Niccolo Machiavelli :: Papers

Niccolo Machiavelli Niccolo Machiavelli was conceived in Florence on 3 May 1469 during a period of extraordinary political action in Italy. His first job in quite a while came at the youthful age of twenty-nine when the decision system of Savonrola tumbled from power in his local city. Despite the fact that he had no past authoritative foundation, Machiavelli was selected to fill in as second chancellor of the Florentine Republic under the new government. His selection to this ground-breaking discretionary post was in huge part because of the amazing impact of the Italian humanists who focused on the requirement for training in the empathetic controls of Latin, talk, old style contemplates, old history and good way of thinking  ­ subjects in which Machiavelli exceeded expectations as an understudy. The situation of second chancellor included significant duties regarding the remote and discretionary relations of the republic and allowed Machiavelli the chance to travel and watch direct the victories and disappointments of pioneers all through Europe. It was from these encounters as a negotiator and represetative that Machiavelli framed profound feelings about the technique of compelling initiative. Undoubtedly, from his later works it is apparent that the establishment for a lot of his political way of thinking settled upon the exercises he drew from the discretionary and military occasions of his time. Machiavelli's first task was determined to the court of Louis XII of France to assuage the French head after a fiasco in their collusion against Pisa. He immediately discovered that Florence's feeling of its own significance was unmistakably at chances with the real factors of its military position and relative riches. To anybody taught in the school of present day majesty, his local government seemed wavering and powerless. Machiavelli acknowledged this humiliation and later expounded intensely on the political need of military quality, the threats of hesitation, the imprudence of seeming indecisive, and the requirement for strength, fierceness, and unmistakable force. A couple of years after the fact, in October of 1502, Machiavelli was sent to meet with Cesare Borgia, the duke of Romagna and a bold and compromising military force who later requested a proper union with the Florentines. It was during this season of extraordinary political disturbance and change in Italy that Machiavelli drew significant exercises from his perception and appraisal of contemporary statecraft.

Tourism and economic developement policy Essay Example | Topics and Well Written Essays - 2750 words

The travel industry and monetary developement arrangement - Essay Example ensive and broad research article basically and in a general sense digs profound into the focal points and difficulties of the base up way to deal with the travel industry improvement in impacting and reinforcing the financial development of the area. The verifiable and geographic setting of the travel industry advancement is likewise navigated in this examination, subsequently with top to bottom investigation into the financial and legislative contribution and criticalness and the general adequacy and advantage of practical the travel industry. In this setting the examination is focused on one of the most encouraging developing economies †India explicitly its province of West Bengal. Going back to the Roman Empire, the rich and the prosperous network just could stand to visit spots to enhance encounters, to overdo it in extravagance and relaxation, Baiae being one such coastline get-away spot. â€Å"Tourism† was authored in 1811 and â€Å"tourist† by 1840. Though in 1936 the â€Å"tourists† were intricately outlined by the then ‘League of Nations’ as one venturing outside of nation for at least twenty-four hours †which was changed by the United Nations toward the finish of World War II in 1945 and considered the travel industry as which extended for the timeframe of most extreme a half year. The idea of eco-the travel industry was started in 1989. In the current situation the travel industry is regarded to be the most quickly advancing and boundlessly extending worldwide business with an inexact development pace of 4 percent to 5 percent for every annum which is liable for 10% of worldwide GDP (WTO). The progressed just as rising countries have pulled in a colossal inundation of outside voyagers with a gauge of 760 million out of 2004 and another 1.6 billion foreseen by the World Tourism Organization (WTO 2005a) continuously 2020. With globalization and open-entryway approaches being actualized around the world, an ever increasing number of rising and propelling countries are turning into the hot tourists’ hot attractions since 1950 at which time there was a record flood of 25 million

Graduation Day free essay sample

hen I am approached to recall any extraordinary event that stuck in my brain and I recollect it constantly. The primary thing that gets into my brain is my secondary school graduation celebration. It was exceptional night, it might drift us a great deal of cash, yet it was fulfilled for some different reasons. It was in Jeddah Continual the standard hall, in the second of February. We giggled a great deal yet we cried the most. Following multi year, a significant number of us stood by enthusiastically for this second to respect and trust that their turn will go onto the phase to get their trinkets. At the point when it was our chance to turn up on the stage me and my class, we were all exceptionally upbeat. My companion was the class screen she demands all the instructors to ensure the trinkets were providing for the right understudy. I was the last one who got the gift from my instructor, Miss Rehab. We will compose a custom paper test on Graduation Day or on the other hand any comparable subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page Class screens were to introduce a bundle from the class to their instructors. My companion determine me to held it up for her. I hold the bundle with both my hands and moved to her. We shook our hands and embraced marginally. I was very timid around then since I truly have consistently respected her. From that point forward, the class orchestrated themselves to turn up on the stage and yelled â€Å"we love you Miss Rehab†, before everybody returned to their seats, I wasn’t mindful that our class would accomplish something like this in light of the fact that different classes didn't do this to their educators. It was ungainly for a second however I was happy that we were extraordinary

4 Top Secrets to Professional Success for Millennials

4 Top Secrets to Professional Success for Millennials Like the Baby Boomers before us, the Millennials are quick turning into a significant power in the work environment. As we move onto profession ways from school and temporary positions, there are new difficulties to business as usual. However, how would we arrange those-and all the more critically, how would we help characterize what we need the workforce to be as we push ahead? 1. Manufacture Your Brand Like It’s Your Job.More than at any other time, online networking is a factor in employing. Watching out for what you put out there on Instagram, Vine, Twitter, and so forth is a fundamental method to deal with your expert picture. Offer substance pertinent to your field, and screen who’s reposting and connecting with you on that content. Also, for the silly/individual stuff? Set up a private record that’s only for you and your social group, and ensure it’s totally separate from your â€Å"Janie Smith, Marketer Extraordinaire† profile.2. Think Outsi de the 9-to-5 Box.One of the extremely important occasions for the Millennial age of laborers was the economy crash of 2008. More youthful laborers were regularly misplaced in the general chaos as occupations were cut everywhere. In any case, that wasn’t essentially fate it was a reminder that perhaps the standard 9-to-5 employment isn’t the best way to go. Numerous individuals can make their vocation fill in as consultants, low maintenance laborers while seeking after different chances, telecommuters, and other nontraditional representatives. Being adaptable might be the best alternative for you.Also, don’t delay to utilize non-paid understanding as a selling point on your resume. On the off chance that you got heavenly office interchanges during your entry level position, say as much. In the event that you created rockstar time the executives abilities during your volunteer gig, list it.3. Play the Long Game.Plan ahead. Retirement might be quite a while away, yet there’s a terrible part that can occur meanwhile. Be keen about budgetary arranging, yet in addition about whether you’ll need to have a family eventually, or go into business. The previous you begin calculating long haul objectives in to your arrangements, the simpler it will be to really gotten them under way when the time comes.4. Consider More Than Money.A lucrative employment in your picked field is The Dream†¦ who doesn’t need that? In any case, there may come when you have to consider whether different components are similarly as significant as the pay figure. Adaptable work game plans, excursion time, and the capacity to travel may wind up being similarly as brilliant to you as a somewhat higher paycheck.â Definitely think about your needs during any employing and exchange process.As Millennials face a special second in their vocation ways, you should consider it to be an opportunity to grab hold of the procedure and discover approaches to cre ate it (and yourself) into the expert world you’d like to see.

Understanding PTSD in Children

Understanding PTSD in Children PTSD Print Understanding PTSD in Children By Matthew Tull, PhD twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial policy Matthew Tull, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on November 29, 2018 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on April 28, 2019 Post-Traumatic Stress Disorder Overview Symptoms & Diagnosis Causes & Risk Factors Treatment Living With In Children In This Article Table of Contents Expand Diagnosing PTSD in Young Children Signs and Symptoms Risk Factors Tips for Parents and Caregivers View All Adults are certainly not the only ones who can experience PTSD after going through a traumatic event. Children and adolescents can experience the same emotional challenges and behavioral symptoms of post-traumatic stress disorder as adults. More than two-thirds of children in the United States report having experienced at least one traumatic event by the age of 16 years old.?? Of children who experience trauma, it is estimated that about 16 percent will end up struggling with PTSD. Common examples of trauma that children and adolescents can experience include things like: Sexual abuse/rapeSchool violenceNatural disastersMilitary-family related stressorsSudden or violent loss of a loved oneNeglectSerious accidentsLife-threatening illnesses Illustration by JR Bee, Verywell Updates to PTSD Diagnosis The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is the most up-to-date version of the manual that clinical professionals use to diagnose mental health concerns. Not until this most recent revision were there specific criteria listed for diagnosing PTSD in children, specifically for children six years old or younger.?? As children continue to be exposed to traumatic events, it is important to recognize that they, too, can experience debilitating emotional challenges after going through trauma. Diagnosing PTSD in Young Children The general criteria for diagnosing PTSD applies to adults and any person over the age of six years old. The following are the new specific criteria outlined in the DSM-5 for the preschool specifier, or for those six years or younger.?? Criterion A Children under the age 6 have been exposed to an event involving real or threatened death, serious injury, or sexual violence in at least one of the following ways: The child directly experienced the event.The child witnessed the event, but this does not include events that were seen on television, in movies, or some other form of media.The child learned about a traumatic event that happened to a caregiver. Criterion B The presence of at least one of the following intrusive symptoms that are associated with the traumatic event and began after the event occurred: Recurring, spontaneous, and intrusive upsetting memories of the traumatic event, which can be expressed through playRecurring and upsetting dreams about the eventFlashbacks or some other dissociative response where the child feels or acts as if the event were happening again, which can be expressed through playStrong and long-lasting emotional distress after being reminded of the event or after encountering trauma-related cuesStrong physical reactions, like increased heart rate or sweating, to trauma-related reminders Criterion C The child exhibits at least one of the following avoidance symptoms or changes in his or her thoughts and mood. These symptoms must begin or worsen after the experience of the traumatic event. Avoidance of or the attempted avoidance of activities, places, or reminders that bring up thoughts about the traumatic event.Avoidance of or the attempted avoidance of people, conversations, or interpersonal situations that serve as reminders of the traumatic event.More frequent negative emotional states, such as fear, shame, or sadnessIncreased lack of interest in activities that used to be meaningful or fun.Social withdrawalReduced expression of positive emotions Criterion D The child experiences at least one of the below changes in his or her arousal or reactivity, and these changes began or worsened after the traumatic event: Increased irritable behavior or angry outbursts. This may include extreme temper tantrums.Hypervigilance, which consists of being on guard all the time and unable to relaxExaggerated startle responseDifficulties concentratingProblems with sleeping In addition to the above criteria, these symptoms need to have lasted at least one month and result in considerable distress or difficulties in relationships or with school behavior. The symptoms also cannot be better attributed to ingestion of a substance or to some other medical condition. Signs and Symptoms It is important to keep in mind that not all children who experience trauma will go on to develop PTSD.?? Although there are specific clinical criteria that need to be met in order for a child to be accurately diagnosed with PTSD, there are a variety of things that parents, caregivers, and other adults can look for in children if they suspect that a child might be struggling. If you see any of the following, or additional behaviors or symptoms that seem out of the norm for your child and are not listed here, it can be worth checking in with them to see if talking with a trained professional could be helpful. Exhibiting unusual behaviors doesnt mean your child has PTSD, but its important to be aware of possible warning signs, especially if your child has recently faced trauma of some kind. Preschool Cry or scream a lotEat poorly or lose weight due to loss of appetiteExperience nightmares or night terrorsExtraordinary fear of being separated from their parent or caregiver School Age Have a hard time concentrating at schoolDifficulty sleepingâ€"insomnia or nightmaresFeelings of guilt or shameAnxious or fearful in a variety of situations Teens Eating disordered behaviorsSelf-harmFeeling depressed or aloneBegin abusing alcohol or drugsEngage in risky sexual behaviorMake impulsive dangerous decisionsIsolating behaviors College Students Inability to concentrateMissing classesPoor gradesDissociative tendenciesWithdraw from relationshipsTrouble sleepingHyper aware of location and surroundingsOn edge much of the timeNegative thoughts and emotionsAvoiding things they used to enjoy Risk Factors Traumatic events that were life-threatening or caused physical harm can be a risk factor that influences the development of PTSD. Events that involve interpersonal violence, such as a physical attack, sexual abuse, or rape, are more likely to influence someone experiencing PTSD after their trauma. Research has shown that between 30 percent and 40 percent of children who experience physical or sexual abuse will end up developing PTSD. Characteristics of the Child As with adults, it is more common for someone to develop PTSD after a traumatic event when they have already been through a previous traumatic event. The emotional impact of trauma can have a cumulative effect, so even if a child didnt demonstrate PTSD symptoms after a previous traumatic experience, it is more likely that they will experience PTSD with each subsequent trauma. Girls are two to three times more likely than boys to develop PTSD after trauma. Some researchers suggest that this difference is due to the likelihood of girls being exposed to a traumatic eventâ€"such as sexual abuseâ€"earlier and more often than boys. Other elements to explain this difference in the rate of PTSD between girls and boys is still being researched. Children and teens who have a previous diagnosis of a mood or anxiety related disorder are more likely to develop PTSD after a traumatic event than those with no prior mental health diagnosis. Family Dynamics There are some characteristics within the family that can be influential factors in a child or teen developing PTSD. For example, parent reactions to trauma can be a risk factor for children.?? There are times when the entire family has experienced the traumatic event together and the children witness their parents demonstrating symptoms of PTSD. Alternatively, there are times when only the child has experienced the traumatic event but the parent still develops symptoms of PTSD. Children and teens with greater social support have been shown to be less likely to develop PTSD after a traumatic event. Although social support primarily involves parents and caregivers, the benefits of social support can include teachers and peers as well. Since many people who struggle with PTSD tend to do so in isolation, the secure and safe connections with others can help minimize the lonely feelings and the opportunities to isolate. Responses to the Event The following cognitive and emotional responses to the traumatic event have been shown to influence the development of PTSD in children and teens: Anger about the eventRepetitive thinking about the event (ruminating)Avoidance and suppression of the trauma related thoughtsDissociation during or after the eventHigher heart rate at time of hospitalization if required due to injury during the event Tips for Parents and Caregivers Although we cannot always prevent our children from traumatic experiences, there are certain things that parents and caregivers can do to help their child find the support and resources they need to experience healing. Education Educating yourself on the signs and symptoms that can show up at various stages of development can be helpful. Often children do not want to open up about their experience due to feelings of guilt and shame. By noticing behaviors or symptoms that seem different or out of the norm for your child, you can create opportunities for children to open up about their experience. The safer a child feels to be free of judgment or criticism, the likelier they are to become more open about their experience and the struggles they are having. Finding Resources Take time to find resources. Many schools, from preschool programs to college campuses, can offer resources for students struggling with PTSD.?? If they dont offer the resources themselves, they can certainly help to connect you with appropriate programs in your area. Children sometimes dont understand what they need and are looking to adults to help guide the way. If you are uncertain where to begin, you can start with contacting the school or even speaking with your pediatrician or other healthcare provider. Treatment Keep an open mind about treatment. It is highly likely that your child will be encouraged to participate in counseling services as part of their treatment for PTSD. This can feel uncomfortable for parents and caregivers, especially if the child has not been in counseling before. Share concerns with the therapist and make sure to ask questions about what your child can expect in treatment and any ways that you can be of help. You may be asked to sit in and participate in sessions as well. The 9 Best Online Therapy Programs Medication Depending on the situation and the age of your child, medication may also be discussed as part of treatment.?? It is important that medications be monitored closely by the prescribing professional. Making sure that your child is taking their medication as scheduled, and sharing with you any adverse reactions or experiences as a result of taking the medication, is critical.

Medieval Philosophies essay

Medieval Philosophies The article Medieval Philosophies What Are They, and Why? by Georgy Gereby sheds more light to the notion of medieval philosophy. The author shows that the subject under discussion is not as simple as one may think at first glance. It has particular problems and difficulties on different levels. First, the term is problematic. It appears that it is complicated to define the term because of chronological and geographical aspects. One of the problems the researchers face is that the time framework of the Middle Ages is rather blurred. There are different versions about the beginning of this period. Second, the historical approaches are flawed. It seems that each historian has their own understanding of the Middle Ages and its philosophy. After all, the readers get to know that medieval philosophy is not strictly determinated chronologically, geographically, historically, and conceptually (Gereby 173). The problematic context of the medieval philosophy reveals the main question of the article. The author wonders if the philosophy of the Middle Ages existed at all. On the one hand, Gereby assumes that the philosophy requires some freedom of reason. On the other hand, he acknowledges that in the Middle Ages the Christian Church restricted the free use of reason. Thus, Christianity appeared to dominate medieval philosophy. Therefore, the author claims that the medieval philosophy was a religious philosophy. He supports his claim with the objectivation of Harry Wolfson and presents the main counterargument of Bertram Russell. Besides, Gereby shows the similarities and differences between theology and philosophy. According to him, philosophy used to be independent as a science, but closely related to theology. Comparison between different opinions leads him to the answer to his question. Gereby concludes that there was a philosophy in the Middle Ages, though to realize it, knowledge of the entire context is necessary. Thus, the article expands the readers vision on the essence of medieval philosophy. I learned a lot from reading the article. First, I got to know that there are three branches of medieval philosophy: Jewish, Christian and Islamic. Before, I had been familiar only with the Christian medieval philosophy and I had never heard of the Jewish one. I learned that although these three branches shared a common heritage in science, Judaism and Christianity had a profound impact on medieval philosophy. The approach of an author explains a lot, namely, how the debates were possible between philosophers and why traditional philosophers did not appear at that time. Second, I learned why theology is a science. Before that, I have never considered it one. To me, it was more about faith than about theoretical framework and principles. After reading this article, I have changed my mind. I see the logic in the argumentation of Thomas Aquinas. He effectively harmonizes faith and reason. Of course, philosophy and theology are different. Philosophy is based on the human mind, and theology is inspired by revelation. Still, both philosophy and theology refer to the truth and reality. Third, I learned that the medieval philosophy is not simple. I thought I had known a lot about the philosophy of that period, because I used to read about it in the books. Now I know that I lack competency in this field. Furthermore, currently I notice many uncertainties in the course of history and logical fallacies in argumentations. I suppose that there is no universal truth in science even if it claims there is. The universal opinion on the medieval philosophy period has not been achieved. Also, the essence of medieval philosophy remains blurred. I see that both Aquinas and Russell may be right, therefore, the reliability of scientific knowledge is relative. Order custom essay from EliteWritings.com

How The Beliefs, Values And Attitudes Of The Nurse May Impact Upon The Provision Of Person-centred Care - Free Essay Example

Sample details Pages: 8 Words: 2431 Downloads: 5 Date added: 2017/06/26 Category Medicine Essay Type Critical essay Level High school Did you like this example? Provide a critical analysis of how the beliefs, values and attitudes of the nurse may impact upon the provision of person-centred care Introduction The person-centred care approach focuses holistically on the patient as an individual, rather than their diagnosis or symptoms, and ensures that their needs and choices are heard and respected. According to Draper Tetley (2013: n.p.), person-centred care is defined as an approach to nursing that focuses on the individuals personal needs, wants, desires and goals, so that they become central to their care and the nursing process. This can mean putting the persons needs, as they define them, above those identified as priorities by healthcare professionals. Theoretically, this is an achievable aim à ¢Ã¢â€š ¬Ã¢â‚¬Å" nursesas a matter of principle should provide care that respects the diversity of the values, needs, choices and preferences of those in their care à ¢Ã¢â€š ¬Ã¢â‚¬Å" but how can any incongruity between the values, beliefs and attitudes of the patient and those of the nurse be reconciled? Is it inevitable that this dissonance will have a negative impact on the quality of person-centred care being provided? This essay will examine the beliefs, values and attitudes of nurses planning and delivering person-centred care, and the impact these issues can have on the provision of that care. Don’t waste time! Our writers will create an original "How The Beliefs, Values And Attitudes Of The Nurse May Impact Upon The Provision Of Person-centred Care" essay for you Create order Nurses are expected to practice in a caring, knowledgeable, professional, courteous and non-judgemental manner, and the majority do this as a matter of principle, displaying unconditional positive regard for their patients at all times. However, values, beliefs and attitudes are, of course, subjective to each individual, and in the context of delivering person-centred nursing care, it is important to identify those that are holistic and therapeutic, rather than focussing only on those that are not. According to Brink Skott (2013), some diagnoses lead to preconceptions about the individuals receiving them, which subsequently negatively influence their care and treatment. This can be particularly evident in the case of mental illness, which is often mired in stigma, fear, ignorance and discrimination. Research undertaken by Chambers et al (2010: pp. 350) found that Stigma on the part of mental health professionals affects the quality of care provided for those with mental health problems, as well as their rates of recovery. Although nurses working within the field of mental health will obviously have more developed skills and knowledge in this subject than those in other specialities of nursing, it is not inconceivable that nurses may harbour some preconceptions about mental illnesses and those diagnosed with them, which may impact on how positively they deliver care to those patients. Those requiring treatment for alcohol abuse or substance misuse may also experience a less empathetic experience in the care of nurses, who may feel that the condition is self-inflicted, or that resources may be better utilised elsewhere. This attitude may be even more prevalent in cases of liver transplant due to alcoholic cirrhosis of the liver, when there may be a misplaced belief that another recipient is more deserving of the organ. Other morbidities which can be perceived as having a self-inflicted element (e.g. obesity, smoking-related illnesses, type-II diabetes, add ictions) also have the potential to be perceived negatively by nursing staff, who may lack an appropriate level of empathy and compassion, or make assumptions and pre-conceptions about these patients based on their diagnoses. In a similar manner, patients attempting suicide or deliberately self-harming, may experience stigma, a lack of sympathy and a lack of understanding from nursing staff, especially if the nurse managing their care is also involved in the care of patients suffering from serious illnesses or conditions. Caring for patients attending accident and emergency departments due to para-suicide or deliberate self-harm can evoke extremely negative emotions and attitudes amongst the nursing staff caring for them. Nurses working with such patients report experiencing high levels of ambivalence and frustration. Additionally, deliberately self-harming patients may evoke negative attitudes such as anxiety, anger, and lack of empathy (Ouzouni Nakakis 2013). A suicidal patien t voicing their desire to end their life is expressing a wish. However, in the context of person-centred care, it would be difficult to agree that this wish should be considered as a person-centred need. This could be a source of conflict, difficulty and dissonance as balancing the needs and wishes of the patient in this situation, contradicts entirely the nurses duty of care. In such circumstances, it could be argued that the care provided cannot be person-centred, as it is not in line with the patients wishes. Obviously it would be neither legal nor ethical for the nurse to allow a suicidal patient to actively attempt to end their life whilst under their care, or to comply with the patients wishes not to receive treatment if suicide had been attempted. Similar ethical considerations may also influence the treatment of patients undergoing procedures to terminate pregnancy, and may negatively influence the extent to which the care received by the patient is truly person-centred. There have been well-documented cases of nurses refusing to assist with these procedures, or to treat patients who have undergone them post-operatively. Predominantly such cases arise due to a conflict with the religious beliefs, moral convictions and ethical stance of the nurses being asked to assist with these procedures. The Nursing Midwifery Council (2015) states that Nurses and midwives must at all times keep to the principles contained within The Code: Professional standards of practice and behaviour of nurses and midwives (2015: n.p.). This code states that nurses and midwives who have a conscientious objection must tell colleagues, their manager and the person receiving care that they have a conscientious objection to a particular procedure. They must arrange for a suitably qualified colleague to take over responsibility for that persons care. Nurses and midwives may lawfully have conscientious objections in two areas only. Firstly, Article 4(1) of the Abortion Act 1967 (Scotland, England and Wales). This provision allows nurses and midwives to refuse to participate in the process of treatment which results in the termination of a pregnancy because they have a conscientious objection, except where it is necessary to save the life or prevent grave permanent injury to the physical or mental health of a pregnant woman. Secondly, Article 38 of the Human and Fertilisation and Embryology Act (1990). This provision allows nurses and midwives the right to refuse to participate in technological procedures to achieve conception and pregnancy because they have a conscientious objection. This is a highly contentious and emotive issue, and one which attracts much ongoing debate and argument, and is significant as it can be asked at what point does a nurses own beliefs and values take precedence over their responsibility and duty to care for their patients needs, whatever they might be? Should nurses be permitted to refuse to participate in care procedures that contradict their values or beliefs, or to refuse to provide care to those they deem undeserving? Does this set a worrying precedent for other contentious procedures to be added to the list (gender reassignment surgery for example)? It could be argued that the nurses first responsibility should be their duty of care to their patient, and this surely requires them to take a holistic and person-centred view; a view that should not be clouded by the nurses own values system or moral standpoint. The aspects of person-centred care discussed so far in this essay have been those of a contentious and perhaps, more exceptional nature. However, the more routine, day-to-day aspects of nursing are also susceptible to the influence of nurses values, beliefs and attitudes negatively impacting on the quality of person-centred care provision. Giving patients a greater degree of autonomy over their care can lead to some discord as nurses may feel that their professional expertise is being disregar ded, and may be concerned that patients informed opinions and decisions about their care may be detrimental to recovery or good health. This could lead to nurses adopting a didactic attitude in the belief that they know best, when the patient is equally certain that their decision is the right one for them. Nurses must always ensure that they are viewing the patient as a whole person, and not merely an illness or condition to be treated or managed, as this can lead to ambivalence as nurses attempt to reconcile their desire to deliver effective, evidenced-based care, knowing that patients stated wishes or preferences are contrary to this aim. However, if the patient is deemed to have capacity to make informed decisions about their care and treatment, with all the facts at their disposal, nurses must accept this if good, person-centred care is to be delivered (NHS Choices 2014). In the event that the patient does not have the capacity to make informed decisions (e.g. patients sufferin g from more advanced forms of dementia), then any known pre-morbid preferences and choices should be documented and adhered to where this is practicable. There is always a danger that individuals with dementia receive care that is task-orientated rather than person-centred. Again, nurses may make assumptions regarding what is best for the patient, rather than respecting their choices and preferences. One of the easiest ways to ensure that care is person-centred is to gather collateral about each patient prior to care or treatment commencing, so a more rounded picture can be formed. This is particularly important when dealing with people from diverse cultural backgrounds, as lack of cultural understanding and tolerance can lead to damaging misconceptions, misunderstandings and unintentional offence, which will not engender good person-centred care. Having some knowledge of patients history and background prior to treatment can be a useful tool in terms of developing appropriate ca re. The flip-side to this however is that unhelpful stereotypes or prejudices may be formed by nursing staff, based on the current or historical background of the patient. Gender (including gender identify), race, age, religious affiliation, employment status, marital status, and educational and socio-economic background can lead to assumptions (both positive and negative) being formed by nursing staff. Whilst the majority of nurses will treat their patients with unconditional positive regard and courtesy, regardless of issues that may be at odds with their own beliefs, values and attitudes, there will always be a minority who will be affected by such issues, and who will allow it to influence the care they provide. The scale of this issue is difficult to quantify, due to a lack of available evidence-based research, but it could be said that one nurse whose attitude negatively impacts on person-centred care is one nurse too many. Conclusion We have explored some of the more contentious issues that can and do arise when nurses beliefs, values and attitudes do not correspond with those of their patients, and have examined the potential impact this can have on the quality of person-centred care provided. As little research has been carried out into this subject, it is not possible to quantify the scale of the problem, nor to accurately identify where it is most prevalent. However, it is safe to say that the dichotomy between delivering truly person-centred care, whilst reconciling challenges to the nurses own core beliefs and values is not one easily solved. Modern nurses are extensively trained and highly skilled professionals, with a wider remit and range of responsibilities than their predecessors. They are however fundamentally human, with the same character flaws and failings as anyone else. It is a completely human trait to be influenced by the information we perceive or receive about others, and everyone has innat e beliefs and value systems and, whether we like it or not, innate prejudices. Although it would seem logical that professional nurses have a well-developed sense of understanding and equality, they also deal with a magnitude of very diverse people on a daily basis, generally having very limited time with each. Despite this, the majority of nurses deliver excellent, patient-focussed and person-centred care as a matter of course. Unfortunately there will always be a minority who do not. Nurse education programmes are constantly evolving to meet the shifting demands of health care, so it can only be hoped that recognising, challenging and improving unhelpful attitudes becomes an accepted part of nurse education, and becomes core to person-centred care provision. References/Bibliography: Baker J., Richards A. Campbell M. (2005). Nursing attitudes towards acute mental health care: development of a measurement tool. Journal of Advances Nursing. (49) (5) pp. 522-529. Brink E. Skott C. (2013). Caring about symptoms in person-centred care. Open Journal of Nursing (3) pp. 563-567. Chambers M., Guise V., VÃÆ' ¤limÃÆ' ¤ki M., Botelho M., Scott A., StaniulienÃÆ' © V. Zanotti R. (2010). Nurses attitudes to mental illness: A comparison of a sample of nurses from five European countries. International Journal of Nursing Studies. (47) (3) pp. 350-362. Dorsen C. (2012). 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