King Lear Vision Essays - King Lear, Edmund, Cordelia, Goneril, Lear

King Lear Vision In Shakespeare's tragedy, King Lear, a prominent reoccuring theme is vision and it's relovence. The characters, Lear and Gloucester are Shakespeare's principal means of portraying this theme. Although Lear can physically see, he is blind in the sense that he lacks insight, understanding, and direction. In contrast, Gloucester becomes physically blind but gains the type of vision that Lear lacks. It is evident from these two characters that clear vision is not derived solely from physical sight. Lear's failure to understand this is the principal cause of his demise, while Gloucester learns to achieve clear vision, and avoids a fate similar to Lear's. Throughout most of the play, Lear's vision is clouded by his lack of insight. Since he cannot see into other people's personalities, he can never identify them for who they truly are. When Lear is angered by Cordelia, Kent tries to reason with Lear, who is too stubborn to remain open-minded. Lear responds to Kent's opposition with, "Out of my sight!" to which Kent responds, "See better, Lear, and let me still remain" (I.i.160). Here, Lear is saying he never wants to see Kent again, but he could never truly see him for who he was. Kent was only trying to do what was best for Lear, but Lear could not see that. Kent's vision is not clouded, as is Lear's, and he knows that he can remain near Lear as long as he hides behind his mask. Lear's visual perception is so superficial that the merely the garments and simple disguise that Kent wears easily dupe him. Lear cannot really see Kent. He only learns of Kent's noble and honest character just prior to his death, when his vision is cleared. By this time, however, it is too late for an honest relationship to be saved. Lear's vision is also worsened by his lack of direction in life, and his poor foresight, his inability to predict the consequences of his actions. He cannot look far enough into the future to see the consequences of his actions. This, in addition to his lack of insight into other people, condemns his relationship with his most beloved daughter, Cordelia. When Lear asks his daughters who loves him most, he already thinks that Cordelia has the most love for him. However, when Cordelia says, "I love your Majesty/According to my bond, no more nor less" (I.i.94-95), Lear cannot see what these words really mean. Goneril and Regan are only putting on an act. They do not truly love Lear as much as they should. When Cordelia says these words, she has seen her sisters' facades, and she does not want to associate her true love with their false love. Lear, however, is fooled by Goneril and Regan into thinking that they love him, while Cordelia does not. Kent, who has sufficient insight, is able to see through the dialogue and knows that Cordelia is the only daughter who actually loves Lear. He tries to convince Lear of this, saying, "Answer my life my judgment, / Thy youngest daughter does not love thee least" (I.i.153-154). Lear, however, lacks the insight that Kent has. He only sees what is on the surface, and cannot understand the deeper intentions of the daughters' speeches. As his anger grows from the argument, his foresight diminishes, as he becomes increasingly rash and narrow-minded. When Lear disowns Cordelia, he says, "we/Have no such daughter, nor shall ever see/That face of hers again" (I.i.264-266). He cannot see far enough into the future to understand the consequences of this action. Ironically, he later discovers that Cordelia is the only daughter he wants to see, asking her to "forget and forgive" (IV.vii.85). By this time, he has finally started to gain some direction, and his vision is cleared, but it is too late for his life to be saved. His lack of precognition had condemned him from the beginning. Lear depicts Shakespeare's theme of clear vision by demonstrating that physical sight does not guarantee clear sight. Gloucester depicts this theme by demonstrating clear vision, despite the total lack of physical sight. Before scratching his eyes out, Gloucester's vision was much like Lear's. He could not see what was really going on around him. Instead, he only saw what was presented to him on the surface. When Edmund shows him the letter that is supposedly from Edgar, it takes very little convincing for Gloucester to believe it. As soon as Edmund mentions that Edgar could be plotting against him, Gloucester calls him an "Abhorred villain, unnatural, detested,

The Discovery of Otzi the Iceman and Its Significance

The Discovery of Otzi the Iceman and Its Significance On September 19, 1991, two German tourists were hiking in the Otzal Alps near the Italian-Austrian border when they discovered Europes oldest known mummy sticking out of the ice. Otzi, as the iceman is now known, had been naturally mummified by the ice and kept in amazing condition for approximately 5,300 years. Research on Otzis preserved body and the various artifacts found with it continues to reveal much about the life of Copper Age Europeans. The Discovery Around 1:30 p.m. on September 19, 1991, Erika and Helmut Simon from Nuremberg, Germany were descending from the Finail peak in the Tisenjoch area of the Otzal Alps when they decided to take a shortcut off the beaten path. When they did so, they noticed something brown sticking out of the ice. Upon further inspection, the Simons discovered that it was a human corpse. Although they could see the back of the head, arms, and back, the bottom of the torso was still embedded in the ice. The Simons took a picture and then reported their discovery at the Similaun Refuge. At the time, however, the Simons and the authorities all thought the body belonged to a modern man who had recently suffered a deadly accident. Removing Otzis Body Removing a frozen body thats stuck in the ice at 10,530 feet (3,210 meters) above sea level is never easy. Adding bad weather and a lack of proper excavation equipment made the job even more difficult. After four days of trying, Otzis body was finally removed from the ice on September 23, 1991. Sealed up in a body bag, Otzi was flown via helicopter to the town of Vent, where his body was transferred to a wooden coffin and taken to the Institute of Forensic Medicine in Innsbruck. At Innsbruck, archaeologist Konrad Spindler determined that the body found in the ice was definitely not a modern man; instead, he was at least 4,000 years old. It was then that they realized that Otzi the Iceman was one of the most amazing archaeological finds of the century. Once it was realized that Otzi was an extremely important discovery, two teams of archaeologists went back to the discovery site to see if they could find more artifacts. The first team stayed only three days, October 3-5, 1991, because the winter weather was too harsh to work in. The second archaeology team waited until the following summer, surveying from July 20 to August 25 1992. This team found numerous artifacts, including string, muscle fibers, a piece of a longbow, and a bearskin hat. Who Was Otzi the Iceman? Otzi was a man who lived sometime between 3350 and 3100 BCE in what is called the Chalcolithic or Copper Age. He stood approximately five feet and three inches high and at the end of his life suffered from arthritis, gallstones, and whipworm. He died at about the age of 46. At first, it was believed that Otzi had died from exposure, but in 2001 an X-ray revealed that there was a stone arrowhead embedded in his left shoulder. A CT scan in 2005 discovered that the arrowhead had severed one of the Otzis arteries, most likely causing his death. A large wound on Otzis hand was another indicator that Otzi had been in close combat with someone shortly before his death. Scientists have recently discovered that Otzis last meal consisted of a few slices of fatty, cured goat meat, similar to modern-day bacon. But many questions remain regarding Otzi the Iceman. Why did Otzi have over 50 tattoos on his body? Were the tattoos part of an ancient form of acupuncture? Who killed him? Why was the blood of four people found on his clothes and weapons? Perhaps more research will help answer these and other questions about Otzi the Iceman.   Otzi on Display After seven years of study at Innsbruck University, Otzi the Iceman was transported to South Tyrol, Italy, where he was to be both further studied and put on display. At the South Tyrol Museum of Archaeology, Otzi was encased within a specially made chamber, which is kept dark and refrigerated to help preserve Otzis body. Visitors to the museum can glimpse Otzi through a small window. To remember the place where Otzi had remained for 5,300 years, a stone marker was placed at the discovery site.

School Uniforms Essay Example | Topics and Well Written Essays - 750 words

School Uniforms - Essay Example If uniforms are not made mandatory, rich students would look down to the poorer students as it gives a chance to them to show-off their wealth. Therefore introduction of uniforms will help to deal with this problem. Therefore there will be no economic differences among the students in the schools. Uniforms will also decrease the violence among students in the students. When students wear the same type of dress the probability of group formation or gang behaviour would be minimum. Uniforms would make schools a safer place for students especially the underprivileged one. Schools uniforms can save much of the time of students because they don't have to waste time in choosing which clothes to wear. Choosing of clothes seems to be a small thing but this really is a big task and consumes actually a hell lot of time. Not only this, we should also consider the time which they spend in malls in order to find the perfect dress. And if the school goers are able to save this time they can concentrate on more important thing like completing their homework or having breakfast. Having uniforms in school would stop the discrimination and teasing on clothing but there are many things to discriminate or tease rather than only clothing like personality, race, colour to name a few. Richer students can tease or look down on the poorer students by having a costly watch or an expensive bag. ... Richer students can tease or look down on the poorer students by having a costly watch or an expensive bag. And therefore uniforms cannot prevent the discrimination or the economic differences. It is only the education which the students get from their parents and teachers which will help them to avoid discrimination on the basis of sex, creed, religion, race or colour. Many feel that making uniforms mandatory would end symbols of being in a gang. But they should understand that there are many ways through which students can show that they belong to a particular gang like rolling up your sleeves or having a band on the hands. Therefore uniforms cannot to a large extent avoid gang behaviour. If uniforms are not made compulsory students can begin to develop their own personal style and they can be more mature. Students will be given the opportunity to decide what they have to wear and therefore this will inculcate the habit of decision-making among the students. Making uniforms compulsory actually violates a student's right of self-expression. The personality of a person (to some extent) is reflected by the clothes he wears so if the students are allowed to choose the clothes which they have to wear they will have an opportunity to express themselves. CONCLUSION Though there are umpteen numbers of arguments both in favour of as well as against making school uniforms mandatory but I personally feel that making school uniforms compulsory would be more effective and efficient in promoting uniformity and equality, in avoiding violence and gang behaviour, in avoiding discrimination on the basis of sex, creed, religion, colour etc and

The Great War What were the war aims OR military strategies of the Essay

The Great War What were the war aims OR military strategies of the various belligerents in World War I How was the Great War the first truly global conflict - Essay Example Reflecting on what happened during the Russo-Japanese War, Block felt that this new, technological sort of war would destroy Europe. 1 A new belief circulated amongst European General Staffs that contingency plans needed to be made allowing them to win any future war they might come upon. The main problem that followed from this, however, was the fact that they did not understand the concept of modern war, and thus the plans they put together actually resulted in a catastrophic war of attrition. Four reasons actually caused this catastrophe. The first issue was the fact that industrialization resulted in weapons and equipment being made on a large scale. Next, there was a huge population growth which allowed for the manpower necessary to create the large armies necessary to fight the war. Third, reserves became a popular concept, and this allowed the armies to grow quickly. Last, the creation of large railroad networks allowed for armies to be supplied in the trenches. The combination of these four concepts would alter the face of war forever, and this resulted in a near death struggle by the end of 1914 that neith er country wanted nor expected. Furthermore, none of the European rulers could discover a way to end the terrible war or justify the large amount of men lost to it during the first months of war. Most of them, instead, focused on the next campaign, believing that it would finally win the war-and of course, it never did.2 Each side involved in the war had several issues it needed to face. These issues included figuring out how to mobilize the necessary items in order to actually but together a successful industrial war without completely destroying society as a whole. History indicated that a short, decisive war would be best (the only recent war standing out that stood out in contrast to this at the time was the American Civil War, which at this time was largely ignored as a usual war). The most recent wars, which has included the Russo-Japanese War and the Italian Unification Wars made many believe that modern wars could be quick, fast business forcibly decided by a few short battles. So, there was an overall feeling present in Europe that the European military establishments could win quickly. 3 However, they would be wrong, and they could not have necessarily guessed or understood that they would be. Obviously, they were searching for an answer and looking at things from optimistic perspectives, although they did not necessarily realize this at the time. They are not to blame, because even today, modern historians have problems understanding this war. If one, for example, decides to take a close look at memoirs and study each campaign, the picture simply becomes more and more complex. The only way one can truly understand this war is by taking a close look at military demography, economic systems, labor controls, and transportation theory. One can only understand the Great War by taking a close look via a material assessment in order to lift away obscurity. Therefore, one needs to conclude that three material factors led to the outcome of the war, and these two items include economic mobilization, human and resource mobilization. With this concept in mind, one can understa nd how each coalition developed its strategies to win the Great War. The outcomes of the Great War were serious indeed; the excessive force of economic

Effects of Classical and Post-Classical Religions Research Paper

Effects of Classical and Post-Classical Religions - Research Paper Example With the fall of the empires and their economies, the people had to find means to live and believe in order to proceed with their normal lives. People then got the chance to migrate to different areas and meet new people, develop new ideas and learn new and diverse ways of life. Religion would not have come at a better time for them since it enabled them have a venue to express their beliefs and needs. Christianity being one of the religions was embraced by people and they henceforth developed allegiances in accordance with the different religions that they embraced. Eastern mediteranian, for example, enjoyed the aftermath of the Roman empire’s collapse as it opened trade and opportunities for them . Politically, the rise of Christianity saw changes in leadership styles and allegiances. The previous empires like the Roman empire always dictated and demanded that people worked with allegiances sworn to the leardership. This changed with the belief that were embraced by the chri stian teachings. The teachings enabled and required people to work together with others to collectively help improve their lives and in unity to build a strong kingdom of God . The supreme being was nolonger the emperor, but God. These religious people happened to be in regions that identified with the religion that was more dominant. Christianity did institute within its gorvenance structure and formation tactics borrowed from the Roman empire. Cultural and artistic ways and lives of people also changed.... The teachings enabled and required people to work together with others to collectively help improve their lives and in unity to build a strong kingdom of God 3. The supreme being was nolonger the emperor, but God. These religious people happened to be in regions that identified with the religion that was more dominant. Christianity did institute within its gorvenance structure and formation tactics borrowed from the Roman empire. Cultural and artistic ways and lives of people also changed with the transition of the society into the religions of salvation. The Roman empire, for instance, had their gods that they would offer sacrifices to in times of their needs. They belived that the gods were many and that every god had a purpose, authority and power to reward and punish those who did not heed to or obey them. Christianity, on the other hand, came up with the teaching that the last sacrifice was that of the death of Jesus Christ and that there was only one GOD 4. This brought about c onflict of interest and cultural discomforts, as well as disagreements between the emperors and the christians resulting in christians being prosecuted. Christianity introduced a way of life in which people lived together in harmony and peace. It brought forward a community that preached against violence and discrimination. On the other hand, the previous empires used coercion, divide and rule kind of leadership that only benefited those in power. Social lives of the people received a great change and boost, one that the people found easy to embrace as it cared for the well being. However, the leadership was immensely affected since their ways of gaining more power and strength was being overshadowed by the strong beliefs that the people developed.

Administration of Colonoscopy Reflective Account

Administration of Colonoscopy Reflective Account This essay aims to provide a reflective account of the authors personal and professional experience of a patient being admitted for a colonoscopy. To achieve this, a model of reflection will be used and a rationale provided to support this choice. The main point of discussion is communication and advocacy. Advocacy is central to communication and part of a caring nurse-client relationship (Arnold Boggs, 2003). The author as a newly appointed nurse on the Endoscopy Unit, will reflect upon how they could have been a better advocate for the patient in question. Ethical and legal issues will be examined. Finally implications for practice will be discussed. Using a model of reflection allows the nurse to re-appraise the care they have delivered to a patient/client and in doing so can evaluate the effectiveness of that care (Basford Slevin 1995), thus with the intention of influencing future practice for the better. Before starting the reflection process it will be more helpful for the professional to have a guideline or framework from which to work from (Palmer, Burns and Bulman 1994). Palmer et al (1994) view the process as something that is dynamic and they advise a cyclical style model using questions to provide a format for reflection. It is for these reasons that the Gibbs Reflective Cycle has been chosen (Gibbs 1998) for this essay. In accordance with the Nursing and Midwifery Council standards on respecting confidentiality in practice, all names and locations have been made anonymous (NMC 2008). As this is a reflective essay the author will refer to herself as I where appropriate. The reflective cycle is divided into six sections each with their own key questions. These are: Description: What happened? Feeling: What were you thinking and feeling? Evaluation: What was good or bad about this experience? Analysis: What sense can you make of the situation? Conclusion: What else could you have done? Action Plan: If it arose again what would you do? (Gibbs 1998) These areas for reflection provide the main topics for the rest of this assignment. When the practitioner has developed an action plan they can then return to the beginning of the cycle with the extra knowledge they have obtained from the first reflective experience (Gibbs 1998). It is here though with the description of the incident that the reflective cycle will begin. The following situation led me to question my actions when admitting a patient for a colonoscopy. The patient a 43 year-old male was referred for a colonoscopy by his GP following a three-week history of fresh rectal bleeding, anal itching (pruritus ani) and a change in bowel habit. Two weeks prior to the scheduled test, a pack containing a letter of appointment was sent to the patient by the endoscopy administration staff. Enclosed were two sachets of Picolax bowel preparation, full instructions for usage, highlighting the need to follow instructions precisely to ensure clarity of view and aid diagnostic accuracy. Included with this pack was a pre-endoscopy questionnaire to enable the nurse to assess the patients general state of health and identify any potential risk factors or complications, which may arise. A booklet was in this pack explaining the procedure, reasons for the test, complications and risks and what to expect during the test. The booklet stated other available investigations in order that he could make an informed decision and enable him to give informed consent for the test to go ahead. The Nursing and Midwifery Council (NMC) (2008) state that before any treatment or care is given to the patient, consent must be obtained. The BSG (2008) warn that consent issues are a major source of problems, sometimes leading to both complaints and litigation throughout the NHS. Therefore valid and robust consenting is now a required standard for the Endoscopy Global Rating Scale (GRS, 2009) which is a tool that enables endoscopy units to assess how well they provide a patient-centred service. Information in the booklet covered the option of sedation and the need for appropriate after-care. A consent form was enclosed for him to sign at home, providing the patient had read, understood an d agreed to under-go the procedure. A morning appointment was made for the patient and he arrived at the unit by himself. He was greeted by myself, I checked his personal details. This is in accordance with the BSG (2008) guidance for obtaining a valid consent for elective endoscopic procedures as it states that identity checks at key stages in the procedure are essential as some patients have even been known to undergo procedures intended for another due to loss of autonomy and anxiety which can result when entering the hospital. When this information was confirmed he was made to feel comfortable in the preparation room. The patient was clearly anxious. He was looking down a lot and he had his arms folded. He spoke very quickly and with a quiver in his voice one of the first things he said to me was, please knock me out for this. I explained to the patient that although we could give him some sedation which would make him feel more relaxed, he would still be awake as it would be unsafe to knock him out for the test. The sedation used for all endoscopic procedures is conscious sedation. This has been defined as: A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drug and techniques used to provide conscious sedation should carry a margin of safety wide enough to render loss of consciousness unlikely. BSG (2003, p3). He explained that he saw on the consent form that sedation would be offered and he interpreted this to be a general anaesthetic. I further explained to him that although the patient may feel sleepy, he would be conscious throughout the test and he would be able to talk to us. Cotton and Williams (2003) agree, believing that the desired effect of the sedation on the patient is sleepy, relaxed but rouse able. The patient clearly expressed a preference for sedation and it was established that the patients wife could collect him after his procedure and would remain with him over the next 24 hours. It is a requirement that any patient undergoing a procedure with sedation should be accompanied home by a responsible adult who will remain with them for 24 hours as sedative effects are known to remain in the body system for up to this period of time (Royal College of Surgeons, 1993). At this point, I as a newly appointed staff nurse on the unit was unsure whether the consent form that the patient had signed was valid as he originally thought that he was going to have a general anaesthetic when he had signed the form. I had been trained in taking consent which is documented in my e-portfolio as regards the national GIN training programme (Gastrointestinal in Nursing Training Programme), but was unsure what to do in this instance as I had never experienced the situation before. My initial thought was that is was not valid as the patient had a different perception of the test. I explained to the patient that I was just going to get some advice from my colleague (who had worked in the endoscopy unit for several years) as regards the validity of his consent form. I said that I would need to explain the situation to my colleague and he agreed to this joking that we did not both want to get into trouble from the headmaster and get a detention. I said that I would only b e a couple of minutes and left the room to find advice. I explained the situation to the nurse who was sat in recovery. The nurse said that the Endoscopist performing the procedure would go over consent again in the procedure room and not to worry about it. I expressed concern at this because I knew that consent must never be obtained in the procedure room. Guidelines readily available in relation to consent include British Society of Gastroenterology guidelines (BSG) (2008) and the Joint Advisory Group Guidelines (JAG) (2001). Booth agree that consent should not be taken in the procedure room. Guidance on good practice in consent implies that all patients must have had adequate time to absorb and reflect upon new information. This is not achieved if consent is obtained at the last possible moment which is in the procedure room itself. The nurse was dismissive and made unpleasant comments regarding men in general. There was a short distance between the nurse and the preparation room where the patient was so it is likely that the patient heard her remarks. I did not comment at this time even though I felt her remarks to be inappropriate. Luckily this gentleman was the first patient on the mornings list and as such, no other patients were in recovery to here the comments. The nurse picked up the patients notes and knocked on the preparation room door. I thought that I had better observe too as the nurse looked ready for a challenge. The nurse was very brusque in manner and asked the patient if he had read the booklet which the unit has sent out for the test and the section regarding sedation. The patient said that he had read the booklet and indeed the section regarding sedation but there was no mention that he would be awake after he had been given the sedative and assumed therefore that he would be asleep. The nurse then got a copy of the booklet. As she was flicking through trying to find the page with the relevant sedation information on, she said it clearly states in the booklet that if sedation is given, the patient will be awake throughout the test. However, when she got to the page regarding sedation there was no mention of this. It just stated that sedation would be offered prior to the colonoscopy but if the patient decided to have sedation that it was essential that someone was available to stay escort the patient home and stay with them overnight. The nurse went bright red, but did not apologise to t he patient and said that she was going to have words with the administration staff and left the procedure room. I felt guilty that I had not challenged the nurse regarding her rude manner with the patient at the time but felt intimidated and unable to voice my opinion, I also felt I had failed in my duty of care. I thought that the nurse had made a big deal when there was no need. I apologised unreservedly for my colleagues attitude and said that I would take steps to make sure that the booklet was clearer. I then realised that my original question regarding the consent form had not even been answered. I asked the patient if it was okay if I asked another colleague their opinion. The patient said yes but not that do-lally nurse and said that he would be making a complaint regarding her attitude. I then found the endoscopist who was actually going to be undertaking the patients test and asked them about the consent issue. They said that the consent form was fine as long as I reiterated that the patient would be awake and that they fully understood the test. The Endoscpist said that they would d iscuss the consent form with the patient again prior to the procedure as this is normal practice. I went back into the preparation room and said that the consent form was not a problem and that we would discuss it further. I spoke to the patient in a reassuring way, trying to compensate from his previous treatment from my colleague. I asked the patient if he understood the test he was about to have and its related risks. When I felt like the patient had a clear understanding of the procedure I asked him if he had any questions regarding the procedure, the patient replied he had no further questions. He added that he was even more nervous now after the experience with the nurse but just wanted it to be over as quickly as possible. I began to explain the procedure that he was going to undergo and asked if he knew why the GP had referred him for this procedure and relayed the benefits of viewing the bowel in this way. The patient was happy that a diagnosis might be forthcoming from this test. I then reiterated the possible risks of the procedure to the patient explaining that they w ere rare but never the less very real. The patient said that he understood the risks involved but wanted to go ahead with the test to obtain a diagnosis of his problems. I stated that if the patient was going to have sedation, then he should not drive or operate any machinery and should not sign any legally binding documents as the side effects from the sedation would still affect him for twenty four hours. I explained that the endoscopist would endeavour to complete the investigation however, if complications were to occur such as patient distress or poor bowel prep that the test would be abandoned. During a Gastrointestinal Endoscopy and Related Procedures Course at The University of Sheffield (Feb 2010, SNM 2215/3232) it was suggested that the guideline for informed consent was signified by the acronym EMBRACE, Explanation of the procedure, Motive for the procedure, Benefits, Risks, Alternatives, Complications and side Effects of the procedure. I believe that these guidelines were fully complied. Following the taking of a medical history and completion of a further in-depth health check questionnaire to ascertain any condition or reason to which sedation would be contraindicated such as elderly patients who may have significant co-morbidity and even in younger patients, the presence of heart disease, cerebrovascular disease, lung disease, liver failure, anaemia, shock and morbid obesity (BSG, 2003). It became evident that sedation would be an option. I explained to the patient that a nurse would be with him continuously throughout the procedure and would encourage him to breathe through any discomfort he may feel, or to push some of the air out of his bottom to relieve any pain. The patients blood pressure, pulse and saturations were taken and all were within acceptable limits. This provides a good baseline of the patients observations for the procedure itself and can determine any changes that may occur as a result of the cardio or respiratory depression that may be induced by sedation. Pascarelli (1996) states that during the procedure, the nurses primary responsibility is to monitor the patients vital signs along with communication with the endoscopist, administration of medications and emotional support to the patient. Clarke (1994) warns that patients who undergo invasive procedures are usually anxious and their vital signs are commonly elevated however the sedation lessens the anxiety, and all of the vital signs decrease therapeutically to that patients resting level. The sedation of choice in my workplace is intravenous Midazolam. Midazolam is a benzodiazepine reputedly well suited for use in endoscopy. It has an amnesic affect causing a reduction in memory recall. Clarke (1994) agrees saying that the goal of IV conscious sedation is some degree of amnesia. Patients will occasionally remember some parts for example, the initial introduction of the colonoscope. It is for this reason clear written discharge instructions are given to the patient prior to discharge, with a contact telephone number in the event of any problems and this was explained to the patient. Sedation may be indicated for many reasons. In the main these may include allaying of fears regarding a procedure, and aims to facilitate compliance with repeat procedures as a result of the amnesic affects induced. In many cases it assures co-operation and eases difficulties for the endoscopist and generally provides a rapid, safe return to the normal activities of daily living. The patient was asked to undress from the waist down and to put on the gown provided. When the patient was ready he was taken by myself into the procedure room and introduced to the endoscopist and the appointed staff nurses where the issues of consent and sedation would once more be discussed with the patient as it is the endoscopists ultimate responsibility. Throughout the experience, I felt that several important issues had been highlighted. One issue is that of the booklet that is sent out to the patients prior to the test. I believe that individual patients perspectives regarding the effects of sedation may vary greatly, from a mild sedative to a general anaesthetic. I conclude this to result from the individual interpretation of patient information received and relatives and friends giving a distorted image of their own experience due to the amnesic affect of the sedation. I would advocate good effective communication skills are paramount in allaying misconceptions and fears and the giving of a realistic overview is therefore essential. It was clear that there needed to be some improvement of the explanation of conscious sedation as I felt that is merely skimmed the surface explaining that the option of sedation was there and that there needed to be someone to escort the patient home and stay with them overnight. I felt that it needed to be clearer in the fact that it needs to mention that the patient will not actually be anaesthetised and furthermore that amnesia is a common side effect from the sedation given. This has subsequently been mentioned to the ward sister and the booklet has been updated to clarify conscious sedation. Perhaps one of the most obvious issues is that of the attitude of the other nurse. The BSG (2008) state that the patient must not be put under any pressure and have sufficient time to digest the information in order for consent to be valid. I felt that the attitude of the nurse in question did put pressure on the patient and caused further anxiety for the patient. I felt that the nurse spoke to the patient in a degrading way and showed a lack of professionalism. The Nursing and Midwifery Council (NMC 2008) state that nurses must treat people as individuals and respect their dignity, must not discriminate and must treat people kindly and considerately. This was not the case in the above example. The Equality and Human Rights Commission (2008) state that no matter your circumstances you should always be treated fairly and with respect when using healthcare services. The Department of Health (2008) cite the UK Human Rights Act in their guidelines about human rights in healthcare when they state that people have an absolute right not to be treated in a degrading way. This means that it is unlawful for the NHS organisations to act in a way that is incompatible with the human rights act. Endoscopy nurses and indeed all NHS staff should be thinking about their practice and how their response to a situation may impact on a patient or clients human rights. If the patient had chosen to complain (as he said he was going to do) about the nurses attitude towards him, then the nurse may have well been in trouble. This experience has made me question my future practice as a registered nurse and how I would deal with a similar situation. Arnold and Boggs (2003) suggest that an advocate is someone who speaks out; supporting a person so that their views are heard and their rights are upheld, with the sole purpose of maximising the patients health. I was not assertive as I did not defend the patient and therefore did not fulfil my duty of care by becoming an advocate for the patient, ensuring he was treated with dignity and respect. I was worried about what may happen if I challenged the nurses practice. I need to develop my assertiveness and be able to communicate confidently and effectively with both patients and health care professionals. It is quite easy for a nurse to be an advocate for the patient when there is no stress involved but it can be quite difficult when it goes against other health professionals (Kendrick 1994). In this instance there was a conflict between the patients best inter est and my fear of challenging the nurse. If I had been a more experienced nurse on the endoscopy unit and known the nurse involved in this situation better, I think I may have been able to foresee her reaction to the patient and perhaps may not have approached this particular nurse or used my communication skills together with advocacy to diffuse the situation. Gates (1994) states advocacy is one of the main responsibilities nurses have; it is part of communicating on behalf of the patient and/or their families, acting as a mediator to express their needs and experiences. In health care, communication is fundamental to promoting the safe and effective care of patients. The Department of Health Knowledge and Skills Framework (KSF) (DoH 2004) is a competence framework to support professional development and career progression through the NHS and is about lifelong learning. It has core dimensions essential to providing quality care. Core dimension 1 (level 4) is concerned with communication. It states that the purpose of communication may include advocating on behalf of others. In order for me to progress as a nurse on the endoscopy unit I need to be familiar with and work within the KSF and other guidelines. On reflection, I feel that I did communicate with the patient well. Smith (1995) proposes that reflection does not necessarily entail an incident that was dramatic or negative; it could easily be something positive that a person finds they obtain valuable learning experience from. Communication with the patient has to be one of the most important aspects of nursing care. An integral part of this process is the way a nurse should use and understand body language (Wilkinson 1991). It is as vital a part of the communication process as speaking and should be treated as such. Body language can convey all human emotions either consciously or not and can show a persons true feelings regardless of what they have said (Pease 1984). I could tell by the way that the patient was communicating non-verbally that he was anxious. His facial expressions and posture showed the classic signs of someone being anxious (Teasdale 1995). Seeing this, perhaps I should have explained to the nurse beforehand t hat the patient was anxious so that she may have acted with a bit more respect towards the patient. It is clear that good clear communication skills can improve patient satisfaction and compliance, thus reducing anxiety. I believe that during the admitting process with the patient I did actively discuss the procedure with the patient. I felt that I gave the patient opportunity to ask questions and allay any fears he was harbouring. I sat beside the patient and spoke to him about the procedure in an informal and pleasant manner, giving him opportunity to voice any concerns that he had. I believe that the patient is at their most vulnerable and anxious upon entering the endoscopy unit and some encouraging reassurance makes the patients experience less of an ordeal. It is my opinion that an assessment of a patients personality and level of understanding regarding consent and sedation enables the development of a communication strategy accordingly thus providing a sound knowledge of the test, sedation offered and therefore informed consent. This essay has allowed me to reflect upon my own practice and how I should have acted differently by standing up for the patient at the time, not allowing my own lack of confidence to prevent this. I understand that the care of the patient is my first concern and that I must work with others as a team to protect and promote the health and wellbeing of those in my care (NMC 2008). Perhaps with this understanding, I will be less anxious about felling inferior around other professionals. I will articulate my professional judgement given a similar situation, using what I have been taught which is the best evidence based practice to rationalise my reasons for questioning their practice. I will aim to develop my assertiveness (as I realise that assertiveness does not come naturally to me) to speak out in the interests of the patient, whatever the situation. I will develop my ability to communicate with both patients and other professionals to offer them the opportunity to rationalise their own care delivery and reflect upon it. I believe these actions will enhance my professionalism and promote best practice, in the interest of the patient. I had chosen to focus on communication and advocacy as these are areas in which I feel I need to work on. Gibbs (1998) reflective cycle was used in this assignment because it is a familiar tool that I have found to be useful and uncomplicated. Learning from an experience and then reflecting on that experience is an excellent way of improving the skills in my chosen profession (Kolb 1984). From my own personal point of view, I went into this assignment with some degree of emotional imbalance for the fact that I did not speak out for the patient but now I feel that I have gained in several areas. I feel my reflective skills have increased and with it my confidence regarding tackling such situations again. Also I feel more relaxed with the idea of reflecting uncomfortable incidences because I can see the benefits in doing so.

A Comparison of Two Paintings from the Renaissance Period Essay

A Comparison of Two Paintings from the Renaissance Period Introduction   Ã‚  Ã‚  Ã‚  Ã‚  This paper will compare the themes found in the paintings â€Å"Madonna and Child with St. John the Baptist and an Angel† by Domenico di Bartolomeo Ubaldini (Puligo) and â€Å"Madonna Enthroned† by Giotto. Both paintings deal with fables from the Christian faith but were executed during different periods in art. The Giotto painting was created around 1310 and the Puglio painting was executed between 1518 – 1520. Here, these two paintings have similar themes both at the extreme beginnings and endings of the Italian Renaissance, and as such they serve to present an exceptional example of the developments in art that occurred within that time. This paper shall compare these two paintings through addressing a series of questions on the subject. Subject Matter or Iconography   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Madonna Enthroned† is the earlier of the two works to be surveyed in this paper, and as such there is a great deal more popularity surrounding this work. The image is simple: The subject matter is religious and concerns a host of holy figures surrounding the Madonna with an infant figure of Christ on her lap. â€Å"Madonna and Child with St. John the Baptist and Angel† is similar in that other holy figures are gathered to pay their respects to Christ but the scene is more open and less focused on just the two central figures. â€Å"Madonna and Child†¦Ã¢â‚¬  in my opinion is therefore a more complex composition, where instead of having two recogn...