Contract Definition Paper Essays - Contract Law, Contract

Contract Definition Paper Essays - Contract Law, Contract Contract Definition Paper Brian Olson Business Law 8 January 2001 A contract is a binding agreement made between two competent parties that can be written verbal or implied. The purpose of a contract is to create an agreement that can be supported by the law (Wests Encyclopedia). As we enter the new millenium, and with the increase in the number of businesses (including e-commerce), we need to know more and more about contract law. Knowledge of contract law can also protect consumers and businesses from misunderstandings. The six elements of a contract are: binding agreement, competent parties, form required by law, legal in purpose, consideration, and genuine assent. Binding Agreement A binding agreement is a contract, verbal or written, between parties that is bound by law. When two competent parties make an agreement, it is considered binding. A binding agreement must have an offer and an acceptance. An example of a binding agreement would be if Kelly told Jamie that she would buy her car for $6,000 and they both agreed to it. This agreement is legal in purpose, supported by consideration, is in the form required by law and is made by two competent parties who gave genuine assent. Competent Parties To make an agreement a legal contract, both parties have to be competent. All adults are assumed to be competent. Its important for people who are making contracts to be of sound mind. This means that the people involved cannot be under the influence of any substances or be mentally ill. Convicts and enemy aliens are also considered to lack capacity. Capacity means the ability to understand ones actions and the effects of those actions. It is legal for minors to enter into contracts, but they cannot be bound by law because younger people have limited experience and are more vulnerable than adults (Mietus 163). The purpose of competency is so people dont take advantage of those who are not competent when entering into contracts. When an adult makes a contract with a minor, the minor is the only one who can disaffirm the contract. The adult is bound by law (Mietus 163). An example of a contract that cannot legally be bound would be if John wanted to buy Ryans car for $2000 and Ryan refused. Later that day, John took Ryan out to a bar and offered him several drinks. John offered to buy Ryans car again and Ryan agreed because he was under the influence of alcohol. Due to Ryans lack of competency, this contract is void. Consideration Consideration is the promise or action that one person (the promisor) gives in exchange for the promise or action of the promisee (Mietus 198). A promise of giving without receiving is not a legal contract and would be called lack of consideration. An example of lack of consideration would be if grandpa said he would pay for your college tuition if you get straight As in high school and then decides not to do it. That promise would not be legally binding because he is not getting anything in return. Both parties must get something in return for the contact to be legal. An example of consideration is if two competent parties traded a pen for a watch. Each party is giving and receiving something of value, which is called consideration. One of the exceptions to consideration is promissory estoppel. An example of this would be if your dad said he would buy you a brand new car if you paid your way through law school. Because you suffered an economic loss to hold up your end of the bargain, the other party could be legally bound by promissory estoppel. Another exception to consideration are charitable contributions. For example, if I told Red Cross that I was going to donate $500 per year, then I could be legally bound to do so. Genuine Assent Genuine assent exists when consent is not clouded by fraud, duress, undo influence or mistake (Mietus 212). For example, if Billy pulled out a gun and got Ed to agree to sell his bike for $5, Ed is under duress and is not giving genuine assent to sell the bike. Genuine assent must be communicated clearly in some way (written, verbal or strongly implied). An example of not

Throes vs Throws - Commonly Confused Words

Throes vs Throws - Commonly Confused Words The words throes and throws  are  homophones: They sound alike but have different meanings. The plural noun throes means a great struggle or a condition of agonizing pain or trouble. The idiom in the throes of means in the midst of some painful or difficult experience.Throws is the third-person present singular form of the verb throwto toss, hurl, or discharge. Examples They simulated agonized death throes, rolling around on the ground, twisting their bodies into grotesque shapes and making hideous faces. (Ken Follett, The Pillars of the Earth)In the late 1970s, Uganda was in the throes of economic collapse, and there were long lines in Kampala for even the most basic goods.A young lady appears at the window and throws kisses to the crowd.A sacrifice bunt should be attempted only when the pitcher throws a strike. Practice: My four-year-old son whines and _____ a fit every time we try to take him to the playground.The country was in the _____ of revolution, and the king was compelled to abdicate.Gertrude _____ flowers into Ophelias grave, saying, Sweets to the sweet. Farewell.If you are in the _____ of a hurricane, steer for the calm spot. Answers My four-year-old son whines and  throws  a fit every time we try to take him to the playground.The country was in the  throes  of revolution, and the king was compelled to abdicate.Gertrude  throws  flowers into Ophelias grave, saying, Sweets to the sweet. Farewell.If you are in the  throes  of a hurricane, steer for the calm spot.

Reasoning for Bible Allusions in the Bear Essay Example | Topics and Well Written Essays - 750 words

Reasoning for Bible Allusions in the Bear - Essay Example Also Sam Fathers painted Isaac's face with the deer of the blood after his first kill of a deer, a ritual that symbolizes sacrifices. The bear Old Ben, conversely, is a complex object of symbolism. Many scholars interpreted Old Ben as a symbol of strength and willingness of human nature. Some sees him as a symbol of freedom in wilderness. However, in Biblical allusion, Old Ben was compared to the Tree of Knowledge. Hunters are hunting down devotedly the old bear. Not because it was a threat to the nearby civilization, but because of the hunters' pride in the achievement of the wild bear's declination. The curiosity is intriguing and enticing to accomplish. The same goes with the Tree of Knowledge. The fruit of the three was forbidden to eat. Thus it became a center of curiosity for the first man and woman habituated the garden, its taste, its effect after eating it. The majestic figure of the bear fascinated the minds of the Southern Hunters. The rewarding hunters' pride to take down Old Ben was like a devil that tempted Eve to defy and eat the forbidden fruit. It is then tempting the mind towards viciousness of the southern people to go after the cruel reward awaiting. Canaan is obviously referring to the So... It was also directly describing the South where Faulkner himself explored with his early years as well as Isaac's during his early years, as Hebrew Bible illustrated Land of Canaan as extension southward from Gaza to the Brook of Egypt. The civilization in the second part of the story that Isaac gone to had came from the concept of Canaan. Faulkner used both Biblical places to emphasize the contrast between the wilderness and the civilization. From the Garden of Eden, Isaac fled to Canaan, and eventually learned that people in the civilization can be more uncivilized as creatures in the wilderness were, if not being paralleled. This in regards to the lifestyle he witnessed during in his relatives in the South, like McCaslin Edmonds, and Uncles Buddy and Buck. The practice of incest, the deception in the Buck and Buddy's old ledger of ownership, Cass' prejudices, all of these made Isaac to see that Old Ben is a symbol of untamed human willingness and at a same time of great independence of human spirit. The fascination to kill Old Ben was the curse that brought in people's lives towards their greed and viciousness. Now, in the last part of the story, Boon's madness could be the result of the curse in discovering the curiosity of killing Old Ben. The same goes when Adam and Eve have eaten the forbidden fruit of the Tree of Knowledge, a curse bestowed to them along with the knowledge they suddenly acquired upon eating the fruit. Boon suddenly thinks he owns everything in the wilderness as he defeated the most regarded powerful creature in it. He acquired a thinking of replacing Old Ben's mightiness. Thus the impossible possession he had will make him madder eventually. A repeat to the excerpt of Faulkner's description "Arcadian Biblical vision of a world which

FedEX company Essay Example | Topics and Well Written Essays - 500 words

FedEX company - Essay Example The Company also aims to achieve a 10% increase in its operating margin. In order to attain to this long term objective, the Company has set out certain business goals, as laid out below (www.fedex.com): Additionally, the Company also plans to improve its reputation as an environmentally friendly organization, by reducing carbon dioxide emissions by 20 percent by the year 2020. (www.thaipr.net). The central focus of the Company’s plans and goals revolves around its people, i.e., â€Å"people are the wind beneath our wings.†(Frock, 2006:201). In the achievement of its goals, FEDEX has capitalized the vision of its founder, Smith who believed the success of the Company lay in IT(Lappin, 1996) and has implemented IT systems that are geared towards strengthening its e-commerce operations. The realization that information systems could play a vital role in ensuring the success of business has enabled the Company to survive and gain a head start in package delivery (www.garyclarke.com). The Company has made large investments in technology, using tracking software in order to ensure that the current delivery status of a package is always available, through the use of its proprietary network called Cosmos. The Company also sets up computer terminals at its customers’ offices and allows them access to the tracking software as well, so that they are able to generate their own pick-ups and deliveries (www.brainmass.com). Customer tracking of packages is facilitated through the use of the Powership software and terminals (www.informationweek.com). The Company has been using wireless applications for a long time, but the efficiency of its current operations has been achieved by integrating SAP into its tracking system in managing its supply chain. The significant aspect of its technology development is the use of SAP R/3 systems to integrate its tracking systems with its supply chain logistics.

Alberto Korda Essay Example for Free

Alberto Korda Essay The history of Spanish culture and their historic events have been captured through art for centuries. Photography is one form of art that has documented and symbolized historic events that are still used today as historical documents. A Cuban photographer, Alberto Diaz Gutierrez, also known as Alberto Korda, famously documented the events of the Cuban Revolution. Alberto Korda became the world’s most famous Cuban photographer for his photography, documenting history of the revolution with over 55,000 revolutionary themed photographs. Korda was born in Havana Cuba in 1928. He taught himself about photography with his father’s camera, leading to capturing some of the world’s most famous photographs known today. Korda’s career began shooting photographs at weddings and baptisms, and selling his photo’s as souvenirs at the event after he developed them. In 1953 Korda opened up his own studio with photographer Luis Pierce. When the studio first opened, they were accepting any jobs that they came across from advertising to fashion jobs. Korda’s style of photography was distinctive from the traditional photographers style. Korda was different from the traditional style because he disliked artificial lighting and only used natural light in his studio. Korda was quoted saying that artificial lighting was â€Å"a travesty of reality.† It was Korda’s unique style that helped him become widely recognized in the fashion world photography. He quickly established himself as Cuba’s leading fashion photographer. This unique style of untraditional photography led his business to becoming more then a photography studio, but an art studio. In 1959, Korda hit a turning point in his career, the Cuban Revolution. When the Cuban Revolution began, a newspaper was created which was different from most, in which it had many more photographs than articles documenting the uprising events in Cuba. Korda was sent with a team of photographers from the paper to the United States to document the events while Fidel Castro was visiting the United States in 1959. One of the first monumental photographs taken during the visit was a photo of Castro’s visit to the Lincoln Memorial in Washington, D.C, photographed by Korda. From then on, Korda became Castro’s personal photographer; following Castro wherever the revolution took him Korda went, traveling throughout Cuba and overseas. On an assignment after the guerrillas defeated dictator Fulgencia Batista, Korda encountered such extreme poverty that changed his life, transforming himself to become a part of the revolutionary cause. Korda said, â€Å"Nearing 30, I was heading toward a frivolous life when an exceptional event transformed my life: The Cuban Revolution. It was at this time that I took this photo of a little girl, who was clutching a piece of wood for a doll. I came to understand that it was worth dedicating my work to a revolution which aimed to remove these inequalities.† The photograph was named La Nina de la Muneca de Palo. One of the images that Korda captured of the leaders involved was of Fidel and Nikita Khrushchev, illustrating the differences in each of them that were obvious in their individual politics. He continued to follow the new Cuban leaders wherever the revolution took them, Korda followed. Fidel returned to Sierra Maestra, in 1959, where the attacks of Fulgencio Batista regime began. Korda would always get himself in front of the uprisings Fidel was leading in order to get the photographs he wanted. Whenever Korda was return home, he would develop the documentary images and give them to the newspaper to print. During the trip to Sierra Maestra, Korda snapped many pictures and named the series of photos â€Å"Fidel Returns to Sierra.† In 1960, Korda captured a worldwide symbol of revolution and rebellion, the iconic image of Che Guevara. The image was taken at a protest rally after a Belgian freighter carrying arms to Cuba was blown up by counterrevolutionaries while being unloaded in Havana harbor, killing more then 100 people. Doctor Ernesto Che Guevara joined revolutionaries to help save lives, but during a historic battle, her took up arms and came a symbolic freedom fighter. This photograph of Che Guevara captured by Alberto Korda is considered to be the most iconic image in human history. Every one of Alberto Korda’s photographs of the revolution was symbols of the revolution. He wanted to help complete the goals that were thought to be what the revolution was about. He dedicated his life to Fidel Castro as an official photographer, a friend, and a personal photographer. Korda did not get paid to be Fidel’s photographer. Korda more recently spoke in Havana and said, â€Å"Life may not have granted me a great fortune in money, but it has given me the even greater fortune of becoming a figure in the history of photography.† Korda had a passion for photography, his country, and the causes of the revolution.

Welsh Language Census Report :: essays research papers

Sociolinguistics LING 2150 Assessment 1 Use the census data available on Welsh to build up a picture of what happened to a chosen small area of Wales over a period for which data is available in the census. The focus of your discussion should be on the rise/fall/stability of the minority language. Try to use data about the age of speakers, and degree of literacy. For this essay, I plan to look at what has happened to the number of speakers of Welsh in both Swansea and the Lliw Valley over time by using census data, comparing the two areas which both lie in South Wales in the county of West Glamorgan. These areas are of a similar size, with Swansea recorded in the 1991 census as being 24,590 hectares, and the Lliw Valley as 21,754 hectares. These measurements do not differ more than 500 hectares from year to year in the data I will use, however, I will have to take into account the fact that the boundaries for Welsh counties sometimes change between censuses. For this reason, I will have to be very careful when choosing my data. The population of my chosen areas differs dramatically though. In the 1991 census it was recorded that the population of Swansea was 181,906 and the Lliw Valley was 63,099. This means that in Swansea there are 7.4 persons per hectare contrasted with 2.9 in the Lliw Valley. Due to this, I thought it would be interesting to compare such an urban area as Swansea with a rather more rural area as the Lliw Valley to see if there are any differences that can be found regarding the number of Welsh speakers.   Ã‚  Ã‚  Ã‚  Ã‚  We can see these two areas on the following map. Note the dense network of major roads around the Swansea area contrasted with the small amount in the Lliw Valley. Also, we can see that the counties of Dyfed and Powys are large rural areas, with sparse scatterings of major roads: (The public's library and digital archive, 1993) â€Å"Of the languages spoken at the present time in mainland Britain, Welsh has been here by far the longest,† (Price, 1984:94), so why, may we ask, has it come to be that it is only spoken by a minority of the Welsh population? We can see from the following table the extent to which the number of speakers of Welsh in Wales has declined since 1901:   Ã‚  Ã‚  Ã‚  Ã‚  Speaking Welsh only  Ã‚  Ã‚  Ã‚  Ã‚  Speaking English and Welsh  Ã‚  Ã‚  Ã‚  Ã‚  Total

Epicatechin content in green tea (Camellia sinensis) supplements and their antioxidant activities

Introduction/background Green tea produced from Camellia sinensis is a popular beverage and is consumed worldwide. Green tea produced from Camellia leaves are mainly consumed in East Asian countries including China, Japan and Taiwan; whereas in western parts and south Asian countries, black tea is relatively popular (Chan, et.al. 2011). Green tea produced from Camellia is believed to have several health benefits. The tea from Camellia mainly contains flavanols or catechins, epigallocatechins, epicatechin gallate and epicatechin. The tea is manufactured in such a way that the catechin oxidation by polyphenol oxidase is prevented (Chan, et.al. 2011). Although all of these components in green tea are reported to have several health benefits, in this study only the role of epicatechin in green tea from Camellia has been extensively reviewed. Epicatechin is a strong antioxidant, which has been suggested to have several health benefits (Ravindranath, et.al. 2009).1.1. Project Aims Considering the antioxidant acti vities of epicatechin content in Camellia sinensis, and having reviewed available literature on the subject area, this project therefore aims to; Identify and quantify epicatechin content in herbal supplements by using standard compound. Understand and evaluate the antioxidant property of the standard compound that has been reported to be the antioxidant activity of the supplements. These aims were targeted with the views to providing clearer understanding of the role of antioxidants, present in green tea, as well as the health benefits associated to it.1.2 Standardization of plant extractsHerbal supplements are the complex mixtures containing organic chemicals derived from different plant sources including leaves, stems, flowers, roots and seeds. Although most herbal supplements and their compounds present in them are safe, many have been reported to have biologically active compounds that can alter several physiological processes within the body, as well as may interact with drugs. Thus, it is important to know the presence of active ingredients in the herbal supplement (Bent, 2008). Moreover, plant extracts are found to be rich in free radical and reactive oxygen species that are implicated in the alterations of various metabolic processes, and may lead to human diseases (Cases, et.al. 2010). Information on the biologically active compounds in herbal products will also help consumers in many aspects. Higher therapeutics effects can be seen in standardized extracts compared to the whole herb or non-standardized extracts; this is because, active principal is concentrated to a much higher level in the extracts than in the plant itself. Thus, purchasers of herbal products will get health benefits if extracts are standardized (Cases, et.al. 2010). 1.3 AntioxidantsAntioxidants are the compounds that are commonly derived from enzymes such as superoxide dismutase, catalase, and glutathione peroxidase and glutathione reductase; from minerals such as selenium, manganese, copper and zinc; as well as naturally from A, C and E vitamins (Lobo, et.al. 2010). Natural antioxidants are commonly found in plants consumed in the diet including carotenoids and phenolic compounds. Moreover, plants contain high concentrations of numerous antioxidants that include polyphenols, carotenoids, tocopherols, tocotrienols, glutathione and ascorbic acid (Charles, 2013). Their most important role in the body is to protect cells against the effects of free radicals. Free radicals are the unstable molecular species containing an unpaired electron that are able to exist independently. Most of these species are highly reactive and are potentially damaging to the cells (Lobo, et.al. 2010). Some of the common oxygen- free radicals that are involved in many human diseases include hydroxyl radical, superoxide anion radical, hydrogen peroxide, oxygen singlet, hypochlorite, nitric oxide radical, and peroxynitrite radical. Increased levels of these reactive species in the body cells induce damage of the DNA, proteins, carbohydrates and lipids. Thus, a balance between free radicals and antioxidants is necessary for proper physiological function (Lobo, et.al. 2010). Any dis-balance in this may result the initiation of various diseases including cancer, vascular diseases and degenerative diseases. Hence, the study of antioxidants and their sources have been the focus of intense research.1.4. Brief information on herbal supplements to use in the projectThis project studies the presence of epicatechin content in Camellia sinensis; thus, the project uses herbal capsules from Camellia sinensis as herbal supplements. Camellia sinenis is taken as green tea and contains antioxidants i n it, which is why it is commonly used in herbal medicine. Epicatechin is abundantly found in Camellia sinensis herbal supplement. Cameillia sinensis also contains various active compounds as extracts. Some of the major active compounds found in Camellia sinensis include catechins, caffeine, flavonols and proanthocyanidins (Charles, 2013). The health benefits of green tea (Camellia sinensis) epicatechins are being extensively studied and explained . Endothelial cells are associated to vascular function and homeostasis whose dysfunction may have implication in cardiovascular disease including atherogenesis. (Moore, et.al. 2009). Moreover, some studies suggest their anticancer role by enchaining apoptosis (Ravindranath, et.al. 2009). With findings emerging from several new studies regarding the health benefits of the green tea from Camellia sinensis, it is being increasingly popular among the people. Methods Simple and reliable techniques will be chosen in this project to investigate epicatechin content in Camellia sinenis. Experiments will be carried out using reflux extraction to determine the biologically active compounds present in the test supplement (herbal capsules from Camellia sinensis). This will be confirmed by NMR analysis. NMR analysis will be done to confirm that determination of correct biological compound including antioxidants from Camellia sinensis. Crude extract will be made from the material extracted from herbal capsules using a suitable solvent under reflux, which will then be run on thin layer chromatography (TLC) to see if a corresponding band for the standard also appears in the extract. This will tell whether or not the compound is present in the extract, as the study of organic compounds present in the supplement of Camellia sinensis can be made using this technique. To cut of the evaporation time, rotary evaporation method will be employed while evaporating th e solvent. Reverse phase analytical high performance liquid chromatography (HPLC) will be used to identify the standard compound in the extract and then to quantify the amount of compound in it. Finally, the antioxidant assay will be carried out to determine the antioxidant activity of the extracted compound; as a control, plant Flavonoid quercetin, which has antioxidant activity, will be used. REFERENCES Charles, J.D. (2013). Antioxidant Properties of Spices, Herbs and Other Sources. Natural Antioxidants. 39-64. Chan, E.W.C, Eu, Y.S, Tie, P.P, Law, Y.P. (2011). Pharmacognosy Research. Antioxidant and antibacterial properties of green, black, and herbal teas of Camellia sinensis. 3(4), 266-272. Irshad, M and Chaudhuri, P.S. (2002). Indian journal of experimental biology. Oxidant-antioxidant system: role and significance in human body.. 40(11), 1233-1239. Lobo, V, Patil, A, Phatak, A, Chandra, N. (2010). Pharmacogn Rev. Free radicals, antioxidants and functional foods: Impact on human health. 4(8), 118-126. Moore, R.J, Jackson, K.G, Minihane, A.M. (2010). The British journal of nutrition. Green tea (Camellia sinensis) catechins and vascular function. 96(4), 597-605. Ravindranath, M.H, et.al.,. (2006). Evid Based Complement Alternat Med.. Epicatechins Purified from Green Tea (Camellia sinensis) Differentially Suppress Growth of Gender-Dependent Human Cancer Cell Lines. 3(2), 237-247. Ravindranath, et.al., (2009). Evidence-based complementary and alternative medicine. Differential Growth Suppression of Human Melanoma Cells by Tea (Camellia sinensis) Epicatechins (ECG, EGC and EGCG). 6(4), 523-530. Roman, M, (2001) Natural Products Insider, http://www.naturalproductsinsider.com/articles/2001/04/the-benefits-and-pitfalls-of-standardizing-botanic.aspx, 11/12/2013. Uzunalic, A.P, et.al.. (2006). Food Chemistry. Extraction of active ingredients from green tea (Camellia sinensis): Extraction efficiency of major catechins and caffeine. 96(4), 597-605. Yang, Z, Xu, Y, Jie, G, He, P and Tu, Y. (2007). Asia Pac J Clin Nutr. Study on the antioxidant activity of tea flowers (Camellia sinensis) . 16(1), 148-152.

Qualified nurse during a clinical placement Essay

Decision making essay Decision making is important to nurses in today’s society, ( Thompson et al 2002) as a number of policy and professional imperatives mean that nurses have to worry about the decisions they make and the way in which they make them. The government has produced several policy initiatives (DOH 1989, 1993a, 1993b 1913c,1994, 1995, 1996a, 1996b,1997, 2000, 2000) which have led to the creation of an evidence based health care culture ( Mulhall & Le May 1999). Thompson et al (2002) believe that poor decision making will no longer be acceptable, the government aim to examine professional performances and the outcome of clinical decision making for the first time. Evidence based practice will no longer be an optional extra but a requirement of all health care professionals. The aim of this essay is to analyse and evaluate a decision made by a nurse in a community practice. The author will highlight why she chooses the particular issue and how it is important to nursing. The author will provide an overview of two general approaches to decision making, rational and phenomenological, by evaluating and analyzing them. The author will consider decision making theories, and try to apply them to the decision making process witnessed in her community placement. She then aims to show, how they should or could have been used as an aid in effective decision making. She will also consider influencing factors that effected the decision making process. A pseudonym is used throughout the essay to protect the patient’s identity, as stated in NMC (2002) code of professional conduct section 5. The patient chosen for the purpose of this essay will be referred to as Jo. Jo is 53 year old women who suffer with rheumatoid arthritis. This also resulted in Jo having bilateral hip replacements. Jo is on steroid treatment, which leads to thinning of the skin and susceptibility to trauma (Mallet and Dougherty 2001). Jo lives with her husband and two grown up  sons. Jo was refereed to the district nurse on her discharge from hospital following her second hip replacement. The initial referral was to check the surgical wound. However on arrival it was pointed out by Jo that she had a skin tear on her left shin that wasn’t healing. The district nurse performed an assessment and concluded the wound was a venous leg ulcer as it had been present for 6 weeks. The district nurses used Sorbisan and Telfa to dress the wound. Twice weekly visits were carried out to Joe for a further 4 weeks, and it became obvious that the ulcer was not improving. The district nurse had to make a decis ion on what care to provide. The decision was to try another dressing Aticoat which is impregnated with silver, and not to refer the patient to the leg ulcer clinic at the local hospital. The district nurse involved with Jo’s care was a G grade nurse and in charge of a community practice that had 3 other nurses working in it. The author decided to focus on this particular decision, as she was influenced by the amount of evidence based research available on the issue, and how the district nurse chose to ignore the evidence, and made a decision on the basis of personal knowledge. The author visited a leg ulcer clinic while on her community placement, and asked the expert nurses running the clinical at what stage they would like to see patients referred to them. She was told if a wound wasn’t healing after 4 weeks the patient should be referred, this information was passed on to the district nurse and ignored. The district nurses felt that if he referred all his patients after 4 weeks the leg ulcer clinic at the hospital wouldn’t be able to cope. In doing this he chooses to ignore the expert advice. I found this very frustrating and interesting, and as Scott (2004) said we ought to promote good and not cause harm, in Jo’s case, the action of not referring her to the appropriate expert nurse could be seen as prolonging healing thus causing her harm. I decided to investigate further what issues led to him making his decision. To achieve excellence in care nurses need to base there decision on evidence based care (Parahoo 2002). There is no shortage of research on wound care  and the management of venous leg ulcers. However because research is based mostly on opinions or experience, hence the development of guidelines and protocols that have practical use is difficult (Leaper et al 2004). There are many sources of evidence, Journal; the Cochran Library database relevant to wound care, however there is so much information it would be difficult for nurses to know where to start. Evidence suggest the management of patients with venous leg ulcers is fragmented and poorly managed ( Carrington 1999). Vowden (1997) agrees and suggests healing rates are poor and treatment costs are high, this could be as a result of nurses not referring patients to appropriate experts for assessment and using expensive, inappropriate dressings such as aticoat, which is impregnated with silver. Although there is evidence to suggest that dressing impregnated in silver and sorbisan are highly effective in heavily exudating wound (Leaper et al 2003& BNF (2004) Jo’s ulcer was shallow and not heavily exudating. The evidence for the care of venous leg ulcers strongly points to the uses of 4 layer bandaging. This is demonstrated in Allen and Nelson (1996) work, they found that healing rates improved for patients who  attended a leg ulcer clinic and had 4 layer bandaging applied. This is also backed up by evidence printed by the RCN(`1998), and Research carried out by Nelson (1996), which suggests that between 40 and 80% of leg ulcers heal with the application of compression bandaging. Jo had suffered with her leg ulcer for 10 weeks before a decision was made by the District nurse to change the dressing from Sorbisan to Aticaoat. The use evidence based care, provides the foundation for evidence based practice ( Harding et al 2002), the ulcer healing rate and outcome for Jo could have been improved by a quick referral to the leg ulcer clinic, as this is seen as the most effective way to treat leg ulcers ( Musgrove and Woodham 1995). One of the reasons the district nurse was hesitant about referring Jo to the ulcer clinic, was that he felt compression banging is uncomfortable and requires a strict regime (House 1996), and his experience patients didn’t often comply. However Jo was not offered the choice. Taylor (1996) believes that communication with patients is crucial to compliance, he suggest by educating patients it will enable them to understand the importance of the compression and assist patient to comply to treatment. Patients need to be given the option of whether they are involved in the decision making process. In Jo’s case the district nurse made the decisions, he didn’t explain alternative treatments to Jo, or explain the 4 layer bandaging to her. In the authors opinion the patient was not given an informed choice. There is a professional responsibility to obtain informed consent from patients before a nursing care procedure is carried out (Cable 2003, Averyard 2000, NMC 2002). The ethical issue of informed consent came essentially from the Nuremberg Code (1947)  as a result of human experimentation in world war two. This was aimed specifically at humans involved in medical research, however consent is now applied to nursing clinical procedures (General Medical Council 1988). There is increasing evidence to suggest that well-informed patients manage their health and treatment better, this enables them to feel in control of there illness (Ogden 2001) and have better psychological outcomes (Gibson 2001). Although Gibson (2001) argues that knowledge alone does not change health outcomes for patients, to allow Jo to give informed consent she would need information that was relevant to her condition and treatment. Jo is an intelligent women and giving her a choice of treatment would have protected her autonomy (Edwards 1996) and individual rights (Caress 2003), however Jo was not offered a choice in treatment, and alternatives were not discussed. The district nurse made a decision and applied the treatment. In doing this the district nurse used his power to manipulate Jo into accepting the treatment the he wanted to give. Giving restricted information the nurse restricted the patient’s choices to secure her compliance (Lukes 1974). The district nurses actions went against advocating the government Expert Patient Policy (DOH 2000), which highlights the need for changes in society that mean individuals expect to have choices, and be involved in decision  making (Kenney 2003). Although Jo gave consent for the treatment given, she did not, in the author’s opinion, give informed consent. Decision making can be divided into two groups, decision making from a rationalist perspective and from a phenomenological perspective ( Tanner 1987). Rational  decision making is a step by step approach that follows a logical course, and clearly definable stages (Harbison 1991), taking into account obvious starting points and objectives, assessment tools, policies and protocols. It gives clear predictable outcomes and is process driven. Rational decision making works, on the basis that when a problem arises, the decision maker agrees a definition of the problem and  discovers all the possible solutions, matches the problem with the recourses and chooses a solution that best matches the problem, and then implement solution  ( Harbison 1991).This approach fits in well with the current trend towards research and evidence based care (Harbison 1991). Using the rational approach to decision making, makes assumptions that all decision makers will take into consideration all possible options and consequences, in light of a thorough understanding of a situation. However in practice this approach would be influenced by time constraints, habit and routine, and Harbison (1991) argues that sensitivity could be lost when following a rational approach. Using Phenomenological process in decision making can be seen as a subjective individual approach (Easen et al 1996). This approach takes into account nurses opinions and views, for this reason as discussed by Thompson (1999) it can create bias, as it is based on experienced expert knowledge. Using expert clinical reasoning the nurses draws on a deep understanding of the patient situation and holistic care needs. Intuition is a quality that  nurses have traditionally valued (Trueman 2003), however with the development of evidence based care it is now seen be some to be unreliable, unscientific and unsuitable for nursing practice (Trueman 2003). Intuition has been criticised for not being able to provide a rational for the decision made,  however Benner (1984) believes intuition is understands without a rational. Benner (1984) argues that during a long nursing career, nurses can gain a great deal of knowledge and skill practice, this leads to them being intuitive about the decisions they make. Intuition is not something that is measurable according to Benner (1984), it is developed through experience, expertise and knowledge, along with personal awareness and personality. McCutcheon and Pincombe (2001) also believe that there are benefits derived from intuition in practice, such as enhanced clinical judgment and effective decision making. Although Cioffi (1997) argues that holistic patient assessment and improving nurse-patient relationships are being undermined by a drive for evidence based care. Intuition has been identified as a useful tool as nurses can analysis the situation as a whole rather that a series of tasks (McCutcheon and Pinchcombe 2001). Both the phenomenological and rational decision making theories have a number of strengths and limitations. McKenna (1997) argues that knowledge can only become known by others if it is shared knowledge and communicated to others. McKenna (1997) suggests this causes a problem for the phenomenological model it is almost impossible to communicate something which is intangible, and which the practitioner is unable to express. Using a mixture of both theories can create a holistic and well documented procedure. Lauri and Saklantera (1995) using a factor analytical approach found evidence that both Benners (1984) intuitive model, and the hypothico- deductive approach of information processing, had a degree of analytical usefulness in explains the decision making of nurses. The implications were that both had something to offer and neither is often a single solution to explain decision making in  practice. Using a decision making model such as Carroll and Johnston (1990) would have enabled the district nurse to reflect and evaluate the effectiveness of the care delivered. Carroll and Johnston (1990) outline seven stages of temporal decision making, and acknowledged that these stages may not simply be followed through there sequence, but the nurse can backtrack at any stage. The first two stages of recognition and formulation involves the examination and classification of the situation by the district nurse. During a home visit the community nurse may be confronted with a range of patient problems (Bryans and McIntosh 1996). Some of these are discrete and easily recognised, while others are likely to dependent upon various circumstances in the patients life, which are likely to remain hidden unless they are explored by the nurse (Bryans and McIntosh 1996). In view of the fact that patient and nurses are strangers to each other, Thompson et al (2002) believe this exploration must be skillfully negotiated by the community nurses, if nurses appropriately identify needs, and thus begin the process of addressing these needs and planning suitable care. If this part of the assessment had been undertaken effectively by the district nurse, the patient may not have suffered for a long period with the leg ulcer. Bryans and McIntosh (1996) suggest this phase of decision making is generally less conscious and deliberate, and more difficult to articulate, than subsequent phases. Although Elstein et al (1978) suggest this a very important part of decision making it often gets neglected. Many decision making models start with an assessment phase such as Walsh (1998)  nursing process, which has four stages of decision making, assessment, planning, implementation and evaluation. If the assessment carried out by the District nurse is poor then the rest of the planning and care delivered will be poor. It has been highlighted in many publications Lait & Smith (1998), Lawrence (1998), Thompson (1999) that a holistic assessment is needed in the care of patients with leg ulcers. Holistic assessments help to identify underlying pathology, and ensure correct diagnosis (Moffat & O’Hara 1995). However the way each individual nurse views the wound will depend on there experience and whether they have come across a similar situation before (Thompson et al 2002). Walsh (1998) highlights the need for a goal to measure against in the assessment phase. In Jo’s case the tool used, could have been a wound chart. A wound chart was however was not used, so on subsequent visits the nurse’s used there own judgment on whether the wound had changed. It was however difficult to clearly classify the wound, a point highlighted by Flanagan (1997) who warns wound classification can lead to inconsistencies in care. Different nurses visited each time making it difficult to provide continuity of care. The district nurse had defined the objective, which was to treat the leg ulcer. However the planning phase of Walsh (1998) model was not implemented, the nurse did not consider an alternative as identified as important in Schaefer (1974) theory. The best outcome, in the district nurses view, was considered although not in an evidence based way. Carroll and Johnson (1990) refer to the common sense view of decision making, in  stages 3,4, and 5, alternative generation, information search and judgment or choice. These three stages can be associated with problem solving approaches and with hypothetic deductive models such as Dowie & Elstien (1988). Hypothetic deductive  method could have been used to identified what was going on with the wound e.g. blood test could have been taken to test for clotting factors, a Doppler could have been used to test for circulation. However nurses can’t always wait for a lab test to give a hypothesis so the district nurse then drew on his experience. However using reflection in action (Schon 1983) and taking into consideration of the added problem of Jo being on steroids, he could have put these things into action to help create an evidence based care plan. Carroll and Johnston (1990) usefully includes decision making and subsequent (stages 6, 7) action and feedback. The inclusion of action and feedback in models of decision making has particle relevance to Jo’s community nursing assessment, because her assessment was continuous in nature ( Cowley et al (1994). If the district nurses had utilized the information properly the outcome for Jo may have been more successful. The best outcome for the patient depends on the patient’s response to treatment the nurse’s intervention and appropriate use of information gained from the evaluation (Luker and Kenrick 1992). District nurses need to be flexible in providing care in patients own homes, because of the sheer diversity of home environments and lifestyles of there patients. Luker & Kenrick (1992) believe that community nurses have there own personally owned knowledge that they find difficult to describe. Benner (1984) would describe this as intuition. However many influencing factors are involved with the nurses decision making, the district nurse that treated Jo had 20 years experience, but in the authors opinion had not used reflective and evidence based practice. The use of reflection enables nurses to learn from there experience and build up an expert knowledge base. However if you don’t learn from your mistakes it doesn’t make you an expert. 02971588 11 Experience doesn’t always equal expertise. If you are a ineffective nurse to start with you may always be a ineffective nurse. The district nurse involved with Jo’s case didn’t seem to reflect upon his actions and learn from practice but just performed a task. As long as the patient was being visited twice a week it didn’t seem to matter how long the wound took to heal, as Thompson et al (2002) suggest 20 years experience may be no more than one years experience repeated 20 times. According to Walsh and ford (1990) there is a need for assertiveness and this  was sadly lacking. Walsh & Ford (1990) argues the lack in assertiveness may be generated from being a mainly female profession, and Corbetta (2003) suggests women that work tend to be judged as inferior. However the district nurse involved in this decision making essay was a man, so I would question whether social conditioning had rubbed of on him. The district nurse seemed to resist altering his practice as directed by the ulcer clinic, it was almost as if he had ownership of the patient’s problem and care, and he saw it as a failure if he had to refer the patient on to a specialist service. It is the resistance to change practice that is cited by several authors (Gould 1986, O’Conner 1993, Koh 1993) as major influence inhibiting the introduction of research into practice. However Parahoo (2002) suggests to change the way nurses work, using evidence based practice, nurses need to think about what they do, how they relate to the people they care for and generally stimulate a more reflecting and questioning attitude. Reading research articles can generate a reflective approach (Parahoo 2002) although the author is aware that changing practices based on one research article is unsafe. Nurse managers have an important role in coordinated efforts, aimed at providing effective evidence based care. Although not all nurses are inclined towards academic work (Jootun 2003), the district nurse was the manager so without him being aware and appreciative of nursing research his team of community nurses provided an inadequate service. However as Sleep (1992) states it is unfair and unrealistic for educational programmes to place upon practitioners the burden of introducing research into the workplace, unless the climate prevailing in both service and management spheres is receptive to change. The organisation needs to facilitate changes in nursing to allow the professional as a whole to practice evidence based care (Parahoo 2002). The district nurse worked in a small isolated practice and his priority seemed to be the setting up of new PCT policies. Patients with leg ulcers were almost in the way. If the district nurse had a positive attitude towards research and regularly read research articles on wound care, which as Gould (2001) suggest are available in digestible form, the  care provided would have been evidence based effective care. Recommendations Joint education and clinical career pathways are needed to close the theory practice gap. Many nurses working in small practices are not getting the education they need to prove the government with a highly effective and trained workforce. Many organizations within the NHS are busy and overworked. The time is not available for them to update their knowledge and training. To help nurses who work in isolated community practices the setting up of groups or research meetings could enable them to keep up to date with relevant research, and would enable the effective utilisation of research findings. Nurses can also be encouraged to use expert nurses that are available at many hospitals and PCT. The use of computer networks and interactive software and research newsletters could also aid in the implementation of research practice. Evaluation Carroll & Johnston (1990) provide a framework for decision making, the author feels if the district nurse had used such a framework the care delivered to Jo could have been more effective and evidence based. The District Nurse didn’t evaluate or reflect on the care he delivered. Using decision making model such as Carroll and Johnston (1990) and Walsh (1998) nursing process, the nurse could have delivered evidence based reflective care. Models such as these are used as a guideline to nursing procedures, if they are followed it ensures that patients get best care and that nurses don’t become complacent in the care they deliver, but use a systematic approach alongside there  experiences and expertise Conclusion Intuition has been identified as a useful tool that needs to be recognised within nursing, however a need for a ration approach along side it is necessary. This will enable nurses to provide evidence based care with clear rationales. There are many aspects of nursing that cannot be subjected to measurement, and intuition is one of them, and so is caring. To ignore intuition as a nursing skill would be to deny the patient of truly holistic care. However I would say that the nurse involved with Jo’s care was not an expert in the care of leg ulcers, and was baseing his care on limited research. The effect this had on the patient was a poor standard of care. Reference list Aveyard, H. (2000) Is there a concept of autonomy that can usefully inform nursing practice? Journal of Advanced Nursing 32, 352-358 (BNF). (2004) British National Formulary British Medical Council. London Benner, P. (1984) From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley, Workingham. Bryans, A. McIntosh, J. (1996) Decision making in community nursing: an analysis of the stages of decision making as they relate to community nursing assessment practice. Journal of Advanced Nursing 24, 24-30. Cable S et al (2002) Informed consent. Nursing Standard. 18, 12, 47-53. Caress, A. L. (2003) giving information to patients. Nursing Standard. 17, 43, 47-54. Carrington, C. (1999) A nurse led clinic for treatment of venous leg ulcers. 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Wilcockson, J. (1996) Intuition and Rational Decision making in professional thinking: a false Dichotomy, Journal of Advanced Nursing, 24 (4) 666-673 Edwards, S. D. (1996) Nursing Ethics; A Principle-Based Approach. Macmillan Basingstoke Elstein, A. Shulman, L. Sprafka, S. (1978) Medical Problem Solving: An analysis of clinical reasoning. Harvard University Press, Cambridge. Flanagan, M. (1997) Guidelines and protocols in Clinical decision making Journal of Wound care 6 (5) 207. General Medical Council (GMC). (1988) Seeking Patients Consent: The Ethical Consideration. General Medical Council, London. Gibson,P. (2001) Self-Management education and regular practitioner review for adults with asthma ( Cochran Review). The Cochran Library. Issue 3. Oxford, Update Software. Gould, D. (1986) Pressure sore prevention and treatment and example of nurses failure to implement research findings. Journal of Advanced Nursing, 11, 389-394 Gould, D. (2001) Pressure ulcer risk assessment. 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ECONOMICS OF THE UAE Case Study Example | Topics and Well Written Essays - 4250 words

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