Saturday, December 28, 2019

Hawaii, Hawaii And Las Vegas - 1119 Words

People are always talking about how much fun visiting Hawaii or Las Vegas was. When they describe the sites and their best attractions, one can only assume that these are the best places. Some people would rather visit other sites that have different attractions or activities that fit their desires. Hawaii and Las Vegas both have everything you can want; they have everything from the outdoors to the casinos. While Hawaii is obviously a different type of fun than Las Vegas nonetheless they both are enjoyable places. Hawaii and Las Vegas both have some of the greatest tourist attractions in the world. Hawaii is known for its beaches and relaxing outdoor entertainment. While Las Vegas is known for its partying and casinos. Hawaii is fun for the family as relaxation trip and Las Vegas is fun for people who are looking for parties. There are similarities between the two considering they both are some of the greatest vacation trips. A person could enjoy both sites equally without feeling l ike they are missing out on something that they wanted to do. They have the best tourist sites and create a fun experience for the people who visit. Hawaii and Las Vegas are the best places to visit, sight see, have fun, and relax with friends and family. Hawaii is like the outdoor fun vacation that everyone wants to experience. It has so many activities that one could only wonder how they would be able to enjoy all of them. Hawaii is known for its beaches, but they also have great campingShow MoreRelatedLegalized Gambling in Hawaii1683 Words   |  7 PagesCasinos in Hawaii: A Good or Bad Gamble? The streets of Las Vegas Boulevard, which are littered with advertisements picturing naked girls willing to provide their services for a price, can be a scary place as someone takes a stroll. Drunk men stumble out of strip clubs and casinos, and girls in gaudy clothing and stilettos apply lipstick at their post. 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Lobbyist would pay off debts for congressmen to get their votes. Full-scale gambling became legal in 1931 in the US. Hawaii and Utah are the only states that don’t have legalized gambling. Early US presidents George Washington, Thomas Jefferson, Andrew Jackson, and Andrew van Buren all enjoyed gambling. Washington bet on horse races and cards. Thomas Jefferson publiclyRead MoreTourism In America803 Words   |  4 PagesByrd Williams The United States of America The United States of America is a country with 50 states. Alaska is located in the northwestern part of North America, and Hawaii extends the nation into the Pacific Ocean. The capitol is located in Washington D.C. and its coordinates are 38.9072 ° N, 77.0369 ° W. There are several bodies of water around the United States such as the Pacific Ocean, Gulf of Mexico, and Atlantic Ocean. The weather varies all over USA. Summers are hot and humid in theRead MoreMy Mom Is The Only Child859 Words   |  4 Pagesin Texas. 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Friday, December 20, 2019

International Human Resource Management. Introduction.

International Human Resource Management Introduction Human resource managers, outlines, directs and facilitates the regulatory elements of an association. They supervise the selecting, meeting, and contracting of new staff; counsel with top officials on the key Strategic obligation; and fill in as a connection between an association s administration and its workers. To flourish in the disorderly and turbulent business condition, firms need to always enhance and be â€Å"on the ball† regarding business practices and methodologies. It is from this inspiration to be at the highest point of the pack that HRM turns into an important apparatus for administration to guarantee achievement. Banters about the significance of Human Resources†¦show more content†¦Relocation of employees has been frequently a need for the development and achievement of a business. Nevertheless, moving somebody can be costly and presents a few difficulties, especially if the individual has a family. When an HR manager based in Melbourne, Australia wants to relocate a manager to manage one of their subsidiary companies in London, there are challenges faced that must be considered. They include; Cost There will always be an expense when an employee is being relocated. The human resource manager has to consider the cost of relocating the manager to London. This includes travel expenses, housing, etc. It actually costs more to relocate an employee than to hire a new one. However, regardless of the cost, human resource managers will always opt for the most experienced with their company operations and objectives. This is, one of the main issues the HR manager will face while allocating the manager to London The willingness of the manager to relocate The human resource manager should be in the position to identify if the manager is willing to relocate. The employee is backed with strong laws that mitigate their rights and they cannot be abused by the employer. Nevertheless, there are also indicators that are strong determinants if the manager will agree to relocate.spouse or family is the most common of all. Employees with a family will analyze if relocation will beShow MoreRelatedExamples of Ihrm and Domestic Hrm Essay841 Words   |  4 PagesIntroduction The primary cause of failure in multinational ventures stem from a lack of understanding of the essential differences in managing human resources in foreign environments (Desatnick Bennett 1978). The world has become more globalized, competitive, dynamic and uncertain than ever before. As more and more firms operate internationally, the search for the elements of global competitive advantage is a prominent theme in the management literature (Dickman Mà ¼ller-Camen,Read MoreInternational Hrm : International Human Resource Management Essay740 Words   |  3 PagesInternational HRM is the interaction between the human resource functions, countries and types of employees1 - parent country nationals (PCNs), local or host country nationals (HCNs), and nationals from neither the parent nor host country but from a third country (TCNs). 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The purpose of this paper is to summarize the advantagesRead MoreWomen Expatriates1187 Words   |  5 PagesISM UNIVERSITY OF MANAGEMENT AND ECONOMICS INTERNATIONAL HUMAN RESOURCES MANAGEMENT BACHELOR STUDIES 3rd year students: Rasa Bartulyt Silvija Daikeryt Ieva Avulyt 2012 10 03 Women Expatriates Supervisor: Lineta Ramonien VILNIUS, 2012 Contents Introduction ..................................................................................................................................... 3 Women do not want to be international managers........................................Read MoreThe Impact Of Labour Flexibility On The International Management Of Human Resources1741 Words   |  7 PagesResearch critically discuss the implications of labour flexibility on the international management of Human Resources. Introduction In order to sustain in the business market and meet the consumer demands, the organizations and the employers of 21st century are required to come up with new methods and unbeatable prices of products and services. Moreover due to the emergence of globalisation, these organizations are bound to apply cost-cutting approach (lower wage approach), which influences theRead MoreOrganizational Culture And Human Resource Management1048 Words   |  5 Pages(1996) indicated that organization performance is better in the companies which there is congruency between national culture and human resources practices. If the human resources management practices are not in line with the basic tenets shared by employees, it will lead to dissatisfaction, lack of commitment and discomfort among the employees (Early, 1994). Introduction Culture affects and governs all facets of life by influencing values, attitudes and behavior of a society, while organizationalRead MoreCase Study : International Human Resource Management Essay1448 Words   |  6 PagesCase study Introduction The case study tells about the future profitable growth of the Padi- cepat a Malaysian company. The company has instant food, beverages and baking products business. In this company have different technologies for marketing strategies. Judgment is needed to identify the growth of the company so they look after the PBIT. In the time of 1990s they provide expansion opportunities Malaysian company pedi-cepat planned export offices in India, Singapore and Japan bit it failsRead MoreMicrosofts Human Resource Management Strategy679 Words   |  3 Pagesï » ¿Microsoft CORPORATION HUMAN RESOURCE MANAGEMENT STRATEGY EXECUTIVE SUMMARY The Company Profile: Microsoft Corporation Importance of Strategic Human Resource Management Talent Management Strategies Compensation and benefit packages for employees Policies and practices for Labor relations management Comparison with the Competitors Conclusion OBJECTIVES OF THE HRM STRATEGY To design effective talent management strategies; including recruitment and selection, motivation and retention, performance

Thursday, December 12, 2019

Reflection Clinical Incident Hiv free essay sample

ABTRACT Central Venous Catheter Blood stream infections (CVCBSIs) is a major cause of morbidity and mortality in patients with end- stage renal disease treated with chronic haemodialysis (Jaber 2005). The purpose of this review is to determine whether the use of Biopatch on the exit site of central venous catheter (CVC) can help prevent infection. Before any research was undertaken, a focused question was formulated and a search strategy was then developed to compare the available evidence. A PICO (Sackett et al 1997) was undertaken using the terms Central Venous Catheter, Chlorhexidine, Biopatch and Infection. A Facet analysis (Ranganathan 1967, cited by Spiteri 1998) was performed and a literature search was conducted using four electronic databases. This databases searches, contains both nursing and medical research and reviews. The databases used were Medline (1982-2011), CINAHL (1996-2011), Embase (1982-2011) and BNI (1982-2011) Mckibbon and Mark (1998) states that CINAHL and Medline databases are the most appropriate methodological to identify studies that report high quality research which can be used for clinical application. Most of the search result, produced articles that were Control Randomised Trails (RCT). Torgerson and Torgerson (2008), states that RCT is the gold standard for research method and for addressing the what? question in ‘evidence-informed’ policy making and practice. The literature search in CINAHL generated 145 article and limited to 2 articles which did not answer the question directly, however before the limits were applied two articles were found to relate to the question but one article answer the question and was a crossover intervention trail. The searches in BNI yielded 14 results and were limited to 1 article which did not relate to the question. Further searches in Medline and Embase, produced 19 and 21 results consecutively and none of this search answered the question. BACKGROUND The purpose of this research is to analysed published researched article on the effectiveness of Biopatch for the prevention of central venous catheter. Working in an area where CVC is being used, prompted the need to look for the best evidence available for the prevention of CVC line infection. There has been a steady rise of CVC infection in the past months and this has raised concern for both patients and staffs, as some of those patients affected had to have their lines removed, and even ITU admissions. In view of this problem, the need to look for preventive method prompted the question of the efficacy of Biopatch for the prevention of CVC. The life line of haemodialysis (HDX) patients, remain their vascular access. People with end stage renal disease (ESRD), requires a reliable access for their circulatory system to receive life sustaining HDX. The ideal access would be long lasting, free of complication and permits adequate flow rates to deliver effective treatments (Schwab 1997). 25% of hospital admissions for HDX patients are for access problems and access failure is a major cause of morbidity (Levy et al 2005). Central Venous Catheter (CVC) is an important aspect in HDX vascular access with 46% to 70% of patients commencing HDX through CVC; however it is a known risk factor for staphylococcus aureus infection and bacteraemia, ( sattler et al). Catheter related bacteraemia (CRB) include exit site infection, tunnel line infection and bacteraemia. CRB are the most common and important infection associated with CVC use and may be cause by a wide variety of gram positive and gram negative organism (Jaber 2005). There has been several preventive measures introduced to try and reduce the rate of CRB at the catheter insertion site or lines, this include the use of prophylactic topical antimicrobial ointments at the catheter exit site, the use of prophylactic catheter locking solution for prevention of CRB, strategies for management of the catheter and the use of vascular access managers and quality initiative programmes and also a dressing consisting of a biopolymer composite foam with antimicrobial agents are also being used to prevent infections. For an effective databases search, a clear question must be formulated. Craig and Smyth (2007) states that a carefully formulated question maximises the likelihood that relevant, high quality evidence is identified and incorporated appropriately into decision making process. Formulating question is a fundamental skill for evidence base practitioner and this help to focus search learning time on evidence that is highly relevance to patients needs (Cullum et al (2008). Sackett et al (1997) cited in Craig and Smyth (2007)devise a framework known as PICO for making question to be more focused. By structuring a question, the answer may be found more efficiently. The PICO divide the question into four key parts which are then the focused of the targeted literature search. According to Cullum et al (2008), the four key parts are P- population or problem, population is the client group or clinical condition or problem, I- intervention is the aspect of health care of interest or a action plan, C- counter intervention, the counter intervention involves choosing between the alternative cause of action or no action and O – outcome, is the result that is hope to achieve. A PICO format helps with the term that can be use to begin a search for answers, it also helps to narrow down and refine the question to obtain relevant answers and outcome. See the table below. Table 1: PICO POPULATION| INTERVENTION| COUNTER INTERVENTION| OUTCOME| Central venous catheter| Chlorhexidine| None| Infection prevention| By putting each part of the question into the appropriate column, eases the task of developing a searchable question. Devising a focused question can save a great deal of searching time with the key words of the question becoming the key term for the search. Nursing research aspire to improve the quality of care given to patients which provide nurses the opportunity to ask question about their practice and look for ways to improve them and to ensure that it is achieved and also based on evidence. This forms the background to which the focused clinical question arose â€Å"Does chlorhexidine sponge dressing (Biopatch) prevent exit site infection in CVC for patient undergoing HDX? The paper chosen answered the question and was a crossover intervention trail as reference below : Camins et al (2010) A cross over intervention trail evaluating the efficacy of a chlorhexidine- impregnated sponge in reducing catheter- related bloodstream infections among patients undergoing haemodialysis. This paper is presented as appendix 1. METHOD Clinical evidence can be acquired from numerous areas, such as text books , bibliographic data, course article and even colleague. Greenhalgh (2006) suggested that providing evidence from systematic review of existing evidence is one contribution towards achieving clinical effectiveness. The main aim of searching is to find good quality valid evidence to support clinical decision making. Subsequently a search strategy was developed to identify appropriate literature. Any terms that could be used as alternatives to the key term were identified. This structured identification of alternatives search term is called Facet analysis (Ranganathan 1967, cited in Spiteri 1998). Facet analysis consist of the use of specific alternative spelling, abbreviations, plurals, word specific therapies, in relation to PICO word to help in analysing the search (Sackett et al 1998). The Facet analysis was translated into a search strategy by using three key index terms as heading for each of the three facets. Synonyms were added and truncations, wild card and Boolean Operators used, were necessary. Search engine uses two methods to identify information, the first is by searching the word entered as index term and the second is by free text term which has been prepared by the compliers of the databases (Gillespie and Gillespie 2003). Another search tool used was truncations and wild cards. The use of truncation during search helps to prevent time wasting by searching for different variation of the word and wildcard gives room to identify alternative spelling of the same word easily Craig and Smyth (2007). Truncation is represented by ($) in Ovid while wildcard is represented by (? ) and is used within or the end of a search term to substitute for one or no character An example of facet analysis is shown on the table below. Table: two POPULATION| INTERVENTION| COUNTER INTERVENTION| OUTCOME| Central venous catheter| Biopatch| None| Infection Prevention| FACET ANALYSIS INDEX TERMS| INDEX TERMS| INDEX TERMS| INDEX TERMS| Central venous catheter| Chlorhexidine/ Biopatch| None| Infection Prevention| FREE TEXT TERM| FREE TEXT TERM| FREE TEXT TERM| FREE TEXT TERM| Central venous cathe$| Chlorhe$| None| Infectio$| Central lines| Chloraprep| | Infect| Central line$| Antimicrobial dressing| | Exit site infection| Haemodialysis lines| Antiseptic dressing| | Cat? eter related infection| CVC| Antisep$| | | Intravascular cathete$| | | Catheter related bacteremia| Vascular access| | | Bactere| Intravasc$| | | | In health care the National Library of Medicine (NLM) has developed the Medical Subject Heading (MeSH) list which, specify terms to be used by the indexer compiling entries for Medline database. These index terms are arranged in a tree view with the specific term below more general ones. By using the MeSH system, the computer searches for relationships or connections on the basis of the initial search strategy (Gilbride2004). The literature database searches were carried out in CINAHL, MEDLINE, EMBASE and BNI as this gave wider and in-depth coverage of each element of the topic. CINAHL and Medline databases are the most appropriate methodology to identify studies that report high quality research which can be used for clinical applications (Marks 1998). CINAHL (cumulative index to nursing and allied health literature) data base covers nursing and health science, and related discipline from 1982 to present (Greenhalgh, 2001). The MeSH was used when searching the key terms by checking the â€Å"Map to Subject Heading† checkbox on the databases main page. This produce the Mapping display page and a list of subject headings including the key search term and various other terms based around it. By clicking on the key terms, example central venous catheter, â€Å"include Subheading† and â€Å"Explode. † The included Subject Heading option gives a choice of either adding subheading to the subject heading or making the subject the main focus of the article (Harris, 2000). Exploding the MeSH heading incorporates all the more specific MeSH heading shown in the tree search. This process was repeated for each of the 3 key search terms. Next a free text search of each facet was perform by un-checking the Map to Subject Heading checkbox. The free text search was necessary because according to Gillespie and Gillespie (2003), â€Å"one cannot rely solely on the accuracy of indexing, or there may not be an index term that specifically describes the concept of interest†. When this was completed, the combined searches with Boolean operator â€Å"OR† was selected, combining the terms within the same concept together and facilitating retrieval of citations containing any of the previous search term. This was carried out for each of the 3 key terms and their facets. Boolean refers to the 19th century British mathematician George Boole who in 1847 invented â€Å"linguistic algebra†, a mathematical logic that represent relationship between entities and ideas (Harris 2000). The results of each 3 search elements combined using Boolean operator â€Å"OR† were finally combine with the operator â€Å"AND† which combined the different concepts together resulting in retrieval of citations containing all of the three core search elements ( Levy 2004). The resulting list of the four data base search articles was limited to English language, human, randomised control trail and research paper thereby eliminating less relevant result. Medline is produced by United state National Library of medicine, Medline covers the international literature on biomedicine, allied health and Biological and physical sciences (Gray 1997). Embase focuses on pharmacology but include other biomedical specialities. It also contains information from 1974 to date and has a European bias. British Nursing Index, (BNI) produced in the UK, contains information from 1994 to date. The search history from CINAHL, Embase, Medline and BNI databases are shown in appendices 2, 3, 4 and 5. FINDINGS OF THE REVIEW The Camis et al (2010) paper was produced by CINAHL, Medline and Embase searches and is a Crossover Intervention Trial. Cross-over studies or crossover trials are a type of randomised control trial. Cross-over studies are studies comparing two or more treatments or interventions in which the subjects or patients, upon completion of the course of one treatment, re switched to another (Senn, 2002). In the case of two treatments, A and B, half the subjects are randomly allocated to receive these in the order A, B and half to receive them in the order B, A. A criticism of this design is that effects of the first treatment may carry over into the period when the second is given. In this study, 121 were enrolled, 2 withdrew and 119 were analysed. This particular study was chos en because of the larger sample size, as sampling error- the gap between a sample’s representativeness and the size of the sample increases (Thompson, 1999). However a randomised control trial show that the use of chlorhexidine-impregnated dressing with tunnelled central venous catheters resulted in fewer documented exit site infection. There has been no randomised control trial study on HDX patients. The Embase search produced the largest no of citation but did not answer the research question, in Medline, 19 citations was found, 2 were randomised control trials and 1 was relevant to the question but not answer the question. BNI found 1 citation and was not relevant to the question. However CINAHL found 145 citations and 1 answered the research question further limits were applied and this gave 2 citations which did not answer the question directly. Table three: TABLE OF FINDINGS Databases| Citations| Type of study| Relevant to question| Study population| CINAHL| 2| RCT : 2| 1| Central venous catheter| MEDLINE| 19| RCT :12| 1| Central venous catheter. | EMBASE| 21| RCT: 12| 2| Central venous catheter. | BNI| 1| RCT : O| 0| Central venous catheter. | CRITICAL APPRAISAL OF RESAERCH PAPER O’Rourke (2005)cited in Craig and Smyth (2007) defined critical appraisal as a discipline for increasing the effectiveness of one’s reading by encouraging systematic assessment of reports of research evidence to see which ones can best answer clinical problems and inform best practice. According to Burns and Grove (1993), critical appraisal is often related to critical thinking which requires carefully developed intellectual question. Craig and Smyth (2002) states that critical appraising allows us to make sense of research evidence and thus begins to close the gap between researchers and practice. Finally Chambers (1998) also states that critical appraisal is the assessment and interpretation of evidence by considering its systematic reviews, relevance validity and results for specific situations. In this critical appraisal, the critical appraisal skills checklist (CASP) 10 question to help make sense of randomised controlled trials by Guyatt et al (1993) was used to appraise the paper. Appendix 7 CASP is a multidisciplinary programme aimed at all those who make health care decision and all those who seek to influence the decision making process. It help people develop skills in finding and critically appraising evidence about the effectiveness in order to promote the delivery of evidence- base health care ( Public Health Resource Unit 2006). The purpose of this study was, to determined whether the use of Chlorhexidine sponge dressing (Biopatch prevent exit site infection in central venous catheter? This question was focused enquiring the effect an intervention (Biopatch) would have on the outcome (Infection) and the population studied was 121 patients who underwent HDX through tunnelled central venous catheters. This study was not a randomised control trial. RCT is the strongest design for questions of whether health care interventions are beneficial (Cullum et al 2008). This groups have been formed through random allocation or similar methods, this ensure that allocation bias is eliminated at baseline. This research paper was a Crossover intervention trial as stated by Senn (2002) that Cross-over studies or crossover trials are a type of randomised control trial. Cross-over studies are studies comparing two or more treatments or interventions in which the subjects or patients, upon completion of the course of one treatment, are switched to another. This trial was conducted in a 2 HDX centres and participates were allocated into group A which were the intervention group centre 1 and B group who where in the control group centre 2. The participants were group in the centre they dialysed in and had the same nurse to patient ratio and shared the same infection prevention specialist. The intervention was started in group A whilst group B continued with the same old routine for six months and then it was switch over where group B became the intervention group and group A control group. The participants and staff were not blinded to the study and every patient who had a tunnel central venous catheter receives the intervention. At the beginning of the trial, there were 121 patients enrolled for the study and 2 patients withdrew from the study as they develop dermatitis after 2 sessions and 119 remain on the study. All the remaining participants were followed up and the outcome was analysed by the group they were originally allocated. A 2 sided P-value of less than or equal to . 05 was considered to denote statistical significance. P- value is the probability the difference between the group has risen by chance (Peat et al 2008) In research this is used to indicate the likelihood that a result has occurred by chance, rather than because there is a relationship between variables. The result in this research was presented in a table and narrative form and reports that there were 37 catheter related blood stream infections (CRBSIs) during the intervention period (incidence, 6. 3 CRBISs per 1,000 dialysis session, and 30 CRBSIs during the control period (incidence, 5. 2 CRBSIs per 1000 dialysis session. Relative risk (RR) 1. 22 (95% confidence interval (CI), 0. 75-1. 97) P= 46. 2 patients less than 2% were discontinued due to adverse effect. The result of the studies did not show significant reduction in CRBSIs. The result shows that there was not a significant reduction in the incident of CRBSIs in the group. The difference between the two centres was the frequency of dressing changes 54% vs. 39%: P=. 1 and more patients with substance abuse 9% vs. 2%: P=. 1. This was a significant risk factor for development of CRBSIs on bivariate analysis. Two variables have a P- value of less than 1. Confidence interval, are a function of the sample size and out-come frequency, the smaller the sample size, the wider the confidence interval (Torgerson and Torgerson 2008). In this study the confidence interval was 95%. Although there is a plan to implement this, product at my area of work, these research paper has not shown any significant evidence to show the effectiveness of Biopatch for the prevention of CRBSIs although the patient and the relative might be interested in the product, a RCT needs to be done before any implementation is done. IMPLEMENTATION: SITUATIONAL ANALYSIS. Making any changes in clinical practice is a very challenging and complex matter. In finding evidence that Biopatch may not be helpful in reducing the incidence of CRBSIs, a challenge exit in actually implementing the practice. Clinical research helps to move away from the tradition approaches whilst increasing consistency of care as well as the understanding of treatment option (Thomas 1999). Given the complexity of behaviour change and the multiple factors that can influence it in positive and negative ways, there is a growing recognition that implementation efforts should be guided by conceptual models or framework (McDonald et at 2004) Grol and Wensing (2004) states that â€Å"one of the most consistent finding in health services research is the gap between best practice as (determined by scientific research) and actual clinical care†. They also affirmed the studies in United States and Netherland, suggest that 30%-40% of patients do not receive care according to current scientific evidence. To overcome obstacle and aid implementation of change, Grols 5 steps model of change (1997) was design. This design appears to be the right tool to use as a guide to implementing Biopatch dressings. These 5 steps are as follows, to develop a concrete proposal for changing clinical practice. This should involve drawing up a proposal and involving the multidisciplinary team members, to discuss the proposal. Identify obstacle to change, this will involve the process of making sure all the challenges that will prevent change to be implemented are identified as proposed by Hayes (2002). The third model was to link intervention to obstacle in clinical practice. Grol (1997) says that knowing the target group well is crucial, as is the understanding their needs and problem with changing. The obstacle to change can be address by education session and meeting in collaborative approach. Developing a plan, a key component of the plan will be staff and patients education about the product. The use of this product should be started in a small minority of the patients with a developed care plan in place to monitor any changes. Carry out the plan, the use of Biopatch will be evaluated and continuous audit will be carried out monthly and the result will be discussed with other multidisciplinary team. Carrying out an effective plan and evaluation of progress by performance of audit and survey as has been established by Greenhalgh (2006). CONCLUSION In conclusion, this research review has shown that Biopatch was not effective in the prevention of CRBSIs, however other studies by Timsit et al (2009) has demonstrated that Biopatch was effective in reduction of CRBSIs in critically ill patients and also another trial carried out on neutropenic patients also show significant reduction in CRBSIs, although there has been no research done, before this on patient undergoing HDX. The method used to find evidence include a focused question, planning the literature search using PICO and Facet analysis, using electronic databases for literature searches, appraising the evidence and developing an implementation strategy. Grol’s 5step model was found to be helpful and practical tool in planning the implementation. The method of search provided a good structure around to base clinical exploration or enquiry and has improved my knowledge in searching the databases for clinical evidence. REFERENCES Timsit JF, Schwebel C, Bouadma L. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter related infections in critically ill adults: a randomised controlled trial. JAMA 2009, 301: 1231-1241. Carmis BC, MD, MSCR,. Richmond M, RN, MHS, CIC,. Dyer KL, MPH. Zimmerman HN, MPH,. Coyne DW, MD. Rothstein M, MD. Fraser VJ, MD. ; Infection Control and Hospital Epidemiology, Vol. 31, No 11 (November 2010), pp. 1118-1123. Levy J, Morgan J, Brown E. 2005) A practical guide todialysis and how to manage end stage renal failure. Oxford handbook of dialysis (2nd edn) New York: Oxford University Press. Grol R, Wensing M. What drives change? Barriers to incentives for achieving evidence-based practice. Med J Aust 2004;180:S57-60. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Intervention for preventing falls in elderly people. Cochrane Database syst Rev 2003; CD000340. Guyatt GA, Feeny DH, PatrickDC. Measuring health-related quality of life. Ann intern Med 1993; 118:622-629. Levy MD. ;A new register for clinical trials information. Can Med Assoc J. 2000; 162-970-971. Gray J. (1997) Doing the right things in Evidence Base health-care. Churchhill Livingstone, New York ch2, P17.

Wednesday, December 4, 2019

Senior High School English Teachers’ Roles Under the New English Curriculum free essay sample

He teaches in the society in accordance with his special responsibilities he takes and with the roles he plays. Therefore he is required to be quite sensitive to its expectations and perform rightly and appropriately with his due roles and to change his role rightly and timely with the development of the society and with the changes of his specific responsibility he takes. The educational reform in China requires the study of teacher’s roles. The reform of senior high school education in China at present has been leading to a radical change of educational beliefs which are certain to demand a great change of teacher’s roles. In China, the reform of senior high school education has widely aroused peoples attention. In order to promote the implementation of the new curriculum, experts and researchers of teaching have begun their study of changing teaching methods. Therefore, this thesis dedicates to the research of how the senior high school English teachers today should change their role under the condition of the New Curriculum, and hopes to bring up some new ways apt in teaching. 2 The significance of New Curriculum 2. Embodiment of the Essence of Education The course of education is a course of ideality. Its essence is to strengthen the spiritual power of human beings. Plato wrote in his most famous book Utopia the true notion of education through a metaphor told by Socrates: The â€Å"True Education† is to guide people, its soul, and spirit to reach an authentic world, from darkness to brightness, from an opinion-based world to a truth-based world (Socrates 129). This guidance of spirit is in fact the guidance of one’s living. Knowledge and skills are the ladders by which the soul could climb to a higher level. Our ancient classical book The Great Learning penetrates so straight to the point that â€Å"The way of achieving great learning started with one person’s knowing of the morality, carrying on by performing nice to the other people, and having the goodness in one’s heart. † ( 15). The purpose of learning is to reveal the morality in one’s heart, to make a fresh start of one’s life, and to keep a person’s mind in the stage of best morality. Apparently, in modern or ancient times, in China or elsewhere, almost all the great masters of education believed that the essence of education is to perfect the spiritual world of human beings. And the Curriculum standards must be responsible for the developing and growing of students. In the examination-oriented education system, a student is no more than a container of text-book knowledge. The duty and responsibility of a student is to process knowledge no matter how much it actually relates to reality. The actual use value of the knowledge has been ignored; the activeness of the students has been killed. Paper mark is an evaluation tool for every thing. The Ma Jiajue event of a school boy murdering his three roommates made us feel chilling and begin altering. May I ask how this type of students could have a positive attitude towards the challenges in society? How could they cooperate with people and pursuit a further development?! There is an old Chinese saying â€Å"To teach a student six years, a teacher must foresee his sixty years of life. This is the social responsibility of a teacher. To educate students, a teacher must not only make them masters of the textbook knowledge, but also masters of the method and strategies of learning. A teacher would form a positive mental attitude and active desire of the students and guide them enjoying the happiness through the pursuit of success, build up the student’s sense of accomplishment, and make it the motivation of making prog ress. New curriculum standards proposed a â€Å"tool† (an effective tool for high school English teacher to guide the students) and â€Å"humanism† (the new curriculum put humanism as its core) is the unification of the basic characteristics of English courses. The purpose of the study by English students is to improve the English literacy and lifelong learning for students and lay the foundation for the development of personality. Here, â€Å"exploring ability† and â€Å"personality development† received full attention. And the ability to understand and get to the point of the curriculum integration, appreciation, nderstanding, development, innovation has become a real purpose. Evidently, the new course is surprising, it really practices a â€Å"people-oriented† concept of education, reflects the nature of the education. 2. 2 Reflection of the Policy of Education The New Curriculum reflects the actual need to fully carry out the guiding principle on educ ation. We should establish accurate values on education and fully carry out the guiding principle on education in order to bring up quality talents of a new era. The values on education of a lower gradation are to educate individuals and pay too much attention to the chase of making a living or angling for material profits and prestige, but to neglect or depreciate the values of a deeper gradation formed by a full development of individual characteristics and magnificent states of mind. As the human being itself has a potential of many-sided development, the mission of education is to turn the students potentials into developing reality. Its not only the fundamental concept of democracy but the basic right of every student that all of them could develop themselves. The principle to evaluate the standard of lessons reflects two Faces-firstly, face the fully rise of students qualities and secondly, face the entire group of students. This kind of education can make every student develop himself more completely, which is stipulated by the guiding principle on education and also the intrinsic reflection of carrying out ability oriented education. 3 Suggestions on Senior High School English Teaching During a live observation on English teaching in senior high school, it seems common that the teaching materials are making use of teachers, rather than the teachers are using teaching materials. Needless to say, this phenomenon will definitely affect the quality of English teaching in senior high school and as a result, were not able to achieve the goal of English learning which is brought up by ability oriented education. What should senior high school English teachers do to deal with this phenomenon? 3. 1 New Educational Concepts as the Guidance The new education concept refers to the changing from giving undue mphasis to English language techniques into paying close attention to the development of students entire personality and cultivating their positive attitudes as well as encouraging them to learn how to get information and use it creatively. While in the process of senior high school English teaching, the English teachers should transfer from purely emphasizing instructing s tudents in the complex, troublesome and dull English knowledge in books, into providing basic and various information connected with real life for the students, in order to widen their field of view and make English study more effective and interesting. While talking about the manner of the senior high school English teacher, the new concept requires the teachers changing from teaching knowledge of isolated courses into connecting different but related courses with each other and encouraging students to study by experience, investigation and introspection. With respect to the senior high school English teaching evaluation, the new concept suggests the education transferring from emphasizing distinguishing good from bad, selection in contest, demarcating ranks, etc. nto promoting every students improvement of capability and respecting the diversity of personalities and levels of understanding, so as to help them all gain the feeling of success. And with respect to aspect of the relationship between teachers and students, the new concept suggests the shifting from centering on teachers into considering students main, seeking the equal conversation between teachers and students and joint improvement in interaction. 3. 2 Renewal of the Education Capacity The English teaching ability refers to the English teachers structure of knowledge and ability and they should not only have basic knowledge and ability of English language, but also multiple elements consisting of education, psychology, management, art of literature, philosophy and so on, which will make a composite effect. Owing to this composite effect combined with knowledge of various courses, the senior high school English teachers should renew his/her education capacity. He/she should not only make creative use of new teaching materials, organize fully directed English teaching contents and instruct students lessons effectively according to the education principle. He/she should teach according to ones ability. Whats more, they should inspire the students motivation of learning to the full extent and ensure their healthy study in order to achieve the final goal of cultivating the students ability to learn throughout their life. 3. 3 Building-up of the Self-development Approach Teachers arent able to renew knowledge, learn throughout their life and search for self-development. Through lack of approaches to development subjectively, as well as objective reasons such as busy work of teaching or a heavy burden of housework, some teachers have to live on their own limited fat gained in school and without doubts, its difficult for them to adapt to the continuous development of the situation of educational reform. A number of senior high school teachers complain about the new edition text-book and the general requirement of the new curriculum. They used to teach in a traditional way. They as well feel indifferent to the new material in the textbook and don’t know how to teach it to the students. In order to make full use of the new teaching material and raise the quality of English education, theres no doubt that firstly we should establish a new modern educational concept. 4 New Classroom Roles of Senior High School English Teachers What roles should the 21st century senior high school English teachers have? The society informationization and knowledge economy development of the 21st century propose our education on the intense transformation request; the traditional way of study is transformed to the innovative study. This request the teachers to change from the traditional 40-minute teaching role to the shepherd, the organizer, the participant during the educational process, the teacher must have bigger compatibility and flexibility. With the social development today, the science and technology developed rapidly, the computer and the information technology also have a widespread application in teaching. The relationship between the teachers and students is already not completely the simple transmission and acceptance pattern, sometimes the student may acquire knowledge from other channels, they even know in certain aspects comparable more than some teachers do. Teachers authoritative status has been threatened; the teacher and students relation becomes more and more complicated. The teachers role also multiplies. Having the ability to form the fine personality and the multiplex knowledge tructure of the students, and mastering many skills while specializing in one are requirement for teachers today. The teacher must have rich knowledge and many kinds of abilities. Moreover, it is also the duty of a teacher to form the students’ spiritual world, fills the instructive and the creative essence. In the modern society, the teacher has not only changed with the traditional performers basic function, but also has to transmit the experience directly. The students must participant the learning activity. The teacher must guide the students to explore in the environment which he carefully designs. The teacher is no longer a pure transmitter, but also students’ companions, activity organizer, the supporter and helper in the process of students’ learning activity. I will discuss the teachers role mainly in the following part. 4. 1 Teacher as Organizer As is said by Doll, an American expert in education, the teachers status in the relationship between teachers and students is â€Å"a chief in equality† (Doll 191). This conversion requires teachers to step down from the altar filled with â€Å"teachers respect†. And the teachers ought to interact and explore with the students standing on the same flat and help them grow up, mature and become worthful. To organize means to form into a whole with mutually connected and dependent parts. The success of many activities depends on good organization and on the students knowing exactly what they are to do. To be an organizer, senior high school English teachers have to organize the activities and teaching stages successfully in the classroom. Teachers organizing of the class roughly includes two parts— psychological organization and the organization of activity. The central idea of psychological organization is to stimuli students motivation. The main aim of the teacher when he organizing an activity is to tell the students what they are going to talk about, and to give clear instructions about what exactly their task is, get the activity going, and then organize feedback when it is over. For example, for the topic discussion, the teacher can assign students to groups. Jeremy Harmer (1983) noted that the organization of an activity can be divided into three main parts. First the teacher gives a lead-in. Like the lead-in for presentation or for the treatment of receptive skills this will probably take the form of an introduction to the subject. In senior high school English classrooms, teachers can tell students what they are going to talk about during this period. The teacher and students may briefly discuss the topic in order to start thinking about it. He/She should give clear instructions. When the lead-in stage has been accomplished the teacher instructs. This is where he explains exactly what the students should do. Finally the teacher initiates the activity, which is to get the activities going. He gives a final check that students have understood. So the teachers job is to organize the activity as efficiently as possible, frequently checking that the students have understood. Once the activity has started the teacher will not intervene unless it is quite necessary for gentle correction or promptness. During the first year of teaching senior high school English, role play helps the students to use the language flexibly. While students play their roles on their own, the teacher may walk around the classroom to listen to their talks. When necessary, the teacher can also give guidance and advice. After role play, the teacher can ask students to perform in class, and then make comments on their work. 4. 2 Teacher as Guide As is said by ancient people, Teachers are the people who spread logic, teach lessons and solve confusion. The new standard of lessons requires a conversion from â€Å"teaching lessons† to guiding the students to participate in English activities actively, think by themselves and cooperate in investigation, which aims to develop the students abilities to gather and cope with information in English, to gain new knowledge, to analyse and solve problems and to communicate and cooperate. The basic requirements of a teacher as a guide are as follows: 1) To help students to set up right and feasible goal, both long and short term. Once the short goal within the long-term goal is reached, students may be filled up with happiness of success which further motivates them forward. 2) To make classroom activities interesting and meet the needs of the students. The teacher can present language in meaningful contexts, elicit language from students, make instructions clear to everyone by using a variety of techniques (cards, texts, ICT, open questions), manage pairs and groups to maximize practice, monitor individuals and groups, stand back and view the whole class, try to meet the needs of all irrespective of gender or ability, praise warmly, correct when appropriate, confirm and welcome good use of the target anguage, smile and enjoy their job, with general qualities of sensitivity, flexibility, humor, enthusiasm and stamina (similar to those required by the average parent). Moreover its particularly important to separate the role of the motivator from the role of the expert. Teachers often easily play the role of expert often; hence miss the chance to motivate their students. 4. 3 Teacher as Participant To be a participant means that a teacher may take part in the classroom activities. A teacher might join simulations as a participant. However, the teacher should be careful not to dominate, although the students will both allow and expect this to happen. Instead of being the dominating authority in the classroom, the teacher facilitates the communicative process among all the learners and between the students and the various tasks, giving guidance and advice when necessary. Furthermore, teachers may act as independent participants within the learning-teaching group. Any unnecessary intervention on the teachers part may prevent learners from becoming genuinely involved in the activities and thus hinder the development of their communicative skills. Once a teaching activity is in progress, it is still the teachers obligation to develop the students potential through external direction. Although the teacher may be nondirective in general, it is still the teachers responsibility to recognize the distinctive qualities in the students (Han 1979) and to help the students develop those qualities. In senior high school English class, in different settings, students may be asked to attend different activities. Teacher should not be afraid to attend these activities. It can improve the atmosphere in the class. For example, when students talk about current events, students are willing to listen to different peoples opinions on the topic. Sometimes when the whole class takes part in a debate, teachers can also act as a chairperson, or offer students help when it is needed. 4. 4 Teacher as Trainer We used to say that the teachers should have a bucket of water in order to give the students a glass of water. However, this idea should also be changed, which demands the teachers not to limit themselves to knowledge and experience in their mind, but according to the demands of the students, to choose and exploit English teaching resources, design and launch kinds of English teaching activities, open up the room for teaching, guide the lessons into a larger range, strengthen the relation between the English language learning and social life reality. In short, the teachers should help the students to carve out the source of knowledge. As strategy trainers, the teachers describe, model, and give examples of potentially useful strategies; they elicit additional examples from students based on the students own learning experiences; they lead small group or whole class discussions about strategies including activities designed to raise students awareness of strategies and the learning process as a whole, as well as activities designed to teach students how to use a specific strategy. It is a fact that some senior high school English teachers already use many activities in their classes that can be considered â€Å"strategies-based†. However, what seems to be missing is the awareness on the part of the students of what those strategies are or how to get those strategies to work for them. Effective strategy use is often associated with better students, those who have already â€Å"mastered† the learning process. Thus teachers may well be making a real contribution to facilitating the learning process by discussing selected strategies explicitly in the classroom. In class, senior high school English teachers can explain the purpose of the language activity, or call attention to how the teacher has organized the course materials e. g. laying out the range of possible strategies for reading a text in order to summarize it, addressing the many strategies associated with writing a coherent summary. 4. 5 Teacher as Creator of a Positive Environment This is a change of the teachers role in nature. This conversion requires that the teachers should â€Å"push the students forward† instead of â€Å"pulling them along†, and motivate the students instead of â€Å"pressing them†. Whats more, the teachers should help the students to establish a proper goal for English learning, confirm and correct their paths chosen to achieve this goal, and inspire them to develop themselves actively by means like spur, encouragement and commendation. Senior high school English teachers should provide positive classroom environment for students. Classroom climate refers to the atmosphere of the classroom, its social, psychological, and emotional characteristics (DunkinBiddle, 1974). The importance of lassroom climate as it relates to motivation derives from the notion that teaching is leadership intended to affect classroom behaviors. Classroom climate is often described using such terms as warm, cold, permissive, democratic, autocratic, and learner-centered. The climate in the classroom is largely established through teacher-student interactions. In China, teachers teach students English in non-target environment, which is different from those in the natural environment. The refore it is more important to create a good learning environment. Teachers here play an important role in providing a supportive environment that encourages students motivation, self-confidence, curiosity and desire to learn, and input and production. According to the findings in the investigation, this role also has positive effects on students achievements. The investigation shows that Teacher A provided the best language environment among the three classes. From the classroom observation, it can be found that As English is excellent. This shows that the teachers ability of creating the positive environment has much to do with the teachers language proficiency. In order to provide positive environment, the teacher has to: 1) Be capable of speaking fluent English. 2) Give students as many opportunities as possible to practice English. 5 Conclusion This thesis aims at analyzing classroom roles of senior high school English teachers under the requirement of new English Curriculum. This thesis firstly introduces the significance of the new curriculum from two aspects: new curriculum embodies the essence of education, at the same time; it reflects the policy of education. Secondly, according to the new curriculum, the author gives three suggestions on senior high school English teaching. The suggestions aim at bringing out new concepts on high school English teaching as well as renewing the teachers education capacity and building up self-development approach. Thirdly,in order to set up the roles as scientifically as possible, the author investigates students’ expectation and analyzes the relationship between the teacher’s roles and the students’ achievements. The author makes a profound analysis of each role and gives further suggestions. With limited study and knowledge, the explanations in many places are rather weak. The study can only be considered as a start for further insightful researches and findings.

Thursday, November 28, 2019

Six thinking hats Essays - Hats, Educational Psychology,

Six thinking hats Six Thinking Hats' is an important and powerful technique. It is used to look at decisions from a number of important perspectives. This forces you to move outside your habitual thinking style, and helps you to get a more rounded view of a situation. This tool was created by Edward de Bono in his book '6 Thinking Hats'. Many successful people think from a very rational, positive viewpoint. This is part of the reason that they are successful. Often, though, they may fail to look at a problem from an emotional, intuitive, creative or negative viewpoint. This can mean that they underestimate resistance to plans, fail to make creative leaps and do not make essential contingency plans. Similarly, pessimists may be excessively defensive, and more emotional people may fail to look at decisions calmly and rationally. If you look at a problem with the 'Six Thinking Hats' technique, then you will solve it using all approaches. Your decisions and plans will mix ambition, skill in execution, public sensitivity, creativity and good contingency planning. How to Use the Tool You can use Six Thinking Hats in meetings or on your own. In meetings it has the benefit of blocking the confrontations that happen when people with different thinking styles discuss the same problem. Each 'Thinking Hat' is a different style of thinking. These are explained below: White Hat: With this thinking hat you focus on the data available. Look at the information you have, and see what you can learn from it. Look for gaps in your knowledge, and either try to fill them or take account of them. This is where you analyze past trends, and try to extrapolate from historical data. Red Hat: 'Wearing' the red hat, you look at problems using intuition, gut reaction, and emotion. Also try to think how other people will react emotionally. Try to understand the responses of people who do not fully know your reasoning. Black Hat: Using black hat thinking, look at all the bad points of the decision. Look at it cautiously and defensively. Try to see why it might not work. This is important because it highlights the weak points in a plan. It allows you to eliminate them, alter them, or prepare contingency plans to counter them. Black Hat thinking helps to make your plans 'tougher' and more resilient. It can also help you to spot fatal flaws and risks before you embark on a course of action. Black Hat thinking is one of the real benefits of this technique, as many successful people get so used to thinking positively that often they cannot see problems in advance. This leaves them under-prepared for difficulties. Yellow Hat: The yellow hat helps you to think positively. It is the optimistic viewpoint that helps you to see all the benefits of the decision and the value in it. Yellow Hat thinking helps you to keep going when everything looks gloomy and difficult. Green Hat: The Green Hat stands for creativity. This is where you can develop creative solutions to a problem. It is a freewheeling way of thinking, in which there is little criticism of ideas. A whole range of creativity tools can help you here. Blue Hat: The Blue Hat stands for process control. This is the hat worn by people chairing meetings. When running into difficulties because ideas are running dry, they may direct activity into Green Hat thinking. When contingency plans are needed, they will ask for Black Hat thinking, etc. A variant of this technique is to look at problems from the point of view of different professionals (e.g. doctors, architects, sales directors, etc.) or different customers. Example The directors of a property company are looking at whether they should construct a new office building. The economy is doing well, and the amount of vacant office space is reducing sharply. As part of their decision they decide to use the 6 Thinking Hats technique during a planning meeting. Looking at the problem with the White Hat, they analyze the data they have. They examine the trend in vacant office space, which shows a sharp reduction. They anticipate that by the time the office block would be completed, that there will be a severe shortage of office space. Current government projections show steady economic growth for at least the construction period. With Red Hat

Sunday, November 24, 2019

Free Essays on Critical Analysis Of Albert Camuss

, and recognizing the voids they reveal, the reader sees Meursault as the stranger – a foreigner in an emotional, consequential world teaming with morality and sentiment. Society endures because of its own understood, furtive laws – laws which keep conformity, habit, and social harmony perpetually present – laws which Meursault cannot fathom. Religion, ambition, love – contempt, disapproval, sorrow – are all sensations by which people life – by which people are ruled; they are all sensations by which Meursault is never governed. Meursault’s rules to live by are hardly understandable to those of society. He is not ruled by emotion, he is not controlled by morals, and he is not bothered by decisions. Mersault is governed by absent fate, minimal satisfaction, and listless habit. He serves no God, no dream – no purpose. In the end, Meursault, living according to his own myriad of absurd rules, must welcome death as his only m eans to be in harmony with the indifferent universe. Meursault is aware of feelings and opinions in others, but he acknowledges few emotions in himself. Particularly in situations where one expects feelings, he professes to have none. Thus, he feels little sorrow at his mother’s death, little joy at Marie’s love, little pleasure at the boss’s offer of a promotion, little remorse for his crime. He expresses no anger and hardly any regret even at the loss of his freedom. He seems to feel no resentment toward Raymond, who drew him into the quarrel with the Arabs; nor toward his lawyer; who handles his case poorly; nor toward the court, which condemns him... Free Essays on Critical Analysis Of Albert Camus's Free Essays on Critical Analysis Of Albert Camus's Albert Camus was haunted with the notion that â€Å"our world exists in a universe which holds no place for us, where our life makes no sense.† In his novel, The Stranger, Monsieur Meursault is a man rendered in such a situation. He subsists from day to pointless day, morally deprived and socially detached. Holding Meursault to his words, and recognizing the voids they reveal, the reader sees Meursault as the stranger – a foreigner in an emotional, consequential world teaming with morality and sentiment. Society endures because of its own understood, furtive laws – laws which keep conformity, habit, and social harmony perpetually present – laws which Meursault cannot fathom. Religion, ambition, love – contempt, disapproval, sorrow – are all sensations by which people life – by which people are ruled; they are all sensations by which Meursault is never governed. Meursault’s rules to live by are hardly understandable to thos e of society. He is not ruled by emotion, he is not controlled by morals, and he is not bothered by decisions. Mersault is governed by absent fate, minimal satisfaction, and listless habit. He serves no God, no dream – no purpose. In the end, Meursault, living according to his own myriad of absurd rules, must welcome death as his only means to be in harmony with the indifferent universe. Meursault is aware of feelings and opinions in others, but he acknowledges few emotions in himself. Particularly in situations where one expects feelings, he professes to have none. Thus, he feels little sorrow at his mother’s death, little joy at Marie’s love, little pleasure at the boss’s offer of a promotion, little remorse for his crime. He expresses no anger and hardly any regret even at the loss of his freedom. He seems to feel no resentment toward Raymond, who drew him into the quarrel with the Arabs; nor toward his lawyer; who handles his case poorly; nor toward the court, which condemns him...

Thursday, November 21, 2019

Cultural Sensative Counseling Essay Example | Topics and Well Written Essays - 1500 words

Cultural Sensative Counseling - Essay Example 72). The ultimate goal is for the counselor to be â€Å"culturally sensitive† in that he/she â€Å"is aware of, shows recognition of, demonstrates some knowledge of, and expresses an interest in the client’s ethnic identity and cultural background† (Day 2008, p. 72). This is very important because conduct in one culture may be more distressing in another culture. For example, a Filipina student going against her parents’ choice of major may be more of an issue than for an American student. In other words, there is no universal prescription for dealing with all human beings’ problems (Day 2008, p. 72). Cultural sensitive interviews will help the counselor obtain the information necessary for narrowing the issues down to a specific culture. Therefore a cultural sensitive interview will begin by first determining the client’s first language. Language questions will seek to determine whether or not the client’s family or home speaks anothe r language or languages and what language or languages are used at home. The client’s feelings about whether his or her language is â€Å"standard English or nonstandard English† will also be queried at a cultural sensitive interview (Day 2008, p. 73). Secondly, the client will be questioned about family roles. Essentially, the counselor will attempt to determine what is expected of children within the family and how those expectations are modified throughout childhood to adulthood. Other questions about family roles will include information about whether or not adult children have to take care of their parents; the degree of authority that parents have over their adult children and adolescent children’s decisions; whether or not parents are strict and if the client follows their parents own â€Å"parenting style† (Day 2008, p. 73). The client will be questioned about sex/gender distinctions and roles. Specifically, the counselor attempts to determine cul tural beliefs relative to sexes and the degree to which those beliefs and distinctions are reflected within the client’s family. The counselor will also need to ascertain the client’s own feelings about those prescribed differences and roles. The counselor will also endeavor to obtain information about sexual orientation. More specifically, the counselor will attempt to determine the degree to which the client’s sexual orientation or the sexual orientation of others affects the client. Information about what the client learned about sexual orientation from the family and whether or not the client’s own concept of sexual orientation has been refuted (Day 2008, p. 73). Another area of query includea information about the client’s independence. Specifically, the counselor will be required to determine if the client firmly believes in â€Å"freedom from others’ influence†, or if co-dependence within the family or the community ranks highe r (Day 2008, p. 73). Questions about the spirituality and its influence on the client are also important. How the client’s culture defines success and how conflict is dealt with by the client’s culture are also important questions. Cultural and family history and its influence on the client are also important questions in a cultural sensitive interview. Questions about money, more specifically class status, economic objectives and the importance of wealth to the client’