The Arrangement of the Genes Essay Example | Topics and Well Written Essays - 1000 words

The Arrangement of the Genes - Essay Example The only thing keeping us safe from them is our immune system. Our innate immune system (e.g. skin, mucous membranes, sneezing, blinking, excretion of waste, etc.) is the first responder and is responsible for most of the pathogens we encounter everyday. For the uncommon pathogens, we rely on our adaptive immune system to quickly develop and combat new and rare pathogens that the innate immune system cannot handle. That aside, it also changes itself to be prepared for a repeated attack by the same organism. It is amazing to think about how many harmful organisms are repelled again and again by this system that continuously changes to keep us safe. Some of the key players in our adaptive immune system are our T cell antigen receptors (TCR). They are ‘highly variable antigen-recognition structures’1 whose job is to recognize antigens and activate the appropriate lymphocytes to combat them. Since the TCRs are antigen-MHC compound specific and insoluble at the same time, iso lating them was very difficult until scientists started using clonotypic monoclonal antibodies.2 With this method, they were able to determine that the TCRs were heterodimers of 2 sets of chain genes: the ?:? and the ?:? chains. The two have similar structures, but they detect different antigens. The ?:? is the most common (90-99%) while the ?:? is the minority (1-10%). 3 The former detects antigens presented with Major Histocompatibility Complex (MHC) while the latter doesn’t need MHC to detect certain antigens. The genetic structure of the TCR is similar to that of the immunoglobulins (Ig) in B cells. It is composed of Variable (V) and Constant (C) regions. The variable region contains Variable (V), Joining (J) and Diversity (D) segments depending on whether the chain is a light or heavy immunoglobulin (or an ? or ?, or a ? or ? chain for a TCR). In heavy immunoglobulin chains, VDJ gene segments join together randomly, while in the light chains (Lambda and Kappa), they only have V and J segments to join. Combinatorial association in B cells further increases variability by giving the ability to create ‘any one possible heavy chain and any one possible light chain’ in all individual B cells.4 Because of the large number of possible gene rearrangements, the structure of Ig or TCR genes is virtually unique for each B or T lymphocy te.5 Figure 1 T-cell receptor ?- and ?-chain gene rearrangement and expression6 Since T cells also have antigen receptors like the immunoglobulin, they also have a similar process of gene rearrangement and expression. In Figure 1, we can see an ?- and ?-chain rearranging and coming together to form a TCR. The ?-chain gene rearrangement is similar to the light chain because they do not have a D? to combine. The ?-chain is also similar to the heavy chain because it combines V?, D? and J? gene segments. The less common ?- and ?-chains are structurally similar to the TCR?- and ?-chains, but with a few changes. The ? chain is found inside the TCR? chain, between the V? and the J? gene segments. This arrangement causes a loss of ? chain whenever the TCR?-chain rearranges, since any segments in between V? and J? will be deleted. The ?-chain is similar to the TCR?-chain in that it has V, D, and J segments. The ?:? receptors are largely a mystery to scientists as of the moment.7 One of the f ew things determined to be true is the fact that they can detect non-classical major histocompatibility complex class I molecules T10 and T22.8 Combinatorial association further increases the variability, making it possible to have a unique genetic arrangement for every T cell receptor. Figure 2 The numbers of human T-cell receptor gene segments and the sources of T-cell

REFLECTIVE REPORT OF PRESENTATION Essay Example | Topics and Well Written Essays - 1250 words

REFLECTIVE REPORT OF PRESENTATION - Essay Example I came to learn quite a number of things through my own presentation as well as those of my colleagues. The presentation was scheduled for the 28th of February 2014, an aspect that happened. Both the students and the assessors were seated in the year one classroom ready for the presentations at 11:00 a.m. Due the number of students that had presentations the time, some time was spent which led to the culmination of the presentations at 16:30 pm. The timing allowed scheduling of the presentations into two sessions; the morning and afternoon sessions. Personally, I was scheduled to present in the afternoon session, which kicked off at around 14:30 pm, immediately after the lunch break. I specifically took the stand at around 15:45 pm and did the presentation within the ten minutes that were set by the assessors. The team of assessors included; Bernadine, Dr. Paige, Florence and Dr. Tukasi. The feedback from the assessors provided a challenge for me to improve on my presentation skills. The preparation for the presentation was a daunting task for me. I understood that I needed to give my best especially based on the poor performance in last year’s presentation. my determination was evident; I made quite a number of consultations with friends and educators. In addition, I visited the British library where I visited a number of books and journals that expanded my understanding on the inspirations of the Bible and how they affect the life of a Christian. Some of the materials visited included; All these sources among others that were not directly quoted provided meaningful insight while laid a good platform for understanding of the topic. In addition, some other books as well as the internet provided some guidelines on public presentation. During my research and preparation phase, I came across a lot of literature. There was so much information that was available in the books as well as the internet sources. However, the internet sources lacked

Financial Reporting case study Coursework Example | Topics and Well Written Essays - 1500 words

Financial Reporting case study - Coursework Example accounting practices in different countries, the International Finance and Reporting Standards has established guiding principles to facilitate the convergence of the international accounting practices and to improve the quality of the information presented to different users. In the attempt to achieve the convergence in accounting practices, the IFRS has established the following principles: information relevance, information reliability (faithful presentation, neutrality, complete and free from material error and prudence), comparability (consistency and disclosure of accounting policies), understandability and materiality. In addition, the IFRS has also provided a standard definition and guides in recognition of various elements of the financial statements such as revenue recognition, definition of different assets and liabilities (ZüLch & Hendler 2011, pp. 12-18). In response to the needs and requirements of various bodies such as the FASB and the IFRS, and different stakeholders in the government and their agencies, customers, the investors, the employees, lenders, suppliers and other trade creditors and the public, it is necessary to create financial statements. The needs of the mentioned stakeholders are as follows: the investors, who provide capital to a company are concerned about the levels of risk and return on their investments. They need financial information to help them decide whether they should buy or sell shares of a particular company. They also need the information that enables them to assess the ability of the business to pay the cash dividend. The second category of people is employees. Employees need to know whether their employer is financially stable. They use this data to evaluate the employer’s ability to implement a fair remuneration package, provide retirement benefits and be able to offer employment chances (S audagaran, 2009, pp. 150-155). Lenders use financial information to access the ability of a company promptly to pay both

Relationship between humans and nature Essay Example for Free

Relationship between humans and nature Essay Marlowe in his poem ‘The passionate shepherd to his love’ talks of the strong link between humans and the nature that surrounds them. The poem from beginning to the end talks mainly of the nature that surrounds us wherever we go. The poem makes us understand that we are actually dependent on nature for all our needs. The nature in its splendor is so beautiful that Marlowe has actually united with the environment. The poem captures the joy of love, in the midst of nature. In fact reading the poem makes one wonder, if the natural splendor that surrounded Marlowe when he wrote the poem, was the reason for his love to flow like a river. Nature makes one forget about the present. In fact, it makes us forget all about ourselves and become one with nature as we enjoy and be part of the beauty that surrounds us in all its glory. Marlowe in this poem talks more of the nature that surrounds him and less about his love. The poem talks of the quiet simplicity of rural life and how humans are part of nature. There is no way of separating humans from nature. The humans are dependent on nature for their very existence. The nature is dependent on humans to be admired and glorified. The human dependence on nature is highlighted by the fact that Marlowe is sitting upon a rock. He wants to make a bed of roses; wool for a coat from the lambs, buckles for the slippers from gold, a belt of straw, the list goes on. Marlowe by writing this poem has made the readers understand the relationship between humans and nature. Annie Dillard in ‘Sojourner’ talks of the Earth in its entire splendor. She talks of the mangrove tree that floats and becomes like an island in a sense. She rediscovers the magic of nature and how it can be viewed in a beautiful sense. People ordinarily will not give a second thought to a tree floating. She magnifies the significance and projects a simple natural event into something extraordinary. In fact Annie Dillard brings to life the mangrove tree that is all but dead. A tree that has no life has been brought to life with her words. When Dillard talks about the mangrove tree, she actually means the Earth and its movements. She tells that Earth is a sojourner, creating its own path and moves in a path that cannot be followed by any other thing on Earth. She tells that Earth is a wet ball thrown into eternity and humans are part of this. We the humans and nature have united to become one. She ends with a question asking what will happen at the end of the journey. The mangrove tree will finally end up in the Ocean. So where do the Earth and the humans living on it finally end up, is a question left unanswered. Mangroves play a major role in the essay by Annie Dillard. She uses the tree to show the human nature. The mangrove starts from scratch and builds a strong foundation. The human nature and relationships are similar. We all start from scratch and build many strong relationships as we grow. Some who are not able to make any relationships are like the mangrove tree felled by the hurricane, being tossed and not knowing the final destination. Annie Dillard unites with nature and is part of it. She talks of the Earths movement in words that make a person imagine and feel the true aura of nature. She has merged the human nature and the nature to be examples of each other.

Disease, Sickness, Death, and Decay in Hamlet Essay -- Shakespeare Ham

Death, Sickness, and Decay in Hamlet    Decay is defined as "a gradual decline; deterioration," disease as "any departure from health."   Both have many forms: physical, psychological, social, etc.   Multiple examples of illness and deterioration can be found in the tragedy Hamlet.   In this drama, Shakespeare uses imagery of decay and disease and the emotional and moral decay of his characters to enhance the atmosphere of the play.   Ã‚  Ã‚   The drama Hamlet abounds with images of decay and disease.   Celestial bodies are described in this manner; in Act I Horatio says that the moon "Was sick almost to doomsday with eclipse," and in Act III, Hamlet says that the moon is "thoughtsick" at his mother's sin.   Abstract ideas such as wealth and peace are also associated with such imagery by Hamlet in Act IV: "This is th'imposthume of much wealth and peace, / That inward breaks, and shows no cause without / Why the man dies."   In addition, in Act I Laertes uses an example from plant lore to convince his sister Ophelia to preserve her virginity: The canker galls the infants of the spring Too oft before their buttons be disclosed, And in the morn and liquid dew of youth Contagious blastments are most imminent. Furthermore, in Act I the ghost uses words associated with disease to describe his poisoning and death: The leperous distillment, whose effect Holds such an enmity with blood of man That swift as quicksilver it courses through The natural gates and alleys of the body, And with a sudden vigor it doth posset And curd, like eager droppings into milk, The thin and wholesome blood.   So did it mine, And a most instant tetter barked about Most lazarlike with vile and loa... ...this play.   The atmosphere of disease serves to heighten the audience's disgust for the situation.   Secondly, disease leads to death, so this figuratively diseased society is doomed.   Because of this sense of doom, there is a slight foreshadowing of the play's tragic end.   The tragic atmosphere is enriched by the motif of disease and decay.   Ã‚  Ã‚   The atmosphere of the play is reinforced by imagery of decay and disease and the emotional and moral decay of the characters.   This atmosphere is an integral part of the play as a whole and contributes greatly to its impact upon the audience.   Shakespeare's skill in weaving this motif into the play is evidence of his genius as a playwright and quality of his writings. Works Consulted: Shakespeare, William. The Tragedy of Hamlet. ca. 1600-1601. Ed. Edward Hubler. A Signet Classic. New York: Penguin Publishers,1963.

Beauty in “The Bluest Eye” Essay

The Bluest Eye is a brilliantly written novel revealing the fictional trauma of an eleven-year-old black girl named Pecola Breedlove. This story takes place in the town of Lorain, Ohio during the 1940’s. It is told from the perspective of a young girl named Claudia MacTeer. She and her sister, Frieda, become witness to the terrible plights Pecola is unintentionally put through. Pecola chooses to hide from her disabling life behind her clouded dream of possessing the ever so cherished â€Å"bluest of eyes†. The Breedlove’s constant bickering and ever growing poverty contributes to the emotional downfall of this little girl. Pecola’s misery is obtained through the touch of her father’s hand and the voice of her community’s struggle with racial separation, anger, and ignorance. Her innocence is harshly ripped from her grasp as her father rapes her limp existence. The community’s anger with it’s own insecurities is taken out on this poor, ugly, black, non-ideal, young girl. She shields herself from this sorrow behind her obsessive plea for blue eyes. But her eyes do not replace the pain of carrying her fleeing father’s baby. Nor do they protect her from the shady eyes of her neighbours. Though this book discuses negative and disturbing situations, it teaches a very positive lesson. The theme of The Bluest Eye is that of depending on outside influences to become aware of one’s own beauty and to fabricate one’s own self image can be extremely damaging. Topic Tracking: Beauty Beauty 1: Claudia is constantly faced with white ideals of beauty. For Christmas one year, she receives a blue-eyed, blonde-haired, pink-skinned doll. Rather than adore the doll, she destroys and dismembers it as a result of her anger. Claudia feels she can never measure up to the beauty of white children, the beauty that all the world reveres. Beauty 2: The Breedloves are poor and ugly. At least that is how they think the world views them. Their beliefs that they are ugly come from white American media always portraying whites as representations of what is beautiful. Because of this, they do not strive for more, for they think that they do not deserve to have more. Beauty 3: Pecola wishes that she had blue eyes. She thinks that if her eyes were blue, and therefore beautiful according to white American standards, then her problems would go away and her life would be beautiful. Then maybe, her classmates and teachers would not despise her and think she was so ugly. She so hates hersel f that she stares at herself in the mirror trying to figure out where her ugliness comes from. Beauty 4: For one year Pecola prays that her eyes will turn blue. She has many problems in her life, starting with family issues, and she thinks that if she had blue eyes, her problems might go away. And even more than that, if she had blue eyes, people would see her as beautiful, and then she would be able to see herself as beautiful too. Being a black little girl in a society that idolizes blonde-haired blue-eyed beauty, Pecola thinks she is ugly. Pecola sympathizes for the dandelions because she knows what it is like to be devalued. She finds beauty in the weeds, for she thinks that people see her as a weed. Beauty 5: A new little girl, named Maureen Peal, comes to Claudia and Frieda’s school. Maureen is revered for her looks, which people deem beautiful. She has lighter skin and eyes than most of the other children, and everyone adores her because of this. She is looked upon as beautiful because her characteristics are somewhat more â€Å"white† than other black people’s. This causes many to be jealous of her. However, Claudia and Frieda are not jealous. They see through the standards placed on beauty, and if Maureen is what is beautiful, this means that they are not beautiful (according to society). Beauty 6: When the girls are walking home from getting ice cream after school, they pass a movie theater with a picture of Betty Grable on the building. Maureen and Pecola both say that they love Betty Grable, an icon for white American beauty with her blonde hair and blue eyes. However, showing her disdain for such standards placed on beauty, Claudia says that she prefers the actress, Hedy Lamarr, who has dark hair. Beauty 7: In her younger years, Pauline Breedlove occupied herself by going to the movies. It was here that she got her first glimpse into what idealized beauty was. She saw the Hollywood blonde-haired, blue-eyed bombshells as being true representations of beauty. And anything that strayed from these looks, including her own, was seen as not pretty. American society placed their standards of beauty onto the world, and because of this, many people began to realize how far away they were from those standards. Beauty 8: Pecola goes to visit Soaphead Church with the hope that he will be able to fulfill her wish to have blue eyes. She thinks that with blue eyes, all of her problems will disappear and the world will love her because she will be beautiful. The world, seen through blue eyes, will also appear beautiful to Pecola. Beauty 9: Claudia prays that Pecola’s baby will survive. She needs the baby to live to counteract society’s standards set on beauty, which say that blonde-haired, blue-eyed little girls are all that is pretty. Claudia hopes that with this new black baby people will change and see blackness as something that can be admired and something that is beautiful. Topic Tracking: Culture Culture 1: Mr. Henry moves into Claudia and Frieda’s house. One day, the girls come home and when they walk in Mr. Henry greets them. He flatters them by telling them they look just like Greta Garbo and Ginger Rogers, two white American female actresses. These two actresses represented American society’s ideal beauty, with their blonde hair and blue eyes. They, and other actresses like them, were so idealized by the media that it forced young American girls, both white and black, to question their own beauty if it differed from the standard of blond hair and blue eyes. Culture 2: After seeing the cup with Shirley Temple on it, Claudia explains her ill feelings for her. Shirley Temple was the epitome of what all of America adored in little girls: her bouncy blonde curls and big blue eyes. This sickened Claudia, as she was so different from Shirley Temple and all of the other little girls who looked like Shirley. Culture 3: Claudia tells the story about the doll she recei ved for Christmas one year. This doll was a beautiful doll that had blonde hair, blue eyes, and pink skin. Instead of appreciating the doll like most other children would have done, Claudia dismembered and destroyed the doll. She was sick of having American ideals of beauty placed on her, which said that being white with blonde hair and blue eyes was what was deemed as beautiful. Culture 4: This excerpt from a first grade reading primer describes the perfect white family. Morrison uses these excerpts in many points of the story to illustrate the dichotomy between the ideal white family, and the family of blacks, specifically Pecola’s family. The reading book perpetuates the stigma that what is seen as â€Å"ideal† in American culture means having a neat little house, run by two loving parents, with two children, one of which has blonde hair and blue eyes, and a fun loving dog who plays with the children. This social stigma presses on children who are â€Å"different† that are reading these books, and makes them think they are abnormal and unacceptable. Culture 5: The Breedloves are described. They think they are poor and ugly, and it says that much of the reason they think this is because of the white American media. The media, as part of our culture, sets the standards for what defines beauty, and anything straying from these standards is viewed as ugly. Culture 6: Pecola is constantly faced with the standards set on her society by American culture. She cannot even enjoy a piece of candy without feeling that she is different and lacking in some way in terms of beauty. When she goes to eat her Mary Jane candy, she is mesmerized by the little girl of Mary Jane on the cover, a blonde-haired, blue-eyed girl. These cultural pressures of what defines beauty make Pecola aware of just how much she strays from that defined beauty. This eventually leads to her desire for blue eyes, which in turn leads her into madness. Culture 7: When Pecola, Maureen, Claudia and Frieda are walking home from the ice cream shop, they pass a theater with a picture of Betty Grable on it. Young girls are bombarded with American culture’s ideals of beauty, such as pictures of famous actresses. Betty Grable in particular , with her blonde hair and blue eyes, makes Pecola and Maureen want to look like her. However, despite all of their hopes and wishes, they will never be able to look like that, and they are left as the victims of a culture that standardizes and limits young children. Culture 8: During her younger years, Pauline Breedlove spent a lot of time at the movie theater. It was here where she learned American standards of true beauty. Constantly faced with actresses like Jean Harlow, the ultimate Hollywood blonde bombshell, Pauline was forced to examine her own beauty in terms of Harlow’s. She realized that she did not look anything like Harlow, and based on this, came to the conclusion that she must be ugly. However, her feelings of ugliness were purely based on cultural standards set on her through the medium of Hollywood. Culture 9: Claudia feels the need for Pecola’s baby to be alive and healthy. She wants the baby to survive because she wants to counteract the cultural emphasis placed on white girls with blonde hair and blue eyes, exemplified by the types of white baby dolls most children adore (dolls that look like Shirley Temple). If Pecola’s baby lives, maybe people can learn to love a black baby and see black as beautiful too . At least this is what Claudia is hoping for. Culture 10: Pecola beats her arms like a bird, and attempts to fly up to the sky. However, she cannot. The reason she cannot is because she has been held back by the culture in which she lives, a culture that values white beauty, and ignores black beauty. It was an inevitable end result that Pecola would never be able to achieve the standards of beauty she wanted to. She was born a black child, and unfortunately, her culture does not accept black beauty. Thus, her dreams would never be fulfilled. And even though she thinks she has blue eyes, the world around her does not recognize her as she wishes to be seen. And because of this, she is driven to madness, caused by the pressures and social standards of her culture.

Research Paper About Daily Activities of Nurses in Hospital.

1. 0 INTRODUCTION I propose to study the attitude, knowledge and experiences of nurses on prioritizing comfort measures in care of the dying patient in an acute hospital setting. I am particularly interested in this field as I worked in a hospice during semester break where palliative care of the dying concentrated on the quality of life of the patient. When the prognosis for the patient was imminent death, care was focused on reducing the severity of the disease symptoms rather than vainly trying to stop or delay development of the disease itself or provide a cure. When the prognosis for a patient is imminent death, hospice care concentrates on the quality of life of the patient, reducing the severity of the disease symptoms rather than vainly trying to treat the disease itself. To assist in delivery of this type of quality end-of-life care to patients in acute hospitals the Alor Setar Hospital developed a Hospice Friendly Hospital programme (HFH). This HFH developed the Quality Standards for End-of-Life Care in Hospitals to set out a shared vision for the type of end-of life care that each hospital should aim to provide. This development is significant as almost 50% of those who die in Kedah die in hospital and care of the dying in Alor Setar hospitals, while regarded as good, is described as ‘care at the end of life’ rather than ‘end-of-life care’ because the care seems to lack an effective palliative care component† LITERATURE REVIEW To investigate international perspectives on end-of-life care, the current international literature was reviewed using the key themes of identifying the dying phase, comfort care and symptom control for the dying patient. It was conclude from the literature review that nurses and medical staff often differed in their approach to care of the dying patient and this hindered effective delivery of end-of-life-care. Education on end-of-life care was recommended in the literature as being a solution to the problems in delivering this care even though research had not been done on the status quo in education. RESEARCH PROBLEM Before planning such specific education programmes, it would seem necessary to conduct research studies to establish the education and training levels of nurses and doctors in end-of-life care and to establish if attitudes and experience also influence the medical and nursing models in the delivery of this care. This research proposal is concerned with the nursing model and it proposes to establish what influences the nurse’s approach in delivering end-of-life care. METHODOLOGY A quantitative approach using a descriptive design is proposed for this study. Questionnaires will be used as the data collection method with a simple random sample of 200 staff nurses employed in a Alor Setar hospital being selected as participants in the study. RESEARCH QUESTION The research problem leads to the following research question: â€Å"What are the attitude, knowledge and experience of nurses on prioritizing comfort measures for dying patients in an acute hospital? † OBJECTIVES (i) To establish the attitude of nurses on prioritizing comfort measures for dying patients. ii) To establish if nurses’ knowledge of prioritizing comfort measures for dying patients is adequate. (iii) To establish if nurses’ experience in prioritizing comfort measures for dying patients is significant. 2. 0 METHODOLOGY Introduction to Research Methodology The methodology selected for the proposed study will be detailed here. The planned research design, methods of sample selection, data collection and analysis of results will be explained. Ethical consi derations for this particular research study will also be detailed. It is hoped that the chosen methodology will generate useful information through the collection and analysis of data on the attitude, knowledge and experiences of staff nurses on the effect of comfort measures in care of the dying patient in the acute hospital setting. Research Design The research design of a study outlines the basic approach that researchers use to answer their research question (Polit & Beck 2010). To meet the aims and objectives of the study it is important that the researcher selects the most appropriate design for achieving the aims of the study (Parahoo 2006). The quantitative approach arises from the belief that human phenomena and variables in human behaviour can be studied objectively (Parahoo 2006) and so this approach has been chosen as an appropriate research method. Quantitative research uses a fixed design that organises in advance the research question and a detailed method of data collection and analysis (Robson 2007). It is proposed that this survey will collect details of the current attitude, knowledge and experience of nurses on comfort care of the dying patient. The method of data collection chosen is a written questionnaire, allowing large sample size without major expense, to produce quantitative data that can be analysed by statistical computer programmes, Population/sample Parahoo (2006, p. 258) defines a population as â€Å"the total number of units from which data can potentially be collected†. The population in this study will be staff nurses working in the acute hospital setting in Ireland. This population will be delimited to a homogenous group of subjects through inclusion/exclusion criteria. Inclusion criteria †¢ Registered general staff nurses who work in the acute-care setting. Exclusion criteria †¢ Staff nurses working with children †¢ Agency staff nurses Staff nurses, fitting the above criteria, from a large Dublin acute hospital will be chosen as a smaller convenience group of the target population. It is then proposed to select a simple random probability sample (from the convenience sample). Proctor et al. (2010) maintain that the use of probability sampling in quantitative research reduces errors and biases in the study. Sampling is the process by which researchers select a proportion of the target population, as the study population, to represent the entire unit. It is more practical and economical to work with samples rather than with large target populations (Polit & Beck 2010). The researcher will obtain the names of all eligible nurses from the Human Resources Department in the hospital. This list of nurses will form a sample frame from which the researcher will select nurses at random by assigning a number to each name and ‘picking the numbers out of a hat’. Data collection Quantitative data are collected to classify and describe attributes, behaviours and activities of populations according to Parahoo (2006). Data collection should be objective, systematic and repeatable (Lacey 2010). Robson (2007) maintains that a researcher should use the simplest manner of collecting the data to get answers to the research question and should not collect any more data than necessary. Mindful of these conditions the data collection instrument selected for this study is a questionnaire. Questionnaires A questionnaire is a method of data collection that asks participants to give written or verbal replies to a written set of questions (Parahoo 2006). It is a quick,convenient and inexpensive method of collecting standardised information . A questionnaire can be used to collect information on attitudes,knowledge and experience of staff (Parahoo 2006). A structured writtenquestionnaire that uses a quantitative self-report technique, as outlined by Polit & Beck (2010), will be used to collect data in this study. The questionnaire will have three parts (see Appendix ). Part A of the questionnaire will use a Likert-type scale to gather data on the attitudes of nurseson the effect of comfort in care of the dying. The questionnaire will consist of positively and negatively worded statements with six different response options ranging from strongly disagree to strongly agree. Positive statements are scored one to six (one for strongly agree through to six for strongly disagree) and scores are reversed for negative statements. The score for each item will be reported individually. Parts B and C will use a fill the box format and will gather data on the knowledge and experience of nurses on comfort care of the dying respectively. ETHICAL CONSIDERATION According to Polit and Beck (2010), researchers must deal with ethical issues when their intended research involves human beings. Ethical approval will be requested in writing from the Director of Nursing (as gatekeeper) and the Hospital Ethics Committee of the hospital involved in the research . As gatekeeper, the director of Nursing must be made aware of all nursing research taking place in the organisation to monitor the effect of all such projects taking place. She will also need to be convinced of the value of the research and the competency of the researcher (Lee 2005). The main ethical principles that will be considered in conducting this research study are respect for persons, confidentiality and beneficence /non-maleficence. 3. 0 PROPOSED OUTCOME Following this proposed study, a report will be compiled discussing all aspects of the research process including the results, limitations and benefits. It is anticipated that the results of the study will give an indication of nurses’ attitude, knowledge and experience in the domain of comfort care of the dying in Ireland and indicate where interventions are needed through education, training or management. It is also anticipated that the findings of the research study will reveal if other factors such as attitude or experience impact on the effective delivery of care of the dying patient. It is anticipated that these results will contribute to recommendations in future nursing practice, nurse education and research and that this will in turn move palliative care higher up on the agenda of the nursing profession in general. This study will have limitations as it will be conducted in only one acute hospital. It will give a general overview of the current attitude, knowledge and experience of nurses in this hospital. The researcher recommends that other studies, both quantitative and qualitative be carried out in hospitals in other Irish cities so that a more general picture could be established of end-of-life nursing care in acute hospitals in Ireland. Qualitative research is explanatory and descriptive in nature and so it could help in determining the nature of the phenomena being studied (Barroso, 2010) and consequently give a more complete picture of care of the dying. It is the intention of the researcher to share the findings of the study with management of the partaking hospital and the schools of nursing and midwifery in Ireland. It is hoped that this will highlight the necessity of planning on-going education and training for nurses in end-of-life care. To present the research report to a broader audience the researcher intends applying for publication of the study report in relevant nursing journals. Time Scale A clear and practical time scale is necessary to facilitate the organisation and coordination of each stage of the research process and the successful integration of the stages (Cormack, 1991). An 18 month period is proposed as the time frame for this study and a detailed integrated time plan is included in appendix . Resources An estimated budget account for the proposed study is outlined in appendix. 4. 0 APPENDIX Part A: Questionnaire on attitudes Directions: Write your opnion whether agree or not. 1. Nurses are capable of identifying that a patient is dying. 2. I would not like the responsibility of identifying a patient as dying. 3. Nurses cannot cease routine care for the dying patient without permission from a doctor. 4. The length of time taken to care for a dying patient is vitally important. 5. Nurses should not give dying patients honest answers about their condition. 6. End stage palliative care does not do anything for the patient. 7. The focus of care should be adapted when death becomes imminent. 8. When a patient has been identified as dying a ‘do not resuscitate order’ should be placed on his/her chart. 9. Nurses play a key role in helping patients die in comfort. 10. Comfort care for the dying patient should not replace routine nursing practice. 11. I would not like to care for a dying patient. 12. Comfort care will enhance the dying patient’s quality of life. 13. Specialist palliative care teams are never necessary to deal with a dying patient. 14. Symptom control for the dying patient is not the nurse’s responsibility. 15. When nursing a dying patient it is good practice, when possible, to frequently ask them about symptom control. 16. Symptom control guidelines are necessary for delivering optimal end-of-life care. 17. Nurses cannot manage symptom control in the dying phase. 18. The dying patient’s physical needs should be decided by them when possible. 19. Dignity of a patient is not more important that effective care. 20. Administration of opioids by means of a syringe driver is often an essential measure in symptom control. Part B: Knowledge Questionnaire Please answer all the following questions by ticking the appropriate box to indicate the answer you consider to be correct. Tick one box only. 1. The decision that a patient is dying should be made by a multidisciplinary team. Correct __ Incorrect__ 2. There is a need for specialist palliative care teams to be involved with every dying patient. Correct__ Incorrect__ 3. The dying person should not be allowed to make decisions about his/her physical care. Correct__ Incorrect__ 4. Treatment procedures should be continued even when the patient is dying. Correct__ Incorrect__ 5. Routine nursing practice should not take precedence over a patient’s comfort. Correct__ Incorrect__ 6. Dehydration is a normal part of the dying process. Correct__ Incorrect__ 7. Frequent repositioning of a dying patient is not always desirable. Correct__ Incorrect__ 8. When a patient is diagnosed as dying current medication should be reassessed and non-essentials discontinued. Correct__ Incorrect__ 9. Use of opioids is appropriate to control pain for the dying patient. Correct__ Incorrect__ 10. Symptoms of increased chest secretions and terminal agitation are unavoidable in dying patients. Correct__ Incorrect__ 1. Regulation of bowel movements is often a problem for a dying patient. Correct__ Incorrect__ 12. Retention of urine is more likely than urine incontinence in the dying patient. Correct__ Incorrect__ 13. All dying patients will be at high risk of skin breakdown. Correct__ Incorrect__ 14. Breathless is a common symptom in the dying phase. Correct__ Incorrect__ 15. Gene ral comfort care should not take precedence over skin care. Correct__ Incorrect__ 16. Maintaining a fluid balance record for the dying patient is important. Correct__ Incorrect__ 17. The dying patient should not be coaxed to eat. Correct__ Incorrect__ 18. It is appropriate to control pain in the dying phase by use of both analgesia and sedation. Correct__ Incorrect__ 19. An acute episode in a chronically ill patient may represent a terminal event. Correct__ Incorrect__ 20. Reducing the respiratory rate can relieve breathlessness for the dying patient by reducing anxiety. Correct__ Incorrect__ Part C: Experience survey Section 1 Please answer each question by ticking the appropriate box. 1. Please indicate your number of years nursing experience. 1-5 years 5-10 years 10-15 years 15-20 years >20 years 2. Have you received pre-registration education in end-of-life care? Yes No 3. Have you received post-registration education in end-of-life care? Yes No Section 2 35 The following section concerns your experience in delivering comfort care to dying patients. Please indicate your answer to the question by placing a number in the box which corresponds to your experience (see answer guide). Answer guide: 0 1 2 3 4 5 never 1– 5 times 5–10 times 10–15 times 15– 20 times > 20 times 1. I have been present as a nurse when a patient has died. 2. I have been in charge of nursing care for a dying patient. 3. I have used an integrated care pathway for end-of-life care. 4. I have been part of an interdisciplinary team that identified a patient as dying. 5. I have collaborated with an interdisciplinary team in delivering end-of-life care for a dying patient. 6. I have nursed a dying patient with a do not resuscitate order. 7. I have set up a syringe driver for subcutaneous administration of anticipatory prescribed medications to a dying patient. 8. I have administered prescribed opiate drugs to a dying patient to control pain. 9. I have administered prescribed drugs to a dying patient to control respiratory secretions. 0. I have administered prescribed drugs to a dying patient to control breathlessness. 11. I have been involved in cessation of artificial hydration for a dying patient. 12. I have been involved in cessation of artificial feeding for a dying patient. 13. I have dealt with nausea and vomiting episodes for a dying patient. 14. I have managed constipation problems for a dying pat ient. 15. I have inserted a urinary catheter to manage urine retention for a dying patient. 16. When caring for a dying patient I have been involved making the decision to cease routine care and focus on comfort care. 7. I have managed physical comfort measures for a dying patient with the provision of an air mattress. 18. I have discussed the prognosis of dying with a patient in the dying phase 19. I have acted as advocate for a dying patient when he/she needed their wishes to be heard regarding treatment. 20. I have negotiated a cessation of diagnostic interventions for a dying patient Thank you for taking the time to complete this questionnaire. I sincerely value the important contribution that you have made to knowledge development in this area.