Experience In Giving Oral Care

Experience In Giving Oral Care Reflection is the process of reviewing an experience in order to describe analyse, evaluate and so inform learning about practice (Reid 1993).This essay will reflect on the importance of; and the experience I gained whilst giving oral care on a student placement simulation using a reflective model. Jamieson et al (2002) believe mouth care is the use of a toothbrush and paste to help patients recover and reduce risk of infections, communicate better, eat more easily and maintain dignity. Yet, it is also a role which too often delegated to health care assistants. I chose this area to highlight its need and the scope of opportunities in learning it has provided in improving my skills in practice. There are different models of reflection one of which is Gibbs (1988). On this occasion, Gibbs model will be used as a framework in guiding me, because it focuses on different aspects of an experience and feelings, and exploiting it fully will be more appreciated. Description I was part of a placement simulation group which went to the multi-skills laboratory to practice mouth wash. I was assigned a colleague to brush his teeth using a toothbrush and paste. I put on gloves so as to prevent contamination with body fluid. Seeking his consent, I undertook a brief  visual assessment of  the health status of his mouth. I then put him in a comfortable position so as to tolerate the wash. Thereafter, I cleaned all-round the mouth, gums and tongue. I finished off with mouthwash. I treated  my partner as though he was physically unable to hold the brush himself  to scrub his own teeth, but he was able to communicate with me and was able to assist me in terms of spitting and gargling with water at the end of the procedure. Feelings My immediate concern was I had not brushed anyones teeth outside of my family before and hence, how my partner will behave (Dowling, 2006). Although alert and dignified, I felt in giving mouth care, both the carer and patient are put into a state of uncertainty, embarrassment, inadequacy and a sense of intrusiveness to their privacy (Lewis, 2006; Sturdy, 2007). I became helpless with his facial expression shown no trust in me. Rungapadiachy (1999) defines trust as being honest, open, sincere, supporting and dependable, genuine, warm and accepting. Our reaction put us on the high score scale of Millon (1994), Hesitating (Reticent) pattern of behaviour. In spite of my concerns, I felt comfortable in completing the task. Evaluation Reflecting on or in action is becoming a great learning tool This experience taught me that, oral care provides any nurse with an ideal opportunity to undertake a thorough physical, emotional and cognitive assessment of a patient (DOH, 2001). I was pleased to find that, no injuries were sustained as I checked mouth prior and after. Also, I was pleased my communication skills improved and the therapeutic relationship built up; and with the knowledge I got from supporting literature formed the foundation of my learning and practice. Burnard (2002) suggests that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses. From his feedback, I understood feedback is an important learning tool. One crucial point to come from some recent research (Burke, 2009) is that many students do not know how to use feedback as many have never been taught how to do so. However, the experience highlights the complex problems I have to solve in practice and the provision of care needs to patients for whom I may not have had contact with before. Although this task caused me discomfort and added pressure in the short term, I realise that it was a very significant event in my studies. Analysis WHO (2010) describes a healthy mouth as being free of chronic mouth and facial pain; and helping patients/service users to meet their hygiene needs is a fundamental component of nursing care (Essence of Care, 2003). In 2007, 50% UK adults attended an NHS dentist. Older people in residential homes were at risk of infection, with infection identified in 80% of one study population (Holman et al, 2005). The care of a patients mouth forms an important component of assisting hygiene needs and yet is an aspect of practice which is not always afforded the attention it fully deserves (Evans, 2001).It is now clear that, mouth care is important and that, nurses have a role in assessing and maintaining it (Malkin, 2009). The task identified encouraging people to acknowledge their intuitive capacity helps them to appreciate their strengths and weaknesses (SWOT). Jasper (2003) regards SWOT analysis as getting to know ones self. The understanding of our skills and abilities and the awareness of where our limits lie is seen as crucial to being able to act as a professional practitioner. My confidence grew and got more interested, encouraging him to do as much as he could. Jackson and Mannix (2001) note that amount of interest the nurse shows in the learning needs of the student and the key role he or she plays in their achievement are essential to the students development. Conclusion I feel that the whole process went on smoothly. Caring for a patient requires a relationship and empathy. By developing collaborative relationship with patients, I can provide prompt and focused interventions which can limit illness. Nonetheless, it has raised awareness the effects of others on my practice. Action Plan At the moment, I read more books a day than practice. My aim is to be proactive in the future by promptly opening up through total participation and doing more practices on regular basis. I aim to develop the skill of emotional resilience to be able to deliver and receive any care or learning activity by keeping diaries of events and reflecting on them. Conclusion My belief now is brushing teeth loosens and removes debris trapped in the spaces and prevents the growth of plaque which habours bacteria and that; nurses have a role to play in mouth care. Due to my lack of experience in care and the job title of student nurse, I perceived that most sessions would run in a lecture format. I now believe practical skills development using reflection is as important as lecture tuition although, Quinn (2000) believes most students and many professionals note that learning acquired from placement experience is much more meaningful and relevant than that acquired in the lecture room. The process of learning I went through is more complex than Gibbs suggests. It is not as cyclical as this model implies and I found myself jumping or combining some stages, before coming back. However, it has taken me out of my comfort zone, challenging my thinking.

Howard Stern Essay -- essays research papers

.   Ã‚  Ã‚  Ã‚  Ã‚  Howard Stern has been labeled as many things, such as offensive, obnoxious, discussing and by the majority of his listeners a genius. He grew up in a suburb of Manhattan in the early sixties. His father, Ben Stern, worked at radio station WHOM where the was the engineer. His father commuted every day about 40 miles to and from work. Howard would spend little time with his father but on occasion he would get to go to work with him. This is what interested Howard to being on the radio.   Ã‚  Ã‚  Ã‚  Ã‚  At the time, the area Howard lived in was going through a racist change. His mother told his friends who were making racist comments about the negros that she and Howard were part negro, but they weren’t really. Roosevelt High School, his school, was a fully integrated educational system, which in his words meant â€Å"six thousand black guys and him.† In his high school years he turned to marijuana because he had to deal with several personal problems. He said the personal problems affected his personal life forever.   Ã‚  Ã‚  Ã‚  Ã‚  In his college years it was pretty hard for him to find a date. So, he stayed at home and masturbated constantly. His senior year he got on at the college radio station known as WTBU. That year he met the woman who would be his future wife. She was in his first film for his film class. He won an award for the film.   Ã‚  Ã‚  Ã‚  Ã‚  After completing college Howard went to his first job interview on May 12, 1977. His interview was at WRNW and he got the job. After two months on the air, the manager who said he would never be a good DJ and that he had a lousy voice, promoted him to program director because he was a hard worker and came to work on time.† After saving money and working for awhile he then married Alison. They got their own place and was doing well with Howard making $250.00 a week.   Ã‚  Ã‚  Ã‚  Ã‚  After three months of being program director Howard quit his job because he didn’t want to fire an employee. So, Howard was now unemployed himself. Howard decides to make a major decision and move to another city. He moves to Hartford and begins working as a morning man on WCCC. Time has moved to October , 1979. Howard then met his partner Fred who wil... ...ey say â€Å"I want to see what he will say next.†   Ã‚  Ã‚  Ã‚  Ã‚  Howard is invited to be on the David Letterman show and talks down about NBC. On a July of 1985 he tops the rating charts in New York. A rally is thrown for his accomplishment AC/DC plays at the ceremony. It is held in Central Park, on the field it is a sold out show. During the concert Alison’s water breaks. He named his first daughter Emily.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Three children later he is still the best known radio personality in years. Occasionally he might make a fool of himself in public like the MTV music award incident as Fartman. To this date the FCC still wants him off the radio and so does every other fundamentalist group in the United States. Most of the things he does are mostly misunderstood but that is the fate of most geniuses right? Stern, Howard (1997). Private Parts. New York City, NY: NBC Retived (11/17/00) From http://www.california.com/~rpcman/HOWARD1.HTM Retived (11/17/00) From http://www.sgi.net/~jon/howard/

The Sputnik Satellite Essay -- Space Satellites

Works Cited Incomplete Sputnik: The Satellite That Inspired Generations Introduction In 1950, a group of American and European scientists decided to establish a worldwide program to promote research and understanding of the world around them. They decided that July 1957 to December 1958 would be called the International Geophysical Year, or IGY. They hoped that drawing attention to geophysical matters would stimulate new projects and inventions, and increase the knowledge the world had of the planet, its atmosphere, and the things that lay beyond. This focus galvanized many countries to produce new innovations in science and technology. At the same time, the United States and the Union of Soviet Socialist Republics were involved in the Cold War. They were competing against one another, constantly trying to show that their country (and therefore their form of government and ideals) was the better choice. They were competing for influence over the rest of the world. Eventually the USSR and Communism lost, but far more important results came out of this competition instead. Development of Sputnik The idea that a satellite could be put into orbit around the Earth was introduced to the scientific community in 1903. Konstantin Tsiolkovsky showed that this could be done, but his work was all mathematical. In 1948, another Russian named Mikhail Tikhonravov talked to the famed scientist Sergei Korolev about turning this theory into an actual working device. Tikhonravov presented his ideas to the Academy of Artillery Sciences, but they refused to support the project. The Academy president Anatoli Blagonravov, however, could not get the idea that the project would have huge value out of his head. Eventually he brought the p... ...rsity. Accessed May 22, 2003. [URL] 6. Jorden, William J. "Soviet Fires Earth Satellite Into Space?" New York Times, October 5, 1957. [URL] Accessed May 22, 2003. 7. Launius, Roger D. "Sputnik and the Origins of the Space Age." 1997. NASA. Accessed 2 Apr. 2003. 8. Plumb, Robert K. "Satellite is First Step Into Space." New York Times, October 5, 1957. [URL] Accessed May 22, 2003. 9. Siddiqi, Asif A. "Korolev, Sputnik, and The International Geophysical Year." 1997. NASA. Accessed 2 Apr. 2003. [URL] 10. Sullivan, Walter. "Scientists Wonder if Shot Nears Moon." New York Times, November 5, 1957. [URL] Accessed May 22, 2003. 11. Wright, Michael. "Sputnik: First Artificial Satellite." 30 Aug. 1997. Accessed 2 Apr. 2003 [URL]

Essay --

1. What is RCRA and what are its goals and objectives? Resource Conservation Recovery Act of 1976 was created to regulate solid waste and hazardous waste as well as regulate underground storage tanks. The goals and objectives of the RCRA are: †¢ Protect human health and the environment from the potential hazards of waste disposal †¢ To conserve energy and natural resources †¢ To reduce the amount of waste generated †¢ To ensure that wastes are managed in an environmentally sound manner (EPA, What is RCRA?, 2010) 2. What are the two agencies that regulate the generation and transportation of hazardous waste? Briefly describe these agencies. The 2 agencies that regulate are the EPA and the Department of Transportation (DOT). The EPA is known to all as the Environmental Protection Agency and is the main government control group. All other entities report to the EPA. The DOT is the Department of Transportation. This group is in charge of everything that moves across the nation on wheels, and has the record control. 3. What is a hazardous waste manifest and what is it used for? The ...

Case Study Pizza War Essay

BSB, Inc. is a large nationally operated food-services company. The company serves client organizations on a contract basis. Its business is divided into three (3) market-oriented divisions of corporate, airline and university or college. Case Summary Renee Kershaw is BSB’s manager of food services at a medium-sized private university in the Southeast. BSB has been operating at the university for the past 10 years and Kershaw has been the manager at BSB for the past 18 months. At the university, BSB caters for 6000 students and 3000 faculty staff and support personnel via its 3 different eateries in the university campus. The three eateries are: a)The Cafeteria ? Open for breakfast, lunch and dinner daily b)The Dogwood Room ? Serves an upscale luncheon buffet on weekdays only c)The Grill ? Open between 11a. m to 10p. m daily and until midnight on Friday and Saturday nights Initially, after 4 months being in-charge of BSB’s operations at the university, Kershaw conducted a survey on customer needs and market trends. The survey revealed that students were not satisfied with the food services at the university. A large amount of the food being consumed by students was not from BSB’s facilities mainly due to a lack of variety and unsuitable facilities’ serving time for the students. Below are the data from the survey: Food prepared in dorm room20% Food delivered from off campus36% Food consumed off campus44% Students with cars on campus84% Students with fridges or microwaves in their rooms62% Food that students consumed outside BSB, Inc. facilities43% As a result of the survey conducted by Kershaw, she decided to include pizzas in the menu. In addition to the new menu, Kershaw also introduced delivery service (by bicycle) for its pizzas. Currently, apart from placing the pizza making facilities at the grill, space is also being allocated at the grill to store pizza ingredients, as well as to prepare and stage pre-made pizza. In order to keep the cost down and provide fast delivery, only a limited number of ? standard pizzas’ are offered in the menu. Challenges and Problems Despite the rise in sales and profit from the pizza operations, increase in demand for the pizza has led to capacity problems and increase in delivery times. As a result, the pizza’s sales began to level off. Furthermore, Kershaw is concerned of the competition from a new food court to be opened in campus which will house Pizza Hut, Dunkin’ Donuts and Taco Bell. Specifically, Pizza Hut will be putting up a facility offering a limited menu and pizzas on a â€Å"walk-up-and-order† basis. Question 1 Does BSB, Inc. enjoy any competitive advantages or core competencies? Answer Competitive Advantage is the ability of a company to win consistently over the long term in competitive situation. Core Competencies are the unique resources and strengths that an organization’s management takes into account when formulating strategies. BSB enjoys competitive advantages or core competencies in a number of ways. a)Specialization – BSB is a specialized food-services operator for universities and colleges. b) Experiences ? BSB has been serving the university for 10 years therefore they have first hand knowledge relating to customer preferences and needs derived from their experiences in the market. For e. g. : survey data. c)Existing facilities and services provided ? new entrants have to start from scratch. For e. g. : location and delivery services in the university are very important due to the lack of parking spaces. d)Brand Recognition – Familiarity among the campus community of the BSB ? brand’ as it has been in existence for some time. e)Close proximity – Close proximity to the customers is critical for pizza delivery as it allows quicker and lower cost delivery. Question 2 Initially, how did Renee Kershaw choose to use her pizza operations to compete with off campus eateries? What were her competitive priorities? Answer Kershaw decided to use her pizza operations to compete with off campus eateries based on the following reasons: a)Available resources ? Based on time, location and staff available for Kershaw at that time, pizza operation is the most logical choice to be adopted in competing with off campus eateries. Pizza operations do not require much time to be set-up. Furthermore she can run the operation from one of the available eateries (she decided at the Grill) and a minimal amount of staff training is required to run the pizza operations. b)Food variety ? By introducing pizzas in the menu, Kershaw has somewhat addressed the problem of the lack of food variety by only implementing minimal changes in her normal operations. c)Catering for students’ tight schedules ? Through delivery services, Kershaw is able to cater for students with tight and erratic schedules. This decision is based on the high percentage of food not purchased from BSB facilities whereby 36% of the food is delivered from off campus. Since pizza can be kept and reheated easily, going into the pizza business seemed like the best option for Kershaw because 62% of students in the university have fridges and microwaves in their rooms. Competitive Priorities are the critical dimensions that a process must possess to satisfy its internal or external customers both now and in the future. Kershaw’s competitive priorities when choosing the pizza operations to compete with off campus eateries were: a)Cost ? Low cost of operating since pizza operations require minimal staff training and delivery is done by bicycle. Limited combinations of toppings and ? standard pizzas’ available enable Kershaw to keep cost down. b)Flexibility ? Through minimal changes, Kershaw is able to add a selection of pizzas to her menu as part o her efforts to increase the variety of food offerings. c)Time ? The limited number of pizzas that can be prepared and cooked would be able to speed up preparation and delivery time since ? standard pizzas’ can be pre-assembled and ready-to-cook once orders are received. QUESTION 3 a) What impact will the new food court have on Kershaw’s pizza operation? The immediate impact would be direct competition from other food operators. As announced by the University, the new food court would accommodate, among others, food franchises such as Dunkin’ Donuts, Taco Bell and Pizza Hut. BSB, Inc was the sole contractor and provider of food services in the University campus prior to the announcement, thus it has, until recently, enjoyed somewhat monopoly status. Of even more concern to BSB is the fact that the new food operators are coming in as established brand names, hence making competing with them an even more difficult task. Competition to BSB, Inc would come in the form of alternative food types. Dunkin Donuts, for example, would offer snack-type food for the students, where as the likes of Taco Bell offers easy-to-go fast food. Students would find these types of food suitable for life on campus. Students are normally subject to hectic schedules and are always on the move, therefore having the convenience of easy and ready-to-go food services (as offered be the new operators) would suit them very well. Of more significance (to BSB) is the emergence of Pizza Hut on campus. Kershaw’s BSB has recently introduced grilled pizza as an item on its grill menu, and has so far enjoyed considerable success too. Of course, this was before Pizza Hut came into the picture. There is little argument that Pizza Hut would provide the keenest and most direct competition to Kershaw’s pizza business. In fact, Pizza Hut, being a reputable and an established franchise coupled with its financial muscle, would be a serious and immediate threat to BSB’s market share in pizza sales. However, Kershaw should take note of the fact that the Pizza Hut franchise on campus has its limitations. For one, the Pizza operator does not offer delivery service (for now), as it operates on a ? walk-up-and-order basis. Secondly, it is only offering limited selection of toppings for its pizzas, preferring to focus on a ? standard menu’. QUESTION 3 b) What competitive priorities might she choose to focus on now? BSB’s competitive priorities can be divided into three main categories; Cost, Flexibility and Time. With the establishment of the new food court and the emergence of the new food franchises at the food court, Kershaw’s BSB would now have to decide which competitive priorities would give it a competitive advantage and thus allow it to better compete with its more established competitors. BSB may choose to focus on its wide array of food selection it provides on campus via its three main food facilities; the Cafeteria, the Dogwood Room and the Grill. Compared to its competitors which serve mainly homogeneous products i.e. donuts, tacos and pizzas, BSB offers a better selection of food items including those offered by its competitors i. e. pizza, which may work to BSB’s advantage in serving customers who desire for an ? expanded’ menu to satisfy their culinary instincts. As part of its efforts to offer a variety of food selection, BSB can also look at increasing the topping combinations for its pizza to compete head-on with Pizza Hut’s limited selection of toppings. BSB’s efforts at expanding its menu should not be at the expense of quality, while at the same time attempt to maintain the pricing for its food items. Another competitive priority that Kershaw and BSB would do well to leverage on is its ability to provide delivery service. Since BSB’s competitors do not offer delivery service, BSB has an edge in this area, as students, which make up the majority of it customers, would usually prefer not to dine out given their hectic schedules. Also, BSB’s customers would be able to enjoy food in the comfort of their own dwellings. In addition, Kershaw may want to set a minimum amount limit for delivery orders to ensure the service remains cost viable, and also to ? encourage’ customers to order more food or higher priced food items. QUESTION 4 a) If she were to change the competitive priorities for the pizza operation, what are the gaps between the priorities and the capabilities of her processes. In its efforts to add variety to its food selection and in response to a customer survey conducted, BSB has started offering pizza to its customers. BSB’s pizzas were well received by the students, and soon after, sales increased, resulting in higher profit margins for the company. However, the new found success comes with new challenges. Kershaw soon found that her existing capacity is not sufficient to cater for the increasing demand for her pizzas. She lacks storage space for pizza-making equipment and facilities i. e. ovens and space for her pizza ingredients. Her pizza operations are putting a strain on her other grill activities, which is forcing her to re-look at some of the selection on the grill menu. Given her existing facilities, she faces the dilemma of increasing her pizza supply at the expense of other food items. This may defeat her initial purpose of attempting to offer a variety of food selection. b)How might that affect her operating processes and capacity decisions? Kershaw was also faced with the problem of longer delivery time for her call-to-order pizzas. She deduced that the gap arising between her existing capacity and the growing demand for her pizzas has, to some extent, caused delivery time for pizza orders to slowly increase, possibly leading to ensuing complaints from its customers. The poor service (delay in delivery orders) may influence customers to seek alternative food services in and off campus. As a consequence of the gap, customers’ satisfaction may decline, potentially leading to loss of regular and existing customers as they opt for alternatives. As a result, sales will suffer, and inevitably affecting BSB’s bottom-line, if not immediate, in the long run. Lower margins and ultimately declining profitability will in turn impact the company’s overall performance and viability as a going concern. QUESTION 5 What would be a good service strategy for Kershaw’s operations on campus to meet the food court competition? With the emergence of new food services in campus namely Dunkin’ Donuts, Taco Bell and Pizza Hut, Kershaw should first invest time and resources in understanding the impact of the emergence of these competitors on customer preferences. Knowing very well the fact that Pizza Hut are of world class standard with regards to quality and taste, Kershaw needs to come up with a better business strategy. Our group has deliberated on the following recommendations as part of Kershaw’s strategy: 1. Offer Variety of Pizzas at Cheaper Price Off Campus food outlets, especially those offering Pizzas have emerged as a serious source of competition to BSB. These food operators are likely to offer many pizza combinations. Thus, Kershaw could maintain its competitive advantage by offering a variety of pizza with a wide range of toppings at reasonable prices. The key to this strategy is to maintain quality and to innovate on product offerings. For instance, Kershaw could offer pizza selections which are different from what Pizza Hut currently offers (such as Spicy Tandoori Pizza, Vegetarian Pizza and Chicken Hot Pizza). This might allow the customers to have more choices that are superior in quality yet affordable. By offering Vegetarian Pizza which is not being offered by Pizza Hut, the international students who are vegetarians (i. e. students from India and China) could also indulge in the pizza. This could create a niche market for BSB among vegetarians. Due to the fact that the majority of the university’s residents are students who do not earn a fixed and stable income, Kershaw should offer pizzas that are affordable to them. To beat her competitors, Kershaw should sell the pizza at lower prices than Pizza Hut. By offering a variety of pizzas at lower prices, Kershaw could increase the demand for its pizza, ultimately increasing its profits. 2. Maintain Good and Consistent Quality Understanding customer needs and maintaining good quality are paramount in ensuring success, especially in the food industry because customers are extra value conscious when it comes what they ?consume’ i. e. food and beverage. For some customers, price may be of less importance compared to quality. Kershaw should continuously reinforce its pizza quality and standards to remain ? relevant’ with in-campus and off-campus customers. 3. Phone Order and On-time Delivery Kershaw’s direct competitor, Pizza Hut could probably match BSB’s pizza prices, but may lose out in terms of selection and delivery. Since Pizza Hut does not accept phone orders and do not offer delivery services, Kershaw should take advantage by offering these services to the customers. Kershaw should allow phone orders because most of the students face erratic schedules that discourage them from eating out In addition, the delivery should be made timely to ensure customers’ satisfaction. 4. Longer Operation Time Due to the fact that the schedule of students are tight and normally did not fit with cafeteria serving hours, Kershaw should extend its business operations until midnight. Some students tend to study until midnight and like to have supper. In fact, they will find the nearest food court for convenient. Many students tend to study and have a group discussion outside the library while having supper at the same time. Thus, it is important for Kershaw to extend its operation hours and serve food such as pizza or burger at the cafeteria. As a result, Kershaw could maintain its competitive advantage and compete against the likes of Pizza Hut and Taco Bell. 5. Expanding the Distribution Network Presently, Kershaw is renting three food-service facilities namely the cafeteria, Dogwood Room, and Small Grill. However, she is nearing full capacity on her pizza operations and is looking to expand. Thus, she may have to consider a new location, as there seems to be limited space at the grill location. Clearly, she can choose to set up new convenient and attractive food-facilities such as the Kiosk and Bistro-type facilities, provided that the return on investment is worthwhile. CONCLUSION AND RECOMMENDATION In conclusion, by adding variety to the menu while maintaining the quality and delivery speed, it is possible for BSB to maintain its competitive advantage despite the emergence of new rivals such as Pizza Hut and Dunkin Donut. The increase in requests for additional topping combinations and levelling of sales suggest that BSB should expand its product variety. This suggests customers’ desire for a variety of selection, and the expanded hours will enable BSB to offer its services when the Pizza Hut is closed, or when students are in their dorm rooms. However, an increase in product variety will affect both service and cost. Kershaw probably cannot have as many pre-made pizzas ready to be thrown into the oven. She will also need to stock additional toppings. If she wants to maintain good service, she will need to hire additional workers. Hence, there will inevitably be some trade-offs between quality service and cost if she decides to focus on product flexibility.

The American Health Care System’s Limited Access

Identify and discuss the factors that limit access to health care services for many people in America. According to a published Guidebook for providers entitled â€Å"Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families (January 2001)†, there are two general and primary factors that limit certain groups of the American population in their access to appropriate health care.   These are the structural barriers and the cultural barriers.Structural barriers are further categorized into two sub-factors. These are the   External barrier factors such as lack of health insurance coverage and out of pocket costs and the Logistical difficulty factors such as lack of transportation, language difficulty (or comprehension) and illiteracy (CC Guidebook, 2001).Meanwhile, Cultural barriers are also categorized into internal and external factors.   Internal factors are those caused by traditional practices among certain ethnic groups like Asians – particularly the older Chinese generation – who refuse to reveal details about their affliction or disease because they regard these matters as purely personal and should be kept within tight family circles only.   Particularities of these traditional beliefs usually affect the provision of a more thorough health scanning and diagnosis, thus resulting to usual misdiagnoses or prognoses (CC Guidebook, 2001).Cultural external factors include a lack of comprehensive background data or earlier studies about the cultural nuances and statistics for these underserved minority groups (CC Guidebook, 2001).   As a direct result, the lack of available research data affects the decision of policy makers and federal level planners to incorporate cultural nuances into intervention programs that could break the trend of a â€Å"cultural block† or absence of data.Furthermore, policy makers tend to group together certain ethnic groups as those â€Å"not needin g† specific care like nursing home services or elder care because of the assumption or misconception that all elderly people from a specific ethnic group like the Hispanics who have close personal ties and the Asian groups, that they will take care of their elderly.   Research did confirm this fact (CC Guidebook, 2001, p10) but this shouldn’t be the norm or primary continuing assumption in the future.   To quote from the Guidebook (CC Guidebook, 2001, p10):â€Å"Research does confirm that a significant proportion of minority elders live with their family. Unmarried older African Americans are twice as likely to live with family  members as whites, Hispanic American and Asian American elders are three times as  likely, and half of urban Native American elders live with family members (controlling for income, health status, and other characteristics)†.2. Identify the specific populations and groups that face difficulties with access to health care services. According to the Fact Sheet published by the Agency for Healthcare Research and Quality, two predominant ethnic minority groups lack the basic access to primary and preventive care in the US.   These groups are the African-Americand and the Hispanic population in the US (AHRQ, February 2000). To quote:â€Å"About 30 percent of Hispanic and 20 percent of black Americans lack a usual source of health care compared with less than 16 percent of whites.Hispanic children are nearly three times as likely as non-Hispanic white children to have no usual source of health care.African Americans and Hispanic Americans are far more likely to rely on hospitals or clinics for their usual source of care than are white Americans (16 and 13 percent, respectively, v. 8 percent)†.These data from AHRQ and other agencies such as the Department of Health and Human Services formed the (HHS) formed the basic tenets and foundation for the 18 out of 28 focal areas for their Ten year Plan entitled â⠂¬Å"Healthy People 2010†.   Six out of these 18 focal areas are geared toward eliminating factors to health barriers and disparities such as: gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.   According to the OMH, there is â€Å"Compelling evidence indicates that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations in all these categories and demands national attention’ (Fact Sheet, AHRQ, 2000).References:Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families (January 2001). (Chapter 10 and 11). Retrieved on February 28, 2007. From: https://aoa.acl.gov/#search=`Achieving%20Cultural%20CompetenceAddressing Racial and Ethnic Disparities in Health Care. Fact Sheet, February 2000.   Ã‚  Ã‚  Ã‚  Ã‚   AHRQ Publication No. 00-PO41. Agency for Healthcare Research and Quality,    Rockville, MD. Retrieved on F ebruary 28, 2007. From:                   https://www.ahrq.gov/research/disparit.htmCover the Uninsured Week 2007 (April 23 to 29).   Retrieved from the homepage on February 28, 2007.   From: http://www.rwjf.org/en/library/articles-and-news/2011/06/looking-back-on-cover-the-uninsured-week.html?cid=xdr_ccs_001Keppel, K. et. al. National Center for Health Statistics (NCHS). Trends in Racial and   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Ethnic-Specific Rates   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   for the Health Status Indicators: United States, 1990-98.    Retrieved on February 28, 2007.   From:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://www.cdc.gov/nchs/data/statnt/statnt23.pdfNational Center for Health Statistics (NCHS). Midcourse Assessment of Healthy People   Ã‚  Ã‚   2010 Goal II (PPT). (2006). Retrieved on February   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   28, 2007.   From:http://www.iom.edu/Object.File/Master/4/176/PatientversionFINAL.pdfOffice o f Minority Health website. â€Å"Eliminating Racial & Ethnic Health Disparities†.Retrieved on February 28, 2007. From:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://www.cdc.gov/omh/AboutUs/disparities.htmâ€Å"What Healthcare Consumers need to know about Racial and Ethnic disparities in   Ã‚  Ã‚  Ã‚  Ã‚   Healthcare†. (March 2002). Institute of Medicine. Retrieved on February 28,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2007. From:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://www.iom.edu/Object.File/Master/4/176/PatientversionFINAL.pdf

Different attitudes to war Essay

Rupert Brooke and Wilfred Owen are poets who fought for England in the First World War. Both poets depict the same topic of war, but through different views and opinions. Despite them pertaining to the similarly themed subject, their language and tone invoke contrasting feelings in readers and affects their impression of war in opposite ways. Examples of these differences can be seen in the two poems by Rupert Brook ‘The Dead (iii) and ‘The Soldier’ and two by Wilfred Owen ‘Anthem for Doomed Youth’ and ‘Dulce et Decorum Est’. Rupert Brooke writes ‘The Dead (iii)’ in an extremely relaxed and romantic mood. Brooke had not experienced war, so with this in mind the poem seems very clear and concise. Brooke aims to show us the glory that is brought about by dying for your country. He thinks that war is a simple and dignified cause. He aims to make us more patriotic and convince us to die for our country in war. The first line is very energetic and joyous for a horrendous subject such as war. This may mean that Brooke tries to symbolise enthusiasm and glory. Since bugles are used at a grand occasion, but also militarily charges and retreats he may be trying to indicate that dying for your country is a glorious way to end your life. â€Å"Blow out, you bugles, over the rich Dead!† As he says, it has made them ‘rich’. This probably means that they are wealthy with glory, praise and admiration. He makes no mention of the pain and suffering in war. The third line explains that dying has again made them important. But, dying has made us rarer gifts than gold. Gold is very rare, so by dying they have been them valuable and unique. Brooke is trying to signify that not many people sacrifice their lives this way. This in Brooke’s belief is a very honourable and glorious practice. The sestet explains to us how the soldiers dying bring England a lot of honour and credibility. Honour has come back, as a king, to earth, And paid his subjects with a royal wage; The peace that has been present for so long has made her weak. ‘Heritage’ is use to clearly link with the overall theme of ‘payment and reward’. It implies ‘that which is rightfully theirs’, has been successfully implemented. And we have come into our heritage. In ‘The Soldier’, Brooke feels content to die for his motherland to protect the people left behind. The title conveys a sense of pride and loyalty to the reader. Although fully aware of the possibility of death, indicated by the line ‘If I should die’, think only this of me:’ Even if his ashes, his ‘richer earth’, were to lie in a land distant from England, his love would still be ‘forever’. This is further stressed when his relationship is compared to the bond between mother and child. ‘A dust whom England bore, shaped, made aware,’ His purpose of fighting for his country is to protect England, indicated by the words, ‘Gave, once, her flowers to love, her ways to roam,’ His sense of pride and honour is so strong that he does not dwell on the gloom and misery that is associated with war, instead views it as if through rose-tinted glasses. Even if his contributions were minute, shown by the comparison of, ‘A pulse in the eternal mind’ ‘Give somewhere back the thoughts England given’, He is happy to repay England and wishes to preserve her ‘laughter’ and ‘gentleness’ for the future. This contentment and happiness is clearly shown by the words ‘peace’ and ‘heaven’, even if he is dead, he can rest in peace as he has loyally served his country. This patriotism is frequently brought to attention with the repeated use of the word ‘England’ and ‘English’ throughout the poem. The Soldier gives out an optimistic tone, making war out to be a peaceful and heroic act. It is written in the form of a Petrarchan sonnet, which is traditionally used to express personal thoughts and feelings. This could have been the reason why Rupert Brooke chose to write in this form. It is also an autobiographical poem in which the author expresses a personal viewpoint on war and his love for his country. Rupert Brooke also makes use of iambic pentameters, which is a line containing five stresses. It gives his written words authority by using this classical verse. It also provides a rhythm, which reminds the reader of a heartbeat or a ‘pulse’. This helps in making his argument more convincing. The stanzas are separated into two. The octave talks about the possibility of death while the sestet talks about death itself and what his sacrifice will mean for England. It gives the traditional, naive and biased view of war. It also gives a pastoral description yet a biased view of England as he blatantly ignores the negative side of England only mentioning its best side. He uses a religious diction, for example the last line reads, ‘In hearts at peace, under an English heaven’. ‘ This reveals Brooke’s belief in God and Heaven. This is what makes the poem sound somewhat like a sermon. Rupert Brooke expresses patriotism and his conviction that England is worth fighting for as he also claims that God is on England’s side by saying ‘blest by the suns of home’. By believing in  this, Rupert Brooke makes himself believe that he should sacrifice his own life for England and by doing so he would be returning the favour of being born British and so believes it is an honour to go to war, and an even greater honour to die in battle for one’s country and in return, portrays in his poem an image of one dying a painless death. Such a view is in the Victorian tradition of war which viewed it as a glorious and noble enterprise, with such poems as Tennyson’s ‘Charge of the Light Brigade’. This patriotic fever was simply carried on by Brooke who still saw warfare in terms of duels and honour. By looking at these sonnets, we can come to the obvious conclusion that Brooke was very idealistic about war and had no idea of the horror and suffering involved. However Wilfred Owen’s ‘Anthem for Doomed Youth’ achieves a totally different effect on the reader, as it is completely devoid of any obvious sense of national pride, and instead questions the very purpose of war. His use of ironies throughout produces a mocking tone, which serves to emphasize his view of the uselessness of war. This is revealed in the title, where the effect of the word ‘Doomed’ suggests that the soldiers are destined to die and are without any hope. However, it is ironic that it is used with the word ‘Anthem’, a word reserved for praise. ‘What passing-bells for these who die as cattle? ‘ The soldiers are compared to ‘cattle’ that are slaughtered, indicating that they have no other purpose than to die. The comparison also suggests that the soldiers were killed numerously, mercilessly and systematically. He uses crude words to convey the complete absence of love or honour on the battlefield and numerous contradictions to invoke the feelings of pity in the reader; instead of ‘passing-bells’ there are only ‘guns’ and ‘stuttering rifles’. The words ‘monstrous anger’ refers to the fierceness and violence of war. ‘Only the monstrous anger of the guns. Only the stuttering rifles’ rapid rattle’ The word ‘monstrous’ also suggests that the soldier’s task is immense, almost impossible to do, which emphasizes the feeling of hopelessness of war. This is again highlighted when the poet refers to the gunshots as ‘stuttering’. This means that there are bullets whizzing everywhere, and chances are most of the men would have been hit. The alliteration of the ‘R’s in rifles rapid rattle indicate the sounds of gunshots; again appealing to the reader’s senses to highlight the bleak conditions in the battlefield which are terrible and ugly. Owen is obsessed with the cruelty, indignity and senseless wasting of their lives. The use of the word ‘patter’ refers to the bullets hitting a soldier’s body. It gives the effect of raindrops hitting a window, which when used to describe how a body is inflicted with bullets paints a very cruel and inhumane picture. When he writes, ‘No mockeries now for them; no prayers nor bells’ He says that the dead are forgotten; they are neither mourned nor prayed for. This is because the dead are so many that it would take too much effort to bother to tend to them. The only things to mark their deaths are the ‘choirs’, yet there are not ordinary choirs but, ‘The shrill, demented choirs of wailing shells’. It is as if death has become the norm for them; it does not receive much attention or sympathy. The words ‘shrill and wailing’ seem to suggest that even in their deathbeds, there is no peace. The ‘bugles calling for them from sad shires’ seem to be calling in vain, because the soldiers are all dead. If anything, the soldier’s deaths are undignified and not the least bit honourable. There is no hero worship and the dead are ignored. There is no pride, no honour and still the war continues. Owen writes about the effects of so many casualties of war and how it ironically destroys the homes the soldiers died to protect. The numerous deaths caused by war  ravages even the younger generations left behind, shown by the ‘candles’, ‘What candles may be held to speed them all? Not in the hands of boys, but in their eyes Shall shine the holy glimmers of goodbyes. ‘ This refers to their tears and the ‘pallor of girl’s brows’ which is the paleness of the girls. It is all they have to mourn the dead soldiers, and they are plagued with sadness at the death of a loved-one. The line, ‘And each slow dusk a drawing-down of blinds’  shows that they are slowly losing hope against the darkness, which signifies their sorrow and misery. He says that the youth are supposed to be the hope for the future but are doomed because of the past, which is ironic because so many soldiers wasted their lives hoping to protect these children. The calmness achieved by the consistency only serves to suggest the mood is heartless, without emotion, cold, cruel, and that like of a machine. In ‘Anthem for Doomed Youth’, the rhythm is broken and unsteady; it serves to create an impression on the reader of how grave and miserable war is. In ‘Dulce et Decorum Est’, the tone is more sombre and angry; making out the same war is grim and insufferable. The Latin words used in the title of the poem Dulce et Decorum Est mean, ‘it is a sweet and fitting thing to die for ones country’. This is ironic as throughout the poem, Wilfred Owen gives the reader a negative picture of war and towards the end of the poem, calls his title ‘the old lie’. This is because at the start of the war the Latin phrase had become a motto which was used in supporting patriotic statements about war and to encourage other young men to become soldiers. But Owen himself had been at the front lines for three years and so by now knew what war really meant and so he uses his poetry as a means to express the views of soldiers to people who had no experience of it; namely the public. Wilfred Owen begins his poem with the soldiers’ description, ‘Bent double, like old beggars under sacks, Knock-kneed, coughing like hags,’ This is strange coming from a soldier himself and directly opposes the stereotypical soldier. Throughout, his choice of words describing the soldiers, his experience and war itself, Wilfred Owen puts the reader into a state of shock and disillusion. He uses the analogy of war as being like a plague or a lethal disease that is highly contagious and can cause mass destruction, in order to emphasise the harsh reality. This is shown when he writes, ‘like a man in fire or lime’; as in the days of plague where lime was used as a substance to decompose dead bodies, and in saying this, he says that those who enter war, those who actually participate and experience war at its worst, for them there is no return to normality, or indeed humanity. He writes about a soldier who had died of poisonous gas inhalation and describes it vividly, trying to make the reader imagine the scenes before him using the present progressive verb form ending with ‘-ing’. For example, ‘He plunges at me, guttering, choking, drowning. ‘ This gives the sense of immediacy, that the reader is actually witnessing the soldier’s death. This soldier died by breathing in poisonous gas. Then Owen describes how the man’s dead body was treated, ‘Behind the wagon that we flung him in, And watch the white eyes writhing in his face, His hanging face, like a devil’s sick of sin, ‘ This shows the pain he was in, as he was on the brink of death. This is to  illustrate that as the devil is destined to commit evil until the end of time, it has come to the extent that even the devil is sick of the amount of evil and torture around it. The religious diction used here symbolizes the relationship between war and the devil and that they too, are playing on the same grounds as the devil. A direct address to the readers is also used, using a persuasive technique, especially in the last stanza, for example, ‘If you could hear†¦Ã¢â‚¬â„¢ in line 21, ‘My friend, you would not tell†¦Ã¢â‚¬â„¢ in line 25, This is so that the reader would feel sympathetic towards him and the soldiers. It is almost as if Owen is begging the reader to understand. Through describing this man’s tragic death and his burial, Wilfred Owen tries to change the views of the public. The use of fricatives symbolizes the harsh reality of war as by using fricatives, for example a hard ‘c’ is used in words such as ‘corrupted’ and ‘cud’, it becomes as though the reader can actually hear the person dying as it sounds like choking and so writes in a very vivid form. In the last few sentences he makes his final message clear, ‘My friend, you would not tell with such high zest To children ardent for some desperate glory, The old lie: Dulce et Decorum Est Pro Patria Mori.’ Again he makes a personal plea to the reader telling them not to tell children that war is a patriotic act and the only answer to the world’s problems. It is in fact the worst possible answer, there can never be honour as a result of war and there are only dire consequences. Brooke’s love for England is shown throughout his work. As in Dulce et Decorum Est repetition and alliteration used. The words England and English are repeated many times to show his love for his country and alliteration such as, ‘Her sights and sounds’ magnify the beauty of England. It is also used to mask the horrors of death on a battlefield as it states, ‘That there’s some corner of a foreign field’. He also believes that heaven will look similar to England by stating ‘under an English heaven’ and therefore also believes in the superiority of the English, ‘a richer dust concealed’. Owen, on the other hand, witnessed twentieth century war in all its cruel destructiveness and as a consequence brought war poetry into the modern era. Although both poets write about the same topic, which is war, they both have different views and attitudes towards it. Perhaps this is because of their different experiences with war. Brooke is like a new soldier, naà ¯ve and yet to experience its horrors. Owen writes as if he has just witnessed the worst, as he was involved with the uglier and bloodier part of the war. He also reveals the effects both on and off the battlefield. Both authors have distinctly different impressions of war because of their different experiences, but ultimately, both describe the subject, although from totally opposite sides. The two poets really contrast and oppose each other greatly. Brooke writes about war idealistically and with passion, Whereas Owen does the complete opposite. Owens’s poem is however more reliable since he has experienced war. ‘The Dead’ was written before the war. The Soldier was written in 1914, a year before Brooke died, and Owen wrote Dulce et Decorum Est in 1917, three years after the First World War had started. In these dates we may find the reasons behind the conflicting ideology the two men gained. Brook wrote his poem at the beginning of the war, and so the ideas and perceptions of war and fighting for one’s country as being noble and heroic were still fresh in his mind and the public’s. Owen, on the other hand, wrote his poem three years into the war and in that time was able to see and accept the realities of war, so his perception of war was changed to bitterness and this was reflected in his many poems such as Anthem for Doomed Youth in which he reveals the same feelings on war as he does in Dulce et Decorum Est. In one of his previous poems, The Ballad of Peace and War, he himself had supported  the idea of, ‘How sweet it is to live in peace with others, but sweeter still far more meet to die in war with brothers. ‘ Therefore, it would be concluded that the only reason why the two poets have conflicting ideologies of war, is time. If Brooke had experienced more of the war he might have wrote later poems that portrayed the same bitterness as Owens.