Clinical Nursing Essay Example for Free

Clinical Nursing Essay Introduction Nurses utilize multiple theories daily to care for patients and their families, though these theories range from grand, to situation-specific, to mid-range the nurse tends to focuses on which theory will provide the best care to his/her patient. Perhaps in my opinion mid-range theories with their growing frequency of use are best suited for nursing in the 21st century. Mid-range theories are said to be middle rather than ordinary but they are specific enough to evaluate observed situations (McCurry, Revell, Roy, 2009). There are multiple reasons why mid-range theories offer some of the most up to date information when it comes to the care of our patients and families, but let’s just break it down to three; interpersonal relations, family, and health promotion. The middle range theories of these three examples will provide a set of assumptions and/or predictions from specific situations confirmed by research (Nolan Grant, 1991). Interpersonal relations First, Hildegard Peplau’s Theory of Interpersonal Relations has influenced patient care in the 21st century worldwide. What is so crucial and probably most significant with this mid-range theory is its focus on human issues and its value of future generations (Barker, 1998). Nurses utilize this theory to treat each patient as an individual realizing that each person and their situation are unique. By applying this knowledge to each patient the nurse is able to develop a therapeutic relationship, which will promote the planning and implementation of nursing care. For nursing care to be successful they must view the nurse/patient relationship as a partnership being aware both are working together for a common goal (Barker, 1998). Also, interpersonal relations are used in all areas of nursing, which is why it is so important for the future of nursing, because without these relationships we would not be effective in our profession. These relationships are needed to expand our know ledge of each patient and their situation. By establishing trust the patients are encouraged to express themselves openly and honestly. Therefore the relationship built bridges barriers that may have hindered the patient outcome. Family Second, Hildegard Peplau’s mid-range theory of family systems has revolutionized the nursing approach in which families are incorporated into decision makers. Currently, families are viewed as the most influenecial person when it comes to the care of their loved one, meaning not only are nurses to build a therapeutic relationship and trust with the patient but with their family as well (Forchuck Dorsay, 1995). This theory molds nurses into advocates for the family unit, which in turn influences the patient’s quality of life. These relationships with families are crucial when it comes to care, for example, if a patient was unable to provide the nurse with health history or tell them when they are in pain the family is able to be the eyes, ears and speech of their loved one. This action improves the care for the patient and nurses need the families as much as the patient needs the nurse. This is one of the reason’s why this theory works in the 21st century even wi th all the technology in the world, we as nurses still need the human interaction to open our eyes to the patient/family dynamic. Family system nursing is both the individual and the family simultaneously instead of just merely family nursing where the nurse takes care of the patient within the context of the family (Forchuck Dorsay, 1995). This practice focuses on the interactions and relationships made between the nurse, individual and family. In order for this theory to be successful the nurse must be aware of the range of choices and downfalls associated with family system nursing. Also it is necessary to build on these relationships to provide creative personal choice and consistent flow of care for the patient to enhanced achievable goals. This engagement of nursing with family systems opens the door for problem solving of patient situations, which implements structure in the nurse/individual/family relationship (Forchuck Dorsay, 1995). Health promotion Third, is the promotion and maintenance of health by utilizing Nola Pender’s Health Promotion Model. Health promoting behavior is enhanced through nursing practice, which enhances the patient’s overall well being. This mid-range theory is important today because it guides a supportive and educative system in health promotion in a patient who needs teaching and  demonstration in performing self-care. By applying this method the nurse is able to identify patient’s health promoting behavior’s such as, health importance, self-efficacy, perceived control of health and perceived health status to find any gaps and/or barriers to their health promoting behavior (Simmons, 1990). By promoting health the nurse seeks to care for the individual by developing these behaviors of healthy living, which sets the stage for the individuals to gain knowledge to care for themselves. This applies to all nurses who actively promote healthy living by becoming an active influence in developing healthy living behaviors through education and guidance. Conclusion These middle range theories set the groundwork for research. Each are utilized daily in clinical practice to provide the best patient care. The rationale for considering the middle range theories is an important factor when considering a care plan, which requires the use of the nursing process. These theories follow the nursing process and help guide our responses to promote, educate, integrate and build relationships with these individuals and their families with the same common goal of promoting health. These authors point out how the nursing profession is influential in the care of other and how their actions influence health beliefs. These middle range theories build on other theories, which is why they are so important in nursing practice today. These theories can be used in different areas of nursing as well as using multiple theories in one area of nursing such as mental health. Also, middle range theories have identified multiple interventions for health related issues throug h simple research (McCurry et al., 2009). Nurses like myself have adopted these theories and incorporate them into daily practice to increase my own understanding of my patient and their situations and this is why I chose middle range theories. References Barker, P. (1998). The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy. Journal of Psychiatric and Mental Health Nursing, 5, 213-220. doi:10.1046/j.1365-2850.1998.00128.x Forchuk, C. Dorsay, J. (1995). Hildegard Peplau meets family systems nursing: innovation in theory-based practice. Journal of Advanced Nursing, 21, 110-115. doi:10.1046/j.1365-2648.1995.21010110.x McCurry, M. Roy, C. (2009). Knowledge for the good of the individual and society: linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11, 42-52. doi:10.1111/j.1466769X.2009.00423.x Nolan, M. Grant, G. (1992). Mid-range theory building and the nursing theory-practice gap: a respite care case study. Journal of Advanced Nursing, 17, 217-223. doi:10.1111/j.1365-2648.1992.tb01876.x Simmons, S. (1990). The Health-Promoting Self-Care System Model: directions for nursing research and practice. Journal of Advanced Nursing, 15, 1162-1166. doi:10.1111/j.1365-2646.1990.tb01708.x

Skinheads in the Antelope Valley :: essays papers

Skinheads in the Antelope Valley William Finnegan's essay "The Unwanted" explains the history and make-up of the Antelope Valley and then explores the lives of some teenage citizens in order to discover reasons that two rival gangs have such a significant role in the community and on its people. Absent parents and lack of education are just two factors facing teens that ultimately led the Los Angeles Suburb into becoming a society where Skinheads and Boneheads are a norm and accepted as a part of everyday life. C. Wright Mills' idea of the sociological perspective, looking past the facades, is useful when analyzing the micro; individual, and macro; broad, causes of teens becoming skinheads. Each day America seems to become more and more diverse. Some people learn to accept the fact that America is made up of many different ethnic groups, while others believe the only ethnic group should be their own. There are various reasons for discrimination and it is a very controversial issue. In Finnegan's article he describes two gangs with opposing views concerning racism and how each group expresses their beliefs. The racist and anti-racist beliefs don't always end at the individual. Death is an all too common end and when an opinion becomes life threatening a problem arises. According to Finnegan, one of the two major gangs that occupy the streets of Lancaster and the Antelope Valley is, "a white-supremacist skinhead gang, the Nazi Low Riders (N.L.R.'s)" and the other is, "their rival gang of anti-racist skinheads, the Sharps" (1998, p.88). One major quality the two gangs share is their lack of education. Most, if not all, of the teens Finnegan interviewed, dropped out of school, even though later some used other means of getting a high school diploma or acquiring a higher education. Also it appears both gangs tend to resolve their issues with violence. Most people would agree that some violence is in everyone, but it seems that well educated people often find other means to conquer their problems or go about solving them. Through history knowledge has proved to be an unavoidable part of life. As children in the community began dropping out of schools in vast numbers these kids were forced to, willingly or not, gain knowledge elsewhere (1998). A macro cause for the growing numbers of students dropping out of school and joining the gangs, could be that the ideas and values of those gangs quickly spread through the streets and classrooms. This Leads the teenagers to make decisions about wether or not they agree with the

Disease in the News Critical Appraisal

There has been a rise in the number of cases of HIV/AIDS in men who have sex with men in the US. Trends suggest that between the years 2001 to 2004, the number of HIV/AIDS cases is rising in African American and Hispanic populations compared to the White population. The survival rates after 3 years were the lowest for men belonging to the African American and the Hispanic community compared to the White community. Since, the year 1999, there has been a rise in the number of cases of HIV/AIDS especially in men who have sex with other men.The article is a thoroughly peer-reviewed journal suggesting that the information is current, evidence-based, validated and researched carefully. The authors of the article include Hall, H. I. , Byers, R. H. , Ling, Q. , and Espinoza, L. They work for the Division of HIV/AIDS Prevention, which is a unit of the Center for Disease Control and Prevention (CDC), Atlanta, US. The journal has given the details including the contact address and the email ID of the authors thus permitting clearance of queries and doubts. The authors are well versed and experienced in the field of HIV/AIDS.Hall and Byers have completed their PhD, Ling has done MS, and Espinoza has completed DDS. The authors are from various groups, and hence they would express the problems of these groups in their work. Each of the authors has played a different role in bringing out the journal. The writing, origin of the study, designing of the study, review and the interpretation has been done by Hall. Major contributions of the writings and modeling of the data has been done by Byers. Ling has performed analysis of the data and the data progression details.Espinoza has done the interpretation and discussion of the data. As this study was just about collecting data and not performing a clinical trial, it did not involve following a protocol. The article has been broken into various subtopics including abstract, introduction, methods, results, discussion, conclusion and references. Credential web sites such as Pub med and the CDC have also cited the article. The article is about the diagnosis of HIV in the male homosexual population, and determining the rate at which the disease progresses.The researchers are interested on working with this topic as highly active antiretroviral therapy (HAART) has seemed effective in delaying the symptoms of the disease and the development of fatal outcomes from the disease. In the 1990’s, there was a reduction in the mortality rates arising from AIDS, due to development of HAART. This therapy is able to reduce the viral load. Since the year 1999, there has been a rise in the number of cases of HIV/AIDS due to the increase in homosexual men amongst certain segments of the population.Another indicator of the trend of men having sex with other men was the rise in the number of cases of syphilis in the male homosexual population. The cases of HIV/AIDS were especially high in men below the age of 30 years. In o ther parts of the world, the results obtained from similar studies were different. For example, in the UK, it was found that the high incidences of HIV/AIDS were observed in men who had sex with men between the ages of 25 to 44. The incidences of HIV/AIDS increased in higher numbers in the African-American and Latin populations compared to the Whites.It was about 10 and 3 times higher. Before this study was conducted, HIV/AIDS was not detected in a high proportion of the study model. The Whites were more aware of their HIV status compared to the Hispanics and the African-American population. This suggests that the Whites are more likely to start HAART faster and develop better outcomes with the disease. The data was collected for this study by the HIV surveillance system in place. Several statistical methods such as Poisson regression was utilized to determine the HIV diagnosis rates.The study demonstrated that higher rates of HIV/AIDS were observed in homosexual men belonging to Af rican-American and Hispanic background compared to other segments of the population. Besides, the survival rates after 3 years was also lower the same populations. HIV progressed faster in Hispanics and African population. The article talks about a specific population, namely the homosexual men. The geographical area of this study was limited to the United States. However, the results of the study were compared to other countries such as the United Kingdom.The various ethnic groups that were studied included Hispanics, African-American and Whites. The CDC performed the study. The article does make claims of the treatment. In this case, it is HAART to treat HIV/AIDS. HAART plays a major role in reducing the mortality and morbidity from HIV. The study picks up some evidence available from 1996-1999 in which HAART was utilized to reduce the transmission of HIV infection. This may be in the fact that HAART helps to reduce the viral load in infected people.The article speaks of the ongoi ng emphasis given to the Governments Healthy People 2010 policy, and the need to reduce the transmission of HIV infection. The article also aims to reduce the transmission of HIV/AIDS in the homosexual male population especially. There are various strategies suggested for treatment including prevention, early diagnosis, HAART therapy, etc. The article has used about 48 current and relevant journals written by authors whose credentials are also good. The user can access the abstract of the references by clicking on the link provided. References: Espinoza, L., Hall, H. I., Campsmith, M. L. et al (2005), â€Å"Trends in HIV/AIDS Diagnoses — 33 States, 2001—2004,† CDC MMWR, 54(45), 1149-1153. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5445a1.htm Hall, H. I., Byers, R. H., Ling, Q. et al (2007), â€Å"Racial/Ethnic and Age Disparities in HIV Prevalence and Disease Progression Among Men Who Have Sex With Men in the United States.† AJPH, 97(6), 1060-1066. http://www.ajph.org/cgi/content/full/97/6/1060

Battle of Shiloh in the Civil War

The Battle of Shiloh was fought April 6-7, 1862, and was an early engagement of the Civil War (1861-1865). Advancing into Tennessee, Major General Ulysses S. Grants troops were attacked by the Confederate Army of Mississippi. Taken by surprise, Union forces were driven back towards the Tennessee River. Able to hold, Grant was reinforced during the night of April 6/7 and launched a massive counterattack in the morning. This drove the Confederates from the field and secured a victory for the Union. The bloodiest battle of the war to date, the losses at Shiloh stunned the public but were far lower than the battles that would come later in the conflict. Lead-up to the Battle In the wake of the Union victories at Forts Henry and Donelson in February 1862, Major General Ulysses S. Grant pressed up the Tennessee River with the Army of West Tennessee. Halting at Pittsburg Landing, Grant was under orders to link up with Major General Don Carlos Buells Army of the Ohio for a thrust against the Memphis and Charleston Railroad. Not expecting a Confederate attack, Grant ordered his men to bivouac and commenced a regimen of training and drill. Lieutenant General Ulysses S. Grant. Photograph Courtesy of the National Archives Records Administration While the bulk of the army remained at Pittsburg Landing, Grant dispatched Major General Lew Wallaces division several miles north to Stoney Lonesome. Unbeknownst to Grant, his Confederate opposite number, General Albert Sidney Johnston had concentrated his departments forces at Corinth, MS. Intending to attack the Union camp, Johnstons Army of Mississippi departed Corinth on April 3 and encamped three miles from Grants men. Planning to move forward the next day, Johnston was forced to delay the attack forty-eight hours. This delay led his second-in-command, General P.G.T. Beauregard, to advocate cancelling the operation as he believed the element of surprise had been lost. Not to be deterred, Johnston led his men out of camp early on April 6. General P.G.T. Beauregard. Photograph Courtesy of the National Archives Records Administration Fast Facts: Battle of Shiloh Conflict: Civil War (1861-1865)Dates: April 6-7, 1862Armies Commanders:UnionMajor General Ulysses S. GrantMajor General Don Carlos BuellArmy of West Tennessee - 48,894 menArmy of the Ohio - 17, 918 menConfederateGeneral Albert Sidney JohnstonGeneral Pierre G.T. BeauregardArmy of Mississippi - 44,699 menCasualties:Union: 1,754 killed, 8,408 wounded, and 2,885 captured/missingConfederate: 1,728 killed, 8,012 wounded, 959 captured/missing The Confederate Plan Johnstons plan called for the weight of the assault to strike the Union left with the goal of separating it from the Tennessee River and driving Grants army north and west into the swamps of Snake and Owl Creeks. Around 5:15 AM, the Confederates encountered a Union patrol and the fighting began. Surging forward, the corps of Major Generals Braxton Bragg and William Hardee formed a single, long battle line and struck the unprepared Union camps. As they advanced, units became entangled and difficult to control. Meeting with success, the attack drove into the camps as the Union troops attempted to rally. The Confederates Strike Around 7:30, Beauregard, who had been instructed to remain in the rear, sent forward the corps of Major General Leonidas Polk and Brigadier General John C. Breckinridge. Grant, who was downstream at Savannah, TN when the battle began, raced back and reached the field around 8:30. Bearing the brunt of the initial Confederate attack was Brigadier General William T. Shermans division which anchored the Union right. Though forced back, he worked tirelessly to rally his men and mounted a strong defense. Major General John McClernand. Photograph Courtesy of the Library of Congress To his left, Major General John A. McClernands division was also forced to stubbornly give ground. Around 9:00, as Grant was recalling Wallaces division and attempting to hasten the lead division of Buells army, troops from Brigadier Generals W.H.L. Wallaces and Benjamin Prentiss division occupied a strong defensive position in an oak thicket dubbed the Hornets Nest. Fighting valiantly, they repulsed several Confederate attacks as Union troops on either side were forced back. The Hornets Nest held for seven hours and only fell when fifty Confederate guns were brought to bear. Johnston Lost Around 2:30 PM, the Confederate command structure was badly shaken when Johnston was mortally wounded in the leg. Ascending to command, Beauregard continued to push his men forward and Colonel David Stuarts brigade achieved a breakthrough on the Union left along the river. Pausing to reform his men, Stuart failed to exploit the gap and moved his men towards the fighting at the Hornets Nest. With the collapse of the Hornets Nest, Grant formed a strong position extending west from the river and north up the River Road with Sherman on the right, McClernand in the center, and the remnants of Wallace and Brigadier General Stephen Hurlbuts division on the left. Attacking this new Union line, Beauregard had little success and his men were beaten back by heavy fire and naval gunfire support. With dusk approaching, he elected to retire for the night with the goal of returning to the offensive in the morning. Between 6:30-7:00 PM, Lew Wallaces division finally arrived after an unnecessarily circuitous march. While Wallaces men joined the Union line on the right, Buells army began arriving and reinforced his left. Realizing that he now possessed a sizable numerical advantage, Grant planned a massive counterattack for the next morning. Major General Don Carlos Buell. Photograph Courtesy of the Library of Congress Grant Strikes Back Advancing at dawn, Lew Wallaces men opened the attack around 7:00 AM. Pushing south, Grant and Buells troops drove the Confederates back as Beauregard worked to stabilize his lines. Hampered by the previous days intermingling of units, he was not able to form his entire army until around 10:00 AM. Pushing forward, Buells men retook the Hornets Nest by late morning but met strong counterattacks by Breckinridges men. Grinding on, Grant was able to retake his old camps around noon, forcing Beauregard to launch a series of attacks to protect access to the roads leading back to Corinth. By 2:00 PM, Beauregard realized that the battle was lost and began ordering his troops to retreat south. Breckinridges men moved into a covering position, while Confederate artillery was massed near Shiloh Church to protect the withdrawal. By 5:00 PM, most of Beauregards men had departed the field. With dusk approaching and his men exhausted, Grant elected not to pursue. A Terrible Toll The bloodiest battle of the war to date, Shiloh cost the Union 1,754 killed, 8,408 wounded, and 2,885 captured/missing. The Confederates lost 1,728 killed (including Johnston), 8,012 wounded, 959 captured/missing. A stunning victory, Grant was initially vilified for being taken by surprise, while Buell and Sherman were hailed as saviors. Pressured to remove Grant, President Abraham Lincoln famously replied, I cant spare this man; he fights. When the smoke of battle cleared, Grant was praised for his cool demeanor in saving the army from disaster. Regardless, he was temporarily relegated to a supporting role when Major General Henry Halleck, Grants immediate superior, took direct command for an advance against Corinth. Grant regained his army that summer when Halleck was promoted to general-in-chief of the Union armies. With Johnstons death, command of the Army of Mississippi was given to Bragg who would lead it in the battles of Perryville, Stones River, Chickamauga, and Chattanooga.