Postpartum Stress Disorder Essay Example for Free

Postpartum Stress Disorder Essay The postpartum period has been defined as a bringing forth of the period following childbirth (Webster, 1988, p. 1055) or occurring after childbirth or after delivery, with reference to the mother (Doriand, 1988, p. 1343). In nursing or medical textbooks, the postpartum period is defined as the 6-week interval between the birth of the newborn and the return of the reproductive organs to their normal non-pregnant state (Wong Perry, 1998, p. 480). However, Tulman and Fawcetts (1991) found that the recovery of postpartum womens functional status from childbirth takes at least 3 to 6 months. Websters Dictionary defines stress concretely as a physical, mental, or emotional strain that disturbs ones normal bodily functions (Webster, 1997, p. 735). Stress is produced by stressors. Wheaton (1996) defines stressors as conditions of threat, demands, or structural constraints that, by the very fact of their occurrence or existence, call into question the operating integrity of the organism (p. 2). In addition, four characteristics of stressors are described: (1) threats, demands, or structural constraints; (2) a force challenging the integrity of the organism; (3) a problem that requires resolution; and, (4) identity relevant in threats in which the pressure exerted by the stressor, in part, derives its power from its potential to threaten or alter identities. Further, awareness of the damage potential of a stressor is not a necessary condition for that stressor having negative consequences; and a stressor can be defined bidirectional ly with respect to demand characteristics. That is, it is possible for both over-demand and under-demand to be stress problems (Wheaton, 1996). Accordingly, based on the above definitions of the postpartum period, stress, and stressors, postpartum stress is defined as a constraining force produced by postpartum stressors. Postpartum stressors are defined as conditions of change, demand, or structural constraint that, by the very fact of their occurrence or existence within six weeks after delivery, call into question the operating integrity of body changes, maternal role attainment, and social support. Due to its many adjustments, the postpartum period has been conceptualized as a time of vulnerability to stress for childbearing women (Too, 1997). Postpartum Period The postpartum period has been conceptualized by a variety of cultures as a time of vulnerability to stress for women (Hung and Chung, 2001). It is characterized by dramatic changes and requires mandatory adjustments that involve many difficulties and concerns, possibly leading to new demands, or structural constraints and, therefore, stress. All mothers face the multiple demands of adjusting to changes in the body, learning about the new infant, and getting support from significant others. For women going through this transition, it may be a uniquely stressful life experience. Several stressors specific to the puerperium as it exists in the literature have been identified. Those pertaining to body changes include: pain/discomfort, rest/sleep disturbances, diet, nutrition, physical restrictions, weight gain, return to prepregnancy physical shape, care of wounds, contraception, resuming sexual intercourse, discomfort of stitches, breast care, breast soreness, hemorrhoids, flabby subcutaneous tissue, and striae. Stressors pertaining to maternal role attainment include: concerns about infant crying, health, development, bathing, clothing, handling, diapering, night-time feeding, breastfeeding, conflicting expert advice, keeping the baby in an environment with a comfortable temperature, bottle feeding, appearance, safety, elimination, body weight, skin, babys sex, breathing, spitting up, sleeping, and cord care (Moran et al. , 1997; Too, 1997). Finally, those stressors pertaining to social support include: running the household, finances, perception of received emotional support, giving up work, finding time for personal interests and hobbies, fathers role with the baby, relationship with the husband, restriction of social life, relationship with children, and coordinating the demands of husband, housework, and children (Moran et al. , 1997). In addition, Hung and Chung (2001) shows that after childbirth women will encounter another type of stress during the postpartum period, which is characterized by dramatic changes and requires adjustment. Conditions of change, demand, or structural constraint may occur during these dramatic changes, creating many difficulties or concerns. Therefore, in addition to general stress, postpartum stress is induced after delivery during the postpartum period. Postpartum Stress Disorder Postpartum Stress Disorder (PSD) is the most serious, least common, and most highly publicized of the postpartum mood disorders: mothers with PSD have killed their infants and themselves. It is on the extreme end of the postpartum continuum of mood disorders (Nonacs, 2005) and attention to symptoms is vital for any postpartum support program. The treatment issues will not be fully discussed here because of their specialty and complexity. However, it remains a primary function of the service delivery to recognize symptoms and refer appropriately for specialized psychiatric care and management. A sensitive, direct question such as, Some women who have a new baby have thoughts such as wishing the baby were dead or about harming the baby; has this happened to you? (Wisner, et al. , 2003, p. 44), is an essential element of postpartum evaluation and Wisner and colleagues (2003) have suggested that this question be asked of all postpartum women. PSD is a rare, severe disorder with a prevalence of one to two cases per one thousand births (Seyfried Marcus, 2003). Symptoms are abrupt and often occur within 48 hours of delivery but can be delayed as long as two years (Rosenberg, et al, 2003). Typically, however, symptoms occur within the first three weeks, and two thirds appear within the first two weeks postpartum (Chaudron Pies, 2003). Symptoms include mood lability, distractibility, insomnia, abnormal or obsessive thoughts, impairment in functioning, delusions, hallucinations, feelings of guilt, bizarre behavior, feelings of persecution, jealousy, grandiosity, suicidal and homicidal ideation, self-neglect, and cognitive disorganization (Wisner et al. , 2003). Women with PSD who harbor thoughts of harming their infant are more likely to act on those thoughts (Wisner et al. , 2003). Because of the severity of the illness and significant concern for the safety of both the infant and the mother, PSD is considered a psychiatric emergency and hospitalization is necessary. Etiology of PSD There has been some debate about the etiology of PSD. As noted previously, the incidence is approximately one or two women per one thousand births. This rate has remained unchanged for that last 150 years (Wisner et al. , 2003). In cross-cultural studies the rates for PSD are similar to those reported in the United States and the United Kingdom. These findings suggest a primary etiologic relationship between PSD and childbirth, rather than psychosocial factors (Wisner et al. , 2003). OHara (1997) has noted that women are 20 to 30 times more likely to be hospitalized for PSD within thirty days after childbirth than at any other time during the life span, leading him to speculate, with little doubt, that for women there is a specific association between childbirth and PSD. There are subgroups of women who may be more likely to develop stressful symptoms after delivery. Primaparas appear to have a higher risk for c than multiparous women (Wisner et al. , 2003). This may be the result of an undiagnosed bipolar disorder. Women with a history of bipolar disorder or PSD have a 1 in 5 risk of hospitalization following childbirth (Seyfried Marcus, 2003). The overall pattern of symptoms described as PSD suggests the illness is on a continuum of bipolar mood disorders (Wisner et al. , 2003). The clinical presentation of PSD is often very similar to a manic episode (Seyfried Marcus, 2003). Affective disturbances may be depressive, manic, or mixed (Chaudron Pies, 2003). While there is no typical presentation, women often display delusions, hallucinations, and/or disorganized behavior. Delusional behavior often revolves around infants and children, and these women must be carefully assessed because thoughts of harming their children are sometimes acted upon (Chaudron Pies, 2003). The predominant affective symptom in those postpartum women who commit infanticide, filicide, or suicide is depression rather than mania (Chaudron Pies, 2003). In reviewing the connection between bipolarity and PSD several studies have shown evidence for a link in four areas: symptom presentation, diagnostic outcomes, family history, and recurrences in women with bipolar disorder (Chaudron Pies, 2003). The relationship to bipolar disorder is considered quite persuasive and it has been suggested that acute onset PPP be considered bipolar disorder until proven otherwise (Wisner et al. , 2003). However bipolarity does not account for all cases of PSD and a meticulous differential diagnosis is mandatory for those women with presenting stress symptoms. A careful checking of the patients history for previous manic or hypomanic episodes as well as any family history of bipolar disorder is important in order to rule out bipolar disorder. Organic causes contributing to first onset PSD need to be examined and ruled out. These include: tumors, sequelae to head injury, central nervous system infections, cerebral embolism, psychomotor seizures, hepatic disturbance, electrolyte imbalances, diabetic conditions, anoxia, and toxic exposures (Seyfried Marcus, 2003). Of special consideration in postpartum women is thyroiditis. This is relatively common in postpartum women and usually begins with a hyperthyroid phase progressing to hypothyroidism. In either phase PSD can occur (Wisner et al. , 2003). Obtaining serum calcium levels is important to rule out hypercalcemia for patients displaying PSD symptoms (Wisner et al. , 2003). Sleep loss resulting from the interaction of various causes may be a pathway to the development of PSD in susceptible women (Wisner et al. , 2003). The later stages of pregnancy and the early postpartum period are associated with high levels of sleep disturbance. This seems to be more prevalent in primiparous women than in multiparae. Historical and contemporary studies have noted that insomnia and sleep loss are significant and early symptoms of PSD. The rapid and abrupt changes of gonadal steroids after delivery and the evidence that estrogen has an effect on mood and the sleep-wake cycle (Wisner et al. , 2003) suggest an interaction between hormonal fluctuations, sleep loss, and the onset of PSD. Treatment of PSD PSD is a severe illness and should be considered a psychiatric emergency requiring hospitalization (Rosenberg et al. , 2003). The stigma attached to mental illness and especially to mothers who may harm their infants and themselves, often prevents women and their families from seeking help. PSD is often marked with periods of lucidity that can fool those close to the mother and health care professionals. Because of the complexity of the diagnosis and treatment, referral to a psychiatric specialist is required and formal treatment is beyond the scope of this program. However, it will be necessary to recognize symptoms and be cognizant of risk factors, such as history of bipolar disorder or previous PSD. Such awareness is essential, as is the readiness to offer support until adequate services can be implemented (Wisner et al. , 2003). Prevention of PSD is unclear, but early identification of a history of bipolar disorder and/or previous PSD would be an element of a comprehensive postpartum program. Prenatal education describing symptoms is an important aspect of a proactive approach to postpartum care. Part of the prenatal and postpartum educational effort will include urging women to share any bizarre thoughts and fears with their health care professionals and families. New mothers experiencing insomnia will be encouraged to seek assistance from their physicians and to engage other family members to care for the infant during nighttime feedings (Wisner et al. , 2003). As noted earlier, specific treatment is beyond the scope of this program, but a proactive approach to early identification and recognition of unusual thoughts, feelings, and experiences may help to initiate treatment and avoidance of tragic results. Conclusion During the postpartum period, women are immersed in the realities of parenting and coping with balancing their multiple roles (e. g. , wife, mother, and career woman). However, women frequently report difficulty in adjusting to the needs of the baby and other children, difficulty with housework and routines, concerns over support to cope with family needs, and concerns over weight gain and body changes. Accordingly, postpartum stress has an important role in a womans life and influences her health status, both physical and mental.

Ethics Of Pre Implantation Genetic Testing Philosophy Essay

Ethics Of Pre Implantation Genetic Testing Philosophy Essay Humanity revolves around procreation. We need to reproduce in order to produce future generations. In the past few years, science and medicine has gained an immense amount of knowledge about pregnancy and the underlying developmental stages of how it works. Furthermore, science is progressively improving, resulting in our ability to diagnose, manipulate and sometimes treat genetic abnormalities. Procedures such as the pre-implantation genetic diagnosis (PGD) were developed as a means to avoid selective abortions by detecting that the embryo is free of terrible lethal genetic diseases such as Huntingtons disease. However, recently PGD has been raising some ethical questions as people began using this technology for medically unrelated and unjustified reasons. Vanity and secondary motives of patients who use PGD for the creation of designer babies and savior siblings violates the fundamental principle of morality. Using PGD for reasons other than justified genetic testing is impermissi ble because it treats the potential baby as a means not as ends in itself; therefore, it violates Kants second categorical imperative. Scientific Background PGD works through a process of In Vitro Fertilization (IVF). In this procedure, multiple eggs are produced, retrieved from the ovaries and [manually] fertilized with the husbands sperm in a laboratory, outside of the female body3. As the embryos develop in vitro, embryo biopsy is performed by removing a single cell from each three day old embryo4. These cells are analyzed-by a variety of methods-for particular chromosomal or genetic abnormalities in order to distinguish which embryos are free of genetic disease. Normal, healthy embryos are then transferred into the uterus where they can grow and develop into a healthy child. Arguments Kant Immanuel Kant came up with a moral philosophy that was based on a theory of the Categorical Imperative. These are valid principles based off of the concept of duty that must be obeyed by all and are good in and of themselves. The second categorical imperative states that one should Act in such a way that you treat humanity, whether in your own person or in the person of any other, always at the same time as an end and never merely as a means to an end2. In other words, one has perfect duty to not use someone as a means to achieve a personal goal. This principle of rationality formulates the core of moral law and requirements that rational agents must follow. Furthermore, each rational being has autonomy, or a free will to define their own law. However, possession of autonomy by each being implies that all persons should be treated equally, with the same amount of respect and one cannot infringe on the others rational will. The intuitive essence of humanity, therefore, objects to usin g others as a mere tool because it overlooks ones integrity and humanness. So, one cannot assert a moral right to own a person-like a piece of property-because proprietary right over a person denies any existence of a free rational action; furthermore, it denies the person a right to be an end in themselves. But, humans have value and worth; hence, they require to be respected. Each person deserves to be respected for his/her integral being (of who they are). While PGD is performed on fetuses, its use is still unjustified because fetuses are potential persons and therefore, require the same amount of respect as any other person. Furthermore, the use of PGD in creating designer babies and savior siblings violates Kants second categorical imperative. Designer Babies A very compelling argument against PGD arises out of its questionable potential use in creating perfect designer babies. The technology behind PGD would allow parents to select specific and nonessential traits (such as eye color, height, athletic ability, even intelligence) that they want their child to express. Such technology is reminiscent of the Build-a-Bear Workshop but for grown-ups. Using PGD as a means for eugenics is fallacious and unjustified in many ways, such as its violation of the second categorical imperative. Parents have abused PGD use in order to have it cater to their individual conceited expectations of creating a perfect child. They vainly pick and chose the traits they find beneficial and get rid of ones they find unhealthy or unperfect so they could satisfy their goal of not having a financially and socially burdensome child. Not only is this wrong because it discriminates against the disabled but also because it violates the core value of humanity by infringing upon the childs autonomous will by treating him/her as a means to an inappropriate end. The parents social and economic ends are being pursued while the childs ends are being neglected. In designing a child, parents destruct the childs will (in a few different ways) therefore, they fail to treat them as an end in themselves. Physically, parents annihilate certain features their child would naturally possess (not to mention the obliteration of unwanted fetuses). By doing so, parents fail to treat the child humanely. Also, al tering mental abilities of a child is deceptive and confuses their will. Hence, it overlooks the rational ability of a-potential-rational agent and his/her end in himself/herself. Finally, parents restrict their childs will by altering their whole mental and physical being and not allowing them to pursue their individual goals as they see fit4. In order for the mental and physical humanity to be treated as an end, ones will must exist. However, when parents select traits for their child, they overlook their childs dignified and humane right to be how they were naturally meant to be. They use their child as a means to reach some vain, social or economical end, therefore, violating Kants second categorical imperative. Every human being is a rational agent (even the fetus which is a potential person) and has autonomy; therefore, one should not be treated as a means to an end. Because the use of PGD allows parents to use their children as a means to an unjustified end, its use is imperm issible. Savior Siblings Another issue with using PGD rises out of its unjustified creation of savior siblings. A savior sibling is a child created by tissue typing and help of PGD in hope of providing a perfect HLA-match for the seriously sick sibling in order to save his/her life. While the engineered child does not benefit or is harmed, the implications of such procedure are morally unethical. It objectifies the child, viewing him/her as a mere commodity, disregarding the childs humane right to equality. Treating such child as a tool to cure another violates an ethical principle of treating a person as an end in himself/herself (violates the second CI) because it uses the child as a means for which to treat the unhealthy older sibling. Such applications of PGD resemble slavery, where the savior child is a slave and the parent is a slave-owner. The parent would possess a right to own the slave child affirming the child as a commodity. But a child is not an object to have possession over; the child is a per son who requires respect and possesses an autonomous will to be an end in himself/herself. Therefore, creating a slave or savior sibling would violate the categorical imperative due to the demolishment of the childs free rational action. Thus, use of PGD for the creation of savior (slave) siblings is unjustified because it strongly violates Kants second categorical imperative. Furthermore, creation of savior siblings leads to other problems. In addition to being unethical, there is a strong belief that a childs profound identity would be impaired. They would be viewed as a secondary gain, a tool solely designed for the purpose of saving another life. This impaired will of the child would lead to countless psychological problems. The mental aspect of the childs humane nature would be compromised-the child would lack self-esteem and self-rescpect-as he/she would not be praised for his/her individual value but rather as a means to a particular end. Parents, by using PGD for instrumentalization of their children, would violate the childs autonomous will and individual personal value by using them as mere means to parental ends and limit[ing] a childs right to an open future4. In sum, PGD promotes unjustified creation of designer babies and savior siblings. The use of this technology allows parents to use their children (or potential children) as a means to satisfy their parental end; therefore, neglecting the childs autonomous will to be an end in himself/herself. Thus using PGD to create designer babies and savior siblings is impermissible because it violates Kants second categorical imperative. Opposition PGD is argued to be unethical in this paper; however, others view its use acceptable and nothing more than a legitimate autonomous right of parents to produce healthy children. They believe that because parents are the most socially and economically affected by the birth of a child, then they should have the right and freedom to choose the identity of their offspring. Having a healthy child is in the parents interest because it is less socially and financially constraining and burdensome. Besides, being healthy is in the best interest of the child as well. The child would want to live a happy and healthy life, free of disease. If PGD can provide a tool for removing such lethal and stigmatizing disease form society, then it should be perfectly plausible to be able to use it. Parents have a right to choose what it best for their children and family; therefore, using PGD as a means that will allow them to select for traits they see best fit for their child would be perfectly justified. Rebuttal However, while these are plausible reasons for the use of PGD, they are not strong enough to justify its immoral applications. Every single individual-even the potential person and the disabled-has a right to autonomy. No one can or should be able to define what life is worth living; furthermore, no one can impose the quality of life of principle on another. As previously stated, we can not say that the disabled lead a good or a bad life; it is simply not for us to decide. In fact, values of good and bad are of human conception and will vary from person to person. Parents need to take responsibility, financially and mentally for their child regardless of its physical well-being. Good parent do not choose; furthermore, they do not use their child as a means to appease their interest of having a less socially and financially constraining life. Using PGD for vain reasons is never morally justified. Using PGD for medicinal reasons is appropriate; however, using it for designer babies and savior siblings violates the fundamental principle of ethics (Kants second categorical imperative) and therefore, can never be morally justified. Conclusion In conclusion, PGD has revolutionized reproduction. It has granted access into a remote realm by allowing persons to select favorable genetic characteristics of offspring before implantation. However, while its promising view of the world without suffering and disease sounds appealing, moral justifications of PGD and its policy raise many concerns. More specifically, some of the issues with the use of this technology deal with the unjustified creation of designer babies and savior siblings. These are serious issues, the implications of which can have destructive and irreversible consequences on the present and future generations. While some of the applications of PGD may be accepted; nevertheless, as of now, the risks outweigh the benefits. It is not medicines role to make one more socially accepted or be better-off. Those are not the types of standards for us to decide. Intentional destruction of potential human life is never justified. PGD runs on a dangerously thin line of potenti al medicinal benefit and playing God. It also violates Kants second categorical imperative by treating fetuses as a mere means to an end. Therefore, until clear, strictly medicinal and ethical applications of PGD are established, the use of this technology can not be justified.

Beckett’s Writings :: Literary Analysis, Beckett, Winnie

1. How can you apply the Latin phrase Esse est percipi to a specific and concrete analysis of Beckett’s material? Esse est percipi, or To be is to be seen, is a very profound statement which Beckett seems to use as one of the major themes of his playwriting. Beckett’s Collection of Shorter Plays often have no beginning or end and build good examples of to be is to be seen. Beckett’s utilizes the senses in his writing. With the use of the sense of seeing, and the sense of hearing, Beckett builds his characters very being and thus brings forth the idea of to be is to be seen.. In Happy Days, Beckett created the character of Winnie who is trapped and buried in a mound of dirt. Beckett has written Winnie as being a great deal focused on seeing. During the play, Winnie is constantly doing things that emphasize the act of seeing. She is putting on and removing her glasses, reading the tube of toothpaste, reading the handle of the brush and other such acts. By seeing each item, and reading the writing on it, she justifies its existence and in reading and seeing each item she exists. Her eyes are used as props, opened and shut, demonstrating â€Å"that one sees the other the other sees the one† (28). This declaration is very powerful example of each person justifies the other by seeing the other. Without one seeing the other, there is no one to see the one. In this simple statement, Winnie proclaims the very act of existence. Winnie makes many other statements about the act of seeing, during the play, when talking with her husband Willie, as in â₠¬Å"Could you see me, Willie do you think, from where you are, if you were to raise your eyes to me [†¦] Lift your eyes to me† (28). Winnie needs Willie to look at her to verify that she is still there by seeing him, and him seeing her. Being stuck in the same routine of her day-to-day living can be a prison. By sharing that day with someone, even if it is just hearing or being seen, it gives Winnie a reason to go on and â€Å"to be†. Winnie articulates the feeling of disappearing in a blink of an eye by stating â€Å"Strange feeling that someone is looking at me.

Dream Essay -- essays papers

Dream Money and Success: The Myth of Individual Opportunity The American Dream is different for everyone, though it is most commonly associated with success, freedom, and happiness. The concept of the American Dream seems to have dwindled from where it was in the past few generations. It has gone from success, freedom, and happiness to having lots of money and the nicest possessions. In today society we all hope and strive for this dream, but how many actually achieve the American Dream? Is it a reasonable goal that Americans should strive for, or is it a myth that only leads to self-destruction? Having a lot of money, a good job, and expensive possessions are all characteristics of this American Dream. Even though, many Americans seek to achieve all of these material possessions, how many can say that they are truly happy, once they reach this goal? There is no standardized description of being rich. Some people see money as the only way of measuring how prosperous one is, but is money the only way to achieve the American Dream? One can only have so much money. ...

A Precious Gift :: Personal Narrative Essays

A Precious Gift Education has always been considered very important in my family. Prior to the earliest time I can remember I am told that my mother and father read to me nightly. My family has a deep background in books, my father being a collector, and my mother working at a library. My father loves books, in every way I can think of. He loves to read them, as do the rest of my family, but he has a collector's interest in books that we lack. He once wondered to a local library to check if they had a book sale. They did indeed have a book sale, and he bought quite a many books from their shelves. Soon he became a volunteer, and then the organizer, and soon had his own key to the library. As the relationship between my father and I goes, I started going with him to the book sale. I loved reading and I helped him a little also. We discovered that the special semiannual book sale was coming up. I came with my dad that morning and we began carrying boxes of books out to the tables. We observed a tag sale across from us that apparently went hand in hand with our sale. I was given the job of collecting money, and the day was going well, for we had already made nearly four hundred dollars for the library. At one point a small boy began his ascent up the small hill from the tag sale. He was only seven or eight by my estimate, and went directly to the table marked 'children.' After a minute or two he had found four or five books that he liked, put them in a neat pile and started his way back down the hill to the tag sale. Nearly a minute later he came back with a rather sad look on his face. "What's the matter?" I asked him as he took the pile and placed the books back on the table. He shrugged and I pushed. "You don't want those books?" I asked. I could tell he was shy. We already had something in common. "No, I can't get them." "Oh? Why not?" I asked. I could sense that he wanted them. "Because my mother won't give me the money for the 'stupid books.

Do Not Resuscitate Legal and Ethical Issues Essay

Introduction DNR, Do Not Resuscitate, is an order that alerts medical professionals not to perform cardiopulmonary resuscitation, CPR, on an individual. CPR consists of life saving methods such as procedures that can involve mouth to mouth resuscitation to using a defibrillator, intubation, and using cardio tonic drugs to bring the patient back to life. DNR orders is a legal document that has been sustained by the individual or proxy, typically is for patients that are seriously ill or may be terminally ill, preventing aggressive efforts to bring them back to life. DNR enables a person to exercise their right to autonomy, to make decisions about their healthcare in case they are unable to do so in the future. In this paper I will be analyzing the requirements of New Jersey’s DNR. Secondly I will be identifying the requirements of three hospitals DNR’s in New Jersey. The three hospitals will be Jersey City Medical center, St. Joseph’s Hospital, and Hackensack Medical Center; I will examine the differences and similarities between the three hospital DNR requirements and address the following: what they are and which one should be followed. Lastly the paper will explain how a DNR is applied if a patient is under hospice care and the EMT’s are called. Requirements for New Jersey Do Not Resuscitate Orders State of N.J. www.state.nj.us/health/ems/dnr_introduction.shtml This is the State of New Jersey Department of Health website. This website contains the requirements for the state of N.J. This also contains information of the guidelines for  physicians, policies for EMS personal, and Do Not Resuscitate brochure. This web site is valuable for the research paper in the understanding of the states requirments and policies. New Jersey Do Not Resuscitate (DNR) http://www.njha.com/media/33214/DNRGuidelines.pdf. This website provides the state’s education for guidelines for health care professional, patients and their families. This also contains important information about the DNR background and history to further understand the requirements. The website also includes physician guidelines, EMS policy, how to get a valid out of hospital DNR, bracelet guidelines, and an educational brochure for family members. The website will allow me to identify the requirements of New Jersey’s DNR policy and also provides tools for the patient and their family. DNR’s Advanced Directives-NJ http://www.njha.com/media/33214/DNRGuidelines.pdf. This website is the NJ Hospice and Palliative Care Organization; this will enrich my knowledge about hospice care, DNR orders, Advanced Directives, and living wills. Duke, G., Thompson, S., & Hastie, M. (2007). Factors influencing completion of advanced directives in hospitalized patients. International Journal Of Palliative Nursing, 13(1), 39-43 This was retrieved form the Ashford library; this is a journal article that discusses the completion of DNR forms and the importance in protecting the patient’s right in making decisions for end of life care. The article gives important in formation about DNR and also describes assessment tools that are used to better educate the patient. Advanced Directives- Jersey City Medical Center https://www.libertyhealth.org/pdf/LibertyHealth_Advance_Directive.pdf St Joseph’s Health care- https://www.stjosephshealth.org/patients-and-families/your-hospital-stay-information/24-your-hospital-stay-information Advanced Directives-Hackensack Medical Center http://www.hackensackumc.org/assets/1/7/advdirectives.pdf. This is the Jersey City Medical Center’s, St. Joseph’s Hospital’s, and Hackensack Universities advance directive information and DNR forms. They provide education for the patient and or families. This will provide me the information to examine the differences and similarities between the states and the three hospitals DNR requirements to address the following questions:  what are they and which one should be followed. DNR is applied under hospice care and EMT’s are called Do Not Resuscitate Orders State of N.J. www.state.nj.us/health/ems/dnr_introduction.shtml This website provides information on how a DNR is applied if patients are under hospice care and the EMT’s have been called. This will be very important in the research paper. Providing information and ethic realization to issues when DNR guidelines and a call for emergent services on a hospice patient. This is the State of New Jersey Department of Health website. This website contains the information how DNR is applied if a patient is under hospice care and EMT’s are called. From researching the information provided this will greatly help me explain and understand the issues involving DNR document and a call for to the EMT’s to provide help. Van Leuven, K. (2012). Advanced care planning in health service users. Journal Of Clinical Nursing, 21(21/22), 3126-3133. doi:10.1111/j.1365-2702.2012.04190.x This was retrie ved form Ashford University Library; this journal article provides information of advanced directives and DNR orders. This is critical to my research paper, it will help me to understand and analysis various situations such as EMT’s being called with a patient that has a DNR. Croke, E., & Daguro, P. (2005). Liability for the health care provider: non-implementation of patients’ advanced directives. Journal Of Legal Nurse Consulting, 16(2), 19-24. This was also retrieved form Ashford Universities library, the journal artical explains how a DNR should be kept with a patient and should also be kept in the patient’s permanent medical record. DNR orders should be honored by health care professional including EMT’s. The information also explains that a living will is not a DNR and that a bracelet is one of the best ways for EMT’s to recognize a patient’s wishes. Taghavi, M., Simon, A., Kappus, S., Meyer, N., Lassen, C., Klier, T., & †¦ Wiese, C. (2012). Paramedic’s experiences and expectations concerning advance directives: A prospective, questionnaire-based, bi-centre study. Palliative Medicine, 26(7), 908-916. doi:10.1177/0269216311419885 This was also retrieved form the Ashford library; it is a questionnaire based investigation from the EMT’s perspective. It explains their concerns for improved guidelines on end of life decisions and to not provide cardiopulmonary resuscitation in palliative care patients.

Pardoner’s Tale

Dec 1st, 2011 Death. It has many shapes and sizes in books and stories. In Chaucer’s book â€Å"The Pardoners Tale,† it takes the shape of an old man. He is very old and weary and seems like a completely innocent character. But, in this tale, he is the cause of three deaths. He is the very embodiment of death itself. The first clue to the old man’s identity occurs when he provided the rioters with the directions to find Death. â€Å"†Well sirs,† he said, â€Å"if it be your design To find out death, turn up this crooked wayTowards that grove, I left him there today Under a tree, and there you’ll find him waiting†Ã¢â‚¬  182-185 In this quote the old man knows he is telling the rioters where the gold is. He knows it will turn the rioters against themselves. Once they saw he gold they started plotting to kill each other to take the gold for themselves. Another clue hinting to you that he is no ordinary old man happens to be when he is tal king to the rioters. â€Å"† Not even death, alas, will take my life; So, like a wrenched prisoner at strife Within himself, I walk alone and waitAbout the earth, which is My mother’s gate Knock-Knocking with my staff from night to noon And crying, â€Å"â€Å"Mother, open to me soon! †Ã¢â‚¬  142-152 In this segment from the story he is saying that he can’t die. But, it also shows that he wants to die. In line 152 he says â€Å"Mother, open to me soon! † -152, meaning that he wants to be die and be buried in the earth. Calling the earth his mother. The final easy-to-see hint is how he changes subject when talking to the rioters. You can clearly see in lines 147-152 that he wants to die.But, when the rioters accuse him of being death or being a spy for death and act like they will kill him he suddenly changes his aim. â€Å"See how I wither, Flesh and blood and skin! / Alas! When will these bones be laid to rest? † 154-155. Here is an examp le of him clearly showing that he is ready for death. â€Å"Say where he is or you shall pay for it! † -178 Once the old man hears this he tells the three rioters where death supposable is. But, he knows that he is sending them to the gold where greed will overtake them and they will kill themselves over it. Pardoner’s Tale Dec 1st, 2011 Death. It has many shapes and sizes in books and stories. In Chaucer’s book â€Å"The Pardoners Tale,† it takes the shape of an old man. He is very old and weary and seems like a completely innocent character. But, in this tale, he is the cause of three deaths. He is the very embodiment of death itself. The first clue to the old man’s identity occurs when he provided the rioters with the directions to find Death. â€Å"†Well sirs,† he said, â€Å"if it be your design To find out death, turn up this crooked wayTowards that grove, I left him there today Under a tree, and there you’ll find him waiting†Ã¢â‚¬  182-185 In this quote the old man knows he is telling the rioters where the gold is. He knows it will turn the rioters against themselves. Once they saw he gold they started plotting to kill each other to take the gold for themselves. Another clue hinting to you that he is no ordinary old man happens to be when he is tal king to the rioters. â€Å"† Not even death, alas, will take my life; So, like a wrenched prisoner at strife Within himself, I walk alone and waitAbout the earth, which is My mother’s gate Knock-Knocking with my staff from night to noon And crying, â€Å"â€Å"Mother, open to me soon! †Ã¢â‚¬  142-152 In this segment from the story he is saying that he can’t die. But, it also shows that he wants to die. In line 152 he says â€Å"Mother, open to me soon! † -152, meaning that he wants to be die and be buried in the earth. Calling the earth his mother. The final easy-to-see hint is how he changes subject when talking to the rioters. You can clearly see in lines 147-152 that he wants to die.But, when the rioters accuse him of being death or being a spy for death and act like they will kill him he suddenly changes his aim. â€Å"See how I wither, Flesh and blood and skin! / Alas! When will these bones be laid to rest? † 154-155. Here is an examp le of him clearly showing that he is ready for death. â€Å"Say where he is or you shall pay for it! † -178 Once the old man hears this he tells the three rioters where death supposable is. But, he knows that he is sending them to the gold where greed will overtake them and they will kill themselves over it.