Duodenal Atresia Research Paper Example | Topics and Well Written Essays - 250 words

Duodenal Atresia - Research Paper Example Usually, duodenal atresia brings about other birth defects as well. Symptoms of duodenal atresia include swelling of upper abdominal, heavy early vomiting, continued vomiting even without being fed, lack of bowel movements after the initial meconium stools, and lack of urination following the initial voidings. Amniotic fluid is observed in the womb in excessive amounts by a fetal ultrasound; a condition termed as polyhydramnios. X-ray of the abdomen may reveal the presence of air in the start of the duodenum and the stomach, with no air in the further parts of the duodenum; a condition termed as double-bubble sign. In order to treat duodenum atresia, the stomach is decompressed by placing a tube. An intravenous tube is inserted to correct dehydration and electrolyte abnormalities. Other congenital anomalies are also evaluated alongside. A surgery may be required to remove the duodenal blockage, commensurate with the nature of abnormality. In most cases, the patient recovers after the treatment whereas if left untreated, duodenal atresia can prove fatal. There is no way to prevent duodenal

How music affect the brain Research Paper Example | Topics and Well Written Essays - 1750 words

How music affect the brain - Research Paper Example The pitch and rhythm of music are primarily the functions of left brain hemisphere, whereas melody and timbre are mostly processed in the right hemisphere of the brain. The processing of meter takes place in both hemispheres of brain. The spatial-temporal tasks are located in the very brain areas which are stimulated by music. Such spatial-temporal tasks include spatial reasoning required to build structures, and physical objects’ 2-D and 3-D manipulation. Music stimulates the brain areas that are related to spatial reasoning. While this effect usually is only 15 minutes long after the end of music (â€Å"How Music Affects†). The spatial reasoning of an individual is markedly increased while listening to music. Brain’s response to music Music constitutes fragile timing violations. Experience suggests the listeners that music is not threatening. The frontal lobes ultimately identify these violations as a source of pleasure. As a result of this expectation, anticip ation is developed that when met, helps develop the reward reaction. A fundamental characteristic feature of music that differentiates it from other stimuli is its ability to conjure up feelings and images which might not necessarily reflect in the memory directly. A certain kind of mystery still remains in the overall phenomena; the factors explaining the thrill of listening to music are integrally linked with synesthesia based theories. The brain of a new born baby has not differentiated its structure into components meant for the identification and appreciation of various senses. It takes time for the brain to develop this differentiation. As the theory suggests, babies perceive the world as â€Å"a large, pulsing combination of colors and sounds and feelings, all melded into one... The "How music affects the brain" essay outlines how the brain understands and processes it. Music constitutes fragile timing violations. Experience suggests the listeners that music is not threatening. The frontal lobes ultimately identify these violations as a source of pleasure. As a result of this expectation, anticipation is developed that when met, helps develop the reward reaction. A fundamental characteristic feature of music that differentiates it from other stimuli is its ability to conjure up feelings and images which might not necessarily reflect in the memory directly. A certain kind of mystery still remains in the overall phenomena; the factors explaining the thrill of listening to music are integrally linked with synesthesia based theories. The brain of a new born baby has not differentiated its structure into components meant for the identification and appreciation of various senses. It takes time for the brain to develop this differentiation. As the theory suggests, babies perceive the world as â€Å"a large, pulsing combination of colors and sounds and feelings, all melded into one experience – ultimate synesthesia† (Mohana). Different areas of the brain become specialized in the different senses with the development of brain over the passage of time. â€Å"After a year of training, the kids who have been in the music training are better able to synchronize to the beat and to remember the beat† (Kraus cited in Wise). Music improves intelligence, learning, cognition, and motor skills.

Energy in American History Essay Example | Topics and Well Written Essays - 750 words

Energy in American History - Essay Example Coal was seen to be economical in the production of steel and iron. The first half of the 19th century energy consumption in America grew significantly in major sectors (Altomonte and Coviello 37). However, after the Second World War, coal began being replaced by petroleum. The coal used in the locomotives was replaced by diesel and gasoline. Coal was increasingly viewed as unsafe and expensive with regard to labor. However, the use of coal in the production of electricity caused coal to remain relevant (Williams 412). At the same time, natural gas and petroleum became the predominant sources of energy in the energy consuming American society (Altomonte and Coviello 37). During the depression, the consumption of petroleum began to rise. This was accelerated by the oil embargoes in 1973. The Europeans played a crucial role in transforming the American natural resources into commodities. According to research, early America was considered to be in a misconception for extremely dependin g on farming. However, the industrial revolution brought a new approach into the American households. This marked the rise of free market and challenged the ancient sources on energy. In the nineteenth century, steam power was introduced. The new concept interlinked technological risks, factory development and energy consumption to ethnicity. ... This marked the beginning of high energy consumption levels in America (Smith 59). According to Nye, the discovery of electricity energized the popular culture. The energy needs of the society rose significantly and the culture of consumption gained momentum. The American society had an assumption that energy supply was surplus (Williams 412). This explains the majority in the American society failed to understand the energy crises in 1970. Research shows that Americans did not associate the energy shortage with the levels of energy consumption and throwaway attitude. However, production and consumption was reconfigured when the computer was embraced (Smith 59). Most of the Americans thought a computer was an energy controlling tool. The quest to explore new sources of energy became a strong social construction. The electricity and automobile had a transformative impact on the society (Altomonte and Coviello 37). The high energy use in America was associated to Americans’ hope s for unlimited energy in a liberal and consumer economy (Altomonte and Coviello 37). Americans believed in self-reliant individualism. The effects of pollution on human health in America have caused the American government to rethink the energy sources. The impacts of greenhouse gases on global warming have caused America to reduce the traditional sources of energy. This is happening through the energy regulation controls and improved technology (Williams 412). There has been a push for America to reduce its dependence on petroleum and natural gas (Smith 59). Moreover, there have been proposals on carbon taxes which might have an impact on the American economy. However, the levels of energy consumption in America have

WEEK 4 DQ 7 Assignment Example | Topics and Well Written Essays - 250 words - 1

WEEK 4 DQ 7 - Assignment Example Generally, organizational culture helps in enhancing teamwork in the organization. The type of organizational culture adopted and applied in an organization depends on the management and the amount of control that it wants to exercise in the organization (Schein, 2010). The most common types of organizational culture include the collaborative culture, the controlled culture, the competitive culture, and the creative culture. The collaborative culture encourages teamwork and cooperation of activities while the controlled one depends on punctuality and has fewer margins for error. On the other hand, the competitive culture encourages competition between the employees on a daily basis while the creative one allows independence in projects. The culture provides a sense of identity, promotes trust, fosters commitment, and gives the employees a reason to behave in a certain way (Sims, 2002). An organization’s culture is very important because the organization can use it to improve i ts overall performance. This is because the culture determines the mode of decision making in the organization as well as the extent to which the employees can communicate with the management to provide input on certain issues that may be affecting the organization. A good organizational culture can even function as an organization’s competitive

Education Research Paper Example | Topics and Well Written Essays - 2000 words

Education - Research Paper Example It can be argued that better education may be an inclination toward better life. The primarily role of education to an individual is the ability to offer knowledge, competence and the skills required of an individual to participate effectively in the happenings of the society as well as the economy. Education has the capacity to improve the lives of individuals within the society such that it helps in the development and advancement of political interests, health challenges, wellbeing and participation in civic activities. According to OECD Better Life Index, research studies reveal that educated people within the society lives longer and actively partake in political matters (OECD). Further, individuals with better education participate actively in the communities where they reside, engage less in criminal activities and do not depend on social assistance as their counterparts with no or little education. Better education is somehow equated to better life because of the increased opportunities and potential that quality education offers in securing good employment and pocketing good earnings. When compared to individuals with poor educational background, educated members of the society are affected by the unemployment tendencies to a lesser extent because the educational accomplishments make them more attractive to the labor market (Rouse). It is also argued that higher levels of education correspond to increased earnings in the employment market (OECD). As a result, highly educated people would have the advantage of having higher earnings with the advantage of accessing better services such as health services. Alternatively, individuals can achieve better life without necessarily having better education. The case of Malcolm X for instance, enjoyed better life but did not have the privilege to acquire better education. He had little education but still succeeded in life because the education he acquired was not imperative for his success but helped to understand the world in a much better way. He could communicate effectively with members of the society. He came to understand about several words that existed that he did not have an idea of. The little education that Malcolm got made him to go places, meet people and understand events that took place in the world (Wiener 84). Success in life can arise from individuals with low education but are innovative and productive with their lives. Nonetheless, education is important in helping individuals to improve their understanding of the world and relationship with the society. Talent, motivation and creativity in individuals are the most important elements in the success and prosperity of people (Thiel). These elements are not imparted in individuals through good education; therefore, education cannot be a necessity for better life. Good education is considered as a secondary factor in achieving success and prosp

ICT in Organisations Essay Example for Free

ICT in Organisations Essay 1: Introduction: What is EPOS? What is epos? Epos is a name for a till that operates in big organisation. EPOS systems are mainly used by businesses that have large numbers of regular sales like debenhams, EPOS stands for Electronic Point of Sale, is an electronic system that processes credit cards transactions so that the credit card has the right funds in it ,it is also Checkout tills that are connected to a computer with a bar code scanner that scans the products . The EPOS also provides full stock control; it also provides the tracking of refunding goods. It electronically receives and sends bar code information. How debenhams use epos is that it controls Product handling at point of sale, stock control, automatic reordering and rate of sale information and also is set up to retain a database of all customers volunteering their name/address/telephone number, for the purpose of mailing lists or other marketing database. EPOS can hold details on a maximum of 100,000 stock items. It Takes about 0.25 seconds per product to find its name /country / expiry date, With a 10,000 item stock file. The barcode can be read with a hand held scanner at the checkout .the scanner makes a light appears the reflects off the barcode. The white lines on a barcode reflect the light strongly while the black lines reflect less strongly. There are many differnet types of epos systems that have different makes and different types of size , proccesor , speed a Epos systems include the following features that are on EPOS systems that are in debenhams * Barcode entry sales * Discounts for staff customers * Stock search * Refunds to customers * Stock control * entry for credit card details * customers details * suppliers details * statements * invoices * make barcodes * stores details 2 : description of each of the components Input devices Input devices that are used at debenhams are à ¯Ã‚ ¿Ã‚ ½ Keyboard à ¯Ã‚ ¿Ã‚ ½ Mouse à ¯Ã‚ ¿Ã‚ ½ Scanner à ¯Ã‚ ¿Ã‚ ½ Barcode reader à ¯Ã‚ ¿Ã‚ ½ Sensors à ¯Ã‚ ¿Ã‚ ½ Magnetic stripe reader à ¯Ã‚ ¿Ã‚ ½ Touch screens Input devices are devices that can enter the computer, input devices can give access to information so that it can be stored or entered in the computer for processing or the act of storing goods or the state of being stored on a magnetic tape or a storage device that stores information. Input devices One input device that is on an epos system that is used in debenhams that I will be discussing in detail will be a keyboard. One of the most used input devices in debenhams is called a keyboard, it changes key presses into the computer code, say for example pressing the C key produces electrical signals which the computer uses to represent that letter. Computer uses a different code for each character on the keyboard. A key board is also A hardware device consisting of a number of mechanical buttons (keys) which the user presses to input characters to a computer. How keyboards input devices work is that When a key is pressed, it pushes down on a rubber dome sitting beneath the key. A conductive contact on the underside of the dome touches (and hence connects) a pair of conductive lines on the circuit below. This bridges between them and allows current to flow changing the signal strength. A scanning signal is worked by the chip along the pairs of lines to all the keys. When the signal in one pair becomes different, the chip generates a make code corresponding to the key connected to that pair of lines. The code generated is sent to the computer either via a keyboard cable or over a wireless connection. A chip inside the computer receives the signal bits and decodes them into the appropriate key press. The computer then decides what to do on the basis of the key pressed (e.g. display a character on the screen, or perform some action). There are many different types of keyboards that are used in a epos systems but one that is used at debenhams is called a QWERTY keyboards named after the first six alphabetic keys on the keyboard . Keyboards are especially useful for entering text and numbers. How a type of input device that is used in debenhams which is called a keyboard is used is that it helps the employees working at debenhams to find prices of products that loses it barcode or if they have a mistake in the receipt it can resolve the mistake and give them there money back or if they have to multiply a product more than once so that they dont have to carry it because if its to heavy . They input devices used as part of EPOS in debenhams There are many input devices that are used at debenhams for EPOS systems , one of them is a Bar code scanner its make is Symbol LS6000 , the second input devices that I will be talking about is a Magnetic stripe reader its make is NCR and also its a 3 track reader . Processor used The processor (also called Central Processing Unit, or CPU) is the part of the computer that actually works with the data and runs the programs. the processor is called the brain of the computer, It is a microchip which carries out all of the searching, sorting, selecting and calculating within the computer. Specification of the processor used at debenhams is that most common CPUs in PCs are Celeron Processors made by Intel , it has a fast speed measured in MHz and also it has a hardware that can get the computer up to scratch . .the processor is needed in debenhams epos systems because it helps debenhams to sort everything up to date and get everything sorted to scratch so that it can run like a functional company and also helps debenhams to calculate its shares so that they can know whither the have loses or profits . I think the processor helps debenhams get up to date for that debenhams can gain profits because they have a well fulfilling company that meets its processing needs. The processors used as part of an EPOS system in debenhams There are many processors used at debenhams for epos systems ,one of them is a Store server its make is NCR Worldmark 4455 and the processor type is Pentium Xeon and its processor speed is 500MHz and the size of the RAM is 500MHz. the second processor I will be talking about is the mainframe , its make is IBM ISeries model 840, its size is 3.1Tb, its processor type is 64 bit RISC #23FC , and its processor speed is 16,500 CPW batch 2,000 CPW Interactive . Output devices devices that are used at debenhams are * VDU * Printers * Monitor * Scanner * Hand held barcode scanners

Clinical experience

Clinical experience Describe an example of communication from your recent clinical experience and discuss the factors that contributed to its outcome â€Å"Most people have felt anger and helplessness at not being listened to when saying something important. Also the intense frustration of being misunderstood† Ellis, RB. (2003). Defining Communication. In: Ellis, RB, Gates, B, Kenworthy, NInterpersonal Communication in Nursing. 2nd ed. London: Churchill Livingstone. p3. All names in this text have been changed, to respect the confidentiality of the patient and other healthcare professionals (NMC 2002). I have recently been on 7 week placement in a nursing home for the elderly. It was a residential home but also had a small dementia unit in which patients with mental health problems were taken care of. This experience has taught me that communicating with elderly patients with dementia can be extremely difficult due to their loss of memory, language skills, lack of attention and general disorientation. In certain circumstances although the patients indicated that they wanted my attention I found it hard to understand what they wanted due to these communication barriers. In my essay I begin by outlining what dementia is, what communication is and how important verbal and non verbal communication is to sufferers of dementia. Currently in the UK it is estimated that 700,000 people are suffering from dementia (BBC statistics) Dementia is a condition that is connected with an ongoing declineof the brain and itsabilities. It is generally caused by damage to the structure of the brain and is most common in people over the age of 65. Thinking, language, memory, understanding, and judgement are all affected in someone who has Dementia. Sufferers may also have problems in controlling their emotions andbehaviour when in social situations. Due to this their personalities may appear to change. There are 4 kinds of dementia. Alzheimers disease, Vascular dementia, Dementia with Lewy bodies and Front or temporal dementia. These 4 kinds were all present in patients in the dementia unit, where I spent 7 weeks; however I will be concentrating on Alzheimers. Communication is commonly defined as the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs. Although there is such a thing as one-way communication, communication is normally a two-way process in which there is an exchange and progression of thoughts, feelings or ideas towards a mutually accepted goal or understanding. Communication is a process whereby information is imparted by a sender to a receiver via some medium. The receiver then decodes the message and gives the sender a feedback. All forms of communication require a sender, a message, and a receiver. Therefore communication requires a common medium. There are auditory means, such as speech, song, and tone of voice, and there are nonverbal means, such as body language, sign language, touch, eye contact, and writing. (Unknown Author (2000).Communication.Available: http://en.wikipedia.org/wiki/Communication#Communication_Modeling . Last accessed 2 Jan 2010) All forms of communication verbal and non are used by a healthcare worker. With dementia sufferers, good non verbal communication is essential. (Argyle, 1978) believes that non verbal communication can have five times as much effect on a persons understanding of a message compared to the verbal communication at the time. Chomsky calls the act of speech (verbal communication) ‘performance and the knowledge of the language ‘competence. People perform the complexity of speech daily but have no real knowledge of why or how they came to be able to. Speech allows us to hold conversations, ask question, give instructions, hide the truth, build routines and most importantly talk about interactions in which we are involved (Argyle, 1978). Berlo has produced the following model of communication. It is stated below, taken from Berlo, D.K ( 1960) The Process of Communication: an introduction to the theory and practice. New York. Holt, Rinehart and Winston. Berlo believed that the most valuable tool for successful communication is in the relationship between the communicator, known as the Encoder or Source, and the listener, known as the Receiver or Decoder. He believed that common factors must exist between the encoder and decoder for successful communication to occur; as well as an agreed format of communication, known as a Channel. Berlos SMCR model describes the communication process into four components: Source, Message, Channel and Reciever. Berlo states that the source and receiver must share the same set of fundamentals in order to have successful communication. He argues that the way people communicate relate to their position within the socio†cultural system whether they are educated or non†educated, wealthy or poor. He claims that it is these factors that affect both Source and Receiver and in turn, affect the communication process. Both Source and Receiver have to possess the following elements: Communication skills: Both Source and Receiver have to use the same language or code in order to converse. They also have to share the same usage of signs, words and imagery. Berlo states that there are five verbal communication skills that fall under this category. The first four are taken from the Shannon†Weaver model; two encoding skills being speaking and writing and two decoding skills listening and reading. The fifth skill is the most crucial as it relates to thought and reasoning. Take for instance a highly skilled linguist who is fluent in numerous languages. As the linguist travels abroad, he succeeds in speaking and communicating with the natives of the country but fails to comprehend the codes of etiquette or gestures. In doing so, the receivers opinion of the source alters whilst the source is unaware of this mishap; resulting in a changed relationship between the two. Good communication skills are extremely important for health workers. It is essential for a healthcare worker to understand a patients needs and individual requirements in order to ensure best care and patient well being and to ensure that the patient feels respected, valued and is treated with dignity. All of these considerations contribute to patient care. If a patient cannot be understood properly it is very hard to give appropriate care. If there is good communication between a patient and healthcare worker, it will also ease the patients anxiety. Research has shown that patients are at risk of high levels of anxiety and frustration if communicative attempts are unsuccessful. (Finkee, Erin HMS 2008). Communication helps the carer and patient get to know each other better, it helps them to bond which usually results in the patient feeling able to express what makes them happy or upset, what foods they like and more importantly any problems they are experiencing. A good bond can be hard to achieve with a patient with dementia as short term memory is often lacking so previous conversations can be forgotten. Approach towards patients with dementia is very important, facial expressions, tone of voice, uniform and how we present ourselves can say a lot about us and our attitude to the patient. When communicating with the elderly residents if I were to raise my voice in an aggressive way they may feel threatened and scared by me, but if I speak to them in a pleasant tone of voice the then the resident is more likely to feel at ease around me. Eye contact was very important particularly when trying to engage a disorientated patient. I could then start gaining trust and understanding between myself and the resident. When a patient has dementia they cant speak by the final stage. Closed questions are usually more effective by this stage. There are 2 types of questions, open and closed. Open questions leave the answer open to respond with a lot of information or a little. Closed questions are those that a patient has nod or shake their head to or use other body parts such as thumbs up or down. Closed questions such like Are you okay?†, Are you hungry?† allowed the patient to communicate with us without having to construct a sentence. These types of closed questions are a type of non verbal communication.(Berlos communication channel) It was often very difficult to use verbal communication with Alzheimers patients because there short term memory is limited so they quickly lost the thread of the conversation. Nevertheless it is essential to communicate with dementia sufferers in order not only to care for them but to provide comfort and reduce the fear and isolation associated with the disease. On several occasions during the placement I drew on the communication skills I had learned from caring for very young relatives such as my younger brothers. Using games and closed questions to engage them, opening discussions on items around them which were precious to them such as photos or ornaments. Allowing them to discuss the game or object. However I was careful never to push them to recall memories as this may have caused them distress especially if they could not remember such things as where they were born. (In Berlos model I was trying to ensure a common channel) Even using closed questions one sometimes had to explore further than one answer. I witnessed a female patient who was obviously agitated. When questioned she indicated that yes she would like to go to the toilet. When the duty nurse attempted to assist her she became severely distressed to the point of hysteria. Even after she had been to the toilet she remained upset. After some time it became apparent through much questioning that although she needed assistance she had not wanted it from the male duty nurse. Bearing in mind the fact that the patient was a very elderly female who may have been raised with certain attitudes to propriety this incident could have been avoided with more effective communication. (This appears to be an incompatability between the codes of te two individuals making communication impossible. The nurse understood the language of the lady in that she wanted the toilet but did understand the cose/ etiquette of her upbringing) According to Argyle (1990) in a conversation, words make up only 7% of a message; tone, tempo and syntax make up to 38% and body language makes up to 35%. Non verbal communication can be expressed by our facial movements, gaze and eye contact, gesture and body movement, body posture and body contact, use of space and time and how we dress. (Henley 1977) states that how powerful we feel in an interaction can be expressed non- verbally. Our unspoken communication can be shown through our body language. Touching patients can be an essential tool for a nurse. It can offer support and understanding, comfort and security. It adds extra meaning to the spoken word. Often a patient would simply ask me to sit or stand with them or hold their hand. Although this seemed a very simple form of care it was often very emotional for me but seemed to be of benefit to the patient. I have wondered if at such moments the patients were feeling disorientated and the simple act of someone trustworthy being close seemed to help reduce their anxiety for a short while. It was my experience that a smile when appropriate often initiated an attempt to communicate. Macleod and Clark (1991) suggest that most touch between nurses and elderly patients is related to practical procedures, fulfilling a practical rather than an emotional purpose. However i found this not to be true, as i mentioned often i patient would just want you to hold there hand for emotional comfort. Care workers are not always able to spend as much time with individual patients as they would like. This on occasion led to a mismatch between verbal and non-verbal communication. Patients got upset with care workers who although they were carrying out a helpful task looked tired or impatient possibly because of their workload but not because they didnt care. Some patients would like care workers to sit with them during meal times but this could not always be done and on occasion such patients did not eat their meal. It is well recognised that giving nurses the time to listen and be attentive assist patient well-being. Contrary to this were the occasions when patients refused to eat or drink either because they did not want to eat or drink or because they were neither hungry nor thirsty or they did not like the food or drink. These opinions were communicated non-verbally by patients refusing to open their mouth, spitting food out. The inability to explain verbally was a significant barrier to communication. Staff in turn needed to ensure that their verbal and non-verbal communication did not cause further barriers e.g. impatient tone of voice, facial expression or body language. Where patients could communicate verbally barriers still existed to ensuring full understanding especially where lack of concentration was a concern. Background noises, e.g. loud radios or televisions, people around talking as well as us, this can confuse and provide distraction patients. Turning the television down whilst having a conversation with a patient can help. Speaking clearly in a language, style or accent understood by the patient improves verbal communication. Speaking clearly and giving simple instructions also helps patients understanding but listening is by far the most important verbal communication in understanding patients needs. It is important to learn patients names and use them. This helps attract and hold patients attention and more importantly identifies them as an individual with individual needs and not simply a patient. Working in the dementia unit was very emotional. Patients were often distressed and unhappy and seldom happy. Regardless the patients were welcoming and often keen to engage on differing levels. I endeavoured to maintain a positive attitude and outward appearance, to listen and be aware of my own body language. Although I endeavoured to show empathy rather than sympathy it is impossible to really understand how terrible it must be to lose our communication skills so dramatically but most nurses make every effort to ensure maximum two way communication with patients, utilising different means of communication. A nurse can also ensure that she/he obtains a full understanding of the problems dementia sufferers face and guidance on professional best practice. The following case study from my recent clinical experience illustrates communication and the factors that contributed to its outcome. Mr. Jones was brought to the nursing home by his son. He is 88 and has suffered from dementia for a number of years but in the past year Alzheimers has progressed fairly quickly and the need for round the clock care has left his son unable to care for him. Mr Joness symptoms include major confusion, withdrawal from society, delusions and extreme mood swings, he often gets extremely angry. He needs carers for certain normal activities essential for daily living such as finding the toilet, helping him on with his clothes and generally watching over his throughout the day. Some of his needs may also be due to his age; he has problems with his mobility so needs a carer for that not just due to the Alzheimers. My mentor asked me to spend some time with Mr Jones, talking to him and trying to build up a rapport with him. The day before my mentor had given me some leaflets on the subject of dementia and Alzheimers to prepare me and give me a better understanding. When I first sat down with Mr Jones he just seemed like a ‘normal elderly gentleman of fine health for his age, however as I began speaking to him I found quickly how advanced his Alzheimers was. It was quite upsetting for me as I had never been in that situation before. Within the first 20 minutes of speaking to Mr. Jones he had asked me the same question and we had the same conversation around 5 times. I found this rather awkward as I was unsure whether to continue with the repetitive conversation or try to change the subject as I was not sure if either of these would cause Mr. Jones to become distressed. I decided to continue to listen to Mr Jones showing interest in his conversation. Eventually Mr Jones was able to extend that particular conversation little by little telling more of the story. Mr Jones mentioned to me that he was the homes Gardener. Confused by this I went to my mentor who assured me that this was a delusion he had thought was real since his son moved him into the home and to just ‘leave him to it. I was not able to speak to a dementia expert on the subject but I did wonder if this ‘delusion was an expression of a proud mans need to be independent and a provider. Perhaps it was a coping technique at the thought of being put into a home. I therefore chose to discuss gardening with Mr. Jones. I was very careful not to ask any questions about the particular gardening he did at the home for fear of causing embarrassment or confusion. During these conversations one would not have known that they were based on a delusion and Mr Jones remained calm at all times. I found that after the first week of my working there Mr Jones recognised my face, he still continued to ask me the same questions such as ‘where do you live?, ‘do you know my son? and tell me about his gardening job but he would remember by name. The outcome of listening and being attentive during our conversations had enabled Mr Jones to remember my face and in time he might have associated my name with my face. Would this have provided some sense of continuity in his life? The thing that worried me the most however was that Mr Jones would ask me when he was going to get his pay cheque. The other staff told me to tell him ‘next week. I found this shocking and an insufficient answer. I felt that if I did as the other staff told me this would just reinforce the delusion and so I when he asked me the next time I told him the truth. This however made him very distressed and upset. The NMC (2002) advises that we must not add extra stress or discomfort to a patient by our actions. I should have asked my mentor for an explanation of her advice. I have now read further on the subject of dementia and by telling him ‘next week it allowed him to stop worrying about it at that time and enabled us to change the subject to one we could communicate about or to engage in an activity such as a board game. Telling him ‘next week was using his short term memory to prevent distress. This experience has shown me that I have lack of knowledge in my communication skills; I had focussed too much on my morals and worry that I was being untruthful with him when infact perhaps reinforcing his view would have caused him less displeasure. I had not considered his other needs like his wishes or desires and I had not gathered enough personal information about him beforehand to know this maybe he liked gardening.( It would appear that we (Mr Jones the source and me the encoder were speaking the same language but were not on the same cultural channel which led to poor communication in that neither of us understood the others message) This experience was very frustrating and upsetting and highlighted the need for me to improve my communication skills and ensure better understanding of patients conditions and needs before attempting anything more than basic needs communication e.g. are you hungry? I tried not to communicate my frustration, lack of understanding and emotional distress to Mr. Jones by being attentive, asking appropriate questions and using open, non agitated body language ( promoting empathy in the form of my own body language to promote active listening (Egan 2002) until the moment he became distressed at which point I did not have the necessary communication skills to deal with the situation positively I should have allowed more time to understand what Mr. Jones was thinking and feeling by maybe asking him calm questions such as do you know where you are, how long have you been here? And perhaps he would have come to a gradual realisation by himself. I now realise that my concerns about the value of truth (truth is always the best policy) were not compatible with his care needs. when taking into account Berlos model, when one element is missing the communication fails. In the example given, the source and the receiver had a common channel but the message was interpreted differently, there was no common understanding of the message. I hope with further training i will develop a better understanding of communication. Rowe (1999) explains that a person must identify their weaknesses as an initiative for becoming self-aware. I will take all this into account when on my next placement and through the rest of my nursing career.