Exploring The Role Transition Student To Qualified Nurse Nursing Essay

Exploring The Role Transition Student To Qualified Nurse Nursing Essay In this essay the author will explore the role transition from student nurse to qualified member of staff and discuss in brief some roles and responsibilities of the newly qualified nurse (NQN). Focus will be placed on delegation and administration of Patient Group Directions (PGDs) as two responsibilities of the NQN who is both a delegator and a dispenser of medicines. Delegation can be challenging for NQNs as it involves entrusting designated tasks to non-qualified member of staff while still retaining professional accountability. Administration of PGDs will be discussed as well as group protocol arrangements for medicines administration has become over the last few years valuable to nurses, especially those working in settings where immunisation programmes and family planning services are delivered. Roles of the newly qualified nurse Critical discussion (400 words) Contemporary nursing has changed considerably in terms of its roles and responsibilities. A big turnaround came with the change in the European Working Time Directive which reduced drastically the working hours of junior doctors, leading to Registered Nurses (RNs) extending their roles and undertaking tasks traditionally carried out by medical professionals (McKenna et al, 2004; Kessler et al, 2010). In order to meet patient needs and to fill the gaps left by those nurses, Healthcare Assistants (HCAs) were then expected to start extending their skills and assume delivery of care that was previously the domain of registered staff (Kessler et al, 2010, Griffiths and Robinson, 2010). This was a positive step for modernising nursing careers with nurses now working across boundaries and with the creation of new specialist roles (DH, 2006a), but naturally it decreased at the same time engagement in direct patient care (Kessler et al, 2010). Registered nurses (RN) in the United Kingdom are expected to acquire the necessary knowledge and skills to meet Nursing and Midwifery Council (NMC) standards, which aim at guiding and supporting them in the delivery of high quality care. Nurses are expected to delegate, lead and supervise other nurses and healthcare professionals and have therefore to gain and develop analytical, problem-solving and decision-making skills (NMC, 2010) both during their training and throughout their nursing career. Even with development of the RN role If nursings original professional identity is to be uphold, it essential that NQNs enter the profession sensitive to its core values and roles, even while trying to advance practice (Harmer, 2010). Rationale for role choice (200 words) The author chose the role of delegation both Role 1 Delegation (700 words) RN are expected to organise and supervise the work of HCAs and the ability to delegate effectively is central to their success (Curtis and Nicholl, 2004) The NMC Code of Conduct (2008b) stresses that RN must delegate effectively and establish that anyone they delegated to is able to carry out their instructions. In addition it states that nurses must confirm that the outcome of the delegated tasks meet required standards and that anyone they are responsible for, is supervised and supported. The employer is in turn the one responsible for ensuring that HCAs have sufficient training and education to competently undertake the aspects of care which a RN is expected to delegate to them (NMC, 2008a). The NMC fails however to give a reasoned justification as to why the RN is still accountable for the delegated tasks if the employer is the one responsible for confirming competency or if indeed the RN is expected to confirm this her/himself how she/he is expected to effectively gain knowledge of the education, training and qualifications of all HCAs they work with in clinical practice (including bank staff). Both the RCN and the DH have sought in the past further clarification from the NMC as far as delegation and accountability are concerned as the advice provided by the body has been regarded as confusing (Harrison, 2007) HCAs education and training is not mandatory and standardised in terms of content, assessment and accreditation (Griffiths and Robinson, 2010) and therefore there is no default quality assurance on their competencies so caution and uncertainty is to be expected from the RN when delegating work as she/he could see her/his registration put at stake for any error in judgement (Kessler et al, 2010. This is because although the HCA retains responsibility in their actions carrying out the delegated task, the RN is ultimately accountable (NMC, 2004, RCN, 2006a) to their regulatory and professional body. Accountability is a key element of professional practice and it is intimately linked with delegation. RNs are professionally accountable to the NMC for any actions and omissions in their practice and must be able to justify their decisions. Failure to comply with the code may bring their fitness to practice into question and jeopardize their registration (NMC, 2008b). RNs are also accountable to both civil and criminal law, their employer (NMC, 2009, Dimond, 2008) and on a moral dimension, to themselves (Dimond, 2008). If tasks are matched successfully against HCAs skills and knowledge though, delegation can result in improved productivity and efficiency as this makes best use of available human resources. In some cases if the clinical area is particularly understaffed, delegation becomes a necessity, rather than an option. Effective delegation can potentially enable RNs to focus on doing fewer tasks well, rather than many talks inadequately (Curtis and Nicholl, 2004) and can create a more motivated and co-operative team (Eaton, 2009). On the other hand studies suggest that excessive task delegation can lead to feelings of frustration as nurses end up having less contact with patients than they originally hoped for. Accountability issues can also lead to increased levels of stress (Takase et al, 2005). Research has found that in order to comply with the code of conduct nurses can spend large amounts of time inducting, training and supervising HCAs (McKenna et al, 2004) on tasks that HCAs were theoretically undertaking to alleviate nurses workload (Kessler et al, 2010). Demands of supervision can also compromise the time NQN should be devoting to consolidate and develop their clinical skills (Griffiths and Robinson, 2010). Paradoxically, literature suggests that experienced HCAs frequently act as unofficial mentors to NQN and are seen as a significant source of formal and informal knowledge and guidance to less experiences members of staff (Griffiths and Robinson, 2010, Kessler et al, 2010). The process of delegation assumes inevitably a hierarchical command structure (Curtis and Nicholl, 2004) which could easily pose challenges for NQN, whom in real terms are expected to supervise and be accountable for HCAs who may be considerably more experienced. Role 2 PGD (700 words) PGDs provide a legal mechanism to administer and/or supply medicines to patients by a specific range of health care professionals, without the need of consultation with a doctor or a dentist (NPC, 2009). A PGD is written instruction for the supply or administration of a licensed medicine(s) in a specifically identified clinical scenario that is not aimed at a specific patient, but rather at any patient that meets the criteria established on that PGD. The PGD must be written up at a local level by a multidisciplinary team including a doctor, a pharmacist and a representative of any professional group expected to dispense under the PGD. For a PGD to be valid it must be signed by a doctor or a dentist and a senior pharmacist, ideally the ones involved in developing the direction. It must also be authorised by the PCT or NHS trust which will use it (MHRA, 2010a). PGDs can only be administered by registered healthcare professionals such as nurses, midwifes, health visitors, paramedics, radiographers, etc. Each PGD must however, list individually the names of the registered professionals allowed to dispense under the direction. A senior individual in each profession should assume the responsibility to ensure that all designated dispensers in the PGD are fully competent, registered and trained professionals. (DH, 2006b). A PGD can act as a direction to a nurse to supply and/or administer prescription-only medication to patients that meet the criteria, based on the nurses assessment of their needs and without needed to refer to a doctor for an individual prescription (RCN, 2006b) The supply and administration of medicines under a PGD should be reserved for specific circumstances where it is advantageous for patient care, it does not compromise patient safety and is consistent with professional accountability (MHRA, 2010a, NPC, 2009, DH, 2006b), as the nurse must always act within their own expertise and competence (DH, 2006b). PGDs are a convenient way of recognising nurses ability to use medication to the benefit of the patient and any registered professional dispensing medication under the terms of a PGD should act in accordance with the NMC Code of Conduct and the NMC Standards for Medicines Management (RCN, 2006b). The legislation requires that every PGD must contain key information: the place where the PGD will be used (eg. primary or acute care), the date the directive comes into force and the date it expires (it is recommended good practice that PGDs should be reviewed every two years), a description of the medicine to which the PGD applies (both the name and the purpose of the medication should be included, eg. analgesic or oral contraceptive), class of the healthcare professional able to supply/administer the medication (the PGD should clearly state which of the professional groups can use but each individual can only do so if she/he is named individually), the signature of a doctor/dentist and a pharmacist (only approved prescribers as doctors/dentists), signature by a representative of an appropriate health organisation (eg. chief executive of a trust), the clinical condition to which the PGD applies to (a description of the problem a patient must present with in order to receive medicat ion under the directive), a description of patients that are to be excluded from treatment under the PGD (detailed guidance on which circumstances a patient should be excluded and provided with an individual prescription, eg. complex medical condition or a specific medical problem), a description of when further advice should be sought from a doctor/dentist and when to arrange for referrals (a patient might meet the criteria set on the directive but depending on which specifics they present, further advice might still be needed from a medical professional), details of the appropriate dosage, maximum total dosage, quantity, pharmaceutical form and strength, route, frequency of administration, minimum and maximum period over which the medication should be administrated and the legal status of the drug should all be specified (this ensures that the correct medicine is given in the right dose for the appropriate length of time), relevant warnings including potential adverse reactions (a s with any medicines it is essential to be aware of any contra-indications of potential adverse effects), details of any follow-up action and under which circumstances (a patient might need to be seen again in order to detect if the medication had the desired effect) and finally a statement of records to be kept for audit purposes (the directive must specify which records need to be kept, eg. as a minimum full patient details and full information regarding the drugs that has been administrated) (MHRA, 2010a, NPC, 2009, RCN, 2006b) PGDs cannot be used in independent and public sector care homes or independent sector schools that provide healthcare services outside the NHS. (MHRA, 2010b) PGDs can only be used in the NHS and other services funded by the NHS but provided by the private, voluntary or charitable sector. Certain non-NHS organisations such as independent hospitals, agencies and clinics registered under the Care Standards Act 2000, prisons healthcare services and police services, and defence medical services can however use PGDs for the sale, supply and/or administration of medicines (NPC, 2009) NQN registered with the NMC and on the live register are allowed to administer medication under a PGD, providing they are one of the named dispensers on the directive. However, because robust clinical judgement is necessary to assess the patient prior to administration, a more experienced member of the nursing team is likely to be named over a NQN. Both the RCN and NMC offer no specific recommendations for the administration (or not) of medicines under a PGD, by a NQN. There are also no specific national training programmes for PGD, however individual organisations must ensure that any professional administering medication under a PGD is competent to do so (DH, 2006b) Conclusion (300 words) The role of the RN has expanded considerably over the last years. NQN now enter the profession expected to assume roles of leadership, delegation and supervision very shortly afterwards being students nurses and working with alongside and under the protection of their mentors. As soon as they gain their pin number and join the NMC register a whole new raft of expectations is placed upon them. Many NQN however reportedly feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. Delegation is a fundamental skill every RN and NQN must gain and develop in order to be able to manage their workload effectively in clinical practice. Delegating as a NQN can be challenging as often the recipient of the task is a more experienced member of the team, for whom she/he is still yet professionally accountable. Medicines administration is another responsibility of the RN. PGDs have become increasingly impor tant tools for nurses working in clinical settings delivering immunisation, working in travel clinics and family planning services. With many NQN now opting to join community services, PGDs become increasingly relevant to them.

Human Nutrition in the Developing Country of Guyana

Topic:  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Human Nutrition in the Developing Country of Guyana * Introduction * According to the United Nation and the International Monetary Fund, countries are categorized according to their socio-economic position with respect to their Gross Domestic Product (GDP), income per capita, life expectancy and the wellbeing of the natives. These factors are compared to all the countries all over the world. Countries with a low level of material wellbeing are considered developing or underdeveloped. According to the Human Developing Index, approximately 85. % of the world’s population lives in developing countries making this issue of Health and Nutrition in this global community a major and pressing issue. Economically, many of these countries cannot establish stable enough economies due to the history of imperialism and colonization that caused a disruption in the development of these countries. Because of the lack of funds to cultivate the raw materials, t hese countries cannot establish successful and stable systems to produce food to feed their populations or even hospitals to cure many of the diseases and disorders created as a result of malnutrition. For this study, focus will be localized to a village that is located in Guyana, South * America. This is the native country of my parents, and I was fortunate to make several visits to this location, the most recent of which was last summer, so I am familiar with the lifestyle practices of the inhabitants not only from a first hand basis, but also from the inherited practices that were passed down to my family through my parents. * Brief History of Imperialism and Development as a Developing Country Guyana is located on the northern tip of the continent of South America, and the location of this case study is also on the northern tip that referred to as the coastal plain. Guyana recieved its name from the Native Indian tribe called the Amerindians, and it means â€Å"Land of Many wat ers† because of the many rivers and streams that are found in the country. The country is also near to the equator, so it has a tropical climate for most of the year, with only tow seasons, the wet season and the dry season. The former season is usually rainy and occurs between October to May and the latter which is usually dry and hot (temperature ranging from the early 80 degrees to 100 on humid days) from June through September. * Guyana is also below sea level, and like many of the other countries in the region was subjected to colonial expansion, so it changed Imperial governments between the British, Dutch and Spanish for a brief period. The Dutch and English had longer influences, with the English finally securing dominance for the last and longest period in the history of the country. So, due to the many rivers and the fact that that the country is susceptible to flooding, when it was occupied by the Dutch large systems of sluices, dams and sea walls were constructed to prevent excessive flooding, but the rich silt deposits from the river made the coastal plain fertile for agricultural initiatives, so the main produce from Guyana have always been sugar from the cane plants and rice. * The System of Self Sufficiency in Union Village, Guyana, SA: Introduction * Since Union Village is located on the coastal plain of the Corentyne River, the land is also fertile and it is one of the many farming communities along that plain. Some of the villagers have become wealthy rice farmers as they own large plots of rice lands, but the majority of people are self sufficient by planting kitchen gardens to supplement the staple ric e diet with ground provisions, fruits and vegetables. Those villagers also rear livestock of chickens, ducks, turkeys, pigs, sheep, goats and cows. Some of the rice farmers also rear fish farms. They use the waste from the rice covering/ shell to feed the fish, and their livestock. The milk comes from the cows and goats; eggs come from the chicken and ducks and meat come from all livestock and fish. Since fish is in most abundance and is therefore the cheapest, fish is usually the protein of choice for the diet. * The System of Self Sufficiency in Union Village, Guyana, SA: Environmental Perspective * Environmentally, the living habits of these villagers generate positive carbon footprint because of their waste management and recycling habits, long before the awareness was created at the international level. They were engaged in those activities out of necessity, but it paid off very well for the community and ensured sustainability for them. By planting seasonal crops, they learned to rotate the crops they plant and maintain the fertility of the soil by natural eco-balancing. They also use even the waste produced by the cows, especially as fertilizer, so helped by the rain and sunshine, the land stays lush and green. The dogs eat leftovers from the family meals, so they do not incur additional expenditure of having to buy separate dog food and the livestock eat the waste products of the plants such as the rice and corn. Because a majority of the food in Guyana is produced locally and sold in large market places their carbon footprint is significantly lower than a majority of other countries that rely on outside imports of food. Limiting the importation of food and exportation of goods decreases carbon emissions in transportation like large jets, freight planes and other large automobile s that emit pollution in the air. However, during the 21st century Guyana has begun to follow the growing trend of increasing its involvement in the global community through the exportation of minerals like Gold and Bauxite. In addition to the few food products that Guyana is historically known for since imperialism: sugar and raw materials. * Because Guyana is increasing its involvement in the global community exports as well as few imports have increased due to sanctions from the International Monetary Fund’s involvement in the project of developing small countries like Guyana industrially and economically. As shown in the graphs below, Guyana’s carbon emissions have increased significantly since the 1950’s especially at the turn of the 21st century when the United Nations introduced their initiatives to better developing countries. * Graph 1a. (http://rainforests. mongabay. com/carbon-emissions/guyana. html) * * Graph 1b. (http://rainforests. mongabay. com/carbon-emissions/guyana. html) * * The System of Self Sufficiency in Union Village, Guyana, SA: Socio-Economic * As a result, from the socio-economic perspective, based on their life styles, the villagers eating habits may not b e sufficient enough to ensure proper nutrition because their foods are not imported they have to rely on the fickle patterns of nature in order to yield a good harvest and raise healthy livestock. Guyana’s weather correlates with their socio-economic standing and the problem of malnutrition. * With many floods, monsoon type weather and the rainforest atmosphere, villagers rely heavily on the weather that develops a particularly unbalanced eating regiment. From a social perspective, meats like chicken, cows and other animals are only cooked on special holidays and large festivals while on a regular basis, rice is the main staple for many impoverished families. From rice and pepper to shine rice (rice and butter), these dishes will not suffice nutritionally. In most cases however, village people consume a lot of fresh fruit on a daily basis from their personal yards. While these foods are healthy, fresh and organic, with no addition of chemicals, artificial fertilizers or pesticides, the foods are eaten leisurely and not measured daily to ensure a balanced and accurate amount of nutrition. With the lack of education on how to properly balance their diets with vegetables, proteins and even fruits, they eat leisurely and do not fairly balance their diets per day. While many industrialized and developed countries hold health classes that teach children from a young age to balance a fruit a day and a proper portion control. In actuality, although the foods in Guyana are fresher, the genetically altered or artificial products that are produced by developed countries guarantee a higher yield of foods to be distributed along with added vitamins and proteins that still ensure a sufficient amount of nutrition. Despite these set backs in education on diets, Guyana still produces a variety of foods that can suffice in feeding the people to ensure healthy nutrition (See Graph 3 Below). * Graph 3. (ftp://ftp. fao. org/es/esn/nutrition/ncp/guymap. pdf) * Also, owing to the location from the centralized city, they do not have quick access to quality medical facilities as the nearest medical center is approximately 25 miles from the village and the hospital is almost 40 miles away. As a result, they have non-traditional attitudes towards conventional medic al practices such as screenings, for example, which are considered as routine and expected from an international stand-point. In addition, socially, since they are semi-rural, some of them do have access to technology and amenities such as electricity, radios and even a sprinkling of television, but that is not widespread. Therefore, Internet and computer access or in many cases, even access to a telephone is not widespread. This is a blessing in disguise because economically it saves both the people and the government money and most of all saves the environment from utilization of so much electricity. Even for cooking, they use outdoor brick ovens that are fuelled by dry brushes and wood or coal collected from forest fore remnants. Resulting Issues from the Environmental and Socio-economic Factors * As aforementioned in the introduction of the topic, countries are still categorized according to their socio-economic position with respect to their Gross Domestic Product (GDP), income per capita, life expectancy and the wellbeing of the natives. These factors are compared to all the countries all over the world. The wealth of countries are categorized according to their abilities to export and their level of industrialization. * According to the Human Developing Index, approximately 85. % of the world’s population lives in developing countries making this issue of Health and Nutrition in this global community a major and pressing issue. Economically, many of these countries are not capable of establishing stable enough economies due to the history of imperialism and colonization that contributed to their dependency on foreign aid as well as their economic destabilization. Due to the absence of capital to process the raw materials such as bauxite, in the case of Guyana to produce aluminum, dependency is on ALCAN in Canada and Reynolds in the USA to purchase that raw material. The same case is with the excess rice and sugar produced, so the local economic system is incapable of sustaining quality hospitals and health care services that could address disease prevention and cure and even some kinds of malnutrition. * When examined environmentally, in an article in the Health and Wellness Magazine discussing underdeveloped countries, Dr. Majid Ezzati from Harvard School of Public Health points to the lack of clean water and sanitation as the major problem causing the malnutrition. Potable water is a problem in many of the Guyanese communities, as many people still cannot afford indoor plumbing. Furthermore in an article from the Royal Society of Medicine Press on Experimental Biology and Medicine the article deals with the problem of nutrition and infectious disease in these developing countries and the acquired immunodeficiency syndrome. The institute states, â€Å"Infectious diseases are the major causes of death and morbidity in underdeveloped countries, particularly in children† which is caused by malnutrition. * One major effect of malnutrition is an increase in child mortality rate. As seen in the graph below * One Step forward in Industrialization, Two Steps back in Sustainability * Because of the new push towards development, many supermarkets and grocery stores are replacing the marketplace and the tiny food shops in Guyana. As shown in the chart below Guyana’s carbon emissions have increased significantly since the 1950’s. This increase is largely due to the development of supermarkets and the importation of processed goods from United States companies that have specific relations with the Guyanese government. In order to ensure that Guyana returns to its more sustainable systems, the country should create better programs to educate its people on eating well balanced meals to avoid malnutrition with respect to the three major forms of malnutrition in Guyana as recorded by the Food and Agriculture Organization are Protein-energy malnutrition (PEM), anemia, and overweight/obesity are the most common nutrition-related disorders. As seen in Graph 4, Guyana produces a large amount of varying foods and products that can adequately resolve its problems of malnutrition. YEAR| Carbon emissions| Per capita emissions| 1950| 71| 0. 17| 1951| 78| 0. 18| 1952| 92| 0. 21| 1953| 123| 0. 27| 1954| 129| 0. 27| 1955| 141| 0. 29| 1956| 150| 0. 3| 1957| 146| 0. 28| 1958| 125| 0. 23| 1959| 151| 0. 27| 1960| 180| 0. 32| 1961| 201| 0. 34| 1962| 185| 0. 31| 1963| 168| 0. 27| 1964| 177| 0. 28| 1965| 294| 0. 46| 1966| 322| 0. 49| 1967| 361| 0. 54| 1968| 363| 0. 53| 1969| 373| 0. 53| 1970| 431| 0. 61| 1971| 409| 0. 57| 1972| 426| 0. 59| 1973| 492| 0. 68| 1974| 424| 0. 58| 1975| 498| 0. 68| 1976| 478| 0. 65| 1977| 518| 0. 7| 978| 561| 0. 75| 1979| 415| 0. 55| 1980| 488| 0. 64| 1981| 491| 0. 65| 1982| 383| 0. 51| 1983| 340| 0. 45| 1984| 383| 0. 51| 1985| 387| 0. 51| 1986| 285| 0. 38| 1987| 357| 0. 48| 1988| 383| 0. 52| 1989| 326| 0. 44| 1990| 311| 0. 42| 1991| 306| 0. 42| 1992| 287| 0. 4| 1993| 288| 0. 39| 1994| 364| 0. 49| 1995| 404| 0. 53| 1996| 417| 0. 54| 1997| 437| 0. 56| 1998| 451| 0. 58| 1999| 450| 0. 58| 2000| 431| 0. 58| 2001| 414| 0. 56| 2002| 422| 0. 56| 2003| 409| 0. 54| 2004| 394| 0. 52| 2005| 407| 0. 54| * Table 1. (http://rainforests. mongabay. om/carbon-emissions/guyana. html) * * * * * * * * * * * * * * * Graph 4. (ftp://ftp. fao. org/es/esn/nutrition/ncp/guymap. pdf) * * * * * * * * * References: * Colchester. Marcus. (1997). Guyana, fragile frontier : loggers, miners and forest peoples. Kingston, [Jamaica] : Ian Randle Publishers ; New York, NY : Distribution in North America by Monthly Review Press * Currie-McGhee. (c2009). Leanne Protecting ecosystems. Ann Arbor : Cherry Lake Pub. * Grant, Nancy S. (2008) The pocket idiot's guide to your carbon footprint. New York, NY : Alpha Books. U. S. G. P. O. (1990-[2002]. Country reports on economic policy and trade practices : report submitted to the Committee on Foreign Relations, Committee on Finance of the U. S. Senate and the Committee on Foreign Affairs, Committee on Ways and Means of the U. S. House of Representatives by the Department of State in accordance with section 2202 of the Onmibus Trade and Competitiveness Act of 1988. Washington : U. S. G. P. O. , Congressional Printing Office http://rainforests. mongabay. com/carbon-emissions/guyana. html

What Makes Catawba College - 943 Words

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Prince Of A Town Called Bel Air - 946 Words

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John Chaffee s Philosophy Textbook - 1203 Words

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Technology Has Changed the Live of Teen Agers Free Essays

string(101) " subjects had dinner before drinking and only one subject did not consume any food before going out\." DOI: 10. 1111/j. 1464-5491. We will write a custom essay sample on Technology Has Changed the Live of Teen Agers or any similar topic only for you Order Now 2006. 01868. x Glycaemic control Review Article 23 0742-3071Publishing, alcohol Diabetic Medicine and2006 consumption D. Ismail et al. DME UK Oxford, article Blackwell Publishing Ltd Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia D. Ismail, R. Gebert, P. J. Vuillermin, L. Fraser*, C. M. McDonnell, S. M. Donath†  and F. J. Cameron Abstract Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, *Wimmera Base Hospital*, Horsham and † Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Melbourne, Australia Accepted 10 June 2005 Aims To determine the effects of social consumption of alcohol by diabetic adolescents on glycaemic control. Methods Fourteen (five male) patients aged 16 years were recruited from the diabetes clinic at the Royal Children’s Hospital. The continuous glucose monitoring system (CGMS) was attached at a weekend when alcohol consumption was planned for one night only. For each patient, the 12-h period from 18. 00 h to 06. 00 h for the night with alcohol consumption (study period) was compared with the same period with non-alcohol consumption (control period) either 24 h before or after the alcohol study night. Thus, each subject was his /her own control. Glycaemic outcomes calculated from continuous glucose monitoring included mean blood glucose (MBG), percentage of time spent at low glucose levels (CGMS 4. 0 mmol/l), normal glucose levels (CGMS 4. 0–10. 0 mmol/ l) and high glucose levels ( 10. mmol/ l) and continuous overall net glycaemic action (CONGA). Results The mean number of standard alcohol drinks consumed during the study period was 9. 0 for males and 6. 3 for females. There was no difference in percentage of time at high and normal glucose levels in the study and control periods. During the control period, there was a higher percentage of time with low glucose levels compared with the study period (P 0. 05). There was an increas ed level of glycaemic variation during the study time when compared with the control period. Conclusions In an uncontrolled, social context, moderately heavy alcohol consumption by adolescents with Type 1 diabetes appears to be associated with increased glycaemic variation, but not with low glucose levels. Diabet. Med. 23, 830–833 (2006) Keywords adolescence, alcohol, glycaemic control Abbreviations CGMS, continuous glucose monitoring system; CONGA, continuous overall net glycaemic action; MBG, mean blood glucose; RCH, Royal Children’s Hospital Introduction Adolescents with Type 1 diabetes frequently engage in risk-taking activities [1]. Amongst these activities is the social Correspondence to: Dr Fergus Cameron, Deputy Director, Department of Endocrinology and Diabetes, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail: fergus. cameron@rch. org. au consumption of alcohol, frequently as underage drinkers [2]. Whilst the effects of alcohol consumption upon glycaemia have been well described in a controlled setting [3– 6], little is known about the impact on glucose levels of alcohol consumption by adolescents within an ambulant, social context. The purpose of this project was to utilize continuous glucose monitoring to study the impact of social alcohol consumption on glycaemic control in a group of alcohol-using adolescents.  © 2006 The Authors. 830 Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 831 Patients and methods This study was approved by the Human Ethics Research Committee of the Royal Children’s Hospital (RCH). That approval was contingent upon the fact that the investigators should not be seen to encourage underage drinking in adolescents. Consequently, we only approached adolescents who we knew were drinking socially and, despite our previous counselling, elected to continue to drink alcohol on a semi-regular basis. We recruited 22 adolescents with Type 1 diabetes from the RCH diabetes clinic. The adolescents were considered eligible only if 16 years old and parental/patient consent was obtained. HbA 1c (Bayer DCA 2000 immunoagglutination method, Calabria, Barcelona, Spain) was measured, and diabetes duration and insulin doses were recorded. The MiniMed continuous glucose monitoring system (CGMS) was attached to the study patients over a weekend period. Patients were required to have an alcohol-free period for at least 24 continuous hours during the weekend trace period. A diary was kept of activities during the trace period (insulin injections, meal, snacks, dancing, alcohol consumption, sport). There was no change in insulin doses between study and control periods. In the evening when alcohol was consumed, patients were asked to recall how many and what type of drinks were consumed and how inebriated they became. Patients recall of alcohol consumption was converted to ‘standard drinks’ (one standard drink contains the equivalent of 12. ml 100% alcohol) using The Australian Alcohol Guidelines [7]. CGMS data was recorded between 18. 00 and 06. 00 h on the evening when alcohol was consumed (the study period) and between 18. 00 and 06. 00 h on the evening when no alcohol was consumed (the control period). CGMS data were only analysed if there had been regular calibrations with intermittent capillary blood glucose readings at a maximum of 8-h intervals. Each CGMS trace was qualitatively and quantitatively analysed using mean glucose values, per cent time in glycaemic ranges and ontinuous overlapping net glycaemic action (CONGA) [8]. CONGA values were calculated to assess glycaemic variation over 1-, 2- and 4-h intervals. Low glucose values were defined as CGMS values 4 mmol/ l, normal glucose values when CGMS values were 4– 10 mmo/ l and high glucose values when CGMS values were 10 mmol/ l. Each patient acted as their own control with study periods and control periods being compared. Inter-individual values were grouped for comparison. Differences between study and control periods were analysed using paired t-tests. Analyses were done in Stata [9]. ales and nine females. The mean age was 18. 5 years (range: 17. 4 – 19. 5). The mean duration of diabetes was 9. 4 years (range: 3 – 16. 3). Six of our subjects took four insulin injections per day and eight took two injections daily . The mean insulin dose was 1. 1 units /kg/day (range: 0. 7 –1. 8), and the mean HbA1c was 9. 6% (range: 8. 2 – 10. 8). Activities during the study period Thirteen subjects had dinner before drinking and only one subject did not consume any food before going out. You read "Technology Has Changed the Live of Teen Agers" in category "Papers" Three subjects ‘danced a lot’ and six subjects went dancing but did not dance a lot. Ten subjects had something to eat after drinking. Alcohol consumption during the study period The mean number of alcohol drinks consumed on the study night was 9. 0 (range 3–16) for males and 6. 3 (range 3–14) for females. All the females consumed pre-mixed sweetened alcohol drinks (5% alcohol), with only one consuming beer and one consuming wine. Four of the males consumed mixed spirits, one mixed spirits and beer and one beer only. Forty per cent of the males had more than seven standard drinks during the study and 67% of the females had more than five drinks. In total, 80% of the subjects had pre-mixed sweetened alcohol drinks at some point during the study period. Forty-three per cent of the subjects reported that they became inebriated and 14. 3% consumed alcohol to the point where they became physically sick. None of the subjects lost consciousness or took recreational drugs during the study period. Comparative CGMS data between study and control periods Results Patients There was no significant difference between the overall mean glucose levels of patients when comparing study and control periods (Table 1; P = 0. 43). Similarly, there were no significant differences in the amount of time spent with either normal or high glucose values between study and control periods (Table 1). A larger proportion of time was spent with low glucose values during the control period when compared with the study period (1. 9 vs. 16. 8%, P = 0. 03). A significantly larger degree of glycaemic variation was seen in the CONGA values in the study period when compared with the control period (Table 1). The difference in CONGA values were consistent and independent of whether glycaemic variation was assessed over 1-, 2- or 4-h intervals. Of the 22 subjects recruited, eight were excluded because their CGMS traces did not have sufficiently frequent calibration points with intermittent capillary measures of blood glucose. Of the 14 subjects remaining, we were able to obtain study period data on 14 patients and matched control period data on only 12 patients. The study period occurred on the night prior to the control period in nine subjects. There were five Discussion It has long been recognized that a prohibitionist approach is usually ineffective when counselling adolescents who engage in risk-taking behaviours [10]. Many centres today, ourselves included, have instead adopted a harm minimization approach in dealing with such behaviours. An important component  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 832 Glycaemic control and alcohol consumption †¢ D. Ismail et al. Outcome measure Mean difference between Study period Control period study period and mean value mean value control period (95%CI) P-value 10. 6 16. 8 58. 6 24. 6 2. 1 3. 2 3. 7 1. 2 (? 2. 1, 4. 4) ? 14. 9 (? 28. 1, ? 1. 8) ? 0. 8 (? 27. 3, 25. 8) 15. 7 (? 4. 5, 35. 8) 0. 6 (0. 2, 1. 0) 1. 1 (0. , 1. 9) 1. 8 (0. 4, 3. 1) 0. 43 0. 03 0. 95 0. 12 0. 006 0. 01 0. 01 Table 1 CGMS outcomes, study and control periods Blood glucose levels (mmol/l) 11. 8 Per cent time low glucose 1. 9 Per cent time high glucose 57. 8 Per cent time normal glucose 40. 3 CONGA1* 2. 7 CONGA2* 4. 3 CONGA4* 5. 5 *CONGA calculated at 1-, 2- and 4-h intervals. CONGAn is the standard deviation of differ ent glucose measures n hours apart for the duration of the CGMS trace. of counselling using a harm minimization approach is that the information provided be credible and reflective of ‘real’ or ‘lived’ circumstances. Continuous glucose monitoring provides a technique whereby the glycaemic consequences of various behaviours can be documented in an ambulant or non-artificial setting. Adolescents with Type 1 diabetes frequently consume alcohol in a social context [11]. Alcohol is known to inhibit the gluconeogenic pathway, to inhibit lipolysis, impair glucose counter-regulation and blunt hypoglycaemia awareness [3,4]. Previous studies in young adults with Type 1 diabetes have shown that moderate consumption of alcohol in the evenings without concomitant food intake may cause hypoglycaemia the following morning [5]. Consumption of alcohol after a meal, however, has shown no similar adverse effects on glucose [6]. It is reasonable to assume, therefore, that alcohol consumption may be a significant risk factor for hypoglycaemia in adolescents with Type 1 diabetes [5]. Studies of the glycaemic effects of alcohol consumption in an ambulant adolescent/young adult population can be difficult. This is because such behaviours are uncontrolled, often spontaneous and usually in the context of other social activities (parties, dancing, etc. ). In order to ensure that we only reported accurate CGMS data during these activities, capillary blood glucose calibration was considered vital and those patients who failed in this regard were excluded from analysis. Just over 60% of the patients recruited were able to successfully wear and calibrate a CGMS unit during these activities. Given that patients who experience hypoglycaemic symptoms are more likely to perform capillary self measures of blood glucose, we feel that it is unlikely that those patients excluded from the analysis had a greater frequency of hypoglycaemia than those patients reported. We were unable to record our subjects’ alcohol consumption in a contemporaneous fashion and hence were reliant upon their recall. It is possible that their remembered patterns of consumption were not entirely accurate. This potential inaccuracy should not be seen as a weakness of this study, as we only set out to determine patterns of glycaemia in adolescents engaging in spontaneous and uncontrolled alcohol consumption. We neither specified the type nor the amount of alcohol to be consumed (our ethical approval was contingent on this not occurring). The data as to amount of alcohol consumed have been included for descriptive purposes only. The results of this study show that alcohol consumption by adolescents in a social context is associated with a greater degree of glycaemic variation and less time spent with low glucose values than evenings where no alcohol is consumed. Whilst the second of these findings appears counter-intuitive, there may be several possible explanations. Firstly, the vast majority of our study group ate a meal prior to going out and ate upon their return before going to bed. These are practices that we have instilled as harm minimization strategies to avoid alcohol-induced hypoglycaemia in our clinic. Secondly, most of the alcohol consumed was as pre-mixed spirit and sweetened, carbonated beverages. Finally, alcohol consumption was only associated with vigorous exercise (dancing) in a minority of our study group. All of these factors could have combined to negate the hypoglycaemic effects of alcohol. In a previous study of glycaemia during alcohol consumption in adult men [5], hypoglycaemia occurred most often 10–12 h after wine consumption when the evening before ended at 23. 0 h. We analysed our data to see if a similar phenomenon occurred in this study and found that the per cent of time spent with CGMS readings 4 mmol/l between 06. 00 and 12. 00 h on the morning after the study period (i. e. the morning after the drinking night) was only 1. 1%. Notwithstanding the fact that our cohort frequently consumed alcohol later than 23. 00 h, the facto rs that impacted upon glycaemic control during the study night appear to have carried over to the ‘morning after’. The findings in this study highlight the importance of ambulant testing. It is important to note that the findings of the group studied here may not be seen in adolescents who drink non-sweetened alcoholic drinks or in those adolescents with better underlying metabolic control. Whilst alcohol consumption in isolation may reasonably be thought to cause hypoglycaemia, alcohol consumption by adolescents in the context of meals, sweetened mixers and little activity did not result in more hypoglycaemia than an alcohol-free evening. Whether the increase in glycaemic variation seen on an evening  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 833 of alcohol consumption has negative clinical outcomes remains an area for further investigation. Competing interests CMM was a Novo Nordisk research fellow. FJC received fees for speaking at conferences and funds for research from Novo Nordisk. References 1 Cameron F, Werther G. Adolescents with diabetes mellitus. In: Menon, RK, Sperling, MA, eds. Pediatric Diabetes. Boston: Kluwer Academic Publishers, 2003: 319–335. 2 Frey MA, Guthrie B, Lovelandcherry C, Park PS, Foster CM. Risky behaviours and risk in adolescents with IDDM. J Adol Health 1997; 20: 38–45. 3 Avogaro A, Beltramello P, Gnudi L, Maran A, Valerio A, Miola M et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycaemia in IDDM patients. Diabetes 1993; 42: 1626–1634. 4 Kerr D, Macdonald IA, Heller SR, Tattersal RB. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 diabetes. Diabetologia 1990; 33: 216–221. 5 Turner BC, Jenkins E, Kerr D, Sherwin RS, Cavan DA. The effect of evening alcohol consumption on next morning glucose control in type 1 diabetes. Diabetes Care 2001; 24: 1888–1893. 6 Koivisto VA, Tulokas S, Toivonen M, Haapa E, Pelkonen R. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16: 1612–1614. 7 National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. DS9. Available from: http://www7. health. gov. au/nhmrc/publications/synopses/ds9syn. htm. 8 McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilising glycaemic variation. Diab Tech Therap 2005; 7: 253–263. 9 StataCorp. Stata statistical software. Release 8. 0. College Station, TX: Stata Corporation, 2003. 10 Kyngas H, Hentinen M, Barlow JH. Adolescents perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care? J Adv Nurs 1998; 27: 760–769. 11 Patterson JM, Garwick AW. Coping with chronic illness. In: Werther, GA, Court, JM, eds. Diabetes and the Adolescent. Melbourne: Miranova Publishers 1998, 3–34.  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 How to cite Technology Has Changed the Live of Teen Agers, Essays

Wordsworths Memories by Derek Furr free essay sample

As you read the essay, write down answers to the numbered analysis questions that accompany it. You can find the poem beginning on page 552 of your Holt Literature and Language Arts textbook. from Poetry for Students Memory: William Wordsworth and â€Å"Tintern Abbey† by Derek Furr I magine yourself five years from now. You’ve 1. How does the writer received an invitation to your high school reunion attempt to engage and, feeling a little anxious and nostalgic, you arrive audience interest? Who early to walk around your old stomping grounds. You do you think his wander into the empty gym, where you played your intended audience is? first varsity ball game; you sit in the back of your old chemistry class, staring at the board that once held puzzling equations; you stroll through a courtyard where you held the hand of someone you thought you couldn’t live without. Slowly you recollect how you felt as a teenager, how you saw the world around you—who was important, what made a difference. Doubtless you’ll carry both fond and troubling memories of high school, and when you return, both will re-surface at the sites where they originated. But when five years have passed, the emotions of your teen years may prove difficult to recover. Revisiting your past, you may be surprised not so much by From â€Å"Tintern Abbey† by Derek Furr from Poetry for Students, edited by Marie Rose Napierkowski and Mary K. Ruby. Copyright  © 1997 by The Gale Group. Reprinted by permission of the publisher. 1 Copyright © by Holt, Rinehart and Winston. All rights reserved. the changes in your old school—the gym will be in the same spot, the cafeteria will serve the same mysterious foods. Rather, as you recall your former self, walking through that courtyard, holding that hand, you may be struck—with melancholy and wonder—by how much you have changed. William Wordsworth returned to the Wye valley in 2. What background July 1798, five years after he had first toured the region information does the with his sister, Dorothy. As he looks at the valley, writer provide? hrough the lens of memory, he sees himself—both as Why do you think this he once was, and as he is now. With his â€Å"Lines,† information is important Wordsworth attempts to make sense of the changes he to understanding the has undergone, and, in the process, he offers some poem? interesting insights into the machinery of memory and the Romantic lyric. The specific setting of Wordsworth’s poem is clearly important to him. Indeed, in the very title of his poem, he announces the time and place of his return visit, and lets us know where he is positioned in the landscape that he describes. He sits in a specific spot, a â€Å"few miles above† an abandoned abbey in the valley of the river Wye; thus he has a broad perspective on the landscape he will describe. As he composes the poem (or so he claims), he is reclined â€Å"under [a] dark sycamore. † It is mid-July, the day before Bastille Day,1 and three times in the space of two lines Wordsworth asserts that â€Å"five years have past† since he last visited. Those were five tumultuous 2 years in European history and in Wordsworth’s life, and it is as though he has longed to return to this spot above Tintern Abbey. He is nostalgic, in a contemplative,3 reflective mood. Like the many topographical or landscape poems that preceded â€Å"Tintern Abbey† in the 18th century, Wordsworth’s poem goes on to describe the scene in detail, appealing to our eyes and ears—the sound of â€Å"rolling† waters, the sublime 4 impressiveness of â€Å"steep and lofty cliffs,† and so forth. But note how often Wordsworth repeats the first person pronoun, â€Å"I†Ã¢â‚¬â€ â€Å"I hear/These waters,† â€Å"I behold,† â€Å"repose,† â€Å"view,† and â€Å"see. † Wordsworth’s 3. How does the writer description emphasizes his personal engagement or explain Wordsworths 1. Bastille (bas†¢tel’) Day: commemoration of the 1789 siege and destruction of the Bastille, a Paris prison, during the French Revolution. 2. tumultuous: turbulent; uneasy. 3. contemplative: thoughtful. 4. sublime: awe-inspiring. repetition of the pronoun â€Å"I†? 2 Copyright © by Holt, Rinehart and Winston. All rights reserved. involvement with the landscape; he is concerned with how the vista 5 affects him. Likewise, we should be concerned with how his point of view affects the vista. Critics have often noted—see, for example, Marjorie Levinson’s Wordsworth’s Great Period Poems—that Wordsworth does not depict the Abbey and the valley as it really appeared in 1798. The abbey was ruined and overgrown, and the valley had been scarred by the industrial revolution. To some extent, Wordsworth sees what he wants to see—an idyllic 6 landscape. Looking down on the valley through the lens of memory, much as you might look back on your old school five years from now, he sees a mixture of the present and the past. With stanza two, it becomes clear that â€Å"Tintern 4. What key point does Abbey† is not so much about the landscape of the Wye the writer address in valley in 1798 as it is about the landscape of memory— this paragraph? Wordsworth’s memory. And that landscape is natural and harmonious. During his five years’ absence from the valley, Wordsworth suggests, the tranquil environs of Tintern Abbey have been constantly present with him, in the â€Å"beauteous forms† stored in his memory. Notice the contrasts that Wordsworth establishes between civilization and nature, the â€Å"din/Of towns and cities† and the â€Å"murmur† of the Wye river, the â€Å"fretful stir† and â€Å"fever of the world† and the peaceful meandering of the â€Å"sylvan7 Wye! † When Wordsworth has been troubled with the ways of the â€Å"unintelligible world,† he asserts, remembering nature has not only brought him peace but has also given him insight â€Å"into the life of things. † Through an act of memory—specifically, through reflecting upon natural scenes—Wordsworth discovers a spirit that connects all life. Just as Wordsworth has returned often to the Wye in memory, so he would recur frequently to this theme in his early and middle-period poetry. â€Å"Tintern Abbey† purports8 to record a moment of revelation, when Wordsworth suddenly realized that nature and acts of memory had given him insight into the life of things. But fond memories alone do not lead him to this discovery. Think again about returning to your high school, several years from now. Your school fight song probably won’t stir you like it once did. You’ll probably be more 5. 6. 7. 8. vista: view or scene. idyllic (i†¢dil’ik): pleasant; simple. sylvan (sil’v? ): associated with the forest. purports: claims. 3 Copyright © by Holt, Rinehart and Winston. All rights reserved. responsible, but also have more responsibilities. Wordsworth waxes9 melancholy as he recalls how enthusiastic and engaged he was with nature on his previous visit to the Wye. Again he sets up a contrast, here between the pure emotion of youth and the rarefied contemplativeness of adulthood. In lines 76 and following, he mourns the loss of that passionate attachment to nature. However, as a â€Å"thoughtless youth,† he maintains, he could not have seen into the â€Å"life of things,† for such a discovery requires thoughtfulness, reflection. Perhaps the most important passage in â€Å"Tintern Abbey† occurs at the moment that Wordsworth makes his discovery: â€Å"For I have learned/To look on nature, not as in the hour/Of thoughtless youth; but hearing oftentimes/The still, sad music of humanity,/Nor harsh nor grating, though of ample power/To chasten and subdue. † Wordsworth has lost his youth, has seen 5. How does the writer five more years pass, has felt the sorrows of others and explain the complex ideas the â€Å"fretful stir† of the world. But becoming acquainted expressed in the with sorrow and loss has given him the power to quotation? ympathize with others and with nature. Note how What literary elements deliberately the lines are set forth, with measured does he point out? phrasing and frequent pauses, and how the â€Å"music† is carefully qualified. These are â€Å"thoughtful† lines, and the spirit that Wordsworth has discovered â€Å"impels/All thinking things. † Up to this point in â€Å"Tintern Abbey,† we have watched Wordsworth move from nostalgia for a lost perspective on nature to joy in a new one. Uttered in the present tense, at a specific time and place, â€Å"Tintern Abbey† appears to record Wordsworth’s discovery â€Å"as it happens. Robert Langbaum has called such poems a â€Å"poetry of experience†; in the Romantic period lyric, Langbaum maintains, the poet always makes a discovery over the course of writing the poem and engaging with his/her subject. As readers of the poem, we too experience this discovery. In â€Å"Tintern Abbey,† there is actually a character who represents us—Wordsworth’s younger sister, Dorothy, who is the â€Å"Friend† addressed in the final stanza of the poem. Dorothy’s significance in William Wordsworth’s li fe and writing cannot be overstated. Their affection for each other was powerful; many have argued that Wordsworth’s â€Å"Lucy† poems10 are actually about his sister. Often she plays the 9. waxes: grows; becomes. 10. Lucy poems: a series of poems written by Wordsworth in 1799, which discuss themes of love and loss. 4 Copyright © by Holt, Rinehart and Winston. All rights reserved. classical role of muse in his verse. And many of his poems, most famously â€Å"Resolution and Independence,† are lyrical renderings of Dorothy’s journal entries about experiences she and William shared. In the final stanza of â€Å"Tintern Abbey,† we learn that Dorothy is with William (at least in spirit) as he speaks this poem, just as we have been. He sees his former self in Dorothy: â€Å"in thy voice I catch/The language of my former heart, and read/My former pleasures in the shooting lights/Of thy wild eyes. † Therefore, he advises her to take his discovery to heart, and in lines that echo a spiritual benediction,11 instructs her to have faith that nature will always provide solace in hard times and fresh insight into the meaning of life. Curiously, however, the tone of this final stanza shifts 6. What change in tone from confidence to anxiousness. Wordsworth’s advice does the writer identify? that Dorothy not forget â€Å"Nature† shifts to a plea that What evidence does he Dorothy (and perhaps we the readers) not forget him. supply to show this Note the interplay of â€Å"remember† and â€Å"forget† in the change? final lines of Wordsworth’s address. Again, memory is an essential concern of â€Å"Tintern Abbey. † How we remember the past was a subject of the early stanzas; why we remember it is a question raised by Wordsworth’s desperate plea â€Å"Nor wilt thou then forget. An important reader of Wordsworth, Paul DeMan, has suggested that in the passing of his youthful frivolity12 and in the â€Å"still, sad music of humanity,† Wordsworth has recognized his own mortality. Perhaps the impetus13 behind Wordsworth’s final address to Dorothy and to us, therefore, is his desire for a kind of immortality. Just as he would carry the â€Å"beauteous forms† of the Wye valley with him always and draw on them for comfort, so he would want Dorothy and us to carry his lines in our hearts and minds. How we remember Wordsworth now differs from how Dorothy and her contemporaries saw him in 1798, and 7. What closing thought how we will think of him five years from now will does the writer leave his surely differ from how we hold him at present. But readers with? â€Å"Tintern Abbey† has certainly given Wordsworth a kind Evaluate whether this is of immortality, for neither he nor this poem has yet an effective conclusion. passed from our culture’s memory.