The Epidemic Facing The Homeless And Mentally Ill

The Epidemic Facing the Homeless and Mentally Ill Have you ever wondered what happens to war vets when they return home from the front lines? Some of the outcomes are not as happy as most people would like them to be. War veterans that survive come home with Mental Illnesses and other issues. Many war veterans end up homeless because of Alcohol and Drug Abuse, and some are even living with the homeless men and women at shelters because they cannot receive the help they need from the government. In a study from a Research Brief in 2012, â€Å"Veteran and non-veteran participants were compared in a nationally-supported housing initiative for chronically homeless adults. Veterans were not found to be at increased risk for adverse outcomes once†¦show more content†¦To follow with medical assistance, the 2012 Research Brief stated that â€Å"After entering the program and obtaining housing, veterans and non-veterans both decreased their use of outpatient and inpatient health services. Only half of veteran participants reported using the VA for medical services and less than one-fifth reported using VA psychiatric or substance abuse services. Veterans often use the services of community providers, therefore the VA should continue to work with community provider to serve homeless veterans.† Housing is another issue that seems to make headlines; War veterans that come home do not always get jobs which cause delays on payments on their houses which results in foreclosures on their homes because they cannot afford the payments. Healthcare plays an important part in life, especially for the ones who need it most such as veterans. If veterans cannot receive the medical help they need they will end up getting very sick and will start dying. In a study by the Northeast Program Evaluation Center, Department of Veterans Affairs and Psychiatry, Yale School of Medicine, â€Å"This study directly compared mortality risk in homeless andShow MoreRelatedWhy Do People Become Homelss1750 Words   |  7 PagesM1 ASS IGNMENT WHY PEOPLE BECOME HOMELESS AND WHY IT DOESN’T STOP LAVERNA MOORER ARGOSY UNIVERSITY Abstract This paper is going to present to you why people become homeless and why it does not stop Homelessness is a problem that have getting out of hands because of not addressing the situation on time. The focus is not so much the why but, if it will ever stop. Homelessness is a phenomenon that has so much to address research has been done; it was discover that for our government to concentrateRead MoreHomelessness And Its Effects On Society2302 Words   |  10 Pagesamong the homeless include the elderly, children, and those who are mentally ill. This is a cause for concern for citizens who are living their daily lives. Some people express their fear of homeless persons, believing that they are just beggars for money and take up space on the streets. Although the description homeless people is not always true, homelessness does affect society and puts the future generation at risk of becoming homeless as well. People need to bring attention to the homeless problemRead MoreWhy Homeless R esort to Violence Essay2194 Words   |  9 Pages Homelessness is a growing epidemic across the country. Over 2 million people are homeless in America, and that number is increasing. 40% are families with kids, 30% are drug and/or alcohol addicts, 23% are mentally ill and 10% are veterans. This terrible misfortune has led to many unsuspecting people leading impoverished lifestyles, and facing the horrific and heart-wrenching tragedy of abandonment. 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There are so many people from so many different backgrounds and demographics that it is a truly overwhelming task to keep track. Most of them will go without the base level of needs for a human, including food, clean water, and shelter. In almost every case, with homelessness comes poverty. Dreisbach (2013) says, homelessness in America is a persistent, complex, and widely-occurringRead MoreHomelessness Should Be Top Priority Essay1929 Words   |  8 Pagesreduce or remove this epidemic of homelessness should be top priority. Many people are affected by homelessness such as families, children, and veterans. According to National Alliance to End Homelessness (2016), â€Å"In January 2015, 564,708 people had no place to sleep one or more nights in the United States. Of that number, 206,286 were people in families, and 358, 422 were individuals† (National Alliance to End Homelessness, 2016). 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The supposition being, miasma couldRead MoreLogical Reasoning189930 Words   |  760 Pages.............................................................................................................vi CHAPTER 1 How to Reason Logically ........................................................................................ 1 Facing a Decision as a Critical Thinker ............................................................................................... 2 Advice for Logical Reasoners .....................................................................................Read MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 Pagesbehavior. This is one of the most comprehensive and thorough revisions of Organizational Behavior we’ve undertaken, and while we’ve preserved the core material, we’re confident that this edition reflects the most important research and topical issues facing organizations, managers, and employees. Key Changes to the Fifteenth Edition †¢ The most substantial updating ever. The following sections of each chapter are new to the fifteenth edition: †¢ Opening Vignette †¢ Myth or Science? †¢ Ethical Choice

Martin Luther King, Marcus Garvey, Malcolm X Discussion...

2012: Segregation Still at Its Worst The way todays events and the lifestyle of living is approached, the people of our past would have been surprised to know how much we have accomplished, and even more surprised to know some things still remain the same. Since the beginning of mankind, people have fought for their rights in order to make life a much easier way to live with one another. Documents like the Bill of Rights, the Declaration of Independence, and even far back to the Ten Commandments, have been written to show some sort of peace structure to live by, with out harming one another. In America, freedom, justice, and equality for all has been a major issue that is yet to be fully fulfilled. Although, America is all about†¦show more content†¦Our country is a nation of freedom, but yet that is taken away when the freedom of others choosing the one to marry, the ones they love, comes to place. Since the beginning of our nation we have been fighting for religious, racia l, and many other basic human rights. Denying gay marriage is fighting against a human’s basic right to love. Marcus Garvey in the beginning of this conversation, is trying to state that if it is really important to homosexuals, they should just leave their state and enter one where same-sex marriage is legal. Something he had also been saying to his people during his reign of leadership, enduring in people s mind to simply go back to Africa where they are sure to receive equal treatment within their colored people. Readings had been done about the topic by Martin Luther King, who wanted to uncover deeper about the subject of gay marriage. He learned that conservative Theodore B. Olson, of the republican party, states in his article; â€Å" The Conservative Case for Gay Marriage†, that legalizing same-sex marriage would be a recognition of basic American principles, and it would represent the culmination of our nation s commitment to equal rights. Theodore also states that it is the last major milestone to be over came in our fight towards civil rights. After accomplishing the black and white racism battle over theShow MoreRelatedManagement Course: Mba−10 General Management215330 Words   |  862 Pages2004 9 CHAPTER 1 NEW MANAGEMENT FOR BUSINESS GROWTH IN A DEMANDING ECONOMY 9 Dell. This has also been a basis for the resurgence of great technologydriven corporations such as IBM from the severe down cycles it had experienced. This marriage of leadership and technology capability can also be credited for the success of E-Bay. Some astute investors and managers long ago figured out this power of management capital in establishing their valuations of growth companies—and with lucrative

Hiv and Nutrition Free Essays

string(49) " between the shoulder blades, or on the breasts\." Few crises have affected human health and threatened social and economic development like HIV/AIDS. As infection rates continue to escalate around the world — particularly in countries with large rural populations and widespread small-scale agriculture — the pandemic is having a significant impact on food security and nutrition, creating a deadly cycle: HIV/AIDS typically strikes the household’s most productive members first. When these people become ill, there is an immediate strain on the family’s ability to work, feed themselves and provide care. We will write a custom essay sample on Hiv and Nutrition or any similar topic only for you Order Now As the disease progresses, it can become even harder for a family to cope, especially as resources are drained — for instance, valuable assets, such as livestock and tools, may need to be sold in order to pay for food and medical expenses — and poverty advances. Without food or income, some  family members  may migrate in search of work, increasing their chances of contracting HIV — and bringing it back home. For others, commercial sex may be their only option to feed and support their family.Food insecurity also leads to  malnutrition, which can aggravate and accelerate the development of AIDS. Likewise, the disease itself can contribute to malnutrition by reducing appetite, interfering with nutrient absorption, and making additional demands on the body’s nutritional status. Therefore nutrition plays a big part in enabling patients to properly take medication, manage side effects, and maintain adequate nourishment. Some of the nutritional issues inc lude:- 1. Recommendations for light snacks are included, as are remedies for unpleasant tastes caused by some medications. . Weight gain is an issue for all AIDS patients on antiretroviral therapy. 3. Nutritionists advise that to manage increasing weight, patients should cut fat and calories, but not eliminate the good fats, such as monounsaturated fats and Omega 3 polyunsaturated fat. 4. Because AIDS-related illnesses can cause loss of lean body mass and wasting, people with AIDS need to consume more protein. It is also important to maintain calcium in the diet for bone health, blood clotting, nerve transmission, and regulating heartbeat. 5.Carbohydrates round out the healthy diet by lowering cholesterol, lowering glucose absorption, alleviating constipation, and facilitating movement through the bowel. 6. Aside from a well balanced diet, it is important to prepare food safely and to know the source of any drinking water. As we have seen, HIV and nutrition are intimately linked. HIV infection can lead to malnutrition, while poor diet can in turn speed the disease’s progress. As AIDS treatment becomes increasingly available in the poorest parts of the world, critical questions are emerging about how well the drugs work in people who are short of food.Uncertainty also surrounds the role of vitamins and other supplements. And for those already receiving treatment, side effects such as body fat changes are a daily concern. Understandably, HIV positive people and those who care for them are keenly interested in whatever might benefit their health. RELATIONSHIPS BETWEEN HIV AND NUTRITION, AND WHAT THIS MEANS FOR TACKLING THE DISEASE. 1. Body changes AIDS  is well known for causing severe weight loss known as wasting. In Africa, the illness was at first called â€Å"slim† because sufferers became like skeletons.Yet body changes are not only seen during AIDS; less dramatic changes often occur in earlier stages of HIV infection. Whereas starving people tend to lose fat first, the weight lost during HIV infection tends to be in the form of lean tissue, such as muscle. This means there may be changes in the makeup of the body even if the overall weight stays the same. In children, HIV is frequently linked to growth failure. One large European study found that  children with HIV  were on average around 7 kg (15 lbs) lighter and 7. 5 cm (3 inches) shorter than uninfected children at ten years old. What causes these changes? One factor behind HIV-related weight loss is increased energy expenditure. Though no one knows quite why, many studies have found that people with HIV tend to burn around 10% more calories while resting, compared to those who are uninfected. People with advanced infection or AIDS (particularly children) may expend far more energy. But faster metabolism is not the only problem. In normal circumstances, a small rise in energy expenditure may be offset by eating slightly more food  or taking less exercise.There are two other important reasons why people with HIV may lose weight or suffer childhood growth failure. The first factor is decreased energy intake or, to put it simply, eating less food. Once HIV has weakened the immune system, various infections can take hold, some of which can affect appetite and ability to eat. For example, sores in the mouth or throat may cause  pain  when swallowing, while diarrhoea or nausea may disturb normal eating patterns. Someone who is ill may be less able to earn money, shop for food or prepare meals. Stress and psychological issues may also contribute.Secondly, weight loss or growth failure can occur when the body is less able to absorb nutrients – particularly fat – from food, because HIV or another infection (such as cryptosporidium) has damaged the lining of the gut. Diarrhoea is a common symptom of such malabsorption. 2. Effects of antiretroviral treatment Current  antiretroviral drug treatments  control HIV infection and prevent severe wasting, as well as other AIDS-related conditions. Emaciated people tend to regain weight once they begin treatment, and stunted children start to grow faster.Nevertheless, the drugs do not eliminate wasting. Studies have found that relatively small weight loss (between 5% and 10% over six months) is quite common among people with HIV who are taking treatment and not trying to lose weight. Although this might not seem like much, losses of this size have been linked to an increased risk of illness or death, as discussed below. In addition, some antiretroviral drugs have been linked to a problem called lipodystrophy. Whereas HIV-related wasting tends to deplete lean tissue, lipodystrophy involves changes in fat distribution. Prolonged treatment is sometimes associated with losing fat from the face, limbs or buttocks, or gaining fat deep within the abdomen, between the shoulder blades, or on the breasts. You read "Hiv and Nutrition" in category "Papers" Antiretroviral treatment can also contribute to lipid abnormalities by raising LDL cholesterol, lowering HDL cholesterol, and raising triglyceride levels in the blood. This may result in higher risks of heart disease, stroke and diabetes. Other side effects of antiretroviral treatment include insulin resistance, which can occasionally lead to diabetes. 3. Micronutrient deficienciesMicronutrients are vitamins and minerals that the body needs to maintain good health. Researchers have found that people with HIV are more likely to show signs of micronutrient deficiencies, compared to uninfected people. Specifically they have found low levels of vitamin A, vitamin B12, vitamin C, vitamin D, carotenoids, selenium, zinc and iron in the blood of various populations. Nevertheless, it must be noted that the evidence is not entirely conclusive. It is possible that HIV might affect the markers used to measure micronutrient levels more than it affects the actual amounts of micronutrients available in the body.Some studies suggest that antiretroviral treatment improves micronutrient status. EFFECTS OF NUTRITION ON HIV 1. Disease progression The links between HIV and nutritional status run both ways. It has long been known that weight loss strongly predicts illness or death among people with HIV. More recently it has been found that this applies even to people taking antiretroviral treatment. Losing as little as 3-5% of body weight significantly increases the risk of death; losing more than 10% is associated with a four- to six-fold greater risk.A Zambian study involving nearly 30,000 patients has shown that failure to gain weight six months after the start of antiretroviral treatment increases the chance of death ten fold when compared with those who gain over 10 kilograms. Therefore, HIV leads to:- * Insufficient food intake, malabsorption, increased energy expenditure * Worsened disease * Nutritional deficiencies Various micronutrients have been linked to changes in the rate at which HIV infection progresses to AIDS. Low levels of vitamin A, vitamin B12, vitamin E and selenium seem to accelerate progression.The effects of other micronutrients, however, are more controversial. One such example is zinc. Although zinc is essential for a healthy immune system, it has been shown to play a role in HIV’s replication cycle. On the other hand, some scientists claim zinc delays HIV disease progression. 2. Antiretroviral treatment There is strong evidence that malnourished people are less likely to benefit from antiretroviral treatment. One study in  Malawi found that patients with mild malnutrition (a low body weight for their height) were twice as likely to die in the first three months of treatment.For those with severe malnutrition the risk was six times greater than for those of healthy body weight. Researchers in Singapore have reported similar findings. A study in  Zambia  showed death rates in the first three months of starting antiretroviral treatment were highest (95%) among the most severely malnourished. This is not just an issue for developing countries; for example a study of people receiving antiretroviral treatment in Sydney, Australia found that one in three did not have access to nutritious food, and one in five said they regularly went hungry.Without food or the right nutrition, taking antiretroviral drugs can be so painful that people simply don’t. In a choice between taking pills with no immediate or obvious effect, and eating food to survive, food will almost certainly take priority every time. A health worker in Zimbabwe, where malnutrition is widespread, explained that taking antiretroviral drugs on an empty stomach is like digesting razor blades. The result is that many simply do not take them. In resource-poor countries such as,  treatment in children  is made more difficult because many children wi th HIV are severely malnourished. Very little is known about how best to treat such children, and in particular whether it is best to start antiretroviral treatment before or after nutritional rehabilitation. The World Health Organisation recommends treating the malnutrition first, but stresses that â€Å"further research on these matters is urgently needed. † The ways in which the body digests, absorbs and makes use of drugs are very similar to the ways in which it treats food, providing many opportunities for food-drug interactions. As explained later in this article, a number of foods and supplements are known to alter the effects of antiretroviral drugs.It is also possible that some micronutrient deficiencies may make the drugs less effective, or may worsen side effects 3. HIV transmission The chance of someone transmitting HIV is linked to the amount of virus in their bodily fluids, which is known as the viral load. In theory, micronutrient deficiencies may increase viral load by enabling HIV to replicate faster, or by weakening the immune system. Similarly, someone whose immune system has been weakened by micronutrient deficiencies may be more likely to acquire HIV.Research in this area has, however, been largely inconclusive. The strongest evidence links low levels of retinol (the animal form of vitamin A) in women’s blood with increased rates of  mother-to-child transmission. Poor nutrition may also affect the spread of HIV in a very different way: by altering sexual behaviour. One study of two thousand people in  Botswana  and  Swaziland  found that women lacking enough food to eat were less likely to use condoms and more likely to engage in risky activities, such as exchanging sex for money or resources.DIETARY ADVICE FOR HIV POSITIVE PEOPLE Dietary advice should be tailored to individual circumstances. However, in general the recommendations for people living with asymptomatic HIV infection are much the same as for everyone else, meaning a healthy, balanced diet. Only three differences are worth noting: * Because people with untreated HIV tend to burn more energy, the total number of calories should be around 10% higher than the usual guideline amounts, and up to 30% higher during recovery from illness. The balance of fat, protein and carbohydrates should remain the same. Many experts recommend a daily multivitamin (usually without iron, except in menstruating women or people with iron deficiency). * The World Health Organisation recommends vitamin A supplements every 4-6 months for young children living with HIV in resource-poor settings. HIV positive people suffering loss of appetite may need to make an extra effort to ensure they are eating enough. Helpful suggestions include eating several small meals per day, taking exercise to stimulate appetite, possibly mashing or liquidising food to ease swallowing, and seeking advice from a health provider or dietician.If other approaches have failed to reverse wasting then doctors may recommend a l iquid food supplement, an appetite stimulant, or resistance exercise to build muscle. Other possibilities include steroids and hormone treatments, though these can be expensive and have serious side SUPPLEMENTS AS AN OPTION TO BOOST THE DIETARY NEEDS When scientists compare people who have chosen to take a supplement versus people who haven’t, they cannot be sure that the supplement is making the difference; for example, it could be that those taking the supplement tend to lead generally healthier lifestyles.Therefore the most reliable evidence comes from large trials in which scientists randomly choose who takes the supplement and who takes a dummy pill called a placebo. Yet even the results of randomised trials must be treated with caution because diet and nutritional status vary widely. It is possible for a supplement that benefits one group of people to be ineffective or even harmful in another group. Multivitamins A trial involving a thousand HIV positive pregnant women in Tanzania found that daily multivitamins benefited both the mothers and their babies, compared to placebo.After four years, multivitamins were found to reduce the women’s risk of AIDS and death by around 30%. A large trial in Thailand also found that multivitamins led to fewer deaths, but only among people in the advanced stages of HIV disease. A third, smaller trial in Zambia found no benefits from multivitamins after one month of use Based on these and other, less rigorous studies, many experts recommend multivitamins for people living with HIV, particularly those who are undernourished and have advanced disease.For example  PEPFAR  (the American government’s international AIDS initiative) supports the provision of micronutrient supplements to high-risk individuals with inadequate diets Individual nutrients When it comes to supplementing individual vitamins and minerals, the evidence is less clear. Few studies have found significant effects on HIV transmission, disease progression or death rates. The most interesting results have come from studies of vitamin A and zinc. Vitamin A supplements have been found to reduce rates of illness and death among African children living with HIV.The World Health Organisation recommends vitamin A supplements every 4-6 months for all young children (6-59 months old) at high ri sk of vitamin A deficiency; this includes those born to HIV positive mothers in resource-limited settings. In contrast, studies providing vitamin A to pregnant, HIV positive women have had mixed results. Two trials in  South Africa  and Malawi found no effect on mother-to-child transmission, but saw some other benefits for the infants. A third trial in Tanzania found that vitamin A supplementation had no beneficial effects, and actually increased the risk of mother-to-child transmission by 40%.The inconsistency of these results (perhaps due to differences in diet) means that vitamin A supplementation is not generally recommended for HIV positive, pregnant women Several studies have found that zinc supplementation reduces cases of diarrhoea among children in developing countries. 30However most trials have been conducted among HIV negative children outside Africa, and their results may not apply in all situations. One study in South Africa found that zinc supplements reduced bouts of diarrhoea among HIV positive children, without hastening the progress of their HIV infection.Other results from Africa have been mixed, with some studies finding no evidence of benefit. 32 Studies und ertaken on zinc supplementation and adults living with HIV paint an equally unclear picture. While some studies have found that zinc supplements do not have any impact on HIV positive patients,  another has shown a 60% reduced risk of diarrohea in the HIV positive participants of a study conducted over 18 months. Potential for harm Some HIV positive people take a lot of supplements in the hope that at least some of them might be beneficial.This is not necessarily a sensible idea, however, because supplements can do harm as well as good. As an expert reviewer has noted: â€Å"different doses may have different and even opposite effects, and the effect of the same dose may depend on baseline micronutrient intake or status†¦ Furthermore, micronutrients often interact, so that the effect of a micronutrient supplement depends on the intake of other micronutrients. † Taking doses of vitamins far in excess of the recommended daily allowances – known as megavitamin therapy – is certainly not advisable.Megadose vitamin C, for example, has no proven benefit and can lead to diarrhoea, while too much vitamin A can cause a range of ailments including jaundice, nausea and vomiting. Some foods, herbs and supplements interact with antiretroviral drugs, potentially increasing the risk of treatment failure or side effects. Harmful interactions have been observed between certain drugs and some of the foods promoted as nutritional therapy for people living with HIV, which otherwise may be beneficial as part of a balanced diet.Notable examples are St John’s Wort, African potato, Sutherlandia, garlic, vitamin C and grapefruit juice. It is important for HIV positive people to tell their doctors about any supplements they are taking. NUTRITIONAL ASSISTANCE Because HIV and nutrition are so strongly linked, nutritional assistance is seen as an important part of the response to HIV. This may take the form of nutritional assessment, counselling, or food provision. Nutritional assessment and counselling Nutritional assessment helps HIV positive people receive appropriate treatment, care and nutritional support.Even in the poorest settings, according to the World Health Organisation: â€Å"Screening for nutritional status and assessment of dietary intake should be included routinely in HIV treatment and ca re for adults and children. † In the US, the Department of Health and Human Services advises that, ideally, all people living with HIV should have access to the services of a registered dietician with expertise in HIV/AIDS. A dietician can assess the patient’s diet, lifestyle and nutritional status, and provide counselling and referrals as necessary. Nutritional counselling may include education on various topics, including: * Healthy eating Achieving or maintaining a healthy body weight * Managing lipid abnormalities and lipodystophy * Managing dietary complications related to antiretroviral treatment * Managing symptoms that may affect food intake * Appropriate use of herbal and/or nutritional supplements * The role of exercise * Food safety (important for preventing  opportunistic infections) Providing food Providing food supplements to malnourished patients on antiretroviral treatment can increase programme success. Some programmes helping people living with HIV provide a limited amount of fo od to those most in need.For example  PEPFAR funding may be spent on food for the following groups, if funds cannot be obtained elsewhere: * Orphans  and vulnerable children born to HIV infected parents * HIV-positive pregnant and lactating women * Malnourished adults in antiretroviral therapy and care programmes Foods provided in resource-poor areas include peanut butter-based paste, milk, flour and vegetable oil, each fortified with micronutrients. Alternatively HIV positive people may be helped to set up vegetable gardens or animal rearing projects to improve their diet.In some rich countries there are non-profit organizations that deliver meals to the homes of people who are ill because of HIV infection. Examples include Moveable Feast in Baltimore, USA, and The Food Chain in London, England. Food provision is, however, not without its hazards. Organizations focused on combating HIV are wary of getting drawn into providing long-term food aid. In communities with widespread hunger, providing food only to HIV positive people may fuel discrimination, or even appear to reward people for becoming infected.In most cases food is provided to mitigate the impact of HIV, or to support antiretroviral treatment. Some experts have suggested that more general hunger alleviation could have a role in slowing the spread of the epidemic: â€Å"In poverty-stricken communities, the incentive of reducing HIV risk behavior should be an added reason for national governments and international agencies to invest in reducing hunger by improving infrastructure and development†¦ Ignoring such basic issues as food or hunger could be a major stumbling block to HIV prevention strategies. Professor Nigel Roll ins Why is good nutrition important in HIV? * Good nutrition helps keep your immune system strong, enabling you to better fight disease. A healthy diet improves quality of life. * Weight loss, wasting, and malnutrition continue to be common problems in HIV, despite more effective antiretroviral medications, and can contribute to HIV disease progression. * Good nutrition helps the body process the many medications taken by people with HIV. Diet (and exercise) may help with symptoms such as diarrhea, nausea, and fatigue, and with fat redistribution and metabolic abnormalities such as high blood sugar, cholesterol, and triglycerides. CONCLUSION HIV and nutrition are directly related and there is need for proper nutrition for those infected. Patients need to fortify the body with all the nutritional requirements to help the body withstand the ravages of the diseases and to cope with the ARV’s. Dietary requirements and recipes are available to ensure that the daily nutritional needs of the patients are met. However there are so many challenges that need to be overcome in developing countries like Kenya, the biggest of which is lack of sufficient income to cater for the special dietary needs of the patients.REFERENCES1. NUTRITION/INFECTION UNIT: -http://www. tufts. edu/med/nutrition-infection/hiv/health. html2. EFFECTS OF HIV ON NUTRITION: http://www. avert. org/hiv-nutrition. htm3. FAO: HIV AIDS, FOOD SECURITY AND NUTRITION : http://www. fao. org/ag/agn/nutrition/household_hivaids_en. stm How to cite Hiv and Nutrition, Papers

Context of Caroline postoperative patient †MyAssignmenthelp.com

Question: Discuss about the Context of Caroline postoperative patient. Answer: Patients context Caroline is a day five postoperative patient, and her discharge has changed by a day. She is an employee working at a given Information Technology company, upon her discharge she hopes to return to her employment. She will be on the medication (Panadeine Forte 2 tablets qid).Caroline is very keen to go back to her bed. Cues collected from the scenario: Caroline has: She has declined the communitynursing services She hopes to return to her employment shortly in the IT company She is very happy to go back home and stay in her bed. Medication Panadeine Forte is a kind of medicine with the brand names of Panadeine Forte Tablets. The active ingredients are Codeine phosphate, hemihydrate, and Paracetamol. The medicine is very good for the relieved of both the severe pain and fever. The patient should be properly educated on the prescription depending on her age. Failure to follow medical instruction may lead to future complications. The medicine should be kept away from children and at a temperature of about 250Celcius. Script Justification Good morning Caroline my name is Robert and am a Registered Nurse in charge of your dischage. First I would congratulate you for the quick improvement. The pharmacist has sent me with your medication. I would like us to go through the medication before you have your discharge. This introduction part is to build a relationship with the patient. Use of polite greetings and introduction makes feels that despite her condition the nurses still cares for her. Introduction also initiates the agenda of the discussion. It is ok. Robert, youre most welcome. Thank you, Mrs. Caroline. You have been given a new medication due to the change in your discharge. I am going to help you on how to how to take the medicine. Would it be ok if I sit down Mrs. Caroline? Feel free to ask any question as we go through this medical prescription. According to the principles of adult learning, adults always respond well to the learning that is centered towards performing a common task (Melton, 2017). I will ensure that I maintain an eye contact and display comfortable body language including sitting in front of Mrs. Caroline to engage her closely. A conducive environment is required for Caroline to ask questions freely. During the discussion, she should be encouraged to ask as many question as possible. You may sit down Robert. Thank you for taking your time to visit me. I wish to know more about the medication. Thank you, may I get closer to you? This is Panadeine Forte. The medication is very special; it will help you get relieved from both severe and moderate pain. It will also help with fever. Do you remember our surgical Registrar talked to you about what to do and not what to do while at home? According to adult learning principle, the adults always want to know why they are learning about new medication (Bradley, Chang, Fallar and Karani, 2015). I would ensure that I maintain an eye contact and the body language to facilitate learning. The environment should be pleasant and free from noise. I would sit down and display best body language to capture the attention of Caroline (Melton, 2017). Yes, I remember well. He advised me on the proper medication to take Excellent Mrs. Caroline, Panadeine Forte Tablets helps with both severe and the moderate pain. You should take two tablets at an interval of 6 hours (2 table 3 times a day) that is two tablets in the morning, afternoon and evening. You need to take the tablets with clean water. Always ensure that you take medicine as prescribed because the side effects due to overdose are severe.Incase of any problem with the medication, plesase feel free to contact the doctors for any consultation. Is that right? I should always ensure that several learning preferences are included in our learning process not only through the verbal. Demonstrations and discussions may also be used because these might be Carolines preferences (Knier, Stichler, Ferber and Catterall, 2015). It is ok, I will follow all instruction as prescribed in this medication. Thank you, Caroline, together with the medication, take time to walk around and have some small exercise as this will help you with the joint pain. It is also advisable to take a lot of water because to avoid constipation which may occur as one of the side effects. At this point, I want to confirm if I have explained the medication correctly. Are you at position to take me through the procedure? Provide Caroline with the print documents because of it the best way of reinforcing learning (Veronovici, Lasiuk, Rempel and Norris, 2014). At this method, I will use teach-back method of learning to confirm Caroline understanding on the medication. Yes, Mr. Robert.I will take two tablets in the morning, afternoon and evening. I should always take it with clean water. Exercise and water are also good for my health.In case I clear the dose yet the condition not changed what I should do? That is a good question, Caroline. You will need to come back to the hospital for further consultation as well with the stoma nurse who will be checking on you. Positive response is used to reinforce the response on the importance of asking questions by patients; this motivates Mrs. Caroline with in-depth mastery of the medication (Peter, 2015). Did you have any other question, Caroline? In case you have any question while at home you can always contact pharmacist or doctor. The medication also has some printed documents to take home with you. References Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K. and Salas-Lopez, D., 2015, Reducing readmissions using teach-back: enhancing patient and family education,Journal ofNursing Administration,45(1), pp.35-42. Veronovici, N.R., Lasiuk, G.C., Rempel, G.R. and Norris, C.M., 2014, Discharge education to promote self-management following cardiovascular surgery: An integrative review,European Journal of Cardiovascular Nursing,13(1), pp.22-31. Knier, S., Stichler, J.F., Ferber, L. and Catterall, K., 2015, Patients perceptions of the quality of discharge teaching and readiness for discharge,Rehabilitation Nursing,40(1), pp.30-39. Melton, L., 2017., Evidence-Based Discharge Education Guidelines to Improve Adherence to Self-Care and Decrease 30-Day Readmissions for Older Heart Failure Patients, Bradley, S.M., Chang, D., Fallar, R. and Karani, R., 2015, A patient safety and transitions of care curriculum for third-year medical students,Gerontology geriatrics education,36(1), pp.45-57.

Philosophy - Socrates Essays - Dialogues Of Plato,

Philosophy - Socrates Philosophy is a vast field. It examines and probes many different fields. Virtue, morality, immortality, death, and the difference between the psyche (soul) and the soma (body) are just a few of the many different topics which can be covered under the umbrella of philosophy. Philosophers are supposed to be experts on all these subjects. The have well thought out opinions, and they are very learned people. Among the most revered philosophers of all time was Socrates. Living around the 5th century B.C., Socrates was among the first philosophers who wasn't a sophist, meaning that he never felt that he was wise for he was always in the pursuit of knowledge. Unfortunately, Socrates was put to death late in his life. One of his best students, Plato, however, recorded what had occurred on that last day of Socrates' life. On that last day of his life, Socrates made a quite powerful claim. He claimed that philosophy was merely practice for getting used to death and dying. At first, the connection between philosophy and death is not clear. However, as we unravel Socrates' argument backing up his claim, the statement makes a lot of sense. In order for Philosophers to examine their world accurately and learn the truth accurately, they must remove them selves of all distractions. These not only include physical distractions, but they include mental distractions and bodily distractions as well. Philosophers must get used to viewing and examining the world with out any senses. Senses merely hinder and obscure the truth. Sight for example can be fooled easily with optical illusions which occur normally in nature. Sound can be very distracting as well when a philosopher is trying to concentrate. All of these cloud the judgement, and must therefore be detached from the soul. Socrates argues that philosophers must view the world around them with their souls in order to accurately learn about it. However, by detaching their souls from all bodily functions, philosophers may as well be in an induced state of death. In mortem, the soul wanders free and there are no bodily hindrances. Socrates also believed that philosophers look upon death with good cheer and hope. This I find hard to believe because if this were true, the philosopher would not be able to love life, and without the love of life, there is no life to examine and learn about. It is understandable however from another point of view to understand why the philosopher would look forward to death with good cheer. Once the philosopher is dead, his soul is free to roam around without hindrances forever, and all the worlds secrets shall be revealed to him. In fact, Socrates' sees his death as a liberation from the shackles of life for his last wish was for Crito to sacrifice a rooster to Asclepius. This god was normally given sacrifices to free the sickly from the grips of a virus or illness. Perhaps Socrates saw the body as a sickness that fed upon the soul. If this were the case, then indeed Socrates would be happy to leave the bonds of life, for then he could have an eternity to seek out his answers, all without the diversions and distractions of a body. Socrates believed that it was this search that was important, even more so than the answers them selves. Socrates believed that the journey toward the answers is where most of the learning takes place, and it is this journey that truly integrates the answers as part of your very own being. --===--

Informative Abstract Example Essays

Informative Abstract Example Essays Informative Abstract Example Paper Informative Abstract Example Paper Essay Topic: Informative Ronnie Green Informative Abstract June 28, 2011 Image gap is the difference between how a person wants to look and sound compared to how they are actually viewed by others. Projecting your desired image can build trust and is critical to successful communication. Projecting an inappropriate image, however, can erode trust and cause others to doubt your abilities. Four components of your overall image are your projected first impression, your depth of knowledge, your breadth of knowledge, and your enthusiasm. Your projected first impression is the initial impact you make on another person due to your dress, voice, grooming, handshake, eye contact, and body language. First impressions tend to be long lasting and difficult to overcome. To create a positive first impression, you should have a firm but not overpowering handshake. Sit and walk in a straight yet relaxed manner. Maintain high standards of personal hygiene and grooming. Speak clearly while naturally varying your tone and volume. Finally, dress appropriately for your job responsibilities and work environment since skillful dressing can evoke positive responses to your personality. Depth of knowledge refers to how well you know your area of expertise. Demonstrating your depth of knowledge can project credibility and demand respect. You can develop depth of knowledge by studying company policies and industry standards. You can also take advantage of training programs offered by your company. Breadth of knowledge reflects your ability to communicate with others on topics outside your area of expertise. Breadth of knowledge allows you to more easily develop rapport with others. It will also allow you to increase your circle of influence with various types of people. You can increase your breadth of knowledge by reading a variety of books and magazines, watching and listening to a diverse selection of television and radio programs, and interacting with a wide array of individuals. If you encounter a person whose interests you are not familiar with, you can quickly gain knowledge and show interest by asking questions. An appropriate level of enthusiasm demonstrates your sincere interest in a subject and desire to accomplish a task. Enthusiastic people tend to work harder, longer, and more accurately than those who are not enthusiastic. Additionally, your enthusiasm, positive or negative, will spread to those around you. These elements help dictate the response you receive from others in everyday interactions. A positive response demonstrates successful interpersonal relations. It will also foster open, honest, and trusting communications.

Constructions of childhood and western ideologies of street children Literature review

Constructions of childhood and western ideologies of street children - Literature review Example Being a child on and of the streets may be different in one aspect, but long term results of the situation is equally harmful as it touches issues on child labor and children’s health. Childhood for Street Children Before identifying the possible consequences of being one of the street children, it is important to internalize the meaning of childhood as a phase and the expected characteristics of ‘normal’ children. According to Glasper and Richardson (2006, p. 298), childhood refers to the earlier phase of a person’s life under 18 years or before reaching young adulthood. Aside from underdeveloped physical qualities which are subject to change as they grow older, children are expected to love play as a usual activity. According to Ginsburg (2007, p. 183), play is important in childhood development because it allows children â€Å"to use their creativity while developing their imagination, dexterity, and physical, cognitive, and emotional strength.† I n other words, play would develop a child’s cognitive skills and tolerance towards unexpected events such as losing in a game and being sport about it. In the United Kingdom, The Children’s Act of 1989 serves as guidelines in which the rights of the child are protected and sustained through the regulations promoted by the Parliament. The legislation encompassed the responsibilities of both the authorities and the parents or guardians. It is ensured that the act â€Å"protect[s] children from the harm which arises from family breakdown or abuse within the family,† however still respecting family lives and avoids â€Å"unnecessary intervention† (The Children's Act 1989. (c.1)). How ever the law protects the children, it is still indefinite if it can really protect their absolute population. Deprivation of basic needs would force underprivileged children to see the public street as a new place in which they can sustain themselves. The history of the lives of the street children can be traced from the nineteenth century onwards, since the growth of the industrial market. Especially in Britain's northern and midland counties, â€Å"child cruelty† was at its peak which gave inspiration to the formation of legislations protecting children’s rights (Shore, 2009, p. 563). The difficulty of their parents to provide them with proper nourishment encouraged these children to be on the streets to start looking for meager amount of money. Lemba (2002, p. 1) of the United Nation Children’s Emergency Fund (UNICEF) reported that most street children are found in the â€Å"market, bars, shopping centers, bus stations, and parks.† Most of these children have minimal or no contact at all with their family. Such descriptions would lead to the definition of street children as: â€Å"children less than 18 years old, males or females, who spend all or most of their time on the streets who maintain minimal contact with their fami lies resulting to lack of supervision, protection or guidance which makes them vulnerable to hazards.† (Ali, n.d., p. 7) Wernham (2004) cited two categories of street children of which she called as children on the street and children of the street. The slight difference of the two phrases is significant in developing further the definition of

Personal Development Plan Essay Example | Topics and Well Written Essays - 1000 words

Personal Development Plan - Essay Example This article gives an answer why getting into a Masters Degree in the University College of London program entails a different set of skills and abilities. Author gives an example of her skills and abilities demanded for this program. The University College of London (UCL) is known to be one of the world’s best universities. This is the ultimate reason why I have decided to apply for a master’s degree program with UCL. Its academic programs are known to be one of the best in UK. UCL, being a public research university, offers affordable education without sacrificing quality. This is another reason for choosing UCL. I can comfortably attend to my studies without worrying about the costs. Furthermore, this university is also proximal to my area of residence. In the Chinese history, Liu Bang was the founder and first emperor of the Han Dynasty, and Xiang Yu was a political figure during the same period with Liu. There was a famous battle between them, which is known as Chu-Han Contention. Xiang got 400,000 very strong soldiers. However, he failed in the war by fighting with only Gao's 100,000 soldiers. The reason of Gao's success was because he put the right people in the right place from this ancient example, we can know how important the enterprise management would be. In 2011 and 2012, I took the internship in CITIC Securities Ltd and PWC respectively. In these two periods, I further my understanding about the significance of enterprise management since I was connected closely with the staff within management from the first day I came in to the last day I left. In the very beginning, the representative of enterprise management provided all the interns with primary training for a half day in order to familiarize all the routines during our work. In the preceding time, I needed to frequently contact with them, not only handing in my time sheet but also reporting them any particular personal issues such as a sick leave. From ancient example and my personal experience, I see that enterprise management has played and will continue to play an essential role in a company or even a nation. Without it, the enterprise would never survive especially in present society with such an intensive competition. Essentially, Enterprise Management develops in a person the skill to look into business management from a holistic and integrated perspective. That is why I have been intrigued by enterprise management. To me, it is a higher level of understanding business

Staffing Shortage in the nursing profession Research Paper

Staffing Shortage in the nursing profession - Research Paper Example Exploring the problem of the nursing shortage is essential in order to come up with structured and long term solutions. Some of the factors known to have contributed to this problem include the aging of the registered nurses and the impact of educators in the nursing field. Negative perception of the nursing perception of the nursing procession has a profound effect on the enrollment rates. The negative impact of some of these factors has been felt in both nursing profession and the quality of patient care. Nurses are supposed to provide adequate safe care in a critical care setting. The problem is linked to the high turnover rates of registered nurses in the profession. The problem has been compounded by the incompetent leadership with is hand-off and laisser fair. The shortage of the nurses is a multicultural set up can only be addressed through a balanced approach. The leadership style used by the nurse manager is essential. This is because it can be a source of inspiration, or reduce the morale among nurses (Bland, 2008). The leadership style of the manager was easy going but keen of getting the job completed. During the clinical experience, the clinical nursing management was evidently approachable, trustworthy and naturally quiet. The quality of nurse education depends on the clinical experience. Both professors and hospitals play a crucial role. However, management and leadership can affect the effectiveness in the profession. Research shows that effective students placement given rise to confident professional nurses (Peter & David, 2009). The experiences are central to student nurse preparation before entering the workforce. Clinical experiences expose nurses to role models and develop their problem solving skills. It becomes easy to incorporate the theoretical skills into practical experiences in a clinical environment (Buchan, 2006). Pa tient care is a priority. When nurses are subjected to strenuous professional conditions, patient care tends to falter. Studies show that staff shortage and strenuous jobs cause the nurses to have emotional exhaustion and excellent job dissatisfaction. This can result to avoidable deaths. Nursing shortage is said to affect the work-life of nurses, and the time spent with patients. A survey indicated that 75 percent of the registered nurses believe staff shortage increases stress among nurses. 93 percent indicated that nurse shortage lower the quality of patient care and 93 percent also believed this resulted in high rates of turnover. Therefore, the clinical experience indicated that increasing the staff leads to a reduction in hospital mortalities. However, it is increasingly becoming clear that hospitals lack the required supply of nurses to cater for the increased workloads. The staff mix depicted a multicultural set up with 60 percent Philippines, 30 percent whites and a minorit y of 10 percent blacks. This called to an inclusive culture where negative ethnicity or racism was highly discouraged. The attribute of cultural diversity was viewed as strength. Multilingual skills were a strong advantage in the hospital when it came to overcoming

Theory And Practice Of Supervision

Theory And Practice Of Supervision Supervision theories and practices began emerging as soon as counsellors started to train other counsellors (Bernard Goodyear, 2009). Several different theoretical models have developed to clarify and support counselling supervision. The focus of early models of supervision had generally been based on counselling theories (such as Cognitive Behavioural Therapy, Adlerian or client-centred), but these orientation-specific models have begun to be challenged as supervision has many characteristics that are different to counselling. Competency as a counsellor does not automatically translate into competency as a supervisor, and when supervisee/supervisor orientations differ, conflicts may arise (Falender Safranske, 2004). More recent models of supervision have integrated theories from psychology and other disciplines, for one-to-one, peer and group supervision. As supervision has become more focused, different types of models emerged, such as developmental models, integrated models, and agency models. As a result, these models have to some extent replaced the original counselling theory models of supervision, and supervisors may utilise several different models to qualify and simplify the complexities of supervision (Powell, 1993). This paper will briefly look at a definition of supervision, and an outline of two different models agency and developmental. What is Supervision? Supervision is the process where by a counsellor can speak to someone who is trained to identify any psychological or behavioural changes in the counsellor that could be due to an inability to cope with issues of one or more clients. A supervisor is also responsible for challenging practices and procedures, developing improved or different techniques, and informing clients of alternative theories and/or new practices, as well as industry changes. The supportive and educative process of supervision is aimed toward assisting supervisees in the application of counselling theory and techniques to client concerns (Bernard Goodyear, 2009). The supervisor is responsible for monitoring the mental health of their supervisee, in turn protecting the public from unhealthy counsellors. Counsellors can face issues such as transference and burn out without any recognition of the symptoms. A supervisor should notice the symptoms before the counsellor (Australian Counsellors Association, 2009). Supervision is a formal arrangement for counsellors to discuss their work regularly with someone who is experienced in counselling and supervision. The task is to work together to ensure and develop the efficiency of the counsellor/client relationship, maintain adequate standards of counselling and a method of consultancy to widen the horizons of an experienced practitioner (ACA, 2009). The supervisors primary role is to ensure that their clients are receiving appropriate therapeutic counselling. By ensuring the counsellor continually develops their professional practice in all areas, the supervisor ensures a counsellor remains psychologically healthy. The supervisor is also responsible for detecting any symptoms of burn out, transference or hidden agendas in the supervisee. The Australian Counsellors Association (2009) recommends that supervisors cover the following as a matter of course: Evaluation Supervisees counselling; Developing process of self-review; Quality assurance; Best practice; Service outcomes of service delivery; Identifying risk for supervisee and clients; Referrals; Follow up on client progress; Helping the counsellor assess strengths and weaknesses. Education Establishing clear goals for further sessions; Providing resources; Modelling; Explaining the rationale behind a suggested intervention and visa versa; Professional development; Interpreting significant events in the therapy session; Convergent and divergent thinking; Use of self; Topping up; Facilitating peer connection; Duty of care; Legal responsibilities. Administration Procedures; Paperwork; Links; Accounting; Case planning; Record keeping; Insurance. Support Advocate; Challenge; Confront; Empower; Affirm; Availability; Empowering; Use of self. A range of different models have evolved to provide a framework for these topics within which supervisors of can organize their approaches to supervision, and act as an aid to understanding reality (Powell, 1993). Agency Model of Supervision Kadushin Kadushin describes a supervisor as someone to whom authority is delegated to direct, coordinate, enhance, and evaluate on-the-job performance of the supervisees for whose work he/she is held accountable. In implementing this responsibility, the supervisor performs administrative, educational, and supportive functions in interaction with the supervisee in the context of a positive relationship (Powell, 1993). In educational supervision the primary issue for Kadushin is the counsellor knowing how to perform their job well and to be accountable for work performed, and developing skills through learning and feedback. The object is to increase understanding and improve skill levels by encouraging reflection on, and exploration of the work (Tsui, 2005). In supportive supervision the primary issue is counsellor morale and job satisfaction, as well as dealing with stress. The stresses and pressures of the coaching role can affect work performance and take its toll psychologically and physically. In extreme and prolonged situations these may ultimately lead to burnout. The supervisors role is to help the counsellor manage that stress more effectively and provide re-assurance and emotional support (Tsui, 2005). The administrative function is the promotion and maintenance of good standards of work and adherence to organisational policies and good practice. This includes reviews and assessments. The interpretation here is that the supervisor inducts the counsellor into the norms, values and best practices. It is the community of practice dimension ensuring that standards are maintained (Tsui, 2005. Not every supervision session will involve all three areas or functions, and at different times there may be more of a focus on one area rather than another. The supervisor cannot avoid the pressure that arises from their responsibility to the workplace, other staff, and to clients. No simple model of supervision is to be expected to be practical in every situation. Supervisors are expected to adapt approaches to the developmental level of supervisees, and both must adapt to the varying demands of any professional situation (Powell, 1993). For this model, the focus of supervision is as a prompt for behavioural change and skill acquisition. The emphasis is on persuading staff to learn how to use oneself in counselling to promote behavioural change in the client (Powell, 1993). The supervisors attention should be on the activities of the supervisee rather than on study of the supervisee themselves. With a focus on the activity, rather than the worker, it allows the supervisee to listen to constructive criticism rather than feeling compelled to defend themselves from a personal attack (Tsui, 2005). This model has several strengths in that it is very flexible, and open to exploration and experimentation. It is also more challenging for both the supervisor and supervisee. This style of supervision can be tailored to meet different needs and variables. This model may prove unsatisfactory when the supervisor has insufficient experience to be able to provide proper direction and support, and where supervisor skills do not allow for appropriate evaluation of the supervisee (Powell, 1993). Developmental Models of Supervision Erskine Underlying developmental models of supervision is the notion that as people and counsellors we are continuously growing and maturing; like all people we develop over time, and this development and is a process with stages or phases that are predictable. In general, developmental models of supervision define progressive stages of supervisee development from novice to expert, each stage consisting of discrete characteristics and skills (Bradley Ladany, 2000). For example, supervisees at the beginning or novice stage would be expected to have limited skills and lack confidence as counsellors, while middle stage supervisees might have more skill and confidence and have conflicting feelings about perceived independence/dependence on the supervisor. A supervisee in a later developmental stage is expected to employ good problem-solving skills and be reflective about the counselling and supervisory process (Haynes, Corey, Moulton, 2003). Erskine (1982) identifies three stages in the development of the skills of a therapist, each of which represents specific characteristics and responds to specific training needs. In the beginning stage of training, therapists have operational needs as they are developing professional skills, a sound theoretical reference system, and intervention techniques. They also have emotional needs: to feel comfortable in their professional role, to be reassured of their ability to do the work, and to feel adequate to act in this new undertaking. This is the stage at which trainees most need positive motivations centred on their skills so that they can know their strengths and on which they can build their skills. Erskine (1982) suggests temporarily ignoring what the trainee does not do well so as to reduce any feelings of inadequacy and to support self esteem, provided this does not cause harm to the trainee or clients. During the intermediate stage of training, Erskine proposes that trainees need to reinforce their personal identity as therapists, learn to define the direction of treatment, and draw up a treatment plan. At the personal level, their goal is to integrate their sense of self and to work on their emotions in order to understand and solve any personal difficulties that might create obstacles to their contact with clients. According to Erskine, in this second phase, trainees personal therapy is of highest importance (Bradley Ladany, 2000). During the advanced stage of training, trainees need to learn various approaches and to integrate theoretical frameworks, to recognise alternative interventions, and to choose among them so as to encourage flexibility. Trainees must also practise self-supervision and learn to differentiate between observations of behaviour, and theorising about observations (Stoltenberg Delworth, 1987). One of the potential drawbacks of developmental models is that not only do people learn in different ways but they also develop at diverse speeds, in varied areas. The development model does not show how the supervisee develops and moves from one stage to the next, and how this progress is connected to the supervision process (Bradley Ladany, 2000). For this model, it is necessary to modify the relationship to meet the supervisees needs based on their current developmental level. Supervisors employing a development approach to supervision need to be able to accurately identify the supervisees current stage of development and provide feedback and support appropriate to that developmental stage, while at the same time assisting the supervisees advancement to the next stage (Stoltenberg Delworth, 1987) Commonalities Regardless of the model used or theoretical background, any model or theory of supervision should cover some common fundamental principles. Supervisors are responsible for the professional developmental of those under supervision. These responsibilities involve issues such as informed consent, confidentiality, and dual relationships (ACA, 2009). Ethical and legal concerns are central to supervision. The balance between a supervisory relationship and a therapeutic one only becomes a problem when the supervisor discovers that personal problems hold back the supervisee. The supervisory relationship becomes a dual relationship if the supervisor tries to become the students therapist. A dual relationship is considered unethical (Powell, 1993). Dual relationships can occur in different ways. A supervisory relationship can develop into a close, emotional relationship between supervisor and supervisee. The supervisory relationship will in this situation be less effective and supervision should not continue. In consensual relationships the emotional relationship can continue; however, the professional relationship has to end. The supervisory relationship needs to be governed by the same ethical principle as is the therapeutic process (Powell, 1993). Different ways of evaluating the supervisory process are important both for the supervisor and the supervisee. Establishing a contract for the supervisory relationship makes evaluation easier. The contract should include the students developmental needs, the supervisors competencies, and supervisory goals and methods (Stoltenberg Delworth, 1987). Throughout the supervision process, the supervisor is responsible for evaluating the quality of the supervisory relationship (Powell, 1993). This responsibility especially comes to bear when a conflict arises or an impasse develops. Investigating problems and challenges often begins with asking questions about various aspects of the supervisory relationship. When asking these questions, it is important to consider not only how the counsellor may be contributing to a problem but also how the supervisor may be contributing. The supervisor has a responsibility to ensure that confidentiality is maintained, and any information obtained in a clinical or consulting relationship is discussed only for professional purposes and only with persons clearly concerned with the case (ACA, 2009). Conclusion Supervision is not a senior counsellor watching over the shoulder of a new or junior counsellor. Nor is it a conversation between two practitioners, or a dialogue of personal matters with a counsellor. It is a distinct intervention, to enhance professional functioning and monitor the quality of counselling services being provided (Bernard Goodyear, 2009). Clinical supervision is a complex activity; it can be education or support, assists with confidence or doubts, it can process through different levels or stages. The competent clinical supervisor must embrace not only the domain of psychological science, but also the domains of client service and trainee development. The competent supervisor must not only comprehend how these various knowledge bases are connected, but also apply them to the individual case (Bradley Ladany, 2000). The purpose is to help identify obstacles that prevent the supervisee from learning, growing and ultimately helping their client. No matter what theoretical framework is used, supervision can be used as a means to develop professionally. Like any other relationship in life it is not perfect, nor is it an answer to every problem. Like any other relationship, it is necessary to be honest, consistent, and dependable, and work hard to build trust. Supervisors and supervisees have to work together to make it successful. Powell (1993) theorised that the emphasis should not be on why a counsellor feels a certain way, but on being able to put a end to behaviours that inhibit change. Powell advises professionals to develop their own model of supervision in order to understand what one is doing and why. Whatever model of supervision if employed, a supervisor should seek to encourage ongoing professional education, challenge the supervisee to improve their skills and techniques A supervisor should intervene where client welfare is at risk, and ensure that ethical guidelines and professional standards are maintained. A supervisee should endeavour to uphold ethical guidelines and professional standards, be open to change and alternative methods of practice, maintain a commitment to continuing education and consult the supervisor in cases of emergency. Supervision, regardless of any model used, should enable counsellors to acquire new professional and personal insights through their own experiences. REFERENCES Australian Counsellors Association (2009). Professional Supervision. Accessed 2nd February 2010. http://www.theaca.net.au/docs/Supervision_Complete.pdf Bernard, J. M., Goodyear, R. K. (2009). Fundamentals of clinical supervision (4th ed.). Needham Heights, MA: Allyn Bacon. Bradley, L.J., Ladany, N. (2000). Counsellor Supervision: Principles, Process and Practice. Philadelphia, PA: Brunner-Routlege. Erskine, R. G. (1982). Supervision for psychotherapy: Models for professional development. Transactional Analysis Journal, 12, 314-321. Falender, C. A., Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association. Haynes, R., Corey, G., Moulton, P. (2003). Clinical supervision in the helping professions: A practical guide. Pacific Grove, CA: Brooks/Cole. Powell, D. (1993). A developmental approach to supervision. In Clinical supervision in alcohol and drug abuse counselling. (p. 58-84). New York, NY: Lexington Books. Stoltenberg, C. D., Delworth, U. (1987). Supervising counsellors and therapists. San Francisco, CA: Jossey-Bass. Tsui, Ming-Sum (2005). Social work supervision: contexts and concepts. Thousand Oaks, CA: Sage Publications.

William Faulkner’s The Sound and the Fury Essay -- Faulkner Sound Fury

William Faulkner’s The Sound and the Fury In William Faulkner’s The Sound and the Fury, the image of honeysuckle is used repeatedly to reflect Quentin’s preoccupation with Caddy’s sexuality. Throughout the Quentin section of Faulkner’s work, the image of honeysuckle arises in conjunction with the loss of Caddy’s virginity and Quentin’s anxiety over this loss. The particular construction of this image is unique and important to the work in that Quentin himself understands that the honeysuckle is a symbol for Caddy’s sexuality. The stream of consciousness technique, with its attempt at rendering the complex flow of human consciousness, is used by Faulkner to realistically show how symbols are imposed upon the mind when experiences and sense perceptions coalesce. Working with this modernist technique, Faulkner is able to examine the creation function of symbols in human consciousness. The occurrences of honeysuckle in the Quentin section suggest that Quentin came to view this plant as a symbol for Caddy’s sexuality involuntarily. When Quentin attempts to convince his father that he was the one who impregnated Caddy, he connects honeysuckle with his sister’s loss of virginity: â€Å"I fooled you all the time I was in the house where that damn honeysuckle trying not to think the swing the cedars the secret surges the breathing locked drinking the wild breath the yes Yes Yes yes† (94). In Quentin’s memory of the night Caddy lost her virginity, he recalls honeysuckle as a significant element of the event. In addition, he is hostile towards the plants and its meaning, which can be seen in his damning of it. This connection to the sexual act and the hostility, which is ascribed to it, suggests the internal conflict in his anger... ... of our deepest memories, rather they are active forces in our life, capable of controlling the mind of the individual. Works Cited Bauer, Margaret D. Southern Literary Journal. â€Å"`I Have Sinned in That I Have Betrayed the Innocent Blood': Quentin's Recognition of His Guilt.† 2000: 32.2 70-90. Bockting, Ineke. Style. â€Å"The impossible world of the `schizophrenic': William Faulkner's Quentin Compson.† 1990:24.3 484-498. Kartiganer, Donald M. â€Å"The Meaning of Form in The Sound and the Fury.† The Sound and the Fury. Ed. David Minter. New York: W.W. Norton and Company, 1994. 333. Vickery, Olga W. â€Å"The Sound and the Fury: A Study in Perspectives.† The Sound and the Fury. Ed. David Minter. New York: W.W. Norton and Company, 1994. 285. Zender, Karl F. American Literature. â€Å"Faulkner and the Politics of Incest.† 1998: 70.4 739-766.

Analysis of Current Accounting System Essay

1. Terms of reference 1.1.1 This report has been prepared to cover the requirements of the learning and assessment area Principles of Internal Control and Evaluating Accounting Systems at Level 4 of the Association of Accounting Technicians (AAT) Diploma in Accounting qualification. 1.1.2 This report forms an evaluation of the Accounting System of the Inkwell Limited. 1.1.3 The main purpose of the report is: To evaluate the accounting system and procedures that are currently in place at IWL To identify weaknesses within the system, suggest possible improvements and make recommendations for improvement. To analyse cost benefit for suggested improvements. 2. Executive summary 3. Methodology 3.1.1 This report has been prepared using information provided by AAT case study text and study materials from Home Learning College. 3.1.2 Research for the recommendations has been made using internet. A list of websites used can be found in Appendix 1. 3.1.3 In developing the report support and assistance from my Home Learning College tutor was provided. 4. Introduction 4.1. Inkwell Ltd (IWL) was formed seven years ago. IWL is the medium-sized company that supplies a complete range of re-manufactured inkjet and laser toner cartridges that are fully compatible with all major printers. Since its launch IWL has grown steadily and now has revenue of over  £16 million. The company employs around 180 full-time employees. 4.2. IWL has adopted the functional structure system with three departments i.e. finance, sales and purchases. The BODs comprised of Managing Director, Sales Director and Finance Director is responsible for all decision-making activities in the company. The management structure chart can be found in Appendix 2. 4.3. The main purpose of accounting function of the IWL is to collect and process information from other departments in order to prepare statutory and management accounts as well as to determine the price of cartridges the company can pay for in order to achieve required profit margin (management accounting). The Finance Departme nt is also responsible for making sure that inventory levels meet IWL’s policy, the company’s credit rating is kept strong, management accounts are prepared every month, orders from suppliers are monitored and supplier payments are arranged for. 4.2 To make an effective use of the accounting systems and procedures in place the finance department has been divided into two main areas of accounting i.e. financial accounting and management accounting (cost accounting). The area of financial accounting has been further sub-divided into the sections of general ledger and inventory, purchase ledger, sales  ledger, payroll and personnel database. The chart showing the structure of The Accounts Department is provided in Appendix 3. 4.2.1 Sections within the finance department interact and maintain a relationship with other departments. The information flows to general ledger from the sales ledger, purchase ledger and payroll, personnel section and shops. The general ledger provides information to the Company Accountant for the purpose of preparing monthly management accounts and approving supplier payments, to The Finance Director for the purpose of preparing financial statements and to the Sales Director for the purpose of costing IWL’s products. The Purchase Ledger section has a direct relationship with the General Ledger and the IWL’s suppliers. The Sales Ledger section maintains a close relationship with the sales department as well as with the General Ledger. The Payroll and Personnel Database section is working closely with shop managers from whom it collects the information to prepare payroll for employees. The department also co-operates with external users such as HMRC in order to comply with statutory requirements. The Costing Section is working closely with The Sales Director. 4.3 The objective of financial statements is to provide information about the financial position, performance and changes in financial position of an enterprise that is useful to a wide range of users such as suppliers, customers, government agencies or financial institutions in making economic decisions, for instance, whether to grant a loan or to give credit to the company. At the financial year end the Finance Director at IWL prepares the following financial statements: 4.3.1 Income Statement: this statement provides information about the financial performance of the company in terms of revenue from sales, costs and expenses incurred to generate the profit. It also provides information about gross and net profit generated for past financial periods. It is also referred to as the Profit and Loss Account. 4.3.2 Statement of Financial Position: this statement shows the financial position of the company at the end of each financial year. It provides the information about the company’s assets, liabilities and the equity claim of its shareholders. It is also referred to as the Balance Sheet. 4.3.3 The Statement of Cash Flow: this statement provides a link between the Income Statement and Statement of Financial Position as at the year end of the  previous and current financial years. Its main purpose is to reconcile liquid funds to profit by providing an analysis of cash inflows and outflows from operating, investing and financing activities. 4.4 A stakeholder is an entity that can be affected by the results of a company in which they are said to be stakeholders, i.e. that in which they have a stake. The critical external stakeholders for IWL have been identified as follows: 4.4.1 The financial institutions- IWL has a strong relationship with its bank. Through producing a series of convincing annual business plans, the company directors have been able to raise sufficient finance to grow IWL into a significant player in the cartridge supplies sector. Without this co-operation it would be much harder to expand the Company to its current position. They are IWL’s stakeholders because they lent money to The Business and they would be affected in case The Company becomes insolvent. 4.4.2 Customers- the IWL has a base of around 120 large trade customers. These customers account for 20% of IWL’s revenue. It is imperative to maintain good relationship with customers in order to remain competitive and have high customer satisfaction level. Customers are categorised as stakeholders because the company’s actions can affect their financial position. 4.4.3 Government- The government is interested in businesses as they set out the regulations and need the businesses to do well to keep the economy healthy. Economic policies introduced by The Government through taxation, and the ability of The Government to influence interest rates, impact on the business through prices and costs. The company needs to make sure that it is paying the right amount of tax and VAT and that it complies with all government’s policies and accounting standards. 4.5 IWL is the medium-sized, centralized, manufacturing company operating nationwide. For a small sole trader or partnership type organisation, like off-licence shop, there are likely to be few transactions to process. As a result the basic single entry record system, with detailed cash book, would most likely be used. A simple structure where the owner or partners make all the decisions related to the business would also be adopted. However, the single entry system lacks controls necessary to verify the accuracy of the postings and therefore would not be practical in circumstances where a high  volume of business transactions had to be processed. Medium and large sized companies will most likely use more sophisticated, double entry bookkeeping system. Higher amount of transactions would require more people to operate it and therefore the structure would be more sophisticated too, with either divisional or matrix structure adopted. The IWL uses double entry system. 5 Analysis of the Current Accounting System 5.1 The main external regulations the IWL has to comply with has been identified as: 5.1.1 The Company Law- compulsory legislation that governs the formation and registration of limited companies. It sets out the responsibilities of companies, their directors and secretaries and also determines the requirements relating to the preparation of Financial Statements of a company. It is legally binding on all limited companies in UK. In case of any changes in The Company LAW, staff training may be required to ensure compliance which will affect The IWL’s cash flow and availability of resources i.e. staff released for training. 5.1.2 The Pay As You Earn (PAYE) Regulations- this regulation apply when a business organisation employs individuals and sets out the requirements for deducting PAYE income tax and National Insurance Contributions (NIC’s) from payments made to employees. The regulation also stipulates rules for sending PAYE income tax and employees’ NIC’s to HMRC and identify the forms and returns that must be kept and submitted when administering the scheme. Any changes to the regulations i.e. change of the company tax rate or the National Insurance Contribution (NIC) has a direct effect on IWL because these are statutory requirements and The BODs need to make sure the staffs are appropriately trained and that they comply with the regulations. This may require substantial cash outlay as well as additional labour to provide cover for absent staff so these sorts of changes may significantly affect the Company’s finances. Accounting Standards-these are the regulations and codes of practice which have been developed to try to reduce the number of different interpretations and treatments used by accountants in preparing and presenting the Financial Statements for limited companies. This regulation have a direct impact on the company’s actions, as IWL is a limited company and have to prepare Financial Statements each year. The  Finance Director, being ACCA qualified, is applying accounting standards while preparing the financial statements. Changes made to the standards may require the Finance Director to undertake additional training which again will affect the company’s finances and the availability of staff. 5.1.4 The Data Protection Act 1998- the act lays down the principles by which the personal data should be managed by ‘data controllers’. Business organisations that keep personal data in respect of living and identifiable person are data controllers. The IWL has Payrol l and Database section in the Accounts Department therefore is obliged to comply with the regulation. Only authorised members of staff are to use IWL’s computers. In case of any changes in the Data Protection Act 1998, the Company may be required to, for example, purchase new safe for keeping the records in safe and secure way or to purchase new database software to meet the requirements of the regulation as well as train staff and review and implement changes in company’s policies. 5.2 Fraud is an intentional act by management or employees in order to obtain an unfair or illegal advantage. The most common causes of fraud in a business can be identified as a lack of operational internal control procedures within the business, lack of internal anti-fraud controls, especially risk management, as well as a lack of internal audit. In order to improve fraud and theft detection, the BODs needs to regularly review company’s fraud policies and procedures to ensure that they effectively reduce risk, improve processes and are in compliance with prevailing laws and regulations. This involves identifying the company’s specific fraud risks and then developing and implementing controls, procedures and operational changes to mitigate those risks. 5.3 The most common types of fraud can be identified as the theft of assets and corruption. The effects of the fraud activities can devastate the company in various ways, for instance, financial loss, external confidence , company morale or increased audit costs. Theft- this is probably the most common method of fraud, usually carried out because staff are presented with opportunities due to lack of physical controls and little or no segregation of duties with individual members of staff being given too much personal control over procedures. Impact of the theft can be fairly easy quantified. If, for  example, the manager overstates the hours worked by an employee, these can be easily calculated by multiplying the rate per hour by hours worked. In fact this is stealing the company’s time and subsequently money. There is a high risk of such an activity occurring within IWL shops as the company has no procedure in place for sales, warehouse or administrative staff to sing in or out when they arrive or leave work. This type of fraud often happens without knowledge of the management. 5.3.2 Corruption- this form of fraud usually involves a dishonest member of staff working in collusion with others to commit acts of fraud. The example of su ch an activity is changing contract terms and conditions after it have been awarded in favour of the supplier. There is a great possibility of this type of fraud occurring in the IWL’s due to lack of internal control procedures for purchasing inventory. This results in loses to the company because, the company is paying more for the product therefore reducing the Company’s revenue. 5.4 The accounting system can support internal control by means of setting the standards and using of control systems. 5.4.1 Standards allow the organisation to define its expectation of how things should be achieved. They allow the management to monitor the performance of the employees. These standards can be based on what the organisation expects from the staff, for example, implementing of company’s procedures. The organisation will generally outline to the staff what it expects in relation to performance levels, like cost of ensuring work is carried out effectively and that the deadlines are met, as well as in relation to the error allowance. Standards should be set in relation to the organisation’s objectives and goals. A tool commonly used for the purpose of measuring performance is that of standard costing. A main feature of standard costing is variance analysis, where differences between budgeted and actual figures are monitored. This allows the organisation to identify where changes may be required. 5.4.2 Use of control in systems is aimed at ensuring that the plans of organisation are being met. Deviations found by the control monitors should be investigated and if they negatively affect organisation then corrective action should be taken. An internal control system includes all the policies and procedures adopted by the organisation to achieve the objectives of: Effective conduct of the business, Implementation of internal policies and procedures, Safeguarding the assets of the organisation, Detecting and preventing incidences of fraud and error, The accuracy and completeness of the financial records, The timely preparation of reliable financial information. Regardless of the size of the organisation the accounting system must be reliable, cost effective and capable of being used effectively by the person(s) operating it. An accounting system of the IWL is a collection of computerized and manual accounting processes, procedures and controls created to collect, record, classify, summarize and interpret financial data for decision making by management. The record keeping systems of IWL meet organisation’s requirements for financial information. The Strengths, Weaknesses, Opportunities and Threads (SWOT) analysis has been prepared to identify those areas of the current accounting system that do not operate satisfactory and can be found in appendix 4. The analysis showed that the work is going through the correct sequence of events and processes and that there is good segregation of duties within the department. However, there are areas where the systems could be improved. These have been identified as better staff training and introd uction of audit trail. Better trained staff would become specialised in the area they operate which would enable them to complete tasks more efficiently and effectively and therefore reduce costs. The audit trail would minimise potential for error and would act as a control tool for staff activity. Weaknesses Identified Within The Accounting System The weaknesses that rise potential for error and possible exposure to fraud within The Accounting System of the IWL have been identified as insufficient staff training and lack of audit trail procedures. 6.2 Insufficient staff training caused many problems during the last six months period. There was not enough cover in the sales ledger section when the clerk was off sick or on holiday leave which caused accumulation of work that affected other departments as the financial information was not presented in the timely manner. The fact that no one was able to provide cover was evident proof of staff training needs. Another area where problems  occurred due to lack of training is that of the payroll and database section. The clerk was provided with only one day in-house training of how to operate payroll software and this resulted in mistakes with the staff salaries calculations. This is the example of error that occurred because of the lack of training. Some of them have been underpaid what may result in lower staff morale and de-motivate them which will result in worse productivity or alternatively may give a reason to commit fraud. Work could be delegated to different persons what would also act as an anti-fraudulent control because the person providing cover could spot any unauthorised or suspicious activities and report it to the management. It is recommended that all staff should be sent for training in order to become multi skilled. 6.3 Another weakness identified is the lack of internal audit procedures within the accounts department of the IWL. The impact on the organisation may be significant to the company in terms of money and reputation, should the fraud activities took place. Internal audit has proved to be the most successful method of detecting fraud. It would be advantageous to any organisationif its internal audit function were able to advise management on identifying and assessing the risks associated with fraud co uld review and monitor the internal control procedures in place to minimise the risk of fraud and also actively engage in detection of fraud within the accounts function. Internal controls are also successful as means not only of deterring or preventing fraud, but also of exposing acts of fraud. Many of the causes of fraud can be guarded against and, together with analysis of reports and trends and the investigation of errors and anomalies, fraudulent activities are often expose. The typical measures introduced in practice to help deter and prevent fraud has been identified as: Educating staff and raising awareness of the possible types of fraud and the likely impact of fraud on the organisation and its stakeholders. Whilst there is a belief that that such education could not only alert staff to types of fraud but could also encourage staff to indulge in fraudulent activities, research shows that money spent on educating staff and promoting staff awareness does in fact deter fraud and in the long run benefits outweigh costs. 6.4.2 Monitoring performance and making sure that accounting procedures are being followed. One member of staff, for instance accounting technician when his review and recommendation process is  completed, could be delegated to perform this task with all the discrepancies and suspicious activities reported to the management and appropriate action taken to mitigate risks. 6.5 The company can support individuals who operate accounting sys tems using training, manuals and written information and help menus. 6.5.1 Training- well trained staffs operate their accountancy systems more effectively than the untrained staffs. A review of the training needs of the company and its accounting staff has been undertaken, these have been identified as follows: General ledger and inventory clerk- appropriate training in the work of the Sales Clerk would relieve pressure from the Sales clerk who has no accounting or credit control qualification and who has a heavy workload during busy periods. 6.5.1.2 Purchase ledger clerk- this member of staff is already familiar with the work of the sales ledger section and an update of skills in this area is worth considering. The Purchase Ledger clerk is part AAT qualified and expressed an interest in studying for intermediate level 3 exams. 6.5.1.3 Sales ledger clerk and credit controller- this staff member has experience of the purchase ledger having worked as a Purchase Ledger Clerk before joining IWL. Some further training in this area would give a greater degree of flexibility. The clerk has expressed an interest in professional accountancy training and this should be encouraged. 6.5.1.4 Payroll and Personnel Database clerk- this staff member is working on a recently installed system has a heavy workload and is in need of additional training. Further training by a company who sold IWL new system is recommended. The clerk has an accounting qualification but further training should be discussed. 6.5.1.5 Costing technician- this is the only member of staff that has the experience to operate costing system. This member of staff shows reluctance to gain accounting qualification. The issue needs to be reso lved to the benefit of the company. 6.5.2 Manuals are files containing documents which provide the user with detailed information relating to procedures and operating activities. An example of the manual is handbook created by the Finance Director of the IWL relating to the IT systems. 6.5.3 Help menus- are aimed at providing assistance to the system user by allowing them to query items relevant to their effective use of the system. It provides the information on how to use the software in the correct manner. Sage payroll has such a facility in place. 6.5.4 Written information- the example may be company policy handbook issued by the Finance Director. 6.6 Every member of accounting staff is required to comply with statutory and organisational requirements. The types of controls that can be put in place to ensure compliance may include: data security controls and administrative controls. 6.6.1 Data security controls are put in place to ensure that the organisation’s data files are not subject to unauthorised access, change, disclosure to unauthorised persons, loss, damage or destruction. The IWL has a data security controls in place, however these are not being adhered to properly. It is recommended that staff should be informed about requirements of changing the password regularly and that unauthorised person should not be given access to the company’s computers. 6.6.2 Administrative controls can be categorised as segregation of duties, written policies and procedures and supervision. Due to lack of staff training, it is not possible to segregate and share duties between workers as they are not multi-skilled. This rise a possibility of error occurring as well as fraudulent manipulation of the system. Written policies are in place however, accountability and responsibility for implementing should be clearly defined. Every member should be informed about the consequences in case the procedures are not followed. Supervision of individuals or groups involved in the processing, checking and use of information within the system is essential. It is recommended that the activities of staff should be controlled by either member of the BODs or the Company Accountant. 6.7 The potential areas of fraud arising from lack of control within the accounting system have been identified as inventory control section and the purchase ledger section. Inventory control system would benefit from acquiring the Purchase Order Processing module which would improve the accuracy and reliability of the inventory control and would minimise risk of fraud. The Purchase Ledger section need more supervision as the Purchase Manager seems to be the most unreliable and suspicious person.