Interview methods for children as eyewitnesses Essay

Interview methods for children as eyewitnesses - Essay Example The special circumstances under which children may be interviewed such that their testimony yields credible, admissible evidence requires special support in recent legal reforms. For this reason, advances in legislation in many countries have greatly improved the manner in which children are interviewed in court.1 This is because young children above the age of 5 are highly susceptible to suggestive influences that may affect the credibility of their testimony in court. Suggestibility of very young children Bruck, Ceci, Francoeur & Barr 2 studied the influence of postevent suggestion on children’s accounts of their visit to the doctor. After their DPT shots, children were given one of three types of feedback: (1) that the shot hurt (pain affirming); (2) that it did not hurt (pain denying); and (3) that the shot is over (neutral). One year after, the children were again visited, and were again given either pain denying or neutral feedback in three separate visits. They were als o given either misleading or non-misleading information about the actions of the nurse and doctor. Children given pain denying feedback reported that they did not cry or hardly at all, and said the shot did not hurt, or at least hurt less than the children who received neutral feedback. Also, children who were given misleading information about the actions of the nurse and doctor made more false allegations about their actions than children not given misleading information. ... The study showed that timing of the misinformation affected the memories of single and repeated events, depending on the combination of event-misinformation and misinformation-test delays rather than overall retention interval. In the study by Milne and Bull,4 and that of Holliday,5 the objective was to examine if the cognitive interview would enhance the recall of events when used with children, and whether the cognitive interview increased children’s resistance to suggestive questions. (The cognitive interview focuses on the cognitive processes respondents use to answer survey questions, and the interview is held in some private location such as a laboratory environment.6) In the experiment, eight to ten year old children were shown a video recording of a magic show. The following day they were interviewed individually, some using cognitive interview and some using structured interview. A pre-set list of leading or suggestive questions was given to the children either before or after the interview. The findings were that the children who were interviewed using the cognitive interview had a better and more accurate recall of significantly more details. They were also more resistant to suggestive questions subsequently asked. The study established that the cognitive interview was found to comprise a reliable interviewing technique that enhance recall and enables children to be more resistant to the influence of misleading and suggestive questions. There were implications in other studies. For instance, it was found that both true and false memories tended to increase with age, but did not differ for children who were maltreated as against those who were not.7 Also, suggestibility effects were

Aerospace business management and legislation Essay

Aerospace business management and legislation - Essay Example are some of the reasons that the Airline has stayed successful and has been able to survive the global economic problems that have befallen the aviation industry in recent times. Southwest Airlines has continued to be successful due to good financial planning on the part of the company’s administration, which has ensured that the company has continued to grow steadily over a period of more than 30 years. Although Southwest provides low-cost airline transport, new customers may assume that the airline’s services might be less professional because of low training budgets or that the airline acquire cheaper facilities for lowering of operational costs. (Butler and Keller, 2000) This can prevent the more picky travelers from trying out the airline’s services and thus prevent the airline from getting business from these travelers. Although pickier customers would not mind paying lesser amounts for tickets, the customers will probably not be willing to endure any poor equipments or inadequate services. Upon entering any new market or market sector the airline’s low fares usually stimulate demand at a fast rate. Although this stimulates higher a load factor, the airline has been able to handle increase in capacity through proper financial planning. In this light, some other airlines have been known to respond by dropping their own fares and further stimulating the total market. The airline’s financial plan also caters to the financial needs of their employees, as they are known to pay their employees well. This translates into more success for the company, as well paid employees are usually happy employees, and would possess better company morale than the employees of their competitors. The airline has been using only one type of aircraft (Boeing 737) and this strategy was intended to keep maintenance costs low, as well as lower training costs too, because the pilots, engineers and flight attendants only have to undergo training for Boeing 737 airplanes.

The War Of 1812 How And Why History Essay

The War Of 1812 How And Why History Essay The United States declared its independence from Great Britain in 1776 and won its independence in 1783. The United States Constitution comes into play and George Washington becomes the first United States President in 1789. In 1793 war breaks out between Britain and France. Thomas Jefferson oversees the purchase of the Louisiana Territory from France in 1803. The United States was worried about the war between France and Great Britain. Britain and France were at war with each other, as was much of the rest of Europe. Both sides thought that American ships were supplying the other with food, weapons, and other supplies. American ships were routinely stopped by both France and Britain. Each demanded to search the cargo holds. A lot of times these situations ended in violence. In 1807 Britain imposed the Orders in Council that restricted American shipping and Congress passed the Embargo Act cutting off trade with Britain. It was hoped that it would punish the two nations, who were at w ar with each other, but it backfired and hurt the United States. The War of 1812 has also sometimes been called, The Forgotten War along with the Second Revolutionary War. President Harry Truman called it the silliest damn war we ever had. (Nardo, 2000) It was a war between America and Great Britain. It was caused in part by disagreements over shipping and trade on the high seas and the kidnapping of American sailors who were forced to serve in the British navy. Support in the United States was divided with the West and South looking for a fight, but people of the New England strongly opposed to war. As the war continued, opposition became much stronger. The War Hawks in Congress pushed fighting and President James Madison was steered toward asking Congress for a declaration of war. The United States declared war on Great Britain during its war with France on June 18, 1812. In 1794 the United States Constitution provided for the introduction of a navy. Congress passed a bill giving permission to build six navy ships. One of these was the U.S.S. Constitution. Constructed over a period of three years at the cost of $318,719 it was the second largest warship. (Howes, 2002) The U.S.S. Constitution never lost a battle. During the War of 1812, the Constitution sunk a large number of ships belonging to the British navy. The Constitution commanded by Captain Isaac Hull, got its nickname, Old Ironsides. when a British seaman saw one of his cannon balls hit the wooden hull of the U.S.S. Constitution, bounce off, and fall into the sea. In amazement, the seaman said, Huzzah, her sides are made of iron! (Howes, 2002) Old Ironsides captured 24 enemy vessels. The first major battle of the War of 1812 ended in disaster for the United States when General William Hull who was leading an American army of 2200 men, surrendered to British forces at Detroit without firing a shot. One American soldier, Private Nathaniel Adams, later wrote to his brother, we could have whipped the hell out of the rascals but General Hull has proved himself a traitor and a coward. (Nardo, 2000) Two years later General Hull was sentenced to death for cowardice, but the 61-year-old Revolutionary War veteran was later pardoned by President James Madison. The next battle called for troops to cross the Niagara River into Canada. An American army of 6,000 men commanded by General Stephen Van Rensselaer invaded Canada crossing the Niagara River at Queenston. The Canadian Army commanded by British General Isaac Brock attacked the Americans while they were in the process of crossing the river. Van Rensselaer unwisely divided his forces and Brocks army cut most of a group of 800 Americans to pieces while the rest of the army stood idly by only a few miles away. General Brock took a shot in the chest and was killed in the battle. (Nardo, 2000) In October of 1812, Captain Stephen Decatur, commanding the USS United States, captured the Macedonian, a British warship, near the Madeira Islands off the coast of North Africa. And in December of that same year James Madison is elected to a second term as president of the United States. He receives 128 votes in the Electoral College. Opponents of a second war with Great Britain had revived the Federalist organization, and Federalists from eleven states met in New York and agreed to support De Witt Clinton, not on account of his war views, which were not in accord with their own, but as a protest against the policy of Madison. De Witt Clinton, representing the Federalist Party, receives 89 votes. Elbridge Gerry is elected vice-president and dies two years later while still in office. (Renwick, 1845) Those events led to the Battle of Lake Erie where Captain Oliver Hazard Perry leads a fleet of eleven ships against a British fleet of six vessels on Lake Erie. Eight minutes after Perry broke the British line the ships one by one ran up their white flags. Perry had snatched victory from what had seemed a certain defeat. It was the first time that an entire British fleet had been captured. And with Lake Erie now controlled by the Americans, the British were no longer able to get supplies. Perry announces the American victory in a memorable dispatch on the back of an old envelope to headquarters: We have met the enemy and they are ours. (Greenblatt, 1994) The way was open at last for Harrison to invade Upper Canada and to recapture Detroit and in September of 1813, General William Henry Harrison led a force of 4,500 Americans across the recently secured Lake Erie in pursuit of British troops forced to abandon Detroit. On October 5th, Harrison defeated the enemy at Moravian Town to defeat the British and their Indian allies in the Battle of the Thames. Tecumseh, the Shawnee leader of the Pan-Indian confederation earlier defeated at Tippecanoe, is killed in the battle, leading many of Britains Indian allies to abandon the alliance. (Freehoff, 1996) In the same month in Europe, Napoleons French army is crushed at the Battle of Leipzig. Napoleon, forced to retreat from Russia in 1812 after seeing 400,000 of his men killed and 100,000 captured in an ill-fated invasion, sends a new but untrained army into battle against a coalition of European nations at Leipzig, suffering another defeat that forces his retreat back into France. Soon after their victory at Leipzig the allies offered Napoleon peace under which France boundaries would be the Rhine and the Alps. Napoleon ignored the offer and the allies began a coordinated campaign that made its way through France. Napoleon was defeated in a series of battles each bringing the allies closer to Paris. On March 31, 1814 a victorious allied army entered Paris, and French foreign minister Talleyrand influenced the Senate to declare that Napoleon had forfeited the throne. On April 11th he abdicated the throne to the allies who gave him the island of Elba as his own sovereign principality with an annual income of 2,000,000 francs. (Cronin, 1994) Direct talks between the United States and Great Britain, proposed by the British foreign minister, Lord Castlereagh, began in Ghent. The American delegation consisted of Albert Gallatin, James Bayard, John Quincy Adams, Henry Clay, and Jonathan Russell. As the British army of approximately 4,000 approached, the majority of Washington residents fled the city. (Coles, 1965) On August 24th American defenders, with President James Madison in attendance, were quickly routed by the invaders in a battle at Bladensburg a few miles from the city. A messenger was dispatched to the White House to warn First Lady Dolly Madison of the arrival of the British. She and her staff fled by carriage across the Potomac but not without taking with her the full-length portrait of George Washington painted by Gilbert Stuart. It had been necessary for her servant to chop the frame apart with a hatchet in order to remove the canvas. (Greenblatt, 1994) That evening, the vanguard of the British army reached Capitol Hill and began its systematic destruction of all public buildings in the city. British forces captured Washington, D.C. The White House, the Capitol, and executive department offices are burned. Secretary of War John Armstrong was blamed for the poo r planning and intelligence that left Americas capital poorly defended and was forced to resign. After capturing and burning Washington so easily, the British didnt think they would have any trouble taking Baltimore. They figured they would sail their ships right into the harbor and destroy Fort McHenry with cannon fire making way for a land assault on the city. But the British attack on the capital had given the Americans time to prepare for them with more than 16,000 troops and thousands of civilians. When General Ross tried to attack by land he was killed and his troops driven back. A Washington lawyer named Francis Scott Key witnessed the action from a boat about 8 miles away catching glimpses of the bright stripes and bright stars of the forts flag lit up by the rockets red glare. (Nardo, 2000) The sight inspired him to write The Star-Spangled Banner to the tune of an old British drinking song. The song became the national anthem of the United Stated in 1931. During the Battle of Plattsburg on Lake Champlain in September of 1814, American forces turned back a British army of 11,000 men under the command of Sir George Prevost at Lake Champlain, New York. The Americans, who were outnumbered three to one established superior positions on the lake and shoreline, forcing Prevost to withdraw from the field. In the wake of his defeat, Prevost abandoned his invasion and retreated to Canada. The American victory saved New York from possible invasion and helped lead to the conclusion of peace negotiations between Britain and the United States in Ghent, Belgium. The Hartford Convention convenes as Federalist delegates from Massachusetts, Connecticut, Vermont, New Hampshire, and Rhode Island meet to discuss their opposition to the war. There is speculation that the convention will recommend New Englands secession from the United States and the negotiation of a separate peace with Britain. Instead, the delegates propose constitutional amendments requiring a two-thirds vote for declarations of war and laws restricting commerce, forbidding successive presidents from the same state, eliminating the three-fifths clause, and restricting future presidents to one term in office. These proposals will reach Washington just weeks before the end of the war. The War of 1812 ended when the Treaty of Ghent was signed at the end of 1814, guaranteeing that the United States and Britain would end their battle. Neither side was able to claim complete victory and they continued fighting for several more weeks. The Treaty of Ghent had come too late to prevent the slaughter in New Orleans. Two weeks after negotiators in Europe reached an agreement on a peace treaty to end the War of 1812, but a month before news of the treaty reaches North America, the United States won its greatest military victory of the conflict. The Battle of New Orleans was a prolonged battle and was the final major battle of the War of 1812. American forces, commanded by General Andrew Jackson, defeated an invading British Army intent on seizing New Orleans and the vast territory America had acquired with the Louisiana Purchase. The battle is often regarded as the greatest American land victory of the war. Speedy communication would have eliminated this battle. The War of 1812 could be called the war of poor communication. (Coles, 1965) It had no impact on the final settlement. The war to me didnt seem to accomplish much of anything. It seemed to be a whole bunch of failures in my opinion. I dont think they were prepared at all and things quickly went from bad to worse. I do believe that the war brought a patriotic feeling to the Americans and they gained some confidence and maybe even some respect from other nations that helped commerce to expand to other nations. It didnt really solve any of the problems that they went to war over but it did cause expansion and nationalism.

Salvador Dali :: essays research papers fc

(1904-1989) Salvador Dali was born into a middle-class family on May 11th, 1904 in Figures Spain. In 1921 he entered the San Fernando Academy of Fine Arts in Madrid where he made friends with Federico Garcia Lorca, Luis Bunuel, and Eugenio Montes. He pursued his personal intersest in Cubism and Futurism. In June of 1923 Dali was suspended from the Academy for having indicated the students to rebel against the authorities of the school. He was let back in October of 1925, and a year later Dali was permanently expelled. In 1924 he was imprisoned in Figures and Gerona for political reasons. Dali joined the Surrealists in 1929 due to the influence of metaphysical paintings, and his contact with Miro. Dali developed his method over the next few years. He describes his method as 'paranoic-critical, a 'spontaneous method of irrational knowledge based on critical and systematic objectivation of delirious associations and interpretations.' Works he produced at this time include The Lugubrious Game 1929, The Persistence of Memory 1931, and Surrealist Objects, Gauges of Instantaneous Memory 1932. Salvador Dali was the top Surrealists of this time. Surrealism explored the subconscious, the dream world, and irrational elements of the psyche in the belief that the discoveries to be made from such exploration would be of more fundamental importance to the human condition than any other form of social analysis. Salvador Dali was very fascinated by the fleeting state of the mind between sleep and consciousness, dream and reality, sanity and insanity, as one in which the mind functioned purely, free from the constraints of logic and social behavior. He read psychological case histories, hoping to represent neuroses in an ultra-realistic style, objectifying the irrational with photographic accuracy. In 1936, Dali began painting in a classical manner again, switching between Italian, Spanish and pompier styles. Dali was very politically involved, and had some extreme opinions. He was fascinated with Hitler, and his relations with the rest of the Surrealist group became strained after 1934, breaking away in 1939 when he declared his support for Franco. He moved to the USA, living there from 1939-1948. Dali held many one-man shows during his career. He directed and was a part of many films including the first surrealist film "Un Chiea A Dalou A Andalusian Dog", with the director Luis Bunuel. In 1945 he designed the surrealistic dream sequence for Hitchcock's Spellbound, and filmed Don Juan Tenorio, in 1951. Salvador Dali :: essays research papers fc (1904-1989) Salvador Dali was born into a middle-class family on May 11th, 1904 in Figures Spain. In 1921 he entered the San Fernando Academy of Fine Arts in Madrid where he made friends with Federico Garcia Lorca, Luis Bunuel, and Eugenio Montes. He pursued his personal intersest in Cubism and Futurism. In June of 1923 Dali was suspended from the Academy for having indicated the students to rebel against the authorities of the school. He was let back in October of 1925, and a year later Dali was permanently expelled. In 1924 he was imprisoned in Figures and Gerona for political reasons. Dali joined the Surrealists in 1929 due to the influence of metaphysical paintings, and his contact with Miro. Dali developed his method over the next few years. He describes his method as 'paranoic-critical, a 'spontaneous method of irrational knowledge based on critical and systematic objectivation of delirious associations and interpretations.' Works he produced at this time include The Lugubrious Game 1929, The Persistence of Memory 1931, and Surrealist Objects, Gauges of Instantaneous Memory 1932. Salvador Dali was the top Surrealists of this time. Surrealism explored the subconscious, the dream world, and irrational elements of the psyche in the belief that the discoveries to be made from such exploration would be of more fundamental importance to the human condition than any other form of social analysis. Salvador Dali was very fascinated by the fleeting state of the mind between sleep and consciousness, dream and reality, sanity and insanity, as one in which the mind functioned purely, free from the constraints of logic and social behavior. He read psychological case histories, hoping to represent neuroses in an ultra-realistic style, objectifying the irrational with photographic accuracy. In 1936, Dali began painting in a classical manner again, switching between Italian, Spanish and pompier styles. Dali was very politically involved, and had some extreme opinions. He was fascinated with Hitler, and his relations with the rest of the Surrealist group became strained after 1934, breaking away in 1939 when he declared his support for Franco. He moved to the USA, living there from 1939-1948. Dali held many one-man shows during his career. He directed and was a part of many films including the first surrealist film "Un Chiea A Dalou A Andalusian Dog", with the director Luis Bunuel. In 1945 he designed the surrealistic dream sequence for Hitchcock's Spellbound, and filmed Don Juan Tenorio, in 1951.

Creativity art

The Creativity Spirit During my entire life I encountered a creativity killer. The type of the killer that Eve encountered are surveillance, evaluation, rewards, competition, and pressure. The reason why I encountered the type of killer of surveillance was because during in every classroom I had through my life from K-8, the teacher will always watch my classroom work not letting me to take the risk of being creative in learning.Another type of killer Eve got through my life was evaluation because through-out my life Eve always had other people Judging on what I was doing, they wouldn't satisfy themselves of me being myself. The other killer that Eve encountered in my life is rewards because every time in my life when I tried to achieve a goal that I set my self I would always rewards myself with success. Competition Killer Eve also encountered through-out my life because since I have played soccer my entire life Eve always faced competition.Finally the last type of killer that I fac ed in my life Is pressure cause since I'm the oldest out of my brother and sister. I'm trying to set an example for them so I feel like I have a lot of pressure because I feel like I need to establish grandiose expectation for them. I feel that Creativity Killers do impact learning and creating in college student because I feel that they need to be free to learn and be creative to learn. Also adults enter ultimate state of creativity called flow in which whole absorption can provoke peak desire and creativity. I feel that It's a mixed Impact of positive and negative .

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 av oid 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 patient’s 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 patient’s 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 pro gnosis, my patient’s 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 i nterest 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 Gadow’s 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

Political changes of 17th cent essays

Political changes of 17th cent essays When one looks at the religious wars, it is very difficult to identify a beginning and middle. People can argue that the seed for the wars was planted in the wars between the Calvinists and Hapsburgs, otherwise known as the Dutch and the Spanish. In addition, people can argue that the Protestant Reformation in Germany and other parts of Europe sparked these "religious" wars. It was inevitable that the growing division between Christian churches in Europe would lead to a series of armed conflicts for over a century. Protestants and Catholics would shed each other's blood in monumental amounts in national wars and in civil wars. These struggles would eventually destroy the European monarchical traditions themselves. But truly, were they even religious wars? Thus, the question arises. The Bohemian War, fought from 1618 through 1623 was most likely the one war that had anything to do with religion. After Mathais, Ferdinand the Second took over as the Holy Roman emperor. Being a passionate member of the Catholic Church, Calvinism was just out of the question in his book. No one in Bohemia would be allowed to carry out religious services in any way promoting Calvinism. The conflict went much further. The Bohemian princes became irritated, and Ferdinand sent two ambassadors to try to ease the tensions. This only sparked an onslaught of aggression. Fear of being forced into Catholicism was enough t push the princes over the edge, and the two ambassadors were thrown out the window in objection. Thus came the defenestration of Prague. The fighting still had a long way to go, and at the Battle of White Mountain, the forces collided. The Catholic group, called the Catholic League, was backed by Ferdinand II, Spain, the Elector in Saxony (Germany) and also the Pope, conqu ered the relatively smallish Bohemian army. The success was immense, and Alsace went to Spain to maintain good ties. To move on to the next wars, one must discuss Cardinal Ri...