Exploring the contribution of forensic science

Exploring the contribution of forensic science Forensic psychology has proven itself to be a quite intriguing field of study. From serial killers to child custody cases, the work of a forensic psychologist is involved. Forensic psychology is the intersection between the field of psychology and the legal system (Huss, 2001). Or, as defined by the American Board of Forensic Psychology (ABFP), [forensic psychology] is the application of the science and profession of psychology to questions and issues relating to law and the legal system (ABFP, 2010). This profession is not restricted to just one area of the legal system; in fact it contributes to the subspecialties of corrections, civil court, investigations, criminals, juveniles, and police. The purpose of this paper is to explain the roles and responsibilities a forensic psychologist has in each subspecialty, review court cases and research relative to the area, and discuss ethical dilemmas/ challenges and controversial issues forensic psychologists may encounter. Note: Throughout the text the terms forensic psychologist and psychologist are used interchangeably to describe the profession Introduction Criminal Criminal psychologists can be found in various settings with a wide array of roles and responsibilities. Aside from studying criminal behavior, criminal psychologists work with the police departments assisting with investigations, giving advice on how to conduct interviews with suspects and witnesses, they provide their services as an expert witness, aid in the process of rehabilitating an offender, and continuously research developments related to their field (Bull, Hatcher, Cooke et al, 2009). In the case of Jenkins v. U.S., 1962, it was ruled that a medical degree was no longer a requirement for an expert witness and that with the proper training and level of expertise a psychologist could now testify on issues relating to mental disorders. However in the role of an expert witness there are a couple challenges that appear which are attorney contracted psychological services and the admissibility of expert testimony in court proceedings. During a court proceeding a criminal psychologist may be called upon to give their expert opinion about a matter related to the case. The purpose of an expert testimony is either to explain or give information to help in either the jury or judges decision making and is related to the psychologists area of expertise (Shuman Greenburg, 2003). According to the Federal Rule of Evidence (Fed. R. Evid.) 702 If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise, if (1) the testimony is based upon sufficient facts or data, (2) the testimony is the product of reliable principles and methods, and (3) the witness has applied the principles and methods reliably to the facts of the case. In cases when a psychologist is asked to be an expert witness by an attorney who is requesting information to defend his or her client, problems may arise. An attorney seeks out a psychologist to provide expert testimony and evidence that will benefit the case of their client, not the opposing side. However, a psychologist is ethically responsible for providing an unbiased opinion or delivery of facts regardless of which attorney contracted their services. The pressure to be loyal to the attorney that has contracted the psychologists services causes a problem for those psychologists who uphold the integrity of the profession. When caught in a situation where the findings of the psychologist are not aligned with the goals of the attorney, the psychologist can either give a testimony that is altered to fit the requests of the attorney and risk civil liabilities and ethical complaints, or they can report the facts and risk not being called upon again. Although it is a true dilemma to de cide which direction to take as a professional, upholding individual integrity and that of the profession is vitally important. Based on the responsibilities outlined in the Specialty Guidelines for Forensic Psychologists (1991), forensic psychologists should make a reasonable effort to provide their services in a manner that is responsible and forthright. When a the services of a psychologist are requested, they should be upfront about their position to be unbiased and only report the facts regardless of the outcome. Another challenge that surfaces with expert testimony given by a psychologist is its admissibility in court. As mentioned earlier in the Fed. R. Evid. 702, an expert testimony may be utilized if it is based on sufficient facts or data. The facts and data are what determine the reliability of the experts testimony. This becomes a factor when it must be determined whether the information presented should be admitted as evidence in the court proceeding. Prior to the case of Daubert v. Merrell Dow Pharmaceuticals Inc.(1993) in order for an experts evidence to be admitted in court it must follow the rule of general acceptance, which meant the evidence must have been obtained using scientific techniques that were generally accepted in the scientific community (Bartol Bartol, 2008). With the ruling in Daubert v. Merrell Dow Pharmaceuticals, Inc. it is now left to the discretion of the judge to determine whether experts evidence should be admitted. For a psychologists is becomes a challenge to convince the judge that the information they are presenting is both valid and reliable. As a safeguard, psychologists should disclose the sources of all of the information used to form their testimony (Committee on Ethical Guidelines for Forensic Psychologists, 1991). Aside from the challenges criminal psychologists face as an expert witness, they also must address the controversial issue of whether offenders can be rehabilitated. The Bureau of Justice Statistics reported a study that looked at the level of recidivism of a group of prisoners released between 1983 and 1994. What they found was that a high percentage of these individuals were re-arrested (Beck Shipley, 1997; Langan Levin, 2002). With high numbers of released prisoners returning to the prison or criminal justice system, the effectiveness of rehabilitation programs is questionable. Research is still being done on what causes crime and what type of psychological effects do prisoners experience while incarcerated (Benson, 2003). Hopefully with a better look into what leads a person to commit a crime, better ways to rehabilitate them will be developed. Juvenile There are two themes that govern the juvenile justice system which are the welfare of the juvenile offender and public safety (MacArthur Foundation research Network on Adolescent Development and Juvenile Justice). The forensic psychologist in this specialty adheres to these themes in their roles and responsibilities to conduct assessments, evaluate competence, and provide therapy (Bartol Bartol, 2008). Forensic psychologists may be called upon to assess a juveniles level of threat to society, whether they are competent to make certain decisions, and decide what type of treatment can be offered to them (Bartol Bartol, 2008). Working with juveniles is not the same as working with an adult population. One ethical dilemma that comes about when working with juveniles is whether the psychologist has sufficient competence for working with juveniles if they have only assessed adults. Outlined in the Specialty Guidelines for Forensic Psychologists (1991) under competence, it states a forens ic psychologist should only provide services in areas that they either have specialized knowledge, education, experience or skill. Psychologists must be very careful when assessing juveniles because they do not present the same behaviors as adults; some of these behaviors may be misinterpreted by the assessor if they have no knowledge of juvenile assessments (Bartol Bartol, 2008). Assessment is a very important part of the juveniles dealings with criminal justice system, so a psychologist should make every effort to ensure they are competent in this area prior to providing services. When approached about providing services as a juvenile assessor, the forensic psychologist should be honest about their limitations in competence and either make an effort to become knowledgeable about the area, or decline the request (Committee on Ethical Guidelines for Forensic Psychologists, 1991). Dual relationships also pose an ethical challenge for forensic psychologists in this area of specialty. Forensic psychologists should avoid the role of both evaluator and treatment provider (Bartol Bartol, 2008). This is an issue because as an evaluator, the forensic psychologist is contracted with the court, who is the client. Which means the forensic psychologist must warn the individual of the limits to confidentiality. In the role of the therapist, the client is the individual patient and there is some protection of confidentiality under patient-therapist privilege. In the case of Jaffe v. Redmond (1996) the U.S. Supreme court supported confidentiality in federal courts. It is best practice to avoid dual roles. If the two roles must be combined, there should be an effort to avoid any negative effects to the individual client (Committee on Ethical Guidelines for Forensic Psychologists, 1991). Levels of juvenile cognitive skills and adjudicative competence are issues that are still being debated in the juvenile justice system. The MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice define competence as ones ability to understand the processes associated with the trial, aid the attorney, and make important decisions. However, research has found that a number of juveniles 15 and under have mental competency scores similar to adults with serious mental disorders (MacArthur Foundation). Which means juveniles are not capable of making reasonable decisions related to waiving their constitutional rights, confessions, and plea bargains (Mac Arthur Foundation)The goal of the juvenile justice system has been to rehabilitate offenders so that they can eventually lead healthy lives as adults, without much focus on their competency to understand the justice system (Viljoen Wingrove, 2007). The belief is that juveniles should be assessed based on their levels of development, not the standard of the justice system which is geared towards adults because some developmental issues may not be detected (Ryba, Cooper, Zapf, 2003). The decision whether a defendant should be transferred from juvenile court to criminal court is an issue that is still being worked out in the justice system. In the case of Kent v. United states (1966) where 16-year-old Morris Kent, after confessing to his crimes, was transferred to criminal court and found guilty of housebreaking and robbery, and not guilty by reason of insanity for rape. Kents attorney argued that Kents case should have remained in juvenile court because he would have had a better chance of rehabilitation than in criminal court where he was sentenced to 30 to 90 years in a mental institution (Kent v. United States, 1966). Even today research is still being done on whether juveniles have adjudicative competence and if they should be transferred to criminal courts. Civil The Civil Court is primarily designed to handle private disputes between individuals or organizations (Britannica Online Encyclopedia, 2010). The major roles of the forensic psychologist in the civil court setting are those of an assessor and evaluator. Forensic psychologists may be called upon to assess emotional factors related to traumatic or personal injury litigations; assessment of psychological factors in relation to harassment, discrimination, and workers compensation disability, as well as post-mortem assessments and competency evaluations (Franklin, 2006). Forensic psychologists are also called upon in family courts to complete child custody evaluations (Franklin, 2006). Child custody evaluations conducted by psychologists tend to bring up some ethical concerns. An unresolved controversial issue in this subspecialty is that there is currently no standard practice when conducting child custody evaluations (Bartol Bartol, 2008). Many psychologists choose to use several forms of psychological testing as means to determining child custody in response to the American Psychological Associations (APA) (1994), request that there should be several methods for collecting data (Bow Quinnell, 2001). The issue with the psychological tests used is that there is no empirical evidence to support it (Bow Quinnell, 2001). To ensure adherence to the APA guidelines, the psychologists should use several techniques to conduct evaluations such as interviews, self-report studies, and psychological testing (Bartol Bartol, 2008). If a forensic psychologist is called upon to conduct a mental evaluation of a victim in sexual harassment suit, it is important that the psychologist thoroughly explain the potential use of the information gained. Informed consent now becomes an issue in this case because the victim must reveal personal information regarding their past sexual history during the evaluation (Bartol Bartol, 2008). The APA state in the Ethical Principles Psychologists and Code of Conduct section 3.10(c) When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding. This can become a challenge for a forensic psychologist if the victim does not fully understand the limits of confidentiality in this situation. The forensic psychologist should take special care to explain to the client, in language they underst and, that the information provided may be used in the courtroom. By doing this the psychologist is making an effort to reduce the potential for more harm to the client. One of the most controversial issues in this area of forensic psychology is physician-assisted suicide. Physician-assisted suicide takes place when a competent individual requests that a physician prescribe a medication that will aid them in ending their life. The role of the psychologist is to determine whether or not the individual is competent to make such a decision. The state of Oregon, in 1997, enacted its Death with Dignity Act which allows for physician-assisted suicide (Oregon State). The debate on whether other states will join Oregon is ongoing, as well as the research on the responsibilities of the forensic psychologist in this role (Bartol Bartol, 2008). The case of Daubert v. Merrill Dow Pharmaceuticals, Inc (1993) is pivotal in this subspeciality because of the forensic psychologists role as an expert witness in civil cases. Research is still being done on how the Daubert standard affects the admissibility of expert testimony given by forensic psychologists (bartol Bartol, 2008). Investigative The work of the investigative forensic psychologist may be the most popular because of the media hype over the role of criminal profiling. In the case of U.S. v. Sokolow (1989) a form of profiling was used to make an arrest based on the behavioral characteristics of drug dealers. Criminal profiling methods have been around long before the gained popularity in the media. Actually, forensic psychologists have a few other roles and responsibilities dealing with investigations besides criminal profiling. Forensic psychologists use a variety of techniques to link a suspect to a crime. They study the crime scene to get a better understanding of the physical and verbal behaviors of the suspect (Woodham, Hollin, Bull, 2007); they also use geographical profiling to determine the territory of a serial offender (Bartol Bartol, 2008). This information is then used to narrow down the list of possible suspects put of a larger population. Psychological autopsies are unique responsibility of inves tigative forensic psychologists because they are done to determine the mental state of an individual prior to their demise. Also an investigative psychologist may conduct a forensic hypnosis to aid in a witnesss or victims recall of a traumatic event. Much scrutiny surrounds the use of forensic hypnosis as well as criminal profiling. Despite the glamorous appeal profiling has shown on various TV shows and movies, it is not a widely accepted practice. There are several concerns that cause profiling to be a very controversial issue. From the lack of research supporting its reliability and validity (Mcgrath, 2000), to the belief that profilers are creating opinions based on gut feelings (Bartol Bartol, 2008), and its inability to meet the basic expert witness standards sought under the section of the Federal Rule of Evidence 702 that states the testimony [of an expert] is based upon sufficient facts or data, . . . is the product of reliable principles and methods, and the witness has applied the principles and methods reliably to the facts of the case (Alison, Bennell, Ormerod, Mokros, 2002). This brings about ethical challenges because forensic psychologists are obligated to provide services that are consistent with the highest standards of the profession (Committee on Ethical Guidelines for Forensic Psychologist s, 1991, p. 657). As Alison, et al. (2002) assert, the methods used for profiling result from an understanding of personality and trait approach that is both naÑ-ve and outdated. Many researchers suggest that psychologists should be cautious about using profiling in criminal investigations (Bartol Bartol, 2008; Alison, et al., 2002), but if it must be done, appropriate steps should be taken to base their opinion on current empirical evidence that is available and not just on gut feelings (Torres, Boccaccini, Miller, 2006). As of today, there is still a need for research to support the use of profiling. Pretrial identification methods is another area of ethical concern for psychologists because of its vulnerability to bias and error. Many police agencies use lineups and photospreads to help witnesses identify a suspect. The issue of bias arises when either the investigator or administrator make suggestions or subtle innuendos about who the suspect is. In a study conducted by Greathouse Kovera (2009) it was found that in situations where the administrator of the lineup and photospread knew who the suspect was, the witness was more likely to correctly identify them as oppose to situations where neither the administrator nor the witness knew the suspect. To resolve an ethical dilemma of this type, it is recommended that those administering the lineup and photospread should not have knowledge of who the suspect is (Bartol Bartol, 2008). Correctional In 2005 nearly half of the inmate population in prisons and jails reported having a mental health problem (James Glaze, 2006). With such a rise in the number of mentally ill inmates, the prison system may now be the nations largest provider for this special population (Fellner, 2006). Rising numbers indicate there is an even greater need for forensic psychologists working in the prison systems today. The role of a forensic psychologist is that of assessor and treatment provider. Within these roles, forensic psychologists are responsible for coordinating and ensuring the mental health programs are running properly, supervising the employees assigned to these programs, and administering mental health services to the inmates that need it. The forensic psychologist also functions as a trainer for the staff and screens the staff that will be working with inmates in special mental health units and step up to help in crisis situations (Magaletta Verdeyen, 2005; International Association f or Correctional and Forensic Psychology, 2010). Working in correctional facilities can be very challenging for the forensic psychologists. The work environment is no way comparable to the application of psychology in the community or private setting. There are various risks and safety issues when dealing with criminals in this type of setting such as dual roles. The Standards for psychology services in jails, prisons, correctional facilities, and agencies address this issue by stating Mental health services staff do not assume a dual role that overlaps with other functions and services (e.g., security) of the correctional agency or facility that could result in unethical dual-role relationships that risk harm to their offender or inmate clients (International Association for Correctional and Forensic Psychology, 2010, p. 19). At times, a correctional psychologist may act in the role of evaluator and therapist, or even as the therapist and a stand-in correctional officer. In some correctional facilities the expectation is that a psychologist is a correctional officer before any other role, thereby making it a responsibility of the psychologist to aid in doing a count of the inmates, conducting searches of an inmates cell and person, supervise inmates, and escort inmates to segregated areas (Bonner Vandecreek, 2006). Dual roles of this type create mistrust between the inmate and the psychologist because the psychologist is now viewed as another correctional officer and not someone there for the interests of the inmate. In order to eliminate the potential of dual roles, the psychologist should request in writing that they should only be assigned to duties that align with their particular profession and ethical standards (Bonner Vandecreek, 2006). A second ethical challenge for psychologists is avoiding situations that would intentionally cause harm to their client. The conditions of prison are not necessarily adequate for those suffering from mental illness, and many times many of them go undertreated (Fellner, 2006). The prison walls are riddled with too many inmates, violence, and victimization by other inmates and the staff (Bartol Barto, 2008).It is the responsibility of the psychologist to maintain their position as an advocate for their client and not as an additional perpetrator of their rights but this is challenging when jail and prison conditions prevent effective treatment. The IACFP (2010) contend that Offenders are incarcerated as punishment, not for punishment (p. 759). Participating in or allowing the inhumane treatment of inmates, mentally ill or not, goes against the standards for psychologists in this subspecialty. Unfortunately, psychologists may be harming unintentionally causing harm by not provided the adequate treatment needed. The climate of the prison environment will take several steps in order to see a change, but there are things a psychologist can do to resolve some of these issues. It is important that the psychologist does not fall into the same mentality of a correctional officer and participate in activities that are intended to do harm. The IACFP (2010) suggest that psychologists should avoid any delays when a request has been made for mental health services; avoid imposing any biases or beliefs on or towards inmates; meet the requirements of due process; practice within ones personal scope of competency; and continuously advocate for better mental health services in jails and prison. One controversial issue that surrounds the treatment of mentally ill inmates is their segregation from the general population. In the case if Perri v. Coughlin (1999) a severely disordered inmate was kept in an observational where an inmate is stripped of their clothes and placed in a cell for their protectionfor a total of 108 days without any treatment. Another issue is although inmates have the right to refuse treatment, they can be forced to do so if it is determined that they are severely disordered and cause a threat to themselves and others which was argued in the case of Washington v. Harper (1990). Forced consent to treatment stirs up controversy for psychologists because inmates may only consent to treatment for fear of privileges being taken away, such as in the case of McKune v. Lile (2002). Despite the controversies that come about it the correctional system, the research focus has been on reducing recidivism and increasing rehabilitation. Police The final subspecialty of forensic psychology to be discussed is police psychology. Police psychology is the application of psychological principles to the profession of law enforcement and public safety (Bartol Bartol, 2008). As a police psychologist the primary role is to provide psychological services to law enforcement either through counseling, employee screenings, fitness-for-duty evaluations, assessment of incidents requiring deadly force, crisis counseling, and special unit evaluations (Bartol Bartol, 2008). Police psychologists assist with the special units of police agencies including, SWAT, hostage negotiations, and victims response. Just as with all the other areas forensic psychologists team up with, there are a few ethical issues that emerge. Conflicts between agency requirements and the ethical standards of the psychologist can pose a serious ethical dilemma when working with police agencies. Two ethical challenges in particular are the interrogation methods of some police agencies that lead to false confessions. Leo Ofshe (1998) assert that false confessions are a result overzealous police officers who are so eager to arrest a suspect that they tend to overlook evidence that may point towards the individuals innocence. Some tactics police may use to gain these confessions are deprivation, humiliation, or manipulation (Bartol Bartol, 2008). These actions cause problems for psychologists because they position is to advocate for human rights, when these actions can be viewed as violations of these rights. When psychologists are caught in situations that cause ethical conflicts they must abstain from taking part in those behaviors. It is at the discretion of the individual psychologist whether they wish to continue consul ting with police agencies that practice abusive interrogation techniques (APA, 2007). If they decide to continue their work, psychologist should consult with police on interrogation strategies that will not impede on an individuals human rights and decrease the likelihood of a false confession. Interrogation tactics have begun to come into the lime light with Americas War on Terrorism. But before then there was focus on another controversial issue, excessive force. Excessive force has been a controversial issue for decades. Many Civil Rights protesters can probably recount various incidents when they were victims of police excessive force. However the most striking case of our time dealing with police excessive force is that of Rodney King in 1991. Surrounding the issue of excessive force is also deadly force, although its occurrence is not frequent. With both of these issues, psychologists may be asked to conduct fitness-for-duty evaluations to determine the officers ability to carry out their required duties (Bartol Bartol, 2008). A plethora of research is available for the subspecialty of police psychology. Topics range from cultural competency, dealing with the mentally ill, on the job stress, excessive force, employment screening, and community relations. As the research in this area progresses, enhancements can be made to the types of treatment psychologists offer. Conclusion The field of forensic psychology encompasses a wide range of roles and responsibilities; with various contributions to the fields of law and psychology. In its short existence there have been tremendous gains in research and practical applications. As the profession of forensic psychology grows in popularity among the public, there is sure to be greater strides in the collaboration of psychology and law.

Integration of Evidence-Based Practice Into Professional Nursing Practice Essay

In this paper we will discuss the integration of evidence based practice into professional nursing practice. Scott & McSherry (2008) define evidence based practice as the combination of individual, clinical, or professional expertise with the best available external evidence to produce practice that is most likely to lead to positive outcomes for a patient. Despite literature surrounding what evidence based nursing is and isn’t, nurses struggle to get evidence into practice. Many reasons have been reported including a lack of understanding about evidence based nursing means. Scott & McSherry (2008) also define evidence based nursing is a process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient outcomes. We will also discuss nursing’s simultaneous reliance on and critique of EBP in the context of critical reasoning. There will also be discussion of a study done that examined the effects of integrating evidence based practice into clinical practicum among RN-BSN students and the limitations of evidence based practice and an alternate view of decision making. Lastly we will discuss evidence that challenges the traditional practice regarding injection sites (Cocoman & Murray 2010). According to Guem et al. (2010) evidenced based practice is a problem solving approach to clinical care that incorporates the conscious us of the current best available evidence, a clinician’s expertise, and the patient values. Evidence for evidence based practice does not always rely on research findings. Sources used can include research findings, clinical experience, quality improvement data, logical reasoning, recognized authority, and client satisfaction, situation, experience, and value (Leddy & Pepper 2008 p. 66). On the contrary evidence based nursing is essential because of its potential to save time and money and improve patient outcomes by decreasing costs, through standardizing and streamlining costs (Scott & McSherry 2008). It is important o understand the difference between evidence based practice and evidence based nursing because at times they are used interchangeably. Scott & McSherry (2008) state that the nursing practice has welcomed EBP but when it comes to EBN, it is still yet to come reality because the concept is much unsophisticated and can lead to problems associated with its use and misuse. EBN is merely a construct and has yet to be successfully implemented (Scott & McSherry 2008). In essence the dilemma with EBN is that we don’t really know the definition of nursing. Although there are problems with the definition we know that clinical judgment is one of the major concepts used in nursing thus it reinforces the notion of EBP and ultimately EBP. To advance the profession and ensure solid standards of practice, we should look beyond evidence based practice, while useful in implementation it is just one of many other component parts (Jutel 2008). Evidence based practice is like the new black in nursing practice and already occupies a prominent position, several international nursing organizations support its use as a strategic action in the advancement of the profession. Despite the emphasis on EBP, there is also a strong opposition to it, not with the actual use of EBP being a problem but with the fundamentals on which it stands. These arguments complain of the veracity of the criteria used in EBP which simultaneously undermines and cannot support EBP (Jutel 2008). If it had not been for the cultural turn which recognized that things are not always as they seem or that power, society, and culture contribute as much as science to generating knowledge, the debate about EBP would have never surfaced (Jutel 2008). Although nurses argue against EBP, they lack important tools necessary to replace EBP. â€Å"Nursing education places high value on authority and adherence to clinical protocols, rather than on skills† (Jutel, 2008. P. 419). Opponents of EBP suggests that development of clinical practice guidelines, critical care pathways, and protocols may actually interfere and entice practitioners to develop somewhat of a cookbook recipe attitude to client care (Leddy & Pepper 2010). With quality improvement being rooted in industrial production, perhaps standardization may not be as desirable because patients have unique needs and characteristics the may be overlooked when adhering to strict clinical practice guidelines. Nursing adopts a devoted and somewhat naive trust when assessing information, we are quick to accept the truths of a peer reviewed article, drug company propaganda, and quick to accept an argument on inconsistencies of EBP. The tools EBP claims to own, are incredibly useful, however, are not tools of EBP; they are critical skills of information appraisal. As evidence based practice rapidly replaces the traditional paradigm of healthcare decision making, health care members have an obligation to access knowledge, apply it in practice, and lead others to use it appropriately (Geum et al. 010 p. 387). For example RN-BSN programs; these are adult students who have clinical knowledge and skill, structured background and educational preparation and employment experience but have not taken a formal research course, thus they show less confidence to include evidence based practice in their practices because these are courses that are not common outside a baccalaureate curriculum. To examine the effectiveness of the integration of EBP into a clinical practicum a study was done among Korean RN-BSN students. The main goals were to enhance students’ competencies for EBP knowledge skills and attitudes and to expose students to opportunities that would encourage the use of best evidence (Geum et al. 2008). Each student was instructed to define patients nursing problems for their individually assigned patient and to formulate nursing problems using the EBP question format, PICO, which we discussed earlier in the semester, to select the nursing intervention for the problems posed. Before the EBP practicum, the overall and individual scores for EBP efficacy among RN-BSN students indicated that students were â€Å"a little confident† regarding the EBP process (Geum et al. 2008, p. 389). Results of this study indicate that integration of EBP into an RN-BSN clinical practicum had a positive effect on EBP efficacy and decreased barriers to research utilization among students in Korea, which also corroborates with studies conducted in other countries. Evidence based practice is a learned set of skills thus critical thinking is vital in developing evidence based nursing practice (Geum et al. 2008). Regardless if the evidence on complications, nurses in clinical settings still continue to use and instruct nursing students on the use of dorsogluteal injection sites as the site of choice for intramuscular injections (Cocoman & Murray 2010). So, where should an intramuscular (IM) injection be given? Nurses have traditionally used the dorsogluteal, but recent literature has advocated the ventrogluteal site. Choosing sites has been a matter of personal preference, rather than the results of evidence based practice. Slow uptake of medications, major nerves and blood vessels present make this site problematic. A British study suggests â€Å"as previous studies have shown the low efficacy of gluteal intramuscular injections, this route should be avoided for most drugs† (Cocoman & Murray, 2010. P. 1171). As the sciatic nerve lies only a few centimeters from the injection site, injuries pose a significant threat, making the need for accurately identifying landmarks especially important. An alternative site is the ventrogluteal, seen by many as the preferred site. This site provides the greatest thickness of gluteal muscle and is free from penetrating nerves and blood vessels (Cocoman & Murray 2010). Despite evidence favoring the ventrogluteal site, nurses are slow to use it, relying on the much taught and used dorsogluteal site. â€Å"Studies show that only 12% of American nursing staff uses the ventrogluteal site† (Cocoman & Murray 2010. P. 1172). Studies suggest that some reasons the site is not used is because of nurses’ unfamiliarity in locating the site and potential needle stick injury. Unfortunately, nurses have not come to realize that when using the V method, the non injecting hand is to be removed, as it’s only used for visual land marking (Cocoman & Murray 2010). Throughout this paper we have discussed the integration of evidence based practice into nursing from various articles. In the various articles the authors talked about evidence based practice compared to evidence based nursing, the integration of evidence based practice in RN-BSN programs. We also discussed the article on a clinical example which suggested that the ventrogluteal intramuscular injection site over the dorsogluteal site is preferred when it comes to positive patient outcomes.

Being a Man

Being a Man in the male perspective may be projected with ease as it seems, however, masculinity or the concept of being a man in a strict sense is a trait that has an offending nature. Much of this can be attributed to the fact that the social conditions throughout history suggest that men are commonly compelled to show their masculinity in every domain of endeavor. As such, the framework from where the concept of manliness is based has created an almost irreversible plague that has gone hand in hand with history.Manly concepts belittle the core of their female counterparts due to the fact that the masculinity rouses a sense of self-glorification. In sports, in all fields of life, men have become triumphant at the expense of women. This is because of how boys are bred and raised to become â€Å"men† (Theroux 411), up and coming men become totally obsessed with the idea of proving their manhood through their chosen field. Therefore, the enthusiastic individual will do what he deems necessary to achieve such goal.Femininity plays a vital role in belittling their sexuality because of the female species' vane nature and alertness to man's inadequacy (Theroux 411). Alfonsina Storni's blatant aversion to manliness appears to be a of how manliness is being glorified objectively over and over. It is a good argument that men and women are equal beings each with distinct qualities, and given the distinction, it is also plausible to think that both genders have their set of issues to deal with.However, social constructs, media presentations, and cultures across the world suggest that the nature of manhood demean women in every way. Superhero archetypes for instance are all modeled after men, the earliest superhero characters Superman and Batman are patterned to the typical male image. Likewise, other heroes such as Supergirl and Batgirl are female characters influenced by male characters. Masculinity is not a written law obliging every male person to conform to so ciety's traditional standards.However collective social opinion backed by media sensationalizing and cultural practice dictates the concept of manhood. Furthermore, the dictated solidarity in the concept of being a man eliminates the concept of individuality and the true precept of manliness. Works Cited Theroux, Paul. Being a Man. Reading and Writing about Gender in The World is a Text: The Writing, Reading, and Thinking About Culture and Its Contexts (2nd Edition). by

John Steinbeck s Of Mice And Men - 1248 Words

In Steinbeck s novel Of Mice and Men, He uses imagery many times to create a realistic setting and plot. Steinbeck’s depiction of migrant workers and their daily complications during the depression are objectively precise due to his use of imagery with idioms, dreams, nature, loneliness and animal imagery. The main theme of the book transpires to be loneliness and fate. While George and Lennie, the main characters have a synergetic relationship, fate steps in and does away with their dreams, which were very close to be within reach. George the smallest of the two, less strong, brains of the operation. While Lennie is the giant, brawn, lug who more or less has the brain of a 5-year-old child. He relies on a sense of touch, which makes†¦show more content†¦Subsequently, since Curley has insecure feelings he mistreated her and forced her to search for someone who would give her the attention she wanted so badly, even if that destined flirting with other men. She was over looked by the farmhands and her husband and for that reason she was being forced into loneliness, the one thing she battled so hard to eliminate (Rasmussen). Lennie’s fondness for soft, furry things makes him vulnerable. He strokes her hair to the point that she becomes alarmed and panics. When she does, Lennie breaks her neck (Shumam). Candy can also be another man who is used for an example of lonely migrant workers. Loneliness affects Candy in two key ways, his old age and his disability. This makes him quite different than the young fully capable farmhands on the ranch which is ironic because he only has on hand. He performs basic task like cleaning up the ranch and sweeping. It s until Lennie and George arrives that he plays the role as the outcast. With the new addition of the duo, Candy is requested by George to accompany them in their dream ranch, but not all will bode well for the trio in the long run. Further into the story you see more of Lennie’s child side I wish we d get the rabbits pretty soon (Steinbeck 10). This is an infamous reference to the rabbits in which Lennie dreams so dearly about. The rabbits are part of LeninShow MoreRelatedJohn Steinbeck s Of Mice And Men897 Words   |  4 Pagesthat we possess. Many people feel certain emotions based on events that have taken place in their lifetime or how they were raised throughout their childhood. In John Steinbeck’s Of Mice and Men, he portrays the feelings of isolation and loneliness in three different characters. George’s isolation is illustrated in Steinbeck’s, Of Mice and Men. George expresses many hard feelings towards Lennie at the opening of this story. â€Å"‘...you’re a lot of trouble,’ said George. ‘I could get along so easy and soRead MoreJohn Steinbeck s Of Mice And Men1243 Words   |  5 Pagesis what John Steinbeck achieves by portraying this through the characters in his novella Of Mice and Men. The main characters are affected by loneliness in their own different way throughout the novella. rf The loneliness is maintained by the challenges that the characters have to face, and they sustain those challenges of being inhumane towards each other. Crook, a figure in the story who experiences discrimination encounters the challenge of race, due to the book’s setting in the 1930’s duringRead MoreJohn Steinbeck s Of Mice And Men1080 Words   |  5 Pagesâ€Å"I want you to stay with me Lennie. Jesus Christ, somebody’d shoot you for a coyote if you was by yourself.† The novel Of Mice and Men by John Steinbeck shows the relationship between two migrant workers in the 1930s, George and Lennie, along with the other members on the new ranch that they began working on. Georgie and Lennie dreamed of following the American Dream and owning their own patch of land and the novel revolves around the dream and the obstacles that stand in their way. Lennie, a strongRead MoreJohn Steinbeck s Of Mice And Men1286 Words   |  6 PagesThe realistic fiction novella O f Mice And Men by John Steinbeck explains the journey of two migrant farm workers. Lennie and George are forced to overcome the Dust Bowl and The Great Depression around 1938. This makes jobs even harder to come by because everyone wanted one. Lennie and George were kicked out of Weed and they now work at a ranch in Soledad. At the new farm the friendship between Lennie and George becomes harder to maintain. The people on the farm are all different shapes, sizes, andRead MoreJohn Steinbeck s Of Mice And Men2167 Words   |  9 Pagesjobs. In John Steinbeck’s Of Mice and Men, George Milton and Lennie Small wander through California in search of a new job that would help them make enough money to live their American dream on â€Å"the fatta the lan’†(Steinbeck 14). George and Lennie’s hard work and determination is not enough for them to live their dream. Lennie has a mental disability that slows the two friends down from living their dream; they have to ru n from job to job because of Lennie’s unintentional actions. Steinbeck incorporatesRead MoreJohn Steinbeck s Of Mice And Men1360 Words   |  6 Pagesfeeling, thinking and acting in everyday life. In the story Of Mice and Men by John Steinbeck, a duo of farmers, George and Lennie, search for work wherever they can. Their dream of having a farm of their own is coming into reach, while George has to wield Lennie away from the temptation of Curley’s wife and the reality of what Lennie can do. John Steinbeck uses characterization to illustrate the nature of human existence. Steinbeck portrays George as a man who tries to help, and helps others soRead MoreJohn Steinbeck s Of Mice And Men1448 Words   |  6 Pages In the novella, Of Mice and Men, John Steinbeck discusses the idea of loneliness and how people who work at the ranch have no family and no future in lives. He indicates that all people at the ranch are lonely, but he specifically uses a few characters to highlight their state of being lonely and more miserable than the others. He emphasizes the loneliness of ranch life during the Great Depression, and shows how people are willing to try and find friendship in order to escape from the state ofRead MoreJohn Steinbeck s Of Mice And Men1205 Words   |  5 Pagesand the time period of John Steinbeck s novella, Of Mice and Men, exemplifies the idea that people from minorities are held back from achieving their version of the ‘American Dream’. This goes to prove not everyone will overcome the overbearing tidal waves of their hardship s, which makes the American Dream nothing more than a dream to them. Crooks, the black stable hand, faces discrimination due to his skin color as this unfortunately was common in the 1930’s. John Steinbeck uses Crooks’ situationRead MoreJohn Steinbeck s Of Mice And Men968 Words   |  4 PagesSolidifying the theme of John Steinbeck’s Of Mice and Men, the protagonist George expresses his significant loneliness despite a strong kinship with his friend Lennie, â€Å"’I ain’t got no people†¦ I seen the guys that go around the ranches alone. That ain’t no good’† (41). Published in 1937, amidst the horrific turmoil of the Great Depression, Steinbeck’s novella struck a sensitive chord with readers. Set in the heart of California’s Central Valley, this story follows two men, George and Lennie, as theyRead MoreJohn Steinbeck s Of Mice And Men1387 Words   |  6 Pageslanguage. Soledad is also town in which Of Mice Men takes place. The entire novel displays the idea of solitude. Alon g with the presence of loneliness in this story, John Steinbeck also ties in the idea of companionship through the everyday lives of individuals. The correlation of loneliness and companionship in the lives of these characters, along with the diversion of lifestyles consistently shows. Of all the many themes of the book, Of Mice and Men, the most important theme is the theme of loneliness