How Internet Has Changed People Essay

The Internet has changed a lot over the year and a lot of people really don’t talk to each other anymore instead they talk either on Facebook or another Internet site. With all the things that you can do most families really don’t spend any time with each other anymore because everyone is doing something on the Internet. Now a day’s people can log on the Internet where ever they are. Because the internet decreases face to face interaction, makes it easier to retreat into a cyber-world, and vastly polarizes opinions and minimizes basic etiquette, the internet has done much to divide the global population, rather than connect it. About 86 percent of the world population uses the internet on a daily bases. Over the years Internet has decreased face to face interaction quite a bit. Now days if someone want to talk to someone they will just video chat with them over the Internet on apple devices, cell phones, computers, and Xbox. Also when someone wants write someone else they don’t get out paper and pen they go on the Internet and email them. Now days it is much easier to retreat into a cyber-world, than it is to retreat in this to in the real world. Social websites like Facebook and twitter have made people a whole lot less social than they were years ago. The average Facebook user creates 90 pieces of content every month! Internet has done so much to divide the global population, rather than connect it. Instead of families spend quality time with each other they are all in different rooms on the Internet doing different things. I have noticed over the years that a lot of people have become more depend on the internet that they don’t know what they would do without it. A lot of things for schools are now on the internet like for my math class everything is online and very little on paper. Now days most parents don’t see their kids because they are usually in their room on the internet doing different things like either video chatting, play a game online, or online chat rooms. According to Pewresearch.org â€Å"A new Pew Internet Project report reveals that 93% of teen’s ages 12†17 go online, as do 93% of young adult’s ages 18†29.† Today every teenage has their own TV, computer, and other electronic devices just in their room. A lot of people think that they need their cell phones or their computers and they don’t know what to do when it dies when the power is out. They think that it is the end of the world when either their phone dies or their computer dies when they power is out. Peoples are lost without the internet. Devices that have internet access are addicting and people sometimes don’t know when to stop. The internet has come a long way since it started and now everything is online from banking to emailing and lots of other things. A lot of education is on the internet more and more each year, for example if you need help and don’t know how to do a math problem and you don’t want to leave your house you can just search the internet for an online tutor. 107 trillion emails sent in 2010 and many more since then. People are now dating other people over the internet, instead of meeting each other the old fashion way. With online chat rooms you can talk to someone that is in a whole different country and not even know that. Individuals are becoming less independent on families than they were before. According to SocialMediaToday.com writer Tim Patterson, Facebook has 518 million users. I think that the internet is making people a whole lot less social than they were before the internet started. My family can be so caught up in what we are doing on the internet that forgets that one another are even home. I think that people should spend less time on the internet and more time with their families. According to InternetWorldStats.com in 2010 the United States Internet Users the top 5 states are California (29.8 million users), Texas (17.2 million users), New York (16.1 million users), Florida (14.8 million users), and Illinois (10.2 million users).

History of Nestle Essay

In 1866, Anglo-Swiss Condensed Milk Company set up the first European condensed milk factory in Cham, Switzerland. In 1985, the founder of Anglo-Swiss Condensed Milk Company who is German pharmacist : Henri Nestri. He had save the life of his neighbor’s child by using Farine lectee. Farine lectee product is made by cow’s milk, wheat flour and sugar. Henri Nestle embodied many of the key attitudes and values that form part and parcel of the corporation culture that included pragmatism, flexibility, the willingness to learn, an open mind and respect for other people and culture. In 1905, the Anglo-Swiss Condensed Milk Company that own by Americans Charles and George Page, merged with nestle. In 1920s, the economics is in downturn that cause Nestle to suffer a lot, the operations partially streamlined, but the company was able to continue with acquisition of Cailler, Peter, Kohler Swiss Chocolate Company, chocolate became an integral part of nestle business. In that moment, variety product being introduce which included Milo. In 1938, Nescafe coffee was launched by nestle. After two year, Nescafe became an instant success and followed by Nestea. Nestle try to reorganize the organization by introduce new product after economic downturn. In 1939, during the World War II, members of the board and General Management were transferred to US, coordinate Nestle activities in Western Hemisphere, the British Empire and Overseas. The War help Nescafe coffee became a staple beverage of American serviceman in Europe and Asia. In 1945, the end of the world also the beginning of particular dynamic phase of nestle. Many new product are introduce after war end. Maggie product were intro in 1947. In 1948, the instant chocolate, Nesquik was developed in US. In 1974, Nestle became a major shareholder in Loreal, the world leading makers of cosmetic. In 1977, nestle again merge with Alcon Laboratories Inc, a U.S manufacturer of pharmaceutical and ophthalmic products. A boycott against Nestle was initiated by the U.S based organization Infant Formula Action Coalition about the promotion on the infant formula in developing country. The boycott end in 1984 by signing a Statement of Understanding between Nestle and International Nestle Boycott Committee. In 1986, Nespresso story began that enable anyone to create the perfect cup of espresso coffee, just like a skilled barisa. In 1988, the Italian brand Buitoni became a part of Nestle . Buitoni more concern on quality, creativity and tradition. In 1988, Baby Milk Action launched a product to against nestle until today. In 2001, Nestle merged with Ralston Purina Company to form a new pet company, Nestle Purina PetCare Company. In 2002 two more acquisition was made : the merger of U.S Nestle ice cream with Dreyer’s and acquisition of Chef America Inc, a leading frozen food product business. In 2003, the Movenpick Ice cream that own by Nestle had enhance Nestle to became market leader in super premium category. In May 2010, Nestle launched Nestlà © Cocoa Plan with high quality, disease-resistant plantlets to farmers which aim to help farmer rejuvenate their farms and increase productivity. In September 2010, Nestlà © Health Science and the Nestlà © Institute of Health Sciences was create. In March 2011, Nestle became the first infant formula manufacturer to be included in the FTSE4Good Index. Nestle in Malaysia In April 2011, Nestle partnership with Chinese food company, Yinlu, a manufacturer of ready-to-drink peanut milk and canned rice porridge. In November 2011, Nestle partner with the Fair Labor Association. This partnership will help Nestle investigate if children are working in cocoa farms that supply to Nestle factories. Nestle began in Malaysia in 1912 as the Anglo-Swiss Condensed Milk Company in Penang and later, growth and expansion made a move to Kuala Lumpur necessary in 1939. Since 1962, first factory in Petaling Jaya , Nestle Malaysia now manufacture its products in 7 factories and operates from its head office in Mutiara Damansara. Nestle was publicly listed on Bursa Malaysia Berhad on 13 December, 1989. The share price of Nestle is RM 59.420.Now, the Nestle employs more than 5000 people and manufactures as well as markets more than 300 Halal products in Malaysia. Its brand name such has MILO ®, NESCAFÉ ®, MAGGI ®, NESPRAY ® and KIT KAT ® have become trusted household names and enjoyed for generations.

Of Human Bondage Essay

‘Of Human Bondage’ is a story about Philip Carey, a man with a clubfoot. He was orphaned when he was nine years old, and lived with his vicar uncle and aunt in Blackstable. His stay there was lonely and miserable. His uncle lived a religious and monotonous life, while his aunt was a typical Victorian Era wife, submissive to her husband. But while his uncle was always strict and rigid, his aunt sometimes showed him affection and love. His handicap made him feel isolated and an outcast, especially when he entered preparatory school in Tercanbury. But he was able to graduate and enter King’s school. There he met Mr. Perkins the headmaster, who was quite unpopular because he came from a family of linen drapers. Philip was encouraged to learn because Mr. Perkin commended his intelligence. He even made a friend named Rose, who was everything that he was not, popular, liked, and an unintelligent boy. But due to scarlet fever, which made him go home to Blackstable, their friendship suffered. It is at this episode that Maugham will start to clearly point out what his novel is about, classifying human experiences between bondage and freedom. The analysis of the novel will be seen through the classification of the experiences of the main character as he transferred from one place to another. Up to this point, it was all about bondage; Philip has to conform to the rigid and unaffectionate life with his uncle and aunt and to the unforgiving cruelty of young people when he was in the preparatory school and King’s school. But when he decided to transfer to Heidelberg, he started to experience freedom. In Heidelberg, Philip was influenced on how to think, and learned so many things. He lived in a boarding house by Professor Erlin, and he was able to meet new friends, with different qualities and approaches in life. When winter arrived, he decided to go back to Blackstable. He is then subjected to bondage again when he got into an affair with Emily Wilkinson, a guest in the vicarage. Being older than him, she was possessive and demanding which made Philip tire of the relationship easily. But thankfully, she left the vicarage for Germany, enabling Philip to decide about what to do with his life. His uncle then convinced him to go to London and become an accountant. Philip found London to be dreary and lonely. He did not like the silence and self-centeredness of the people. We can then deduce that Maugham intended to show London as a form of bondage for Philip; he had to conform to his uncle’s intentions for him to live a respectable but also a boring and rigid life. He broke off from this bondage and decided to transfer to Paris, with his aunt’s help. Paris was a combination of freedom and bondage for Philip, freedom because he made new friends and was able to expose himself to all kinds of ideas. However, he also experienced bondage because he discovered that he cannot become a great artist. His friend committed suicide because of the same realization. With the news that his aunt died, he immediately went back to Blackstable. His uncle was a disappointment because he did not show any sign of mourning, he even ate a big meal. But being able to see beyond his uncle’s hypocrisy, he accepted his uncle’s recommendation to enter the medical profession. He then goes back to London. After being responsible with his studies for a while, he met Mildred, the person who will be the biggest obstacle for him to succeed. He became obsessed with her, even to the point of stopping his medical study so he can give expensive gifts to her. After a series of betrayals by Mildred, he finally realized that he can let go of her. Philip then entered a financial slump; binding him with poverty. Thankfully, the Althelny’s were able to help him get a job. His uncle then died, leaving him with six hundred pounds, enough to let him continue his studies. He experiences a feeling of freedom after he finishes with his medical studies, and repaid the Athelny’s for their kindness. He decided to marry Sally, the oldest daughter and live a life happy ‘bondage’ with her in Dorcestershire. Reference http://pinkmonkey.com/booknotes/monkeynotes/pmOfHuman01.asp

Frank Sinatra As An Italian American Term Paper

Frank Sinatra As An Italian American - Term Paper Example A midwife reportedly injured him during the birth process and he was born without breathing until his grandmother held him under water to force him to come to life. (RatPack, 2011) While Sinatra recovered well enough to live a long and successful life, the story of his birth illustrates how different life was in the early 20th century. In 1915, the farmhouse and log cabin were still the predominant form of community habitation in America, and most people lacked basic education and health care for their families. The public safety net taken for granted now in social security and other benefits programs did not exist, nor did modern medicine, making survival difficult for the poor immigrants like Sinatra’s family who came to America. While infant mortality rates in birth were very high at that time in relation to now, it can also be said that most early Americans experienced the same threats of disease, nutrition, poverty, and livelihood as Sinatra’s family, but something made him different to stand out from the crowd. Frank Sinatra allegedly won a talent contest in order to earn his big break into show business at age 23 in the New York area. (RatPack, 2011) In this regard, his upbringing in New Jersey inevitably led him to New York which was the center of entertainment as well as industry, finance, and business. Sinatra’s official biography tells of him being inspired by the music of Bing Crosby when he was a youth, and this â€Å"big band† sound of white jazz would become his musical trademark. Sinatra’s early career was made through singing at dinner lounges, and he began to find some work on local radio programs in New Jersey. The jazz and big band musician Harry James discovered and signed Sinatra to a... Frank Sinatra was a controversial Italian American who was one of the greatest role models of his generation. His life and public activity helped define what it is to be a pop star and celebrity in America. While his music was not groundbreaking or innovative technically, it reached a wide audience drawn together by the events of WWII and helped them define their feelings as a nation. Sinatra was one of the earliest stars on radio, TV, and motion pictures, which gave him a larger than life appearance and influence on his generation. Whether or not he used his power, wealth, and fame for the most socially beneficial or progressive causes is really not an issue of history, for he represented himself according to a dynamic that was self –determined as he expressed so vividly in the song, â€Å"My Way†. Whether or not he was just, fair, honest, friendly, and kind to others would seem to be a minor issue, because he seized the path to fame, wealth, power, and affluence that most all of his contemporaries only dreamed about. Nevertheless, as a role model of rugged individualism as symbolized by the post-war American culture, and as an Italian American celebrity of the 20th Century, there are few who can compare to Sinatra in stature and influence.

Present the argument from evil against the existence of god,and Essay

Present the argument from evil against the existence of god,and explain the major objections to the argument, and the major resp - Essay Example One of the primary assumptions of a supreme being is that they would embody morally just or ‘good’ qualities. With a morally just God the question then becomes why there is evil in the world. Another important consideration is that if there is a God or creator figure then he must be an extremely powerful entity. With this power then why does the God not eliminate evil in the world? In these regards, the actual structure of the argument is that: 1. If God exists, then God is supreme and moral. 2. If God is supreme, then God has the ability to do away with evil. 3. If God is supreme, then God knows where to locate evil. 4. If God is moral, then God has the desire to do away with all evil. 5. There is evil in the world. 6. If evil exists and God exists then God would have done away with evil. Therefore, God doesn't exist. Objections When considering these points, there are a number of objections that have been raised. When considering these points a number of objections hav e been raised. One of the major objections surfaces from believers in God who argue from a religious perspective. This perspective is that the existence of evil and God are not contradictory because God intends for individuals to have free will.

The differences in educational attainment in class, gender and Essay

The differences in educational attainment in class, gender and ethnicity - Essay Example This discussion is in the context of ethnic groups, turns toward the socio-economic factors when one tries to find out reasons behind these differences. The Labour Force Survey( 2004/05) as in defined households poverty on the basis of income and presented the percentage of different ethnic groups. White British are 20% of the total with the lowest in income poverty. Compared to the Whites, 25% of Indian, 30% of Black Caribbean, 45% of Black African, 55% of Pakistani and 65% of Bangladeshi households are in income poverty. Strand and Lindsay (2009) reported an economic disadvantage on the basis of Free School Meal in the UK. They indicate that in 2005, 11% Chinese, 12% Indian, 14% White British pupils, up to 30% for the Black Caribbean, 34% for Pakistani, 44% Black African and 47% for Bangladeshi pupils.Patterns emerge between the achievement gap and socioeconomic disadvantage.The sociologist explains that such gaps are rooted in the economic backgrounds. Historically, as early as 19 60, it had been pointed out that poor children fell behind rich and middle-class during the early age and then stayed behind all school life. The most significant factor or factors had not been found. Sylva et al expressed that, in the early years, parenting practices and learning environment at home are crucial factors in educational attainment and progress.Hart and Risley conducted an intensive research project on language acquisition. The study continued for ten years and covered 42 families with newborn children in Kansas City.... Sylva et al, (2004) expressed that, in the early years, parenting practices and learning environment at home are crucial factors in educational attainment and progress. Hart and Risley(1995) conducted an intensive research project on language acquisition. The study continued for ten years and covered 42 families with newborn children in Kansas City. They families can roughly be divided into two classes naming ‘professional’ and ‘on-welfare’. During the first three years, they visited each family once a month. They recorded all communication between the child and the parents. The researchers then analyzed each child’s language development comparing the each parent’s communication style. They found the following amazing gaps Child Development Professional Families On-welfare Families Vocabulary by 3 years 1100 525 Parents Utterances per hour 487 178 Encouragement Expressions listened by 3 500,000 75,000 Discouragement Expressions listened by 3 80 ,000 200,000 Average IQ of the group 117 79 Table 1 developed on the data from Hart and Risley(1995) These findings from Hart and Risley(1995) expose some interesting and crucial relationships. The comparison of the vocabulary scores of each child correlated closely to the number of words the parents spoke to the child. Further, the child from lower socio economic class heard more discouragement and disapproval words whereas child from professional families heard encouragement and praise words most of the time. Children’s higher IQ , their higher vocabulary and the higher encouragement words by the parents have correlation among the professional families. On the other hand, Children’s lower IQ , their lower vocabulary and the lower encouragement words by their

Supply chain Essay Example | Topics and Well Written Essays - 1000 words - 1

Supply chain - Essay Example The concept of standardization applies to multiple industries, and the cost savings can be significant; estimates by governmental leaders and industry analysts project that the auto manufacturing industry alone could save as much as $1 Billion annually (6). With a focus upon cost savings, there are several ways in which standardization assists a company or industry in improving its SCM processes to achieve the desired end. These include the enhancement of SCM planning, the enabling of SCM transparency, as well as the increase of cooperation and efficiency between the components. In terms of planning, the process of standardizing practices across the entirety of the supply chain requires management to consider each element in the system and how those elements interact. To standardize a process means that each component is reviewed with an eye toward streamlining the interactions so that the ultimate process works better; a concept that applies to virtually any supply chain. For example, in the healthcare industry, one author notes that considering all the criteria which directly link to â€Å"product selection, product use, product disposal, and environmental and community health impacts† should be incorporated into the SCM so that a â€Å"holistic perspective† is maintained (Eagan, Kaiser, and Shaner 207). It makes sense that a non-compartmentalized view of the supply chain would contribute to efficiency in planning, resulting in cost savings. Accordingly, the first improvement standardization brings to SCM is that of forcing management to und erstand the entire process so that it all works together in an organized fashion. Another improvement gained through standardization is found in the principle of transparency. Published and recognized standards allow each component within the chain to understand the processes of the other elements and work in cooperation with them. As discussed in other research, the linear

Evaluation of the Software Project (Travel App) Research Paper

Evaluation of the Software Project (Travel App) - Research Paper Example From the software application Travel App., usability of the system has been considered and met in the design of the application. It is very easy to learn and understand as the number of buttons used has been minimized completely. Where fewer buttons are used, the user of the system has time to glance at them through at once to get the intended button with ease. The way the buttons have been labeled is another aspect that makes the application easy to learn and use as the instructions to be input are clear and precise. Even a naà ¯ve user can confidently use the system without any form of problem. It has been designed using the user-centered design as the clarity of the buttons dictates. A good designed user interface facilitates completion of tasks by users of the system without requiring them to pay more attention to the system. The manner in which a good interface is designed should facilitate its usability. This is achieved through balancing of the visual components and the techn ical functionality of the system when designing it, as it ensures development of usable, operational systems that are adaptable to changing user needs. It can therefore be concluded that the Travel Application has been designed in a usable manner as it meets most of these requirements in the way it has been designed and developed.

HW Assignment Example | Topics and Well Written Essays - 500 words - 1

HW - Assignment Example For example, from the scale it indicates that there is no specialization of tasks which eliminates competition among employees. There is no competition among the employees and merit is a group pride but not an individuals. I would recommend that the two organizations have similar ratings on any of the scales because both have different hierarchy. Despite the two organizations following different hierarchy, they can be evaluated on the same scale (Daft, 2012). This is because they follow different norms, their method of leadership is different and their level of specialization differs. For instance, Daft compares a tall, horizontal and government agency on the same scale. From the given scale, while evaluating the formality of the organizations, one has many rules while the other has almost no rules. Therefore, this makes it possible to rate them on same scale. Another reason is that they are not producing similar products. One is a product based organization while the other is a service based organization (Daft, 2012). From the given scale, GoPro technology is product based while Morning Star is service based organization. Similarly, Daft compares the three organizations that do not offer similar products on the same scale. One is a software development company, the other is a retailing company and the last one is a government service company. Therefore, both GoPro and Morning Star are comparable on the same

Computer Science-Information System Essay Example | Topics and Well Written Essays - 750 words

Computer Science-Information System - Essay Example in the case of industrial espionage or actions on the competitors' side) or inadvertent. Anyway, uncontrolled distribution of private information (especially about customers, e.g. card numbers, addresses, orders, business transactions, etc.) will result in withdrawal of customers and business partners, numerous lawsuits, and reducing revenues and profits. Therefore, often companies try to protect own information systems at the expense of employees privacy. This is a part of computer crime prevention measures with usage of specialized encrypting and authentication hardware and software, anti-malware programs such as Internet filters, firewalls, antiviruses, intrusion detection systems, etc. In some cases company's prevention measures contain monitoring for employee's communications from office workstations including e-mail control. Here, it is necessary to note that federal laws permit employers to monitor e-mail sent and received by employees. However, most companies maintain own privacy policies, trying to balance between privacy rights and security of business information. Sometimes corporate privacy policies allow employees and customers to access data about them and let them decide how that data can be used. This helps to avoid possible misunderstandings between company, employees, and customers. 2. 2. It is obvious that working conditions in IT Company must be designed to prevent computer crimes and simultaneously to avoid negative ethical consequences of prevention procedures. In fact, there is need to balance between some restrictions of Company's information flows and some rights to privacy, and also some rights to know; see Freeman & Graham Peace (2005), and also Tynan (2005). There are two main strategies to achieve such balance which often combined in practice. First strategy is "the way of prohibitions", namely not to distribute business information and information about technical processes, innovations, features of source codes, information from Company's internal databases, not to delete or corrupt information without clear instructions, etc. These restrictions can be easy formulated, described and then realized by technical means. Also, there are certain possibilities to reveal and investigate almost all cases of violation such Company's rules. These violations can be classified as computer crimes and often related to industrial espionage and information "wars" between competing companies. It is necessary to note that employee must have access to certain parts of Company's data to perform work tasks; therefore, information cannot be concealed at all. Alternative strategy is "the way of responsibility and obligations" or using corporate ethic rules. These rules determine generally accepted and discouraged activities within IT Company and between organizations. Employees define acceptable practices more strictly than just refraining from committing computer crimes; they also consider the effects of their activities on other people and organizations. Therefore, it is necessary to promote ethically responsible use of information systems on the base of developed codes of ethics, e.g. AITP code of ethics. This code of ethics is a set of obligations to management, fellows, society, employer, and country. For each area of obligation, standards of conduct describe the specific duties and

Air contaminants Essay Example | Topics and Well Written Essays - 250 words

Air contaminants - Essay Example Nitrogen Dioxide and Lead. Safe level of exposure can be determined. Toxic Air Contaminants: No safe level of exposure. Have over 250 compounds. Hazardous Air Pollutants: generally produced as by-products of industries. Greenhouse gases: Carbon dioxide, Methane, Nitrous oxide, fluorocarbons, Ozone. They promote climate change. Indoor air Pollutants: Mold, Volatile Organic Compounds, Radon, Ozone, Asbestos, Environmental tobacco smoke. Various methods can be adopted to sample the air pollutants occurrence and exposure in an environment. For Particulates: Cyclone is used for respirable dust sampling and works on the general principle of centrifugal and gravitational forces to separate aerosols into various size fractions. It is usually a 10mm cyclone and filter holder assembly attached to a low-flow pump and worn by the worker to obtain personal samples. Further there are many optical particulate direct reading instruments operating on the principle of the interaction between the parti cles and visible light such as Transmissometers and nephelometers. Smear technique is also used for identifying sites of contamination. Smear is done using a sterile swab that is rotated on the surface that is to be sampled. For Vapors and Gases: Electronic direct reading instruments are used based on the principles of amalgamation, chem.-luminescence, combustion, electrochemistry, infrared spectro-photometry and photo-ionization.

Technology and Decision Making Essay Example for Free

Technology and Decision Making Essay The quality of patient care, communication between health care staff, and the safety of patients has greatly improved since the onset of technology. Through the improvement of information technology, the ability to collect data and manage the decisions based on the data collected has enhanced in the clinical setting as well as in the business portion. Health care informatics incorporates theories from informational science, computer science, and cognitive science (Englebardt Nelson, 2002). This information helps to gather and process it in order to make an informed decision. Important information could be missed if the data is ignored. Some of the most recent technology which includes the internet and cell phones has made it possible to access information quickly in order to make the best decision for the patient in order to provide good quality care. Technology changes every day and it is important to keep up with these changes that will help support clinical decisions made by the caregivers. This paper on informatics will show the systems and information theories, the DIK model, and the role of the expert system in nursing care and medicine. System and information theories System. â€Å"A system is a set of related interacting parts enclosed in a boundary† (Englebardt Nelson, 2002, p.5). There are many types of systems which include but are not limited to: computer systems, school systems, health care systems, and people. Systems can be living or nonliving, open or closed. Closed systems do not act with the environment whereas open system have the ability to act with the environment. Open systems can be used to understand technology and those individuals associated with its use. This type of system takes input from the environment, processes it, and then returns it back to the environment as output, which serves as feedback. This theory can better help the individual understand the way people work with systems in the health care industry and allow for a visualization of the whole picture. A common term using in computer science is GIGO, â€Å"garbage in, garbage out†. This applies in the sense that a system is only as good as its user. If the user is inputting garbage, or poor quality data, the computer is likely to output the same. A system requires an accurate source in order for accurate material to be produced as a result. Open systems have three types of characteristics which include: purpose, functions, and structure (Englebardt Nelson, 2002). The purpose is the reason for the existence of the system or the program and is most often stated in the organization’s mission statement. This is true for health care organizations, churches, and schools. For example, the mission statement of the local public health department to promote health, prevent illness, and control communicable disease by providing quality services, health education, and environmental services for the community. Computer systems are often classified by their purpose and may have more than one purpose. By selecting a purpose that all individuals agree upon within the organization, a system can be chosen. It is important to take the time to identify the purpose with all those who will be using the system. Functions identify the methods in which the system will achieve its purpose. â€Å"Functions are activities that a system carries out to achieve its purpose† (Englebardt Nelson, 2002, p.6). When a computer system is chosen a list of functional specification must be put in writing to identify each function and how it will be performed. Systems are structured to allow the functions to be carried out. Some examples of structured systems include the nursing department. The nurse in charge will assign patients to the staff nurses with the purpose to provide care. The charge nurse will ensure that the team is functioning with the ability to provide the care the patient needs and deserves. Two different models can be used to visualize the structure of a system: hierarchical and web. In the hierarchical model, each computer is a part of the local area network (LAN) which in turn is part of a wide area network (WAN) that is connected to the mainframe computer system. The mainframe is the leader of the system or lead part. The web model functions much like that of a spider-web. It has the capability to pass information to many departments that may use it for different purposes. For example,  laboratory results may be sent to the pharmacy to calculate a medication dosage and patient vitals may be sent to another department for review and use. â€Å"A system includes structural elements from both the web and hierarchical model† (Englebardt Nelson, 2002, p.7). Everything living or nonliving are in a constant state of change. Six concepts are helpful in understanding the change process: 1)dynamic homeostasis, 2)entropy, 3)negentropy, 4) specialization, 5)reverberation, and 6)equifinality. Dynamic homeostasis consists of maintaining an equal balance within the system. At times, increased stress can throw off the balance and cause challenges to the organization. A health care informatics specialist’s job is to decrease the stress and restore the balance within the organization. Entropy can be best described as the tendency of the system to break down into parts. This can be the loss of some data when transmitted from one department to another. All systems, living or nonliving, reach a point where they are no longer repairable. When this point is reached, a system must be replaced. Negentropy is the opposite of entropy and is best described as the system’s ability to multiply and become more complex. As the size of the health car e industry grows, so do the health care information systems. Information technology. â€Å"Information technology has the potential to greatly streamline healthcare and greatly reduce the chance of human error. However, there is a growing literature indicating that if systems are not designed adequately they may actually increase the possibility of error in the complex interaction between clinician and machine in healthcare† (Borycki, E., Kushniruk, A., Brender, J., 2010, p. 714). The term information has more than one meaning and the term information theory refers to multiple theories. The two common theoretical theories of information theories are: Shannon and Weaver’s information-communication model and Blum’s model (Englebardt Nelson, 2002, p. 10). The information theory was presented as a formal theory in 1948 with a publication by Claude Shannon titled â€Å"A Mathematical Theory of Communication†. In this theory, the sender is the originator of the message and then the encoder converts the message into a code. A code can be a number, symbol, letters, or words. The decoder then converts the message to a format that can be recognized by the receiver. Shannon was a telephone engineer and explained this theory in a way that the decoder was the  telephone converting sound waves into a message the receiver could understand. â€Å"Warren Weaver, from the Sloan-Kettering Institute for Cancer Research, provided the interpretation for understanding the semantic meaning of a message† (Englebardt Nelson, 2002, p. 12). He used Shannon’s works to explain the interpretational aspects of communication as each individual perceives things different from the next. Different types of circumstances may occur causing a message to be interpreted wrong. For example, if a physician is using medical terminology that the patient cannot understand there is definitely a communication problem. If the patient cannot hear what is being said because the ear is not transmitting sound, then there is a different type of communication problem. The message must convey meaning and produce the intended result. Bruce L. Blum defined three types of health care computing applications called Blum’s Model. He grouped these applications in data, information, or knowledge. Data are those things such as height, weight, age, and name. Information is defined as data that has been processed. Knowledge is the relationship between data and information. Using these concepts, it is possible to identify different levels of computing and automated systems. Data, Information, and Knowledge (DIK) model Healthcare informatics can be explained using a model consisting of three parts: data, information, and knowledge (Georgiou, 2002). The three parts are demonstrated using a hierarchy pyramid. Data is the platform in the model, representing the foundation. Data is represented as facts and observations, but without supporting context, the data is irrelevant. Until the information is validated or manipulated the data is not significant, once it is manipulated, the data can provide value to the user. Information is the product of data once the data has been manipulated. The result of data and information is evidence-based knowledge. Evidence based knowledge can be used to support evidence based medicine. Some individuals feel that too much focus has been put on data, limiting the ability to practice medicine as a science. Instead, the use of data suggests that medicine is being practiced based on statistics instead of science. Yet, the same critics will use the same hierarchy of data, information and knowledge to treat a patient that develops a fever after hip surgery. The fever alone does not provide significant information but combined with information of a  recent surgery, a physician will test further for signs of infection. The end result is the knowledge of why the patient is feverish. Viewing informatics in the form of the decision-information-knowledge (DIK) model allows individuals to see the process as a whole. The data must be accurately representing what is occurring or the information will not be accurate. The statement, â€Å"dirty in, dirty out,† can be applied to the platform of the model. It is essential that clean data be entered into the system, allowing clean data and information to be produced. The product, knowledge, can then be substantiated through the evidence produced. Just as evidence is used to make clinical decisions, the DIK model is used, in conjunction with the scie ntific information, to build evidence based medicine. Health informatics involves spreading and distributing information as just one piece of the process of producing knowledge which is multifaceted (Georgiou, 2002). The role of expert system in nursing care and medicine Nurses and other health care professionals make decisions on a daily basis that affect patients’ care and treatment. Nurses and health care professionals are not expert in all areas of nursing care and medicine. Health care workers specialized in certain area or field of medicine or nursing are not always readily available to everyone. Expert systems have been developed to assist medical and health care providers with decisions about care and treatment of patient. An expert system is a knowledge-based computer program designed to â€Å"enhance the human ability to analyze, problem solve, treat, diagnose, and estimate prognosis of health-related conditions† (Englebardt Nelson, 2002, p. 114). â€Å"Nursing expert systems can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise† (Courtney, Alexander, and Demiris, 2008, P. 697). Examples of expert systems include MYCIN, a system that advise physicians about antimicrobial selection for patients with meningitis or bacteremia and INTERNIST-1, a system that assist with diagnosing complex problems in general internal medicine (Shortliffe, 1986). Health care workers may not always have the knowledge base to diagnose and treat every condition or situation encountered. Expert systems are used to close the gap in knowledge providing effective, efficient, and  accurate care. The concept of expert system is driven by the desire to improve patient care, reduce cost, and disseminate expert knowledge. Expert systems are used just as x-rays and lab values are obtained to improve the human understanding of a patient’s condition. The human memory has limitations. Expert systems can be the answer to eliminating a large number of preventable medical mistakes. This system can alert health care workers about drug interactions and allergies, and provide preferable form o f treatment. Expert systems can assist in diagnostic suggestions, testing prompts, therapeutic protocols, and practice guidelines. The utilization of expert systems has an impact on the quality of care, economy, and medical education of staff. Expert systems, when used effectively can improve patient outcomes and decrease health care costs. Fewer mistakes lead to lower financial expenditures and increased profits. Improved quality of care result in improved patient satisfaction that leads to increased reimbursement from Medicare and Medicaid. Expert systems can also decrease the variation in medical practice emphasizing standardized and evidence-based practice of care. Along with expert systems, decision aids and decision support systems are used to improve patient care. The use of decision aids and decision support systems Clinical decision aids help to identify solutions to clinical situations. Decision aids can be either paper-form or electronic. The electronic decision aids can be accessed via recorded media or the Internet. Decision aids are utilized to facilitate shared decisions between the patient and interdisciplinary team taking care of them. They help the patient to think about the multiple decisions they must make in the course of their treatment regimen. An example is the Ottawa Patient Decision Aid. This decision aid helps to determine whether or not patients should seek antibiotics for bronchitis. Another example is a decision aid about whether or not someone should place his or her family in a long-term care facility for Alzheimer’s disease (Englebardt Nelson, 2002). A decision support system (DSS) is an interactive, flexible, and adaptable computer-based information system (CBIS), which was made to support decision-making as it relates to the solution of an individual problem. â€Å"A clinical decision support system (CDSS) is an automated decision support system (DSS) that  mimics human decision making and can facilitate the clinical diagnostic process, promote the use of best practices, assist with the development and adherence of guidelines, facilitate processes for improvement of care, and prevent errors† (Englebardt and Nelson, 2002, p. 116). Decision support systems utilize data and provide easy user interface that permit for the decision maker’s own insights. Four components of decision support systems are user interface, model library, model manager, and report writer. User interface makes communication between the executive and decision support system. Model library includes statistical, graphical, financial, and â€Å"what if† models. Model manager accesses available models. Report Writer generates written output (Englebardt Nelson, 2002). Four types of CDSS used in patient care decision-making are systems that use alerts to respond to clinical data, systems respond to decisions to alter care by critiquing decisions, systems suggest interventions at the request of care providers, and systems conduct retrospective quality assurance reviews. Examples of nursing-specific decision support systems are nursing diagnosis systems such as the Computer Aided Nursing Diagnosis and Intervention (CANDI) system, care planning systems such as the Urological Nursing Information System, symptom management systems such as the Cancer Pain Decision Support system, and nursing education systems such as the Creighton Online Multiple Modular Expert System (Courtney, Alexander, and Demiris, 2008). The uses of technology for patient and client management As Information Technology continues to have more presence in health care, patients, physicians, and staff are benefiting from on-demand access to information anyplace, anytime it is needed. Advances in technology provide healthcare organizations the ability to improve the quality of patient care. An ultimate goal of using technology is to improve the quality of care patients receive (Become a Meaningful User of Health IT, 2010). Technology can be found patient homes, clinics, extended care facilities, and hospitals, to name just a few. As the number of chronic diseases continues to increase technologies like telemedicine and video-conferencing can improve the quality of life of patients with chronic conditions, and reduce costs caused by these illnesses (Finkelstein Friedman, 2000). Improving quality, access, and client management is done by enhancing the  exchange of information between providers, institutions, and payers, allowing patients to receive uninterrupted continuity of care. For the people living in rural areas, the restrictions placed on services and specialists can be improved using technology (Smith, Bensink, Armfield, Stillman, Caffery, 2005). Telecommunications in the healthcare environment can provide patients and providers an opportunity to meet and even exceed expectations clients and the community have. A physician accessing a patients’ record from his home can provide treatment and develop a plan of care without sitting in his clinic to access the patients’ chart. Caregivers are no longer at the mercy of ongoing education provided at a variety of locations and cost. Learning management systems available via the Internet allow staff to review material and participate in competency testing. Tools are available through the advances in technology, which allow training by developing simulations of patients used for assessment training in virtual environments, assessing cognitive skills of providers (McGowan, 2008). As technologies in healthcare continue to improve, caregivers and patients will continue to experience changes in many areas.  Communication, teaching, and documenting will be affected, which change the way clinicians provide care and the way clients will receive it. Analysis of the effect of technology on health care and health status Prior to computers and digital equipment seen in today’s healthcare facilities, most of what was done for patients was done manually. Manual processes could be time consuming and the opportunity for human error, which could affect the quality of care a patient received, was real. In a recent report from the Institute of medical care, it was stated that humans are inherently imperfect, and error is frequent in medical car (Patton, 2001). Technologies affecting patient care and a person’s health status include improvements to imaging systems, documentation solutions, and scheduling systems. Modern medicine relies on technological systems coming together: the operating room, clinical laboratory, radiology department, and radiation oncology facility each incorporate interrelated networks of technologies (Patton, 2001). Surgeries that once required large incisions can be done through microscopic incisions resulting in shorter hospital stays. Early diagnosis and improved treatment plans have been inevitably affected by technology. Although technology allows healthcare to improve access to patient information allowing easier access that is current and up-to-date there are also disadvantages to this kind of access. Consumers and caregivers have large volumes of information, which can be accessed, not all of the information accessed will be understood or accurate. Society must be aware that not all sites will be able to monitor and ensure information being accessed is credible; it is inevitable some of the information provided and retrieved will be inaccurate. Worse yet information which are by law confidential, may also be accessed without the consent of the patient. In addition to the ability to monitor healthcare information, technology may also make it challenging for physicians to practice under complete autonomy. With the increase in the complexity of technology, physicians must agree on how components relate to one another, also known as standards (Patton, 2001). As a result, some physicians can be seen resisting the adoption of new processes, but with ongoing development of user-friendly systems, resistance can be overcome. References Become a Meaningful User of Health IT. (2010). HHN: Hospitals Health Networks, 84(12), 47. Borycki, E., Kushniruk, A., Brender, J. (2010). Theories, models and frameworks for diagnosing technology-induced error. Studies In Health Technology And Informatics, 160(Pt 1), 714-718. Finkelstein, J. J., Friedman, R. H. (2000). Potential Role of Telecommunication Technologies in the Management of Chronic Health Conditions. Disease Management Health Outcomes, 8(2), 57-63. Retrieved from EBSCOhost. Courtney, K. L., Alexander, G. L., Demiris, G. (2008). Information technology from novice to expert: implementation implications. Journal of Nursing Management, 16(6), 692-699. doi:10.1111/j.1365-2834.2007.00829.x Englebardt, S. P. Nelson, R. (2002).Health care informatics. An interdisciplinary approach. St. Louis, MO: Mosby Elsevier. Georgiou, A. (2002). Data information and knowledge: the health informatics model and its role in evidence-based medicine. Journal Of Evaluation In Clinical Practice, 8(2), 127-130. McGowan, J. J. (2008). The Pervasiveness of Telemedicine: Adoption With or Without a Research Base. JGIM: Journal of General Internal Medicine, 23(4), 505-507. doi:10.1007/s11606-008-0534-z Patton, G. (2001). The two-edged sword: how technology shapes medical practice. Physician Executive, 27(2), 42-49. Shortliffe, E. H. (1986). Medical Expert Systems- Knowledge Tool for Physicians. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307157/?page=2 Smith, A., Bensink, M., Armfield, N., Stillman, J., Caffery, L. (2005, October-December). Telemedicine and rural health care applications. Journal of Postgraduate Medicine, 51(4), 286.

An Exegesis Of Colossians 3 12 17 Religion Essay

An Exegesis Of Colossians 3 12 17 Religion Essay Introduction In society there are innumerous encounters and engagements between Christians and non-Christian daily, some of these encounters are religious in nature the others are secular. The challenge to the Christian is to continuously exercise the commandment or requirements that God revealed via the Prophet Micah to do what is right, to love mercy, and to walk humbly with your God (Micah 6:8, NLT).  [1]  The elements for living a holy life are not difficult and they are not exhaustive; however, because of so many different interpretations available to the Christian readers, congregants and students, there is a high probability that confusion will reign in the minds of many. There are myriad teachings available to the Christian that are full of error, personal interpretations, non-Christian agendas and false teachings to name a few, that will lead to inappropriate application of biblical principles that will not properly represent Christ in the Christian ambassadorship to each other and t o the world. Following this further, living a holy life is a requirement for all Christians and the instruction for how to live holy is imperative knowledge for the Christian. Colossians 3:12-17 is an excellent source of instructions for Christian living. The passage asserts that God chose Christians to be a holy people. It stands to reason that He authored provisions to help Christians reach that goal. The passage presents several principles for instructing the Christian how to exhibit him or herself as a representative of Christ. The exegesis of this passage will disclose if the principles are applicable to the contemporary audience as it were to the original audience or if there is time driven deviation that renders it less impactful for modern application. Setting/Historical Background In order to comprehend the context of Colossians 3:12-17 it is important to have background information for the period in which it was written. Pauls penned intervention had to reflect his understanding of the Colossians worldview. It was a worldview that was eclectic and problematic. Its multiculturalism created a challenge for a church leader who was not versed and or educated in true Christian doctrines and its applicability. Paul is the author of the letter to the Colossians, he has the authority to write an account of holy living because of his conversion and life experiences. His history prior to his conversion on the road to Damascus and his experiences that trained him as an apostle to the Gentiles equipped him with the wisdom and knowledge for teaching and instructing. His pre-apostolic days begin with him being born into and raised in a prominent Jewish-Roman family. He is from the tribe of Benjamin which is where he obtained his name Saul, but his Roman name is Paul. He was circumcised on the eight day in accordance with the law; he was afforded the opportunity to be educated in the Greco-Roman rhetoric as well as Hebrew.  [2]   Paul was a student of Gamaliel (Acts 5:34) who was the grandson of Hillel and one of seven scholars to obtain the title Rabban which means our master.  [3]   The church in Colossae was composed of Jews and Gentiles which created a culture of syncretism, mixing Jewish legalism, with Greek speculation and the mysticism of the Orient.  [4]   The city of Colossae was a major city located on the Lycus River with accessibility to trade routes. It was downgraded to a secondary city by the first century A.D. Colossae was a neighboring city to Laodicea and Hierapolis; each city was approximately 10 miles from Colossae.  [5]  The church at Colossae received the gospel from Epaphras, a convert from the church in Ephesus; he urged Paul, who was in prison in Ephesus, to write a letter to Colossae to address heretical issues that were plaguing the church in Colossae regarding its battle with heresy; which was creating disruption in churches all over the western portion of Asia Minor.  [6]   Although, Paul never visited the city of Colossae, he was aware of the heretical spirit that swept the region. Like its neighbors, Colossae was infiltrated by a mixture of pagan doctrines influenced by pre-Gnosticism that regarded the body as evil to promote spiritual/non-material items as superior human form, known as mystical wisdom. The pagan influence led to questions about Jesus having a physical body as an ordinary man, error in esteeming angels, and proclaimed that salvation was the result of knowledge rather than faith.  [7]   There is contention that Paul wrote the letter to the Colossians from Rome and that it was delivered to the church by Tychicus during the early 60s. This is supported by those who refer to 4:7-8 as the reason for choosing Rome over Ephesus and Tychicus over Epaphras.  [8]   Analysis of Colossians 3:12-17 The Colossians comfort with pluralism subjected them to vulnerability in achieving solidarity in understanding and incorporating the doctrines of their new Christian faith. Their failure to comprehend the true essence of Christ and his personage as well as exclusiveness of Christianity revealed their need for intervention from one of authority in the doctrines such as an apostle in the faith. Therefore, Pauls letter to the Church of Colossae was necessary to substantiate the tenets of the faith and to emphasize as well as educate the new Christians regarding the expectations of their lives as Christian. Paul is the apostle to the Gentiles and it is incumbent upon him to respond to the needs of the Colossians as they struggle to manifest their faith and its tenets according to their understanding. Pauls letter is an instructional guide as well as being comprised of words of encouragement. Chapter 3 and verses 12 through 17 describes to the new Christians how they are new creatures in Christ. He reaffirms that Christ is deity in bodily form and the supreme head of the church (1:15-23). He also warns against false teaching and calls for the rejection of it. He further instructs them on how to live holy (Chapter 3). More specifically, Colossians 3:12-17 concentrates on two main ideas; one idea focuses on how to live holy as an individual and as a member of the body of Christ; and the other focuses on holy living as an individual and as a collective member of the body of Christ. The tools used to explore passage 3:12-17 are the King James Version (KJV), the New International Version (NIV), the New International Readers Version (NIRV), The Message (MSG) and the New Living Translation (NLT) Bibles, along with The New Analytical Greek Lexicon (The Lexicon), The Greek English Interlinear New Testament (The Interlinear) and Strongs Strongest Exhaustive Concordance of the Bible (Strongs) with various commentaries. Colossians 3:12-14 Put on therefore, as the elect of God, holy and beloved, bowels of mercies, kindness, humbleness of mind, meekness, longsuffering; forbearing one another, and forgiving one another, if any man have a quarrel against any: even as Christ forgave you, so also do ye. And above all these things put on charity, which is the bond of perfection. In verse 12 holy living entails more than a confession or conversion experience, it regards a change in lifestyle. The Interlinear uses put on (endysasthe) in the active continuous form emphasizing that Christians must continuously display Gods characteristics which manifests his holiness. They are manifested as mercy, kindness, humbleness, meekness, and longsuffering. The Message says, Dress in the wardrobe God picked out for you. Its rendition offers that these characteristics are not natural human characteristics; therefore, it requires action on the part of the individual and is attainable with the guidance of God. In the KJV, the word bowels (splagchna) are used; The Lexicon defines it as the heart or affections of the heart, meaning these qualities must come from within. By separating the characteristics by commas the KJV, NIV and the NLT indicate that each of the characteristics is part of a whole. However, the NIVR presents them in multiple sentences to demonstrate them as de finitive commands. The NLT renders that the Christian should demonstrate holy living by being clothed in tenderhearted mercy which is a translation for compassion (oiktirmou), kindness(chrestoteta), humility(tapeinophrosyne), gentleness for meekness(prauteta), and patience as longsuffering(makrothymian); these are acts that God has demonstrated towards us. Bruce Buoton describes the characteristics of tenderhearted mercy, kindness, humility, gentleness and patience as imitations of Gods acts towards man.  [9]   In verse 13 holy living is explored further, here all Christians are required to forgive one another because Christ has forgiven (charixomenoi) them. Failure to forgive others whom God has forgiven results in suffering. Robert E. Wall expressed that the holy response (to any offense) prompted by grace is to forgive. . .We forgive because we are already forgiven, we secure Gods forgiveness by forgiving others.  [10]  Forgiving allows the Christian to tolerate the offenses of others and to act in their behalf for their benefit. Forgiveness is essential in Christian growth, fellowship and manifestation. It is one of the characteristics of God that allows Christians to imitate him without necessarily displaying overt actions. The act of forgiving is a sign that the Christian is maturing as a Christian. In verse 14 love is exhorted above all the other characteristics and is determined to be the virtue that bonds all the characteristics together. It is impossible to live a holy life without love, The MSG expresses, And regardless of what else you put on, wear love. It is your all purpose garment. Never be without it. All of the aforementioned translations agree on loves ability to make the other virtues possible, for instance the NLT interprets the verse as, Above all, clothe yourselves with love, which binds us all together in perfect unity. The Greek word for bond (sydesmos) in The Lexicon is described as bundle or connection. It is used in the same way in Ephesians 4:3 make every effort to keep the unity of the Spirit through the bond of peace (NIV). Love is the adhesiveness that unites all the virtues; it is joined in significance by the virtue of peace. Colossians 3:15-17 And let the peace of God rule in your hearts, to the which also ye are called in one body: and be ye thankful. Let the word of Christ dwell in you richly in all wisdom; teaching and admonishing one another in psalms and hymns and spiritual songs, singing with grace in your hearts to the Lord. And whatsoever ye do in word or deed, do all in the name of the Lord Jesus, giving thanks to God and the Father by him. When the Christian has adopted the characteristics in verses 12-14 and internalized them, a notable change should be evident by familiar observers. Holiness should be readily manifested and perceivable. One of the key words in verse 15 is the word rule. The Interlinear, shows rule is derived from let arbitrate (brabeutw) in all of the translations besides The MSG. The MSG converts the Greek into in tune. . .in step with each other. Pauls familiarity with the word, in accordance with The Lexicon, would have been umpire, or someone who governs a conflict. The Colossians would have understood keeping the peace as tantamount to resolving conflicts.  [11]   The MSG emphasis is the body of Christ unified (swma(i))as it addresses the meaning of the verse. It emphasizes every collective decision and action that comes from the community will have the character of peace if all members stay in tune and/or in step with each other.  [12]   Furthermore, verse 15 exhorts Christians to be thankful (euchiaristoi) or mindful of the benefits  [13]  if being part of the body of Christ. Strongs Concordance clarifies thankful as in mind and attitude which enhances the spiritual well-being concerted with the physical well-being of the individual and the body of Christ.  [14]   Verse 16 moves the reader or Christian to the command to teach and admonish one another in wisdom (sophia) which has both divine and secular connotations, according to Strong; however, Pauls inclination was a reference to Christian enlightenment as found in 1 Corinthians 12:8.  [15]  There is variance between The MSG which denotes this virtue or command to mean use common sense, whereas, the NLT state Teach and counsel one another with all the wisdom he gives. Verse 16 iterates to Christians to exercise the virtues of holy living and to continuously communicate that to one another. The emphasis is that when God enlightens a person that person is qualified to exercise authority to teach and admonish others. Each member of the body of Christ is called to model the holiness demonstrated by Christ. In order to imitate his model the individual must have the Spirit of God residing inside of him, moreover, the Spirit of God can only dwell in the individual if the that individual lives a life of holiness. The Interlinear text uses let dwell (enoiketw) in the imperfect tense in verse sixteen. It is used to demonstrate that Christs spirit within the heart first occurred when the individual accepted Christ as Lord; it is an action that is present and ongoing. The other aspect of verse 16 includes the singing of psalms, hymns and spiritual songs. The MSG says sing your hearts out to God whereas the NIV, NIRV and NLT render the concept as to sing with thankfulness. The KJV links both sections of verse 16 as a single action, meaning that the singing and teaching are synonymous to praise and admonishing. Also, the singing of the songs, spirituals and hymns with joy and thanksgiving display to others that the Spirit of Christ dwells within. When Christs spirit dwell within the Christian then Christ rules the heart and life and the person is authorized to teach and admonish because it is accommodating the Spirit of Christ. Verse 17 mandates that whatever and whichever virtue the Christian manifests, do it in the name of the Lord Jesus with thanks to God and the Father through him. The primary responsibility of living a holy life is for the glory of God. In concert, the verses 12-17 equip the Christian with guidance and instructions to live a holy life within the ability of the Christians and in response to Pauls exhortation in Romans 12:1-2. Applications The worldview has crept into the church and some of the moral authority of the church has come into question because of the level of tolerance experienced by the church today. Tolerance is not a negative thing, but there are mandates such as notable in the Ten Commandments that restricts some tolerations. The behaviors exhibited by a large number of highly visible Christians (not just renowned ministers) in their lives denote that holy living has been compromised. There are denominations that allow clear abominations to exercise the office of pastors and ministers, such as ordaining homosexual ministers and subjecting Christians in need of guidance, teaching and admonishing to their authority. Equally compromising is the congregations that outwardly support and accept this deviancy. The modern society in First World countries is replete with narcissism, public acceptance of vulgarity (as demonstrated in music and audio-visual media)and Christian lifestyle has become compartmentalized. Applying the principles or virtues found in the passage of Colossians 3:12-17 in todays society should be exceptionally easy because of the communications capabilities that are available such as the internet, satellites, cell phones and public forums. These same forums are used to counter the work of the church emphatically. The Church has to do as Paul and the other apostles and early Christians did in building up the faith and the church. It must espouse it doctrines at every opportunity and do not settle for a small corner to shout from. It must begin within the body of Christ first. The church must hold Christians accountable for their behaviors that are compromised and encourage them in the behaviors that exemplify the virtues found in the passage. Heads of households must take the responsibility of their family religious education in the home environment and not allow worship and services to be a Sunday event only. Holiness must become a lifestyle; it must be exhorted within the body of Christ community first and then missioned to the rest of the world. Music must be acceptable, television and other media must adhere to family values by presenting wholesome entertainment. Finally, each Christian has to develop the attitude to teach one, reach one so that no Christian is left behind. The children must be taught Christian values at home without compromise. Most importantly, Christian hearts must be governed by Christ and honor given to God. There needs to be a campaign to teach and encourage each Christian to exert the virtues of mercy, kindness, humbleness of mind, meekness, longsuffering/patience, forgiveness and love. Each church should have an education plan to initiate and sustain such a campaign. Conclusion The Bible is composed of mandates, laws and principles for Christian living that is sometimes explicitly clear such as You must not murder. (Exodus 20:13), and some not so evident such as And let the peace that comes from Christ rule in your hearts. (Colossians 3:15). There are several translations of the Bible that create debate within the Christian community and sometimes result in controversial applications in some aspects, such as Exodus 20:13 rendered in the New Living Translation as You shall not murder. whereas in the King James Version it is rendered Thou shall not kill. The impact of the two different wordings has affected the secular arena as well as the religious one. Abortions, military wartime service and the death penalty are three of the subjects associated with controversy regarding both editions of the verse. Avoiding confusion and controversy is not always possible, there are passages in the Bible that are not just principles but also instruct the Christian how to live. A law or situation is not necessarily transferrable from the context known to the original audience to the conditions and situations in modern times; some applications are situational and time sensitive. The instructions are clear and applicable to life situations for the environment of the original audience or for the contemporary audience. Sometimes they are applicable to both audiences but there must be some parallel but not necessarily the same conditions present. The examination of the words of Paul in Colossians 3:12-17 reveals there are instructions that are clear and applicable for holy living and they migrate across the time spectrum from the original audience through the contemporary audience. Living a holy life is mandatory for Christians and necessary to please God. It is the Christian responsibility to present God to the world, the passage aforementioned provides instructions and guidance for execution. How the Christian lives should reflect what he or she believes in accordance with the conditions set forth by the applicable Scriptures. The Christian walk should parallel the Christian talk. As a member of the body of Christ the modern Christian incurs the responsibility to teach and admonish fellow Christians as needed. He and she have the advantage of hindsight as well as the principles denoted in the passage 3:12-17 to aid and assist their growth and development as productive Christians with the same urgency and proficiency of the early Christians. Appendix Block Diagram Colossians 3:12-17 (NIV) 12Therefore, as Gods chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience. 13Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you. 14And over all these virtues put on love, which binds them all together in perfect unity. Therefore As Gods chosen people Holy and dearly loved Clothe yourselves With compassion, kindness, humility, gentleness and patience. Bear with each other And Forgive whatever grievances You may have against one another. Forgive as the Lord forgave you. And Put on love over all these virtues Which binds them all together in perfect unity. 15Let the peace of Christ rule in your hearts, since as members of one body you were called to peace. And be thankful. 16Let the word of Christ dwell in you richly as you teach and admonish one another with all wisdom, and as you sing psalms, hymns and spiritual songs with gratitude in your hearts to God. 17And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him. Let the peace of Christ rule in your hearts Members of one body (Since As) You were called to peace. And Be thankful. Let the word of Christ dwell in you richly As you sing psalms, hymns and spiritual songs With gratitude in your hearts to God. And Whatever you do (Whether) in word or deed Do it all in the name of the Lord Jesus Giving thanks to God The Father through Him. Sunday School Lesson for Adults Colossians 3:12-17 Focus verse: Colossians 3:13 Introduction Forgiveness -As for volunteers to read each verse. -Give an illustration of a marital event that requires forgiveness although it is very difficult to do. Why do we forgive? Definition of forgiveness Explanation Discuss focus verse and Gods command to forgive Inquiry- Have class name times/situations that they have done something wrong and how they felt. Bearing with one another/ Ways to forgive. Explanation We are to forgive others because God forgives us refer back to verse. Explain how the husband is a reflection of God and wife is a reflection of the sinner. Demonstration- Two class members will act out scenarios followed by brief discussion of the incidents: -inappropriate conversations with the opposite sex -meeting someone other than the spouse for friendly night out Application- Have class name situations in which they/others should be forgiven and how to do so. Reiterate the passage that emphasizes that God forgave us first. Illustration- Finish story with husband forgiving wife due to her sincere apology. Re-emphasize how God forgives us and we should forgive others. Conclusion We are to seek forgiveness and forgive others because God forgives us. -Review of passage focus verse. Allow for questions/comments. -Prayer asking God to forgive us for our sins and help to forgive others. -Song.

Mental Health Service User Case Study

Mental Health Service User Case Study 1.1 Decision making by nurses is now firmly established in practice, policy and educational agendas. New constantly evolving, roles, and a policy context that is challenging traditional professional boundaries mean that, more than ever, nurses are being given autonomy and power to be able to exercise their decision choices (Thompson, 2001). 1.2 Clinical decision making may be defined as having a variety of options and choices and a process that nurses undertake during their everyday activities whilst caring for service users. It usually involves nurses making judgements about the care that they provide to service users (Thompson et al, 2002). Similarly ONeill et al (2005) argues that clinical decision making is a complex activity that requires nurses and other health professionals to be knowledgeable in relevant aspects of nursing, to have access to reliable sources of information and to work in a supportive environment. 1.3 Shared decision-making on the other hand is an interactive collaborative process that occurs between the nurse and the service user that is used to make health care decisions. Adams and Drake (2006) note that in shared decision-making the nurse becomes a consultant to the service user, helping to provide information, to discuss options, to clarify values and preferences and to support the service users autonomy (p.88). 1.4 Policy changes and trends in professional development within the last decade have reiterated the importance that nurses and other relevant health professionals need to recognise that the decisions they make have a direct impact on health care outcomes and service users experiences (DH, 2000). 1.5 Decisions can be easily examined in the form of decision trees which provide a highly effective structure within which many different options can be explored (Goetz, 2010). Goetz (2010) further argues that the decision tree encourages people to think through their options, to act consciously and with consideration. It has also been suggested by Corcoran (1986, cited in Bonner, 2001, p.350) that the decision tree is able to provide a clear structure which helps to assess a range of actions that health professionals may choose when making decisions regarding the care and treatment of a service user. 1.6 In contrast, Bonner (2001) argues that the decision tree is under researched within the scope of mental health practice. He does acknowledge that the use of the decision tree in practice allows nurses to examine the options available to them in more detail, whilst also considering the complex variables that influence the decision-making process. 1.7 It would be expected that the decision tree is hierarchically structured and spans a specific period of time which will be determined within the Justifications section of this report. 2. Methodology 2.1 The purpose of this report is to identify a service user with whom one was currently working with in practice. Using a decision tree, the service users journey will be detailed from their current health needs from the point of referral to mental health services to the current point in time. Once the decision tree is formed, it will then be essential to identify up to three critical decision points and analyse the decision making process for each decision chosen. 2.2 The information required to form the decision tree is to be gathered during a 60-minute unstructured interview with the service user, which can be thought of as a guided conversation. The reason that this type of methodology will be utilised is because unstructured interviews allow a particular focus on specific areas through asking open-ended questions but also allow for probes and follow-up questions to be used in order to effectively obtain more information to construct the decision tree as accurately as possible (Streubert Carpenter, 1999). 2.3 In order to ensure that the information gathered is accurate, it will be beneficial to form a lifeline with the service user, looking at major life events and decisions that have been made. This lifeline can be found in Appendix 1. 2.4 It will also be essential to explore the service users medical notes (with their consent) in order to gain a clearer idea of events that have occurred, the vital decision points and whether service user involvement was evident throughout. 2.5 The decision tree that was formed can be found in Appendix 2. 3. Justification 3.1 The service user that will provide the focus of this report will be referred to as Sarah (a false name in order to maintain confidentiality). 3.2 Sarah is a 43-year old lady who has a diagnosis of borderline personality disorder. She has had multiple admissions to psychiatric units including admissions under the Mental Health Act (See Appendix 3 for supporting information). 3.3 Sarah was chosen because it was felt that the she would be able to provide a good history and account of events that have occurred in her past in relation to the care and treatment that she has received. Sarah was also deemed to have capacity and was therefore suitable to take part within this piece of work. 3.4 The timescale that the decision tree covers will focus upon a 6-year history whereby Sarah began her first contact with adult acute mental health services. This will be explored up to the current point in time. 3.5 During the gathering of information, both primary and secondary sources were used. Primary sources refer to first-hand accounts of events that have occurred (i.e. interview with service user). In comparison, secondary sources refer to information that has already been documented from the past (i.e. medical/nursing notes). It was decided to use both sources as they would provide information richer in validity and ensure the reliability of the findings. 3.6 The report will cross the boundaries between in-patient care and community services within the North of England. The key decision points that have been chosen for analysis within this report were chosen because it was evident that some decisions had a certain degree of service user involvement in comparison with others whereby service user involvement did not seem to be present. This does however introduce a debate in regards to service user involvement because those decisions that did not involve Sarah and that were made on her behalf, can be argued were made in the best interests of the individual i.e. admission to hospital to ensure Sarahs safety and well-being. 3.7 Each of the decisions will now be individually analysed with a specific focus upon the decision itself, the issues that they may involve and the concepts that they may introduce. 4. Referred and taken onto caseload with a Community Mental Health Team following gate-keeping assessment (See Appendix 4) 4.1 Sarah was referred to her local community mental health team following a visit to her General Practitioner (GP) whom was worried about the self-harming thoughts that Sarah was currently experiencing. The General Practitioner was very concerned about Sarahs apparent deterioration in her mental health, therefore he felt that it was necessary to refer her to the community mental health team who would then be able to offer assessment and work from that point onwards. The GP discussed this with Sarah who did admit to being a little apprehensive beforehand however after a short period whereby she was able to reflect on her current circumstances, Sarah was agreeable to this. 4.2 Borg et al (2009) argues that service user involvement has a crucial significance especially for individuals that work within a community mental health setting as this involves accessing patients in their own homes (p.285). Sarah did feel that she had developed a good rapport with her community psychiatric nurse because Sarah was always offered choices in terms of her care and treatment and she felt actively involved in the decisions that were made. The therapeutic relationship that was developed between Sarah and her community psychiatric nurse also played a vital role in Sarahs care as Reynolds and Scott (2000) argue that it is through this therapeutic relationship that we can assess the needs of the patients that we work with and then plan future care to assist in their recovery. 4.3 An important consideration is the potential risk involved in maintaining Sarahs mental health in the community. This was clearly documented within Sarahs treatment plan with specific actions outlined and crisis contact numbers provided to both Sarah and her Husband. The National Institute for Health and Clinical Excellence (2009) provides guidance on risk assessment in patients with a diagnosis of emotionally unstable personality disorder. It informs that the risk assessment should take place as part of a full assessment of the patients needs and this is exactly what occurred due to the high level of risk involved and potential self-harm of Sarah within the community. 4.4 The main influences behind the decision to make a referral to the local community mental health team was Sarahs safety and how able she was to maintain this. Also if the GP felt that Sarah required a hospital admission and there were no hospital beds available, then a referral to the community mental health team or crisis resolution would be necessary. This therefore would indicate that care and treatment is dependent upon what resources are available at that specific time. 4.5 In order to ensure that the correct decisions are made, the specific team must have an effective leadership style and a variety of skills amongst team members. The New Ways of Working practice implementation guide (DH, 2007) outlines how a team can effectively achieve their maximum potential. In order for this to be achieved, a number of measures must be addressed which include; Focusing upon skills and matching these to the needs of service users; Distributing responsibility fairly amongst the team rather than delegating; Focusing on ability and competence of team members rather than role. 4.6 The policy discussed in section 4.5 appears to be utilised well within this team because Sarah was allocated to a senior care coordinator that had a large amount of experience of working with individuals with a diagnosis of personality disorder. The health professional was also able to engage and was competent in carrying out Dialectical Behavioural Therapy with Sarah which is a specialised treatment suitable for those with a diagnosis of personality disorder (Comtois et al, 2007). 4.7 There are many alternate decisions that the General Practitioner could have made in order to ensure that Sarah received the treatment that she required to meet her needs. A referral to the local crisis resolution home treatment team could have been made who would offer assessment and then decide a plan of action. Brimblecombe (2001) argues that a team such as this could have the potential to reduce the number of hospital admissions, therefore utilising resources and funding more effectively but at a cheaper cost. 4.8 Another possible course of action could have been to make a referral to the acute community day services (day hospital) who would be able to provide care throughout the day for Sarah if she required support. This would be a less restrictive alternative than hospital admission and Sarah may be more likely to engage with this service based in the community. 4.9 Alternatively, the GP could have chose to not do anything except review Sarah after a few weeks to assess whether her mental health was still deteriorating however this may be seen as unethical especially if Sarah was suffering due to her experiences and self harming thoughts, which ideally should be resolved as soon as possible. 5. Voluntary (informal) admission to acute psychiatric hospital following presentation in Emergency Department (See Appendix 5) 5.1 When Sarah becomes acutely unwell, the most common course of action is to admit her to hospital for her own safety and well-being but also the safety of others. This particular hospital admission was informal which therefore indicates that Sarah was willing and agreed to go into hospital, having been assessed by a team which specialises in self-harming behaviour. 5.2 The Mental Health Act (2007) refers to informal patients as those that accept and agree to go to hospital without the use of compulsory powers. Sarah was not detained therefore she was permitted to have leave from the ward to spend at home with family. This was Sarahs choice and was discussed in collaboration with the Consultant Psychiatrist until an agreement was made. 5.3 The decisions to admit Sarah to hospital was made by a health professional that assessed Sarah in the Emergency Department following an incident of self-harm. Sarah did feel that she was fully involved within the decision because alternatives to hospital admission were discussed with Sarah however she felt that hospital admission was the most appropriate action to ensure her safety at that specific time. Furthermore the Nursing and Midwifery Council code states that as a professional, nurses are personally accountable for actions and omissions in their practice and must always be able to justify their decisions (NMC, 2008). 5.4 The main influences behind this decision were the levels of risk involved due to an escalation in Sarahs self harming behaviours within the community. The Ten Essential Shared Capabilities (DH, 2004) aimed to set out the shared capabilities that all staff working in mental health services should achieve. Promoting safety and positive risk taking is one of the major points within the document with the hope of empowering individuals to determine the level of risk that they are prepared to take with their health and safety. Ideally this includes working with the tension between promoting the individuals safety and positive risk taking which should be detailed within the individuals care plan. 5.5 Positive risk taking and risk management has been largely debated within the scope of mental health nursing. Parsons (2008) argues that people learn through a process known as trial and error. This therefore suggests that if Sarah self-harmed so significantly that her life was endangered then she would not carry out this behaviour again. This theory however can be largely critiqued in regards to Sarahs case because the self-harming behaviour is a regular occurrence with Sarah in full knowledge of the consequences that this may have. 5.6 A study carried out by Bowers et al (2005) examined the purpose of acute psychiatric hospital wards and they concluded that in most circumstances, patients are admitted because the possibility of harming themselves or others had increased significantly. They also found that when an individual is experiencing a severe mental illness whereby their behaviour is unmanageable in the community, this provides the requirements for a hospital admission. 5.7 In contrast, the quality of care on acute psychiatric hospital wards has largely been questioned in regards to the usefulness that hospital admission can actually have upon a person (Quirk Lelliott, 2004). In some circumstances, many individuals will receive high-quality care whilst in hospital however recent studies have suggested that for some individuals, the experience of hospital admission was rather negative (Baker, 2000; Glasby Lester 2005). 5.8 The Royal College of Nursing (2008) acknowledges that every nursing decision made has an ethical dimension and furthermore that ethics and ethical decision making abilities are applicable to every aspect of nursing practice. The decision to admit Sarah to an acute psychiatric hospital ward does introduce ethical dilemmas because it can be argued that it is unethical to admit a person to a locked ward and therefore restricting their freedom. 5.9 Beauchamp and Childress (2001) developed a framework which consists of four main principles. The first principle outlines the respect for an individuals autonomy i.e. respecting the decisions that they make and the reasons for making a particular decision. Sarah was given a choice in regards to hospital admission because she could have been detained under the Mental Health Act (2007) however she agreed to hospital admission and was therefore admitted as an informal patient. 5.10 The second principle is that of Beneficence which examines the benefits of having a particular treatment against the risks involved. This was discussed with Sarah and the reasons for hospital admission were fully explained which were to ensure Sarahs safety. Sarah understood the health professionals concerns and worries and did accept hospital admission therefore the health professional was acting upon beneficence. 5.11 The third principle is Non-Maleficence which refers to the avoidance of causing harm to an individual. It can be argued that any treatment can have to potential to cause harm however the benefits of the treatment must exceed this which in this case, the benefit plays much more of a vital role. 5.12 The final principle within the framework is Justice which examines the distribution of benefits, risks and costs equally. It therefore indicates that individuals should be treated fairly in similar circumstances and offered the same intervention/ treatment. In terms of hospital admission, the choice would be to go in as an informal patient or be detained under the Mental Health Act using compulsory powers. This decision would be given to most individuals however when capacity becomes a concern then detention may be required. 5.13 There are many alternate decisions to a psychiatric hospital admission which may have been decided. Sarah may have been referred to an acute community day service (day hospital) which offers assessment and treatment for working age adults that are experiencing acute mental health difficulties. A systematic review of randomised controlled trials of day hospitals within the United Kingdom, concluded that day hospital treatment is generally cheaper, the outcomes are greater and that there was greater satisfaction with treatment compared with in-patient care (Marshall et al, 2001). 5.14 Another alternative decision to hospital admission may be a referral to a crisis resolution home treatment team that would be able to provide 24-hour care. The Mental Health Policy Implementation Guide (DH, 2001) informs that the crisis resolution team is for adults between the ages of 16-65 with a severe mental illness or experiencing an acute crisis that without the involvement of a crisis resolution home treatment team, hospital admission would be necessary to ensure the safety of the individual. This however had been attempted in the past and Sarah did not feel that she benefitted greatly from the service because although they provide a 24-hour service, they cannot offer the same kind of interventions that a hospital ward could offer. 6. Diagnosed with Emotionally Unstable Personality Disorder (See Appendix 6) 6.1 Sarah was diagnosed with Emotionally Unstable Personality Disorder whilst an in-patient on an acute psychiatric ward. The decision to change Sarahs primary diagnosis of deep depression with psychotic episodes was made by the Consultant Psychiatrist that was involved in Sarahs care and treatment. 6.2 The National Institute of Mental Health (2001) describes emotionally unstable personality disorder as a serious mental health illness that is characterised by a pervasive instability in moods, interpersonal relationships, self-image and behaviour. The symptoms of emotionally unstable personality disorder are maladaptive behaviour learnt to make sense of the world and to manage the constant negative messages experienced (Eastwick Grant, 2005). It is important to note that Sarah did experience sexual and psychological abuse from an outsider of the family during her childhood which she did not disclose to her family until she was an adult. Sarah recognised that this was a major factor in the way that she perceived the world and was directly linked to her self-harming tendencies. 6.3 During this period of time, Sarahs behaviour became increasingly unsafe to manage in the community therefore warranting a hospital admission. Her self-harming tendencies had increased and there was a great concern for her safety mainly expressed by her family who were worried about Sarahs deterioration in her mental health. 6.4 When Sarah was given the diagnosis, she was unhappy due to the non-apparent involvement within the decision as she was not consulted in regards to the diagnosis or asked about her thoughts and feelings. Bray (2003) argues that decision making and service user involvement cannot always occur with individuals that have a diagnosis of emotionally unstable personality disorder due to the varying symptoms that they may experience i.e. impulsive behaviour which can diminish responsibility. 6.5 Once the diagnosis was made, Sarah felt that peoples opinions and attitudes had changed towards her including ward staff. According to Nehls (1999) individuals with a diagnosis of emotionally unstable personality disorder have described health professionals as being unhelpful, displaying negativity and generally being unhelpful. 6.6 A consultation document known as New Horizons (DH, 2009) outlines a cross Government vision in the hope of eradicating the stigma that surrounds mental health and improving the quality and accessibility of services, ensuring that services are service user friendly. The document stresses the importance of mental health and encourages individuals to understand that mental health problems should be equally as important as physical health conditions. 6.7 Services that are provided by the National Health Service (NHS) are commonly built upon effective partnerships between those providing care and those accessing care. The Department of Health (2004) informs that better healthcare outcomes are achieved when the partnership between health professional and service user is at its strongest. Within this particular decision, there was no partnership as Sarah was not involved in the decision making process in regards to her care and treatment and decision to make a diagnosis without consultation with Sarah. 6.8 An important consideration is that of power because the Consultant Psychiatrist that made the decision, created a position of power over the service user through expertise and knowledge. Pyne (1994) argues that knowledge is a form of power, therefore if we share this knowledge with the patients that we work alongside, then this can promote the process of empowerment in patients. The author then progresses to a stage whereby he questions why nurses do not always demonstrate this behaviour in practice. In comparison, McQueen (2000, cited in Henderson, 2002, p. 502) argues that power associated with special knowledge, that created a barrier between health professionals and patients is slowly diminishing. Furthermore, McQueen believes that both nurses and patients need to be seen as respected autonomous individuals with something to contribute towards an agreed goal. 6.9 There are alternate decisions that could have been undertaken rather than making a diagnosis of emotionally unstable personality disorder. The Consultant Psychiatrist may have decided to not make a formal diagnosis however this could therefore have an effect on Sarahs care and treatment as she would not receive the correct care and treatment to meet her needs. Sarahs previous diagnosis of deep depression with psychotic episodes may have remained the same however it cannot be determined how long this would have lasted due to the frequency of self-harming behaviours and multiple hospitals admissions due to an increased concern for Sarahs safety. 7. Comparisons 7.1 It has become evident that the three chosen decisions for analysis had common themes running through each decision. Power has become an important consideration because although Sarah had a degree of power within each decision, the overall decision was made by those within higher positions i.e. hospital managers and leaders. This can therefore provide the service user with a false misinterpretation of the power that they actually withhold as it is clear that the final decision is not made by the service user and instead it is those with more power i.e. the GP making the referral to the community mental health team and the Consultant Psychiatrist changing Sarahs diagnosis to emotionally unstable personality disorder without consulting Sarah beforehand. 7.2 Leadership has been defined many ways in the literature reviewed, however several features are common to most definitions of leadership and the forms that it can take. Faugier Woolnough (2002) argue that leadership is a process which usually involves a certain degree of influence, but also with a focus upon the attainment of goals .The leadership style mostly present within each of the key decisions is that of a democratic style because there was a degree of consultation with staff on proposed actions before an actual decision was made. 7.3 The care and treatment provided to Sarah was driven by resource availability and this was clearly evident within each decision. If resources are not available, this would impact on the decision whether to allow Sarah to have the treatment. The admission to an acute psychiatric hospital for example would be dependent upon the capacity of that specific organisation because if there was not a bed available for Sarah then other alternatives would have been considered. Fortunately there were resources available for Sarah, however the outcomes may have been different if this was not the case. 7.4 Sarah had also had a large amount of input from a number of services and there was a large amount of movement through mental health services. It can be argued that this is not beneficial towards service users as they are not able to sustain good therapeutic relationships with health professionals which can often be a reason as to why an individual may relapse. 8. Conclusion 8.1 Decision-making within practice takes place in many ways i.e. often the service user is consulted throughout their care and treatment however in some circumstances the service user can be made a recipient of their care and treatment which is not good practice. This report has identified a patient that one is currently working with and using a decision tree, their journey through mental health service was detailed. Three decisions were chosen for analysis and provided the basis of this report, considering factors that influence the decision-making process and also the alternatives that could have occurred. 8.2 Barker et al (2000) argues that the experience of being mentally unwell can be a disempowering period of time because choices can be taken away due to a number of reasons and the patient may feel a recipient of their care and treatment, rather than actively involved in the decision making process. 8.3 Defining decisions as good or bad is problematic, mainly because nurses operate in an environment that is characterised by uncertainty (Buckingham et al, 2000). Baron (2000) further suggests that the best decisions are those that produce the best outcomes for achieving a patients goals and wishes. 8.4 Sarah did feel the majority of time that she was involved in her care and treatment, including reviews and meetings held about her care and treatment whilst an in-patient and within the community. There were times however when Sarah did not feel involved in the decision making process i.e. when her diagnosis was changed without any consultation or discussion. 8.5 Clancy (2003) argues that there is a great tendency in decision-making to bypass a thorough analysis and jump too quickly into solutions. This seems to be evident at times within the chosen decisions for analysis because some decisions were made on behalf of Sarah and there was no consultation or service user involvement. 8.6 Throughout this report, the main aim was to analyse the decision-making process of three key decisions, taking into consideration concepts such as; autonomy, power, leadership and empowerment. It became apparent that they key to successful decision-making was to involve the service user and carers within the decision-making process, listening to their thoughts and opinions and respecting their right to choose between different alternatives. 8.7 It has also become apparent that those within higher positions and those that uphold a certain degree of power were leading the decision-making in Sarahs care. This is obviously not the way that things should work as the service user should be actively involved in all aspects of their care and treatment including decisions that are made. 8.8 Overall I feel that the whole process was an enjoyable one and I feel that I worked well in collaboration with the service user throughout. Collating the decision tree was a rather time-consuming activity, however I understand the importance that they hold and the benefits they possess. I have also become more aware and gained a greater understanding of how the decision-making process can impact on the lives of service user and carers, especially when service user involvement is not evident. 9. Recommendations 9.1 There should be a greater focus upon the decision-making process and how it can affect the service user. Decisions should be decided in collaboration with the service user to promote the nurse-patient relationship and allow good rapports to establish. Service user and carers should be actively involved in the decision making process. Decision making should be an identified topic for pre-registration nursing students to equip them with the desired skills. Decisions are to be based on the best available evidence and regularly discussed with users and carers ensuring that an understanding has been reached. Service users thoughts, feelings and opinions to be clearly documented to inform future nursing practice in regards to decision-making.