Discuss the role that grudges and rivalries play Essay

Discuss the role that grudges and rivalries play within â€Å"The Crucible† by Arthur Miller Arthur Miller’s play â€Å"The Crucible† is set in the 17th century in a village called Salem. It is written in the time of the McCarthy period in the 1950’s, when Joe McCarthy (senator of the USA) attacked people for communism. Joe McCarthy accused many people including Julius and Ethel Rosenberg for leaking information about the atomic bomb to the Russians; they were then executed on 19th June 1953. He even attacked Hollywood for communism; in one case he ordered Charlie Chaplain out of the USA for un-American activities. The trials carried out by Joe McCarthy were very flawed and there were numerous appeals. The McCarthy period started when the Russians joined the ‘nuclear club’ sooner than expected, and caused paranoia across the USA. This is reflected in the Salem society because the population of Salem started to blame people for witch-craft to get themselves more respect and to settle grudges. This was then named the witch hunt. It is a puritan society that believes they themselves were chosen by God. They also believe they could only work and pray; that the Universe was centred on God; and that man was sinful and corrupt but thankfully saved by God. Their society was ruled by religion and was very rigid. This is ironic because the lies and trickery performed by the girls of the council goes against the Salem society, and yet they believe what they say. Reverend Parris of Salem was a high-ranking individual who demands a lot of respect that he thinks he deserves. He is dogmatic and dominant and thinks himself to be the top man of Salem. His niece Abigail is soon to follow him by being a snob and constantly lying. Abigail is attracted to John Proctor, a man that in the Salem society is a dangerous man and is to be afraid of. Reverend Parris’ maid Tituba is a black slave in her forty’s from the Caribbean. She is an innocent women but trouble always seems to follow her. Betty Parris (Reverend Paris’ Daughter) is thought to have been consumed by the devil; she was involved in an act of ‘conjuring’ and was then left unconscious, this is when the witch-hunt began. The play is set in the 1962 witch trials of Salem . This is when people were blamed for witch craft to settle grudges and rivalries. The trials were flawed and even the jury was lying. This is linked to the McCarthy period because Joe McCarthy blamed others for communism to settle his grudges and rivalries against him. Abigail Williams is the niece of Reverend Parris. Abigail Williams is a young â€Å"strikingly beautiful† seventeen year old girl who is an orphan of low social status. She once had an affair with John Proctor when she was his maid; she was then ordered out of their house after John Proctor’s wife, Elizabeth Proctor, discovered this. Abigail Williams has a grudge against Elizabeth Proctor. Abigail is an aggressive woman, â€Å"I’ll beat you Betty! † From this, the audience can tell how far Abigail will go to get out of trouble. In addition to this, we recognise how cruel and selfish she is. Furthermore, it shows that she doesn’t care about anyone other than herself; not even her cousin. Arthur Miller portrays Abigail Williams in this manner to shock the audience by presenting Abigail Williams as an outcast compared to all the other women in the village. When women are addressed in the Salem society, they are usually referred to as â€Å"Goody†; this isolates Abigail Williams because her reputation is â€Å"blackened in the village†. Abigail Williams has strong feelings for John Proctor after the events which happened when Abigail Williams was John Proctor’s maid, â€Å"Gah! I’d almost forgot how strong you are, John Proctor! † From this quote the audience can connote the deep feelings that Abigail Williams has for John Proctor. Use of the word â€Å"forgot† shows the audience that Abigail Williams and John Proctor had a past life together. This also outlines Abigail Williams grudge against Elizabeth Proctor. In addition, the stage direction â€Å"she comes a little closer, with a confidential, wicked air† shows the deep temptation that Abigail Williams has for John Proctor. Abigail Williams has made a confliction for herself between John Proctor and herself, â€Å"My wife is innocent, except she knew a whore when she saw one! † By use of the word â€Å"whore†, John Procter immediately shows the audience the disgust he holds for Abigail Williams for ruining his love life with Elizabeth Proctor. In later acts, John Proctor further shows the audience that he hates her for what she has done when he says â€Å"A whore’s vengeance†. By saying this John Proctor shows the audience how much his life has been ruined due to his affair with Abigail Williams. Abigail Williams holds strong grudges against Elizabeth Proctor, â€Å"It’s a bitter woman, a lying, cold†¦ † This quotation shows the outright hatred she has for Elizabeth Proctor. By referring to Elizabeth Proctor as â€Å"it† shows a lack of respect because she talks about Elizabeth Proctor as if she was an object. Furthermore, Arthur Miller uses the rule of three to emphasise her pure hatred against Elizabeth Proctor. The words that Abigail William’s uses sound cold and dirty, this emphasises her rivalry against Elizabeth Proctor because Abigail William’s is trying to make Elizabeth Proctor sound like she has no heart. When Abigail Williams is introduced, Arthur Miller makes us question her character, â€Å"with an endless capacity for dissembling. † This stage direction shows the audience that Abigail Williams has a bad reputation. The use off the word â€Å"endless† shows that she will stop at nothing to get hew own way; it also puts the audience at the edge of their seats. Abigail Williams also has a reputation for doing anything to get herself out of trouble, â€Å"Not I, Sir- Tituba and Ruth. † The audience recognises that Abigail Williams will lie to get herself out of trouble. This is linked to the McCarthy period where people would blame other’s to climb higher in the social ladder. Arthur Miller also introduces the fact that Abigail Williams is ruthless, aggressive and selfish to the people that surround her. This is reflected in modern day life because Joe McCarthy was also very ruthless to his grudges and rivalries. The girls of Salem are scared by Abigail Williams because she is wicked and sly to them, â€Å"Let either of you breathe a word, or the edge of a word, about the other things and I will come to you in the black of some terrible night and I will bring you pointy reckoning that will shudder you. † From this speech by Abigail Williams the audience can see Abigail Williams controlling the other girls that danced with her in the forest. By use of the word â€Å"black†, Abigail Williams tries to remind the other girls of the devil and scare them. In addition, â€Å"pointy reckoning† is used to scare the girls because it reminds them of the devil and they are extremely religious. Even the â€Å"der† in â€Å"shudder† provokes the feeling of endless pain. Abigail Williams developed her violent lifestyle when she was young, â€Å"I saw Indians smash my dear parents’ heads on the pillow next to mine, and I have seen some reddish work done at night. † From this the audience can sympathise with Abigail Williams because she had a troubled child hood. However, Abigail Williams uses this speech to terrify the girls that danced with her in the forest. The phrase â€Å"next to mine† emphasises the close shave of death that Abigail Williams has had; she introduces to the girls that she has seen someone killed and she knows what its like. Abigail Williams enhances the fact that she has no problems to kill the girls of Salem by saying â€Å"I have seen some reddish work done at night. † In addition, the personal pronoun, â€Å"I† underlines to the girls that she will do it herself. â€Å"Reddish† also enhances the gory and graphical image that Abigail Williams is trying to create inside the other girls heads to scare them further. This imagery does not scare Abigail William’s because she has seen it happen and she is not afraid. Abigail Williams is very good at lying, â€Å"If the girls a saint now, I think it is not easy to prove she’s fraud. † From this dialogue by John Proctor, the audience can see that Abigail Williams has persuaded the court that she is a good citizen of Salem. Using the word â€Å"saint†, John Proctor evokes the feeling that Abigail Williams has got herself a good reputation in the court’s mind. Reverend Parris is the towns Reverend. He has worked very hard to get in his position and he wishes to keep it. However, from Reverend Parris’ high status, he has become very paranoid. This is reflected in the McCarthy period because Joe McCarthy became Senate of the USA and he also got very paranoid. Reverend Parris is obsessed with his reputation and strides for a high status within the Salem society,† he cut a villainous path. † This stage direction evokes the feeling that Reverend Parris is not entirely honest; the use of the word â€Å"cut† connotes that he some how cheated his way to this high ranking authority in the community. This reflects the time in which Arthur Miller was writing The Crucible because Joe McCarthy blamed people for communism to stay as the Senate of the USA. In Act One, Reverend Parris shows his concern for his high status and authority, â€Å"Abigail, I have fought here three years long to bend these stiff-necked people to me, and now, just now when some good respect is rising for me in the parish, you compromise my very character. † From this quote the audience can see how paranoid that Reverend Parris has become. â€Å"Stiff-necked people† enhances the corrupt view of Reverend Parris has on the people of the Salem society; it also puts emphasis on the amount of grudges and rivalries that Reverend Parris has. Reverend Parris is obsessed with his high social status, â€Å"I am not some preaching farmer with a book under my arm; I am a graduate of Harvard College. † From this quote the audience can see that Reverend Parris is trying to make himself look more important. The use of the word â€Å"some† show that Reverend Parris doesn’t think himself to be just anyone. Reverend Parris also uses the word â€Å"farmer† to emphasise on his high education at Harvard College; also he uses â€Å"farmer† to belittle John Proctors low education and simple life and job. Reverend Parris is so eager to rise in social status that he shows little care for his own daughter, â€Å"They will howl me out of Salem for such corruption in my house. † This quote connotes the fact that Reverend Parris does not care about Betty Parris, who is his own daughter. From the word â€Å"me† it is highlighted that he doesn’t care about his family; he just simply looks after himself and his authority. Furthermore, â€Å"howl† puts even more emphasis on how Reverend Parris thinks his grudges and rivalries will attack him if they think that he is corrupt. This is mirrored in the McCarthy period where Joe McCarthy blamed others for communism to make himself rise in the social ladder.

The Key Elements For Human Happiness Essay - 2093 Words

Arriving at a definition of happiness is no simple task. Philosophers and scientists alike have researched the subject of happiness for some time and there is no one simple answer as to what happiness is or what makes people happy. This mix of factors that contribute to an individual’s happiness are often unique to that individual. At the most basic level, a happy person may be defined as â€Å"someone who experiences frequent positive emotions †¦ and infrequent (though not absent) negative emotions† (Khoddam, 2015). This definition, while very broad in scope, provides a solid foundation for understanding happiness. Carl Jung, considered by most as the founder of analytical psychology, defined the five key elements for human happiness: 1) Good physical and mental Health 2)Good personal and intimate relationships, such as those of marriage, the family, and friendships 3) The faculty for perceiving beauty in art and nature 4) Reasonable standards of living and satisf actory work 5) A philosophic or religious point of view capable of coping successfully with the vicissitudes of life (Rubin, 2012). Each of these 5 points will be discussed in this paper, after first covering the topic of GDP and equality. For different people, the definition of happiness is different. For the country, it is almost the same. 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Huxley shows that no amount of stability and happiness is worth the loss of everything that makes us human. That means a utopian society isRead MoreBuddhism, Hinduism, Confucianism And Monotheistic Religions1108 Words   |  5 Pagesmankind to the path of happiness, pleasure and contentment as well as, savior from suffering an d degradation. A final religion placing importance on the concept of the â€Å"self† is Taoism. Taoism is known as a religion as well as, a philosophy. In Taoism, the pursuit of happiness, the embrace of wonder and joy through the trials of life, is the primary teaching. Hinduism is religion and way of life that was born in modern day India. Enlightenment of the self is a key element to the religion. The pathRead MoreThe Positive Side Of Interpersonal Communication1126 Words   |  5 PagesIn the following answer, I will be addressing how we can be communicating in ways to enhance our quality of being human with others and in turn, hopefully allow other human beings to enhance their interaction with their world as well. I will discuss the areas in the first three chapters of the book â€Å"The Positive Side of Interpersonal Communication by Thomas J. Socha and Margaret J Pitts. This book is a collection of articles comprised by some of the best people within the communication field. The

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Shiloh Essay - 1579 Words

Norma Jean Moffit is a simple, southern woman, but she is also a caterpillar who is discovering that there is more to life than crawling around on the ground. She has with-in her, the power to grow wings and fly away; The opportunity to view the world through the eyes of a butterfly. Since Larrys accident, she has come to realize that she has reached a crossroads in her life. If she goes straight on through, complacency and neglect are the only stops ahead. If she veers to either the left or right, there is mystery, knowledge, and change; The opportunity for a new life. It would appear with-in the story, she has opted for some change, and begins her adventure in experiencing new things such as quot;... cooking unusual foods - tacos,†¦show more content†¦quot;He has a steel pin in his hip. He will probably not be able to drive his rig again.quot; His truck quot;sits in the backyard, like a gigantic bird that has come home to roost.quot; are both symbolic of his coming home, l ounging around the house, and not quite knowing what to do with himself. He tries putting together some crafts and models, as well as trying his hand at needlepoint. He doesnt appear to possess any motivation, nor does he appear to have any direction in his life. Leroys life, as it stands, has become very complacent. quot;While on the road, he would pick up hitchhikers and tell them his life story. In time he had the feeling that hed been telling the story over and over....quot; Nothing in Leroys life has changed so drastically, as to place any variations in his story. Leroy drives around town by himself quite a bit, and he is quite careless in his driving habits. quot;He almost had one or two accidents, but having an accident in a car seems minor to him.quot; suggests that he knows that his life has no direction and it seems inconsequential to him. Leroy has this crazy idea about building a log cabin and had even sent away for the blueprints. quot;Ever since they were married, he h as promised Norma Jean he would build her a new home one day.quot; Leroy believes that building that house would bring them closer together, but it isShow MoreRelated Shiloh Essay1192 Words   |  5 PagesShiloh After Shiloh the South would never smile again. Known originally as the Battle of Pittsburg Landing, The Battle of Shiloh was the bloodiest battle fought in North America up to that time. Pittsburg Landing was an area from where the Yankees planned to attack the Confederates who had moved from Fort Donelson to Corinth, Mississippi. 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However, few disagree that the issue of slavery (and the status assigned to black Americans) had been eroding relations between Northern and Southern states from the first days of American independence, and culminated in actual armed conflict shortly after Abraham Lincoln’s first election to the presidency in 1860 (â€Å"The American Civil War,† n.d.). On April 12, 1861 Confederate troops underRead MoreInvestigating The Battle Of Shiloh1105 Words   |  5 PagesFor my battle analysis assignment, I have chosen to examine the battle of Shiloh. This battle began April 6 – 7 1862, in the Pittsburg Landing area of Tennessee. In Hebrew Shiloh, means â€Å"peace† nonetheless, this battlefield was far from a place of peace from April 6-7 1862. This battle was the bloodiest civil war battle to date and occurred between the Union and Confederate armies. 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However, the main battle of the book, the Battle of Shiloh, takesRead MoreThe Battle Of Shiloh : May It Never Be Forgotten2315 Words   |  10 PagesThe Battle of Shiloh: May It Never Be Forgotten On April 5th, 1862, the fields and thickets surrounding Shiloh church was just another peaceful backwoods landscape. Soon it would undergo a horrific transformation. The cheerful chirping of birds would be replaced by whizzing of flying pieces of metal shot with the intent to kill. The green grass of the hillsides would be trampled and splattered his blood and gore. Instead of the plains being inhabited by the occasional deer, they would beRead More Shiloh Essay1234 Words   |  5 Pages The Second Battle of Shiloh nbsp;nbsp;nbsp;nbsp;nbsp;The switch to college life can definitely change people. In high school, one makes friends that will hopefully last a lifetime. Then comes senior year, and after all the college admissions letters have been received, one must face the realization that his/her best friends will not be by their side 24 hours a day / 7 days a week any longer. Still ecstatic by what this new life, college, holds for them, students enter into their chosenRead MoreHistory of the Battle of Shiloh1902 Words   |  8 PagesBattle of Shiloh is historically known as one of the bloodiest battles of the Civil War. Part of the Western Campaign, Shiloh came on the heels of Union victories at Fort Henry and Fort Donelson, primarily as a Confederate attempt to halt the Unions advance into the deep South. Though causes of the Union victory at Shiloh may be disputed, the significance of this Battle to the Wars outcome is undeniable. Analysis When, Where and Why the Battle of Shiloh Took Place The Battle of Shiloh took place

Taking Advantage free essay sample

A study on the use of fallacious argument in advertising today. This paper examines the use of fallacious argument in advertising today. It describes that consumers must be critical and aware of the facts presented by the advertiser and that advertising as a whole, is one with many gray areas and should be treated as such. The author writes, because the power of advertising the power of words, images, context, and connections has become so fully developed, it remains imperative that the public view advertising critically to determine its veracity before accepting the ads messages. Advertisements are prolific in todays consumer-based world. Indeed, so important is the construction of effective advertising that many corporations and agencies utilize plethoric methods and strategies to make their ads successful. This does cause a problem: many of these are tainted with fallacy and exude false innuendo, thus misleading or confusing the public (U-Haul Intern v. We will write a custom essay sample on Taking Advantage or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Jartran, 1994). Because the power of advertising the power of words, images, context, and connections has become so fully developed, it remains imperative that the public view advertising critically to determine its veracity before accepting the ads messages.

Sports Physical Education Essay Example For Students

Sports Physical Education Essay Physical Education is the basis of all sports. Throughout life we as Americans are exposed to physical education in elementary, secondary, and high school, therefore much of our athletic ability is due to our physical educational backgrounds. As in the theory of Existentialism our skills, values, etc., are all products of what we learned. Physical Education is a very important tool in helping the positive development of children in schools today. Any professional athlete today has probably had some sort of physical education in his/her life. Physical Education should be included in all schools and should be mandatory up until the last year of high school. Sports has probably been the best form of entertainment the world has ever experienced from the beginning of time. But, has sports been taken out of context? Being a professional athlete entitles one to be paid, but what about the programs that have been setup for college athletes. These particular programs allow alumni to adopt the student yea right! Colleges are becoming more and more corrupt and more restrictions should be put on them. Pragmatism states that individuals experiences are achieved through experimentation, and one cannot fully criticize the colleges nor the students without being in their shoes, but my point of view is that professionals should be paid for their skills, not college athletes . We will write a custom essay on Sports Physical Education specifically for you for only $16.38 $13.9/page Order now

Mobility in stroke rehabilitation Essay Example

Mobility in stroke rehabilitation Essay Mobility in stroke rehabilitation BY Itsas0101289 Mobility in Stroke Rehabilitation The purpose of this assignment is to identify the nursing role in the mobility rehabilitation of a patient who had a lacunar ischaemic stroke affecting the right corona radiata. The nursing care and the interdisciplinary management of the impairment will be critically evaluated as well as the patient progress during the stay in the hospital. The patient that will be discussed in this assignment was given the pseudonym of Martha. Martha is a 76 year old female who had a lacunar ischaemic stroke of the ight corona radiata. She has relevant past medical history of hypertension. on admission, Martha was presented with weakness on her left side in both her leg and arm with sensation preserved and no cognitive impairments. The corona radiata is a white matter that contains both descending and ascending axons that carry information from and to the brain cells that make up the cerebral cortex, an area of the brain that is responsible for the processing of conscious information and where the orders to initiate voluntary movements (walking, tapping your foot) first originate (Similima, 2011). These areas of the nervous system activate muscles all over the body to move. Therefore if the corona radiata is affected by a stroke, movement will be interrupted. The type of stroke that affects the corona radiata is called Pure motor stroke and is the most common type of lacunar strokes, accounting for more than 50% of all cases (Similima, 2011). Pure motor strokes cause partial or complete weakness in the face, arm and leg on one side of the body. It can occur in any of these areas, alone or in combination with either of the other two. We will write a custom essay sample on Mobility in stroke rehabilitation specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Mobility in stroke rehabilitation specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Mobility in stroke rehabilitation specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Most commonly, pure motor strokes cause either a combination of arm and leg eakness, sparing the face (this is the case of Martha), or a combination of arm, leg and face weakness. By definition, there is no loss of sensation anywhere in the body, no visual or speech symptoms or higher cognitive impairment (Wityk and Llinas, 2007). The hemiplegia is one of the most common neurological impairments following stroke and it needs to be managed by every member of the medical team all patients have the benefit of the range of expert advice needed for high quality care (NHS, 2010). Multidisciplinary teams (MDT) need to bring together staff with the ecessary knowledge, skills and experience to ensure high quality diagnosis, treatment and care. The MDT meeting is about considering the patients individual case not Just about treating a stroke. To support this, an MDT should take account of the patients views, preferences and circumstances wherever possible when consulting on the care that is most appropriate for the patients condition. MDTs should be alerted if there are significant changes to their recommendations and the reason for this is so they have the opportunity to review and build upon each case The aim of the Multidisciplinary approach to a patient who suffers from a motor impairment is to maximise functional ability by providing time, space for activities, aids and equipment, preventing injury and promoting safety (Woodward and Mestecky, 2011). When caring for a patient it is of the utmost importance to ensure there is no further injury, therefore the communication within the team is crucial. Every member of the team should know what the patient is able to do and how they should be cared for to gain the best rehabilitation. Marthas case was approached this way and her status was discussed twice daily in the handover. Also during the day it is the nurses duty to speak the physiotherapist and get her recommendations. When possible, I found very helpful going with the physiotherapist and doing the daily exercises together enabling me to get a better understanding of Marthas condition and Martha seemed to like the added support. This also gave Martha more confidence around me when doing transfers as sometimes it can be very scary for a patient trying to mobilise when suffering from hemiplegia. Along this the Multidisciplinary meetings were done twice a week with the consultant, the hysiotherapist, the occupational therapist, the ward sister and myself or the nurse who was on duty looking after Martha. Correct positioning and early mobilisation of a patient following stroke is important in preventing potential complications arising from impaired movement which can develope changes in muscle tone such as spasticity. Around 19% of patients suffer spasticity following a stroke associated with pain and which interferes with rehabilitation interventions (Woodward and Mestecky, 2011). On admission the physiotherapist performed the Modified Ashworth Scale and Martha scored 1 which eans that there was slight increase in muscle tone. This was manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension (Bohannon and Smith, 1987) (Woodward and Mestecky, 2011). From the beginning Martha used to hate being in bed and after being assessed by the physiotherapist making sure she was safe to do so she used to spent most of the time sitting in the chair provided. She was educated to sit well back and in the centre of the chair placing the affected arm well forward n a pillow with the feet flat on floor and knees directly above the feet. She was very comfortable in that position and she always had the nursing bell close to her and used to call us if the pillow fell down or when similar issues arose. However, there were times that Martha was feeling tired and she had to spent longer periods resting. While in bed she usually prefer lying on her affected side so she could be more independent. She liked having two pillows for the head and the affected shoulder was moved well forward placing the good leg forward on a pillow and another pillow placed behind her back. Although her preference was lying on the affected side, after being educated of the complications of immobility she didnt have any problem to lie on the non affected side, especially during the night. The affected shoulder was placed forward with arm on pillow and the affected leg backward on a pillow. Plus an extra pillow was also placed behind her back. Another action taken postulated to be secondary to promotion of anti-gravity muscle activity in the trunk and lower limbs, maintenance or improvement in soft tissue and Joint flexibility, modulation of the neural component of spasticity through prolonged stretch and ltered sensory input, reduction of lower limb spasms and positive psychological effect (Stevenson VL, 2010). At the beginning this was Just carried out by the physiotherapist with the nurses help for safety reasons. Active movements were also performed to increase strength, re-educate movement patterns and improve cardiovascular fitness. Active movements should be encouraged because the effects are greater than those seen with passive exercise alone. These benefits have been seen in studies of people suffering from a stroke (Stevenson VL, 2010). Marthas rogress was incredible and when she left the hospital she was able to walk with a walking stick and the supervision of her daughter or with a zimmer frame and the Modified Ashworth Scale score was O. This was an achievement as when she came she wasnt able to mobilise at all. Another complication that can occur as a consequence of having a mobility reduction is the damage of the skin integrity therefore several tools were done to assess this risk. Within the first 6 hours of admission every patient needs to be assessed using the waterlow assessment and the MUST nutritional screening, also the skin needs to be inspected. Martha got a waterlow score of 17 on admission which placed her at high risk of developing a pressure sore, she was continent of faeces and urine and no pressure sore was found on admission. The taken actions according to NICE guidelines 2005 were to provide her an air mattress, to place her in a position chart ensuring that the prolonged pressure on bony prominences was minimised and ensuring the correct usage of manual handling devices in order to minimise shear and friction damage. Two sliding sheets were provided and the bony prominences were kept from direct contact from one another by using pillows in between them. At the beginning Martha found very difficult to get used to sleep on an air mattress because of the noise but the benefits of using it were explained and she agreed to use it. By talking to her I discovered that she loved listening to music when she was going to sleep and the following day when her family came to visit her, the difficulty of sleeping because of this device was discussed and they brought Marthas iPod with her favourite music which helped her to sleep peacefully through the night. Having a good night sleep is very important for any patient, specially for those who re having rehabilitation as they require a lot energy and strength. Additionally skin inspections were done regularly and Martha, as she wasnt mentally impaired was taught how to inspect her skin. She was shown what the high risk areas were (heels, sacrum, ischial tuberosities, elbows, temporal region of skull, shoulders, back of head and toes) and early signs of skin integrity deterioration (persistent erythema, non- blanching erythema, blisters, discolouration, localised heat, localised oedema and localised induration) (NDNQI, 2013). Regarding general hygiene, Martha required assistance due to her mobility impairment. Such care was provided regularly according to the RCN guidelines that recommends that skin cleansing should be done with mild detergents using warm water to minimise irritation and drying and particularly over bony prominences should be avoided (RCN, 2009). Martha was always very helpful and used to do as much as she could by herself, at the beginning she required more assistance but by the end of her time at the hospital we Just needed to supervise her when going to the shower and she used to do everything by herself. She usually liked to have her shower after the physiotherapist session and his preference was respected as much as possible. Also she didnt like to use the hospital clothes which according to her made her look less sick so the family brought her own clothes. The MUST score obtained was 1 on admission. Adequate nutrition is required by the body for maintaining tissue integrity and preventing tissue breakdown (NPUAP,2009) Due to this score Martha was put on food chart which helped us monitoring her food intake along with daily weight measurements and she was also referred to the dietician on the day of admission who put her on food supplements and which were discontinued when Martha started having a etter food intake. The family was made aware of the importance of having a good food intake and they brought Martha her favourite cakes and homemade food. At the beginning Martha needed assistance with feeding herself as she wasnt able to cut her food, opening leads etc. Assistance was given regularly and the kitchen staff was made aware about her requirements, therefore before serving her food they always used to come and talk to us first as it can be very frustrating not being able to feed yourself and have the food in front of you. Martha had a good progression during her tage in the hospital and she put on 3kg, her food intake was appropriate and she didnt develop any pressure ulcer. When the mobility of a patient is reduced the risk of VTE (Venous Thromboembolism) increases and therefore in a patient who suffers from hemiplegia after stroke should be assessed for this risk and preventive measurements should take place. According to The National Institute for Clinical Excellence (NICE, 2010), recommendations are that all patients should be assessed for risk of developing thrombosis (blood clots) on a regular basis. Martha was assessed on admission scoring 8 using the adapted tool rom Autar 2003 (Version 2PT 5/12) She was assessed again 24 hours after admission and when her mobility was better she was reassessed scoring 5. Because of the risk of developing a WE Martha was put on Enoxaparin and all the effects and risks were explained. Current NICE guidance suggests LMWH (Low Molecular Weight Heparin) prophylaxis for acute medical patients at WE risk unless there is a high bleeding risk (NHS, 2012). Stockings were not put on her because according to the Clots in Legs or Stockings after Stroke (CLOTS) trial 1 GECS (can even present a greater risk to patients f skin breaks, blisters, ulcers and skin necrosis (CLOTS Trial Collaboration, 2009). Early mobilisation is fundamental to prevent WE along with more risks and that is why this patient was mobilised as soon as possible with the physiotherapist support (NICE, 2010). A very weak arm due to its considerable hanging weight, is at risk of stretching the shoulder Joint structures and developing a partial dislocation or subluxation (Turner- Stokes and Jackson, 2002). Shoulder subluxation is considered a problem because it Many studies have suggested that trauma to the shoulder Joint can be prevented by roper positioning and handling. The shoulder should be protracted, the arm forward, the wrist in neutral or slight supination and the fingers extended. Another important aspect that needs to be considered is not to pull from limbs when doing transfers, especially from the affected one. Therefore Martha and family were educated not to do so. An arm sling was provided to her to support the affected arm. However,the sling was only used while doing transfer. When she was sitting on the chair a lap tray was provided positioning the arm away from the body, discouraging dduction and internal rotation and allowing bilateral upper limb activities (Turner and Jackson, 2002). Martha didnt develop a shoulder subluxation during her stage in the hospital. This was confirmed by an X-Ray that was taken to ensure there was no underlying problems. However she had pain on the shoulder and that is why this X- Ray was performed initially. Hemiplegic shoulder pain, or post stroke shoulder pain, occurs in at least 30 percent of patients although another estimate placed it at 70 percent . Post stroke shoulder pain can adversely affect both length of in patient ehabilitation and overall functional outcome (Woodward and Mestecky, 2011). Martha was on regular paracetamol but she wasnt put on NSAlDs from the beginning. When she started to feel this pain the consultant was informed who requested an X-Ray, the physiotherapist and the rest of the team were also made aware of the troubles. The consultant also put the patient on PRN Ibuprofen which was very effective in reducing the pain levels. I consider that the approach to this risk wasnt the most effective one as Martha suffered from shoulder pain and it can be an area to improve for future patients. However the communication within the team was very successful and the problem was solved in a short period of time. Another recommendation for the future supported by evidence based documentation could be the practice of passive movements which improve the spasticity (Lynch, et al. 005). After suffering a stroke the person can suffer an alteration on the body image understanding as such as the beliefs and feelings about how our bodies look and function. This is influenced by what we think we should look like, and how we think our bodies should perform. In Marthas case the main issue for her was the loss of unctionality of half of her body. Martha went from being able to perform all the activities of the daily life by h erself to require assistance for most of them. Successful adjustment and adaptation to this new situation depend on how well the acquirement of the new knowledge is and skills needed in order to get on with her life. (Woodward and Mestecky, 2011). The rehabilitation team role was crucial here because we needed to teach her new skills and this was achieved by good coordination and communication within the team. It was very important to proceed in the same way and reinforce the knowledge. As supportive measures a board was used to remind Martha the steps she had to follow and also it was very helpful for her family as they knew which was the appropriate way to help her mother. Also setting realistic goals was very positive for her as every day she had a new challenge to achieve and that kept her motivated. Motivation also plays a vital role in with the way in which a patient evaluates their chances of successful rehabilitation and that this is influenced by social or external factors (Woodward and Mestecky, 2011). Martha as already mentioned was always motivated to improve her skills and his had a very positive impact on her evolution. Also she had a very good support from her family who was always there to help her and a good support from the health team. After 5 weeks of rehabilitation Martha was discharged being able to perform the activities of the daily life by herself, walking with a walking stick and assistance from her daughter or with a zimmer frame. She went to a nursing home for a couple of weeks while they were adjusting her house for her (she lived with her daughter). After she was seen by the team (consultant, physiotherapist) as an outpatient and she also came to visit the team to the ward. Reference list Bader ,M and Littlejohns, L (2004) AANN Core Curriculum for Neuroscience nursing. th edition. Missouri. Saunders Bohannon, R. and Smith, M. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy 67(2): 206. Jun Hao Pan, Xin Yuan Song,; Sik Yum Lee, Timothy Kwok, (2008) Longitudinal Analysis of Quality of Life for Stroke Survivors Using Latent Curve Models. 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