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Medical Discussion Paper - Post Traumatic Stress Disorder. Display and print this document in The Death Penalty Worldwide, Portable Document Format (PDF). The Brethren: The Supreme? To do this, you must have Adobe Acrobat® Reader (version 4 or higher) installed on your computer. You can download this free software from the Adobe web site. Post Traumatic Stress Disorder. Discussion paper prepared for. The Workplace Safety and Insurance Appeals Tribunal. Revised September 2015.

Dr. Diane Whitney MD, FRCPC, BCETS. Assistant Professor of Psychiatry for Northern Ontario School of The Death Penalty Worldwide Medicine University of is there a democratic in the uk Toronto, Adjunct Professor Western University. Dr. Diane Whitney is Penalty Essay a community based psychiatrist in Thunder Bay, Ontario. Her clinical interests include: Post Traumatic Stress Disorder, mood disorders and women’s mental health. She works with military members veterans, police officers including OPP City of Thunder Bay Police and paramedics. Her clinical care includes mood trauma assessments in is there a democratic deficit in the, addition to The Death Penalty Worldwide Essay the provision of individual and effects, group therapy. She also acts as the Psychiatric Consultant on the Canadian Mental Health Lambton Kent, Rapid Assessment Intervention Team.

Dr. Whitney enrolled in the Canadian military in 1985 through the Medical Officer Training Program. She was posted to CFB Baden, West Germany, in 1989 where she provided medical care to military personnel and their families. She served as a flight surgeon in the first Persian Gulf War from October 1990 to February 1991. During the war, her clinical work focused on the management of psychological symptoms i.e. Penalty Essay? anxiety, trauma related to the war and the threat of chemical and biological weapons.. Prior to moving to Thunder Bay, Dr. Whitney was the how did, Clinical Director of the Women’s Program at the Centre for Addiction Mental Health in Toronto (CAMH). The Program treated women with complex mood anxiety disorders usually with a history of childhood and/or adulthood interpersonal trauma. She was also the Vice President of Medical Affairs at CAMH for a period of time. Dr. The Death Penalty Worldwide Essay? Whitney is an Assistant Professor with Northern Ontario School of Medicine and the University of Toronto as well an Youth Essay, Adjunct Professor with Western Ontario.

She is the Site Director of The Death Penalty Essay Psychiatry Northern Ontario School of is there deficit in the Medicine Residency Program in Thunder Bay. She is actively involved in teaching medical students and Psychiatric Family Practice Residents in Thunder Bay.. This medical discussion paper will be useful to those seeking general information about the medical issue involved. It is intended to provide a broad and general overview of a medical topic that is frequently considered in Tribunal appeals. Each medical discussion paper is written by a recognized expert in the field, who has been recommended by the Tribunal€™s medical counsellors. Each author is asked to present a balanced view of the current medical knowledge on the topic. Discussion papers are not peer reviewed.

They are written to be understood by lay individuals. Discussion papers do not necessarily represent the views of the Tribunal. A vice-chair or panel may consider and rely on the medical information provided in Penalty Worldwide, the discussion paper, but the to what is there, Tribunal is The Death Worldwide Essay not bound by an opinion expressed in a discussion paper in any particular case. Every Tribunal decision must be based on the facts of the particular appeal. Henry Iv Characters? Tribunal adjudicators recognize that it is always open to the parties to an appeal to rely on or to distinguish a medical discussion paper, and to challenge it with alternative evidence : see Kamara v. The Death? Ontario (Workplace Safety and Insurance Appeals Tribunal) [2009] O.J. No. 2080 (Ont Div Court). Trauma has long been associated with psychological symptoms and disability.

The diagnosis of primary effects Post-Traumatic Stress Disorder has been extended to non-war trauma including work place accidents, natural disasters and Penalty Essay, motor vehicle accidents. In addition, the sequelae of how did the mongolian childhood sexual and physical abuse are understood as a form of Worldwide Essay PTSD called Complex Post Traumatic Stress Disorder. Complex PTSD relates to The Brethren: Court Essay repeated childhood trauma that impacts on personality development, interpersonal relationships and affect regulation (disturbed ability to deal with feelings) that persists into adulthood. Childhood abuse is a significant risk factor for the development of PTSD related to adult traumas. Post-Traumatic Stress Disorder is The Death often associated with substance abuse, depression, difficulties in and recency, interpersonal relationships and self-destructive behaviour. Definition of The Death Penalty PTSD per iv characters, The Diagnostic and Worldwide, Statistical Manual. 5 th Edition (DSM 5)

With the Effects of Daily Media Youth Obesity, introduction of DSM 5, there have been significant changes in the diagnosis of The Death Worldwide Post-Traumatic Stress Disorder. PTSD moved from the class of anxiety disorders into a new class of “trauma and stressor-related disorders”. This class also includes the diagnosis of Acute Stress Disorder. The rationale for the creation of a new class is based on clinical recognition of variable expressions of Nursing - Gastroenterology Essay distress as a result of traumatic experience(s). The current criteria for DSM 5 are outlined below:. The person was exposed to Essay death, threatened death, actual or threatened serious injury or actual sexual violence, as follows: (one required) Direct exposure.

Witnessing in person. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g. first responders, collecting body parts, professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.. The three clusters of the The Brethren: the Supreme, Diagnostic and Statistical Manual IV (DSM IV) are divided into The Death Penalty Worldwide Essay four clusters in Nursing, DSM 5 as outlined below.

The rationale for the change was based on factor analytic studies and now requires one avoidance symptom for PTSD diagnosis. The traumatic event is persistently re-experienced in the following way(s): (one required) Recurrent, involuntary, and intrusive memories. Traumatic nightmares. Worldwide Essay? Dissociative reactions (e.g., flashbacks) which may occur on to what is there deficit a continuum from brief episodes to complete loss of consciousness. Intense or prolonged distress after exposure to traumatic reminders. Marked physiological reactivity after exposure to The Death trauma-related stimuli. Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required) Trauma-related thoughts or feelings Trauma-related external reminders (e.g., people, places, conversations, activities, objects or situations). Criterion D: Negative alterations in cognitions and mood.

Negative alterations in cognitions and mood that began or worsened after the the mongolian empire, traumatic event: (two required) Inability to recall key features of the The Death Essay, traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs). Persistent (and often distorted) negative beliefs and expectations about oneself or the the mongolian empire fall, world (e.g., “I am bad”, “The world is completely dangerous”). Persistent distorted blame of self or others for causing the traumatic event or resulting consequences. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame). Feeling alienated from others (e.g., detachment or estrangement). Constricted affect: persistent inability to experience positive emotions. Criterion E: Alterations in arousal and Penalty, reactivity.

Trauma-related alterations in Registered Essay, arousal and reactivity that began or worsened after the traumatic event: (two required) Irritable or aggressive behaviour. Self-destructive or reckless behaviour. Hypervigilance. Worldwide Essay? Exaggerated startle response. Problems in concentration. Sleep Disturbance. Persistence of symptoms for more than one month. Criterial G: Functional Significance. Significant symptom-related distress or functional impairment (e.g., social, occupational). Disturbance is not due to medication, substance use or other illnesses.

In DSM V there are several specifiers related to dissociative symptoms and time of onset of trauma symptoms. The dissociative subtype is The Brethren: Inside Court a new classification. An individual experiences high levels of dissociation related to either of the following in reaction to trauma-related stimuli. Depersonalization: experience of being an outside observer of or detached from one self (e.g., feeling as if “this is not happening to me” or one were in a dream). De-realization: experience of unreality, distance or distortion (e.g., “things are not real”). Specify if: With delayed expression. Full diagnosis is not met until at least six months after the trauma(s), although onset of symptoms may occur immediately. Implications of The Revisions in DSM 5: Based on The Death Worldwide Essay the analysis of DSM 5 criteria, the prevalence of iv characters PTSD is The Death Essay expected be similar to what it was with DSM IV.

The one item removed from the stressor category in DSM 5 is and recency death of a relative from natural causes and The Death Essay, this may influence the prevalence of PTSD. Similar to DSM IV, prevalence of PTSD for DSM 5 is expected to be higher in women than men and increased prevalence increased with multiple traumatic event exposure. (PTSD: National Center for PTSD 2014) Until the DSM IV there had been no diagnostic entity or clinical term for trauma symptoms that occur immediately after the Registered Nursing - Gastroenterology Essay, trauma. In military settings the The Death Worldwide, term Combat Stress Reaction has been used for acute trauma related to war activities. With Acute Stress Disorder the symptoms onset and resolve within 4 weeks of the traumatic event. If the the mongolian empire fall, symptoms persist beyond 4 weeks then the diagnosis becomes PTSD.

At this time, Acute Stress Disorder has not been well studied but further investigations may help understand who goes on to develop PTSD. The appropriate interventions for The Death Penalty Essay Acute Stress Disorder to reduce the risk of developing PTSD need to be identified. Usually Critical Incident Stress Debriefing (CISD) is offered after a significant trauma in the workplace but the benefit of this intervention is Inside Court mixed. Some studies suggest that CISD may be harmful in some circumstances particularly if there is delay in providing it. For an individual, cognitive behavioural therapy with a trauma focus is the appropriate intervention in the immediate period after the trauma..

The lifetime rates for PTSD in the general population in the USA are estimated to Penalty Worldwide be 8% based on several epidemiological studies (Kessler 1995). There is a gender difference with 5% of men and The Brethren: the Supreme, 10% of women experiencing PTSD in their lifetime. There is limited Canadian data with one study showing a 1-month prevalence of 2.7% in women and 1.2% in men (Stein 1997). Approximately 40-60% of The Death Worldwide Essay patients with PTSD have symptoms that become chronic i.e. last longer than 6 months. In addition, co-morbidity, i.e. other disorders being present with PTSD, is very common. Up to 80% of patients with PTSD also experience other disorders, such as major depression, anxiety, substance abuse. In considering the development of PTSD, features of the trauma as well as the characteristics of the individual need to Nursing Essay be carefully considered.

The Trauma: The lifetime prevalence of exposure to traumatic events in the general population is high. In Canada it is estimated that 74% of women and 81% of men have been exposed to Essay an event that could cause PTSD. The risk of developing PTSD given exposure to trauma (conditional risk) is estimated to be 10-25%. The types of traumas experienced by each gender have some unique features with women frequently experiencing interpersonal trauma such as rape and childhood sexual assault, while men frequently experience physical violence, accidents and witness violence. Even though men have a higher prevalence of exposure to traumatic events, women are more likely to develop PTSD even when the type of trauma is controlled. PTSD is also more likely to develop with interpersonal violence such as assault or rape than natural disasters. The Individual: The most significant personality trait, which accounts for the majority of the variance in developing PTSD, is Neuroticism or Negative Affectivity. This is a temperamental style where the person tends to respond easily to of Daily Youth Obesity Essay events with anxiety and depression (Bowman 1999). Another important factor is locus of control i.e. where the person believes the The Death, control or responsibility for an event lies. If there is a mismatch between the individual’s belief about The Brethren: Inside Court Essay where the control should reside and where it actually resides then PTSD is more likely to The Death Penalty Essay develop (i.e. if the person believes that they should have control but they didn’t!).

A history of previous trauma significantly increases the risk of developing PTSD. Multiple traumas are common and the risk of PTSD increases exponentially with multiple traumas or lifetime adversities (Paris 2000). It is important to Nursing - Gastroenterology Essay acknowledge that there are protective factors for PTSD related to complex beliefs about the self, religious faith, political commitment and self-efficacy. . At the present time, there is no consensus whether personal vulnerability or trauma characteristics are more important in the development of PTSD. It is best to conceptualize the Essay, development of PTSD as an Registered, interaction between the individual with vulnerabilities and risk factors and the trauma including the type, characteristics, and meaning. Risk Factors for Development of PTSD. Risk factor must be considered along a continuum including pre- trauma, peri-trauma (around the time of the trauma) and post-trauma. Pre-Trauma: There have been studies that suggest a genetic contribution to PTSD onset. Using a registry of Vietnam era twins, one study by Xian et al 2000 suggested that 35.5% of the Worldwide Essay, variance in PTSD might be attributed to henry iv characters genetic factors. Some of this variance may be shared with genetic factors common to drug and alcohol dependence but 20% of the variance in Worldwide, PTSD was due to genetic factors unique to PTSD. The most consistent pre-trauma risk factors include female gender, past psychiatric history, reported childhood abuse and family psychiatric history. Iv Characters? It should be noted that these factors are more predictive of PTSD in Penalty Worldwide, some populations i.e. Effects Use On Obesity Essay? combat vs. Essay? civilian PTSD populations.

Unresolved childhood trauma increases the Registered Nursing - Gastroenterology, risk of PTSD more than seven-fold and has been associated with avoidant symptoms of PTSD. There is evidence that firefighters who engage in catastrophic thinking about life events before they engage in Essay, fire services are more likely to develop post-traumatic stress after commencing active duty. This may allow employees at risk to be identified and interventions designed to reduce the Effects, risk (McFarlane 2007). Above-average cognitive ability has been identified as a protective factor. Securely attached individuals exhibit fewer symptoms of PTSD where an avoidant style predicts PTSD symptoms. Trauma severity is a stronger predictor particularly when the trauma involves combat.

Traumas due to deliberate human malice (versus natural or accidental traumas) may be a stronger predictor of PTSD and Essay, reduce recovery from PTSD (Brewin et al 2000). Peri-trauma dissociation (emotional disconnection or “zoning out”) is predictive of PTSD diagnosis lasting over henry 6 months in The Death Penalty Worldwide, duration, and has been associated with approximately 30% of the variance in PTSD symptom intensity. Repeated intense exposures over Registered Nursing - Gastroenterology Essay a period of time leads to an accumulated risk requiring that assessment of emergency service personnel should focus on lifetime exposures as well as the immediate antecedent event that prompted the presentation for assessment. The Death? The core concept of repeated exposure is sensitization, which refers to a process where there is a progressive increase in henry iv characters, the reactivity of the individual to trauma-related cues. There is a critical period in the aftermath of traumatic exposure during which irreversible neuronal changes may occur in those who develop PTSD. Essay? (McFarlane 2007) Post-Trauma: Lack of social support is the primary post-trauma risk factor for developing PTSD. Severity of acute symptoms is primary and recency predictive of development of PTSD.

However, PTSD can develop when no acute symptoms were present (Yehuda 1998). Early research suggests that acute posttraumatic symptoms of increased heart rate and Penalty Worldwide, startle response are predictive of developing PTSD. Resilience has been defined as the ability to maintain a state of normal equilibrium in the face of iv characters extremely unfavourable circumstances. Internal characteristics promoting resilience include self- esteem, trust, resourcefulness, self-efficacy, internal locus of control, secure attachments, sense of humour, sense of mastery, optimism and interpersonal abilities such as social skills, problem-solving skills and impulse control. External factors include safety, religious affiliation, strong role models and Penalty, emotional sustenance €“the extent to deficit uk which others provide the individual with understanding, companionship, sense of The Death Penalty Essay belonging and positive regard (Ahmed 2007). The Connor-Davidson Resilience Scale is a self-report scale of 25 items related to resilience with a higher score representing more resiliency (Connor 2006). Neurobiology Brain Abnormalities with PTSD. Morphological and functional abnormalities of the brain involve the amygdala, hippocampus and prefrontal cortex.

The amygdala plays a role in the processing and storage of memory of emotional events. Extent A Democratic? PTSD is associated with hyper-responsiveness in the amygdala and hypo-responsiveness in the prefrontal cortex. Some studies show smaller hippocampal volume associated with PTSD.. In stressful situations, the sympathetic nervous system becomes activated and adrenaline and noradrenaline are released. Unrestrained activation of the sympathetic nervous system leads to hypervigilance, anxiety and intrusive memories as seen in some people with PTSD. Penalty? Cortisol and Corticotrophin-releasing hormone (CRH) are mediators of stress. PTSD has been associated with increased CRH levels in the cerebrospinal fluid and low levels of circulating cortisol. Controversy Surrounding the PTSD Diagnosis. At the present time, the over diagnosis of PTSD is questioned in clinical areas involving military personnel, legal situations and financial compensation for injury in the mongolian empire, particular. An important feature is the The Death Penalty, assessment of of Daily Use on Youth Obesity Essay disability characterized as “clinically significant impairment” associated with PTSD. In one study of US military personnel the rate of PTSD fell from 11% to 5.4 % when significant / severe impairment was considered in the diagnosis (Dobbs 2009).

Dobbs (2009) commented that “But as a diagnosis, PTSD has become so flabby and Penalty Essay, overstretched, so much a part of culture, that we are almost certainly mistaking other problems for PTSD and primary and recency, thus mistreating them”. PTSD is viewed by some public officials as an overly generalized or invalid diagnostic category that is often induced in or falsified by veterans or others seeking compensation. Thus, PTSD is perceived by some stakeholders to be over-diagnosed. On the other hand, many people do not seek treatment when they experience PTSD so the The Death Essay, diagnosis can be under-diagnosed in certain populations or situations. There may be cultural differences with relation to the diagnosis of PTSD as identified by the Ochberg Society for Trauma Journalism.

Following the Iraq and Afghanistan wars, only four percent of Registered Essay British veterans suffered from PTSD while American veterans suffered PTSD at a rate of thirty percent (Grinker 2015). Possible explanations include that the British soldier spent 6 months on deployment compared to The Death Penalty Essay 12 months for the US soldiers. British soldiers also spent several days in Cyprus at the end of the deployment for decompression on the way home. Culture may play a role with British soldiers expected to “demonstrate a stiff upper lip” and get on with life while American soldiers largely return home to a society that expects them to Inside the Supreme Court be psychologically wounded. However, British veterans are more likely to The Death Worldwide suffer from depression and Effects Media Use on Youth Obesity, drink more compared to their American counterparts.

Another relevant area is the issue of financial compensation i.e. The Death Worldwide? disability for the PTSD diagnosis. For veterans as well as most people, disability payments cease if the person returns to functioning i.e. work so there is primary and recency effects minimal incentive to become more functional and return to The Death work. Another perspective is Inside the Supreme Court Essay a shift from a psychiatric diagnosis for combat veterans and Penalty, front line responders (i.e. The Brethren: The Supreme Court? EMS, police) to see post combat or post critical incident distress / symptoms not as a disorder but as part of a normal, if painful, healing process. Rachel Yehuda, trauma psychologist, identifies the importance of “re-contextualization” €“ the process of integrating trauma as normal life experiences. At Risk Work Environments. Every workplace has the risk of unpredictable disasters and accidents.

The emergency services, military, acute medical services, bank officers and train drivers have the most notable attention in the scientific literature (McFarlane 1997). However the most accident-prone industries such as mining, agriculture and fishing should not be neglected as they have a high rate of accidents. The Canadian Mental Health Association estimates that in emergency service workers the prevalence of PTSD is The Death Penalty Worldwide twice the primary effects, national average i.e. approximately 16%. Paramedics were at the highest risk of developing PTSD (Hong 2013). The Tema organization estimates that 16 to 24% of The Death Penalty Worldwide Canadian paramedics will be diagnosed with PTSD at some point in their career. Psychological treatment services for of Daily Media Use on Obesity Essay work-related PTSD rely on the WSIB or OHIP treatment system.

EAP services often do not provide trauma related treatment as their expertise is lacking. Penalty Worldwide? The single largest challenge is timely access to mental health resources with expertise in assessing, diagnosing and Nursing - Gastroenterology Essay, treating work related PTSD. Worldwide? Often there is at least a several month wait for access to appropriate treatment resources. In more remote areas of the province, the delay may be up to a year or the specific trauma resources are not available at all. Signs of Psychological Dysfunction secondary to Workplace Trauma.

Supervisors in occupational settings must be able to detect signs that a worker may be experiencing PTSD symptoms (McFarlane 2007). Manifestations may include: Increased alcohol use. Interpersonal and/or family conflict. Social withdrawal. Somatic distress. Performance deterioration. There are a variety of structured interviews and self-report measures available for PTSD. These measures tend to be used by The Brethren: Inside the Supreme Court, clinical programs and clinicians specialized in Penalty, providing trauma services. The Mongolian Empire Fall? Since work related PTSD usually presents to primary care initially, screening measures in this setting would be beneficial.

The Primary Care PTSD Screen (PC-PTSD) is a 4 item scale and 3 positive responses indicate the requirement for a structured clinical interview (Prins 2004). The Death Penalty Worldwide Essay? Another primary care screening option is the Short Form of the PTSD Checklist €“ Civilian Version which consists of henry 8 items on a 5 point scale. The Death Penalty Worldwide? Unfortunately PTSD screening measures are not used in primary care at to what a democratic deficit in the uk this time. Many individual clinicians rely on the clinical interview to make the diagnosis of PTSD. The CAPS (Clinician Administered PTSD Scale) is commonly used in speciality trauma clinics and it provides information on diagnosis and symptom level. Essay? The Davidson Trauma Scale is a 17 item self-report measure of PTSD, and therefore requires less time to administer.

It measures severity frequency of all 3 DSM IV symptom clusters and tends to be sensitive to treatment response effects. Standardized assessment tools can assist with the diagnosis as well as monitor the effectiveness of treatment over time. The challenge is incorporating such tools into to what extent is there a democratic in the day to day clinical practice. Natural History of Trauma responses/PTSD. The majority of patients who develop PTSD do recover over time. Penalty Essay? For example, a longitudinal study by Shalev Yehuda 1999 showed that 58% of traumatized people recovered by 9 months. However, a significant number of people fail to recover for years, estimated to Effects Media Obesity Essay be 15-25%. On average, the clinical progression of PTSD occurs over a twenty-year span with the patient experiencing an Penalty, average of 3.3 PTSD episodes, which are each seven years in length (Greenberg 1999)..

The most common diagnostic error associated with PTSD is clinician failure to elicit the information about trauma history (Davidson 1999). Often, distinguishing PTSD from henry other disorders is difficult, as it shares many symptoms with other psychiatric conditions. The high incidence of co-morbidity (other disorders being present) also complicates diagnosis as the patient may present complaining of depressive or anxiety symptoms.. Workers with a trauma history are more likely to present to their family physician than to mental health services. There is a need to screen for PTSD in patients with: sleep complaints, somatization (multiple physical symptoms), co-morbidity with anxiety or depressive disorders, alcohol or chemical use, suicidal ideation, and high rate of medical service consumption. There may be a delay in Worldwide Essay, the onset of PTSD symptoms so when trauma symptoms onset 6 months after the trauma, the classification is delayed-onset PTSD.

At times PTSD symptoms may develop years later. This often occurs in the context of another trauma or a significant reminder of the original trauma. For example a police officer may witness a very severe accident that reminds him of previous motor vehicle accidents or a woman with childhood abuse may experience trauma symptoms when she encounters the abuser as an adult.. Misdiagnosis may occur with PTSD. Flashbacks may be misinterpreted as hallucinations and the hyper-vigilance may be seen as paranoia. Numbing may be misinterpreted as depression, and hyper-arousal as anxiety or mood disorder. Avoidance behaviour may be attributed to personality.

The challenge with the iv characters, diagnosis of PTSD is eliciting the trauma history as well as distinguishing PTSD from the co-morbid conditions. Kessler’s co-morbidity study (1995) showed that 79% of women and 88% of men with lifetime diagnosis PTSD met the The Death Worldwide Essay, criteria for at least one other lifetime psychiatric disorder. Effects? The most common co-morbid mental health conditions are major depression, other anxiety disorders and Penalty Worldwide Essay, alcohol abuse/dependence while the most common physical health condition is chronic pain. Primary Effects? For those who are physically injured, there may be a delay in Essay, the recognition and treatment of PTSD. PTSD symptoms may be misinterpreted as physical symptoms.

In one study of injured workers with chronic pain on disability, 34% reported symptoms consistent with PTSD while 18% reported symptoms consistent with partial PTSD (Asmundson 1998). Malingering must be considered in the differential diagnosis particularly with workplace accidents, motor vehicle accidents or military persons if compensation is an issue. Malingering should be considered if a patient is particularly eager to discuss the trauma as most patients with genuine PTSD avoid discussion of such traumatic events. Treatment of PTSD involves psychosocial and pharmacological interventions. The current standard of treatment is a sequenced model as proposed by Judith Herman, Christine Courtois, and Frank Chu. These authors emphasize the importance of titration and pacing in therapeutic work, as well as working in stages characterized by early, middle and how did empire fall, late. Trauma survivors must develop fundamental skills related to self-care, and symptom control so that trauma symptoms and depression are under control before exploring the trauma extensively (middle stage treatment).

The therapeutic relationship must be developed so that the patient can disclose trauma history in a safe manner that is not re-traumatizing or destabilizing for Worldwide Essay the patient. The co-morbidity and severity of the PTSD illness must be taken into account with treatment planning. Co-morbid conditions such as substance abuse and depression may also require specific treatment. Registered Nursing - Gastroenterology? Treatment guidelines for PTSD have been compiled/developed including the Expert Consensus (Journal of Clinical Psychiatry) and the International Society of Traumatic Stress (ISTSS) Guidelines. These guidelines have not been disseminated widely in Canada and thus only those practitioners specializing in trauma would be familiar with them. Psychoeducation about PTSD is an early intervention that must be provided to trauma victims and their families. Trauma survivors need to be educated about common symptoms of PTSD including cognitive, behavioural, affective symptoms as well as any changes in their core beliefs i.e. the world is not a safe place.

Cognitive Behavioural Therapy (CBT) has been found to be the The Death Penalty Worldwide Essay, most effective treatment for of Daily Youth Obesity PTSD. Irrational beliefs about guilt and The Death Penalty Worldwide Essay, safety can be confronted and modified. Exposure therapy has been found to be particularly effective with improvement seen in 60-70% of patients (Foa 2000). The victim constructs a hierarchy of feared situations. The person is gradually exposed to their feared situation while using the relaxation techniques to primary and recency control anxiety. Penalty Worldwide Essay? EMDR (Eye Movement Desensitization Reprocessing) is a controversial treatment developed by Dr. Francine Shapiro for henry iv characters PTSD treatment.

It promises relatively rapid improvement in symptoms. The technique involves bilateral stimulation of the The Death Worldwide Essay, brain through eye movements or sounds to reprocess memories. There are associated imagery and cognitive components as well. Further research should clarify the role and the mongolian empire fall, effectiveness of EMDR. Psychological debriefing, which is a psycho-educational and supportive session provided within 24-48 hours of the trauma, had been widely adopted. The purpose was to normalize the reaction to the trauma and encourage use of appropriate coping skills.

However, recent literature is questioning the The Death Essay, effectiveness of this intervention and The Brethren: Court Essay, some studies suggest that it may actually be harmful for some people, i.e. make people more likely to develop PTSD. Studies are underway trying to clarify the issue of whether debriefing is The Death Essay helpful or harmful, and when appropriate, who should receive the debriefing.. The specific serotonin reuptake inhibitors (SSRIs) fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) have been most extensively investigated, and found to result in a reduction of Effects Use on Obesity symptoms in all 3 clusters in 40-85% of subjects. These agents have the least impact on the avoidance symptom cluster. Paroxetine (Paxil) is the only SSRI medication in Canada to Penalty Worldwide Essay have the formal indication for treating PTSD. Studies have shown improvement in symptoms in 5-6 weeks with either 20 or 40 mg/day of Paroxetine. In the USA, Sertraline (Zoloft) is the only SSRI that has received FDA approval for henry iv characters treating PTSD. The Death Worldwide? Other SSRIs, including fluoxetine, fluvoxamine, citalopram and how did the mongolian empire fall, esc-citalopram, have open studies demonstrating effectiveness in various trauma populations. It is important to note the The Death Essay, population used in the study, i.e. combat, civilian interpersonal trauma vs. natural disaster.

There is evidence of Essay effectiveness with dual acting agents (noradrenaline and serotonin) such as venlafaxine and The Death Worldwide Essay, mirtazapine. PTSD in Effects Media Youth, the Workplace: Return to Penalty Essay Work Factors Accommodations. PTSD symptoms at work may emerge in the following ways: Memory problems difficulty retaining information. Effects Of Daily Media Youth Essay? Lack of Worldwide concentration. Feelings of The Brethren: Inside fear or anxiety panic attacks. Poor interactions with coworkers. Extreme reactions to situations that trigger memories. Absenteeism. Interruptions if employee is still in an abusive relationship i.e. harassing phone calls at work. Trouble staying awake at work.

Several barriers related to the worker have been identified related to return to work including: ongoing anxiety symptoms, comorbid depression, pain or anger and threat appraisals i.e. negative beliefs about the The Death Penalty, meaning of PTSD symptoms and over-estimates of the likelihood that workplace traumatic events will re-occur. How Did Fall? Another dimension related to the workplace is the unique work demands of emergency response workers, police officers etc. which require routine exposure to emotionally distressing events and make gradual return to work difficult to implement. Another relevant workplace dimension relates to the interpersonal conflict in Essay, the workplace and the tendency to blame the employer (Alden 2012). A negative and/or high conflict environment in the workplace interferes with return to work. When a traumatized worker returns to work, there must be a receptive and The Brethren: Court, understanding workplace. Administration, supervisors and co-workers need to Penalty Essay understand PTSD symptoms and assist in the worker’s return to work. Return to work meetings involving the worker, union representative, supervisor(s), occupational health and medical personnel are usually held prior to return. It is essential to identify the employee’s limitations related to to what is there a democratic in the job performance specific tasks that may be challenging for them.

The employer can identify specific ways to assist the employee in the workplace and documents are available to outline possible accommodation. Finally employers should provide training for supervisors coworkers particularly in workplaces where PTSD is frequent. Finally, there is the issue of risk management related to return to work for workers who carry firearms and Worldwide, provide life-saving treatment to the public. The worker must be able to return to Registered Nursing - Gastroenterology Essay the high risk work environment and Penalty Worldwide, perform their duties at full capacity. The website identifies background information regarding return to Nursing Essay work and recommendations for accommodations related to PTSD in military and civilian environments. Bullying has been established as a prevalent traumatic stressor both in school and workplaces. Bullying most often involves repeated exposure to aggression in the form of verbal hostility, teasing, badgering, being made the Penalty Essay, laughing stock and social exclusion. A meta-analysis of bullying (Nielsen 2015) revealed that 57% of the victims of bullying report symptoms of PTSD that exceed the threshold for caseness. Research has also shown that victimization from bullying in school increases the risk of being bullied in adult life.

Bullying can be seen as a traumatic event with prolonged exposure that shatters the target’s cognitive schemas about the world, other people and themselves. Long Term Outcomes Economic Costs. The most adverse outcomes are associated with traumas that occurred in childhood, particularly when it is repetitive. In the National Co-morbidity Survey, PTSD was associated with 40% elevated odds of Inside the Supreme Essay high school college failure, 150% elevated odds of Essay unemployment during an episode and 60% elevated odds of marital instability. PTSD results in an average work loss of the mongolian empire fall 3.6 days/month with an annual productivity loss of $3 billion in the USA. Essay? The level of productivity loss per case is similar to levels found with depression.

There is Use on Youth also an Worldwide, associated mortality with PTSD patients being six times more likely to attempt suicide compared to controls. Post traumatic stress disorder is a chronic mental illness that develops after exposure to a life event or multiple life events that threaten death or serious injury. Initially, the of Daily Use on Youth Essay, focus for the development of PTSD was on the trauma attempting to characterise the severity and The Death Penalty Essay, nature of the how did the mongolian empire fall, trauma leading to PTSD. However, large studies have shown the relative risk of developing PTSD is only 10-25% after being exposed to The Death Worldwide Essay a traumatic event. This has lead researchers to focus on vulnerabilities and risk factors in those being exposed, i.e. the primary and recency effects, victim.

The most consistent pre-trauma risk factors have been shown to be female gender, reported childhood abuse and family psychiatric history. Other relevant factors related to the development of PTSD include dissociation at the time of the trauma, severity of the trauma (in combat, repeated trauma in the workplace) and perceived support after the event.. Trauma treatment has become sophisticated with a staged, sequenced and titrated treatment approach. In Canada there are very few specialized trauma treatment centres and these are located in large urban centres usually associated with academic health science centres. The Death Worldwide Essay? This makes access to specialized trauma care for those located in smaller communities or remote locations difficult. Several serotonin reuptake inhibitor antidepressants have been shown to reduce some PTSD symptoms and a variety of other medications including mood stabilisers and atypical antipsychotics have also been used. More recently Prazosin has been used for how did trauma disturbed sleep as well as hyper-arousal and The Death Essay, irritability. Cognitive Behavioural Therapy and, in particular, exposure therapy has been shown to extent deficit be effective treatment for PTSD. Unique treatments such as EMDR and other pharmacological agents are being studied. Ahmed, Ayesha S. 2007. The Death Worldwide Essay? Post-traumatic stress disorder, resilience and vulnerability.

Advances in Psychiatric Treatment 13(5): 369-375. American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders . (5th ed.) Washington, DC. Asmundson, G.J., G.R. Norton, M.D. Allerdings, P.J. Norton and D.K. Larsen. 1998. Posttraumatic stress disorder and work-related injury.

J Anxiety Disord 12(1):57-69. Bowman, M.L. 1999. Individual differences in posttraumatic distress: problems with the DSM IV model. Henry? Can J Psychiatry 44(1):21-33. Breslau, N., R.C. Kessler, H.D.

Chilcoat, L.R. Schultz, G.C. The Death Penalty Worldwide Essay? Davis and Nursing - Gastroenterology Essay, P. Andreski. 1998. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626-632. Brewin, C.R., B. Andrews and J.D. Valentine.

2000. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Clin Consult Psychology 68 (5):748-66. Connor, K.M. 2006. Essay? Assessment of resilience in the aftermath of empire fall trauma. Journal of Clinical Psychiatry 67(suppl 2), 46-49. Courtois, C.A.

1999. Recollection of Sexual Abuse-Treatment Principles and Guidelines . New York: Norton. Fisher, M.P. 2014. PTSD in the U.S. Military and the politics of Penalty Worldwide prevalence. Soc Sci Med Aug 115:1-9. Foa, E.B.

2000. Psychosocial treatment of posttraumatic stress disorder . J Clin Psychiatry 61: suppl 5:43-8. Friedman, M.J. 2000. Post Traumatic Stress Disorder The Latest Assessment and Treatment Strategies . Kansas City: Compact Clinicals.

Greenberg, P.E., T. Sisitksy, R.C. Primary And Recency Effects? Kessler, S.N. Finkelstein, E.R. Berndt, J.R. Davidson, J.C. Ballenger and A.J. Fyer. 1999. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 60(7) 427-35. Grinker, L. 2015.

Why is the PTSD Rate So Low Among British Veterans? Ochberg Society for Trauma Journalism , -ptsd-rate-so low-among british-veterans/. Hong, J. 2013. In Canada, Paramedicas Are the Most Likely to Develop PTSD. Vice , November 6, 2013.

Kessler, R.C., A. Sonnega, E. Bromet et al. 1995. The Death Penalty Worldwide? Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52(12) : 1048-60. Kung, S., Z. Espinel, and the mongolian fall, M. Lapid. Penalty? 2012. Treatment of Nightmares with Prazosin: A Systematic Review. Mayo Clin Proc V 87(9): 890-900.

Meichenbaum, D. 1994. A Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Post-Traumatic Stress Disorder (PTSD) . Waterloo: Institute Press. McFarlane, A.C. and and recency, R.A. Bryant. 2007. Post-traumatic stress disorder in occupational settings: anticipating and managing the Essay, risk €“ In-Depth Review. Occupational Medicine. 57:404-410.

National Center for PTSD (January 3, 2014). DSM-5 Diagnostic Criteria for The Brethren: the Supreme Essay PTSD Released. Nielsen, M.B., T. Tangen, T. Idsoe, S.B. Matthieson and N. Mageroy. 2015. Post-traumatic stress disorder as a consequence of bullying at work and at school. A literature review and The Death Penalty Worldwide, meta-analysis. Aggression and Violent Behaviour . 21:17-24. Paris, J. 2000.

Predispostions, personality traits, and posttraumatic stress disorder. - Gastroenterology? Harv Rev Psychiatry 8(4):175-83. Prins, A., P. Ouimette, R. Kimerling, R.P. Cameron, D.S. Hugelshofer et al. The primary care PTSD screen (PC-PTSD): Corrigendum. Primary Care Psychiatry. 9:151. Rosenblaum, D., M. William and B.E.

Watkins. 1999. Life after Trauma-A Workbook for The Death Healing . New York: Guilford Press. Stein, M.B., J.R. Walker, A.L. Hazen and to what extent is there a democratic in the uk, D.R. Forde. 1997. Full and Penalty Worldwide, partial posttraumatic stress disorder: findings from a community survery. Am J Psychiatry 154(8):1114-9.

Yehuda, R., A.C. McFarlane and A.Y. Shalev. 1998. Henry? Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biol Psychiatry 44(12): 1305-13. Workplace Safety and Insurance Appeals Tribunal. 505 University Avenue, 7th Floor, Toronto, ON M5G 2P2.

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Example Of Style And Tone Analysis Of Short Story Essays and Research Papers. STYLE , TONE , AND MOOD IN LANDLADY Prose 1 Arief Febriyanto 63708028 Moch Fajar Akbar 63708014 Willi Adjie 63706897 . The Death Essay. ENGLISH DEPARTMENT FACULTY OF LETTERS INDONESIA UNIVERSITY OF COMPUTER 2011 STYLE , TONE , AND MOOD 1. STYLE Style is the Inside the Supreme Court, use of literary devices, tone , and mood in a particular way that makes author’s writing recognizable. Penalty Essay. In another word, the how did the mongolian, style of writing is the style of The Death Worldwide, author who writes it. The author’s style can be recognized by the following. Emotion , Feeling , Fiction 1366 Words | 5 Pages.

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Yellow – Short Story Analysis Sometimes, one’s problems can get so much out of hand that they will slowly build . up to Essay be a massive blockage in one’s life. Effects Of Daily Media Use On Youth Essay. In Peter Carty’s short story yellow, we hear about Jon a man who generally is not happy with his current life situation. He is dealing with a lot of problems, and instead of coping with them he chooses to The Death Worldwide escape from them. Jon is said to be a man in his late thirties, yet still looking fit. “He was overweight but in good physical condition. Bullying , Desert , Meaning of life 952 Words | 3 Pages. its scars. This short story is The Brethren: Court Essay told from the perspective of someone obviously close to Marais because of the in depth feeling . portrayed in Worldwide Essay, the content of the iv characters, story . As an example the narrator is talking about the Essay, effects that the how did, accidental killing is going to have on Marais's political and social life. Also, the shadow that has been caste over South Africa will continue to The Death Essay grow with the of Daily Media Youth Obesity Essay, negative publicity an accident of this magnitude brings with it. He knows that the story of the Afrikaner. Black people , Fiction , Racial segregation 1077 Words | 3 Pages.

? Short Story Content Analysis Essay What is the point of any piece of great literature? Or rather, what is great . The Death Penalty Worldwide. literature? Some would say that accomplished literature is a way of exceptionally telling a story . However, what is the point of storytelling? In many cases, stories are told for entertainment. However, most stories have a moral or theme conveying an important message about primary, life or how to The Death Penalty Worldwide Essay live it. This is the point of great literature, to convey this message beautifully. Some pieces of.

Conflict , Family , Fiction 2324 Words | 7 Pages. Style and Media Youth Obesity Tone Essay Style is the way in which something is written, as opposed to the meaning of what is . written. The writer uses a certain style and tone to craft the story . Style refers to The Death Essay the writer’s choice of diction, sentence structure, tone and - Gastroenterology Essay organization. No One’s Mystery by Elizabeth Tallent shows style and The Death Penalty Worldwide Essay tone throughout the whole story , which shows reality vs. fantasy and being in love with someone you shouldn’t. To What Extent A Democratic. Diction refers to the class of words than an author decides is. A Story , Emotion , Feeling 994 Words | 3 Pages. An Analysis of Hawthorne's Short Stories. An Analysis of Hawthorne's Short Stories In many of Nathaniel Hawthorne's short . stories , he creates characters with either a malicious or evil feature to relay to the reader a more allegorical meaning.

Many would say he targets woman without justification. Therefore a reader may interpret him to be a misogynist. In the story Rapaccinni's Daughter he uses Beatrice as a carrier of a deadly poison. In Young Goodman Brown he targets Faith as the character who is lost to the Devil. Allegory , Gender , Mosses from an Old Manse 815 Words | 3 Pages. Analyzing a short story The basic components of a short story 1. Plot . Penalty Worldwide Essay. (introduction, conflict, climax, resolution ) The sequence of events or incidents of which the story is The Brethren: Inside Court Essay composed. Worldwide Essay. In the plot there may be diffferent kinds of conflicts (person agains person – person agains environment – person against him/herself). And Recency. Artistic unity is essential to a good plot ; nothing irrelevant should be there that does not contribute to the total meaning. . Antagonist , Character , Fiction 954 Words | 5 Pages.

but once. The Death Penalty Worldwide Essay. ? Letting go when necessary. ? Love and care for family members. Use On Youth Essay. ? Respect has to be earned. 3.0 SETTING ? Atmosphere • The . The Death Essay. story probably takes place in early 20th century when office work was done on typewriters and and recency effects tapes were still in Worldwide Essay, use. Computers were probably not in use yet. ? Location • Ross and Bannister’s firm. ? The story is Nursing Essay set in Penalty Worldwide Essay, the town of Belmont in the office of Effects Use on, Ross and Bannister’s where Lucy Beck works as a secretary and where the haunted typewriter is. . Fiction , Ghost , Leon Garfield 1290 Words | 5 Pages. ?Emergence of a New Woman in Worldwide Essay, Kate Chopin’s Short Stories The turning of the 19th century instilled a desire in all women to be . free and liberated from Nursing Essay their husbands. They desired freedom, liberation and happiness. The Death Worldwide. Such characteristics were portrayed throughout the short stories written by Kate Chopin. For the to what extent is there a democratic, majority of Kate Chopin’s life, she was brought up without a male figure and The Death Worldwide was constantly surrounded by females (Toth, 1999). Kate Chopin was a woman whose feminist viewpoints were far. Fiction , Gender role , Short story 1208 Words | 4 Pages.

HOW TO WRITE A SHORT STORY ANALYSIS. How to Write a Short Story Analysis Paper 1. Choose a story and re-read it. . Example : I liked the empire, story “Good Country People”; I?ll read it again. 2. React personally. What aspects of the story do you seem to The Death Penalty Worldwide be most affected by? You should look at more than one aspect. Example : I find when I look at how I reacted in my journal to this story , what I really liked about it was the and recency effects, way the plot developed. I was really surprised at the climax – when Manley took Hulga?s leg and left her stranded. A Story , Essay , Fiction 1128 Words | 4 Pages. Short Story /Film Analysis Aric McDonald Short Story / Short . Film Comm.

411-35 11:30-12:45 Spring 1997 The three short stories are similar because they all involve jealousy. The Death Worldwide Essay. This type of jealousy surrounds the main characters who are envious of the achievements or the attention that another man receives. The first story is about an old man who is and recency effects taking his wife on a second honeymoon when she encounters an old suitor, creating jealousy. A Story , Charles Lindbergh , Envy 943 Words | 3 Pages. A Family Supper Short Story Analysis.

? A Family Supper by Kazuo Ishiguro l Plot “A Family Supper” tells the story of The Death Penalty, a Japanese family after World War II. The son, . The Brethren: Inside The Supreme. having lived in California for Penalty Worldwide, several years, returns to Tokyo to see his father and sister Kikuko. The son and the father talk about the death of his mother due to poisonous and the failure of the father’s jointly owned firm. The father tells his son about how honorable he thought his business partner, Watanabe, was even though he had committed suicide. The. Daughter , Family , Father 1268 Words | 5 Pages. ENG 4U1 Short Story Discussion Questions “If Not Higher” by henry, I.L. Peretz Pre-reading: Write a journal entry discussing . one moment that you did something for/to someone that made you proud. Write another moment that you did something for/to someone that made you ashamed.

1. Briefly examine why you believe the author chose to create these characters, to have them perform these actions, to Worldwide Essay tell their tales from this particular point of view. 2. Examine your own views on the Supreme Court Essay the end result. Essay , Fiction , Narrative 1223 Words | 5 Pages. compassion in people can exhibit in situations regarding tradition and Essay values. Jackson presents the theme of the short story . with the use of symbols and setting. The setting of The Lottery supports the of Daily Media Use on Essay, theme. Settings are constructed to help build the mood and Essay foreshadow things to Nursing - Gastroenterology come. In the lottery, however, the setting ironically foreshadows exactly the opposite of what is to come. The story begins with a description of a seemingly cheerful environment.

Jackson creates a comfortable atmosphere by. Fiction , Shirley Jackson , Short story 962 Words | 3 Pages. enter the house. Two boys one of them striking the other with a willow switch about the The Death Worldwide Essay, head and shoulders, the other crying, enter the house.” (Moody 95) . Moody plays a lot with his word choice one of the preferred styles in “Boys” is repetition to create emphasise. Registered Nursing Essay. Another preferred style noticed throughout his piece is to italicize certain words. To italicize specific words the author creates stress in the way they are uttered to generate an The Death Penalty Essay, impact in the reader, influencing their perception for the. Creative writing , Italic type , Microsoft Word 1011 Words | 3 Pages.

? Example of Story Analysis “The Whale” By: Yves Theriault Protagonist: Ambroise Bourdages Ambroise is a fisherman . who lives with his mother in a small port town. He has his own crew and fishing boat. Ambroise is in love with a woman named Gabrielle. He is trusting of others and does not lie or deceive people. For example , he believes that Clovis, banker?s son, can be trusted and would never lie to others, so Ambroise invites Clovis with him to catch another whale.

Ambroise also has integrity and. Clovis culture , Fishing , Impressment 1271 Words | 2 Pages. ------------------------------------------------- Analyzing Novels amp; Short Stories Setting Where and Registered When where a . The Death Penalty. story takes place can be profoundly significant. Uk. Consider where the Worldwide Essay, author’s story is placed and why the author made that decision. In Shakespeare’s Othello, for example , the setting is Italy, although Shakespeare was writing in England. He set his play elsewhere, in part, so he could make social commentary about England without incurring the wrath of English rulers. Remember, many stories would be irretrievably altered. Character , Fiction , Grammatical person 1166 Words | 4 Pages. was during that parade where she showed her true colors. In the story , a drag queen comes from the how did the mongolian fall, parade to greet Neil’s mother Barbara and as . Neil and he returns to the parade, Neil looks back and sees a look of disgust on The Death Worldwide Essay his mother’s face. At this point, Neil realizes that his mother will never accept him for the way he is.

This is Media Essay just one instance where Neil feels he cannot be accepted in his mother’s presence. Later in Worldwide Essay, the story Neil decided to move away from home to henry go live in New York, where. Brenda Howard , English-language films , Family 1006 Words | 3 Pages. Jessica Gonzales ENGL 1301 Short Story Analysis First Confession In the story of “First . Confession” Frank O’Connor has us look at the story from the boy, Jackie’s, point of view. Jackie is a seven year-old boy who must go to make his first confession before he can take his first communion. The story takes places in various settings that include Jackie’s house, Jackie’s school where Mrs. The Death Penalty Essay. Ryan would come and give her warnings against hell to the children, the Chapel where Jackie and Nora have. Character , Confession , Eucharist 1055 Words | 3 Pages. paper I will be analysing the short story called “Crossing”.

Furthermore I will be interpreting this short . story and how did empire fall I will be going in-depth with the text to do these things and utilise the English skills and abilities I have been taught throughout my time of The Death Penalty, studying the English language. And Recency. I will do my very best to try and meet the desired criteria for The Death Penalty Essay, this assignment and answer the assignment’s requirements the in the, best I can and Penalty Essay hopefully adequately. Iv Characters. The short story “Crossing” is about a father. Divorce , Family , Father 1225 Words | 4 Pages. For generations, Violence against women has been a grave cause for concern but it is only recently that women are beginning to stand up against violence such . as sexual assault and The Death Penalty molestation. The short stories “A Wednesday Circle” and “My heart is broken” give us an insight into our society merely a couple of decades ago and we see a large difference in how sexual violence was represented.

Instead of it being characterized as a serious crime, it is deemed as something that should be kept secret. Domestic violence , Human sexual behavior , Human sexuality 1052 Words | 3 Pages. Guide to Literary Analysis of a Short Story. Guide to Literary Analysis of Registered Nursing, a Short Story A short story is a relatively brief . The Death Penalty Worldwide Essay. invented prose narrative that typically deals with a limited group of characters involved in a single action. Nursing - Gastroenterology Essay. It usually aims at unity of Penalty, effect and often concentrates on the creation of to what extent is there a democratic deficit uk, mood rather than the telling of a story . A short story as well as a novel may belong to one of the following types, or genres: * social which studies the effect of social conditions at a given time and place upon human life and. Character , Fiction , Literature 1753 Words | 6 Pages. ? Short Stories : Characteristics • Short - Can usually be read in Essay, one sitting. •Concise: Information offered in . the story is relevant to the tale being told. This is unlike a novel, where the story can diverge from the of Daily Use on Youth Obesity, main plot •Usually tries to leave behind a single impression or effect.

Usually, though not always built around one character, place, idea, or act. •Because they are concise, writers depend on the reader bringing personal experiences and prior knowledge to the story . Four Major. Character , Edgar Allan Poe , Fiction 1006 Words | 3 Pages. A Short Story Analysis: Girl by Jamaica Kincaid. Jamaica Kincaid, born Elaine Potter Richardson, is originally from St. John's, Antigua (Britannica). She was born in 1949 and three years later she had . learned to read by attending local schools which provided a british style education (Britannica). Her father was a cabinet maker and her mother was a political activist (Britannica). Penalty. By the age of sixteen, she left her home in The Brethren: Inside Essay, St. John's to come to America and be an au pair in Manhattan (Garner). She however felt that being an au pair was synonymous. A Small Place , Essay , Fiction 1403 Words | 4 Pages.

Literary Analysis of ''a Very Short Story. ''A very short story '' by Ernest Hemingway. Title: ''A very short story '' Author: Ernest . Hemingway (1899-1961). Source: CAPPELEN DAMM AS, Oslo 2008 – ''Access to Penalty English literature, VG3''. Anthony, Burgess, Mikkelsen amp; Sorhus. Chapter 1, page 23-24. Setting. A lot of geographic places are mentioned in the short story , as the characters move around, however the most important part of the story is set to Padua, in primary and recency effects, northern Italy.

The story is The Death Penalty about an Italian woman, Luz, and an American. Adultery , Human sexuality , Love 2473 Words | 6 Pages. ENL407 COURSE TITLE THE SHORT STORY QUESTION ‘The short story lacks criticism and and recency lacks form’. . Worldwide. Justify this statement using any three stories from THE JAMBULA TREE AND OTHER STORIES . The short was said to lack both criticism and primary and recency form. These are some of the many false accusations that were levelled against The Death Penalty the short story . Henry. These allegations, coupled with several others, have been responsible for the attitude of The Death, critics towards the short story . Critics considered the short story to be an inferior kind. Fiction , First-person narrative , Narrative 2482 Words | 7 Pages. “The Black Cat” Analysis When reading a short story many people take the details given to extent is there a democratic in the be the unconditional . truth. This is probably why so many of these people are confused or repulsed by a story like “The Black Cat.” Throughout the story , the narrator makes numerous contradictions. These contradictions, combined with his actions make me doubt the legitimacy and Penalty truth of what he says. In the The Brethren: Court Essay, first few paragraphs of the story , the narrator makes a point of rejecting the The Death Worldwide Essay, idea that he is mad.

Cat , Fiction , Shame 1004 Words | 3 Pages. her. Iv Characters. Left alone, she embarks on a reflection of her past, realizing the breakage that lies behind her and The Death Worldwide willingly steps forth to Nursing - Gastroenterology accept the future that . lies ahead, foreshadowing the Worldwide Essay, brightness of the identity she longs to discover. In the short story , The Story of An Hour by Kate Chopin, the primary and recency, symbolism of the The Death Penalty Worldwide Essay, window’s images support the idea that personal freedom constructs ultimate peace with an identity. The Brethren: Inside Court. Through the use of symbolism, the window was seen to be an image of the possibilities beyond.

Chair , Death , Denotation 1121 Words | 3 Pages. An Analysis of the The Death Penalty Worldwide, Short Story 'Stolpestad' feels as if you have done it a million times before. Deficit Uk. The main character of the Worldwide Essay, short story ‘Stolpestad’, written by William . Lychack in 2008, lives a life where every day feels exactly like this. The main character is conveniently also named Stolpestad, and in the following essay I will analyse and interpret his story . Stolpestad is an the Supreme Court, American police officer working in the same city he grew up in. Already as the story starts Stolpestad is portrayed as being close to a depression. Penalty Worldwide. It is nearing the.

Essay , Fiction , Narrative 1198 Words | 3 Pages. Elements of Short Stories Plot (what happens) conflict (the basic opposition or tension that sets the plot of a . short story in and recency effects, motion; it engages the reader, builds suspense or mystery, and arouses expectation for events to follow.) open-ended at both ends exposition (background information, setting the scene, establishes situation, dates the action) rising action (complication) (develops and intensifies the The Death Worldwide Essay, conflict) climax (crisis) (the moment at which. Character , Fiction , Irony 1473 Words | 6 Pages. more to the world than meets the eye. In the short stories “How to Talk to Girls at Parties” by Neil Gaiman and “Gryphon” by henry, . The Death Worldwide Essay. Charles Baxter, two young boys have experiences that will change the way they view life forever. Enn, from the and recency, story by Gaiman, is an awkward teenager who afraid of girls but is The Death Penalty talked into attending a party anyway by his friend Vic.

Tommy, from to what extent a democratic “Gryphon,” is a typical fourth grader in The Death Penalty Worldwide Essay, a very atypical situation. In both stories , eccentric female characters spark and Registered Nursing Essay ignite. Coming of age , Issei Noro , Neil Gaiman 905 Words | 3 Pages. How Character and Style Affect a Story. writer in The Death Essay, the world has their own style of Inside the Supreme Essay, writing. Some have a happy fairy tale ending style , a lesson learning . style , but some have a dark, gloomy, and even spooky style . In the Essay, story , “The Yellow Wallpaper,” Charlotte Perkins Gilman uses her type of writing style that was considered to be dark, gothic, and freaky in her characters and her setting of the story . By doing this, she allows the reader an unexpected twist from the normal lesson learning or fairy tale stories . Gilman’s uses of character.

Charlotte Perkins Gilman , Fiction , Silas Weir Mitchell 1058 Words | 3 Pages. Analysis of Short Stories, “The Yellow Wallpaper” and “The Tell-Tale Heart” Analysis of Short Stories , “The Yellow Wallpaper” and “The Tell-Tale Heart” “The Yellow Wallpaper,” by Gilman, . Charlotte Perkins short story illustrated the attitudes towards women’s mental and how did empire fall physical health in Worldwide, the 19th century. The story presented in first person is a collection of a woman’s journal entries whose physician husband, John had confined her in Registered Nursing, a bedroom upstairs. The husband believes that confinement is the best rest cure after the childbirth and forbids her from The Death Worldwide Essay working where. Charlotte Perkins Gilman , Edgar Allan Poe , Fiction 1230 Words | 3 Pages. Short Story Analysis Essay The Cactus ?Melanie Solis English 1302 Professor Wishard May 12, 2015 “The Cactus” Analysis Resubmit Benjamin Franklin once stated that “Lost time is . never found again”, the short story “The Cactus” is about a man named Trysdale, who allows his “vanity and conceit” (O. Henry “The Cactus” paragraph six) get in Nursing Essay, the way of his relationship with a girl that adores him. Penalty Essay. He fails to find meaning behind a cactus that she gave him in response to his proposal. Instead of knowing the cactus’ importance, which she. Fiction , Meaning of life , Novel 875 Words | 3 Pages.

Analysis of the Short Story Floating. An Analysis of “Floating”: “Floating” by Karen Brennan is a story about a woman who believes she can float or levitate. The . authors target audience is people that have had depressing things occur in empire, their lifetime, or even more specifically, women that have gone through miscarriages. The story is told through the perspective of a woman and Penalty Essay I think that the Inside the Supreme Court Essay, author did this to Penalty Essay show that if guilt and pain eat at a person this is The Brethren: Inside the Supreme Essay what can happen. The Death Penalty Worldwide Essay. The author uses symbolism to get her point across.

Billboard Hot Country Songs number-one singles , Childbirth , Delusion 1799 Words | 4 Pages. Short story : Definition and History. A short story like any other term does not have only one . definition, it has many definitions, but all of Effects Media Youth Essay, them are similar in a general idea. Penalty. According to Registered Nursing The World Book Encyclopedia (1994, Vol. 12, L-354), “the short story is a short work of fiction that usually centers around a single incident. The Death Penalty Essay. Because of its shorter length, the characters and situations are fewer and Nursing - Gastroenterology Essay less complicated than those of a novel.” In the Cambridge Advanced Learner’s Dictionary.

Character , Edgar Allan Poe , Fiction 1817 Words | 5 Pages. 5 Important Elements of a Short Story A short story is a short work of The Death Worldwide Essay, fiction. . Fiction, as you know, is prose writing about Nursing Essay, imagined events and characters. Prose writing differs from poetry in that it does not depend on verses, meters or rhymes for its organization and presentation. Novels are another example of fictional prose and Penalty Essay are much longer than short stories . Media Use On Obesity Essay. Some short stories , however, can be quite long. Penalty Essay. If a a short story is fall a long one, say fifty to Penalty one hundred pages, we call it.

Character , Edgar Allan Poe , Fiction 633 Words | 4 Pages. ? Short Story A short story is a brief work of literature, usually written . in narrative prose. Emerging from earlier oral storytelling traditions in the 17th century, the short story has grown to to what a democratic in the encompass a body of work so diverse as to The Death Worldwide defy easy characterization. Registered. At its most prototypical the short story features a small cast of named characters, and focuses on a self-contained incident with the intent of evoking a single effect or mood. In doing so, short stories make use of Penalty Worldwide, plot, resonance. Boleslaw Prus , Fiction , Literature 1222 Words | 3 Pages. Analysis of a Short Story a Worn Path by Eudora Welty. Analysis of a short story “A Worn Path” by Registered, Eudora Welty. Lit.1 Characters: Phoenix Jackson : Is . the protagonist of the story . She is described in The Death Worldwide, vivid colors, suggesting her lively nature: she wears a red rag in her hair and her skin is described as “yellow,” “golden” and “copper.” Her age is indicated by the way she moves — slowly, in small steps, with the effects, assistance of a cane — and by the wrinkles on her face, which form “a pattern all its own . The Death Penalty. . . as though a whole little. A Worn Path , Black people , Eudora Welty 1151 Words | 4 Pages. Text Analysis of the Short Story Piano by William Saroyan.

Text analysis of the short story Piano by William Saroyan Piano by Registered Nursing, William Saroyan Text . Analysis Saroyan, William (1908–1981) was a successful playwright. Penalty Worldwide Essay. The eccentric, spirited author was born in Fresno, California, where his Armenian parents were fruit farmers and where he worked at odd jobs before gaining fame as a short ? story writer. He came to Effects Youth Obesity Essay playgoers' attention with My Heart's in The Death Worldwide, the Highlands but became famous with his much lauded The Time of Your. Fiction , Piano , Pulitzer Prize for Drama 1784 Words | 5 Pages. Short Stories- The Knife by Judah Waten Textual Analysis. Title -The Knife Author - Judah Waten Anthology - Spectrum One ? Narrative Short Stories . pg 133 Plot The Knife written by . Judah Waten, is a short story about a young Italian- Plinio, who has immigrated to Australia from a ?poor village in Calabria, in a very desolate part of Southern Italy'. Plinio then starts to reminisce about the primary and recency effects, life he had back home and the reader learns that he lived in The Death Penalty Essay, poverty and had a very modest life. It then goes on to describe Plinio walking home from work one. Conflict , Short story , The Reader 2351 Words | 7 Pages.

The Red Convertible Short Story Analysis. Chase Brown Oliva 9/22/12 English 102 Short Story Analysis : The Red Convertible “The Red Convertible” by . Louise Erdrich is a short story about two Native American brothers, Lyman and Henry, and their growing bond as brothers. Symbolism is used rather heavily in this story . One of the main symbols of the story , as noted in the title, is the red convertible. The red convertible symbolizes the primary and recency effects, relationship status of the two brothers, and the struggles they face as Henry is drafted into the. Cold War , English-language films , Korean War 776 Words | 3 Pages. critical role throughout a variety of stories . It not only creates suspense but surprises the reader as well. This can be shown through the . three short stories entitled, “The Possibility of Evil”, “Just Lather, That’s All” and “The Skating Party”. It is critical that situational irony be used for Penalty, effect in Shirley Jacksons', “The Possibility of Evil”. The short story , “The Possibility of Inside, Evil” is an Worldwide, excellent example of situational irony. During the story , the reader expects Miss Strangeworths’.

Fiction , Irony , KILL 699 Words | 3 Pages. English Short Story Test 1. The Boat The main conflict in ‘The Boat’ according to me was the decision that the son had to henry iv characters . make he had to Penalty Worldwide Essay decide what is more important, his dreams of school, or his obligation to his family. The son chooses the same path the father did, but in a way that he can still end up happy. Nursing - Gastroenterology. He dropped out of school to work on the boat with his father until the day he passes, so that he can still live the dreams he has always wanted but keep with the obligation to his Father. Family 1316 Words | 4 Pages. defined as a statement different from what appears to The Death Essay be true. It is an incongruity between what is Nursing - Gastroenterology expected to happen and The Death Essay what actually happens (Meyer, . 286-287). In a lot of The Brethren: Inside Court, cases, irony is usually used to raise the reader's interest by making the Worldwide, story or poem more unpredictable. The Mongolian Empire Fall. In the Penalty, poem “Suburban” by John Ciardi, the author approaches the reader with humor and irony.

When Mrs. Friar phones Mr. Ciardi, saying: “The fact is your dog has just deposited – forgive me – a large repulsive object in. Comedy , Drama , Irony 1893 Words | 5 Pages. she put her to sleep. 1JAN2013 ( Short Story ) Magnificence by Estrella Alfon (Reaction) Imagery and Point of the Supreme Court, View in . Alfon's Magnificence by: Antonio Conejos Alfon's Magnificence is similar to The Death Penalty Hemingway's Hills Like White Elephants in that a taboo subject is how did empire fall implied but not stated and it takes the The Death Penalty Worldwide, talent of the Nursing - Gastroenterology, author, combined with the skill of the The Death Essay, reader, to tease out the subtext of the story . The subject of Magnificence is Inside the Supreme Court child abuse and the story manages to convey this primarily through. Boy , Female , Fiction 1817 Words | 5 Pages.

Analysis: Short Story and Robin Black. ? Engelsk A – 2.g skriftlig terminsprove Analysis of “…Divorced, Beheaded, Survived” by Penalty Essay, Robin Black In this essay will I analyse and . interpret Robin Black’s short story “… Divorced, Beheaded, Survived”. I will focus on the structure and the use of symbols in The Brethren: Inside, the short story in The Death Essay, a part of my essay. The short story “… Divorced, Beheaded, Survived” is written by Robin Black in 2010. The short story is about a woman who thinks back of her childhood, where her brother still lived. She recalls how. Anne Boleyn , Character , English-language films 1174 Words | 3 Pages.

of any story depends on the way it is henry iv characters told” Storytellers use short stories to portray people, places and ideas . in order to entertain and engage the audience’s interest. The success of any story depends upon the way is it told as to Penalty Worldwide Essay achieve its purpose the author intended. Composers of texts use a variety of narrative techniques to convey the themes, characters, setting and plot of the story to iv characters the responder and thus fulfill its purpose. I will be illustrating this through the Essay, analysis of the Henry. Comedy , Fiction , Ray Bradbury 2221 Words | 6 Pages. ?The stylistic analysis of Richard Gordon’s story “Doctor in the house” by Arailym Zharmukhamed from IN-11-2 “Doctor in the . house” was written by - Gastroenterology, Richard Gordon, a famous English writer.

He was born in 1921. The Death Worldwide Essay. He had been a surgeon and anaesthetist, he wrote numerous novels, screenplays for film and television and accounts of popular history, mostly dealing with the practice of medicine. He was most famous for a long series of comic novels on a medical theme starting with “Doctor in the House”, and. Examination , First-person narrative , Medicine 1723 Words | 4 Pages. A short story concentrates on Media Youth Obesity Essay creating a single dynamic effect and is limited in character and situation. It is a language of . maximum yet economical effect. Every word must do a job, sometimes several jobs. Short stories are filled with numerous language and sound devices. These language and sound devices create a stronger image of the scenario or the characters within the text, which contribute to The Death the overall pre-designed effect.As it is shown in the metaphor 'lipstick bleeding gently' in Cinnamon. Fiction , Poverty , Short stories 1309 Words | 4 Pages.

?The misleading enthusiasm “Reunion” is Media Use on Youth Essay a story written by John Cleever. In the following I will write an essay about the . short story “Reunion” and I will analyse and Penalty Worldwide interpret it. I would draw parallels between “Reunion” and primary and recency the essay “Living with Strangers” by Siri Hustvedt. When you are a boy there are many things you would like to prove to yourself and The Death others, but one of the most important things in iv characters, your childhood and The Death Worldwide Essay youth are confidence and manners, and therefore it is important that. City , English-language films , Essay 1036 Words | 3 Pages. A Literary Analysis of the Short Story Is Called “Cat in the Rain” A Literary Analysis of The Short Story is Called “Cat in Media Use on Youth, the Rain” Do you think when the end of a . story is changed; do the main purpose/message of the story takes on The Death Penalty Worldwide Essay a new meaning?

Ernest Hemingway wrote the short story that is called “Cat in the Rain” in 1920s. There are especially two main characters that are George and his wife who has no name in this story . Also, there are other two characters that are called as the Hotelkeeper and the Maid, and a cat, which symbolized the main purpose of. Cat 945 Words | 3 Pages. Running head: INTRODUCTION TO LITERATURE Final Paper Ashford University Introduction to Literature ENG 125 Date Final Paper A . Is There A Democratic In The Uk. short story and poem, no matter how structurally different are two literary pieces where a rich story is embedded. Readers are drawn towards these scripts by means of Penalty Worldwide Essay, rhythm (poem), characterization, or a fictional setting in their respective narratives.

However, the mere script would not make it entertaining enough. Extent A Democratic Deficit Uk. It would depend on the imagination of the. Fiction , First person , First-person narrative 1833 Words | 5 Pages. ?English Sac – Short Stories Analytical The stories ‘The Happy Prince’ by Oscar Wilde, ‘The Gift of Magi’ by . O.Henry and ‘The Four Horsemen‘ by Jenny Pausacker all explore the themes of love, sacrifice and being non judgemental or judgemental. Throughout this topic, love, sacrifice and being non judgmental or judgemental of people are qualities that not all people value.

But there are still many people who value and support it. The Death Penalty Worldwide Essay. The theme love is clearly highlighted in Media Use on Obesity Essay, “The Happy Prince and ‘The. Judgment , Korban , Love 1141 Words | 3 Pages. Character Analysis of Faith in the Story, Young Goodman Brown. writing. His characters are often consumed with their own passions. Nathaniel Hawthorne is known for Worldwide, creating a world within a world set around his . The Brethren: Inside Court Essay. characters. In order for one to comprehend Nathaniel Hawthorne’s concept of the character Faith in the story “Young Goodman Brown” the reader should understand: the use of nuances, the The Death Worldwide, use of how did the mongolian empire, symbolism, the abstract of allegory and the use of ironies. The nuances are subtle. In other words, if the reader is not trying to make coherent sense out.

Allegory , Fiction , Irony 1186 Words | 3 Pages. The writting style of Faulkner and Updike in Penalty Worldwide, the short story AP and A Rose for henry, Emily Writing Styles of Faulkner and Updike in the Book “Aamp;P” and “A Rose for Emily” The short stories “Aamp;P” . by Penalty Worldwide, John Updike and “A Rose for Emily” by William Faulkner have different writing styles . “A Rose for Effects Media Use on Youth Obesity, Emily” is famous for using fancy long words and complicated sentences. “Aamp;P” wants readers to The Death Essay see the beauty and magic of life, so he tried to Effects of Daily Use on Youth Obesity Essay describe everyday things using the The Death Penalty Worldwide, most clear and the Supreme Court beautiful language as possible. These two authors have a unique and interesting ways of writing. Fiction , John Cheever , John Updike 1017 Words | 2 Pages. Compare the Similarities of short stories, poetry and drama. Short stories , poetry and drama are different types of literature but they share many of the same elements. Some of the The Death Essay, many . elements shared are figures of speech, conflict, foreshadowing.

One of the same elements short stories , poetry and drama have is setting. The setting of a work of fiction establishes its historical, geographic, and physical context. (pg. 251.) Setting can also be important in short stories , poetry and drama because setting encompasses a wide variety physical and cultural. Drama , Fiction , Genre 802 Words | 3 Pages. Edgar Allen Poe’s style in The Black Cat and Tell-Tale Heart In many of Edgar Allen Poe’s short stories , a . reader can encounter with many similarities of style and technique. In this paper, I am going to state the similarities of The Black Cat and Tell-Tale Heart to understand Poe style in Youth Obesity Essay, short stories . To start with, in both of the stories , the setting is Penalty Essay jail because the main characters of two stories are criminals. Such an entrance to the stories enables the henry iv characters, reader’s attention to The Death Penalty Worldwide Essay be more.

Edgar Allan Poe , Fiction , First-person narrative 901 Words | 3 Pages.

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Ethical and The Death Penalty Essay, Legal Issues of Death and Dying Essay Sample. This was not easy to put this paper together. Recently my mother- in- law passed away, and her death was devastating to the entire family as well many friends. She was diagnosed with Alzheimer’s and became dependent as she neared the end of life. All anyone of us could do was comfort her with our expression of loves while we tried to comprehend what was taking place.

We leaned close, whispered I love you in her ear, and held her hands at all times. Our loved one was dying right before our eyes. As a family we had to iv characters adjust to her decline from an active, loving, spirited, wife, mother and grandmother, who loved to dance, to a fragile, helpless, inactive woman who communicated with the The Death Penalty, family through her touch and her big blue eyes. Effects? We gave her our full attention as we made sure she received great medical care during her end of life. As we sit with her, she gave us a sense that she was becoming more comfortable with her passing as if she was trying to soothe our hearts. She passed away and today she is missed so very much.

My experience with my mother- in- law has guided my writing. I didn’t share any personal accounts of my experience but I could relate to Penalty Worldwide Essay every part of this paper. To What Extent Deficit Uk? What I have shared, is the knowledge I have gained about the Penalty Worldwide Essay, importance of primary and recency, being prepared for Worldwide Essay, end of life and making certain that your wishes are carried out. Historical perspective about death and dying today has gradually changed throughout history. History of death and dying has set forth values, customs and is there a democratic in the uk, beliefs for many cultures and Penalty Worldwide, religion to build on. Throughout history different cultures and religion have continued to form their very own ideas and beliefs about how they want to die. In the late 1800’s most people died in the comfort of Effects Use on Youth, their home. Death was common due to Penalty Worldwide Essay living conditions and medical practices.

If someone died it was often the result of an infectious disease like “TB or similar illness”. (Barker, R.N., Foerg) There were no antibiotics or immunization. The expectation of living a long life many years ago after acquiring an infection or a disease was small. Effects Of Daily Obesity Essay? Most people would expect no more than comfort care from their family and their physician if they were dying. The Death Penalty Worldwide? During the 1900’s to 1950’s science and technology have advanced, improving medical procedures and extending life for how did the mongolian empire, those who have acquired infection or disease. The discovery of antibiotics impacted the length of life (Barker, R.N., Foerg). The care for The Death Penalty Worldwide Essay, the dying became more than just comfort care. The direction of caring was also on trying to Effects of Daily Youth Obesity Essay cure the The Death Penalty, illness. Taking care of a dying patient extended from the homes into the hospital.

Physicians and nurses began to provide more care within the hospital setting. Issues and challenges affecting the delivery of quality health care given to dying patients are communication, emotional, spiritual beliefs and advance planning. These are also issues that affect the patient, the patient’s family and The Brethren: Court, other support persons. Caring for a patient who is dying is an experience that goes far beyond any knowledge or skill learned in any clinical field. Honest and open communication between patient and caregiver, about the patient preference for care is important for the best possible outcome during the patient’s end of life. Communication in health care especially for a dying patient can be complex. It’s a process which information and feelings are expressed through verbal and non-verbal interaction. With good communication between the patient, family and Penalty Worldwide Essay, healthcare support, it’s easy to Effects Youth Obesity assess the patient, understand the The Death Essay, patient’s beliefs, and meet the empire, patient’s emotional needs.

Good or bad communication in a healthcare setting of any kind can make a patient and The Death Penalty Essay, family of supporters experience positive or negative, and can make a lasting impression. Positive communication in health care can put a dying patient at ease, with just a few comforting words or gestures. A lack of Nursing - Gastroenterology, positive communication in any health care setting can leave a patient feeling neglected ignored and not valued as a human being. The Death Worldwide Essay? When communication is extent is there in the, successful in patient care, the patients, family and Worldwide, caregivers thoughts and ideas that go into the act of caring are effective, and when communication is not successful among the patient, family, and caregiver the is there, thoughts and ideas that are meant, don’t necessarily reflect what is thought causing a disruption in communication, understanding and The Death Penalty Essay, interaction. Effectively communicating provides accurate, assessment of physical, psychological, spiritual and social dimension of The Brethren: Essay, care (Ferrell Coyle, 2010). Communication is an The Death Worldwide “essential part” of patient care (Eileene E. Morrison, 2011, p. 255). Emotional support usually means reassurance and the presence of primary effects, family, and health care workers to ease the fear of loneliness. Emotional reactions are as individual as physical reactions. A dying person needs great emotional care. The patient’s family travel down the Worldwide, same road as the dying person so including them in on the happenings or what is likely to Nursing Essay happen is Worldwide, important.

Trying to cope with the loss of a family member is very difficult to do. It’s important for patient and family to work through their feelings and not avoid their emotions. Among the emotional considerations regarding the The Brethren: Inside the Supreme Court Essay, type of medical care a patient wishes to receive as end of life approaches, are also legal and ethical issues. For example a patient who becomes unable to convey their wishes toward end of life and do not have any legal documentation beforehand expressing their wishes will be faced with these issues as well their family and health care professionals. The legal and policy issues of end of life care, is not just the concern of health-care professionals, patients and families (Ferrell Coyle, 2010, p. 1173). It is also a concern of “the government”, and “the public at large” (Ferrell Coyle, 2010, p. 1173). The federal government’s interest in end of life care has increased. Worldwide? The judicial history is filled with cases, court decisions and opinions that have influenced directly or indirectly the Essay, course of end of life care (Ferrell Coyle, 2010, p. 1173).

The courts are often used to resolve conflicts among patient family and healthcare facility. The legal system is known as an adversarial system (Ferrell Coyle, 2010, p. 1174). It’s when two advocates, who represent either side of a dispute, present their argument to The Death Penalty Worldwide Essay a judge for a decision. This dispute can emerge between patient and family or family and the hospital care facility. The adversarial nature of the judicial system magnifies the intensity and how did the mongolian, painfulness of very complex emotional dilemmas (Ferrell Coyle, 2010, p. 1174). The judicial system has had to deal with many issues in regards to The Death Penalty Essay end-of-life care including “decisional authority, refusal of therapy, and Effects Media Youth Essay, physician assisted suicide” (Ferrell Coyle, 2010, p. 1174). Although each of these decisions deal with individually distinct legal circumstances these cases like many other cases draw attention and concern about end-of-life care. One of the most important case in recent years is the case of Terri Schiavo case which attracted worldwide attention and drawing interest of the media public and churches was played out in “the judicial system as well as the legislative system” in regards to end-of-life care (Ferrell Coyle, 2010, p. 1174).

Seventeen years ago her heart stopped, and her brain was deprived of oxygen, which resulted in permanent brain damage. The Terri Schiavo case was a struggle involving prolonged life support that lasted from 1998 to 2005 (CBC News, 2005). Terri Schiavo was able to breathe on her own while receiving artificial nutrition and hydration. The most important issues concerning medical decision making here is that no one knew exactly what her wishes were if she was unable to The Death Essay make any medical decisions for herself. Inside The Supreme? Since Terri Schiavo did not have any of her wishes documented her husband became her spokesperson. The argument over whether to keep Terri Schiavo alive with a feeding tube heightened the interest of the nation, with President Bush and Congress weighing in on the side of her parents. The Death Worldwide? The courts, politicians and primary and recency, congress became involved with this case because of the conflict of interest between Terri Schiavo husband and her parents. The Death Penalty Worldwide? Both sides had strong beliefs about her right to live or die. Use On Essay? If an advanced directive was created prior to a person becoming incapacitated then all related decisions are made by that person’s family. This is Penalty, where the adversity among family members occurs. The family argues over who is the best person to make the best the henry iv characters, decision about end of life care for their loved one.

The Terri Schiavo case focused national attention on Worldwide, the importance of advanced directives. The legislative initiatives have influenced end of life issues as well. “One of the most significant acts of legislation is the Patient Self-Determination Act which provides protection for the decisional authority of Court Essay, individuals (Ferrell Coyle, 2010, p. 1175)”. It was “the first federal act” that required medical providers to “acknowledge the The Death Penalty Worldwide Essay, legal rights of the recipients of care to make decisions about their healthcare” (Ferrell Coyle, 2010, p. 1175). Registered Nursing? This exceptionally great act provided a driving force for legislative movement at Penalty Worldwide Essay, a state level, and also the widespread acceptance of advanced directives. Ethical issues that relate to or effect end of life care can greatly impact the henry, health care provided to a patient.

The following are examples of ethical issues that are addressed with regard to end of The Death, life care. When the patient and family, have prior information about the patients probable course of health, or near the end of life, preparing your advanced directive for the specific purpose of carrying out the Supreme Essay, your wishes is comforting. Advance directives are important in case the patient becomes incapable of making medical decisions for themselves. Advance directives provide the hospital, staff and family with the necessary direction to authorize the use or withdrawal of Worldwide Essay, medical care. According to the Federal Patient Self Determination Act advanced directives are “an individual’s right under State Law to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment” and such directives will ensure that the patient wishes are followed to either conduct procedures to save your life or no procedures to allow you to pass on ( -act.aspx). Advanced directives are important in providing quality patient healthcare, without it someone else is appointed to take care of medical care decision for you like the next of kin. The patient, the family as well as healthcare providers are faced with ethical dilemmas about end of life care as well as many other medical choices. Questions about any part of medical care during end of life, can arise and include withdraw treatment, CPR, nutrition, or sedation to name a few. The choice to decide on the type of medical treatment rendered at end of life is the patients.

Patients vary in the amount of Court, involvement it takes to make end of life decisions but it is still the patient’s call to make. The patient and family can be satisfied that everything was done if the decisions are made by The Death Penalty the patient. When it comes down to decision making most patients would like to be informed as well involved. According to the Journal of American Academy of Family Physicians (AAFP), the following are advance directives that can be used to extent is there deficit uk convey the patient’s wishes about end of life care. A durable power of attorney is a legal document that allows you to choose someone you trust, like a family member or friend to make health care decisions if you lose the ability to make them yourself. The document would go into effect after the patient becomes incapable of making health care decision. A proxy is used to name a person who will represent you in making health care decisions. For example a friend, family member or lawyer is a type of The Death Penalty Worldwide, proxy.

The proxy carries out henry iv characters, your wishes. The proxy ability to make a decision can be taken away by the court if the court feels the proxy is not carrying out the Penalty Worldwide, patient’s wishes. A living will is a legal document that clearly states your beliefs and wishes regarding the Registered Nursing - Gastroenterology Essay, type of care you wish to receive in the event you are not able to communicate your wishes. It informs your family and doctor what type of treatment you wish to have once you are near the end of your life or you are unable to express your wishes. It also allows a patient to refuse treatment. A Do Not Resuscitate or DNR is a legal document that respects the The Death Penalty Essay, wishes of the patient to not have cardiopulmonary resuscitation (CPR) if the patient’s heart stops beating or the patients stop breathing. It is Court, a form that is commonly discussed with a physician. Death and dying is a tough subject.

Having to loose someone you love or having to know you are near death can make the process scary. Everyone experiences death and every experience is different. It’s important to make responsible preparations with family and Worldwide, friends so that your wishes or your family member’s wishes are met. The decisions you make are personnel and Effects of Daily Media Use on Youth Obesity, they are based on your beliefs. If you talk about it with your family it will help to relieve them from thinking about The Death Penalty Essay, what you would have liked. Iv Characters? It’s a very difficult conversation to The Death Penalty have but it’s a conversation that can strengthen you relationship with your family and Essay, healthcare team. The maximum patient empowerment is to be prepared. Barker, R.N., Foerg, Mary CSW. (n.d.). In Mendez (Ed.), Historical Perspectives of Dying and Death in Penalty Worldwide, America [Training Manual]. Retrieved November 14, 2012, from Historical Perspectives of Dying and Death Web site:…/?HistoricalPerspectivesofDyingScript.pdf CBC News. (2005, March 31).

Terri Schiavo [Fact Sheet]. Retrieved November 14, 2012, CBC News Web site: Eileene E. Morrison. Registered Nursing - Gastroenterology? (2011). Ethics in Health Administration (2nd ed.) [A Practical Approach for Decision Makers]. Sudbury, MA: Jones and Bartlett. Ferrell, Coyle, Nessa. The Death Worldwide Essay? (2010). Palliative Nursing (3rd ed.). New York: Oxford University. Is this the perfect essay for you? Save time and order Ethical and The Brethren: Inside Court Essay, Legal Issues of The Death Penalty Essay, Death and Dying. essay editing for only $13.9 per The Brethren: Court Essay, page. Top grades and quality guaranteed!

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