sacrifices for me. I want to give you things, not take things away from you. I don’t want to steal your future. If I were human—† Bella stifled my objections by putting her hand over my mouth. â€Å"You are my future. Now stop. No moping, or I’m cal ling your brothers to come and get you. Maybe you need a bachelor party.† My brothers must have agreed with her, for Emmett’s thoughts suddenly interrupted my own. Maybe we’ll catch them with their clothes off! Hope so. Ha, ha! â€Å"Oh, for the love of all that’s holy!† â€Å"What’s wrong?† â€Å"You don’t have to call my brothers. Apparently Emmett and Jasper are not going to let me bow out tonight.† Bella tightened her grip for a moment before releasing me. â€Å"Have fun,† she said. Perhaps it would be better for Bella if I left. Then I wouldn’t upset her with the â€Å"cold feet† I’d told her I didn’t have. I had no second thoughts about marrying Bella—I could hardly wait to do that! My second thoughts were all about the wedding night. Yes, I should leave. Maybe she would get some sleep if I did. â€Å"If you don’t send Edward out,† Emmett threatened in his best, creepy-monster voice, â€Å"we’re coming in after him!† Bella lau ghed. â€Å"Go! Before they break my house.† Kissing her forehead, I advised, â€Å"Get to sleep. You’ve got a big day tomorrow.† â€Å"Thanks! That’s sure to help me wind down.† â€Å"I’ll meet you at the altar.† I gave her a sly smile. â€Å"I’ll be the one in white,† Bella announced nonchalantly, as if we were planning a rendezvous at the mall. I chuckled at that, considering the anxiety attacks that overcame her every time I mentioned the wedding. â€Å"Very convincing,† I tossed over my shoulder as I leaped out the window. My feet landed squarely on Emmett’s head, knocking him to the ground. â€Å"Dammit, that hurt!† Emmett stage whispered, as he jumped up and took a swing at me. I dodged the punch easily. His thoughts always gave him away. â€Å"You’d better not make him late,† I heard Bella warn my brothers. Jasper leaped up and grabbed the eaves outside Bella’s window. He turned on his soothing vibes. â€Å"Don’t worry, Bella. We’ll get him home in plenty of time.† â€Å"Jasper? What do vampires do for bachelor parties? You’re not taking him to a strip club, are you?† she whispered to Jasper and I had to smile. As if that would be fun for me! No woman had ever affected me like Bella did. Women could dip themselves in blood and parade around naked all day and it wouldn’t do a thing for me. I should know†¦Tanya had tried such tricks many times to get me into her bed. â€Å"Don’t tell her anything!† Emmett hissed at Jasper, earning himself a friendly forearm shove that knocked him to the ground†¦again. I could never beat Emmett if we fought strength to strength, but with my mind-reading skill, he rarely got in a good punch. I laughed at his expression as he stood up and brushed the grass off his jeans. He tried to loo k casual as he readied himself for a â€Å"surprise† counterattack. Just as he launched himself at me, I took off running, knowing he couldn’t catch me at full speed. â€Å"Relax,† I heard Jasper reply to Bella. â€Å"We Cullens have our own version. Just a few mountain lions, a couple of grizzly bears. Pretty much an ordinary night out.† Jasper had told Bella the truth. We would be celebrating our boys’ night out with a hunt. I didn’t need the blood at the moment, but it was still a good idea. If I fed now, then I wouldn’t have to leave Bella to hunt for the first two weeks of our honeymoon. Besides, I only had one more day to remain chaste until Bella and I were married. I did not want to slip-up at this late date—getting out of Bella’s bed would make that a whole lot easier. Running gave me time to think about the last couple of months. As my fiancà ©, Bella had accepted the black credit card with her name on it attached to my account. Like the cell phone, I’d presented it as a â€Å"safety precaution,† but she’d started to use it for other things too, and that had been the point. Bella had quit her job at Newtons Olympic Out fitters, so she didn’t have any pocket money to speak of. I was glad that she’d quit. I preferred not giving Mike Newton the opportunity to gape at and entertain salacious thoughts about my bride-to-be as was his habit. Also, I was happy that we could spend more time together. I didn’t have to part with her company for the three or four days a week she would have worked for what I considered to be spare change. Unless she really liked the job—and I knew that she didn’t—I saw no point in sacrificing our time together. It had been a great summer. The only slight comedown had been the â€Å"father-in-law talk† Charlie had initiated with me. I haven’t encountered many people who could surprise me in the last eighty years, but Charlie was one who could. His mind was so quiet—in the sense of relatively impenetrable to me—that while I could perceive his feelings, I often couldn’t hear the inner dialogue that went with them. I didn’t like the sense of insecurity it gave me not knowing what he was thinking. I was used to having more time to consider how to react to people than I ever had with Charlie. One evening five weeks earlier, Charlie had grabbed my arm as Bella and I were leaving his house for the evening. We’d found a number of private parking spots around the area and we liked to visit them as often as possible. Because he’d surprised me, I reflexively yanked my arm out of his grip at my natural strength. Immediately, he’d put both palms up as if he was surrendering. He’d mistaken my quick reflex as a sign of anger. The interaction reminded me of the television show â€Å"Cops,† in which hooligans whirl around and punch an arresting police officer just on principle. Charlie must get that a lot. I quickly raised my palms to indicate a mutual surrender. I would have smiled if I hadn’t thought Charlie would interpret it as a taunt. Bella had missed our interaction and was continuing toward the car. â€Å"What can I do for you, Charlie?† I inquired politely. â€Å"I was just wondering what your folks think about you proposing to my daughter.† â€Å"Oh, they love her, they really do.† â€Å"That’s not exactly what I meant.† â€Å"No?† I wasn’t going to help him interrogate me. â€Å"No†¦uh†¦I meant what do they think of you getting married right out of high school?† â€Å"Oh! Well, you know they got married quite young themselves. Esme already had Jasper and Rosalie to look after when she met Carlisle. They fell in love and Carlisle wanted to help support the kids, so he proposed when Esme was younger than he might have otherwise. They’ve been extremely happy, so they don’t have any prejudice against getting married young.† â€Å"Do you think you’re old enough to handle this kind of responsibility? That’s my daughter you’re promising to support for the rest of your life. A re you one hundred percent sure that you’re ready for that?† â€Å"I will be there for Bella. I can assure you of that.† â€Å"What if you screw it up and things fall apart?† Charlie pressed. I thought about that for a moment before answering. I knew what he was referring to without having to read his thoughts. â€Å"There are many ways I could mess things up,† I admitted. â€Å"I’ve already made mistakes with Bella. I know that. I wasn’t here for her when she needed me. I swear to you, Charlie, I left because I wanted Bella to have a chance to find somebody better than me. But I found that I couldn’t live without her and so I came back. Jacob might be a better choice for her, but she still wants me and as long as she does, I won’t leave her. I don’t make the same mistakes twice.† Charlie just gave me his dark-eyed, policeman’s stare. I didn’t blame him. He’d watched Bella suffer daily after I abandoned her. Jacob had impressed upon me all the painful details he could summon about that time. â€Å"Jacob’s a good young man,† Charlie finally responded, â€Å"but I wouldn’t want him marrying her at his age, either.† I took another moment to consider my response, and then sighed, knowing I’d never convince him with words. â€Å"The only way to know whether I’ll be good for Bella is with time. I can’t offer you proof, but I love her more than my own life and I will take care of her, Charlie. I just hope that I can make her as happy as she makes me, though I hardly think it’s possible.† Charlie’s stare didn’t change, so I continued. â€Å"If it makes you feel any better, my family is behind us, and you know Carlisle well enough to know that he would never let Bella down†¦even if I did. My family would step in for me. That’s just the way my parents are. They’re great people.† â€Å"I know they are†¦Edward. I trust Carlisle and that’s why I’m not making more of a fuss about this.† I acknowledged his statement with a nod. â€Å"Just so you know, Charlie†¦Bella and I discussed eloping to Las Vegas and marrying without telling anyone. But Bella didn’t want to cut you out of her decision in that way, so we decided to make it a family event.† â€Å"I knew there was something going on!† Charlie exclaimed. â€Å"I had a feeling you two were going to take off together!† â€Å"Bella wants you there to walk her down the aisle, or the stairs, rather. I hope you can see your way clear to do that for her on her day.† Charlie nodded stiffly and I turned to follow Bella to the car. â€Å"That’s a fancy car you got my daughter.† â€Å"Yes, it’s a loaner. Carlisle called in a favor for me. It’s a very safe car.† â€Å"Well, that’s good. You can hardly get a car that’s safe enough to share the roads with all the bad drivers and drunk drivers out there.† â€Å"I agree. Goodnight, Charlie.† â€Å"’Night.† Charlie shut the front door and I saw that Bella was coming back to get me. I hurried toward her. â€Å"What was all that about?† â€Å"Charlie wanted to have a little ‘man-to-man’ talk about his precious daughter, but I told him I agreed with everything he said, so he loves me now.† I grinned and winked at Bella. She didn’t buy it. â€Å"No, what did he really want?† she demanded. â€Å"Tell me, or I’ll march right back and ask him!† I sighed. â€Å"Charlie just wanted to warn me about the dangers of marrying too young and make sure I was knew what I was doing.† â€Å"What did you say?† â€Å"I said that I was old for my age,† I replied, giving her a crooked smile. â€Å"You did not!† â€Å"Sure, why not? I am, aren’t I?† I teased. â€Å"Ancient. I should be grossed out being with you.† â€Å"Fortunately, I still look good and that’s what really counts.† We both laughed and, to my relief, Bella dropped the subject. Bella’s mother, Renee, had flown in two days earlier and Bella was sticking close to her except when our mothers worked on the wedding. It was odd behavior for a bride-to-be, but I wasn’t marrying Bella because she was like everyone else. Quite the opposite. When I’d come home two evenings previous, Renee was visiting Esme. In an attempt to demonstrate her acceptance of me as her almost son-in-law, Renee had dashed across the living room and thrown her arms around my neck. â€Å"Welcome to our family, Edward!† she’d said. I thought perhaps she was overexcited by the trip or by meeting my family. I hadn’t expected such an exuberant greeting, though she had no particular misgivings about Bella marrying me. Renee ended the hug abruptly when her arms encountered my cold, hard self. â€Å"Hmm,† she mumbled as she broke off contact. Hard body! was her thought, and I almost laughed out loud. The picture in her mind was complimentary, not lite ral. She was imagining what my upper body looked like without a shirt. I’d already gotten acquainted enough with Renee when Bella and I went to Florida that I knew she didn’t mean anything by it. A cougar†¦just like Bella, I thought, and smiled to myself. It was a little sad to meet Renee again, knowing that this was the last time Bella would see her, or possibly even talk to her on the phone. As I watched Bella over the course of the two days, I sensed that she was saying her goodbyes. If I’d had to give up Carlisle and Esme to be with Bella, I could have done it. I had given them up once before. But it was hard to accept that I could make Bella happy enough to give up seeing her parents. I’d asked her again last night whether she was prepared to do that and her response had been, â€Å"Are you trying to ditch me?† Then we’d started laughing and the question had gotten lost. My brothers and I didn’t get back from hunting until a couple of hours before the wedding. Esme collared us immediately and sent us to the back garden to hang flower garlands for Alice. It had to be done at the last minute or the August day would wilt them. Alice had prohibited me from going anywhere near where she was preparing Bella, so I headed to my third-floor room to make myself presentable. Alice had changed my old-fashioned tux just enough to convert it from â€Å"vintage† to â€Å"vintage chic,† as she put it. It did look good, I had to admit. I tried to neaten my normally unruly hair. I put some hair gel on it and convinced it to lie down in a semi-orderly fashion. After a time, Jasper came upstairs to tell me that the first guests were arriving. He and Emmett would be ushering them to their seats. Of course, Jasper could have told me that from downstairs, but Alice had specifically asked him to come get me, so that I wouldn’t be parading down the bride’s decorated stairway in full view of the guests. I walked outside through the kitchen door, telling Carlisle that I’d be waiting out back. He and Esme were standing by the front door to greet everyone as they arrived. This was the most important day of my life, but I hoped to have infinitely more wonderful days to enjoy with my Bella. I felt exceedingly fortunate that she wanted me as I wanted her. I could have lost her so easily. I heard the Denali clan arrive and recognized Tanya’s mental voice: Where’s Edward? It will be good to see that man again†¦mmm hmm! Who is this human girl? I can’t imagine Edward with a woman, not even a vampire woman. This will be interesting†¦ I smiled, glad to be escaping Tanya’s clutches for good. She’d given me a hard time when we were living in Alaska. She wasn’t used to being told â€Å"no thank you.† Neither vampires nor humans ever turned down Tanya’s advances. She was beautiful and charming, everything a man could want. She just wasn’t for me and she never could accept that. It was one of the reasons Carlisle decided to move our family farther south. He told everyone that we were too conspicuous and perhaps we were, all there together, but I’d had the chance to hear another reason in his mind—that Tanya can’t leave Edward alone. My father empathized when Tanya had set her sights on me. Carlisle had had plenty of pushy admirers. During his first few weeks at a new hospital, nurses would line up three deep to ogle him. He had to temper that initial interest by telling some number of them that he was happily married, thank you. Of course, he wore a wedding ring, but that didn’t discourage everyone. Once people met Esme, though, they usually stopped chasing Carlisle. She was simply too beautiful, inside and out, to compete with. I know Esme had always worried that I wasn’t fully mature as a man when Carlisle had changed me and that I might never find, or even wish for, a mate. It was true that I wasn’t interested in any of the Denali ladies. And after the trouble I’d had with Rosalie when she joined our family, I didn’t expect anything good could come of such interest anyway. When the Denalis met the only bachelor vampire they’d seen in years, each of them had set about seeking my affection. I didn’t blame them, particularly. Perhaps they’d gotten tired of human men and wanted someone more durable to partner with for a change. I could understand that to a certain degree. I didn’t go inside to greet the Denalis or any of the other arrivals. I couldn’t focus on anyone but Bella—it seemed like such a long time since I’d seen her. I was trying to reason myself out of an irrational fear that she wasn’t really there in our house, that she had changed her mind and would leave me standing alone at the altar. If I listened, I could hear her voice now and then, but I couldn’t hear her thoughts and that had never bothered me so much as it did at that moment. To distract myself, I listened at random to our guests’ thoughts and found that everyone was astonished by the decorations. Alice had put her all into planning this wedding and it showed. The flowers alone were beyond imagining. Exquisitely fragrant arrangements covered every surface of our living room and the reception area outside. Alice was particularly fond of flowers. I thought perhaps it was because she’d been deprived of beauty for so many years at the asylum. Whatever the reason, it was a boon for us all. Rosalie had started playing my grand piano, making the one instrument sound like several. I knew that Pachelbel’s Can on in D was my cue to enter the living room with Carlisle and stand in front of the flower-covered archway. He would come looking for me in the kitchen when the time came, so I walked back into the house. In due course, Carlisle came to retrieve me and after a final, heartfelt hug, we took our assigned places in front of the assembled crowd. I stood, frozen with emotion, and watched anxiously for my beloved to appear at the top of the stairs on her father’s arm. I had waited a lifetime to stand in front of these witnesses and declare my undying devotion to the one and only woman I would ever love. Time had stopped making sense when I finally heard the familiar C-F-F-F notes of â€Å"Here Comes the Bride.† I could not believe my eyes when an angel from heaven began to descend the stairs, one by one, her eyes lowered to watch her feet. It was only when I heard her whisper â€Å"Don’t let me fall, Dad,† that I knew for sure it was Bella†¦my Bella. I fretted for a second that my angel might fall and I readied myself to dash across the room to catch her. Seeing the groom disappear and reappear somewhere else would not go over well with anybody, though I reasoned that all of the guests would be looking at Bella, not at me. Still, perhaps we should have served champagne before the ceremony, just in case something like that did happen†¦but then, Bella was descending the final step. She lifted her face, searching for me. When our eyes finally met, a look of such utter joy crossed her face that I broke into an ecstatic smile. Bella’s feelings often were written on her face, but today her expression was utterly transparent. The adoration in her eyes was unmistakable and I was jubilant enough to break out in song†¦almost. Our eyes remained glued to each other while Bella carefully traversed the fifteen-foot aisle that Alice had kept short to give Bella a fair chance of remaining upright. With the way she looked in that dress, with that makeup, with everything†¦the glow, the scarlet blush, the prisms of tears in her eyes†¦I wanted to rush down the aisle to meet her and carry her back to the altar. But I remained patient, stretching out my palm so that Charlie could place Bella’s hand in mine. He regarded me seriously as he did so and I nodded my thank you to him for his great sacrifice. Charlie seated himself beside Renee, with Phil on her other side, and Bella and I turned to face the minister. I loved the traditional wedding ceremony with its promises and pronouncements, but on this occasion, each word resonated with newly unveiled meaning. When I declared â€Å"I do† to my beloved, I’d never been happier in my life. I wanted to repeat the words in every language I knew. My lovely new wife was overcome with emotion. When I leaned over to kiss her for the first time as her husband, Bella’s arms encircled my neck and she held on a s if she would never let me go. The audience had disappeared—she only had eyes for me. I kissed her with a swell of love and tenderness that made my eyes burn with the tears that didn’t come, and she met my passion with her own. Emotion poured from her as she clung to me, melding her lips with mine as if we were utterly alone in that moment. I did not mind in the least. Bella was happy to be married to me—I could feel it in my bones. When the guests began to titter, I eased my love’s face gently away from mine and looked into her tear-filled eyes. I felt my happiness radiate from me like the heat of a coal fire and I wondered briefly if my skin was sparkling in its glow. When Emmett cleared his throat unsubtly, I turned us both to face the loved ones who had gathered there and everyone broke into smiles and quiet laughter. I could not let go of Bella for a second. I wrapped my arm around her waist and practically carried her down the aisle when she forgot to move her feet. Fortunately, they were hidden by the length of her dress. Another detail that Alice had not overlooked. Bella was so stunningly beautiful that I wasn’t surprised to hear a number of inappropriate thoughts as the reception line shuffled slowly past us and on to the buffet. Alice had timed things well, so that the vampires would not have to step outside until twilight, just in case the sun came out. It was good that she did, because we had a beautiful wedding day with plenty of sunshine filtering through the ancient cedars. I was extraordinarily pleased that Billy Black and Sue and Seth Clearwater had come to the wedding. Despite the Cullens’ official status as â€Å"mortal enemies† of their tribe, the three of them were there in support of Bella and Charlie, and perhaps as a gesture of gratitude to Carlisle as well. Seth was there for me, too. Our friendship had not faded since we’d joined forces to battle Victoria and Riley. â€Å"Congrats, guys,† Seth said, coming toward me with his arms out. I hugged him with one arm while I held Bella tightly with the other. â€Å"It’s good to see things work out for you, man. I’m happy for you.† â€Å"Thank you, Seth. That means a lot to me.† Releasing Seth, I faced Billy and Sue with honest gratitude. I knew they were not there for me. â€Å"Thank you, as well. For letting Seth come. For supporting Bella today.† â€Å"You’re welcome,† Billy replied cordially and I hoped his attitude boded well for the change that was coming. I didn’t know how I was going to approach the Quileute wolf pack about Bella’s upcoming transformation. It was possible that if we left the area to avoid their ancient vendetta, that Jacob still would come to hunt us down. He had no motivation to let me change Bella, but I hoped that he and all the wolves would agree to the one exception to our treaty. Billy wasn’t giving anything away with his thoughts, but Sue’s mind was full of concern about being in a house with so many vampires. As the receiving line moved along, the only slightly awkward moment was introducing Tanya to Bella. â€Å"Ah, Edward, I’ve missed you,† Tanya said, pulling herself close to me in an intimate embrace. She lingered a bit too long in my one-armed hug—on purpose. I chuckled at her audacity as I employed one of Carlisle’s tricks for dealing with forward women†¦to press her shoulder away as if to admire the full length of her. â€Å"It’s been too long, Tanya. You look well.† Though Bella would never believe it, her beauty outshone Tanya’s many t imes over in my eyes. â€Å"So do you,† Tanya replied, a familiar note of longing in her voice. With a great swelling of pride, I interjected, â€Å"Let me introduce you to my wife.† Kate and Carmen giggled at the emphasis. My joy at using that word for the first time sang in my words. â€Å"Tanya, this is my Bella.† Bella had been uncertain about inviting Tanya and her coven, but I’d convinced her that as extended family—orphans, to boot—they must be included. I also wanted Tanya there specifically to underscore the point that I was officially and permanently unavailable. â€Å"Welcome to the family, Bella,† Tanya responded appropriately, if not altogether enthusiastically. â€Å"We consider ourselves Carlisles extended family, and I am sorry about the, er, recent incident when we did not behave as such. We should have met you sooner. Can you forgive us?† â€Å"Of course. It’s so nice to meet you,† Bella replied, blushing. I noted the brief flare of excitement among my cousins at the rush of blood before each of them contained it. â€Å"The Cullens are all evened up in numbers now. Perhaps it will be our t urn next, eh, Kate?† Tanya grinned. Kate’s sarcastic sense of humor kicked in. â€Å"Keep the dream alive,† she said, rolling her eyes. â€Å"Welcome, Bella.† Kate took Bella’s hand and Carmen stepped up to add hers. â€Å"I’m Carmen, this is Eleazar. We’re all so very pleased to finally meet you.† â€Å"M-me, too,† Bella stuttered. I thought she was holding up well considering she was meeting my â€Å"relatives† for the first time. â€Å"We’ll get to know each other later. We’ll have eons of time for that!† Tanya remarked, laughing. I enjoyed performing the rituals of the wedding celebration. Alice had ordered a gorgeous, artfully decorated cake, its beauty being the only aspect of it I could truly appreciate. I did not relish swallowing the chunky blob Bella pushed toward my face, but that could not be avoided with such an attentive audience. Flashbulbs popped, capturing the uncomfortable moment for all time. Bella tossed her bouquet to Angela, who blushed puce and carefully avoided the eyes of her escort, Ben, which are six inches lower than her own. When it came time to lift Bella’s skirt and remove her garter with my teeth, she blushed hotly while Jasper and Emmett guffawed at her embarrassment. I wasn’t allowed to venture too far up her dress, since she slid the garter below her knee before I got the chance. Still, it was a fun moment, biting the elastic band and dragging it slowly down her calf. After detaching it from her leg, I stretched the elastic into a slingshot, aiming for Mike Newton’s head. The garter snapped him in the forehead and his mouth dropped open.

Sociology Of Health And Illness Assignment Social Work Essay

Sociology Of Health And Illness Assignment Social Work Essay The aim of this assignment is to discuss the strengths and limitations of the social model of disability and how nurses can promote anti-discriminatory practice in relation to people with disabilities. Defining disability is said to be very difficult due to the fact that disability is a complicated, multidimensional concept (Altman 2001). Furthermore Slater et al (1974) has gone as far as stating that constructing a definition that would fit all circumstances is in reality nearly impossible. However attempts have been made by various different people, legislation and models in different ways. According to Altman (2001) these attempts are the reason why there has been a lot of confusion and misuse of disability terms and definitions. The Disability Discrimination Act defines a disabled person as a person who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities. (DDA 2005) However the medical model of disability sees disability as the individuals problem and that it should not concern anyone other than the disabled person, for example, if a student who is in a wheelchair is unable to get into the building due to the steps, the medical model would assume that it is due to the wheelchair rather than the steps. Whereas on the other hand the social model would say that the steps are acting as a barrier to the student, therefore the barrier should be removed. The social model of disability was brought about by activists in the Union of the Physically Impaired Against Segregation (UPIAS) during the 1970s. This model is seen as the main theory which tests disability politics in Britain (Shakespeare et al 2002). The UPIAS argued that there is a major difference between impairment and disability. They defined impairment as lacking part or all of a limb, or having a defective limb, organ or mechanism of the body. They have also defined disability as the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities (Giddens 2006). The social model of disability can be defined as an idea that it is society that disables an individual with the way everything is constructed to meet the needs of the majority who are not disabled (Shakespeare et al 2002). Whereas, the social model can be compared with the medical model of disability which tends to focus purely on finding a cure and that to be able to fully participate in society they need to treat their impairment (Crow 1996). The model has several key points. First it describes disabled people as an oppressed social group (Shakespeare et al. 2002) meaning that on top of their impairment, disability is something more deep that excludes and isolates them from participating in society (Oliver 1996). The difference between the impairments that people have to deal with and the oppression which they experience is fundamental to the British social model. Finally, the model defines disability as a form of social oppression, not a form of impairment (Shakespeare et al. 2002). Therefore the aim of the model is to empower disabled people so that they dont feel as though their condition is the problem, but that society is the problem due to the number of barriers it places on disabled people (Giddens 2006). For example, everywhere you go there will be steps, steps to get into a building, steps to climb floors and it is this barrier which causes problems for disabled people therefore the social model provides a soluti on saying that ramps and lifts should be fitted in all buildings, the problem of not being able to stand for too long should be tackled by placing more seats in public places. It is barriers like these that the social model aims to find solutions to. The British disability movement has found great importance in the social model in various different ways. Hasler (1993) describes it as the big idea of the British disability movement. For example, identifying a political strategy to remove barriers in society that played a large role in disabled peoples lives, which was also the main strength of the social model (Shakespeare et al. 2002). Examples of barriers that disabled people faced in all areas of life were the inability to access public transport systems due to the fact that a person was in a wheelchair or had visual or hearing impairment, their inability to find work because employers felt that the disabled person was incapable of doing the job, housing problems and so forth (Thomas 2004). The removal of such barriers would mean that if those people with impairments felt disabled by society then by taking away these barriers would help to empower and promote the inclusion of people with impairments (Shakespeare et al. (2002). The model tries to bring about change in society to suit the individuals need rather than taking up a medical view where you try and look for a cure, or rehabilitation (Shakespeare et al.2002). For example, people who have schizophrenia have to take medication in order to live normal lives. However it is argued that the social models complete view of changing society has become too simplistic or rather an over- socialised explanation. Furthermore, Vic Finkelstein (2004) argues that the social model looks at enabling people to be human in a society rather than having access to their rights. However the medical model of disability has a different perspective. They believe that people with disabilities need to be assessed, that they are incapable of making their own decisions, that they are the problem and that people with disabilities have to be adapted to fit into the world, but if this is not possible then they are placed in specialised institutions or isolated at home where only basic needs are met (Rieser, 2009). A second strength seen from the model was the actual impact on the disabled people themselves. The social model made disabled people feel free as they lifted the view of a medical approach, where the problem was the individual and placed it on society saying that social oppression was the root of the problem. This as a result made people feel liberated and empowered as they were made to believe they were not at fault: society was, that society was in need of the change: not the individual (Shakespeare et al. 2002). The social model helped to bring disabled people to come out like raising feminist consciousness in the seventies, or lesbians and gays coming out (Shakespeare et al. 2002). The social model has played a very important part in many disabled peoples lives, however, despite these strengths to the model there are a number of limitations. Firstly, the social model has been criticised for being unable to deal with the realities of impairment (Oliver, 2004), meaning that the model is not about peoples personal experience of impairment (Oliver, 1996) but about peoples collective experiences of disablement in society (Oliver, 1990). Another point criticised is that other social divisions such as race, gender, ageing, sexuality and so on are not incorporated in to the social model (Oliver, 2004). However Oliver (2004) that just because the social model hasnt incorporated these divisions does not mean that they are unable to. Oliver (2004) states that those who criticise the model are the ones who should try and forge the social model into action when dealing with issues such as race and gender and age and sexuality. Cultural values have also been pointed out to be ignored by the social model. There is an argument about the issue of otherness, meaning that it is the cultural views that people hold which place disabled people as others, not the physical and environmental barriers (Oliver, 2004). Furthermore, another limitation of the social model is that it clearly neglects and ignores the experiences of impairments and disability which are the main cause of problems in most disabled peoples lives (Giddens, 2006). Shakespeare and Watson (2002) argue that we are not just disabled people, we are also people with impairments, and to pretend otherwise is to ignore a major part of our biographies. Against this accusation, Oliver (2004) finds it difficult to accept that disabled peoples experiences are not considered because it is after all the main reason why the model emerged to begin with-due to a number of disabled activists in the 1970s. Furthermore defenders of the model argue that the social model merely focuses on social barriers that disabled people face rather than denying them of everyday experiences due to their impairment (Giddens, 2006). The social model has been criticised as being inadequate as a social theory of disablement (Oliver 2004). Corker and French (1998) talk about social model theorists and then conclude that the social model is not a theory, however Oliver (2004) argues that how can people criticise the social model for something it has never claimed to be? Oliver (2004) states that most people who have developed the social model have claimed that they have said the social model of disability is not a theory of disability. Leading on from the strengths and limitations, there is a substantial amount that nurses can do to promote anti-discriminatory practice in relation to people with disabilities by maintaining a positive attitude towards people with disabilities as they are constantly involved with the treatment and care of people with physical or intellectual disabilities (Klooster et al. 2009). Nursing schools as like other professions, tend to be based around the medical model of care where they aim to diagnose and treat diseases (Klooster et al. 2009). However as Byron et al (2000) has stated that not all disabled people are unwell and may not have a disease. Nurses have an important role, like other health professionals, in influencing a disabled persons response to treatment (Oermann Lindgren, 1995). Therefore Carter et al (2001) has stated that inappropriate attitudes and behaviours from staff are the biggest barriers which disabled people face, which has led to further research indicating that nursing students should move away from the medical model of care when working with people with disabilities and should focus on a more social model perspective (Scullion, 1999). Further research has indicated that nursing students attitudes towards disabled people may be improved by educational programmes which can help nurses to be in direct contact and to work with disabled people (Oermann Lindgren, 1995). However, the research literature suggests that this is currently not happening in nursing practice (Klooster et al 2009). For example, Brillhart et al (1990) found that nursing students had more negative attitudes then the person with the disabilities themselves. Nurses can help to provide clear information as Hammel (2003) states that professionals need to listen to what people are telling them and that actions and non-verbal messages can speak very loudly. Nurses can form strategies to communicate with disabled people in order to make their life easier (Hammel, 2003). However it is common that fewer health care professionals are reluctant to provide services for disabled people as they age (Hammel, 2003). By providing clear information nurses also involve other people who are important in the disabled persons life and ensuring that they are informed about options and benefits for the disabled person as well as themselves. Nurses can also act as advocates for disabled people so that they have equal use of services or even provide information of advocacy groups for the disabled person for example Centres for Independent Living (Hammel, 2003). Furthermore, where young people are concerned nurse can give advice to families about possibilities for independence and can also refer them to community resources that may help young people pursue further education, find a job and live independently (Blomquist et al. 1998) Lastly the Disability Discrimination Act is a guide for nurses to help them provide better care for people with disabilities and also how they can develop their practice (Aylott, 2004). There are many aspects with which nurses can help promote anti-discriminatory practice in relation to people with disabilities however, nurses need to keep a positive attitude towards people with disabilities in order for the anti-discriminatory practice to work. In conclusion for there to be equal rights for people with disabilities, Oliver (2004), states that people spend too much time discussing the strengths and limitations of each model therefore he suggests that both models should be integrated, ideas of both models should be put together and used in concordance so as to actually help people with disabilities. Oliver (2004) claims that if we imagine that throughout history carpenters and builders of the world had spent their time talking about whether the hammer was an adequate tool for the purpose of building houses, we would still be living in caves. Therefore there is a hammer in the disability movement and if it was used properly then the social model of disability can become the hammer of justice and freedom for disabled people (Oliver 2004). References Altman, B.M., (2001). Disability definitions, models, classification schemes and applications. In G.L. Albrecht. K.D. Seelman, M. Bury, (eds.) (2001). Handbook of Disability Studies. Sage, California. Ch.3. Aylott, J., (2004). Learning disabilities. Autism: developing a strategy for nursing to prevent discrimination. British Journal of Nursing, 13(14), 828-833. Blomquist, K.B., Brown, G., Peersen, A., and Presler, E.P., (1998). Transitioning to independence: challenges for young people with disabilities and their caregivers. Orthopaedic Nursing, 17(3), 27-35. Brillhart B.A., Jay H. Wyers M.E. (1990) Attitudes toward people with disabilities. Rehabilitation Nursing. 15(2), 80-82. 85. Byron M. Dieppe P. (2000) Educating health professionals about disability: attitudes, attitudes, attitudes. Journal of the Royal Society of Medicine, 93(8), 397-398. Carter J.M. Markham N. (2001) Disability discrimination. British Medical Journal, 323(7306), 178-179. Crow, L., (1996). Including all of our lives: Renewing the social model of disability. In C. Barnes. Geof Mercer, (eds.) Exploring the divide. Leeds: The Disability Press, pp.55-72. Finkelstein, V., (2004). Representing Disability. In J. Swain., S. French., C. Barnes., and C. Thomas, (eds.) Disabling Barriers- Enabling Environments. 2nd edition. Sage, London. Ch.2. Giddens, A. (2006). Sociology. 5th edition. Polity Press, Cambridge. Hammel, J., (2003). Technology and the environment: supportive resource or barrier for people with developmental disabilities. The Nursing Clinics of North America, 38(2), 331-349. Klooster, P.M.ten., Dannenberg, J.W., Taal, E., Burger, G., and Rasker, J.J. (2009). Attitudes towards people with physical or intellectual disabilities: nursing students and non-nursing peers. Journal of Advanced Nursing, 65(12), 2562-2573. Oermann M.H. Lindgren C.L. (1995) An educational programmes effects on students attitudes toward people with disabilities: a 1-year follow-up. Rehabilitation Nursing 20(1), 6-10. Oliver, M. (1990). The Politics of Disablement. Macmillan Press, Basingstoke. Oliver, M. (1996). Understanding Disability: From Theory to Practice. Macmillan Press, Basingstoke. Oliver, M. (2004). If I had a hammer: The social model. In J. Swain., S. French., C. Barnes., and C. Thomas, (eds.) Disabling Barriers- Enabling Environments. 2nd edition. Sage, London. Ch.1. Rieser, R. (2009) The Social Model of Disability [online article]. Available from [accessed 6th January 2010]. Scullion P.A. (1999) Conceptualizing disability in nursing: some evidence from students and their teachers. Journal of Advanced Nursing. 29(3), 648-657. Shakespeare, T., Watson, N. (2002). The Social model of disability: an outdated ideology?. Research in Social Science and Disability, 2, 9-28. Thomas, C., (2004.) Disability and Impairment. In J. Swain., S. French., C. Barnes., and C. Thomas, (eds.) Disabling Barriers- Enabling Environments. 2nd edition. Sage, London. Ch.3.

Physics Lab Report Essay -- essays research papers

Physics Lab Report Statement of the Problem:   Ã‚  Ã‚  Ã‚  Ã‚  The problem that was arisen in Problem #5: Motion up an Incline was in reference to a change in acceleration in both an uphill and downhill motion. The question on hand was whether or not the acceleration was the same going uphill as it was downhill or different from each other in both directions. To obtain a secure conclusion this experiment required the use of a frictionless cart, an inclined ramp, motion sensor, meter stick, and assistance of computer programs. These tools help us to achieve/correct our predictions by giving us precise information about the acceleration of the cart in both the up and downhill direction. Prediction:   Ã‚  Ã‚  Ã‚  Ã‚  My prediction for Problem # 5 was how I felt that the acceleration of the cart would be equal but opposite to each other on the way up and down. As the cart is going uphill it would have a negative acceleration (see notebook for rough sketch of graph) because it’s slowing down and eventually going to return back to the bottom. As the cart is going down hill it is working with the acceleration making acceleration positive in a quantitative sense. Data & Results:   Ã‚  Ã‚  Ã‚  Ã‚  The lab for Problem #5 was conducted in a pretty simple manner. Since are main goal was to see if acceleration were the same on the way up as it was down we just had to do a couple experimental runs by launching the cart up the hill, allowing it to reach its max distance up and then come back down. While doing the previ...

Social Learning Theory

By definition the term Social learning theory is an approach that emphasizes on the role of modeling otherwise known as imitation or observational learning, in the development of behavior (Matlin, 85). The behavior in which children learn is typically gender-related meaning that they will act based on their gender for example, girls will learn how to act in a feminine way and boys will learn how to act in a masculine way. The way children learn how to act gender appropriate is through their parents, peers, media, and finally school. The first factor in the Social leaning theory is the child’s parents, their first teachers.Even though parents may not be consciously aware of it, they tend to teach their daughters and sons differently when it comes to gender characteristics. For one, take the activities that children tend to take part of whether it varies from chores to the toys they play with, parents will encourage the appropriate gender behavior. When it comes to chores a fema le will more likely to have to do more of domestic chores such as cleaning the living room and the bathroom while on the other hand a male will more likely have to the heavy duty chores such as taking out the trash and repair items that are broken.Once again parents encourage children to participate in the activity that is â€Å"appropriate† by using positive and negative reinforcement, they discourage the activities that they believe will be inappropriate based on the child’s gender and encourage those they believe to be appropriate. The book mentions a study by Campenni done in 1999 that states that parents are more scared of their male child becoming sissies then their female child becoming a tom boy. Another way parents influences gender-type activities is through the conversations in which they have with their children.The book states a study done by Fivush and Buckner in 2000 showed that 21% of mothers will discuss anger with their sons in a conversation that wil l last a half an hour where as 0% of mothers will discuss anger with their daughters but, they will discuss fear and sadness with them (Matlin, 90) Even though some parents prefer to talk about aggression to their daughter some boys might learn how to be aggressive through their father by imitating them which again is what the Social learning theory is about. Peers are a big factor in the Social Learning theory in which a child will learn how to behave in a gender type of way.During the time a child begins school he or she will fall into their â€Å"Peer Group† in which will be the group of children that is the age as them. Children tend to encourage gender typing by rejecting the child that is acting in an â€Å"inappropriate† way. Young children to fall into two groups: boys and girls, and with the separation of genders they treat each other differently. First, if a female child comes to school with baggy jeans and baseball cap on her peers will reject by either not playing with her or tease her for being different.Once Again, the book states that in 2003 Judith Blakemore asked children from the age 3 to 11 if they would be friends with someone who clearly violated traditional stereotypes. The results shown that children particularly dislike a boy who wears a girl hair style and played with a Barbie doll and will judge girls less harshly for the same violations of traditional stereotypes. Children tend to isolate themselves from the opposite gender and associate with the same gender. When boys participate in gender segregation they tend to develop a feeling of entitlement which means since they are male they deserve better and greater things.Another way aspect that helps shape gender typing is the media. The media can consist of books and televisions. When it comes to children’s picture books, females are clearly depicted as invisible leaving the main characters to be mostly males. As stated by the book Ochman (1996) created a study in w hich children watched a video tape of an actor reading different books where each story required the main character to solve a problem which would result in the enhancement of the character’s self esteem.Over a 6 week period a of a group of 7 to 10 years old listened to the stories but, half heard the story where the main character was a male and the other half heard the story where the main character was a female. The results shown that the girls who heard about the female character had a higher increase of self esteem and boys showed the same result when the main character was a male (Matlin, 100). The finally aspect that shapes gender typing is school. Even when it comes to school males are treated more valued then females.Even the teacher behavior supports that males are treated better than females, where girls are not given equal treatment. The activities of the classroom are typically to appeal to boys rather than females. Females are even less shown in text books. Boys tend to get a positive feedback in the class room since they will be called upon more, praised for their creativity, and included more in class discussion. Take for an example if a question was asked and the a female raised her hand and gave the correct answer and then a male an answer that is â€Å"wrong† the male will receive recognition for that answer (Sadker, 97)There are many aspects that can contribute to the Social learning Theory. The first will be Parents since they are the child’s first teachers and the first people in the child’s life to give them positive and negative reinforcement. The second aspect will be their peers which consist of the children they pay with. Those children will mostly likely encourage appropriate gender behavior more than inappropriate behavior. The media and school are last aspects of the Social learning theory.

Red and White Mulberry Information and Identification

Red and White Mulberry Information and Identification Red mulberry or Morus rubra is native and widespread in the eastern U.S. It is a rapid-growing tree of valleys, flood plains, and moist, low hillsides. This species attains its largest size in the Ohio River Valley and reaches its highest elevation (600 meters or 2,000 feet) in the southern Appalachian foothills. The wood is of little commercial importance. The trees value is derived from its abundant fruits, which are eaten by people, birds, and small mammals. The white mulberry, Morus alba, is native to China and has several differences including size, foliage, and color of fruit. Fast Facts: Red Mulberry Scientific name: Morus rubraPronunciation: MOE-russ RUBE-ruhFamily: MoraceaeUSDA hardiness zones: 3a through 9Origin: Native to North AmericaUses: Bonsai; shade tree; specimen; no proven urban toleranceAvailability: Somewhat available, may have to go out of the region to find the tree Native Range Red mulberry extends from Massachusetts and southern Vermont west through the southern half of New York to extreme southern Ontario, southern Michigan, central Wisconsin and southeastern Minnesota; south to Iowa, southeastern Nebraska, central Kansas, western Oklahoma and central Texas; and east to southern Florida. It is also found in Bermuda. Description Size: 60 feet tall; 50 foot spreadBranches: Dense branches that droop as the tree grows, and will require pruning for clearance; should be trained to a single leader.Leaf: Alternate, simple, broadly ovate to roughly orbicular, pointed, 3 to 5 inches long, serrate margin, even base, rough and fuzzy undersidesTrunk and Bark: Showy trunk; Gray colors with flattened and scaly ridges.Flower and Buds: Small and inconspicuous flowers with off-center buds; usually dioecious but can be monoecious (both male and female flowers on different branches); male and female flowers are stalked axillary pendulous catkins and appear in April and MayFruit: Reddish black and resembling blackberries; reach full development from June to August; composed of many small drupelets developed from separate female flowers ripening togetherBreakage: Susceptible to breakage either at the crotch due to poor collar formation, or the wood itself is weak and tends to break. Special Uses Red mulberry is noted for its large, sweet fruits. A favored food of most birds and a number of small mammals including opossum, raccoon, fox squirrels, and gray squirrels the fruits also are used in jellies, jams, pies, and drinks. Red mulberry is used locally for fence posts because the heartwood is relatively durable. Other uses of the wood include farm implements, cooperage, furniture, interior finish, and caskets. In landscape use. the species is considered invasive and fruits cause a mess on walks and driveways. For this reason, only fruitless cultivars are recommended. Differentiating White Mulberry When compared to red mulberry, the white mulberry has several key differences:Size: Smaller, at 40 feet tall and 40 foot spreadBranches: Less dense with fewer branchesLeaf: Brighter green, smoother, and more rounded with uneven basesTrunk and Bark: Brown with thick and braiding ridgesFlower and Buds: Centered budsFruit: Less sweet, smaller, and lighter in color, with creamy brownish white berries that start as green, purple, or even black; only females bear fruit Red and White Mulberry Hybrids Red mulberry hybridizes frequently with white mulberry, which has become naturalized and somewhat more common than its native sister throughout parts of the Eastern United States.