Messages

Messages are all around us, and they are able to change how successful we are in life. The messages you receive from your environment dicta the way you act. For example, a study using children and dolls show that messages are conveyed even in the early years of life. A different study showing how our appearance can have an affect on people. In the realistic fiction by Sherman Alexei, â€Å"The Absolutely True Dally of Part-Time Indian,† demonstrates how messages can affect us.The mall character,Junior, has always lived by the preconceived Idea that he was supposed to conform Like everyone else unfortunately, that message was always pushed onto him; and It affected the way he thought. If continued, his quality of life. He was always told that white people were above him. This affected how he saw them, he put them on a pedestal. This book shows that people are affected by their environment. The experiment conducted by CNN, The Doll Test, showed that messages even affect the youn g. It opens our eyes to how well messages invader brains.They presumed thing about the dolls just based on looks and no other evidence. White children have n overwhelming bias toward white, and that black children also have a bias toward white but not nearly as strong as the bias shown by the white children. These messages will eventually grow and affect how they Judge others. A study by freakishness discussed the question, â€Å"can you put a price on looks? † It shows how subconscious feminism/female entitlement is in our culture. Beautiful women have the most power with their looks.Also, the data in the study referred to how much extra income a male of a different skin color would need to make to be as appealing. There hidden messages in the subconscious of all our minds telling swath we want and don't want. This proves that messages are likely to change how successful we are in life. Messages are all around us, and they are able to change how successful we are In life. Ul timately, messages can effect our future success. Based on the assumptions of others we have different chances of success. Our environment, our development, and our phallic characteristics will effect how successful we are In life.Messages By dazed In the realistic fiction by Sherman Alexei, â€Å"The Absolutely True Dairy of Part-Time Indian,† demonstrates how messages can affect us. The main character, Junior, has always lived by the preconceived idea that he was supposed to conform like everyone else. Unfortunately, that message was always pushed onto him; and it affected the thing about the dolls Just based on looks and no other evidence. White children have we want and don't want. This proves that messages are likely to change how our physical characteristics will effect how successful we are in life.

Ways to De-Stress in College

Ways to De-Stress in College Knowing how to destress can make all the difference between a crazed college experience and one you feel you have control over. Sometimes, however, knowing that you need to destress can be different than actually knowing how to destress. Check out this list of tips- theres sure to be one (or more) for nearly everyone! Relaxing Ways to Destress Breathe deeply.  It only takes a few minutes, but it can really help you achieve more positive mental health. Focus on inhaling and exhaling while trying to let all the stress in your brain slowly melt away.Put your headphones in and listen to some music.  Closing your eyes and relaxing while listening to some music can do wonders for your brain. Tuning out the world for even just five minutes can be a great way to lower your stress and increase your mental clarity.Daydream about your life after  graduation.  College can be overwhelming because there is so much to do all of the time. Let yourself daydream for a few minutes about what your dream life will be like after graduation. Dont worry about how youll make everything happen; just imagine the best possible scenario and the goals youre working so hard to achieve.Look through your personal pics online.  You can check out things youve posted on Facebook or elsewhere. Looking through your personal pics can warm your heart a nd cool your stress. Look through the pics you have on your phone.  Most people take a ton of pictures with their cell phone- and then forget all thats on there. Take a quick trip down memory lane while also giving yourself a break and a few minutes to relax.Read motivational quotations about college and education.  Sometimes, college life can simply seem- if not be- overwhelming. Give yourself some perspective by reading over some  motivational quotations about college  that can help remind you why you work so hard in the first place.Come up with a list of 10 things youve accomplished today/this week.  Sometimes people can get so focused on what they have left to do that theyve forgotten all the things theyve already done. Lower your stress by writing down at least 10 things youve accomplished today or this week. You just might surprise yourself!Take a quick shower.  Most of the time you shower to get clean. Today, however, take a shower to just relax yourself. Let the hot water massage your shoulders and try to imagine your stress being rinsed off and going down the drain, too. Take a quick bath.  If youre lucky enough to live in a place that has bathtubs, a quick bath can be a magical escape. Squirt some soap (or even shampoo) in for some bubbles and pretend youre somewhere far, far away.Wash your face.  If you dont have time for a bath or a shower, a quick face-wash can help wake you up, making you feel refreshed, and relax you- even if its just for a minute or two. If you dont have your soap handy, a quick splash of water will do.Give yourself a mani/pedi.  You dont have to escape to a nail salon to feel fancy. Grab some polish and give yourself a visual pick-me-up as a way to destress and focus on something fun and funky for a few minutes.Address the thing that is stressing you out the most.  Chances are, amidst all your stressors, theres at least one or two things that really stand out. Do at least one thing to address the biggest stress factor(s) in your life- even if its deciding not to worry about it until tomorrow. Active Ways to Destress Do some stretching.  You dont have to be a yoga teacher to know how to stretch. Whether youre in the library, the quad, or your room, a few minutes of slow, deep stretching can improve your mood immensely.Do some  yoga specifically catered to stress reduction.  Of course, if you do love yoga, you know how helpful some good stretching and breathing can be for your health. Take what youve learned in a yoga class and apply it at a time you need it most.Go for a walk.  It doesnt matter where you go- in fact, an aimless walk might be better than one with tasks assigned to it. Remove yourself from a stressful situation and enjoy a few minutes out and about.Go for a quick run.  Grab your shoes, throw on some running clothes, and get your stress out while hitting the pavement (or track or treadmill). A quick, high-intensity run can lower your stress and increase your energy for hours afterward.Go for a bike ride.  Who says you can only use your bike to get to and from class? Go f or a quick ride thats more fun than functional. Ride a skateboard.  If youre able to ride a skateboard on (or near) campus, this pastime can be a great break from your regular, stressful college routine.Clean up your desk.  Alright, it sounds lame, but wouldnt it be nice to start your homework with a nice, clean, organized desk? A clear space leads to a clear mind and cleaning up your desk can do wonders for your productivity.Clean up your room.  Even people who like clean rooms often dont like actually cleaning them. Set a timer for five minutes and see how much you can get done in that time. Youll get yourself moving, get your things organized, and get your head away from the source of your stress for at least a few minutes.Clean out your backpack.  Boring? Maybe. Well, actually ... totally boring. But doing something completely mindless that will result in feeling productive can be a great way to focus on something other than your stress.Do  some laundry.  You may not want to do it, but think of the benefits: Youll get yourself out of your current, stress-inducing project, youll get yourself moving, youll get a mental break from your more stressful tasks, and youll finally get some clean clothes. Dance.  For some, dancing can be a great escape from the stressors of everyday life. Dance to your hearts content for a few minutes before returning to your regularly scheduled tasks.Go for a walk and buy a cup of tea.  Sure, you may have some tea in your room, but sometimes the extra little splurge can be worth it. Youll get moving while also getting a break.Go for a walk and buy a cup of coffee.  If its looking like itll be a long night, go walk to the campus coffee shop and splurge on a cup o joe. Youll get your blood pumping while also getting a little caffeine in your system.Go for a walk and buy a healthy snack.  Sure, those french fries look delicious, but opting for a piece of fruit and some whole wheat toast from the dining hall will make you feel better, both physically and mentally.Go for a walk and treat yourself to, well, a treat.  Alright, lets be honest here: Sometimes you just need a candy bar. Take the long way to the vending machines before selecting a spe cial treat to pick you up and lower your stress, even if its just for a little while. Social Ways to Destress Call a friend and catch up for a few minutes.  Checking in with someone you hold near and dear can be great for your heart. Get the latest from your friend while also sneaking in a nice mental break, too.Send a friend an email.  Chances are that theres at least one friend you need to catch up with, but you may not have time right now for a phone call. Send a quick email letting them know the latest and greatest in your life. And if youre lucky, the next time you need a break, there will be an email from them, too!Send your parents an email.  Face it- you dont talk to your parents enough while youre away at school and theyd like you to  keep in touch more. If a phone call isnt going to work for you right now, zip them a quick email about whats going on with you.Send your sibling(s) an email.  Many students get so caught up in their lives in college that they forget to check in with their siblings. Take a moment or two to send along an update to your brother(s) and/or sister( s)- you might be surprised at how much better doing so makes you feel. Go hang out with other folks for a few minutes.  Even if youre on a tight deadline and feel like you cant spare a few minutes, guess what? You can. Spending a few minutes de-stressing with friends can help your productivity during the rest of the night.Find some friends and have everyone give everyone else a quick massage.  The power of a 3-minute neck and shoulder rub should never, ever be underestimated. Grab several folks, line up, and have everyone rub each others shoulders for a few minutes.Kiss your significant other.  The power of human touch can always help you destress. Grab your honey and enjoy a few minutes of lip-locking before getting back to what you have to do.Look at the events happening on campus this weekend.  If youre feeling overwhelmed with what you have to do between now and the weekend, looking at what options await you at the end of the tunnel can be a great way to destress. Check out an events calendar online or go for a quick walk and actually take t he time to read the posters and flyers everyone puts up all over the place. Make fun plans for the weekend.  If taking a break from campus is what your brain needs, make some fun plans for the weekend. Check out a local city guide or call a friend to see what the scoop is. Fun Ways to Destress Watch your favorite scene from your favorite movie on  YouTube,  Hulu, etc.  Even if you dont own your favorite movie, chances are you can find it online somewhere. Treat yourself to some old-fashioned escapism and tune out for a few minutes.Search for funny clips on YouTube.  Things go viral so quickly that theres always new stuff to watch. Put yourself on a time limit and watch ridiculous things to your hearts content.Create a new  Pandora  channel.  If you really need to work, incorporate ways to destress into your process. Create a new Pandora channel that will energize and refocus you as you work.Treat yourself to some new songs on iTunes.  Buying a few songs for a few bucks can perk you up, give you something fun to look forward to, and let you feel happy instead of stressed- both during and after your purchase.Play around on  Facebook.  Of course, the key here is only to do so for a few minutes. Losing 30 minutes when youre stressed can sometimes add more f uel to the fire. But spending a few minutes poking around can be a great break for your brain. Play around on  Twitter.  Even if youre new to Twitter, seeing what the buzz is at any point in time can be a fun diversion.Play around on  Flickr.  If youre a visual person, looking at cool pictures of things that make you happy can be a nice uplift for your heart- and a nice decrease for your blood pressure.Play around on  StumbleUpon.  StumbleUpon can be enjoyable because it takes you to new sites you may never have heard of but that other users, with interests similar to yours, have recommended. Its a great way to surf the web and find new sites without getting lost in a ton of junk.Read the national news headlines.  Reading the national news can be a great break for your mind while also helping to keep you informed of current events. If youre really lucky, the headlines you read today can be used during a class conversation tomorrow.Read the news headlines in your local town.  You may be so busy living your college life that you dont know what current events are in your new local town. Find out a little more about your home-away-from-home by checking out the local paper online. Read news headlines from your hometown.  What better way to get out of your little stress bubble at school than to learn about the happenings back in your hometown? Even the ads for local restaurants you havent thought about for months might cheer you up a bit.Play around on a gossip website for a few minutes (like  People).  Catching up on the latest celebrity news can be entertaining and provide a fun few minutes of escape.Catch up on the latest sports news.  Most students spend so much time reading homework in college that skimming the latest from the sports world isnt really an option. Check out whats happening with your favorite team, favorite sport, or favorite athlete for a few minutes.

Depression Essay Example

Depression Essay Example Depression Essay Depression Essay Depression Name: Institution: Lecturer: Course: Date: Depression Depressed mood is a normal experience that occurs when we encounter disappointments, defeats and discouragements in our lives. Nevertheless, this depressive mood lasts for a short period, and does not interfere with ones daily activities. From this background, it is important to distinguish depressive moods from depressive illness. Depressive illness, or disorder, lasts for longer time durations, it is prone to reoccurrence, and the symptoms are serious enough to disrupt our daily activities and relationships with the society. Despite its numerous effects on the sufferers it is often unrecognized or misunderstood condition leading to many sufferers not getting the treatment they need (Lim, 2008). This report will be based on a case study of my depressed cousin. It involves giving him a brief background about the illness, usual symptoms, its major causes, types of treatments and therapy available, and lastly advice on how to cope with depression. Depression is often viewed in terms of its paradoxes. It often distorts the depressed person’s image of her or himself contrasting the objective facts. For instance, a prominent scientist berates himself for being stupid. These self-biased ideas of the patient further torment him and lead him to acts that further enhance his feelings. These attitudes and behaviors seem to defy some of the established dictums of human nature. In regards to the â€Å"pleasure principle† the patient should seek satisfaction and avoid pain at all cost. In addition, the concept of self-preservation dictates that man should prolong life rather than terminate it (Lim, 2008). The importance of diagnosing and treating depression needs to be emphasized. This is because untreated depression causes loss of quality of life, low disease immunity, suicidal tendencies, and has residual symptoms that cause long-term effects further hindering the individual from making meaning contribution to the society (Beck, 2009). The common signs and symptoms of depression are; feelings of hopelessness and helplessness, drastic weight gains and losses, loss of interest in carrying out routine tasks, feelings of worthlessness or guilt, being easily agitated, continuous overemphasis on personal faults, sleep disorders, general body fatigue and unexplained body aches. These symptoms vary from one age group to another, for instance irritability is the predominant symptom of depressed teenagers. Others include hostility, grumpiness and unexplained aches (Barlow 2008). There are several types of depression with each having its own distinct signs, causes and effects. These include major depression, dysthymia (recurrent, mild depression), seasonal affective disorder (SAD), and bipolar disorder. Since my cousin suffers from major depression, our study will be focused on the same (Barlow 2008). Major depression is often characterized by a constant inability to find joy in life, with the feeling ranging from mild to severe. If unrecognized and unnoticed, the feeling might last for up to six months. For most patients the feeling occurs once in a lifetime, but commonly the disorder is recurrent. Nevertheless, there are many avenues to support your mood and reduce the chances of recurrence. The recent global recognition of major depression as a leading cause of disability has resulted in increased interest in clinical and scientific research on the same. New drugs like selective serotonin reuptake inhibitors, SSRIs, have been developed. They have high efficacy and are chemically unrelated to antidepressants, heterocyclic and tricylic medications. These new generation tablets cause fewer side effects and provide greater protection in case of overdosing. In addition, they have improved tolerance and patient compliance. The dosage may also be augmented with psycho stimulants, lithium and other agents. For therapy the most appropriate method is the IPT i.e. Identification of Interpersonal Problems Areas. IPT sets to determine which interpersonal issues is contributing t the person’s depressive period. The therapist focuses on the patients major problems and then presents this to the patient as a formulation (Barlow 2008). The treatment is conducted in three phases in itial, middle and termination. The treatment also involves psychological preparation of the patient for recurrence of the disorder. References Barlow, D. H. (2008). Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford Press. Beck, A. T., Alford, B. A. (2009). Depression: Causes and treatments. Philadelphia: University of Pennsylvania Press. Lim, L. (2008). Depression: The misunderstood illness. Singapore: Armour Pub.

Gangs and the Violence They Create in the Prison System Research Paper

Gangs and the Violence They Create in the Prison System - Research Paper Example In the light of these studies, correctional officers can understand the mechanism of gangs in prison and take appropriate steps to deter violence in prisons. The existence of gangs in prison poses numerous challenges for the jail authorities because these gangs are involved in creating violence inside prison systems. Gangs in prison are formed usually be former street gangsters and as such, formation of gangs in prison is inevitable because gangsters prefer to associate themselves with gangs because it enables them to continue their illegal activities even inside the prison. Gangs within prison become a source of grouping such inmates that share the same ideas or philosophies; or that share common criminal background. However, the possibility cannot be ruled out that gangs forcibly involve such inmates that were not previously part of any gang. Being a part of prison gang is not a temporary connection. Gangsters must remain loyal to the gangs they join in prison. The reason why gangsters naturally become members of prison gangs is that individual gangsters cannot perform the same way, as they would in a gang. The network of gangs may be affiliated with other networks in and outside the prison. This facilitates their activities inside prison, as a result of which much of the violence is created in the prison systems. Prison gangs are off-shoots of street gangs; however, the working of prison gangs is entirely different from street gangs. In prison, the gangs must operate within the limits of the prison walls and they do not have the liberty to run away or escape. They do not have their secret hideouts to plan and execute their actions. Moreover, due to the strict surveillance in prisons, gangsters cannot communicate or transmit their messages as they would in an open environment. Thus, they need to develop their specific way of communication through various symbols and signs. Using symbolic language is much safer than verbal or other typical

Critically assess whether strategic HRM leads to 'high performance Essay

Critically assess whether strategic HRM leads to 'high performance - Essay Example Hence to survive in such a globally competitive environment organizations emphasize on attaining a competitive edge. An aligned strategy with HRM is a source to successful competitive edge businesses can achieve that focuses more on company’s resources than its costs. This is the reason that the role of HRM has been under the limelight recently as it serves as a competitive advantage to the companies it also has to deal with the challenging changes (Armstrong 2011). Unlike personnel management human resource management is linked to strategic level planning of the organization and execution of those plans in order to improve the organization’s overall performance. Human Resource Management is related to company’s vision, philosophies, practices, and policies that are influencing the management of people in a company. Strategic HR means aligning HR function with the company's strategies and then formulates and implements those strategies accordingly with the help o f HR activities such as recruiting, selecting, training and rewarding personnel. (Armstrong 2011; Reilly 2012) There are few theoretical perspectives to the Strategic Human Resources Management. First approach is the Universalist approach .This approach refers to one best way of dealing human resource to improve business performance only. It is also known as the best practice human resource management. This approach states that there is only one way people can be managed in order to improve the performance of the organization. Regardless of differences amongst different organizations, differences like size of the organization, to which sector it belongs, all organizations can be managed in same way by identifying a set of best HRM practices, committing to them despite the practical difficulties and applying and implementing them. This approach also measures organizational success in terms of financial performance. Results from past experimentations reveals that this approach leads t o high performance and it is becoming common to group or combine HR practices in order to create more coherent explanations of the HRM-performance link. (Gooderham, Cranfield, Ringdal, 2008 pg 7) Second theory is the Configurational theory that proposes that the relationship between HRM and performance involves complex interactions between bundles of HRM activities and outcomes. Once these complementary practices are bundled they produce high performance results and outputs than individual HRM practices. Firms have realized that rather than altering individual policies, their combinations are a better determinant and should be altered and worked upon to achieve better productivity. (Gooderham, Cranfield, Ringdal, 2008) There is a drawback of this approach as this approach has this assumption that HRM bundles and combinations are ideal and will give the same effective result under all circumstances. Secondly both universalistic approach and cofigurational approach are closely related approaches and it is problematic to differentiate between these two approaches at times. Groups of HR practices combined additively may clearly be universalistic but the identification of a configurational approach is sometimes problematic. (Gooderham, Cranfield, Ringdal,2008) Second, approach is the Contingency approach. Contingency approach is to create a positive impact on businesses by aligning HR

Reasons for Not Closing Guantanamo Research Paper

Reasons for Not Closing Guantanamo - Research Paper Example The research paper "Reasons for Not Closing Guantanamo" explores the reasons why the Guantanamo Bay detention facility has not managed to close. There have been numerous efforts to close Guantanamo Bay detention facility during Obama’s term as president. Previously, when the President issued the Executive Order for the closure of the facility, the engaged Congress opposed him, hence restricting the delivery of his earlier pledge. There are various problems facing Guantanamo Bay, and even when shut down, more legal, social, and economic challenges would arise if proper measures are not put in place. Besides the Congress, several legislatures have factored into the logistical problems, by acting to withhold funds meant to aid in closure of Guantanamo detention camp. For quite a while, the Congress has repetitively voted against the closure of the facility and included provisions that would prevent the use of appropriated funds for any actions aiding in its closure. The detainees in the detention facility have been categorized into 3 groups; those under preventive detention meant to stop them from returning to the battlefield, those under preventive detention and still expected to appear before the military or other tribunal for criminal charges, and those cleared for transfer or release to other foreign nations, after contentment that they pose no security threat or did not engage in any hostilities. Moving the detainees as the last category infers, requires funds to relocate the detainees into other countries. In 2010, after Obama’s Order, the Congress passed a legislation (Defense Authorization Bill), blocking the department of defense from spending any finances in relocation of Guantanamo prisoners from the US for any reason (Landers, 2010). Therefore, any acts of reducing the populating in the facility in line with its closure have failed. On a further opposition, the Congress made it certain that the detainees required to be in the facility and hence restricted the action of building another facility in the mainland United States. Despite the Administration’s clear opposition of section 413, the Congress prohibited the utilization of funds to construct, upgrade or renovate, and expand the US correctional facility in order to house individuals held in the Guantanamo detention facility (Executive Office of the President, 2013). Through the ban, the congress made it clear that not even other US prison facilities would be spared. None would receive financial support to aid in extra housing of the detainees that would be transferred from Guantanamo, which included the expansion activities or operating costs in maintenance of the detainees. Apparently, it is evident that the congress has consistently been usin g its spending oversight authority to control government funds from acquisition by an Illinois state prison (as a detention facility of one category for Guantanamo detainees), financing trials or even of the

Case Analysis for Nursing Ethics Paper Essay Example for Free

Case Analysis for Nursing Ethics Paper Essay Overview A forty-eight year old female patient was brought into the emergency department with petechiae/purpura distributed over her skin. Her husband reported that she started to bleed from her nostrils and mouth. She suddenly appeared to have had what seemed to be unexplained bruises on her body and was semi comatose. In a state of panic, her husband brought her to the emergency department. With a heart rate of 180, her blood pressure was 60/24 and she was going into endotoxic shock. She received emergency care that made her stable enough to be transferred to the ICU where she became conscious and able to communicate. The medical team explained the seriousness of her condition and their plans for her treatment but she declined their proposal for further care and complained about inadequate insurance coverage for that hospital. She further professed her faith in God for divine healing. The medical team was then faced with offering this patient treatment regardless of her ability to pay to avoid the imminent danger of her leaving the hospital at that time. Medical Indications This forty eight year old female patient, who had no medical history in this hospital was diagnosed with Disseminated Intravascular Coagulation (DIC). DIC is a rare, life-threatening condition that prevents normal blood clotting in an individual. A treatment refusal or decline may hasten the disease process resulting in excessive clotting (thrombosis) or bleeding (hemorrhage) throughout the body leading to shock, organ failure or even death. Prognosis varies depending on the underlying disorder and the extent of clotting. Regardless of the cause, the prognosis is often poor, with 10-50% of patients dying. The goal of treatment is to stop bleeding and prevent death. According to WebMD (2007), in DIC, the body’s natural ability to regulate clotting does not function properly. This causes the platelets to clump and clog small blood vessels throughout the body. This excessive clotting damages organs, destroys blood cells, and depletes the supply of platelets and other clotting factors so that the blood is no longer able to clot normally. This often causes widespread bleeding, both internally and externally, a condition that can be reversed if treatment is carried out  promptly. Current indication for treatment include interventions such as transfusion of blood cells and other blood products to replace what has been lost through bleeding. Numerous tests to establish the probable cause of this condition have to be done because it is usually a first symptom of a disease such as cancer or it could be triggered by another major health problem. Patient Preferences The patient is informed of the benefits of follow up interventions after emergency care as well as the likelihood of losing functions of major organs and even death without following interventions being implemented. The principle of autonomy comes to play since it is her right to choose where, when and how she gets her health care. Based on the medical report and her personal reasons for deciding to leave the hospital against medical advice, there seems to be no evidence that she is mentally incapable. There is also no justification in disregarding her requests nevertheless, it is doubtful if she actually understands and appreciates the situation. Her preferences were to be signed AMA (against medical advice) so she can find cheaper, alternative care. Her husband, who was present with her, tried to convince her to accept the teams’ proposal but she insisted that she could not afford it. In my opinion, the patient decision was as a result of her ignorance of what choices was av ailable to her. Quality of life The quality of life for this patient is severely compromised because of the symptoms associated with this diagnosis (bleeding, syncope, weakness, shortness of breath, etc). As stated earlier, DIC could be as a result of an underlying disease such as cancer. If so, chemotherapy and radiation could help alleviate symptoms and give her a vibrant life expectancy. Also, there is the possibility that she would experience tremendous medical progress with treatment if her diagnosis has to do with platelet malfunction. However, we cannot tell, since she turned down any advice by the team to carry out blood tests. Without immediate treatment, she runs the risk of damage to major organs of her body, which could eventually lead to death. Time is of essence here because the longer she delays intervention, the more likely she has irrevocable damage that might negatively alter her previous  quality of life. Ethical issues that would arise with this patient is the emergency care she got, it got her stable enough to where she could refuse treatment. An assumption that we could make about receiving that care is, ‘what if she got into a DIC coma and had to be on a ventilator?’. She would have been unconscious and would probably not be able to debate whether she receives care or not. Contextual features Without casting aspersions, the reason, obvious to me, for refusal of care is financial. The patient talked about shopping for cheaper healthcare. This is a patient born to American missionaries in Brazil. As an American citizen, she took up the calling of her parents and was also a missonary in Brazil for most of her life. She married a man from England who is unaware of how the American system works. Her reason is justified because she probably had little to no social security and with her sojourn in Brazil, we can say that she has been accultured. Therefore her outlook and way of thinking would affect her decision about healthcare in America. Another contextual feature is that of religion and faith, the patient said that her faith in God would heal her but failed to see that this might be why she was at the hospital at that time. It is difficult to attribute her decision solely to faith or finance alone but one thing that stands out is the fact her husband tried to convince her otherwise. Still, she kept saying this was what she wanted. Her husband seemed helpless as he tried to communicate with the team however the patient kept saying that this was about her not him. My patient’s lack of insurance, her job as a missionary and her inability to pay acts as a bias that would prejudice the providers’ evaluation of her quality of life. Analysis The goal of medicine involves promoting health, curing disease, optimizing quality of life, preventing untimely death, improving function (maleficence), educating and counseling, avoiding harm (non-maleficence) and assisting in a peaceful death. The ethical dilemma is deciding to let her go based on her wishes (autonomy) versus doing what seems to be the overall right thing (paternalism), which is giving her treatment (beneficence), thus preventing harm (non-maleficence). The maleficent nature of medicine propels the team to convince the patient of what they think would restore her  health. In a bid to ‘do good(maleficence), she got emergency care that made her stable enough to communicate and state her wishes. Apart from maleficence and non-maleficence there are multiple ethical issues embedded in this case; the medical team is faced with honoring this patient’s autonomy and letting her go when they know she could be dead in a few hours without treatment. Nevertheless the patient is exercising her autonomy at her own detriment because she and her husband got adequate disclosure communicated clearly by the healthcare team about the reasons for treatment and the benefits burdens related to her decision. The team’s scope of disclosure covered her current medical state, the possible interventions to improve prognosis and their recommendation based on clinical judgement. In addition, they are faced with medically determining her decisional capacity because of the possibility that her mental state might be affected by the pathology and her inability to afford care. If proven to be incompetent, then interventions are carried out regardless of what she wants. Hence, the medical team will deliberately override this patient’s autonomy because of their perceived notion of beneficence (paternalism). As medical practitioners, the team weighs the consequence (utilitarianism) of letting her go. To them, the action that would produce the best overall result is to go ahead and give her treatment. The ethical theory of deontology gives the team, the moral duty and obligation to do good and prevent harm. Compassion and sympathy (Ethics of care) also play a big role here, consider a patient who had committed her life to helping others, yet in her time of need could not get reciprocity. These emotions should play a major role in how the team decides to proceed. The nurse involved with this patient has an obligation to get to know this patient so that she can effectively advocate for her. Inasmuch as I know she has the right to refuse treatment, I strongly believe that her refusal is based on the insubstantiality of information and her lack of knowledge of what is accessible to her. Recommendation I recommend that the patient’s autonomy be empowered not overpowered by giving her information on what is available to her. An advocate (her nurse, case manager or social worker) should be assigned to her. In addition, the Chaplain should be invited to offer spiritual counseling. Asking the right questions, getting to understand her fears and giving her hope. Many  hospitals and clinics have patient navigators that can help determine financial aid for patients who cannot afford care or who do not have Medicaid/insurance. The team should encourage the patient that at this point money is of no consequence, her life and health come first in other words everything will be done to get her aid. I also recommend that the team critically asseses the decision-making capacity of the patient since it determines whether a patient’s health care decisions will be sought and accepted. Furthermore the patient should also be educated on and encouraged to put in place advanced directives to promote her autonomy and avoid a situation where there is no one to decide in case she is incapacitated. Justification In my opinion, Individuals respond favorably to people, things, beliefs and circumstances that hold significance, value and passion for them. Pesut’s (2009) article, confirms that incorporating spirituality into care where appropriate, has the potential to maximize health care quality. For this to be effective, the healthcare team has to look at the patient holistically, they have to put into consideration her profession of faith and how getting the chaplain involved will convince her that the medical team does not just want her money rather they value her worth. Subsequently, paternalism as a recommendation seems to be arbitrary and counteracts the autonomy of the patient, yet Whitney and McCullough (2007) in their article Physicians Silent Decisions: Because Patient Autonomy Does not Always Come First, give support to selective paternalism. They argue that Patients values and preferences play varying roles in medical decisions (Whitney et al. 2004). Indeed my patients refusal to accept care was not because she wanted to die but because her values of faith and her preference to spend within her means trumped getting the immediate intervention. Suffice to say that culture can be considered in this case because it influences values and preferences. My patients background was Brazilian, this is a country where there is little trust for the healthcare system. Hospitals and clinics are more interested in how much money they can make. So, Individuals that reside there, do not have routine checkup, they often wait till they are about to die before they go to a physician. And in this time they are constantly visiting places of worship in belief that they would be miraculously healed. As a result, my  patient probably had many symptoms over a period of time but did not go to the hospital, incidentally when she was brought in, it was a matter of life and death. With the team’s knowledge of her diagnosis and its prognosis, my patie nts preference became largely irrelevant. Yet, the physicians wanted to respect her autonomy and her sense of dignity by maintaining her part in the decision-making. As medical practitioners we uphold the goals of shared decision-making and of empowering patients to make important choices. However, these objectives provide important insights, not universal answers. In medicine, as elsewhere, individual choice, however highly we value it, must compete with individual welfare and with constraints of time and money hence the decisive factor will depend on the particular situation at hand. (Whitney and McCullough 2007 p. 37). Next, they explained that decision-making, whether silent or spoken by the physician must be understood in terms of the clinical encounter. In fact the overriding of her autonomy was for her own good. My rationale for encouraging advanced directives especially if she is deemed competent at the moment is, in the event that she can no longer make a decision in the future, something and someone will be in place to help. It will help to guide future clinical decisions and promote confidence in the decision of the surrogate she choos es. According to Lynch, Mathes and Sawicki (2008), patients are in the best position to make choices for themselves, or at least a position that is superior to that held by any other party. Therefore, patient directives must be enforced, though not through the mechanism of strict liability. (p. 158). Therefore, a decision written and signed by the patient legally would prevail, in the event that she becomes incapacitated and cannot decide she would already have that in place. Medical practitioners are encouraged to inform all patients’ about the importance of advance directives because it removes the burden of dealing with what the patients would have wanted. In summary, the discussion and justification of proceeding with medical intervention yet disregarding the patient’s decision, proves that autonomy can be respectfully countered. This is congruent in continuing with medicine’s obligation to do no harm, do good and serve in the best interest of the patient. Evaluation The desired outcome was that this patient receives the care and intervention  that she needed in time to prevent gross damage to her body thus altering her quality of life. With the input of the chaplain, her husband, the advocate and careful communication with this patient, the patient admits that she wanted the best care. She accepts the offer for financial assistance and receives the appropriate intervention. The nurse and medical personnel express satisfaction in saving her life (maleficent), Her husband is elated and he also signs an advanced directive for himself. It seemed difficult to convince the patient at first but once the suggestion for financial aid and the Chaplain was received, the patient complied with all other recommendations. References Lynch, H. F., Mathes, M., Sawicki, N.N., (2008). Compliance With Advance Directives: Wrongful Living And Tort Law Incentives. The Journal Of Legal Medicine, 29:133–178. Retrieved from http://www.ncbi.nlm.nih.gov.proxy.medlib.iupui.edu/pubmed/18569439 Pesut, B. (2009). Incorporating patients spirituality into care using Gadows ethical framework. Nurs Ethics. 2009 Jul;16(4):418-28.Retrieved from http://nej.sagepub.com.proxy.medlib.iupui.edu/content/16/4/418.long WebMD, (2007). Retrieved November 26, 2012, from http://www.webmd.com/a-to-z-guides/disseminated-intravascular-coagulation-dic-topic-overview Whitney, S. N., McCullough, B. L. (2007). Physicians’ Silent Decisions: Because Patient Autonomy Does Not Always Come First. The American Journal of Bioethics, 7(7): 33–38, 2007. Retrieved from http://mcr.sagepub.com.proxy.medlib.iupui.edu/content/early/2012/10/31/1077558712461952.long