Writing Expository Essays for Middle School Students

Writing Expository Essays for Middle School StudentsExpository essays have been around a long time and are not much different today. This kind of essay includes writing material that includes an introduction, body, conclusion, and then ending with the resource box at the end. These types of essay help to draw your audience in with interesting concepts that you want to share in this short paragraph.As you can see, expository essays help middle school students learn more about the subject. Writing an expository essay is different than writing any other type of essay. The way in which you incorporate word in your writing is very important so that you can easily communicate ideas to your audience.The most important thing to remember when writing an expository essay is to be simple and brief. The idea that you are trying to get across should not take too much time to read. The longer it is, the more difficult it will be to communicate the idea that you want to convey. So try to keep it si mple and brief.In writing an expository essay, you may want to create an outline first and then work from the top down. An outline will help you focus your thoughts on the section of the essay you want to write. The outline will also help you come up with ideas for the other sections.Writing with an outline is the best way to start writing your expository essay. By doing this, you will be able to focus on each part. By taking the ideas that you feel like writing down, you will be able to come up with a concise but detailed idea about your topic.When writing your expository essay, you need to consider the topic that you would like to cover in your essay. What do you want to discuss in this article? This will help you to create the concept of your expository essay.You need to choose the right topics when writing your expository essay for middle school students. The ones that are popular and easy to write about are easy to study. The harder ones are harder to research and do a good job of conveying ideas to your audience.Your expository essay for middle school students can help you develop as a writer. It will help you develop your own sense of creativity and imagination. It will also help you to develop your own research skills that you will use for other writing projects that you want to do.

Most Important Macro Environment Factors In Qantas Tourism Essay Essay Example

Most Important Macro Environment Factors In Qantas Tourism Essay Essay Corporate scheme of Qantas has been back uping all its concern aims and besides employee degree single aims so that the company produces better consequences for the satisfaction of clients. Airline industry is a immense topographic point where different companies are working and if planning and strategic determinations do non run into the demands of the current environment of the concern than it would be bad for the company. Selling and Auditing are the cardinal countries where the strategic determinations of the Qantas have to concentrate. In Australia the air hose industry has been under crisis since 2000 so the Qantas had to undertake the state of affairs by strategic moves and proper planning has to be done for that. Selling auditing has been done by the company several times to look into the effectivity of the strategic determinations that were being made to back up the selling activities sing new and old clients ( Kain and Webb, 2003 ) . In add-on to these, a important worldwid e tilting in rapid expression of low-priced transporter was empirical and the challenge for Qantas to keep both the low cost and high quality criterions was hard but feasible and it worked on it. Australian air hose industry was non opposed to this, two moderately priced air hoses that is to state wish and Virgin Blue Airlines were launched in 2000 and so they created a sense of competition in footings of selling activities for the company and therefore auditing was going necessary. Use OF BUSINESS TOOLS TO UNDERTAKE FORMAL MARKETING, AUDITING AND PLANNING We will write a custom essay sample on Most Important Macro Environment Factors In Qantas Tourism Essay specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Most Important Macro Environment Factors In Qantas Tourism Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Most Important Macro Environment Factors In Qantas Tourism Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Business tools like schemes and client services tools like package, plans and policies if used decently for the Qantas would assist set abouting the formal selling, scrutinizing and be aftering. Formal Marketing would come if the selling schemes are planned based on perfect concern tools that are available in the market for market research, client analysis and selling scheme preparations. Similarly if we move toward the scrutinizing side the construction could be formalized through several concern tools that would automatically bring forth scrutinizing study to analyse concern schemes. Auditing tools like package tools and concern bundles should ever be a beginning of support to set about more formal schemes to be made, more complex analysis to be done and more accurate planning to be done. Planning is another major portion which would bring forth consequences for the Qantas ( Kotler, Brown, Adam, Burton, and Armstrong, 2007 ) . Planning is the most critical portion because if it s d one good, ends good and if non so the result would besides acquire disturbed Planning concern tools available in the market let us to use the resources at best of the capableness to do them bring forth best consequences and this is what is needed at the point of clip. Qantas has already been utilizing several different concern tools for selling, scrutinizing and planning and besides bring forthing consequences expeditiously. If farther utilised good Qantas can do it a competitory border for the company and an effectual manner to fulfill the clients. MOST IMPORTANT MACRO-ENVIRONMENT FACTORS IN QANTAS Macro environment factors that are act uponing the Qantas Airlines include Political, Economic, Societal, Technological, Environmental and Legal factors. All these factors are really critical for the success of Qantas. Political factors like Australian political relations and the province Torahs are traveling to act upon the tendencies of the company and the net income devising would Torahs be disturbed if the revenue enhancement policies changes from the governmental governments. So Qantas has to concentrate over such schemes really carefully and it has to be prepared for such alterations because they are out of control of the company. Social factors like altering tendencies among clients, debut of new tendencies in the society and altering similitude and disfavor of people are all such factors that should be prepared and should be decided in schemes ( Kain, and Webb, 2003 ) . Technological factors are altering twenty-four hours by twenty-four hours and therefore this would hold bee n a biggest challenge for Qantas to get the better of such challenges and get by up with all new technological betterments go oning twenty-four hours by twenty-four hours. Particularly it has to be really strong in Research and Development so that every coming engineering comes foremost in Qantas before hitting the rival companies. Environmental factors like conditions and environing states and their policies are really of import to be considered so that Qantas designs its schemes consequently as it has been making antecedently. Legal factors are last but non the least factors which play portion in success of the company and they play really critical function in doing such policies. MOST IMPORTANT MICRO-ENVIRONMENT FACTORS IN QANTAS Micro environment has been besides really of import and several factors are portion of micro environment like strengths, failing, chances and menaces of the company. Qantas Airways, a national Australian air hose established in 1920 is the universe s 2nd oldest air hose header towards a century of age in 2020 ( Harcourt, 2004 ) . Strengths Along with its subordinates served destinees, a figure of international flights includes about all the continents like Africa, Oceania, Asia, Europe and the Americas. Bing the most oldest in age, Qantas airways is far in front in experience, operational answerability, engineering and services. For all categories including economic system category a epicurean amusement system is provided along with in flight cyberspace installation and with every place holding a LCD screen. Promising a comfy journey, going by Qantas air hoses is cost effectual. A complete cabin system is provided with First category, concern category, premium economic system category and economic system category classification. A paramount committedness is assured through a proper client charter including client s safety, in clip going and reaching, proper caretaking in instance of any bad luck and procuring personal information of their clients. An environment friendly attack through group environment policy sing all modern-day issue sing environment for the attainment of green planet. Airway squad has ever been working for supplying every possible path that is widening twenty-four hours by twenty-four hours. Shows their goodwill gestures at the clip of exigency in their ain part or for their ain people settled abroad in the class of emptying charter. Qantas air passages had been declared as World Skytrax Airline of the Year ( for five back-to-back old ages ) , Skytrax Best Airline Australia ( 2005, 2006, 2008 ) , and Skytrax Best Regional Airline Australia ( 2006, 2008 ) for their services along with several wine design and amusement awards. Failings A conservative policy is implicated while flight that kids going unaccompanied are non allowed to sit along with male travellers, which compels the work forces to experience sex discriminated as females can every bit be suspected for kid maltreatment. Despite being the oldest among the air hoses, Qantas air passages had gone through one air accident in about each decennary which indicates inefficiency in trifle. Due to environmental restraints, some long path direct flights are frequently delayed. Opportunities Proper policies are launched for regular circulars by points gaining through any type of activity that includes money disbursement, either through hotel staying, recognition card use, auto leases, dining and much more. Members are besides given different types of premiums clip to clip. Turning points increases client value from Ag, gold to Pt. Leases has been announced for new aircraft fleet to provide more riders, employment chances, services efficiencies and widening winging concern. For advancing business communities entree to universe with no problem a nine has been organized for uninterrupted and epicurean travel with precedence cheque in and certain concern related and personal installations. Subscription can be made from one to several old ages. Menaces Strong response to planetary fuel monetary value addition, by about half duplicating the ticket on about 10 % addition in fuel monetary values that has late been noticed. Certain efforts of extortion have been made that had an inauspicious consequence on air hose repute but now they are about sorted. Qantas has been accused in 2006 and had been proved guilty for monetary value repair. They had to pay they were fined a immense trade of money, if this happens in hereafter will turn out a dire menace to air hose repute. Selling RESEARCH AND MARKETING INTELLIGENCE Soon the Qantas Group is among one of the few major air hose groups in the universe that are still doing net incomes. Several air hoses are doing considerable losingss, and few amalgamations have besides been seen in past ( for case KLM-Air France ) , coup detats by some large companies and bankruptcies of houses ( e.g Northwest and American Airlines ) . In malice of the apparent flushed first feeling, the existent profitableness word picture across the Group has been diverse, with Jetstar s domestic and planetary operations normally executing good, while the Qantas divider of the concern has been executing less than them. This has been critically because concern intelligence is really of import. Market research has to be on precedence to gain precedences and therefore if company falls down the major issue is low research of market. Qantas s market portion has declined bitterly in the last decennary. At the same clip as the air hose was in a taking market topographic point with 34.4 % of the transition to and from Australia, from 2010 to 2011 its market portion had declined to 18.7 % ( Bamber, Lansbury, Rainthorpe, and Yazbeck, 2005 ) . Intense market research has let it go on and the Qantas has ever been really concerned about that and in response to market needs the launch of Jetstar was planned, which has fascinated 8 % of planetary transition into and out of Australia separating the in general Qantas Group with a 26.5 % market portion at the terminal of 2011. Cleavage AND SPECIFIC SEGMENTATION VARIABLES Cleavage is really of import and critical for Qantas as it has been aiming the domestic and international markets together. The economic capableness of the Qantas international concern is, however, critical to the Qantas s purposes and ends. Dazzling this, a demand to take down the costs is an indispensable occupant of the Group s program for Qantas. Harmonizing to the air hose, the cost base is about 20 % higher than major rivals ( Porter, 1979 ) . Cleavage should be done consequently so that the demands are met and no infinites are left for the rivals to take over. But side by side it is besides really of import that the company follows its ain capacities while aiming a market section. It merely does non hold the small cost formation of many of the rivals, in peculiar the Asiatic rivals. Cleavage needs to be on the footing on geographic as age, gender and other factors do non truly count. Segmentation and specific cleavage variables like demographics, psychographics, buyer-graphics and geographic are critical if selling of the company is planned. Pricing criterions should be set harmonizing to the demands of the clients and cleavage can be based upon that every bit good. Understanding OF MARKET POSITIONING Positioning has been really critical portion of selling scheme which has to be decided by the Qantas and it already has done it good. It has positioned its merchandise domestically on the footing of monetary value incursion while international the placement is based over quality more. The major measure of positioning policy is to be familiar with likely violent net incomes. Qantas has many times for distinguishing its extent and augmented repetitive benefit against its rival Virgin Blue from side to side merchandise and service division ( Coyne, and Sujit 1996 ) . We know that Qantas is a most of import supplier of air conveyance ; the cardinal advantage that a client will take release of is time-critical conveyance . Understanding OF BUYER BEHAVIOR Buying behaviour of client is another major factor which it considers good and behaviour of clients towards the air hoses. Customers have ever thought of holding privileges in footings of monetary values and quality of services. Customer behaviour has ever been a critical phenomenon to analyze when it comes to success or failure of a company ( Brandenburger, and Nalebuff, 1995 ) . Customer would wish to hold proper services and installations during the flight with the sense of security and safety during the journey. Customer s penchant should ever be the centre of attending for the company. Customer is ever right and his attitudes and behaviours are ever critical for the success of the Qantas. Behavior of the bing client of Qantas toward the trade name is loyal but the new client or the client who is utilizing rivals services are non cognizant of the company strengths wholly and this makes it hard for them to take Qantas among all. For this Qantas has to plan a really strong selling run that would convey benefit in footings of client base and the social consciousness about Qantas. Customer base when increases bring a batch of benefits for the company and this should be the focal point of Qantas right now. Decision The overall appraisal of different factors of Qantas have made us recognize that the market analysis and research is really critical and strategic determinations, planning, appraisals and hearing could be done reasonably and more accurately after you have complete cognition about internal and external factors of the company. Position of the merchandise plays really important function in its success or failure so Qantas should take attention about that. Customer behaviour besides plays really of import function and analyzing client behaviours would once more be done through the market research activities. Qantas if focal points all above exactly would acquire privilege to acquire success shortly and for long term.

Night3 essays

Night3 essays This whole situation started out simple enough. The men and myself first moved into this little town called Sighet. The people there seemed so naive. None of them realized what was about to happen; none of them realized what happened when the Germans move into town. We first started by imprisoning the officials and made all the Jews were yellow stars. The Jews were then moved into a very small ghetto and cramped quarters. It was obvious that none of them had heard of the horror of the concentration camps and what awaited them once they left the safety of their homes. Me and some of the other officers tried to be nice to the Jews because I, personally, hated carrying around this gun. Once you were in the camp the site of these officers holding these weapons struck fear into the hearts of all in the camp. We had finally gotten all of the people of the town of Sighet onto the train and had started the journey towards Auschwitz. The condition on the train is something I dont think I could have stood for. The Germans were put in charge of the train in the middle of the journey. The officers were told to collect any valuable from the people on the train and if they refused to yield their valuables, the were to be shot. As I have said I hated carrying around this gun but I did have a job to do and I was willing to follow orders if need be. Luckily I never had to unload a single shot on that train. Some people on the train were in very bad shape. They were hallucinating and many of them simply couldnt take the heat and the smell any longer. They were beginning to go crazy. The officers had a meeting and we were told to tell them that they were all just going to a labor camp and the families would be kept together. The lying was also a normal part of my job. Little did they know that they were going to a terrible place in which the males and females would be sepera ...

Promoting Rights of Children in Ghana Essay Example | Topics and Well Written Essays - 1000 words

Promoting Rights of Children in Ghana - Essay Example Ecological systems theory The ecology of human development theory as propounded by Bronfenbrenner has defined as the † mutual accommodation between an active, growing human being and the changing properties of the immediate settings in which the developing individual person lives†. In accordance with this theory, the child is envisaged as developing within a complex system of relationships affected by multiple levels of the environment surrounding the child. In Ghana, this has been complicated by HIV/AIDS,children are experiencing death pf parents at an early age and are taken care of by other foster parents. Attachment theory Development and emotional functioning of children occurs in a context of relationships (Bronfenbrenner 1979,Osofsky 2004). Children depend on their caretakers as sources of protection and safety. Aims and research questions: The aims of our research and the questions that we want to answer through the research are as follows: †¢ Are NGOs actually helping children to progress in any way? †¢ In what ways are children being helped? †¢ What are the aspects of life of the children that are affected by the NGOs? †¢ To prove that NGOs are needed not only for orphan kids but also for kids who have parents taking care of them. †¢ To prove NGO workers and volunteers are sometimes more effective in child welfare than the Government or police. Background Child welfare is an important issue in any country. In Ghana, this responsibility is shouldered by the nuclear or extended family of a child. Nuclear family include the parents, while Extended family includes, the grandparents, uncle, aunty, or any other relative. However, poverty, HIV, child abuse and child labour is affecting families, and eventually affecting the children. Our concern is the role that is played by the international and local N.G.Os in these children's life. Methodology While the two common types of research methods are the Qualitative and Quantitative research methods, I would be using the mixed method procedure that is a mix of both qualitative and quantitative research methods. It is a relatively new research approach in the social and human sciences. It is unique because it included the advantages of both the qualitative and quantitative methods. While quantitative methods asks how many, and qualitative asks what and how, mixed methods asks why. The mixed method research has both thematic and numerous One of its strength is also that its validity and reliability standards. It has both closed ended measures and open observations. The study used would be Qualitative methods of data collection and data analysis , which will be followed by quantitative methods of data collection and analysis. The data collection for qualitative methods were INTERACTIVE INTERVIEWING The aim of the interview is to find out the participant's perception, hence their views should be unbiased. Interviews can also be a group interviews. The answers should preferably not be, YES or NO, asthat makes details unachievable. The researcher should choose an environment thatmakes the participants comfortable. PARTICIPANT OBSERVATION The researcher should monitor observation and recordpersonal bias of the participant. The researcher himself should be very neutral and not haveany prejudice while observing participant. FOCUS GROUP The focus group session is, indeed, an interview (Patton, 1990) not a discussion group, problem-solving session, or decision-making group. Comprises of both

Islamic history Essay Example | Topics and Well Written Essays - 750 words

Islamic history - Essay Example However, the study will be guided by such questions as where did Islam start and who were the first people to adhere to it? What are the main ideologies that define Islam and how has they evolved over time? When did Islam start and what historical significance has the ideology had over the course of its evolution to the modern day Islam? Islam started in the seventh century (C.E) as instituted by Prophet Mohammed and it took over the Arabic region, which was characteristically defined by polytheism. It is adherent to monotheism and as such the ideology stipulates that there is no other God to be worshiped but Allah. It therefore transformed greatly the religious systems of the traditional nomadic life that was characteristic of the Arabs from the extremes of worshiping many Gods as well as paganism to the faith in Allah. Prophet Mohammed was born in late sixth century and in the early seventh century; he is believed to have had an encounter with an angle of God where he became the pr ophet (apostle) of God (Nawwab, Speers and Hoye, para 1-5). Through divine revelations, Mohamed is said to have written the Quran as it is adhered to in Islam. Therefore, among other great ideologies that define Islam, Quran as it was written by the last prophet of Allah (Mohammed) is complete, infallible, perfect and eternal and thus holds eminently against any influence or modification. In religious matters, the tenets presented in Quran held and continuously holds to define Islam. Islam ascribes to various ideologies which include that God is transcendent and omnipotent, that there are angles, that Quran are words of God’s revelation through his prophets as well as there is the last day that awaits all and in which God’s judgment to mankind will be pronounced. Moreover, the Islam believes that God is all knowing and as such, he is omniscient (â€Å"The History of Islam† 1-3). Despite the great transformation that characterized the inception of Islam, as a rel igion in the Arabian countries in matters of polytheism believes, Islam held to the supremacy of Allah as god who was more impressive than the rest. Besides being the creator, Allah was and is believed to be the provider as well as the determiner to human destiny in eternity (â€Å"History of Islam† para 3). Besides, the Muslims have dispersed everywhere to occupy all the parts of the globe where Islam has been introduced. Little is seen to have changed in terms of believe systems and ideologies as they were instituted and depicted in Quran. The modern day Islam upholds five basic rules, which are prayer, fasting, faith, almsgiving as well as pilgrimage at Ka’bah (â€Å"History of Islam† 5). The evolution in Islam has been more in matters of spread and global acceptance as unlike in matters of systems of believes. Besides much of what is practiced in the modern day in Islamic circles is purely as it was practiced traditionally as instructed by Prophet Mohammed i n Quran (Nasr, vii-xix). In spite of the little evolutionally changes that has been shown in ideological aspects of Islam, misinterpretation and misrepresentation of the ideologies has led to wrong perception of the culture. It is increasingly being associated with acts of terror due to few of its teachings on Jihad and such political activism which has in the past led to political as well as religious conflicts in different parts of the globe

Palliative Care Essay Example for Free

Palliative Care Essay Within this assignment the writer aims to identify and explore in depth the role development of the specialist palliative care nurses in the community setting, and in particular how their role has evolved over the last 5 years. The writer aims for the first part of the assignment to provide the reader with a brief background into the development of palliative care and a history of how the traditional role of a palliative care nurse has expanded from a more generalist perspective to that of a position of specialism. The writer will highlight the essential skills and qualities deemed crucial from a professional perspective in implementing such an expanded nursing role, with particular attention focusing on the impact this role development has made to patient centred care. The writer will highlight the importance of inter-professional working in palliative care, and provide evidence of how the government priorities have changed the boundaries of palliative care and how this has impacted on provision of palliative care services. The second half of the assignment aims to show analysis of both the role development of community specialist palliative care nurses and the recent changes, and provide evidence of how this role has impacted on society. The writer will aim to show evidence of how the role has been successful by providing patients perspectives of the service, and more importantly what improvements could be made in order to ensure the safety of positions with the introduction of the new commissioning process being implemented. The World Health Organisation (2009) defines palliative care as supporting patients and their families with physical, psychological, social and spiritual aspects of care during a physically and emotionally difficult journey of living with a non-curative condition. People’s awareness of palliative care has been linked to the rise of the modern hospice movement back in 1967, when a doctor by the name of Dame Cicely Saunders was responsible for opening a hospice in London called St Christopher’s. Cicely voiced concerns about the way death was dealt with in hospitals around this time and focused her attention on approaching death of cancer patients with more dignity and humanity (Kearney and Richardson 2006). Cicely went on to write several articles for nursing journals and her work was thought to be key to the development of the role of the clinical specialist palliative care nurse (Payne 2008). In the 1970’s the first Macmillan nurses were introduced. Macmillan nurses were generally employed by the National Health Service owever their posts were funded by Macmillan cancer support. The charitable service provider offered local health authorities the opportunity to enrol on a programme that would fund a Macmillan nursing post for a period of 3 years. Once the 3 year period ceased the health authority would become solely responsible for continuing the service out of their budgets (Lugton and Mcintyre 2005). Primarily the role of the Macmillan nurse back in the 1970â€⠄¢s was to provide direct hands-on care for patients whose illness had progressed to the terminal stage as well as support for their families. The role of the Macmillan nurses today tends to focus on meeting the specialist palliative care needs of patients. They provide support with how to manage difficult symptoms associated with the illness and various pain control methods as well as advice on numerous other things, as opposed to the general palliative care in the form of hands on nursing care. This type of palliative care is provided by generalist nurses within the community, such as district and community nurses. Their caseload not only consists of patients requiring palliative care but patients with various other nursing needs. Not all specialist palliative care nurses have the title Macmillan nurse, only those whose post were initially funded by Macmillan Cancer Support and then the NHS. Macmillan nurses are registered nurses who have at least 5 years experience in nursing. In addition they have experience in cancer or palliative care and further to their general nurse training have completed specialist courses, which enable them to have the title specialist nurse (Macmillan Cancer Support 2010). The work carried out by both Macmillan nurses and clinical specialist palliative care nurses differ only slightly, regardless of where they work (Cambridge University Hospitals NHS 2007). According to Seymour et al (2002) the role of the Macmillan nurse has evolved to that of the clinical nurse specialist. A clinical nurse specialist was defined by The Royal College of Nursing in 1988 as having gained through further training an advanced expertise and knowledge in a particular branch of nursing care. They further clarified the role as having responsibility for clinical practice, education, management and having knowledge of relevant research on their specialist area of nursing (Newbury et al 2008). Palliative care patient’s medical needs can change rapidly and may require the expertise of specialist palliative care nurses. Unlike generalist nurses, specialist palliative care nurse’s sole priorities lie with patients with palliative care needs. Referrals to specialist nurses are made when the needs of palliative care patients are becoming more complex and their symptoms harder to manage (Buckley 2008). However a review carried out by Ahmed (2004) suggests that there is lack of understanding of when and to whom referrals should be made to making them inconsistent. This lack of knowledge could be a barrier to the specialist palliative care nurses success. Another view could be that generalist nurses have been providing palliative care for many years, so why should they feel they need to hand over the care of the patients? The Royal College of Nursing (2002) outlined essential skills that were thought to be necessary to the role of specialist palliative care nurses. These were effective communication and the ability to deal with people’s grief, loss and bereavement. Lugton and Mcintyre (2005) suggest that communication is the key attribute to the role of the specialist palliative care nurse however Penson (2000) argues that comfort is the key attribute. Community specialist palliative care nurses are just one group of professionals that make up the multi-disciplinary team providing patients with palliative care. Their work involves close contact and communication with patient’s general practitioners, district and community nurses as well as community matrons. Community matrons are a relatively new role development. They were introduced in 2006 and the role was thought to be developed as a result of the population of the United Kingdom living longer and living with long term conditions. Their work involves looking at the patient holistically and supporting them whilst addressing the complex needs associated with their long term condition. (Sines et al 2009). Supporting patients to manage their symptoms and aiding them to live independently was one of the main proposals set out in the National Service Framework for long term conditions (Department of Health 2005). Prior to the introduction of community specialist palliative care nurses palliative care for the past 150 years or more was provided by district and community nurses in the home environment (Pellett 2009). According to Meehan (2010) within the United Kingdom numbers of qualified district nurses working in the community has fallen dramatically. This questions whether the introduction of the specialist nurses such as community specialist palliative care nurses and community matrons has contributed to these numbers falling. With shortages of district nurses patients care will be impacted upon. Terminally ill patients who have agreed their preferred place of care may have this taken away if problems arise in their condition and they eventually end up having to be admitted to the hospital or hospice unnecessarily (National Audit Office 2008). This in turn will have an impact on the current trends at the heart of the government’s priorities which following the NHS next stage review looked at increasing areas of healthcare into the community and reducing hospital admissions in an attempt to cut NHS costs (Darzi 2008). When the government announced their financial cuts to the NHS back in 2007 specialist nurse posts came under attack. Specialist services as opposed to generalist services are expensive and specialist nurses are in a higher pay band making them more vulnerable to losing their positions in spending cuts (Dean 2010). This questions the government’s views on specialist nurses. Are they seen as additional extras that could cut back in future spending cuts, in turn having an effect on patient care? Although the role of the specialist palliative care nurse is not a recent development to community nursing their role has changed over the last five years. This is in response to the needs of the population and government priorities. Demographic changes are a feature that have impacted on the work of the community specialist palliative care nurse. According to Sines et al (2009) the United Kingdom’s population is set to increase by 7. 2% by the year 2016. The central reasons for this increase are due to the fact that individuals are living longer and migration. Gomes and Higginson (2008) suggest that by the year 2030, 22% of the United Kingdom and Wales will be aged 65 years and over, with two thirds of people being over 75 years old when they die. Older age inevitably increases the certainty that people are more likely to suffer from non communicable diseases as well as cancers and the presence of co-morbidities (Payne 2008). The needs of the aging population will mean that community specialist palliative care nurses will be called upon to deal with increasing demand on palliative care services. As well as the population of the United Kingdom increasing so has patient’s expectations of the NHS, health and social care due to the input from the media. The introduction of the white paper: Our Health, Our care, Our say: a new direction for community services (2006) set out by the Department of Health was thought to be responsible for these expectations. People up and down the country were asked what they liked and wanted from their local health and social care services. People responded with enthusiasm and the government listened and promised to give the public more choices, providing better information about their health and how to stay healthy. The paper gave people more power and influence over the type and recommended standard of service they were to be offered locally. People expect to be treated more as partners and equals and expect choices and options available to them (Department of Health 2006). The provision of palliative care has also changed, historically provision of palliative care focused on supporting patients with cancer however over the last few years moves have taken place to expand the scope of specialist palliative care in order to attend to needs of patients with non-malignant diseases (Small et al 2000). In 1997 the department of health released a white paper: The New NHS: Modern and Dependable which suggested that the Calman-Hine Report: A policy Framework for Commissioning Cancer Services (1995), which examined and proposed a restructuring to cancer services in the United Kingdom could extend its services even further to include people with non-malignant diseases (Department of Health 1997). Amongst the Calman-Hine report were recommendations that everyone with cancer should have equal access to high levels of expertise regardless of where they reside in the country, and a distinction between palliative and terminal care meaning that patients have access to services earlier on in their illness (Calman Hine 1995). Expanding specialist palliative care to patients with non-malignant diseases has had a significant impact on the work load of specialist palliative care services by stretching resources to the limit. Although emphasis has been on providing all patients with life limiting diseases palliative care, is this actually being done? According to Watson et al (2005) specialist palliative care services are not readily available to patients with non-malignant diseases as they are to cancer patients. There is also a lack of support for patients from the voluntary services such as Marie Curie. In order to assist nurses to deliver evidence based practise initiatives such as care pathways were developed. These developments were put in place following the introduction of the white paper: A First Class Service-Quality in the new NHS back in 1998. The white paper was proposed by the government and aimed at producing a strategy to improve the delivery of health care. Three national initiatives which are important parts to the palliative care approach are the Gold Standard Framework, Preferred Place of Care document and the Liverpool Care Pathway. The Gold Standard Framework is a programme of assessment and care. Its aims are to improve quality of life for both patients and their families in the last year of a patient’s life. The Liverpool Care Pathway was developed 10 years ago and is a tool to assist health care professionals care for those who are in their last few days of living. The third initiative preferred place of care document is aimed at putting the patient at the centre of care, giving patients the choice regarding where they would like to be cared for and where they choose to die (Ellershaw Wilkinson 2003). The preferred place of care document is important to the changing role of the community specialist palliative care nurse. The End of Life Strategy for England delivered by the Department of Health (2008) set out a comprehensive plan to improve end of life care for all dying people. This is the first strategy that does not solely concentrate on improving end of life care for people with cancer. Following on from the government’s proposals in 2003 one of the key components of the strategy is giving people the choice about where they choose to die. Given the choice many people would prefer to die in their own homes with adequate support from professionals, however this is not always possible (Thomas 2004). At the beginning of the 20th century the majority of people who were terminally ill died in their own homes whereas today statistics show that 66% of people die in hospitals and 19% at home (Ellershaw Wilkinson 2003). Some of the reasons why this is not possible are due to inadequate symptom control, which is an important role of the community specialist palliative care nurses. Community specialist palliative care nurses generally work normal working hours so what provision is there for patients outside of these hours and who covers the work of the nurses when their working day is complete? Palliative patient’s complex needs require swift responses from palliative specialists when it comes to out of hours services. If patients were receiving 24 hour care unnecessary emergency hospital admissions and suffering of patients would be reduced. A number of community specialist palliative care nurses within certain trusts have gone onto complete nurse prescribing courses. They have the ability to prescribe from the extended formulary making them independent prescribers. For specialist nurses’ having this expanded nursing skill means they have the opportunity to work more autonomously. As one of the key roles of the community specialist palliative care nurse is managing difficult symptoms having the ability to prescribe immediately and appropriately helps promote a service that will reduce patients and carers distress (Mula and Ware 2003). This further acknowledges the importance of specialist nurses working out of normal working hours. The National Institute for Clinical Excellence (2004) suggests that in order to provide good end of life care patients need to have access to specialist palliative care 24 hours a day, 7 days a week. However a report by the National Audit office (2008) reported that just over half of local health authorities provided such care. The last government promised that all cancer patients would have access to specialist nurses trained in their condition (Rose 2010) however generally this too is only available during normal working hours according to Macmillan Cancer Support (2010) meaning that it is then acceptable for such care to be provided by generalist nurses.

The Battle Continues When Soldiers Return from Iraq Essay -- Mental Il

The Battle Continues When Soldiers Return from Iraq Even though Jimmy Massey, a former U.S. solider in Iraq, was pulled out of the war almost two years ago, it remains at the center of his life. On May 15, 2003 Massey was flown back stateside and though he lives a life without bullets and tanks, he now fights off terrible nightmares, constant anxiety, and bouts of depression. Massey, 34, was a marine for almost 12 years before he was deployed to Iraq during the initial U.S. invasion. There he witnessed the shooting of more than 30 innocent civilians and his thoughts of war transformed forever. Massey was honorably discharged from the military with Post Traumatic Stress Disorder and suffered major depression. Despite being called a coward by his superiors Massey, with the help of his wife Jackie, sought the mental health treatment he needed. The Massey’s search for assistance proved not to be a simple task. â€Å"At first all he did was see therapists. It took us about six months to get him set up through the Veterans Administration to get his medicine and start therapy. There is such a huge waiting list that he doesn't get to go to therapy as often as he would like but I guess at this point something is better than nothing,† his wife, Jackie said. There have been times when the Massey’s feel they are fighting an uphill battle with the Department of Veterans Affairs (VA). Because there is no cure for Post-Traumatic Stress Disorder Massey will likely be in need of treatment for all his life. Post-Traumatic Stress Disorder (PTSD) is a mental illness that develops after a person experiences a horrific or traumatic event. More specifically, the term Combat PTSD was developed after Vietnam, even though the condition h... ...holism and PTSD go hand in hand and the VA Hospital made a terrible mistake that day,† Lessin said. MFSO never want a situation like Jeffery Lucey’s to occur again. Through working with organizations like MFSO and educating people about PTSD, people like the Massey’s hope the system can make progress within the system. Jackie Massey believes the blame should not only lie on the VA Hospital, but on the huge lack of funding and lack of staff. The VA reported that in 2003 almost 200,000 veterans were on waiting lists to receive health care. â€Å"I am working right now to make some changes. I want to have a database of therapists and doctors who will offer their services to returning soldiers for free or reduced costs so that these men and women can receive treatment outside the military. I think that is a very important key in the whole process,† Jackie Massey said.