Palliative Care Essays - Hospice, Palliative Medicine,

Palliative Care The role of the expert palliative care nurse is complex and unique. The nurse functions as an integral part of a Multidisciplinary team, providing expert skilled assessment and nursing care, supporting the patient and the family to make informed choices thereby encouraging the patient to continue to make autonomous decisions about their care towards the end of their life. However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope with the many dilemmas she must be well armed. The complex needs of the terminally ill patients and their families make the multidisciplinary team approach the most effective method of care Staff from a range of disciplines including medical, nursing, social work, dietitian, physiotherapist, pharmacist and others bring diverse and unique skills. As a team they provide an excellent sounding board for ethical dilemmas thereby hopefully- enhancing ethical practice. (Latimer, 1998) The Nurse in her role is required to act as patient advocate and ensure that the patients rights are respected. Unfortunately this advocacy is sometimes perceived negatively as a threat or implied criticism of medical care. Doctors need to listen to the nurses more accurate perspective of patient concerns. Consistency across the team leads to better outcomes for patients. Reinforcing the same information by both medical and nursing staff help to allay patient anxiety far more than conflicting views on such things as symptom control. (Jeffrey, 1995) The members of the Multidisciplinary team sometimes make decisions. regarding treatments, which they may perceive to be of the most benefit to the patient whilst in fact the patient, does not perceive the benefits in quite the same way. Nurses have more prolonged contact with the patient than most other members of the team due to the hands on patient care that they do. They often establish a close rapport with the patient and the family and are most likely to be aware of the patients likes, dislikes, hopes and dreams and are privy to often delicate and very private details of the patients life. The very fact that the nurse spends so much time with the patient makes them more likely to have knowledge of this kind of information. Doctors rounds in a Palliative Care Unit enable the doctor to spend perhaps 30minutes maximum per day in talking to the patient. In the community, appointments times with Doctors are restrictive and Home Visits limited. Patient Nurse dependency ratios in hospitals and palliative care units mean that Nurses are spending approxi mately four hours per day on one to one patient contact. Again, other team members are very limited in the amount of time they spend with patients due to the number of clients/patients they may have. A dietitian for example may spend 15 minutes with a patient twice during their six-week stay in a Palliative Care Unit or 30 minutes as an outpatient during the course of the Terminal illness. Social workers often spend long periods at a time with patients and/or their families in lengthy discussion however these discussions may only take place a couple of times over the period of the illness. Therefore the Nurse is far more likely to be aware of issues affecting patient care. There can be many difficulties for the Nurse expert providing high quality care to palliative patients whilst respecting their right to autonomy In the setting of the Palliative Care Unit, the role of the Nurse is to painstakingly assess the needs of patient and family. These needs may be constantly changing and there is no room for the Palliative Care Nurse to become complacent in her patient care. Symptoms may be physical such as pain, nausea, and dyspnoea or psychosocial or spiritual. In identifying care needs the nurse must be able to determine who is the most appropriate team member to refer to provide optimum management of these needs. E.g. although the expert nurse will have counselling skills, she must be aware of her limitations and refer on where appropriate to counsellors, psychologist

Facts About the Element Fermium

Facts About the Element Fermium Fermium is a heavy, man-made radioactive element on the periodic table. Here is a collection of interesting facts about this metal: Fermium Element Facts Fermium is named for the physicist Enrico Fermi.Fermium is the heaviest element that may be made from neutron bombardment of lighter elements.The element is one of those discovered in the products from the  first hydrogen bomb test at Eniwetok Atoll, the Marshall Islands in 1952. For security reasons, the discovery was not announced until 1955. The discovery is credited to  Albert Ghiorsos group at the University of California.The discovered isotope was Fm-255. which has a  half-life 20.07 hours. The most stable isotope that has been produced is Fm-257, with a half-life of 100.5 days.Fermium is a synthetic transuranium element. It belongs to the actinide element group.Although samples of fermium metal have not been produced for study, it is possible to make a fermium and ytterbium alloy. The resulting metal is shiny and silver-colored.The usual oxidation state of fermium is Fm2, although the Fm3 oxidation state also occurs.The most common fermium compound is fermium chloride, F mCl2.Fermium does not exist naturally in the Earths crust. However, its natural production was once seen from the decay of a sample of einsteinium. At present, there are no practical uses of this element. Fermium or Fm Chemical and Physical Properties Element Name: FermiumSymbol: FmAtomic Number: 100Atomic Weight: 257.0951Element Classification: Radioactive Rare Earth (Actinide)Discovery: Argonne, Los Alamos, U. of California 1953 (United States)Name Origin: Named in honor of the scientist Enrico Fermi.Melting Point (K): 1800Appearance: radioactive, synthetic metalAtomic Radius (pm): 290Pauling Negativity Number: 1.3First Ionizing Energy (kJ/mol): (630)Oxidation States: 3Electronic Configuration: [Rn] 5f12 7s2 References Los Alamos National Laboratory (2001)Crescent Chemical Company (2001), Langes Handbook of Chemistry (1952) CRC Handbook of Chemistry Physics (18th Ed.)

Capital Punishment Essays (10436 words) - Human Rights, Free Essays

Execution of criminals and political opponents has been used by nearly all societies?both to punish crime and to suppress political dissent. In most places that practice capital punishment it is reserved for murder, espionage, treason, or as part of military justice. In some countries sexual crimes, such as rape, adultery, incest and sodomy, carry the death penalty, as do religious crimes such as apostasy in Islamic nations (the formal renunciation of the State religion). In many countries that use the death penalty, drug trafficking is also a capital offense. In China, human trafficking and serious cases of corruption are punished by the death penalty. In militaries around the world courts-martial have imposed death sentences for offenses such as cowardice, desertion, insubordination, and mutiny.[14] Anarchist Auguste Vaillant guillotined in France in 1894The use of formal execution extends to the beginning of recorded history. Most historical records and various primitive tribal practices indicate that the death penalty was a part of their justice system. Communal punishment for wrongdoing generally included compensation by the wrongdoer, corporal punishment, shunning, banishment and execution. Usually, compensation and shunning were enough as a form of justice.[15] The response to crime committed by neighbouring tribes or communities included formal apology, compensation or blood feuds. A blood feud or vendetta occurs when arbitration between families or tribes fails or an arbitration system is non-existent. This form of justice was common before the emergence of an arbitration system based on state or organised religion. It may result from crime, land disputes or a code of honour. "Acts of retaliation underscore the ability of the social collective to defend itself and demonstrate to enemies (as well as potential allies) that injury to property, rights, or the person will not go unpunished."[16] However, in practice, it is often difficult to distinguish between a war of vendetta and one of conquest. Severe historical penalties include breaking wheel, boiling to death, flaying, slow slicing, disembowelment, crucifixion, impalement, crushing (including crushing by elephant), stoning, execution by burning, dismemberment, sawing, decapitation, scaphism, or necklacing. The Christian Martyrs' Last Prayer, by Jean-L?on G?r?me (1883). Roman Colosseum.Elaborations of tribal arbitration of feuds included peace settlements often done in a religious context and compensation system. Compensation was based on the principle of substitution which might include material (e.g. cattle, slave) compensation, exchange of brides or grooms, or payment of the blood debt. Settlement rules could allow for animal blood to replace human blood, or transfers of property or blood money or in some case an offer of a person for execution. The person offered for execution did not have to be an original perpetrator of the crime because the system was based on tribes, not individuals. Blood feuds could be regulated at meetings, such as the Viking things.[17] Systems deriving from blood feuds may survive alongside more advanced legal systems or be given recognition by courts (e.g. trial by combat). One of the more modern refinements of the blood feud is the duel. Giovanni Battista Bugatti, executioner of the Papal States between 1796 and 1865, carried out 516 executions (Bugatti pictured offering snuff to a condemned prisoner). Vatican City abolished its capital punishment statute in 1969.In certain parts of the world, nations in the form of ancient republics, monarchies or tribal oligarchies emerged. These nations were often united by common linguistic, religious or family ties. Moreover, expansion of these nations often occurred by conquest of neighbouring tribes or nations. Consequently, various classes of royalty, nobility, various commoners and slave emerged. Accordingly, the systems of tribal arbitration were submerged into a more unified system of justice which formalised the relation between the different "classes" rather than "tribes". The earliest and most famous example is Code of Hammurabi which set the different punishment and compensation according to the different class/group of victims and perpetrators. The Torah (Jewish Law), also known as the Pentateuch (the first five books of the Christian Old Testament), lays down the death penalty for murder, kidnapping, magic, violation of the Sabbath, blasphemy, and a wide range of sexual crimes, although evidence suggests that actual executions were rare.[18] A further example comes from Ancient Greece, where the Athenian legal system was first written down by Draco in about 621 BC: the

Program management Article Example | Topics and Well Written Essays - 250 words

Program management - Article Example PMO also aids in the improvement of the project success rates in an organization due to the incorporation of skills and expertise in the management of projects and ensures standardization of projects across the organization. The article goes further to give the two models of PMO; consultative and centralized PMO capacities and gives the other advantage of PMO as augmenting employee productivity through efficient resource allocation in an organization. The type of PMO to be implemented in an organization depends on the culture and the changes and benefits that the organization aims at achieving within a stipulated time leading to the need for customization and patience for a PMO office that result in increased bottom-line results, customer satisfaction, and resource utilization (Santosus, 2013). The article is useful in aiding the development of PMO through giving the benefits of having PMO, the strategies to introduce PMO in an organization, the challenges that are faced by a PMO, and the skills and expertise that the PMO brings to the organization. The article explores varied factors for the choice of PMO model to implement depending on the factors inherent in the organization allowing organizations to have a better understanding when developing PMO. The article also aids in developing the PMO due exposition of results from companies that have implemented the development giving companies a benchmark for their needs and results of a

Transition temperatures in toughness Research Paper

Transition temperatures in toughness - Research Paper Example This method uses the fault size, as well as features, constituent geometry, loading state of affairs and the substance property known as fracture toughness to calculate the capacity of a constituent containing a fault to oppose fracture (Metallurgical Society of AIME, 2005). Samples having typical proportions but dissimilar complete size bring into being dissimilar standards for KI. This comes about because the pressure states adjoining to the fault changes with the sample thickness (B) in anticipation of the breadth surpassing some critical measurement. Once the breadth surpasses the critical measurement, the value of KI turns out to be comparatively unvarying and KIC , is a accurate material asset which is known as the plane-strain rupture toughness. The affiliation amid stress strength, KI, and rupture toughness, KIC, is comparable to the correlation amid pressure and tensile pressure. The stress strength, KI, embodies the height of â€Å"pressure† at the top of the crack, as well as the rupture roughness, KIC, is the utmost value of pressure strength that a substance under precise conditions that is plane-strain, that a substance can bear up without rupture. As the stress strength factor gets to the KIC value, unsteady fracture takes place. As with a substance’s other motorized properties, KIC is usually reported within reference books, as well as other sources (American Society for Testing and Materials, 2006).    When a substance with a fracture is loaded in pressure, the materials build up plastic tensions as the capitulate stress is surpassed in the area near the fracture tip. Substance within the fracture tip pressure field, located close to an open surface, can distort tangentially that is in the z-path of the representation since there cannot exist any stresses standard to the open surface. The condition of stress is inclined to biaxial, as well as the substance rupture in a distinctive ductile way, with a 45o cut off lip being create d at each open surface. This situation is known as â€Å"plane-stress" furthermore it takes place in comparatively lean bodies where the pressure through the breadth cannot differ significantly because of the thin segment (Metallurgical Society of AIME, 2005). On the other hand, substance away from the open surfaces of a comparatively thick constituent is not liberated to distort tangentially because the adjoining material inhibits it. The stress situation under these circumstances is inclined to triaxial furthermore, there is zero tension at a 90-degree angle to both the tension axis and the bearing of crack transmission when a substance is loaded in pressure. This form is known as â€Å"plane-strain† and is instituted within thick plates. Underneath plane-strain circumstances, substances behave fundamentally, elastic pending the rupture stress arriving at and then swift fracture takes place. Given that slight or no plastic warping is noted, this form rupture is referred to as fragile breakage (Smith, Temenoff & Gall, 2009) . When carrying out a fracture hardiness test, the most widespread test sample designs are the single periphery notch bend (SENB), as well as the compact stress (CT)

Women in the Civil War Essay Example for Free

Women in the Civil War Essay Historians agree that World War II changed life for American women in the 20th century. The Civil War had just as great an impact on the lives of American women in the 19th century. (http://www.defenselink.mil) Staying at home, women could help the war effort by running businesses, making clothes, and taking care of their farms, but some women wanted to do more. Some women went to become nurses and helped wounded soldiers, some became spies, and still others posed as men and enlisted in armies, almost all women did their best to help during the civil war. Over 3,000 women served as nurses between 1861 and 1865. Since nursing schools were not established until 1873 they had no formal training. Many had no work experience outside the home. (http://www.northnet.org) As nurses, women worked in hospitals taking care of wounded soldiers. The novelist Louisa May Alcott described the soldiers as riddled with shot and shell and torn and shattered. Two famous nurses were Mary Edwards Walker, who earned a Congressional Medal Honor for her medical service, and Clara Barton. Clara Barton was known as the Angel of the Battlefield, she used her home as a warehouse to store medical supplies, and with the help of her friends, she distributed them to troops. When the government began to send adequate supplies, she began an organization to locate missing soldiers. In 1869, she founded the American Red Cross, after traveling abroad. Dorthea Dix, who originally worked towards improving the care of mentally ill people, was recruited as the superintendent o f the Union army nurses. She made hospitals, oversaw sewing societies, helped get medical supplies, and recruited and trained women to be nurses. Her requirements in a nurse were strict not too young, not too pretty, and of strict moral character. She preferred farm women accustomed to the sight of blood. Nurses wore only plain brown or black dresses with no hoop skirts, jewelry, or accessories and no curls. (http://www.northnet.org) Many women became nurses to care for loved ones who had been injured in battle. Maria Eastman Olmstead Eldred, Ellon McCormick Looby, and Alvira Beech Robinson were a few nurses who left their homes to care for their injured husbands. (http://www.northnet.org) Many of the nurses were unprepared for the challenges and horrors that would face them. However, surrounded by death, confronted with the mangled bodies of soldiers and piles of loose limbs,  they persevered. Other women took a more active role in helping with the war and became spies. Two such women spies were Ginnie and Lottie Moon. They were two sisters who spied for the Confederates during the war. They were born in Virginia but moved to Oxford, Ohio when they were young. Their home, The Moon House is a historic site in Oxford. Emmeline Piggott was another spy and smuggler. She carried supplies and messages in large pockets under her full skirts. After doing this many times, she was caught, arrested, and imprisoned. However, she was released and sent home eventually. Elizabeth C. Howland was another successful Confederate spy. She sent her young son and daughter to carry messages. The young children, appearing innocent, were allowed to pass through enemy lines. (http://userpages.aug.com) One of the most famous female spies was Belle Boyd. After the war, she became an actress and was know on stage as La Belle Rebelle. Her real name was Isabelle Boyd, she was born in Martinsburg, West Virginia in 1844. Near the beginning of the war, she helped in traditional ways, rolling bandages and raising money for the Confederate forces, but that soon changed. Union soldiers occupied Martinsburg in July of 1861; Boyd mingled with Union officers and learned some of their plans. She told the Confederate forces all that she had heard. Boyd continued to spy for the Confederates and delivered messages for Maj. John S. Mosby. She was arrested by Union forces and held in Washington until she developed typhoid and was paroled in a prisoner exchange. Elizabeth Van Lew, a Union spy, accomplished much more than Boyd. Born in Richmond, Virginia, she despised slavery. She freed all of her family slaves and even bought other slaves to free them as well. She often visited Union prisoners held in Richmond, she took them food and medicine. Many of the prisoners had heard Confederate plans after they were captured, and Van Lew invented a code to send what they knew to Union forces. Her neighbors called her Crazy Bet, and she decided to act the part. She talked to herself, dressed in old and battered clothes, and did not comb her hair. All of Richmond thought that Crazy Bets sympathy for the Union was part of her madness. Van Lew also got one of her former slaves, Elizabeth Bowser, a job as a house servant for Jefferson Davis. Together, they collected and passed a great deal of information to the North. (http://www.defenselink.mil) Nancy Hart  served as a Confederate scout, guide, and spy; she carried messages between Southern Armies. She went to isolated Federal outposts, pretending to be a peddler, to report their strength, population, and vulnerability to General Jackson. Hart was twenty years old when she was captured and jailed, with guards constantly patrolling the building. Nancy gained the trust of one of her guards, got his weapon from him, shot him, and escaped. (http://userpages.aug.com) You will see by this paper that on the 15th day of November 1866 I enlisted in the United States army at St. Louis, in the Thirty-eighth United States Infantry Company A, Capt. Charles E. Clarke commanding. (http://www.buffalosoldier.net) Cathay Williams or William Cathay was a former slave, liberated by the Union who wanted to help in the war effort. She joined the war but before her three years were finished, she decided that she wanted to leave the army and complained of pains in her side, and rheumatism in her knees. The doctor who examined her discovered that she was a woman and she was discharged. (http://www.buffalosoldier.net) Other women who served as men were Sarah Emma Edmonds, alias Franklin Thompson, Jennie Hodgers who served and fought for three years as Albert Cashier, and a woman known only as Emily, who ran away from home at 19 and joined the drum corps of a Michigan Regiment. (http://userpages.aug.com) She was shot and her sex discovered, while dying she at first refused to give her real name but eventually agreed to dictate a letter to her father in Brooklyn. Forgive your dying daughter. I have but a few moments to live. My native soil drinks my blood. I expected to deliver my country but the fates would not have it so. I am content to die. Pray forgive me Emily. (http://userpages.aug.com) I think that if women had not helped as much as they did during the Civil War, it could have been completely different. These women greatly expanded the scope of expected persona of women in the 19th century. From La Belle Rebelle to 19 year old Emily, everyone helped in their own way.

State and Federal Authority in Screws v. United States Essay -- Suprem

State and Federal Authority in Screws v. United States Outside the courthouse in Newton, Georgia, in the early hours of January 30, 1943, Robert â€Å"Bobby† Hall was beaten unconscious by M. Claude Screws, Frank Edward Jones, and Jim Bob Kelley[1] while in their custody for the alleged theft of a tire;[2] Screws, Jones and Kelley were, respectively, Baker county sheriff, night policeman, and a civilian deputized specifically for the arrest.[3] Without ever recovering consciousness, Hall died as a result of a fractured skull shortly after his arrival at an Albany hospital that morning.[4] The NAACP and FBI investigated Hall’s death in the following months and federal charges were brought against Screws, Jones, and Kelley for violation of Section 20 of the Federal Criminal Code, which stipulates that no person may â€Å"under color of any law †¦ willfully† deprive a person of â€Å"any rights, privileges, or immunities secured or protected by the Constitution and laws of the United States.†[5] After bei ng found guilty in the lower courts, the defendants brought their case to the Supreme Court on appeal, alleging that they had violated a state rather than federal law and, consequently, could not be held liable under Section 20. The Supreme Court’s central concern in Screws et al. v. United States was to interpret the intent and breadth of Section 20 in order to judge its constitutionality; in doing so, the Court struggled to reach a consensus regarding the definition of state action and the indefinite nature of the rights protected by the statute. Such consensus proved difficult, indeed, as the case was narrowly decided and divided the Court along deep constitutional lines; while a majority of the Court advocated reversal of the lower co... ... [41] Screws et al. v. United States, 325 U.S. 91, 151-152 (1945). [42] Ibid., 143. [43] Ibid., 111. [44] Ibid., 145-146. [45] Ibid., 149. [46] Memorandum by Mr. Justice Jackson, February 2, 1945, Jackson Papers, 5. [47] See Justice Murphy’s dissent, wherein he insists that â€Å"it is idle to speculate on other situations that might involve  § 20 which are not now before us.† Screws et al. v. United States, 325 U.S. 91, 136 (1945). [48] Felix Frankfurter to Chief Justice Stone, November 30, 1944, Harlan Fiske Stone Papers. [49] Justice Frank Murphy’s Notes on Screws et al. v. United States, Frank Murphy Papers. [50] Screws et al. v. United States, 325 U.S. 91, 139 (1945). [51] Memorandum by Mr. Justice Jackson, February 2, 1945, Jackson Papers, 6. [52] Harlan Fiske Stone to William O. Douglas, November 25, 1944, Harlan Fiske Stone Papers. State and Federal Authority in Screws v. United States Essay -- Suprem State and Federal Authority in Screws v. United States Outside the courthouse in Newton, Georgia, in the early hours of January 30, 1943, Robert â€Å"Bobby† Hall was beaten unconscious by M. Claude Screws, Frank Edward Jones, and Jim Bob Kelley[1] while in their custody for the alleged theft of a tire;[2] Screws, Jones and Kelley were, respectively, Baker county sheriff, night policeman, and a civilian deputized specifically for the arrest.[3] Without ever recovering consciousness, Hall died as a result of a fractured skull shortly after his arrival at an Albany hospital that morning.[4] The NAACP and FBI investigated Hall’s death in the following months and federal charges were brought against Screws, Jones, and Kelley for violation of Section 20 of the Federal Criminal Code, which stipulates that no person may â€Å"under color of any law †¦ willfully† deprive a person of â€Å"any rights, privileges, or immunities secured or protected by the Constitution and laws of the United States.†[5] After bei ng found guilty in the lower courts, the defendants brought their case to the Supreme Court on appeal, alleging that they had violated a state rather than federal law and, consequently, could not be held liable under Section 20. The Supreme Court’s central concern in Screws et al. v. United States was to interpret the intent and breadth of Section 20 in order to judge its constitutionality; in doing so, the Court struggled to reach a consensus regarding the definition of state action and the indefinite nature of the rights protected by the statute. Such consensus proved difficult, indeed, as the case was narrowly decided and divided the Court along deep constitutional lines; while a majority of the Court advocated reversal of the lower co... ... [41] Screws et al. v. United States, 325 U.S. 91, 151-152 (1945). [42] Ibid., 143. [43] Ibid., 111. [44] Ibid., 145-146. [45] Ibid., 149. [46] Memorandum by Mr. Justice Jackson, February 2, 1945, Jackson Papers, 5. [47] See Justice Murphy’s dissent, wherein he insists that â€Å"it is idle to speculate on other situations that might involve  § 20 which are not now before us.† Screws et al. v. United States, 325 U.S. 91, 136 (1945). [48] Felix Frankfurter to Chief Justice Stone, November 30, 1944, Harlan Fiske Stone Papers. [49] Justice Frank Murphy’s Notes on Screws et al. v. United States, Frank Murphy Papers. [50] Screws et al. v. United States, 325 U.S. 91, 139 (1945). [51] Memorandum by Mr. Justice Jackson, February 2, 1945, Jackson Papers, 6. [52] Harlan Fiske Stone to William O. Douglas, November 25, 1944, Harlan Fiske Stone Papers.