Reflective Essay On Breaking Bad News To Patients Nursing Essay

Reflective Essay On Breaking Bad News To Patients Nursing Essay Im writing a reflective essay based on Gibbs model of refection, this is a six stage evaluation process and promotes good practice through evaluation of experiences, aids learning and better understanding on how to deal with similar situations in future practice, the six stages comprise of description, feelings, evaluation, analysis, conclusion and finally an action plan (Gibbs, 1998). The department of health (DoH) advises primary care, to use reflective practice and encourages integrated working with all professional within the community and hospitals of the local trust (DoH, 2000), which is incorporate in my reflection. All names and identities have been changed to maintain confidentially in accordance with the code of conduct (NMC, 2009). I will explore an experience I had whilst based in a local trust hospital, discussing a situation that I felt uncomfortable with and unsure how to manage emotionally, psychologically and professionally. This situation evolved after a patient had been giving bad news by a doctor and talks about the events after this occurred. I feel it is important to discuss breaking bad news as this area of communication is often an area that even the professional person finds difficult (Brewin, 1998). The inter-professional teams all have different education and preparation leading to different views as to how the subject should be managed and the best way to break bad news. Schildman et al. (2005) stated there is a need for specific education on breaking bad news, ensuring all professionals where proficient in this area with an aim to improve skills and continuity. By bad news Buckman (1984) described as any information given that is likely to dramatically alter a patients view of their future. The bad news that is delivered may not be about terminal illness or death but could be a lifestyle altering condition like diabetes, heart disease or HIV (Peate, 2006). Arber Gallagher (2004) defined bad news as any information given that is not welcome. Traditionally delivering bad news has been considered the doctors role, despite having little education or preparation in this area (Vandekieft, 2001). Although a nurse may not be delivering bad news directly, it is an inescapable part of healthcare (Price, 2006) and an integral part of their role (Tobin Begley, 2008). It is however, important to remember that the role of breaking bad news is not the responsibility of just one profession but should be a shared responsibility with all the inter-professionals within the multi disciplinary team (Jevon, 2010). Mr M, 72 year old male, admitted to the ward and initially presented with intense intermittent pain in pelvic area and legs. After several investigations with other hospital inter-professional teams Mr M underwent tests such as x-rays, cat scans and MRI scans. This led to a diagnosis that Mr M had bone and lung metastases, this is also known as secondary cancer. Metastatic cancer occurs when the cancer cells breaks from the primary site, relocate to another area of the body and then forms secondary tumours (American Cancer Society, 2010). Cancer is deemed as the most feared diagnosis in todays society (Kalber, 2009). The junior doctor had discussed these results with Mr M, whilst he remained on the ward and without another member of staff with him during the conversation. It is suggested that bad news should be delivered to the patient by someone they know (Lomas et al, 2004). This leads to a much debated subject as to who should break bad news (Brewin, 1998), due to the belief that some doctors are not well prepared and have lack of training and preparation for this task (Vandekeift, 2001). Whereas, the nurses have more communication with the patient and can build a better rapport (Jevon, 2010). The doctor with Mr M should have made him aware, that he had terminal cancer but we were unable to verify this. The written information in Mr Ms notes where thought by the nurses to be to brief and therefore not well recorded due to a lack of in-depth detail but the doctor could argue the notes were ok, they had acknowledge he had spoken to Mr M about his results. After the doctors consultation Mr M was positive and upbeat and still trying to do as much as he could for himself. Later that day he had spoken to me stating that the doctor wanted to run more test, informing me that they were going to look for the primary cancer site as this may be treatable. My intrinsic feeling was that Mr M thought he could be cured. This made me feel awkward and uncomfortable being around him and I found it difficult to know what to say to him, as I was aware of his terminal diagnosis. I was unsure as to what information the doctor had told Mr M or if the doctor had checked he had understood. As doctors have different education and views than the nursing staff it leads to professional indifferences. Mr Ms behaviour may have been his way of coping and could have indicated that he was in denial. Denial is a way for the individual to cope and regain some control, when bad news is delivered leading to an uncontrollable situation like a diagnosis of terminal illness (Burgess, 1994). I felt as if I was withholding information from him that he should be aware of. This made me feel as if I was lying to Mr M, something I was uncomfortable with and I felt compromised ethically, as I was more that aware of his rights to be informed and my code of conduct that states I should be open and honest (NMC, 2008). This made me want to avoid conversation with Mr M as I was unsure how to manage the situation and was worried in case he asked me any questions, as this could have led to further distress to myself or Mr M. However, it is normal when giving or receiving bad news to feel psychological distress but if supported and managed well you can avoid damaging long terms effects (Fukui et al, 2009). I had discuss with nurse in charge that I had concerns about Mr M and queried if he had definitely been told of his terminal diagnosis. Mr Ms mood and behaviour was monitored by the nursing staff over the next two weeks, with occasional subtle prompts for him to a sk any questions or to comment on how he felt. After this time the palliative care team were informed of Mr Ms situation and invited to the ward by the nursing team, to talk to Mr M and explain his illness was terminal, help him acknowledge this and start to come to terms with his situation and prepare himself and his family with what was to come. The palliative care team have more experience and practice in communication with those diagnosed with terminal cancer. The terminal patient can experience many different emotions (Peate, 2006), these have been studied by Kulber-Ross in the 1960s and Murry-Parkes in the 1980s. They both suggest that there are five stages of grief and structured these into models of bereavement (sometime known as the grief cycle). Kulber-Ross (1969) stated that not every person will react in the same way or go through all the stages in order. The five stages are Denial, Anger, Bargaining, Depression or grief and then Acceptance. A dying patient will often go through these stages whilst coming to terms with their own death (Kulber-Ross, 1969). I felt it was good that Mr M had taken onboard some of the information the doctor had told him and he was in good spirits and trying to do as much as possible. That Mr M was able to communicate well with the nursing team and had benefited from the expertise, kindness and knowledge from all the inter-professional teams from the porters who regularly moved Mr M and showed patience and understanding regarding his pain, to the reassurance given him by the radiographers and their expertise to minimise his discomfort, pain and the palliative care team who showed patience and understanding and with their unique knowledge were able to help Mr M come to terms with his terminal cancer, understand it better and help him cope with his situation. All these people are specialist in their own fields and were involved with Mr Ms care amongst several others. It was good that personally I had built a good rapport with Mr M, which helped me to be aware of his behaviour and highlight my concerns with th e nurses. Enabling me to raise awareness and question the nurses as to if Mr M had been informed of his diagnosis or question was he in denial? I thought it was bad that no-one who had worked regularly with Mr M i.e. a nurse was with the doctor when he was told his diagnosis and that it was a junior doctor that Mr M did not know very well. The information about the discussion hadnt been recorded in detail, as to what was said and if Mr M had understood this information. So we had to make assumptions due to the lack of detail, we could only ascertain if Mr M was in denial through time. Also that I felt I had to avoid communication with Mr M as I found it difficult due to his terminal illness and was unsure what to say to him. I realised talking about dying directly with the dying patient an area I was uncomfortable with and felt unprepared for and therefore avoided the situation. This is echoed by Trovo de Arujo and de Silva (2004) where he suggested that many people will approach communication differently with a dying patient; this includes avoidance patterns, which may be due to difficulties in coping with human suffering a nd death. I have to assume the doctor had given Mr M the correct information about his diagnosis, which left the conclusion that Mr M had not fully understood this information or was in denial about his terminal cancer. I should have contacted the doctor who consulted with Mr M to ascertain as to how the information was given and how he felt Mr M had responded to this. Explaining Mr Ms current behaviour and his understanding that they were still looking for the cause of the cancer and this when located could be treated. This may have improved the situation, by leading to the doctor returning to re-explain to Mr M with another member of the ward. It is now thought that the doctor may not be the most appropriate person to give bad news and in some situations it may be better for a nurse to do this role (Resuscitation Council UK, 2006). If I was presented with a similar situation, I now feel I would manage the situation better, as I have learnt through reflection of these events. Sometimes caring for a dying patient can be daunting as in our nursing role we believe we are there to improve a patients health so they will get better (Peate, 2006) but the reality is we have a unique role to assist the patient to health or to a peaceful death (Henderson, 19996). Common sense and forward planning, the use of a structured model can help prevent any distress or communication disasters (Walker et al, 2001). I feel that the communication of bad news should be delivered to a patient avoiding medical terminology (Back et al, 2005), as this reduces misinterpretation (Innes, 2009). The inter-professional teams will benefit the individual by supporting each other and drawing on each others knowledge, helping to reduce long term distress (Fukui et al, 2009) or further avoidance of distressing situations. It is also important to be aware that every patient will react differently to bad news (Kulber-Ross, 1969) and to remember their family will also require lots of information and support at this time (Dougherty Lister, 2008).

Opinion Essay

With a proper cable obstruction, one's television can display 75+ channels of moving pictures. At some point in our lives, we have watched television. There are numerous reasons why television appeals to many people. In an effort to appeal to large numbers of people, many television shows look to outdo one another for ratings. Unfortunately, a quest for ratings sometimes leads to a lack Of valuable and educational material. While it is easy to chastise television for some of its raunchier shows, we might agree that television can offer some valuable, quality television programs.For this essay assignment, consider the following: In your opinion, is television good or bad for American society? In either case, what evidence can you provide to strengthen your point? For this essay, you will want to do the following: Choose 1 or 2 shows that can help strengthen your argument (focusing on too many shows will cause you to lose track of your main point) Incorporate outside sources that agree and help strengthen your position in the essay (a minimum of 2 sources are required aside from your television show as an example) Remember that it is not enough to say, â€Å"Television is bad† or â€Å"Television is a good thing. You must explain how and why. PAP Format: Engel is 3 pages Font: Times New Roman Spacing: double-spaced Remember, a strong essay will have a clear thesis statement that establishes your position. The remainder of your essay will support your thesis statement with reasons and evidence. Module 1 Homework Assignment Instructions upon reading the Essay 1 prompt, you will consider your position on the essay topic. Your task for this Module 1 Homework Assignment is to submit an introductory paragraph with a thesis statement regarding the above essay topic.Remember that a thesis is the claim or main idea or premise of an argument, so you will submit your claim in this Module 1 Homework Assignment. F-or some information about writing thesis statements, p lease read Tips and Examples for Writing Thesis Statements (Purdue Online Writing Lab). Since you have to submit a thesis statement for this assignment, it will help to include an introductory paragraph. Remember that a thesis statement (your claim/argument) is usually placed toward the end of the introductory paragraph.By including your thesis statement in your introductory paragraph, you allow your reader to understand your argument early in the essay. Once you have an introductory paragraph with a strong Hess statement, the remainder of your essay will flow better. There is a very high concentration of violent and sexually suggestive shows on television. In certain circumstances, however, television can be a powerfully beneficial medium, when used properly. The American society has taken too much of an entertaining stance to television, and children now are too involved in the wrong types of shows.Although television has many positive aspects, the potential negative consequences of some shows outweigh the positive. Part II: Using Appeals Directions: After you have written your introduction and thesis statement, oh should consider what you will use in order to convince your audience. For each – ethos, pathos, and logos – write a paragraph in which you describe how you would use this appeal in your essay. Ethos (Credibility), or ethical appeal, means convincing by the character of the author. We tend to believe people whom We respect.One of the central problems of argumentation is to project an impression to the reader that you are someone worth listening to, in other words making yourself as author into an authority on the subject of the paper, as well as someone who is likable and worthy of respect. With the respected community of the PAP and CAP on childhood psychiatry, one can trust that with the research the medical professionals are conducting, credible information will be portrayed. Common Sense Media is dedicated to the media aspect Of c hildhood, and its information is verifiable through various outlets.Debate. Org is a community based website where every day people can make their opinions heard. With the diverse group represented here, there are many differing backgrounds weighing in on the presented scenarios. Pathos (Emotional) means persuading by appealing to the reader's emotions. We can look at texts ranging from classic essays to contemporary advertisements to see how pathos, emotional appeals, are used to persuade. Language choice affects the audience's emotional response, and emotional appeal can effectively be used to enhance an argument.With childhood obesity at an all-time high in the United States, something needs to be done. After years of watching television, missing countless opportunities for physical exercise, more Americans are becoming overweight, causing a wide variety of health issues. A body at rest tends to stay at rest, while a body in motion tends to stay in motion. This reflects on how me tabolism is slowed when someone is crushing the couch cushions in front of the television. Logos (Logical) means persuading by the use of reasoning.This will be the most important technique we will study, and Aristotle favorite. We'll look at deductive and inductive reasoning, and discuss what makes an effective, persuasive reason to back up your claims. Giving reasons is the heart of argumentation, and cannot be emphasized enough. We'll study the types of support you can use to substantiate your thesis, and look at some of the common logical fallacies, in order to avoid hem in your writing. Data on obesity is perfectly clear. Americans are gaining weight at an alarming rate.At the risk of condoning television watching, flip through the channels and see how many commercials for both weight loss supplements and exercise programs are for sale. It is a matter of common sense that Americans are becoming lazy and would choose to take a pill to lose weight over physical exercise. There ha ve been many studies showing that childhood obesity is linked to the hours spent watching television. The Center for Disease Control and Prevention states that obesity now effects 7% of all children and adolescents in the united States, which is triple the rate from just one generation ago. Opinion Essay With a proper cable obstruction, one's television can display 75+ channels of moving pictures. At some point in our lives, we have watched television. There are numerous reasons why television appeals to many people. In an effort to appeal to large numbers of people, many television shows look to outdo one another for ratings. Unfortunately, a quest for ratings sometimes leads to a lack Of valuable and educational material. While it is easy to chastise television for some of its raunchier shows, we might agree that television can offer some valuable, quality television programs.For this essay assignment, consider the following: In your opinion, is television good or bad for American society? In either case, what evidence can you provide to strengthen your point? For this essay, you will want to do the following: Choose 1 or 2 shows that can help strengthen your argument (focusing on too many shows will cause you to lose track of your main point) Incorporate outside sources that agree and help strengthen your position in the essay (a minimum of 2 sources are required aside from your television show as an example) Remember that it is not enough to say, â€Å"Television is bad† or â€Å"Television is a good thing. You must explain how and why. PAP Format: Engel is 3 pages Font: Times New Roman Spacing: double-spaced Remember, a strong essay will have a clear thesis statement that establishes your position. The remainder of your essay will support your thesis statement with reasons and evidence. Module 1 Homework Assignment Instructions upon reading the Essay 1 prompt, you will consider your position on the essay topic. Your task for this Module 1 Homework Assignment is to submit an introductory paragraph with a thesis statement regarding the above essay topic.Remember that a thesis is the claim or main idea or premise of an argument, so you will submit your claim in this Module 1 Homework Assignment. F-or some information about writing thesis statements, p lease read Tips and Examples for Writing Thesis Statements (Purdue Online Writing Lab). Since you have to submit a thesis statement for this assignment, it will help to include an introductory paragraph. Remember that a thesis statement (your claim/argument) is usually placed toward the end of the introductory paragraph.By including your thesis statement in your introductory paragraph, you allow your reader to understand your argument early in the essay. Once you have an introductory paragraph with a strong Hess statement, the remainder of your essay will flow better. There is a very high concentration of violent and sexually suggestive shows on television. In certain circumstances, however, television can be a powerfully beneficial medium, when used properly. The American society has taken too much of an entertaining stance to television, and children now are too involved in the wrong types of shows.Although television has many positive aspects, the potential negative consequences of some shows outweigh the positive. Part II: Using Appeals Directions: After you have written your introduction and thesis statement, oh should consider what you will use in order to convince your audience. For each – ethos, pathos, and logos – write a paragraph in which you describe how you would use this appeal in your essay. Ethos (Credibility), or ethical appeal, means convincing by the character of the author. We tend to believe people whom We respect.One of the central problems of argumentation is to project an impression to the reader that you are someone worth listening to, in other words making yourself as author into an authority on the subject of the paper, as well as someone who is likable and worthy of respect. With the respected community of the PAP and CAP on childhood psychiatry, one can trust that with the research the medical professionals are conducting, credible information will be portrayed. Common Sense Media is dedicated to the media aspect Of c hildhood, and its information is verifiable through various outlets.Debate. Org is a community based website where every day people can make their opinions heard. With the diverse group represented here, there are many differing backgrounds weighing in on the presented scenarios. Pathos (Emotional) means persuading by appealing to the reader's emotions. We can look at texts ranging from classic essays to contemporary advertisements to see how pathos, emotional appeals, are used to persuade. Language choice affects the audience's emotional response, and emotional appeal can effectively be used to enhance an argument.With childhood obesity at an all-time high in the United States, something needs to be done. After years of watching television, missing countless opportunities for physical exercise, more Americans are becoming overweight, causing a wide variety of health issues. A body at rest tends to stay at rest, while a body in motion tends to stay in motion. This reflects on how me tabolism is slowed when someone is crushing the couch cushions in front of the television. Logos (Logical) means persuading by the use of reasoning.This will be the most important technique we will study, and Aristotle favorite. We'll look at deductive and inductive reasoning, and discuss what makes an effective, persuasive reason to back up your claims. Giving reasons is the heart of argumentation, and cannot be emphasized enough. We'll study the types of support you can use to substantiate your thesis, and look at some of the common logical fallacies, in order to avoid hem in your writing. Data on obesity is perfectly clear. Americans are gaining weight at an alarming rate.At the risk of condoning television watching, flip through the channels and see how many commercials for both weight loss supplements and exercise programs are for sale. It is a matter of common sense that Americans are becoming lazy and would choose to take a pill to lose weight over physical exercise. There ha ve been many studies showing that childhood obesity is linked to the hours spent watching television. The Center for Disease Control and Prevention states that obesity now effects 7% of all children and adolescents in the united States, which is triple the rate from just one generation ago.

Kill A Mocking Bird And Trayvon Martin s Black Lives...

Samantha Ekanem Mrs. Nelson Pre ­AP English 2 24 August 2015 To Kill A Mocking Bird From Trayvon Martin to ‘Black Lives Matter’ People have different opinions and views on subjects and we won’t always agree with them or understand why they think that way. â€Å"You never really understand a person until you consider things from his point of view... Until you climb inside of his skin and walk around in it.† I like that Atticus is teaching his kids valuable lessons. We don’t know what makes someone act or dress or do the things they do, so we make assumptions and conclusions in order to â€Å"understand†, but the only true way of understanding someone is through sympathy and compassion. I value this next quote because I believe a lot of what Atticus is saying still applies today. Not just white men cheating black men but white people in general cheat colored people everyday simply for being white. â€Å"As you grow older, you ll see white men cheat black men every day of your life, but let me tell you something and don t you forget it - whenever a white man does that to a black man, no matter who he is, how rich he is, or how fine a family he comes from, he is trash.† For example in today’s society we have wage gaps, people get paid based on what their race is even if they share the same job and do the same work. Even though today we like to deny racism exists, it does we just chose to ignore it. Again in the book we see Atticus teaching his children that making assumptions and

A Brief History of U.S.-Israeli-Palestinian Relations

Even though Palestine is not an official state, the U.S. and Palestine have a long history of rocky diplomatic relations. With Palestinian Authority (PA) head Mahmoud Abbas set to appeal for the creation of a Palestinian state at the United Nations on September 19, 2011—and the U.S. set to veto the measure—that foreign policy history is again in the spotlight. The story of U.S.-Palestinian relations is lengthy, and it obviously includes much of the history of Israel. This is the first of several articles on the U.S.-Palestinian-Israeli relationship. History Palestine is an Islamic region, or perhaps several regions, in and around the Jewish-state of Israel in the Middle East. Its four million people live largely in the West Bank along the Jordan River, and in the Gaza Strip near Israels border with Egypt. Israel occupies both the West Bank and Gaza Strip. It created Jewish settlements in each place, and has waged several small wars for control of those areas. The United States has traditionally backed Israel and its right to exist as a recognized state. At the same time, the U.S. has sought cooperation from Arab nations in the Middle East, both to achieve its energy needs and to secure a safe environment for Israel. Those dual American goals have put Palestinians in the midst of a diplomatic tug-of-war for nearly 65 years. Zionism Jewish and Palestinian conflict began at the turn of the 20th Century as many Jews worldwide began the Zionist movement. Because of discrimination in the Ukraine and other parts of Europe, they sought territory of their own around the Biblical holy lands of the Levant between the coast of the Mediterranean Sea and the Jordan River. They also wanted that territory to include Jerusalem. Palestinians also consider Jerusalem a holy center. Great Britain, with a significant Jewish population of its own, backed Zionism. During World War I, it took control of much of Palestine and maintained post-war control through a League of Nations mandate finalized in 1922. Arab Palestinians revolted against British rule on several occasions in the 1920s and 1930s. Only after Nazis staged mass executions of Jews during the Holocaust of World War II did the international community begin backing the Jewish quest for a recognized state in the Middle East. Partitioning and Diaspora The United Nations authored a plan to partition the region into Jewish and Palestinian areas, with the intention that each become states. In 1947 Palestinians and Arabs from Jordan, Egypt, Iraq, and Syria began hostilities against Jews. That same year saw the beginning of a Palestinian diaspora. Some 700,000 Palestinians were displaced as Israeli boundaries became clear. On May 14, 1948, Israel declared its independence. The United States and most members of the United Nations recognized the new Jewish state. Palestinians call the date al-Naqba, or the catastrophe. Full-blown war erupted. Israel beat the coalition of Palestinians and Arabs, taking territory that the United Nations had designated for Palestine. Israel, however, was always felt insecure as it did not occupy the West Bank, the Golan Heights, or the Gaza Strip. Those territories would serve as buffers against Jordan, Syria, and Egypt respectively. It fought—and won—wars in 1967 and 1973 to occupy those territories. In 1967 it also occupied the Sinai Peninsula from Egypt. Many Palestinians who had fled in the diaspora, or their descendants, found themselves again living under Israeli control. Although considered illegal under international law, Israel has also built Jewish settlements throughout the West Bank. U.S. Backing The United States backed Israel throughout those wars. The U.S. has also continuously sent military equipment and foreign aid to Israel. American support of Israel, however, has made its relations with neighboring Arab countries and Palestinians problematic. Palestinian displacement and the lack of an official Palestinian state became a central tenet of much anti-American Islamic and Arabic sentiment. The United States has had to craft foreign policy that both helps keep Israel secure and allows American access to Arab oil and shipping ports.