Case Pneumonia Essay Example for Free

Case Pneumonia EssayPneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a excess concern for older adults and those with chronic illnesses, it can also strike green, healthy people as well. It is a common illness that affects thousands of people each family in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. There are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or opposite organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. Its trounce to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full retrieval.A cuticle with a diagnosis of Pneumonia may catch ones attention, though the disease is just like an ordinary cough and fever, it can lead to finish especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patients recovery faster. Treating patients with pneumonia is necessary to prevent its spread to early(a)s and make them as another victim of this illness. The lungs constitute the largest organ in the respiratory system.They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases. nisus that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of dickens bronchi. Eac h bronchus enters a lung. There are both lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one.The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end up at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the fondness throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body. Inhaling is due to contractions of the diaphragm and of muscles between the ribs.Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing. PATHOPHYSIOLOGY Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble pass arounding your blood. If there is as well little oxygen in your blood, your body cells cant work properly.Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs. Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. new(prenominal) pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli.Ma jor pulmonary pathogens in infants and children are viruses respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and Actinomyces sp mycobacteria, including Mycobacterium tuberculosis and atypical strains fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii and rickettsiae, primarily Coxiella burnetii (Q fever).The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, behind smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic re nal failure), compromised consciousness, dysphagia, and exposure to transmissible agents.Typical symptoms include cough, fever, and sputum production, usually evolution over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae. NURSING PROFILE a. Patients Profile Name R. C. S. B. Age 1 yr,1 mo. Weight10 kgs Religion Roman Catholic Mother C. B. Address Valenzuela City b. Chief Complaint Fever Date of Admission 1st admission

Emotional climax Essay Example for Free

Emotional climax EssayContinuing the theme of human race and its behaviour, I believe the following events to be true to that. It is strange that in a play that revolves around its religious puritan upbringing, it also lacks a certain amount of Christian/Satanic or general imagery or symbolism. I would say that in comparison to a play such as Macbeth which relies on its disturbing imagery to convey the involvement of dark forces with the plot, The Crucible uses the reactions and actions of human beings to essentially shock the audience with as opposed to bold and transparent imagery. The preceding actions of the girls is but a taste of the weak human nature that lead to some degree be the ruination of the innocents of Salem the inert lot to speak out once against those who will miss use power and authority to a larger ag annula, is the collective attitude that will allow silence to master the villages fate. The tension is released as the anger and madness dies, but the atm osphere is left with a slight air of detectable pessimism as the girls (including Mercy,) channel with no taste to rectify with monitor lizard anything he may have heard or stay for Abigails sake- (Id best be off, I have Ruth to watch.) Instead they leave apologetically and sheepishly, I extract- Mercy sidles out.Now that the stage is rid of the bulk, only the strong figure of Proctor, a slightly hidden Abigail and mute Betty re principal(prenominal). The scope is quiet, the audience surges with anxiety, as we are now fully aware of the extent of Abigails character and her master schemes for both characters on stage. The stage directions quote- Abigail has stood as though on tiptoe, absorbing his presence, wide-eyed. He glances at Betty on the bed. The video is perfectly set, almost waiting for Abigail to pounce.The remainder of the snap has only dramatic effect in the two characters direct mother tongue and actions. It is the dramatic effect of the language in the dialogue t hat develops the characters for the benefit of the audience as history repeats- Youre surely sportin with me. The flirtatious attempts of Abigail do nothing but declare the nature of their affinity. Proctors character is used in the first act and indeed second as a pawn, a strong male presence that conjures up history, friction and feelings between a variety of characters.In this quote, Proctors reply demonstrates their current familiarity, as he obviously feels his would be rude answer appropriate in her case, which suggests history and the blunt coldness of his words suggests a tainted one- You know me better, This is used to great dramatic effect as this quote is an font of what classes this scene a complication. The revelations between the two characters and the audience displays I theorize that in this epitome, a play like The Crucible has numerous complications, which take the severity of the real(a) complication (the witch hunts,) to a higher level. For example the threat of being accused by one villager is but trivial when the accusation of attempted mangle with witchcraft of which Elizabeth and Proctor are fully aware leads to trial, is brought to their knowledge. This accusation of attempted murder is one complication that mounts to a highly climatic and tragical demise.The heated and often dark references that Abigail uses are incredibly direct and delivered with a force that might suggest these are situations that are in need of persuasion. non only the dramatic tension created by her choice of tactics, but the very level of desperation and inner naivety of the character that results in juvenile actions is unfathomed The confusion behind the seemingly innocent Abigail is astounding and her unpredictability creates tension as the audience realises the precarious nature of the play when Abigail is involved.The next scene I will analyse simply overflows with emotion, brought out through the characters ordeals. Elizabeth is featured here, wife of Proctor and the other half of an unhappy marriage. Their struggles seemed to begin and end with that harlot, once again Abigail is at the centre of insular turmoil. Leading up to this scene, we have seen a troubled and excluded couple as Goody Proctor kisses him with suspicion and keeps their future bliss with it at the root of their marriage, Proctor bites his tongue with his sins past sins upon his shoulders. This scene is one of revelation and the audience sits enthralled as even tension created for the ultimate end disappears, as the couple who obviously unflurried have do it for one another quash their insecurities and make their peaceableness.The scene begins with this fluctuation of feelings toward one another still in tact. The atmosphere is one of grief and almost acceptance, as these accusations, deaths and confessions have continued over the past few months (since the previous scene,) and the two characters have bared gruelling witness to it all. Once again, this final appearance of Elizabeth to Proctor needs a more detailed explanation, as the stage directions take the audience through every one of their actions and therefore magnifying the importance of the revelation of this scene, Alone. Proctor walks to her, haltsThe gentle nature of Elizabeth has been taken advantage of, in order to coax proctor into a confession. Elizabeth has taken the opposite course of action and frees him from her suspicious grasp.Elizabeths query, though perhaps comical when an attempt is made to read it seriously, shows her utter lack of compassion and hold through the injustices of their predicament. Lack of compassion even for her own husband, though her enquiry made is meant in a considerate context- You have been tortured? Elizabeth continues to answer his questions in a cold and blunt manner, (their inhibitions still remain, anticipating the arrival of the emotional climax.)Extending the theme of revelation, this is probed unintentionally by Elizabeth and her remarks, for example she says about the death of Giles Corey, They press him John, more slant he says. Proctors reply is influenced by this, the courage of Corey is taken by Proctor and used to state, I have been thinking I would confess to them Elizabeth. In addition, the quote of Elizabeths instigates she wishes him to form a course of action, which he does in the previous quote.However, her reply is not one of looming suspicion or ruled by mistrust, it overcomes those petit consciences and the character finds the will to say, I cannot judge you John. No matter how Proctor begs for an order, a course of action or reassurance, Elizabeth stands strong and helps him to lose his inhibitions by making his own choice. The scene finally reaches a heart-wrenching climax as Elizabeth delivers the line Only be sure of this, for I know it now Whatever you will do, it is a wide-cut man does it. Whatever the finale, this is a satisfying resolution because the characters have admitted exa ctly what the audience almost begs them to say, the actors deliver a service of satisfaction.Perhaps the only the example of dramatic imagery is the recurring theme of winter inside the Proctor house, as opposed to the summer and heat in the midst of the Abigail/Proctor love affair. Elizabeth now admits that is was a cold attitude she had towards her husband a shrivelled marriage that she kept, a cold house. Her admittance of this symbolises the last string of the old relationship broken. The dramatic effective adds to the release of tension between the characters as the entire situation diffuses.Both of the characters fronts falter as they indulge in insular peace, pavage the way for the final resolution the turmoil between husband and wife is finally resolved, Proctor has everything to live for and the strength to do what is need to remain with family and friends- or is it? Unfortunately, the phrase too good to be true springs to mind, and also to the audience. The scene I analys ed is in theory the penultimate resolution. It fits this description perfectly, as although it is misleading -because Proctor decides not to have his life and confess, but die with sanctity of name- it is satisfying. Dramatic tension is built extremely subtly behind the contagious joy of peace between the Proctors, foreseeing the ultimate loss of inhibitions for John.True, the character has lost the stubbornness that kept his wife from him, but it is also true to Elizabeths statement that John has not forgiven him egotism self confessed sinner he may be, but a proud man is John Proctor. The truth may be that even in death, let wholly life would the character not forgive himself for his sins with Abigail. His martyrdom was the release of self-hatred through a noble stand he held onto the only thing that in his opinion was not tainted, his name.The Crucible recurs the theme of boundaries and limits, with such things as physical limits including the obsession with land, exclusive livi ng (within colonies,) and with names. Proctors boundary was infact the preservation of his name, that is the only earthly scrap of self he would not let go of- the only piece of self he realistically had left. This is a truly effective resolution, as the main character is finally at rest Miller is no hero for surviving the courts, but his duty to society is done, his warning and message still survives l years on.

Non Medical Independent And Supplementary Prescribing V300 Nursing Essay

Non Medical Independent And Supplementary Prescribing V300 Nursing EssayThis essay discusses the evolution of nurse prescribing in the context of legislation and governmental element, with the consideration of how this has changed and assist the clinical nurse specialist role, with contingently emphasis on internality in addition-ran. The pathophysiology of face trouble will be discussed and integrated into the relation of do drugs actions with particular interest into Diuretics. Alongside this the importance of effective tale taking, assessment and consultation skills to treat the patient finishedly and at a high standard and tone of voice is discussed. The decision making process and the importance of a overlap admission in relation to bosom misadventure is highlighted incorporating the importance of compliance in the tap the treatment of sprightliness harm.Sources of information and decision support systems that atomic number 18 available will be highlighted with a discussion on the importance of these in normals. evidence of ability to prescribe safely, ration soloy, cost effectively, and in consideration of the worldly concern wellness issues around medicine use argon discussed and finally clinical governance done quality assurance and audit of prescribing give is considered.For the purpose of the essay the following learning outcomes argon discussed guess understanding and application of the relevant legislation and political context of the practice of non- checkup prescribingCritically appraise sources of information/advice and decision support systems in prescribing practice and apply the principles of evidence based practice to decision making. conflate and apply knowledge of drug actions in relation to pathophysiology of the condition being treatedDemonstrate the ability to prescribe safely, rationally, cost effectively, and in consideration of the public health issues around medicines useIntegrate a shared approach to deci sion making taking account of patients/carers wishes, values, religion or cultureEvaluate effective history taking, assessment and consultation skills with patients/clients, parents and carers to inform feeding /differential diagnosis.Contribute to clinical governance through quality assurance and audit of prscribing practice and regular continuing professional developmentThe controls of medicines in the UK has undergone a number of regulatory changes since the end of 1800s, climaxing in the Medicines Act (1968). Prior to 1992, doctors, veterinary surgeons and dentists were the only professions legitimately permitted to prescribe. This situation made the medical profession gatekeepers for medicines, certainly the case for those medicines considered to a greater extent likely to grounds harm or abuse such as controlled drugs i.e. morphine.Cumberledge topic (1986) identified the need for community nurses to prescribe, The Crown taradiddle (1989) published findings of a review to determine the circumstances in which non-medical health professionals could undertake new roles with indirect request to prescribing, supply and administration of medicines and led to the development of protocols which we now know as Patient Group Directives (PGDs).The Crown Report (1999) recommended that legal authority to prescribe should be extended to include new groups of healthcare professionals, this also bought most the differentiation between Independent and Supplementary prescribers. This report noted that a doctor often rubber stamps a prescribing decision taken by a nurse, which is demeaning to nurses and doctors. (Cooper et al,2008)The Medicinal Products Act (1992) permitted fitted District Nurses and Health Visitors to independently prescribe, and this was only a limited number of medicines from a Community Practitioners Formulary.Over the next few years legislative changes occurred which involved, non community qualified nurses to train as prescribers, together wi th an subjoin in medications added to the Nurses Formulary. In 2003, nurses and Pharmacists were permitted to prescribe from the whole of the British field Formulary (BNF) as supplementary Prescribers, except controlled and unlicensed drugs. Controlled Drugs were prescribable by nurses and pharmacists using supplementary prescribing from 2005. During this m other allied Healthcare professionals such as physiotherapists, Radiographers, Podiatrists and optometrists were also able to bugger off supplementary prescribers. (DOH, 2005)These rapid changes in the development of non medical prescribers in the united Kingdom were a contrast to the gradual introduction to prescribing rights in the United States of America. (Armstrong,1995). The UK now has the most extended non medical prescribing rights in the world. (Armstrong, 1995) In 2006, DOH (2006) permitted clever nurses and pharmacists to independently prescribe all medicines within their clinical competence. The most recent chan ges have occurred to the Misuse of Drugs Regulations (2012) which now bureau that appropriately qualified nurses and pharmacists will be able to prescribe controlled drugs like morphine, diamorphine and prescription strength co-codamol.Currently on that point are more than 50,000 Non medical prescribers in the UK, around 19,000 nurses and almost 2,000 pharmacists are qualified as Independent and/or supplementary prescribers (Carey, 2011)The changing legislation of Non medical Prescribers has changed alongside with the environment of the NHS services. This is recognised in the guide produced by NMC (2010) stating that the services delivered by the NHS become more challenging and labyrinthine as there is an ever increasing need for improved productivity without the compromising of quality.Coronary nerve centre disease, puts commodious pressure and demands on the National Health Service (NHS). Hospital admissions for Chronic feel failure have increased markedly, chronic heart fa ilure accounts for intimately 5% of all medical admissions and approximately 2% of total health care expenditure. Despite improvements in medical management, under treatment for heart failure is still universal. (Mcmurray et al, 2002) In 2002, The British middle Foundation (BHF) piloted a scheme and funded with the help of Big Lottery Fund ninety two Heart failure nurses throughout the United Kingdom. The results were shown in the final report BHF (2008) showing an average reduction in heart failure admissions of 43% and an average estimated saving, per heart failure patient of 1, 826. Increasing the role of the Non medical prescribers therefore increasing the skills and knowledge of nurses/pharmacists only enhances the vital role within the field these nurses have in todays stream fight to provide the highest quality care possible. It has been shown that registered nurses are extending their roles and responsibilities to work in new ways (Furlong + smith, 2005). Crowther et al ( 2003), Gattis et al (1999), Paniagua (2011) Lambrinou et al (2012) and Jaarsma (2010) have all shown that Heart failure nurse specialists are optimal providers to assist physicians with Heart failure care for this complex and time-consuming patient population.The management of heart failure is complex involving both pharmacologic treatments and strategies to improve patients functional status and quality of life (Palmer et al, 2003) Heart failure go off be defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues. (ESC, 2012)Clinically patients present with ordinary symptoms breathlessness, ankle swelling and fatigue. And signs elevated JVP, pulmonary crackles and displaced apex beat. Diagnosis of heart failure relies on a detailed history and accurate physical interrogative (NICE, 2010). These symptoms can be related to either a reduction of cardiac ourput (fatigue) or to excess fluid retention (dysapnea, orthopnea and cardiac wheezing) fluid retention also results in peripheral edema and occasionally an increasing abdominal girth secondary to ascites. Symptoms and signs are often non- unique(predicate) and could be related to other conditions. Knowledge on the use of other symptomatic services is necessary Echocardiography, Electrograph, Chest Xray, Blood tests all contribute to the confirmation of diagnosis.Case study One demonstrates a regular(prenominal) presentation of a patient presenting with first presentation of heart failure symptoms typically compromised and in need of expert medical treatment Pharmacological and non pharmacological therapies. This patient presented with clear signs of congestion and volume retention of which a diuretic therapy plays a central role in the treatment (Felker and Mentz, 2012)As the heart fails, there is a reduction in both blood pressure and cardiac output, in response to this the body conse rves water which results in oedema. Diuretics act at different sites of the kidneys, they then eliminate sodium and water through enhanced excretion from the kidneys so are able to relieve the symptoms of fluid congestion. Different classes of diuretics work at different points within the kidney tubules. (Davies et al, 2000) Appendix two shows the diuretics available.This patient was treated with Furosemide intravenously (IV), most patients receive a loop diuretic as first line treatment for heart failure (Faris et al, 2012.) Loop diuretics are the most frequently utilise diuretic in treatment of Chronic heart failure despite their unproven effect on survival, their indisputable efficacy in relieving congestive symptoms makes them first line therapy for most patients. (Bruyne, 2003) Appendix trine shows how loop diuretics work.As already stated first line treatment for acute decompensated heart failure is intravenous diuretic therapy either as a bolus or via continuous infusion. Despite being available for decades, few randomized trials exist to guide dosing and administration of this drug. In 2011, the Diuretic Optimization Strategies Evaluation (DOSE) trial used a prospective, randomized design to compare bolus versus continuous infusion of IV furosemide, as well as high- window glass versus low-dose therapy. The study found no difference in the primary end point for continuous versus bolus infusion. High-dose diuretics were more effective than low dose without clinically important negative effects on renal function. Although no difference was found between IV and bolus dose there are benefits to both elements so clinical judgement would be made on the specific patient needs and requirements, for example, immobilization, duration of therapy requirements, haemodynamic status. The aim of using diuretics is to achieve and maintain euvolaemia (the patients dry weight with the lowest achieveable dose. (ESC, 2012).Case study two identifies a patient whom is ano ther example of heart failure but offers a different presentation this accentuates the importance of a careful physical examination and valuable accurate history taking. The absent breathe sounds over the right base of lung field along with the history was an indication of pleural effusion and initiated the prescription of a radiograph chest to be performed. Absent or diminished breath sounds strongly suggest an effusion (Kalantri et al, 2007) unfortunately Congestive heart failure is the most viridity cause of a pleural effusion. (Enrique, 2008) Again, Pleural effusions from heart failure are managed with diuretic therapy, initially with a loop diuretic, intravenously titrated in response to clinical signs, daily weights and renal function to avoid excessive volume depletion. (Light, 2002)Non-compliance in patients with heart failure (HF) contributes to worsening HF symptoms and may lead to hospitalization. (Van der wal, 2006). Using skills that were taught during grassroots nur sing training is imperative in conducting a beneficial and effective clinical examination, these interpersonal skills may dictate how the patient and carers perceive and acknowledge there diagnosis and may have an influence on the approach the patient has on his/her own health.Over the past 3 decades, the biopsychosocial model of health has become increasingly important in the effective practice of medicine. Central to this model is an emphasis on treating the patient as a whole person, including the biological, psychological, behavioral, and social aspects of their health (Engel, 1980). The American Heart Association (AHA) in collaboration with other professional societies has issued a new scientific statement for the management of patients with advanced heart failure. It emphasizes shared decision making and is designed to help physicians and other health professionals align medical treatment options with the wishes of the patients. Allen (2012) recognises the complexity of heart failure and complexity of the treatment options can be a barrier to shared decision making, but this only emphasizes why such a patient-centred approach should be undertaken in Advanced heart failure. Shared decision making has received particular emphasis in relation to the prescribing of drug treatments. Traditionally, studies have identified 50% of patients with chronic conditions do not take their treatment as prescribed, with major reasons being because they do not share the doctors views, or they are worried about side effects. (REF QUOTE?) consequently the aim is to explore these issues by adopting a shared decision making approach and reach a concordance between doctor and patients. at that placefore acquire patients involved in the planning and management of care, being sensitive to the individuals need, spending time figuring out what is important to them, will hopefully subject about of the confusion and complexities concerning heart failure. Although knowledge alone does not insure compliance, patients can only comply when they possess some minimal level of knowledge about the disease and the health care regimen. (Van der wal, 2006).The National Prescribing Centre (2012) designed a competency framework which can be seen in appendix 3. One of the three domains is the consultation which highlights three areas of importance 1 Knowledge pharmacological and pharmaceutical. 2 Options concerning the diagnosis and management 3 Competency involving shared decision making with parents, patients and carers. The information is clear that for the benefit of the patient and success with the treatment regimen it is vital to consider wishes of the patient/carer, ethical, cultural opinions, lifestyle of the patients. Also contributing factors which may cause non-complicance whether intentional or not for example polypharmacy, complicated dose regimens, unpleasant side effects, and cognitive problems or physical disability preventing the patient taking the medi cines. A large number of factors need to be incorporated into the thought process prior to getting to the point and writing a prescription.Surrounding issues that directly and indirectly support patient orientated prescribingSources of information are on number of levels. In a hospital ward, for example, immediate sources of information include the British National Formulary (BNF) and ward pharmacist. The role of both is, at least in part, to assist in ensuring that, for any prescription, the correct dose and timing of administration are correct and appropriate for the indication. The BNF is widely available and accessible and can and should be used to assist in prescribing whenever there is any doubt about dose and timing. The Pharmacist provides an additional safety netting, by checking prescriptions before providing the medications. In addition, the pharmacists role includes ensuring that medications prescribed are available for administration.Further afield, but still within the hospital, topical anaesthetic policies give guidance on what drugs are available and recommended for a particular indication. These policies may be produced by the hospital or by regional bodies, including SHA, earnings PCTs, for example, local arrangement may mean that a particular statin is used for primary prevention of coronary heart disease, collectable to local procural agreements or cost effectiveness analyses.Beyond the hospital setting, a number of sources provide guidance on what should actually be prescribed, or considered, for a minded(p) condition. Such sources might include home(a) bodies, in particular National institute of clinical excellence (NICE) and specialist societies. The latter may be national and or international. For example, in the field of heart failure, NICE has given guidance on what medications should be administered and at what stage of the disease and symptoms. For all patients ACEI should be given. There are many different ACE I. The guidelin es recommend using only those which have actually been proven to be of benefit in heart failure these emailprotected. For those who are intolerant of ACE ARB should be used. Again, NICE recommends thoses that have shown efficacy in clinical trials, and these emailprotected. Beta-blockers are recommened but not any betablocker. only those with proven in heart failure should be used these are Aldosterone Antagonists should also be used for patients with advanced heart failure (NYHA III/IV). counselling recommends spironolactone, or eplernone if not tolerated (most usually due to gynaenomastia in men)From the above, it may be seen that the National guidance indicates which drugs from each class should be considered for each purpose. This leaves room for local policies and prescribers to decide which of the available agents is suitable for a particular individual.Pursuing the example of heart failure further, international guidelines are issued by a number of bodies. The principle o f these is the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) and the American Heart Association (AHA). Of these, the ESC guidelines are most applicable to the United Kingdom. Societal guidelines tend to focus more on a particular disease and the available evidence to provide best treatment, whereas NICE guidelines have greater emphasis on appraisal of cost-effectiveness, which is of greater relevance to the local health economy in the UK. Furthermore, ESC guidelines give a strength of recommendation for a particular treatment (Class I, IIa, IIb) and an indication of the level of evidence toilet the recommendation. (A, B, C)Ultimately, the source of information which informs societal guidelines comes from research, in the form of clinical trials, performed on the back of pre-clinical research. Therefore, the doses of drugs which are recommended for use usually reflects the dose and frequency of a drug or used in a clinical trial which demonstrate d benefit.There are therefore numerous levels of information and advice which support prescribing practice. For many conditions, these are ultimately based on evidence derived from clinical trials, in some areas these will be the gold standard RCT. However, some trials provide softer evidence, such as observations data or even anecdotal. Understanding of these various trials and guidelines is important to understanding how local guidelines and daily prescribing practice come about and are supported by evidence.The trials/guidelines all mentioned above have provided convincing evidence that clinically significant improvements can be achieved in heart failure by appropriate drug treatment. Moynihan et al (2002) recognises that the adoption of more effective and/or safer drugs, new technologies are usually more expensive, aging of the population leads to increased morbidity and drug therapy, all play a role in increasing drug expenditure.Medicines are regarded an expenditure, but can a lso be an enthronisation, if they are used rationally. Rational prescribing means cost effective use of safe and effective drugs.Specialist clinics for heart failure are a tool for delivering care according to clinical guidelines and providing diagnostic treatment. They provide optimal management of the condition, education of patient and carers about the signs and symptoms of worsening disease and medication compliance. Advances in medication and technology for heart failure are vast, which again strengthens the need and importance of such clinics to enable patient treatment to change accordingly and appropriately. Studies have shown that if patients are treated by Cardiology clinicians or Heart failure specialist nurses, clinical guidelines are more likely to be followed and readmission rates are lower for these patients. (Reis et al, 1997)An example of prescribing within heart failure is an investment for the patient and the NHS is the use of Angiotensin-converting enzyme inhibi tors (ACE I). These have been shown to improve symptoms, survival and slow progression of heart failure. (Luzier et al, 1998). ACE I are one of the inseparable therapies for all heart failure patients, if tolerated. Treatment should be maximised and in maximising the dose quite often you can reduce or stop the use of loop diuretics due to improved symptoms and clinical signs. (Hoyt et al, 2001) Therefore patients who are appropriately treated and titrated to maximal therapy therefore benefit clinically, may reduce other medicines and they can overall reduce the chances of hospital admission with decompensated heart failure which is beneficial to the patient and the NHS finances.A recent study by Dharmarajan et al (2013) covering three million hospitalizations showed that more than a third of readmissions (within 30 days of discharge) were for heart failure. Their thought was that many of these could have been preventable, with greater input from pharmacists, physicians, nurse speci alists, and greater consideration to social elements cut down readmission also reduces other risks involved in exposing patients to hospitalization. The National Heart failure Audit (2012) conducted by NICOR is an audit to monitor progress, clinical findings and patient outcomes of patients with heart failure. It is an essential audit for each NHS trust to comply and complete. ++. It provides critical information on management and outcomes which then provides data essential to drive future improvements.Conclusion shell STUDY ONEDescription of clinical settingPatient was an inpatient on the Cardiology ward he was admitted the day before and had been referred to Heart failure clinical nurse specialist for review.Case historyAn 84 year old retired postman was admitted from home with progressive worsening shortness of breath over the blend in 6 weeks. He had been to see the General Practitioner two weeks ago who treated him for a chest infection with a course of oral antibiotics (Amox ycillin). He denies any chest pain, however he complains of palpitations at times of exertion and a productive cough. Patient had not experienced any syncope, dizzy spells only other complaint was loss of appetite and poor quality sleep. Patient has been quiescency with 4 pillows, waking regularly due to struggling for breathe and resulted to sleeping in the chair downstairs. Exercise tolerance had drastically reduced to 50 metres before having to stop due to breathlessness.On examination the patient was tachypnoeic, pulse was 95 and regular, sitting blood pressure was 110/62 standing 105/55. Weight 97kg. Oxygen Saturations on air 94%. Inspiratory crackles were clearly perceive on both lung bases, no heart murmur could be auscultated and apex beat was misplaced to the anterior auxiliary line. JVP was raised +4. Pitting peripheral oedema up to thighs and a large distended abdomen, which was soft and not tender on palpation. ECG confirmed Sinus tachycardia with Q waves in antero lat eral leads. Chest x-ray also confirmed cardiomegaly and interstitial oedema.Drug treatment pre admissionaspirin 75mg once a day (OD)Blood pressure controlPast medical historyAnterior lateral Myocardial infarction 7 years ago (2005) followed by Angioplasty to the right coronary artery.No further operations or admission to hospital.Blood resultsChemistry Sodium 128mmol/l, Potassium 4.8 mmol, Urea 9 mmol/l, Creatinine 145 mmol/l, LFTs, HB and clotting was all unremarkable.Echosevere left ventricular dysfunction, with minor tricuspid regurgitation.Social backgroundPatient lives with wife in a two bedroom bungalow, they are both normally well and independant. He has no allergies and takes no over the counter medications or recreational drugs in the past or present.Drug chart to date in hospitalAspirin 75mg ODFrusemide 80 mg ODRamipril 2.5 mg ODDiscussionPatient was fortunate enough to have had Echocardiography that morning, which offered me the definitive diagnosis. This gentleman presen ts with a common clinical presentation of progressive systolic dysfunction of an ischemic cause. The patient was comfortable and stable enough for a steady and methodical examination and history taking.On construction of a management plan for this patient, clearly first line treatment is diuretic therapy, T Effective dieresis and consequent leeway of the loading conditions of the failing heart is generally regarded as essential (Raftery, 1994)This patient went on to be prescribed Intravenous Diuretics, instructions for Daily weights, Fluid balance, advice and rehabilitation for heart failure. Then longer term plan for titration of Heart failure medications to achieve maximum therapy suitable for this patient.Allen, L.A., Stevenson, L.W., Grady, K.L., Goldstein, N.E., Matlock, D.D., Arnold, R.M., Cook, N.R., Felker, G.M., Francis, G.S., Hauptman, P.J., Havranek, E.P., Krumholz, H.M., Mancini, D., Riegel, B. and Spertus, J.A., for the American Heart Association Council on pure tone of Care and Outcomes Research Council on Cardiovascular Nursing Council on Clinical Cardiology Council on Cardiovascular Radiology and Intervention Council on Cardiovascular Surgery and Anesthesia, 2012. stopping point making in advanced heart failure a scientific statement from the American Heart Association. Circulation, 125(15), pp.1928-1952.Armstrong, P., McCleary, K. J. and Munchus, G., 1995. Nurse practitioners in the USA their past, present and future. some(prenominal) implications for the health care management delivery system. Health Manpower Management, 21(3), pp.3-10.Avery, A.J. and Pringle, M., 2005. Extended prescribing by UK nurses and pharmacists. British Medical Journal, 331, pp.1154-1155.Bruyne, L.K., 2003. Mechanisms and management of diuretic resistance in congestive heart failure. Postgraduate Medical Journal, 79(931), pp.268-271.Carey, N. and Stenner, K., 2011. Does non-medical prescribing make a difference to patients? Nursing Times, 107(26), pp.14-16.Coope r, R., Guillaume, L., Avery, T., Anderson, C., Bissell, P., Hutchinson, M., Lynn, J., Murphy, E., Ward, P. and Ratcliffe, J., 2008. Non medical prescribing in the United Kingdom developments and stakeholder interests. Journal of Ambulatory Care Management, 31(3), pp.244-252.Crowther, M., 2003. optimal management of outpatients with heart failure using advanced practice nurses in a hospital-based heart failure centre. Journal of the American Academy of Nurse Practitioners, 15, pp.260-265.Davies, M.K., Gibbs, C.R. and Lip, G.Y., 2000. first rudiment of heart failure. Management diuretics, ACE inhibitors and nitrates. British Medical Journal, 320(7232), pp.428-431.Department of Health and Social Security, 1986. Neighbourhood nursing a focus for care (Cumberledge report) London, HMSO.Department of Health, 1989. Report of the Advisory Group on Nurse Prescribing (Crown report) London, HMSO.Department of Health, 2000. National Service Framework for Coronary Heart Disease. London, HMSO.D epartment of Health, 2005. Supplementary prescribing by nurses, pharmacists, chiropodists/podiatrists, physiotherapists and radiographers within the NHS in England. A guide for implementation. London, HMSO.Department of Health, 2006. Improving patient access to medicines A guide to implementing Nurse and Pharmacists independent prescribing within the NHS in England. London, HMSO.Dharmarajan, K., Hsieh, A.F., Lin, Z., Bueno, H., Ross, J.S., Horwitz, L.I., Barreto-Filho, J.A., Kim, N., Bernheim, S.M., Suter, L.G., Drye, E.E. and Krumholz, H.M., 2013. Diagnosis and timing of 30 day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Journal of American Medical Association, 309, pp.355-363.Diaz-Guzman, E. and Budev, M., 2008. Accuracy of the physical examination in evaluating pleural effusion. Cleveland Clinic Journal of Medicine, 75(4), pp.297-303.Faris, R.F., Flather, M., Purcell, H., Poole-Wilson, P.A. and Coats, A.J., 2012. Diuretics for heart failure. Cochrane Database of Systematic Reviews, Issue 2. Art. No. CD003838. DOI 10.1002/14651858.CD003838.pub3.Felker, G.M., Lee, K.L., Bull, D.A., Redfield, M.M., Stevenson, L.W., Goldsmith, S.R., LeWinter, M.M., Deswal, A., Rouleau, J.L., Ofili, E.O., Anstrom, K.J., Hernandez, A.F., McNulty, S.E., Velazquez, E.J., Kfoury, A.G., Chen, H.H., Givertz, M.M., Semigran, M.J., Bart, B.A., Mascette, A.M., Braunwald, E., OConnor, C.M., for the NHLBI Heart Failure Clinical Research Network, 2011. New England Journal of Medicine, 364(9), pp.797-805.Felker, G.M. and Mentz, R.J., 2012. Diuretics and ultrafiltration in acute decompensated Heart failure. Journal of the American College of Cardiology, 59(24), pp.2145-53.Furlong, E. and Smith, R., 2005. Advanced nursing practice. Policy, education and role development. Journal of Clinical Nursing, 14, pp.1059-1066.Gattis, W.S., Hasselbied., V., Whellan, D.J. and OConnor, C.M., 1999. Reduction in heart failure events by the addition of a cl inical pharmacist to the heart failure management team. Archives of Internal Medicine, 159, pp.1939-1945.Hawkins, N.M., Petrie, M.C., Jhund, P.S., Chalmers, G.W., Dunn, F.G. and McMurray, J.J., 2009. Heart failure and chronic obstructive pulmonary disease diagnostic pitfalls and epidemiology. European Journal of Heart Failure, 11, pp.130-139.Hoyt, R.E. and Bowling, L.S. 2001. Reducing readmission for congestive heart failure American Family Physician, 63(8), pp.1593-1598.Hunt, S.A., Baker, D.W., Chin, M.H., Cinquegrani, M.P., Feldman, A.M., Francis, G.S., Ganiats, T.G., Goldstein, S., Gregoratos, G., Jessup, M.L., Noble, R.J., Packer, M., Silver, M.A., Stevenson, L.W., Gibbons, R.J., Antman, E.M., Alpert, J.S., Faxon, D.P., Fuster, V., Gregoratos, G., Jacobs, A.K., Hiratzka, L.F., Russell, R.O. and Smith, S.C. Jr American College of Cardiology/American Heart Association Task Force on commit Guidelines (Committee to rewrite the 1995 Guidelines for the Evaluation and Management of He art Failure) International Society for Heart and Lung Transplantation Heart Failure Society of America, 2001. ACC/AHA Guidelines for the evaluation and management of chronic heart failure in the adult Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure) Developed in collaboration with the International Society for Heart and Lung Transplantation Endorsed by the Heart Failure Society of America. Circulation, 104(24), pp.2996-3007.Jaarsma, T., 2010. Multidisciplinary approach in heart failure evidence, experiences and challenges. Journal of Cardiac Failure, 16(9), pp.1071-9164.Kalantri, S., Joshi, R. and Lokhande, T., 2007.

Horror Women Clover

Horror Women CloverHow has the role of women in horror reads changed? Using Carol Clover, Theory of Final Girl to analyse 1 shaft from The Hitcher, the changing roles of women in horror films willing be explored. Tradition altogethery horror films accommodate seen women take on the role of the victim. More recently this has changed whereby thewomen has taken on a more powerful and dominant position. Carol Clover a professor of film wrote a book called Men, Women and Chainsaw gender and the modern horror film which focused on women. She developed a theory, which changed the way gender is count oned upon in horror films. In a lot of slasher films the women argon represented as victims although what kindle me is how the womens role has changed in recent years to what Carol Clover claimed to be the final fe potent child. Women moderate been subject to dissimilar representations throughout time, within the horror music genre of which female audience consider being a sexist image . I will be exploring how women ar represented in the films mentioned, analysing the dioramas and comparing this to Carol Clover, and how the roles of women have changed through time. To do this I will look at The Hitcher a 2007 remake (Michael Bay production) (Director Dave Meyer) which presents a clear representation of the final female child. gentleness Andrews (Sophia Bush) and Jim Halsey (Zachary Knighton) limit to hit the road for spring break. However the film turns from a chick flick to the two of them fighting for their lives and hard to save others. The 1986 original is some what different from the remake where on that point is no final girl and the associate is the only subsister. Dave Meyers wanted to create female empowerment which is an added twist to the remake.Female empowerment is to a fault demonstrated in a film series called Saw. Directed by James Wan, the plot revolves around Jigsaw Killer who kidnaps his victims, put them in traps and gives them a ch ance to repent from their previous lifestyle in which they took for granted. One victim from Saw named Amanda Young (Shawnee Smith) survives the trap and becomes Jigsaw Killer partner. Amanda is a heroin soak which she started while in prison. She is Jigsaws only known survivor and believes it has do her a better person. This film clearly displays the female role changing from victim to survivor although this film goes against the theory of Carol Clover, in foothold that Amanda becomes a murderer.Women throughout horror film history have been stereotyped to victimisation and the focus of vicious murder. History has seen change from women not being able to vote to having basic human rights and a high status in society. Feminists have come on way to changing this stereotype, this being, able to direct films and having the chance to control a piece of media which affects the way people (women) are perceived by an audience.(Bridget (1999) Without feminism there would have been no f inal girl or avenging women. This quote shows that even though films such as The Hitcher or Scream were not writen, directed or produced by women, feminism has come a long way where women have more power in soceity and is being portrayed in films s croupetily as Dave Meyers wanted to create. This is to do with social change.According to film maker magazine blog, women are now attending the cinema to watch horror films more and are exceeding male figures. Carol Clover questioned who the audience identifies them with. It is assumed that the male identifies with murderer who is usually male. Many argue that men in the audience are sexually aroused by the victimisation of the female. This is caused by the camera angles and lighting. Murder of the female if virgule from the mens point of view Gaze Shot (masculine voyeur vs distaff victim).Carol Clover argues that the audience identifies with final girl, and that the viewer (male or female) identifies with the fright of being attacked rather than the satisfaction of the murderer as he attacks. The final girl remains virginal and pure while her friends do the opposite. She escapes because she does not partake in adult hood such as drugs, and sexual intercourse. The final girl fights back and is the damsel in distress. The unempowered woman makes a movement to power over men.In order to compare Carol Clovers theory to The Hitcher I shall look at 2 scenes from The Hitcher. The first scene opens and the viewer sees aggrandize (Sophie Bush) and Jim (Zachary Knighton) walk to a motel. There, they take a shower together and Jim steps out of the mode to make a phone call, telling her that he will be gone for 15 minutes. Hes gone for several hours and clemency falls asleep reflexion a Hitchcock film. She is then awakened by someone in the bed who is feeling her up. She assumes it is Jim but then sees that it is Ryder (Sean Bean) trying to rape her. She tries to push him away, but Ryder gets on top of her. We see his hand over her mouth trying to stop her screaming.The camera shot is high angle which is used to make her look defenseless and powerless. We see her bite Ryder hand and he hits her. The shot is then focused from pity Eyes also known as point of view shot. When the humiliated angle shot is used it emphasises the power and strength that Ryder has being on top of her. Throughout the scene a master shot is applied whereby the theater director cut from Ryder to Grace and back to Ryder throughout most of the scene. This showed the reaction of the two characters and established a clear spatial (space) and temporal (time) relationship.The audience then sees Grace grab the phone on the side table, of which she then hits him over the head and tries to get off the bed. Grace hits him over the head with the lamp she picks up from the floor and runs to the bathroom. Grace is trying to shut the door and the camera is focused mainly on her. here a Close up is used. This is to draw the viewer/a udience side by side(predicate) and involve them in what is happening. The close up shot also enables the audience to observe the reactions of Ryder and the emotions of Grace.There are two sorts of lighting being displayed in the scene these are artificial and key light. The artificial lighting is low key to create a slight shadow on Ryder to make him seem disastrous and mysterious vindicatory as his character is portrayed throughout the film. The key lighting was needed as the scene was shot in the bathroom where there is no natural light available. Grace manages to close the door as she reaches for a gun and Ryder walks out of the room. She then makes her way to find Jim who she sees tied up between two trucks of which is stretching Jim every time Ryder accelerates. Throughout the whole of the last scene you see her fight for her life and she survives but she becomes extremely timid in this next scene when Jims life is on the line.Ryder keeps hitting the gas, brutally hurting Jim and tells Grace to get in and close the door. Grace begs and pleas with Ryder to stop and begins to clapperclaw but asks him questions such as what do you want and calls him sick. Her character changes from being strong to being very adynamic. Ryder says he cant stop and he wants to die. Here the theory of Carol Clover audience identification takes place. The close up shot enables the audience to recognise with him or her and clearly the director wanted the scene to be focused on the audience identifying with the female. When focusing on editing of the scene there is a lot of cuts from Grace to Ryder and a two shot in between, this is often used when two people are in conversation. When counting the cut shots, when focused on Ryder they add up to less than 30 while the shots focused on Grace are over 30.The cops show up and see Grace with Ryder at gunpoint. They tell her to drop the gun, but Ryder tells Grace not to listen to them. Ryder then tells her to point the gun betwee n his eyes. Grace cant do it so Ryder does it for her. Ryder then tells her to shoot him, but she cant, puts the gun cut back and says for Ryder not to hurt Jim. Grace shows a sign of femininity whereby she becomes very emotional and shows how much she cares for Jim Throughout the scene the audience can project Jim moaning and groaning in agony. Ryder then gets impatient and snatches the gun out of her hands. He then mutters under his breath, Useless waste.There is a FX sound effect where the audience can hear a splat where the air explodes outwards to make the audience feel as thought they are the experiencing what has just happened to the victim (Jim). Although there is more to this than blood and emotion that makes the scene work, if she shoots him the foot will come off the brake and he will die and if she doesnt he puts his foot on the accelerator and Jim will die. Its a no get on situation making you wonder what will be her decision.At the end of the film Grace does shoot and kill Ryder. before hand Ryder smiles and asks Grace if it feels good. Grace tells him she doesnt feel a thing shoots him and walks away.The analysis has made the theory of Carol Clover more clear in terms of audience identification. Who does the audience identify with and why, are questions Clover asked when watching the slasher films. According to her theory, Carol said that audience identification was down to gender fluidity whereby the male killer was sexually repressed and therefore the male viewer could not identify themselves with them. For example films such as Halloween, Psycho and Nightmare on Elmstreet, all the killers are sexually repressed and having something wrong mentally. Freddy Kruger (Nightmare on Elmstreet) was the result of him being brutally raped, and Halloween was in response to his sister indulging in adulthood. However Ryder is not sexually repressed. Here her theory does not work. I believe that the camera shots and cuts affect who the audience is forc ed to identify with. The audience (male) was being made to identify themselves with the female (Grace). Whereby there were more cuts of her, the audience had no choice but to see her emotion and hear her plea. At times Grace was isolated and unaccompanied making the audience only identify with the character they are being shown. I also feel as though the male audience identifies with Grace rather than Ryder because he lacks masculinity and deep down is weak as I will explain. Many times Ryder says he wants to die and for them to kill him as he cant do it himself. He makes Grace strong sufficient to kill him by killing others. However its always a no win situation. It is as if he doesnt want to die alone and is scared. The analysis above demonstrates a no win situation.Eric rubicund (director is Hitcher 1986) talks about the film in 1986 and states that,Because of the hell living inside his skin, John Ryder wants to die. But he wants to make Jim Halsey strong enough to kill him an d he does. (Eric Red Interview)In the 2007 remake, Grace is made strong enough to do this. There is a connection between her and the killer just like there was a connection between Jim and Ryder in the original Eric Red says,I really think that this strange psychological connection between The Hitcher and the Kid, the irony that something of value is passed from this horrific guy Ryder to Halsey, strength to grasp in a nightmarish world (Eric Red Interview)Looking closely at the film, it has made me has made me think about the narrative structure and that although the train victim in cab scene was not a girl Ryder used Jim to get to Grace. Ryder was making Grace even more vulnerable and weak by taking away the man (protector) of her. She proved her weakness by not shooting Ryder and letting her boyfriend (Jim) die. This causes the narrative to move on and have Grace as Ryders last victim and for her to be the avenging women/ final girl. The audience does not need to know the kille r past, but here the killer is trying to pass what he does and what he feels onto someone else so they can kill as well. This also happens in Saw. Amanda takes on the role of Jigsaw. Ryder many times says he wants to die and for them to kill him, but its always a no win situation. It is as if he doesnt want to die alone. For example the analysis shown above demonstrates a no win situation.Moving on, Clover argued that the final girl fights back just as Grace is doing. Grace is the one who sees everyone die.Final Girl is trail cornered, wounded whom we see scream, stager, and fall, rise, and scream again. She alone looks death in the face, but she alone also finds the strength either to stay with the killer long enough to be rescued (ending A) or to kill him herself (ending B). (Screams Of Terror)The two different endings are due to the evolution of feminist movement in film. If we look back at one of the first Final Girl films such as in Psycho, Lila figures out the unknown and whe n Bates attacks her, she is not given the chance to fight back as she is almost immediately rescued. This is ending A. Halloween, Laurie, was the first final girl to fight back (Ending B). Hitcher has ending B whereby the female (Grace) has empowerment to kill Ryder and to be just as strong as a male. This is where gender fluidity of the final girl plays its part. This enables the final girl to be identified by the male audience. She is not too feminine but has masculine traits such as being brave, intellectual and strong. The Final Girl is the one to make it to the end of the film.However I feel as though that her theory has left out an important thought that females can be crazy and psychotic as men. Urban Legend, Friday the thirteenth and May show that females can be serial killers too. I feel as though her theory is one sided. Urban legend is the result of her boyfriend dying due to few girls carrying out an urban myth. The killer in Friday the 13th is revealed as a middle-aged woman whose son, Jason, drowned years earlier as a consequence of negligence on the part of the camp counselors. The women in these films commit each murder as an act of revenge. However May just like the male according to Clover theory is also sexually dysfunctional. May doesnt understand how to react around others and this frightens people, so the only way she can keep them in her life is by killing them and keeping parts of them to make a big doll. The big doll wont even moderate her as a doll isnt real. BibliographyCarol Clover (1992) Men, Women and Chainsaws Gender and the modern horror film, BFI PublishingBridget, Cherry (1999) Refusing to look female viewers of the horror film, publishing companyThe HitcherSaw 1, 2, 3www.best-horror-movies.com/female-serial-killer.htmlcomm2.fsu.edu/faculty/comm./sapoisky/research/bookch/slasher.html Mass Media and Society edited by A. Wells and EA Hakanen. 1997. Greenwich, CT Ablex Publishingwww.filmmakermagazine.com/blog/2007/02/female-tro uble.php Hitch with Red, Jan. 16, 2007 http//www.joblo.com/arrow/index.php?id=6449 Eric Red Interviewhttp//everything2.com/index.pl?node_id=1775841 Feminist Horror Film Theory Mon Jan 09 2006http//www.screams-of-terror.com/teenie.asp screams of terror 14/2/08

Transformational leadership style of influence

Transformational masterminding style of influenceABSTRACT This piece of work w failure critic entirelyy evaluate the chassis upes of transformational leading, which enhance employee well being. It allow for turn into the substance of transformational leadership and the necessary leadership attempt or style that outhouse influence employee well- being positively at work, and atomic number 18as of employee well- being the leadership court will improve. Also the overall implication that employee well-being has on movement and why it should be a core harbor in any governing body will be analyzed.INTRODUCTIONOne of the current approaches to leadership that has been the focus of much research is the transformational approach. Transformational leadership is part of the juvenile leadership paradigm, which chokes more trouble to the charismatic and telling elements of leadership. The transformational leadership involves an exceptional style of influence that makes employee s to perform beyond expectation. And its approach usually incorporates the charismatic and visionary leadership.(Mullins 2007).The leadership approach is the beat out suitable for campaigning a strategic vision of change or a new work routines. It facilitates feedbacks learning beca use up the leadership is an ensnareive communicator, who can scoff commitment in the employees towards realisation of the firms vision. The employees under this leadership feels secured, a sense of trust is established and feels apprise, respected and classical hence they are ready to be committed to the organisations goal.The leadership motivates employees to overcome resistance to change since they trust the leadership all fears of uncertainty are easily eroded.It is obvious that the leadership of where an employee served will go along a way to give value, steamyly to the employee or the reverse maybe the case. The leadership on focus here is one which will coin employee emotions positively an d build trust within the relationship because, It is a leadership that value the employee and is mostly resideed in ensuring that the employee succeed in the toil or organisation goal set.All businesses seek to be in a sound province of well-being, since employee in a perfect emotional, mental, intellectual and mental state of well-being will successfully perform at a high level and the company will remain streamlined and profitable.We will consider nigh factors or approaches of the transformational leadership that gave it achievement in improving employee well-being.TRANSFORMATIONAL LEADERSHIPIn recent years increasing business competitiveness and the need for the most effective use of human resources has dissolvented in writers on solicitude focusing attention on how leaders revitalise or transform organisations (Laurie Mullins 2007).The transformational leadership uses strategic influences and techniques that place employees and enhance their self-efficacy and change th eir values, norms and attitudes, consistent with the vision developed by the leadership which will positively enhance psychological well-being. On the other hand transactional leadership influences employees with the use of power, sanctions, rewards and formal authority to induce pursuit compliance behaviour (Bass 1985 CongerKanungo 1998) tally to (Burns 1978) transformational leadership was defined as a military operation where leadership (employers) and followers (employees)engage in a mutual process of raising one another to higher levels of morality and motivation. Burns M. J was the first to bring about the model of transformational leadership to prominence in his extensive research into leadership theories.Effective transformational leaders are those who inspires and According to Whitehead (Mullins,L. 2007) the big word now associated with leadership is vision. The ability to see the bigger picture, to take the long-term view. What the ultimate objectives of the organisatio n are and how people can work together to achieve them..perhaps the most important attribute is that a good leadership inspires people by creating a climate where it is OK for people to make mistakes and learn from them, rather than what happened in the forward(prenominal) which was to blame and punish them. Leading from this position, they gain higher level of commitment from their people than mere compliance.As its name implies transformational leadership is a process that changes and transforms individuals. It is concerned with trust, emotions, values, standards and long term goals and includes assessing followers motives, satisfying their require and treating them as full human beings.EMPLOYEE WELLBEINGThere has been umteen definitions of employee well-being by scholars and link professional bodies. The Chartered Institute of personnel development has defined well-being at work to be creating an environment to promote a state of triumph which allows an employee to flouris h and achieve at their full potential for the benefit of themselves and their organisation. (CIPD 2006).The well-being in focus is more than that of physical health of avoiding falling ill or sick. This is as to do with achievement of personal well being that revolves round a number of positive decisions regarding life style, which is different from stress turning away and not being able to cope. It represents a wider bio-pyscho-social spectrum that includes physical, emotional, mental, and social well-being. It is an initiative to help employee be more proactive at work in order to coin their full potentials-intellectually, mentally and psychologically.Well-being requires the organisation to actively enhance employees to maximise their psychological , intellectual and emotional state of health. The necessary leadership approaches are in addition of advantage to people at all level both inside and outside the working environment. It modifies the working environment to be highly p roductive, attractive and corporately answerable place to work. One being an employee will enthusiastically long to always be at work since its an environment that improves one state of mind for productivity, quite of the strictly transactional approach. Every employee prefers that leadership that cares and is ready to help develop you than the caseful that publicly criticise your flaws.According to Felce and Perry (1995), well-beingcomprises objective descriptors and subjective evaluations of physical, material, social and emotional well-being together with the extent of personal development and purposeful activity, all weighted by a personal set of values. This is important because the definition extends the meaning of well-being to a range of different dimensions beyond the conventional health issues which can be stretched further to workplace.Employee wellbeing is an important factor in determine an organisations long term profitability. Many studies show a direct relation be tween productivity levels and the employee well-being. A happy and healthy employee will be of benefits to the employer since performance will be good, reduction in absenteeism and organisation can achieve the set goals or target. However employer does not necessarily confound to focus entirely on the physical health conditions but more on the mental, psychological and emotional health conditions of employees.(CIPD 2006).To be organisationally effective, employee well-being necessitate to be part of a regular business dialogue and to be deeply embedded into an organisational leadership culture. And the leadership that has embedded employee well-being in its culture, style and approach is the transformational leadership. Organisational wellbeing involves many things but the most important of it is employees having meaningful and challenging work and having the opportunity to apply their skills and familiarity in effective working relationships (CIPD 2006).TRANSFORMATIONAL LEADERS HIP APPROACH ENHANCING EMPLOYEE WELLBEING.Researchers have critically measured the approaches of transformational leadership through different ways, by interviews, questionnaires with employees in various organisations and it has been observed from the findings that the leadership has employ the following instruments in enhancing employee well-being at work. According to (Bass1998),the transformational leadership motivates employees/followers to do more than is originally expected and the extent of this transformation is measured by the effectiveness on employees performance.EMOTIONAL intelligence serviceThe ability to perceive, observe, and manage employee emotions will enhance a foundation for social, emotional, and intellectual competencies of well-being, which is necessary for high performance on the job. It is ability that transformational leadership can use to improve productivity and psychological well-being in employees.This could be described as a type of social intelligen ce that involves a sensitive approach of monitoring and observing employees feelings and emotions, in order to use the observation to assist the employees thinking (mental) and action that is working pattern for good job performance (Salovey Meyer 1990).According to (Fleishman Harris 1962) leadership with the ability to establish mutual trust, respect and good relationship among employees will achieve great productivity.TRUSTEvery relationship requires trust to survive, if the employees can trust the leadership under which they work, employees will turn out to be proactive on the job and winning the hearts of employees to any new change, lies in the ability of the leadership to influence which will be easier when there exist trust between the two parties. This is an approach a transformational leadership possessed that allays all fears and any form of indecision from the employees towards their leadership. Building a good relationship like that of a transformational leadership is what makes it easy for trust to and loyalty to grow and employees boob any new policy set by management and work without any form of threats or unkn own anticipated fear. This invariably gives an employee a lasting emotional state of mind to perform better.CHARISMATIC APPROACH Transformational leadership behave in ways that allowed them to serve as role models for employees. (Bass,1985) . The leadership is admired, respected, and trusted. Employees are proud to identify with the leadership and desire to imitate them. The leadership is viewed to be possessing extraordinary abilities, persistence and determination. This style is often a natural behaviour of transformational leadership, whose idealise influence emphasizes on having a collective vision by reassuring employees of the fact that , obstacles can be overcame. This leadership can be trusted to do the right thing and to demonstrate high standards of ethical and moral conduct. Invariably employees have confidence in their le adership.INSPIRATIONAL/ MOTIVATIONAL Transformational leadership behaves in a manner that motivate, inspire and encourage the people working with them by providing meaning and challenge to the employees work. This leadership gets work going by being enthusiastic and pollyannaish and get employees involved in envisioning attractive future states, by creating clearly communicated expectations that employee needs to meet and in addition show commitment to goals and shared visions.(Bass. B and Riggio E. 2006).According to (Mullins 2007) its been observed by researchers that, for the past30 years there has been increasing amounts of data to suggest that leadership has a lot more to do with inspiration and visions than with not bad(p) forward technical competence.INDIVIDUALISED CONSIDERATIONThis is a leadership approach that listens, and value an employee, in order to give them a sense of belonging in that the employee feels like an inherent part of the organisation (Boorstin 2004) fr om Bernard Bass .Transformational leadership is leadership felt throughout the organisation. It is obvious that employees perform better when they are respected and valued by the leadership. Obviously this leadership style or approach goes a long way to enhance the psychological well being of employees positively and result to greater excellent performance. Every individual loves to be given consideration, which gives them sense of value, and when given a fair hearing puts the employee in a good shape of mind psychologically and emotionally to obtain an excellent performance on the job. A two- way communication is encouraged where management is near to the employee, (the leadership remembers previous discussions, is aware of individual concerns and sees the individual as a whole person rather than just an employee), Bass Riggio. This type of leadership listens in effect and gives special concern to the emotional developmental needs of their employees.INTELLECTUAL STIMULATIONTransfo rmational leadership work on the intellectual strength of the employees by encouraging them to be creative and innovative. Soliciting new approaches for the performance of work and attending to task creatively are encouraged by the leadership. The leadership stimulate employees to view problems as challenge and not as obstacle. This leadership does not openly criticise or embarrass individual employees errors or shortfalls. Employees are encouraged to proactively come up with new ideas to solving problems and are not castigated in anyway, simply because their own ideas may differ from the management ideas.Undoubtedly speaking this approach goes along a way in positively stimulating, energising and productively improving the intellectual wellbeing of any employee. When the mind is at its peak or highest level of productivity, the performance will be indescribably incredibly excellent and organisations image and reputation is improved, services also will be good and more patronage fro m customers, leading to more profit. However for the employee an environment where one can be productive enhances intellectual growth and a stable and balance mental well being is achieved. This approach mentally empowers an employee to be self dependent, self reliable, accountable and general self development to becoming an expertise is obtained. COACHINGThis is an essential style of transformational leadership, one leadership beyond the tralatitious supervisor or manager that tells someone what to do instead showing them how to do it. Coaching by extension is mentoring someone, influencing people by providing new knowledge and skills required for the task. Work activities dont put smile on peoples face, what brings the smile is leadership that mentored, taught and coached employees to be better persons. Transformational leadership pays special attention to apiece individual employees needs for achievement and self development by acting as a coach or mentor. Employee individual d ifferences in terms of needs and desires are recognised and are therefore developed to successively higher levels of potential. This approach is more realisable in a supportive environment with new learning opportunities. Bass describes this approach further as a type where the leadership behaviour demonstrates good understanding of individual differences for instance in a situation where the leadership give some employees more encouragement, some are more empowered, some more firm standards, and others possible more task structure. The leadership coach by task delegation and proper monitoring of it to develop the employee and give direction and assistance where necessary and assess the progress without employee feeling being overly controlled rather think the leadership style of taking time to coach and mentor.EFFECTS OF TRANSFORMATIONAL LEADERSHIP ON EMPLOYEE WELL-BEING TO HIGH PERFORMANCE.Transformational leadership in its leadership style has effectively built trust between emp loyees and management and this usually lead to a smooth and pleasant working relationship that does not give room to suspicion in case of any change in policy or organisational change. Employees trust the leadership and they in turn are committed and loyal to the organisation. The employee is in a perfect emotional state of mind, since there is no fear of unknown or any need to panic. However, the trust sometimes could lead to developing since leadership knows that employees so rely on every of their judgement this but its been argued that the integrity of the transformational is to ensure the individual development of the employees. This leadership cares and is concerned about the employees and also inputs the companys value in the minds of employee and constantly reminds them of the vision and goal to the realisation of a high performance.The leadership that gives attention to individual consideration is able to identify each individual strength and weakness and of logical argum ent will be able to train and develop them without compares but handle them based on each persons capableness (the leadership give some employees more encouragement, some are more empowered, some more firm standards, and others possible more task structure gibe to their capability and needs). This leadership style improves the employee well-being psychologically since the employee is treated unambiguously and not measured by the others standard or ability, it gives an employee sense of acceptance and is uniquely assessed and assisted where necessary. Employee is psychologically, emotionally and intellectually motivated to perform without fear of others is better, here employees are treated as ends and not just means.(Bass and Steidlmeier 1999). The more capable that leadership is able to recognise the personal interests and concerns of individual employee, the very likely leadership will be able to create a team where employee well-being is an integral part of getting the job don e.(CIPD 2006 Journal).In a scenario where an employee under performs an emotional intelligent leadership like the transformational leadership is quick to observe that something could be defile instead of criticising ,that leadership initiate a good relationship by communicating with the employee to know what the problem is. By so doing the employee is mentally, socially and psychologically restored, and of course performance will improve, resulting to organisational profitability. Thus, it is of necessity to reiterate that the well-being of employee goes a great way in affecting performance and in turn the organisations as a whole.The effect of intellectual stimulation on employee well-being cannot be overly emphasized. Employee is allowed to think independently, given room to be creative and allowed to do things in their own unique way which improves employee mental state of well-being. Generally speaking when there are strong relationships like that of a transformational leadersh ip, between employees and line managers to the top managers and management as a whole, levels of well-being are enhanced. The level of performance will also be immeasurably excellent and the organisational goal is realised.One major effect of transformational leadership style is that it perfectly erodes power distance via the leadership style of delegation which gives employee a measure of autonomy to take decisions on the task delegated to be implemented. The leadership style encourages low power distance and create room for accountability and in over all gives opportunity for employees to be self efficient and of course an avenue to learn. Employees are to an extent empowered under this leadership and of course will feel valued and important, this feeling improve employees intellectual and psychological state, a feeling of empowerment and importance is essential for a positive psychological well-being. The leadership foster team work allowing every employee to participate and enha ncing good relationship to the realisation of self efficacy and high performance.CONCLUSIONThe leadership approach has a great effect on employee well-being, because how one is been treated goes a long way in affecting the individual thinking and hence the behaviour. In order words, it is argued that transformational leadership should be a core value for organisations that will embed employee well-being in its culture and style of leadership.(Bass 1998).RECOMMENDATIONI strongly recommend the transformational leadership style to be a core value to organisations in the embedding of employee well-being, based on my findings that it is the type of leadership that motivate, inspire, stimulate, and mentor employee to a mental, emotional balance and good psychological state of well-being, which will ultimately lead to a high excellent performance of employee productivity and to the organisations profitability advantage. I perfectly support the transformational leadership style in the embed ding of employee well-being and recommend it to the Nigerian banking industry as particularly.However, my judgement is also based on my personal experience with my manager who has no single traits of transformational leadership in her approach, my manager was the type that does not have any relationship with the team, i was in the marketing team in the bank at that time, she does not listen to individual needs or concern, she announces and criticise the team errors, even individual weak point and it was always a sad moment at work because of her attitude, she was seen has a bully. When I changed job and joined stanbic bank, it was a different ball game altogether because the stanbic leadership style was very different, since the transformational leadership approach was a core value being an international bank. The transformational leadership style positively affected my intellectual, psychological, and emotional well-being, to the fact that i performed better and even got promoted. I will at anytime take and argue in support of this leadership style because have been through it has an employee and i know how a good leadership can enhance employee well-being.

A Trip to Paradise :: Vacations Travel Essays

A Trip to ParadiseIf I had no limits as to how much I could spend on a vacation, I would take a trip to different cities in Mexico. My dads side of the family is Latino and many of my relatives live in Mexico. My month long trip would consist of a variety of cities I have visited before and others that I would be visiting for the first time. I would take advantage of Mexicos rich culture by combat-ready in the peoples customs and getting as much experience as possible. The trip would be really meaningful because my heritage is something that I am very proud of and passionate about.My permanent residence is in Bettendorf, Iowa and the closest airport is in Moline, Illinois. Unfortunately flights dont leave the Quad City Airport for Guadalajara, my first stop, so Ive decided to take a limousine from Bettendorf to Chicago, which would roughly take two and a half hours. Although the limo ride would cost around two degree Celsius dollars, it would be well worth it because I would not b e paying OHare Airport to park there for a month. I checked out lead websites to obtain airplane ticket information Expedia.com, CheapTickets.com, and Orbitz.com. All were extremely useful except for Orbitz.com which wanted me to create an account. This discouraged me from spending anymore time at this site. Expedia.com and CheapTickets.com were very easy to use, but were crammed with different advertisements. Despite the clutter, the sites loaded fairly fast. All of the websites included times for departure, length of flight, cost, which airports used, and airlines used. I also found a variety of different flights taking me to the cities I wanted to visit first class, coach, direct flights, round trip, one- way, etc. Overall, my search for a plane ticket was successful.My abutting obstacle was finding hotels to stay in when I wouldnt be staying with relatives. It was difficult trying to find hotels by checking their sites, so I searched city sites which proved to be more successfu l. Fortunenatey these websites were not packed with different ads. Hotels ranged from one to five star and cost between twenty and one thousand eight hundred dollars per night. virtually were all inclusive while others didnt even have swimming pools They gave information on addresses, policies, and different packages. I used Google.com and MSN.com search engines to find the different cities websites (Gomanzanillo.

Essay :: essays research papers

Unit 1Narrative Essay     Feeling complete with your own personal mental and physical standpoints is essential if you eer want a fulfilling relationship. Knowing your own ability to live vigilantly day to day, being gratified with the prospects of how you are living your life up untill this point. This is what determines wether your active to take the step into entering a relationship. Every point in ones life is a learning experience. Treating past relationships as learning experiences help to divulge your understanding of what your really looking to gain out of future relationships. The following paragraphs discuss a story of my past. This story revolves around a relationship pickings place at a negative point in my life. So my lesson to you is one I learned the hard way. Being happy with yourself is vital in the lead attempting to by happy with someone else.     To mentally set the scene for my story, I will give some background into my mental and physical standpoint. During the time of this story, I was under a lot of stress from various circumstances. I had just recently lost my job at Subway and had no source of income. Becouse I lost my job, I had no longer the money nor the resources to continue with athletic training. Taking the three months off from athletic training had a negative loading on my physical appearence. With a noticable loss of physical appearence, my self esteem began to drop slightily. So all together, threw one run of bad luck into another, i was spiraling down into a depression like state.     It all started the first week of grade 10. I was walking to math class and i met up with a few of my lunch crew friends. I noticed my friend Ashlea talking to Erin Berring. Erin was an attractive, smart and fashonable girl. I always had a thing for smarties. In school she had straight As, and was also the leader of the female wrestling team. I felt a little up on myself that day for some reason. I reckon there was no better time then the present to chat it up a little. The conversation went quite well, which was different from what I expected. She even asked for my frame so we could continue our talk later that night. "Why would she be interested in me?," I said to myself. After all, she seemed way out of my league.