Tuesday, August 6, 2019
Prose Commentary, Pat Barker Essay Example for Free
Prose Commentary, Pat Barker Essay The title of the book from which this excerpt is taken, Regeneration, highlights what I see as the main theme in this thought provoking prose piece. This piece of prose raises images for me of the moist dampness, humid soil, death and the prospect of life arising from the continuation of the cycle of life and death. These Images are shown in phrases such as the final sentence, which says, Now they could dissolve into the earth as they were meant to. This sentence is the one which stuck out most to me in the whole excerpt; I found it very powerful in that it brings out the theme of regeneration to the reader and it is a sentence which sticks in your mind. I can see this as an overall whole picture, where Burns, who I view as a returning soldier, perhaps from the Gulf War given the date, experiences, and successfully faces one of his terrible fears, picked up from the war, of bloody, dead corpses, and through this finds the prospect of soul peace before him. I also see that nature and the cycle of life as a big theme in this excerpt as it shows up in nearly every line. Words such as, rain, mud, trees and wind support this. The narrative structure of this excerpt is also important, because it is as if the story of Burns is being told by someone else and so it is likely not subject to the bias of the actual persons account. In the first three paragraphs, rain and the wetness of the land is a large part of describing, setting the scene and the tone of the rest of the excerpt. The author creates a feeling about Burns, that he is somewhat stranded, for the writing states, He didnt know what to do and so long since hed been anywhere alone. As well as creating a lost feeling this sentence confirms the thoughts, though not directly, that Burns is a returning soldier. The use of the words, Raindrops dripped with the repeated d sound, creates the patter of large raindrops. Persistent and monotonous link up with each other to remind the reader of the continuity of the wetness. When Burns reaches a fence, he sees that, A tuft of grey wool had caught on one of the barbs. Perhaps an animal had once quite recently struggled to free itself from this discontinuity in nature as Burns does when he too gets caught on a barb just like an animal. The repetition of the b sound in Burns blinked, carries on the theme of the persistence of the rain. Throughout the whole of the third paragraph there is another repetition of the b sound, this time though it is used to bring out the sound of the thud and plodding of Burns in his mud encumbered boots. There is also a repetition of the s sound in words such as slipping and stumbling for exactly that, to create the sound of someone slipping in the wet mud. The writer also uses words such as cold, khaki and tight cloth to create a chilling stiff sound to make the reader feel the cold that Burns is experiencing. In the next two paragraphs, the author makes the wind and its severity, an impacting factor on Burns' progress toward the safety that he seeks. The wetness of the setting which surrounds Burns is also again a major influence in his quest. The tone of these two paragraphs is much more severe than the first three. The author says that the wind tries to scrape Burns off its side. suggesting that the situation has become more intense. That line is very effective literally because the word scrape is an onomatopoeic word and when joined together with side it creates an alliterating s sound. The fact that he has to keep his head bent and the Rain beat onto his head both confirm the increased severity of the weather. When the weather is so bad that the distance vanishes in a veil of rain, the alliterating v sound bringing out the hum of the constant rain, Burns' survival instinct kicks in and he decides to take shelter, running clumsily toward a clump of trees. But again he is slowed to a walk because of the dragging mud. The words mud dragged are effective here, for even to say them together takes effort and your reading is slowed by them, amplifying their effect. The sucking of your reading is again shown in the words mud-clogged boots, the d, g and b sounds all together make the reader have to pronounce each syllable in a drawn out way. Where the author talks about, the whine of shells he is referring to the sound that you hear when you put a shell to your ear and compares it to the noise of the wind through the trees. In paragraph five the author shows the exhausted Burns so tired he cannot even be bothered to wipe away the rain drenching his face. In the next three paragraphs, the tone of the extract becomes quieter; there is neither mention of the intense rain nor the sound of it. The tone of the setting becomes almost sinister amongst the trees. Burns now in what he thinks is the safety of the trees continues to stumble and the writer again uses the repeated b sounds in the words, began, stumbling, blindly and between to show us that Burns has still not quite got his bearings right yet. The author uses the repeated c sounds in the words catching, clumps and bracken to the same effect. Because he is stumbling blindly, something brushed Burns' cheek and when he tried to push it away, his hand touched what he first thought to be slime. On turning to see what it was, Burns discovered that there was a dead mole, suspended, apparently, in air. The use of commas in those few words are effective because they make the reader pause and thus put emphasis on a very important part of the extract, it begins the change in plot of the whole extract. Its small pink hands folded on its chest. suggests the authors feeling that the mole was innocent, but was still killed. The author provokingly compares the dead animals Burns sees to a fruit tree bearing, what the author makes you think are heavy fruit by using the word laden. Heavy fruit because they are generally more likely to smell of decay, which is what the dead animals are, decaying. The author quite interestingly uses animals from each part of the earth; the magpies from the sky; the fox from the ground and the moles from under the ground, this I see as a continuation of the regeneration theme carried on throughout the whole excerpt. I think that the fox scared Burns so much because it reminded of something that he saw in the war. Again in paragraph eight the trees are against Burns. The author uses the alliteration of the words twigs tore through the t sound to remind the reader of the snapping sound of twigs and the force that Burns was putting into getting away was enough to snap the twigs on his skin. It brings out how frightened he really was. The writers reference to dead leaves also fits in with the theme of Regeneration for dead leaves must dissolve into the earth to create nutrients for the trees from which they fell and thus continue the circle of life. In the short paragraph nine, the setting changes briefly once more because Burns goes out into the field once more. He splashes effectively through the alliterated flooded furrows, the f making the sound of the swishing water. Burns then hears a voice, probably the voice of a fellow soldier from the war. It is said to be the voice of a person named Rivers. I did find it quite ironic that the author of the book from which this excerpt is taken, would use the name Rivers for the voice which Burns hears because in Scotland a small river is called a burn. This brings out to me that the author is making the aspect of water very important to this particular scenario. I feel that the use of water here is important to the overall theme of regeneration because water is a key part in the cycle of life, it is the source of all life and so I think that this is why the author emphasises this point. The voice that Burns hears tells him that, If you run now, youll never stop. basically telling him to face his fear. This may be because perhaps Burns ran away from something before and did not face his fear. The last two paragraphs of the excerpt talk of Burns facing his fear, finding a peace amongst his dead companions and his finding a control which he did not have at the beginning of the excerpt. Burns turns back therefore facing his fears. The fact that the author talks about what the real Rivers might have said confirms that Rivers is a real person and he is probably still alive. When Burns lets down the dead animals he is allowing for the natural cycle of Regeneration to be complete. This seems to make him feel better for he sits down inside the circle of his companions who he no longer views as scary and is happy because, Now they could dissolve into the earth as they were meant to do. By facing his fear, Burns was regenerated in himself, this also made him content. The last line is the most important in the whole text; it sums up and puts into context the entire idea of Regeneration. In conclusion I would say that there is one main theme in this excerpt; it being the ongoing recurrence of the idea of Regeneration through the means of nature, water, the cycle of life and death and the facing of fear. It is also important to say that in order for regeneration to happen, something has to die.
Monday, August 5, 2019
Communicating with Customers
Communicating with Customers COMMUNICATING WITH CUSTOMERS PO 3 Customer Service Message Photograph of an organisation/business exterior. Negative: The front of this shop is not very inviting because the windows dont have much clothing/products in them, it does not tell the customer what they are selling.  In fact, you cant really tell whats being sold. The entrance is very dark. The upper story window is messy and disorganised. Recommendations I would recommend putting more lighting on the outside, at the entrance, plus more lighting on the windows, so the customer can see exactly what is for sale. Put mannequins on the bottom and top windows, showing the customer what clothing is on sale inside, and some of the other products they sell, e.g. curtains and childrens clothing. http://guineys.ie/ Customer Service Message Photograph of an organisation/business exterior Positive: This photograph shows the Woodstock Hotel which is a beautiful hotel close to the centre of Ennis and yet has a country feel to it.  The entrance is warm and inviting, with lovely lighting and stained glass. The cut stone gives this hotel character. The entrance also caters for the disabled with wheelchair access.There are large flower pots that have evergreen shrubs planted, which breaks up the grey of the stone. http://www.hotelwoodstock.ie/ Customer Service Message A screen shot of an organisations website. Positive: Guineys have a very good website, showing all the departments that you can browse through. It shows you whats best value at the moment and weekly deals that are in store at present. It tells you that they accept the One4all vouchers from An post.  The customer can phone in their order between certain times. The customer can sign up for their newsletter and its all private. This site is very user friendly. http://guineys.ie/ Customer Service Message A Screen shot of an organisations website Negative: I was looking to purchase a glass house in Ireland and came across this website. I felt frustrated trying to navigate around it as I could not find anything close to what I wanted, in fact they said they had certain sizes of glass houses but they were impossible to find on this page, which to me is false advertising. It also said there was a price list but there wasnt one. There were very few pages of information compared to what the page said. I rang the number on the page several times for help, but nobody answered. Recommendation:I would recommend they hire a web designer, it doesnt cost a lot, but it would bring in money to the company. The company should then keep the website updated on a regular basis. I would recommend then that the company hire a person to answer the phone at all times, again this would obviously make money for them, because I as a customer gave up wanting to buy anything because I couldnt speak to anyone in this company. http://www.polydome.ie/glasshouses_search.php?maincatid=3 Customer Service Message Printed Material from and Organisation (flyer, leaflet, brochure) Positive: The Irish Cancer Society is a wonderful organisation, who do a lot of work for people and their families suffering from cancer. Daffidol Day is held every year in March, this year its the 24the March, and the money raised goes to the County you are collecting in. You can donate at any time online. This charitable organisation uses the money also for patients travel to and from hospital. Counselling services for patients and families. Information and services on Pallative care and end of life care. There is a freephone number, for people to contact a nurse for confidential advice and information. See Appendix A at the back https://www.cancer.ie/?gclid=CMKB1ua97NICFa-97QodHIUEcw https://www.cancer.ie/support/coping-with-cancer/palliative-care#sthash.xYq8CER1.dpbs Printed material from an Organisation Negative: When you look at this flyer it doesnt jump out at me, to tell me what its exactly about, in fact there is very little information on it about the food/meals its serving. The background is a dark colour and takes away from the writing underneath. Recommendations: I would recommend that they would include visuals of what food they serve. They should change the background colour, something brighter and the print then would contrast better against it. The font actually should all be in bold. See Appendix B Customer Service Message News Report/Clipping regarding employment conditions, corporate ethics, environmental ethics, sponsorship, etc. Positive: Aldi have a great initiative in tackling food waste, by distributing left over food from the shops, to families who are in need and charitable organisations like St. Vincents de Paul who look after poor people, for example those living on the streets and in shelter in the cities. https://www.aldi.ie/love-ireland Customer Service Message News report/clipping regarding employment conditions, corporate ethics, environmental ethics, sponsorship, etc. Negative: Tesco are in an ongoing battle with about 3,000 of their employees over their pre-1996 contracts for work. Tesco wants these employees to take lower rates of pay and conditions, just like their new employees. During the strike periods Tesco stores all over Ireland have lost millions of euros, because customers did not want to pass the picket line. At the moment a mediator has been appointed to try to come to some agreement with both parties over this row. Recommendations: I would recommend Tesco come up with a fair package for all their employeesas they work hard and have long hours of work. This country is doing well again and these companies are making plenty of money, so why not give a fair package like Lidl and Aldi who have set a precedent here. See Appendix C at the back.
Sunday, August 4, 2019
History Of Kosovo Essay -- essays research papers
The Balance of Power Theory and It’s Application to Kosovo                          Ideas are the corner-stones of International Relations and Diplomacy. These ideas are often titled theories, a term that grants the ideas a certain degree of credibility in application, though they remain theories; they cannot be proved., only applied intelligently in hopes of arriving at the correct conclusion. One theory concerning the Balance of Power (BOP) falls under the Neo-Realist analysis of conflict within the International system. This Essay will attempt to apply this theory, somewhat retroactively to the situation in Bosnia and more specifically, to that in Kosovo. Retroactively, because the essay will principally examine how these theories can be applied to the history of the Kosovo conflict, dating to the present. Secondly, it will undertake to detail the current situation in that region in these same terms, providing an accurate description of the status quo. Finally, the Balance of Power Theory will be employed in a prospective manner, to offer a so lution to the situation in terms of actually creating a balance of power within the country of Bosnia.      Outline: I. Definitions of Terms for the Purpose of this Essay      A. Neo Realism      B. Balance of Power Theory (BOP)      C. Power Transition (PT) II. Retroactive Application of Theory      A. History of Kosovo Situation      B. How BOP/PT Theory Explains Kosovo Conflict III. Immediate Application of Theory      A. How Status Quo is Represented by BOP Theory IV. Prospective Application of Theory      A. What Actual Balance of Power may lead to Peace in the Region V. Conclusion I. A. Neo-Realism      Neo-Realism is one of the schools of thought in International Relations theory. It is a sub-school of Realism, which originated in the aftermath of World War II. Realists tended to blame the Second World War on Liberals and their failure to deter the fascist powers that initiated that war. Some of their specific criticisms include these principles:   &n... ... sees the concurrence of Serbian longing for Kosovo, and their longtime friend Israel’s feeling for their Holy land.      The Balance of Power theory, however, does not allow for emotional rationalization when discussing war and politics. The final peace will depend on the power held by each party as the war ends. Serbia had, in 1995 presented a plan for peace in a magazine which passed unnoticed by the rest of the world. In it, they proposed to have a buffer zone free of ethnic Albanians. The buffer zone would lie between Albania and Kosovo-Metohia, which would effectively end the mutual ethnic cleansing, and act as a sort of containment solution. The implementation of this plan however is far from realization, since the war continues to rage. V. Conclusion      The situation in Kosovo, is a long and exciting study of the Theories on Balance of Power, and its role in peace keeping. Unfortunately, the theory has been more of a method for analyzing the patterns of war in the region. It will take some measure of inequality to end this war. It is currently too much an equality of military forces for either side to emerge victorious.
Family at the Bedside Essay -- Health, Spirituality and Holistic Care
Discussion of family presence during invasive procedures has been ongoing for many years. Some healthcare organizations have instituted policies to allow family members to be present during invasive procedures, which they would previously forbid during these procedures. Attitudes of healthcare provider’s differ drastically. (MacLean et al., 2003) This paper will illustrate the important benefits of having a family member present during these procedures. Terms used in this search includes: Pro family at bedside, Importance of family at bedside invasive procedure, Family centered car in the operating room and position statement on Family presence. The following articles were deemed appropriate for this paper. 1. Baumhover N, Hughes L. Spirituality and support for family presence during invasive procedures and resuscitations in adults. American Journal of Critical Care July 2009; 18(4):357-367 Several health organizations have made recommendations and written guidelines to include family presence at the bedside during invasive procedures. A quantitative study was done of health care professionals exploring their thoughts and attitudes to family presence during invasive procedures. This article explores the importance of Spirituality and holistic care. The design for this study was exploratory, descriptive, and correlation. The setting was a 210-bed not-for-profit Christian-based hospital located in the Southwestern United States. Data was collected from the individuals in this study and analyzed. The study found that 58% of nurses Compared with 34% of physicians and physician assistants strongly agreed that family presence during invasive procedures is a patient’s right. This study ... ...eterization, 84%; sedation and analgesia, 81%; bladder catheterization, 80%; sutures, 79%; lumbar puncture, 66%; and cardiopulmonary resuscitation maneuvers, 44%. The families’ reasons for being present included calming the child, suffering less anxiety, and watching over the procedure. Eighty percent thought that the family’s presence could be beneficial. 10. American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112:Supp IV-1-IV-211.Retrieved December,7,2010.From: http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-6 The American Heart association support having family members present during invasive procedures. They have out clear and concise directions on establishing a family member presence at the bedside that any hospital can adapt.
Saturday, August 3, 2019
Great Expectations: A thematic analysis :: Great Expectations Essays
Great Expectations: A thematic analysis As the reader begins the book, Dickens instills in the reader a bond with Pip as it is through his eyes in a first person narrative. Dickens’ use of Pip as the narrator is very significant to the telling of the story. We are able to see the progression of Pip as he grows up and his views on the characters in the book. We form an idea about someone from their outward appearance, so having Pip as a narrator it creates a one-sided view about a character because we only see the world from Pip’s eyes and we feel most strongly what Pip is feeling and we feel, about other character what Pip feels about them. Dickens creates sympathy by telling the reader that Pip has never seen his mother & father, instead he sits on their graves trying to find clues that reflect their appearance and personality. Pip at this point is trying to emphasize that his father is superior to his mother, as the antithesis is shown with Joe and his sister. Dickens also tries to make the reader feel sympathy by referring to Pip’s name. On one level his name shows how isolated Pip is, this empathize that Pip created his own nickname. However on a symbolic level his name ‘Pip’ represents the start of life, a seed, as it grows toward its fate. Dickens is trying to emphasize to the reader the solitude of Pip, by using extended sentence structure to increase the tension and prolong the suffering. He also restates that Pip is all alone by using repetition on the word ‘dead’, implicating the loss of 5 of Pip’s siblings, as they died before they were born. The prolonged sentence structure also leads to an ominous word ‘savage lair’. This pathetic fallacy foreshadows the encounter which will make Pip’s life a lot worse. When Magwitch is first introduced, a sad and lonely atmosphere is already established. The fearful connotations in the atmosphere ‘place overgrown with nettles’, the isolated graveyard ‘dark flat wilderness’ and the symbolic place of death ‘the marsh country’ makes Magwitch appearance even more memorable. Magwitch’s social status becomes apparent when Dickens describes his handling of Pip. He addresses Pip in a very rough manner, shaking him and using harsh words. â€Å"Keep still you little devil or I’ll cut your throat!†.This portrayal of Magwitch emphasizes the fact that he is of a lower social class and this ties in with a stereotypical view that someone in the lower half of the social divide will be more likely to commit a crime. This reflects the
Friday, August 2, 2019
Medicine and Mental Illness
K272 TMA01 Consider the usefulness of a holistic model in explaining the experience of mental health. A holistic approach to mental illness means that the user’s physical, mental and spiritual health along with the user s state of mind, lifestyle and social factors will all be taken into consideration when analysing them. Holism refers to treating the whole person. This means that holism feels disease doesn’t just affect the body, but also the mind and spirit as well. It’s said that the five dimensions are all inter related and so if one is c hanged then the other dimensions will all be impacted in some way or another. In a sense I feel that holism is practical as it explores several avenues in order to treat mental illness rather than the bio-medical approach which uses only one. The World Health Organisation (1946), define health in the following way ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity’. This definition of health supports both the medical and social models. In suggesting that wellbeing is the key to health the definition embraces the idea that in the treatment of illness all factors, social, mental and physical must be taken into account. If this definition is what professional’s base their treatment of mental health upon, then it could be seen that the medical and holistic models are intertwined and should in fact work in harmony. Yet one model holds dominance over the other. It is the medical model which is predominantly used in the treatment of mental health (Bentall, 2003) The Biomedical Model The bio medical model evolved as a response to diseases in the 19th century. German psychiatrists then used this model, based on their beliefs and not hard evidence, to categorize the symptoms of mental distress into distinct conditions, one of which was Schizophrenia (Bentall, 2003). The model suggests that mental health is an illness, characterised by specific symptoms that have a pathological base. This came about because research supported the notion that mental ill health was due to chemical imbalances, body dysfunction or injury (McCullough et al, 2005, Pritchard, 2006). However there is another suggestion that mental health is a hypothetical construct†(Boyle, 2002: 14). The fundamental focus of this model is that the individual is the source of their mental illness. Therefore the person can be treated and as with most illness the medical model will look at medication as the way forward (Beresford, 2005). Within this model the body is seen as a device rather than a person and as an appliance its functions will often need repair (Giddens, 2006). This thought process is damaging, it can encourage a poor relationship. When the ‘person’ becomes lost and is seen as a list of symptoms, they become stigmatised and labelled. This labelling can cause further mental distress and so more ‘symptoms’ may be seen (Thompson, 2006). The medical model sees mental illness as a brain malfunction, an imbalance, a set of symptoms, to restore mental health the medical experts will endeavour to adjust the imbalances with a variety of drugs. The use of drugs often does give a quick fix to some symptoms; however the use often creates a dependence, which may last until death (Harris et al, 2007). This dependence on drugs will give further credence to the medical model. Many researchers point out that this reliance on medication causes further mental distress, as the side effects can be many and enduring, adding further problems to those with a diagnosis of mental illness(Wallcraft, 2005,Usher et al, 2006). The Holistic Model As we know the holistic model is not the most popular model, it is however very important as it represents a way of thinking and understanding mental distress and gives a positive approach to working with and supporting people experiencing mental illness. Each person’s experience of mental illness is unique. Seedhouse (2000, pp 59-60) suggests that holism makes two main claims: that the whole cannot be fully understood separately and that they separate parts cannot be understood apart from the whole. Holism has many available methods including counselling, and congestive behaviour therapy. Although all of these aspects work together each promotes its own therapeutic power, which doesn’t really take a holistic perspective as it claims to. This can be very confusing and distressing for a user who has only ever encountered the biomedical model. A good example of this is (Taussig, 2002, p10) â€Å"the recovery from breakdowns has always been slow and painful, and each one has brought a different treatment ranging from C. B. T therapy to psychoanalysis. On each occasion when I called on the providers to help me out of the dark, each stood proudly alone protesting their own therapeutic power and efficacy†. Holism allows users to see how the body and mind are connected by letting them reflect. Reflection matters because it is continuous with practise. How you think about what you are doing affects how you do it, or whether you do it at all. It may direct your research or your whole attitude to people who do things differently, or indeed your whole life. (Blackburn 1999) However holistic approaches can bring the mind-body divide to the forefront as its been proven that reflecting on emotions can bring on physical distress such as raised heartbeat, headaches, and pains. Bringing supressed thoughts to the surface can also cause people to become dependent on such things as alcohol and drugs which need some biomedical intervention. Mind-body relations are always mutual and bidirectional-the body affects the mind and is affected by it. mind and body are so integrally related that, in practise], it makes little sense to refer to therapies as solely â€Å"mental†or†physical†, rather mind-body could perhaps be best regarded as an overall process that is not easily dissected into separate and distinct components or parts. (Seedhouse 2002, p55). . Whilst there are arguably opposing principles within the medical and holistic model it can be suggested that the diversity can be productive. There are aspects of both models that may help with the diagnoses of mental illness. The bio medical model through research will continue to strive for a specific, pathological base. Medicine aims to prevent mortality, with a high incidence of morbidity within the group of people diagnosed with mental illness, on-going research is a must (Muir-Cochrane 2006). The holistic model will strive to ensure, that the person with mental distress will have an individual programme tailored to their needs and therefore a selection of treatments may be the answer. The Hippocratic Oath which is fundamental in medicine suggests that interventions delivered from the medical profession of which psychiatry belongs ‘do no harm’ Sokol (2008). If the so called experts used the model to treat service users with a diagnoses mental illness in a way that caused no harm they would strive to ensure that when assessment was undertaken all aspects of the medical and holistic models of mental distress would be taken into account. The complex nature of mental illness would be identified and a more impartial framework of support could be supplied. It could look at solutions and ways of coping, rather than problems and illness. It would value the service user with mental distress, building a relationship and remembering that ‘mental illness’ it is not just an illness, a list of symptoms, there is a person present that needs to be respected. Perhaps the unification of these two models would enable the treatment for mental illness to be more people centred and unique. Service users could define what help was needed, and the balance of power would be with the expert. (Warren, 2007). References Beresford, P. (2005) Social Approaches to Madness and Distress: User Perspectives and User Knowledge, In J Tew (Ed), Social Perspectives in Mental Health: Developing Social Models to Understand and Work with Mental Distress, London: Jessica Kingsley. Bentall, R. P. (2003) Madness Explained: Psychosis and Human Nature, London: Penguin. Blackburn, (1999) Bowen, P. (2007) Blackstone’s Guide to the Mental Health Act 2007, Oxford: Oxford University Press. Boyle, M. (2002) Schizophrenia: A Scientific Delusion, London: Routledge. Giddens, (2006) Harris Et Al (2007) McCullogh Et Al (2005), Pritchard (2006) Muir-Cochrane (2006) Seedhouse (2000 P59-60) Seedhouse (2002 p55) Sokol (2008) Thompson (2006) Toussig (2002 p10) Usher Et Al (2006) Warren (2007) Word Count -1750 including references
Thursday, August 1, 2019
Cocept Analysis: Adaptation
The Concept of Adaptation Using Sis. Callista Roy's Model of Adaptation A Concept Analysis St. Augustine's College Exploring the Concept of Adaptation Adaptation has long been described as one of the mean tools of human and animal survival. A chameleon changes its color to hide from a predator, a child becomes withdrawn to deal with the death of a loved one or a soldier learns how to walk with a prosthetic limb after the traumatic amputation of a leg due to injury.All of these situations describe a form of adaptation on behalf of the individual in order to deal with a stressful situation. According to Sister Callista Roy (2009)†adaptation is the process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration†(McEwen & Wills, 2011). The purpose of this paper is to explore the concept of adaptation in the hope to bring clarification to the use of the term in nursing resea rch and practice. This will be done in the form of a concept analysis.A concept analysis is the rigorous process of bringing clarity to the definition of the concepts used in science (McEwen & Wills, 2011). The concept analysis process of Walker and Avant (2005) includes selection of a concept, determining the aims or purpose of the concept, identifying all the possible uses of the concept, determining the defining attributes, identification of model cases: identifying borderline, related, contrary, invented and illegitimate cases, identifying antecedents, consequences and lastly defining the empirical referents (McEwen & Wills, 2011).The concept analysis process is important because most of nursing theory has been based on concepts adopted from other disciplines, so it is necessary to explore these concepts to discover their relevance to the nursing profession (McEwen & Wills, 2011). Aim of the Analysis The aim of this concept analysis of adaptation is to discover what descriptors of this concept make it more relevant to nursing practice and research.As pointed out by Rodgers and Knafl (2000) the value of discussing concepts is to promote the clarification and refinement of an idea that is intended to contribute to the problem solving efforts of a discipline (Holden, 2005). Literature Review of the Theory Adaptation Taylor’s (1983) cognitive adaptation theory states that individuals use positive thought processes as a form of adapting to stressful circumstances. Engaging in mildly positive self-relevant distortions enables an individual to maintain an optimistic outlook, enhance self-esteem and encourage a sense of mastery when facing a threatening event (Henselmans et al. 2009). Taylor proposes that these positive thoughts give an individual a sense of control which will then force the individual to take constructive action when dealing with a stressful situation. Schkade and Schultz (1992) in their occupational adaptation theory proposed that there i s a normal process that individuals go through as they strive for competency on their jobs. There is an interaction with the environment that drives the individual to attain mastery over work related challenges.In this process the individual evaluates their responses to the challenges based on an internal sense of effectiveness or satisfaction. The self-assessment phase is the only means of evaluating the level of adaptation in this theory. Charmaz (1995) proposed that adaptation for most people is a gradual process of evolution where an altered individual changes to accommodate bodily and functional loss (Livneh & Parker, 2005). The changes in the individuals result from a recognition of a loss of their former self -image and the adaptation only comes about after that realization.Yoshida (1993) believes that adaptation through identity reconstruction only comes about after the individual struggles between their identity as a disabled person and their identity as their former self ( Livneh & Parker, 2011). There is a constant internal struggle to which the outcome cannot be predicted. Lewin speaks of a reciprocal, interactive process of adaptation that involves the individual and the environment (Livneh & Parker, 2011). The environment consists of internal and external factors that influence the adaptation process.The internal factors can include type and severity of illness and/or the individual’s concept of self. The external factors include variables such as physical, social and vocational aspects of the external environment. The level of adaptation will depend on the interaction between the individual and these environmental factors. Uses of the Concept Adaptation as defined by Merriam-Webster (2013) is the adjustment to environmental conditions, adjustment of a sense organ to the intensity or quality of stimulation. Synonyms for adaptation: acclimation, accommodation, acclimatization, adjustment and conformation.Charles Darwin theory of natural sele ction states that organisms adapt to their environment to become better fitted to survive and that they pass these genes on to the next generation ( ). According to Natural Resources Canada (NRC) adaptation includes activities that are taken before impacts are observed (anticipatory) and after impacts have been felt (reactive). Both anticipatory and reactive adaptation can be planned as a result of deliberate policy decisions and reactive adaptation can also occur spontaneously (NRC, 2008). Defining Attributes Two defining attributes of adaptation are interaction and environment.A common theme that emerged during the review of information researched for this topic was that adaptation occurs after interaction between the individual and the environment. The Roy adaptation model (Roy & Andrews, 1999) viewed the individual as a holistic adaptive system who responds to different stimuli in the environment, he/she processes changes in the environment through emotional channels that involv e perception, learning, judgment and emotion (Cunningham, 2002). Model Cases Walker & Avant (2010) state that a model case illustrates or exemplifies the concept and includes demonstrations of all defining ttributes (CCN, 2012). A model case of adaptation could be a previously withdrawn 45 year old female patient with a new colostomy. The patient Mrs. X shied away from learning how to care for her colostomy, refusing even to look at the colostomy during colostomy care. Subsequently Mrs. X now asks appropriate questions, has become more involved even to the point of changing her colostomy appliance. During this process the nurse encourages the patient by asking open ended questions about her feelings, the nurse also assures the patient that when she is ready to talk or learn someone will be available to answer her questions.Mr. L is a 35 year old newly diagnosed diabetic, who is open and receptive to diet and lifestyle changes that has become necessary to control his blood glucose le vels. The adaptation can be seen by the patient taking part in the discussion with his nutritionist, asking appropriate questions and requesting information about resources that will be available to him should he need more support in adjusting to his new lifestyle changes. A contrary case is an example that does not display the attributes of the concept. Ms.B a 25 year old that received a right lower limb amputation due to a car accident refuses to take part in physiotherapy. In fact, she is somewhat hostile to the healthcare team and does not take part in any discussion about her plan of care and her rehabilitation. Attempts by the nurses to build a therapeutic relationship by asking open ended questions and sitting with the patient to offer comfort and support are not acknowledged. Related cases, according to Walker & Avant (2010), include most but not all of the attributes that relate to adaptation (CCN, 2012).Safety in many cases can be related to adaptation. Nurses find that th ey will have to step in and modify a patient’s environment to aid in the adjustment to an ongoing ailment. This may include dimming the lights, providing a quiet atmosphere and limiting visitors for a patient that has a dissecting aortic aneurysm. The nurse understands that it is important for this individual to have a calm quiet environment he/she also knows the importance of administering antihypertensive medication and sedative as needed to achieve an internal environment that is conducive to this person’s health.Providing safety may also come in the form of providing a clutter free environment for all patients. This includes ensuring that the bed is in the lowest position, all electrical cords are secured properly and the patient’s belongings and the call light are within the patient’s reach. These little changes go a long way in helping people adjust to the strange environment of a hospital room and by performing these tasks the nurse is fulfilling h is/her role of promoting adaptation according to Roy’s Adaptation Model. Antecedents and ConsequencesAccording to Walker and Avant (1995), antecedents are the events or incidents that happen before the concept (Cheng, Foster & Huang, 2003). An antecedent to adaptation is stress, stress which can affect the body as a result of an accident, infection or an illness. The onset of a physical trauma or the diagnosis of a life threatening illness can set into motion a chain of psychosocial experiences, reaction or responses (Livneh & Parker, 2005). The goal of nursing at this point would be to promote adaptation (McEwen & Wills, 2011).The needs of the patient will be assessed and the plan for an appropriate intervention should be formulated. Control over the situation maybe beyond the scope of nursing practice however, the goal is for the patient to try to achieve integration with the environment, external or internal. Consequences are the events or incidents that happen as a result of the concept. A consequence of adaptation is that a change has taken place, a change in mindset or behavior. A patient that was not able to ambulate without assistance may now be able to walk around their home using crutches or a cane.The newly diagnosed breast cancer patient is no longer fearful because she has developed a positive outlook about her disease. She has started to look for support groups and researching natural intervention to help battle her illness. Taylor (1983) proposed that self -generated control perceptions prevent helplessness and promotes constructive thought and action (Henselmans et al. , 2009). Empirical Referents Walker and Avant (2010) define an empirical referent as a measurement tool or mechanism for the demonstration of the existence of the defining attributes of a concept (CCN, 2012).Cognitive adaptation is measured by the individual’s feelings of control or mastery over the illness as well as the individual’s positive outlook relatin g to their illness. One of the tools used to measure optimism is the Life Oriented Test (LOT). It consists of eight items and yields a total score between 0 and 32. An example of a question is: ‘I always look on the bright side of life’. The participants are asked to rate this statement on a 5 point scale, ranging from 0 (strongly disagree) to 5 (strongly agree). The Pearlin and Schooler’s Mastery Scale is used to assess feelings of control over events.Seven items are used to assess global beliefs of perceived control rather than events being controlled by fate. Five items are phrased in a positive way and two items in a negative way. An example of a statement is ‘I have little control over the things that happen to me’. A five point scale is used here also 1 (strongly disagree) to 5 (strongly agree). Higher points on both scales, indicates a higher level of perceived control or optimism which points to positive adaptation. Conclusion Adaptation is a n innate basic function that all humans and organisms must have to overcome different stressors in life.How one adapts is closely related to our coping strategies. Adaptation can be positive which results in human and environmental integration (McEwen & Wills, 2011). The nurse’s role in this process is to adapt to the patient’s needs by performing a thorough assessment to be able to provide the tools needed for the individual to positively adjust to complications that they are experiencing. References Chamberlain College of Nursing. (2012). NR 501 Theoretical basis for advanced nursing practice. Concept Analysis: Directions with Scoring Rubric.St Louis, MO: Author Chen, S. F. , Foster, R. L. , & Huang, C. Y. (2003). Concept analysis of pain. Tzu Chi Nursing Journal 2:3 Cunningham, D. A. (2005). Adaptation of Roy’s adaptation model when caring for a group of women coping with menopause. Journal of Community Health Nursing 19(1), 49-60 Henselmans, I. , Sanderman, R. , Helgeson, S. V. , de Vries, J. , Smink, A. , & Ranchor, A. V. (2010). Personal control over the cure of breast cancer: Adaptiveness, underlying beliefs and correlates. Psycho-Oncology 19: 525-534 Holden, L.M. (2005). Complex adaptive systems: Concept analysis. Journal of Advanced Nursing 52 (6) 651-657 Honoch, L. , & Randall, M. P. (2005). Psychological adaptation to disability: Perspectives from chaos and complexity theory. Rehabilitation Counseling Bulletin 17-28 Lorre, G. A. , Schkade, J. K. , & Ishee, J. H. (2004). Content validity of the relative mastery measurement scale: A measure of occupational adaptation. Occupational, Participation and Health 24 (3) McEwen, M. , & Wills, E. (2011). Theoretical basis for nursing (3rd ed. . Philadelphia, PA: Wolters Kluwer Health. Merriam-Webster. com. (2013). Adaptation. Merriam-Webster Online Dictionary. Retrieved from http://www. merriam-webster. com/dictionary/adaptation Stiegelis, H. E. , Hagedoorn, M. , Sanderman, R. , Van der Ze e, K. I. , Buunk, B. P. , & Van den Bergh, A. C. M. (2003). Cognitive adaptation: A comparison of cancer patients and healthy references. British Journal of Health Psychology 8 303-318 What is Adaptation? (2008) Natural Resources Canada. Retrieved from: www. nrcan. gc. ca
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