Professional Essay Writers To Assist You!

Professional Essay Writers To Assist You! Presenting the same essay as someone else constitutes plagiarism and this will end in a serious tutorial punishment. I never thought I was going to say this however I can recommend using writing providers any more. I’m surprised however I’m completely proud of the essay I received and don’t even have to ask for revisions. You will be able to look at your masterpiece from a fresh perspective. In case you don’t have time for postponing, you'll be able to flip to our service for help. Our writers are properly versed in producing authentic, distinctive and plagiarism free content. With us, you get the opportunity to contact the designated writer through our 24/7 communication strains. Our representatives may be accessed by way of telephone, e-mail or through 24-hour reside chat support to discuss your queries, concerns, and talk your project requirements. This is likely one of the biggest concerns that generally prevent college students from getting help from a paper writing service. Do not fear that someone will study our cooperation. No private data of yours is collected, so there are no links to your identity. The writers had been polite to me and I appreciated working with them. Once after I needed enhancements the writer amended the textual content actually rapidly proper after my request. Students who purchase essays low-cost are often concerned about the originality of the returned papers. Teachers take note of the circulate of a textual content you submit in addition to spelling errors. Our tip would be to complete writing and are available again to enhancing the following day. If the service presents prepared essays, you need to keep from it as properly. Even a superb essay can get you into bother if it has been sold to different college students as well. To dispel these doubts, we provide a plagiarism report, generated by a dependable software program, used business-extensive. The option to buy this report is available at the time of order placement. Our essay assist online takes strict measures to make sure 100% consumer satisfaction. Our experts will write and proofread an outstanding paper for you. The better part is that enhancing and proofreading are already included within the value. You may assume that from now on your life will be cloudless and cheerful, however it is fairly removed from the truth. As a scholar, you have probably skilled a great deal of work in class and at home already, and so the prospects of socialization or fun time begin looking bleak and unachievable. If you think about enhancing to be a waste of time, we suggest you're taking a better look at it. It is a boring process but without editing and proofreading your chances of getting an excellent grade decrease dramatically. Everything you say and monetary transactions you perform are encrypted and protected, and we often replace and elaborate our protection systems. Now that you are a joyful school scholar, we do need to congratulate you on this accomplishment! As you are conducting various activities on the similar time while learning, including earning money, it might turn into troublesome to do enough analysis for getting good grades. You can do all this or simply rent a reliable tutorial writing service to finish your paper with only a click of the mouse and make your best option. And it's making you anxious and also you need assistance from skilled essay writers to resolve high quality points related to plagiarism and different issues. Expert in evaluation and research, James is considered one of our senior-most skilled essay writers who has always impressed us with his skills. Tried the service for three times and all the time was satisfied.

Custom Essay Service

Custom Essay Service This is as a result of the phrases that you're acquiring from the translation software program are not technically your words. In addition to the fact that you shouldn't do that, it additionally is not a very good technique from practical purposes. Translation software program isn't yet at the stage where the sentences come throughout very coherent; the grammar is usually nonetheless questionable. Careful observe taking would have ensured that you maintained your educational integrity. In this text, we’ll outline a few of the primary features of plagiarism and what you need to do when writing a tutorial paper. The second you request educational help online, you may feel insecure and find yourself asking questions like, “Is it dishonest? This method, papers for college kids who pursue university degrees are greater than for those finding out in high schools. We address brief deadlines simply â€" three hours are sufficient to put in writing a quality paper. Yes, it requires a sharp concentrate on the duty and quick achievement, which is why the costs go up. As for grammar, the principles seem a bit more unclear. Some universities will allow you to employ somebody to examine your grammar; others want you to state in your paper that you've got employed the companies of a proof-reader. Some universities reserve proofreading for graduate-level work and prohibit undergraduates from utilizing this service â€" others are more flexible. So, right here, we again recommend checking the regulations of your school before asking for someone to make adjustments to your paper. So, use appropriate punctuation and spellings and make your reader related with an essay. Make certain you’re crystal clear concerning the basic construction of your essay before you begin writing. Most essays, regardless of size, follow the identical fundamental formulation - you introduce your matter, discuss your findings and analysis, and then come to a conclusion. Whether you like it or not, essay writing is an element and parcel of completing a level. Even those who often excel at written work can discover themselves feeling the fear when faced with the prospect of putting collectively a lengthy essay or dissertation. With a couple of helpful hints, you can get heading in the right direction to writing a masterpiece. Secondly, utilizing a professionally written mannequin essay as inspiration in your personal writing could be extraordinarily useful. ” Ordering educational samples isn't a fraudulent action, nor is using such examples of written works as a research information or foundation on your personal paper. It will give you a priceless asset in your studying process, not the dangers associated with dishonest. The higher the complexity of the order, the upper the worth. If you're using direct quotes, you need citation marks. You also must know where the quote has come from â€" like the page quantity. For example, let’s say you might be reading a textbook and you come across a passage that you just assume is really necessary. You then copy down this passage into your pocket book. Three weeks later, you might be reading through your notes making an attempt to write down your assignment. You come throughout the passage and now you incorporate that into your assignment…however you don’t reference it. In addition, there are other ways to include other individuals’s ideas into your personal work. Typically, you’re either using direct quotes or you might be paraphrasing. Also, when writing a paragraph, the way in which something is composed in a second language just isn't the identical as the way it will be in English. So while plagiarism will be the concern with this strategy, it's generally one which ought to be prevented. Remember, you possibly can't submit a mannequin essay and attempt to cross it off as your individual. But you can be taught from it, paying attention to the language used, the way in which sentences and the argument are crafted, and the way the essay flows . You additionally mustn't write your paper in your first language and run it by way of translation software program (e.g. Google Translate).

Custom Essay Service

Custom Essay Service This is as a result of the phrases that you're acquiring from the translation software program are not technically your words. In addition to the fact that you shouldn't do that, it additionally is not a very good technique from practical purposes. Translation software program isn't yet at the stage where the sentences come throughout very coherent; the grammar is usually nonetheless questionable. Careful observe taking would have ensured that you maintained your educational integrity. In this text, we’ll outline a few of the primary features of plagiarism and what you need to do when writing a tutorial paper. The second you request educational help online, you may feel insecure and find yourself asking questions like, “Is it dishonest? This method, papers for college kids who pursue university degrees are greater than for those finding out in high schools. We address brief deadlines simply â€" three hours are sufficient to put in writing a quality paper. Yes, it requires a sharp concentrate on the duty and quick achievement, which is why the costs go up. As for grammar, the principles seem a bit more unclear. Some universities will allow you to employ somebody to examine your grammar; others want you to state in your paper that you've got employed the companies of a proof-reader. Some universities reserve proofreading for graduate-level work and prohibit undergraduates from utilizing this service â€" others are more flexible. So, right here, we again recommend checking the regulations of your school before asking for someone to make adjustments to your paper. So, use appropriate punctuation and spellings and make your reader related with an essay. Make certain you’re crystal clear concerning the basic construction of your essay before you begin writing. Most essays, regardless of size, follow the identical fundamental formulation - you introduce your matter, discuss your findings and analysis, and then come to a conclusion. Whether you like it or not, essay writing is an element and parcel of completing a level. Even those who often excel at written work can discover themselves feeling the fear when faced with the prospect of putting collectively a lengthy essay or dissertation. With a couple of helpful hints, you can get heading in the right direction to writing a masterpiece. Secondly, utilizing a professionally written mannequin essay as inspiration in your personal writing could be extraordinarily useful. ” Ordering educational samples isn't a fraudulent action, nor is using such examples of written works as a research information or foundation on your personal paper. It will give you a priceless asset in your studying process, not the dangers associated with dishonest. The higher the complexity of the order, the upper the worth. If you're using direct quotes, you need citation marks. You also must know where the quote has come from â€" like the page quantity. For example, let’s say you might be reading a textbook and you come across a passage that you just assume is really necessary. You then copy down this passage into your pocket book. Three weeks later, you might be reading through your notes making an attempt to write down your assignment. You come throughout the passage and now you incorporate that into your assignment…however you don’t reference it. In addition, there are other ways to include other individuals’s ideas into your personal work. Typically, you’re either using direct quotes or you might be paraphrasing. Also, when writing a paragraph, the way in which something is composed in a second language just isn't the identical as the way it will be in English. So while plagiarism will be the concern with this strategy, it's generally one which ought to be prevented. Remember, you possibly can't submit a mannequin essay and attempt to cross it off as your individual. But you can be taught from it, paying attention to the language used, the way in which sentences and the argument are crafted, and the way the essay flows . You additionally mustn't write your paper in your first language and run it by way of translation software program (e.g. Google Translate).

Custom Essay Service

Custom Essay Service This is as a result of the phrases that you're acquiring from the translation software program are not technically your words. In addition to the fact that you shouldn't do that, it additionally is not a very good technique from practical purposes. Translation software program isn't yet at the stage where the sentences come throughout very coherent; the grammar is usually nonetheless questionable. Careful observe taking would have ensured that you maintained your educational integrity. In this text, we’ll outline a few of the primary features of plagiarism and what you need to do when writing a tutorial paper. The second you request educational help online, you may feel insecure and find yourself asking questions like, “Is it dishonest? This method, papers for college kids who pursue university degrees are greater than for those finding out in high schools. We address brief deadlines simply â€" three hours are sufficient to put in writing a quality paper. Yes, it requires a sharp concentrate on the duty and quick achievement, which is why the costs go up. As for grammar, the principles seem a bit more unclear. Some universities will allow you to employ somebody to examine your grammar; others want you to state in your paper that you've got employed the companies of a proof-reader. Some universities reserve proofreading for graduate-level work and prohibit undergraduates from utilizing this service â€" others are more flexible. So, right here, we again recommend checking the regulations of your school before asking for someone to make adjustments to your paper. So, use appropriate punctuation and spellings and make your reader related with an essay. Make certain you’re crystal clear concerning the basic construction of your essay before you begin writing. Most essays, regardless of size, follow the identical fundamental formulation - you introduce your matter, discuss your findings and analysis, and then come to a conclusion. Whether you like it or not, essay writing is an element and parcel of completing a level. Even those who often excel at written work can discover themselves feeling the fear when faced with the prospect of putting collectively a lengthy essay or dissertation. With a couple of helpful hints, you can get heading in the right direction to writing a masterpiece. Secondly, utilizing a professionally written mannequin essay as inspiration in your personal writing could be extraordinarily useful. ” Ordering educational samples isn't a fraudulent action, nor is using such examples of written works as a research information or foundation on your personal paper. It will give you a priceless asset in your studying process, not the dangers associated with dishonest. The higher the complexity of the order, the upper the worth. If you're using direct quotes, you need citation marks. You also must know where the quote has come from â€" like the page quantity. For example, let’s say you might be reading a textbook and you come across a passage that you just assume is really necessary. You then copy down this passage into your pocket book. Three weeks later, you might be reading through your notes making an attempt to write down your assignment. You come throughout the passage and now you incorporate that into your assignment…however you don’t reference it. In addition, there are other ways to include other individuals’s ideas into your personal work. Typically, you’re either using direct quotes or you might be paraphrasing. Also, when writing a paragraph, the way in which something is composed in a second language just isn't the identical as the way it will be in English. So while plagiarism will be the concern with this strategy, it's generally one which ought to be prevented. Remember, you possibly can't submit a mannequin essay and attempt to cross it off as your individual. But you can be taught from it, paying attention to the language used, the way in which sentences and the argument are crafted, and the way the essay flows . You additionally mustn't write your paper in your first language and run it by way of translation software program (e.g. Google Translate).

Ethical Issues Associated With Forced Medication - 1925 Words

Ethical Issues Associated With Forced Medication (Essay Sample) Content: Ethical Issues associated with forced MedicationNameInstructorCourseInstitutionDateEthical Issues associated with forced MedicationPsychiatrists treating mental illnesses are faced by a myriad range of ethical issues to consider in their practice, ranging from telling the truth to acutely ill patients or patients with paranoia about the seriousness of their condition to issues regarding their medication (Latha, 2010). The latter has serious ramifications, especially when patients with mental capacity are put under forced medication. According to Larcher, Craig, Bhogai, Wikinison, and Brierley (2012) a competent adult has a legal right to refuse treatment regardless the fact that his informed decision is likely to adversely affect him. This means that mental health professional are supposed to respect even unwise decisions made by patients with mental capacity to make decisions about their treatment because no one should legally provide consent for medication for such persons. This paper will analyze the ethical dilemma facing mental health patients with respect to their duty to administer medication to patients.Cohen and Ezer (2013) theorized that consent to medical treatment is arguably the most critical principle that governs the law about treating people with mental health problems or illness. Likewise also, Klein (2012) argued that forced medication violates a persons competence, insight and competence. The philosophy behind consent to medical treatment is that forced treatment on patients potentially violates the probation against violent and degrading treatment that violates human rights (Latha, 2010). Therefore, patients should be accorded their right to autonomy and self determination through informed consent for their treatment, provided they the mental capacity to decide.Mental health professionals should carefully consider the degree of moral weight the value of doing good and avoid harm when deciding on respecting the value of pati ents with impaired decision making capabilities (Latha, 2010), for instance a patient suffering from advanced schizophrenia. Therefore, psychiatrists are expected to wisely consider forced medication or treatment because it might result to irreversible damages such as diminishing the chances of recovery because compliance is highly unlikely, breach of trust between physicians and patients, and increased vulnerability of potential patient abuse (Latha, 2010). Nevertheless, proponents of forced and covert/surreptitious administered medication support are motivated by the claim that it is the duty of a physician to ensure well-being of the patients without the competence to give informed consent.A Case ScenarioMary, a fictitious name, came into the clinic and reported that her husband-Peter- had been behaving strangely lately. She claimed that her husband seemed to be in distress and was no longer eating. She also stated that he was easily agitated and was worried that his condition wa s worsening. She therefore asked whether our mental health professionals could pay him a visit to conduct preliminary analysis, and possibly invite him into the clinic for mental health examination.The crisis team, where I am a member, paid the Peter a visit to determine the seriousness of his condition and potentially invite him into the clinic for more examination. When we arrived at his home, we found him reading a newspaper and he welcomed us. He was casually dressed in a jean, t-shirt, and pair of sneakers. From his physical appearance he seemed normal. We introduced ourselves and briefed him that his wife was worried about him. He seemed calm until one of the team members told him that he needed help to ensure that his condition did not worsen. He was quick to deny that he did not have any condition, and he certainly did not need any intervention. We treated his claims as routine denials that most of our clients seem to have, hence none of us was alarmed; even by his agitation because we have become accustomed to such reactions from most of our clients. He later calmed down and declared that he was willing to corporate and undergo any necessary medical examinations to proof that he was okay. We booked him an appointment for the following day.He honored his appointment and his wife accompanied him to the clinic. He was put into the in-patient unit and mental examination commenced. In the cause of the examination, it was discovered that he was not exactly mentally ill but the couple was going through a divorce. He was not only stressed about separating with his wife of 20 years, but he was also involved in legal battle with his wife for the custody of their children. Although these circumstances could have resulted to symptoms that his wife noted, the physician prescribed him Risperidone for psychosis because of his agitation episodes, which he claimed were unpredictable. Although the client insisted that he was not mentally ill and he did not need the me dication, the doctor forced him to take the medication.I did not think prescribing psychotic medication for him was the right decision because he did not exhibit alarming signs of mental illness besides his, otherwise normal, reaction of a normal husband and father in the blink of losing his family. In addition, a history of mental illness could potentially minimize his chances of getting custody of his parents, especially if he identified with history of mental illness.The Kantianism theoretical framework of forced medicationImmanuel Kant, a German philosopher derived the deontological theory to support his argument about the significance of intension, respecting three distinct imperative, and adhering to personal moral duties (Ohreen Petry, 2012). Kantianism, named after Immanuel Kant, emphasizes on widespread moral duty, which determines the intention behind an action. Therefore, Kantianism is based on duty, supported by the notion that the right moral action is vindicated by on es intrinsic values; meaning that people do the right thing (for instance, administering medication) because they have a moral duty to do so, as opposed to motivation by extrinsic values (for instance refraining from administering medication could potential bad consequences like self-harm or harming others) (Markovits, 2011). Therefore, Kantianism involves setting moral rules to give chance to rational argument to achieve universally applicable categorical imperatives, which are used to govern people to have good will.Thomas (2015) argued that once the categorical imperatives are set, they become binding and demand adherence in practical application. For instance, allowing adults with mental capacity to give consent to medication is a categorical imperative that is supposed to ensure that mental health practitioners show respect for patient autonomy. Nevertheless, it could be argued that this categorical imperative could lead to potential bad consequences such as self-harm or harm t o others if the patients remain untreated for unpredictable psychotic episodes. Therefore, Kantianism presents mental health physicians with an ethical dilemma in their decision-making because they both have a duty to respect patient autonomy and protect a person from harming both self and others.Nevertheless, Kantianisms rationale of deontology is hardly enough reason to justify the need for physicians to respect patient autonomy, According to Stohr (2011) Kantianism describes autonomy as a personal choice. In other words, it explains autonomy of the will belongs to the will by which it is considered a law by itself. Kant also claimed that the principle of autonomy regarding a choice in which only choosing in a certain manner that maxims of an individualized choice is part of a universal law in the same violation, forms the sole principle of morals (Stohr, 2011). In other words, Kant believed that people choose autonomously when choosing something because of the pure act of will, as opposed to choosing based on attractiveness of the choice. From Kants perspective, autonomy is based on the philosophy that everyone has a worth because of making personal and independent decisions and they have the ability to make informed choices based both on individualized desires and guidance by moral principles. This means that when people rationalize values considered important like theirs, they can make rational decisions. Therefore, the doctor made a rational decision because it was his duty to look after the long-term wellbeing of the patient, who according to him has unpredictable agitation episodes.DiscussionAs highlighted above, autonomy in health care is important because it implies that patients are not to be coerced into medication or treatment if they are capable of making informed decision about their condition (Owen et al., 2013). According to Kantianism physicians have a duty to treat patients to prevent escalation of their conditions, hence providing room for forced treatment. There are specific laws on involuntary psychiatric treatment provided there is genuine concern about the severity of the patients condition, which might predispose him or her to endangering self or others (Sjstrand et al., 2015). Although physicians might justify their moral duty of forced treatment, citing their moral obligation to prevent potential self harm and others, follow-ups on patients subjected to involuntary treatment have indicated that substantial number of patients disapprove the process and cite negative experiences associated with violation of their freedom and personal integrity (Katsakou et al., 2012).From Peters mental examination, it was apparent that he was not suffering from any apparent mental health illness but the doctor decided force him to take psychosis prescriptions, violating not only autonomy of his patient, but also other important aspects such as...

Florence Nightingale As A Hero - 1021 Words

Edward Albert once said, â€Å"The simple act of caring is heroic†. This gives precedence to the fact that not all heroes have stories or myths written about them; some are known simply for the kindness that they have exhibited towards others. The idea that a hero is inclusive, means that the person is considered a hero to all parts of the world (not just a certain culture or time-period); however, this is simply not true. For instance, Jesus is considered a hero and savior to those that follow the Christian/Catholic Religion, but to those that follow the Islamic religion he is simply a prophet and messenger of God (Largen, 2014). Thus, cultural heroes differ and they are known mostly to the cultures they impact. An example of such a little†¦show more content†¦Nightingale underwent a multitude of adventures and journeys on her heroic path towards bettering the medical society. She travelled the world (Cook, 2012) learning how to heal and care for the wounded. She al so continually fought against the sexism that was rampant throughout the time-period (Steele, 2017). Nightingale was successful in her battles for a better medical society. She brought about major changes in the practices and teachings of others, particularly in the field of nursing. Prior to her actions, the medical culture did not put much thought into handwashing and other hygiene practices (Steele, 2017). She also laid the foundation of professional nursing with the establishment of her nursing school in London, which became the basis for professional nursing schools across the world (Steele, 2017). During Nightingale’s work with the Crimean War, the media released multiple articles about her actions, and how they decreased the death rates for the soldiers (McDonald, 2013). Some believe that this was to give the public a hero during wartime, while others believe that it was simply due to her actions. Even though Nightingale may not have claimed credit for the decrease in death rates, she was a hero to the public for helping the soldiers return home due to her actions causing a decrease in the death rates of the soldiers that were largely due to preventable diseases (McDonald 2013). The terms for being â€Å"heroic† are bound to eachShow MoreRelatedTaking a Look at Florence Nightengale730 Words   |  3 PagesI chose Florence Nightingale for a number of reasons one being that I happen now that theres a school named after her. So I kind of want to see why was she so famous for so a school could be named after her. An also I feel that not everyone might write about her so it could be excited to research about her. History has forgotten to remind us about all the great women that have changed the world. Like that of famed military nurse and also mathematics Florence Nightingale. The essay will containRead MoreThe Most Influential Nurse Of History : Florence Nightingale1322 Words   |  6 PagesThe Most Influential Nurse in History Florence Nightingale did not start out as the successful woman she is known as today. She belonged to the upper social class of England. Many restrictions were placed on women in Nightingale’s social class such as what they were allowed to read or where they could go. Among her family and social class, nursing seemed out of the question as a career. If you had a â€Å"regular job† you did not belong to society. Because nurses were doing a dirty, miserable job forRead MoreFlorence Nightingale: Non-Profit Management Case Study1560 Words   |  7 Pages   1    â€Å"The   Fixed   Determination   of   an   Indomitable   Will,   Florence   Nightingale†       Florence   Nightingale    Florence   Nightingale   was   born   to   make   a   change,   because   she   possessed   the   ambition   and   devotion    to   help   people   at   a   very   young   age.   The   obstacles   she   had   to   face   as   a   woman   practicing   medicine   in    the   nineteenthRead MoreFlorence Nightingale and Her Effect on Society2440 Words   |  10 PagesFlorence Nightingale and Her Effect on Society Florence Nightingale was a national hero in Victorian England who shaped the role of women and the image of hospitals in society forever. Miss Nightingale had gained her reputation through the Crimean War where she served as one of the head nurses and saved hundreds of lives. When she returned from the war, she was greeted by the royal Queen Victoria and the society of England as a heroine. Punch magazine depicted Miss Florence Nightingale as aRead MoreFlorence Nightingale : A Courageous And Helpful Woman1770 Words   |  8 Pageswork. Then, there was Florence Nightingale who believed at an early age, that she could make a difference. In analysis of historical images and poems, Florence Nightingale was represented as a courageous and helpful woman. Propaganda during this time period played a huge role in advertising Nightingale and her accomplishments. Florence Nightingale took a stand during the 1850’s often portrayed as someone who couldn’t succeed in the path sh e wanted to follow. However, Nightingale quickly earned theRead MoreEssay about History of Nursing: Florence Nightingale1795 Words   |  8 PagesFlorence Nightingale was born in Florence, Italy on May 12, 1820. Even in her early life, Florence would find it necessary to help the sick people in her community. As the years went on Florence realized nursing was her future because it was her divine purpose. Her parents were not enthused by her plans to become a nurse and even prohibit her to pursue nursing. It was frowned upon in this time period of a woman with her social background to become a nurse. It was actually in the rights for her toRead MoreFlorence Nightingale : The Joan Of Arc Of Nursing1830 Words   |  8 PagesFlorence Nightingale: The Joan of Arc of Nursing Florence Nightingale is known as a pioneer of public health. Not only was she a fantastic nurse, but aside from working directly with individuals she also affected populations. She worked hard addressing matters of epidemiology, such as breaking the chain of infection as well as meticulously measuring health outcomes. She utilized mortality rates and surveillance in her research methods. Her accomplishments affected thousands of people. Florence NightingaleRead MoreNursing Association : Nursing As The Profession Or Practice Of Providing Care For The Sick And Infirm2003 Words   |  9 Pageshistory of nursing is very interesting, from the people who made it a possibility to the breakthroughs and improvements that have happened in the field. Because of the early years of nursing, our greatest accomplishments came from people such as Florence Nightingale, and if it were not for people like her, nursing would still be frowned upon today. According to Gail Thomas and Eileen Richardson, the first nursing school was established in India in 250 B.C. At that time only men went to nursing school.Read MorePs330 Final3059 Words   |  13 Pagescourse I have chosen Florence Nightingale. Nightingale is such a significant person in my career field as a registered professional nurse; she of course is the unsung hero of my profession and an outstanding pioneer of her time. There aren’t as many influential nursing figures in history as there are musicians, entertainers, or even sports players. We must always peer deeply into our inspirations and our careers and find who our pioneers are; for me it is Florence Nightingale. When we think of nursesRead MoreThe Changing Context of Nursing Essay examples1635 Words   |  7 Pageschanging from the late 1800’s to present, the images are made from individual’s perceptions by what is seen in the media, how education is taught in nursing and historical figures (Daly, Speedy, Jackson, 2014). Historical figures mainly include Florence Nightingale and her, self-sacrifice and the nurses who transformed education (Fee Garofalo, 2010, p. 1591; Allen, 2010, p. 35). Education has moved forward by the enhancing strategies of teaching student nurses to improve the image of nursing and gaining

Strengthening Reporting of Observational Studies

Question: Discuss about the Strengthening Reporting of Observational Studies. Answer: Introduction: Borderline personality disorder (BPD) is a set of abnormal behavior is observed in an individual characterized by unstable mood, behavior, emotion and functioning. There is extreme feeling of depression, anxiety, self-harm and suicidal thinking among people with BPD. The rate of suicide and suicidal behavior is high in people with borderline personality disorder. There are argument regarding the values of hospitalization on patients with BPD and one research suggests that hospitalization can produce negative effects for patients. This is because of the chronic suicidality characteristics of BPD. The management of chronic suicidality characteristic is based on specific treatment, which should not be restricted to hospital setting. Hospital should be reserved for specific treatment such a neuroleptic therapy for psychotic patients which cannot be delivered outside the hospital. Hence, suicidal prevention in hospital leads to more regression in patients (Paris, 2004). Another study just ifies in-patient treatment for such patients to promote safety, however the suicidal precaution steps used in hospital setting reinforce suicidal thinking in patients. People continue to have suicidal intention even after suicide (Bateman Fonagy, 2010). Hence, the purpose of hospitalization for these patients is not met. People with BPD are often hospitalized for continuous psychotic episodes, serious suicide attempts and self-mutilation. This has been found of no value for recovery of patient and lead to negative effects in patients. Some of the prolonged impact of extended inpatient hospitalization includes continued risk of assaultive behavior, poor physical and social functioning, eating disorder and non-adherence to treatment. It is also an additional expense in terms of cost. Hence, psychiatric admissions are often opposed by mental health professionals due to adverse effect of regression and iatrogenic dependency (Koekkoek et al., 2010). Apart from this negative impact of hospitalization on patients, the negative attitude of psychiatric staffs on treatment of patients BPD also creates risk for patient. Negative attitude and lack of empathy towards patients further increased the burden and cost of treatment (Bodner et al., 2015). The analysis of literature revealed that there is lack of studies regarding the long-term impact of prolonged hospitalization on people with BPD. Although studies present reinforcement of suicidal tendency despite hospital, researchers have not yet explored the long-term impact of hospitalization on mental health of BPD patients. Objective of the study The purpose of this research is to analyse and evaluate the long-term impact of prolonged hospitalization on patients with BPD and identify the strategies or approach by which the impact can be reduced. The research question for the study includes the following: How does prolonged hospitalization affect patients with BPD? What are the long-term impact of hospitalization on patients with BPD? What strategies or interventions are needed to reduce the adverse impact of hospitalization? Research approach The review of research presents several contrasting viewpoint for hospitalization in BPD patients. Short-term hospitalization is effective in severe crisis situation and for the diagnosis of BPD. Short-term hospitalization is also supported to provide temporary relief from acute stressful episodes and self-destructive behavior. However, there is doubt regarding prolonged hospitalization for this group of patients as most of the symptoms of BPD can be managed by structured outpatient program like individual therapy and medication. Hence, due to the lack of study regarding the adverse effect of prolonged hospitalization in this patient, this research is important to widen the knowledge regarding adverse effect of hospitalization and find alternative ways to reduce the harm in patients. Grounded theory approach to qualitative research will be done to conduct this research. This methodology of research is used to construct theory through the analysis of data relevant to the purpose of study. It is an inductive way of research in which specific research question guides the future course of investigation. The data collected for the study is reviewed repeatedly with separate repeated idea and categorize data into different codes. This codes can be further developed into a concept and consequently specific categories (Charmaz, 2014). Conventional research is based on a theoretical framework on the basis of which data is collected to show prove whether the theory applies to the phenomenon under study or not. In contrast, grounded theory research method offers explanation related to the phenomenon of study which results in the development of theory. Apart from generation of theories from data, this research methodology also helps in the discovery of emerging patterns in the data. By this means, several social patterns of society can be easily conceptualized (Kelle, 2010). The methodological strategies of grounded theory by means of extensive data analysis lead to the development of middle level theories. The final result has credibility as it is made on the basis of strong empirical foundation. Reflexivity in grounded theory can contribute to validity of the research by means of analysis and interpretation of different phases of research (Gentles et al. 2014). This methodology has been chosen for the current study because there is lack of studies regarding the harmful long-term impact of hospitalization in BPD patients. Short-term impact has been discussed, however there is lack of theory regarding long-term potential impact of prolonged hospitalization. Hence, study with this group of people through grounded theory approach will help to evaluate the long-term impact and develop theory regarding potential ill-effect. It will help in better understanding of the phenomenon related to adverse impact of prolonged exposure to hospitalization (Creswell, 2012). Other advantage of using this methodology in current study is that it will sequentially guide the research process and offer specific strategies for handling the research data. It will promote conceptual understanding and enhance the legitimacy of the qualitative research (Kolb, 2012). Data collection The data collection for this research will be based on the data collection technique of participant observation to generate data for the grounded theory and research question. It will help to gain familiarity with the study participants a specific environment for a certain period of time (Bryman, 2015). As the aim of the research is to develop understanding about long-term hospitalization process on people with BPD, the research will be conducted for extended time period. Participant for the study will be recruited from the outpatient unit of the Department of Psychiatry in the regional hospital of Australia. The inclusion criteria for the participation included diagnosis of BPD within 1 year and absence of other chronic disease. They should also have past history of at least one suicidal attempt in the past one year. This criteria is important because if participants with other chronic illness are include in the study, it might give biased and invalid results. The participants will be assessed for inclusion by means of assessment carried out by experienced clinician. They will confirm the diagnosis of BPD on the basis of criteria listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) classification system and clinical history of participants (Sellbom et al., 2014). As this group of participants will be kept in hospital for about 3 months period, their clinical assessment will be done before and after hospitalization. After provi ding the same treatment protocol to all patients during the hospitalization, their health status and symptom will be assessed quarterly followed by one-year follow-up to evaluate any long-term impact of hospitalization. After the hospitalization phase, the severity of the symptoms will be assessed by means of Hamilton Rating Scale for depression and Anxiety. Secondly, suicidal behavior questionnaire will be distributed to each participant and they will be asked to give their response. This will help to observe suicide ideation post-hospitalization (Linehan et al., 2015). Ethics of research The ethical requirement in conducting the research will be met by taking ethical approval for the research from the Australian Institute of Applied Psychology Human Research Ethics Committee. This approval will reflects that the research process will follow the standards of ethical conduct as mentioned in the Australian Code for Responsible Conduct of Research. The permission or approval of research depicts that research process has been assessed on all level such as quality, safety, ethical responsibility, risk management and financial management (ACAP Research Ethics ACAP, 2017). Secondly, during the recruitment phase of research, participants will be included in the study only after taking written informed consent for the participants. This will mean informing participant about the purpose of study, any risk during the process, concealment of identity of participants and method of dissemination of study finding. The detail regarding the treatment protocol and interventions will a lso be provided to participants while taking informed consent. This will ensure that participants will voluntarily participate in the research based on relevant risk and benefits of the research for them. The main information given to participant will include purpose of research, expected duration, right to decline, reasonable foreseeable risk factors and limits of confidentiality (Kass et al., 2015). Steps taken to strengthen the credibility and generelisability of the findings The research is mainly concerned with identifying the long-term adverse impact of hospitalization on patients with BPD. Analysis of recent literature on the topic has propose little value of hospitalization on suicide ideation and depression in patients with BPD. Research studies have analyzed the impact of certain interventions in hospital setting, however there is lack of studies regarding the impact of hospitalization in people with BPD. To gain insight into the issues faced by patient after prolonged hospitalization and plan strategies to reduce the effect, the participant observation and clinical assessment is considered important for this research study. Furthermore, the credibility of the research will be enhanced by means of appropriate tool to assess the level of anxiety and suicide ideation among participants post-hospitalization period (Noble Smith, 2015). In this study, Hamilton Anxiety Rating Scale (HAM-A) will be used to measure the severity of anxiety level in participants post-hospitalization. This will enhance the credibility of the research data and findings as it is validated tool used to assess response of patient following an intervention or treatment. The score obtained from the HAM-A will help to evaluate the potential bad or good effect of prolonged hospitalization on management of symptoms of BPD (Thompson, 2015). This means of clinical assessment and collection of data related to anxiety and suicide ideation will enhance the richness of the data collected. Furthermore, the trustworthiness of the data will be increased by analyzing data through the data triangulation method. By this technique, the validation of the data will be enhanced through cross verification from two or more sources. In this research, the two approaches for understanding the phenomenon (adverse impact of hospitalization) include use of anxiety and su icide ideation tool as well as completing the Suicidal behavior questionnaire. By this multiple technique of assessment, the study finding can be cross-verified and any biasness or confounding factors in research can be readily identified. This technique will help to overcome the limitations of research, which is based on single-observation technique (Hussein, 2015). The credibility of the finding is also enhanced by maintaining consistency in research findings so that it can be readily understood and replicated by others. All this is dependent on method of inquiry, analysis and presentation of research finding. Integrity in this research will be maintained by recruitment of experienced clinical staff involved in dealing with BPD patients and other psychological disorder. This involvement of experienced staff in research will establish control over the data collection, data analysis and reporting of the research finding. As this research used observation method for data collection, the guidelines for reporting observational studies will be followed. It helped in reporting of data transparently so that readers and reviewers can easily follow the research process, study finding and the final conclusion of the research. The study finding will also be compared with other relevant research to analyze consistency level. This form of critical assessment and comparison with other research article will help to identify strength and weakness in study design and analysis. The use of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement checklist of items required for reporting observational studies will enhance the reporting process of studies (Von Elm et al., 2014). Grounded theory methodology is chosen for this research study to develop theory or approach regarding impact of hospitalization on BPD patients. The rigour in the grounded theory research can be developed by special consideration regarding this in the data collection phase. For this research study, the rigour and validity of the research is dependent on scores obtained for each participant in the Hamilton Anxiety Scale and the Hamilton Suicide Ideation Scale. Furthermore, the response that will be obtained from the Suicide Ideation Questionnaire will first be code and categorized into different concepts. Secondly, the emerging concepts obtained from participants response will be cross-checked by the score obtain from the clinical assessment tool for the study. Other research experts will be consulted for to make sampling and analytical decisions. This step will reflect the rigour in research as well as strengthen the credibility of the research study. This inductive-deductive process will lead to theory generation specific to the objective of the research (Cooney, 2011). Another aim of this research is to reduce the impact of hospitalization on BPD by suggestive effective inpatient intervention for this group. This is highly dependent on the level of severity found in participants post- hospitalization. To address the negative impact of hospitalization on BPD patient, it is suggested to include partial hospitalization in patients with severe psychotic symptoms and self-harm attempts. Furthermore, BPD patients can be provided therapy in residential setting. One example of an intervention that can be given outside the hospital include the Dialectical behavior therapy. This treatment consists of multiple components such as individual therapy, skills training and coping skills to achieve positive outcome for patients. The efficacy of this intervention for treatment of risk behavior in BPD has been proved by various research studies and it has revealed reduced rate of suicidal and self-injurious behavior in treatment groups. This intervention is increasin gly provided in community setting where patients are not restricted to the limits of the hospital and gets chance to do other activities. This promotes well-being and better results post the intervention (Linehan et al., 2015). The utility of dialectical behavior therapy in patient treatment of BPD patients has also been analysed by Bloom et al., (2012) and the researcher showed that it is effective in reducing symptoms related to BPD in inpatient setting. However, this involved variation in certain strategies of the intervention such as phone consultation was removed from treatment schedule. Secondly, duration of the treatment was changes according to the convenience of patient. This resulted in reducation in self-harm behavior, suicidal intention and aggressive behavior in patients. This suggestion of appropriate intervention to reduce the risk of harm to patients with BPD will reflect that research situation was appropriately verified and analyzed to improve health outcome of target group. This will help to fulfill the purpose of the study and promote the transferability of the research in real context and clinical scenario. Furthermore, transferability will be promoted by appropriate reporting of key findings, strength and limitation of the study. Reference ACAP Research Ethics ACAP. (2017).Acap.edu.au. Retrieved 13 April 2017, from https://www.acap.edu.au/faculty-and-research/acap-research-ethics/ Bateman, A., Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder.World psychiatry,9(1), 11-15. Bloom, J. M., Woodward, E. N., Susmaras, T., Pantalone, D. W. (2012). Use of dialectical behavior therapy in inpatient treatment of borderline personality disorder: a systematic review.Psychiatric Services,63(9), 881-888. Bodner, E., Cohen-Fridel, S., Mashiah, M., Segal, M., Grinshpoon, A., Fischel, T., Iancu, I. (2015). The attitudes of psychiatric hospital staff toward hospitalization and treatment of patients with borderline personality disorder.BMC psychiatry,15(1), 2. Bryman, A. (2015).Social research methods. Oxford university press. Charmaz, K. (2014).Constructing grounded theory. Sage. Cooney, A. (2011). Rigour and grounded theory.Nurse researcher,18(4), 17-22. Creswell, J. W. (2012).Qualitative inquiry and research design: Choosing among five approaches. Sage publications. Gentles, S. J., Jack, S. M., Nicholas, D. B., McKibbon, K. (2014). Critical approach to reflexivity in grounded theory.The Qualitative Report,19(44), 1-14. Hussein, A. (2015). The use of triangulation in social sciences research: Can qualitative and quantitative methods be combined?.Journal of Comparative Social Work,4(1). Kass, N. E., Taylor, H. A., Ali, J., Hallez, K., Chaisson, L. (2015). A pilot study of simple interventions to improve informed consent in clinical research: Feasibility, approach, and results.Clinical Trials,12(1), 54-66. Kelle, U. (2010). The development of categories: Different approaches in grounded theory.The Sage handbook of grounded theory, 191-213. Koekkoek, B., Van Der Snoek, R., Oosterwijk, K., Van Meijel, B. (2010). Preventive psychiatric admission for patients with borderline personality disorder: A pilot study.Perspectives in psychiatric care,46(2), 127-134. Kolb, S. M. (2012). Grounded theory and the constant comparative method: Valid research strategies for educators.Journal of Emerging Trends in Educational Research and Policy Studies,3(1), 83. Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., ... Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis.JAMA psychiatry,72(5), 475-482. Noble, H., Smith, J. (2015). Issues of validity and reliability in qualitative research.Evidence Based Nursing,18(2), 34-35. Paris, J. (2004). Is hospitalization useful for suicidal patients with borderline personality disorder?Journal of Personality Disorders,18(3), 240-247. doi:10.1521/pedi.18.3.240.35443 Sellbom, M., Sansone, R. A., Songer, D. A., Anderson, J. L. (2014). Convergence between DSM-5 Section II and Section III diagnostic criteria for borderline personality disorder.Australian New Zealand Journal of Psychiatry,48(4), 325-332. Thompson, E. (2015). Hamilton rating scale for anxiety (HAM-A).Occup. Med.(Lond.),65, 601. Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gtzsche, P. C., Vandenbroucke, J. P., Strobe Initiative. (2014). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.International Journal of Surgery,12(12), 1495-1499.