Perioperative nursing

Perioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurse’s decisions during this period of the patient’s institutionalization are based on universal moral principles. As the patient’s advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but al so ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patient’s trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002: 306). At the same time nurses provide a listening ear  Ã‚   to their patient while providing encouragement and support.Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996: 186).The Nurses’ RoleWithin the framework of the nursing process, nurses’ work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 2004:16). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 2005:3).As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct care ; coordinating comprehensive care and educating patient and their families (Spry:3).The impact of illness particularly when invasive procedures are due usually limits the patients’ individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position.   Patients and family members often feel helpless in a health care setting; how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care.It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patient’s needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patient’s needs whenever ne cessary while providing perioperative care.In addition, the nurse’s role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980: 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002: 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not equip ped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses’ safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002:306).Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect. Other virtues and excellence of character like loyalty and honesty further promote nurses’ abilities to ful fill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impedeethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employee’s ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002: 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery; patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001:117).Facing Ethical DilemmasA nurse, for exampl e, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998:156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital.The nurse will not do any injustice if she takes on the role as the patient’s advocate in all aspects of health care (Seifert, 2002:309). In truth, all health care providers should function as patient advocates (Kohnke, 1980:2040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 2005:3). It may be that all cases in which nurses advocate involve ethical action, but not all cases may ne cessarily involve ethical conflict (Seifert, 2002:309).The nurse’s role in perioperative practice has two components which implies supporting the patient’s autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patient’s decision. One of the fundamental duties of nursing is to promote and defend patients’ rights (Segesten and Fagring, 1996:142). The act of suppressing an individual’s rights serves as the catalyst response of the nurse to act as the patient’s advocate which is her second role.If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations; the nurse may not have a level of experience or communication skills that will facilitate advocacy; they may not be empowered as related to a restrictive care environment; or they just may not have a level of understanding about advocacy in general (Seifert, 2002:308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior; institutional responses to such behavior; and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002: 34).When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001:118).Conclusion:As an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring:144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patient’s advocate particularly during the perioperative phase.This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has any problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 1995:18). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patient’s rights, wishes and care issues (Seifert, 2002:312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills. Related essay: â€Å"Ati RN Community Health Online Practice 2016 B†Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen: Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice: Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy: An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy: An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation: The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research: Nurse-p hysician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040. Perioperative nursing Perioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurse’s decisions during this period of the patient’s institutionalization are based on universal moral principles. As the patient’s advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but al so ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patient’s trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002: 306). At the same time nurses provide a listening ear  Ã‚   to their patient while providing encouragement and support. Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996: 186).The Nurses’ RoleWithin the framework of the nursing process, nurses’ work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 2004:16). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 2005:3). As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct ca re; coordinating comprehensive care and educating patient and their families (Spry:3).The impact of illness particularly when invasive procedures are due usually limits the patients’ individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position.   Patients and family members often feel helpless in a health care setting; how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care. It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patient’s needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patient’s needs whenever necessary while providing perioperative care.In addition, the nurse’s role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980: 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002: 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not eq uipped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses’ safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002:306). Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect.Other virtues and excellence of character like loyalty and honesty further promote nurses’ abilities to fulfill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impede  ethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employee’s ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002: 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery; patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001:117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998:156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital. The nurse will not do any injustice if she takes on the role as the patient’s advocate in all aspects of health care (Seifert, 2002:309). In truth, all health care providers should function as patient advocates (Kohnke, 1980:2040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 2005:3). It may be that all cases in which nurses advocate involve ethical action, but not all case s may necessarily involve ethical conflict (Seifert, 2002:309).The nurse’s role in perioperative practice has two components which implies supporting the patient’s autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patient’s decision. One of the fundamental duties of nursing is to promote and defend patients’ rights (Segesten and Fagring, 1996:142). The act of suppressing an individual’s rights serves as the catalyst response of the nurse to act as the patient’s advocate which is her second role. If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations; the nurse may not have a level of experience or communication skills that will facilitate advocacy; they may not be empowered as related to a restrictive care environment; or they just may not have a level of understanding about advocacy in general (Seifert, 2002:308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior; institutional responses to such behavior; and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002: 34). When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001:118).Conclusion:As an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring:144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patient’s advocate particularly during the perioperative phase. This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has a ny problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 1995:18). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patient’s rights, wishes and care issues (Seifert, 2002:312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills.Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen: Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1 996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice: Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy: An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy: An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation: The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research: Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040. Perioperative nursing Perioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurse’s decisions during this period of the patient’s institutionalization are based on universal moral principles. As the patient’s advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but al so ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patient’s trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002: 306). At the same time nurses provide a listening ear  Ã‚   to their patient while providing encouragement and support. Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996: 186).The Nurses’ RoleWithin the framework of the nursing process, nurses’ work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 2004:16). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 2005:3). As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct ca re; coordinating comprehensive care and educating patient and their families (Spry:3).The impact of illness particularly when invasive procedures are due usually limits the patients’ individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position.   Patients and family members often feel helpless in a health care setting; how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care. It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patient’s needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patient’s needs whenever necessary while providing perioperative care.In addition, the nurse’s role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980: 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002: 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not eq uipped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses’ safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002:306). Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect.Other virtues and excellence of character like loyalty and honesty further promote nurses’ abilities to fulfill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impede  ethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employee’s ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002: 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery; patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001:117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998:156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital. The nurse will not do any injustice if she takes on the role as the patient’s advocate in all aspects of health care (Seifert, 2002:309). In truth, all health care providers should function as patient advocates (Kohnke, 1980:2040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 2005:3). It may be that all cases in which nurses advocate involve ethical action, but not all case s may necessarily involve ethical conflict (Seifert, 2002:309).The nurse’s role in perioperative practice has two components which implies supporting the patient’s autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patient’s decision. One of the fundamental duties of nursing is to promote and defend patients’ rights (Segesten and Fagring, 1996:142). The act of suppressing an individual’s rights serves as the catalyst response of the nurse to act as the patient’s advocate which is her second role. If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations; the nurse may not have a level of experience or communication skills that will facilitate advocacy; they may not be empowered as related to a restrictive care environment; or they just may not have a level of understanding about advocacy in general (Seifert, 2002:308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior; institutional responses to such behavior; and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002: 34). When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001:118).Conclusion:As an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring:144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patient’s advocate particularly during the perioperative phase. This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has a ny problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 1995:18). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patient’s rights, wishes and care issues (Seifert, 2002:312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills.Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen: Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1 996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice: Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy: An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy: An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation: The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research: Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040.

Book Report on “Babouk”

Guy Endore tells the story of the drastic slave history through the eyes of an African – Babouk. He starts by focusing on the cargo of a French slaver during the late years of the eighteenth century. He explores the characteristics of a slave trade through his presentation of the ship and its primary quest. As the ship gets loaded with captured slave at Goree, readers are provided with the concept of how lowly did the early Americans view the African Negroes.The way in which they were â€Å"loaded† to the ship makes the thought of slavery dreadfully equated to the scene of hoarding tools and equipment that will soon be used to gain profits. In general, what makes the story terribly disturbing is the way by which one race maltreats the other because of their difference in color, race, and cultural structures. This was shown when the slaves were stricken with opthalmia during their long, tiring, and devastatingly miserable trip towards San Domingo.During the voyage to the enslaved land, those who failed to meet and satisfy the standards of â€Å"slave eligibility† because of the disabilities that they developed (such as the loss of the sense of sight) were disposed in an inhuman way- being thrown overboard to drown and die. As the slaves reach their unfortunate destination of lifelong enslavement, the story becomes much worse as the once free men take their roles as full-pledged slaves under the rule of â€Å"masters† who treat them disdainfully and without any sign of gratitude and appreciation. However, the drastic enslavement also brings about a positive effect on the part of the Haitians.The slavery drives them to fight. The pain of being treated appallingly and the feeling of being taken away from their home and families eventually evolved into an urge to fight and defend themselves. The slavery of their white fellows transformed them into revolutionaries which eventually became as harsh as they were. Unfortunately, the supposed e nlightenment of the slaves ended in their tragic death. Apathy yields indifference In the story of Babouk, readers were provided with a glimpse of how dreadful early Americans treated their potential slaves.In the story, they showed no signs of remorse in what they were doing. They failed to recognize that Africans like Babouk had the same rights and privileges that they enjoyed. They equated their potential slaves in the same way that they treat beasts of burden and tools for trade and profit. They showed no apathy and acted as if the indifference was a normal part of life and living. In effect, they instilled hatred in the heart of their slaves and they promoted the idea that a human being may treat their fellows in an inhuman way, for as long as they can delineate differences in their race and culture.They showed that violence was normal part of societal interaction and that â€Å"survival of the fittest† exists not only in the jungle. In response to this elaborate show of apathy, they harvested nothing but indifference from their revolutionist slaves. The most disturbing demonstration of this sadistic harvest is when Babouk threw a white child on the ground, struck a pike into its innocent and defenseless body, and used it as a banner. Reference: Endore, Guy (1934). â€Å"Babouk†. New York: Vanguard Press

Conccussions

Informative speech on Concussions Intro Imagine your head pounding and you don’t know where you are, your eyes are dilated and you can’t remember how or what happened. All of a sudden you’re getting help being carried off by people you can’t recognize. You get to the sideline and they start asking you multiple questions, who are we playing? What’s the score? And you stumble to answer these questions and get them wrong. Then they make you take a seat on the bench and say your done playing and inform you that you have received a concussion. 1st body- what concussions are, causesFirst I would like to discuss what concussions actually are. According to Web MD, a concussion is a type of brain injury that is caused by a blow to the head or body, or another injury that jars or shakes the brain inside the skull. By definition, a concussion is not a life threatening injury but it can cause both short term and long term problems. There most likely arenâ€℠¢t any visible signs of a brain injury when a concussion occurs. Even though it is a minor traumatic brain injury, they are still very serious. It can affect how your brain works for a while.A concussion can result from a fall, sports activities, and even a car accident. Your brain is a soft organ that is surrounded by spinal fluid and protected by your hard skull. The fluid around your brain acts like a cushion that keeps your brain from banging against your skull. If your head or body is hit hard enough though, your brain can collide with your skull and be injured. There are many ways to receiving a concussion; they aren’t just involved with sports. Today there are three different types of grades you can receive for a concussion. A grade 3 concussion is the worst one you can get.According to Center for Disease and prevention, recent data shows that, on average, approximately 1. 7 million people sustain a traumatic brain injury annually. 2nd body-symptoms Now that we have a clear understanding of what a concussion is, let me share some of the symptoms with you. Symptoms of a concussion can range from mild to severe and can last for hours, days, weeks, or even months. E medicine health states some very important concussion symptoms and they are loss of consciousness after any trauma to the head, confusion, headache, nausea or vomiting, or even blurred vision.All of these may not occur when you sustain a concussion though; you could only get one or two of them. You don’t have to pass out to have a concussion either, that’s why they are always difficult to tell if someone has one. There are four main categories that concussion can fit into and they are thinking and remembering, physical, emotional and mood, and sleep. All four of these areas have different symptoms for each of them. 3rd body-treatments/my experience with them/prevention Now that I have discussed symptoms of concussions, let me explain the treatments and preventions.According to MayoClinic rest is the best way to allow your brain to recover from a concussion. Any person who may have had a concussion needs to see a doctor. If a doctor thinks you have a concussion, he or she will ask you multiple questions about the injury. These questions will test your ability to pay attention and your learning and memory. A person who might have a concussion needs to immediately stop any kind of activity or sport. Being active again too soon increases the person’s risk of having a more serious brain injury.It is very important to allow yourself time to get better and to slowly return to your regular activities. Conclusion In conclusion, we have discussed what concussions are, its symptoms, and treatments. Concussions can be prevented in some situations, but not all of them. So the next time you receive a headache from hitting your head, the best thing you can do is call your doctor. Concussions are not something you want to mess with, they are a very serious mat ter and you want to get them treated right away. Thank you. Works cited Webmd. com Emedicinehealth. com Mayoclinic. com Cdc. com

To what extent does the variety of capitalism prevailing in a Essay

To what extent does the variety of capitalism prevailing in a particular economy determine the choice of HR policies by organisations in that economy Give re - Essay Example Hall and David (2001) agree with this idea completely since they place the firm at the centre of economic activity in any society. HR and Business related activities like training and education of labour, bargaining with unions, capital and asset acquisitions, even interactions with other companies are connected with the flavour of capitalism used in the economy. Naturally, firms in the country would tend to move towards a system which has inherent support from the national institutions and the government. Over a long period of time, the business processes and the HR policies would become mirrors to the methods used by the political and social institutions of the country. The history of capitalism itself is quite recent since during the 1960s, the word ‘capitalism’ was not prevalent in academic discussions. In fact, it was used by Russian and Chinese Communists to describe the economies of the western nations. During those times, the Conservatives talked about ‘free enterprise while the liberals used the term ‘mixed’ economy and anyone who put forward the idea that the economics of the society is the fundamental guiding principle of production and government were seen as materialists (Block, 1999). With time, the New Left took the term capitalism and applied it to the economies which stand in America, Canada, a large part of Europe and some parts of Asia. During the 1980s and 1990s, a lot of development took place in economic theory in international terms and economists began to see varieties of capitalism itself. The neo-liberal viewpoint that there is only one system of Capitalism in the world is put in doubt when examples are seen from Germany and Japan. One can see unionists sitting on the corporate boards of German companies and Japanese companies tend to focus more on stakeholders and employees than shareholders and clients (Block, 1999). At the same time, when the term ‘capitalism’ is used,

Texas Constitution Essay Example | Topics and Well Written Essays - 750 words

Texas Constitution - Essay Example This essay characterizes Texas Constitution, describing its history and how its main features were developed. Dating back to the history of the Texas Constitution, San Antonio was the capital of Texas back in 1773 to 1824. At that time, Texas government was under the rule of Spain, and was, otherwise or constitutional, largely an abstraction in much of the Texas wilderness. During that time, a follower of Father Miguel Hidlgo Costilla, Jose Bernado Gutierrez, led an abortive revolt against Spanish authority in 1810 for which he was executed for trying to continue the revolution in Texas. Later developments leading more directly to Texas constitutionalism started with the official settlement of Anglo Americans in Texas. The first link in the chain of events that Led to Texas independence was a convention called by the colonists in 1832 to meet in San Felipe de Austin. The Texas constitution comprises of bill of rights that is more expansive than in most state constitutions. The bill of rights follows the national pattern by establishing a separation of authority between judiciary, legislative and executive branches and then establishes a unique system of checks and balances that serves to allow each branch to limit or monitor the powers of the others. The governor of Texas State has limited power and authority in their capacity and role as chief executives since Texas has a plural executive system that consists of several independently elected executives over whom the governor has no control.

Total Quality Management Essay Example | Topics and Well Written Essays - 3250 words

Total Quality Management - Essay Example Japanese remember him as their hero and the father of their post world war revolution. In fact, much of the industrial boom that Japanese manufacturers witnessed after the Second World War was due to the application of the concepts taught by Sir William Edwards Deming. The Japanese industrial leaders invited Deming to their country and in less than four years, the impact was visible. In the next couple of decades, Japanese products were everywhere in the American markets (Neave, pp. 219-222, 1990). These products were better in terms of quality and much cheaper as compared to their American substitutes. Despite the fact that he remained in the headlines in Japan but in his country of origin, the man was running a slow consultancy business. Managers and CEOs were skeptical of his ideas since they were staunch followers of Taylorism. However, in 1980, NBC made a documentary with the title of â€Å"If Japan can†¦why can’t we?† It became almost impossible for the busin ess world to avoid him anymore. From 1981 to 1993, he gave more than 250 four-day seminars where he explained. When he died at the age of 93, his ideas were still far from gaining the publicity and respect that he deserves. Even today, his ideas are gaining prominence and they remain the basis of many researches, studies, and theories. (Bauer, Duffy & Westcott, pp. 85-89, 2006). This paper is an attempt to explore the ideas of W. E. Deming regarding quality management. The paper would then apply those ideas to a company for their better understanding and application. In the last part, the paper would attempt to present a critical analysis of Deming’s theories in light of the recent developments in the field of quality management. Discussion Deming’s approach to Quality Management Much of Deming’s teachings can be summarized with his classical fourteen points from his book, Quality, Productivity, and Competitive Position, which was renamed Out of the Crisis in 19 86. Deming never used the term â€Å"total quality management† within his fourteen points, however, observers and experts agree that with his fourteen points, a new era began in the field of management, which is now known as Total Quality Management. Interestingly, Deming did not put great emphasis on quality but his central focus was on management and management styles. Following are Deming’s fourteen points: 1. â€Å"Create constancy of purpose towards improvement of product and service, with the aim to become competitive, stay in business, and to provide jobs. 2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change. 3. Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by creating quality into the product in the first place. 4. End the practice of awarding business based on price tag. Instead, min imize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust. 5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs. 6. Institute training on the job. 7. Institute leadership. The aim of leadership should be to help people, machines, and gadgets to do a better job. Leadership of management is in need of overhaul, as well as leadership of production workers. 8. Drive out fear so that everyone may work effectively for the company. 9. Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service. 10. Eliminate slogans, exhortations, and targets for the work force that ask for zero defects and new levels of productivity. 11. Eliminate work standards (quotas) on the factory floor. Substitute

Opposing Viewpoints Essay Example | Topics and Well Written Essays - 1000 words - 1

Opposing Viewpoints - Essay Example Genesis is not merely prolonged exercise of metaphors rather it provides an in depth analysis, as evolutionary believers have used metaphors for their interpretations as well. Natural selection in case Charles Darwin mechanism and Dawkins talk of selfish genes. Early scientists believed that God has created earth and life primarily based on some knowledge and not merely a divine whim which would be revealed through inquiries. Life is governed by rational, cognitive and eternal set of laws. Although grudgingly, yet the persecution of Galileo was accepted as mistake of the past. However, the recent events have unfolded the defamation of therapeutic cloning by the same conservative and erratic school of thought. Science and religion co-existence is the only way forward. At times science has owed to the nature. Science has profoundly admired the explicit concepts of nature and making a premise for the fathoming of science and religion. Similarly religion cannot stand alone or the proposition of denying religion with reference to science should be obliterated. Like the early scientists, who were as Christian as evolutionist paved the way for the harmony among science and religion. Also, both science and religion should adapt to the ever changing world and embrace the new concepts emerging on the surface of the world. The religion must not abscond the realms of the science for the prosperity and developments of nations, societies and world at large. 8. Louis Bolce and Gerald De Maio. "American Politics Is Dominated by Battles Between Religious and Secular Voters." At Issue: How Does Religion Influence Politics?. Ed. James D. Torr. Detroit: Greenhaven Press,

Human Resources-Employee Engagement Essay Example | Topics and Well Written Essays - 1000 words

Human Resources-Employee Engagement - Essay Example The main focus on this report is on employee engagement and evaluating the relationship between employee engagement and productivity. Furthermore, a discussion will be carried out showing that organizations need to be updated about the latest trends and changes in Human Resource policies in order to reflect new expectations, which can provide a positive approach towards maximizing productivity in the organization. Employee Engagement Attributes Employee engagement is a phenomenon, which consists of three attributes; attitudes, behavior and outcomes. These are interlinked with each other and provide a virtuous circle of employee engagement. An employee needs to feel committed (attitude) towards carrying out their duties through proactive conduct (behavior) by the way he carries out in his tasks which can provide a result (outcome) in a form of higher productivity with little or no conflicts. These attributes are caused by organizations that engage employees to have a vision towards ca rrying their responsibilities through elements of mutual trust and understanding. Hence, through employee engagement programs there are improved performances. However, employees cannot be manipulated towards commitment because it may result in disillusionment so it is necessary there are scales to review their performances. Employee engagement needs to be measurable so that it can be correlated with the amount of effort an individual puts in performing his tasks (Macey et al., 2011). Employee Engagement and Productivity Employers can play a very effective role in enforcing employee engagement in the organization and use it as a tool to increase productivity. In order to increase the potential of employees, there is a need to incorporate them together by defining the core values and principles of the organization. Productivity can be increased through employee engagement as employees may feel that they are motivated to work towards each other and they may also own the outcome of thei r performances as they are liable to connect their tasks with the organizational goals. Hence, these engaged employees tend to be more vigilant and have a pro-active relationship with each other and the employer. Communication with employees is necessary in order to engage them and define the purpose of their roles as it creates an engagement, which can help achieve these organizational goals. Employers who take part in engagement through effective communication can drive them to do better jobs. The main focus for employers should be how these individuals can identify themselves. Employers need to provide support to them through rational content as well as at a personal level. Ability of the employer to engage them will also lower turnover in the organization. Employees who feel more engaged with the workforce may find themselves more secured and this employee retention will be cost effective for the organization. In organizations, where there is a problem in retention of employees there is a constant need to hire new employees and also carry out their training and development, which may be costly for the organization. Thus, engagement of employees increases the level of satisfaction among individuals, which increases their productivity as well (Albrecht, 2010). Fostering employees towards engagement In order to drive employees towards engagement, there is a need of a strategy through which a culture is developed in which besides judging the person’

Gender Bias at Birth Research Paper Example | Topics and Well Written Essays - 500 words - 1

Gender Bias at Birth - Research Paper Example During 1990 Amartya Sen conducted a research named â€Å"More than 100 million women are missing† and figured out that there is a variation between the population of females in Western nations and Eastern nations (Sen 1). She even figured out that in nations that fall in the regions of Asia and Africa face the issue of lower birth rate of female gender than male gender. She even asserts that certain Asian nations such as Japan are experiencing women majority population while others that are less developed such as Pakistan and India experience male majority in the society. She further figured out that certain regions of India, the female population is in the majority and in other regions the male population is in majority. The most common reasons cited for decreased women population in an Eastern nation is that Eastern nations are sexist. Amartya argues that this is not true since there are certain Eastern nations such as Japan that have a women majority. A similar research was conducted by Sucharita Sinha Mukherjee named â€Å"Women’s Empowerment and Gender Bias in the Birth and Survival of Girls in Urban India†, in this research she figured out that the previously held view that as development arises, biases towards female birth and anti-feminists believe the decline is incorrect (Mukherjee 26). The researcher figured out that census of India has failed to accurately account for females in the nation. She even figured out that even during the census of 2001 sex selection at birth still occurs. The researcher focused on discrimination at birth in the context of gender still prevails even in the fast developing urban regions of India and the previously held view that this kind of discrimination only arises in underdeveloped nations is flawed. The researcher even figured out that rich families of India prefer birth of females as this does not cause the issue of inheritance.

Business, Research Paper Example | Topics and Well Written Essays - 1750 words

Business, - Research Paper Example In this regard supply chain management has a key role to play in the success of companies with aspects like outsourcing being on the rise. The present study would analyze the aspect of vertical integration versus strategic alliances as a possible supply chain management strategy of firms engaged in the aerospace and defense industry competing in the international markets in a globalised market environment. Business level co-operative strategy In general terms, strategic alliances can be defined as co-operative agreement and arrangements between the two or more partners, and hence, the co-operative relationship management is one of the prime requirements in strategic alliances. The strategies aims to meet this requirement are known as the business level co-operative strategies. Co-operation is one of the basic attributes of the strategic alliances and the partners must have a clear understanding of this attribute for framing a set of business level co-operative strategy. Kwok and Hamp son have identified the very specific parameters to measure and frame the co-operative strategies in case of strategic alliances. ... oss border strategic alliance The need for greater consolidation within the highly capital intensive aerospace and defense industry segment has paved the way for greater alliance and collaboration among various organizations for an effective supply chain management. The need to develop high end research has also promulgated the need to have greater strategic alliances with international partners. For example the NATO partners are actively trying to enter into greater collaborations and strategic alliances with the US and European companies in a bid to improve upon the efficiency of the companies (Lorell et.al, â€Å"Implications of European Consolidation and Increased Aerospace Globalization†). Strategic alliances also help in developing a greater synergistic association between the companies and the civil sector. The example of the modern air fighter Euro fighter Typhoon is a good example in which five European nations namely Germany, UK, Spain and Italian companies went into a strategic alliance to create a world class fighter aircraft. Another such example involves the case of EUROFLAG consortium in which five European national companies have entered into a strategic alliance to manufacture fifth generation fighter aircrafts. However the aspect of cross border alliances also involve certain hindrances mainly in the form of government contracts and regulations, arms policies and export rules of different nations, disparities in the requirements and finally the absence of multinational legal structure across various nations etc that can have serious implications on the development of cross border strategic alliances between players in the aerospace and defense industry (Commission of the European Communities, â€Å"Cross Border Industrial Integration†). Vertical

Research paper on William Hartnell and Tiburcio Vasquez

On William Hartnell and Tiburcio Vasquez - Research Paper Example As a student he was known for his fluency in English and Spanish. Life was good until he started seeking company stronger than himself. It is embedded in the psychology of a human mind to seek out friendships stronger than him. That’s when he found Anastacio Garcia, who happened to be the most notorious group of bandits known to California at the time. (Boessenecker, 68) Tiburcio Vasquez was an audience and sometimes the participant to various notable slayings. Whether he was involved or not is a moot topic for discussion. Some people believe that he chose exile over imprisonment and punishment while other are of the view that he did it for the best interest of his country. According to his supporters he took part in those violent actions against North Americans who threatened the safety of Mexican Americans. His partnership with Garcia ended after the bandit was killed in the person. That’s when he took to the road, kept moving from place to place but fate could be outrun only for so long. He ended up in the prison only to break out of it in a rogue manner that took the lives of many of his fellow prisoners. For some time he led the life of a normal innocent man but later his addiction to crime revealed itself in the most horrific manner there could be. He took recourse to theft, heinous murder, rape and many other crimes for which he soon smelled the prison air yet again. Wherever there were bodies with hands tied behind their backs and face down, was a site visited by Vasquez. Human beings are astonishing creatures some are mad optimists while others are suicidal pessimists. Some people mostly Mexican Americans emulated him. They thought he was a blessing in disguise that had the brevity to stand up against North American penetration. As a student he was brilliant and had inherited a fair share of property which meant there was no real need for theft and other crimes he was charged for. They also believe

An inspector calls Essay Example for Free

An inspector calls Essay How does Priestley use the Inspector to create a sense of impending doom for the Birling family in act one of An Inspector calls? There are several themes portrayed by certain characters including responsibility, community, guilt, egocentricity and denial. They are key ideas in Priestleys play An Inspector calls, and contribute to the general sense of imminent trouble. There is a great deal of contrast with regards to social events and historical context between the time the play is set in, 1912 Pre World Wars, and the first staging of the place, post World war 2, 1945-46 (disputed). This difference is what fuels many ironic statements throughout Act one, mainly by Mr Birling (one example of this is his speech on page 4). The class Hierarchy also plays an important part in the play, as the Birlings are upper-middle class, and Act One conveys this impression of the stereotypes of class very well. The Impact of the staging suggests a money-orientated posh lifestyle surrounding the family, which the audience would generally disapprove of because of the economic slump and more lower classes present post World War 2. The Birlings are an almost aristocratic family and they look down on any one who is below them in the social hierarchy. Priestley uses the inspector as a key dramatic device and moral conscience to teach the Birlings moral values and the themes discussed earlier. There are many emotive metaphors one can link to the idea of war in the play, such as fire blood and anguish. Furthermore Priestley may have written this detective thriller play set in Edwardian England in an industrial city to convey the message Learn from your mistakes so it doesnt happen again referring to the world wars. Who is the inspector? No real person of interest, more something like a personified bad conscience of guilt and internal voice. The play opens with an intimate celebration of Gerald and Sheilas engagement. Priestley presents the audience with a calm, family and celebratory mood at the beginning of Act Ones first scene. This is clearly shown in the stage directions the lighting should be pink and intimate. The adjective intimate may suggest a mood of relaxation, cosiness and self-involvement. This contrasts to the set as being described as not cosy and homelike implying something is out of place in the atmosphere, which may suggest presage to looming mess and confusion. It also contributes to the foreshadowing of the inspectors entrance (as one would expect contrast later in a play) when the lighting is described as brighter and harder. The comparative adjectives brighter and harder both suggest the mood turns focused and may imply an intensification of the already tense atmosphere caused by the dramatic effect of the inspectors entrance. Moreover this use of lighting hints at the foreshadowing of the trouble that the Birlings will come to turns with. Priestley presents Mr Birling in a very arrogant and negative light to the viewers. An example of this is Mr Birlings toast on page 4, when he talks about his view regarding the engagement of his daughter. Perhaps we may look forward to a time when Crofts and Birlings are no longer competing For lower costs and higher prices. This shows Mr Birlings possible key objective and may suggest Mr Birling is materialistic, as that is how he finished his speech, pressing more emphasis on money and profit. This is an example of his totalitarian obsession with money, and is likely what caused the idea of Eva Smiths loss of job, and eventual death, exposed by the inspector. In addition, the focus on reputation and honour are key factors in presenting Mr Birling as a corrupt, self-obsessed, and acquisitive businessman, obsessed with his image. I gather there is a very good chance of a knighthood so dont get into police court or start a scandal his suggestion of a knighthood may indicate his need of representation within his social class; as a righteous citizen, showing the Birlings have high hopes within their society. Mr Birling appears to use his social status to acquire respect and nobility from Gerald. It is also ironic that he asks his family not to get into police court or start a scandal since that is exactly what appears happens in the play, and this can ironically foreshadow the future events. His obsession in keeping his image, and his attitude toward lower classes is what makes him reluctant to disclose details concerning and regarding his company, Birlings and Company, to the inspector. This defensive attitude, this wall is what he inspector expects and retaliates against. By doing so he makes the family feel uncomfortable as if there is something worse to be revealed, adding to the sense imminent disaster in this Act. Furthermore, Mr Birlings strict view on life is another probable cause for the unfolding of the events. The fact that Mr Birling says that a man has to mind his own business and look after himself and his own and- shows his self-obsessed and uncaring side, which makes the audience feel uneasy. At this point, at the pinnacle and point of Mr Birlings speech, the doorbell sharply rings interrupting him. This has a substantial dramatic impact as Mr Birling was likely to say family and, ironically, the inspectors supposed aim is to teach him and his family community responsibly, as if the inspector wants to say community by ringing the doorbell, and, by using hindsight, one may assume this foreshadows the inspectors intentions. Also, the inspectors entrance is considerably significant, as it adjusts the mood and alters the atmosphere. His entrance invokes a sense of apprehension which is built on later on in the play, starting the sense of impending doom of the inspectors interrogation because no one would expect anyone to come to the house this late, unless it concerned something very important, urgent or a combination of the two. His first words are Mr Birling? simply inquiring to if it is Mr Birling he is talking to. This may imply the inspector wants to cut to the chase and start the inquiry, to the annoyance of Mr Birling, as he wants to butter him up and get it over with. It may also show that the main reason the inspector is here is Mr Birling, and he may directly implicate Mr Birling just by asking a simple question, even though we know that is not true later on in the Act, the audience is still unaware. This adds to the uneasy, nervous atmosphere caused by his entrance. The stage directions clearly intensifies the mentality and superiority of the Inspector, as he creates at once an impression of massiveness, solidity, and purposefulness. The sense of anxiety, interest and uneasiness rises at the sudden impact of a police inspectors entrance, just spelling trouble, and the fact that it is late at night implies deep trouble for the Birlings and Gerald. Moreover, the inspector makes the family ask him questions rather than the other way around (as one might expect with an inspector, as that is his job, to ask questions) and he intentionally withholds details and information from the family to use their curiosity to implicate themselves. For example when Eric tries to get out of the interrogation as he says he feels uneasy, the Inspector tells him he should stay there, and waits for Eric to ask Why should I? and replies with It might be less trouble. If you turn in, you might have to turn out again soon. This answer could simply state the impracticality of Eric turning in yet his answer may also be ironic because he will implicate Eric in a number of ways, revealing Eric is in more trouble than he previously thought, possibly because he stayed. This may be because the inspector is trying to teach them a lesson, and he does so by Inspecting the family and he gathers and uses the information he derives from the reactions of the characters, in this case Eric. By telling Eric to stay he makes not only the characters but also the audience feel uncomfortable, and this further builds on the apprehension and mystery surrounding the inspector, adding to the sense of impending doom in the Act. Moreover, Mr Birling is trying to get the interrogation over with and refuses to believe he is involved. For example, Mr Birlings reaction when he realises hes not the only one involved, but also his family, is quite significant. He said If id known that earlier, I wouldnt have called you officious and talked about reporting you and may imply that Mr Birling is relieved that he isnt involved, but the fact that its any better for him that his family is involved, is quite disconcerting for the audience because it shows he is more self-involved and egocentric, as he cares more about himself than his wife and children. The statement may also imply that, in the point of view of Mr Birling, his temper got out of hand when he talked about calling him officious, and he now regrets what he said either because he was just worried about himself and looked for an excuse to show his remorse to show himself in a more positive light, or because he feels he needs to protect his family, and that his calling the inspector officious he may have offended him and this could negatively change the inspectors view of the family, which may lead the inspector do or act unsympathetically towards them, and by explaining his actions he could avoid impending trouble. In addition, Priestley presents Sheila as being part of the audience. He does this by using her as a dramatic device, as the inspector. But in contrast to the use of the inspector as a dramatic device to be the voice of moral value, Sheila may be used to represent the ear, or audience to absorb Priestleys lessons. For example the inspector talks about Eva Smith not exactly going on the streets, Sheila enters, as if her entrance represented the audiences curiosity toward Eva. Sheila immediately inquires whats this about streets? Leading into her involvement in the supposed suicide of the character Eva Smith by making her ask the questions and him using emotive language. Finally he shows a photograph, which may or may not be the character Eva Smith, to Sheila and she instantly exposed herself with the person on the photographs involvement. The inspector feeds on this and uses it to implicate her further. This gives an impression of the inspectors superior knowledge To the Birlings and builds on the sense of impending doom in the Act. Adding to that, the family, especially Sheila, feel there is no point in lying because the inspector knows the truth. The family, and event he audience, might wander why the inspector asks the questions if he already knows the answers? The answer to that may simply be he wants to find out he credibility and honesty of the family but I think its deeper than that. It could be Priestleys intention of teaching audience, through the play, moral responsibilities and values by showing the social flaws at the time. An example of this is the discussion of the inspector between Gerald and Sheila at the end of Act 1 revealing Geralds connection with Eva Smith (Daisy Renton) and Sheilas reluctance to lie to the inspector. This shows how deep the dramatic impact of the inspector really is, as was foreshadowed earlier in the Act concluded by the entrance of the inspector right before the curtain falls leaving a dramatic cliff-hanger at the fall of the curtain. Finally, Priestley was a soldier in the First World War, experienced many of the harsh realities of war; which may have motivated him to write this play. He wanted to express his beliefs through a character. So he created the inspector as his image to convey his scepticism and criticism toward anti-socialist upper-class arrogance represented by the Birlings. Priestleys use of the inspector as a dramatic device and Sheilas representation of the audience promoted and got across his views throughout the play and especially in Act One. He created the sense of doom for the Birlings to show what happens to such attitudes represented by the family, because as we know, the war would have had a devastating impact on them. The mood of the act started out intimate and casual and slowly evolved to tense and disquieting because of the inspectors interrogation and even by him simply being there. What J. B. Priestley wanted to tell the audience through the play and through the inspector was One Eva Smith has gone but there are millions and millions of Eva Smiths and John Smith still left with us We dont live alone. We are members of one body. We are responsible for each other. I didnt much like the play, but I did enjoy the subtleties and casual metaphors that made me think. To conclude, I think it is a piece of literature that was significant at the time, though I think a different piece which wouldve evoked more interest wouldve been a better choice to analyze. I hope you enjoyed reading it more than Ive enjoyed writing it.

Concept of Individualised Care: Geriatric Case Study

Concept of Individualised Care: Geriatric Case Study Explain what is meant by the term individualised care. Discuss, using examples from a second practice placement, how one individual patients /clients needs were met using this approach. An essay Introduction The traditional way of trying to assess if a particular treatment or the clinical condition of a patient has changed, is by running blood tests, clinical evaluation, and other laboratory tests. While these measures undeniably give us certain levels of information about a patient, they tell us virtually nothing about the disease process from a personal and social context. (Higginson et al 2001). No illness exists in a vacuum. This essay is a discussion of the concept of individualised care with particular reference to my recent placement on a geriatric ward. I am going to discuss the case of Mrs.J., a 83 yr. old lady. Mrs J has been on the ward for two weeks. She was originally admitted with a chest infection. She was very ill at the time of admission and it was not easy to get a history from her. We could only establish that she lived on her own and had been found by a neighbour who had called her General Practitioner who had then arranged her admission. Her chest infection was treated and she responded reasonably quickly. As she became more lucid, it became obvious that Mrs.J. had had a mild stroke leaving her with an expressive dysphasia. It was not possible to ascertain whether these changes had been present for a long time or had just come on, as she had not seen the General Practitioner for nine months prior to this admission. We also discovered that Mrs.J. had developed a mild form of Type II diabetes mellitus as she was putting out small but constant levels of sugar in her urine and her blood sugar levels were mildly elevated. In brief, her care plan called for her to mobilise with the physiotherapist, to receive speech therapy for her dysphasia, to see the dietician for advice regarding her dietary control of her Type II diabetes mellitus and to see the social work team for assessment for discharge as it was considered unlikely that she would actually be sufficiently self-caring to be able to discharge to her home. The nursing profession, almost by definition, is a very personal and interactive profession. (Yura et al 1998) In order to provide good individualised care there must be a number of interactions in place. The nurse must have a good understanding of the medical elements of the case and also have a good knowledge of the patient both as a person and of all their circumstances. (Meleis 1991) This helps to allow the formulation of good individualised care without making any inappropriate decisions that may be based on an incomplete understanding of the situation.(Holzemer et al. 1994) The case of Mrs.J. is complicated because of her expressive dysphasia. In a nursing context the â€Å"interpersonal processes† that are necessary to establish rapport and empathy were made very much more difficult. (Platt et al 1999). The verbal and motor cues that are a vital part of this essential process were not there by virtue of her cerebro-vascular accident, and it made proper and meaningful conversation very much more difficult. (Carpenito 1997). It was not helped by the fact that she did not appear to have any close relative that we could use to get information. It was not simply a matter therefore of deciding what was medically the best for her, but in order to try to engage with her on the level of empowerment and education, we had to try very hard to understand her feelings and situation in order to provide individualised care. (Woolhead et al 2004) If we try to apply the Roper Logan Tierney model of nursing care (Roper et al 1983) to Mrs.J.’s situation of needing dietary advice for her newly diagnosed Type II diabetes mellitus, the aim would be to try to provide individualised care and to take into account the degree to which the problems of her inability to communicate actually interferes with the other activities of daily living. (Howe et al. 2003). It is in this respect that the concept of individualised care becomes clearly apparent. For the average patient., it may simply be appropriate to fill out a dietetic referral slip and let the dietetic department do the rest. If we wish to fully implement the concept of individualised care, then we would need to establish that Mrs.J. needed and understood why she needed dietetic advice, that she could adequately understand what was being said, (Kuhse et al. 2001), and also make sure that the dieticians were fully aware of all aspects of the situation when they were able to visit her and give advice. (Newell et al 1992) This approach allows us to make an assessment of both the positive and negative aspects of the decision. We can also make an assessment of whether Mrs.J. would eventually be in a position to take responsibility for her own diabetic (or dietary) care in the long run. (Marks-Moran et al 1996) In individualised care, it is important to be as empathetic as possible to the patients needs. One must appreciate the fact that, in this particular case, the imposition of a diet may be seen by the patient as yet another (iatrogenic) restriction imposed upon an already severely restricted lifestyle. Generally speaking, concordance and explanation are better than dogma and enforced compliance (Marinker 1997). Another important aspect of individualised care, is the process of reflection (Gibbs 1998). It is generally comparatively easy to make clinical decisions, but the key to ensuring that they are actually the correct decisions for that individual patient, is to reflect upon them and consider all of the aspects of that particular patient’s case, which may not have actually been impinging upon the original decision making process. (Taylor 2000). For example, it is almost certainly the correct decision to invoke the help of the dietician to assist Mrs.J. in managing her Type II diabetes mellitus. It is however, possible that, upon reflection, Mrs.J. might not be able to adequately manage her diet because her motor problems now preclude her from going independently to the shops, and the person who buys her food for her may have absolutely no idea of the basic concepts behind the maintenance of a regular and restricted sugar intake. Conclusions and Discussion Mrs.J. ‘s case fortunately did have a comparatively happy ending. She accepted the dietician’s advice and proved to be remarkably adept at both managing and manipulating her dietary needs.(Carr et al 2001). It became apparent that part of her confusional state and her dysphasia, was actually due to her hyperglycaemia. As her hyperglycaemia improved and her blood sugar levels returned to more normal levels she rapidly became more communicative. The interpersonal interactions that we referred to earlier, then became both easier and certainly more meaningful. (Stowers et al. 1999). Mrs.J. improved to the point where she was well enough to allow discharge to warden assisted accommodation. Her warden came onto the ward to learn how to help manage the dietary considerations and was able to speak at length to the dietitian. I would like to think that the warden left the hospital as empowered and educated as Mrs.J. was. References Carpenito LJ. 1997 Nursing diagnosis. Application to clinical practice. 7th edition. Philadelphia: Lippincott Company, 1997. Carr AJ, Higginson IJ. 2001 Are quality of life measures patient centred? BMJ Vol18 Issue 42 2001 Gibbs, G (1988) Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Higginson and Carr 2001 Measuring quality of life: Using quality of life measures in the clinical setting BMJ, May 2001; 322: 1297 1300. Holzemer W, Tallberg M, et al, editors. 1994 Informatics: the infrastructure for quality assessment improvement in nursing. Proceedings of the 5th international nursing informatics symposium post-conference; 1994 June 24–25; Austin, Texas. San Francisco: UC Nursing Press, 1994. Howe and Anderson 2003 Involving patients in medical education BMJ, Aug 2003; 327: 326 328. Kuhse Singer 2001 A companion to bioethics ISBN: 063123019X Pub Date 05 July 2001 Marinker M.1997 From compliance to concordance: achieving shared goals in medicine taking. BMJ 1997;314:747–8. Marks-Moran Rose 1996 Reconstructing Nursing: Beyond Art and Science London: Balliere Tindall October, 1996 Meleis A. 1991 Theoretical thinking: development and progress. 2nd edition. Philadelphia: Lippincott Company, 1991. Newell and Simon. 1992 Human Problem Solving. Prentice-Hall, Englewood Cliffs: 1992. Platt, FW Gordon GH 1999 Field Guide to the Difficult Patient Interview 1999 Lippincott Williams and Wilkins, pp 250 ISBN 0 7817 2044 3 London: Macmillian Press 1999 Roper Logan Tierney 1983 Using a model for nursing Edinburgh: Churchill Livingstone Stowers K, Hughes RA, Carr AJ.1999 Information exchange between patients and health professionals: consultation styles of rheumatologists and nurse practitioners. Arthritis Rheum 1999; 42(suppl): 388S. Taylor. B. J (2000) Reflective Practice: A Guide for Nurses and Midwives. Buckingham: Open University Press. Buckingham 2000 Woolhead G, Calnan M, Dieppe P, et al. 2004 Dignity in older age: what do older people in the United Kingdom think? Age Ageing 2004;33:165–70. Yura H, Walsh M. 1998 The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. PDG Word count 1,562 Muhammad Rafiq Azam Architect: Case Study Muhammad Rafiq Azam Architect: Case Study Table of Contents (Jump to) Introduction Analysis Climatic condition Architectural theory Clients Culture Materials Discussion Conclusion References Book resources Internet resources Introduction: The purpose of indicting this particular essay is to understand architecture via language especially in term of vocabulary, grammatical structure; both physical and intellectual. Through certain arrangement, it carries message and communicates meanings. Rafiq Azam had been chosen as the target of analysis of self and architecture. Muhammad Rafiq Azam is an award-winning architect. He is also a globally acclaimed architect of vernacular architecture from Bangladesh. Shatotto is an architectural studio led by Rafiq Azam, which specialized in architectural aesthetics inspired by lush, riverine landscape of Bengal delta, and ancient architecture heritage of particular region. South Water Garden is a project by Shatotto which was being executed by Shatotto under the lead of Rafiq Azam. It was an apartment building project which located at United Nations Road, Baridhara diplomatic zone, Dhaka, Bangladesh. It is a region not much an exception in term of green. A lake and a narrow strip of green patch on the west of the plot is a fortune. The built area of particular project is about 33600 square feet and had been cost about 576000 US dollar. The particular project was owned by South Breeze Housing and had been completed in 2007. Analysis: In analyzing and theorizing the south water garden imbued architecture quality in term of climatic condition, architecture theory and factors of client, culture and material as well, the analysis depicted that: In term of climatic condition: Apparently, Dhaka undergoes a drastically scorching climate, which characterized as wet, hot and humid climate as it has been categorized under koppen climate classification. Dhaka has been determined as it possess of tropical savanna climate as well. Furthermore, the particular city also has a distinct monsoonal season. In order to design a responsive building, Rafiq Azam had to take account into Dhaka’s climatic conditions as premise. First and foremost, the orientation of building sun screening faà §ade in response to climatic condition of Dhaka is necessarily required in order to reach the standard thermal comfort level in accord to human comfort. Via the analyzing of South water Garden buildings’ plan orientation and building configuration as well, it was obviously to identified and figured out that Rafiq Azam’s intention on creating a parallel configuration. Via the particular array and permutations, the parallel respective building’s blocks tend to act as protective screen in against to direct exposure to summer solstice and winter solstice during the noon. Conclusively, the southern block aids to shade the northern block during the winter solstice, in contrary, the northern block aids to shelter southern block during summer solstice. The incorporation of two hundred square feet of green patch in front of the building on the east road and utilization of large tree and lake on the west as cooling device for the apartment buildings create a balanced interrelation with building configuration in opposing the unstable climatic conditions of Dhaka. Simple interior is connected to beautiful lake and large trees on the west, enabling the south east summer breeze flowing via the entire house. Apart from that, the intention of respective parallel blocks also enables itself to achieve optimal light density for residents’ daily activities. Therefore, sun path effects had been considered as primarily factor as it contributed much i nfluences on building’s comfortability to live. Tactics of Orifice consideration in response to prevailing wind and summer breeze is also a mean to achieve optimal cross ventilation in order to fulfill the human comfort level. The south east and east prevailing wind flow through the house, simultaneously drifting away the heat that gained inside the apartment aid to create a cozy atmosphere inside the apartment buildings. In term of architectural theory: South Water Garden is designed based on phenomenological architecture. Preliminary, looking deep into Dhaka geographical situation as the land characterized with tropical vegetation and moist soils in the primarily was currently being destructed as these all were replaced by construction of multi-storeys building and other real estate developments. Traffic congestion and industrial waste has drastically resulted the deteriorating of air and water pollution. Hence, the regional biodiversity was being demolished. The opposing current aspect of philosophy create trend of creating green in order to preserving extinction of it stimulates local architects to take step into phenomenological architecture especially Rafiq Azam. In response to the particular environment’s situation, an intention of retention among the green and originality of Dhaka’s elemental human experiences, natural features were incorporating into the South Water Garden design in order to create a building design which is concretely defined as â€Å"the place† Dhaka, as well as the South Water Garden residents’ experiences among Dhaka’s originality coincidentally take place in the building. In ground floor plan, Rafiq Azam arranged interior spaces in a simple functional way in order to emphasize on the connectivity between building interior and exterior. By achieving this, he’s skillfully utilizing natural elements such as lake and large trees on the west as transition space that gradually emanating to the surrounding. In contrary, this condition facilitated particular permutation and arrangements of design maneuvering away from abstractions of science and its neutral objectivity as well. In the orizing Rafiq’s architecture via analyzing of South Water Garden roof plan, the imbued intention of connectivity between roof and ground is being emphasized through the two roof tops design of South Water Garden. Incorporation of green living at roof tops is to respond natural elements of rear plot. The continuity of roof tops green to west ground natural features enhances the interrelation of both which then established a strong connectivity among them. Apart from that, the both roof tops of the apartment buildings were created in a way that evidently displays the quality of human experiences of green living as the community green of roof tops which encompassing lawns and bushes subtlety embracing the residents into a sense of Mother Nature. A small pavilion was located poetically at the midst of green community which formed a strong desire toward the nature. This scheme then transformed into a subtropical architectural vocabulary which addressing Rafiq Aza’s concern on shortage of green space in Dhaka. In term of clients Rafiq Azam had been assigned to work with an area of seven thousand five hundred square feet plot. This was a project that formed through the deal between landowner and developer. They both agreed to divide the land in an equal two pieces respectively to construct two six storied buildings of two thousand eight hundred square feet floor area each in order to share equally each. In looking deep into this particular condition, Rafiq Azam’s consideration on requirement that insisted by the clients also influenced much of the design. The clients insisted to put the design into a challenge in terms of creating open green space. In respond to client’s requirement, Rafiq Azam suggested to take forty square feet over seven thousand five hundred square feet from the plot impartially which placing along with eight feet gap of two building respectively, five feet road set back as per rule in order to create a two hundred square feet of green patch in front of the building on the e ast road. This is quite emphasizing of direct residents’ experience toward the buildings as well as the intimacy of natural elements with the users was being created. In term of culture: The richest heritage is formed in neighboring region and lesser developed civilization, as South Water Garden which is located at United Nations Road, Baridhara diplomatic zone. In response to this condition, the arrangement of South Water Garden with no boundary wall notion delivers a more friendly approach toward the local residents. Little pews are placed which delivered a token of respect for pedestrians and community living around. The creation of small pavilion on the roof tops enables gatherings and roof party to be occurred among the neighborhood, which cordially implement the building language co-relation to achieve a hormonal atmosphere amidst the environment. In term of materials: Major buildings in Dhaka, Bangladesh had used brick and concrete as construction materials as these are the most responsive materials to Dhaka’s subtropical climate. In response to surrounding context, exposed brick and concrete are majorly being utilized as construction materials in South Water Garden Apartment. Moreover, the utilization of exposed as cast structural beam and column exterior with terracotta brick in fill is also an approach to subtropical climate of Dhaka that being intended by Rafiq Azam. The selection of materials is quite responsive to human comfort level. Discussion: Rafiq Azam architecture is quite based on experience of space and sensory properties of building materials. This might due to his childhood experiences. By acknowledging that most of the architectural production in Dhaka are dominated on quantitative which driven by profitable motives, he realized that most architect’s keen of sensibility towards a social, ecological and conceptual content is minimized. Growing up in a city which is excessively illustrates segregation of individual architecture as a singular building in a schmooze of materials such as glass, metal, and concrete, there are probably no initiative in thinking much, especially ways of creating an urban which ensemble of various kinds of spaces, which from private to communal, and from hard to green conditions. It was no hard to imagine that with all types of buildings and spatial arrangements coming out of a calculus of market dynamics and borrowed style of architecture. This strictly constricted the architects un til only left with the privilege of addressing buildings with windows. Additionally, Bangladesh has a unique relationship with water, and their sensibilities to its bounty and destruction are a tangible part of the national psyche. The Bangla axiom paanir opor naam jion (water is another life) aptly demonstrate this psychological architecture and the determinative influences of the more than fifty trans-boundary rivers between India and Myanmar, with all their hydrological, social, economic, and political ramifications. With Azams strong impression towards all the impact in his childhood, little wonder then that water bodies are a constant architectural features for Rafiq Azam which is giving out the unrestricted and exposure kind of mood towards the whole city. And his desire to revitalize nostalgia is as ubiquitous in his designs as the water itself in Bangladesh. In his architectural theory, his building is not compendious as the locality, in contrary; it ought to be encompassing of local concretely characteristics or atmosphere which being illustrated via the use of material substances, shape, texture, and color. For instances, the use of cast structural beam and column exterior with terracotta brick in fill is simple way of approach toward subtropical climate of Dhaka as well as the materiality of intimate locality experiences. The consideration of human sensory experiences of building materials is obviously demonstrated through the human comfort responses’ design. In the means of creating spaces, Rafiq Azam allows certain spaces with identical functions to embody a different architectural quality in accord with the local unique characteristics in term of culture and environment conditions. For instances, the local gathering culture was being incorporated into South Water Garden’s roof tops design as the roof pavilion was being created for roof top party. Rafiq Azam attempts to implement his architecture return to things, somehow maneuvering away from abstractions of science and its neutral objectivity. By achieving this, he tries to make things priory happens to be conveys it unique conversations with its place the relevant topic. His design then becomes settlement of different scales in contrasting with surrounding other components. The paths between these subsequently create the Rafiq’s design become secondary defining characteristics of place. The distinction between these conditions offers him the step toward the phenomenological approach. For instances, the emphasis of connectivity inside and outside by Rafiq has been vividly proved via the South Water Garden’s design. Both of the roof tops were created as community green which forms a connection between roof and ground. Conclusion References Book resources Rosa M.F., Kazi K.A. Philip Goad. (2013). Rafiq Azam – Architecture for Green Living. Italy: Skira editore S.p.A. Internet Resources http://www.architecturenewsplus.com/projects/2218 http://archpresspk.com/new-version/Rafiq-azam-book.html http://www.worldarchitecture.org/main/winners.asp?winarchive=11thcyclecyc=11 http://archpresspk.com/new-version/architect-rafiq-azam-interview.html