Study On The Definition Of Evidence Based Practice

Study On The Definition Of Evidence Based Practice I have studied Nursing for 4 years in the Philippines and I have not encounter the term Evidence Based Practice. It took me by surprise that such subject exist. On my first day of class at Thames Valley University I have learned that EBP is about exploring a medical intervention through research of published research articles based on clinical trial conducted by various researchers and clinicians. The process starts by proposing a research question, and I chose to focus on Pain Management but I have notice that pharmacological management is too common. For such reason, I have decided to aim the attention of my research to Non-pharmacological Management such as Diversional Therapy. This kind of therapy is seldom used in the clinical setting because a lot of medicines are being discovered and used as often. As the process continues, I have learned how to properly critically appraise an article and notice its importance no matter how old it was and enhance my problem solving skills. Fur thermore, adjusting and somehow changing the learning method is a big alteration I have encounter as I need to spend a lot of time reading and making the paper. After all the amplitude I put into making this Folder of Evidence, I consider the entire course a success. I have learned so much of new things that somehow I ignored before. Mapping Grid: Module Learning Outcomes Evidence 1 Evidence 2 Evidence 3 Evidence 4 Identify and critically examine priorities for improving practice. Page 12 Para 1 [P] Asses the ability to identify evidence and critically appraise its value. Page 15 Para 2 [P] Critically analyze the change description and understanding about the nature of evidence in health care practice. Page 12 Para 1 [C] Page 18- 21 Para 2, 3, 4, 5, 6 [P] Evaluate the possibility and effectiveness of evidence for change in practice. Page 24- 25 Para 2, 5 [P] Learning Log: Study Day 1: 11th October 2010 Topic Understanding the Nature of Evidence Key Concepts/Issues Evidence Based Practice History Development Teaching/Learning Lecture Group Discussion Information Skills Development Classroom Activity AM Exploration of the Concept of Evidence Based Practice. PM Sources of Evidence Developing Search Skills Library Session (1) Brief Notes Evidence based practice is providing the best evidence of treatment to facilitate effective treatment/intervention. A discussion of what to be expected from folder of evidence as it highlights how the folder will be collated and how to set aims and objectives for FOE. Study Day 2: 25th October 2010 Topic Questioning Practice/Research Questions: Finding Evidence Key Concepts/Issues The relationship between questions and types of evidence; Questioning own practice explore types of research questions. Developing simple and structure search strategies Teaching/Learning Lecture Group Discussion Group Presentation Information Skills Development Classroom Activity AM Group Presentation: Evidence Based Practice Group Poster Presentation Concepts Definitions and Understandings Session Relationship Between Questions and Types of Evidence Descriptive and Relational Questions PM Writing Searchable Questions for Evidence Based Practice PICO Identifying Preliminary Search Terms Developing Search Skills Library Session (2) Brief Notes We discussed how to proposed a searchable question and how important it is. I formulated a topic based on my own interest and experience beforehand. Revision of question also was supervised and breakdown using PICO framework. Study Day 3: 8th November 2010 Topic Differentiating Between Research Paradigms. Key Concepts/Issues Evidence Based Practice Experimental Research Naturalistic Research Teaching/Learning Lecture Group Discussion Quiz Information Skills Development Classroom Activity AM Quiz Review Research Designs Discussion of Types of Questions (researchable and unsearchable questions). Group Work to Refine Final Practice Issue and Search Question Refine PICO Framework for Search PM Inclusion and Exclusion Criteria Appraisal Tools, CASP, SIGN, AGREE Group Work Assessment and Discussion of Two Papers Retrieved Last Week. (Question, Design, Methods and Results). Brief Notes I have learn the different types of research designs that supports my research scheme for the 5 primary articles together with supporting documents that will be used in making EBP. This session also emphasizes the importance of PICO as this will help how to refine searches. Different appraisal tool was also discussed and its importance as this provide effective filter for the reliability and validity of published literature. Study Day 4: 29th November 2010 Topic Systematic Reviews/Meta-analysis: An Introduction Appraising Evidence Part 1. Key Concepts/Issues Systematic Reviews Developing Critical Appraisal Skills Teaching/Learning Lecture Group Discussion Group Presentation Individual Exercise Classroom Activity AM Group Presentation Features of Systematic Review Group Discussion How Does an SR Differ From a Traditional Review? Appraising a Systematic Review Individual Exercise and Group Discussion. PM Using Appraisal Tools Appraising of an RCT and a Qualitative Study Using CASP or an Alternative Appraisal Tool. Group Discussion Analysing the Appraisal Process and Effectiveness of the Appraisal Tool. Brief Notes A systematic review is a study that identifies, appraise, select ans synthesize a collection of research articles with relevance to each piece of work. Critically appraising a systematic review article excludes lesser quality studies to minimize error and bias in the findings. It Assess the validity of research by means of determining whether the methods used during the study can be trusted to provide a genuine, accurate account of the treatment being studied. Study Day 5: 6th December 2010 Topic Establishing the Quality of Evidence Key Concepts/Issues Making Judgements About the Quality of Evidence Synthesising Evidence Teaching/Learning Lecture Group Discussion workshop Individual Exercise Classroom Activity AM GRADE How to Move from Evidence to Recommendations. Workshop- Grading Evidence PM Tutorials Independent Work or Further Electronic Searches. Brief Notes As I appraise each primary articles collected, a summary of critical appraisal of the 5 primary articles was made. This strategy helped me to make an apprehension toward the affirmation of each articles towards making the summative 3. Study Day 6 13th December 2010 Topic Implementing EBP Key Concepts/Issues Translating Evidence Into Practice Implementing EBP Guiding Principles for Implementing EBP Barriers to Implementing EBP Teaching/Learning Lecture Group Discussion Group Presentation Individual Exercise Classroom Activity AM Group discussion Identify Barriers to Implementing Evidence Base in Practice Identify Strategies to Implementation that Avoid/Overcome these Barriers. PM Students to work in pairs to devise a search strategy for use in one electronic database to identify an article that describes and evaluates the introduction of evidence based change in practice. Brief Notes Implementation has its various barriers to consider such as time, support, lack of knowledge, lack of motivation of the workers and too much research evidence. As a group activity we critique an implementation article as to determine the process of implementation of the studied intervention. Study Day 7 10th January 2011 Topic Evaluating EBP Key Concepts/Issues Evaluating Changes in Practice Application of a Framework for Evaluating Change. Final Module Evaluation Teaching/Learning Lecture Group Discussion Group Presentation Individual Exercise Classroom Activity Measurement for Improvement/Change Sustainability of Change Examine Effectiveness of Evaluation Strategies. Module Evaluation and Individual Tutorials Brief Notes It discussed about the evaluation process of a study and the use of guidelines in each step. Evaluation meant by achieving a research aims and objectives and most importantly if the study conducted able to answer the hypothesis, as this entails whether the study is effective or not. SUMMATIVE WORK Summative 1: Concept of Evidence-based Practice The challenge for best quality of care, combined with the need for recommended usage of resources has heightened the pressure on health care professionals to ensure that clinical procedures is based on sound evidence. Frequent change and advancement in treatments, an increasingly numbers of research information, and the increase of expectations from clients to provide the best care possible, place high demands on healthcare providers to maintain a service that is based on current best evidence. (Bennett and Bennett, 2000). Evidence-based practice (EBP) is a clear path to healthcare wherein health professionals use the best evidence possible, such as the most suitable information available, clinical decisions for individual patients. EBP values, enhances, and builds on clinical expertise, knowledge of disease process, and patho-physiology (McKibbon,1997). Evidence-based practice presume knowledge of and skills in literature searching, research methodologies apprehension , appraisal an d apprehension of research. It also requires healthcare professionals to have access, critique and coordinate literature study with clinical experience and clients aspect. In order to gain a greater interpretation about the nature of evidence in the context of health care, consideration needs to be given to the history of the evidence-based health care movement while the concept was originated in medicine, it has influenced a wide range of health professions (Trinder Reynolds, 2000). In addition, it is an approach to decision-making that has permeated all aspects of healthcare. Its characterize can be seen in many of the leading health systems and government health policies across the world. EBP model highlights the value of research as a source of information which is potentially less biased than other sources for informing practice, it also clearly acknowledges the importance of integrating this research with clinical expertise and clients perspectives (Sackett et al., 2000). Moreover, it involves complex and reliable decision-making based not on available evidence alone but also on patient characteristics, situations, and preferences. Changing practice is not easy to do therefore careful selection of the topic is very significant. For the benefit of the patient is of first importance when selecting a topic, however it can not be the main basis as to literary evidence is inadequate to figure what are the benefits. Researchers must also consider the time, level of consumption and other resources for the study. Research evidence is most frequently found in peer-reviewed journals as this is where results are first published and where enough detail on methodology exists to make informed judgements on the validity and clinical relevance of the findings (Bury Jerosch-Herold, 1998). Research using the strongest and most appropriate study design for the question being studied, will provide the best evidence. Summarizing the evidence is a vast intellectual endeavor according to Fitzpatrick (2007). Healthcare workers must be capable combining ideas and recommendations from an extent of references to make appropriate advices. Implementing a plan is consider challenging because standards and regulation of an organization can either help or ruin an EBP approach to care. Evaluation process involves short term and long term coverage to provide essential data. Word count= 503 Reference List: Bennett S Bennett J (2000) The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal. 47 p171-180. McKibbon K (1997) Evidence-based practice. Bulletin of Medical Library Association. 86(3)p396-401 Trinder, L., Reynolds, S. (Eds). (2000). Evidence-Based Practice A critical appraisal. Oxford: Blackwell Science. Sackett D, Richardson W, Rosenberg W, Haynes R (2000).Evidence based medicine: How to practice and teach EBM (2nd edn). Edinburgh: Churchill Livingstone. Bury T Jerosch-Herold C. (1998). Reading and critical appraisal of the literature. Evidencebased healthcare. A practical guide for therapists Oxford: Butterworth Heinemann. p136-161 Fitzpatrick J (2007. Finding the research for evidence-based practice,part one: The development of EBP 103 (17) p.32-33 Summative 2: Critical discussion on formulating question using PICO There are many times that new information is required when contemplating clients in order to analyze clinical problems and make treatment resolutions, and these questions pertains to a specific client or groups of people. Questions usually arise concerning the effectiveness and choices of an intervention, how treatments are best implemented and whether there are any associated difficulties included (Bennett and Bennett, 2000).The question for this study is about the effectiveness of Diversional Activities as a form of pain management to paediatric clients. Pain management is the alleviation of agony and suffering of a patient with the use of Pharmacological and Non-pharmacological treatment or nursing intervention. Diversional therapy is a non-pharmacological approach and a client centered practice that recognizes the leisure and recreational experiences of an individual (Diversional Therapy Association of Australia,2008).Through the act of psychological and behavioral factors regard ing pain, complimentary medicine are significant in altering pain experiences. These interventions bears to minimize fear, worry, pain and heighten a clients bodily process. According to Bennett and Bennett (2000), when there is uncertainty, the need for information can be interchange into a clinical question. Clearly framing a question not only clarifies what to aim, but it can also facilitate the search for answers. Sackett et al. (1997) point out that the identification of congruent data for answering a particular clinical question may be facilitated by diving the question into components including: A client or a dilemma being considered, an intervention or indicator being considered, outcomes of interest you would like to measure or achieve and a comparison. PICO represents an acronym for Patient, Intervention, Comparison and Outcome. These four components are the essential elements of the research question in EBP and of the construction of the question for the search of evidence (Santos et al. 2007). The PICO strategy can be used to compose several kinds of research analysis, originated from clinical practice, human and material resource management, the search of evidence assessment instruments, among others. The research question allows for the correct definition of which evidence is needed to solve the clinical research question, focuses on the research scope and avoids unnecessary searching (Fleming, 1999). Based on the clinical question formulated and utilization of PICO, a literature search strategy can then be formulated that includes search terms reflecting each component of the question. The next step in the evidence-based practice process is to search the literature for evidence that may assist in acknowledging the question posed. The literature search will be focused by the clinical question that has been identified with use of PICO, as well as other relevant information (Bennett and Bennett, 2000). While evidence for informing clinical decisions may come from various sources including clinical experience, education, textbooks, discussion amongst colleagues and from clients, evidence from well-performed research may be less prone to bias or to the tendency to believe what we want to believe ( Tickle-Degnen, 1999).The internet and the portals of open-access journals allow for accessibility to knowledge, keywords such as non-pharmacological, complimentary medicine and diversional therapy were used to search for the 5 primary articles to be used for this study. An article must be good and interesting, should be well written, and old articles are also considered. Moreo ver, comprises a body of knowledge in academic and scientific based from an original research. Word count= 548 Reference List: Bennett S and Bennett J (2000) The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal. 47 p.171-180 Diversional Therapy Association of Australia(2008) what is diversional therapy?[online]. Available at:http://www.diversionaltherapy.org.au/Home/tabid/38/Default.aspx Flemming K.(1999) Critical appraisal 2: Searchable questions.NT Learn Curve 3(2) p. 6-7. Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB (2000) Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone. 2nd edition. Santos C, Pimenta C, Nobre M.(2007) The PICO strategy for the research question construction and evidencesearch. Rev Latino-am Enfermagem maio-junho. 15(3) p.508-11. Tickle-Degnen,L. (1999). Organizing, evaluating and using evidence in occupational therapy practice. American Journal of Occupational Therapy; 53 p.537 539. Summative 3: Synthesis of research findings. This part of work is the review of the 5 primary articles chosen for the topic effectiveness of diversional activities for pain management to pediatric clients. The articles will be analyzed by using CASP tool, examining each relevant findings and by compare and contrasting ideas of each authors, thus, resulting to further evaluation of such intervention in hospital and non-hospital setting for its efficacy. This research desires to have a thorough understanding of non-pharmacological intervention in managing pain to children that soon will complement pharmacological management by provide stronger evidence. Pain is a dreadful feeling and emotional experience related to injury or damage to children s body, it is usually caused by trauma, disease, medical procedure or surgery. Pain may affect children s appetite, sleeping patterns and lessen energy level hence disabling child to do things. Pediatric pain is complex and often difficult to assess, that is why effective pain management in children is a challenge to medical practitioners because there are many special considerations when providing treatment. On the other hand, non-pharmacological therapies or diversional activities are treatment that do not use medicines to decrease or control child s pain. They may convey comfort to the patient during a long standing condition or illness. Certain activities may help improve the child s state by making him/her more comfortable and relaxed. It involves methods such as teaching and leading your child through thinking exercises and other techniques. It can also be used before and after a child undergoes painful experience, such as medical procedure or surgery. Vessey et al. (1994) stated that, Distraction is the single most commonly used diversional activity among children. Fernandez (1986) stated that distraction refers to the direction of attention to a non-noxious event or stimulus in the immediate environment. When a patient worries too much about his/her pain causes more pain than what is really there. Vessey et al (1994) surveyed 100 children, aged 3 years to 12 years, majority are males (62%) to examine the effectiveness of Distraction method during venipuncture or needle prick, the child s memory may lead to stressful psychological responses, such as crying, and physical responses such as venous constriction during the procedures. It is important that in conducting a study the respondent s age, developmental level and prior hospital experience must be considered during the selection, Broome (1985). Furthermore, Researchers uses the Wong-Baker FACES pain rating scale in evaluating children s perception of pain. Wong-baker pains scal e is know to be a reliable and valid device for children 3- 18 years of age in evaluating their pain,Wong and Baker (1988). In using distraction, the patients may paint, play with friends, watch TV and play with board games or video games and other novelty toys to help them relax and deflect their attention during the procedure since it provokes curiosity and require children to use their auditory, visual, tactile and /or kinesthetic senses. These activities may keep them from thinking about the pain. Weekes et al (1988) Distress is known to cancer patients for years during and after the completion of anti cancer treatments. According to National Institute of Clinical Excellence (NICE), (2005) the role of imagination can play in a childs ability to cope with painful operations. The NICE concluded that there was a strong evidence for the use of hypnosis in alleviating chronic pain associated with cancer. Richardson et al (2006) mentioned that hypnosis is a method where the subject is guided by another to respond to suggestions for changes in subjective experience such as perception, sensation, emotion, thought or behavior. It can be utilized in a variety of ways to cut down stress, acquire coping strategies and halt the experience of pain. Self-hypnosis tends to ease self management of symptoms, hence providing a sense of self-efficacy and control over pain and distress, however, it creates less therapeutic benefit compared to therapist- directed hypnosis. It is evident that patien ts who underwent hypnosis reported less anxiousness and pain while using direct and indirect forms of hypnosis, demonstrating leveled effectiveness. Though, there is some evidence that under hypnosis, girls exhibited more distress behavior compared to boys, Katz et al (1987). Richardson et al (2006) concluded that hypnosis has potential as a clinically valued intervention that could impart to the establishment of procedure- related pain and distress in pediatric cancer patients. Oshikoya et al ( 2008) reported that complementary and alternative medicine has been advantageous for children by some parents, such benefits includes prevention of illness, maintenance of good health, relief of musculoskeletal pain, control of asthma symptoms, treatment of mild respiratory problems, relief of sickle cell anemia and enhancement of the immune system in cancer. 80% of the parents used alternative medicine to cure their children during the study, however, 7% discontinue the use of such practice because the symptoms of the illness come about in their children with exacerbation after their regular medications had been discontinued. Moreover, Kemper et al (2010) expressed that pediatric patients benefit from stress reduction by means of using complimentary medicines and techniques such as biofeedback which teaches the child to control and calm body s reactions when there is pain, it is one of the treatments researched most extensively for migraine, Allen (2004). Guided ima gery is used by letting the patient imagine that he/she is his/her favorite place, the patient will feel safe and relaxed and pain may be decrease. Relaxation and self-hypnosis methods that re mostly used for migraines and headache by asking the child to breathe slowly and deeply and let the patient imagine that his/her muscles are relaxing.. Holroyd and Drew (2006) stated that cognitive behavioral therapy has been utilized successfully to help manage headaches, depression, and anxiety, Lawler and Cameron (2006). This practice has proven effective in reducing migraine headaches, improves mood and cognitive function through an experiment. Also, Acupuncture and Massage can help both adults and pediatric patients who have chronic headache and can be provided by family members, which allows for more regular, inexpensive and favorable treatments. Salantera et al (1999) investigates 265 nurses about the knowledge and abilities of nurses towards pain management of pediatric clients. Health care practitioners such as nurses, are well placed to provide such supportive interventions in both pharmacological and non-pharmacological treatments. According to Ross et al (1991) Healthcare providers lack of knowledge and negative attitudes may lead to under medication and under treatment of pain. Nurses are close to the children the whole day and have more chance to use non-pharmacological pain management methods in their work. Clarke et al (1996) that education about pain was most inadequate in areas of non-pharmacological interventions to relieve pain, the difference between acute and chronic pain, and the anatomy and physiology of pain. Nurses knowledge differed according to their age, education, and place of work, and uses a fairly wide range of non-pharmacological pain alleviation methods, most of the time the nurse was in the activ e role and the child was passive, restricting the child to take an active part in their own pain comfort. Studies shows that children like to have some responsibility for their own care. Furthermore, Pederson and Harbaugh (1995) explicit that there are obstacles in terms of using non-pharmacological pain management in hospital setting and found to be that excess workload, lack of proper materials, lack of knowledge and skills, and not knowing the child were the most common problems nurses confronts. Some of them felt that they receive very brief education on non-pharmacological pain management, and 90% had no documented evidence of the use of any non-pharmacological modalities to relieve pain that will serve as nurse s guidelines. The nurses who thought they had good knowledge about non-pharmacological management got a lower score from the survey, nurses consider themselves knowledgeable in stress reduction but not in play therapy and hypnosis method. Effective pain management in ch ildren requires cognition of both pharmacological and non-pharmacological methods. There are evidence found that nurse s characteristics, such as age, knowledge, experience, intuition, attitudes and beliefs, as well as nurses personal experience with pain, determines their implementation of pain interventions and knowledge about it. Nurses should be encouraged to actively seek new information and extend their training. More comparative, dismantling, constructive, and process oriented research strategy is required in the area of non-pharmacological pain management and different practice of pain alleviation should be generalized. Non- pharmacological approach has been found to be an effective adjunct method for the control of pain. A wide range of complementary and alternative medicine therapies are being used by children, including herbs and dietary supplements. Given the influence of psychological and behavioral factors on pain, non-pharmacological interventions are important in altering pain perception/behaviors. Diversional activities are intervention used for managing pain in both children and adult to reduce fear and, minimize distress and pain and increase a childs sense of control. For these techniques to be effective, it must be appropriate to patient s age and developmental abilities and must also be appealing to the recipient. There is still continues need to educate the medical community regarding the long term outcomes of pain control. Word count = 1514 Reference List: Allen KD (2004) Using biofeedback to make childhood headaches less of a pain. Pediatric Annual. 33: 241-245 Broome M (1985). The child in pain: A model for assessment and intervention. Critical care quarterly, 8: 47-55 Fernandez E (1986). A classification system of cognitive coping strategies for pain. Pain. 26: 141- 151. Holroyd KA, Drew JB (2006) Behavioral approaches to the treatment of migraine. Seminar Neurology. 26: 199- 207 Katz E, Kellerman J, Ellenberg L (1987) Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology; 12: 379- 394 Kemper K, Breuner C, (2010) Complimentary, Holistic, and Integrative Medicine; Headaches. American academy of pediatrics, 31(2) p.17- 23 Lawler SP, Cameron LD (2006) A randomized, controlled trial of massage therapy as a treatment for migraine. Annual Behavioral Medicine. 32: p50-59 National Center for complimentary and alternative medicine, NIH (2007) Non-pharmacological pain management therapies for children. Available at http://nccma.nih.gov National Institute for clinical excellence (NICE) (2005) Service guidelines for improving outcomes in children and young people with cancer-second consultation. Available at http://www.nice.org.uk/pdf/cacancer_2ndcons_manual.pdf Oshikoya K, Senbanjo I, Njokanma O, Soipe A ( 2008) Use of complimentary and alternative medicines for children with chronic health conditions in Lagos, Nigeria. BMC complimentary and alternative medicine 8 (66), p.1- 8 Pederson C, Harbaugh B. (1995) Nurses use of Non-pharmacological techniques with hospitalized children. Issues comprehensive pediatric Nursing; 18: 91- 109 Richardson J, Smith J, Pilkington K (2006) Hypnosis for procedure-related pain and distress in pediatric cancer patients: A systematic review and methodology related to hypnosis interventions. Journal of Pain and symptom Management, 31 (1) p.70- 83 Ross RS, Bush JP, Crummette BD (1991) Factors affecting nurses decisions to administer PRN analgesic medication to children after surgery: an analog investigation. Journal of pediatric Psychology, 16: 151-167 Salantera S, Lauri S, Salmi T, Helenius H (1999) Nurses knowledge about pharmacological and non-pharmacological pain management in children. Journal of Pain and symptom Management, 18 (4) p. 289- 299 Vessey J, Carlson K, McGill J (1994) Use of Distraction with Children during an acute pain experience. Nursing Research, 43(6) p. 369-372 Weeeks DP, Savedra MC (1988) Adolescent cancer: coping with treatment- related pain. Journal of Pediatric Nursing; 3: 318- 328. Wong D, Baker C (1988) Pain in children s comparison of assessment scales. Pediatric Nursing, 14: 19- 17.

Shakespeare and the Wedding Ring Tradition :: William Shakespeare

The Wedding Ring Tradition Significance of Rings To Shakespeare During Shakespeare's time, the wedding and engagement rings indicated commitment. The rings Portia and Nerissa gave to Bassanio and Gratiano, that they were never to remove, were just that. "I give them with this ring, Which when you part from, lose, or give away, Let it presage the ruin of your love And be my vantage to exclaim on you" (3.2.171-4). The rings stood for the man's commitment to his wife just as rings Bassanio and Gratiano would give to Portia and Nerissa at their weddings would stand for the wives' commitment. Rings were common mainly among the richer parts of society, who could afford such a token. Mary Queen of Scots sent a diamond ring to Thomas Duke of Norfolk to indicate her willingness to marry him. However, peasants would give smaller tokens or none at all. It was usually the case that everyone in a village knew who was married, so no symbol was necessary. In the case that a man wishes to break a wedding contract, he must give back double all of the tokens he has received, usually a collection of small items. This made it even less practical for the poorer people in society to give rings. The fact that Portia and Nerissa gave rings to Bassanio and Gratiano is mainly an indication of their wealth. The commitment could have been symbolized by any token given to the men, but using a ring also shows that they are wealthy. Elizabethans would know that the ring itself was of no consequence to the marriage, but rather what it stood for was important. Origin Of The Tradition Engagement rings initially served a double purpose. In the days when brides were purchased, these rings were partial payment for the bride in addition to symbolizing the groom's intentions and woman's agreement. Diamonds were first found in Medieval Italy and due to their hardness symbolized enduring love. Shakespeare and the Wedding Ring Tradition :: William Shakespeare The Wedding Ring Tradition Significance of Rings To Shakespeare During Shakespeare's time, the wedding and engagement rings indicated commitment. The rings Portia and Nerissa gave to Bassanio and Gratiano, that they were never to remove, were just that. "I give them with this ring, Which when you part from, lose, or give away, Let it presage the ruin of your love And be my vantage to exclaim on you" (3.2.171-4). The rings stood for the man's commitment to his wife just as rings Bassanio and Gratiano would give to Portia and Nerissa at their weddings would stand for the wives' commitment. Rings were common mainly among the richer parts of society, who could afford such a token. Mary Queen of Scots sent a diamond ring to Thomas Duke of Norfolk to indicate her willingness to marry him. However, peasants would give smaller tokens or none at all. It was usually the case that everyone in a village knew who was married, so no symbol was necessary. In the case that a man wishes to break a wedding contract, he must give back double all of the tokens he has received, usually a collection of small items. This made it even less practical for the poorer people in society to give rings. The fact that Portia and Nerissa gave rings to Bassanio and Gratiano is mainly an indication of their wealth. The commitment could have been symbolized by any token given to the men, but using a ring also shows that they are wealthy. Elizabethans would know that the ring itself was of no consequence to the marriage, but rather what it stood for was important. Origin Of The Tradition Engagement rings initially served a double purpose. In the days when brides were purchased, these rings were partial payment for the bride in addition to symbolizing the groom's intentions and woman's agreement. Diamonds were first found in Medieval Italy and due to their hardness symbolized enduring love.

The First Day In Australia

Would like to talk about my first day in Australia in this essay. I arrived in Sydney on the 3rd of April 201 3 and it was raining heavily. However, everything looked interesting to me. Was planning to visit Commonwealth Bank at Martin Place as soon as I stepped out of the airplane. When got there, was surprised because the architectural style of the building was luxurious and antique, and it felt very Western. Then I met a teller who greeted me kindly. He made jokes to me. They were funny jokes, but at that time, I did not answer.I was regretful I could not say anything to him in English. After that, I left for a backpacker hostel that is known as a popular place for foreigners. Unfortunately, there were a lot Of people waiting to Stay in there. Thus, I had to move another one. Finally I found a different backpacker hostel. As I opened the door of my room, its melancholic atmosphere overwhelmed me. Eventually, I decided to stay only 3 days because of the uncomfortable, unfamiliar ai r and because the accommodation fee was unfair.In the first night, I was not able to sleep deeply. Lying in the bed, really worried about my life in Australia. Being unsure about my future made me afraid. Time has slipped along. Compared with the past, many things have changed recently. Nowadays I am trying to improve my life in Australia constantly in order to step forward by studying English and making friends. If I have an opportunity, I would like to settle in Australia.

Word Choice Elicit vs. Illicit - Proofread My Papers Academic Blog

Word Choice Elicit vs. Illicit - Proofread My Papers Academic Blog Word Choice: Elicit vs. Illicit Some words sound so alike you’d struggle to hear the difference, even when they’re obviously distinct on paper. Understandably, it’s easy to get such words confused. For example, â€Å"elicit† and â€Å"illicit† are similarly pronounced; however, they diverge significantly in spelling and meaning, so you wouldn’t want to mix them up in your written work. But what exactly is the difference? And how should these terms be used? Elicit (Draw Out or Evoke) The term â€Å"elicit† is a verb meaning â€Å"to draw forth or bring out† and often used when something is done to provoke a reaction or obtain information: At first he ignored me, but a few probing questions eventually elicited an answer. Usually, â€Å"elicit† is reserved for deliberate attempts to gain a response, but it can simply describe being affected by something: The death of her childhood hero elicited an emotional response. Illicit (Illegal or Forbidden) Something â€Å"illicit† is either illegal or counter to society’s moral standards: Until recently, Cuban cigars were an illicit tobacco product. Although Ted and Diane were happily married to other people, they could not deny their illicit love. Note the second sentence above is merely something of which society disapproves (an extramarital affair) rather than something illegal. Elicit or Illicit? As you can see, these terms have very little in common beyond the way they sound when spoken. For example, it wouldn’t make sense to say something â€Å"illicited a response† or to refer to stolen goods as â€Å"elicit items†! Luckily, since â€Å"illicit† is a synonym for â€Å"illegal† and both start with â€Å"ill-,† it’s pretty easy to remember which word to use in any given situation: Is what you’re describing against the law or forbidden? If so, use the adjective â€Å"illicit†; Are you describing something that has provoked a response? If so, use the verb â€Å"elicit.†

A Day in the Life of Noble essays

A Day in the Life of Noble essays Describe a day in the life of noble and his family. A noble was a person of the official or upper class. They were men of great wealth. Their wealth came mainly from real estate appointed to them by the king. They were highly respected and were expected to live up to certain roles. A nobles household was a hive of activity. A noble would have many servants to attend his every need. A day in the life of a noble man would consist of.... When a nobleman and his wife woke up, their first task for the day was grooming. Before beginning their day they would pay very close attention to their personal cleanliness and appearance. This was achieved by the men removing body and facial hair with bronze razors, tweezers and scrapers, they also anointed their bodies with perfumed oils. Because Egypt was a warm place to live in their clothing was lightly clad. They men went bare chested except for many large pieces of expensive, bright, beaded and jeweled colars and jewellry. He also wore a broad, pleated white linen kilt and sandals. His short-cropped hair was covered in a wig. The noblemans wife paid particular attention to her hair and cosmetics. She would surround her eyes with kohl and malachite, which served for beautification and protection. Their dress was much more different to those of the men. They would wear simple ankle length sheaths of linen with broad straps over the shoulders. A woman would accessorize her outfit with beautiful jewellry. Once the nobleman had completed his toilet he would then receive the reports from his overseers and foremen. His scribes were always available to write any letters or dispatches that he needed. He also kept all the estate records. A noble man would enjoy three daily meals. He would be able to choose form a large banquet of foods. Their meals consisted of bread, cakes stews, fish, barley, cereal, fruit and would even indulge five types of poultry, sixteen form ...

9.1 Select and Discuss an Image Coursework Example | Topics and Well Written Essays - 500 words

9.1 Select and Discuss an Image - Coursework Example As can be depicted from the art, it was able to portray John Sloan adherence to realism and hence socialism. The central focus of the art is the beach with the people in it, most probably depicting the behavior of people inside; consequently, showing the realist nature. His preference for expression of what is happening in the contemporary settings, as can be seen by the woman touching her hat, in the middle ground. The other people, still in the middle ground have turned their focus on the woman, appreciatively, as they continue lounging on the beach sand. They embrace each other with joy and passion, as can be seen by those women supporting themselves on the men. Intuitively, the artist constructively uses women in his piece as objects of desire in the society. He depicts the ability of different genders to interact with one another with a recommendable touch, within our contemporary world. The use of happy women in the picture also portrays Sloan’s realism view about the modern New Yorkers. One can assume that the women in the middle ground are happy beside the male characters because of the presented gleeful atmosphere. This insinuates the new independence found within the New York residence that makes them interact freely with each other. Just like realist before him, he was able to capture the essence of independence found in the urban life. Nonetheless, the artist also depicts beauty of urban life in his art. They are wearing gleaming hats which fits them in a glamorous manner. Further, the women have also worn dresses which discern the curves and beauty of their bodies, as shown by the one adjusting he art. The realism nature of the piece also comes out when accessing the artist’s ability to depict urban genre scenes. As aforementioned, the beach had few visitors at the time; he makes use of dark palette, bold and sketch brushwork to give the island park an

Ethical Pitfalls in Negotiation Essay Example | Topics and Well Written Essays - 1000 words

Ethical Pitfalls in Negotiation - Essay Example As lying holds risk as well as ethical issues, it should be eradicated from the negotiation strategies. However, lying depends on the values, culture and situation. A lie may be accepted in Poker business but may be not acceptable in some other business. Therefore, depending on different situations and cultures the extent to which misrepresentation and lying is deemed is acceptable. Though, discretion in making statements and claims should not be perplexed with misrepresentation. A negative commitment is another pitfall in negotiation, to prove credibility, every commitment made should be executed. It is irrational to harm ones self interest in order to hurt the opposite party. The statements of these types are generally made when one is under stress and through negative emotions. Taking an over belligerent stand very early in negotiation can turn off the opposite negotiator. Therefore, others should be allowed to open negotiation or one should practice to tone down opening statements or positions. A commitment to a process is a significant requirement. The situation is made worse, if there is failure to assert the position. As it forces the opposite negotiator to compete till the resistance is met. ... It is viewed as a war that is unfavourable to achieve the integrative prospective in most of the negotiation circumstances. Therefore, there is a need to develop listening skills and communicate clearly. If there is valid argument it needs to be addressed or at least rebutted. One should not close off to the attempts made by the other negotiator to be persuaded (Bucaro, Frank). Ethical aspects of negotiation in today's globalization It is a time of encompassed values and ethics, and there is quite a lot of stress on the importance of values and ethics in day to day life. Therefore, taking personal responsibility, ethical behaviour and ethics play an even more significant role in the present business world and globalization. In any business the question of what is of good for others, be it employees, customers, family or such other relation takes priority over ones desires and needs. Generally ego takes preference over good relationship building and ethical business practices. Ego can harm and disrupt true services. Therefore, while working the job should be strived to make a difference in other people's lives that is for the common good of the people. In simple words an ethical balance should be maintained and the central factor should be focused on others priorities. Before considering a decision, the concept of common good is of utmost importance a simple question such as what can one do to get the other coop erate can go a long way in giving precedence to other peoples needs, feelings and concerns. Business sometimes demands to be focused narrowly. On certain times ones approach alone seems to be the best approach. However, it is essential that there are people around who can give invaluable advice to know whether one is doing what