Branding, Pricing and Distribution

The name of the company is JAL Global club. It is recognized to be an exclusive club that is committed to the JAL Group's most practiced and precious travelers. The product is termed to be very much effective just to carry upon business practices incessantly. The product of the company is providing effective lounges, baggages and quality treatment for the regular travelers. The domestic and global product branding strategy is termed to be very much effective just to make conditions highly well-versed and better than before. The club duly feels to maintain effective brand just to make clients informed regarding the same. This merely demands of looking forward for maintaining such brand image that offers a sense of satisfaction to the intended audience. The branding strategy is said to be highly effective and it supports the business to raise its effectiveness domestically and internationally. Most prominently, the aim, is just to offer best possible and well-versed products and services that are said to allure customers attention at its best possible manner. This would make sure that the business is growing and flourishing with due smoothness (Burrow, 2008). The pricing strategy so considered by the company is optimum and effective in nature. It primarily sees to it that the running conditions are supposed to be made highly supportive just to meet customer’s expectations. There stays great need to go for carrying upon business growth and progression hopefully. Pricing strategy so developed by the company is said to be very much effective just to make it in reach of the clients. Not only this, the customer’s attention needs to be made grabbed at its largest. It is surely going to influence the clients to have products and services at its best possible manner. The aim is just to go for seeing to it that the running conditions are supposed to be made managed and understood as well. All what is being demanded is just to carry upon business practices with proper effectiveness. The pricing strategy is affordable and carries effective and unique features that leads to make clients very much pleased and satisfied. The pricing strategy is said to support the branding strategy. This greater demands for seeing to it that the running conditions are expected to be made managed and hopeful. At the same time, the pricing strategy forms an effective coalition with the branding strategy. It is must go about locating far better opportunities just to make customers influenced. This tends to be very much effective just to execute business practices at its largest possible manner. This is surely going to help the organization maintain its presence in its highest possible way. Pricing strategy and branding are this much effective that attracts customer’s audience. It means a lot just to get allured towards customers with the help of offering them with unique and top-notch products. The running conditions are supposed to be made hopeful and understandable as well. The aim is just to go for carrying upon business growth and development incessantly. In this way, the customer’s attention can also be grabbed with proper effectiveness. It appears to be very much well-versed just to make sure that the business growth would be made out hopeful and better than before (Burrow, 2008). The distribution channel analysis is made out identifying the wholesaler, distributor, and retailer relationships including e-Commerce as well. All these altogether are termed to be very much effective just to make product’s accessibility very much more effective. The company is expected to go about assessing distributor’s relationships just to make customers feel good enough. The aim is just to go for seeing to it that the running conditions are expected to be made very much viable and successful. This tends to be very much effective just to execute business practices with due effectiveness. The wholesalers, distributors and retailer along with e-commerce is said to be very much successful. This tends to be very much successful just to make sure that the customer’s attention are grabbed accordingly. All what is being demanded is just to raise the growth and productivity levels. The running conditions are supposed to be made very much well-versed and supportive in approach. Not only this, the products would be made available to the customers with such well-versed channels. It is must to go for carrying upon business growth and development with due effectiveness (Lamb, 2011). A pull strategy will be used just to make out the high outlay on advertising and consumer promotion to fortify consumer demand for a respective product. This tends to be very much effective just to go for managing conditions with proper potential. The respective strategy would turn out to be very much effective just to obtain favorable outcomes. Not only this, the product so made accessible need to be very much successful. It is must to go for carrying upon business growth and progression with due effectiveness. All what is being demanded is just to run a business accordingly. The strategy is considered to be very much effective and supportive and leads to make things highly managed and understood. It is equally imperative to go for utilizing this strategy just to obtain hopeful resultants. The need of the hour states that the business growth and progression should be made out hopeful and better than before. It is being identified upon that the strategy so employed would offer with lucrative results. The distribution strategy fits the product / service, target market, and overall marketing strategy for the company. It is must go for making best possible use of distribution strategy just to better up business functions. The need is just to adopt such an effective strategy that gets fit with product, target market, and overall marketing strategy. All what is being demanded is just to make things highly managed and understood as well. With this, the company would be helped to meet customer’s expectations. The aim is just to go for making clients accessible with products, reaching target audience expectations and considering useful marketing strategy. The need of the hour states that the business growth and development should not be compromised at any cost. With this, it can also be stated that the distribution strategy need to be very much successful just to obtain far better resultants. It mainly calls for adopting effective steps just to make things managed and understood. The company is expected to understand the customer’s expectations with due effectiveness. All what is being demanded is just to realize far better resultants (Lamb, 2011). At the end, it can be stated that the marketing strategy should be very much effective just to help the business to generate effective results. It mainly calls for seeing to it that the running conditions need to be made highly managed and understood as well. It is must go for making business growing and flourishing with due effectiveness. The need is just to adopt such favorable steps that are considered to be highly effective and successful. In this way, it can also be stated that the business growth should not be compromised at any cost. It means a lot from the perspective of realizing far better resultants. With this, it can also be stated that the business growth should be made out successful.

Hotel Model Essay

The hotel model is where support staff do things for the people they look after and then become observers by not doing things for themselves. Active support is a way of ensuring people are able to engage and take part in their own support by having a person centred plan for them. Promoting Independence help the people I work with to regain or learn new skills to live there everyday life Informed Choice making sure the patient knows all the options that are available to them so they can make a choice of what they want to do  Valued life is the balance of activities that contribute to a good quality of life for the patients including domestic, personal, leisure, social actives and education Active support is a person centred model that is focused on the Individual and their needs it promotes independence by allowing the individual to do things for themselves, however small. Being independent doesn’t mean being completely on their own, but being Supported to do things for thems elves. It also gives them an informed choice the individual is given thorough information in order to make informed choices Themselves and valued life by giving them access to a good quality of life with all the different services and activities that are on offer The three elements in positive interaction that promote the individuals participation in an activity are naturally occurring reward (cup of tea they made for themselves) praise from staff and peers or getting to do an activity that they enjoy. I would speak to the patient and use visual aids and give them all the relevant information so they can make an informed choice. Highlight the potential risks and benefits and rehearsing the journey, where appropriate. I would make sure they have had their medication prior to the journey and that they take any medication they require with them for the journey they want to take. I would make a social story to explain what was going to happen and where we are going from leaving the unit to returning and ask the individual if this was ok. I would check the section 17 status for the patient, the seating plan for the vehicle and the patitais care plan for any new procedures the risks, dangers and difficulties associated with making journeys with the individual I work with, that they are wearing their seat belt. I would review the journey, with individuals, key people and others whether the journey met the planned outcomes and any changes that should be made for future journeys. I would ask the individual if they had a good time the things they liked about the trip the things they didn’t like and feed this back through the actives sheet for the trip. Fill out the activities sheet and the section 17 Leave form My assessor can see the forms I have completed. An individual’s participation represents the balance of activity associated with a valued life by joining in with the group, building social skills and friendships learning how to interact with peers and carers. Making choices for themselves, learning new skills, getting exercise and new domestic skills. Giving positive reinforcement through praise and rewards helps the individual to feel valued and part of the group

Nobody Is Perfect Essay

A man and his girlfriend got married in a large celebration. All of their friends and family came to see the lovely ceremony. The bride was gorgeous in her white wedding gown and the groom was very dashing in his black suit. Everyone could tell that the love they had for each other was true. A few months later, the wife comes to the husband with a proposal: â€Å"I read in a magazine, a while ago, about â€Å"How can we strengthen our marriage† she offered. Each of us will write a list of the things that we find a bit annoying with the other person. Then, we can talk about how we can fix them together and make our lives happier together.† The husband agreed, so each of them went to a separate room in the house and thought of the things that annoyed them about the other. They thought about this question for the rest of the day and wrote down what they came up with. The next morning, at the breakfast table, they decided that they would go over their lists. â€Å"I’ll start,† offered the wife. She took out her list. It had many items on it enough to fill 3 pages, in fact. As she started reading the list of the little annoyances, she noticed that tears were starting to appear in her husband’s eyes. â€Å"What’s wrong?†She asked. â€Å"Nothing† the husband replied, â€Å"keep reading your lists.† The wife continued to read until she had read all three pages to her husband. She neatly placed her list on the table and folded her hands over top of it. â€Å"Now, you read your list and then we’ll talk about the things on both of our lists.† She said happily. Quietly the husband stated, â€Å"I don’t have anything on my list. I think that you are perfect the way that you are. I don’t want you to change anything for me. You are lovely and wonderful and I wouldn’t want to try and change anything about you.† The wife, touched by his honesty and the depth of his love for her and his acceptance of her, turned her head and wept. LEARNING 1 In life, there are enough times when we are disappointed, depressed and annoyed. We don’t really have to go looking for them. We have a wonderful world that is full of beauty, light and promise. Why waste time in this world looking for the bad, disappointing or annoying when we can look around us, and see the amazing things before us?

Nonverbal communication questions Assignment Example | Topics and Well Written Essays - 750 words

Nonverbal communication questions - Assignment Example With respect to the tests and results to prove the linkage and correlation between verbal and non-verbal forms of communication, the authors reveal how these two separate forms were analyzed both side by side and apart from one another and then the results compared as a means of being able to infer what the true impacts of these can be. 8. These perceptions that are utilized, according to Knapp, include all of the human senses, and a great deal of emphasis upon the visual interpretation of nonverbal forms of communication. a) as such, naturally, designed, and manipulated environments in which such interactions and communications take place can have a profound level of impact with regards to the take-away information that an individual is able to glean. Due to the conflicting and differentiated cues that an individual would receive in each of these, the ultimate wording and intent could be identical in each of these three situations; however, the understanding could be entirely differ ent. b) Ultimately, influenced perception by setting up a false archectural construct as a means of focusing attention, the listeniner/viewer is able to distance themselves from some of the distractions that might otherwise capture their attenion at the scene. For this very reason, news crews and cameramen attempt to stage a scene so that the ultimate focus can be on the individual providing the information and not on the scene itself; unless otherwise warranted. 9. People tend to orient towards time as an environmental feature due to the fact that the changing rate of culture and understanding sets continual new precedents that must be engaged in a different way depending upon the time that is represented. Monochronic refers to only one â€Å"time† being represented at a single instance; whereas polychronic represents several times being represented. Likewise, Gonzales and Zimbardo referenced 7 different time zones dealing with the way in which individuals integrated with ne w information. Interestingly, even though these time zones can be understood as unique vantage points from dissimilar groups, a noted level of overlap was discovered with respect to the way that individual integrated with information. 10. Territoriality, personal space, and conversational sdistance, as well as seating arrangements and patterns, has to do with the geometry and actual geographic relationship that the speaker has to the audience. As such, these factors impact heavily upon the way in which information is understood and the rate at hwhich a level of comfort can be provided to the speaker/audience. 11. A sense of territoriality can vary and change depending upon the cultural makeup of the audience and/or the speaker. As such, a level of sensitivity to the unique needs and expecations of different groups is required prior to seeking to plan the way in which territoriality will be evidenced within a specific space. 12. Contextual factors such as a sense of fear or friendshi p, the overall level of perceived reception, and/or a litany of other factors impact upon the level and extent to which territoriality is perceived and a sense of threat or invitation is understood. 13. Seating arrangements

Critically discuss the legal relevance of the enlightened shareholder Assignment

Critically discuss the legal relevance of the enlightened shareholder concept - Assignment Example In 1998, there were several calls by various agencies and stakeholders for the UK company law to be reviewed as it was considered to be overly based on common law (Lowry and Dignam, 2006). This call was mainly led by the Department of Trade and Industry which put forward a proposal, which was later considered by the Company Law Review Steering Group (CLRSG). Going into parliament in November 2005 as the Company Law Reform Bill, there was a passage into what is now known as the Company Law Act 2006. Even though enshrined with several provisions and regulations, one aspect of the Company Law Act 2006 that has generated a lot of public, academic and professional debate and discourse is S 172 CA 2006, which touches on the duties of directors. Theoretically, S 172 CA 2006 has been said to promote what is now known as enlightened shareholder (Kraakman et al., 2009). This paper there seeks to critically discuss the legal relevance of the enlightened shareholder concept in relation to what u sed to exist before the S 172 CA 2006. The concept of enlightened shareholder became part of public, academic and business discourse starting from the passage of the Company Law Act 2006 (Lowry and Dignam, 2009). Since then, there have been various interpretations for the term. In a much generalised framework of discourse, the enlightened shareholder concept can be said to be an approach to corporate governance whereby the role and place of the shareholder has been redefined in a more elaborate and expanded manner (Sealy and Worthington, 2010). By the use of the term approach, reference is being made to the fact that the enlightened shareholder concept has become a way of corporate life which entails a set of conduct and actions that must be exhibited or put up to justify the execution of the concept (Micklethwait and Adrian, 2003). Most commonly, the enlightened shareholder concept is said to an expansion on

IT Essay Example | Topics and Well Written Essays - 500 words

IT - Essay Example According to Mintzberg (1999), they are â€Å"functional strategy, operational strategy, business strategy, dynamic strategy and corporative strategy. Strategic business unit is also included† (Mintzberg, 1999). Functional strategy in its turn includes strategic development of new products, marketing strategies, economic strategies, lawful principles, human resources and information technologies. Information technology can not only assist in reducing the number of mistakes usually made during the work with papers, it can also let workers save the time they spend on communication with customers (Schoemaker, 1993). This extra time appears because the procedures are held more effectively and professionally. Work with papers includes making corrections and some mistakes are usually left uncorrected that can cost much (Porter, 1996). The correct information technologies implementation is not an easy task in terms of the involvement of all company’s employees. Moreover, this process should be considered as a long- period leaning, where progress is made gradually, because in order to make the process effective all the employees should learn how to apply new methods. Furthermore, the appropriate use of the system needs understandable instructions and regular testing. Today more and more companies with different kinds of activity apply information technologies and face the task of its implementation. Some of them are already successfully using new opportunities these technologies provide, while in some areas, for example, healthcare area, information technology has not been fully implemented yet. We should hope that soon all the industries will use this opportunity to improve their activity, because information technology is valuable both for employees and the clients. According to Huber (1990), ‘information technologies should reduce centralization in decision making in centralized organizations and increase

Identify an up and coming or a new business, identify the strengths Research Paper

Identify an up and coming or a new business, identify the strengths and weaknesses or challenges, and your forecast of the company's success - Research Paper Example The business will gain from a corporation since all profits, losses and taxes are presented to the federal administration, and all the personnel as well as the owners file their individual income duties. The corporation can attract more financiers to the enterprise for development, and therefore, all losses, liabilities, and profits can be shared. Furthermore, lenders and vendors will award more prospects to a corporation. One of the limitations of the company is the double taxation since the owner has to pay taxes for the company as a distinct entity and the stockholders must file for the taxes too. This may prove tasking since the company has just been established and it is still trying to find its ground (Internal Revenue Services, par 3). Another challenge facing the company is keeping up with the marketplace since business settings change continually. The company must keep up with the market to meet its customers’ needs. The company can obtain information sources that afford insights on market trends and conditions (Internal Revenue Services, par 8). The other challenge is that the company does not have the right systems to delegate tasks and responsibilities. Financing the right systems such as quality control can improve the company’s productivity and convince clients that the firm can be trusted (Bizoffice par 2). Another challenge is welcoming change. Change can be overwhelming for a new company since change demands adequate resources and time, which the company may not have, and the company might not have the capacity to incorporate change (Internal Revenue Services, par 7). A change like personnel dismissal or changing suppliers can be dangerous for the business. Change demands coaching and developing personnel and being updated about the new technologies, which can be costly for a new company (Bizoffice par 3). The other challenge facing the company is the challenge of

Role of Police with Reference to Community Issues Essay

Role of Police with Reference to Community Issues - Essay Example Microsoft, Oracle, Satyam Computers, Tata Computer Services, and other educational institutions which have established their branches in the different countries do need man power, for which they need to provide necessary facilities. In this context, certain housing associations are pretty much indulged in the process of providing housing facilities. In such condition, where world meets world, different nationalities, race, colour, caste, community, it is inevitable that there would be certain issues arising every now and then. Therefore, it is necessary there should be certain policies developed by the housing association to combat such issues. In United Kingdom, Pennine Housing 2000 is one such association which provides shelter facilities on rent by complying with the regulations set up by the regulatory authority. Pennine Housing 2000 established in 2001 is Calderdale's largest and registered social landlord, managing the rented housing stock just over 11,000 properties.2 It states that the rents are kept low so that it is within the reach of everybody and standard of homes are constantly improving due to improvement programmes.3 The company has gained support and funding from Housing Corporation to continue to regenerate number of areas, replacing unpopular and rundown properties to newly built housing estates. During the Annual Tenants Conference, a tenant expressed that 99% of tenants view Peninne Housing 2000 with great respect as it is doing stupendous work while remaining 1% want more and much greater services.4 The company has always focused on meeting high standards for which over 112 million between 2001 to 2006 were spent on internal improvements, new central heating systems, and external works such as new doors, re-roofing etc. The company also promises tenancy rights of the tenan t through tenancy agreement. Pennine was recognized nationally within the social housing sector. At the National Housing Federation iNBiz Awards, it won the Best Leadership and the Employer of Choice categories - achievements which clearly place the company as a quality organisation. It also received Gold RoSPA award for Health & Safety and West Yorkshire NHS Modernisation Award for Healthy Living campaign amongst its staff. Pennine Housing being a well known housing company has its duties and responsibilities cut out. It has to provide all the facilities to its tenants as well as the society. It has the responsibility to see that their tenants are not the victims of social exclusion as there may be people of different communities and nationalities. It has to protect the rights and interest of every individual, so that he/she may not get deprived of the facilities to which he/she may be entitled. The company has also tackle issues like labeling where such acts turn an innocent, known to be good guy to some criminal. Such acts/ issues should be addressed and tackled with effective measures for the welfare of the society. And it is the responsibility of Pennine Housing 2000 to look after the buildings and have a vigilante look at all corners of the edifice and see that the repairs are done wherever necessary so that the locality does not turn into a prostitute's hub or crime yard. The company should take effective policing measures to tackle all such issues in the wake of providing decent and good

Trip to Oregon Essay Example | Topics and Well Written Essays - 500 words

Trip to Oregon - Essay Example I am exhausted.   The journey was quite an adventure passing through the Oregon Trail before settling here in Willamette Valley.   My parents chose to settle here because this is the most accessible part of Oregon where a series of trails can get anybody here.   The Oregon Trail we passed through is a 2,000 mile east to west route and I think the trail was made by the fur trappers.   The road was horrible especially during â€Å"spring when the melting snows and the up-heaving of the frost made mud† that buries the wheel of our carts. We traveled through the new invented mode of transport which is really a big cart called a wagon.   We passed through the Missouri River to the Valleys in Oregon but mostly dirt road.   Although it was more comfortable than riding horseback, the long travel was draining.   It took us a year by a wagon that I missed my 17th birthday because I was on the road with my parents on our way here.   I am going to make up that birthday wit h my debut this year.I am exhausted.   The journey was quite an adventure passing through the Oregon Trail before settling here in Willamette Valley.   My parents chose to settle here because this is the most accessible part of Oregon where a series of trails can get anybody here.   The Oregon Trail we passed through is a 2,000 mile east to west route and I think the trail was made by the fur trappers.   The road was horrible especially during â€Å"spring when the melting snows and the up-heaving of the frost made mud† that buries the wheel of our carts. We traveled through the new invented mode of transport which is really a big cart called a wagon.   We passed through the Missouri River to the Valleys in Oregon but mostly dirt road.   Although it was more comfortable than riding horseback, the long travel was draining.   It took us a year by a wagon that I missed my 17th birthday because I was on the road with my parents on our way here.   I am going to mak e up that birthday with my debut this year. Since the travel was anticipated to be long, we brought foods that can be stored to sustain us during the travel.   Among those we brought with us were dried meat, live poultry, potatoes, and beans.   I also brought furs and comfortable shirts because the weather can get extremely hot and extremely cold.  Ã‚   We met Indians along the road which was also traveling because of the enactment of the Indian Removal Act where they will be relocated. We also met other missionaries when we were near here but mostly, it was the natives who my parents intend to minister.  Ã‚  

Intern proposal memo Essay Example | Topics and Well Written Essays - 250 words

Intern proposal memo - Essay Example It is important to analyze such aspects since to access the level of entrepreneur skills among the audience. The sessions will also equip the interns with the necessary entrepreneur skills in addition to the ‘innate skills’ that they possess. Interns will be taken through a rigorous program and equip them with knowledge and skills on subjects such as non-verbal communication, attitude towards foreigners, politics and technology. When the interns possess these knowledge, I can state with a lot of conviction that any abroad travel will be success. In summary the following tasks will be done to ensure that the interns are more than competent before they travel to foreign countries for any responsibility that the company will require them to perform. The schedule of tasks to be incorporated in the Program include communication, technology, politics and attitude towards foreigners. This can be demonstrated by the following chart in terms of percentage of how each task is

Short Religion Films Essay Example | Topics and Well Written Essays - 500 words

Short Religion Films - Essay Example The solution to the Jews’ major problem of exile is storytelling and the law. For instance, the Jews have the creed and advocate for ‘Remember’, which is the law. In addition, the Jews have the Torah, which refers to the first five books of the Old Testament and the entire Hebrew prophetic books, which acts as the law. Therefore, some of the aspects of Judaism include following the law, ‘storytelling’ that implies to follow the commandments (Stephen, 2011). Christians believe that, the only way to separate ourselves from the stain of sin is through salvation. Stephen Prothero, believes that the only way to find this salvation is by our sins being taken away, through Jesus when he comes to the world in form of a human being; lives a sinless live, and dies on the cross consequently taking our sins into his body, person and soul. For instance, the Catholics say you need to be a good a person, have faith and trust in Jesus for you to go to heaven. Although the Protestants oppose the being a good person, they both, however, believe that having faith in Jesus can take you to heaven (Stephen, 2011). The major problem to Buddhism is suffering thus; they believe they can live in the world without suffering if they understand why they suffer, and the origin of suffering so that they can reverse it, which is called nirvana (blowing out suffering). For instance, Buddhism says that you can have religion without having a god because they believe that having a god will make them no better, less in pain or sorrowful. Some of the aspects of Buddhism are that, Buddhists do not care about a god; they meditate, they believe suffering has an origin and can be reversed, hence leading them to nirvana (Stephen, 2011). The solution to the central problem of Confucianism’s lack of care, social order and the belief that society is falling is apart, is ritual, etiquette, virtual ethics and being kind to one another. For instance, there is

Importance of Time in Chinese Culture Essay Example for Free

Importance of Time in Chinese Culture Essay The importance of time is always dependent on the different perspectives of people’s origin, particularly culture. â€Å"Time is one of the most important bases by which culture rests and all other activities revolve† (Riggs et al 31). Different cultures handle time differently. In the past, time was measured in daylight, darkness, or in seasons; however, nowadays, time has become more important and more complicated. Yet, no matter how complicated it has become, it always boils down to the influence of culture, just like China, one of the countries with a very rich culture. The impact of modernization in China on the changes of Chinese’ behavior is significant. However, these changes in their behavior have had a more significant impact on their values. Indeed, Chinese seem to have never given up one of their most important cultural characteristics, Guanxi, which up until now, remains as an important Chinese business element. In the advent of globalization, Chinese has kept and reinforced this unique characteristic even in the most important socio-cultural changes. Yes, China has indeed undergone substantial cultural changes; nonetheless, with regards to the thinking and dealing process, modern China remains rooted to its traditional Yin Yang approach, and this is reflected on their shrewd use of time to keep their relationship intact. Because Chinese people value relationship more than anything else, as they believe that this could lead them to success, it is logical to expect that the Chinese society concentrates on fluid/multi-focus time value. Chinese people are both famous and infamous in different negotiations for their wise use of time as their bargaining tool. Chinese are known to have adept ability to run down the clock because they prioritize their relationships with their associates or business partners first. This way, they know that the value of relationship or guanxi continues. Moreover, Chinese can afford or stand to play the waiting game, provided that there is always someone left to invest and spend for them. Cultures around the world have developed their own way of responding to time. The dimension for time orientation is based on two aspects; the relative significance the culture gives to its past, present, and future, and its way of approaching the time. China has indeed embraced globalization since the last three decades. Despite this, its stronghold to its culture is still very evident. This is because China is considered as a past-oriented culture country. Countries that fall under this category have a culture that is largely leaned towards the past; they see their future as a repetition of their past experiences. Moreover, they have high respect and regard for their collective historical experiences and their ancestors. As per David Thomas’ description of the country, China embraces its tradition and culture of ancestor worship and has strong pride of its customary and cultural persistence for over thousands of years (73). The Chinese society holds the perspective that their past is their guide on how to live their lives in the present. According to an old Chinese proverb, â€Å"Consider the past and you will know the present† (Quotations). Work Cited Riggs, James, et al. Industrial Organization and Management. Manila, Philippines: McGraw-Hill, Inc. , 1980. Lo, Vincent. Chinese Business Culture: Guanxi, An Important Chinese Business Element. 17 March 2005. 01 May 2009 http://chinese-school. netfirms. com/guanxi. html Thomas, David. Cross-Cultural Management: Essential Concepts Second Ed. California: Sage Publications. 2008. Quotations. 14 February 2008. 01 May 2009. http://www1. bbiq. jp/quotations/past. htm

Congestive Cardiac Failure Case Study

Congestive Cardiac Failure Case Study Mr. Sam Toscana is a 70 year old client admitted to the ward with congestive cardiac failure (CCF). The client states that he has had increasing SOB over the last 3 days and his feet are as swollen as he cannot put his shoes on. The cardiologist saw him this morning and he admitted for management of his CCF. The client states he has had a fluid problem on and off for the last five year. History Age: 70 Allergies: NKA Ht: 165 cm WT: 75 kg Next of kin: Wife Maria Children: 1 daughter Mr. Toscana lives with his wife in the family home; they have lived there for 40 years. His daughters house is near by and she is very helpful and takes him and his wife to appointments. However she has 3 children at school that keep her very busy. They remain very sociable attending the local Italian club. He was diagnosed with CCF 10 years ago. Past History AF, Hypercholesterolemia, CCF, CABGs 10 years ago, ex-smoker, positive coronary artery disease family history. Medical Management The following about medications were told by Mr. Toscana: Lasix is not taken when they go outings organized by the Italian club. Digoxin is taken one in the morning (blue pills). Aspirin is taken in the morning with water. Warfarin is taken in the night and blood test is getting every couple of days. Perindopril is taken one in the morning for his heart. Observations on admission BP 95/50, AF pulse irregular 80, SaO2 93% on room air, Temp 36.9, R Rate 22 bpm, Crackles noted in the right lung base. This essay will explain the pathophysiology of presenting condition of Mr. Toscana. Secondly, this paper will explain what nursing assessment will be performed on Mr. Toscana and justify the framework for assessment chosen. Thirdly, education and psychosocial support will be offered on Mr. Toscana will be described with justifying. In addition, nursing care plan for Mr. Toscana with two short term and two long term goals including nursing interventions, rationales, and evaluations will be provided. Furthermore, diagnostic tests that will assist with the assessment and management of Mr. Toscana will be investigated. Moreover, this essay will perform a risk assessment on the client drawing on the information provided. Lastly, two of the medications Mr. Toscana is taking will be discussed and including action, use (as discuss why this client been prescribed this medication), relevant interaction, three adverse effects, and three nursing points or precautions. Pathophysiology of the presenting condition of Mr. Toscana Heart failure is defined as a condition that results from some abnormality in myocardial function. The abnormality, whatever the cause, results in the inability of the heart to deliver enough oxygenated blood to meet the metabolic needs of the body. When the right and left ventricles fail as pumps, pulmonary and systemic venous hypertension ensue, resulting in the syndrome of congestive heart failure (Fletcher Thomas 2001). Dyspnoea or shortness of breath, orthopnoea and pulmonary crackles are signs and symptoms of pulmonary edema and pleural effusion when left ventricular in the heart failure. There are two major consequences occur when the left ventricle is unable to pump enough blood to meet the bodys demands: signs and symptoms of decreased cardiac output and pulmonary congestion. Increased pressure in the left side of the heart backs up into the pulmonary system, and the lungs become congested with fluid. Fluid leaks through the engorged capillaries and permeates air spaces in lung (Christensen Kockrow 2011). According to Christensen and Kockrow (2011) edema appears in the body as right ventricular failure. Right ventricular failure occurs when the right ventricle in unable to pump effectively against increased pressure in the pulmonary circulation. The right ventricles inability to pump blood forward into the lungs results in peripheral congestion and an inability to accommodate all the venous blood that is normally returned to the right side of the heart. Venous blood in reflected backward into the systemic circulation. Increased venous volume and pressure force fluid out of the vasculature into interstitial tissue or peripheral edema. Nursing assessment with justifying Christensen and Kockrow (2011) state that subjective data to assess Mr. Toscana include complaints of dyspnea, orthopnea or sudden awakening from sleep because shortness of breath (paroxysmal nocturnal dyspnea), and cough. Besides that, fatigue, anxiety, weight gain from fluid retention, and edema may be reported by patient. In addition, any pain such as angina or abdominal and the patients stated ability to perform activity of daily living needs to be documented. Collection of objective date includes noting presence of respiratory distress, the number of pillows required to breath comfortably while attempting to rest (orthopnea), edema (site, degree of pitting), abdominal distension secondary to ascites, weight gain, adventitious breath sounds, abnormal heart sounds such as gallop and murmurs, activity intolerance, and jugular vein distension. Blood flow to the kidneys is diminished, resulting in oliguria. Oxygen deficit in tissues results in cyanosis and general debilitation (Christensen Kockrow 2011). Education and psychosocial support with justifying According to Washburn and Hornberger (2008) heart failure is a complex, chronic illness often requiring major lifestyle modifications for patients and their families. Nurses play a key role in educating and counseling patients and their families about these changes. Education should be provided to patients about symptom and weight management, dietary and exercise recommendations, and medications. Patient should be taught the signs and symptoms of worsening congestive cardiac failure such as increased dyspnea, development or worsening of orthopnea, weight gain, and exercise intolerance or inability to perform the normal activities of daily living without increased fatigue (Fletcher Thomas 2001). The research shows that up to more than fifty percent of hospital admissions are due to noncompliance with both pharmacologic and non-pharmacologic treatment regimes. Non-pharmacologic therapies include a no added salt diet, which constitutes about two three grams of salt per day. Patients should be instructed to avoid foods containing large amounts of sodium, such as highly processed foods, canned foods, and luncheon meats. A nutrition consult is helpful especially if patient is overweight. Some patients may need to have their daily fluid restricted to 1.5-2.0 liters per day. This is a clinical judgment based on signs of congestion, fluid over load and weight gain. Patients should be instructed to weigh themselves daily or every other day and record the data in a log, which should be taken to every visit with the clinician. A weight gain of two to three pounds should trigger a visit to the clinician. All patients with CCF should be encouraged to exercise to improve overall physical conditioning. The established standard for assessment of physical capacity is an exercise test, which provides objective data regarding exercise time, distance, peak workload, and oxygen consumption (Fletcher Thomas 2001). Washburn and Hornberger (2008) state that it is importance for nurses providing education to patients with heart failure to have an understanding of the drugs used in the management of heart failure. So patient should be taught the name of each drug and its purpose, dosage, frequency, and significant side effects. Patients should be advised to bring all prescriptive and non-prescriptive medications to office visits for review and assessment of patients understanding of them. Nursing diagnoses include interventions, rationale, and evaluations for two short term and two long term goals (use the nursing care plan template) In Mr. Toscana situation, excess fluid volume is the first nursing short term diagnosis as edema, dyspnoea on exertion, and weight gain. The expected outcome for Mr. Toscana is fluid balance. Fluid balance can be demonstrated as peripheral pulses palpable, peripheral edema not present, orthostatic hypotension not present, skin hydration, and body weight stable. To achieve this expected outcome, patient should be weighted daily and monitor trends to monitor fluid retention and weight reduction. Serum electrolyte levels and therapeutic effect of diuretic are monitored to assess as a response to treatment. In addition, respiratory pattern is monitored for symptoms of respiratory difficulty for early recognition of pulmonary congestion. Moreover, fluid balance is monitored by monitoring renal function and intake and output (Brown et al. 2008). The second short term nursing diagnosis is impaired gas exchange as manifested by increased respiratory rate, dyspnoea on exertion and Mr. Toscana states that he has had increasing shortness of breath over the last three days. The evaluation for this diagnosis expects patient breathe easily, dyspnoea with exertion not present, oxygen saturation and respiration rate are in normal range limit. Nursing interventions include respiratory monitoring, oxygen therapy, and positioning. To monitor respiratory, auscultative breath sound, noting areas of decreased or absent ventilation and presence of adventitious sounds, to assess congestion. Dyspnoea and events that improve worsen it are also monitored to detect events that can influence activities daily living. Oxygen therapy such as administer supplemental oxygen as ordered to maintain oxygen levels and change oxygen delivery device from mask to nasal prongs during meals as tolerated sustain oxygen levels while doing activities daily living (Brown et al. 2008). Besides short term diagnosis, Mr. Toscana may be faced with long term effecting due to congestive cardiac failure. Disturbed sleep pattern and deficient knowledge are considered as Mr. Toscana long term diagnosis. Disturbed sleep pattern related to nocturnal dyspnoes, unable to assume favored sleep position, nocturia and manifested by inability to sleep during the night. There are six interventions for this diagnosis. First, determine patients sleep or activity pattern to establish routine. Secondly, patient is encouraged to establish a bedtime routine to facilitate transition from wakefulness to sleep in order to establish a pattern and decrease number of waking periods. Thirdly, adjust environment to promote sleep. Fourthly, regulate environmental stimuli to maintain normal day-night cycles to help promote sleep cycle. Fifthly, adjust medication administration schedule to support patients sleep cycle. Lastly, monitor patients sleep pattern and number of sleep hours to determine hou rs of sleep. Expected outcomes of those nursing interventions are uninterrupted sleep, increase hours of sleep, feelings of rejuvenation after sleep, and vital sign in expected range (Brown et al. 2008). According to Brown et al. (2008) deficient knowledge related to disease process as Mr. Toscana states that he has had a fluid problem frequently come and gone for the last year. Patient expects to descript of disease process, descript of signs and symptoms of complications, and descript of precautions to prevent complications after been educated. Patients current level knowledge related to heart failure is assessed to demonstrate areas of teaching needed. Describe common signs and symptoms of heart failure so patient will know signs and symptom of worsening heart failure. Patient is instructed on measures to prevent or minimize side effects of treatment for the disease as patient may be able to decrease number of acute episodes of heart failure. Family member or significant others encourage to include in teaching to provide support for the patient. (Would like to see the N Diagnostic tests that will assist with the assessment and management of Mr. Toscana According to Christensen and Kockrow (2011) the most noninvasive diagnostic tool for evaluating a patient with heart failure is an echocardiogram. Echocardiography is done to determine valvular heart disease, presence of pericardial fluid, heart failure as the percentage of end diastolic blood volume ejected during systole, and ejection fraction. Secondly, a chest radiograph reveals pulmonary vascular congestion, pleural effusion, and cardiac enlargement. Thirdly, ECG reveals cardiac dysrhythmias. Moreover, pulmonary artery catheterization is done to assess right and left ventricular function. Exercise stress testing is also done to determine activity tolerance and severity of underlying ischemic cardiovascular disease. In addition, laboratory tests include electrolytes, sodium, calcium, magnesium, and potassium levels will assist with the assessment and management of Mr. Toscana. Blood chemistry will reveal elevated blood urea nitrogen and creatinine resulting from decreased glomerular filtration; liver function values will be mildly elevated. BNP, a neurohormone secreted by the heart in response to expansion of ventricular volume and pressure over load, is useful in monitoring chronic heart failure (Christensen Kockrow 2011). Perform a risk assessment on the client drawing on the information provided (examples of risk assessment tools that would be appropriate) Firstly, since depression was a significant predictor of fatigue in congestive heart failure patients, fatigue patterns should be closely monitored. Congestive heart failure patients mood should be monitored for obvious disturbance, and if necessary, they should be referred to mental health or psychiatric practitioners for further assessment and proper treatment (Tang, Yu Yeh 2010). Secondly, according to Brown et al. (2008) nocturia is one of a risk assessment should be performed on Mr. Toscana. A person with chronic heart failure will have impaired renal perfusion and decreased urinary output during the day. However, when the person lies down at night, fluid movement from interstitial spaces back into the circulatory system is enhance. This cause increased renal blood flow and diuresis. The patient may complain of having to void six or seven times during the night. Thirdly, because the tissue capillary oxygen extraction is increased in a person with chronic heart failure, the skin may appear dusky. It may also be cool to the touch from diaphoresis. Often the lower extremities are shiny any swollen, with diminished or absent hair growth. Chronic swelling may result in pigment changes, causing the skin to appear brown or brawny in areas covering the ankles and lower legs (Brown et al. 2008). Discuss two of the medications Mr. Toscana is taking Lasix or Frusemide is one of high-ceiling (loop) diuretics medication. Action of this group is potent diuretics that inhibit sodium, potassium and chloride re-absorption in the proximal and distal renal convoluted tubules, but mainly in the ascending limb of the loop of Henle, resulting in increased water excretion. Frusemide is effective within one hour by oral, peak one to two hours, and duration on six to eight hours (Tiziani 2006). According to Pharmaceutical Society of Australia (2010) one of indications of Frusemide is oedema associated with heart failure and it is reason why Mr. Toscana has been prescribed this medication. Pharmaceutical Society of Australia (2010) shows that non steroid anti -inflammatory drugs (NSAIDs) reduce renal function and may reduce diuretic effect and increase risk of nephrotoxicity. However, low dose aspirin is unlikely to be a problem. The combination of loop diuretics and ACE inhibitors (Perindopril) may increase the risk of ACE inhibitor-induced renal impairment, so renal function should be monitored closely (Pharmaceutical Society of Australia 2010). The first adverse effect of Lasix is fluid and electrolyte disturbances. Secondly, hypovolaemia and dehydration should be considered. The third adverse effect is postural hypotension (Tiziani 2006). Christensen and Kockrow (2011) argue that when patient is prescribed loop diuretic such as Lasix, it should be administered in the morning to prevent nocturia. The second of nursing interventions is monitoring for electrolyte depletion. Thirdly, sulfa allergy is encouraged to consider. Perindopril (Angiotensin-converting enzyme inhibitors) is indicated for heart failure due to Mr. Toscanas situation. ACE inhibitors block conversion of angiotensin I to angiotensin II and also inhibit the breakdown of bradykinin. They reduce the effects of angiotensin II-induced vasoconstriction, sodium retention and aldosterone release. They also reduce the effect of angiotensin on sympathetic nervous activity and as a growth factor (Pharmaceutical Society of Australia 2010). Common adverse effects of ACE inhibitors are hypotension, cough, hyperkalaemia, headache, dizziness, fatigue, nausea and renal impairment (Pharmaceutical Society of Australia 2010). Following Mr. Toscana case, the first nursing point or caution of Perindopril is nurses need to know that heart failure is usually treated with a diuretic and digoxin in associated with ACE inhibitor. Secondly, patient is advised that a low salt diet may be beneficial in reducing blood pressure. However, potassium containing salt substitutes are not recommended because of the increased risk of hyperkalaemia. Thirdly, for patient with congestive heart failure, blood pressure and renal function should be monitored before starting and regularly during therapy (Tiziani 2006). Congestive Cardiac Failure Case Study Congestive Cardiac Failure Case Study Congestive cardiac failure or congestive heart failure can be defined as the inability of the heart muscles to pump enough blood to all parts of the body, for example brain, liver and kidneys. Heart failure can develop slowly over time as the result of other conditions (such as high blood pressure and coronary artery disease) that weaken the heart. It can also occur suddenly as the result of damage to the heart muscle.(university of Maryland medical center 2014) Congestive heart failure affects several organs in our bodies and it includes, heart, kidneys, lungs, brain, liver, skin and spleen. Then organ systems that are affected are, cardiovascular system, respiratory system, nervous system, circulatory system skeletal system, and urinary system A brief overview of the normal functioning of the affected body systems. one of the body systems that is affected with congestive heart failure is the cardiovascular system, this system consists of heart, blood vessels and blood. Its responsible for pumping blood through the body as well as oxygen, nutrient, hormones and cellular waste. It regulates blood pressure through the contraction of the heart pumping and also helps to maintain fluid balance within the body. The main function of respiratory system is to supply blood rich in oxygen to all parts of the body. The respiratory system does this through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide. This exchange of gases usually takes place in the alveoli and the capillaries. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same path out of the lungs when you exhale. The circulatory system has its main functions as to pump blood containing oxygen and other nutrients around the body. the system consists of the heart, arteries, capillaries and veins. The heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system, the circulatory system contains of two loops of circulatory, the pulmonary circulation which transports de-oxygenated blood from the right atrium and right ventricle to the lungs to pick up oxygen and nutrients and returns to the left side of the heart. The systemic circulatory which transports blood rich in oxygen from left side of the body and transports it all the body tissues. The circulatory system control the pressure of the blood as it travels through the body and taking away the wastes The urinary system consists of the kidneys, bladder, ureters and urethra. its main function is to filter metabolic wastes, excess ions, and chemicals from the blood to form urine. They also maintain the homeostasis of several important internal conditions by controlling the excretion of substances out of the body.through this it regulates the blood pressure. After the whole process of urine formation is completed the ureters carry urine to the urinary bladder and later discharged in the urethra. The nervous system consists of brain, spinal cord, sensory organs, and all of the nerves that connect these organs with the rest of the body. Together, these organs are responsible for the control of the body and communication among its parts. Neurons transmit information through electrical signals to the brain. chemical help to bridge gap between one neuron and the other. there are several signs and symptoms of heart failure and they are discussed here below: Shortness of breath. This is one of the signs and symptoms of heart failure, this happens due to the back up of blood in the pulmonary veins which leads fluid to leak and build up in the lungs because the heart cant keep up with the supply. Tiredness or fatigue. This happens because the heart cant keep up with the demand of supply of blood to all the body tissues so u feel tired because its being overworked. Edema. There build up of excess fluids in the body parts because the heart cant pump all the blood as a result there is the excess build up of fluids. there is slow cardiac output. Persistent coughing or wheezing due to the build up fluids in the lungs as a result of heart not pumping all the blood out of the lungs. Lack of appetite , nausea this occurs because there is less cardiac out as a result less blood reaches the digestive system which cause problems with the digestion process. Confusion. This is one of the symptoms and the reason behind is because there is less cardiac out the nutrients also is less and not enough for the body tissues, which will lead to less nutrients like sodium which will lead to someone having confusions and impaired thinking. Tachycardia. This is one of the signs and symptoms of heart failure. The increased heart rate is due to the heart pumping harder to meet the demands of supply of blood and nutrients to the rest of the body which is not enough.(American heart association 2014) sudden weight gain from fluid retention. Chest pain if the heart failure is caused by heart attack. Elevated blood pressure due to tachycardia as a result heart trying to pump more blood to other parts of the body. When critically analysing Mr wrights admission form it clearly indicates signs and symptoms of congestive cardiac failure. his circulation is not okay because he suffers from peripheral vascular disease which it can easily contribute to heart failure. secondly considering the loss of appetite which can be attributed to low blood supply to the digestive system. Checking his oxygen saturation levels which are low due to the heart failing to pump lots of blood out of the lungs which can lead to leak of fluids in the lungs. another sign is the confusion. Despite him having dementia but have low cardiac out supply to the rest of the body tissues can lead to confusion which is also a sign of heart failure. Well diabetes might be related to his leg ulcer considering the fact that patients who are diabetic at a certain stage they may have reduced sensation of the skin on there feet. They are nerve endings on the skin usually fails to detect any pain or sensation and as a result it can be a high risk of leg ulcer if the patient has a cut or blister on the feet it can easily develop to leg ulcer which can if its serious it may lead to amputation. for his case it might have played a role. In patients who are diabetic there might be poor circulation of blood to the feet which might be a contributing factor to his leg ulcer and finally the amputation of the left toe. Lasix (furosemide) is a diuretic (water pill) that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine(drug14).if you got excess fluids it helps to reduce them. it treats fluid retention in people with congestive heart failure, kidney problems and liver diseases. He is given the drug in order to get rid of the excess fluids retention. the systems affected by this drug re cardiovascular and urinary system. Conditions that are commonly associated with aging according to Mr wrights relevant medical history. Arthritis the inflammation of the joints, and creates pain and stiffness when moving these joints. Osteoarthritis is the most common in the elderly. when cartilage is damaged or worn out the bone rub on each other causing friction which causes pain when moving the joints. diabetes mostly type 2 which affects the older people though young people Can also develop it. The risk of developing type 2 diabetes increase with age mostly over 55 years of age. Its where the pancreas produces insulin but its not sufficient enough to work effectively. Glaucoma is an eye diseases that results to blindness in the elderly especially over 80 years. Its a group of eye disease in which the optic nerve at the back of the eye is slowly destroyed. Poor blood supply to the vital optic nerve can lead to glaucoma.(glaucoma2014) Factors that may impact his safety whilst in hospital and when he returns home. Checking through his admission history and assessment increased level of confusion can be one of the factors that can impact his safety. He fails to remember because the low blood supply and low oxygen levels in the body which fail to supply enough to the brain and as a result this will lead to increased levels of confusion. He may not remember why he is in hospital, he may forget to take his medications as prescribed the correct dose at the right time and this is likely to occur when he is at home. Mr. Wright is receiving meals on wheels while he is at home, because of his loss of appetite as a result of congestive heart failure he may not take his meals and he can be at a risk of being malnutrition, which will eventually lead to a high falls risk because he will not have the strength and energy to walk. From the assessment it seemed he cared for his dog and as a result of being hospitalised he his anxious about the dog which can lay an impact on his safety. He is not settled at all and it may increase risk of more complicated health problems considering he has congestive heart failure. he worries a lot about the dog wondering who is going to care for it yet he is not well. While he is at home because of the level of consciousness which at time deteriorate he might just forget to walk with the walking stick at all times and combine with the nutritional problems he might be of high falls risk. Because he got glaucoma this might also play a role considering his safety back at home which can have a huge impact on hi mobility. Other health professionals that can be involved in Mr Wrights can and what services they can provide Dietician because he is diabetic and has lost appetite, the dietician would assess and provide the best solution to help improve his appetite. Physiotherapist would also be involved in Mr wrights care to assesses the mobility levels and recommend the best way of care he needs as fur as mobility is concerned. he would check if he is a high or low falls risk and provide the best tool to aid mobility. Optometrist would also be involved in his care, he would assess the level of glaucoma and check if its worsening or getting better and the likely impacts it can have on his levels of mobility. From the medical history he has dysphagia the speech pathologist will be involved to assess his level of swallowing if the problem is worsening or it has improved and make necessary recommendations so that when he goes home the meals on wheels can supply him with the recommended type of food that he can tolerate. An occupational therapist would also be involved in his care he or she will come in handy to assess the hazard at home and all the id tools that he requires in order to reduce any risk of injuries occurring at home. For example He may assess and recommend commode at night to avoid the walking to the toilet at night in order to reduce the risk of falling. A social worker will also be involved in his care considering he is at home alone with his dog, he might need home visits where the social worker will check how he is coping in the community and assess if he is socially isolated or he gets involved in the society, if family and friends visit him at all. The nursing documentation expected to be used in the care of MR. Wright are as followed. Admission form and passed medical history form. medications chart nursing care plan. progress notes allied health chart, ECG charts, observation charts fluid balance chart and bowel chart. References University of Maryland Medical Center 2014 viewed 18th sept 2013 http://umm.edu/health/medical/reports/articles/heart-failure#ixzz3CXXtD2EZ Virtual medical center 2014 last reviewed 7th may 2010 respiratory system http://www.myvmc.com/anatomy/respiratory-system/ Cardiovascular system the inner body last viewed 2013 http://www.innerbody.com/image/cardov.html Urinary system the inner body last viewed 2013, http://www.innerbody.com/image/urinov.html#full-description Nervous system the inner body last viewed 2013 http://www.innerbody.com/image/nervov.html#full-description American heart association (2014) warning-Signs-for-Heart-Failure last reviewed 20/8/2012 http://www.heart.org. Australia, Diabetes. (2014, January 6). Diabetes and Your Feet. Retrieved from Australia Diabetes: https://www.diabetesaustralia.com.au/Living-with-Diabetes/MindBody/DiabetesYour-Feet/ Drugs.com. (2014). Retrieved from Lasix: http://www.drugs.com/lasix.html Australian institute of health and well being (2013)osteoarthritis http://www.aihw.gov.au/osteoarthritis/ Gabrielle K, Kate S and Jodie H (2013)theory and practice Tabbners nursing care 6th edition. Glaucoma Australia (2014)Retrieved from Glaucoma http://www.glaucoma.org.au/what.html. The human heart circulatory system:(2014)retrieved from Franklin institute: http://learn.fi.edu/learn/heart/systems/circulation.html

Public Health Reflection on Care

Public Health Reflection on Care Title: Reflect upon an incident which occurred during your clinical placement as a student Public Health Nurse. The chosen incident is one where you met an elderly client with a leg ulcer who was not complying with the treatment prescribed from hospital. This essay is a reflective consideration of a case that had been encountered in clinical practice. For the purposes of illustrative discussion, I shall use the Gibbs model of reflection as a guide. (Gibbs, G 1988) Description: describe in c.400 words the experience. Client fell at home and fractured lower ankle. He neglected this and developed ulcer. He attended GP and completed 2 courses of antibiotics: referred to leg ulcer clinic in local hospital; diagnosis was ulcer with mixed arterial / venous disease. The client concerned will be anonymised and referred to as Mr.S in accordance with the NMC guidelines (NMC 2004). Mr.S is a 68 yr old man who lives alone having been widowed for 12 years. He is normally self caring but has been getting progressively more frail as time goes by. He fell at home and fractured his lower tibia. There was a suspicion that he has been drinking rather more than might be considered good for him and it is possible that this fall was after a bout of drinking. (Nicol M et al. 2004). Being generally very stoical, he initially ignored this but was forced to seek medical advice when the pain got too great. The fracture was treated with a plaster cylinder after reduction of the fracture but he subsequently developed a leg ulcer from direct pressure and friction from the cylinder which eventually attained a size of about 10 15 cms across and, despite being referred to the leg ulcer clinic and having regular visits from the community nurse who applied Aquacell AG , it refused to heal. (Harding K G et al. 2002) It was subsequently discovered that after the nurses had been to clean and dress the leg, Mr.S would take the dressings off and put iodine onto the wound which produced a marked allergic reaction. When challenged about this he said that he â€Å"didn’t hold with these newfangled ideas† and that he wanted to use a remedy that his grandmother had used with great success when she had developed a leg ulcer. Initially there was an impasse with the nurses wanting to use the dressings that had been prescribed by the hospital and Mr.S, although allowing them to be out on, would promptly disturb them and put the iodine directly onto the wound. The community nurses were asked to persist with the dressing regime and after a few weeks it became clear that the leg ulcer was making no progress at all. It was not healing, it was permanently infected and persistently sore with inflamed and macerated wound edges. (Donnelly A et al. 2000). There was considerable discussion in the primary healthcare team relating to Mr.S’s right to autonomy (Seedhouse D 1998) and whether it was right or not to continue to commit large amounts of resources to a clinical situation that was not only not healing but was actually being actively undermined and made worse by the patient. (Thomas J E et al. 1990). To an extent, it is not ethical to insist on, or to impose a treatment which the patient is (by word or action) objecting to. It is difficult to justify a course of therapeutic action, which may have the strongest of evidence bases, if the patient does not want it. (Hunt T 1994) The situation was compounded by the fact that Mr.S was not an easy patient to deal with as, since his wife died, he had become progressively more reclusive and he was clearly uneasy with other people coming into his house. The current course of treatment was clearly not successful and therefore a completely different approach needed to be tried. Feelings: how did client/you/others feel in this situation? How did you know this? The student was annoyed that the client was not complying with treatment and she knew the treatment he was applying was outdated and potentially harmful. Student is accountable to An Bord Altranais for their practice and must refer to evidence based practice. Student observed how the treatment applied by client had its place in the past and PHN made family aware that new dressings have silver content which has greatly improved results. Empowerment and advocacy were adopted. I found my feelings ran through an evolution of emotions and that the initial set of feelings were of annoyance, frustration and irritation that Mr.S could not see that the healthcare professionals were trying to help him. I initially saw him as a rude and aggressive gentleman who clearly did not want â€Å"interference† from the nurses and was content to live in comparative squalor. His persistence of the use of the iodine seemed to me to be mainly due to sheer perversity rather than any rational reasoning. (Osterberg L et al. 2005) I know that my original exchanges with him were very terse and aggressive, as I could not understand why he was persisting in using something which had no substantive evidence base and was clearly making the situation worse. My feelings changed to being less overtly annoyed as I came to realise that Mr.S was actually trying to use something that he had seen his grandmother use to heal her own leg ulcer and that there was a degree of reason beneath his obstinacy. My mentor took a different view and explained that empowerment and education (Howe J et al. 2003) was the way to achieve success with Mr.S and I watched as she firstly gained his confidence and then explained the reasoning behind the new Aquacell AG, she also explained that the iodine, far from helping healing was, in his particular case, preventing the leg ulcer from healing and that his situation was quite different from the situation of his grandmother‘s ulcer. (Miller, A. 1995). After about three sessions, it was noted that Mr.S had stopped interfering with the dressings and that the iodine was no longer being applied. As a result, the wound started to heal. As soon as he saw this, Mr.S became much more content to allow the nurses to continue with their work and actually became almost welcoming. (Faden, R R et al. 1986). At this stage, I found that my feelings changed to actually liking Mr.S and looking forward to each meeting. I also developed a great deal of respect for m y mentor and the other important realisation was a feeling of annoyance towards myself at my own initial inability to realise the motivation behind Mr.S’s actions. (Schon, D. 1997) Evaluation: what was good and bad about the situation? Mentor was able to develop relationship of trust with client. The bad elements of the situation was that the concept of empowerment and education (Howe J et al. 2003), was not embraced earlier in the treatment programme and that each treatment application was simply met by the acceptance that Mr.S was interfering with the dressings. There was the additional possibility that Mr.S was drinking more than was good for him and this element of the situation was overlooked with the prime focus being on the leg ulcer rather than making a holistic assessment of the whole situation. Equally bad was my inexperience-based lack of insight into the situation. On the good side, the fact that the mentor was able to â€Å"stand back† from the situation and make a dispassionate and empathetic assessment of the situation, construct an appropriate managements plan and then persuade Mr.S to comply with it to achieve a good clinical outcome, was a very positive step and a testament to the clinical experience of the mentor. Analysis: what sense can you make of the situation? what knowledge did or should have informed you? how does this connect with previous experiences? Reflection is necessary to enlighten a clinical situation. Element of compromise needed. Client centred approach required. Student PHN had experience of working as Community General Nurse. She found observing how the mentor dealt with the situation very enlightening. Discussion with clients family was beneficial. Analysis of the situation shows the potential gulf between the pursuit of evidence based medicine and the practical difficulties in actually applying it. It is all very well knowing that Aquacell AG releases ionic silver into the wound in a delayed and controlled release manner as the wound exudate is absorbed, thereby releasing more silver in the most contaminated wounds. ( Bowler P G, 2003). The fact that the dressing formulation itself is thought to protect the periwound skin and thereby aid in granulation formation is of theoretical importance. In cases of leg ulceration, the fact that the dressing conforms easily to the surface of the wound helps with occlusion and thereby maintains a moist healing environment (Jude E B et al. 2007) is clearly a substantial contribution to the evidence base in this area. The fact that dressing exerts a demonstrable antimicrobial activity for up to 7 days reduces the need for frequent dressing changes and therefore frequent wound disturbance (Jude E B et al. 2007) is of practical and clinical importance, but none of these factors are of any use at all if the patient does not understand or is willing to comply with the clinical therapeutic regime. In essence, this case illustrates the gulf between the knowledge that is assimilated in an isolated academic situation and the knowledge that is derived from experience in clinical situations. (Van Manen, M. 2007). It was my reflection on the situation that allowed me to appreciate the true value of my mentor’s experience and handling of the situation which was the critical factor in persuading Mr.S to understand both his predicament and the rationale behind the treatment that was being offered and this was the key to his eventual understanding and compliance. (Marinker M. 1997). It was clear that simply persisting with the situation was not going to achieve the desired effect and that a degree of compromise was needed. That compromise was achieved by viewing the situation from the patient’s viewpoint and then tailoring the clinical approach to an empathetic understanding of that perspective. In other words a client centred approach. (Platt, F W et al. 1999). The point about Mr.S’s drinking was no longer overlooked and discussions with his extended family confirmed the clinical suspicion. Pressure was exerted by the family to reduce the opportunities for his drinking and they increased the degree of social interaction (reduced his social isolation) which also had a beneficial effect (Wilkerson, S. A et al. 1996) Conclusion: how do you now feel about this experience? what else could you have done? has this changed my ways of knowing? I can say with confidence that reflection on this whole episode was a major learning experience for me. Not only did I witness and important lesson in patient management, but I was able to reflect on the evolution of my emotional approach to the situation. It showed me how my initial aggression and annoyance was not only completely misplaced, but that it was also completely counterproductive. As a conclusion, I have seen just how important it is to stand back from a difficult or deteriorating situation and make a completely dispassionate and holistic assessment of the patient and his clinical situation before trying to construct an appropriate management plan. A further conclusion must be that there is very little merit in simply knowing the evidence base surrounding a particular course of treatment if one lacks the experience or humanity to actually effectively put it into action. (Fawcett J 2005) Action Plan: if this arose again, what would you do differently? As I have already mentioned in the conclusion, it is because this episode was a major learning experience for me that I can say with confidence that, if a similar situation arose again, I would deal with it in a completely different way to the way which I handled this episode. I would not initially approach Mr.S with a feeling of aggression and annoyance as it proved not only to be counterproductive but it was also a barrier to my standing back and reviewing the situation. If Mr.S was clearly not complying with the treatment I would ask myself (and the patient) what were the reasons why compliance was a problem. Having ascertained the reasons, I would then construct an appropriate treatment or management plan which directly addressed this reason and contained a mechanism for directly confronting it. Empowerment and education have been demonstrated to me as very powerful tools in the quest for patient compliance and concordance. I would actively use these concepts to try to maximise t he effectiveness of the treatment and also to enhance the overall patient experience. (Hewison, A. 2004) References Bowler P G, 2003. Progression towards Healing: wound infection and the role of an advanced silver-containing dressing. Ostomy Wound Management 49 : (8) Suppl. 2 5 Donnelly A, Alistair M Emslie-Smith, Iain D Gardner, and Andrew D Morris (2000) ABC of arterial and venous disease : Vascular complications of diabetes BMJ, Apr 2000; 320 : 1062 1066. Faden, R R, Beauchamp, T L. (1986) A History and Theory of Informed Consent Oxford University Press New York. 1986 Fawcett J (2005) Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories, 2nd Edition. Boston: Davis Co 2005 ISBN : 0-8036 1194 3 Gibbs, G (1988) Learning by doing: A guide to Teaching and Learning methods. EMU Oxford Brookes University, Oxford. 1988 Harding K G, Morris H L, Patel G K. (2002) Healing chronic wounds. BMJ 2002; 324 : 160 163 Hewison, A. (2004) Management for Nurses and Health Professionals : Theory into practice. Blackwell Science: Oxford. 2004 Howe J, Anderson M (2003) Involving patients in medical education. BMJ, Aug 2003 ; 327 : 326 328. Hunt T (1994) Ethical issues in Nursing. London : Routledge 1994 Jude E B, Apelqvist J, Spraul M, Martini J. (2007) Prospective randomised controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med. 2007; 24 : 280 288. Marinker M.(1997) From compliance to concordance: achieving shared goals in medicine taking. BMJ 1997; 314 : 747 – 8. Miller, A. (1995) The Relationship between Nursing Theory and Nursing Practice. Journal of Advanced Nursing 10, 417 424. Nicol M, Carol Bavin, Shelagh Bedford-Turner Patricia Cronin, Karen Rawlings-Anderson (2004) â€Å"Essential Nursing Skills† 2nd ed. Churchill Livingstone, Mosby 2004 NMC (2004) Nurse Midwifery Council: Code of professional conduct: Standards for conduct, performance and Ethics (2004) London : Chatto Windus 2004 Osterberg L, Blaschke T (2005): Adherence to medication. N Engl J Med353 : 487 – 497, 2005 Platt, F W Gordon G H (1999) Field Guide to the Difficult Patient Interview 1999 Lippincott Williams and Wilkins, pp 250 ISBN 0 7817 2044 3 London: Macmillian Press 1999 Schon, D. (1997) Educating the Reflective Practitioner. Jossey Bass, San Francisco. 1997 Seedhouse D (1998) Ethics; the heart of health care. London, John Wiley Sons 1998 Thomas J E Waulchow W J (1990) Well and Good : Case Studies in Biomedical ethics. Broadview Press 1990 Van Manen, M. (2007) Linking Ways of Knowing with Ways of being Practical. Curriculum Inquiry 6 (3), 205 228. Wilkerson, S. A., Loveland-Cherry, C. J. (1996). Johnson’s behavioral system model. In J. J. Fitzpatrick A.L. Whall (Eds.), Conceptual models of nursing: Analysis and application (3rd ed., pp. 89-109). Stamford, CT : Appleton Lange. 1996

Essay --

PROPOSAL TO CHANGE THE SMOKING POLICY ON CAMPUS INTRODUCTION Purpose This proposal is to improve the campus environment. Non- smokers does not like the smell of nicotine so it is their right to have a smoke-free environment where they pay tons of thousands of dollars in tuition every year, every semester in many cases. It is designed to encourage better health for everybody. Scope This report covers up policies on our campus. It also compares the policy with policies from other colleges and schools. There are few ways we can deal with this growing issue and improve atmosphere around us. BACKGROUND General Information Every year, there are hundreds of new students admitted to our campus. We are given the student handbook at beginning of the year, which includes school policies. Majority of students do not read the book or just read it for once. We have to start encouraging students to read the policies about smoking and tobacco usage on and around the university properties. Most of the students do not smoke but the other half population that does come from experience in smoking. They start smoking from high school. Research For this issue, I decided to talk to some of the smokers, non-smokers, faculty, and nurses. Most of them had the same opinion on smoking on campus. I also used internet to find policies on our campus and other colleges around us. Some of them had very strict policies on smoking and usage of tobacco around their campuses. When I looked at the smoking policy on our campus, I found that it has not been updated since 2006. It is a long time to overlook an issue of this level. Findings/ Issues Through my research, I came over with few ways we can make our campus green. I also came across the issue of cig... ...ial parking spots just for smokers away from the campus buildings. They can smoke there whenever they without jeopardizing other people’s health. Like proposed before, we can establish â€Å"Smoking Huts† one far end of the parking lot. 7. We can recommend students using the electronic cigarettes instead of traditional smokes. 8. Like many major universities across the nation, we can ban smoking altogether on the campus. This proposal is least likely to pass but as a non-smoker, that is the best way to make our campus environment fresh and clean. CONCLUSION Speaking as a non-smoker, this issue is very serious for us. We definitely have to respect smokers’ choice to smoke but they have to respect ours as well. Not many people like the smell or burning nicotine. These proposals certainly can help clean our community and provide better environment for future generations.

The Physics of Riding Bulls Essay -- Sports Rodeo Essays

The Physics of Riding Bulls Rodeo is a sport that came about by everyday work being made into competition. Every event in rodeo has a practical purpose; all but one that is. There is no practical reason to get on a bull; only the thrills, chills, and rush of excitement. It ¡Ã‚ ¦s more than a challenge between riders. It ¡Ã‚ ¦s a challenge between man and beast. Legendary cowboy Larry Mahan had an even different way of looking at it. He said,  ¡Ã‚ §It ¡Ã‚ ¦s not a challenge with the animal but with the weakness in one ¡Ã‚ ¦s self ¡Ã‚ ¨. At any rate, it ¡Ã‚ ¦s all about the challenge. The challenge is simple; stay on the bull ¡Ã‚ ¦s back for eight seconds while keeping one hand fee from contact with the bull or your own body. Well it sounds simple anyways. Bull riding is a difficult challenge that involves overcoming many forces. Bulls will try just about anything to get a rider off their back. This includes raring, kicking, spinning, jumping, belly rolls, and some unintended moves such as stumbling and falling down. All the moves produce some sort of force the rider has to overcome. Fortunately the rider can produce a few forces of their own. Mainly, the rider only has a combination or leg strength and arm strength to counter with. But, there is a lot that a rider can do to overcome these forces through body positioning. There are really two different types of bulls; fast bulls, and strong bulls. Fast bulls are the hardest to ride. Typically, a bull can move much faster that a human making it difficult for the rider to keep up. There are basically three types of motions that a bull can make: linear, circular, and rotational. Linear motions include the rare, kick, jump, and just plain running. Circular motions include spinning. Rotational m... ...ay at the center point of the circle. Some bulls can do so many random and different moves so fast that the rider may black out or loose focus. The only way to really get good is through experience. Experience trains the subconscious so that as the rider feels what the bull is doing he can react faster. A bull rider must also be in great shape. Much energy is spent in the course of a bull ride. The energy is equal to the force applied times the distance traveled. The forces are great and as fast as a bull can move they can cover a lot of ground in eight seconds. This adds up to a lot of energy being expended. Bull riding can be loads of fun. But it is definitely no picnic. WORKS CITED Kirkpatrick, Larry D., and Gerald F. Wheeler. Physics A World View, Fourth Edition. 1992. Orlando: Harcourt, 2001. p. 275. http://plabpc.csustan.edu/astro/newton/cpetal.htm The Physics of Riding Bulls Essay -- Sports Rodeo Essays The Physics of Riding Bulls Rodeo is a sport that came about by everyday work being made into competition. Every event in rodeo has a practical purpose; all but one that is. There is no practical reason to get on a bull; only the thrills, chills, and rush of excitement. It ¡Ã‚ ¦s more than a challenge between riders. It ¡Ã‚ ¦s a challenge between man and beast. Legendary cowboy Larry Mahan had an even different way of looking at it. He said,  ¡Ã‚ §It ¡Ã‚ ¦s not a challenge with the animal but with the weakness in one ¡Ã‚ ¦s self ¡Ã‚ ¨. At any rate, it ¡Ã‚ ¦s all about the challenge. The challenge is simple; stay on the bull ¡Ã‚ ¦s back for eight seconds while keeping one hand fee from contact with the bull or your own body. Well it sounds simple anyways. Bull riding is a difficult challenge that involves overcoming many forces. Bulls will try just about anything to get a rider off their back. This includes raring, kicking, spinning, jumping, belly rolls, and some unintended moves such as stumbling and falling down. All the moves produce some sort of force the rider has to overcome. Fortunately the rider can produce a few forces of their own. Mainly, the rider only has a combination or leg strength and arm strength to counter with. But, there is a lot that a rider can do to overcome these forces through body positioning. There are really two different types of bulls; fast bulls, and strong bulls. Fast bulls are the hardest to ride. Typically, a bull can move much faster that a human making it difficult for the rider to keep up. There are basically three types of motions that a bull can make: linear, circular, and rotational. Linear motions include the rare, kick, jump, and just plain running. Circular motions include spinning. Rotational m... ...ay at the center point of the circle. Some bulls can do so many random and different moves so fast that the rider may black out or loose focus. The only way to really get good is through experience. Experience trains the subconscious so that as the rider feels what the bull is doing he can react faster. A bull rider must also be in great shape. Much energy is spent in the course of a bull ride. The energy is equal to the force applied times the distance traveled. The forces are great and as fast as a bull can move they can cover a lot of ground in eight seconds. This adds up to a lot of energy being expended. Bull riding can be loads of fun. But it is definitely no picnic. WORKS CITED Kirkpatrick, Larry D., and Gerald F. Wheeler. Physics A World View, Fourth Edition. 1992. Orlando: Harcourt, 2001. p. 275. http://plabpc.csustan.edu/astro/newton/cpetal.htm

The Invincible and the taking over of technology :: essays research papers

In recent years, new advances in technology have freed people from tedious tasks, enabling them to do more in less time. We have come to rely excessively on this technology, to the point that we may be giving computers too much intelligence and independence. If machines ever develop intelligence on a level that could challenge humans, will they find that the most efficient course of action for humans is removing them? Stanislaw Lem’s novel The Invincible tells of a race of robots that dwell on a planet and come to threaten the lives of a crew looking for their sister ship, The Condor. Robots were placed upon the planet millions of years ago and evolved according to the environment. They needed to destroy anything that would cause their species to discontinue, including humans. The Invincible proves that the advancement of intelligent machines will threaten our society one-day.   Ã‚  Ã‚  Ã‚  Ã‚  Throughout history, humans have become fascinated with how far technology may someday take us. Works of science fiction through literature and entertainment have made it possible to uncover potential future developments. Levels of technological advancements are at an all time high, while computing power is set increase dramatically in coming decades. Gordon Moore, the co-founder of Intel, predicted, in what is now known as Moore’s Law, that the processing power will double every 18 months. This and the development of quantum computers may account for new tools toward artificial intelligence. Some have looked at this upcoming enhancement in artificial intelligence with anticipation and others with dread. Professor Hans Moravec, well known for his belief that machines will inherit the earth, believes that it is only the next logical step in evolution. Mechanical machines are capable of far greater learning and development and will therefore replace biological humans.   Ã‚  Ã‚  Ã‚  Ã‚  John Leslie, professor of philosophy at Guelph Univerisy, predicted a number of ways these intelligent machines may cause the extinction of mankind. The super intelligent machines may argue to themselves that they are superior to humans. They may also develop the theory that the only way to save humans, is to save us from ourselves. They may eliminate some of us due to overpopulation trends or disease.   Ã‚  Ã‚  Ã‚  Ã‚  Although we do not currently possess the ability to create such complex intelligence, many who are studying this field have thought of ways to prevent an intelligent machine takeover. Isaac Asimov, a quintessential author of more than 500 science fiction works, developed a group of fundamental rules humans would give to intelligent machines in order protect themselves.

Cartoon Interp

Cartoon Interpretation. A. 1. The person in the cartoon is, Woodrow Wilson (president of America. ) 2. The name of the bubble is, League of Nations. 3. The bubble shows that Woodrow Wilson was an idealistic person, but like most bubble, it will probably burst. 4. The cartoon is critical. This is because he is an idealistic person, and he wants to have peace amongst the nations, but in reality the bubble will burst and this will not be the case. B. 1. The country represented by the horse is Germany. 2. The countries represented by Briand and Lloyd-George are Britain and France. . The part of the Treaty of Versailles the cartoon is commenting on is the settlement. The large load represents the settlement the country had decided for Germany. The horse being lifted up represents Germanys inability to move as there are too many re-payments on there shoulders. 4. The comment the cartoon is making about the aspect of the treaty is that Germany should be carrying less of a burden in order fo r them to pay back the settlement. The man with the whip is France. France wanted Germany to pay back for all the French land and lives destroyed.The man with the shovel is British He doesn’t want the Germans to be treated as harsh as the French wanted. C. 1. The ‘Tiger’ is Clemenceay of France. 2. The two other figures in the cartoon are, Woodrow Wilson and Lloyd George. 3. The child has just seen the peace treaty. 4. The child represents Germany. 5. The title of the cartoon was ‘Peace and Future Cannon Fodder. ’ It became one of the most prophetic cartoons because it was given this name and was believed that all the Treaty of Versailles did was set up the future generations of the world to be nothing more than â€Å"Cannon Fodder† (solders treated as expendable in battle. It also tells us that there is peace now but will be war in the future. The person who drew the cartoon does not agree with the terms set on the Treaty of Versailles as he predicts that the present peace will stir up anger in the Germans and eventually lead to war. D. One of the weaknesses between these two cartoons could be that they are very similar in opinion that the terms of the Treaty of Versailles are much too harsh on the Germans.

The Millers Prologue And Tale Analysis English Literature Essay

Geoffrey Chaucer was a gothic author and regarded as the greatest of shopping mall English authors. Born in London, Chaucer was the boy of a affluent merchandiser who displace him to be trained at a baronial family. There he was improve and began to take journeys along with the male psyche sovereign for concern. Chaucer was a really busy while of affairs, and in his trim clip he would compose. He wrote The Canterbury Tales, during the fourteenth-century, a fabliau, which was slightly a group of populate stating their narratives on a pilgrims journey to the Canterbury Cathedral. The milling machine s news report mirrors at once s stand-up funniness modus operandis as manifest in the Miller s usage of timing, sarcasm, and personal narratives to raise his narrative. ATheA Millers Tale started by vernacular production of fundament, a carpenter, and an gagaer gentleman, and his untested married woman, Alison, an 18 twelvemonth old adolescent. He tell apartd her to a gr eater extent than he loved himself. outhouse was described as world covetous, because of her age, thereby maintaining her caged. In actuality, he was good hearted and really naA?ve. He was a typical older openhanded male that merely wanted to work dangerous and love his married woman. Alison was described as wild and babyish, with a slender, graceful fundamental structure . Today there argon older work forces that marry jr. large(p) females, unless normally non at such a immature age. trick loved his married woman more than himself and virtually work forces right away, who argon attracted to immature heavy(p) females, are really in love and naA?ve every bit good. Alison was in love with a immature adult male that happened to be her and her hubby s roomie. She was nt in love with put-on, still she knew that he would make anything for her. At such a immature age, it sounds worry she wanted what adult females in today s guild, would call a sugar dada , person to gi ve her nutrient, shelter, money and demo her true(a) love.Nicholas was a salesclerk, and he was besides John and Alison s roomie. He was immature, wild and a con-artist. He was besides, in love with Alison. Although he never truly described her as did the other portions, the Miller made it evident of his fondness for her. His occasion in today s society could be compared to a wild college pupil at an ivy League university. He did nt mind a challenge and finally played the biggest function in the Tale because he plan a fast one in order to pass clip with the adult female that he loved. He could articulate deal good because he conjured up a program that worked ab initio, to flim-flam John so that he could pass the shadowy with Alison. He pretend that something was incorrect with him and being naA?ve, John taked him. He spoke around a major inundation and had John hanging bathing tubs. They all got in the bath until John had fallen slumbrous in the bath, so Alison and Nichol as snuck off to be together. While I do nt cognise anyone in today s society that would travel this far, the play with Nicholas and Alison reminded me of a sidereal day soap opera sing they would bend so low as to do up this narrative, and prosecute sexual brushs in Alison s hubbies sleeping room.The last character in the narrative, Absolom, was besides a clerk and in love with Alison. Absolom was reasonably and sapphic , and day-dreamed about Alison. He described her as spare, and so sweetly lecherous . deal John, he was infatuated by Alison. Alison mentioned that Absolom is populating in a bubble. He has nil just a laugh for all his problem. It appeared that he did nt hold a hint about adult females and had neer dated before, just now was happy merely being allowed to pour forth to Alison and lavish her with vocals, money and gifts. Today, there are many immature work forces alike Absolom, who in secret loves a better-looking adult female but bet they have no exis tent chance on holding her so, settle on woolgathering alternatively. The sarcasm of this character is that he was so clueless that he ended up blowing the screen of Nicholas and Alison s love matter by firing Nicholas s butt. I would state that things like this as it relates to today s society, happens when there is a sloppy deceiver, sloppy things come to circumpolar rayAlthough there was no deterrent example to the narrative, throughout the narrative, each character could be compared to in some facet, with people in today s society. I believe the author ran across aliens during his travel, and to maintain himself entertained, lay down ways to compose about these opposite people and utilize it for his ain self pleasance. Possibly his occupation was so sound that he had to do visible radiation of any given state of affairs. The writer could hold really good encountered most of these people throughout his life. We will neer cognize what his logical thinking was, but it s as tonishing to see that people today are still like they were in some facet to the people in the in-between ages. The writer utilise timing, sarcasm, and personal narratives to maintain people interested, yet it is so closely related to today s society.