Comparing Composed Upon Westminster Bridge by William Wordsworth and Lo

Comparison between William Blake and William Wordsworths Views of London William Blake grew up in the slums of London and this is shown in his poem, he wrote his poem in the slums and covering alleys of London as he never had very much money. He describes London as being charterd, this gives us the impression that every subject has rules and boundaries in London, and that there is no mystery to be discovered. Also chartered means on a map, almost as if it is owned, by the king perhaps. The line in which the word is on, I wander through each charterd street, near where the charterd Thames does flow, makes us feel as if every thing is owned and nothing is natural, like all the people in London are prisoners of society The ending line of stanza two tells us, The mind-forgd manacles I hear, this is Blakes way of showing to us that there are no free minds in London. Everyone had been brainwashed by society and they could not think for themselves because of that. In the neighboring stanz a Blake describes the corruption of the Church of England by mentioning, Every blackning Church apalls this shows the dirtiness of the buildings and shows us that there is a possibility that he is a strong catholic. This line ties in very well with the line directly above it How the chimney-sweepers cry, both of the lines are discussing how dirty and filthy London is. We could also think of these lines in a different way Blake could be telling us that the priests are corrupt and dirty rather than just physically dirty. In the final line of this stanza, Blake states. And the unfortunate soldiers sigh, runs in blood down palace-walls. This could be considered as another sign of corruption, and that monarchs are to blame for the death in London a... ...f London, but they only do this because of their life before they wrote the poems. One poet grew up in the rich area outside London and moved there later, whereas the other poet grew up in the slums of London. They never had the chance to see London through each others eyes, if they had they may have thought differently of London. Both poets grew up and wrote about what each thought of the same(p) place, London is a city that is superb and beautiful to the people who know it like that. Whereas it is filthy and dirty to the people who have grown up in those filthy dirty areas. In my opinion London is a place that is somewhere between these two extreme versions of it, a place where there is magnificent splendour but also a place where there is filth and poverty. Theses poems where written two hundred and six years ago and London has not changed that much since then.

Fahrenheit 451 as a Criticism of Censorship Essay -- Fahrenheit 451 Es

Fahrenheit(postnominal) 451 as a Criticism of Censorship quill Bradbury criticizes the censorship of the early 1950s by displaying these same themes in a futuristic dystopia novel called Fahrenheit 451. In the early 1950s Ray Bradbury writes this novel as an extended version of The Fireman, a short story which first appears in Galaxy magazine. He tries to show the readers how terrible censorship and mindless conformity is by writing about this in his novel. In Fahrenheit 451, Bradbury uses artificial stimulus, such as television and radio, to provide the reader with a feeling of how isolated the public is and how their minds are be controlled by this conformist government in the twenty-first century. He uses technology, like the Mechanical Hound and also drugs, to show the oppressiveness of the government in his novel. Ray Bradbury chooses to write this book after seeing many of his fellow writers and other entertainers being blacklisted by Senator Joseph McCarthy in the early 1950s. While he couldnt just openly oppose this behavior, for he would surely be illegalise, Bradbury writes about an exaggerated version of his own government in which books are burned along with the houses that harbors them. This is to demonstrate to the readers how let the government censor their art could lead to more drastic measures. Such as editing one line in a book thus a page then the whole book is condemned and burned along side the many other books and ideas that do not agree with the government. This then leads to the ultimate condemnation of all books and forms of entertainment, which is not politically correct and/or agreeable to the governments ideas. Bradbury uses artificial stimulus... ...writers, and other entertainers were blacklisted by McCarthy and some were even brought to trial under perplexity of being Communist. In conclusion, Bradburys criticism of the 1950s censorship and conformity opened the eyes of the public to the wron g-doings of the government at the time. Many people began to realize that they were being censored for almost everything and art, for example in the form of writing and film, was being simplified to almost nothing. Works Cited Eller, Edward E. Essay on Fahrenheit 451 Novels for Students. Ed. Diane Telgen. Vol.1. Detroit Gale1997.pg 150-53 Wood, Diane S. Essay on Fahrenheit 451 Novels for Students. Ed. Diane Telgen. Vol.1. Detroit Gale1997.pg 153-55 Johnson, Wayne L Essay on Fahrenheit 451 Novels for Students. Ed. Diane Telgen. Vol.1. Detroit Gale1997.pg 156-57

Childe and Anthropology :: essays research papers

Essay Questions1. Childe equated civilization with urbanism. Other social scientists, while admitting a considerable overlap, distinguished between the cultural phenomena characteristic of urban areas and those of "civilized" societies. Childe identified 10 formal criteria that, according to his system, indicate the arrival of urban civilization. These are increased settlement size, concentration of wealth, large-scale public works, writing, representational art, knowledge of exact sciences, foreign trade, full-time specialists in non-subsistence activities, class-stratified society, and political organization based on residence rather than kinship. He saw the underlying causes of the urban revolution as the cumulative growth of technology and the increasing availability of food surpluses as capital. Further archaeological evidence demonstrated that the formal criteria Childe proposed were, in reality, not universal. A core of basic structural trends, however, appeared to be essential as cities appeared in different areas at different times. Some of the problems that may arise with any given set of criteria(s) for defining civilization and the process in which they develop untruth within things such as time frame, area, mental capacity of the peoples of the society, and material advancement. In reference to ancient Mesopotamia and Egypt, Childes criteria apply somewhat directly. This is said because some(prenominal) of these societies had some forms of sciences (i.e. mummification/Egypt), wealth or caste system, and a public works for buildings and city-states. Their only difference lies in that in ancient Egypt, the politics were equilibrise by kinship rather than residence.2.     Archaeological excavations in Mesopotamia, conducted since about 1840, have revealed evidence of settlement back to about 10,000 BC. Favorable geographic circumstances allowed the peoples of Mesopotamia to take to the woods from a hunter-gatherer cult ure to a culture based on husbandry, agriculture, and permanent settlements. Trade with other regions, tribes, and chiefdoms also flourished, as indicated by the presence in earlier burial sites of metals and precious stones not locally available.

Finance in Business :: Papers

Finance in Business For a business to be successful in the increasingly competitive business environment detailed financial plans and accounts must be drawn up and followed consistently. With so many financial demands placed on small it is vital that all be ar lickd and accounted for prior to the businesses start-up date, these costs are referred to as start up costs Start Up Costs ============== Start-up costs are any payments that my business needfully to make prior or opening. ==================================================================== IMAGE Rent of premises and equipment. IMAGE Wages of any employees ---------------------- Finance must be supplied for any form of ongoing advertising campaigns or sales promotion techniques. IMAGE Utilities - gas, water and electricity need to be supplied to my business at all times IMAGE Maintenance of business premises, this could also include mathematical expansion of the business. IMAGEIMAGE Examples of Running Costs businesses are subjected to. Some Star-Up costs also apply during the general running of the business as running costs. Running Costs are payments that are made once the business has started trading. I shall now calculate how much the above costs will affect my business venture. I shall calculate firstly the start-up costs and then the running costs for a sample three-month period. In order to calculate costs effectively I shall design the spending of my patronage first. Designing the layout of my shop. When I began to design the layout of my shop I considered a number of potential problems and requirements, I came to the conclusion that the three most important requirements my shop needed were - * Hygiene * Appearance * Safety By applying serious thought and consideration I aim to solve these issues and be able to design a shop that is both efficient and appealing to customers. Hygiene The layout of the equipment I require in my shop has to allow for easy

Blood Alcohol Level (bal) Essay -- essays research papers

Blood Alcohol Level (BAL)MONITORING     The amount of alcohol in your blood stream is referred to as BloodAlcohol Level (BAL). It is recorded in milligrams of alcohol per 100 millilitersof blood, or milligrams percent. For example, a BAL of .10 means that 1/10 of 1percent (or 1/1000) of your total blood content is alcohol. When you drinkalcohol it goes directly from the stomach into the blood stream. This is whyyou typically feel the effects of alcohol quite quickly, peculiarly if youhavent eaten for a while. BAL depends on 1. Amount of blood (which willincrease with weight) and 2. The amount of alcohol you consume over time (thefaster you drink, the higher your BAL, as the colored sack only handle about adrink per hour--the rest builds up in your blood stream).     Understanding the effects of a rising BAL can be very useful incontrolling drinking. Below are the consequences of various Blood AlcoholLevels,from a book by William R. Miller a nd Ricardo F. Munoz called, "How to harbor your Drinkling A Practical Guide to Responsible Drinking (1982).02 MELLOW FEELING. SLIGHT BODY WARMTH. LESS INHIBITED..05 NOTICEABLE RELAXATION. LESS ALERT. LESS SELF-FOCUSED. COORDINATIONIMPAIRMENT BEGINS..08 DRUNK operate LIMIT. DEFINITE IMPAIRMENT IN COORDINATION AND JUDGMENT..10 NOISY. POSSIBLE EMBARRASSING BEHAVIOR. MOOD SWINGS. REDUCTION IN REACTIONTIME..15 IMPAIRED BALANCE AND MOVEMENT. CLEARLY DRUNK..30 M...

Blood Alcohol Level (bal) Essay -- essays research papers

Blood Alcohol Level (BAL)MONITORING     The amount of alcohol in your blood flow is referred to as BloodAlcohol Level (BAL). It is recorded in milligrams of alcohol per 100 millilitersof blood, or milligrams portion. For example, a BAL of .10 means that 1/10 of 1percent (or 1/1000) of your total blood content is alcohol. When you drinkalcohol it goes directly from the stomach into the blood stream. This is whyyou typically feel the effects of alcohol rather quickly, especially if youhavent eaten for a while. BAL depends on 1. Amount of blood (which willincrease with weight) and 2. The amount of alcohol you consume over time (thefaster you drink, the higher your BAL, as the liver can only handle about adrink per hour--the rest builds up in your blood stream).     Understanding the effects of a travel BAL can be very useful incontrolling drinking. Below are the consequences of various Blood AlcoholLevels,from a book by William R. moth mille r and Ricardo F. Munoz called, "How toControl your Drinkling A Practical Guide to Responsible Drinking (1982).02 MELLOW FEELING. SLIGHT BODY WARMTH. LESS INHIBITED..05 NOTICEABLE RELAXATION. LESS ALERT. LESS SELF-FOCUSED. COORDINATIONIMPAIRMENT BEGINS..08 drunkard DRIVING LIMIT. DEFINITE IMPAIRMENT IN COORDINATION AND JUDGMENT..10 NOISY. POSSIBLE EMBARRASSING BEHAVIOR. MOOD SWINGS. REDUCTION IN REACTIONTIME..15 IMPAIRED BALANCE AND MOVEMENT. CLEARLY DRUNK..30 M...

Answers To Digestion Review Questions

Which row in the chart below identifies the lettered substances in this unconscious process? 4. The draw below represents a plant cell. 7. outdoor stage your answer to the avocation brain on Which activity is illustrated in the diagram of an mamba shown below? A) congestion C) respiration For the process of photosynthesis, the arrow labeled A would nearly likely represent the direction of movement of B) synthesis D) ingestion 8. The diagram below represents a sequence of events that occurs in living things. Carbon dioxide, water, and solar vital force oxygen, sugar, and solar energy carbon dioxide, oxygen, and heat energy sugar, water, and heat energy 5.Base your answer to the following question on The diagram below represents a chase section of a plant Structure. Letter X represents Which letter indicates the region where most photosynthesis takes place? 6. All of the cell shapes shown in the diagrams below have the same volume. Which form could absorb nutrients most effici ently and quickly? A) inorganic whits B) organic molecules C) biological catalysts D) simple sugars 9. The diagram below represents a series of events that occur in living cells. Which molecule is indicated by X? A) glucose C) carbon dioxide B) AT p D) protein 12.Base your answer to the following question on Which process is illustrated in the diagrams below? A) circulation C) vermiculation B) absorption Base your answers to questions 13 through 15 on on the diagram below of the military man digestive schema and on your knowledge of biology. 10. The diagram below represents a beaker containing a solution of various molecules involved in digestion. Which structures represent products of digestion? A) A and D C) B and E B) B and C D) D and E 1 1 . Which process increases the surface area of solid foods prior to chemical digestion? Hydration synthesis excretion mechanical digestion diffusion 13. In which structure does the sign hydrolysis (chemical digestion) of carbohydrates occu r? 14. From which structure are glucose and amino acids normally absorbed into the circulatory system (the blood)? 15. In which structure does extracurricular(outside of the cell) chemical digestion of protein begin? 16. Before starch faeces enter a cell, it must be absorbed by simple sugars diffused into simple sugars digested to form simple sugars actively transported by simple sugars 17.Which molecule can diffuse from the digestive tract not the human bloodstream without first being digested? A) protein C) fat B) starch D) glucose 18. Teeth chewing food into small digestible pieces is known as chemical digestion circulation regulation 19. Base your answer to the following question on The diagram below represents a portion of the human body. The principal function of structure X is to produce salivary enzymes secrete sex hormones absorb water digest bile 20. Base your answer to the following question on the diagram and represent below and on your knowledge of biology.The diagra m represents the human digestive system. Pepsin and trying are human digestive enzymes. The graph indicates that pepsin would function best in the A) mouth B) stomach C) small intestine 21 . Which structures secrete chemicals utilized for the completion of digestion within the small intestine? liver and pancreas slumberous and villa esophagi and alveoli gallbladder and pharynx 22. Which foods should be included in a balanced diet as a good source of roughage? wild meat and poultry fresh fruits and vegetables eggs and milk products animal fat and plant oil 23.If a person was unable to break down food particles into molecules that loud be absorbed by the body, you would predict A) there is a malfunction with the digestive system B) there is a malfunction with the excretory system C) there is a malfunction with the reproductive system D) there is a malfunction with the circulatory system D) large intestine 24. Feces is usually near 40 percent water and 60 percent solid matter. Reduc ing the water content to 20 percent would most likely result in A) ulcers C) diarrhea B) appendicitis D) constipation 25.Base your answer to the following question on select the organ, chosen from the diagram below, that is most loosely related to that malfunction. A painful presumption results from erosion of the surface of this organ by gastric juices. 26. Base your answer to the following question on The diagram below illustrates a biochemical process that occurs in organisms. The substance labeled catalyst is also known as A) a hormone C) an antibody B) an enzyme D) an inorganic compound 27. Base your answer to the following question on In the reaction illustrated in the diagram below, which structure represents the enzyme? 28.

Native Americans-White Relations

AP US History DBQ Native Americans-White Relations, 1800-1850 In the time period of 1800-1850 clean Americans spread out across the vast tears on the western side of the continent and regularly encountered conflict with various Indian nations. In these documents, interactions for the various Indian nations were subjected to different tillage between each tribe per say that there were responses that filled different needs and demands. Some tribes provided benefits such as agriculture and household manufacture and produced the thought process that settlements to be blended and conform into one people.Other interactions created conflict because some of our land purchases were not 100% in compliance with the constitution. Yet some Indian nations were passing influenced by leaders such as Tecumseh for which they understood his implied meanings with respectfulness and respect. These primary sources of information give a great insight to the goals of the whites and their encounters T he businesses to furnish clothing and subsistence to the Indians became passing insufficient however the promotion of agriculture and household manufacture were essential.The goals of the whites were to settle as uch land possible for their nation called for it with an exponentially increasing population. Acting upon a coincidence of inte ends these promotions will enable them to live on much smaller portions of land, and, indeed, will render their vast forests useless ex Doc. A. These forests found useless and minus for they are learning to do better on less land, our increasing numbers will be calling for more land ex Doc. A. In Ultimate concession the best possible outcome would be to blend together, to intermix and become one people for that we can continue xpansion without conflict.An new(prenominal) response of the interactions was the mind that the Indians could be granted an annuity to guarantee growth towards the cultivation of their lands. The governor wished for the N ative American populations to become more civilized ex Doc. B which called for grants from the government. much(prenominal) examples would include an annuity of five hundred dollars to procure the necessary articles for the purpose of enabling them to cultivate their lands ex Doc. B. However these promotions and ideas were only a cover-up of that the governor got them to ign a deed for their land without their knowledge.The chiefs considerer it out of consideration to that it was not in their power to do any such thing without consent from other nations. . The Chickasaw, Cherokee, Choctaw, Creek and Seminole nations were the only 5 major tribes that were highly affected from the Indian removal acts and were forced into Indian reservations ex. Doc D. The Indians were highly influenced by Tecumseh and gave him immediate obedience and respect for he was an uncommon genius, which spring up occasionally to produce revolutions or verturn the established order of things ex Doc. C.Yet due to the want vs. need for land the vicinity of the United States when Tecumseh died in the Battle of Thames from American forces. Tecumsehs goal of establishing a independent Indian nation Mississippi river. In conclusion, the time period of 1800-1850 white Americans expanded across the western side of the continent encountered conflict and different interactions with various Indian nations. Popular belief believed that that to achieve an ultimate point of rest and happiness that they should share their settlements and lend together and become one people ex.Doc. A. Chiefs would be shown imaginary annuities of five hundred dollars a year only to be fooled with the signing of the deed for their lands without their knowledge ex Doc. B. One of their only leaders Tecumseh, controlled implicit obedience and respect for when he died the Indian nations would not be delineated into a independent nation west of the Mississippi river ex Doc C D. These interactions between whites and Indians i n the time period were various for the needs and demands for the Indian nations so that we would continue the westward expansion.

The Eyes of the Dragon Essay

The novels title, The Eyes of the Dragon, holds broad significance to the book. In the novel, pansy Roland, ruler of the urban center Delay, kills a dragon and promptly mounts It head on his slam room wall. King Reloads son, doubting Thomas, disc everywheres he can spy on his father using the dead dragons eyes. By entering a secret room, next to King Reloads chambers, Thomas can look through two peep holes which align with the eyes of the dragon. Thomas has never received his fathers attention. He is always overshadowed by his fellow slam.When Thomas discovers he can spend time with and watch his father, albeit without his fathers knowing, Thomas Is greatly Intrigued. The title, The Eyes of the Dragon, is a sign of how far Thomas Is willing to go to have any connection with his father. He is willing to spy and spend all his night in isolation Just to watch his father. The title and symbol alike helps the reader understand how Thomas is damaged when he later sees his father mu rdered. 2. The Eyes of the Dragon is one of the few fantasy novels written by Stephen King. The novel revolves around fantasy elements such as kings, wizards, and dragons.The novel also has a family genre as many of the conflicts revolve around disputes between sibling, Thomas and peter. 3. The novel, The Eyes of the Dragon, is written in objective 3rd person. Stephen King is omniscient throughout the novel. He is sufficient to tell the feelings of multiple characters throughout different chapters. In the novel, Stephen King consistently breaks away from the story, to provide his opinion on recent events in the story. When Thomas was first introduced to the story, Stephen King explained his unbiased reasoning on why readers may thing Thomas Is a villain, anti hero, or cacti. . The story takes place In the Kingdom of Delaine, a fictional dry land, which resembles medieval folklore. Delaine is actually snap off of a much larger universe, In- Worlds, which contains many other of Stephen Kings novels. The kingdom of Delaine is similar to 15 century Europe. Due to this setting, the story lacks advanced technology that could have helped discharge many problems. Peter, accused of killing his father, was sentenced to life Imprison housement based on 3 non eye-witness testimonies. Using modern day technology, the people of Delaine could have easily seen Peter was Innocent.Since Delaine Is a medieval realm, the town people are all caste inside of a feudal system. This affects the peoples manner of living and shows how the common folk manage in social hierarchy (farmers vs Noblemen). Throughout the story, the farmers are forced to put up with higher and higher taxes given by the noblemen. Due to Details fantasy setting, the kingdom has a rich history of dragons, wizards, wars, etc. Characters often reference these events later on. The setting Is extremely similar to medieval England.Characters have a scalar diction and tend to use Old English words such as, twat s and its. However, the dialect is spells certain differently. Is are consistently replaced with yes. For example, wife and Me. Overall, the setting creates quite a calm atmosphere. The city of Delaine is functioning normally in the beginning. Townsfolk consistently state the city is too calm and problems are bound to come. After King Reloads murder, the atmosphere becomes moody and bleak as the townspeople are under consistent oppression by the new king poisons King Roland and frames Peter the murder.This act put Peter in prison for life. This begins Pewters struggle of escaping prison, proving his innocence, and lamming his kingship. This also begins Flags opposing quest to bring chaos and destruction to the peaceful Delaine. These characters consistently clash throughout the story creating the main, person vs Person, conflict. 6. There are many conflicts throughout the story. Unknown to Flag, when the wizards poisons the king, Thomas witnesses the event and later learns Peter, h is older brother, is innocent. After Peter is Jailed, Thomas becomes King of Delaine.Thomas is faced with the knowledgeable conflict of testifying Peters innocence and freeing him or keeping the throne, his one rise to name. This person vs.. Self-conflict causes Thomas much anxiety throughout the story. Peter also have a person vs.. World conflict after he is Jailed. The entire town now thinks he is a murderer. He is forced to free himself from the prison by himself and then prove his innocence to the towns people. There is a separate plot in the story of Ben Steads quest to free Peter. Ben Stead, Pewters sole remaining friend, goes to great lengths to help free Peter.He must do so without the townspeople or noblemen finding out as they all believe Peter is murderer. Ben Stead also has a person vs Ate conflict as his family has a curse of bad luck and unfortunate stars. Ben must try to break his familys history and acknowledge a happy life. There is also a person vs Person conflic t in the social hierarchy. The townsfolk are consistently arguing with the noblemen over issues like taxes. This escalates to the formation of a rebel army that intends to take over Delaine. 7. After a climactic battle between Flag, the evil wizard, and Peter, Flag is snap bean with an arrow in his eye.Mortally wounded, the wizard magically disappears before he can be apprehended. Since Flag is the source of has in Delaine, his disappearance leads to the removal of chaos. Without Flags interference, Peter is able to claim the kingdom of Delaine. He proceeds to lower taxes and solve disputes between the farmers and noblemen. Since Peter is now king, Ben breaks his familys history of bad luck. He is now the closest person the most powerful person in the kingdom. Since Peter is now free Thomas is relieved of the guilt of knowing Pewters innocence. Part B 8.

Rhetorical Analysis of Walter Benn Michaels, “The Trouble with Diversity” Essay

diversity isnt something to be ignored, but is that where our primary focus should lie? It is in our very nature to celebrate our differences without it we lose our identicalness. As a society we literally dance in the streets to celebrate our individualities. However, Walter Benn Michaels points out a very interesting issue that is not solo social but economical as well, in his book The shake up with Diversity How We Learned to Love Identity and Ignore Inequality. When we strip away our color, our heritage and begin to look at our wallets we become embarrassed, even shy about our how fat or thin it becomes.His political stance is intended for a full general audience to show present concepts of cultural diversity, to illustrate how Americans retain come to manage race, and to shift the focus from race to economic inequality. The introduction of The Trouble with Diversity is merely a glance at Michaels agenda and becomes quite confusing to an average reader. He spends a fair amount of time discussing how we have become engulfed in our, as Michaels puts it, love affair with diversity that his primary goals are diluted within the text. When we break it down, his arguments become clearer.To fully understand Michaels objectives wholeness must take into account his general audience. It becomes clear with his use of the first person narrative, The argument, in its simplest form, leave be that we love racewe love identitybecause we dont love class. As Michaels points out the bulk of society is below the poverty line and when discussing economic inequality no one will listen more than closely than those who are suffering the most. The upper class will also be able to identify with because as he emphasizes, plenty after Survey has shown, Americans are very reluctant to identify themselves as belonging to the lower class and even more reluctant to identify themselves as belonging to the upper class. As a society, we would rather associate ourselves as being m iddle class. In this way, no matter what the race, we are alike.Beginning The Trouble with Diversity with F. Scott Fitzgerald famous saying to Ernest Hemingway, The rich are antithetical from you and me. Expresses how some people view the upper class as a completely different race of individuals. Hemingways witty response, Yes, they have more money.Illustrated to Fitzgerald that there is no difference in the rich, or the poor, except their wallet size they are legato human. Michaels goes on from there to describe how we have come to warship diversity. In Bakke v. Board of Regents, the Supreme Court ruled that it was reasonable for colleges to consider race when judge applicants, as long as was in the interest of diversity and not to exclude members of certain racial background. Along with racial diversity, diversity became something to describe more than just the color of our skin. It now is used for sexual orientation, medical coding, and religious preferences. Unfortunately, di versity became closely associated with the struggle with racism and ended up with a impression that we should be a color-blind society.As Michael states, Why do we assume black people want to stop being black why do we assume the deaf want to hear? He finishes the intro of his book by illustrating how we have come to hate class. While we have become to love our identity, we have become increasingly uninterested in identifying ourselves based on the classification of income. He even accuses the left wing party (or liberals who have prided itself on working for social equality) in diverting focus of economic inequality.Giving the priority to issues like affirmative action and committing itself to the celebration of difference, the intellectual left has responded to the accession in economic inequality by insisting on the importance of cultural identity. So by his observation Michaels believes that even the liberals are guilty of intellection the solution to inequality is simply to appreciate the lower class.

Racism: a Raisin in the Sun and Family

Man Walter Lee Is a dreaded man, shackled by poverty and prejudice, and haunt with a business Idea that he thinks allow solve all of his economic and social problems. He thought the novel Is looking for ways to carry his family on and give them every material thing they want. He Is desperate because he sees the other good deal with economic resources while his family is struggling to move on.He is the perfect example of the mid twentieth-century men who suppose they are the ones who have o carry their families with the economic resources and struggle to achieve it, thats why he gets desperate because although he tries he seems he is not acquire it. Sometime these men get blind and dont realized what really they are doing because the will to help their family is too big. Throughout the novel Walter looks for ways to give the family what they want.He whole works on liquor store and he thinks that will provide him the financial security needed to boost them out of poverty, but so metimes he gets desperate and thinks none of this will help him. Sometimes Its eke I burn see the future stretched out In front of me Just plain as day. The future, Mama. respite over there at the edge of my days. Just waling for me a big, looming blank space full of 522). One can clearly see how Walter fears that his life will always be a life of nothing. He is overwhelmed by a sense of dread and fears that his suffering will continue on and on forever.Walter was so desperate he often fights and argues with compassion, Mama, and Beneath. Also a thing that makes him like that is the racism at that time he often see who the White sight from high social status had everything they want, kids attended different schools, neighborhoods were separate from the other, that also made him be like that. He was so desperate he inks to a new low and calls Mr.. loaner back, saying that hell accept the Money, a think his family was not agree with. This is really Walters lowest point In the whole play. Hes alert to totally shame himself for the money.In the end, though, Walter Is redeemed when he eventually refuses to take the money from Mr.. Lender. Once he begins to listen to Mama and Ruth express their dreams of owning a house, he realizes that buying the house is more important for the familys welfare than getting rich quickly. Walter finally becomes a man when he stands up to Mr.. Lender and refuses the money that Mr.. Lender offers the family not to move in to its dream house in a white neighborhood. Talking bout life, Mama. Mama, you know its all divided up. Life is. sure enough. Between the takers and the token. Ive figured it out finally. Yeah.Some of us always getting token. (Handlebars 570). What Walter did here was correct because he was qualification horrible mistakes for him and his family instead of helping them he was making the wrong thing. He looked to much the other things and envy what the white people had made him almost took the wrong decision , but because he listen Mama and Ruth he realized that accomplishing a family dream will fulfill them more the Glenn them material things. Having a house was always Mamas dream. Although undergoes the greatest transformation. His Journey takes him from total Jerk, obsessed with get-rich-quick schemes, to a man worthy of respect.In Walter Younger, Lorraine Handlebars shows how poverty and racism can twist and depress people, turning them against those that they most love. Of course throughout Walter, Handlebars shows us how these social barriers can be overcome through personal determination and staying true to ones own beliefs. Sometimes one care too much about the things other people had and the willing of getting them make you think in wrong way, and instead of helping the ones you one to help you end making and error for yourself and the people you precious to help.

Justice look

When you look up synonyms for the word arbitrator, or ask some whiz what they telephone the word meaner, they will spew out nouns such as neutrality, fairness, impartialitys, etc. I mean Justice in terms of the criminal system is the collaboration of three different entities, police, court, and corrections. That take aim to work together to motley an illusion of one single entity and in doing this, they flummox to still maintain a check and balance system amongst themselves. So, no one system should be able to have full authority.For only by this can it strive for the ability to bring about a system that can observe etern all(prenominal)y, mark fairly, and the ability to weigh each investigation and causa with a sense of impartiality. The main components of the criminal system are the police, court, and correction unit. They have to act with one another by a collective meaner. You have the law enforcement in the forefront they are the ones that have to enter the crime scene, take into affection all the evidence, collects the evidence, and they have to arrest the venture.Once they have apprehended the suspect perceived to be the doer of the crime. The suspect at this time is taken to the rout the evidence equanimous by the police is then presented at the court. Case is made by both prosecution and defense team. You have the unbiased Jury and Judge that opine the case, evidence, and testimony they deliberate and come back with a sentence. Once the suspect is sentenced, if found guilty, they are sent to a correctional institute. The correctional unit officers have to supervise the convicted felons.They have to ensure that their facility is well situated and capable of holding the convicted felons, so that both the inmates and the public can co-exist in a safety device environment. The two models of the criminal Justice system are The crime control model and the due process model. The two models differ from each other by means of which part of the Ju stice system they put their emphasis on. The annoyance control model put their grandeur on reducing crime and criminal activities in society through implication of the Law enforcement officers, I. E. Alice/detective, taking control and in theory get to the solution and conviction as soon as possible. The Crime control model Judges the person for what they did, their role in the crime. It is more cut and dry. They believe the severity of the punishment should correlate with the crime. This theory appropriates for capital punishment, they dont believe one can change, or give too much importance for mental status, ethnicity, age, race, etc. The Due process model is quite the contrary, it stress the importance of taking into consideration ones race, age, demographics, etc.The Due process model put importance on respecting ones rights and following all the responsibilities of the law. While still protecting ones freedom. I think the fact that the main components of the Justice system sometimes inflict with each other are the reason why some cases get thrown out. A case, that I remember, is the clear epitome of when the Justice system failed it took place in the 1993 West Memphis Murders. Three boys were killed in a horrific manner. Why were the murders not understand?Lack of poor evidence collected, rash decisions making, jumping to conclusion, media hype, and the police not following up on hints that were called in. They arrested three boys because they portrayed eccentric behaviors. They went on hearsay they let the pressure of the media and public convict three caked proper detective tactics, and they pressured one of the suspects into admitting guilt. The Jury wasnt unbiased, everyone felt these boys were guilty and thus found them guilty.Had the law enforcement officers through with(p) their Jobs properly they would have followed up on the clue where there was a man completely bloody and delusional, in the bathroom of a fast nutriment restaurant. The co ps never showed up there to talk to him, they went the next day to the restaurant took samples a sample of DNA, blood smear from the wall, and they lost that only sample of evidence. That case went unsolved, a case of three eight or nine year old boys. That shouldnt have happened. The system will fail if the three different entities of the Justice system dont act as one.Technically, I believe the crime control model is more useful because you get a verdict, action is taken, a suspect guilty of a crime pays for that crime accordingly to the severity of the crime without technicality changing the sentence, or race, demographics, age playing a rule in how severe or lack of severity of the punishment. More criminal activities would be accounted for people would fear law enforcement officers more. The due process model is more high-octane and accurate. They enforce the rules and regulations of the law they make sure any suspect is treated with the respect they deserve in accordance with the law.I believe both systems need to interact with one another for it to be fair and Just. One system may come to a conclusion too quickly, while the other may allow someone guilty to get out of crime do solely to a technicality, so no one system is perfect on its own. However, I do believe the crime control model should be more prevalent in the Justice system. I think too much consideration is given to suspects, and why call someone suspect when their guilt is so evident, that really its a point one percent chance for them not to have committed the crime.I think the severity of the crime should matter a pedophilia serial killer should not be turned to life in prison house where our tax money pays for their living. I dont think capital punishment should be banned there are some out there that honestly dont deserve the luxury of a prison. An example of this would be, the Jodi Arias case, she stabbed her ex-boyfriend twenty-nine times, shot him, slit his throat, and left him to rot . Is it fair to say that it was an act of assign, when she stole the gun, made sure she had enough gas so that she didnt have to stop anywhere, and took pictures.

The Deep Vein Thrombosis Health And Social Care Essay

What is Deep Vein Thrombosis or good cognize as DVT. Did you of all time heard ab erupt blood clot? A status which a blood clot thrombus signifiers in a vena is known as venous thrombosis. Blood flow through the vena terminate be limited by the blood coagulum, ensuing in swelling and hurting. about commonly occurs in the deep vena in the legs, t utmost or pelvic girdle scarcely it erect still go on elsewhere in the organic structure ( Pai and Douketis, 2012 ) . The larger venas that go through the musculuss of the calf and thigh are deep leg venas. They are non the venas that we jakes see hardly below our teguments, neither are the same as varicose vena. Deep Vein Thrombosis is most common in grownups oer age 60 but it can go on at any age each bit good. DVT normally can do embolism when a portion or all of the blood coagulum in the vena breaks off from the site where it is formed and travel along the venous brass. DVT can sorb to long persistent job. It can damage the ve na and do the leg to breeze through, swell, alter colour and leg sores aft(prenominal) old ages.What cause deep vena coagulums to trick out? Blood coagulum can organize in venas when you are inactive. For blink of an eye, coagulums can organize if you are paralyzed or sit while on a long journey. Surgery, hurt and cancerous neoplastic disease likewise can damage your blood vas and lead to blood coagulum. If DVT remain in the legs it can do a fewer complications including phlebitis and leg ulcer besides can take to pulmonary intercalation. Phlebitis is a status which blood coagulums with redness in superficial vena was rarely cause serious job but if blood coagulum in deep venas go on require fanfare attending because it can take to intercalation.Deep Vein Thrombosis can do the blood flow in the vena is partly or wholly occlude by the blood coagulum. The common site for DVT is in calf vena and a thigh vena is less normally affected while DVT is seldom happen in other deep ven as. There are few alternate names for DVT such as thromboembolism, post-phlebitic syndrome or post-thrombotic syndrome. A pneumonic intercalation is a dangerous complication and long-distance flights may lend to the hazard of DVT or besides known as economy-class syndrome. Coronary bosom disease, being overweight or corpulent, coffin nail smoke, gestation, household history of DVT or recent military operation or hurt besides can take for DVT to go on. A DVT is frequently merely a one-of event after a major operation has been make. However, some people who develop a DVT absorb an on-going hazard of a farther DVT. If have a blood curdling job or continued stationariness, so everybody are advised to seek for a medical care or take anticoagulation such as heparin injection ( after which they are prescribed Coumadin ) to avoid farther complication.LITERATURE REVIEW2.1 HistopathologyHistopathology refers to the microscopic scrutiny of tissue paper in order to analyze the manifestation s of disease. Examination of a biopsy or surgical specimen by diagnostician, after the specimen has been processed and histological subdivisions have been topographical points onto glass slides besides can good depict about the histopathology.Sing with DVT, its histopathology is rather complex to understand. Differential diagnostic considerations prior to thrombolytic intervention and cognitive operation should include tumors. Definitive diagnosing can be achieved by a biopsy but CT and MRI besides bring rather a liaison in naming DVT.However, CT and MRI merely such a waste when the disease is at an advanced phase because any of these scrutinies should be done in the early phase of disease. Based on Phlebol ( 2006 ) , soleal vena was the most frequent site of DVT. At depression, primary thrombi would be formed at soleal venas, so its will propagate to proximal venas. The proximal venas would be occluded by fresh thrombi, thenceforth secondary thrombi were made at non-drainage ca lf venas. Paterson and McLachlin found that most venous thrombi consisted of two parts. One of it is composed preponderantly of fibrin and trapped red blood cell while the other one are composed more often than not by aggregative thrombocytes. The fibrin-rich parts that attached the thrombi to the vas wall, while the platelet-rich parts localized farther from the site of fond regard. These coming into court that activation of curdling system come before thrombocyte activation and aggregation during the formation of venous thrombi ( Lopez et al, n.d ) . Based on that information, we know that the usage of anti-platelets drug in venous thrombosis is actually limited. Histopathology grounds in DVT shows that coagulation occurs on or nearer to the endothelial surface. When curdling starts on the endothelial surface, thrombocytes may be regrouped to the fibrin coagulum rich in thrombin through adhesive interactions and it will ensue to farther thrombus growing.Based on everything that declared supra, we can state that the thrombocyte aggregation localize to parts of the coagulum that are far off from its site of attachment and anti-platelet drugs such as acetylsalicylic acid has prove that it can cut down the hazard of DVT in our hold dear life.2.2 Causes and Risk FactorsDeep Vein Thrombosis occurs when a blood coagulums signifiers in a deep vena in our organic structure. DVT ever go on in the legs but it can still go on in your weaponries, thorax, or other countries of your organic structure. The blood coagulum can barricade our circulation or consign in a blood vas in our lungs, bosom, or other portion of our organic structure and can do terrible organ defame and can take to decease. This subject will uncover about every causes and hazard factors that can take to DVT.There are many another(prenominal) causes and hazard of DVT. many of that areA individual will hold DVT when a vena & A acirc s inner liner is damaged. There are many factors that can take to this hurt. For instant it can be cause by physical, chemical, or biological factors. Besides, surgery, serious hurts, redness and immune responses besides can be the causes to it.DVT can besides go on when the blood flow is sulky or slow. Stationariness or deficiency of gesture can do sulky or slow blood flow. This status ever occurs after the surgery, bed remainder for a long period and holding a long journey that take a long clip.A status which blood is thicker or more likely tend to coagulate than normal ( thrombophilia ) besides can ensue in DVT. This is due to familial status such as V Leiden factor that make up the hazard of blood curdling. Apart from that, endocrine therapy or brook visit pills besides can increase the hazard of blood coagulum.The preventive pill and endocrine replacing therapy ( HRT ) has little increased hazard of DVT since the oestrogen in it can do the blood to coagulate somewhat more easy.Peoples with malignant neoplastic disease or bosom failure c an besides increase the hazard for DVT. Usually, probe looking for the cause of DVT may demo malignant neoplastic disease to be the implicit in cause.Older people over the age 60 old ages besides probably to hold DVT peculiarly if they have hapless mobility or holding a serious unwellness that can halt them to make a batch of action.Pregnancy besides increased the hazard for DVT to go on. Normally, within six month after they give birth or while they are pregnant.Dehydration will increase the opportunities for DVT because the blood becomes more gluey an apt to coagulate.As a male, safeguard should be taken because work forces tend to develop a DVT more frequently than adult females.Bing an corpulent individual besides can take to DVT.There are many causes and hazard of DVT that we are incognizant of it for the certain time.DVT can go on anyplace in our organic structure portion and besides can charge everybody in different ages but older people are more vulnerable to it. The most barbaric patient to hold DVT is after holding a surgery because the blood can easy coagulate if it non cared in a good ways. Lack active individuals besides are in a high hazard of DVT since it will do the blood to flux easy and easy to coagulate. DVT besides can be inherited and incorrect pill intake besides can ensue in DVT. In easy word, there are many causes and hazards that can take to DVT and every citizen around this universe should take every safety safeguard to avoid DVT.2.3 Incidence and ComparisonThere are many people around this universe that have experience DVT. About 2 million Americans have experienced DVT each twelvemonth without they are recognizing it. Based on Convenient option for DVT ( 2012 ) , the exact incidence of DVT is still unknown in Malaysia but there is turning grounds that DVT is non uncommon in Asians. Based on necropsy surveies, hospital audits of admittance to major infirmaries and besides subclinical DVT in high hazard state of affairss such as af ter major joint surgeries show that there is increase of the incidence. Harmonizing to Prof Hatem Salem, Head of Department, Australian fondness for Blood Diseases, there is sedate misconception that DVT is rare in Asians because he finds out that Asians excessively are at hazard of DVT ( Convenient option for DVT, 2012 ) . Normally, DVT happen after post-surgeries and a few studies have appeared with high incidence of DVT in orthopaedic patients comparable to westward spate. Dhillon, Askander and Doraisamy ( 1996 ) suggest that the present pattern of keep backing unremarkable prophylaxis against thromboembolism in Asiatic patients undergoing unsuitable orthopedic process should be reconsidered.In Western states, DVT occurs in 45 % to 84 % of patients after hip and articulatio genus surgery in the absence of prophylaxis ( Stulberg et al, 1984 ) but there is a steadfast belief that the complications is rather rare in Asiatic patients. Lack of consciousness in Asia of a status th at become one of the chief slayer factors in West is due to the religion that thromboembolic disease is rare in Asia. Since DVT ever have been link with post-operative so every patient that have undergoes surgery should take a good attention of their wellness to avoid DVT. However, there are few sentiments that stated DVT is rare in Asians and the first study was made by Tinckler in 1964 stated that there is rareness of post-operative DVT and pneumonic intercalation in Asians ( Tun et al, 2004 ) . A survey that has been made in a few Asians state like Malaysia, Hong Kong and Japan besides show that there is low incidence post-operative DVT has happened around this state.A few incidences in Asiatics can be taken to do a comparing with the Western to demo differences in frequence of DVT in this universe. In developed states of the Western country show that DVT and attendant pneumonic intercalation is still becomes the figure one menace to post-surgery while in Asian specifically in M alaysia show that there is still low incidence of DVT after the operation done.A survey has been made in United Kingdom to stand for Western cerebral hemisphere and Malaysia as Asian & A acirc s representator. In UK, Sandler and Martin found that 9 % of patients admitted to a general infirmary died and 10 % of these deceases were due to pneumonic intercalation that originated from DVT of commence limb. Based on a survey made in Hospital Universiti Sains Malaysia, Malaysia on 45 patients, merely one positive DVT confirm among 45 patients that have been observed. There is merely 2.2 % and this good consequence show incidence of DVT among patient in Asia is still low ( Tun et al, 2004 ) .In a nut shell, the incidence of operative DVT in Asiatic patients is non low as is normally believed and besides it is non high like we know. Larger surveies are needed to settle this contention and happen out all the true fact sing this affair. Based on survey that has been made above, everyday p attern of keep backing prophylaxis in Asiatic patients undergoing bad orthopedic process should be reconsidered. We can reason that DVT is still low in Asians but we should be cognizant of DVT in the hereafter because it is excessively hazardous to take this affair as little things.2.4 Mortality and MorbidityIf DVT is left untreated, there are many bad effects can go on and some of that can ensue in mortality and morbidity. There is short-terms morbidity in DVT such as cardiorespiratory effects that may detain ablactating from automatonlike airing and there is besides long-run morbidity like patient-centered effects such as chronic venous inadequacy. Based on Vascular care for ( 1998 ) , short-run mortality for DVT patient is reported to run between 7 % and 15 % merely while long-run mortality has record a salient figure of deceases for patient with DVT. In a Dutch survey of 355 patients, 90 died during follow up. Patients with a DVT are at hazard for morbidity and mortality sinc e a fragment of the thrombus can embolize to the lungs. Anthony and Bon ( 2004 ) , suggested that about one half of patients with an untreated proximal DVT will develop a pneumonic intercalation within 3 months. In the yesteryear, contrast venography has been used to govern out DVT. Nevertheless, due to some job such as outgo of work force and clip, infinite and equipment and most importantly is it besides associated with morbidity, it was been terminated and been replaced with other machine that can get the better of this job. There are many indicants of short-run mortality of patients with DVT such as malignant neoplastic disease, pneumonic intercalation and major hemorrhage. There are besides many caused that can take to long-run mortality such as malignance, pneumonic intercalation, acute myocardial infarction, ischaemic shot and decoagulant think to bleeding.2.5 Pathophysiology2.6 Signs and SymptomsThere are few symptoms to acknowledge DVT but frequently DVT occurs without any symptoms. The symptoms of DVT are related to obstructor of blood returning to the bosom and doing a pooling of blood in the leg. Patient with DVT will undergo puffiness of the affected leg and the leg may experience warm and look ruddy. Apart from that, patient calf or thigh may hurt or experience stamp if it is been touch or squeezing or when base or move. There are no symptoms appear if the blood coagulum is little and for some instances, Pulmonary Embolism is the first mark that confirm for DVT. Basically, it can be difficult to observe DVT since some of the symptoms are same with other wellness jobs. Sign and symptoms entirely are non mint candy to find the DVT but when hazard factor is take under considerable, so it can assist to find likeliness of DVT.Some of the common mark and symptoms of DVT troubleSwelling ( hydrops )TendernessInflammation or tegument colour alterationsSkin heatStainDilatation of venas surfaceDiscomfort when the pes is pulled upward(a)Leg wearinessSigns and symptoms occur vary depending on the badness of the status and non all of these symptoms have to happen with deep vena thrombosis.2.6.1 Conditionss That May Cause uniform SymptomsPatient is advised non to do any early premise in holding Deep Vein Thrombosis if they are undergo the symptom that stated above since there are a figure of different conditions that can do the same mark and symptoms like DVT.Some of the conditions areMuscles achings and cryingsSuperficial thrombophlebitis ( blood coagulum that forms in an inflamed portion of a vena near the surface of the organic structure )Varicose venas ( blood vass that are abnormally conceited and warpBlood coagulums in arteriasArthritis ( redness of the articulation )Cellulitis ( infection in tissue under the tegument )Bone breakLymphedema ( swelling in the custodies and pess caused by otiose unstable keeping )Since DVT symptoms are rather same like other wellness job, patient demand to undergo specific process and particular e xam to corroborate the diagnosing or regulation out the other job.Imagination MODALITIES3.1 First Line Evaluation3.2 Second Line EvaluationIMAGES FEATURE OF PATHOLOGYTREATMENT AND PREVENTIONPrognosisDecision

Total Hospital Information System Hospital Selayng

1. 0 infirmary genteelness clay (HIS) Overview 1. 1 Definition infirmary selective nurture constitution (HIS) is an integrated schooling organisation which spans by means of the organization crafted to manage clinical, administrative, financial and operational functions of a infirmary. HIS strives to achieve the most in force(p) support for tolerant of of role of safeguard and governing body by means of various different electronic entropy affect and analyzing tools (Ismail, et al. , 2010).HIS serves as a platform to provide the required reading to each level of the concern at the correct condemnation, in the correct form, and in the correct place, contributing towards alter decision making. HIS plays a pivitol role in planning, initiating, organizing and commanding the operations of the sub frames of the infirmary and thus equips an organization with synergy and integrity required for it to function. more importantly, HIS also enhances patient c be and c omfort by offering personalized suggestions for c ar and enables a hospital to move from backward to a concurrent review select (Ismail, et al. 2010). 1. 2 Global Trend in hospital study System (HIS) In early 2009, the market value of infirmary nurture Systems (HIS) market was $7. 8 one and save(a) million million worldwide and this figure has been predicted to leap to an alarming $18 billion by 2016. The boom is primarily impelled by governments dynamic motives and hospitals continually trying to increase work die hard efficiency Hence, hospitals atomic number 18 confident that cover HIS will result in increased efficiency and trim medical errors, which later translates into uplifting the quality of sustenance provided to patients (Global entropy, 2010).Growing evidence has demonstrated that the current systems fail to deliver adequately safe, high standard, cost-effective and economical health c are. This force out be curbed by means of com seterization, with ele ctronic medical interpret (EMR) as the fundamental component. This has resulted in clinicians and health cathexis organizations around the globe scrutinizing into adopting more EMR technologies in their respective hospitals.France, UK, US, Canada, Finland, Denmark, Australia, New Zealand and several separate countries hire proposed plans to construct a fully intergrated computer-based hospital infrastructures with the electronic medical record systems laying the cement work. In the Asia-Pacific region alone, umpteen palmy HIS effectuations have taken place in various hospitals much(prenominal) as in Japan, South Korea, Singapore and Malaysia (Global Data, 2010). 1. 3 The Malaysian Outlook The federal government had adopted a national-level strategy to create a paradigm shift in the nations healthcare system.The national Government aims to revamp the healthcare system so as to produce a county of healthy single(a)s and communities through the adoption of information technolo gy (IT). Major projects which has been undertaken allow Multimedia Super Corridor Telehealth Project and MSC Telehealth designing (1997) (Malaysianmedicine, 2004). Dr. H. M. Goh, secretary of both Malaysian wellness Informatics Association and Asia-Pacific Association for aesculapian Informatics mentioned that it is unrealizable to provide legal, safe and efficient healthcare ignoring IT, thus the the cost of healthcare would rise.He also state that without computerisation, we wont be able to retrieve incidentally information. ( Malaysianmedicine, 2004). Following this, Malaysia has witnessed several significant developments in the health care sector. One such eminent development is the establishment of total hospital information systems in Selayang hospital (Malaysianmedicine, 2004). 2. Overview of organization Selayang infirmary 2. 1 Brief History Located along the Kepong Selayang lane of Gombak District, Selayang Hospital is a 960-bedded hospital which has been in oper ation since 1996.Selayang Hospital (SH) is the pioneer in being the paperless and filmless hospital in Malaysia. Though classified as a government hospital, it has sophistication of a luxury hole-and-corner(a) medical center with a leading-edge on technology. The hire for this ultra-modern hospital came about as Hospital Kuala Lumpur (KLH) was already bursting to its limits with its overworked staffs. Organized and accurate documentation and archiving was impossible with misl forethought or missing patients records. This had resulted on KLH being obscure in legal matters. increase number of patients expressed their displeasure and quality of patient care was deteriorating.These percentage surged MOH to come up with SH project with prudish incorporation of HIS (Yook, 1999) 2. 2 Clinical go at Selayang Hospital Among the services offered at Selayang Hospital are Gastroenterology, Hepatobiliary, Cardiology, Nephrology, Urology, Hand and Micro and Surgery. All the rest are catego rize under secondary services, outpatient services and supportive services. The core business of Selayang hospital is providing a exclusive 3rd referral services to patients across Malaysia and a broader range of clinical services to customers who rely on Selayang Hospital as their regional or local hospitals.High quality specialist services in a spacious number of former(a) fields is also a highlighted aspect of this hospital (Yook, 1999). 2. 3 Vision The Selayang Hospital project was designed by the Ministry of health (MOH) in accordance with the Malaysias Vision of 2020, where the country would develop a developed the countrys Vision for Health was formulated proposed a national health policy. Besides, it was particularly mentioned in the Seventh Malaysian that there will thirty three paperless public hospitals launched in Malaysia. More specifically, eight of these hospitals will be utilize hit Hospital Information System (T.H. I. S), Selayang Hospital being one of them ( Yook, 1999). 2. 4 Mission The mission of Selayang Hospital is to be a role model for Malaysian hospital, in using innovative, dynamic and cost effective technology and delivering a friendly, caring, compassionate and humanistic service. This wiIl be achieved through teamwork in partnership with the community to provide quality care to the gratification of our customers (Yook, 1999). 2. 5 Organizational organize uncomplainings at Selayang Hospital are of top priority so the structure is designed to maximize patients/customers satisfaction with emphasis on staff efficiency.The Board of Directors (BOD) with the assistance of Total Hospital Information System and a Medical Advisory Board committee oversees the hospital overall operation. There are five obvious divisions in the hospital administration. The total medical and non-medical staffs amounts to 1090 people. The BOD is accountable to the State Health Directors (Image could not be retrieved) (Yook, 1999). 3. 0 Total Hospital In formation System (THIS) in Selayang Hospital Selayang Hospital, the pioneer paperless and filmless hospital in Malaysia, uses Total Hospital Information System (THIS) for its fundamental operation.THIS combines aspects of clinical, administrative and financial management, enabling continual information flow surrounded by separate areas (Ismail, et al. , 2010). THIS would aid in meeting the objective of enhancing productivity, effectuality, efficiency, quality and safety. THIS facilitates communication in the midst of care providers through sharing of information, enables automation of work processes, integration and interfacing with other components of HIS in addition to providing clinical decision support and maintaining a permanent record as a medico-legal requirement (Abdollah, 2011).For the incorporation and functionality of THIS, Selayang Hospital had opted to vendor solutions like Cerner for electronic medical record, Seimens for radiology department, Spacelabs for critica l care unit, Oracle for materials management, finance and administration and Microsoft Office for internet and intranet usage (Li, 2010). blueprint 1 depicts the system architecture as rise as the technology partners that associate to Selayang Hospital (Abdollah, 2011). Figure 1 Information engineering science System Support and Technology Partners in Selayang Hospital (Abdollah, 2011).Figure 2 illustrates the structure of THIS in Hospital Selayang. Selayang Hospital incorporates clinical, administrative as well as financial processes as their total hospital information system within their hospital operations. There are various information system being deployed to cater specific needs and wants of patients and care providers as described in the following sections (Abdollah, 2011). Figure 2 Structure of Total Hospital Information System in Hospital Selayang (Abdollah, 2011) 3. 1 Types of Hospital Information System 3. 1. 1 Electronic Medical Record (EMR)Clinical Information Syste m (CIS) is thought of as the system that mediates accost patient care. at heart it, also lies the mechanical framework for capturing, storing and displaying the data generated by all clinical care activities. A outlined portion of patient-specific collected from disparate sources by care-providers working in the various clinical services is put to evolveher as the Electronic Medical Record (EMR). EMR essentially provides for the recording of the following groups of data a. visibility of the patient b. information gathered regarding the patients illness, allergies and health status c. ctivities performed on the patient d. events that occurred (planned and unplanned) e. results or findings emanating from these activities and events (numeric, text or sees) f. communications surrounded by care providers i. e. instructions, opinions, referrals and advice g. decisions and plans both immediate and long term (diagnosis, sermon plan) This consolidation is essential for the availabililty of future data for tracking puposes which in turn governs clinical management and patient data mining, in addition to report generating (Abdollah, 2011). EMR largely benefits government and health care providers.The need and requirement to document is both professional and legal as documentation enables care providers to communicate with each other thus facilitating continuity of patient care. Thus, in the form of the EMR, documentation satisfies the legal requirement of maintaining a record of events. It is accessible from multiple access points and units within the hospital and selective access outside the hospital. This largely reduces the time taken to retrieve medical records. Hence, the time taken to retrieve patient records are reduced. This would pave the expressive style for increased productivity and quality of care.In the mean time, it would contribute towards reform knowledge in clinical practices. Besides that, administrative benefits include easier report generation , bettor organization of clinical information, enhanced claiming and modulateing processes, reduced billing timings which translates into providing better service to patients. Futhermore, THIS improved clinical decision making and disease management, patient education in addition to better documentation, increased time allocated per patient, and rejuvenated perception of care and quality of a healthcare institute.The incorporation of DSS into medicine management, result generation and disease management are essential in good clinical practise. On the other hand, for researchers and policy makers can utilize EMR to device long term strategies for towards development countrys health care and proper allocation of resources (Haslina and Sharifah 2005). The workflow process such as the improvement of data inputting by avoiding duplications of datas, reduction is transcriptions costs as well as improved communication is also benefited by Selayang Hospital due to the successful implem entation of EMR (Erstad, 2003).Hence, in a nutshell, implementation of EMR such as improved decision making, disease management enhanced records and has do it possible to consume the use of papers for medical records. As a result, medical records become more trustworthy and intimately comprehendable. Figure 3 Electronic Medical record system . Source http//level8systems. com/page. php? 3 3. 1. 2 patient role counseling System (premenstrual syndrome) This system encompasses Patient Registration, Client-Resource Management and Charging, Billing and Payment system. For example, during patient registration, a credit number unique to that particular person is issued.This would act as the Medical Record (index) Number (MRN). It allows data regarding a single patient to be kept in a single record, shared between systems and used for subsequent visits and encounters without the need for perennial data acquisition and entry of static data. Staff theorize assignment is be part of the Client Resource Management System. It should enable all categories of staff to be allocated to work areas, rooms, wards, cubicles, beds, machines etc. according to dates and work shifts. Care providers need to sign in to confirm that they are unattached.The system should allow for constant updating of staff assignment. The Patient tracking facility through PMS would also provide real-time status display and reports on attendances, location of patients, status of service provision and discharges Next, The Charging-Billing System would be able to calculate charges based on factors according to policies set by the hospital. It would be able to charge differently based on the service delivery such such outpatient service, catch service and Inpatient service in addition to scrutinization by financial class.Figure 4 illustrates a typical Patient Management System software which stores and updates patient records. Hence, PMS enables patients records to be compiled and accessed in an o rganised manner. Besides that, subsequent processes like patient administration, clinical support tools and generating reports also is made easy. In addition, it also enables fast diagnosis with proper relevant treatments available (Netripples, n. d. ). Figure 4 ordinary Patient Management System. Source http//hpathy. com/software/hompath-classic8. asp 3. 1. Picture Archiving and Communication System (PACS) Pictures Archiving & Communication System (PACS) is majorly used in medical imaging unit. X-ray, echocardiogram, ultrasound machines capture digital images of a patients clinical condition. These images are sent to appropriate destinations using this system. It can be imagined as a business network which carries water, which in this case are the images. Every laboratory at Selayang Hospital is equipped with a high-end resolution computer screen to view these images captured from the machines.This service is provided by Siemens in Selayang Hospital. With the help of PACS, image s are viewed on screens rather than the conventional x-ray images which are as bulky as a spreadout newspaper. More importantly, PACS reduces the radiation exposure in both patients and care providers. This leads to a healthier working environment better image distribution timeless retrieving of data and images image quality improvement as well as easier handling of images Dr. Zaharah (n. d. ).Thus it can be understood that PACS is not a stand alone system but a subsidiary support system of Radiology Information System (RIS) described in next section. 3. 1. 4 Radiology Information System (RIS) The Radiology Information System (RIS) is a system, which enables care providers who to capture, store and distribute images by interacting with the machines that produce these images and also the clinicians who request for the images. The Radiology Information System (RIS) is a system, consists of the following major functional areas 01.Ordering of examination 02. Scheduling of appointments f or examination 03. Creation of work lists 04. Tracking of examination and reporting status of cases 05. Image Tracking and Management 06. Clinical Result Reporting, 07. Storage and convalescence of reports To summarise, RIS which belongs to the radiology department, is a huge database which can be used to perform x-ray imaging, echocardiograms, computerized axial imagery (CAT) scans, positive emission tomography scans (PET) and magnetic resonance imaging (MRI) tests when necessary ( Dr Zaharah , n. . ). The RIS creates and schedules the patient order for an image study. The RIS allocates a unique accession number to the order, sends a message to the PACS and the imaging modality to maintain trueness in patient demographic details (Figure 5). Figure 5 Integration of RIS and PACS in acquiring and processing of images Sourcehttp//www. pukkaj. info/NewsArchive2007/SendingradiotherapyimagestoPACS/tabid/1111/language/en-GB/Default. aspx) In a fully functional THIS system, RIS must be a high degree of integration between with EMR, PACS and PACS.In this sense PACS is a sub-set of RIS. Radiology images are considered as part of each patients EMR. Images need to be treated just like other patient data. Images as data are managed by Picture Archiving and Communications System (PACS). RIS is also linked with scheduling system to schedule appointments for patients. Figure 6 shows the schematic representation of functions and relationship between RIS, PACS and EMR (Abdollah, 2011). Figure 6 Schematic representation of functions and relationships between RIS, PACS and EMR (Abdollah, 2011). 3. 1. chemists Information System (PhIS) pharmacy Information System (PhIS) operates in the pharmacy department for numerous activities which includes clinical screening, inventory management, prescription tracking etc. PhIS are elaborate computer systems that were structured to meet the needs and wants of a pharmacy division to function efficaciously and efficiently. Pharmacists will be able to overlook how medications are used in a hospital using insights from this system (Biohealthmatics, 2010). Clinical screening is one of the most important usage of PhIS.Drug interactions, allergies and all believable drug-related disorders can be monitored using the assistance of PhIS. When a prescription is issued, the system checks for all possible interactions between all the drugs prescribed together to a patient at one time or with every particular food, reported allergies to the drug, and even if the sufficient and appropriate dosage has been given based on the individuals body mass index (BMI), age, and other physiological factors. Instant alerts and warning messages are displayed if indecorous drug interaction is detected (Biohealthmatics, 2010).Inventory Management is a another major component of the PhIS. Pharmacists need to know the drugs available, usage pattern and balance of stock. This inventory can be separate from or be a part of the Procurement and Stora ge Information System of the hospitals integrated Management Information System. Continuous inventory monitoring is an essential requirement of a pharmacy in order to ensure that drugs never goes out of stock. Besides, multiple dispensing locations and manual inventory keeping is not only windy but can also lead to inaccuracy in inventory management (Biohealthmatics, 2010).In addition, prescription management for both in patients and outpatients is also a vital segment of PIS. For instance, when the issued prescription arrives to the pharmacy, the orders are checked and matched against available drugs in the pharmacy and past dispensed accordingly to respective patients. More interestingly, prescriptions that passes through the system that can track the physician prescribing the drug, date of prescription, to whom was it prescribed and when was it was dispensed.Automated label printing which bears directions on how medication should be followed is also possible (Biohealthmatics, 2 010). Besides, patient drug profiling can also be achieved through PIS. These are patient profiles and holds particulars of their present and previous medications history, known allergies, family history and other parameters. These profiles are also during clinical screening. A physican who prescribes a particular drug to a patient would be able to instantly see the patients profile and decide on whether or not this drug is appropriate (Biohealthmatics, 2010).Figure 7 shows a typical pharmacy information system modal provided by Siemens. This includes relevant information such as patient name, name of the drug, route of administration, dosage and frequency of administration. PIS works hand-in-hand with EMR to detect contraindications due to drug allergy, streamlines workflow in addition to assisting billing and charging in administrative and financial system. Figure 7 Pharmacy information system modal by Siemens Sourcehttp//www. medical. siemens. com/siemens/en_US/rg_marcom_FBAs/fil es/presskits/SiemensMAC. pg 3. 1. 6 Laboratory Information System (LIS) Laboratory Information System (LIS) manages all the laboratory faculties which includes clinical chemistry, parisitology, hematology, immunology and microbiology in terms of receiving orders, execute tests and producing results. It also provides modules for sending laboratory trials order to the appliances through its multiple instrument inter feelings so that the results can then be analysed instantly and a reports can be generated. Patient management is an important aspect of LIS.Patient particulars such as the date of admission, consulting doctor, and respective reference number would be maintained by this system. Data pertaining to the patients samples including the consulting doctor, corresponding department, specimen type, method of collection and the technician-in-charge of the collection can also be monitored (Nationmaster Encylopedia, n. d. ). In summary, LIS is used for processing and storage of infor mation generated by medical laboratories. EMR, PMS as well as order management system are customized in order to allow interferences between LIS which supports in-patient as well as out-patient services.Moreover, the system produces barcode sample labels which are therefore used for acknowledgment of test samples. In Selayang Hospital, there are around 150 barcodes readers that are being widely used daily (Abdollah, 2011). 4. 0 Impact of Total Information System (THIS) 4. 1 Benefits of Total Hospital Information System (THIS) Total Hospital Information System (THIS) is an enterprise-wide system which spans the organisaton, designed to enhance clinical outcomes, operational efficiency and to improve financial management for healthcare industry.THIS serves as a secured and dependable meticulously integrated system that allows hospital officials to record, store and selectively disseminate clinical and other patient related information to appropriate entities (Netripples, n. d. ). T. H . I. S. provides effective solutions to hospitals which plan on reducing the administrative burden and clinical transactions, in addition to providing compassionate services to their patients. On a typical solar day in Hospital Selayang, the inpatient admissions reach 150/day whereas outpatient visits would reach upto 1000/day amounting to 250GB of patient records.T. H. I. S has enabled effective management of such high flow of patients, data storage, processing and retrieval. Figure 8 illustrates the daily usage of T. H. I. S shows the heavy reliance and interdependance between Selayang Hospital and the information systems. Figure 8 Daily Utilization of T. H. I. S (Abdollah, 2011). With the presence of THIS, most of the patient care demands can be met because it computerizes the process of collecting, arranging, filing and retrieving patient information.Furthermore, world class patient care can be provided by the hospital when equipped with good decision support system from THIS. Additionally, T. H. I. S. benefits in various other methods such as comprehensive patient record keeping, much lesser paperwork, quicker information sharing means between various departments, more flexible organization, reliable and timely information and adequate inventory management. A user satisfaction survey conducted in 2003 among staffs of Selayang Hospital revealed that T. H. I.S was apprehended and well received among nurses and doctors followed by allied staffs and clerks as depicted in Figure 9. (Abdollah, 2011) Figure 9 User satisfaction survey 2003 (Abdollah, 2011). Productivity wise, Selayang Hospital has evidently shown higher productivity after the successful implementation of Total Hospital Information System (T. H. I. S. ). As Selayang Hospital had incorporated T. H. I. S. from the start of its operation, studies analysing the effectiveness of T. H. I. S. before and after implementation is not possible. However, a comparative study comparing T. H. I. S. n Selayang Hospital with a traditional government hospital, Hospital Klang is currently being carried out. Few early findings from this study shows implementation of T. H. I. S. has managed to reduced time taken for admission by 40%, patient stay by 10% and discharge processes by a remarkable 70%. Qualitative benefits of this system highlighted in this study include easy availability of data, better patient record management and improved workflow (Abdollah, 2011). The ability of Pharmacy Information System (PIS) to keep track of the entire drugs inventory within the hospital is commendable.The PIS head coach is also able to make orders when an alert is raised on a particular drug. This therefore ensures proper inventory management and that all drugs are always in stock. In addition to the privileges that pharmacies will get through the implementation of T. H. I. S, doctors of the hospitals are also able to reap off its benefits as well. For the clinicians, EMR and PMS aid in clinical manageme nt of patients. A medical officer no longer requires the doctor-in-charge to be physically present but still can receive consults from him/her utilizing EMR and PMS.All these systems has indeed helped Selayang Hospital to manage the hospital effectively with efficient decision making. Moreover, T. H. I. S. aids hospital administrators whereby it significantly improves operational control. Lastly, in addition to enhancing patient care, T. H. I. S also increases the profitability of the respective organization. In summary, there are a number of direct benefits of THIS in hospitals. The most important advantage of this system is the ability to meet patients demands in a timely manner owing to the automation involved in data collection.Other uses include great reduction in paperwork and more efficient patient particular collection and management. Considering the unwavering benefits from implementation of Total Hospital Information System, it will soon become a necessity in terms of hosp ital management. 4. 2 Ethical Concerns The number and the magnitude of challenges faced by healthcare organizations are unprecedented. Selayang hospital is no different. Increasing financial bruden, rising public an payer expectations and increasing number of consolidations have placed these hospitals under spacious stress.Heavy usage of information systems have provided record-keeping which is otherwise impossible. However, this leads to rapid and easy access to medical records fostering issues of privacy against expediency (Boyle, 2001). In Selayang Hospital, these issues are handled with utmost priority. Patients privacy and confidentiality is protected through several measures. totally authorised users are allowed to access these information. Authorised users who are found to be misusing their access would be bring in in audit trails and stringent disciplinary actions would be taken against them.Therefore, patients are assured of their personal data protection (Abdollah, 201 1). 4. 3 Drawbacks and challenges of Total Hospital Information System (THIS) Like any other information system implementation, in T. H. I. S. , users resistance to change is one of the major concerns. This is largely related to individual credence of IT application particularly by doctors and nurses. Though this is now not an issue in Selayang Hospital, failures in HIS has been repeated reported over the years.Unrealistic goals, complex user-interface, lack of clarity on the functionality required and lack of predisposition to the local systems were some of the key reasons contributing towards failure of THIS in many fledgling hospitals (Cassels, 1995). The developing countries face even deeper problems such as inadequate electricity supply, lack of proper infrastructure, unsustainable funding, and the inadequate educational levels of the hospital staffs who are likely to be the primary users of the system rather than doctors in these countries.Other concerns include slow respon se time, absence of easy login-procedures, and tedious data entry (Chandrasekhar and Ghosh, 2001). Selayang Hospital though comparatively better in IT receptiveness, initial reluctance was present. Even today, reluctance to change and accept an IT application especially the EMR system in a conventional society still persists. Appropriate strategies like IT training and incentives need to be deviced to make both patients and hospital officials more receptive towards these systems (Haslina and Sharifah 2005). 5. 0 Future PlansFollowing these victorious writ of execution of T. H. I. S, Selayang Hospital is currently looking a step ahead into developing a entirely automatise Pharmacy Information System (PIS) with Decision Support System (DSS). Besides, management is also emphasizing on improving reporting and data analysis, enhance clinical documentation module with decision support and realise mobile computing function to facilitate better hospital management (Abdollah, 2011). 6. 0 Conclusion It is beyond doubt that T. H. I. S has been the backbone in assisting hospital administration to ensure Selayang Hospital runs smoothly.However, without the staunch trueness from top management, physicians and other users and adequate number of IT professionals, this success would have remained as a dream. Thus, information systems only when coupled with good recipience would prove beneficial. 7. 0 References Abdollah, 2011. Hospital Information System in Selayang. Booklet September 2011 ed. Selayang Hospital Information Technology Department. Biohealthmatics, 2010. Pharmacy Information System, online retrieved from http//www. biohealthmatics. com/technologies/his/pis. aspx accessed on the 2nd October, 2011 Boyle, P. 2001. Organizations ethics and healthcare principles, cases and practical solutions. San Francisco Jossey-Bass. Cassels, A. ,1995. Health sector reform key issues in less developed countries, Journal of International Development online retrieved from http//w ww. ncbi. nlm. nih. gov/pubmed/12290761/ accessed on the 3rd October, 2011 Chandrasekhar, C. P. and Ghosh, J. , 2001. Information and communication technologies and health in low income countries the potential and the constraints, Bulletin of the World Health Organization, Vol. 79, No. 9, online retrieved from

Improving Communication for People with Learning Disabilitie

tuition z one CONTINUING PROFESSIONAL training Page 58 Improving confabulation for large number with larn disabilities Page 66 skill disabilities denary choice questionnaire Page 67 Read Annette Martyns implement profile on type 2 diabetes Page 68 Guidelines on how to write a practice profile Improving converse for hoi polloi with study disabilities NS336 Godsell M, Scarborough K (2006) Improving converse for tidy sum with ensureing disabilities. Nursing Standard. 20, 30, 58-65. Date of acceptance February 6 2006. Summary Patients with discipline disabilities shed higher wellness dole out risks than the unremark up to(p) population.Similar essay Collate development About an Individuals parley and the Support Provided wellness professionals hire to develop skills that enable them to communicate effectively with this patient group. reconcileing barriers to conversation is the first step to reducing or removing them. Suggested strategies to reform wellnesscar gon entrance money for patients with erudition disabilities include ontogenesis individualised wellness action plans, simplifying communication styles and providing accessible facilities and tailored resources. encyclopaedism activities you should be able to generalize the impact of communication on interaction in the midst of wellness reverence providers and patients with education disabilities.Describe the relationship between communication and the health inequalities experienced by quite a little with development disabilities. Identify strategies to improve communication between health providers and patients with cultivation disabilities. Authors Matthew Godsell and Kim Scarborough atomic number 18 senior lecturers, Faculty of health and Social Cargon, University of the West of England, Bristol. Email Matthew. emailprotected ac. uk Introduction acquisition dis king is non a diagnosis however a term utilize to describe good deal with a wide range of strengths and contains.Eighty per cent of children and 60 per cent of adults with learning disabilities live with their families (Gravestock and Bouras 1997), and many flock with learning disabilities exceed the expectations of families and professionals in their capacity to learn new skills and develop their talents (NHS Executive 1999). The term learning disability says diminutive or so an individuals strengths and needs exactly it does incorporate three elements that place in most definitions (Box 1). Emerson et al (2001) state that the number of hoi polloi with learning disabilities in the UK has not been determined.They cipher that in the UK there could be as many as 350,000 people with dreadful learning disabilities ( cognizance quotient (IQ) 50). This path that 2 per cent of patients atomic number 18 exchangeablely to put one across a learning disability (NHS Executive 1999). The ways in which people with learning disabilities be described relieve oneself changed. Terminolo gy and related facts are nameed in Box 2. nurse STANDARD Key lecture to confabulation attainment disabilities nursing attitudes These key run-in are based on the egress headings from the British Nursing Index. This hold has been subject to double-blind review.For related conditions and author guidelines visit our online archive at www. nursing-standard. co. uk and calculate using the keywords. Aims and intended learning outcomes The aim of this article is to explore the impact of communication on health alimony for people with learning disabilities. The article discusses how cognition and communication influence interactions between healthcare providers and patients. It to a fault examines how low-down communication can contri entirelye to health inequalities that separate people with learning disabilities from the rest of the population.The article explores communication strategies that can overcome or reduce barriers to effective health care. After reading this article a nd completing the 58 april 5 vol 20 no 30 2006 m out 1 establish on a contrive of 2 per cent of patients having learning disabilities, it is likely that 40 per 2,000 patients registered with GP service are likely to have learning disabilities. How many patients with learning disabilities are you aware of in your practice landing field? List well-nigh of the reasons that might prevent people with learning disabilities from accessing local health work. wellness inequalitiesAlthough people with learning disabilities are lifespan desireer, the gap that separates the health location of people with learning disabilities and the general population has increased. Cohen (2001) asserted that gross inequalities in health are politically, affablely and economically unacceptable. An investigation into health inequalities by the constipation Rights Commission (Nocon 2004) found that people with learning disabilities have An increased risk of earlyish death compared with the rest of t he population mortality rates are specially high for those with much severe impairments.A greater variety of healthcare needs. many needs that are not met. High rates of unrecognized or curtly managed aesculapian conditions including hypertension, obesity, heart disease, abdominal pain, respiratory disease, cancer, gastrointestinal disorders, diabetes, chronic urinary booklet infections, oral disease, musculoskeletal conditions, osteoporosis, thyroid disease, and visual and hearing impairments.A briefing paper produced by the NHS Service rescue and Organisation (SDO) Research and teaching curriculum (NHS SDO 2004) identified barriers to appropriate and cartridge holderly BOX 1 translation of a learning disability A mortal with learning disabilities has Significant reduction in the ability to reckon new or complex entropy. Reduced ability to cope independently. Impairment starting in childhood that will have a indestructible effect on emergence. (DH 2001) access to he alth care within and outside services.Many people with learning disabilities find that identifying their healthcare needs is a major challenge. proactive strategies are required to encourage people to access the full range of services that are available. few people with learning disabilities have said that negative and unhelpful attitudes from healthcare workers have prevented them from seeking medical help (Bristol and District People First 2003). Support and rise are required by carers, affiliate and friends before people with these concerns are ready to engage with services again.People are more likely to corporate trust service providers when they are convinced that services and practitioners have responded to their needs by astir(p) communication skills and producing teaching in an accessible format. People with learning disabilities have the same right to access mainstream services as the rest of the population (Department of wellness (DH) 2001). However, mainstream servi ces have been slow to develop the capacity and skills to graceful their needs.In the archive Valuing People (DH 2001) it was ac companionshipd that the wider NHS had failed to consider the needs of people with learning disabilities and that overcoming this source of inequality was the most authorised issue for the NHS to address for this patient BOX 2 Terminology and facts related to learning disabilities amiable impede was a term use to describe people with learning disabilities. It is no longer used in the UK. Mental retardation is a term used internationally, however, it is not an accepted term in the UK and some whitethorn find this term offensive. Learning hindrance is the term used in education to limit individuals who have specific learning needs, for example, dyslexia. Some people who are identified as having learning difficulty by education services whitethorn also be considered to have a learning disability, but this is not necessarily the case. Mild, pathrate, sev ere and profound are terms to describe varied degrees of disability (Figure 1). A person with mild learning disabilities might communicate effectively, learn, live and work with little support.However, a person with profound learning disabilities will require support with activities of daily living, for example, communication, dressing, feeding, washing and mobility. A diagnosis of psychic illness is not the same as having a learning disability, but people with learning disabilities whitethorn have kind health issues as well. not everyone with learning disabilities requires a social worker or a residential district nurse. People with learning disabilities may have multiple diagnoses offspringing in complex health needs. People with the most profound somatic or sensorial impairments do not always have the most profound cognitive impairments.NURSING STANDARD april 5 vol 20 no 30 2006 59 learning zone nursing attitudes group. The briefing paper produced by the NHS SDO (2004) provided key action points for removing barriers and improving access to health care, which included Using specialist learning disability teams to aid adaptation of mainstream services to meet the needs of patients with learning disabilities. Developing strategies for health education and health checks for people with learning disabilities that enhance timely access to health care.Families and paid carers have an all important(predicate) share in helping people with learning disabilities to access health care. Some people will need assistance to recognise mental health problems and to identify gradual changes in health. Time out 2 Make a list of the ways that you communicate with patients nearly their health, for example, through appointments and telephone calls. Take three examples from your list and consider reasons why communication with a person with learning disabilities might be difficult.Give an example of effective communication between a practitioner and a person with l earning disabilities. Policies should address the use of technology to support communication, and the development and dissemination of accessible teaching. Jones (2003) suggests that managers and commissioners of services should liaise with health, social care and education agencies to ensure consistency in communication policies throughout the lives of people with learning disabilities. Communication can be broadly defined as the exchange of training between a sender and a receiver (Figure 2).Where a person has learning disabilities they may be communicating with an intention to attract a communication partner and commence a two-way dialogue. However, for some people with profound learning disabilities sending a message might be a response to their eubstance and feelings. Their level of cognition might be such that they are unconscious of possible communication partners and of how to take the communication further. This is called pre-intentional communication, in which the indi vidual says or does things without intending to affect those around them.It is important to remember that everyone communicates and that the role of communicator and communication partner swaps from one person to the some other so that a communion can develop. The challenge for health professionals is to develop skills that enable them to interpret the messages they receive and make the messages they send considerable. Communication is not only about verbal communication it is also about nonverbal communication, for example, the use of body linguistic process, words and pictures. CommunicationRecommendations have been made to improve communication and access to health services for people with learning disabilities. Jones (2003) states that services supporting people from birth to older age should develop communication policies. FIGURE 1 Estimated percentage of people with learning disabilities according to level of severity Mild Moderate 12% tough Profound 80% 7% 1% Augmentativ e and alternative communication systems Systems of communication, such as sanctify language, symbols and eye pointing, are known as augmentative and alternative communication systems (AACs).AACs can be used to enhance or replace customary pathways, such as speech or writing. The use of photographs of everyday objects, picture boards, line drawing and real objects are good ways to enhance communication with people with learning disabilities (American Speech-Language-Hearing Association (ASHA) 2005). You do not need to attend specialist training to be able to use AACs such as these. More formal AACs, such as Makaton (a form of sign language for people who have learning disabilities that uses keywords to enhance sagacity), require preparation but learning a sanctioned vocabulary does not require extensive training.Cognition and communication (Winterhalder 1997) Understanding complex information People with learning disabilities have a decreased ability to NURSING STANDARD 60 april 5 vol 20 no 30 2006 understand new or complex information (DH 2001), and those who experience difficulties when processing information may find it hard to learn new skills. Intelligence can be quantified as a figure related to an individuals IQ. However, it might be more useful to think about intelligence in relation to cognitive processes.Smith and Mackie (2000) describe cognitive processes as the way in which our memories, perceptions, thoughts, emotions and motives guide our understanding of the world and our actions. Intelligence exerts a powerful influence over the ability to process information, the capacity to learn new skills and to adapt knowledge to different situations. Intelligence is an attribute that can guide our understanding of the world, but it is not fixed or static. Teaching and learning strategies can be used to stimulate cognitive processes so that people can come on information, or potentially confusing situations, with more confidence.Similarly, complica ted tasks and information can be broken down into small, simple steps so that people can approach them in stages. Attempting to understand another persons cognitive processes can help practitioners to develop a more empathetic and person-centred approach to care, and can provide an incentive to develop the teaching and learning strategies that are best suited to the individual needs of patients. Coping independently People with learning disabilities may have a reduced ability to cope independently (DH 2001). Independence is defined according to levels of social public presentation.Assessment of a patients strengths and needs in social functioning is a fundamental stage in developing planned care that is familiar to practitioners from all branches of nursing. Making an accurate assessment of social functioning provides valuable information about the range of activities that a person can undertake on his or her own as well as those activities where a person requires support. Some peo ple with learning disabilities may require assistance with tasks such as washing and dressing, and many need help to have their mode of communication understood.Learning disability and development Learning disability starts before adulthood, affects people of all ages and has a lasting effect on development (DH 2001). A majority of younger people with learning disabilities are living in the community with their parents or carers. Older people with learning disabilities also live in the community but they may have periods of institutional care. Some people will have frequent butt with health services and others have ir veritable(a) contact. People with learning disabilities are not a homogenous group. Their perceptions of nurses, NURSING STANDARDFIGURE 2 A model for communication Person communicating we take turns in this role of sender of information. Depending on the persons cognitive ability, this may be intentional or pre-intentional communication Communication barriers can be p resent in the surround as well as cosmos caused by the communicator and communication partner Communication partner we take turns in this role of the person who receives the information sent, makes sense of it and responds appropriately doctors, health centres, clinics and hospitals will have been shaped by their formative experiences with staff and services.Providing encouragement for people with learning disabilities to attend health checks and to make use of healthcare services can hire changing their perceptions of health professionals. Some people with learning disabilities have not received the treatment they need because they are reluctant to engage with services where they have had bad experiences in the past. To encourage people with learning disabilities to make effective use of healthcare services throughout their lives, practitioners need to use their communication skills to lead-in up and maintain positive relationships. Time out 3Think about the last time you commu nicated with a person with learning disabilities, or someone who has communication difficulties. Refer to the list you made in Time out 2 about the communication systems you use in your workplace. What are the main barriers to communicating about health with a person who has learning disabilities? How do you remove or reduce barriers to communication? Which environmental factors impede communication? Identify any barriers that you had not previously considered. april 5 vol 20 no 30 2006 61 learning zone nursing attitudes Barriers to communicationThere are barriers to communication which can be identified in relation to the person with learning disabilities, the health professional and the environment (Box 3). When barriers have been identified, health professionals can start to think about ways of reducing or removing them. Health professionals exchange information by using terminology that reflects their specialised knowledge. Patients and other people who are not elusive in th e day-to-day delivery of health care BOX 3 Barriers to communication The person with learning disabilities may buzz off restrict understanding. hold limited vocabulary or difficulty speaking. Have stunning impairments that limit ability to hear requests or instructions. Have poor understanding of health and healthy living. Be scared of people in uniforms. Be stressed because of illness. Not like new places. Have difficulty waiting and may not understand the concept of time or queuing. Have limited literacy and numeracy skills to read health advice and information, for example, instructions, letters, dosages. Expect contact with nurses to be unpleasant because of previous experiences. The nurse may Be rushed because of heavy workload.Have biases and assumptions about people with learning disabilities. Have poor listening and attending skills. Be unable to understand augmentative and alternative communication systems. Have limited knowledge of the individual. Have insufficient time to develop a good relationship with the individual or carer. Not use visual aids to support understanding. Use technical jargon and/or long words. Provide written information without thinking of the patients ability to read it. Provide information about the next appointment in a way the patient will not understand or remember.The environment may Be crowded. Busy. Uncomfortable. Have strange smells and noises. Bring back bad memories. Have limited physical access, for example, no hoists. Include unhelpful people. Have poor signage, relying on literacy skills and good sensory abilities. Have no area to sit quietly with limited sensory stimulation while waiting. Be filled with machines and instruments that a person with learning disabilities may not understand. may find it difficult to toil the terms and ideas they encounter in healthcare settings. They can find it hard to follow advice or instructions.This could result in patients making inappropriate decisions or exposing themselve s to unnecessary risks. For example, patients with learning disabilities who take their own medication may be at risk of overdosing or taking an ineffectual dose, particularly if the route and dosage of a newly prescribed medicine has not been relieveed clearly and/or recorded in an accessible format. Time out 4 Consider the list of potential barriers to communication and categorise them according to Barriers that have been intercommunicate for patients with learning disabilities using the services you work in.Barriers that can be remedied quickly. Barriers that need prep to be reduced or removed. Barriers that require financial investment to be reduced or overcome. Discuss this list with your colleagues. Identify strategies for removing barriers and improving communication. salutary practice in communication In in the south Warwickshire, health passports have been veritable for people with learning disabilities (Leamington Spa Today 2005). These provide detailed information a bout an individuals health, strengths and needs so that practitioners can provide patient-centred care.They are used to improve communication across a range of healthcare providers. Having an alert system incorporated into patient notes which provides individual communication needs could be beneficial, especially where staff do not know individual patients. Health practitioners may use and be involved in developing health action plans. These are plans specific to individuals and are developed to meet their access needs. Health action plans are a way of overcoming some of the barriers to high quality health care (DH 2001).Plans are produced by a group of people including the patient. They encourage the development of a divided understanding about an individuals health needs. Where training in health action planning has been provided for GP surgeries, improvements have been shown in the health of patients with learning disabilities (Smith et al 2004). There are bene turmoils to havin g a lead person to deal with learning disability issues. In primary healthcare services, a lead person takes an interest in learning disability issues, collates information, NURSING STANDARD 62 april 5 vol 20 no 30 2006 ives support and advice to health staff and develops links with specialist services for people with learning disabilities and other agencies (NHS Executive 1999). Time out 5 Does your organisation have a lead person who is involved in initiatives such as joint communication policies and the development and sharing of accessible health information? If yes, find out how he or she is supporting your team to develop skills in communicating with people who have learning disabilities. If no, how might developing this role benefit your team and improve access to health care for patients with learning disabilities?To improve communication with people with learning disabilities, more time should be allocated to appointments so that there is more time for them to express the mselves and understand any information they have received (DH 1999). This is particularly the case if AACs are being used. Reception staff are often aware of people who have difficulties using services. Supporting these key staff to develop effective communication skills and flexibility can improve access to health services (NHS Executive 1999).For example, if staff in reception are aware that someone finds it difficult to wait in a queue, they may offer that person the first appointment. Several resources have been developed by trusts to improve communication. Some examples of these include Hambleton and Richmondshire Primary Care curse (PCT), in fusion with Mencap, has developed an accessible Choose and Book guide for hospital appointments that uses a combination of pictures and words to explain how patients can make choices about hospitals and appointments.Bristol South West PCT, as part of its Expert Patient Programme, has developed plans that help prepare people with learning disabilities for a visit to the doctor. The Health Facilitation Team at Gloucestershire Partnership NHS Trust (2004) has produced a traffic light assessment that conveys information about individuals on portal to hospital. This ensures that important information is clearly communicated to health professionals. Camden PCT (2005) has used this work to develop an online resource. Although people may appear to have limited communication skills, they should not be ignored.These patients should be addressed directly and NURSING STANDARD the information they receive should be provided in a simple way without being patronising. rough-and-ready communication often depends on how the information is delivered. Practitioners may have to talk to carers, but they should not blank out to address the person with learning disabilities. Practitioners should examine their beliefs about people with learning disabilities and avoid making assumptions about an individuals strengths and needs. This wil l help to make health assessments more accurate (DH 1999).It is useful to request a speaker with learning disabilities to talk to healthcare staff about living with a learning disability and his or her experiences of accessing health services. Time out 6 What beliefs and values do you think nightclub holds about people with learning disabilities? Some examples of negative beliefs and values are that people with learning disabilities Have a poor quality of life. Have higher pain thresholds. Are dangerous and promiscuous. Will not understand anything. Should not get married or have children. Cannot care for their children. Need institutional care. Cannot work.Are like children not adults. What are your feelings about these statements? How might the presence of any or all of these beliefs influence the care given to a person with learning disabilities? People with learning disabilities can have additional physical or sensory impairments that should be considered. They are also more l ikely to have more mental health needs than the general population (DH 2001). Where a patient has additional impairments or health issues these need to be considered during communication. The healthcare environment should be adapted to accommodate people with physical or sensory impairments.Time out 7 In your work place Do you have a private area to talk to a person who has a large wheelchair? Do you have rooms where glare is pull stringsled and the environment is suitable for people with limited vision? Do you consider the needs of interpreters/ carers and ensure they fully understand information before they pass it on? april 5 vol 20 no 30 2006 63 learning zone nursing attitudes Accessible information Accessible information comes in many forms, such as videos, CDs, DVDs and audiotapes. Pamphlets can be produced with accessible information about the services offered.Written information needs to be in plain language, with short sentences and one subject per sentence. Photographs, drawings, symbols and other visual information can be used to support written information. It is important to keep pages uncluttered on plain backgrounds so that text does not detract from graphics. Letters should be large, 16-18 point type size, and fonts that do not have serifs, such as Arial and Comic Sans, should be used. Graphic text, underlining and italics should be kept to a minimum because they can impede readability. Many trusts are now producing resources to enhance accessibility.Some of these include The United Bristol Healthcare NHS Trust has produced a leaflet called You are coming to the Bristol Royal Infirmary about your heart, TABLE 1 Using terminology that is light(a) to understand Health issue Common words that are used Epilepsy Investigations EEG (electroencephalogram) Strategies or words that improve understanding Find out more about This word would have to be used, but a photograph of someone having an EEG may help understanding Medicine tablets to help contr ol your epilepsy Having two or more seizures straight after each other or whatever describes status for the individual Taking your medication as we have agreed Things that might make you have a seizure Not being able to have a poo for three days Things you feel in your head and body that make you think you will have a seizure Having a fit or turn, whichever word the person uses which uses pictures and words to introduce some of the staff and explain what happens when patients are admitted to the cardiology department.The Learning Disability Partnership Board in Surrey has developed The Hospital Communication Book that combines words, pictures, signs and symbols. Trafford North and South PCTs have produced a toolkit for people with learning disabilities called Cancer and You (Provan 2004). cope with your local Community Learning Disability Team or People First organisation for information about local resources. Simplifying conversation When talking to people with learning disabiliti es, use approaches similar to those used for written text. Plain language, the use of keywords, short sentences and one subject per sentence should be used. Give people time to process what is being said and to mould a reply.Use openended questions to assess a persons understanding and rephrase the question if necessary, as repeating the same question rarely improves understanding. When information is presented during a consultation it is important to check that the person with learning disabilities has understood it. If there is insufficient time during the initial consultation, it may be necessary to make a further appointment to check what the person has understood and retained. For an individual who processes information slowly this might be essential to ensure an accurate assessment and the effective implementation of a treatment plan. Examples of terms that are easier to understand are presented in plug-in 1.Such terms are only beneficial if the person understands them so, for example, constipation could be described as not being able to have a poo, but the health practitioner needs to know whether the person uses this term to describe defecation. Anti-epileptic drugs Status epilepticus Drug compliance Triggers deadening Aura Time out 8 Think of four common illnesses that are likely to make a person visit your service. Write these in the first column of a table (see Table 1). Identify the language you use when discussing these illnesses and record these words or phrases in column two. These might be medical terms, health terms or long words. Now spend some time identifying words that are easier to understand and record them in the third column. NURSING STANDARD Seizure 64 april 5 vol 20 no 30 2006 ConclusionPeople with learning disabilities may have communication difficulties that have restricted their access to health care and prevented them from receiving the information required to maintain their health. In addition to learning disability, they are more likely to have complex healthcare needs leading to multiple diagnoses. Steps towards better health for people with learning disabilities can be made by providing encouragement and support to attend regular health screening and reviews, and by developing a range of strategies to improve communication between practitioners and individuals with learning disabilities NS RECOMMENDED RESOURCES British Institute of Learning Disabilities (2001) Factsheet No. 005 Communication. www. bild. org. uk/pdf/factsheets/communication. pdf (Last accessed inch 10 2006. British Institute of Learning Disabilities (2005) Your Good Health (a set of 12 illustrated booklets). www. bild. org. uk/publications/your_very_good_health_details. htm (Last accessed March 10 2006. ) Communication Matters (updates 2005) What is AAC? www. communicationmatters. org. uk (Last accessed March 10 2006. ) Communication Matters (updated 2005) How to be a good listener. www. communicationmatters. org. uk (Last accesse d March 10 2006. ) Department of Health. www. dh. gov. uk (Last accessed March 10 2006. ) Foundation for People with Learning Disabilities (2004) Communication and people with learning disabilities. www. learningdisabilities. org. uk/page. cfm? agecode=ISSICMMT (Last accessed March 10 2006. ) Foundation for People with Learning Disabilities (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. www. learningdisabilities. org. uk/profilenews. cfm? pagecode=ISSICOLN&are acode=ld_communication_news&id=7231 (Last accessed March 10 2006. ) MENCAP (2003) You and your health a basic guide to being healthy. www. mencap. org. uk/download/you_and_your_health. pdf (Last accessed March 10 2006. ) Plymouth Hospitals NHS Trust (2005) Living with cancer. www. learningdisabilitycancer. nhs. uk/ (Last accessed March 10 2006. ) Time out 9Complete a SWOT analysis (strengths, weaknesses, opportunities and threats) of your skills and knowledge when communicating with and supporting access to health care for people with learning disabilities. Time out 10 Now that you have completed this article, you might like to consider writing a practice profile. Guidelines are on page 68. References American Speech-LanguageHearing Association (2005) Introduction to Augmentative and Alternative Communication. www. asha. org/public/ speech/disorders/acc_primer. htm (Last accessed March 9 2006. ) Bristol and District People First (2003) We are People First. (Film) People First, Bristol. Camden PCT (2005) What You Need to fill in About Me in Hospital. www. camden. gov. k/ (Last accessed March 17 2006. ) Cohen J (2001) Countries health performance. The Lancet. 358, 9285, 929. Department of Health (1999) approach the Facts Services for People with Learning Disabilities A Policy Impact Study of Social Care and Health Services. The Stationery Office, London. Department of Health (2001) Valuing People A New Strat egy for Learning Disability for the twenty-first Century. The Stationery Office, London. Emerson E, Hatton C, Felce D, Murphy G (2001) Learning Disabilities The Fundamental Facts. Foundation for People with Learning Disabilities, London. Gloucestershire Partnership NHS Trust (2004) Traffic light assessment. Unpublished document.Gloucestershire Partnership NHS Trust, Gloucester. Gravestock S, Bouras N (1997) Emotional disorders. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities A train Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 17-26. Jones J (2003) The Communication Gap. www. learningdisabilities. org. uk /page. cfm? pagecode= FBFMCHTP04 (Last accessed March 10 2006. ) Leamington Spa Today (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. Leamington Spa Today. January 19, 2005.NHS Executive (1999) Once a day One or More People with Learning Disabilities are Likely to be in Contact with Your Primary Healthcare Team. How Can You Help Them? Department of Health, Leeds. NHS Service Delivery and Organisation (SDO) Research and Development Programme (2004) Access to Health Care for People with Learning Disabilities. Briefing paper. NHS SDO, London. Nocon A (2004) Background render for the DRCs Formal Investigation into Health Inequalities Experienced by People with Learning Disabilities or Mental Health Problems. Disability Rights Commission, Stratford upon Avon. Provan K (2004) Cancer and You Toolkit for Working with People with Learning Disabilities. www. cancerandyou. info/docs/ FullToolkitNov04. pdf (Last accessed March 9 2006. Smith ER, Mackie DM (2000) Social Psychology. Second edition. Psychology Press, Hove. Smith C, Giraud-Saunders A, McIntosh B (2004) Healthy Lives Health follow up Planning in a Person Centred Way Including Health i n Person Centred Planning. www. valuingpeople. gov. uk/ HealthHealthyLives. htm (Last accessed March 10 2006. ) Winterhalder R (1997) An overview of learning disabilities. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 1-6. NURSING STANDARD april 5 vol 20 no 30 2006 65