Alma College Admissions - ACT Scores, Financial Aid...

Alma College Admissions - ACT Scores, Financial Aid... Students applying to Alma do not need to worry about submitting letters of recommendation or an application fee. The schools acceptance rate was 68% in 2016; with good grades and decent test scores, students have a good chance of getting in. Of course, any extracurricular activities, job experiences, and honors courses are also helpful. Interested applicants are encouraged to visit the school and meet with an admissions counselor. Will You Get In? Calculate Your Chances of Getting In  with this free tool from Cappex Admissions Data (2016): Alma College Acceptance Rate: 68 percentGPA, SAT and ACT Graph for Alma AdmissionsTest Scores 25th / 75th PercentileSAT Critical Reading: 420  / 590SAT Math: 460  / 593What these SAT numbers meanCompare top Michigan colleges SAT scoresACT Composite: 21 / 26ACT English: 21  / 26ACT Math: 21 / 26What these ACT numbers meanCompare top Michigan colleges ACT scores Alma College Description: Alma College is a private, Presbyterian  liberal arts college  located in Alma, Michigan, about an hour north of Lansing. Alma prides itself on the personal attention its students receive. With no graduate students (and thus no graduate instructors), a 12 to 1 student / faculty ratio, and an average class size of 19, students at Alma have a lot of interaction with their professors. For its strengths in the liberal arts and sciences, Alma College was awarded a chapter of  Phi Beta Kappa. The college also embraces its Scottish heritage, evidenced by its kilt-wearing marching band and annual Scottish games. Enrollment (2016): Total Enrollment: 1,451  (all undergraduate)Gender Breakdown: 42  percent male / 58 percent female95  percent full-time Costs (2016- 17): Tuition and Fees: $37,310Books: $800 (why so much?)Room and Board: $10,238Other Expenses: $2,265Total Cost: $50,613 Alma College Financial Aid (2015- 16): Percentage of New Students Receiving Aid: 100 percentPercentage of New Students Receiving Types of AidGrants: 100 percentLoans: 95 percentAverage Amount of AidGrants: $26,926Loans: $8,555 Academic Programs: Most Popular Majors:  Biology, Business Administration, Communication Studies, Elementary Education, English, Health Professions, Music, PsychologyWhat major is right for you?  Sign up to take the free My Careers and Majors Quiz at Cappex. Retention and Graduation Rates: First Year Student Retention (full-time students): 67 percent4-Year Graduation Rate: 56 percent6-Year Graduation Rate: 67 percent Intercollegiate Athletic Programs: Mens Sports:  Football, Track and Field, Tennis, Wrestling, Lacrosse, Soccer, Golf, Baseball, Basketball, Cross CountryWomens Sports:  Bowling, Basketball, Swimming, Tennis, Track and Field, Volleyball, Softball, Cross Country Data Source: National Center for Educational Statistics Alma College Mission Statement: mission statement from alma.edu/about/mission Alma College’s mission is to prepare graduates who think critically, serve generously, lead purposefully, and live responsibly as stewards of the world they bequeath to future generations.

Primary Research Essays

Primary Research Essays Primary Research Essay Primary Research Essay The primary research consisted of focus group and face to face interviews as Zikmund (1984) defined an interview as a purposeful discussion between two or more people in order to gain valuable knowledge. If utilised correctly an interview can be used to gather valid research data, which is reliable (Saunders et al. , 2002). Researchers usually begin their investigation with interviews involving people who perceive, and are also part of, a problem, as well as those who have had experience with similar problems (Corey 1990).One of the main advantages that surround interview-based research centres on the ability to interrogate the interviewee in greater detail and relevance, compared to, say, a closed- ended questionnaire. When carrying out interviews it is important to determine whether a structured or non-structured interview be carried out. A structured interview follows a predetermined set of questions. Non-directed interviews allow for flexibility in the discussion, relying on the interviewee to volunteer relevant facts and opinions, with broad guidance from the interviewer.For this study semi-structured interview was conducted and it provided an opportunity to obtain a more in-depth, subjective and exploratory perspective of the subject at hand. The semi-structured approach was chosen to obtain the required data, as it enabled the interview to follow an established list of questions revolving around the research aims and objectives. But more importantly, Saunders et al. , (2002) acknowledged, it provides the flexibility to ask immediate or probing questions.The duration of the interviews were kept minimal and succinct, lasting 30 minutes for face to face interviews and 60 minutes for the focus group interviews. Secondary data can be created within an organization itself (such as corporate annual reports), or generated by sources outside a corporation like books, a number of articles in journals, individual papers in collections of reference papers, and the internet. There are various sources of information being exploited in this research and are as follows: text books and journals that relates to internationalization, foreign direct investments and entry modes.Other sources heavily used in this study included but not limited to TopicalCare Publications both hard and electronic copies, World Bank, OECD and Nigerian government publications. The using of secondary data has the advantage for the investigator in terms of time saved and less expense. Nevertheless, the main problem is that this data may not completely fit to the objective. It is crucial to assess the suitability of secondary data. Moreover, the published documents may contain outdated information. The most significant problem of using secondary data is that it is difficult to prove how reliable the information is.

Sickle Cell Anemia Essay Example | Topics and Well Written Essays - 1500 words

Sickle Cell Anemia - Essay Example Each cell of a human body consists of a nucleus. All the genetic material required for the physical characteristics of a human being are present in the 23 chromosomes located inside the nucleus. A single unit of a DNA is called a gene. A gene provides us with the directions required for synthesizing a protein and these proteins are responsible for our traits. Each gene consists of a specific order of nucleotides and these nucleotides dictate the order of amino acids which in turn form chains and links to form proteins. These sequences of amino acids are very important because they are responsible for the shape, structure and characteristics of a protein. Any change in this sequence is called a mutation and the effects could be dreadful. Change in this sequence could cause the characteristics of a protein to change completely. Mutation is basically the spontaneous change in the structure of a gene or chromosome. There are many types of mutations and they could either be beneficial or harmful. This type of mutation is an example of a point mutation or a missense mutation, and is obviously extremely harmful, if the gene occurs in a homozygotic form. It occurs in the beta globin gene (HBB) which is present in the 11th chromosome. The HBB gene is responsible for normal blood production. The point mutation causes the beta hemoglobin molecule to convert the GAG codon into a GUG codon by transcription i.e. it encodes the amino acid valine rather than the seventh amino acid, glutamic acid. Valine is hydrophobic (water hating) causing the hemoglobin molecule to bend inwards, causing it to become sickle shaped. There are no other changes in the structure. The synthesis of any protein is a two-step process. Firstly the instructions in the gene, present in the DNA, are copied onto a messenger RNA (mRNA) with the help of RNA polymerase. The synthesis of the mRNA is a complex process. This stage is known as transcription. In this stage, the RNA polymerase breaks the bonds of the double helical molecule of DNA and with the help of base pairing, different RNA nucleotides are added one at a time. To understand the concept of base pairing, one needs to understand the structure of RNA first. Each RNA molecule consists of a nitrogenous base, sugar and a phosphate molecule. But unlike DNA, RNA is single stranded. During transcription, each DNA nucleotide is paired with a complimentary RNA nucleotide. The complimentary base pairs are as follows: Guanine with Cytosine Thymine(DNA) pairs with Adenine (RNA) Adenine (DNA) pairs with Uracil(RNA) One of the basic differences between DNA and RNA is of the nitrogenous bases. In place of Thymine, RNA contains Uracil. This method of base pairing ensures that the correct sequence of nucleotides, present in the DNA, is copied onto the mRNA chain. (Gary H. Perdew) These instructions consist of the sequence in which the amino acids should be linked together to form the protein. In this case, the new mRNA formed at the 11th c hromosome is encoded with the mutant code. Then the information on the mRNA bases is translated by the ribosomes so that they can place amino acids in the given order to form the protein that was coded for by the gene in this case, the beta s globin. Three nucleotides in an mRNA molecule are the code for one amino acid. This set of nucleotides is known as a codon. This sequence of codons is actually the code for the sequence of amino acids in a protein. Because of the point mutation the HBB gene

Article Review Example | Topics and Well Written Essays - 750 words - 11

Review - Article Example riment among a small group of autistic children in different settings to analyze the results of multi-exemplar training to establish a repertoire of sharing behaviour. Evaluating the research design using the Scientific Merit Rating Scale (SMRS) the writer would assign a rating of four to this design. This rating is based on the study using a single-subject design with four subjects in total. The researchers compared control and treatment data by using a concurrent multi-probe design and baseline treatment. The research design helped in maintaining uniformity and accuracy of the response of the subjects. Each baseline and treatment trials consisted of eighteen sessions each out of which 9 sessions were teaching sessions. The verbal offers for sharing were randomly assigned to each of the participants and the offers were rotated in each session. The order of trials was also randomized the only exception being the training trials which was conducted both before as well as after a session. There was no mention of data loss of any kind in the article. Direct observation was adopted in the experiment to measure response which was done by trained observers using pencils and paper data sheets. The scoring of two observers was compared. Interobserver data was collected for all the subjects and the mean percentage was 99% across all the trials and all the subjects. Using the SMRS the researchers would rate the quality of dependent measure a five. Each verbal instruction tasks and observation were specified. The mean percentage accuracy on procedural components was 99%. Subject wise individual integrity scoring was also done. A rating of four would be given according to SMRS since the overall accuracy was above 80 and implementation accuracy as studies in at least 25% of the sessions for each participant. The four children who participated in the study were diagnosed with autism. The diagnosing was done by independent agencies. The 4 participants studied in a school

U07d2 Laws Balancing Access and Protection Essay

U07d2 Laws Balancing Access and Protection - Essay Example The organizations now aim at having paper free offices and all the doctors now use the electronic medium to communicate rather than in paper. However, similar to the use of paper, this method of record keeping also has its own merits and demerits. In today’s world, everyone is very concerned not only about themselves but also about the environment around them, hence the paper less offices and reducing carbon footprints. However one important thing to note is that the use of computers for keeping records can be quite a threat to security for the personal information of millions and millions of people (Centers for Medicare and Medicaid Services, 2010). In order to ensure that the electronic data is in place and is standardized and hack free, there have been a number of changes including the shift from the traditional viewpoints to newer auditing methods. Similar to the many laws that have been developed over the years, the Privacy Rule also works on the need for independence and personal space in terms of the collection and distribution of healthcare information. Apart from the difficulty of the medical records, the health care organizations are also faced with an issue to upkeep the confidentiality of the communication both in terms of verbal as well as written (Adler, 2008). As the data protection act prohibits the leak of any personal information, similarly, all medical information should also be kept very confidential and should only be shared with consent of the patient. The chapter brings out the most important point of focus, i.e. that the medical records, irrespective of whether they have been tampered or not for any profits, any fabrication or falsifying of data can lead to both criminal as well as civil liability (Beaver & Herold, 2003). No information can be leaked out, modified, or destroyed as this can lead to a criminal charge against the healthcare personnel. The basic idea of the

Management of Self-harm Patients in AE

Management of Self-harm Patients in AE The acute incident was a case of ‘deliberate self-harm’ (DSH), admitted to an A E unit. DSH incorporates deliberate non-habitual acts of self-harm that are not fatal, and may or may not involve attempted suicide (Repper, 1999). Emergency departments provide the main ‘entry point’ for such patients (NICE, 2004). The patient in this case had slashed his wrists in several places, severing a key artery. He was bleeding profusely, and in a semiconscious state on arrival. There was a history of psychopathology dating back several years. He was unmarried, lived alone, and had recently undergone treatment and observation at the forensic mental health unit of a local NHS Hospital Trust. Reppers (1999) review of the relevant literature on the management of self-harm patients in A E units highlights several key issues for nursing care. It is essential that the qualified nurse is cognisant of the relevant Codes of Professional Conduct specified by the Nursing Midwifer y Council (NMC, 2002), including ethical concerns such as respect, confidentiality, and trust. This is particularly crucial when dealing with self-harm patients because research suggests that emergency department nurses often hold negative attitudes towards this type of patient (McAllister et al, 2002). Furthermore, self-harm patients have reported dissatisfaction with the care provided by nurses and other health care staff. The empirical literature on the management of self-harm patients in A E highlights the value of problem-solving approaches to patient care (Repper, 1999). The basic problem-solving model incorporates five principles, outlined in Table 1. These tenets are consistent with protocols for effective decision-making, for both individuals and groups (Janis Mann, 1977). They are also consistent with NICE/DOH guidelines for caring for the mentally ill (NICE, 2004, Clinical Guideline 16). NICE guidelines recommend immediate assessment of risk, and mental, physical, emotional stability, once a patient arrives at A E. Staff are then required to account for underlying emotional factors that may have precipitated the self-harm episode, as well as evaluating the seriousness of the injury, before deciding the most appropriate treatment for the patient. Reesal et al (2001) highlight some of the key principles of management that are relevant to nurses working with mental health patients. These relat e to assessment, phases of treatment, psychiatric management, goals of treatment, psychotherapeutic management, the management of medication and self-harm/suicide, and medical-legal issues (also see DOH, 1999; NICE, 2004). Nurses need to conduct a comprehensive psychosocial assessment, in full cognisance of the biological, psychological, and social context, and also precipitating and perpetuating factors. Mental health problems can often be long-term/chronic, rather than short/acute, and self-harm is no exception. An underlying condition like depression can be conceptualised in terms of three treatment phases – response, remission, and relapse. Principles of psychiatric management dictate that consent must be obtained prior to treatment. A good psychiatric-patient rapport is essential, and treatment must involve a multidisciplinary team, of which nurses are an essential part. Goal setting is paramount as it facilitates the development of a treatment plan and allows the patien ts progress to be evaluated more accurately. Psychotherapy can be based on any one of several models (e.g. cognitive-behavioural, interpersonal, dynamic). Recovery must be closely monitored – patients who have not recovered within 2 months may require a change in treatment modality. Some knowledge of pharmacology is essential for effective medication management, but it is usually up to a psychiatrist to prescribe the necessary medication. In managing suicide/self-harm cases, it is important for the nurse to establish whether the patient â€Å"feels desperate, hopeless, helpless, or is tired of struggling with life. Has the patient not wanted to go on living? Is there active suicide ideation? How strong are the thoughts? How frequent, persistent, and irresistible are they? Is there a plan? Do the means and opportunities exist? How impulsive is the patient?† (Reesal et al, 2001, p.25S). Since self-harm episodes are generally unpredictable, there are bound to occur irrespective of psychosocial assessments and psychiatric management. Salient issues for inpatient management (see Table 2) include safety, crisis intervention, di agnosis, patient response to treatment, level of depression, inability to live effectively at home, and the level of social support (i.e. friends, family). Medical-legal issues include confidentiality, risk assessment, information sharing, truth telling, and liability. Some of these are considered later in this essay. Overall, patients must believe they are receiving equity, justice, and consideration, and that clinical management is set up to facilitate good quality care. Ethical and legal issues in the management of mental health patients are outlined in the Nursing and Midwifery Council’s codes of conduct (NMC, 2002), the National Service Frameworks (NSF) Modern Standards and Service Models for mental health patients (DOH, 1999), and the National Institute for Clinical Excellence (NICE, 2004). There is currently strong emphasis on evidence-based nursing practice (NICE, 2004). Clinical decisions, where possible, should be based on good quality empirical research. The NICE Clinical Guidelines No.16, for the care of self-harm patients, are rooted in scientific evidence. It is therefore incumbent on nurses to ensure that decisions about all aspects of patient care comply with these standards. Thus, for example, nursing staff are compelled to consider using an integrated physical and mental health triage scale, establish physical risk and mental state, and offer psychosocial assessment at triage. The problem here concerns the practical realities of guidelines adherence in a busy A E unit. Due to time constraints and hectic work routines, nurses may be unable to check adherence to standards. Senior nurses may rely more on their clinical experience in certain instances, whereas younger nurses finding it easier to consult colleagues for clarification, rather than locate and check practice standards. While guidelines will help ensure that this patient receives good quality health care, nurses and other health professionals will ultimately responsibility for clinical decisions. It is therefore essential that staff are adequately trained and resourced to make informed choices that are in the best interests of the patient. Decision theorists Janis and Mann (1977) propose that such informed decision making requires that a viable clinical solution is perceived to be available, to deal with the patients problem, and that there is adequate time in which to find it. If a nurses is uncertain what to do, perhaps due to inadequate training, lack of guideline information, or unfamiliarity with self-harm patients, then he or she may resort to ineffectual decision strategies, such as delaying treatment, looking for another nurse to take responsibility, or even discounting the severity of the patients condition. Time constraints can be a serious problem in emergency depart ments, where patients arrive with life-threatening injuries, and nurses are required to make multiple clinical decisions, in quick succession. Severe time limits may induce panic or frantic behaviour in clinical staff, leading to hasty clinical decisions that fail to account for all aspects of the patient’s clinical condition. In 2005 the Department of Health published its Patient Led NHS (DOH, 2005). Central to this discourse is the notion of empowerment – enabling patients to have more say in clinical decisions about their care, by providing them with the all relevant information, support, and guidance. This is consistent with the 1983 Mental Health Act which states that patients are provided with all necessary and correct information by an informed health care professional, for example on the nature, purpose and probable effects of treatments, and detention, renewal, and discharge. Thus, the patient in A E will have to be treated accordingly by nursing staff. The Department of Health has encouraged the faster emergence of best practice guidelines (DOH, 2005), as this is key to successful empowerment. Currently there are no commissioned best practice statements for the care of mentally ill, or specifically those who self-harm. Since the devolution of responsibility from health authorities to loca l primary and secondary care trusts (DOH, 2002a, 2002b), nurses have assumed greater responsibility implementing national guidelines on mental health. An important part of this empowerment is to liase or network with relevant multidisciplinary professionals, agencies, and local communities. Nurses working in mental health view networking as a major area of responsibility (Rask Hallberg, 2005). Thus, emergency department staff dealing with this particular will be required to contact social services, and the patients’ GP/PCT, friends, family, employment, and other relevant parties. Where necessary, partnerships can be set up, for example with local primary care or social service units, to arrange particular aspects of care, such as home visits, 24 hour access, and development of care plans. The NMC Code of Professional Conduct (NMC, 2002) states that nurses are to behave in a way that enhances trust and confidence in the patient. In other words it is incumbent on a nurse to be truthful and keep his or her patients’ confidence (Tschudin, 1992; Rumbold, 1999; Reesal et al, 2001). Yet in reality this may pose a very difficult ethical dilemma. During psychosocial assessment nurses often need to obtain personal information from the patient, information that the patient will not normally share with anyone. Patients may divulge information on the understanding that it would be kept in confidence. However, serious problems arise if a patient expresses an intention to reattempt self-harm, or even suicide. Is it ethical for the nurse to share this information with other staff and relevant authorities? The NMC (2002) Codes of Conduct are inherently contradictory, because on the one hand they require nurses and midwifes to â€Å"protect confidential information† (p.11 ), but on the other hand mandate that staff â€Å"must act to identify and minimise the risk to patients and clients† (p.11). Crow et al (2000) argue that effective handling of this dilemma requires an understanding of the patient’s own cultural background and general worldview. It is essential for a patient to sign release forms stating that he or she wishes to be present during information-sharing, and takes responsibility for the clinical consequences of such information. Nurses must take extra care when dealing with patients whose cultural backgrounds denotes different understandings of truth and presents linguistic barriers, â€Å"Frequently, when patients from other cultures are asked if they understand something, they nod yes and smile amicably. However, do they really understand what is being stated.., and does it make sense from their cultural perspective of truth?† (Crow et al, 2000). A break down of trust, through truth telling without consent, may aggravate the patients’ psychological state, precipitating the very outcomes the nurse is trying to prevent. And trust can be difficult to generate if nurses fail to develop a good rapport with patients. Long (1998) points out that nurses are often expected to apply nursing models, such as the Activities of Daily Living (ADL) (Rask Hallberg, 2000), in developing and executing a care plan. Such frameworks of care seem at odds with experiences of someone who wishes to commit self-harm a nd possibly suicide. Normal daily activities would be anything but ‘normal’. Moreover, the application of academic models to such situations creates a sense of detachment from the patient, so that an â€Å"‘I-It’ relationship, takes priority over the person in need of care, and in need of developing a therapeutic ‘I-thou’ relationship† (p.5). RISK ASSESSMENT STRATEGIES NICE (2004) guidelines stipulate that self-harm patients undergo a comprehensive risk assessment. This must include an identification of the fundamental clinical and demographic factors that are implicated in the risk of further self-injury. According to Reesal et al (2001) these may include staff attitudes, the presence of anxiety, agitation, panic attacks, persistent global insomnia, anhedonia and poor concentration, feelings of hopelessness/helplessness, substance abuse (alcohol, drugs), impulsivity, being male and aged between 20-30 years or over 50 years, or female aged between 40 and 60 years, being older, having a history of self-harm or suicide attempts, and/or a family history of self-harm, or suicide attempts. The NICE (2004) also require an identification of depressive symptomatology. Nurses carrying out risk assessments must always use a standardised risk assessment scale. Decisions about referral, discharge and admission are partly based on the outcome of risk evaluation s. Crowe and Carlyle (2003) argue that risk assessment in mental health care reflects a form of clinical governance, driven more by organisational, financial, political, and legal considerations, than by concern for patient welfare. For example, risk assessment forms part of professional standards for nurses, and failure to adhere to this requirement in patient care increases clinician liability if a patient (or their family) decides to sue for negligence (Samanta et al, 2003). The result is that the welfare of the patient may not be accorded the priority it deserves. QUALITY ASSURANCE Central to quality assurance is the notion of clinical governance (Ayres et al, 1999; NHS Executive, 1999; Hungtington et al, 2000). The purpose of clinical governance is to maintain the quality of service delivery. This is particularly crucial in A E units, where critical incidents, such as the mismanagement of a badly injured self-harm patient, can easily lead to death. As Huntington et al (2000) point out, this situation, combined with a proclivity for staff to protect their reputation, can engender a culture of blame, scapegoating, and secrecy, all of which may hinder improvements in the quality of patient care (NHS Executive, 1999). Governance typically entails organisational change, from a ‘blame culture’ to a ‘learning’ orientation. Of course such change is subject to the usual organisational restraining factors that Kurt Lewin (1951) refers to in his model of change. These include excessive staff workloads, a â€Å"not another cha nge† attitudes, and general reluctance to give up ‘tried and tested’ practices, time constraints, and patient inconvenience. The critical issue in an A E is whether staff consistently adhere to professional standards of care, as prescribed by NICE (2004), the Royal College of Psychiatrists, and the National Service Framework for Mental Health (DOH, 1999). Nurse attending to a self-harm patient will need to ensure that they are familiar with these guidelines before attending to the patient, or at least have quick assess to relevant information, and/or are supervised by a more experienced colleague with better knowledge of professional standards. This is essential as failure to adhere to professional standards has major legal implications (Samanta et al, 2003; Wilson, 1999). Although clinical governance leaders within acute and community NHS trusts have a responsibility to ensure that nursing staff deliver good quality care, such governance can only be effective wi th adequate resourcing (Huntington et al, 2000). For example, there needs to be clarity from professional bodies about best practice (there are currently no best practice statements for the care of mentally ill/self-harm patients), as well as support from health authorities, and clinical governance leaders at regional office, professional, and local district levels. This essay considers nursing issues in the management of a self-harm patient admitted to an emergency department unit of an NHS Trust. Salient issues for the qualified nurse include ethical dilemmas, associated with conflicting codes of conduct, important management issues relating to assessment, diagnosis, psychological and medical treatment, in-patient care, and medical-legal considerations. Nurses now command greater empowerment in the modern NHS, and but must somehow adhere to strict professional standards, while simultaneously exercising good clinical judgement. Additionally, they must also manage to overcome the unique clinical and psychological circumstances of deliberate self-harm. Support from clinical governance leaders, and adequate training in management, decision making skills, and clinical practice, are essential, if nurses are to delivery high quality patient care References Ayres, I.L., Cooling, R. Maughan, H. (1999) Clinical governance in primary care  groups. Public Health Medicine. 2, pp.47-52. Crow, K., Matheson, L. Steed, A. (2000) Informed consent and truth-telling:  cultural directions for health care providers. Journal of Nursing  Administration. 30, pp.148-152. Crowe, M. Carlyle, D. (2003) Deconstructing risk assessment and management in  mental health nursing. Journal of Advanced Nursing. 43, pp.19-27. DOH (1999) National Service Framework for Mental Health: Modern Standards   Service Models. London: Department of Health. DOH (2002a) National Service Framework: A Practical Aid to Implementation in  Primary Care. London: Department of Health. DOH (2002b) Improvement, Expansion Reform – the next 3 Years: Priorities and  Planning Framework 2003-2006. London: Department of Health. DOH (2005) Patient Led NHS. London: Department of Health. Horrocks, J., House, A. Owens, D. (2004) Establishing a clinical data base for  hospital attendances because of self-harm. Psychiatric Bulletin, 28, pp.137-139. Huntington, J., Gillam, S. Rosen, R. (2000) Clinical governance in primary care:  organisational development for clinical governance. British Medical Journal.  321, pp.679-682. Janis, I.L. Mann, L. (1977) Decision Making: A Psychological Analysis of Choice,  Commitment. New York: Free Press. Lewin, K. (1951) Field Theory in Social Science. New York: Harper Row.   Long, A., Long, A. Smyth, A. (1998) Suicide: a statement of suffering. Nursing  Ethics. 5, pp.3-15. McAllister, M., Creedy, D., Moyle, W. Farrugia, C. (2002) Nurses attitudes  towards clients who self-harm. Journal of Advanced Nursing. 40, pp.578-586. NICE (2004) Self-Harm: The Short-Term Physical and Psychological Management  and Secondary Prevention of Self-Harm in Primary and Secondary Care  Clinical Guideline 16. London: National Institute for Clinical Excellence.   NHS Executive (1999) Clinical Governance in the new NHS. London: NHS  Executive (HSC 1999/065). NMC (2002) Code of Professional Conduct. London: Nursing Midwifery Council. Rask, M. Hallberg, R. (2000) Forensic psychiatric nursing care – nurses  apprehension of their responsibility and work content: a Swedish survey.  Journal of Psychiatric Mental Health Nursing. 7, 163-177. Reesal, R.T., Lam, R.W. the CANMAT Depression Work Group (2001) Clinical  guidelines for the treatment of depressive disorders: Principles of Management  II. The Canadian Journal of Psychiatry. 46 (Suppl 1), pp.21S-28S. Repper, J. (1999) A review of the literature on the prevention of suicide through  interventions in Accident and Emergency Departments. Journal of Clinical  Nursing. 8, pp.3-12. Rumbold, G. (1999) Ethics in Nursing Practice (3rd edition). London: Balliere Tindall. Samanta, A., Samanta, J. Gunn, M. (2003) Legal considerations of clinical  guidelines: will NICE make a difference? Journal of the Royal Society of Medicine. 96, pp.133-138. Tschudin, V. (1992) Ethics in Nursing: The Caring Relationship (2nd Edition).  London: Heinemann. Wilson, J. (1999) Best practice guidelines. British Journal of Nursing. 8, pp.293-294.

Epic of Beowulf :: Epic of Beowulf Essays

The poem begins with a brief genealogy of the Danes. Scyld Shefing was the first great king of the Danes, known for his ability to conquer enemies. Scyld becomes the great-grandfather of Hrothgar, the king of the Danes during the events of Beowulf. Hrothgar, like his ancestors before him, is a good king, and he wishes to celebrate his reign by building a grand hall called Heorot. Once the hall is finished, Hrothgar holds a large feast. The revelry attracts the attentions of the monster Grendel, who decides to attack during the night. In the morning, Hrothgar and his thanes discover the bloodshed and mourn the lost warriors. This begins Grendel's assault upon the Danes. Twelve years pass. Eventually the news of Grendel's aggression on the Danes reaches the Geats, another tribe. A Geat thane, Beowulf, decides to help the Danes; he sails to the land of the Danes with his best warriors. Upon their arrival, Hrothgar's thane Wulfgar judges the Geats worthy enough to speak with Hrothgar. Hrothgar remembers when he helped Beowulf's father Ecgtheow settle a feud; thus, he welcomes Beowulf's help gladly. Heorot is filled once again for a large feast in honor of Beowulf. During the feast, a thane named Unferth tries to get into a boasting match with Beowulf by accusing him of losing a swimming contest. Beowulf tells the story of his heroic victory in the contest, and the company celebrates his courage. During the height of the celebration, the Danish queen Wealhtheow comes forth, bearing the mead-cup. She presents it first to Hrothgar, then to the rest of the hall, and finally to Beowulf. As he receives the cup, Beowulf tells Wealhtheow that he will kill Grendel or be killed in Heorot. This simple declaration moves Wealhtheow and the Danes, and the revelry continues. Finally, everyone retires. Before he leaves, Hrothgar promises to give Beowulf everything if he can defeat Grendel. Beowulf says that he will leave God to judge the outcome. He and his thanes sleep in the hall as they wait for Grendel. Eventually Grendel arrives at Heorot as usual, hungry for flesh. Beowulf watches carefully as Grendel eats one of his men. When Grendel reaches for Beowulf, Beowulf grabs Grendel's arm and doesn't let go. Grendel writhes about in pain as Beowulf grips him. He thrashes about, causing the hall to nearly collapse. Soon Grendel tears away, leaving his arm in Beowulf's grasp.