Essay about Drug Testing For Missouri Welfare Recipients

On 30 January 2011, the Missouri House of Representatives passed a bill and sent it to the senate that would require drug testing for those receiving state Temporary Assistance for Needy Family (TANF) funds. Funding from food stamps, medicare, and public housing would not be affected by this bill (Keller – House). According to Columbia Tribune reporter Rudi Keller, the bill is very similar to the Arizona law which is the only other state that tests welfare recipients. Missouri and Arizona would use a questionare and interview which would determine which applicants to test. The two states are also similar in their caseload of 45,017 people on assistance in Arizona and 42,885 in Missouri. The state would not be obligated to provide treatment†¦show more content†¦According to Keller’s article, the law would protect children. It would discourage parents from using drugs which would create a better home environment. It would also ensure that state money would be use d for supporting families, not recreational drugs (Keller). Rep. John McCaherty said â€Å"The bill will show the state expects TANF recipients to be responsible with public money.† (Qtd. in Keller). The idea behind those that support this legislation is that the state is responsible for ensureing that taxpayer’s money doesn’t ultimately end up buying illegal substances and drug testing is an effective means to ensure this. As with all political issues, there are those on the other side of the fence. People oppose this legistlation for various reasons: from constitutionality to cost. According to a study done by the American Civil Liberties Union (ACLU), welfare recipients are no more likely to use drugs. Furthermore, placing a requirement to be tested may place a stigma upon those receiving welfare which would be counterproductive to their relief (Drug Testing). An editorial by Henry Waters in the Columbia Daily Tribune, the bill is the government attempting t o punish a class of people who are presumed worthless (Waters). Another reason people oppose this legislation is the cost. The ACLU study reports the average cost of a drug test at $42 per person. There are less invasive and cheaper methods toShow MoreRelatedDrug Testing : A Controversial Issue Right Now1439 Words   |  6 PagesRUNNING HEAD: Mandatorily Drug Testing Welfare Recipients Does More Harm Than Good Mandatorily Drug Testing Welfare Recipients Does More Harm Than Good Clare M. Pitlik Marist High School Author Note First paragraph: Introduction to history of drug testing welfare recipients Second paragraph: Explains why drug testing welfare recipients is unconstitutional Third paragraph: Explains why drug testing welfare recipients is costly Fourth paragraph: Rebuttals Fifth paragraph:Read MoreDrug Testing For Welfare Recipients1347 Words   |  6 PagesIntroduction Since the reformation of welfare in 1996, nearly all states have attempted to pass legislation to require the use of drug testing among welfare recipients. Thirteen states have passed legislation and there are currently seven states testing applicants for drugs. The results have been somewhat anticlimactic, as the number of positive drug test results is lower than the national average. There are many concerns surrounding the issue of drug testing welfare recipients, including the cost, constitutionalityRead MoreThe Welfare System Is A Broken System1590 Words   |  7 Pagesor other benefits directly to poor families† (Tanner). Welfare is a broken system that needs to be fixed because it is teaching the current generation the wrong way to live, encourages people to not work for what they need or want, and lacks accountability for how or where the money is being spent. The welfare system was originally created to help people who were temporarily out of work or in need of assistance, but â€Å"total welfare spending has nearly doubled since 1996† (Donovan and Rector)Read MoreDrug Testing the Less Fortunate 1023 Words   |  4 PagesShould drug testing be a necessity for all state and federal aid programs? Drug testing welfare recipients have been a major issue across the United States for a few years now. Many indicate that if working class people are subject to a test prior to hire or randomly during the duration of employment, why should those that don’t have to work for money not have the same treatment? The government estimated that random annual drug testing for welfare recipients would cost each taxpayer an additionalRead MoreThe Issue Of Drug Testing Welfare Recipients And Applicants1231 Words   |  5 Pagesissue of drug testing welfare recipients and applicants. The journals and articles used to determine whether d rug testing is necessary or a hindrance to public assistance applicants, recipients and the government vary in their argument on the effects of those who receive assistance. The study, completed by Anderson, Shannon, Schyb and Goldstein (2002) determined that, due to the change in Welfare reform in 1996, the disruption of benefits increased the risk homelessness and usage of drugs and alcoholRead MoreWelfare Reform : Social Welfare Policy1257 Words   |  6 Pages Social Welfare Policy Social Welfare Policy Analysis Eric Dean University of Arkansas Introduction Several states have recently begun to enact legislation that requires welfare recipients to submit to drug tests before they are eligible to receive any public assistance. The purpose of mandatory drug testing is to prevent the potential abuse of taxpayer money, help individuals with drug problems, and ensure that public money is not subsidizing drug habits (Wincup, 2014). WhileRead MoreShould Drug Testing Welfare Recipients?1679 Words   |  7 Pageswho test positive for drugs should be able to receive welfare. It was an argument that flooded social media, arguments filling comments with opinions. It is a subject that continues to be discussed within our peer groups, our communities, and our states. This paper will discuss the opinions of individual’s within the country, the beneficial factors of drug testing welfare recipients as well as the unbeneficial factors, as well as who decides if drug testing welfare recipients goes into effect or notRead MoreWelfare Reform For D rug Test Recipients Essay1719 Words   |  7 Pagesexactly how many taxpayers feel about welfare recipients that refuse to take drug test prior to receiving their welfare checks. Since 1996 there has been a call for welfare reform to drug test recipients prior to admission, but any attempts have been unsuccessful because they are viewed as a violation of the fourth amendment, more harmful for children, and an unnecessary expense. These common fallacies have been the main arguments leading the anti-drug testing campaign, but in the past few years manyRead MoreDrug Testing For The United States Essay1589 Words   |  7 Pages The state spent $493,000 on drug testing for this fiscal year. It received 32,511 welfare applications and referred 636 for drug testing. Only twenty came back positive, although nearly two hundred people refused to comply. But even if all 200 were drug users, that still comes to more than $2,200 per positive result, which is more expensive than the median bene fit in the state. (Benen 1) Many people do not think it is worth the money to stop just a mere few individuals. Even though two hundred wereRead MoreDrug Testing and Public Assistance1299 Words   |  5 PagesDrug Testing Public Assistance Public or federal assistance is considered to be a federal program and service, provided to the needy by the federal government. These federal programs are meant to assist government, organizations, and individuals in all areas such as health, public safety, education, and public welfare. These various programs can typically reach over $400 billion annually; and are provided through many federal agencies. Perhaps the most controversial these days is drug testing

3d Animation in Film Industry - 785 Words

1.0 Abstract Evidence of artistic interest in depicting figures in motion can be seen as early as the still drawings of Paleolithic cave paintings, where animals are depicted with multiple sets of legs in superimposed positions, clearly attempting to convey the perception of motion.[1] Other examples include a 5,200-year old earthen bowl found in Iran in Shahr-e Sukhteh and an ancient Egyptian mural. The Persian bowl has five images painted along the sides, showing phases of a goat leaping up to nip at a tree.[2][3] The Egyptian mural, found in the thomb of Khnumhotep and Niankhkhnum, at the Beni Hassan cemetery. The paintings are approximately 4000 years old and show scenes of young soldiers being trained in wrestling and combat.[4]†¦show more content†¦The technology kept getting better and better until 1995, when the film company Pixar raised the bar on 3D technology with their box office hit â€Å"Toy Story†. â€Å"Toy Story† was the first feature film created entirely with 3-dimensional animations. Since then Pixar and other film production houses have jumped on board and began producing similar films because they were guaranteed to be hits, but Pixar remains the top studio. The process The main reason the technology used in 3-dimensional animations took off dealt with the amount of work it took to create a motion graphic in a digital setting creating depth to the images. The process begins with developing a primitive outline of a character or object. 3-dimensional animation differs from 2-dimensional animation because it is done entirely through a computer program rather than paper. After the initial model is created the animator begins texturing it to give the character more depth and adding realistic details. During this step the animator adds features such as hair and clothing. The last step of creating an animated character is the actual animation and adding in the last of the physical details. The animation of a character can be done in various ways such as moving the characters frame by frame or using a built in physics engine to help the characters move naturally. Once this is completed, the character is finished, but the characters that need to beShow MoreR elatedPixar Animation Changed The World1537 Words   |  7 Pages Pixar Animation changed the game of animation, but how? Is it the beautiful quality, the picturesque feel, or the new change that brought the animation industry to a new focus? Animation is so much more than what we think or know about it. It is an art that challenges the way we look at the world. It brings a new level of realism and imagination to our bleak, everyday lives. Animation changed not only from Disney but also from the 3D beauty that lead the world to an understanding of whatRead MoreEssay on My Dream of Being a 3D Animator575 Words   |  3 Pagesbind imagination and reality into one, when applied to animation the boundaries of visual imagery are endless. An individual possesses the ability to create at the minds will with the possibility of one day being able to affect millions globally. The film and gaming industries, now utilise the power of animation to its full effect, this is where I ai m to belong, fulfilling my dream of being a 3D animator within either industries. Animation has always had a profound impact on my perception of theRead MoreLightwave Essay992 Words   |  4 Pagesthe use of rendering 3D images. These can be animated and static renders of images and it includes a rendering engine within it to support reflections that look realistic, refraction, radiosity and caustics. It supports both polygon modelling and subdivision surfaces. It is developed by NewTek Inc. and it can be used on the AmigaOS, Windows and MacOS, it uses animations, visual effects, product design, architectural visualisations etc and can be used with everything that a 3D software can do. It alsoRead MoreHayao Miyazaki: Auteur Essay1138 Words   |  5 Pagescreative aspects of a film. They develop the vision for a film and carry the vision out, deciding how the film should look. The director may also be heavily involved in the writing and editing of the film, as well as managing the script into a sequence of shots, coordinating the actors in the film and supervising musical aspects. The Auteur Theory suggests that films contain certain characteristics or ‘signatures’ that reflect the director’s individual style and give a film  its personal and uniqueRead More3D Artist Essay1356 Words   |  6 Pagesproduced at steady rates. However, many of the artists behind the new animated cartoons and movies do not have such steady rates. 3D artists’ salaries are dropping and some artists are losing their jobs; as they are a big part of the entertainment industry, the public should have more care about these artists keeping their jobs and being compensated with what they deserve. 3D artists and animators are being pushed too hard for not enough reward. The Occupational Outlook Handbook is a website which listsRead MoreIs Academy Voters Are Ignorant About Animation?1592 Words   |  7 PagesFor it appears that the Academy has a differing opinion on these animated films. Amid Amidi, brings attention to how some judges’ feel for their nominations, in his article, â€Å"Definitive Proof That Academy Voters Are Ignorant About Animation†. One such judge stated how, â€Å"I have seen none of them. I have no interest whatsoever. That ended when I was 6. My son dragged me to a few when he was 6; I would seat him and go outside and make phone calls.† This academy judge apparently didn’t even waste theirRead MoreThe Ever Changing Field Of Film Essay1223 Words   |  5 Pages The Ever-Changing Field of Film The world of film has changed dramatically over the years and will likely continue to change along with technological and professional developments. Like many modern innovations, film has changed substantially over a rather short period of time, from black and white movies to modernized color films. Still, it is impressive to think how far film has come, and looking back into the near past affords an appreciation of the technology that no longer exists. Thus my viewingRead MoreThe Importance of Technology in the Production of 3d Animation Films Among the Animators in Malaysia.2220 Words   |  9 PagesOF TECHNOLOGY IN THE PRODUCTION OF 3D ANIMATION FILMS AMONG THE ANIMATORS IN MALAYSIA. DINIZAR BIN DANIAL 2010273278 AD2214B LECTURER : EN MD SABRI MOHAMAD ASSIGNMENT 3 The importance of technology in the production of 3D animation films among the animators in Malaysia. Issue - 3D animation films Problem - importance of technology in the production Sample - animators Location - Malaysia Direction - the importance INTRODUCTION Animation generally refers to the process of settingRead MoreRecognizing the Advancements in Animation615 Words   |  3 PagesGCC’s animation department consists of about nine classes each term, which are taught by experienced animators. Technology keeps advancing, and 3D is being widely used in the film industry. Yina Chang is one of the talented professors in the animation department. She teaches Art 233 (Character set-up) and Art 235 (character animation). In her class, before they animate on the computer, they sketch it out on a story board to get their ideas flowing. Then, they begin their animation process. Read MorePixar1465 Words   |  6 PagesPixar’s resources and capabilities have set a standard that is extremely difficult to imitate. Through its highly talented employee pool, culture of creativity and collaboration, and proprietary 3D computer animation software, Pixar has created a competitive advantage in the animation film industry that yielded average total box office sales of $538 million with just six movies. Pixar shareholders should be wary of the potential breakdown of these resources and capabilities, which in essence

The Death Penalty Is Inevitable - 1629 Words

Punishment is inevitable in a world that judges one’s every move. Common decisions turn into tendencies and tendencies turn into life choices that construed a life forever. For centuries people have faced execution for crimes which were considered to be horrendous. A system that has remained in our judicial system since the first execution in 1606 (deathpenalty.org). As of 2015 execution is only recognized as a form of correction in 31 states throughout the U.S. To ensure justice crimes are punished in a form or fashion equal to the severity of the crime committed. According to the US Federal Government list there are 41 capital offenses punishable by death. Included in this list are crimes such as first-degree murder, treason, and genocide. The death penalty is a largely debatably topic that is constantly criticized for its faults. Many argue that the death penalty violates an individual’s eighth amendment which prohibits the federal government from imposing excessive bail, excessive fines, or cruel and unusual punishment. This is provided to every American under the United States Bill of Rights. The justice system provides many methods of deterrence in hopes of decreasing crime rates. One that is prevalent is the power of publicity. Research shows that in comparison to other deterrent methods, publicity has a significant Impact on future crime rates. A Study done by a man named Robert Dann questioned the effectiveness of deterrence using the media. For his sample heShow MoreRelatedDeath Penalty Is The End Of Life906 Words   |  4 PagesAccording to the Webster’s Dictionary, death means the end of life (Dictionary, 80) and penalty means punishment for any crime or offense (Dictionary, 223). Therefore, by definition the death penalty means the end of a life due to punishment for a crime or offense. The death penalty is started with the Code of King Hammurabi’s in the eighteenth century B.C. This code consisted of 282 laws that stressed justice as clearly stated in the opening of the code, An eye for an eye, and a tooth for a toothRead MoreAbolishing The Death Penalty Is Justified910 Words   |  4 PagesEliminating the Death Penalty According to the Webster’s Dictionary, death means the end of life (Dictionary, 80) and penalty means punishment for any crime or offense (Dictionary, 223). Therefore, by definition the death penalty means the end of a life due to punishment for a crime or offense. The death penalty is started with the Code of King Hammurabi’s in the eighteenth century B.C. This code consisted of 282 laws that stressed justice as clearly stated in the opening of the code, An eye forRead MoreAnother Fact Is That The Death Penalty Is Not A Deterrent.Reports908 Words   |  4 PagesAnother fact is that the death penalty is not a deterrent. Reports have shown in 2008, the 14 states that did not have active capital punishment had surprisingly low homicide rates. They were actually at or below the national homicide rate. So, there is no documentation or proof that having capital punishment deters criminal acts of violence. In fact, in 2009, a survey showed that over 88% believed that t he death penalty was not a deterrent for heinous criminal acts. Thomas Sowell, a columnistRead MoreThe Death Penalty As A Form Of Punishment1491 Words   |  6 Pages The Death Penalty Elizabeth del Rio San Jose State University Abstract This paper will propose all the arguments for and against the use of the death penalty as a form of punishment. The death penalty, also known as Capital Punishment, is a punishmentRead MoreArgumentative Essay On Death Penalty931 Words   |  4 PagesArgument Essay: Death Penalty The American Justice System has been using the death penalty, also known as capital punishment, as a way to serve a prisoners sentence usually due to the crime of murder. The death penalty in the American Justice System has been used for many years now. Although in 18 states the death penalty has already been abolished, there are still 32 states where it is still legal. The death penalty should not be legal in the American Justice System, because it is immoral, unjustRead MoreEssay about What Effects the Death Penalty Causes to Society?582 Words   |  3 PagesWhat effects Death Punishment causes to society? My first instinct about the topic as a part of the society was â€Å"People, who private another person of his life, should not have any right to conserve his own life either†. Putting ourselves in the positions of the victims, the families’ victims and the fear caused to` society in general. Death punishment, gives closure to the people involved with the tragedy. It helps to the overpopulation problem in the prison system, instead keeping an internRead MoreThe Lord Of The Rings905 Words   |  4 PagesMany that live deserve death. And some that die deserve life. Can you give it to them? Then do not be so eager to deal out death in judgment. - Gandalf, in the Lord of the Rings: The Fellowship of the Ring, by J.R.R. Tolkien. Many people question whether the death penalty is right or wrong. Issues regarding the possibility of putting an innocent person to death based on faulty investigative work and a flawed legal system are often explored. References to the concept of lex talionis are made, wonderingRead MoreThe Death Penalty Is Justified1143 Words   |  5 PagesAllison Shu 2/25/16 Period 2 Objective paper on the death penalty Capital punishment is legally authorized killing as punishment for a crime. The death penalty questions the morality of killing a person as justification for their crime. It also brings to question whether the death penalty actually serves as a deterrent for crime, and that some of the people executed are found innocent afterwards. The debates over the constitutionality of the death penalty and whether capital punishment should be usedRead MoreThe Death Penalty Should Not Be Applied975 Words   |  4 PagesCourt ruled that the death penalty was unconstitutional, removing over 600 prisoners from death row. The justices described the application of the death penalty as arbitrarily, random, and discriminatory. Justice Potter Stewart remarked that the death penalty like being â€Å"struck by lightning† and that â€Å"if society s ultimate punishment cannot be applied fairly, it should not be applied at all†  ¹. Of the 22,000 homicides committed every year, less than 100 people are sentenced to death, and politics, theRead MoreAbolition of The Death Penalty Essay1051 Words   |  5 PagesThe Abolishment of the Death Penalty As Americans we live in a modern republic under a government constructed to secure the rights of the people. Today’s government and judicial systems were forged by our founding fathers as they fought to establish a government free from tyranny and brutality and thereby forming a constitution based on civil liberties. Our country has grown and matured through the centuries and in effect has made changes and alterations as innovations and advancements have deemed

John Anthony Burgess s A Clockwork Orange - 1706 Words

A relatively unknown author at the beginning of his writing career, John Anthony Burgess Wilson, better known under his pen name by just Anthony Burgess, would become a prominent author towards the end of his life. Burgess has allowed many to scrutinize his novels, ranging from his three colonial novels at the beginning of his writing career, Time for a Tiger, The Enemy in the Blanket, and Beds in the East to his most well known novel, A Clockwork Orange (The International Anthony Burgess Foundation). Burgess’s dystopian classic continues to provoke deeper thinking, yet also startle those today. Many believe that Burgess is a remarkable author due to his stunning portrayal of extreme youth violence in his novel A Clockwork Orange. From a†¦show more content†¦A couple of years after his father remarried, Burgess would begin writing his earliest published poems and short stories. Similar to many children today, Burgess despised his stepmother, declaring how â€Å"she s ubscribed to all the current bigotries.† The relationship between father and son was not the ideal relationship either, his father, to an extent, still blamed him for his mother s death. Burgess did not only lose his mother, but he would lose his father as well, gaining â€Å"a mostly absent drunk who called himself a father† (Burgess). Before Burgess could even speak, he lost his mother, and the affection of his father. Burgess was schooled at St. Edmund s Elementary School before moving to Bishop Bilsborrow Memorial Elementary school, both Catholic schools in Moss Side. As a child, he be largely isolated from others his age, due to being either persecuted because of his wealthier appearance, or ignored by all (Burgess). As a result of Burgess’s impressive grades, he would be given a place in Xaverian College. This would be where he would stay to complete his School Certificate examinations. Burgess’s first published poems would appear in the school magazine, named The Manchester Xaverian, under the name John Burgess Wilson. Although uninterested in music as a child, Burgess would find his passion after listening to a flute solo in which he described as â€Å"sinuous, exotic, and erotic.† Music was not taught atShow MoreRelatedAnthony Burgess and A Clockwork Orange987 Words   |  4 Pagesnothing you can do about it. Anthony Burgess created this world through his novel, A Clock work Orange. Anthony Burgess was born in 1917 and died in 1963. A lot of social changes occurred during this period of time, such as: the roaring twenties, prohibition, the Great Depression, World War II, the fall of the Berlin Wall, and many more. Burgess not only lived through those changes, but also helped influences some social changes in literature and music. Anthony Burgess was a jack-of-all-trades throughoutRead MoreA Clockwork Orange, by Stanley Kubrick1139 Words   |  5 PagesKubrick’s 1971 film adaptation of Anthony Burgess’ 1963 novel, A Clockwork Orange has been used to explore contemporary anxieties. A Clockwork Orange takes place in an outlandish and dreary vision of future Britain governed by an oppressive, totalitarian super government. In this society, ordinary people have fallen into a dazed state of complacency, unaware of the sinister growth of a rampant, violent youth culture. Anthony Burgess wrote his short novel A Clockwork Orange in 1962 as a way of coming toRead MoreEssay on The Need for Brutality in A Clockwork Orange 4668 Words   |  19 Pages   Ã‚  Ã‚   Burgess A Clockwork Orange, a critically acclaimed masterstroke on the horrors of conditioning, is unfairly attacked for apparently gratuitous violence while it merely uses brutality, as well as linguistics and a contentious dà ©nouement, as a vehicle for deeper themes. Although attacks on A Clockwork Orange are often unwarranted, it is fatuous to defend the novel as nonviolent; in lurid content, its opening chapters are trumped only by wanton killfests like Natural Born Killers. BurgessRead More Literary Comparison Of A Clock Essay1743 Words   |  7 Pages A Literary Comparison Of A Clockwork Orange and The Crucible nbsp;nbsp;nbsp;nbsp;nbsp;The existence of evil in the world is a universal question that is often contemplated. Anthony Burgess and Arthur Miller in their novels A Clockwork Orange and The Crucible address this question of evil. One of these stories is set in the future, and the other in the past confirming the belief that the human struggle between good and evil is timeless and applies to every person in society. Throughout historyRead MoreAnalysis Of The Movie Clockwork Orange 1517 Words   |  7 Pages Ryan Wadzinski Clockwork Orange A clockwork orange is an adaptation of Anthony Burgess novel of the same name, it’s also probably Kubrick’s most faithful adaptation. This may be because a screenplay was never actually written. Instead, Kubrick worked it out as he went along, working directly from the book as he did. The thing about Kubrick that drew me to want to explore this movie so just how bizarre and deprived it is, but yet the all of its wild and crazy parts are able to come together toRead MoreAnalysis Of George Orwell s The Lord Of The Rings 747 Words   |  3 Pagesby C.S Lewis 7) Lord Of The Flies by William Golding 8) Animal Farm by George Orwell 9) Catch-22 by Joseph Heller 10) The Grapes Of Wrath by John Steinbeck 11) Gone With The Wind by Margaret Mitchell 12) Slaughterhouse-Five by Kurt Vonnegut 13) Lolita by Vladimir Nabokov 14) One Flew Over The Cuckoo’s Nest by Ken Kesey 15) A Clockwork Orange by Anthony Burgess 16) Are You There God? It’s Me, Margaret by Judy Blume 17) Watchmen by Alan Moore 18) Never Let Me Go by Kazuo Ishiguro 19) Atonement by IanRead More Art, Literature And Society From 1955-1970 Essay examples5829 Words   |  24 Pages Fear and Loathing in a Clockwork AgeAh! The noble search for identity. That intangible achievement that all artists lust after and lay in torment over. And during the post war era that struggle reached incredible magnitudes. The world cried out for legions of anti-heroes, who were only virtuous in their unapologetic and brutally honest lack of virtue. And the art world provided as many counter culture messiahs as was needed to quot;Damn the Manquot;. The Beats, hippies, and punks are evidenceRead MoreUsage And Knowledge Of Tools And Crafts1657 Words   |  7 Pagesthemes, including systems, methods of organization, and techniques. The term can either be applied generally or to specific areas: examples include construction technology, medical technology, or state-of-the-art technology. The human race s use of technology began with the conversion of natural resources into simple tools. The prehistorical discovery of the ability to control fire increased the available sources of food and the invention of the wheel helped humans in travelling in and controllingRead MoreEssay on Analysis of George Orwells 19844218 Words   |  17 Pages In short, 1984 was not a condemnation of socialists, but rather a warning to them of the path which they should avoid. Big Brother is obviously modeled after Stalin, Goldstein after Trotsky. 1984 actually reproduces much of the environment of 1930s Soviet Russia. Ingsoc is socialism based on terror, coercion, and surveillance with a total lack of civil liberty.Orwell saw in Soviet Russia the betrayal of the revolution and Marxist idealism. Revolution became a perversion of itself, with the new

Analgesic and Facilitator Pain Assessment Free Essays

string(102) " on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy\." Individual Research Article Critique Presentation Resource: The research study that you selected in Week Two Develop a 10- to 15-minute presentation in which you address the following points (7 pts): †¢Strengths and weaknesses of the study †¢Theoretical and methodological limitations †¢Evidence of researcher bias †¢Ethical and legal considerations related to the protection of human subjects †¢Relationship between theory, practice, and research †¢Nurse’s role in implementing and disseminating research †¢How the study provides evidence for evidence-based practice †¢ Identify the following for the research study selected (choose 1 or 2 NOT BOTH): 8 pts. †¢ 1. Quantitative Research Article Critique (Follow the example pp. We will write a custom essay sample on Analgesic and Facilitator Pain Assessment or any similar topic only for you Order Now 433–442 of the text): †¢ a. Phase 1: Comprehension b. Phase 2: Comparison c. Phase 3: Analysis d. Phase 4: Evaluation †¢ 2. Qualitative Research Article Critique (Follow the example pp. 455–461 of the text): †¢ a. 1. Problem (problem statement; purpose; research questions; literature review; frame of reference; research tradition) b. 2. Methodology (sampling sample; data collection; protection of human subjects c. 3. Data (management; analysis . 4. Results (findings; discussion; logic; evaluation summary †¢ Format the presentation as one of the following (5 pts): †¢Poster presentation in class †¢Microsoft ® PowerPoint ® presentation including detailed speaker’s notes †¢Video of yourself giving the presentation uploaded to an Internet video sharing site such as www. youtube. com –Submit the link to your facilitator, include a written reference page in APA format †¢Another format approved by your facilitator Pain Assessment in Persons with Dementia: Relationship Between Self-Report and Behavioral Observation Ann L. Horgas, RN, PhD,A Amanda F. Elliott, ARNP, PhD,w and Michael Marsiske, PhDz OBJECTIVES: To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN: Quasi-experimental, correlational study of older adults. SETTING: Data were collected from residents of nursing homes, assisted living, and retirement apartments in northcentral Florida. PARTICIPANTS: One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired. MEASUREMENTS: Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activitybased protocol to induce pain. RESULTS: Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors was signi? antly related to self-reported pain intensity (b 5 0. 40, P 5. 000) in cognitively intact elderly people. CONCLUSION: Cognitively impaired elderly people selfreport less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors su pports the validity of behavioral assessments in this population. These ? ndings support the use of multidimensional pain assessment in persons with dementia. J Am Geriatr Soc 57:126–132, 2009. Key words: pain; dementia; measurement From the ADepartment of Adult and Elderly Nursing, University of Florida, College of Nursing, Gainesville, Florida; wDepartment of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and zDepartment of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida. Address correspondence to Ann Horgas, College of Nursing, University of Florida, PO Box 100197-HSC, 101 S. Newell Drive, Room 2201, Gainesville, FL 32610. E-mail: ahorgas@u?. edu DOI: 10. 1111/j. 1532-5415. 2008. 02071. x ain, a persistent daily problem for many elderly adults, is associated with physical and social disability, depression, and poor quality of life. 1 Between 50% and 86% of older adults experience pain; 32% to 53% of those with dementia experience it daily. 2 The high prevalence is associated with proliferation of pain-related health conditions in late life, such as osteoarthritis, hip fractures, peripheral vascular disease, and cancer. Dementia complicates pain assessment, because it impairs memory, judgment, and verbal communication. Dementia is associated with central nervous system changes that alter pain tolerance4 but not pain thresholds (e. g. , minimum level at which a painful stimulus is recognized as pain). 5 No empirical evidence indicates that persons with dementia physiologically experience less pain; rather, they appear less able to recognize and verbally com municate the presence of pain. Findings that cognitively impaired older adults underreport pain relative to nonimpaired elderly people7 and are less likely to be treated for pain than their cognitively intact peers8,9 re? ect dif? culty assessing pain in this population. Self-report is considered the criterion standard of pain assessment. Despite recent studies supporting the reliability and validity of self-report in persons with dementia,7,10 healthcare providers and pain experts recognize that selfreport alone is insuf? cient for this population and that observational pain assessment strategies are needed. In 2002, the American Geriatrics Society established comprehensive guidelines for assessing behavioral indicators of pain. 1 More recently, the American Society for Pain Management Nursing Task Force on Pain Assessment in the Nonverbal Patient (including persons with dementia) recommended a comprehensive, hierarchical approach that integrates selfreport and observations of pain behaviors. 11 Recently, tools to measure pain in persons with dementia have proliferated. In 2006, a comprehensive stateof-the-science review of 14 observational pain measures was completed. The authors concluded that existing tools are still in the early stages of development and testing and that more psychometric work is needed before tools are recommended for broad adoption in clinical practice. 12 Others, including an interdisciplinary expert consensus P JAGS 57:126–132, 2009 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/09/$15. 00 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 127 panel on pain assessment in older persons,13 have corroborated these conclusions. 4 In particular, these authors highlight the need for more evaluation of observational pain measures, including validation against the criterion standard of self-report in intact and impaired populations. Almost all research on measuring pain in persons with dementia has focused exclusively on persons with moderate to severe disease. There has been only one published study that compared pain behaviors and self-repor ted pain in persons with and without cognitive impairment, but it focused on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy. You read "Analgesic and Facilitator Pain Assessment" in category "Essay examples" 5 Thus, the purpose of this study was to investigate the relationship between self-report and behavioral indicators of pain in cognitively intact and impaired older adults with persistent pain. Speci? cally, this study evaluated whether cognitive status (intact or impaired) differentially in? uenced verbal and nonverbal expression of pain. It was hypothesized that self-reported pain would be lower in cognitively impaired elderly people than in those who were cognitively intact but that pain behaviors, because they are more re? exive and less reliant on verbal communication, would be equivalent in both groups. The relationship between pain behaviors and self-reported pain was also evaluated in cognitively intact elderly people to validate whether behaviors measured are indicators of pain. The following research questions were asked. Does cognitive status in? uence self-reported pain? Does cognitive status in? uence observed pain behaviors? Are self-reported pain and observed pain behaviors related, and is the relationship different in cognitively intact and impaired elderly people? One hundred forty participants were enrolled and completed the baseline interview; 126 (90%) completed the protocol. Attrition analyses revealed no signi? ant differences between completers and noncompleters on demographic, residential status, health, or pain variables. The ? nal sample was predominantly female (81%), Caucasian (97%), and widowed (60%), with a mean age of 83 (range 5 65–98). Thirty-nine percent resided in nursing homes, 39% resided in assisted living, and 22% lived independently in retire ment apartments. Participants’ average Mini-Mental State Examination (MMSE) raw score was 24 (range 5 7–30, median 5 27, mode 5 29). Based on 10th percentile education-adjusted MMSE norms as the cutoff,16,17 64 (50. 8%) were cognitively intact, and 62 (49. %) were impaired. See Table 1 for a description of the total sample and of cognitively intact and impaired subsamples. Groups differed only in residential status (cognitively Table 1. Sample Characteristics, Overall (N 5 126) and According to Cognitive Status Total Sample Cognitive StatusA Intact Impaired (n 5 64) (n 5 62) PValue Characteristic METHODS The University of Florida institutional review board approved this study. Informed consent was obtained from cognitively intact participants and from impaired elderly people’s legally authorized representatives, with assent from persons with dementia. Design A quasi-experimental, correlational design was used to investigate pain in older adults with mild to moderate dementia, because dementia status cannot be experimentally manipulated. Cognitively intact elderly people functioned as a comparison group to examine behavioral indicators and self-reported pain in the two groups. If self-report and behaviors were related in cognitively intact persons, there would be some basis to infer that the same behaviors indicated pain in cognitively impaired elderly people. Participants One hundred ? ty-eight older adults were screened for enrollment from 17 assisted living facilities, nursing homes, and retirement communities in north central Florida. Inclusion criteria were aged 65 and older, English-speaking, able to stand up from a chair and walk in place, diagnosed osteoarthritis in the lower body, and adequate vision and hearing to complete the interview. Sex, n (%) Male 24 (19. 0) 12 (18. 8) 12 (19. 4) Female 102 (81. 0) 52 (81. 3) 50 (80 . 6) Race, n (%) White 123 (97. 6) 63 (98. 4) 60 (96. 8) Black 1 (0. 8) 0 (0) 1 (1. 6) Other 2 (1. 6) 1 (1. 6) 1 (1. 6) Marital status, n (%) Married 37 (29. ) 21 (32. 8) 16 (25. 8) Unmarriedw 89 (70. 6) 43 (67. 2) 46 (74. 2) Education, n (%) ohigh school 11 (8. 7) 5 (7. 8) 6 (9. 7) graduate High school graduate 38 (30. 2) 17 (26. 6) 21 (33. 9) Some college or 31 (24. 6) 18 (28. 1) 13 (21. 0) equivalent College graduate or 34 (27. 0) 18 (28. 1) 16 (25. 8) more Residence Assisted living 49 (38. 9) 28 (43. 8) 21 (33. 9) Nursing home 47 (37. 3) 14 (21. 9) 33 (53. 2) Retirement apartment 30 (23. 8) 22 (34. 4) 8 (12. 9) Analgesics taken 579 ? 1,320 313 ? 699 853 ? 1,708 (in acetaminophen equivalents), mean ? SD Age, mean ? SD 82. 2 ? 7. 3 81. 9 ? 7. 83. 1 ? 7. 6 Number of medical 6. 7 ? 3. 1 6. 6 ? 2. 9 6. 9 ? 3. 4 diagnoses, mean ? SD .93 .59 .39 .84 .001z .02 § .55 . 63 A Cognitive status was computed using the following education-adjusted Mini-Mental State Examination scores as cuto ffs: o8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher 5 27. 16,17 w Unmarried 5 never married, widowed, separated, or divorced. z Chi-square 5 15. 2, degrees of freedom 5 2, P 5. 001.  § t (124) 5 2. 22. SD 5 standard deviation. 128 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS mpaired elderly people were signi? cantly more likely to reside in assisted living or nursing home facilities). to use in elderly adults than the traditional visual analogue scale. 21 Procedures Participants completed a brief screening interview to con? rm study eligibility and to ascertain cognitive status. Those eligible were interviewed about their pain and completed an activity-based protocol designed to evoke pain behaviors in persons with persistent pain (described in more detail below). Activity Protocol Participants were asked to sit, stand, lie on a bed, walk in place, and transfer between activities. Based on previous work, the activity protocol had several strengths for use with this population. First, it simulates performance of basic activities of daily living, thereby enhancing ecological validity of the tasks. Second, it was tested in other studies, and activities were shown to induce pain in persons with osteoarthritis and chronic low back pain, thus providing a naturalistic pain induction method. Third, use of these realworld tasks avoids undue health or safety risks for elderly adults and eliminates potential bias associated with arti? cially induced (e. g. , laboratory-based) pain induction techniques. 8,19 The protocol was simpli? ed by using only 1-minute activity intervals (to reduce complexity of directions and physical demands for frail or cognitively impaired participants) and substituted walking in place for walking across the room and back (to accommodate physical space limitations in residential care facilities where data were collected). Activities were conduct ed in random order to minimize order effects, and the entire 10-minute protocol was videotaped. Measures Self-Reported Pain The principal investigator (ALH) or a trained research assistant interviewed each participant in a private session about their pain experience. Pain presence, intensity, locations, and duration were assessed. Pain Presence. Questions from the Structured Pain Interview (SPI)20 were used to assess presence of self-reported pain. During the pain screening interview, participants were asked ‘‘Do you have some pain every day or almost every day (daily pain)? ’’ Pain was also assessed immediately before the start of the activity protocol (‘‘Are you having any pain right now? ’’ (pre-activity)) and immediately after it (‘‘Did you experience any pain during these activities? ’’ (postactivity)). Response choices to all three questions were yes (1) or no (0). Pain Intensity If participants responded ‘‘yes’’ to experiencing pain (daily, pre-activity, or postactivity), they were asked to rate the intensity using a numerical rating scale (NRS). The NRS was presented as a horizontal line with 0 5 no pain and 10 5 worst pain as anchors and equally spaced dashes representing pain intensity rating of numbers 1 through 9. The scale was printed in large, bold font on an 8. 5†³ A 11†³ paper to facilitate use with older adults who may have vision dif? culties. The NRS is considered valid, reliable and easier Pain Duration Participants were asked to indicate how long (in months and years) they had experienced daily or almost daily pain. Responses were coded as less than 1 year, 1 to 5 years, 6 to 10 years, 11 to 15 years, or more than 15 years. Pain Locations The pain map from the McGill Pain Questionnaire22 was used to assess pain locations. Participants indicated areas on the body drawing in which they were currently experiencing pain. Total number of painful locations was summed. This widely used measure has been validated in several epidemiological studies and has high interrater reliability (average kappa 5 0. 2). 23 Observed Pain Behaviors Pain Behaviors A modi? ed version of the Pain Behavior Measure18 was used to measure behavioral indicators of pain. Based on standardized behavioral de? nitions, occurrence of the following speci? c pain behaviors was evaluated: rigidity, guarding, bracing, stopping the activity, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint. Standardized de? nitions were adapted from previous work,18,19 modi? ed for use in this older, moreimpaired population, and pilot tested in a sample of nursing home residents with dementia. 4 This measure has adequate reliability and validity. 13 Pain Behavior Coding Independent raters, all registered nurses blind to participants’ cognitive status, scored the videotaped activity protocols. Coders completed extensive training in coding procedures until intrarater and interrater agreement (with the master coder (PI) and another rater) reached a kappa coef? cient of 0. 80 or greater, indicating good to very good reliability. 25 After coding reliability was attained, reliability checks were conducted on 10% of all videotapes to minimize rater drift. Noldus Observer software was used to analyze digitized videotapes and code pain behaviors (Noldus Information Technology, Wageningen, the Netherlands). The following summary variables were created and used in the analyses: total number of pain behaviors observed, number of times each behavior (rigidity, guarding, bracing, stopping, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint) was observed, and total numbers of pain behaviors observed during each activity state (e. g. , number of behaviors while walking, reclining, sitting, standing, and transferring). Cognitive Status Cognitive status was assessed using the MMSE,26 an 11-item screening instrument widely used to assess general cognitive status in elderly adults. The following MMSE scores served as the cutoffs to classify participants as intact or impaired: less than 8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher, 27. 16,17 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 129 Analgesic Medications Drug data for each participant were coded according to the American Hospital Formulary Service system. All pain medications were identi? ed and converted to acetaminophen equivalents. 8,27 This standardized drugs and dosages to a common metric and facilitated comparison of analgesic dosing. To ensure that only analgesics actually taken would be controlled for, equianalgesic dosages were considered in these analyses only if they were taken within the standard therapeutic dosing window for each drug (e. g. , acetaminophen, every 4–6 hours) before the activity protocol. Data Analysis SPSS, version 15. 0 (SPSS Corp. , Chicago, IL) was used for data analysis. Descriptive statistics, Pearson chi-square (w2) tests, and t-tests were used to describe sample characteristics and examine group differences. Analysis of covariance (ANCOVA) was used to test relationships between cognitive status, pain intensity, and pain behaviors. Logistic regression was used to predict pain presence. Multiple regression was used to predict pain intensity and number of pain behaviors, with a centered cognitive status–by–pain intensity interaction term to identify group differences; standardized regression coef? cients (b) are reported in the results. RESULTS Self-Reported Pain The majority of participants (86. 5%) reported experiencing pain every day or almost every day. More than 65% reported experiencing pain for more than 1 year ( $ 40% indicated duration of 45 years). On average, participants reported pain in four body locations (range 5 1–25); usual pain intensity was 4. 3 (moderate) on a scale from 0 to 10. Immediately before the activity protocol, 45 (35. 7%) participants reported experiencing pain. Mean pain intensity was rated as 1. 7 (range 5 0–9). After the protocol, 79 (62. 7%) reported experiencing pain during the activities; mean pain intensity was 3. (range 5 0–9). Relationship Between Cognitive Status and Self-Reported Pain Chi-square analyses were conducted to examine the relationship between cognitive status (impaired vs intact) and presence of self-rated daily pain and pain duration at baseline. The baseline pain interview was not always conducted on the same day as the activity protocol, a nd analgesic use before the interview was not assessed. Thus, initial analyses are descriptive only and do not control for analgesic use. At baseline, 77. 4% of impaired and 95. 3% of intact participants reported experiencing pain every day (w2(1) 5 8. 6, P 5. 003). Cognitively impaired elderly people also recalled shorter pain duration (w2(3) 5 16. 0, P 5. 001) than intact participants, but no signi? cant differences were reported in the number of pain locations. Logistic regression, controlling for acetaminophen equivalents, indicated that cognitive status was not signi? cantly predictive of pre-activity pain presence. Regression analyses, with pre-activity pain intensity as the dependent variable and cognitive status and analgesics as predictors, revealed no signi? cant difference between the two groups (Figure 1). Intact Impaired 16 14 12 Mean values 10 8 6 4 2 0 In te a * t ns y SR 😛 a re- cti v in Pa ng cing ing rbal aint sity pi b l n e ra uar ig Sh op rima Rub onv mp Inte B G R St G N al co ain P rb Ve activ tos 😛 SR b Pain indicators cin g n di g i id ty in ift g a tt Si g g g g g in din kin yin rrin l e n L sf a Wa St an Tr c Activity states Figure 1. Relationship between self-report and observed pain behaviors in cogni tively intact and cognitively impaired elderly people (N 5 126). aMean self-reported (SR) pain intensity, controlling for acetaminophen equivalents taken. bMean number of behaviors observed for each pain indicator, controlling for acetaminophen equivalents taken. Mean number of behaviors observed during each activity state, controlling for acetaminophen equivalents taken. 130 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS At the end of the activity protocol, cognitive status was signi? cantly associated with the reported presence of pain, controlling for analgesics (b 5 1. 2, P 5. 002); cognitively impaired elderly people were less likely to report pain. Impaired participants also reported signi? cantly lessintense pain than intact participants after the activity protocol (3. 8 vs 2. 6; F (1) 5 A 5. 0, P 5. 03). Paired t-tests indicated that pain intensity increased signi? cantly from start to end of the protocol for both groups (Figure 1). Table 2. Relationship Between Self-Reported Pain Intensity and Observed Pain Behaviors (N 5 126) Total Number of Behaviors Observed Model bA P-Value 1 Pre-activity pain intensity Analgesics taken Pain intensity A cognitive status R2 F 2 Postactivity pain intensity Analgesics taken Pain intensity A cognitive status R2 F Standardized regression coef? cient. R2 5 coef? cient of determination. A Relationship Between Cognitive Status and Observed Pain Behaviors On average, 21. pain behaviors per person (range 5 3–50, median 5 21, mode 5 16) were observed during the activity protocol. ANCOVA models, controlling for analgesics, revealed no signi? cant differences in mean number of pain behaviors observed between cognitively intact and impaired participants (covariate-adjusted means 5 21. 8 and 21. 3, respectively; F (1) 5 0. 08, P 5. 77). The number of oc currences of each of the eight behavioral indicators observed was summed. ANCOVA models, controlling for analgesics and using Bonferroni correction for multiple comparisons (P 5. 005), revealed no signi? ant differences between cognitively intact and impaired elderly people for any behavioral pain indicators investigated (Figure 1). Of the activity states observed during the protocol, transferring elicited the most frequent pain behaviors (mean 5 13. 4; range 5 2–43). No signi? cant differences were noted between cognitively intact and impaired participants in number of behaviors observed during any of the ? ve observed activity states. Relationship Between Self-Reported Pain and Observed Pain Behaviors Regression analyses were conducted to examine the relationship between elf-reported pain intensity and total number of pain behaviors observed, controlling for analgesics. Before the activity protocol, pain intensity was signi? cantly predictive of the pain behaviors sum score (b 5 0. 27, P 5. 002), but the relationship did not differ between cognitively intact and impaired participants. After the activity protocol, self-reported pain intensity was signi? cantly (and more strongly) related to number of pain behaviors observed (b 5 0. 40, P 5. 000), and the painby-cognitive status interaction was signi? cant (b 5 0. 22, P 5. 008). Thus, postactivity pain intensity and summed behavioral indicators were signi? antly related in intact but not impaired participants (Table 2). DISCUSSION It was found that cognitive impairment diminishes selfreported pain assessed at rest but only when analgesics are not controlled. At baseline, cognitively impaired elderly people were signi? cantly less likely than cognitively intact elderly people to report pain, consistent with reports in the literature,7 but when analgesics were controlled for, these differences disappeared. This ? nding highlights the need to control for analgesics taken when making group comparisons, whic h to the best of the authors’ knowledge, has not been previously done. The few studies reporting medication use include drugs prescribed or number of doses taken 0. 27 0. 01 0. 09 0. 08 2. 9 0. 40 A 0. 03 . 22 . 18 6. 70 .003 . 99 . 30 . 02 . 00 . 75 . 01 . 000 (regardless of medication class), whereas the current study identi? ed analgesics in the subject’s body during the pain assessment protocol. After the activity-based protocol was completed, selfreported pain intensity increased for both groups, but cognitively impaired elderly people reported less-intense pain than their intact peers. This ? ding supports the usefulness of the protocol to exacerbate pain in those with painful conditions and highlights the importance of mobility-based pain assessments. 12,14 This ? nding held even when the amount of analgesics taken by participants was controlled for in the statistical analysis. Behavioral indicators of pain observed during activities were equivalent across both groups. This ? nding contradicts previous work15 and may re? ect that medicatio n use was controlled for and that the focus of the current study was on persistent pain, as opposed to more-acute, postoperative pain. This research con? ms that reliance on selfreport alone is insuf? cient to assess pain in older adults with dementia, because the pain experience may be underestimated,11 and supports growing recognition that behavioral observation is a necessary and useful pain measure, particularly in subjects with cognitive impairment. Cognitively impaired elderly people took signi? cantly more pain medication than their intact peers. The difference was approximately 500 acetaminophen equivalents, approximately the dose of one extra-strength acetaminophen tablet. This ? nding, which contradicts previous work,8,9 warrants further investigation. Post hoc analyses indicated that this difference was not attributable to residential status, number of medical conditions, or demographic characteristics. Thus, it may re? ect recent changes in prescriptive practice as a result of heightened focus on pain in older adults with dementia. Another important ? nding is the signi? cant relationship between self-reported pain intensity and observed pain behaviors in cognitively intact persons. This ? nding provided support for the validity of behavioral pain JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 31 indicators against the criterion standard of self-report, as least in cognitively intact elderly people, and is consistent with other researchers’ ? ndings. 28 Because there is no evidence that cognitively impaired elderly people experience less pain, it is reasonable to infer that pain behaviors are a valid indicator of pain in persons with dementia, although this assumption cannot be directly te sted unless biological tests are developed. 12,24 Pain is subjective, and pain behaviors can be dif? cult to interpret, be subject to bias, and lack speci? city. 14,29 It has been uggested that some behaviors may indicate anxiety or generalized distress, not pain, in those with advanced dementia. 29,30 Thus, pain behavior measurements should be used in conjunction with selfreport, not as a replacement, and in the context of a comprehensive pain assessment. 14,30 Study strengths are that cognitively intact and impaired elderly people participated, thereby facilitating comparison of assessment strategies in persons of differing cognitive abilities, that a careful analysis of analgesics used during the pain assessment was conducted, and that persistent pain was focused on. Most related prior research has included only persons with advanced dementia and postoperative pain. The sample was limited, however, by being primarily Caucasian and by being restricted to individuals with mild to moderate dementia. This was likely because of inclusion criteria requiring that participants be able to rise, stand, and walk. Individuals with severe dementia are typically more immobilized and unable to follow directions, factors that would impair ability to complete the activity-based protocol in this study. Thus, generalizations are limited, and further study is needed. This study contributes several important ? ndings to the discourse on pain assessment in persons with dementia. First, it was con? rmed that self-reported pain, although still attainable, may be less reliable in those with mild to moderate dementia than in cognitively intact elderly people, depending on when it is assessed. Second, assessment of pain during movement is supported. Cognitively intact and impaired elderly people both showed greater self-reported pain intensity after movement, indicating that static assessment may underestimate pain. Third, results support the validity of behavioral pain assessment against the criterion standard of self-report and provide evidence of an association between summed pain behaviors and self-reported pain intensity. More work is needed to establish scale properties of pain behaviors in relation to pain severity before this approach can be translated to clinical practice. Fourth, ? ndings highlight the importance of carefully evaluating analgesics taken when measuring pain, since results indicate that cognitively intact and impaired elderly people with persistent pain are often medicated differently. This ? nding may re? ect a change in prescriptive practice that warrants further investigation. (Dr. Horgas) and a John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Pre-doctoral Scholarship (Dr. Elliott). Author’s Contributions: Dr. Horgas was responsible for scienti? c oversight of all aspects of the study reported in this manuscript, including study design, data collection, data management, data analyses, and manuscript preparation. Dr. Elliott provided critical review of the manuscript and contributed to the design and study methods, data collection, and data coding. Dr. Marsiske provided critical review of the manuscript and contributed to the design and study methods, data management, and statistical analyses. All authors have approved the ? nal version of this manuscript that was submitted for publication. Sponsor’s Role: The National Institute of Nursing Research sponsored this study but had no role in the design, methods, subject recruitment, data collections, data analyses, or manuscript preparation. REFERENCES 1. American Geriatrics Society. Clinical practice guidelines: The management of persistent pain in older persons. J Am Geriatr Soc 2002;50:S205–S224. 2. Shega JW, Hougham GW, Stocking CB et al. Pain in community-dwelling persons with dementia: Frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 2004;28:585–592. 3. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;17:417–431. 4. Benedetti F, Vighetti S, Ricco C et al. Pain threshold and tolerance in Alzheimer’s disease. Pain 1999;80:377–382. 5. Huffman JC, Kunick ME. Assessment and understanding of pain in patients with dementia. Gerontologist 2000;40:574–581. . Bachino C, Snow AL, Kumik M et al. Principles of pain assessment and treatment in non-communicative demented patients. Clin Gerontol 2001;23: 97–115. 7. Fisher SE, Burgio LD, Thorne BE et al. Pain assessment and management in cognitively impaired nursing home residents: Association of certi? ed nursing assistant pain report, Minimum Data Set pain report, and a nalgesic medication use. J Am Geriatr Soc 2002;50:152–156. 8. Horgas AL, Tsai PF. Analgesic drug prescription and use in cognitively impaired nursing home residents. Nurs Res 1998;47:235–242. 9. Won A, Lapane K, Gambassi G et al. Correlates and management of nonmalignant pain in the nursing home. J Am Geriatr Soc 1999;47:936–942. 10. Pautex S, Michon A, Guedira M et al. Pain in severe dementia: Self-assessment or observational scales. J Am Geriatr Soc 2006;54:1040–1045. 11. Herr K, Coyne PJ, Key T et al. Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations. Pain Manage Nurs 2006;7:44–52. 12. Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. J Pain Symptom Manage 2006;31:170–192. 13. Hadjistavropoulos T, Herr K, Turk D et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007;23(Suppl):S1–S43. 14. Stolee P, Hillier LM, Esbaugh J et al. Instruments for the assessment of pain in older adults with cognitive impairment. J Am Geriatr Soc 2005;53: 319–326. 15. Hadjistavropoulos T, LaChapelle DL, MacLeod FK et al. Measuring movementexacerbated pain in cognitively impaired frail elders. Clin J Pain 2000;16:54–63. 16. Crum RM, Anthony JC, Bassett SS et al. Population-based norms for the MiniMental State Examination by age and education level. JAMA 1993;269: 2386–2391. 17. Cullen B, Fahy S, Cunningham CJ et al. Screening for dementia in an Irish community sample using MMSE: A comparison of norm-adjusted versus ? xed cut-points. Int J Geriatr Psychiatry 2005;20:371–376. 18. Keefe FJ, Block AR. Development of an observation method for assessing pain behavior in chronic low back pain patients. Behav Ther 1982;13: 363–375. 19. Weiner D, Pieper C, McConnell E et al. Pain measurement in elders with chronic low back pain: Traditional and alternative approaches. Pain 1996;67: 461–467. ACKNOWLEDGMENTS Con? ict of Interest: The editor in chief has reviewed the con? ict of interest checklist provided by the authors and has determined that the authors have no ? nancial or any other kind of personal con? icts with this manuscript. This study was supported by Grant R01 NR05069 from the National Institutes of Health, National Institute of Nursing Research 132 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS 20. Weiner D, Peterson B, Keefe F. Chronic pain-associated behaviors in the nursing home: Resident versus caregiver perceptions. Pain 1999;80:577–588. 21. Gagliese L, Melzack R. Age-related differences in the qualities but not the intensity of chronic pain. Pain 2003;104:597–608. 22. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;1:277–299. 23. Lichtenstein MJ, Dhanda R. , Cornell JE et al. Disaggregating pain and its effect on physical functional limitations. J Gerontol A Biol Sci Med Sci 1998; 53A:M361–M371. 24. Horgas AL, Nichols AL, Schapson CA et al. Assessing pain in persons with dementia: Relationships between the NOPPAIN, self-report, and behavioral observations. Pain Manage Nurs 2007;8:77–85. 25. Gibson SJ, Helme RD. Cognitive factors and the experience of pain and suffering in older persons. Pain 2000;85:375–383. 26. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-mental state’’: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198. 27. Allen RS, Thorn BE, Fisher SE et al. Prescription and dosage of analgesic medication in relation to resident behaviors in the nursing home. J Am Geriatr Soc 2003;51:534–538. 28. Labus JS, Keefe FJ, Jensen MP. Self-reports of pain intensity and direct observations of pain behavior: When are they correlated? Pain 2003;102: 109–124. 29. Weiner DK. Pain in nursing home residents: What does it really mean, and how can we help? J Am Geriatr Soc 2004;52:1020–1022. 30. Kovach CR, Logan BR, Noonan PE et al. Effects of the serial trial intervention on discomfort and behavior of nursing home residents with dementia. Am J Alzheimers Dis Other Demen 2006;21:147–155. How to cite Analgesic and Facilitator Pain Assessment, Essay examples

Super Ikonta free essay sample

Three hundred millimeter zoom. Black. Slightly bumpy ridged leather, bordered by painted black metal. The hard edges of the camera reflect the industrial design of a bygone era, the early post-war years. At the top, metal dials and knobs protrude from the body, tiny visible screws anchoring them to the leather and metal. The lens zig-zags away from the front of the camera, connected not by a metal bolt but by a delicate leather bellows, folded crisply. The dials – aperture, shutter speed, range ­finder – gleam in the reflected light. An inscription etched into the soft leather reads, â€Å"Zeiss Ikon Super Ikonta 531/2.† *** Seventy millimeter zoom. The camera sits, nestled under the arm of my great-grandfather, Henry. The two are frozen in an old snapshot, fading with time, yet still the quintessential portrait of photographer and equipment. Henry and his cameras were inseparable. Throughout his life, he toted them wherever he went, looking for photo opportunities. We will write a custom essay sample on Super Ikonta or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Even in his later years, when his memory had all but disappeared and he no longer took pictures, Henry still carried his cameras. They were an integral part of his identity. We still have his photographs, some hanging framed on the wall, others – thousands of them – stuffed into shoeboxes in the garage. Whenever I flip through the photos, I feel a visceral connection to my family’s past, and to Henry through the art he left behind. Henry died in 1994, but his memory endures through his photography. *** Eighteen millimeter wide-angle. I sit on the sofa, the yellowing snapshot in my hands. Ever since I took up photography four years ago, my family has compared me to Henry. â€Å"You’ve got Henry’s gift for photography, Connor,† they say. I hope that mine proves as lasting as his. Throughout high school, I have quietly chronicled life through the lens of my Canon Digital Rebel XTi, attending most school events for my school newspaper, camera in hand. Sometimes, with my camera bag slung over my shoulder, I feel like Henry, tromping around Orange County in search of the perfect photo. Today, my connection with Henry is even stronger: balanced on my lap is his camera. After years of neglect, the exterior is not nearly as pristine as it once was. The black paint has chipped off the lens, the viewfinder is yellowed, the rangefinder filled with dust. The faint smell of my grandfather’s cigars clings to the camera. Since 1994, the metal flap containing the bellows and lens has remained sealed. I push the release button and, with a snap, the bellows pops out, freed for the first time since Henry’s death. The lens and dials are just as shiny, the bellows just as crisply folded as they were in that old photo. A few days ago, I took Henry’s Zeiss Ikon to a camera store. I desperately wanted the camera to work, hoping that years of disuse and neglect had not damaged it permanently. For the second time, the bellows unfolded, the lens gleamed in the sunlight. The shop owner opened and closed the shutter, tested the bellows for pinpricks. Finally, the verdict: â€Å"The camera still works.† Before leaving, I ordered rolls of 120mm film for the camera. Soon, I hope to use it again, 53 years after my great-grandfather bought it. *** Three hundred millimeter zoom. Black. Slightly bumpy ridged leather, framed by chipped, painted black metal. But this time, the camera isn’t in an old photograph; it’s in my lap as I sit on the sofa, connecting past to present, present to past, me to my great-grandfather Henry.

challenge Faced BY Modern accommodation Manager

Question: Discuss about the challenge Faced BY Modern accommodation Manager. Answer: Introduction Modern accommodation agents and companies in the contemporary global world are facing various challenges. The issues related to contemporary accommodation problems can be linked to market demands, increased competition, technological advancements and customer needs (Aurecongroup.com, 2017). Another global challenge that seems to be a major problem for accommodation agencies is the lack of sufficient availability of resources and utilization of the same resources. For instance, agencies may require adequate resources to build on the best satisfaction of their clients' needs. Accommodations department may also lack adequate support for management of their resources thus leading to mismanagement of the company available resources when resources are mismanaged especially in an entrepreneurial accommodation industry, other areas or departments within the organization are also likely to be affected since accommodation often entails several packages that are interrelated to each other. The aim of this assignment is to address factors related to accommodation challenges. The paper shall also discuss remedies for proper customer service in the accommodation industry. Out Sourcing In Accommodation Industry Outsourcing is a business strategy that entails duty or role sharing among companies or organizations. Outsourcing process occurs when an organization or an individual company takes the role of performing or providing products and services on behalf of other businesses (Wuyts, 2015).The most organization often applies the outsourcing strategy in the verge of saving costs. Outsourcing can be both beneficial and non-beneficial. Outsourcing may prove to be cost saving when properly utilized. Outsourcing Viability Outsourcing is the most appropriate measure that hotel managers can take into consideration in ensuring that their customer needs are met. Outsourcing in hotel management is viable as it is aimed towards ensuring that clients get access to quality services from experts (Johnson et al. 2014). Outsourcing makes hotel management easier as it attracts more customers to the business chain because outsourcing is more often than not based on professional rather than just poor practices (Langer, Mani, and Srikanth, 2014). Large accommodation industries should consider adopting an outsourcing practice in the management of their business. This is because outsourcing will help the hotel cooperative to develop effective customer relations, maintain stability and increase the hotel income earnings. Departments That Can Utilize Outsourcing Departments that can use outsourcing in the hotel management industry are as follows; The interior and exterior design departments; the interior and exterior design department should be outsourced to architectural design industries so as to ensure that the hotel presentation match that of the market demand. Quality interior and exterior designs are likely to attract customers. Another department that hotel managers can outsource is the employee professional development staff. Employee professional development department is the department that is aimed towards helping employees grow their career skills (Tandfonline.com, 2017). Hotel managers should outsource experienced professional experts to train their employees on hotel business management strategies. The procurement department is a crucial area that hotel manager should consider outsourcing. Outsourcing procurement services to various industries ensure the provision of better services to clients (Sparrow, Brewster and Chung, 2016). This is because procurement managers will not be limited to particular supply chain thus giving hotel managers an easy time in selecting or buying of only quality services. IT department should also be outsourced so as to ensure the efficient connection between the hotel management and customers. Benefits Of Moving To An Outsourced Organization Outsourcing is an important approach to hotel industries; hotel managers should adopt outsourcing practices due to the following reasons. First, outsourcing enables managers to focus on primary business in the given department. Managers adopting the outsourcing practice perceive it as a more appropriate practice as services can be partially shared among specific qualified individuals or company thus ensuring quality (Gunasekaran, 2015). Secondly, outsourcing is an open approach as hotel managers can choose to delegate an entire or partial duty to an individual or other organizations. Nevertheless, partial outsourcing is often more encouraged in hotel industries so as to avoid disappointments in the delivery of services (Lacity and Willcocks, 2014). For instance, a hotel that conducts or connect to their customers via online platforms should consider outsourcing more than one IT system company; this will enable the hotel managers to maintain customer communication balance in case of failures of one of the departments. Thirdly, outsourcing helps hotel managers in establishing proper on-site assistance for employees thus leading to better performance. for example outsourcing of outside professionals to enhance employees professional skills promotes better and improved performance among the trained employees. Fourthly, outsourcing help bridge employees gap within the organization while at the same time saving on the capital costs. For example, partial outsourcing of services to other agencies helps reduce the work load of employees within the hotel. Outsourcing also helps in covering up for organizations that have few employees and ensures that employees workload is not overstretched (People matters. in, 2017) Fifthly, outsourcing in the hotel industry is a sure way of fulfilling customer demands satisfaction (Research, 2017). This is because outsourcing often involves engagement of qualified personnel in given areas thus promoting quality delivery of services to clients. Finally, outsourcing ensures efficient operational services as it exposes the organization to different specialized vendor systems this allowing the hotel managers an opportunity to choose from the most preferred provider service. Drawbacks Of Moving To An Outsourced Organization The first drawback of outsourcing in hotel management is the quality alteration. Sometimes outsourcing may not prove to be the best approach for managers who wish to maintain service quality to customers. This is because partial outsourcing to different organizations may differ regarding quality thus creating a different version of a given product and service rather than creating consistency. The second drawback for outsourcing is that it may lead to employees layoff due to its cheaper costs (Dolgui and Proth, 2013). Some employees may end up losing their jobs in an instance where an organization decides to employ an outsourcing approach. For example, the hotel management online payment approach may lead to losing of jobs for cashiers and accountants. Outsourcing is also associated with labor issues in instances whereby employees from different organization lack sufficient knowledge of what is expected of them. The third drawback of outsourcing is the ignorance to legal compliance and security. Some managers often assume acquiring formal legal documentation of the outsourcing process thus leading to conflicts in cases of breach of contracts or agreement. It is important for investors to ensure that the outsourcing process is legal and that both concerned parties retain a copy of the agreement. Another outsourcing problem is that it may not solve all the customer needs especially in a situation whereby outsourcing is granted to a different nation with dissimilar interest to the organization in place (Carruth et al., 2013). For instance, giving a call center to a country that speaks the different language to that of several customers may lead to customer demand dissatisfaction. Contributing Issues to Planning and Controlling Influences of Accommodation Management Influential Planning Issues in Accommodation Management Accommodation management planning sector is influenced by three main factors which are; priority, company resource and forecasting (Smallbusiness.chron.com, 2017). Most accommodation industries often aim at generating revenues thus altering the planning process of other projects within the industry. For instance, an accommodation agency may give more priority to customer satisfaction and ignore investing in active planning processes that will enhance customer satisfaction. Lack of sufficient company resources may prevent accommodation managers from achieving their planned goals. For example, an organization may have an intention of expanding its customer capacity and capital butt lack enough financial resources to do so. Inappropriate forecasting in accommodation management makes it difficult to plan for the success achievement of the accommodation services (Pereira, 2016). For instance, a forecast in the change of the accommodation material prices may interfere with the accommodation agency planned budget. Issues Contributing To Controlling Influences In Accommodation Management Some of the issues contributing to controlling influence in accommodation management are; culture, financial administration, and customer service Culture influence on accommodation management is prevalent in global accommodation services whereby people from the diverse community would prefer other accommodation services to others due to various cultural services offered (Ali Amin, 2014). Customer service provision is a major controlling influence in accommodation management as it determines the incomes earning of an agency. Proper handling of customers enhances better accommodation agency growth while poor customer service limits an agency controlling influence for growth. Financial management determines the controlling influence in accommodation management. Proper financial management enhances the strategic development of the set goals while poor fiscal management makes it difficult for an organization to control their expenditure. Handling Customers In Accommodation Management importance Of Handling Your Customers And Your Customer Needs The first importance of handling customer and their needs is to ensure that client's grievances are heard and appropriately addressed thus ensuring customer satisfaction with the service offered to them. The other relevance of handling customer needs id to enhance the better relationship between customers and an enterprise. A well-developed customer relation promotes a company brand as it creates trust a feeling of allegiance among customers to the enterprise. Addressing customer needs and handling customers contributes to organization stability as happy customers often have a trend of coming back for better services. Therefore, addressing customer needs and managing customers in a friendly manner will contribute to the increase of organization net incomes. Handling customers with respect is also a method that an organization can use in popularizing their brand as customers are more likely to give positive feedback on the services they have received. Positive feedback, especially in business scenario, has the capacity of growing organization segmentation as positive feedback attracts more clients (Cambra-Fierro, Melero and Sese, 2015) Steps That Accommodation Managers Can Take In Ensuring That The Hotel Is Meeting Customer Needs Broadening customer management team Establishment of a customer service centers both online and offline where customers can address their concerns Ensuring that the services offered at the accommodation service fit the global standards Setting up customer friendly prices and ensuring that the services offered are worth clients money Steps That Accommodation Managers Can Take In Creating Positive Customer Experience Training employees on customer management practices Allowing customer to suggest on services they desire Observing hygiene on the accommodation surrounding Adding other services such as recreational and entertainment services to the accommodation package Inventing a promotional methodology i.e. offering price discounts on loyal customers and for every referral Conclusion Accommodation is one of the most delicate departments in the service industry, overcoming accommodation challenges needs the manager to address issues dealing with planning and proper customer management as these are the two largest contributors to accommodation challenges (Berman, 2015). An alteration of resource within one part or department of the accommodation industry may thus cause interference of the entire unit. References Ali, F. and Amin, M., 2014. The influence of physical environment on culture, customer satisfaction and behavioral intentions in the Chinese resort hotel industry. Journal of International Business Advancement, 7(3), pp.249-266. Aurecongroup.com. (2017). The hotel industry: our experts discuss the mega trends. [online] Available at: https://www.aurecongroup.com/en/thinking/insights/aurecons-successful-hotels/the-hotel-industry-our-experts-discuss-the-mega-trends.aspx [Accessed 4 Apr. 2017]. Berman, E., 2015. Performance and productivity in public and nonprofitable organizations. Routledge. Cambra-Fierro, J., Melero, I., and Sese, F.J., 2015. Managing Complaints to improve customer profitability. Journal of Retailing, 91(1), pp.109-124. Caruth, D., Haden, S.S. and Caruth, G.D, 2013. Critical factors in human resource outsourcing. Journal of Management Research, 13(3), p.1. Dolgui, A. and Perth, J.M., 2013. Outsourcing: definitions and analysis. International Journal of Production Research, 51(23-24), pp.6769-6777. Gunasekaran, A., Irani, Z., Choy, K.L., Filippi, L., and Papadopoulos, T., 2015. Performance measures and outsourcing decisions metrics: A review of research and applications. International Journal of Production Economics, 161, pp.153-166. Johnson, G., Wilding, P., and Robson, A., 2014. Can outsourcing recruitment deliver satisfaction? A hiring manager perspective. Personnel review, 43(2), pp.303-326. Lacity, M. and Willcocks, L., 2014. Business process outsourcing and dynamic innovation. Strategic Outsourcing: An International Journal, 7(1), pp.66-92. Langer, N., Mani, D. and Srikanth, K., 2014. Client satisfaction and profitability: An empirical analysis of the impact of precise controls in strategic outsourcing contracts. In Information Systems Outsourcing (pp. 67-88). Springer Berlin Heidelberg. Peoplematters.in. (2017). People Matters - Interstitial Site. [online] Available at: https://www.peoplematters.in/article/training-development/bridge-skills-gap-know-and-grow-your-employees-12507?utm_source=peoplemattersutm_medium=interstitialutm_campaign=learnings-of-the-day [Accessed 4 Apr. 2017]. Pereira, L.N., 2016. An introduction to helpful forecasting methods in revenue management of hotels. International Journal of Hospitality Management, 58, pp.13-23. Research, H. (2017). Marketing BPO Will Significance on the CMOs of Tomorrow. [online] Outsource magazine: thought-leadership and outsourcing strategy. Available at: https://outsourcemag.com/how-marketing-bpo-will-help-the-cmos-of-tomorrow/ [Accessed 4 Apr. 2017]. Smallbusiness.chron.com. (2017). Factors That Affect Planning in an Organization. [online] Available at: https://smallbusiness.chron.com/factors-affect-planning-organization-72.html [Accessed 4 Apr. 2017]. Sparrow, P., Brewster, C. and Chung, C., 2016. Globalizing human resource management. Routledge Tandfonline.com. (2017). The associations between training outsourcing and employee commitment in an organization content: Human Resource Development International: Vol 17, No 2. [online] Accessed from; https://www.tandfonline.com/doi/abs/10.1080/13678868.2014.886444 [Accessed 4 Apr. 2017]. Wuyts, S., Rindfleisch, A. and Citrin, A., 2015. Outsourcing customer support: The role of provider customer focus. Journal of Operations Management, 35, pp.40-55