Campaign Finance Reform free essay sample

Asseses Senate Bill 1219 and obstacles to its passage. Discusses background, need for, politics, constitutionality, provisions, goals, bipartisan support and interest groups. Campaign finance reform has been debated since Richard Nixon ran for the Vice Presidency under Eisenhower. In the wake of the Watergate fiasco, some meaningful reforms were made. However, there have been no major changes to campaign finance laws since that time. The time is ripe for change, but what kind of changes do we want? Do we want changes that make a joke of our constitution or do we want changes within the boundaries of the constitution? The major issue is soft money was originally intended to go to party-building activities and get-out-the-vote drives but which increasingly has been used as a way to funnel large contributions to presidential and other candidates. (Hamburger, Tom Campaign-finance debate jumps to center stage // There is widespread agreement that federal election rules need repairing. We will write a custom essay sample on Campaign Finance Reform or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page But there is no consensus on how, and there is lots of opposition to the lead. Minneapolis Star Tribune, 09-28-1997, pp 21A). However, the McCain-Feingold bill, the one most advocates support, would also limit advertising. The problem with that is any changes that try and skirt around the constitution, by limiting free speech, will most likely be thrown out by the Supreme Court. Until recently most congressmen did not look at finance reform seriously.

Realism in On the Waterfront essays

Realism in On the Waterfront essays Though the style of realism is not big, flashy, or constantly moving, it does have a sort of richness about it that, director, Elia Kazan achieves so accurately in his 1954 classic, On the Waterfront. Through his use of subtle photography, we, as an audience, are able to break away from the fact that we are watching a movie, and focus on the interaction and emotion of the characters. It is as if we are standing in the very room with the characters, observing the scene. Almost nothing is shown that we wouldnt be able to see ourselves. In fact, virtually the only obscure angle in the entire film was an oblique angle near the end when we are shown the severity of Terrys injuries through his eyes as he attempts to walk up the dock. In any formalistic film, this angle and others like it would have been used much more freely. Similar to the photography, the editing in On the Waterfront is miniscule. Most of the editing techniques are match cuts; flowing steadily through the scenes with only a few cuts to necessary characters or places. This minimalism becomes quite evident in the scene where Terry and Edie nearly get hit by the truck. In a formalistic film, the director might have chosen to show the frantic chaos of a moment by inserting multiple jump cuts, cutaways and cut-ins. An example of this would be the shower scene in Hitchcocks horror classic, Psycho, because he jumps in, out and away throughout those few moments of the murder and the audience is able to see exactly what Marion Crane sees. On the contrary, in a realistic film, such as On the Waterfront, we must rely on the actors reaction and expression in order to grasp the mood or feeling. When Terry turns around and sees that truck headed for himself and Edie, we know by that frozen look of horror, that this is a bad situation. Because On the Waterfront is a realistic fi...

Housing economics (Housing Studies) Essay Example | Topics and Well Written Essays - 3500 words - 1

Housing economics (Housing Studies) - Essay Example There is no government intervention in this economy (Grant & Vidler, 2000, p. 19). The free market system consists of four main categories of actors. They are â€Å"consumers, producers, owners of private property (land and capital) and government† (Economics, 1977). Each actor in the pure market economy is motivated their own self-interest and they take every decision based on their private gain. In this context we make an assumption of rationality. It is a very important assumption that considers that the market actors are rational in the sense that they are both consistent and transitive in the choices that they make. If a person chooses a basket of commodities ‘X’ over a basket of commodities ‘Y’ at a particular point of time, she would choose the same basket of commodities an instant later provided that there are not any alterations made in the baskets. Secondly, if a person chooses ‘X’ over ‘Y’ and ‘Y’ over ‘Z’, he would prefer ‘X’ over ‘Z’. It is a lso to be noted that a rational individual would want more of a normal good (increases consumption of which gives increased utility) than less of it. In the free market economy, any stability issue is resolved without external intervention and it is made possible through â€Å"consistent maximization of a well-ordered function, such as a utility or profit function† (Etzioni, 2010, p. 142) by the two main forces of the market; the consumers and the producers. According to the famous proposition by Adam Smith, an invisible hand works in the free market economy. The housing system in the United Kingdom is a large and complex system and includes a range of relationships between the owners and occupiers of the homes. The houses might e occupied by the owners or might involve various rental tenures in the private sector including the â€Å"not-for profit and local authority sectors† (Diacon, Pattison & Vine, 2009, p. 6). This market consists of millions of existing

Statistics Assignment Essay Example | Topics and Well Written Essays - 1000 words

Statistics Assignment - Essay Example According to Gore and Altman (1992), Chi-square test is used in situations where the data table has two or more rows and columns and where there is no cell with less than 5 as a value. In this case, Chi-square tests can be performed since the table obeys the two conditions. If otherwise, the Chi-square exact goodness of fit test is used since it takes care of cells with less than value 2. In case of less than two rows, then independent t-test will be used. The ANOVA test compares the variations due to regression (SSR) and un-explained variation (SSE). Further, the analysis computes the F statistics (F computed) using the formula; F = MSE/MSR and compares it with the F tabulated value; qf(.95,1,198) = 3.89 and then compares the two values. According to Gore and Altman (1992), the regression model is significant if F (computed) > F (tabulated). The analyzed data further assures that there is no significant difference between the two groups with F =1.929 (p=.166; p>.05). This is so because, F (computed) = 1.926 .05 we reject the null hypothesis that the impact of the two groups is statistically significant at 95% level of significance. The two groups explain about 4.805 (sum of squares due to regression) of the variations in back pain improvements. The difference between participating in group discussions and group exercises is about 4.805 regression sum of square with. The un-explained variation (residual sums of squares) is about 493.995. Statistically, the interaction between certain factors may have a negative impact on the data being modelled. Considering each factor alone is encouraged to avoid the negative effects of interactions. Adjusting for extra factors changes the outcome results. For example, in this analysis, fully adjusting the explanatory variables results into a different p-value although statistically significant. The interaction between age, race and sex adjusted and

Criminology in the Future Essay Example | Topics and Well Written Essays - 500 words

Criminology in the Future - Essay Example As criminals become more sophisticated in their use of technology, forms of crime committed by them also become increasingly complex and difficult to understand and manage. Thus police and security officials must stay current in their knowledge and understanding of emerging crime, and both well resourced and expert regarding their own technological capabilities (p.36). Schmalleger (2012, Chapter 13) considered technology to be one of the causes of new forms of crime, since it facilitates new forms of criminal behavior. In his Chapter 13, Schmalleger (2012) named several types of cybercrimes, including crimes requiring use of modern technology, such as identity theft. All of these types of crimes arose out of technological innovations. However, criminal justice system has been revolutionized too since the 1970’s, all due to new technologies (Peterson & Leggett, 2007, p.621). Modern technology has revolutionized the criminal justice system. DNA testing by forensic biologists has become crucial in many capital offenses, as it exonerated many innocent defendants and eliminated blind faith in the criminal justice system (Petherick, Turvey & Ferguson, 2010, p.309). In 1990, the Combined DNA Index System (CODIS) was established in order to gather DNA of all convicted felons (Peterson & Leggett, 2007, p.635 - 636). Use of computers has been crucial in fighting crime as well. In the 1980’s, first computerized databases of forensic evidence were established (Peterson & Leggett, 2007, p.630). Database forensics evolved, and soon became crucial in fighting cybercrimes (Khanuja & Adane, 2011, p.170). More subfields evolved. Forensic toxicology enables testing of drugs and other chemical compounds found on the crime scene (Petherick, Turvey & Ferguson, 2010, p.432). Other forensic scientists conduct fire debris analysis, which is again a chemical compound analysis (Petherick, Turvey & Ferguson, 2010, p.434). Trace evidence analysis

Classifications of Liquid Crystals

Classifications of Liquid Crystals 1. Introduction 1. Introduction to Liquid Crystals 1.1 Historical background Liquid crystals are a unique state of matter, between solid (crystalline) and liquid (isotropic) phases some compounds form a distinct, different intermediate phase, sometimes referred to as the â€Å"fourth state of matter† or â€Å"mesophase†. These compounds display properties of both solid and liquid. Anisotropic intermolecular interactions of the molecules, or mesogens, within a liquid crystalline material mean that the molecules possess some orientational or positional order but with a lower degree of organisation compared with a crystalline solid. This means liquid crystals possess liquid-like flowing behaviour, but because of their positional order, such compounds are often more viscous. Liquid crystals are attributed to their sensitivity to various stimuli, such as temperature, electric and magnetic fields. This sensitivity, combined with the self-assembling behaviour of liquid crystals make them extremely interesting and fascinating for chemists and physicists . Friedrich Reinitzer, a botanist at the Karl-Ferdinands-Università ¤t was the first to discover and publish work on liquid crystals[1] in 1888. In this paper he described the melting phenomena of cholesterol benzoate, in which there were two melting points; the compound transforms into a cloudy fluid at 145.5  °C which became clear at 178.5  °C.[1] Reinitzer could not explain these observations, so he sought help from physicist Otto Lehmann, an expert in polarisation microscopy. Lehmann investigated the optical properties of the compound and found crystallites in the cloudy fluid, and observed this to be an intermediate phase (or â€Å"mesophase† – from Ancient Greek,ÃŽ ¼ÃƒÅ½Ã‚ ­ÃÆ'ÃŽ ¿Ãâ€š (mà ©sos) meaning â€Å"middle†) between the liquid and solid phase. This intermediate phase showed birefringence but also flowed like a liquid.[2] In 1904, Lehmann was the first to coin the term â€Å"Liquid crystal† for these types of compounds. Vorlà ¤nder, a German chemist, was another pioneer in liquid crystal research and he discovered that molecular shape was very important in the geometry of the mesophase.[3] In 1935 Vorlà ¤nder retired but due to his research most of the liquid crystals up this date had been synthesised by him. For a long time liquid crystals were merely scientific curiosity.[4] The unique properties of liquid crystals together with some molecules being sensitive to electric fields, began the research by Heilmeier[5] in 1968 which led to the discovery and widespread applications in liquid crystal displays (LCDs).[6][7][8][9][10][11] 1.2 Classifying Liquid Crystals Liquid crystals are classified in many ways,[12][13] molecules within the mesophases (mesogens) can be calamitic (rod-like), discotic (disc-like), amphiphilic, nonamphiphilic, metal containing, non-metal containing and low molecular weight or polymeric. Liquid crystals either show thermotropic behaviour or lyotropic behaviour. Thermotropic behaviour means the compounds are liquid crystalline within a defined temperature range, below this range compounds are crystalline and above it compounds are isotropic liquids (figure 1). Thermotropic liquid crystalline compounds also require no solvent. Lyotropic liquid crystals are dependent on solvents, where solvent concentration affects aggregation and liquid crystal behaviour. Figure 1: Rod-like (calamitic) molecules representing molecular arrangement of thermotropic liquid crystalline phase transitions. This work is focused on calamitic, thermotropic liquid crystals. Mesophases of such liquid crystals can be divided into categories which depend on the orientation and order. The main categories are nematic (N), smectic (Sm) and cholesteric (N*) (or chiral nematic) (figure 2). Figure 2: Molecular arrangements of different sub-phase allignments. 1.2.2 Nematic Phases The nematic phase is the simplest mesophase known; there is long range orientational order between the mesogens but no short range positional order. Mesogens are able to freely translate and rotate along the director field (n) but are randomly distributed in space. â€Å"Nematic† comes from the Ancient Greek word ÃŽ ½ÃŽ µÃŽ ¼ÃŽ ± (â€Å"nema† meaning thread) as when observed through a microscope thread-like structures are observed. 1.2.1 Smectic Phases Liquid crystals with smectic mesophases were originally discovered from amphiphilic molecules, the phase type coming from the Ancient Greek word ÏÆ'ÃŽ ¼ÃŽ µÃŽ ºÃâ€žÃŽ ¿ÃÆ' (â€Å"smektos† meaning soap-like). Today, the word smectic is used for liquid crystals in which the molecules occupy orientational order, but are also organised in layers[14]. These organised layers can slide relative to each other, which contributes to the liquid character of the liquid crystal phase. Many smectic phases have been discovered, each smectic phase differs in the orientation and position of the mesogens.[15] Smectic phases are distinguished by letters; SmA, SmB, SmC etc. with SmA and SmC being the most common. Smectic phases are distinguished via the molecular orientation within the layers (figure 2).[16][17] Smectic A (SmA) mesophases have molecules aligned along a director field (n) and are parallel to the layer normal and in smectic C (SmC) mesophases the molecules are tilted at a certai n angle away from the layer normal.[17] Compounds exhibiting smectic mesophases are sometimes referred to as two dimensional liquids, since there is no positional order within each layer.[14] 1.2.3 Cholesteric Phases The cholesteric phase is the nematic phase only mesogens change orientation in a helical manner with respect to the director field (n). The director field in the cholesteric phase changes direction and is perpendicular to the direction of the helix. The chirality comes from the molecules orienting themselves into a helix; each layer is non-superimposable. Within the cholesteric mesophase is the pitch, which is defined as the distance between one mesogenic layer and another which has rotated 360  ° to the director field (figure 3). Figure 3: Representation of the cholesteric mesophase with the cholesteric pitch. The first observed liquid crystals based on cholesterol derivatives showed this mesophase type, which is where the mesophase name â€Å"cholesteric† originates.[1][2] 1.2.4 Chiral Liquid Crystals There are 3 main types of chiral liquid crystals. The first type was found with cholesterol benzoate (the first liquid crystal discovery) in which the molecule contains one or more stereocentres. These form liquid crystals with helical order in the mesophase. The second type contains two molecules; a chiral guest molecule and an achiral nematic molecule. These molecules are mixed together to form chiral cholesteric structures. In the third type, mesogens layer themselves perpendicular to each other forming a helix or twist. These molecules do not need to be chiral, as the perpendicular stacking form helixes, giving this third type the name twisted nematic. Twisted nematic phases are found in liquid crystal displays and chiral liquid crystals overall are useful in the field of stereochemistry, optics and material science.[12] 1.3 Ionic Liquid Crystals Knight and Shaw were the first to discover liquid crystals which were ionic in 1938; the compounds had a pyridinium cationic core and flexible alkyl chains attached.[18] Ionic liquid crystals possess properties characteristic of liquid crystals (molecular order, mobility, anisotropy of physical properties) and ionic liquids (conductivity, thermal stability)[19] making them very interesting and useful for ion conduction (aligned ionic liquids[20][21]), electroluminescence (which can be used in organic light emitting diodes), manufacturing of displays[10], spatial light modulators[22], optical connectors and switches[23], molecular sensors and detectors[24][25] References [1] F. Reinitzer, Monatsh Chem 1888, 9, 421–441. [2] O. Lehmann, Z Phys Chem 1889, 4, 462–472. [3] D. Vorlà ¤nder, Z Phys Chem 1923, 105, 211–254. [4] T. J. Sluckin, D. A. Dunmur, H. Stegemeyer, Crytals That Flow Classic Papers from the History of Liquid Crystals, 2004. [5] G. H. Heilmeier, L. A. Zanoni, L. A. Barton, Appl Phys Lett 1968, 13, 46–47. [6] M. Schadt, H. Seiberle, A. Schuster, Nature 1996, 381, 212–215. [7] M. Schadt, W. Helfrich, Appl Phys Lett 1971, 18, 127–128. [8] M. Schadt, Jpn. J. Appl. Phys. 2009, 48, 03B001. [9] H. Kawamoto, Process IEEE 2002, 90, 460–500. [10] M. A. Karim, Electro-Optical Displays, CRC Press, 1992. [11] P. Yeh, C. Gu, Optics of Liquid Crystal Displays, John Wiley Sons, 2010. [12] I. Dierking, in Textures Liq. Cryst., Wiley-VCH Verlag GmbH Co. KGaA, 2003, pp. i–xi. [13] P. J. Collings, J. S. Patel, Handbook of Liquid Crystal Research, Oxford University Press, 1997. [14] A. Jakli, A. Saupe, One- and Two-Dimensional Fluids: Properties of Smectic, Lamellar and Columnar Liquid Crystals, CRC Press, 2006. [15] C. Bahr, in Chirality Liq. Cryst. (Eds.: H.-S. Kitzerow, C. Bahr), Springer New York, 2001, pp. 223–250. [16] M. Barà ³n, Pure Appl. Chem. 2001, 73, DOI 10.1351/pac200173050845. [17] B. Chen, X. B. Zeng, U. Baumeister, S. Diele, G. Ungar, C. Tschierske, Angew. Chem. Int. Ed. 2004, 43, 4621–4625. [18] G. A. Knight, B. D. Shaw, J. Chem. Soc. 1938, 682–683. [19] K. Binnemans, Chem. Rev. 2005, 105, 4148–4204. [20] T. Kato, Science 2002, 295, 2414–2418. [21] M. Yoshio, T. Kagata, K. Hoshino, T. Mukai, H. Ohno, T. Kato, J. Am. Chem. Soc. 2006, 128, 5570–5577. [22] B. Bahadur, Liquid Crystals — Applications and Uses: (Volume 3), WORLD SCIENTIFIC, 1992. [23] J. L. De Bougrenet de la Tocnaye, Liq. Cryst. 2004, 31, 241–269. [24] A. Hussain, A. S. Pina, A. C. A. Roque, Biosens. Bioelectron. 2009, 25, 1–8. [25] C. Ohm, M. Brehmer, R. Zentel, Adv. Mater. 2010, 22, 3366–3387.

The Symbol of Blood in William Shakespeares Macbeth Essay -- William

The Symbol of Blood in William Shakespeare's Macbeth Blood represents life, death and often injury. It is an essential part of life, and without blood, we could not live. In Macbeth, Shakespeare uses the symbol of blood to represent treachery, murder and death. The word "blood", or different forms of it, appear numerous times throughout the play. Interestingly, the symbol of blood changes throughout the play, corresponding to the atmosphere and mood changes in the characters and the play. First, blood is a reference of honor, and this occurs when Duncan sees the injured sergeant and says, "What bloody man is that?"(1.2.1). This is symbolic of the brave fighter who been injured in a valiant battle for Scotland. The sergeant goes on to describe the courageous actions of Macbeth and says, "With his brandished steel, which smoked with bloody execution . . . [Macbeth] unseamed [Macdonwald] from the nave to th? chops"(1.2.20&23). This refers to Macbeth?s braveness in confronting and executing Macdonwald in battle, using his sword that is covered in the blood of the enemy. ...

Asessment

I will continue to use this priority direction as the example in this assessment 1 guide. Your assignment task is to: 1 . Select one priority direction from the list. For example: One of the six priority directions of the Nest action agenda is ‘Improving the social and emotional wellbeing of young Australians' (pig 14). 2. Introduce the priority direction highlighting the significance for Australian children and youth You could: Discuss what Is social and emotional wellbeing and what are the benefits or outcomes of emotional and social wellbeing for children and youth.For example the early year's research provides evidence that Infant bonding and positive early life social experiences can strengthen healthy brain development providing the potential for greater educational achievement and the capacity to form successful relationships (National Scientific Council on the Developing Child 2004, Children's Emotional Development Is Built into the Architecture of Their Brains: Working Paper No. 2. Http://www. Developmentally. Net). 3.Identify the current status of child and youth health and wellbeing in Australia (birth to 24 years) in your selected priority direction and present the problem currently faced in Australia. Identify Australian statistics from various resources that indicate the outcomes related social and emotional wellbeing for Australian children. You may use RACY evidence such as Report Card: The wellbeing of young Australians along with other Australian sources e. G. AYAH to support your discussion.The RACY Report Card uses the average of all ‘Loved and Safe' measures to provide a global indicator of social and emotional wellbeing. You can refer to this. You could also provide statistics related to various determinants and related outcomes for this priority area and issues how the factor is relevant e. G. Bullying and the impact on youth mental health. 4. Discuss what determinants of health and wellbeing are contributing to these outcomes . Identify determinants from across various contexts influencing child and youth outcome I. E. Processes in the micro, mess, ex. Or macro systems.In this section you can discuss the factors that influence the statistics and health outcomes you have raised in your essay. For example identify various determinants of social and emotional wellbeing including both protective and risk factors. Discuss owe unemployment (ex.) might affect family functioning (micro) such as positive communication. 5. Propose strategies supported by research and the literature that will help achieve one or more aspects of the Nest action agenda vision for Australia's children and in any context influencing child and youth outcomes I. . Processes in the micro, mess, ex. Or macro systems. Intimidates is a school health promotion program that helps schools support young people to achieve their goals, build relationships and cope with challenges (http:// wry. Intimidates. Due. AU/about-Intimidates/what-is-Intimid ates). How can implementation be encouraged in your local school? Tips on the structure of your essay You have some freedom in this assessment task to select broad or focused issues impacting on child and youth health.This will impact on how to present your work. Plan your presentation carefully. Your presentation can follow the order of assignment tasks listed in the unit outline or you may reorder the information to improve the logical flow of your ideas and the essay. You can present your work as an essay however, you may use headings to respond to the various tasks. A good resource on effective writing and how to write an essay is: http://unlearning. IOW. Due. AU/main. HTML.See also a comparison between essay and a report style http://unlearning. IOW. Due. AU/report/l b. HTML Correct referencing following the Harvard style is required See the marking criteria in the unit outline for the areas your work will be assessed against. Each lecturer will arrange a webbing session for yo ur group where you can ask question about the first assessment. These sessions will be recorded so that if you can't attend the set time you can listen to the questions and answers at a later time.

Discuss the global roles and responsibilities of a newly qualified nurse The WritePass Journal

Discuss the global roles and responsibilities of a newly qualified nurse Introduction Discuss the global roles and responsibilities of a newly qualified nurse IntroductionDECISION MAKING PROCESSPatient Group Direction (PGD)When can PGDs be used?Which POMs can be supplied or administered under a PGD?How should PGDs be drawn up?Pharmacy Only (P) and General Sales List (GSL) MedicinesConclusion References:Related Introduction The aim of this assignment is to discuss the global roles and responsibilities of the newly qualified nurse. The exercise will begin by briefly looking at the transition from student to nurse and thereafter outlining the basic roles of the newly qualified nurse and try to fit them into appropriate professional skills. In addition, there will be a critical examination of two roles in more detail with one of them focusing on Patient Group Directions (PGD), and justify their importance. We will then look at some legal, professional and ethical considerations before making a conclusion on the future role development of the nurse. The NMC require a student nurse to demonstrate professional and ethical practice, be competent in care delivery and care management, and show personal and professional development in order to join the register (NMC, 2010). On becoming a qualified nurse, the expectations and dynamics of relationships changes fundamentally. Suddenly the newly qualified nurse is the one who must ‘know the answer’, whether it is a query from a patient, a carer, a work colleague or a student. The newly qualified nurse will encounter many challenging situations where she or he must lead care delivery. This includes dealing with care management within the team, dealing with patients/service users, dealing with other professionals, and dealing with the required needs of the whole workplace environment. These changes require a large shift from the experience of being a student and a mentored supervised learner, so it is essential that one is equipped with all the skills required to successfully make the transition. The newly qualified nurse must demonstrate they are fit to enter the NMC register and therefore be eligible to practice as a qualified nurse. In all cases, the newly qualified nurse is seen as: Provider of care Educator Counsellor Collaborator Researcher Change Agent Patient Advocate Manager The above are typically the roles of a newly qualified nurse which can be compressed into the NMC professional skills requirements listed below: Maintaining standards of care Making ethical and legal decisions Being accountable Teamworking Teaching others Being in charge. It is recognized that there is a certain amount of overlap in these professional skills and that some concepts cross all of them, in that there are no clear lines drawn where one skill ends and another starts. For the purpose of this analysis, we will look at the issue of making ethical and legal decisions and the Patient Group Direction. Decisions and actions are taken by nurses in the course of day-to-day practice. One would not usually consider each of the skills or concepts in isolation in relation to particular incidents but would make a decision based on the factors contributing to the situation. However, when analysing any situation, in the decisions made and the actions taken, some of the individual conceptual principles may be recognized and highlighted. For example, asking a member of staff to complete a task on your behalf is delegating. This fits neatly into leadership theory and also relates to aspects of accountability. Completing a health and safety audit in the work environment might relate to management theory and responsibility taken on. Completing a review of an individual’s care and setting goals for them in multidisciplinary meetings might relate to team working theory. Reporting of poor practices or environments might relate to aspects of accountability and maintaining standards of care. However, all of the above aspects could arise from analysing one situation where the nurse has to make decisions about a certain aspect of care management thus emphasizing the great importance of making ethical and legal decisions. DECISION MAKING PROCESS Nurses are problem solvers who use the nursing process as their tool. The chief goal of ethical decision-making process is to determine right and wrong in situations where clear demarcations are not apparent, and then search for the best answer. For a newly qualified nurse, the following will be a guide to making ethical decisions: State the Dilemma State dilemma clearly, determine whether the problem/decision involves the nurse or only the patient, focus attention on ethical principles and follow the client’s wishes first while considering the family input in case of unconsciousness. Collect and Analyze Data Know client’s and family’s wishes and all information about the problem. Keep abreast of any up to date legal and ethical issues; which may also overlap. Consider Choices of Action – Most ethical dilemmas have multiple solutions, some of which are more feasible than others. The more options that are identified, the more likely it is that an acceptable solution can be identified. It may require input from outside sources and other professionals such as Social workers etc. Make the Decision – The most difficult part of the process is making the decision, following through with the action, and then living with the consequences. Ethical dilemmas produce differences of opinion and not every one is pleased with the decision but it must be emphasized that client’s wishes always supercede the decision by health care providers but ideally, a collaborative decision is made by client, family, doctor and nurse thus producing fewer complications. Act – Once a course of action has been determined, the decision must be carried out. Implementing the decision usually involves collaboration with others. Evaluate – Unexpected outcomes are common in crisis situations that result in ethical dilemmas. It is important for decision makers to determine the impact an immediate decision may have on future ones. It is also important to consider whether a different course of action might have resulted in a better outcome. If the outcome accomplished its purpose, the ethical dilemma should be resolved and if the dilemma has not been resolved, additional deliberation is needed. Patient Group Direction (PGD) The legislation (Statutory Instrument, 200a) states that ‘Patient Group Direction means – in connection with the supply of a prescription only medicine a written direction relating to the supply and administration of a description or class of prescription only medicine or a written direction relating to the administration of a description or class of description only medicine, and which in the case of either is signed by a doctor and by a pharmacist; and relates to the supply and administration, or to administration, to persons generally (subject to any exclusions which may be set out in the Direction).’ In practice this means that a PGD, signed by a doctor and agreed by a pharmacist, can act as a direction to a nurse to supply and/or administer prescription-only medicines (POMs) to patients using their own assessment of patient need, without necessarily referring back to a doctor for an individual prescription. When can PGDs be used? The law is clear that the majority of care should be provided on an individual, patient-specific basis, and that the supply and administration of medicines under PGDs should be reserved for those situations where this offers an advantage for patient care (without compromising safety), and where it is consistent with appropriate professional relationships and accountability. The RCN interprets this to mean that PGDs should only be used to supply and/or administer POMs to homogeneous patient groups where presenting characteristics and requirements are sufficiently consistent for them to be included in the PGD e.g. infants and children requiring immunisation as part of a national programme. Which POMs can be supplied or administered under a PGD? PGDs can be used to supply and administer a wide range of POMs although there are currently legislative and ‘good practice’ restrictions in relation to controlled drugs, antimicrobials and black triangle drugs. Controlled drugs The use of controlled drugs continues to be regulated under the Misuse of Drugs Act 1971 and associated regulations made under that Act. The Home Office has agreed to allow the supply and administration of substances on Schedule 4 (with the exclusion of anabolic steroids) and all substances on schedule 5 to be included in PGDs. Antimicrobials can be included within a PGD but consideration must be given to the risk of increased resistance within the general community. When seeking to draw up a PGD for antimicrobials, a local microbiologist should be involved and approval sought from the drug and therapeutics committee or equivalent. Black triangle drugs and medicines used outside the terms of the Summary of Product Characteristics Black triangle drugs (i.e. those recently licensed and subject to special reporting arrangements for adverse reactions) and medicines used outside the terms of the Summary of Product Characteristics (SPC) – sometimes called ‘off label use’ (for example, as used in some areas of specialist paediatric care) may be included in PGDs. Their use should be exceptional and justified by best clinical practice, and a direction should clearly describe the status of the products. How should PGDs be drawn up? The law (Statutory Instrument, 2000a) requires that PGDs should be drawn up by a pharmacist and the doctor who works with the nurses who will be using them. The relevant health authority should also ratify the PGD. In England, when PGDs are developed locally, HSC 2000/026 (NHSE, 2000) requires that a senior doctor and a senior pharmacist sign them off with authorisation from the appropriate health organisation, i.e. the trust, and that all nurses using the directions are specifically named within the PGD and signed by them. The RCN acknowledges this as good practice and recommends the following steps be taken throughout the UK. The NMC Standards for Medicines Management (2007) state that ‘the administration of drugs via PGDs may not be delegated and students cannot supply or administer under a PGD. Students would however be expected to understand the principles and be involved in the process (NMC 2007). Failure to ascertain that a PGD is the most appropriate route can lead to waste of valuable time and resource and place increased risk on delivery and quality of patient care. Anyone involved with PGDs (whether developing, authorising or practising under them) should understand the scope and limitations of PGDs as well as the wider context into which they fit to ensure safe, effective services for patients. Any extension to professional roles with regard to administration and supply of medicines must take into account the need to protect patient safety, ensure continuity of care and safeguard patient choice and convenience. It also has to be cost effective and bring demonstrable benefits to patient care. Any practice requiring a PGD that fails to comply with the criteria falls outside of the Law and could result in criminal prosecution under the Medicines Act. With regard to the written instruction required for the supply and administration of medicines by non-professionals, Medicines Matters (2006) (3) clarifies that a suitably trained non-professional member of staff can only administer medicines under a Patient Specific Direction (PSD). Medicine Matters (2006) states that: Patient Specific Direction is the traditional written instruction, from a doctor, dentist, nurse or pharmacist independent prescriber, for medicines to be supplied or administered to a named patient. The majority of medicines are still supplied or administered using this process. There is nothing in legislation to prevent PSDs being used to administer medicines to several named patients e.g. on a clinic list. PSDs are a direct instruction and therefore do not require an assessment of the patient by the health care professional instructed to supply or administer the medicine. Pharmacy Only (P) and General Sales List (GSL) Medicines Medicines legislation states that a PGD is not required to administer a P or GSL medicine. The use of a simple protocol is advisable for best practice and from a governance perspective. All medicines administered must be recorded in the patients medical record. Where a GSL medicine is to be supplied it must be taken from lockable premises and supplied in a pre-pack which is fully labelled and meets the GSL requirements. A PGD will be necessary for the supply of P medicines by anyone other than a registered pharmacist. Recommend further advice to be sought from a pharmacist. (Ref: NPC PGDs 2004). For safe administration of drugs, the newly qualified nurse must give the right dose of the right drug to the right patient in the right route at the right time. When giving medications, the nurse needs to be aware of possible interactions between the patient’s different drugs. It is the nurse’s responsibility to protect the patient from harm. If they think the wrong drug or the wrong dose has been ordered, they must ask for help from the nurse or the doctor in charge. The newly qualified nurse needs to know the doses of the drug which are safe to administer. Sometimes the pharmacy gives out drugs in grams when the order specifies milligrams, or the other way around. They need to know how to convert these. It is important to know what types of dilemmas newly qualified nurses may face during their careers and how they may deal with it. It is also important for nurses to understand what malpractice is and how they may protect themselves from a malpractice suit. Firstly, it is important to understand the difference between law and ethics. Ethics examines the values and actions of people. Often times, there is no one right course of action when one is faced with an ethical dilemma. On the other hand, laws are binding rules of conduct. When laws are broken, it is punishable by an authority. There are four types of situations that pertain to law and ethics. The first would be an action that is both legal and ethical. An example of this would be a nurse carrying out appropriate doctors orders as ordered. A nurse may also be faced with an action that may be ethical but not legal, such as allowing a cancer patient to smoke marijuana for medicinal purposes. The opposite may arise where an action may be legal but not ethical. Finally, an action may be neither legal nor ethical. For example, when a nurse makes a medication error and does not take responsibility to report to it appropriately. The right of service users to expect practitioners to act in their best interests is reinforced by professional codes of conduct and legislation such as the Mental Health Act. It is also reflected in equality of opportunity legislations such as the Sex Discrimination Act and the Race Relation Act, which aim to ensure that everybody has equal access to and is offered equal care by health and social care service. Patient’s right to confidentiality under statutory duties is stipulated in the Data Protection Act, Article 8 European Convention of Human Rights, Access to Personal Files Act 1987 and Access to Health Record Acts 1990. The code does require that nurses must disclose information if they believe someone may be at risk of harm in line with the law. As a nurse, respecting autonomy means you must effectively communicate with patients, be truthful, enable patients to make decisions freely, provide appropriate information and accept the patient’s preferences. Legally, patients must be given enough information to make a balanced judgement however we must be aware that if nurses fail to comply with the legal duty of disclosure, they could face a negligence claim. However, under the principle of therapeutic privilege they can legally withhold information that they think will harm the patient Some patients whether children or adults are unable either to make or to communicate their decisions therefore they lack (or have limited) capacity. The Mental Capacity Act 2005 that create and clarifies the common law on consent in England and Wales, affects everyone aged 16 and over, and provides a statutory framework to empower and protect people who may not be able to make some decisions for themselves. The moral justifications for acting without consent are the principles of beneficence (the duty to do good) and non-maleficence (the duty to do no harm). Paternalism is overriding someone’s autonomy because you think it is for their own good. However, it is justifiable if we can demonstrate that the patient is at risk of significant, preventable harm, or the action will probably prevent the harm, or the patient’s capacity for rational reflection is either absent or significantly impaired, or at a later time, it can be assumed that the patient will approve of the decision taken on his/her behalf, or the benefits to the patient of intervention outweigh the risks. Also, we live in a society where demands for accountability and taking responsibility are so commonplace that pinning the blame on someone or something has become almost a fad. The NHS’ culture of blame has developed basically because no one wants to be accountable or responsible for actions or omissions hence there are no longer any accidents or mistakes. Principles of beneficence and non-maleficence underpin the concept of fault – which lies at the heart of negligence law. Beneficence means that you must act in ways that benefit others (i.e. duty to care), and Non-maleficence means that you have a duty not to harm others nor subject them to risk of harm. Every nursing intervention that aims to benefit patients may at the same time also harm them. Sometimes the harm will be unavoidable or even intentional and at other times it can be unintentional and unexpected, therefore it is appropriate to think about the principles of non-maleficence and beneficence together in order to balance harm and benefits against each other. We can resolve this problem responsibility and accountability. These words are sometimes used interchangeably because they do overlap but in actual fact they do not mean the same thing. Being responsible can mean that it is your job or role to deal with something and/or that you have caused something to happen. Accountability on the other hand is about justifying your action or omissions and establishing whether there are good enough reasons for acting in the way you did. Even where the newly qualified nurse delegate tasks to others, such as nursing auxiliaries or care assistants she/he is accountable to the   patients through a duty of care, underpinned by a common-law duty to promote safety and efficiency, and legal responsibility through civil law, the employer as defined by your contract of employment, the profession as stated in the relevant codes of conduct and the public. Conclusion All newly qualified nurses were faced with assumptions from others that they should ‘know everything’. This was also a high expectation they had of themselves. In meeting the NMC standards of proficiency the nurse should have demonstrated the relevant knowledge and skills in order to practise in their relevant specialized fields. However, it is important to recognize that not every nurse knows everything about everything in their field, especially if they are practising in highly specialized fields. What they need is to be able to develop and adapt to changing situations. Therefore, for the nurse it is impossible to know everything, but they should have developed the skills to find out relevant information, reflect on it, and apply this to their practice. In essence they should have learned how to learn. There is a great deal to be learned once qualified, especially related to a nurse’s ‘new’ area of work and a good deal of the development needs to ta ke place ‘on the job’. References: Bach, S. Grant, A., 2009. Communication Interpersonal Skills for Nurses. Exeter: Learning Matters Ltd. Chitty, K. K., 2001. Professional Nursing: concepts challenges. 3rd ed. Pennsylvania: W. B. Saunders Company. Davis, M., 1988. Managing Care – Teaching Nurses Workbook. London: DLC South Bank Polytechnic. Dimond, B., 2008. Legal Aspects of Nursing. 5th ed. Harlow: Pearson Education Limited. Dimond, B., 2009. Legal Aspects of Consent. 2nd ed. London: MA Healthcare Limited. Lancaster, J. Lancaster, W., 1982. The nurse as a change agent. Missouri: The C.V. Mosby Company. Nursing Midwifery Council, 2010. Standards for medicine management. London: Nursing and Midwifery Council. Nursing Midwifery Council, 2010. The Code. London: Nursing and Midwifery Council. Nursing and Midwifery Council (2010). Competencies for entry to the register (Online). Available at standards.nmc-uk.org   (Accessed March 18, 2011). Royal College of Nursing (2006). Patient Group Directions: Guidance and Information for Nurses. Londoon: RCN

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