Influencial Person during the American Revolution Essay

Influencial Person during the American Revolution - Essay ExampleHe was born in Thetford, England, to a corset-maker father and a religious mother, both of whom were Quakers1. He enrolled in school, attending regularly until almost the age of thirteen, when he was forced to drop out and learn his fathers trade. Deciding that he disliked being a corset-maker, he tried a number of other trades, including teacher, grocer, and excise tax collector2. While he worked his ruff at these occupations, Paine really had no desire to make these occupations his for the rest of his life, and therefore fared badly in all of them. Paine came to the colonies in 1774, settling in Philadelphia after merging with gum benjamin Franklin in London. Franklin wrote what was known at the time as letters of introduction for Paine, and Paine left for the colonies to begin a new life3. Less than two historic period later, Paine found himself embroiled in the American Revolution. Many Americans believed, at fi rst, that the fight with the British was non about license or gaining any sort of freedom, besides rather to plead with the King for a redress of grievances4. In 1775, when the revolution had progressed as far as the Battles of Lexington and Bunker Hill, four of the Founding Fathers, including John Adams, Benjamin Rush, Benjamin Franklin, and George Washington, met to review dispatches, during which time Paine entered the room5. After being introduced by Franklin, Paine states aboveboard, These States of America must be independent of England. That is the only solution to this question6 though most of the men felt that this was, in essence, a shocking statement, they all sort outd that Paine was right, and that independence must be achieved if they were to live freely from England7. Paine proceeded, not dogged after, to write the pamphlet that would energize the American people, entitled Common Sense. In this pamphlet, he addressed the problems of the English monarchy, the adv isability of separation from England and gaining American independence, the nature of the American colonists as a society, and also made some modest proposals for a new form of government8. His motive, in writing the pamphlet, was not only to plant the idea of independence in the minds of the colonists but to turn the anger of Americans away from particular parliamentary measures and towards what he considered the root of the problem, which, in his mind, was the English constitution itself9. Common Sense exchange more than 100,000 copies in only a few months, and helped to create a rapid growth of support for the idea of independence in the early months of 177610. adept of the reasons for its success was that, by coincidence, it was published first on the same day that a speech from the King of England reached the United States, denouncing all Americans in the colonies as traitors and rebels, and stating frankly that it would be the right of England to bind the colonies forever11. Though at first it was read with a wide amount of alarm, as most colonists knew from almost the first run-in that it was a statement against the grain of normal thought at the time, after taking many pauses and re-reading it over and over again, most of the American public came to realize that Paine was right, and that independence would be the only way to free themselves from English tyranny forever12. Paine had an audience ready to listen to him and hail him as a prophet not because of his words, but

Compare and contrast the nursing theorist models of Parse and Watson Essay

Compare and contrast the nursing theorist models of Parse and Watson - Essay ExamplePatients now want to be consulted first, they have more approach shot to various medical information, and want to be respected, recognized, and referred to when it pertains to their well-being. All new developments have also made nursing a highly-specialized profession, and nurses must continually update their knowledge they gained in the academe and from work experiences with continuing education. A hardly a(prenominal) examples of nursing specializations are in pediatrics, geriatrics, acute care, natal care, cardiology, surgery, palliative care, toxicology, and mass casualties, to name clean a few. In this regard, the nursing profession must not lose sight of its primary or core mission, despite the moderneity in health care delivery. Its main aim is to render human care in whatever setting, be it in administrative, clinical, institutional, assisted-living facilities, senior retirement homes, or in a medical research facility. It is quite easy to get lost in all the complexity and forget human values necessary in a patient-nurse relationship. In an attempt to preserve the noble heritage of nursing, several prominent nurses and educators have developed their own theories with regards to nurses responsibilities despite all the heavy workload, from a paucity of nurses to increased number of patients nowadays. This paper examines the theories of denim Watson and Rosemarie Parse. Discussion Although there are many nursing theories propounded by eminent practitioners, there are a few of these theories which had gained widespread acceptance and greater credibility due to their salient points when it comes to giving patient care. Over the years, nursing schools and hospital administrators have promoted these viable nursing theories as models for the nursing profession in exded to be followed and applied in all health care settings. The idea is that nursing has core values which are applicable anywhere, and these must be applied consistently so that a patient recovers faster, while the nurse retains his or her humanity as an archetypal ideal nurse. Jean Watson she developed her own theory of nursing based from her extensive work experiences in both academic and clinical settings. She has an undergraduate degree in nursing, a masters degree in psychiatric (mental health) nursing, and also a doctorate degree in educational psychology, together with three other honorary doctorate degrees given by three countries, of Canada, Sweden, and the United Kingdom. A basic principle of her nursing theory is the return to the basics, in effect, what Florence Nightingale of England had tried to achieve when she first founded todays modern nursing practice during wartime conditions to care for the wounded. The key elements of Watsons theory are composed of three paradigms in nursing care, which are the carative (from the Greek word of care) factors composed of ten basic elements, the trans-personal relationship, and the caring moment. All the three paradigms are intended to make a nurse aware that a patient is a person with feelings and emotions which hind end adversely affect his health if not handled properly. Moreover, a nurse must give due care to a fellow human being in a holistic approach, as contrasted to the medicines used to cure a patient (Watson, 2008). Rosemarie Parse

Applied management accounting Essay Example | Topics and Well Written Essays - 1000 words

Applied management accounting - Essay ExampleFurthermore, since its NPV of $20,149.83 is greater than the NPV of Machine 2 therefore we ordain break out it a higher priority because of higher NPV.This equipment has a payback period of 3 years and 11 months therefore it lags behinds in terms of recovering the initial capital expenditure than Machine 2 or Machine 3. However, the payback period is not the ultimate criterion in accepting and rejecting projects therefore we allow first look at this projects NPV.This project has the highest NPV of $169,311.58 therefore we will invest in this Machine as it has the power to add sterling(prenominal) value to the company. However, this is the most risky project as the larger cash flows will be generated during the long-term which are most of the quantify difficult to exactly predict due to uncertainty.The Net Present Value Method push backs into account the time value of the money plus it also determines how much of the wealth will be a dded to the companys net worth. Or we can say that it gives us an idea of the profitability of the projectThe payback period calculates how much time it would take the project to recover the capital expenditure invested in the project. It is useful when the time horizon is short as it becomes vital to know how quickly the enthronisation will be recovered.The payback period does not incorporate the time value of money. Another inherent flaw in this method is that it does not take into account the future cash flows which will be available after the initial expenditure has been

John Smith Essay Example for Free

John Smith EssayDear Hiring Manager In response to your late(a) advertisement for Customer Service Manager, I have enclosed a copy of my resume for your review. As you will note, I have spent to a greater extent than five years in the Customer Service profession in different positions of increasing responsibility. I have a track record with assisting customers and am skilled in communication and computer applications. My career is chronicled by meritorious promotions and the fact that I am well versed in interpersonal skills is a significant contributing factor to the successes I have achieved. I am seeking to further my career in the customer service field where I can maximize my communication and organizational skills to further business goal and bottom-line objectives. In my candidacy, you will find A team oriented professional with a positive work ethic and deep commitment to providing excellent results A track record of excellent performance as an employee at my various plac es of example The proven ability to build genuine rapport.Your review of my enclosed resume to explore a possible match between your needs and my skills is much appreciated. I would welcome the opportunity to meet with you in person to learn more about your business and to explore employment possibilities. You may reach me at 802-555 5550 or via email at emailprotected com Thank you for your time, and I look forward to hearing from you soon. Sincerely, John Smith Enclosure.

PASS Lifestyle, Leisure and Recreation Essay Example for Free

PASS Lifestyle, Leisure and Re foot EssayIntroduction The pleasure and unoccupied activities present in our valet de chambre at once argon differ from what generations 100 years ago participated in. Our physical environment is changing continuously under the effect of natural, cultural and economic systems which influence deals lifestyles. As lifestyles change, commonwealths way of spending their leisure time, and leisure activeness preferences, also change. Urban open public spaces such as parks come out to lose their democraticity as shopping malls have become the new leisure centres due to the increasing need to consume of todays societies. Our age has the handiness of information and convenience of abundant transport to take us the venues that we fag end enjoy ourselves, or free ourselves from the issues of our daily life. Information of available activities that we know today, generally come from sources such as the internet and the television or media. Media has shaped the many lifestyles of today, via their advertising of activities and appliances. By shifting our lifestyle, some of our interests in recreation and leisure have changed over the ages. Activities that existed 100 years ago but not today Stickball.Stickball was a street game that is immensely related to baseball which adapts to the environment it was played in. The activity only required a rubber ball and a stick of any form. This activity has gradually died out, as people started to earn more money to afford playing other sports that involved swinging at a ball. The media also easeed advertise Americas major(ip) League Baseball, which put peoples interest into a more popular activity. Some people believe that this activity did not actually die out as it was the origin of all bat-and-ball sports that exist today.Playing Cards and Dominoes Since people living in the early 1900s, mainly middle-aged men, gathered together at bars after their days break down, they took attractio n to group activities. Their main activities were card games which involved betting small amounts of money or a ice rink of beer. In their houses, Dominoes was a common family game which arouseed to all age groups. In todays lifestyle, not all people have the luxuriousness of time to participate in these activities or have lost interest due to the introduction of personal technological devices.These devices include the inferd iPod and computers, in which people can surf the internet to find out many leisure and recreational activities which suit their lifestyle. Activities that exist now but not 100 years ago Shopping The availability of shopping centres has increased rapidly in the past 10 years, as the worlds economy grew, and the average earning of families increased. The shopping for recreation and leisure of today mainly refers to excessive buying of wanted materials for interest of the buyer. This modern activity is common among females, usually in groups.It fits into the lifestyles of women who do not work on weekends, and consumes much of the day, thus the inclusion of food courts in shopping centres. 100 years ago, shopping was not popularised as income of an average household was lower, and many women had to stay home to attend to the housework. The availability of shopping centres and transport to shopping centre venues was limited during that time. Most of the time, shopping was a chore rather than a leisure activity because it involved buying needs for the family, such as food and scholarship materials.Extreme Sports With increased knowledge and equipment to ensure safety, extreme sports are quite popular in modern society. These activities often involve speed, height, a high level of physical exertion, and they can help isolate thoughts of current issues, help set new goals, and improve physical fitness. Some extreme sports which are available near suburban areas are mountain bike riding, indoor or outdoor rock-climbing, body boarding and ca noeing. In the 1900s, people were not aware of these activities due to the inconvenience of less media sources.Among teenagers and young adults, free running is particularly popular in city areas which have a variety of artificial environments. This activity did not exist 100 years ago because it originated from later popular movements desire graffiti and internet groups. Dining Out The modern society values the bonding of couples more than the world 100 years ago. A common activity amongst couples is dining out, to create an atmosphere of romanticism. By observing the growing population, the variety of employed jobs is also growing.The food industry is one of the largest in the world, and has led to the creation of restaurants of different cuisines. Since the countries of the world are becoming more multicultural, people want to break away from eating their traditional foods. Dining out allows a resultant to changing tastes, and may sometimes aid in saving time as cooking at hom e may take several hours when attempting to provide fine food. Activities which existed 100 years ago and still exist now Soccer 100 years ago, soccer teams received growing groups of supporting members and fans that popularise the sport.The soccer associations of today have provided many opportunities for sport betting, employment and sponsorship to advertise brands or companies. In many schools of the 1900s and today, grassed areas were easily converted to soccer fields so that students could play this sport during or after school time. Older age groups can join soccer clinics and clubs where they can play for enjoyment at learning levels to competitive levels. Watching soccer matches is also considered a recreational and leisure activity among fan groups which follow the current soccer.Film Going out to bide movies was a leisure and recreational activity that was present 100 years ago and now. This activity is popular as many films relate to the current world affairs. This activ ity would not have survived if not for the extremely low pricing of cinema tickets in the 1900s. The price of tickets has inflated in our era, but this is acceptable as our average income has increased. Conclusion From the research I have accumulated in recreational and leisure activities of 100 years ago and today, I have found out that a major factor of the changing pursuits has been the shifting of daily lifestyles.The trends originating from media has shaped the many lifestyles of our world today, which has in turn changed our interests. Another factor of our leisure and recreational pursuits is the availability of information and transport we have today that lets us do what we want. However, the popularity of early activities has declined as our society has further developed these activities, while the appeal of the activities has been surpassed by our modern trends and movements.

Is Beer Becoming More Concentrated Essay Example for Free

Is Beer Becoming More Concentrated EssayAt first glance, the UK brewing industry might appear to be highly competitive, with many pubs in close proximity to 1 another and with many brands of beer and lager offered for sale. However, in reality most pubs are owned by the major brewers. Tied houses, as they are called, account for about 40 per cent of a brewers turnover, and sell only a limited range of the beers and lagers that are available. Consumer election is clearly constrained. The oligopolistic nature of the brewing industry can be seen when we consider the market shares of the leading brewers (see table). In 1985 the three largest brewers held 47 per cent of the market.By 2001 this had large(p) to 73 per cent. What is also significant is that small independent brewers, which generally operate within a local or regional market, welcome seen a hammy fall in their market share. With this huge growth in the market power of the major brewers have come large rises in the p rice of beer (even subsequently taking inflation and tax increases into account). Prices in the UK have risen faster than anywhere else in Europe. Market shares of the largest brewers 1985 2005 (%) (%) Bass 22 Scottish-Courage 27 Allied Lyons (Carlsberg) 13 Coors (Carling, Worthington) 20 Grand Met (Watneys) 12 nbev (Bass, Becks, Stella) 19 Whitbread 11 Carlsberg UK (Carlsberg, Tetleys) 13 Scottish and Newcastle 10 Diageo (Guinness) 6 Courage 9 Anheuser-Busch (Budweiser) 2 Others 23 Others 13 sum 100 Total 100 3-firm concentration ratio 47 3-firm concentration ratio 66 5-firm concentration ratio 68 5-firm concentration ratio 85 1987, the Monopolies and Mergers Commission, the forerunner to the Competition Commission (see section 6. 6), investigated the brewing industry and in 1989 issued the Beer Orders, requiring the large brewers to sell many of their pubs.The objective was to increase competition as little brewers and other companies and individuals bought these pubs and then stocked a range of beers. However, the hopes were ill-founded. The pubs that were sell were the least profitable, and many have since closed. There is thus now less competition among pubs. Also, about 40 per cent of UK pubs are now owed by large pub chains. The Beer Orders also required that over 10 000 pubs owned by the declamatory breweries should stock guest beers from rival breweries.But the big breweries responded by selling most of these pubs. In pubs not owned by the big breweries, and where there is the terror of genuine competition, the big breweries often supply their beers at lower prices, thus making it impossible for the smaller breweries to compete. The brewers, finding a reduction in their scene for achieving economies of scale from vertical integration (owning both(prenominal) breweries and pubs), have sought to gain economies of scale from horizontal integration (having a larger share of total brewing).Mergers and takeovers in the br ewing industry have been common. For example, in May 2000 Interbrew (the Belgian brewer and owners of the Stella Artois brand) acquired Whitbread, the UKs third largest brewer, and a month later acquired Bass, the second largest. This gave Interbrew nearly one third of the market. The acquisitions were referred to the Competition Commission, which recommended a break up of the new giant a recommendation accepted by the government.In response, at the end of 2001 Interbrew (now called nbev) sold most of the Whitbread division, including brands such as Carling, Caffreys and Worthington, to the US brewer Coors. In the light of this splitting of Interbrew, and feeling that this proved that competition policy was effective, the government in 2002 decided to scrap the Beer Orders. This was greeted with dismay by small independent brewers, which were already reluctant to expand, faced with the power of such massive competitors in both issue and retail, with heavily advertised brands gainin g larger and larger shares of the market.Small independent brewers are understandably reluctant to expand, faced with the power of such massive competitors in both production and retail, with heavily advertised brands gaining larger and larger shares of the market. Questions 1. What are the barriers to entry in (a) brewing (b) opening new pubs? 2. Do small independent brewers have any market advantages?

Analyse Contribution Of Engagement In Biopsychosocial Assessment Client Nursing Essay

Analyse Contribution Of dispute In Biopsychosocial Assessment node Nursing EssayIn this essay the dish up of building a therapeutic relationship and assessing knobs own circumstances within the inpatient admission and the modeling found in convention get out be uses analysed and criticized by using pranks (1994) model of reflection.The framework that has been used in kind wellness proceedss is the dread Program Approach (certified public accountant), which it has been profoundly criticised since it was introduced. Therefore the reflection will look into other model of nurse, Tidal set, which offers a different philosophy of divvy up. The reflection will also explore the interpersonal interactions theories which the nursed used during the judgement and how these aided to engage the invitee in the biopsychosocial assessing process. It also will be discussed other interpellation models and the possible usage in similar situations.In order to begin the analysis of the ab ove occlusives, utilization invites to be defined. Thur just (cited by Norman and Ryrie (2004) p.650) depict it as can be broadly defined as providing a service that is god by service users (including business concernrs) as acceptable, accessible, positive and empowering. Although this definition gives an thinker of the concept, it lacks to define the key elements of strife, which Cutcliffe and Barker (2002) identified as forming a human to human relationship, expressing tolerance and acceptance, and hearing and understanding. Both definitions gather the skipper values of the service and the interaction itself. Yet, Cutcliffe and Barker (2002) definition can be considered more practical when holistically assessing clients. However, these definitions do non acknowledge factors of engagement that are behind the interpersonal relationship, such(prenominal) as personal or organisational perspectives of engagement. The personal perspective for the nurses practice is underpinned by poor structural organization, occupational cultures and stress, bureaucratic constrains, lack of time and nursing culture driven by measurable targets (Hosany et al (2007) and Addis and Gamble (2004)). On the other hand, clients and their families are conditioned by the mental illness, their past experiences with other services, the consecrate in the service and the relevance of it. Additionally, the organizational issues effect upon engagement and care by reducing services budgets, by non providing resources and also by politics.Engagement has been recognized as an important part of mental health services users care. The National Service Framework (NSF), the National Institute for clinical Excellence (NICE) and the segment of wellness (DoH) appoint that users under CPA should be fork outd with resources to build a therapeutic relationship, optimise engagement and reduce risks. These documents also highlight the need to turn in a therapeutic environment in order to leave alone best care and to engage the clients and their families with the service.Taking into account all the above information a reflective account will be taking station in the following pages by using gutters model of reflection (1994).1. Description of the experienceThe clinical environment where this assessment took place was in an acute adult hospital ward. The ward is based in an old mental health hospital, which has old and pilling off wooden windows, untidy roofs and old fashioned flooring. The ward had untidy carpets, the curtains did not draw appropriately and the painting on the walls was peeling off. These are the organisational barriers affecting engagement.This particular client was known by the service already, to protect his right to confidentiality he will be referred as arse (NMC commandment of practice 2008). John had been stable for 10 years, but in the past few months his mental state had worsened. His psychosis and levels of anxiety increased he distrusted neighbours and other acquaintances as well as strangers. Consequently, he stop going out of his house and began to self medicate with over the counter sedatives. Crisis and Resolution Home Treatment Team (CRHTT) was involved and as they felt that John was not able to cope at home, they decided that an inpatient admission would be beneficial.Before the admission the CRHTT forwarded the CPA form 1A, which updated the ward staff round the latest assessment of the clients biopsychosocial needs. Once John arrived to the ward, he fully understood the situation where he was in. He was able to consent and had capacity to agree with give-and-take and, thus, he was admitted as an informal client. This facilitated the initial interaction and the initial grounding for the nurse/client relationship. Before the beginning of the assessment Tom (Johns named nurse) introduced e reallyone to John, roles were explained, a take in pack with the ward information and a CPA booklet were given and Tom p rovided all the information in an oral and written manner.The nurse started the assessment by formulating open questions. However John gave single direct answers (yes, not, not sure ). Consequently, the nurse decided to change to more direct questioning. After that the client was precise co-operative and was answering all the questions. He reported to be genuinely anxious, which also was noticeable by looking to his body language (he was sweaty, clenching his fingers, rubbing his men on the chairs arms and removing his spectacles some(prenominal)(prenominal) times during the interview). At this stage the nurse decided to undertake an anxiety assessment by using the scales tools for sale on the ward the Becks anxiousness Inventory (BAI, see attachment 1).Following this assessment, John began to answer the questions more in depth and he appeared more eased, stating several times that he was in hospital for help and was going to do everything that was available for his retrieva l. Following the local trust policies and NICE guidelines, the CPA 1A assessment was think (as it must to be completed within 72 hours of the admission) the Integrated carefulness Path course for Inpatient Safety and the Patient Property Liability Disclaimer were make full in and signed by nurse and client.2. ReflectionThe whole assessment was intended to gather as much information as possible close to John in order to understand the clients actual biopsychosocial situation (holistic assessment) and the context that led to the admission, which would highlight the needs and strengths of the client. However, inpatient admissions are more likely to cogitate on a more medical approach to health, mainly because social incumbrances cannot be implemented until the clients mental state has stabilized and he is ready to lift on to community settings. Along this process the multi-disciplinary team organizes care to build up the grounds to enable recovery (Simpson 2009). This particular ward was focus on treatment and stabilizing, workings on one to one interventions (nurse-client), building a therapeutic relationship through unified and unstructured interventions, and used CPA as a nursing intervention framework. Alongside these individual interactions, the activity nurses and the occupational therapist offered daily social and leisure activities. These groups provided skills and entertainment to the clients on the ward, but did not follow a particular model of nursing, such as the Tidal Model, and they offered activities to spare the free time on the ward without promoting recovery.The Tidal Model provides structured group-work centred on recovery (Barker and Buchanan-Barker 2005). This model centres its assessment on a holistic approach for the short and long term needs, viewing the mental illness as a unique experience of each individual, their families and social environment. It looks into the lowest point of the illness (such as an inpatient admission like Johns) as the point where the recovery begins with a positive approach to the illness.There are three working groups recommended in this model discovery, solutions and information (see appendix 3), where therapeutic relationship is built and issues customary to the individual and others are discussed and explored. As mentioned above, the ward nurses had more structured interventions with clients, and the issues discussed in these interviews were correlated to the Tidals Model theme groups. In these interviews the clients engage with their primary nurses and they discuss their concerns in relation to their care or other personal matters. These interventions or interviews were intended to happen at least twice weekly for at least an hour. However, for organizational issues (usually low number of staffing) not all the clients had the opportunity to benefit from these one to one interventions on a regular basis.Initially, the Tidal Model look into was criticised for creation bias, f or lacking to fully describe clients pre and post intervention with the model, not taking into account Hawthorne effect and most of physiological factors and by not reasoning the need for a new model in mental health care (Noak 2001). However, further research and analysis showed that the Tidal Model provides tools and structure to cleanse care in acute ward admissions filling the gaps in care pointed in the NSF and The Sainsbury Centre for affable Health (Gordon et al 2005). One could say that this model has been shown to improve mental health services, fulfil the historical gaps within nursing practice and to be grounded on evidence-based practice. However, the author of this essay believes, after reading the relevant literature, that for the carrying into action of the Tidal Model the levels of staffing (and therefore the service budget) should be increased and nursing practice cultures must be changed by re-educating the workforce. Arguably both implementations are very diffi cult to achieve as the health service has seen budgets cut downs in the recent years and nurses practiced has been subject to negative ward cultures towards nursing models.On the other hand CPA, which is the framework used on the ward, was first designed after a series of fatal incidents which involved mentally ill people. It was aimed to be introduced in Wales by 2004 (in England was do by 1991). CPA is person centred focus which promotes social inclusion and recovery, through assessment and planning of individualized needs and strengths, working with the clients and their families or carers (Care Programme Approach Association (CPAA) 2008). Despite the initial intention that the CPA was brought to improve service users quality of care, to increase inter agencies communication and to be a fictional character management tool, some critiques appeared. Simpson et al (2003a) researched showed CPA was thought to be an over-bureaucratic duty within the professionals. The author of this paper has rewardd in practice, not in this particular assessment, that some professional do not reassess clients when they are admitted. Instead the latest CPA 1A form (usually filled in by the CRHTT) is photocopied or copied-pasted and re-used to speed up the process. This would be acceptable if the client was assessed the day or night before the admission, because the social, psychological or biological needs would set out not changed in that period of time. When older assessments are used, changes in circumstances might vex not been updated. In the worst case scenario a health professional could rescue misunderstood the clients needs and have documented them wrongly. This misunderstanding could be carried over, therefore care would be affected. This hypothetical scenario shows that CPA assessments should be done every time when needed.CPA as a case management tool fails to compile the most important features which promote therapeutic relationship. In distinguish with other case managements models the role of the care co-ordinator is more of an administrative and as an alternative service prescriber (Simpson et al 2003a). This means that there is no need for a specific training or skills related to therapeutic relationship, partly because other services (or service providers) will engage with the client, and the care co-ordinator just oversees the process of care. Moreover, CPA also lacks a nursing model background and fails to define specific roles within the multi-disciplinary team. These factors reduce the teamness feeling amongst the health professional (Simpson et al 2003b). Although, it could be argued that the reason, why CPA is lacking nursing background, is that it was not designed as a mental health nursing framework but for the use of mental health services. In this particular reflexion the care co-ordinator was not present in the admission and never mention during the assessment. Whether it was a usual situation or not it is something that never was discussed, but it shows Simpson et al (2003a and 2003b) critiques of CPA as a case management were factual.CPA and Tidal Model are intended to provide holistic care for clients and their families. However, the Tidal Model is more clients centred than CPA, and it also looks into the more positive side of the clients situation, foreseen the now and future as a whole. It explains the illness as an accumulation of life factors. The Tidal Model complements other health and social care professionals, as well as it searches to nurse by building a special relationship between health practitioner and client. Moreover, CPA always looks for risk signs in the short-term and from a psychiatric approach. As this assessment took place in an inpatient admission it is important to bear in mind that in this particular environment CPA forms (1A, 2, 2A and 4) were used for assessment, planning, implementing and evaluation of inpatient care and for the liaison with other health professional i n tertiary care (such as physiotherapist, dietician or occupational therapist). Perhaps CPA would benefit from overlap some principles of a nursing model (like the Tidal Model), by using it as a tool more than as a paperwork and from a go against staff training and promoting adherence to nursing models (Barker 2001).Whether the ward uses Tidal Model or CPA to structure care, an inpatient admission is always stressful and self-conscious experience for clients and their families. John saw the nurse as a stranger in an unfamiliar place, however, Tom was there to guide the client throughout his care, to provide information and to be somebody he could relay on. This first encounter related to the orientation phase described by Peplau (1952) (cited by Sheldon (2005), see appendage 2). In this phase Johns past experiences, expectancies, culture and believes were to condition the initial interaction. Following this phase John went into the identification stage, where he sought assistanc e for anxiety abatement techniques, deal outd needs and strengths when and co-designed care plans and began to have feelings of belonging and capability, therefore decreasing negative feelings. This exchange of feelings is going to lead to exploitation and resolution phases, where John will engaged with treatment (medical, physical and social), having different needs at different times, starting to be informed well-nigh all the help available towards the last stage, feeling as an important part of the whole nursing process and finally ending the professional relationship when discharged. The exploitation and resolution phases were not observe as at the time of writing John was still an inpatient.John had had previously one bad inpatient admission. He reported that he was very unhappy when he was in the other hospital 10 years ago. He explained that the bad experience was related to the other clients and organizational issues rather than staff. John stated that he was feeling anxi ous but happy that he was getting help. His positive attitude helped to engage him in the assessment process and on the ward activities, which were the first steps towards the identification phase. Therefore, John could begin to have professional input from other members of the multi-disciplinary team.Tom interacted in a way that John felt understood, respected and individualized. Tom did not appear to have preconceived ideas of the client after reading the CPA forma 1A. And certainly, Tom treated John respectfully and as an equal human being. He followed the NMC code of practice 2008, which states that you must treat people as individuals and not to discriminate in any way those in your care. Tom tried to adapt the pace of the questioning to the clients needs, involving him and asking in a respectful manner. Tom also acknowledged Johns anxiety feelings, and showed it when taking further (BAI see appendix 1) assessments to empathize more with Johns situation. This reinforced the app roachability and genuineness of the nurse and led John to open and engage with the assessment process and the health professional.3. Influencing factorsJohn scored 45 points in the BAI (see appendix 1), which is a high scoring. This could have been influenced by the hospital admission and the assessment process. Despite these factors and Johns actual mental state he engaged in the assessment actively. The BAI scales consist of 21 observable and self-rating symptoms of anxiety, rated from 0 to 3 (0 being the lowest score), which can also be easily transformed in direct questions or self rating. At the end of the assessment the scores are added up and compared against the scales.There are several assessment tools available such as Hospital disquiet and first gear Scales (HADS) or Hamilton Anxiety Scales (a collection of them can be found in the Appendix 1 reference). The BAI is shown to be a quick and reliable when measuring clients anxiety levels and it also differentiates General Anxiety Depression and depression (Fydrich et al 1992). Although, these characteristics appear to be positive, it could be argued that BAI is just a merely adaptation of the DSM-IV panic symptoms and therefore it could also be said that measures panic attacks rather than anxiety levels (Cox et al 1996 and de Beurs et al 1997). On the other hand, HADS which achieves good levels of anxiety and depression screening could have been more appropriate for hospital settings and more accurate (Bjelland et al 2002).It is important to point out that NICE clinical guideline for management of Anxiety (2004) does not recommend a specific tool for assessment of anxiety, which gives to the professional practitioner quality on the usage of available tools. This affects practice as these scales are not used as often as they should be. Most practitioners relay on their observations and experience to perform informal assessments, rather than using research based scales. It is perhaps understandable wh en dealing with clients unable to fully understand these assessments. But in practice it can be noticed that nurses do not tend to use anxiety inventory even with clients that could engage with the process.Tom designed care plans in partnership with John and made him realise which were more realistic goals in the short and long term. Tom had shown knowledge and understanding of the professional capabilities that the NSF defined in the documents The Ten Essential Shared Capabilities (2004) and The Capable Practitioner (2001). These documents set basic principles that underpin positive mental health practice as well as providing the basic grounding for service workers to continue development and learning skills. Therefore, it was observed during the placement that along the whole admission the nursing team also direct care and practice as appointed by these documents. They provided patient-centred care, which is accountable for each client and respecting the individual. The team als o had a broad knowledge of national legislations as well as local policies and services, and worked under the homogeneous professional and ethical principles recognizing the rights of the clients and their families. They promoted recovery and self-realisation by identifying people needs/strengths and empowering the individuals. Most of the team members were lying-in further training, to keep their skills up-to-date or be able to transfer their existing skills to new environments. They also worked in partnership with family, carers, lay people and remote agencies, such as community care services, voluntary associations and vocational services.4. EvaluationIn the interview Tom used a Rogerian approach (Roger (1961) cited by Sheldon (2005)). He also showed knowledge of Peplaus interpersonal theories and applied them in practice by creating a shared experience of care. However, it also would be appropriate to use the Herons six-category intervention framework (Heron 1989). This frame work was designed to enable a practitioner (nurse) taking the lead to facilitate the clients specific needs or arising issues. Therefore this intervention could have been used in the admissions assessment and the following one to one sessions, which have been described in this essay. The framework is made off two categories, which are subdivided in three more. The first category is determinate which it can be prescriptive, in which the nurse influences and directs behaviour, gives advice and prescribe goals. It also can be informative providing information or giving feedback for the clients behaviour. The third subcategory is confronting, in which the practitioner challenges the clients beliefs or actions. The second category is the facilitative which is divided into cathartic, in which the nurse tries to release the clients painful feelings and talks about or express them with actions (tears, anger or shouts). Next subcategory is catalytic, where the nurse tries to help the client and encourage self-discovery and learning. Finally, supportive is the category where the client is supported in an categorical manner.The facilitative stage of the framework would have been the most appropriate to use in the first assessment. Johns mental state would not have benefit from an authoritative approach as he might have felt threatened by the staff, therefore his willingness to engage with the service could have reduced greatly. This approach shares the same goals as the one that Tom used. The outcome would have been the same, which was the beginning to build a relationship towards recovery. However, it is important to know different ways to practice and to interact in order to provide an individualised care. This principle is shared by the models discussed in the essay (CPA and Tidal Model) and also by the nursing professional code (NMC code of practice 2008).5. LearningAlthough, it was difficult to deal with Johns anxiety levels and his initial unwillingness to engage with the assessment, it was possible to create a therapeutic relationship between nurse and client. After this reflexion it was learnt that nurses knowledge and usage of the right nursing models, strategies and tools can be adapted to individual situations and their own circumstances. It is also important to share principles of care and to change some nurses cultures regarding models of care.It was positive to reflect upon this experience and, therefore, to realise how the theory learnt was applied in practice. Since nursing studies and practice are moved towards research based knowledge it seems that the human connection and relationship building have lost their place in the nursing profession. As a student it is good to see that values based nursing promoted safe, trustful and supporting environment, which led to a healthy therapeutic relationship (Hewitt 2009).In conclusion, the reflection and analysis of engagement through a biopsychosocial assessment illustrated how personal a nd organizational factors effect on clients care. It was found out that applying specific intervention techniques, mental health screening tools and the commensurate adaptation to the individual and the situation promote engagement and build a healthy therapeutic relationship. Furthermore, the research showed that the relevant mental health regulations and nursing professional code recognise the need to keep up-to-dated knowledge and skills in order to provide the best care.All the above techniques and tools were found to be used in a very individual way between the nursing professionals. In addition to this, it was found that theses personal adaptations to practice and clients care were beneficial when reducing barriers for engagement and personalising the care.The positive and negative characteristics of the actual mental health framework CPA were brought forward and it was found that it lacks a nursing model background. CPA and Tidal Model when compared and contrasted, showed th at both mental health frameworks differ gratefully from each other but at the same time they could benefit from each other.Despite the ward worked under CPA and used a more medical approach to nursing, the nursing team shared the same professional capabilities and worked towards holistic goals and recovery.Over all, in order to engage and to provide relevant services for clients and cares biopsychosocial needs there should be a continues connection between practice and theory in nursing.ReferencesAddis J Gamble C (2004) Assertive outreach nurses experience of engagement. 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Journal of Psychiatric and Mental Health Nursing 10, 472-483.Simpson A Miller C Bowers L (2003b) The history of the Care Programme Approach in England Where did it go wrong? Journal of Psychiatric and Mental Health Nursing 10, 489-504.The Sainsbury Centre for Mental Health (2001) The Capable Practitioner.http//www.scmh.org.uk/publications/capable_practitioner.aspx?ID=552Accessed 29/12/09AppendixesAppendix 1Beck Anxiety InventoryBelow is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by circling the number in the corresponding space in the column bordering to each symptom.Not At AllMildly but it didnt bother me much.Moderately it wasnt pleasant at timesSeverely it bothered me a lotNumbness or tingling0123Feeling hot0123Wobbliness in legs0123Unable to relax0123Fear of worst happening0123Dizzy or lightheaded0123Heart pounding/racing0123Unsteady0123Terrified or afraid0123Nervous0123Feeling of choking0123 Hands trembling0123 rickety / unsteady0123Fear of losing control0123Difficulty in breathing0123Fear of dying0123Scared0123 upset stomach0123Faint / lightheaded0123Face flushed0123Hot/cold sweats0123Column SumScoring Sum each column. Then pairing the column totals to achieve a grand score. Write that score here ____________ .InterpretationA grand sum between 0 21 indicates very low anxiety. That is usually a good thing. However, it is possible that you might be unrealistic in either your assessment which would be denial or that you have learned to mask the symptoms commonly associated with anxiety. Too little anxiety could indicate that you are detached from yourself, others, or your environment.A grand sum between 22 35 indicates moderate anxiety. Your bod