John Locke outlinect Essay Example for Free

John Locke outlinect Essay â€Å"Rationalism is the thought that appeals to reason or intellect a primary or fundamental source of knowledge or justification. † â€Å"It is typically contrasted with empiricism, which appeals to sensory experience as a primary or fundamental source of knowledge or justification. † John Locke argues that, â€Å"We come to this world knowing nothing whatsoever. † (Warburton 74). He believes that experience teaches us everything we know. This view is usually known as empiricism, in contrast to innatism, (the theory that some of our knowledge is in born), and to  rationalism (the strife that we can achieve knowledge of the world by the power of reason alone). ?Locke’s essay â€Å"Human Understanding† published in 1689, soon became a philosophical bestseller. He produced four editions of it in his lifetime, and it had already reached its eleventh by 1735. This book is complex and wide ranging work; its main focus is the origin and limits of human knowledge. He tries to answer these questions. * what can we know? * What is the relation between thought and reality? These are real the perennial questions of the branch of philosophy called epistemology, or the theory of knowledge. ?Locke described his role as that of an underlabourer , clearing away conceptual confusions so that the scientists, or natural philosophers, as they were then known, could carry on their important work of adding to human knowledge. (Warburton 75). ? No innate principle 1. Locke does not believe that it makes sense to say that someone could be having a thought without their knowing what that thought was about. He rejects any idea of unconscious thoughts as nonsensical. A) One argument he uses to support his claim that there are no innate principles is that it is obvious that there is not total agreement about what the supposedly innate  principles might be. If we were all born knowing that, for example, we should keep our promises, then everyone would recognize this as fundamental principle. But, as Locke points out, there is no such general agreement. (Warburton 76). Nor do children immediately recognize the principle as one binding on them. Locke continues to argue that there is no innate principle aside from the principle that is taught and learnt. ?Locke supports his idea by saying, if there were innate principles then children must strongly abide by them since adults have already influenced by the culture and people. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ These and other arguments lead Locke to reject the view that there are any innate principles. This led him with the task of explaining how it is that the human mind comes to be furnished with thoughts, beliefs, and knowledge of the world. His answer is that all our ideas come from experience. Ideas Locke uses the word idea to mean whatever it is that anyone thinks about. When you look out of your window, what you see – a tree perhaps, or a sparrow – is not the tree or sparrow itself, but rather representation of it, an idea, something like a picture in your head. (Warburton 76). Locke believes that not all our ideas are received from immediate sensation of the world. Some of them are ideas of reflection, such as when we reason, or remember or will do something. Locke believes that all our ideas ultimately come from experience, so that the contents of our thoughts, even when we are reflecting rather than perceiving, all come from sensation. Example: A child locked away would have no more idea of scarlet and green than he would of the taste of  oyster or pineapple if he had never tried them. Ideas can be combined in several ways, so that once we have the idea of scarlet and the idea of a coat, we can imagine a scarlet coat, even if we’ve never actually seen one. But the simpler ideas from which the complex ones are built all originate in perception by one or more of the five senses. ( Warburton 77). Primary and Secondary Qualities When we say that a snowball is greyish-white and cold and round, what we mean is that it can produce in us ides of these properties. Locke distinguishes primary and secondary qualities , giving a very different account of each. -Primary qualities are inseparable from objects. The primary qualities of a snowball would include its shape and solidity, but not its color or its coldness. Solidity and shapes are more likely to remain constant at place over time. Secondary qualities would be color and coldness because its coldness can be changed at a different room temperature while different light settings can give shade to whatever object of your concentration that in a way gives you an illusion view of what you’re actually watching. Personal Identity.

Impact of Aphasia on Health and Well-being

Impact of Aphasia on Health and Well-being Abstract This discussion paper considers the impact of aphasia on health and well-being, and following an in-depth exploration of relevant literature, provides suggestions for appropriate nursing interventions in respect of this relatively common condition following stroke. The introduction states that effective communication is essential to holistic care and positive outcomes for individuals affected by aphasia. However, when verbal communication is absent, nurses fail to adequately utilise alternative strategies so that the standard of nurse/patient communication is frequently poor. The discussion introduces the Theory of Human Scale Development. This theory emphasises that quality of life depends as much upon self-actualisation and relation-building as on physical health. The theory is used as a framework within the discussion in order to highlight the significance of communication to quality of life, and how its loss has profound psychological and social consequences. By utilising the theory, the discussion demonstrates that nursing care delivery must address loss of self-actualisation and relationship-building abilities, as well as physiological communication skills. The discussion reflects upon how aphasia results in loss of self, and how the situation is exacerbated by inadequate healthcare communication strategies such as nurse-controlled conversation, talking-over, and elderspeak. Suggestions are offered regarding more appropriate strategies. Efficacy of family input is considered; nursing competence regarding language practice therapies is discussed, and the quest approach is explored. Next, the discussion reflects upon the impact of aphasia on relationships. Aphasia denies access to support networks and results in isolation, stress, and loneliness. The individuals predicament is worsened by negative nursing responses such as communication filtering and avoidance tactics. The discussion reflects upon positive nursing strategies, which alleviate effects of aphasia on individuals social health. Concept analysis and self-awareness exercises as methods of enhancing compassion skills are explored. The social model of disability is discussed in order to highlight the benefits to individuals of environmental adaptations. Also, the social benefits of aphasia-group affiliation are discussed. The discussion concludes by emphasising that fundamental human needs involve social and psychological as well as physical aspects. Nursing interventions must therefore address all needs in order to provide holistic care in its fullest sense. Key Words Aphasia: nursing: relationships: self: Theory of Human Scale Development Summary Statements What is already known about this topic Good communication between nurses and patients is essential to the provision of quality healthcare that protects patients rights, autonomy and choice. Aphasia compromises nurse/patient communication leading to discrimination in health services, suboptimal care, poor long-term outcomes, and restricted rights. Communication difficulties faced by individuals with aphasia risks loss of self, and diminishes the beneficial impact of social integration on health. What this paper adds The multifarious impact of aphasia on the lives of individuals with the condition must be recognised and acknowledged by nurses. During their day-to-day nursing activities, nurses can facilitate the immediate communication needs of individuals with aphasia. Nurses can initiate aphasic individuals abilities to function independently and autonomously in the wider world via supporting the maintenance of personal identity and social integration. Introduction It has long been acknowledged and purported that good communication is essential to the provision of quality healthcare as it is integral to effective clinical assessment, health promotion, and patient choice and autonomy. Models of communication and research studies (Peplau, 1952; Fosbinder, 1994; Charlton et al, 2008) suggest that care delivery and health outcomes are improved when nurses use communication as a reciprocal interaction to express concern and commitment, and in return invite trust and human connection. These texts demonstrate that proficient interpersonal skills transform patients from objective clinical tasks to individuals meriting empathic, holistic care. However, because most communication strategies depend upon speech, the expediency of interpersonal relationships becomes severely compromised for individuals who experience aphasia as a consequence of stroke. Indeed, although the World Health Organisations (2001) definition of communication impairment encompasses verbal, non-verbal and graphic abilities, Finke et als (2008) systematic review finds that nurses continue to focus on stroke patients inadequate ability to verbally meet communication needs. Non-verbal messages are assigned a secondary, supporting role, and are therefore not adequately exploited as legitimate alternative strategies. The subsequent poor standard of professional/patient communication, described as appalling in the United Kingdoms National Sentinel Stroke Audit (Intercollegiate Stroke Working Party, 2009, p.12) has serious ramifications. O Halloran et als (2008) literature review suggests that health professionals inability or unwillingness to effectively enga ge with individuals affected by aphasia leads to discrimination in stroke services, suboptimal care, poor long-term outcomes, and restricted rights. Theory of Human Scale Development To avoid the suboptimal care of patients with aphasia, nurses must realise the necessity of effective communication to health and well-being. If nurses are to be motivated to explore, improve and exploit communication strategies as therapeutic tools, they must, in the first instance, understand the devastating impact of aphasia on quality of life. An analysis of aphasia in relation to the Theory of Human-Scale Development (Max-Neef et al, 1991) helps to illustrate its effect on the individual. According to the Theory of Human-Scale Development, quality of life depends upon the satisfaction of nine classes of interrelated ontological fundamental human needs (figure 1). Of these, only subsistence relates to physical health, the others being concerned with psychological and social issues associated with the sense of self and relationships. Because quality of life correlates with the number of satisfied needs, if a synergic satisfier (one satisfier that satisfies multiple needs) such as the ability to fluently verbally communicate, is removed, the impact on life quality is devastating (figure 2). Charmaz (1983; 1995; 1999) symbolic interactionist perspective reaches similar conclusions. These grounded theory studies of chronic illness demonstrate that the self is developed and maintained via self-actualisation and social relationships. Where illness reduces individuals participation in society, and prompts negative reactions from others, feelings of discreditation and loneline ss follow. Individuals beliefs that they are encumbrances on society rather than valuable contributors, lead to suffering and the loss of self. It is essential, therefore, that rehabilitative therapies should result in a synergic effect so that self, relationships, and thus quality of life are improved and maintained to the highest possible level (figure 2). However, many individuals with aphasia bemoan the fact that health professionals consistently focus on physical, biomedical definitions which view the condition as synonymous with physiological stroke events, rather than separate aphasia disability experiences (Liechty and Heinzekehr, 2007; Shadden et al, 2008; Wertheimer, 2008). This leads to the dismissal of psychological and social aspects of communication impairment and a thwarting of attempts to address them. Thus, the biomedical perspective, which defines aphasia as an inability to use or comprehend language as a consequence of injury to the cerebral cortex, results in the comment, I have aphasia, generating the response, You mean you had a stroke (Liechty and Heinzekehr, 2007, p.316). But, as Liechtys autobiographical account illustrates, aphasia is not an objective condition but a subjective reality, and focusing on the physiological brain damage both de-emphasises the pain that aphasia causes and denies the continual struggl es faced (p.316). Liechtys experience suggests that a psychosocial definition is more appropriate to describe the full extent of the consequences of aphasia to the individual. Sundin et als (2000) wider definition describes the condition as a defect in the use of language which causes extensive damage to psychological and social well-being resulting in isolation and depression. This study suggests that understanding the meaning of the illness for the individual rather than concentrating on the underlying physical causes, is the true initiator of holistic healing. O Halloran et al (2008) agree. This systematic review proposes that a biomedical perspective impoverishes care delivery because attributing communication breakdown to the disease process reduces nurses responsibility and motivation to develop ongoing communication strategies. The review suggests that a psychosocial perspective where nurses view communication impairment as an illness experience as well as a medical phenomenon, promotes the ide a that difficulties result from impaired interaction between nurse and patient. This increases nurses feelings of responsibility to overcome communication barriers and seek out the individual behind the disease. It is apparent, then, that reference to the Theory of Human-Scale Development helps to illustrate how a professional attitude which attempts to satisfy all fundamental human needs, not just the physical need of subsistence, subsequently leads to richer, more meaningful outcomes. Although fundamental human needs are to an extent, interrelated (figure 1), they are broadly split into three categories. The discussion paper will explore the impact of aphasia by focusing on self-actualisation and relationship needs. Self-Actualisation Needs Impact of Aphasia on the Self Rogers (1967) personality theory states that self-concept and self-perception are fundamental components of personal identity. He proposes that because life-meaning and behaviour are essentially purposeful, individuals require freedom to make choices, and create and develop their own personalities, in order to construct a valid presence in the world. Of course, language is the core of this process of self-construction. Without language, the ability to narrate lived experiences is lost. The individual cannot inform the world who and what he/she is, or understand who and what others are, hence is unable to find an appropriate place in the scheme of things. Shaddens (2005) literature review describes this predicament as identity theft, a state of affairs in which individuals with aphasia are ignored and invisible. However, Kagans (1995) masking of competence model refutes this, proposing that the individual is transformed rather than rendered invisible by aphasia. The model states that because communication impairment makes it difficult to perceive the individuals functional mind, it becomes difficult to envisage capacity. With capacity hidden, the individual is transformed from a person to a mere physical presence and is often viewed as a burden with little social value. According to Charmaz (1983), witnessing ones former self-image crumbling away is itself a fundamental form of suffering (p.168). Time and again, autobiographical narratives refer to the pain experienced when the self is reduced by an assumption that language loss is synonymous with the loss of intellectual and cognitive abilities (Neal, 1988; Bauby, 2008; Liechty and H einzekehr, 2007). Bauby (2008) summarises the feeling thus, [They] left no doubt that henceforth I belonged on a vegetable stall and not to the human race (p.90). Buber (1958) refers to this objectivising of people as an I-It relationship (as oppose to an I-Thou relationship defined by its reciprocal and mutually respectful nature). Aphasia renders the establishment of a nurse/patient I-Thou therapeutic relationship particularly challenging, because sharing and understanding become difficult to achieve. Unfortunately, this often results in I-It communication within the healthcare arena, which in nursing, is intrinsic to detached task-orientated care. According to Gordon et al (2008), this denies individuals with aphasia the freedom to control and direct their own lives. Gordon et als (2008) observational study concludes that staff control conversations and focus dialogue on their own nursing-task goals. The studys use of conversation analysis demonstrates that patients rarely initiate conversations and therefore have little influence over topics. In addition, due to heavy reliance on the sequential context of dialogue in order to maximise unde rstanding, individuals with aphasia find it difficult to alter the course of conversation to suit their requirements. Such asymmetrical, task-orientated communication is neither therapeutic or responsive to holistic needs. This results in a reduction of the self and a denial of individuals rights to participate in their own care or in the creation of their own future. According to Wertheimer (2008), curbing the freedom to express the self commonly leads to feelings of entrapment. Wertheimers (2008) detailed analysis of post-subarachnoid haemorrhage experiences suggests that language difficulties and loss of control during hospitalisation contribute to depression, and dreams and hallucinations, which frequently involve images of imprisonment and dictatorial authoritarianism. The negative impact of nurse-controlled conversation is exacerbated further by persistent occurrences of talking over patients. Flegels (2008) short article acts as a reminder that talking over is unethical because it contradicts health professionals codes of conduct that stipulate patient autonomy is paramount during care delivery. Quoting Kants (1785) argument that autonomy depends upon the hypothesis that all individuals have unconditional worth, Flegel (2008) believes that talking over signifies to patients that their presence is of no consequence and therefore they are not autonomous. Elderspeak also diminishes autonomy. This speech style is generally used as a means to communicate with elderly patients, but research confirms that it is commonly used by nurses when encountering individuals with physical, cognitive and communication disabilities (Kemper et al, 1998; Williams et al 2004; Melton and Shadden, 2005). Williams et al (2004) describe elderspeak as a demeaning mode of communication similar to baby talk that features exaggerated, simplified, repetitive language. Because elderspeak stereotypes elderly and disabled patients as incompetent and incapable, individual potential and progress may be ignored, thus reducing control and the sense of self even further. Reactions to Loss of Self Unsurprisingly, individuals with aphasia struggle to instigate the fight to rescue the self, and often surrender to discreditation. Charmaz (1983) explanation that self-concept depends upon reflected images of the self by others is confirmed by Simmons-Mackie and Damico (2008). This study of communication therapy sessions suggests that external negative responses to individuals with aphasia leads to internal negative perceptions of the self and a silencing of the voice. Poor nurse communication techniques based on task-orientated conversation, elderspeak and talking over compound this internalisation process. According to Ryan et als (1986) seminal literature review and subsequent theory of dependency over-accommodation, implications of incompetence and diminished capacity which arise from such condescending speech styles lower individuals confidence and self-esteem. This increases dependency and passive acceptance of care, and consequently promotes feelings of worthlessness and powe rlessness. Parr et al (2003) agree. This literature review reports that individuals faced with inadequate communication attempts of service providers, feel so diminished that they often apologise for their own existence. By reflecting on the impact of aphasia on self-actualisation needs, it seems that the nursing role in care delivery should involve supporting the individual to both recover the pre-aphasic self and connect this self to the new disabled identity. In order to achieve this, the nurse must firstly get to know the patient as a person, then secondly, empower that person to regain the creativity, confidence and freedom required to control his/her own life. Nursing Implications Use of Family Liaschenko and Fisher (1999) identify person knowledge as integral to the establishment of effective therapeutic communication and holistic care. The acquisition of this knowledge involves knowing the patients private biography with a view to revealing the unique individual. Where aphasia inhibits direct verbal interaction between nurse and patient, family and friends can relay information and re-construct much history, therefore contributing to the satisfaction of a range of fundamental human needs. According to Williams and Davis (2004), this indirect narrative is invaluable as it allows the nurse to participate in individualised communication when speaking directly to the patient. This deters any tendency for task-focused interaction or elderspeak, which in turn, reinforces the individuals sense of self. There are barriers to implementing such interaction however. Paradoxically, despite, for example, British Government calls for improved professional/patient/carer communication (Intercollegiate Stroke Working Party, 2009), some studies report that nurses efforts to personalise care by informal chat with patients and families are thwarted by sociopolitical systems that prioritise task completion over person knowledge. (McCabe, 2004; Speed and Luker, 2004). Also, Fairburns (1994) study of attitudes to visiting hours reports that nurses often feel patients and relatives resent staff presence as an intrusion upon their private time together. Perhaps the use of patient diaries can help overcome these barriers. Combes (2005) introduction of diaries in the intensive care setting demonstrates that by encouraging families to produce ongoing written narratives, which are left at the patients bedside, readily accessible relevant information concerning what is significant and individual to the patient is made available. This data can be utilised and built upon in later nurse/patient interactions. Research into the use of diaries in aphasia care should therefore be undertaken. Families are also useful when nurses are trying to ascertain the individual with aphasias immediate concerns and opinions. Goodwins (1995) well-cited case study illustrates that needs are more easily interpreted when relatives, familiar with the individuals gestures, facial expressions and idiosyncrasies, and who share common social contexts with him/her, are on hand to translate. Indeed, Finke et als (2008) systematic review finds that, where nurses are prepared to ask families for suggestions, or written directives, regarding the meanings of the individuals non-verbal strategies, communication is much more efficacious. In terms of advocacy, Hedberg et als (2008) study of multi-disciplinary care-planning meetings demonstrates that an in-depth knowledge of the individual with aphasias life and views, equips family members to act as advocates in the negotiation of care needs and future plans. The research therefore concludes that nurses require training in how best to involve relatives in the decision-making process in order to ensure individual needs remain salient. While the recommendation to involve families in the communication process is essentially sound, much of the proposing nursing literature quoted above nevertheless fails to fully explore the potential risks to patient autonomy of relying heavily on alliances with relatives. Translation literature (Englund-Dimitrova, 1997; Bradby, 2001; Leininger and McFarland, 2002) confirms that any form of interpretation via a third person amplifies the chances of misinterpretation. However, the risk is further heightened by relatives conscious or subconscious propensity to distort, omit or add to the patients messages and opinions in order to address their own concerns. Shadden et als (2008) review of autobiographical narratives reports that, while the well-being of patients is the central concern of most families, disability caused by stroke has a significant negative impact on the lives of all close family members. This may result in the interpretation of aphasic communication being influenced by the intermediarys own slanted perspectives. Thus, relatives feelings of guilt, fear, stress, and fatigue may filter out some of the true messages that the individual with aphasia is trying to express. Ryan et al (1986) offers a more cynical consequence to family advocacy by suggesting that it may undermine the individuals power to control situations, and can even disguise the sense of self by recreating and redefining elements of the individuals history, personality and wishes during the advocacy process. Hence, although it is helpful to use family knowledge to obtain patient information, nurses must recognise that individuals needs may not be adequately supplied by biased intermediaries. Nurses must therefore be able to use their own disinterested objective strategies to reach an understanding of the individual with aphasias meaning. Nursing Implications Competence Theory and research which explores the meaning of caring (Halldorsdottir and Hamrin, 1997; Brilowski and Wendler, 2005; Chang et al, 2005) states that a fundamental strategy when nursing any illness is the alleviation of the patients fear that nothing can be done to treat the condition. This literature reveals that while patients appreciate expressive caring behaviours, competence when performing instrumental therapies, is considered imperative to a secure caring base. As Halldorsdottir and Hamrin (1997) assert, caring without competence is meaningless (p.123). It is apparent that in aphasia, where preservation of the self is at stake, the nurse needs to convey competence and confidence in attitude and execution of language practice therapies, so that the individual with aphasia feels secure in the knowledge that recovery of identity is possible and in hand. Nystroms (2009) phenomenological study of interviews and biographies finds that such provision of security via nursing competence encourages patient hope, motivation, and fighting spirit (p.2509). Finke et al (2008) believes that nursing competence in language practice therapy requires training in basic speech therapy, familiarity with augmentative and alternative communication, and regular consultations with speech and language therapists. However, currently, none of these schemes are widely implemented. Hemsley et al (2001) suggests this is due to individual and organisational attitude barriers, which view specialised communication techniques as both too time-consuming and beyond the remit of nurses. Finke et al (2008), proposes that time and resources spent on enhancing nurses communication competence may prove more efficient than relying on minimal task-orientated interactions. This is because ineffective interactions are at high risk of misinterpretation, ineffective at meeting individual needs, result in frustration, fear and despondency, and may contribute to depression. Also, Nystrom (2009) finds that extended time periods required for personal care support, provide ideal opportunities for skilled practitioners to simultaneously offer language practice (thus reducing rehabilitation time and resources), while allaying patient fears. A participant in the research is quoted thus, One nurse talked to me while helping me to eat and get dressed†¦that made me feel calm and secure (pp.2507-8). Nursing Implications Quest Approach Aphasia traps individuals in the present. Struggling to express details of past achievements, individuals situations are worsened by an inability to shape the future. In effect, individuals have lost both identity, and the freedom and creativity to restore it. They have lost their place in the world. Nystrom (2009) believes that the optimal method of regaining place is to defer to individuals pre-stroke identities. An awareness of individuals previous competencies, allows the nurse to personalise language practice, communication strategies and conversation by basing subject matters on familiar contexts of family, work, interests, and achievements. This enables individuals with aphasia to grasp meanings more easily, but it also helps to maintain a sense of the old valued, accomplished self, thus providing a structure on which to base rehabilitation goals. This method, defined by Moss et al (2004) as a restitution approach, is fundamentally flawed because it overlooks the fact that for many individuals, aphasia remains a permanent disability. Preoccupation with the old self could therefore lead to a painful mourning for what is lost. It could even exacerbate feelings of worthlessness by highlighting comparisons between past abilities and present inabilities. Moss et als (2004) exploration of online illness narratives purports that a quest approach is more psychologically healthy. Here, individuals are encouraged to accept their changed circumstances, and envisage and create a different future. For the nurse, this involves using the individuals history, not as a source of goals, but a source of interests on which new modified goals can be built. This requires strong multi-disciplinary co-ordination skills to bring patient, nurse, speech therapist and occupational therapist together in order to fully explore interests, resources, potential and progress. Furthermore, according to Vickery et als (2009) quantitative analysis of self-esteem scales, the nurse must kindly but firmly guide individuals to a realisation of their limitations so that the risk of disappointment is reduced. However, simultaneously, the nurse should demonstrate motivating and commendatory attitudes that elicit a sense of pride from individuals in their gains and success es, which ultimately increases confidence, self-worth and a sense of freedom. Relationship Needs Impact of Aphasia on Relationships Berkman et als (2000) review of social integration theory demonstrates that relationships and affiliations are formidable influences on physical and psychological health. The study explains that relationships provide informational, instrumental (practical), appraisal (decision-making) and emotional support, as well as opportunities for social engagement. All these aspects are essential to the endorsement of meaningful roles, the reinforcement of participation and belonging, and the promotion of affection and pleasure. Charmaz (1983; 1999) reiterates that these factors add to the sense of self as a valuable entity. Any process or condition which leads to alienation, separation or disconnectedness from society, adversely impacts on mental well-being and mortality (figure 2). Generative studies by Durkheim (1952) and Bowlby (1991) suggest that relationships serve to buffer detrimental influences of stressful events. These texts illustrate that when consistent, reliable relationships are absent or damaged, psychological stability is weakened and the risk of depression increases. Berkmans (1988) hypothesis takes this concept further by suggesting that social isolation is itself a chronic stressor resulting in persistent heightened hypothalamic-pituitary-adrenal (HPA) axis responses which consequently accelerate physiologic aging and functional decline. Because conversation is pivotal to interaction and relationship building, aphasia inhibits individuals from exploiting the health benefits of social integration. Pound et al (2006) believe that conversation is primarily transactional, enabling individuals to participate within a supportive society consisting of mutually supportive relationships. Aphasia therefore, results in an inability to access support strategies resulting in isolation and stress. For example, appraisal support is compromised because individuals with aphasia are unable to talk problems over with friends. Likewise, informational and instrumental support may be inaccessible if individuals cannot express their opinions and needs, nor comprehend disseminated messages. While Laver (1975) acknowledges the transactional element of conversation, he also emphasises its interactional nature, which allows the development of social connections. He explains that it is a bonding ritual, which explores and categorises social position, conveys intimacy, conspiracy, affection and belonging, and as such, its loss can lead to a devastating sense of loneliness. For individuals with aphasia, whose health is already severely impaired by stroke, it is imperative that nurses are able to support the relationship-building process, and hence, diminish risks of further health problems associated with social isolation. Ramos (1992) research concludes that this is best achieved by establishing reciprocal or connected nurse-patient relationships which involve the development of emotional and cognitive bonds that persuade the individual to feel the nurse is taking on part of the burden (p.503). Reciprocation also encourages nurses to perceive coping with illness as a shared responsibility. Pound et al (2006) agree, stating that if professionals acknowledge patients are not solo performers, but part of a company of players (p.18), then this idea of joint responsibility is accentuated. However, poor therapeutic relationship development in aphasia remains a common problem. Perhaps this can be explained by Hindles (2003) suggestion that any phenomenon, which undermines nurses competence as communicators, leads to the implementation of communication filter barriers, such as rationalisation and projection. Sundin et al (2000) believe aphasia is a relationship leveller because both nurse and individual with aphasia have difficulty being understood by, and understanding, each other. This situation is uncomfortable for nurses working in a healthcare social construction that is founded upon competency achievement and proficient practice. Balandin et als research (2007) validates this idea. This small qualitative study finds that the undermining of competence and power results in rationalisation and projection in the form of defensive attitudes such as its not my job or the patient doesnt need to communicate (p.58). These avoidance tactics have been so widespread that Stock well (1972) included individuals with aphasia in her list of unpopular patients. Reactions to Diminished Relationships Charmaz (1983) research, confirmed by Davidson et als (2008) case study, reveals how unwillingness or inability of family, friends and professionals to establish effective relationships with individuals affected by aphasia leads to feelings of rejection. This in turn erodes patients perseverance to pursue support and comfort, often resulting in retreat and the seeking of solitude. Lyon (1998) refers to this behaviour as constructive because it provides a protective cocoon (p.12) in which individuals can rest and quietly contemplate their situation. Likewise, Shadden et al (2008) believe solitude-seeking is beneficial as it allows individuals to recapture the self which appears to bolster self-esteem. The authors quote from a patient interv

Pure Competition Essay -- essays research papers

There are many industries. Economist group them into four market models: 1) pure competition which involves a very large number of firms producing a standardized producer. New firms may enter very easily. 2) Pure monopoly is a market structure in which one firm is the sole seller a product or service like a local electric company. Entry of additional firms is blocked so that one firm is the industry. 3)Monopolistic competition is characterized by a relatively large number of sellers producing differentiated product. 4)Oligopoly involves only a few sellers; this â€Å"fewness† means that each firm is affected by the decisions of rival and must take these decisions into account in determining its own price and output. Pure competition assumes that firms and resources are mobile among different kinds of industries.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   No single firm can influence market price in a competitive industry; therefore a firm’s demand curve is perfectly elastic and price equals marginal revenue. Short-run profit maximization by a competitive firm can be analyzed by comparing total revenue and total cost or applying marginal analysis. A firm maximizes its short-run profit by producing that output at which total revenue exceeds total cost by the greatest amount. A complete firm maximizes profit or minimizes loss in the short run by producing that output at which price or marginal revenue equals marginal cost, provided price exceeds minimum average v...

German Nazism vs. Italian Fascism Essay -- Papers Nazi Fascism Compare

German Nazism vs. Italian Fascism Fascism and Nazism were two different political groups taken place in two different locations. Nazism was evolved in Germany which were the people that mainly were against Judaism. As for fascism, it took place in Italy and focused mainly on a system of government that was under a dictator, or a ruler who had absolute power. Both these groups had similariteis as well as differences in which will soon be understood. Benito Mussolini which was born in 1883 and died in 1945. He came to power with his new ideas in 1919, called Fascio di Combat, which is also known as Fascism. To understand Fascism better, it is basically a spiritual attitude. It sees not only the individual but also the nation and the country. Individuals and generations are bound together by a moral law. Adolf Hitler and his national socialist state influenced Mussolini. In time, Mussolini became the victim of his own propaganda efforts. He dreamed of wars of conquest, but these wars that were far beyond the industrial capacity of the state to maintain. Mussolini came to involved the state in wars of colonial conquest, which was probably the last of the great imperialistic wars of Europe. In 1938 a change was made in the Italian government which separated the people from the decision-making process entirely. The list of parliamentary candidates was no longer offered to the masses for their approval. Mussolini merely emulated Hitler by creating the totalitarian state while removing basic democracy. After Mussolini's fall from power and his heroic rescue by German paratroopers, it was created under the watchful protection of nazi troops. There was, however, time remained to develop a theory. Mussolini was wholly ... ...hen Germany becomes a dictatorship ruled by Hitler and the Nazi Party. It was also the begging of total chaos, such as several revolutions and world War II. There were many revolts like the Kristallnacht, which was a destructive rampage against the Jews. The Jews were drastically restricted and leaving Germany was each time becoming more difficult. In time the Nazis Parteis and Adolph Hitler killed many Jews, more than 30 thousand. Even though World War II was later finished by an agreement, it took many lives away. As for the fascist parties, they were not as gruesome as Nazism, even if one influenced the other. Although both were beliefs, which involved later in to something much greater and catastrophic, they were only people fighting for what they believed were right. But the problem was it effected on innocent's people's lives, and that is not tolerable.

Riordan Manufacturing MRP Evaluation Project Essay -- Information Syst

Overview Scope of the Project Riordan Manufacturing can continue to expand by reducing the inventory cost of raw materials and finished goods. Riordan currently has a legacy MRP Information System (IS) in place, and this project provides an excellent opportunity to upgrade the infrastructure to allow for a more cost-efficient way to track inventory. Goals of the Project Riordan would like to develop or acquire an MRP system that will track and manage raw materials and finished product inventory across all plants to help ensure reduced inventory costs throughout the entire company. Business Objectives The exploratory committee has identified the following as the Business Objectives for this project: • Accurately track and manage raw materials and finished goods • Reduce inventory cost of raw materials and finished goods • Improve MRP infrastructure Measures of Success The following tasks will be performed to measure the success of the project at six (6) months and one (1) year: • An inventory analysis validating the accuracy of tracked inventory • A cost analysis comparing the cost of inventory management to previous reports • Hire an IS analysis firm to analyze the new Riordan MRP system's efficiency Statement of Scope, Objectives, and Constraints Current Needs Riordan Manufacturing needs to reduce the inventory cost of raw materials and finished goods. To reduce these costs, Riordan would like to develop or acquire an MRP system that can accurately track and manage raw materials and finished product inventory across all plants. Objective I am investigating the feasibility of developing or acquiring an MRP/MRPII information system to ensure that Riordan can accurately track and manage raw materials and ... ...w for better tracking of goods, which prevents lost materials. This, in turn, will allow Riordan to reduce the cost of inventory and allow us to gain sales with lower customer prices. The third objective is to improve the MRP infrastructure. Removing the legacy equipment and slow data lines will allow much more inventory to be processed. This will increase productivity throughout all of the plants. Conclusion Riordan Manufacturing will more than recover the expenditures of this IT project within two years of the upgrade. Riordan will experience an increase in sales and a decrease in inventory loss due to accurate and low-cost inventory management. On-going costs will be minimized with an internal IT department handling support and maintenance of the new system. All of the project's objectives have been met, and Riordan's expectations have been fulfilled.

Enduring Pak-China Relations Essay

During Prime Minister Yousaf Raza Gilani’s visit to China, there have been speculations that he undertook this ‘emergency’ trip in the aftermath of Osama bin Laden’s killing in Abbottabad by US forces. Nothing could be further from the truth. During the visit, the Chinese leadership assured Pakistan of their full support in its hour of need. Prime Minister Wen Jiabao informed Pakistan that China had urged the US to respect Pakistan’s sovereignty. In addition to agreements on banking, technical and economic cooperation, China agreed to expedite the delivery of 50 J-17F Thunder fighter jets to Pakistan. This has provoked some American Congressmen to interpret it as Pakistan’s leaning on China to countervail pressure from Washington. Contrary to speculations, this visit was not prompted by the Abbottabad incident. It was planned much before and was part of the ongoing Pak-China strategic relations. Also, 2011 marks the 60th anniversary of the Pak-China relationship and has been designated as the year of friendship between the two countries, which was reflected in the celebrations and extraordinarily warm welcome extended to Pakistan’s prime minister in China. Therefore, to suggest that the visit was organised on the spur of the moment is misleading. Pakistan and China have a longstanding relationship, especially since 1962, when China and India went to war over a disputed border. The Chinese have been steadfast friends and have supported Pakistan through thick and thin. China’s interest lies in a stable and prosperous Pakistan. They have been very generous in sharing their development and progress in the economic and technical fields and have aided Pakistan in every possible manner. Therefore, the visit of Prime Minister Gilani should not be considered as reactive. Pakistan is a sovereign country (despite challenges) and has the right to choose its friends and explore options for positive relationships other than the US. Pakistan is not bound to have a one-track relationship with the world through the US. The US raid in Abbottabad created a perception that Pakistan’s air force is weak and compromised, prompting India to remark that it could carry out similar attacks on jihadi outfits in Pakistan. Like a true friend, the Chinese have agreed to speed up the production and delivery of 50 JF-17 Thunder aircraft for Pakistan. This has not only sent a clear signal to the world that China stands by Pakistan but will actually strengthen our air defense against any such misadventure. Gwadar port: China has a keen interest that Pakistan’s vision to become a trade and energy corridor, which links Central Asia, Russia and China with the warm waters of the Arabian Sea should become a reality. If the Gwadar Port develops and is linked with rail and road infrastructure, China’s interests will also be served. Compared to shipping from the eastern seaports, trade through Pakistan will tremendously ease trade for China. China wants to develop its relatively undeveloped interior western regions. The best way to achieve this is to provide an outlet for the region through Gwadar. The Chinese have agreed to take over the operation of Gwadar Port after the contract with the Singapore Port Authority expires in anticipation of this dream becoming a reality. China has stakes in a developed and prosperous Pakistan and is ready to help it grow. Is Pakistan ready to avail this opportunity and develop the capacity to take advantage of Chinese generosity? SECOND EDITORIAL: Attack on US Consulate staff Another day, another attack. An improvised explosive device (IED) struck two bulletproof Land Cruisers of the US Consulate staff in Peshawar on Friday, injuring 11 people and killing one passerby. Two consulate personnel suffered minor injuries in this first attack on US diplomats after the operation that killed Osama bin Laden. This comes in a sequence of similar attacks that have been taking place throughout the country since al Qaeda’s leader was killed, including against Saudi personnel in their Karachi consulate. It is feared that this is just the beginning as the extremists might be getting warmed up to fulfil their pledge of revenge against Pakistan, the US and other countries that had a part to play in bin Laden’s death. Other NATO countries too are on the terrorists’ hit list. The Taliban have claimed responsibility for the Peshawar attack and have declared it retribution for bin Laden’s death at the hands of US Navy SEALs. When such a red alert situation exists in the country, it is shameful that adequate security measures are still lacking to prevent such attacks from taking place. Just as Osama was a high value target for the US, likewise, US, European, Saudi and even Pakistani citizens are high-value targets for the militants. To have foreign and our own citizens under threat on our shores and to be woefully unequipped to protect them is pathetic, to say the least. It is almost as if the security forces in Pakistan are too de-motivated in the face of a murky, bloodthirsty enemy. The area where this latest attack took place, University Town, is considered to be one of the more posh residential locations in Peshawar. It is a community where foreigners usually live. For a militant onslaught to take place there shows that even the most well-off of places is unsafe, what to say of the rest of the country. The security and law enforcement agencies have to get their act together. Our intelligence establishment cannot afford to fall asleep (again?) in the wake of the bin Laden episode and our police and security forces need better methods of detection and prevention. Arrangements must be made to better police the streets and allow citizens, whether international or local, to move about without incurring the risk of being blown to bits. * Home | Editorial

Fahrenheit 451 Equality Essay

Why is equality impossible? In both Fahrenheit 451 by Ray Bradbury and â€Å"Harrison Bergeron† by Kurt Vonnegut, the government’s try to suppress freedom by calling it equality. Both the characters, Guy Montag and Harrison Bergeron try to oppose their government’s idea of equality. They show that there will always be individuals who rebel, are not the same, and try to start their own society to fight against the government. In these readings, both authors, Bradbury and Vonnegut, suggest that equality is unattainable because there will constantly be individuals that challenge the idea of people being the same in everyway possible. Even as the government concealed knowledge in both readings, individuals rebelled in order to obtain knowledge. Harrison Bergeron challenged the government, all while he wore a tremendous pair of earphones that mentally handicaps intelligent people. Nonetheless he refused to sit still and live his life like everyone else in the world. Instead he wanted to be emperor of the world and fought until his death trying to achieve his vision. Harrison proclaims on television, â€Å"‘I am the emperor! †¦ Do you hear? I am the emperor†¦ Even as I stand here†¦ crippled, hobbled, sickened- I am a greater ruler than any man who ever lived! ’†(Vonnegut 3). Despite the fact that Harrison is only fourteen years old and carried three hundred pounds, he rebelled against the government on account that he loathed the world he currently is in. This shows that even if the government forces people into being equal, people will rise up and rebel against them. In Fahrenheit 451, Guy Montag also rebelled against his government. He was not allowed to read or owned books since it was against the law. Knowing this, Guy still rebelled by smuggling books home from his fireman job. Bradbury writes, â€Å" Without looking at [the book, Guy] dropped it to the floor†¦ He kept moving his hand and dropping books on the floor†¦When he was done he looked down upon some twenty books lying at his wife’s feet† (65-66). Though Guy was a fireman and books for a living, he began to doubt and rebel against his government’s idea of equality. As the government burnt books, citizens that normally obeyed the law began to rebel against it and collected books. This shows that even people who enforce the law might rebel against it, if they begin the doubt it. No matter how hard the governments try to suppress knowledge, everyday citizens who want knowledge will find a way to obtain it. Even in the world where everyone is allegedly equal, there will be people that are above others. In â€Å"Harrison Bergeron†, everyone in the world is the same, no one is prettier than anyone else and no one is smarter than anyone else. This is untrue because Diana Moon Glampers, the United States Handicap General, is able kill people. Vonnegut writes, â€Å" Diana Moon Glampers, the Handicap General, came into the studio with a double- barreled ten-gauge shotgun. She fired twice, and the Emperor and the Empress were dead before they hit the floor† (Vonnegut 4). Even though everyone is supposedly equal, the Handicap General has more power than everyone else. She holds the power of life and death in her hands because she is not the same as the other citizens. This shows that there will always be someone that has more power than the rest; thus proving that people will never be perfectly equal. In Fahrenheit 451, the government prevents any person to possess more intelligence than the rest of the population. People who try to gain more knowledge through books are sent to an asylum and their books are burnt to the ground. Montag asks, â€Å"‘ I-I’ve been thinking. About the fire last week. About the man whose library we fixed. What happened to him? ’ [Beatty answers] ‘They took him screaming off to the asylum’† (Bradbury 33). When people try to learn more than others, the government makes sure that they are removed so that no one is smarter than anyone else. Even though they send people in possession of books to an asylum, it does not stop people who want to obtain knowledge from collecting books. This shows that no matter how much the government tries to enforce equality, there will be people that strive to obtain knowledge. No matter how much censorship is used to make everyone the same, certain individuals will always have more knowledge and power than others. As people disagreed with the government’s idea of equality, they band together and form their own society. In â€Å"Harrsion Bergeron†, Harrison Burgeron wanted to start his own empire. He disagreed with the current government and wanted to rule the world. Harrison Bergeron states, â€Å"‘I am the emperor! †¦ I am a greater ruler than any man’†(Vonnegut 3). This shows that Harrison Burgeron wants to create his own world. He opposes the government’s law and plans on creating a different society before he was shot down. Harrsison Bergeron shows that even in the most controlled world, humans who want difference will try to make their own world. When Guy Montag ran away from the society he knew, he encountered a group of people that opposed the way the government works. This group thought that books and knowledge are important unlike the government. Granger says, â€Å"‘We’ll pass the books on to our children, by word of mouth, and let our children wait, in turn, on the other people’† (Bradbury 153). Granger and his group felt that books are important and that individual knowledge is more important than everyone being perfectly equal. They thought that the world is not ready for their knowledge. By having their own group with different ideas from the government’s, they have started a society where people can appreciate books instead of burning them. They have created a society that directly contradicts what he government is trying to accomplish. When people do not agree with the government, they will band together and form a society hoping to overthrow the law. Equality is an unachievable idea due to the fact that there are people who will rebel, be smarter or more powerful than others, and people that band together to form their own ideal society. The more a government forces their citizens to be equal, the more likely people will oppose what the government is doing. In both â€Å"Harrison Bergeron† and Fahrenheit 451, the government tries to censor the amount of freedom and knowledge every individual has, by calling it equality, but people had still rebelled against the government. Both stories show that equality is a truly impossible because certain individuals will always challenge what equality truly is.