Management Of Chronic Pain Nursing Essay

Management Of Chronic Pain Nursing Essay This project is a complete illustration of pain and how treated by understanding how its work, references can be visited for more detailed information or contact me. Chronic pain is defined as a painful condition that lasts longer than 3 months. Chronic pain can also be defined as pain that persists beyond the reasonable time for an injury to heal or a month beyond the usual course of an acute disease. There are four basic types of chronic pain: (1) pain persisting beyond the normal healing time for a disease or injury, (2) pain related to a chronic degenerative disease or persistent neurologic condition, (3) cancer-related pain, (4) pain that emerges or persists without an identifiable cause. Chronic pain differs from acute pain in its function. Acute pain is an essential biologic signal to warn the individual to stop a potentially injurious activity or to prompt one to seek medical care. Chronic pain serves no obvious biologic function. Chronic pain patients presenting to the emergency department (ED) have not been well studied, despite their apparent numbers. Complete eradication of pain is not a reasonable end point in most cases. Rather, the goal of therapy is pain reduction and return to functional status. Chronic pain syndromes discussed in this paper include myofascial headaches, transformed migraine headaches, fibromyalgia, myofascial chest pain, back pain, complex regional pain types I and II, post-therapeutic neuralgia, and phantom limb pain. Drug-seeking patients are also covered. EPIDEMIOLOGY Chronic pain affects about a third of the population at least once during a patients lifetime, at a cost of-80 to 90 billion dollars in health care payments and lawsuit settlements annually. Chronic pain is also common in those who do not seek medical attention. Despite similar subjective pain, those who seek medical attention are less physically active, experience more social alienation and more psychological distress than those who do not seek medical attention. The causes of chronic pain are more complex than the causes of acute pain. Chronic pain may be caused by (1) a chronic pathologic process in the musculoskeletal or vascular system, (2) a chronic pathologic process in one of the organ systems, (3) a prolonged dysfunction in the peripheral or central nervous system, or (4) a psychological or environmental disorder. In contrast, acute pain may be influenced by, but is not primarily caused by, a psychological or continuous environmental disorder. A detailed listing of all the epidemiologic factors of the various chronic pain syndromes is beyond the scope of this paper. However, in general, patients who attribute their pain to a specific traumatic event experience more emotional distress, more life interference, and more severe pain than those with other causes. PATHOPHYSIOLOGY The pathophysiology of chronic pain can be divided into three basic types. Nociceptive pain is associated with ongoing tissue damage. Neuropathic pain is associated with nervous system dysfunction in the absence of ongoing tissue damage. Finally, psychogenic pain has no identifiable cause.3 Many chronic pain states begin with an episode of nociceptive pain and then continue with neuropathic or psychogenic pain. For example, an acute injury with fracture involves nociceptive pain, but an associated nerve injury may lead to neuropathic pain. Chronic disability may lead to psychogenic pain. Nociceptive pain results from the stimulation of nicotinic receptors in tissues or organs by noxious mechanical, thermal, or chemical stimuli. Chemical mediators of inflammation such as bradykinins and prostaglandins are essential elements in the pathophysiology of nociceptive pain. Examples of chronic nociceptive pain include cancer pain and pain due to chronic pancreatitis. Patients with nociceptiv e pain usually respond well to centrally acting analgesics. Neuropathic pain is caused by disease of the central or peripheral nervous system. Examples of neuropathic pain include complex regional pain type II (causalgia), post-therapeutic neuralgia, and phantom limb pain. Neuropathic pain responds poorly to common analgesics, including narcotics. Psychogenic pain is a diagnosis of exclusion and can be difficult to establish in the ED. Patients with psychogenic pain believe their pain is physical and tend to strongly reject the concept that it is psychological. CLINICAL FEATURES To better define the psychology of chronic pain, psychiatrists have divided patients characteristics into two groups.4 The first group has normal psychological function at baseline. However, continued pain and its effects, such as inability to work or altered body image, result in psychological dysfunction. The second group has primary psychopathology that predates the onset of chronic pain. Hypochondriacally, hysterical, pain-prone, and depressive personalities are included in this group. The following set of historical inquiries may prove helpful in the ED. The patients should be asked to describe the nature of the current pain, initiating and exacerbating or relieving factors. Other useful information includes determination of the chronic nature of their pain, quantification of similar episodes, and sources and modes of treatment, including medications and dosages for physician-prescribed, over-the-counter, or alternative medications. Outcomes of previous therapeutic efforts and the effect of the condition on the patients functional status are also important. Addiction to drugs or alcohol or experience with detoxification programs should also be noted. Finally, a review of systems should be done to rule out any other conditions. Substance abuse is a frequent problem in chronic pain patients. Patients referred to chronic pain clinics meet Diagnostic and Statistical Manual of Mental Disorders, third revised edition (DSM III-R) criteria for active substance abuse disorders in 12 to 24 percent of cases, while 9 percent meet criteria for remission diagnosis. Drug detoxification is often the first step of the therapeutic plan for new patients referred to a pain clinic. Objective findings of acute pain include tachycardia, hypertension, diaphoresis, and muscle spasms on stimulation. Objective evidence of chronic pain includes muscle atrophy in the distribution of pain due to disuse, skin temperature changes due to the effects of the sympathetic nervous system after disuse or secondary to nerve injury, and trigger points, which are focal points of muscle tenderness and tension. However, these findings do not have to be present for the pain to be factual. BACK PAIN   Ã‚  Ã‚   Risk factors for chronic back pain following an acute episode include male gender, advanced age, evidence of nonorganic disease, leg pain, prolonged initial episode, and significant disability at onset. Chronic back pain symptoms and causes can be divided into myofascial or muscular, articular, and neurogenic types. Myofascial back pain is characterized by constant dull and occasional shooting pain that does not follow a classic nerve distribution. Pain may or may not be exacerbated by movement. Usually trigger points can be found at the site of greatest pain, and muscle atrophy is not found. Range of motion of the involved muscle is reduced, but there is no actual muscle weakness. Previous recommendations for bed rest in the treatment of back pain have proven counterproductive. Exercise programs have been found to be helpful in chronic low back pain. Articular back pain is characterized by constant or sharp pain that is exacerbated by movement and associated with local muscle spasm. Myofascial and articular back pain may be indistinguishable from each other except by advanced imaging techniques beyond the usual scope of practice in the ED. Neurogenic back pain is classically characterized by constant or intermittent pain that is burning, shooting, or aching. The pain is usually more severe in the leg than in the back and follows a dermatome. Muscle atrophy as well as reflex changes can be seen over time. DIAGNOSIS The most important task of the emergency physician is to distinguish chronic pain from an exacerbation that heralds a life- or limb-threatening condition. A complete history and physical examination should either confirm the chronic condition or point to the need for further evaluation when unexpected signs or symptoms are elicited. An electrocardiogram (ECG) may be needed in some cases of chronic myofascial chest pain to help differentiate it from acute ischemic chest pain. Because chronic pain patients may be frequent visitors to the ED, the entire staff may prejudge their complaint as chronic or factitious. Physicians should insist that routine procedures be followed, including a full triage assessment and a complete set of vital signs. Rarely is a provisional diagnosis of a chronic pain condition made for the first time in the ED. The exception is a form of post-nerve-injury pain, complex regional pain. The sharp pain from acute injuries, including fractures, rarely continues beyond 2 weeks duration. Pain in an injured body part beyond this period should alert the clinician to the possibility of nerve injury, and proper treatment, discussed below, should be instituted. Definitive diagnostic testing of chronic pain conditions is difficult, requires expert opinion, and often expensive procedures such as magnetic resonance imaging (MRI), computed tomography (CT), and thermography. Therefore, referral back to the primary source of care and eventual specialist referral are warranted to confirm the diagnosis. TREATMENT Emergency physicians must avoid labeling patients with pain as either drug seekers or legitimate patients deserving narcotics for pain relief. With these labels, emergency physicians may exacerbate the problem and promote the learned pain response, where patients believe that they must come to the ED for pain relief. Chronic pain patients often request narcotics, although the lure of going to the ED can be just as strong without receiving narcotics. Any drug that alters sensorium can exacerbate the learned pain response. The external rewards of visiting the ED for medication or evaluation are many: attention and comforting from family and nursing staff, status as a special patient who must go the ED for pain control, avoiding responsibilities at work and at home, potential money if litigation is involved, and potential income if a disability claim is pending. Treatment with opiates frequently contributes to the psychopathologic aspects of the disease. Chronic pain and disability lead to distress and increased stress in the life of the patient. The potentiated psychological stress heightens physiologic arousal, which increases pain sensations. Elevated pain sensations exacerbate the patients disability. Opiate use only temporarily relieves the pain sensations, but the side effects frequently increase the disability associated with chronic pain, therefore exacerbating the psychological stress and the syndrome. Furthermore, a new problem is created as the patient becomes preoccupied with seeking pain relief from opiates. Another essential consideration is that many types of chronic pain are poorly controlled by opiates, and yet the side effects remain. It is interesting to note that the presence of objective evidence of pain does little to influence a physicians administration of narcotics. Physicians opiate-prescribing habits are most commo nly prompted by observed pain behaviors, such as facial grimacing, audible expressions of distress, or patients avoidance of activity regardless of the physical findings. With the exception of cancer-related pain, the use of opioids in the treatment of chronic pain is controversial. Many pain specialists feel that they should not be used. There are two essential points that affect the use of opioids in the ED on which there is agreement: (1) opioids should only be used in chronic pain if they enhance function at home and at work, and (2) a single practitioner should be the sole prescriber of narcotics or should be aware of their administration by others. Finally, a previous narcotic addiction is a relative contraindication to the use of opioids in chronic pain. In contrast to the concerns listed above, narcotics are both recommended and effective treatment for cancer pain. Long-acting narcotics such as methadone or transdermal fentanyl may be more effective than the short-acting agents. . The medications listed under Primary ED Treatment are familiar to emergency physicians. While NSAIDs are most helpful in conditions where there is ongoing tissue injury, such as chronic inflammatory arthritis or cancer-related nerve or bone damage, they are also helpful in many cases of chronic pain where no evidence of tissue damage or inflammation is evident. Non-steroidal anti-inflammatory drugs have been shown to be more helpful in acute than in chronic pain. However, the need for long-standing treatment of chronic pain conditions may limit the safety of the NSAIDs. Standard dosing procedures may be followed except in the elderly: Antidepressants and, most commonly, the tricyclic antidepressant drugs, are the most frequently used drugs for the management of chronic pain. Often, effective pain control can be achieved at doses lower than typically required for relief of depression. Tricyclic antidepressants appears to enhance endogenous pain inhibitory mechanisms. When antidepressants are prescribed in the ED, a follow-up plan should be in place. Discussion with a pain specialist is often beneficial. The most common drug and dose is amitriptyline 10 to 25 mg, 2 h prior to bedtime. Anticonvulsants are used for several pain disorders, especially neuropathic pain. Anticonvulsants prevent bursts of action potentials, which may prevent the severe lancinating pain of certain neuropathic syndromes. Carbamazepine (start 100 to 200 mg/d), valproic acid (start 15 mg/kg/d divided), and clonazepam (start 0.5 mg/d) are the most frequently used. Muscle relaxants, such as cyclobenzaprine 10 mg every 8 h, have been useful for chronic pain patients. Their sedating effects may limit their success. Tramadol is an atypical centrally active analgesic. It has less respiratory depression, less tolerance, and less abuse potential than do opiates. Tramadol has been used with success in patients with fibromyalgia, migraine headaches, low back pain, and neuropathic pain. The dose of tramadol is 50 to 100 mg every 4 to 6 h by mouth. Chronic Pain in the Elderly Elderly patients frequently complain of chronic pain. Unfortunately, many of the commonly used medications for pain have higher complication rates in the elderly. In particular, the non-steroidal anti-inflammatory drugs (NSAIDs) are associated with higher rates of gastrointestinal bleeding and renal disease in the elderly. Opioids also may cause debilitating sedation and/or constipation in the elderly; however, opioids may have less debilitating side effects than NSAIDs. Doses of many agents should be reduced when treating the elderly, to avoid side effects, and it is essential that a follow-up plan be in place at the time of discharge. There is a perception that the elderly are under medicated for pain control. While this may be true, the elderly do not seem to be under medicated more than other age groups. Conclusion In the end you can notice that pain can affect any one at any age, and its management is not easy as anyone think, especially in chronic moderate to severe pain. The variety of drugs that synthesized for this purpose are too much now, but no class of these drugs can cure the different causes of pain, and scientists now a days improving the activity of these drugs. In fact the now by the end of 2009 working on new formulation that is said to cure pain caused by inflammation. Thus aspirin will only be used for its anticoagulant and antipyretic activities, but not for anti-inflammatory action, this will reduce the toxicity cases caused by the aspirin over doses if it is used as anti-inflammatory or pain relief agent. Most important is that people with pain must ask doctor to find the cause of pain, so he/she can give the right medication and cure any type of inflammation or cancer if there is any early before the exacerbating of the current case, then it will be too late to try to cure the advanced disease and death may occur in most of the cases, so be careful any small pain can be the start for any kind of disease starting from stress ending with fatal cancer.

International Management- Hunter Boots Ltd.

â€Å"Designed to be outstanding in any field, from city streets to music festivals and rugged countryside, Hunter footwear is recognized for its performance durability and comfort – achieved through a fusion of tradition and technology† (Hunter Boot Ltd. , 2013) Hunter Boot Ltd. was founded in 1856, styled as the North British Rubber Company, producing not only rubber boots but also tyres, conveyors and flooring. The famous ‘wellies’ or wellington boots rose to fame when they were mass-produced during World War I to supply the army.By the end of the war ‘wellies’ had become popular for use among the general population as well. After changing ownership several times Hunter Rubber Company became a standalone company in 2004, and was bought out of administration as Hunter Boot Ltd. in 2006. Now solely focusing on footwear, the company has since positioned itself firmly and both the UK and USA footwear markets. In 2008 Hunter closed its plant of 9 6 years and relocated its headquarters to Edinburgh (Scotland) and production to China.Striving for more efficiency and effectiveness in the production process Hunter boots are only still visually similar to its original design, whereas they have in fact become virtually identical to the boots produced by its competitors. Nevertheless Hunter has experienced a period of considerable growth and is now distributed internationally in over 30 countries (Hunter Boot Ltd. , 2013). The author feels that is important to make a clear distinction between the years up to 2006, which is the year Hunter Boot Ltd. was placed into admission, and the years 2007 and onwards to where Hunter Boot Ltd. s currently controlled by Searchlight Capital Partners LP (SCP). , which is a private investment firm operating in North America and Europe. First this paper will analyse the rise, and demise, of the company and then will shed some light on its resurgence in popularity and turn-around sales in recent year s (Paton 2011). According to Porter (1991) sustainable competitive advantage in international business is determined by the four factors that form the diamond of national advantage; factor conditions, demand conditions, related and supporting industries and firm strategy, structure and rivalry. The factors are nterdependent and all are essential for achieving (international) success. The application of this framework certainly holds true for Hunter Boot Ltd. ’s (international) success from its founding years to the early 2000’s. Diamond of National Advantage| Hunter Boot Ltd. 1856 – 2006| Relative level of Importance| Factor Conditions| ‘Dumfries’ production plant, skilled labor and sufficient infrastructure. | High Importance| Demand Conditions| Wet weather conditions make suitable footwear a necessity. Army supplier during both WWI and WWII. Loyal customer ranging from the British Royal Family to general population. High Importance| Related & Supp orting Industries| Close working relationships with suppliers and end-users within national boundary. | Medium Importance| Firm Strategy, Structure and Rivalry| Ability to manage vast growth in both production and labor force. Ambitious management strategy. | High Importance| Table 1: Porter’s Diamond of National Advantage applied to Hunter Boot Ltd. 1856-2006 The company’s decline became inevitably clear in the years 2003-2005 when it recorded a pre-tas loss of approximately ? 700,000 with a net debt that had grown to more than ? 2m. These perils can be explained by two of Porter’s factors.Firstly the company’s Factor Conditions, mainly its production plant, changed from major strength to major weakness. The location and facilities that helped bring to company to greatness during the war became hopelessly outdated in later years leading to relatively high costs of trying to continue its Scotland production. Lower production costs abroad, due to surges in gas, electricity and rubber prices in the UK, and the overall British manufacturing decline made Hunter Boot Ltd’s ambitions to remain an independent producer based in Scotland unsustainable (Financial Times 2006).Also blamed in the process was the company’s CEO Mark Sater, which relates to Porter’s factor on firm strategy, structure and rivalry, who chose to pursue a diversification strategy in that under his rule the product range was extended extensively in an effort to boost sales. The company even added a range of branded clothing and partnered with charities and fashion designers. With the previously mentioned financial situation the company was forced to consider external business proposals in an effort to keep the company afloat.Driving the following negotiations were the company’s demand conditions which were clearly articulated by an anonymous insider in the Financial Times (2006) as ‘anyone who hunts or fishes and has a few quid fancies themselves as the next owner. It is so close to the hearts of so many people it is almost owned by the nation. None of the offers gained sufficient support of the board and the company collapsed in the spring of 2006. In several consecutive constructions Hunter Boot Ltd. Generated sales of ? 56m in 2010 and ? 78 in 2011 which is a strong financial improvement and turnaround from its pre-tax losses in 2005.Since early 2012 the company is under control of American-owned private equity group SCP which is pursuing global expansion. This makes Hunter Boot Ltd. one of many luxury brand buy-outs by private equity groups the like of SCP in recent times. SCP has announced that it will try to set up stores selling the Hunter brand exclusively across the globe in the coming years. This is a major change in its international strategy since Hunter products are currently sold exclusively via wholesale retail channels (Paton 2011&2012).Despite the many changes in ownership Hunter product are still clearly trying to hang on its British heritage in a dual effort to maintain its loyal UK customer base and to differentiate itself from its competitors. As an example the company has two different website interfaces, one for UK customers and one for USA customers. Both emphasize the exclusivity and craftsmanship of the product, but the UK website further emphasizes its heritage by portraying the British flag and colors clearly on every opportunity. From a theoretical perspective one could argue that Hunter Boot Ltd. s current (international) business strategy can no longer be sufficiently explained by Porter’s Diamond model, and now bears more resemblance to Barney’s VRIO model which is a resource-based view focused on the firm’s internal capabilities (Barney 1991). The resource-based view argues international success stems from the theory that some firms in one nation generate exports that are valuable (V), unique (R), hard to imitate (I) and supported by orga nizationally sound processes (O) which firms from other nations find beneficial to import.A valuable resource will lead to competitive parity, a valuable and rare resource to temporary competitive advantage, the addition of inimitability will lead to sustained (short-term) competitive advantage and meeting all VRIO-criteria will lead to (long-term) sustainable competitive advantage (Shahriari, M. & Ahmadi, A. , 2010). While companies may have many tangible and intangible resources only few of them are strategic in nature. Most strategic resources are of the created and intangible kind and often knowledge-based, yet they can only be facilitated with the help of tangible resources.This mix is what enables a company to move past competitive convergence and into competitive advantage (Shariari et al. 2010 and Barney 1991). Globalization has affected Hunter’s home-based competitive advantages in that in a global economy there has been a shift from natural assets (land and untraine d labor) to created assets (human capital). Many of these created assets are intangible and firm or ownership specific which mean they are often no longer controlled by specific countries or governments except within the constraints of the (national) law. Multinational firms (MNEs) like Hunter Boot Ltd. re free to move assets from a domestic to a foreign location which is often done when trying to pursue and generate new valuable assets (Dunning, J. H. , 1993). This opportunity is exactly what the company pursued when it moved its production plant to China while maintaining its HQ in Scotland. It is the company’s intangible or created asset of ‘reputation ‘that currently provides it with a long-term sustained competitive advantage over its competitors. Its constant customer focus and technological capabilities are a close second but do not withstand a long-term orientation to a similar extent.This is particularly true for Hunter Boot Ltd. ’s technological c apability since the recent move of its production facilities and cost-cutting strategy has made the company more vulnerable to imitation by competitors. Recently Hunter Boot Ltd. has been enjoying great success and it will have to prove if this is sustainable or not. It will come down to the following question: Is the company’s gaining in internal capabilities and resources enough to make up for the loss of its national advantages?The author states that it is vital for the company to uphold its reputation since this is currently the single sustainable source of competitive advantage and not one that cannot be affected. It might be that the company will lose some of its loyal (mainly UK) customers and gain a large number of mass-market global customers, but it is doubtful this will provide long-term success if the company is not able to differentiate itself sufficiently from its competitors in the near future. Bibliography BARNEY, J. , 1991.Firm resources and sustained competi tive advantage. Journal of management, 17(1), pp. 99-120. DUNNING, J. H. , 1993. Internationalizing Porter's Diamond. MIR: Management International Review, 33 (Extensions of the Porter Diamond Framework), pp. 7-15. FINANCIAL TIMES, 2006, Future far from bright for Britain’s wellies, viewed on 28th of February 2013 ;http://www. ft. com/intl/cms/s/0/628795c2-cbd4-11da-a7bf-0000779e2340. html#axzz2MYTEnuR ; HUNTER BOOT LTD, 2013, viewed on 4th of March 2013 ;http://www. hunter-boot. com/about-us; PATON, E. 2010, Luxury industry movers and shakers, Financial Times, viewed on 1st of March 2013 ;http://www. ft. com/cms/s/0/0f2e5894-1c62-11e2-ba75-00144feabdc0. html; PATON, E. , 2011, Hunter boots to pursue international growth, Financial Times, viewed on 28th of February 2013 ;http://www. ft. com/intl/cms/s/0/4846403a-2800-11e1-a4c4-00144feabdc0. html#axzz2MYTEnuRw; PORTER, M. E. , 1998,  Competitive advantage of nations,  Free press. SHAHRIARI, M. and AHMADI, A. , 2010, A Reso urce-Based Framework of Strategic Marketing Planning to achieve Sustainable Competitive Advantage, pp. 1-13.

What to Expect From Samples of Reflective Essay in Nursing?

What to Expect From Samples of Reflective Essay in Nursing? Nursing practices in Australia lacks a suitable structure and so requires the implementation of an innovative practice to offer appropriate support and direction for the increase and evolution of nursing as a profession in the nation. Technology may also help the graduate nurse in order to produce a comparison and conduct monitoring and evaluation. Nursing is among the toughest disciplines out there. Nursing can many times be an emotionally charged career, particularly for nurses working in areas like psychiatric wellness and palliative care. Loneliness is never a symptom of happiness. These essays are intended to be informative that people keep in mind that there's an entirely different world out there to explore. Reflective essays are personal parts of the writer which they have translated into words. When you simply have a few critical concepts, you don't need to be so confident that you believe you can write t he essay all on your own. Reflection essays aren't merely a school exercise. An excellent reflective essay may be a wonderful reflective essay with the appropriate planning. How to compose a reflective essay. A Secret Weapon for Samples of Reflective Essay in Nursing As my arguments grew stronger, I have begun structuring my papers to deal with the particular audience. There are a couple of different elements that have to be incorporated into a critical reflective paper. Essays term papers dissertations and a whole lot more. The type of writing will look at the author's creativity as well as analytical energy and ought to come as part of a severe project that has simply been accomplished. A travel essay likewise gives a glimpse of the culture of a certain place. My ultimate purpose is to develop an equally potent and unique style. The food has an important influence on the wellbeing, and it's the chief reason why the topic is valuable to me. Nursing is a domain that's peculiar, in the feeling that it's endowed with a distinctive nature. Proper knowing of unique facets of the profession with the proper comprehension of phenomena is the primary central portion of this kind of knowing (Garrett and Cutting 2015 pp 99). The Gibbs' Reflective Cycle is going to be applied since this is a well-known model of reflection. It's quite simple to use together with self explanatory. The Do's and Don'ts of Samples of Reflective Essay in Nursing It's an essay within which you include a personal experience or numerous experiences, together with direct details about the events. The next portion of your outline is perhaps the most significant. The reflective practice pieces are YOUR direction of showing how you consider your practice. Receive a customized sample essay written based on your requirements. Each paragraph should address just one point and ought to have supporting evidence. The finish of your reflective essay ought to be the finishing touch t hat brings the entire bit of writing together nicely. The many sections of the synthesis essay must be carried over in the finest possible fashion and it's best explained through synthesis essay examples. Include a concise overview of your most important points (as mentioned in the body paragraphs), together with the total takeaway from your reflection. Nursing is a lifestyle, not merely work. If you are searching for Reflective Essay Sample you've come to the correct spot. Prefers to stay anonymous. The 5-Minute Rule for Samples of Reflective Essay in Nursing Writing quality essays is the principal use of our services. To purchase essay online, you merely will need to fill in the application form and you'll get superior work on the desired topic. EightTen page you're writing. Our site provides custom writing help and editing help. This platform was made to meet the requirements of those that are interested in getting an essay done fast. Examination of any given encount er or event and making relationships with the ideal theory is what we've got a strong control. The progressive region of the event was that the event let me in acquiring lots of confidence. More aging-related promotion must be done to improve societal comprehension and eliminate the myths surrounding aging. The Little-Known Secrets to Samples of Reflective Essay in Nursing This model is appropriate for novice practitioners, and it's used utilized by them at various levels. Coyne (2008) has found that young men and women are rarely involved with the decision-making process once it regards their consultations. Oftentimes, her relationship with the remainder of the health group and other professionals faced difficult efforts due to the autonomy. Consequently, reflection on those emotions and exploration of the way to manage them and strengthen management of them in the future is of specific value in the nursing profession. High school isn't free in Kenya. Instructors normally utilize essays to evaluate the learning outcomes of students. To conclude, reflective practice is a tool that is regularly utilized as a considerable facet of students-nurse education along with in clinical practices. The New Angle On Samples of Reflective Essay in Nursing Just Released Kane (2009) states in line with the NMC nurses must offer appropriate and thorough care to all patients, no matter their reason for being in hospital. As a previously skilled nurse, this was a significant dilemma in my very own reflective writing. The procedure for nursing majorly depends on the delivery of excellent patient care and arriving at better decisions suddenly which will provide the attender an excellent wisdom and confidence to carry further urgent instances. The medical caretaker ought to be steady and useful, communicating with the patient to investigate their encounters and health care problems.

The Constitution of the United States - 800 Words

The Constitution of the United States took many years of controversy to establish. The final Constitution set up a government based on the system of checks and balances. This Constitution consists of three branches, the Legislative, the Executive, and the Judicial. Powers given to each branch help keep any individual branch from taking over. The first Constitution was called the Articles of Confederation. It was drafted by the Continental Congress in 1776 and approved in 1777 as the American Revolution was in motion. This was not too long after the Declaration of Independence was ratified in 1776, and the Articles of Confederation became ratified 5 years later in 1781, a little before the Battle of Yorktown, which effectively ended the†¦show more content†¦An event in 1787 finally brought these problems to a head. It was Shays’ Rebellion, a rebellion led by a former captain in the Continental army, Daniel Shays of Massachusetts. After risking his life to fight for his country, Shays had come home to his farm, only to find himself in court for nonpayment of debts. Seeing that he was not alone in this injustice, he gathered together a group, made up of mostly farmers and attempted to take over a federal arsenal. Their goal was to Reform the state government. The rebellion lasted nearly a year, and the feder al government did not have the power to stop it. Finally the state militia managed to catch the rebels off guard and the rebellion ended. Shay and many of his followers managed to escape, and eventually they were pardoned. This rebellion made it clear that the federal government had no power, and the Constitutional Convention was arranged. The Constitutional Convention had a total of 55 delegates from every state but Rhode Island. George Washington, originally not planning to go, became unanimously elected the Convention’s president. At first their plan was to refine the Articles of Confederation, but after about a week of debate, they decided to simply write a whole new constitution. The convention lasted four months, during which the doors of the Pennsylvania state house remained closed to all but the delegates. Many heated debates occurred in that stateShow MoreRelatedThe United States Constitution And The Constitution Essay1491 Words   |  6 PagesThe United States Constitution, this very detailed group of words was written in 1787, but it did not take effect until after it was ratified in 1789, when it replaced the Articles of Confederation. It remains the basic law of the United States then and till the present day of 2016. The first state to ratify the Constitution was Delaware; the last of the original thirteen to ratify was Rhode Island and since only nine were required, this was two years after it went into effect. When the U.S. ConstitutionRead MoreThe Constitution Of The United States Constitution Essay1185 Words   |  5 Pages(framers’ of the U.S. Constitution) position on the Presidency: The framers experienced the abuse of the English monarchs and their colonial governors. As a result, the framers were skeptical of the excessive executive authority. Furthermore, they also feared excessive legislative powers. This was something that the Articles of Confederation had given their own state legislatures. The framers of the constitution deliberately fragmented power between the national government, the states, and among the executiveRead MoreThe Constitution Of The United States885 Words   |  4 Pages In 1787, our founding fathers came up with a few principles that would establish what we now know as the United States of America. These principles were put on paper to serve as a guideline for how the United States would be operated and structured. This historical piece paper became known as the Constitution of the United States. In the Constitution, a Preamble is implemented at the beginning that essentially tells what the founding fathers set out to do. â€Å"We The People, in order to form a moreRead MoreThe Constitution Of The United States894 Words   |  4 Pagesthe substratum for that country. A Constitution can be defined as a document that is the substratum of the country’s principles. Elements in the Constitution may contain sundry information. Which can include: how many terms a leader may serve, what rights the citizens have, how the judicial system works, etc. The United States in no different from those countries. Every constitution is different, no country has the exact constitution as another. The U.S Constitution is a four-page document detailingRead MoreThe United States Constitution Essay1515 Words   |  7 PagesThe United States constitution was written in 1787 by the founding fathers of this country. Now it might be appropriate to question why a document that is the basis of the government for one of the most culturally and racially diverse countries in the world, was written by a group of heterosexual, cisgender, rich, white men. Some might think that a constitution written well over 200 years ago would be outdated and irrelevant to the American society of today but with some research, it is quite theRead MoreThe Constitution Of The United States756 Words   |  4 PagesPromulgation and Legislation in the U.S. Constitution: The federal system of government of the United States is based on its constitution. The Constitution grants all authority to the federal government except the power that is delegated to the states. Each state in the United States has its own constitution, local government, statute, and courts. The Constitution of the United States sets the judiciary of the federal government and defines the extent of the federal court’s power. The federalRead MoreThe Constitution Of The United States1007 Words   |  5 PagesThe United States of America has previously experienced failure every now and then. With trial and error, the country has learned to correct its ways and move toward(s) perfecting itself. Realizing the ineffectiveness of the Articles of Confederation is a prime example of the U.S. learning how to better itself. Subsequent to the Articles of Confederation, the Constitution of the United States was set as our new and improved framework of government. Possessing knowled ge on how America, although strongRead MoreThe Constitution Of The United States951 Words   |  4 Pageshappening again. Unlike the artifacts, The Constitution of the United States has not been forgotten, it is actually still very alive today. Unlike most relics, The Constitution still holds a very heroic and patriotic implication, freedom. With freedom comes self-government, freedom of speech, religious tolerance, etc. With all these things comes the great responsibility to adapt and fit to the wants and needs of the decade. Even though the Constitution was made for the interests of the people ofRead MoreThe Constitution Of The United States1338 Words   |  6 Pages The Constitution is the basis of law in The United States and has been since it was written in 1789. Since then it has been amended 27 times with the first ten amendments collectively known as the Bill of Rights. The US Constitution was preceded by the Articles of Confederation and supported by the Federalist Papers which we will touch more on later. James Madison, Alexander Hamilton, John Adams and Thomas Jefferson all wrote or influenced The Constitution in a very important way. Alexander HamiltonRead MoreThe Constitution Of The United States1388 Words   |  6 PagesInterpretation of the Constitution is one of the biggest conflicts within the United States–the highly contentious issue of states’ rights resulted from two different interpretations of what powers should belong to the federal government versus what powers belong to the individual states. No issue has ever caused as much turmoil as the issue of states’ rights–but one side must have more v alid arguments. Should the federal government’s power be superior, or should the authority of the individual states be held