Learning Outcomes Assessment for Student Nurse

Learning Outcomes Assessment for Student Nurse Learning Outcome 1 – Pre-assessment The ultimate goal of the pre-assessment is to assure that those patients identified as suitable for day surgery are properly identified while those considered unsuitable for a selected procedure are identified early enough in the process to allow for other treatment options (National Health Services, n.d.a, p. 13). Although ultimately it is a joint decision between the surgeon and anaesthetist who make the final determination (National Health Services, n.d.b), the nurse plays a vital role in the process and should be involved in the selection criteria (Royal College of Nursing 2004, p. 1). Pre-assessments of patients scheduled for day surgery are usually performed by an outreach nurse from a day surgery centre, by telephone screening, or by questionnaire (National Health Services, n.d.a, p. 9) or via appointments with day surgery staff or in specialized pre-admission clinics (Joanna Briggs Institute 2004, p.2). Many institutions are combining pre-assessment interviews with the opportunity to work with the patient in a preoperative education status in order to decrease patient anxiety, assess the needs of the patient and/or family members and to personalise information (Joanna Briggs Institute 2004, p.2). The National Health Services (n.d.a, p. 11) states this is an effective opportunity to also discuss the surgical procedure in greater detail with the patient, note special requirements for admission, surgery and/or discharge and allow the patient to choose their own date for surgery, finalizing and/or setting the appointment. According to the Royal College of Nurses (2004, p. 3), nurses performing the pre-assessments must have the option of being able to contact the anaesthesiologist of surgeon if a problem is identified that could potentially increase the risk during anaesthetic or surgical intervention.† This is critical; otherwise, there is no apparent reason for the assessment if the nurse cannot raise her concerns. The National Health Services (n.d.a, p. 9) day surgery guidelines state pre-assessments performed as soon as possible following the surgical consultation can allow for treatment of underlying physical issues that might preclude them from the day surgery procedure, such as high blood pressure and/or arrange for home care. If this is not possible, the National Health Services (n.d.a., p. 13) recommends that patients should then complete a â€Å"health-screening questionnaire before leaving the outpatient department.† According to the National Health Services (n.d.a., p. 11), incorporating the pre-assessment step in the day surgery process has been shown to reduce surgical cancellations and increase communication across the multidisciplinary team. Based on research, it is important to note that the day surgery pre-assessment is a valuable tool that can help the patient, the perioperative and surgical nursing teams as well as surgeons and anaesthesiologists. The pre-assessment is a way of initiating a comprehensive set of documentation for the entire team. Learning Outcome 2 – Effective communication According to the Joanna Briggs Institute (2004, p. 4), caseload can determine the staffing mix required. The staffing mix for a day surgery centre, however, can vary from a group of individuals who work together on a regular basis such as the case in a specialized clinic setting to a group of individuals who rely on departmental shift staffing for perioperative nurses and surgical residents in a busy teaching hospital. No matter what the group mix is, however, the need for communication is critical to patient care in all settings, especially surgical, where according to Cowen et al. (2005) communication is especially challenging for workers in environments that are high stress and time sensitive. Vazirani et al. (2003, p. 72) states that improving the level of collaboration, not just communication, can enhance job satisfaction among medical professionals while increasing the quality of care and patient satisfaction. While traditional communication techniques such as â€Å"active listening, positive voice tone, [and] reiteration to confirm understanding† are desirable goals, in the surgical setting other barriers often compound communication problems, including status and posturing between doctors versus the communication found between doctors and nurses or nurses and nurse practitioners. Vazirani et al. (2003, p. 72) discuss the care nurse practitioners took â€Å"not to violate the autonomy of residents or interns [and] did not admit patients on their own or write orders without the consent of a resident or an intern.† Essential to a multidisciplinary team is the need for collaboration, where decision-making is a shared event for doctors and nurses and that open communication between the two professionals exists (Vazirani et al. 2003, p. 73). It is important to note that research demonstrates physicians view collaboration differently than nurses, such that physicians believe collaboration implies â€Å"cooperation with follow-through† pertaining to following orders rather than sharing in the decision making process (Vazirani et al. 2003, p. 75). Vazirani et al. (2003, p. 76) also cited nurses as not being provided timely or accurate information regarding patient information when physicians autonomously make a change in their normal protocol, stating nurses need the information most as they are the ones at the patient’s bedside. Communication is a commonly sited problem and is one that, despite all the best suggestions and recommendations, from outlining roles and responsibilities, collaborating as a team or mutual team members each afforded appropriate professional respect (Vazirani et al. 2003) to developing Integrated Care Pathways (ICPs) as outlined by Fisher and McMillan (2004) is difficult to remedy. Ultimately, human emotions and professional pride create unnecessary friction that discourages open communication for fear of reprisal. Cowen et al. (2005) emphasize the need for an accurate flow of information between various disciplines as the most critical aspect in order to assure patient safety. Learning Outcome 3 – Patient selection criteria Patient selection criteria primarily focus on three primary factors: surgical, medical and social (National Health Services, n.d.a, p.11; National Health Services, n.d.b.). Surgical criteria assess whether the procedure will leave the patient dependent on others and/or if it has a statistically significant postoperative morbidity level. The National Health Service (n.d.b.) states that the surgical procedure should take less than 1 hour, involve minimal blood loss, be unlikely to produce severe post surgical pain or nausea and be unlikely to result in a loss of physical independence. When assessing social appropriateness, according to the Association of Anaesthetists of Great Britain and Ireland (cited by Joanna Briggs Institute 2004, p. 2), the pre-screening interview is an opportunity to assess the patient’s willingness to have surgery, the certainty of adult care in the home following surgery, telephone access and taking into consideration the patient’s home situation. For example, are there several young children and toddlers or infants at home requiring constant care; is the only adult available to help the patient an elderly or frail individual, or has the patient stated they feel they are being pressured into having the surgery. These are all reasons that should be presented to the surgeon, anaesthesiologist and the rest of the multidisciplinary team as reasons the patient should be precluded from day surgery. Additionally, patients with a social history of significant levels of alcohol consumption and/or who smoke are indications of potentia l preclusion or the need for additional counselling prior to surgery (National Health Service n.d.b.). The Royal of College of Nurses (2004) also states that the patient must have the availability of an escort home following surgery and that the travel time home must be within one and a half hours; and if small children are present in the home that a caregiver is available specifically to tend to the children. Medically, it is important to assess cardiac fitness, assurance of height/weight appropriateness and if they are â€Å"physiologically under 70 years of age[1].† Exclusions are usually automatic if there is uncontrolled hypertension, recent history of cardiac failure, pregnancy, angina, asthma, diabetes or epilepsy. Additional issues that require notification of the appropriate medical personnel include prior difficulties with anaesthesia or current medications that would either preclude day surgery or require either a modification and/or temporary cessation of the pharmaceutical agent, particularly warfarin. The American Society of Anaesthesiologists’ (ASA) (cited by The Royal College of Nursing 2004) uses three classifications to assess physical status: Class 1: patient is mentally and physically fit and the surgical procedure is localized without systemic disruption, for example, removal of a uterine fibroid in an otherwise healthy female or the repair of an inguinal hernia in a healthy individual. Class 2: patient suffers from mild to moderate systemic pathology that is either caused by the pathology to be treated by the day surgery or by other pathology, for example anaemia or mild diabetes or slightly limiting organic heart disease. Class 3: patient suffers from a severe mental or physical disorder from whatever cause, such as angina pectoris, moderate to severe levels of pulmonary insufficiency, vascular complications from severe diabetes or significantly limiting heart disease. Criteria used for patient evaluation and assurance of fitness for day surgery as outlined above are focused primarily on the suitability for general anaesthesia without complication. It is essential however, to couple both the individual patient status as provided by the pre-assessment with the type of surgical intervention proposed. The medical professional cannot use the same set of pre-assessment criteria for all patients for all procedures; they must simply be a guide. For example, physiological trauma, anaesthetic requirements and post-operative pain are different for those having arthroscopy as opposed to a laparoscopic cholecystectomy or partial thyroidectomy. All three are considered day surgical procedures by the Royal College of Nurses (2004, p. 2). Patient selection criteria are important for nurses to understand from many aspects. The nurse has to understand the physician’s reason for suggesting day surgery for their patient, she needs to understand the surgeon’s belief in appropriateness and she has to understand the potential risks that are often overlooked by physicians and surgeons that now become her responsibility to ascertain. Although it is often a delicate position for the nurse to be in, it is essential that she bring to the surgeon or anaesthesiologist’s attention any patient not appropriate for day surgery. This is an issue of legal liability for all professions on the multidisciplinary team and for the clinic or hospital as well as one of ethical concerns for the patient’s overall care and wellbeing. Learning Outcome 4 – Pain management According to Lipp and Yap (2005, p. 64) prior to 2003, the responsibility for post-surgical pain was the sole responsibility of the anaesthesiologist and no routine or regular pain assessments were conducted. In 2003, pain management assessments and the nursing role in pain management in the day surgery setting became the standard. The Royal College of Anaesthetists (as cited by Lipp Yap 2005, p. 64) tell us that following a day surgical procedure, less than five percent of all patients should experience severe pain while up to 85 percent will have mild or no pain following surgery. Beauregard et al. (1998, p. 309) believes that it is not unusual for pain to persist during the entire week following surgery, but that the best predictor of significant post-surgical pain following hospital discharge was inadequate pain control during the first few hours of following surgery. Research has acknowledged that the longer an individual is experiencing pain that is not attended to or interrup ted in some way, the more sensitive to painful stimuli the patient becomes (Mukherji Rudra 2006, p. 355). Ultimately, the goal of effective post-surgical pain management is to be â€Å"safe and effective, produce minimal side effects such as nausea. It was stated that the criteria for patient selection should be individualized based on patient status and type of surgery. Similarly, Mukherji and Rudra (2006, p. 355) state that patients should be identified as potentially at risk based on â€Å"age, physical status, presence of pre-existing pain, site and extent of surgery.† Additionally, researchers believe that the amount of postoperative pain a patient experiences is also a factor of the surgeon and surgical techniques used ( Mukherji Rudra 2006, p. 356; Chung et al. cited by Beauregard et al. 1998, p. 305). Mukherji and Rudra (2006, p. 355) discuss several pain assessment tools: the visual analogue scale (VAS) where pain is rated along a continuum from â€Å"no pain at all to the worst pain imaginable† and the Oucher’s scale for children. Many patients themselves downplay post-surgical pain for reasons ranging from believing that pain is part of the natural recovery process and what they are experiencing is normal (Beauregard et al. 1998, p. 209). Post-operative pain management can take different forms, including pre-emptive analgesia and prophylactic analgesia (Mukherji Rudra 2006, p. 356). There are also pharmacologic and non-pharmacologic pain management interventions. Pharmacological interventions can be opioid or non-opioids. Opioids are centrally acting and systemic in nature whereas non-opioids are also centrally acting but have a peripheral mode of action, and include codeine, metamizol, paracetamol and non-steroidal anti-inflammatory (NSAIDS) (Mukherji Rudra 2006, p. 356). Another problem cited by the Joanna Briggs Institute (2004) is that of inadequate pain management techniques and/or follow-through by the patient place additional burdens on family caretakers and the community at large. For example, Girgis and Sanders (2004, p. 66) tell us that parents generally underestimate and under treat pain; this can be extrapolated to caregivers in the adult community as well. Home caregivers failing to recognize and/or intervene in pain management is often problematic and it is the responsibility of the nurse to assure that proper discharge information is adequately communicated to the patient and/or caregiver/escort, including proper pain management techniques and interventions. To assure there is no confusion, these should be clearly documented and reviewed with the patient and caregiver verbally. References Beauregard, L., Pomp, A. Choiniere, M., 1998. Severity and impact of pain after day surgery. Canadian Journal of Anesthesia, 45 (4), pp. 304-311. Fisher, A. McMillan, R., 2004. Integrated care pathways for day surgery patients. British Association of Day Surgery [Online]. Available from: http://www.bads.co.uk/pdf%20files/IntegratedCarePathways.pdf [cited March 17, 2007]. Girgis, M. Sanders, D. 2004. Are we giving our children the right dose? The Journal of One-Day Surgery, 14 (3), pp. 65-68. Joanna Briggs Institute, 2004. Management of the day surgery patient [Online]. Joanna Briggs Institute Best Practices. Available from: http://www.adsna.info/attachments/BPISSup.2004.pdf [cited March 17, 2007]. Lipp, A. Yap, H, 2005. Is our pain relief protocol effective? The Journal of One-Day Surgery, 15 (3), pp. 64-66. Mukherji, S. Rudra, A., 2006. Postoperative pain relief for ambulatory surgery. Indian Journal of Anaesthesia, 50 (5), pp. 355-362. National Health Services, n.d.a. Day surgery pre-assessment: A brief guide [Online]. Available from www.wise.nhs.uk/surgery/NationalGoodPractice/downloads/14/14d4.doc [cited March 17, 2007]. National Health Services, n.d.b. Day surgery: A good practice guide [Online]. Available from: http://www.wise.nhs.uk/sites/crosscutting/access/Access%20Document%20Library/1/Day%20Surgery/Day%20Surgery%20Guide.pdf [cited March 17, 2007] Royal College of Nursing, 2004. Day surgery information: Selection criteria and suitable procedures [Online]. Available from: http://rcn.org.uk/publications/pdf/daysurgery_selection.pdf [cited March 17, 2007]. Society of Critical Care Medicine, 2005. Tools for effective communication [Online]. Society of Critical Care Medicine. Available from: http://www.sccm.org/SCCM/Publications/Critical+Communications/Archive/February+2005/communicationsfeb05.htm [cited March 17, 2007]. Vazirani, S., Hays, R. D., Shapiro, M. F. Cowan, M., 2005. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. American Journal of Critical Care, 14 (1), pp. 71 – 77. 1 Footnotes [1] According to the National Health Service (n.d.b), the phrase refers to a patient who is â€Å"independent, active and compos mentis.†

Preschool Literacy Essay

2 This paper is going to outline the myriad of benefits that high-quality preschool literacy programs will afford families, communities, school districts and the world. Today, numerous researchers are delving into HOW to establish an effective and successful pre-school program. In this paper, I hope to answer several questions: ? What is pre-school literacy? ? What benefits do participants in a preschool program receive? ? HOW do we go about establishing a high-quality pre-school literacy program? I am rather passionate about this area. Being a speech pathologist, literacy skills and communication skills are so interwoven it is difficult to separate them. I have to say that while going to school many years ago, we didn’t learn that much about literacy as it related to speech and language development. It is only recently that researchers and educators have identified the importance of how both developmental areas are linked. I feel that establishing successful and highly effective programs that incorporate family and child directed activities are crucial to the success of our young students. That being said, let’s explore pre-school literacy. What is preschool literacy? Most people hear the word ‘literacy’ and equate that with ‘reading’. This would be an adult analogy. For very young children, we don’t, nor should we, expect them to read! Early literacy skills refer to many different things, none of which is sitting down with Mom at the age of two and reading aloud for her. At the youngest ages, early literacy skills refer to children’s exposure and experience with books. The following list is derived from Schickendanz (1999) and Early Literacy (www. zerotothree. com) . It states that early literacy behaviors include: ? Book handling behaviors – handling and manipulating the book ? Looking and Recognizing- how are they paying attention to the book, pictures, words; demonstrating recognition of pictures, etc. ? Picture and Story Comprehension – Imitation of actions noted in a story, talking about a story ? Story-Reading Behaviors – verbal interactions with the books, imitating a pointing a finger at words and/or pictures. ‘Establishing strong early literacy behaviors is essential to literacy development and should be the focus of early language and literacy programs’ (Early Literacy, 2003) It is suggested that these skills develop naturally and unfold as a result of social interactions with parents and caregivers, rather than direct instruction. I agree with this statement wholeheartedly. Ideally, it is everyday interactions with infants and toddlers that include talking and book reading that help establish the crucial beginning stages of literacy development. I recently heard on a radio program (can’t cite it) that children between the ages of 0-3 years should hear approximately 30,000 words a day to build an effective vocabulary! Amazing. Todd Risley, co-author of Meaningful differences in the 3 everyday Experiences of young American children (Mangione, 2005), states that isn’t an intentional teaching of these behaviors but rather embedded in the social interactions. He believes, as do I, that oral language skills appear to be the basis of phonological processing skills, which is a strong indicator for reading readiness in kindergarten. As children move into the preschool realm, (typically described as ages 3 through 5), prereading skills are developing along a continuum, rather than as a set of discrete and separate skills. In the article Critical Issue: Addressing the literacy Needs of Emergent and Early Readers (www. ncrel. org), the authors made a very interesting point I’d like to share with you. They discussed the various stages of literacy development that are not relevant to this article, however, an important transition occurs when a child’s â€Å"‘reading’ of a story changes from sounding like oral language to sounding like written language. This demonstrates a change in ideas from thinking of reading as spoken words to understanding that reading is recreated from written text that has special wordings† (McGee & Richgels, 1996;Sulzby, 1991). It is the beginning of the child’s print recognition. With respect to specific pre-school literacy behaviors that we should see addressed in a high-quality preschool program, the most important would be: ? Oral Language- engaging in rich conversational exchange with students, developing oral vocabulary, reading aloud daily, having children develop their own stories by looking at pictures (Tomie DiPola books are excellent for this) ? General Knowledge – what prior knowledge are the student’s coming into school with that they share, encouraging questions and new experiences with in the classroom, ? Print Awareness- being exposed to various written materials, some repetition of early literacy behaviors, point/drag techniques while reading ? Alphabet knowledge – the ABC song, recognizing sounds that letters make, letter recognition. ? Phonological awareness- Increased awareness of the sounds of the letters and how to play with them through rhyme, segmenting, blending, ? Pre-writing skills – later stages of development and exposure to writing mediums (pen, pencil, crayon, markers, paint), using journals with self-made pictures, word walls. (Roskos, K; Christie, J, Richgels, D, www. naeyc. org) How do participants in high-quality preschool programs benefit? I think I could go on for days about the benefits of an excellent preschool experience. For the sake of brevity, I won’t! Numerous studies have been conducted to determine whether preschool programs are beneficial and cost effective. The majority of studies suggest the answer to that is an overwhelming YES. 4 The Chicago Child Parent Center (CPC), the High/Scope Perry Preschool Program and the Abecedarian Project are all examples of highly qualified preschool programs. The CPC is recognized by the US Department of Education as an exemplary early childhood program. A comparison of the benefits of these programs was conducted, yielding what I thought were incredible results. These programs have been in effect since the 1960’s, servicing low-income areas in Chicago and Michigan (Lee, J, www.ccsso. org). In a speech given by Dr. W. Steven Barnett of the National Institute for Early Intervention Research in 2006, three separate studies compared the results of participants enrolled in the above-mentioned preschool programs against a control group that wasn’t enrolled in any preschool program. Their longitudinal studies revealed amazing results, which are credited to the attending of the preschool programs. According to them, participants in the program (as compared with non-participants): ? Were less likely to be enrolled in special education ? Had a higher rate of high school completion ? Demonstrated higher test scores ? Were less likely to repeat a grade ? Had increased earning after completing high school ? Engaged in less criminal activities ? Had a lower incidence of smoking, pregnancy and abortion. These benefits did not stop at the poverty line. They also demonstrated that middle class children benefited from the experience as well. He discussed the well-known fact that disadvantaged children benefit more when they are in class with children from different socio-economic backgrounds. An analysis I found very interesting was that ‘For every dollar invested into the preschool programs described in this paper $7 is saved in public expenditures’ (Lee. www. ccsso. org). WOW, think what that could mean to a superintendent’s budget! When trying to determine whether a preschool program could benefit those in the middle class, the US Dept. of Education, NCES, (1997) article entitled Dropout rates in the United States:1995 determined that middle class children have fairly high rates of the problems that preschool reduces for low-income children. While benefits decrease gradually with an income increase, the overall benefits are greater when ALL children are exposed to PreK. In an evaluation of 5 state prek programs conducted by Barnett,W. S, Lamy, C. and Jung, K. (2005), results revealed that in all programs, whether universal or targeted, students demonstrated gains in language, literacy and math. While all students (various SES backgrounds) gained, the low-income students gained more. Soooooo†¦Ã¢â‚¬ ¦ 5 How do we go about establishing high-quality preschool literacy programs? In an ideal world with unlimited funding, it wouldn’t be too difficult. However, we don’t live in an ideal world and much needed financing is often diverted to other important (or not so important! ) causes. Really, what is more important than education? One resolution could be to emulate the success demonstrated by the Chicago and Michigan programs spoken about earlier in this paper. In Rockland County, some school disctricts already offer a district-based preschool program. This year, all districts were alloted slots to participate in a Universal PreK initiative. However, while that is an excellent start to establishing a much needed entity, a lot of work still exists. During my research gathering I read many, many articles that discussed the family-centered literacy approach. Such as at the CPC, involving the parents and providing them with strategies and useful techniques to help their children empowers them and makes them feel useful and successful. Without parental involvement at the preschool level, literacy development suffers. Since the institution of NCLB, many school disstricts are seeking wasys to provide needed support to their students without it becoming a ‘special ed’ component or target program. Instituting a universal prek program benefits all. Looking at the various achievement gaps that Dr. Barnett identified in his paper, while there is significantly more of an achievement gap at the lower SES levels, there are still marked gaps in the middle class level, thus further justifying why ALL students would benefit from the experience. In an effort to establish successful high-quality preschool programs in Texas, the retired CEO of Texas Instruments was aware of the huge impact the Perry Preschool Program had on its communities and he was eager to replicate that success in Texas. Therefore, after establishing a successful pilot program, the participants wanted to be able to spread the success throughout the state and a handbook â€Å"Improving Early Literacy of Preschool Children’ was developed for prekindergarten educators. The authors and editors really were able to target what a high-quality program looks like with suggestions on how to implement them into your existing programs. The following steps are indicated to improve a preschool program: ? Set goals ? Create an improvement plan ? Build a classroom library ? Train the teachers and encourage collaboration? Keep rack of student’s progress ? Inform and involve parents 6 ? Communicate with elementary schools the children will attend ? Measure and document results (Dougherty, 1999) All of these steps are so important to developing a program that is successful. It is hard to determine whether one step is more important than another. Personally, I really feel that if the teachers and the teaching assistants and/or aides are given the proper training, every interaction with a child will take on new meaning. The Margaret Cone Head Start Center in Southeast Dallas has serviced predominantly low-income populations. As part of their language enrichment program (LEAP), each teacher attends six weeks of instruction at the nearby university as well as several workshops a year. Because of these teacher trainings, Cone Center children have produced improved scores on a variety of tests targeting vocabulary, language skills and social skills. I believe that involving the parents as much as possible and having them in the classroom for a half-day a week or twice a month lets them see what is happening and provides modeling they can use at home. Obstacles that I can identify at this point to establishing high-quality preschool programs that ALL children can attend include: ? FUNDING ? Private preschool programs vs. school district based programs ? Consistent participation on the part of the parents ? Difficulty providing quality training programs for the teachers and teaching assistants/aides due to lack of funding, time, resources While I feel there are many excellent examples of qualified and successful preschool programs in Rockland County, we do not meet the needs of all the children of the preschool age. As CPSE chair, I am able to provide special education needs to many children that require it. However, there is great variability between the programs that we recommend students attend. Consistent high-quality preschool programs would be beneficial to ALL students involved, not just the special needs children. In conclusion, it is a well-documented fact that preschool literacy education benefits all children involved. The need lies in our ability to establish high-caliber programs that are consistent, with staff that is well trained and caring. I think if we can distribute the information about the long-term effects researched and prove to the masses (school boards! ) that the bottom line would be cost savings to the community, we might see some change. I look forward to that day! References 1. Schweinhart, L. J. Lasting Benefits of Preschool Programs ERIC Digest. ericdigests. org. Retrieved February 25, 2008, from http://www. ericdigests. org/1994/lasting. htm 2. Dougherty, C. , et al. Improving Early Literacy of Preschool Children – a Handbook for Prekindergarten Educators. Texas Instruments, 1999. 3. Lee, J. The Benefits of Preschool for High School and Beyond. Council of Chief State School Officers. Retrieved February 25, 2008, from http://www. ccsso. org 4. Roskos, K. A. , Christie, J. F. & Richgels, D. J. The Essentials of Early Literacy Instruction. National Association for the Education of Young Children. Retrieved February 23, 2008, from www. naeyc. org/resources/journal 5. Mangione, P. L. (2005). Creating Language and Literacy Experiences for Infants and Toddlers. PITC Graduate Conference. Berkeley, CA. 6. Johnson, D. & Sulzby, E. Critical Issue: Addressing the Literacy Needs of Emergent and Early Readers. North Central Regional Educational Library. Retrieved January 21, 2008, from http://www. ncrel. org/sdrs/areas/issues/content/cntareas/reading/li100. htm 7. Barnett, W. (2006, Jan. 10). Research on the Benefits of Preschool Education: Securing High Returns from Preschool for All Children. New York, NY. 8. Brain Wonders. Early Literacy (2003). Zero To Three. Retrieved January 24, 2008, from www. zerotothree. org/BrainWonders

New Ideas Into Essay Samples Structure Never Before Revealed

New Ideas Into Essay Samples Structure Never Before Revealed The Honest to Goodness Truth on Essay Samples Structure There's, obviously, a limit on the variety of pages even our finest writers can produce with a pressing deadline, but usually, we figure out how to satisfy all the clients seeking urgent assistance. You may use the samples as a foundation for working out how to write in the proper style. Unique things to various folks, since the situation demanded. After discovering our website, you will no longer will need to bother friends and family with these kinds of requests. While the effect of vertical structure appears to exist the level of specialization still plays an extremely vital part in the provision of exclusive managerial solutions. The lower informational asymmetry may assist the practice of decision making and additionally help to produce increased information and offer more proficiency. This structure does a good deal for the total purpose of the epic. Thus, organizational structure is quite important today and it is crucial to grasp the performance of organizational structure will help to enhance the organizational performance consistently. Critical essays are absolutely common once you reach college, but you might not know just how to begin writing one. Please be aware that a few of these college essay examples could possibly be responding to prompts that are no longer being used. Students lead busy lives and frequently forget about an approaching deadline. Students must always remember that anIELTS essay sampleis extremely crucia l so as to find an education in the English-speaking nations. You see, the conventions of English essays are somewhat more formulaic than you may think and, in lots of ways, it can be as easy as counting to five. Essay writing skills is a tough and time-consuming undertaking. Students may purchase custom essay samples online and raise their odds of writing a superb paper. Most students don't know what an appropriate structure of an essay appears like, which is the reason why their writing skills leave a lot to be desired. Nevertheless, human interaction is still possible through the net and this essay disagrees technology ought to be dismissed because of this. Students often utilize search engines to answer a question and just copy the text from a site, in place of thinking about the question. Usually, they simply run over stimulus and prompt and begin to write immediately believing that they will save time this way. Sooner or later in the class of education, every student is going to have to compose essays, sooner or later. All the activities that are connected with each such function are put in the exact same unit. You should make certain you divide your primary body into structural segments, like subheadings and paragraphs so that it doesn't look so clustered and confusing to the reader. There are several sorts of structures that could get you a high score. Hence, you have to know the required basicsessay structure, specifically. It is very important to discover genuine sources which prov ide dependable and accurate information lest one's essay is full of lies and inaccurate info. In case the author is an individual, then their very first name is used first. Bridget's essay is quite strong, but there continue to be a couple little things that could be made better. Stephen's essay is quite effective. Although there's a consistent essay formula that will assist you to structure your essay and paragraphs, you will need to be careful of the various varieties of essay questions there are. Possessing an objective is indeed important to writing an adequate important essay and it is crucial to outline it clearly. The last portion of the simple essay structure is the conclusion. This essay structure example can help you produce a coherent and comprehensible essay which has a smooth flow and organized details. If you're to really gain from model essays, you want to understand how to read the techniques of the writer'. The introduction is part of an essay that sells the entire text to the reader. You may examine the extra info about how to compose an eye-catching essay introduction with a hook. Replace a number of the cliched language. Beginning an essay with a concise story has become the most common and effective of such techniques. To end the full essay, it's essential to make an overall concluding statement. The conclusion plays a critical role in the feeling it ties up the full essay. An essential essay conclusion isn't any different to other essay conclusions.

Essay on John Savage Desires What Makes - 1359 Words

Brave New World illustrates a world where everything that is morally right in our society, is wrong. Monogamy is sinful, massive orgies are not. Serious thinking is unnecessary because life has already been planned out. Hardships and stress can be solved with a few tablets of soma. This is the world which John Savage and others in the novel foolishly came to hate. All of the things that John Savage desires are the things that make our society unstable. Huxley uses John Savage to show the reader that this world is distopian, when this society is the closest example to a stable, utopian society. nbsp;nbsp;nbsp;nbsp;nbsp;Uninhibited sexual freedom provides happiness to this society’s citizens, the Fordians. Promiscuity is encouraged,†¦show more content†¦A current example of such a drug is marijuana. Users take this drug in order to lift themselves out of depression, or just for entertainment. The difference between Soma and marijuana is that soma is given out as a free daily ration. There are many people in our society that spend large amounts of money in purchasing these types of narcotics that are very dangerous and illegal. Soma, on the other hand, was developed by pharmacologists, so that use of the drug would not be harmful within reasonable dosages. As Mustapha Mond puts it, â€Å"†¦if ever by some unlucky chance, anything unpleasant should somehow happen, why, there’s always some to give you a holiday from the facts. And there’s always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half you morality about in a bottle.† (pg. 217) Soma is Christianity in pill form, as Mustapha Mond puts it. The user’s mind is cleared of hate, and replaced with love, harmony, and happiness. Instead of beating himself when he sins, he can take a gramme of soma and reconcile himself. nbsp;nbsp;nbsp;nbsp;nbsp;Stability is what makes the Fordian society utopian. Predestination is what makes the society stable. It may be unfair andShow MoreRelatedJohns Character Development A Brave New World1394 Words   |  6 Pagescan’t gain real acceptance from anywhere. John’s mother, Linda, is from the brave new world but gave birth to him in the savage reservation and her different behaviors based on the framework of the brave new world caused John’s isolation in the savage reservation. John decides to move to the brave new world and becomes popular in this society, but his identity, influenced by his â€Å"savage† culture, can’t be accepted by the community. His conflict with the brave new world finally forces him to try to changeRead MoreBrave New World By Aldous Huxley1293 Words   |  6 Pagescan’t gain real acceptance from anywhere. John’s mother, Linda, is from the brave new world but gave birth to him in the savage rese rvation and her different behaviors based on the framework of the brave new world caused John’s isolation in the savage reservation. John decides to move to the brave new world and becomes popular in this society, but his identity, influenced by his â€Å"savage† culture, can’t be accepted by the community. His conflict with the brave new world finally forces him to try to changeRead MoreJohn The Savage As A Dystopian Society1360 Words   |  6 PagesNew World, John The Savage has come to a part of the world he is not familiar with. This society is very different from the society he is use to; this dystopian society has mass-produced humans, so that everyone who is doing the same job is identical in appearance and skill level. John The Savage learns the hardships of being different and not quite understanding the World State’s way of living as the book progresses. In Aldous Huxley’s dystopian novel A Brave New World, John the Savage, MustaphaRead MoreJane Austen s The Of The Bathroom 1174 Words   |  5 Pagesand be more sexually open because she has been with Henry for four months. Being with one single person for a certain amount of time is against the flow of society in terms of normal sexuality. Lenina then mentions that she was invited to visit a Savage Reservation by hypnopaedia specialist, Bernard Max. When Lenina sees Bernard in person to accept his invitation, Bernard brushes it off and asks that they talk about it alone another time. Hearing this, Lenina goes off to see Henry while BernardRead MoreExploration Of A Brave New World1131 Words   |  5 Pagesof a Brave New Individual Envision a world without despair, and everything is designed a specific way. Total freedom and perfection. Utopia is an imagined place or state of things in which everything is perfect. Values are the determining factor to what inhabits a perfect society. 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The story contrasts two worlds: the traditional world where the â€Å"savages† reside and the new World State: a negative utopia where unrestrained sexual freedom, reproductive technology, and mind numbing drugs run rampant. Aldous Huxley was born in England, July 26, 1894 to an elite family of revered social status (â€Å"Aldous†)