Twelfth Night - Analysis Of Fools Essays (1288 words) -

Twelfth Night - Analysis of Fools A fool can be defined in many meanings according to theOxford English Dictionary On Historical Principles. The word could mean "a silly person", or "one who professionally counterfeits folly for the entertainment of others, a jester, clown" or "one who has little or no reason or intellect" or "one who is made to appear to be a fool" (word originated from North Frisian). In english literature, the two main ways which the fool could enter imaginative literature is that "He could provide a topic, a theme for mediation, or he could turn into a stock character on the stage, a stylized comic figure". In William Shakespeare's comedy, Twelfth Night, Feste the clown is not the only fool who is subject to foolery. He and many other characters combine their silly acts and wits to invade other characters that "evade reality or rather realize a dream", while "our sympathies go out to those". "It is natural that the fool should be a prominent & attractive figure and make an important contribution to the action" in forming the confusion and the humor in an Elizabethan drama. In Twelfth Night, the clown and the fools are the ones who combine humor & wit to make the comedy work. Clowns, jesters, and Buffoons are usually regarded as fools. Their differences could be of how they dress, act or portrayed in society. A clown for example, "was understood to be a country bumpkin or 'cloun'". In Elizabethan usage, the word 'clown' is ambiguous "meaning both countryman and principal comedian". Another meaning given to it in the 1600 is "a fool or jester". As for a buffoon, it is defined as "a man whose profession is to make low jests and antics postures; a clown, jester, fool". The buffoon is a fool because "although he exploits his own weaknesses instead of being exploited by others....he resembles other comic fools". This is similar to the definition of a 'Jester' who is also known as a "buffoon, or a merry andrew. One maintained in a prince's court or nobleman's household". As you can see, the buffoon, jester and the clown are all depicted as fools and are related & tied to each other in some sort of way. They relatively have the same objectives in their roles but in appearance wise (clothes, physical features) they may be different. In Shakespeare's Twelfth Night, Feste's role in this Illyrian comedy is significant because "Illyria is a country permeated with the spirit of the Feast of Fools, where identities are confused, 'uncivil rule' applauded...and no harm is done". "In Illyria therefore the fool is not so much a critic of his environment as a ringleader, a merry-companion, a Lord of Misrule. Being equally welcome above and below stairs.." makes Feste significant as a character. In Twelfth Night, Feste plays the role of a humble clown employed by Olivia's father playing the licensed fool of their household. We learn this in Olivia's statement stating that Feste is "an allowed fool"(I.v.93) meaning he is licensed, privileged critic to speak the truth of the people around him. We also learn in a statement by Curio to the Duke that Feste is employed by Olivia's father. "Feste the jester... a fool that the Lady Olivia's father took much pleasure in"(II.iv.11). Feste is more of the comic truth of the comedy. Although he does not make any profound remarks, he seems to be the wisest person within all the characters in the comedy. Viola remarks this by saying "This fellow's wise enough to play the fool"(III.i.61). Since Feste is a licensed fool, his main role in Twelfth Night is to speak the truth. This is where the humor lies, his truthfulness. In one example he proves Olivia to be a true fool by asking her what she was mourning about. The point Feste tried to make was why was Olivia mourning for a person who's soul is in heaven? "CLOWN Good madonna, why mourn'st thou? OLIVIA Good Fool, for my brother's death. CLOWN I think his soul is in hell, madonna. OLIVIA I know his soul is in heaven, fool. CLOWN The more fool, madonna, to mourn for your brother's soul, being in heaven. Take away the fool, gentlemen. Adding to the humor of the comedy, Feste, dresses up as Sir Topaz, the curate and visits the imprisoned Malvolio with Maria and Sir Toby. There he uses his humor to abuse Malvolio who is still unaware that he is actually talking to the

Deportacin y su procedimiento, causas y perdn

Deportacin y su procedimiento, causas y perdn La deportacià ³n puede afectar a cualquier migrante, indocumentado o legal, e incluso a residentes permanentes legales titulares de una green card. Las causas de deportacià ³n son muy variadas, pudiendo ir desde la presencia ilegal a la comisià ³n de delitos inmorales o agravados.   En cuanto al tiempo que dura todo el proceso puede ser largo, para empezar por las demoras para presentarse en Corte.   Procedimiento de la deportacià ³n en Estados Unidos La deportacià ³n judicial, ordenada por un juez o corte. No confundir con expulsià ³n inmediata ni tampoco con la remocià ³n ordenada por el Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s). Se aplica un tipo de procedimiento u otro segà ºn la naturaleza de la infraccià ³n y de la situacià ³n migratoria de quien la cometa. La deportacià ³n la dicta un juez de una corte migratoria o, si se apela su decisià ³n, entonces es la orden que dicta el BIA, es decir, el tribunal de apelaciones. Es fundamental entender cul es el cargo que se imputa al migrante, buscar un buen abogado, arreglar las actividades diarias para presentarse en corte el dà ­a de la cita y analizar cules son las opciones legales para luchar contra la deportacià ³n. Suspensià ³n deportacià ³n por perdà ³n, asilo, ajuste de estatus o violencia domà ©stica Para poder solicitar y obtener un alivio de la deportacià ³n, deben reunirse una serie de requisitos que varà ­an segà ºn el estatus legal del extranjero. En ningà ºn caso podr ser solicitado por aquellas personas que hayan sido condenadas por un delito agravado (aggravated felony en inglà ©s). Una de las opciones es obtener un  perdà ³n o alivio  que es concedido por un juez, segà ºn su mejor opinià ³n. En cada aà ±o fiscal se pueden conceder hasta un mximo de  4,000 perdones. Tambià ©n es posible suspender la orden de deportacià ³n por ajuste de estatus, asilo o violencia domà ©stica. De hecho, hay hasta nueve recursos legales para luchar la deportacià ³n. En estos casos es muy aconsejable contar con un buen abogado especialista en inmigracià ³n o con un representante acreditado con competencia para llevar el caso. Consecuencias de la deportacià ³n en Estados Unidos La persona deportada no podr regresar a Estados Unidos por un periodo de tiempo que va desde los diez aà ±os  a una prohibicià ³n de por vida para los casos de deportados por haber cometido un delito agravado. Sin embargo, la ley prevà © la posibilidad de solicitar una excepcià ³n waiver, que permita la reentrada antes de cumplirse el tiempo de castigo impuesto. Estos son los posibles perdones que se pueden solicitar, ya que es posible que adems del perdà ³n por la deportacià ³n sea necesario pedir por otras penalidades.   Pero antes de tomar ninguna decisià ³n se debe tener en cuenta si podrà ­a aplicar la proteccià ³n 245(i) para migrantes con peticiones antiguas aprobadas. Si se tiene una orden de deportacià ³n que no se apela o ya se han agotado todas las opciones de lucharla es posible pedir en determinadas circunstancias un aplazamiento o suspensià ³n temporal de la ejecucià ³n de la deportacià ³n. Es lo que se conoce como stay. Salida voluntaria y deportacià ³n: cosas diferentes Puede ser solicitada en determinados casos -est prohibida para los condenados de delitos graves y por actividades terroristas. Si es concedida, el extranjero no tendr prohibida la reentrada a EEUU por ningà ºn periodo de tiempo. Es decir, la salida voluntaria no lleva aparejada la penalidad de aà ±os sin ingresar a Estados Unidos que sà ­ aplica con la deportacià ³n. Bastar con que cumpla los requisitos generales de admisibilidad en la frontera. En este caso, la persona extranjera debe salir del paà ­s dentro del plazo concedido. Si no lo hace podr ser multado y deportado. Consejos para evitar ms problemas Cuando se inicia un proceso de deportacià ³n la mejor opcià ³n es buscar un abogado migratorio y ver cules son todas las opciones para intentar ganar el caso. Es fundamental entender que no presentarse a una cita en corte dar lugar a que el juez dice una orden de deportacià ³n que se conoce como in absentia. Esto quiere decir que el migrante puede ser deportado en cualquier momento, sin derecho a presentarse ante un juez. NOTA: este artà ­culo es meramente informativo. No es asesorà ­a legal.

Famous and Wise Quotes About Friendship

Famous and Wise Quotes About Friendship What more can you ask God for, if you have already been gifted a good friend? True friends are difficult to find. Friendship is a flower that needs to be nurtured. Over a period of time, friendship blossoms and makes your life fragrant with love and energy. And should you need a shoulder to lean on, friendship provides you with a strong one. Read these famous quotes about friendship and gain from the experience of the experienced. Euripedes Real friendship is shown in times of trouble; prosperity is full of friends. Marlene Dietrich It is the friends that you can call at 4 a.m. that matter. George Jean Nathan Love demands infinitely less than friendship. Mahatma GandhiIt is easy enough to be friendly to ones friends. But to befriend the one who regards himself as your enemy is the quintessence of true religion. The other is mere business. Pam Brown Odd how much it hurts when a friend moves away and leaves behind only silence. Aristotle Friendship is a single soul dwelling in two bodies. Proverb God save me from my friends I can protect myself from my enemies. Mark Twain The proper office of a friend is to side with you when you are in the wrong. Nearly anybody will side with you when you are in the right. Elbert Hubbard Your friend is the man who knows all about you, and still likes you. Nigerian Proverb Hold a true friend with both your hands. Anais NinEach friend represents a world in us, a world possibly not born until they arrive, and it is only by this meeting that a new world is born. Emily DickinsonMy friends are my estate. Leo BuscagliaA single rose can be my garden... a single friend, my world. Anne Morrow LindberghMen kick friendship around like a football but it doesnt seem to break. Women treat it like glass and it goes to pieces. David Tyson GentryTrue friendship comes when the silence between two people is comfortable. Aristotle My best friend is the man who in wishing me well wishes it for my sake. C. S. LewisFriendship is born at that moment when one person says to another, What! You too? I thought I was the only one. Albert Camus How can sincerity be a condition of friendship? A taste for truth at any cost is a passion which spares nothing.

Saigon Essay Example | Topics and Well Written Essays - 250 words

Saigon - Essay Example Buddhism is Saigon’s predominant religion that was introduced to the city during its domination by the Chinese, as well as by Indian preachers (Grey 34). Confucianism was also introduced by the Chinese but, interestingly, it became important after Chinese domination ended because the resulting monarchy viewed its political philosophy as more favorable. Finally, Taoism was also introduced by the Chinese and especially appealed to the local Saigon residents because of its polytheism and mysticism (Grey 38). Saigon’s history is mostly associated with war and destruction by most in the West, and for good reason. After being at the epicenter of Vietnam’s struggle for independence against the French, it again became the focus of attention in the US’ anti-Communism war in Asia during the 60s and 70s (Vo 51). The fall of Saigon in 1975 marked one of the biggest military defeats for the US and, soon after, its name was changed to Ho Chi Minh City. There is more about Saigon than its position in the War for Vietnam. The City is well known for its independence from outsiders despite its occupation by Khmer settlers, the Chinese, the French, and the US (Kent 41). The fall of Saigon to Communist forces also marked the end of direct military interventions in South East Asia. Moreover, Saigon’s contribution to popular culture cannot be overlooked with numerous movies and books about what its fall meant to the free

The Hotel Industry Assignment Example | Topics and Well Written Essays - 250 words

The Hotel Industry - Assignment Example People visit hotels for different purposes. The industry offers their customers various of services. The customers need lodging facilities where they can spend their nights and means of transport to move them from one place to another. Restaurants provide foods and drinks during the stay. The hotel industry offers cruise line services, especially for hotels that are located along the coast. Sometimes, customers may contract a selected hotel to oversee planning of special events such as anniversaries, weddings, and special days’ celebrations with proper entertainment services (Puri & Chand, 2009). Products provided by the hotel industry include all types food, soft drinks, and hard drinks. Customers for the hotel industry include people of all ages and races (Barrows & Powers, 2009). Demanders for hotel services and products consist of students, children, middle-aged citizens and the aged. People of all walks usually attend ceremonies such as weddings, conferences and other official functions because they have roles to perform in each of them. Wedding customers demand services of event planners, and these are mostly found in the hotel industry. Business travelers travel on expense account and seek secure hotels that are close to the places of their business rendezvous (Lockyer, 2007). Another group of hotel customers are leisure travelers; these also look for hotels that have leisure activities such as gymnasiums, swimming pools, playgrounds and racing equipment. The hotel industry is dispersed among many companies, each controlling a small market (Brody, 2009). The market structure for the hotel industry is perfect competition. In a perfectly competitive market, there are several buyers and sellers of a particular product; hence, customers have a variety of choices (Khan, 2007). This breaks the market into small portions and each company controls its own market portion. There are several companies in the hotel industry. These include Lords of the Manor, The Feathers Hotel Woodstock, Talbot Hotel, The Trout at Tadpole Bridge, Holbeck Ghyll County House Hotel, and Assured Hotels.

Knowledge and Perceptions of Type 2 Diabetes Individuals

Knowledge and Perceptions of Type 2 Diabetes Individuals Miller, and Achterberg (2000) constructed a multiple choice questionnaire to asses the nutrition and food label knowledge among women with type 2 diabetes mellitus who aged from 40 to 60 years. The questions were placed from the easier to the hard so as to foster confidence among the participants. The questions that measure the factual knowledge were placed in the beginning followed by the more difficult questions (procedural knowledge). The test was designed to be completed within 30 to 40 minutes by most respondents. The reliability of the test was found to be 0.80 based on Kuder-Richardson formula 20(K-R 20). After this the item analysis of the original knowledge test was done. Three questions were deleted from the test because of high index of difficulty (two questions) and item discrimination of only 0.20.The item analysis for the revised version of the test was done and the reliability of the test was found to be 0.81 using the Kuder-Richardson formula 20 (K-R 20) formula. The revised test was administered to 43 women Al Shafaee et al (2008) developed a questionnaire to understand the Knowledge and perceptions of diabetes in a semi-urban Omani population. 563 adult residents of Omani village were interviewed using the questionnaire. The final survey instrument contained 24 items which were subdivided into 5 sections. The first two sections covered the demographics and medical history of the participants. The third section was for the diabetic participants. It covered their diabetic history and glycemic control status. The fourth section included knowledge regarding the diabetes definition, signs and symptoms, risk factors and complications. The final section focused on the community awareness, the participants perception regarding diabetes prevalence, perceived risk of developing diabetes and prevention. Likert-type response scale was used in the questionnaire. To collect data that were otherwise unobtainable with a typical Likert scale, open-ended questions were included which followed a closed e nded question. The questionnaire was pre-tested and piloted within a convenience sample of students and staff at the College. Substantial inter-coding agreement for the scale items was observed (r = 0.86, p Heikes, Eddy, Arondekar, Schlessinger, (2008) developed a Diabetes risk calculator for the U.S. population to calculate the probability that an individual has either undiagnosed diabetes or pre-diabetes. The diabetes risk calculator included questions on age, waist circumference, gestational diabetes, height, race/ethnicity, hypertension, family history and exercise. The tool was validated using the v-fold cross-validation and by performing an independent validation against National Health and Nutrition Examination Survey (NHANES) 1999–2004 data. The data was taken from the National Health and Nutrition Examination Survey. Two tools were built using different methods. The two methods were logistic regression and classification tree analysis. The tool that served the objective of the study was then compared and selected. Classification tree model was chosen on the basis of its equivalent accuracy but greater ease Parmenter, K., Wardle, J. (2000)of use. Dickson-Spillmann, Siegrist, Keller, (2011) developed and validated a nutrition knowledge questionnaire which was administered on participants above the age of 18. The questionnaire initially consisted of sixty-four nutrition knowledge items. Two approaches were used for item generation. The first source of items was through the interviews with the consumers where they were asked about food and health. The second source of items of items was recommendations by Swiss nutrition experts. Content validity was tested by two food scientists who reviewed the questions after which some items regarded as inappropriate by the experts was removed and a few others were re-formulated for enhanced precision and clarity. Twenty items were retained to build the final nutrition knowledge scale that included declarative nutrition knowledge questions on calorie and nutrient contents. Internal reliability was assessed using Cronbach’s alpha. Teede, Harrison, Teh, Paul, Allan, (2011) developed a risk prediction tool to identify gestational diabetes among high-risk women in early pregnancy. The participants for the study were 4276 pregnant women who delivered at Monash Medical Centre, Australia. Previously identified maternal Gestational Diabetes Mellitus risk factors from large epidemiological studies were considered, including increasing age, increasing Body Mass Index, ethnicity, first-degree family history of diabetes, past history of Gestational Diabetes Mellitus GDM and history of poor obstetric outcome. Logistical regression was used to analyse the data. It was observed that the women’s clinical characteristics were significantly associated (p Koontz et al., in the year 2010 developed and validated a Questionnaire to Assess Carbohydrate and Insulin-Dosing Knowledge in Youth with Type 1 Diabetes. They developed a PedCarbQuiz (PCQ) questionnaire by content analysis using a panel of 14 experts. The panel identified seven domains which was necessary for successful implementation of flexible basal-bolus regimens. Each item of the domain was reviewed and revised by the expert panel. Cronbach alpha and split-half testing was used to check the reliability. Further the scores were correlated with expert assessments, A1C, parent educational level and complexity of insulin regimen to assess the validity of the questionnaire. The final PCQ questionnaire was a 20-30 minute, multiple choice, paper based, self-administered questionnaire that had 78 items. Lai, Chua, Tan, Chan (2012) developed the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument. Twelve experienced pharmacists and researchers formulated the DHL knowledge instrument by using the face and content validity. The researchers when through three drafts before they approved the final draft having 28 questions with 5 domains which was in the true or false form. After this the final draft was piloted on 20 practising community and hospital pharmacists. It also included five diabetic patients in a tertiary hospital. This was done to obtain their feedback concerning the clarity and relevance of the instrument. A nutrition knowledge questionnaire for obese adults was developed by Feren, Torheim, Lillegaard (2010). The process of developing the questionnaire had four main steps. The first step was to evolve a structure that involved collecting literature review about the knowledge of nutrition. This was done to describe the scope of the questionnaire. After the information was collected from the literature review, four main sections to assess the knowledge level were formulated. The second step was to generate the items based on the literature review. 273 items were generated based on six existing nutrition knowledge questionnaires and checked for content validity and face validity by an expert panel. Finally this resulted in 98 items. The third step was to pilot study the questionnaire for internal consistency and item difficulty. This procedure reduced the items to 94 after consultation from the expert panel. The fourth step was to test and re-test it for construct validity and reproducib ility. The final questionnaire had 91 items after the entire process. A descriptive research design was used by Okolie, Ijeoma, Peace, Ngozi (2009) to understand the Knowledge of diabetes management and control by diabetic patients at Federal Medical Center Umuahia Abia State, Nigeria. The sample included 96 diabetic patients who went to Federal Medical Centre Umuahia during the time of study. The instrument used for data collection was a questionnaire that was constructed after going through the recent literature on diabetes knowledge and self-management. The face validity was assessed by five Nigerian registered nurses after which a pilot test was conducted at another hospital. The questionnaire was also tested for the reliability by re-testing it before the study. Paddock, Veloski, Chatterton, Gevirtz, Nash (2000) developed and validated a questionnaire to evaluate patient satisfaction with diabetes disease management. To develop the diabetes Management Evaluation Tool (DMET) the items measuring diabetes disease management were identified by an expert panel of health care professionals who recognised the 14 major domains. Content validity was confirmed by diabetes care professionals. To establish face validity a patient focus group was conducted. The final questionnaire consisted three sections having 87 items. The questionnaire measured the satisfaction on 711 diabetes patient using the Likert scale. Further the reliability and validity of the questionnaire was assessed by calculating product-moment correlations and Cronbach’s alpha. Kaur, Saini, Walia (2009) developed a tool to assess mothers preparedness for delivery, postnatal and new born care. The literature was reviewed to prepare an interview schedule. Content validity (content revision, item order revision and item wording) was done with the help of twelve experts in the field of nursing and public health department. The modified interview schedule was pre tested for feasibility in a village on 10 antenatal mothers of trimester. Cronbachs alpha was used to check the internal consistency and factor analysis was used to assess the construct validity. After factor analysis 20 out of the 30 items tool was retained with five factors. A cross-sectional observational study was done by Hamoudi, Al Ayoubi, Vanama, Yahaya, Usman (2012) aimed to assess the knowledge and awareness among diabetic and non-diabetic Nigerian population in Kaduna state towards diabetes mellitus (DM). Non randomized sampling strategy was used to select three hundred forty (340) people (33.7% diabetic and 66.2% non-diabetic participants). A self-administered questionnaire was evolved using the previous review of literature and it was validated by two specialists (a community medicine expert and a clinical pharmacist). Appropriate statistics were then used to derive the results. Diabetes Nutrition Knowledge Survey was developed and validated by Rovner, Nansel, Mehta, Higgins, Haynie, Laffel (2012). The Nutrition Knowledge Survey (NKS) was developd by a multidisciplinary team. It consisted of 39 multiple choice questions four response options. This was then administered on 282 youth with type 1 diabetes and their parents. To check for validity associations were made between the NKS scores with A1C and dietary quality. Reliability was assessed using the Kuder-Richardson Formula 20 (KR-20) and correlations of domain scores to total score. Roopa, Devi (2014) developed and validated a study pertaining to studying the effect of an educational module as an intervention programme in the management of Diabetes Mellitus among the elderly with regard to the improvement in their knowledge, attitude and practices. The sample was determined through purposive random sampling. The sample constituted 80 people between the ages of 65-76. The sex ratio of the sample population was 1:1. The method of study preferred by the investigators was the Structured Interview Schedule (SIS) on knowledge, attitude and practices (KAP) with regard to diabetes was used for assessment.The study involved co-operative action research with an initial exploration of knowledge, attitude and practices in the management of diabetes mellitus among the elderly people as well as a post intervention study. The data obtained during pre and post assessment was analysed. Huizinga et al., (2008) conducted a study in regards to the development and validation of the Diabetes Numeracy Test (DNT).The first phase of development included item generationby a group of experts in diabetes, literacy and numeracy. 70 items were developed and administered to 40 individuals without diabetesto assess understandability. The next phase involved the recruitment of a convenience sample of 398 participantsat clinic visits. The sample was determined based onthediagnosis of type 1 or 2 diabetes, age of the individual (between 18-80) and language spoken by the individual (English speaking) .To eliminate redundancy,the expert panel reduced the measure to 45 itemsthat represented the five self-management areas. The presence of the 45 items was accepted as an adequate indicator to address the range of numeracy skills required in the management of diabetes. Reliability was evaluated through internal consistency testing with the Kuder-Richardson 20 formula. Hearnshaw, Wright, Dale, Sturt, Vermeire, Van Royen, (2007) developed and validated the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes. The questionnaire was developed with the help of previous research and literature review. The sample for the study included 180 people with Type 2 diabetes who were recruited from 22 general practices in the UK. The questionnaire initially comprised of 113 items having five themes which was reduced to 77 items after analysis. The Face and content validity were established by 21 members of the Warwick Diabetes Care Research User Group. These people gave extensive feedback to the research team on the questionnaire design and content. The Diabetes Obstacles Questionnaire was combined with two other questionnaires for the study to establish criterion validity of the questionnaire. Smith, Lang, Sullivan, Warren (2004) made use of two new tools for assessing patients knowledge and beliefs about Obstructive Sleep Apnea (OSA) and continuous positive airway pressure therapy. The sample for the study consisted of81 consecutive adult patients, diagnosed via polysomnography with OSA in the clinical group and 35 members in thenon-clinical group recruitedfrom a local community group in response to an advertisement calling for healthy volunteers without a sleep disorderdiagnosis. The investigators in the initial version of the Apnea Knowledge Test (AKT) based it on a similar measure as developed by Murphy et al., (2000). They initially formulated a set of20 AKT items; however an expert review process resulted in the exclusion offive items and modification of two items. Post this review, it is seen that the version of the AKT that the investigators finally chose to administer included 15 items multiple choice questionnaire, six items from the original Murphy et al., (200 0). The test was then subjected to patient review. The test was administered to the first 10 study participants withinstructions to comment on any difficulties experienced with the items. Further, Cronbach’s alpha was calculated to evaluate the internalconsistency of the AKT.The second tool used by the investigators was the Apnea Beliefs Scale (ABS). These items were evolved based onan exhaustiveliterature review and consultation with the staff members. Content thought to be fundamental to compliance was targeted inconstructing this questionnaire. The final version included 24 statements to assesspatients’ attitudes and beliefs about sleep Apnea andContinuous Positive Airway Pressure. Wright, Wallston, Elasy, Ikizler, Cavanaugh, (2011) investigated the development and results of a kidney disease. The investigation was carried out through the administration of a knowledge survey given to patients with Chronic Kidney Disease (CKD).The survey questions had been developed by experts. The sample consisted of 401 adult patients with CKD (stages 1-5) attending a nephrology clinic from April-October 2009.Approximately 100 questions were generated first to maximize content relevant to kidney knowledge. This was done through an exhaustive study of pre-existing literature. Using an iterative process, items were reviewed for face and content validity and redundancy and ultimately decreased to 34 kidney knowledge questions. These questions were initially tested on a small group of clinical and nonclinical personnel for clarity. The first20 study participants were asked to comment on clarity and content and it was seen that there were no additional suggestions. In order to cal culate survey reliability, the Kuder-Richardson-20 coefficient was used. They established construct validity by testing a priori hypotheses of associations between survey results and patient characteristics. The descriptive statistics that was assimilated was analysed. Warden, Hurley, Volicer (2003) developed and evaluated the Pain Assessment in Advanced Dementia (PAINAD). The PAINAD scale was developed after extensive study of existing literature and available pain assessment tools. The projects were carried out in a Dementia Special Care Unit where 96 in-patients received care for dementia. The sample was determined based on the following criteria, (1) diagnosis of dementia written on the medical record, (2) no planned discharge, (3) inability to report pain or discomfort to caregivers, and (4) a proxy decision maker identified in the medical record. The construct validity was determined using the contrasted groups and hypothesis testing methods. Further, Cronbach’s alpha was selected as the measure for verifying internal consistency. Zeolla, Brodeur, Dominelli, Haines, Allie (2006) development and validated an instrument to determine patient knowledge about oral anticoagulation. The oral anticoagulation knowledge test consisted of20 multiple choice questions. To develop this, Four nationally recognized anticoagulation experts contributed in the making to ensure content validity. The test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin. This was done to assess construct validity and to check test–retest reliability a subgroup of warfarin subjects were retested after 2-3 months of the initial testing. Kuder–Richardson 20 value was calculated to assess internal consistency reliability. Also, to assess performance of each individual the item analysis was done. Peyrot, Peeples, Tomky, Charron-Prochownik, Weaver (2007) developed the Diabetes Self-management Assessment Report Tool (D-SMART). Thefirst resource that the investigators used was a set of existing DSMEmeasurement tools .The second resource they availed of was a set of publications regardingthe evaluation of diabetes education programs,including a description of a comprehensive DSME evaluation system,reviews of studies of DSME,and anumber of studies of specific programs that illustratedkey components of an evaluation system. After multiple drafts of the D-SMART, it was administeredto several individuals with diabetes and diabeteseducators to obtain feedback regarding readability andfeasibility. Post this plot test, several changes were made. D-SMART has completed three rounds of pilot testing and is currently undergoing a fourth round. Eachround is resulting in revisions to the original instrument.

Diploma in Health Essay

There are many different roles within the working environment. This being so, there are many different working relationships, however subtle the difference. When working with another Nursing Assistant there seems to be an immediate understanding of what is required. Although the routine my differ from ward to ward, the tasks largely remain the same and are performed with relative fluidity. When working with a Staff Nurse on something outside of my training, they will take the lead and instruct me in the task. The same can be said for when assisting doctors, physiotherapists and all other professionals. Each has their own role and it is important that they work within the scope of that role, as performing duties not within your skills is breaking with policies and procedures. It is equally as important to be accessible to those who cannot perform certain duties beyond their own remit. Before going to work (I work mainly night shifts) I dress according to the Dress Code, with washed and ironed uniform, sensible enclosed shoes, nothing below the elbows which follows the Hand Hygiene Policy, ID and name badges present. On arrival I gel my hands, put my belongings in the cloakroom and wash my hands before entering the staff room. Before handover we are read the CUBAN which relates to staffing and patient levels, patients with dementia and/or having special needs or one to one care and falls risks. In handover we learn about what has happened during the previous shift, any changes in condition of patients and about new patients needs. All the information is confidential and so the Confidentiality Policy needs to be adhered to. We are all issued with a handover sheet with these details on and I jot down and highlight any tasks that immediately concern me. E.G. Catheters/measured urine, observation times, pressure care, hourly checklists and blood sugars. We are allocated which bays we are to concentrate our efforts on and plan the best course of action, which is  usually standard routine. We then load trolleys with the necessary paperwork and go from patient to patient, checking which paperwork needs replenishing and noting down what time physiological measurements etc. need doing and tidying the bed areas. We then do a hot drinks round and update the fluid and food charts as necessary. Next we help patients into bed. After gaining consent, we help them wash and get into their night clothes. If they need toiletting, the patient’s preferred way of doing so is used. The Dignity Policy is maintained at all times. If it is documented that a patient needs more than one member of staff to transfer them safely then we help each other to do so., thus sticking to Health and Safety and Manual Handling Policies. Usually at this time the trained nurses are available and are easily approachable and willing to help. After the patient is s afely and comfortably in bed, we fill in the repositioning and personal hygiene charts as per Policy. Usually, we start the observations around 22:00, reporting any NEWS score over 3 or anything untoward to the the Staff Nurse who will inform a doctor who may order an ECG, which I would perform and report straight back to him/her. This is an example of how communication and co-operation is so important to working in partnership. Any missing ‘cog’ in a machine could spell disaster, especially in the care industry. More often than not, we answer call bells of patients requiring pain relief through the night. We take the drug chart to the Staff Nurse and she will dispense it. Unfortunately we quite often need to wash and change a patient after a mishap. The correct PPE is always used and Infection Control policies are observed as are Waste Disposal policies. At around 05:30 we empty catheter bags and document output in the fluid charts. We also tidy the bed areas again. Observations, urine measurements and toiletting continue throughout the shift until handover to the day s taff.