Caring for patients with PEG feeding

Caring for patients with PEG feeding According to Boud et al. (1985),Reflection is a form of response of the learner to experience. Reflection helps to recall about an experience, makes us think about it and finally helps us to evaluate it. I feel reflecting back on our experience can broaden our knowledge and skills by making us conscious of our strengths and shortcomings and thus in the long run help us to excel in that particular task. Since nursing concepts and practices are changing day by day, reflection is of much importance to provide effective and competent care in nursing. Among the various models of reflection I have chosen Gibbs model of reflection (1988) to reflect my experience in achieving the learning outcome, care of patients with PEG feeding. This model of reflection consists of six stages as seen in diagram. http://www.qmu.ac.uk/futurefocus/images/writing_clip.gif PEG feeding is the most common form of enteral feeding in people requiring artificial nutritional support for longer than 4-6 weeks. According to a study among stroke patients conducted by Cummins C, Marshall T, Burls A (2002) to ascertain whether endoscopic feeding is more effective than nasogastric tube feeding (NGT), concluded that PEG feeding was more efficient than NGT feeding, and also when compared with NGT feeding, PEG feeding of dysphagic stroke patients was associated with small increases in patient well-being. Since I am working in an acute stroke ward, we get many clients with enteral feeding. Dysphagia secondary to acute stroke is an appropriate referral for PEG-feeding rather than nasogastric feeding (Norton et al, 1996 as cited by Chapman, W. and Ditchburn, L., 2005). Even though I have cared for patients with nasogastric tube during my previous working experiences, I have never got a chance to care for a patient with PEG feeding. So I selected this learning objective to get acquainted with it to provide effective care for those clients. I read books and journals to acquire knowledge and also browsed the internet to gather related information. I also observed meticulously senior colleagues caring for patients with PEG feeding and administering the feed. I also read the active hospital policy to comply with it. Then, I undertook care of patients under supervision, my mentor and other colleagues gave me feedback on my performance and I was able to make corrections based on it. Initially I was anxious and tense in undertaking care of a client with PEG feeding. Undertaking care under supervision helped me to clarify doubts regarding the procedure and build my confidence. As the patients are nil by mouth, oral care was provided which is an inevitable component while caring for a client with PEG as well as cleaning the site of tube insertion after healing with mild soap and water daily and drying thoroughly (Arrowsmith, 1996 as cited by Chapman, W. and Ditchburn, L., 2005). Also, I made a point to flush the tube with sterile water before and after feeds or administering medications (NICE, 2003) and to rotate gastrostomy tube to prevent blockage (Stroud, H., Duncan, H., and Nightingale, J., 2003) Refreshing my knowledge and working under supervision enabled me to build my confidence. Guidance and feedback given to me by my mentor and colleagues helped me to perform better each time. My mentor has assessed me competent in caring for a client with PEG. I feel by selecting this learning outcome I was able to achieve an important skill essential for my placement area. By reading journals and active hospital policy I was able to understand the rationale behind each of my action. This has helped me build my confidence immensely as well as to expand my knowledge on the same. I also ensured documentation in enteral checklist was completed regarding the time the feed started, volume, rate per hour recorded in a consistent, concise manner, which fulfils the principles of record-keeping as laid down by the NMC, 2008. I believe that by taking this learning objective I was able to gain knowledge and skills for safe and effective practice when working without direct supervision (NMC, 2008). Working along with my mentor and colleagues gave me opportunity to clarify doubts and achieve this skill which expanded my skills and knowledge and made me familiar with another method of maintaining nutritional status. Learning new skills and keeping knowledge up to date helps one to develop professionally. By accomplishing the learning objective I am able to care for patients with PEG feeding and this will benefit me to provide efficient care. In order to provide proficient care in forthcoming days, I should keep myself aware of the policies and procedures followed in the trust and must keep my knowledge and skills up to date (NMC, 2008) to function better. Also, I must consult and take advice from colleagues when appropriate (NMC, 2008).

Mark Twains The Damned Human Race Essay -- Mark Twain Humanity Damned

Mark Twain's The Damned Human Race Within his essay of The Damned Human Race, author Mark Twain powerfully declares that the human race is both flawed and corrupt, and that people actually should be classified as 'lower animals' rather than the formerly known 'higher animals.' Twain does not hold claim to a Darwinian or creation standpoint, but rather draws conclusions from his own observations in performed experiments. He states that 'man is the cruel animal,' and that we can attribute this to his moral character. However, there appears to be another side which contradicts his findings. Perhaps man is indeed the 'highest animal,' but possesses something which other animals do not.   Ã‚  Ã‚  Ã‚  Ã‚  Twain claims that his observations are based on experiments executed in the London Zoological Gardens. With these examinings, he went on to state that humans displayed a variety of shortcoming not seen in other animals. His first point was that humans were cruel, while other animals were not. This was backed by the story of the hunter killing seventy-two buffalo, and eating only part of one. He contradicted this by experimenting with anacondas and calves. The anaconda only killed what it needed, as opposed to the Earl. This seemed to suggest to Twain that the man descended from the anaconda, and not the other way around. Perhaps the Earl did not respect the buffalo, which is true. But does it mean that all humans always kill to be cruel and wasteful? Or could some animals exhibit sig...

Cultural Competence Essay

The claim that every person is a product of his own cultural background which includes, among other things, his life experiences as well as family, religion, ethnicity and age (Kim, 2001, p. 207) reflects the idea that cultural competence inevitably requires an understanding of other people’s cultural background other than one’s own. While it is true that â€Å"our cultural inventory provides us with valuable insights for understanding our beliefs and attitudes† as well as our values and assumptions† (Kim, 2001, p.  207), it is also important to consider the need to fill that inventory with how other individuals perceive people from other cultural backgrounds. With respect to cultural competence, it is not always enough to satisfy the need to widen our cultural awareness solely through our personal knowledge of other cultures. Indeed, it is true that we should look into the different parts of â€Å"our own cultural identity and examine their positive and negative impacts on our professional and personal development† (Kim, 2001, p. 27). But more to that, we should also consider how other people see other people in terms of their cultural background. In essence, cultural competence can sustain cultural awareness and tolerance inasmuch as it can further foster interaction among cultures. According to Johnson, Lenartowicz and Apud (2006), cultural competence involves at least four elements: knowledge of personal cultural worldview, knowledge of other cultural worldviews and practices, perception towards differences in cultures, and cross-cultural skills. Assuming that we are the products of each of our own cultural backgrounds, it appears that to be culturally competent means to be able to recognize other cultures and to be able to interact with those cultures. Interaction can come in many forms, from simple hand and facial gestures to the more complex ones such as personal interaction on a verbal basis. Whatever way we choose to interact with people who belong to another culture, it is important to practice tolerance towards cultural differences. Cultural intolerance can very well lead to disagreement or, worse, to bigotry. Cultural competence presupposes cultural tolerance precisely because the latter allows individuals from distinct cultures to interact with one another without resorting to hatred or bigotry. Cultural tolerance can only progress if people begin to realize the idea that the belief-systems that each one of us subscribes to does not necessarily invoke the task to assimilate others into our own belief-systems (Persell, 1997). It can also progress if people are able to realize that various cultures can live side-by-side without necessarily interfering with the affairs of one another (Fischer, 2007). If communities of individuals are able to coexist and interact, the cultural landscape becomes one that is peaceful and lively. In a peaceful and lively society thriving with unique cultures, the task of obtaining and practicing cultural competence becomes an easy task. On the other hand, a society where racial bigotry exists among others is a society that pre-empts cultural competence right at the bud. One way to achieve cultural tolerance is through seeing and understanding how other people understand other people from other cultures. Additionally, it also helps to see and understand how other individuals interact with other individuals from other cultures. Like a third-person viewer, being aware of the dynamics of the cultural exchanges of people expands our mental horizons as we become more equipped with cultural knowledge that we may have hardly had in directly interacting with people from other cultures. Our cultural inventory becomes more comprehensive since we are able to gather more information about how people from different cultures communicate, for instance, with one another. Many different forms of cultural exchanges happen in ordinary life and to be able to bear witness to these different forms gives us a clearer picture of what it takes to be culturally competent. When we begin to realize that cultures do not essentially incite hatred and indifference, we become more convinced to study other cultures and to mingle with other people. Eventually, being culturally competent becomes an easy task to take. Another way to achieve cultural tolerance is through a theoretical study of the practices and beliefs of various cultures. This can be done with the help of academic institutions which offer formal ways to introduce and to educate people about the ways of other cultures. These institutions provide a pivotal role in enlightening people—presumably students—about unfamiliar cultures and their practices and beliefs. Armed with cultural insight, people can, in a manner of speaking, let other cultures be. Moreover, the education given by these academic institutions provide a fundamental block towards reaching the goal of cultural competence; for without at least an academic knowledge of cultures there can hardly be any individual progress towards any one of the four elements of cultural competence. Perhaps the most effective and yet most difficult way of achieving cultural tolerance is through the study and practice of the languages of other people. Interestingly, it is argued that language holds the most useful key to understanding other cultures (D’Andrade, 2002). The setup and function of the linguistic component of culture appears to be universal. That is, every language in the world regardless of cultural distinctions involves the receiver and the sender of the message of the medium, language being the medium. Language regardless of cultural distinctions is essentially used for communication, which is why learning a ‘foreign’ language is a crucial step in learning a ‘foreign’ culture because it enables us to penetrate linguistic barriers. Having the language of another culture as part of our so-called â€Å"cultural inventory† is a formidable advantage in dissolving the hindrances towards a comprehensive cultural awareness and, ultimately, cultural competence. How is it possible that cultural tolerance leads to cultural competence? For the most part, a person who is tolerant of other cultures is a person who has already satisfied the need to know one’s own culture and other cultures. An individual cannot be tolerant of a culture which he or she is not even aware of. Moreover, the culturally tolerant person is also someone who has already formed his own perceptions towards other cultures including his own. The only thing missing in all of these is the actual practice of that tolerance into reality. A person who is fully tolerant of other cultures is one who is already able to interact with other individuals who belong to another race or religion, for instance. As a case in point, expatriates are people who have been absorbed into another culture in more or less the same way as they have absorbed such culture into their lives. They are culturally tolerant individuals because, at the least, they are able to mingle and live with people of what used to be a different culture. More importantly, expatriates are also individuals who possess cultural competence not only as a result of their cultural tolerance but also as a product of their interest and inclination in becoming ‘one’ with another culture. They become thoroughly attached to another culture to the point that they are already able to speak the native tongue, subscribe to and practice the dominant religion or even adapt the general lifestyle of that culture. In any case, cultural competence and cultural tolerance go with one another in most, if not all, instances. It may be noted, however, that our reflection on â€Å"the various aspects of our own cultural identity and [our examination of] their positive and negative impacts on our professional and personal development (Kim, 2001, p. 207)† may not necessarily lead to cultural competence. It may only lead us to cultural tolerance to a certain degree without ever reaching the stage of putting into practice what we have learned from our acts of reflection and examination of our cultural identity. Even though â€Å"each of us is a product of our cultural background (Kim, 2001, p. 2007),† we are not naturally inclined to be culturally competent. The fact that there are people who struggle to become culturally competent and that there are those who deny themselves of the chance to become one suggests the same thing—human beings are not naturally inclined to know other cultures and to interact with them. However, what it entails on a positive note is the idea that there is the possibility of an overlap among the many different factors involved in determining the cultural identities of individuals. Perhaps the biggest struggle towards achieving cultural competence is overcoming the possibility of treating one’s personal cultural worldview or even one’s culture as superior to the rest. In submitting to such risk, we become more prone to cultural intolerance as we tend to put down cultures other than our own. We may eventually lose interest in knowing other cultural worldviews and in observing people of different cultures interact with one another from an outsider’s perspective. Our â€Å"cultural inventory† becomes filled only with our own cultural worldviews and our reflection and examination of culture may hardly extend towards other cultures. Nevertheless, people can overcome all these risks and struggles as part of the task of becoming culturally competent. A person’s level of cultural competence may hardly be quantified (Fischer, 2007) but it does not mean that there is no such thing as cultural competence. The fact that cultures exist and the fact that each person is the product of his own cultural background (Kim, 2001) suggests that interaction among cultures is possible, if not highly likely. Obtaining cultural competence may be a laborious task but, in the end, it poses large benefits in sustaining cultural tolerance on both personal and group levels. REFERENCES D’ANDRADE, R. (2002) Cultural Darwinism and Language. American Anthropologist, 104, 223-232. FISCHER, M. M. J. (2007) Culture and Cultural Analysis as Experimental Systems. Cultural Anthropology, 22, 1-65. JOHNSON, J. P. , LENARTOWICZ, T. & APUD, S. (2006) Cross-Cultural Competence in International Business: Toward a Definition and a Model. Journal of International Business Studies, 37, 525-543. KIM, E. Y. (2001) The Yin and Yang of American Culture: A Paradox, London, Intercultural Press. PERSELL, C. H. (1997) The Interdependence of Social Justice and Civil Society. Sociological Forum, 12, 149-172.

Free Essays on Jeanette Rankin

Who were the three black forces in the late nineteenth and early twentieth century? The three major forces behind the Blacks’ position in the late nineteenth and early twentieth century consisted of Booker T. Washington, W.E.B. DuBois, and Marcus Garvey. They were the most effective of all of the different activists of the time. They each came from different times and different places. They were also all brought up differently while they were young. They were all about 10 years apart from each other. Here is their story. Booker T. Washington was the first to emerge. He was born into slavery on April 5, 1856 in the state of Virginia. (Notes, 1) After the Emancipation Proclamation his mother had taken him and two other children to the state of West Virginia. (Amer. Jour., 571) After leaving, he and his family had started working in Coal and Salt mines. (Notes, 1) He was at the age of nine when he first started working in the mines. The hours were long and hard. He went back to Virginia to go to school. (Amer. Jour., 571) He enrolled in Hampton Normal and Agricultural Institute. (Amer. Jour., 571) He worked as a Janitor while attending. (Notes, 1) It was the premier black educations institution in the South at the current time. (Amer. Jour., 571) He worked hard to get through the school and graduated. He taught for three years and then founded the Tuskegee Institute in 1881. It was for black students in rural Alabama. (Amer. Jour., 571) His thoughts were that all students would be b! est served if they learned a trade and become work place disciplined. (Amer. Jour., 571) With a trade he believed that black people would develop more self-respect and economic independence. (Amer. Jour., 571) Another African-American Leader was W.E.B. DuBois. He was born in Massachusetts in February of 1868. He did not accept Washington’s view of black social inequality. He was the first African-American to graduate from Harv... Free Essays on Jeanette Rankin Free Essays on Jeanette Rankin Who were the three black forces in the late nineteenth and early twentieth century? The three major forces behind the Blacks’ position in the late nineteenth and early twentieth century consisted of Booker T. Washington, W.E.B. DuBois, and Marcus Garvey. They were the most effective of all of the different activists of the time. They each came from different times and different places. They were also all brought up differently while they were young. They were all about 10 years apart from each other. Here is their story. Booker T. Washington was the first to emerge. He was born into slavery on April 5, 1856 in the state of Virginia. (Notes, 1) After the Emancipation Proclamation his mother had taken him and two other children to the state of West Virginia. (Amer. Jour., 571) After leaving, he and his family had started working in Coal and Salt mines. (Notes, 1) He was at the age of nine when he first started working in the mines. The hours were long and hard. He went back to Virginia to go to school. (Amer. Jour., 571) He enrolled in Hampton Normal and Agricultural Institute. (Amer. Jour., 571) He worked as a Janitor while attending. (Notes, 1) It was the premier black educations institution in the South at the current time. (Amer. Jour., 571) He worked hard to get through the school and graduated. He taught for three years and then founded the Tuskegee Institute in 1881. It was for black students in rural Alabama. (Amer. Jour., 571) His thoughts were that all students would be b! est served if they learned a trade and become work place disciplined. (Amer. Jour., 571) With a trade he believed that black people would develop more self-respect and economic independence. (Amer. Jour., 571) Another African-American Leader was W.E.B. DuBois. He was born in Massachusetts in February of 1868. He did not accept Washington’s view of black social inequality. He was the first African-American to graduate from Harv...

What Would Mark Zuckerbergs Resume Look Like if Facebook Failed

What Would Mark Zuckerbergs Resume Look Like if Facebook Failed We all spend so much time fretting about what is and what is not on our resumes. We also spend a great deal of time idolizing tech billionaires and entrepreneurs who went an unorthodox route and really made career magic happen for themselves. But what does a carefree, â€Å"I made it on my own† resume really look like on paper? It’s important to remember that the risk takers and innovators often have resumes that look a little out of balance. And hey, it worked out for them. No matter what your past looks like, there’s proof that a lot of hard work (and sure, a smidgen of luck) can combine to bring you great success.Here are a few bullet points from Mark Zuckerberg’s would-be resume if his Facebook gamble had failed and he had found himself out on the post-grad job market with the rest of his Harvard class.Mark ZuckerbergEducationHarvard University, Psychology and Computer Science    (Sept 2002 – ongoing)Phillips Exeter Academy, Classical studies and Science    (May 1999-2001)   Ã‚  GPA 4.0Software Development ExperienceFacemash   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   (Oct 2003 – ongoing)Internal social media website allowing visitors to rate their classmates at Harvard University as â€Å"hot† or â€Å"not.† Hugely popular and experienced such a spike in numbers as to overwhelm the Harvard servers.CourseMatch    (2003 – ongoing)Mini-social medial, the first of its kind, allowing university students to choose their courses based on the choices of their classmates, and to form study groups and meet-ups.Synapse Media Player (2000 – 2001)App using artificial intelligence to learn the listening preferences of the user, then recommending appropriate music. Featured on the SlashDot, rated 3/5 by PCMag, and reached more than 1000 downloads in the first month alone. Attracted significant interest from Microsoft and AOL.AchievementsFounded two of the most popular apps at HarvardWon over 10 prizes in Math, Physics, Astronomy, and ClassicsProficient or advanced proficient in six languages (English, Mandarin Chinese, French, Hebrew, Latin, Ancient Greek)Developed first software application at the age of 12Captain of prep school fencing teamTech Skills StrengthsProduct DevelopmentArtificial IntelligenceHTML CSSPHPAtari BasicSoftware ApplicationsZuckNet (1996 – 1997)Dental practice software, designed at age 12 using Atari Basic, allowing family computers to communicate with those of family dental practice.Computer versions of Monopoly Risk (1995-1996)Digitized versions of two popular board games for up to 6 players.MembershipsAlpha Epsilon PiKirkland House  PassionsThe Odyssey The Iliad, Tennis, Rowing, Fencing, and Programming  Verdict? Not really all that impressive. Keep this in mind as you build your own resume. Make sure to view your career goals and accomplishments with a healthy amount of perspective.

Supreme Court Week 6 #12 Essay Example | Topics and Well Written Essays - 250 words

Supreme Court Week 6 #12 - Essay Example If precedence has been established, the Court is unlikely to change precedence. This is not to say that this never happens. Precedence is sometimes overturned as the make-up of the court changes and the interpretation of the Constitution changes over the years. The next idea is that of the judicial conference. This is an even t when all of the Federal justices get together and talk about things. The conference was established in 1922 and is made up of the Chief Justices of the Supreme Court and a justice from each of the circuit courts. The purpose of this conference is to establish rules that Federal justices are to follow. The rules are largely procedural, but they can affect which cases the Supreme Court hears. A final way to filter cases is by looking back at the published opinions of Supreme Court justices and other federal judges. An opinion gives insight into why a judge ruled the way she did. This can be used to justify bringing a case to the Supreme Court if the opinion shows the ruling to be very narrow or biased in some

Discuss the theme of how it reflects to the play Essay

Discuss the theme of how it reflects to the play - Essay Example In this book, Henrick Ibsen shows a clear opposition of a male’s society and the women’s lives in the golden cages, and nothing is better than freedom, and money cannot substitute wings. Henrik Ibsen’s  A Doll’s House intrigues the audience by first developments of the feminism discourse. Oppression of a woman in the nineteenth century by males is represented by the writer as a common thing. Nora is just a doll and she is not an entity, she is the â€Å"other† pretty thing of her husband. Her husband gives funny names for her, such as â€Å"squirrel†, a â€Å"song bird† or a â€Å"little skylark†. He thinks that she does not have valuable ideas and her brain is empty. However, Nora is not a silly woman, because she realizes this ever existent oppression and she confirms that her father told her about his ideas all the time and, finally, these ideas became her own ideas. Actually, this woman was passed from her father’s hands to the hands of her husband like a fragile and empty thing. She feels uncomfortable and she suffers from her wasted life (Goldman 38). It is more comfortable to be a doll and to live in a dollâ €™s house in case a woman has experienced lobotomy, but a sound mind can never accept such a daily humiliation. Nora’s husband is strong enough to shelter and comfort her, but Nora feels like a bird in a golden cage. Material concerns of her husband and her father prevent her from making her own desires and wishes come true. She lacks freedom and does not have an opportunity to satisfy her material needs (Templeton 345). She borrows money from another person, but she cannot become a happy person. Torvald oppresses her and treats her like a child. It seems like he has some mental illness, because it is an inappropriate behavior of a modern, strong man to project his father’s feelings onto his wife. Because of material problems and the lack of social power, Nora did not have an opportunity to make friends even with women, because her