Chapter 13 Guided Reading

Guided Reading Chapter 13 Terms: 1. Tropics- Areas with high humidity and temperatures 2. Monsoons- an overflow of water from rivers 3. Ecosystems- communities of living things within a certain climare 4. Bilad al-sudan- West African Jewish communities who were connected to known Jewish communities from the Middle East, North Africa, or Spain and Portugal. 5. Dhow – any of various types of sailing vessels used by Arabs on the east African, Arabian, and Indian coasts, generally lateen-rigged on two or three masts. 6. Swahili – a member of a Bantu people of Zanzibar and the neighboring coast of Africa.Also, Kiswahili, ki-Swahili. the Bantu language of the Swahili people, used also as a lingua franca in Tanzania, Kenya, and parts of the Democratic Republic of the Congo. 7. Urdu- an official language of Pakistan, also spoken in India. The script derives primarily from Persia. It belongs to the Indic branch of the Indo-European family of languages, being closely related to H indi but containing many Arabic and Persian loan words 8. Junks- Chinese Ships that can contain up to 40 tons Places: 9. Niger River – the principal river of western Africa, extending about 4,180 km 10.Indus River – is a major river which flows through Pakistan. It also has courses through western Tibet (in China) and Northern India. 11. The Ganges – a trans-boundary river of India and Bangladesh. The 1,569 mi river rises in the western Himalayas in the Indian state of Uttarakhand, and flows south and east through the Gangetic Plain of North India into Bangladesh, where it empties into the Bay of Bengal. 12. Mekong River- a river in Southeast Asia. is 4,350 km From the Tibetan Plateau this river runs through China's Yunnan province, Burma (Myanmar), Laos, Thailand, Cambodia and Vietnam. 13.Swahili Coast-The Swahili Coast refers to the coast or coastal area of East Africa inhabited by the Swahili people, mainly Kenya, Tanzania, and north Mozambique. The term may also include the islands such as Zanzibar, Pate or Comoros which lie off the Swahili Coast. 14. Strait of Malacca – is a narrow, 805 km (500 mi) stretch of water between the Malay Peninsula and the Indonesian island of Sumatra. It is named after the Malacca Sultanate that ruled over the archipelago between 1414 and 1511. 15. Mogadishu – the Moroccan traveller Ibn Battuta's appearance on the Somali coast in 1331, the city was at the zenith of its prosperity.He described Mogadishu as â€Å"an exceedingly large city† with many rich merchants, which was famous for its high quality fabric that it exported to Egypt, among other places. He added that the city was ruled by a Somali Sultan originally from Berbera in northern Somalia who spoke both Somali and Arabic with equal fluency. The Sultan also had a retinue of wazirs (ministers), legal experts, commanders, royal eunuchs, and other officials at his beck and call. 16. Kilwa -Kilwa Kisiwani is a community on an islan d off the coast of East Africa, in present day Tanzania. 7. Aden – In 1421, China's Ming dynasty Yongle Emperor ordered principal envoy grand eunuch Li Xing and grand eunuch Zhou Man of Zheng He's fleet to convey an imperial edict with hats and robes to bestow on the king of Aden. The envoys boarded three treasure ships and set sail from Sumatra to the port of Aden. This event was recorded in the book Ying-yai Sheng-lan by Ma Huan who accompanied the imperial envoy 18. Malabar Coast – The Malabar Coast is a long and narrow coastline on the south-western shore line of the mainland Indian subcontinent.Geographically, it comprises the wettest regions of southern India, as the Western Ghats intercept the moisture-laden monsoon rains, especially on their westward-facing mountain slopes. The term â€Å"Malabar Coast† is also sometimes used in reference to the entire Indian coast from the western coast of Konkan to the tip of the subcontinent at Cape Comorin. 19. Malac ca – the third smallest Malaysian state after Perlis and Penang. It is located in the southern region of the Malay Peninsula, next to the Straits of Malacca. It borders Negeri Sembilan to the north and Johor to the south.Malacca was founded by Parameswara, also known as Iskandar Shah or Sri Majara, the last Raja of Singapura (present day Singapore) following a Majapahit attack in 1377. He found his way to Malacca around 1400 where he found a good port—it was accessible in all seasons and on the strategically located narrowest point of the Malacca Straits. 20. Timbuktu – The first mention is by the Moroccan traveler Ibn Battuta who visited both Timbuktu and Kabara in 1353 when returning from a stay in the capital of the Mali Empire. [25] Timbuktu was still relatively unimportant and Battuta quickly moved on to Gao.At the time both Timbuktu and Gao formed part of the Mali Empire. A century and a half later, in around 1510, Leo Africanus visited Timbuktu. He gave a description of the town in his Descrittione dell'Africa which was published in 1550. [26] The original Italian was translated into a number of other languages and the book became widely known in Europe. [27] Empires/ Kingdoms: 21. Delhi Sultanate – five short-lived dynasties, Delhi based kingdoms or sultanates, mostly of Turkic and Pashtun (Afghan) origin in medieval India. The sultanates ruled from Delhi between 1206 and 1526, when the last was replaced by the Mughal dynasty.The five dynasties were the Mamluk dynasty (1206–90); the Khilji dynasty (1290–1320); the Tughlaq dynasty (1320–1414); the Sayyid dynasty (1414–51); and the Afghan Lodi dynasty (1451–1526). 22. Mali Empire – a West African empire of the Mandinka from c. 1230 C. E. to c. 1600. C. E. The empire was founded by Sundiata Keita and became renowned for the wealth of its rulers, especially Mansa Musa I. The Mali Empire had many profound cultural influences on West Afric a, allowing the spread of its language, laws and customs along the Niger River.It extended over a large area and consisted of numerous vassal kingdoms and provinces. 23. Kanem- Bornu – existed in modern Chad and Nigeria. It was known to the Arabian geographers as the Kanem Empire from the 9th century AD onward and lasted as the independent kingdom of Bornu until 1900. At its height it encompassed an area covering not only much of Chad, but also parts of modern southern Libya, eastern Niger, northeastern Nigeria and northern Cameroon. The history of the Empire in the longue duree is mainly known from the Royal Chronicle or Girgam discovered in 1851 by the German traveller Heinrich Barth. 4. Gujarat – From 1297 to 1300, Allauddin Khilji, Sultan of Delhi, destroyed Anhilwara and incorporated Gujarat into the Delhi Sultanate. After Timur's sacking of Delhi at the end of the fourteenth century weakened the Sultanate, Gujarat's Muslim Rajput governor Zafar Khan Muzaffar asse rted his independence, and his son, Sultan Ishaan Shah (ruled 1411 to 1442), restructured Ahmedabad as the capital. 25. Bahmani Kingdom – was a Muslim state of the Deccan in South India and one of the great medieval Indian kingdoms. Bahmanid Sultanate was the first independent Islamic Kingdom in South India. 6. Vijayanagar Empire – an empire based in South India, in the Deccan Plateau region. It was established in 1336 by Harihara I and his brother Bukka Raya I of Sangama Dynasty and Dhangar / Kuruba Gowda lineage. 27. Great Zimbabwe – Great Zimbabwe acted as a royal palace for the Zimbabwean monarch and would have been used as the seat of their political power. One of its most prominent features were its walls, some of which were over five metres high and which were constructed without mortar. Eventually the city was abandoned and fell into ruin. Individuals / Peoples: 28.Muhammed ibn Ab-dullah ibn Buttata – a Muslim Moroccan explorer, known for his exte nsive travels, accounts of which were published in the Rihla (lit. â€Å"Journey†). Over a period of thirty years, he visited most of the known Islamic world as well as many non-Muslim lands; his journeys including trips to North Africa, the Horn of Africa, West Africa, Southern Europe and Eastern Europe in the West, and to the Middle East, South Asia, Central Asia, Southeast Asia and China in the East, a distance surpassing threefold his near-contemporary Marco Polo. Ibn Battuta is considered one of the greatest travellers of all time.He journeyed more than 75,000 miles (121,000 km), a figure unsurpassed by any individual explorer until the coming of the Steam Age some 450 years later. 29. Sundiata – founder of the Mali Empire 30. Mansa Kankan Musa – the tenth Mansa, which translates as â€Å"King of Kings† or â€Å"Emperor†, of the Malian Empire. At the time of Mansa Musa's rise to the throne, the Malian Empire consisted of territory formerly bel onging to the Ghana Empire and Melle (Mali) and immediate surrounding areas, and Musa held many titles, including: Emir of Melle, Lord of the Mines of Wangara, and Conqueror of Ghanata, Futa-Jallon, and at least another dozen states. 1. Mansa Suleiman – mansa of the Mali Empire from 1341 to 1360. The brother of the powerful Kankan Musa I, he succeeded Musa's son Maghan to the throne in 1341. His son Kassa briefly assumed the throne following his death in 1360, but was succeeded the same year by Maghan's son Mari Diata II. 32. Sultan Iltutmish – He was a slave of Qutb-ud-din Aibak and later became his son-in-law and close lieutenant. He was the Governor of Badaun when he deposed Qutub-ud-din's successor Aram Shah and acceeded to the throne of the Delhi Sultanate in 1211.He shifted Capital from Lahore to Delhi, remained the ruler until his death on May 1, 1236. Iltutmish introduced the silver tanka and the copper jital-the two basic coins of the Sultanate period, with a standard weight of 175 grains. He introudced Iqtadari system: division of empire into Iqtas, which were assigned to the nobles and officers in lieu of salary. 33. Sultan Raziya – First female Sultan referred to as Razia Sultana was the Sultana of Delhi in India from 1236 to May 1240. She was of Seljuq slave ancestry and like some other Muslim princesses of the time, she was trained to lead armies and administer kingdoms if necessary.Razia Sultana, the fifth Mamluk Sultanate was the only woman ruler of both the Sultanate and the Mughal period. Important Events: 34. Mansa Musa’s Pilgrimage – Musa's journey was documented by several eyewitnesses along his route, who were in awe of his wealth and extensive procession, and records exist in a variety of sources, including journals, oral accounts and histories. Musa is known to have visited with the Mamluk sultan Al-Nasir Muhammad of Egypt in July 1324. Questions to Outline: 1.The ecosystems in Africa are controlled by their location in comparison with the equator and there are many different ecosystems with in a tropical environment which is an area with a high temperature and humidity. 2. It mobilized the labor of ordinary people in order to produce surpluses, helped support powerful states and profitable commercial systems. 3. Muslim conquests in the Indian subcontinent mainly took place from the 13th to the 16th centuries, though earlier Muslim conquests made limited inroads into North India as early as the time of the Rajput kingdoms in the 7th century.Some historians consider parts of the conquest the bloodiest chapter in human history. 4. The Indian Ocean trade has been a key factor in East–West exchanges. Long distance trade in dhows and sailboats made it a dynamic zone of interaction between peoples, cultures, and civilizations stretching from Java in the East to Zanzibar and Mombasa in the West. Cities and states on the Indian Ocean rim were Janus-faced. They looked outward to th e sea as much as they looked inward to the hinterland. In the contemporary period, the re-assertion of Asia’s cultural, political, and economic trength has manifested itself in varied events such as the meteoric rise of the Chinese economy and the growing influence of India’s culture industry, and the rise of Dubai as a global financial hub. These processes indicate a gradual movement of the fulcrum of global economic and military exchanges away from the Atlantic to the Indian Ocean, a shift which is being keenly watched by national elites and global institutions. 5. Their status was determined by males, Tasks were cooking, brewing and farm work, family organization was important in society and some women didn’t adopt veiling. . The spread of Islam, Commercial contacts and the rise of Mali and Ghana. These changed many things with in the people such as what rights they had, the amount of slavery, taxes and trade, economy was based off gold and their religion. 7. They made certain adjustments such as irrigation systems, and adopted different means of surviving such as wild food and fish hunting, herding and grain trade, farming of rice, wheat , sorghum and millet. They also built dams and reservoirs.

Polycystic Ovary Syndrome

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrinology disorder affecting 15–20% of women in reproductive age worldwide (1).   PCOS characterized by hyperandrogenism and high level of insulin resistance which leads to the dysfunction of the hypothalamic-pituitary-ovary axis, resulting in anovulation and menstrual irregularity (2-6). PCOS is considered the most common cause of anovulatory infertility. Around 90%–95% of an-ovulatory women visiting infertility clinics have PCOS (7). The current first-line infertility treatment in women with polycystic ovary syndrome is Clomiphene Citrate. However, it has drawbacks, including its overall poor efficacy (only a 22% rate of live birth with up to six cycles of clomiphene (8)), ovulation rate of only 46% (9) and an undesirable side-effect profile, including mood changes and hot flushes. Failure either to ovulate (clomiphene resistance), or to conceive with ovulation (clomiphene failure) often leads to the use of more expensive treatment options for infertility that associated with higher multiple pregnancy rates and an increased risk of the ovarian hyperstimulation syndrome (10). Insulin-sensitizing agents, such as metformin, have been used successfully to treat women with PCOS (11). However, metformin also has multiple undesirable gastrointestinal side effects such as nausea (61%), vomiting (30%), and diarrhea (65%). (12,13) Furthermore, many women who have PCOS are not satisfied with pharmaceutical treatment. In a survey done on women with PCOS, 99% expressed their desire for effective treatment alternatives to fertility drugs, (14) and as many as 70% of women with PCOS use complementary medicines (15-16). Herbal Medicine is still widely used from world population for approximately 75-80%; this is because that herbal medicine is considered more culturally acceptable, less dangerous and more natural form of treatment (17). In Saudi Arabia, approximately 80% of the population use herbal medicine, and one of the main reasons is the ease of use of herbs that could be taken orally without painful procedure or invasive methods (18). Cinnamon, a commonly used spice, has become a natural product of interest because it has been considered to have health benefits, such as reducing blood glucose, total cholesterol, LDL cholesterol and decreasing insulin resistance (19). Cinnamon increases insulin sensitivity likely because of its effect on intermediate metabolites acting at the cellular level (20). Several studies stated that polyphenol polymers isolated from cinnamon could increase insulin-dependent glucose metabolism. (21-23) Cinnamon usually causes no serious side effects. The reported adverse events of cinnamon include headache, heartburn and menstrual cramps (24). In general, herbal medicines are better tolerated than pharmaceutical medications as shown in a systematic review for critical evaluation of clinical efficacy and adverse events of herbal remedies (25). Cinnamon extract may offer a low cost, readily available and relatively easily implemented means of reducing insulin resistance and thereby improving ovulation in women with PCOS.2. Literature Review: A randomized, double-blinded, controlled trial investigating the effect of cinnamon on menstrual cyclicity in women with PCOS, women receiving daily 1.5 g of cinnamon treatment showed significant improvements in menstrual cyclicity, whereas patients receiving placebo did not. Sampling from different patients in the study showed the luteal phase serum progesterone (progesterone level >3 ng/mL), sonographic visualization of corpora lutea, and pregnancy which all support that the bleeding has resulted from ovulatory cycles, rather than merely changes in menstrual flow (24). That suggests that cinnamon supplement may have an effect on ovulation induction in women with PCOS. Regarding the effect of cinnamon on insulin resistance, a study conducted in 2017 involving 66 women with PCOS in a randomized, double?blind placebo?controlled clinical trial. The women in the first group treated by cinnamon capsules 1.5 g/day for three months and the second group by placebo capsules. The homeostatic model assessment for insulin resistance (p = .014) reduced after the three months in the cinnamon group compared with the placebo (26). Another randomized control study concluded that oral administration of 1g of cinnamon extract daily for eight weeks was well tolerated and improved insulin sensitivity in nondiabetic women with PCOS (27). A double-blind randomized control study, comparing the effect of cinnamon and metformin on insulin resistance in 112 women with PCOS taking 1g of cinnamon versus 1g of metformin daily, shows that both significantly decreasing the insulin resistance (28). A study in non-PCOS patients with elevated serum glucose, 173 patients were enrolled and given 500mg of cinnamon daily for two months, showed a significant reduction on fasting insulin, glucose, total cholesterol, and LDL cholesterol and enhanced insulin sensitivity (29). There are many studies conducted on metformin as insulin-sensitizing agent on ovulation in PCOS women. In a systematic review, forty-four trials (3992 women) were included for analysis, 38 of them using metformin and involving 3495 women, clinical pregnancy rates were improved for metformin versus placebo (pooled OR 2.31, 95% CI 1.52 to 3.51, 8 trials, 707 women) and for metformin and clomiphene versus clomiphene alone (pooled OR 1.51, 95% CI 1.17 to 1.96, 11 trials, 1208 women) (30). Since the cinnamon have been suggested to improve the insulin resistance in previous studies and taking into account the side effects of metformin, a cinnamon supplement may offer a good and natural alternative to metformin as an insulin-sensitizing agent and thereby improve the ovulation in women with PCOS.3. Rational:The rarely and non-serious reported side effects of cinnamon along with the cost-effectiveness and availability lead to the need of exploring the effectiveness of cinnamon supplement as a complementary medicine for ovulation induction in women with PCOS.4.1 Aim:To determine the effectiveness of cinnamon supplement and clomiphene citrate (CC) combination on ovulation in women with PCOS.4.2 Objectives:Primary Objective:To compare the effectiveness of cinnamon supplement in combination with clomiphene citrate versus clomiphene citrate alone on ovulation in women with PCOS, in King Abdulaziz University Hospital in Jeddah 2018.Secondary Objectives:To measure the difference in insulin resistance after three months of cinnamon supplementation in women with PCOS in King Abdulaziz University Hospital in Jeddah 2018.To determine the effect of cinnamon and CC combination on menstrual cyclicity, approximated by menstrual frequency, during the study period, in women with PCOS in King Abdulaziz University Hospital in Jeddah 2018.To measure the pregnancy rate in women with PCOS in King Abdulaziz University Hospital in Jeddah 2018.To evaluate the quality of life in women with PCOS in King Abdulaziz University Hospital in Jeddah 2018.Materials and Methods Place of study:The study will be carried out in King Abdulaziz University Hospital, Obstetrics and gynecology clinics, in Jeddah 2018. Exclusion criteria:Current pregnancy or lactation.Current use of treatment of infertility.Established diagnosis of diabetes mellitus.Use of Insulin-sensitizing treatment within the past three monthsHormonal treatment involving estrogen or progesterone within the past three months.Known hypersensitivity to cinnamon.Use of statin medication.Any other supplements that contain cinnamon within the past month.BMI 35.Sample Size:To detect a clinically significant difference of 30% between the previously reported systematic review of ovulation rate (~46%) (9) with a one-sided 5% significance level and power of 80%, a sample size of 82 participants (41 per arm) is required. (Fleiss, Statistical Methods for Rates and Proportions, formulas 3.18 &3.19). Randomization:The participants will be randomized in 1:1 fashion using a computer program by trained assistance. Allocation concealment will be ensured using similar bottles labeled by letters A and B to receive either the combination of cinnamon supplement and clomiphene citrate or clomiphene citrate with placebo. The intervention allocation will be blind for both investigators and participants.5.6 Intervention:The Cinnamomum cassia  (C. aromaticum) capsules will be purchase from Spring Valley company (distributed by Wal-Mart Stores, Inc. USA) by the investigator. Placebo capsules will be prepared by Batterjee Pharma Company and will contain 450 mg of starch and 50 mg of cinnamon powder (to improve blindness regarding taste and odor). Shape, size, and color of placebo capsules will be completely similar to the cinnamon capsules.Cinnamon and placebo capsules will be provided to both groups monthly for 12 weeks. Participants will be required to consume two capsules twice per day after meals (2g/day). The last packages of capsules will be checked at the end of the month, and the number of remaining capsules will be counted; after that, new packages will be delivered to patients. All capsules will be given simultaneously with the clomiphene citrate medication. Participants will be asked to keep their normal lifestyle including daily food and physical activity level.The 2g dose of cinnamon is chosen based on published clinical trials in patients with PCOS (8,15,16,17). All participants in both groups will be followed for three months or until pregnancy confirmed. The three month-period has chosen based on a systematic review that showed the effect of cinnamon could be as early as 4 weeks and up to 18 weeks (31).5.7 Adherence:Compliance with diet and medications and interval progress will be monitored with monthly visits with the investigator or his trained assistances along with SMS reminder or WhatsApp messages. Also, participants will be asked to return all study packs (including empty bottles) at every monthly visit.5.8 Patient safety:Patients will be monitored monthly during the study period, and any occurrence of adverse events will be recorded.5.9 Study Outcomes:Primary outcome: Progesterone level > 3ng/mL (ovulation confirmation) or pregnancy confirmed.Secondary outcomes: Changes in insulin resistance, menstrual cyclicity, pregnancy rate and fertility quality of life at the end of the study in comparison with the baseline values. Procedure:The study will be initiated after obtaining approval from the Unit of Biomedical Ethics in King Abdulaziz University and approval from Saudi Food and Drug Authority. All patients will be explained the procedure and risks involved in common, understandable languages and a written informed consent will be obtained. First visit: Patients meeting inclusion and exclusion criteria will be evaluated during the early follicular phase (day 3-7) after a spontaneous or induced menses (medroxyprogesterone acetate 10 mg twice?daily for 5 days) for: Baseline blood work:o (Hormone profile: FSH, LH and testosterone levels).o In day 21 (luteal phase) patients will be tested for progesterone level.o Insulin resistance using homeostasis model of insulin resistance [HOMA-IR] and Quantitative Insulin Sensitivity Check Index [QUICK-I].? QUICK= 1 / (log(fasting insulin  µU/mL) + log(fasting glucose mg/dl))? HOMA-IR= (FPI(mU/l) Ãâ€" FPG (mmol/l))/22.5 Height and weight will be measured and recorded for body mass index (BMI). Diagnosis of oligo-/anovulation will be based on a menstrual pattern of oligo/amenorrhoea (cycle >35 days) and/or a low mid-luteal serum progesterone concentration. Hyperandrogenaemia will be diagnosed either clinically (acne/hirsutism) or biochemically (testosterone ?2.5 nmol/l).Last Visit: At the end of three months, all subjects will be re-evaluated during the early follicular phase (day 3-7) after a spontaneous or induced menses for: Baseline blood work:(Hormone profile: FSH, LH, testosterone levels).o In day 21 patients will be tested for progesterone level.Insulin resistance using homeostasis model of insulin resistance [HOMA-IR] and Quantitative Insulin Sensitivity Check Index [QUICK-I].Height and weight for body mass index (BMI).Menstrual cyclicity, approximated by menstrual frequency, (number menses/number months observed).Pregnancy rate using positive urinary hCG and ultrasound detection of the gestational sac.Assessment of dietary intake: To assess participants' dietary intake, a 24-h food recall will be collected three times during the study (at baseline, middle and end of study). Patients will complete food descriptions including food and drinks (brand names), food preparation (ingredients) in detail as much as possible in the last day. Pictures of food commonly consumed in Saudi Arabia, together with a set of common household measurement tools (glass, cup, soup bowls, plates, teaspoon and tablespoon) will be provided to assist subjects in estimating the portion sizes of the food. Assessment of physical activity levels: IPAQ will be applied to assess the physical activity level of participants. The IPAQ form comprises walking, moderate- intensity and vigorous-intensity activity and will be expressed as metabolic equivalents per minute (MET-min) per week. The levels of physical activity will be categorized into low, moderate and high, based on the IPAQ criteria. Statistical Analysis:Statistical analysis will be performed using SPSS 25. Data will be expressed as mean  ± SD for continuous variables and percentage for non-continuous variables. Normality tests will be assessed through Shapiro-Wilk tests carried out on each parameter before analysis. Intention-to-treat (ITT) analysis will include all randomized subjects, regardless of whether or not they received the study treatments. Per protocol (PP) analysis will include all randomized subjects who received the study drug and were not lost to follow-up. Participants who lost to follow-up will be assumed neither to be pregnant nor to have ovulation in the ITT analysis.Relative risk, relative risk reduction, Number Needed to Treat and Number Needed to Harm will be calculated at 95% confidence interval. Study variables:VariableOperational definitioni.e., indicatorScale of measurementOvulationProgesterone level in capillary bloodContinuous:Progesterone level ;3ng/mLInsulin resistanceHOMA-IR and QUICK-IOrdinal:HOMA-IR Healthy Range: 1.0 (0.5–1.4)?Less than 1.0 means insulin-sensitive which is optimal.?Above 1.9 indicates early insulin resistance.?Above 2.9 indicates significant insulin resistance.QUICK-I range between 0.45 in healthy individuals and 0.30 in diabetics.Lower values reflect greater resistance with values below 0.339 indicating insulin resistance. Menstrual cyclicityMenstrual frequencyContinuous:(No. of menses/ No. of month)Pregnancy rateNo. of pregnancies including live births, induced abortions, and fetal deaths per 1,000Continuous:(Number of pregnancies including live births, induced abortions, and fetal deaths / Number of women aged 15 – 44 years) Ãâ€" 1,000Quality of lifeInfertility quality of life questionnaire Ordinal Ethical considerations:Approval from the Unit of Biomedical Ethics in King Abdulaziz University will be obtained before the start of the study.Informed consent of the participants will be considered an essential prerequisite for enrollment in the study.This study will be registered in Saudi Food and Drug Administration (SFDA) and at Clinicaltrial.gov website.Confidentiality of the response of the participants will be ensured by keeping the collected data secured and used only for the study purpose.Study duration:The recruitment period will be three months; each arm group will be followed for three months, the total study duration with data analysis and writing the thesis will be ten months.Table1: study time frame

Apa Snippets and Style Writing Pointers to Help Tcl Nursing

The abstract should be one paragraph of no more than 120 words on a page by itself. Other features of an abstract include double-spacing, one inch margins without indentation, and Times Roman or Courier 12 font. APA Snippets and Style Writing Pointers to Help TCL Nursing Students Write Excellent Papers The aim of this article is to discuss the varieties of pain assessments, and to determine under which circumstances each assessment is most appropriate. Pain is rated differently by each patient, and is subjective to many factors in the patient’s life, including but not limited to culture and past experiences with pain. Since pain may have an effect on all aspects of a patient’s life, healthcare providers must strive to most properly identify the amount of pain in order to properly control it. Symptoms such as â€Å"crying, elected temperature, facial grimacing, groaning, moaning, guarding of the affected area, loss of sleep, nausea, vomiting, restlessness, rise in blood pressure, rise in respiratory rate, and tachycardia† are typical indicators that a patient is in pain; but how much pain? Healthcare providers, namely nurses, use a system of scales and work with the patient to rate their pain. Nurses must be aware of the different pain rating scales available in order to most accurately assess a patient’s pain level. A nurse must not only be able to determine which pain scale is most appropriate for the patient to identify and express his or her pain level, but also be able to carefully interpret and evaluate the scores. For example, the pain scale that is appropriate for a fully functioning adult will differ from one that is appropriate for a child and differ from one that is appropriate for a patient affected by dementia, etc. A variety of unidimensional scales quantify the intensity of the pain and are more simple; while multidimensional scales do so plus identify the pain quality, uration, and any relieving factors, and are more complex. If time permits, a nurse may choose to use a combination of pain assessments in order to be as thorough as possible. Nurses can implement the use of a variety of pain assessments reviewed in this article into their patient’s shift assessment. A nurse may choose to use a more complex, thorough multidimensional scale upon his or her patient’s admi ssion assessment, and then use a more simple, quick unidimensional scale upon his or her patient’s regularly scheduled shift assessments. Regardless of the type of scale being used, a nurse must always use â€Å"effective and sensitive communication with the patient to assist in expressions of pain. † Nurses must listen to their patient and accurately document their patient’s subjective descriptions of the pain. Also, nurses should allow their patients ample amount of time to respond to their questions, which should also be open-ended questions. After the doctor has reviewed the pain assessment and ordered meds, the â€Å"effects of analgesia should be monitored closely and recorded in nursing notes to maintain continuity of patient care. In conclusion, nurses should assess the patient’s abilities, then choose and tailor the pain assessment to the patient’s needs. Assessments are of immeasurable importance as they have a direct effect on the patient’s quality of life. The more extensive of knowledge a nurse has of the plethora of pain assessments to choose from, the more he or she ca n also select the most appropriate pain scale per the patient, which in turn will have the greatest impact on the patient’s progress. Resources In the text, cite resources used to prepare the paper. Cite references in parentheses at the end of the sentence, but before the period (Burckhalter, 2009). Give the author’s last name, a comma, and year of publication. When citing the same resource several times in the same paragraph, it is necessary to cite the author every time but the year only once (Burckhalter). Cite a page number only for quotes. For works by two authors, name both every time and use an ampersand (Merwin Sapp, 2008). For works with three to five authors, name all in the first citation (Bible, Simmons, Beasley, 2009). In later citations, cite only the first author’s name and the term et al. nd the year. For works of six or more authors, cite only the first author’s surname followed by et al. and year in the text, but identify all the authors in the reference list (Slyh et. al, 2007). When a group or organization is the author, cite the group’s name followed by the year (TCL Nursing Faculty, 2008). References Cite all resources used in the text. For the reference list, center the word â€Å"References† at the top of the last page. Double space the entries and indent all lines, except the first line of each entry, five to seven spaces. Alphabetize the list by the authors’ surnames. Include only the initials and last name of authors, not full names or professional initials. Examples of citations are in the sample reference list with this paper. Note the examples of punctuation and capitalization. Journal citations capitalize only the first word of the article title. All major words in the title of the journal are capitalized. The name of the journal and the journal volume are italicized, but the issue and page numbers are not italicized. For books, the reference citation begins with the author or authors, followed by the date of publication. Only the first word of a book title is capitalized. Book titles are italicized. The publisher’s location is cited by city and state, a colon, and the name of the publisher. Electronic citations use the same guidelines indicated above. Do not place a period at the end of an electronic address. Email sent from one to another should be cited as personal communication and is not included in the reference list. Information from classroom lectures are also personal communication (S. Beasley, April 14, 2009). Conclusion A paper should have a conclusion which restates the purpose of the paper, states the major points, and gives recommendations for practice and/or research. This paper has presented suggestions for helping TCL nursing students write excellent papers. A student may also consider using this document as a foundation for a paper. The margins are set correctly. References American Psychological Association. (2009). Publication manual of the American Psychological Association (6th ed. ). Washington, DC: Author. Author, C. K. (2007, September 30). Title of a journal article. Imprint, 21, 35-40. Retrieved from Academic Search Premier database. Benton Foundation. (1998, July 7). Barriers to closing the gap. In Losing ground bit by bit: Low-income communities in the information age (chap. ). Retrieved from HYPERLINK â€Å"http://www. Benton. org/Library/Low-Income/two. html† http://www. Benton. org/Library/Low-Income/two. html Bible, C. M. , Simmons, A. W. , Beasley, S. G. (2009). Summer events at TCL. Journal of Nursing Education, 46(8), 89-96. Burckhalter, T. S. (February 2009). Beaufort’s best nursing students. Nurse Educator, 53 , 46-65. McPheron, S. (2009). Mapping families. Imprint, 23(4), 14-27. Merwin, D. M. Sapp, M. P. (2008). Where to find happiness. Journal of Divine Meditation, 38(5), 35-42. Simmons, A. (2007). Frustrations in nursing education. In M. Sapp (Ed. ), Success for nursing students (pp. 13-29). Beaufort, SC: Technical College of the Lowcountry. Slyh, K. P, Merwin, D. M. , Sapp, M. L. , Bible, C. W. , Slachta, P. A. , Simmons, A. W. (2007). What nursing students want. Journal of American Community Colleges, 26(3), 32-46. Nursing Faculty. Technical College of the Lowcountry nursing student handbook (2008). Beaufort, SC: Author. Thomas, C. L. (Ed. ). (2008). Taber’s cyclopedic medical dictionary (21st ed. ). Philadelphia: F. A. Davis. APA SNIPPETS AND STYLE WRITING PAGE * MERGEFORMAT 7 PAGE Apa Snippets and Style Writing Pointers to Help Tcl Nursing The abstract should be one paragraph of no more than 120 words on a page by itself. Other features of an abstract include double-spacing, one inch margins without indentation, and Times Roman or Courier 12 font. APA Snippets and Style Writing Pointers to Help TCL Nursing Students Write Excellent Papers The aim of this article is to discuss the varieties of pain assessments, and to determine under which circumstances each assessment is most appropriate. Pain is rated differently by each patient, and is subjective to many factors in the patient’s life, including but not limited to culture and past experiences with pain. Since pain may have an effect on all aspects of a patient’s life, healthcare providers must strive to most properly identify the amount of pain in order to properly control it. Symptoms such as â€Å"crying, elected temperature, facial grimacing, groaning, moaning, guarding of the affected area, loss of sleep, nausea, vomiting, restlessness, rise in blood pressure, rise in respiratory rate, and tachycardia† are typical indicators that a patient is in pain; but how much pain? Healthcare providers, namely nurses, use a system of scales and work with the patient to rate their pain. Nurses must be aware of the different pain rating scales available in order to most accurately assess a patient’s pain level. A nurse must not only be able to determine which pain scale is most appropriate for the patient to identify and express his or her pain level, but also be able to carefully interpret and evaluate the scores. For example, the pain scale that is appropriate for a fully functioning adult will differ from one that is appropriate for a child and differ from one that is appropriate for a patient affected by dementia, etc. A variety of unidimensional scales quantify the intensity of the pain and are more simple; while multidimensional scales do so plus identify the pain quality, uration, and any relieving factors, and are more complex. If time permits, a nurse may choose to use a combination of pain assessments in order to be as thorough as possible. Nurses can implement the use of a variety of pain assessments reviewed in this article into their patient’s shift assessment. A nurse may choose to use a more complex, thorough multidimensional scale upon his or her patient’s admi ssion assessment, and then use a more simple, quick unidimensional scale upon his or her patient’s regularly scheduled shift assessments. Regardless of the type of scale being used, a nurse must always use â€Å"effective and sensitive communication with the patient to assist in expressions of pain. † Nurses must listen to their patient and accurately document their patient’s subjective descriptions of the pain. Also, nurses should allow their patients ample amount of time to respond to their questions, which should also be open-ended questions. After the doctor has reviewed the pain assessment and ordered meds, the â€Å"effects of analgesia should be monitored closely and recorded in nursing notes to maintain continuity of patient care. In conclusion, nurses should assess the patient’s abilities, then choose and tailor the pain assessment to the patient’s needs. Assessments are of immeasurable importance as they have a direct effect on the patient’s quality of life. The more extensive of knowledge a nurse has of the plethora of pain assessments to choose from, the more he or she ca n also select the most appropriate pain scale per the patient, which in turn will have the greatest impact on the patient’s progress. Resources In the text, cite resources used to prepare the paper. Cite references in parentheses at the end of the sentence, but before the period (Burckhalter, 2009). Give the author’s last name, a comma, and year of publication. When citing the same resource several times in the same paragraph, it is necessary to cite the author every time but the year only once (Burckhalter). Cite a page number only for quotes. For works by two authors, name both every time and use an ampersand (Merwin Sapp, 2008). For works with three to five authors, name all in the first citation (Bible, Simmons, Beasley, 2009). In later citations, cite only the first author’s name and the term et al. nd the year. For works of six or more authors, cite only the first author’s surname followed by et al. and year in the text, but identify all the authors in the reference list (Slyh et. al, 2007). When a group or organization is the author, cite the group’s name followed by the year (TCL Nursing Faculty, 2008). References Cite all resources used in the text. For the reference list, center the word â€Å"References† at the top of the last page. Double space the entries and indent all lines, except the first line of each entry, five to seven spaces. Alphabetize the list by the authors’ surnames. Include only the initials and last name of authors, not full names or professional initials. Examples of citations are in the sample reference list with this paper. Note the examples of punctuation and capitalization. Journal citations capitalize only the first word of the article title. All major words in the title of the journal are capitalized. The name of the journal and the journal volume are italicized, but the issue and page numbers are not italicized. For books, the reference citation begins with the author or authors, followed by the date of publication. Only the first word of a book title is capitalized. Book titles are italicized. The publisher’s location is cited by city and state, a colon, and the name of the publisher. Electronic citations use the same guidelines indicated above. Do not place a period at the end of an electronic address. Email sent from one to another should be cited as personal communication and is not included in the reference list. Information from classroom lectures are also personal communication (S. Beasley, April 14, 2009). Conclusion A paper should have a conclusion which restates the purpose of the paper, states the major points, and gives recommendations for practice and/or research. This paper has presented suggestions for helping TCL nursing students write excellent papers. A student may also consider using this document as a foundation for a paper. The margins are set correctly. References American Psychological Association. (2009). Publication manual of the American Psychological Association (6th ed. ). Washington, DC: Author. Author, C. K. (2007, September 30). Title of a journal article. Imprint, 21, 35-40. Retrieved from Academic Search Premier database. Benton Foundation. (1998, July 7). Barriers to closing the gap. In Losing ground bit by bit: Low-income communities in the information age (chap. ). Retrieved from HYPERLINK â€Å"http://www. Benton. org/Library/Low-Income/two. html† http://www. Benton. org/Library/Low-Income/two. html Bible, C. M. , Simmons, A. W. , Beasley, S. G. (2009). Summer events at TCL. Journal of Nursing Education, 46(8), 89-96. Burckhalter, T. S. (February 2009). Beaufort’s best nursing students. Nurse Educator, 53 , 46-65. McPheron, S. (2009). Mapping families. Imprint, 23(4), 14-27. Merwin, D. M. Sapp, M. P. (2008). Where to find happiness. Journal of Divine Meditation, 38(5), 35-42. Simmons, A. (2007). Frustrations in nursing education. In M. Sapp (Ed. ), Success for nursing students (pp. 13-29). Beaufort, SC: Technical College of the Lowcountry. Slyh, K. P, Merwin, D. M. , Sapp, M. L. , Bible, C. W. , Slachta, P. A. , Simmons, A. W. (2007). What nursing students want. Journal of American Community Colleges, 26(3), 32-46. Nursing Faculty. Technical College of the Lowcountry nursing student handbook (2008). Beaufort, SC: Author. Thomas, C. L. (Ed. ). (2008). Taber’s cyclopedic medical dictionary (21st ed. ). Philadelphia: F. A. Davis. APA SNIPPETS AND STYLE WRITING PAGE * MERGEFORMAT 7 PAGE

Genetics Essay Example | Topics and Well Written Essays - 750 words - 1

Genetics - Essay Example This was done to obtain the RAD51+/- cells (EMBO, 1998). Then, the RAD51+/- cells have been transpected with conditional human Rad51 expression constructs to obtain RAD51+/- cells carrying the constructs at random sites on the chromosome (RAD51+/-/HsRAD51)." (, 1998) Finally, the RAD51 construct that contained the blasticidin was then transpected into "several RAD51+/-/HsRAD51 clones to isolate RAD51-/-/HsRAD51 clones." (EMBO, 1998) The targeting process is shown in figures one and two. In order to target the necessary genes, a probe and southern blot analysis were used to indicate the knockout constructs. Samples of the cells and genetic material were loaded onto five different lanes and were combined with SDS-polyacrylamide gel. The three samples were the wild-type DT40, which was loaded onto lane 1, the RAD51+/-, which was loaded onto the second lane, a RAD51+/- clone that contained the human Rad51 transgene, which was loaded onto the third lane, #110 RAD51-/- clone was placed onto the fourth lane, and a human B lymphocyte line Ramos was loaded onto the fifth lane (EMBO, 1998). The targeting probe was constructed of A chicken RAD51 (GdRAD51) cDNA, and this probe was used to isolate the genomic clones that were of the RAD51 locus. These clones were, in part, sequenced to determine the position of the exons. Approximately "5.5 kb of the GdRAD51 locus was then amplified by long-range PCR using genomic DNA from DT40 as a template." (EMBO, 1998) Targeting events were determined by using southern blot analysis. From the targeting process, we also have found out that when RAD51 is deleted, a buildup of cells occurs in the g2/m phase, and the cells then die (EMBO, 1998). - Propose an alternative conditional targeting strategy for the Same paper (250 words 20%) Another tactic could have been used to target the RAD51 gene and could possibly achieve the same results in the experiment. This is known to researchers as siRNA. Though this technology is fairly new, it is effective at targeting certain genes, nonetheless. According to a particular FAQ concerning siRNA, it is stated that siRNA is an effective technology in knocking out genes, as well as testing resistance or sensitivities to certain drugs. Just like the method of gene targeting, certain gene sequences can be achieved in humans or in mice, so long as these genes are correctly aligned ( While a bit less labor intensive, the same results can possibly be achieved in the experiment using siRNA. After all, the technology has been designed to reach a common goal. This goal is to experiment and further the research in genetics. - Discuss advantages and disadvantages of siRNA versus Gene Targeting as tools for Reverse Genetics (500 words 30%) When working with reverse genetics, there are two tools that are known for their effectiveness. These tools are siRNA and gene targeting. Both of these tools use in depth technologies to aid in

Progress paper Essay Example | Topics and Well Written Essays - 1000 words

Progress paper - Essay Example Also, the project is worth undertaking given the huge potential that it has. Thus the E-coin project will be well out thought venture for Goldman Sachs given the numerous investments. Moreover, the internet usage of E-coin continues to show a tremendous sign of growing over the past few years. The return for Goldman to investment in E-coin is invaluable if E-coin becomes one of the most popular online payment systems. Strategy on putting the advert about E-coin technology that Goldman seeks to introduce was crafted. This involved how the technology would be advertised. In doing this, some of the reputable media organizations were approached to do the advert. The department involved in executing this task was the marketing department. The advert was to be done in a full-page paper in magazines as well as through TV adverts and radio adverts. Further, also, negotiations were done with the supplier companies that would be tasked with the production of the technology. The negotiations entailed a meeting at the company headquarters where resolutions were arrived at. Among others, the resolutions included the manner in which the technology would be secured and made easy to use, that is, user friendly. The down payments for the technology were done. Further, an agreement was made that the IT team from Goldman Sachs would work collaboratively with the company’s IT team. The work at this stage is more of transition work that I am doing to ensure that Goldman Sachs properly adopts the E-coin payment system. At this stage, we have acquired a number of equipment to see the adoption and implementation of technology. We are bringing experts also on board at this stage so as to implement the technology successfully. Therefore, lots of resources are bing deployed at this stage to ensure successful execution of task. Deploying resources means that we

Planning and Controlling Purchases and Materials Usage Essay

Planning and Controlling Purchases and Materials Usage - Essay Example Budgeting is an important tool adopted by the company for planning and controlling purchases and materials usage. Sales forecast is the basis for planning and budgeting after carefully considering various factors such as capacity available and product mix. Since inventory involves significant investment, keeping it at an optimum level is very important for controlling cost. Material requirement planning is carried out in line with the production schedule for the year. Importance of study Home appliances market is very competitive. The company’s products face stiff competition from the products imported from China and Japan. The company is under tremendous pressure to ensure quality of its products and make improvements to maintain its market share. The company focuses on ‘planning and controlling purchases and materials usage’ with a view to bring down the cost of production to make its products more competitive in the market. The main objective of inventory plann ing is to keep the investment low for reducing the interest cost. The inventory can be classified into three categories. 1. Raw materials 2. Components purchased for assembly 3. Finished products Purchase and production departments along with stores are responsible for planning and controlling of inventory of raw materials and components and the production department is responsible for planning and controlling of material usage. There are varieties of household appliances manufactured and marketed by the company. Since most of the appliances are electrically operated, quality of materials purchased is very important, keeping in view the safety of the customers. Timely supply of raw materials and components avoid disruptions in production schedule usually. Order size is decided based on factors such as price, usage and lead time required for supply of materials. The materials should be purchased without compromising quality of materials at the cheapest cost in line with the purchase policy of the organization. This requires product knowledge and negotiating skills on the part of purchase manager. Planning and control of purchases is closely relating to storing of raw materials and component part before issue to various production or assembly units of the organization. Inventory planning is therefore is an important aspect in planning and control of purchases in the organization. According to Michalski (2008) â€Å"The basic financial inventory management aim is holding the inventory to a minimally acceptable level in relation to its costs. Holding inventory means using capital to finance inventory and links with inventory storage, insurance, transport, obsolescence, wasting and spoilage costs.† Planning and control of usage of materials in production department depends upon the regular supply of materials by the stores department, efficiency in production by the workers and keeping generation of scrap at minimum level. At the same time, requirements as p er the production schedule and changes thereof for a week need to be informed in advance to the stores for closely monitoring the stock levels of various raw materials and components for making necessary requisition to purchase department for initiating purchase process. Though reorder levels are fixed for various materials, uncertainties in lead time and sudden demand for appliances should be informed to the purchase and

Research paper Example | Topics and Well Written Essays - 1250 words - 3

Research Paper Example In the last work by Langston Hughes that is I, too were identified varied themes, symbols and metaphors. This paper intends to unravel the commonality of those themes, symbols and metaphors in the two short stories by the author, which are Father and Son and Cora Unashamed. As was traced in the poem I, too by Langston Hughes, the short story Father and Son by the same writer delineates the atrociousness and brutality of the Jim Crow rules, but in a more detailed and intricate manner. Father and Son is a story about a Georgia white man Colonel Thomas Norwood who keeps a black woman Nora for a mistress and fathers five children by her. The story reveals the psychological and social might of the Jim Crow laws. In the story, Colonel Tom is showed to harbor feelings of constrained affection and liking for his sons from Cora, as is natural for any man. However, his allegiance to the Jim Crow system is evinced to be more doughty and mightier than his commitment to the voice of human feeling s within him. He not only tends to publically deny his children from his black maid Cora, but considers an open profession of affection by his son Brat to be a mark of dishonor and disgrace. As in I, too, in Father and Son, Hughes exposes the absurdity and fickleness of Jim Crow laws, which allow a white man to get into the most intimate of relationships with a black girl and to father sons by her, yet, do not allow one to socially and legally recognize the relationships that such intimacies and acts entail. As in other works of Hughes, the register attributed to the black characters further exposes the bestial and subhuman level to which the blacks character are supposed to stoop in Jim Crow America, replete with invectives like nigger, darkie and yard-nigger. In Father and Son, Hughes elaborately shows the decorum and mannerisms which the black dependants were expected to follow in subservience to Jim Crow norms that he alludes to in I, too. The black slaves owned by Colonel Tom a re never allowed to enter his home from the front door or to roam about in his inner chambers, irrespective of their long service to him or their relationship to him. The blacks were always to approach his home from the backdoor and allowed to gather only in the kitchen. Like a dog, they were expected to maintain a respectable distance from and decorum with their white master. The story also reinforces the social status attributed to black characters in Hughes’ other works. All the black characters are shown to be serving in menial positions. Colonel Tom do tries to be good to his children by extending to them educational and other opportunities and facilities. However, the magnanimity of his concern for his children never dares to cross the boundaries marked by Jim Crow laws. The story also reveals the fear of marginalization of the whites, as in Hughes’ other works. When Brat, the youngest son of Colonel tries to rebel against the constraints of segregation and recla im his relationship with his father, the system comes crashing down on him and his brother. Cora Unashamed is one of the masterpieces of Langston Hughes. Though the writer predominantly repeats the themes, symbols and metaphors in the story with which he deals with in his

What are the criteria Postgraduate students use to determine career Dissertation

What are the criteria Postgraduate students use to determine career choice - Dissertation Example y 3.6 Ethical Considerations 3.7 Research Limitations Chapter 4: Findings and Analysis 4.1 Introduction 4.2 Relative Importance of Factors 4.3 Impact of Internal Factors on the External Factors 4.4 Impact of Internal Factors 4.4.1 Impact of Family Factors 4.4.1.1 Parental Influence 4.4.1.2 Parental Guidance 4.4.2 Impact of Socio-Cultural Factors 4.4.2.1 Cultural Factors 4.4.2.2 Social and Gender Sterotypes 4.4.3 Impact of Emotional Factors 4.4.3.1 Impact of Anxiety Levels 4.4.3.2 Impact of Life View 4.4.3.3 Self Concept and Identity 4.4.4 Impact of Self-Efficacy 4.4.5 Impact of Personal Interest 4.4. 6 Impact of Personality Factors 4.5 Impact of External Factors 4.5.1 Impact of Image of the Institute 4.5.2 Impact of Marketing Activities 4.5.3 Impact of Resources and Facities of the Institute 4.5.4 Impact of Culture 4.5.4.1 Impact of Policies and Procedures 4.5.4.2 Impact of Classroom Teaching Methods 4.5.5 Impact of Placement and Campus Recruitment 4.5.6 Impact of Financial Support 4 .5.7 Impact of Research Funding Available to the Institute 4.5.8 Impact of Location of the Institute Chapter 5: Conclusions 5.1 Summary of Research Findings 5.2 Limitations of Research Scope for Future Research List of Figures and Tables Figure 1: Parental Influence Figure 2: Impact of Parental Guidance Figure 3: Impact of Culture Figure 4: Impact of Socal and Gender Sterotypes Figure 5: Impact of Anxiety Levels Figure 6: Impact of Life View Figure 7: Awareness of Life’s Aims Figure 8: Ability to Gather the Information Figure 9: Ability to Analyse the Information Figure 10: Awareness of Interests and Aptitude Figure 11: Impact of Personality Factors Figure12: Impact of Image of Institute Figure 13: Impact of Marketing and Promotional Activities Figure 14: Impact of Resources and... The current research is aimed to assess the important factors which influence the postgraduate students in management to determine their career choices. The research was conducted among 40 management students who were selected in a random manner from the management course in X institute. The research was conducted using quantitative survey questionnaire that was sent and collected using emails. It was found that Promotional Activities of the Institute, Image of the Institute, Placements and Alumni record of the institute and Resources and Facilities of the Institute comprised of the most important factors that were used by the students to assess their career choices. In addition, internal factors like parental influence, awareness of life aims and interests, parental guidance and culture were found to be importance influencers in the career decision-makig process. The research also found that factors like image of the institute is greately influenced by parental guidance, parental in fluence and culture, and importance of placement record as a criteria of career choice is highly correlated with both family and personal interest and self-identity factors. The research analyses the findings with the aim of filling the gaps in the available research and providing further inspiration for future research in the same area.Higher Educational Institutes (HEI) are facing an increased competition in terms of getting governmental or private funding for research and also suffer from a dwindling application numbers from students

Measurement and Instruments for a Quantitative Research Plan Coursework - 1

Measurement and Instruments for a Quantitative Research Plan - Coursework Example It is against this background that the levels of measurement to be selected for the study would follow the principle of ordinal scale of measurement. This means that grading shall be assigned to the students according to their performance rate. The levels of measurement shall therefore be a grading system to be tagged or labeled as ‘A’, ‘B’, and ‘F’. As an ordinal scale, these levels of measurement shall be directly linked or related to the performance rate of students. In the given situation, students who score grade ‘A’ shall be given the classes they applied for whiles students who score ‘B’ shall be placed in one class below the class they applied for. Finally, students scoring ‘F’ shall be rejected a place in the schools. Given the levels of measurement that will be used in the study, the researcher shall design a multiple-indicator instrument or test. The multiple-indicator instrument will be used because it has the potential of ensuring validity on a number of scales. Cherry (2012) explains that â€Å"When a test has content validity, the items on the test represent the entire range of possible items the test should cover.† This means that the study shall ensure content validity by setting out questions to cover all aspects of the course content to be given to the students (Rodchua, 2009). By so doing, the test items shall represent the entire range of possible items because no aspect of the course content shall be left out. On empirical validity, it has been said that for empirical validity to be achieved, it is important that the researcher creates a criteria with which the results obtained can be compared for confirmation (Cheng, 2009). In the present study, the empirical validity can be measured by means of comparing the scores of the test, to the continuous assessment results that the students will bring from their respective

A movie of social relevance - Sigwa Essay Example for Free

A movie of social relevance Sigwa Essay Sigwa began with Dolly (Dawn Zulueta, Megan Young) returning to the Philippines to look for her long lost daughter. She was a Filipino-American journalist sent to the Philippines in the 1970’s to write about the rising social unrest at that time. But later, she found herself being recruited to the revolutionary and underground youth group Kabataang Makabayan. While looking for her daughter, Dolly is also reunited with her fellow comrades, almost 40 years since they last saw each other. They were Rading (Jaime Pebanco, Jay Aquitania) an urban poor out-of-school-youth activist, Oliver (Tirso Cruz III, Marvin Agustin) an arrested student activist who later became a presidential spokesman, Azon (Gina Alajar, Lovi Poe) who grew frail and weak caused by the trauma of the rape when she was arrested, and Cita (Zsa Zsa Padilla, Pauleen Luna), once a student activist now a leader of the New People’s Army. Sigwa was simply amazing. The cast was great as well as their portrayal of their roles. It seemed so real. After watching Sigwa, I have realized that the movie provided more than just a retrospect of Philippine history. It also brought me back to the First Quarter Storm of the year 1970, where I have witnessed Martial Law through the lives led by six young activists. It is more than just a commemorative film: it had relived the tempest of our country’s history and allowed us to reflect about its significance in the present. Sigwa gave us only a glimpse of how the Filipinos in the past have struggled to attain democracy, to relive the history of the Filipinos struggle against Martial Law, and to show our continuing aspiration for democracy, peace and justice. And yet through the movie, I had reflected from the country’s history how we continuously try to reach total democracy today; that the recurring problems about democracy that we are facing today are also the same in the past; watching the movie enlightened me more about the Martial Law and the events that took place during the First Quarter Storm.

A Study On Music Videos

A Study On Music Videos Music videos have a big impact on how the world is viewed today. Many videos disrespect women and portray them in a negative way. Most videos stereotyped race, womens body types, and skin color. These videos have influenced the younger generation lives and how they should act. Mainly all music videos teach the youth unhelpful information that they do not need to know in their everyday lives. Today individuals minds are twisted with images from songs, melodies, and lyrics in which music videos have influenced and made a big impact on peoples attitude and there lifestyles; these images shape the way people think in their everyday lives. Regardless of what an artist is singing or rapping about in their music video you will always see a sexual hint. Clearly you can see women being portrayed in music videos in sexual way this may not affect how you feel at first, but after seeing this happen over and over in different music videos may makes people treat women with less respect. How women are portrayed in this way comes with many consequences. Most rap videos today show sexually disapproving and harmful depictions and treatment of women, mainly women of color. Women are stereotyped in music videos because they are often portrayed as hypersexual, selfish, and amoral, examinations of music videos have publicized this. They are also portrayed as non-educated and very getable. By watching music videos people might bring to a close that the world is made up of light skin and white women. Disregarding the massive series of colors in between, a lot of women in music videos today are light skin, white, Asian, and Latina and it could be hard on women and young girls who dont like this. Their representation frequently overemphasizes their sexualized, physical looks and places them as attractive objects rather than active agents in the music videos. Most artists nowadays use light skin, Asians, and Latinos in their videos because they think they will lose viewers. These artists that havent used other races of women in their videos have already lost a lot of views because there are different races of women all over the world; people dont want to keep seeing the same thing over and over. Artist try to go with what they think everybody else would like to see instead of what they like. Women bodies today are very important to society. Television shows, movies, music videos, and magazines also play a big part in displaying women bodies in a negative way. These types of sources portray what the media thinks is the ideal of a perfect female body. Most men think that light skin women are the pretties, and that they have the curviest bodies and big behinds. There are also other women that have the same types of bodies, but they are rarely showcased in the videos. America needs to include women with different types of figures. By doing t his it would seriously expand the worlds thoughts and definition of what true beauty should look like. When women go out to clubs, or just out to have a good time men think that they can just walk up to them and grab them and say anything they want. Most women in music videos are always half naked, dancing in an inappropriate manner, and are insulted in different ways. By the women in these videos acting in this way it shows the world that all women are the same and they really are not, because most music videos have the same concept. So many music videos display these kinds of actions, and men dont realize that these videos are not real and they cant treat women with disrespect. The media have affected young girls today on becoming thinner. Half of Americans basic school students between the first and third grades are trying to become thinner. By the age of ten children are scared of being classified as overweight. Most young girls watch music videos and are influence that they are not beautiful, because there are always thin girls in the videos. When music videos showcase thin women all the time it makes young girls feel like they have to look a certain way. Young children shouldnt have to worry about problems like this at their age but people have forced so much on the youth and they become overwhelmed with these issues. Most music videos make women feel bad about the way they look, because of how the women look in them. The women in the videos are always skinny, white, Asian, or Latino anything but black, and if they are she is very light. What men fail to realize is that not all women look like this, and that they should put all types of women in their videos so viewers wont feel bad about their physical appearance. There are all different sizes, shapes, colors, and races of women, and to just limit the videos to certain races and skin color, and one body type makes women look at their self in a different way. It makes them wonder if men think that only women that look like this is beautiful than what about the rest of the women in the world, how do men look at them? The result that popular music has on children and young peoples behavior and emotions is a big concern today in society. Several of hip-hops well-known songs have influenced violence, drugs, alcohol, sex, disrespect for authority, and lack of respect for woman. The view and the result of musicvideomessages are important, as research has reported that it contacts to sexual messages, sexual stereotypes, and use of substances of violence in musicvideos might produce major changes in behaviors and attitudes of young viewers. There is a relationship between violence in music and the youth culture. For many young children and teenagers by listening to this music it creates an atmosphere that is harmful to their lives and education. Does violence in music videos cause violence in the youth culture? Yes it does because teenagers watch these music videos and act upon what they see. Most rappers make songs about using drugs and children look up to them and they imply that its okay to use drugs when really is not. Young children and teenagers in todays society are always looking for a role-model and some type of fashion to copy. A teenagers favorite types of music could be related to certain behaviors preformed in music videos. Children and teenagers rewinds songs and learn the lyrics. The youth culture will not become better into artists really think about who listens to their music and watches their videos the most, and think about what they are teaching the young people. When young girls watch music videos and see how women act and are disrespected over and over, most of them will grow up thinking that it is ok to let a men treat them with disrespect. What do boys think when they see these type of things displayed on television how women are portrayed as sex objects. Half of Boys that view music videos will grow up not caring about females feeling or how they treat them because most music videos show lack of respect for women. Children are losing their innocence from watching, listening, reading, and wearing the clothing they see in music videos. Parents shouldnt want their children studying violence, but with the technology today like headphones, and downloads they are unsure of what is going on. The mass media tells children that the artists in the music videos are not who they portray to be. African American females that spend more time watching music videos have a higher opportunity of drinking and having several sex partners, and more liable to test positive for marijuana. American teenagers use up about four and a half hours a day listening to music and studying music videos, According to American according to American Medical Association. 48% of Americans say violence in music should be regulated. In popular music parents are tired of suggestive, violent, lyrical content. There are so many music videos in the hip hop culture that stereotypes women in so many ways. In these videos women expose themselves in ways that you would never imagine. Nas feat. Braveheart Oochie Wally, Ludacris booty poppin, Jadakiss knock yourself out, 50 Cent disco inferno, and Nelly tip drill. Nellys video tip drill is the most degrading of women that I ever saw the lyrics and how the women carry themselves. Nellys music video Tip Drill really stereotypes women, in this video he says â€Å"I said it must be ya ass cause it aint ya faceI need a tipdrill, I need a tipdrill† (Nelly). This stereotypes that if a women has a big beheld than men really dont take their time to look at her face, they just want to see what her body looks like. A tip drill is another name for running a train on a girl in the video ali verse say â€Å"I said it aint no fun less we all get some I need a tipdrill, we need a tipdrill† â€Å"Now come on girl you know what we came here for Is You a tipdrill, we need a tipdrill† (Ali). The women in this video really dont care if they are being exposed â€Å"You lookin well in them shorts but they look better on the floor Cause yous a tipdrll, cause yous a tipdrill† ( Kyjuan). Women in this video are walking around Naked, letting the touch on them in any kind of way, touch on other women â€Å"Now ya see I want to let you ride but the rubber m ight slide Yous a tipdrill, girl you a tipdrill† (Murphy Lee). â€Å"Turn that ass up mama put that dip in ya back And let me tipdrill, just let me tipdrill† this videos degrade women and make other countrys look at us in a negative way. The girls in the video have a part and they say â€Å"It must be ya money, cause it aint ya faceYou a tipdrill, nigga you a tipdrill† â€Å"My apple bottom look right, I know you wanna bite Yous a tipdrill, I heard you was a tipdrill† I got you payin my bills and buyin automobiles Yous a tipdrill, nigga you a tipdrill â€Å"I know you a trick go spend that shit You old tipdrill, you monkeyass tipdrill â€Å". These videos degrade women and make other countrys look at us in a negative way; it makes men feel like they have power over women. Music videos in todays society have misled people to how the American culture should be viewed. Women are stereotyped all the time because other women want to expose their self in a negative way in music videos. If society try to put a stop to what going on in these videos there will be less valence, and abuse. If artist try to make music videos that are more positive, and stop putting stereotypes of women in their videos children would have someone to look up to. Sawa Kurotani, Learning what hip hops all about, December 16, 2008 Tuesday, http://www.lexisnexis.com/us/lnacademic/results/docview/docview.do?docLinkInd=truerisb=21_T7909056810format=GNBFIsort=RELEVANCEstartDocNo=1resultsUrlKey=29_T7909056813cisb=22_T7909056812treeMax=truetreeWidth=0csi=145202docNo=16 Delilah Cummings,The Effects of Hip Hop Music on Todays Youth, 10/31/03, http://media.www.msuspokesman.com/media/storage/paper270/news/2003/10/31/Perspectives/The-Effects.Of.Hip.Hop.Music.On.Todays.Youth-547432.shtml Policy StatementImpact of Music, Music Lyrics, and Music Videos on Children and Youth. Pediatrics 124.5 (2009): 1488-1494. Academic Search Complete. EBSCO. Web. 2 Dec. 2009. http://web.ebscohost.com/ehost/detail?vid=7hid=2sid=bf1584aa-9f34-4439-beb9-eb33944df1cc%40sessionmgr4bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9hAN=45407672 Peterson, Shani H., et al. Images of Sexual Stereotypes in Rap Videos and the Health of African American Female Adolescents. Journal of Womens Health (15409996) 16.8 (2007): 1157-1164. Academic Search Complete. EBSCO. Web. 2 Dec. 2009. http://web.ebscohost.com/ehost/detail?vid=13hid=2sid=bf1584aa-9f34-4439-beb9-eb33944df1cc%40sessionmgr4bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9hAN=27063114#db=a9hAN=27063114 2002-2009 DirectEssays.com, Portrayal of Women in Music Videos, All Rights Reserved http://www.directessays.com/viewpaper/103197.html 2002-2009 DirectEssays.com, the Female Body, the Media, an, All Rights Reserved. http://www.directessays.com/viewpaper/34603.html 2002-2009 DirectEssays.com. All Rights Reserved, Lyrical Violence, http://www.directessays.com/viewpaper/18773.html Joan Morgan (1999) sings of life in the USA, Boston New York, Sonia Maasik, and Jack Solomon Cheryl Wetzstein, Rap music perpetuates stereotypes of women, june 22, 2008 Sunday, http://www.lexisnexis.com/us/lnacademic/results/docview/docview.do?docLinkInd=truerisb=21_T8067453482format=GNBFIsort=RELEVANCEstartDocNo=1resultsUrlKey=29_T8067453495cisb=22_T8067453494treeMax=truetreeWidth=0csi=8176docNo=11 2002-2009 DirectEssays.com. All Rights Reserved. The Female Body, the Media, an, http://www.directessays.com/viewpaper/34603.html Nelly, Tip Drill, 11/25/03, music video, September, 16, 2007 http://www.muvids.com/2725_video_nelly_tip_drill

Admissions Essay: To Fly Alone :: Medicine College Admissions Essays

Admissions Essay: To Fly Alone "Dr. Johnson ... Dr. Johnson...." As I wearily walked down the artificially lit corridor, I realized it was my father's doctor being paged. I turned and ran towards the intensive care unit I had left a few minutes ago. The sterilized odor of the hospital overwhelmed me as I raced through a maze of white walls to confront his death. After bolting through heavy metal doors, I saw doctors and nurses rushing frantically around the room. I could only hear one sound. It filled the air and was audible above all the commotion and the heavy pounding of my heart. The monotonous beep of the monitor meant Daddy was gone forever. While sitting next to his cold body, I focused at the crimson drops, which stained the yellow linoleum floor and slowly remembered what a terrible ordeal the past six weeks of hospitalization had been. My Life had changed forever since the day I sped through traffic with my Dad shivering in the back seat next to my worried mother. I was scared to death without even knowing that the killer was Leukemia. Although the chemotherapy proceeded well, it gradually wore my father away. The first side effects were a loss of appetite accompanied by nausea and vomiting. His hair fell out next, and I could tell my Father's courage was beginning to waver. A look of pain and anguish had replaced his usual smile and with each passing day he looked more like my grandfather. It all seemed like a bad dream. While packing up hours after he had passed away, I found a note directed towards me. It was in Father's handwriting; blurry scribbles because the medicine made his hands shake. I sat down and cried because it said in Spanish, "My son, it is time for you to fly alone." It is hard to understand Dad's absence, and that he left on my 17th birthday. Although I miss him everyday I am grateful for all the time we spent together and everything my father taught me. He pointed me in the right direction and made me believe in myself. There is good in this beautiful world, and life will always receive my best effort. I will never be embarrassed by my heritage and will succeed. I know he is proud of me.

The Christian Perspective on Capital Punishment and Rehabilitation Ess

Abstract Christian’s hold three distinct perspectives on capital punishment, namely Rehabilitationism, Reconstructionism and Retributionism. Rehabilitationism is the view that death sentence should not be allowed for any crime; Reconstructionism holds that death penalty should be allowed for any serious crime; Retributionism recommends death sentence for some capital crimes. The last two positions share a somewhat similar view. This paper focuses on rehabilitationism. Proponents of this view comprise those who appeal to the Bible for justification and those who do not. The paper presents the arguments of those in the former group. Contrary to the view of the rehabilitationalists that the aim of punishment is reformatory or remedial, the paper argues that the aim of capital punishment is justice and a good society. Conceptualization of Capital Punishment and Rehabilitationism Capital punishment is the taking of an offender’s life for a crime which he has committed and found guilty of by a court or tribunal under law. For Etuk, capital punishment is the death penalty when it is executed after a due process of law carried out by a society’s duly constituted apparatus (2000, 6). It is distinguished from other forms of extra-legal killings such as shooting on sight of suspected criminals, assassinations, disappearance of persons carried out by state agents, among others. Capital punishment thus defined has existed in almost all civilizations and the modes of its execution have varied from country to country. Amnesty International in 1989 listed out the following modes of execution in current use: hanging, shooting, electrocution, lethal injection, gassing, beheading and stoning (Etuk, 6). In Nigeria, the most prominent me... ...ence†. SOPHIA: An African Journal of Philosophy, Vol. 2 No 1, 2000, pp 1 – 18. Geisler, N. L. Christian Ethics. Grand Rapids: Baker Book House, 1989. Ige, E.    â€Å"Death Penalty in the Dock: Seminar that Explores its Retention or Abolition†. Vanguard, November 1, 2002. Iwe, N. S. S. Socio-Ethical Issues in Nigeria. Oruowulu – Obosi: Pacific Publishers, 1991. Stamps, D. C. (ed.) The Full Life Bible Study. Grand Rapids: Zondervan Publishing House, 1992. Walvoord, J. F. & Zuck, R. B. The Bible Knowledge Commentary (Old Testament). USA: Cook communications Ministries, 1983. Walvoord, J. F. & Zuck, R. B. The Bible Knowledge Commentary (New Testament). USA: Cook communications Ministries, 1983.

Music Is Cool!!! :: essays research papers

I love music my TWO greatest type of genries are Rap and Alternative. I was really surprised how great that DR. Dre did! I think that Eminem and dre are great. Eminem is definetlt a new era of a rap star he is puttin out some mad skillz. Papa Roach has just came out with a super great song that is called last resort.I play basketball and i am a very emotional person i like songs that have a deep impact on me and a true meaning. Here is how the billboard charts are as of today:1 1 8 'N Sync: No Strings Attached 7 Jive | 41702 1 2 - 1 Soundtrack: Mission:Impossible 2 Hollywood | 162244 2 3 6 48 Santana: Supernatural 12 Arista | 19080 1 4 3 24 Sisqo: Unleash The Dragon 4 Dragon/Def Soul | 546816* 2 5 4 4 Joe: My Name Is Joe Jive | 41703 2 6 7 33 Creed: Human Clay 4 Wind-up | 13053* 1 7 5 3 Toni Braxton: The Heat LaFace | 26069 2 8 2 2 504 Boyz: Goodfellas No Limit | 50722* 2 9 14 37 Dixie Chicks: Fly 5 Monument | 69678 1 10 16 27 Faith Hill: Breathe 3 Warner Bros. (Nashville) | 47373 1 11 15 42 Macy Gray: On How Life Is 2 Epic | 69490* 4 12 9 42 Destiny's Child: The Writing's On The Wall 4 Columbia | 69870* 5 13 11 72 Kid Rock: Devil Without A Cause 8 Lava/Atlantic | 83119* 4 14 12 26 Dr. Dre: Dr. Dre -- 2001 4 Aftermath | 490486* 2 15 8 3 Cypress Hill: Skull & Bones Columbia | 69990* 5 16 10 20 Jay-Z: Vol. 3... Life And Times Of S. Carter 2 Roc-A-Fella/Def Jam | 546822* 1 17 20 14 3 Doors Down: The Better Life Republic | 153920 17 18 13 21 DMX: ...And Then There Was X 3 Ruff Ryders/Def Jam | 546933* 1 19 - 1 Hanson: This Time Around MOE/Island | 542383 19 20 18 38 Christina Aguilera: Christina Aguilera 6 RCA | 67690 1 21 - 1 Mandy Moore: I Wanna Be With You 550 Music | 62195 21 22 31 26 Celine Dion: All The Way... A Decade Of Song 6 550 Music | 63760 1 23 26 33 Marc Anthony: Marc Anthony 2 Columbia | 69726* 8 24 19 5 No Doubt: Return Of

Things Fall Apart Uchendu’s Speech

Uchendu’s Speech: Saving Ourselves My friends and fellow Ibo, I come to tell you the evils of the abomination called Christianity. To see what I have seen in my homeland Mbanta, I cannot look upon these people with respect and camaraderie. They have stolen our brothers and sisters, angered our gods, and assaulted our age old culture. As a member of this tribe, I cannot stand by and watch the destruction of our people’s traditions. My son-in-law, Okonkwo, was known throughout his fatherland and all neighboring villages as one of the greatest men of his time.His achievements were famous, and he had always hoped his son would carry on his legacy. His oldest son, Nwoye, had betrayed Okonkwo by converting to the new religion. You may ask how one can ignore the lessons of his father and the examples of hard work, dedication, and loyalty to our customs. But the even the protective mother lion can lose her young cub who runs after a little bug. Nwoye was intrigued by the new pe ople, and unfortunately he had been tainted; he did not want to return to us.I understand the Christians say they teach our people civil behavior, but to take a young boy away from his own father is just inhumane. We must raise our children right and protect our sons and daughters from being taken by the Christians. They tear families apart. They have soiled our tribe, our traditions, and our hopes. If this continues, Mbanta, Umuofia, and Mbaino will be no more unless we stick to our customs. If our sons and daughters convert to the new religion, any hopes of preserving our history will be ruined.

Perioperative nursing

Perioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurse’s decisions during this period of the patient’s institutionalization are based on universal moral principles. As the patient’s advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but al so ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patient’s trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002: 306). At the same time nurses provide a listening ear  Ã‚   to their patient while providing encouragement and support.Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996: 186).The Nurses’ RoleWithin the framework of the nursing process, nurses’ work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 2004:16). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 2005:3).As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct care ; coordinating comprehensive care and educating patient and their families (Spry:3).The impact of illness particularly when invasive procedures are due usually limits the patients’ individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position.   Patients and family members often feel helpless in a health care setting; how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care.It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patient’s needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patient’s needs whenever ne cessary while providing perioperative care.In addition, the nurse’s role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980: 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002: 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not equip ped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses’ safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002:306).Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect. Other virtues and excellence of character like loyalty and honesty further promote nurses’ abilities to ful fill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impedeethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employee’s ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002: 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery; patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001:117).Facing Ethical DilemmasA nurse, for exampl e, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998:156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital.The nurse will not do any injustice if she takes on the role as the patient’s advocate in all aspects of health care (Seifert, 2002:309). In truth, all health care providers should function as patient advocates (Kohnke, 1980:2040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 2005:3). It may be that all cases in which nurses advocate involve ethical action, but not all cases may ne cessarily involve ethical conflict (Seifert, 2002:309).The nurse’s role in perioperative practice has two components which implies supporting the patient’s autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patient’s decision. One of the fundamental duties of nursing is to promote and defend patients’ rights (Segesten and Fagring, 1996:142). The act of suppressing an individual’s rights serves as the catalyst response of the nurse to act as the patient’s advocate which is her second role.If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations; the nurse may not have a level of experience or communication skills that will facilitate advocacy; they may not be empowered as related to a restrictive care environment; or they just may not have a level of understanding about advocacy in general (Seifert, 2002:308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior; institutional responses to such behavior; and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002: 34).When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001:118).Conclusion:As an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring:144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patient’s advocate particularly during the perioperative phase.This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has any problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 1995:18). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patient’s rights, wishes and care issues (Seifert, 2002:312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills. Related essay: â€Å"Ati RN Community Health Online Practice 2016 B†Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen: Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice: Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy: An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy: An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation: The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research: Nurse-p hysician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040. Perioperative nursing Perioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurse’s decisions during this period of the patient’s institutionalization are based on universal moral principles. As the patient’s advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but al so ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patient’s trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002: 306). At the same time nurses provide a listening ear  Ã‚   to their patient while providing encouragement and support. Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996: 186).The Nurses’ RoleWithin the framework of the nursing process, nurses’ work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 2004:16). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 2005:3). As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct ca re; coordinating comprehensive care and educating patient and their families (Spry:3).The impact of illness particularly when invasive procedures are due usually limits the patients’ individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position.   Patients and family members often feel helpless in a health care setting; how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care. It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patient’s needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patient’s needs whenever necessary while providing perioperative care.In addition, the nurse’s role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980: 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002: 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not eq uipped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses’ safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002:306). Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect.Other virtues and excellence of character like loyalty and honesty further promote nurses’ abilities to fulfill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impede  ethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employee’s ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002: 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery; patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001:117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998:156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital. The nurse will not do any injustice if she takes on the role as the patient’s advocate in all aspects of health care (Seifert, 2002:309). In truth, all health care providers should function as patient advocates (Kohnke, 1980:2040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 2005:3). It may be that all cases in which nurses advocate involve ethical action, but not all case s may necessarily involve ethical conflict (Seifert, 2002:309).The nurse’s role in perioperative practice has two components which implies supporting the patient’s autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patient’s decision. One of the fundamental duties of nursing is to promote and defend patients’ rights (Segesten and Fagring, 1996:142). The act of suppressing an individual’s rights serves as the catalyst response of the nurse to act as the patient’s advocate which is her second role. If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations; the nurse may not have a level of experience or communication skills that will facilitate advocacy; they may not be empowered as related to a restrictive care environment; or they just may not have a level of understanding about advocacy in general (Seifert, 2002:308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior; institutional responses to such behavior; and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002: 34). When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001:118).Conclusion:As an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring:144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patient’s advocate particularly during the perioperative phase. This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has a ny problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 1995:18). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patient’s rights, wishes and care issues (Seifert, 2002:312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills.Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen: Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1 996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice: Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy: An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy: An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation: The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research: Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040. Perioperative nursing Perioperative nurses take the responsibility of safeguarding the rights of surgical patients before, during and after his surgery. The nurse’s decisions during this period of the patient’s institutionalization are based on universal moral principles. As the patient’s advocate or representative during this crucial period, the nurse ensures the quality and continuity of care that a surgical patient needs.This is simply based on the premise that patients during this period cannot functionally and actively participate, decide and monitor the regimen of care that best suits them particularly during and after sedation. Often, Perioperative nurses are faced with decisions necessary when caring for surgical patients. They are therefore necessarily prepared to recognize that soon ethical dilemmas will occur and the nurse must take appropriate courses of action through responsible nursing decisions. Not only are they expected to make clinical and technical decisions but al so ethically and morally sound decisions suitable for the treatment of their patient.In a daily encounter and exchange with the patient, nurses often have the potential to develop relationships with their patients based on trust. Patient’s trust that nurses will support and follow through with any concerns or issues that have been discussed ((Seifert, 2002: 306). At the same time nurses provide a listening ear  Ã‚   to their patient while providing encouragement and support. Likewise, nurses are provided with the opportunity to learn and gather information essential to the health concerns of their patients including fears and apprehensions. This provides an ample opportunity for nurses to exact information that could be relayed to physicians and other family members pertinent to the regimen of treatment acceptable to the patient. Base on the parameter of therapeutic use of self, nurses are encouraged to maintain a professional and therapeutic relationship between nurses and patients and their family members (Rushton et al, 1996: 186).The Nurses’ RoleWithin the framework of the nursing process, nurses’ work in collaboration with the other health team members in order to achieve desirable patient outcomes (AORN, 2004:16). They are enjoined to use the tools of the nursing process to meet the needs of the patient undergoing invasive procedures. Although much of the practice involves technicalities, the patient is still the main focus of the perioperative nurse rather than on her technical functions. The goal is still to provide care and support for the patient and for their families (Spry, 2005:3). As the perioperative nurse, one is likewise expected to assist the patient and their families in making sound decisions to meet the overall desired outcome of wellness after surgery and a healthy return to normal life. Along the lines of perioperative nursing, care is provided in various settings based on three major aspects of providing direct ca re; coordinating comprehensive care and educating patient and their families (Spry:3).The impact of illness particularly when invasive procedures are due usually limits the patients’ individual autonomy and ability to make decisions, thereby placing the perioperative nurse in a powerful position.   Patients and family members often feel helpless in a health care setting; how much more when a love one is scheduled for operation? The patient is therefore vulnerable at this stage so the role of the nurse as an advocate for the patient is stressed as vital to patient care. It would most likely help the patient and his family t know that the nurse during a perioperative setting and procedure ensure a continuous assessment of care for the patient while in the OR, thereby providing ample assurance that the patient’s needs are being met. The nurse, as a moral agent of the patient, must therefore be ready and be able to act and advocate for the patient’s needs whenever necessary while providing perioperative care.In addition, the nurse’s role includes informing patients of their rights and to ensure that patients are given all the necessary information necessary to make/participate in the decision making and likewise support them in whatever decision they undertake. Although the nurse has a responsibility in safeguarding the patient from the incompetence of other health care professionals her main ethical duty is the prevention of a potential injury to the patient and to third parties (Kohnke, 1980: 2039).Nurses in general and in particular perioperative nurses must act as an advocate for the patient, co-worker, family members and students (Seifert, 2002: 307). By virtue of her relationship with the patient, her obligation is to provide a safe, professional and ethical care particularly during the perioperative phase when the patient and family members are most vulnerable. Likewise, technically, the patient and the family member are not eq uipped to understand the aspect of perioperative invasive procedures which is why the nurse should come as an advocate for the rights of the patient and their families. Thus it is in principle the duty of the nurse to provide patients with ethical care they ought to receive during this particular phase of their treatment.Promoting perioperative nurses’ safetyIt is therefore another vital job of a perioperative nurse to ensure and create an environment that fosters ethical behavior. As a duty to herself, the nurse must engage in a life-long learning experience, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace (Seifert, 2002:306). Nurses must be able to establish, maintain, and improve the work environment and maintain an ability to preserve their integrity and moral self respect.Other virtues and excellence of character like loyalty and honesty further promote nurses’ abilities to fulfill moral obligations and cited as exemplary qualities of the moral person to behave in an ethical manner (ANA, Sec.20). The environment strongly influences in the acquisition of virtues and excellence that may support or impede  ethical behavior. Certain policies, procedures and position often help in influencing behavior that can affect the delivery of care. Certain intolerable policies that become inconsistent with a nurse job like mandatory overtime can greatly become an impediment to an employee’s ethical performance.When nurses are exposed under a strong foundation of ethical practice, standards can positively guide in her performance in the surgical setting. Not only will she be able to identify activities and interventions that help her achieve specific patient outcome but also link her actions t ethical behavior. Most set standards are often based on clinical mandates with virtues of wisdom, honesty, loyalty and courage that are the same qualities of the moral person (AORN, 2002: 492). Nurses who are exposed to this professional standard are likely to employ these standards and view them as a normal practice essential to improve unethical and unsafe practices within her responsibility.Providing a therapeutic work setting or enhancing a safe environment will likewise be a concern to all perioperative nurses. Potential hazards, risks, and unsafe conditions abound in the surgical arena where constant distractions, excessive noise, hasty reviews of patient records, and frequent interruptions can produce situations where the likelihood of error increases. It is always right to alert physicians and others within the health team of any unsafe or deteriorating patient condition that can lead to an active error like sending the wrong patient for surgery; patient morbidity and perhaps mortality. An enlightened approach to this error is to replace blame and punishment with learning and improving (Reeder, 2001:117).Facing Ethical DilemmasA nurse, for example, has a statutory duty to report suspected cases of abuse or potential for injury, and this situation may arise when a coworker demonstrates incompetent practice. This is an ethical dilemma facing nurses and it seems that nurses are no closer to a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty (Martin, 1998:156). In essence, the nurse would exercise moral alignment with the patient rather than with the physician or the hospital. The nurse will not do any injustice if she takes on the role as the patient’s advocate in all aspects of health care (Seifert, 2002:309). In truth, all health care providers should function as patient advocates (Kohnke, 1980:2040). In instances such as clarifying consent issues, perioperative nurses may act as advocates in a potential ethical conflict (Spry, 2005:3). It may be that all cases in which nurses advocate involve ethical action, but not all case s may necessarily involve ethical conflict (Seifert, 2002:309).The nurse’s role in perioperative practice has two components which implies supporting the patient’s autonomy or his right to choose freely, regardless of whether the nurse is in agreement with the patient’s decision. One of the fundamental duties of nursing is to promote and defend patients’ rights (Segesten and Fagring, 1996:142). The act of suppressing an individual’s rights serves as the catalyst response of the nurse to act as the patient’s advocate which is her second role. If advocacy implies speaking up for someone, then it is her duty to speak up for the welfare and benefit of the patient. Again, this could be an identifiable problem because not all nurses are comfortable with conflict situations. Others may not recognize any rights violations; the nurse may not have a level of experience or communication skills that will facilitate advocacy; they may not be empowered as related to a restrictive care environment; or they just may not have a level of understanding about advocacy in general (Seifert, 2002:308).During an error occurrence during the perioperative phase communication and interdisciplinary relationships is the common cause coupled with disruptive physician behavior; institutional responses to such behavior; and the effects of such behavior on nurse satisfaction, morale, and retention (Rosenstein, 2002: 34). When errors or mistakes do occur, it is imperative that nurses learn what occurred, identify systems gaps that represent latent conditions that can lead to errors, collectively review the causes of the error, and share lessons learned.(Reeder, 2001 118). Unfair, illegal, or unethical practices challenge the creation of a moral environment thus collaboration, fairness, and respect for patients and all members of the health care team are more likely to support fulfillment of ethical obligations(Reeder, 2001:118).Conclusion:As an ethical practice, the nurse acts in behalf of the patient, the institution and for herself. This creates confusion particularly when the nurse is faced with a dilemma that conflicts between her personal values and professional obligations (Segesten and Fagring:144). Nurses must therefore act in accordance with the practice standards and code of ethics in coordination with her own values. Speaking up in behalf f the perioperative patient suggest that she is favorably acting as the patient’s advocate particularly during the perioperative phase. This should be viewed as her essential role as a professional and should base her actions according to ethical principle and values. She should speak up when an injustice occurs although in some cases, she would face danger for her actions such as loosing her job. Insofar as ethical practice is concern, an individual must be able to choose whether to sacrifice oneself for her patient and follow a principle of justice. Otherwise if a nurse has a ny problems with this, she can choose a field that may not compromise her personal beliefs, values or ethics when challenged.The advocacy training for nurses starts within the confines of the nursing education and working environment for the nurse. The philosophy of nursing in which nursing practice stems from supports an individual to promote his/her well-being which is the ethics f practice (Gaylord, 1995:18). In the nursing school, one must be prepared to identify the ethical issues in patient care and understand the ethical principles and philosophies found in the daily practice and be trained to recognize the patient’s rights, wishes and care issues (Seifert, 2002:312). The knowledge of such ethical principles allows the nurse to stand as an advocate for the patient and speak in his behalf using effective communication skills.Works CitedSpry, Cynthia. (2005). Essentials of Perioperative Nursing (3rd ed.) Aspen: Jones and Barlett.Rushton, C., Armstrong, L., McEnhill, E.(1 996,June).Establishing therapeutic boundaries as patient advocates. Pediatric Nursing 22, 185-189.Seifert, P.C. and American Nurses Association. (2002, August). Ethics in perioperative practice: Duty to self. AORN Journal 76, 306-313.United States. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements, 20.Segesten, K. and Fagring, A. (1996, October). Patient advocacy: An essential part of quality nursing care. International Nursing Review 43, 142-144.Gaylord,N. and Grace, P.(1995,March). Nursing advocacy: An ethic of practice. Nursing Ethics 2, 11-18.Martin, G. (1998, March). Communication breakdown or ideal speech situation: The problem of nurse advocacy. Nursing Ethics 5, 147-157.Rosenstein, A. (2002, June). Original research: Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing 10, 26-34.Reeder, J. (2001,April). Patient Safety, Errors and mistakes, and perioperative Nursing. Seminars in Perioperative Nursing 10, 115-118.Kohnke, M.(1980, November). The nurse as advocate. American Journal of Nursing 80,2038-2040.