Reflection Paper 1 page about Eveline and the other page about the Essay

Reflection Paper 1 page about Eveline and the other page about the lottery - Essay Example r home.† Everybody can relate to hoping for something better, for change that might improve their life, and are often faced with difficult choices. In weighing up the possible advantages of going far away, gaining status as a married woman, looking at the bad things in her present situation, Eveline seemed to be trying to convince herself to make the changes. â€Å"She had consented to go away, to leave her home. Was that wise?† The doubts are always bubbling beneath the surface of the narrative, this is a universal dilemma when life is not ideal and something better seems to be available. The chance to travel, to have a loving husband might make a young woman happy and excited, or so I thought. Eveline’s dilemma reflects how many of us would feel and there is also a question as to whether she loved Frank. The ideal of a love that could overcome every obstacle is missing; Eveline might well be running from one controlling man to Everybody hopes their choices will lead to change for the better in their life, but sometimes fear of the unknown, and taking stock of what you already have helps to make the decision for you. This is what I think Eveline did, but I am left with the question – did she make the right choice for the right reasons? Maybe the answer is in these words: â€Å"Her eyes gave him no sign of love or farewell or recognition.† Told from the objective point of view, this story was shocking and horrific, as the tension built, and what at first appeared a positive, pleasant village custom, became something very sinister. I thought the stones were for some childish game, to be played after the lottery finished. I saw nothing significant in â€Å"..eventually made a great pile of stones in one corner of the square and guarded it against the raids of the other boys.† I believed that somebody was going to win a pot of money and life would go on, with everybody pleased at the winner’s good fortune. But this story had a darker meaning about

Live performance viewing Essay Example | Topics and Well Written Essays - 750 words

Live performance viewing - Essay Example There were happy and beautiful moments where the performance shows the development of United Kingdom from the historical time to date. The five Olympic rings that came from the industrial stage of the performance, that rose high above the stadium and started sparkling was spectacular. Happy mood is also seen when the dancing nurses came with beds to celebrate the National Health Service and the world- leading children’s hospital at Great Ormond Street. These two are clearly worth celebrating and being proud of. The performance also celebrates British great literature with scenes featuring Harry Potter’s enemy Veldemort who is defeated by Mary Poppins figures and the child-catcher from Chitty Chitty Bang Bang. Children are saved and returned to the safety of their beds. There was also humor and some confusion in this performance, especially when the fictional James Bond went to collect Queen Elizabeth from Buckingham Palace and brought her in the Stadium. The performance then shows an actor dressing like the Queen jumping from the helicopter. This scene was confusing but brought little humor to the play. The performance had a sad mood when there was the performance of adoptive sporting anthem â€Å"Abide With Me† by Emeli Sande. This song was accompanied by a tribute of the 7/7 terror attack victims in London that claimed the lives of 52 people. This is a very emotional moment in the performance. It was a moment of silence when the memorial wall of the victims was shown. My most favorite movement of the performance was in the industrial age. The performers were able to perfectly transition from the historical time where there were green fields to the Industrial Revolution. The performance perfectly utilized the space on the stage by displaying chimneys and factory production lines throughout the stage. Thousands of performers were able to show the crucial development in the social and cultural

Autism Paper Essay Example | Topics and Well Written Essays - 500 words

Autism Paper - Essay Example His autism presents itself as a need for order, esoteric ways of viewing the world and difficulty communicating that to his classmates despite being very friendly and sometimes very outgoing, and a degree of judgment about others. In games with others, he frequently has different goals and objectives and wonders why everyone else is so â€Å"stupid†. The ADI-R and CSBQ may be able to guide my work with Adam. I would recommend, however, that they put him through the ADOS before designing a plan. The ADOS is designed to work with the ADI-R, and while I don't think it's strictly necessary, I believe that it's important to get as many different points of information as possible before beginning a regimen. The ADI-R focuses on social interaction, communication and behavior patterns. I think these are important, but I'd want a more holistic, qualitative look at his symptoms. The CSBQ is helpful because, as a questionnaire, it can provide more data than the ADOS. In conjunction, I th ink they are a useful guide. One thing I'd want to see specifically is his degree of restricted and repetitive behaviors.

Changing an Outdated Policy Assignment Example | Topics and Well Written Essays - 1750 words

Changing an Outdated Policy - Assignment Example This policy stipulates that the tutor must be present during the actual class lesions .The tutor is required to teach, make presentations in class and to evaluate the students. The evaluation is always in either in the form of short questions answered within the class. This policy enables the tutor to get direct feedback from the students on whether the topic or the lecture has been understood. The students are also able to seek clarifications of unclear points. The policy makes the classroom teaching more interactive. The student gets the chance to reason out points among themselves in class. The interactions make learning more fun and interesting. Though this policy has its own advantages, it also has some disadvantages. It has low differentiation level. That is, it does not allow students to move at their own paces. It has lower student attendance and engagement. Once a student misses a lesson, catching up will be difficult hence reduced engagement in the class activities. The stu dent and the tutor will not be about the same topics. The current method that needs to be introduced by educators to make learning more productive is the flipped classroom. ... The flipped classroom has a lot of advantages over the traditional teaching method. It allows for greater differentiation since the students are able to move at their own paces. Improved student attendance and engagement since when the teacher will be present in class, he or she will be dealing with the assignments where everyone is required to participate. It facilitates more proactive interactions between the teachers and the students. This is because both the parties will be engaged in problem solving. The flipped classroom is student centered, more economical on the part of the administrators since it allows them to hire fewer teachers since the teachers do not spend a lot of time in class. Changing the Policy The first , ISLLC standard for school leaders states that a school administrator is an educational leader who promotes the success of all students by facilitating the development , articulation , implementation and stewardship of a vision of learning that is shared and supp orted by the school community. This means that a school administrator should always strive to bring changes that will improve the performance of the students. This includes updating of the out of date policies. The policy that the teacher or the tutor must be present during lesions is out of date and should be replaced by flipping classroom where the teacher’s presentations are recorded on video and the tutor only discusses the assignments the student in class. The selected policy to update or change will benefit the school in many ways. Firstly, it’s economical since the school will not be required to hire more teachers since the teachers will not be required to spend a lot of time in class. Secondly, the policy change will help to improve the grades in the

Compare and contract the views of society presented in Equus and the Essay

Compare and contract the views of society presented in Equus and the time machine - Essay Example This will be illustrated by excerpts from H. G. Wells’ The Time Machine and Peter Shaffer’s Equus. This essay will focus on two aspects of social conformity namely; normalcy and entropy. The works of both writers portray a vision of a troubled future if man continues to dwell within the societal confines that propagate passivity while ignoring pressing issues such as social class splits and individual passion. Normalcy refers to what the society considers the right aspects of behavior. Passivity means inactive or submission to the will of others. In Equus, Dysart is considered normal as he rarely strays outside of societal boundaries. He is married, has no children, and has a good education and profession that places him in a high social class. However, he feels that his life is dull with no spiritual communication. His marriage lacks intimacy as illustrated by his admission that he has not kissed his wife for six years. Disillusioned with modern civilization and unhapp y with his role in it, he turns to Greek civilization for spiritual comfort. This highlights the internal conflict that most people have. In conforming to society’s belief of what is considered normal, one loses their individualism and passion, causing misery in their lives. In contrast, his patient, Alan, seems full of passion and vigor. Alan goes against the societal indoctrination to conceive the idea of a god that differs from the traditional Christianity. This is propagated by the conflicting views on religion of his parents. His mother is a staunch Christian who read him the bible daily and taught him that the sexual act was dirty. His father was an atheist and a strict disciplinarian that could not even allow him to watch television because he believes that it takes away one’s intelligence and concentration. Both parents are products of social norm, which requires them to exist in a world without passion and worship. As a result, Alan conceives a horse god, Equu s, with which he freely expresses his passionate worship and sexuality. He compares the horsegod to Jesus when he says, â€Å"I see you, I will save you.† (66). This adoration hits its climax when he blinds six horses. As a result, he is declared unbalanced and in pain and sent to Dysart to heal his mind. This violence brings out the conflict between the two myths: the pagan worship he created, and the Christian one he inherited which saddled him with guilt and shame concerning his sexuality. The eyes are symbolic of society’s checks on its members, constantly judging and punishing. By striking the eyes, Alan fights the society that has oppressed him. Thus, society forces blind obedience and individuals are forced to suppress their desires. Even though most people are aware of this consequence and are dissatisfied with their miserable existence, they lack the commitment to change their lives. Dysart feels that by removing one’s uniqueness he is destroying part o f their personality, but ultimately strips Alan of what he desires most. Normalcy and passivity are also evident in The Time Machine. The social disparity between the leisurely wealthy upper class and the working class was considered normal, especially in the Victorian England. The rich exploited the workers for profits to finance their passive lifestyle as portrayed by the laziness in the dinner guests in chapter one, who meet to dine and chat. The time traveler belongs to the upper class. This passivity is also evident among the Eloi (upper

Arthur Reed Case Study Essay Example for Free

Arthur Reed Case Study Essay This case study involves Arthur Reed who works for Blue Grocery Stores Incorporated as a warehouse supervisor (case study, 2010) and is having a difficult time fulfilling staffing requirements during the summer months he has tried some options that didnt fulfill the needs of the business. This case study will help Arthur meet these goals. Staffing Issues The summer months were a staffing headache for the warehouse supervisor at Blue Grocery Stores Incorporated (case study, 2010). Everyone wanted to take their accrued vacation then. After all, summer time was the perfect time for family vacations and activities. What made this staffing issue a bigger headache was the fact that a significant number of employees were calling in for sick days during this time of year as well. Replacement workers hadnt worked in the past so thats another challenge to overcome. Options for Optimum Staffing The first suggestion would be for the company to pay for the costly steel-toed boots for the replacement workers and waive any union dues for the replacement workers (case study, 2010). If for some reason that didnt work, the next suggestion in solving this staffing issue would be to hire a summer temporary force using college students. College students can always use extra money for school. I would suggest that the company to pay for the costly steel-toed boots, this would help attract more potential temporary employees for the summer months. The final option would be to adjust the warehouse hours for the summer time. Instead of working a day and afternoon shift, consolidate both teams of employees into one team with two different starting times, two hours apart. That will optimize the staffing, while eliminating the need to hire temporary employees for the summer. If corporations have to rely on temporary employees to fulfill the needs of the business, then they are risking the business objectives. Temporary employees are just that, temporary, and there is a strong possibility that the company performance would slip in relying on them. There could be compromises and arrangements made with the shipping and receiving of supplies so that the business goals are still obtained. This is the best option if successful, not only does it not rely on temporary employees to fulfill the business needs, this keeps the company budget down while maximizing the resources that are available.

Reflection on Nursing Communication Scenario

Reflection on Nursing Communication Scenario INTRODUCTION TO COMMUNICATION SKILLS Communication is a vital part of the nurses role. Theorists such as Peplau (1952), Rogers (1970) and King (1971) all emphasise therapeutic communication as a primary part of nursing and a major focus of nursing practice. Long (1992) further suggests that communication contains many components including presence, listening, perception, caring, disclosure, acceptance, empathy, authenticity and respect. Stuart and Sundeen (1991, p.127) warn that while communication can facilitate the development of a therapeutic relationship it can also create barriers between clients and colleagues. Within Healthcare, communication may be described as a transitional process that is dynamic and constantly changing (Hargie, Saunders and Dickenson, 1994, p.329). It primarily involves communication between the nurse and the patient. If the interaction is to be meaningful, information should be exchanged; this involves the nurse adopting a planned, holistic approach which eventually forms the basis of a therapeutic relationship. Fielding and Llewelyn (1987) contend that poor communication is the primary cause of complaints by patients. This is supported by Young (1995) who reports that one third of complaints to the Health Service Commissioner were related to communication with nursing staff. Studies by Boore (1979) and Devine and Cook (1983) demonstrate that good communication actually assisted the rate of patient recovery thus reducing hospital admission times. This suggests that good communication skills are cost effective. In this assignment, I have reflected on situations that have taken place during my clinical work experience. These situations have helped to develop and utilise my interpersonal skills, helping to maintain therapeutic relationships with patients. In this instance, I have used Gibbs (1988) reflective cycle as the framework for my reflection. Gibbs (1988) reflective cycle consists of six stages in nursing practice and learning from the experiences. Description of the situation that arose. Conclusion of what else would I could have done. Action plan is there so I can prepare if the situation rises again. Analysis of the feeling Evaluation of the experience Analysis to make sense of the experience My Reflective Cycle Baird and Winter (2005) illustrate the importance of reflective practice. They state that reflecting will help to generate knowledge and professional practice, increase ones ability to adapt to new situations, develop self esteem and greater job satisfaction. However, Siviter (2004) explains that reflection is about gaining self confidence, identifying ways to improve, learning from ones own mistakes and behaviour, looking at other peoples perspectives, being self aware and making future improvements by learning from the past. I have come to realise that it is important for me to improve and build therapeutic relationships with my patients by helping to establish a rapport through trust and mutual understanding, creating the special link between patient and nurse as described by Harkreader and Hogan (2004). Peplau (1952), cited in Harkreader and Hogan (2004), notes that good contact in therapeutic relationships builds trust as well as raising the patients self esteem, often leading t o the patients personal growth. Ruesh (1961), cited in Arnold and Boggs (2007), states that the purpose of therapeutic communication is to improve the patients ability to function. Therefore, in order to establish a therapeutic nurse/patient interaction, a nurse must possess certain qualities e.g. caring, sincerity, empathy and trustworthiness (Kathol, 2003) (P.33). These qualities can be expressed by promoting effective communication and relationships by the implementation of interpersonal skills. Johnson (2008) defines interpersonal skills as the ability to communicate effectively. Chitty and Black (2007, p 218) mention that communication is the exchange of information, thoughts and ideas via simultaneous verbal and non verbal communication. They explain that while verbal communication relies on the spoken word, non-verbal communication is just as important, consisting of gestures, postures, facial expressions, plus the tone and level of volume of ones voice. Thus, my reflection i n this assignment is based on the development of therapeutic relationships between the nurse and patient using interpersonal skills. My reflection is about a particular patient, to whom, in order to maintain patient information confidentiality (NMC, 2004), I will refer to as Mr R. It concerns an event which took place when I was working on a surgical ward. Whilst there were male and female wards, female and male surgical patients were encouraged mingle. On this particular day, I noticed that one of the male patients was sitting alone on his bed. This was Mr R., a 64 year old gentleman who had been diagnosed with inoperable cancer of the pancreas, with a life expectancy of 18-24 months. He was unable to control his pain, and whilst some relief could be provided by chemotherapy, Mr R. had a good understanding of his condition and knew that there was no cure available. He was unable to walk by himself and always needed assistance even to stand up or sit down. Because of his mobility problems I offered to get him his cup of tea and I then sat with him as he was lonely. I would now like to discuss the feelings and thoughts I experienced at the time. Before I gave Mr R. his cup of tea, I approached him in a friendly manner and introduced myself; I tried to establish a good rapport with him because I wanted him to feel comfortable with me even though I was not a family member or relative. When I first asked Mr R. if I could get him a cup of tea, he looked at me and replied I have asked the girl for a cup of tea, I dont know where she is. I answered Well, I will see where she is and if I cant find her, I will gladly get one for you Mr R. In doing this, I demonstrated emphatic listening. According to Wold (2004, p 13), emphatic listening is about the willingness to understand the other person, not just judging by appearance. Then I touched MrR.s shoulders, kept talking and raised my tone a little because I was unsure of his reaction. At the same time, I used body language to communicate the action of drinking. I paused and repeated my actions, but this time I used some simple words which I though Mr R. would understand. Mr R. looked at me and nodded his head. As I was giving him his cup of tea, I maintained eye contact as I didnt want him to feel shy or embarrassed. Fortunately, using body language helped me to communicate with this gentleman. At the time I was worried that he would be unable to understand me since English is not my first language but I was able to communicate effectively with him by verbal and non-verbal means, using appropriate gestures and facial expressions. Body language and facial expressions are referred to as a non-verbal communication (Funnell et al. 2005 p.443). I kept thinking that I needed to improve my English in order for him to better understand and interpret my actions. I thought of the language barrier that could break verbal communication. Castledine (2002, p.923) mentions that the language barrier arises when individuals come from different social backgrounds or use slang or colloquial phrases in conversation. Luckily, when dealing with Mr R. the particular gestures and facial expressions I used helped him to understand that I was offering him assistance. The eye contact I maintained helped show my willingness to help him; it gave him reassurance and encouraged him to place his confidence in me. This is supported by Caris-Verhallen et al (1999) who mention that direct eye contact expresses a sense of interest in the other person and provides another form of communication. In my dealings with Mr R., I tried to communicate in the best and appropriate way possible in order to make him feel comfortable; as a result he placed his trust in me and was more co-operative. Evaluation In evaluating my actions, I feel that I behaved correctly since my actions gave Mr R. both the assistance he needed and provided him with some company. I was able to successfully develop the nurse-patient relationship. Although McCabe (2004, p-44) would describe this as task centred communication one of the key components missing in communication by nurses I feel that the situation involved both good patient and task centred communication. I feel that I treated Mr R. with empathy because he was unable to perform certain tasks himself due to his mobility problems and was now refusing chemotherapy. It was my duty to make sure he was comfortable and felt supported and reassured. My involvement in the nurse-patient relationship was not restricted to task centred communication but included a patient centred approach using basic techniques to provide warmth and empathy toward the patient. I found that I was able to improve my non-verbal communication skills in my dealings with Mr R. When he first mentioned having chemotherapy, he volunteered very little information, thus demonstrating the role of non-verbal communication. Caris-Verhallen et al (1999, p.809) state that the role of non-verbal communication becomes important when communicating with elderly people with incurable cancer (Hollman et al 2005, p.31) There are a number of effective ways to maximise communication with people, for example, by trying to gain the persons attention before speaking this makes one more visible and helps to prevent the person from feeling intimidated or under any kind of pressure; the use of sensitive touch can also make them feel more comfortable. I feel that the interaction with Mr R. had been beneficial to me in that it helped me to learn how to adapt my communication skills both verbally and non-verbally. I used body language to its full effect since the language barrier made verbal communication with Mr.R. difficult. I used simple sentences that Mr R. could easily understand in order to encourage his participation. Wold (2004, p.76) mention that gestures are a specific type of non-verbal communication intended to express ideas; they are useful for people who have limited verbal communication skills. I also used facial expressions to help encourage him to have chemotherapy treatment which might not cure his problem but would give him some relief and make him feel healthier. Facial expressions are the most expressive means of non-verbal communication but are also limited to certain cultural and age barriers (Wold 2004 p.76). My facial expressions were intended to encourage Mr R. to reconsider his decision with regard to chemotherapy treatment. Whilst I could not go into all the details about his treatment, I was able to advise him to complete his treatment in order to alleviate his symptoms. Analysis In order to analyse the situation, I aim to evaluate the important communication skills that enabled me to provide the best level of nursing care for Mr R. My dealings with Mr R. involved interpersonal communication i.e. communication between two people (Funnell et al 2005, p-438).I realised that non-verbal communication did help me considerably in providing Mr R. with appropriate nursing care even though he could only understand a few of the words I was speaking. I did notice that one of the problems that occurred with this style of communication was the language barrier but despite this I continued by using appropriate communication techniques to aid the conversation. Although it was quite difficult at first, the use of non verbal communication skills helped encourage him to speak and also allowed him to understand me. The situation showed me that Mr R. was able to respond when I asked him the question without me having to wait for an answer he was unable to give. Funnell et al (2005, p 438) point out that communication occurs when a person responds to the message received and assigns a meaning to it. Mr R. had indicated his agreement by nodding his head. Delaune and Ladner (2002, P-191) explain that this channel is one of the key components of communication techniques and processes, being used as a medium to send out messages. In addition Mr R. also gave me feedback by showing that he was able to understand the messages being conveyed by my body language, facial expression and eye contact. The channels of communication I used can therefore be classed as both visual and auditory. Delaune and Ladner (2002 p.191) state that feedback occurs when the sender receives information after the receiver reacts to the message, however Chitty and Black (2007, p.218) define feedback as a response to a message. I n this particular situation, I was the sender who conveyed the message to Mr R. and Mr R. was the receiver who agreed to talk about his chemotherapy treatment and allowed me to assist. Consequently I feel that my dealings with Mr R. involved the 5 key components of communication outlined by Delaune and Ladner (2002, p.191) i.e. senders, message, channel, receiver and feedback. Reflecting on this event allowed me to explore how communication skills play a key role in the nurse and patient relationship in the delivery of patient-focussed care. Whilst I was trying to assist Mr R. when he was attempting to walk, I realised that he needed time to adapt to the changes in his activities of daily living. I was also considering ways of successful and effective communication to ensure a good nursing outcome. I concluded that it was vital to establish a rapport with Mr R. to encourage him to participate in the exchange both verbally and non-verbally. This might then give him the confidence to communicate effectively with the other staff nurses; this might later prevent him from being neglected due to his age or his inability to understand the information given to him about his treatment and the benefits of that treatment. I have set out an action plan of clinical practice for future reference. If there were patients who needed help with feeding or with other procedures, I would ensure that I was well prepared to deal patients who werent able to communicate properly. This is because, as a nurse, it is my role to ensure that patients are provided with the best possible care. To achieve this, I need to be able to communicate effectively with patients in different situations and with patients who have differing needs. I need to communicate effectively as it is important to know what patients need most during there stay on the ward under my supervision. Whilst I have a lot of experience in this field of practice, communication remains a fundamental part of the nursing process which needs to be developed in nurse-patient relationships. Wood (2006, p.13) states that communication is the key to unlock the foundation of relationships. Good communication is essential if one is to get to know a patients individu al health status (Walsh, 2005, p.30). Active learning can also help to identify the existence of barriers to communication when interacting with patients. Active learning means listening without making judgements; I always try to listen to patients opinions or complaints since this gives me the opportunity to see the patients perspective (Arnold, 2007, p.201). On the other hand, it is crucial to avoid the barriers that occur in communication with the patients and be able to detect language barriers. This can be done by questioning patients about their health and by asking them if they need help in their daily activities. I set about overcoming such barriers by asking open-ended questions and interrupting when necessary to seek additional facts (Funnell et al, 2005, p.453). Walsh (2005, p.31) also points out that stereotyping and making assumptions about patients, by making judgements on first impressions and a lack of awareness of communication skills are the main barriers to good communication. I must not judge patients by making assumptions on my first impression but should go out of my way to make the patient feel valued as an individual. I should respect each patients fundamental values, beliefs, culture, and individual means of communication (Heath, 300, p.27). I should be able to know how to establish a rapport with each patient. Cellini (1998, p.49) suggests a number of ways in which this can be achieved, including making oneself visible to the patient, anticipating patients needs, being reliable, listening effectively; all these factors will give me guidelines to improve my communication skills. Another important factor to include in my action plan is the need to take into account any disabilities patients may have such as poor hearing, visual impairment or mental disability. This could help give the patient some control and allow them to make the best use of body language. Once I know that a patient has some form of disability, I will be able to prepare a course of action in advance, deciding on the most appropriate and effective means of communication. Heath (2000, p.28) mentions that communicating with patients who have an impairment requires a particular and certain type of skill and consideration. Nazarko (2004, p.9) suggests that one should not repeat oneself if the patient is unable to understand but rather try to rephrase what one is saying in terms they can understand e.g. try speaking a little more slowly when communicating with disabled people or the hard of hearing. Hearing problems are the most common disability amongst adults due to the ageing process (Schofield. 2002, p.21). In summary, my action plan will show how to establish a good rapport with the patient, by recognising what affects the patients ability to communicate well and how to avoid barriers to effective communication in the future. Conclusion In conclusion, I have outlined the reasons behind my choosing Gibbs (1988) reflective cycle as the framework of my reflection and have discussed the importance of reflection in nursing practice. I feel I have discussed each stage of the cycle, outlining my ability to develop therapeutic relationship by using interpersonal skills in my dealings with one particular patient. I feel that most parts of the reflective cycle (Gibbs 1988) can be applied to the situation on which I have reflected. Without the model of structured reflection I do not feel I would have had the confidence to consider the situation in any depth (Graham cited in Johns 1997 a, p.91-92) and I fear reflection would have been remained at a descriptive level. I have been able to apply the situation to theory; as Boud Keogh Walker (1985, p.19) explain that reflection in the context of learning is a generic term for those intellectual and effective activities whereby individuals engage to explore their experiences in ord er to lead to a better understanding and appreciation. Boyd Fales (1983, p.100) agree with this and state that reflective learning is the process of internally examining and exploring an issue of concern, trigged by an experience that creates and clarifies meaning in terms of self and which results in a changed conceptual perspective. However, I personally believe that the reflective process is merely based on each individuals own personality and beliefs as well as their attitude and approach to the life. Appendix Mr R., a 64 year old gentleman, was an inpatient on a surgical ward. Earlier that day his consultant had directly informed him that he had inoperable cancer of the pancreas with a life expectancy of 18-24 months. Some relief might be offered by chemotherapy, but there was no cure. Mr R. was understandably shocked, but had suspected the diagnosis. At that time he remained in the care of the specialist nurse. Later in the day, as I was passing through the ward, I notice Mr. R. alone on his bed. Prescriptive A prescriptive intervention seeks to direct the behaviour of the client, usually behaviour that is outside the client-practitioner relationship. My first intervention was to open the conversation and demonstrate warmth. I provided information myself and gave Mr R. the choice of staying on his own or engaging with me. By shaking Mr R.s hands I was attempting to provide reassurance and support as well as communicating warmth in order to reduce his anxiety and promote an effective nurse-patient relationship. Practitioner: Hello Mr. R, I am one of the nurses here this  morning with Dr. M. Is there anything I can get you or would you rather be on your own? (Shook hands). Mr. R: NO, I remember you from this morning, come and sit down. Ive asked the girl for a cup of tea, I dont know where shes got to. Practitioner: Well give me a minute and Ill bring you one in. Do you take sugar? Mr. R: I suppose I shouldnt, then why worry. Two please. Practitioner: (Returning with a cup of tea) Here we are, dont blame me if its horrible, I got it from the trolley. (I smiled at Mr.R. and tried to establish eye contact, then sat down in the chair next to him). Mr. R: Thanks, thats just what I need. 2. Informative An informative intervention seeks to impart knowledge, information and meaning to the patient. My intention was to reinforce the nurse-patient relationship by smiling and attempting to establish eye contact as well as using facial expressions to put the patient at ease and establish a good rapport. By making Mr. R a cup of tea it created a pleasant response in a time of crisis. Practitioner: Jane (specialist nurse) was here this morning, what did you think about what she had to say? Mr. R: Oh yes she was very nice, mind you Im an old hand at this, I looked after my wife when she had cancer. Mr. R: She was riddled with cancer, but we kept her at home and looked after her. She could make a cracking cup of tea (Mr.R. smiles) Practitioner: (smiles and nods) When did she pass away? 3. Confronting A confronting intervention seeks to raise the clients consciousness about limiting behaviour or attitudes of which they are relatively unaware. By meeting the patients needs at that time I felt the urge to continue to show a display of warmth and develop the relationship further. Mr. R: It will be two years next month that she died. Practitioner: You must miss her. Mr. R: Theres not a day goes by that I dont talk to her. Goodness knows what she would make of all this, its brought it all back. 4. Cathartic A cathartic intervention seeks to enable the client to discharge/react to a painful emotion primarily grief, fear and/or anger. Mr. R spoke emotively and angrily by using such words as riddled and cancer. He spoke loudly and angrily with congruent non-verbal cues. Practitioner: Has what youve been discussing with Jane reminded you of your wifes death? Mr. R: Yes, (patient covers his face with his hands). Practitioner: What is it about what youve heard that is worrying you, do you think you can tell me? 5. Catalytic A catalytic intervention seeks to elicit self-discovery, self direct living, learning and problem solving in the client. Mr. R had a broad scope in which to discuss any concerns he may have had, but his response only concerned his wife, not him as his wife was the one who suffered from cancer. Mr. R: (Pause) ..Im an old hand at this and I dont want any of that chemo. Practitioner: What is it about the chemotherapy you dont like? Mr. R: My wife had it and we went through hell. Practitioner: You went through hell Mr. R: The doctors made her have the chemo and she still died in agony. 6. Supportive A supportive intervention seeks to affirm worth and value of the clients person, qualities, attitudes and actions. It is done to encourage the client to say more and to explore the issue further. Support is provided by non-verbal means like giving warmth, supportive posture and maintaining eye contact. I wanted to convince Mr. R that I was interested in what he had to say and help him believe that he was worth listening to that his opinions really mattered. Practitioner: Do you think the same thing will happen to you? Mr. R: Yes, thats the one thing Im worried about. Practitioner: em, if Im honest with you chemotherapy treatment is not a subject I know a lot about. (Pause), would you like to see the specialist nurse again? She can go over things with you and explain your options. Mr. R Well if she doesnt mind, Im just not sure the chemo will be worth it. Learning outcomes From this experience, I have learned the importance of:- Practice in accordance with the NMC (2004) code of professional conduct, performance, when caring for adult patients including confidentially, informed consent, accountability, patient advocacy and a safe environment. Demonstrating fair and anti-discriminatory behaviour, acknowledging differences in the beliefs, spiritual and cultural practices of individuals. Understanding the rationale for undertaking and documenting, a comprehensive, systematic and accurate nursing assessment of physical, psychological, social and spiritual needs. Interpreting assessment data to prioritise interventions in evidence based plan of care. Discussing factors that will influence the effective working relationships between health and social care teams. Demonstrating the ability to critically reflect upon practice.