Teenage Alcoholism Essays - Alcohol Abuse, Drinking Culture

Teenage Alcoholism Let American Consumer Counseling Help you Get Out of Debt! Teenage Alcoholism Teenagers today have no idea what alcoholism really is. They think that they can never become alcoholics. They think that it could never happen to them, but they are wrong. Stress, Family problems and the desire to be popular are wrong the cause of teenage alcoholism. Signs that a teenager has a drinking problem and steps that parents can take to help their child are what I will discuss in this paper. The critical ingredient common to all alcoholic beverages is ethyl alcohol or ethanol ( Lang 21). It is a clear, tasteless liquid formed through the fermentation of sugars by yeast spores ( Lang 21). The amount of alcohol produced depends on the type and amount of sugar in the original mixture, the type of yeast used, the temperature maintained during the fermentation process. American beers, which contain about 3% to 6% alcohol, are made from malted barley and hops (he ripened and dried cones of the hop plant). Most wines are made by fermenting grapes or berries, and normally reach a maximum of about 15% alcohol. Though they are sometimes fortifies with additional ethanol alcohol and thus may reach 20% alcohol in cherry or port wines. Teenage years are filled with unsure time. Intense pressure to perform and succeed are felt by many youths, according to Alliant Health Systems, Louisville, Ky. Perceived failure at home and or school can lead to the need for escape. Teenagers often see their parents react to stress by drinking. This providing and example for them. They also see their favorite movie actors or actresses getting drunk when they go to a movie so they think that it's OK for them to o it but what they don't know it really hurts them in the long run. With their parents, the might being having marital problems and that can usually drive a teenager to drink. The desire to be accepted and popular among their friends encourages many to begin drinking as well. The ability to consume a lot of alcohol is associated with being a "real man or woman" ( Lang 23). When teens see adults drink heavily and movie stars on screen getting drunk, the message that gets through is that "it's cool to drink" which is the wrong one to be sending. Almost one half (47.9 %) of seniors drink alcohol at least once a month 19.8 % drink at least once a week. Nearly one third (30.7%) of ninth graders drink some kind of alcohol monthly or more often 12% drink at least once a week. Thirteen (13.2%) of seventh graders and 6.6% of sixth graders drink alcohol regularly. Regular use of alcohol has no changed significantly since the first survey in 1989. (Casey 1). Crime is inextricably related to alcohol and other drugs (AOD). More than 1.1 million annual arrests for illicit drug violations, almost 1.4 million arrests for driving while intoxicated, 480,000 arrests for liquor law violations and 704,000 arrests for drunkenness come to a total of 4.3 million arrests for alcohol and other drug statutory crimes. That total accounts for over one-third of all arrests in this country. ( Lang 33) The impaired judgment and violence induced by alcohol contribute to alcohol-related crime. Rapes, fights, and assaults leading to injury, manslaughter, and homicide often are linked with alcohol because the perpetrator, the victim, or both were drinking. The economic cost of AOD-related crime is $61.8 billion annually. Many perpetrators of violent crime were also using illicit drugs. Some of these drugs, such as PCP and steroids, may induce violence. These drugs can also be a catalyst for aggressive-prone individuals who exhibit violent behavior as a result of taking them. The need for preventing alcohol and other drug problems is clear when the following statistics are examined: Alcohol is a key factor in up to 68 percent of manslaughters, 62 percent of assaults, 54 percent of murders/attempted murders, 48 percent of robberies, and 44 percent of burglaries. Among jail inmates, 42.2 percent of those convicted of rape reported being under the influence of alcohol or alcohol and other drugs at the time of the offense.[5] Over 60 percent of men and 50 percent of women arrested for property crimes (burglary, larceny, and robbery) in 1990, who were voluntarily tested, tested positive for illicit drug use. In 1987, 64 percent of all reported child abuse and neglect cases in New York City were associated with parental AOD abuse. (Lang 55) In 1992, there were 6,839 deaths due to alcohol. There were 1,154 deaths from direct alcohol

How do Jacobs and Dickens create a foreboding atmosphere and build up tension in The Monkeys Paw and The Signalman Essays

How do Jacobs and Dickens create a foreboding atmosphere and build up tension in The Monkeys Paw and The Signalman Essays How do Jacobs and Dickens create a foreboding atmosphere and build up tension in The Monkeys Paw and The Signalman Paper How do Jacobs and Dickens create a foreboding atmosphere and build up tension in The Monkeys Paw and The Signalman Paper Essay Topic: Literature The Black Monk The Haunting Of Hill House To Build a Fire The main idea of a mystery story is to give the readers something to wonder about. You have to give them the clues one by one and lead your reader to a conclusion they werent expecting. A good mystery story will keep a reader guessing until they see the final twist and then everything they didnt understand before fits into place. This is definitely true in The Signalman. One of the techniques that Dickens uses to create a feeling of uneasiness and tension can be seen right from the very beginning. In the very first paragraph there is a sense of the unexplained: There was something remarkable in his manner of doing so (instead of the signalman looking up to where the narrator stood, he turned himself about, and looked down the Line. ), though I could not have said for my life, what. The vocabulary Dickens uses also adds to the atmosphere and it is well worth a close look at this. Words such as violent, clammier and earthly dead smell build up the sense that the narrator is in a dangerous location and that something terrible is about to happen. This sort of language use can be found throughout the tale. The angry sunset Dickens describes adds to the effect, as does the clammy and wet stones of the way down. These are indicative of a ghost story, and even the tunnel is described in such a way as to make us wonder about it. The description of the tunnel itself could very well remind us of the mouth of hell, which is appropriate because of what happens later in the story. terminating in a gloomy red light, and gloomier entrance to a black tunnel, in whose massive architecture there was a barbarous, depressing, and forbidding air. So little sunlight ever found its way to this spot, that it had an earthy deadly smell; and so much cold wind rushed through it, that it stuck chill to me, as if I had left the natural world. Charles Dickens uses repetition quite a lot to build up the feeling of fear and uneasiness, and this is particularly effective at the end. There is also the description of place, and the damp unpleasantness like he has left the natural world. The colors he uses are often associated with evil, such as red and black, and its with language like this that Dickens makes the audience uneasy and feeling that something is about to go wrong. Any comments on words such as monstrous will be useful, as will the miming of the actions. That is quite a visual effect and gives the full eerie effect at the end when the signalman dies. The repetition of words and phrases adds to the uneasiness of the story Below there! Look out! Look out! For Gods sake, clear the way! The use of the references to the supernatural and the story the signalman tells all add to the feeling of fear. Even the narrator says that he felt a slow touch of a frozen finger tracing out my spine. These are techniques in ghost stories, made more chilling by the fact that they are foreshadowing what is to come. Everything about the place and the signalman seems to be unnatural and uneasy. The spot is isolated and the feeling of fear and unease is built up by the speakers comments: The monstrous thought came into my mind as I perused the fixed eyes and the saturnine face, that this was a spirit, not a man. The signalmans behavior is at times inexplicable and this is contrasted with the exactness with which he does his job. There is definitely something odd about him. His manner seemed to make the place strike colder to me. The man himself is most mysterious, and the narrator was uncertain of whether he was man or spirit or even slightly disturbed because, there was something in the man that daunted me. All this contributes to the building of the tension, as does the eeriness of the signalman believing that he had seen the narrator before, despite the narrators certainty that he had never been there. The signalman himself even suggests some supernatural connection part way into the story. The draw of the signalman is so great that the narrator goes back to hear more. For the first time the specific reference to the gesture of waving frantically to clear the way becomes so important. The signalmans story is chilling. The language is indicative of a ghost story, like damp stains, frozen finger tracing my spine, disagreeable shudder. There are also rational explanations for what had happened. The tales of the appearances of the spectre are fearful, as are the narrators reactions, such as pulling his chair back from the floorboards where the young lady was laid. The wind, personified as wailing, also adds to the effect of the story. There is conflict between what the two people heard and saw the previous evening, but both agree that the spectre is not there now. The signalman gains empathy because he is aware that danger is imminent but he is powerless to do anything. Another technique that is used to prolong the suspense is the fact that the narrator could not see anyone nor hear the bell ring when the signalman claimed the spectre was there. The dismissing of events as a coincidence builds up tension, as we feel sure he is going to be proven wrong. The twist in the tale is so effective because everything has been building towards this, but we did not fully understand what was to happen. The third evening concludes the story. The narrator sees the figure waving in the mouth of the tunnel, but it is not supernatural: The nameless horror that oppressed me, passed in a moment, for in a moment I saw that this appearance of a man was a man indeed. The way Dickens talks directly to the audience in this story, is a good way of fully involving the reader in the mystery. It raises questions that he then leaves unanswered and unravels later. The death was that of the signalman himself, and the visions he had seen had been the premonition of his own death. There is the repetition of the action and also of the words that the signalman said were haunting him. The Monkeys Paw is based upon the unexpected happenings of a supernatural tale. Mr. White meets up with an old war buddy and invites him to his home for an evening visit. The purpose is to complete a story he had told of a monkeys paw and an old fakir. Sergeant-Major Morris has brought the paw with him and tells the story. At the beginning of the story, the mood is mysterious and ominous, created by these details: a cold, wet night; a house in an out-of-the-way place; a visitor tells of faraway places and strange events. Mr. White, his wife and son soon learn that the soldier had his three wishes granted and would rather have the paw destroyed than pass it on to anyone else. When pressed for more details he tells his hosts that the first owner used his third wish to wish for death and that was how he came into possession of the paw. With that he tosses the paw into the fireplace, but Mr. White rushes to the hearth and retrieves it before it is completely destroyed. The soldier leaves and warns them to wish for something sensible. At the sons urging, the father wishes for some money (two hundred pounds). Nothing immediately happens and they turn in for the night. Of course, only trouble can follow. Sergeant- Major Morris has warned the White family that the wishes come true almost like a coincidence, and his reactions to the paw show he is afraid of what it can do he throws it on the fire to destroy it, he turns white when he is telling of its history and is frightened when Mrs. White makes the joke about wishing for four pairs of hands. Once the wish has been made and the paw moved, we fear that gaining the two hundred pounds is not going to be a positive experience for the Whites. The story is neatly divided in three sections and primarily deals with three characters -Mr. White, his wife and their son. In the first section we are introduced to the wish motif and the family makes their first wish. In the second half they make their second wish. In the third and eeriest portion the husband ends their ordeal with a final wish -the only wise wish the family ever made. The old fairy tale motifs are all present and indeed Mrs. White at one point says Sounds like the Arabian Nights. There is some making fun of the whole idea and we get the idea that the family does not totally believe in the powerful magic they have come into contact with. Jacobs describes the son as frivolous and he mocks the idea by telling his father to wish to be an emperor to escape his nagging wife, Mrs. White asks the husband to wish her to have four hands and they all laugh at the prospect of getting what one truly desires. The reader knows only too well that this family is doomed. The foreshadowing events the author uses to prepare the reader for the events to come are: Morris says the paw has a spell on it -foreshadows negative reactions once someone wishes upon it, perhaps even Herberts death; Morris presses Mr. White to throw the paw away which foreshadows bad things to come, including Herberts Death, Herbert sees a vision in the fire and feels a shiver when he grasps the paw which foreshadows his own demise. When Mr. Mrs. White realize that in following the sons suggestion for money they have altered their lives in a horrible way they panic. The money comes to them as compensation for a horrible accident at the factory where their son worked. He has died at the hands of the machinery. Mrs. White immediately wants to wish her son back to life and runs to find the paw. There is a struggle and an argument. The family is beginning to learn that there is strange magic at bother, that they truly can defy the laws of nature. The husband is reluctant but is powerless at the maniacal urging of his wife and when he refuses to make the wish she does so herself. To some extent The Monkeys Paw depends on horror brought about through the death of a main character in the story. Herbert is killed in an accident because of the first wish and we experience revulsion at the thought of him being brought back to life. The story builds up to a climax at the end, and although we understand what will happen next, it has far more impact being left at the pinnacle of the action. It is at this point that Jacobs uses the best tool of the writer of a ghost story -the power of suggestion. We feel the terror of the husband and know the longing of the wife for her son. The terrible knocking at the door, the fact that the wife rushes downstairs while the reader remains upstairs with the husband who dare not move from his spot. While he envisions what must have happened to his son, remembering the accident and imagining something hideous crawling out of a fresh grave, his wife frantically tries to open the door but has trouble with the bolt. The reader is wondering as well: Will she see her son? What will happen to her? What kind of family will they be with a dead son returned from the grave? The word it implies that Mr. White believes whatever is on the other side of the door is not human. He believes perhaps it is his sons dead corpse. The word it creates suspense and a sense of fear. The husband at last makes the final and inevitable wish -the only sensible wish made while the paw was theirs those brief fateful days. And the story ends with an eerie image complete with a poignant sound effect that sends a final frisson up your spine: A cold wind rushed up the staircase and a long loud wail of disappointment and misery from his wife gave him courage to run down to her side, and to the gate beyond. The street lamp flickering opposite shone on a quiet and deserted road. It is certain that the echo of that misery-filled wail reached all the way to the cemetery where no doubt it settled like a mournful shroud on the still undisturbed grave of their hapless son.

How to Create a Homeschooling Lifestyle

How to Create a Homeschooling Lifestyle Academics are a vital  aspect of homeschooling. However, we homeschooling parents need to avoid the trap of becoming  overly focused on them and on trying to recreate a traditional classroom setting. Doing so can cause us to  lose sight of what a gift it is to have the  freedom  to homeschool our children. Home educating doesn’t mean that we bring school home. Instead, it means that we incorporate learning into our everyday lives until it becomes an extension of our family life. Try these simple tips to put the home  in your schooling. 1. Snuggle up together to read – even if you’re all reading different books. It doesn’t matter if you’re reading books for school or books for fun, if you’re reading aloud or everyone has their own book – snuggle up to read together! A bed or couch is a perfect, year-round snuggle spot. A blanket in the back yard makes a stress-relieving warm weather book nook. Move the blanket near the fireplace or heater for a cozy cold weather spot. 2. Bake together. Baking together provides opportunities for younger kids to practice real-life math applications (such as adding and subtracting fractions), following directions, and basic kitchen chemistry. It allows older students to learn home-making skills in a real-world context. Baking together creates  discussion time for kids of all ages. It also helps your entire family to bond and create memories together. 3. Learn alongside each other. You don’t have to fumble your way through algebra or chemistry. Take the course with your students and learn together. This shows your kids shows them that learning never stops. 4. Discover family hobbies. Discovering activities that you all enjoy doing together builds family relationships .It also  provides additional  learning opportunities. For older kids, family hobbies may even translate to elective credits for high school. 5. Take family field trips. It’s fun to go on field trips with your homeschool group, but don’t forget about family-only field trips. The kids often learn more because they’re not distracted by friends. Family field trips also provide the non-teaching parent a chance to get involved with what the kids are learning. 6. Involve the non- teaching parent in real, practical ways. Let Dad (or Mom) do something besides ask, â€Å"What did you learn in school today?† Let the parent who isnt the primary teacher do science experiments or art class on the weekends or in the evenings. Let him read aloud to the kids in the evenings. Ask him to teach them to change the oil in the car, cook a favorite meal, or set up an Excel spreadsheet. Be aware of practical opportunities for homeschool dads (or moms) to be involved based on their talents and your family’s needs. 7. Allow character training to take place over academics. There comes a time in every homeschooling family’s life when character training needs your focus. It’s a time when you need to put the books aside and give your attention to the issue at hand. The books will still be there tomorrow or next week or next month. 8. Involve your children in your everyday life. Don’t overlook the educational value of everyday activities such as grocery shopping, running errands, or voting. Take your children with you. Don’t feel that school has to be a completely separate part of your day. 9. Don’t consider life events a disruption to school. At some point, most families will face life events such as a death, a birth, moving, or an illness. These are not disruptions to learning. They are opportunities to learn and grow together as a family. 10. Be involved in your community. Look for ways to get involved in your community as a family. Serve in the local soup kitchen. Volunteer at the library. Work in local politics.   Homeschooling families need to understand that learning happens all the time. We need to embrace these moments,  instead of seeing them as a disruption to school.   Dont miss the opportunities that are all around you to put the home in your schooling.

Leading educational change Essay Example | Topics and Well Written Essays - 1500 words

Leading educational change - Essay Example When dealing with school leadership in the Australian context, it is important for the articles by Gurr et al, (2005) and Dinham (2007) to be considered so that a better perspective of the issue under discussion can be achieved. While one would state that there are some areas of agreement between these two articles, especially touching on the various aspects of leadership, how these leadership styles are applied has been found to have some divergence. It is a fact that in Australia, there has developed a vast body of research that has confirmed that the teacher in a classroom has a profound influence on the performance of his or her students. In the abovementioned two articles, there is general agreement that it is important to find out how the quality of teaching and learning can be influenced and improved through the development of good leadership skills among the teachers in the classroom. In both articles, it is stated that educational leadership is of principle importance when d etermining the quality of teaching and learning and as a result has a pertinent influence on the achievement of the students involved. ... It is often essential for the teacher to ensure that they have undergone some kind of leadership training so that they can be better able to handle diverse and unique situations in their classrooms. He further states that it is often necessary for the teacher or school leader to realise that each and every one of their students is unique in many ways and that the behaviour of students should not be categorised in general terms. What one student may be able to understand over a short period of time does not apply to another student who might not be capable of understand over the same time. This means that in order for the teacher to be effective in their classroom, it is often necessary for him to ensure that he treats each of his students in the most flexible way he can in order to cultivate their unique capabilities. Gurr et al (2005) are also of this opinion although they go even further by stating that teachers have to do a self-examination to determine whether they have the neces sary qualities that will enable them to become effective leaders so that they can be able to not only strengthen these qualities, but also work towards ensuring that they have acquired those qualities which are most essential in helping in the academic performance of their students. The two articles adopted different methodologies and these have been manifested in the divergent outcomes that resulted from the studies they conducted. Dinham, for instance, chose to pursue two types of research sites with the aim of studying how leadership had an effect in determining the exceptional student outcomes. The first of these was the conducting of studying on departments, which were responsible for the teaching of subjects in secondary schools for

ASSESS THE CURRENT MOVE TOWARDS COMPETITION AND CHOICE IN HEALTH CARE Essay

ASSESS THE CURRENT MOVE TOWARDS COMPETITION AND CHOICE IN HEALTH CARE IN TERMS OF THE EFFICIENCY VS. EQUITY TRADEOFF - Essay Example It has been a key concern for policy makers to promote choice and competition, so as to increase productivity and responsiveness to consumers in healthcare. The western countries in Europe and the United States have embarked on renovating their healthcare services, to allow patient choice through availing price competition between the health care providers that customers can choose from. In the past, healthcare service had been a government dominated area, and in most developing countries it enjoyed a monopolistic position, with ability to provide a variety of services and capture the customer surplus in the market. However, today there are many private organizations that venture in the healthcare service as hospitals and pharmaceuticals, which are highly relying on modern technology to offer the customers quality service. As a result, this has made the cost, quality, and healthcare accessibility a legislative and policy issue that ought to be managed, due to the rising variation. Th e economic benefit of promoting competition and choice is to enhance competition pressure, so that private firms become more efficient, causing them to reduce costs of service and improve their services and products as a way of attracting clients, which is generally healthy and an improvement of the economy (Propper, 2010). New forms of health care financing and delivery have developed as a result of the competitive pressure for cost containment, to slow health care inflation and encourage clients to choose from the available relatively lower cost health care. Hospitals and physicians have been each forming mergers and joint ventures with their partners in the healthcare industry, hence influencing costs and bargaining power as they improve the quality of health care and its distribution to ensure equity in the society (Federal trade commission, 2004). Competition, Patient Choice, and Equity In health care, improving patient and user choices are perceived different in accomplishment of healthcare systems objectives. However, it has become a key concern for most nations so that they get to direct their future in health and public services in regard to patients wants. According to Fotaki, offering patient choice in England is viewed as an attempt to address the failure of the pre-existing policies that had been operational in providing equitable and high quality services to the population, while it is perceived as a way to achieve other desirable goals, for example reducing the waiting lists, hence not an explicit policy objective on its own merit (2007). There are numerous patient choice policies being developed in health care industries, but how efficient and effective they will be will depend on the adjustments they would have made from the past policies, and how attractive it would be to the customers in the already competitive market. The transition made so far is that the patient or user choice policies are been made based on the learned experiences in the previous policies. The health systems of most developing and developed countries are still been challenged in responding to the needs of the less privileged members of the society; therefore creating inequality when it comes to choice in healthcare and its delivery. Although the mergers and consolidation of health facilities and physicians have improved, it does not mean that the service being provided to some people, especially in the marginalized areas are similar to those being delivered in urban parts. The networks being formed have been effective to ensure equitable health outcomes, but the efficiency in health

Exploring the Relationship Between Mother and Baby Essay Example for Free

Exploring the Relationship Between Mother and Baby Essay Exploring the relationship between mother and baby in the NICU in relation to nursing support. Abstract Aim -To explore the effect of interaction related to care-giving and information exchange between nurses and mothers in relation to maternal stress and maternal-infant relationship in the newborn intensive care unit (NICU) throughout the hospital stay. Background Mothers in the NICU experience depression, anxiety, stress, and loss of control, and they fluctuate between feelings of inclusion and exclusion related to the provision of health care to their neonate. This literature review helps to identify nursing interventions that promote positive outcomes between mother and baby by reducing maternal feelings of stress and anxiety. Search Method A literature search covering the period 2008-2012 was conducted. Five articles reporting both quantitative and qualitative studies relative to the subject were retrieved. Findings Findings reveal that positive and trustful relationships between nurses and mothers develop when nurses communicate and interact with mothers. This alleviated mother’s anxiety and enhanced their confidence when interacting with their baby. Discussion Critical analysis as well as strengths and weaknesses of the relative journals reviewed is given together with useful recommendations that emerge from the evidence. Conclusion The literature reviewed shows that nurse-mother interaction improves mother-infant relationship. In turn, this will eventually assist in decreasing maternal stress and improve the maternal well-being. INTRODUCTION Mothers develop attachment to their baby during pregnancy, which continues and develops more fully after the child is born (Cleveland 2009). However, the pathway to becoming a mother is threatened with the admission of the baby to the NICU. This occurs due to the unfamiliar and intimidating environment of the NICU (Obeidat et al 2009). During the initial admission parents can believe that the healthcare team is more able to care for their baby and this can instill feelings of inadequacy (Cockfort 2011). As a result, maternal attachment may be delayed by the lack of socialisation between mother and baby as most of the care is done by nurses (Cleveland 2009). DeRouck and Leys (2009), found that the parents of an infant admitted to the NICU face challenges including access to information, disclosure about the diagnosis, treatment and prognosis of their newborn, as well as a lack of control over the care of their newborn. Adding to this distress is the uncertainty of survival or the eventual impact of the infant’s condition on later health and well-being. In addition, feeling guilty to mother an unhealthy infant creates fear of social prejudice. Further, the structure of the NICU places significant barriers on mothers’ abilities to enact the parental role since decision-making and the daily care of the infant is taken over by medical and nursing staff restricting interactions with the babies stripping off their maternal authority (Cleveland 2009). In fact, when babies are in the NICU, traditional conceptualizations of the parental role are altered. The situation demands heightened parental participation while simultaneously placing severe restrictions on parental involvement. In response, parents need to negotiate this tension and traditional definitions of the parental role, which must be continually redefined throughout their experience What emerges is that the predominant source of distress is inability of the mother to protect the infant from pain and provide appropriate pain management. (Fenwick et al 2008). A lot of procedures cause pain in the neonate creating concerns for the mother, starting from peripheral cannulas, indwelling catheters and intubation to mention a few. In intubated babies, even though morphine infusions are administered, the baby still shows signs of distress during nursing times. In this case, we administer a small bolus of pain relief prior to nursing so that the baby would be more comfortable. Conversely, Fenwick et al (2008) describes factors that contribute to parents’ satisfaction in the NICU. These include; assurance and psychological support, the provision of consistent information, education, environmental follow-up care, appropriate pain management, and parental participation and proximity, as well as physical and spiritual support. Therefore, it is imperative that nurses should do their best to improve the mothers’ sense of confidence, competence and connection with her infant through guided participation (Domanico et al 2011). Johnson (2008) notes that skin-to-skin holding or kangaroo care promotes maternal-infant feelings of closeness, builds maternal confidence, and may be a stress-reducing experience for both the mother and infant. Hence the importance of providing the opportunity for kangaroo care to occur. Hunt (2008), notes that KMC is also crucial to stabilize parameters, such as cardio-respiratory parameters whilst being beneficial for maintaining body temperature. They add that even the incidence of nosocomial sepsis and the duration of hospital stay decreased with practicing KMC. In addition, Ali et al., (2009), found that Kangaroo mother care also showed positive outcomes towards practicing exclusive breastfeeding. Cockfort (2011) notes that, continuity of care needs to be ensured hence the importance of documentation. Therefore, it is suggested that handover should not be rushed, whilst a more comprehensive handover can ensure the smooth transition of care for staff and the family. When parents ask questions relating to their baby they feel assured in the competency of staff when information has been passed on correctly. When information is not shared effectively parents can lose trust and the partnership breaks down. In Malta, even though handover of 2 consecutive days is given, conflicting advice is still given at times due to the nurses’ different view-points. Consequently, this requires ward meetings in order to clarify important issues so that advice given and practice is consistent. In Malta, about 373 babies are admitted yearly (Grech et al 2012). In view of the benefits discussed, nurses should do their utmost to improve the overall experience of the mothers of such babies. Search Method A review of published research consisted of the following steps; broad reading to determine areas of focus, identification of inclusion and exclusion criteria, literature search (appendix 1) and retrieval, critical appraisal and analysis of the research evidence and synthesis of evidence. Evidence was reviewed with the aims of identifying barriers that affect the motherinfant interaction within the neonatal intensive care unit and how nurses can actively support attachment. Articles were included if the setting was primarily in a neonatal intensive care unit (neonatal unit or neonatal intensive care unit) and the participants were mothers of infants admitted to neonatal intensive care units or nurses working within that setting. In addition, All articles were critically analyzed with two primary questions in mind: (a) What are the needs of parents in the NICU? (b) What nursing behaviors support parents in meeting these needs? Articles were also included if they were primary research studies published between 2008 and 2012 and written in the English language. Primary and secondary literature searches were conducted through the EBSCO, ERIC, Sciencedirect and Medline databases. The primary search terms included â€Å"NICU,† â€Å"Neonatal Intensive Care Unit,† â€Å"family support,† â€Å"communication,† â€Å"nurse† and â€Å"early intervention.† The secondary literature search terms included â€Å"nursing support,† â€Å"efficacy,† â€Å"family,† â€Å"communication,† â€Å"support†, â€Å"neonatal† and â€Å"Kangaroo Mother Care†. These terms were used and utilised in all possible combinations to perform an extensive literature search of the above mentioned electronic databases. Thirdly, a review of references was conducted of the identified articles for any further studies. Eighteen articles were found through the search. Six studies met the inclusion criteria of which, 3 were qualitative and 3 quantitative (appendix 2). The subject was limited to the last 5 years. This time frame helps in the getting the most recent experiences since NICU is a changing environment especially as regards to technology which effects the mothers as well as the nurses. Both quantitative and qualitative studies were found. Both qualitative and quantitative research was conducted to identify what is known about the needs of NICU parents and what behaviours support these parents. Both methods of research were included because of the potential for each to contribute to a more complete understanding of this topic. In selecting a research design, researchers should be guided by one overarching consideration: whether the design does the best possible job of providing trustworthy answers to the research questions. One needs to note that both studies have limitations (Cottrell McKenzie, 2011). In quantitative research, the researcher’s aim is to determine the relationship between one variable (an independent variable) and another (a dependent or outcome variable) in a population (Morrow 2009). In contrast to quantitative designs, qualitative designs do not result in numerical data for statistical analysis (Schira, 2009). In qualitative methods, researchers are interested in interpreting social phenomena and exploring the meanings that people attach to their experiences (Polit and Beck 2010). Moreover, views, attitudes and behaviours may be explored (Wood Kerr, 2011), through grounded theory as it develops theories that are grounded in the groups observable experiences, but researchers add their own insight into why those experiences exist. Findings Table 1 includes information about the 5 studies that met the inclusion criteria . Once an infant is admitted into an NICU, many factors account for parental stress. Admission of the infant to the NICU places mothers in a stressful situation where they must cope with the NICU environment and its associated demands. In the study conducted by Parker (2011), a grounded theory approach was used to understand feeling and stressors of 11 mothers whose new-borns were in the NICU. It was found that the early days shock and numbness accompanied feelings of none or little control over their lives. Moreover, all mothers described feeling unprepared for the premature delivery and the sight of their baby in the NICU. Comparative results were found by Lee et al (2009), with regards to the shock experienced with the initial sight of the baby. Everyday unpredictable changes occur leaving no time for adjustment or preparation. Constant fears about the life and death of the baby do not subside and several mothers spoke about their experience of always anticipating the death of the baby. These findings are also reflected in my clinical setting when mothers would be recounting their experience once the baby’s condition improves. This is in line with the findings of Fenwick et al (2009) and Lee et al (2009). In addition, the findings imply that the positive reassurance of the effects of a positive and caring environment and support network between parents and nurses in the NICU is not always evident among every unit. Nicholas-Sargent (2009) found that assurance is the most important aspect to be fulfilled. Her quantitative study of 46 mothers found that the length of stay in the NICU and mothers’ information needs were found to be significantly inversely correlated. Therefore, this suggests that the longer an infant remains hospitalized in the NICU, the less emphasis the mother places on receiving information about the infant’s condition. This shows that the needs of the mothers in the NICU can change over time. My observations match these findings since mothers familiarise themselves and adapt to the situation. Moreover, they would eventually want to be successful with the care of the baby. This is reflected in the grounded theory analysis conducted by Fenwick et al (2008), using semi-structured interviews. They found that the nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. Being successful in their desire to care for the baby, engendered feelings associated with being a ‘‘real’’ mother. However, not all women in this study were able to successfully employ these strategies. In the situation where the mother perceived herself as ‘‘quiet and unassertive’’, and in a position without any power, it was very difficult to gain the confidence needed in order to be able to openly question, negotiate and direct the care of her infant. Therefore, it is very important to identify these mothers in order to help them by giving them continuous reassurance. This would particularly be required when the situation changes from support needing to encouragement in participation. Lee et al (2009) found that mothers received support from the healthcare professionals and the social networks that mothers made. These helped to create the connections that developed between the mothers and infants making their journey towards parenthood possible. They discovered that challenges are further compounded in Taiwan, where women are traditionally required to practice the cultural ritual which includes confinement to the house with a special balanced diet for the first month postnatal. Lee et al (2009) used the grounded theory approach with in-depth interviews and constant comparison. All interviews were audio-taped and notes were made during and immediately after the interview concerning actions and body language of the mother during the interview. The finding of this study further indicated that the initial sight of the life-support equipment was shocking. The technological environment created a fearful atmosphere, and the medical equipment attached to their infants caused the mothers further physical separation. The mothers indicated that they were so afraid of the equipment that it took them a long time to be able to participate in their infants’ care. In turn, this hampered them from establishing positive mother–infant interactions. Chiu and Anderson (2008), found that preterm births often negatively influence mother–infant interaction due to lack of physical contact. In addition, they found that skin-to skin contact post-birth has positive effects on infant development. These researchers conducted a randomized controlled trial (RCT) using questionnaires for data collection. In addition, mothers were further video-taped during a feeding session. Ali et al., (2009),highlight the importance of kangaroo care in their RCT where the researchers conducted their study with one hundred and fourteen infants. This study showed that the infants exposed to kangaroo mother care had an increase in rectal temperature compared to conventional care, therefore having a decreased risk of hypothermia. The mean temperature during kangaroo mother care was of 37 degrees Celsius while the mean temperature during conventional care was of 36.7 degrees Celsius. The data collected was through posted questionnaires. Discussion In the 3 qualitative studies found, the data was collected through interviews of which 2 were semi-structured while 1 was unstructured. Parker (2011), Fenwick et al (2008) and Lee et al (2008), used the Grounded theory approach. However, while Parker and Fenwick use semi-structured interviews, Lee uses unstructured interviews. In semi-structured interviews there is a topic guide with list of areas or questions to be covered with each respondent. This technique ensures that researchers will obtain all the information required, and gives respondents the freedom to respond in their own words, provide as much detail as they wish, and offer illustrations and explanations. Lee et al (2009) uses ground theory approach but incorporated with unstructured interviews. Unstructured interviews also known as are flexible but are more time-consuming than semi-structured since the interviewer listens and does not take the lead. The interviewer listens to what the interviewee has to say. The interviewee leads the conversation (Wood Ross-Kerr, 2011). However, anonymity for confidentiality which is of utmost importance is not possible. When using unstructured interviews, the researchers have to be able to establish rapport with the participant. The reason is that the interviewers have to be trusted if someone is to reveal intimate life information. This may lead to interviewee bias. Also, it is important to realise that unstructured interviewing can produce a great deal of data which can be difficult to analyse. Lee et al (2008) and Fenwick et al (2008) conducted the interviews themselves while Parker (2011) did not, thus reducing the bias. However, interviewer bias occurs even if someone else is conducting the interview. The number of mothers in the study of Lee et al (2008) was adequate since with in-depth interviews 20 participants are enough. However, to account for the small sample, more interviews and observations were done with the same participants in order to reach theoretical saturation. Usually informants are selected for in-depth interviews in a purposive manner questioning the generalizability of the results (Wood Kerr, 2011). A major controversy among grounded theory researchers relates to whether to follow the original Glaser and Strauss procedures or to use the adapted procedures of Strauss and Corbin (Polit Beck 2010). Grounded theory method according to Glaser emphasizes induction or emergence, and the individual researchers creativity within a clear frame of stages, while Strauss is more interested in validation criteria and a systematic approach. Parker (2011) uses the original Glaser and Strauss (1967) paradigm while Lee et al (2008) and Fenwick et al (2008) use Strauss and Corbin (1998) procedures. One of the fundamental features of the grounded theory approach is that data collection, data analysis, and sampling of study participants occur simultaneously. A procedure referred to as constant comparison is used to develop and refine theoretically relevant categories. Categories elicited from the data are constantly compared with data obtained earlier in the data collection process so that commonalities and variations can be determined. As data collection proceeds, the inquiry becomes increasingly focused on emerging theoretical concerns. All 3 studies use constant comparison. All the above 3 studies use audio-taping for data collection except for Fenwick et al (2008) who used field note documentation as well. Audio-taping enables eye contact to be maintained and to have a complete record for analyses, however, some interviewees may be nervous of tape-recorders. On the contrary, in note taking on the other hand, a lot of eye contact is lost unless a type of short-hand is learnt. However, the interviewer will have plenty of useful quotations for report when transcribing the interview. Randomized controlled trials consist of a complete experimental test of a new intervention, involving the random assignment of a large and varied sample to different groups (Polit Beck, 2010). The intention of an RCT is to arrive to a judgment as to whether the novelty of an intervention is more effective than the traditional intervention (Polit Beck, 2010). This intention was well noticed throughout the RCTs chosen by Ali etal., (2009). Wood Kerr, (2011) sustain that RCTs are the most rigorous method to determine a cause-effect relationship between the treatment and the outcome. Furthermore, RCTs were also described as the gold standard trial for evaluating the effectiveness of a clinical intervention ((Muijs 2010). One of the primary aims of RCTs is to prevent selection bias by distributing the patient, randomly between the two groups, so that the difference in the outcome and results can be justified and attributed only to the intervention under study. Thus, through random selection there is a better balancing of any confounding factors, therefore creating similarity between the groups (Cottrell McKenzie, 2010). In effect in this literature review, RCTs were found to be useful and beneficial to compare the effect of KMC and conventional care on the physiological aspects of the infant. Ali et al., (2009) chose to add blocking to randomisation so as to ensure a better balance in the number of infants allocated in the groups. These groups were randomized through simple randomization and the disruption of groups was achieved by delivering a concealed envelope technique. Through random sampling, Polit Beck (2010) explain that each element in the population has an equivalent, autonomous chance of being chosen. However, this design is not used frequently as it is lengthy and may be expensive (Wood Kerr, 2011). Chiu and Anderson (2008), use mixed methods of data collection by using both questionnaires and video-taped interviews. The use of multiple sources or referents to draw conclusions about what constitutes the truth is called triangulation. This is one approach in establishing credibility as it enables the researcher to counteract the weaknesses in both designs. The use of video-taping provides the most comprehensive recording of an interview since it captures body language, facial expressions and interaction (Gerrish and Lacey 2010). However the interviewee may become uncomfortable and act differently than in normal circumstances questioning the reliability of the data collected. In addition, questionnaires are the main research tools used in quantitative research. They are very advantageous as they can be constructed in such a way as to meet the objectives of almost any research project. In the Family Needs Inventory used by Nicholas-Sargent (2009), the ‘not applicable’ part was removed from the Likert scale in order to report definite opinions. Questionnaires can measure the participants factual knowledge about a certain subject or an idea or else they can be used to explore opinions, attitudes or behaviours (McNabb, 2008). Moreover, questionnaires are also less expensive than most other research instruments and are also less time-consuming . Self-administered questionnaires provide the participants with anonymity, and responses are not affected by the interviewers mood or presence (Wood Ross-Kerr, 2011). On the other hand, the main disadvantage of questionnaires is that there is a high possibility of a poor response rate since some questions are ignored, misinterpreted, incorrectly completed or inadequately detailed (Polit and Beck 2010). The RCT of Chiu and Anderson (2009) and Ali etal. (2009),, is one of the most powerful tools of research where people are allocated at random to receive one of several clinical interventions. However RCT’s are vulnerable to multiple types of bias at all stages of their workspan (Geretsegger et al 2012). Hence the need to establish validity and reliability. In the study done by both Ali etal.,(2009) and Chiu and Anderson (2009),the researchers increase the rigor on the study by using a large number of participants. In addition, Chiu and Anderson (2009) use the Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales. Nicholas-Sargent (2009), improved the rigour by using the Critical Care Family Needs Inventory (CCFNI), as a framework for the FNI. CCFNI has been thoroughly reported with results indicating internal consistency and construct validity (Gerrish and Lacey 2010). Despite this, Nicholas-Sargent (2009), use a small scale study and therefor e the results cannot be generalized. Limitations In the study done by Lee et al (2008), the data were only collected from one hospital in this present study causing generalisability of the results to be low. Moreover, the sample was restricted to those who did not have additional social, cultural or medical circumstances to consider. Moreover, coding was done by researcher itself and this might have caused some bias. Both Nicholas-Sargent (2009) and Parker (2011) use small scale studies but these were qualitative studies. Therefore, to a certain extent the findings cannot be generalized across the population of families involved with the NICU. In addition, Parker (2011) uses a retrospective study, which might have been subject to bias in recalling information. There was absence of pilot study in both Nicholas-Sargent (2009) and Chiu and Anderson (2009). The use of pilot studies helps to assess the design, methodology and feasibility of the tool and typically includes participants who are similar to those who will be used in the larger research study ( Wood Kerr 2011). Hence, their importance. Also, the instruments chosen by Chiu and Anderson (2009), being the (NCAST and the feeding and teaching scales) for this study might not be sensitive enough to capture any between-group difference in changes resulting from the intervention. Finally, Ali et al., (2009) fail to mention intention to treat analysis where researchers can introduce reality into research by outlining that not all randomised participants will continue throughout the study. Therefore, this might be a potential weakness in this study. It was also noted the there was no detailed report about the time intervals between the two different groups. Hence, this may also have introduced performance bias. In the grounded theory approach taken by Fenwich et al (2008), limitations lie in the method of data collection itself through semi-structured interviews that were tape-recorded and field note documentation done. The authors did not acknowledge limitations in the study. Recommendations Maternal contact Fenwich et al (2008) suggests prioritising maternal-infant closeness when underpinning policies and protocols and suggests the unrestricted access to their child. Lee et al (2008) found that in Taiwan mothers are allowed to visit for 30 minutes twice a day. In Malta, mothers are allowed to stay with the child 24 hours a day. In addition, skin-to-skin contact is recommended by both Lee et al (2008) and Chiu and Anderson (2009). The latter suggests that all mothers, if they are able and whether or not they ask for it, skin-to-skin contact should be encouraged. My suggestions on interventions for critically ill infants include encouraging the parents’ presence at the bedside, assisting the parents in personalizing the bedside, and teaching the parents to gently touch their infant. Another approach is to hang a simple picture board with the first names of nurses and practitioners near the entrance to the unit. This picture board helps anxious families feel welcomed in this healing environment. In our unit, those babies who have central lines such as umbilical arterial catheters (UAC), the mothers are not allowed to hold the baby for fear of bleeding if the UAC gets dislodged. However, if the mother shows signs of needing contact with the baby, we allow her to hold the baby with constant supervision. In the case of babies that are ventilated mothers are only allowed to hold their baby if the prognosis is very poor. Therefore, this shows that, if the baby is on long term ventilation, skin-to-skin is hindered from being introduced. Fenwich et al (2008), recommend the development of tools that can better evaluate the satisfaction of the mother. Hence, the need for longitudinal qualitative research. In my opinion this would yield good results when past experiences would show which improvements were helpful and which were not. NICE standards (2010), specify the use of surveys. We can incorporate these surveys after consideration with the midwifery officer. Mother-nurse-infant interaction Because of the complexity of illness, parents of critically ill infants are anxious and fear the worst with every visit to the NICU. Strategies need to be adapted to decrease maternal anxiety while supporting the needs of these infants. (Nicholas-Sargent 2009). Nurses play a vital role in helping parents throughout the stressful and challenging experience of the NICU by developing therapeutic relationships and providing emotional support. These approaches enable parents to feel more supported, more involved, confident, and more effective as parents of their vulnerable newborn. The experience of parents in the NICU occurs during an emotionally intense period fraught with anxiety, stress, depression, and feelings of hopelessness. Therefore, Nicholas-Sargent (2009) suggests that, it would be vital to do an NICU orientation for expectant parents with a high risk of giving birth to a premature infant or a compromised newborn. Supporting and facilitating their parenting role will help decrease their stress, strain, anxiety, and depression. Lee et al (2008), nurses need to respect the cultural preferences of mothers as this would promote desired health outcomes. This would aid in meaningful, holistic and individualized care. According to Nicholas-Sargent (2009), personalized one-to-one as opposed as opposed to group support would be helpful. In addition Nicholas-Sargent (2009), suggests that nurse education is needed to improve the awareness of the impact of the counselling service. However, the service needs to be more flexible due to fluctuations in the health condition of the baby. In fact, what we notice is that mothers would require counselling at different stages of the hospitalization. Therefore, if the service was refused once, it may still mean that mothers would need it at some other point in time. Nicholas-Sargent (2009), further suggests that the counselling service would be extended to the whole family from the hospital as well as in the community., Both the DH (2009), and NICE (2010) highlight the importance of Family-Centered Care (FCC) views the family as the ‘child’s primary source of strength and support’ and allows for collaboration, respect, and support with the parents and family during all levels of the service delivery. To foster participation in care for the infant, unrestricted visiting hours should be encouraged for the nuclear family of the neonate. In Malta, visiting hours are restricted to parents only due to increase in cross infection when family members were allowed to visit for 1 hour everyday during the day. However, timing of care may still be arranged to facilitate parents’ participation. In addition, special moments such as baby’s first time off CPAP (continuous positive airway pressure) needs to take place during parents’ presence. Cockfort (2011), highlights that missed opportunities to involve parents in care, heighten anxiety and can create a sense of sadness and loneliness . Information for mothers Mothers vary in the amount of information they can assimilate under stress. Therefore identifying parents’ feelings through active listening and observing will help us to pick up on parents cues and respond appropriately in order to provide parents with accurate and clear information (Fenwick et al 2008). Nicholas-Sargent (2009), adds that, information regarding the health status of the baby needs to be give in a timely provision. Parker (2011), recommends the access to certified interpreters for non-English speaking parents to enable them to ask questions and get the information they need as well as information regarding the counselling services. Likewise, an updated information board at the infant’s bedside helps mothers retain information while feeling welcome at the bedside. In my opinion, these interventions create an environment that facilitates maternal- infant attachment by promoting maternal competence with meaningful positive parenting skills and fostering partnership in care.. Conclusion In summary, the findings showed that parents of infants admitted to the NICU experience stress, depression, anxiety, and feelings of powerlessness, hopelessness, and alienation within the environment of the NICU. These situations are often overwhelming and catastrophic for the mothers keeping in mind that the process of motherhood is a protecting and loving phenomenon. Therefore mothers should participate in the care of their sick, fragile infant in the NICU through mother-infant interaction. Nurses need to be supportive and informative in dealing with parents in the NICU. Therefore, the need for parents to be given the access of interpretation by certified interpreters in order to overcome language barriers has been identified. Further, information and emotional support is required throughout the stay in the NICU, However, it was further found that information in preparation for discharge planning is vital. This enhances parental knowledge and decreases stress, which promotes more effective parenting. Further, as understanding of the parents’ experience of having an infant admitted to the NICU increases, nurses will be better prepared to meet parental needs and alleviate parental suffering. Providing holistic, developmentally supportive care and open communication with parents in this stressful experience is essential. Moreover, the need for family-centered care has been identified. REFERENCE LIST Ali, M.S., Sharma. J., Sharma. R., Alam. S. (2009). Kangaroo mother care as compare to conventional care for low birth weight babies. Dicle Tip Dergisi. 36(3), 155-160. Chiu S. Anderson G.C., (2009). Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial. International Journal of Nursing Studies, Vol. 46, pp.1168–1180. Cleveland, L.M., 2008. Parenting in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, Vol. 37 (6), 666e691. Cockfort S., (2011). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care? Journal of Neonatal Nursing, Vol.95(5), pp.365-368. Cottrell, R.R. McKenzie, J. F. (2011). Health Promotion and Education Research Methods using the Five-Chapter Thesis/Dissertation Model (2nd ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers. DeRouck, S. Leys, M., (2009). Information needs of parents of children admitted to a neonatal intensive care unit. A review of the literature. Patient Education and Counselling, 76 (2), pp.159-173 DH: Department of Health, 2009. Toolkit for high-quality neonatal services. DH, London. Domanico R., Davis D.K., Coleman F. Davis B.O. (2010). Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. Journal of Perinatology, Vol.31, pp. 281–288 Fenwick J., Barclay L., Schmied V.,(2008). Craving closeness: A grounded theory analysis of women’s experiences of mothering in the Special Care Nursery. Women and Birth, Vol. 21, pp.71—85. Geretsegger M., Holck U. and Gold C., (2012). Randomised controlled trial of improvisational music therapys effectiveness for children with autism spectrum disorders (TIME-A): study protocol. BMC Pediatrics Vol.12(2), pp.1471-2431. Gerrish K. Lacey A. (2010). The Research Process in Nursing. Blackwell Publishing Ltd. UK. 6th ed. Glaser, B.G., Strauss, A., 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine, NewYork. Gray, D. E. (2009). Doing Research in the Real World (2nd ed.). London, California, New Delhi, Singapore: Sage Publications. Grech V., Cassar M. Distefano S., (2012). Nurse staffing levels on a regional neonatal paediatric intensive care unit. Journal of Paediatric Intensive Care, Vol. 1(1), pp.25-29. Johnson, A.N., 2008. Promoting maternal confidence in the NICU. Journal of Paediatric Health Care, Vol. 22 (4), 254e257. Lee S., Long A. Jennifer B. (2009). Taiwanese women’s experiences of becoming a mother to a very-low-birth-weight preterm infant: A grounded theory study. International Journal of Nursing Studies, Vol.46, pp. 326–336 McNabb, D. E. (2008). Research Methods in Public Administration and Non-Profit Management: Quantitative and Qualitative Approaches (2nd ed.). New York: M. E. Sharpe Incorporation. Morrow V., (2009) The Ethics of Social Research with Children and Families in Young Lives: Practical Experiences. Young Lives. Oxford: Department of International Development. Muijs D., (2010). Doing Quantitative Research in Education with SPSS. London: Sage Publications NICE: National Institute for Health and Clinical Excellence, (2010). Quality Standard for Specialist Neonatal Care http://www.nice.org.uk/media/17A/A8/ Obeidat H.M, Bond E.A. Callister L.C., (2009). The Parental Experience of Having an Infant in the Newborn Intensive Care Unit. The Journal of Perinatal Education | Summer, Vol. 18(3), pp.23-29. Parker L., (2011). Mothers’ experience of receiving counselling/ psychotherapy on a neonatal intensive care unit (NICU). Journal of Neonatal Nursing, Vol.17, pp.182-189. Polit D.F. Beck C.T. (2010) Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 7th ed. Wolters Kluwer Health | Lippincott Williams Wilkins, Philadelphia. Nicholas-Sargent A., (2009). Predictors of needs in mothers with infants in the neonatal intensive care unit. Journal of Reproductive and Infant Psychology, Vol. 27(2), pp.195–205. Schira, M. (2009). Appraising a single Research Article. In Mateo, M. A. Kirchhoff, K. T. (Eds.), Research for advanced practice nurses: from evidence to practice (pp. 73-85). New York: Springer Publishing Company. Strauss A. Corbin J.( 1998). Basics of qualitative research. 2nd ed. Newbury Park, CA: Sage Publishers;. Watson, H., Booth, J. Whyte, R. (2010). Observation. In Gerrish, K. Lacey, A. (Eds.), The Research Process in Nursing (6th ed.) United Kingdom: Blackwell Publishing Limited. (pp. 382-394). Wood, M. J. Ross Kerr, J. C. (2011). Basic Steps in Planning Nursing Research: From Question to Proposal (7th ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers.

Edgar Allan Poe :: essays research papers

Edgar Allan Poe Poe, Edgar Allan, known as a poet and critic but most famous as the first master of the short-story form, especially tales of the mysterious and macabre. The literary merits of Poe's writings have been debated since his death, but his works have remained popular and many major American and European writers have professed their artistic debt to him. Born in Boston, Massachusetts, Poe was orphaned in his early childhood and was raised by John Allan, a successful businessman of Richmond, Virginia. Taken by the Allan family to England at the age of six, Poe was placed in a private school. Upon returning to the United States in 1820, he continued to study in private schools. He attended the University of Virginia for a year, but in 1827 his foster father, displeased by the young man's drinking and gambling, refused to pay his debts and forced him to work as a clerk. Poe, disliking his new duties intensely, quit the job, thus estranging Allan, and went to Boston. There his first book, Tamerlane and Other Poems (1827), was published anonymously. Shortly afterward Poe enlisted in the U.S. Army and served a two-year term. In 1829 his second volume of verse, Al Aaraaf, was published, and he effected a reconciliation with Allan, who secured him an appointment to the U.S. Military Academy. After only a few months at the academy Poe was dismissed for neglect of duty, and his foster father disowned him permanently. Poe's third book, Poems, appeared in 1831, and the following year he moved to Baltimore, where he lived with his aunt and her 11-year-old daughter, Virginia Clemm. The following year his tale â€Å"A MS. Found in a Bottle† won a contest sponsored by the Baltimore Saturday Visitor. From 1835 to 1837 Poe

Benefits of a C Corporation Essay

Firstly, a C Corporation can be defined as a legal unit of business that has its own separate identity from its owners or the persons that form it. To use the general legal term, it is a â€Å"body corporate†, a â€Å"legal entity†, which simply means a corporation can be treated just like an individual in law, it can sue and can be sued. This singular characteristic does not only make it quite unique but also gives it an edge over other business entities such as sole proprietor, partnership, limited liability Company to mention but few. However, the two major types of corporation, which are the C Corporation and S Corporation. The C Corporation has quite numerous benefits; the most technical of these is its ability to guard its owners’ personal assets from judgment against the business. Owners can also split profit and loss with the business for a lower overall tax rate. Yet another benefit is that it has no limits in number of shareholders and owner. Again, Owners do not need to be U. S. citizens or residents; both foreign and local are equally allowed to share in its ownership. A C corporation also has the flexibility of being owned by yet another business entity, rather than an individual or several individuals. Finally, the C Corporation has a package of much greater tax advantages over any other business entity, for it was primarily designated for tax purposes, while the â€Å"S† corporation passes it tax to the shareholders, the C Corporation on the other hand acts as it own tax entity. Reference Bakan J. , 2004, The Corporation: The Pathological Pursuit of Profit and Power. USA

Christian Science Monitor Essay

An article in the Christian Science Monitor last January tries to educate consumers about the value of carbon offset programs and whether they have any real effect on global warming. The article, published January 10, 2007, discusses the concept of carbon offsets and the efforts of some companies to become carbon neutral. The ideal are based on the idea that as consumers we emit a certain amount of greenhouse gases or are responsibility for having been emitted. In an effort to reduce that amount, the so-called â€Å"Carbon footprint†, consumers are being offered the chance to buy â€Å"carbon offsets†, a process by which a company takes some action to reduce the amount of greenhouse gases being emitted. If enough offsets are purchased, the person or company can become â€Å"carbon neutral† meaning that their actions are not increasing the amount of greenhouse gases in the world. This article, â€Å"Do Carbon Offsets Live Up to Their Promise? †, is about the first report by someone trying to evaluate whether this is a good environmental effort or a giant fraud. The report, by the non-profit organization Clean Air-Cool Planet, argues that three-quarters of the 30 companies currently selling carbon offsets are doing a less than mediocre job of it. The companies were ranked on a scale of 1 to 10, 75 percent ranked less than a five. The article also details what criteria were used to evaluate the carbon offset programs. The intended reader of this article is the highly-informed readership of the Christian Science Monitor. The newspaper is one of the most well-respected in the country for journalistic excellence and assumes a certain amount of base knowledge in its readership. As such, the article could have been better at explaining some of the basic terms it used, but appeared to be scientifically accurate. Surprisingly, many of the article’s sources were people active in the environmental community. This would seem like an inherent bias in the article, but many of those people were willing to point out flaws in the carbon offset system. One representative of the Sierra Club told the Monitor that if carbon offsets were viewed like papal indulgences and people used them as an excuse to keep polluting, they could potentially be harmful to the planet. The article was also peppered with scientific facts including the idea that methane is a more dangerous greenhouse gas than carbon dioxide without feeling like a science lecture. This article made me angry because it seemed to make it clear that carbon offsets are a sham. The article indicated that one criteria of the evaluation done by Clean Air-Cool Planet was to determine how many of these greenhouse gas reducing activities would have taken place regardless of whether the offsets were purchased. For companies who use producing alternate fuel sources as a carbon offset, it appears that this new trend is simply a way to capitalize their projects and make even more money. Other companies called planting trees their â€Å"carbon offset†. Since trees are a renewable resource, I am skeptical about when and where these trees were being planted. If they were planted to replace a forest that had just been clear cut for the local paper mill, then calling them a â€Å"carbon offset† is fraudulent and ridiculous. This article made me very leery of those who use carbon offsets in general, as it appears that this may indeed be a way for the indulgent to continue their polluting ways, never change their lifestyles to reflect the needs of the planet, and feel better about themselves while nothing is being done to stop global warming. This article left me with the impression that much of the hype about stopping global warming has been just that, hype, and that we will realize in a few years that the problem is getting exponentially worse despite our â€Å"efforts† to fix it.

Comparing the Marketing Techniques Essays

Comparing the Marketing Techniques Essays Comparing the Marketing Techniques Essay Comparing the Marketing Techniques Essay Ml- Compare the marketing techniques used by the two organizations. Comment on the advantages and disadvantages of each. Thorpe Park Thorpe park use many different way of promoting Its selfs. The way that Thorpe Park promotes its self is very clever and reaches out to a certain audience of people. For MI I will be looking at the different ways that Thorpe park and compare that market promote their selfs and the products. Promotion Technique There are servile techniques that Thorpe Park uses so they can attract more people to the park and overall make a bigger profit. A big way that Thorpe Park promotes its self on the internet. The way that it does this is through social media and adverts that pop up on places like Youth before a video and pop that appear on websites. There are section times that Thorpe park promotes its self-more. The main times are when the school holidays start and a couple of days before. This is due to the fact that Thorpe parks mall audience Is a range of kids/ students ranged from 13-21. At the moment the big thing that Thorpe Park Is promoting Is the fright nights. They have two weeks of radio ads, on radio stations Like and KISS. Also Thorpe Park has ads in newspapers like the Sun and other local papers. Thorpe Park promotes its self the most when a new ride is being built and when its officially launched. Place technique Thorpe Park is placed very well and its location is key to its success. Being centre of everything is very for getting huge amounts of customers a year and provides people to come to the park that live all over the I-J. As you can see form the map the big road the MOM and the MM are very close to Thorpe Park, theses road go all round the UK and Its very easy driving once you get on these roads, so this attracts more customs to Thorpe Park. Its hard to place the roller coasters as Thorpe Park has limited land. Also Its hard to get planning promotion. Planning promotion Is a very big thing at the moment, because Its getting harder and harder to get the planning promotion to build the new rides. Product After Sales Service Thorpe Park provides an After Sales Service, this is very important to some customers provoking teen Walt security when Dulling a product. Ensuring satisfaction Thorpe Park use exit questionnaires and other research methods to measure customer satisfaction. Services many guests regrettably lose personal items out of their pockets. Guest services then have the difficult responsibility of matching the reported lost items with the recovered property from in the ride areas. Last season Thorpe Park recovered nearly 2000 items, and returned nearly 25%. Deal with complaints Thorpe Park respond in writing to any complaints that need following up, or in reply to letters, phone calls or emails within 7 days of receiving the initial complaint. The main service is that Thorpe Park is an entertainer, and provides assure for different age groups. The product life cycle The product life cycle of the roller coasters are very long and when its getting old they staff will revamp the roller coasters so they are looking new again. So the product never really runs out unless the roller coaster gets knocked down to build a new one. Some of the roller coaster has been at Thorpe Park for 20 years or so. The roller coasters take a lot of where, but they never fully break because they always gets an annually services, and gets repairs from there. USPS The USPS for Thorpe park is the angry birds land.

Why Awe Matters More Than Quantity

Why Awe Matters More Than Quantity DailyGood.org is a favorite site of mine. It takes life, slows it down, and teaches me how to give it more substance and deep down quality. It makes me ponder my existence. We all need that periodically. Maybe we need it more often than that. This post stopped me longer than most, Why We Need To Cultivate Awe In The Workplace.  dailygood.org/story/1342/why-we-need-to-cultivate-awe-in-the-workplace-homaira-kabir/ Humans crave to be part of something larger than self . . . and once we think about it, we actually call it awe. We teach it to our children, or in many cases, we remember it Awe is akin to soul. I believe that when we sense something bigger than ourselves, when awe stops us in our tracks, we are tapping into our soul. We allow that door to open a tad, letting out emotion  we are often afraid to embrace. As adults we tend to guard ourselves, fearful of letting down the wall. As stated in this piece, when we sense awe, We see our fragility and vulnerability, which gives us a profound sense of humility. We dont like feeling fragile or vulnerable, and all too often, we let that fear inhibit us in how we write, how we publish, and how we market ourselves. Yet, we are in awe of those authors who dare to write a daring tale, expose their inner thoughts, and throw themselves before the publics eye. And the author who writes the memorable story is revered more than the author who wrote 15 stories and made money, though we cannot recall the characters. We should strive to be in awe of our work, and awe-struck

Solar energy Essay Example | Topics and Well Written Essays - 1500 words

Solar energy - Essay Example Solar power is the transferring of sunlight into electrical energy, either directly by means of photovoltaic, or indirectly by means of concentrated solar power (CSP). CSP structures utilize â€Å"lenses or mirrors and tracking systems to focus a large area of sunlight into a small beam. PV converts light into electric current using the photoelectric effect† (Chiras, 2009). Thermal mass is any substance that can be utilized to accumulate heat from the Sun. General thermal mass substances consist of ‘stone, cement and water’. In the past, they have been utilized in dry weathers or mild humid areas to keep buildings stay cool by soaking up solar energy throughout the daytime.Agriculture seeks to optimize the storage of solar energy for the yield of plants. Methods â€Å"such as timed planting cycles, tailored row orientation, staggered heights between rows and the mixing of plant varieties can improve crop yields† (Bradford, 2008). Solar sanitization can be u tilized to make salty water drinkable. The initial recorded case of this was taken place in 16th century. â€Å"A large-scale solar distillation project was first constructed in 1872 in the Chilean mining town of Las Salinas. The plant, which had solar collection area of 4,700 m2, could produce up to 22,700 L per day and operated for 40 years† (Chiras, 2009).. Solar water disinfection involves placing plastic polyethylene terephthalate bottles, filed with water, in sunlight for couple of hours. Duration of time differ according to climate and type of weather.... Thermal mass is any substance that can be utilized to accumulate heat from the Sun. General thermal mass substances consist of ‘stone, cement and water’. In the past, they have been utilized in dry weathers or mild humid areas to keep buildings stay cool by soaking up solar energy throughout the daytime. Agriculture seeks to optimize the storage of solar energy for the yield of plants. Methods â€Å"such as timed planting cycles, tailored row orientation, staggered heights between rows and the mixing of plant varieties can improve crop yields† (Bradford, 2008). Solar sanitization can be utilized to make salty water drinkable. The initial recorded case of this was taken place in 16th century. â€Å"A large-scale solar distillation project was first constructed in 1872 in the Chilean mining town of Las Salinas. The plant, which had solar collection area of 4,700 m2, could produce up to 22,700 L per day and operated for 40 years† (Chiras, 2009).. Solar water d isinfection involves placing plastic polyethylene terephthalate bottles, filed with water, in sunlight for couple of hours. Duration of time differ according to climate and type of weather from at least ‘five hours to two days’ in completely cloudy situation. It is a suggestion from the World Health Organization (WHO) as a practical way for domestic water handling as well as protected storage. More than three million people in developing nations apply this technique for their everyday drinking water. Advantages and Disadvantages Solar Energy is uncontaminated, renewable and sustainable, facilitating to safeguard the atmosphere. It does not contaminate the air by the discharge of ‘carbon dioxide, nitrogen oxide, sulphur dioxide or mercury’ into the air