Nursing Essays Therapeutic Relationship Patient

Nursing Essays Therapeutic Relationship Patient Introduction Within the context of healthcare one of the most important factors is the establishment of an effective therapeutic relationship between the nurse and patient (Foster Hawkins, 2005). The ways in which nursing staff and patients interact can be influential in terms of information transfer, provision of psychological support, and may also provide some therapeutic benefits in themselves (Welch, 2005). Hence, there has been a renewed focus on the importance of how nurses interact with patients in practice, in order to enhance patient outcomes (Nursing and Midwifery Council, 2008; Sutcliffe, 2011). Understanding the fundamental components of this relationship and how to achieve these components in practice remains a vital aspect of nurse training and continuing professional development (Ramjan, 2004; Perraud et al., 2006). In accordance with the perceived importance of the therapeutic relationship, the aim of this paper is to provide an evidence-based review of how this relationship may be used in nursing practice. This will be supplemented with a reflection on personal observations made by the author, utilising a reflective model (Nielsen et al., 2007). The model in this case will be that devised by Gibbs (1988), which has been validated as a useful tool for personal practice development and goal-setting in the clinical domain (Foster Hawkins, 2005). This model emphasises a step-wise approach to reflection, encompassing: description, feelings, evaluation, analysis, conclusion and action plan formulation (Gibbs, 1988). Therefore, this paper will consider the therapeutic relationship from the perspective of a specified practice context experienced by the author, with a discussion of how practice can be improved based on the best available evidence from the literature. Reflection context The main context of care that will be the focus of this essay is the elderly rehabilitation ward, where the author first encountered a number of issues regarding the need for optimal relationships between practitioners and patients in practice. The goal of this ward is to assist elderly patients in adapting to their functional capacities and lifestyle abilities, in order that they can achieve the maximum possible degree of quality of life in the community setting following discharge (Routasalo et al., 2004). Consequently, numerous health professionals provide an input into the care pathway, including physiotherapists, occupational therapists and physicians, in addition to nursing staff (Hershkovitz et al., 2007). From the perspective of the author, there are several important aspects of this scenario that relate to the therapeutic relationship: the large increase in personal responsibilities in terms of assisting patients with activities, the need to motivate and communicate effectively with patients to ensure that they are able to remain psychologically motivated, and the need to coordinate personal clinical care activities with those of others to ensure the patient journey is smooth (Siegert Taylor, 2004). The remainder of this paper will consider the therapeutic relationship grounded within this practice context, supplemented with personal experiences from this placement, in order to highlight these factors in greater detail. Evidence-based reflection Defining the therapeutic relationship In order to fully appreciate the need for a therapeutic relationship it is important to define this relationship in a practice context. The term is often used within the context of psychiatric or psychological therapy distribution in modern literature, although the aim of this paper is to consider the term as a more general way in which nurses communicate and interact with patients to establish a clear clinical outcome (Bulmer Smith et al., 2009). McKlindon Barnsteiner (1999) suggest that the therapeutic relationship needs to be a two-way, reciprocal relationship at all times, involving nursing staff, the patient and their family, where appropriate. There is a need to emphasise caring in this relationship, with positive communication and clear boundaries of both personal and professional interactions (McCormack, 2004). Hence, the relationship between a nurse and patient should fit into the patient-centred model of care, where patients are not only listened to within a clinical decision-making context, but are actively encouraged to participate in their own care pathway (McCormack McCance, 2006). The therapeutic relationship encompasses three important domains of care: physical, psychological and emotional care (Pelzang, 2010). These elements may be more profoundly encountered by nursing staff on hospital wards due to their prolonged exposure to specific patients and their in-depth interactions in the patient care journey, when compared to other members of staff who may have less face-to-face time with individuals (Pelzang, 2010). Within the setting of the elderly rehabilitation ward, many patients are transitioning from an acute or chronic care scenario to community care and require additional, specialist assistance in doing so (McCormack, 2003). Consequently, nursing staff in this ward are exposed to patients for extended periods of time and need to consider the holistic aspects of care in order to achieve successful rehabilitation (Cott, 2004). Therefore, the therapeutic relationship in this context involves establishing the capabilities of the patient, working with the patient to achieve set goals, and ensuring that the psychological and emotional aspects of chronic illness or disability can be managed effectively in the long term (McCormack McCance, 2006). Communication In light of the definition of the therapeutic relationship within the context of rehabilitation, the remaining sections of this paper will evaluate the core aspects involved in maintaining a therapeutic relationship, with this section focusing on communication between nurse and patient. The specific clinical scenario the author has struggled with in the rehabilitation placement is when a patient has higher expectations than they should in terms of their ability to perform tasks or live independently following discharge. Patients are obviously passionate in maintaining independence in the majority of cases and this can cloud their judgement as to their genuine abilities and capabilities in functional tasks (Cott, 2004). While it is important to acknowledge the feelings and ideas of a patient and act accordingly, it can be negligent of nursing duties not to act with the patient’s best interests at heart (McCormack, 2003). Therefore, the nurse needs to maintain that their actions are guided by medical evidence and professional protocols, as well as reflecting the need and desires of the patient (NMC, 2008). Communication encompasses not only verbal communication with the patient, but is also reflected in body language and actions (Yoo Chae, 2011). Having an open body posture, including the avoidance of crossed arms, can help in establishing rapport, while maintaining eye contact and avoiding distractions during conversations with patients can enhance the bond between nurse and patient (Brown Bylund, 2008). Communication is also as much about relaying information as it is about receiving information and therefore, nursing staff should be able to elicit patient concerns specifically and utilise these appropriately without blocking these interactions with a one-sided approach to conversation (Yoo Chae, 2011). The opposite is also true, whereby overly expressive patients may limit the nurse-led component of the communication episode; both parties need to be good at communication for a perfect mutual appreciation of ideas to occur (Sheldon et al., 2006). In practice this may be difficult to achieve, but the obligations of the nurse to facilitate this process are a core component of the therapeutic relationship. Communicating effectively with patients in the elderly rehabilitation setting was a massive responsibility and challenge for the author, as this was their first encounter with such patients in this setting. The expectation of knowledge in this setting was high and it could be frustrating to patients who want answers from a junior or inexperienced practitioner (McCormack, 2003; Leach, 2005). Hence communication needed to focus on establishing information, sharing action plans and building general rapport that would enable the development of trust and a mutually beneficial exchange of ideas (Leach, 2005). The author found this form of communication challenging to achieve on a routine basis within the rehabilitation setting, due to the need to balance a motivational approach with a realistic form of communication regarding expected patient capabilities and outcomes. Hence, the reflective scenario will focus on aspects of this particular communication episode as a component of the therapeutic relationship. Empathy Empathy is a cornerstone of effective communication with patients and is defined as the ability to share or identify with the emotional state of the patient (Brunero et al., 2010). If done effectively an empathic response to patient concerns can yield a sense of shared understanding, reinforcing the notion that the patient’s concerns are being listened to (Kirk, 2007). By establishing an empathic response with a patient, practitioners often remark that they are better able to connect with the experiences of the patient, allowing them greater insight into how they can help the patient (Brunero et al., 2010). Therefore, empathy is a core component of establishing a meaningful therapeutic relationship with patients in all settings. The nurse can develop empathic communication skills in a number of ways, including through specific communication skills training (Webster, 2010). This training often emphasises the role of open-ended questions and body language within the context of empathy, whereby nurses should ask patients specifically about their emotions and feelings during a clinical interaction (Stickley Freshwater, 2006). Often the process of asking a patient how they feel about a particular reaction is sufficient to allow them to relax and become more comfortable conveying these thoughts and feelings. On the part of the nurse, it is important to reflect these responses back to the patient by further exploring these issues and offering an active listening approach, rather than redirecting the focus of the conversation back to more clinical matters (Brunero et al., 2010). Although it has been argued that empathy is an intrinsic quality, which some people possess, the representation of empathy in communication is important in clinical care and should be delivered through verbal, non-verbal and emotional communication skills (Welch, 2005). In the present scenario, the author was able to empathise with patients on the rehabilitation ward to a high degree and many patients were frank and open about their emotional needs and worries regarding the rehabilitation process. Often the patients’ worries were highly emotive and this affected the author such that the patient was regarded as an object of sympathy or pity in some cases due to their hardships. This made the author feel uncomfortable during patient interactions for a number of reasons: firstly, because it was an emotional situation, and secondly because the expectations of the patient with regards to rehabilitation were higher than expected and it was often difficult to address these in a controlled manner. Hence, the reflective experience demonstrates a number of feelings in this situation, which reflect problems with the therapeutic relationship. Trust and respect One of the primary outcomes of the therapeutic relationship is to establish a caring and trusting relationship between the nurse and patient (Brown et al., 2006). Trust is a concept based on respect and openness within this relationship and this often takes time to establish, acting as an extension of the professional respect a patient may hold for a nurse and vice versa (Miller, 2006). Within the context of elderly care rehabilitation, nurses need to establish a strong bond of trust as patients will often have to make compromises in terms of assisted living devices and acceptance of their functional limitations when attempting to optimise their quality of life (Schmalenberg et al., 2005). Unless they trust the healthcare professionals involved in their care they are less likely to adhere to recommendations or to accept help, reducing the potential positive impacts of nursing interventions (McCabe, 2004). Establishing trust within a therapeutic relationship requires time and demands that the practitioner is able to manage their communication skills appropriately to ensure the patient feels that they are listened to and involved in their own care (Brown et al., 2006). Both the practitioner and the patient must be receptive to the idea of trust within the relationship in order for this to be achieved, which often involves addressing barriers to trust, including suspiciousness of the intentions of healthcare professionals, poor communication, and mutual respect on a personal level (Miller, 2006). When a trusting relationship is achieved there is a greater chance that patients will be receptive to clinical interventions and nursing input, at least when delivered on a personal level (Wolf Zuzelo, 2006). Equally, nursing staff can trust that patients will make informed decisions about their care and will follow guidance, when appropriate (Schmalenberg et al., 2005). Within the present reflective context, the author felt as though there was a distinct lack of trust in the therapeutic relationship, primarily due to the fact that a patient would often wish for their expectations to be met without heeding specific nursing advice on several occasions. This was likely secondary to the fact that the author found it difficult to convey these ideas in a sensitive manner, while addressing the concerns of the patient in an empathic way. Hence, it can be perceived that the patient and nurse did not enter a trusting relationship, as communication between the two was suboptimal (McCabe, 2004). However, on a more positive note, the relationships formed with patient during the initial days on placement were friendly and demonstrated a degree of mutual respect, which is an important facet of the therapeutic relationship (Stickley Freshwater, 2006). Hence, there were positive and negative aspects to the therapeutic relationships formed in practice during this placement, according to a reflective evaluation. To make sense of this situation, the author analysed these positive and negative factors within this context. What was clear to the author was that the communication skills that had been utilised so far in therapeutic relationship building relied heavily on patient factors, rather than nursing input. Hence, there was an imbalance in the way information was presented and received within this relationship, to the detriment of the therapeutic journey. The reasons for poor communication and trust establishment stemmed from multiple factors, including the younger age of the author compared to patients, relative inexperience on the part of the author, and the highly charged emotional nature of interactions in this setting. Therefore, it was clear that one of the main factors that was missing in the therapeutic relationships was the projection of a strong professional identity, which could guide the patient towards a suitable clinical outcome and would assist in developing the appropriate communication tools for the rehabilitation process. Professional values While it is clear that the need for the therapeutic relationship stems from a desire to form a constructive clinical partnership with a patient in a specific context, there is also a professional responsibility to engage patients in this manner in practice (Chitty Black, 2007). The Nursing and Midwifery Council (2008) advocate communication, trust, dignity and respect during the treatment of all patients as a fundamental aspect of care delivery and therefore establishing a therapeutic relationship can be considered a core aspect of all nursing practice (Fahrenwald et al., 2005). However, within the context of effective nursing practice it is recognised that there is a need to respect the personal boundaries of the patient and to act as a professional rather than a friend in most cases (Rushton, 2006). Professionalism in the context of rehabilitation care includes the need to be realistic with regards to patient expectations, while ensuring appropriate levels of motivation and commitment to a therapeutic plan (Fahrenwald et al., 2005; Rushton, 2006). For some practitioners, an overly empathic response to patients and their condition can lead to sympathy and warped clinical decision making processes, often favouring the opinion of the patient over established guidance (Bulmer Smith et al., 2009). This is likely to have a detrimental impact on the patient in the long term and should be avoided as a result. Within the Gibbs reflective cycle (1988), the author has noted that one of the main conclusions that can be drawn from working within the rehabilitation sphere is that maintenance of professional values and boundaries is essential to avoid becoming overly emotional or inappropriately involved in patient care (Stickley Freshwater, 2006; Baker et al., 2008). The author should try not to become too attached to patients during their care journey in order to make an objective assessment of their capabilities and therapeutic needs, as relying too heavily on the opinions and desires of the patient can yield unsatisfactory results in the long term, particularly when these go against recommended practice (Leach, 2005). By applying more rigorous professional boundaries in the future, and focusing on explaining complex situations from a nursing perspective, rather than yielding to the patients’ wishes, the author can improve their contribution to practice in the long term and enhance the patient journey through rehabilitation. Conclusion In summary, this paper has considered the personal experiences of the author within the context of a reflective practice episode in order to appreciate the value and tenets of the therapeutic relationship in practice. The core components of the therapeutic relationship, as they relate to the present scenario, have been discussed with reference to the evidence base in order to develop a constructive reflective episode reflecting a description of events, feeling, evaluation, analysis and conclusion. The process of reflection should yield a suitable action plan and in this case the author feels that they should engage with patients in a more professional manner, ensuring that they maintain an empathic and understanding approach to care while maintaining nursing boundaries. In order to achieve this, communication skills should be enhanced in the future, through attendance at specific communication skills courses, in order to become more comfortable in managing potential conflicts or hostility. This should enhance the therapeutic relationship and ensure that future patients can be managed in a manner that benefits all members of the relationship. Furthermore, it is important that the author is aware of how other colleagues maintain professional boundaries and can direct their relationship accordingly in practice, and consultation with colleagues on this point would be a useful learning tool. On completion of these tasks, the author should therefore feel better prepared to engage with patients in a meaningful way, ensuring that trust is developed and that patients have an effective care process, in all areas of care. References Baker, C., Pulling, C., McGraw, R., Dagnone, J. D., Hopkins†Rosseel, D., Medves, J. (2008). Simulation in interprofessional education for patient†centred collaborative care. Journal of Advanced Nursing, 64(4), 372-379. Brown, D., White, J., Leibbrandt, L. (2006). Collaborative partnerships for nursing faculties and health service providers: what can nursing learn from business literature?. Journal of Nursing Management, 14(3), 170-179. Brown, R. F., Bylund, C. L. (2008). Communication skills training: describing a new conceptual model. Academic Medicine, 83(1), 37-44. Brunero, S., Lamont, S., Coates, M. (2010). A review of empathy education in nursing. Nursing Inquiry, 17(1), 65-74. Bulmer Smith, K., Profetto-McGrath, J., Cummings, G. G. (2009). Emotional intelligence and nursing: An integrative literature review. International Journal of Nursing Studies, 46(12), 1624-1636. Chitty, K. K., Black, B. P. (2007). Professional nursing: concepts challenges. London: WB Saunders Co. Cott, C. (2004). Client-centred rehabilitation: client perspectives. Disability Rehabilitation, 26(24), 1411-1422. Fahrenwald, N. L., Bassett, S. D., Tschetter, L., Carson, P. P., White, L., Winterboer, V. J. (2005). Teaching core nursing values. Journal of Professional Nursing, 21(1), 46-51. Foster, T., Hawkins, J. (2005). The therapeutic relationship: dead or merely impeded by technology?. British Journal of Nursing, 14 (13), 698-702. Gibbs, G. (1988). Learning by doing: a guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford Hershkovitz, A., Kalandariov, Z., Hermush, V., Weiss, R., Brill, S. (2007). Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Archives of Physical Medicine and Rehabilitation, 88(7), 916-921. Kirk, T. W. (2007). Beyond empathy: clinical intimacy in nursing practice.Nursing Philosophy, 8(4), 233-243. Leach, M. J. (2005). Rapport: a key to treatment success. Complementary Therapies in Clinical Practice, 11(4), 262-265. McCabe, C. (2004). Nurse–patient communication: an exploration of patients’ experiences. Journal of Clinical Nursing, 13(1), 41-49. McCormack, B. (2003). A conceptual framework for person†centred practice with older people. International Journal of Nursing Practice, 9(3), 202-209. McCormack, B. (2004). Person†centredness in gerontological nursing: an overview of the literature. Journal of Clinical Nursing, 13 (s1), 31-38. McCormack, B., McCance, T. V. (2006). Development of a framework for person†centred nursing. Journal of Advanced Nursing, 56 (5), 472-479. Miller, J. F. (2006). Opportunities and obstacles for good work in nursing.Nursing Ethics, 13(5), 471-487. Nielsen, A., Stragnell, S., Jester, P. (2007). Guide for reflection using the clinical judgment model. The Journal of Nursing Education, 46(11), 513-516. Nursing and Midwifery Council (2008). Code of Professional Conduct. Available at: http://www.nmc-uk.org/aDisplayDocument.aspx?documentID=5982 [accessed 6 th October 2014] Pelzang, R. (2010). Time to learn: understanding patient-centred care. British Journal of Nursing, 19(14), 912. Perraud, S., Delaney, K. R., Carlson†Sabelli, L., Johnson, M. E., Shephard, R., Paun, O. (2006). Advanced practice psychiatric mental health nursing, finding our core: The therapeutic relationship in 21st century. Perspectives in Psychiatric Care, 42(4), 215-226. Ramjan, L. M. (2004). Nurses and the ‘therapeutic relationship’: Caring for adolescents with anorexia nervosa. Journal of Advanced Nursing, 45(5), 495-503. Routasalo, P., Arve, S., Lauri, S. (2004). Geriatric rehabilitation nursing: developing a model. International Journal of Nursing Practice, 10(5), 207-215. Rushton, C. H. (2006). Defining and addressing moral distress: tools for critical care nursing leaders. AACN Advanced Critical Care, 17 (2), 161-168. Schmalenberg, C., Kramer, M., King, C. R., Krugman, M., Lund, C., Poduska, D., Rapp, D. (2005). Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 2. Journal of Nursing Administration, 35(11), 507-514. Sheldon, L. K., Barrett, R., Ellington, L. (2006). Difficult communication in nursing. Journal of Nursing Scholarship, 38(2), 141-147. Siegert, R. J., Taylor, W. J. (2004). Theoretical aspects of goal-setting and motivation in rehabilitation. Disability Rehabilitation, 26(1), 1-8. Stickley, T., Freshwater, D. (2006). The art of listening in the therapeutic relationship: The role of the modern mental health nurse is becoming more technical when, argue Theodore Stickley and Dawn Freshwater, what would really benefit patients is the often misunderstood art of listening. Mental Health Practice, 9(5), 12-18. Sutcliffe, H. (2011). Understanding the NMC code of conduct: a student perspective. Nursing Standard, 25(52), 35-39. Webster, D. (2010). Promoting empathy through a creative reflective teaching strategy: a mixed-method study. The Journal of Nursing Education, 49(2), 87-94. Welch, M. (2005). Pivotal moments in the therapeutic relationship. International Journal of Mental Health Nursing, 14(3), 161-165. Wolf, Z. R., Zuzelo, P. R. (2006). â€Å"Never again† stories of nurses: dilemmas in nursing practice. Qualitative Health Research, 16(9), 1191-1206. Yoo, M. S., Chae, S. M. (2011). Effects of peer review on communication skills and learning motivation among nursing students. The Journal of Nursing Education, 50(4), 230-233.

Food Memoir Essay

Eating it as soon as it gets out of the oven is an amazing experience. The elation increased inside me as soon as I started to smell the juicy baked chicken. Suddenly, it feels like a irresistible need to grab a bite of it right away. Obviously you can’t resist it, so you cut a piece of it and eat it. The crunchy sensation of the baked cereal all around the chicken is wonderful, but not only the texture felt good, the gooey of the sugar that comes with the cornflake make it taste like glory. The sweet mixed with the salt of the seasonings is an incredible party inside the mouth. Adding a delicious bowl of baked potatoes with bechamel sauces makes the dish even better. I always love to cook and be creative while cooking; preparing different kind of dishes with different seasons, all natural most of the time. Cooking is not about following recipes and going by the cooking book. Instead it’s about being able to mix different seasonings to create the perfect taste. The history behind this invention comes from the lack of resources to prepare a decent dish. It was a quite night like tonight, listening to John Mayer and my roommate and I were really hungry. Then we looked at the refrigerator and cabinets to see what we could cook but we only found chicken, tomatoes, garlic, salt and pepper. Having all those seasons and been tired of eating grill chicken I decided to make it baked crunchy chicken, but sadly there wasn’t any ground bread and I figured it out late so the only thing that I could use was the cereal. So that is how it happened, a happy mistake. I used cornflakes instead of bread crumbs for the baked chicken. At the time I started to prepare the chicken, two girls came in looking for us. They reaction was priceless; they screamed â€Å"Oh my god! You guys are crazy! † at us. My roommate after he laughed for few seconds he told them that it was going to taste good and that they will want me to cook for them after they taste it. The girls said ok and stayed in our apartment all night with us having fun. While the chicken was in the oven, I put some potatoes to boil. Then when the potatoes were cooked, I prepared bechamel sauces. I took a bowl with all the potatoes and I let the bechamel sauces rain over it. Then I put the bowl inside the oven with the chicken as well. In the meantime, I sat down between the two girls and we talked about something â€Å"special†. That happened later that night. When it was time to take the chicken and the potatoes out of the oven, we all went to the kitchen to see how it looks like. First I took out the chicken and placed on the dinner table, and then I go back to the kitchen to take out the potatoes as well. When I come back from the kitchen, I found that my friends had already eaten one chicken to taste it in like 8 seconds. I told them that they attacked the chicken too fast. Therefore one of the girls said to me that it was really good, that the sugar on the chicken was delicious. We sat on the table, each of us four with 2 boneless Baked Cereal Crunchy Chicken, with baked potatoes doused in bechamel sauce and many very cold coke cans. The coke cans were so cold that I had to use my can handler while the others used a can bag that we have. Those 15 to 30 minutes that we were eating on the table, became a good memory to our brains and especially to our tongues. Even though, that like five other people came to the apartment to check out our dinner and ate from our food, it was a good. They find out about it because the girls posted some pictures on instagram. Every single people who tasted the food, at the beginning when they saw what was it, they were all like â€Å"Cornflakes with Chicken? † However they all found it very tasty. Good enough to tell me that I should do that again. After we ate, I laid down on the sofa with my head over one of the girl legs. Then my friend yelled out loud â€Å"Toy timbi†, that is a Dominican expression that people say when we cannot eat more. My roommate went to the kitchen to clean the dishes, as it was his turn. After he was done, the girls screamed â€Å"Special time! † and suddenly a bottle of Jose Cuervo appeared. They prepared some margaritas with lemon and strawberry mixer. Later on, after around 3 rounds of margaritas we started to listen and dance merengue and salsa. We dance for like hour and half non stopping. Also we were singing a bit while we were dancing. We stopped dancing when he figure out that it was 4:00 am and we had class at 8:30 am. We were all tired but we were also in a happy mood. We all went to bed right away, but sadly none of us make it through the next four hours; the one who woke up earlier was the younger girl at 10 o’clock. She nocked my door very hard, until I woke up really mad because we skipped the class at 8:30 am. When we were all ready, we talked about last night. And the first thing that came out was that the chicken was really good and when I would do it again.

Necessity is the mother of invention Essay

Introduction Rationale This research topic â€Å"necessity is the mother of invention. Evaluate this statement in relation to scientific and technological experiment.† was chosen for studying in the area of informatics study. However, the research topic was seemed to be in the philosophical term to understand the basic need of technology more than the informatics subject, which deals with creating and developing of computer study. So that this topic needed past experience and historical background to be evaluated, but didn’t need much in education background because the topic wasn’t related to the theory or language of computer study. The topic in this area was very interested for future study because it could helps in understanding and forecasting the need of society need when developing or creating new technology or inventions which lead to the success in business. These are the fact of this chosen topic. The analysis of the research topic The research question is â€Å"Necessity is the mother of invention. Evaluate this statement in relation to scientific and technological experimentation†. The key words that show the content of the question are â€Å"Necessity is the mother of invention†. The relationship of this question is to show the relation between necessity and invention that necessity is the cause of the invention or not. The requirement of the question is to prove the relationship between necessity and invention by evaluates the statement according to scientific and technological experiment. The proposes of the thesis are to show that to what extent does necessity be the mother of invention and to evaluate according to scientific and technological experimentation. Three areas were analyzed during the study. These three areas, which are communication, industry, and medicine, were studied in the area that involve in scientific and technological experimentation. The communication was studied to understand its necessity and invention of the present. The industry was studied to analyze the situation of necessity in the economical competition,  which lead to the use of invention. The medicine was studied to show why it is very necessary to human life and what are the alternative inventions that come after. So all evidences were collected to support the thesis of the research question and its purposes that the study defends an argument on the proving of the necessity that lead to the invention. The diagram on the next page shows the structure of the analysis of the research topic. Data Collection The Research Method The research was carried out in three steps. The first step was to understand the research topic by searching for definition, background history, and general information from the source books and journal articles. Then all the information was evaluated to find out which areas are mostly involved in the research topic and range, which is the scientific and technological experimentation. The second step was the collection of data to find the relevant information. The information was analyzed according to the relevancy to the research area, the objectivity of the author, and the period spent on collecting of the data. Then third step, the limitation of the information will be analysis on the certain aspects of the topic areas of the scientific and technological experimentation. Therefore, the research will focus only the necessity and invention in the areas of scientific and technological experimentation. Most of the sources that use in the research were some kinds of business and socia l case study such as â€Å"Cleft palate case in the medicine study†(Singer and Bergthold, 2001, pp.2161-2230). Annotated Bibliography Cotterell, A. (1988). An overview of research and co-operation in advanced information technology. In A. Cotterell, Advanced Information Technology in the New Industrial Society (pp.1-27). New York: Oxford University Press. Written for expert manager who involve in information technology that want to find out which technologies are matched for their business  area. This chapter describe about new technologies that involves in industry and focus on future technology. The improvements of communication and computer storage are used to compare in industry area to explain how necessity are they. Also, this chapter explains the expert system in new technology to shown that new technologies have invented new ideas in the industry. Fuglsang L. (1993). The â€Å"soft† information technologies and its critics: the risk of wild policy making in science and technology. In L. Fuglsang, Technology and New Institution (pp.54-96). Denmark: Copenhagen. Written for computer managers that involve in information system research and development of technology in future research. These chapter focuses on what invention creates by the risks which cause when new science and technology are emerging while old are crisis. The history of technology over 50 years is used to prove that risks cause necessity to create invention of new technology. Hall, B.J. (2000). Use of the pulmonary artery catheter in critically ill patients: Was invention the mother of necessity? Journal of the American Medical Association, 283(19), 2577-2578. This article has been written for doctor and hospital that involve in surgery area. This article discusses two studies regarding the use of pulmonary artery catheters in critically ill patients and the process of its future evaluation. The use of pulmonary artery catheters is necessary for the medicals and surgical intensive units (ICUs). It helps to manage critically ill patients. Singer, S., & Bergthold L. (2001). Cosmetic vs. reconstructive surgery for cleft palate: A window into medical necessity debate. Journal of the American Medical Association, 286(17), 2162-2203. This article has been written for doctor in plastic surgery and people who interest in cosmetic surgery. Medical necessity is a term that  used in most commercial health plan to create invention. This article is focus about plastic surgery for a cleft palate, and the debate about whether the surgery is cosmetic or reconstructive. But because of medical necessity can mean different things to different people and organization, so it could be both general meaning. Stewart, J. (1992). Technological change and industrial location. In J. Stewart, The Management of Science and Technology (pp.110-192). Denmark: The Australian National University. This book has been written for educator and manager that involve in information technology and works on the productive area of research. This chapter focus on Just-in-Time system, which is the new industry system that create by the competition in the world economic. Because of competition in the market industrial investment, the Just-in-Time system is used to because it is necessary to control cost and increase profit. Tate, A. N., Clayton B.S. & Gourley K.G. (2001). Development and implementation of a managed care rotation in medical necessity review: Exposing students to new opportunities. Journal of American Pharmaceutical Education, 65(3), 261-307. The purpose of this journal is for fourth-year PHD students to design a rotation in managed care through medical necessity review. The rotation involved working with the Tennessee department of Health’s TennCare Appeals Units. It shows how the impact of pharmacists can have on patients’ lives. They claim by using professional development experience to show the advantage of utilizing pharmacists. The Literature Review The five articles that are reviewed focus mainly on scientific and technological experiments, which separate into three major areas. These three areas are communication, industry, and medicine. The writers ‘s attitude toward the study of information technology and science, which are  used in society, raised a very detailed discussion and neatly analysis on the proving of necessity as mother of invention. The sub-topics in each area contain important information involve in necessity of both individual and social points of view. Evidence is provided completely from all sources and can accurately be used to prove that necessity is the mother of invention as reasons and evidences. The purpose of the review is to make a clearly analysis on these six articles toward similarities and differences in their areas. The first article, an overview of research and co-operation in advanced information technology by Arthur Cotterell, mostly represents in the area of communication. In this article, he discusses that the communication is important to the future of society. Cotterell compares the different between old and new mediums of communication, which lead to the social necessity. He explained the medium clearly in details and supported by using a city named Swindon (Cotterell, 1988, p.26), which wildly use fiber optic (medium) as his evidence. The successful of the fiber optic is picked up to prove his documents. In the second article by Jenny Stewart, â€Å"Technological change and industrial location†, represents in industry area, which focus mainly in competition in market industry investment and scarcity of natural resource for industrial manufacturing. She points and explains the effect of competition and scarcity lead to the change of new system. The Just-In-Time (JIT) system, which is a new information system, is used to compare how efficiency it is with the old system. This system is the very successful system that helps reduce and eliminate cost, waste, and speed in production. She analyse automotive industry in Australia, which success in this system, as her evidence. The smaller, more technological advanced players, and accurate in the industry is the main point of the invention in this article. The third article, which is written by Fuglsang, in the article, he expresses the meaning specifically of how and why invention is created (Fuglsang, 1993, pp.54-96). The main point of his article is to show that when the time is running and population is increasing, they cause the old invention to become crisis and it is necessary to invent something new to replace the old. This article can be used as theory and reason to explain and clearly support all three areas of communication, industry, and  medicine. The phases of invention development are used to show the steps of scientific and technological improvement. In each phase provide the evidence of the development of invention clearly since past fifty years when a manual turning-machine was created to the automatic machine are used. He also supports his evidence by using the development of American technology. He mentions that the growing application of new technologies in society creates a need, so it is very important to studies more about technology network in political process. The forth article written by Sara Singer and Linda Bergthold, they mainly represents in the area of medicine. This article focuses on medical necessity by compare the different between cosmetic surgery and reconstructive surgery. They support the document that medical necessity in the area of surgery is really necessity by using â€Å"health plans† (Singer and Bergthold, 2001, p.2162). This health plans is medical necessity standard that use permanen tly all over the world. They also comment generally that social viewing among medical necessity in surgery is also included in some case. The case of a cleft palate patient is used to analysis and discusses the different between cosmetic and reconstructive case. Then they argue and support that medical necessity determinations involving the condition that proven to be especially problematic not self-desirable. The fifth article written by Jesse B. Hall, â€Å"Use of the pulmonary artery catheter in critically ill patients: Was invention the mother of necessity?† the article show that pulmonary artery catheters is necessary to most patients that involve in heart, lung, and blood problems. He analysed this technology from 10217 patients in 34 medical and surgical intensive care units (ICUs) in 1998. According to Hall, the pulmonary artery is used in the case that no medicine can used to cure the sickness. He suggests that this invention still has high risk, so this is very necessary to improve this invention to help critically ill patients and the process of its future evaluation. All issues in five sources, which written by Arthur Cotterell, Jenny Stewart, Fuglsang, Jesse B. Hall and Sara Singer and Linda Bergthold, are considered very important to show the audience the historical and current significance of continuity about necessity as mother of invention in the term of scientific and technological experiment. This is because when the old  invention is considered as the necessity for the future improvement, the continuing improvement to the new invention will be created. Arthur Cotterell writes about the use of communication medium during the past 10 years until the use of new medium today (Cotterell, 1988, p.26). His examples of twisted pair and fiber optic cable show the fact that the why the increase of performance of new medium are used by the change in society. It shows the audience clearly the distance between time in the past and present of social necessity. This article also talks about the rapidly increases of necessity which lead to the improvem ent of new medium in the future continuously. In the issue of Jenny Stewart and Fuglsang have the similar area in the industry that also express the same meaning of need in the industry. Jenny Stewart shows the change in industry system by using automotive industry in Australia since 1990 (Stewart, 1992, p.124). Fuglsang shows the rationalization phase (Fuglsang, 1993, p.56), which is one of 4, phases in technological invention development. This phase analyses from the past 50 years of the development. Both Jenny Stewart and Fuglsang’s article shows the change in the industry, which involves in commercial interests and competition. This article helps to show the link between competition and tutorial in the industry, which leads to the use of the new invention. In the rest of the issues from Jesse B. Hall, and Sara Singer and Linda Bergthold are involved in medicine area that involve in the surgery. Jesse B. Hall talks about the result of the use of pulmonary artery catheter (Hall, 2000, pp.2577-2578). This result shows the need of cosmetic surgery among the people who have problem of the natural disable of the body and also explain the use of the invention to help solve the problem. Sara Singer and Linda Bergthold article also help to shows that since from the past the meaning of medical necessity is mean only reconstruction to the normal state of patients. Both issues from Jesse B. Hall, and Sara Singer and Linda Bergthold come form the different medical case but they have similar thesis, which are medical necessity that lead to the invention of new medical invention. All the writers come from the different areas but they have the same meaning of their issues that the continuing of the time lead to the increase of need of invention in both new and improvement. So that their issues are strongly support the statement that necessity creates the invention in the part of science and technological experimentation. There are three articles which surely are the objective of the writers when they present research their research results and evidence to support their arguments because these articles provide complete information and details of the document. The first article, which is objective, by Arthur Cotterell supports and expresses the meaning of his argument clearly by using the complete examples and information of communication mediums (Cotterell, 1988, pp.1-27). He shows the detail number of capacity, speed, range, and material made in each medium sample clearly. He also compares the different in each medium by mathematical calculation. This helps audience to easily understand the different even technical term. The second article, which is objective, from Fuglsang is objective because he has the acknowledgment from Massachusetts Institute of Technology in the United States (Fuglsang, 1993, pp.54-96). His article and support evidences come from the case studies in Denmark, US, and Sweden. Th ey are emphasis and detail clearly on the influence of culture, organizational choices and institutional concerns through research. The third article, which is objective, from Jenny Stewart is objective because her argument and sources come from the federalism research centre (Stewart, 1992, pp.110-192). She provides the information clearly in the example of automotive industry in Australia in percentage of profit, time, competitor, and increase of product output. The other two articles from Sara Singer and Linda Bergthold, and Jesse B. Hall are not objective because they provide the information too general. It is general because the information they provide is not specific in number of result from the succession in medical treatment. Both of them show only the result from the invention by using only reasons, causes and effects after treatment (Singer and Bergthold, 2001, 2162-2203). This is because most of the article is the summary of the result of the cleft palate research, so that they just mention about the need and future development, which result from the succession of cleft palate surgery. Although they don’t provide completely information, the area that they work is in medicine area, which concentrates only the result of necessity. So that their article can express their main ideas easy and clearly understand by using reason, cause, and effect documents. By compare all the articles which each others, the information that provided by the authors are enough to support the necessity of  invention by using their specific details and information, research, reasons, causes, and effects. Their sources are considered as essential in comparative and explaining the necessity as mother of information in scientific and technological experiment. The interpretation of data is clearly in all five sources because all data can be analyse to evaluate the need of the research topic in relation to scientific and technological experiment easily. The relationship between the necessity and the invention is linked in clearly understand. There are three different ways in their interpretation of data. The first way is represented by the article of Arthur Cotterell. He interprets his information by explain the detail of old communication medium and new communication medium in technical term and estimated calculation of speed, capacity, and range. For example, he explains that twisted-pair could carry 10Khz but if compare with fiber optic (Cotterell, 1988, p.26), fiber optic is faster than twisted-pair million times. He also clarifies the use of fiber optic that it uses in linking between two or more networks and twisted-pair uses in local phone line. The second way is represented by Fuglsang and Jenny Stewart. They interpret their sources by using the result of the time in the industrial development. They show the change and need since from the past and result of it in the present. The time between standardization and rationalization is used by the author to show the relation of the improvement of the invention from first creation to the first development (Fuglsang, 1993, 56-56). The third way is represented by Sara Singer and Linda Bergthold, and Jesse B. Hall. They interpret their sources by using the result of their information, which is the specific in medication. They summarize the result of medication from the patient and use it to support their argument. The research result of the patient in a cleft palate case is used to analysis the term of medical necessity in the surgery area of medicine. The result after the surgery is used to compare that the surgery is reconstructive surgery not cosmetic surgery. In comparison of all the writers, they interpret all data clearly. All the data are separated into three areas, which Arthur Cotterell is in communication area, Fuglsang and Jenny Stewart are in Industry area, and Singer S. and Linda Bergthold, and Hall are in medicine area. There interpretation of data can support each others and express their  understanding in analyse that necessity as mother of invention clearly. There are three articles that are conducted the research thoroughly in order to prove the points by the writers. The complete research could help the claim of research topic to become more strong and reliable without being counter by other argument. Arthur Cotterell, Singer S. and Linda Bergthold, and Jenny Stewart are the writers who do their research thoroughly. Arthur Cotterell researches neatly on the information system research, which express all the meaning, material used, quality, and performance of each medium between communications clearly (Cotterell, 1988, p.15-27). He use a city name Swindon to do his research. This city is widely use in fiber optic and coaxial cable to link between communication which mean that it is a very efficiency sources to use on communication research. Singer S. and Linda Bergthold research on the medical necessity on surgery course. They use a patient who was born with cleft palate problem as their research (Singer and Bergthold, 2001, pp.2162-218 0). They clearly research on the result before and after that patient take the surgery. They also research on the health plan of the medical standard and analyse it with medical theory as the reconstructive medication. Jenny Stewart researches on the Australia industry. She finds out that the reasons of necessity in industry come from the competition, which lead to the need of more flexible, fast, and efficiency technology(Stewart, 1992, p.124-192). This led her to find out the new system, Just-in-Time system, and research it on the Australia automotive industry. She has the result of how efficiency and profitability it is. The other sources from Fuglsang and Jesse B. Hall are not researched thoroughly because they get the information from general source directly without fully detail. Fuglsang picks up the history to speak to support the argument but the detail on his suggestion seem not clear on details and analysis. From Arthur Cotterell, Singer S., and Linda Bergthold, and Jenny Stewart research, they are very to understand their point of view from their research and directly connect audience to the understanding. The clearly details and information of their research link their ideas to the necessity as mother of invention in the scientific and technological experiment. From five sources, there are four sources that provide practical and  realistic suggestion by the writers. The practical and realistic of suggestion can help the article to become more clear and ease of understanding. First is Jenney Stewart, she suggests that future of the industry needs smaller, more technological advanced players, and accuracy (Stewart, 1992, p.125). The writer suggestion shows that her study is very important to the use of technology for the future use. Her suggestion is proved by her comparative of old technology and new technology that show the change of size, quality, quantity, and speed. Second is Arthur Cotterell, he suggested that by the help of computer-aided design would help to avoid a lot of tentative material cutting. The writer suggestion shows that his study is very important for the industry to increase their performance of the system. This is very useful in showing the relationship between necessity and invention. Third is Sara Singer and Linda Bergthold, they suggest that cosmetic or treatments intended primarily to improve appearance is exclude in medical necessity standard (Singer and Bergthold, 2001, p.2162). The writers’ suggestions are used for people to understand that the purpose of surgery is different in some case because some case could count as personal desirable such as cosmetic. This shows the relation between medical necessity and invention clearly. They support their suggestion by evaluate the cleft palate in the medical necessity term and health plans. Forth is Fuglsang, he suggests that the growing application of new technologies in society creates a need to assign a more offensive and organized role to technology studies networks in the political process. This suggestion shows that his detail on study is very important for who is interested in technological development. The writer proves his suggestion by evaluate and show the need over past 50 years of the development of information and communication technologies in four phases (Fuglsang, 1993, p.55-58). From all the suggestion of all writers could help the audience to know what are the main interests in on the articles of the writers, which are very useful. There is no surely use of expert opinion from all the writers. They haven’t pick up any expert opinion but they adapt to use another people and place from other sources as their expert opinion. The expert opinion on the article of Sara Singer and Linda Bergthold is not mentioned clearly. They  use the term physician as their expert opinion to help support their argument in consider appropriate medication for a patient, such as treatment intended primarily to improve appearance. As same as Sara Singer and Linda Bergthold, Jenny Stewart doesn’t use expert opinion but she uses other opinion, Lamming (1998), who is one from her source. Lamming talks about the industry remaining effectively in â€Å"stress period†. This opinion helps audience understand the best period of industry development. In the article of Fuglsang L., this writer use Sloth Andersen and Slavo Radosevic, who are not mention clearly who are they, as the expert opinion. They talk about an innovation forum, which help to support the writer about the change of technology during a century so that the view of technological change would be see as the important to the new invention. The rest of the writers do not have any expert opinion to support their argument. But in the case of their writing, the support of expert opinion is not important because the evidences and examples are enough to call as expert opinion in the case of science and technological experiment. In conclusion, all of the five articles are clearly review, analyse, and can be reliable. All the sources talks in the areas of communication, industry, and medicine by using variety of evidence and alternative ways of using expert opinion. The objectivity of each writers are confirm in all sources and the interpretation are very clear. The thoroughness of treatment of the subject matter could confidentially be used from the analysis. Each suggestion from all writers are mentioned mostly point to the future use and analysis. For further research the study of more variety of necessity in creating invention must be more research and study to express their meaning widely in different area. This could help to look and analysis more widely in today and future development of invention. But the main point of all reviews is to find out the best ways to the result of successful future. The Limitations of research This research limited by certain factors. The research was limited by some limitations of the topic. The personal factor was caused by the research topic is not directly related to the past experience and educational  background but mostly related to the philosophical area which is not computer study. This caused the lack of some specific or direct information that could help analyze the topic more efficiency. Another reason is the topic question is some kind of question that can answer in two ways that people could agree and disagree depends one the personal opinion so that the degree of the answer to the question is not strong enough. This caused some part of the argument easy to be counter by some situation in both side of agree and disagree. The suggestions for future study The problems of limitation of research need some suggestions to be made for future study. Firstly to solve the problem of lacking in specific education background, this research needs the specific education of philosophy and psychology to help provide more specific and strong supported information for the term of human necessity. This can help to improve the supported argument of the essay to become more reliable. This future study can do by focus on the continuous of inventions in each area in term of psychology, which will be very helpful in this research. The research doesn’t need to find out the started point or the first creation of the invention because this essay was only focusing in present invention. Second future study is by searching more support from the expert opinion to help solve the limitation of unstable argument due to the meaning of research topic, which is too wide in general. The more researched findings of supported expert opinions can strongly help to support the argument and make the research become more reliable. This could be done by focus on the expert opinions that involve in the succession in each area of industry, medicine, and communication. The success of expert opinions is more reliable and couldn’t be counter by other argument easily. In conclusion, if all suggestions of future study are completely finished the research will not have any blank spaces to be counter by other counter argument.

The Impact Of Black Upward Mobility On The Corporate...

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