Bp’s Ethical Culture Essay Example for Free

Bp’s Ethical Culture Essay We will go through the BP business context and culture, safety aspect, organization capability, responsiveness and risk assessment aspects of their ethical culture, result from the management and caused the disaster. BP Business Context and ethical culture: From the BP management employer aspects, they are not follow some mechanical level, safety procedure over and ignored which required by Act (e.g. Clean Air Act) over 8 year for their production. At the end the huge explosion occurred in March 2005. Because of the hydrocarbon liquid leakage and vapor, the ignition explosion result of the accident. They failed to give the safeguards protection tools to protect employees, this accident killing employees and injured people in Texas oil refinery. And the other issue of the Alaskan oil pipelines leaked; their culture also reflect the safety negligence in their operation and management. Not check the pipelines by routine maintenance. BP management did not doing any corrective action on the contract worker discovered the first pipeline leak in March of 2006, (e.g. whole stop the pipelines operation for checking details), still waiting the leakage happen on August 2006. And in October 2007 another spill in Prudhoe Bay, once again showing that BP was ignored the maintenance equipment and the safety level of the production. In 2010, violations again at BP facilities (at Ohio factory), the Occupational Safety and Health Administration (OSHA) found that workers might be exposed to injury or death should explosive or flammable chemicals be released at an Ohio factory. The BP working environment have the characteristic that is resistance to change, lack of trust and motivation; unclear expectations about supervisory and management behaviors, led to rules not being followed consistently and no initiating improvements. Management did not set or consistently reinforce process safety, operations performance and systematic to reduce the risk. e.g. neglected the safety protection tools. (Reference 01) Organizational Capability: poor management and communication in the complex organization, high turnover of refinery plant managers which will affect their consistency of responsibilities. Inability to see the risk, poor level of hazard awareness and process safety knowledge, e.g. the temporary worker doing wrong on the hydrocarbons to atmosphere with unclear control in the high risk and safety industry practice. Lack of early warning system in the refinery plant; e.g. poor communication, poor performance-management process and deteriorating the work standards. Means that BP allows the defective process in their production refinery and pipelines channel. Even though the project was carried out before the extensive research to identify any potential environment risks of the pipelines stretched to their network From the BP investor aspects, even a huge amount of fines, criminal penalties were paid again. They just only concern the profit rather then the employees, environment, base on their short term focus with high level oversight on prevention or improvement and safety management. Even the production was shut down a month for repairing; they just focus on resume the production which means profit as a priority. From the interest group, e.g. National Fish and Wildlife, the state law and act. BP was neglected their monitoring role, just paid the fund or fines to be a remedy, but still running at their loosen management culture. From the BP employees aspects, insider trading and fraud document (mail fraud and wire fraud), and reward from the manipulate the propane market at a high prices Integrity of the BP management, also lack of monitor and alert of the internal control. As the National oil company, the management let company making loss on violate Act, not setting a well control system for employees for prevention. These parts clearly showing the history of disregarding the well-being of stakeholders not follow the law and high level operation and maintenance level of BP. Different refinery plane have their own safety management system, and they did not share their best practice with others. So doing the same work but running at different safety system level. And as the employees of BP, from the result of the explosion, oil leakage and fraud issue all of them are affecting their society and economic damage. They know and maintain these BP culture but they do not concern until the accident or issue occurred. From these aspects of the BP ethical culture, and still no solid continues improvement, then it was caused the Gulf Coast oil spill disaster. At the beginning, BP tried to shift their responsiveness to the contractor Transocean, Ltd., loosen and negligence management style (know but not concern style), lying on the accident real situation to public. And delay the recovery work which subject to their management decision and style.

Pain Perception And Processing In Alzheimers Disease

Pain Perception And Processing In Alzheimers Disease Alzheimers patients feel pain as powerfully as others. Pain perception and processing are not diminished in Alzheimers disease, thereby raising concerns about the current inadequate treatment of pain in this highly dependent and vulnerable patient group. Pain activity in the brain was just as strong in the Alzheimers patients as in the healthy volunteers. In fact, pain activity lasted longer in the Alzheimers patients. Pain may be even more bewildering to more severely affected patients. The experience of pain may be more distressing for these patients on account of their impaired ability to accurately appraise the unpleasant sensation and its future implications. Doctors can use a tool called the Pain and Discomfort Scale or PADS. Its a system for evaluating pain based on facial expressions and body movements. People caring for someone with Alzheimers disease or other dementias can do an even better job than doctors can. Caregivers have an incredible capacity even beyond doctors to know the behavior of the person they are caring for and to look for the times they are in discomfort or pain. The trick is to watch the facial expressions and movements of patients when they are not in pain, both during sleep and waking hours. Using this as a baseline, you should be attentive to circumstances where they seem agitated, where eye contact is altered, where there is grimacing or a facial expression indicative of discomfort. As Alzheimers disease progresses towards the later stages, the ability of the affected person to communicate becomes increasingly compromised. Caregivers can no longer ask are you comfortable? or, are you in pain? and get a reliable answer. A caregiver has to interpret what behavior means. Are shouts, screams, severe withdrawal, aggression, due to confusion, something else, or are they signs of pain?   The way in which a normal person experience pain differs. Pain is a subjective experience. People who have problems communicating are disadvantaged. Research into the prevalence of pain in elders in nursing homes is estimated at between 40 and 80 percent. There is evidence that people with cognitive disabilities may have an even higher risk of being under-medicated for pain. Painful conditions such as arthritis, cancer, urine infections are sometimes not treated with painkilling medications. Even when people can communicate effectively research suggests that observers tend to assume that people over-report pain either verbally or in their facial expressions.   Effective pain management for people with dementia is a complex issue. Families and health professionals caring for people with dementia have to acquire new skills and it can be a rather hit and miss situation. The first step in pain management is assessment of the discomfort. Acute pain syndromes commonly follow injuries, surgical procedures, etc. and require standard analgesic or narcotic management. Acute pain syndromes are expected to last for brief periods of time, i.e., less than six months. Pain that persists for over six months is termed chronic pain. Chronic non-malignant pain requires a more complex strategy to minimize the use of narcotics and maximize non- pharmacological interventions. Acute pain rarely produces other long-term psychological problems, such as depression, although acute discomfort will produce distress manifested by acute anxiety or agitation in the demented patient. Mildly demented patients can become agitated or anxious with pain because they rapidly forget explanations or reassurances provided by staff. Amnestic individuals may forget to ask for PRN non-narcotic analgesics such as acetaminophen and these patients need regularly scheduled medications. Disoriented patients do not realize they are in a health care facility and aphasic patients may not comprehend the staffs inquiry about pain symptoms. The symptoms of pain expressed by patients with moderate to severe dementia include anxiety, agitation, screaming, hostility, wandering, aggression, failure to eat, and failure to get out of bed. A small number of demented individuals with serious injury may not complain of pain, e.g., hip fractures, ruptured appendix, etc. Assessment of pain in the demented patient requires verbal questioning and direct observation to assess for behaviors that suggest pain. Standardized pain assessment scales should be used for all patients; however, these clinical instruments may not be valid in persons with dementia or psychosis. The past medical history may be valuable in assessing the demented resident. Individuals with chronic pain prior to the onset of dementia usually experience similar pain when demented, e.g., compression fractures, angina, neuropathy, etc. These individuals can be monitored carefully and non-narcotic pain medication can be prescribed as indicated, e.g., acetaminophen on a regular basis, anticonvulsants for neuropathy. The management of pain in any person requires careful consideration about the contribution of each component of the pain circuit to the painful stimulus. Neuropathic pain is produced by dysfunction of the nerve or sensory organ that perceives and transmits noxious stimulus to the level of the spinal cord. Persons with serious back disease may have herniated discs that compress specific nerve roots. This pain is often positional and produces spasms of the musculature in the back. The brain interprets pain in a highly organized systematic pattern. Discrete brain regions interpret and translate painful stimuli from specific body regions, e.g., arm, leg, etc., misfire in that discrete brain region will misinform the person that pain or discomfort is being experienced in that limb or part of the trunk. A person who loses a limb from trauma or amputation may continue to experience painful sensations in the distributions for that limb termed phantom limb pain. Management of chronic pain involves three elements (1) physical interventions, (2) psychological interventions, (3) pharmacological interventions. Physical interventions include basic physiotherapy that incorporates warm or cool compresses, massage, repositioning, electrical stimulation and many other treatments. Dementia patients need constant reminders to comply with physical treatments e.g., using compresses, sustaining proper positioning, etc., and many do not cooperate with some interventions, like nerve stimulators or acupuncture. Physical interventions are particularly helpful in older persons with musculoskeletal pain regardless of cognitive status. Psychological interventions usually require intact cognitive function e.g., relaxation therapy, self-hypnosis, etc. Demented patients generally lack the capacity to utilize psychological interventions; however, management teams should provide emotional support to validate the patients suffering associated with pain. Demented patients may experience more suffering from pain than intellectually intact individuals because they lack the capacity to understand the cause of their discomfort. Fear, anxiety, and depression frequently intensify pain. Pharmacological management begins with the least toxic medications and follows a slow progressive titration until pain symptoms are controlled. Clinicians must distinguish between analgesia and euphoria. Some medications that appear to have an analgesic or pain relieving effect actually have an euphoric effect, which diminishes the patients concern about perceived pain. The goal of pain management is to remove the suffering associated with the painful stimulus rather than making the patient euphoric or high to the point where they no longer care whether they experience pain. Euphoria-producing medications can cause confusion, irritability, and behavioral liability in patients with dementia. Narcotic addiction is not a common concern in dementia patients as these individuals have a limited life expectancy and rarely demonstrate drug-seeking behaviors. Pharmacological interventions always begin with the least toxic, i.e., least confusing, medications. A regular dose of acetaminophen up to 4 grams per day will substantially diminish most pain and improve quality of life. Clinical studies show that regular Tylenol reduced agitation in over half the treated patients. Chronic arthritic pain with inflammation of the joints may also respond to non- steroidal anti-inflammatory (NSAIDS) or Cox-2 inhibitors. The gastrointestinal toxicity associated with NSAIDS is greater than that of Cox 2 inhibitor medications. Patients who fail to respond to non-narcotic analgesics should receive narcotic-like medications, i.e., Tramadol. Patients who fail to respond to maximum doses of Tramadol, i.e., 300 mgs per day, may require narcotic medications.  

Mental Health Service User Case Study

Mental Health Service User Case Study 1.1 Decision making by nurses is now firmly established in practice, policy and educational agendas. New constantly evolving, roles, and a policy context that is challenging traditional professional boundaries mean that, more than ever, nurses are being given autonomy and power to be able to exercise their decision choices (Thompson, 2001). 1.2 Clinical decision making may be defined as having a variety of options and choices and a process that nurses undertake during their everyday activities whilst caring for service users. It usually involves nurses making judgements about the care that they provide to service users (Thompson et al, 2002). Similarly ONeill et al (2005) argues that clinical decision making is a complex activity that requires nurses and other health professionals to be knowledgeable in relevant aspects of nursing, to have access to reliable sources of information and to work in a supportive environment. 1.3 Shared decision-making on the other hand is an interactive collaborative process that occurs between the nurse and the service user that is used to make health care decisions. Adams and Drake (2006) note that in shared decision-making the nurse becomes a consultant to the service user, helping to provide information, to discuss options, to clarify values and preferences and to support the service users autonomy (p.88). 1.4 Policy changes and trends in professional development within the last decade have reiterated the importance that nurses and other relevant health professionals need to recognise that the decisions they make have a direct impact on health care outcomes and service users experiences (DH, 2000). 1.5 Decisions can be easily examined in the form of decision trees which provide a highly effective structure within which many different options can be explored (Goetz, 2010). Goetz (2010) further argues that the decision tree encourages people to think through their options, to act consciously and with consideration. It has also been suggested by Corcoran (1986, cited in Bonner, 2001, p.350) that the decision tree is able to provide a clear structure which helps to assess a range of actions that health professionals may choose when making decisions regarding the care and treatment of a service user. 1.6 In contrast, Bonner (2001) argues that the decision tree is under researched within the scope of mental health practice. He does acknowledge that the use of the decision tree in practice allows nurses to examine the options available to them in more detail, whilst also considering the complex variables that influence the decision-making process. 1.7 It would be expected that the decision tree is hierarchically structured and spans a specific period of time which will be determined within the Justifications section of this report. 2. Methodology 2.1 The purpose of this report is to identify a service user with whom one was currently working with in practice. Using a decision tree, the service users journey will be detailed from their current health needs from the point of referral to mental health services to the current point in time. Once the decision tree is formed, it will then be essential to identify up to three critical decision points and analyse the decision making process for each decision chosen. 2.2 The information required to form the decision tree is to be gathered during a 60-minute unstructured interview with the service user, which can be thought of as a guided conversation. The reason that this type of methodology will be utilised is because unstructured interviews allow a particular focus on specific areas through asking open-ended questions but also allow for probes and follow-up questions to be used in order to effectively obtain more information to construct the decision tree as accurately as possible (Streubert Carpenter, 1999). 2.3 In order to ensure that the information gathered is accurate, it will be beneficial to form a lifeline with the service user, looking at major life events and decisions that have been made. This lifeline can be found in Appendix 1. 2.4 It will also be essential to explore the service users medical notes (with their consent) in order to gain a clearer idea of events that have occurred, the vital decision points and whether service user involvement was evident throughout. 2.5 The decision tree that was formed can be found in Appendix 2. 3. Justification 3.1 The service user that will provide the focus of this report will be referred to as Sarah (a false name in order to maintain confidentiality). 3.2 Sarah is a 43-year old lady who has a diagnosis of borderline personality disorder. She has had multiple admissions to psychiatric units including admissions under the Mental Health Act (See Appendix 3 for supporting information). 3.3 Sarah was chosen because it was felt that the she would be able to provide a good history and account of events that have occurred in her past in relation to the care and treatment that she has received. Sarah was also deemed to have capacity and was therefore suitable to take part within this piece of work. 3.4 The timescale that the decision tree covers will focus upon a 6-year history whereby Sarah began her first contact with adult acute mental health services. This will be explored up to the current point in time. 3.5 During the gathering of information, both primary and secondary sources were used. Primary sources refer to first-hand accounts of events that have occurred (i.e. interview with service user). In comparison, secondary sources refer to information that has already been documented from the past (i.e. medical/nursing notes). It was decided to use both sources as they would provide information richer in validity and ensure the reliability of the findings. 3.6 The report will cross the boundaries between in-patient care and community services within the North of England. The key decision points that have been chosen for analysis within this report were chosen because it was evident that some decisions had a certain degree of service user involvement in comparison with others whereby service user involvement did not seem to be present. This does however introduce a debate in regards to service user involvement because those decisions that did not involve Sarah and that were made on her behalf, can be argued were made in the best interests of the individual i.e. admission to hospital to ensure Sarahs safety and well-being. 3.7 Each of the decisions will now be individually analysed with a specific focus upon the decision itself, the issues that they may involve and the concepts that they may introduce. 4. Referred and taken onto caseload with a Community Mental Health Team following gate-keeping assessment (See Appendix 4) 4.1 Sarah was referred to her local community mental health team following a visit to her General Practitioner (GP) whom was worried about the self-harming thoughts that Sarah was currently experiencing. The General Practitioner was very concerned about Sarahs apparent deterioration in her mental health, therefore he felt that it was necessary to refer her to the community mental health team who would then be able to offer assessment and work from that point onwards. The GP discussed this with Sarah who did admit to being a little apprehensive beforehand however after a short period whereby she was able to reflect on her current circumstances, Sarah was agreeable to this. 4.2 Borg et al (2009) argues that service user involvement has a crucial significance especially for individuals that work within a community mental health setting as this involves accessing patients in their own homes (p.285). Sarah did feel that she had developed a good rapport with her community psychiatric nurse because Sarah was always offered choices in terms of her care and treatment and she felt actively involved in the decisions that were made. The therapeutic relationship that was developed between Sarah and her community psychiatric nurse also played a vital role in Sarahs care as Reynolds and Scott (2000) argue that it is through this therapeutic relationship that we can assess the needs of the patients that we work with and then plan future care to assist in their recovery. 4.3 An important consideration is the potential risk involved in maintaining Sarahs mental health in the community. This was clearly documented within Sarahs treatment plan with specific actions outlined and crisis contact numbers provided to both Sarah and her Husband. The National Institute for Health and Clinical Excellence (2009) provides guidance on risk assessment in patients with a diagnosis of emotionally unstable personality disorder. It informs that the risk assessment should take place as part of a full assessment of the patients needs and this is exactly what occurred due to the high level of risk involved and potential self-harm of Sarah within the community. 4.4 The main influences behind the decision to make a referral to the local community mental health team was Sarahs safety and how able she was to maintain this. Also if the GP felt that Sarah required a hospital admission and there were no hospital beds available, then a referral to the community mental health team or crisis resolution would be necessary. This therefore would indicate that care and treatment is dependent upon what resources are available at that specific time. 4.5 In order to ensure that the correct decisions are made, the specific team must have an effective leadership style and a variety of skills amongst team members. The New Ways of Working practice implementation guide (DH, 2007) outlines how a team can effectively achieve their maximum potential. In order for this to be achieved, a number of measures must be addressed which include; Focusing upon skills and matching these to the needs of service users; Distributing responsibility fairly amongst the team rather than delegating; Focusing on ability and competence of team members rather than role. 4.6 The policy discussed in section 4.5 appears to be utilised well within this team because Sarah was allocated to a senior care coordinator that had a large amount of experience of working with individuals with a diagnosis of personality disorder. The health professional was also able to engage and was competent in carrying out Dialectical Behavioural Therapy with Sarah which is a specialised treatment suitable for those with a diagnosis of personality disorder (Comtois et al, 2007). 4.7 There are many alternate decisions that the General Practitioner could have made in order to ensure that Sarah received the treatment that she required to meet her needs. A referral to the local crisis resolution home treatment team could have been made who would offer assessment and then decide a plan of action. Brimblecombe (2001) argues that a team such as this could have the potential to reduce the number of hospital admissions, therefore utilising resources and funding more effectively but at a cheaper cost. 4.8 Another possible course of action could have been to make a referral to the acute community day services (day hospital) who would be able to provide care throughout the day for Sarah if she required support. This would be a less restrictive alternative than hospital admission and Sarah may be more likely to engage with this service based in the community. 4.9 Alternatively, the GP could have chose to not do anything except review Sarah after a few weeks to assess whether her mental health was still deteriorating however this may be seen as unethical especially if Sarah was suffering due to her experiences and self harming thoughts, which ideally should be resolved as soon as possible. 5. Voluntary (informal) admission to acute psychiatric hospital following presentation in Emergency Department (See Appendix 5) 5.1 When Sarah becomes acutely unwell, the most common course of action is to admit her to hospital for her own safety and well-being but also the safety of others. This particular hospital admission was informal which therefore indicates that Sarah was willing and agreed to go into hospital, having been assessed by a team which specialises in self-harming behaviour. 5.2 The Mental Health Act (2007) refers to informal patients as those that accept and agree to go to hospital without the use of compulsory powers. Sarah was not detained therefore she was permitted to have leave from the ward to spend at home with family. This was Sarahs choice and was discussed in collaboration with the Consultant Psychiatrist until an agreement was made. 5.3 The decisions to admit Sarah to hospital was made by a health professional that assessed Sarah in the Emergency Department following an incident of self-harm. Sarah did feel that she was fully involved within the decision because alternatives to hospital admission were discussed with Sarah however she felt that hospital admission was the most appropriate action to ensure her safety at that specific time. Furthermore the Nursing and Midwifery Council code states that as a professional, nurses are personally accountable for actions and omissions in their practice and must always be able to justify their decisions (NMC, 2008). 5.4 The main influences behind this decision were the levels of risk involved due to an escalation in Sarahs self harming behaviours within the community. The Ten Essential Shared Capabilities (DH, 2004) aimed to set out the shared capabilities that all staff working in mental health services should achieve. Promoting safety and positive risk taking is one of the major points within the document with the hope of empowering individuals to determine the level of risk that they are prepared to take with their health and safety. Ideally this includes working with the tension between promoting the individuals safety and positive risk taking which should be detailed within the individuals care plan. 5.5 Positive risk taking and risk management has been largely debated within the scope of mental health nursing. Parsons (2008) argues that people learn through a process known as trial and error. This therefore suggests that if Sarah self-harmed so significantly that her life was endangered then she would not carry out this behaviour again. This theory however can be largely critiqued in regards to Sarahs case because the self-harming behaviour is a regular occurrence with Sarah in full knowledge of the consequences that this may have. 5.6 A study carried out by Bowers et al (2005) examined the purpose of acute psychiatric hospital wards and they concluded that in most circumstances, patients are admitted because the possibility of harming themselves or others had increased significantly. They also found that when an individual is experiencing a severe mental illness whereby their behaviour is unmanageable in the community, this provides the requirements for a hospital admission. 5.7 In contrast, the quality of care on acute psychiatric hospital wards has largely been questioned in regards to the usefulness that hospital admission can actually have upon a person (Quirk Lelliott, 2004). In some circumstances, many individuals will receive high-quality care whilst in hospital however recent studies have suggested that for some individuals, the experience of hospital admission was rather negative (Baker, 2000; Glasby Lester 2005). 5.8 The Royal College of Nursing (2008) acknowledges that every nursing decision made has an ethical dimension and furthermore that ethics and ethical decision making abilities are applicable to every aspect of nursing practice. The decision to admit Sarah to an acute psychiatric hospital ward does introduce ethical dilemmas because it can be argued that it is unethical to admit a person to a locked ward and therefore restricting their freedom. 5.9 Beauchamp and Childress (2001) developed a framework which consists of four main principles. The first principle outlines the respect for an individuals autonomy i.e. respecting the decisions that they make and the reasons for making a particular decision. Sarah was given a choice in regards to hospital admission because she could have been detained under the Mental Health Act (2007) however she agreed to hospital admission and was therefore admitted as an informal patient. 5.10 The second principle is that of Beneficence which examines the benefits of having a particular treatment against the risks involved. This was discussed with Sarah and the reasons for hospital admission were fully explained which were to ensure Sarahs safety. Sarah understood the health professionals concerns and worries and did accept hospital admission therefore the health professional was acting upon beneficence. 5.11 The third principle is Non-Maleficence which refers to the avoidance of causing harm to an individual. It can be argued that any treatment can have to potential to cause harm however the benefits of the treatment must exceed this which in this case, the benefit plays much more of a vital role. 5.12 The final principle within the framework is Justice which examines the distribution of benefits, risks and costs equally. It therefore indicates that individuals should be treated fairly in similar circumstances and offered the same intervention/ treatment. In terms of hospital admission, the choice would be to go in as an informal patient or be detained under the Mental Health Act using compulsory powers. This decision would be given to most individuals however when capacity becomes a concern then detention may be required. 5.13 There are many alternate decisions to a psychiatric hospital admission which may have been decided. Sarah may have been referred to an acute community day service (day hospital) which offers assessment and treatment for working age adults that are experiencing acute mental health difficulties. A systematic review of randomised controlled trials of day hospitals within the United Kingdom, concluded that day hospital treatment is generally cheaper, the outcomes are greater and that there was greater satisfaction with treatment compared with in-patient care (Marshall et al, 2001). 5.14 Another alternative decision to hospital admission may be a referral to a crisis resolution home treatment team that would be able to provide 24-hour care. The Mental Health Policy Implementation Guide (DH, 2001) informs that the crisis resolution team is for adults between the ages of 16-65 with a severe mental illness or experiencing an acute crisis that without the involvement of a crisis resolution home treatment team, hospital admission would be necessary to ensure the safety of the individual. This however had been attempted in the past and Sarah did not feel that she benefitted greatly from the service because although they provide a 24-hour service, they cannot offer the same kind of interventions that a hospital ward could offer. 6. Diagnosed with Emotionally Unstable Personality Disorder (See Appendix 6) 6.1 Sarah was diagnosed with Emotionally Unstable Personality Disorder whilst an in-patient on an acute psychiatric ward. The decision to change Sarahs primary diagnosis of deep depression with psychotic episodes was made by the Consultant Psychiatrist that was involved in Sarahs care and treatment. 6.2 The National Institute of Mental Health (2001) describes emotionally unstable personality disorder as a serious mental health illness that is characterised by a pervasive instability in moods, interpersonal relationships, self-image and behaviour. The symptoms of emotionally unstable personality disorder are maladaptive behaviour learnt to make sense of the world and to manage the constant negative messages experienced (Eastwick Grant, 2005). It is important to note that Sarah did experience sexual and psychological abuse from an outsider of the family during her childhood which she did not disclose to her family until she was an adult. Sarah recognised that this was a major factor in the way that she perceived the world and was directly linked to her self-harming tendencies. 6.3 During this period of time, Sarahs behaviour became increasingly unsafe to manage in the community therefore warranting a hospital admission. Her self-harming tendencies had increased and there was a great concern for her safety mainly expressed by her family who were worried about Sarahs deterioration in her mental health. 6.4 When Sarah was given the diagnosis, she was unhappy due to the non-apparent involvement within the decision as she was not consulted in regards to the diagnosis or asked about her thoughts and feelings. Bray (2003) argues that decision making and service user involvement cannot always occur with individuals that have a diagnosis of emotionally unstable personality disorder due to the varying symptoms that they may experience i.e. impulsive behaviour which can diminish responsibility. 6.5 Once the diagnosis was made, Sarah felt that peoples opinions and attitudes had changed towards her including ward staff. According to Nehls (1999) individuals with a diagnosis of emotionally unstable personality disorder have described health professionals as being unhelpful, displaying negativity and generally being unhelpful. 6.6 A consultation document known as New Horizons (DH, 2009) outlines a cross Government vision in the hope of eradicating the stigma that surrounds mental health and improving the quality and accessibility of services, ensuring that services are service user friendly. The document stresses the importance of mental health and encourages individuals to understand that mental health problems should be equally as important as physical health conditions. 6.7 Services that are provided by the National Health Service (NHS) are commonly built upon effective partnerships between those providing care and those accessing care. The Department of Health (2004) informs that better healthcare outcomes are achieved when the partnership between health professional and service user is at its strongest. Within this particular decision, there was no partnership as Sarah was not involved in the decision making process in regards to her care and treatment and decision to make a diagnosis without consultation with Sarah. 6.8 An important consideration is that of power because the Consultant Psychiatrist that made the decision, created a position of power over the service user through expertise and knowledge. Pyne (1994) argues that knowledge is a form of power, therefore if we share this knowledge with the patients that we work alongside, then this can promote the process of empowerment in patients. The author then progresses to a stage whereby he questions why nurses do not always demonstrate this behaviour in practice. In comparison, McQueen (2000, cited in Henderson, 2002, p. 502) argues that power associated with special knowledge, that created a barrier between health professionals and patients is slowly diminishing. Furthermore, McQueen believes that both nurses and patients need to be seen as respected autonomous individuals with something to contribute towards an agreed goal. 6.9 There are alternate decisions that could have been undertaken rather than making a diagnosis of emotionally unstable personality disorder. The Consultant Psychiatrist may have decided to not make a formal diagnosis however this could therefore have an effect on Sarahs care and treatment as she would not receive the correct care and treatment to meet her needs. Sarahs previous diagnosis of deep depression with psychotic episodes may have remained the same however it cannot be determined how long this would have lasted due to the frequency of self-harming behaviours and multiple hospitals admissions due to an increased concern for Sarahs safety. 7. Comparisons 7.1 It has become evident that the three chosen decisions for analysis had common themes running through each decision. Power has become an important consideration because although Sarah had a degree of power within each decision, the overall decision was made by those within higher positions i.e. hospital managers and leaders. This can therefore provide the service user with a false misinterpretation of the power that they actually withhold as it is clear that the final decision is not made by the service user and instead it is those with more power i.e. the GP making the referral to the community mental health team and the Consultant Psychiatrist changing Sarahs diagnosis to emotionally unstable personality disorder without consulting Sarah beforehand. 7.2 Leadership has been defined many ways in the literature reviewed, however several features are common to most definitions of leadership and the forms that it can take. Faugier Woolnough (2002) argue that leadership is a process which usually involves a certain degree of influence, but also with a focus upon the attainment of goals .The leadership style mostly present within each of the key decisions is that of a democratic style because there was a degree of consultation with staff on proposed actions before an actual decision was made. 7.3 The care and treatment provided to Sarah was driven by resource availability and this was clearly evident within each decision. If resources are not available, this would impact on the decision whether to allow Sarah to have the treatment. The admission to an acute psychiatric hospital for example would be dependent upon the capacity of that specific organisation because if there was not a bed available for Sarah then other alternatives would have been considered. Fortunately there were resources available for Sarah, however the outcomes may have been different if this was not the case. 7.4 Sarah had also had a large amount of input from a number of services and there was a large amount of movement through mental health services. It can be argued that this is not beneficial towards service users as they are not able to sustain good therapeutic relationships with health professionals which can often be a reason as to why an individual may relapse. 8. Conclusion 8.1 Decision-making within practice takes place in many ways i.e. often the service user is consulted throughout their care and treatment however in some circumstances the service user can be made a recipient of their care and treatment which is not good practice. This report has identified a patient that one is currently working with and using a decision tree, their journey through mental health service was detailed. Three decisions were chosen for analysis and provided the basis of this report, considering factors that influence the decision-making process and also the alternatives that could have occurred. 8.2 Barker et al (2000) argues that the experience of being mentally unwell can be a disempowering period of time because choices can be taken away due to a number of reasons and the patient may feel a recipient of their care and treatment, rather than actively involved in the decision making process. 8.3 Defining decisions as good or bad is problematic, mainly because nurses operate in an environment that is characterised by uncertainty (Buckingham et al, 2000). Baron (2000) further suggests that the best decisions are those that produce the best outcomes for achieving a patients goals and wishes. 8.4 Sarah did feel the majority of time that she was involved in her care and treatment, including reviews and meetings held about her care and treatment whilst an in-patient and within the community. There were times however when Sarah did not feel involved in the decision making process i.e. when her diagnosis was changed without any consultation or discussion. 8.5 Clancy (2003) argues that there is a great tendency in decision-making to bypass a thorough analysis and jump too quickly into solutions. This seems to be evident at times within the chosen decisions for analysis because some decisions were made on behalf of Sarah and there was no consultation or service user involvement. 8.6 Throughout this report, the main aim was to analyse the decision-making process of three key decisions, taking into consideration concepts such as; autonomy, power, leadership and empowerment. It became apparent that they key to successful decision-making was to involve the service user and carers within the decision-making process, listening to their thoughts and opinions and respecting their right to choose between different alternatives. 8.7 It has also become apparent that those within higher positions and those that uphold a certain degree of power were leading the decision-making in Sarahs care. This is obviously not the way that things should work as the service user should be actively involved in all aspects of their care and treatment including decisions that are made. 8.8 Overall I feel that the whole process was an enjoyable one and I feel that I worked well in collaboration with the service user throughout. Collating the decision tree was a rather time-consuming activity, however I understand the importance that they hold and the benefits they possess. I have also become more aware and gained a greater understanding of how the decision-making process can impact on the lives of service user and carers, especially when service user involvement is not evident. 9. Recommendations 9.1 There should be a greater focus upon the decision-making process and how it can affect the service user. Decisions should be decided in collaboration with the service user to promote the nurse-patient relationship and allow good rapports to establish. Service user and carers should be actively involved in the decision making process. Decision making should be an identified topic for pre-registration nursing students to equip them with the desired skills. Decisions are to be based on the best available evidence and regularly discussed with users and carers ensuring that an understanding has been reached. Service users thoughts, feelings and opinions to be clearly documented to inform future nursing practice in regards to decision-making.

Another JD Salinger :: essays research papers

J.D. Salinger's youth and war experiences influenced his writings. J.D. went through four different schools for education. He then went to World War II. After the war, he had a lot to say, so he wrote down his thoughts. And, he sure had some things to say. Jerome David Salinger came into this world on January 1, 1919. J.D. was short for Jerome David. Jerome David went by J.D. when he was young and he never let go of the name as he got older. J.D. was born in New York City, New York (Ryan 2581). J.D. Salinger's parents were Sol and Miriam Salinger (Ryan 2581). His father, Sol Salinger, was born in Cleveland, Ohio, and is said to have been the son of a rabbi. However, Sol drifted far from orthodox Judaism to become an importer of hams. Sol married a Scotch-Irish lady (French 21). The lady's name was Marie Jillich. She changed her name to Miriam to fit into her husband's family (French 21). Jerome David had a roller coaster marriage record. He was allegedly married to a French physician in 1945 and divorced her in 1947 (Ryan 2581). But other sources say that Salinger has never admitted this marriage and the records of the Florida Bureau of Vital Statistics fail to indicate that a divorce was granted in that state in 1947 to Jerome David Salinger (French 26). He then married Claire Douglas on February 17, 1955. Claire Douglas was a Radcliff graduate born in England. In 1955, the two of them settled down in Cornish, New Hampshire, where they raised two children (Unger 552). J.D. divorced Claire Douglas in October 1967 in Newport, New Hampshire (Ryan 2581). In 1932, the time J.D. should have begun high school, he was transferred to a private institution, Manhattan's McBurney School. There, J.D. told the interviewer that he was interested in dramatics; but J.D. reportedly flunked out within a year (French 22). In September 1934, his father enrolled him at Valley Forge Military Academy in Pennsylvania (French 22). In 1935, while attending Valley Forge, J.D. was the literary editor of Crossed Sabers, the Academy Yearbook. Salinger's grades at Valley Forge were satisfactory. His marks in English varied from 75 to 92. His final grades were: English 88, French 88, German 76, History 79, and Dramatics 88. As recorded in J.D.'s Valley Forge file, his I.Q. was 115. While such scores as J.D.'s must be treated with caution, this one and another one of 111 that he made when tested in New York are strong evidence that he was slightly above the average in intelligence, but far from the "genius" category. At Valley Forge, Salinger belonged to the Glee Club, the Another JD Salinger :: essays research papers J.D. Salinger's youth and war experiences influenced his writings. J.D. went through four different schools for education. He then went to World War II. After the war, he had a lot to say, so he wrote down his thoughts. And, he sure had some things to say. Jerome David Salinger came into this world on January 1, 1919. J.D. was short for Jerome David. Jerome David went by J.D. when he was young and he never let go of the name as he got older. J.D. was born in New York City, New York (Ryan 2581). J.D. Salinger's parents were Sol and Miriam Salinger (Ryan 2581). His father, Sol Salinger, was born in Cleveland, Ohio, and is said to have been the son of a rabbi. However, Sol drifted far from orthodox Judaism to become an importer of hams. Sol married a Scotch-Irish lady (French 21). The lady's name was Marie Jillich. She changed her name to Miriam to fit into her husband's family (French 21). Jerome David had a roller coaster marriage record. He was allegedly married to a French physician in 1945 and divorced her in 1947 (Ryan 2581). But other sources say that Salinger has never admitted this marriage and the records of the Florida Bureau of Vital Statistics fail to indicate that a divorce was granted in that state in 1947 to Jerome David Salinger (French 26). He then married Claire Douglas on February 17, 1955. Claire Douglas was a Radcliff graduate born in England. In 1955, the two of them settled down in Cornish, New Hampshire, where they raised two children (Unger 552). J.D. divorced Claire Douglas in October 1967 in Newport, New Hampshire (Ryan 2581). In 1932, the time J.D. should have begun high school, he was transferred to a private institution, Manhattan's McBurney School. There, J.D. told the interviewer that he was interested in dramatics; but J.D. reportedly flunked out within a year (French 22). In September 1934, his father enrolled him at Valley Forge Military Academy in Pennsylvania (French 22). In 1935, while attending Valley Forge, J.D. was the literary editor of Crossed Sabers, the Academy Yearbook. Salinger's grades at Valley Forge were satisfactory. His marks in English varied from 75 to 92. His final grades were: English 88, French 88, German 76, History 79, and Dramatics 88. As recorded in J.D.'s Valley Forge file, his I.Q. was 115. While such scores as J.D.'s must be treated with caution, this one and another one of 111 that he made when tested in New York are strong evidence that he was slightly above the average in intelligence, but far from the "genius" category. At Valley Forge, Salinger belonged to the Glee Club, the

Life on Other planets. Essay -- essays research papers

One of the most common unanswered questions scientists find themselves asking is "Is there life on other planets?" Since the first famously documented UFO sighting in 1947, the idea of extra-terrestrial life has been debated almost non-stop. The subject has inspired many TV programs, such as The X-Files, and films (Mars Attacks, Independence Day, and the Men in Black films to name but a few). Scientists have come up with many new ideas and ways of trying to either prove or disprove the existence of life elsewhere. Mars is a very similar planet to earth in relation to size and atmosphere. Therefore it seemed like the most likely place to search for life. At the end of the 19th century, an American named Percival Lowell built himself an observatory so that it was possible for him to study Mars in intimate detail when its orbit was closest to Earth. At this time it had recently been suggested that the planet had a system of channels on the surface, present from the evaporation of flowing water. Looking through his telescope Lowell became convinced he could see a network of artificial canals. This led him to believe that there were intelligent beings on Mars who had built these canals. However, spacecraft have now visited Mars and found that there is no evidence of water at all. It is now thought that the lines he could see were the combination of Lowell's overactive imagination, and scratches on the lens of his telescope. We are now searching one of Jupiter's moons, Europa, as this seems to be th e next likely place to hold life. It is seen to be more likely, however, that we will find less intelligent life in one of two different ways: It may be possible for us to obtain material from another planet or moon or star from elsewhere in the Solar System. Spacecraft may be able to visit these bodies and, for example, use a robot to collect material for examination. This may be examined on site, or brought to Earth to be investigated in laboratory conditions. They could be tested for things such as evidence of fossilised organisms. Another, possibly slightly far-fetched hope is that we may find simple organisms like bacteria actually living on the desired planet. These ideas spanned from the discovery of rock on our planet that originated from Mars; knocked from the planet when a comet collided with it. In 1996 a group of scientists created conflict by ... ...them is so great that they are dragged to our planet. Another idea is that UFO's are not really from other planets at all, but created right here on Earth. Supposedly Germans, Americans and Soviets started the 'Projekt Saucer' in Germany towards the end of World War II. During the war Germans sent ships to the Antarctic with equipment and plans for a massive underground structure. It is said that at the end of the war scientists and engineers who had been working on Projekt Saucer in Germany ended up in this underground structure, where even more advanced saucers were created. In a manner of thinking this is by far the scariest theory should it be proved correct, for it brings up more questions than it gives answers. What would people on Earth want to create spaceships for? Why keep it such a secret if everything is harmless? Maybe, if this theory is proved correct, it is better not to know the answers. To conclude, there are no solid facts on the existence of extra-terrestrials. Whether or not they exist will, until definite proof is brought forward, be a topic of major debate. Personally I believe that there is something out there-although what it is I wouldn't hazard a guess.

Public Schools vs. Private Schools Essay

Public or private? That is the question. One important thing to keep in mind when determining a school choice is the long and short term effects on students and their views. The differences between them can help with the decision on which kind of school to choose. Public and private schools are different in funding and their learning environment. Public and private schools have different sources of support. Public schools depend on various government funding. One example being, they get funds from the state sales taxes collected from businesses, stores, etc. Another way they get their funds is by The Minimum Foundation Program, which is the state approbation formula. Finally, the most common way of funding is through local sales taxes and from the communities property taxes. Private schools, however, are not supported by money from the government. The main way they receive their money is the tuition payments made by the families of the students. Similarly, they’re also able to receive money from grants, such as The Private School Aid program, and also A+PELs Grant and Scholarship Program. Finally, charitable donations by the local community organizations play a big part in funding things needed for the  schools. Also, public and private schools have different learning environments.Public schools are generally known to have a poor learning environment. One example being, they have a tendency to be virtually all one race dependent on  the communities’ location. Also, their learning atmospheres are generally not a safe and secure environment. Finally, there would be more of a chance of being around drugs and violence. Public school discipline procedures tend to be more lenient. Often many rules are broken and nothing is done to punish the rule breakers. On the other hand, private schools tend to have a better learning environment. They’re mostly chosen for the well being of the child. For example, having strict procedures allows the student to have a more independent means of achievement. Also, they tend to have more racial diversity and economic groups, which put a better clientele of students together. And finally, having these procedures allows the student to focus more on their studies, rather than having to worry about what another student will do to them. In conclusion, there are different funding and learning environments in public and private schools. However, it is still up to an individual to make the choice on where to go. Some parents may choose public schools, because financially that is all they can handle. On the contrary, some will choose private schooling simply based on its learning environment. The better environment a student has the better protection and knowledge it will receive.

Drink and Creative Writing Planning Essay

Sometimes people choose to try things for the first time because they want to or they like trying new things or they are forced to. It was the day I was always waiting for, my first ever 9th grade party. I was so thrilled that the person even invited me, only the ‘cool’ people were invited to huge parties and well let’s just say I was an ordinary girl. My friend Adriana and got ready at my place with excitement and off we went to experience our one life opportunity with the popular groups. I walked in the big huge giant building I started to have goose bumps all over my body, my heart started to race as fast as a rocket, I was so nervous. It was all dark and the music was so loud my ears felt as if I was on a plane and about to take off. Everyone was dancing, drinking and doing all sorts of things I only thought happened in movies. I looked on my right and there was Adriana with some guy sitting on his lap and drinking, she moved quit fast. I went over to check if she was okay. She said she was but she sure didn’t look okay. I was already starting to regret coming to this party. I didn’t fit with these people, I was with all the ‘popular’ people but I still felt like an outcast. Sitting in the corner alone, then a loud voice crawled into my ear â€Å"Hey, what are you doing sitting down alone? Come with me! † I had never seen this girl in my life, or maybe I have but she was just covered by the heavy make-up. The strange girl handed me a drink, and told me to drink it, it’s nothing. Mum warned me about this, not taking drinks from random people. I hesitated and told the girl I don’t want the drink. But she kept implying that I should just take a little bit and I was in the middle of all her friends and I didn’t want to be humiliated. I took my first sip of alcohol and then I saw myself dancing and making a complete full of myself. The room started to spin uncontrollably. I don’t remember half of the things I even did; it was like I was a different person. I look to my right and I see two people fighting and Adriana in the middle. I was so worried she was in trouble so I headed over there to help her. I was pushed and shoved around trying to get to Adriana and all I remember is some aggressive boy picking up a bottle and I was on the floor. All I could see was a blurred vision of Adriana screaming my name and it all went blank. That night would have to be the worst night of my life. One single drop of alcohol changed my whole night. I regret every single decision I made that night. I wish I can take it all back. Who would’ve thought the impossible could be possible.