Bartleby Essays - Bartleby, The Scrivener, English-language Films

Bartleby By Melville In Herman Melville's "Bartleby the Scrivener", the author uses several themes to convey his ideas. The three most important themes are alienation, man's desire to have a free conscience, and man's desire to avoid conflict. Melville uses the actions of an eccentric scrivener named Bartleby, and the responses of his cohorts, to show these underlying themes to the reader. The first theme, alienation, is displayed best by Bartleby's actions. He has a divider put up so that the other scriveners cannot see him, while all of them have desks out in the open so they are full view of each other, as well as the narrator. This caused discourse with all of the others in the office. This is proven when Turkey exclaims, " I think I'll just step behind his screen and black his eyes for him."(p.2411) The other scriveners also felt alienated by the actions of the narrator. His lack of resolve when dealing with Bartleby angered them because they knew that if they would have taken the same actions, they would have been dismissed much more rapidly. The narrator admits to this when he said, " With any other man I should have flown outright into a dreadful passion, scorned all further words, and thrust him ignominiously from my presence." (2409) The next theme is man's desire to avoid conflict. The narrator avoids conflict on several occasions. The first time Bartleby refused to proofread a paper, the narrator simply had someone else do it instead of confronting him and resolving the issue right then. By ignoring the problem, he left the door open for more disobedience. As expected, Bartleby continued to refuse to proofread and the narrator eventually gave up on asking him to do it. The narrator went to great lengths to avoid a confrontation. When Bartleby refused to leave the office after being fired, the narrator chose to move his office to a different location instead of removing the eccentric man by force. The narrator informs the reader of this idea when he says, " No more then. Since he will not quit me, I must quit him. I will change my offices." (2422) By doing so, the narrator displays just how far man is sometimes willing to go to avoid conflict. The final theme is man's desire to have a free conscience. Melville reveals this theme through the actions of the narrator as well as the new tenants of the office. The narrator attempts to appease his conscience by giving Bartleby money above his wages when he fired him. The new tenants of the office try to put the responsibility of dealing with Bartleby back on the narrator, but they are denied and eventually have the man removed from the premises by law officers. Herman Melville uses the actions and reactions of the characters in "Bartleby the Scrivener" to disclose three important themes, alienation, man's desire to avoid conflict, and man's desire to keep a free conscience. In doing so, he gives us an inside look into the workings of the human mind. The reader is left with the impression that all people, including lawyers, have compassion for other humans, and at some point, that compassion will show through Biblio- Heath Anthology of American Lit., Third Edition, Vol I , Paul Lauter Ed.

Nursing health assessment is an important role for a patient being diagnosis and give appropriate treatment The WritePass Journal

Nursing health assessment is an important role for a patient being diagnosis and give appropriate treatment Nursing health assessment is an important role for a patient being diagnosis and give appropriate treatment IntroductionCase scenarioAssessment of abdomen  Health history and lifestyle health practicesPhysical examination of abdomenInspectionAuscultationPalpationDocumentationPast health history and lifestyle practicePhysical examinationAction and responsesConclusionReferenceRelated Introduction Nursing health assessment is an important role for a patient being diagnosis and give appropriate treatment (Bellack, 1992, p.12). In my past clinical practice, only some simple assessments were conducted as it is able to reduce the affect of the problem but not solve it. After studied nursing health assessment, some more extensive and specific assessments should be done to identify patient’s health status. The actual problem, strengths deviations and the risk of the health problem are explored at a detail and in-depth way. This article is going to discuss about the specific nursing health assessment for a patient suffered from abdominal pain, who was met in my past practicum placement. Case scenario Ms. Ma, Age 54, housewife, admitted via AE and complained she was having abdominal pain for 5 days. Sharp pain starts at mid-abdomen and then at right lower quadrant. Level of pain increased when coughing. She had had Panadol 500mg an hour ago but pain can not relief. Nausea and vomited small amount of undigested food twice in the past few days. No diarrhea. She feels tired but can not sleep because of the sharp pain. Her vital signs are: pulse 98, blood pressure 148/85 mmHg, temperature 39.2oC. Her skin is warm and dry. Rebound pain occurred at the right lower quadrant of abdomen. She has hypertension and need to take medicine 2 times per day. Ms. Ma was diagnosed with acute appendicitis. Keep NPO and IV 500ml normal saline is established. Blood test, abdominal X-ray and ultrasound abdomen are planned. Assessment of abdomen In the past clinical practice, I only give analgesics by doctor’s order and the patient may sometimes relief pain after medication. However, abdominal assessment skills are necessary to identify Ms. Ma‘s condition for getting at the root and having a better outcome. There are five important steps for evaluating abdomen: take health history, inspection, auscultation, percussion and palpation. These assessment skills will be discussed one by one in the following paragraphs.   Health history and lifestyle health practices First, find out the patient’s chief complaint, record the details and observe Ms. Ma‘s general appearance. Then, assess the abdomen pain by COLDSPA- character, onset, location, duration, severity, pattern and associated factors. It is the most accurate measurement to identify whether it is parietal peritoneal pain, visceral pain or referred pain (Judy, 2008). After that, collect individual and family past and current health status. Ask if there was any injuries or trauma may cause the pain, any eating disorder, any abdominal surgery was done before, any food allergy, history of suffering inflammatory bowel disease, family history of cancer and chronic disease, etc. Also, collect Ms. Ma‘s lifestyle and health practices. Ask her if smoke, drink or not, her eating habit, bowel pattern and movement, the amount, colour and texture of stool, any change in appetite, weight and abdominal girth recently and her stress level (Medical Education, 1998). Past history and current lifestyle health practices are the useful information to identify the risk factors of the problem. After collecting all background information, the physical examination should be proceed. Physical examination is using senses to collect objective data. It is used to identify the actual and potential health problems, discover patient’s abnormalities and diagnosis the problem (Nursing 2010 Magazine, 2010). For physical examination of abdomen, Ms. Ma needs to empty her bladder first in order to avoid the bladder irritation then, place Ms. Ma in a supine position. The hands should be at aside and knees slightly bent. Tell her keep relax of the abdominal muscles. The assessment should be started in the right lower quadrant of abdomen and then proceeding in a clockwise direction. Also, the examination should go forward in the order of inspection, auscultation, palpation and finally percussion for avoid affecting the quality of bowel sound and increase peristalsis (Bellack, 1992). Physical examination of abdomen Inspection Inspection is systemic visual examination. For abdominal examination, it should be started at the mouth, which is the beginning of gastrointestinal tract, and finally the rectum and anus (Bellack, 1992). First, ask Ms. Ma opens her mouth and says â€Å"Ar† or use tongue depressor to inspect the structure of mouth cavity to see whether any inflection, ulcer or not. Then, give a swelling test to Ms. Ma for examine the swelling ability. Place a spoon with some water on the middle part of her tongue and ask her to swell the water slowly to observe any choking or water leaks out. After that, inspect the texture of abdomen, the condition and colour of skin, any bruises or scars presence on abdomen. Normally, abdomen is homogenous in colour. If redness or yellow orange appear, it may indicate inflammation or liver disease respectively. Normal abdomen should also be symmetry from side to toe, flat and have normal movement when smooth respiration. If the abdomen is asymmetric, obesity, abnormal enlargement of organs, fluid distention or even intestinal obstruction may be suffered. Also, aortic pulsation should be present as Ms. Ma is having hypertension. Finally, ask Ms. Ma to take a d eep breathe and hold it, it is used to inspect the presence of hernias or not (Bellack, 1992). Auscultation Auscultation of abdomen is used to define the bowel sound, which are caused by the movement of air or fluid at small intestine, by stethoscope. The examination is started at the right lower quadrant, where the clearest bowel sound can be heard. Normal bowel sounds are at high-pitched, bubbling sound and occur five to thirty times per minute. If hyperactive bowel sounds occur, it indicates diarrhea or early stage of gastroenteritis. If hypoactive or even absent of bowel sounds for five minutes, it indicates intestinal obstruction, peritonitis or pneumonia. Besides bowel sounds, vascular sounds of aortic, renal, iliac, and femoral arteries can also be auscultated. It is an important examination to assess hypertension patient such like Ms. Ma whether she suffers from portal hypertensive and liver cirrhosis or not. If the vessels constricted or dilated, a bruit can be heard when blood flows (National Institute for Health and Clinical Excellence, 2008). Palpation Palpation is using sense of touch to collect data. For abdominal examination, finding out the location of pain is a great help of diagnosis abdominal pain. Light palpation and deep palpation are used to assess the abdominal organs, to define the tenderness and presence of mass. It is essential to assess the liver and spleen in abdominal examination. Light palpation which is not more than 1 am deep on each quadrant. Normal abdomen should be smooth and consistent. If broad-like hardness appears, it states peritoneal irritation is suffered. Deep palpation, which is press deeply from5cmto8cm, is used to indicate the abdominal organs and detect some obscure masses. Palpate the liver to test Murphy’s sign of cholecystitis. Palpate on the right upper quadrant at midclavicular line and parallel to the midline. If Ms. Ma feels pain and has inspiratory arrest, it states positive Murphy’s sign and indicate cholecystitis. Then, palpate the spleen at costal margin on left upper quadrant to feel if the spleen is enlarged and Ms. Ma will feel pain when the peritoneum is inflamed. Finally, as the rebound tenderness was being tested to Ms. Ma, that is pushing 90o angle at the right lower quadrant deeply and then release quickly. It is the reliable test of peritoneal inflammation if the patient feels sharp pain when the force released (Watkins, 2010). Besides, obturator test and iliopsoas test can also be done for diagnosing appendicitis. For obturator test, Ms. MA need to hold her right leg above the knee at 90o angle, grasp the ankle and rotate her leg laterally and medically. If she feels pain, it states obturator muscle is irritated. For iliopsoas test, straight up Ms. Ma’s right leg and press deeply on her upper thigh and ask her to oppose the pressing force. If she feels pain, it states that she is suffering from appendicitis (Beltran, 2009). Percussion Percussion collects data by vibrations and sounds. For abdominal examination, percussion is used to assess the amount of fluid or gas, the location of mass, the size of liver and spleen. Normally, tympanic sound is found at hollow organs such as stomach and intestine; dullness sound is found at liver, spleen or masses. To estimate the liver is enlarged or not, the normal distance of liver is 6 to12cm, which depends on the body size and gender, at the midclaricular line. To estimate the spleen by percussing behind the left midaxillary line. If the distance is greater than7cm, it states that the spleen is enlarged due to infection, mononucleosis or trauma. Moreover, test of shifting dullness and fluid wave to assess ascites. If the ascites of abdomen is more than 500ml, shifting dullness will be found. Normally, tympany is produced at abdominal midline (Bellack, 1992). However, for the abnormal case, dull sound is produced because of the cumulated fluid. Ask Ms. Ma rolls to right side and percuss from top to bottom. If the fluid is present, sound will change from tympanis to dullness and fluid wave will be generate when percuss on a side of the abdomen. It also has great variate in the abdominal girth. Documentation After the physical examination, documentation is necessary for the findings and development of care plan. Current of illness Ms. Ma states that her abdominal pain started five days ago. On the pain scale from 0 to 10, as 10 being the worst, she rates her pain is 7. Sharp pain occurs at mid-abdomen and then at right lower quadrant continuously. Level of pain increases when coughing. She has no known drug allergy and food allergy. She had Panadol 500mg an hour ago but pain can not relief. Nausea and vomited small amount of undigested food twice in the past few days. She has loss of appetite and lost about 3 pounds of body weight. No change in her abdominal girth. She has no diarrhea. She feels tired but can not sleep because of the sharp pain. She is having fever as her vital signs are: pulse 98, blood pressure 148/85 mmHg, temperature 39.2oC. Past health history and lifestyle practice Ms. Ma is a non-smoker and non-drinker. She has hypertension and need to take medicine 2 times per day. No abdominal surgery was dome before. She denies any injury or trauma occurs recently on her abdomen. She does not have history of suffering inflammatory bowel disease or family history of cancer and chronic disease. She states that her eating habit is health and the amount, colour, texture of stool are normal, but constipation sometimes. She does not feel stress or depression. Physical examination Ms. Ma has normal structure of mouth cavity and good swelling ability. There is no bruise or scar presence on abdomen. Her abdomen is symmetric and homogenous in colour. Her skin is warm but dry. By using the stethoscope, her bowel sounds are normal and no bruits are heard. Ms. Ma has rebound tenderness at the right lower quadrant of abdomen, pain occurs at obturator test and iliopsoas test when palpation.   Normal tympanic sound is produced at abdominal midline when percussion. Action and responses Ms. Ma is hospitalized. IMI 50mg Tramadol is given and her pain is temporary relief. Blood test was done and the result shows the level of white blood cell is high. The abdominal X-ray and ultrasound abdomen show her appendix is enlarged Ms. Ma is booked for an urgent operation for appendectomy. Conclusion In conclusion, some early symptoms of disease are not obvious, which will be easily misdiagnosed. Therefore, collecting health history and physical examination are very important as the data collected are in-depth and specific. It helps to have fast and accurate diagnosis in order to provide appropriate treatments to solve the patient’s problem and the symptoms at the same time. Reference Bellack, J.P. (1992). Nursing assessment and diagnosis (2nd ed.).Boston : Jones andBartlett Publishers. Beltran, M. (2009). Give this diagnostic test if appendicitis is suspected: early acute appendicitis may be difficult to diagnose. ED Nursing, 12 (5), 56ï ¼ 67. Judy, B. (2008). Pain evaluation and assessment. London : Piper Books in association with Heinemann. Medical Education. (1998). Nursing Assessment [Videotape].America: Meridian Education Corporation. National Institute for Health and Clinical Excellence. (2008). Appendicitis [Brochure].England:Newcastle Health Information Centre. Nursing 2010 Magazine. (2nd ed.). (2010).America: AuthorBio Publishing Group Ltd. Watkins, J. (2010). Recognizing the signs of acute appendicitis. British Journal of School Nursing, 5 (10), 488ï ¼ 91. [/level-freee-rstricted]

Important challenges museums are facing today and how to respond to Term Paper

Important challenges museums are facing today and how to respond to them - Term Paper Example Museums are important places where people are able to debate upon and shape the public views, cultural views and identity. Museums have been facing several changes inside and out of the country due to the new expectations of the audience such as students, tourists, donors.Museums have been facing several changes inside and out of the country due to the new expectations of the audience such as students, tourists, donors. As a result this has caused challenges to the museum management. As a result this has caused challenges to the museum management. These challenges are in terms of how to organize staff members, creation of exhibitions, shaping of collections and creation of effective programs. Important Challenges Facing Museums Today Financial challenge has become an obvious threat to the museums today. During recession period one of things to be cut off from financing is museum as many view it non-essential services. It is also not considered to have any significant formal role to t he public and especially to education. Participation in museums is mostly considered voluntary and that amounts to why it does not receive much funding like other corporations. Acquiring expert collection staff is another challenge that is facing museums. The lack of expertise in the museums staff makes it impossible for the museums to ensure proper interpretation of collections and how to improve museum education. Many people do not prefer studying on museum issues and in most cases such issues are not in the curriculum. The expert collection staffs are significant people in the museum since they are the ones who provide various collections according to expectation of the audience. They are also able to choose right objects for display and ensure they are relevant for the occasion hence every museum should have these kinds of people. Any collection in a museum without an expert taking care of it, it loses any inherent value attached to it according to Flyyin (2007). Poor management of museums has also been a major challenge facing museums. Museums have often regarded as areas of less duty and this has led to the downfall of the industry. There are several activities which need to be taken care of in the museum so as to make it a place worthy visitation. For instance the need to improve access to collection, improving attract more people, make more relevant exhibitions to those served by the museum and to generate income which important for development .Therefore it is the work of the management to ensure all these activities are taken care of. Lack of information about objects found in the museum has been a major challenge to the industry. This information is as important as the objects since without it, it is unlikely that people will recognize the importance of such objects Many museums have not been able to standardize information of their artifacts and those which have managed to do so have lacked the right data and vocabulary. This can be attributed to t he failure of the government to introduce a national standard for museums. Creation of different classification for different artifacts in the museum has also remained a major challenge in the industry. This can be attributed to the lack of unified standard framework which needs to be single framework for museums. Cultural heritage is playing a major role in the museums and without this standard framework it is unlikely that museums will achieve any significant progress in future. The declining attendance to the museum has also been a major challenge. This is because one of the main sources of cash for the museum is through the entrance fee. On the same note, with the decline of attendance it implies that the museum is not selling out itself as not many people will be aware of what it offers. This is a challenge which needs a lot of attention as it important aspect of the museum. The issue of which works to display and which works not to display has also posed a challenge to the mus eums as suggested by Flyyin (2007). For instance most museums are not sure of whether to display works with sexual content. This is case especially when the museum operates with