OPEC essays

The Essential Qualities and Knowledge for Effective Counseling

An advisor is an expert who is prepared to assist individuals with handling their enthusiastic, social, and physical issues. At the point when somebody chooses to counsel a guide it is on the grounds that he/she feels that the advocate is the main individual who can offer compelling right hand. In advising there are different characteristics that must be controlled by a counselor.Advertising We will compose a custom research paper test on The Essential Qualities and Knowledge for Effective Counseling explicitly for you for just $16.05 $11/page Learn More Besides, the advisor should utilize various procedures on the grounds that a method that worked for one customer may not work in another customer. This paper will conceal some light into the above expressed parts of advising. The primary goal of an advisor is to support his/her customers take care of their issues. Being an advisor is a calling subsequently on the off chance that somebody contemplate bringing in cash, it is better for him/her to discover another profession where bringing in cash is the primary target. At the point when an instructor is controlling somebody he/she should realize that by misdirecting the customer he/she isn't just responsible to that specific customer yet additionally to the maker of sky and earth (Burnard, 2005). An advisor ought to never hop into ends thus he/she should focus on what the customer is stating in light of the fact that by being unsteady he/she may miss critical data that could have made it more clear the client’s issues. This suggests an advisor ought not feel like he/she knows everything in light of the fact that regardless of how comparative the circumstances may sound there is constantly a distinction. Indeed by listening more the guide will get familiar with the character of the customer as opposed to when he/she is doing the vast majority of the talking (Gladding, 2008). An advocate needs to practice a ton of tolerance and acknowledgment since hurrying things can demolish the advising procedure. Tolan (2003) states that in guiding calling the customers are from varying backgrounds going from sedate addicts to hoodlums and along these lines the instructor must acknowledge them simply the manner in which they are on the grounds that they want his/her administrations. This is because of the way that they are needing assistance and in the event that they are dismissed they may not see the need of being improved. Gladding (2008) proposes that tolerance in mental advising is significant on the grounds that it encourages an instructor to oversee outrage when aggravated by a client’s conduct or moderate advancement. An advocate should realize that a few methods may take longer than expected to be finished and thus issues can't be understood in a solitary day since they additionally took days to be established.Advertising Looking for examine paper on brain science? How about we check whether we can support you! Get your first paper with 15% OFF Learn More All the encounters experienced in guiding ought to be reflected in a counselor’s work. This incorporates comprehension of people’s societies and convictions on the grounds that these are a portion of the components that cultivate or prevent directing. A decent instructor ought to figure out how to acknowledge client’s assorted variety and if conceivable become familiar with the client’s local language on the grounds that now and again he/she may have customers who don't comprehend national dialects. Also, training is significant in guiding yet then the authentications don't stamp the finish of learning for an instructor on the grounds that the field offers more learning chances to a receptive outlook than what is educated in the study hall. This is on the grounds that there are new difficulties in directing, for example, social contrasts, and when they are handled they are the exercises that couldn't be learnt back in school (Burna rd, 2005). Truth be told in many callings understudies learn more when working than in school. In this light, an instructor ought to be a straightforward individual who is available to companionship. Being well disposed and kind to the customers will make them open up on the grounds that it is simpler to confide in somebody who is blunt than somebody who puts on a stone face constantly. This suggests an advocate ought not show any impressions of outrage in any event, when he/she is distraught. This is supported in light of the fact that it advances the certainty of the customers in the advisor. In any case, there are customers who might be hostile to social. The advisor should attempt to fit into their point of view by valuing them for what their identity is. An advocate must have regard for his/her customers consistently whether or not the customer is to be faulted for his/her concern. Regard involves not revealing the data furnished by customers with others. In the event that a cu stomer discovers that the data he/she provided for a guide has been imparted to others he/she may feel mortified and may never look for help from such an instructor. For advising to be compelling, there are different procedures which must be utilized by an instructor. The main strategy is being a decent audience. Nelson-Jones (2009) contends that listening causes an advocate to assemble data being passed on by the customer. Interferences, for example, calls ought to be abstained from during this time on the grounds that the instructor is relied upon to give full consideration to the customer. On the off chance that an advocate interferes with his/her discussions with the customer it may look like absence of concern and it might close the customer not to uncover all the fundamental data. During the discussions the instructor should look at the customer without flinching in light of the fact that this will fabricate a feeling of trust in the customer. The instructor ought to consider taking a few notes during the discussion since he/she will allude to the notes in later stages. Asking the customer inquiries that were replied at the underlying stages may show that the advocate isn't not kidding with his/her job.Advertising We will compose a custom research paper test on The Essential Qualities and Knowledge for Effective Counseling explicitly for you for just $16.05 $11/page Learn More The advisor should be cautious about his/her non-verbal communication subsequently ought to sit in an upstanding stance and should utilize his/her non-verbal communication, for example, gesturing of the head to cause the customer to talk more. The instructor ought to never talk when the customer is talking yet ought to rather hang tight for his/her chance to speak (Tolan, 2003). Posing inquiries is likewise a productive procedure in advising on the grounds that it permits the advocate to extricate data from the customer. Questions are arranged into two, to be specific the ones that require short answers and the ones that require long replies. Short inquiries are planned for getting specific data while long inquiries are planned for causing the customer to give more data. When posing inquiries the advocate should utilize well mannered language and tone in light of the fact that being discourteous may infer that he/she is as of now making a decision about the customer. A portion of the data passed on by the customer should be reproduced utilizing pleasant words since some are communicated with loads of outrage and the advisor ought not articulate similar words that sound impolite. Recreating the focuses put across by the customer infers that the guide has nothing against the customer. This recreating incorporates the utilization of a milder tone if the customer utilized a higher tone since this will ensure that the counselor’s compassion toward the customer is unmistakably communicated. Burnard (2005) clarifies that it is imperative to have an outline of each visit which ought to be perused to the customer after the guide has completed the process of getting data from the customer. The outline ought to contain all the significant issues that are orchestrated by their pertinence. Those that issue the most ought to be given the main goal. Having a rundown encourages the advisor to comprehend which issues ought to be managed first rather than when the guide is handling issues indiscriminately. The advisor can likewise give customers a task to do all alone once at home since this will cause them to become familiar with their concern. Besides, the task causes them to acknowledge what they can do and what they can't do. This is vital in light of the fact that it encourages the instructor to comprehend the qualities and shortcomings of the customer. In like manner, successful guiding requires the information on applying different directing hypotheses. In advising there are different hypotheses that clarify the fundamental methodologies ap plied, yet this paper will just feature two of them. These incorporate Solution Focused Therapy and Client Centered (Rogerian) directing. In arrangement put together treatment the advocate centers with respect to what the customer wishes to secure in the treatment. In this treatment the fundamental concern is moved from what truly pestered the customer in any case. The things that were said or done in the past don't make a difference in this treatment on the grounds that the principle target of this treatment is to address the present and face what's to come. At the point when this treatment is being actualized tackling the present issue is crucial than what may have caused it since it expect that the past is now gone henceforth it is essential to concentrate on what is left (Nelson-Jones, 2009).Advertising Searching for look into paper on brain research? How about we check whether we can support you! Get your first paper with 15% OFF Find out More In customer focused (Rogerian) advising the customer is in full control of what he/she needs to have and turn into. This hypothesis expresses that the customer has all the possibility to do anything as long as he/she is made to accept that he/she can. As per Tolan (2003) this treatment is planned for building confidence of the customer since that is the thing that causes somebody to trust in him/herself. In this treatment the advisor helps the customer by permitting him/her to communicate him/herself and by enduring the perspectives on the customer. The advocate doesn't bounce into any ends since this may look like hindrances to the customer. Moreover, the guide demonstrates compassion to the customer by posing inquiries in a cordial way and tone. The significant job of the advisor here is to give positive conditions to the customer to acknowledge what he/she needs to do. Taking everything into account, a great instructor

Two AP Language 2020 B Essay Samples

Two AP Language 2020 B Essay SamplesToday I want to show you two AP Language 2020 B Essay samples that you can use as a sample for your own essay. The first one is from Caesar A. Kenney and the second one is from John A. Butts. This is one of the most difficult subjects to write because the subject matter is very broad and can be seen as a world history. You have to remember that in English the most important history is that of American, British, and then European.The first Caesar A Kenney essay sample is entitled 'Dictatorships in a World Market'. I will let Caesar tell you about this sample. 'This lesson is being provided by American History teacher Caesar A. Kenney. The lesson in this lesson is about the various types of dictatorships in a world market. We will examine how these dictatorships affect the individuals that live under them and the culture that they created in their countries.This lesson is appropriate for AP students who are attempting to get good grades on an AP Exam . The AP section of the AP Exam tests the student's comprehension of the written word in reading, writing, and arithmetic, in addition to some problem-solving skills.Like most teachers, Kenney has different techniques in which he would like to make his lesson fit the AP student's style. That is one reason why the AP Writing and Research sections are taught to the students separately. This course is also an example of how Caesar's AP courses use what he calls 'customized AP questions' so the students can better prepare for the AP Exam.The second Caesar A. Kenney essay sample is titled 'The Antithesis of Independence'. This AP lesson discusses the importance of government to human beings. Kenney explains how an individual can become or not to become, a free person based on the manner in which the government chooses to define it.In this lesson, Kenney covers topics such as the independence movement in America, slavery, the Civil War, Reconstruction, and the end of Reconstruction. The l esson makes clear that the values of freedom of speech, of the press, and of religion were essential to the formation of the American political system. It is interesting to see that there were arguments and debates about the effect of slavery on the formation of America. Yet, it was considered by many that slavery brought about and accelerated the formation of America.Kenney also teaches about the Civil War, emphasizing the reality that Americans in the past were, in fact, slaves. He explains the difference between Civil War veterans and post-Civil War veterans of slaves. This is the reason why the United States always needed to emancipate its slaves. And yet, many Civil War veterans of slaves were considered free persons of color, despite the fact that they had to endure extreme physical conditions during the Civil War.The AP Language B Essay samples from Caesar A. Kenney cover subjects such as basic principles, the history of American English, the pronunciation of American English , and how to answer questions on the AP Exam. Kenney stresses that an AP course must teach the students something that they don't already know. Although this topic is usually difficult, the simple tools you can use to keep in mind can help you become familiar with the topic and, therefore, familiar with yourself. Remember, Caesar knows that you do not know as much as you think you do.

Theme Analysis of Alienation in Books the Catcher in the...

Alienation sometimes called estrangement is a psychological, sociological or Philosophical-anthropological category, largely derived from the writings of Hegel, Feuerbach and Marx. When one is not accepted by society, he becomes an Outsider to everyone around him. Alienation refers to an individuals estrangement from traditional community or others in general (social isolation), the dominant values of society, or even themselves (self-estrangement), but in General the term implies a lack of identification between a person (or what he Considers himself to be) and another entity Alienation is a very widely, and Loosely, used Concept, which originates in its modern form with Marx. For Marx Alienation is a Condition†¦show more content†¦J.D. Salingers novel The Catcher in the Rye represents the life of a teenager dealing with his personal issues. The main characters name is Holden. Holden has a record of poor grades and has been kicked out of a number of good private boarding schools. Phoebe, Holdens sister, seems to be the only person in the book that Holden can have a mature conversation with without thinking the person is not genuine. Another extremely important character in the novel is Sally Hayes. Sally is a love interest of Holden who plays a large part in Holdens life. Jane Gallagher also plays a major role in Holdens life even though she never physically appears in the novel. There are many situations where Holden feels alienated from his friends and society. The Catcher in the Rye represents the theme of alienation through one of the main characters in the novel, Sally. There are many instances where Sally alienates Holden. Sally alienates Holden when they are in the cab. After Holden tells Sally that he loves her, she tells him crew cuts are...corny and that Holden should grow his hair out. Sally alienates Holden in this situation because she tells Holden that she loves him too but that he should change the way he looks. Her comment was rude and shows how she likes him but that he doesnt completely fit her standards. Holden can also alienate himself from people. Holden also alienates

Sample Resume Managerial Accounting - 1411 Words

MASTERS IN PROFESSIONAL ACCOUNTANCY STUDENT NAME : Shilpa Thakran STUDENT ID : 17909848 UNIT NUMBER : 530 REPORT : MANAGERIAL ACCOUNTING TUTOR NAME : CHEOW WING WONG DUE DATE : September 12, 2014 TABLE OF CONTENT INTRODUCTION†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.3 1.0 PRODUCT COSTING†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦4 1.1 JUST IN TIME APPROACH†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...........................................4 1.2JUST IN TIME APPROACH IS DISTINCT FROM PRODUCT COSTING†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..4 1.3 USES OF PRODUCT COSTING†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.................................................5 1-4 IMPORTANCE OF†¦show more content†¦Product costing emphasizes on cost allocation which incurred at the time of manufacturing to the final product and Just in time approach involves ordering of material as per need and have no inventories at the end. Traditional costing based on manufacturing and assumptions. Activity based costing is time consumable and is suitable for both manufacturing and non-manufacturing businesses. If companies reports are showing less profit for most efficient products and more profit for the product the company is not efficient in making then there is a need to adopt product costing. The report also covers how managerial accounting and financial accounting differ and why managerial accounting cannot be replaced by financial accounting. These branches of accounting differ in various ways like managerial accounting is more future-oriented while financial accounting based on past records. Also, managerial accounting is made for internal users like managers while financial accounting focus more on external users. The purpose of the report is mainly to through light on various aspects of managerial accounting like the uses and purpose of managerial accounting and how its different approaches helps in increasing profits and controlling costs and wastages that incur during production. The company in the given issue is not following product costing due to which the company has little influence over the product price and in a competitive environment

Makes the audience Essay Example For Students

Makes the audience Essay The inspector slowly says are you sure you dont know. Then he looks at Gerald, then at Eric, then at Sheila. By looking at them all separately you guess all three of them have had a part in the girls life that has made her commit suicide. This creates tension by wanting know what they even though they have never heard her name. Looking at them individually is like hes trying to read their minds and this scares them and will worry them making them feel guilty which will show on their faces. The Inspector tells Birling what Birling thought the inspector wouldnt be able to answer. The inspector gives a list of all the problems the girl had with in her life after she was sacked. The inspector says so after two months with no work, no money coming in, and living in lodgings, with no relatives to help her, few friends, lonely, half-starved, she was feeling desperate. The list creates a lot of tension by the sentences getting shorter and the inspector saying the list as if it was obvious what would happen to her. The inspector makes Birling look even worse to the audience by saying this is Birling done to her life from sacking her. Because Birling looks bad capitalism looks bad. Birling believes the women who work in his company are just investments for an increase in money. Sheila says But these girls arent cheap labour theyre people. Birling doesnt care if he pays lower wages than the women deserve as long as he makes money. Birling probably thinks he is helping them by giving them a job. Birling says sacking the girl had nothing to do with her committing suicide that was two years I sacked her. Nearly two years ago obviously it has nothing whatever to do with the wretched girls suicide. Eh, Inspector? The inspector replies saying No, sir. I cant agree with you there. Birling quite angry about the inspector not agreeing with him says Why not? Birling wouldnt like this because he believes he is always correct and we no hes probably wrong from what he said in his speech. So the audience prefers to believe the inspector rather than Birling and we then think socialism is better than capitalism. When Sheila finds out Eva Smith was sacked from Milwards for a customer complaining she becomes agitated. Sheila wants to know more and says staring at him, agitated When was this? Then the Sheila says What what did this girl look like? The audience feel Sheila is arrogant but she knows she has done wrong and she feels guilty. Shes starting to get nervous hoping it wasnt her who made the girls life worse and being involved in the chain of events before her suicide. Sheila looks at the photograph knows she was the customer that got the fired and runs out the room. He produces the photograph. She looks at it closely, recognizes it with a little cry, gives a half stifled sob, and then runs out. Sheila running out cry bewilders the other three and Birling gets angry with the inspector and says, We were having a nice little family celebration tonight. And a nasty mess youve made of it now, havent you. This reminds the audience they were all relaxed at the start of the play and the tension has increased a lot more since the inspector arrived. Gerald and Eric become very tense when they are the people left in the room with the inspector. The inspector hints that all of them have a part in the chain of events towards the suicide. .u709b7c11470ae6594fa149948f381b89 , .u709b7c11470ae6594fa149948f381b89 .postImageUrl , .u709b7c11470ae6594fa149948f381b89 .centered-text-area { min-height: 80px; position: relative; } .u709b7c11470ae6594fa149948f381b89 , .u709b7c11470ae6594fa149948f381b89:hover , .u709b7c11470ae6594fa149948f381b89:visited , .u709b7c11470ae6594fa149948f381b89:active { border:0!important; } .u709b7c11470ae6594fa149948f381b89 .clearfix:after { content: ""; display: table; clear: both; } .u709b7c11470ae6594fa149948f381b89 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u709b7c11470ae6594fa149948f381b89:active , .u709b7c11470ae6594fa149948f381b89:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u709b7c11470ae6594fa149948f381b89 .centered-text-area { width: 100%; position: relative ; } .u709b7c11470ae6594fa149948f381b89 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u709b7c11470ae6594fa149948f381b89 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u709b7c11470ae6594fa149948f381b89 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u709b7c11470ae6594fa149948f381b89:hover .ctaButton { background-color: #34495E!important; } .u709b7c11470ae6594fa149948f381b89 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u709b7c11470ae6594fa149948f381b89 .u709b7c11470ae6594fa149948f381b89-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u709b7c11470ae6594fa149948f381b89:after { content: ""; display: block; clear: both; } READ: An Inspector Calls - Differences and Comparisons Of Arthur B. And Sheila B. EssayGerald becomes uneasy and says, Well, I dont suppose I have - but Eric suddenly burst out saying, Look here, Ive had enough of this. Audience think Gerald and Eric arent as tough as they show they are and that they deserve what they get. They are both getting very tense at whats happened to their celebration has been demolished. The inspector says short and direct sentences to them dryly I dare say. He cuts in when Eric says hes had enough and the inspector knows he has but he has to stay because he has an important part to play still yet and if he goes he will just have to come back. The audience just want to know what Eric has done to be in the chain of events. Gerald says after all, yknow, were respectable citizens and not criminals. The inspector gives an ironic reply and you want to know what he knows about them Sometimes there isnt much difference as you think. The inspector is also saying everyone can be a criminal sometime in there life. Sheila re-enters the room and tells the truth about what she had done to make herself run out the room in tears. Because she tells the whole truth and is distressed about whats she done and regrets it the inspector softens up on her. Sheila admits, It was my own fault because she was in a bad temper and jealous. The audience like the inspector for softening up on Sheila as she is telling the truth and rather distressed about what she done. After Sheila has confessed everything to the inspector he becomes aggressive again and doesnt care what she says shes guilty anyway. Sheila says, if I could help her now, I would- The inspector cuts in telling her she cant change what shes done and she should except the consequences. The inspector says in a harsh voice Yes, but you cant. Its too late. Shes dead. This is a harsh thing for the inspector to say but it is the truth and straight to the point. Tension is created because after the inspector being nice he turns back to his usual harsh self. When the inspector says the name Eva smith changed to Gerald is startled. The inspector tells them what she done next with her life Now she had to try something else. So first she changed her name to Daisy Renton- Gerald cutting in is startled and says What? None of them know why Gerald suddenly got even tenser from hearing the name. Gerald the wants a drink showing hes very shocked but he tries to then act normal again. Gerald tries to pull himself together and says, Dyou mind if I give myself a drink, Sheila? Its obvious he knows its all going to go down hill for him now from that name being mention. Gerald confesses to seeing another women and tries to tell Sheila they dont have anything to do with the murder. Once Gerald has admitted it all and Sheila has told him to stop being an idiot and that the inspector already knows so he cant lie. Gerald says, You dont. Neither of us does. So for gods sake dont say anything to the inspector. Sheila has realised the inspector knows everything that happened to the girl that committed suicide and she laughs hysterically at Gerald for being shocked, nervous and acting naive. The inspector walks in and just says well? Which finishes Act One on a cliffhanger because you want to know whether the inspector was listening through the door or if he already knew? The beginning of the act is a party and everyone is happy and cheerful but at the end of the act Gerald, Birling, Sheila and Eric are very tense and shocked. .ua612a25eabf3bb49ffab642537b9db91 , .ua612a25eabf3bb49ffab642537b9db91 .postImageUrl , .ua612a25eabf3bb49ffab642537b9db91 .centered-text-area { min-height: 80px; position: relative; } .ua612a25eabf3bb49ffab642537b9db91 , .ua612a25eabf3bb49ffab642537b9db91:hover , .ua612a25eabf3bb49ffab642537b9db91:visited , .ua612a25eabf3bb49ffab642537b9db91:active { border:0!important; } .ua612a25eabf3bb49ffab642537b9db91 .clearfix:after { content: ""; display: table; clear: both; } .ua612a25eabf3bb49ffab642537b9db91 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ua612a25eabf3bb49ffab642537b9db91:active , .ua612a25eabf3bb49ffab642537b9db91:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ua612a25eabf3bb49ffab642537b9db91 .centered-text-area { width: 100%; position: relative ; } .ua612a25eabf3bb49ffab642537b9db91 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ua612a25eabf3bb49ffab642537b9db91 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ua612a25eabf3bb49ffab642537b9db91 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ua612a25eabf3bb49ffab642537b9db91:hover .ctaButton { background-color: #34495E!important; } .ua612a25eabf3bb49ffab642537b9db91 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ua612a25eabf3bb49ffab642537b9db91 .ua612a25eabf3bb49ffab642537b9db91-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ua612a25eabf3bb49ffab642537b9db91:after { content: ""; display: block; clear: both; } READ: Book of blood EssayBut miss Birling has been out of the act ever since the inspector arrived and has only been involved in the party. The atmosphere is very tense now unlike the start where it was a happy celebration. The unity of place for An Inspector Calls is only in the lounge. This creates more tension because the audience can just focus on one place so its easier to know whats happening and imagine the setting. The unity of action for An Inspector Calls is only one plot line the girls suicide. Having just the girls suicide makes the audience able to understand whats happening and increases the tension. An Inspector Calls time to watch and the playtime is the same, which makes it more tense and easier to concentrate on what the time is in the play. Tension is increased in An Inspector Calls throughout the play. First the atmosphere is happy and they are having a celebration. Hints of tension are lights changing to white harsh light and Eric acting unusual. Preistley gives you detailed opening staged directions of the celebration. He describes what each character is like so you know if they are acting strange. When the inspector arrives the amount of tension increases tremendously. The inspector reveals secrets each of the characters have and telling all the other characters. The audience want to know how he knew so much and he ends Act One in a cliffhanger by saying just well? The tension increases by the inspector falling out with each character one by one. The inspector knows they are all selfish, lying, snobs and doesnt care what they say but they should accept the punishment. So Preistley is very subtle in creating and increasing the tension in the play.

Post Sigmoid Coletomy Care Essay Example

Post Sigmoid Coletomy Care Essay This paper will critically examine the care needs and management of Mr Braun. An appropriate framework will be used, namely the ABCDE. Alternative treatment will be analysed using the 5 WHs critical decision making too (Jasper, 2006)l. His care will be based upon the nursing process ensuring that patient outcomes are agreed, implemented and evaluated. The assessment framework to be used is this assessment is the ABCDE assessment framework. The ABCDE framework looks at Airway, Breathing, Circulation, Disability, and Exposure/Elimination. The reason for choosing this framework is that it uses a systematic method of assessing, it aids with elimination of post op complications. In addition, it is a commonly accepted framework which is widely used and can be used in critical care situations, pre post-operative care and emergency situations. Furthermore, it allows the nurse to use her skills in accessing the patient’s needs. The disadvantages of the framework are that it is a medical model in the sense that it looks specifically at the biological aspects of care and lumps emotional/psychological/cultural/social care under the exposure/elimination catergory. We will write a custom essay sample on Post Sigmoid Coletomy Care specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Post Sigmoid Coletomy Care specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Post Sigmoid Coletomy Care specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Therefore it does not promote exploring these issues in great detail (Younker, 2008 Hargan 2012) Cancer Physiology Bowel cancer normally starts in the rectum or sigmoid colon. It starts as adematous polyps and then progresses to adematous carcinomas. It spreads by direct extension via the bowel circumference, submucousa and outer bowel wall layers. It can also spread to other areas by direct extension, for example, to the liver, pancreas and spleen. Metastasis is normally by way of the surround lymphnodes. Primary cancerous cells can also travel into the lymphatic and circulatory system causing secondary cancer in other organs such as liver and pancreas (LeMone Burke, 2003). Mr Braun is undergoing an operation for his sigmoid colon cancer. One route to take would be the traditional method. This consists of open bowel surgery. This entails making a large opening. A bowel prep is given prior to surgery, there is a longer starvation process, which can cause dehydration and electrolyte imbalance. Furthermore, it causes stress on the body, insulin resistance in the body is longer and the recovery period is longer. In addition it causes longer paralytic ileus (Siddiqui et al. , 2012). The alternative treatment to the traditional method would be the laparoscopic method. Mr Braun would have a smaller incision, therefore making a quicker recovery. He would be in less pain and would be able to mobilise quicker. He would have a quicker return of GI function and a lesser period of paralytic ileus. He would be able to deep breath better as he would not be experiencing a lot of pain, therefore he would be at less risk of contracting a chest infection. This would all work towards him having an earlier discharge, for example, 3-5 days post op compared to anywhere between 8-12 days on the traditional method. Research has also shown that community rehabilitation is much quicker, 2-3 weeks rather than 6-8 weeks on the traditional method (Jenson 2011). Further research shows that patients undergoing laparoscopic surgery have fewer complications post discharge (Hargan 2012). It appears then the laparoscopic route has better outcomes for the patient and in addition, the NHS. Being able to discharge a patient between 3-5 days who experience fewer complications post operatively not only frees up beds but costs less to treat the patient. Therefore, after weighing up the pros and the cons of both the traditional and the laparscopic it would seem that Mr Braun would be better off having the laparoscopic route. It appears from research that the lapascopic route is the route which is used in almost 90% of colorectal surgery. However, the route that is taken ultimately depends on the surgeon’s choice. Prior to collecting the patient from the recovery room Before collecting Mr Braun from the recovery room I will need to check the bed area. This includes checking that the oxygen is working. I will need to ensure that there is a nasal tube and a venturi mask. I will also need to check the suction is working and ensure that a new tube is present by the bedside. I will also need to make there is a yonker. I will put a dynamap beside the bed which will allow me to take Mr Braun’s clinical observations on return to the ward. I will also ensure that a drip stand is next to the bed as he may be on fluids or have a PCA on his return to the ward (Nicol et al. 2012). Collecting the patient from the recovery room On collecting the patient from recovery, I will take with me a kidney bowel in case the patient needs to be sick on his return journey, a pair of gloves, a oropharyngeal (geudel) airway in case his airway becomes compromised in anyway and a pocket mask for mouth to mouth. My first priority is to ensure that Mr Braun is safe to return to the ward. I will check his level of consciousness using the AVPU tool. This tool looks at whether he is Alert, whether he responds to Voice or whether he only responds to Pain and whether he is Unconscious. I will then take a handover from the recovery nurse. This should include informing me of the procedure Mr Braun has had, how well he has responded to the surgery and his current responsiveness/consciousness level. I would need to check with the recovery nurse whether his vital signs are within the normal range. This is for patient safety which is paramount and is at the centre of nursing care. This would need to be checked against the Early Warning Score (EWS) system which includes level of consciousness, the physiological parameters, for example, temperature, blood pressure, Oxygen saturation (SATS), respiratory rate, pulse and urine output. The EWS gives an overall score which informs me whether or not it is safe to take Mr Braun back to the ward. The recovery nurse would also inform me which medications he has had, information regarding IV fluids, how long they should run for and whether more are needed when it finishes and check they are written up on the drug chart. In addition, I would need to see the wound bed. This would help with later assessment on the ward where I would be able to compare whether there has been any further bleeding or leakage. I would need to see the stoma site. The recovery nurse would inform me whether Mr Braun had a urinary catheter and whether there had been any urine output. After handover I would say hello to the patient and manually take his pulse so that I can get an indication of his heart rate (Nicol et al. 2012). On the ward On returning to the ward I will orientate the patient. I will inform him of every procedure that I do so that I can gain informed consent (NMC 2012). I will immediately carry out a set of clinical observations. This is so I can make a comparison with his perioperative baseline. Although doing the clinical observations with the dynamap, I will manually take his pulse as it is vital that I know whether it is regular/irregular, strong or weak. ABCDE Assessment Airway The best way to check the airway is to speak to ask the patient and get him to respond to you. If he is able to talk in normally, this will be indicative of his airway being patent. I would need to listen to whether there are any sounds, like barking or gurgling as this could indicate that there is partial obstruction. I would also need to check whether Mr Braun is experiencing any nausea or vomiting. If Mr Braun is experiencing this I would need to immediately administer an anti-emetic as per drug chart instruction. This would help prevent the risk of pulmonary aspiration. I would also need to check whether Mr Braun has any allergies. I would ensure that he is wearing two red wrist bands with the allergies clearly written on them so that other staff members are aware. His allergies would be documented in his nursing notes and on his drug chart with information on what sort of reaction he experiences. Assessing whether Mr Braun has any allergies is extremely important as allergic reactions can cause swelling of the tongue and in the throat which would compromise his airway and leave him with difficulties breathing (Resuscitation Council UK, 2012). Breathing I would now assess breathing by checking Mr Braun’s respiratory rate (RR). The normal range is between 12-20 breaths per minute. In PAC, his RR was slightly raised. This could have been due to anxiety but was more than likely due to his anaemia (this will be looked at further under circulation). I will be able to gain a comparison and start looking for a trend. It is important that the RR is counted for a full minute. His breathing may be irregular and therefore not counting the full minute would give an inaccurate measurement. I would also check Mr Braun’s SATS. The normal range should be 95%. Checking his SATS will inform me whether he is getting enough oxygen and whether his tissues are being perfused adequately. Lack of oxygen can cause hypoxia which if not managed will lead to multiple organ dysfunction and ultimately death. I will also therefor check for cyanosis as this will also inform me whether he is lacking oxygen. It is important to look at how Mr Braun is breathing. For example, is he struggling to breath, is he breathing deeply or is it shallow. Does he have to use his accessory muscles to help him breath. I would check whether his chest is rising equally on both sides. I would also speak as him a question to ascertain whether he is able to speak in full sentences because someone who is struggling to breathe is unable to speak in full sentences. I would look at whether he is breathing fast or slow. Furthermore, I would look at how he is sitting, for example, is he leaning to one side. Also when you are assessing breathing it is important to listen for any wheeze or stridor. RR is one of the first things to alter when a patient is deteriorating. It is vital that if Mr Braun is experiencing any of the above, the nurse responds quickly. The first thing would be to check whether he is written up for any more oxygen and if so to increase it. The nurse would then have to check in RR and SATS again after 15 minutes to ascertain whether there was any improvement or further deterioration even. If the patient was deteriorating further the nurse would need to involve the doctor who would be able to review Mr Braun immediately and give further instructions on his care (Queen Mary University City University, 2006). Circulation An assessment of Mr Braun’s pulse needs to be undertaken. This will allow the nurse to ascertain his heart rate. In addition, it would allow me to feel whether his pulse is strong or weak and whether it is regular or irregular. The normal resting pulse should be between 60-80 beats per minute (bpm). In the PAC, Mr Braun was slightly tachycardic, which could be due to anxiety of his diagnosis, hearing about the treatment he would receive or his prognosis. By taking his pulse it will allow for a baseline, pre-operative and peri-operative comparison. His blood pressure (BP) would also be assessed. The normal ranges are 90/60-140/90. Mr Braun’s BP in PAC was 135/80. Although this is still within the normal range, it is slightly high. However, this would be an appropriate BP given his age. It is vital that clinical observations are carried out every 15 minutes for the first two hours post-op as there is a higher risk of complications occurring and clinical signs are the physiological parameters which tell you whether a patient is deteriorating or improving. For example, if a patient is tachycardic and hypotensive this could be indicative of hypovolaemic shock which would need to be managed immediately as this can lead to potential death. It is vital when taking clinical observations that the nurse is aware that she should not only rely on the measurements. This is because a patient can be in hypovolaemic shock and still have a normal BP. This is because in hypovolaemic shock, the compensatory mechanisms take over and the body will do everything it can to keep the BP at normal level. Therefore, it is vital that the nurse also observes what the patient looks like, for example, does he look palor, he is sweaty or clammy. These are all important factors when carry out clinical observations. When a patient undergoes surgery he has enforced reduced mobility. Mr Braun will be in bed for a while and due to these factors is therefore at risk of Deep Vein Thrombosis (DVT), which is one of the highest cause of PE leading to hospital deaths. The nurse should check whether he still has his TED stockings on and check that they are not rolled down or creased as this may prevent them from achieving good prophylaxis. Furthermore it could compromise his skin integrity. Mr Braun will probably also be prescribed oral or subcutaneous anticoagulants as a further prevention of DVT. Mr Braun’s Hb levels should be checked to ensure that his anaemia is improving. If Mr Braun was assessed in PAC as having met the criteria, which is expected to make a good recovery, for the ERP, his anaemia would have been dealt with prior to him being admitted. He would have been assessed for any co-morbidities and his GP would have been involved to treat his anaemia. If his anaemia had not been treated, prior to his admission, it is likely that Mr Braun would have undergone a blood transfusion during surgery. This would mean that he would have a cannula in situ which would need to be assessed to check for phlebitis. This would need to be documented on the VIP chart (Hargan 2012). The cannula needs to be checked to ascertain whether it is patent. The date of insertion should also be noted on the VIP chart as it is not allowed to stay in for longer than 72 hours. Mr Braun will also have a catheter in situ. Therefore it is important to check for urine output. Mr Braun should have a urine output of 0. 5ml/kg/hr, in other words half his body weight per hour. Therefore if Mr Braun weighs 80kg, he should have a urine output of 40mls per hour. If going through the traditional method, Mr Braun would have to have a low residue diet approx. 2 days prior to the operation. He would only be allowed clear fluids approximately 12-18 hours before surgery and would then be starved from the midnight before the day of surgery to prevent aspiration. Research has shown that prolonged starvation causes dehydration and electrolyte imbalance. It causes the body to experience insulin resistance for longer and cause the body more stress (Burch Slater 2012). In contrast, he would have been given carbohydrate loading prior to surgery in the form of iso-osmolarity which 90% passes through the stomach within 90 minutes therefore he would have been able to have it one and a half hours prior to surgery. This would cause less insulin resistance and put his body through less stress. He would be able to come off any IV fluids as he would be encourage to eat and drink at will post operatively.