Asthma Case Study Essay

Asthma Case Study Essay This essay is written as a case study referring to a patient from my practice area. As I will be reflecting on my practice in relation to the case study, use will be made of first person writing where appropriate. Hamill (1999) supports the use of first person writing in academic essays such as case studies and suggests it develops self-awareness, reflection, analysis and critique. As this essay is focused on a specific patient from my practice area it is important to consider issues of confidentiality. Therefore, throughout neither my practice area nor the patient name will be identified. However to be able to discuss key issues in relation to the patient I will refer to their age, gender and lifestyle, and use a false name to aid the flow of writing. Introduction Asthma affects 5.2 million people in the UK: 1.1 million children and 4.1 million adults according to Asthma UK in their 2004 report. However, depending which report one reads, this number can almost double to 10.1 million (Masoli et al 2003). This wide variation of prevalence maybe explained by the different studies and reports used to gather the data and differing inclusion criteria used. There is nevertheless agreement on the fact that the numbers of cases of asthma are increasing. Asthma UK (2004) reports a 400,000 increase in the number of adults with asthma in the UK between 2001 and 2004. The rising patterns of asthma prevalence however are not explained by current knowledge of causes of asthma, but are paralleled by increases in other allergic conditions such as eczema and rhinitis (Masoli et al 2003). There is currently no agreed definition of the disease. Widely documented in the literature however, is the National Heart, Lung and Blood Institute (1992) definition who describe it as, a chronic inflammatory disorder of the airways causing widespread but variable airflow obstruction†¦Obstruction is often reversible, either spontaneously or with treatment. The severity of the condition varies significantly (Rees and Kanabar 2000) from mild intermittent asthma, to a distressing disabling condition which results in time off work or school, disturbed sleep, restriction of social and leisure activities and anxiety (Hyland 1998). The main aim of asthma management is to control symptoms, minimise asthma exacerbations and optimise quality of life (Scullion 2005). As a student of the Acute Care Pathway Degree, one of the specific learning outcomes for my pathway is to be able to manage programmes of care for patients with chronic diseases (St Martins College 2006). Hyland (1998) states that the Advanced Nurse Practitioner has become a major provider of asthma care in the UK. Watkins, Edwards and Gastrell (2003) agree, and suggest that currently the management of long-term conditions, including asthma, are a core component of a Advanced Nurse Practitioners work. Therefore it is crucial that I have an understanding of this condition and be able to review patients effectively (Wiggins 1999) using evidence based guidelines, and to have the confidence to provide advice on the management of their condition. I aim to improve my understanding and asthma management skills through critically reviewing key issues of patient care as a case study. The key issues I intend to focus on relating to a specific patient are: Treatment of Asthma in the Emergency Department Patient education Patient concordance Initially this essay will examine my current practice in relation to asthma management through reflecting on my present level of knowledge and understanding, discussing the level of care I can provide for patients with asthma at the moment. I then intend to give a brief outline of the patient chosen for this study, explaining the reasons for that choice and the rationale behind the key issues highlighted for discussion. A critical review of the key issues will follow using up to date evidence based literature and considering relevant policies. The conclusion will summarise the main points, reflect on what I have learned from this module and consider ongoing learning requirements in relation to asthma management. Reflection on current practice At the time of writing I have so far completed 16 hours in practise, Therefore my first few days in practice were spent adjusting to this new and very different area of nursing. Nevertheless I have had the opportunity to observe my mentor assessing patients with asthma and recently have become more involved in the review of these patients, with supervision. Prior to starting the course I did feel I had some understanding of the disease process of asthma from working in the Emergency Department, albeit very fundamental, and some basic knowledge of the management. Some of this understanding comes from personal experience but also through my previous experience working in dermatology. Often patients presenting with atopic eczema would also be asthmatic, there is a well known link between these conditions (Hyland 1998). Some of the advice given in eczema management, for example allergen avoidance, will also be relevant in asthma management (Rees and Kanabar 2000). Using Benners (1984) novice to expert model I would classify myself at present as an advanced beginner. This is someone who has a marginally acceptable performance with some background experience but who still requires supervision. I feel this accurately describes my current ability in practice in relation to asthma management. With supervision I am able to undertake an assessment using a template for guidance, check medication usage, check symptoms and carry out peak flow assessment. However I still find the array of inhalers confusing and dont feel confident in interpreting the information gleaned during assessment into planned care within the time constraints of the clinic. When I have the time to reflect on the information and review the guidelines away from the patient I feel more confident. I need however to be able to make the transition from an advanced beginner to a competent practitioner, increasing my level of proficiency to no longer requiring supervision but being aware of my own limitations. I feel with more experience in practice and by working through this case study I should be able to achieve this. Rationale for choice of patient and key issues Rolfe, Freshwater and Jasper (2001) suggest that choosing an event or incident to reflect upon or analyse is concerned with anything that happens to us that we want to write about for some reason. It is the significance of the experience within our daily lives which helps us choose one experience over another. Having decided to focus on asthma as the topic for my case study, when I looked back at the patients I had seen with asthma, it was the above episode of care which held the most significance for me. Pharmacological management The aims of the pharmacological management of asthma are to control symptoms, prevent exacerbations and achieve the best possible lung function while minimising side-effects and long-term sequelae (Scullion 2005). National clinical guidelines developed in 2003 by the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) were produced in collaboration with, amongst others, Asthma UK and the Royal College of Physicians of London, and have more recently been updated in 2005. They are widely accepted as the Gold Standard of evidence-based asthma care for health care professionals working in the UK (Levy and Pearce 2004). Patient education and concordance The issues of education and concordance will be discussed together as they are inextricably interlinked. It is difficult for the health professional to achieve concordance with the patient without providing education about their disease and its management (Levy and Pearce 2004). It is estimated that one quarter of asthma patients in the UK have a compliance rate of 30% or less (Das Gupta and Guest 2003). The term compliance in health care has become less fashionable recently due to it implying that a patient is perhaps ineffectual and hasnt followed the health professionals instructions (Hyland 1998). Whereas in reality the reasons for non-compliance are complex (Holgate and Douglass 2006) and not necessarily the fault of the patient, for example, not being shown how to use their inhaler device properly (Carter et al 2005). Nevertheless non-compliance is thought to contribute to between 18% and 48% of asthma deaths (Asthma UK 2003). Concordance is the term used to describe a negotiat ed agreement between health professional and patient with regard to the management of their condition (BTS/SIGN 2005). However even when concordance seems to have been achieved a patient still may not adhere to the agreed plan of care for many reasons (Weller and Booker 2006). Ensuring patients are well informed about how their medication works has been shown to improve adherence and control (Boulet 1998). They need to be aware of the risks of taking and of not taking their medication (Levy and Pearce 2004). The latter is of particular concern in asthma in that persistent inflammation of the airways may lead to irreversible obstruction (Rees and Kanabar 2000). Written personalised asthma action plans have been shown to improve outcomes of care (BTS/SIGN 2005). They reinforce verbal education and set out for patients what to do if their symptoms worsen (Roberts 2002). Conclusion Asthma is a frequently seen chronic condition in the Emergency Department and one that Advanced Nurse Practitioners are expected to be involved in the management of (Hampson 2002). Therefore as am Acute Care Pathway Degree Student, I need to develop my knowledge and skills in this condition to enable me to provide a high standard of evidence-based care for patients. Throughout this essay I have endeavoured to demonstrate my understanding of asthma especially in relation to the pharmacological management and issues of education and concordance. These issues have been discussed and have shown to be interrelated; without achieving concordance, adherence to prescribed medication cannot be achieved and without patient education concordance cannot be realised. Although I have been unable to discuss all aspects of asthma management due to word limit constraints, my understanding of asthma medications and the use of the stepwise guidelines has increased significantly to the point where I now feel more confident in practice. More recently when seeing patients with asthma I have been able to visualise which step they are on which has helped me to decide whether they are on the correct medication in relation to the severity of their disease. Reviewing the issues of concordance and education has made me realise how important these aspects of management are; however the time needed to address these issues in practice often doesnt correlate to the time allowed for appointments. To enable me to become a competent practitioner in asthma management I need to consolidate the increased knowledge I have gained from writing this essay with more experience in practice. I need to increase my knowledge in areas not discussed in this essay, such as non-pharmacological management through self-directed study and perhaps consider further education through an accredited asthma diploma course, on completion of my degree course.

Language and Identity Essay

This paper is explaining and assessing the relationships between language and Identity. As the topic is too large to discuss, the paper will be focusing on the language and identity of teenagers. By looking at their characteristics, we will discuss how they build up a kind of identity in different social group by means of language. The paper will also include the argument on how people view the relationships between language and identity. Defining Identity According to The Free Dictionary by Farlex, identity is the state of having unique identifying characteristics held by no other person or thing. It is the individual characteristics by which a person or thing is recognized. For my own definition of identity, it is one’s conception and expression of themselves in groups, family, society. Identification is one of the related concepts of identity, which can help explaining what identity is. In sociological aspect, identification means one’s interests and values are accepted in a social group. The acceptance offered by the social group help building up one’s own identity. Subjectivity is another relating concept of identity. It means one’s thoughts and ideas are in the state of being subjective. Undoubtedly, think subjectively is a good way to show one’s unique identity. After discussing certain concepts related to identity, so, how identity is relating to language? Identity relating language As defined as above, identity is the recognition of one’s values and expressions in a social group. In a community, there are numbers of social group: family, schools, workplace, etc. Usually, an individual is a member of several social groups at the same time, and certainly, one is playing quite a different role in different social groups. As every social group is having its unique natures, ideas accepted by a group may not be accepted by another. Therefore, using appropriate language to show one’s identity is essential. In different social group, we can show our unique identity by means of language, since language enables us to express certain status, as well as giving impression to others. In the following part, we are discussing how teenagers view on their relationships around by looking at some characteristics of them and surely, the discussion will be based on language and identity perspective. Language and Identity: teenagers’ views on the relationships In teenage ages, schools and family are believed to be the two closest social group of adolescent. Therefore, we will be focusing on teenagers’ views towards these two groups of people, friends and parents. Friends/Peers Regarding to some common characteristics of typical teenagers, they usually put friends at the first place and like hanging out with friends. They even feel like no one understands them except their friends. Also, they start paying attention to their appearance and find peer’ recognitions on their outfit very important. Such being the case, language used among peers are usually aim at seeking recognition. For example, they like to develop some special terms or vocabularies which are only understand by them, but not their teachers or parents. This is one of the ways showing how teenagers build up a kind of unique identity among peers using language. Parents People in teenage ages usually want to get rid of parents’ control and start setting up a set of own values, which is often quite different from their parents. Besides, they emphasize on individuality. Furthermore, they start doing some adult-like things such as smoking, doing make up and buying luxury goods to express their desire on gaining more rights. Teenagers hate doing things which their parents expect them to do while enjoy doing things which their parents do not want them to, with a view to expressing individuality and drawing attention from their parents. Therefore, whenever their parents hold a disagree view on what they do, they love using language like ‘You know what?’ or ‘You don’t even try to understand me!’ to reply their parents. This show how teenagers view on their parents and how they using language express a kind of ‘new identity’ in the family. In next part, the paper will include analysis of some daily conversations, which are all real examples I took in my daily life. The analysis will be based on the SPEAKING acronym and the theory by Bakhtin about how speech genre affects one’s speech. Language and Identity: Case study Theory by Bakhtin Bakhtin proposed that language is used in typical social situations. He also added that speaking occurs in speech genres which guide the interaction and which are determined by social structure. Speech genres organize our speech in almost the same way as grammatical forms do.

Stress Of Working Women Health And Social Care Essay

The term reappraisal of literature refers to the activities involved in placing and seeking for information on a subject and developing an apprehension of the province of cognition of the subject. This term is besides used to denominate a written sum-up of the province of art on a research job. The research worker carried out an extended reappraisal of literature on the research subject in order to derive deeper penetration into the job every bit good as to roll up maximal relevant information for constructing up the survey. This was accomplished by utilizing MEDLINE, cyberspace, and study of the latest diaries and books. The reappraisal of literature is organized under the undermentioned headers: 2.1 Prevalence and Causes of Stress of working adult females. 2.2 Surveies related to consequence of music therapy in decrease of emphasis. 2.1. Prevalence and Causes of Stress among Working Womans: A cross-sectional population survey was conducted to measure the prevalence of work-related emphasis and its association with self-perceived wellness and sick-leave in a population of working adult females in Swedish. Wholly 424 working adult females were participated. Study revealed that 10 % of the group reported high sensed emphasis due to indistinct organisation and struggles, and 25 % high perceived emphasis due to single demands and committedness and 33 % reported work intervention with leisure clip. All classs of overall work-related emphasis were significantly associated with increased odds of high degree of unwellness symptoms, with the highest uneven ratio for high sensed emphasis due to indistinct organisation and struggles and high perceived emphasis due to single demands and committedness with an uneven ratio of 3.17 ( CI = 1.51-6.62 ) and 4.53 ( CI = 2.71-7.56 ) severally. High perceived emphasis due to indistin ct organisation and struggles and low influence at work were significantly associated with sick-leave with an uneven ratio of 3.85 ( CI = 1.59-9.30 ) and 2.54 ( CI = 1.17-5.48 ) severally. This survey showed an association between work-related emphasis and unwellness symptoms and sick-leave ( Holmgrane, K. , 2009 ) . A study was conducted to place the Gender differences in emphasis among doctors. Wholly 1414 doctors participated ( Male: Female: 107:107 ) Consequence showed that female doctors more frequently experience stressors in relation to their on the job life. It was besides shown that female doctor had more than twice the hazard of being stressed on a day-to-day footing compared to male doctor ( Hareave, M. , 2007 ) . A survey was conducted to place the psychological and physiological factors doing emphasis among working and non-working adult females from Ludhiana metropolis. Data was collected from 75 working and 75 non -working adult females. Consequences revealed that common factors of emphasis in both classs were unfinished undertakings, irresistible impulse of making disliked activities, decease of close comparative, improper slumber. In working adult females, stressors were ‘pleasing others ‘ ( average score 0.92 ) and overburden of work ( 1.04 ) , whereas in non- on the job adult females stressors were ‘wrong on the job position ‘ ( 0.97 ) and ‘non – engagement in decision-making by household ‘ ( 1.02 ) . This survey showed that working adult females were more stressed as compared to non – working adult females ( Harshpinder, 2006 ) . A survey was conducted to happen out the causative factors for emphasis and different emphasis direction technique used by working and non working adult females of Ludhiana. Results showed that workingwomen were significantly more stressed. Highest-ranking societal force per unit area was ‘unexpected invitees ‘ followed by ‘compulsory socialisation ‘ as disclosed by both the groups. All the topics agreed that hubby ‘s emphasis was besides the major factor lending to their ain emphasis followed by emphasis due to alteration of their personal ends. Main emphasis point related to their kids ‘s hereafter was besides agreed upon by both the groups of topics. Majority of respondents were used music, relaxation, supplications as a stress direction technique ( Aujla, P. , 2004 ) . A longitudinal survey was conducted to analyse how increasing demands from work and household life affect the degree of strain and whether there are any important gender differences among Swedish persons. Wholly 9000 persons were participated. Result revealed that multiple demands increase the hazard of enduring from weariness among both adult females and work forces, but it is merely among adult females that an addition in the per centum ( Nordenmark, M. , 2004 ) . A survey was conducted to measure the adult females ‘s work functions and their impact on wellness, wellbeing, and calling. Study findings showed that adult females put in more attempt to household jobs and child care and less to the workplace than work forces do. Heavy work loads adversely affect adult females ‘s wellness, particularly holding a clerical, managerial, professional, or executive place, or caring for immature kids. Women ‘s entire work duties frequently impact their callings due to compensatory decreases in work committedness and occupation position ( Gierdingen, D. , 2000 ) . A survey was conducted to look into psychosocial factors of emphasis and wellbeing in occupationally active adult females. Wholly 98 adult females both blue- and white-collar workers participated. The survey found that psychological work demands affected most significantly wellbeing of adult females, and work insecurity was the most serious factor impacting the sensed emphasis experienced by adult females. The work-related stressors greater than that of the stressors associated with the household map, although the relationship between household operation, emphasis and wellbeing was besides important ( Makowska, Z. , 1995 ) . 2.3. Surveies Related to Effect of Music Therapy In Reduction of Stress: A survey was conducted to measure the consequence of music on postoperative hurting and anxiousness among patients who underwent a entire articulatio genus arthroplasty. Wholly 56 ( 56 ) patients were indiscriminately assigned to either a music intercession group or a quiet remainder group. Study showed that the music group ‘s was non significantly different from the comparing remainder group ‘s lessening in hurting ( F = 1.120 ; P = .337 ) or anxiousness ( F = 1.566 ; P = .206 ) . However, statistical findings within groups indicated that the sample had a statistically important lessening in hurting ( F = 6.699 ; P = .001 ) and anxiousness ( F = 4.08 ; P = .013 ) ( Allred, K, D. , 2010 ) . A randomized controlled test was conducted to happen out the effects of music intercession on physiological emphasis response and anxiousness degree of automatically ventilated patients in China. Wholly 137 patients indiscriminately assigned to music listening group, earphone group or control group. Study revealed that a important decrease in physiological emphasis response ( bosom rate and respiratory rate ) in music hearing group ( P & A ; lt ; 0.001 for both variables ) and a important addition in bosom rate and respiratory rate in control group ( P & A ; lt ; 0.001 and p = 0.032 ) .There was no alteration in earphone group. The Spielberger State-Trait Anxiety Scale showed a important decrease in anxiousness for the music listening group ( P & A ; lt ; 0.001 ) and earphone group compared with control group ( P & A ; lt ; 0.001 ) ( Sit, J, W. , 2010 ) . A randomized controlled test was conducted to find the effects of music therapy on labour hurting and anxiousness in Chinese para I female parents. Sixty para I expected to hold a normal self-generated bringing were indiscriminately assigned to either the experimental group ( n = 30 ) or the control group ( n = 30 ) . The experimental group received everyday attention and music therapy, whereas the control group received everyday attention merely. Pain and anxiousness between groups were compared during the latent stage ( 2-4 centimeter cervical dilation ) and active stage ( 5-7 centimeter ) individually. The consequences revealed that compared with the control group, the experimental group had significantly lower hurting, anxiousness and a higher finger temperature during the latent stage of labour. Though no important differences were found between the two groups on all result steps during the active stage ( Liu, YH. , 2010 ) . A randomized controlled clinical test was conducted to happen out music versus Valium to cut down preoperative anxiousness. Wholly Two hundred and seven ( 207 ) patients were participated. The Patients were randomized in to 2 groups to have Valium or listen to music on the twenty-four hours of surgery and the old twenty-four hours. Just before the operation, anxiousness was assessed with the State-Trait Anxiety Inventory. Study revealed that there were no important differences in anxiousness, cortisol degree, bosom rate, or blood force per unit area were found between the 2 groups ( music vs ataractic ) . The findings indicate that music is every bit effectual as depressants for cut downing preoperative anxiousness ( Berbel, P. , 2010 ) . A survey was conducted to mensurate and gauge the effectivity of music therapy intercessions on hurting and anxiousness control in patients undergoing bone marrow biopsy and aspiration at the Tabriz Hematology and oncology centre in Iran. Wholly 100 patients were indiscriminately assigned to one of two groups: one group listened to music during the process, and the other did non. Consequences demonstrated that participants who listened to music had lower province anxiousness and hurting degrees than those who did non listen to music ( Shabanloei, R, 2010 ) . A randomized controlled survey was conducted on Comparison of the effectivity of music and progressive musculus relaxation for anxiousness in chronic clogging pneumonic disease ( COPD ) . Wholly 82 COPD topics were selected from K.M.C hospitals.. After being screened, 72 topics were selected for the survey. Music group listened to a ego selected music of 60-80 beats per minute for 30 proceedingss. PMR group practiced relaxation through a pre-recorded sound of instructions of 16 musculus groups. Study showed that important chief consequence across the Sessionss for province anxiousness ( F = 62.621, P = 0.000 ) , trait anxiousness ( F = 19.528, P = 0.000 ) , dyspnoea ( F = 122.227, P = 0.000 ) , systolic blood force per unit area ( F = 63.885, P = 0.000 ) , pulse rate ( F = 115.780, P = 0.000 ) and respiratory rate ( F = 202.977, P = 0.000 ) .There were greater alterations noted after the 2nd session in both groups.Music and PMR are effectual in cut downing anxiousness and dyspnea alo ng with physiologic steps such as systolic blood force per unit area, pulse rate and respiratory rate in two Sessionss in COPD patients. Though, decreases in the music group were greater compared to the PMR group ( Singh, V, P. , 2009 ) . A randomized controlled survey was conducted to find the consequence of music intercession in stress response among patients who have undergone bosom surgery in Sweden. Wholly Fifty-eight ( 58 ) patients who had undergone unfastened coronary arteria beltway grafting or aortal valve replacing surgery were included. On the first postoperative twenty-four hours, patients were allocated to have 30 proceedingss of uninterrupted bed remainder with music and so 30 proceedingss of bed remainder or instead 60 proceedingss of uninterrupted bed remainder. The music was soft and relaxing, included different tunes in new-age manner, played with a volume at 50 to 60 dBs, and distributed through a music pillow connected to an MP3 participant. After 30 proceedingss of bed remainder, there was a important difference in s-cortisol degrees between the groups ; 484. 4 mmol/L in the music group versus 618.8 mmol/L in the control group ( P & A ; lt ; .02 ) ( Nilson, U. , 2009 ) . A case- control survey was conducted to measure the consequence of music on anxiousness, emphasis, and depression degrees in patients undergoing coronary angiography. Consequences showed that important lessenings in average tonss of province anxiousness ( P = 0.006 ) , emphasis ( P = 0.001 ) and depression P = 0.02 ) who listened to 20 proceedingss of loosen uping music, as compared with the control group who had 20 proceedingss of bed remainder ( Moradipanah, F.,2009 ) . A prospective randomized controlled test was conducted to measure the effectivity of music in decrease of anxiousness degrees among patients go toing for endoscopy. Wholly 180 patients were indiscriminately assigned to either a music intercession group or a quiet remainder group. Result revealed that important decrease in anxiousness tonss in music intercession group compared to command ( EL-Hassan, H. , 2009 ) . An experimental survey was conducted to research the effects of preferable music hearing on anxiousness and hurting perceptual experience in patients who diagnosed with terminal phase nephritic failure undergoing hemodialysis. Wholly 60 patients were indiscriminately assigned to two groups. Preferred music given to intervention group. The control group scored significantly higher in province anxiousness, and higher hurting strength than the experimental group ( Pothoulaki, M. , 2009 ) . A survey was conducted to happen out the consequence of music entirely, aromatherapy entirely, and music in add-on to aromatherapy on anxiousness degrees of grownups attach toing kids to a paediatric exigency section waiting country. The survey was carried out over 28 back-to-back yearss, the group was assigned an intercession, music, aromatherapy, and both music and aromatherapy. The music was classical with a pacing of 60 to 70 beats per minute. The aromatherapy used the indispensable oil Neroli dispersed utilizing 2 aromatherapy diffusors placed in strategic airflow terminals of the exigency section. After the 1104 studies, there was a statistically important lessening in anxiousness degree on those yearss when music was playing ( 36.3 vs. 39.2 ; P = 0.017 ) ( Holm, L. , 2008 ) . An experimental survey was conducted to measure the impact of music on pregnant adult females. Wholly 236 pregnant adult females participated. The pregnant adult females assigned to two groups, 116 pregnant adult females to a music group and 120 to a control group. The music group showed important decreases in emphasis, anxiousness and depression after merely two hebdomads compared than control group ( Chang, M, Y. , 2008 ) . A randomized control test was conducted to analyze the consequence of music therapy on emphasis response in patients undergoing twenty-four hours surgery. Sixty patients were randomized to one of three groups. Before and during surgery, patients in group 1 listened to new age music and those in group 2 listened to a pick of music from one of four manners. Patients in the control group heard the normal sounds of the operating theater. Plasma degrees of hydrocortisone were evaluated earlier, during and after the operation. Plasma hydrocortisone degrees decreased during surgery in both patient groups who listened to music, but increased in the control group ( Leardi, S. , 2007 ) . . An experimental survey was conducted to look into the consequence of unrecorded music on diminishing anxiousness in patients undergoing chemotherapy intervention. Wholly 50 ( 50 ) patients were assigned to experimental ( n = 25 ) and control ( n = 25 ) group. Subjects in the experimental group received 20 proceedingss of familiar unrecorded music during their chemotherapy intervention. Subjects in the control group received standard chemotherapy. Consequences of the survey showed statistically important betterment for the experimental group on the steps of anxiousness, fright, weariness, relaxation, and diastolic blood force per unit area ( Ferrer, A, J. , 2007 ) . An experimental survey was conducted to analyze the consequence of music therapy on the anxiousness degrees and sleep forms of abused adult females in shelters. Wholly 28 ( 28 ) adult females were randomized in to two groups. First group had a 20-minute recording of participant-selected music with a Progressive Muscle Relaxation book ( Experimental ) . Second group non listen any types of music ( Control ) . Consequences indicated that music therapy constituted an effectual method for cut downing anxiousness degrees. Results besides indicated a important consequence on sleep quality for the experimental group, but non for the control group ( Hernandenz-Ruitz, E. , 2005 ) . An experimental survey was conducted to measure the effects of loosen uping music on cardiac autonomic balance and anxiousness among acute myocardial infarction. Wholly 45 ( 45 ) patients were included. They were grouped in to 3 groups. Group ( 1 ) had 20 proceedingss of music in a quiet, reposeful environment ( experimental group ) ; group ( 2 ) had quiet, reposeful environment without music ( attending ) ; or group ( 3 ) had intervention as usual ( control ) . Immediately after the intercession, decreases in bosom rate, respiratory rate, and myocardial O demand were significantly greater in the experimental group than in the control group. Increases in high-frequency bosom rate variableness were significantly greater in the experimental and attending groups than in the control group instantly after the intercession. State anxiousness was reduced in the experimental group merely ( White, J, M. , 1999 ) . An experimental survey was conducted to measure the effectivity of a music therapy intercession on relaxation and anxiousness for patients having ventilator aid. Wholly 50 four ( 54 ) were participated. The group randomized in to two groups. State anxiousness ( pre and post trial ) , bosom rate, respiratory rate were obtained every 5 proceedingss for 30 proceedingss. Patient who received music therapy ( na†¢?27 ) reported significantly less anxiousness station trial than those patient in the control group ( na†¢?27 ) .Heart rate and respiratory rate decreased over clip for those patient in the music group was compared with the control group topics ( Chlan,1998 ) . An experimental survey was conducted to measure the effects of relaxation and music therapy among patients with presumptive acute myocardial infarction. Wholly 80 patients were indiscriminately assigned to a relaxation, music therapy, or control group. The relaxation and music therapy groups participated in three Sessionss over a two-day period. Study revealed that take downing apical bosom rates and raising peripheral temperatures were more successful in the relaxation and music therapy groups than in the control group ( Guzzetta, C, E. , 1989 ) .

Henry Jamess The Turn of the Screw Are The Ghosts...

Through out the short novella, The Turn of the Screw, by Henry James, the governess continually has encounters with apparitions that seem to only appear to her. As Miles behavior in school worsens so that he is prevented from returning, and as Flora becomes ill with a fever, the governess blames these ghosts for corrupting the children, Miles and Flora, and labels them as evil and manipulative forces in their lives. But why is it that these ghosts only seem to appear to the governess even when the children are present at the time of the sightings by the governess? Evidence from the short story leads the reader to believe that the ghosts are not real but are merely the evidence of the fragmenting sanity of the governess. When the†¦show more content†¦She describes the encounter as lasting a long, intense moment before the man passes from her view never breaking his stare at her all the while. This ghost is Peter Quint whom Mrs. Grose mentions in chapter two as liking yo ung, fair women as employees as governesses. This appearance of the ghost could possibly be a figment of the governesses imagination because it was just before its manifestation that she was fantasizing about her employer with whom she is infatuated and in her fragile mental state, this could have fostered an appearance of a man who was attracted to his employees, something that the governess may wish upon her situation. The second visitation of the ghost of Peter Quint also occurs while the governess is by herself. As the governess, the children, and Mrs. Grouse are preparing for church, the governess goes back into the house to retrieve gloves she sees a visage of the same man she saw at the tower. When Mrs. Grose sees her face she immediately asks what is wrong. The governess goes on to describe the man that she has seen in an odd mixture of attraction and revulsion. 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One of James novels, The Turn of the Screw (1898), has caused a lot of controversy among many critics, and each of them has had a particular interpretation. James creative writing built a close connection between his novel and his readers. The reactions of the readers toward The Turn of the Screw can be researchedRead More Is Henry James The turn of the Screw a traditional ghost story?1529 Words   |  7 PagesIs Henry James The turn of the Screw a traditional ghost story? Ghost stories are found way back in history, some dating back to the Victorian times. The Victorians were known to be greatly interested in ghosts and the supernatural and showed this fascination through telling ghost stories. The telling of ghost stories was used as a way of entertainment especially around Christmas time and it was also very common for upper class Victorians to participate in seances where they would tryRead MoreHenry James, the Art of Fiction and the Turn on the Screw3624 Words   |  15 Pages1. Henry James’s theory of the novel, introduced in his critical essay The Art of Fiction, has been considered as â€Å"playing an important part in the definition of the new conventions of the modernist novel† (Dobrinescu, 203). The theory’s central point or main concern has to do with, as Hopkins considers, â€Å"taking the novel (and, consequently, theoretical discussion of the novel) seriously†. For James, the novel corresponds to the ultimate art form and it should have a position the community as suchRead MoreHomosexuality in Victorian Literature Essay1847 Words   |  8 Pagescarefully disguised metaphors, the story conveys pertinent information regarding the reception of homosexuality in England during the Victorian period. Similarly, Henry James psychological tale, `The Turn of the Screw sub tly deals with homosexuality as taboo, and elucidates the repercussions of sexual deviance in children. Many people think Henry James was homosexual. He lived in an era and society that was particularly unforgiving of deviation from the sexual norms. It was Oscar Wilde who called homosexualityRead MoreEssay Finding Meaning in The Turn of The Screw, by Henry James2788 Words   |  12 Pagesappears to be a rather lonely place. The vividly bleak backdrop for The Turn of the Screw houses a handful of servants, two orphaned children, and ghosts who fade in and out of view. But there are others present who are less obtrusive yet just as influential as Peter Quint and Miss Jessel. Peering into and out of Blys windows and mirrors, engaging with the text and the lingering trace of author Henry James, a crowd of real and virtual readers hope to catch a glimpse of a specter or to unravelRead More Narrative Frames and Ambiguity in Henry James The Turn of The Screw2226 Words   |  9 PagesNarrative frames and Ambiguity in The Turn of The Screw   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Since it was written, Henry James The Turn of The Screw has been acclaimed by numerous critics to be one of the most immaculate, engrossing and terrifying ghost stories ever produced. Harriet Waters Preston described it as, a sheer mortal horror, like the evil dream of a man under the spell of a deadly drug1, and Gertrude Atherton said, [it] is the most horrifying ghost story ever written!2 I will argue that itRead MoreLogical Reasoning189930 Words   |  760 Pagesdifferent 5 from Giardia, you wonder. Thinking about all this you conclude it is likely that boiling will do the trick. So, Juanita’s worry about the danger of getting a bad disease such as Giardia is more than offset by the low probability of actually getting the disease if you boil the water. So, you recommend that your group stay in the mountains, boil the water and drink it after it cools. Thats how you have made your own decision. Is it a reasonable one? Yes, because it is based on high-quality