The war which the world feared upon never happened

The war which the world feared upon never happened, the Cold War. United States of America and the Soviets are preparing for this battle as who among these super powers will really dominate the world. As a means of preparation they are to dominate the seas, especially the under sea navigational fleet, the Submarines.American leaders as a means of preparing for battle put their trust and confidence in their submarine force. Empowered by their own power plants these nuclear submarines are to dominate the seas with unbelievable sophistication and with weapons of incredible destructive power.The idea of submarine came from the Germans who were the ones who pioneered in the creation of the vessel during World War II (Weir, 1998). The US Navy has envisioned that submarines of the future would go deeper and move much faster. Thus as the years passed, the nuclear submarine was created.Under the US military force, the main mission of the first known SSBNs or â€Å"Ship Submersible Ballistic Nuclear† was for the prevention of war to happen. They are to be deployed to strategic sites for them to guard and thus to prevent war   (Weir, 1998). Because of their relentless power, as the nuclear is used to propel them, they have the capability to submerge and circumnavigate the world with fewer expenses. They can submerge for number of days to avoid detection and can easily guard strategic sites as their main mission. They are considered as the guardians of a possible nuclear war.According to David Munns in his book, the greatest advantage so that submarines, armed with ballistic missiles, can release its relentless power is that they have to be close to the shore. This idea was the main basis for the development of the undersea military force of both United States and the Soviet Union. Throughout the 45-year Cold War both countries developed submarines, especially nuclear powered, to gain intelligence or for espionage, due to its stealth power, and to attack and destr oy any possible enemy surface ships. Its powerful ballistic missiles have the ability to attack ground or land based targets. Both countries develop such powerful undersea fleet and were considered as the most potent nuclear threat for both of them. (Munns, 2004)The main idea was that to counter this powerful surface warships and nuclear propelled missile cruisers and aircraft carries they have to develop more powerful underground fleet (Munns, 2004). With the development of the nuclear power, the first ship that was ever built by the Americans that went to sea is the USS Nautilus. It went to sea on January of 1955. It is propelled by pressurized-water nuclear reactor plant. This firs submarine built by the Americans sets the new standard for submarines (Huchtausen, 2002).The Russians on the other hand, built their first submarine which went to sea on a much later date. The K-3 or also known as Leninsky Komosol, it is a part of the November class of attack submarines only went to se a only on 1958. This submarine was the first Soviet sub who have reached the North pole, only in 1962, which the United States first sub USS Nautilus have already done four years earlier. The November class submrines however had serious problems one example was the accident happened in 1968 of its K-27 due to a radioactive gas lead which killed 9 people (Huchthausen, 2002).The next Class of submarines that was built by the Americans was the Skipjack Class Submarines. Built in 1959, this attack submarine was the first to combine nuclear power which has extraordinary speed. This is more hydronamic which has a new teardrop hull design. All other US submarines that was created was based on this design. The known accident that happened for this class of submarine was on May 21, 1968 when the USS Skipjack Scorpion was lost in the sea and was nowhere to be found even due to extensive military search. All the 99 people aboard the submarine also lost their lives (Compton-Hall, 1999).The Sovi et built the Hotel-class submarines on 1960. This is the first Soviet Nuclear subs which carries with it ballistic missiles. The design of the November Class is much similar to that of the November class, but with much larger compartment to accommodate the ballistic missiles (Compton-Hall, 1999). On the same year the Skipjack Class was created, the US Military built the USS George Washington Class. Built and deployed on 1959, this submarine was the first Nuclear Ballistic missile submarine which was created. The main idea for this ballistic missile submarines was that it would attack land-based targets with its nuclear weapons. They are to be deployed near shore targets so that their long range missiles can easily hit their targets.The Soviets then build the Victor Class submarines in 1967. Their design was to attack enemy submarines and to protect surface ships of the Soviets. The new teardrop hull enabled the Victor Class to attain higher speed. The Soviets however abandoned the c onstruction of the second Victor submarine design after learning through spy information that the NATO forces could easily track them (Compton-Hall, 1999). Due to this, the Soviets created the Victor III submarine.The Americans on 1961 built the Thresher Class attack submarines. This submarine is much stronger, much faster, and can dive much deeper. It is also designed to be quieter than the Skipjack Class, the materials used in this class have more streaming improvements. The name was however changed from Thresher Class to Permit Class when the submarine Thresher sank in New England in 1963 killing all 129 crew (Huchtausen, 2002).In 1967, the Soviets created the Yankee Class submarines. This is the first Submarine that has the same firepower as that of the US submarines. This is much quieter than the Hotel Class due to a new hull shape, a new propeller design, and exterior sound-deadening coatings which is much harder to track. Several modifications were also made on this class, wi th its big design it was enabled to carry miniature submarines.On 1976, the Americans built and deployed the Los Angeles class. This class had 62 vessels built and is considered as the world’s largest nuclear-propelled submarine. This class was designed to primarily protect carriers and other enemy submarine. The purpose of this submarine was the same as that of the Soviet’s Victor Class. This submarine however was much more powerful than the Victor class because of its capability to do other special missions such as deployment of Special Forces on the ground and attacking larger targets. The Los Angeles class was also improved for better ice operations on the North and South Pole (Compton-Hall, 1999).The next class built by the Soviet and one of the last Class is the Typhoon class submarine. During its time, in 1981, it was considered as the world’s largest attack submarine. This improved design which is much quieter compared to its size. This submarine is also more maneuverable even if it is huge. The design of this submarine is much more complicated due to the existence of two pressure hulls which is parallel with each other and a third hull which is on top of them. This design increases its width and had simplified internal arrangements. Being part of a cooperative arms reduction program of the former Soviet states, six of the Typhoon class was dismantled in 2003 (Compton-Hall, 1999).The Ohio-class submarine is the last among the long line of designs of the ballistic-missile submarine fleet of US.   It replaced the old 1960s version and was larger and more capable than its precedents.   These subs can carry more and longer-range weapons, operate more quietly, and dive deeper (Compton-Hall, 1999).   Russia, on the other hand, designed the contemporary of Ohio, the Oscar submarines.   These are Russia’s largest and most advanced and are still active submarines.   Designed to attack U.S. aircraft carrier battle groups, it carries three times as many antiship cruise missiles than its predecessors (Compton-Hall, 1999).Norman Polmar and K.J. Moore, were two naval officials under the US Armed Forces who were interviewed by Munns in his book. They said that â€Å"the United States and the Soviet Union put to sea a combined total of 936 submarines, of which 401 were nuclear propelled,† during the whole Cold war from 1945-1991 (Munns, 2004). The Soviet Union was the one who is aggressive in the development of submarines. This development still continues until after the 1970’s where research and effort to make the vessels more powerful were developed.From the mid-1940s until early 1990s, Cold War was a period of conflict and competition between two superpowers, the United States and the Soviet Union.   It was also a period of great technological advancements in the military with no less than the development of nuclear submarines.   Faster, quieter and deadlier weapons were developed. It wa s also this same period which placed the entire world on edge. And knowing the potentials of these weapons, the war that never happened also brought unparalleled relief to mankind.WORKS CITED:Compton-Hall, Richard. The Submarine Pioneers. Sutton Publishing, 1999.Huchthausen, Peter. K-19: The Widowmaker—The Secret Story of the Soviet Nuclear Submarine. National Geographic Books, 2002.Munns, David W. Sea Power. May 2004. Retrieved at http://findarticles.com/p/articles/mi_qa3738/is_200405/ai_n9345820Polmar, Norman and Moore,K.J. COLD WAR SUBMARINES: The Design and Construction of U.S. and Soviet Submarines.   Dulles, Va.: Brassey's, March 2004. 336 pp.Weir, Gary E. Deep Ocean, Cold War. Washington: Brassey’s, 1998.Evolution of Subs: U.S. and Soviet Submarine Milestones of the Cold War. National Geographic. < http://www.nationalgeographic.com/k19/evolution_main.html>

A Professional Moral Compass Essay

Ethics, a branch of philosophy refers to the values for human conduct, considering the rightness and wrongness of actions and motives. As nursing profession is an integral part of the health care environment, the nursing ethics provides the insight to the values and ethical principles governing nursing practice, conduct, and relationships. The Code of Ethics for Nurses, adopted by the American Nurses’ Association (ANA) is intended to provide definite standards of practice and conduct that are essential to the ethical discharge of the nurse’s responsibility (American Nurses Association, 2012) A nurse cultivates personal ethics through personal, cultural and spiritual values which becomes a moral compass for their professional ethics. Personal ethics in combination with the code of ethics often assist the nurses in personal and social decision making during ethical dilemma. This ability prompts them to better respond to needs of the suffering patient and their own well-being. This paper will discuss the personal, cultural, and spiritual values contributing to nurses’ individual worldview and philosophy of nursing and the moral and ethical dilemma being faced in this profession. Values Contributing to Individual’s Worldview and Philosophy of Nursing Born in a Christian middle class Western Indian family, the strict traditional values helped to embed the concept of service, trust, respect, integrity and responsibility through family, friends, education and beliefs. The personal and spiritual belief on the remarks, â€Å"Do to others as you would have them do to you†, from the New International Version of Bible has kindled the concept of service, integrity and respect at an early age of one’s personal life. The cultural quench to care for fellow humans and strive to make difference in one’s own life prompts one to accept Nursing as a profession. Acquaintance to different cultures, languages and religions influences the world views and nursing decisions in providing culturally sensitive care. The traditional spiritual and cultural moral values along with diverse worldviews became the directorial moral compass to take the right decision on behalf of the patients and personal life and empowered to improve the confidence and capability as a nurse. Values, Morals and Ethics in Nursing Practice Values, Morals and Ethics are often reflected as interweaved behavioral rules. Values are one’s fundamental beliefs developed from childhood through family and society. Morals are values that attribute to a system of beliefs. Ethics is the ability to make right and wrong decision based on adopted morals (Navran F. J. , 2010). When values, morals and ethics of an individual have influence over the nurses’ professional conduct, it often tips to conflicting situation in one’s nursing practices. One such situation is the issue of ‘abortion’. When a nurse’ spiritual doctrine is against abortion, it would be against their moral to assist in decision making to abort the baby even when the fetus is deformed, thus arising an ethical dilemma between the personal moral values and the professional ethics. Thus a communication barrier is often felt by nurses while dealing with physicians/ patients during the early days of practice in different cultures but eventually scholar to converse on behalf of the patient and to be an efficient patient advocate. The moral values adopted during the years of experience gets reformed with new believes and practices and hence enables to provide better ethical care during the nursing profession. The Codes of Ethics serves as guidelines when the nurse’s individual moral values conflict with the actions expected from their profession (American Nurses Association, 2012). Morals and Ethical Dilemmas Faced in the Health Care Field As nurse’s role in health care environment varies from caring, communicating, teaching to advocating and leadership, the likelihood of moral and ethical dilemma is inescapable. Such situations arise when there is an opposing conflict among intentions, decisions, and actions between the right and wrong. A common dilemma faced by the care providers is based on religious and spiritual background. Some religions do not support induced death by humans and nurses may have trouble supporting the patient and family about cases like abortion. Although it is the individual’s right to make decisions about their bodies, the religious values do not allow one to be a part of the procedure. Another issue is when nurses encounter’s with patients diagnosed with AIDS or other sexually acquired diseases. The nurses become judgmental towards the patient ultimately interfering in the care of such patients. Any of the above circumstances affects the behavior and decision making to provide quality care to the patients that will place nurses in ethical dilemma, and will force them to turn towards the ethical guidelines set forth by the Code of Ethics for Nurses. The nurses should always strive to safeguard patient’s right, and their well-being while maintaining professional integrity (American Nurses Association, 2010) . Conclusion Nurses’ being the important element of the health care field, their decisions along with commitment plays an essential role for the welfare and safety of humanity. Their decision making capabilities molded from the framework of their personal, cultural and spiritual values often lead them to ethical dilemma. In situation with conflicting moral values, the nurses are expected to be professional and ethical, and refer the Code of Ethics to get guidance for the ethical dilemma to allow nurses to deliver quality care. Although a nurses’ worldview is influenced by the cultural, religion and moral values, one should follow the code to maintain the respectability and integrity of their profession.

Addiction and Addictions Essay Example for Free

Addiction and Addictions Essay ? There are many factors that are damaging today’s society. Addictions are a fast growing concern, it has branched off and caused many problems whether it be related to drugs, alcohol, gambling, sex, Internet, or eating. Addictions are something society faces everyday. Although there are many reasons behind why addiction are growing, and where they stemmed from, today’s society has focused primarily on how someone with an addictions problem can seek help. Also the many Gaps and Barriers around addictions are enabling people who wish to seek help from receiving it. The increasing amounts of people with drug or alcohol addictions has increased vastly over the years especially among young teens who are still yet to be of age to buy alcohol. With addictions being a commonly known problem in society, there should be more awareness put out to people on how to help those with an addiction or more services that are equally accessible for those who wish to seek help on their addictions. Even though drugs and alcohol is widely known as bad in society, people continue to abuse it. Once on has chosen to abuse drugs or alcohol continuously they lose the ability to say â€Å"no† to another drink or † no† to another puff of weed. Soon the person will continuously think about drinking or using drugs, and cannot wait to abuse either substance again. Generally there are two components that stem from drug addiction: physical and psychological dependencies. Physical dependency occurs when a drug has been used habitually and the body has become immune to its effects. Where as psychological dependency occurs where a drug as been used immensely and the mind has become dependant and the mind begins to become emotionally reliant on the effects. Either to feel pleasure or to relieve pain, then the mind does not feel capable of functioning without the drug. Internet addictions not only include an over excessive amount of chat room participation, but it does not help their social or financial well being. Dysfunctional use of the Internet by children as well as adults can result in diminished participation in the family. Over thirty percent of Canada’s population has reported that they use the Internet to escape from everyday life or problems. Either by finding someone else on chat rooms with the same problems or just playing games or â€Å"surfing† the web. Gambling has many traumatic effects in a person’s life if it is abused the wrong way. It can cause people to loose their family; can put a person into bankruptcy, fraud, domestic abuse, theft or even homelessness. Pathological gamblers tend to be under the age of thirty. Six percent of gamblers in Canada commit suicide. The government profit from gambling in Canada is thirteen billion nationally. In Canada 340,000 people have a modern or severe case of a gambling addiction. Food addictions affect mostly a person’s health. Food addictions lead mostly to eating disorders, such as: obesity, diabetes, bulimia and food allergies. An eating addiction is signaled the same way in our brains as an alcohol addiction. Recent studies on rats have proven that eating triggers a pleasure receptor in our brain. Ten percent of people with anorexia or bulimia are male. Eight percent of children in Canada are obese, and twenty three percent are adults. The majority of agencies have no costs, no referrals, are wheelchair accessible and have age limited restrictions. The new internet addiction has left a gap in services, simply because it went so long before it was † discovered†, agencies are just now figuring out ways to support this  addiction. This makes it hard for someone with an Internet addiction to seek help due to the lack of support out there for the general public to use. The majority of services are available from ages thirteen plus. Which limits â€Å"teens† under the age of thirteen with addiction problems help. With today’s society having an increasing amount of children drinking, this set’s a bit of a barrier. Since there are no programs offered for children of a young age who have already begun drinking to seek help it allows the problem to grow instead of getting to it when it is still fresh and not yet a full-blown addiction. Although many services do not offer help to those who are disabled. Addiction services are generally offered only in English, which poses a problem for those who have immigrated to Canada or simply have grown up speaking a different language. The hours for addiction centers is limited, unless it is a housing service, most programs run on the nine to five clock, enabling those who seek help after hours from getting the service that is required by them. This shelter is for men going through withdrawals from drugs or alcohol. They offer a short-term residence. Also give information and education sessions for men in a safe environment. Also provide one on one counseling for individuals in purpose of defining specific needs and how to treat them. They take in men who are inebriated, who are going through withdrawals or that are at high risk of falling into old patterns. Service for this center in 7 days a week 24 hours a day, there is no fee; admission is immediate accordingly to bed availability. Mental Health and Addictions Services in Grey Bruce This program also known as DART (drug and alcohol registry of treatment) is helpful for people with addictions or mental health problems locate treatment options. It also links local communities with assessment and referral programs for themselves or people that they know. CAMH Center For Addictions and Mental Health The largest organization for addictions and mental health in Canada. Its provides research, broad-based education offerings, clinical services and health promotion activities. They provide information on the best services around, their facilities allow you to locate research resource materials, and contribute to addictions and mental health system planning. They are open Monday to Friday 8:30- 4:30, they are only partially accessible, and only provide services in English. This facilities helps youth with drug or alcohol based addictions. They work with clients one on one with any problems they are having. This is a private organization, and the program is only offered through referral. The program allows you to come and go as pleased, unless you are an involuntary client. The councilors help take you through the steps that got you to where you are and also the choices that you made to get you there. Located on downtown Hamilton. The hours are 8:00am to 6:00 pm. Appointments are to be made no walk inn’s are allowed. Throughout this report, there have been examples of all types of addictions. Showing how increasingly they are on the rise, and that day-to-day a new  addiction is born. Without services being available to the new born addictions they continuously grow and there is no way to receive help for them. The amount of young teens becoming addicted to things such as drugs or alcohol has grown increasingly and services are yet to be prepared for that situation. Many of the gaps and barriers within these programs or services are what prevent people from seeking the help they need and deserve. It has been proven that not only are addictions physical they are majority psychological and require a great deal of acknowledgement from family, friends, support groups, and government funded programs, so that people can acquire the amount of treatment necessary. With language and hours of availability being a barrier many people with problems are not getting the help they deserve, Canada needs to broaden its’ options when it comes to addiction programs, allowing twenty-four hour services for people with serious or mild conditions. If the programs continue to enable people from receiving help the amount of people with addictions will continue to increase. Being aware of the problem is the first step to solving one. Addiction and Addictions. (2016, Jul 25).

Popularity of Collegiate Women in Rugby in America Research Paper

Popularity of Collegiate Women in Rugby in America - Research Paper Example Stereotypically, women are expected to cheer lead or at the most play individual sport such as swimming or running track. Most people feel that women-designated sports are figure skating, tennis, and gymnastics. In the early years, sports for women were considered to be recreational rather that competitive considering that hey were informal and without any rules. A research done Griffin has showed the existence of sex role stereotypes. According to the research conducted on four children (two boys and two girls of different ages), there were variation in physical, sociological and psychological characteristics between the sexes. The research showed that the traits that are usually associated with male behavior are desired by both males and females. Griffins insisted in his research that just as there are behavioral traits associated with males and females, there are also activities classified as meant for females or male. One activity that is commonly associated with men is sports. Although females participate in athletics, their efforts are often rewarded with only a few positive results (Griffins, 513). In the article Sex in Education, A Fair Chance for Girls, Dr. Clark stated that women should reduce muscular and brain labor when they are on menstruation (Clarke, 100). Many women became interested in sports to remain physically fit and healthy.   Other females play sports to define their value and satisfy their ego.   There are also those who use sports as a means of liberation.   Women receive psychological satisfaction from staying physically fit, being a part of a team, and competing. It is not surprising that the intense the sport, the more satisfaction women receive. These women began to resist the notion of the weakness of the female body (Field). Women in sports are often misrepresented as being masculine, and may struggle with gender identities in acting out both feminine and masculine roles. Scholars have determined

Project Proposal Requirements Essay Example | Topics and Well Written Essays - 1000 words

Project Proposal Requirements - Essay Example The mission of the organization involves, distributing water and electrical services in a reliable, environmentally safe, and financially effective manner (Fried & Ferris, 2007). AADC has hundreds of employees; and hence it strives to adopt appropriate staff satisfaction measures. The staff motivation approaches used in the project are training, career development and challenging work environment. Job satisfaction entails the experiences of employees at the workplace, and also superior working life quality (Burgoon, 2006). Job satisfaction at AADC is effectively analyzed through significant factors like; working environment, general wellbeing, home-work relationship, work control, and stress at the work place. Employees generally enjoy their work environment, if they achieve significant attributes related to their job. The project aims at illustrating three significant issues at AADC. Firstly, the project will research on the levels of employee satisfaction at the AADC. Secondly, the project illustrates the types of employee satisfaction approaches, which are applied effectively and efficiently at AADC. Thirdly, the project aims at illustrating the management and staff relationship in formulating and implementing the employee satisfaction approaches at the workplace (Rode, 2014). High employee satisfaction levels are very important for the achievement of the short and long term objectives of AADC. This is because high job satisfaction levels increase the motivation of employees. There are several factors that influence motivation levels at the workplace. The factors are broadly categorized into four; environmental factors, effective employee recognition, individual factors, and psychological wellbeing. Communication processes within the organization should be effective, so as to ensure high satisfaction levels. The communication process should adequately involve the input of employees. Work environments which effectively recognize the

Analytical Summaries Essay Example | Topics and Well Written Essays - 1000 words

Analytical Summaries - Essay Example However, author Carey, reduces the intensity of his convincing the readers. The author admits that playing a violent video game may not the exclusive reason for the violent crimes. Other factors may have triggered the violent game players to commit felonies and possibly heinous crimes. It just happened that the youth criminals were violent video game enthusiasts. In some areas, statistics show that an increase in the sale of violent video games showed a decline in the actual crime statistics. To avoid committing crimes, the youth vented their anger or grievances on the video game characters, not on real persons. Author Carey uses several evidences to convincingly support his proposed assertions. Initially, the author uses actual examples to bring his point. The Columbine High School students are purported to act out the fantasy video games’ shooting scenes within the school premises, killing several students and adults. The video gamer acted out the fantasy shooting scenes by killing the Aurora, Colorado Movie audiences. Next, author Carey uses the findings of social research scientists to persuade the readers. One research affirms violent video games can stir up influentially mild aggressive behavior immediately after playing the games. However, the hostile urges are classified as short term consequences of violent video games. The scientists’ researches validly show shooting video games bring out avoidable hostile personalities among the gamers. Finally, author Carey discusses an experiment to convince the skeptics. The experiment focuses on 47 student respondents. They play Mortal Kombat for an estimated 14 minutes. Compared to the non-gamers, the findings proved the students playing the video game were more hostile. However, author Carey insists that the above discussion is not conclusive. Other factors may contribute or aggravate the youths’ engaging in crimes or

Teaching Prediction Essay Example | Topics and Well Written Essays - 750 words

Teaching Prediction - Essay Example The first step encourages metacognitive thinking by having the students think about their own life experiences in relation to the article. A brief explanation of the article or story is presented and students pause to try and make connections with the topic to their own life experiences. This is also the step when students would think about prior learning if the reading were a summary or culminating activity relative to learning in another school subject. Making connections across the curriculum through reading has been shown to also help students retain more important information. The second step in the process is a question sequence that begins with a stated main idea. This is then followed with a question designed to get students to think about how this main idea is connected to their prior learning and experiences. Students are then instructed to write a prediction about what the article or story will say about the main idea based on the students personal experiences with the subject. The last step involves the independent reading of the story or article. They then discuss their predictions as a class and compare their past experiences to the information and experiences conveyed in the text. This method is especially appropriate for a sixth grade literature class. Children this age have had enough life experiences to have a broader range of existing knowledge to draw upon, allowing for a more diverse conversation about each topic. Also, as young adolescents, sixth graders have a growing awareness of themselves. Their metacognitive abilities are rapidly developing or ripe to be developed. Finally, I feel that this is an especially good method to use for sixth grade students because students this age a capable of sustained independent reading. Individual students will vary in their proficiency at this task, but most will be able to accomplish the third step

Genetically Modified Organisms and Concerns of Safety Research Paper

Genetically Modified Organisms and Concerns of Safety - Research Paper Example Humans have long sought to push the boundaries and experiment well outside the zones of comfort and recommendation. Such pushing of the envelope has given us the age of jet travel, space exploration, advanced science, and many other inventions and realities that we would not otherwise have. Yet, the fact remains that pushing the envelope and seeking to engage in something that is unknown is a process which only certain individuals within society have been comfortable at performing. Due to such an understanding, it becomes obvious that expecting all of society to engage in an activity that might be entirely outside of their comfort zone is neither ethical nor advantageous. This is very much the situation with regard to the use of GMOs in food supplies around the globe. With the rapid advance of science, scientists and researchers have been able to genetically modify a host of different plants and organisms as a means of tweaking the way in which they produce. This level of scientific manipulation has been able to provide the world with heartier and more productive crops; however, the fact of the matter is that the true levels of drawbacks that are exhibited within these genetically modified organisms are not fully understood. Due to the level of incomplete knowledge that exists with regard to GMOs within the food, many nations around the world have banned them entirely. However, the United States and several other developed nations have not. As a means of analyzing the potential drawbacks and negatives that GMO might exhibit within a nation’s health and food supply, this particular analysis will focus upon several of these determinants and seek to provide relevant and up-to-date information.

The advantages of living in the East Bay Essay Example | Topics and Well Written Essays - 750 words

The advantages of living in the East Bay - Essay Example ban areas becomes a great competitor for big city life with its constant noise, high level of pollution and fuss, as it is able to meet numerous demands of men seeking calm life free from numerous threats for physical and mental health. In this respect, the East Bay of the San Francisco Bay Area represents a vivid example of suburbs’ popularity among Americans due to the numerous advantages of living in its territory. For the beginning it must be mentioned that the East Bay is distinguished by its coastal living with every possible benefits of such an area. One way or another, the impact of a close proximity of the Pacific Ocean can be felt in all its contrasts being non-covered by muggy air of San Francisco. So, the residents of the bay area have a great opportunity to enjoy Mediterranean climate. Unpolluted air being mixed with favorable effect of the climate on humans’ health attribute to the general attractiveness of the region for families with children of any age. Adding to more or less safe conditions of county life, the quenching Mediterranean climate with its comfortable air temperature appears to be an extremely helpful for upbringing of healthy kids. Altogether, the East Bay climate alongside with remoteness from city pollutants turns to be a charming factor and one of the main advantages of the place. Comfortable houses of modern building design as well as diversity in their choice from ordinary, almost classical ones to penthouses with totally private area for spending vacations and leisure time in personal huge pools, roof-top patios and other facilities for outdoor activities. Anyway, the East Bay is a much more open space, so the life there is certainly more comfortable for a family and an individual than in urban areas. Furthermore, there are accompanying benefits of living not in a large city, namely: absence of problems with parking, neighbors’ placement at a sufficient distance, an opportunity to enjoy nature and communication with it in

Mr. Jayanti Purohit Essay Example for Free

Mr. Jayanti Purohit Essay Q 1. When Shanaya Malkan boarded her Air India flight to London in Mumbai, she was seated in the middle of an unkempt person who apparently had not bathed recently on one side and a baby crying on the other. The person in front of her immediately reclined his seat. Shanaya knew she would not be comfortable in making the seven hour long trip under these circumstances. What can Shanaya do to make the trip more comfortable? Q 2. Ms. Anjali Chaturvedi is the head of the sales division in Fedington Technologies. Whenever she asks for feedback during the departmental meetings, she blasts anyone offering criticism which causes her sub-ordinates to agree to everything she says and not voice their true opinion on the way they manage their functioning. You want to talk to her about it , but what should you say ? List some of the points that you would like to make with when you would discuss this issue with her.

Benefits of Postnatal Debriefing

Benefits of Postnatal Debriefing 215133 POSTNATAL DEBRIEFING STILL VALUED BY WOMEN Introduction Providing debriefing for women in the postnatal period is believed by many midwives to help women to adjust to their childbirth experiences, and to help reduce postnatal psychological morbidity. The evidence base is equivocal in relation to the efficacy of these kinds of interventions, which are typically delivered by midwives in clinical practice. This essay will review several pieces of research relating to postnatal debriefing associated with the psychological distress and potential post traumatic stress disorder associated with childbirth. It will look at the quality of evidence available and discuss some of the parameters of the arguments surrounding the provision of postnatal debriefing, listening and counselling services. It will also make recommendations for practice in relation to this kind of provision, and in relation to future research. Discussion Lavender and Walkinshaw (1998) carried out a randomised trial of a postnatal ‘debriefing’ service provided by midwives, to see what effect it had on psychological morbidity after childbirth. The authors comprise one midwife and one obstetrician, and the midwife has a postgraduate degree, suggestive that they have the skills to carry out and report on such a study. Using a randomised trial design is aimed at filling an apparent gap in the research at the time of the study, in relation to this area of practice (Lavender and Walkinshaw, 1998). This study was carried out â€Å"in a regional teaching hospital in northwest England, and used a sample of â€Å"one hundred and twenty postnatal primigravidas†, who were â€Å"allocated by sealed envelopes to receive the debriefing intervention (n 4 56) or not (n 4 58).† (Lavender and Walkinshaw, 1998 p 215). The study involved the collection of baseline intrapartum and demographic information in order to assess a wid e variety of variables in the study (Lavender and Walkinshaw, 1998). The intervention is described as follows: â€Å" Women randomised to the intervention participated in an interactive interview in which they spent as much time as necessary discussing their labour, asking questions, and exploring their feelings. One research midwife, who had received no formal training in counselling, conducted the interviews, which lasted between 30 and 120 minutes, the duration being guided by the needs of the respondent. Hospital notes were available throughout the interview so that direct questions could be answered. No interview schedule was defined, since the interviews were respondent led.† (Lavender and Walkinshaw, 1998) This approach raises several points. To being with, it is positive that there is such transparency in explaining the intervention, even if the intervention is brief, because it allows the reader to understand the nature, it aids replication, and it demonstrates the lack of specialist knowledge required to perform the intervention. Secondly, it shows that a research midwife, who was not a counsellor, was carrying out the intervention. And thirdly, it demonstrates a woman-focused, midwifery-oriented approach, in that the interviews were respondent led and the length was not limited. Such an approach reflects midwifery philosophies which makes the article useful for midwifery practice. Lavender and Walkinshaw (1998) used an established data collection instrument, the Hospital Anxiety and Depression (HAD) scale, which was administered by postal questionnaire 3 weeks after delivery. Using an established data collection instrument adds strength to the study, but there is a small amount of unreliability about postal questionnaires, because there is never any guarantee that they are filled out by the person they are sent to. Using the pre-tested scale allowed the authors to compare the proportion of women in each group with anxiety and depression scores of more than 10 points, using odds ratios and 95% confidence intervals, both of which are acceptable statistical applications for these data. The 95% response rate ensured a good sample size (Lavender and Walkinsahw, 1998), although the study would have had even more statistical significance if it could have been carried out across more than one site. The benefits of this intervention were established by the study, but the authors raise some concerns, including concern at the high levels of morbidity detected, and question whether using the chosen scale was appropriate for measu ring psychological morbidity after childbirth (normal or abnormal) (Lavender and Walkinshaw, 1998). This study is limited now by its age, and by being superceded by more recent studies. Kershaw et al (2005) carried out a prospective randomised controlled trail with two arms, which compared debriefing methods after birth which were aimed at reducing fear of future childbirth. As can be seen, this studied a more specific intervention, in relation to a very specific outcome, rather than measuring psychological morbidity per se. This would make it more applicable to specific aspects of practice. This study was also carried out in one site, and the authors provide details of the hospital site, which this author would question due to the issue of confidentiality. Kershaw et al (2005) focused on mothers whose first birth was an operative delivery, and gained ethical approval. More details about the ethics of this study would have enhanced its quality. Kershaw et al (2005) provide their inclusion and exclusion criteria, but do not discuss controlling for other variables. They also use a pre-established measurement tool to assess the fear of childbirth experienced by the stu dy participants (Kershaw et al, 2005). They do subsequently present demographic information, and they use a range of suitable statistical tests, explaining the significance of these, which makes it easier for the novice reader to begin to assess the quality of the data analysis. This again was a debriefing intervention carried out by midwives in the postnatal period (Kershaw et al, 2005). However, unlike the previous study, this one differed because the debriefing was held on two separate occasions, and sessions were held at home (Kershaw et al, 2005). Another significant element of this study was that the midwives involved received training in critical incident stress debriefing (Kershaw et al, 2005). The authors justify their study as follows: â€Å" In this study fear of childbirth and post-traumatic stress were measured rather than maternal depression and general health. It was decided not to measure maternal depression as research has suggested this is frequently associated with factors not related to childbirth. Women were allowed sufficient time to debrief, sessions lasted up to an hour and a half.† (Kershaw et al, 1508). This shows some strengths, including a focus on specific psychological features, rather than on general health and depression, which can be difficult to assess. Although the authors state women were allowed sufficient time for the session, this study does not reflect the kind of midwifery philosophy that the Lavender and Walkinshaw (1998) study did. The findings from this study do not support the use of this particular intervention in this particular population. â€Å"The findings of this study demonstrated in the short term no significant difference in the WDEQ fear of childbirth scores and IES emotional distress scores. These findings show community-led debriefing is not proven to be of any value in reducing women’s fear of childbirth following an operative delivery.† (Kershaw et al, 2005 p 1508). However, this study may not be the last word on this kind of intervention, and there are limitations, including the focus only on women who had operative deliveries, focusing on one site, and in the intervention itself. Maybe the nature of the intervention, and the training provided for midwives, was limited. The authors agree that a longer-term evaluation might show different results (Kershaw et al, 2005). It might be that the data collection tool was inappropriate, as with the previous study. However, this study, as with the previous one, does establish the usefulness and facility of midwives providing postnatal support of this kind. Kershaw et al (2005) show that midwives identified those women who would be needing debriefing, but this author would argue that midwives are not experts in mental health, and limiting debriefing to those identified by midwives as at higher risk might miss important cases. Reading between the lines of this study seems to imply that this intervention is valued by midwives and by patients, despite the findings of the statistical analysis. Small et al (2000) carried out a randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth, again, focusing on women who are viewed as potentially at higher risk of mental health morbidity postnatally. This study was carried out in a large maternity teaching hospital in Melbourne, Australia, unlike the previous two studies, which were carried out in the UK. Small et al (2000) had a sample of 1041 women who had given birth by either caesarean section (n = 624) , by assisted vaginal delivery using forceps (n = 353) or vacuum extraction (n = 64), and these women were randomised to the intervention group or the control group (Small et al, 2000). The sample size was statistically calculated for significance, which is a strength of the study. The methodology is clear and the randomisation process described. The intervention â€Å"provided women with an opportunity to discuss their labour, birth, and post ­delivery events and expe riences† (Small et al, 2000 p 1044). Although there is a woman-centred focus in this study, only 1 hour maximum was allowed for the discussion, which this author would suggest is a severe limitation of this intervention in relation to woman-centred debriefing. The midwives were not trained but described as experienced and skilled. The main outcome measures were â€Å"maternal depression (score >13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF ­36 subscales) measured by postal questionnaire at six months postpartum† (Small et al, 2000 p 1044). Again, established scales are being used to lend strength to the study. Small et al (2000) found that â€Å"more women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio = 1.24, 95% confidence interval 0.87 to 1.77)† and â€Å"they were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio = 1.37, 1.00 to 1.86).† (p 1043). According to this study, the authors demonstrated that midwife led debriefing following operative births was not only not effective in reducing maternal morbidity (in particular, psychological morbidity), at the six month point after delivery, but that it may have been a contributing factor to emotional health issues for certain women (Small et al, 2000). This author would suggest that it might be the nature of the intervention that is the issue here, because it was provided in hospital, soon after birth, and may not have been particularly woman-centred. Cultural differences between Australian women and UK women cannot be ruled out; neither can cultural differences in models of care and practice. Priest et al (2003) carried out a randomised single-blind controlled trial, stratified for parity and delivery mode, to test whether critical incident stress debriefing after childbirth reduces the incidence of postnatal psychological disorders, also in Australia, in two maternity hospitals. They had a large enough sample size, consisting of 1745 women who delivered healthy term infants between a specificed time period, with 75 allocated to the intervention group and 870 to control group (Priest et al, 2003). Again, the study design is transparent, and the randomisation process clear. As with the previous study by Small et al (2000), the intervention was carried out soon after delivery, but this intervention consisted of an individual, standardised debriefing session based on the principles of critical incident stress debriefing. The intervention is described briefly, and it is stated that the midwives were trained in the intervention (Priest et al, 2003). However, the intervention i tself and the training is not really described in great detail, which affects replication of the study. The intervention is based on theories which are not specifically developed for childbirth trauma, but that have been adapted, and this may be a weakness. As with the other studies, recognised outcome measures are used. Priest et al (2003) found that â€Å"there were no significant differences between control and intervention groups in scores on Impact of Events or Edinburgh Postnatal Depression Scales at 2, 6 or 12 months postpartum, or in proportions of women who met diagnostic criteria for a stress disorder (intervention, 0.6% v control, 0.8%; P = 0.58) or major or minor depression (intervention, 17.8% v control, 18.2%; relative risk [95% CI], 0.99 [0.87–1.11]) during the postpartum year. Nor were there differences in median time to onset of depression (intervention, 6 [interquartile range, 4–9] weeks v control, 4 [3–8] weeks; P = 0.84), or duration of depression (intervention, 24 [12–46] weeks v control, 22 [10–52] weeks; P=0.98).† (p 544). This leads to the conclusion that this single session of midwife led, specific debriefing was ineffective as a means of prevention of postnatal psychological disorders (Priest et al, 2003). While the authors conclude that the intervention had no ill effects (Priest et al, 2003), this author finds these findings significant in their lack of support for the intervention, and would suggest, again, that it may be the nature of the intervention that is leading to these kinds of results. Gamble et al (2005) carried out a randomised controlled trial to assess the effectiveness of a counselling intervention after a traumatic childbirth, based on a midwife-led brief counselling intervention for women deemed at risk of developing symptoms of psychological symptoms postnatally. This was a smaller study group, with only 50 in the intervention group and 53 in the control group, and the intervention was also provided as face to face counselling within 72 hours of birth, as with the previous study, but also had a telephone counselling session at between four and six weeks postnatally (Gamble et al, 2005). The allocation/randomisation process is described, but the midwife was not blind to the randomisation, which may represent a potential source of bias. Established data collection scales were used as with all the previous studies: â€Å"Edinburgh Postnatal Depression Scale (EPDS) , Depression Anxiety and Stress Scale-21 (DASS-21) , and Maternity Social Support Scale (MSSS)â €  (Gamble et al, 2005 p 13). Gamble et al (2005) measured the following outcome measures: posttraumatic stress symptoms, depression, self-blame, and confidence about a future pregnancy. Gamble et al (2005) provide great detail about the underpinnings of the therapeutic intervention, and there is a midwifery/woman-centred focus to the intervention (and, by association, to the study). Gamble et al (2005) found their intervention to be effective in reducing symptoms of trauma, depression, stress, and feelings of self-blame. All of these studies fall within the scope of good standards of evidence for practice, but find marked differences between studies in relation to efficacy and non-efficacy of interventions. There may be a number of reasons for this. Only one study suggests potential negative effects of this kind of intervention, but this was not conclusive and warranted further investigation. However, the literature around this subject does seem to predominantly suggest that such interventions are useful for women following birth. Axe (2000) suggests that women can use such support to help them cope with the difference between their expectations and experiences of birth. Robinson (1999) argues for the increasing occurrence of post traumatic stress disorder following traumatic childbirth, and suggests that this is under-diagnosed and represents a significant maternal morbidity which needs addressing, a suggestion also found by Ayers and Pickering (2001). Creedy et al (2000) state that â€Å"posttraum atic stress disorder after childbirth is a poorly recognized phenomenon,† and that â€Å"women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate† (p 104). Therefore, the focus on debriefing may not be the only way forward to improve psychological morbidity – there may be a need for research to explore ways of reducing the trauma that occurs in the first place. Czarnocka and Slade (2000) suggest that there may be opportunities for prevention of post traumatic stress and psychological morbidity after birth, through providing care in labour that enhances perceptions of control and support. One study demonstrates that negative experiences of interactions with maternity staff can contribute to psychological morbidity (Wijma et al, 1997). Kenardy (2000) suggests that it is the nature of the debriefing that may be ineffective in those studies that have found such results. Gamble et al (2002) also suggest that the kind and timing of the debriefing warrants further investigation. Hagan et al (1996) did not find any reduction in psychological morbidity following this kind of intervention. Alexander (1999) suggests that some of the problems may be linked to the lack of clarity and understanding that exists about these processes, which are neither necessarily formal psychological counselling nor a simple sharing session. Yet there does seem to be some indication that these kinds of supportive therapies are found to be useful by women and by midwives. Westley (1997) describes providing women with the opportunity to talk about their birth experiences, and have their questions answered, as useful, a finding supported by Smith et al (1996), Phillips (2003), Inglis (2002), Dennett (2003), Charles (1994), Charles and Curtis (1994), Baxter et al (2003), and Allott (1996). Certainly, a range of literature established post-traumatic stress disorder as a potential and/or real psychological morbidity for women having had a baby (Ayers and Pickering, 2001; Creedy et al, 2000; Laing, 2001; Menage, 1996; Robinson, 1999; Ballard et al, 1995; Crompton, 1996). Psychological debriefing interventions may be effective in preventing or managing post traumatic stress disorder in a range of situations (Rose et al, 2004), but there would seem to be some dangers inherent in some of the interventions found in the literature ( Kenardy, 2000; Madden, 2002). Conclusion It would appear from the randomised controlled trials analysed here that while some evidence supports postnatal debriefing as a means of reducing psychological morbidity, significant evidence shows no correlation between postnatal interventions of this kind and improved emotional health outcomes. However, anecdotal evidence and other literature suggests that midwives and women find some benefit from opportunities to talk about their childbirth experiences. Some of these simply allow women an opportunity to talk and to ask questions about what happened to them. This leads to the conclusion that such interventions require much more research, preferably research which includes detailed, qualitative evaluations of interventions, and interventions which are specifically designed for this client group. 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