Concert Attendance Report Essay

I am a casual listener because I like having music playing, filling the environment with sounds. I can listen to music while studying and sleeping, and I like listening to music because it can make me relax and ignore the noise that around me. I attended the concert on October 5 at 8:00pm. Contrapunctus XIX, from The Art of the Fugue, BWV 1080 by Johann Sebastian Bach, Metamorphosen by Richard Strauss and Symphony No.7 in A major, Op.92 by Ludwig Van Beethoven were performed. The style of Contrapunctus XIX, from The Art of the Fugue, BWV 1080 is set progresses to double, triple, and mirror fugues, culminating in a quadruple fugue. Metamorphosen is a memorial elegy. Symphony No.7 in A major, Op.92 is in four movements, Poco sostenuto – Vivace, Allegretto, Presto and Allegro con brio. The orchestra had violins, violas, cellos, basses, flutes, piccolo, oboes, English horn, clarinets, bassoons, horns, trumpets, trombones, tuba, keyboards and harp. Contrapunctus XIX, from The Art of the Fugue, BWV 1080 is an unfinished work by Johann Sebastian Bach. The Art of the Fugue is a set of fugues of increasing complexity using every theoretical device. The set progresses to double, triple and mirror fugues, culminating in a quadruple fugue that was incomplete because of Bach’s death, and his son arranged for him. Bach is the Baroque composer. Contrapunctus XIX was incorporating counterpoint, and explicitly and systematically explored the full range of contrapuntal. The volume of this piece is soft. Its tempo is Adagio or Lento (slow). Its contour repeated pitch melody, direction is static, and had a narrow range. Its rhythm is alternation of tension and relaxation. It is a strophic form. It is a classical music. Metamorphosen by Richard Strauss. This piece uses as its primary motivic element a passage from the funeral march in Beethoven’s Eroica Symphony. Its tempo is andante (at leisurely walking speed). Its volume is crescendo (becoming louder). Its rhythm is alternation of tension and relaxation. Its contour jagged melody, direction is static, and had a wide range. It is a  repetition and contrast which is ternary form. It is a romantic music. Symphony No.7 in A major, Op.92 by Ludwig Van Beethoven. The Seventh Symphony is in four movements. After a slow introduction (as in the First, Second and Fourth Symphonies) the first movement is in sonata form and is dominated by lively dance-like rhythms. The second movement, in A minor, is â€Å"slow†, although the tempo marking is _Allegretto_ (â€Å"a little quickly†), making it slow only in comparison to the other three movements. This movement was encored at the premiere and has remained popular since. The ostinato (repeated rhythmic figure) of a quarter note, two eighth notes and two quarter notes is heard repeatedly. The third movement is a scherzo and trio. Here, the trio (which is based on an Austrian Pilgrims’ hymn[2]) is played twice rather than once. This expansion of the usual A-B-A structure of ternary form into A-B-A-B- A was quite common in other works of Beethoven of this period, such as his Fourth Symphony and String Quartet Op. 59 No. 2. The last movement is in sonata form. Donald Francis Tovey, writing in his _Essays in Musical Analysis_, commented on this movement’s â€Å"Bacchic fury†. Its volume is crescendo (becoming louder). Its rhythm is tension. Its contour jagged melody, direction is upward, and had a wide range. It is a repetition and contrast which is ternary form. It is a classical music. I enjoyed the concert so much because I like Beethoven’s music, and I am so happy to see such a large orchestra! I have never seen it before. I am looking forward to attend it again.

The Great Change (Langston Hughes)

One of the most important men in the Harlem Renaissance was Langston Hughes. His identity was formed in the neighborhood of New York City although it was said that he had much travel in his life that he can be considered as the man with no roots at all. But Langston had his heart dedicated to voicing out the experiences and the sorrow of the African American people. During his time, he created poems, plays, and books about the black making real their status in the society. He was one of the great men who were against racism and inequality. He found direction in his life not just through writing but also to listening to jazz and blues. He was the kind of man who would sit in a bar and listen to music and in that way he created a new direction not just in his poetry but in art itself. His importance and value was seen in the way he made other blacks to reach out their longings to the society, their wanting not just to be free from racism but also to be seen and valued like the whites. Hughes spoke of value as a man for the Blacks.The Harlem Renaissance characterized by new ideas was emphasized by Hughes through his music and poetry. One of his famous poem was â€Å"The Negro speaks of River† helped him make a good start in the world of poetry and cultural exposition.The Negro Speaks of Rivers (to W. E. B. B. DuBois)I've known rivers: I've known rivers ancient as the world and older than the flow of human blood in human veins.My soul has grown deep like the rivers.I bathed in the Euphrates when dawns were young. I built my hut near the Congo and it lulled me to sleep.I looked upon the Nile and raised the pyramids above it. I heard the singing of the Mississippi when Abe Lincoln wentdown to New Orleans, and I've seen its muddy bosom turnall golden in the sunset.In this poem, he gave significance to the â€Å"Blacks† being the builders of civilization, something that should be considered in history. For a long time, prior to the African American Cultur al Movement, the black people have experienced injustice in different forms, whether at work, in school and in the community as a whole. Their existence was seen to be less than the white where some African American people would say that they never really existed at all. The poem speaks of the places known to every black, and it can be noticed that these places all have historical significance.The persona and his comrades not only look for significance and visibility but also for home. The poem creates an image of longing for home where there is comfort and justice. The words â€Å"lulled me to sleep† are quite powerful for the readers to see what is being longed for by the persona, that’s none other than tranquility within. This can be related to the home that the blacks have searched for a long time in the community of whites who dominated and received the best of what the world could offer. The poem also raises the blacks’ voice of considering them the builde rs of growth and civilization because they have always been there, in the past, in the present and in the future. Hughes tried to create an immortal stand of the blacks against invisibility, an element that made racism flourish.Another poem by Langston Hughes entitled â€Å"Dream Deffered† exposes sorrow and heavy burden in life. â€Å"What happens to a dream deferred? Does it dry up like a raisin in the sun? Or fester like a sore and then run?†Ã‚   The poem is made of questions that seem to be unending. The tone is with hopelessness. The language used was simple, simple enough to be understood that it’s all about dreams of the blacks that were held long enough by time. Possibilities and ways of the process of disappearance can be seen in the poem like for example drying up from the heat of the sun which was mentioned a while ago.The line â€Å"Does it stink in a rotten meat? Or crust and sugar over – like a syrupty sweet?† is another question that may be related to the kind of death that blacks experience. The image of a rotten meat suggests something mournful and intolerable while the latter is an image of a sweet death. It makes one wonder just how tolerable is it to just throw one’s body into the river because the one who died is not really that significant and his existence is not really valued, a very common scenario of the black people who are enslaved and sold to the market of the whites. But more than the question of privilege for a peaceful death is their â€Å"right† to have it. If they are removed of the privilege to have even a good burial or death, should the question on chances for a good fate be questioned still?The tone for â€Å"Quiet Girl† can also be likened to â€Å"Dream Deffered† as it speaks also of grief over a status or position but the difference is that there is a glimpse of hope that can be seen in it.   Ã¢â‚¬Å"I would liken you to a night without stars were it not fo r your eyes. I would liken you to a sleep without dreams were it not for your songs.†   The night without stars can be seen as another hopeless case of some sort in the scene, however, it is given a sprinkle of a good chance through the eyes that was silently assumed to sparkle instead of the stars. The songs were made powerful in attaining a tranquil sleep even if there was no dream. The wonderful thing that can be derived from the poem is the sound of continuity of life despite some faulty circumstances in the lives of the black. There is the balance that is being claimed from the poem, the balance that could give meaning to the blacks’ existence.But if there is one particular poem that can characterize the present African Americans, with the way they react and live in the present society, that would be the poem â€Å"Me and the Mule.†My old mule, He's gota grin on his face. He's been a mule so long He's forgotten about his race.I'm like that old mule   Black — and don't give a damn! You got to take me Like I am.A mule that is known for its good working ability for an animal not only works for nothing, but also works for a master. But that can be one point of the poem. It can be seen also in a positive sense in the way that there is a courage directly shown from the mule and from the persona to not care, yes, not care at all from all the discrimination that he has experienced and from what the world tells about him. The mule just like the persona shall continue to live no matter how hard it is to exist and no matter how heavy the load seems. The present though doesn’t change the blacks’ past. Still, even after the Harlem Renaissance, it can’t be denied that they were still despised of their rights to experience a just treatment. But right now they are already visible, yet they will still be like the mule that won’t give a â€Å"damn† to the society’s offensive thoughts. Perhaps, ju st like the mule, giving no â€Å"damn† will make them live longer, and stronger.Hughes was able to see and react on the basis of his position and his art, his love for music, poetry and plays made him more than a figure of the Harlem renaissance. He made himself and his race visible to the world and worth it of the great and positive changes with the way blacks are treated. More than a poet, Langston Hughes was the big difference of the Harlem Renaissance.Sourcesâ€Å"A Renaissance Man.† April 23, 2007   Ã¢â‚¬Å"Langston Hughes.† April 23, 2007 â€Å"Langston Hughes Biography.† April 24, 2007 â€Å"Langston Hughes.† April 24, 2007

Growing industrialism of the Gilded Age Essay

The growing industrialism of the Gilded Age was indeed a threat to American Democracy. The American Government stood idly by as the Industrialists became more and more powerful. The Preamble of the document that is the foundation of this great country, The Constitution of the United States, reads: ‘We, the people of the United States, in order to form a perfect Union, establish Justice, insure domestic tranquillity, provide for the common defense, promote the general welfare, and secure the blessings of Liberty to ourselves and our Posterity, do ordain and establish this constitution for the United States of America.’ The American Government was not doing its best to ensure domestic tranquillity or to promote general welfare. Major Industrialists of the time were not kept in check, and the working class citizen paid for it big time. Company towns, the presence of monopolies, and an inactive government all contributed to this threat to American Democracy. During the Gilded Age many large companies took over entire towns. Everybody in that particular town worked for that company. These were called company towns. The large companies replaced all the stores that already existed in that town with their own stores. To keep the citizens of that town from going to other towns to buy supplies they printed their own money and the workers were paid with that. This allowed the large companies to charge an unfair amount for the goods sold in their stores. All competition was eliminated in that town. Competition is the major principle behind the American economy and ultimately the American Democracy. Without competition, weather it be between companies for a profit or politicians for a political office, this great American Democracy would fail. Company towns were also a center for political corruption. Many immigrants that came to this country were given a job and a home in a company town. In exchange for these gifts they were made to vote for candidates that the company supported. This undermines the basic selling point of American Democracy which was that government was of the people, by the people and for  the people. At this point American Democracy was more like a government of the Industrialists, by the Industrialists and for the Industrialists. Industrialists’ monopolies were not limited to the control over towns. The major Industrialists also extended their monopolies into businesses. If ABC corporation manufactured steel, they would buy out all of the other businesses that manufactured steel. ABC corporation might also buy out businesses that sold them the supplies to make steel. With this monopoly in place, ABC corporation would now essentially be able to manufacture steel for only the cost of labor. Because so many powerful Industrialists such as Carnegie and Rockefellar controlled monopolies, the working class was once again punished. Not only could these men charge unfair amounts for their products, they could also pay the workers unfair wages. If a worker was tired of working for unfair wages and quit his job, he would be unable to find another job with better wages. Because there were no other better jobs to be found large corporations also forced workers to work in unsafe work environments. In these monopolies, that important concept of competition was once again eliminated and American Democracy was threatened by this. Through all of this, the American government did nothing. The government did little to stop the forming of monopolies. Because government did not step in and stop the major Industrialists competition was virtually eliminated. It is well known that competition is the backbone of America’s economy and always has been. It is competition that allows America to have a free-market economy. However, it is as equally true to say that competition is an important part in government. Politicians were able to compete for the votes of only the major Industrialists, and still win an election. Those major Industrialists were so powerful that they were able to control who people voted for, as stated previously. The Industrialists had the politicians in their back pocket. If a politician wanted to get elected, he could most likely do that by siding with major Industrialists on important issues. The lower could be completely ignored. Because of this, politicians competed for the votes of only the major Industrialists and ignored the middle and lower  classes. Many people may say that it is not governments job to do anything. However, those people should refer back to the Preamble of the Constitution. The Preamble states that one of the purposes of this union is to promote the general welfare of the people. By allowing the major Industrialists to eliminate competition in business and in government, the American Democracy was threatened. It became increasingly obvious that American Democracy was not promoting the general welfare of the nation, thus not doing its job.

Education Reflection papers Essay

Reflection Students Can Improve by Studying their Learning Processes Before I started my student-teaching at the UBHS, I listed down some of my observations with the Grade 8 students like their strengths and weaknesses. This is why I formulated my goals and objectives that I need to achieve in order to address these concerns when I will be teaching them. Most of the students are actively participating but there are times that they are too active to handle. When they get bored during the discussion, they start talking creating nuisance and distraction on the teacher’s part. On the other hand, most of them also are expressive into sharing their feelings and experiences to the class. When I ask them what they felt unto a certain experience, they can describe this in details. But when I tell them to write it as an essay or in few paragraphs, they are unable to do so. Moreover, I also observed that students keep making the same error during Science classes especially in the problem -solving activities. The worst part is that they don’t really mind if they fail maybe, because most of them are doing it. I can foresee that this is becoming a habit and when they are promoted to the next level, it would be the same problem all over again unless they decide to change this cycle. It’s a good thing that I read this article when I was preparing my orientation with the class before I would be their teacher. At the very first day that I entered the room as their teacher, I introduced my rules on behavior, attitude and classroom management. Along with attitude, I told them that in my class, â€Å"Science is not only about intellect but it also includes perseverance, determination and other virtues they should keep in mind.† I shared to them what I read in this article, that they should know their learning processes in order to improve not only their grades but also their learning strategies. â€Å"According to the principles of learning, Learning is an active process whic h is activated by the learner himself†. On the other hand, â€Å"Learning is a painful process but it is non-sense if you got hurt and learned nothing. So, get up, face your mistakes and make it right this time.† These are my words to them which got their attention and until now, they keep on reflecting on them and finding out what this means to them. Every time I got the chance, it may annoy them but I keep on reminding them these principles. Whenever they got low scores during quizzes, â€Å"I ask them, so what should you do about it?† I pause and  say, â€Å"That’ right, find out where you went wrong and next time don’t make the same error again. In that way, you will make-up for the lost points while gaining up confidence for your achievement. Don’t give up with just few failures; instead use these failures to motivate you to learn a lot more.† Sometimes, I think I’m not teaching Science anymore or I’m teaching Science less. My objectives in my lesson are to define terms, derive formulas, demonstrate the concept, etc. but it seems at the end of the lesson, I wasn’t able to achieve them ‘cause I discussed more on how to improve their study habits, attitude, behavior. After teaching with them in almost three weeks, I noticed that with the self-regulated assessment, most had improved with this experimental method. I think it’s a slow, long process like the evolution but with patience, perseverance and other necessary characteristics, I will be able to achieve this goal. I hope that during my stay with them, I will be able to help the students not only to survive but also to excel. Source: Glenn, D.The Education Digest.September 2010. p.13-20 Reflection 3 Using Humor in the Classroom It’s a trend for the students to have a misconception and pre-conviction that Science is a stone-cold, serious and boring subject. This is why few are interested to listen during Science classes and which is also why it makes our job as Science teachers a lot more difficult. According to this article and the principles of teaching, using humor is effective for the students to like the teacher. At first, I don’t really care if the students like me or not just as long as they listen to me. But at the students’ age and level of maturity, it’s a pre-requisite for them to like me so they will listen to me. So, I started adding the enough sense of humor during my Science classes. And, it works, at least most of the time. Just like what the article says, â€Å"the benefits of humor is that it can help capture and retain students’ attention, reduce stress and anxiety, increase student motivation and participation, promote a sense of acceptance in class tha t allows students to think in creative and divergent ways and others.† Humor has really helped me a lot into refraining my students sleep during my classes. However, I have to admit that sometimes I go too far and make inappropriate jokes. Just like everything, there is a need of balance. Too much of  anything is not good so just like what this article say, there should only be small doses of humor just enough to maintain the students’ attention which is also appropriate for their age and status. There are also times that students can hardly connect at the essence of my jokes. I think it’s because my jokes are sometimes outdated or too complicated for them to deduct. So, I associate my jokes with the current trends along with my lesson. I also use the terms they use with their peers like â€Å"boom-panes†, â€Å"ice-bucket challenge† and other trendy words at the moment. In choosing an instructional materials and preparing activies, I see to it that it is fun, funny and explorative but at the same time informative and educational. For example, when I had my lesson on Work as defined in Physics, I made them perform a role-playing activity. In order for the students to be attentive, I asked them to re-enact the work done by a ballot vendor, â€Å"bote-landok† buyer and seller, a beauty queen and a secretary. I chose those attention-seekers in the class to do the activity and I was impressed how they were able to give a very energetic performance. I enjoyed it personally and so does the audiences which are the other students. In this way, the students laughed and learned a lot in relation to our topic. Just like what the article says, there are positive and negative effects of humor. When used properly, it enhances learning in many ways but when it is misused, it can hurt the students’ as well as the teacher’s feelings. Therefore, in using humor, proceed with caution and use it wisely. Source: Ivy, L. The Education Digest. October 2013. p.54-57 Reflection 1 Creativity: A Cure for the Common Curriculum Students love it when I compare them to the process of metamorphosis. I tell them that they are just caterpillars for now and soon, they will become beautiful and colorful butterflies. In order to achieve metamorphosis in the world of Education, Creativity is not only a miscellaneous but rather a need in the students’ learning process. However, in this day and age, few students realize the importance of enhancing their own innate creative being. In the classes that I taught, I observed that there are hesitations which hinder them into letting out their creative self. They are afraid to make mistakes or try then fail. They think they are doomed if they fail once  or twice. This is why I always assure them that in my class, there are no wrong answers but instead there are trials, lots of trials in order to arrive at the correct answer. Whenever they answer and their answer does not directly address my question, I ask them supplemental questions until we arrive at the main poin t. In this way, they hone their convergent and divergent thinking ability which are requirements of Creativity. In the traditional curriculum, students are trained to follow patterns and do things by the textbook. Yes, this is essential for the students should be oriented of the basics and disciplines. However, they must also learn how to do things their own way, create new things and innovate from what they know, from what they learned. This is why in my Science class, I require my students to create and design things. Just like when we had the lesson on the law of motions, I required my students to make a paper-balloon car which is functional, durable and presentable. When they submitted their outputs, I can see that they have the potentials and that they can do more. So I appreciated their effort and recognized their ingenuity and innovativeness. I also gave recommendations for them to improve. On the contrary, it’s hard to measure the creativity presented in their product. So I learned that in process and product-assessment activities, there should really be a reliable and valid rubric to be prepared so that the students will have a guide into creating things. According to the article, â€Å"Creative tasks are, by nature, ambiguous with no clear right or wrong answers. Such tasks require taking intellectual risks, trying, evaluating and discarding ideas, and making connections.† In reality, there are lot of difficulties in infusing creativity in my lesson and curriculum as a teacher. I’m realizing it now that creativity is not taught in few settings but rather it is honed and developed through time. It’s a holistic process which involves all the learning areas and dimensions. It is not only the brain (cognitive domain) involved in this process but also the heart (affective domain) and body (psychomotor domain) as well. However, I am still hoping that with more experience and practice, I’ll be able achieve this creative goal of mine. Source: Berret, D.The Education Digest.October 2013. p.13-20 Reflection 4 Classroom Control In the traditional classroom setting, teachers can literally spank those students who are misbehaving. It seemed effective back then like the friars in the Spanish period but it only instilled fear and forced obedience among the students. With the principles of teaching-learning and also with my personal experience, I strongly oppose this as a method of controlling the class. This is neither effective nor complement the students’ learning process. During my teachings at the UB-High School, first on my list of difficulties is how to manage the class. Most of the Grade 8 students are highly active in making noises rather than in participating during the discussion of the lesson and other activities. What really annoys me is that they are unaware that they are distracting me even if their chatter is louder than my voice. They think they’re innocent of such fault. After reading this article, I started to draw my plans in implementing classroom management strategies. It†™s a good thing that at the first day of my teaching with them, I oriented them of my expectations into behaving into class. Every now and then, I keep reminding them of the house rules that we established following Ivan Pavlov’s conditioning technique. Just like what the article suggested, I pause for a while whenever most of the students are noisy and I make a strong direct gaze at the offenders until they get the message to stop their noise. If it doesn’t work, I sit instead and let their classmates call the attention of those misbehaving. I also try the numbers game. I tell the class that I would give them at least two minutes to settle down before we can proceed. If it is break time, I tell them that I would not dismiss them until they are all well-behaved or I dismiss the behaved ones on time but I let the offenders stay in the classroom a little bit longer so I can have a talk with them. As much as possible, I refrain from embarrassing the students who are misbehaving. So I tell the class to stop teasing the student whom I called his/her attention. There are times that I go near the st udents who are being noisy instead of calling out their names. I would stare at them while I would still be discussing the lesson to avoid interruptions. I thought my grooming would be irrelevant with the lesson discussion but students are actually bothered if I didn’t groom neatly and properly. There are times that instead of asking something related to the topic, they would ask if I wore my uniform properly comparing me to the other student-teachers. They also care about my hair and make-up, shoes,  nail polish and accessories. They made me conscious then of what I’m supposed to wear because I realized that I will earn their respect somehow by dressing professionally. Not all students are misbehaving so I also give praises and encouragement to those who are behaving properly so that they can be the role-models of the class. I give credits to them so they will continue their good behavior and not be discouraged if all the attention goes to the noisy ones. There are really difficulties when it comes to managing the class especially that we are student-teachers and most students don’t abide with us because of this. We still have to earn their respect through time and exposure. We have established routines, disciplinary measures and other strategies to manage t he class. Therefore, patience and endurance are the key values needed. Source: Andrew Ilagan. The Educator. March-April 2013 Reflection 2 Hands-On Science To many students, Science might be a unicorn or a leprechaun at the end of the rainbow. They do not appreciate the reality of the lessons being discussed in Science. In the traditional lesson proper of the Science subjects, students are asked to read and memorize definitions and terms with just theoretical explanations. Sometimes, it’s like telling a fairy tale like the unicorn and leprechaun that I mentioned. With the new K-12 curriculum today, students are made to explore in order to deepen their understanding with the concepts. How? Through having experiential learning activities such as laboratory activities and varied approaches and instructional materials in teaching Science, students are able to transfer or convert the theoretical knowledge into a concrete experience. And with my teaching experience and the principles of teaching-learning backing me up, these are more effective methods for the teaching-learning process. According to the article, resourcefulness is one o f the most important qualities of a science teacher. Conducting laboratory activities and presenting real objects for the lesson could be a challenge especially if the resources are scarce at the teacher’s location. This is why as a Science teacher, I should be able to substitute, improvise and customize as suggested in this article. At the UB- High School, the Science Department’s  projector is not functional. So instead of presenting video clips and animations which I find very helpful, I demonstrate or I let the students demonstrate the concept with the real objects to explore. I also give the students varied activities like role-playing, designing, composing jingles/songs and other group-works so they will actively participate with the lesson proper instead of me just talking in front. However, in conducting these activities, the class should be oriented of the rules and guidelines which must be observed before, during and after each activity. Organization is essential so the task will be carried out in accordance to the objectives to be accomplished. Instructions should also be given clearly and carefully. Curiosity among the students should also be developed. In my classes, I always encourage my students to be asking questions if they didn’t understand the lesson and they shouldn’t hesitate into asking questions especially if it’s a â€Å"what if?†. As a Science teacher, I also promote creativity and innovation. At their young minds, I believe they can create and design peculiar things which can be productive. I gave my students a task on designing a balloon car and some of them surprised me. It is fulfilling on my part as a teacher that they submitted more than what I expected them to. For those who were not able to excel, I encourage them to do better next time and don’t give up trying. In general, many say that Science is a difficult subject but I say, sometimes it depends on the teacher. No task is that hard to a person who is dedicated to her work. Source: Reyett Paunan. The Educator. March-April 2013

Care for Mechanically Ventilated Patients

Care for Mechanically Ventilated Patients The following case study will focus on a discussion around pain assessment and complexity of care delivered to individuals, who are mechanically ventilated, with altered levels of consciousness. The pathophysiology of ventilation and its associated consequences and symptoms for a patient’s care will be thoroughly examined. Aspects of pain assessment in individuals, who are sedated on ventilation support, and nursing interventions to identify levels of pain will be critically analysed and justified. Finally, the complexity of patient’s care will be argued and critically evaluated and the wider context of care management will be conscientiously discussed. The International Association for the Study of Pain (IASP) outlines the definition of pain as an â€Å"unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage† (IASP, 2017). In accordance to Chanques et al (2007) pain is one of the mo st occurring complications associated with intensive care stay with an occurrence of moderate to severe level of pain experienced by almost 50 % of medical and surgical patients. Bertollini et al (2002) reported that approximately 80 % of patients on critical care units, amongst Europe, have experienced pain during nursing interventions and have not received adequate analgesia. In multicentre studies 50 – 65% of patients complained that they suffered severe pain in ICU; 15% were unhappy with the pain management they received. To maintain confidentiality and to protect the identity of an individual, the name of the patient will be changed to Mr Kenneth Smith (pseudonym), in line with Nursing and Midwifery Council (NMC,2015). Kenneth is an 74 year old male admitted to cardiac intensive care unit (day 10) following coronary artery bypass graft surgery. Kenneth was previously diagnosed with triple vessel coronary artery disease, following myocardial infarction four weeks prior to surgery. Currently, he cannot maintain his own breathing, therefore, to promote haemodynamic stability Ken is ventilated with a use of synchronised intermittent mandatory ventilation (SIMV) mode. To facilitate Ken’s ventilation, he is also sedated however, it has been found that Ken reacts to voice and occasionally opens his eyes. The possibility of delirium also emerged as the patient’s wife deems, that Kenneth appears disorientated and agitated at times (Kings compromising successful post-operative recovery (Rakel and Herr, 2004).   Twycross (2002) argues that pain appears to be a problem in acute settings, yet the knowledge and understanding of its management is limited amongst nursing staff; which breaches the principles of effective practice in line with the best available evidence (NMC, 2015). Awareness of causes and interactions of pain, agitation and delirium in Kenneth’s case is essential, to promote quicker recovery by managing pain effect ively and weaning patient off the ventilation support (Stein-Parbury and Mckinley, 2000). Endotracheal tube combined with sternal wound and chest drains contributes to nociceptor activation and sensitization at various levels (Dahl and Kehlet, 2006). Hence, Kenneth is experiencing ongoing pain at rest, that increases with movements. Although, pain analgesia is administered on regular basis to control discomfort levels (WHO, 2015); Koppert et al (2003) argues that increased pain sensitivity in surgical patients to stimuli is commonly recognised as an effect of opioids. The thesis is strongly supported by Wilder Smith (2006) who acknowledge, that hyperalgesia has a major effect on the way brain processes pain signals. There several mediators that contributes to nociceptor activation: prostaglandins, interleukins, cytokine and neutrophils (Brennan, 2017). Peripheral neutrophilic granulocytes (NG’s) also have an impact on peripheral sensitivity and contribute to pain where the in cision was made (Carreira et al, 2013). The intensity of pain is amplified by nociceptive neurones that send electrical signals to central nervous system along axons, which again depends on many factors, including surgical site and discomfort caused by endotracheal tube or Kenneth position (Steeds, 2016). Recent Kenneth’s arterial blood gas reading revealed, decreased tissue pH and increased lactate concentration, which in accordance to Brennan (2011) could also influence the intensity of pain and spontaneous pain behaviour. Initially, Kenneth was commenced on mechanical ventilation post operatively to maintain his haemodynamic stability, decrease cardiac workload and provide optimum for gaseous exchange (Goldsworthy and Graham, 2014). Upon physician assessment, Kenneth receives SIMV, which delivers set amount of breath and encourages patient to take spontaneous breaths (Wiesen et al, 2013). SIMV mode helps to reduce Kenneth’s cardiac output, although it has been p roved that it prolongs ventilation dependency. Due to persistent episodes of hypoxemia, weaning from ventilation is delayed, which put Kenneth at risk of further complications (Chlan, 2011). Pillbeam and Cairo (2006) conducted a study which shown that prolonged ventilation increases the mortality rate. Challenges faced by nursing staff in pain management influences the process of weaning, hence it affects Kenneth’s quality of life (Baazm et al, 2014). Nelson et al, 2010 argues that patients who struggle to wean of ventilation support are at greater risk of infection, delirium, pain and they are often experiencing anxiety. Therefore, it could be questioned whether, unmanaged pain is a leading cause of prolonged ventilation or vice versa. Whitehouse et al (2014) reports that pain can trigger stress response which can have detrimental effect on patient’s health and wellbeing. Increased levels of catecholamines can cause arteriolar vasoconstriction, impair tissue perfusion and decrease tissue oxygen partial pressure which would impact on delayed weaning of ventilation support and increased oxygen consumption (Barr et al 2013). Catabolic disturbances and hypoxemia caused by pain can also impair wound healing process and lead to wound infection; pain decreases natural killer cell activity, cytotoxic T cell and neutrophils which are pivotal for immune system (Woolf, 1989). Wagner et al 1998 emphasises that other factors such as sleep disturbances and anxiety can aggravate pain perceptions. Royal College of Nursing (2003) concludes that nurses have duty of care to minimise distress and suffering from pain. The â€Å"gold standard† in pain assessment by nurses is self-reporting by the patient, providing necessary information, that helps to identify source, intensity and underlying condition so that appropriate analgesia can be administered (Chanques and Constantin, 2010). but Kenneth cannot give sufficient response due to endotracheal tube and se dation level (Craig and Schlavenato, 2010). Pain is difficult to measure as it is an individual experience and everyone perceive it on their own way. It encompasses wide spectrum of physiological and psychological responses; therefore, it is pivotal for nurses to provide holistic approach when looking after critically ill patients (Woodrow and Moore, 2004). Kenneth during morning activities, whilst being assisted with personal hygiene needs appeared to be in discomfort, especially during moving and handling manoeuvres. Bird (2003) argues that there is no specific pain assessment tool for ICU patients and should evaluate effectiveness of tools used, to manage pain effectively. Chanques and colleagues (2010) have manifested that visually enlarged numeric rating scale (NRS) from 0 (minimal discomfort) to 10 severe pain, is the most successful and valid across other pain assessment tools available. Jensen (2003) has reviewed 164 journals and demonstrated that NRS tool is the most reliab le indicator of pain intensity. Although Kenneth can blink his eyes occasionally when asked about pain levels, it is difficult to determine the accuracy of patient’s perception due to level of sedation and cognition state. Kenneth’s effort to express and communicate pain is respected and adequate pain analgesia is provided. The evidence shows that the belief of patient’ report creates trust relationship between patient and healthcare professional, therefore pain management is more successful and effective (D’Arcy, 2011). Pain can increase with activity and it is revealed as dynamic process, therefore Kenneth is reassessed on a regular basis to maintain comfort and minimise distress (Dahl and Kehlet, 2006). Barr (2013) emphasises that pain in intensive care unit patients’ needs to be assessed frequently and repetitively in an effective manner to maintain high quality of care and promote healing. Puntillo (2009) stresses that healthcare professionals must use â€Å"structured, valid and reliable tools† due to complexity of patients’ needs. Upon Kenneth pain assessment, it was found that Behavioural Pain Scale was the most effective. Nurses observed that Kenneth is becoming restless and agitated and facial grimacing is present, which resolves with appropriate analgesia (Feldt, 2000). These behaviours fit into criteria of pain indication as per Checklist of Nonverbal Pain Indicators (CNPI) (Young, 2006). Nurses derived the total BPS score of 8-10, which indicated that Kenneth was experiencing severe pain on assessment. D’arcy (2011) speculates that the use BPS is not as effective and developed as current tools that have been in use for years. Li and colleagues (2008) also argue that there is some evidence about BPS, an updated revision in regards to validity and effectiveness is needed, so that it can be applicable for ICU patients. However, Payen (2008) and Arbour et al (2011) dispute with the opinion of h is colleagues and demonstrate that there are recent studies which show that BPS improve pain management and successful recovery, followed by shorter duration of mechanical ventilation. Implementation of Payen BPS appeared to be extremely useful, when repositioning Kenneth in bed, as it assesses compliance with ventilation, detecting specific pain behaviours (Puntillo et al., 2001). In addition to respiratory support, pain is also triggered by sternal wound and both chest drains which increase the intensity of pain experienced by Kenneth. The study carried out by Payen (2001) demonstrated that 63% of ICU patients could remember pain and 40% patients post cardiac surgery experienced the worst pain due to chest drains and surgical wounds. In addition to BPS, there are other assessment tools for critically ill patients, like Kenneth, such as Gelinas Critical Care Pain Observation Tool (CPOT) which is also based on behavioural observations (Gelinas et al, 2006). Its effectiveness was a gain reported during moving and handling manoeuvres, where ventilation machine was observed for alarms, which displayed that Kenneth stopped breathing spontaneously. Slight resistance was also felt by nursing staff; which indicated muscle tension that potentially resulted from pain (Li et al 2008). Marjorie, Kenneth’s wife, was also asked to provide information in regards to Kenneth’s usual behaviours which could be then compared with those gathered during specific assessments. Nursing staff found difficulties in interpreting Kenneth behaviours at times, as they represented numerous things amongst various periods of time (Garteth and Williams, 2017). Olding et al (2015) suggest that family involvement in nursing care positively influences patients care despite its complexity; therefore, behaviour changes were written down over a shift duration, with Marjorie’s active involvement, and clear picture of Kenneth’s behaviours created. It also facilitated imp lementation, care planning and evaluation that promote holistic and family centric model of care (World Health Organisation, 2007). Surrogate designation of Marjorie to help with pain assessment, represents Kenneth’s wishes and needs; effective communication and good relationship between relatives and nursing professionals protects Kenneth’s autonomy (Sprung and Azoulay, 2004).   Marjorie, visits Kenneth daily, hence, nursing staff could go through the pain assessment tool together, improving its effectiveness and recognising new changes. It has been reported that, when Marjorie is present, Kenneth is more settled and less agitated, therefore, social contact with beloved ones maximises quality of care and recovery (Aust, 2013). Family interaction in basic nursing care and patient psychological and emotional support is a way of demonstrating love and care, a unique aspect of care that can be only provided by them (Engstrom and Soderberg, 2007). Dowling and Wang ( 2005) conclude that family support has a positive impact on patient’s outcome and recovery rate. Close contact with family gives them strength to overcome struggles related to their condition and enables them to regain orientation within the environment (Magarey and McCutcheon, 2005). Kenneth’s physiologic parameters are monitored regularly to maintain patient’s stability and to provide nurses with information about Ken’s physiologic status so that, they can react fast upon any changes (National Institute for Health and Care Excellence [CG50], 2017). During personal hygiene and moving and handling manoeuvres, it has been noted that Kenneth’s blood pressure (BP), heart rate (HR) and respiratory rate (RR) increased with visible behavioural changes and became stable once the painful stimuli was removed. Although, vital signs are widely used by nurses in pain assessment, they are not validated and supported by clinical evidence (Donaldson et al., 200 3). Kenneth’s is also receiving inotropic therapy in terms of cardiovascular support and sedative agent are also used, therefore, his vital signs are likely to fluctuate (Imal et al., 2011); however, they have not been discussed further in this discussion. Payen et al. (2001) with Gelinas and Johnston (2007) found that BP and mean blood pressure (MAP) increased in patients with altered level of consciousness, when exposed to nociceptive stimuli. However, Frazier et al (2002) argued that alteration of vital signs could result from activation of autonomic nervous system as a stress response and anxiety indication from performed procedures. Barr et al. (2013) in Clinical Practice Guidelines do not recommend that vital signs should be used when performing pain assessment, although they can be used as a suggestion and cue to conduct further assessment.

Contract Essay Example | Topics and Well Written Essays - 2000 words - 1

Contract - Essay Example All three cases are of Contract. The basic principle of contract law is "[t]he purpose of the law is to put the plaintiff in as good a position as he would have been in had the defendant kept his contract." 1 Principle of Incorporation: Within this principle, specifically the concept of mutual understanding is applicable which is â€Å"derived from the conduct of the parties that the conduct of hire was to be based on one of the party’s usual conditions’. 3 The first issue in the first scenario is whether or not the words â€Å"excellent reputation for being reliable† constitutes a misrepresentation, due to the fact that LLL were unreliable by arriving late and sending a limousine that was not clean and up to the mark. This was a common understanding developed that the service will be of good quality and presentable. The above statement could be seen as a mere puff (sales talk) which is not considered to be a statement of fact as courts would treat such as idle boasts with no contractual significance as in Dimmock v Hallet where the statement â€Å"Fertile and Improvable† was considered to have insufficient substance to be classed as a representation. Also the statement could be seen as an opinion as in Economides v Commercial Union Assurance Co Plc (1997) where estimate of content given to the insurance was considered to be a statement of opinion as he was not an expert thus not a misrepresentation. On the other hand, the above statement could be considered as opinion of a person in a better position to know the facts in which case it is misrepresentation as in Smith v Land & House Property Corporation where it was held that a statement of opinion from someone who knows the fact best is a statement of fact as the knowledge of fact justify the opinion. Furthermore, the statement was made by one party to the other i.e. LLL to AAA and if Lynda relied and acted on the statement to make her decision to give the contract to LLL, although the

Script Adaptation Coursework Example | Topics and Well Written Essays - 250 words

Script Adaptation - Coursework Example She gesticulates very actively and addresses the audience. Her eyes are constantly moving as if the girl is asking someone from the audience to help her and take her from this dull life. Bridget stretches her hands to the sky and tells that she hates seeing her mother phoning the list of people who had died. The decorations are changed when Bridget’s mother appears on the stage. There are more dark colours now. This is closely connected with the women’s relation to death. During the conversation between two people a calm but alerting music is playing. These sounds give the feeling that something awful or strange will happen soon. The girl asks her mother to give up phoning the list. Bridged embraces and kisses her mother. Her gestures are very gentle. She should do everything that may show her passion towards mother. The latter stays calm and says that she is not planning to stop phoning the list of dead people. Bridged tells that these things affect their relationship in the family; the girl turns aside and bursts out crying. Her mother leaves. More lights appear on the stage after her disappearance. In a few seconds a stranger in black coat comes to Bridget, touches her hand and tells that Archie Shearer killed Jennifer MacDonnell. There is a silent scene after these words. Works Cited Coady, Lynn. Strange Heaven. Canada: Goose Lane Editions, 2010.