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Accounting Cycle Research Paper Example | Topics and Well Written Essays - 750 words

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Analyse Contribution Of Engagement In Biopsychosocial Assessment Client Nursing Essay

Analyse Contribution Of Engagement In Biopsychosocial Assessment Client Nursing Essay In this essay the process of building a therapeutic relationship and assessing clients own circumstances within the inpatient admission and the framework found in practice will be uses analysed and criticized by using Johns (1994) model of reflection. The framework that has been used in mental health services is the Care Program Approach (CPA), which it has been profoundly criticised since it was introduced. Therefore the reflection will look into other model of nursing, Tidal Model, which offers a different philosophy of care. The reflection will also explore the interpersonal interactions theories which the nursed used during the assessment and how these aided to engage the client in the biopsychosocial assessing process. It also will be discussed other intervention models and the possible usage in similar situations. In order to begin the analysis of the above points, engagement needs to be defined. Thurgood (cited by Norman and Ryrie (2004) p.650) described it as: can be broadly defined as providing a service that is experienced by service users (including carers) as acceptable, accessible, positive and empowering. Although this definition gives an idea of the concept, it lacks to define the key elements of engagement, which Cutcliffe and Barker (2002) identified as forming a human to human relationship, expressing tolerance and acceptance, and hearing and understanding. Both definitions gather the professional values of the service and the interaction itself. Yet, Cutcliffe and Barker (2002) definition can be considered more practical when holistically assessing clients. However, these definitions do not acknowledge factors of engagement that are behind the interpersonal relationship, such as personal or organizational perspectives of engagement. The personal perspective for the nurses practice is underpinned by poor structural organization, occupational cultures and stress, bureaucratic constrains, lack of time and nursing culture driven by measurable targets (Hosany et al (2007) and Addis and Gamble (2004)). On the other hand, clients and their families are conditioned by the mental illness, their past experiences with other services, the trust in the service and the relevance of it. Additionally, the organizational issues effect upon engagement and care by reducing services budgets, by not providing resources and also by politics. Engagement has been recognized as an important part of mental health services users care. The National Service Framework (NSF), the National Institute for Clinical Excellence (NICE) and the Department of Health (DoH) appoint that users under CPA should be provided with resources to build a therapeutic relationship, optimise engagement and reduce risks. These documents also highlight the need to provide a therapeutic environment in order to provide best care and to engage the clients and their families with the service. Taking into account all the above information a reflective account will be taking place in the following pages by using Johns model of reflection (1994). 1. Description of the experience The clinical environment where this assessment took place was in an acute adult ward. The ward is based in an old mental health hospital, which has old and pilling off wooden windows, untidy roofs and old fashioned flooring. The ward had untidy carpets, the curtains did not draw appropriately and the painting on the walls was peeling off. These are the organisational barriers affecting engagement. This particular client was known by the service already, to protect his right to confidentiality he will be referred as John (NMC code of practice 2008). John had been stable for 10 years, but in the past few months his mental state had worsened. His psychosis and levels of anxiety increased; he distrusted neighbours and other acquaintances as well as strangers. Consequently, he stopped going out of his house and began to self medicate with over the counter sedatives. Crisis and Resolution Home Treatment Team (CRHTT) was involved and as they felt that John was not able to cope at home, they decided that an inpatient admission would be beneficial. Before the admission the CRHTT forwarded the CPA form 1A, which updated the ward staff about the latest assessment of the clients biopsychosocial needs. Once John arrived to the ward, he fully understood the situation where he was in. He was able to consent and had capacity to agree with treatment and, thus, he was admitted as an informal client. This facilitated the initial interaction and the initial grounding for the nurse/client relationship. Before the beginning of the assessment Tom (Johns named nurse) introduced everyone to John, roles were explained, a welcome pack with the ward information and a CPA booklet were given and Tom provided all the information in an oral and written manner. The nurse started the assessment by formulating open questions. However John gave single direct answers (yes, not, not sure ). Consequently, the nurse decided to change to more direct questioning. After that the client was very co-operative and was answering all the questions. He reported to be very anxious, which also was noticeable by looking to his body language (he was sweaty, clenching his fingers, rubbing his hands on the chairs arms and removing his spectacles several times during the interview). At this stage the nurse decided to undertake an anxiety assessment by using the scales tools available on the ward the Becks Anxiety Inventory (BAI, see Appendix 1). Following this assessment, John began to answer the questions more in depth and he appeared more eased, stating several times that he was in hospital for help and was going to do everything that was available for his recovery. Following the local trust policies and NICE guidelines, the CPA 1A assessment was concluded (as it must to be completed within 72 hours of the admission); the Integrated Care Pathway for Inpatient Safety and the Patient Property Liability Disclaimer were filled in and signed by nurse and client. 2. Reflection The whole assessment was intended to gather as much information as possible about John in order to understand the clients actual biopsychosocial situation (holistic assessment) and the context that led to the admission, which would highlight the needs and strengths of the client. However, inpatient admissions are more likely to focus on a more medical approach to health, mainly because social interventions cannot be implemented until the clients mental state has stabilized and he is ready to move on to community settings. Along this process the multi-disciplinary team organizes care to build up the grounds to enable recovery (Simpson 2009). This particular ward was focus on treatment and stabilizing, working on one to one interventions (nurse-client), building a therapeutic relationship through structured and unstructured interventions, and used CPA as a nursing intervention framework. Alongside these individual interactions, the activity nurses and the occupational therapist offered daily social and leisure activities. These groups provided skills and entertainment to the clients on the ward, but did not follow a particular model of nursing, such as the Tidal Model, and they offered activities to spare the free time on the ward without promoting recovery. The Tidal Model provides structured group-work centred on recovery (Barker and Buchanan-Barker 2005). This model centres its assessment on a holistic approach for the short and long term needs, viewing the mental illness as a unique experience of each individual, their families and social environment. It looks into the lowest point of the illness (such as an inpatient admission like Johns) as the point where the recovery begins with a positive approach to the illness. There are three working groups recommended in this model: discovery, solutions and information (see appendix 3), where therapeutic relationship is built and issues common to the individual and others are discussed and explored. As mentioned above, the ward nurses had more structured interventions with clients, and the issues discussed in these interviews were correlated to the Tidals Model theme groups. In these interviews the clients engage with their primary nurses and they discuss their concerns in relation to their care or other personal matters. These interventions or interviews were intended to happen at least twice weekly for at least an hour. However, for organizational issues (usually low number of staffing) not all the clients had the opportunity to benefit from these one to one interventions on a regular basis. Initially, the Tidal Model research was criticised for being bias, for lacking to fully describe clients pre and post intervention with the model, not taking into account Hawthorne effect and most of physiological factors and by not reasoning the need for a new model in mental health care (Noak 2001). However, further research and analysis showed that the Tidal Model provides tools and structure to improve care in acute ward admissions filling the gaps in care pointed in the NSF and The Sainsbury Centre for Mental Health (Gordon et al 2005). One could say that this model has been shown to improve mental health services, fulfil the historical gaps within nursing practice and to be grounded on evidence-based practice. However, the author of this essay believes, after reading the relevant literature, that for the implementation of the Tidal Model the levels of staffing (and therefore the service budget) should be increased and nursing practice cultures must be changed by re-educating th e workforce. Arguably both implementations are very difficult to achieve as the health service has seen budgets cut downs in the recent years and nurses practiced has been subject to negative ward cultures towards nursing models. On the other hand CPA, which is the framework used on the ward, was first designed after a series of fatal incidents which involved mentally ill people. It was aimed to be introduced in Wales by 2004 (in England was done by 1991). CPA is person centred focus which promotes social inclusion and recovery, through assessment and planning of individualized needs and strengths, working with the clients and their families or carers (Care Programme Approach Association (CPAA) 2008). Despite the initial intention that the CPA was brought to improve service users quality of care, to increase inter agencies communication and to be a case management tool, some critiques appeared. Simpson et al (2003a) researched showed CPA was thought to be an over-bureaucratic duty within the professionals. The author of this paper has observed in practice, not in this particular assessment, that some professional do not reassess clients when they are admitted. Instead the latest CPA 1A form (usually filled in by the CRHTT) is photocopied or copied-pasted and re-used to speed up the process. This would be acceptable if the client was assessed the day or night before the admission, because the social, psychological or biological needs would have not changed in that period of time. When older assessments are used, changes in circumstances might have not been updated. In the worst case scenario a health professional could have misunderstood the clients needs and have documented them wrongly. This misunderstanding could be carried over, therefore care would be affected. This hypothetical scenario shows that CPA assessments should be done every time when needed. CPA as a case management tool fails to compile the most important features which promote therapeutic relationship. In contrast with other case managements models the role of the care co-ordinator is more of an administrative and as an alternative service prescriber (Simpson et al 2003a). This means that there is no need for a specific training or skills related to therapeutic relationship, partly because other services (or service providers) will engage with the client, and the care co-ordinator just oversees the process of care. Moreover, CPA also lacks a nursing model background and fails to define specific roles within the multi-disciplinary team. These factors reduce the teamness feeling between the health professional (Simpson et al 2003b). Although, it could be argued that the reason, why CPA is lacking nursing background, is that it was not designed as a mental health nursing framework but for the use of mental health services. In this particular reflexion the care co-ordinato r was not present in the admission and never mention during the assessment. Whether it was a usual situation or not it is something that never was discussed, but it shows Simpson et al (2003a and 2003b) critiques of CPA as a case management were factual. CPA and Tidal Model are intended to provide holistic care for clients and their families. However, the Tidal Model is more clients centred than CPA, and it also looks into the more positive side of the clients situation, foreseen the now and future as a whole. It explains the illness as an accumulation of life factors. The Tidal Model complements other health and social care professionals, as well as it searches to nurse by building a special relationship between health practitioner and client. Moreover, CPA always looks for risk signs in the short-term and from a psychiatric approach. As this assessment took place in an inpatient admission it is important to bear in mind that in this particular environment CPA forms (1A, 2, 2A and 4) were used for assessment, planning, implementing and evaluation of inpatient care and for the liaison with other health professional in tertiary care (such as physiotherapist, dietician or occupational therapist). Perhaps CPA would benefit from sharing some principles of a nursing model (like the Tidal Model), by using it as a tool more than as a paperwork and from a better staff training and promoting adherence to nursing models (Barker 2001). Whether the ward uses Tidal Model or CPA to structure care, an inpatient admission is always stressful and uncomfortable experience for clients and their families. John saw the nurse as a stranger in an unfamiliar place, however, Tom was there to guide the client throughout his care, to provide information and to be somebody he could relay on. This first encounter related to the orientation phase described by Peplau (1952) (cited by Sheldon (2005), see Appendix 2). In this phase Johns past experiences, expectancies, culture and believes were to condition the initial interaction. Following this phase John went into the identification stage, where he sought assistance for anxiety relief techniques, shared needs and strengths when and co-designed care plans and began to have feelings of belonging and capability, therefore decreasing negative feelings. This exchange of feelings is going to lead to exploitation and resolution phases, where John will engaged with treatment (medical, physic al and social), having different needs at different times, starting to be informed about all the help available towards the final stage, feeling as an important part of the whole nursing process and finally ending the professional relationship when discharged. The exploitation and resolution phases were not observe as at the time of writing John was still an inpatient. John had had previously one bad inpatient admission. He reported that he was very unhappy when he was in the other hospital 10 years ago. He explained that the bad experience was related to the other clients and organizational issues rather than staff. John stated that he was feeling anxious but happy that he was getting help. His positive attitude helped to engage him in the assessment process and on the ward activities, which were the first steps towards the identification phase. Therefore, John could begin to have professional input from other members of the multi-disciplinary team. Tom interacted in a way that John felt understood, respected and individualized. Tom did not appear to have preconceived ideas of the client after reading the CPA forma 1A. And certainly, Tom treated John respectfully and as an equal human being. He followed the NMC code of practice 2008, which states that: you must treat people as individuals and not to discriminate in any way those in your care. Tom tried to adapt the pace of the questioning to the clients needs, involving him and asking in a respectful manner. Tom also acknowledged Johns anxiety feelings, and showed it when taking further (BAI see appendix 1) assessments to empathize more with Johns situation. This reinforced the approachability and genuineness of the nurse and led John to open and engage with the assessment process and the health professional. 3. Influencing factors John scored 45 points in the BAI (see appendix 1), which is a high scoring. This could have been influenced by the hospital admission and the assessment process. Despite these factors and Johns actual mental state he engaged in the assessment actively. The BAI scales consist of 21 observable and self-rating symptoms of anxiety, rated from 0 to 3 (0 being the lowest score), which can also be easily transformed in direct questions or self rating. At the end of the assessment the scores are added up and compared against the scales. There are several assessment tools available such as Hospital Anxiety and Depression Scales (HADS) or Hamilton Anxiety Scales (a collection of them can be found in the Appendix 1 reference). The BAI is shown to be a quick and reliable when measuring clients anxiety levels and it also differentiates General Anxiety Depression and depression (Fydrich et al 1992). Although, these characteristics appear to be positive, it could be argued that BAI is just a merely adaptation of the DSM-IV panic symptoms and therefore it could also be said that measures panic attacks rather than anxiety levels (Cox et al 1996 and de Beurs et al 1997). On the other hand, HADS which achieves good levels of anxiety and depression screening could have been more appropriate for hospital settings and more accurate (Bjelland et al 2002). It is important to point out that NICE clinical guideline for management of Anxiety (2004) does not recommend a specific tool for assessment of anxiety, which gives to the professional practitioner choice on the usage of available tools. This affects practice as these scales are not used as often as they should be. Most practitioners relay on their observations and experience to perform informal assessments, rather than using research based scales. It is perhaps understandable when dealing with clients unable to fully understand these assessments. But in practice it can be noticed that nurses do not tend to use anxiety inventory even with clients that could engage with the process. Tom designed care plans in partnership with John and made him realise which were more realistic goals in the short and long term. Tom had shown knowledge and understanding of the professional capabilities that the NSF defined in the documents The Ten Essential Shared Capabilities (2004) and The Capable Practitioner (2001). These documents set basic principles that underpin positive mental health practice as well as providing the basic grounding for service workers to continue developing and learning skills. Therefore, it was observed during the placement that along the whole admission the nursing team also guided care and practice as appointed by these documents. They provided patient-centred care, which is accountable for each client and respecting the individual. The team also had a broad knowledge of national legislations as well as local policies and services, and worked under the same professional and ethical principles recognizing the rights of the clients and their families. T hey promoted recovery and self-realisation by identifying people needs/strengths and empowering the individuals. Most of the team members were undertaking further training, to keep their skills up-to-date or be able to transfer their existing skills to new environments. They also worked in partnership with family, carers, lay people and external agencies, such as community care services, voluntary associations and vocational services. 4. Evaluation In the interview Tom used a Rogerian approach (Roger (1961) cited by Sheldon (2005)). He also showed knowledge of Peplaus interpersonal theories and applied them in practice by creating a shared experience of care. However, it also would be appropriate to use the Herons six-category intervention framework (Heron 1989). This framework was designed to enable a practitioner (nurse) taking the lead to facilitate the clients specific needs or arising issues. Therefore this intervention could have been used in the admissions assessment and the following one to one sessions, which have been described in this essay. The framework is made off two categories, which are subdivided in three more. The first category is authoritative which it can be prescriptive, in which the nurse influences and directs behaviour, gives advice and prescribe goals. It also can be informative providing information or giving feedback for the clients behaviour. The third subcategory is confronting, in which the pract itioner challenges the clients beliefs or actions. The second category is the facilitative which is divided into cathartic, in which the nurse tries to release the clients painful feelings and talks about or express them with actions (tears, anger or shouts). Next subcategory is catalytic, where the nurse tries to help the client and encourage self-discovery and learning. Finally, supportive is the category where the client is supported in an unqualified manner. The facilitative stage of the framework would have been the most appropriate to use in the first assessment. Johns mental state would not have benefit from an authoritative approach as he might have felt threatened by the staff, therefore his willingness to engage with the service could have reduced greatly. This approach shares the same goals as the one that Tom used. The outcome would have been the same, which was the beginning to build a relationship towards recovery. However, it is important to know different ways to practice and to interact in order to provide an individualised care. This principle is shared by the models discussed in the essay (CPA and Tidal Model) and also by the nursing professional code (NMC code of practice 2008). 5. Learning Although, it was difficult to deal with Johns anxiety levels and his initial unwillingness to engage with the assessment, it was possible to create a therapeutic relationship between nurse and client. After this reflexion it was learnt that nurses knowledge and usage of the right nursing models, strategies and tools can be adapted to individual situations and their own circumstances. It is also important to share principles of care and to change some nurses cultures regarding models of care. It was positive to reflect upon this experience and, therefore, to realise how the theory learnt was applied in practice. Since nursing studies and practice are moved towards research based knowledge it seems that the human connection and relationship building have lost their place in the nursing profession. As a student it is good to see that values based nursing promoted safe, trustful and supporting environment, which led to a healthy therapeutic relationship (Hewitt 2009). In conclusion, the reflection and analysis of engagement through a biopsychosocial assessment illustrated how personal and organizational factors effect on clients care. It was found out that applying specific intervention techniques, mental health screening tools and the adequate adaptation to the individual and the situation promote engagement and build a healthy therapeutic relationship. Furthermore, the research showed that the relevant mental health regulations and nursing professional code recognise the need to keep up-to-dated knowledge and skills in order to provide the best care. All the above techniques and tools were found to be used in a very individual way between the nursing professionals. In addition to this, it was found that theses personal adaptations to practice and clients care were beneficial when reducing barriers for engagement and personalising the care. The positive and negative characteristics of the actual mental health framework CPA were brought forward and it was found that it lacks a nursing model background. CPA and Tidal Model when compared and contrasted, showed that both mental health frameworks differ gratefully from each other but at the same time they could benefit from each other. Despite the ward worked under CPA and used a more medical approach to nursing, the nursing team shared the same professional capabilities and worked towards holistic goals and recovery. Over all, in order to engage and to provide relevant services for clients and cares biopsychosocial needs there should be a continues connection between practice and theory in nursing. References Addis J Gamble C (2004) Assertive outreach nurses experience of engagement. Journal of Psychiatric Mental Health Nursing 11 (4) 452-460. Barker P (2001) The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing 8 233-240. Barker P Buchanan-Barker P (2005) Tidal Model: A guide for mental health professional. Brunner-Routledge. Hove. UK. Bjelland I Dahl A A Haug T T (2002) The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research 55(2) 69-77. Cox B J Cohen E Direnfeld D M Swinson R P (1997) Does the Beck Anxiety Inventory measure anything beyond panic attacks? Behaviour Research Therapy 34 (11/12) 949-954. Cutcliffe J R Barker P (2002) Considering the care of the suicidal client and the case for engagement and inspiring hope or observations. Journal of Psychiatric Mental Health Nursing 9 611-621. Department of Health (2002) Mental Health Policy Implementation Guide: Adult Acute Inpatient Care Provision. Department of Health (2004) The Ten Essential Shared Capabilities. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4087169 Accessed: 29/12/09 de Beurs E Wilson K A Chambless D L Goldstein A J Ulrike Feske U (1997) Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia Depression and Anxiety 6 140-146. Fydrich T Dowdall D Chambless D L (1992) Reliability and Validity of the Beck Anxiety Inventory. Journal of Anxiety Disorders 6 55-61. Gordon W Morton T Brooks G (2005) Launching the Tidal Model: evaluating the evidence. Journal of Psychiatric Mental Health Nursing 12 (6) 703-712. Heron J (1989) Six-Category Intervention Analysis (3rd EDN) Human Potential Resource Group, University of Surrey, Surrey, UK. Hewitt J (2009) Redressing the balance in mental health nursing education: Arguments for a values-based approach International Journal of Mental Health Nursing 18 368-379. Hosany Z Wellman N Lowe T (2007) Fostering a culture of engagement: a pilot study of the outcomes of training mental health nurses working in two UK acute admission units in brief solution-focused therapy techniques. Journal of Psychiatric Mental Health Nursing 14 (7) 688-695. Johns C Graham J (1996) Using a Reflective Model of Nursing and Guided Reflection. Nursing Standard 11 (2) 34-38. National Institute for Clinical Excellence (NICE) Clinical Guideline for Management of Anxiety (2004) http://www.nice.org.uk/nicemedia/pdf/cg022fullguideline.pdf Accessed: 26/11/09 National Service Framework (NSF) Modern Standards and Service Models for Mental Health (1999) NHS our Healthier Nation. Noak J (2001) Do we need another model for mental health care? Nursing Standard 16 (8) 33-35. Norman I Ryrie I (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles. Open University Press. Maidenhead. UK. Nursing and Midwifery Council (NMC) (2008) The Code. (NMC, London). Sheldon L K (2005) Communication for Nurses: Talking with Patients. Sudbury; Jones and Bartlett. Simpson A (2009) The acute care setting. In Barker P (2009) Psychiatric and Mental Health Nursing: The craft of caring. Edward Arnold Ltd. London. Simpson A Miller C Bowers L (2003a) Case management models and the care programme approach: how to make the CPA effective and credible. Journal of Psychiatric and Mental Health Nursing 10, 472-483. Simpson A Miller C Bowers L (2003b) The history of the Care Programme Approach in England: Where did it go wrong? Journal of Psychiatric and Mental Health Nursing 10, 489-504. The Sainsbury Centre for Mental Health (2001) The Capable Practitioner. http://www.scmh.org.uk/publications/capable_practitioner.aspx?ID=552 Accessed: 29/12/09 Appendixes Appendix 1 Beck Anxiety Inventory Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month, including today, by circling the number in the corresponding space in the column next to each symptom. Not At All Mildly but it didnt bother me much. Moderately it wasnt pleasant at times Severely it bothered me a lot Numbness or tingling 0 1 2 3 Feeling hot 0 1 2 3 Wobbliness in legs 0 1 2 3 Unable to relax 0 1 2 3 Fear of worst happening 0 1 2 3 Dizzy or lightheaded 0 1 2 3 Heart pounding/racing 0 1 2 3 Unsteady 0 1 2 3 Terrified or afraid 0 1 2 3 Nervous 0 1 2 3 Feeling of choking 0 1 2 3 Hands trembling 0 1 2 3 Shaky / unsteady 0 1 2 3 Fear of losing control 0 1 2 3 Difficulty in breathing 0 1 2 3 Fear of dying 0 1 2 3 Scared 0 1 2 3 Indigestion 0 1 2 3 Faint / lightheaded 0 1 2 3 Face flushed 0 1 2 3 Hot/cold sweats 0 1 2 3 Column Sum Scoring Sum each column. Then sum the column totals to achieve a grand score. Write that score here ____________ . Interpretation A grand sum between 0 21 indicates very low anxiety. That is usually a good thing. However, it is possible that you might be unrealistic in either your assessment which would be denial or that you have learned to mask the symptoms commonly associated with anxiety. Too little anxiety could indicate that you are detached from yourself, others, or your environment. A grand sum between 22 35 indicates moderate anxiety. Your bod

Stonehenge :: essays research papers fc

  Ã‚  Ã‚  Ã‚  Ã‚  Stonehenge, located in England has been a wonder of the world for years and years to come. Its mystery is baffling and can be seen as inconceivable. For over 5,000 years it has stood silently in its current position. It has been excavated, x-rayed, measured, and surveyed. Even though so much has been discovered about this wonder, such as its age and the way it was constructed, its real purpose still remains a mystery. No other place has generated so many theories as to its purpose than the great standing stones of Stonehenge. (www.mysteriousplaces.com)   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  The semi nomadic peoples that populated the Salisbury Plain began to build what is now known as Stonehenge around 3500 BC. Originally this stone structure was a circular ditch with 56 holes forming a ring around the perimeter. The first stone place in it was the Heel stone. (www.mysteriousplaces.com) About 200 years later, 80 blocks of blue stone were taken from a quarry nearly 200 miles away in the Prescelly Mountains. (www.mysteriousplaces.com) These stones were stood up forming two circles joined together. At some point in time this original structure of the site was dismantled and the blue stones were moved with in the circle. The gigantic stones were installed at this time also. Some of these stones weigh as much as 26 tons and it is still a mystery as to how a supposed primitive people moved them to a location 200 miles away. (www.mysteriousplaces.com)   Ã‚  Ã‚  Ã‚  Ã‚  The construction of the site is also a complete mystery. There are carefully carved lintels that are placed on top of upright stone blocks, which are held in place by ball and socket use. The constructions of these have become known as, â€Å"trilithons†. (www.mysteriousplaces.com) The final block added to the site was the alter block, which is a large block of green sandstone from South Wales. It was placed in front of one of the trilithons. (www.mysteriousplaces.com)   Ã‚  Ã‚  Ã‚  Ã‚  Over the years, each new generation has tended to these monuments. Seeing as nothing last more than a few decades in this day in age, it is completing awing to imagine the fact that a people maintained this structure for almost 2 millennia. (www.mysteriousplaces.com)   Ã‚  Ã‚  Ã‚  Ã‚  The most pondered question of this great Stonehenge is the question of its use. What was it built? Nothing can be certain, but there are definitely well educated theories. For instance, Gerald Hawkins’ theory. He was an astronomer of the 1960’s and he used a computer to provide concrete evidence that Stonehenge was used to observe the heavens.

With reference to several specific moments in the play, explain how you would perform the role of Masha

The part of Masha is a female who starts at the age of 21 and in act3 aged 35.Her clothes are in the colour black so we learn from this she is a melancholy and mysterious character. She is the middle sister out of the three and is married to Kulygin. Kulygin is a high school teacher. She starts by reading a book, whilst whistling. This gives the immediate impression she is quite solemn and subdued. She then says a quote which she repeats later in the play. â€Å"By a curving shore stands a green oak trees, Bound with the golden chain †¦Ã¢â‚¬ ¦Bound with the golden chain†¦.'† Her character seems down at the point because she feels trapped in her marriage to Kulygin. She married him at a young age of 18 and thought he was quite a wise clever man but now she feels stuck in her relationship with him. We learn this later in the play, but at the moment, the character of Masha is dull and unenthusiastic. I would act the part as if I was uninterested in my surroundings and what is going on. I would act unfocused towards the fact it is my sister's name day and I would be indulged in my own pity. She feels trapped in her marriage to him, and is depressed by the reality of life, that she is stuck in this marriage, and in Moscow. I would say lines quite pessimistically and would move around the stage slowly and with my head slightly tilted up as in to be looking to the heavens for help. This would show the audience I am unhappy, and am feeling low. The audience would learn I am unhappy, and would learn soon that it is from my surroundings by which I feel this. Masha does not mind showing her emotions, so I would not hold back my feelings whilst saying my lines and acting in general. The audience would learn straight away that Masha is sad and unhappy with her life. Also is act1, we find out Masha's thoughts of Protopopov. â€Å"I can't stand Protopopov†¦Ã¢â‚¬ ¦You shouldn't invite him.† I would say this line with quite passion, as Masha's character seems quite open with what she thinks. I would seem quite angered at the thought of him. Also, because Masha is already in a bad mood, the mention of some one who she doesn't like upsets her more than usually. I would show this if I was playing the part. This shows the audience she is quite a good judge of character as she later on learns about the affair he is having with Natalya, her brother's to-be wife. They also learn a lot from Masha's derelict that she is to the point and honest with her thoughts. When the part of Veshinin enters, I would make a dramatic change in Masha's tone of voice, and presence on stage. This is because Veshinin is from Moscow, so the 3 sisters are automatically drawn to him. Also, Masha is interested in Veshinin as more than a friend from the beginning, and I would portray this from the moment he walks on stage. We learn this when she becomes excited by having a conversation with Veshinin about Moscow. â€Å"The both laugh delightedly. Masha (animatedly) Ah, I remember!†¦..† I would act this very animated as it says in the directions, and be intrigued about learning about Veshinin. I would forget about the others on stage around me, especially my husband, and stay interested in Veshinin. My face would now be lifted, and focused on Veshinin, my eyes widely opened and a smile on my face. All three sisters have an obsession with Moscow and this would come across in her keenness towards Veshinin. The audience would see that Veshinin's entrance has changed Masha's feelings. They have changed from feeling depressed and down to animated and awake. She emphasises this point when she says: â€Å"I'll stay for lunch.† I would say this line quite abruptly as I want everyone to know I am staying. Also it shows the audience how strong my interest is in Veshinin. The audience would also see me take my hat off, which emphasises the fact I'm staying. Near the end of the act she tells Kulygin she is not going. When he asks why she says: â€Å"Oh right, I'll ho. Just leave me alone, please.† I would say this line whilst not looking at Kulygin, to show that I don't care about him. I will say it with no animation on my face and would be getting cross with him. I feel he is a burden to me so I show this by getting annoyed with him. My tone of voice would sound aggressive and angered, and I would be speaking a little louder than usually. I would pause between saying â€Å"alone† and â€Å"please†, to emphasise the please. This would also so my frustration with him to the audience.This tells the audience Kulygin doesn't interest Masha any more, and she no longer is in love with him. At the end of act1 she repeats the quote: â€Å"By curving shore stands a green oak tree, bound with a golden chain†¦Ã¢â‚¬  Masha is about to be leaving and going back to her house with her husband whom she does not love any more. I would show this by looking depressed and saying this line quite slowly and be thinking of a better life for me as Masha. In act2, Masha is on stage with Veshinin. They are alone, talking about how unhappy they both are. Masha says â€Å"†¦terribly learned, clever and important, so I thought. And now I don't†¦Ã¢â‚¬  I would say this so Veshinin would feel sorry for me and know that I am welcome for something to happen between the two of us. I would look into his eyes when I talk which would show the audience I love him, and look coldly when I talk of my husband so he knows I don't have any feelings towards Kulygin any more. This shows the audience Masha is interested in Veshinin but doesn't want any one to hear to see, as this conversation takes place in the dinning room of the Prozorov's house. Later on in this conversation Veshinin tells Masha he loves her. When he kisses her hand she moves as she knows what she is doing is wrong. When he says it, she says: â€Å"When you speak like that, I laugh, I don't know why†¦..† If I was playing Masha, I would make my face look brighter, and I would star into his eyes lovingly. Because of her character, I feel she is the type who cannot hide her true emotions, so at this precise moment of intensity between the two of them, she probably wouldn't care what she looked like. The audience would see the love Masha feels for Veshinin through how she looks at him. When Veshinin leaves during the act, Masha becomes aggressive. â€Å"Oh, get away! Stop pestering me, leave me in peace†¦.† As I mentioned earlier, her character is quite open with her emotions. Because Veshinin, has left Masha is now upset and angered. I would say this line very snappy and loudly as my whole frame of mind has moved from love to anger. The tone of my voice would have completely changed. They would now be shorter and snappier. This is so the audience can see Masha is upset with Veshinin's exit. When Masha enters Olga and Irina's room during act3, after Veshinin's speech about how wonder he feel life is, her and Veshinin echo each others line: â€Å"Tram-tam-tam†¦Ã¢â‚¬  But this part in the play, Veshinin and Masha both like one another, and this small conversation is a special language they are speaking to each other. Masha is very happy as Veshinin is present in the room, and that he loves her back. From her entrance, I would play the part as if I am happy, quite dreamy, calmly. I would act quite excited as I would be having this secret language with the man I love, but no one else in the room knows what we are talking about. The audience would see the secret verbal affair going on, and would see how no one knows anything is going on. After Veshinin exit's Masha becomes bored, and low again. â€Å"†¦I'm so very, very bored!..† And then she brings up how her brother Andrei is in dept from his gambling problem. Due to Veshinins's exit, Masha focuses on the bad parts of her life again. I would start saying the lines now to the point, and as if I don't care who hears. She is bored now as Veshinin has now left, and so she feels depressed now, and as she is depressed she is thinking of depressing things. I would tell them about Andrei's gambling problem quite bluntly. This would show the audience the effect Veshinin's presence has on Masha. A little later on in the act, after Kulygin has exited, she confesses to her sisters about her love to Veshinin. â€Å"I've a confession to make†¦.I can't keep it any longer†¦.† I would say this conversation with a huge passion as Masha is very in love with Veshinin, and so even talking about him would excite her. I feel she wants something to happen and so coming clean with it to her sisters may hopefully mean that something good may come of it, but this is not so. It's the first bit of happiness any of the 3 sisters have had since they have moved away from Moscow, and that is a reason why this short conversation with Olga and Masha is very important to Mashas part in the play. She is the only 1 out of the 3 sisters who experiences true happiness during the duration of the play. The fact that she is actually in love with someone, and for them to love her back, is extraordinary to them. Ironically, Masha is the only one who cannot move back to Moscow, as she is married to Kulygin, who works in the school in the are they live in now. This upsets Masha more, and is another reason why her love for Veshinin is so important, because it is the only happiness she has had since she has moved. But the reality kicks in when they hear someone approaching the room. She has to now go back to her husband who she doesn't love and pretend she hasn't shared any of this information with her sisters. I would now act solemn and upset again, as once again, I, as Masha, would have to be putting up with sharing my life with a man who I do not love. The audience would see how much Masha loves Veshinin by the passion in her voice and actions when telling her sisters about her feelings. In Act4, it is time for Veshinin to say good bye, as this is the day when all the soldiers are leaving. The atmosphere on stage during this act is a lot calmer than the other 3, as everyone on stage knows the stage in their lives with the soldiers it is nearly over.

Mat Rempit

Illegal street racers, or in the well known names, Mat Rempit, is a serious issue that knock our country right now. Known for their kamikaze skills on the road, causing chaos in society, their unmannered attitude and the current is murdering people. Statistics shows that this group causes too many crime and problems. With their enormous amount, they felt like the road is belongs to them and nobody have any rights to punish them. This is why almost everyday we heard and see their actions and news on the media. Their popularity is equal to Mawi and Datuk Siti Nurhaliza until then, the film maker had decided to make film about them.So, as a Malaysian, what is our role in solving this issue? Do we need to blame themselves for all this or it is us who let this things happen? Let us see why this Mat Rempit issues happens and how we should solve it together. As we can see, almost all of Mat Rempit is in the youth group. We should realize that in this stage, their thinking, attitude and acti on were influenced by their peers. They used to follow their friends rather than their own parents and teachers advice. This peer influence is very strong and sometimes dangerous if they follow the wrong path for example the illegal racing. Related article: Causes of Snatch TheftThis is why the amount of Mat Rempit is increasing from time to time. Furthermore, the desire to try something new and challenging is one of the factors that lured them into the illegal racing. They felt that it is very admirable and outstanding if they can win the race or do suicide skills such as riding in the high speed or get away from the police road blocks. They love to break the laws since they think that it is just an amusement for them. So, how we want to solve this problem? How we want to settle down this issue that has been caused many problems to us?The government, politicians and police have done many things to settle this, but it seems like there are no stopping point for the Mat Rempit. We should give a compliment to Pemuda UMNO for their effort to convert this Mat Rempit to â€Å"Mat Cemerlang† by giving them an opportunity to change and UMNO membership. Although this step is like a politics campaign, we should bear in min d that maybe one day they will realize that there are people who concern about them and hoping they will change. Next, schools play an important role in order to solve this problem.I’m not saying parents since I know that some parents didn’t know their son’s attitude very much compared to the teachers and their friends. This is because in school, they used to be with their friends and we can determine their attitude very well by observing with whom they are making friends. Schools should collaborate with the police to identify which students involved in illegal racing and punish them by sending them to the counselor or in the serious case, dismiss them from school. This is very important in order to prevent this student to influence the other students to join him.Although this approach is too drastic and cruel, we should consider that the youth is tending to be influenced by their friends. Furthermore, in my opinion, the National Service Training Program or PLKN should include a module that thought the trainee to avoid and aware the illegal racing. They should be exposed to the danger of illegal race, the punishment that will wait them if involved and how to enjoy their life in the best ways. By implementing this approach, at least, the trainee can think wisely and preventing them to become one of the Mat Rempit candidates.As a conclusion, what I can say is, action speaks louder than words. It is useless if we just babbling around and blaming them for all this problems although some of them caused some serious case. We should cooperate with government, politicians and NGOs to track back how this thing happen and find a solution to solve it. The Mat Rempit should be thankful for the government and society for not treating them like the snatch thief and the homosexual group although they have cause many problems. The government and society still can accept them as long as they want to change.We can see many campaign and approach for them rig ht now. After all, this group is our country’s apprentice that will lead us in the future. If they are still like now and we are just blaming them, the one who are needed to blame is just our self. One of Mat Rempit's favourite ‘Aerodynamic Pose' a. k. a. ‘Superman' seen on the streets of Malaysia. A Mat Rempit is a Malaysian term for ‘an individual who participates in illegal street racing', usually involving underbone motorcycles (colloquially known as Kapcai) orscooters.Not all Mat Rempits are involved in street racing; some of them perform crazy stunts for fun, such as the wheelie, superman (lying flat on the seat), wikang, and scorpion (standing on the seat with one leg during a wheelie). Mat Rempits usually travel in groups and race in bustling city centres on weekend nights. In recent times, Mat Rempits have been linked to gangsterism, gang robbery[1][2], street fighting, assault[3], vandalism, theft and bullying. Most motorcycles used by the Mat Remp its do not meet standard specifications, or have been modified extensively for greater speed, or just to make the exhaust noisier.Additionally, some Mat Rempits do not have valid motorcycle licenses, do not pay road taxes, and ride stolen motorcycles[4][5]. A growing number of housing estates have also been turned into racing tracks[6]. It is estimated that there are about 200,000 Mat Rempits in Malaysia[7]. In some other countries, the term Mat Rempit is also u Etymology The word ‘Rempit' came from the combination of ramp it (ramp the throttle). The definition of ‘Rempit' in Kamus Dewan[2] is menyebat dengan rotan in malay or whipping with cane.An alternative source of the word, ‘Rempit', is derived from the noise made by a 2-stroke motorcycle. ‘Mat' is a malay slang term to call or to refer to a person who usually is of Malay descent but usually used derogatorily. sed, but more to refer to one as a motorcycle lover or rider (Mat Motor), as opposed to an ill egal motorcycle racer. Sometime the terms of Mat Rempit misused to refer any individual who rides an underbone motorcycle. Related to this is the Mat Konvoi, which claim to be the non-racing version of Mat Rempit.