Tuesday, August 6, 2019
The Ultimate Island Essay Example for Free
The Ultimate Island Essay Global warming has caused our body and our earths temperature to rise by a few degrees. The continuous release of greenhouse gases has turned our once peaceful work environment into a polluted and hellish cell of exhaustion. During those times we spend harassing our mind and body in such â€Å"incarceration†, all of us have imagined being in a place where we can relax ourselves worry-free, where we can retreat with our family, and â€Å"socialize†for the bachelors and bachelorettes. A place away from pollution, noise, and disorder. A place where all we do is appreciate the existence of a heavenly environment here on earth. And if all of you dream of these things while at work, you really need a vacation.            In the long list of vacation spots we can find on the internet or in tourist brochures scattered in hotels and travel agencies, one place would always be ahead of everywhere else, Bali, Indonesia. This island will not be on top of the list for no reason.            Being the largest archipelago found in the Pacific, Indonesia is proud of its 7000 islands including Bali (Diving Indonesia). This particular island includes miles of sandy beaches, enchanting rice-terraces, volcanoes of up to 3,000 meters high, caves, lakes, forests, and valleys enough for you to tell yourself, â€Å"Oh! This is heaven on earth!†(Bali Tours)            Being an island of only 2,000 square miles, appreciating the exotic and picturesque features of Bali is easy. There are lots of day tours which will take you anywhere in the island and take you home very satisfied in the evening (Introduction to Bali).            Surrounded by rich waters of the Pacific, Bali will bring you the best of ocean life through scuba diving, surfing, parasailing, and snorkelling offered by the best facilities in the island (Popular Bali Activities). After your water adventure, the white sand beaches will soothe your tired and aching muscles.            For the young ones who came with adventurous spirits, who are in great need for  physical satisfaction, there are sea-side bars, beach clubs, and activities such as white-water rafting, paint ball war games, bungee jumping, horseback riding, nature tours, mountain cycling, kayaking, and jungle trekking to exhaust your undying energy (Popular Bali Activities).            Since vacation is not only for enjoying the itineraries Bali tours are offering every visitors, with the great variation of their interests ranging from nature appreciation to learning, the island also has opportunities that will satisfy everyone’s thirst for new information.            Its rich Malayan history and culture will amaze you as you witness the everyday lives of its people, visit famous temples and palaces, and watch cultural shows, films, and festivals (Bali Tours). Also, with many museums and exhibitions open to all visitors, Bali will satisfy every tourists need for rare and unique information (Bali Museums and Art Exhibitions).            Lastly, your visit to Bali will not be that convincing without shopping for local products. Shopping areas provide a variety of souvenirs like handicrafts, pieces of furniture, woven fabrics, accessories, paintings, wood carvings, clothes, and jewelry (Shopping in Bali). All these are available for you to take home, that is, if you still want to go home.            All work and no play truly makes our lives dull. And because of the many factors which creates uneasiness and dissatisfaction in our work area, and for those who will be entering the professional world for the first time, it is best to have an idea of what beauty and peace is all about to inspire us in our endeavours.            This summer, why dont we call our employers for a vacation and our travel agents for an immediate flight to this heaven on earth? Dont wait and endure your punishment-like work environment for another year and visit this one-of-a-kind destination. References: Adventure Indonesia. Diving Indonesia. Retrieved 31 March 2008, from http://www.indonesiadiving.com/ Bali Tours. Bali.com Ltd. Retrieved 31 March 2008, from http://www.baliguide.com/balitours.html Introduction to Bali, Indonesia. Bali.com Ltd. Retrieved 31 March 2008, from            http://www.baliguide.com/geography.html Popular Bali Activities. Bali.com Ltd. Retrieved 31 March 2008, from            http://www.baliguide.com/baliactivities.html Shopping in Bali. Bali.com Ltd. Retrieved 31 March 2008, from  http://www.baliguide.com/shopping.html Bali Museums and Art Exhibitions.Bali.com Ltd. Retrieved 31 March 2008, from            http://www.baliguide.com/balimuseums.html
Monday, August 5, 2019
Natural Law Essay
Natural Law Essay The theory of Natural Law was put forward by Aristotle but championed by Aquinas (1225-74).  It is a deductive theory it starts with basic principles, and from these the right course of action in a particular situation can be deduced.  It is deontological, looking at the intent behind an action and the nature of the act itself, not its outcomes. Traditional natural law is based on value judgements, which emanate from some absolute source e.g. Gods revealed word. However the term natural law lacks a precise definition, and there is very little agreement, even among experts or proponents of natural law theory about its application to specific, complex, moral, or legal issues. [1] The unwritten body of universal moral principles that underlie the ethical and legal norms by which human conduct is sometimes evaluated and governed. Natural law is often contrasted with positive law, which consists of the written rules and regulations enacted by government. The term natural law is derived from the Roman term jus naturale. Adherents to natural law philosophy are known as naturalists. The major opponent to legal positivism as a conception of the nature of law goes by the label natural law theory. Natural law theory is probably not the best name for this view its a bit of a historical accident that this view in the philosophy of law came to have this name but it is the traditional label. [2] And I will not try to displace it here. Aquinas says that the principles of practical rationality-that is, those principles that tell us how to act reasonably-both are Gods law for our conduct and are knowledgeable by nature, even apart from special divine revelation. So the principles of practical rationality are both law and natural, and hence are natural law. Because Aquinas says that human law must be in accordance with reason and he sometimes says that human law must be in accordance with reason and he sometimes says that human law must be in accordance with natural law. The label is unfortunate because there are some writers who believe that the principles of rati onality or morality place a constraint on legality, but who do not believe that these principles of law rationality or morality are God-given law. These writers are called natural law theorists even though they do not, strictly speaking, believe in natural law. There are important objections to be made to Aquinass theory of natural law. O Connor rightly identifies the main one: Aquinas fails to explain just how the specific moral rules which we need to guide out conduct can be shown to be connected with allegedly self-evident principles. [3] But the objection that Aquinass account of natural law purposes an illicit inference from is to ought is quite unjustified. What are the principles of natural law? There is a set of basic practical principles which indicate the basic forms of human flourishing as goods to be pursued and realized, and which are in one way or another used by everyone who considers what to do, however unsound his conclusions; and a set of basic methodological requirements of practical reasonableness (itself one of the basic forms of human flourishing) which distinguish sound from unsound practical thinking and which, when all brought to bear, provide the criteria for distinguishing between acts that (always or in particular circumstances) are reasonable-all-things-considered (and not merely relative-to-a-particular purpose) and acts that a reasonable-all-things-considered, i.e. between ways of acting that are morally right or morally wrong-thus enabling one to formulate a set of general moral standards. [4] Naturalists believe that natural law principles are an inherent part of nature and exist regardless of whether government recognizes or enforces them. Naturalists further believe that governments must incorporate natural law principles into their legal systems before justice can be achieved. There are three schools of natural law theory: divine natural law, secular natural law, and historical natural law. Divine natural law represents the system of principles believed to have been revealed or inspired by God or some other supreme and supernatural being. These divine principles are typically reflected by authoritative religious writings such as Scripture. Secular natural law represents the system of principles derived from the physical, biological, and behavioural laws of nature as perceived by the human intellect and elaborated through reason. Historical natural law represents the system of principles that has evolved over time through the slow accretion of custom, tradition, and experience. Each school of natural law influenced the Founding Fathers during the nascent years of U.S. law in the eighteenth century and continue to influence the decision-making process of state and federal courts today. Religious studies are flourishing again. Most scholars were convinced that religion definitely belonged to the past and were of interest only to a tiny group of specialists. Today religious studies are pursued by a host of people in a range of departments. Because of the relevance of cultural issues to the contemporary world, religions have moved from the periphery to the very centre of public and academic concern. Their startling resurgence has given rise to the growing number of studies that explore this phenomenon in fresh, new ways. [5] Among the many publications that have appeared recently, I would like to draw attention to a volume edited by Mark C. Taylor, which appeared in 1998. Entitled Critical Terms for Religious Studies. [6] It describes the field in terms of 22 notions some of them old acquaintances, others new comers from belief to writing. Each article analyses the theoretical value of one of these notions, examining it in a particular religious tradition s. [7] Another volume that appeared recently Guide to the study of Religion [8] likewise explores such notions as classifications, comparison, and gender 31 notions in all. Examining the concepts in the two volumes. I was struck by the absence of both history and tradition from each; ironically, only modernity has survived. As it happens, though, the essay on modernity by Gustavo Benavides in Critical Terms is not a bad substitute for the two missing. [9] In Ireland at present there is certain unease in an increasingly secular culture in relation to its linkages with religion and the law of god. Quinn has also stated that as natural law drew the judiciary into novel fields, and as secularisation broke down the old conventions revealing deep divisions over first principles, it became harder to credibly assert that there was one right way and that the courts were uniquely positioned to identify it [10] Despite the problems associated with a disenchanted secular society, there is also the added problem of ascertaining what natural law actually means. It is submitted that, a feature of most of the judicial references to natural law or natural rights under the Constitution is that they assume that there is a general consensus about the identity of the natural law. However, the concept of natural rights has a variety of meanings [11] The use of natural law is problematic because in fact there is no general consensus about the identity of the political, moral, judicial and theological theory being named, and there is no guarantee either that the constitution will in some sense benefit by relying on such a theory. Hogan and Kelly have also stated that, Judicial invocation of such an un-distilled concept of natural law in the context of review presents the obvious danger that invalidation of legislation passed by the Oireachtas might not always be seen to be based on objective, ascertainable criteria [12] The difficulty of interpreting the natural law One of the issues often highlighted by opponents of the use of natural law is that it is ambiguous and consequently very difficult to interpret. Von Prondzynski notes, There is a general aversion among lawyers at having to deal with something they cannot immediately define. [13] The difficulties with the use of natural law cannot be denied. It has been argued, there are two entirely different kinds of natural law theories [14] , one secular and one based on religion. Murphy also noted that, while the state may be Christian, this does little to help define natural law as Christian groupings fundamentally disagree as to what the divine law actually is. [15] However, this difficulty is not insuperable and should not be treated as so. It is clear from the constitution and from judicial decisions such as that of Justice Kenny in the Ryan case, that a Christian type of natural law is advocated rather than a secular natural law theory. The issue of what exactly this means and how it can be applied to complex cases is more difficult to resolve. Von Prondzynski believes that natural law in its legal sense, as seen by the Constitution has nothing whatever to do with the imposition on us all of a concise set of religious rules as propounded by the Churches. [16] The difficulties of natural law interpretation could be considerably reduced by the construction of some form of guidelines for the judiciary to use. These would help the judiciary to define the natural law and to interpret it accordingly. It is submitted that the use of natural law by the judiciary in the 1950s and 1960s was less contentious owing to the nature of society that existed at the time. Ireland during this period in history was relatively homogeneous in terms of its core values, and as such doing the right thing was not necessarily perceived as being undemocratic when everyone knew what the right thing was. In Ireland at present there is certain unease in an increasingly secular culture in relation to its linkages with religion and the law of god. Quinn has also stated that as natural law drew the judiciary into novel fields, and as secularisation broke down the old conventions revealing deep divisions over first principles, it became harder to credibly assert that there was one right way and that the courts were uniquely positioned to identify it. [17] Despite the problems associated with a disenchanted secular society, there is also the added problem of ascertaining what natural law actually means. It is submitted that, a feature of most of the judicial references to natural law or natural rights under the Constitution is that they assume that there is a general consensus about the identity of the natural law. However, the concept of natural rights has a variety of meanings. [18] The use of natural law is problematic because in fact there is no general consensus about the identity of the political, moral, judicial and theological theory being named, and there is no guarantee either that the constitution will in some sense benefit by relying on such a theory. Hogan and Kelly have also stated that, Judicial invocation of such an un-distilled concept of natural law in the context of review presents the obvious danger that invalidation of legislation passed by the Oireachtas might not always be seen to be based on objective, ascertainable criteria. [19] One of the main questions therefore that emerge from the debate regarding the use of natural law is the extent to which natural law can provide guidance to members of the court in deciding constitutional issues. It can be taken for granted that in a parliamentary democracy the judicial review procedure as provided for in the constitution is necessary to defend the rights of individuals. Therefore inevitably the burden of defending the rights of individuals against oppressive legislation falls in part, on members of the court. [20] Thus while defending the rights of individuals may be a prerogative of the judiciary, one is forced to ask; Can such a prerogative ever be justified by reference to principles of natural law? And if so can such a right ever be justified in overriding the democratic will of the people? The answer is a clear no! While there is widespread acceptance that the task of judges is to interpret the Constitution, during this process it is necessary for the judiciary to rely on the text, without reliance on sources from outside the four corners of the Constitution. Whether or not the judiciary should supplement the text cuts to the very heart of what it means to have a written Constitution, enforced by an independent judiciary, in a democratic state. As such the apparent death of natural law should not necessarily be seen as a bad thing if it results in more consistent, truly impartial, reasoned judgments from the judiciary. Proponents of natural law often argue that the use of natural law far from being a licence for unlimited government and a roving judiciary, natural rights and natural law arguments are the best defence of liberty and of limited government. [21] However despite such sentiments, the decision in Re Information [22] , like all previous Article 26 references will not be overturned. What the decision in Re Information makes clear is that natural law cannot be relied upon to invalidate any explicit provision of the Constitution, however it is also suggested that it does not address what residual role natural law plays in the constitutional order. [23] It would appear therefore that a deep fissure exists between concepts of popular sovereignty and natural law. When push comes to shove the Irish judiciary have preferred the former to the latter. Therefore the politics of normative choice through the democratic process is open and not bounded by fixed notions of natural law. [24] The Future of the Natural Law in Irish Constitutional Jurisprudence: Is Natural Law Dead? The future of natural law in Irish Constitutional jurisprudence is currently far from clear. It would appear from the Supreme Court decisions in recent years that for the foreseeable future natural law will not play a significant role in constitutional jurisprudence. [25] While the recent demise of natural law has been described as one of the great tragedies of the bitter debate on abortion [26] , it would be wrong to conclude that the Regulation of Information Bill 1995 signalled the death of natural law. [27] They suggest that the natural law component remains a significant aid to interpretation, [28] although it will remain inferior to the canon of harmonious interpretation. Although not dead, natural laws place in Irish constitutional jurisprudence has been radically altered. The doctrine now has a reduced significance in constitutional interpretation and a future growth in stature remains unforeseeable. Its application has led to many difficulties. Howeve r, the use of natural law is not without benefits and its diminution and potential evisceration by the judiciary may prove detrimental. Natural law was invoked over an extended period to protect the rights of citizens not expressly provided for in the constitution, including the right to bodily integrity, the right to travel, the right to earn a livelihood, the right to privacy and the right of access to the courts. It remains to be seen if the Supreme Courts decision will prevent the recognition of further unremunerated rights. Natural law will remain a significant aid in constitutional interpretation, however it is submitted that it will not be as influential as it has been in the past. In order to be really effective, the natural law must have its first home not in the judiciary, but in the population at large and in a constitutional democracy this means in the populace as represented in legislatures. That legislation and not adjudication should be the primary forum for the application of the natural law seems to have been recognized by no less an authority than St. Thomas Aquinas. [29] Here it is noteworthy that the application of natural law by Irish judges has largely been in the context of fundamental rights jurisprudence, for it is precisely when the substantive structures and ethos of community begin to break down that legal issues become primarily issues of rights. [30] So here the debate over natural law may ironically be a 178 Catholic Social Science Review function of the secularization process itself and suggests the larger question of the extent to which cultural problems lend themselves to judicial answers. Is it a coincidence that the incr ease in the activity of constitutional courts in the realm of personal rights, an increase which visible on a global scale, is taking place in a time of increasing secularization and cultural dislocation? [31] Why is it that the natural law doctrine, despite its flaws and inconsistencies, has had such an influence in the history of European thought? Kelsens answer is that natural law satisfies a deeply-rooted need of the human mind, the need for justification. To justify the subjective value judgements which emerge from the emotional element of his consciousness, man tries to present them as objective principles by transferring to them the dignity of truth, to make them propositions of the same order as statements about reality. Hence he pretends to deduce them from reality, which implies that value is imminent in reality. [32] This has a comforting corollary: belief in natural law enables a person to obey a civil law, not because he is compelled to do so by the civil power, but because of the laws intrinsic value. But, as we have learned, at the heart of Kelsonss argument lies the contention that value is not imminent in reality. Natural law nevertheless strikes a chord with a long- lasting and deep-seated need felt by mankind the need for certainty, for the existence of truths that are absolute and unchanging. [33] For writers down the ages it has been a quality of natural law that it is eternal and universal. Finnis believes that the principles of natural law hold good, as principles, however extensively they may be overlooked, misapplied or defied and however little they may be recognised. They would hold good just as the mathematical principles of accounting hold good even where, as in medieval banking community, they are unknown and misunderstood. [34]Â
Sunday, August 4, 2019
Greedy Needs :: Essays Papers
Greedy Needs Imagine a life with no food, no shelter and no family. This is hard because most people have never been without these basic needs. Some people however, find it hard to imagine a life with these needs, as in â€Å"The Ultimate Safari†by Nadine Gordimer. This story takes place during civil war, where the greed of bandits along with the greed of rebels cause conflict which can only be solved through sharing and co-operation. The greed of the bandits causes many conflicts with the people that are not in the war by taking away their food, shelter and thus causing illness. The villagers have nothing to eat because the bandits have taken it all for themselves. â€Å"But the third time they came back there was nothing to take, no oil, no food, so they burnt the thatch and the roofs of our houses fell in.†(page 120) as Gordimer writes. The people can not eat on their long journey through Kruger Park because although they find food to cook, they must not make a fire as it will draw attention to themselves. They have no food to take on the trip, so the people find fruit and eat it which results in illness, as it is poisonous. The greedy bandits take away the shelter of the villagers by burning their houses. This means the people must go to find food and shelter elsewhere. The people must walk farther due to bandits on the lookout for them near the fence, which means more nights spent in the animal-filled park without any shelter to stay in. Having no shelter in the park creates a safety risk to the people, for there are hungry lions surrounding them. Sickness is inflicted upon the people by the bandits stealing their food and taking away their shelter. Being cold and hungry can cause a serious sickness to the people. The bandits are not the only people who conflict with the people, the rebels also inflict a great deal of problems. The rebels are greedy in that they escalate the conflict for the people, they cause consequences to the others from the government, and they force the villagers into refugee camps. The rebels, only thinking of themselves cause conflict to expand within the others. The children that are growing up in the war environment, will see fighting as the only way to solve problems.
Saturday, August 3, 2019
Divisive, but Effectual: Reinstating the Draft Essay -- U.S. Military
Ever since World War II, the last war that garnered full American support, the percentage of American citizens enrolling in the U.S. Army has diminished significantly. The U.S. is a major military power in the present world; American soldiers are engaged in many multi-theater positions, consequently dispersing troops over various regions worldwide. As only one in ten citizens has served in the US Army, American knowledge of military conditions is rapidly lessening along with the national harmony that complements such knowledge. Therefore, the comprehension that American security is closely associated with a formidable military never resonated within the greater part of modern American citizens. Although antiwar activists may decry compulsory conscription as unconstitutional, it needs to be reinstated in order to solidify the meaning of being an American citizen, boost the economy by providing jobs, and unify the American people with enhanced homeland security. Generally, reinstating the Constitutional draft would solidify the meaning of being an American citizen. Often, wealthier and more privileged people are able to ask for exemption from serving, so representation of soldiers in combat is composed of less-privileged citizens. With compulsory conscription, all American citizens, men or women, ages 18-26 are subject to be recruited for the armed forces. In fact, only 4 members of the 107th Congress who voted in favor of the Iraq war had children serving there. Politicians would know how it feels to have loved ones in a war, instead of freely speaking about wartime without experiencing it in any way. 1 (206) Americans feel that public support for war in foreign countries is not strong because the soldiers fighting are poorly rep... ..." CQ Researcher Outline, January 11, 1991. http://library.cqpress.com/cqresearcher/cqresrre1991011100 (accessed March 19, 2012). "Binding the Nation: National Service in America." U.S. Army War College, 2008. http://www.carlisle.army.mil/usawc/parameters/Articles/08winter/grigsby.pdf (accessed March 12, 2012). â€Å"Learn about National Service." Americans for a National Service Act, . nationalserviceact.org (accessed March 19, 2012). Greenblatt, Alan. "Upward Mobility." CQ Researcher, April 29, 2005. http://www.cqpress.com/product/Researcher-Upward-Mobility-v15-16.html (accessed March 14, 2012). Farrell, Brenda S. "Military Personnel: Evaluation Methods Linked to Anticipated Outcomes Needed to Inform Decisions on Army Recruitment Incentives." U.S. Government Accountability Office, September 19, 2008. http://www.gao.gov/products/GAO-08-1037R (accessed March 19, 2012).
Essay on Whartons Ethan Frome: Despair -- Ethan Frome Essays
Despair Ethan Frome Despair is not anonymous, it has a name, and the name is Starkfield. "Guess he's been in Starkfield too many winters." This significant phrase describing Ethan Frome in the prologue of Edith Wharton's novel, Ethan Frome, provides insight into the most major theme portrayed in this story. The imagery of the harshness and despair of winter, first brought up in the prologue, is present in every aspect of this book. Winter describes the character of Zeena as well as the character of Ethan after the "smash up" which contrasts that of Mattie, Ethan's true love. It is also used to illustrate the themes of silence and isolation, and darkness and despair. Zeena is a character often portrayed using harsh winter imagery. She is characterized as controlling, insensitive, and rather unattractive. This is evident in Ethan's perception of her prior to her doctor's visit when he says that she is sitting in "the pale light reflected from the banks of the snow." The images of snow which first appear in the prologue symbolize this character's personality. The fact that Ethan connects his wife with the severity and strength of winter snow illustrates that he envisions her as stringent and powerful, characteristics he dislikes. Throughout the novel, Ethan is attracted to true inner beauty, something he believes Zeena lacks. He considers his marriage a mistake and attributes it to the fact that he met Zeena at a time when he felt isolated and alone, another major theme in the book. After his mother died one winter, he needed companionship and attached himself to Zeena. Ethan resents winter because he associates it with the death of a loved one. Due to his isolation, Ethan overlooks Ze... ...e what Ethan becomes after the "smash-up." Ethan is essentially dead spiritually and the author uses the desolate imagery of wintertime to show this. The narrator also describes Ethan's appearance by saying, "He looks as if he was dead and in hell now!" Ethan's world is dark despair after the accident. He realizes that there was no escape from Starkfield and the harsh reality of the dead winters. He is at the mercy of winter and is forced to see what his love, Mattie, has become. Ethan's appearance at the end of the prologue represents what he strives to avoid throughout the novel, a tragic end. The prologue introduces several of the novel's major themes, the most prominent being that of winter harshness. Hence, it foreshadows the major events in the book and provides insight into the personalities of the characters. Essay on Wharton's Ethan Frome: Despair -- Ethan Frome Essays Despair Ethan Frome Despair is not anonymous, it has a name, and the name is Starkfield. "Guess he's been in Starkfield too many winters." This significant phrase describing Ethan Frome in the prologue of Edith Wharton's novel, Ethan Frome, provides insight into the most major theme portrayed in this story. The imagery of the harshness and despair of winter, first brought up in the prologue, is present in every aspect of this book. Winter describes the character of Zeena as well as the character of Ethan after the "smash up" which contrasts that of Mattie, Ethan's true love. It is also used to illustrate the themes of silence and isolation, and darkness and despair. Zeena is a character often portrayed using harsh winter imagery. She is characterized as controlling, insensitive, and rather unattractive. This is evident in Ethan's perception of her prior to her doctor's visit when he says that she is sitting in "the pale light reflected from the banks of the snow." The images of snow which first appear in the prologue symbolize this character's personality. The fact that Ethan connects his wife with the severity and strength of winter snow illustrates that he envisions her as stringent and powerful, characteristics he dislikes. Throughout the novel, Ethan is attracted to true inner beauty, something he believes Zeena lacks. He considers his marriage a mistake and attributes it to the fact that he met Zeena at a time when he felt isolated and alone, another major theme in the book. After his mother died one winter, he needed companionship and attached himself to Zeena. Ethan resents winter because he associates it with the death of a loved one. Due to his isolation, Ethan overlooks Ze... ...e what Ethan becomes after the "smash-up." Ethan is essentially dead spiritually and the author uses the desolate imagery of wintertime to show this. The narrator also describes Ethan's appearance by saying, "He looks as if he was dead and in hell now!" Ethan's world is dark despair after the accident. He realizes that there was no escape from Starkfield and the harsh reality of the dead winters. He is at the mercy of winter and is forced to see what his love, Mattie, has become. Ethan's appearance at the end of the prologue represents what he strives to avoid throughout the novel, a tragic end. The prologue introduces several of the novel's major themes, the most prominent being that of winter harshness. Hence, it foreshadows the major events in the book and provides insight into the personalities of the characters.
Friday, August 2, 2019
Assessment and Planning of Discharge Needs in Geriatrics Essay
Elderly patients have unique discharge planning needs. As such, the hospital nurse and case management team may find themselves challenged to not only identify the needs of each patient, but to also address those needs when planning the patient’s discharge. In the case of Mr. Trosack, a 72-year-old widower being discharged following a total hip replacement (THR), careful assessment of his home situation needs to be completed prior to discharge to ensure his safety and continued recovery once home. Healthcare Issues After reviewing the patient’s chart and performing interviews with the patient and his family, the case manager identifies three healthcare issues that need to be addressed on discharge.  ·The patient admits he has not seen a doctor in over 10 years prior to this hospitalization.  ·The patient has been diagnosed with two new health issues: hypertension and diabetes.  ·He has been prescribed new medications for each new diagnosis that he will need to continue taking after discharge.  ·The patient cannot identify pills he currently takes at home, stating simply that they are â€Å"vitamins†for â€Å"energy. Importance of Healthcare Issues Each of these issues needs to be addressed to ensure Mr. Trosack’s safety and continued recovery after discharge: The patient has not seen a doctor in over 10 years prior to this hospitalization. It is important for the case worker to find out why the patient has not seen any doctors, as it may be detrimental to his well-being. For example, did he have a bad experience with a previous provider and refuses to go back? Or, has he just not felt ill? Is his reasoning ability still sound? Or, is there some confusion? Is he in denial or facing fear that has kept him from seeing someone? If the patient is able to make sound decisions and simply has no concerns, he may do well at home. However, it may also be that he is unaware he should be seeing a physician, as â€Å"elderly patients may not report symptoms that they consider part of normal aging†(Besdine, 2009, para. 9). And, if he has had a bad experience in the past with a physician, it may have lead to a mistrust of the entire profession. If he has been refusing to see a doctor despite some concerns over the years, it could foreshadow similar situations in the future. He may not call when new problems or questions arise about is new medications. And, as evidenced by the cabinet of unused medications in the bathroom, he has a history of poor compliance, which could further impact his health. By discussing the reasons behind his lack of preventative care, the case manager will better understand the patient’s mindset and any concerns he may have. If a previous provider’s treatment or behavior has caused a mistrust of the profession, the case manager can recommend or introduce the patient to other providers, especially those that specialize in caring for geriatrics, as these providers have specialized training in caring for the elderly. If cost is a factor, the case manager can refer the patient to applicable programs such as food stamp programs, insurance and Medicare supplement policies, state-based programs, drug company assistance programs and more. If transportation is an issue, the case manager can refer to area agencies or senior citizen centers to utilize low-cost or volunteer-driven services that assist in transporting seniors. The patient has been newly diagnosed with hypertension and diabetes. New medical diagnoses can be scary for any individual, but with elderly patients, it can often bring about a new level of uncertainty and anxiety. Like all patients, they have questions about the new diagnosis and prescribed medications. However, the elderly patients of today grew up in a time when medical problems were not openly discussed. And now, society often looks at senior citizens as â€Å"lesser†citizensâ€â€a source for humor and pity in the media, weaker, less productive and expected to retire as they age (Day, 2011). Because of the way in which they were raised and the beliefs of society today, elderly patients may not feel comfortable asking questions. Knowing this, the nurse will look for additional clues from the patient’s interview as to how Mr. Trosack is feeling about his new diagnoses. During his interview with the case manager, the patient seems reluctant to accept his new diagnoses. Stating he doesn’t need any â€Å"darn†medications and doesn’t like being â€Å"disabled,†the patient also shows frustration. When a patient expresses this level of frustration and denial, there is an increased risk for lack of compliance. The need for education is greatly increased in this elderly patient. Because he has no outward symptoms of his new diagnoses, the patient does not feel he needs the new medications. The nurse needs to help the patient understand that his medications need to be continued to help prevent future symptoms from occurring. In addition, the nurse needs to be aware of additional challenges the patient may incur. Since elderly patients have often lost several members of their family (parents, siblings, even children in some cases), they are very much aware of their own mortality. A new diagnosis can bring a new awareness of that mortality, sometimes leading to a depression. When planning other discharge needs, the case manager needs to include these factors into her plan. Home health nurses can assist by visiting the patient at home during the week to ensure proper medication administration as well as assessing the patient for signs of depression and worsening hypertension, diabetes or depression. The patient has two new medications to continue upon discharge and cannot identify pills he currently takes at home. With the patient’s new diagnoses, he has been prescribed new medications. He has already voiced opposition to the idea of continuing these new medications because he does not feel he needs them. Because he does not feel they are needed, he is likely to have poor compliance in taking the medications. The patient would benefit greatly from education about why the medications have been prescribed and that–with appropriate compliance–he will be more likely to remain free of symptoms. The patient being unable to state which pills he does take on a daily basis is cause for concern. Without the name of the pills, there is no way to verify its overall safety. Furthermore, the nurse and case manager cannot be sure there are no contraindications to taking the newly prescribed medications with the pre-admission supplements. The patient’s inability to recall the name of the pills also reiterates the concerns above regarding the new medications he has been prescribed. The case manager needs to work with the patient’s nurse to ensure the patient understands the importance of maintaining a current medication list, including over-the-counter â€Å"vitamins†for â€Å"energy,†to avoid future problems when being seen for other medical concerns. The Interdisciplinary Team For the patient’s discharge to be a success, the case manager needs to incorporate appropriate members of the healthcare team to make a discharge plan. In the case of Mr. Trosack, this interdisciplinary team needs to include the patient’s nurse, physical and occupational therapy staff, a dietician, a pharmacist, and staff from the local home health agency or public health district. Each member of the team will bring to the discharge plan a unique vision for the patient’s recovery. The nurse is familiar with the patient’s medical history, as well as his feelings regarding his new diagnoses and medications. S/He has learned how best to communicate with the patient and worked to educate the patient on his new health problems and medications. In creating a discharge plan, the nurse will share this information with the home health nurse, include the medication and treatment regimens that are to be continued, and identify goals for the patient related to each. The physical therapist will instruct the team on the patient’s abilities and limitations in relation to the patient’s ambulation and transfers. He may visit the patient’s home to complete an evaluation of additional needs. And, he will create an exercise regimen for the patient to continue once home and make recommendations for assistive devices that the patient may be able to use. The occupational therapist will also identify assistive devices and continued therapy needs, however, these recommendations will be in relation to the patient’s activities of daily living (ADLs) rather than ambulation. She will watch the patient get completely dressed to identify any special needs and assess risk (can the patient tie his shoes or will the laces be a fall hazard? ). She will assess the patient’s ability to shower or bathe, looking for shortcomings or safety concerns. She may also visit the home to complete a home safety evaluation, watch the patient has he carries out his ADLs, and make recommendations for ways to alter his methods to ensure safety. The dietician will make nutritional recommendations based on the patient’s needs for adequate healing. In doing so, she will take into consideration his abilities and limitations identified by the physical and occupational therapists. The dietician may suggest menus for the patient to follow. And, her knowledge of nutrition will allow for suggestions on easy-to-carry foods, snacks or supplements that require no refrigeration and can be stored outside the kitchen, making it easier for the patient to obtain. The pharmacist will provide the other members of the team with information related to his medication regimen. He will alert the other team members to possible side effects, adverse reactions and interactions that may occur. This information will be helpful to the other members of the team as they make their own recommendations for needs after discharge. The dietician will nclude foods that have less chance of interacting with medications and the therapy staff will be alerted to side effects that may impact the patient’s safety. Because the patient will be homebound, he will likely be referred to home health. The staff from the home health agency or public health district will take the information from all of the team members in making their own plans for assignment and recommendations after discharge. They will perform safety evaluations of their own to identify risks for patient and staff alike. They will assign staff to the patient based on the recommendations from the nurse and therapists. They may sign the patient up for meals-on-wheels, or a similar program, based on the recommendations of the dietician and assessments of the patient’s ability to cook and clean up as needed. They will reiterate the teaching provided by the nurse and therapists while visiting the patient and look for side effects or adverse reactions while working with the patient. In short, they will develop a complete plan of care to incorporate all of the feedback from the interdisciplinary team. Safety Assessment There are several areas of concern in regards to safety at the patient’s residence. First, the patient requires a walker and lives on the second floor in a building with no elevator. This presents a safety issue, as well as a potential psychosocial problem. Not only will the patient be unable to safely enter his apartment without assistance; but, he will also not be able to safely leave. The patient, should he reach his apartment after discharge, would be isolated from friends and family and completely homebound. He would not be able to assist in the bakery located downstairs; instead, becoming dependant on his brother to maintain the business. Additionally, the family members interviewed by the case manager share concerns about the patient’s safety once inside his apartment, due to the small and cluttered environment. They worry that the apartment is too cluttered with memorabilia from World War II for him to safely ambulate with a walker. Per the safety assessment, there are also several rugs throughout the space. Each rug represents a trip hazard and should be removed from the environment prior to the patient’s discharge home. Additionally, there are no safety devices in the bathroom. While these devices can be installed, the patient is at risk until the installation is complete. And, until the devices are installed, the patient cannot be assessed by the occupational therapist to ensure safe use. With the safety issues present in his current apartment, it is unlikely the patient will continue to improve in this environment. Not only is he at a high risk for fall and injury in this apartment, but his mobility will also be greatly limited by the crowded environment, reducing his physical activity. Such limitation would reduce the patient’s physical improvement, which is vital in recovery from a total hip replacement. Discharge Planning Needs Per the family interview, there is a lack of support available to the patient. For any patient to recovery successfully after discharge from the inpatient setting, they must have adequate support from friends and family. Elderly patients are especially reliant on adequate support, as they are more likely to experience a functional decline from baseline in the two weeks following a hospital discharge (Naylor et al. , 1994). Mr. Trosack has a brother and a married middle-aged son. Mr. Trosack co-owns the bakery with his brother, who is now running the bakery on his own. His son is somewhat estranged due to a difference in religious beliefs, has a young family of his own, and works nearly 60 hours a week, as does his wife. None of the people closest to Mr. Trosack can make him a priority in their lives. During the family interview, the case manager learns that they were planning on taking turns assisting the patient in his home. However, their busy lifestyles leave little time for that and they do not want to bring in outside assistance. Further, the family does not seem to understand the importance of regular medication administration in addition to denying the two new medical conditions exist since the patient has shown no outward symptoms of being sick. Their answer to cleaning up the apartment is throwing away some of the patient’s most treasured items. Rather than asking for suggestions in making the apartment safer, the family would prefer to have Mr. Trosack dispose of his memorabilia from World War II. This, combined with the social isolation brought on by being homebound and unable to participate in his long-time business, would worsen his chances of developing depression. Should the patient develop depression, his recovery would be further impacted by lack of compliance with medications (Carney, Freedland, Eisen, Rich, & Jaffe, 1995). Further, depression can lead to elderly patients becoming confused or forgetful, eating less, poor hygiene, and becoming further isolated from friends and family (â€Å"A. D. A. M. Medical Encyclopedia,†n. d. ), all of which would further delay a complete recovery. Social Isolation & Psychological Factors With the patient’s physical limitations, if he were to discharge to his apartment, he would be isolated from the outside world. Because he still relies on a walker, he would be unable to climb or descend the stairs and unable to participate in his own bakery business. He would also rely on visitors for his groceries, trash removal as well as any social interaction. Despite the fact that family members are physically close to his apartment, the relationships are strained and their schedules do not allow for him to become a priority in their lives. When patients are socially isolated, they tend to do poorly. Not only do socially isolated people tend to become anxious and depressed, but they are also more likely to develop high blood pressure. Additionally, isolation has been significantly correlated both with an extended wound-healing time (Cacioppo & Hawkley, 2003). Despite the length of time the patient has been in the hospital setting, he is still recovering and his body is still healing. The patient needs to be in an environment that promotes healing. Furthermore, isolation has also been shown to cause impaired vision and hearing, which could increase the likelihood of fall and injury in the patient’s cluttered apartment (Frintner, 2008) In addition to the health-related dangers of social isolation, there are emotional reactions to isolation that one should consider when planning Mr. Trosack’s discharge. Isolation and loneliness not only affect the body’s immune and cardiovascular systems, but it can also lead to sleep disturbances and depression (Marano, 2003). Depression makes social interactions difficult and sometimes even stressful, causing the depressed person to withdraw from family and friends even more. And, with the patient being unable to fulfill his duties at his family-owned business, the likelihood of dev eloping depression increases, due to a reduced sense of purpose (Smith, Robinson, & Segal, 2011). The patient’s risk for isolation upon discharge home indicates that the patient may do better in another setting. Recommendation Upon review of Mr. Trosack’s chart, interviews with the patient and family and the safety assessment performed, it is the recommendation of this writer that the patient not be discharged home. This recommendation would be different if the patient lived on a first-floor apartment or had access to an elevator. However, given the safety and isolation issues present in his home, the patient would be better served in an assisted living facility. Because the patient does not need skilled nursing care, and can perform his most of his ADLs, the patient does not require nursing home placement. An assisted living facility would allow the patient to have some independence in regards to his individual space and performing his ADLs while ensuring the patient a safe environment. An assisted living facility allows for monitoring of the patient overall wellness and general health and can coordinate medication administration and monitor compliance (Maryland State Bar Association, 1998). The services provided by the assisted living facility would help to ensure that the patient stays safe by keeping a watchful eye on the patientâ€â€routine safety checks are performed and fall risks are identified and corrected as needed. The facility can also monitor his overall health through the routine safety checks as well as monitor his medication compliance, ensuring the patient takes his medications as scheduled. Furthermore, several facilities offer social activities, which would increase the patient’s likelihood of continued physical activity and reduce the risk of depression and decline after discharge.
Thursday, August 1, 2019
The characteristics of Judaism
The characteristics of Judaism such as the beliefs, ethics, rituals and ceremonies and sacred texts do have a major impact in many ways on the adherents and it provides a source of purpose and identity for individuals. It gives meaning and guidance in contemporary situations and therefore it is considered a dynamic, living religion. Beliefs Judaism is a monotheistic faith, meaning that Jews believe there is only One God. Often this God is beyond our ability to comprehend, but God is nevertheless present in our everyday lives. The covenant is an agreement the Jewish people have with their God. Jews believe that there is only one God, no other being participated in the work of creation and God is the only being to whom they offer praise. The terms of the covenant are summed up in the Ten Commandments that reveal adherents must have a respectful, obedient relationship with God and live harmoniously and respectfully with others. In return God will never abandon his Chosen people and God will provide salvation. Ethnics Jewish adherents ethical beliefs are derived from the 613 mitzvoth that Orthodox Jews believe were given to Moses on Mt. Sinai and taught to the Israelites as they travelled the desert to the Promised Land. Other variants believe they may have also been delivered to other divinely inspired people over time. The 248 positive and 365 negative commandments have been discussed and interpreted throughout the centuries by divinely inspired philosophers and rabbis so that they can provide guidance in every aspect of everyday life. Sacred Texts There are many sacred wri tings in Judaism, all of which teach Judaism's adherents how to live ethical and moral lives. The writings are a major source of the laws which regulate Jewish life. Jewish sacred writings are read and studied on an ongoing basis by believers. The Jewish holy book is the Tanakh, containing the Torah and the prophetic books. The Torah is the most holy book of Judaism. Torah, which means â€Å"teaching†, is God's revealed instructions to the Jewish People. It is important to note that while â€Å"Torah†is generally used to refer to the Five Books of Moses or Pentateuch, it is sometimes used to refer to the basic texts of Judaism in general. In this sense, â€Å"Torah†includes the Torah itself, as well as Midrash, Mishnah, and Talmud, which are the Oral Torah. Ceremonies and rituals There are many sacred ceremonies and rituals in Judaism such as Circumcision (Bris) male Jewish children are circumcised on the eighth day after their birth as a sign of a covenant between Abraham and God.. A Bar Mitzvah; at the age of thirteen, Jewish law considers boys to have reached adulthood. A special service is held in the boy's honour, and he is permitted to read from the Torah for the first time. The comparable ceremony for girls is a Bat Mitzvah which varies in religious significance depending on the sect of Judaism. The Sabbath, Rosh Hashanah, Yom Kippur, the Passover, Shavuot, are all other important ceremonies that are apart of Judaism. The Commandments of the Torah The most important source of ethical guidance for Jews is the Torah which encompasses the Written and Oral Torah. Jewish ethics is derived from the covenantal relationship where they were protected and taught their responsibilities towards God and other people. There are 613 mitzvot 248 positive and 365 negative. The Prophetic Vision The Prophets advocated a pro-active stance to reforming social structures by emphasizing the broad themes of justice, equality and peace during a time when these concepts were of secondary importance compared to observance of law and ritual. The implication of Tikkun Olam is that all individuals have the dual responsibility of rectifying inequalities in society by helping the poor and needy, and acting as a steward by caring for the earth. The book of Wisdom The Book of Proverbs is one of the most significant collections within the genre of Wisdom literature. The Book of Proverbs is a collection of short, pithy statements which offer practical and simple advice on how to lead a moral life and behave prudently. (Wisdom, righteousness, purity, generosity of spirit) Shabbat Of the many observances and practices of Judaism, the Jewish Sabbath or Jewish Shabbat (in Hebrew) is the best known and most commonly practiced. The Jewish Shabbat is a day of rest at the end of the week, beginning on sundown Friday night, and ending on Saturday night, when three stars appear in the sky. It is an eagerly awaited chance for the Jewish people to set aside so many of their common concerns and worries and enjoy higher pursuits. Human beings are called to imitate God who rested on the seventh day after creating the world. Shabbat is the most significant liturgical event of the week. Shabbat reminds the Jewish people of the greatness of God in creating the cosmos. It reminds the Jewish people of the Covenant between God and the People of Israel which lies at the heart of Judaism (Exodus 31:16). The Jewish Sabbath is a day of celebration as well as one of prayer. It is the only rituals laid down by the Ten Commandments and is considered to be one of the most important ritual observed by the Jewish faith. The day itself is a day of rest and enrichment. The word â€Å"Shabbat†derives from a root word in Hebrew that means â€Å"to cease, to end, to rest. †Intense preparation is needed as the day approaches. Physical preparations include shopping and cleaning, which must be completed so that Shabbat is not interrupted. The meals need to be prepared and the table laid for the Friday evening meal. This is an important family occasion. Before the Friday night meal, the most significant, Kiddush (a blessing) is recited. Many Jews attend synagogue services on Friday night and Saturday morning. Shabbat being over, a plaited candle is lit and hands are spread out towards the light as a third blessing is said. This is a reminder that the first thing God created was light to be used to good purpose. From this is can be concluded that Jews believe that by fulfilling the commandments, they are communicating with God on the Shabbat. They understand the mitzvot to be God’s way of reaching out to people. The Shabbat provides a means of reflecting on these commandments and developing a deeper, joyful relationship with god and family. Conclusion Judaism is a powerful, living religion because it has provided adherents with purpose, meaning, heritage and identity. Judaism focuses on relationships; the relationship between God and man, between God and the Jewish people, between the Jewish people and the land of Israel, and between human beings. The scriptures specify the mutual obligations created by these relationships, although various movements of Judaism disagree about the nature of these obligations. Some say they are absolute, unchanging laws from God (Orthodox); some say they are laws from God that change and evolve over time (Conservative); some say that they are guidelines that you can choose whether or not to follow (Reform, Reconstructionist). The variants have formed as different communities have interpreted beliefs and ethics and adapted rituals to meet their needs in different context and because of this Judaism is clearly a dynamic religion.
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