Friday, January 31, 2020
Managing Conflict Essay Example for Free
Managing Conflict Essay Managing conflict Medicolegal issues We live in an increasingly demanding and vociferous society and incidents of conflict and aggression are sadly commonplace. Kate Taylor, Clinical Risk Manager at the Medical Protection Society offers advice on how to deal with the problem Working in general practice is busy and demanding, with increased workloads, stretched time and some patients having greater expectations of care. At times, when expectations are not met, we can find ourselves in conflict with patients and in some situations this can turn to aggression. As nurses, how should we deal with potentially difficult situations? This article aims to increase our understanding of conflict and provide strategies to deal with it effectively. It also includes practical tips to reduce risks associated with managing conflict and aggression. DEFINITIONS Conflict means different things to different people. The Health and Safety Executive defines workplace violence as any incident where staff are abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or health.1 Non-physical violence can be defined as the use of inappropriate words or behaviour causing distress and/or constituting harassment.'[ 2] The scale of the problem There is limited documentation relating to violence against nurses working in general practice. However, a recent survey carried out by the British Medical Association, to which 20% of doctors responded, found:[ 3] * Violence is a problem in the workplace for half of doctors (same for GPs and hospital doctors). * 1 in 3 respondents had experienced some form of violence in the workplace in the last year (same for hospital doctors and GPs). * 1 in 5 doctors reported an increase in violence in the past year, but the level remained constant for the majority. * Among doctors who reported some experience of violence, most had been the victim of verbal abuse in the past year while more than half had received a threat, and a third had been physically assaulted. Most injuries were minor, but 5% were serious. In April 2011, NHS Protect was set up. It is responsible for leading on work to protect NHS staff and resources from crime in England.[ 4] According to its statistics, physical assault against NHS staff is steadily increasing. However, these statistics do not capture the incidents where staff have been subjected to non-physical violence. In general practice, members of staff are more likely to be subjected to non-physical violence. Imagine working as a practice nurse and an unhappy patient threatens you, telling you I know where you live? We cannot underestimate the impact that such non-physical violence can have on individuals. CONTRIBUTORY FACTORS Circumstances * Members of the general practice team are particularly vulnerable as they often consult with patients alone. Doctors and practice nurses often work in small numbers. * Home visits are usually carried out alone. System and Organisational Problems * Delays, restrictions and mistakes such as lost prescriptions or delays in test results * Lack of appointments * Patient disappointment often results from unmet expectations, whether realistic or unrealistic. Environment * Waiting room (heating, lighting, noise and seating) * Cramped consulting rooms without easy exit for health professionals * Lack of privacy * Availability of potential weapons. Patient Factors * Increased expectations and the difficulties in meeting these demands. Dissatisfaction with the care provided is perceived as the most common cause of aggression and violence * Strong patient emotions e.g. uncertainty, frustration, stress and anxiety. Anger is often secondary to emotions such as anxiety or grief * An underlying medical condition such as hypoglycaemia or psychotic illness * Physical symptoms including pain, headache or over-tiredness * Mental health problems such as * Personal problems e.g. financial, relationship, stress at work * Drugs and alcohol. Staff Factors * Under pressure staff-working in noisy cramped rooms, unable to trace or contact staff * In adequate staff numbers * Escalating the situation by confrontation, over-reacting, poor ccmmunication, inconsistencies in handling patients, patronising behaviour, ignoring a situation or falling to apologise. COMMUNICATION SKILLS Good communication with patients is likely to reduce the risk of conflict and violence. As nurses, how we communicate with our patients can have an impact on how difficult situations develop. We need to think about what we say and how we say it. We should rely on our strong communication skills to determine with our patients what they can expect from the services we provide. A study by American psychologist, Albert Mehrabian, determined that non-verbal communication represents over 50% of an interaction.[ 5] Being aware of your own body language can be the first step to understanding how it is perceived by our patients. Listening and empathising with patients are essential skills for nurses-so how do we ensure our patients know we are listening? * Give the patient your undivided attention * Dont trivialise the patients issue * How is the patient feeling are they angry, afraid, frustrated? Respond to the emotion as well as the words * Allow the patient to finish what they are saying * Ask questions, paraphrase and reflect to ensure you understand the message. CHALLENGING INTERACTIONS Challenging interactions with patients can be a significant cause of stress for nurses, yet the nature of most clinical jobs makes these encounters unavoidable. It can be difficult to communicate your point of view effectively for fear of generating conflict, which can lead to frustration and dissatisfaction, and may affect your ability to give good care. It is vital to build a trusting relationship with the patient in these circumstances; ensure you listen attentively, empathise and avoid confrontation. Maintain eye contact and try to establish a shared understanding of the patients problem. Having acknowledged their perspective, respectfully inform them of your position. Then work on achieving a mutually agreeable solution or way forward rather than focussing on points of disagreement, which can otherwise degenerate into an argument. Then help and support the patient to achieve the agreed solution. After challenging interactions that have required you to state your position, ensure there is effective communication with other members of the practice clinical team, along with a clear record of the discussions held. This will ensure consistency should the patient approach a different clinician seeking to re-negotiate an alternative plan or outcome. PRACTICAL TIPS Practices should consider: * Providing a side room or separate area to deal with upset/aggressive patients or those who need more privacy. * Providing good temperature and ventilation control, adequate seating and clear signage * Providing calming measures to reduce frustration, anxiety or boredom such as distractions in waiting room e.g. toys for children, magazines for adults * Adding an agreed marker to the summary of a patients record who has a history of violence (and ensure it is factually accurate) * Having a protocol for involving the police and removing patients from the list * Using CCTV * Ensuring all practice staff have access to panic alarms * Providing locks for all areas where patient access is restricted CONCLUSION We can and will experience conflict in general practice due to the sheer volume of patient contacts that occur every day. The key to managing a conflict situation is to try to de-escalate it as much as possible.confidentiality is central to the trust between nurses and their patients think how easy it may be to breach confidentiality when you have a situation with an aggressive patient. The Nursing and Midwifery Council Code of conduct clearly states you must respect peoples right to confidentiality.[ 6] As a last resort you can remove a patient from the practice list. However, this can be seen as an emotive issue, risking criticism from bodies such as the Parliamentary and Health Service Ombudsman, the GMC and the media. You can find useful information on how to go about it in the MPS factsheet, Removing patients from the practice list (September 2013).[ 7] http://www.medicalprotection.org/ uk/england-factsheets/removing-patients-from-the-practice-list. CASE STUDY Nurse E is about to start her clinic when she notices Mrs S on the list of patients for the day. Her heart sinks. Mrs S often presents with one or more complaints, talks nonstop and does not listen to advice provided. She knows from experience that interactions with Mrs S will be challenging. Mrs S is called in 20 minutes later than her planned appointment and she lets Nurse E know that she is not happy. Nurse E admits that her clinic is running late but tells Mrs S that she had an unavoidable emergency. She proceeds to take Mrs Ss blood pressure and other vital signs. Mrs S then asks Nurse E for a prescription for antibiotics as she is going on holiday and wants them just in case her chest flares up while away. Nurse E advises her that she will need to make an appointment to see the GP. Mrs S, now increasingly unhappy, begins to raise her voice and bang her fist on the desk, demanding a prescription before she leaves. Nurse E, staying calm, advises Mrs S that she is unable to give her a prescription as she doesnt have any active symptoms. Mrs S storms out of the consultation room pushing past Nurse E. Understandably upset, Nurse E calls the practice manager to report the incident. How could this situation have been dealt with better? * Apologise when mistakes occur or when clinics are running late. Some practices ask reception staff to inform patients when they are checking in if clinicians are behind schedule * Ensure patients are well informed about how systems at the practice work to try to reduce unrealistic expectations * Acknowledge the patients emotions and allow them to express them, which can take time. Ask the patient to tell you about their concerns. Listen actively using comments such as I see, or go on?, and nodding your head. Summarise their experiences, feelings and concerns back to them * Work with the patient to resolve the situation. Agree a plan for dealing with their concerns and moving forward. * Try to offer an alternative solution to demonstrate that you are keen to help them. For example, Im sorry Mrs S, but I am unable to give you a prescription. However, if you wish to make an appointment with one of the GPs you can discuss this with them * Consider the layout of the consulting rooms and reception area to ensure you can leave the room if the situation escalates. Aggression in healthcare settings is becoming all too common REFERENCES 1. Health and Safety Executive: work related violence www.hsegov.uk/violence 2. NHS Business Services(2012) Not part of my job http://www.nhsbsa.nhs.uk/Documents/ SecurityManagement/NP0J1 .pdf 3. British Medical Association (2008). Violence in the workplace. The experience of doctors in the UK. http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/ PDFviolence08/$FILE/Violence.pdf 4. NHS Protect 2013 http://www.nhsbsa.nhs.uk/Protect.aspx 5. Mehrabian, A(1971) Silent messages Belmont, CA:Wadsworth 6. NMC(2011)The code: Standards of conduct, performance and ethics for nurses and midwives http://www.nmc-uk.org/Documents/Standards/ nmc TheCodeStandardsofConduct PerformanceAndEthicsForNursesAndMidwives%5FLargePrintVersion.PDF 7. MPS Factsheet removing patients from practices list September 2013 http://www.medicalprotection.org/uk/england-factsheets/removing-patients-from-the-practice-list ~~~~~~~~
Thursday, January 23, 2020
Analysis of The World of Wrestling by Roland Barthes Essay -- The Worl
Analysis of The World of Wrestling by Roland Barthes Roland Barthes's essay on "The World of Wrestling" draws analogically on the ancient theatre to contextualize wrestling as a cultural myth where the grandiloquence of the ancient is preserved and the spectacle of excess is displayed. Barthes's critique -- which is above all a rewriting of what was to understand what is -- is useful here insofar as it may be applied back to theatre as another open-air spectacle. But in this case, not the theatre of the ancients, but the Middle English pageant presents the locus for discussing the sport of presentation, or, if you prefer, the performance of the sport. More specifically, what we see by looking at the Harrowing of Hell -- the dramatic moment in the cycle plays that narratizes doctrinal redemption more graphically than any other play in the cycle -- as spectacle offers a matrix for the multiple relationships between performance and audience and the means of producing that performance which, in turn, necessarily produces the audience. Â Â Â Â Â The implications of the spectacle could sensibly be applied to the complete texts of the cycle plays, and perhaps more appropriately to the full range of the pageant and its concomitant festivities. The direction of pseudo-historical criticism, especially of the Elizabethan stage, certainly provides a well-plowed ground for advancing the festive and carnivalesque inherently present in the establishment and event of theater. Nevertheless, my discussion here is both more limited and more expansive: its limits are constructed by the choice of an individual play recurrent through the four extant manuscripts of what has come to be called the Corpus Christi plays; its expansion is expressed through a delivery that aims to implicate the particular moment of this play in the operations of a dominant church-state apparatus, which is, ostensibly, a model of maintaining hegemony in Western culture. The Harrowing provides a singular instance in which the mechanisms of control of the apparatus appear to extend and exploit their relationship with the audience (i.e. congregation). The play is constructed beyond the canonized operations of the sacred, originating a narrative beyond (yet within) the authorized vulgate; it is constructed only through church authority yet maint... ...thorizing. It seems we are not merely to claim, as Hardin Craig does, that the plays are "a theological intelligence motivated by structural imagination that lasted from age to age in the development of a great cycle of mystery plays." Instead, we should interrogate the multiple dimensions of artistry and artificiality of the play; our task is to ask how these plays operate as a performative moment coming directly from the dominant arms of orthodoxy while still being influenced by the severely limited mass culture. We may find, then, at the center of the controlling mechanisms of the church-state apparatus, the necessitated desire for community that even Satan validates and proclaims: Â Â Â Â Â Â Â Â Â Â Nay, I pray the do not so; Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Vmthynke the better in thy mynde; Â Â Â Â Â Â Â Â Â Â Or els let me with the go, Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â I pray the leyffe me not behynde! The desire, of course, extends past Satan's plea, for the homogenized desire of the congregation ultimately -- which is in history written and yet to be -- is directed toward a different answer from Jesus: one that affirms salvation and again confirms the church's orthodox pageantry of performance. Analysis of The World of Wrestling by Roland Barthes Essay -- The Worl Analysis of The World of Wrestling by Roland Barthes Roland Barthes's essay on "The World of Wrestling" draws analogically on the ancient theatre to contextualize wrestling as a cultural myth where the grandiloquence of the ancient is preserved and the spectacle of excess is displayed. Barthes's critique -- which is above all a rewriting of what was to understand what is -- is useful here insofar as it may be applied back to theatre as another open-air spectacle. But in this case, not the theatre of the ancients, but the Middle English pageant presents the locus for discussing the sport of presentation, or, if you prefer, the performance of the sport. More specifically, what we see by looking at the Harrowing of Hell -- the dramatic moment in the cycle plays that narratizes doctrinal redemption more graphically than any other play in the cycle -- as spectacle offers a matrix for the multiple relationships between performance and audience and the means of producing that performance which, in turn, necessarily produces the audience. Â Â Â Â Â The implications of the spectacle could sensibly be applied to the complete texts of the cycle plays, and perhaps more appropriately to the full range of the pageant and its concomitant festivities. The direction of pseudo-historical criticism, especially of the Elizabethan stage, certainly provides a well-plowed ground for advancing the festive and carnivalesque inherently present in the establishment and event of theater. Nevertheless, my discussion here is both more limited and more expansive: its limits are constructed by the choice of an individual play recurrent through the four extant manuscripts of what has come to be called the Corpus Christi plays; its expansion is expressed through a delivery that aims to implicate the particular moment of this play in the operations of a dominant church-state apparatus, which is, ostensibly, a model of maintaining hegemony in Western culture. The Harrowing provides a singular instance in which the mechanisms of control of the apparatus appear to extend and exploit their relationship with the audience (i.e. congregation). The play is constructed beyond the canonized operations of the sacred, originating a narrative beyond (yet within) the authorized vulgate; it is constructed only through church authority yet maint... ...thorizing. It seems we are not merely to claim, as Hardin Craig does, that the plays are "a theological intelligence motivated by structural imagination that lasted from age to age in the development of a great cycle of mystery plays." Instead, we should interrogate the multiple dimensions of artistry and artificiality of the play; our task is to ask how these plays operate as a performative moment coming directly from the dominant arms of orthodoxy while still being influenced by the severely limited mass culture. We may find, then, at the center of the controlling mechanisms of the church-state apparatus, the necessitated desire for community that even Satan validates and proclaims: Â Â Â Â Â Â Â Â Â Â Nay, I pray the do not so; Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Vmthynke the better in thy mynde; Â Â Â Â Â Â Â Â Â Â Or els let me with the go, Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â I pray the leyffe me not behynde! The desire, of course, extends past Satan's plea, for the homogenized desire of the congregation ultimately -- which is in history written and yet to be -- is directed toward a different answer from Jesus: one that affirms salvation and again confirms the church's orthodox pageantry of performance.
Wednesday, January 15, 2020
Lord of the Flies Notes by William Golding Essay
The Setting A deserted island which is describe as a tropical paradise, and with a scar, a lagoon and a beach. It was shown by the appearance that the island was presented as beautiful as the garden of Eden. On the other hand, evilness and danger were hindered and were shown through different sentence throughout the chapters. B.The Plot †¢Exposition (Conflicts, confrontation, chaos) In the middle of a war, a plane with a group of British schoolboys was shot down over a deserted island. Two boys, Ralph and Piggy, found a conch shell, and Piggy suggested that it could be used as a horn to call for the other boys. Once all the boys were there, they decided to elect a leader. They chose Ralph as their leader, and Ralph appointed Jack to be in charge of the choir boys who would be hunting for food. Ralph thinks that they must light a fire by using Piggy’s glasses so to attract the attention of passing ships, hoping that someone would see the fire and save them. The boys succeed in making a fire, but it burned down quickly because no one was watching the fire. Jack thinks that Ralph shouldn’t be the leader and Jack forms a new tribe. †¢Climax The boys thought that there was a beast in a cave on the island, and none of them dared to go in to find out who or what the beast actually was. Simon was brave, and he found out that the true identity of the beast was actually a dead parachutist. He planned to run down to the beach to tell the rest of the boys, but he ran into the middle of Jack’s tribe’s gathering and they thought that Simon was the beast. They ended up killing Simon. The next morning, Piggy realized that Jack’s tribe had stolen his glasses, so Ralph and Piggy went to find Jack’s tribe and ask for the glasses back. But they refused and Roger rolled a boulder down a mountain and killed Piggy. †¢Resolution Ralph knew that Jack’s tribe would be finding him, hunting him down. So Jack told his tribe to light the entire forest with fire to scare Ralph out of his hiding place. When Ralph saw the fire, he immediately ran towards the beach and fell down because he was tired. Ralph looked up and saw a British naval officer. Ralph cries in the end because of his loss. C.The Characters Ralph One of the main characters / main protagonist Elected leader He was responsible of the well-being of all the other boys in the story ï µHe the one and only boy who could still remain civilized and rational at the end of the story Piggy The smart one/ the most intelligent one His glasses is the key to making the fire Made fun of because of his weight and outlook The outsider Was killed by the stone Jack Leader of choir boys / hunters Main antagonist Longs for total power He is rival to Ralph and eventually declares himself as the chief Simon Knows the true identity of the beast Was killed Oddball of the group Roger and Maurice The hangman of Jack’s tribe Roger’s Jack’s lieutenant who has a sadistic streak. Maurice was Roger’s henchman Kills Piggy Same and Eric / Samneric Twins Loyal Seemed to be the boys who†breathed together†and â€Å"grinned together†D.The Themes Civilization V.S. Slavery Ralph (Order) V.S. Jack (Wanting for power) Civilized, mannered, English boys V.S. Brutal, wild Loss of Innocence Boys were supposed to be innocent, but they were brutal Crowd Mentality Good and evil The conch group V.S the savages The boys V.S terrifying beast Attemps at rescue from a passing ship V.S imprisonment on the increasingly chaotic island E.Read the Introduction and answer the following questions: 1.How was the novel inspired by Coral Island? Both stories’ plots are about boys being stranded on a deserted island. In â€Å"Coral Island†, the author, R. M. Ballantyne, wrote his perspective of what British boys would do if they were stranded on an island. In the story, the three boys worked together. They built huts, hunted for food and explored the island. They were at first, primitive cast mates, but then evolved into civilized people. â€Å"Lord of the Flies†was inspired by the plot and idea of boys being stranded on an island, but William Golding wrote his own perspective of how he thought a group of civilized boys would react to being stranded on a deserted island. The difference is that in â€Å"Coral Island†, the boys became civilized people while in â€Å"Lord of the Flies†, the civilized boys became â€Å"monsters†. 2.Briefly describe the three parts of the novel For the first part, it’s mainly the background of how the boys got stranded on the island and the election of their leader – Ralph. Ralph thinks that they should start a fire to get the attention of passing ships in order to rescue them from the island. The second part is mainly about Jack forming a tribe against Ralph and them killing Simon because they thought that he was the beast. But actually, Simon knew that the beast was actually a dead soldier, but he was killed because Jack’s tribe thought that he was the beast. The third part is mainly about how Jack’s tribe stole Piggy’s glasses to start the fire and how Roger rolled a boulder down the mountain, killing Piggy. And about how Jack’s tribe tried to kill Ralph by setting fire to the entire forest, but Ralph was rescued by a British Naval officer. 3.Briefly comment on the style in which the novel is written The author wrote the story in a very straight forward style. There weren’t too lengthy descriptions. The characters and objects in the story have symbolic meanings that show us the main theme of the story. This story is based on the author’s real – life experience with the cruelty and brutality of World War II.
Monday, January 6, 2020
Giving Universities the Business Essay - 1444 Words
Giving Universities the Business The business of America is business. Calvin Coolidge To talk in public, to think in solitude, to read and to hear, to inquire and answer inquiries, is the business of a scholar. Samuel Johnson In the last ten years there has been a concerted movement in this country to re-design schools according to the Business Model--a movement which has recently gained an apparently unstoppable momentum. We hear continually of the universitys need to open up new markets, to learn new ways to compete and create new customer bases; simultaneously, we are bombarded with demands from the politicians and administrators who control our public funds to increase our productivity and accountability. (1)†¦show more content†¦(2) The implicit assumption of this and similar reports was that, left on their own, scholars had turned American education into doctrinaire trivia, and that University faculties particularly were, as a now infamous editorial in the Wall Street Journal put it, a new leisure class which needed the firm hand and clear vision of the business community to put things right. How to refute this? During the period which this camp claims saw the wholesale deterioration of American education, American universities developed and grew like never before and American graduate schools became the envy of the entire world. But even more specifically, hasty calculation will reveal that a professor teaching 4/4 must work 60 hour weeks (and thats figured over a 50 week year). (3) There may be lazy communities out there, but the university aint one of them. Which brings us to the Times Are Tough argument. My response to this is simple: when have times not been tough? 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