Behaviourist Learning Theory Directed Nursing Practice Nursing Essay

Behaviourist Learning Theory Directed Nursing Practice Nursing Essay According to professional standards of the College of Nursing of Ontario, the leadership expectation is not limited to nurses who are in formal leadership positions; all nurses, no matter of what kind the positions they are, have obligation to demonstrate leadership. Leadership requires knowledge to understand not only our own beliefs, values and behaviour affecting others, but also others beliefs, and values to build respect, trust, and integrity in a health care team. This course requires students choose a theoretical framework to guide developing a learning plan, and then applying the theory to a practice project for the purpose of expanding their perspective of nursing practice as an independent thinkers in the organizational or global level of hospital or community setting. My project report will review and analyze how behaviourist learning theory (BLT) directs my learning activities in clinical practice as an independent thinker to prepare myself in optimizing my future nursing practice. It includes two components: knowledge and application. The knowledge component will involve reviewing and comparing relevant content about the correlation between the generations of nursing workforce and choice of leadership style from five recent scholarly articles, identifying their strength and limitation, as well as guiding my nursing practice to achieve my learning goals. The application component includes how the acquired knowledge was utilized to guide my critical thinking process for figuring out the true reality of correlation in working setting between the generations of nursing workforce and choice of leadership style, as well as the challenges I have experienced. Knowledge Component BLT views learning as the product of the stimulant conditions and the response; its focus is mainly on what is directly observable. Behaviourist may closely observe responses and then manipulate the environment to triage more desired stimulus to bring the intended change (Bastable, 2008, p. 54). That is the inspiration I choose the stimulant conditions different choice of leadership style from different generation of nursing workforces in my questionnaire survey project, and the response my learning outcome from the project, as the core concept from BLT as literature research topic to acquire related knowledge and apply it to my project about the correlation between generational diversity and choice of leadership in my clinical placement setting. Literature Review / Five Relevant scholarly Articles In her article, Hahn (2009) clearly realized todays reality is that nursing workforce is made up of multigenerational staff. Nursing managers and their team members might hold different attitudes, beliefs, work ethics, and job expectations. The generation gap increases and creates more opportunities for misunderstanding and conflict. For both leaders and team members, the understanding generational differences would benefit in creating strength and opportunity or a source of stifling stress and conflict. How to deal with the challenge from the multigenerational diversity and develop a highly functioning and cohesive nursing team are current focuses for the nurse manager to be an effective leader. Although Hahn did not directly explain which leadership style would fit current workforce situation, the suggested strategies in her article for managers to effectively manage a multigenerational team indicate the transformational leadership to be the choice as an effective leader. Her argum ent was supported by previous researches done by Ulrich (2001), Zemke, Raines and Filipczak (2001). According to the research done by Cummings, MacGregor, Davey, Lee, Wong and Lo, et al (2010), some forms of leadership might be possible to lead to negative outcomes. They made their research from 10 electronic databases that include 53 published quantitative studies, then used content analysis to analyze these studies; 64 outcomes emerged from their analysis were classified into five categories: (1) work environment factors, (2) productivity and effectiveness, (3) staff relationships with work, (4) staff satisfaction with work, role and pay, and (5) staff health and wellbeing. Their research found the leadership styles that focused on people and relationships, such as transformational, resonant, supportive, and consideration, were reported in 24 studies, which were associated with higher nurse job satisfaction; whereas the leadership styles that focused on tasks, such as dissonant, instrumental and management by exception, were reported in 10 studies, which were associated with lowe r nurse job satisfaction. Therefore, they concluded that the leadership that focused on task completion alone is not sufficient to achieve optimum outcomes for the nursing workforce; transformational and relational leadership are needed to enhance nurse satisfaction, recruitment, retention, and healthy work environments, particularly in this current multigenerational workforce. Differently, Stanley (2008, 2010) argued that congruent leadership will be the one that can facilitate greater effectiveness when dealing with generational issues. Because this approach of leadership rests on the leaders values and beliefs that are demonstrated on leaders role modelling of their personal nursing / health care or organizational values; the actions of this leadership style are matched (or are congruent) with followers values and beliefs when dealing with multigenerational employees. Followers who have the same or similar values will support and follow these leaders because of their own values alignment. While realizing the difference of values and beliefs that are truly existed between the generational groups, Stanley emphasized that leaders core nursing / health care values are likely to offer significant common ground for this leadership approach to ensure it will be employed successfully. Kowalski, Bradley and Pappas research (2006) seems to be in a supportive posit ion to Stanleys argument. In her article, from the efficiency and positive outcome of management in a health care organization, Robbins and Davidhizar (2007) articulated there is a direct link between leadership style and staff retention, satisfaction and patient satisfaction. Currently, the changing faces in health care workforces pushes the management of nursing on the edge of the change in management strategy using effective and appropriate leadership to prompt greater success in gaining and maintaining staff satisfaction, staff retention, and then, in long run, improving patient satisfaction. Staff retention and satisfaction are the driving forces for achieving the patient satisfaction. Comparing with transactional leadership in leadership strategy, mission and vision, communication, relationship-building, they argued that transformational leadership is more effective in gaining and maintaining staff satisfaction, retention, and patient satisfaction in health care organizations. Poor leadership on a nursi ng unit leads to unhappy, unmotivated, and less dedicated staff. The underlying fundamental is that a transformational leader has the ability to effectively communicate the vision, mission, and empower nursing staff, which in turn build and promotes a healthy working environment for the entire team. Generally, Arsenault (2004) realized that todays workforce is more diverse than ever. There are many diverse issues. One of them is generational differences, which is created by a shared collective field of emotions, attitudes, preferences, and dispositions. Relatively, the differences in the unique attitudes, values, and beliefs of each generation determines how each generation views leadership, and ranks admired leadership characteristics, which correlates to their choice in leadership style and favourite leaders. He concluded that generational differences are a legitimate diversity issue that must be recognized and understood by organizations and needs to be addressed in developing current and future leaders. The leaders of organizations need to recognize and understand that a unique persona, which is developed from generational difference and already translated into a mind-set that demonstrated in different emotions, attitudes, beliefs, values, preferences, and embodied activitie s in working setting. Accordingly, this mind-set creates differences in leadership style how a person of a generation will lead or how they prefer to be led. In summary, five researches reached the common port, that is, the generational diversity is a current issue in workforce that organization and leaders must recognize and understand in designing effective and productive leadership strategy and style in creating a healthy working environment. However, for what is the correlation between generations and choice of leadership style, Stanley (2008, 2010)s articles reached his unique port; it argued the congruent leadership will be the one that can facilitate greater effectiveness when dealing with generational issues. The research done Cummings, MacGregor, Davey, Lee, Wong and Lo, et al (2010) clearly reached the conclusion that transformational and relational leadership styles will enhance nurse satisfaction, recruitment, retention, and healthy work environments in todays multigenerational workforce; because their research was based on extensive search of related database, so their conclusion derived from the evidence-based literature rev iew is highly credential and statistically significant. Also, Hahn (2009) and Robbins and Davidhizar (2007) generally articulated the nursing leaders should take transformational leadership as the core concept of their management, but their articles do not show strong evidence to support their argument. Arsenaults article emphasized the generational diversity of workforces and its impact on leadership, but he actually did not figure out which leadership could be the effective in current working environment. Summary of Behaviourist Learning Theory (BLT) According to Bastables book (2008, p.54-55), whether dealing with animals or people, BLT views the learning process as a relatively simple chain or cycle; the focus of BLT is mainly on the phenomenon that is directly observable stimulus conditions and the associations formed in the learning process; the learning process is understood as the product of the stimulus from the environment and the responses. In order to enhance the learning process leading to the desired result, behaviourists or learners can closely observe and manipulate the environment by utilizing operant conditioning techniques of positive or negative reinforcement (Skinner, 1974, 1989) to increase or decrease the stimulus, thus, to reinforce or decrease the responses to bring about the intended change. Plan of Implementation Based on my learning goal (see appendix A), I applied the acquired knowledge of BLT to my learning process through a survey project about the generational difference in the perceptive response in their admiring leadership style based on their different emotions, attitudes, beliefs, values, working ethics, preferences, and embodied activities in working setting. Each answer to the survey questionnaire is one of the stimuli for my learning process. What I learned form the project is the response of the learning process. I designed a survey questionnaire (see appendix B) about the correlation between generational difference and choice of leadership styles, randomly distributed to 55 staff in two medicine units of two hospitals, and 53 responses has been collected; the statistically valid representative sampling size is 96.36%. Statistical analysis on the response has been done (Table 1). Poster presentation (Appendix C) has been presented in my clinical placement unit for feedback. Application Component The Rationale of Choosing Behaviourist Learning Theory (BLT) BLT suggests the learning process is the product of the stimulus from the environment and the responses to the stimulus; it views the learning process as a reoccurring chain or cycle between stimulus and response through operant conditioning techniques of positively or negatively enhancing stimulus. Learning will occur while the stimulus is positively or negatively enhanced. Such a theoretic framework can be applied to health teaching process (Bastable, 2008, p. 54-60). The designation for students project from the course outline is about the learning from the project about a nursing issue in a global or organizational level of a hospital or community setting. Based on the acquired knowledge from BLT, my intention of my project design is to view the responses from the survey as stimulus for my learning about the choice on leadership style in a health care team staff would be either as a leader or a team member. Each response is one of the stimuli for my learning. More choice selecti vely occurred on one particular leadership style will become an enhanced stimulus for my learning that will give me the idea of which leadership is most admired in current health care team. In my future career, I would work as either a team member or a team leader; I have to prepare my self to be knowledgeable for these two roles. I am trying to apply BLT to my self teaching and self learning process. Actually, teaching and learning are the two phases of one process. Summary of the Process Involved in Applying BLT From the literature review, the generational difference in the perceptive response in their admiring leadership style based on their different emotions, attitudes, beliefs, values, working ethics, preferences, and embodied activities in working setting was found (Stanley, 2008, 2010; Arsenault, 2004; Weston, 2006; Kramer, 2010; Swearingen Liberman, 2004; Robbins and Davidhizar, 2007; Hahn, 2009; Cummings, MacGregor, Davey, Lee, Wong and Lo, et al, 2010). Based on this finding, my project designed a survey questionnaire to ask two questions: (1) what is your generation? (2) transactional or transformational leader: which one you would like to be or prefer? The answers to these two questions will give me two kinds of information: what is the content of current workforces and what kind of leadership style is admired more in the working setting. The answer for each respondent could be viewed as one of the stimuli for my response my learning result for my future choice of leadership in future career. 55 copies of questioner were randomly distributed to health care team of two medicine units of two hospitals, including nurses, social workers, physiotherapists, occupational therapists, speech therapists, manager, nursing educators, and unit supervisors / coordinators, clinical instructor, and nursing students. 53 copies of responses have been collected. Data has been coded and statistically analysed. The percentage of each generation in the health care teams, and the percentage of selecting transactional or transformational leader from each generation, and from the total sampling were calculated. The finding demonstrates the transformational leadership style is admired most in current working setting. This finding has been supported from the literature review of this report above. Discussion of how Gained Knowledge was Integrated into Learning Process The major components of stimulus and response of BLT were used in my learning process. Before my project survey, I had qualitative idea about the generational difference in beliefs, values, employment expectation, working ethics and orientation, but no quantitative idea about such difference, and no idea about how much their difference was in choosing working sett leadership style. Through the survey, I get the idea about how much each generation constitutes the content of health care workforce in these two units: Veterans are retired, Baby Boomers is 19%, Generation X is 53%, and Generation Y is 28%; the generation X and Y already constitutes 81% of the workforces. Among 10 answers from Baby Boomers, 2 answers chose transactional leader (20% of the generation), 8 answers chose transformational leader (80% of the generation); among 28 answers from Generation X, 4 answers chose transactional leader (14.3% of the generation), 24 answers chose transformational leader (85.7% of the gener ation); among 15 answers from Generation Y, 1 answer chose transactional leader (6.7% of the generation), 14 answers chose transformational leader (93.3% of the generation). Among the total samplings, 86.8% of answers chose transformational leader, only 13.2% of answer chose transactional leader. The finding also shows a trend of the major choices from each generation on the leadership style: from Baby Boomers to Generation Y, the percentage of the responses decreases in choosing transactional leader, and percentage increases in choosing transformational leader. It clearly demonstrates the significant difference between generations in admiring leadership style based on their different emotions, attitudes, beliefs, preferences, and embodied activities in working setting. The information analysed and concluded from the survey is the wanted stimulus for my learning it gives me the idea which leadership style could be effective and productive in a health care working environment. The m ultiple kinds of information obtained from the survey like the enhanced stimulus positively manipulated by behaviourist to strengthen my response in advocating transformational leadership as the style I will choose to be my favourite one in working environment. Challenge Encountered and Related Management Because my project about learning process involves the questioner survey, the challenge comes from the design and implementation of the survey process. The first challenge is the survey of this project is not a formal and academic survey. It is an anonymous mock survey. It does not involve in any interesting conflict and retain any private information about responders name, exact age, and gender, etc. Its purpose is limited to get the true information about the leadership style choice from different generation in the real working setting for my personal clinical learning process. So, it was not submitted to university ethics committee to seek pre-approval. The management strategy is anonymous survey and keeping the survey result within the learning process of this course. The second challenge is the design of the questioner survey. As a student project, there is no funding for rewarding the participants. Staff are busying with daily assignment and dont have spare time and compassion to answer too complicated questioner. The management strategy is to simplify the questionnaire design as much as possible, but it is still remained in detail enough to collect enough information to meet my learning goal. The third challenge is the limitation of sampling size. As a student project, it is impossible to have adequate time and financial resource to take survey in multiple units of multiple health care facilities. The management strategy is to utilize the chance of my working unit at another hospital and clinical placement unit at St. Michaels hospital to take my survey so that the sampling process will be more statistically valid and the finding will be more statistically representative from the limited sampling size. Outcome of the Project and Evaluation The outcome of the project is the finding of my survey truly demonstrates the generational difference in choosing leadership style in real working environment, which is supported from the literature review. The outcome of the project also reached my learning goal of this project: it uncovers the reality of generational difference in choosing leadership style and future trend in real working environment; and the finding is strong enough as enhanced stimulus to my response in my learning process based on BLT. Evaluation Criteria of Self-Evaluation of Learning Plan and Planning Change In my learning plan, the criterion of self-evaluation for knowledge component was set up as: able to select a specific theoretical model of leadership style based on current nursing environment. To better reflecting the learning experience from the project, I will modify it as: able to select related scholarly publication and a particular theoretical framework of leadership style based on current nursing working environment for literature review to acquire knowledge in guiding my learning process and practice project. For application component, the criterion of self-evaluation was set up as: able to develop questionnaires of assessing staff nurses values, beliefs and expectation on their choice of leadership style. To better reflecting the learning experience from the project, I will modify it as: (1) able to develop questionnaires of assessing staff nurses values, beliefs and expectation on their choice of leadership style; and (2) able to analyze the survey result and figure out the significant finding. Personal Growth and Development Before this clinical placement, I did have general idea about the generational difference in emotions, attitudes, beliefs, values, preferences, and embodied activities in working setting. However, I did not have clear idea about the generational difference in choosing leadership style in real working environment. Through applying BLT to assess staffs values, beliefs, expectation, attitude about the employment and work-life quality, and expectation of each generation on their choice of leadership style within the multiple generational cohorts, I found (1) current health care workforces is a three generation cohort, not a four generation cohort that was articulated in most of previous literatures, because Veteran generation is retired already; (2) from Baby Boomers to generation X and Y, the percentage of staff who choose transactional leadership style is linearly decreasing, the percentage of staff who choose transformational leadership style is linearly increasing; (3) presently, gen eration X is the majority in health care workforce, and generation Y is in the second place; in these two generations, the percentage of staff who chose transformational leadership style is 86% and 93%, which releases a clear information that transformational leadership style will work better for them. Totally, the outcome of the project tells me that in my future career, either as a team member or a team leader, transformational leadership was the style I should choose to work comparatively in a team or lead a team effectively. Conclusion According to the learning objective and teaching strategy of this course, a learning plan and practice project plan were developed based on the chosen theoretic framework. The project of survey was implemented in two medicine units of two hospitals. The survey result was statistically analysed and poster presentation was presented in the clinical placement unit. This report summarizes the acquired knowledge through the reviewing of five scholarly articles and the chosen theoretic framework, discussed the rationale on theoretic framework choosing, and the major concepts of BLT stimulus and response, which have been applied in my learning process. Also, the outcome of the project, experienced challenges, possible personal growth and development obtained from the project are discussed.

Effects of Back Massage on Chemotherapy-related Fatigue

Effects of Back Massage on Chemotherapy-related Fatigue Shahida Abbasi This paper is aimed to critique on a quantitative research article. â€Å"Effects of back massage on chemotherapy-related fatigue and anxiety: Supportive care and therapeutic touch in cancer nursing† Written by Karagozoglu and Kahve (2013) as part of my assignment. The Problem The problem is significant to nursing as noted by Karagozoglu and Kahve (2013) that nurses are directly involved to provide care and deal with patients receiving chemotherapy and their experienced side effects. It is also mentioned that problem is significance to nursing, as nursing interventions intend to improve quality of life by reducing the stress level of the patient with cancer. Moreover, the purpose of conducting quasi experimental and cross sectional study research was to determine the effectiveness of back massage, a nursing intervention, on fatigue process which develops due to chemo therapy. Furthermore, on the anxiety level which develops, and has been explained explicitly. In my point of view this study can accomplish its purpose as Burns and Grove (2011) mentioned that effects of independent variables on dependent variable can be determined through quasi experimental studies. In addition, quasi experimental; a quantitative approach study design is best fit to determine the effectiveness of back message. In the article research variables back massage independent variable and fatigue as dependent variable has been explained with literature support, whereas I feel the dependent variable anxiety need more elaboration. The investigators promptly introduced the problem statement at the end of the introduction. In my point of view the answer to the problem provide insight into current issues in nursing practice because there was no study found which determine the effects of back massage in decreasing fatigue and anxiety of chemotherapy patients. In addition, the investigators has stated the assumptions very clearly that â€Å"back massage providing during chemotherapy reduces fatigue and anxiety† Moreover, limitations are not listed explicitly but reader can infer easily as evident by this statement, small sample size was used therefore, the findings of the study could not be generalized. The limitations of quasi study design are as mentioned in Polit and Beck (2012) noted that in interventional study participants show reluctance to be selected through randomization. Thus these assumptions and limitations are realistic. Review of the Literature The literature reviewed by the researchers is comprehensive, critical, and logical. Moreover, the literature was published during the period 1988- 2013 and most of them were not recent but relevant to the problem. The relationship to the research purpose is evident by the literature review. In addition to that the researchers included 21 recent research studies and of these three studies published in 2013 were also used. The investigators paraphrased the reviewed adequately did not use any quotation. The researchers made a case logically for conducting a new study based on the review Protection of Human Rights This study was designed to minimize risk and maximize benefits to participants. Moreover, the researchers indicated very explicitly that participants gave voluntary, verbal and written informed consent and no evidence of coercion was found. However, it is not evident in study that participants were invited to consent during periods of high stress. There is no evidence in the study that individuals can be identified and linked to study. The researchers very clearly mentioned that approval to conduct the study has been taken from an independent ethics committee of Cumhuriyet University Faculty of Medicine. Theoretical / Conceptual Framework The researchers did not describe any theory or framework to guide their study. Coughlan, Cronin and Ryan (2007) noted that theoretical frameworks tend to be better developed in experimental and quasi-experimental studies. Burn and Grove (2011) noted that a well-developed quantitative study is based on clearly stated framework and quality of frame work needs to be evaluated for practicality. However, in this study the absence of theory or frame work did not detract the researchers from the significance of the research. Hypothesis The investigators formally stated hypotheses. It is appropriate to have the hypothesis in quantitative study as the investigators were interested to test the effectiveness of back massage. Burns and Grove (2011, p.167) stated that this type of researches are required to have hypothesis in order to predict outcome. Moreover, hypotheses are naturally derived from the research problem and transform the problem into predictable results. In this study hypotheses contain two dependent and independent variables. Furthermore, the investigators stated hypotheses clearly and objectively and the prediction is evident. It is very obvious that these predictions are supported by the literature. Sampling The target population carefully described by the researchers i-e patients who at least underwent for chemotherapy. The target population was appropriate according to the study problem and desirability. However, resource limitations are not mentioned in the study. The investigators described sample selection procedures by giving strict eligibility criteria. However, it would be better if they had clearly mentioned the type of sampling procedure used. Moreover, the sampling method fits with the research design and level of inquiry of study. However, the authors did not describe potential sample biases. According to Polit and Beck (2012) under representation of the sample pertaining to research question should be acknowledge by the researchers. The sample is sufficiently large as Polit and Beck (2012, p.285) propose that small sample size will be adequate if researcher is certain about the strong relationship of the independent and dependent variables and it is described under the subhe ading of methods p.212.This study can be generalized on the target population and patients receive chemotherapy. The investigators have described the eligibility criteria to enroll participants on ( p.212) to ensure a representative sample. However, sampling error can be minimized by increasing the sample size. Research Design The investigators used quasi experimental and cross sectional design to determine the effects of the interventions. The design used for the level of inquiry of research question and purpose of research was appropriate as Burn and Grove (2011, P.151) mentioned that this study design is to determine the effects of back massage on independent variables. The researcher did not discussed potential effects of confounding variables and possible measures to control such effects (validity). Polit and Beck (2012) proposes selection of homogeneous sample to control confounder, however, statistical analysis can also be used for the same purpose. The researchers gave enough information based on which study can be replicated. Data Collection The instruments Personal Information Form, The State Anxiety part of Spielberger State- Trait Anxiety Inventry (STAI) Brief Fatigue Inventory (BFI) were used for data collection. Personal Information consists of nine questions for that detail is given under the subheading of Personal Information on p. 212. Moreover, State- Trait Anxiety Inventory (STAI) instruments developed by Spielberger et.al in 1964 has been used by Oner and Le Compte. Cronbach’s alpha coefficient was given that shows validity and reliability. In addition, Brief Fatigue Inventory (BFI) developed by Mendoza et.al. (1999) which consists of 10 questions was used to assess fatigue, and the same scale was used by Cinar, Sezerli,Sarsmaz and Ments. The value of Cronbach alpha reliability coefficient of the scale verifies its validity and reliability. However, rationale for the selection of instruments was not given. Instruments used in this study were congruent with research questions. Are results of these tests sufficient to indicate their use? The instruments are suitable for use with the study sample. Quantitative Analysis Determining the effectiveness of back massage is the third level of inquiry of study question, and for that quasi experimental and cross sectional study design is best fit. The investigators calculated mean and standard deviation for age. Chi-square test has been used for qualitative ordinal variables. A non-parametric Friedman test that is substitute of ANOVA has been used to analyze mean BFI score for intra group variability. Moreover, a Wilcoxon non-parametric test alternative to paired t-test was used to examine mean STAI scores of patients before, after and right after chemotherapy. Furthermore, Mann-Whitney U test was used for mean STAI and BFI score of patients before and right after chemotherapy. Despite the fact that data were normally distributed, non- parametric test have been used. The link between the analysis and findings are logical, clear, and are evident by statistical rejection of null hypothesis by P-value. The researchers did not go beyond the data during interpretation of the findings, and they presented statistical result both in the narration and in tabulated form. The investigators used inferential statistic that is enough eviden ce to establish the correctness of the statistical result as Coughlan Cronin, P., Ryan (2007) noted that statistical significance assist the investigators to rule out threat to validity. The investigator presented findings in a table which is clear, simple, and accurate. Conclusions and Recommendations Data analysis clearly explained in reference to research questions and hypotheses. Since the study sample was small, the researchers made appropriate decision; based on significant findings and did not claim for generalizations beyond the study sample or population. However, the results are applicable on our patients who are planning for chemotherapy. If we will implement this intervention to our context, then it will lead to increase comfort, decrease fatigue, and anxiety. Furthermore, there are no risks of implementing study findings mentioned explicitly or inferred. The authors also recommended that back massage during chemotherapy is effective intervention to be practiced to control the side effects especially fatigue and anxiety and this recommendation is well supported by the others studies. However, the investigators did not give recommendations for future research studies. To determine the efficacy of back massage, a nursing intervention is a unique study which is significance for nursing practice. In this study the investigators used quasi experimental and cross sectional study design. Moreover, the study purpose of the study is explicitly stated. The investigators tested hypothesis with instrument which are reliable and valid and they described the instrument very comprehensively. Moreover, sample selection was carried out on strict eligibility criteria. Study findings have been explained in narration and in table. Finally, investigators gave conclusion based on findings that back massage is effective nursing intervention to decrease the fatigue and anxiety of the patients who receive chemotherapy. The investigators also mentioned that study cannot be generalized other than target population. References Burns, N., Grove, S. K. (2012). Understanding Nursing Research: Building an Evidence-Based Practice. Elsevier Health Sciences. Polit, D. F., Beck, C. T. (2012). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams Wilkins. Coughlan, M., Cronin, P., Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research.British Journal of Nursing,16(11), 658-663.

Shakespeares Hamlet - A Clear Revenge Tragedy? Essay -- Revenge Veng

Hamlet – a Revenge Tragedy?  Ã‚        Ã‚   Most of the revenge-tragic aspect of the Shakespearean play Hamlet is explicitly presented. Some is disguised as straight tragedy, for example, Ophelia’s insanity and death; and some is implied tragedy found in the history of verbal allusions.    In the essay â€Å"An Explication of the Player’s Speech,† Harry Levin discusses the implied tragic dimension of the â€Å"Hecuba† soliloquy:    But the lyrical note can prevail no more than the epical, since Shakespeare’s form is basically tragic; and here his classical model is indicated when Polonius, introducing the Players, warns: â€Å"Seneca cannot be too heavy.† From â€Å"English Seneca read by candlelight,† according to Thomas Nashe, playwrights were lifting handfuls – or were they Hamlets? – of â€Å"tragical speeches.† (31)    Howard Felperin sees in Hamlet a return to the once-extinct revenge play (Felperin 105). Although defunct for awhile, the revenge tragedy resurrected prior to the date of Hamlet’s composition.    The prince has a possible motive for revenge from the very outset: he is dejected by the â€Å"o’erhasty marriage† of his mother to his uncle. Hamlet’s first soliloquy sees the expression of his negative feelings and their growth in intensity; it emphasizes the corruption of the world and the frailty of women:    Must I remember? why, she would hang on him,   Ã‚  Ã‚  Ã‚   As if increase of appetite had grown   Ã‚  Ã‚  Ã‚   By what it fed on: and yet, within a month—   Ã‚  Ã‚  Ã‚   Let me not think on't--Frailty, thy name is woman!—(1.2)   Ã‚   Based on the meeting of the hero and Horatio, A.C. Bradley in Shakespearean Tragedy presents convincing evidence of the depth of the hero’s melancholy – is it potent enough to perform rev... ...ry Rhetoric in the Renaissance. N.p.: Yale University Press, 1976.    Levin, Harry. General Introduction. The Riverside Shakespeare. Ed. G. Blakemore Evans. Boston: Houghton Mifflin Co., 1974.    Mack, Maynard. â€Å"The World of Hamlet.† Yale Review. vol. 41 (1952) p. 502-23. Rpt. in Shakespeare: Modern Essays in Criticism. Rev. ed. Ed. Leonard F. Dean. New York: Oxford University P., 1967.    Shakespeare, William. The Tragedy of Hamlet, Prince of Denmark. Massachusetts Institute of Technology. 1995. http://www.chemicool.com/Shakespeare/hamlet/full.html No line nos.    Wright, Louis B. and Virginia A. LaMar. â€Å"Hamlet: A Man Who Thinks Before He Acts.† Readings on Hamlet. Ed. Don Nardo. San Diego: Greenhaven Press, 1999. Rpt. from The Tragedy of Hamlet, Prince of Denmark. Ed. Louis B. Wright and Virginia A. LaMar. N. p.: Pocket Books, 1958.   

Essay --

The Battle for Justice â€Å"It takes a warrior to fight a battle and survive. This here is a battle if I’ve ever seen one† (Beals 113). In the novel Warriors Don’t Cry, nine students from Little Rock Arkansas are set out on the battlefield for integration. Melba Pattillo and eight other friends are challenged with starting off the integration of Little Rock’s Central High School. The students were signed up and asked to attend the high school in hopes of getting rid of segregation. Although entering high school may seem as easy as signing in and going to class, the test and trials the Little Rock nine went through shows a true test of determination. Comparatively, the â€Å"Arab Spring†, a movement of protests in the Middle East, has caused controversy all over the world. Citizens are rebelling against an unfair government in hopes of create a new way of life. Tired of all the disrespect, unjust, and oppressive government Muslims and Middle Easterners have created a bat tle of their own. While trying to create a better life for themselves, the Little Rock Nine and those involved in the Arab Spring uprisings have stepped on to the battlefield for fair human rights. September 4, 1957 was the date set for the Little Rock Nine to enter into Central High School. While making their way to find the others, Melba and her mother spotted Elizabeth, one of the nine, standing in the midst of a screaming mob. There were national guards towering over her, but none seemed to do anything to stop the threats. Although Elizabeth was frightened, she still tried to enter the school. Elizabeth tried finding a way into the school but, â€Å"Each time she approached, the soldiers closed ranks, shutting her out† (Beal 36). The National Guard was told by Governor Faub... ...of great determination to increase human rights. A serious battle is one worth fighting for. The Muslims and Middle Easterners are still fighting for their right for a fair government. They are tired of the disrespect. They’re tired of the humiliation and unnecessary tactics used by the government. They want more of a democracy, to be able to have a say in the laws that are over their people. Even though they have chosen violent ways they still are trying to make a change. Although the Little Rock Nine were not violent, they wanted to make a change, to better their lives and those of their families. They chose to challenge the government and with the support of outside help they accomplished their goals. Fighting a battle isn’t easy. You need to make sure you have the right tools to conquer. Sometimes the strongest armor you could wear is faith and determination.

Lab Report: Effect of Temperature on a Rate of Reaction between Sodium Thiosulphate and Hydrochloric Acid :: essays research papers

My aim in this piece of work is to see the effect of temperature on the rate of a reaction in a solution of hydrochloric acid containing sodium thiosulphate. The word equation for the reaction that will occur in the experiment is: Sodium thiosulphate + hydrochloric acid →, sulphur + sulphur dioxide + sodium chloride + water ..where the sulphur is an insoluble precipitate. And the symbol equation for it is: Na2S2O3 + 2HCl →, S + SO2 + 2Na + H2O Before conducting my experiment I will research into, amongst other things, the factors that affect the rate of a reaction. This is so that I may enough information to understand the effect of temperature on the rate of a reaction and also gain appropriate understanding to make a suitable prediction as to what the outcome of my experiment will be. Reactions occur when the particles of reactants collide together continuously. If they collide with sufficient energy, then they will react. The minimum amount of kinetic energy required for particles at the time of collision is called the activation energy and this theory is known as the ?collision theory?. Reactions occur in all circumstances. Chemicals are always combining and breaking up: Reactants and products combine and break apart in all reactions.

Torrent Syndrome

The documentary that I listen to was about Tourette's syndrome ,Neurological problem to take control the body which cause snapping coughing disease lots of expression, I have Tourette but turrets doesn't have me they have problem in childhood in social life. It's about how to live with this syndrome they are talking with 3 people. This disease not shows it self very good One of them tell that even after he told his teacher he had Tourette syndrome she told I forgot cause I don't see it in you .One of the child during the show told that if he would try is best to suppress the tick it would get lots of mental energy from him. The more you suppress it u need to do it more. Eye blinking and some noises are some things you might see from them they have ticks, cause some of them had susspsion they might have this problem. One of the men who has it told that at first they even go to the allergist but they told it's not allergies. Tourette is so misunderstood, after it is diagnosed it is not obvious and there isn't that much drugs for it .In the point of view when the culture of school say that we accept these kind of differences it would be more valuable and other children can handle it more easily. Make the diagnoses early; the kids are aggression that kind of behavior can be for them for 5 years of age. About 50 % has ocd have anxiety disorders and some has disability learning some of the medications handle some of these problems. Some patients in the childhood has problem with suppressing their ticks in the school and when they came home he will go to his room lock the door and let the ticks goes out single gene mutation.There is no real medication that works and all of them had side effects and the other problem that they have is they don't exactly know that it was the drugs' effects or normal response of body to Tourette. Tourette sometimes get more Sevier. There are lots of alternative therapies like acupuncture they might have effects. Stress make the ticks eve n worse but if they can focus on something like game they can gradually make it stop and try not to think about it. Common misunderstanding about Tourette each of the people have syndrome has different severity which shows it differently.The best thing it's the children with this problem talk about it and share what situation they are going through some children try to suppress it and not talk about it but communication is a good thing. IN THAT AUDIO a person believes that children in early age is more acceptance than getting older and in adolescence they really want everyone to be the same as themselves. There were some callers to talk about terrors syndrome, dealing with other people was hard part for some of them it was quite interesting for me that an adult called and told he's glad that he has something unique and he can deal with it.It really makes me want to think about my own life, it's really great perspective that a person could have about his/ her disease. Some of them sa id that beside all the hardship it made me who I am and I don't want to remove it from my life. It can express itself in so many ways. If you know you deal with turrets, the patient has to get lower in anxiety level and it was pretty interesting for me when one of the specialist told that try to teach your children to talk about their problems honestly and they can tell to the their classmates friend that I have this problem which cause me make this sounds that I would rather not do that.One of the person that have this problem believes that it's good to have social contacting it's not good to stay at home lonely and try to use home schooling and I really agree with what he said. In My opinion the only thing that they need to deal with is talking with their society about their problems cause everyone in this world has a problem but it might be in variety aspects. It's god to know that doing what you like and hobbies can cause the ticks fall away. Diagnose this problem is hard as wel l.

Adoption: Infectious Diseases Issues Essay

Adoption is and always has been something that many couples consider in doing throughout their lives. One couple might consider adopting a child due to being unable to have a child of their own or another in wanting to help a child in need of parents to look over them. In recent years, many young parents have given their child up for adoption because of not being able to provide for the child or the mother is too young to take full responsibility. But, the biggest concern regarding adoption is the birth records of the child that are being sealed away from them. Once the child grows up and finds out they were adopted, they are unable to look at their actual birth certificates and find out where they came from. Many have been raising questions to why they are sealed and a resolution must be found to make it fair for the adopted children to find out where they came from and who their real parents are. In the U.S., most laws from the 1930’s and 40’s still remain firm in 44 states. These laws are forbidding adopted children who are now adults to their original birth records that are locked away from them that has the primal question: Who am I? Identity is many things, but it begins with the knowledge of one’s own truth of heritage and birth. According to Lorraine Dusky, one of the situations that are standing in the way of the further progress to resolve this problem is the argument that most mothers want to keep their â€Å"privacy† protected. She says that more work is needed to show that these outdated laws and arguments are not true but only myths. Dusky states that most mothers are more than happy to welcome in their children back into their lives and in states as in Oregon, mothers have the option to fill out a form indicating whether or not they want to be contacted. She concludes that mothers asking for no contact are now no more than one a month. (Dusky). This is a good indication that the birth parents do not want to lose contact with th eir child when he or she chooses to find them when they grow up. Adoption has also brought an important function to other people’s lives. According to Annette Baran, Reuben Pannor and Arthur D. Sorosky, adoption fulfills couples’ dreams that are unable to have children of their own and want have a complete family unit that conceals their infertility and denies the existence of another set of parents. They say that in the past, adoption was more open and was not unusual before World War II for a couple to take in a pregnant woman and take care of her while she was pregnant till she delivered, then adopt the child. They state  that it was easy for the mother to give her child to the couple because of the connection they formed and the mother felt comfortable giving her child to the people she knew very well who would take care of the baby and provide for it. They conclude that there is no further evidence showing that there were any complications for both the birth and adoptive parents or any harassment from either of them after the child was given away. (Baran et. al. 97-98). After looking at the aspect of the benefits of both the birth parents and adoptive parents, there are also emotional and health issues with the adoptees. The only reason to why birth records are being sealed away is to keep the privacy of the birth parents but that is completely unfair to the adoptees that want to find out what is wrong with them and where they came from. Some adoptees have health risks and are unable to continue their treatments if they do not have their actual birth records. According to Karen March, one of the strongest challenges against secrecy comes from the adult adoptees that have established contact with their birth parents. She states that before the adoptees reunited with their biological parents, they felt a sense of incompletion from their inability to fully find out about their biological parents and background information to put together who they truly were. March says that after finally reuniting with their parents, they were finally able to move on w ith their life and accept the reality of why they were sent to adoption. She concludes that many adoptees that have problems with their birth records being released find themselves emotionally unstable to cope with why their biological parents have left them. (March 653-654). By giving these adoptees the opportunity to place self with a biosocial context, reunion gave them a means of gaining stronger social acceptance. In a book titled â€Å"Adoption, Identity, and Kinship† written by Katarina Wegar, assistant professor of sociology at Old Dominion University, investigated the historical, physiological, social, cultural, and gender issues that are surrounding issues over the sealed birth records. Wegar writes that over 60 years of perspectives on adoption, she was able to find that instead of showing adoption as a social institution, many researchers have often depicted adoptive families as deviant people. Moreover, Wegar argues that some adoption activists have accepted facts from psychiatrists, who blame the adoptees’ problems rather than on social and cultural causes. She believes that the American family is  a natural or a biological arrangement, to look at adoption as a solution to a social problem rather than the social problem to be solved. Wegar concludes that the main structure of adoption in the American adoption system is the race and class, along with gender, age, family structure, and sexual preference. (Wegar 36-123). Adoption, according to Wayne E. Carp, is present everywhere in the American society that is creating invisible relationships with biological and adoptive parents and is touching many people. He states that adoption is the most controversial issue in the United States and recent articles have accused many adoptive families of being associated in Cambodian black market baby-buying rings. Carp writes that in 1994, Congress passed a law stating with the intention of prohibiting adoption agencies from using race or national origin as a basis to deny the placement of a child in transracial adoptions. Also, Carp believes that one problem with activists, is that they commonly believe that adoption causes much pain and lifelong suffering to everyone involved and in 1995, the Florida Supreme Court upheld a la w stating that gay couples are prohibited from adopting. Carp says that as late as the 1950s, most Americans would not have considered the subject of adoption or closed records as controversial. In fact, most Americans viewed it in positive terms because it seemed to solve many social problems. Also, according to Doris H. Bertocci, she says the same about how these sealed records are far more complicated than anyone would have expected. (Bertocci 252). Carp states that single women were able to escape the stigma of having a child out of wedlock and were able to move on with their lives, which usually meant getting married. He concludes that it was also an escape route for children to escape the stigma of illegitimacy and then were able to find a good home with two loving parents who on the other hand found a solution to having their own child. (Carp 434). The question was never raised to why records are being sealed away from adoptees. According to Carp, not until the early 1970s was when adult adoptees discovered that birth records were b eing sealed, thus they went right into the political process to change this unfair practice. Carp, states that once the reform movement began, the birth mothers reacted immediately and the reason to that was because of the situation they were in. He writes that the mothers believed they were doing the right thing for their babies and that they would be able to avoid  society’s condemnation of having a child without being married. Because of this, Carp says that the mothers received promises from adoption agencies that their identities would remain a secret and many kept it away from their husbands as well. But, many activists, according to Carp were able to gain access to adoption records through lawsuits, ballot initiatives, and state legislation, which resulted in success for the state of Oregon to allow adult adoptees to their original birth certificates, for the most part, the result of the reformers’ lawsuits have failed in the courts and failed to open adoption records unconditionally. He argues that the reason to their lack of success, there exists an ethical and moral dilemma: Who’s rights are pre-eminent, those of adopted adults or those of birth parents? Many states have tried to make both sides satisfied: adult adoptees, who want to have the right to open birth records and the birth parents, who were promised secrecy of their identity by the private adoption agencies. (Carp 435). Taking a look at another aspect of adoption, many complications can arise regarding international adoption. In recent research done by Laurie C. Miller, she finds that since 1986, nearly 220,000 children from other countries have been adopted by American families and since 1995, the top 4 countries have been China, Russia, South Korea, and Guatemala. She states that the living circumstances of children before adoption all varied greatly and most of the children came from orphanages, where they experienced malnutrition, emotional and physical neglect, harsh living environments, and exposure to infectious diseases. Miller states that thanks to the International adoption medicine, new specialized pediatrics have been able to address the specific health care needs for the children after arriving to the United States. But, Miller argues that one of the primary concerns of international adoption medicine is the evaluation of international adoptees for infectious diseases as for other immig rant children. She also argues that many adoptive families sometimes encounter difficult situations related to infectious diseases like the recent severe acute respiratory syndrome (SARS) epidemic in Asia that has affected many adopting families in the United States. Miller concludes that these days, consultants have much to offer for internationally adopted children and the adoptive parents as well as appropriate screenings that allow assessment of the child’s health. (Miller 286-287). In the United States, adoption by a same-sex partner was  first granted in 1985. According to Nina Dethloff, nowadays, adoption by same-sex couples is aloud in a number of states however, there are several differences in other countries. Dethloff states that at least in six states the court has held adoptions by same-sex couples to be permissible. But, adoptions by a homosexual partner are possible in New York, New Jersey, Massachusetts, Illinois, Vermont, Pennsylvania, and in District of Columbia. She says that the adoption of a child that is not biological, but the previously adopted, child of the other partner is exceptional. She argues that he or she can adopt both a biological child and a previously adopted child of his or her partner but only a few states prohibited and still prohibits adoptions by homosexuals. Dethloff states that previously held prejudices on children who live in a homosexual family are more likely to develop a homosexual orientation or might even be abused, especially by gay men, have not been fully confirmed. Furthermore, she shows evidence that there is no scientific proof that children show developmental or behavioral disturbances as a result of their parents’ sexual orientation. Dethloff concludes that there is evidence that homosexual parents raise their children differently than the opposite-sex couples, but the only real concern is that due to constant prejudices, children raised by same-sex parents may suffer from harsh discrimination. ( Dethloff 201). Every couple, regardless of their sexual orientation, should have the right to raise and adopt a child. Looking at the child’s perspective, would it not be better to give a child a home? According to Gregory K. Popcak, executive director of the Pastoral Solutions Institute, there are significantly more children waiting to be adopted than there is same-sex couples waiting to adopt. He states that by contrast, each year there are no more than 70,000 to 162,000 married couples in the U.S. who have filed adoption papers or are filing papers. Popcak believes that this means that in any given year there are 1.2 and 2.7 married couples per waiting child meaning that there is no need to open up adoption centers for homosexual couples. (Popcak 13). Though Popcak’s arguments may remain true, he is not helping in the fact that all people should be treated equally regardless of their sexual orientation and children should have a home provided for them. Dethloff shows that in a coun try where a large number of children are living under institutional care in order to be placed in a family, same-sex couples will be more than ready  to take in a child and provide for it like any other responsible parent would. (Dethloff 202). Though many adopted children get discriminated because of their parents’ sexual orientation, they at least know that they have parents that they could talk to and have a real home with. Because they are adopted, they will always look for who their real parents are and what is their real birth certificate as well as have the right to access to it. According to David B. Biklen, adult adoptees who want access to their birth records argue that the information in the birth records belongs not only to the birth parents or state, but also to the child, now an adult. Biklen argues that birth parents should not have control over their adult child’s access to his or hers birth name, heritage, history and the state should not continue to be a party that is keeping all of this information secret. He states that adult adoptees claim the right to their information and because they have a legitimate need, medical and otherwise, to full access to their genetic heritage. Biklen states t hat recent adoption research indicates that secrecy in adoption can be damaging for everyone involved. Secrecy in a family can cause much pain, shame, and psychological damage even when the secrets are not revealed and holding back information can be very damaging to the child. (Biklen). Regarding the medical information of the adoptee, it is very important for them to know about where their health risks come from. Biklen states that current sealed records system burdens adult adoptees’ access to family medical information that may be critical to their own health care. He says that many adult adoptees have been having difficulties answering routine, even critical health questions about the health history of their genetic relatives. Also, under the legislation of some states, from having a â€Å"sin† of his or hers birth parents, the adopted child was â€Å"reborn† into the adoptive family with a new identity, name, and birth certificate to give an illusion that the child was born in the adoptive family. Biklen argues that the original birth certificates were then sealed and replaced with a new birth certificate that gave false information, a legal fiction. In addition, Biklen says that to attempting to change sealed record laws, many adult adoptees have used other ways to search for their birth information by using professional consultants, volunteer networks, and self-help search groups that help address the demands by the adult adoptees to finding their birth parents. (Biklen). Adoptees now have become more  outspoken and are searching for their birth parents without their adoptive parents’ permission. Not only do adoptees have a say on this controversial topic but as well as their adoptive parents. According to Phyllis R. Silverman, Lee Campbell, and Patricia Patti, adoptive parents are finding themselves to be caught in a situation they were never prepared for. They stated that many adoptive parents were expecting their adoptive child will not want to reunite with their birth parents for the papers are sealed and kept away. They say that in a study done of adoptive families, they preferred to have veto power over adoptees searching for their birth parents even when the child grew up into an adult. The researchers say that today, many adoptive and birth parents are now being informed that the child might or will be searching for them when he or she get older. But, the real concern adoptive parents have is about what type of question might pop up when the child grows up and them not knowing how to answer it. They state that most adoptive parents will not know about the child meeting or them finding their birth parents or what to expect when something like this will occur. In conclusion, they say that adoptive parents get protective of their adoptive children and are afraid of them leaving after they find out the truth. (Silverman et. al. 543). The controversial aspect of adoption helps bring a better understanding of how adoption works as well as the controversy behind it. There will always be debates to what is best for the child and who is the best choice to provide for the child as to help them grow up to be better people and to have a family of their own to where they can feel complete. Every child needs a family, but every adoptee would have preferred to stay with their biological mother from the beginning even if she could not provide for them. Others, on the other hand are grateful that they have been adopted because it gave them the happiness of being wanted in a family where the biological parents wanted the best for them, out of love. No matter what the choices are made, it is never possible to tell what the outcome may be, and that is the controversial issue. Sealed birth records have the answers to the adoptees questions and could also be beneficial to their medical health risks that could save their life or help form a healthy biological family of their own. Reference Baran Annette, Reuben Pannor, and Arthur D. Sorosky. â€Å"Open Adoption.† Social Work 21.2 (1976): 97. Academic Search Complete. Web. 9 May 2013. Bertocci, Doris H. â€Å"On Adoption.† Social Work 23.3 (1978): 252. Academic Search Complete. Web. 8 May 2013. Biklen, David D. â€Å"Sealed Adoption Records.† (1999). 10 May 2013. www.cga.ct.gov Carp, Wayne E. â€Å"Adoption, Blood Kinship, Stigma, And The Adoption Reform Movement: A Historical Perspective.† Law & Society Review 36.2 (2002): 433. Academic Search Complete. Web. 8 May 2013. Dethloff, Nina. â€Å"Same-Sex Parents In A Comparative Perspective.† International Law FORUM Du Droit International 7.3 (2005): 195-205. Academic Search Complete. Web. 10 May 2013. Lorraine, Dusky. â€Å"Help adult adoptees find birth parents.† USA Today n.d.: Academic Search Premier. Web. 9 May 2013. March, Karen. â€Å"Perception of Adoption as Social Stigma: Motivation For Search And Union.† Journal Of Marriage & Family 57.3 (1995): 653-660. Academic Search Complete. Web. 8 May 2013. Mill er, Laurie C. â€Å"International Adoption: Infectious Diseases Issues.† Clinical Infectious Diseases 40.2 (2005): 286-293. Academic Search Complete. Web. 9 May 2013. Popcak, Gregory K. â€Å"Misplacing Children.† First Things: A Monthly Journal Of religion & Public Life 164 (2006): 12-13. Academic Search Complete. Web. 10 May 2013. Silverman, Phyllis R., Lee Campbell, and Patricia Patti. â€Å"Reunions Between Adoptees And Birth Parents: The Adoptive Parents’ View.† Social Work 39.5 (1994): 542-549. Academic Search Complete. Web. 8 May 2013. Wegar, Katarina, Adoption, Identity, and Kinship: The Debate over Sealed Birth Records. New Haven and London: Yale University Press, 1997.