Envrionmental Anaylysis Of Nissan And Renault Marketing Essay

Envrionmental Anaylysis Of Nissan And Renault Marketing Essay Presentation: The associations working in 21st century are portrayed by unpredictable, tempestuous, and energetic changes. The quick pace of changes has both positive and negative effect on the working example of representatives in the current condition. In addition, initiative, globalization, assorted variety, adaptability and systems are the significant drivers and patterns of progress the executives. These patterns make openings and dangers in the association which are delineated as follows. Patterns ISSUES Globalization Worldwide versus Nearby Assorted variety Homogeneous versus Heterogeneity Adaptability Adaptability versus Dependability Systems Reliance versus Freedom As per Ghosn (2009), Diversity has various points which unite things which are blocked off in the professional workplace and in physical world. In addition, decent variety assumes a significant job in executing successful change and to remain serious in the worldwide condition. The world is so perplexing and changing at a quickening speed accordingly the plan ought to be driven by assorted variety and globalization. In any case, assorted variety isn't something that can be forced in authoritative culture and convictions (Anderson, 2008). Besides, the idea Diversity is essentially connected managing the change. At present, associations rely upon cross practical groups to improve worldwide serious edge. Nonetheless, this sort of groups can't give in anticipated execution (Ancona Caldwell, 1992). Interestingly, cross utilitarian group need coordinated effort between them. Here, to improve the presentation cross utilitarian groups, they have to comprehend the idea of assorted variety. NISSAN RENAULT AT GLANCE: Organization Points of interest Nissan Renault Vision Advance people groups life Drive the change Strategic To offer selective and creative car items and administrations by guaranteeing top notch esteems towards partners in coalition with Renault. To make progress intensive economical advancement by shielding quality in which organization works with its accomplice Nissan. Date of Joining 26th, December, 1933. 25th, February, 1899. Incomes (FY 2009) 3.35 billion euro. 33.71 billion euro. President Carlos Ghosn. Carlos Ghosn. Headquarter Japan. France. Representatives 1,75,766. 1,24,300. Item Range Vehicles, Outboard Motors, Forklift Trucks. Car, Industrial Vehicles and Financing. Auxiliaries Interminability, Nissan Forklift, Nissan Marine, Nismo, Autech. Vehicle Dacia, Renault Samsung Motors. Working Around the world 118 nations around the globe. Renault Nissan Alliance is an incomparable organization of two organizations joined for execution and made a national vehicle gathering of worldwide scale, marked on March 27, 1999. This union dependent on two fundamental establishing standards: By joining the two organizations qualities and building up every single imaginable cooperative energies all through to pass on a beneficial methodology for example Win-Win results. Regarding and saving each companys independence of their image uniqueness and own corporate. The restoration plan created by a global group of 200 Nissan administrators. What this worldwide group has done is completely comprehend the underlying drivers of our momentum issues and create arrangements that permit Nissan to act unequivocally ( Ghosn). The recovery plan meet up undertaking to create Nissans business and presence of market and it likewise pay off net obligation from 1.4 trillion Yen to under 700 billion and furthermore decrease the expense by 1 trillion Yen by FY 2002. The blend of development and cost decrease will permit Nissan to accomplish a combined working benefit of 4.5 percent of deals by FY2002, (Ghosn). The fundamental and the primary objective of restoration plan are to return Nissan to productivity for FY2000. While cost cutting will be the most sensational and obvious piece of the recovery plan, we can't spare our approach to progress (Carlos Ghosn). Recovery plan features Nissans devotion to become overall accomplishing developing piece of the pie, serious and benefit dependent on attractive items and brands. This restoration plan not just shows Nissan gain ground and form into a solid organization over once more, in any case, make Renault as the universes fourth biggest vehicle creator. ENVRIONMENTAL ANAYLYSIS OF NISSAN RENAULT: Nuisance Analysis Variables Nissan Renault Political Government strategy: Affected positive on car segment in order to Nissan-Renault Strategy to advance nearby produces and exporters Efficient Time of inflationary and deflationary: Because of ascend in financing costs , there is climb in costs of oil and vehicle, purchasing intensity of clients goes on pick which in a roundabout way influence to the Nissan-Renault. Money Evaluation: Unpredictability and insecure cash rates influences the activity and deals of Nissan Renault. Effect on nations economy: Car industry utilizes a lot of products, for example, aluminum, plastic, elastic, PC chips, vinyl, materials, elastic, coppers, iron and steel.. Social Character status: As way of life of rises, individuals decide on increasingly sumptuous vehicle. Populace: Increment in populace brings about more deals of vehicle. Guidelines and mentalities: Various qualities and mentalities are influences on the client. Innovative Innovative change: The changing in the innovation has gigantic effects on the item life cycle. Web: Nissan Renault has immense chance to advert their item by on site and increases upper hand. Openings As Nissan Renault is route back in to the cross breed innovation so organization needs to adjust this innovation. Be that as it may, crossover innovation isn't a lot of old so Nissan Renault should starts to deliver half and half vehicle. Keep on growing for the most part in the creating nation especially in the Eastern Europe and Latin America. Present new inventive thoughts. Dangers Unsteadiness of fuel costs holds the deals of vehicles. Buying intensity of the buyer is been influenced by the worldwide economy. Contender development is been expanded in this period for the Nissan Renault. Full scale factors, for example, financing costs, expansion, earnings, downturn, and joblessness. Authority AND DIVERSITY : There is no doubt about the authority vision of Carlos Ghosn. At the point when he assessed the restoration plan by watching the qualities and shortcoming. He examines the circumstance by setting a few goals that were influencing the organization from performing at better level. He makes the groups to pick the better strategies for accomplishing the objectives. Carlos comprehend the target and vision of Nissan and work culture was undefined. He clears the technique and vision in its Revival Plan. The way of life of Nissan was homogeneous as they were suspecting in a similar way. Despite the fact that the CEO of Nissan settle on the changes, however the work power didn't feel the progressions was vital in the way of life of association. So as to change Nissan, there was requirement for new culture to have sway on the way of life of association (Nakae, 2005). The cross practical groups needs to accomplish something so as to conveyance of recovery plan effectively. For this target the c ross practical groups were structure with both vehicle producing association and the ideal result was to balance the social qualities. Cross utilitarian groups are overseen by administrators delegated via Carlos who are liberal, dependable, socially enhanced. The entire change of administration was to improve the presentation of the Nissan. The Cross Functional groups were not made to share perspectives and thoughts of each culture. Be that as it may, the adage underneath was to part the various leveled boundaries in the authoritative culture. In any case, empowering the adjustments in the association can't give confirmation of achievement. The insurance of confidence of the specific culture and the recognizable proof of association must be guaranteed. Be that as it may, he contends that encouraging change with maintaining enthusiasm of association would wobbly be able to adjust act (Ghosn, 2002, Harvard Business Review). The administration of Carlos Ghosn has normal for social asso rted variety and with the assistance of his enhanced social experience, he remove the social contrasts in association. Moreover, when restoration plan of Nissan was executed, this was phase of performing for the cross useful group. Be that as it may, the factor which considered as basic and obstacle in the stage was eastern community and homogeneity of Nissan authoritative culture. Then again, singular sponsorship with both various groups can be useful to expel certain hindrances to assorted variety of cross utilitarian groups. CHANGE APPROACHES: Following are the change resistors and change approaches given by Kotter to Schlesinger (1979) which can support Nissan and Renault union so as to effectively execute rival plan. Support Contribution of individuals in Staff Groups Dynamic Increment Commitment Assistance Support in Distinguishing Resistance Persuading the Commitment to change Mentality Behavior to Change Impulse or compulsion Express or Implicit Cautioning for conduct Composed notification for end on Failure Arrangements Understandings to Beat Resistance Utilization of Effective Third-party settlement Correspondence Learning about the change by Educating Instructing Defending Settling questions Modifications Co-activity Utilization of Power to satisfy requirement for modification Gathering Threats and Rewards to satisfaction While executing this change there may be protection from change at various level in the organization as recommended by Kotter Schlesinger ( overseeing advancement change : A basic guide for associations second version, Nigel King Neil Anderson 2002). Singular level Gathering level Authoritative level Explanations behind ALLAINCE: The principle reason of the partnership was to sharing speculation, innovation, individual societies and supporting one another. The union was especially made on the excitement of the Carlos Ghosn to forthcoming effective cooperative energy and keep opportunity of th

Changes in Life Positive and Negative Effects

One of the constant real factors in life is that we are each in a condition of progress. These progressions might be sure or negative yet paying little mind to their inclination, they are a principal part of our lives and it is significant that we support ourselves for them. In my life, I have had numerous changes; some of which have been irrelevant and other which have truly denoted a defining moment in my life. Publicizing We will compose a custom exposition test on Changes in Life: Positive and Negative Effects explicitly for you for just $16.05 $11/page Learn More In this paper, I will describe one of the huge changes throughout my life to feature the way that our impression of the change does on occasion decide if the experience will be pleasant or will respect uneasiness and uncertainty. The especially critical change in my life came to fruition because of the declaration by my folks that we would be moving from Texas to New Mexico. What rolled out this improvement so critical to me was that we had been living in a similar neighborhood for whatever length of time that I could recall and the moving procedure felt like truly been removed. Accordingly, the change spoke to being detracted from what I knew about and wanted to being put in an outside spot which held a great deal of vulnerability for me. My underlying response was that of stun and misery at the possibility of what life in the new spot would hold. While I enjoyed visiting new places, I had never envisioned myself moving from my old neighborhood consistently. In an offer to oppose the change, I attempted to reason my folks out of their choice. This was a purposeless endeavor for the most part since I had no strong reasons with respect to my restriction to our moving. At the point when it was at last obvious to me that we were going to move paying little heed to my position, I surrender to my destiny and I floundered in self centeredness as I communicated my situation to my companions. Be that as i t may, one of my companions who had originated from New Mexico commented that the spot was really agreeable and held numerous an intriguing scenes for individuals. What's more, he remarked on the beautiful neighborhoods and the very close networks that were there. His announcements made me fully aware of the potential outcomes that the adjustment in my life introduced. I had been too enjoyed the vulnerability and uneasiness that would emerge from the move that I had neglected to consider the various prospects that the change introduced. Promoting Looking for paper on brain research? How about we check whether we can support you! Get your first paper with 15% OFF Learn More In my visual impairment, I had decided to stay away from the change and neglected to perceive the entrancing additional opportunities. Starting here on, I took up a progressively uplifting viewpoint and really anticipated the move. On getting to New Mexico, I found that while everything was not as pleasant as my c ompanion had proposed, the spot was really charming and the network was not that not the same as the one in my past neighborhood. Because of the way that I had prepared myself for the change, I ignored the negative parts of my new old neighborhood and because of my good faith and cheerful moods, the change ended up being one of the most critical ones throughout my life. From my experience, I discovered that occasionally the adjustments in our lives are impartial and it is our recognition that makes them either a delight to be anticipated or an agony to be disregarded. I likewise discovered that our feelings of trepidation of progress by and large spring from unwarranted suspicions and our own preferences. Thusly, it is significant for us to receive a receptive and idealistic standpoint as we experience the various changes that life presents to us. By doing this, we will be expanding our odds of driving a fantastic and satisfying life. This article on Changes in Life: Positive and Negative Effects was composed and put together by client Jamar Leonard to help you with your own investigations. You are allowed to utilize it for research and reference purposes so as to compose your own paper; be that as it may, you should refer to it in like manner. You can give your paper here.

Ethical Computing Guidelines free essay sample

The five best core values incorporate to consistently act with trustworthiness, as respectability is a significant fixing to a sound business, observe the law consistently, as organizing an organization to be well behaved is vital to keeping up the drawn out strength of the organization, be straightforward and reasonable, as genuineness and decency are priceless to acquiring trust from clients, uncover and report all data honestly without control or deception, as dishonestly revealing discoveries of examinations can prompt more awful issues of control not far off, and to regard and support decent variety and never oppress anybody, as assorted variety is an essential incentive for a solid society. (Duke) B) Are networking letters fortunate or unfortunate? Is it accurate to say that they are illicit? Sum up the restricting contentions you find. Networking letters are awful and frequently illicit on the off chance that they demand cash or different things of significant worth and guaran tee a considerable come back to the members. A run of the mill networking letter shows up in the beneficiaries post box with a rundown of names and addresses. The beneficiary of the junk letter is told to send a specific measure of cash, frequently $5, to the name and address at the highest priority on the rundown, expel that individual from the highest priority on the rundown and spot the beneficiaries own name at the base of the rundown. The beneficiary at that point is told to send duplicates of the letter to others with the guarantee, expecting each and every individual who gets the letter takes an interest, the beneficiary will move to the highest priority on the rundown and get a generous measure of money. Junk letters are betting and abuse Title 18, United States Code, Section 1302, the Postal Lottery Statute. The contradicting contention, most likely shaped from the originators of junk letters, is that networking letters speak to free venture and a type of network sharing of assets. They would contend that mailing letters and a modest quantity of cash in the desire for getting a generous return is innocuous and ought to in no way, shape or form be unlawful. In any case, junk letters are unlawful, and whats more are a terrible speculation, to be specific since you are probably not going to get an arrival on your venture. Junk letters are fruitful under the presumption of everybody taking an interest. In the event that somebody in the chain doesn't partake, you won't get an arrival on your venture. The U. S. Postal Service advices beneficiaries of junk letters to restore the letter to the Post Office with a note on the networking letters envelope demonstrating it might be unlawful. (Valentine) C) How does unknown email work and for what reason would you use it? Mysterious email works through a framework empowering an email client the capacity to send email througha outsider, consequently veiling their character from the beneficiary of the email. Unknown email additionally shrouds the email senders email address, the time stamp demonstrating the time the message was sent, and the message way from sender to collector. A valid justification to utilize mysterious email is stay unknown, anyway a typical motivation to utilize unknown email is exploitative message sending. A programmer may utilize mysterious email with bogus contact data to tempt the beneficiary to send individual data in answer, for example, ledger numbers. Mysterious messages use PC infections to acquire individual data, for example, these ledger numbers, or standardized savings numbers. Mysterious email works by the sender of these messages making bogus cases and distorting their actual character, causing the beneficiary to accept they are getting the email from a believed source mentioning this individual data. (Janssen) D) What are five different ways email use can be exploitative? Untrustworthy business email use incorporates spamming, and inside spamming there are different deceptive methods of utilizing email. Mass email sent aimlessly to thousands or even a huge number of individuals is exploitative. An email containing a chance to pursue something, be it a membership to a magazine or some other sort of administration, without a substantial quit condition is additionally untrustworthy. A typical an exceptionally untrustworthy utilization of email includes the utilization of web bugs or undesirable following treats that the collector of the email unconsciously surrenders himself to once he opens the email. The utilization of reapers, extraordinary robots intended to assemble email addresses from sites is an exceptionally untrustworthy utilization of email. At last, email use without substantial email header data is additionally exploitative. Email header data demonstrates to the collector of the email who is sending it. Sending it with bogus email header data is dishonest. (Rainoff) E) Why is the intentional spreading of infections dishonest? Name in any event five reasons. The purposeful spreading of PC infections is illicit, in this manner it is likewise deceptive. Second, PC infections are viral in nature, which means they spread out of hand by their very nature, putting different frameworks in danger. Third, purposely spreading PC infections obliterates the endeavors of people and organizations, wrecking unsalvageable data once the PC infection accesses the information and data. The purposeful spreading of PC infections adds to a progressing fight between PC programmers who appreciate this deceptive action and purchasers, expanding the important expenses of security from infections through PC hostile to infection programs. Fifth explanation, the purposeful spreading of PC infections bargain significant information, from monetary information including financial balance information to national resistance information including delicate key data. (Webroot) Works Cited Duke, Mike. Walmart Statement of Ethics. September 2008. Site. 23 May 2013. lt;http://az301759. vo. msecnd. net/statementofethics/pdf/U. S_SOE. pdfgt;. Janssen, Cory. techopedia. 2010-2013. Site. 23 May 2013. lt;www. techopedia. com/definition/15052/unknown emailgt;. Rainoff, Mathew J. SpanRejection. com. 2000-2013. Webs ite page. 23 May 2013. lt;http://www. spamrejection. com/whatisspam. htmgt;. Valentine, Qiana. U. S. Postal Inspection Service. 2012. Site. 23 May 2013. lt;https://postalinspectors. uspis. gov/examinations/MailFraud/fraudschemes/sweepstakesfraud/ChainLetters. aspxgt;. Webroot. 2004-2013. 28 May 2013. lt;http://www. webroot. com/En_US/shopper/articles/PC security-dangers PC virusesgt;.

Determining What Makes A Career Criminal essays

Figuring out What Makes A Career Criminal articles Figuring out What Makes A Career Criminal The vocation criminal, or, all the more distinctly, those people who partake in criminal follows up all the time for both a focal and steady wellspring of salary has, by and large, a particular arrangement of distinguishing factors which, while indisputable in laymen's terms, neglect to meet the measures fundamental for logical request. While definitions exist with respect to what a profession criminal is, the examination techniques utilized in deciding these definitions are an enormous purpose of dispute for criminal equity scholars, particularly because of their latent capacity and for all intents and purposes up and coming consideration to present day speculation regarding the matter. These examination techniques incorporate longitudinal information assortment and aggregation, cross-sectional information assortment and arrangement, and, as in any event one gathering of scholars contend, the most effective strategy, useful talking. The longitudinal research strategy utilizes an information assortment method which centers around the span of a specific actin this case, the alleged criminal careerbased not upon explicit episodes, yet the period of time estimated between such acts (Blumstein, Cohen, and Farrington, 1988). That is, a person's inclination for criminal lead in a supposed profession mode would be estimated first by the first go about as a beginning, at that point with the succeeding demonstrations, until a last point got obvious. In this way, such an exploration strategy would sensibly reason that a person who performed or took an interest in criminal direct on two events quite a while separated would be viewed as a lifelong crook. It is hence, that criminal equity scholars contrast with respect to the materialness and importance of the longitudinal research technique (Blumstein, Cohen, and Farrington, 1988). Since the longitudinal research technique could translate two independentor even two interdependantcriminal goes about as the basic make-up of a lifelong lawbreaker, scholars may speculate mistakenly as to ... <!

Why I Took A Gap Year

Why I Took A Gap Year For most of high school, the US was just a vague blip on the radar of my imagination. My friends and I sometimes imagined what the experience of studying in the US would be like, but we spoke in the offhanded, dreamy tone people usually use to describe things like “winning the lottery” or “running for president”. I had read one of the MIT blogs once, stumbling onto Anna’s post, “Being Qualified for MIT”, but only with distant fascination, fascination because it was such good writing and MIT seemed like such an amazing place, distant because I didn’t seriously think that I could attend a university whose site I had stumbled onto from a friend’s Google search of “World’s Best Universities.” And then one morning, towards the end of the first trimester of high school senior year, I was sitting in the library, studying for a Geography exam when someone ran up to me and said I had a package awaiting me in the secretary’s office. I rarely received packages of any sort, so I was pretty curious. Not being a cat, I ran quickly to the office and seconds later, was tearing off DHL-branded tape from what appeared to be a thick file. The file was from the University of Pennsylvania, and inside I found several brochures, and a letter. The contents of the letter went along the lines of, “You seem like a pretty motivated student; you just might be the kind of student we’re looking for! We encourage you to seriously consider applying to Penn.” It was the first time I had heard of Penn, and my mind hadn’t yet been cultured to the term “Ivy League” or anything of that sort. I knew nothing about the US admissions process, and hadn’t been searching, but the idea that a college thousands of miles away would send me mail of this heartwarming sort was unbelievable. I called my parents and more or less ranted about it. I was given rare access to the internet to find out more about Penn. I checked out the university’s website and Wikipedia page. I found CollegeConfidential links to angst-filled posts covering the spectrum of Penn from its prestige to its exclusivity. I did try to think of why they had contacted me. I had taken the SAT nearly a year ago, but that had been routine process for my high school (which was partly owned by the Turkish Government), and only because a bunch of Turkish universities required the SAT. There had also been the AMC and AIME, which I think may have contained some random clause about sharing scores with universities and scholarship organizations. Regardless of the reason, I was glad some university out there seemed interested in me. Deadline was already fast approaching, so I hastily worked on my Common Application, and sent it to Penn within days of their mail. I also sent in my SAT scores and registered for the SAT Subject Tests. I could barely wait the three months to find out the status of my application. In that time, I joined CollegeConfidential, and began to read more about Penn. I found old admit and reject threads and, for the first time since receiving the package, was daunted. My SAT score from 11th grade had been 2080. It was possibly the reason Penn had contacted me, and I was pretty fine with it. But then there were all these amazing scores…2350…2390…even perfect scores…getting rejected or waitlisted. And CollegeConfidential was full of pages upon pages of these drab stories, rejected applicants whose achievements transcended some exam to cover a host of truly amazing feats. It was my first real introduction to the holistic mechanism of the US admissions process, and it created a whirlpool of uncertainty. Did Penn make a mistake? Did Penn really send me that package? It was all I could do to balance my sanity between the fear precipitated by the high scores on the reject threads, and the glimmer of hope induced by the relatively lower scores on some parts of the admit threads. I went back to my application, and with some clarity of mind I must have gained in the past couple of weeks, cringed at some of my essays. To one of them asking why I wanted to be at Penn, I had started thus: “I am one of several applicants aspiring to become a member of the prestigious UniPenn (!). To begin, I feel like the resources the university has to offer are unparalleled relative to anything I’ve seen before…” Was this enough? Would this be enough? It was a little while before Penn’s decision date when the results for the AMC12   contest were released, and I saw that I had placed at the 99th percentile worldwide, and had qualified to the AIME. I was pretty excited, and after a while, in a realm of elation separate from mere joy at this achievement, I realized that the news could also “boost my chances”. Excitedly, I sent an e-mail to one of the admissions officers that had contacted me some weeks back, informing him of the news. He replied a few days later, saying that it would be considered with the rest of my application. Awesome! March 29th, 2012 was a Thursday. Penn’s decision was hours away. The anxiety, the pure, crazy anxiety permeating the pages of CollegeConfidential was this charged cloud you could feel poking your sides. I was tense; I was crazy. I played the “will they-won’t they” game in my mind. I posted like crazy on CC, asking one of the common “What are my chances” post. Some said I had a decent shot but it was hard to tell. Others said everyone had a low shot. A few were highly cynical of the post itself. All these really just combined to feed the worry. My friends were around me, and they had nothing but positive comments: “You’ll get in; it’s you!” and “They’ll be crazy to reject you!” I didn’t know what to think, but the closer the decisions came, the more encouraging my friends got, and from their words, a real glimmer of hope emerged. You do have a chance, I told myself. Penn encouraged you to apply! A while later, I was somehow standing beside my vice-principal while he logged onto Penn’s website. Drums banged in my chest and throat. Three close friends crowded behind me. I typed in my initials, my hands so shaky it took two tries to get the password right. And text suddenly appeared, text that read: “Dear Vincent, After careful review of your application, we are unfortunately unable to offer you admission into Penn’s class of 2016…” My heart calmed. My body went very still. A friend behind me groaned and flung his books. I rose and said in a falsely nonchalant voice, “Well, I tried.” My friends mumbled words I didn’t really hear. I walked out of the office and sadness overwhelmed me. *** The week following Penn’s rejection was long and slow. I was moody. Classes seemed to trudge. I realized that for the past four months, regardless of my fears regarding the Penn outcome, I had absentmindedly imagined myself as a student there, a Penn Quaker, soaking sun in the quad and screaming cheers in the Franklin Field. It didn’t seem fair. It didn’t seem right. In the weeks that progressed however, what was left of school took over my mind. Writing stories took over my mind. Olympiad classes took over my mind. Penn faded. *** I finally convinced myself that I’d been indulging in wishful thinking by imagining that I could study in the US. I decided to face my local exams and gain admission into an awesome Nigerian university. Admission into a Nigerian university is different and purely quantitative, depending on a combination of three necessary componentsâ€"an exam called WAEC, taken by most West African High school students, a localized examination called JAMB and the concerned university’s own examination (usually called post-JAMB). Due to great restriction on the number of Nigerian universities I could send my JAMB scores to, and a number of post-JAMB conflicts, I only really had one Nigerian university I could apply to, which of course depended on me passing its post-JAMB. So imagine my shock when, at a hotel in Amsterdam for the International Math Olympiad 2012, I decided to check the post-JAMB schedule and saw something quite interesting: the exam was set to take place in about five days. It was the beginning of IMO, and there was clearly no way I’d make it back to Nigeria in time. I spoke to my mom in distress about this, but in the sweet, soothing tone that parents often use, she assured me that I’d be fine. *** Just shortly before graduation, my high school had held an annual Nigerian-Turkish cultural event. Activities bloomed throughout the day, with tasty food on standby for the hungry or tired. My mom came for the event, which was nice since I attended a pretty secluded boarding high school, and rarely got the chance to see her. Towards the end of the day, she made a friend called Mrs. Jimoke. As they chatted about the school, my mom told Mrs. Jimoke about most of the academic things I’d been up to, including taking the SAT. Mrs. Jimoke insisted that I reconsider applying to US universities, and gave my mom the contact information of one of her friendsâ€"Shade Adebayoâ€"who worked in an educational sector of the United States Embassy. So after I missed my post-JAMB and after it became clear that I would have to wait at least a few months before I could apply anywhere else, Shade insisted that I apply to US universities. At first I was reluctant, but I realized that a world of possibilities did exist out there, and even if Penn hadn’t accepted me, I could probably find some other institution that would. Shade, energetically, vehemently, believed so. I consciously avoided considering extremely selective colleges, and did as much research as I could on the others. Since I was so far away, campus tours and admission information sessions were out of the question. I toured CC, read up several college-related books Shade let me borrow from the US Embassy. I went through websites and Wikipedia pages and more detailed places like Unigo. And I came upon UW-Madison. It had a strong engineering program and a campus that seemed to pulse with unique life. As I became more and more entrenched in UW-Madison, reading up its online newspapers, poring over CC threads, I realized an important difference in the way I was attached to UW-Madison and the way I had been attached to Penn. My obsession with Penn had stemmed from both the strange joy of being reached out to and the beauty of the idea that I could be an undergraduate there. I was overwhelmed by the sense of prestige it possessed and some awareness that it had amazing resources I felt I cou ld only find in few other places. I merely had a general sense of what Penn could be for me, a generality that translated into my barely specific essays. But getting to consciously choose to apply to UW-Madison, I did so on the heels of a more developed sense of what the university and its culture were about. I applied for the Spring 2013 term and was accepted. I was speechless with joy when I saw the letter of acceptance. My parents were jubilant. But of course, there was a problem. *** UW-Madison did not offer aid to international students, and my parents would have to pay just a little over forty thousand dollars per year. They assured me that it wouldn’t be a problem, but my mom did wonder if I wanted to apply anywhere else. I was somewhat vehement about my choice of UW-Madison, having grown deeply attached to it, and she assured me that as long as I was sure, it was fine. I spoke to Shade afterward. She told me something my mom had confided in her. My parents were willing to pay forty thousand dollars, but it was really money they didn’t have. They had begun contemplating possible assets they could sell to fork up some of the money, and the only reason they hadn’t divulged this to me had been a result of my endless excitement with the acceptance news. Shade told me that it would be worth it, absolutely worth it, if I could let UW-Madison go in favor of some university, any other university, that wouldn’t cost as much. Later that night, I sat alone in my room and thought of my parents’ willingness to sacrifice that much for my happiness. I thought of how my educational future, once bright and limitless, now seemed and felt infinitely more constrained. I was overwhelmed by weariness and a strange sense of loss. And so I sat on my bed and cried. I cried for a while, and my mom slipped into my room while I lay hunched over, just feeling deflated. She held me really close. She told me things would be alright. She told me that I would end up where I wanted and needed to be, and that she would walk to the ends of the Earth to secure my happiness. I believed her, every word. I held her closer. The next day, I declined UW-Madison’s offer of acceptance. *** And that’s the bulk of it. That’s why I took a gap year. I applied for the fall term to US universities. I meticulously compiled a small list, considering two important personal factorsâ€"cost and culture. Culture in the sense of its people, culture in the sense of energy, culture in the sense of challenge. I had spent most of high school taking extracurricular olympiad classes that pushed me to work late hours at night. I had felt most ingrained in the learning process when I raced with those challenges constantly, and especially with my classmates. I wanted an environment like that. I wanted an atmosphere built on merit and challenge and collaboration, one that could let me push myself, because I understood I could thrive there.   I also needed a place I could afford. I took the SAT for a second time, attaining a score of 2390. I wrote more, feverishly, stories and novellas and ultimately a novel. I spent that year primarily outside of classes, although I did do a few things   like teaching and attempting to burn down the kitchen cook. I grew closer to my family. I grew closer to myself. More clearly than ever, I began understanding what I wanted. Princeton accepted me Early Action. Harvard rejected me. MIT accepted me on Pi Day, and I will never forget ten words that kept sinking into my mind when I saw that letter of acceptance: We think that you and MIT are a great match. I will never forget the sheer look of joy on my parents’ face when they saw the letter of acceptance and the immensely generous financial aid offer that had come with it. I will never forget them enclosing me, the world vanishing, for that moment of intimacy to take over, a moment that told me in no uncertain terms that things were fine. Things were good. *** I’m not really going to talk about CPW or about making the choice of college in this blog post, because that’s not really what it’s about. I’ll tell you what I hope this post is about. It’s about the frightening rollercoaster that the college application is. This process is merely more than just typing up words and hitting a ‘submit’ button. You’re sending away, with each application, a little investment of emotions, and a little bit of life that washes into some machinery and potentially shapes the next four years. Yes, the applications are important, and yes, it’s alright to be invested. If this is about where you will spend a good chunk of your life, I daresay it’s necessary to be invested. But at the same time, you’ll need to distance yourself from the process a bit. Care about it but not to the extent that it intricately wraps itself around your self-worth.   For colleges as deeply selective as MIT, there’s a lot out of your control, and regardless of what that letter you see on Pi Day says, it really won’t matter in the long run. If it’s a yes, congratulations. You’ve been given a great opportunity. MIT deeply believes in you. If it’s a no, that’s fine. It’s not a declaration of your worth; it’s not MIT saying that you don’t belong; it’s not a testament to some kind of skewed outlook your future will take. A long time ago, I did all the wrong things. I worried about the little details and applied without a true sense of what I was applying for. I tried to put greater meaning into “scores” and “stats” than they really held. I was obsessed with “getting in” to the point that it somehow became the center of my daily thoughts. And when r ejection did come, I was stunned and upset. I felt denied of some deserved right, when it was really more privilege than right. Genuinely care about the places you apply to, and if you do find that a certain college has no room for you at this point in time, then I’ll tell you what my mom told me: you will be fine. Penn’s rejection tore me down, but if I’d known then what I know now, not about where I would end up, but about how I can rise above a letter of rejection, I’d have handled it a whole lot better. And I do want you to know. With tenacity of will, the future will shape itself to suit you and your inner strength. Life delights in throwing stumbling blocks. But where wounds may be inflicted, scars heal and strength grows. *** Another thing I hope this post is about: time, people. The people that have been there with you from the get-go, the friends that you made in high school, the parents that have held you close and whispered assurances; they’ve forged themselves into your life before now, and they will for a long, long time. Every step of the way that led to MIT, for every rejection and acceptance and moment of uncertainty, I had friends and family who wiped away my tears when tears came and held me high when joy arrived. Time with the people we love is a truly beautiful gift. Consider the extent of the things they have done and could do, will do, for you, and learn to appreciate them every day. Life is much bigger than what will happen soon, more unpredictable than whatever signs that hang in your mind try to suggest. For now, try not to fret. Keep doing the things you love. Keep writing. Keep playing trombones. Keep making slam-dunks. Keep singing. Keep watching your favorite TV shows. Keep laughing. And keep the people you love close to you. I took a gap year out of necessity. At the time, it felt like the worst thing that could happen. It felt too long and the question of where I would end up seemed very subject to chance. But I kept living. I kept pushing forward. And somehow, I’m here right now, typing from a place that had once felt too large to be a dream. Whatever happens in the next couple of days, you will find that you do have the strength to keep living, that you will be where you need to be, and that you will thrive. Don’t overanalyze the steps leading to that point. Some things you just can’t predict. And even though it may not always feel like it, trust me. You’ll be fine. ***

Attempted Suicide - Health Dissertations - Free Essay Example

Investigation into nurse strategies to prevent or minimise attempted suicide in patients over 65 This dissertation considers the rationale for positive nurse-based intervention in consideration of issues relating to suicide in the elderly. The introduction sets the context, including the historical context, of the issues and discusses the negative effects of ageism on issues relating to suicide in the elderly. The literature review considers selected texts which have been chosen for their specific relevance to the issue and particularly those that espouse the view that ageism is counterproductive to a satisfactory quality of life outcome for the elderly person. Conclusions are drawn and discussed with specific emphasis on those measures that are of particular relevance to the nursing profession whether it is in a secondary care facility, a residential home setting or in the primary healthcare team and the community. Introduction We can observe, from a recent paper (O’Connell H et al. 2004), the comments that, although there is no doubt that the elderly present higher risk of completed suicide than any other age group, this fact receives comparatively little attention with factors such as media interest, medical research and public health measures being disproportionately focused on the younger age groups (Uncap her H et al.2000). Perhaps we should not be surprised at the fact that both suicidal feelings and thoughts of hopelessness have been considered part of the social context of growing old and becoming progressively less capable. This is not a phenomenon that is just confined to our society. We know that the Ancient Greeks tolerated these feelings in their society and actively condoned the option of assisted suicide if the person involved had come to the conclusion that they had no more useful role to play in society (Carrick P 2000). Society largely took the view that once an individual h ad reached old age they no longer had a purpose in life and would be better off dead. In a more modern context, we note the writings of Sigmund Freud who observed (while he was suffering from an incurable malignancy of the palate: It may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear. (cited in McClain et al. 2003) We would suggest that one of the explanations of this apparent phenomenon of comparative indifference to the plight of the elderly in this regard is due to the fact that the social burden of suicide is often referred to in purely economic terms, specifically relating tools of social contribution and loss of productivity. (Breeching A et al.2000). This purely economic assessment would have to observe that the young are much more likely to be in employment and less likely to be a burden on the economic status of the country whereas with the elderl y exactly the converse is likely to be true. This results in economic prominence being given to the death of a younger person in many reviews. (Adcock P,2003). There is also the fact that, despite the fact that we have already highlighted the increase in relative frequency of suicide in the elderly, because of the demographic distributions of the population in the UK, the absolute numbers of both attempted suicides and actual suicides are greater in the younger age ranges and therefore more readily apparent and obvious. The elderly are a particularly vulnerable group from the risk of suicide. In the industrialised world males over the age of 75 represent the single largest demographic group in terms of suicide attempts. Interestingly (and for reasons that we shall shortly discuss) although there is a general trend of increasing suicide rate with age the excess rates associated with the elderly are slowly declining in the recent past (Castell 2000). We can quantify this stateme nt by considering the statistics. If we consider the period 1983 to 1995 in the UK then we can show that: The suicide rates for men reduced by between 30% and 40% in the age groups 55–64, 65–74 and 75–84 The rates for the most elderly men (males over 85 years) remained fairly static, this group still having the highest rates of any group By way of contrast, the 25- to 34-year-old male group exhibited a 30%increase in suicide rate during the same period, this group are becoming the group with the second highest rate, while the 15- to24-year-old male group demonstrated a 55% increase in suicide rates.(WHO 2001) Female suicide rates have shown a similar overall decrease, reducing by between 45 and 60% in the 45–84 age group. Elderly women, however, retain the highest rates throughout the life span (Castell 2000) The ratio of male to female elderly suicide deaths remains approximately 3:1 (Fischer L R et al. 2003) We can suggest that thes e trends in reduction of suicide, particularly in the elderly are likely to be due, amongst other things, to: The improved detection of those at risk together with the advent of aggressive treatment policies relating to mental illness in the elderly. (Warn M et al. 2003) One of the main reasons, we would suggest, for this obviously changing pattern and the discrepancies in the suicide rates between the age ranges, is the fact that, in direct consideration of the context of our topic, the elderly are more likely to be both amenable to professional help and also, by virtue that a higher proportion are likely to be in direct contact with healthcare professionals either through failing health or nursing homes and hospitals, (Soutine K teal. 2003), have the warning signs of impending suicide recognised and acted upon more promptly than the younger, arguably more independent age group. In specific consideration of the elderly group we should also note that attempted suicide is mo re likely to be a failed suicide attempt rather than a Para suicide. (Rubenowitz E et al. 2001). There is considerable evidence that the incidence of depression is increased in the presence of a concurrent physical illness (Conwell Yet al. 2002) and clearly this is going to be more likely in the elderly age group. Some sources have cited association rates of between 60-70%of major depression with physical illness in the over 70yr olds.(Conwell Y et al. 2000). Another significant factor is that it is commonly accepted that an attempted suicide is a strong independent risk factor in the aetiology of further suicide attempts. (Conwell Y et al. 1996) This trend is much more marked in the elderly group with a ratio of about 4:1 which compares very badly with the ratios in the younger age groups of between 8:1 and 200:1 (depending on age range, definition and study).(Hippie J et al. 1997) Aims and objectives In this dissertation it is intended to gain evidence based knowledge of the scope and significance of the phenomenon of attempted suicide in the elderly. In addition it is intended to gain evidence based knowledge in the use of strategies to ameliorate attempted suicide in the elderly to highlight gaps in the literature available and to suggest recommendations for change in nursing practice It is hoped tube able to suggest areas for research into the phenomenon of attempted suicide in the elderly. Methodology The initial strategy was to undertake a library search at the local post graduate library and the local university library (Client: you might like to personalise this) on the key words â€Å"suicide, elderly, prevention strategies, industrialised societies†. This presented a great many papers. About 40 were selected and read to provide an overview of the literature in this area. During this phase, references were noted and followed up and key literary works were assimilated. The bulk of the papers accessed and read were published within the last decade, however a number of significant older references were also accessed if they had a specific bearing on a particular issue. The most significant references were accessed and digested. The dissertation was written referencing a selected sub-set of these works. Rationale for proposal To increase nurses knowledge and understanding of attempted suicide in the older age group and to highlight through the literature review, evidence based strategies that can be employed to ameliorate attempted suicide amongst the elderly. Literature review Before commencing the literature review, it is acknowledged that the literature on this subject is huge. The parameters of the initial search have been defined above. In addition it should be noted that there is a considerable literature on the subject of assisted suicide which has been specifically excluded from these considerations The literature base for suicide in the elderly is quite extensive and provides a good evidence base for understanding, appropriate action and treatment. (Berwick D 2005) One of the landmark papers in this area is by Hippie and Quinton(Hippie J et al. 1997) which provided a benchmark, not only on the aetiology of the subject, but also in the long term outcomes, which, in terms of potential nursing care input, is extremely important. The paper points to the fact that there is a good understanding of the absolute risk factors for suicide in the elderly but a comparative lack of good quality follow up studies in the area. It set out to identify100 cases of attempted suicide in the elderly and then follow them up over a period of years. The study was a retrospective examination of100 consecutive cases of attempted suicide that were referred to the psychiatric services over a four year period. The authors were able to make a detailed investigation (including an interview of many of the survivors), about four years later. Their findings have been widely quoted in the literature. Of particular relevance to our considerations here we note that they found that of the 100 cases identified, 42 were dead at the time of follow up. Of these, 12 were suspected suicides and five more had died as a result of complications of their initial attempt. There were 17further attempts at suicide in the remaining group. Significantly, the twelve women in the group all made non-lethal attempts whereas all five of the men made successful attempts. The authors were able to establish that the risk of further attempts at suicide (having made one attempt)was in excess of 5% per year and the â€Å"success† rate was 1.5% per year in this group. From this study we can also conclude that the risk of successful repeat attempted suicide is very much greater if the subjects male. The authors were also able to establish that, because of their initial attempt, those at risk of self-harm were likely to be in contact with the Psychiatric services and also suffering from persistent severe depression. We can examine the paper by Dennis (M et al. 2005) for a further insight into the risk factors that are identifiable in the at risk groups. This paper is not so detailed as the Hippie paper, but it differs in its construction as it is a control matched study which specifically considered the non-fatal self-harm scenario. The study compared two groups of age matched elderly people both groups had a history of depression but the active study group had, in addition, a history of self-harm. The significant differences highlighted by t his study were that those in the self-harm group were characterised by poorly integrated social network and had a significantly more hopeless ideation. This clearly has implications for intervention as, in the context of a care home or warden assisted setting, there is scope for improving the social integration of the isolated elderly, and in the domestic setting community support can provide a number of options to remove factors that mitigate towards social isolation. This would appear to be a positive step towards reducing the risk of further self harm. The O’Connell paper (O’Connell et al. 2004) is effectively a tour divorce on the pertinent issues. It is a review paper that cherry-picks the important information from other, quite disparate, studies and combines them into a coherent whole. It is extremely well written, very detailed, quite long and extremely informative. While it is not appropriate to consider the paper in its entirety, there are a number of f actors that are directly relevant to our considerations here and weshall restrict our comments to this aspect of the paper. In terms of the identification of the risk factors associated with attempted suicide in the elderly, it highlights psychiatric illnesses, most notably depression, and certain personality traits, together with physical factors which include neurological illnesses and malignancies. The social risk factors identified in the Dennis paper are expanded to include â€Å"social isolation, being divorced, widowed, or long term single†. The authors point to the fact that many of the papers referred to tend to treat the fact of suicide in reductionist terms, analysing it to its basic fundamentals. They suggest that the actual burden of suicide should also be considered in more human terms with consideration of the consequences for the family and community being understood and assessed. (Mason T et al. 2003) In terms of nursing intervention for suicide prev ention, we note that the authors express the hypothesis that sociality exists along a continuum from suicidal ideation, through attempted suicide, to completed suicide. It follows from this that a nurse, picking up the possibility of suicidal ideation, should consider and act on this as significant warning sign of possible impending action on the part of the patient. The authors point to the fact that the estimation of the actual significance of the various prevalence’s of suicide varies depending on the study (and therefore the definition) (Kirby M et al. 1997). In this context we should note that the findings do not support the ageist assumptions expounded earlier, on the grounds that the prevalence of either hopelessness or suicidal ideation in the elderly is reported asap to 17% (Kirby M et al. 1997), and there was a universal association with psychiatric illness, especially depressive illness. If we consider the prevalence of suicidal feelings in those elderly peop le who have no evidence of mental disorder, then it is as low as4%. It therefore seems clear that hopelessness and sociality are not the natural and understandable consequences of the ageing process as Freud and others would have us believe. This has obvious repercussions as far as nursing (and other healthcare) professionals are concerned, as it appears to be clearly inappropriate to assume that sociality is, in most cases, anything other than one of many manifestations of mental illness. It also follows from this, and this again has distinct nursing implications, that suicidal ideation and intent is only the tip of the iceberg when one considers the weight of psychological, physical and social health problems for the older person. (Warn M et al. 2002) If one considers evidence from studies that involve psychological autopsies, there is further evidence that psychopathology is involved. Depressive disorders were found in 95% in one study. (Duberstein P R teal. 1994) Psychotic di sorders and anxiety states were found to be poorly correlated with suicidal completion. Further evidence for this viewpoint comes from the only study to date which is a prospective cohort study in which completed suicide was the outcome measure. (Ross R K et al. 1990). This shows that the most reliable predictor of suicide was the self-rated severity of depressive symptoms. This particular study showed that those clients with the highest ratings were 23 times more likely to die as the result of suicide than those with the lowest ratings. It also noted that other independent risk factors (although not as strong), were drinking more than 3 units of alcohol per day and sleeping more than 9 hours a night. One further relevant point that comes from the O’Connell paper is the fact that expression of suicidal intent should never be taken lightly in the older age group. The authors cite evidence to show that this has a completely different pattern in the elderly when compared t ithe younger age groups. (Beauties A L 2002). The figures quoted show that if an elderly person undertakes a suicide attempt they are very much more likely to be successful than a younger one. The ratio of Para suicides to completed suicides in the adolescent age range is 200:1, in the general population it is between 8:1 and33:1 and in the elderly it is about 4:1. (Warn M et al. 2003). It follows that suicidal behaviour in the elderly carries a much higher degree of intent. This finding correlates with other findings of preferential methods of suicide in the elderly that have a much higher degree of lethality such as firearms and the use of hanging. (Jorum A Feet al. 1995). The paper by Cornwell (Y et al. 2001) considers preventative measures that can be put in place and suggests that independent risk factors commonly associated with suicide in the elderly can be expanded to include psychiatric and physical illnesses, functional impairment, personality traits of neuroticism a nd low openness to experience, and social isolation. And of these, t is affective illness that has the strongest correlation with suicide attempts. We have discussed(elsewhere) the correlation between impending suicide and contact with the primary care providers. Cornwell cites the fact that 70% of elderly suicides have seen a member of the primary healthcare team within 30days of their death and therefore proposes that the primary healthcare setting is an important venue for screening and intervention. It is suggested that mood disorders are commonplace in primary healthcare practice but, because they are comparatively common, are underdiagnosed and often inadequately treated (ageism again). The authors suggest that this fact alone points to the fact that one of the suicide prevention strategies that can be adopted by the primary healthcare team. they suggest that clinicians, whether they are medically qualified or nursing qualified, should be trained to identify this group a nd mobilise appropriate intervention accordingly. Obviously the community nurses can help in this regard as they are ideally placed to maximise their contact with vulnerable and high risk groups. We have identified the role of a major depressive illness in the aetiology of suicide in the elderly. Bruce (M L et al. 2002) considered the role of both reactive and idiopathic major depression in the population of the elderly in a nursing home setting. This has particular relevance to our considerations as firstly, on an intuitive level, one can possibly empathise with the reactive depressive elements of the elderly person finding themselves without independence in a residential or nursing home and secondly, this is perhaps the prime setting where the nurse is optimally placed to monitor the mood another risk factors of the patient and continual close quarters. The salient facts that we can take from this study are that there was substantial burden of major depressive symptomatology in this study group (13.5%). The majority (84%) were experiencing their first major depressive episode and therefore were at greatest risk of suicide. The depression was associated with comorbidity in the majority of cases including â€Å"medical morbidity, instrumental activities of daily living disability, reported pain, and a past history of depression but not with cognitive function or socio demographic factors.† All of these positive associations which could have been recognised as significant risk factors of suicide in the elderly. Significantly, in this study, only 22% of all of the seriously depressed patients were receiving antidepressant therapy and none were receiving any sort of psychotherapy. In addition to this the authors point to the fact that 31% of the patients who were put on antidepressants were taking a sub therapeutic dose (18% because they were purposely not complying with the dosage instructions). The conclusions that the authors were able to dr aw from this study were that major depression in the elderly was twice as common in the residential setting as opposed to those elderly patients still in the community. The majority of these depressed patients were effectively left untreated and therefore at significant risk of suicide. There was the obvious conclusion that a great deal more could be done for this study population in terms of relieving their social isolation and depressive illnesses. And, by extrapolation, for their risk of suicide. Ethical considerations. In consideration of the issue of suicide in the elderly we note that there are a number of ethical considerations but these are primarily in the field of assisted suicide which we have specifically excluded from this study. (Pabst Batten, M 1996) Evidence for positive nursing interventions Having established the evidence base in the literature that defines the risk factors that are known to be particularly associated with suicide in the elderly, we take it as read that this will form part of the knowledge base for the nurse to be alert to, and to identify those patients who are at particular risk of suicide. It is equally important to be aware of those factors that appear to confer a degree of protection against suicide. This will clearly also help to inform strategies of intervention for the nurse. Studies such as that by Gunnel (D et al. 1994) point to the fact that religiosity and life satisfaction were independent protective factors against suicidal ideation, and this factor was particularly noted in another study involving the terminally ill elderly where the authors noted that higher degrees of spiritual well-being and life satisfaction scores both independently predicted lower suicidal feelings. (McClain et al. 2003). The presence of a spouse or signific ant friend is a major protective factor against suicide. Although clearly it may not be an appropriate intervention for nursing care to facilitate the presence of a spouse(!) it may well be appropriate, particularly in residential settings, to facilitate social interactions and the setting up of possible friendships within that setting (Bertolote J M et al. 2003) Conclusions and discussion This Dissertation has considered the rationale behind the evidence base for nursing intervention and strategies to prevent or minimise suicide attempts in the elderly age group. We have outlined the literature which is directed at identification of the greatest â€Å"at risk† groups and this highlights the importance of the detection and treatment ofboth psychiatric disorders (especially major depression), and physical disorders (especially Diabetes Mellitus and gastric ulceration).(Thomas A J et al. 2004) Although we have been at pains to point out the relatively high and disproportionate incidence of suicide in the elderly, we should not lose sight of the fact that it is not a common event. One should not take the comments and evidence presented in this dissertation as being of sufficient severity to merit screening the entire elderly population. (Erlangen A et al. 2003) The thrust of the findings in this dissertation are that the screening should be entirely opportunis tic. The evidence base that we have defined should be utilised to identify those who are in high risk groups, for example, those with overt depressive illnesses, significant psychological and social factors, especially those who have a history of previous attempted suicide. The healthcare professional should not necessarily expect the elderly person to volunteer such information and if the person concerned is naturally withdrawn or reserved, minor degrees of depressive symptoms may not be immediately obvious. (Callahan C M teal. 1996). In terms of direct nursing intervention, this must translate into the need to be aware of such eventualities and the need to enquire directly about them. The nurse should also be aware that the presence of suicidal feelings in a patient with any degree of depression is associated with a lower response rate to treatment and also an increase in the need for augmentation strategies. The nurse should also be aware of the fact that these factors may indicate the need for secondary referral. (Gunnel D et al. 1994). If we accept the findings of Conwell (Y et al. 1991), then the estimated population at risk from significant mood disorder and therefore the possibility of attempted suicide in the elderly, is 74%.This can be extrapolated to suggest that if mood disorders were eliminated from the population then 74% of suicides would be prevented in the elderly age group. Clearly this is a theoretical viewpoint and has to be weighed against the facts that firstly â€Å"elimination† of mood disorders (even if it were possible), would only be achieved by treatment of all existing cases as well as prevention of new cases, and the secondary prevention of sub-clinical cases. We know, from other work, that the detection and treatment of depression in all age ranges is low, and even so only 52% of cases that reach medical attention make a significant response to treatment(Bertolote J M et al. 2003). These statistics reflect find ings from the whole population and the detection rates and response rates are likelyto lower in the elderly. (Wei F et al. 2003). It follows that although treatment of depressive illness is still the mainstay of treatment intervention as far as suicide prevention is concerned, preventative measures and vigilance at an individual level are also essential. Nursing interventions can include measures aimed at improving physical and emotional health together with improved social integration. Sometimes modification of lifestyle can also promote successful ageing and lead to an overall decrease in the likelihood of suicidal feelings. (Fischer L R et al. 2003) On a population level, public health measures designed to promote social contact, support where necessary, and integration into the community are likely to help reduce the incidence of suicide in the elderly, particularly if we consider the study by Cornwell (Y et al.1991) which estimated the independent risk factor for low leve ls of social contact in the elderly population as being 27%. Some communities have provided telephone lines and this has been associated with significant reduction in the completed suicide in the elderly (Fischer R et al. 2003) To return to specific nursing interventions, one can also suggest measures aimed at reducing access to, or availability of the means for suicide such as restricting access to over the counter medicines.(Slog I et al. 1996), Some sources (Castell H 2000) point to the possibility of introducing opportunistic screening in the primary healthcare setting. The rationale behind this suggestion is the realisation that there is high level of contact between the suicidal elderly person and their primary healthcare team in the week before suicide (20-50%) and in the month before suicide (40-70% make contact). This is particularly appropriate to our considerations here because of the progressively increasing significance of the role of the nurse within the primary healthcare team particularly at the first point of contact. (Houston, Ret al. 2002) The evidence base for this point of view is strengthened by reference to the landmark Gotland study (Ruts W et al. 1989) which examined the effect of specific training in suicide awareness and prevention in the primary healthcare team by providing extensive suicide awareness training and measures to increase the facilitation of opportunistic screening of the population. Prior to the intervention, the authors noted that, when compared to young adults, the elderly were only 6% as likely to be asked about suicide and 20% as likely to be asked if they felt depressed and 25% as likely to be referred to mental health specialist. This balance was restored almost to normality after the intervention. Suicide in the elderly is a multifaceted and complex phenomenon. It appears to be the case that the elderly tend to be treated with different guidelines from the young suicidal patient insofar as the increa sed risk is not met with increased assistance. (Kouras L et al.2002). We have presented evidence that the factors included in this discrepancy may include the higher overall number of young suicides, the higher economic burden that society appears to carry for each young suicide together with ageist beliefs about the factors concerning suicide in the elderly. From the point of view of nursing intervention, both in a hospital and in a community setting, there should be greater emphasis placed on measures such as screening and prevention programmes targeted at the at-risk elderly. There is equally a need for aggressive intervention if depression or suicidal feelings are overtly expressed, particularly in the relevant subgroups where additional risk factors may be active, for example those with comorbid medical conditions or social isolation or recent bereavement. (Harwood D et al. 2001), Many of the elderly spend their last years in some form of sheltered accommodation, whether this is a nursing home, a hospital, warden assisted housing or being cared for by the family. (Haut B J et al.1999) In the vast majority of cases this is associated with a loss of independence, increasing frailty and an increasing predisposition to illness that comes with increasing age. (Juurlink D N et al. 2004).This loss of independence and increasing predisposition to illness is also associated with depressive illnesses of varying degrees. (Bruce ML et al. 2002). These patients are arguably, by a large, more likely to come into contact with the nurses in the community. (Munson M L 1999)The comments that we have made elsewhere relating to the nurse’s role in being aware of the implications for the depressed elderly patient are particularly appropriate in this demographic subgroup. As a general rule, it may be easier to keep a watchful eye on patients who are exhibiting early signs of depressive illness or mood disorder in this situation by making arrangements to visit o n a regular basis or on â€Å"significant anniversaries† such as the death of a spouse or a wedding anniversary. (Nagatomo I et al. 1998) when the risk factors for suicide increase dramatically (Schonberg H C et al. 1998) The literature in this area is quite extensive and covers many of the aspects of suicide in the elderly. It is noticeable however, that there is a great deal of literature on the subject of risk factors and associations of suicide together with plenty of papers which quote statistics that relate the various trends and incidences. There are, by comparison, only a few papers which emphasise and reflect on the positive aspects of nursing care. The positive steps that can be taken by the nursing profession specifically to help to minimise the burden of suicidal morbidity. There is clearly scope for studies in areas such as the impact that a dedicated community nurse might have on the levels of depression in the community if regular visits were timetabled. It is fair to observe that the community mental health nurses fulfil this role to a degree, but are severely hampered in most cases by sheer weight of numbers in the caseload. (Mason T et al. 2003) Having made these observations, we must conclude that there appears tube an overwhelming case for opportunistic screening of the at risk elderly at any point of contact with a healthcare professional. It is part of the professional remit of any nurse to disseminate their specific professional learning with others. (Yuri H et al. 1998). This can either be done on an informal professional basis in terms of mentorship or, if appropriate in a lecture or seminar situation.(Houston, R et al. 2002). There clearly is little merit in critically evaluating the literature and creating one’s own evidence base if it is not disseminated to one’s professional colleagues. (Hunt T 1994) Reflections John Dewey is generally credited with first propounding the concept of reflective thinking in the early part of the 20th century. He initially defined it as an â€Å"active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends.† (Dewey J1933). Over the passage of time this concept has been refined and expanded by a number of educationalists and thinkers such as Taylor(2000) who included the concept of not only considering the recall of memories of events, but also constructing plans and strategies so as to deal with similar situations, should they occur again, with the benefit of the reflective experience. Palmer points to this concept as being dynamic process which allows the healthcare professional to build personal knowledge base to enhance their practice and therefore grow in professional stature. (Palmer 2005) Other academics have defined the proces s further and in different directions. Boyd and False (1983) placed the emphasis on reflection as a learning experience rather than simply a process and Scion (1987), in the course of extensive writing on the subject sub-divided the opportunities for reflection into â€Å"reflection in action† and â€Å"reflection on action†, the former being the process whereby the healthcare professional adapts their professional practice whilst working and the latter is a process of quiet contemplation. It is this latter process that is being adopted here. It should be noted that the concept of reflection as being a useful adjunct to the learning cycle Gibbs, G (1988) is not universally accepted. James and Clarke (cited in Atkins, S. Murphy, K. 1993)suggest that asking some healthcare professional to engage in critical analysis of their practice may actually result in some practitioners not engaging at all. They point to the fact that some practitioners seem incapable of accu rate recall of a past situation indulging in what the authors call hindsight bias. This effectively means that the practitioner finds it difficult to consider the situation in any way other than that which compliments the already known outcome. (Goodmann,J. 1989). Quite clearly one must be prepared to take a completely dispassionate look at any given situation if any significant learning experience is to be gained from it. Reflection on the learning experience that writing this literature review has provided has proved to be very useful and educational experience. Prior to writing, I had clearly appreciated that the elderly had a greater tendency to appear to be depressed and in low mood. On reflection I believe that I may well have subscribed to the ageist ideas that have been outlined in the introduction of this piece and considered that the fate of feeling of little value to society together with the increased weight of probable morbidity, was part of the natural scheme of reaching old age, and was a reasonable intuitive explanation for feeling occasionally miserable or indeed becoming depressed when the person concerned reflected upon their own situation. I do not believe that I had actively considered this viewpoint before, but that I had come to an unchallenged appreciation of the situation from uncritical clinical experience. Having gone through the process of the literature assimilation prior tithe preparation of the review, I realised that this assimilation proved to be something of a catalyst and that the causes of depression in the elderly may well be to a degree, reactive. This does not necessarily mean that they are untreatable or modifiable. The comments made by a number of authors quoted (and others that have been read but not included in this piece), show that it is quite possible to take simple, but effective, steps to reduce social isolation and to help lift depression but the fact of the matter is that it needs to be clearly iden tified first. In real terms, I believe that this can be most effectively done by keeping the possibility firmly in mind when one is dealing with an elderly person and opportunistically screening for it, perhaps not formally, but certainly by asking relevant and probing questions in an empathetic manner. It is clear that depression in the elderly is a significant problem. It clearly has a much greater impact on the incidence of suicide in the elderly as a group than it does in the younger age ranges. I feel that the knowledge that I have gained in preparing and producing this review will help me to understand and empathise better with the situation that many of the elderly find themselves in. I hope that such an understanding will help to improve my professional behaviour in approaching the clinical problems surrounding the elderly patient. References Adcock P, 2003 Social policy in Britain, Macmillan 2003. Atkins, S. Murphy, K. 1993 Reflection: A Review of the Literature. Journal of Advanced Nursing. 18 (8), 1188-1192. Beauties A L. 2002 A case control study of suicide and attempted suicide in older adults. Suicide Life Threat Behave 2002 ; 32 : 1-9. Bertolote J M, Fleischmann A, De Leo D, Wasserman D. 2003 Suicide and mental disorders: do we know enough? Br J Psychiatry 2003 ; 183 : 382-3. Berwick D 2005 Broadening the view of evidence-based medicine Qual. Safe. Health Care, Oct 2005 ; 14 : 315 316. Boyd, E. False, A. 1983 Reflective Learning: Key to Learning from Experience. Journal of Humanistic Psychology 23 (2) , 99-117. Breeching A. Brown, H and Erbium (2000) Critical Practice in Health and Social Care Open University, Milton Keynes 2000 Bruce, M L., Gail J. Malay, Patrick J. Rouà ©, Ellen L. Brown, Barnett’s. Meyers, Denis J. Ethane, , David R. Pagoda, and Carol Weber 2002 M ajor Depression in Elderly Home Health Care Patients Am J Psychiatry 159 : 1367-1374, August 2002 Callahan C M, Hendry H C, Ninebark N A, Tierney W M. 1996 Suicidal ideation among primary care patients. J Am Geriatric Sock 1996 ; 44 : 1205-9. Carrick P 2000 Medical Ethics in the Ancient World Georgetown University press 2000 ISBN: 0878408495 Castell H 2000 Suicide in the elderly Advances in Psychiatric Treatment : 2000 (6) : 102-8 Conwell Y, Duberstein P R, Cox C, Hermann J H, Forbes N T, Caine E D. 1996 Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry 1996 ; 153 : 1001-8 Conwell Y, Olsen K, Caine E D, Flannery C. 1991 Suicide in later life: psychological autopsy findings. Into Psychogeriatric 1991 ; 3 : 59-66. 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Essay on The Relevance of Logic in Our Everyday Lives

BABCOCK UNIVERSITY ILISHAN-REMO OGUN STATE AN ASSIGNMENT SUBMITTED IN PARTIAL FULLFILLMENT OF THE COURSE PHILOSOHY AND LOGIC TOPIC: THE RELEVANCE OF LOGIC IN EVERYDAY LIFE. DEPT: BUSINESS ADMIN AND MARKETING COURSE: BUSINESS ADMIN MATRIC NO: 06/0388 SUBMITTED TO: MR FILADE SUBMITTED BY: FOLARIN ABISOLA 400LEVEL. TOPIC: THE RELEVANCE OF LOGIC IN OUR EVERYDAY LIFE WHAT IS LOGIC ALL ABOUT? Logic can be seen as the basic structure of reasoning. According to Karl Marx, he defined logic as the money of the mind. Also according to Steven layman he find logic as the basis method of evaluating arguments. Logic is a way of learning to think and communicate clearly and coherently. In daily living, clear and coherent communication is†¦show more content†¦Logic, is a deductive reasoning that results when the human brain calculates the most rational and acceptable outcome of any given situation and recognizes that answer as the most constructive, and consequently the most desirable. 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