Comparison of Capital Flows in Asia

Examination of Capital Flows in Asia 1.1 Background of the Study Capital controls were generally used to forestall the free progression of assets between nations until the late 1970s. A mindful unwinding of such controls during the 1980s demonstrated predictable with more noteworthy financial reconciliation among cutting edge nations and fortified the case for capital market opening all the more for the most part. By the mid 1990s, capital controls gave off an impression of being done as a genuine strategy instrument for moderately open economies. The customary view about universal budgetary joining is that it should empower funding to spill out of high salary nations, with moderately high capital work proportions, to low pay nations with lower capital work proportions. On the off chance that interest in poor nations is compelled by the low degree of household sparing, access to remote capital should support their development and it would likewise permit occupants of more extravagant nations to get more significant yields on their reserve funds co ntributed abroad. Receptiveness to capital streams can uncover a country’s money related division to rivalry, prod upgrades in local corporate administration as remote financial specialists request similar norms locally that they are utilized to at home, and force discipline on macroeconomic strategies and the administration all the more by and large. In this way, regardless of whether remote capital isn't required for financing, money related transparency, to the two inflows and outpourings, may make ‘collateral benefits’, for example, local budgetary part improvement which could upgrade development in all out factor productivity[1]. Capital record advancement in monetarily stifled economies regularly prompts a time of quick capital inflows followed by money related emergencies with worldwide monetary reconciliation and strategy plan for additional progression of capital inflows. Concern has likewise been communicated with respect to whether the expenses of expa nded helplessness to money related delicacy probably won't exceed the additions from budgetary coordination. Be that as it may, a large portion of the nations keep on advancing in disassembling capital controls to incorporate their monetary markets with the remainder of the world. 1.2 Justification and Relevance of the Study Financial development is believed to be an element of speculation and different elements. The traditional conviction is that remote capital inflows bring new investible assets and outside trade with which the beneficiary nation can accomplish higher paces of speculation and in this way development. The job of remote capital in monetary development is an issue that has incited consistent discussion. Outside capital enlarges the complete asset accessibility in a nation, yet its effect on speculation and monetary development is questionable. In the event that prudently utilized, it could effectsly affect financial development through higher venture and other constructive outcomes. Be that as it may, it is additionally conceivable that outside capital venture probably won't yield any net advantage to the host nation. Monetary progression and globalization have brought about quick portability of assets between countries as to procure the relative preferred position of the separate nation. The 1990s saw various capital record emergencies in developing business sector economies. The emergencies, which were encouraged by an unexpected inversion of capital inflows, happened against the foundation of budgetary market deregulation, capital record progression, and money related part opening. Deregulation and advancement have without a doubt achieved benefits as more prominent money related asset preparation for residential speculation and monetary development. Simultaneously, this has made new wellsprings of vulnerabilities in a critical position sheets of business banks, organizations, and the open segment. For Countries that are still during the time spent opening the capital record, how best and how quick to continue stays an uncertain issue. There is no assumption that the asset prerequisites of executing a snappy change are either littler or bigger than those of dealing with a long progress process or managing capital controls. Creating viable administrative system re quires significant investment, however a protracted procedure may make wrong motivating forces and bends. An enormous detonation approach might be fitting if a drawn out change is probably going to make opposition from personal stakes or if various components of the current framework are so reliant upon one another that a piecemeal change is beyond the realm of imagination without making critical twists. Global capital developments can bolster long haul development however are not without transient dangers. The drawn out advantages emerge from a productive portion of sparing and venture among excess and shortage nations. In any case, enormous capital inflows may challenge the absorptive limit of host nations in the short run by making them defenseless against outer stuns, elevating the dangers of monetary overheating and unexpected inversions in capital inflows, and encouraging the development of credit and resource value blast and-bust cycles. The inflows extended the accessible assets for subsidizing profitable ventures and privatization, and for raising fare limit and helped fund current record shortages. They added to the advancement of local monetary markets and the productivity of banking frameworks. Remote interest in household government protections markets added to liquidity of auxiliary markets and more prominent advancement of money related administrations, for example, in Hungary and Poland. FDI helps in moving the administrative and mechanical abilities, and fortify residential organizations. For the European Union promotion nations, capital inflows are a commonly fortifying element during the time spent combination into the European Union[2]. The drawn out capital streams, especially of direct speculation have been a significant factor in the capital record excess, and the pattern of higher long haul inflows has planned to be continued. A significant explanation behind this has been the accomplishment of modification programes embraced in Indonesia, Malaysia and Thailand in the mid 1980, after a time of insecurity. In these three nations, an exaggerated cash was deteriorated, huge financial shortfalls design was rehashed in the Philippines in the mid 1990s. In each of the four nations, macroeconomic adjustment was joined by approaches to open the economy to remote exchange and change the budgetary sector[3]. As an outcome of the remote capital flood experienced by various creating nations, since the mid 1990s global financial experts and arrangement producers have been bantering about whether outside capital streams ought to be the object of explicit approach. The discussion solidified around two inverse positions. From one perspective, there were the individuals who asserted that capital streams were generally exogenous to the beneficiary nations and, likewise, very destabilizing. The ramifications of this view was that the monetary specialists should plan and execute arrangements to hose the effect of capital streams on household macroeconomic factors. The contrary position left from the supposition that capital streams generally react to residential factors, be they long haul i.e., those influencing the country’s hazard premium, or identified with transient interest the executives. In either case, there is no compelling reason to stress expressly over capital streams. Approach producers focus solely on improving household strategies. An early, and compelling, investigation of the capital flood to creating nations attributes it for the most part with the impact of falling worldwide premium rates[4]. There were different factors also, the majority of them exogenous to rising economies. Specifically, the downturn in created nations decreased paces of profit for capital and made financial specialists search for better yields somewhere else. In like manner, since the Asian monetary emergency, outside capital has withdrawn from most rising economies, paying little heed to the nature of household approaches. Now and again, the unexpected stop[5] has been especially horrendous e.g., if there should arise an occurrence of Argentina and Chile. In Argentina, the abrupt stop in capital streams made the monetary and budgetary issues. In Chile, it has had less shocking, albeit still very horrible, impacts. In any case, in all cases, the inversion of the 1990s inflows h as been emotional, and it has been joined by a sharp disintegration in development execution. Expanding upon Ricardo, the government assistance gains from the global parcel of work are generally recognized. The financial approach suggestion has been to evacuate conversion scale instability to encourage exchange and development. The effect of swapping scale instability on exchange among two or a gathering of nations has both a small scale and macroeconomic measurement. From a microeconomic point of view swapping scale instability, for example estimated as everyday or week to week conversion scale vacillations is related with higher exchanges costs since vulnerability is high and supporting remote trade chance is exorbitant. In a roundabout way, fixed trade rates upgrade worldwide value straightforwardness as shoppers can look at costs in changed nations all the more without any problem. On the off chance that conversion scale instability is wiped out, universal exchange upgrades effe ctiveness, profitability and government assistance. These microeconomic advantages of conversion standard adjustment have been an adverse inspiration of the European financial joining process. Low exchange costs assume a significant job for worldwide and intra-local exchange and capital streams. 1.3 Research Questions We have talked about above about the need of global money related incorporation, advancement of capital records and potential advantages of capital streams. Numerous nations on the planet opened their capital record to receive the rewards of global capital streams for their monetary turn of events and development. Various investigations have been done as such far for the investigation of capital streams on various issues. A few investigations are connected with advantages and advancement of capital record which are: does capital record progression lead to development? by Quinn and Toyoda in 2008; why capital acco

The Door Free Essays

A positive result steps up to the plate. In his sonnet, ‘The Door’, Miroslav Holub recognizes us to start change by emblematically opening the entryway. Perceiving the significance of progress Holub rehashes his order a few times in the sonnet, ‘Go and open the door’. We will compose a custom article test on The Door or then again any comparable subject just for you Request Now To motivate us to acknowledge transform he records prospects you can discover on the opposite side of the entryway. Enchantment city is simply creative mind. Holub is persevering us to be in a positive mental state once we start change. In his sonnet, ‘The Door’, Miroslav Holub urges you to look for and welcome any sort of progress in your life. By starting change, you experience various hindrances and regardless of whether it is simply little Holub trusts it will in any case upgrade your life. Regardless of whether it is scarcely anything, for example, ‘hollow wind’, the aim of rolling out an improvement will have any kind of effect. Regardless, Miroslav Holub spurs us to take the risk. There will perhaps be a ‘The Door’ gives you confirmation that past the impediment you face there will be better results as long as you permit yourself to advance and think decidedly. ‘If there is a haze, It will clear up. ’ When the mist clears up Miroslav Holub rouses us by posting prospects that might be hanging tight for on the opposite side of the entryway. ‘a tree, or a wood, A nursery, Or an enchantment city’ An enchantment city is inventive. Holub persuades us to ‘Go open the door’. He orders us to ‘Go open the door’ on the grounds that he accepts the adjustment in our life will profit us. Regardless of whether there is simply ‘hollow wind’, it will even now profit us. He consoles us that the ‘fog will clear up’ and the ‘darkness will tick by’ and positive change will be looking out for the opposite side of the entryway for you, as long as you permit yourself to open the entryway. Step by step instructions to refer to The Door, Essay models

Anxiety Medications for Borderline Personality Disorder

Anxiety Medications for Borderline Personality Disorder September 19, 2019 Paul Bradbury/OJO Images/Getty Images   More in BPD Treatment Diagnosis Living With BPD Related Conditions To date, there are no medications approved by the Food Drug Administration (FDA) to treat borderline personality disorder (BPD). However, some individuals with BPD are prescribed anti-anxiety medications, also known as “anxiolytics, to treat the intense anxiety and agitation associated with BPD. This is completely up to your individual doctor and your unique situation. Like any medication, however, there are both advantages and drawbacks to treatment with anti-anxiety medications. Here are some things to keep in mind and to ask your doctor if your psychiatrist is considering prescribing anti-anxiety medications for your BPD symptoms. Are Anti-Anxiety Medications for BPD Effective? Unfortunately, there is very little research to indicate whether anti-anxiety medications for BPD are actually effective. There are a few published papers that describe patients with BPD who have found relief from symptoms when taking these medications, but no controlled clinical trials have examined the usefulness of anti-anxiety medications for BPD. Research has been mixed on these medications overall effects. On an individual basis, some have reported significant improvement in their BPD symptoms. Others reported worsened symptoms when taking certain drugs like Xanax  because it heightened their urges for impulsive behaviors. Types of Anti-Anxiety Medications The most commonly prescribed anti-anxiety medications are called benzodiazepines. Some examples include: Ativan (lorazepam)Klonopin (clonazepam)Xanax (alprazolam)Valium (diazepam) Unfortunately, these may not be the best choice for individuals with BPD who also have substance use problems, because benzodiazepines can be habit-forming. There are some non-benzodiazepine anti-anxiety medications that are not habit-forming, and these may be an alternative to medications from the benzodiazepine family. These tend to be more frequently recommended, as they can help you transition as you make progress in your therapy and recovery. Risks and Side Effects of Anti-Anxiety Medications Its important to know that these drugs can have significant side effects, particularly in people with BPD since they have not been thoroughly tested in that population. The most common side effect of anti-anxiety medication is feeling sleepy, fatigued or groggy. Other side effects include impaired coordination and memory problems. You should not take anti-anxiety medication if you drink, as it can worsen the foggy effect. Many anti-anxiety medications should not be taken by pregnant women or women trying to become pregnant. Medications from the benzodiazepine family should not be mixed with other sedating medications or alcohol. Questions to Ask Your Psychiatrist You should talk to your psychiatrist before you start taking anti-anxiety medications or any other type of medication for BPD. If you have any concerns, let them know. Make sure you understand the risks and side effects and be sure to have an in-depth discussion about the reasons you are being prescribed a certain medication. Borderline Personality Disorder Discussion Guide Get our printable guide to help you ask the right questions at your next doctors appointment. Download PDF

The Article, Timing And Type Of Alcohol Consumption And...

In the article, Timing and Type of Alcohol Consumption and the Metabolic Syndrome by Bruna Angelo Vieira, Vivian Cristine Luft, Maria Inà ªs Schmidt, Lloyd Ellwood Chambless, Dora Chor, Sandhi Maria Barreto, Bruce BartholowDuncan, it discussed the correlation between alcohol consumption and the prevalence of metabolic syndrome. Metabolic syndrome is the clustering of risk factors that predict the chances of having cardiovascular disease and type 2 diabetes. These risk factors include obesity, hyperglycemia, hypertension, and etc. According to the abstract, metabolic syndrome is a rising problem throughout the world. This condition correlates with many lifestyle choices and factors. However, its relationship with alcohol intake was unclear, therefore the purpose of this research was to determine if there is a correlation between alcohol intake and the prevalence of metabolic syndrome. The researchers investigated â€Å"interactions between the quantity of alcohol, the timing of its consumption with respect to meals, and the predominant beverage type in the association of alcohol consumption with the metabolic syndrome (et al.).† The Brazilian Longitudinal Study of Adult Health, which is an adult health study to investigate diabetes and cardiovascular disease, was used for this research. The researchers used 14,375 subjects between the ages of thirty five and seventy four years. The subjects were instructed to not drink alcohol twelve hours before the testing. According to the

The Treaty Of Versailles And The World War II - 848 Words

What better way to follow-up â€Å"the war to end all wars† then with what would become the deadliest war in history, thus far? Whether or not war, in general, is inevitable is a solid question but whether World War II could have been stopped takes the cake. The Treaty of Versailles was signed at the close of the first world war and dictated the terms of Germany s punishment. It reclaimed land for Poland, France, and Austria as well as restricted Germany s military to 100,000 men, six battleships and no air force among other articles. Between these restrictions and Hitler’s racial ideology gaining a following, did the world really expect Germany to stay silent forever? Hitler believed that the ideal German Empire needed to expand over central and eastern Europe and that the only way it could occur was by waging war on the Soviet Union. Many historians agree that World War II was ‘Hitler’s War’ and despite fair warning that his ideas would come to blo ws, nobody stopped it. The propaganda machine used by Nazi Germany helped to propel Hitler s message out of Germany to the 27 million German people living outside of the country and began to funnel his anti-Semitic message internationally. Wanting to avoid another war and believing the Nazi anti-Bolshevik propaganda, Britain and France believed that Hilter would be the one to save the world from Stalin and the Soviet Union. Believing that the Treaty of Versailles had been unfair to Germany, Britain and France were willingShow MoreRelatedWorld War II : The Treaty Of Versailles Essay2042 Words   |  9 Pagesterritory in a sequence of devastating wars. Treaty of Versailles: The treaty of Versailles was imposed on Germany on June 28 1919 by the Allies. France, Great Britain, the United States and the other allies demanded that Germany dismantled their military, only allowing a token army and navy and forbidding them an Air Force. Germany had to give up some of its lands to reconstitute Poland, and accept military occupation in its remaining territories. The treaty also contained a â€Å"Guilt Clause† requiredRead MoreThe Treaty Of Versailles During World War II Essay1864 Words   |  8 Pagesand gruesome bloodshed, World War I concluded on November 11th, 1918 as the Allied Powers claimed victory and the Axis Powers accepted defeat. In order to promote peace, finalize the outcome and prevent another large scale war, the victorious Allied Powers created a treaty, the Treaty of Versailles. Under the terms and conditions of the Treaty of Versailles, Germany and its allies were harshly sanctioned. Germany, viewed by the Allied Po wers as the primary inciter of World War I, received the worstRead MoreThe Treaty of Versailles and World War II552 Words   |  2 Pagestime where World War 1 was turned to be too overwhelming, a way of ending World War 1 was necessary. The solution was to create and sign a treaty from each of the Allies, in order ensure world-peace in the future; an intention to avoid any more World Wars or other related disasters. This treaty was signed in Versailles (hence the name came from), and enforced by the leaders of France, Britain, The United States of America and Italy. The big four’s (the world leaders that signed the treaty) names wereRead MoreThe Influence of the Treaty of Versailles on the Outbreak of World War II931 Words   |  4 Pages The Treaty of Versailles influenced the outbreak of WWII by angering the Germans, weakening their country, and making Germany vulnerable to Hitler’s influence. The Treaty of Versailles was made to keep Germany from stirri ng up commotion again by starting another war. It was signed at the end of WWI, which the Germans had lost, and therefore they were forced to sign the treaty, which took away their colonies, sectioned their land, made them pay for other countries military costs, and forcedRead MoreDid the Treaty of Versailles Make World War Ii Inevitable?2239 Words   |  9 PagesDid the Treaty of Versailles make World War II inevitable? JANUARY 8, 2008 STUDENT ID: 081404078 ABSTRACT This essay analyses the origins of the Second World War by briefly summarizing the events from 1919-1939. However, most emphasis is put on the amount of responsibility the Treaty of Versailles deserves for the outbreak of war. Other than analysing the Treaty of Versailles on its own, it also analyses the effects of the 1929 Wall Street Crash on the world, the riseRead MoreThe Treaty of Versailles1684 Words   |  7 PagesInvestigation The Treaty of Versailles was created to bring peace between nations after WWI. This investigation will answer the following question: To what extent did the Treaty of Versailles bring peace? In this investigation, the extent of the Versailles Treaty’s success will be evaluated by examining the period of its development, 1918, to the rise of Hitler, 1933. Several sources were used in this investigation including a number of books that look at the terms of the Treaty of Versailles and the reactionsRead MoreThe Treaty Of Versailles Ended World War I1708 Words   |  7 Pages The Second World War took approximately 50,000,000 to 60,000,000 lives (â€Å"World War II†). But this total does not include the millions not accounted for, many of them infants. The war had many causes, but the vast fault lay on a piece of writing from twenty years before the war even started. The Treaty of Versailles ended World War I but instigated the events that led up to World War II. Because the treaty of Versailles was so harsh on Germany, the effects of those terms allowed the Nazi partyRead MoreThe Treaty Of Versailles Necessary978 Words   |  4 PagesWorld War II was one of the bloodiest wars ever fought. World War II cost over 60 million lives and trillions of dollars. However, the entire war could of been prevented. Many wars in history could have been prevented. Rash decisions ignite wars and change history forever. One example of a rash decision is the Treaty of Versailles. The Treaty of Versailles required Germany to pay excessive reparations. This was impos sible at the time, as the country was just in a long and expensive war. Another irrationalRead MoreWorld War II Was The Second Greatest War Of The Twentieth Century860 Words   |  4 PagesWorld War II lasted from 1939-1945, but there were a number of circumstances leading up to the beginning of World War II. It involved the majority of the nations in the world in which they formed two military alliances. Those alliances were the allies and axis. In a state of total war, World War II was the most deadly war in history. This war was caused there was a violation of the Treaty of Versailles from WWI. Then, there was the expansion of the Japanese and fascism. Another reason for the outbreakRead MoreThe Declaration Of The Treaty Of Versailles1133 Words   |  5 Pages World War II ended in 1945, but it affected so many people that it is taught in schools; the thought of having another World War is terrifying. Imagine having the world thrown into that much chaos, causing so much des truction again. To avoid another World War people need to learn what caused them. The whole purpose of the Treaty of Versailles was to promote peace and stop the wars, but in the end all it did was create another World War. Many predicted the result of the weak treaty, but

The Beginnings of Industrialization Free Essays

The Beginnings of Industrialization A. Perceiving Cause and Effect: As you read this section, make notes in the chart to explain how each factor listed contributed to an Industrial Revolution in Great Britain Factor Contribution to the Industrial Revolution 1 . Agricultural Revolution- boosted demand for products and provided labor led to an increase of population increased Food supplies. We will write a custom essay sample on The Beginnings of Industrialization or any similar topic only for you Order Now 2. Abundant Natural Resources- Surplus of natural resources such as coal, ore harbors and ports. 3. Political Stability- allowed Britain to devote its energy and resources to the economic expansion. 4. Factors of Production- Britain had most the resources to produce products. 5. Technological advances- had improved the quality and speed of cloth production Higher profits. 6. Entrepreneurs- they had provided organization skills and took financial risk in creating a business. 7. Building of factories- allowed the industry to move in and out of the home into a main location. 8. Railroad boom- gave an inexpensive solution to transport materials created new jobs. B. Enclosure: the enclosure of the agriculture produce to contain u rope rotation: the rotation Of crops to industrial industry Explain how both paved the way for an agricultural revolution. Both of these paved the way for agricultural revolution by the growth of the crops and the enclosure that the agriculture needs C. Define the following terms: Industrial Revolution- the revolution for agriculture use. Industrialization- the change of agriculture to man made products. Factors of production- factory, place, time, management Factory- a place that produces or builds products for a profit Entrepreneur- a type of business person. How to cite The Beginnings of Industrialization, Papers

Recitatif By Toni Morrison Essays - Recitatif,

Recitatif By Toni Morrison Toni Morrison's essay, "Recitatif" is about two girls, Twyla and Roberta, who grow up in an orphanage because their mothers could not properly care for them. The underlying theme in "Recitatif" deals with racism. An interesting twist is the mystery of the girls' race. Leaving clues, but never stating whether Twyla or Roberta was black or white, Morrison makes it clear that the girls come from different ethnic backgrounds. At one point in the essay Twyla comments, "that we looked like salt and pepper." Due to the fact that the story is told in the first person, it seems natural for the reader to associate Twyla with himself/herself. "Recitatif" proves to be a noteworthy experiment, "toying" with the reader's emotions and effectively noting stereotypical races and their characteristics. Morrison never states the race of the girls for a purpose: to make the reader form his/her own opinion. The story begins with Twyla's mother dropping her off at the orphanage. There she met Roberta, who became her best friend, bonding because they were not real orphans with "beautiful dead parents in the sky." Instead of being "real" orphans, they were just abandoned kids whose mother's did not want them. Although the girls had few friends, their lives did not lack adventure. For example, they enjoyed spying on the big girls who liked to smoke and dance, and sadly got a laugh out of yelling mean things at Maggie, the woman who couldn't defend herself because she was mute. One of the last times the girls saw each other in the orphanage was the day of the picnic. Shortly after the picnic Roberta's mother came to take her home, marking the first small fracture in their friendship. The next time they saw each other was years later in the restaurant that Twyla worked. Roberta acts coldly towards Roberta partly because she was high off of drugs, on her way to see a Jimi Hendrix concert. Twyla was deeply offended that her former best friend would treat her so badly. Twelve years later they meet again at a grocery store. Roberta married a rich man and was now called Mrs. Benson; she was dressed in dimonds and talked much nicer to Twyla. By this time, Twyla has one child and Roberta has four. Strangely, Roberta acts extremely friendly, like she has met her long lost best friend. Twyla can't hold back her emotions and questions Roberta about their last encounter at the restaurant. Roberta shrugs it off, "Oh, Twyla, you know how it was in those days: black?white. You know how everything was." A friendly goodbye and the women go their own separate ways again. The third time they meet is at the school where Roberta's kids attend. Roberta and the other mothers were picketing because they didn't want their kids to be segregated. This led to a fight that would be not resolved until Twyla and Roberta meet for a final time, severing any last chance of friendship for the women. The problem lies inside the hearts of two special women, two childhood friends, and two different races. "Recitatif" challenges the reader to not be judgmental toward of the either girls and accept their color. Morrison gives clues to encourage the reader to make assumptions about the girls' race. From the beginning the author asserts that one girl is black and one is white, but not which is which. There are many instances that Morrison uses things that are stereotypically"black" or "white," almost begging one to infer the race of each girl. Although there is no answer to the mystery, what one decides for himself/herself says something about his/her own ethnic background. Morrison thrives off the stereotypes people have set for blacks and whites. For example, Twyla's mother told her that "those" people smelled funny because they didn't wash their hair. This might suggest that Roberta was black because many black people don't wash their hair often. On the other hand she could have been talking about the orphans not bathing properly which could cause them to smell"funny." Everything seems to be a gray area. On the night of the picnic when her mother came to visit, Twyla was embarrassed because her mother was wearing"those tight green slacks that made her butt stick out." Many people have labeled blacks as generally having larger behinds then whites, so Morrison may have had this sort of implication in mind. Twyla's mother, therefore, could have been black. Of course, she could have been a heavy white woman

Developing practitioner The WritePass Journal

Developing practitioner Introduction Developing practitioner IntroductionReflection in nursingConclusion ReferencesRelated Introduction Reflection has increasingly become an essential element of nursing professionalism. However, the term ‘reflection’ is not clearly defined in the literature and most definitions could be described as complex or vague (Atkins and Murphy 1993). Williams and Lowes (2001) define reflection as; ‘.a way of exploring and evaluating previous experiences and appreciating their value on personal practice and self.’ (pg. 1) Reflection is important to student nurses as it enables us to look at ourselves and our practice objectively. However, Mackintosh (1998), as well as other authors, are dubious that reflection can do all that it claims to do. What is agreed by nursing writers is that we can grow and mature as both a professional and a person by integrating our theory and knowledge into practice. The process of reflection can help move us from a student, to a nurse, and later to a competent and expert practitioner (Benner 1984). As nurses we should have the competencies to identify and respond to issues and make decisions that are informed and based on knowledge. All healthcare professionals make daily decisions that have ethical implications. Ethics for student nurses can be challenging as many of these decisions are emotive and students find these feelings hard to dismiss and difficult to rationalise (Clarke 2003). In their study, Ellis and Hartley (2001) found that student nurses expressed concerns over ethical problems and their ability to deal effectively with them. With the focus on a legal and ethical issue which I encountered whilst on clinical placement, I will reflect upon and critically analyse the issues raised in the incident using a recognised model of reflection. The model which I have chosen for this purpose is Borton’s Reflective Framework (1970, in Jasper 2003) which is increasingly being used by healthcare professionals as an approach for reflection. Jasper (2003) describes Borton’s model as simple and pragmatic, which meets the needs of practitioners to describe, make sense of and respond to situations. Howev er, the model has been criticised and Rolfe et al (2001) suggest it does not include the finer details of reflection and offers no prompts as to how reflection is to be conducted within each stage of the process. Even so, Rolfe et al (2001) do state that in comparison to Gibbs’s (1988, in Jasper 2003) and Johns (1998, in Johns 2005) models of reflection, it can be seen that the activity of reflection leads to action being taken in Borton’s framework, rather than just proposed, therefore moving from the realms of ‘maybe’ back into the reality of practice. The simplicity of the model and the proposal of action being taken in future situations prompted me to consider this model for this assignment purpose. Also, when reviewing the literature around reflective models, I found evidence by Burrows (1995) to suggest that nursing students under the age of 25 do not have the cognitive abilities and experience to reflect and alter their practice. Bulman and Schutz ( 2004) reiterate this perspective by implying that less mature students are more inclined to use more descriptive models such as Gibbs rather than more advanced, as these may not be of any use to them. As I would consider myself a mature student and want to develop my knowledge beyond that of a novice practitioner, taking into account the simple structure of the model as discussed, I feel that Borton’s Reflective Framework (1970) is an appropriate choice to use as a guide to my reflective account. The incident I have identified to reflect upon involves the refusal of further treatment by a patient who is terminally ill. With a view to gaining new knowledge, insights and to further develop as a nurse practitioner, I will reflect upon the ethical and legal issues that arose from this encounter. These include autonomy, beneficence, capacity and informed consent, as well as my own feelings and preconceptions. I will maintain confidentiality throughout this assignment by changing the names of those persons involved incompliance with the Nursing Midwifery Council (NMC) ‘Code’ (2008). Reflection in nursing Reflection is not just about adding to our knowledge; it is about challenging the concepts and theories as we try to make sense of that knowledge (Burton 2000). Kim (1999) argues that constructing knowledge from clinical practice is not enough and that nurses must also reflect on how that knowledge can lead to intentions to act. Several authors distinguish a gap between theory and practice in nursing (Conway 1994; Lauder 1994) and suggest that reflective practice may be the process with which to alleviate this. However, these authors do not support their claims with any evidence and are only offering opinion. The question still remains as to whether reflective practice produces better patient care as intended as there is very little research evidence on the benefits of reflective practice in nursing (Hargreaves 1997). Burton (2000) further reiterates this point by recognising that reflection relies entirely on information from patients and claims to be to their benefit, but is resear ched solely in the terms of the effects on practitioners. Reflective practice is also a fundamental concept of nurse education, with students encouraged to challenge their clinical practice and widen their knowledge base. However, Mackintosh (1998) stated that; ‘The implementation of reflection for students is as uncertain as its definition, with no guidelines or uniform method of application available.’(pg. 7) This criticism is evident in more recent literature, with Ireland (2008) and Hong and Chew (2008) both recognising that there are no definite guidelines on how to structure reflective practice in education. Writing reflective journals is one way reflective practice is encouraged in education as it allows students privacy and also to look back at previous entries to see how they have developed as nurse practitioners. However, Hargreaves (1997) suggests that reflective journals can be repetitive and time consuming, leading to boredom for the student. Hargreaves (1997) also proposes that when students are required to reflect in groups, this can lead to low self esteem as there is a lack of privacy. Also, when reflecting-on-action for assessment purposes, students may feel anxious about writing open and honest accounts in case of bad marks, leading to them writing what they think others want to hear and not the truth (Teekman 2000). When reflecting-on-action for this assignment purpose, I have been aware of these issues and this has encouraged me to reflect a true account of the incident, regardless of how difficult I may have found it to expose myself in such a way. Ethical issues relating to confidentiality also arise when reflecting, both for the person writing them and for the patient, as writing ‘stories’ about them without their consent can been seen as bad practice. However, Hargreaves (1997) argues that nurses have always ‘used’ patients and it is these experiences with patients that shape practice and it can be proposed that if a patient’s case is discussed but she has no knowledge then it can cause no harm and may actually benefit the patient directly or indirectly (Hargreaves 1997). Despite these criticisms, as opposed to giving care uncritically, reflection allows nurses to examine, question and learn from their experience and Andrews et al. (1998) recognise a danger of nursing care becoming ritualistic if it is not challenged. Using the three basic starting points in Borton’s Reflective Framework (1970) as a guide to the structure of my account, I am now going to reflect on the ethical and legal issue which I encountered recently whilst on clinical placement. What? It is important to recognise before recounting the incident, that as well as students being inclined to alter the scenario when reflecting-on-action as acknowledged, hindsight bias (Jones 1995) is also a concept by which a person’s recollection of events is influenced once they know the final outcome of the situation. Factors involved in hindsight bias are the desire to appear correct, maintain self esteem and to enhance feelings of competence (Jones 1995). Also stressful situations can affect attention and Saylor (1990) concluded in his study on recall, that for novice nurses and students in difficult interpersonal situations, such as topics on death, these are likely to cause stress resulting in less important issues being remembered. I had been involved in Mrs Jones’s care for a number of weeks and I was aware that she had returned from theatre the day before where she was to have had a secondary tumour removed. I was also aware, as was she, that she was terminally ill. I was in the room with Mrs Jones and her husband and we were chatting as I did her clinical observations. She was telling me that she was not afraid of dying and that she had been very lucky and had had a wonderful life. I felt very saddened by this and can clearly remember thinking to myself that I must remember what they told us in University about communicating with the dying patient, as I didn’t know what I was going to say once she finished speaking. In the end I decided that it was best if I say nothing rather than saying something inappropriate. This made me feel guilty at my own incompetence. The consultant then entered the room with my mentor and I asked my mentor if I should leave, but Mrs Jones insisted that I stay. The consultant then told Mrs Jones that they had been unable to remove the tumour. Mrs Jones nodded at this and said that she thought that would be the case. I suddenly felt out of my depth and wished I could just leave the room. The consultant continued by saying that he could offer Mrs Jones radiotherapy to try and shrink the tumour and prolong her life. He told her the side effects of the treatment, the frequency and also that it would not cure her, only ‘give her more time’. Mrs Jones stated that she did not want any more radiotherapy and just wanted to be pain free. I felt quite upset at this point and was trying not to make eye contact with anyone else in the room as I knew I would probably cry. The consultant continued by saying that although radiotherapy had side effects, it could add months to her life, and that there were options avai lable to help counter the side effects and that it might be worth considering. I remember thinking that Mrs Jones will probably decide on the radiotherapy if the doctor says it is the best thing to do, I couldn’t make sense of why she wouldn’t. Mrs Jones stated again that she did not want any further treatment, that she had discussed it with her family and that all she wanted was for her kids to see that she was happy, pain free and peaceful. Mrs Jones’ husband was crying at this point but told the consultant that they had talked about it and that he respected his wife’s decision and they would now like some time alone. At that the consultant, myself and my mentor left the room. The incident played on my mind immediately afterwards and although I wanted to talk with someone about it, I knew if I opened my mouth to speak I would cry so I busied myself with other things. So What? I had nursed Mrs Jones for a number of weeks and felt personally affected by her prognosis and her refusal of treatment to prolong her life. Mrs Jones was the same age as my own mother and had similar family dynamics to myself. I felt guilty that I could not offer some sort of comforting response when talking with her and during her interaction with the consultant. The feeling of guilt elevated as I felt inadequate to respond in what I felt was an appropriate manner. A study carried out by Kelly (1991) found that feelings of guilt are evident in students and appear more frequently as students gain experience. These findings are similar to those of Smith (1998) who concludes that guilt feelings in students are associated with a perceived inadequacy of personal responses and ethical dilemmas. The more experience gained, the more students felt fearful and guilty as they worry about what will be expected of them. I can relate to this evidence having worked in the health care setting for a number of years prior to starting my nurse training and now being in my second year, I have high expectations of myself and my practice. I feel that if I don’t match up to these expectations, and what I believe other people expect from me, I am letting myself and others down. Smith (1998) recognises that students develop coping mechanisms such as detachment and adopt these when they are in situations that are difficult for them. I tried to detach myself from the situation by not making eye contact or speaking as I felt out of my depth within the situation. Although detachment can be seen as a threat to the nurse-patient relationship, Smith (1998) concluded that some degree of detachment is necessary for students to maintain the ability to function and prevent breakdown. I adopted this coping mechanism to prevent myself from crying and upsetting the situation further, which appears to support the findings proposed by Smith. However in a study carried out by Kralik et al (1997) on patient’s experiences in hospital, the participants stated that, when cared for by nurses who appeared detached, it was a negative experience and they felt vulnerable and insecure. I am aware that if I allow detachment to become embedded within my future practice it may aff ect my ability to offer compassionate care to patients. Although I was aware of the knowledge around communication with the terminally ill, I was unable to reflect-in-action and apply this knowledge to practice. Schon (1983) describes reflection-in-action as the way that nurses think and theorise about practice whilst they are doing it. This is seen as an automatic activity that occurs subconsciously in practice. According to Street (1992), students experience difficulty connecting theory with the realities of practice. However, Street does suggest that there are indications that students are able to integrate theory gained in the classroom with practice, but at first it is deliberate and conscious. This evidence suggests that reflection-in-action is developed through experience. I felt upset that Mrs Jones did not want any further treatment and I kept thinking that if it was my own mother I would want her to stay alive as long as possible. I may have felt like this as I did not want to experience the grief that comes with death, which appears now to be a selfish act. The refusal of treatment with a view to end of life can sometimes be associated with voluntary euthanasia. This term involves the deliberate intervention or omission with the intent of ending an individual’s life at their request (Saunders and Chaloner 2007). Despite a Bill passing before parliament on assisted dying or assisted suicide, existing laws remain unchanged and euthanasia of any sort is illegal in the UK. However a person’s right to refuse treatment is legal in the UK and is supported in the NMC ‘Code’ (2008) which states; ‘You must respect and support peoples rights to accept or decline treatment and care’. Although the consultant was persistent in his offer of further treatment, he did not at any time disregard Mrs Jones’s decision to refuse treatment. UK law goes to great lengths to protect a person of full age and capacity from interference with personal liberty. In the case of Sidaway v Bethlem Royal Hospital (1985) it wa s stated that; ‘a capable adult has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to their own death.’ (Lord Scarman 1985 pg. 3) This absolute right has been upheld in more recent cases such as Re T (adult: refusal of medical treatment) (1997) and Re B (adult: refusal of medical treatment) (2002). The courts also recognise that in law there is a distinction between letting die (refusal of treatment) and killing a person (euthanasia), even though this is not accepted by some philosophers (Dimond 2005). Saunders and Chaloner (2007) question whether there is a moral distinction between withholding life sustaining treatment at the patients request and actively taking steps to end the patient’s life at their request. However, a concept that is shared amongst UK law, literature and philosophers is the respect for a person’s autonomy. This makes me consider whether the consultant, despite his persistence, did not disregard Mrs Jones’s decision as he was respecting her right to be autonomous. Buka (2008) proposes that to be autonomous means to be able to choose for oneself and involves individuals being able to formulate and determine the course of their own life. Autonomy consists of values and beliefs that are unique to the individual and that change with circumstances, so what Mrs Jones considered to be of value to her prior to her illness could well have changed at the time of the incident. Also what Mrs Jones believed to be of value to her could very well be different to what I would consider to be of importance. Begley (2008) acknowledges that dying well involves living well until the end of life and living well throughout the dying process depends on the responses of each unique person to the conditions in which they find themselves. Mrs Jones spoke about wanting her kids to see she was happy, pain free and peaceful, which appeared to me to be her main priority. Mrs Jones also spoke about how she was not afraid to die and that she had had a wonderful life. In their study of patients with incurable cancer, Voogt et al. (2005) found that while approximately a third of the participants strove for length of life, a third wanted quality of life. Mrs Jones’s values and beliefs may have been intertwined with an autonomous decision to die with dignity. Radley and Payne (2009) suggest that when people refuse treatment later on they want to spend quality time with their family without the side effects of treatment. Tingle and Cribb (2007) also recognise that although medicine can now provide the means of staving off death, the cost to the individual may be too high. Some may not want to spend their last days or weeks attached to tubes and drips. Tingle and Cribb further reiterate their point by proposing that it needs to be recognised that even if the pain of those who are terminally ill can be controlled, what they may fear the most is the technology that potentially leads to a loss of self-respect and self esteem. The concept of dying with dig nity is supported in UK law, and Article 3 of the Human Rights Act (1998) states that ‘no-one shall be subjected to torture or inhuman or degrading treatment or punishment’, an article which can be used to support cases of withdrawal of treatment. An autonomous person is also defined by Beauchamp and Childress (2001) as an individual who has the capacity to make decisions for themselves, as well as being competent to evaluate and deliberate information in order to reflect their own life plan. Capacity in the law is defined as the ability to understand information and make a balanced decision (Griffith 2007). Capacity is a fundamental component of autonomy and the Mental Capacity Act’s (2005) starting point is the presumption that a person has the capacity to make decisions for themselves unless it can be shown that they are incapable. Mrs Jones had been involved in decisions to do with her care throughout her treatment and the consultant knew her well. However, Tingle and Cribb (2007) suggest that patients are not very good at saying when they don’t understand and Pellegrino (2004, in Harrison et al. 2008) found in his study that patients suffering from cancer are on a negative spiral of events which may diminish their clinical competence and result in feelings of ‘powerlessness’. This evidence could suggest that Mrs Jones may have felt that she did not have the power to not only make a competent decision, but to tell the consultant that she did not understand what he was saying. The decision of whether a person has capacity is to be made at the time of the decision making (MCA 2005) and Larcher (2005) acknowledges that clinical competence may fluctuate, depending on the circumstances and compounding factors such as pain. Mrs Jones had regular analgesia to control her pain and did not before, during or after the encounter make any complaints of discomfort. She had support from her husband and was familiar with her surroundings as well as the staff present in the room. All these factors indicate to me now that Mrs Jones had the capacity to evaluate and deliberate the information given to her and make a decision that reflected her own life plan. The main principle of the Mental Capacity Act (2005) stresses that a person’s right to autonomy must be respected and can be further supported by requiring steps to be taken to maximise decision making capacity. One of these steps is informed consent. The Mental Capacity Act (2005) states that information given must include the nature of the decision, the purpose for which it is needed and the likely effects of any decision made. The need to weigh the information as part of the process of making the decision has been described by the courts as; ‘The ability to weigh all relevant information in the balance as part of the process of making a decision and then use that information to arrive at a decision.’ (Re MB Caesarean section 1997, in Griffith 2007). The consultant gave Mrs Jones information about her prognosis and treatment in compliance with the Mental Capacity Act (2005) as well as other health care policies (DOH 2007; 2008). He disclosed the factual details such as the advantages and disadvantages of the treatment and the potential side effects of undertaking further radiotherapy. However questions still arise as to how much information needs to be disclosed to the patient before consent can truly be said to be informed. As a moral matter it has been suggested that you should disclose whatever information a reasonable person would want to know plus whatever further information the actual individual wants to know (Radley and Payne 2009). However, research carried out by Clarke (2003) does suggest that patients demonstrate poor levels of knowledge and comprehension, particularly where bad news has been given. When the consultant told Mrs Jones that they hadn’t been able to remove the tumour she had replied that she had t hought that might have been the case. This indicates to me that Mrs Jones had already taken the time to consider her options and the possibility that the tumour may not be removed, prior to the encounter with the consultant. Seymour (2001) proposes that the informed decision to refuse treatment may be about regaining control in a situation where there may be few desirable options. Radley and Payne (2009) suggest that the decision to refuse treatment, is not a rejection of medicine but a rejection of false hope or an acceptance of another sort of hope in which quality of life is preferred over quantity of life. Mrs Jones had undergone intensive treatment in the months leading up to this final prognosis and I now consider that the finality of this diagnosis may have given her not the opportunity to ‘give up’ but to spend quality time with her family without the side effects of a treatment which was not going to cure her. Therefore Mrs Jones was taking positive steps to safeguard the death she wanted. After Mrs Jones initially refused the treatment the consultant went on again to say that ‘it could add months to her life’. I thought at the time that Mrs Jones may take time to consider this again given that the consultant was to me the ‘expert’. From a medical viewpoint, death is seen as a failure, rather than as an important part of life (Smith 2000), so there may be a conflict when a patient chooses to make a decision that is likely to end in death. Physicians who are unable to keep patients alive may struggle to avoid experiencing an inevitable sense of failure (Clarke 2003) as it is widely accepted that medicine’s primary goal is to restore a person’s health (Heaney et al. 2007). By offering Mrs Jones a treatment to delay the inevitable the consultant was acting in a beneficent manner and tension can arise when beneficence and autonomy are in conflict. With advanced medicines today life can be sustained for longer periods, however Van Kle ffens et al (2004) found in their study that for the patients who refused the treatment, their decision was not based on the pros and cons of treatment from a medical perspective but a ‘circumstantial basis’. In a further study by Van Kleffens in 2005, the patients who decided not to accept further treatment said it was based on their own experiences, values and meanings in life. Voogt et al (2005) also proposed that physicians do not engage sufficiently with the world of the patient that extends outside of medicine. So although the consultant knew Mrs Jones well and had been involved in her care for many months, he had only been associated with her in the medical concept. Contemporary opinion suggests that where there is tension between autonomy and beneficence, autonomy should take precedence (Dimond 2005). Now What? Mrs Jones passed away how she wished, in hospital surrounded by her family. Consideration of the ethical and legal principles discussed required a depth of knowledge that I as a student did not hold for this particular situation which was to me personal, complex and difficult to define. From reflection on this incident I recognise now that I have gaps in interpreting theory into practice. Benner’s (1984) work proposes that nurses move from novice to expert as a result of both experiences and training. By analysing the situation with reference to theories and concepts, I have come to realise that only through experience, greater knowledge and confidence will these gaps begin to close. I now know that no one solution was correct nor was it incorrect. Nurses have a legal and moral duty to act in a beneficent way which at times may conflict with the autonomy of the patient. However, providing the patient is of age and has the capabilities to make informed and balanced decisions, in cases of conflict the law will favour autonomy over beneficence. I have come to appreciate that the patient is the only one who can decide what matters to them and what is good based on the information given and as a nurse I am in a position to recognise when patient autonomy is at risk of not being respected and help to restore it. This would then result in the principles of autonomy and beneficence working in partnership rather than in conflict, with the act of beneficence being the action that increases the autonomy of the patient. The process of reflection can bring up painful emotions again but if followed properly and supported appropriately, it can help the reflector to come to terms with their emotions and move on. I now know that the feelings I expressed were natural for a novice like me. Should this particular situation arise again I know I would be able to take this new knowledge with me but am unsure as to whether it would diminish my feelings of sadness, I am however confident that I could now put them to one side. Conclusion Reflection is an important aspect of nurse education and can assist student nurses in linking theory and practice and in developing self-awareness skills. Borton’s (1970 in Jasper 2003) reflective framework has assisted me in both reflecting on what was to me a difficult and personal experience and being able to structure an academic assignment based on it. Even though critics claim that Borton does not include the finer details of reflection or any guide as to how reflection is to be conducted within each stage of the process, I found that these omissions allowed me a wider scope and more freedom to analyse and challenge the situation and my own feelings. Had I used a model such as Gibbs (1988 in Jasper 2003), which consists of prompt questions, it may have restricted my reflection as I tried to answer the specific questions. I am aware of the negative elements of reflection but feel that by acknowledging these within my assignment I was able to conduct a reflection that was an honest and true account. The ethical and legal issues that arose in the incident were autonomy, beneficence, capacity and informed consent. All these issues are interlinked and have an impact on each other and I now understand that each must be considered both as individual components and together in order to gain an accurate perception of a situation and provide patient centred care. My professional knowledge and understanding of these issues and the importance of reflection in nursing has increased considerably by completing this reflective assignment. I understand that by reflecting on situations that occur within clinical practice I will gain new insights, knowledge and understanding therefore empowering me in my practice. This will enhance my nursing practice in future in variety of ways, in particular by assisting me in conti nuous professional development throughout my nursing career, as required by the NMC (2008). References ANDREWS, M.; GIDMAN, J., and HUMPHREYS, A., 1998. Reflection: does it enhance professional nursing practice? British Journal of Nursing 7, 413-417 ATKINS, S.; MURPHY, K., 1993. Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192 BEAUCHAMP, T.L.; CHILDRESS, J.F., 2001. Principles of Biomedical Ethics, 5th edition. Oxford: Oxford University Press BEGLEY, A.M., 2008. Guilty but Good: Defending voluntary active euthanasia from a virtue perspective. Nursing Ethics 15(4), 434-445 BENNER, P., 1984. From Novice to Expert. California: Addison-Wesley BORTON, T., 1970. Reach, Touch and Teach. London: Hodder Arnold cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD B, RE (adult: refusal of medical treatment).; 2002. 1 FLR 1090. Available from: bailii.org/ew/cases/EWHC/Fam/2002/429.html (Accessed 14th May 2011) BUKA, P., 2008. Patients’ Rights, Law and Ethics for Nurses: A practical guide. London: Hodder Arnold BULMAN, C.; SCHUTZ, S., 2004. Reflective Practice in Nursing, 3rd edition. Oxford: Blackwell Publishing LTD BURROWS, D., 1995. The nurse teacher’s role in the promotion of reflective practice. Nurse Education Today 15, 346-50 BURTON, A.J., 2000. Reflection: nursing’s practice and education panacea? Journal of Advanced Nursing 31(5) 1009-1017 CLARKE, J., 2003. Patient centred death. British Medical Journal 327, 174-175 CONWAY, J., 1994. Reflection, the art and science of nursing and the theory-practice gap. British Journal of Nursing 3, 114-118 DEPARTMENT OF HEALTH., 2007. Cancer reform strategy. London: Crown Publications DEPARTMENT OF HEALTH., 2008. End of life care strategy. London: Department of Health DIMOND, B., 2005. Legal Aspects of Nursing, 4th edition. London: Pearson Education Limited ELLIS, J.R.; HARTLEY, C.L., 2001. Nursing in today’s world: Challenges, Issues and Trends. Philadelphia: Lippincott GIBBS, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Blackwell Publishing cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD GREAT BRITAIN. Human Rights Act 1998: Elizabeth ll. Chapter 42. 1998. London: The Stationery Office. Available from: legislation.gov.uk/ukpga/1998/42/contents (accessed on 14th May 2011) Great Britain. Mental Capacity Act 2005: Elizabeth II. Chapter 9. 2005 London: The Stationery Office. Available from: legislation.gov.uk/ukpga/2005/9/contents (Accessed on 15th May 2011) GRIFFITH, R., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 HARGREAVES, J., 1997. Using patients: exploring the ethical dimension of reflective practice in nurse education. Journal of Advanced Nursing 25, 223-228 HEANEY, M.; FOOT, C,. and FREEMAN, W., 2007. Ethical issues in withholding and withdrawing life-prolonging medical treatment in the IC U. Current Anaesthesia Critical Care 18, 5-6, 277-283 HONG, L.P.; CHEW, L., 2008. Reflective practice from the perspectives of the bachelor of nursing students in International Medical University (IMU). Singapore Nursing Journal 35(3), 5-6,8-10,12-15 JASPER, M., 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD JOHNS, C., 1998. Opening the Doors of Perception. Oxford: Blackwell Science cited in C. Johns and D. Freshwater, 2005 (eds), Transforming Nursing through Reflective Practice. Oxford: Blackwell Science JONES, P.R., 1995. Hindsight bias in reflective practice: An empirical investigation. Journal of Advanced Nursing 21, 783-788 KELLY, B., 1991. The professional values of English undergraduates. Journal of Advanced Nursing 16, 867-872 KIM, H.S., 1999. Critical Reflective inquiry for knowledge development in nursing practice. Journal of Advanced Nursing 29(5), 1205-12 KRALIK, D.; KOCH,T., and WOTTON K., 1997. Engagement and detachment: Understanding patients’ experiencing with nursing. Journal of Advanced Nursing 26(2), 399-407 LARCHER, V., 2005. Consent, competence and confidentiality. British Medical Journal 330, 7487, 353-356. LAUDER, W., 1994. Beyond reflection: practical wisdom and the practical syllogism. Nurse Education Today 14, 91-98 MACKINTOSH, C., 1998. Reflection: a flawed strategy for the nursing professional. Nurse Education Today 18, 553-7 MB, RE (Caesarean Section)., 1997. 2 F.L.R. 426 cited in R., Griffith., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 NURSING MIDWIFERY COUNCIL, 2008. The code: standards of conduct, performance and ethics for nurses and midwifes. London: NMC PELLEGRINO, E., 2004. Ethical considerations in head and neck cancer. California: Addison-Wesley cited in L, Harrison., R, Sessions., W, Hong., 2008 (eds). Head and Neck Cancer: A Multidisciplinary Approach, 2nd edition. Philadelphia: Lippincott Williams Wilkins RADLEY, A.; PAYNE, S.A., 2009. A sociological commentary on the refusal of treatment by patients with cancer. Mortality 14(4), 309-24 REID, B., 1993. ‘But we’re doing it already!’ Exploring a response to the concept of Reflective Practice in order to improve its facilitation. Nurse Education Today 13(4), 305-309 ROLFE, G.; FRESHWATER, D.; and JASPER, M., 2001. Critical Reflection for Nursing. Hampshire: Palgrave Macmillan SAUNDERS, K.; CHALONER, C., 2007. Voluntary euthanasia: ethical concepts and definitions. Nursing Standard 21(35) 41-44 SAYLOR, C.R., 1990. Reflection and professional education: art, science and competency. Nurse Educator 15(2), 8-11 SCHON, D., 1983. The Reflective Practitioner: How professionals think in action. London: Temple Smith SEYMOUR, J.R., 2001. Critical moments: death and dying in intensive care. Buckingham: Open University Press SIDAWAY V BETHLEM ROYAL HOSPITAL.; 1985. AC 871, 1985 1 All ER 643, 1985 2 WLR 480. Available from: bailii.org/uk/cases/UKHL/1985/1.html (Accessed 14th May 2011) SMITH, A., 1998. Learning about reflection. Journal of Advanced Nursing 28(4), 891-898 SMITH, R., 2000. A good death: an important aim for health services and for us all. British Medical Journal 320, 7228, 129-130 STREET, A.F., 1992. Inside nursing- A clinical ethnography of Clinical Nursing Practice. New York: Albany TEEKMAN, B., 2000. Exploring reflective thinking in nursing practice. Journal of Advanced Nursing 31(5), 1125-1135 TINGLE, J.; CRIBB, A., 2007. Nursing Law and Ethics, 3rd edition. Oxford: Blackwell Publishing LTD VAN KLEFFENS, T.; VAN BAARSEN, B., and VAN LEEUWEN, E., 2004. The medical practise of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective. Social Science Medicine 58, 2325–2336 VAN KLEFFENS, T.; VAN LEEUWEN, E., 2005. Physicians’ evaluations of patients’ decisions to refuse oncological treatment. Journal of Medical Ethics 31, 131–136 VOOGT, E.; VAN DER HEIDE, A.; RIETJENS, J.A.C.; VAN LEEUWEN, A.F.; VISER, A.P.; VAN DER RIJT, C.C.D., 2005. Attitudes of patients with incurable cancer towards medical treatment in the last phase of life. Journal of Oncology 23, 2012-2019 WILLIAMS, G.R.; LOWES, L., 2001. Reflective practice. Reflection: Possible strategies to improve its use by qualified staff. British Journal of Nursing 10(22), 1482-8

Rajasaurus, the Deadly Indian Dinosaur

Rajasaurus, the Deadly Indian Dinosaur Also known as theropods, meat-eating dinosaurs- including raptors, tyrannosaurs, carnosaurs, and too many other -saurs to list here- had a wide distribution during the later Mesozoic Era, from about 100 to 65 million years ago. An otherwise unremarkable predator, except for its small head crest, Rajasaurus lived in what is now modern-day India, not a very fruitful location for fossil discoveries. It has taken over 20 years to reconstruct this dinosaur from its scattered remains, discovered in Gujarat in the early 1980s. (Dinosaur fossils are relatively rare in India, which helps explain why the regal word Raja, meaning prince, was bestowed on this carnivore. Oddly enough, the most common Indian fossils are ancestral whales dating from the Eocene epoch, millions of years after the dinosaurs went extinct!) Why did Rajasaurus possess a head crest, a rare feature in carnivores that weighed in the one-ton-and-over range? The most likely explanation is that this was a sexually selected characteristic, since colorfully crested Rajasaurus males (or females) were more attractive to the opposite sex during mating season- thus helping to propagate this trait through succeeding generations. Its also worth noting that Carnotaurus, a close contemporary of Rajasaurus from South America, is the only identified meat-eating dinosaur with horns; perhaps there was something in the evolutionary air back then that selected for this characteristic. It may also be the case that the crest of Rajasaurus flushed pink (or some other color) as a means of signaling other pack members. Now that weve established that Rajasaurus was a meat-eater, what, exactly, did this dinosaur eat? Given the paucity of Indian dinosaur fossils, we can only speculate, but a good candidate would be titanosaurs- the gigantic, four-legged, small-brained dinosaurs that had a global distribution during the later Mesozoic Era. Clearly, a dinosaur the size of Rajasaurus couldnt hope to take down a full-grown titanosaur all by itself, but its possible that this theropod hunted in packs, or that it picked off newly hatched, elderly, or injured individuals. Like other dinosaurs of its kind, Rajasaurus probably preyed opportunistically on smaller ornithopods and even on its fellow theropods; for all we know, it may even have been an occasional cannibal. Rajasaurus has been classified as a type of large theropod known as an abelisaur, and was thus closely related to the eponymous member of this genus, the South American Abelisaurus. It was also close kin to the  comically short-armed Carnotaurus mentioned above and the supposed cannibal dinosaur Majungasaurus from Madagascar. The family resemblance can be explained by the fact that India and South America (as well as Africa and Madagascar) were joined together in the giant continent Gondwana during the early Cretaceous period, when the last common ancestor of these dinosaurs lived. Name: Rajasaurus (Hindi/Greek for prince lizard); pronounced RAH-jah-SORE-us Habitat: Woodlands of India Historical Period: Late Cretaceous (70-65 million years ago) Size and Weight: About 30 feet long and one ton Diet: Meat Distinguishing Characteristics: Moderate size; bipedal posture; distinctive crest on head

The advent of internet Essay Example | Topics and Well Written Essays - 2250 words

The advent of internet - Essay Example MD of the company told 'A' since she has done a module in IT Law, she can write an essay on legal issues related to practice or policies in the company. This will give 'A' working knowledge of the company and in case she detects any problems, then this can be raised with legal specialist. This company has a full order book designing and maintaining websites for small local businesses. But most work is put on its own website- StudentBar.com. The product aims to integrate successful product genres into an engaging virtual environment. Here online, past and present students can meet, reminisce and swap files, share music, mails, graphic files and chat. But when you look this site, you can notice quickly that there is active sharing of MP3 and adult files, and gossiping about their old lecturers and colleagues. There were also complaints from lecturers regarding these comments, asking for immediate removal of material and archve.There is also an issue of old assignment solutions being circulated to present students. The student Bar has a plethora of links to other sites including deep links well inside other sites providing up to date news, games, information, hacking resources, music, gossip, and academic cheat resources sites. Another main problem -Mr.' X 'one of the core development team member resigned over an argument over promotion. It was also found that he was selling the details of the subscribers to the site on to other agencies without the knowledge of the WWW. Now they are thinking of doing it themselves. Mr.'X' was taken, despite being renowned by his disposition to hacking, as he has worked previously in a similar site in the past. So he was considered for his expertise and he brought useful source code for the new project. There are also concerns that the recent viral attack on the site may have originated from this disgruntled employee, who is threatening to launch an identically themed site using no doubt the code he developed at WWW. The MD is aware there was no mention of intellectual property rights in the cursory job contract used for this employee. (MD notes in passing that he would welcome any idea of contract for his staff.) Some subscribers have complained that they have been approac hed by other organizations that appear to have information about them, which must have originated from the StudentBar.'X' who resigned over a payment and promotion row, is also demanding to see any file about him in the possession of WWW which give reasons why he was being, in his view, blocked from promotion. There

Local or National Healthcare Policy or Regulation Problem Essay

Local or National Healthcare Policy or Regulation Problem - Essay Example For instance, the victims were found not be involved in physical activities that assist in cutting down body fats (Natarajan, 2010). In addition, their lifestyles were questionable. Through the information found in the report, healthcare policy makers can be able to embark on ways in which to assist the obese people. Obesity viewed as a failure of an individual by uncontrolled eating, lack of exercise among other poor health practices (Natarajan, 2010). The author of the article was biased with regard to the subject of obesity. The author outlines the factors that influenced obesity to be only personal factors like reckless eating habits and lack of physical exercise. Nevertheless, obesity is also genetic, and at times, it is a medical condition. Even when an individual tries to cut down fatty foods, the individual is still termed as obese (Natarajan, 2010). Therefore, lifestyle cannot be considered the only reason for obesity. Therefore, when addressing the issue healthcare managers and policy makers should not be biased and should not blame the victims for their health condition. Instead, the individuals should be addressed appropriately without hurting their feelings. The author supports the information in the article by providing some statistical evidence of how the obese people conduct their lives. As a result, a number of obese victims were found to live a reckless life and were lazy to get involved in physical activities. The author further adds that if the condition is not controlled healthcare providers will undergo an extra cost in dealing with obese people. In addition, the author adds, people should understand the factors that enhance obesity to control the problem. Obesity raises a number of health concerns, and if proper assistance provided the issue can be tackled (Natarajan, 2010). Obesity is a global concern and the healthcare providers and policy makers should address the issue with

Living Proof :: social issues

Living Proof A radical nut can be screaming at you off a street corner shouting something about your soul and a â€Å"God† who loves you. He yells â€Å"God is real, save your soul!† and no one stops to think much more then â€Å"This guy is crazy!†. Where is the proof in that? This is one of the major problems people have when trying to understand a higher power. This essay will consist of mind bending proof that we walk by each day, and the changing effects of having faith in Jesus Christ. It’s safe to say that many people of this age believe in a higher power, as did many hundreds of years ago. In fact Adolf Hitler wanted to kill every living Jew because they thought that God had told him them to do it. The ancient Egyptians worshipped cats as Gods. Any cat owner can tell you that cats have never gotten over it! Statistics of today show that 1.7 billion people world wide are Christians and that 875 million are Sunni Islamic. Recent Canadian Census only counted 21,975 agnostics (someone who is uncertain about the existence of God) and a surprising total of 1.3 million North Americans are atheists (has no belief in God). That makes up 0.5% of the North American people. Many people say â€Å"I need proof† as they are walking past a tree that gives that gives them the very oxygen they need to live. We as humans take for granted the proof that is around us each day. Creation itself is working proof of God. A tiny ant is complete with a brain and nervous system, the planets are perfectly aligned for us to neither freeze nor burn, we have teeth to chew, nails to scratch and cells so complex we can function. Speaking of complexity look at our bodies, our bones and blood so perfectly designed.. After a few biology classes most of us can agree that life was created on purpose. When one evaluates the scientific evidence for the existence of a creator and accept evolution instead, they have more faith then any Christian. They have faith in chance, by which somehow everything came to be. The thing that is so amazing about this eternal, devoted creator is that of all his vast creation, humanity is what He cares and loves the most. It is the Christian belief that shortly after the creation, humans were cut off from his creator by disobeying Him.

IKEA Looks to Further Penetrate the U.S. Market

Given the SWOT analysis presented in the case, what are IKEA’s key competitive advantages? What strategic focus should the company take as it looks to further expand into the U. S. market? * IKEA’s low cost structure has been the very core of its success. It’s low-cost and high-quality strategy fits with the current state of the economy. Offering convenience factors within IKEA’s stores would fit well with IKEA’s low cost structure. It maintains its low-cost business model by creating a different furniture shopping experience. IKEA supplies customers with all possible materials needed to complete their shopping when they enter the store (that are, measuring tape, paper, pencils, catalogs, strollers, and shopping bags). Although IKEA is not set up as a traditional furniture store, the company does provide several added amenities. There is no denying that brand image is a key strength for IKEA. IKEA considers the environmental impact of every step in its business processes by making products that are environmentally conscientious and cost-effective. * To further expand into U. S. arket, IKEA must address two key issues. The first is the overwhelming individuality of U. S. consumers. Further expansion into the U. S. market will require IKEA to adapt its offerings and stores to local tastes. The second key issue is quality. Although American consumers are increasingly value-driven, they also demand quality products. Many Americans view self-assembled furniture as being lower in quality, and similar to the type s of furniture one might buy at Walmart or Target. 2. What factor is the biggest reason for IKEA’s growth and popularity: value or image? What can IKEA do to sustain growth after it loses some cache? * There is no denying that brand image is a key strength for IKEA. Even if they have not been in a store, most people around the globe recognize the blue and yellow logo as a symbolic representation of trendy, modern, and fashionable furniture which have been based on Swedish home-based clean and efficient service. * Diversification can be a good way that IKEA does to sustain growth after it loses some cache. Product innovation and market development such as IKEA’s expanding goal in U. S. market. It is a risky strategy but with careful selection of the right kind of businesses, considerable improvements in profitability can be experienced. To try and maintain growth, IKEA is considering diversification outside of the furniture market. 3. What strategic alternatives would you suggest IKEA employ to further penetrate the U. S. market? * Add more services to enhance customers’ experience, and implement a customer relationship management system to track current customers and communicate with them. Keep IKEA’s brand image and focus on correct placement of stores. Expand product lines to flank the budget line with a higher-priced line. Clever advertising and promotion. 4. Speculate on what will happen at IKEA stores as they are adapted to fit local tastes. Is the company’s trade-off of service for low cost sustainable in the long term? * IKEA’s management philosophy; â€Å"Our vision is to create a better everyday life for the many people. Our business idea is to offer a wide range of well-designed, functional, home furnishing products at prices so low that as many people as possible can afford them. and all its activities is founded on its mission of offering wide variety of functional furniture for the house, of a quality and at a price affordable by a majority of people. This mission shows IKEA’s competitive advantage, positioning strategy and marketing mix. Tailoring IKEA’s stores and product to local tastes will cause IKEA to change its mission, to lose its competitive advantage and to redesign its positioning strategy and marketing mix.

The Effects Of Television On The World - 1845 Words

Mandy Sanguigni Ms. Morrow Essay #3 4 May 2015 Seeing the World How quickly can something capture the eye? What could take a person on an emotional roller coaster, of happiness, sadness, hunger, fatigue, or being scared? The remarkable world of television can take a person anywhere. Television is a central form of communication which connects people with the outside world. The television has been around for decades and is found in practically every household. People watch the news, movies, game shows, or reality shows; there is a show for everyone, and, like it or not, there are plenty of advertisements. The creation of the television has been the beginning, with no sign of an end, connecting people to the past, present, and future,†¦show more content†¦Then between 1891 and 1895 Dickson shoots numerous 15 second motion pictures using Edison’s kineograph, his motion picture camera. Later in 1895, the first public demonstration of a motion picture occurred in France (History of Television). During 1900, the wo rd â€Å"television† was first used by Russian inventor Constantin Perskyi. He introduced this word at the World’s Fair in Paris during the first International Congress of Electricity (Bellis 1). Starting in 1923, Russian emigrant, Vladimir Zworkin patented his isconscope, a TV camera cathode ray tube, which became the major component in television development (Bellis 2). American inventor Charles Francis Jenkins transmitted pictures of Herbert Hoover from Washington DC to Philadelphia. Jenkins called this invention â€Å"radiovision† (Elon.edu 1). By 1924, Vladimir Zworkin patented a color television system (Bellis 2). Each method developed upon previous developments, each looking for a way to reach people in a more efficient way. The history of the television has many roots and inventors who were determined to reach out and embrace the world starting with technology of motion pictures working to grow forward into the world of television and beyond. Interes tingly, the birth of the television set brought countries and people together through the growing pains of the past, present, and, now