Romeo and Juliet Coursework Essays

Romeo and Juliet Coursework Essays Romeo and Juliet Coursework Essay Romeo and Juliet Coursework Essay Romeo and Juliet is an epic love story that climaxes in tragedy. The story follows two lovers from opposing families over the course of two days, and it features many twists and turns that always keeps the audience on its toes. In my opinion, Romeo and Juliet is one of William Shakespeares greatest plays. It features love, tragedy, comedy, action and a classic story that will never be forgotten.During this essay I will discuss the passions that are in this play, and how they feature. Are passions dangerous, and do they need to be controlled? Or are passions what make life worth living, and without them the world would be dull and meaningless? I will discuss both these questions, and try to come to a conclusion.Every character experiences some kind of passion during the play. Romeo and Juliet obviously both feel love, but they feel other passions such as anger, sadness and vengefulness. For instance, Romeo feels anger when Tybalt has killed Mercutio. Alive, in triumph! and Mercutio sl ain! Away to heaven, respective lenity, and fire-eyed fury be my conduct now! is what Romeo says when he eyes Tybalt after the killing. This shows how angry Romeo is at Tybalt. Previously, Romeo was speaking in kindness to Tybalt, telling him he loved the Capulet. Tybalt did not yet know that Romeo and Juliet were now husband and wife, and wished to fight the groom. Romeo declined, and Mercutio stepped forward. Mercutio was killed in combat, and Romeo became angry. In his fury, he killed Tybalt. This is a defining moment in the play because the fight resulted in Romeo being banished from Verona.Yet, as Romeo feels such anger at one point, he feels much loveduring another. Oh, she doth teach the torches to burn bright! Her beauty hangs upon the cheek of night, as a rich jewel in an Ethiops ear is what Romeo says upon seeing Juliet at the Capulet party. This not only demonstrates that Romeo thinks Juliet is absolutely beautiful; it also brings some poetry to the play. Throughout the s cenes, Shakespeare manages to add many pieces of poetry into the play, which gives the scene that little extra magic. This quote also highlights how passion is necessary at the right moments. If there were no passion during this scene, the scene would be pointless.I think it may be worth noting at this point that since the couple met, they have never held a real conversation. I think it is ironic how the two can tell each other they love one another when they have never talked about their personalities or lives. Whenever Romeo and Juliet meet, all they ever talk about is how they love each other and want to stay togetherJuliet has a wide range of emotions and passions throughout the play. She also feels happiness, but also feels sadness and deep sorrow. Is there no pity sitting in the clouds that sees into the bottom of my grief? is what Juliet speaks when she finds that she must marry Paris, even though she is married to Romeo. Yet she cannot tell her parents she is married, as the y can never know she is sharing her life with a Montague. I think she also feels anger towards her family at this point too. She cannot be with her love because of the families frivolous feud and she wants it to end. It is worth noting that Shakespeare never reveals why the families quarrel. I believe he does this because he wants to make the audience feel that the grudge they bear against each other is so old, neither families remember why they fight. I think this shows that angry passions do need to be controlled, as they can have dangerous consequences.Sadness features quite often in this play. Most characters feel sadness at some stage in the play. Once again, it is ironic that possibly the greatest love story ever written features so many negative feelings. Maybe Shakespeare wanted to teach us something about love; love can only lead to pain. While many good things come from love in this play, it all eventually leads to the tragedy of Romeo and Juliet dying. One could blame the ir deaths on the families fighting, but they would never have died if they had not been in love.The audience always knew that the play would be ending in sadness and tragedy. In the prologue the audience is told A pair of star-crossd lovers take their life, revealing that both Romeo and Juliet kill themselves. Therefore, throughout the play the audience always has on their minds that the couple will kill themselves before the end of the play. Even when the audience should be happy that Romeo and Juliet are in love, they always know that it will end in death. I think Shakespeare does this to keep the theme of tragedy running in the play, even at the happiest of moments.In contrast to many other characters, Mercutios personality rarely changes. At every appearance during the play, even leading to his death, Mercutio is witty and charming, his language filled with sexual comments. However, during Mercutios death scene his words become deadly serious. When Mercutio first appears, he is headed with Romeo, Benvolio, and friends to the Capulet party. Mercutio debates everything the sad, gloomy Romeo says and lightens up the mood with his wit. His upbeat personality contrasts sharply with Romeos melancholy. He counters Romeos every complaint with comment that is bound to make the audience smile. It is also ironic how Romeo is the main character and hero of the story yet the focus is always on Mercutio whenever the cheerful character is around.Mercutio dies in a very memorable way. He and Tybalt are duelling, and Mercutio is doing very well. Yet Romeo foolishly intervenes and Mercutio is slain. It is debatable that if Romeo had never got in the way of the duellists, Mercutio would have probably won the duel. However, Romeos new found love for the Capulet family blinded him and all that was on his mind was stopping the fight, no matter what the cost. This obviously shows that passions do need to be controlled in certain situation, as they can lead to this. However, if t he characters passions were controlled this scene would not exist. If they were controlled there would be no anger felt toward each other therefore this encounter would have been avoided.When Romeo tells Mercutio that the wound is not deep, Mercutio replies: No, tis not as deep as a well, nor so wide as a church-door; but tis enough, twill serve. This time, Mercutios wit is accompanied by a curse on both families. The wound is only small, but is enough to kill him. He says A plague o both your houses! many times before he dies. This shows that even when Mercutio has been witty and charming, he is angry with the families because of their frivolous row. As Mercutio is one of the audiences most loveable characters, this makes the audience angry with the families for such a ridiculous feud that can lead to such consequences.From Mercutios death, the plays tragedy doesnt stop. A vital character from the play is killed, and this triggers the tragedy. From this moment on, nothing happens t hat is celebrated. Many people are angry with Shakespeare for killing off such a cheerful and important character half way through the play. I agree with them.The friar is a close friend to both Romeo and Juliet. It is the Friar who agrees to marry Romeo and Juliet in secrecy, though he knows their parents would not consent. He also concocts the plan for Juliet to play dead and is supposed to get the word out to Romeo. He fails. I cannot help but notice that everything that the Friar touches goes wrong.I believe that the Friars passion is to bring the two feuding families together. This is why he marries the two star crossed lovers as he believes that it will bring the two families closer together.Romeo greets the Friar Good morrow, father, and Friar Lawrence responds by calling Romeo Young son. Though these exchanges are appropriate because of the religious context, this interchange has greater importance. It is not just the exchange between the priest and the penitent. The Friar a lso stands in for Romeos own father since there are no scenes between Romeo and his parents. The Friar is the only person to whom Romeo turns for advice, and he is the last person to whom Juliet turns after all others have forsaken her. In this sense, he is father to them both and responsible for upholding order.The Friar is always there to comfort and help the two lovers, especially Romeo. One part that stands out is in the Friars cell, when Romeo has just been banished. Romeo is having a tantrum, and is incredibly upset that he has been separated from Juliet and fair Verona. The Friar tells Romeo this: O deadly sin! O rude unthankfulness! Thy fault our law calls death; but the kind Prince, Taking they part, hath rushd aside the law, and turnd that black word death to banishment. This is dear mercy, and thou seest it not. The Friar is telling Romeo that he should be thankful and lucky to still be alive. At this point, The Friar tells off Romeo, and demands that he stop crying and a cting like a girl. From this scene it is obvious to see why The Friar is seen as a father figure to Romeo, as he is saying everything a father would say to his boy in such a situation.However, even though he is seen as a father figure, many of his ideas go awry. He is the person to suggest that Juliet should fake her death, therefore leading to Romeos death. This was obviously a ridiculous idea from the start, one that would never work. I think the Friar has a constant passion, one that is to try and direct Romeo and Juliet. This shows that passions need to be suppressed and controlled because he often leads the couple the wrong way. Ultimately, it is the Friar that kills Romeo and Juliet. He is the person to suggest the ludicrous fake death plan, and this drives Romeo to suicide. Romeos death then destroys Juliet.At the end of the play, the Friars loyalty is tested. He is in the tomb when Juliet awakes, and she spies Romeos corpse. Instead of staying to help, he hears a noise and f lees. How can someone seen as a father figure do this? Even though the two lovers regularly turn to him, his advice is usually bad and he proves how disloyal he is at the end of the play.Even though such terrible things can come from passions, I still believe that the world needs them. I believe that they could never be controlled as they put the excitement into our lives. Without passions, there would be no point in living. Without passions, life would be incredibly dull. We need passion to keep us alive. I believe Shakespeare felt the same, even though such feelings can lead to such disastrous consequences. As the old saying goes, what is the point in living if you cant feel alive? Romeo and Juliet Coursework Essays Romeo and Juliet Coursework Paper Romeo and Juliet Coursework Paper Act 3, Scene 5 of Romeo and Juliet is one of the key scenes of Shakespeares play. Consider why this scene is so important and show how a production of it could be directed to create its full dramatic impact.Act 3, Scene 5 is one of the most significant scenes in the play. It is Romeo and Juliets last night together and Shakespeare has already shown us how risky it is for them to be together because of what has happened before the scene begins. The audience knows that Romeo should be out of Verona but is not, and that Lord Capulet wants Juliet to marry the County Paris on the Thursday of the same week. As we can deduce the whole play is kept in quite a short time-space. As the scene begins the tone is sorrowful because Romeo and Juliet both know they might never see each other again.In Acts 1 and 2, Shakespeare shows Juliet to be the centre of the events because he demonstrates how she is a young girl who has not experienced love until she meets Romeo, the son of her enemy. The playwr ight shows Juliet to be willing to accept the possibility of marriage to Paris, I look to like, if looking liking move, but when she meets Romeo she falls in love and Paris love does not occur to her. We know that Juliets mother would like her to marry Paris and Shakespeare reveals to us that Lady Capulet was married young. This means that she might be a little anxious as to whether Juliet should be married young as well, or she would just accept it as appropriate for her daughter.At the beginning of the scene, Shakespeare shows the audience Romeo and Juliet the morning when Romeo must leave Juliet. We later realise it is the last time that they see each other alive. Romeos words are dramatic and tense, this shows that something could happen, I must be gone and live, or stay and die. As soon as Juliet realises this as the truth she hastily tells him to leave, hie hence, be gone, away, this shows us how afraid she is of losing Romeo. When the Nurse enters she hurries things up becaus e she knows that Juliets mother is coming to see Juliet, this creates a sense of urgency and tension. Juliet, as she opens the window says, Then window let day in and let life out, this shows as daylight comes into her room, Romeo, her life must go.O thinkst thou we shall ever meet again? are some of the most significant words spoken by Juliet before Romeo leaves because Shakespeare shows the audience how much Juliet feels and fears for Romeo; she knows how dangerous it is to have him in her house and in her life yet she cannot bear to see him leave. Juliet also has a vision as Romeo leaves, As one dead in the bottom of a tomb, Juliet sees Romeo dead and this ominous thought gives the audience another reason to believe that something could happen.Once with her mother, Shakespeares use of language allows Juliet to be ambiguous for a lot of this scene, I will not marry yet and when I do, I swear it will be to Romeo, whom you know I hate. As an audience we realise this because Juliet i s married to Romeo and loves him, not hates him. When Lady Capulet enters, Juliet does not know the reason of why her mother has come to see her because Lady Capulet does not get straight to the point. What unaccustomed cause procures her hither? Shakespeare then shows Juliet to be crying, Lady Capulet believes it is still because of the death of Tybalt, Juliets cousin, evermore weeping for your cousins death? however, the audience knows that it is because of the loss of Romeo. Juliets relationship with Lady Capulet is distant, Shakespeare shows the audience this by Lady Capulet echoing Juliets words, let me weep for such a feeling of loss, so you shall feel the losswhich you weep for. During this dialogue with Lady Capulet and Juliet Shakespeares uses Juliets feeling to portray ambiguity in a large amount of what she says, I will not marry yet, and when I do, I swear it shall be Romeo whom you know I hate To create dramatic irony, Shakespeare presents a character that hates Romeo and one that loves him. With Romeo, till I behold him dead is my poor heart, Lady Capulet believes the Juliet wants Romeo dead, however the audience realises the Juliet is being ambiguous and would rather have a dead heart, so she does not have to cope with all the emotions she is during the play.When Lady Capulet tells Juliet the good news, Juliets reaction is not at all what she expects however Juliet does not know it was coming and so is panicked and shocked and so is too outspoken, now by Saint Peters Church and Peter too, He shall not make me there a joyful bride In the century that the play is set, this sort of comment was considered blasphemy, as it was deemed to be swearing by the church. I would have set this particular dialogue between Lady Capulet and Juliet to be distant and I would have the Nurse in the background wanting to interrupt but holding back because we know that the Nurse likes to talk when the subject applies to Juliet.During this scene, when Lord Capulet i s on stage, Shakespeare shows the audience how his anger builds because Juliet does not want to marry Paris. Capulet is surprised because during Act 1, Scene 3, Juliet is open-minded about the possibility of being married off, speak briefly; can you like of Paris love? I look to like, if looking liking move. Shakespeare shows us Capulets anger by making him echo Juliets words, I thank you not, and yet not proud.' Capulet also insults Juliet because he finds it hard to understand why Juliet will not marry Paris when he truly believes it is the right thing to do, out, you green-sickness carrion! However before Lord Capulet mentions the marriage to Paris, he seems caring because he says, evermore showring? In one little body which shows that he feels sorry for her. Shakespeare also uses imagery to show sympathy, Sailing in this salt flood; the winds, thy sighsShakespeare also uses Lady Capulets line to be dramatically ironic, Capulet asks Lady Capulet if she has told Juliet about the m arriage and Lady Capulet says, Ay sir, but she will none, she gives you thanks. I would the fool were married to her grave. We realise that Lady Capulet has little sympathy for Juliet because she had to marry young, and she knows that if she argued with Capulet she would not be being loyal. As Capulets anger builds, Shakespeare shows us the full extent of his anger, my fingers inch, which suggests that he wants to hit her but doesnt, however he knows that because he is the dominant figure in the house he has the most power and so Juliet should respect it. We also realise that Lady Capulet does not speak much because she has turned her back on Juliet.In this scene, when Juliet tells her father she does not want to marry Paris, Shakespeare shows us that Capulet cannot contemplate what his daughter is saying he only wants the best for her. As an audience we realise this because he loves Juliet being his daughter and so wouldnt think of putting her out on the streets or disowning her , we know this that he has only reacted like this because he is hurt and upset. Shakespeare has shown us Capulets love for Juliet in Act 1, Scene 2. Capulet and Paris talk about a possible marriage, however Capulet does not seem sure about the idea of arranging a marriage yet for his only daughter as she is so young, and too soon marred as those so early made. Capulet, during Act 3, Scene 5 hasnt really understood what Juliet has been saying but does understand the underlying meaning, how how, how how, chopt logic?Lady Capulet does not really say anything because she knows she is supposed to be loyal to her husband and go along with what he says. (In the times that Shakespeare was writing and has set his play, the wife of the household was expected to do exactly as the man desired and if that meant not defying him and not expressing her own opinions, she would not.) However, the audience knows that Lady Capulet would not want to hurt Juliet and so must be increasingly worried. I thi nk that this should be shown on stage if Capulet is up close to Juliet when the tension builds, and Lady Capulet could pull her husband away to show that she does not want Juliet to think that she does not care and so that Lord Capulet does not hurt Juliet physically.Later on in the scene when Capulets anger builds, we hope that he doesnt mean what he says but is just hurt and angry, hang, beg, starve, die Capulet also shows his dominance and authority by putting characters in place. In the century that the play is set in, men were the most important people in the house and so they could say whatever they wanted. Capulet speaks rudely and severely to the Nurse, but is allowed to because she is a servant, hold your tongue, peace you mumbling fool.We know that Capulet reacts the way he does because he is so surprised by what Juliet thinks and how she reacts to the concept of marriage to Paris. We know that he wants what is best for Juliet and so when she refuses to marry him, Capulets first reaction is that she is defying her father, Shakespeare shows us this reaction by the anger we see on stage.Juliets reaction to the proposal of marriage is as expected, the audience realises this because she has just spent her last night, perhaps for ever, with her love and now is being forcefully asked to marry someone who she does not have any feelings for. It is quite the opposite to earlier in the play when Juliet is open-minded to the idea of marriage but her change of heart is understandable.By the end of this scene, Shakespeare shows the audience that she is decisive by the way she tricks the nurse and the rest of her family into thinking that she is going to ask Friar Laurence for forgiveness, when the audience knows that she is going to see him for advice or a potion to kill herself, Ill go to friar to know his remedy; if all else fail, myself have power to die.Juliets mother, Lady Capulet reacts in a way that makes the audience wonder if she feels anything for Julie t, Talk not to me, for Ill not speak a word. Do as thou wilt, for I have done with thee. She does not help Juliet and does not comfort her when Capulet exits. This could either be because she fears Capulet and so does not want to defy his wishes. Also Shakespeare may have wanted the audience to believe that she does not comfort Juliet because needs to convince herself, Lady Capulet was married to Capulet when she was young and so perhaps wasnt happy, maybe this means that she needs to grasp that it is happening to her daughter, Juliet.The Nurses reaction in this scene is not to be expected. She has been supportive of Romeo and Juliets love from the beginning but when Capulet puts across his point, the Nurses opinion changes. This surprises Juliet, that same tongue which hath praised him above compare so many thousand time. I think that the Nurses opinion changes because she sees Capulets reaction and is scared of his response if he found out that she went against his word, also it c ould be a practical response because the Nurse realises that Romeo and Juliets love has too high a risk and is pointless. Maybe she is also afraid of losing her job.During Act 3, thehs of major characters, Tybalt, Juliets cousin, and Mercutio, a friend of both families. We know that Romeo kills Tybalt out of anger because Tybalt kills Mercutio. This creates tension between both families, Lady Capulet wants Romeo dead and Juliet knows this, which is why she has to be careful when Romeo comes to see her. It is the Nurse that tells Juliet about Tybalts murder but still convinces Juliet to stay on Romeos side, which is why it is a surprise to Juliet when the Nurse suddenly chooses to tell Juliet to forget about Romeo. Act 3, Scene 3 is when Shakespeare shows us that Romeo does not know who to turn to for help and so seeks Friar Laurences advice, however by the end of this act it is Juliet who does not know who to turn to and so she too turns to Friar Laurence for help.

Care Plan Chronic Heart Failure Health And Social Care Essay

The physician to population ratio grew from 2/1000 people in 2000 to 2.4/ 1000 people in merely a mere 5 years3. Despite the rapid growing, the ratio is still short as compared to other European states viz. France, Germany or Italy. This is worsened by the fact that the figure of patients treated in NHS infirmaries rose by 15 % at the same clip interval3. It is of import to use the expertness of other health care professionals, viz. community druggists, in support of the increasing figure of patients in the community in order to better patient attention. The World Health Organization defines chronic complaints to be ‘a wellness job necessitating on-going direction over a period of old ages or decennaries ‘ . NHS Scotland has identified that chronic unwellness is farther complicated by demographical alterations, increasing co-morbidities, widening spread of wellness inequalities and the increased outlooks placed on the health care system4. Actions have been taken to promote modernisation of NHS community pharmaceutics in Scotland. The debut of the New Pharmacy Contract was the action program from the Scottish Executive ‘s scheme papers ‘The Right Medicine ‘ in which nucleus pharmaceutical attention services such as Chronic Medication Service ( CMS ) , Minor Ailments Service ( MAS ) , Acute Medication Service ( AMS ) and Public Health Service were designed to optimise the use of community druggist ‘s accomplishments to widen the range and farther better the quality of attention proviso to patients5. The contract was driven by a quotation mark by the World Health Organization ( WHO ) in 2002, adverting that reacting to the demands to patients with chronic conditions post the biggest challenge to wellness systems around the globe4. The foundation of the CMS is built upon the cardinal countries: patient centered ; clinical administration ; collaborative working ; support for execution ; monitoring and reappraisal and service development6. The nucleus aims of CMS are summarized in Appendix 1. The altering function of the druggist is in response to the increasing demand for betterment in patient ‘s medicines direction. The debut of the CMS is to further develop the parts of the community druggist to guarantee the continuity of pharmaceutical attention in patients with long-run conditions every bit good as cementing the stature of community druggists in the NHS4. Pharmaceutical attention is an effectual tool in the direction of chronic complaints and is defined as the responsible proviso of drug therapy for the intent of accomplishing definite results that improve a patient ‘s quality of life harmonizing to Hepler and Strand7. Pharmaceutical attention is hence a collaborative attempt between healthcare professionals endeavoring to better drug therapy direction via uninterrupted monitoring of inauspicious effects, effectivity and patient instruction all meeting to better patient ‘s quality of life8. Healthcare professionals play a critical function in autho rising patients to take charge of their ain wellness, as this would ease them in accomplishing their coveted quality of life relevant to their wellness believes6. Community druggist can be the accelerator in smoothing the patient ‘s journey of attention by being the gateway of information via improved entree to healthcare services and to back up self-care6. It is simple to merely purchase a battalion of medicine over the counter to handle an false unwellness but the bulk is incognizant of the possible injury it presents. Some might non take earnestly an overdose of medicines that have a broad curative index but for drugs that have a narrow curative index, a simple overdose could be fatal. There is merely so much a prescriber could make but hanker term attending is indispensable to guarantee that patients get the best out of their medicine particularly in those who have multiple co-morbidities. The attack of CMS is through the constitution of curative partnerships between general medical practicians, druggists and patients to better patient attention by guaranting better local entree to wellness care6. Fostering such commitment will minimise duplicate of functions and, with good defined functions, can advance a holistic attack to the pharmaceutical and clinical attention of patients6. The end is to assist patients harvest the most out of their medical specialties but besides minimise any associated risks4. Community druggist is frequently the first and lone point of call. Community druggists can bridge the spread in a patient ‘s journey of attention and therefore better the whole curative class by expecting, placing, deciding and forestalling medicine-related issues4,9. These medicine-related issues include: Safety and efficaciousness Side effects Conformity and harmony Identify markers of hapless control Symptom specific markers to motivate referral Supplying and advancing wellness information and instruction CMS is a service that requires patients ‘ voluntary engagement and is by and large broken down into 3 phases. Phase 1 involves the enrollment of the patient for the service. Stage 2 involves the debut of a generic model for pharmaceutical attention planning. Phase 3 is the constitution of the shared attention component between the GP and the community pharmacist6. A pharmaceutical attention program paperss the patient ‘s pharmaceutical attention demands, attention issues, desired results and actions required as portion of the pharmaceutical attention planning of the patient. Figure 1 summarizes the pharmaceutical attention be aftering rhythm. Identify and prioritise patients with pharmaceutical attention demands Identify and reexamine pharmaceutical attention issues Implement and proctor pharmaceutical attention program Formulate and document a pharmaceutical attention program Figure 1: Pharmaceutical Care Planning Cycle To get down of with attention planning, critical information that may act upon the attention program such as patient ‘s general wellness, allergic reactions or sensitivenesss, other medical conditions and hazard factors are noted. A hazard appraisal is so made to help the druggist in placing and prioritising any pharmaceutical attention needs that a patient might necessitate or is deprived from in footings of service, which as a consequence influences the therapy6. Next, an appraisal is made to place and reexamine the patients pharmaceutical attention demands and refering issues. This can enable the druggist to measure the medical specialties regimen that a patient is on in footings of efficaciousness or toxicity profile and besides allows the druggist to measure how deep the patients understand their medicines and intervention and the extend of their wellness believes. Subsequently, a pharmaceutical attention program is drafted based on the attention issues that have been iden tified with the understanding of the patient. This attention program serves as a protocol in which issues are placed on a hierarchy of precedence, outcome ends are defined, proposals to any class of action documented every bit good as clearly specifying the health care forces and their duties for assorted monitoring that ought to be conducted. Changeless reappraisals and monitoring is done to measure the results of the attention program upon execution and alterations are made along the manner, when required, to maximise the curative result. To accomplish the maximal curative benefit, the patient ‘s wellness belief and apprehension of the therapy is indispensable. Hence, reding and advice by the druggist before, during and after the procedure is good. Chronic Heart Failure ( CHF ) is one of the 13 long-run disease provinces covered in the CMS protocol stand foring the most frequent indicant for therapy4. The list of all 13 disease provinces are listed in Appendix 2. Heart Failure is one of the most crippling medical conditions which can badly impact a patient ‘s quality of life hence seting force per unit area on hospitalization and health care budgets10. The Scots Intercollegiate Guidelines Network ( SIGN ) defines CHF as a complex clinical syndrome ensuing from any structural/ functional upset that impairs the ability of the bosom to react to physiological demands for increased cardiac output11. Hence, bringing of blood is compromised12. Abnormality in cardiac construction, beat, map or conductivity can all take to unequal perfusion, venous congestion and disturbed H2O and electrolyte balance that underlie CHF13. In add-on, normal compensatory mechanisms become compromised taking to maladaptive secondary physiological effe cts that contribute to the progressive nature of the disease12. CHF can be a effect of assorted underlying complications such as myocardial infarction and/or high blood pressure and the most common being left ventricular systolic disfunction ( LVSD ) . Coronary arteria disease, aortal stricture, dilated myocardiopathy, alcoholic myocardiopathy, Chagas ‘ disease, endomyocardial fibrosis and other mechanical defects such as cardiac valvular disfunction, degenerative valve disease, arthritic valve disease, terrible anaemia and thyrotoxicosis are the more common causes of CHF around the Earth but other rarer causes do exist12,13. Management of these predisposing factors can be good in relieving the symptoms of bosom failure. Table 1 is the New York Heart Association ( NYHA ) categorization system used to sort patients with bosom failure based on their functional position. Table 2 is ACC /AHA phases of HF ; a addendum to the NYHA categorization. It is estimated that there is a prevalence of about 1-2 % for bosom failure in developed countries10,14. The life-time hazard of developing HF is approximately 20 % for patients above 40 old ages old and besides the taking cause of hospitalization for patients above 65 old ages old10,14. Harmonizing to the European Society of Cardiology, above 15 million patients are diagnosed with HF in 51 European states consisting a population of around 900 million15. The prevalence of HF is about 1-2 % in the western society and the incidences are between 5-10/ 1000 instances per annum16. A recent US population-based survey, the prevalence of bosom failure was 2.2 % ( 95 CI 1.6 % to 2.8 % ) , increasing from 0.7 % in individuals aged 45 through 54 old ages to 8.4 % for those aged 75 old ages or older17. Similar minor expense forms, 1 % for the 55-64 age group increasing to 13 % in the 75-84 age group was observed from the Rotterdam study18. In the contrary, for the below 50 age group, incidences of HF are rare16. Improved endurance from acute myocardial infarction ( MI ) coupled with the aging population contributes to the spike in incidence and prevalence of HF19. One critical function community pharmacist drama is to advice and offer guidance on a healthy life style. Lifestyle and dietetic alterations are schemes aimed at forestalling cardiovascular diseases ( CVD ) which are possible predisposing factors taking to CHF. The development of CVD is affected by multiple dietetic factors and an overall healthy diet will significantly cut down the hazard of CVD20. Consumption of fruits, veggies, grain merchandises, low-fat dairy merchandises and curtailing the sum of salt and unstable consumption are all portion of a well balanced diet11,21. Keeping a healthy organic structure weight is indispensable as fleshiness is an independent hazard factor for CVD. Morbid fleshiness has a strong association with mortality from CVD particularly in immature grownup males. Therefore, bar of fleshiness has to be taken early and in an aggressive manner22. Keeping optimum blood force per unit area, blood glucose every bit good as a desirable lipid profile is advise d to command or lower the hazard of CVD21. Maintaining physical and cardiovascular fittingness and a healthy weight can be achieved by changeless physical activities as it improves cardiovascular hazard factors every bit good as take downing the hazard of developing other chronic diseases21,23. Evidence has proven the strong association between smoking and cardiovascular jeopardies every bit good as the benefits of smoking cessation24. Therefore, look intoing the smoke position of patients and offering intercession where appropriate will be good to patients peculiarly in those who are at hazard of enduring from cardiovascular events24. Patients with CHF should be advised to discontinue smoking11. Moderate ingestion of intoxicant should besides be advised as extra alcohol ingestion can increase the hazard of CVD11,25. The above are merely the chief life style and dietetic parametric quantities that should be addressed with precedence to command or lower CVD hazards. Such steps should non be seen as stairss taken to forestall CVD but instead as stairss taken to promote everybody to populate a healthy life style to forestall any signifier of disease provinces. Psychosocial and psychological hurt have a important impact in morbidity and mortality after HF and hence societal and relationship factors may play an of import function in pull offing chronic conditions such as CHF26. The ends of intervention are to better quality of life11,13. Angiotensin Converting Enzyme Inhibitors ( ACEi ) Evidence has shown that ACEi therapy is good in take downing mortality, MI and rehospitalization for patients enduring from HF with LVD or HF with or without a recent MI27. A meta-analysis has shown that patients with CHF prescribed with an ACEi have a 23 % decrease in mortality and a 35 % decrease in rehospitalization27. Further meta-analysis is patients with LVSD, HF or both after MI has a comparative decrease in mortality rate of 26 % 27. Therefore, ACEi therapy is recommended in patients with all NYHA functional categories of HF due to LVSD11. Adverse effects include cough, hypotension, nephritic damage, angio-oedema and hyperkaelaemia. Dose titration and nephritic and electrolyte monitoring should be included in the attention program particularly in susceptible patients utilizing other medicines so that intercession could be established in instances where inauspicious effects are marked. Beta Blockers Treatment with bisoprolol, carvedilol and Lopressor Forty shows a decrease in mortality in patients with advanced HF based on the CIBIS- II, COPERNICUS, and MERIT-HF tests severally. Beta-blockers benefits in HF by demoing a 29 % decrease in hazard of mortality in CVD, 36 % decrease due to pump failure and all cause mortality decrease of 23 % 28. All patients with HF due to LVSD of all NYHA functional category should be started on beta-blockers every bit shortly as their status is stable and should be the first line picks for patients with CHF due to LVSD11. The effects of beta-blockers might non be seen instantly. Furthermore, deterioration of HF and hypotension might be present at the get downing hence dose should be titrated up suitably upon supervising. Beta-blockers are contraindicated in those with asthma, bronchospasm, 2nd or 3rd degree auriculoventricular bosom block or diagnostic hypotension11. Angiotensin II Receptor Blocker ( ARB ) ARBs antagonizes the binding of angiotonin II to its type 1 receptor hence exercising its action similar to ACEi ‘s with the benefit of non bring forthing dry cough as a side effect13. In CHARM Alternative, ARB intervention led to a comparative decrease of 23 % in primary result of CV deceases or rehospitalsation for patients with CHF having candesartan who are intolerant to ACEi29. The add-on of ARB to ACEi or beta-blocker intervention non merely had no consequence on mortality but markedly reduced HF rehospitalisation and mortality combined30. Patients with CHF due to LVSD, HF or LVSD or both station MI who are intolerant to ACEi should be considered for ARBs whilst patients with HF due to LVSD who are still diagnostic despite already on ACEi and beta-blockers, add-on of candesartan might be beneficial11. Aldosterone Adversaries Aldosterone adversary has been studied in patients with terrible diagnostic HF, led to a pronounced decrease in mortality and morbidity and improved symptoms13,31. It is recommended for patients with HF in NYHA category III and IV despite being on ACEi and beta-blocker while there is no grounds that Aldactone has any benefits in mild HF11,13. The RALES test has shown that the add-on of Aldactone to an ACEi yielded an all cause mortality of 30 % and cardiac mortality by 31 % 31. However, aldosterone adversaries produce many inauspicious effects on vascular map and myocardial fibrosis11. Spironolactone produces gynaecomastia, hyperkaelaemia, and nephritic disfunction hence blood carbamide, creatinine and electrolyte monitoring is essential11. Patients with terrible HF due to LVSD should be on Aldactone unless contraindicated11. Eplerenone can be used if patients are intolerant to spironolactone as grounds from EPHESUS survey has demonstrated a 13 % decrease from CVD or hospitalization for CVD and 21 % comparative rate of sudden decease in patients on eplerenone32. Diuretic drugs Fluid keeping doing ankle hydrops, pneumonic hydrops or both consequences in symptoms of dyspnea in most patients enduring from HF11. A meta-analysis supports that diuretic therapy is good for patients with dyspnea or hydrops with a 75 % decrease in mortality and 63 % betterment in exercising capacity33. The hazard of loop water pills doing hypokalaemia is offset by ACEi, ARBs and Aldactone. Therefore, monitoring of serum K is of import. Doses of water pills should be individualized to minimise unstable keeping taking into history the possibility of desiccation and nephritic impairments11. Digoxin In a Cochrane reappraisal, patients on Lanoxin showed a 64 % betterment in symptoms and a 23 % decrease in hospitalization but unluckily no betterment seen on survival34. Digoxin should be considered as an accessory therapy for instances in which patients with HF in fistula beat are non relieved on optimal therapy11. There are many issues associated with the usage of Lanoxin because of its narrow curative index, some of which are fatal such as its ability to increase the possibility of sudden decease and the hazard of toxicity in instance of hypokalaemia11. Therefore, the hazard over benefit of Lanoxin therapy should be carefully considered in the best involvement of the patient. Care Plan Chronic Heart Failure Health And Social Care Essay The physician to population ratio grew from 2/1000 people in 2000 to 2.4/ 1000 people in merely a mere 5 years3. Despite the rapid growing, the ratio is still short as compared to other European states viz. France, Germany or Italy. This is worsened by the fact that the figure of patients treated in NHS infirmaries rose by 15 % at the same clip interval3. It is of import to use the expertness of other health care professionals, viz. community druggists, in support of the increasing figure of patients in the community in order to better patient attention. The World Health Organization defines chronic complaints to be ‘a wellness job necessitating on-going direction over a period of old ages or decennaries ‘ . NHS Scotland has identified that chronic unwellness is farther complicated by demographical alterations, increasing co-morbidities, widening spread of wellness inequalities and the increased outlooks placed on the health care system4. Actions have been taken to promote modernisation of NHS community pharmaceutics in Scotland. The debut of the New Pharmacy Contract was the action program from the Scottish Executive ‘s scheme papers ‘The Right Medicine ‘ in which nucleus pharmaceutical attention services such as Chronic Medication Service ( CMS ) , Minor Ailments Service ( MAS ) , Acute Medication Service ( AMS ) and Public Health Service were designed to optimise the use of community druggist ‘s accomplishments to widen the range and farther better the quality of attention proviso to patients5. The contract was driven by a quotation mark by the World Health Organization ( WHO ) in 2002, adverting that reacting to the demands to patients with chronic conditions post the biggest challenge to wellness systems around the globe4. The foundation of the CMS is built upon the cardinal countries: patient centered ; clinical administration ; collaborative working ; support for execution ; monitoring and reappraisal and service development6. The nucleus aims of CMS are summarized in Appendix 1. The altering function of the druggist is in response to the increasing demand for betterment in patient ‘s medicines direction. The debut of the CMS is to further develop the parts of the community druggist to guarantee the continuity of pharmaceutical attention in patients with long-run conditions every bit good as cementing the stature of community druggists in the NHS4. Pharmaceutical attention is an effectual tool in the direction of chronic complaints and is defined as the responsible proviso of drug therapy for the intent of accomplishing definite results that improve a patient ‘s quality of life harmonizing to Hepler and Strand7. Pharmaceutical attention is hence a collaborative attempt between healthcare professionals endeavoring to better drug therapy direction via uninterrupted monitoring of inauspicious effects, effectivity and patient instruction all meeting to better patient ‘s quality of life8. Healthcare professionals play a critical function in autho rising patients to take charge of their ain wellness, as this would ease them in accomplishing their coveted quality of life relevant to their wellness believes6. Community druggist can be the accelerator in smoothing the patient ‘s journey of attention by being the gateway of information via improved entree to healthcare services and to back up self-care6. It is simple to merely purchase a battalion of medicine over the counter to handle an false unwellness but the bulk is incognizant of the possible injury it presents. Some might non take earnestly an overdose of medicines that have a broad curative index but for drugs that have a narrow curative index, a simple overdose could be fatal. There is merely so much a prescriber could make but hanker term attending is indispensable to guarantee that patients get the best out of their medicine particularly in those who have multiple co-morbidities. The attack of CMS is through the constitution of curative partnerships between general medical practicians, druggists and patients to better patient attention by guaranting better local entree to wellness care6. Fostering such commitment will minimise duplicate of functions and, with good defined functions, can advance a holistic attack to the pharmaceutical and clinical attention of patients6. The end is to assist patients harvest the most out of their medical specialties but besides minimise any associated risks4. Community druggist is frequently the first and lone point of call. Community druggists can bridge the spread in a patient ‘s journey of attention and therefore better the whole curative class by expecting, placing, deciding and forestalling medicine-related issues4,9. These medicine-related issues include: Safety and efficaciousness Side effects Conformity and harmony Identify markers of hapless control Symptom specific markers to motivate referral Supplying and advancing wellness information and instruction CMS is a service that requires patients ‘ voluntary engagement and is by and large broken down into 3 phases. Phase 1 involves the enrollment of the patient for the service. Stage 2 involves the debut of a generic model for pharmaceutical attention planning. Phase 3 is the constitution of the shared attention component between the GP and the community pharmacist6. A pharmaceutical attention program paperss the patient ‘s pharmaceutical attention demands, attention issues, desired results and actions required as portion of the pharmaceutical attention planning of the patient. Figure 1 summarizes the pharmaceutical attention be aftering rhythm. Identify and prioritise patients with pharmaceutical attention demands Identify and reexamine pharmaceutical attention issues Implement and proctor pharmaceutical attention program Formulate and document a pharmaceutical attention program Figure 1: Pharmaceutical Care Planning Cycle To get down of with attention planning, critical information that may act upon the attention program such as patient ‘s general wellness, allergic reactions or sensitivenesss, other medical conditions and hazard factors are noted. A hazard appraisal is so made to help the druggist in placing and prioritising any pharmaceutical attention needs that a patient might necessitate or is deprived from in footings of service, which as a consequence influences the therapy6. Next, an appraisal is made to place and reexamine the patients pharmaceutical attention demands and refering issues. This can enable the druggist to measure the medical specialties regimen that a patient is on in footings of efficaciousness or toxicity profile and besides allows the druggist to measure how deep the patients understand their medicines and intervention and the extend of their wellness believes. Subsequently, a pharmaceutical attention program is drafted based on the attention issues that have been iden tified with the understanding of the patient. This attention program serves as a protocol in which issues are placed on a hierarchy of precedence, outcome ends are defined, proposals to any class of action documented every bit good as clearly specifying the health care forces and their duties for assorted monitoring that ought to be conducted. Changeless reappraisals and monitoring is done to measure the results of the attention program upon execution and alterations are made along the manner, when required, to maximise the curative result. To accomplish the maximal curative benefit, the patient ‘s wellness belief and apprehension of the therapy is indispensable. Hence, reding and advice by the druggist before, during and after the procedure is good. Chronic Heart Failure ( CHF ) is one of the 13 long-run disease provinces covered in the CMS protocol stand foring the most frequent indicant for therapy4. The list of all 13 disease provinces are listed in Appendix 2. Heart Failure is one of the most crippling medical conditions which can badly impact a patient ‘s quality of life hence seting force per unit area on hospitalization and health care budgets10. The Scots Intercollegiate Guidelines Network ( SIGN ) defines CHF as a complex clinical syndrome ensuing from any structural/ functional upset that impairs the ability of the bosom to react to physiological demands for increased cardiac output11. Hence, bringing of blood is compromised12. Abnormality in cardiac construction, beat, map or conductivity can all take to unequal perfusion, venous congestion and disturbed H2O and electrolyte balance that underlie CHF13. In add-on, normal compensatory mechanisms become compromised taking to maladaptive secondary physiological effe cts that contribute to the progressive nature of the disease12. CHF can be a effect of assorted underlying complications such as myocardial infarction and/or high blood pressure and the most common being left ventricular systolic disfunction ( LVSD ) . Coronary arteria disease, aortal stricture, dilated myocardiopathy, alcoholic myocardiopathy, Chagas ‘ disease, endomyocardial fibrosis and other mechanical defects such as cardiac valvular disfunction, degenerative valve disease, arthritic valve disease, terrible anaemia and thyrotoxicosis are the more common causes of CHF around the Earth but other rarer causes do exist12,13. Management of these predisposing factors can be good in relieving the symptoms of bosom failure. Table 1 is the New York Heart Association ( NYHA ) categorization system used to sort patients with bosom failure based on their functional position. Table 2 is ACC /AHA phases of HF ; a addendum to the NYHA categorization. It is estimated that there is a prevalence of about 1-2 % for bosom failure in developed countries10,14. The life-time hazard of developing HF is approximately 20 % for patients above 40 old ages old and besides the taking cause of hospitalization for patients above 65 old ages old10,14. Harmonizing to the European Society of Cardiology, above 15 million patients are diagnosed with HF in 51 European states consisting a population of around 900 million15. The prevalence of HF is about 1-2 % in the western society and the incidences are between 5-10/ 1000 instances per annum16. A recent US population-based survey, the prevalence of bosom failure was 2.2 % ( 95 CI 1.6 % to 2.8 % ) , increasing from 0.7 % in individuals aged 45 through 54 old ages to 8.4 % for those aged 75 old ages or older17. Similar minor expense forms, 1 % for the 55-64 age group increasing to 13 % in the 75-84 age group was observed from the Rotterdam study18. In the contrary, for the below 50 age group, incidences of HF are rare16. Improved endurance from acute myocardial infarction ( MI ) coupled with the aging population contributes to the spike in incidence and prevalence of HF19. One critical function community pharmacist drama is to advice and offer guidance on a healthy life style. Lifestyle and dietetic alterations are schemes aimed at forestalling cardiovascular diseases ( CVD ) which are possible predisposing factors taking to CHF. The development of CVD is affected by multiple dietetic factors and an overall healthy diet will significantly cut down the hazard of CVD20. Consumption of fruits, veggies, grain merchandises, low-fat dairy merchandises and curtailing the sum of salt and unstable consumption are all portion of a well balanced diet11,21. Keeping a healthy organic structure weight is indispensable as fleshiness is an independent hazard factor for CVD. Morbid fleshiness has a strong association with mortality from CVD particularly in immature grownup males. Therefore, bar of fleshiness has to be taken early and in an aggressive manner22. Keeping optimum blood force per unit area, blood glucose every bit good as a desirable lipid profile is advise d to command or lower the hazard of CVD21. Maintaining physical and cardiovascular fittingness and a healthy weight can be achieved by changeless physical activities as it improves cardiovascular hazard factors every bit good as take downing the hazard of developing other chronic diseases21,23. Evidence has proven the strong association between smoking and cardiovascular jeopardies every bit good as the benefits of smoking cessation24. Therefore, look intoing the smoke position of patients and offering intercession where appropriate will be good to patients peculiarly in those who are at hazard of enduring from cardiovascular events24. Patients with CHF should be advised to discontinue smoking11. Moderate ingestion of intoxicant should besides be advised as extra alcohol ingestion can increase the hazard of CVD11,25. The above are merely the chief life style and dietetic parametric quantities that should be addressed with precedence to command or lower CVD hazards. Such steps should non be seen as stairss taken to forestall CVD but instead as stairss taken to promote everybody to populate a healthy life style to forestall any signifier of disease provinces. Psychosocial and psychological hurt have a important impact in morbidity and mortality after HF and hence societal and relationship factors may play an of import function in pull offing chronic conditions such as CHF26. The ends of intervention are to better quality of life11,13. Angiotensin Converting Enzyme Inhibitors ( ACEi ) Evidence has shown that ACEi therapy is good in take downing mortality, MI and rehospitalization for patients enduring from HF with LVD or HF with or without a recent MI27. A meta-analysis has shown that patients with CHF prescribed with an ACEi have a 23 % decrease in mortality and a 35 % decrease in rehospitalization27. Further meta-analysis is patients with LVSD, HF or both after MI has a comparative decrease in mortality rate of 26 % 27. Therefore, ACEi therapy is recommended in patients with all NYHA functional categories of HF due to LVSD11. Adverse effects include cough, hypotension, nephritic damage, angio-oedema and hyperkaelaemia. Dose titration and nephritic and electrolyte monitoring should be included in the attention program particularly in susceptible patients utilizing other medicines so that intercession could be established in instances where inauspicious effects are marked. Beta Blockers Treatment with bisoprolol, carvedilol and Lopressor Forty shows a decrease in mortality in patients with advanced HF based on the CIBIS- II, COPERNICUS, and MERIT-HF tests severally. Beta-blockers benefits in HF by demoing a 29 % decrease in hazard of mortality in CVD, 36 % decrease due to pump failure and all cause mortality decrease of 23 % 28. All patients with HF due to LVSD of all NYHA functional category should be started on beta-blockers every bit shortly as their status is stable and should be the first line picks for patients with CHF due to LVSD11. The effects of beta-blockers might non be seen instantly. Furthermore, deterioration of HF and hypotension might be present at the get downing hence dose should be titrated up suitably upon supervising. Beta-blockers are contraindicated in those with asthma, bronchospasm, 2nd or 3rd degree auriculoventricular bosom block or diagnostic hypotension11. Angiotensin II Receptor Blocker ( ARB ) ARBs antagonizes the binding of angiotonin II to its type 1 receptor hence exercising its action similar to ACEi ‘s with the benefit of non bring forthing dry cough as a side effect13. In CHARM Alternative, ARB intervention led to a comparative decrease of 23 % in primary result of CV deceases or rehospitalsation for patients with CHF having candesartan who are intolerant to ACEi29. The add-on of ARB to ACEi or beta-blocker intervention non merely had no consequence on mortality but markedly reduced HF rehospitalisation and mortality combined30. Patients with CHF due to LVSD, HF or LVSD or both station MI who are intolerant to ACEi should be considered for ARBs whilst patients with HF due to LVSD who are still diagnostic despite already on ACEi and beta-blockers, add-on of candesartan might be beneficial11. Aldosterone Adversaries Aldosterone adversary has been studied in patients with terrible diagnostic HF, led to a pronounced decrease in mortality and morbidity and improved symptoms13,31. It is recommended for patients with HF in NYHA category III and IV despite being on ACEi and beta-blocker while there is no grounds that Aldactone has any benefits in mild HF11,13. The RALES test has shown that the add-on of Aldactone to an ACEi yielded an all cause mortality of 30 % and cardiac mortality by 31 % 31. However, aldosterone adversaries produce many inauspicious effects on vascular map and myocardial fibrosis11. Spironolactone produces gynaecomastia, hyperkaelaemia, and nephritic disfunction hence blood carbamide, creatinine and electrolyte monitoring is essential11. Patients with terrible HF due to LVSD should be on Aldactone unless contraindicated11. Eplerenone can be used if patients are intolerant to spironolactone as grounds from EPHESUS survey has demonstrated a 13 % decrease from CVD or hospitalization for CVD and 21 % comparative rate of sudden decease in patients on eplerenone32. Diuretic drugs Fluid keeping doing ankle hydrops, pneumonic hydrops or both consequences in symptoms of dyspnea in most patients enduring from HF11. A meta-analysis supports that diuretic therapy is good for patients with dyspnea or hydrops with a 75 % decrease in mortality and 63 % betterment in exercising capacity33. The hazard of loop water pills doing hypokalaemia is offset by ACEi, ARBs and Aldactone. Therefore, monitoring of serum K is of import. Doses of water pills should be individualized to minimise unstable keeping taking into history the possibility of desiccation and nephritic impairments11. Digoxin In a Cochrane reappraisal, patients on Lanoxin showed a 64 % betterment in symptoms and a 23 % decrease in hospitalization but unluckily no betterment seen on survival34. Digoxin should be considered as an accessory therapy for instances in which patients with HF in fistula beat are non relieved on optimal therapy11. There are many issues associated with the usage of Lanoxin because of its narrow curative index, some of which are fatal such as its ability to increase the possibility of sudden decease and the hazard of toxicity in instance of hypokalaemia11. Therefore, the hazard over benefit of Lanoxin therapy should be carefully considered in the best involvement of the patient.

Early Childhood Assessment Essay Example | Topics and Well Written Essays - 250 words

Early Childhood Assessment - Essay Example ely participate in the process because they happen to spend most of the time with the child, and hence, are the best source of information about the child’s behavior. Assessments of young children are made primarily to enhance their readiness for school (NAP, 2011). Learning problems, if not attended to in the very early years of the child’s academic career, can aggravate with the passage of time and it is far more difficult to make them leave in a grown-up child as compared to an infant or toddler. The pattern of early childhood development is the most fundamental determinant of the development in the later years. In the contemporary age, there is so much competition among students that a child can not afford to be weak in any sense if he/she wants to build the career on the basis of his/her grades. In order to enable the child achieve his/her full potential and optimize on his/her skills to make best use of them, it is imperative that their problems are addressed at the right time, i.e. early

Ethics Essay Example | Topics and Well Written Essays - 500 words - 48

Ethics - Essay Example seek to conduct a comparison of the various differences and similarities that tend to exist between utilitarianism, deontological ethics and virtue theory. The main similarity between the three theories of utilitarianism, deontological ethics and virtue theory is that they all attempt to try and set a common standard by which an individual who is considered to be a good moral person can live by within a given community (Manias et al, 2013). The virtue ethics measure morality in an individual by using aspects such as moral standing and character within a given community so as to effectively determine the individual’s goodness Devettere (2002), this is similar to deontology whereby a person is considered to be good and moral in the event that their actions within a given community are considered to be the right choice and as such, the actions are good and moral (Tännsjö, 2013). In utilitarianism, individuals are encouraged to base their actions and decisions on what action will ultimately be in the best interest for the majority of people (Manias et al, 2013). The common ground between these three theories is based on mora lity and goodness as is perceived by other individuals within the wider community. The three theories of deontological ethics, virtue theory and utilitarianism can also be seen to be similar in that they all share the same consequence of action. Although it might not be the main focus of the action, the outcomes of the action’s consequences are considered to be primary as a result. All these theories work towards what is being perceived to be the best result depending on exactly what someone else happens to believe that the best results may be. The main difference between the three theories of utilitarianism, deontological ethics and virtue ethics is that deontological ethics are primarily based on a fixed moral law and duty, utilitarianism on the other hand is based on an enlightened self interest, or simply what serves to make us all

Aristotle, Temperance, Pleasure, and Pain :: Philosophy Research Papers

Aristotle, Temperance, Pleasure, and Pain(1) ABSTRACT: Aristotle argues that temperance is the mean concerned with pleasure and pain (NE 1107b5-9 and 1117b25-27). Most commentators focus on the moderation of pleasures and hardly discuss how this virtue relates to pain. In what follows, I consider the place of pain in Aristotle’s discussion of temperance and resolve contradictory interpretations by turning to the following question: is temperance ever properly painful? In part one, I examine the textual evidence and conclude that Aristotle would answer no to our question. The temperate person does not feel pain at the absence of appropriately desired objects. In parts two and three, I reconstruct some reasons why Aristotle would hold such a view based. My discussion here is based upon Aristotle’s discussion of continence and the unity of the virtues. While the accounts of temperance in the Eudemian Ethics and the Nichomachean Ethics share some similarities, the treatment of the topic in the latter is much more developed.(2) As Charles Young argues, Aristotle draws a distinction between common appetites and peculiar appetites. The appetite for food when one hasn’t eaten for several hours is a common, natural appetite. The appetite for a particular food or a particular amount is peculiar. Temperance most properly concerns the peculiar appetites, because, Aristotle says, people don’t tend to go wrong about common appetites since the appetite disappears with replenishment (NE 1118b15-19).(3) A further refinement in the Nicomachean account comes at 1119a16-20. Here Aristotle distinguishes between pleasures conducive to health (called healthful foods by Young) and pleasures that do not interfere with health (called treats by Young). On this more positive account of temperance, one has temperance just in case one’s peculiar appetites for food, sex, and drink are determined by judgments about the contribution to or compatibility with healthfulness.(4) One nice result of this account is that temperance loses any connotations of austerity that it might have had. For a temperate person, on Aristotle’s account, enjoys treats to the extent that they are compatible with health. This quick summary of the Nicomachean and Eudemian treatments of temperance, while showing some of the subtlety of Aristotle’s position, has selectively omitted a range of issues. The focus has been on pleasure rather than pain. Clearly the intemperate person enjoys consuming foods to an excess. However, it also surely is true that the intemperate person is pained by the absence of those peculiar things he desires.

Assessing Young Learners’ Speaking Ability in the Fifth Grade of Three Elementary Schools in Padang Essay

CHAPTER I INTRODUCTION A. Background of the Problem Communicative view development in English learning makes the focus on English teaching changed. What once became structurally focused, it now moves toward meaningful language-focused. Students are not asked to memorize structure-based dialogues without knowing the meaning anymore. There are no more grammatically controlled sentences for students’ meaningless repetition. Dialogues, if used, center around communicative functions and are not normally memorized (Richards & Rodgers, 1986). That makes the teaching of speaking becomes the core part of English teaching. Just like the adults, young learners today are also taught speaking meaningfully and communicatively. However, young learners have distinctive characteristics compared with adult learners. One of them is children are still developing cognitively, linguistically, socially, emotionally, and physically (Teaching Knowledge Test Young Learners: Handbook for Teachers, 2010). In other words, in teaching speaking to them, teachers need to consider children’s development of skills in the native language first. Young learners also enjoy rhythmic and repetitive language more than adults do. They are more likely to play with language than adults are, and they can be more effectively engaged through stories and games (Peck, 2009). The different techniques and approaches in teaching speaking to young learners lead to different ways in the speaking assessment. This is the problem faced by Indonesian young learners’ teachers nowadays. Most teachers do not know how they should assess their young learners’ speaking ability; some finally choose to skip the speaking assessment and focus on pencil-paper-tests. Thus, this research is conducted to discover and reveal ways of assessing young learners’ speaking ability. B. Identification of the Problem Based on the background above, the speaking assessment techniques used for young learners should be different from the adult. It should be suited with their cognitive, linguistic, social, emotional, and physical development. As we looked upon Language Assessment: Principles and Classroom Practices by Brown (2010) and integrated it with curriculum standard in Indonesia, KTSP 2006, young learners will be better to be assessed in imitative and intensive speaking categories, such as imitating teachers’ saying, directed response tasks, read-aloud tasks, and dialogue completion tasks. Alternative assessments such as interviews and conferences can also be applied for them. C. Limitation of the Problem In this research, the problem will be focused on the speaking assessment techniques in the fifth grade of three selected elementary schools in Padang. D. Formulation of the Problem * What kind of speaking assessment technique used by elementary school English teachers? * Why do they use such techniques? E. Purpose of the Research The purpose of this research is to discover and reveal the technique used by English teachers to assess elementary school students’ speaking ability. F. Significance of the Research Theoretically, this research is aimed to give a description of how speaking assessment for young learners done in Indonesia. Practically, some techniques used by English teachers provided here can be a source of alternative speaking assessment. CHAPTER 2 REVIEW OF RELATED LITERATURE A. The Nature of Assessment There has been various explanation of what assessment is. Brindley (as stated in Linse, 2005) refers assessment as â€Å"collecting information and making judgments on a learner’s knowledge†. It means that in assessing students, we need to find out what students know about the subject being taught and how far that understanding has reached the learning indicator. In the same line with Brindley but with an addition, Brown (2010) states assessment as â€Å"an ongoing process of collecting information about a given object of interest according to procedures that are systematic and substantively grounded.† In his statement above, Brown implies that the process of collecting and judging students’ understanding is not done orderly in one single time; it is done continuously. Harris and McCann (1994) also give an essential note that in doing assessment teachers have to measure the performance of their students and the progress they make, as well as diagnose the problems they have and provide useful feedback. In other words, collecting and judging students’ intelligence is not enough; finding out what becomes students’ problem and giving advice to them to overcome the problems is also important to create a more successful learning process. Based on the theories above, it can be seen that assessment involves collecting information about students’ knowledge and judging their understanding in order to diagnose the learning problems they have so that students can get useful feedback to be more-successful learners. B. The Nature of Speaking As stated in the previous chapter, today’s English teaching focuses more on communicative purpose of language learning than in the past. It leads to the more important consideration of speaking skills than in previous time. Just like assessment, there is also various definition of speaking. One of them is from Lingua Links (1998) that defines speaking as productive skill in the oral mode that involves more than just pronouncing words. Referring to today’s communicative view, of course speaking cannot be thought as just pronouncing words; it needs to be meaningful, and communicative. Furthermore, Noonan (2003) states that, if pronunciation included, speaking involves three areas: mechanics (pronunciation, grammar, and vocabulary), functions (transaction and interaction), and social cultural norms and rules (turn-taking, rate of speech, etc). All of them are connected to each other and prove that speaking is not only about what is uttered, but also the meaning and social purpose. C. The Nature of Young Learners Young learner is a child who is in their first six year of formal education, from age 6 to 12 (Teaching Knowledge Test Young Learners: Handbook for Teachers, 2010). Many experts argue that it is beneficial to teach the children English since young age. TKT Young Learners (2010) notes one of the advantages that those children will have positive self-esteem toward English and it will help them to learn English more once they are adult. That is why teaching English to young learners considered important today. However, young learners have characteristics that make them different from the adults (Teaching Knowledge Test Young Learners: Handbook for Teachers, 2010). First, they are still morally, cognitively, psychologically developed. Based on Piaget’s theory of cognitive development, children in age 6-12 years old are still in concrete operational thought stage, they already have the ability to do logical reasoning and understand reversibility with the help of concrete objects (Santrock, 1998). It means that explaining theory will not do for them, we need to make them move, do games, sing, etc. Second, young learners often have no obvious reason for learning English. Unlike adults who want to do it because of the career-related reasons or teenagers that do it to pass an exam, young learners do not have concrete reason why they must learn English. However, it does not mean they are not motivated to learn English; their goodwill, energy, and curiosity to learning overcome that. Third, they may not always have well-developed literacy skills to support their learning of English. Many children in the age of 6-12 years old are just getting to know their first language. It means that as a teacher we need to not have too-high expectation and do more. Fourth, young learners often learn slowly and forget quickly. It is related to the first characteristic that young learners are still developed morally, socially, and cognitively. Their still-ongoing developments in those basic things make them forget easily and learn slowly. This is why songs, agmes, and chants do best for them. D. Principles of Assessing Young Learners According to METU Open Course Ware (2006), principles of assessing children’s language learning are: 1. Assessment should be seen from a learning-centered perspective. It means that we cannot get a true assessment by testing kids what they can do alone. It has been stated by many experts that the goal of learning English is to be able to communicate meaningfully in English. Testing students, let alone young children, as a tool to get true assessment will not congruent with the real goal of English learning and it will just be wasting time. 2. Assessment should support learning and teaching. This is something that is not also becomes a problem with young learners, but also with the adult. Before performance-based assessment is introduced, teachers chose paper-and-pencil tests as their source of assessing (Puppin, 2006). It becomes a problematic then since students do not see the connection between the learning and the test they are doing, ; they see them as two different incongruent things. If the assessment done is congruent with the learning they did, children will feel that what they have learned is useful. 3. Children and parents should understand assessment issues. Their understanding will make the assessment process more meaningful since they can participate and supports greatly on behave of children’s English development. On the other hand, if they do not understand why the teacher does this and that, there will be no good communication between these three subjects to help children’s development. E. Techniques of Speaking Assessment Brown (2010) states some techniques of speaking assessment based on students’ language development level: Imitative Speaking This kind of assessment is intended to see whether students can imitate saying in English correctly. Eventhough it focuses on the accuracy of repeating words, it does not mean that it cannot be communicative and meaningful. Besides, in recent years many experts have discovered that an overemphasis on fluency can sometimes lead to the decline of accuracy in speech. Intensive Speaking There are four tasks in this kind of assessing: directed response task, oral questionnaire, and picture-cued task. In oral questionnaires, students are first given time to read the dialogue to get its main idea and to think about the appropriate lines to fill in. Then, as the tape, teacher produces one part orally; the students respond. In directed response task, students elicit a particular grammatical form of a transformation of a sentence. Such tasks are clearly mechanical and not communicative, but they do require minimal processing of meaning in order to produce the correct grammatical output. Picture-cued task requires a description from the students. Pictures may be very simple, designed to elicit a word or a phrase, or composed of a series that tells a story or incident. This task is meaningful since sometime a little sense of humor is injected. Responsive Speaking Assessment of responsive tasks involves brief interactions with an interlocutor, differing from intensive tasks in increased creativity given to the student and from interactive tasks by somewhat limited length of utterances. The kinds of this assessment are question and answer, giving instructions and directions, and paraphrasing. Questions and answers involve oral interaction with teacher.

The After-Life of Slavery - Free Essay Example

Sample details Pages: 4 Words: 1149 Downloads: 5 Date added: 2019/07/03 Category Literature Essay Level High school Tags: Beloved Essay Slavery Essay Did you like this example? The After-life of Slavery In the book beloved, we are introduced to many different characters the setting is after slavery to a home where Sethe lives in. Before Sethe moved to 124 home, she lived on the plantation sweet home. She escapes from the underground railroad by the help of a woman. Don’t waste time! Our writers will create an original "The After-Life of Slavery" essay for you Create order Before, Sethe didnt want to have her children go through slavery as she did. Throughout the book beloved, you see it focused on her older daughter, which she called Beloved. Throughout the book, you see the different relationships in the book to where you see the characters try to move forward after slavery. You will see how Beloved affected her life after slavery, making Sethe more emotional and guiltier through the time of her freedom. Firstly, in the first chapter in the book, you get a little background about the characters. We are introduced to Baby Suggs, which is Sethe mother-in-law. She is very sad after slavery because she lost all her children besides Halle. Baby Suggs doesnt know where Halle is. Paul D is introduced. A friend of Sethe and Halle at the plantation Sweet home. We see a very deep connection and relationship with Paul D and Sethe. When Paul D escape from sweet home the goes to 124. This was a friendly relationship he had with her. When Sethe was talking to her other daughter Denver. Denver asked what her mother was thinking about. Sethe told Denver she was thinking about the memories she has. Sethe seems to believe that the past will repeat itself. The one thing to see in the novel is how Sethe is trying to protect her children from the world. She thought killing Beloved was the best choice she has because she didnt want her children going through a life of slavery as she did. Even though they are free Sethe tries to protect Denver in the same context by informing her that the past can repeat itself. Sethe is trying to move forward into freedom and wants her daughter to make the right decisions in the future. Also, Sethe way of relaxing was a place called Clearing. She takes Denver and Beloved with her. Before Baby Suggs became depressed. Sethe blames herself because she left Halle behind. She would cry and la ugh to make herself feel better. She also wanted to love herself for who she was. This was Sethe way of moving forward to freedom with her Daughter Denver. To let go of all the things she didnt love about herself and try to let them go in these moments. She continues to talk about her past with Denver, how she escapes slavery while she was pregnant with her. She describes how she was protected and how she got to 124. We see Denver and Sethe Relationship change one, because of Beloved and two because of Paul D. Denver didnt care too much for Paul D and Sethe relationship, this made things difficult as they tried to move forward. We see the relationship of moving forward with Baby Suggs and Sethe after she escapes. She sits with Baby Suggs, Sethe seems to be calling at her mother-in-law as if she needs to be comforted. Once Sethe tries to turn for her Baby Suggs for comfort she finds that she is being strangled by her. Beloved comes to confront her and make sure she is okay. Sethe pushed Beloved from her. Denver is thinking that Beloved is the one strangled Sethe. Baby Suggs has a connection with Sethe because of Baby Suggs Son Halle, which Sethe wanted to marry. Baby Sugg wanted to know where her son is, and this is how the relationship between Sethe and Baby Sugg started. Sethe and Baby Suggs were both sad of the lost. Baby Suggs didnt know where Halle is and Sethe is morn for Beloved. Moving forward they found ways to clear their thoughts. Baby Suggs later fell into a deep depression and died because of the effects of slavery Secondly, you see the afterlife of slavery through beloved. Throughout the novel, you are to believe she still alive but actually, she isnt. Sethe is still grieving the loss of her daughter and see Sethe. As beloved is living with Sethe and Denver they start to care for her. Even though she doesnt seem to be sick or anything. It shows that Sethe has sympathy for Beloved. Sethe tries to be more caring for Beloved than anyone else. Throughout the entire novel, you see that Sethe try to put the death of her daughter so deep back where she actually forgets and take her in to care for her. This shows how mentally slavery affected people even after slavery ended. Sethe becomes more open with her daughters about her past and the choice she made. Part of the reason why is because Beloved is back in her life. The choices she made with Beloved make her realized that she has to be more open with her other daughter Denver. Beloved starts to hang around the house more epically with Denver. Once Denver sees Beloved actions she starts to wonder if she can Stop Beloved from hurting Sethe. Paul D seems to want to be more than just friends with Sethe. When he is free, the first thing he does is try to find Sethe. Once they reconnected you see them trying to move forward after slavery, even though they still shared stories about the plantation. Even though they shared their hard times they still want to move forward with their lives. Paul D, Denver, and Sethe goes to a carnival for Blacks enjoy themselves. At this point they all are happy. After Paul D discovered what Sethe did to her eldest daughter he left to figure out what is next from him. He tries to make Beloved understand why her mother killed her. Paul D tries to find comfort with Sethe because of he like her. He wanted to move forward with her and realize that what he wanted after slavery wasnt all he wanted to be. It was difficult after slavery finding love and what was next for them. In conclusion, Through Beloved, we see how difficult life after slavery affected everyone. From moving forward to where to go, with moving on from the emotional pain of the death of Sethe oldest Daughter. Even though slavery ended, it was still a challenge for African Americans to move forward with their lives. It took Sethe 18 years after and some to grieve her daughter death. In the book, Paul D talks to Sethe. Sethe said, She was my best thing (). You see Sethe is more caring for Beloved after slavery, while Sethe and Denver explained the events leading up to when they came to 124. Beloved makes everyone question the past, while they still try to move forward. She is the after life for them.