Evaluation Of Workshops And Dante Inferno - 1624 Words

Evaluation Of Workshops And Dante Inferno This evaluation dissects and explores the strategies we used during the workshops to investigate the Seven Deadly Sins and Dante’s Inferno. The sins are; Pride, an excessive belief in one s own abilities. It has been called the sin from which all others arise. Pride is also known as Vanity.Envy is the desire for others traits, status or situation. Gluttony is an inordinate desire to consume more than that which one needs. Lust is an inordinate craving for the pleasures. Anger is manifested in the individual who hates love and opts instead for fury. It is also known as Wrath. Greed is the desire for materialistic wealth or gain, ignoring the realm of the spiritual. It is also called Avarice or Covetousness. Sloth is the avoidance of physical or spiritual work. Additionally we learnt about â€Å"Dante’s Inferno† which tells a story of Dante whose girlfriend had been taken away from him by Lucifer or Satan.Dante then met Virgil a famous poet born before Christ therefore he was stuck in limbo which is not hell or heaven. Dante and Virgil entered the wide gates of Hell and descended through the nine circles.. In each circle they saw sinners being punished for their sins on earth. We also explored William Blake’s poem the Proverbs of Hell including quotes in our narration using it to present the Seven Deadly Sins with accuracy. For our first workshop we explored and evaluated the use of Still Images and Transitions. The class was split

The Colonialism Of The Walt Disney Company - 1571 Words

My topic is the colonialism of The Walt Disney Company. When defining colonialism, I will be referring to two general definitions that are applicable to modern day colonialism as seen through cultural appropriation, and cultural commodification of Disney and the tourist industry. Oxford Dictionaries defines colonialism as, â€Å"the policy or practice of acquiring full or partial political control over another country, occupying it with settlers, and exploiting it economically,† and Stanford Encyclopedia of Philosophy’s defines colonialism as, â€Å"a practice of domination, which involves the subjugation of one people to another.† My case study is the Disney movie, Moana. I am focusing on Moana because it is the most recent Disney animated film†¦show more content†¦I will use box office sales and other prominent statistics associated with the Disney company to help demonstrate the influence Disney has on the public. Pedagogy scholars Kevin M. Tavin and David Anderson’s journal article, â€Å"Teaching (Popular) Visual Culture: Deconstructing Disney in the Elementary Art Classroom† informs readers of the power of the Disney company in all medias to create â€Å"individual and collective identities† (23). In journal article, â€Å"Tackling MÄ ori Masculinity: A Colonial Genealogy of Savagery and Sport†, MÄ ori scholar Brendan Hokowhitu will build off this source by not only referencing cultural stereotypes formed by others, due to the media, but also identities formed about one’s own native culture and heritage. He uses a direct example of MÄ ori men stereotypes. I plan to synthesize many of my sources like this: with one showing a various perspective (i.e. pedagogical or colonial) on the Disney company and another highlighting the point of view from a Polynesian. The book, Waves of Resistance, by Isaiah Helekunihi Walker, a Hawaiian surfer and scholar of Hawaiian history and colonialism, delves into Polynesian stereotypes that have been present since eighteenth century colonialism. This source provides background on this topic for my paper. These Polynesian stereotypes include women sexualized with coconut bras and grass skirts, and men portrayed as ignorant savages.Show MoreRelatedAulani Marketing Report3654 Words   |  15 PagesIntroduction This marketing research project is developed to benefit the future development of Aulani, a Disney Resort and Spa, especially focus on green marketing perspective. In this project, the format of marketing plan is followed and it has four main parts. First, a general business description is given, having an overview of Aulani. Second, the internal business environment of Aulani is analyzed, from both fundamental principal of marketing perspective and green marketing perspective. FollowingRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 Pagesinterior of India and China. By the 1910s in China, the Chinese used Swedish or Japanese matches to light cigarettes sold by the British American Tobacco Company and lamps filled with Standard Oil kerosene so that they could see more clearly while using their Singer sewing machines. The Indian countryside was also decisively transformed by colonialism and integration into global markets—albeit with policies that at times made Indians less mobile rather than more so. But the 30 †¢ CHAPTERRead MoreOrganisational Theory230255 Words   |  922 PagesUniversity Joanne Duberley Birmingham Business School, The University of Birmingham Phil Johnson The Management School, The University of Sheffield . Pearson Education Limited Edinburgh Gate Harlow Essex CM20 2JE England and Associated Companies throughout the world Visit us on the World Wide Web at: www.pearsoned.co.uk First published 2007  © Pearson Education Limited 2007 The rights of Joanne Duberley, Phil Johnson and John McAuley to be identified as authors of this work have been asserted

Bluetooth Essay Example For Students

Bluetooth Essay BLUETOOTHTechnology is constantly advancing in all different directions. Some see it as a good thing others see it as a horrible tragedy. Personally I feel that with out technology the quality of the lives we live would still be the same we just would not be able to communicate with each other as easily. Communicating with each other is a very important and vital brick in the building block of our daily lives. Just imagine how much you could get accomplished if you could not communicate with anyone; other than those close enough to you to talk to. Imagine if it still took three or four days to get a letter from California to New York. Would businesses be able to operate at the same speed? Communications however, effects much more than just the business world. Communications effects our daily lives. Recently a new technology was introduced to the electronics world. This technology is known as Bluetooth. Bluetooth is a wireless networking standard for your personal area that provides l icense-free operation in Europe, Japan, and the United States. What makes Bluetooth so special is its ability to create a wireless link between devices equipped with this new technology. Bluetooth opens us up to a new level of data communications. By making it possible to communicate wirelessly to any device equipped with a Bluetooth chip. Mobile phones can communicate with lap top computers, digital daily planners can be linked to personal computers and have e-mail down loaded to them the moment it is sent a multitude of possibilities are born. Bluetooth works on a 24.5 GHz ISM free band which means that there is no restrictions for travelers using Bluetooth enabled equipment. For transmission of information between Bluetooth enabled devices there is no necessary line of sight, which means that these devices do not work in the same fashion that television remote controls work. Devices that are equipped with Bluetooth can communicate room to room or from different floors in an office building instantaneously sharing and updating information. The baseband protocol for the Bluetooth chip is a combination of circuit and packet switching, which makes it possible to transmit both voice and data with the same device. The Bluetooth chip has two channels one channel capable of transmitting a 64 Kbit/s synchronous (voice) link, while channel two the asynchronous channel can support a 721Kbit/s asymmetric link in either direction. Both channel one and two are transmitted while allowing 57.6Kbit/s of information in the return direction. The actual link range is anywhere from 10cm to 10m between devices, however links can be extended to 100m+ by increasing the transmit power.Data terminal equipment (DTE) uses a method of establishing a temporary full-duplex connection to another data station known as circuit switching. Once a connection is made the channel and the bandwidth provided by the switching network become exclusive to the equipment being used until the connection is broken by one of the stations. Once a switched connection is made all of the data being communicated is transmitted on the same channel for the entire transmission. No time buffering is necessary making this method of exchanging data very effective when you are dealing with high data transfer rates. Packet switching is another method of data communications that until recently had been the most advanced and established method of data switching technology used for Wide Area Networks. (Warren Hioki, pg. 374). Packet switching breaks down the information being sent into units of variable length known as packets. Breaking the information down in to packets makes it possible to have multiple users on the same channel. Packets of information are assembled and disassembled by a P.A.D. (packet assembler/disassembler). These packets of information do not necessarily end up at the receiving end in the same order in which they are sent, nor do they take the same line of transmission. The packets are gathered at the receiving node and placed in their o riginal order. Bluetooth technology seems to be a very important step in communications field. Being able to update the files in your personal computer through your laptop, or access the Internet through your phone or digital planner can prove to be almost a necessity in big business today. This however is only the first step. The kind of technological advances that we can expect to see in the not so distant future will probably be shocking. Hopefully with all of this technology at our fingertips we as a society will not loose sight of what is really important.

Surprise under the carpet at Northern Sigma

Information learnt about the plant Northern Sigma is a state of the art company that embraces up to date technology in the manufacture of advanced technology equipments. The company is located in South Africa and has several plants distributed in the country. Among them is the Midrand plant that is managed by Peter Barnes.Advertising We will write a custom assessment sample on Surprise under the carpet at Northern Sigma specifically for you for only $16.05 $11/page Learn More This plant has a policy of employing women and disadvantaged groups from the population of the local society. This is because these groups have been neglected in the employment sector as they only constitute of 13% of the working force. The strategy has been working well up to the last two years when the plant started to experience some complains. A research was therefore conducted to investigate this issue. From the results, it is evident that there is lack of team work, communicat ion, coordination, respect and organization culture in the firm (Robbins et al, 2011). The two groups that were investigated in the research (women and disadvantaged group and the management) contained different views on the same matter. They both blamed the other party for the problems that were being experienced in the firm. Cause of the problem These problems could only come up if poor leadership is being exercised in the plant (Robbins et al, 2011). The manager of the plant should have and exercise good leadership skills and qualities. Sound leadership ensures that there is an organization culture which has to be adopted and followed by all the employees (Robbins et al, 2011). There should also be respect among all the employees of the firm. Team work should be emphasized (Robbins et al, 2011). The manager should also involve all employees in decision making regardless of the rank they hold in the firm. He should come up with a forum that explores their ideas and innovations. Al l these qualities are not present at the Midrand plant and this had played a great role in the promotion of the problems that are being experienced at the plant (Robbins et al, 2011).Advertising Looking for assessment on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More Consequences of these problems The persistence of these problems might lead to the downfall of the plant. The poor leadership skills that are being exercised at the firm will lead to lack of coordination among the employees. The firm will experience increased expenditure in the recruitment programme due to the high rate of employee turnover. This is due to the poor working conditions that are present at the firm (Robbins et al, 2011). The lack of team work will reduce the rate of production and the quality of the products. This will reduce the revenue earned by the firm and the level of customer satisfaction. It will therefore be very hard for the firm to ac hieve its goals and objectives, run into losses and become unsustainable in the long run. Who is to blame? It is the manager’s fault that the plant is experiencing these problems. As a leader, he should ensure that the employees have respect for one another, work together as a team, motivate them and provide a conducive working environment for them. Most importantly, the he should have up to date information of the situation at the ground which will assist him in formulating policies and guidelines that will ensure that operations at the firm are effective and efficient. Barnes failed at this; he was managing the firm on decision based on assumptions. Recommendations To improve the operations of the firm, a good leadership model should be adopted by the firm which does not embrace bureaucracy (Robbins et al, 2011). The manager should ensure that the employees have respect for one another, a conducive working environment is present and that his staff work together as a team. H is administration should recognize and reward their hard work and provide an avenue for individuals to rise up the ranks in the organization. As stated by Robbins et al (2011) these improvements can only be achieved if the firm has a sound organization structure (p. 501-507).Advertising We will write a custom assessment sample on Surprise under the carpet at Northern Sigma specifically for you for only $16.05 $11/page Learn More Reference Robbins, S.P., Judge, T.A., Millett, B, and Boyle, M. (2011). Organizational Behaviour.  Frenchs Forest: Pearson. This assessment on Surprise under the carpet at Northern Sigma was written and submitted by user Jace P. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Sweatshops essays

Sweatshops essays How do Sweatshops tie into our Nations Products? Many companies and schools in the United States buy their products from factories that have their workers working in horrible conditions. That is employing over 50,000 workers to work in these conditions. They have the workers work from 5 A.M. until nighttime inhaling dangerous chemicals and working in temperatures that get as high as 130 degrees. These high temperatures cause heat stress, burns, and injuries to workers. Many of the factories that the United States buys from are in another countries. In these countries they have horrible working conditions. Working in these places called sweatshops should be banned. Sweatshops are a shop or factory in which employees work long hours at low wages under poor conditions. These factories cause problems for their workers later in the worker's life. Occasionally these problems lead to death. Many workers do not get to see a doctor when they are ill. Workers choose to go work to make money rather than see a doctor. Most do not receive regular vaccinations that help their body fight against "smallpox, whooping cough, tetanus, polio, and diphtheria". A sweatshop factory brings visions of dangerous, filthy, and cramped conditions. Many of these sweatshops do not pay their workers the right amount. "In Bangladesh and Myanmar, they pay ten to eighteen cents; in China, Pakistan, Vietnam, India, Sri Lanka, and Indonesia they pay twenty to sixty-eight cents per hour. Why do owners pay their workers so little? The wages they give these workers should be different. Many of these factories hire children who are ineligible to work in these places. About 250 million children between the ages five and fourteen work in sweatshops. Half of these children are working full time and one third of them are working in extremely dangerous conditions. These children do not belong working in such dangerous conditions. "Many of these childre...

9 Things I Learned From Rewriting My First Childrens Books Series

9 Things I Learned From Rewriting My First Childrens Books Series 9 Things I Learned From Rewriting My First Children's Book Series As a primary school teacher, Heather B. Moon always knew she eventually wanted to write books for children. She also felt that she had a leg up in terms of knowing her market. In this article, she discusses what she learned from rewriting her first series of children's books with the help of a professional developmental editor.   Lessons learned? You can see how I made changes that addressed the problems that we talked about earlier:Introducing secondary characters: I brought other characters into the story in a more entertaining way. But more importantly, I have introduced them through Lottie’s eyes! She is still the main focus of the story, and the people around her have been woven into the action instead of taking the main stage.Show, don’t tell: I must admit it took me a while to get the hang of this - but once I did, my brain fizzed and frothed with ideas. See what I did there? Don’t say: â€Å"I thought of an idea† - that is boring adult speech. If your character is feeling frightened, write something like: â€Å"I felt a giant chunk of ice plop into my tummy.† This is much more appealing to a child and gets the feeling across that the character is scared.Make current, relatable references: Kids might not know what a DVD is - but I’ll bet they can all identify with hoping for WiFi to continue their interrupted iPad games!The young readers I have shared Lottie’s story with have responded well - and a lot of it is thanks to the changes that Rachel and I made to my dialogue and prose. 9 tips for writing books that children will want to read again and again. That’s the best tip I have for other writers looking to publish children’s books: understand how your little readers see the world and talk to them on their level. It might not be as easy as 1-2-3, but with supportive people in your corner, you’ll be on your way to sparking the imaginations of a new generation of readers.Please share your thoughts, experiences, or any questions for Heather B. Moon  in the comments below!Lottie Saves the Dolphins is available on Amazon and on Amazon Kindle!

Human Resource Management in the Context of Organizations and Their Essay

Human Resource Management in the Context of Organizations and Their Environments - Essay Example Human resources management is an organization sector which is crucial for the performance of a specific firm. In its area, there are several theories that have tried to examine the conditions and the terms on which a hr strategy should be applied. In this context, Jackson et al. found that HRM can be used as ‘an umbrella term that encompasses (a) specific human resource practices such as recruitment, selection, and appraisal; (b) formal human resource policies, which direct and partially constrain the development of specific practices; and (c) overarching human resource philosophies, which specify the values that inform an organization's policies and practices’. On the other hand, Ulrich notices that ‘HR professionals can apply innovative ways to develop current employees, including: new and stretch job assignments, membership on project teams, action learning in training experiences, leaders running training programs, 360[degrees] feedback, coaching, Web-based bes t practice and learning mechanisms, and Web-based skill building’. In order for the above hr strategies to succeed in their mission, the existence of continuous employee support would be necessary. For this reason Elsdon et al. stated that ‘a person-to-person career counseling should be offered to the extension that such an activity creates greater workforce flexibility by enabling employees to respond rapidly to a changing environment and customer needs’.

The Book of Kells and its influence on the State of Arizona Research Paper

The Book of Kells and its influence on the State of Arizona - Research Paper Example It contains full pages of extraneous decoration for the canon tables; symbols and text of the evangelists Matthew (the Man), Mark (the Lion), Luke (the Calf) and John (the Eagle); the opening words of the Gospels; the Virgin and Child; a portrait of Christ, and complex narrative scenes such as the earliest to survive in gospel manuscripts which corresponds the arrest of Christ and his temptation by the Devil. The word Christ has been abbreviated with letters Chi Rho in medieval manuscripts and Chi Rho page is the most famous page in medieval art which introduces Matthew’s account of the nascence. However, the book is not a full copy of the Vulgate and contains a number of variations from the Vulgate and also some uncorrected errors. It is assumed that around 30 folios of the text had been lost in the medieval and early modern periods and some pages are deteriorated.3 According to experts, the handwriting differs throughout the text therefore the artwork seemed to have produced by at least three different artists.4 Today the manuscript contains 340 folios with 330 by 250mm dimensions, and scriptures are written with a range of pigments including yellow, red, green, purple and black. The manuscript is believed to have created by Celtic monks in year 800, but the date and origin of the book has been a controversial issue. The widely accepted belief is that the text creation might have started at Iona from where it was brought to Abbey of Kells, when Vikings invaded the island of Iona, where the artwork might have been continued to be undertaken. The text was revered at Kells as a souvenir of Saint Columba throughout the medieval periods. The Book of Kells is the considered to be one of the finest manuscripts and described as â€Å"the chief treasure of the Western world†. The Annals of Ulster record stealth of the book in year 1006 and that it discovered again after many years, stripped off its ornate gold. Around 1653, the Book of Kells was sent to Dublin, Ireland for safety concerns and after few years it was brought to Trinity College, Dublin where it has been on display in library over there. The text has been bound in four volumes, since 1953, of which two volumes can commonly be seen in library, one opened to display a major decorated page, and the other to show two pages of script.5 A quote of Sir Edward Sullivan demonstrates the concept of how mind-bending the artwork of The Book of Kells: "The finest draftsmen of the entire world have tried to recreate the Chi-Rho page, and have failed." Anyone in today's modern world could not recreate it as it takes an ineffable artist working in the Middle Ages to create something.6 However, in 1951, the first facsimile of the Book of Kells was produced by a Swiss publisher, Urs Graf Verlag Bern, in black-and-white photographs and color reproductions as well. Second facsimile in full color was produced in 1974 by photographers Thames and Hudson in Dublin, and included all the full-p age detailed illustrations and also an ornamentation representative section in the manuscript. In the 1980s, Faksimile-Verlag Luzern produced with permission from Trinity College,

Things Fall Apart by Chinua Achebe Essay Example for Free

Things Fall Apart by Chinua Achebe Essay In Chinua Achebes Things Fall Apart, Okonkwo plays the role of father to his son, Nwoye, and his daughter, Ezinma. Okonkwos fear of looking weak like his father, which can be interpreted as his tragic flaw, causes him to expect more from both of his children and to act rashly, similar to the behavior of my father. Although both relationships—the relationship between Okonkwo and his son and the relationship between my father and I—involve disagreements between father and son, I constantly aim to see eye to eye with my father, just like Okonkwo and Ezinma, whereas Nwoye does not attempt to fulfill his fathers wishes. The relationship between Okonkwo and Nwoye is one of disagreement, contretemps, and failure; Okonkwos inflexible expectations are not reached which triggers tension. This conflict commences at the start of the novel but at this point it seems minor: Okonkwo is merely concerned that his son shows some characteristics of his lazy father, Unoka. He is trying to prevent this by all means but it starts to become somewhat undeniable. Okonkwos features being strong, hard-working, and somewhat misogynic conflicts with the impudent, weak, eccentric, and indolent characteristics of Nwoye. Though as the story proceeds, it seems likely that the relationship will be repaired: Ikemefunas involvement in Nwoyes growth puts Nwoye on the path sought by Okonkwo. Unfortunately, this period of healing is disturbed by Okonkwo taking part in Ikemefunas death which results in the fear of Okonkwo by Nwoye and the lack of trust between the two. This instability continues throughout the majority, if not the entirety, of the book. Ezinma, the only child of Okonkwos second wife, Ekwefi, has a relationship with Okonkwo that shows understanding and agreement, unlike Nwoyes relationship. Surprisingly enough, this relationship is rather implicit since Okonkwo doesnt speak to Ezinma a great deal of times, especially when compared to Nwoye. This may be due to the fact that she is a girl and she is generally not involved with masculine tasks that would bring her closer to Okonkwo. Still, Okonkwo believes that she should have been a boy (61) and she continually attempts to carry out masculine duties such as bringing Okonkwos chair to the wrestling match, which is said to be a boys job (45).  This form of complement establishes amplification of the bond that is made between Okonkwo and Ezinma. My father and I have a relationship that consists of clashing points of view, similar to the link between Okonkwo and Nwoye. We have frequent arguments, abundance of miscommunication, and we fail to see eye-to-eye. Both my father and Okonkwo seem to possess this stubborn feature which, in turn, results in senseless disputes. In fact, in chapter 5, Okonkwo initiates an argument about a dead banana tree which actually is alive; he ends up giving Ekwefi a beating because she merely cut off a few leaves to wrap some food (39). Another aspect they both share is their large amount of accomplishments; my dad being a successful translator who has traveled the world and Okonkwo being a famous wrestler and a leader of the Umofia clan has lead to higher expectations in their children, specifically Nwoye and I. This causes us distress while trying to reach that expectation and results in disappointment from our fathers when we dont attain it. This kind of pressure is not asserted on Ezinma because she does not have to meet any expectations, besides doing feminine tasks like cooking, cleaning, etc. Though, Ezinma and I do share the aspect of attempting to see eye-to-eye with our fathers, generally unlike Nwoye; Nwoye seems to make an attempt when he starts grumbling about women, building the walls of the obi, and doing other masculine actions but in reality, he just trying to fit in with the patriarchal clan. Therefore, Ezinma is similar to me when it comes to intention, but different to Nwoye and me when it comes to the circumstances. In conclusion, the novel emphasizes the importance of parental influence on the child, whether positive or negative. The analysis of Nwoye and Ezinma has taught me to generally stay on the path made for me by my ancestors and my parents in order to avoid conflict and I believe that I could teach them that although that path may be tough, the end result will be satisfying to both them and their parents. Works Cited Achebe, Chinua. Things Fall Apart. New York: Fawcett, 1985.

Essay --

Jonathan Swift’s Gulliver’s Travels is a magnificent story of adventure, satire and fantasy that has entertained many readers from all over the world. This text is a multi-genre work that embroils, all at the same time, travel adventure writing as well as fantasy writing, and satirical probe of politics, colonialism, human characteristics and human ideals. When readers of the 21st century view multi-genre work such as Gulliver’s Travels, criticism, effortlessly, can categorize the book into one simple genre. Contemporary readers perceive Gulliver’s Travels as an imaginary saga full of little people, giants, flying islands and horse people. In 1726, when the book was first published the readers approached the text differently. The birth of storytelling created a powerful stage for social annotation. This stage can be traced back from present day ordinary literary works of science fiction and fantasy to Homer, Ovid, George Orwell and many more. Jonathan Swif t with his creative spirit shaped his own special effects, without any motion animation or any software, thus all of his satire set the main platform for the later literary genres. His travel literature created the blueprints for present day pulp fiction. In the final book of Gulliver’s Travels, the narrator describes his visit to Houyhnhnms. Houyhnhnms are very intelligent race of horse people, who live along side of ruthless human like creatures called the Yahoos. The readers should take good note of the Yahoo people, because it shows evidence that Swift contributed to present day vocabulary as well as the internet. The fantasy genre can also be considered an extension of Swift’s blueprints. Presently countless fantasy novels use a map as the main guide for the readers. Surely,... ...ses these little changes to convey his satire through the use of fantasy and travelogue genre. After the first journey, Gulliver’s image of humankind is a bit changed, similarly his view declines through the second and third voyage, until he meets the Yahoos on his fourth journey. This way Swift was able to insert his own interpretation of the human condition. When one analyzes the human condition, many tragic flaws can be discovered, but because of our ability to reason, human beings are capable of changing for the better. Nonetheless, flaws of pride keep us from gaining the ideal qualities that are personified in Houyhnhnm reason and Brobdingnaggian morality. Through the analysis of Swift’s satire, fantasy, and travelogue adventure genre it is notable to say that Gulliver’s Travels is Swift’s greatest satirical attempt to bring perspective and truth to the table. Essay -- Jonathan Swift’s Gulliver’s Travels is a magnificent story of adventure, satire and fantasy that has entertained many readers from all over the world. This text is a multi-genre work that embroils, all at the same time, travel adventure writing as well as fantasy writing, and satirical probe of politics, colonialism, human characteristics and human ideals. When readers of the 21st century view multi-genre work such as Gulliver’s Travels, criticism, effortlessly, can categorize the book into one simple genre. Contemporary readers perceive Gulliver’s Travels as an imaginary saga full of little people, giants, flying islands and horse people. In 1726, when the book was first published the readers approached the text differently. The birth of storytelling created a powerful stage for social annotation. This stage can be traced back from present day ordinary literary works of science fiction and fantasy to Homer, Ovid, George Orwell and many more. Jonathan Swif t with his creative spirit shaped his own special effects, without any motion animation or any software, thus all of his satire set the main platform for the later literary genres. His travel literature created the blueprints for present day pulp fiction. In the final book of Gulliver’s Travels, the narrator describes his visit to Houyhnhnms. Houyhnhnms are very intelligent race of horse people, who live along side of ruthless human like creatures called the Yahoos. The readers should take good note of the Yahoo people, because it shows evidence that Swift contributed to present day vocabulary as well as the internet. The fantasy genre can also be considered an extension of Swift’s blueprints. Presently countless fantasy novels use a map as the main guide for the readers. Surely,... ...ses these little changes to convey his satire through the use of fantasy and travelogue genre. After the first journey, Gulliver’s image of humankind is a bit changed, similarly his view declines through the second and third voyage, until he meets the Yahoos on his fourth journey. This way Swift was able to insert his own interpretation of the human condition. When one analyzes the human condition, many tragic flaws can be discovered, but because of our ability to reason, human beings are capable of changing for the better. Nonetheless, flaws of pride keep us from gaining the ideal qualities that are personified in Houyhnhnm reason and Brobdingnaggian morality. Through the analysis of Swift’s satire, fantasy, and travelogue adventure genre it is notable to say that Gulliver’s Travels is Swift’s greatest satirical attempt to bring perspective and truth to the table.

Inflation: Definitions Essay

Inflation: A persistent increase in the price level, measures how much more expensive a set of goods and services has become over a certain period, usually a year. Consumers believe that low stable and predictable inflation is best for economy, too high and too low are not good. Measuring Inflation: To measure the average consumers cost of living, government agencies conduct household surveys to identify a basket of commonly purchase items and then track the cost of purchasing this basket over time. Consumer Price Index: (CPI) The cost of the basket when measuring inflation at a given time expressed relative to a base year. Consumer Price Inflation: The percentage change in the CPI over a certain period, most widely used measure of inflation. Ex: base year CPI is 100 and the current CPI is 110 inflation is 10 percent over the period. Core Consumer Inflation: Excludes prices set by the government and the more volatile prices of products such as food and energy that are most affected by seasonal factors or temporary supply conditions focuses on the underlying and persistent trends in inflation and is also watched closely by policymakers. Deflation: A persistent decline in the price level GDP Deflator: A measure comparing the prices of all goods and services produced in the economy during a given year to the prices of those goods and services purchased in a base year. Gross Domestic Product Deflator: (GDP) The overall inflation rate for not just consumption good but all goods produced in an economy, more broader coverage than the CPI. Inflation Rate: The percentage increase in the price level from one year to the next. Inflation Targeting: A policy used to maintain low and stable inflation used by many central bankers. Introduction of New Goods: Increase variety, allows consumers to find products that more closely meet their needs. In effect, dollars become more valuable, which lowers the cost of, maintain the same level of economic well-being. The CPI misses this effect because it uses a fixed basket of goods, thus the CPI overstates increases in the cost of living. Nominal GDP: Values output using current prices. It is not corrected for inflation. GDP measured in terms of current market prices, value of all final goods and services produced in the economy during a given  year, calculated using the prices current in the year in which the output is produced. Price Indices: Are designed to remove the effect of price changes. Price Level: A measure of the average prices of goods and services in the economy. Quantity Theory of Money: The relationship between money supply and the size of the economy. Real GDP: Values output using the prices of a base year. Real GDP is correct for inflation. GDP measured using constant base year prices. It is the total value of the final goods and services produced in the economy during a given year, calculated using the prices of a selected base year. Real Income: A proxy for the standard of living, when real incomes are rising, so is the standard of living and vice versa. Real Interest Rate: The nominal rate minus the inflation rate. Substitution Bias: Over time some prices rise faster than others, consumers substitute towards goods that become relatively cheaper, the CPI misses the substitution because it uses a fixed basket of goods. Thus, the CPI overstate increase in the cost of living. Supply shocks: Disrupt production, such as natural disasters or raise production costs such as high oil prices. Can reduce overall supply and lead to cost push inflation in which the impetus for price increases comes from disruption in supply. Unmeasured Quality Change: Improvements in the quality of goods in the basket also increase the value of a dollar. The BLS tires to account for quality changes but probably misses some, as quality is hard to measure. Thus, the CPI overstates increases in the cost of living.

Drugs and Society Essay

1b. List and describe briefly the major structures of the brain, as presented in your textbook, including the function of those elements that are most related to psychoactive drug reaction. The first layer of the brain is the cortex which covers the top and sides of the brain. This area controls reasoning and language, and this area will be less active when under sedative drugs. The basal ganglia are located underneath the cortex and it is made up of by the striatum. The striatum controls muscle tone and is part of the dopamine pathway which is a potential transport highway for psychoactive drugs. The hypothalamus is at the base of the brain and serves as liaison between the brain and pituitary gland. The pituitary hormonal output is involved in behaviors such as feeding and temperature regulation. The limbic system affects emotion, location memory, and physical activity. Along the brain stem are the medulla, midbrain, and pons from which contain the bulk of neurons that create dopamine, norepinephrine, and serotonin. The lower brain stem controls vomiting and respiratory functions. If affected, the respiratory function can be suppressed by drugs. 1c. Describe the life cycle of a typical neurotransmitter. A cell membrane with the uptake of a particular precursor absorbs amino acids to create a neurotransmitter. The amino acids undergo synthesis with a reaction with enzymes to become a neurotransmitter. Once created, the neurotransmitters are stored in vesicles until they are released into the synapse. Once released, the neurotransmitters will attempt to attach to the membrane of neurons. If the neurotransmitter does not make it to the neuron, then it will either absorb in the originating cell or be metabolized within the synapse. 2b. Differentiate between drug disposition tolerance, behavioral tolerance, and pharmacodynamics tolerance, and provide reasons why these concepts should be taken into account when determining the effects of a drug. Drug disposition tolerance is defined as the increase of the drug’s rate of metabolism or removal. The user may increase the amount of a drug taken due to the drug being metabolized too quickly or being removed from the body. A person may compensate their behavior when exposed to a drug overtime such as learning to drive while intoxicated. The impairment is reduced and this is known as behavioral tolerance. Pharmacodynamics tolerance is the main contributor to the need to increase the dosage of a drug in order to avoid withdrawal symptoms. The user does not feel the same effects of a dosage so the dosage must be increased in order to get the same feeling. 2d. Provide several specific personal and societal steps you would recommend in an effort to reduce the likelihood of adverse reactions to drugs taken in combination. The largest deficit that can be produced to avoid adverse reactions to drug taken in combination is to avoid doing it all such as alcohol and other depressants. Individuals that need to take multiple medications such as person with diabetes and high blood pressure need to be carefully monitored and educated on the effects of the medications individually and the effects of the medications when combined. 3b. Explain the basic rationale and theoretical foundations for the extensive use of amphetamine in the treatment of ADHD (attention-deficit hyperactivity disorder). ADHD individuals have deficits involved with the functions of executive control within the brain. This control center affects concentration, hyperactivity, and learning. Amphetamines have been shown to produce a calming effect upon the individual from the amphetamines ability to increase brain catecholamine activity whereas ADHD individuals suffer from catecholamine deficits in the prefrontal cortex. 3c. Provide your personal viewpoint on major concerns about ADHD diagnoses and the efficacy of drug treatments that have led to recent controversy. The basis of diagnoses of ADHD has not been fully researched due to any widely accepted knowledge as to why stimulants are effective in treating hyperactivity. The causes of ADHD are still not thoroughly understood. There have also been non-stimulant drugs that have been shown to be just as effective as stimulants such as Strattera and Atomoxetine. I believe that ADHD itself is a complicated issue that requires multiple points of attack such as the use of stimulant and non-stimulant drugs. What may work on one individual may not work on another. 4a. Provide evidence of your understanding of the ways in which time course events of barbiturate and benzodiazepine actions contribute to the onset of psychological and/or physical dependence. Barbiturate are fast acting drugs that may work within fifteen minutes and stay in the system for up to three hours. Due to the rapid activity of the barbiturates, they serve as a strong reinforcement to users due to the drug produced a desired effect quickly and leaving the body just as quickly. Benzodiazepine takes longer to initialize, but also stay in the body for up to ten hours. Barbiturates are taken in higher doses more rapidly, while Benzodiazepine is taken at lower does. Withdrawal symptoms of barbiturates from chronic symptoms are severe due to the rapidness the drug leaves the user’s body without the user’s body being able to adapt to the drug adequately. 4b. Describe the key functions of GABA (g-aminobutryic acid) in producing the effects of various sedative-hypnotic agents, with specific reference to benzodiazepines. GABA is a neurotransmitter that is found in CNS areas and deals with inhibitory functions. Benzodiazepine molecules are strongly attracted to the GABA receptor sites and when bound to the GABA receptor, the Benzodiazepine molecules will increase the inhibitory effects of GABA on the receptors.

Introduction to Leadership Essays - Free Essays, Term Papers

Introduction to Leadership Essays - Free Essays, Term Papers Introduction to Leadership 1. (a)Theories and styles leadership Trait theory This theory recommends that effective leadership is a merger of skills that describes leadership actions and capabilities. The leadership of Coca Cola Company evaluates the workers psychological qualities emphasizing on unique abilities. The CEO of the company assesses the staff based on their actions and job structures. This theory recommends that the ownership of the abilities and traits such as tolerance to stress, persistence, desire to influence others, achievement oriented, ambition, fluent in speaking, and conceptually skilled employees confirms successful goal-orientated leaders in Coca-Cola Company and retaining such employees will be a great focus to the company. Behavioral Theory This theory states that leaders are always made and not born. Leadership abilities are learnt over time and they are not actually inborn qualities but they are successful behaviors of understandable and describable actions that are easier to learn than assuming different abilities. The top leadership of Coca-Cola Company gives employees opportunities to study and create leadership skills monitoring the enhancement from time to time and also choosing employees who possess effective leadership traits. It is moderately easier to assess leaders and leadership traits when developing a behavioral theory in a company. The CEO identifies the behavior use which increases to failure which is added to the layer of understanding. Participative Theory This theory intends at creating an understanding to making decisions in different situations. The theory recommends that persons working in teams must be more cooperative and less competitive. Decision making based on team work is better and more committed than individual persons. Coca Cola Company uses this theory to emphasize on the growth of groups for more focused and supportive decision making rather than working individually. Leaders are carefully chosen based on abilities such as cooperation, commitment, collaboration, and motivation friendly behavior where different programs are prepared so that the team member can create and develop the leadership skills. Leadership Styles The general method of leadership used by the manager is called a management style. The Coca-Cola company motivation to its workers to meet their goals will be based on the management style they will adapt. It therefore uses the following styles of management but each one in different departments. Democratic Style This leadership style comprises of the leader, sharing the decision making capabilities with the team members by promoting their interests and by practicing social equality. This emphasizes on team agreements to create new ideas. The democratic management style of leadership is of two types namely; democratic and consultative democratic. Democratic style is where all leaders, junior members and workers are included in the final decision making process and creating of new ideas. All team members are equal in that no-one has higher level than the others. This management style has been adopted by the Coca Cola Company. Teams and individuals are given tasks and making decisions within a specified framework and they are liable for their actions if anything wrong occurs. Democratic managers listen and act on the views of the team and this will make the workers to be happy and highly productive. Autocratic or Authoritarian style This autocratic type of a leader maintains strictness, close control over the team members by maintaining close rules of the procedures and policies given to the workers. Leaders ensure to only generate a distinct professional relationship to keep main emphasis on the difference of the autocratic manager and their workers. There is no negotiation and is very prescriptive and there is little job satisfaction because the manager makes all the decisions. Nevertheless, the job is quickly done and there is less no conflict between different. At Coca Cola Company, autocratic style is used because workers are controlled by the leaders and follow their instructions. Laissez-faire management style This leadership style is defined as hands off because the manager divides tasks to their employees, while providing little or no direction to the employees. Managers and directors of the company take this style to run their businesses if the employees are meeting their key business indicators. Leaders have a vision to revive every worker each day and the values to take pride in their job, to be true, fair and determined to win and have a passion for their actions. Consultative democratic This style is

Biography of Sarah Bernhardt, French Actress

Biography of Sarah Bernhardt, French Actress Sarah Bernhardt [born Henriette-Rosine Bernard; October 22,  1844- March 21, 1923] was a French stage and early film actress whose career spanned over 60 years. During the late 19th and early 20th centuries, she dominated the world of acting with lead parts in acclaimed plays and motion pictures. She is widely regarded as one of the greatest actresses of all time and one of the first actresses to garner worldwide fame.   Early Life Sarah Bernhardt was born Henriette-Rosine Bernard on October 22, 1844 in Paris. She was the daughter of Julie Bernard, a Dutch courtesan who catered to a wealthy clientele.   Her father has never been identified. At age seven, she was sent to a boarding school where she performed on stage for the first time, playing the role of the Queen of the Fairies in Clothilde. Around the same time, Bernhardts  mother started dating the Duke de Morny, the half-brother of Napoleon III. Affluent and highly influential in Paris society, he would play a key role in the development of Bernhardts acting career. Although Bernhardt was more interested in becoming a nun than an actress, her family decided she should give acting a try. Together with their friend, playwright Alexandre Dumas, they brought Bernhardt to the Comà ©die-Franà §aise, France’s national theater company, for her first theater performance. Moved to tears by the play, Bernhardt was comforted by Dumas, who called her â€Å"my little star. The Duke told her she was destined to act. First Stage Performances In 1860, with the help of Morny’s influence, Bernhardt  was given the chance to audition at the prestigious Paris Conservatory. Coached by Dumas, she recited the fable of The Two Pigeons by La Fontaine and managed to persuade the school’s jury. On August 31,  1862, after two years of acting studies at the conservatory, Bernhardt made her debut in Racine’s Iphigà ©nie at the Comà ©die-Francaise. Playing the title role, she suffered from stage fright and rushed through her lines. Despite the nervous debut, she continued to perform and played Henrietta in Molià ©re’s Les Femmes Savantes and the title role in Scribe’s Valà ©rie. She didn’t manage to impress the critics and after a slapping incident with another actress, Bernhardt was asked to leave the theater. In 1864, after a brief affair with a Belgian prince, Bernhardt  gave birth to her only child, Maurice. In order to support herself and her son, she accepted minor roles at the melodrama theater Port-Saint-Martin and was eventually hired by the director of the Thà ©Ãƒ ¢tre de lÓdà ©on. There, she would spend the next 6 years establishing herself and developing a reputation as a leading actress.  Ã‚   Career Highlights and the Rise of Motion Pictures In 1868, Bernhardt had her breakthrough performance as Anna Damby in Dumas’  Kean. She received a standing ovation and was instantly given a salary raise. Her next successful performance was in Franà §ois Coppà ©e’s Le Passant, in which  she played the part of the troubadour boy- the first of her many male roles. During the subsequent  decades, Bernhardt’s career flourished. Upon returning to the Comà ©die-Franà §aise in 1872, she starred in some of the most demanding roles of the time, including lead parts in Voltaire ´s Zaire and Racine’s Phà ©dre, as well as Junie in Britannicus, also by Racine. In 1880, Bernhardt accepted an offer to tour the United States, which would be the first of many international stage tours of her career. After two years of touring, Bernhardt returned to Paris and purchased the Thà ©Ãƒ ¢tre de la Renaissance, where she operated as artistic director and lead actress until 1899.   At the turn of the century, Bernhardt became one of the first actresses to star in motion pictures. After starring  in the two-minute film Le Duel d’Hamlet, she went on to act in La Tosca in 1908 and La Dame aux Camelias. However,  it was her portrayal of Elizabeth I in the 1912 silent film The Loves of Queen Elizabeth that truly made her rise to international acclaim. Later Life and Death In 1899, Bernhardt signed a lease with the city of Paris to renovate and manage the Thà ©Ãƒ ¢tre des Nations. She renamed it Thà ©Ãƒ ¢tre Sarah Bernhardt and opened the theater with a revival of La Tosca, followed by her other major successes:  Phà ©dre, Theodora, La Dame aux Camà ©lias, and Gismonda. Throughout the early 1900s, Bernhardt made a number of farewell tours around the globe, including Canada, Brazil, Russia, and Ireland. In 1915, years after a knee  accident, Bernhardt suffered from an infection related to the injury and her leg was ultimately amputated. Refusing an artificial leg, Bernhardt continued to act on stage, with scenes being specifically arranged to suit her needs. In 1921, Bernhardt made her final tour around France. The following year, on the night of the dress rehearsal for the play Un Sujet de Roman, Bernhardt collapsed and went into a coma. She spent months recovering and her health slowly improved, but on March 21, 1923, while suffering from kidney failure, Bernhardt collapsed again and passed away in her son’s arms. She was 78. Legacy Thà ©Ãƒ ¢tre Sarah Bernhardt was managed by her son Maurice until his death in 1928. It was later renamed Thà ©Ãƒ ¢tre de la Ville. In 1960, Bernhardt was given a star on the Hollywood Walk of Fame. Bernhardts vibrant and dramatic performances in so many iconic roles captivated audiences and critics all over the world. Her successful transition from stage to screen further established Bernhardt as one of the most celebrated actresses in theater and film history. Sarah Bernhardt Fast Facts Full Name:  Henriette-Rosine BernardKnown As: Sarah BernhardtOccupation: ActressBorn:  October 22,  1844 in Paris, FranceParents Names: Julie Bernard; father unknownDied: March 21, 1923 in Paris, FranceEducation: Studied acting at the Paris Conservatory  Spouses Name: Jacques Damala (1882-1889)Childs Name: Maurice BernhardtKey Accomplishments: Bernhardt was one of the most successful actresses of the late 19th and early 20th centuries. She toured the world, successfully transitioned from stage to screen and back again, and managed her own theater (Thà ©Ãƒ ¢tre Sarah Bernhardt). Sources and Further Reading Verneuil,  Louis. The Fabulous Life of Sarah Bernhardt. London, Harper brothers; Fourth Edition, 1942.Gold, Arthur  and Fizdale, Robert. Divine Sarah: A Life of Sarah Bernhardt. Knopf; First edition, 1991.Skinner, Cornelia Otis. Madame Sarah. Houghton-Mifflin, 1967.Tierchant, Hà ©là ¨ne. Madame Quand mà ªme. Editions Tà ©là ©maque, 2009.

Communication in business Essay Example | Topics and Well Written Essays - 1000 words - 1

Communication in business - Essay Example In economic pursuit, we aim at promoting environmental sustainability.3 Our business is based on a solid philosophy of equal employment opportunities and fostering environmental sustainability through green manufacturing processes. ... n employment or occupation occurs when a potential employee is treated negatively or differently due to his characteristics that are not relevant or inherent for successful performance of the job. Commonly characteristics that employees are mainly discriminated against include race, color, age, sex, gender, political inclination, ethnicity, religion and nationality. We at Hyundai Motors have since extended these characteristics to include sexual orientation, disability and diseases such as HIV/AIDS. Discrimination in employment matters has been witnessed in areas such as recruitment, job allocations, promotions, and performance evaluations, security of tenure, compensation and termination of employment. Hyundai Motors prohibits all manners of employment discrimination, whether direct or indirect discrimination, by ensuring all employees and potential candidates are accorded equal opportunities regardless of their personal characteristics. Discrimination in employment matters infringe s the fundamental human right of equal access to employment and humane treatment in the workplace.7 Principle 8 Initiatives to promote greater environmental sustainability Benefits and implications Hyundai Motors engages in clean manufacturing processes that limit environmental pollution. According to Global Compact principle 8, business organizations undertake measures to promote environmental sustainability.8 According to the Rio Declaration, business organisations have the responsibility of ensuring their activities do not degrade the environment or cause pollution. The immediate communities expect the business organisations to actively participate in environmental conservation initiatives. All business organisations should work closely with the major stakeholders like suppliers in order

Reaction Paper Essay Example | Topics and Well Written Essays - 500 words

Reaction Paper - Essay Example On the other hand, its placement within the Kyper belt makes it part of other debris floating in this space. Its long distance away from Sun and the estimated 560 year orbiting time, also demarcates it from the eight well-established planets. Fascinated I was with Dr. Brown’s free-flowing narrative of the events in the lead-up to the eventual discovery, I was also impressed by his mastery of scientific technique and methodology. The way he explained how digital cameras and high-power telescope were used for the project was quite lucid. Toward the end of the lecture, Dr. Brown expressed his displeasure about the tendency among the community of astronomers to give importance to precise definitions of what a planet is. As per the newly coined definition of a planet, both Eris and Pluto do not qualify, thereby leaving the number of recognized solar planets to be eight (stopping with Neptune). Upon hearing this decision to drop Pluto and Eris from the class of planets, I was a tad disappointed. But as Dr. Brown explains at length, such rigid formalizations go against the spirit of astronomy and cosmology. I agree with his view that it is the concept and description which matters, not narrow definitions. Lecture Notes: Lecture organized by Astronomical society - Dr.

Marketing Plan of Fairmont Empress Hotel Assignment

Marketing Plan of Fairmont Empress Hotel - Assignment Example The marketing team has analyzed the market segmentation and is committed to improving the consumer perception of the brand. The company hopes to increase the market share by a minimum of 20 percent in two years. The management has invested in talent reward management and competitive remunerations to reduce staff turnover rates. The strategic and management team of Fairmont Express Hotels and Resorts is also committed to the overall wellbeing of the local communities through CSR.     The Fairmont Express Hotels and Resorts are located in multiple cities across North America and many parts of the world. They include New York in the US and British Columbia in Canada. The facility offers breathtaking views of natural beauty and rich heritage owing to the fact that it is roughly a century old. This has early the hotel respect and customer perception of high standards. The hotel offers convention rooms, culinary experiences, a variety of foods and family vacation facilities among other s. The management has had to keep evolving to meet the changing demands of the growing market. The hotel has over hundreds of refurbished rooms which are fitted with modern technological features. The brand is established to give a high-end luxury impression to the market. Market situation The role of hospitality the world economy has been on the rise. The industry has been one of the most profitable with unprecedented growth rate. However, the market situation indicates that the market can perform better. Economic decline has had a negative effect on the market performance with the hotel and tourism industry being coerced to scale down. The hotel industry is faced by acute staff shortage during the peak seasons (Wood & Brotherton, 2008). Therefore, the industry is using incentives and reduces staff turnover rates and to ensure that they remain competitive. Hotel industries should segment markets into consumer groups that are homogeneous. Hotels like Fairmont Express target their ma rket segments carefully through identifying the differentiating advantages that attract each segment (Wood & Brotherton, 2008). This includes offering competitive prices and choosing qualified personnel. Implementing marketing segmentation demands proper strategies. Model hotels have to implement market segmentation in complex organizational environments minimal resources and customer legacy (Shoemaker et al, 2007). Market segmentation addresses the market situation directly since its one of the most basic marketing concepts. The hospitality industry is divided into leisure and travel. Research shows that growth is forecasted to drive the hotel industry to reach $640 billion in the coming years. The economic stability in North America has been attributed to the success of the hotel industry in American and Canadian hotels. The market situation has been boosted by the significant growth as a result of a slight decline in the cost of travel (David, 2005). Changing lifestyle and availa bility of leisure time as an integral part of life has increased the market share.  Ã‚  

Importance of Communication in Nursing

Importance of Communication in Nursing INTRODUCTION Communication is a process and has many aspects to it. Communication is a dynamic process by which information is shared between individuals (Sheldon 2005). This process requires three components (Linear model), the sender, the receiver and the message (Alder 2003). Communication would not be possible if any of these components are absent. While peate (2006) has suggested that communication is done every day through a linear process, Spouse (2008) argues that it is not so simple and does not follow such a linear process. He explains that due to messages being sent at the same time through verbal and non- verbal avenues, it is expected the receiver is able to understand the way this is communicated. Effective communication needs knowledge of good verbal and non-verbal communication techniques and the possible barriers that may affect good communication. The Nursing and Midwifery council (2008) states that a nurse has effective communication skills before they can register as it are seen as an essential part of a nurses delivery of care. (WAG 2003) Reflecting on communication in practice will also enforce the theory behind communication and allow a nurse to look at bad and good communication in different situations. This will then enforce the use of good communication techniques in a variety of situations allowing for a more interpersonal and therapeutic nurse patient relationship. This assignment discusses health care communication and why it is important in nursing by: Exploring verbal and non-verbal communication and possible barriers By exploring the fundamentals of care set out by the Welsh assembly and the nurse and midwifery councils code of conduct a better understanding of the importance of communication is gained. Reflecting in practice using a scenario from my community posting. VERBAL COMMUNICATION Verbal communication comes in the form of spoken language; it can be formal or informal in its delivery. Verbal Language is one of the primary ways in which we communicate and is a good way to gather information through a question (an integral part of communication) and answer process (Berry 2007; Hawkins and Power 1999). Therefore verbal communication in nursing should be seen as a primary process and a powerful tool in the assessment of a patient. There are two main types of questioning, open-ended questions or closed questions. Open-ended questions tend to warrant more than a one word response and generally start with what, who, where, when, why and how. It invites the patient to talk more around their condition and how they may be feeling and provoke a more detailed assessment to be obtained (Stevenson 2004). The use open-ended questions make the patient feel they have the attention of the nurse and they are being listened too (Grover 2005). It allows for a psychological focus to be given, this feeling of interest in all aspects of the patients care allows for a therapeutic relationship to develop (Dougherty 2008). Closed questions looks for very specific information about the patient (Dougherty 2008). They are very good at ascertaining factual information in a short space of time (Baillie 2005). There are two types of closed questions: the focused and the multiple choice questions. Focused questions tend to acquire information about a particular clinical situation (e.g. asking a patient who is been prescribed Ibuprofen, are you asthmatic?) whereas multiple choice questions tend to be more based on the nurses understanding of the condition being assessed. It can be used as a tool to help the patient describe for example the pain they feel e.g. is the pain dull, sharp, throbbing etc (Stevenson 2004). For verbal communication to be effective, good listening skills is essential. Difficulty in sharing information, concerns or feelings could arise if the person you are communicating with thinks you are not being attentive and interested in what they are saying (Andrews 2001). Good active listening can lead to a better understanding of the patients most recent health issues (Sheldon 2005). Poor listening could be as a result of message overload, physical noise, poor effort and psychological noise. Therefore being prepared to listen and putting the effort and time are essential in a nurses role (Grover 2005). NON-VERBAL COMMUNICATION This type of communication does not involve spoken language and can sometimes be more effective than words that are spoken. About 60 65 per cent of communication between people is through non verbal behaviours and that these behaviours can give clues to feelings and emotions the patient may be experiencing (Foley 2010, p. 38). Non-verbal communication functions as a replacement for speech; to re affirm verbal communication; to control the flow of communication; to convey emotions; to help define relationships and also a way of giving feedback. The integration between verbal language and paralanguage (vocal), can affect communication received (Spouse 2008) Berry (2007) highlights the depth of verbal language due to the use of paralinguistic language. The way we ask a question, the tone, and pitch, volume and speed all have an integral part to play in non verbal communication. In his opinion, personality is shown in the way that paralanguage is used as well as adding depth of meaning in the presentation of the message been communicated. Foley (2010) identifies studies where language has no real prevalence in getting across emotional feelings, in the majority of cases the person understands the emotion even if they dont understand what is being said. Paralanguage therefore is an important tool in identifying the emotional state of a patient. Non-verbal actions (kinesis) can communicate messages, such as body language, touch, gestures, facial expressions and eye contact. By using the universal facial expressions of emotion, our face can show many emotions without verbally saying how we feel (Foley 2010) refer to Appendix 2. For example, we raise our eye brows when surprised, or open our eyes wider when shocked. First impressions are vital for effective interaction; by remembering to smile with your eyes as well as your mouth can communicate an approachable person who is open. This can help to reassure a patient who is showing signs of anxiety (Mason 2010). BARRIERS TO COMMUNICATION The understanding of the barriers to communication is also very important for effective communication and taken into consideration could result in a failure in communication. The Welsh Assemblys fundamentals of care (2003) showed that many of the problems associated with health and social care was due to failures in communication. These barriers may be the messenger portraying a judgmental or power attitude. Dickson (1999) suggested that social class can be a barrier to communication by distorting the message being given and received as would be the case if the patients feel they occupy an inferior status thus making communication difficult and awkward. Environmental barriers such as a busy ward and a stressed nurse could influence effective communication. This can greatly reduce the level of empathy and communication given as suggested by Endacott (2009). People with learning disabilities come up against barriers in communicating their needs, due to their inability to communicate verbally, or unable to understand complex new information. This leads to a breakdown in communication and their health care needs being met (Turnbull 2010). Timby (2005) stresses that when effectively communicating with patients the law as well as the NMC (2008) guidelines for consent and confidentiality must be adhered to. This also takes into account handing over to other professionals. He suggests that a patients rights to autonomy should be upheld and respected without any influence or intimidation, regardless of age, religion, gender or race. The use of communication in practice is essential and reflecting on past experience helps for a better understanding of communication, good and bad. REFLECTION Reflecting on my experience while on placement in a G.P with a practice nurse in south Wales Valleys, has helped me understand and gain practical knowledge in communicating effectively in nursing practice. The duration was for one week and includes appointments in several clinics to do with C.O.P.D and diabetes. I will be reflecting upon one of such appointments using the Gibbss reflective cycle (1988). Description Due to confidentiality (NMC, 2008) the patient will be referred to as Mrs A.E. The Nurse called Mrs A.E to come to the appointment room. I could see she was anxious through her body language (palm trembling and sweaty, fidgety, calm and rapid speech). The nurse asked her to sit down. The nurse gained consent for me to sit in on her review (NMC, 2008). The review started with a basic questionnaire the nurse had pre generated on the computer. It was a fairly closed questionnaire around her breathing including how it was, when it was laboured. Questions were also asked around her medication and how she was taking her pumps. Reflecting on these questions, I feel that the way the questions did not leave much opportunity for Mrs A.E to say anything else apart from the answer to that question and the nurse controlled the communication flow. The Nurse did not have much eye contact with the patient and was facing the computer rather than her patient. I wondered if the nurse had notice the anxious non-verbal communication signs. The patient seemed almost on the verge of tears, I wasnt sure if this was anxiety or distress from being unwell, barrier of social class or if the lady was unhappy about something else. I felt quite sorry for her as all her body language communicated to me that she was not happy. She had her arms crossed across her body (an indication of timidity) and she did not smile, she also looked very tense and uncomfortable. The Nurse went on with the general assessment and did the lung test and I took the blood pressure and pulse, gaining consent first as required by the NMC. Once all the questions had been answered on the computer the Nurse turned to face Mrs A.E and I noticed she had eye contact with her and had her body slightly tilted toward the patient (non verbal communication). The Nurse gave her information on why her asthma may be a bit worse at the moment and gave her clear and appropriate information on how she can make herself more comfortable. The Nurse gave her lots of guidance on the use of her three different pumps, and got her to repeat back to her the instructions she had given to make sure she understood. I could feel the patient getting more at easy as the communication progressed and also on the confirmation that she understood the instruction. The Nurse knew this patient well and then set the rest of the time talking to the patient about any other concerns she had and how she was f eeling in herself, using a more open question technique. The nurse used her active listening skills and allowed the patient to talk about her problems and gave her empathy at her situation as well and some solutions to think about. She gave the patient information of a support group that helped build up confidence in people with chronic conditions and helped them deal with the emotional side of their condition. Feelings After the patient had gone, my mentor explained that the patient was a known regular patient to the clinic, that she had many anxiety issues which werent helped by her chronic asthma. Through-out the beginning of the review I felt very awkward. I thought because I was sitting in on the review may have been the reason the lady had not said why she seemed so anxious and upset. I also felt the nurse was not reacting to the sign of anxiety from Mrs A.E and this made me feel uncomfortable. I felt like I wanted to ask her if she was ok, but felt that I couldnt interrupt the review. However by the end of the review I felt a lot better about how it had gone. I did feel that by building up a relationship with the patients allowed the nurse to understand the communication needs of the patient and also allowed her to use the time she had effectively. She used empathy in her approach to the lady and actively listened to her. I understand that the start of the review was about getting the facts of the condition using a lot of closed questions, whereas the later part of the review was a more open questions and non verbal communication approach, allowing the patient to speak abo ut any concerns and feelings about those questions asked earlier. Evaluation Effectively using closed questions allow for a lot of information to be gathered in a short space of time, and can be specific to the patients review needs. These pre-generated questionnaires are good at acquiring the information needed by the G.P. and also for good record keeping which are essential in the continuity of care delivered to the patient. It can also protect the nurse from any litigation issues. The use of open and closed questions also allowed for the review to explore the thoughts and feelings of the patient, thus allowing for empathy from the nurse and is considered a vital part of the counselling relationship (Chowdhry, 2010 pg. 22). However the use of the computer screen facing away from the patient, did not allow for good non-verbal communication skills to be used. The lack of eye contact from the nurse may have exacerbated the anxiety felt by the patient. Hayward (1975, p. 50) in a summary of research into anxiety noted uncertainty about illness or future problems was linked to anxiety and therefore linked to pain. Nazarko (2009) points out, it is imperative that a person has the full attention of the nurse when they are communicating. He states that being aware of ones own non-verbal behaviours, such as posture and eye contact can have an effect on how communication is received by the patient. As evident in the reflection, the patient at the beginning of the review was anxious, upset and worried. By the end of the review her body language had significantly changed. The patient looked and felt a lot better in herself and had a better understanding of how her condition was affecting her and understood how to manage it. Whereas, bad communication would have caused more stress and aggression (Nursing standard 34 (30) 2010). This also links back to the need to understand medical conditions so that communication is channelled to the patients needs at the time. The fundamentals of care set out by the Welsh Assembly Government (2003), states that communication is of upmost importance in the effectiveness of care given by nurses. By looking at all the fundamentals of communication and the effect on patient care we can understand and recognise that the communication in this reflection was a good communication in practice. Analysis The closed questions were used at the beginning of the review, had their advantages. They allowed the nurse to focus the on the specific clinical facts needed to be recorded. The start of the review used mainly closed questions to get all the clinical facts needed to be recorded, such as Personal information, Spirometry results, blood pressure, drug management of COPD (Robinson, 2010). The structured approach allows the nurse to evaluate using measurable outcomes and thus interventions adjusted accordingly (Dougherty, 2008). The closed question approach allows the consultation to be shortened if time is an issue. However the disadvantage of this as identified by Berry (2007) is that important information may be missed. The use of closed questions on a computer screen hindered the use of non-verbal communication. Not allowing for eye contact, which is an important aspect of effective communication. The use of open questions in the review allowed the patient to express how they were feeling about their condition or any other worries. The nurse used active listening skills, communicated in her non-verbal behaviour. It gave the opportunity to the patient to ask for advice on any worries they might have. The use of open questions can provoke a long and sometimes not totally relevant response (Baillie, 2005), using up valuable time. The use of Egan (1990, p. 46) acronym SOLER allowed the nurse to focus on the skill of actively listening. Eye contact is another important part of communication in the reflective scenario. The eye contact at the start of the review was limited. The nurse made slight eye contact when asking the closed questions, but made none when given the answer. This may have contributed to the patients anxious state. However, the eye contact given during the open questions section. At this stage, there were several eye contacts between the nurse and patient and information was given and understood. The value of eye contact in communication is invaluable and has great effect at reducing symptoms of anxiety (Dougherty 2008). Reflection conclusion The use of communication in this COPD review was very structured. The use of closed questions helped to structure the consultation and acquire lots of information from the patient. The open questions allowed for the patient to express any feeling or concerns. The nurse used verbal and non-verbal communication methods, to obtain information about the patient; assess any needs and communicate back to the patient, within the time period. However in my opinion, if the computer screen was moved closer to the patient during the closed question section, better interaction could have been established from the beginning. It would also allow the nurse to look at the patient when asking the questions leading to a more therapeutic relationship, whilst still obtaining and recording a large amount of information. Therefore, the use of effective communication skills as seen in this review along with a person centred approach can significantly increase better treatment and care given to the patient (Spouse, 2008) and thus signifies good communication in practice. Action Plan The goal of the plan is to increasing patient participation in the use of the computer as an interactive tool. By allowing the patient to see what is on the screen and being written, allows the patient to feel more involved in the assessment and takes away any feeling of inferiority from social class difference. In attempt to achieving these goals, the following steps would be taken: Set up a team to investigate the issue which could involve nursing staffs or other hospital staffs. Drawing up a feedback questionnaire, to investigate how patients feel about the closed questions on the computer, including a section on how they would feel if they were allowed to look at the screen. Collation, analysis and review of the results of the feedback Identify barriers to the implementation of the plan (e.g. willingness of nurses to this change). Inform the NMC on the issues and the findings from the feedback questionnaire. Implementation of the plan. Set up a monitoring and evaluation team to see if the plan is being implemented appropriately. CONCLUSION This assignment has looked at communication and its importance in nursing practice. Communication is thus an iterative process involving the interaction between one or more persons using verbal and non-verbal methods. Understanding the barriers to communication contributes significantly to how effective a nurse communicates in practice. The use of questioning in nursing has been a valuable tool in assessing a patient and obtaining information. However the way this is done can have an effect on the development of empathy, trust, genuineness and respect, between the nurse and the patient. It is imperative for nurses to however reflect on their communication in practice to further improve the therapeutic relationship between them and the patient as has been identified as essential in the delivery of care (WAG 2003). REFERENCES Alder, RB. Rodman, G. 2003. Understanding human communication (8th edition). USA: Oxford university press Andrews C, Smith J (2001) Medical Nursing (11th edition) London: Harcourt Publishers limited Berry, D. 2007. Basic forms of communication. Cited in. Payne, S. Horn, S. ed. Health communication theory and practice. England: Open university press. Chowdhry, S. 2010. Exploring the concept of empathy in nursing: can lead to abuse of patient trust. Nursing times 160 (42) pg 22-25 Dickson, D. 1999. Barriers to communication. Cited In: Long, A. ed. Interaction for practice in community nursing. England: Macmillian press LTD, pp. 84-132 Dougherty, L. Lister,S. ed. 2008. The royal marsden hospital manual of clinical nursing procedures. Student edition. 7th edition. Italy: Wiley-Blackwell Egan, G. 1990. The skilled helper: A systematic approach to effective helping. (4th edition). California: Brooks /Cole Ekman, p. Friesen, WV. 1975. Unmasking the face. Englewood cliffs, NJ: prentice-hall INC Endacott R, Jevon P, Cooper S (2009) Clinical Nursing Skills Core and Advanced. Oxford : Oxford University Press. Foley, GN. 2010. Non-verbal communication in psychotherapy. Psychiatry (Edgemont) 7 (6) pg. 38-44 Gibbs, G. 1988. Learning by doing: a guide to teaching and learning methods. Oxford: Oxford futher education unit. Grover, SM. 2005. Shaping effective communication skills and therapeutic relationship at work. Aaohn journal 53 (4) pg. 177-182 Hawkins, K. Power, C. 1999. Gender differences in questions asked during small decision-making group discussions, small group research.(30) pg.235-256 Hayward, J. 1975. Information A prescription against pain. London: Royal college of nursing. Pg. 50 Marie- Claire Mason (2010) Effective interaction: Nursing Standard 24 (31) pp 25. Nazarko, L. 2009. Advanced communication skills. British journal of healthcare assistants. 3 (09) pg 449-452 Nursing and Midwifery Council (NMC) (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. London. NMC Peate, I. 2006. Becoming a nursein the 21st century. England: Wiley and Son Robinson, T. 2010. Empowering people to self-manage COPD with management plans and hand held records. Nursing times. 106 (38) pg. 12-14 Sale, J. Neal, NM. 2005. The nurses approach: self-awareness and communication. Cited in Ballie, L. ed. Developing practical nursing skills (2nd edition). London: Oxford university press. Pg. 33-57 Sheldon, L. 2005. Communication for nurses: Talking with patients. London: Jones and Bartlett publishers. Spouse, J. Cook, M. Cox, C. 2008. Common foundation studies in nursing (4th edition). London: Churchill livingstone. Stevenson C, Grieves M, Stein Parbury J 2004 Patient and Person: Empowering Interpersonal relationships in Nursing London. Elsevier Limited. Timby BK (2005) Fundemental Nursing Skills and Concepts Philadelphia. Lippincott Williams and Wilkins Turnbull J, Chapman S (2010) Supporting Choice in Health Care for People with Learning Disabilities. Nursing Standard 24 (22) pg 50 55 Welsh Assembly Government (2003) Fundamentals of Care Guidance for Health and Social Care Staff Cardiff: WAG Importance of Communication in Nursing Importance of Communication in Nursing Communication in nursing Introduction Communication in nursing is vital to quality and safe nursing care (Judd, 2013). There is evidence that continues to show that breakdowns in communication can be responsible for many medication errors, unnecessary health care costs and inadequate care to the patient (Judd, 2013). Several reports exist from the Institute of Medicine that stress the importance of good communication and its link to providing safe and reliable care (Judd, 2013). (Smith Pressman, 2010). However, even nurses with the best communication skills can be challenged by difficult situations such as life threatening threatening illness or injury, complicated family relationships, and mental health issues, to symptoms such as unrelieved pain and nausea. How a nurse may respond during these situations depends on many factors. Each nurse brings their own history, culture, experience, and personality to a situation. Communication in the workplace can either be horizontal among workers at the same hierarchical level, vertical among workers in different hierarchical levels or diagonal amongst different workers in different hierarchical levels. All these kinds of communication are crucial in the work environment because work needs to be done and goals need to be met. A communication channel is made up of three components made up of the sender of the message (encoder), the channel of sending the message and the receiver of the message (decoder) (Anderson, 2013). For effective communication to be achieved, the encoder and the decoder must be able to understand one another. This paper will discuss some strategies which could be implemented to improve both written and verbal communication between nurses, health professionals and between patients and the health care team. Communication, a fundamental aspect of nursing, is a complex, continual transactional process that occurs between persons by which information, feelings, and meaning are conveyed through verbal and non verbal messages (Peereboom, 2012). It is crucial for nurses to identify communication strategies that should be put into consideration every time they are involved in conversations involving their line of practice. This is because clear and accurate communication strategies enable them to identify effective patterns in their interactions and in teaching themselves to improve their patient education techniques. Handover communication between practitioners may at times seclude crucial information and is even prone to misinterpretation. Such communication breakups and challenges can lead to intense mishaps in the continuity of health care, incorrect treatment, and potential harm to the patient in general (Memoire, 2007). Simple strategies can easily impart critical information just by eye sight. For instance, nurses are able to communicate critical patient status issues like allergies and fall risk with color-coded patient identification wrist bands or stickers on their medical records, a seat belt or flag attached to a wheel chair, or any other objects which are easily identifiable by all medical practitioners (Joint contribution resources, 2005). The use of local jargon can also be avoided when making professional conversations because some words may portray a meaning that was not intended or is not readily understood by a large number of people. Assimilation of the ISBAR tool is a strategy that has been really helpful in enhancing communication in the healthcare sector when used. Identifying yourself (I), availability of the situation (S), background (B), assessment (A), and recommendations (R) facilitates communication allowing each health practitioner to receive and give important information in a format that satisfies numerous communication styles and needs (Dixon et al., 2006). This tool should be adopted by everyone to improve communication is because this technique utilizes the use of one common language for passing on critical information without leaving out anything. Another strategy that can be used to improve communication in healthcare centers is the Crew Resource Management technique which is both a communication and team building technique (ECRI, 2009). This strategy trains members of the healthcare sector to assert themselves respectively and be attentive when they are being spoken to and also encourages them to make use of briefings. Briefings are direct communications between physicians, nurses or other caregivers acting on patient status which includes sharing of important information at critical times, such as before the start of a procedure, at the change of shift and during normal patient rounds (ECRI, 2009). COMMUNICATION BETWEEN PATIENTS AND THE HEALTH CARE TEAM One stratergy that can be used to improve communication between patients and the health care team is the use of ‘The World Health Organization Surgical Safety Checklist’. This checklist is to be used in operating suites to ensure everyone involved with the patient including the patient understands what procedure they are having ad gives prompts to tick off so important information is not missed during handovers leading to reduced inpatient complications and death (Department of Health, 2010). In addition to the patient, their family members or next of kin can also be included in the rounds further increasing the opportunity for direct dialogue which reduces the development of complications which arise as a result of miscommunication in the form of home care. It is important to note that if personal care by the family of the patient is not provided as requested by the medical practitioner, cohesive care is not accomplished and the opportunity to achieve patient care goals will not be met (O’Leary et al., 2010). Joint commission reports also indicate that health practitioners should also encourage patients to actively participate in their own care as a strategy to enhance communicational barriers (Stein, 2006). Successful interactions are always co-constructed, involving a constant interplay among the two parties. When the patient and the healthcare provider are comfortable with one another communicating becomes easy and more effective in the sense that the healthcar e provider will be able to solve the needs of the patient. COMMUNICATION BETWEEN HEALTH CARE DISCIPLINES Communication between medical practitioners can greatly influence the general patients care outcomes. Medical practitioners are in the frontline to investigate and identify communication challenges and try to implement solutions that fit their line of duty. Some further research is also being carried out to evaluate potential solutions and more successful options (Rosenstein, 2005). Creating a collaborative relationship between nurses and other medical practitioners is also another strategy that can help reduce communicational barriers and thus improve the general treatment of patients (Arora, 2005). With regard to Schmalenberg and Kramer (2005), â€Å"MD/ RN collaboration is reflected in reduced patient mortality, fewer transfers back to the ICU, reduced costs, decreased length of stay in hospitals, higher nurse autonym, retention, nurse-perceived high quality care, and nurse job satisfaction†. Larabee (2006) also found out that positive relationships between medical practitioners were a major contributing factor to improved nursing job satisfaction and retention. Positive collegial relationships therefore result from good communication, mutual acceptance and understanding, use of persuasion rather than coercion, and a balance of reason and emotion when working with others (College of Nurses of Ontario, 2009, pg. 7). COMMUNICATION BETWEEN NURSES A number of strategies have been set up to address communication issues among nurses. For instance, the implementation of unit based care teams places nurses and people like physicians close to one another thus increasing the chances of communicating effectively (Gordon et al, 2011). The introduction of compulsory bed rounds is also another strategy that has enabled nurses to reduce communication barriers and promote effective communication thus creating patient health satisfaction and general health care providers satisfaction in their duties. The continuous flow of interruptions and multiple patient handoffs affect the ability of nurses and physicians to connect effectively, and establish a trusting and collegial relationship (Tschannen et al., 2011). The fact that the working environment of nurses and other medical practitioners is rather different also induces a number of communication barriers with regard to the intensity of activities on a normal working day (Burns, 2011).this could be improv4d by†¦ Communication challenges are recognized when set goals or achievements are not met or when there is great employee turnover. Technological advances have opened up communication across boundaries of different countries meaning that people with different languages, behaviors and culture interact with one another (Krizan, 2010).In the health care sector in particular, the most pertinent communication barrier is the inability for colleagues to interact physically as they are separated in different departments (Vignam, 2013). This lack of interaction minimizes the ability for team members to collaborate wholly in the sense that the ability to analyze body language and create a sense of energy among team members is null. This can be improved by†¦ Barriers Barriers to communication that exist are the use of machinery and equipment that might malfunction and deliver the message later than expected thus reducing the urgency of information. In addition to this, these machines are not able to express aspects of speech such as tone thus making them a true barrier to effective communication. Language is also a major communication barrier in the case where colleagues do not speak the same language or where they have difficulty in articulating clearly in one common language. The use of local idioms, jargon and acronyms further complicates language and kills communication among team members who find certain words ambiguous (Lingard, 2005). A patient in a hospital setting usually sees more than one health care practitioner and specialist during their stay (Memoire, 2007). Handover communication between practitioners may at times seclude crucial information and is even prone to misinterpretation. By improving communication among healthcare professionals the delivery of patient care improves and is saferStrong and effective nursing care is enriched and strengthened by good communication (2) In Victoria, the direct cost of medical errors in public hospitals is estimated at half a billion dollars annually [1]. Today, healthcare is evermore complex and diverse, and improving communication among healthcare professionals is likely to support the safe delivery of patient care. References Anderson, P., 2013. Technical communication, cengage learning, Canada Arora V, Johnson J, Lovinger D. (2005) Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care Burns, K. (2011). Nurse-physician rounds: A collaborative approach to improving communication, efficiencies, and perception of care. MEDSURG Nursing Dixon, J., Larison, K., Zabari, M. (2006). Skilled communication: Making it real. AACN Advanced Critical Care College of nurses of Ontario. (2009), conflict prevention and management, Toronto, ON ECRI. (2009), Healthcare risk control, 5200 butler pike, Plymouth meeting, PA 19462-1298, USA Fernandez, R., Tran, D., Johnson, M., Jones, S. (2010).Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery. Journal Of Nursing Management Gordon, M., Melvin, P., Graham, D., Fifer, E., Chiang, V., Sectish, T., Landrigan, C. (2011). Unit-based care teams and the frequency and quality of physician-nurse communications. Archives of Pediatric Adolescent Medicine Joint commission resources. (2005), issues and strategies for nurse leaders: meeting hospital challenges today, joint commission resources, Inc, USA Krizan, A., Merrier, P., Logan, J., Williams, K., 2010. Business communication: Business communication series, Mason: USA: Cengage learning Larabee, L., Janney, M., Ostrow, C. Withrow, M. Hobbs, G. Burant, C. (2007), predicting registered nurse job satisfaction and intent to leave, journal of nursing Lingard L, Espin S, Rubin B. (2005) Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care Memoire, A. (2007), communicating during patient hand over, patient safety solutions, vol 1 O’Leary, K., Thompson, J., Landler, M., Kulkarni, N., Hawiley, C., Jeon, J.Williams, M. (2010). Patterns of nurse-physician communication and agreement on the plan of care. Quality and Safety in Healthcare Peereboom, K. (2012), facilitating goals of care discussions for patients with life limiting disease- communication strategies for nurses, journal of hospice and palliative care Rosenstein AH, ODaniel M. (2005). Disruptive behavior clinical outcomes: Perceptions of nurses and physicians.American Journal of Nursing Stein JS. (2006) Improving patient safety communication. Presented at: Philadelphia Area Society for Healthcare Risk Management; Mar 16; ECRI Institute, Plymouth Meeting (PA). Schmalenberg, C. Kramer, M., King, C. (2005), excellence through evidence: securing collegial nurse physician relationships, journal of nursing administration Schmalenberg, C., Kramer, M. (2009). Nurse-physician relationships in hospitals: 20,000 nurses tell their story. Critical Care Nurse Vigman, S., 2013. Global challenges: communication and culture: people issues in a global environment, workforce solutions review Department of Health 2010 Promoting effective communication among healthcare professionals to improve patient safety 1-1-7 Retrieved from http://www.health.vic.gov.au/qualitycouncil/downloads/communication_paper_120710.pdf http://www.health.vic.gov.au/qualitycoun http://www.health.vic.gov.au/qualitycouncil/downloads/communication_paPromoting effective co Importance of Communication in Nursing Importance of Communication in Nursing Communication is a huge topic and can be considered on many different levels from a professional viewpoint. We can consider issues such as the relevance of various forms of communication between the healthcare professionals and the patient which, ultimately determines many of the parameters of treatment (and compliance).(Stewart M 1995) We can also consider the importance of communication between healthcare professionals themselves which can cause inordinate problems for the patient if they are less than optimal. (Hogard E et al. 2006) Firstly, communication requires a definition. There are many attempts at trying to define the essence of communication. They all differ in detail but, in essence, they all describe a complex process of both sending and receiving messages which can be either verbal or non-verbal or, more commonly, a mixture of both. This interchange allows for an exchange of information, feelings, needs, and preferences. Typically the two protagonists in a communication exchange will encode and decode messages in a cyclic pattern. Each making an analysis and response to the preceding gambit. (Wilkinson SA et al. 1999) In the context of professional nursing, its purpose is generally manifold but will include the means of establishing a nurse-patient relationship, to be a tool for expressing concerns or interest in the patient’s circumstances, to elicit information relevant to the patient’s condition and to provide healthcare information. (Bugge E et al. 2006) Implicit in the process of communication is the achievement of a shared understanding of meaning. This is validated by the process of feedback interpretation which indicates if the actual meaning of the message was interpreted as it was originally intended. Communication can be categorised into both type and level. In a nursing-specific context, the level of communication can be defined as â€Å"Social† which is considered to be safe and non-contentious, â€Å"Structuredâ€Å", which is typically utilised for situations of teaching and patient interviews and â€Å"Therapeutic† which has the characteristic of being specifically patient focussed, purposeful and generally time limited. If this is successful it develops further characteristics such as the nurse comes to regard the patient as a unique individual and begins to understand their motivations, and the patient develops a trust in the nurse. It is within this communication context that the nurse is generally able to try to provide care and, more importantly in some instances, help patient identify, resolve, or adapt to health problems. (DAngelica M et al. 1998) The types of communication are capable of endless subdivisions, but in broad terms, they are classified as verbal and non-verbal. The verbal communication requires, by definition, the conscious use of the spoken or written word. The nature, grammar and syntax of the words can reflect the patient’s mental age, their education, their culture and in some cases their mental state and feelings of the moment. Certain inferences can be made from the way the words are delivered such as their choice, their tone or pace of delivery. The characteristics most favourable for efficient and effective communication are that the words should be â€Å"simple, brief, clear, well timed, relevant, adaptable, credible†. (Philipp R et al. 2005) Non-verbal communication relies on the interpretation of facial expressions, hand gestures, and body language. This is an extremely subtle means of communication and can give credence (or otherwise) to the spoken word. In the nursing context, non-verbal communication can be manipulated to the nurse’s advantage to help to elicit information that may otherwise not have been forthcoming. It has been estimated that non-verbal communication accounts for up to 85% of information transfer between communicating adults. In the professional nursing context it requires both systematic observation and careful assessment and interpretation to derive the full meaning of what the patient wishes to convey. Most importantly, the nurse should be aware of incongruity between the verbal message and the non-verbal cues. The patient who smiles while describing a terrible pain is one such example. (Musselman C et al. 1999) Implicit in the understanding and correct interpretation of the non-verbal cues, (and to a lesser extent the verbal ones), is an appreciation of the various environmental and circumstantial factors which can affect the process of communication. There are a number of factors that are of relevance to the clinical situation, including the culture, developmental level, physical psychological barriers that pertain to the patient, their personal space (proxemics) and territoriality that they perceive, the roles and relationships of the people that they are speaking to, the local environment, and their personal attitudes and values and level of self esteem. (Derjung M et al. 2006) On a personal level, I find communication skills most important in the context of the nursing report. One can experience situations where a report is given and very little real information is passed between professionals. Other situations can occur where perhaps the same length of time is taken but enormous amounts of information can be derived from a good report. I recall one particular handover report which, despite being fairly long, left me with no clear information as to what was going on with the patients on the ward. I couldn’t recognise them as people and they were presented more as cattle. The report itself was completely task orientated and comprised little more than a list of jobs that the nurse herself had not been able to accomplish that day. If we consider the literature on the subject we can note that the nursing report predates the Nightingale era. (Carrick P 2000). The nursing profession has evolved as have the requirements, demands and procedures employed. The nursing report is no exception to this evolution. As with any process that involves humans, there is an intrinsic variability. It is seldom perfect and its standard can vary all the way from excellent to dreadful (RCN.2003) In consideration of comments made earlier in this essay we note that the issue of report giving is capable of considerable improvement with learning. This was demonstrated by two independent researchers who produced two seminal papers on the subject coincidentally at virtually the same time. (Ljukkonen A 1992) (Kihlgren et al 1992). In essence, their studies were a period of observation and analysis, a training period and then another period of reanalysis. There is no merit in considering the entire paper in detail here, but the significant findings (in terms of communication) were that before the training the reports were generally: Highly task oriented and (it was noted that) the staff often discussed the patients reaction in vague and general terms without imparting any specific or useful information. The authors were also able to comment that the nursing process was seldom adhered to during the structuring of the report. During the post training assessment the authors noted that the most significant areas of change were: More messages were given per report after the intervention compared to the control ward and the messages with psychosocial content had doubled. The relevance to communication issues is clear. These two studies show that communication is not necessarily innate, but is a skill that can be both learned and enhanced. Good communication equates with both efficiency and, in the case of these two studies, â€Å"less dissatisfaction and a greater team empathy between nursing colleagues which led to more collaboration between the various teams working on the ward.† There are a number of ways in which we can approach the discussion of such topics and we shall consider a few specific different types of communication as an illustrative vehicle for discussion. Much original and groundbreaking work in the area of communication in the healthcare setting was done by Orlando about two decades ago (Orlando I. J. 1987) who suggested that one of the core roles of the healthcare professionals (he was writing specifically about nurses at the time) was to: â€Å"ascertain and prioritise the patient’s needs and instigate and plan appropriate help.† Few would disagree with this comment, but it is clear that effective and precise communication between patient and nurse is essential if the patient’s needs are to be ascertained accurately in the first instance. Communication between healthcare professionals, the patient and other legitimately interested parties such as carers, is then vital if such a plan is then to be optimally implemented The importance of communication as a skill is clearly demonstrated by the fact that it is currently included as one of the six core skills required of the modern nurse manager. (ICN 1998). Another indicator of the importance of good communication is the fact that the majority of complaints currently made to UK Hospital Trusts can ultimately be traced back to poor communication (Richards T 1999). Communication is an attribute and skill that is rarely intuitive. (Davies et al. 2002). There are a great many papers which demonstrate the fact that communication skills can be improved at all levels of competence with both practice and learning. (Hulsman R L et al. 1999) A particularly comprehensive review has been recently published by Heinmann-Koch (2005) which gives an excellent analysis of the strengths and deficiencies in the communication skills of a number of healthcare professionals and the authors make a number of recommendations to address the shortcomings that they identified. The authors quantify the essential skills of communication as â€Å"Personal insight, sensitivity, and knowledge of communication strategies†. The latter being considered vital to maximise the efficiency and effectiveness of one’s communication abilities. If we consider the professional standing on issues of communication, we can note that the Royal College of Nursing has earmarked communication skill as a specific â€Å"competence goal† and the Royal College of Physicians have now included a specific element of assessment in communication skills in their Part II membership exam with elements of information gathering and information giving being specifically assessed. (RCP 2002) Dacre summarises the important elements of the healthcare professional / patient interaction thus: The importance of reflection before a consultation in order to form a clear agenda of the overall aims of the consultation and prepare questions. Checking the patient’s name as an appropriate opening gambit. Starting with an open question. Use a mixture of open and closed questions, structuring the questions carefully, and exploring each area in full before moving on. Make sure each question is effective. Take care not to interrogate patients. Avoid the use of overtly medical language and check at each stage that patients have understood what is being said. Ensure that the healthcare professional does not push his or her own agenda. Allow patients time to finish speaking, using verbal and non-verbal cues to makes it clear that the healthcare professional is listening. Respond to the information that the patient has given to show that this has been heard and understood. Use careful interjections to redirect the interview if necessary. Avoid premature closure (finishing very quickly). There should be a summary—for example, recapping decisions which have been made, and agreement of an immediate plan for the next step. (after Dacre J et al. 2004) In order to explore the area of communication more fully, we will consider a number of specific instances as illustrative examples. We shall begin with the study by Coiera (E et al. 1998). The study starts with the comment: The healthcare system seems to suffer enormous inefficiencies because of poor communication infrastructure and practices. It then cites the Smith paper (Smith A F et al. 2005) which points out the fact that communication problems were the most common cause of preventable disability or death, and were nearly twice as common as those due to inadequate medical skill This study took a cohort of 10 healthcare professionals working in a hospital setting and analysed all of their professionally based communications. For efficiency and content. The paper itself was both long and involved and some of the findings are only of peripheral relevance to our considerations here, so we shall confine our discussions to the parts that are relevant The first major finding was that there was a tremendous range of topics dealt with, ranging from the clinical to the administrative. The authors comment that efficiency of communication is inversely proportional to the diversity of topics. In other words, communication in a designated clinic setting, where all of the problems are likely to have a similar thrust, is more likely to be efficient than conversations encountered in a general ward on general topics. The second general finding was that efficiency of communication was significantly impaired by the frequency of interruptions. It follows that protected time in a consultation, free from interruptions, is more likely to be an efficient communication than one that is frequently interrupted. Interruptions were seen to be associated with a number of well recognised psychological responses including diversion of attention, forgetfulness, and errors. (Blum N J et al. 1992) Paradoxically, the authors found that the most junior staff, (I.e. the least likely to be experienced in communication skills), were the most likely to be interrupted, while the senior staff were the least likely to have their consultations interrupted. We have already considered a number of the factors that can influence communication and various communication strategies can be usefully employed to assist in eliciting appropriate information. Active listening is perhaps the most useful basic tool that the nurse can use. When interacting with the patient, the nurse should endeavour to utilise strategies that will facilitate both conversation and elaboration. Mechanisms such as use of broad opening statements, reflecting, open ended statements and directive questions can be strategically employed to elicit appropriate information. (Huizinga G A et al. 2005) Many patients will not be used to expressing themselves clearly and concisely, and can be helped by techniques such as acknowledging feelings, using silence as a prompt, reflection, and stating personal observations. All of these factors can be enhanced if used alongside strategies that communicate mutual understanding. (Yedidia M J et al. 2003) We have presented evidence that communication is the medium of mutual understanding. We should therefore not leave this area without making comment on some strategies that the professional nurse can employ to maximise the empathetic understanding of those that she is communicating with. These strategies are important not only in the nurse / patient interaction but also in the teaching environment. Ensuring that the message is thoroughly communicated and understood requires techniques such as clarifying, validating, verbalizing implied thoughts and feelings, focusing, using closed questions and summary statements. The converse of this argument is that the nurse should also be aware of issues that are potential barriers to communication. The absence of positive and attentive listening is a powerful disincentive to most forms of communication. The patient who perceives that they are not being listened to is not likely to produce any useful information. Other barrier behaviours include the use of reassuring clichà ©s, giving advice, expressing approval/disapproval, requesting an explanation (asking why?), defending, belittling feelings, stereotyped comments, changing the subject. (Arora V et al. 2005) We have devoted the majority of this examination to the spoken modes of communication, but we should not overlook that the written word is an equally important means of communicating ones thoughts to others, particularly on an interprofessional basis. In order to maximise the efficiency of communication a written report should ideally be brief, concise, comprehensive, factual, descriptive, objective, both relevant and appropriate and legally prudent. (Young B et al. 2003) In this assessment one should draw attention to the distinction between being both brief and concise. Brief equates with shortness as undue length will allow the reader’s attention to wander, whereas being concise implies an absence of irrelevant detail thereby allowing an emphasis on what is important. Conclusions. The preparation and literature review has allowed ample time for reflection on the issues raised. (Taylor, E. 2000). This has proved to be a valuable experience as some issues which I believed that I understood, became clearer and this gave me a much deeper insight into both the mechanisms and the possibilities of accurate and concise communication. Not only have the mechanisms of positive enhancement of communications become apparent but also the active removal of the barriers or impediments to communication clearly play an important role in the ability of the nurse to communication efficiently with both the patient and her healthcare colleagues. References Arora V, J Johnson, D Lovinger, H J Humphrey, and D O Meltzer 2005 Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis Qual. Saf. Health Care, Dec 2005 ; 14 : 401 407. Blum N J, Lieu T A. 1992  Interrupted care: the effects of paging on paediatric resident activities. Am J Dis Child 1992 ; 146 : 806-808 Bugge E and I. 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