Nafta 5 Years Of Failure Essays - Mexico, , Term Papers

Nafta 5 Years Of Failure NAFTA Five Years of Failure In December of 1992, Presidents Salinas (Mexico), Bush (U.S.) and Prime Minister Brian Mulroney of Canada signed the North American Free Trade Agreement (NAFTA). The Mexican legislature ratified NAFTA in 1993 and the treaty went into effect on January 1, 1994, creating the largest free-trade zone in the world. NAFTA's promoters promised 200,000 new jobs per year for the U.S., higher wages in Mexico and a growing U.S. trade surplus with Mexico, environmental clean-up and improved health along the border. The reality of the post-NAFTA surge in imports from Mexico has resulted in an $14.7 billion trade deficit with Mexico for 1998. By adding the Mexican trade deficit to the deficit with Canada, the overall U.S. NAFTA trade deficit for the year 1998 is $33.2 billion dollars. In the last five years we have gone from a pre-NAFTA trade surplus of $4.6 billion with Mexico to a $14.7 billion deficit. Using the Department of Commerce trade data in the formula used by NAFTA proponents to predict job gains, the real accumulated NAFTA trade deficit would translate into over four hundred thousand U.S. jobs lost. A number of companies that specifically promised to create new jobs actually laid workers off because of the agreement. Allied Signal, General Electric, Mattel, Proctor and Gamble, Scott Paper and Zenith all made specific promises to create jobs, and all have laid workers off because of NAFTA as certified by the U.S. Department of Labor's special NAFTA unemployment assistance program (NAFTA TAA). (1) These are not the only companies who broke their promise of new jobs. In February 1997, Public Citizen's Global Trade Watch conducted an investigation of companies that had specifically promised that they would create jobs if NAFTA were enacted in 1993. Of the 67 companies studied, 60 had not created jobs or even increased their exports to Mexico. When we look at the goods exported from the U.S. to Mexico, we must understand that the figures used do not mean goods to be sold in Mexico. Most of the figures released by the government include what is termed as ?industrial tourism?. This means we send goods to Mexico to be assembled in their low wage plants and then re-imported into the U.S. as finished products. (2) A significant portion of the jobs lost to Mexico due to NAFTA are in the higher wage sectors of manufacturing. Many of these are in the automobile and electronics industries. The latest government data shows that 70% of the jobs lost were in manufacturing. The U.S. has gone from a pre-NAFTA manufacturing trade surplus of $4.6 billion with Mexico in 1993 to a $8.9 billion deficit in 1998. Imports from Mexico have increased 129% since NAFTA went in to effect. (3) According to the U.S. Department of Labor, approximately 214,902 American workers have been certified as having been laid off due to NAFTA. These numbers do not take into account the workers displaced out side of the factories. When a plant closes and moves to Mexico it is not only the line worked who is affected but also the entire community. One must look at the retailers who have to layoff works due to decreased sales; restaurants and all service industries tied to the consumer are affected. These workers are not considered by the government as being displaced by NAFTA. The wages paid in the new high tech plants being built in Mexico, are so low there is not a single U.S. worker who could take enough of a pay adjustment to compete. The average hourly compensation for a U.S. manufacturing job is approximately $18.74/hour,) and the average wage in Mexico is $1.51 per hour. (4) NAFTA is directly responsible for the wage stagnation being experienced in the U.S., this is largely due o the threat of closing the business and moving to Mexico every time workers try to organize and negotiate a wage increase. Kate Bronfrenbrenner of the Cornell University School of Industrial Relations found that the percentage of U.S. companies following through on threats to close in response to union drive tripled under NAFTA. NAFTA was supposed to raise the standards of living in Mexico so that the Mexican citizens would be able

The three Vandervell cases were concerned primarily Essay Example

The three Vandervell cases were concerned primarily Essay Example The three Vandervell cases were concerned primarily Essay The three Vandervell cases were concerned primarily Essay The three Vandervell instances were concerned chiefly with the issue of ensuing trusts. The purpose of this assignment is to reexamine the determinations reached in the three determinations and remark on whether or non these determinations, on contemplation, produced right results. It will see the assorted opinions by the Law Lords and whether or non the opinions produced consistent results. The first of these instances is Vandervell v Inland Revenue Commissioners. [ 1 ] In 1958, Vandervell, the commanding manager and stockholder of VP Ltd, decided to give 100,000 portions in VP Ltd to the Royal College of Surgeons to establish a chair in pharmacological medicine. The portions were presently held by Vandervell’s bank under a bare trust for him. Consequently, he directed the bank to reassign 100,000 portions to the RCS. It was intended that RCS should maintain the portions for a limited period merely, and should release them after having ?150,000 income on the portions by manner of dividends. To guarantee that these portions were non kept by the RCS forever, the College, upon reception of the portions, executed an option in favor of a legal guardian company set up by Vandervell. The footings of the option provided that the College must reassign the portions to the legal guardian company upon the future reception of payment of ?5,000 from the legal guardian company. By 1961 the College had received over ?150,000 in dividends from the portions and so the legal guardian company exercise the option to buy back the portions for ?5,000. The present action was brought by the Inland Revenue Commissioners to retrieve revenue enhancement from Vandervell which had been assessed on the dividends. The inquiry that arose was whether or non Vandervell had owned the portions during the period in which the dividends were declared. The Revenue argued that Vandervell, in directing the bank to reassign the portions to the College, had purported to dispose of his just involvement in the portions but had failed to make so because the temperament had non been made in composing [ 2 ] . It was held that by the Godheads that the option has been held by the legal guardian company upon unspecified trusts. In conformity with the axiom equity abhors a vacuity in good ownership, the option could non be permitted simply to stay â€Å"in the air† . Their Lordships held that the benefit of the option must hold been held by the legal guardian company under a resulting trust for Vandervell. In neglecting to stipulate trusts of the option, Vandervell had failed to deprive himself of his just involvement in the option. It followed that he had besides failed to the full to deprive himself of his just involvement in the portions which were the topic of the option. As a consequence, Vandervell was apt to pay revenue enhancement on the dividends, declared on the portions. As a consequence of the Inland Revenue’s claim against him personally, Vandervell, executed a title in 1965 under which he transferred to his legal guardian company all or any right, title or involvement which he might hold in the option, to be held by it on trust for Vandervell’s kids harmonizing to the footings of an bing colony. He so died in 1967. His executors brought the action against the legal guardian company [ 3 ] , claiming that Vandervell had owned the portions for the period between 1961 and 1965. The Inland Revenue was joined to the action and sought to retrieve revenue enhancement from Vandervell’s estate for the period between 1961 and 1965. The Trustee company claimed that the portions should be treated as belonging to the children’s colony. Megarry J held that there are two types of ensuing trusts: â€Å"automatic ensuing trusts† and â€Å"presumed ensuing trusts. [ 4 ] † It was there Lordship’s position, the former arises â€Å"automatically† when some or all of the good involvement in belongings held on an express trust has non been exhausted. In contrast a â€Å"presumed resulting trust† would originate in instances where X buys belongings in Y’s name, or gratuitously transportations belongings to Y. Therefore Megarry identified two chief issues, the first of these was to find whether or non the suspect legal guardian company had taken the option beneficially or on trust. Second, what those trusts were. Having decided that the legal guardian company held the option on trust, his Lordship so asked: â€Å"was the option held on ensuing trust or other trust for Mr Vandervell, or was it held on the trust of the children’s colony? † He concluded that on the above analysis a ensuing trust in favor of Mr Vandervell had arisen: â€Å"I can non see how an purpose non to acquire the portions back can veto a resulting trust if in the event he made no effectual temperament of his good involvement in them and the operation of equity brought them back to him in ways neer considered by him. Whatever may be the place under a presumed resulting trust, I do non see how the donor’s purpose non to hold the good involvement can predominate where the resulting trust is automatic† Megarry J’s position has some support from Lord Upjohn in the first of these instances [ 5 ] when he stated that: â€Å"If A intends to give away all his good involvement in a piece of belongings and thinks he has done so but by some error or accident or failure to follow with the demands of the jurisprudence, he has failed to make so, either entirely or partly, there will, by operation of jurisprudence, be a resulting trust for him of the good involvement of which he has failed effectually to dispose† Megarry J’s analysis was doubted by Lord Brown Wilkinson in West Deutsche Landesbank Girozentrale v Islington London Borough Council, [ 6 ] he claimed that there was no existent difference between the two categories of instance that Megarry J had identified: [ 7 ] â€Å"Megarry J in Re Vandervell’s Trusts ( No 2 ) suggests that a resulting trust of type ( B ) does non depend on purpose but operates automatically. I am non convinced that this is right. If the trustor has expressly, or by necessary deduction, abandoned any good involvement in the trust belongings there is in my position no ensuing trust† He said in the first instance as in the 2nd, Ten transportations legal rubric to belongings to Y and gives nil in return for it. In the first instance as in the 2nd, the infliction of a resulting trust leads to the creative activity of a new just belongings right for X, and as a new right, as Professor Chambers points out â€Å" it can non be explained as the inactiveness of a preexistent good involvement [ 8 ] † It was held, on entreaty from Megarry J, that as a consequence of the exercising of the option by the legal guardian company in 1961, the legal guardian company thenceforth held the portions on trust for the children’s colony. This was because it had been the purpose of Vandervell and the legal guardian company that the portions should be thenceforth held for the benefit of the children’s colony, and the ?5,000 used to exert the option had really been taken from the fund of the children’s colony. It followed that, after the exercising of the option, the share’s did non organize portion of Vandervell’s estate and his estate could non be taxed for the period 1961 to 1965. Lord Denning MR stated that when the option was exercised the â€Å"gap in the good ownership† came to an terminal. The ensuing trust under which the portions had antecedently been held for the benefit of Vandervell ceased to be upon the exercising of the option and the enroll ment of the portions in the name of the legal guardian company. Vandervell and the legal guardian company had, after the exercising of the option â€Å"done everything which needed to be done to do the colony of these portions adhering upon them.† Lord Denning MR, besides held that even if Vandervell had retain an just involvement in the portions after the exercising of the option he would hold been estopped from asseverating his entitlement to those portions as against his kids. Lord Denning said that he could non claim to have the portions holding done everything possible to give them off to the trustee’s of the children’s colony. There are some incompatibilities in the Lord Denning’s opinion. As Watt points out â€Å"Lord Denning MR held that in 1961 Vandervell intended, and did so divest himself of his just involvement in the portions, despite the fact that Vandervell seemingly did non gain until much subsequently that he might hold any just involvement in the portions [ 9 ] † The trouble with Megarry’s differentiation between a presumed and automatic trust is that it is difficult to warrant analytically, and even harder to use in pattern. To state that the ensuing trust arises automatically is to do an averment without any conceptual foundation, it explains simply that such a trust does non originate harmonizing to the settlor’s presumed purpose, it does non explicate, for illustration, why, when a trustor clearly intended to do an straight-out temperament of his belongings, the excess does non go through â€Å"automatically† to the Crown as Bona Vacantia. On the other manus, the job with Lord-Browne Wilkinson’s analysis is that it provides no solution to a instance like Vandervell where Vandervell clearly did non mean to retain the benefit of the portions, but even more clearly did non mean that they should go through to the Crown as bona vacantia. Therefore it can non be said that this instance was decided right, nevertheless a reappraisal of the Air Jamaica Case [ 10 ] , suggests that the Lords of the position that this determination was right, and revealed a return to the place adopted by Megarry and Lord Millet said: â€Å"Like a constructive trust, a ensuing trust arises by operation of jurisprudence, though unlike a constructive trust it gives consequence to purpose. But it arises whether or non the transferor intended to retain a good involvement – he about ever does non – since it responds to the absence of any purpose on his portion to go through a good involvement to the receiver. It may originate even when the transferor positively wishes to portion with the good interest† In the concluding analysis it is concluded that whilst the determination in Vandervell was non an ideal solution to the jobs raised, it is possibly the most suited solution to the trouble of ensuing trusts. It has been said that possibly the best solution to this trouble is in bar and non remedy ; decently constructed trusts will allege the demand for such determinations to be made. In the absence of such bar, the determinations reached in Vandervell produce the right result, the return to the Vandervell place in the Air Jamaica instance support this decision. Bibliography Legislation Law of Property Act 1925 Cases Air Jamaica Limited v Charlton [ 1999 ] 1 WLR 1399 Re Vanderell’s Trust ( No 2 ) [ 1974 ] 1 ALL ER 47 Vandervell V IRC [ 1967 ] 1 ALL ER 1 Vandervell v Inland Revenue Commissioners [ 1967 ] 2 AC 291 West Deutsche Landesbank Girozentrale v Islington London Borough Council [ 1996 ] A C 669 Journal Articles Chambers R, ( 2000 ) â€Å"Resulting Trusts in Canada† , Alberta Law Review 379 Millet, ( 1998 ) â€Å"Restitution and Constructive Trusts† , Law Quarterly Review 114 399 Books Birks P, ( 2002 ) , â€Å"Receipt in Breach of Trust† , Hart Publishing, Oxford Hayton D A ; Mitchell C ( 2005 ) â€Å" The Law of Trusts and Equitable Remedies† , Twelfth Edition, Thomson Sweet A ; Maxwell Ramjohn M, ( 2004 ) â€Å"Cases and Materials on Trusts† , Third Edition, Cavendish Publishing Riddall J G, ( 2002 ) , â€Å"The Law of Trusts† , Sixth Edition, Butterworths, Lexis-Nexis Todd P A ; Watt G ( 2003 ) , â€Å"Cases and Materials on Equity and Trusts† , Fourth Edition, Oxford University Press Watt G, ( 2004 ) â€Å"Trusts† , Oxford University Press

Hotel design Essay Example | Topics and Well Written Essays - 250 words

Hotel design - Essay Example ading Hilton designer Larry Traxler states â€Å"we wanted guests entering the space to experience the same tranquility and freedom they feel at the beach.† (Schiowitz, 2011) In this case white recomposed stone and white oak are used to recreate the light colors of sand and pebbles. This reflects also a trend towards sustainable and low carbon solutions, in order to meet increasing concern with environmental issues. Niche hotels are also in demand, and they aspire to have the high quality standards that global travelers expect, along with the ability to reflect the particular landscape and culture that surrounds them. Hospitality designer Tony Chi remarks that the industry has become too focused on â€Å"fabricated formality† (Straczynski, 2011) and detects a trend back towards meeting the patron’s aspirations for a personal experience with human contact, rather than just appreciation of the spaces. The global financial crisis has meant that design costs are an important factor in current design trends, but inventive use of recycled and local materials, as for example in the Green Leaf Niseko Village in Hokkaido, Japan with its â€Å"rehabbed ski gondolas† and rooftop beer garden with wraparound wood benches (Alati, 2011) demonstrate that style can be achieved within tight budgetary constraints. Straczynski, S. (14 September 2011) Beyond Delivering Aesthetics: Interview with Hospitality Designer Tony Chi. Contract Magazine. Available at:

Connectionist modeling theory Essay Example | Topics and Well Written Essays - 500 words

Connectionist modeling theory - Essay Example Connectionist theory has also been used to explain language. Connectionist theory is basically the process of seeing a connection between the input (perception) and the output (language) (McMurray 2000). The mental processes as explained above are a large part of the processes. Connectionist theory tries to understand how the brain or the neural network makes connections between the input and the output. Basically, it is connection the perceived data with the ideas that come out as output. Connectionist theory comes up with formulas that try to explain the process in creation of words, starting from the understanding of the stimulus, Linguistics has tried to come up with theories to understand language development. But it has largely ignored mental processes. Language is also connected to mental processes. What one thinks, that becomes language. Connectionist theory tries to explain how this process happens. Connections are made between the stimuli and the output. This evolves to how the mind reacts to word as well as objects. It also goes to how the various networks within the brain cause the connections to change – yet another part of the theory. Connectionist theory is thus very interesting in helping linguists map the mental processes in creating ideas. My proposed paper will study the connectionist theory and how it benefits in the study of linguistics. Aside from looking at the basic principles of connectionist theory, the proposed study will look for the most common patterns about how ideas become words using the connectionist perspective. Smith and Samuelson (2003) studied the dissimilarity between the two emergentist theories, connectionism and dynamic systems theory. Both the theories differ in the manner they study development. The authors in the study assert the differences between connectionist and dynamic systems approaches in terms of the basic elements of the paradigms, what they

Role of a Palliative Care Nurse

Role of a Palliative Care Nurse Palliative Care The role of the expert palliative care nurse is complex and unique. The nurse functions as an integral part of a Multidisciplinary team, providing expert skilled assessment and nursing care, supporting the patient and the family to make informed choices thereby encouraging the patient to continue to make autonomous decisions about their care towards the end of their life. However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope with the many dilemmas she must be well armed. The complex needs of the terminally ill patients and their families make the multidisciplinary team approach the most effective method of care Staff from a range of disciplines including medical, nursing, social work, dietitian, physiotherapist, pharmacist and others bring diverse and unique skills. As a team they provide an excellent sounding board for ethical dilemmas thereby hopefully- enhancing ethical practice. (Latimer, 1998) The Nurse in her role is required to act as patient advocate and ensure that the patients rights are respected. Unfortunately this advocacy is sometimes perceived negatively as a threat or implied criticism of medical care. Doctors need to listen to the nurses more accurate perspective of patient concerns. Consistency across the team leads to better outcomes for patients. Reinforcing the same information by both medical and nursing staff help to allay patient anxiety far more than conflicting views on such things as symptom control. (Jeffrey, 1995) The members of the Multidisciplinary team sometimes make decisions regarding treatments, which they may perceive to be of the most benefit to the patient whilst in fact the patient, does not perceive the benefits in quite the same way. Nurses have more prolonged contact with the patient than most other members of the team due to the hands on patient care that they do. They often establish a close rapport with the patient and the family and are most likely to be aware of the patients likes, dislikes, hopes and dreams and are privy to often delicate and very private details of the patients life. The very fact that the nurse spends so much time with the patient makes them more likely to have knowledge of this kind of information. Doctors rounds in a Palliative Care Unit enable the doctor to spend perhaps 30minutes maximum per day in talking to the patient. In the community, appointments times with Doctors are restrictive and Home Visits limited. Patient Nurse dependency ratios in hospit als and palliative care units mean that Nurses are spending approximately four hours per day on one to one patient contact. Again, other team members are very limited in the amount of time they spend with patients due to the number of clients/patients they may have. A dietitian for example may spend 15 minutes with a patient twice during their six-week stay in a Palliative Care Unit or 30 minutes as an outpatient during the course of the Terminal illness. Social workers often spend long periods at a time with patients and/or their families in lengthy discussion however these discussions may only take place a couple of times over the period of the illness. Therefore the Nurse is far more likely to be aware of issues affecting patient care. There can be many difficulties for the Nurse expert providing high quality care to palliative patients whilst respecting their right to autonomy in the setting of the Palliative Care Unit, the role of the Nurse is to painstakingly assess the needs of patient and family. These needs may be constantly changing and there is no room for the Palliative Care Nurse to become complacent in her patient care. Symptoms may be physical such as pain, nausea, and dyspnoea or psychosocial or spiritual. In identifying care needs the nurse must be able to determine who is the most appropriate team member to refer to provide optimum management of these needs. E.g. although the expert nurse will have counselling skills, she must be aware of her limitations and refer on where appropriate to counsellors, psychologist or social worker. Mount (1993) suggests that we must first attend to physical needs and that to do this we need a detailed knowledge of therapeutics. Skilled listening and attention to detai l are paramount in Palliative Care. Our listening skills not only apply to what the patient is saying, but what they may be leaving unsaid. Nonverbal cues such as facial expressions and demeanour, the need to keep the door to their room open at all times or to constantly keeps the curtains drawn. In order for patients to make choices they need to be accurately and appropriately informed, yet Vachon (1993) suggests that whilst caregivers sometimes decide not to tell patient and family what is likely to happen, at other times they may give too much negative information not allowing the patient and family to have any hope. Patients need to know at what stage their disease is and their prognosis in order to choose where to spend their remaining time. The ethical communication of information should be timely and desired by the patient, accurate and given in words understandable to the patient and family and conveyed in a gentle, respectful and compassionate manner. (Latimer, 1998) An example of such communication would be that when asked by my patient (speaking about his fungating tumour) When will this thing on my neck stop leaking? I need to gently but truthfully explain that it will most likely continue to leak blood and fluid until he dies but also that we will continue to con tain the fluid and minimise the discomfort and attempt to disguise the drainage appliance as best we can. To not advise him of the eventuality of the fluid discharge continuing is to encourage him to have false hope and expectations and further disappointment when the discharge continues and probably worsens. However, the nurse needs to recognise that some patients do not wish to have information relayed to them e.g. a patient who did not want to talk about her illness future and continued to deny that her disease was terminal. Dont tell me that, I dont want you to say those words! Yet respect for patient autonomy demands that patients be given honest answers to their questions. Without this, patients become more uncertain and unable to make decisions about their future. Dying patients are by virtue of their physical and emotional situation, frail and vulnerable their treatment and management during this final phase of their life must be of a high standard both professionally and ethically. The Nurse and other members of the team should seek to do the best for the patient and their family. This includes respecting autonomy, through the provision of truthful information and helping them to set realistic goals while providing genuine attentive care during the full course of the illness. Provision of symptom control hinges on accurate assessment. McCafferty and Beebe (1989) suggest that we dont always make assessment easy by the fact that sometimes we dont readily believe what the patient tells us or the patient may deny having pain or refuse pain relief although they may be hurting. The expert Nurse should remember that the person with the pain is the authority- they are the one who is living the experience and we must believe them if they tell us they have pain. It is all too easy to allow ones own values and beliefs to cloud our judgement Unfortunately I have seen it happen where a nurse usually not experienced in Palliative nursing will make a statement such as He says he has pain rated 8 out of 10 but he doesnt look distressed or She was laughing and talking with her visitors 5 minutes ago and now shes buzzing for pain relief. Such comments display the Nurses ignorance and lack of understanding of pain. It seems apparent that they do not understand about adapta tion or distraction or that laughter stimulates the relaxation response throughout the body systems by lowering blood pressure, deepening breathing and releasing endorphins. Also of great importance is the need for the nurse to explore further if a patient denies pain despite indications that they are in fact suffering pain. There may various reasons for denial for example; sometimes our language when asking questions about the patients pain may be inappropriate. Some patients may not consider a dull constant ache as pain but an ache. Others may feel sore. Other words such as discomfort and pressure may be used instead of Pain We as nurses need to avoid misinterpretation by using such other words. The Nurse needs to explore the issue of pain and help to identify the source. Location. Intensity, and Quality of the pain help to identify the source. Eg. Bone, visceral or nerve pain. Identifying the source aids in determining the appropriate treatment method. The expert Nurse will be aware that nerve pain will not respond as well to opiates and that neuroleptic agents need to employed. As suggested earlier, as Nurses spend the most time with the patients they are able to obtain the most information on the patients response to pain management plans, they are able to educate patients on the need to take regular analgaesia; and they can be the most influential in management of pain (Lindley, Dalton and Fields, 1990). Of course we as nurses in Palliative Care need to be aware that not all pain will respond well to traditional or orthodox treatments. Seeing a patient in pain and trying all pharmacological methods without success is distressing for staff as well as the patient and it is then that nurses should further attempt to employ other methods such as relaxation, distraction and music. Studies have shown that that listening to music disrupts the chronic pain cycle. Laughter, Massage and relaxation therapies have also been shown to interrupt this chronic pain cycle (Owens Ehrenreich, 1991) and massaging a dying patients back or feet with oil blends incorporating lavender instils in many cases a feeling of peace, contentment and lessening of pain. Heat and cold packs are also said to be beneficial in the treatment of chronic pain however heat applications are said to be contraindicated in patients with poor vascular supply and in malignancy. Most institutions have policies related to the use of thermal applications. As most nurses working with palliative patients will know, bowel management is of MAJOR importance! The Narcotics we administer to alleviate the symptom of pain have the side effect of causing the symptom of constipation. Vigilant monitoring of a patients bowel status is essential but it is of great importance that patients are not quizzed about their bowel actions in front of visitors or during meal times. Privately and quietly please! Cameron (1992) describes the types of constipation, these being primary and secondary due to pathology or iatrogenic. The goal of bowel management should be the prevention of constipation rather than treatment of constipation and appropriate assessment, regular administration of aperients, appropriate diet and fluids and provision of conditions favourable to bowel evacuation should all be part of the nurses management plan and patient education is paramount here for without the knowledge that opioids will contribute to constipation but that regular ap erients will counteract this symptom, the patient is unable to make informed choices about his symptom control. Nausea and vomiting are other symptoms the nurse can provide valuable assistance in controlling again through adequate assessment and intervention. The nurse needs to be aware of possible causes of nausea and vomiting such as hypercalcaemia, disseminated carcinoma, renal failure and vestibular stimulation particularly in patients with primary brain tumours or secondary cancer deposits. Constipation and radiotherapy, urinary tract infection and chemotherapy- the causes are many and varied. Hogan (1990) suggests that an understanding of the various pharmacological and non-pharmacological interventions is the foundation of symptom control but that the nurses commitment to alleviate the symptoms is the most important variable. Simple techniques like minimising cooking smells, presenting small meals and ensuring offensive odours such as foul linen bags from the vicinity can all be employed in conjunction with pharmacological methods to minimise nausea and vomiting. Successful management r equires an understanding of the cause of the symptoms. Other symptoms that may prove troublesome for the terminally ill patient include oral thrush and stomatitis, diarrhoea, lethargy and insomnia. Dyspnoea can be the cause of great distress and the expert nurse will be aware of the need to employ techniques to minimise discomfort. These may include reducing exertion by the patient, positioning them to allow maximum comfort when breathing and improving air circulation by use of fans or open windows. Humidification by methods such as nebulised saline may also be helpful. Pharmacological methods such as morphine either orally, subcutaneously or as a nebulised solution have also been found to decrease the perception of breathlessness (Chater, 1991) and anxiolitics such as Lorazepam s/l are quite helpful. Reassurance and providing a calm environment are also helpful techniques to employ. Distressed relatives around the bedside can further increase the patients respiratory distress and it is at such times that the nurse needs to take them asi de and explain to them what is happening and how they can help by remaining calm and distracting the patient or helping them to relax. For the terminally ill patient, being in control is vital and the nurse must appreciate that the patient though suffering an illness from which he will eventually die must be allowed to keep his self respect. This self respect can be eroded enough by the nature of the disease its symptoms and suffering, sorrow and emotional pain. There are times when we as nurses see patients admitted to hospital who have already had their autonomy undermined. Whilst it may have been their wish to stay at home longer or until the end, families may feel the burden of care is too great and that they can no longer cope. This is usually when a new symptom presents that the family feel unable to manage. Nurses in the community may sometimes be able to prevent this situation arising by offering a more frequent or higher level of care supported by a Palliative Care Service, education of the family about the patients symptoms and how to help manage them. Sometimes admission is not what the patient wishes but the service is unable to provide appropriate management in the home. There is then an onus upon those providing the care to look at all options to enable the patient to achieve his goal of returning home. To be autonomous means to have choice and control in our own lives yet we must accept that total autonomy is hardly ever possible. Sometimes there are circumstances in which it is not possible to challenge on the patients behalf- times when the patient may wish to have their autonomy eroded. There are times when the patient may not want our advocacy and times when we may not be able to give it- for example controversial ethical issues such as euthanasia. (Coyle, 1992). The nurse may sometimes develop feelings of helplessness and insecurity because of her unrealistic expectations of herself. The complex role we play in management of the terminally ill sometimes may lead the nurse to think she should be all things to all people the doctors handmaiden the patients advocate, the families sounding board. Sometimes nurses can become over involved, infringing on the autonomy of the patient and the family (Scanlon, 1989) and must be aware of when to withdraw. At times when caring for a patient with uncontrollable physical or emotional pain the nurse may feel herself to be a failure. Add to this the likelihood of inadequate resources and staffing, staff conflict and role conflict and there is a pretty good recipe for stress. Abraham and Shandley (1992) list five main sources of work stress. These being: 1. Work overload, 2. Difficulties relating to other staff, 3. Difficulties involved in nursing critically ill patients 4.concerns over patient treatment an d 5. Nursing patients who fail to improve. This again emphasises the fact that nurses specialising in palliative care are likely to suffer high levels of stress. CONCLUSION To help cope with these high demands and continue to maintain the delicate balance between what the patients want and what the health professionals think the patient needs, nurses need to arm themselves with expert knowledge of symptom control, and be well aware of ethical issues related to palliative care. Nurses also need to maintain open active communication with their peers and other members of the facility. We must also realize that even if we do not influence a situation or supply an answer to all needs and if our patients do not maintain total autonomy, it is enough that we have been with them, supporting them as best we can in their journey to the end of their life. Bibliography:

SHIP OF THE HUNTED: A BLEND OF FACT AND FICTION :: essays research papers

Historical fiction is a type of genre that helps paint a more captivating and colourful picture of the past. It combines fact and fiction as it presents mostly fabricated characters set in a definite period of history. Ship of the Hunted, by Yehuda Elberg, defines this genre as it entwines the lives of a fictional family with historical facts and elements such as life in the Warsaw ghetto, hiding to survive, and the Brichah movement of Jews out of Poland. History has recorded that over half a million Jews were crowded into the Warsaw ghetto between October and November of 1940. The squalor, starvation, disease, exposure to cold, and the daily shootings claimed the lives of about 5, 000 to 6, 000 Jews each month. In Ship of the Hunted, the Heshl family struggles to survive this trend. Like so many others living in the ghetto, Golda and her son, Yossel, scavenge the blocks, looking for any items that can be smuggled out of the ghetto in exchange for food. After his father and older sister are deported, Yossel is confronted by Golda, who wants him to stop smuggling. â€Å" ‘This stuff buys food. We have to eat, Mama.’ ‘Yossel, you’re still a child. You know they shoot children for scavenging!’ ‘They shoot mothers for scavenging, too.’ ’’ (Elberg, 17) This conversation demonstrates the desperate measures taken by the Jews to obtain food. The raids in the ghetto also caused their numbers to dwindle. Daily, thousands of Jews were removed from the ghetto and transported to concentration camps. After surviving one such raid by hiding in a bunker, Golda surfaces to find out about another raid on a hospital. â€Å"Liquidated, floor by floor. On foot and by stretcher, they had been sent off – a man with an incision still open; an infant, newly born.† (Elberg, 23) These raids led to deportations, which eventually led to extermination. News spread, and those who refused to be led away to death took part in what would be one of the greatest periods in Jewish history. The Warsaw ghetto uprising began on April 19th of 1943, as the surviving inhabitants of the ghetto resisted the German troops and police who had come to deport them. This battle held out for 20 days till the Germans finally overpowered the lightly armed Jews. In t he novel, Golda is a witness to the uprising and its end.

Veterans

Also, currently not enough care is given to veterans. Veterans have devoted their lives to this country and have made many sacrifices. There are approximately 21. illion veterans In the U. S. as of 2012. Of those veterans over 32,000 soldiers were wounded in Iraq. Also 4,787 U. S. troops died in Iraq serving their country. This service is not as appreciated as you would think, and I believe more effort should be put into taking care for all our veterans. The New Affordable Care Act makes it very difficult for veterans to receive reliable medical benefits and some even do more for our country. Many veterans still contribute to the nation's work force, even after returning home from war. Over half of the veterans In the U. S. are still able to work after returning rom war.Many veterans suffer from post-traumatic stress disorder (PTSD) and are not given the proper attention and care to get back on their feet and find a job. 1 OF2 stu01es snow tnat 4 cases 0T PISD were present arter tne Vletnam war, ana 1 million lifetime cases as a result of the same war. A third of the veterans in the U. S. are out of a Job due to the symptoms of PTSD. The VA needs to take it upon themselves to help veterans cope with life after the war, so that they can get their life back on track. After returning home from war veterans find it very difficult to get a Job and provide or themselves.Especially the individuals who were wounded, while defending their country. A majority of these people are wounded mentally as well as physically, and they cannot provide for themselves anymore. Many people believe that veterans are more of a pain than anything else. Since their tax dollars are being used to fund programs like the VA. These organizations are making it very difficult for veterans to receive any health benefits. The new rule is that veterans must be active duty for 24 continuous months in order to be eligible for any kind of medical coverage.Veterans hat have put their lives on the line to defend their country should not have to worry about how they are going to provide for themselves. It is my firm belief that the VA should extend their support for all veterans for everything they have done for our country. This service should be provided to veterans forever. Veterans have done more than enough to deserve this care, and they can still contribute to the labor force. Finally, not enough care is given to our veterans. Between 130,000 and 200,000 veterans are homeless in America. This represents between one fourth and one fifth of all of the homeless people in the country.