Saturday, August 31, 2019

Clinical Decision Making Skills for the Integrated Worker Essay

This assignment will define and analyse the need for a chosen service improvement within the pathway of mental health, as well as evaluating the suggested service. Demonstrating how this service can inform and benefit integrated practice, discussing the ways in which the agency’s statutory obligations and responsibilities impact on both individual and group decision making. The chosen service improvement for this assignment is the introduction of a mental health nurse into primary care services, for example, a GP Surgery. Focusing on service users with mental health issues in the community and therefore in the care of the local Primary Care Trust (PCT). There is an obvious need for movement towards better health and social care for individuals with mental health illnesses in primary care. No Health without Mental Health: A Guide for General Practice (Department of Health, DoH, 2012, online), sets out what General Practitioners (GPs) can do to improve mental health and enhance care and support offered to those with mental health conditions in the community. This document also states that one in four GP consultations account for mental health problems (DoH, 2012, pg8, online). Treatments for those with mental health issues cost the NHS in the United Kingdom approximately  £105 Billion per year (DoH, 2012, pg8, online). Primary care plays a pivotal role in caring for those with mental health illnesses in the community and in most cases this falls into the responsibility of the local GP surgeries. Therefore GPs are ideally placed to identify signs of distress and those with risk factors for poor mental health (NHS Confederation, 2011, online). Primary care providers, more specifically GPs are usually the first point of call for an individual experiencing some form of psychological distress (DoH, 2012, pg13, online). It is essential there is early recognition and referral to any specialist mental health services required, saving time, money and individual distress in the long-run. An area which remains problematic is the treatment of physical health care needs for those with mental health illnesses. Research continues to  highlight that the physical health of those with mental illnesses is frequently poor and people with long-term physical conditions experience higher levels of mental health issues (Nash, 2010, pg2). It is ironic that a great deal of the research carried out is with individuals that are currently in contact with either health or social care services (Nash, 2010, pg2). This issue could be tackled within primary care services, as GPs especially can treat the whole person linking rather than separating physical and mental health (Knapp, 2011, pg3, online). Professionals within the primary care sector could experience problems when trying to identify their role in relation to meeting the health needs of those with mental health issues, as well as offering interventions and support to those identified as high risk of developing mental health problems, such as, individuals with long-tem physical conditions (Nash, 2012, pg 10). Yamey (1999) found that a number of patients had actually been removed from GP registers at some point prior to accessing secondary mental health services. This causes suspicion that some mental health illnesses could be construed as a reason for being excluded from GP surgeries (Yamey, 1999). MIND (1996) carried out a survey which also showed that a large majority of individuals felt they had been treated unfairly by their GP due to their mental illness. This could be a consequence of lack of understanding and minimal training in the area of mental health in the primary care sector. Although this research is dated, it is relevant as Government white papers and initiatives currently being introduced are still recommending that more specialised training in mental health is required for professionals throughout the primary care sector. Each of the initiatives aim toward improved integrated working and lower hospital admissions due to deteriorating mental health by providing early access to services and early recognition of mental health issues in primary care. This highlights the importance of the chosen service improvement, not only for individuals with mental health issues but for those at risk of developing mental illness and the NHS as a whole. These recommendations are present in No Health without Mental Health: A Guide for General Practice (DoH, 2012, online), The NHS Outcomes Framework 2012/13 (DoH, 2011, online), and numerous others. It remains clear that professionals within the primary care sector are not  receiving adequate training in mental health care. They do not have sufficient knowledge of mental health and many do not possess the general skills required day to day when working with mental health service users (DoH, 2012, pg5, online). This is supported by Good Medical Practice (2006),(General Medical Council, GMC) which sets out the principle guidance for GPs offers no mention of individuals with mental health issues, suggesting that this document is based solely on the general population and does not taking into account the differing needs of those with mental health issues. A programme that was introduced in Wales in 2011 provides Mental Health First Aid Training to a large group of service providers including primary care. It teaches them to provide initial help to someone experiencing mental health problems, deal with a crisis situation or the first signs of someone developing mental ill health and guide people towards appropriate help (MIND 2011, online). This shows some progress towards increasing knowledge and awareness of mental health illnesses in a wider range of healthcare providers. There is evidence to show that in GP practices without mental health professionals, brief training for primary care providers have substantial benefits for patients who are mentally ill (Ross et al, 2001). This supports the need for specialist training and the chosen service improvement, as a mental health nurse in a GP surgery would be specially trained to work with individuals with mental health illnesses and would have an awareness of the difficulties service users may face when accessing services. There are many aspects that could present a barrier to mental health service users when accessing services. Communication difficulties can cause problems for individuals with mental health issues as they may not feel able to make themselves understood by healthcare professionals. They may suffer anxiety or panic disorders making it more difficult to communicate effectively. One of the most problematic areas in mental health and for those suffering mental health illnesses is stigma (Nash, 2010, pg10). Discrimination is not just confined to the general population as research has shown that healthcare professionals can hold stereotypical views towards their clients (Nash, 2010, pg10). This could prevent individuals from seeking help and support for both physical and mental health problems. Some service users  with mental health issues may have previously experienced some form of discrimination and had a negative experience when accessing primary care services. For example, experiences involving reception staff with bad attitudes or individuals being made to believe the physical symptoms they are experiencing are part of their mental illness (Nash, 2012, pg12). This shows that individuals with mental health issues suffer from inequality and discrimination regarding their healthcare reinforcing the need for improved access to primary care services. Previous negative experiences can cause individuals to fear returning causing them to avoid seeking help for a physical condition. Furthermore, if a person believes the may be mentally ill, they may avoid accessing any kind of support as they fear being labelled and discriminated against due to the stigma attached to having a mental health illness. Employing a mental health nurse in a GP surgery can bring services closer to eliminating barriers between primary care services and mental health, improving the healthcare of those in the general community suffering from some sort of mental illness. The proposed service improvement supports the need for reducing health inequalities and barriers to those with mental health issues wishing to access services. Barriers to healthcare specifically Primary care services can include communication difficulties, lack of understanding from both service user and professional perspective and there may be inadequate support available to mental health service users when accessing their local GP surgeries. GPs may lack the interpersonal skills required to manage some symptoms of mental illnesses. Such as inappropriate sexualised behaviour that can be expressed during psychotic episode (Norman & Ryrie, 2009, pg711).The professional may feel uncomfortable and embarrassed when examining an individual and unaware of how best to deal with this situation. Symptoms of mental illnesses can themselves often prevent individuals with a barrier to accessing services. An individual suffering depression will most likely lack motivation and volition (Norman & Ryrie, 2009, pg429) making it extremely difficult for them to self-refer or even care about their mental and/or physical health. Further supporting the need for the chosen service improvement as families, carers and friends of such individuals could support them in attending their local GP surgery enabling them to access specialist help at an initial stage of their illness. It may be necessary for a mental health nurse in a GP  surgery to be advertised; as individuals cannot access services if they are unaware they exist. Booklets and leaflets could be made available to raise awareness of mental health issues and the support available to individuals, their friends and families’ informing the community that specialist help is available first hand within their local GP surgery. Another barrier that is present in the provision of care by primary services and GP surgeries is the use of the medical model. The health professionals within a GP surgery adopt a medical approach when treating their patients. This aims to treat the medical illness and reduce the total number or patients attending the surgery. Although this is necessary within a GP surgery setting there remains a need to consider social factors when adopting the medical approach (Barbour, 1995, pg2). There are limitations when using the medical model, however as it can prevent healthcare professionals from treating patients individually in a person centred manner, treating only the obvious medical condition (Barbour, 1995, pg10). This could have a serious detrimental effect on an individual’s health and well-being, resulting in increased appointments with their GP causing more distress and prolonging their suffering. This in turn increases the likelihood of an individual requiring crisis intervention and ultimately costs the NHS more in the long-run (Norman & Ryrie, 2009, pg172). The Royal College of General Practitioners (RCPG) ‘Roadmap’ (2007) document supports the need for adopting a model in which health and social care needs are considered in general practice (RCPG, 2007, pg1). There has been confusion around which professionals role it is to provide physical health care to the mental health population for many years (Phelan et al, 2001). Government policy recognises the importance in considering physical health care needs of those with mental health illnesses in both primary and secondary care settings (Newell & Gournay, 2009, pg 322). General practice has transformed significantly over the past decade and current government policy is aiming to improve access to and the choice of services available to patients, expanding the role of a GP and improve quality of care overall (Gregory, 2009, Pg3, online). Government policy is implemented in the structure of clinical governance and is important in  highlighting improvements that are required in a wide range of services within the NHS including mental health and primary care (NHS Direct, 2011, pg12, online). Clinical governance is described as ‘a system in which NHS organisations are accountable for continuously improving the quality of their services’ (Scally & Donaldson, 1998, online). It is a framework that ensures professionals continuously develop and improve the quality of the services they provide. Clinical governance involves the research and development, risk management, promotion of openness, education and training for staff, clinical effectiven ess and clinical auditing of services within the NHS. It is extremely important that high quality care is provided in healthcare and clinical governance ensures professionals are individually accountable for the quality of care they provide (South Tees NHS Trust, 2013, online). Buetow and Roland (1999, pg184, online) suggest ‘there is a barrier between managerial, organisational and clinical approaches to quality of care’ denoting that the aim of clinical governance is to bridge the apparent gap by allowing all professionals within an organisation involvement and ‘freedom from the control of managerialism’ (Buetow & Roland, 1999, pg189, online). Although this suggests the aim is to promote equality throughout organisations when it comes to quality of care. There remains a need for one individual or a small group of people to accept the role and responsibility and become the clinical governance lead or team (Buetow & Roland, 1999, pg189, online). In a primary care setting such as a GP surgery this would entail being responsible for a large number of professionals who may have had little reason to communicate with each other previously. This could cause conflict within an organisations culture if the quality of care professionals provide is questioned. The Department of Health (2008) stated ‘the current system of NHS primary care does not ensure a consistent level of safety and represents insufficient quality across the country’. Resulting in GPs becoming required to hold a licence which is reviewed and renewed every five years and to register with the Care Quality Commission (CQC) from 2011 (GMC, 2009, online). This ensures up to date practice, competence and assures the provision of quality care. Clinical governance enables services to show how targets have been met within their organisation and how they meet the needs of their patients, supporting the decisions made by professionals and teams within the organisation (Buetow &  Roland, 1999, pg187, online). All organisations have what is known as an organisational or agency culture. Agency culture is made up of numerous aspects including, values and beliefs, language and communication, policies and procedures and rituals and routines within an organisation. Each organisation has a varied culture with a different set of beliefs and norms. It could be a result of these norms that staff members may not be willing to embrace change or take time to attend extra training for specialist service user groups such as the mental health population. It may appear that the service gains results and targets are met therefore may not want to change anything. This places organisations at risk of neglecting areas for improvement. Changes within agency culture can become a challenging process especially when there is disruption to traditional working routines (NHS Direct, 2011, online). Staff within a GP surgery may have been led by one individual or a small group of the same GPs for a long period of time and may feel the services they provide are sufficient. Newly qualified members of staff joining the workforce may feel their opinions and ideas are underappreciated or not even considered because the routines and procedures are already in place. An unwillingness to accept change could have detrimental effects on the mental health service user population. This is reflected in recommendations by government policy. No Health without Mental Health (DoH, 2012, online), Making it Happen (DoH, 2001, online) and Call to Action (DoH, 2011, online) each suggest recommendations for primary care services to develop the services provided to those with mental health illnesses and stress the importance of mental health promotion within primary care. The culture within a GP surgery may appear to be more superior to other NHS services as most GP surgeries are independently contracted and are not direct employees of the NHS (Gregory, 2009, pg 8, online). This enables them to provide enhanced services such as extended opening hours and specific services fo r those with learning difficulties (Gregory, 2009, pg 8, online). The above are components of General Medical Services (GMS) whereas Personal Medical Services (PMS) enable GP surgeries to cater for the specific needs of the local population (Gregory, 2009, pg 5, online). This could include drug and alcohol services or mental health services if there were a large number of the local  community presenting to their GP surgery with these issues. The cultures within each of these types of GP surgeries could be different completely. In a PMS GPs could have received specialist training in the areas large numbers of patients require support, resulting in patients feeling more valued and respected as well as staff members. GP surgeries can be seen as ‘providing a gateway to specialist care’ (Gregory, 2009, pg8, online). This view could be difficult to change. However by offering a wider range of services and treatment options, the gap between primary and secondary services as well as both an individual’s health and social care needs ca n be filled (Gregory, 2009, pg8, online). This service improvement aims to improve the health and social care needs of individuals with mental health illnesses in the community. However, not only are there barriers in place that service users must overcome to access primary care services there remains a lack of collaborative working between health and social care services. This has consequences on the service user and other professionals involved in their care denying the individual of adequate holistic care. Professionals from different areas such as nursing and social work may be bound by differing statutory obligations which can affect their decision making and the care they provide. Starting with the professional body they are registered with as a professional such as the Royal College of Nursing (RCN) or the Health and Care Professions Council (HCPC), these give professionals a value base they must work from and develop continuously. Legislation also has a huge impact on a professional’s decision making, for example the Mental Health Act (MHA, 2007). The law determines what a professional can and cannot do in a crisis situation. If a mental health nurse was based in a GP surgery they will have specialist training and awareness of the limits of their role determined by the MHA (2007), such as a patient being sectioned. They will be aware of who to contact if a patient is causing danger to themselves or others and need more suitable mental health care. If the mental health nurse was an Approved Mental Health Practitioner they could even have a role in detaining patients especially if a GP within the surgery was specially trained under the MHA (2007). This would save a lot of time and distress to individuals in crisis, members of the public and staff members. There are other noticeable difference between health and social care and the  standards of care provided. Social work would traditionally take a service-led approach to care whereas nursing has become more person-centred and individualised (SCIE, 2010, online). By using a person-centred approach the specific health and social care needs of patients with mental health issues are addressed (Hall et al, 2010, pg178). The service user is the centre of focus and care and support is planned around their specific needs. This is essential when caring for an individual with mental health issues as each condition, symptom and experience is different. Enabling an individual to be fully involved in every aspect of their care and make fully informed decisions regarding their treatment and social options. Continuity of care and positive therapeutic relationships are essential when making an individual feel valued and at ease, allowing them to feel comfortable and more willing to engage with professionals. An individual with mental health issues may feel anxious about attending their GP surgery and may need motivation or encouragement to do so. Having a therapeutic relationship with a particular professional within that surgery could reduce a person’s anxiety levels (Kettles et al, 2002, pg64). The chosen service improvement would be useful for this purpose as a mental health nurse based within a GP surgery could build positive relationships with patients enabling them to develop trust and engage with services and professionals. The mental health nurse would also take into account both the health and social care needs of the patients, decreasing the GPs workload and saving the practice money in the long run. They would also ensure the needs of the individual are fully met as satisfactorily as possible within primary care services or id required could refer them to the most suitable services available to them for their condition and needs. Whether they be health or social care needs. However this service improvement would only be successful with the cooperation and collaboration from GPs within the surgery. Joint decision making would be required as well an equal partnership between GP and mental health nurse. The Personalisation Agenda (Social Care Institute for Excellence, 2010, online) (SCIE) emphasises the need for integrated working, and the need for involvement from a wide range of services, such as; health, social care, housing, transportation and leisure, to ensure service users receive a  holistic, consistent and continuous care package (SCIE, 2010, online). The service user is put first rather than the service. This creates a person-centred rather than a service-led approach. A priority of the Health and Social Care Bill (2011) is improving integration within services. The Bill strives to provide better partnership, integration and collaboration across the government and all NHS services (DoH, 2011, pg1, online). There is evidence to suggest that integrating health and social care services saves a substantial amount of money (DoH, 2011, pg2, online). However in the current government climate there are financial pressures which may cause a barrier to effective integrated working (DoH, 2011, pg1, online). All aspects of the patient journey could benefit from effective integrated working resulting in a positive experience and all needs being met. The suggested service improvement of a mental health nurse in a GP surgery supports integration as there would be a variety of professionals within one building making multi-disciplinary team meeting easier to arrange and joint decisions could be made quickly. However there are barriers to integrated working including the breakdown of communication between staff and different organisations having a detrimental effect on patients (Trevithick, 2009, pg123). However by working in partnership there is a reduced need for specialist services ultimately cutting costs and having a positive effect on many other aspects of an organisation. Such as boosting staff moral and enhancing patient experience (Erstroff, 2010). If barriers to integrated working can be overcome more adequate care can be provided overall. A dual qualified practitioner in a GP surgery would be ideal allowing both health and social care needs to be addressed working in partnership with outside agencies and with patients to gain the best results, without the need for two professionals. It has been stated that services need to detect early signs of individual distress by working closely with primary care (Norman & Ryrie, 2009, pg172-173). By integrating the skills required in a mental health nurse and a social worker a more holistic approach can be taken. The introduction of community care impacted on various professions including general practitioners, social workers and nurses (Malin et al, 1999, pg158). Nurses have become increasingly empowered over time and have become more involved in commissioning alongside GPs. Within General practice more of a  purchase/provide relationship has been established (Malin et al, 1999, pg 159). GPs now have more power and control with funding and choice in the care they provide. However social workers may have felt deskilled by the purchase/provide divide (Malin et at, 1999, pg 159). The cultures of each professional’s organisation could cause conflict among a team. Employing a dual qualified social worker and mental health nurse in a GP surgery would eliminate the chance of conflict. It would become the responsibility of the dual qualified worker and the GP to work in partnership. There is evidence to support the need for the chosen service improvement. Mental health services are improvin g and developing continuously despite government cuts to funding, reflected in No decisions about us without us (DoH, 2012, pg6, online). The document states that primary care services, specifically GPs who play a part in supporting those with mental health issues are not making a difference to the mental health of their local communities. This creates an opportunity for the role of a mental health nurse to develop. The Care Services Improvement Partnership (CSIP, 2006) suggest that nurses are capable of delivering services within primary care settings as they have acquired the specialist knowledge to do so (Norman & Ryrie, 2009, pg 651). There is a need to modernise, develop and integrate services, primary care being a target area. The suggested service improvement would be cost effective and would provide early community intervention also lowering individual and family distress. Integrated working is an essential component in developing health and social care services (Trevithick, 2009, pg109). In conclusion there remains a need for improvements in the health care provided by primary care services to those with mental health issues. Statistics show that primary care services are the first point of contact for many individuals developing a physical or psychiatric condition (DoH, 2012, pg 6, online). The introduction of a mental health nurse into a GP surgery promotes integrated practice and modernises NHS services (DoH Factsheet, 2011, pg1, online), enhancing patient experience. There is evidence to show that this is an already effective role. Primary mental health workers have been introduced in Children and Adolescent Mental Health Teams (CAMHS) supporting colleagues in primary care services providing crisis intervention and contacts to specialist services (Norman & Ryrie,  2009, pg543). Primary care mental health Graduates have also been implemented in parts of London providing a range of interventions (Norman & Ryrie, 2009, pg 457). The suggested service improvement of a mental health nurse in a GP surgery would benefit the mental health service user population enormously. If the National Service Framework mental health standards (NSF, 2012, online) are to be met mental health promotion within primary care must be a focus (Newell& Gournay, 2009, pg 257). References Barbour, A. (1995); Caring for Patients: A Critique of the Medical Model. California, Sanford University Press. Estroff, J. (2010); Effective teamwork: Practical; lessons from organisational research. London: Blackwell Publishing. Hall, A. Wren, M & Kirby, S. (2010); Care planning in mental health: Promoting recovery. Blackwell Publishing. Oxford. Kettles, A. Woods, P & Collins, M. (2002); Therapeutic interventions for forensic mental health nurses. London: Jessica Kingsley Publications. Malin, N. Manthorpe, J, Race. D & Wilmot, S. (1999); Community care for nurses and the caring professions. Philadelphia: Open University Press. Nash, M. (2010); Physical health and well-Being in mental health nursing; Clinical skills for practice. England: Open University Press. Newell, R. & Gournay, K. (2009); Mental Health Nursing; An evidence based approach. Philadelphia: Churchill Livingstone Elsevier. Norman, R. & Ryrie, I. (2009); The Art and Science of Mental Health Nursing: A textbook of principles and practice. Berkshire: Oxford University Press. Trevithick, P. (2009); Social work skills: A practice handbook. (2nd Edition). England: Oxford University Press. Wilson (1997); Cited in; Handy, C. (1993); Understanding organizations. Penguin Books Ltd. Middlesex. England. P.T.O. Online resources: Buetow, S. & Roland, M. (1999); Clinical governance: bridging the gap between managerial and clinical approaches to quality of care, Quality in Healthcare (8) 184-190 http://www.clinicalgovernance.scot.nhs.uk/documents/184.pdf Accessed on 28/01/2013 Care Service Improvement Partnership (2006); Designing Primary Care Mental Health Services: Guidebook. London: DoH. http://collections.europarchive.org/tna/20090610005017/http://dhcarenetworks.org.uk/BetterCommissioning/Commissioninge-book/ Accessed on 02/02/2013 Department of Health, (2012); National Service Framework: standards for mental health. London: DoH. http://www.eguidelines.co.uk/eguidelinesmain/external_guidelines/nsf/mentalhealth_nsf.htm#National_Milestones Accessed on 02/02/2013. Department of Health, (2012); No decisions about us without us: A guide for people who use mental health services, carers and the public, to accompany the implementation framework for the mental health strategy. London: DoH http://www.mind.org.uk/assets/0002/1266/No_decision_about_us_without_us.pdf Accessed 01/02/2013 Department of Health, (2012); No Health without Mental Health: A Guide for General Practice. London: DoH http://www.dh.gov.uk/en/Healthcare/MentalHealthStrategy/index.htm Accessed 04/01/2013 Department of Health, (2011); Health And Social Care Bill Factsheet. C3 London: DoH. http://www.dh.gov.uk/health/files/2012/02/C3-Promoting-better-integration-of-health-and-care-services.pdf Accessed on 01/02/2013 Department of Health, (2011); No Health without Mental Health: A cross government mental health outcomes strategy for people of all ages- a call to action. London: DoH. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123990.pdf Accessed on 31/01/2013 Department of Health, (2011); The NHS Outcomes Framework 2012/13. London: DoH http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131723.pdf Accessed 10/01/2013 Department of Health. (2009); Response to Consultation on the Framework for Registration of Health and Adult Social Care Providers and Consultation on Draft Regulations. London: DoH. www.dh.gov.uk/en/Consultations/Liveconsultations/DH_096991 Accessed on 28/01/2013 Department of Health. (2008). The Future Regulation of Health and Adult Social Care in England: A consultation on the framework for the registration of health and adult social care providers: Partial Impact Assessment on Primary Care. London: DoH. www.dh.gov.uk/en/Consultations/Closedconsultations/DH_083625 Accessed on 28/01/2013 Department of Health. (2001); Making it Happen: A guide to delivering health promotion (Pg 54). London:DoH. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4058958.pdf Accessed on 31/01/2013 General Medical Council (GMC). (2009); Licensing and Revalidation. www.gmc-uk.org/about/reform/index.asp Accessed on 28/01/2013 General Medical Council (GMC). (2006); Good Medical Practice. http://www.gmc-uk.org/static/documents/content/GMP_0910.pdf Accessed 10/01/2013 Gregory, S. (2009); General Practice in England: An overview. London: The Kings Fund. http://www.kingsfund.org.uk/sites/files/kf/General-practice-in-England-an-overview-Sarah-Gregory-The-Kings-Fund-September-2009.pdf Accessed on 28/01/2013 The Health and Social Care Act (2012) http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted Accessed on 01/02/2013 Knapp, M., MacDaid, D. & Parsonage, M. (2011); Mental Health Promotion and Mental Illness Prevention: The Economic case.London: DoH. http://eprints.lse.ac.uk/32311/1/Knapp_et_al__MHPP_The_Economic_Case.pdf Accessed on 12/01/2013 Lakhani, M., Baker, M & Field, S. (2007); The Future Direction of General Practice: A Roadmap. 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(2011); NHS Direct Business Plan 2011/12-2015/16. http://www.nhsdirect.nhs.uk/About/~/media/Files/FreedomOfInformationDocuments/OtherFreedomOfInformationDocuments/201106201_NHS%20Direct%20Business%20Plan2011-16.ashx Accessed on 28/01/2013 NHS Direct (2011); Cultural changes in the NHS. http://www.institute.nhs.uk Accessed on 31/01/2013 Phelan, M., Stradins, L., Morrison, S. (2001); Physical health of people with severe mental illness. British Medical Journal. 322: 443-444. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120844/ Accessed 31/01/2013 Rost,K., Nutting, P., Smith, J., Werner, J & Duan, N. (2001); Improving depression outcomes in community primary care practice: A randomized trial of the QuEST Intervention. Journal of General Internal Medicine 16(3): 143-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494878/ Accessed on 01/02/2013 Scally, G & Donaldson, J. (1998); Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317(7150) 4 July pp.61-65. http://webarchive.nationalarchives.gov.uk/20081112112652/bmj.com/cgi/content/full/317/7150/61 Accessed on 28/01/2013 Social Care Institute for Excellence, (2010); Personalisation: A rough guide. London: SCIE http://www.scie.org.uk/publications/reports/report20.pdf Accessed on 31/01/2013 South Tees NHS Foundation Trust. (2013); Clinical Governance: What is Clinical Governance? Harrogate: Mixd.

Friday, August 30, 2019

What annoys me about the British Weather

British Weather, three words: unpredictable, torturous and unbearable. We have all experienced the excruciatingly painful rain drops plummeting full speed onto our hoods or umbrella’s, haven’t we? Well we live in England of course. As you prepare to leave home, you take one quick glance out of the window, and you see the blazing red hot sun shining, you can actually feel the warm radiation hitting your skin and the last thing on your mind is to remember to take an umbrella or a jacket with you just in case. As you casually walk across the street to the bus stop you have an unexpected encounter with one of your ‘footy mad’ friends who just talks about football. After he bores you to death and then finally leaves things get one notch worse, out of nowhere, completely unexpected you feel this cold spit on your face, few seconds later you endure a torrential torrent of rain blasting onto your body within ten seconds you are drenched in water, unfortunately this has happened to most of us. This diabolical problem needs a solution and the weather forecast is not it. The arrogant weather who miserably dictates us the weather is entirely useless and unreliable. As a BBC clone he talks in that Standard English tone, as you listen you understand that all the information he is presenting to you is all gibberish. The next day you find out that the weather ‘somehow’ turns out to be the complete opposite of what the weather forecast predicted yesterday. So there you have it, the met office should just give up on forecasting the weather because they are completely hopeless. Another point is not the sudden change of weather but the despicably messed up seasons. You never know what you are going to get with British weather it constantly is on the move, there is cold weather in the summer and it’s warm in the winter, this year alone the snow is overdue it’s been expected and hasn’t arrived YET. From the bottom of my heart I would like to tell all of you people who want to visit England that it is not a holiday destination, at all especially in terms of weather. What you will get is not a relaxing, sunny holiday, but mainly an endless pour of rain which blasts on to you like a cannon of water, if you want to experience true English weather then book your tickets in winter as it might be very warm. Britain never inevitably fails to disappoint or leave you feeling in utter despair, whether it is in sport in their terrible world cup campaign or in this case when you want beautiful weather for a special day and it ends up disappointing you. It is always important to always be prepared with a brolly or a coat even if you end up looking like an utter fool in a winter coat like you’re going hiking in the arctic in the hottest day of the year. Cold weather comes natural to the UK and from past experience I get use to this sort of climate as if it was second nature. One of the worst moments is when you have to a spend a depressing Monday of your holidays locked inside at home, bored and in a dull displeasing atmosphere starring obliviously out of the window at the grey, dismal sky. Where droplets of rain are rolling down the window, and you can hear the thunderous cascading rain hitting the roof. At this moment in time you are hopelessly hoping that eventually this annoying rainy weather will just stop! What really ticks me off is that the winter weather causes many disruptions to the public transport system, not that it was the most efficient method of travel anyway. It also causes many businesses and schools to close early which plays mostly in favour for school students. Roads are blocked by the snow and this irritates drivers because they are blinded by the fog, this is disastrous for the economy apparently, because Britain is always caught unprepared even though we experience snowy and foggy conditions almost every year. In summary: don’t even bother to listen to the weather forecast as they talk complete nonsense, and make sure your prepared at least take a coat because it could start raining after all we do live in England.

Thursday, August 29, 2019

Bush Sr & Clinton East Asian Security Approaches Essay Example for Free

Bush Sr & Clinton East Asian Security Approaches Essay President Bush via a main strategic reappraisal as well as continuing below president Clinton together with the U. S Secretaries of Defense Aspin and Perry. The previous administration tried and it is still trying to come into good terms with domestic pressures. It wants a calm dividend as well to adapt what the U. S has been always doing strategically to post cold war circumstances in a safe plus cautious way. All of this assists in helping to keep alive the rationales behind a United States bilateral security relationship with its Northeast Asian allies. Regardless of these echoes of the cold war, there is no one who can escape the truth that the cold war is presently over and that the Soviet Union does no longer exist. Furthermore, in Northeast Asia, also, the need has emerged to restructure U. S post Cold War alliances in order to make them fit the moments. A revision of the bilateral alliance relations goes on; there has been mounting interest in applying multilateral approaches towards the region’s issues. The Clinton administration did not have a well developed vision for what it intended to do in the Asia Pacific region during the time it entered the office. This seems to exactly know how it intended to deal with Asia by putting greater emphasis relatively within diplomacy as well security on a multilateral means over bilateral venues. During the first Clinton administration, inspiration regarding this approach appears to stalk from a bit reluctant admiration for the ways Southeast Asian states have tried to utilize multilateral techniques. The successes enjoyed by hatchling economic organizations in Asia such like the Pacific Basin Economic Council, the APEC forum and the Pacific Economic Cooperation Council. In any case, Assistant Secretary of State for East Asia together with the Pacific Affairs Winston Lord signaled the administration of Clinton. They signaled because Clinton had an intention of relaxing past United States objections towards multilateralism. He intended to do this by stating the goal the administration had towards Asia Pacific region. The goal was just to develop the multilateral forums for safety consultations while maintaining the sold foundation of the alliances. President Clinton has put more emphasis on the multilateral theme when he emphasized the phrase which was â€Å"a new Pacific community†. Winston used this expression earlier on although President Clinton placed it at the center stage internationally. Tokyo gets preoccupied by domestic political turmoil. It got preoccupied because the Japanese seemed to be reluctant to let the well known aspects of their bilateral security go. During the President Clinton administration, was somehow captivated because of the repayments multilateralism tent to give. The major disparagement of the United States governmental enthusiasm came from PRC. Despite the fact that Chinese suspected the idea, there was no any sign that what the Clinton administration was carrying on amounted to a closet form of unilateralism. The prospect for Northeast Asian multilateralism is so challenging. President Clinton, tent to give support concerning multilateral approaches in dealing with the problems of East Asia’s security. In the earlier administration, multilateralism was refused in support of reliance entirely on the existing bilateral alliances. The good security framework for the region consisted of a fan together with its base in Northern America and radiating west across the Pacific. The administration of Clinton reaffirmed the existing security alliances. It called for new equipments multilateral in character which was to supplement the U. S bilateral arrangements in dealing with the present emerging security problems. Washington did not advocate developing new comprehensive agencies, for example the conference on security and cooperation in Asia or the Northeast Asia Treaty Organization within this context. The multilateral agencies are going to be constructed for specific problems and they will differ in membership and the structure as required due to the administration of Clinton. The emphasis on a return towards a more traditional approach to a foreign policy in Asia is actually a prominence on bilateral and unilateral initiatives against multilateral ones. A larger focus on narrow military security issues over economic together with the marginalization of newer issues such as health and environment. However, there was tension and twist in the bush’s administration. The tension was concerning the conflict among the open trade wing of the Republican Party. The tension really emphasizes admission to the markets in promotion of U. S corporate interests. It again emphasized on the more security oriented folks who recognized military threats as the overriding concern of United States policy in the region. As a result, the tension was well-defined in assembly than in the executive branch. Pressure was far above the ground in White House depending on Bush’s arrangements to the key economic posts. The pressure was on the treasury, the United States Trade Representatives together with the description of the National Economic Council. Interweave was not similar with traditional realists. Some members of Bush’s Asia overseas policy squad saw a responsibility for advancing electoral democracy abroad. They saw it as a way of enhancing the economic welfare along with the safety of the United States within the area. During the Clinton’s administration, he tried to position rhetorically more emphasis on the two Asia Pacific forums. He again put more emphasis on the Association of Southeast Asian Nations Post Ministerial Conference plus the new ASEAN Regional Forum. As far as multilateralism is concerned, the Clinton administration expressed a readiness to pay attention in letting nations of the region decide on the regional problems instead of dictating them from Washington. Even if the Clinton administration acted in agreement with these promises they are still not clear. The idea of the President Clinton’s administration did not become a reality with reference to multilateral agencies in supplementing United States bilateral associations. It intended to give a framework for security dialogue as well as the cooperation. It wanted to do this by offering the potential to redress the most stressing aspects of the present approaches to achieving security objectives in East Asia. Bush has foreign policy advisers who had a significant experience about Asia. These advisers really shaped the Bush administration policy towards Asia; from the time Bush signified that he had a big personal interest in associations with Latin America and Europe. Relating to the economic issues, there is a slight difference linking the Clinton administration as well as the Bush administration. Bush seems to be more of an unconditional free trader. That means that even the present modest efforts at integrating environmental and labor matters into bilateral trade agreements will not be present from the Bush outline. This fact will be greeted with sighs of relief between the business leaders together with the region’s political leaders. The biggest change under Bush’s administration was a greater emphasis on intensifying the alliances. He wanted to intensify alliances on matters concerning bilateral with Japan, the Philippines, South Korea and Thailand. That created the establishment of the cold war-era security structural design in Asia. Bush noted that people must show the American powers and purpose in supporting Asian people. That meant that they must keep their promise to discourage violent behavior against the Republic of Korea as well as strengthening security ties with Japan. That was through expanding theater missile defenses between their allies. The main motivation for USG participation in East Asia has always been right of entry to the markets of Asia. In one way or the other the Bush administration determined to strengthen the United States and Japan alliance. He intended to strengthen them by encouraging Japan to play a significant role concerning security matters within the region. That includes the redefining assignment of Japan’s self-protection armed forces as well as paying more of the bills. It is not clear at all that there is support either in the area as a whole or within Japan for Japan to assume a better security task. From China’s opinion, Bush’s success raises the view of stronger White House assistance for theatre in addition to nationwide missile protection systems. His success again raises the advanced levels of United States arms supplies to Taiwan of which Beijing stubbornly opposes. Gore administration gave greater scope to organized labor than Bush White House. The AFL-CIO did not manage to prevent the Clinton administration against pursuing trade at no cost with China. Alternatively Japan has been far less pleased with the next term of the Clinton administration compared to China. Japan resented the downgrading of the United States associations as the keystone in Asia. Clinton’s administration gave acknowledgment on a regular basis to bilateral. He emphasized on U. S and South Korean initiatives within the current cautious steps in the direction of finishing the isolation of North Korea. It is said that President Clinton passed over Japan during his visit to Beijing which was done in the year 1998. There are some issues whereby the Bush administration differs drastically with the Clinton administration. It is said that the Clinton’s administration, there were actually some few foreign policy conquest stories. That was the negotiation of the established structure in the year 1994. North Korea arranged to chill its nuclear plan in trade for the structure of two nuclear reactors as well as fuel oil shipments. During the time when the United States had to follow the guide of South Korean President together with the North, connection eased and pressures on the neck of land were at their depths of despair in memory. During the administration of Bush it really threatened to demoralize the significant development which was made within this area. Congregational republicans over-involved time after time the implementation of the framework. It did this by preserving appropriations, even if South Korea and Japan provided the enormous bulk of the funds beneath the agreement. There are a good number of very essential continuities among the Clinton as well as the Bush administration concerning East Asian security policy. This should not surprise as much as the Clinton administration embraced a lot of bedrocks of post cold war East Asian. They inherited this from the first Bush administration which was actually based on long time United States interests. It might be surprising if at all there were not permanence across administration for the reason that the basics of the US security policy within East Asia really transcend administrations. It is very necessary to recall the aforesaid fundamentals of continuity since the Bush foreign policy team came to office. The Clinton administration had already a bad work with virtually every aspect of the East Asian security policy. It might be astonishing if at all there was no permanence within administrations for the reason that the basics of US security policy in East Asia go beyond administrations (Martin, 112). It is very essential to recall the aforementioned elements of continuity since the Bush foreign policy team appeared to the office. The Clinton administration did not do a good job with virtually every aspect of East Asia security policy. The only way to distinguish the Bush administration with the one for Clinton is that there was a lot of reticent to insist that the core of gravity of United States security policy within East Asia is the coalition with Japan. The Clinton administration was not sure whether China or Japan was significant. it was too preventive in connections with Taiwan even if in fairness, as far as security matters is concerned. The Clinton Defense Department started inquiring very seriously into the state of Taiwan’s defenses and it also started pressing Taiwan to recover the software characteristic of their defense attitude. Bush administration was too captivated with multilateralism that was unsuitable for the region or had the potential to deteriorate bi-lateral alliances. The administration of Bush had a more customary approach meaning that it is not likely to involve Asia effectively on two wide areas of growing concern. That is global environmental matters for example the climate change, ozone, invasive species and global health matters such like communicable diseases. Bush did not propose the ratification of the Kyoto Protocol. He did not consider China’s proposal that greenhouse gas discharge be restricted on a per capita basis instead of a per country basis. The very poor records that were kept by Bush concerning the environment in Texas didn’t bode very well in engaging Asia on essential environmental issues. However, the first Bush administration is more likely to be fragmented, incoherent as well as contradictory. It suffered from the vision thing for so many reasons. In the first place, the Bush administration lacked a clear mandate. When he was campaigning, the new president did not offer sound foreign policy plan as a package, Asia countries included. Last but not least, East Asia has really undergone a considerable transformation since the time President Bush started ruling. Nevertheless, the coverage of this revolution in the western press is over and over again restricted to articles on China’s environmental problems or North Korea’ nuclear ambitions. Most of the East Asia’s leaders believe that for United States policy toward East Asia which has always remained essentially bilateral as well as ad hoc for decades to go on to be valuable, it must be updated to reflect more accurately contemporary realities in the region. Finally, Multilateral as well as unilateral sanctions have always been imposed on Iran in order to increase the pressure on its regime. The United States puts more prominence on its wide range of unilateral sanctions. Works Cited Glen, S. Axis of Evil and Rogue States: The Bush Administration. Washington: Glen Segell Publishers, 2006. Martin, G. International Relations Theory for the Twenty-First Century. Routledge, 2007. Seung, H. North Korea’s Second Nuclear Crisis and Northeast Asian Security. New York: Ashgate Publishing Ltd, 2007. Bush Sr & Clinton East Asian Security Approaches. (2016, Jul 31). We have essays on the following topics that may be of interest to you

Wednesday, August 28, 2019

Different Renditions Of The Song Hallelujah By Leonard Cohen Assignment

Different Renditions Of The Song Hallelujah By Leonard Cohen - Assignment Example The song among the musicians who have covered this song includes Rufus Wainwright, Michael McDonald, Bon Jovi, John Cale, Jason Castro a former contestant in the American Idol among others. The different artists used the original lyrics while other changed the lyrics to fit their preference as Cohen never put a restriction on the modification of this song. One of the famous versions of this song is Jeff Buckley’s version that was the top song on the Hot Digital Songs chart of 2008. The same year another version that again topped the charts was released by Alexandra Burke who won the talent show â€Å"The X-factor† by Simon Cowell mastermind U.K. These are just a few of the many singers who have remixed and performed this song (Browne & Browne 2011). In this paper, the performance by Justine Timberlake and Matt Morris in a charity concert called â€Å"Hope for Haiti† will be compared with Jeff Berkley performance. The performance by Timberlake and Morris moved the crowd. It was a very beautiful duet that moved the crowd. The two sang harmoniously which no wonder is considering that they have been working together. The song was not very different from the original version. It was close to their performance by Jeff Buckley. However, it stood out in the manner the singers put their emotions to their performance and almost drove some of the audience to tears. There were other performers during the show such as Mary J. Blige but Timberlake and Morris's performance stood out.  

Tuesday, August 27, 2019

HBOs Organizational Strategy and Culture Essay Example | Topics and Well Written Essays - 2500 words

HBOs Organizational Strategy and Culture - Essay Example HBO has adapted the organizational strategy of producing only those contents which other channels avoided to land their feet. In this sense, we can easily assume that HBO is largely focusing on practicing Differentiation as a strategy for its products which are offered to the vast majority of its audience. Thus its organizational strategy is based on differentiation. This is also evident from the fact that HBO over the period of time has been spending heavily in creating its brand identity which seems to be an excellent strategy especially in an industry environment which has very different and unique dynamics and a lot of competition to face. Further, an economic model which HBO is following is sort of unique in the sense that it provides it very readily available revenue as the viewers are charged only $12 over their basic cable bills allowing the company to have enough access to the funds to originate programs of unique and original quality. However, the contents produced are some what specific to one cultural stratum of the society and hardly serve the viewers which live in America but have different cultural values such as Hispanic, Spanish etc communities in the US. Â  The cultural aspect of the organization suggests that it is organizational which is largely driven by the creative ideas and an environment which allow unleashing creativity and innovation which is also evident from the contents produced on the channel. This approach towards developing an organizational culture of creativity, innovation and open communication can especially serve the interest of the channel in the long term because it would provide the necessary impetus to the organization.

Monday, August 26, 2019

Business Law Essay Example | Topics and Well Written Essays - 1500 words - 10

Business Law - Essay Example e quoted by the Hard water Co was  £15,000 which was changed to  £10,000 in the terms and conditions defined in Door’s Software and it was signed by the Hard Water Co. Hence it should be accepted by the Hard Water Co. Similarly, the time frame mentioned in the terms and conditions of Hard Water Co was only 3 months which was modified to 5 months in the terms and conditions of Door’s Software and was also acknowledged and signed by the Hard Water Co and hence the final validity of the contract reflects 5 months as the main time frame. At the same time, the price variation clause put by the Hard Water Co was not mentioned in the terms and conditions of Door’s Software and hence it cannot be made liable for its application. As Hard Water Co agreed to the terms and conditions of Doors Software, the price variation cannot be given effect. Moreover, this doesn’t come under Unfair Contract Trade Act of 1977 (UCTA, 1977) and Sale of goods act (1979) and hence it cannot be challenged legally. (1) According to Part II of Sale of goods Act (1979), it was mentioned that any contract of sale of goods is a contract by which the seller transfers or agrees to transfer the property in goods to the buyer for a money consideration, called the price. It also stated that an agreement to sell becomes a sale when the time elapses or the conditions are fulfilled subject to which the property in the goods is to be transferred. Here in this conext, Doors Software didn’t violate the norms of the contract law and hence need not be liable for the price variation. Assuming that software products are goods and referring to the proper statutory instruments, explain whether the software provided by Doors’ Software to Islington District Council was of satisfactory quality. No. The software provided by the Door’s Software to Islington District Council was not of satisfactory quality. It was reflected in the form of disproportionate printing matter when printing instruction was

Sunday, August 25, 2019

NutritionTracking patients with nutritional risks, how does your Essay

NutritionTracking patients with nutritional risks, how does your facility do it - Essay Example In addition, lab work is conducted by examining their protein level, albumin and pre albumin levels. Their LDL and HDL is checked along with vitamin B12 and folic acid levels are checked. Caloric intake is examined by ensuring that patients are taking actual food. Fluid intake is also examined. One of the main aspects that hospitals focus their attention is on pregnant mothers. In order to understand and formulate risks associated with pregnancy, nurses have come up with criteria. If the mother demonstrates multiple gestation, that’s a bad sign. Additionally, gestational diabetes can be detrimental and must be recorded right away. Any dramatic change of 10 to 50 pound weight gain is not healthy. Furthermore, patient’s history of weight loss surgery should be obtained. Nurses and dieticians are majority in charge of handling patient’s nutritional status. Most patients that are sick tend to lose weight and must be supplemented with proper amount of food and nutrients. Conducive research indicates that as many as 65% of elderly patients are malnourished when they enter the hospital while in the hospital. Without having the proper nutritional assessment, it is highly illogical and difficult to monitor their status. Nutrition is integrated into the nursing plan through various ways. If the patient does not need a nutritional consult then the next step is to enroll them in a diet program. Their diet is ordered and is document regarding how much consumption is taken. If a nutritional consult is ordered the dietician makes sure the patient is getting enough nutrients and calories to support a healthy life function. Anthropometric refers to overall growth of human body. These measurements commonly are used to measure development in growth for infants. Growth is obtained and evaluated through length, weight and head circumference. A growth chart lists all the standards of benchmark through previous average

Using Recycled PCC as Aggregate in New PCC Research Paper

Using Recycled PCC as Aggregate in New PCC - Research Paper Example However, these recycled concrete aggregates (RCA) have to meet NJDOT’s quality needs in case they are to be used in PCC. Only 11 states permit use of RCA in PCC, while all but 13 states allow the use of it in base aggregate. Some states also permit its use as miscellaneous aggregate and in HMA. Through the crushing / grinding of concrete pavements or any waste concrete, RCA is produced, after the removing any reinforcing steel. In the same way the production of aggregate from virgin materials is, production of required gradations is too- through screening and crushing (PCA 1). However, significant differences between virgin aggregates and RCA have led officials in state transportation in Muchials and New Jersey in adopting RCA as aggregate for PCC acceptably (PCA 1). The presence of mortar adhering to the Recycled aggregates or cement paste reduces density, increases drying shrinkage, and increases porosity in PCC. The presence of contaminants as well as the quality of the being recycles original concrete are all problems that should be taken in concern additionally (PCA 1). The two primary sources for use in PCC, of stockpiled RCA are precaters who are interested in reusing surplus materials and class B recyclers who crush and accept concrete waste. Before RCA is implemen ted, those are the issues that must be addressed. Another important component of the project is the preliminary review that has been provided for the expansion of this work, as a part of this proposal As the proposers believe, an extensive field installation plan is likely to result to open-ended and long research projects, which address the use of Recycled Concrete Aggregates in PCC. Due to this reason, proposals have been made to include field installation as part of part of the work. The field installation be limited to applications of lower risks that permit the recommendations and

Saturday, August 24, 2019

Traditional Teaching Essay Example | Topics and Well Written Essays - 1000 words - 1

Traditional Teaching - Essay Example rough the lessons, giving clarifications wherever necessary; 2) its adaptability to large classrooms in transmitting a wide body of knowledge to students of divergent skills; 3) efficiency in offering straightforward instructions and explanations; and 4) offering better test results by focusing on likely test questions and administering repetitive drills in order to reinforce memorization of facts and information. The disadvantages of the traditional method of teaching, however are that 1) it turns out more time consuming for students who are slower in digesting information; 2) it does not offer any solution to the students for their difficulties in memorizing and retaining information; 3) the knowledge gained is only basic and limited in scope, as the exploratory stage is entirely done away with; and 4) it is inflexible, putting all students at the same starting point, stuffing them with undifferentiated knowledge, without taking into account their differing capacities and interest in the subject taught. Therefore, the method only benefits willing and ‘better’ students, and is not found fit to kindle genuine interest for the subject. In a traditional classroom setting, therefore, the teacher becomes the focus of action, with importance being given to the ‘textbook’. The student is relegated to the sidelines, and is a passive pawn in the learning process. Remembering the correct answer is the priority, to which end, they are inundated with information, in which process, their analytical skills remain largely untapped and untrained. The sequelae or abnormalities of traditional pedagogy lead to several undesirable consequences. This system enshrines Behaviorism as an essential part of education, and does not consider the impact of a student’s mental makeup on the learning process. Looking at the learning process purely as a uni-dimensional phenomenon results in the following abnormalities. First, students are placed in different classes based on their

Friday, August 23, 2019

A bill of rights is essential to protect citizens from their Essay

A bill of rights is essential to protect citizens from their government. Discuss - Essay Example Recent developments in the Philippines have put this Southeast Asian country in the news and have garnered the attention of the international community once more. This involves the spate of killings of activists and journalists by unknown elements alleged to be connected with the military. (Amnesty International, 2005, p. 202) According to the non-government organization KARAPATAN (Alliance for the Advancement of Human Rights) (2006), there have been 607 documented killings from January 2001 to May 30, 2006. Amnesty International, the European Union and the Catholic Church have each spoken out against the government to condemn these acts of politically-motivated state-sponsored executions. This paper will examine whether or not a bill of rights, standing alone, is enough to protect the people from the excesses of government and it will use the current Philippine problem of extra-judicial killings as background. It will argue that the defense of sovereignty -- and, as a corollary to that, internal security -- is not enough to justify the use of state-sponsored repression. The phenomenon of state-sponsored oppression is by no means unique to the Philippines. It has in fact been extensively researched and discussed all over the world. Says Mitchell and McCormick (1988, p. 476) Governments organize police forces and armies to protect their citizens, build schools and hospitals to educate and care for them, and provide financial assistance for the old and unemployed. But governments also kill, torture and imprison their citizens. This dark side of government knows no geographic, economic, ideological or political boundary. Such killings and torture demonstrate grave violations of political rights and liberties. It has been opined that political rights and liberties are of paramount importance because of their impact on other rights, such as social and economic rights (Bollen, 1986, p. 567). The universal condemnation of

Thursday, August 22, 2019

The Death Penalty Should Be Abolished Essay Example for Free

The Death Penalty Should Be Abolished Essay The death penalty should be abolished as a form of punishment. This paper intends to shine some light on the death penalty in order to help the reader understand what issues face the system today and what problems can be corrected. This paper achieves this by: (1) pointing out the wrongful sentencing of innocent people and the use of DNA testing in attaining their freedom; (2) emphasizing the unjustness of the Capital Punishment system due to the arbitrary, racial and geographically biased nature of the process; And also (3) It shows that the evidence backing up deterrence as a major benefit of the death penalty is exaggerated and unsubstantiated. With a specific look at how â€Å"future dangerousness† plays a part in keeping the death penalty around and how to change that. Last it will look at the rising costs associated with Capital Punishment. The death penalty risks too many innocent lives. DNA testing is currently the single greatest savior of unjustly sentenced death row inmates. It aided in the exoneration of 133 prisoners between 1973 and 2009. (Schmalleger, 2011) But up until the 1960s DNA exoneration by science wasn’t even thought up. This leads us to wonder how many death row inmates are actually innocent today. In most cases, there is no DNA evidence left behind leaving only the account of eyewitnesses to validate the crime. The only issue with that is witnesses have been wrong before. One notable death row case involving an eyewitness’s misconception was DeLuna v. Texas 1983. Carlos DeLuna was wrongfully executed for killing a single mother at his local gas station even after the real killer, who bear a striking resemblance to DeLuna, was captured and placed in a cell underneath his own. The person who helped unwind this web of DeLuna is the notable Columbia law professor James Liebman. In 2001 one of Liebman’s study revealed an error rate of 68% in Capital cases.(William W Berry, 2010) the extinguishing of an innocent human beings life is an irrevocable mistake that could be avoided with a sentence of Life without the Possibility of Parole (LWOP). Imbalanced justice system Part of the definition of Justice is â€Å"fairness or reasonableness, especially in the way people are treated or decisions are made† when you relate this to the death penalty you are presented with many divergence’s to that same logic. The following are a few examples of how the death penalty is unfair to certain groups: first the system is arbitrary in nature. The rich are able the attain some of the best defense attorneys in order to greatly increase their chance of avoiding the death penalty, while the poor must receive state appointed counsel. What makes matters worse is the lack of skilled counsel willing to work on Capital Punishment leads to a continued rise in the backlog of unrepresented sentenced prisoners. (Gray, 2011) The second example of unfairness results from geographic location. In some states, a felony murder is a Capital crime, Maryland is one. While other states, like New Jersey, need aggravating circumstances before the death penalty is given. Also, between the years of 1976 and 2004 more than 700 executions took place. 82% were a product of these ten states: (AL, AR, FL, GA, LA, MO, OK, SC, TX and VA) With Texas and Virginia accounting for half of these nationwide executions. (American Civil Liberties Union, 2002) There are no significant data showing a higher rate of violent crime in those states. So I must infer that, on a nationwide level, the Capital Punishment is unjust or at the very least unbalanced. The third unjustness of the Capital Punishment system stems from its racial disparities. Bias manifests itself in two ways. One, the even though â€Å"Latinos are the largest ethnic minority group in the United States† they still only comprise between 8% and 13% of defendants on death row in the 1990s. (Baik, 2012) now compare that to African Americans who, in the same time period, represented nearly 40% of all death row inmates in the US.(Greenfield, 1991) one case that highlights all three examples of unfairne ss in the Criminal justice system can be found in the 1972 trial of Furman v. Georgia. This was a case of a poor, black, man from a southern state that was prone to issuing the death penalty. The outcome of this trial was a de facto moratorium between 1967 and 1977 where no executions were conducted in the United’s states during this time (Schmalleger, 2011). Deterrence is exaggerated and also obtainable through other ways. There are two possible ways to examine deterrence. First, it can  be viewed the same way that most people understand it by; the Punishment of one criminal will deter multiple others from committing similar gruesome acts. This view has been brought up in a couple of study’s: the 2001 study by Hashem Dezhbakhsh and Paul Rubin at Emory University who concluded that on average one single execution results in 18 fewer murders; an earlier study was conducted by Viscusi in 1993 which pegged the average deterrence at 14. Most of the fundamental testing and deterrence hypotheses used leading up to the present were produced by Isaac Erlich between 1975 and 1977. (Erlich 1975) although a valiant attempt to survey something as complex as this topic, most of these types of data analysis are proven false due to factors such as, failure to include states that do not carry a death penalty; and that some studies have just been methodologically flawed. I would have to agree with the late US Supreme court justice Thurgood Marshall, LLB who said it best at the 1972 trial of Furman v. Georgia, â€Å"Despite the fact that abolitionists have not proved non-deterrence beyond a reasonable doubt, they have succeeded in showing by clear and convincing evidence that Capital Punishment is not necessary as a deterrent to crime in our society.† inconclusive studies and overall popular dismissal, have resulted in arguments in favor of these types of studies to start decreasing over time. As Federal prosecutor Donald Heller put it, â€Å"When someone kills, theyre thinking of satisfying whatever [made them] decide to kill. They never think about the ultimate Punishment.† (Heller, 2011) Second, deterrence, also called incapacitation, can be viewed as a permanent solution to the issue of â€Å"Future dangerousness†, which is, â€Å"the threat an offender will be likely to pose in the future.†(William W Berry, 2010). In William berry’s report, he goes on to say that future dangerousness is the strongest determinant of whether an individual receives the death penalty. This is harmful because studies show that juries tend to over-predict the presence of future dangerousness. In addition, â€Å"between 21% and 32% of jurors stated that their deliberations focused on the issue of future dangerousness extensively even when the prosecution failed to raise the issue.†(William W Berry, 2010) In fact, even practicing physicians have a very low probability of predicting future dangerous so it’s hard to see how a jury can do it accurately. This view of deterrence as in regards to Future dangerousness, compared with the first, has a more tangible way of  proving right or wrong. For instance, in the ring v. Arizona trial, Justice Breyer shared the following reasons why incapacitation could not justify the use of Capital Punishment: â€Å"Few offenders sentenced to life without parole (as an alternative to death) commit further crimes†. She also goes on to cite two studies proving her point; (1) â€Å"studies find average repeat murder rate of .002% among murderers whose death sentences were commuted; † and (2) â€Å"of the Furman-Commuted Inmates: 98% did not kill again either in prison or in free society.† (William W Berry, 2010) The fact that very little criminals that have been released from death row actually kill again, coupled with the poss ible replacement with the less controversial Life without the possibility of parole(LWOP), can make for a great rational for the abolishment of Capital Punishment. The rising cost of Capital Punishment. The cost of placing one person through the Capital Punishment system in some states like California can be as high as 100 Million Dollars. That same person could have been placed in a regular cell for 40 years and the state would still come out ahead. (schmalleger, 2011) Also in some states where the death penalty is not in use the state are still paying millions of dollars In taxes towards the death penalty. With the rising cost of prisons due to overcrowding and lack of funding, it may be only a matter of time before the death penalty becomes too expensive to implement. It would pay dividends to the local law enforcement, community based reform programs, and the economy as a whole if we abolish the death penalty and adopt the sentence of LWOP in its place. Conclusion To progress as a civilized nation and fully comply with international human rights laws. We need to stop murdering our civilians. Even if there was a way to eliminate all risk of erroneous executions of innocent people, we would still be committing murder by executing the criminal. The government takes the responsibility of these deaths away from the executioner and the physicians, but the government is just the culmination of the will of the people, so in turn, we the people are murdering our neighbors if we let this continue. Also, the system is terribly imbalanced. A majority of the nation’s death sentences come from a handful of counties. In turn, someone could commit the exact same type of murder on opposite sides of a state’s  borders, and one will receive the death penalty while the other will be free in about 40 years. There is also a high level of racial disparity amongst the death penalty. A person is more likely to receive the death penalty if they murder a white man, as opposed to a black man. Also, we covered deterrence and future dangerousness. The outcome found no weight in studies showing some decrease in crime resulting from the implementation of Capital Punishment. Furthermore, future dangerousness should be completely taken out of the equation because of the implementation of LWOP mixed with solitary confinement addresses that concern. Finally, the issue of cost is addressed. Cost should never be a deciding factor in whether someone lives or dies, but in our current troubled economy, the death penalty may enter the chopping block in due to the high costs associated with it. I would much rather see it being abolished all together than to see someone’s trial get improper handling due to cutting previously slim corners. Bibliography Baik, E. (2012). Gender, Religion and National Origin: Latinos’ Attitude toward Capital Punishment. Journal of Social Sciences (15493652), 8(1), 79-84. Science Publications. Retrieved from http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direct=truedb=a9hAN=74485107site=eds-live Ehrlich, I. (1975), â€Å"The Deterrent Effect of Capital Punishment: A Question of Life and Death,† American Economic Review 65: 468-474. GavrilÃ… ¡, A. N. (2011). SHOULD THE DEATH PENALTY BE ABOLISHED? ARGUMENTS FOR AND AGAINST THE CENTURIES-OLD PUNISHMENT. Journal for Communication Culture, 2(2), 82-98. Institute for Communication Culture. Retrieved from http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direct=truedb=ufhAN=68630937site=eds-live Gray, J. P. (2011). ESSAY: FACING FACTS ON THE DEATH PENALTY. Loyola of Los Angeles Law Review, 44(3), S255-S264. Loyola of Los Angeles School of Law. Retrieved from http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direct=truedb=a9hAN=67352324site=eds-live Greenfield, L. A. (1991). Capital Punishment 1990, 15. Retrieved from http://www.ncjrs.gov/App/Publications/abstract.aspx?ID=131648 Hayes-Harb, R., Masuda, K. (2008). Development of the Ability to Lexically Encode Novel Second Language Phonemic Contrasts. Second Language Research, 24(5), 5-33. DOI: 10.1177/0267658307082980. Heller, D. (2011, July 06). NEW VOICES: Author of Californias Expanded Death Penalty Law Now Supports Repeal. Retrieved from Death Penalty Information Center: http://www.deathpenaltyinfo.org/new-voices-author-californias-expanded-death-penalty-law-now-supports-repeal Roko, E. (2010). FINALITY, HABEAS, INNOCENCE, AND THE DEATH PENALTY: CAN JUSTICE BE DONE? Washington Law Review, 85(1), 107-129. Washington Law Review. Retrieved from http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direct=truedb=a9hAN=48871624site=eds-live Schmalleger, F. (2011). Criminal Justice Today. Upper saddle river: prenice hall. William W Berry, I. (2010). Ending Death by Dangerousness A Path to the De Facto Abolition of the Death Penalty. Arizona Law Review, 52, 889. Copyright (c) 2010 Arizona Board of Regents. Retrieved from http://vlib.excelsior.edu/login?url=https://search.ebscohost.com/login.aspx?direct=truedb=edslexAN=edslexF5E3C687site=eds-live Viscusi, W.K. (1993), â€Å"The Value of Risks to Life and Health,† Journal of Economic Literature 31: 1912-1946. Weber, A., Cutler, A. (2004). Lexical competition in non-native spoken-word recognition. Journal of Memory and Language, 50, 1-25. DOI: 10.1016/S0749-596X(03)00105-0. Furman v. Georgia 408 U.S. 238 (1972).

Wednesday, August 21, 2019

Price Elasticity of Demand Essay Example for Free

Price Elasticity of Demand Essay Supply and demand plays a vital role in the economy. Price is the central determinant of both the demand and supply, for example the higher the price of a good or a service the less the product is demanded. In circumstance where the price goes down, demand increases. The response of price and quantity demanded create an inverse relationship between the two. Whereas demand portrays the consumer decision making in purchases, supply is drawn on producer’s willingness to make profit (Parkin, 2002). The overriding factor in determining price elasticity of demand is the willingness and ability of consumers to easily switch from one good to another (substitute goods) in case of any price change. If the demand for corn increases due to its use as an alternative energy source, its supply will also increase making the soybean (substitute) supply and demand to go down. This will force farmers to shift their soybeans farms to produce more corn because of the increasing demand at the market. The total revenue of the suppliers of corn oil will increase because of the increasing demand at the market. This is also because of other determinants of supply like price of the product; a producer (farmer) is always aimed at maximizing his/her profits and minimizing his/her cost thus a rise in price will increase the producer willingness to supply and vice versa. Other factors that are likely to affect the supply of products include tax and technology, a producer aim at maximizes his profit but an increase will raise his expenses. Technology helps a producer in minimizing his cost of production-provided that mass production is possible with technology. Parkin (2002) hints that in a market setting, the law of supply and demand predicts that the price level tends to move toward the point that equalizes the quantity supplied and demanded. Therefore, equilibrium point is created; a point where quantity supplied at the market and quantity demanded at the same market is in balance, where the supply curve crosses the demand curve. At equilibrium, when demand exceeds supply there is excess demand and prices will increase. On the other hand, when supply exceeds demand there is excess supply and prices will decrease. Such instances where supply or demand exceeds one another are very common in the market and will cause shifts in price. But when supply and demand balances, there will be no change in price. The price which makes the supply and demand to balance is referred as market price or equilibrium price. Reference Parkin, M. , Melanie, P. Kent, M. (2002). Economics. Harlow: Addison-Wesley Publisher.

Tuesday, August 20, 2019

The Pros And Cons Of The Death Penalty Philosophy Essay

The Pros And Cons Of The Death Penalty Philosophy Essay Introduction Capital punishment, which some also call the death penalty, has been around in society for hundreds of years. Ever since it began, there have been discussions as to whether it is morally right, and as to whether it actually deters criminals. Some believe that the prospect of being put to death often stops criminals from committing violent acts. Others believe exactly the opposite, stating that those that commit violent crimes are driven to do so for various reasons, and whether they have the chance of being put to death or not will not stop them from doing what they feel they must do. Some serial killers and other violent individuals believe that they will never be caught. Others think that they are doing Gods work, or they cite other important reasons for the killings and violent acts that they partake in. Sometimes this is due to mental disorders, but there are other reasons that people commit acts of this nature. Regardless of these reasons, however, violent acts can and do occur and whether these people should be put to death for their crimes remains a hotly debated issue. On one side of the debate, there are those that believe that killing is morally and ethically wrong, whether it is the killer and his victims or the government and the killer. The ethical dilemmas that are faced by this issue are not designed to be discussed here. They are important and worthy of discussion and thought, but the scope of this paper does not allow for space to debate the ethical issues that involve the death penalty as it pertains to violent individuals and their reasons for their actions. The purpose of this paper is to leave those issues aside and determine whether there is a basis of truth in the statement that capital punishment deters violent crime. This statement is used by many who believe in the death penalty, and they argue that these criminals will not be able to do any more harm, which is certainly true, and not a question for debate. What is debatable, however, is whether the idea of the death penalty affects those that might commit violent crimes, and whether it stops them from doing so. There are many that believe this, and others that insist that there is little to no effect. Both sides of the argument will be addressed here, so that conclusions can be drawn from the information presented that will hopefully shed some light on the debate and determine which side is correct. There is, however, seemingly much more information available that is against the death penalty than for it. It is also possible that a determination will not be able to be made due to the fact that there are so many issues and beliefs that surround each side, and statistics can be made to show many things, depending on who is utilizing them and how the numbers are manipulated. It is for this reason that statistics will not play a large role in the scope of this paper, as numbers often vary. Argument for the Death Penalty Those that argue for the death penalty state that, not only does it keep the person in question from committing any more violent acts, but it also serves as a lesson for those that are considering these types of acts in the future. It is not only the United States that has this problem, as many other countries are also concerned about crime rates (Bedau, 1998). In some other countries there are people that feel that doing away with the death penalty offers no deterrent for those that would rape and murder innocent people for some reason, or sometimes for no real reason at all (Bayat, 1999). It is believed that the criminal element that is aware of the death penalty will spend more time considering whether the act they are thinking of committing is worth the price that they might ultimately have to pay (Delfino Day, 2008). The opinion is that many criminals will feel that risking their life for the violent act is not worth the price, and they will refrain from committing these kinds of crimes. Few people, even criminals, have a death wish, and it is believed that this lack of desire for their own death will keep them from causing the deaths of others (Delfino Day, 2008). Despite opposition from those that believe the death penalty should be stopped, some statistics do show that the number of murders does rise when the death penalty is not in force, and this number falls when the death penalty is reinstated (Johansen, 1998). Another point of this argument is that the death penalty brings closure for the victims of the families that have lost loved ones. There is apparently a satisfaction, at least for some, upon seeing these people give up their life at the hands of the government. The chapter of their lives that dealt with that person has come to an end, and they can finally feel that they can move on with their lives (Radelet Akers, 1996). This is somewhat related to violent crime, in that there is always the possibility that survivors who have lost loved ones would consider taking their vengeance out on others because of their pain and sorrow, and this could lead to even more violent crimes. Violent criminals that are paroled also run the risk of being killed by those that know what they did and believe that they should have died. This creates more violent acts in society and more problems with how to punish these individuals. Having the death penalty for violent crimes often prevents this. To summarize, the main point of the argument for the death penalty is that crime will go down because of the fear of punishment. This is the belief of those that advocate the death penalty for all violent crimes, and all of the information to the contrary does not appear to change this opinion. Argument Against the Death Penalty There are many different arguments against the death penalty, and some of these come from law enforcement. Recent polls of police chiefs in various areas of the country indicate that a large majority of them believe that the death penalty is no deterrent to violent crime. It ranks last on their lists of how they should go about reducing violent crime, and studies have shown that it is no better at reducing crime than the possibility of life in prison without any chance of parole (Cook, 1999). This is interesting, in the face of the argument that the death penalty reduces the amount of violent crimes that are committed. Studies have also shown that, contrary to the popular opinion that the death penalty brings closure, most people do not feel that watching someone else die helps them to move on in any way (Cassell Bedau, 2005). Sometimes it seems to profane the name of the lost loved one by associating yet another death with it. The death of the loved one is painful enough without ad ding to it (Cook, 1999). Mainly, Opponents of the death penalty argue that (Policy, 2003): those contemplating criminal activities do not rationally weigh the benefits and costs of their actions, the costs associated with obtaining a death penalty conviction are larger than the costs associated with providing lifetime imprisonment, in a world of imperfect information, innocent individuals may be convicted and executed before exonerating information is discovered, and the death penalty has disproportionately been applied in cases in which the defendant is nonwhite or the victim is white. There are several effective arguments against the death penalty, including the fact that some people have been executed, and the government has later discovered their innocence. There is not much to be done at that point, and instead of deterring violent crime, it makes the death penalty seem unjust and unfair. It also draws into question once again whether the death penalty is such a good idea, since it can sometimes be used incorrectly and innocent people are made to suffer for the mistakes of the police, prosecutors, and government (Rivkind Shatz, 2005). It would seem that many criminals would find this more amusing than frightening. They do not take their chances of being caught and subjected to the death penalty seriously enough to be frightened by the penalty like many assume they will be (van den Haag, 2001). According to some that believe in God and feel that the death penalty is acceptable under the scriptures, make one main point, which is that This is not an issue that may be measured accurately in terms of statistics. No one can ever know how many potential murderers have refrained from taking human life due to their fear of prosecution, conviction, and ultimate execution (Jackson, 2003). It is also questioned during this same argument that those who conclude that the death penalty is not a deterrent to violent crime should also be able to conclude that prison is not a deterrent either, since people seem to keep committing crimes, whether or not they think they will go to jail. Another concern over the death penalty and violent crime is the issue of the mentally handicapped (Banner, 2003). They, along with juveniles, also commit violent crimes on occasion. These mentally handicapped individuals, not to be confused with mentally disturbed or insane individuals, often have low IQs and do not realize what they have done. The death penalty in their cases is not any deterrent. They do not even realize what they have done. One mentally handicapped man actually asked the jailers to save his dessert for him so that he could eat it after his execution. It was clear that he did not understand what the execution was about, no more than he understood the crime that he had committed. Executing individuals like this does nothing for society. Many people find it cruel, and even if it is not, it is certainly senseless. There are no important lessons about not committing crimes that are learned by executing someone who is mentally handicapped (Reforms, 2002). The same is true for juvenile offenders. Some juveniles that are convicted of violent crimes are locked away in prison until such time as they are old enough to be executed, which really does not teach juveniles anything valuable about the death penalty or avoidance of violent crime. More often than not, these juveniles are not executed, and most juveniles know that they will not receive the death penalty, even if they are tried as adults, so they are not deterred by the possibility (Radelet Akers, 1996). There are other arguments, but the most effective argument against the death penalty as a deterrent for violent crime appears to be the fact that crime has not gone down simply because the death penalty is out there (Death, 2000). States that have it do not have lower crime rates on average than states that do not have it, and that would indicate that the death penalty in and of itself is not stopping people from committing violent acts (Ikramullah, 2003). Conclusion Crime, including violent crime, has been with society virtually since the beginning, and it will remain with society until it ends. Nothing will stop some people from committing violent acts, and the death penalty does not appear to be the answer. Sometimes, innocent lives are lost to this process, and many times the families of the victims do not experience the kind of closure that one would hope for simply because the offender has been executed. Since it would appear that even law enforcement does not see the death penalty as an answer to the problems of crime in society, one wonders why it is allowed to continue. It is possible, however, that the death penalty would be a deterrent if it were used more swiftly and more often. Many people who are sentenced to death spend years in prison appealing their conviction and appealing their sentence, and this is a large waste of taxpayer money, as well as a huge burden on the court system. Those that are guilty beyond a shadow of a doubt often wait a long time for their sentence to be carried out. Even when DNA evidence shows that they were the guilty party, the execution is still not swiftly carried out, and this allows many criminals to find some way to avoid it. Instead, they end up spending their life in prison, where they get hot meals every day, are allowed to exercise, and have a bed to sleep in every night. They watch TV and read books, and this is more than many of the hungry and homeless in todays society get. Criminals are treated better than many of these people. The criminals have lost their freedom, but they get a lot of things in return for that, and society is required to pay for them through taxes and other avenues that fund the prisons. One is left to wonder why this is so, and whether the death penalty actually would work if everyone found guilty of a violent crime and proved guilty with DNA evidence and/or a confession was executed within 30 days. There would be less prison overcrowding, and appeals would not be allowed. Enacted in this way, the death penalty might be a better deterrent against violent crime, because the stakes would be much higher than they are now, and the chances of being executed would be much greater. It would give criminals more to think about when they were contemplating their violent crimes, and society (at least that part of society that supports the death penalty) would feel better about not supporting these criminals while they appealed and worked to save themselves. It is also possible that more people would come to see the death penalty as a good idea if they could be shown that there was less prison overcrowding and that the amount of violent crime was actually dropping because of it. This might help society out in several ways, but it is unlikely that this will come to pass. There are always those that will fight for the rights of convicted prisoners, and argue that they are misunderstood. There are also those that will maintain the opinion that killing is wrong, no matter who does it. Every individual is certainly entitled to their opinion, and it would appear that those who feel the death penalty is wrong are winning their battle, at least in some states, because executions do not take place very often. Even when they do occur, it is usually after a lengthy appeals process lasting many years and costing much money. Since society will never be free of crime, dealing with that crime and controlling it has become the focus of law enforcement. If the death penalty can be improved and made to work, it should remain. If it cannot be changed so that it actually deters violent crimes, than perhaps it should be done away with in favor of a system that will actually lower the crime rate and work to prevent violent crimes in the future.

Monday, August 19, 2019

Comparing and contrasting two Poems on the theme of childhood By Essay

Comparing and contrasting two Poems on the theme of childhood By Seamus Heaney. Comparing and contrasting two Poems on the theme of childhood Having read the four poems from Seamus Heaney's collection "Death of a Naturalist", I have decided to Compare and contrast the two poems that I like best, which are "Death of a naturalist" and "Follower". Both of these are childhood stories set in the countryside. These reflect how Heaney felt about different aspects of life in his surroundings. This is one of the reasons that I have chosen these two poems the idea of the countryside makes me feel at home with these two poems. They are both set in the open air, which creates an open atmosphere. "Death of a Naturalist" is the first poem I chose to write about because of the overall effectiveness of the poem. This poem has been written in paragraph like stanzas, this gives me the feel of making the poems look full of descriptions; it also looks very exiting looking at all the stanzas are crammed into one. As you look at the poem you can see effective use of vivid similes such as "Frogspawn grew like clotted Water" Frogspawn that grows like "clotted water" shows you the fullness of the frogspawn it also shows us that the frogspawn is racing and covering the pond water very fast it also gives me an impression that he enjoys seeing the frogspawn growing and covering the pond as he enjoys collecting frogspawn "I would fill jampotfuls of the jellied specs" This shows the enjoyment of a young child collecting and watching something grow. We see the use of positive phrases "There were dragon-flies, Spotted butterflies... " The use of commas and short sentences give us an understanding of the child's ... ...od jobs around the farm. The last lines in the poem make us think about what has happened to his father. "It is my father who keeps stumbling Behind me, and will not go away" the effect this creates by saying his father is weak and falling away behind him tells us that the roles have been reversed. After looking at these two poems many things are very similar in the way they have been written: the language and form are authentic language of farming by this I mean that the poems have got a use of old farm language an describe things in a farming form. Heaney also leaves the reader with a final line to think about. By reading the two poems Heaney now feels that it is time to break away from his past and he also feels different from his family. I think this because he is looking back and writing about the past and he is able to write about the future.