Homeless graduates and Joblessness

Homelessness defines a situation in which a person or a family is living without a home to have their privacy. A home is a basic requirement for every individual to live their life comfortably. It is a place where individual’s basic requirements are fulfilled and provide a healthful environment. In USA it must be a legally owned place to have a safe condition for living.  Currently in United States there are many people who are homeless and among them many our graduates and educated people who do not have living. They might be an individual with no other support or a family with not enough resources to rent or buy a house.The term homelessness is not just limited to the meaning of â€Å"without a home†, but it has a very broad meaning covering mostly that population who is without a job, has no living, no support, and might be suffering from health issues.  Such homeless graduates either live on streets or shelters. Such people may suffer from a mental illness or ph ysical illness due to lack of safety health measures and support. They may face a number of psychological and physiological problems.JoblessnessThis is the major cause of homeless graduates. They do not get adequate job and earnings to have their own home. Such guys spend their time on streets, bars, shelters, and many other such places. The one or the other way they just waste their time. Joblessness may be due to their low score at school, any kind of disorder, inability to cope with job and inadequate pay.Mental illnessHomeless graduates might be suffering from mental illness and psychological problems like depression, stress, insomnia, drug abuse, alcohol abuse and criminal activities. According to one study around 40% of these homeless graduates suffer from various mental ailments. A number of studies have shown that suicidal rate is also high in such individuals.Drug & alcohol abuseDrug abuse and alcohol abuse are the two major problems with homeless graduates. As they do not have a job and most of their time is wasted in bars and streets they easily get addicted with drugs and alcohol.Due to increasingly stress for work and pay they become psychologically depressed. The only way they find out is to have some kind of addiction in order to forget their worries. Such graduates when start on drugs and alcohol are usually unaware of its damaging outcomes and health hazards.Hospital and medical expenditureDue to excessive health hazards their expenses for stay at the hospital and medicines are also very high. These expenses are usually bear by the shelters where they live or donation by charity organizations.Marital statusTheir marital status is also at doldrums. As they cannot support their spouse and children, they easily get differences with them.  Strategies to solve this increasing problem of homelessness is first to give them adequate education to improve their grades in college. Every graduate must be assured of a job after they complete their educat ion.  Graduates can be hired as trainee at first to give them proper training after school to get acquainted with their job.  Homeless graduates must have enough support that should cover their health problems. In addition, their environment must be safe enough in order to prevent any health hazards.Educating such people about hazards of drug and alcohol abuse:As they’re not aware of the damaging effects of drugs and alcohol they start consuming them in abundance. Later when they encounter several health problems it becomes really problematic for the shelter supporting staff and the individual himself to manage health issues.  If measures will be taken to inform them about the dangerous effects of drugs and alcohol then heavy costs of treatment can be saved.The reason for writing this letter is to bring to your awareness these problems in homeless people is every growing. It must be noted that if the concerned authorities do not take appropriate measure to stop this pro blem then this situation can become adverse. As more and more people are graduating and homeless kids are reaching their youth this problem does not seem to be ending.  If a homeless person remains jobless and homeless for long period of time then they can become more, dependant, dysfunctional and a burden to a society.It is of utmost importance that some steps must be taken at your earliest to stop ever growing problems of homeless graduates. The first thing is that to enhance their education, bring awareness about hazards of drugs and alcohol, brining health awareness, awareness about exercising and methods to become more useful.  The most important point is that they must participate in any type of activities. Like communal activities, sports activities and volunteer their time in supporting others with handicap.  If a person can become a useful individual of a society in any form then it will be a spiritual satisfaction and a peace of mind for both the individual and the s ociety.ReferencesYesilonis, Bryan. (2007) Report on Homelessness. Retrieved from http://www.bethesda-mission.org/report.htmHomeless Families Program, USA. Retrieved from http://www.valdosta.edu/~clengleh/writingsample.htm

Milestone Assignment Chemistry Essay

Milestone Assignment Chemistry BY 2233 In Method 1. You start by watching the building from afar, seeing how it is used and what Its general structure Is. You then begin to get closer and more particular, examining systems such as the electrical system and sprinkler system, walls and floors. Your last step is to examine the nails, screws and other elements of the building. Which method do you think is closest to your study of chemistry thus far? What are the pros and cons to proceeding one way rather than another? Write 3-5 arcographs and submit the short essay to your teacher. Have fun’ Method one is most similar to Chemistry. This is because the table of elements is like the building and we began by looking at it as a whole and then learned the individual parts of It. First we learned the anions and canons and where they are located. Also we learned specific elements with their symbols. Second chemistry Is like method 1 because as we learned the symbols we also started to put everything together and began making compounds. We did this by lancing the charges and making sure everything was stable like a building. The periodic table Is the foundation of chemistry as a blueprint Is to a building. A pro about this method Is that we begin to see trends and patterns within the table itself. Which help us identity and put together compounds. A con is that you can become overwhelmed when you first look at the periodic table and see how many parts there are. With out the periodic table there would be no chemistry and without the walls and floors and other elements of a building, It would not exists.

Eveline – James Joyce (Short Personal Response)

â€Å"Eveline†, is a story about a 19 year old girl who diligently reflects on the life she has had residing in the same town (in Dublin) with her siblings, everyone she knows, and her abusive father whom she labours excessively for to support. This is the same town her mother died in that she now anticipates leaving for Buenos Ayres, with her fiance Frank. The story of Eveline, by James Joyce, handles many interconnected themes such as attachments, escape and identity, which employs great attention to a specific situation that is relatable to almost everyone: the time to leave home.Though Eveline’s acting outlets resemble those prominent to my own, what interests me the most about her story is her overbearing dilemma to either leave a hard, yet full and interesting life, for an easy and safe, though mundane one. The reason this grabs my attention is because, I’ve often pondered about why it would be so hard for me to leave my own strenuous and distressing home, and my exasperating mother that has caused me so many detriments.This curiosity has led me to believe that the harder one has had to work at home to make things work, regardless of the results, the more interesting their history becomes and the stronger their attachment to that life becomes. For anyone that has been in such a situation, it becomes clear frequently, how big of a part this life is to you and that through the struggles you have learned everything that you now know, and this life is the only one you do know.Something less than ‘this life’ may leave someone, such as Eveline, feeling useless and lost, possibly causing them to spin out of control searching for meaning and value in a new life that seems too simple. The reader sees this progression for Eveline as the story starts with her rested against the window where she goes to reflect not only on her self, but the relationship to the place which she sits whilst the evening rolls in. James Joyce wonderfully illustrates that, â€Å"the evening invade[d] the avenue† at the beginning of the story, while she leaned against the window.This was my favourite line of the story though, I did not catch the second meaning of it until after I had read it a few more times. First, it is clear that, with evening coming, this represents for Eveline, that she is running out of time at home (not in a pleasant and welcomes way either, â€Å"invade† is a pretty harsh word); though it is latent to her until the end of the story that, she does have a choice to stay home. At this point her decision is so straight forward that, to even question not leaving with her fiance Frank would be absurd.Second, Joyce cleverly uses the term â€Å"avenue,† not only to describe the roads of the town which is being covered with the turning of day, but also because it represents the clouding or loss of an outlet or rather, an escape. Eveline sits at the window reminiscing the days that weren’t so bad, when her father â€Å"was not so bad† either. This was a time prior, to when her mother died and before the man from Belfast bought the field which the neighbour kids used to play in and turned the old little brown houses in to bright brick and red houses.In other words, the look of her home did change, some people left town, some people died, but the memories did not die and their meaning did not dissipate. This is important because it foreshadows the reluctance Eveline has to leave her home after having the epiphany that, even if she did run away to a new setting, she would not change who either she or her father were. This realization that Eveline has is not one that everyone does when leaving home (or a place of equal meaning), but even those who do, don’t always make the choice to stay as she did.Some readers may be confused when trying to understand why she did not take the obvious route and leave her father and tiring jobs behind to be with a loving, safe, and wonderful guy as Frank appeared to be. I personally do not question it, I embrace it. The conclusion I drew from reading Eveline made me feel more secure about my own reluctance to leave home and the avenues which I extensively burdened with my attempts of escape and survival.My first was a relationship that was so perfect in its own harmony that I depended on it too strongly to the point that I only saw it as my escape, instead of a separate entity of pleasure, love, and divinity. The second, like Eveline was faith, which is somewhat ironic considering I abandoned religion so effortlessly at such a young age. This turn was not because of a new belief in God, it was for the mysticism and miracles it provided for believers. Unfortunately, my abandonment of religion was so easy because it never made sense to me and it was never my own thought.So my ‘turn back’ was rather unsuccessful when it came to making miracles out of heartache but, it did provide me with new ins ight on the meaning of faith and spirituality that brings me a sense of peace. Though it may only be alluded to in my eyes, what I see at the end of this story is a woman, Eveline, who realizes that she is so much more than just a runner. After all she has been through it would just be too easy to get up and leave with Frank. It seems as if she believes she does not deserve the luxury of leaving while simultaneously feeling that she is beyond an escape.

Religion Essay Example | Topics and Well Written Essays - 250 words - 17

Religion - Essay Example The experience is the troubles that people encounter and eventually abandons their old living habits and follows what their religion teaches them. In the section, â€Å"Theories of religion† (starting from page 8), Flood explains that there are three different schools of thought in how to define religion. Summarize these theories and discuss their strengths and weaknesses. These theories describe religion to be politics in the other way round, religion is a gene and defined religion to be a cultural response to life (Crockett 14). The first schools gave an illustration that based on the aesthetic reduction. The meaning of this is that religion is part of the cultural mechanism that makes sure that the transmission of genes to the other generations is successful. Explanation of how living being come into existence is specified in a range of constraint, this is the advantage of these theories. The limitation for this is that religious resources that pertain human lives in most instances went against the grain of some scholarships. Correct what Flood describes here with your own experience of religion. Does it resonate? Why or not? Basing on what Floods description, it does not resonate with my experience of religion. The reason behind this is that religions are a unifying, purifying, and holy dominion that brings people closer to God (Crockett 15). Floods highlight does not reveal the genesis of man. Instead, he relates with biological aspects that do not exist in the desired religion.

Heritage tourism - The city Bath Essay Example | Topics and Well Written Essays - 3250 words

Heritage tourism - The city Bath - Essay Example The increasing heritage tourism of the city of Bath is directly providing huge revenues to the UK tourism industry. However, the attention was given to the city of Bath after its recognition as a World Heritage Site. In the last few years, a major portion of budget has been allocated to the promotion of Bath City tourism industry, which has positively contributed to its tourism industry. This is also supported by the previous studies. The year 2009 is going to be an important year in the history of tourism industry of the UK because Government has brought various changes in its tourism policy. Although because of financial global crisis, the tourism industry of the UK has faced a decline however, it is expected that with new tourism strategy the situation would get better. Hence, the heritage tourism of the city of Bath and urban tourism of the other cities of the UK provide great opportunities to boost profits of UK tourism industry.

Forms of Simple Stimulus Learning Essay Example | Topics and Well Written Essays - 1250 words - 1

Forms of Simple Stimulus Learning - Essay Example It is the most fundamental, individual way to reduce the unnecessary excitability of nervous system. Habituation appears after the multiple systematic repetitions of a particular stimulus. If it is not threatening life and body, after many perceptions of a stimulus, reaction decreases steadily. It depends on the frequency of repetitions until complete disappearance of the reaction. In other words, we "learn" do not react to stimuli, which do not cause any harm to us.   For example, a person, living in the vicinity of a railway, stops responding to the noise of passing trains very soon. Though, at first, the noise was annoying enough and interfered with sleeping. The same way, we get used to the sounds of the clock and flowing water, to billboards and road signs. The stimuli are no longer come to our consciousness. Perceiving familiar stimuli as common things, we just ignore them. For us, such adaptation means getting a state, where we can recognize easily new, important stimuli among the multiplicity of familiar, insignificant ones.  Ã‚   The reaction of habituation does not mean getting fatigue or tiredness of receptors. After the development of habituation, the nervous system continues perceiving a stimulus; just it needs a little effort to cause reaction immediately.   In nature, habituation is represented widely: from primitive creatures up to human beings. It provides an adequate reaction of a body to eliminate all superfluous, unnecessary perceptions, maintaining just reactions to the most important key stimuli. Such adaptation of nervous system saves lots of energy for an organism.

Key Elements of HR Strategy of Disney and How it is Linked With Its Co Case Study

Key Elements of HR Strategy of Disney and How it is Linked With Its Corporate Strategy - Case Study Example Training and development of the employees are tailored in a manner which allows the company to train and develop the employees in a manner which delivers consistent value to the customers. However, this has been only possible after the involvement of top management of the company at all levels of management. Â  (Perkins, Shortland and Perkins, 2006) However, it is clear that reward and recognition system may not have been clearly defined. The overall recognition criteria were not well-defined and it is also evident that the employees were allowed to communicate with each other at designated places and during particular times. Â  (Miner, 2007) The overall communication and relationship between the employees and the managers were excellent as managers clearly outlined the expectations from the crew members and what was exactly required of them. Learning and development was the key point which was integrated into the overall HR strategy of Disney as employees were specifically trained in various areas of operations while at the same time allowing them to build on their multi-dimensional expertise. The overall general HR policies regarding hiring, training and developing employees were well-defined and most of the tasks were performed by in-house employees hired and developed over the period of time. (Kreitner, 2009) More focus on developing employees and their personalities so that they can deliver superior value to customers. A supported environment for employees has been created which fosters responsibility and creativity. Leadership and communication skills, which are vital for working in an environment which is client facing. Employees are trained in a manner which improves therefore skills. HR Strategy is further focused towards empowering employees to face the clients in real time. HR Strategy is aligned with the overall corporate strategy as it supports the overall vision of the company. Overall, HR Strategy of Disney was focused on hiring, training and developing employees who can deliver more value to the customers.

Review of literature on Brady Plan Research Paper

Review of literature on Brady Plan - Research Paper Example According to Rosen (2008, 102-103), this period built a new government in the U.S. and saw the democratic elections in Uruguay, Chile, Brazil, and Argentina, and the establishment of new administrations in Venezuela and Mexico. Within this setting, cutting down debt was one method to bolster developing economies in Latin America. Consequently, these countries take advantage of democratic transformation as a bargaining ticket to gain more favorable debt arrangements. These countries, as developing democracies, thought that pressing for inflexible strictness and full debt settlement would estrange newly entitled voters and threaten the continued existence of democratic governments (Hiatt 2009, 388). In September 1985, President Garcia remarked quite frankly that â€Å"We are faced with a dramatic choice: it is either debt or democracy† (Maswood 2008, 94). In view of this, the objective of this research paper is to analyze the status of the Brady Plan after 23 years of its implementation with a focus on Brazil and Mexico. In particular, this paper tries to answer the question, how did the Brady Plan help solve the problems faced by Mexico and Brazil as a result of the Latin American debt crisis? The success of the loan industry ended in 1982 due to the emergence of the debt crisis, raising alarm on global markets (Buckley 2009, 54). This bleak condition forced several international financial organizations to generate a remedial program, which may function to prevent a potential disaster. This mission engaged the government of the United States, but not, at the outset, as the major player. Basically, the Brady Plan included a rigorous debt assistance program where industrial banks may select from a list of debt-stock reduction and new currency selections, practiced within the context of policy contingency (Iqbal & Kanbur 1997, 25). In actual fact, not many industrial banks were eager to grant a new

Should central banks be independent Essay Example | Topics and Well Written Essays - 1000 words

Should central banks be independent - Essay Example They all have different origins hence the difference in the roles and functions that they are expected to play. While some of them were established as a special purpose upon which the government banks were brought up to bring about order in the way that bank notes are issued, others were developed to act as sources of funding for the governments (Downes & Vaez-Zadeh 92). There are other central banks that started off as large commercial banks that dominated and subsequently were able to boost the economy by offering the monopoly rights to provide bank notes. Most of the central banks started their operation during the 20th century as central banks that held the public policy agencies to conduct the functions related to central banking. However, the bundles of functions associated with the central bank have always differed in a substantial way from one country to the other. In this paper the main functions and roles of the central banks will be analyzed and an evaluation performed o w hether the central banks should be made independent (Touffut 52). The key functions of the central bank revolve around the fact that the central bank is an agency that is expected to perform the conducts of monetary policy and provide the means through which it can be settled. In the past, they functioned as the government’s bankers, the monopoly of issuing notes, the banker’s bank, the last resort lender, controller and regulator of credit and the maintenance of external stability (Goodhart xiii). The most important function of the central bank has been linked to the role of financial stability. However, it is considered as the objective that extends or goes beyond the objectives of functions, which contribute towards financial stability. Nonetheless, it is still applicable in many countries where for example in China, it is the role of the People’s bank to ensure that financial risks are mitigated with the effort to provide financial stability

Bell Rock Lighthouse Essay Example for Free

Bell Rock Lighthouse Essay 5 WHERE THE MIND IS WITHOUT FEAR I. (i) The words ‘mind is without fear’ mean that one does not have any fear of oppression or compulsion. The poet is talking about the minds of the people of his country. He says so because his country was under the subjugation of the British, who perpetrated all sorts of oppression on his countrymen. (ii) The words ‘the head is held high’ mean to have self respect. The head is bowed down because of exploitation and oppression of the Indians by the British. It needs to be held high with pride and dignity which characterised the Indians before India was reduced to the status of a subjugated nation. (iii) By the words ‘Where knowledge is free’, the poet wants to say that in his country everyone should have the freedom to acquire knowledge without any restriction. The restrictions imposed on the spread of knowledge include the prejudices based on wealth, caste and religion. Further, the British imposed restrictions on the basis of the ruler (the British) and the ruled (the Indians). They curbed the freedom of speech and expression by putting restrictions on the Press. (iv) Due to the restrictions imposed on the spread of knowledge, people remained glued to their outdated customs and traditions and could not think rationally. (v) A sonnet is a poem of fourteen lines divided into an octave (the ?rst eight lines) and a sestet (the last six lines). The octave presents an idea, raises an argument, makes a proposition or poses a problem, whereas the sestet gives a solution to the problem posed by the octave. The poem ‘Where the Mind is Without Fear’ comprises an octave, in which the poet talks about the wonderful qualities his countrymen must achieve to make their country free and heaven-like. Since this poem is only a part of the complete song in his Nobel Prize winning work, Gitanjali, we can say that this poem is a part of the complete sonnet. II. (i) According to the poet, the narrow domestic walls or divisions based on caste, class, colour, religion, creed, region and superstitions break up the world into fragments or mutually exclusive compartments. (ii) The narrow domestic walls refer to narrow local divisions created 6TEACHERS’ HANDBOOK (ICSE POEMS) by prejudices like caste, colour, creed, region and religion. They are called ‘narrow’ by the poet because they are based on age- old customs and traditions and not on the basis of rational thinking. (iii) The narrow domestic walls can harm the nation by creating divisions among people and thereby, undermining the unity and  integrity of the nation. (iv) The poet wants to say that his countrymen should be able to express themselves truthfully without any fear. He feels so because his countrymen at that time did not have freedom of expression as various restrictions were imposed on the freedom of speech and the Press by the British. (v) Examples of alliteration are: (a) Where the world (b) Where words (vi) The poet shows that he has a religious outlook by praying to God to let his country awake to a blissful heaven of freedom. III. (i) ‘Tireless striving’ means to work hard without getting tired to achieve perfection. The poet wants his countrymen to achieve  the highest goals, i. e. , freedom at all levels — political, religious, spiritual, moral and intellectual. (ii) Reasoning allows a person to have clarity of thoughts without being restricted by narrow domestic walls such as caste, colour, creed, religion, region and superstitions. That is why it has been compared to a clear stream which is free of all impurities. (iii) ‘Dreary desert sand of dead habit’ is a metaphor. Through this metaphor the poet wants to say that his countrymen should work for perfection in everything and should not be led astray from their goal in the dry desert of dead habits, i.e. , in a place where outdated customs and traditions are followed. (iv) According to the poet, the hurdles in achieving perfection include the outdated customs and traditions based on irrational thinking rather than sound reasoning and scienti? c thought. (v) The ? gure of speech in the third line of the given extract is a ‘metaphor’. For explanation refer to answer (iii) above. (vi) This poem by Rabindranath Tagore is taken from his original volume called Naibedya, which bears the title ‘Prarthana’, i. e. , prayer. In this poem, the poet prays to a universal father-? gure, i. e.  , God to let his country awake to a blissful heaven of freedom. Thus, the poem is a song of prayer. 7 IV. (i) ‘Thee’ refers to God. (ii) The mind of the poet’s countrymen is to be led forward to the ‘heaven of freedom’, i. e. , to an ideal state where there is total freedom at all levels — political, religious, spiritual, moral and intellectual. (iii) The phrase ‘Heaven of freedom’ means an ideal state, where the poet wants the Almighty to lead his countrymen to. The three qualities required to be able to attain the heaven of freedom include: (a) there is no oppression and people can hold their heads high in self-respect. (b) there are no prejudices based on caste, colour, creed, religion, region and superstitions. (c) people should work tirelessly to attain perfection in everything by following scienti? c thought and rational thinking, without being led to follow obsolete traditions and customs. (iv) ‘Father’ in the above extract is a reference for God. He will awake the country by leading the poet’s countrymen to a heavenly state where there are all kinds of freedom and where they can hold their heads high in self-respect, without any fear of oppression or compulsion. (v) The poet prays for his country to attain all kinds of freedom —  political, religious, spiritual, moral and intellectual. And only then it will attain the blissful heaven of freedom, an ideal state where his countrymen would be able to hold their heads high in self-respect, will not have a blurred vision based on prejudices and work tirelessly to attain perfection in every sphere of life. I. (i) The Inchcape rock is referred to in the extract. The rock lay hidden in the sea off the east coast of Scotland. It sometimes remained hidden under sea water during the high tide. (ii) The words ‘surge’s swell’ mean the sea-waves moved up and down and rose high due to the in? uence of tides. The warning  bell refers to the bell placed on the Inchcape rock by the Abbot of Aberbrothok, to give a warning to the sailors about the danger from the rock. The warning bell was placed on a buoy and during high tides the movement of waves made the buoy to ? oat and in turn rang the bell and warned the sailors. THE INCHCAPE ROCK 8TEACHERS’ HANDBOOK (ICSE POEMS) (iii) The Rock was said to be perilous because many ships had been wrecked by it when it remained covered by sea water during a high tide. Sir Ralph’s ship struck against the Inchcape Rock and drowned in the sea. (iv) The Head monk of a monastery or church is known as an  Abbot. The mariners blessed the Abbot Aberbrothok because he placed a bell on the Inchcape Rock, which gave a warning to the mariners about the perilous rock and thus, saved them and their ships from drowning. (v) A ballad is a long narrative poem that tells a story. It is a heightened narration that uses narrative technique like rhyme and ? gures of speech. The two elements of ballad in the given extract are the following: (a) The rhyming pattern followed in this extract is aabb (Swell- Bell; Rock-Aberbrothok). (b) There is a repetition of consonant sound at the beginning of words (alliteration) to facilitate narration: 1. .. surge’s swell 2. .. then they II. (i) Sir Ralph was a rover or a sea pirate. He was a wicked and jealous man. (ii) The pleasant day in the spring season made the Rover sing. But the real reason was that in a such calm atmosphere he would be able to carry out his wicked plan of defaming the Abbot of Aberbrothok by cutting off the bell from the Inchcape Rock and thereby, loot the wealth from the shipwrecks. The given lines mean that the Rover’s heart was extremely joyful but his joy was due to his wicked plan. (iii) The Rover saw the buoy of the Inchcape Rock like a dark speck on the green ocean. He asked his sailors to lower the boat and row him to the Inchcape Rock. (iv) The Rover wanted to go near the Inchcape Rock to cut off the warning bell to spoil the fame and reputation of the Abbot of Aberbrothok, who has placed the bell there and to loot the wealth from the shipwrecks. (v) The Rover was in a joyful mood in the extract. His joyful mood is re? ected in the extract by his act of whistling and singing. At the end of the poem, the Rover was in a mood of despair and frustration. 9 III. (i) The boatmen rowed the boat to the Inchcape Rock. (ii) The Rover cut off the bell from the Inchcape Rock. He did so out of jealousy and self-interest. He wanted to spoil the fame and reputation of the Abbot of Aberbrothok, who has placed the bell there. It would also allow him to easily loot the wealth from the shipwrecks, caused by the Inchcape Rock. (iii) The Rover’s act of cutting the bell from the Inchcape Rock led to the collision of his ship with the rock and ? nally, the drowning of the ship with the Rover. (iv) After performing the wicked deed of cutting the bell from Inchcape Rock, the Rover said that from then onwards the mariners who used to thank the Abbot would no longer thank him. (v) The Abbot of Aberbrothok had kept the bell there. The bell was placed on the ? oat because the movement of the ? oat during the high tide would make the bell ring and warn the sailors of the danger from the rock. (vi) The sailors, passing by earlier, blessed the Abbot of Aberbrothok for placing the warning bell on the Inchcape Rock and thereby, saving them from the perilous rock. IV. (i) The Rover sailed away from the Inchcape Rock. He became rich by looting the wealth from the ships that struck against the Inchcape Rock. (ii) After amassing wealth, the Rover was sailing towards the shore  of Scotland. (iii) When the Rover was sailing, there was a thick haze over the atmosphere and no sun in the sky. There were strong winds and darkness all around. The weather conditions predicted that ?nally the Rover would meet his end in the sea. (iv) The Rover was a wicked man who was jealous of the fame and reputation of the Abbot of Aberbrothok. That is why he carried out his wicked plan of cutting off the warning bell on the Inchcape Rock, placed there by the Abbot. He was a robber who became rich by looting the wealth from the shipwrecks. (v) The Abbot was a kind and compassionate man, who placed a  warning bell on the Inchcape Rock to forewarn the sailors about the danger to their ships from the perilous rock. The Rover, on the other hand, was a jealous and wicked man, who cut off the warning bell on the Inchcape Rock to defame the Abbot and to loot the wealth from the shipwrecks. V. (i) When the Rover and his sailors were going towards the shore of Scotland, the weather was bad, with a thick haze over the atmosphere, no Sun in the sky and strong winds. THE INCHCAPE ROCK 10 TEACHERS’ HANDBOOK (ICSE POEMS) (ii) The words â€Å"the breakers roar† mean the roaring of the sea waves, i. e. , the sound made when the sea waves break on the  shore. The breakers roar normally signify a high tide when the sea waves surge up and down with a great force. (iii) The sailors wished that they could hear the Inchcape Rock. The ringing of the bell would have indicated the presence of the perilous rock and thus saved the ship from colliding with it. (iv) The sailors could not see any land on the way to Scotland’s shore because of bad weather. There was a thick haze in the atmosphere and total darkness in the absence of the Sun in the sky. Sir Ralph was optimistic that the weather would improve by night when the moon would rise in the sky. (v) In the absence of the Inchcape Bell, no warning sound was heard by the sailors and the vessel struck against the Inchcape Rock. VI. (i) They could not hear any sound due to the absence of the warning bell on the Inchcape Rock, which the Rover had cut off. If the sailors had heard the normal expected sound of the warning bell from the Inchcape Rock, they would have saved the ship from striking against the rock. (ii) (a) the swell is strong: there are strong waves in the sea. (b) They drifted along: They moved slowly towards the shore. (iii) The vessel struck against the Inchcape Rock. It was a shivering  shock because the ship collided with the rock and the waves from all sides began to engulf it. (iv) Sir Ralph was in a state of despair and shock when he realised that his ship had struck against the Inchcape Rock. In his frustration, he pulled his hair and cursed himself. Sir Ralph’s ship struck the very rock from which he had removed the warning bell and sank in the sea. (v) Sir Ralph was a sea pirate. He was a wicked and jealous man. He used to loot wealth from the ships that fatally crashed against the Inchcape Rock. But when the Abbot of Aberbrothok placed a warning bell, he cut off the bell to defame the good Abbot  and put the other helpless sailors into trouble. However, he got caught in his own trap of mischief when his ship struck against the Inchcape Rock and sank in the sea alongwith him. (vi) The moral conveyed through this poem is—As you sow, so shall you reap. The Rover cut off the bell from the Inchcape Rock, but his own ship struck against the very Rock because of the absence of any warning sound and sank in the sea. 11 VII. (i) The Rover could hear the sound of his sinking ship, which seemed to him like the sound made by the Inchcape Bell. The sound was dreadful because there was no chance of surviving  the shipwreck. (ii) The sound of the Inchcape Bell was a forewarning of the danger from the perilous rock to the sailors and was thus life-saving. The dreadful sound, on the other hand was that of the sinking ship that signalled the end of Sir Ralph. Therefore, it appeared to be like a funeral bell being run by the Devil himself. (iii) The Devil below was ringing his knell mean that the sound which Sir Ralph was hearing appeared to him like the sound of the Inchcape bell. But actually the sound was that of the sinking ship. (iv) Sir Ralph, the Rover cut off the warning bell, which the Abbot of  Aberbrothok had planted on the Inchcape Rock as a forewarning to the sailors. But Sir Ralph’s own ship struck against the very rock due to the absence of any forewarning sound and drowned in the sea with Sir Ralph. Thus, the evil that Sir Ralph plotted for the Abbot and the other sailors, recoiled on him. (v) The Inchcape Rock is a ballad comprising adventure, valour and jealousy. Sir Ralph, the pirate, went on an adventure trip on the sea with his sailors. He had the valour to take the risk of cutting off the bell from the Inchcape Rock, which the Abbot of Aberbrothok had placed there to warn the sailors. He did this wicked act out of jealousy as he could not accept the popularity of the good Abbot and wanted to defame him. He also did so because of sel? sh motive as he used to make wealth by looting money from the ships that crashed after striking against the Inchcape Rock. I. (i) The merchants are in the bazaars of Hyderabad. They are selling their goods in the market. The words ‘Richly displayed’ mean that the goods to be sold in the market have been beautifully displayed by the merchants to attract the buyers. (ii) The goods on sale in this market included crimson and silver  turbans, purple brocade tunics, mirrors framed in brownish yellow colour and daggers with handles of jade. (iii) The poet begins the stanza with a question to elicit an answer from the vendors about the goods they are selling. This pattern IN THE BAZAARS OF HYDERABAD 12 TEACHERS’ HANDBOOK (ICSE POEMS) of question-answer is used to bring out the splendour of the traditional bazaars of Hyderabad. The poet has used repetition as well as lyrics full of vibrant and colourful images to describe the scene. (iv) (a) Mirrors with panels of amber mean the mirrors having frames of brownish and yellow colour. (b) Scabbards of gold for the king mean sheaths of gold for the King to keep his swords in. (v) The King and his nobles are the likely customers of tunics of purple brocade and daggers with handles of jade. (vi) The visual imagery is stimulated by mentioning the various hues of colours in this stanza like silver, crimson, purple, amber and jade. II. (i) Chessmen are the pieces deployed on a chessboard for playing the game of chess. Ivory dice refers to small cubes made of ivory, having six sides numbered by dots from one to six. These are used to play games. (ii) Saffron, lentil, rice, sandalwood, henna and spices are sold by  weight, whereas chessmen and ivory dice are sold by numbers. (iii) The sellers of various goods in the bazaars of Hyderabad are referred to as vendors and merchants. The sellers, who go about from place to place with their goods for sale are called the pedlars. (iv) Food items included saffron, lentil and rice. Cosmetic items included sandalwood and henna and the recreational items included chessmen and ivory dice. (v) The senses of sight are stimulated in this extract by the various colours of the items like saffron, lentil, rice, sandalwood, henna and various spices. The sense of taste is produced by the mention  of staple Indian food like lentil and rice and spices. III. (i) The jeweller’s shop is referred to in the extract. ‘Girdles of gold’ mean ornamental belt made of gold worn round the waist by the dancers. ‘Scabbards of gold’ refer to the sheaths of gold for the king to keep his swords in. (ii) The items of gold on sale included ornaments like wristlets, anklets, rings, belts of gold worn by the dancers and sheaths for swords used by the kings. The gold jewellery reveals that both the owners and the buyers belonged to the wealthy sections of the society. 13 (iii) Bells were tied to the feet of blue pigeons as ornaments as well  as identity marks. Sheaths of gold were used by the kings, girdles (belts) were used by dancers and wristlets, anklets and rings were used by other people. (iv) â€Å"Frail as a dragon-? y’s wing† means as delicate as the wings of a dragon-? y. Frail is an apt description for describing the delicateness of the bells tied to the feet of blue pigeons. (v) The poet has described the Indian goods at the Indian bazaars for two reasons: (a) to depict the splendour of Indian bazaars which beckon the customers with their sounds, scents and goods. (b) to extoll the Indians to buy Swadeshi goods and boycott  foreign goods. IV. (i) The fruits included lemons, pomegranates and plums, whereas the musical instruments included sitar, sarangi and drum. (ii) The poet asks the musicians what musical instruments they are playing and asks the magicians what they are chanting. (iii) Spells for aeons to come mean the magical spells used by the magicians to charm everyone till eternity with their chanting. (iv) The whole poem is Indian in context and presentation as it depicts the beauty and vibrance of a traditional Indian bazaar. The landscape, the characters, the images and the background is typically Indian — such as: (a) the mention of dresses worn by Indians such as turbans and tunics. (b) the gold ornaments worn by Indians like wristlets, anklets, rings and girdles. (c) the musical instruments played by Indians like sitar, sarangi and drums. (d) the food items like lentil and rice and spices and fruits like lemons, pomegranates and plums. (e) the use of fresh ? owers on both happy and sad occasions. (v) The magicians are present in the bazaar for chanting magical spells to charm the customers. (vi) The panoramic view of the Indian bazaars presented in the poem with its hues of colour, sounds, smells and sights has appealed  to me the most because it gives a glimpse of the Indian culture, society and prosperity. IN THE BAZAARS OF HYDERABAD 14 TEACHERS’ HANDBOOK (ICSE POEMS) V. (i) The poet has highlighted the occupation of simple folks in India like the merchants, pedlars, vendors, fruit sellers, goldsmiths, musicians, magicians and ? ower girls. (ii) The ? owers are used on happy occasions like wedding for making garlands for the bridegroom and to decorate his nuptial bed. The ? owers are used on sad occasions such as death to pay the last respects by placing ? owers on the dead bodies or the graves. (iii) Crowns, chaplets and garlands were used for making garlands for the bridegroom and for decorating his nuptial bed. (iv) ‘Tassels of azure and red’ mean ornamental threads of sky-blue and red colour tied at one end to make garlands and nuptial beds for the bridegroom. (v) â€Å"To perfume the sleep of the dead† mean to place sheets of freshly gathered ? owers on the dead bodies or on the graves, which give pleasant smell. I. (i) The soldier boy was sitting underneath a tree during the war because he was fatally wounded and could not get up. (ii) The soldier was sitting calmly because he was fatally injured  during the war, was thirsty and could not get any help from anybody around. (iii) The soldier asked the narrator to come near him because he was thirsty and needed a sip of water. (iv) The battle had been long and hard can be discerned from the deep craters in the earth and the number of dead bodies of the soldiers, which the narrator could see lying all around. (v) In the above extract, the poet wants to convey the horrors of war and the agony of the soldiers, who ? ght it out on the battle? eld. II. (i) The narrator has been referred to by the soldier as ‘Sir’. He was on the battle? eld at that time. (ii) The soldier, according to the narrator, ‘smiled as best he could’ to hide his pain and suffering from him. It shows the spirit of a soldier, who gives up his life for his country, with a smile on his face. 15 (iii) The soldier wanted â€Å"A sip of water† because he was thirsty and fatigued for he had fought a long and tough battle throughout the night and was fatally wounded. (iv) The soldier could not take any rest because he had been ? ghting continuously day and night against the enemy. It tells us about the horrors of war and pain and suffering the soldiers had to endure on the battle? eld. (v) The soldier was having a pain in his chest because of the wound he had sustained during the ? ght on the battle? eld. Being a true soldier, who considers everything smaller than his duty for his country, the soldier called it as ‘small pain’. Further, in comparison to the soldiers, who had received larger wounds and had succumbed to their injuries on the battle? eld, his was a small pain. III. (i) The large stain on the soldier’s shirt was caused by a wound he received while ? ghting on the battle? eld. (ii) ‘warm blood mixed in with Asian dirt’ refers to the blood oozing  out from the wounds of the soldier and mixing with the dirt of the Asian soil as the war was being fought in Asia. (iii) By saying â€Å"Not much†, the soldier wanted to say that his wound was nothing in comparison to the wounds suffered by his fellow soldiers, who succumbed to their injuries. He said so because he was still alive. (iv) The soldier considered himself more lucky than his fellow soldiers because they died of the injuries sustained during the war, while he was still alive. IV. (i) The soldier was feeling weak and said that his weakness must be due to fatigue. His fatigue was caused by ? ghting day and  night on the battle? eld. (ii) The soldier smiled weakly because he had sustained fatal wounds and was in pain. It shows that though the soldier was in pain, he was trying to hide his suffering in the true spirit of a soldier. (iii) The soldier felt that he was getting old because he found himself weak and fatigued after battling it out on the warfront. (iv) The soldier felt cold despite the shining sun because the light of his life was fading, i. e. , he was about to die due to the fatal wounds that he had received on the battle? eld. (v) ‘The night exploded’ means that an explosion took place at night. As a result of the explosion the soldier got fatal wounds on his SMALL PAIN IN MY CHEST 16 TEACHERS’ HANDBOOK (ICSE POEMS) body, whereas a number of his fellow soldiers died because of the injuries sustained during the explosion. V. (i) The narrator described the soldier’s smile as the brightest that he has ever seen because the soldier wanted to express his gratitude to the narrator for providing water to him as well as to hide the pain he was enduring. (ii) The soldier was suffering from fatal physical injuries sustained during the explosion at night on the battle ? eld. Due to these injuries he was feeling physically weak and fatigued. (iii) The soldier considered it silly to be defeated by a small pain in his chest because he was a young, healthy man, full of energy and enthusiasm, who could have defeated even death. (iv) The soldier felt ashamed of himself to think about his wife’s reaction when she would see her husband, a strong and grown up man, sitting there defeated. He felt that his mother would never have imagined during his childhood that one day his son would be sitting on the battle? eld, defeated by a small pain in his chest. (v) ‘HERE’ refers to the battle? eld. The soldier was undergoing a mental pain at the thought of the reaction his wife and mother would have on seeing him sitting defeated on the battle? eld. VI. (i) The soldier felt that it was getting dark earlier than it used to be because the light of his life was fading, as he was slowly losing consciousness because of the fatal injuries sustained on the battle? eld and seeing the darkness all around him. (ii) ‘He’ refers to the soldier. He winced up at the sun with an expression of pain on his face to ? nd out why was it getting  dark so early despite the shining sun. (iii) (a) In the given line, the soldier told the narrator that before he would start his journey further, he would like to take a little rest. It signi? es the soldier’s spirit to continue his duty after taking little rest. It is also symbolic of the ? nal journey, i. e. , death, towards which the soldier was heading. (b) The narrator said â€Å"I think I must have cried†. He said so because he could not recall what was his reaction when the wounded soldier died in front of his eyes. It signi? es that the narrator was petri?  ed on seeing the horrifying death of the soldier. (iv) When the narrator pulled the soldier towards himself he felt the wound in his chest and the gravity of the pain the soldier was enduring. 17 (v) The narrator said that he had a large wound in his heart compared to the small one in the soldier’s heart because he was hurt by the suffering of the dead soldier, and felt the guilt on the part of humanity at not being able to give up war and thereby, end the suffering of the soldiers. VII. (i) The expression ‘Asian dirt’ means Asian soil and this indicates that the war was fought in Asia. The two hardships experienced by the soldier included: (a) The physical pain caused by the fatal wounds sustained on the battle? eld. (b) The emotional agony at being lonely and surrounded by dead bodies and the thought of his family’s reaction on seeing him defeated. (ii) Despite sustaining fatal injuries during the war, the soldier did not leave the battle? eld because he considered it at his duty to continue the ? ght till the end and die smiling while performing his duty in the true spirit of a soldier. (iii) The phrase â€Å"a small pain in my chest† is a refrain which is  repeated throughout the poem to emphasise the pain and suffering a soldier undergoes on the battle? eld. (iv) Yes, indeed the poem has a poignant ending. It makes the readers—(i) feel the agony a soldier endures on the battle? eld; and (ii) realise the horrors of war and the need to give up wars for the sake of humanity. (v) Small Pain in My Chest is an anti-war poem that describes the horrors of war and conveys the message to shun hatred and warfare. I. (i) The speaker wants to say that all his children, i. e. , his sons are economically well off and his two daughters are happily married. (ii) By saying, â€Å"Both have cars†, the speaker wants to convey that both his sons are well off and have a status in society. It conveys that in Indian society the worth of an individual is measured more by his ? nancial status than anything else. (iii) The â€Å"other† is a reference for the speaker’s third son. The speaker says that he is not doing â€Å"so well† because in comparison to his THE PROFESSOR 18 TEACHERS’ HANDBOOK (ICSE POEMS) other two sons, who have managerial jobs and are economically well off, he is not as successful as they are. (iv) By saying, â€Å"Every family must have black sheep†, the speaker  intends to say that in every family there is a person, who is different from the rest of the family and is an embarrassment to the family. The speaker considered his third son as the black sheep in his family because he was not as well off as his other two sons. (v) The extract shows that Indians value economic success more than academic success through the speaker’s attitude, who measures the success of his two sons by their managerial jobs and the cars they owned. II. (i) Sarala and Tarala are the speaker’s daughters. The practice of giving rhyming names to the siblings like ‘Sarala and Tarala’ is shown in this extract. (ii) The speaker says that his two daughters ‘Sarala and Tarala’ are happily married to nice boys. The speaker’s comment about the marriage of Sarala and Tarala hints at the gender bias prevalent in Indian society, which considers the success of a man by his economic status and a woman’s by getting married to a nice boy. (iii) By saying, â€Å"How many issues you have†, the speaker wants to enquire from his student about the number of children he has. He is directing this question to his former student. (iv) In reply to his former student’s remark that he has three children, the speaker says â€Å"That is good†. The speaker considers his student having three children as â€Å"good†. (v) The speaker is not against family planning. The irony in this statement is the fact that though the speaker says that he is not against family planning, yet he feels proud at having eleven grandchildren. (vi) The poem The Professor is a satire on the urban Indian way of life as it satirises: (a) the urban Indian society, which measures the success of a man by his economic success rather than his academic excellence. (b) gender bias present in Indian society which believes that woman should be happily married and con? ned within the.

Breast Cancer Awareness And Assessment Health Essay

Breast Cancer Awareness And Assessment Health Essay Programme evaluation is one of the key skills required of public health professionals. Evaluating healthcare interventions is important in order to allocate resources efficiently, assist decision-making and inform policy[1].It is also important in order for programme managers to monitor progress in achieving set objectives, improving programme activities, justify need for continuity and accountability to project funders. The proposed evaluation would be carried out using the CDC framework of programme evaluation which has six steps[2].This evaluation would be somewhat pluralistic in nature as there would be an interplay of the perspectives of different groups[3].However, the dominant perspective would however be that of the policy makers-a managerial perspective[1].This evaluation would be carried out three years after the start of the programme. It would take a long time to achieve the overall programme aim, hence the need for reliance on short or intermediate indicators (Parry)cited in[4]. An evaluation working team would be set up for the proposed evaluation and a leader would be appointed. In this evaluation, the author would be the lead evaluator and would be responsible forselecting members of the evaluation team, scheduling meetingswith stakeholders, planning, and budgeting funds for the evaluation, addressing data collection needs, reporting evaluation findings, and working with consultants whose services may be required. Prioragreement would be on the reasons for carrying out the evaluation, the primary user of the evaluation findings, funding arrangements, time-line for completion of the evaluation and reporting of its findings. Engaging stakeholders The programme mainly targets postmenopausal women between 48 and 63 years as breast cancer commonly affects this population. However, the 40-47 age group would be included as early presentation occurs commonly in this population. The key stakeholders involved in the programme are the clients, the Federal Government of Nigeria, the Federal Ministry of Health, Oyo State Ministry of Health, the Ministry of Women Affairs, University College Hospital, Ibadan, programme managers, and staff. Professional associations-Nigerian Medical Association (NMA), Association of Radiologists of West Africa and the Medical Women Association ofNigeria (MWAN) -advocate for the implementation of a national breast cancer screening programme and policy which is currently non-existent[5, 6]. Other stakeholders are advocacy groups-the Genevieve Pink Ball Foundation , Breast Cancer Association of Nigeria (BRECAN),Medicines Plus; media groups-Silverbird Entertainment, Inspirational FM, City People, Genevieve mag azine, Globacom Limited-a leading telecommunications firm. The primary users of this proposed evaluation are the policy makers and the programme management.The findings would determine if the programme is worth its ‘value for money and would help inform decision on the whether the programme should be continued and if a screening policy would be implemented. The purpose of the evaluation would be made clear and agreed upon by all key stakeholders from the outset[4]. It would have been possible to develop the logic model for this evaluation using the theory of change approach with the stakeholders. Defining a theory of change which is agreed by all stakeholders can mitigate the effects of causal attribution[4].One representative would be selected from each key stakeholders group to form an evaluation working group. The stakeholders in the team would be asked about their vested interests in the programme, their expectations, and what resources they would put in during the actual implementation of the evaluation. The Ibadan-Ibarapa Breast Cancer Screening Initiative The programme was commissioned in December, 2006 in response to the growing concern for the need for early detection of breast cancer. The programme aims is to reduce incidence and mortality from breast cancer in women. Breast cancer screening is a secondary prevention programme that takes the form of physical examination using in combination with radiographic techniques-mammography. Health needs assessment using the epidemiological approach conducted prior to the implementation of the programme revealed that breast cancer is the most common cause of female cancer deaths in Nigeria. Breast cancer is the most common cancer affecting women globally[7] and in Nigeria [5, 8-11].It accounts for the greatest proportion of cancer deaths in women in Nigeria. Previous surveys showed a rising prevalence in breast cancer in Nigeria from 33.6 per 100,000 in 1992[12] to 116 per 100,000 in 2001[5].A retrospective review of hospital-diagnosed cases of cancer revealed 1,216 cases over a four-year period with breast cancer accounting for 13.9% of the cases[11] .Differences exist between the aggressiveness and survival rates in Nigerian women when compared to other populations[13, 14]. The mean age at presentation is 48 years[5]. The average age at menopause of Nigerian women is 48 years[15, 16]. The intervention targeted at women between 40 and 64 years as early presentation-before menopause-has been observed to be the dominant pattern in this population. There is generally a low level of awareness and knowledge of early detection breast cancer among Nigerian women [8, 10, 17-19].Despite the burden, there is currently no national policy or programme for early breast cancer detection[5, 18]. There is a high mortality from breast cancer in Nigeria. This is because most present for treatment late[18, 20-22] and tumours are more aggressive, responding poorly to medical treatment[23].Cultural factors and religious influences also affect health seeking behaviours with some detected cases seeking healing from lay or traditional practitioners. Risk factors for developing breast cancer include age at menopause, at age at first live birth and parity, history of   first-degree relative with breast cancer[24]and smoking. Research evidence supports that early detection of breast cancer leads to improved outcomes. Surveys investigating the knowledge, attitudes and practice of female health care workers showed that with the exception of physicians, there are gaps in knowledge of the risks of breast cancer and low practice of early detection methods [6, 25]. The activities being carried out in this programme are: Breast cancer seminars and workshops for nurses, physicians, community health workers, public health nurses and health promotion specialists in order to increase their knowledge of breast cancer risks and change their attitudes towards screening practices Clinical Breast Examination (CBE) trainings using breast models -donated by the University of Chicago Medical Centre-in order to enhance clinical skills in breast lump detection. Breast cancer education workshops and lectures for postmenopausal women and teaching skills in Breast Self Examination (BSE) to increase their knowledge of the benefits of early detection of breast cancer and to change their attitudes and beliefs on breast cancer Counselling sessions by breast cancer survivors who are volunteers trained to help motivate women in utilising the screening service and reassurance that the benefit of screening outweighs any discomfort felt during the mammography procedure Distribution of IEC (Information, education and communication) materials breast cancer facts leaflets and posters to increase knowledge of breast cancer risks and the benefits of early detection Media campaigns through paid and unpaid advertisements in newspapers and magazines widely read by women; radio jingles in English and the local dialect; role plays on television by volunteers; health promotion messages on television aired in English and Yoruba languages Provision of free Clinical Breast Examination (CBE) and free mammography screening to postmenopausal women between ages 40 to 63 years Funding is mainly from the Federal Government with equal support from the Breast Cancer Research Foundation and the Genevieve Pink Ball Foundation. Shortage of health care staff and inadequately trained staff contribute to mortality from breast cancer. Cultural and religious beliefs also influence cancer health-seeking behaviours. There is increasing interest in cancer issues and many agencies are getting involved in breast cancer awareness activities. Focusing the evaluation design Evaluation design and perspective taken by an evaluation depends on who the primary user of the evaluation is[1].The proposed evaluation takes the managerial perspective[1]. The primary users of this evaluation are the programme managers and the policy makers (health systems). At this stage of the programme, three years after its implementation, it is inappropriate to make judgement based on the achievement of long-term outcomes. It will thus assess the changes in the knowledge, attitudes, and beliefs of the clients concerning breast cancer and the utilisation of the screening service. Purpose of the evaluation In future, evaluating the programme would determine if the breast cancer awareness programme and screening leads to a reduction in incidence and mortality from breast cancer in women aged 40-63 years .The proposed evaluation would carried out in order for policy makers to decide the effectiveness of the programme in promoting health i.e. to evaluate the effectiveness of breast cancer screening as a public health policy; to make decisions about continuity of the service in light of its cost-effectiveness in the face of other healthcare needs competing for funds and to assist in policy making and implementation [4]of a national breast cancer screening programme. It would also assist the programme manager in judging fidelity of implementing the programme activities. The main evaluation questions to be dealt with can be thus can be summarised as follows: Effectiveness-‘Is the programme working as intended? i.e.is it achieving the objectives it set out in its mandate? Efficiency- ‘Are the programme activities being produced with minimal use of resources? The proposed evaluation would use the Before-After (Type 3) evaluation approach[1] in assessing the effectiveness of the programme in producing the change in knowledge, attitudes and behaviour that would ultimately lead to achievement of the programmes goal of reducing the incidence and mortality from breast cancer. This evaluation needs to be carried out in a relatively short period and funding for the evaluation is limited. While true randomised controlled trials are said to be the gold standard for evaluation[26], they would be unethical; expensive to conduct and take a really long time to complete. The main problem with this before-after design is the issue of causal attribution- that the results may not be conclusive in proving that the outcomes are as a result of the programme activities[1].The opinions and inputs of the key stakeholders would also be taken into account at this stage[27].Stakeholders opinion would be sought on how the evaluation would be funded ,how long it wo uld be carried out for and what the reasonable level of achievement should be. The number of years the programme has been in existence would help set the standard against which progress is monitored. Gathering credible evidence-Data collection The mixture of quantitative and qualitative methods would be used in data collection.Observational methods would be used in collecting some primary data for the evaluation as there are few existing databases from which the relevant information for the evaluation can be obtained. Green and South stress that selecting methods for measuring outcomes of health promotion programmes should be based on concern for â€Å"reliability, validity, suitability for purpose, feasibility, consistency with the values and methods of working of the project and appropriateness for use with various groups†[4].Although validity is recognised as being very important in selecting the indicators for evaluation, practical feasibility should also be put into consideration[4]. McNamara fallacy-‘making the measurable important rather than the important measurable. Change in the knowledge, attitudes and practice of healthcare workers would be assessed using a structured self-administered questionnaire placed in the staff pigeon holes at the teaching hospital where the programme activities are carried out. The questionnaire would be pre-tested prior to its use for the evaluation. Pertinent questions would reflect social and demographic characteristics of the respondents, level of knowledge about breast cancer, risk factors for its development, symptoms, screening methods known as well as their individual practice of breast self examination (BSE) and screening using mammography as appropriate. The questions would be closed and pre-coded responses would be included in the questionnaire as these are quick to analyse[28].Careful attention would be paid to the wording of the questionnaire and how the information is coded during its design in order to ensure its reliability and validity. The healthcare workers would be sampled using the stratified ran dom sampling technique based on age and gender. Responses would be anonymised to reduce the chances of reporting bias. The number of healthcare workers would be determined from the training register kept by the programme monitoring and evaluation staff and it can be estimated from the survey in the absence of fidelity in the recording of programme activities. In order to assess if the healthcare workers have developed the appropriate clinical competence in Clinical Breast Examination (CBE).Participants would be observed carrying out the examinations. A hospital researcher skilled in ethnographic methods would be called upon to engage in this aspect of the evaluation. The limitation of this method of investigation is that observer bias is an issue to contend with and the method is not objective[28].To limit observer bias, a different observer would also assess the trained participants-inter-observer comparison[28].The contribution of the Hawthorne effect-a reactive effect which produces bias- is also a limitation worth noting [28].If healthcare staff are aware that they are being studied, they strive to demonstrate that they have the required level of competence in carrying out the breast examination. Changes in the knowledge, attitudes, and practice of screening in the clients would also follow the before-after method of investigation. Study participants would be randomly selected from the community. Informed consent would be ensured before data collection. Data would be obtained using structured pre-coded questionnaires with allowance for open-ended questions delivered via face-to-face interviews trained interviewers. The interviewers would trained on the social skills of establishing good rapport with people in order to reduce potential bias[28].Information obtained would include socio-demographic variables- age, marital status, level of education, religion, occupation-potential risk factors for developing breast cancer-family history of breast cancer, parity, duration of breast-feeding age at onset of menstruation, age at menopause-knowledge of screening methods-Breast Self Examination(BSE),Clinical Breast Examination(CBE) and mammography and on utilisation of screening servic es[29].Barriers to accessing service can also be explored. Mailed questionnaires would have taken less time and would be cheaper to administer but consideration is given to the fact that most people in this community do not have mailing addresses and the literacy level is generally low. Justifying conclusions Data collected from the surveys would be analysed using appropriate tests with statistical software. The main exposure variables of interest the educational component of the programme and the physician skills training in Clinical Breast Examination(CBE) while the main outcome of interest is the utilisation of mammography as a screening service. Secondary variables of interest are the media campaigns, healthcare workers training, Clinical Breast Examination Other factors that would be explored would be the effect of some key demographic characteristics like age, ethnicity, and level of education on the utilisation of the mammography service. In conducting the analysis, adjustment would be made for potential confounding by other influences. The before-after status of the women receiving the educational programme would be compared. For the uptake of mammography as a screening method comparison before and after status would also be compared as though a few other mammography centres exist, none is currently running a similar awareness programme that may qualify its use as a non-random control. The overall results obtained would be compared with the set standards as outlined in the programme objectives or in the absence of this, what was agreed upon at the stakeholders meeting as a measure of success Ensuring use of the evaluation findings The findings would be put together as a draft after representing the data in well-presented graphs and tables as appropriate and circulate among the stakeholders. After reviewing the draft with the stakeholders, the results would be disseminated widely in the hospital journals, as a government publication, in women magazines and other publications as defined by the stakeholders. The results obtained are expected to help inform the development and implementation of a national breast screening policy and programme. Quality assessment There are a number of frameworks that have been developed for investigating the quality of healthcare services[30]. The Maxwells framework would be used for assessing the quality of the screening service. Maxwells conceptualisation of health care quality is organised around the following six dimensions[31]: Access to services-accessibility in terms of time ,distance and location of services, language and other cultural barriers Relevance to need (for the whole community) Effectiveness (for individual patients) Equity (fairness) Social acceptability(cultural competence) Efficiency and economy. Effectiveness The effectiveness of mammography as a screening method has been proven to be beneficial by some studies. A case-control study reported a 50% reduction in mortality from breast cancer using mammography hence supporting its efficacy[32].A recent case control study also demonstrated similar results[33]. Collette et alevaluated a breast cancer screening programme using different methodologies and found that early detection using mammography reduced mortality in the 50-64 age groups[34]. Though a previous meta-analysis demonstrated no benefit to women in the 40-49 age group[35],the well cited Swedish trials have however suggested the need for screening in this age group. Efficiency and economic evaluation This would answer the evaluation question: ‘are we making the best use of limited resources? The economic evaluation of this programme would take the managerial standpoint to answer the policy makers question on if it is the best ‘value for money. It is important in making resource allocation decisions[4]. The overall summary of the programme can be succinctly stated as: Activities- breast cancer education workshops, lectures, and seminars, Clinical Breast Examinations (CBE) for healthcare workers distribution of information leaflets and posters, media campaigns, mammography. Outputs-Number of educational sessions held, number of healthcare workers trained, no of women reached by educational programme, number of women counselled, number of women screened, and number of IEC materials distributed Outcomes -increased awareness and knowledge of breast cancer risks and screening methods (short-term outcome) -increased awareness of early detection (intermediate outcome) -increase in uptake of breast cancer screening (behaviour change) Goal-reduction in incidence and mortality from breast cancer (long term impact) Accessibility, equity, relevance, and acceptability The issue of accessibility and social acceptability would be addressed in the questionnaire survey of clients after the intervention.Relevance to need was initially addressed in the epidemiological needs assessment prior to programme implementation. In further evaluating the need for the programme with respect to the community, focus group discussions with carefully selected members of the community would be held. Members of women groups who are opinion leaders in the community would be involved in these interviews. This technique enables the evaluator explore in-depth views on how social, cultural, religious, and other barriers that affect the uptake of screening service. However, they are time-consuming; data is difficult to analyse; confidentiality is compromised and interviewer bias is a key issue[28]. References Ovretveit, J., Evaluating health interventions : an introduction to evaluation of health treatments, services, policies and organizational interventions. 1998, Buckingham: Open University Press. Centers for Disease Control and Prevention. Framework for Program Evaluation in Public Health.   1999   [cited 2010 7 February]; Available from: http://www.cdc.gov/eval/framework.htm. Naidoo, J. and J. Wills, Evaluation in health promotion, in Foundations for health promotion. 2005, Baillià ¨re Tindall Edinburgh. Green, J. and J. South, Key Concepts for Public Health Practice: Evaluation. 2006, Maidenhead: Open University Press. Adesunkanmi, A.R.K., et al., The severity, outcome and challenges of breast cancer in Nigeria. The Breast, 2006. 15(3): p. 399-409. Akhigbe, A. and V. Omuemu, Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city. BMC Cancer, 2009. 9(1): p. 203. Ferlay, J., et al., Global Burden of Breast Cancer. Li C et al. Breast Cancer Epidemiology, Springer Science, 2008. Okobia, M., et al., Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study. World journal of surgical oncology, 2006. 4(1): p. 11. Okobia, M.N. and U. Osime, Clinicopathological Study of Carcinoma of the Breast in Benin City. African Journal of Reproductive Health / La Revue Africaine de la SantÃÆ' © Reproductive, 2001. 5(2): p. 56-62. Adebamowo, C.A. and O.O. Ajayi, Breast cancer in Nigeria. West African Journal of Medicine, 2000. 19(3): p. 179-91. Nggada, H.A., et al., Breast Cancer Burden in Maiduguri, North Eastern Nigeria. The Breast Journal, 2008. 14(3): p. 284-286. Ihekwaba, F.N., Breast cancer in Nigerian women. British Journal of Surgery, 1992. 79(8): p. 771-775. Ikpatt, O.F., et al., Breast cancer in Nigeria and Finland: epidemiological, clinical and histological comparison. Anticancer Research, 2002. 22(5): p. 3005-12. Huo, D., et al., Population Differences in Breast Cancer: Survey in Indigenous African Women Reveals Over-Representation of Triple-Negative Breast Cancer. Journal of Clinical Oncology, 2009. 27(27): p. 4515-4521. Okonofua, F.E., A. Lawal, and J.K. Bamgbose, Features of menopause and menopausal age in Nigerian women. International Journal of Gynecology Obstetrics, 1990. 31(4): p. 341-345. OlaOlorun, F. and T. Lawoyin, Age at menopause and factors associated with attainment of menopause in an urban community in Ibadan, Nigeria. Climacteric, 2009. 12(4): p. 352 363. Okobia, M., et al., Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study. World journal of surgical oncology, 2006. 4: p. 1 9. Oluwatosin, O.A. and O. Oladepo, Knowledge of breast cancer and its early detection measures among rural women in Akinyele Local Government Area, Ibadan, Nigeria. BMC Cancer, 2006. 6(1): p. 271. Odusanya, O.O., Breast cancer: knowledge, attitudes, and practices of female schoolteachers in Lagos, Nigeria. Breast J, 2001. 7(3): p. 171-5. Ezeome, R.E., Delays in presentation and treatment of breast cancer in Nigeria. J Clin Oncol (Meeting Abstracts), 2009. 27(15S): p. 1527-. Ekanem, V.J. and J.U. Aligbe, Histopathological types of breast cancer in Nigerian women: a 12-year review (1993-2004). African Journal of Reproductive Health, 2006. 10(1): p. 71-5. Ukwenya, A., et al., Delayed treatment of symptomatic breast cancer: The experience from Kaduna, Nigeria. South African Journal of Surgery, 2008. 46(4): p. 106. Gukas, I.D., et al., Clinicopathological features and molecular markers of breast cancer in Jos, Nigeria. West African Journal of Medicine, 2005. 24(3): p. 209-13. Negri, E., et al., Risk factors for breast cancer: pooled results from three Italian case studies. American Journal of Epidemiology, 1988. 128(6): p. 1207-1215. O. Odusanya, O.O.T., Olumuyiwa, Breast Cancer Knowledge, Attitudes and Practice among Nurses in Lagos, Nigeria. Acta Oncologica, 2001. 40(7): p. 844-848. Black, N., Why we need observational studies to evaluate the effectiveness of health care. BMJ, 1996. 312(7040): p. 1215-1218. U.S. Department of Health and Human Services. Centers for Disease Control and revention. Office of the Director, O.o.S.a.I., Introduction to program evaluation for public health programs: A self-study guide 2005: Atlanta, GA. Bowling, A., Research methods in health:investigating health and health services. 2002, Buckingham: Open University Press Akhigbe, A.O. and V.O. Omuemu, Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city. BMC Cancer, 2009. 9: p. 203. Gray, S., The contribution of health services to public health, in Public Health for the 21st Century:new perpectives on policy,practice and participation, J. Orme, et al., Editors. 2007, Open University Press: Maidenhead. Maxwell, R., Quality assessment in health. British Medical Journal, 1984. 288(6428): p. 1470-1. Walter, S.D., Mammographic screening: case-control studies. Annals of Oncology, 2003. 14(8): p. 1190-1192. Puliti, D., et al., Effectiveness of service screening: a case-control study to assess breast cancer mortality reduction. British Journal of Cancer, 2008. 99(3): p. 423-427. Collette, H.J., et al., Further evidence of benefits of a (non-randomised) breast cancer screening programme: the DOM project. Journal of Epidemiology and Community Health, 1992. 46(4): p. 382-386. Kerlikowske, K., et al., Efficacy of Screening Mammography: A Meta-analysis. JAMA, 1995. 273(2): p. 149-154.

Nursing Shortage: Impacts and Strategies

Nursing Shortage: Impacts and Strategies The Nursing Shortage Steven Donahue Introduction According to research conducted by the Bureau of Labor Statistics in December of 2013, the United States is at the precipous of a substantial nursing shortage. Their study indicated that the registered nurse (RN) workforce is expected to grow from 2.71 million jobs in 2012 to approximately 3.24 million in 2022, a 19% increase. This considerable growth coupled with an estimated 525,000 nurses retiring within the same time frame, brings the total of nursing openings to just over one-million jobs (1). The shortage is projected to spread across the country, but be most intense in the South and West regions (1, United Stated Registered Nurse Workforce Report Card). Other professions often endure similar reports about workforce shortages, but shortages specifically affecting the nursing profession are persistent and cyclical. The history of nursing shortages can be linked back to the beginning of nursing as a profession and the first nursing diploma schools, founded in 1873. These diploma schools focused on apprenticeship, and gave young women an opportunity for financial independence and solid employment that was previously not accessible. Physicians and hospitals soon realized the young nurses were a cheap source of labor, and further recruited upper and upper-middle class society for possible nursing candidates. â€Å"It may be argued that the first nursing shortage in the U.S. occurred when hospital training schools found the supply from the upper strata of society had evaporated† (3), and the hospitals were required to scramble and recruit nurses with different economic and cultural backgrounds. Nursing shortages were also prevalent between the years of 1932 and 1952, and exacerbated by the World War II which highlighted an increased need for competent nursing care. In 1943, Congress passed legislation to create the Cadet Nurse Corps, which helped provide an influx of proficient nurses during this shortage. It is estimated that students who graduated form the Cadet Corps provided nearly 80% of the care of hospitalized patents during World War II (3). Documented nursing shortages also occurred in the early 1960’s, early 1980’s, and twice in the 1990’s. Cut? The cause of more recent nursing shortages have become more complex and difficult to define. Research by Goldfarb et. al. in 2008 described two standards to to define a nursing shortage. First, a shortage occurs when there is not enough nurses to provide a certain level of quality care. Secondly, a nursing shortage exists when there are not enough nurses to fill open positions. Based on this description, the current situation can be simplified and more easily defined as a nursing shortage. The causes, impacts, and potential solutions for the current nursing shortage will be further explored. Factors Affecting the Nursing Shortage Societal Demographics A major cause for the nursing shortage is be related to the increased damand required to care for the aging baby boomer population. Members of the baby boomer generation were born roughly between 1946 and 1964 and created a demographic bubble. Between the years of 2008 and 2018, the 55-year old plus demographic is expected to grow more rapidly than any other age group, and will account for a larger share of the total population (9). Figure 1 below illustrates the age distribution and median age from 1960 to 2010 in the United States, and highlights the increasing median age associated with the baby boomer generation. This demographic disparity will create a challenge for healthcare providers, and require a proportional increase in the professional nursing workforce to accommodate the rising elderly population(4). Figure 1. Age distribution and median age: 1960 to 2010 (SOURCE) Demographics of Current Nursing Workforce The current nursing workforce demographics nearly mirror the United States demographics as a whole. According to a survey conducted in 2013, 55% of the registered nursing workforce is age 50 or older (1, #6), and only 14.8% of nurses are aged 30 or younger. The current nursing shortage was further complicated by the 2008 economic collapse. The economic collapse had devastating effects on personal finances, with figures showing an average loss of more than 25% of individuals 401K’s for those nearing retirement (aged 56-65) (http://www.ebri.org/pdf/briefspdf/EBRI_IB_2-2009_Crisis-Impct.pdf). This forced many older nurses to remain in their current positions, or required part-time nurses to return to full-time employment. Statistics showed that the downturn in the economy lead to an easing in the shortage in many parts of the country (1), but this is only temporary and may intensify the shortage after these nurses decide to retire. Nursing Faculty Shortage There are a variety of reasons for the current nurse faculty shortage. First, the average age of nuring faculty also nearly mirrors the United States demographics as a whole. According to the American Association of Colleges of Nurses (AACN), the average doctorally prepared professor is 56.8 years old, and the average master’s degree nursing faculty is 55.1 years old. (http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage). As a wave of retirements over the next decade hits academia, the replacements are both scarce and advanced in age. Salary differentials between nursing educators and those with similar credentials in the private sector is making it difficult to retain nursing educators. Data colleted in 2012 by the Bureau of Labor Statistics found that a Master’s prepared Nurse Practitioner earned a median salary of $92,670 while a Master’s prepared Associate Professor earned $72,590, a differential of approximately $20,000 (BLS website). This monetary difference, along with an increasingly high loan burden associated with attaining a graduate degree makes the private sector more enticing for new graduates with advanced degrees. The faculty shortage has had a significant affect on nursing school admission. The AACN conducted a survey in 2012 and determined that U.S. nursing schools turned away nearly 80,000 qualified undergraduate applicants due to a scarcity in faculty, clinical sites, and classroom space (1,#10). Two-thirds of of respondants indicated that faculty shortages were the number one reason for turning away qualified applicants. Furthermore, approximately 15,000 qualified applicants were turned away from graduate programs for the same reason. The nursing faculty shortage then becomes a two-pronged issue. The nursing shortage requires more nursing students, but a nursing faculty shortage creates limitations on how many students can be prepared for employment, and limits the ability to prepare future nursing educators. Working Conditions Wages The nature of the work, physical fatigue, orthopedic issues,and family strain due to working nights and weekends lead many nurses to leave the hospital setting or the profession altogether. In an era of litigation, nurses must also be cognizant that the individual, and not the system may be held liable in case of patient safety errors. This increased accountability without sufficient decision making authority leads to increased stress on the nursing workforce (4). The nursing profession is challenging and stressful, and many believe that the salary does not reflect the difficulty of the job. According to the Bureau of Labor Statistics, salaries for registered nurses have increased only 4% between 2008 and 2014. While this stagnation may also be indicative of the 2008 economic collapse, the effect of the nursing shortage on wages may not be fully understood until the economy fully recovers. Nursing Shortage Implications The pinnacle concern of the nursing shortage is the effect that it may have on patient loads and quality of care. The growing elderly population coupled with the a shortage of nurses will lead to an increase in patient loads. Numerous studies have indicated that higher patient loads lead to a riskier environment for the patient. A study published in 2011 by Dr. Jack Needleman analyzed the records of 197,961 patients, and found that the mortality rate increased from 1-6% if a facility was understaffed (http://www.nejm.org/doi/pdf/10.1056/NEJMsa1001025). Another study in 2011 indicated that when the hours per patient day was high (an indicator of proper staffing), the incidents of congestive heart failure, failure to rescue, infections, and prolonged lengths of hospital stays decreased (http://www.ncbi.nlm.nih.gov/pubmed/21407034). Lastly, a study conducted in 2013 observed the relationship between higher patient loads and readmission rates of pediatric patients. The research showed th at when the ratio was adjusted by just one patient (5:1), the likelihood for readmission rose 11% (http://qualitysafety.bmj.com/content/22/9/735.full). An increase in readmission rates will further aggravate the problem of patient loads, and has a heavy economic toll. While increased patient loads effect the overall quality of care, they also adversely effect the working conditions of nurses. In a survey conducted in 2005, 75% of respondents believed that the nursing shortage will effect their quality of work and limit the amount of time they can spend with patients. Additionally, 93% of those surveyed believe that the effects of the nursing shortage will cause nurses to leave the profession (1,#11). Another study in 2012 concluded that nurses were likely to attribute staffing insufficiencies as a major factor in job dissatisfaction, stress and burnout. The nursing shortage will ultimately effect patient loads, working conditions, and quality care for the patients in all nursing sectors. If propoer strategies are not developed, the increased stress associated with the shortage may lead to greater turnover in the profession, which only compounds the shortage issue. Strategies to Address the Nursing Shortage Addressing the General Nursing Shortage One way to entice new nurses in to the field has been to make the cost of education more affordable. On the federal level, the Nursing Education Loan Repayement program has been initiated and pays for 60% of a students loans in exchange for a two year commitment to a geographic area determined to have a critical shortage. Many hospitals have reimbursement programs for nurses looking to advance their education in exchange for a future working commitment. While this may entice more new nurses, economists warn that government and other subsidies may interfere with the free market, and may actually depress nursing wages. One possible solution to the free market interference is pay for performance programs. Rather than give subsidies to specific nursing students, pay for performance programs give subsidies to facilities that provide a high quality of care. Since quality care is intinsically tied to nursing performance, this would increase the economic value of nurses, thus improving wages , work environments, and retention (3). In addition to nursing faculty shortages, insufficient clinical sites play a huge role in limiting the student capacity of nursing schools. Increased coordination and strategic partnerships between universities and the private sector can help expand student enrollment. For instance, a joint venture between the Minnesota VA Health Care System and the University of Minnesota in 2013 has helped expand the schools BSN program. In this agreement, the VA committed $5.3 million dollars to expanding clinical placement sites within their facilities and funded additional faculty for the University. By teaming with the University of Minnesota, the VA received enhanced care for their patients. A better work environment can help attract new nurses and limit the amount of nurses who â€Å"burn-out† and leave the profession. Strategies to better the nursing work environment must focus on the emotional and physical stresses of the profession. Research has shown that limiting heavy lifting, decreasing walking, and providing easy access to equipment and information will keep nurses from leaving the profession (From #4 Goodin, 2003) Additionally, â€Å"increasing autonomy, re-allocating work in a more patient centered way, creating systems to recognize achievement in the areas of mentoring nurses, educating patients ans personal growth in practice, creating meaningful internal labor markets, and enhancing supervisor and administrative reports† (Morgan and Lynn, 2009). In order to combat further nursing turnover and burn-out, hospitals and nursing facilities must focus on nurturing an environment that provides these qualities. This is even more important when increas ed nursing turnover costs hospitals millions of dollars per year in recruiting and training new nurses. Further research in 2009 found that organizational constraints and high patient loads adversely affected job satisfaction. Supporters of mandated patient-nurse ratios believe that mandatory ratios will increase positive patient outcomes, increase job satisfaction, and ultimately combat the nursing shortage. Currently, thirteen states have staffing laws for hospitals, but only California has mandated minimum nurse-patient ratios. It should be noted that the American Nurses Association does not necessary support mandated patient-nurse ratios, but rather supports a legislation model which empowers the nurses to create staffing plans specific to each unit, giving the nurses autonomy to make staffing decisions that are best given the fluidity of hospital admissions (http://www.nursingworld.org/mainmenucategories/policy-advocacy/state/legislative-agenda-reports/state-staffingplansratios). Addressing the Nursing Faculty Shortage One major issue plaguing the nursing faculty shortage is the inability to recruit BSN prepared nurses in to the education realm, and has been noticed on both the state and federal level. In January of 2014, Wisonsin announced the â€Å"Nurses for Wisconsin Initiative†, which provided 3.2 million dollars in fellowships and loan forgiveness for nurses who agreed to pursue advanced degrees in nursing education and teach in the state after graduation (1). On the federal level, in December of 2013, the U.S. Department of Health and Human Services provided 45.4 million dollars in funding to provide low interest-loans for nurses pursuing nurse education degrees (Macdonald, 2013 see citation below). In order to attract more nursing educators, the pay discrepancy between the private sector and nursing educators must be addressed. References Budryk, Z. (2013). Is there another way to solve the nursing shortage?. Newton: Questex Media LLC. Retrieved from http://search.proquest.com/docview/1466237287?accountid=3588? Clark, R. C., Allison-Jones, L. (2011). Investing in Human Capital: An academic-service partnership to address the nursing shortage. Nursing Education Perspectives, 32(1), 18-21. Retrieved from http://search.proquest.com/docview/89382362?accountid=3588? Dolan, Tamara B., RN, M.S.N., O.C.N. (2011). Has the nursing shortage come to an end? ONS Connect, 26(8), 8-12. Retrieved from http://search.proquest.com/docview/885241529?accountid=3588? Fox, R. L., PhD., Abrahamson, Kathleen, PhD., R.N. (2009). A critical examination of the U.S. nursing shortage: Contributing factors, public policy implications. Nursing Forum, 44(4), 235-44. Retrieved from http://search.proquest.com/docview/195019237?accountid=3588? Keeping nurses on the job: Retention is part of the answer to the nursing shortage. (2010). AANA Journal, 64(6), 8. Retrieved from http://search.proquest.com/docview/747116085?accountid3588? MacDonald, I. (2013). The nursing shortage: Myth or reality?. Newton: Questex Media Group LLC. Retrieved from http://search.proquest.com/docview/1467698816?accountid=3588? McNamara, M. (2009). Combating the nursing shortage. American Nurse, 41(2), 14. Retrieved from http://search.proquest.com/docview/205506517?accountid=3588? Miovski, Natalie, AIA, L.E.E.D.A.P. (2009). Healing the nursing shortage with staff-friendly design. Healthcare Design, 9(8), 66-69. Retrieved from http://search.proquest.com/docview/195019237?accountid=3588? Schaeffer, R. (2013). The nursing shortage†¦.fact or fiction? Arizona Nurse, 66(2), 3. Retrieved from http://search.proquest.com/docview/1365796219?accountid=3588? Talbert, JeanAnne Johnson, APRN-BC, FNP, MSN, A.O.C.N., D.H.A. (2009). Distance education: One solution to the nursing shortage? Clinical Journal of Oncology Nursing, 13(3), 269-70. Retrieved from http://search.proquest.com/docview/222754879?accountid=3588? References (cont.) Vioral, Anna N., MSN, M.Ed., R.N., (2011). Filling the gaps: Immersing student nurses in specialty nursing and professional associations. The Journal of Continuing Education in Nursing, 42(9), 415-20. doi:10.3928/00220124-20110601-01 Wynn, Stephanie D, DNP, R.N.-B.C., P.M.H.N.P.-B.C. (2013). Addresing the nursing workforce shortage: Veterans as mental health nurses. Journal of Psychosocial Nursing Mental Health Services, 51(12), 3-4. doi:10.3928/02793695-20131029-05

Christopher Columbus Essay -- Christopher Columbus Essays

Christopher Columbus sailed the ocean blue in fourteen-hundred-ninty-two. He came over from Spain in three ships, the Nina, the Pinta, and the Santa Maria and discovered America, or at least that was what I was taught in elementary school. Since then there has been much controversy going on over the issue of weather or not Christopher Columbus really â€Å"discovered† America because when he landed in San Salvador he was not alone. Native Americans already inhabited the land and they had been there long before Columbus, but this doesn’t mean that he should be atacked stripped of his dignity.   Ã‚  Ã‚  Ã‚  Ã‚  Reed Irvine, chariman, and Joe Goulden, director of the media analysis for Accuracy in Media, state in the acticle History Should Continue to Acknoledge Columbus as a Discoverer:   Ã‚  Ã‚  Ã‚  Ã‚  The â€Å"presence† of the North American Continent had been known to the persons living   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  there for centuries before arrival. But Columbus, and those who followed him, recognized   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  the significance of the New World; in this sense they certainly deserve credit for having   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"discovered† America.   Ã‚  Ã‚  Ã‚  Ã‚  Over five hundred years ago he landed in the Americas and now we are starting to question weather or not he should be given credit for discovering America. This doesn’t seem fare. After so many years without controversy it’s just been recently that we have started to question the lagitamitity of his discovery. What brought on this sudden change? Perhaps is was the coming of the five hundred year celebration of our country that brought this on, or maybe now some of the Native Americans are finally starting to speak out, but no matter what the reason may be it shouldn’t be taking place. Columbus should still be given the credit for discovering America. It was the first time that anyone was recognized for landing on a new continent and he still deserves respect.   Ã‚  Ã‚  Ã‚  Ã‚  Irvine and Goulden feel bad for Columbus, too. â€Å"Poor Christopher Columbus. Five hundred years after the fact, the explorer is beng stripped of recognition as the man who ‘discovered’ America and the New World.†   Ã‚  Ã‚  Ã‚  Ã‚  There are many people who bel... ...;  Ã‚  Ã‚  Ã‚  Ã‚  quest for new frontiers continues today as earthlings burst terrestrial bonds and begin the   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  endless voyage beyond planet and galaxy into the illimitable dark.   Ã‚  Ã‚  Ã‚  Ã‚  That desire to go where no one has ever been before is inside of all of us. All of us enjoy exploring new teritory that we have never been on before. It’s that thrill and excitement that fills our heart and soles.   Ã‚  Ã‚  Ã‚  Ã‚  When Columbus landed on the new land he put a flag in the ground claiming it for Spain. Then he met the Native Americans and was very friendly to them. â€Å"I want the natives to develop a friendly attitude toward us because I know that they are a people who can be made free and converted to our Holy Faith more by love thwn by force,† Columbus wrote in his journal.   Ã‚  Ã‚  Ã‚  Ã‚  From everything that we know thus far there isn’t a big enough reason as to why we should all of the sudden stop recognizing Columbus as the founder of our nation. Therefore, he should be given recignition of his accompishments and still be known as the one who discovered America.