The Black Power Mixtape Essay Example | Topics and Well Written Essays - 750 words

The Black Power Mixtape - Essay Example   Ã¢â‚¬Å"The Black Power Mixtape† was directed by Goran Hugo Olsson a Swedish and helps depict a story of black power movement in a neutral eye. A little odd is the fact that the Swedish Journalists were following and recording the efforts and of course frustrations by blacks surviving in America’s back streets.   All the documentation was for long stored in a basement for close to forty years until the making of this Mixtape. Indeed a Mixtape, the film presents the facts as they were, raw in a matter of speaking put together. It is refreshing due to its arbitrariness, not following a style but with the theme of showing the Black power in the 1960’s and early 1970’s. The stylistic approaches used by the director of the film displays the struggles of blacks in 1960’s in a random and virgin, non-fictional memorabilia depicting the atmosphere as it was and benefited the presentation of a cinema of truth. The film is a compilation of interviews from people that championed the Black power movement who after witnessing or experiencing the struggles of their own kind, had to stand up for themselves. Interviews include inter alia; Angela Davis, Stokely Carmichael, Bobby Seale, Eldridge Cleaver, Huey Newton and Dr. Martin Luther King. Their words and voice resonating and evoking such an era-specific picture of what occurred. Fictional movies such as ‘Mississippi Burning’ and Tate Taylor’s ‘The Help’ have often brought this era out in a palatable way.... Angela Davis’s voice interview when in jail reverberates over and over again in my head when she says, â€Å"You ask me if I approve of violence, I just find that incredible.† She struggles to show the misconceptions towards her people, the black people. It shows the irony of the situation where a people violent and racist towards the black people, depict violence as coming from the black people. She evokes so much by her words and silence too just after the short interview that resonates almost half a century later. Stokely Carmichael agrees with the idea of Dr Martin Luther King policy of non-violence as a method for blacks to use to change the hearts of the racial discriminators. In his interview, the impossibility of Dr King’s method is brought out in a humorous and almost seductive way amid the chaotic and dangerous atmosphere. Impossibility in this method is because to be moved to a change of heart required conscience which discriminators seem not to have a s seen by Carmichael. We are reminded of the many failed revolutions and counterrevolutions in a time that shaped the culture that we enjoy today. During an interview with Stokely Carmichael’s mother Mabel, the film takes an awakening turn. In an inspiring and downright courageous act, Stokely takes the microphone from the Swedish journalist and asks his mother why his father, a carpenter was laid off so often. Even without watching more of the film, one can tell the frustration, this fresh graduate feels knowing too well the truth but watching his mother struggle to go around the facts. The lack of freedom of expression or the double standard of it, the fear experienced by the ‘coloured’ people as the mother calls them. The result of the film is sobering making one

Half the Sky Movement Essay Example | Topics and Well Written Essays - 1000 words

Half the Sky Movement - Essay Example Breakthrough is an organization that is committed to deal with violence against women in the society. The organization defines sexual violence as all acts ranging from assault from partners, early marriages, â€Å"honor† killings and rape. Sexual Violence is viewed as a violation of human rights to a safe environment. It is seen as an issue that causes women to be insecure while living on earth. The organization views sexual violence as an act that keeps women from contributing fully to the economy of the community. The organization states that the key reason as to why women are faced with such traumatizing issues is simply because they are women. They are seen as less of a value compared to men. Research also shows that the level of education in women is less than that in women and thus, the gender difference. Thus, the organization states that the only way in which women can stop sexual abuse is self-empowerment. Women should equip themselves with education and skills such t hat; the community will realize that they are of value to the economy. This way, they will be able to earn respect from members of the opposite sex and be able to reduce cases of sexual violence.Equality Now is an organization that is based in New York which mainly deals with social issues affecting the lives of women. The organization also has a branch in Kenya that mainly targets at helping women who suffer from gender-based issues in Africa. Equality Now classifies a number of practices as sexual violence.... The organization defines sexual violence as all acts ranging from assault from partners, early marriages, â€Å"honor† killings and rape. Sexual Violence is viewed as a violation of human rights to a safe environment. It is seen as an issue that causes women to be insecure while living on earth. The organization views sexual violence as an act that keeps women form contributing fully to the economy of the community. The organization states that the key reason as to why women are faced with such traumatizing issues is simply because they are women. They are seen as less of a value compared to men. Research also shows that the level of education in women is less than that in women and thus, the gender difference (CIA, 2012). Thus, the organization states that the only way in which women can stop sexual abuse is self-empowerment. Women should equip themselves with education and skills such that; the community will realize that they are of value to the economy. This way, they will be able to earn respect from members of the opposite sex and be able to reduce cases of sexual violence (Breakthrough Organization, 1). Equality Now is an organization that is based in New York which mainly deals with social issues affecting the lives of women. The organization also has a branch in Kenya that mainly targets at helping women who suffer from gender based issues in Africa. Equality Now, classifies a number of practices as sexual violence. For instance, gang raping, sexual assault, child marriages and bride kidnapping. The organization views sexual violence as being a result of inequality in women. Therefore, the organization mainly works to end such acts through promotion of equality among women. According to the organization, equality between

The Importance of Being Earnest Essay Example for Free

The Importance of Being Earnest Essay The Importance of Being Earnest, having being written in the late Victorian period, shows examples of the contemporary societys attitudes to and customs of marriage. These attitudes serve a very important role throughout the play. The problems and trials of marriage provide the basis for this play. Although this theme of the problem of marriage has featured in a number of English authors works, for example Jane Austen, Oscar Wilde adapted the theme in order for his contemporary audience to relate to it, and so the play is quite unique. Act 1 of the play opens with Algernon holding a brief conversation with his servant Lane regarding marriage. We immediately have an insight into Algernons life as a single man; Algernon is more concerned with money and the high life than he is with responsibility and sensibility. He sees that not having a first rate brand of wine, as it was mentioned was the case in marriage, as demoralising. It is not surprising that Algy, later on in Act 1, expresses such cynical views of marriage. Lane touches on the lower classs attitudes towards marriage briefly in this scene. Lane says that he has had very little experience of marriage he explains that he was only married once and that was a misunderstanding between himself and a young person. The humour in this line lies in the point that experience shouldnt normally be measured in the amount of times one is married but the number of years one has lived in a marriage. He also says that it was a misunderstanding, which is intended to be funny, as marriage is an understanding between two persons. We learn more about Algernons views on marriage in his conversation with Jack. Algernon believes that a proposal is business. This is typical of the Victorian gentlemans attitudes towards marriage. The typical view of marriage was that it was more a way to achieve or sustain social status rather than a way of expressing love. Algernon actually believes that marriage puts an end to all romance. He says that girls never marry the men they flirt with. This is an example of one of Oscar Wildes humorous epigrams, what is even more funny is when it is completely contradicted by what Algernon says shortly after: The amount of women in London who flirt with their husbands is perfectly scandalous.

Outcome Analysis of Burns Patients in BICU

Outcome Analysis of Burns Patients in BICU Outcome analysis of burns patients after admission to burns intensive care unit in a tertiary regional referral centre Goh SY, Thong SY, Win MTM, Ng SY ABSTRACT Background: The clinical course of severely burned patients may be stormy and the prognosis tends to be poor in patients with multiple comorbidities and those with inhalational injury. The aim of this study is to develop an objective and reliable predictive model for mortality in patients with major burns. This will help us identify the important factors influencing outcomes and allows more evidence-based prognostication. Methods: Adult patients admitted to the burns intensive care unit (BICU) in a major tertiary referral center from 2008-2011 are selected. Demographic factors, types, severity and complications of burn injury as well as outcomes are reviewed. Results:In the 4-year period, 181 patients were admitted to BICU. Mean age (SD) was 41 (16) years old. Mean (SD) total body surface area burn was 37.2 (30.2%). Mortality was 39.5%. Mean (SD) length of stay in the BICU and hospital for patients who eventually survived were 8.4 (13.4) and 28.5 (37.9) days respectively. Lower airway burns has a significant relationship with the development of renal failure after multivariate analysis (Odds ratio 5.1, Confidence interval 1.1- 24.0). Greater total body surface burns, development of acute respiratory distress syndrome and older patients with more extensive burns predispose to mortality as shown in table 2. In our cohort of patients, the probability of death may be estimated by this equation: Probability of death= (1+ey)-1 y= -7.008+0.04(TBSA) +1.791(ARDS)*+0.054(Age+TBSA) *= ARDS (0=no, 1=yes) Conclusion: We have developed a predictive model for mortality in major burn patients. This may be useful in prognosis during early stages of care. Introduction Survival after burns injury has improved tremendously over the last few decadeswith the refinement of fluid resuscitation, better intensive care and early surgical excision1as some of the strategies that have significantly influenced patient outcomes. These advancements have contributed to lowering mortality rates in burns patients in Singapore to 4.5% between 2003-20052. Despite these advancements, however, overall mortality rates of patients with major burns remain high. Numerous factors such as age, percentage body surface area burns and inhalational injuries3 have been found to influence the prognosis and outcomes in this group of patients. The combination of these predictive factors into scoring systems that would yield an expected mortality rate for each given patient has been the subject of many studies4-6.However, most of these studies have not been performed or validated in our local population. A robust predictive model would be useful for clinicians as a more evidence-based approach for counselling and prognostication at an early stage of treatment. We can even plan further treatment and intervention based on prognosis and other clinical factors. A standardized model will also provide an opportunity for audit and a basis against which new treatment modalities may be compared. Therefore, the objective of this study was to identify the prognostic variables influencing outcome in patients admitted to our burns intensive care unit and to develop a predictive model for mortality in patients with major burns. Methods Clinical care The burns centre at the Singapore General Hospital is a major tertiary referral centre for burns injury in Singapore as well as the Southeast Asia region. Burn patients presenting at the Accident and Emergency department are assessed by the plastic surgerical team, who decide if the patient requires admission to the specialised burns unit or the burns intensive care unit. The extent and depth of burns were assessed and documented.All patients requiring intensive care, such as those with major burns, are haemodynamically unstable, or have sustained inhalational injury requiring mechanical ventilation, are managed by a team consisting of at least a plastic surgical specialist and an anaesthetist. These patients received fluid resuscitation according to the Parkland’s formula. Adequacy of fluid therapy was assessed by endpoints such as hourly urine output, arterial blood pressure and central venous pressure. Early enteral nutrition, mechanical ventilation and vasoactive support were initiated as required. Early surgery for escharotomy, burns excision and grafting were carried out as early as possible. Patients This study was approved by our centre’s institutional review board. The medical records of all burns patients admitted to the burns intensive care unit at the Singapore General Hospital over a 4-year period between January 2008 and December 2011 were reviewed retrospectively. Information including demographics, comorbidities, mechanism of injury, total body surface area (TBSA) burned, incidence of inhalation injury, complications such as organ failure, length of hospital stay and mortality were recorded and entered into a database. Statistical Analysis Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS version 17, SPSS Inc., Chicago, IL). Data are presented as mean and standard deviationfor continuous variables and proportions for categorical variables. Univariate comparisons of proportions and means were respectively done using Chi Square test, Fisher exact test and t test. Logistic regression and linear regression analysis was applied to study the relationship between the variables and mortality and length of stay, respectively. Variables with a plausible relationship with mortality or p0.05. Results Patient profile During the 4-year study period, a total of 182 patients were admitted to the burns intensive care unit (BICU).These patient characteristics are presented in table 1. The mean age of these patients was 40.5 +/- 16 years old, with males comprising a larger percentage of the cohort (79.1%). Mean total body surface area (TBSA) burned was 37.2 +/- 30.2%. Most of the patients were healthy prior to their burns, with only a small minority having any significant medical issues. A high proportion of the patients suffered inhalational burns (83%). However, only 26 out of the 182 patients (14.3%) fulfilled the criteria for ARDS. Other significant patient characteristics and details of their burns injuries are listed in Table 1. Flame burn was the commonest injury etiology in our patient population (88.4%). Table 2 shows the mechanism of burn injuries suffered by our group of patients. Length of stay The mean length of stay was 20.9 days. The survivors spent a mean of 8.4 days in ICU, as opposed to 6.9 days for the non-survivors. The majority of patients who survived to discharge were discharged home (table 3). TBSA, albumin level and sepsis were found to be significant predictors of LOS, yielding a final predictive model of: LOS = 41.608 – 0.234(TBSA) – 0.919 (albumin) + 16.14 (sepsis*) Where *=presence of sepsis (yes=1, no=0) Mortality Out of the 182 patients, a total of 65 patients or 35.9 % did not survive the hospital stay. The mean age of these patients was 42.1 years. Mean TBSA involved was 66.8% (compared with a mean of 20.6% in the survivor group). In our analysis, we found that the non-survivor group had significantly larger TBSA burns (p To develop the predictive model, we analysed the variables in univariate analysis. Variables with a plausible relationship with mortality or p A predictive model for mortality was thus developed as follows: Probability of death = (1+ey)-1 Where y = -7.008 + 0.04 (TBSA) + 1.791 (ARDS)* + 0.054( Age+TBSA) * = ARDS (no=0, yes =1) Discussion In this study, we elucidated the risk factors that contribute to mortality in patients admitted to the BICU, and developed a predictive model for mortality incorporating these factors. Previous mortality studies have sought to establish prognostic variables associated with burn mortality. In 1961 Baux described in a French thesis a simple empiric formula, stating that mortality rate was the sum of age and percentage area burned7. Inhalational injury was then found to be an important predictive factor and this was included in a mortality probability equation reported by Clark et al in 19868. The abbreviated burn severity index (ABSI), which is in widespread use, assigns numerical values according to the severity of 5 prognostic variables (age, gender, inhalational injury, %TBSA and presence of full thickness burns). The sum of these variables yields a predicted mortality rate9. Similar predictive factors have been found to be relevant in several other studies3,10,11. However, these st udies generated highly variable predictive models, highlighting the need for individualised models for different patient groups. Our study is unique as it is one of only a handful of studies based on an Asian population2,12-14 , with even fewer attempting to develop predictive mortality models5. In addition, we only included burns intensive care unit patients in our study, as opposed to the entire burn population. Advancements in medical care and aggressive early excision and grafting of burns have led to a global reduction in burn mortality in recent times. In Singapore, the overall mortality for burns victims was found to be 4.5% between 2003 and 200512. This improvement has also been evident in severe burns victims, with mortality falling annually from 60% in 2000 to 30% in 20032. However, death rate remains high in this group of patients, and it is our aim to look at the outcomes and predictive factors determining mortality in this susceptible group, and to develop a clinically relevant predictive model targeted at them. Our study found that TBSA, age+TBSA and ARDS were significant predictive factors affecting mortality in our ICU patients. Inhalational injury, generally accepted as a prognostic factor8,9, was not found to be significantly associated with death in our patient group. There could be several explanations for this finding. In our series, 151 or 83% of our patients were diagnosed with inhalational burns. This is a very high percentage compared to most of the other studies, though it is not entirely surprising. Our patient cohort consisted entirely of ICU patients. This unique group of patients have either sustained major burns or inhalational burns that have required ventilatory support. . The remaining 17% of patients that might have been in ICU due to reasons other than inhalational injuries may not have been sufficient in number to demonstrate a survival advantage, if any. Secondly the lack of universally accepted diagnostic criteria means that the diagnosis of inhalational injury can vary widely between different institutions and intensivists, using either clinical examination or fibreoptic bronchoscopy, or a combination of both. Hence it has been suggested that, the need for invasive ventilation, the determination of which is far less complicated than the diagnosis of inhalational injury, may be a better marker for mortality risk6. In our study, we found that the presence of acute respiratory distress syndrome (ARDS), a common complication associated with major burns or severe inhalational injury, was directly associated with death. This could be an indication that the severity of inhalational injury, rather than the presence of it, may be a more suitable prognostic indicator for death, particularly in the group of patients requiring intensive care management. Since this is a retrospective study, we were not only able to collect data relating to the patient’s characteristics at presentation, but also susbequent clinical data as treatment progressed, such as development of ARDS, sepsis and renal failure. Clearly these factors are important as response to therapy is a vital determinant to patient outcomes. However, inclusion of these variables may not be possible at patient presentation, the point at which prediction of mortality is sometimes vital for determining the direction and aggressiveness of therapy. Perhaps future prospective trials can look at determining predictive factors that influence mortality at various stages of treatment, creating a superior prognostic tool with which we may advise patients and families, guide therapy and perform internal audit and research. Clinicians utilising any kind of predictive model to estimate mortality probability in the clinical setting should always proceed with caution. These may be used as a tool to aid clinical decisions regarding treatment but should not replace sound clinical judgment. Neither should the outcomes be judged solely upon whether the patient lives or dies, without scant consideration for the quality of life after the hospital stay. These endpoints are a lot more difficult to assess, and in the absence of a standardized tool the incorporation of quality of life indicators into prognostic scoring systems may still be a long way away. Conclusion In our study, we have developed a predictive model for mortality in our cohort of burn patients admitted to the burns intensive care unit. The next step would be to validate the model in future prospective studies. A validated model can potentially help teams involved in tough clinical decisions to prognosticate and formulate treatment plans for severely burned patients. It also serves to show that further studies need to be done to validate and come up with a more robust model. We did not find a significant relationship between inhalational injury and mortality in our study, a finding consistent with several other studies.

Birth of a Nation Essay -- essays research papers

On March 3, 1915 the movie The Birth of a Nation was released at the Liberty Theatre in New York City. This film was financed, filmed, and released by the Epoch Producing Corporation of D.W. Griffith and Harry T. Aitken. It was one of the first films to ever use deep-focus shots, night photography, and to be explicitly controversial with the derogatory view of blacks.   Ã‚  Ã‚  Ã‚  Ã‚  Throughout the movie, the film justified the need of the KKK in order to keep social harmony among society after the Civil War. In the beginning, the Cameron family was depicted as loving family and the slaves were depicted as sensible and content beings during the slave period. The chaos and madness started after the civil war during the Reconstruction period. Blacks were then portrayed as animalistic savages that were oppressing the rights of the white people in the community and threatened their livelihood. So, African Americans could only be placed into two categories in this movie. They were either the faithful servant or the renegade whose objective was to intimidate and terrorize white people. The black slaves are shown as noble beings that defended their masters against other black people. However, the black people in congress are shown as arrogant and ignorant with no manners. This sort of subtly suggest that blacks proper role is to tend to the land and that they lack the sense and morals to be given them the same equality as a white person. If blacks were on the same le...

The Sedition Act of 1798 :: history

The Sedition Act of 1798 For the first few years of Constitutional government, under the leadership of George Washington, there was a unity, commonly called Federalism that even James Madison (the future architect of the Republican Party) acknowledged in describing the Republican form of government-- à ¿ And according to the degree of pleasure and pride we feel in being republicans, ought to be our zeal in cherishing the spirit and supporting the character of Federalists.à ¿ Although legislators had serious differences of opinions, political unity was considered absolutely essential for the stability of the nation. Political parties or factions were considered evil as à ¿Complaints are everywhere heard from our most considerate and virtuous citizens, equally the friends of public and private faith, and of public and personal liberty, that our governments are too unstable, that the public good is disregarded in the conflicts of rival parties, and that measures are too often decided, not according to the rules of justice and the rights of the minor party, but by the superior force of an interested and overbearing majorityà ¿Ãƒ ¿ Public perception of factions were related to British excesses and thought to be à ¿the mortal diseases under which popular governments have everywhere perished.à ¿ James Madison wrote in Federalist Papers #10, à ¿By a faction, I understand a number of citizens, whether amounting to a majority or a minority of the whole, who are united and actuated by some common impulse of passion, or of interest, adversed to the rights of other citizens, or to the permanent and aggregate interests of the community.à ¿ He went on to explain that faction is part of human nature; à ¿that the CAUSES of faction cannot be removed, and that relief is only to be sought in the means of controlling its EFFECTS.à ¿ The significant point Madison was to make in this essay was that the Union was a safeguard against factions in that even if à ¿the influence of factious leaders may kindle a flame within their particular States, [they will be] unable to spread a general conflagration through the other States.à ¿ What caused men like Thomas Jefferson and James Madison to defy tradition and public perceptions against factions and build an opposition party? Did they finally agree with Edmund Burkesà ¿ famous aphorism: à ¿When bad men combine, the good must associate; else they will fall, one by one, an unpitied sacrifice in a contemptible struggle?à ¿ Did the answer lie in their opposition with the agenda of Alexander Hamilton and the The Sedition Act of 1798 :: history The Sedition Act of 1798 For the first few years of Constitutional government, under the leadership of George Washington, there was a unity, commonly called Federalism that even James Madison (the future architect of the Republican Party) acknowledged in describing the Republican form of government-- à ¿ And according to the degree of pleasure and pride we feel in being republicans, ought to be our zeal in cherishing the spirit and supporting the character of Federalists.à ¿ Although legislators had serious differences of opinions, political unity was considered absolutely essential for the stability of the nation. Political parties or factions were considered evil as à ¿Complaints are everywhere heard from our most considerate and virtuous citizens, equally the friends of public and private faith, and of public and personal liberty, that our governments are too unstable, that the public good is disregarded in the conflicts of rival parties, and that measures are too often decided, not according to the rules of justice and the rights of the minor party, but by the superior force of an interested and overbearing majorityà ¿Ãƒ ¿ Public perception of factions were related to British excesses and thought to be à ¿the mortal diseases under which popular governments have everywhere perished.à ¿ James Madison wrote in Federalist Papers #10, à ¿By a faction, I understand a number of citizens, whether amounting to a majority or a minority of the whole, who are united and actuated by some common impulse of passion, or of interest, adversed to the rights of other citizens, or to the permanent and aggregate interests of the community.à ¿ He went on to explain that faction is part of human nature; à ¿that the CAUSES of faction cannot be removed, and that relief is only to be sought in the means of controlling its EFFECTS.à ¿ The significant point Madison was to make in this essay was that the Union was a safeguard against factions in that even if à ¿the influence of factious leaders may kindle a flame within their particular States, [they will be] unable to spread a general conflagration through the other States.à ¿ What caused men like Thomas Jefferson and James Madison to defy tradition and public perceptions against factions and build an opposition party? Did they finally agree with Edmund Burkesà ¿ famous aphorism: à ¿When bad men combine, the good must associate; else they will fall, one by one, an unpitied sacrifice in a contemptible struggle?à ¿ Did the answer lie in their opposition with the agenda of Alexander Hamilton and the

End of Life Peace Without Pain

End of Life: Peace without Pain Jacqueline R. Reviel Loyola University New Orleans End of Life Peace without Pain Pain management during end of life care is crucial to the comfort and peace of the patient and their family. â€Å"With better pain control, dying patients live longer and better. Pain shortens life. Relief of pain extends life† (Zerwekh et al. , 2006, p. 317). The nurse must educate about (a) disease pathology, (b) signs & symptoms, (c) interventions, (d) medications, (e) alternative therapies, and (f) supportive care, related to end of life care. Pain management involves understanding the pharmacological issues, and management issues surrounding opioid drugs used for pain control. The identification of (a) nursing diagnosis, (b) implementation, and (c) education are essential in keeping the patient and family comfortable and at peace. Pathology, Signs and Symptoms End of life presents with specific pathology which can cause extreme pain and discomfort. The body’s organs begin to shut down as death approaches hypoventilation causes hypoxemia and hypercapnia in turn increasing the workload of the heart as it tries to oxygenate the vital organs. The kidneys and liver begin to fail and toxins begin to build up. The heart fails as it can’t keep up with the demand. Zerwekh (2006) lists specific signs and symptoms associated with death (a) reduced level of consciousness, (b) taking no fluids or only sips, (c) decreased urine output, (d) progressing coldness and mottling in legs and arms, (e) irregular labored breathing; periods of no breathing, and (f) the death rattle. Diagnosis & Interventions Diagnoses related to end of life care are (a) Ineffective tissue perfusion, (b) Alteration in comfort, (c) Activity intolerance, (d) Impaired gas exchange; (e) Ineffective breathing patterns, and (f) Decreased cardiac output. Interventions are attached to each diagnosis and a plan of care is established for the patient. Interventions for alternation in comfort include (a) spiritual, (b) pharmacological, and (c) alternative methods. Ineffective tissue perfusion involves (a) positioning, (b) O2, and (c) fluid management. Activity intolerance is managed by pacing periods of activity with rest. Impaired gas exchange is managed by decreasing fluid shifts with medication. Ineffective airway clearance is helped by (a) positioning and (b) suctioning to clear the airway. Disturbed thought processes interventions are (a) reorient the patient, (b) supporting family, and (c) visitors at times when the patient is most alert. Interventions are tailored specially to the patient’s needs and their disease process. Pain management â€Å"Dying does not need to be painful† (Moynihan et al. , 2003 p. 401). Holistic pain management is crucial during end of life care. Terminally ill patients can have (a) physical, (b) spiritual and (c) emotional pain. Providing comfort is important in decreasing suffering. Emotional pain can be addressed by (a) laughter, (b) memories, and (c) touch. Spiritual pain can be helped with (a) prayer, (b) meditation, (c) talking, (d) listening, (e) pastoral care, and (f) providing the last rights. Physical pain is managed pharmacologically and with alternative comfort measures. Opioids are given to treat severe pain at the end of life. Parlow (2005) used nitrous oxide to control incident pain in terminally ill patients with positive results. Pharmacological issue related to pain management Pharmacological issues surrounding pain management are (a) issues of addiction under medication, (b) legal repercussions, (c) respiratory effects, and (d) side effects. Zerwekh (2006) sums up the fallacy of addiction by stating persons with addiction take their opioids to escape life, whereas persons with pain take their opioids to live life more fully. These issues and lack of knowledge often cause Physicians to under medicate during end of life care. The nurse needs to have full understanding of how opioids work and how to adjust the medications to control severe pain and break though pain without entering into (a) legal issues, (b) respiratory depression and (c) side effects. Complementary and alternative therapies Along with the pharmacological methods to keep the patient comfortable there are many alternative method the nurse can use and teach the family to assist with; giving the family the gift of caring for their loved one and feeling like they are helping. The patient also benefits from the touch and interaction from his or her loved ones. Therapies such as (a) massage, (b) therapeutic touch, (c) guided imagery, (d) aromatherapy, (e) hypnosis and (f) relaxation, are just a few alternative therapies used. Supportive nursing care Often when a family member is dying their loved ones do not know what to say or do and often feel helpless. While providing care for the patient the nurse engages the family in the care and breaks down the fear that they can’t touch the dying patient. The nurse encourages the family to (a) gather, (b) share, and (c) grieve. The family and patient are educated to end of life care so they know what to expect and can recognize it. By giving the family these skills it is a gift so the family has time to say goodbye and to spend the last days in peace not in fear and chaos. The nurse manages symptoms so the patient and the family can concentrate on each other. O’Brien (2011) stated one of the best ways of providing spiritual support in this situation is to allow the patient and family to verbalize their feelings; for the dying person â€Å"one of the greatest spiritual gifts† a nurse can give is to listen (Burns, 1991, p. 1). Patient & Family education Education gives the patient and the family great power and strength to face the path ahead and not be fearful of the process. Discussion around key information such as (a) the patient’s wishes, (b) spiritual care, (c) visitation, (d) pain control, (e) disease process, (f) multi organ failure, (g) specific signs and symptoms, (h) interventi ons that can be provided, (i) interventions the patient may not want, (j) comfort care, and (k) funeral arrangements, must take place with the patient and their family. Patients may believe that pain is to be expected and education informing them that comfort will bring them quality time to spend with their loved ones and to not suffer in silences is vital. Encouraging the family to (a) hold their love ones hand, (b) stroke hair, (c) massage, and (d) talk to them until they take their last breath, is all education the nurse encourages. The nurses’ role is to (a) support, (b) pray and (c) answer question that might arise. Conclusion Caring for patients as they die involves (a) a great deal of knowledge, (b) compassion, and (c) caring, on the nurse’s part. Effective pain management decreases suffering in the terminally ill patient and can make all the difference in how the patient arrives at the end of life. The nurse must be versed and comfortable with the many issues surrounding end of life care so she or he can advocate for the needs of the patient and their family. The nurse’s role in (a) educating, (b) providing spiritual care, and (c) physiological care, to the patient and their family during this very important and stressful time plays a huge part in the comfort and peace that they experience as they journey down the path of loss and grieving. References Moynihan, T. J. (2003). Use of opioids in the treatment os severe pain in terminally ill patients-Dying should not be painful. Mayo Clin Proc. , 1397-1401. O'Brien, M. E. (2011). Spirituality in nursing: Standing on holy ground. Sudbury, MA: Jones ; Barlett Learning. Parlow, J. L. (2005). Self-administered nitrous oxide for the management of incident pain in the terminally ill patient: A blind case series. Palliative Medicine, 19: 3-8. Zerwekh, J. V. (2006). Nursing care at the end of life: Palliative care for patients and families. Philadelphia, PA: F. A. Davis Company. LOYOLA UNIVERSITY NEW ORLEANS NURS 384: End-of-Life Issues Paper Student: _Jackie Reviel__________________________Semester:_Fall__Year:_2011__ Directions: The purpose of this paper is to examine end-of-life issues. Write a 4-5 page paper on one of the topics that are suggested in your syllabus. Focus the paper on the care of the terminally-ill patient; education of patient and family, and supportive nursing care. Use ast least 4 references (current text and articles) for this assignment and format paper in APA style. Criteria: End-of-Life Issues Paper| Max. Points| Score| 1. Describes terminal Illness. Include pathology and signs and symptoms| 15| | 2. Identify palliative care/interventions associated with illness| 15| | 3. Address pharmacological issues related to terminal illness| 10| | 4. Address complementary and alternative therapies | 15| | 5. Describe supportive nursing care related to terminal Illness. | 15| | 6. Discuss at least 5 nursing diagnosis taken from those listed in the North American Diagnosis Association. 15| | 7. Provide key information to be discussed with patients ; families on terminal illness. | 15| | Total Comments: Faculty Signature: _______________________________Date:_______________________ LOYOLA UNIVERSITY NEW ORLEANS Evaluation of Communication Skills Student: ________________________________Semester: ____Year: _____ Skill in communication is defined as the ability to: (a) effectively express ideas through a variety of media, (b) use communication technology to enhance personal and professional functioning, and (c) use the group process for the purpose of achieving common goals. Note: Your grade on Communication Skills will comprise 10% of your final course grade. You will be rated using a scale of 0-10, where â€Å"0† indicates no credit and â€Å"10† indicates maximum credit for the item indicated. | Writing Criteria: Nursing Research Critique Paper | Score| 1. Use appropriate language and erminology. | | 2. Use correct sentence structure and paragraphing. | | 3. Use correct grammar, spelling, and punctuation. | | 4. Demonstrate knowledge of relevant content areas. | | 5. Express ideas clearly and convincingly. | | 6. Organize ideas logically. | | 7. Use APA format correctly. | | 8. Overall effectiveness of the written work in meeting identified goals. | | Communication Skills: Pt s earned (_____)/ 80 pts = _____% Letter Grade:____ Percent of Final Course Grade: [Pts earned (____)/ 80 pts =___%] X 10 = ____% Comments: Faculty Signature:____________________________________Date:______________