6 Skills You Need to Become a Call Center Representative

6 Skills You Need to Become a Call Center Representative A call community agent serves clients, as a matter of first importance. Some activity duties include: noting requests, deciding necessities, satisfying solicitations, settling issues, investigating, and looking after databases. They will frequently invest the heft of their energy explaining either the situation of the organization or the parameters of the issue the client is encountering. Once in a while they will have a chance to place deals aptitudes in real life upselling accounts, or adding highlights to augment the customer’s experience. What's more, they are answerable for speaking to the organization and supporting its notoriety among its clients and on the planet principally by giving phenomenal, point by point, and mindful client service.Now, how to get one! Here are simply the top abilities you’ll need to advertise yourself effectively for a call community agent position.1. RetentionYou may be able to gaze stuff upward. Be that as it may, for this activity, yo u’ll need to be able to hold what you peruse and realize and hear. You’ll need to remember a huge measure of data about your organization, just as common arrangements and how to actualize them. What's more, you’ll need to have the option to hear the customer’s circumstance once without getting befuddled. The objective is never being adjusted when talking a client through an issue since you didn’t recollect the subtleties of their bind. You additionally need to know when you can’t resolve an issue all alone and who to allude your client to instead.2. Regard for DetailYou need this in pretty much every occupation, except it’s especially significant at a call place. You’ll be handling a great deal of similar inquiries consistently, so you’ll need to listen up for subtlety and ensure you’re as yet giving every circumstance one of a kind consideration. Make a point to mark the entirety of the conceivable boxes so your client feels you genuinely tuned in to the inquiry and unraveled whatever should have been solved.3. Adaptability/FriendlinessYou’ll need to connect with a variety of individuals. Some of them will be terribly testing. You should have the option to be powerful and kind in any event, when the individual you are talking with isn't giving back in kind. Attempt to treat each new client with another and well disposed position. What's more, do whatever it takes not to let the sporadic (and frequently extended periods of time) make you excessively disappointed to perform.4. Elegance Under FireA great call community rep is rarely bothered, in any event, when handling various perturbed calls and adjusting a billion little undertakings. Keep your cool with the glib individual who won’t get off the telephone, just as with the brief and cranky one. Simply carry out your responsibility and attempt to score a positive result and you’ll do fine.5. SpeedNeither you nor the clie nt has sufficient opportunity to squander on this call. Ensure you comprehend what you’re doing all around ok to be effective, even quick. Both you and your clients will thank you.6. CreativityRemember, every client and circumstance are extraordinary. Finding a functional arrangement can be extreme particularly if your options are limited with organization approach. Being capable and ready to think and react quickly to treat every client with the regard they merit may very well mean you keep clients returning and that makes you look additional great during audits.

Discuss the major components of an academic essay,outlining the role that each component plays. Essay

A scholastic article is a deliberate bit of composing which has a lucid and union significance. Fundamentally, a scholarly article is chiefly described by a presentation, the body, the end and the reference as will be talked about forward with. In the first place, a presentation as worried by McMillan and Weyers (2010: 90) â€Å"has to be the main contact that the peruser makes with the creator of the text.† This, consequently implies it (the presentation) must be efficient and clear, that is, short and exact to the topic or the subject. In help, Cleary et al (2013: 264) composes, â€Å"The presentation is the official beginning of your paper and acquaints your peruser with the subject.† Furthermore, Gamble and Gamble (2010: 371) underpins the possibility of the acquaintance being the first with intrigue the topic or focuses to be pushed. They further clarify that, â€Å"The elements of an acquaintance are with gain the consideration of the crowd individuals, to cause them to tune in to the speech.† Just like Gamble, Payne (2001) gives an accentuation on getting the consideration of the crowd through presenting the subject. Payne (on the same page) proposes that, the acquaintance has with realize the point, that is, featuring the crowd or the peruser about the subject or theme. Notwithstanding that, Gamble (on the same page) further shows that, in the presentation one of a definitive objectives to be manufactured is compatibility. This thusly, implies making or having a shared connection of comprehension with the crowd. Cleary (2013: 265) proposes that, â€Å"an acquaintance has with clarify the title as vital: characterizing terms utilized in the title and clarifies the reason recorded as a hard copy the subject matter.† This implies, instructing the crowd or peruser about the point and subsequently, gi ving sufficient data identifying with the subject. What's more, McMillan (on the same page) gives an accentuation on the significance of the presentation being brief and, along these lines clarifying of the theme setting. Which means the acquaintance has with be clear and making the subject being plainly comprehended by everybody. Pritchard (2008) likewise features on the plan of the connection between the crowds to convey the data viably. All the more in this way, Payne (in the same place), further blueprints that the job of the acquaintance is with make focusting of the significant thoughts of the topic. Once more, this makes the guide of the remainder of the bit of work or record or discourse, giving bearings and features of what will occur through the course of the composition. In help, McMillan (2010:89) recommends that, â€Å"an presentation ought to have a clarification of how one is going to plan to address the point in a specific book in actuality explanation on intent.† Moreover, Cleary (2013: 265) proposes that, â€Å"an acquaintance has with quickly express the structure of the exposition by giving the principle points.† This consequently gives the peruser an unmistakable picture on the title, the motivation behind composition, the concentration and the paper structure composes. Moreover, a presentation ought not be too hard to even consider understanding. The utilization of basic language which is broadly acknowledged gives validity and the utilization of languages it ought not be utilized while presenting a theme. There ought not be any vagueness while presenting a theme. After the presentation, a scholarly article ought to have the body. This, as composes Payne (2001: 416), â€Å"Is the principle part of the speech.† This accordingly, implies the utilization of good joints of sentences is broadly empowered. This part consequently gives the real factors, proof, basic examination, conversation and a very much developed side line of the story or the subject. Therefore, the primary thoughts or the substance of the subject are effectively feasible proficiently. Notwithstanding, McMillan et al shows that, â€Å"This segment (the body) spreads out the work dependent on the methodology which one has chosen to embrace in sorting out the content.† This piece of the paper should be managed extraordinary consideration, as arranging the data is essential. Since the thought needs appropriate and critical arrangement, this accordingly clarifies the significance of a decent paper structure with a decent arranging of words and an intelligible of good words in sentence development. Clouse (2008) states that, the body comprises of two significant parts which are the theme sentence and the supporting subtleties. The subject sentence needs to introduce the principle subject of the section and reports the paragraph’s primary thought, giving a guide. Likewise, the supporting subtleties are the proof subtleties gave to exhibit reality with regards to the point sentence. As it were, the body needs to clarify the significant focuses, summing up, depicting or epitomizing as a feature of the investigation (McMillan). Moreover, these creators additionally imply on keeping the body part as succinct and clear as could reasonably be expected; this consequently implies the body must have less uncertainty in it. CEES (ed.) commends that the body some portion of a scholarly paper composing needs to effectively give proof, models, references which identifies with the subject sentence. This subsequently, gives the crowd an unmistakable and a very much characterized image o f what is being implied by the theme sentence in play. Likewise, CEES in the same place calls attention to that, the body presents the theme sentence or the focal thought supporting the thesisâ statement or line of contention. In accordance with Cleary (2013: 135-136), passages ought to be all around built and of importance and this is when sentences are orchestrated so that they connect to each other offering clearness to the peruser. Such rationality can be accomplished by organizing the sentences in the grouping that will best impart the message to the peruser through the incorporation of sign words or signals which controls the peruser. Likewise, a smooth progression of thoughts makes the exposition considerably more fascinating, that is, firm importance of the musings or thoughts relating to the subject being talked about. Once more, this uses changes between passages so as to guarantee an ideal progression of thoughts. Be that as it may, the end in a paper effectively summari zes the introduction. All the more thus, McMillan (91) characterizes a determination as a rundown of the entire bit of work. In this manner, a great end needs to introduce and explain what has been talked about, assessed, dissected, and expressed in the perfect work of art (the body) gathering of the exposition. Besides, Redman (2006) gives an accentuation that, appropriate ends needs to return to the key focuses or the central matters of one’s contention, summing up the key discussions raised and attempt to combine them. In this manner, the determination ought to give a consolidated adaptation of the essay’s center contention, and repeating the writer’s position in article. Additionally, Cleary on the same page indicates that, in the end, thoughts not referenced before ought not be presented as this in this way changes the focal point of the end. Payne on the same page (2001: 424), shows that, â€Å"Conclusion is the summing up of the major ideas.† One doesn't need to survey everything said in the discourse, yet a short piece helps the crowd to remember what is significant. The end needs to effectively clarify the issues or thoughts one has recently talked about. Notwithstanding that, Cleary in the same place says, â€Å"The segment of an end is to fill in as a synopsis of the primary concerns, normally alluding to the theory statement.† Besides filling in as an outline, a great end ought to be utilized to elevate the effect of the introduction composes Gamble (2010: 374). The decision must be a manufactured rundown which thusly gives a foundation of common comprehension. Besides, it must effortlessness the bit of work in such a way, that the significant crowd noticed the significant focuses or thoughts of the rundown all in all (Payne). This implies, a great end must be advocated for suggestions. Once more, an end ought to be short, explaining and underlining on the principle subject of the composition, or the topic. Along these lines, this goes about as an apparatus in making the introduction of the remainder of the subject to be very much recalled through a propping end (Payne on the same page). To grasp more on a decent scholarly article, references ought to be made in order to hail crafted by others (A2Z Essay). Cleary on the same page (2013: 361) characterizes, â€Å"Referencing as a normalized technique for recognizing printed or electronic wellsprings of data and thought that one have utilized in the article, in a way that interestingly distinguishes their source.† Furthermore, referencing is a demonstration of back recognizing crafted by others in any acquired actuality in order to protect crafted by others from any copyright infringement claims (A2Z). Basically, referencing is important to maintain a strategic distance from written falsification; to empower perusers to check citations; and to empower perusers to development and read all the more completely refered to authorâ€℠¢s contention or research. On another note, reference gives evidence that permits the perusers or crowds to counsel the source in the event of disarray or further conversations. Once more, references goes about as an evaluation device as in it expects one to discover unwavering quality of the wellsprings of the content, likenesses and contrasts among the sources and making association between the subtleties (

How Social Support Contributes to Psychological Health

How Social Support Contributes to Psychological Health Theories Social Psychology Print How Social Support Contributes to Psychological Health By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Medically reviewed by Medically reviewed by Steven Gans, MD on February 24, 2017 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on December 09, 2019 JGI/Tom Grill / Getty Images More in Theories Social Psychology Behavioral Psychology Cognitive Psychology Developmental Psychology Personality Psychology Biological Psychology Psychosocial Psychology Social support is often identified as a key component of solid relationships and strong psychological health, but what exactly does it mean? Essentially, social support involves having a network of family and friends that you can turn to in times of need. Whether you are facing a personal crisis and need immediate assistance, or you just want to spend time with people who care about you, these relationships play a critical role in how you function in your day-to-day life. It is social support that builds people up during times of stress and often gives them the strength to carry on and even thrive. But social support is certainly not a one-way street. In addition to relying on others, you also serve as a form of support for many people in your life.   The Importance of Having a Strong Social Support Network Psychologists and other mental health professionals often talk about the importance of having a strong social support network. When trying to reach our goals or deal with a crisis, experts frequently implore people to lean on their friends and family for support. Research has also demonstrated the link between social relationships and many different aspects of health and wellness.??   Poor social support has been linked to depression and loneliness has been shown to increase the risk of depression, suicide, alcohol use, cardiovascular disease, and altered brain function. In one study of middle-aged men over a seven-year period, those with strong social and emotional support were less likely to die than those who lacked such relationships.?? So, which aspects of our social environments are so vital to health? And how exactly do our social environments impact our overall well-being? There are two essential aspects of our social worlds that contribute to health: social support and social integration.?? Social Support Social support refers to the psychological and material resources provided by a social network to help individuals cope with stress. Such social support may come in different forms. Sometimes it might involve helping a person with various daily tasks when they are ill or offering financial assistance when they are in need. In other situations, it could involve giving advice to a friend when they are facing a difficult situation. And sometimes it simply involves providing caring, empathy, and concern for loved ones in need. Social Integration Social integration is the actual participation in various social relationships, ranging from romantic partnerships to friendships.?? This integration involves emotions, intimacy, and  a sense of belonging to different social groups, such as being part of a family, a partnership, a social activity, or a religious community.  Experts suggest that being integrated into such social relationships confers a protective benefit against maladaptive behaviors and damaging health consequences. A Closer Look at the Types of Social Support Supportive social networks can come in different forms and play different roles in your life.   Sometimes the people in your life provide emotional support. They back you up when you need it and are there with a shoulder to cry on when things dont go your way. This type of support can be particularly important during times of stress or when people are feeling lonely.?? What to Do When Your Loved Ones Arent There for You In other cases, the people in your social network might provide instrumental support. They take care of your physical needs and offer a helping hand when you need it.?? This might involve bringing you a hot meal when you are sick or giving you a ride when your car is in the shop. Such support is important when people have immediate needs that must be addressed. People can also provide what is known as informational support. This can involve providing guidance, advice, information, and mentoring. Such support can be important when making decisions or big changes in ones life.?? By having this form of support, people may feel less anxious and stressed out about the problems they are trying to solve thanks to the advice of a trusted friend, mentor, or loved one. As you might imagine, people in your social networks may take on different roles. A teacher might provide informational support, while a parent might provide all three types. By having a solid social support network, you are more likely to receive the type of support that you need when you really need it. How Social Support Benefits Our Health So now that we understand that our social support systems involve both different types of social support as well as integration into different social groups, it is time to take a closer look at exactly how these social relationships influence both physical and mental health. Just a few of the possible benefits of social connectedness include. Social groups can encourage healthy choices and behaviors.?? Participation in social groups has a normative influence on behaviors, often influencing whether people eat a healthy diet, exercise, smoke, drink, or use illegal substances. Clearly, social groups can sometimes have a negative influence in this regard when peer pressure and influence leads to poor or even dangerous health choices. However, group pressure and support can also lead people to engage in healthy behaviors as well.   If you have ever tried to give up a bad habit, such as smoking, you probably realize just how important social support can be. If your social connections do not support you, it can make success much more difficult. If your friends and family offer support and encouragement, you may find achieving your goal much more possible. Social support helps people cope better with stress. Social support also helps people to cope with stress. Stress has been shown to have serious health consequences ranging from reduced immunity to increased risk of heart disease. Being surrounded by people who are caring and supportive helps people to see themselves as better capable of dealing with the stresses that life brings. Research has also shown that having strong social support in times of crisis can help reduce the consequences of trauma-induced disorders including PTSD.?? Social support can improve motivation. Social relationships can also help people to stay motivated when trying to achieve their goals. People who are trying to lose weight or quit smoking often find that it helps to connect with people who are actively trying to attain those same goals. Talking to people who are going through the same experience can often be a source of support, empathy, and motivation. Clearly, our social relationships serve a critical role in our overall health and well-being, but what can you do to improve your own social network? Be sure to check out these great tips on how to meet new people and form new friendships, some of the major benefits of friendships, as well as different ways to deal with loneliness.   How to Find a Support Group

Theory Critique of Crabb and Hawkins Essay - 826 Words

Theory Critique of Crabb and Hawkins Jeremy Poling Liberty University Integration Dr. Crabb suggests that there are four viewpoints to integrating spirituality and psychology. The first being â€Å"Separate but Equal† This viewpoint ascertains that psychology and spirituality do not mix any more than if a person needs a filling for a cavity or the excising of their wisdom teeth, they do not peruse the scripture for direction the person goes to a dentist. This view is not solid for its very premise is flawed. When dealing with man’s troubling emotions and thinking scripture has much to say about this. For example in 1 Cor. 10:5, we are directed to control our thought life (Holy Bible). The second view â€Å"Tossed Salad† is acceptable†¦show more content†¦Dr. Hawkins’ model for the counseling process and the description of the person is diagrammed using concentric circles (Hawkins, 2011). The first layer is where the core is: human spirit, image of God etc. The second layer consists of the soul – thoughts, will, conscience, feeling. The third layer consist of the body. The fourth layer consists of temporal systems such as family, friends, church, society, government, economy, and education. The fifth layer consists of supernatural systems such as: God, good angels, demons, and Satan. Hawkins uses a four-phase model grid for tracking process. Phase1 is where the counselor listens to the person talk and seeks to understand. Phase 2 is where one tracks what the patient is saying and sets the direction and proposes a plan of action. In phase 3 one directs the plan of action from the information provided and seeks to have client take ownership. In phase 4 one supports the commitments to change through arranging for accountability. All of this takes place in an atmosphere that is penetrated by love. EvaluationShow MoreRelatedEssay on Theory Critique: Crabb and Hawkins1241 Words   |  5 PagesTheory Critique: Crabb and Hawkins Liberty University Summary of the Content Both authors express many overlapping elements of revealed truth in regard to the process of counseling and the problems that are derived in the life of clients and people suffering from disorders and psychologically unhealthy mindsets. Hawkins utilizes a theory of 5 concentric circles defining the human psyche and physiology. Hawkins goes on to relay his theory of counseling that utilizes 4 phases in which the counselorRead MoreChristian Counseling and Secular Psychology 1320 Words   |  6 PagesTheory Critique In our fast passed and ever changing society, personal experiences built up over time and often make life difficult to deal with over time. Everyone has their own prospective on what is important and how they will tackle various problems they face from day to day. 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I researched â€Å"Spoiling the Egyptians†, as to, I was curious about the scripture base. Spoiling the Egyptians refers to Exodus 12:40-42, as God watched over the Israelites as they went through the wildernessRead MoreTheory Critique1539 Words   |  7 PagesA Critique of Two Theoretical Models: Crabb and Hawkins Amy E. Yesalavich Liberty University COUN 507-B09 Dr. Alan Cheney May 27, 2012 Summary Psychology has been primarily viewed as a methodical system that seeks empirical evidence to explain nature, while theology is often viewed as reasoning based on man’s eternal destiny as discussed in biblical teachings. Falsities are held within both of these historical beliefs. 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I considered several factors that were critical to my personal counseling theory. First, I considered the human personality, such as, individual differences, motivationsRead MorePersonal Theory Paper3660 Words   |  15 PagesPersonal Theory Paper Evie Kuhn Liberty University Abstract This paper is the development of my personal theory on Christian Counseling. I use many scriptural references to support my beliefs and stress the importance of gaining wisdom and knowledge from the bible. It incorporates all of the presentations, readings, and critiques I did at Liberty University’s Theology and Spirituality in counseling course. I talk about how I integrate Psychology, Theology, and Spirituality into my Christian

How Technology Can Be Dangerous For Youth - 887 Words

In this day and age, technology is a major part of our everyday lives. Think of our schedules and where technology fits into them. We wake up, with an alarm clock; technology. We make breakfast, in a microwave; technology. We commute, in cars; technology. Almost everything we do involves technology. One form that commonly occupies our attention and focus is social media. Social media is any communication that can be done using electronics. Not only do older people find themselves immersed in social media, but so do children. This form of technology can be dangerous for youth, tactically imbedding snares, which can easily entangle them. One thing, or person should I say, that children don’t think about when they are networking on social media, is the adult predator. According to the article â€Å"Children Must Be Protected from the Content of Social Networking Web Sites,† found on the Online Social Networking website, while on dating sites or even profiling media, kids d o not remember to think about the sneaky adults that are targeting them. These adolescents are very vulnerable. They can accidentally give out too much information to these older people. Little do they know that these â€Å"thirteen year olds† that they are talking to are actually creepy old men wanting to do terrible things. They are subjected to stalking, kidnapping, rape, and other acts of violence from these pathological liars (Racine). By the time they realize that their new best friend has lied to them and isShow MoreRelatedTechnology And Technology Essay1046 Words   |  5 Pagestechnological advances of the 21st century have changed the way individuals interact with one another. In the 1960s and 1970s, only universities, corporations, and the government owned expensive computers (Levy 285). In the article â€Å"Progress in the Technology of Neuromodulation: The Emperor’s New Clothes,† Robert Levy traces the technological advances from the 1975 mass-pro ducing Altair 800 computer to the growth of personal computing thirty years later. He acknowledges that in 2009, the changes in telephonicRead Moreâ€Å"Seventy-Eight Percent Of Teens Have A Cell Phone, 47 %1275 Words   |  6 Pagesphone. Technology has changed each year, and children want to have the newest smartphone so that they can fit in. Now in days, adolescents can no longer live without their phone because it has become a necessity for them to be up to date with everything. Most parents allow this because they want the child to feel like they fit in. It has become a habit for children to spend a lot of their time on technology rather than spending their time outside. The positive side of technology is that it can helpRead MoreCyber-bullying Powered by Technology869 Words   |  4 Pagesexpansion of communication technologies, bullies are gaining more and more ways to torture their victims. The fact of the matter is, technology isn’t going anywhere anytime soon, s o we need to come up with a way to end cyber-bullies permanently. Cyber-bullying is becoming more of a problem and all of us need to work together in figuring out how we can stop cyber-bullies once and for all. Until we take precautionary measures, cyber-bullies will continue to be a threat to today’s youth. Before putting an endRead MoreEvolution Of The Baseball Bat1525 Words   |  7 Pagesbecause they did not have a lot of pop, which is how hard the ball bounces off of the bat. As the wood bat progressed, the ball began to fly farther and travel faster. This change in wood baseball bats can be related to the change in metal bats. When metal bats were first introduced, they were considered inferior to wood bats until the new and improved BESR bats were introduced. These bats had more pop than ever before, and were considered dangerous. Because of this danger, the BBCOR bats had to beRead More Juvenile Delinquency: Increasing Juvenile Crime and Violence965 Words   |  4 Pagescontrol† (20). Children themselves are considered as dangerous beings. The media broadcast juvenile delinquency one after another and they are focusing on it more than ever before so watching the news about the child crime is not unusual anymore. We suppose that children have been out of control. The media are sound like the sources of creating prejudice against children. Compared with past, in fact, have children been more and more dangerous? Are the juvenile crime and violence increasing? Or areRead MoreTechnology, Helpful Or Hurtful? Essay1585 Words   |  7 PagesTechnology, Helpful or Hurtful? What Can We Do to Help? In today’s society, everyone has a technological device such as a cell phone, tablet or computer. If you walk down the street, you will most likely be greeted by people looking down on their phones rather than paying attention to the world around them. There has been an increase in phone companies trying to prevent texting and driving for a reason. Everyone is attached to their phones. A person cannot simply be out of touch any more now thatRead MoreCyber Bullying And Its Effects1411 Words   |  6 Pagesshould not be tolerated. The expansion of communication technologies is widening the way bully’s can torture their victims. The fact of the matter is, technology is not going anywhere, so we need to figure out a way to put an end to cyber-bullies. Cyber-bullying is becoming a major problem and we all need to do our parts in figuring out what can be done to stop cyber-bullies in their tracks. Cyber-bullies will continue to be a threat to today’s youth until we take preventative measures against them. BeforeRead MoreIs Technology Good or Bad for Today ´s Youth?931 Words   |  4 PagesTechnology is a good or a bad for today’s youth? . . Today is the world of technology and man being a social animal is nothing without this technology. Or in other words can be said that survival along with progression is not possible without the interference of technology in our lives in each and everyRead MoreVideo Games And Its Effects On Society1632 Words   |  7 PagesTechnology is a large part of modern society, especially in industrial society. Depending on who you ask, people are either in favour of the advancement in technology or some are against its progression arguing that people have become too reliant. Cellphones are one of the main forms of technology that people talk about most, questioning whether they are a good thing or bad. Many people are also concerned with the advancement in video games, worrying that video games are the cause of crime and violenceRead MoreNegative Effects Of Social Media On Youth1088 Words   |  5 Pagespositive accomplishments we can attribute to social media, there are also some very negat ive side effects that go hand in hand with the use of social media. From the absence of soft skills to the lasting damage of focus, social media may not be the saving grace we are looking for. The wide spread use of social media has detrimental effects on the development of today’s youth. The detrimental effects social media has on today’s youth should make us rethink our evolution of technology. The repeated use of

Sectionalism Free Essays

Sectionalism Essay During the 1850’s, slavery, a southern necessity both socially and economically, threatened the unity of our nation essay writer site. The tension’s were high between the North and South, and further increased as more and more factors contributed to the strain in the Union. As an outcome of these factors, small and big, sectional hatred began to arise and commenced the splitting of the nation; ultimately leading to the American Civil War. We will write a custom essay sample on Sectionalism or any similar topic only for you Order Now The very first issue that caused sectionalism in the 1850’s between the North and South was the Compromise of 1850. This compromise was a package of bills, passed in the United States in September 1850, regarding the status of territories acquired during the Mexican-American War. It was drafted by Whig Senator Henry Clay and was negotiated with Stephen Douglas in order to avoid secession or civil war in 1850. The Compromise of 1850 caused sectionalism in the Union because it first established California as a free state and turned down the Southern proposal to split California at the 35 ° parallel; causing the South to be frustrated at the admittance of California. To balance out the annexation of California, the South was pleased to hear that the territories of New Mexico and Utah would have slavery decided with popular sovereignty, meaning that the people who settled there would decide whether or not the territory would be free or slave. Little did they know that they were being cheated, because the land in New Mexico and Utah was unsuited for agriculture and not fit for slave plantations. The biggest blow that caused sectionalism in the Compromise of 1850 was delivered when the Fugitive Slave Law became more strongly enforced. The Fugitive Slave Law basically declared that all runaway slaves must be returned to their masters and anyone who assisted the runaway slave would be arrested. It also gave commissioners ten dollars for every slave that was returned to its master and five dollars for every accused slave released, which led to greedy commissioners re-enslaving freed slaves. Lastly, the debate over slavery in the nation’s capital was resolved during this compromise, it banned the trading of slaves in the capital but still allowed slavery to be practiced, which did not do much because people would just bring slaves in from neighboring states. The Compromise of 1850 was made in order to restrain the Union from splitting, but in it’s attempt to please both the North and South, it caused them to develop more sectional hatred for one another. Another factor that caused sectionalism at the time came with the publishing of Uncle Tom’s Cabin in 1852. This book was an anti-slavery novel by the author Harriet Beecher Stowe and was the bestselling novel of the 19th century. She was an abolitionist, which means she was against slavery, and she wrote the book so the North would understand how badly the South were treating their slaves. This book stood out among all the other anti-slavery books because it was the first to develop an emotional impact on the reader and personified the slave, not as a piece of property, but as a living human being. Her words galvanized the North to take action instead of remain undecided on their view of slavery and showed the people in the North, and even other neighboring countries how devastating slavery was in the South. The South saw this book as a direct attack on their practice of slavery and developed a burning hatred for the words of Stowe because she was said to exaggerate greatly on the practice of slavery, making it seem more brutal and savage then it really was. This book caused the Union to become further sectionalized and caused more hate between the North and South; to the point where Lincoln even referred to Stowe as â€Å"the little woman who wrote the book that made this great war. † Uncle Tom’s Cabin did more than awaken the North; it influenced other nations to stay out of the Civil War because they were so moved by the book and were afraid it would stir up troubles in their own countries if they picked a side. The differing views about the institution of slavery contributed to the growing rift between the South and North and was another factor that caused sectional hatred in the 1850’s. A huge factor that caused the chasm between the North and South to grow was one regarding the Kansas-Nebraska Act of 1854. This act was proposed by Steven Douglas and it split the Louisiana Purchase into two and created the territories of Kansas and Nebraska, opening them for settlement and letting them decide the issue of slavery through popular sovereignty. The decision to decide slavery in these territories through popular sovereignty rivaled the great Missouri Compromise of 1820 because both the territories were above the 36 °30†² parallel and yet they had a chance to become slave states if enough people voted for it. The act inflamed the slavery issue and led opponents to form the Republican Party, which was supported by Abraham Lincoln and saw the expansion of slavery as a great evil. The Republican Party held all it’s power in the North and caused many of the Northerners to rally to them on the grounds that the Kansas-Nebraska Act opposed the Missouri Compromise that kept those grounds sacred and untouched by slavery. This caused life in Kansas to be a mini civil war with Northerners and Southerners competing with one another for land and other resources, resulting in a lot of violence, which led to the coining of the term â€Å"Bleeding Kansas† because of the federal governments inability to contain the disorder. Douglas’ plan to find middle ground between the free and slave states ended up driving the North and South farther apart because both slave and free advocates believed they rightfully had claims to the territory, the Northerners supporting the Missouri Compromise, and the Southerners supporting the new-found Kansas-Nebraska Act. The secretive Ostend Manifesto of 1854 played a small role in driving the nation apart. The manifesto contained rationale for the United States to buy Cuba from Spain and implied that the U. S. would declare war on Spain if it refused to sell Cuba to them peacefully. The annexation of Cuba was a huge goal for southern expansionists because they sought to bring in Cuba as a slave state and said that Cuba was vital to the Union’s domestic interests. The document started a diplomatic firestorm, reinforcing foreign fears of aggressive American expansion and caused the Northerners who were now enlightened on the cruelty of slavery to become insubordinate to the South. This led to the coining of the term â€Å"slavocracy† which basically described the people who used their political power to corrupt slavery and spread it across the nation. Although this attempt to annex Cuba into the Union was a failure, it did represent the intentions of the South and cause the North to become agitated. This manifesto was one of the small contributing factors to the separation of the North and South that would soon pile onto the ever growing heap of sectionalism in the Union. Another event that contributed to the sectionalism between the North and South was the famous Sumner Assault of 1856. On May of that year, the brilliant speaker, Charles Sumner made his speech that denounced â€Å"The Crime Against Kansas† along with other Southern leaders, such as Senator Butler. A fellow senator, Preston Brooks, took deep offense to the harsh word from Sumner’s mouth and considered challenging the babbling madman to a duel, but then soon realized he must not stoop so low as to duel someone as scum-like as Sumner. So to solve his problem, on May 22, 1856 Preston Brooks strolls into the Senate Chamber and starts to beat Charles Sumner voraciously with his cane. This caused Brooks to gain much fame from his fellow Southerners and people even went so far as to send him personal cane’s to replace his bloody broken one. The Northerners, on the other hand, were extremely outraged at this praising of Brooks and his violent acts and further supported their theory that the South were savages. In order to show support for their now injured speaker, Massachusetts reelected Sumner for another term and left his seat vacant as a reminder of southern brutality and cause the North to have more reasons to develop sectional hatred for the South. The Dred Scott Decision of 1857 was a landmark decision by the Supreme Court that caused the greatest division between the North and South. It stated that people of African descent brought into the United States and held as slaves were not protected by the Constitution and were not U. S. Citizens. Furthermore, Taney also included in this court case that the slave, Dred Scott was never free, regardless of where he lived, because slaves were personal property. This decision also went so far as to claim the Missouri Compromise of 1820 to be unconstitutional because the federal government had no right to prohibit slavery in the new territories. They also argued that the Constitution supported slavery because it did not outlaw or restrict it within the United States. Antislavery groups were appalled by this court decision and feared that slavery might spread unchecked and as a result, the Republican Party of 1854 fought to gain control of the Congress and the courts. The Dred Scott Decision was also a event that appealed to the people emotionally, much the Uncle Tom’s Cabin, because people began to sympathize for slaves who were treated unfairly, such as Dred Scott. The court decision pleased the South because it allowed slavery to exist everywhere because the federal government has no legal power to take away property, and it upset the North because they saw it as a terrible decision that would allow slavery in their states. This caused the tension between the two to become even more strained and foreshadowed the terrible disunion that was to come. Another written document that caused hostility between the North and South was the Lecompton Constitution of 1857. This constitution was one of the four proposed constitutions for the state of Kansas that were made in the three years since the Kansas-Nebraska Act. During this three year period, the North and South grew increasingly caught up in whether or not Kansas would join as a free or slave state. In the end, the pro-slavery forces won control of the constitutional convention in the town of Lecompton on a day in September. This only happened because the anti-slavery group in Kansas believed the voting was rigged and refused to vote for the constitution, causing the pro-slavery group in Kansas to win the vote and pass the contribution to the Congress. However, the Congress saw something wrong with the voting sensed that the voting was fraudulent and that popular sovereignty did not work effectively because of the North’s refusal to vote. Seeing that the North had not had a chance to vote, Douglas persuaded Congress to called for a new vote on the Lecompton Constitution, and on January 4, 1858 the new vote was swept over with anti-slavery Republicans. This solved the problem of Kansas’ admittance to the Union but it caused other problems such as the splitting of the Democratic Party because of debate over â€Å"Bleeding Kansas† and it also lost Douglas many Southern votes in the upcoming election. This caused the nation to further become sectional due to the Lecompton Constitution ripping apart the only political party that had a mixture of Northerners and Southerners and causing the South to become angered at the rejection of their constitution. One of the last major events in the 1850’s that caused intense sectional hatred between the North and South was the execution of John Brown in 1859. John Brown was a dedicated abolitionist that commanded forces multiple times in Kansas, making him a very stern and somewhat violent man. This proved to be true when Brown led a few of his troops to Pottawatomie to kill five pro-slavery supporters. The death of these pro-slavery men only sated his appetite for justice for a small while and in 1859, Brown sought to carry out a plan that Southerners have feared for every since slavery arose. Brown took his small group of men, and on October 16 of that year, he attempted to start an armed slave revolt by seizing a United States Arsenal at Harper’s Ferry. The attack was so crazy and so unexpected that Brown and his troops took the armory easily, but their problem arose when it came to galvanizing the slaves. With the slaves refusing to fight back, Robert E. Lee and his troops overwhelmed Brown’s small number of men and forced them to surrender. The South, who were appalled by Brown’s crazy attempt to defeat slavery, sentenced him to death by hanging. However, John already saw his fate and found what his purpose was. He believed that he was much more useful as a martyr that would give the abolitionists someone to fight for. His perception of his death caused im to make beautiful speeches against the institution slavery, which gained him sentiment and established a personal bond with all the abolitionists in the North. John Brown’s execution gave many Northerners a reason to hate the South because they had killed a man who was brave enough to stand up for the good of the nation. As a result, tensions increased to it s maximum capacity and caused the Election of 1860 to be the straw the broke the camel’s back. During the 1850’s, there was an overwhelming amount of sectionalism in the United States because of the differences between the North and South. Many factors, small and big, contributed to sectional hatred between the North and South, which was terribly unhealthy for the prosperity of the nation. The buildup of tension came from a variety of things, from frivolous brawls in the Congress to the publishing of a book, and everything in between. All of these tiny disagreements continued to add up, causing hatred to fester between the anti-slavery and pro-slavery groups which began the secession of the South, resulting in the start of the bloodiest war in U. S history, The American Civil War. How to cite Sectionalism, Papers

The Movie Industry Analysis Essay Example For Students

The Movie Industry Analysis Essay IntroductionThe Movie Industry is one of the most exciting and informative business in the world, a business where the revenue of a single feature film can approach or exceed $1 billion. In 1994, U.S. consumers spent over $6 billion on movie tickets and another $34 billion on cable TV and video purchases and rentals. In 1996, worldwide gross revenues generated by motion pictures in all territories and media (including music and ancillaries) amounted to over $40 billion. These figures were only a fraction of total entertainment outlays worldwide, spent mostly on American-made movies. Over 70% of the population rents or goes to movies regularly, this accounts for over 1.5 billion movie attendances each year in the United States. Strategic Issues:1) Blockbuster-ability, or the ability to consistently produce awide variety of popular films at a profit;2) Expanding distribution channels into the ancillary markets where profit margins are higher; and3) The value and depth of film libraries, which extend a films lifecycle and gererate revenues far into the future. We will write a custom essay on The Movie Industry Analysis specifically for you for only $16.38 $13.9/page Order now Key ProblemsCost-Film profits are rare and difficult to measure. There are high promotional and marketing costs which include fees paid to exhibitors, distributions fees, overheads, interset and expenses ( paid usually to studios distributors). These combined costs greatly reduce the revenue sream flowing to the producer and net profit participants. In addition, certain management decisions made in the beginning, whether or not to hire star talent as opposed to an unknown can be quite costly, although this sort of decision may guarentee box office success of the movie. Diversification Integration-The ability to exploit a movie in many markets diminishes investment risk and increases earning potential. Diversification and integration into ancillary markets can turn a movie that has lost money theatrically into a video market winner. Unfortunately, if the studio is a small independent it may cost prohibitive to diversify. If the studio is a major that is not already diversified, the competition and cost to do so would be significant factor. Barriers to entry for independents-The most obvious barrier to entry is the high cost of acquisition. Larger studios owe their survival to ample resources, which afford them the ability to weather box office disasters. Small studios would not necessarily be able to survive box office failures. Major studios also have an advantage in their ability to maintain distribution networks across the country and in foreign markets. This ensures that their films get to theaters and television screens. Competition-Thousands of screenplays are in developement at any given time but only 450 to 500 actually become motion pictures. Of those, approximately 173 are actually released to the theaters. Even then, the success at the box office is not guaranteed because that success is always subject to public preference. Historical trends in the industry-Feature motion pictures have historically had one major source of revenue in the United States and abroad,The movie theater. Industry statistics reveal that in the past ten years there has been an overall increase of at least 30% in many ancillary markets and over 200% in the case of home video. Today much of the world is undergoing a mass communications revolution; hence, new movie markets such as home video, cable and pay-per-view have been growing so rapidly that they are no longer just ancillary markets to the basic theatrical market but have become basic markets in themselves. The latest technological frontier for motion picture companies was in direct-access TV through telephone lines. With the advent of the new computer-based technologies, cable markets and direct digital-delivery of motion pictures via satellite and the Internet are expected to increase dramatically over the next five years, creating an accelerated demand for original and re-run motion pictures. .u043790e5cc93a92a59866c6dd33204e8 , .u043790e5cc93a92a59866c6dd33204e8 .postImageUrl , .u043790e5cc93a92a59866c6dd33204e8 .centered-text-area { min-height: 80px; position: relative; } .u043790e5cc93a92a59866c6dd33204e8 , .u043790e5cc93a92a59866c6dd33204e8:hover , .u043790e5cc93a92a59866c6dd33204e8:visited , .u043790e5cc93a92a59866c6dd33204e8:active { border:0!important; } .u043790e5cc93a92a59866c6dd33204e8 .clearfix:after { content: ""; display: table; clear: both; } .u043790e5cc93a92a59866c6dd33204e8 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u043790e5cc93a92a59866c6dd33204e8:active , .u043790e5cc93a92a59866c6dd33204e8:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u043790e5cc93a92a59866c6dd33204e8 .centered-text-area { width: 100%; position: relative ; } .u043790e5cc93a92a59866c6dd33204e8 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u043790e5cc93a92a59866c6dd33204e8 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u043790e5cc93a92a59866c6dd33204e8 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u043790e5cc93a92a59866c6dd33204e8:hover .ctaButton { background-color: #34495E!important; } .u043790e5cc93a92a59866c6dd33204e8 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u043790e5cc93a92a59866c6dd33204e8 .u043790e5cc93a92a59866c6dd33204e8-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u043790e5cc93a92a59866c6dd33204e8:after { content: ""; display: block; clear: both; } READ: In Cold Blood: Summary EssayDATA ANALYSISWhat is the competitive environment?There are thousands of screenplays in development at any given time, however each year only 450 to 500 of these are produced into motion pictures. Although the majority undergo principal photography in the United States, approximately 60 to 80 are shot offshore (including Mexico and Canada). Of these approximately one-third come from the majors (Disney, Sony, (Columbia-Tristar), Warner Brothers, Universal, Paramount and Twentieth Century Fox) and

buy custom Acquired Immunodeficiency Syndrome essay

buy custom Acquired Immunodeficiency Syndrome essay Acquired Immunodeficiency Syndrome (AIDS) is a disease that attacks the human immune system and renders it ineffective. It makes people more vulnerable to contracting various infections of the body like; diseases, opportunistic infections, tumors, and many other infections that do not easily affect people with a normally working immune system. Briefly, AIDS is a multiple-edge killer disease that kills at every opportunity it gets. Since its discovery in the 1980s, specialists have tried to end the misery of AIDS patients by trying to find a cure for the disease, but this has been unsuccessful. Instead, they have managed to come up with drugs that control the disease by preventing chances opportunistic infections. However, these drugs are either very expensive or completely inaccessible to a larger portion of the infected population. That is why researchers have speculated that come 2030, AIDS will be the third largest killer disease in the globe. Nonetheless, with this dreaded disease everyone is trying to be careful. People are looking at what may put them into the risk of contracting this infection and finding the best way to protect themselves rather than ending up in the hopeless point of lifelong treatment of the disease, which is also very expensive. With regards to that, it is important to note that AIDS is transmitted through many ways such as; vaginal, oral, or anal sex; blood transfusion, hypodermic needles; and exchange from the mother to child during pregnancy, birth, and breastfeeding. Although AIDS does not discriminate based on age group, culture, gender, and race, young people, especially between twenty and thirty years of age, and say in America would be at risk of contracting the infection because of certain circumstances that are mostly related to this group. These are; unprotected vaginal or anal sex with an infected person, sharing piercing equipment like needles, oral sex, blood transfusion, and any form of contact with the mucous membrane or bloodstream with a bodily fluid that has the virus. In conclusion, having learnt the risks of contracting the infection and knowing that I am not exempted from it, I know that I am also at risk. In effect, there are protective measures that an individual would take to avoid the risk of being infected with AIDS. First, and a sure way of avoiding the infection through sexual intercourse is abstinence from sexual activity. However, if someone has to engage in an activity of sexual nature then it is important that they use protective measures like condoms to prevent any exchange of infected bodily fluids. Alternatively, sexual partners must do a test to determine their HIV status before engaging in any sexual encounter. Nonetheless, while using piercing equipment, it is important for an individual to ensure that the tools are not shared with anyone, or that they are thoroughly sanitized. Apart from that, during blood transfusion, the recipient patient should make sure that the blood is thoroughly screened for HIV and other infections befo re it is injected into their bloodstream. These are some of the few preventive measures against HIV. Buy custom Acquired Immunodeficiency Syndrome essay

Milestones in Space Exploration

Milestones in Space Exploration Even though space exploration has been a thing since the late 1950s, astronomers and astronauts continue to explore the firsts. For example, on February 6, 2018, Elon Musk and SpaceX launched the first Tesla into space. The company did this as part of the first test flight of its Falcon Heavy rocket.   Both SpaceX and rival company Blue Origins have been developing reusable rockets to lift people and payloads to space. Blue Origins made the first launch of a reusable on November 23, 2015. Since that time, reusables have proven themselves to be stalwart members of the launch inventory. In the not-too-distant future, other first-time space events will happen, ranging from missions to the Moon to missions to Mars.  Each time a mission flies, theres a first time for something. That was especially true back in the 1950s and 60s when the rush to the Moon was heating up between the United States and the then-Soviet Union. Ever since then, the space agencies of the world have been lofting people, animals, plants, and more into space. The First Canine Astronaut in Space Before people could go to space, space agencies tested animals. Monkeys, fish, and small animals were sent first. America had Ham the Chimp. Russia had the famous dog  Laika, the first canine astronaut. She was launched into space on the Sputnik 2 in 1957. She survived for a time in space. However, after a week, the air ran out and Laika died. The following year, as its orbit deteriorated, the craft left space and re-entered the Earths atmosphere and, without heat shields, burned up, along with Laikas body. The First Human in Space The flight of  Yuri Gagarin, a cosmonaut from the USSR, came as a complete surprise to the world, much to the pride and joy of the former Soviet Union. He was launched into space on April 12, 1961, aboard the Vostok 1. It was a short flight, only an hour and 45 minutes. During his single orbit of Earth,   Gagarin admired our planet and radioed home, It has a very beautiful sort of halo, a rainbow. The First American in Space Not to be outdone, the United States worked to get their astronaut into space. The first American to fly was Alan Shepard, and he took his ride aboard Mercury 3 on May 5, 1961. Unlike Gagarin, however, his craft did not achieve orbit. Instead, Shepard took a suborbital trip, rising to a height of 116 miles and traveling 303 miles down range before parachuting safely into the Atlantic Ocean. The First American to Orbit Earth NASA took its time with its manned space program, making baby steps along the way. For example, the first American to orbit Earth didnt fly until 1962. On February 20, the Friendship 7 capsule carried astronaut John Glenn around our planet three times on a five-hour space flight. He was the first American to orbit our planet and subsequently became the oldest person to fly in space when he roared to orbit aboard the space shuttle Discovery.   The First Womens Achievements in Space The early space programs were heavily male-oriented, and women were prevented from flying to space aboard U.S. missions until   1983. The honor of being the first woman to achieve orbit belongs to the Russian Valentina Tereshkova. She flew to space aboard Vostok  6  on June 16, 1963. Tereshkova was followed 19 years later by the second woman in space, aviator Svetlana Savitskaya, who blasted off to space aboard Soyuz T-7 in 1982. At the time of Sally Rides trip aboard the U.S. space shuttle Challenger on June 18, 1983, she was also the youngest American to go to space. In 1993, Commander Eileen Collins became the first woman to fly a mission as pilot aboard the space shuttle Discovery. The First African-Americans in Space It took a long time for space to begin to integrate. Just as women had to wait a while to fly, so did qualified black astronauts. On August 30, 1983, the space shuttle Challenger lifted off with Guion Guy Bluford  Jr., who became the first African-American in space. Nine years later, Dr.  Mae Jemison lifted off in the space shuttle Endeavour on September 12, 1992. She became the first African-American woman astronaut to fly. The First Space Walks Once people get to space, they have to perform a variety of tasks onboard their craft. For some missions, space-walking is important, so both the U.S. and Soviet Union set out to train their astronauts in working outside the capsules. Alexei Leonov, a Soviet cosmonaut, was the first person to step outside of his spacecraft while in space, on March 18, 1965. He spent 12 minutes floating as far as 17.5 feet from his Voskhod 2 craft, enjoying the first spacewalk ever. Ed White made a 21-minute EVA (Extra-Vehicular Activity) during his Gemini 4 mission, becoming the first U.S. astronaut to float out the door of a spacecraft.   The First Human on the Moon Most people who were alive at the time remember where they were when they heard astronaut  Neil Armstrong  utter the famous words, Thats one small step for man, one giant leap for mankind. He, Buzz Aldrin, and Michael Collins flew to the Moon on the Apollo 11 mission. He was the first to step out onto the lunar surface, on July 20, 1969. His crewmate, Buzz Aldrin, was the second one. Buzz now boasts of the event by telling people, I was the second man on the moon, Neil before me.   Edited and updated by Carolyn Collins Petersen.

Results, Figures, & Discussion Rubric Essay Example | Topics and Well Written Essays - 500 words - 1

Results, Figures, & Discussion Rubric - Essay Example The experiment was able to justify the hypothesis that sought to establish the brand of towel that is the better water absorber. In this regard, the results were able to deduce that the paper towels absorbed water at different rates. Qualitative results were done through observation of the paper towels over a period of time once they were dipped in water. In this regard, the most absorbent paper towel became more visible and easier to see through it. Furthermore, the paper towels were subjected to the sense of touch by gently feeling touching the towels with the fingers and assessing the level of sponginess and mushiness of each. On the other hand, qualitative results was collected through individual weight measures of the paper towels before soaking them in water and after soaking them in water. The actual amount of water absorbed by the paper towels was achieved through subtracting the weight of the soaked paper towels from the weight of the paper towel before absorption. Repetitio n of the experiment six times assisted in the reduction of data errors. The average amount of water absorbed for the premium paper towels was 20mL. The average amount of water absorbed for the recycled premium paper towels was 15mL. The reason for the difference absorption rates can better be explained by the variance in the production quality of each paper towel. In this regard, the recycled premium paper towels are of a lower quality compared to the premium paper towels. In conclusion, the experiment has justified the hypothesis by showing that paper towels have different capacity to absorb

The Longest Day (World War II) Essay Example | Topics and Well Written Essays - 1500 words

The Longest Day (World War II) - Essay Example Although "The Longest Day" to some extent lacks personality development and the typical film plot that trails the "plight of the hero", it still succeeds to include the watcher in the dreadful actions that encircled the D-Day. The movie depicts to carry all the divides impartially, from the Germans, the United States, French and the British. Â  The film regularly covers the German point of action, and how they are getting ready for the violence against the allies, who were their enemies. What makes this movie so convincing is that it attempts to cover the two sides. The film is approximately two hours and fifty minutes in length with a vast joint of a cast, all playing supportive roles. The performers were at all times of the identical race as their fellow characters, and spoke in their instinctive languages. This mouthwatering film offers the feel of the ‘D-Day’ Offensive, "Operation Overlord" which occurred on June 6th, 1944. This mission involved about three and a ha lf million men, two-thirds of whom were Americans. It shows the horror which was undertaken during the preparation and final assault taking place. An issue of the film was the site of invasion. The movie clearly shows that it was difficult for the Germans to comprehend the day when invasion was to happen (Blouin, Blouin and Rosenberg). The allies echoed the airwaves for several months with coded messages about the expected invasion that was taking the place by surprise. Their main objective was to create or awaken resistance from the French forces (Zanuck). The movie did not show the fact that the French soldiers had been mobilized to start assault on the morning when the allied forces began to attack. Hitler during the attack was asleep and the surprise caught everyone by surprise. Â  The film had many fine performances. One of which involved a brave woman who attacked a German soldier at the railway. In deception, John Wayne's firm, petulant commander retaliating his troops, the courageous, British soldier who hints the first round of attack in the at dark to seize a passage, the UK beach commandant who pushes his troops to stand up because the organizations charm is in vulnerability. This scene shows "Winston", the talisman and friend of the beach frontrunner, and the quarrelsome, pessimistic German; Luftwaffe pilot, who constantly is in worry for his weary superiors (A&E Television Networks, LLC). The play’s act was very informative. Â  One of the German high command officers wondered if the allies were on their way to attack the ‘Pas de Calais’ in the place of Normandy. They seem troubled and worried, and tried but were deprived of attainment to reach Adolf Hitler. They made a wrong choice to let German troops under their control stay on base. The German High official in France ascertained that the Allied strategy of attack would finish them off. The movie started by covering a short background of political and military leaders that led the invasion (A&E Television Networks, LLC). One of the notable civilian scenes was when a German soldier goes to French dairy rancher and orders him to give up his milk and leaves on a mule. These actions made the French inhabitants very angry (Blouin, Blouin and Rosenberg). Later on, same French dairy rancher overhears the commencement of the scuffle and the weaponry blasts; he opens his door and praises the Allies. This movie heavily embedded in the allies’

Values of Miss America Pageant Essays -- Beauty

She’s intelligence and humility. She’s fair and honesty. She’s Miss United States. These are not the lyrics to the song that is played after a contestant wins the ever-so coveted crown. These are not lyrics to any song at all actually. But why not? Aren’t those all attributes most people yearn for? While of course these characteristics are things everyone tries to perfect throughout their lifetime, this is not the focal point of the Miss America pageant. The actual lyrics are; â€Å"She’s beauty and she’s grace. She’s queen of 50 states. She’s elegance and taste. She’s Miss United States† (Miss Congeniality). It is shocking to see the digression in humanity’s morals and values over the past decade. As clichà © as it sounds, the media is the center of it all. The way women are being represented, from our television sets, the radio, pornography and even art has pushed beauty to the top of the list of controversial and widely debated topics around the globe. â€Å"Whenever we walk down the street, watch TV, open a magazine or enter an art gallery, we are faced with images of femininity,† (Watson and Martin). Beauty pageants are no help to the cause either. Miss America has become a job for women that represent their country from the way their face looks, rather than their ideas and vocal capabilities. We have become a nation centered around beauty and appearance and this annual television show has followed in this trend’s wake. American’s unneeded celebration of beauty in the pageantry world is digging a hole for the country and has been the contributing factor to the downward spiral we are presently in. The system of this pageant needs to change tremendously in order for it to become a beneficial contest in the future. Beauty pageants to... ...d. Web. 8 May 2012. http://msmagazine.com/blog/blog/2011/01/14/why-arent-we-protesting-miss-america. Shappert, Rhonda. " The Pageant Expert | What Are The Benefits Of Beauty Pageants?." The Pageant Expert | Rhonda Shappert's Blog. N.p., n.d. Web. 8 May 2012. http://thepageantexpert.com/post/What-Are-The-Benefits-Of-Beauty-Pageants.aspx. Watson, Elwood, and Darcy Martin. "The Miss America Pageant: Pluralism, Femininity, And Cinderella All In One." Journal Of Popular Culture 34.1 (2000): 105-126. Literary Reference Center. Web. 8 May 2012. Warnock, Susan Marie. "Writing Samples - Susan Warnock E-Portfolio." www.personal.psu.edu. N.p., n.d. Web. 24 May 2012. . Wolf, Naomi. The Beauty Myth: How Images of Beauty Are Used Against Women. New York: HarperCollins Publishers Inc., 2002. Print.

Case Analysis of Mdd, Gad, and Substance Use

Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Nicole Gapp University of Minnesota School of Nursing Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Major Depressive Disorder (MDD) is a mood disorder with symptoms that greatly affect the life of the individual. MDD could in fact be called a public health crisis, as it is projected that it will soon overtake heart diseases as the major worldwide health concern (Boyd, 2008).Diagnostic criteria for MDD are depressed mood or loss of interest or pleasure in nearly all activities, present for at least 2 weeks. Findings and behaviors associated with MDD are disruption of sleep, suicidal ideation, feelings of worthlessness and hopelessness, and fatigue and loss of energy. MDD is also associated with a high impairment in occupational, social, and physical functioning, causing as much disability and distress as chronic medical disorde rs (United States Department of Health and Human Services, 1999).MDD has been shown to be associated with increased medical illnesses. MDD can make everyday living a challenge, as research shows that depressive symptoms are associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning (Yen, Rebok, Gallo, Jones, & Tennstedt, 2011). It is important for MDD to be identified and treated early on, as MDD that is not treated appropriately results in recurrent depressive episodes, with each successive episode increasing in severity.As MDD is highly associated with suicidal ideation and suicide, it is imperative that MDD be treated to ensure patient safety. Risk factors for MDD are a prior episode of depression, lack of social support, lack of coping abilities, medical comorbidity, substance use, and presence of life and environmental stressors. In addition, major depression may follow adverse or traumatic life events, especially those that involve the loss of an important human relationship or role in life. Social isolation, deprivation, and financial deprivation are also risk factors (APA, 2002).Genetics play a role in the development of MDD, and deficiency or dysregulation of neurotransmitters are also thought to play a part in its etiology. Psychological theories of MDD hypothesize that an early lack of love and warmth may be involved with the development of depressive symptoms, while developmental and family theorists have proposed that parental loss, emotionally inadequate parenting styles, or maladaptive patterns in family interaction may contribute to the etiology of MDD.Women are twice as likely as men to be diagnosed with MDD, though it is believed that the incidence in men is under-diagnosed. Prevalence rates are unrelated to race (Boyd, 2008). Nursing responses to MDD should involve interventions to treat symptoms within the biologic domain, such as changes in appetite, weight, sleep, or energy, as well as symptoms within the psychological domain, such as changes in mood and affect, thought content, suicidal behavior, and cognition and memory. Many types of interventions are used to treat the varied effects and symptoms of MDD.Pharmacologic interventions, such as selective serotonin reuptake inhibitors, tricylic antidepressants, monoamine oxidase inhibitors, and other classes of antidepressants may be used to decrease or manage depressive symptoms. Medication should be continued for at least six months to a year after complete remission of depressive symptoms. Lifestyle patterns, such as good sleep hygiene, activity and exercise, and adequate intake of well-balanced meals should also be encouraged, as these patterns help the client move toward a healthy daily routine that supports remission or recovery.Psychotherapy, such as cognitive therapy, behavior therapy, and interpersonal therapy, has been shown to be effective in individuals with MDD, and a combination of psychotherapy and pharmacotherapy is recommended for patients with severe or recurrent MDD as a strategy to prevent relapse (Boyd, 2008). In addition, electroconvulsive therapy has been shown to be an effective treatment for MDD, especially severe MDD that has not responded to medications. Major depression frequently occurs in conjunction with ther psychiatric disorders, such as anxiety or substance use disorders, which can also affect antidepressant responsiveness. In such cases, the co-occurring mental health problem should be treated in addition to major depression (President and Fellows of Harvard College, 2011). The patient described in this case analysis has comorbid diagnoses of generalized anxiety disorder and substance abuse. Generalized Anxiety Disorder is a psychiatric disorder characterized by excessive worry and anxiety with an insidious onset.The anxiety of GAD persists for at least six months, with excessive anxiety and worry occurring for more days than not, and for some individuals, persisting daily. Risk factors for GAD are thought to be unresolved conflicts, cognitive misinterpretations, and multiple stressful life events (Boyd, 2008)). Few studies have examined the genetic basis of GAD, but it is thought to be moderately heritable. In clinical settings, the incidence of GAD is equally distributed in women and men. However, in wider studies GAD is twice as common in women.In no studies has the prevalence of GAD been related to race (Boyd, 2008). Patients with GAD often have associated depressive symptoms, and MDD is a common comorbid disorder. For this reason, there has been debate surrounding whether GAD is a separate disorder than MDD, or if GAD symptoms are part of the course of MDD. However, research shows that many patients with GAD do not present with a distinct MDD symptom profile. This does not support the hypothesis that co-morbidity between MDD and GAD is artificially inflated because of the similar symptom criteria required by th e current diagnostic system.Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur because of a shared underlying trait (Sunderland, Mewton, Slade & Baillie, 2010). Current diagnostic criteria state that GAD exists when the excessive worry does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder. For example, a patient who experiences persistent excessive anxiety but has minimal or no depressive symptoms would be diagnosed with GAD (Boyd, 2008). However, research has shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage.One particular study comparing individuals with MDD and individuals with MDD and a comorbid anxiety disorder showed that after adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a r ecurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was also characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts (Seo, Jung, Kim, T. , Kim, J. Lee, Kim, J. & Jun, 2011). Patients with GAD are often highly somatic, with many complaints of physical symptoms. One study concluded that painful physical symptoms in patients with GAD are twice as prevalent as in the control group, which consisted of individuals with neither GAD nor MDD. The presence of comorbid MDD was associated with a significantly higher prevalence of painful physical symptoms. Painful physical symptoms were significantly associated with functioning and health status impairment both in GAD alone and in GAD and comorbid MDD compared with controls (Romera, Fernandez, Perez, Montejo, Caballero, F. Caballero, L. , Arbesu & Gilaberte, 2010). In addition, those with GAD also often experience poor sleep habits, irritability, and poor concentration. Patients with GAD often feel frustrated, demoralized, and hopeless. They often feel restless and on edge and experience clinically significant distress or impairment of functioning resulting from anxiety, worry, or physical symptoms. GAD has a significant negative impact on work functioning, although smaller than the effect of MDD (Plaisier, Beekman, de Graaf, Smit, van Dyck & Penninx, 2010).Interventions addressing symptoms of the biologic domain include eliminating caffeine, diet pills, amphetamines, ginseng, and ma huang, which have all been shown to be anxiety-producing substances (Boyd, 2008). In addition, good sleep hygiene should be promoted, as a common symptom of GAD is sleep disturbances. The nurse should teach the patient breathing control and progressive muscle relaxation as calming techniques, help the patient identify other positive coping strategies, and educate the patient on time management.Pharmacological int erventions, such as the use of benzodiazepines, certain antidepressants, and other non-benzodiazepine anxiolytics may be effective in reducing anxiety. Roughly 75% of those with GAD have at least one additional current or lifetime psychiatric diagnosis, with MDD being one of the more common comorbidities. Alcoholism is also a significant problem associated with GAD. Patients may use alcohol, anxiolytics or barbiturates to relieve anxiety, and this may lead to abuse and dependency. Such is the case of the patient described in the case analysis, who also has a substance-related disorder.The DSM-IV-TR defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress. This impairment may be manifested by recurrent use, resulting in failure to fulfill major role obligations at work or home, recurrent use in situations that are physically hazardous, recurrent substance related legal problems, or continued use despite feeling persist ent or recurrent effects of the substance. To constitute substance abuse, three or more of these manifestations must be present within a 12-month period.In general, men consume more alcohol and abuse drugs more than women, though women are more likely to abuse prescription medication. Substance abuse and dependency are not correlated so much with gender as with an early age of initiation of substance use (Boyd, 2008). Comorbid mental disorders occur often with substance dependence and abuse. For some, comorbid mental disorders are byproducts of long-term substance abuse. Other people have mental conditions that predispose them to substance abuse, with substance abuse becoming a comorbid problem as they use drugs and/or alcohol to self-medicate existing mental illnesses.There is a well-documented association between depression and alcohol abuse and dependence which cannot be explained solely by the random overlapping of these two conditions. A systematic review of 35 studies estimate d the prevalence of current alcohol problems in depressed patients to be 16%, as compared to 7% in the general population. The three most commonly described causal hypotheses for this comorbidity are as follows: 1) an independent depressive episode (e. g. he self-medication theory), 2) alcohol induced depressive symptoms and 3) the existence of shared biological and environmental factors that predispose persons to both (Cohn, Epstein, McCrady, Jensen, HunterReel, Green & Drapkin, 2011). In addition, men with at least four heavy drinking occasions were found to be 2. 6 times as likely to be classified as being depressed as men who drank heavily less than four times in the previous 28  days (Levola, Holopainen & Aalto, 2011). Specific substances that have been abused by the patient who is the subject of this analysis are alcohol, cocaine, heroin, and the prescription drugs oxycodone and Valium.At the time of admission, the patient was no longer regularly using drugs or alcohol, but his history of substance abuse, including overdose, is extensive. Thus, although the patient is already withdrawn from drugs and alcohol, his long-term substance use has significant physical and mental consequences. The depression of the central nervous system by alcohol causes relaxed inhibitions, heightened emotions, mood swings, and cognitive impairments such as reduced concentration and attention, and impaired judgment and memory. In particular, this patient engages in periodic binge drinking, drinking up to 15 drinks in one evening.This alcohol use would result in several days of intoxication, which were interspersed with periods of sobriety. The amount of alcohol consumed in an episode of binge drinking can cause severely impaired motor function and coordination difficulties, emotional lability, stupor, disorientation, and in extreme cases, even coma, respiratory failure, or death. Long-term abuse of alcohol can adversely affect all body systems, and research has shown a conne ction between alcohol dependence and increased risk for diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke (Smith & Book, 2010).Cocaine users typically report that cocaine enhances their feelings of well-being and reduces their anxiety. However, long-term cocaine use leads to increased anxiety. Severe anxiety, restlessness, and agitation are all symptoms or cocaine withdrawal. Withdrawal causes intense depression, craving, and drug seeking behavior that may last for weeks (Boyd, 2008). Valium, a benzodiazepine, is a prescription drug that this patient abused. Patients who abuse benzodiazepines often feel hyperactive or anxious after using them.Often, patients who abuse these drugs combine them with alcohol, putting the patient at risk of coma or death. Symptoms during benzodiazepine withdrawal include anxiety rebound, such as tension, agitation, tremulousness and insomnia, as well as symptoms of autonomic rebound, sensory excitement, motor excitati on, and cognitive excitation, such as nightmares and hallucinations (Boyd, 2008). Opiates are powerful drugs that can quickly trigger addiction when used improperly. Heroin is an opiate that was abused by this patient.Heroin is the most abused and most rapidly acting of all opiates. It can be injected intravenously, and such was the method of delivery for this patient. Heroin produces profound degrees of tolerance and physical dependence. Withdrawal from opiates should be tapered, and if abruptly withdrawn from someone dependent on them, severe physical symptoms may occur, along with nervousness, restlessness and irritability (Boyd, 2008). In addition to heroin use, the patient attempted to commit suicide by overdosing on oxycodone, a prescription opiate.Overcoming substance abuse and preventing relapse can be especially difficult as denial is common in substance abusing patients. Denial is defined as the patient’s inability to accept his loss of control over substance use, o r to accept the consequences associated with the substance use (Boyd, 2008). Because many patients find it difficult or impossible to believe they have a serious problem with drugs and alcohol, many do not seek treatment, or stop treatment prematurely. Motivation is a key predictor of whether individuals will change their substance abuse behavior.Several effective modalities are used effectively to treat addiction, such as 12-step programs, social skills groups, psychoeducational groups, group therapy, and individual and family therapies. Depending on the individual, different treatment techniques will be more or less helpful. History of Present Illness The patient is a 58-year-old Caucasian male who was participating in a partial hospitalization program (PHP) at Hennepin County Medical Center (HCMC) for the treatment of severe major depressive disorder. He has been involved in PHP since his last discharge from the HCMC psychiatric inpatient unit in early March.The patient was coope rative with treatment and medication compliant. He was put on a 72-hour hold after becoming angry and hostile during the PHP group and threatening to hang himself that evening when he got home from PHP. He eventually committed himself voluntarily to the HCMC psychiatric inpatient unit. Upon introduction, the patient appears to be clean, casually dressed, and of normal weight. He is alert and oriented. His attention, cognition, and abstract reasoning are intact, and his thought content is appropriate and organized.In conversation, he is pleasant and cooperative, exhibiting a stable mood and a slightly blunted affect. The patient will talk to staff members but interacts minimally with peers and does not attend groups unless encouraged by staff. The patient has a normal gait but moves quite slowly. In addition it appears that his thought processes are slowed, as he is slow to respond during conversation and seems to have difficulty finding the words to express what he wants to say. The patient appears to have intact recall, short-term, and long-term memory.He appears to be an adequate historian though he exhibits poor judgment due to his depressive and anxious symptoms, as evidenced by his extensive history of drug and alcohol abuse and dependency. The patient has psychiatric diagnoses of severe and recurrent major depressive disorder, generalized anxiety disorder, and polysubstance abuse. The patient has been suffering from MDD with chronic suicidal ideation since age 15. His first suicide attempt was at age 15, and he began abusing drugs and alcohol at approximately the same time.His extensive history of substance abuse includes use of alcohol, cocaine, and IV heroin. His alcohol abuse as a teenager led to a DWI charge. He has participated in mental health outpatient treatment and has undergone chemical dependency treatment numerous times. He completed high school without apparent difficulty. The patient seems to be of average intelligence, though his IQ is not listed in the record. He does not have a history of violent or sexual crime. He has a history of five suicide attempts. He began smoking as a teenager and currently smokes one pack of cigarettes per day.In 1983, the patient married and remained so until his wife died 25 years later, in 2008. He had no children. According to the patient, he was happily married, and he called his relationship with his wife â€Å"the best thing that has ever and will ever happen to me. † While he was married, he got completely clean from drugs and alcohol, remaining drug free and sober for 12 years. Though he struggled with episodes of depression and suicidal ideation, he was able to manage his symptoms with medication and mental health outpatient treatment. Most of my problems faded into the background,† said the patient. During this time, he and his wife bought a condo, and the patient was employed as a janitor and handyman, working at the Minneapolis-Saint Paul airport. He remained at this job for over a decade and was promoted to the position of supervisor. He had, as he said â€Å"everything I ever wanted. † In 2007, his wife became very ill and eventually died in 2008 after complications from a surgery intended to prolong her life. The patient reports that as his wife got sicker, he became increasingly depressed.Unlike in the previous 12 years, medication and outpatient treatment did not seem to manage his symptoms. In addition, he started experiencing extreme and persistent anxiety, feeling â€Å"like I was always one second away from a panic attack. † He was diagnosed with generalized anxiety disorder and was prescribed benzodiazepines to manage this condition. As his wife got sicker, he slowly began to self medicate with alcohol and admitted to â€Å"popping an extra pill† occasionally to decrease his anxiety.When his wife died, the patient became so depressed and anxious that he was unable to concentrate at work. He had to give up his job as a supervisor, and said, â€Å"I couldn’t even manage myself, how was I supposed to handle anyone else. † As his depression and anxiety got worse, he turned increasingly to alcohol and drugs. He reported binge drinking, consuming up to 20 drinks in one evening. He would remain intoxicated for several days, and would switch to using drugs as the alcohol cleared his system. He reported being either drunk, high, or both almost every day.Although he used cocaine and heroine, which were the drugs he used as a teenager, he also became dependent on prescription benzodiazepines to manage his increasingly severe anxiety. The increase in anxiety may be explained by his cocaine use, which, though it reduces anxiety while high, causes increased anxiety with long term use. Additionally, though proper use of benzodiazepines decreases anxiety, benzodiazepine abuse or dependency results in increased anxiety levels. When his request for more prescription benzodiazepines was denie d due to drug seeking behavior, he gained possession of Valium illegally and continued abusing them.He was arrested for illegal Valium possession in 2009, and received two DWIs between 2008 and 2011. His medical record notes that he has a history of antisocial behavior, though it does not expand on this statement beyond the mention of his previous arrests. With no income coming in and increasing amounts of money used to fuel his drug and alcohol addiction, he lost his condo and all of his savings and was living at the Salvation Army homeless shelter by June 2008. His depression grew in severity as the major life losses piled up and his substance dependency problem worsened.In 2008, he lost consciousness due to heroin intoxication. In August of that year, the patient overdosed on oxycodone, intending to kill himself. He was brought to HCMC, and for the past several years has experienced being in and out of the psychiatric inpatient. In 2010, he moved from the homeless shelter to Alte rnative Homes in Minneapolis. Following his latest psychiatric hospitalization in March, he began the partial hospitalization program at HCMC. Upon discharge from the current hospitalization, he will be returning o Alternative Homes and participating again in the PHP program. A common finding associated with a diagnosis of either MDD, GAD, or substance abuse is the presence of sleep disturbances. Such is the case with the patient described. These sleep disturbances may present themselves as difficulty falling asleep, trouble maintaining sleep, or waking up too early (National Insititute of Health, 2005). This patient currently experiences insomnia, getting only 3-4 hours of sleep per night. Reportedly, this insomnia has been a chronic issue.The insomnia the patient experience sets him up for a negative cycle. Because of his depression and anxiety, it is difficult for the patient to sleep. This lack of sleep, in turn, exacerbates his anxiety and depressive symptoms. As his symptoms p rogress in severity, he turns to substances to self medicate. The use of substances results in a worsening of his insomnia. Thus, finding a way for the patient to get adequate sleep is important. He has tried a variety of medications to promote sleep, but none have been effective.He can no longer be prescribed many of the medications for insomnia because of his history of abuse and overdose using prescription drugs. Thus, the options available to him for sleep promotion lie in the realm of sleep hygiene promotion. The patient might also consider participating in a sleep study, as this may reveal additional factors that prevent him from getting the sleep he needs. In addition to his mental illnesses, the patient also has significant medical problems. He has been diagnosed with hypertension, hepatitis C, diabetes mellitus, osteoarthritis of the left shoulder, and acid reflux.Research shows that diabetes mellitus, gastrointestinal problems, hypertension, liver disease are correlated wi th substance abuse (Moffitt, Caspi, Harrington, Milne, Melchior, Goldberg & Poulton, 2010). Indeed, the patient’s hepatitis C is a direct consequence from his use of street drugs. Interestingly, multiple studies have revealed that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and mortality among diabetic patients (Moffitt et al. 2010). Also, as previously discussed, patients with GAD and MDD report more painful physical symptoms than the general population, and the patient’s osteoarthritis pain could well be exacerbated by the presence of these psychiatric conditions. Thus, it is possible that with improved management of his psychiatric conditions, his medical problems may improve as well. Family and Social History The patient’s social and family history is somewhat lacking. The patient was adopted at a young age.He has three non-biological brothers and he reports that he is estranged from all of them, and is not willing to contact them until he has â€Å"my life back together. † In addition, both of his adoptive parents are dead. The patient was not keen on discussing his adoptive family or his childhood and adolescence, but stated that this adoptive family â€Å"were good people, and tried hard to give me everything I needed. † He denies any history of physical, emotional, or sexual abuse. According to the social history, there is no history of mental illness in his adoptive family.This does not mean that environmental or social factors play no role in the etiology of his mental illness, but that these factors may be less obvious. Information on the patient’s biological mother and family history is unavailable. The patient was given up for adoption at birth, and remained a ward of the state, living in various foster homes, until he was adopted at age 3. As the patient wa s given up for adoption and adopted at such a young age, he has he has no recollection of his biological family or his time in the foster care system.Any instances of abuse, neglect, or trauma in his early years are thus unknown. Because there is no available family history, it is impossible to know if any of the patient’s first-degree relatives suffered from mental illnesses, or if the biological mother used drugs or alcohol during her pregnancy. This lack of information is unfortunate, as it is impossible to conjecture whether, or to what degree, the patient’s mental disorders have a basis in genetics or in disturbed fetal development.Because MDD, GAD, and substance abuse have all been shown to have a moderate to high degree, of heritability, it is very plausible that mood, anxiety, or substance related disorders were present in his biological family. The patient seems to have very limited social support, as he is estranged from his adoptive siblings and has no commu nication with his biological family. The patient also has a history of limited social interactions and close friendships. He reports that he has felt disconnected from others for as long as he remembers, and that he had few close friendships throughout his childhood, adolescence, and adulthood.In addition, the patient reports that most of the relationships that he would call the closest have been with people who have substance abuse problems, as he spent â€Å"years and years running with the wrong crowd. † The basis of most of these relationships was a shared interest in drug and alcohol use, and he does not think that these friends would be of any support to him in pursuing and maintaining recovery. During the time that he was sober, he states that his wife was â€Å"the only friend I really needed† and as a result, he did not form many close friendships with his peers.He states that he currently has no supportive relationships. Furthermore, he has little desire to f orm such relationships. Application of Developmental Theories Viewing the patient and his family and social history through the lens of attachment theory provides a possible framework for viewing the patient’s development of mental illnesses. Attachment theory, a biologically based framework first proposed by John Bowlby in the mid 1950s, is the theoretical approach used to describe the importance of stable and secure relationships of all infants, especially those in foster care (Bruskas, 2010).This theoretical approach reasons that infants and children have a need to belong and to experience secure relationships with a small number of consistent â€Å"preferred† primary caregivers in order to successfully develop into normal healthy adults who can actively and emotionally participate in social life (Boyd, 2008). In particular, a child should receive the continuous care of this single most important attachment figure for approximately the first two years of life.If the attachment figure is broken or disrupted during the critical two year period the child will suffer irreversible long-term consequences of this deprivation, which might include delinquency, reduced intelligence, increased aggression, depression, and affectionless psychopathy–an inabilityto show affection or concern for others. Research, such as the Adverse Childhood Experiences Study, correlates untreated childhood adversity with an increased risk toward poor developmental health and other major diseases seen later in life such as cardiac disease, depression, and even premature death (Felitti & Anda, 2010).Studies reveal that infants in foster care are among the most vulnerable because of their complex and immense brain development, and the importance of attaining developmental milestones. The onset of brain development begins soon after conception and will continue to mature well into adulthood, but the most abundant and dramatic time of growth is during the first few years of life, specifically within the first three years. The primary and most important developmental milestone for any infant is to establish a relationship, especially one with a primary caregiver.This period presents sensitive â€Å"windows of opportunity† for the development of particular parts of brain structure and circuitry influenced and dependent on social experiences for optimal brain development (Bruskas, 2010). The majority of children entering foster care are infants, and the impact of not addressing mental health needs of preverbal children can have deleterious effects (National Research Council Committee on Integrating the Science of Early Childhood Development, 2000).Although an infant may not be able to articulate losses because of their preverbal age, they nonetheless experience grief and loss, and for many, these experiences will be forever embedded in their memory (Felitti & Anda, 2010). Moreover, the consequences of unresolved losses have a much more devastati ng affect in infancy than adulthood because of the potentially permanent psychological impact on the developing brain of an infant or child (Bruskas, 2010).Infants and children in foster care who are not afforded supportive primary caregivers to help them develop an internal ability to regulate their own will continue to use whatever coping methods they can. Under stress-provoking adversities such as abuse, neglect, and relationship disruptions, children’s coping strategies to manage such circumstances may present as hostility, frustration, and anxiety with underlying feelings of fear, abandonment, and powerlessness (Bruskas, 2010).The relationships infants and children develop while in foster care are crucial; relationships characterized by trust and commitment help an infant or child become more resilient toward the challenges and obstacles that all humans face in life; conversely, a lack of such relationships in life can result in long-term dysfunction socially and physica lly. Attachments and â€Å"templates† of the world are significantly developed by the time a child reaches a year old (Bruskas, 2010).Efforts to address behavioral problems later in life may prove to be more difficult and costly as brain structure becomes permanent and behavior becomes more difficult to change. Due to the patient’s experience of foster care as an infant and toddler, it is likely that he was unable to form a secure attachment with a primary caregiver. Although this disruption in attachment is not the sole contributor to his problems with depression, anxiety, and substance abuse, it is very possible that the chaotic structure of his early years play a large role in the development of these conditions.Applying the concepts of Erikson’s model of psychosocial development allow for a greater understanding of the patient’s current state. Because of the disruption of relationships early in life, the patient may not ever have resolved the developm ental conflict of basic trust vs. mistrust, which is often resolved in infancy. This may be one reason behind his feeling of disconnectedness from others. According to Erikson, this inability to resolve this developmental conflict results in a decreased sense of drive and hope. It is also likely that the patient was able to resolve the developmental conflict of autonomy vs. hame and doubt, which is often resolved in toddlerhood (Boyd, 2008). This may explain the patient’s reliance on his wife as the sole supportive relationship in his life, as well as his fast descent into previous behaviors after his wife’s death. As the patient was never able to develop a sense of autonomy, it seems that he became extremely emotionally dependent on his wife. Because of this relationship, he was able to progress at his job and maintain his recovery. However, with the death of his wife, he was brought back to the conflict of autonomy vs. shame and doubt.Really, it was through the prese nce of his wife that he was able to take initiative, be industrious, and have an intimate relationship, all of which are successful outcomes of developmental conflicts. The marriage provided him with hope, purpose, a sense of devotion and fidelity, as well as affiliation and love. In short, it seems that his wife was his mental and emotional anchor. The recurrence of symptoms of his mental disorders after the loss of the anchor of his life threw him back into the early developmental conflicts that he was unable to resolve due to his unstable childhood.According to Erikson, in order for the patient to move forward from his regressed state he must tackle and resolve the conflicts of trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role diffusion, and intimacy vs. , isolation to reach the adulthood stage of generativity vs. stagnation. Ultimately, with the resolution of all these conflict, the patient will reach a mature sta te in which he is able to attain ego integrity instead of falling into despair. Patient Prognosis and Treatment RecommendationsIt is important to remember that the patient was seeking help and trying to recover prior to his most recent hospitalization. He was enrolled in and regularly attending the partial hospitalization program. In addition, he was no longer abusing drugs or alcohol. PHP staff report that he had been medication compliant, cooperative, and was motivated to change. The patient’s recent hospitalization was precipitated by a change in drug dose and type. He reported that it was only after the medication change that the suicidal ideation intensified.Thus, an important goal for this patient is to find the drug types and dosages that will successfully manage his depression and anxiety. However, because the patient has such an extensive history of addiction, primary care providers are hesitant to prescribe large dosages of often highly addictive medications. This h esitation is especially understandable given the patients past abuse of prescription drugs, including an overdose with the intent to commit suicide. However, the types and dosages of the drugs he is currently receiving are not enough to manage his symptoms.The severity of the patient’s depression and anxiety necessitates the use of powerful antidepressants and anxiolytics, but his past substance abuse and dependency make the prescription of these drugs a last resort. Appropriate pharmacotherapy is also complicated by the fact that this patient has tried various classes and types of drugs to manage his symptoms, but no drug therapy has been effective enough to prevent the periodic recurrences of major episodes of depression and anxiety.To manage his depression, the patient has tried typical and atypical antipsychotics, anticonvulsants, tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors, as well as other classes of antidepressan ts, such as Serotonin Norepinephrine Reuptake inhibitors, Norepinephrine Dopamine Reuptake Inhibitors, Alpha-2 Antagonists, and Serotonin-2 Antagonist/Reuptake Inhibitors. Although the apparent failure of all these drugs to manage his depression might cause one to suspect that he is exhibiting purely drug seeking behaviors, the depressive symptoms he xperiences impair and affect him so severely that a denial of the reality of these symptoms would be unsafe and unethical. Electroconvulsive therapy has been recommended to treat his depression, but the patient has refused to undergo this treatment modality. The patient’s anxiety is more easily managed than his depression, and benzodiazepines have proven effective. However, his past abuse of benzodiazepines make his primary care providers reluctant to give them to him, and they have prescribed non-benzodiazepines, such as Buspar and Zolpidem, instead.Unfortunately, these medications have not been effective in controlling the pati ent’s anxiety. As a result, the patient has been asking repeatedly for benzodiazepines, while promising that he will use them responsibly. Ultimately, for the patient to achieve effective maintenance of his comorbid mental disorders, he must be able to take medications as prescribed. Due to his history of substance abuse and his still unstable depression and anxiety, it is unlikely that the patient will be able to take his medications as prescribed.It is recommended that a staff member have control of his drugs while he is attending the PHP, and that once discharged, a home health nurse be sent to administer his medication. This would reduce the potential for abuse. In addition, the use of coping mechanisms besides substance abuse may help the patient adhere to the prescribed drug regimen, as well as decrease his depression and anxiety. Coping skills the patient has identified as helpful are watching television and spending some quiet time alone.However, interaction with othe rs should also be encouraged, as too much time spent alone will only reinforce depressive symptoms of isolation. An increase in the quantity and quality of sleep will also aid the patient in his recovery, as sleep deprivation is positively correlated with depressive symptoms and anxiety levels. The patient’s prognosis is one of cautious hopefulness. Though the patient has experienced severe recurrences of MDD, GAD, and substance abuse in recent years, the patient had maintained a long period of sobriety prior to this, during which he was happy, productive, and high functioning.The patient’s ability to achieve remission from his mental illnesses during his marriage to his wife shows that investing in a supportive relationship is an important and powerful coping skill for this patient. Thus, if the patient is able to form and maintain new supportive relationships, his chance of recovery will improve substantially. It is also important to remember that he was doing very w ell until his wife died. According to the Holmes and Rahe Index, the death of a spouse is the number one most stressful event that occurs in the life of an individual (Perry & Potter, 2009).It is not an exaggeration to say that with his wife’s death, life as he knew it ended. Many people experience periods of long and severe depression following the death of a loved one. For this patient, his descent into depression, combined with the resurgence of his anxiety sent his life into a complete tailspin. Under the severe stress of not only his wife’s death but also his inability to keep working, he returned to his former coping mechanisms of drug and alcohol abuse.These habits detracted him from working through the grief of his wife’s death, and furthermore caused him to lose his house and his savings, thus increasing his depression and anxiety, thus perpetuating the substance abuse. Now that the patient has withdrawn from drugs and alcohol and is in a safe environme nt, he can continue his grief work. As a result, his depression may begin to subside, and he may be able to get closer to his previous level of functioning. DSM-IV-TR Axis I: Major Depressive Disorder, Generalized Anxiety Disorder, Polysubstance Abuse Axis II: Cluster B traitsAxis III: Hypertension, Hepatitis C, Diabetes Mellitus, Type 2, Osteoarthritis of the left shoulder, Acid Reflux, Bilateral hearing loss Axis IV: Chronic mental illnesses, chronic medical conditions, death of spouse, family estrangement, lack of social support, unemployment, financial insecurity, acute hospitalization, Axis V: 35 (current), 75 (potential) Patient Goals: †¢ I want to find medications that will help my depression and anxiety †¢ I want to keep from abusing my medications †¢ I want my grief over my wife’s death to get better †¢ I want to take one day at a time †¢ I want to feel less alone †¢ I want to get better sleepNursing Goal: Patient will be safe during hos pital stay. Interventions: †¢ Assess for suicidal ideation every shift. †¢ Perform rounds every 15 minutes to ensure patient safety. †¢ Ensure that the patient has no access to potentially harmful objects and/or substances. †¢ Observe, record, and report any changes in mood or behavior that may signify increasing suicide risk and document results of regular surveillance checks. Nursing Goal: Patient will seek help in dealing with grief-associated problems. Interventions: †¢ Develop a trusting relationship with the client by using empathetic therapeutic communication (Eakes, Burke & Hainsworth, 1998). Educate the client that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever (Matthews & Marwit, 2004). †¢ Identify available community resources, including grief counselors and community or Web-based bereavement groups. †¢ Focus on enhanci ng coping skills to alleviate life problems and distressing symptoms such as anxiety and depression. Nursing Goal: Patient will practice social and communication skills needed to interact with others. Interventions: †¢ Discuss causes of perceived or actual isolation. Assess the patient’s ability and/or inability to meet physical, psychosocial, spiritual, and financial needs and how unmet needs further challenge the ability to be socially integrated. †¢ Use active listening skills to establish trust one on one and then gradually introduce the patient to others. †¢ Provide positive reinforcement when the patient seeks out others. †¢ Encourage the client to be involved in meaningful social relationships and support personal attributes (Gulick, 2001). Nursing Goal: Patient will use effective coping strategies instead of abusing drugs and alcohol.Interventions: †¢ Assist the client to set realistic goals and identify personal skills and knowledge. †¢ Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage the client to express emotions such as sadness, guilt, and anger, verbalize fears and concerns, and set goals. †¢ Offer instruction regarding alternative coping strategies (Christie & Moore, 2005). †¢ Encourage use of spiritual resources as desired. Nursing Goal: Patient will identify actions that can be taken to improve quality of sleep.Interventions: †¢ Obtain a sleep-wake history, including history of sleep problems, changes in sleep with present illness, and use of medications and stimulants. †¢ Encourage the patient to develop a bedtime ritual that includes quiet activities such as reading, television, or crafts. †¢ Encourage the patient to use soothing music to facilitate sleep (Lai & Good, 2005). †¢ Teach the patient sleep hygiene guidelines for improving sleep habits (ie. go to bed only when sleepy, avoid afternoon an d evening naps, use the bed only for sleeping, get up at the same time every morning). Use relaxation techniques to decrease anxiety before going to sleep. †¢ Refer to a sleep center if interventions are ineffective. Analysis of Interaction Before interacting with the patient, I read the patient’s medical record and notes. I paid particular attention to ways the patient said he learned best, which for my patient was one on one conversation. Prior to approaching the client, I asked myself if I had any beliefs, biases, or limitations that would affect my interaction with the patient or prevent the formation of a therapeutic relationship.In order to set the tone of a professional therapeutic relationship, I introduced myself to the client, saying that I was a student nurse and shaking his hand. I made some small talk with him about such topics as sports and the patient’s hobbies in order to show interest in the patient and develop rapport. During this conversation, t he patient grew more visibly at ease. His face became less taut, his answers became longer and less forced, and he moved from an erect posture so a somewhat more relaxed position in his chair. The patient spoke slowly and eemed to have difficult finding the words he wanted to use. Such a speech pattern is characteristic of depression, one of the patient’s psychiatric diagnoses. This first conversation was punctuated with the start of morning group. After morning group, I gave the patient some space, as I did not want him to feel overwhelmed or threatened by my questions. About a half hour later, I asked the patient if we could continue the conversation we were having that morning, and he agreed without hesitation. In this second interaction, I began with a few open-ended questions about how group had been.I then started asking the patient some more questions about his readmission into the hospital and precipitating events. I asked open-ended question, and often responded to h is answers by asking further open-ended questions. For example, after asking the patient if he was having suicidal thoughts, he responded that he did not want to hurt himself right now. I replied with the open-ended question, â€Å"So are you feeling safe? † using reflection to redirect the idea back to the patient and allow him to explore whether or not he felt safe.I focused on actively listening to the patient, following the patient’s lead and sometimes asking clarifying questions. Because of the patient’s slower rate of response, I employed the use of silence to allow him to gather his thoughts and proceed at his own pace. As the patient told me more about recent events in his life, including the death of his wife, the loss of his job and his descent into substance abuse, he began to look away more and more. This decrease in eye contact might be the result of the patient feeling ashamed, embarrassed, or guilty about his feelings and behaviors.In order to mai ntain connection with the patient and assure him of my nonjudgmental view of his situation, I used empathy and restatement, saying, â€Å"It sounds as though you have had a very difficult past couple of years. † Upon saying this, the patient looked up, maintained eye contact, and agreed. He then began to expand on his current feeling of hopelessness, saying, â€Å"I wonder if life is worth living, and sometimes I just want to go to sleep and not wake up. † As he explored and expanded on his feelings I alternated between using silence and validating what he said.The silence allowed him to express intense feelings without interruption, while statements of restatement and interpretation, such as â€Å" It sounds like you have been feeling pretty hopeless,† demonstrated empathy and a nonjudgmental attitude toward what the client was feeling. At one point, the patient put his head in his hands, saying â€Å"I had so much going for me, and after my wife died, everyth ing went to pot. † I felt that in this moment, what the client needed was neither a cheery reassurance that things would get better, nor dispensation of advice, but rather a person to understand and acknowledge his current misery.I replied that sometimes life gets you down, and sometimes when it rains it pours, and it’s ok to be sad about that. The patient seemed appreciative of the acknowledgment of his pain and the justification of his sadness. I sat silently with him for 2-3 minutes, as I felt it was important for him to feel, sit with, and process these emotions for a short period of time. During these periods of silence, I continued to lean forward slightly, as I had done throughout the interaction, to show that I was still interested and engaged despite the lack of verbalization.Because I had acknowledged the patient’s hardships and thereby connected with him, I felt that I was in a good position to explore with him goals he had for the future, and ideas th at could help him reach these goals. I made sure to approach this topic not by giving advice or suggestions, but by asking him open-ended questions about what things made him feel less sad or anxious and what things he wanted to work on during his stay. These open ended questions elicited the response of his goals for the future, and his verbalization that he needed to find better coping mechanisms, because his old ones didn’t seem to work.He also stated that he knew he needed to â€Å"continue grieving my wife, because the drugs and alcohol kept me from doing that. † I thought that this realization of substance abuse as inhibitory to his grief process was very insightful, and told him so. He made a small smiling expression and responded that he wanted to â€Å"get back on the straight and narrow† and take his medications â€Å"the way I’m supposed to—no more, no less. † The patient’s elucidation of his goals and his insight into help ful and hindering coping devices was a very positive outcome of this therapeutic conversation.The patient seemed less burdened after the opportunity to talk about his recent losses in life, and more hopeful after verbalizing his goals and ways to meet them. References Ackley, B. J. & Ladwig, G. B. (2008). 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