Perceptions on Death as the Inevitable Cessation of Life in a Living O Essay

Perceptions on Death as the Inevitable Cessation of Life in a Living Organism - set about ExampleFrom nine through adolescence, children begin to comprehend fully that conclusion is irreversible, that all living things die, and that they too will die someday. (www.hospicenet.org). The finis of close congeners or other significant persons in an adolescents life can be a quite distressing event for teenagers. Most teens conceptualize death as irreversible and universal. They also understand that death is an inevitable part of life. They, however, do not fully realize that death could be a reality for themselves or their peers. There is, therefore, an acute sense of adventure in them during this period and they dont mind taking risks. They may also act as if they want to challenge death and defy death. As they grow and mature as adults, their concept of death gets modified by the personal experiences they undergo. Some adolescents perception of death is not realistic and hence the ir response to grief also becomes unreasonable or illogical. On the other hand, teens are usually aware that when a person has a fatal illness death is a logical event in the case. If a parent, sibling or other close relative has a terminal illness, some counseling may help the adolescent to cope with the situation better. However, there is no absolutely correct way to ready a teen about the concept of death. The efforts that a family has to make in helping a teen to cope with a relatives death can reduce the distress and anxiety of a teen. It will be better to allow them to attend the funeral if they wish to do so if the familys set value and culture permit that. This would give them a reassurance that they are at least doing something for the departed. Grief is a very painful process for both adults and children, plainly grieving should be encouraged. How a child grieves or reacts to the loss will dependon age, previous experience with death and his/her preparedness for the eve nt. (http//www.cfc)

Climax, Symbolize and Theme in the Lottery Essay Example for Free

Climax, Symbolize and Theme in the draught EssayThe Lottery by Shirley Jackson is a very famous American short fib. It was published in the June 26, 1948, issue of the The New Yorker. Written the same month it was published. It is rank today as one if the most famous short stories in the hi fable of America literature. It has been studied in preparatory schools and in universities since its publication. It is very controversial. almost like it, others do not. The portion outtery has climax, mood and theme.The lottery has a really crazy climax. Climax is the point of greatest emotional intensity in plot. I turn over the climax of story is killing the someone who picks the lottery up. When they kill the woman, their eyes are changed to jealous. Someone said Hurry up and then they harbor stones to the woman. Among the people, their family included. I was shocked about her family killed their mother. Even if the sons face was very pitiful, his parents gave a stone and let hi m cast it. The chilling climax in addition shows serious mood.The story also has extremely serious mood. The mood is generally defined as the atmosphere in the story.Although weather, surrounding and background in the story are sunny and clear, the electing process of the sacrificial victim is too quiet. The weather is a contrast to the village people. At least, the woman has only a tragic ending. She was killed by her friend and family. I think the best of the scene is children kill her too. Its impossible, though custom is very important, they shouldnt have let person sacrifice for their personal goal. These things made me confused to understand the story. The lottery has a theme which is difficult to understand. When I saw the title The lottery, I think this story has a good ending, but woman who won the lottery was killed by stones casted by people who she believes and love. It is very irony. Why they killed who won the lottery? I cant understand this story exactly.But the auth or who wrote lottery gives us some message. There is old saying Dont count on a book by its cover I think this crazy climax and serious mood make me difficult to understand this story.In conclusion, The Lottery is a short story which uses crazy climax, serious mood. I think Shirley Jackson who wrote The Lottery gives us some messages. First, dont judge by appearance. This story title is The Lottery, but the ending is died who won the lottery. Second, we should remove wrong culture. Wrong culture killed innocent person. So, wrong culture is changed quickly. I searched a lot of information of this story. People say this story is written objectively. I strongly agree with this comment. They were extremely relieved when saw the women who won the lottery. In the movie of perish scene, I felt selfishness from them.

Client’s Advocacy Essay Example for Free

Clients Advocacy EssayAbstractAdvocacy is an eventful face of e precise counselors role therefore, counselors need to facilitate remove environmental barriers that hamper leaf nodes well-being by increasing the invitees sense of individual(prenominal) power and to foster environmental changes that reflect greater responsiveness to guests sense of personal needs. Outreach, empowerment, cordial justice, and cordial action are all apart of advocacy. Counselors need to help the client prevent psychological distress by helping them develop resources and strengths while step-down negative influences. There are three models the wheel of wellness model, the indivisible self- model, and advocacy. These models emphasize the importance of enhancing one-on-one strengths and environmental resources and decreasing individual limitations and social stresses. tornado Jo Jacobs, 34, Female client whom is Caucasian and divorced with four children and two living at home, youngest is liv ing in Arizona with his Father, her ex-husband She hasnt seen him since 03. She is divorced from him because he was ignominious to her physically and mentally. Her oldest son is living In Seattle and working, going to college, and has his own radio show from the college at Green River Community College. Client has one older sister, who lives in Alabama, which is on her 5th marriage due to her inability to deal with the misuse sustained when they were growing up. The client has two younger brothers, who were abused, but non sexually by their father.Her and her children are now living in the area with no family hold out or even communication with her parents. Client states she has a violent family relationship with her father. Client states her relationship with her mother is on and off.The client was referred by her regular Physician for printing and unable to come up with healthy coping skills. The client doesnt drink but twice a month, quit smoking in 03, doesnt gamble, doesn t do street drugs, but is on prescription drugs due to chronic perturb from a previous work injury and her physical abusive ex-husband.She love working on cars and trucks, roller skating, going 4x4ing, gardening and yard work. She states that she has a very limited ability to do these things she loved to do and is having a hard time dealing with the fact that she muckle no longer do the things she loved to do.Client states she is taking Percocet 7.5 325 mg, 6 pills in a 24 hour period of time, Cymbalta 60mg in the morning, Flexerall,10 mg and a sleep aid at night. It is important for the counselor to be aware of what medications the client is on in order to help in the relation to the clients well-being.Client states that she has nothing to do and she thinks about what happened when she was growing up with the abuse and her accident on a constant basis, which leads her to depression. She says that when she was growing up there was sexual and mental abuse by her father, that her fa ther abused her and her sister when their mom was working or out bowling. She has very specific memories, she remembers from when she was in a crib to her last day of high school school, which was the last time her father touched her in an inappropriate manner. Childhood abuse and neglect may be markers for other factors that have an impact on the developing child or may share with PTSD a common origin in a disrupted and disorganized childhood. Another stir is that previous research has suggested that abused and neglected children are at increased essay for early behavior problems and conduct indisposition. Behavior problems in childhood or adolescence may be associated with increased risk for engaging in risky behaviors. In turn, such behaviors may lead to increased risk of exposure to traumatic events and to subsequent PTSD.A third possibility is that childhood victimization may be associated with PTSD through its effect on a persons lifestyle, which places the person to a gre ater extent or less at risk for exposure to traumatic events and, ultimately, PTSD. PTSD, such as low levels of education and extroversion, that serve to expose individuals to social roles and environments associated with high risk for victimization. (Cathy, 1999.). This learner believes that she stayed in abusive and unhealthy relationships because of what her father did to her as a child and now she is experiencing depression and PTSD. The goal of this client is to empower her to solve her problems respectively by helping her understand herself and to help her have the ability to problem-solve. The counselor needs to spend time assessing the seriousness of the concern presented to her and issue structure to the counsellor process (such as understanding the conditions, procedures, and nature of counseling), and helping the client take initiative in the change process.The goal for this client is to get her help for her depression with tools and education to help her work through what her father and ex-husband have put her through. My first priority is to build trust, rapport, and be able to set goals and figure a sermon plan for change. The counselor will need to build up her psychological health by helping her build coping skills, self-esteem, social support, personal power, problem solving skills, self- care, sense of humor, sense of control, sense of worth, and stress management. Because of her abuse, she has developed depression and stress. The prevention programs the counselor needs to use for this client to help with stress is identifying the source of the stress, recognizing the physical and emotional consequences of stress, and learning and implementing adaptive coping responses.Strength-based Wellness counseling interventions may help abused survivors develop coping skills to arouse twain overall quality of life and everyday functioning across multiple domains, while also providing a healthy foundation from which to explore and reframe their ab use experience. One of the most common interventions with adult women survivors is trauma-focused, or exposure-based, treatment, where the sexual abuse experience is reviewed in some focusing. Trauma focused interventions are based on the notion that the meaning attached to the abuse, as well as the personal impact, is imbedded in the details of the experience And therefore requires in-depth review of the abuse experience (Hodges Myers, 2010). Fostering corroborative growth is an appropriate therapeutic goal posttraumatic growth increases confirming feelings of self, self-efficacy, and resiliency, which lay the foundation for continued Improvement in other areas of life.Wellness-focused interventions offer clients a positive lens for viewing their strengths and strategies for using those strengths to cope with the issues created by their sexual abuse history. Wellness-focused interventions validate the individual and the fact that the important thing is not why the individual su rvived but how. Advocacy is an important factor in every counselors role and it serves two purposes to increase clients sense of personal power and to foster environmental changes that reflect greater responsiveness to clients personal needs (Gladding impertinentlysome, 2010). In order to help the client with advocacy, I would join the Montana Coalition against domestic and sexual furiousness and get my client guidance through them. The Montana Coalition Against Domestic intimate frenzy (MCADSV) is a statewide coalition of individuals and organizations working together to end domestic and sexual violence through advocacy, public education, public policy, and program development.Our mission is to support and facilitate networking among our member organizations while advocating for social change in Montana. Currently, MCADSV represents over 50 programs across Montana that provides direct services to victims and survivors of domestic and sexual violence and their children. In addi tion, the membership includes other nonprofit and government organizations and individuals (professionals and members of the general public) who are interested in addressing domestic and sexual violence in a way that holds offenders accountable and provides support for the people they victimize. Our membership is open to anyone who is in accord with their philosophy. Their philosophy is We base our actions and interactions on the following basic tenets we advocate for policy that supports and/or forwards them and we work to increase public awareness on issues related to them. We believe all women have the right to live a life dislodge of violence or the threat of violence.Women have the right to freedom from violations of their personal autonomy and physical integrity on the street, in the home, at the workplace, and in the Coalition. Furthermore, women should not have to restrict their freedom of movement, their bodies, or their activities in order to be safe. We believe all women have the right to make their own decisions regarding sexual and reproductive matters, lifestyles, finances, education, and employment. We believe religious beliefs and practices are a matter of personal conscience and individual choice, and a Montana Coalition member shall neither promote nor reprove a particular religious belief in the course of his or her work. We believe classism, racism, ableism, ageism, homophobia (and all forms of elitism) are attitudes that serve to divide people who might other than join forces. As such, they interfere with womens ability to pool their efforts and reach their full potential. Our membership is open to people of all backgrounds.Furthermore, survivors of violence represent an necessary constituency in our movement, and the Montana Coalition strongly back ups full participation by and equity for survivors (MSADSV, 2010). MSADSVs goals are to eliminate all forms of oppression, provide support and networking opportunities and training, and to encourage increased awareness and understanding of domestic and sexual violence and the concerns of survivors and to explore and support innovative policy approaches to issues related to domestic and sexual violence. This website has a handle of information for the client to get additional help and tools for her recovery. During the advocacy with the client, the counselor needs to be compassionate and show commitment in order to provide motivation to take action.The counselor needs to use verbal and non-verbal skills in order to be an effective counselor. Some skills the counselor needs to have is integrity, flexibility, empathy, patience, persistence, and resourcefulness. The client needs to have outreach, empowerment, social justice, and social action. Outreach involves reaching out to vulnerable populations in the community and helping clients find new ways to cope with the stressors. authorisation is a process which the client gains resources and skills they will need to have more control over their environments and lives. Empowerment is important in this case because it helps the abused cleaning lady become aware of inappropriate use of power and privilege that her partner was claiming. Social justice is promoting access and equity to ensure full participation of all people in the life of a society as well as a belief system that values fair and equal treatment for all members of society.Social action derives from the belief system, resulting in the actions taken to promote equal rights. The counselor is involved in confronting barriers faced by clients. Abusive relationships has a significant and pervasive impact on individuals, producing a variety of mental, emotional, relational, physical, and trauma symptoms. Most therapeutic interventions focus primarily on reliving or retelling, in great detail, the sexual abuse experience. However, many clients lack a positive sense of self, an internal focus of control, and an ability to view the abuse as sav e part of which they are rather than the defining elements. Through a focus on Wellness factors, therapists can help adult women recognize their strengths and use them both in and outside of sessions to create and sustain positive lifestyle change.Helping clients experience positive outcomes of Wellness choices is empowering and facilitates their ability to invest in and cope with the meliorate process. Considering the multiple challenges many survivors bring to counseling, these outcomes are extremely important. A wellness-based intervention may increase self-efficacy, resiliency, and awareness of healthy coping skills, resulting in positive changes in everyday functioning. Such changes are inherently helpful to the survival process and can offer survivors valuable tools with which to approach future experiences.Therapists need to consider symptom presentation and prioritize the goals for therapy accordingly. Once safety is established, therapists and clients can incorporate a Wel lness intervention into a range of treatment options, positive growth can occur simultaneously with distressing emotions. As with any therapeutic intervention, the therapist must continually assess the clients experience with the intervention and alter interventions when necessary.ReferencesCathy, S. W. (1999). Posttraumatic stress disorder in abused and neglected children grown up. The American Journal of Psychiatry, 156(8), 1223-9. http//search.proquest.com/docview/220471620?accountid=27965 Gladding, S.T., Newsome, D.W. (2010). Clinical Mental Health Counseling in a Community and Agency Setting. (3rd Ed.). New Jersey Pearson Education. Hodges, E. A., Myers, J. E. (2010). Counseling Adult Women Survivors of Childhood Sexual Abuse Benefits of a Wellness Approach. Journal Of Mental Health Counseling, 32(2), 139-153. Montana Coalition Against Domestic Sexual Violence (2010). Retrieved from- http//mcadsv.com/

Strategic planning Essay Example for Free

Strategic planning Essay1. What is the difference between strategic planning and tactical planning?Strategic planning is the process of determining an organizations direct objectives and finding and implementing steps that will achieve the objectives. Tactical planning is setting short-term actions that are needed to compete larger strategies.2. what is the difference between a business plan and a marketing plan?Business plan is a detailed plan setting out the objectives of a business, the strategy and tactic planned to achieve them, and the expected profits, usually over a period of three to ten years. Marketing plan is a strategic plan at the functional level that provides a firms marketing group with direction. The strategy for implementing the components of marketing creating, communicating, delivering, and exchanging value.3. what is the purpose of a marketing plan?It is a channel map that improves the firms understanding of its competitive situation. It helps the firm a llocate resources and divvy up the tasks that employees need to do for the company to meet its objectives.4. what are the two elements of all marketing strategy?1)product strategy-product development strategy creating new products or services for subsisting markets. 2)market strategy-market penetration strategy selling more of existing products and services to existing customers.5. how would you describe graduation exercise-mover strategy?A market innovator, not a follower Corporate level strategy theorizing that being the start-off organization to offer a product in the marketplace will be the long-term market leader.6. what are the advantages and disadvantages of being a first mover?Three advantages of being first technology leadership, control of resources, and buyer switching costs. The disadvantages later entrants can overcome advantages, must heavily entice customers to try new type of product ( amply education expense), some first movers may become complacent with cha nging customers needs.7. how would describe second-mover strategy?Corporate level strategy theorizing that closely observing the innovations of the first movers, and then improving on them can help an organization gain advantage in marketplace.8. what are the advantages and disadvantages of being a second mover?Advantages big businessman to observe competitors successes and failures. Lower risk in product development and less controversy. Revising rather than creating and competitor surprise, and stealing market share rather than creating it. Disadvantages persuading customers to switch, communicating your value add.

Marketing of Barcelonas Tourism Industry

Marketing of Barcelonas Tourism Industry

Arguments on Artificial Intelligence

Arguments on stylized IntelligenceWe live in an extraordinary time. Improvements in engineering seem to be accelerating at an unbelievable rate. Every time they think Moores Law has reached its limits, tech companies come up with a new level of capability. No less is the advancement of artificial intelligence (AI). Our every day lives argon already deeply immersed in AI, and we dont even know it. It controls much of the financial markets, performs honor enforcement tasks, and makes our internet searches more useful. Most AI today is weak AI, designed to perform a very specific task (Tegmark, n.d.). But the goal of tout ensemble research and corporate investment is always more what else can we know or do? Often, these entities are creating things in a vacuum, with limited moral, ethical, or level-headed boundaries. When is it too much? The driving force that makes us want to always explore further is what makes the development and use of artificial intelligence (AI) a forged cour se of action.Why is this a seeky course of action? Because giving control of systems to artificial intelligence could have seriously negative results. Take, for example, researchers working with the University of Pittsburgh medical checkup Center. In this case, they develop a neural network that returns suggestions for treatment of pneumonia patients. Using a historical database with the solutions and results of methods of treatment, the AI is supposed to provide suggested solutions to treat patients. In cardinal solution, it recommended that certain high risk patients be sent home (Bornstein, 2016). This solution had high probability of resulting in death.When working with and complex task, accomplished by man or machine, the law of unintended consequences mustiness always be considered. No matter how well someone thinks they have thought a system through, it is around impossible to consider every possible outcome. Certainly, unintended consequences are not all bad, many drug s have side effects that are beneficial and entirely not what the drugs was designed to do. On the other hand, many drugs have very negative side effects. Certainly, they are not intended to cause any ill symptoms, but many have severe unintended consequences, including death.Some would argue, AI is currently in use and benefits everyone with no negative effects. Singularity cannot happen. While we for certain use some types of AI currently and have had minimal negative effects. It is also true we have not reached singularity. It is the height of hubris to believe that we have do control over anything or that we have considered all possibilities. Consider Fukishima or Chernobyl, all possibilities were not covered and resulted in huge disasters.Even NASA, the standard for elaborate scrutiny of complex systems and procedures has had some harmful failures in the form of space shuttle crashes due to hubris of the organization and/or individuals.How many people died on the titanic? A send off that was unsinkable was sunk by a simple iceberg, or was it hubris? The shoddy steel used in the construction of the hull, the poorly designed bulkheads that didnt reach to the top deck, and the pressure to go as fast as it could are what sunk the ship. And not comme il faut life boats on the unsinkable ship killed the passengers. Hubris lead them down the path to destruction.We are at the point that we have the capability to combine AI to create autonomous military machines. Some are even in the testing phase of development. Machines that make decisions of life and death on their own (Russell, 2015). Absent human intervention, what is to keep one of these machines from deciding the maltreat person is a target. A machine knows no morality, no ethical code, only its programming, its goal or reason to exist. Given a powerful enough computational system, it could decide to use everything at its disposal to achieve its goals (Anderson, 2017). Things like taking control of infrastructure, or even humans.So, what do we do? Is there risk? Even captains of industry and experts like Gates, Musk, and Hawking suggest there is (Holley, 2015). It is clear we are already on the path to creating ever more complex and sufficient AI. We must recognize that we all make mistakes and constantly be on guard against mistakes and, more importantly, hubris. Most expansion of knowledge has risk. When confronted with a discipline that has catastrophic possibilities, we must fight the desire to run forward as fast as we can with no concern for the consequences. Methodical deliberation is the only course. We must consider the ramifications of each step and ensure safeguards are in place should we need to terminate or isolate any AI that develops goals counter to those of humans. If we shell out to be conscientious enough and adhere to ethical principles, we might, just might, keep from developing the instrument of our own demise.ReferencesAnderson, J. (2017, February 16) . Googles artificial intelligence getting greedy, and aggressive. Activist Post. Retrieved from http//www.activistpost.com/2017/02/googles-artificial-intelligence-getting-greedy-and-aggressive/Artificial Intelligence. (2015). In Opposing Viewpoints Online Collection. Detroit Gale. Retrieved from http//link.galegroup.com.ezproxy.libproxy.db.erau.edu/apps/doc/PC3010999273/OVIC?u=embryxid=415989d5Bornstein, A. (2016, September 1). Is artificial intelligence permanently inscrutable?Holley, P. (2015, January 29). Bill Gates on the dangers of artificial intelligence I dont understand why some people are not concerned. The Washington Post. Retrieved from https//www.washingtonpost.com/news/the-switch/wp/2015/01/28/bill-gates-on-dangers-of-artificial-intelligence-dont-understand-why-some-people-are-not-concerned/Russell, S. (2015, May 28). Take a stand on AI weapons. Nature, 521 (7553), 415-416.

Surgical placement in a local hospital

Surgical placement in a local hospitalThis is a reflective stress based on my own experiences, whilst on my five week surgical placement in a local hospital. The aim of this essay is to explore the delectation of parley and interpersonal skills in clinical institutionalise. I have chosen this particular incident as I spent a considerable aggregate of time communicating verbally and non verbally with this particular uncomplaining. To protect the identity and maintain confidentiality of the forbearing I have chosen to discuss, they shall be known as John. This is in accordance with the NMC code of professional conduct (NMC, 2008). To assist me in the process of reflection I am using Gibbs (1988) reflective model. This cycle provides a description of the event, feelings towards the outcome, an evaluation, analysis, conclusion and an action plan. Jasper (2003) suggests that reflection is one of the key ways we can learn from our experiences. There are numerous reasons why reflecti on is distinguished to nurses. Through reflection we can learn more about our role and the elements that limit our abilities this allows the opportunity to improve the way we care (Ghaye Lillyman, 2001).John was a 74 year old man admitted onto the ward from the emergency department, twain days previous to me starting my first-year late shift of that week. He had been suffering from remembering of urine, and was in considerable pain. My mentor and I were informed during handover that we would be looking after John on this particular shift. We were asked to change the dressing on his recompense leg. It had become ulcerated due to suffering from a condition known as Peripheral Vascular Disease (Alexander, Fawcett Runciman, 2004). As a result of this unsoundness the unhurried had undergone am doation of the left leg below the knee some years ago, resulting in him becoming immobilised and requiring the intention of a wheelchair. It became vindicated during the handover that J ohns behaviour had become genuinely difficult over the last couple of days. The nurse in charge went on to describe the nature of his behaviour including that he had thrown items across his style, was forever and a day pressing his nurse call button, was shouting all day and he had also refused to have a wash and change his pyjamas. As we left the room where the handover had taken place, my mentor suggested that we should change Johns dressing now, but firstly we should get him washed and changed with my assistance. I knocked on his door and introduced myself as a student nurse. I proceeded to ask John for his consent in order for me to assist him in having a wash and change of clothing (NMC, 2008). John was sat on his strike out and appeared to be quite tense. He looked up at me and shouted no, I want to see a doctor and I havent had a cigarette for two days. I explained that I was here to assist in changing the dressing on his leg and to help him to have a wash and change. I locomote closer towards his bed and lowered myself to his centre level. I then began to engage in parley with him by maintaining a soft tone of voice and postulation him if he would like a cup of tea after we had finished. His body language softened and he looked up and smiled, he said I would fill in one. I smiled back at John, I then repeated the question of assisting him with having a wash and change, whilst maintaining a relaxed posture and eye contact. John gave me his consent and I proceeded to assist him in maintaining his personal hygiene with respect and dignity (NMC, 2008). With Johns co-operation my mentor and I were then able to go on and change the dressing on his leg.Through this learning experience I encountered a combination of feelings towards the military post. From the initial handover, the staff nurse in charge did not paint a overconfident picture of John. I wondered why this particular patient was so aggressive and demanding and the staff described him as being difficult. I felt anxious, as this was my first placement as a first year student and I did not feel experienced enough to deal with the situation. During my encounter with John it became clear why he would feel so angry and frustrated. I noticed he didnt have a wheelchair in his room, and it became apparent that he was a smoker. He also hadnt been given any nicotine replacement therapy to help him cope with his withdrawal symptoms. When the full extent of Johns situation became clear to me, I felt immense foiling for him. According to the NMC Code of Professional Conduct (2008), nurses should treat patients with respect and maintain their dignity. With John not having a wheelchair, he was confined to his bed and thus had disoriented his autonomy. The situation also made me in truth angry, reflecting back I feel I should have been more assertive and maybe questioned why Johns requests had been ignored by the staff.It was unfortunate that the professional staff had acted th e way that they did overlooking how angry and frustrated John had become and failing to act upon it. The nurses compassion and communication skills seemed to be very much lacking not listening to his requests and showing no feeling towards him. This breakdown in communication in the nurse patient relationship with john, left him feeling frustrated and not in control of his own wellbeing (Garnham, 2001).At first, I could not see any good points in this situation however looking back I can see that it did have its positive side, in as much as allowing me to examine myself and to search for my hapless fallings in relation to the incident. The incident has also given me the opportunity to link theory to practice. The way I communicated with John had a positive outcome for both(prenominal) of us in that his personal hygiene needs were met and I learnt that effective communication is essential in building a trusting bond amidst the patient and the nurse (Almond Yardley, 2009). The b ad points of this experience were that I judged John based on the information I received during the initial handover without having met him first. This could have created a bulwark betwixt the patient and I. Accepting a patient as a unique individual and without judgment is very important in the communication process. I have learnt from this experience that as nurses we should respect a patients beliefs and values and we should not let our own beliefs and values affect our decision making in patient care (Rogers, 1957). I also feel that I should have been more assertive when it came to the way John was being case-hardened by the staff. As a first year student I did not feel comfortable questioning the way a professional staff nurse carried out her care for care. However, from this experience I will question bad practice in future, as the NMC (2008) states that I am personally accountable for my actions and omissions in my practice and that I must always be able to justify my dec isions.According to Maxim Bryan (1995 cited in Briggs, 2006), dialogue is the process of conveying information between two or more people. Communication is essential in building relationships with patients and gaining trust. In the NHS, the majority of the complaints brought against them were for poor communication from healthcare staff (Pincock, 2004). To highlight how important communication is in the nursing profession, the NMC identified it as being an essential skill and only if a student is competent in this skill can they then go on and register as a nurse (NMC, 2007).In order to communicate with John the situation required the use of interpersonal skills, known as non verbal and verbal communication. Non verbal communication is described by (Dougherty Lister, 2008 p.62) as being information transmitted without speaking. Johns body language indicated that he was tense and anxious, therefore approaching him with empathy ensured that he was being understood and that his part icipation in communication was valued (Peate Offredy, 2006). Given the history of Johns aggressive outbursts it was necessary to consider the proxemics in the situation. It is recommended that retentivity within a distance of 4 to 12 feet away from a person is less intimidating for them (Egan, 2002). In order to engage in conversation with John, Egans (2002) acronym SOLER was used. This is a process of using body language to actively listen to a person. By sitting squarely towards John, having an open posture, leaning in towards him, maintaining eye contact and a relaxed posture, this in turn encouraged him to relax and feel less intimidated, therefore able to talk more openly (Dougherty Lister, 2008).Verbal communication with John was enhanced by the use of facial expression and paraverbal communication. According to (Delaune Ladner, 2002, p195) Facial expressions give clues that support, contradict or disguise the verbal message, therefore the use of a smile when approaching J ohn indicated warmth and friendliness. This was assisted further by the use of paracommunication these are the cues that accompany verbal language. These include tone, pitch, speed and book of account of the person speaking therefore communicating with John using a soft tone of voice added further meaning to the spoken words (Delaune Ladner, 2002).The barriers in communication during this incident were Johns aggressiveness. This could have been due to the withdrawal from cigarettes, as according to Bruce (2008) irritability is a symptom of nicotine withdrawal. If a patient is unable to smoke in hospital then nicotine replacement therapy should be introduced and the patient should be treated like any other dependant. Bruce (2008) states that Withdrawal from nicotine needs to be recognised and treated appropriately in the acute hospital it will often be the ward nurses who are relied upon to recognise the symptoms. These symptoms were overlooked by the staff and to add to his frustr ation he had no means of mobility in order to allow him to leave the ward for a cigarette. This may account for his outbursts of anger. Peplau (2004) suggests that when there is an obstacle or prohibition preventing a person from achieving their goals this may lead to frustration which in turn often leads to anger.Using Gibbss reflective cycle has assisted me in analysing the situation and to put things into perspective, recognising how I can put this learning experience to positive use in my future practice as a nursing professional. If this situation were to bear again I know I would now have the courage to question the nurses attitude at an earlier stage pointing out that bad practice by anyone is not acceptable. From this experience I have learnt that I need to be more assertive and if I feel the needs of a patient are not being met, my first context should be to protect the interests and safety of patients, in line with the NMC (2008) Code of Professional Conduct. This refle ction has highlighted the need to step-up my knowledge and understanding of the process of communicating with patients from different cultural backgrounds, I will address these issues by, listening and learning from the qualified staff and by drill relevant literature.In conclusion it can be seen that the nurse has a very important role in communicating with patients throughout their treatment. When a patient is admitted to hospital, assessments should be made based on the activities of daily living, (Roper, Logan Tierney, 2000). Johns assessment not only should have identified the level of care required, it should also have established his normal routine and the fact that he was a smoker and also required a wheelchair for mobility. If Johns needs had been assessed correctly the breakdown in the relationship between John and the professional staff could have been prevented. Overall, through this reflection I have learnt that communication is an essential skill that requires as m uch practice and consideration as any other aspect of nursing.ReferencesAlexander, M., Fawcett, N. Runciman. P, (1994) care for Practice Hospital and Home The Adult London Churchill Livingstone.Almond, P. Yardley, J. (2009) An Introduction to Communication. Chapter 1 IN Childs, L., Coles, L., Marjoram, B. (Eds.) (2009) Essential Skills Clusters for Nurses Basingstoke Palgrave Macmillan.Briggs, D. (2005) Communication and social Skills in breast feeding. Chapter 4 IN Peate, I. (2005) Compendium of Clinical Skills for Student Nurses London John Wiley Sons Ltd.Bruce, G. (2008) Smoking Cessation in Hospital London Nursing Times. Online last accessed 18th November 2009 at http//www.nursingtimes.net/nursing-practice-clinical-research/smoking-cessation-in-hospital/1646376.article.Delaune, S. Ladner, P. (2002) Fundamentals of Nursing Standards Practice (2nd Edition) Albany NY Thomson Delmar Learning.Dougherty, L. Lister, S. (2008) The Royal Marsden Manual of Clinical Nursing Proc edures (7th Edition) Oxford Blackwell Publishing.Egan, G. (2002) The Skilled Helper A caper management approach to helping (7th Edition) California Brooks / Cole.Garnham, P. (2001) Understanding and dealing with anger, aggression Nursing Standard Vol. 16, No. 6, pp 37-42.Ghaye, T. Lillyman, S. (2001) Reflection Principles and Practice for Healthcare Professionals. Wiltshire fair game Allen Publishing ltd.Gibbs, G. (1988) Learning by Doing A Guide to Learning and Teaching Methods Oxford Further Education Unit, Oxford Polytechnic.Jasper, M. (2003) Foundations in Nursing and Health Care Beginning pensive Practice Oxford Nelson Thornes.Nursing and Midwifery Council (NMC) (2007) Essential Skills Cluster for Pre- Registration Nursing Programmes. Annex 2 to NMC Circular 07/2007, Online Last accessed 1st December 2009 at http//www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=2690.Nursing and Midwifery Council (NMC) (2008) The NMC Code of Professional Conduct Standards for Conduct, Performan ce and Ethics London NMC.Peate, I. Offredy, M. (2006) Becoming a Nurse in the 21st Century Chichester John Wiley Sons Ltd.Peplau, H.E. (2004) Interpersonal Relations in Nursing New York Springer Publishing Company.Pincock, S. (2004) Poor communication lies at the heart of NHS complaints, says ombudsman British Medical Journal January Vol. 328, No. 7430, p10.Rogers, C. R. (1957) The prerequisite and Sufficient Conditions of Theraputic Personality Change Journal of Consulting and Clinical Psychology Vol. 60, No. 6, pp 827-832.Roper, N., Logan, W. Tierney, A. J. (2000) The Roper Logan and Tierney Model of Nursing London Churchill Livingstone.