Effective Use of Dialogue in All the Pretty Horses Essay -- Pretty Ho

Effective Use of Dialogue in All the Pretty Horses All the Pretty Horses, by Cormac McCarthy, is, among other things, an exploration of its main character, John Grady Cole. The author chooses words carefully and sparingly when creating dialogue for Cole. In doing so, McCarthy creates poetic effects and rich meaning from limited verbiage. This novelist lets his readers get to know his main character largely through dialogue instead of through direct description. In this way, readers find the techniques used by McCarthy similar to those used by Ernest Hemingway in many of his books and short stories. Like the dialogue of Hemingway's protagonists, Cole's speech is sparse, but it is indicative of a great deal of meaning. In Cole's brief discourse, wise readers can find many individuality indicators that help us to understand this stoic character. The first verbal exchange of this novel only requires 17 words of Cole. The first twelve words tell us a great deal considering the limited number of words used: I appreciate you lighting the candle, he said. Como? La candela. La vela. (4) On the first line of Cole's dialogue, he shows his appreciation of a kindness done for him. This act suggests some goodness in his character. This sentence is in English. The person speaking with Cole in this scene replies in Spanish, and we find that our protagonist is at least bilingual in the next line when he replies to the other speaker in Spanish. The fact that Cole knows two different Spanish words for candle suggests a more extensive understanding of his second language. Readers will find that this is not the only example of individuality indicators expressed in Cole's speech. McCarth... ...r He decides" (60). John Grady Cole clearly does not state that the end of the world, or anything about the end of the world, will be effected by anything he does. Cole's God is in charge. Some readers may judge by word-count that Cole doesn't say very much in this novel, but such is not the case. Cormac McCarthy's protagonist, John Grady Cole, tells us a great deal about himself through his dialogue. The author of this book, like many contemporary writers, expects a lot of his readers, and rewards close examinations of his work with deep insights about his characters. The near-poetic density of the language of John Grady Cole helps the author to speak volumes without having to beat the reader over the head with obvious conclusions. "Evocal to the intelligent alone--for the rest they need interpreters." --Motto Pindar, Olympian Odes, 2:85-6

Changes In The Earths Environment Essay -- essays research papers

Changes in the Earth's Environment The 20th century, especially in the second half, has been one of rapid change in the Earth's environment. The impact of humans on the physical form and functioning of the Earth have reached levels that are global in character, and have done so at an increasingly mounting speed. 20 years ago the environment was seen as posing a threat to the future of humanity as death rates from natural hazards had increased dramatically since the turn of the century. The Earth though has always been plagued by natural disasters. Now, with the world population growing at a rapid rate more people are living in hazard prone areas. Events which may have gone unnoticed previously, only become hazards when there is intervention with humans and their lifestyle. With the discovery of the ozone hole in the 1980's attention was now more focused on the threat humans were posing to the environment. With scientific evidence to back up pessimistic predictions of our future, most people, through media coverage, political pressures and general concern now see the environment as being truly threatened by human progress and in desperate need of help. Natural hazards have been defined as â€Å"...extreme geophysical events greatly exceeding normal human expectations in terms of their magnitude or frequency and causing significant damage to man and his works with possible loss of life.† (Heathcote,1979,p.3.). A natural hazard occurs when there is an interaction between a system of human resource management and extreme or rare natural phenomena (Chapman,1994). As McCall, Laming and Scott (1991) argue, strictly speaking there is no hazard unless humans are affected in some way. Yet the line between natural and human-made hazards is a finely drawn one and usually overlapping. Doornkamp ( cited in McCall et al, 1992) argues that many hazards are human induced or at least made worse by the intervention of humans. In the 1970's, natural hazards were an important subject of topical study, as the nature of their impact on human populations and what they valued was increasing in frequency at quite a rapid rate (Burton, Kates, White, 1978). During the 75 years after 1900 the population of the earth increased by a staggering 2.25 billion people. People who needed land on which to live and work. As the population rose people were dispersed in more places and in larger numb... ...cote and B.G. Thom (eds): Natural Hazards in Australia. 3-12, Australian Academy of Science, Canberra. Kevies, D.J. (1992). Some Like it Hot. New York Review of Books. 39:31-39. McCall, G.J.H. (1992). Natural and Man Made Hazards: Their Increasing Importance in the End 20th Century World in G.J.H.McCall, D.J.C.Laming and S.C.Scott (eds): Geohazards: Natural and Man Made. 1-4, Chapman and Hall, London. McKibben,B. (1990). The End of Nature. Penguin, Middlesex. Meyer, W.R. and Turner, B.L. (1995). The Earth Transformed: Trends, Trajectories and Patterns in R.J. Johnson, P.J. Taylor and M.J.Watts (eds): Geographies of Global Change. 302-317, Blackwell, Oxford. Pearce, D. (1995). Blueprint 4: Capturing Environmental Value. Oxford Uni. Press, New York. Perry,A.H. (1981). Environmental Hazards in the British Isles. Allen and Unwin. London. Schnieder, S.H. (1989). Global Warming: Are We Entering The Greenhouse Century ?. Sierra Club Books, New York. Stow, D.A.V. (1992). Preface in G.J.H.McCall, D.J.C.Laming and S.C.Scott (eds): Geohazards: Natural and Man Made. i-ii, Chapman and Hall, London. Suzuki,D. and Gordon, A. (1990). It's a Matter of Survival. Harvard Uni Press, Harvard.

Domino’s Pizza Analysis Essay

Introduction: This report is going to be based upon Domino’s Pizza, a franchised organisation derived in Michigan, USA. This report will firstly give a brief overview of the history of Domino’s; it will then establish and explain the micro and macro factors that affect Domino’s and their effects on the business. It will also contain a strategy which would allow Domino’s to adapt and thrive in its ever changing environment; the report will give details explaining which external opportunities Domino’s should take advantage of, and which external threats it should combat. This report will include a PEST analysis, examining the political, economical, social and technological factors that Domino’s is affected by, a SWOT analysis which will observe the strengths and weakness Domino’s has, and also external aspects that will threaten the business or provide opportunities. In 1960 Tom Monaghan and his brother created ‘DomiNick’s’ Pizza shop, in 1961 Tom bought his brother out of the company and renamed it to the ‘Domino’s’ that we know today. Domino’s is now one of the largest pizza franchises in the world with 9,350 stores in over 70 countries. It employs 175,000 people worldwide and delivers over a million pizzas per day. Tom developed his company using franchising, allowing people to set up their own Domino’s pizza shops, in doing so he eventually made over 1 billion dollars before retiring in 1998. Domino’s is a LLC (limited liability company), merging the characteristics of sole proprietorship and a corporation, meaning that business owners still have control of their business but have limited liability against debt. Part A: This section is going to focus on the macro (external) factors that affect the business using a PEST analysis and the micro (internal) factors such as strengths and weaknesses. Politically, Domino’s is affected by a number of things References: http://www.dominos.uk.com/pdf/information_pack.pdf

Outline and Evaluate the Reasons for the Growing Popularity Essay

Outline and evaluate the reasons for the growing popularity of alternative medicine Alternative medicine is a term that is used to describe medical practices that are different from accepted forms and is used instead of orthodox medicine (Hunt and Lightly, 1999). This term was given to these types of medical practices by the bio-medical model which reflects their power. However, recently it has been become ‘Complementary’ which shows the increasing acceptance of this type of medicine; this now marks a shift from seeing alternatives as in opposition to modern medicine to recognising that they can support orthodox treatment. This type of medicine has a Holistic approach, meaning that it treats the mind as well as the body, unlike the bio-medical model which could be a reason as to why more and more people use certain forms of complementary medicine. Alternative medicine has always been popular in Eastern societies; for example, treatments like Fire Cupping originate from China and over time have becoming increasingly popular in the West. According to a study in 2007, Britons spent ? 91 million on alternative medicine in that year alone and has been suggested that that figure has gone up by 32% in the past five years. Another reason as to why this form of medicine has become largely more popular in Western societies is that GPs and hospitals will often refer people to them if they feel that the bio-medical model can’t help them. Similarly, the NHS will refer to this form of medicine as ‘Complementary’, which shows that they no longer see it as a threat to their form of health care. According to Sharma (1992) the most popular forms on Complementary medicine are Herbalism, Osteopathy and Homeopathy. This could be down to the fact that these ones are the most successful in their treatment, or on the other hand it could be that celebrities have made it into some form of ‘Popular Culture’ in which the masses feel they should also try out. There are a significant amount of reasons as to why there has been a growth in the popularity of alternative/complementary medicine over the last decade. According to Bivins (2007) the popularity of bio-medicine suited a population under permanent threat of infectious diseases. Whereas today, patients’ needs have changed due to the fact that certain chronic conditions have risen which has in turn led to disappointment towards industrial medicine as it is shows that orthodox medicine doesn’t give people other options; it is limited in its treatments. Furthermore, industrial medicine is significantly impersonal compared to complementary medicine which could be another reasons as to why people are choosing alternate forms of health care. On the other hand, Hunt and Lightly (1999) suggest that it could be down to the fact that there are a growing number of people in the population which simply needs/wants to be different and experiment. Illich would put forward his theory of ‘iatrogenesis’ (when medicine does more harm than good), saying that people are concerned about the unpleasant side-effects of drugs and the interventionist nature of medical practice which has been proven by surveys taken out. Another minor issue could be that people now demand for patient input; regarding complementary medicine, the doctor and the patient talk and together come up with solutions; the patient isn’t treated passive and isn’t talked to. According to Bakx (1991) the decline in the cultural dominance of biomedicine and the medical profession has resulted in the re-emergence of the plurality of alternative approached to health. Stanway would refute this view and suggest that people ‘simply want to experiment’. He would also say that this could be down to philosophical/religious reservations about what is being offered. Orthodox medicine have a ‘body dualism’ approach instead of a Holistic approach in which alternative medicine does take; they take into account everything to do with the patients life, whether that be physical or emotional or psychological problems. However, Coward (1989) would refute both models of health saying that they ‘tend to stress that health problems are individual, both in terms of the causes and the cures’. He would say that this ignores the wider social factors that cause ill health, such as poverty, job-related stress and pollution. He would also say that many of the treatments haven’t been tested in the ways that conventional medicine has, so it hasn’t met the ‘Peer Review criteria’ which therefore brings into account the â€Å"Placebo Affect† suggesting that these treatments make people believe that they are feeling better when actually it is all fake. This suggests that the rising popularity of contemporary medicine is ‘fake’ and that the medicine doesn’t actually do anything, but because people think it does they are using it more and more. He would also state that if people on rely on alternative medicine it could be dangerous in the case of serious diseases like Cancer and AIDS where conventional treatments are more effective. Fulder would agree with Coward here and question whether alternative practitioners are prepared to take sole responsibility for their patients when regarding chronic diseases and whether they would refer them to the bio-medical models’ treatment or keep them in their own hands. According to a survey done by Fulder and Monro, it was suggested that the kind of people who use alternative medicine are more likely to be middle class, female and young to middle-aged. Some would argue that this is because alternative medicine can be expensive, and also because women often go to the doctors more than men they are now turning to complementary treatments in hope that (for example) their period pains, morning sickness etc will be sorted by other forms of medicine. To conclude, there are a number of reasons as to why there is a growing popularity of alternative medicine and there isn’t one clear cut answer.

Hannibal and the Carthaginian Empire Essay

Hannibal was great and famous Carthaginian general. He is remembered for his great strategic skills on the battle field and as a great military chief. Born in late 247 BC, was the oldest son of Hamilcar Barca. In 237 BC, Hamilcar took his nine year old son, Hannibal, to the altar of a Carthaginian god and made him pledge eternal hatred to the Romans. Then Hannibal and his father left for Spain. The headquarters of Carthaginian power in Spain was the city of New Carthage. Hannibal saw immediately his father’s techniques for war . When Hamilcar perished in the battle of 230 BC, his son-in-law, Hasdrubal, became the military leader plus the political leader and continued Carthage’s pressure in Spain. In 226 BC Hasdrubal signed an agreement with the Romans. The agreement stated that neither army could cross the Ebro River in the northern Spain . When Hasdrubal was murdered in 221 BC, the Carthaginians collectively elected twenty-six-year-old Hannibal to be the leader in Carthaginian government and commandant of the army in Spain. After Hamilcar’s death Hannibal became an excellent military leader. â€Å"Under [Hannibal’s] control the Carthaginians made large territorial advances†¦Ã¢â‚¬  (I-cias). He learned quickly how to be a leader and with the support of his brothers he was able to succeed through his battles. Hannibal was crossing the Alps and was able to receive rations for a couple days. â€Å"On the third day he captured a Gallic town and provided the army from its stores with rations for two or three days† (Alps). He wanted the best for his army, but had little support from Carthage. Despite the number of men falling from the army due to natural disasters he managed to recruit others. â€Å"Even if many fell from his army during this march because of snowstorms, landslides, and attacks from hostile local tribes, he managed to recruit new personnel along the route. † His strategy was to respond quickly to these natural disasters and it helped him. Hannibal earned his success by enduring hardships with his recruits and reinforcements. Hannibal experienced many challenges including battle delays little amount of military equipment and a small number of reinforcements from home. Other military leaders knew he would not be able to handle a delay due to the lack of preparation he took for each battle. â€Å"He [Fabius, Roman Military Leader] believed that Hannibal lacked the equipment for a prolonged siege and that a delay in the battle would seriously reduce the Carthaginian food supply†. Rome believed that delays would end in the conquering of Hannibal because of the lack of necessities there was little he could do. Hannibal began to suffer during his career due to the lack of food. â€Å"Zama was the only defeat. Hannibal suffered in his military career† . After his defeat his enemies began to discover his weakness. Hannibal was running out of everything during the Battle of Cannae and his help refused to aid him. â€Å"Hannibal needed reinforcements, which the Carthaginian government refused to furnish, and he also lacked siege weapons† . Hannibal’s restrictions could have given him success, had he been willing to bargain with another force greater then his own. Hannibal was the instrument of his own undoing. Hannibal was set on being the conqueror and set on some one else’s defeat, which lead him to his own. His enemy, Rome, was the center of his downfall. He would never settle and there was no satisfaction between them. â€Å"†¦In 218, he clashed with the Roman army. The Romans claimed that this was a break of an existing treaty between Rome and Carthage and demanded Hannibal surrendered to them†¦the Second Punic War started† (I-cias). If Hannibal conquered Romans he would never be able to rule over. â€Å"According to legend, Hamilcar had made the young Hannibal swear on a sacred altar that he would remain an enemy of Rome for life† . Hannibal had made a promise to his father, therefore intending to go on with nothing. â€Å"The loss of the second city of Italy cost Hannibal the allegiance of many of his Italian allies and put an end to his hopes of further replenishing his army from their ranks† . Hannibal had lost it all. His hope had been limited at this point. Hannibal both succeeded and failed. He never won the hearts of the people; therefore he was never able to truly be victorious. Hannibal married a Spanish princess and conquered the surrounding land and took hostages from the adjacent tribes to assure their loyalty to him without crossing the Ebro River, except for the city of Saguntum, an ally of Rome. When Saguntum began trouble between Carthage and Rome in 219 BC, Hannibal invaded the city. This began the Second Punic War . After hearing the declaration of war Hannibal immediately starts off towards Rome. The problem was he had to go by land since Rome controlled the seas. Hannibal began a long and hazardous expedition across the Pyrenees and the Alps in August of 218, with battle elephants walking at the front of his army . In the spring of 218 BC, Hannibal handed over command of the Spanish armies to his brother Hasdrubal. He then led his troops north toward the Pyrenees Mountains and began one of the most famous journeys in history . Hannibal’s army included Libyans and Numidians from North Africa, Iberians and Celtiberians from Spain, and Gauls from Spain, France, and Italy. There were thirty-five thousand foot soldiers, twelve thousand horsemen, and fifty war elephants. Hannibal used the elephants to break infantry lines and to create fear and disorder. The elephants also frightened horses, so they were able to disrupt the enemy’s cavalry . In the Pyrenees, Hannibal encountered resistance from local tribes. He lost a lot of his men to fighting, and some of the mercenaries went home because they were scared of the long journey. With all this, Hannibal continued to move as quickly as possible, but bad luck fell into Hannibal’s lap as early snows and landslides kill many of his men and almost all of his war elephants . He enters Italy with only twenty-six thousand men and five or six war elephants in September 218. Hannibal and his troops spent the winter in Po Valley. In the spring of 217 BC When news of Hannibal’s army reached Rome, the Gauls of northern Italy revolted. They joined Hannibal in fighting the Romans. Now Hannibal had a sufficient army of infantry and cavalry. The Romans had plans to attack Carthage and New Carthage, but they had to be delayed because of the rebelling tribes in Italy and the approach of Hannibal. So the Romans sent troops under the command of Publius Cornelius Scipio, to stop Hannibal at Massilia . Massilia is on the French coast where the Rhone River runs into the Mediterranean Sea. The Rhone is a wide river with a swift current, so it was a great obstacle to Hannibal. Scipio’s troops set up camp by the sea, thinking that Hannibal would reach Massilia in the near future. But he did not realize how fast Hannibal was moving his troops . When Scipio received news of Hannibal, it was too late. Hannibal had moved his entire army across the Rhone, fifty miles north of Massilia . Although Hannibal’s army had been reduced to twenty-six thousand infantry, nine thousand horses, and five or six elephants, it was a great accomplishment to get across the Rhone. To transport the elephants, the men built rafts . When the Alps came into view, Hannibal allowed his army a few days to rest, because he knew that his army had doubts about crossing the Alps. Never before had elephants crossed the Alps. The army did not reach the Alps until late in the year, and many troops and horses were killed. Some troops who came from warmer climates died from the cold. Some troops died of hunger because food was short to come by. Others died in fights with mountain tribes. Some of the mountain tribes rolled big stones down the mountains and caused men and animals to fall from the narrow mountain passage .

The Assessment for Nursing Potential: Nursing Quality Scale

The study integrated the qualities of nursing students (N=227) with their aptitude and academic achievement in a tripartite model. A battery of tests called in the Assessment for Nursing Potential (ANP) composed of the (a) Nursing Quality Scale (NQS) with factors on caring, compassion, commitment and connectedness; (b) Achievement test; and (c) Aptitude test was used in the study. Using a three-wave longitudinal design, the NQS was first administered followed by the aptitude, then the achievement tests.The effects of the nursing qualities on achievement and aptitude were analyzed using Structural Equation Modeling (SEM). The first model indicates that nursing quality as a latent factor has no significant effects on both achievement and aptitude, obtaining a moderate goodness of fit (RMSEA=. 09). However, when the same model was tested including the effect of aptitude on achievement, it resulted to a better fit (RMSEA=. 06). In the second model, aptitude has a significant effect on ac hievement, p

Disaster Planning: Public Health Role

After working through the project â€Å"Disaster in Franklin County,† I will admit that I have a new appreciation for the role of the public health nurse in the event of an emergency. The simulation helped me to understand the important role that the public health team. The plays in assisting the community during a disaster. Role of the Major Public Health Personnel Each of the major public health personnel, including the public health nurse, play a key role in keeping a disaster organized flowing smoothly.The key roles are the medical health director, agency incident commander, public information officer, liaison officer, operations chief, planning chief, logistics chief, finance and administration chief, and public health nurse. With the exception of the public health nurse, the positions are often filled by people who may not be specifically trained for the roles, however, have a general overview of what the specific role requires.Agency Incident Commander – The agen cy incident commander is responsible for making the assignments of each of the other roles. She/he will have a familiarity with the specific skill sets of each person who is eligible for a role and be able to use these skill sets appropriately with in each role to obtain the highest amount of effectiveness. The incident commander will have a broad overview of what the different areas are working on, and know how each role will work to benefit other roles within the big picture.The AIC oversees the development of the incident mission and key goals, and from this comes the development of an Incident Action Plan (IAP). The AIC is responsible for ensuring that the public health agency incident mission and goals are synchronous with those of the other responding agencies and jurisdictions. The person in this position will have natural leadership qualities such as reliable critical thinking and problem solving skills, ability to make a quick decision, flexibility, adaptability, and a broa d understanding of the area affected.Public Information Officer – The public information officer is the communication coordinator or spokesperson. This individual is responsible for assuring that appropriate information is provided to the public, governmental officials and collaborating agencies. The Public Information Officer also assures that the required information is provided to the public health agency staff, so that the message of the agency is consistent, and in synchrony with other agencies.This person needs to be proficient in gathering the correct data for the situation, organizing facts, preparing appropriate releases for the press and the public, should have good communication skills, the ability to think quickly before responding, and have a good working knowledge of correct policy and procedure, standards, and laws in the public health realm. Liaison Officer – The liaison officer interfaces with and coordinates all activities with external agencies.The L iaison Officer assures that external agencies that are working with the department of health are provided with the resources that are required, as well as assure that agency policies, procedures and sovereignty are respected. She will be a point of contact for other agency representatives, and will coordinate assistance from other agencies such as hospitals, counties, EMS and federal emergency management.She will be responsible for creating and maintaining a list of cooperating agencies, their representatives, and point of contacts, and keeping other agencies aware of the public health status within the given situation. The liaison officer will have a functional working relationship with other agencies and have good communication and organizational skills. Operations Chief – The Operations Chief carries out the specific tasks and objectives that the public health agency needs to do in order to accomplish the goals of the incident.In this section, the Incident Action Plan is a ctually executed. This person will have a working knowledge of what needs to be done, how to get it done, and who to send to complete the task. He will also identify additional issues and resources needed and make those requests to the appropriate people. Examples of Operations activities include distribution of vaccines, water or soil sampling, delivery of risk communication messages to the public and case investigation, to name a few.The skill set appropriate for this person is someone with leadership qualities such as critical thinking, direct communication, and the ability to multitask. Planning Chief – The planning chief position is used to organize data, make projections and forecasts about the event and report the information to the AIC. Where required, this person may engage in intelligence activities – which for public health may be gathering, analyzing and sharing incident information (some of which may be sensitive) with other agencies.Examples of intelligen ce activities may include analysis and projections regarding  epidemiological data about a bioterrorist event, risk assessments based on information reported by law enforcement or determination of toxic contamination levels in an environmental incident is responsible for knowing the status of all resources available during a disaster both personnel and equipment. They will know how to obtain these resources, be able to determine current situation and status of the event, making a plan to provide the community with the things that are needed during a disaster, and have contingency plans in case the initial plans are unable to be carried out.This person will have strong contacts throughout the community, a working knowledge of resources available and strong planning skills. Logistics Chief – The Logistics Chief provides the support to all other sections that have been activated in the public health agency so that the work can be accomplished. Logistics acquires and sets up th e things that are needed for Operations to get the job done. A logistics chief will have excellent organizational skills and good ties with the community.Finance and Administration Chief – The finance and administration chief has an essential role including assuring that a contractual and financial process is in place for emergency procurement of supplies, equipment, space and personnel; interpretation of human resource policies; tracking of fiscal resources that are expended during the response (so that costs can be recovered by the agency during the recovery phase of the event) and in some cases, assurance of availability of resources to address the physiological and psychological needs of the paid and volunteer agency personnel who are engaged in the response.Diligent work done by the Finance / Administration Chief during an emergency can serve to prevent a financial or human resource disaster after the event. This person will have a skill set and background in finance or bookkeeping. Public Health Nurse – The public health nurse’s role in a disaster is to assess medical health and safety needs of the community and implement interventions as soon as safely possible after the event.This may include assessing individual needs of community members for things such as appropriate shelter, medications, basic provisions, such as food and water, and assessing for overall coping and stress management skills within a household. As these needs are assessed the public health nurse may refer to other agencies for resources in assisting these community members. The public health nurse will also be involved in vaccine delivery as appropriate and treating basic emergencies as needed. Chain of Command for the Community Health NurseIn the simulation â€Å"Disaster in Franklin County,† the chain of command for the community health nurse began with reporting to the agency incident commander who reported to the public health director, who reported to the medical health director, who then reported to the operations chief for the county incident command system, who reported to the emergency operation center commander. This clear-cut chain of command makes it easy to get information up the chain to the appropriate people without the public health nurse having to relay information to multiple people. Available ResourcesResources available to the community health nurse to deal with situations outside her scope of practice included environmental health specialists to assist with inspections of restaurants available to reopen and inspections of housing before people returned home and help educate the public regarding the use of generators; law enforcement to assist with volatile situations, security and safety needs; hazmat and fire crews to assure safety of homes and businesses, and assist with cleanup efforts; public works to assure water safety, electrical safety, and assess for gas leaks are just a few of the resources available t o the public health nurse to assure that the community is safe throughout the event and healthy upon returning to their homes.Actions Taken During the Door-to-Door Interviews During the door-to-door interviews in the simulation, the community health nurse encountered Mr. Fugate, who did not have his blood pressure medications. This had the potential to be an emergency, had Mr. Fugate’s blood pressure been high, or had he been symptomatic. The simulation stated that Mr. Fugate could have stayed at home or gone to the shelter, according to the community health nurse.In this situation, even though his blood pressure came back at a reasonable reading at the moment, I believe Mr. Fugate would be best served at the shelter where his blood pressure and his general safety could be monitored until events after the storm could be better stabilized. Should Mr. Fugate, choose to stay at home, there is a risk that his blood pressure would spike to a much higher level at a time when he is alone, and unable to receive appropriate medical treatment in a timely fashion. This also increases his risk for issues such as stroke and falls. While we must respect the wishes of the patient, as nurses, we also can make strong recommendations to our patients using basic health facts and logic that will sometimes change their decisions.In the case of Mrs. Alvarez, who spoke Spanish only, the enclosed generator had the potential to be lethal to Mrs. Alvarez and her son. The immediate education regarding the ventilation of the generator was necessary to prevent a buildup of deadly gases. Had there not been anyone at the Alvarez his residence who spoke English, not having access to a translator could have been detrimental to their health as they would not have been a way to discuss the risks with Mrs. Alvarez. Having a plan in place for access to a translator in a time of the disaster is very important as education, such as this, may be necessary on the spot, as opposed to at a later time.In the case of Susan Fuhr, my main concern would have been a lack of coping skills and an immediate danger to herself and her child. In a disaster, many things can happen to cause an increase in stress levels. In a person who is already stressed, any one of the stressors may cause an already overloaded person to be pushed beyond their breaking point. This puts at risk everyone in their path for physical and verbal abuse. Susan Fuhr had the stressors of a young child, as well as caring for her mother-in-law to deal with before the storm. While a recommendation to go to the shelter would have provided her with food, shelter and water, sometimes the stress of being away from your home, especially when caring for others is more difficult to deal with.Assuring that the family had the essentials that they needed and that follow-up was arranged was imperative in this situation. In a disaster, many people are afraid that they will be a burden to others if they ask for help. In the cas e of Mr. Westlund, the chemical spill and cleanup without being educated about the proper ways to do this could be detrimental to Mr. Westlund’s health. Putting him in touch with the appropriate resources, such as the hazmat team, was imperative to assuring that the chemical spill was cleaned up properly, both for Mr. Westlund and the community. Assisting the Community in Coping The community health nurse provided education to each of these families appropriate to their situations.She acted as a coordinator and advocate to put them in touch with the appropriate resources as well as a collaborator, by listening and respecting their needs and wishes. Using these techniques helps to calm the fears of the residents of the community by helping them feel more prepared through education, know that there needs and wishes are important and will be respected by those providing help to them, and by acting as an advocate, they are reassured that someone cares about their situation and wa nts to help them in this time of need. Disaster Nursing-How Can I Help As a nurse in the community, whether working in the public health realm or another sector, it is our instinct to go where they need is.One of the first things that you can do to help in the situation of the disaster is to be preregistered with an organization that is known to provide first responder assistance such as the Red Cross, Salvation Army, or local disaster teams. Even though the areas we are needed are rarely the areas of our expertise, extra bodies and extra hands are always welcome in a disaster. For those that work in areas such as hospitals, emergency rooms, and urgent care centers, checking in with your employer to see where help is needed is always appropriate. As a nurse, I worked through Hurricane Ike in September 2008 as it hit the Texas coastline and wreaked havoc on the city of Houston and surrounding communities. Even though I was in management at the time, I worked 58 hours straight through the hurricane coordinating nursing staff, caring for patients, and doing whatever needed done.This meant that, along with normal nursing duties, I made sandwiches, I cleaned beds, I removed red bags with patient waste inside, I assisted in putting out small fires, and I coordinated a move of the nursery when water started leaking through the ceiling. None of these was my regular duty, however, they were things that needed done at that moment. I believe the biggest service in any disaster for nursing personnel is to first be prepared for the disasters that can happen in your area; have a plan for your own family that can include being separated from them; know how you will get to the area you could be working in should a disaster occur in; and once you’re  there, be willing to do what needs to be done, even if it’s outside your comfort zone.Being a nurse during a disaster can be stressful and exciting all at the same time. It will make you think outside the box to so lve situations in new and different ways. Critical thinking and problem solving are taken to a whole new level during a disaster. Nursing of this type will boost confidence and test endurance as the nurse often works with little sleep, little food, and stress surrounding her. I will also say that nursing during a disaster is some of the most rewarding nursing I have ever done, and as crazy as it will sound to the rest of the world, nurses will always run in as everyone else runs out. It’s just who we are Disaster Planning: Public Health Role After working through the project â€Å"Disaster in Franklin County,† I will admit that I have a new appreciation for the role of the public health nurse in the event of an emergency. The simulation helped me to understand the important role that the public health team. The plays in assisting the community during a disaster. Role of the Major Public Health Personnel Each of the major public health personnel, including the public health nurse, play a key role in keeping a disaster organized flowing smoothly.The key roles are the medical health director, agency incident commander, public information officer, liaison officer, operations chief, planning chief, logistics chief, finance and administration chief, and public health nurse. With the exception of the public health nurse, the positions are often filled by people who may not be specifically trained for the roles, however, have a general overview of what the specific role requires.Agency Incident Commander – The agen cy incident commander is responsible for making the assignments of each of the other roles. She/he will have a familiarity with the specific skill sets of each person who is eligible for a role and be able to use these skill sets appropriately with in each role to obtain the highest amount of effectiveness. The incident commander will have a broad overview of what the different areas are working on, and know how each role will work to benefit other roles within the big picture.The AIC oversees the development of the incident mission and key goals, and from this comes the development of an Incident Action Plan (IAP). The AIC is responsible for ensuring that the public health agency incident mission and goals are synchronous with those of the other responding agencies and jurisdictions. The person in this position will have natural leadership qualities such as reliable critical thinking and problem solving skills, ability to make a quick decision, flexibility, adaptability, and a broa d understanding of the area affected.Public Information Officer – The public information officer is the communication coordinator or spokesperson. This individual is responsible for assuring that appropriate information is provided to the public, governmental officials and collaborating agencies. The Public Information Officer also assures that the required information is provided to the public health agency staff, so that the message of the agency is consistent, and in synchrony with other agencies.This person needs to be proficient in gathering the correct data for the situation, organizing facts, preparing appropriate releases for the press and the public, should have good communication skills, the ability to think quickly before responding, and have a good working knowledge of correct policy and procedure, standards, and laws in the public health realm. Liaison Officer – The liaison officer interfaces with and coordinates all activities with external agencies.The L iaison Officer assures that external agencies that are working with the department of health are provided with the resources that are required, as well as assure that agency policies, procedures and sovereignty are respected. She will be a point of contact for other agency representatives, and will coordinate assistance from other agencies such as hospitals, counties, EMS and federal emergency management.She will be responsible for creating and maintaining a list of cooperating agencies, their representatives, and point of contacts, and keeping other agencies aware of the public health status within the given situation. The liaison officer will have a functional working relationship with other agencies and have good communication and organizational skills. Operations Chief – The Operations Chief carries out the specific tasks and objectives that the public health agency needs to do in order to accomplish the goals of the incident.In this section, the Incident Action Plan is a ctually executed. This person will have a working knowledge of what needs to be done, how to get it done, and who to send to complete the task. He will also identify additional issues and resources needed and make those requests to the appropriate people. Examples of Operations activities include distribution of vaccines, water or soil sampling, delivery of risk communication messages to the public and case investigation, to name a few.The skill set appropriate for this person is someone with leadership qualities such as critical thinking, direct communication, and the ability to multitask. Planning Chief – The planning chief position is used to organize data, make projections and forecasts about the event and report the information to the AIC. Where required, this person may engage in intelligence activities – which for public health may be gathering, analyzing and sharing incident information (some of which may be sensitive) with other agencies.Examples of intelligen ce activities may include analysis and projections regarding  epidemiological data about a bioterrorist event, risk assessments based on information reported by law enforcement or determination of toxic contamination levels in an environmental incident is responsible for knowing the status of all resources available during a disaster both personnel and equipment. They will know how to obtain these resources, be able to determine current situation and status of the event, making a plan to provide the community with the things that are needed during a disaster, and have contingency plans in case the initial plans are unable to be carried out.This person will have strong contacts throughout the community, a working knowledge of resources available and strong planning skills. Logistics Chief – The Logistics Chief provides the support to all other sections that have been activated in the public health agency so that the work can be accomplished. Logistics acquires and sets up th e things that are needed for Operations to get the job done. A logistics chief will have excellent organizational skills and good ties with the community.Finance and Administration Chief – The finance and administration chief has an essential role including assuring that a contractual and financial process is in place for emergency procurement of supplies, equipment, space and personnel; interpretation of human resource policies; tracking of fiscal resources that are expended during the response (so that costs can be recovered by the agency during the recovery phase of the event) and in some cases, assurance of availability of resources to address the physiological and psychological needs of the paid and volunteer agency personnel who are engaged in the response.Diligent work done by the Finance / Administration Chief during an emergency can serve to prevent a financial or human resource disaster after the event. This person will have a skill set and background in finance or bookkeeping. Public Health Nurse – The public health nurse’s role in a disaster is to assess medical health and safety needs of the community and implement interventions as soon as safely possible after the event.This may include assessing individual needs of community members for things such as appropriate shelter, medications, basic provisions, such as food and water, and assessing for overall coping and stress management skills within a household. As these needs are assessed the public health nurse may refer to other agencies for resources in assisting these community members. The public health nurse will also be involved in vaccine delivery as appropriate and treating basic emergencies as needed.Chain of Command for the Community Health NurseIn the simulation â€Å"Disaster in Franklin County,† the chain of command for the community health nurse began with reporting to the agency incident commander who reported to the public health director, who reported to the medical health director, who then reported to the operations chief for the county incident command system, who reported to the emergency operation center commander. This clear-cut chain of command makes it easy to get information up the chain to the appropriate people without the public health nurse having to relay information to multiple people.Available ResourcesResources available to the community health nurse to deal with situations outside her scope of practice included environmental health specialists to assist with inspections of restaurants available to reopen and inspections of housing before people returned home and help educate the public regarding the use of generators; law enforcement to assist with volatile situations, security and safety needs; hazmat and fire crews to assure safety of homes and businesses, and assist with cleanup efforts; public works to assure water safety, electrical safety, and assess for gas leaks are just a few of the resources available to the public health nurse to assure that the community is safe throughout the event and healthy upon returning to their homes.Actions Taken During the Door-to-Door Interviews During the door-to-door interviews in the simulation, the community health nurse encountered Mr. Fugate, who did not have his blood pressure medications. This had the potential to be an emergency, had Mr. Fugate’s blood pressure been high, or had he been symptomatic. The simulation stated that Mr. Fugate could have stayed at home or gone to the shelter, according to the community health nurse.In this situation, even though his blood pressure came back at a reasonable reading at the moment, I believe Mr. Fugate would be best served at the shelter where his blood pressure and his general safety could be monitored until events after the storm could be better stabilized. Should Mr. Fugate, choose to stay at home, there is a risk that his blood pressure would spike to a much higher level at a time when he is al one, and unable to receive appropriate medical treatment in a timely fashion. This also increases his risk for issues such as stroke and falls. While we must respect the wishes of the patient, as nurses, we also can make strong recommendations to our patients using basic health facts and logic that will sometimes change their decisions.In the case of Mrs. Alvarez, who spoke Spanish only, the enclosed generator had the potential to be lethal to Mrs. Alvarez and her son. The immediate education regarding the ventilation of the generator was necessary to prevent a buildup of deadly gases. Had there not been anyone at the Alvarez his residence who spoke English, not having access to a translator could have been detrimental to their health as they would not have been a way to discuss the risks with Mrs. Alvarez. Having a plan in place for access to a translator in a time of the disaster is very important as education, such as this, may be necessary on the spot, as opposed to at a later t ime.In the case of Susan Fuhr, my main concern would have been a lack of coping skills and an immediate danger to herself and her child. In a disaster, many things can happen to cause an increase in stress levels. In a person who is already stressed, any one of the stressors may cause an already overloaded person to be pushed beyond their breaking point. This puts at risk everyone in their path for physical and verbal abuse. Susan Fuhr had the stressors of a young child, as well as caring for her mother-in-law to deal with before the storm. While a recommendation to go to the shelter would have provided her with food, shelter and water, sometimes the stress of being away from your home, especially when caring for others is more difficult to deal with.Assuring that the family had the essentials that they needed and that follow-up was arranged was imperative in this situation. In a disaster, many people are afraid that they will be a burden to others if they ask for help. In the case of Mr. Westlund, the chemical spill and cleanup without being educated about the proper ways to do this could be detrimental to Mr. Westlund’s health. Putting him in touch with the appropriate resources, such as the hazmat team, was imperative to assuring that the chemical spill was cleaned up properly, both for Mr. Westlund and the community. Assisting the Community in Coping The community health nurse provided education to each of these families appropriate to their situations.She acted as a coordinator and advocate to put them in touch with the appropriate resources as well as a collaborator, by listening and respecting their needs and wishes. Using these techniques helps to calm the fears of the residents of the community by helping them feel more prepared through education, know that there needs and wishes are important and will be respected by those providing help to them, and by acting as an advocate, they are reassured that someone cares about their situation and want s to help them in this time of need. Disaster Nursing-How Can I Help As a nurse in the community, whether working in the public health realm or another sector, it is our instinct to go where they need is.One of the first things that you can do to help in the situation of the disaster is to be preregistered with an organization that is known to provide first responder assistance such as the Red Cross, Salvation Army, or local disaster teams. Even though the areas we are needed are rarely the areas of our expertise, extra bodies and extra hands are always welcome in a disaster. For those that work in areas such as hospitals, emergency rooms, and urgent care centers, checking in with your employer to see where help is needed is always appropriate. As a nurse, I worked through Hurricane Ike in September 2008 as it hit the Texas coastline and wreaked havoc on the city of Houston and surrounding communities. Even though I was in management at the time, I worked 58 hours straight through t he hurricane coordinating nursing staff, caring for patients, and doing whatever needed done.This meant that, along with normal nursing duties, I made sandwiches, I cleaned beds, I removed red bags with patient waste inside, I assisted in putting out small fires, and I coordinated a move of the nursery when water started leaking through the ceiling. None of these was my regular duty, however, they were things that needed done at that moment. I believe the biggest service in any disaster for nursing personnel is to first be prepared for the disasters that can happen in your area; have a plan for your own family that can include being separated from them; know how you will get to the area you could be working in should a disaster occur in; and once you’rethere, be willing to do what needs to be done, even if it’s outside your comfort zone. Being a nurse during a disaster can be stressful and exciting all at the same time. It will make you think outside the box to solve s ituations in new and different ways. Critical thinking and problem solving are taken to a whole new level during a disaster. Nursing of this type will boost confidence and test endurance as the nurse often works with little sleep, little food, and stress surrounding her. I will also say that nursing during a disaster is some of the most rewarding nursing I have ever done, and as crazy as it will sound to the rest of the world, nurses will always run in as everyone else runs out. It’s just who we are.