Globe Theatre Essays (1285 words) - William Shakespeare,

Globe Theatre Globe Theatre In the cobblestone roadways and roughly built playhouses, an extraordinary development took place in England in the 1500s. At that time, a burst of literary accomplishments arose that was never before seen in the history of the theater. In the all-new idea of theaters, playwrights lifted the Elizabethan Theater to new heights. Men like Shakespeare and Christopher Marlowe dared to write plays about real people in a variety of real situations. (Yowell 13) Through their efforts, these men and those of similar qualities produced dramas that were far more sophisticated and entertaining than ever before. Audiences expressed their pleasure by demanding more and more plays. The public shared a great deal of interest in the theaters and playwrights of this time. People from all over the city of London would travel to experience the dramatic feel of the Elizabethan Theater. The theater was a very important aspect of Elizabethan life in the medieval ages. Life in Elizabethan times was difficult and dangerous. Many people were poor tenant farmers, often living at the mercy of wealthy landowners. People threw trash of all kinds into streets, and tolerated fleas, lice, and rats in their homes and clothing. (Richman 1) Disease and Death were a part of everyday life. Elizabethans sought relief from their harsh lives by attending plays and other forms of entertainment, which made the theater so important to Elizabethan culture. There were many theaters in Elizabethan times, all very similar to each other. However, when William Shakespeare began writing playwrights, the final production was so exceptional, that no other person could compare. With this, Shakespeare was mainly centered at one theater, The Globe. With the popularity of playwrights in the middle ages, the theaters themselves were popular as well. By the late 1500s, performances were becoming expensive, shutting out the non-payers. (Hartz 35) The solution was to find or construct buildings that were suitable for the performance of plays. By the late 1500s, there were over a dozen theaters in the immediate London area. At this time, the most popular theater, "The Theatre" housed the most prestigious of plays. For years, this one individual theater acted as the center of the town, where the most famous plays were shown. But in 1597, the lease on the land on which The Theatre sat expired and the owner of the land would not renew the lease. (Encarta n/p) In the winter of 1598, while the original owner was away, the people of London decided to move the theater, board by board. They began to rebuild the theater in Southwark, London, near The Rose, The Swan, and The Hope theaters. After ten months of rebuilding, the theater was later renamed as The Globe in 1598. The Globe Theatre was rebuilt primarily for the fall of the previous theater. Upon completion of the newer, revised theater, The Globe actually turned out not to be the largest of it's time. The theater was three stories high, one-hundred feet in diameter, and could hold as many as 2,900 patrons if desired. (Encarta n/p) The Globe Theatre was constructed as a mixture between a Roman Amphitheater and an English Tudor House. The architecture of The Globe was very unique. There was no roof over the actual theater. There was however a thatched roof over the stage. The use of a roof over the stage was not only to protect the performers from the weather, but to improve acoustics as well. (Hornell 44) Two very elaborate, almost gaudy pillars held the roof over the stage, a style favored by the Elizabethans. The stage in itself was rectangular and extended into the middle of the auditorium. Various trapdoors were cut in the center of the stage, through which an actor might disappear or leap forth, as the action demanded. A balcony hung over the rear of the stage and a musicians' gallery was tucked behind the balcony. (Richman 1) Unseen, behind the stage, was the Tiring House. Here is where the actors dressed for the plays. Individual dressing rooms were not a feature of Elizabethan playhouses, so actors were to dress in whatever open space they could find. (Yowell 16) The Globe Theater was the home to one of the most honored writers of the time, William Shakespeare. Here, Shakespeare wrote, rehearsed, and performed his plays. Plays such as "Caesar" and "Romeo Juliet" were performed at The Globe, which helped build The Globe into a very popular and prestigious theater. (Richman 1) When the actual performance was taking place, a flag was raised to show that the play was ready to be performed. (Encarta n/p) Inside the

Interesting Personal Statement Essays - Computer, Head Web Designer

Interesting Personal Statement Essays - Computer, Head Web Designer Interesting Personal Statement National Merit Scholarship "Would you please get the mail," my mother implored as I entered the door. Heading towards the mailbox, I wondered if I would find daily assortment of bills and catalogues or something interesting addressed to me. To my delight, the first item was the new issue of PC Computing. Ever since I was introduced to computers when I was five, I have been fascinated by them. The summer before my sophomore year of high school, I wrote a program called Quickchange 95 using Visual Basic. This program changed the startup and shutdown screens of Windows 95. I distributed the program via shareware archives on the Internet, and I received email from all over the world about my creation. I shuffled through one of my mother?s clothing catalogues to find my issue of Money Magazine. I have been interested in business and finance since the day which we started studying the stock market in fifth grade. The summer before my junior year, I combined my interests in business and computers by starting a web design company with a friend. We created a web site for a local bike shop which is only one of two bike shops in Connecticut to have a presence on the Internet. Currently, I am the head web designer for my school. I intend to combine computers and business in my future career. My goal is to work on the business side of a computer firm, and eventually, I would like to start my own computer company. A board of education letter of commendation for my participation in the FIRST robotics program also arrived today. I have been able to develop my entrepreneurial skills through the FIRST robotics program. FIRST is a national engineering competition in which partnerships are formed between local businesses and high schools to design and build a robot-like machine. The team has about six weeks to build a machine, that must be able to compete in a timed sporting event. I have been involved in FIRST each year of my high school career. Last year, I was team captain, and our team finished fourth in the country out of one hundred and fifty-six teams. As a result of my involvement with FIRST, I have improved my confidence, my leadership, and my team working abilities. FIRST gave me experience working with a diverse group of people with a variety of skills. Working alongside engineers from our sponsor company, International Fuel Cells, exposed me to the professional world beyond the classroom . I have a great appreciation for this program which has challenged me to bring out the best in myself and others. My last piece of mail was Tennis Magazine. I began playing tennis at the age of eight. During my freshman year, I played on the junior varsity tennis team, and I received the Manchester Racquet Club deserving player award which is a scholarship for a year of indoor lessons. The next two seasons, I played on the varsity tennis team. Last year, I was named to the Hartford Courant All Academic Team. Tennis has provided a welcome diversion from my technical pursuits. "What took you so long?" my mother asked as I entered the house. "Oh nothing, I really have to start my homework," as I tucked my magazines under my arms and ran up the stairs.

Disscuction Article Example | Topics and Well Written Essays - 250 words - 1

Disscuction - Article Example Adoption or utilization of the new concepts illustrates either positive or negative aspects of the new opinion or concept. I accept data which challenge my present views. The challenging data provides very many alternative courses of action. For example, I presently believe that the main reason for education is knowledge development for employment purposes. But there are other significant views on benefits of education such as; developing entrepreneurship potential, ensuring innovation and creativity in society, and finally realizing good political governance through developing law abiding citizens. Accepting challenging data ensures understanding of the advantages and disadvantages of the view that I illustrate. For instance, my view on affirmative action is always positive. But there are shortcomings of affirmative action, for example, giving average employees in terms of competencies senior management positions in organizations. There are ideas that can challenge the comfort level that I am in currently; for example technological innovation ideas. New technology creates new processes. The emergence of the social networks has changed the way I communicate with friends. Because of busy work and education schedule, I mostly communicate with friends via Facebook and twitter

Consumer Cultures, Environmental Futures Essay Example | Topics and Well Written Essays - 1750 words - 1

Consumer Cultures, Environmental Futures - Essay Example Catfish is one of the types of fish that people consume, which differentiate the consumers along different lines of the economy, society and political differences. Through this differentiation, people have different perspectives of looking at the catfish both from the perspective they may have from the influence they have from their culture and social ties. The analysis of production and consumption of catfish will help in explaining the various reasons that make it a consumer product of a specific group of people within a society, which may mean a lot of structure formulation within a society. The analysis focuses on the sources of catfish and the places in which it is a common form of food while in some others; it could be a rare commodity (Tucker and Hargreaves, 2004, p.27). Catfish are popularly produced in different places in the world as one of the small-fish that people consume as food for their own and which they sell to a few people around their environment. However, researc h shows that production of small-fish in sector of fishing is an aquaculture that usually target different people who fall in the low economic classes in the society. In the economy, consumption of these small-fish is therefore, related to specific people in the country who could be a having similar general characteristic (Tucker and Hargreaves, 2004, p.39). Catfish is mostly common among the Vietnamese who invest in production of the organisms for food in different place in both large-scale and small-scale levels of the economy. This production is facilitated by the demand that is raised for the food that that has some contents of fish and the different levels of production of catfish through the aquaculture technology implies the different demanding issues that surround food fish production within the society. In this respect, when food fish demand increases, people have adopted various ways through which they can improve the amount of products they obtain from their investment. I n the Vietnamese culture, fish are highly regarded and therefore, people adopt aquaculture in order to meet the local demands as well as the needs of others that are away from the country. In the aquaculture for production of the catfish species of the fish, there are different factors that favour the production in the area, which motivate people to invest in the production as a mode of subsistence or as a commercial activity. In order to produce, people depend on different opportunities that the environment offers, which help people to exploit it for their benefit. In this respect, people have different ways through which they produce the catfish to the different market in Vietnam or away from the country. The most common factors that are important in determining the production of the catfish include the sources of water where the fish will grow, the availability of fingerlings that grow to be the mature catfish and the space that is available for people in to establish their produ ction and the aquaculture. In most cases, people who invest in aquaculture try to establish their production by varying the conditions in the condition of the environment to allow the production even in places that are not very favourable for production. This aquaculture in

How do the views of 'constructivist' theorists about international Essay

How do the views of 'constructivist' theorists about international security differ from those of 'neo-realists'' - Essay Example Much of this analysis will draw from the work of British historian Eric Hobsbawm, arguably one of the most prominent scholars of the history of globalization. We then conclude with an overview of the issues explored and argue that neoliberalism and globalization are intrinsically intertwined. Neoliberalism has been the driving force of the global economic order since the latter half of the twentieth century. The current state of world affairs has its precursors in the social revolution of the 1960s, economic crises in the 1970s culminating the collapse of the New Deal and the OPEC oil crisis, as well as the emergence of neo-liberalism as a driving political and economic force in the 1980s. Events from the late 1960s reverberated in the Communist world and finally came to a head in the 1980s with total economic and political collapse. The Soviet sphere, coupled with the former Yugoslavia, provide the best examples of this phenomenon. Additionally, the end of the Cold War has had important implications for the already precarious states of Africa and has coincided with the emergence of Asian economic â€Å"Tigers†: a global economic shift towards emerging East Asian powerhouses. Our current wave of globalization will be traced back to the late 1960s, beginning with t he â€Å"social revolution† of that decade, and will end with today’s international state of affairs. The social revolution of the 1960s was also a cultural revolution. In fact, the â€Å"rise of a specific, and extraordinarily powerful youth culture indicated a profound change in the relation between generations† (Hobsbawm 1994, p. 324). Leading this cultural revolution were the young: teenagers started wearing jeans – prior to that only farmers wore them – and rock music became the voice of a generation (Hobsbawm 1994, p. 324). In fact, industries saw the potential

Mental Health Service User Case Study

Mental Health Service User Case Study 1.1 Decision making by nurses is now firmly established in practice, policy and educational agendas. New constantly evolving, roles, and a policy context that is challenging traditional professional boundaries mean that, more than ever, nurses are being given autonomy and power to be able to exercise their decision choices (Thompson, 2001). 1.2 Clinical decision making may be defined as having a variety of options and choices and a process that nurses undertake during their everyday activities whilst caring for service users. It usually involves nurses making judgements about the care that they provide to service users (Thompson et al, 2002). Similarly ONeill et al (2005) argues that clinical decision making is a complex activity that requires nurses and other health professionals to be knowledgeable in relevant aspects of nursing, to have access to reliable sources of information and to work in a supportive environment. 1.3 Shared decision-making on the other hand is an interactive collaborative process that occurs between the nurse and the service user that is used to make health care decisions. Adams and Drake (2006) note that in shared decision-making the nurse becomes a consultant to the service user, helping to provide information, to discuss options, to clarify values and preferences and to support the service users autonomy (p.88). 1.4 Policy changes and trends in professional development within the last decade have reiterated the importance that nurses and other relevant health professionals need to recognise that the decisions they make have a direct impact on health care outcomes and service users experiences (DH, 2000). 1.5 Decisions can be easily examined in the form of decision trees which provide a highly effective structure within which many different options can be explored (Goetz, 2010). Goetz (2010) further argues that the decision tree encourages people to think through their options, to act consciously and with consideration. It has also been suggested by Corcoran (1986, cited in Bonner, 2001, p.350) that the decision tree is able to provide a clear structure which helps to assess a range of actions that health professionals may choose when making decisions regarding the care and treatment of a service user. 1.6 In contrast, Bonner (2001) argues that the decision tree is under researched within the scope of mental health practice. He does acknowledge that the use of the decision tree in practice allows nurses to examine the options available to them in more detail, whilst also considering the complex variables that influence the decision-making process. 1.7 It would be expected that the decision tree is hierarchically structured and spans a specific period of time which will be determined within the Justifications section of this report. 2. Methodology 2.1 The purpose of this report is to identify a service user with whom one was currently working with in practice. Using a decision tree, the service users journey will be detailed from their current health needs from the point of referral to mental health services to the current point in time. Once the decision tree is formed, it will then be essential to identify up to three critical decision points and analyse the decision making process for each decision chosen. 2.2 The information required to form the decision tree is to be gathered during a 60-minute unstructured interview with the service user, which can be thought of as a guided conversation. The reason that this type of methodology will be utilised is because unstructured interviews allow a particular focus on specific areas through asking open-ended questions but also allow for probes and follow-up questions to be used in order to effectively obtain more information to construct the decision tree as accurately as possible (Streubert Carpenter, 1999). 2.3 In order to ensure that the information gathered is accurate, it will be beneficial to form a lifeline with the service user, looking at major life events and decisions that have been made. This lifeline can be found in Appendix 1. 2.4 It will also be essential to explore the service users medical notes (with their consent) in order to gain a clearer idea of events that have occurred, the vital decision points and whether service user involvement was evident throughout. 2.5 The decision tree that was formed can be found in Appendix 2. 3. Justification 3.1 The service user that will provide the focus of this report will be referred to as Sarah (a false name in order to maintain confidentiality). 3.2 Sarah is a 43-year old lady who has a diagnosis of borderline personality disorder. She has had multiple admissions to psychiatric units including admissions under the Mental Health Act (See Appendix 3 for supporting information). 3.3 Sarah was chosen because it was felt that the she would be able to provide a good history and account of events that have occurred in her past in relation to the care and treatment that she has received. Sarah was also deemed to have capacity and was therefore suitable to take part within this piece of work. 3.4 The timescale that the decision tree covers will focus upon a 6-year history whereby Sarah began her first contact with adult acute mental health services. This will be explored up to the current point in time. 3.5 During the gathering of information, both primary and secondary sources were used. Primary sources refer to first-hand accounts of events that have occurred (i.e. interview with service user). In comparison, secondary sources refer to information that has already been documented from the past (i.e. medical/nursing notes). It was decided to use both sources as they would provide information richer in validity and ensure the reliability of the findings. 3.6 The report will cross the boundaries between in-patient care and community services within the North of England. The key decision points that have been chosen for analysis within this report were chosen because it was evident that some decisions had a certain degree of service user involvement in comparison with others whereby service user involvement did not seem to be present. This does however introduce a debate in regards to service user involvement because those decisions that did not involve Sarah and that were made on her behalf, can be argued were made in the best interests of the individual i.e. admission to hospital to ensure Sarahs safety and well-being. 3.7 Each of the decisions will now be individually analysed with a specific focus upon the decision itself, the issues that they may involve and the concepts that they may introduce. 4. Referred and taken onto caseload with a Community Mental Health Team following gate-keeping assessment (See Appendix 4) 4.1 Sarah was referred to her local community mental health team following a visit to her General Practitioner (GP) whom was worried about the self-harming thoughts that Sarah was currently experiencing. The General Practitioner was very concerned about Sarahs apparent deterioration in her mental health, therefore he felt that it was necessary to refer her to the community mental health team who would then be able to offer assessment and work from that point onwards. The GP discussed this with Sarah who did admit to being a little apprehensive beforehand however after a short period whereby she was able to reflect on her current circumstances, Sarah was agreeable to this. 4.2 Borg et al (2009) argues that service user involvement has a crucial significance especially for individuals that work within a community mental health setting as this involves accessing patients in their own homes (p.285). Sarah did feel that she had developed a good rapport with her community psychiatric nurse because Sarah was always offered choices in terms of her care and treatment and she felt actively involved in the decisions that were made. The therapeutic relationship that was developed between Sarah and her community psychiatric nurse also played a vital role in Sarahs care as Reynolds and Scott (2000) argue that it is through this therapeutic relationship that we can assess the needs of the patients that we work with and then plan future care to assist in their recovery. 4.3 An important consideration is the potential risk involved in maintaining Sarahs mental health in the community. This was clearly documented within Sarahs treatment plan with specific actions outlined and crisis contact numbers provided to both Sarah and her Husband. The National Institute for Health and Clinical Excellence (2009) provides guidance on risk assessment in patients with a diagnosis of emotionally unstable personality disorder. It informs that the risk assessment should take place as part of a full assessment of the patients needs and this is exactly what occurred due to the high level of risk involved and potential self-harm of Sarah within the community. 4.4 The main influences behind the decision to make a referral to the local community mental health team was Sarahs safety and how able she was to maintain this. Also if the GP felt that Sarah required a hospital admission and there were no hospital beds available, then a referral to the community mental health team or crisis resolution would be necessary. This therefore would indicate that care and treatment is dependent upon what resources are available at that specific time. 4.5 In order to ensure that the correct decisions are made, the specific team must have an effective leadership style and a variety of skills amongst team members. The New Ways of Working practice implementation guide (DH, 2007) outlines how a team can effectively achieve their maximum potential. In order for this to be achieved, a number of measures must be addressed which include; Focusing upon skills and matching these to the needs of service users; Distributing responsibility fairly amongst the team rather than delegating; Focusing on ability and competence of team members rather than role. 4.6 The policy discussed in section 4.5 appears to be utilised well within this team because Sarah was allocated to a senior care coordinator that had a large amount of experience of working with individuals with a diagnosis of personality disorder. The health professional was also able to engage and was competent in carrying out Dialectical Behavioural Therapy with Sarah which is a specialised treatment suitable for those with a diagnosis of personality disorder (Comtois et al, 2007). 4.7 There are many alternate decisions that the General Practitioner could have made in order to ensure that Sarah received the treatment that she required to meet her needs. A referral to the local crisis resolution home treatment team could have been made who would offer assessment and then decide a plan of action. Brimblecombe (2001) argues that a team such as this could have the potential to reduce the number of hospital admissions, therefore utilising resources and funding more effectively but at a cheaper cost. 4.8 Another possible course of action could have been to make a referral to the acute community day services (day hospital) who would be able to provide care throughout the day for Sarah if she required support. This would be a less restrictive alternative than hospital admission and Sarah may be more likely to engage with this service based in the community. 4.9 Alternatively, the GP could have chose to not do anything except review Sarah after a few weeks to assess whether her mental health was still deteriorating however this may be seen as unethical especially if Sarah was suffering due to her experiences and self harming thoughts, which ideally should be resolved as soon as possible. 5. Voluntary (informal) admission to acute psychiatric hospital following presentation in Emergency Department (See Appendix 5) 5.1 When Sarah becomes acutely unwell, the most common course of action is to admit her to hospital for her own safety and well-being but also the safety of others. This particular hospital admission was informal which therefore indicates that Sarah was willing and agreed to go into hospital, having been assessed by a team which specialises in self-harming behaviour. 5.2 The Mental Health Act (2007) refers to informal patients as those that accept and agree to go to hospital without the use of compulsory powers. Sarah was not detained therefore she was permitted to have leave from the ward to spend at home with family. This was Sarahs choice and was discussed in collaboration with the Consultant Psychiatrist until an agreement was made. 5.3 The decisions to admit Sarah to hospital was made by a health professional that assessed Sarah in the Emergency Department following an incident of self-harm. Sarah did feel that she was fully involved within the decision because alternatives to hospital admission were discussed with Sarah however she felt that hospital admission was the most appropriate action to ensure her safety at that specific time. Furthermore the Nursing and Midwifery Council code states that as a professional, nurses are personally accountable for actions and omissions in their practice and must always be able to justify their decisions (NMC, 2008). 5.4 The main influences behind this decision were the levels of risk involved due to an escalation in Sarahs self harming behaviours within the community. The Ten Essential Shared Capabilities (DH, 2004) aimed to set out the shared capabilities that all staff working in mental health services should achieve. Promoting safety and positive risk taking is one of the major points within the document with the hope of empowering individuals to determine the level of risk that they are prepared to take with their health and safety. Ideally this includes working with the tension between promoting the individuals safety and positive risk taking which should be detailed within the individuals care plan. 5.5 Positive risk taking and risk management has been largely debated within the scope of mental health nursing. Parsons (2008) argues that people learn through a process known as trial and error. This therefore suggests that if Sarah self-harmed so significantly that her life was endangered then she would not carry out this behaviour again. This theory however can be largely critiqued in regards to Sarahs case because the self-harming behaviour is a regular occurrence with Sarah in full knowledge of the consequences that this may have. 5.6 A study carried out by Bowers et al (2005) examined the purpose of acute psychiatric hospital wards and they concluded that in most circumstances, patients are admitted because the possibility of harming themselves or others had increased significantly. They also found that when an individual is experiencing a severe mental illness whereby their behaviour is unmanageable in the community, this provides the requirements for a hospital admission. 5.7 In contrast, the quality of care on acute psychiatric hospital wards has largely been questioned in regards to the usefulness that hospital admission can actually have upon a person (Quirk Lelliott, 2004). In some circumstances, many individuals will receive high-quality care whilst in hospital however recent studies have suggested that for some individuals, the experience of hospital admission was rather negative (Baker, 2000; Glasby Lester 2005). 5.8 The Royal College of Nursing (2008) acknowledges that every nursing decision made has an ethical dimension and furthermore that ethics and ethical decision making abilities are applicable to every aspect of nursing practice. The decision to admit Sarah to an acute psychiatric hospital ward does introduce ethical dilemmas because it can be argued that it is unethical to admit a person to a locked ward and therefore restricting their freedom. 5.9 Beauchamp and Childress (2001) developed a framework which consists of four main principles. The first principle outlines the respect for an individuals autonomy i.e. respecting the decisions that they make and the reasons for making a particular decision. Sarah was given a choice in regards to hospital admission because she could have been detained under the Mental Health Act (2007) however she agreed to hospital admission and was therefore admitted as an informal patient. 5.10 The second principle is that of Beneficence which examines the benefits of having a particular treatment against the risks involved. This was discussed with Sarah and the reasons for hospital admission were fully explained which were to ensure Sarahs safety. Sarah understood the health professionals concerns and worries and did accept hospital admission therefore the health professional was acting upon beneficence. 5.11 The third principle is Non-Maleficence which refers to the avoidance of causing harm to an individual. It can be argued that any treatment can have to potential to cause harm however the benefits of the treatment must exceed this which in this case, the benefit plays much more of a vital role. 5.12 The final principle within the framework is Justice which examines the distribution of benefits, risks and costs equally. It therefore indicates that individuals should be treated fairly in similar circumstances and offered the same intervention/ treatment. In terms of hospital admission, the choice would be to go in as an informal patient or be detained under the Mental Health Act using compulsory powers. This decision would be given to most individuals however when capacity becomes a concern then detention may be required. 5.13 There are many alternate decisions to a psychiatric hospital admission which may have been decided. Sarah may have been referred to an acute community day service (day hospital) which offers assessment and treatment for working age adults that are experiencing acute mental health difficulties. A systematic review of randomised controlled trials of day hospitals within the United Kingdom, concluded that day hospital treatment is generally cheaper, the outcomes are greater and that there was greater satisfaction with treatment compared with in-patient care (Marshall et al, 2001). 5.14 Another alternative decision to hospital admission may be a referral to a crisis resolution home treatment team that would be able to provide 24-hour care. The Mental Health Policy Implementation Guide (DH, 2001) informs that the crisis resolution team is for adults between the ages of 16-65 with a severe mental illness or experiencing an acute crisis that without the involvement of a crisis resolution home treatment team, hospital admission would be necessary to ensure the safety of the individual. This however had been attempted in the past and Sarah did not feel that she benefitted greatly from the service because although they provide a 24-hour service, they cannot offer the same kind of interventions that a hospital ward could offer. 6. Diagnosed with Emotionally Unstable Personality Disorder (See Appendix 6) 6.1 Sarah was diagnosed with Emotionally Unstable Personality Disorder whilst an in-patient on an acute psychiatric ward. The decision to change Sarahs primary diagnosis of deep depression with psychotic episodes was made by the Consultant Psychiatrist that was involved in Sarahs care and treatment. 6.2 The National Institute of Mental Health (2001) describes emotionally unstable personality disorder as a serious mental health illness that is characterised by a pervasive instability in moods, interpersonal relationships, self-image and behaviour. The symptoms of emotionally unstable personality disorder are maladaptive behaviour learnt to make sense of the world and to manage the constant negative messages experienced (Eastwick Grant, 2005). It is important to note that Sarah did experience sexual and psychological abuse from an outsider of the family during her childhood which she did not disclose to her family until she was an adult. Sarah recognised that this was a major factor in the way that she perceived the world and was directly linked to her self-harming tendencies. 6.3 During this period of time, Sarahs behaviour became increasingly unsafe to manage in the community therefore warranting a hospital admission. Her self-harming tendencies had increased and there was a great concern for her safety mainly expressed by her family who were worried about Sarahs deterioration in her mental health. 6.4 When Sarah was given the diagnosis, she was unhappy due to the non-apparent involvement within the decision as she was not consulted in regards to the diagnosis or asked about her thoughts and feelings. Bray (2003) argues that decision making and service user involvement cannot always occur with individuals that have a diagnosis of emotionally unstable personality disorder due to the varying symptoms that they may experience i.e. impulsive behaviour which can diminish responsibility. 6.5 Once the diagnosis was made, Sarah felt that peoples opinions and attitudes had changed towards her including ward staff. According to Nehls (1999) individuals with a diagnosis of emotionally unstable personality disorder have described health professionals as being unhelpful, displaying negativity and generally being unhelpful. 6.6 A consultation document known as New Horizons (DH, 2009) outlines a cross Government vision in the hope of eradicating the stigma that surrounds mental health and improving the quality and accessibility of services, ensuring that services are service user friendly. The document stresses the importance of mental health and encourages individuals to understand that mental health problems should be equally as important as physical health conditions. 6.7 Services that are provided by the National Health Service (NHS) are commonly built upon effective partnerships between those providing care and those accessing care. The Department of Health (2004) informs that better healthcare outcomes are achieved when the partnership between health professional and service user is at its strongest. Within this particular decision, there was no partnership as Sarah was not involved in the decision making process in regards to her care and treatment and decision to make a diagnosis without consultation with Sarah. 6.8 An important consideration is that of power because the Consultant Psychiatrist that made the decision, created a position of power over the service user through expertise and knowledge. Pyne (1994) argues that knowledge is a form of power, therefore if we share this knowledge with the patients that we work alongside, then this can promote the process of empowerment in patients. The author then progresses to a stage whereby he questions why nurses do not always demonstrate this behaviour in practice. In comparison, McQueen (2000, cited in Henderson, 2002, p. 502) argues that power associated with special knowledge, that created a barrier between health professionals and patients is slowly diminishing. Furthermore, McQueen believes that both nurses and patients need to be seen as respected autonomous individuals with something to contribute towards an agreed goal. 6.9 There are alternate decisions that could have been undertaken rather than making a diagnosis of emotionally unstable personality disorder. The Consultant Psychiatrist may have decided to not make a formal diagnosis however this could therefore have an effect on Sarahs care and treatment as she would not receive the correct care and treatment to meet her needs. Sarahs previous diagnosis of deep depression with psychotic episodes may have remained the same however it cannot be determined how long this would have lasted due to the frequency of self-harming behaviours and multiple hospitals admissions due to an increased concern for Sarahs safety. 7. Comparisons 7.1 It has become evident that the three chosen decisions for analysis had common themes running through each decision. Power has become an important consideration because although Sarah had a degree of power within each decision, the overall decision was made by those within higher positions i.e. hospital managers and leaders. This can therefore provide the service user with a false misinterpretation of the power that they actually withhold as it is clear that the final decision is not made by the service user and instead it is those with more power i.e. the GP making the referral to the community mental health team and the Consultant Psychiatrist changing Sarahs diagnosis to emotionally unstable personality disorder without consulting Sarah beforehand. 7.2 Leadership has been defined many ways in the literature reviewed, however several features are common to most definitions of leadership and the forms that it can take. Faugier Woolnough (2002) argue that leadership is a process which usually involves a certain degree of influence, but also with a focus upon the attainment of goals .The leadership style mostly present within each of the key decisions is that of a democratic style because there was a degree of consultation with staff on proposed actions before an actual decision was made. 7.3 The care and treatment provided to Sarah was driven by resource availability and this was clearly evident within each decision. If resources are not available, this would impact on the decision whether to allow Sarah to have the treatment. The admission to an acute psychiatric hospital for example would be dependent upon the capacity of that specific organisation because if there was not a bed available for Sarah then other alternatives would have been considered. Fortunately there were resources available for Sarah, however the outcomes may have been different if this was not the case. 7.4 Sarah had also had a large amount of input from a number of services and there was a large amount of movement through mental health services. It can be argued that this is not beneficial towards service users as they are not able to sustain good therapeutic relationships with health professionals which can often be a reason as to why an individual may relapse. 8. Conclusion 8.1 Decision-making within practice takes place in many ways i.e. often the service user is consulted throughout their care and treatment however in some circumstances the service user can be made a recipient of their care and treatment which is not good practice. This report has identified a patient that one is currently working with and using a decision tree, their journey through mental health service was detailed. Three decisions were chosen for analysis and provided the basis of this report, considering factors that influence the decision-making process and also the alternatives that could have occurred. 8.2 Barker et al (2000) argues that the experience of being mentally unwell can be a disempowering period of time because choices can be taken away due to a number of reasons and the patient may feel a recipient of their care and treatment, rather than actively involved in the decision making process. 8.3 Defining decisions as good or bad is problematic, mainly because nurses operate in an environment that is characterised by uncertainty (Buckingham et al, 2000). Baron (2000) further suggests that the best decisions are those that produce the best outcomes for achieving a patients goals and wishes. 8.4 Sarah did feel the majority of time that she was involved in her care and treatment, including reviews and meetings held about her care and treatment whilst an in-patient and within the community. There were times however when Sarah did not feel involved in the decision making process i.e. when her diagnosis was changed without any consultation or discussion. 8.5 Clancy (2003) argues that there is a great tendency in decision-making to bypass a thorough analysis and jump too quickly into solutions. This seems to be evident at times within the chosen decisions for analysis because some decisions were made on behalf of Sarah and there was no consultation or service user involvement. 8.6 Throughout this report, the main aim was to analyse the decision-making process of three key decisions, taking into consideration concepts such as; autonomy, power, leadership and empowerment. It became apparent that they key to successful decision-making was to involve the service user and carers within the decision-making process, listening to their thoughts and opinions and respecting their right to choose between different alternatives. 8.7 It has also become apparent that those within higher positions and those that uphold a certain degree of power were leading the decision-making in Sarahs care. This is obviously not the way that things should work as the service user should be actively involved in all aspects of their care and treatment including decisions that are made. 8.8 Overall I feel that the whole process was an enjoyable one and I feel that I worked well in collaboration with the service user throughout. Collating the decision tree was a rather time-consuming activity, however I understand the importance that they hold and the benefits they possess. I have also become more aware and gained a greater understanding of how the decision-making process can impact on the lives of service user and carers, especially when service user involvement is not evident. 9. Recommendations 9.1 There should be a greater focus upon the decision-making process and how it can affect the service user. Decisions should be decided in collaboration with the service user to promote the nurse-patient relationship and allow good rapports to establish. Service user and carers should be actively involved in the decision making process. Decision making should be an identified topic for pre-registration nursing students to equip them with the desired skills. Decisions are to be based on the best available evidence and regularly discussed with users and carers ensuring that an understanding has been reached. Service users thoughts, feelings and opinions to be clearly documented to inform future nursing practice in regards to decision-making.

David Comparision Essays -- Essays Papers

David Comparision Today, just as Homo erectus did eons ago, modern man strives for expression through art. The evolutionary paths of man and art parallel one another; in that, the complexities, which have accompanied the millenniums, also have brought exponentially progressed forms of art. Sculpture is an art form that maintains a high quality of expression. Two examples of this are the Davids done by Michelangelo and Bernini. Michelangelo’s David and Bernini’s David represent their different time periods and artists while remaining similar. Michelangelo was born in 1475 near Florence. At an early age Michelangelo’s interest in art eclipsed that of his studies, and so he began apprenticing at 13 in lieu of regular school. His time under Lorenzo de Medici was the most influential in his young life; this is where he came in contact with Hellenistic nudes, began with anatomy and embedded his humanitarian views. Michelangelo went to Rome at twenty-one and sculpted the Pieta, which made him famous (Coughlan 85-91). In 1501, in which time, he began the monumental task of carving David from a huge block of marble, Florence was experiencing political turmoil. The central meaning of the piece was to symbolize the greatness of Michelangelo’s proud city. He depicts David before the battle with Goliath as he thought Florence was only just beginning to fight and to remind the people of their duty to defend it (Shaked 1). David is portrayed nude, asymmetrical and in cont...