The Healthcare Quality Strategy For Nhs Nursing Essay

The Healthcare Quality Strategy For Nhs Nursing Essay This essay will discuss a significant event in relation to the peoples priorities identified within the Healthcare Quality Strategy. The essay will demonstrate my understanding and views on reflection and the issues surrounding my practice. I have chosen Gibbs (1988) reflective framework as it has a structured format and six steps which follow in order starting with a description of the event and ending with an action plan for future practice. The steps are Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan (Gray, 2007). Reid, (1993) describes reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice. The Scottish Government introduced the Healthcare Quality Strategy for NHS Scotland in 2010, their aim is to deliver the peoples priorities which are: firstly caring and compassionate staff and services, good communication and a clear explanation about conditions and treatments, effective teamwork between clinicians, patients and others, a clean and safe care environment, continuity of care and clinical excellence. Secondly, to bring together the patients priorities as well as the values of everyone working within the NHS Scotland. Thirdly, by applying these three interventions and putting them into practice improvements within priority areas of the Healthcare Quality Strategy will be met (Scottish Government, 2010, p.6). This reflective account will focus on the importance of communication and will identify if the priority was met in relation to my significant event and it will further clarify its importance (Scottish Government, 2010, p.6). Whilst on my Management Placement I met Janet, all names have been changed to protect her identity and maintain her confidentiality (NMC, 2008). Description Janet is 65 years old and has been admitted to my ward for palliative care. She has end stage bowel cancer and is awaiting a bed at the local Hospice. Janet lives at home with her husband, she has a full package of care and her son also visits on a regular basis. However, Janets doctor has requested that she be admitted onto the ward as she is now confined to bed because of increased pain and a general deterioration of her condition (Dougan and Colquhoun, 2006). Feelings Whilst carrying out my training as a student nurse, I have met a number of palliative patients and I feel that I lack confidence when communicating with these patients and their families at this difficult time. However, as I was on this ward for a longer period of time I was able to build up a good rapport with Janet and her family and this allowed me to provide good patient centred care (NMC, 2008). Therefore when dealing with Janet and her family at this difficult time I must treat Janet as an individual (NMC, 2008), provide her with the best care and be caring and compassionate always (Scottish Government, 2010, p.6). I was privileged to have the opportunity to be involved in Janets care as well as working within a ward of clinical excellence (Scottish Government, 2010, p.6). Evaluation Over the next few days whilst looking after Janet and taking part in the ward rounds, I was able to plan Janets care, the Doctor explained to me that Janet was not going to improve and we would have to keep her comfortable and pain free. Palliative care patients must have good symptom control of their pain and also nausea and vomiting. Janet was placed on a syringe driver to control her pain. A syringe driver is a small portable pump which is attached to the skin by a cannula and gives the patient a continuous dose of analgesics and/or anti-emetics (MacMillan Cancer Support, 2012). In relation to the Scottish Governments Programme Living and Dying Well when caring for palliative patients a holistic approach with continuity of care is extremely important (Scottish Government, 2008) and all nurses have a central role in providing information, care and support (Kennedy and Lockhart, 2007). Excellent communication and good interpersonal skills are paramount when caring for Janet, it is important not only to establish Janets wants and needs but also her families. It is imperative when relaying any information to Janet or her family make sure they understand it, if not explain the information to them again (NMC, 2008). Also when dealing with members of the multi-disciplinary team, effective teamwork is imperative again providing Janet and her family with continuity of care and the clinical excellence they require from all staff. Analysis Palliative care helps to improve the quality of life for patients and their families who have to come to terms with the difficulties associated with life threatening illness. It is about identifying the patients needs through accurate assessment, good symptom control and sensitive nursing care (Scottish Partnership for Palliative Care, 2012). In addition to caring for Janet on the ward I was given the opportunity to go to the Hospice and meet with Janets palliative care nurse and also be included in her multi-disciplinary team meeting. This again highlighted the importance of good communication and good record keeping as all team members were aware of Janets circumstances and could pick up her case notes and know exactly what was happening with Janet at any given time (NICE, 2004). This meant that when I was communicating with Janet and her family I was more confident and I was able to communicate in a language that they understood (Dunne, 2005). As well as building a trusting relationship between nurse and patient, good communication skills helps to reduce fear and anxiety at this stressful time (Dunne, 2005). In relation to Janets transfer from hospital to Hospice the Liverpool Care Pathway (LCP) was put in place, this model allows all staff on the ward and any multi-disciplinary team members guidance on all elements of Janets care. It provides a holistic approach to Janets care and support for her family in the last few days of her life (Marie Curie Palliative Care Institute Liverpool, 2012). Good communication is paramount when dealing with the palliative patient as this forms the basis of a good nurse/patient relationship which greatly improves care and helps to reduce anxiety and stress for patients, relatives and carers (Kennedy and Lockhart, 2007). At the time of this experience I felt I communicated well with Janet and her family and the care I delivered was to a high standard and to the best of my ability. She appeared less anxious than when she was initially admitted onto the ward. I felt my mentor and myself displayed good communication skills, through verbal and non-verbal communication which in turn was upheld through good record keeping and accurate documentation throughout Janets hospital stay (NMC, 2009). On reflection this event has brought further awareness of the level of involvement of staff members from auxiliaries, nurses and consultants. This was shown by the number of multi-disciplinary meetings, assessments, re-assessments, written correspondence and working hours placed into looking after this patient (NMC, 2009). All staff members were committed to providing the correct input and treatment for this patient and to make her last few days as comfortable as possible (Scottish Government, 2010), which also ensured clear communication and collaboration between the doctors, family and nursing staff (Scottish Government, 2010). Conclusion This reflection has demonstrated the difficultly in caring for palliative care patients. It requires a holistic approach to ensure that the patient and their family receive the best possible attention. Nurses have a duty to ensure that the care they deliver is of an acceptable standard (NMC, 2008). While participating in ward rounds I took on board the doctors instructions and carried out and prioritised the care of my patient, therefore making Janets stay in hospital as comfortable as possible. The code provides values, which can be adapted to any setting and as long as these are followed, nurses will be able to carry out their legal and professional duty of care (NMC, 2008). Action Plan Palliative care is a sensitive subject to deal with but I feel that as long as you treat the patient as an individual, listen to their wants and needs, then a positive outcome can be accomplished. Communication and good interpersonal skills are once again highlighted as an essential part of good nursing practice. I must be an effective communicator and be able to provide a high standard of care at all times and this is imperative when dealing with palliative care patients. I must also keep my knowledge and skills up to date (NMC, 2008). In relation to my transition from student to staff nurse I am aware of how important everything I have learned throughout my training is, from personal care, comfort, empathy, a caring and compassionate manner, clear and effective communication, prioritising care and being part of a team and this is only a very small portion of what I have learned. I will take all of this knowledge with me and put into in practice when I am caring for patients and their families in the future as a staff nurse. Identify Steps Through experience of this placement and in relation to my transition from student nurse to staff nurse; the steps to facilitate an improvement and development would be to ensure effective communication with all staff and all members of the multidisciplinary team. This includes accurate record keeping and the collection of all relevant information from the patient and their family in order to deliver safe effective patient care. It also promotes a positive nurse-patient relationship and offers reassurance at this difficult time (Dunne, 2005). In addition palliative care does not only deal with cancer patients but with patients who have long term chronic illnesses such as multiple sclerosis, heart disease and respiratory problems, therefore palliative care is relevant today and also in the future because, we will be caring for an ageing population (Scottish Partnership for Palliative Care, 2012) Conclusion In conclusion reflection is about making sense of the daily challenges which are put before you, as a student nurse transitioning into a staff nurse its about keeping my skills and knowledge up to date and reflecting on my daily practice in order to achieve the best outcome for my patient (Taylor, 2006). Bowie (2010) states that positive practice should be highlighted as it allows others to learn from it and provides opportunities to improve the safety of patient care. Reflecting on these events has helped me to identify areas where practice needs improvement and given me a greater insight into my own role as a registered nurse.

Non-Conformism Is the Refusal to Conform Essay

Non-conformism is the refusal to conform to common standards, conventions, rules, customs, traditions, norms or laws. The bravest act of non-conformism I’ve seen would have to be, Malcolm X. During his life, Malcolm went from being a drug dealer and burglar to one of the most prominent Black Nationalist leaders in the United States; he was considered by some as a martyr of Islam and a champion of equality. As a militant leader, Malcolm X advocated black pride, economic self-reliance, and identity politics. He ultimately rose to become a world-renowned African American/Pan-Africanist and human rights activist. Throughout his life Malcolm X went through many transformations and through them all he still did not conform to what society expected of him. Malcolm (Little) X preached what he believed about racism, discrimination, and segregation. He went through many changes in his fight for equality. The three transformations that really changed the way Malcolm thought and preached where his transformation in prison, his transformation into the Islamic religion (following Elijah Muhammad), and the biggest transformation of all, his pilgrimage to Mecca. Malcolm had a lot of respect from those who believed in what he was preaching. He was a man who knew what he wanted and was going to change the way things were. Malcolm did not have the odds to make something of himself. He overcame those odds and became one of the most inspiring and important people in the struggle for equality. Every one should learn from the way Malcolm turned his life around for the better and how he made an impact on those around him. Malcolm (Little) X is definitely one of the people who made the biggest impact on the 20th Century. We have come along way since Malcolm’s assassination in the struggle for quality. We still have a ways to go before his final goal is reached.

India Gate Essay

SETTING While the narrative begins in London, the theme of the novel is such that the settings change continuously. Mr. Phileas Fogg attempts to go around the world in eighty days and so he covers the major points across the globe Paris ¸ Suez, Bombay, Calcutta, Singapore, Hong-Kong, Yokohama, San Francisco, New York, Liverpool and then back to London. Apart from these major places Fogg also meets adventures in route. As the train from Bombay to Calcutta stops a little beyond Lothal, Fogg and his companions travel to Allahabad on elephants. Later, when the travelers are in America and are attacked by the Sioux, they disembark at Fort Kearney station. Fogg even goes deep into American land in order to rescue Passepartout. Thus the characters in the novel go across the whole globe and see many other places. The setting of the novel is nearly the whole world! CHARACTER LIST Major Characters Phileas Fogg The hero and chief protagonist in the novel. He is introduced to us as a prudent Englishman whose wealth is a source of mystery to all. He is challenged by a fellow gambler to go around the world in eighty days and he takes up the challenge. His rationality, calmness, generosity and self-control impress the readers. Passepartout He appears in the initial stage of the novel itself, as the newly employed French valet of Mr. Fogg. He is an honest as well as a comic French man, who is loyal to his master and yet gets into situations that hinder his master’s plans to travel around the world. Passepartout endears himself to the reader with his warmth, his sense of humor and his ability to act bravely as well as comically. Detective Fix There is a major bank robbery in England around the same time that Fogg leaves for his journey round the world. Detective Fix is one of the many other detectives who seek to find the culprit so they can get a percentage of the stolen money as an award. He comes to the wrong conclusion that Fogg is the bank robber and is merely pretending to go around the world when his real purpose is to flee the law. Aouda Aouda is a Parsee Indian princess who is orphaned at an early age. She is made to marry an old Rajah and when he dies, fanatical Hindus try & force her to commit the sacrifice of her life. She is rescued by Fogg’s group. She goes back with them to England, as she is unable to find her relative in Hong Kong. Minor Characters James Foster We get only one mention of him in the first chapter. He had been a servant of Fogg’s, but Fogg had dismissed him because he had committed the minor offence of bringing the shaving water at the wrong temperature. Phileas Fogg’s Partners at Whist The engineer Andrew Stuart, the bankers John Sullinan & Samuel Fallentin, the brewer Thomas Flanagan and Gauthier Ralph and one of the governors Bank of England are Fogg’s partners at the Reform club. It is one of them that challenges Fogg to go around the world in eighty days. Lord Albemarle The whole of England gets involved in the speculation as to whether Fogg will be able to complete his journey in 80 days while most feel that he will be unsuccessful, one single supporter remains faithful to Fogg, an old paralytic Lord Albermarle. British Consul at Suez He waits along with detective Fix for the boat Mongolia to arrive at Suez. Daily, he would see English ships pass through the canal. The detective tells the consul that they must try and detain Fogg here, but the consul cannot do that lawfully and so doesn’t. Whist Partners on the Mongolia While Fogg is on board the Mongolia ship to Bombay he finds whist players as enthusiastic as himself. These are-a clergyman the Reverend Decimus Smith, a collector of taxes and a brigadier general of the English Army. Later the brigadier general Sir Francis Cromarty also accompanies Fogg from Bombay to Calcutta. Chief of Bombay Police Fix tries to induce the chief of the Bombay police to give him a warrant for Fogg’s arrest. This the chief of police would not do as the case concerned the London police, which alone was empowered by law to issue a warrant. The Guard on the train to Calcutta When Fogg, Cromarty & Fix are travelling from Bombay to Calcutta by train it suddenly stops in the wilderness. They question the guard on this and it is he, who tells them that the rail has not been laid from this Kholby hamlet to Allahabad and so the passengers will have to arrange for their own means of transport. The Indian Owner of an elephant Fogg approaches an Indian to hire an elephant so that they can ride on it to Allahabad. The Indian refuses to hire out the elephant, so it is eventually bought at a very exorbitant price. Parsee Guide A bright looking young Parsee, offers to be the guide on the elephant which will take the travelers to Allahabad. He is a brave and intelligent man and does his job well in conveying the passengers swiftly to Allahabad. Procession Of priests & fanatics While Fogg and his companions are traveling on a elephant to Allahabad they pass by a procession of priests and fanatics. These Hindus are forcibly taking a young princess along with them so that she may commit ‘suttee’ (sacrifice on her husband’s pyre). Later Fogg is able to make a fool of this procession by escaping with Aouda. Judge Obadiah As soon as Fogg is leaves the Calcutta station, a policeman takes him away to court. Judge Obadiah, a rotund looking man presides over this court and over the case of Passeparrtout, who is charged with committing sacrilege by entering a holy place in Bombay with his shoes on. Cousin Jeizeh He is a cousin of Sir James Jejeebhoy and is also related to Aouda. She hopes to get help from this cousin who is based in Hong Kong. But on reaching Hong Kong, Fogg and Aouda find out that he has shifted to another country after making a lot of money. The pilot on the Rangoon He is a sailor on the ship and he is the one who steers the ship into Hong Kong harbor. It is this pilot who informs Fogg that since the Carnatic has postponed its departure for Yokohama Fogg can board it. John Bunsby He is the master of the boat Tankadere, on which Fogg, Fix and Aouda travel. John is a skilled sailor who takes the trio from Hong Kong to Shanghai so that Fogg is able to board the San Francisco boat. William Batulcar He is the manager of a troupe of buffoons, jugglers, clowns, acrobats and gymnasts who were going to give their last performance at Yokohama before leaving for America. Passepartout takes up employment with this troupe in order to be able to leave for America with them. Colonel Stamp Proctor At San Francisco Fogg, Fix and Aouda find themselves in Montgomery Street, which is crowded, by the members of two opposing political parties. The opposing members become violent and Fogg’s group is caught in between. A huge fellow with a red goatee, a ruddy complexion and broad shoulders, raises his fist over Mr. Fogg. Fogg is very angry and later these two men even resort to dueling. Elder William Hitch Mormon missionary A priest boards the train from San Francisco to New York at Elko Station. He is a Mormon missionary, who gives a lecture on Mormonism in Car no. 117 of the train. Forster He is the engine driver of the train bound for New York. When the train stops before Medicine Bow Bridge, which is shaky, it is Forster who suggests a way of getting over. His idea is to take the train over the bridge at a very high speed, which will enable it to pass over. The Guard Fogg and Colonel Proctor decide to perform a duel on one of the platforms where the train to New York stops. But they are stopped by the guard as the train isn’t stopping there. It is this guard who suggests that they fight aboard the train itself. The Sioux These are bold Indians who often attack the trains running across the American continent. A band of Sioux attacks the New York bound train. They are armed with guns and a fierce battle ensues between the passengers and the Sioux. Fort Kearney Captain The Captain in command of Fort Kearney meets Fogg. Fogg insists that the Captain allow some of his soldiers to come with him in order to rescue three passengers who are captured by the Sioux. The captain agrees eventually as he is impressed by Fogg’s gallantry. Driver & Stoker of the train These two are injured by the Sioux, who attack the New York bound train. As the engine is separated from the train they travel in it in an insensible condition till they recover consciousness. Eventually they both turn the engine back to Kearney station. Mudge An American at Fort Kearney station, offers to transport Fogg and group on a sledge to Omaha station. This skipper of a land craft manages to transfer the group safely to Omaha station in a few hours. Andrew Speedy He is the captain of the trading vessel Henrietta, a man of fifty, a sort of sea dog with a growl. He agrees to take Fogg and his companions to Bordeaux but Fogg hijacks the boat and decides to take it to Liverpool instead. The boat finally reaches Queenstown, an Irish port. Clergyman (Reverend Samuel Wilson) When Aouda and Fogg decide to get married Passepartout is sent to the clergyman. After meeting the parson he realizes that the next day is not Monday but Sunday. Both Fogg and Passepartout had not realized that they had reached England a full day earlier. The clergyman then is a source of luck. SHORT SUMMARY (Synopsis) The story begins at England. We are introduced to Fogg, a very precise man who regularly goes to the Reform Club every evening. At one such visit to the club to play cards, he gets into a conversation with his fellow card players as to whether it is possible to go around the world in eighty days.  He believes that it is and is challenged to complete the adventure. This is the beginning of the entire plot and from then on we see how Fogg goes around the world and we witness the amazing adventures that he has with his companions. The main plot is based on Fogg’s travels, while other such plots merely support the central theme Fix, the detective follows Fogg all over. He believes that Fogg is the bank robber who has robbed a great sum from the bank of England. He puts obstacles in Fogg’s path just so that he can arrest him whenever he gets the warrant from England. The suspicion that Fogg might be a clever gentleman robber is the sub-theme of the book and the author makes the reader also suspicious. Passepartout too wonders whether his master might be a robber though in his heart he has ample trust in Fogg’s integrity. The plot moves ahead with Fogg striving through various obstacles to reach London in time. He goes through Brindisi, Suez, Bombay, Calcutta, Hong Kong, Yokohama, San Francisco, New York and finally Liverpool. Fix arrests Fogg at Liverpool and this delays our hero. He thinks that he has missed the deadline and hasn’t reached London in time when in reality he reached a full day earlier. Thus Fogg wins the wager and in the course of his travels, finds himself a worthy charming, beautiful wife too.

Ashley Pondâ€Biography of a Murder Victim

Ashley Marie Pond was a preteen from a broken family when she began spending time at the home of a school friend in Oregon City, Oregon. She became close enough to the family that she accompanied her friend, the friends father Ward Weaver, and Weavers girlfriend on a two-week summer vacation to California in 2001. Six months after the trip, Ashley disappeared after leaving her mothers home for the school bus. Her body was found the following August in a barrel behind the home Weaver was renting. Two years later, Weaver pleaded guilty to her murder, among other charges. Childhood Ashley was born on March 1, 1989. Her mother Lori Davis was barely 16 at the time, almost a child herself. For the first few years of Ashleys life, she lived with her mother and her mothers high school sweetheart David Pond. Eventually, the two married and Ashley viewed David as her father. Ashley was described as a well-behaved, easy child who could entertain herself and adored being hugged. She seemed to live a fairly normal life for a child of parents so young. But when Ashley was 9 or 10, her mother divorced David Pond, and Ashleys world changed forever. Biological Father During the divorce, the couple fought about child-support payments, and a  paternity test was administered to determine if David Pond was Ashleys biological father. To Ashley’s devastation, the test found that he wasnt; a man named Wesley Roettger was her biological father. She began to stay with Roettger on weekends. During this time, friends and family noticed she was growing sullen and confrontational. She began to resist visiting her father, eventually telling her mother that Roettger had been sexually abusing her. In January 2001, Roettger was indicted on 40 counts of raping and sexually abusing Ashley, but eight months later most counts were dropped. He pleaded no contest to one charge and was released on probation. Ward Weaver During the following months, police were called to Lori Ponds apartment for various reasons, including an allegation that Pond was drunk and neglecting the children. By April 2001, Ashley was spending a lot of time at the house of a friend, the daughter of Ward Weaver. In early spring, Linda Virden, Ashleys reading teacher, reported to Gaffney Lane Elementary principal Chris Mills that she saw Weaver kiss Ashley on the lips. According to the Portland Tribune, Ashley spent most of the first half of 2001 with the Weaver family, even joining Weaver, his girlfriend, and Weavers daughter  that summer on a two-week vacation to California. Calls to the police about disturbances at Ponds home continued over the next few months. In early August, Ashley confided to Virden that Weaver was molesting her and threatened to testify against her in her fathers rape trial. In April she had accused two other men of molesting her  but recanted her statements and did not pursue charges. Once the accusations were made, she stopped going to Weavers house and felt ostracized by Weaver, Weavers daughter, and the daughters friends. Due to the sloppy handling of paperwork by county officials regarding Ashleys accusation, Weaver wasnt investigated or charged with sexually abusing Ashley at that time. Throughout the following fall, Ashleys life seemed to settle down. Her grades were improving and she was fighting less with her mother. Some of her bubbly personality seemed to return. As Christmas approached, it appeared that Ashley and the Weavers had partially renewed their friendship. Disappearance According to the Portland Tribune, on Jan. 9, 2002, Lori Pond heard Ashley say goodbye around 8:15 a.m. as she headed out to catch her school bus at a stop near Weaver’s home. What happened to Ashley after that time is unknown. What is known is that at some point before she died, the 12-year-old had consumed as much as five shots of whiskey. On the weekend of Aug. 24-25, Ashleys body was found inside a barrel buried in the backyard of Weavers rental home. A concrete slab had been poured over the hole. According to Weavers son, Francis Weaver, his father confessed to him that he had killed Ashley, although the details of the confession changed from time to time. On Oct. 4, 2002, Weaver was indicted for the murder of Ashley and on 16 other counts including sex abuse, attempted rape, aggravated murder, and abuse of a corpse. He pleaded not guilty to all charges. On Sept. 22, 2004, Weaver pleaded guilty to killing two of his daughters friends and hiding their bodies on his property. He received two life sentences for the deaths of Ashley Pond and ​Miranda Gaddis. As of September 2019, Weaver was serving at the Two Rivers Correctional Institution in Umatilla, Oregon.