Massey Coal Free Essays

Massey Coal Case A person is morally responsible for an injury or a wrong if: 1. the person caused or helped caused it, or failed to prevent it when he or she could have and should have 2. the person did so knowing what he or she was doing 3. We will write a custom essay sample on Massey Coal or any similar topic only for you Order Now the person did so of his or her own free will Question 1 Massey Energy Company should be held morally responsible for the deaths of the 29 miners. The U. S. Mine Safety and Health Administration issued â€Å"too much† citations for the violations in the mines Massey Energy Company owned. The company always challenged several of the citations and corrected enough of the significant and substantial violations to allow its total violations to fall below the level needed to force its closure. This means in terms of safety, the company only make significant safety change in order for their mines not to be totally closed but not make a major safety changes in order to follow all the guidelines of MSHA and eliminate all possible endangerment in the mines. Massey should be held morally responsible because of the lack of effort the company put in to improve the safety quality in their mines. Question 2 Don Blankenship should be held morally responsible for the deaths of the 29 miners. Don wrote a memo stating that managers should concentrate on producing coal and not waste time responding to requests to fix things. It was not clear what had ignited the explosion of April 5 but it was almost certain that is was caused by accumulations of methane and coal dust. If Don had enforced the managers to focused more on the safety of the mines and the miners so that they are up to MSHA safety standards rather than only to concentrate on producing coal, the April 5 incident could well be prevented. Don Blankenship lack of care for the miners and prioritizing profit over safety are enough reasons for him to be held morally responsible for the deaths of the 29 miners. Question 3 MSHA should somehow be held morally responsible for the deaths of the 29 miners. First of all, the company does not operate up to the standard when it comes to protecting the lives of the miners. The agency was understaffed and its inspectors were overworked. Also, the week before the mine explosion, half of the agency’s inspectors failed to attend required training courses and the agency neither kept track of their attendance nor did it sanction them. Not only that, but the company can’t shut down a mine unless the total violations of these coal mine companies are above the level needed to force its closure. Most of the coal mine companies challenged MSHA’s citations and corrected enough of the significant violations so they fall below the shut-down level. This is irresponsible on MSHA’s side. Thy should enforce a tighter and stricter rules when it comes to violations. MSHA should not just imposed fines on the company but they should be more stern when it comes to safety violations by the company. Also, waiting until there is too much violations by the company to close the mines will endanger the lives of the miners. When people lives are on stake, MSHA surely are not up to the standard of that task. Question 4 The miners had some idea of the risks of working in the Upper Big Branch mine however that is not enough for them to be held any responsibility for their own deaths. Don Blankenship had released a memo to the managers specifically stating to ignore wasting time responding to requests to fix things. Managers then would be afraid to object to Don Blankenship requests since they could get fired. During the congressional hearing, survivors and relatives of those who had died testified. Most of the testimony states that they are afraid to go to management and express their fears of the lack of safety in the mine. They are afraid management would look for ways to fire them. So afraid of being fired, miners should not be held responsible for their own deaths because of the lack of freedom they have to express their feelings. Question 5 There is a huge difference between mines without unions like the Massey mines and other mines that had unions. The huge difference is the safety regulations. A union would fought for better enforcement of safety regulations to protect the miners. According to the testimony of Gary Quarles, the huge difference is when MSHA inspector comes to the mines. When an MSHA inspector comes onto a Massey mine property, the code words go out â€Å"we’ve got a man on the property. † When the word goes pit all effort is made to correct any deficiencies or direct the inspector’s attention away from any deficiencies. Also when an MSHA inspector comes to a Massey mine, he/she is only accompanied by Massey people. No coal miner at the mine can point out areas of concern to the MSHA inspector. While in union mines, workers at the mine would accompany the MSHA inspectors during the inspections. Workers also have the right to refuse to work in unsafe conditions without fear of their job. Clearly, in mines without unions like Massey, the people are trying to deceive MSHA inspectors to that they would not get citations for different violations. Seeing the huge difference in enforcing safety regulations, all mines should be forced to have a union. Question 6 The average salary for all jobs in the United States is $43,000 while miners in the Upper Big Branch mine were paid $60,000. Even though a work of a miner required no more than a high school education, the risk of their job is very high, probably the highest. Wages will fail to provide a level of compensation proportional to the risks of a job when markets do not register risks because the risks are not yet known. For example, the health risks involved in mining or using a certain mineral such as manganese may not be known until many years afterward. In this case, wages will not fully compensate for risks. Workers also might accept risks unknowingly because they do not have adequate accept to information concerning those risks. Workers don’t have the money or the tool to collect information needed to assess the risks of the jobs they accept. Workers might accept known risks out of desperation because they lack the mobility to enter other less risky industries or because they lack information of the alternatives available to them. Massey is only paying $17,000 more than the average of all jobs in the United States. Knowing all the risks as a miner such as exposure to methane nd all other lethal gases and also the high rate of accidents in Upper Big Branch mine due to poor safety regulations, a wage of $60,000 surely does not cover the all the risks that the miners are exposed to. Only $17,000 more on the wage of the miners than the average wage of all the jobs in the U. S. is not an ethical approach by the company. There is a far more safer job even though they are lower in wages . But the $60,000 in wages is not worth it for the miners considering all the job risks Massey doesn’t account for. So, Massey was not handling job risk in an ethically appropriate manner. Question 7 Massey Energy Company did not fulfill a lot of ethical obligations. The company violated the ethics of care. An ethic of care says they we should care for those dependent on and related to us. The miners are dependent of the managers and CEO of the company to enforce tighter and stricter safety regulations, however Massey failed to do so. The company violated the ethics of pollution control. Massey was faced with the problem of disposing millions of gallons of coal slurry the mines were producing. They did not control their pollution of coal slurry into the environment, thus violating the ethics of pollution control. Massey also violated different rights. Positive rights state that duties of other agents (Massey) to provide the holder of the right (the miners) with whatever he or she needs to freely pursue his or her interests. The miners interest is to have a high quality safety regulations in the mines and Massey failed to provide this interest. Massey also failed the fairness of wages and the fairness of employee working conditions. The wage they are paying to the miners are not enough to cover all the job risks the miners are exposed to in the mine. Massey also failed to provide proper working condition in the Upper Big Branch. How to cite Massey Coal, Essay examples

Wordsworth Reveals a Personal Affinity free essay sample

Throughout Wordsworth poems, â€Å"my heart leaps for joy and† I wandered as lonely as a cloud† he displays a very deep, spiritual and emotional connection with nature. The poems are focused on the natural beauty of the ‘rainbow’ and ‘daffodils’. In both poems he reveals a personal affinity with nature. This is evident through the interplay of poetic techniques throughout both poems. Living most of his life in rural England, Wordsworth was very much against the Industrialisation and the French Revolution. These two events had a significant impact on his poetry because of its corrosive effect on the individual, the community and the landscape. He strived to immortalise the lost rural landscape in his poetry and does this through his two poems â€Å"my heart leaps up† and â€Å"I wandered as lonely as a cloud†. ‘I wandered as lonely as a cloud’ reflects the inherit connections between man and nature. Wordsworth uses a variety of figurative language to communicate this idea. We will write a custom essay sample on Wordsworth Reveals a Personal Affinity or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Hyperbole, visual imagery and personification are important techniques used as they indicate Wordsworth’s love for nature. In the first line of the poem he uses personification in representing himself figuratively as a cloud. Wordsworth then proceeds to personify the daffodils as humans, describing the daffodils as ‘fluttering and dancing in the breeze’ He also personifies the daffodils as a ‘jocund company’, suggesting the flowers have feelings just as humans do. Again, there is the suggestion of unity between man and nature when Wordsworth describes that ‘a poet cannot be gay, in such a jocund company’.

Difference Between Totalitarianism, Authoritarianism, Fascism

Difference Between Totalitarianism, Authoritarianism, Fascism Totalitarianism, authoritarianism, and fascism are all forms of government. And defining different forms of government isnt as easy as it might seem.   The governments of all nations have an official form as designated in the U.S. Central Intelligence Agency’s World Factbook. However, a nation’s own description of its form of government can often be less than objective. For example, while the former Soviet Union declared itself a democracy, its elections were not â€Å"free and fair† as only one party with state-approved candidates were represented. The USSR was more correctly classified as a socialist republic. In addition, the boundaries between various forms of government can be fluid or poorly-defined, often with overlapping characteristics. Such is the case with totalitarianism, authoritarianism, and fascism. What is Totalitarianism? Benito Mussolini and Adolf Hitler in Munich, Germany September 1937. Fox Photos/Getty Images Totalitarianism is a form of government in which the state’s power is unlimited and is used to control virtually all aspects of public and private life. This control extends to all political and financial matters, as well as the attitudes, morals, and beliefs of the people. The concept of totalitarianism was developed in the 1920s by Italian fascists who attempted to put a positive spin on it by referring to what they considered totalitarianism’s â€Å"positive goals† for society. However, most Western civilizations and governments quickly rejected the concept of totalitarianism and continue to do so today. One distinctive feature of totalitarian governments is the existence of an explicit or implied national ideology, a set of beliefs intended to give meaning and direction to the entire society. According to Russian history expert and author Richard Pipes, Fascist Italian Prime Minister Benito Mussolini once summarized the basis of totalitarianism as, â€Å"Everything within the state, nothing outside the state, nothing against the state.† Examples of characteristics that might be present in a totalitarian state include: Rule enforced by a single dictatorThe presence of a single ruling political partyStrict censorship, if not total control of the pressConstant dissemination of pro-government propagandaMandatory service in the military for all citizensMandatory population control practicesProhibition of certain religious or political groups and practicesProhibition of any form of public criticism of the governmentLaws enforced by secret police forces or the military Typically, the characteristics of a totalitarian state tend to cause people to fear their government. Rather than trying to allay that fear, totalitarian rulers tend to encourage and use it to ensure the people’s cooperation. Early examples of totalitarian states include Germany under Adolf Hitler and Italy under Benito Mussolini. More recent examples of totalitarian states include Iraq under Saddam Hussein and North Korea under Kim Jong-un. What is Authoritarianism? Fidel Castro circa 1977. David Hume Kennerly/Getty Images   An authoritarian state is characterized by a strong central government that allows people a limited degree of political freedom. However, the political process, as well as all individual freedoms, is controlled by the government without any constitutional accountability In 1964, Juan Josà © Linz, Professor Emeritus of Sociology and Political Science at Yale University, described the four most recognizable characteristics of authoritarian state as: Limited political freedom with strict government controls imposed on political institutions and groups like legislatures, political parties, and interest groupsA controlling regime that justifies itself to the people as a â€Å"necessary evil† uniquely capable of coping with â€Å"easily recognizable societal problems† such as hunger, poverty, or violent insurgencyStrict government-imposed constraints on social freedoms such as suppression of political opponents and anti-regime activityThe presence of a ruling executive with vague, loosely defined and shifting powers Modern dictatorships, such as Venezuela under Hugo Chvez, or Cuba under Fidel Castro, typify authoritarian governments.   While the People’s Republic of China under Chairman Mao Zedong was considered a totalitarian state, modern-day China is more accurately described as an authoritarian state, because its citizens are now allowed some limited personal freedoms. It is important to summarize the main differences between totalitarianism and authoritarian governments. In a totalitarian state, the government’s range of control over the people is virtually unlimited. The government controls nearly all aspects of the economy, politics, culture, and society. Education, religion, the arts and sciences, even morality and reproductive rights are controlled by totalitarian governments. While all power in an authoritarian government is held by a single dictator or group, the people are allowed a limited degree of political freedom. What is Fascism? Rarely employed since the end of World War II in 1945, fascism is a form of government combining the most extreme aspects of both totalitarianism and authoritarianism. Even when compared to extreme nationalistic ideologies like Marxism and anarchism, fascism is typically considered to be at the far-right end of the political spectrum. Fascism is characterized by the imposition of dictatorial power, government control of industry and commerce, and the forcible suppression of opposition, often at the hands of the military or a secret police force. Fascism was first seen in Italy during World War I, later spreading to Germany and other European countries during World War II. Historically, the primary function of fascist regimes has been to maintain the nation in a constant state of readiness for war. Fascists observed how rapid, mass military mobilizations during World War I had blurred the lines between the roles of civilians and combatants. Drawing on those experiences, fascist rulers strive to create a rabidly nationalistic culture of â€Å"military citizenship† in which all citizens are willing and prepared to take on some military duties during times of war, including actual combat. In addition, fascists view democracy and the electoral process as an obsolete and unnecessary obstacle to maintaining constant military readiness and consider a totalitarian one-party state as the key to preparing the nation for war and its resulting economic and social hardships. Today, few governments publicly described themselves as fascist. Instead, the term is more often used pejoratively by those critical of particular governments or leaders. The term â€Å"neo-fascist† is often used to describe governments or individuals espousing radical, far right political ideologies similar to those of the World War II fascist states.

History of the Woodstock Music Festival of 1969

History of the Woodstock Music Festival of 1969 The Woodstock Festival (aka An Aquarian Exposition: Three Days of Peace and Music) was a three-day concert (which rolled into a fourth day) that involved lots of sex, drugs, and rock n roll, plus a lot of mud. The Woodstock Music Festival of 1969 has become an icon of the 1960s hippie counterculture. The festival took place on August 15-18, 1969, at Max Yasgurs dairy farm in the town of Bethel (outside of White Lake, New York). The Organizers of Woodstock The organizers of the Woodstock Festival were four young men: John Roberts, Joel Rosenman, Artie Kornfeld, and Mike Lang. The oldest of the four was only 27 years old at the time of the Woodstock Festival. Roberts, an heir to a pharmaceutical fortune, and his friend Rosenman were looking for a way to use Roberts money to invest in an idea that would make them even more money. After placing an ad in The New York Times that stated: Young men with unlimited capital looking for interesting, legitimate investment opportunities and business propositions, they met Kornfeld and Lang. The Plan for the Woodstock Festival Kornfeld and Langs original proposal was to build a recording studio and a retreat for rock musicians up in Woodstock, New York (where Bob Dylan and other musicians already lived). The idea morphed into creating a two-day rock concert for 50,000 people with the hope that the concert would raise enough money to pay for the studio. The four young men then got to work on organizing a large music festival. They found a location for the event up in an industrial park in nearby Wallkill, New York. They printed tickets ($7 for one day, $13 for two days, and $18 for three days), which could be purchased in select stores or via mail order. The men also worked on organizing food, signing musicians, and hiring security. Things Go Very Wrong The first of many things to go wrong with the Woodstock Festival was the location. No matter how the young men and their lawyers spun it, the citizens of Wallkill did not want a bunch of drugged-out hippies descending on their town. After much wrangling, the town of Wallkill passed a law on July 2, 1969, that effectively banned the concert from their vicinity. Everyone involved with the Woodstock Festival panicked. Stores refused to sell any more tickets and the negotiations with the musicians got shaky. Only a month-and-a-half before the Woodstock Festival was to begin, a new location had to be found. Luckily, in mid-July, before too many people began demanding refunds for their pre-purchased tickets, Max Yasgur offered up his 600-acre dairy farm in Bethel, New York for  the location for the Woodstock Festival. As lucky as the organizers  were to have found a new location, the last minute change of venue seriously set back the Festival timeline. New contracts to rent the dairy farm and surrounding areas had to be drawn up and permits to allow the Woodstock Festival in the town had to be acquired. Construction of the stage, a performers pavilion, parking lots, concession stands, and a childrens playground all got a late start and barely got finished in time for the event. Some things, like ticket booths and gates, did not get finished in time. As the date got closer, more problems sprung up. It soon appeared that their 50,000 people estimate was way too low and the new estimate jumped to upwards of 200,000 people. The young men then tried to bring in more toilets, more water, and more food. However, the food concessionaires kept threatening to cancel at the last minute (the organizers had accidentally hired people who had no experience in concessions) so they had to worry about whether or not they could airlift in rice as a backup food supply. Also troublesome was the last-minute ban on off-duty police officers from working at the Woodstock Festival. Hundreds of Thousands Arrive at the Woodstock Festival On Wednesday, August 13 (two days before the festival was to begin), there were already approximately 50,000 people camping near the stage. These early arrivals had walked right through the huge gaps in the fence where the gates had not yet been placed. Since there was no way to get the 50,000 people to leave the area in order to pay for tickets and there was no time to erect the numerous gates to prevent even more people from just walking in, the organizers were forced to make the event a free concert. This declaration of a free concert had two dire effects. The first of which was that the organizers were going to lose massive amounts of money by putting on this event. The second effect was that as news spread that it was now a free concert, an estimated one million people headed to Bethel, New York. Police had to turn away thousands of cars. It is estimated that about 500,000 people actually made it to the Woodstock Festival. No one had planned for half a million people. The highways in the area literally became parking lots as people abandoned their cars in the middle of the street and just walked the final distance to the Woodstock Festival. Traffic was so bad that the organizers had to hire helicopters to shuttle the performers from their hotels to the stage. The Music Starts Despite all the organizers troubles, the Woodstock Festival got started nearly on time. On Friday evening, August 15, Richie Havens got up on stage and officially started the Festival. Sweetwater, Joan Baez, and other folk artists also played Friday night. The music started up again shortly after noon on Saturday with Quill and continued non-stop until Sunday morning around 9 AM. The day of psychedelic bands continued with such musicians as Santana, Janis Joplin, Grateful Dead, and The Who, to name just a few. It was obvious to everyone that on Sunday, the Woodstock Festival was winding down. Most of the crowd left throughout the day, leaving about 150,000 people on Sunday night. When Jimi Hendrix, the last musician to play at Woodstock, finished his set early on Monday morning, the crowd was down to only 25,000. Despite the 30-minute lines for water and at least hour-long wait to use a toilet, the Woodstock Festival was a huge success. There were a lot of drugs, a lot of sex and nudity, and a lot of mud (created by the rain). After the Woodstock Festival The organizers of Woodstock were dazed at the end of the Woodstock Festival. They didnt have time to focus on the fact that they had created the most popular music event in history, for they first had to deal with their incredible debt (over $1 million) and the 70 lawsuits that had been filed against them. To their great relief, the film of the Woodstock Festival turned into a hit movie and the profits from the movie covered a large chunk of the debt from the Festival. By the time that everything was paid off, they were still $100,000 in debt.

Maintaining & Improving Operations Research Paper

Maintaining & Improving Operations - Research Paper Example Cold chain ensures that the integrity of the food is maintained and the nutritional value and freshness of the food is retained. The pull-supply chain has enhanced the effectiveness and the efficiency of McDonald’s. The supply chain is further characterized by the adoption and implementation of technology. The fast-food restaurants have implemented the demand chain planning to enhance the delivery of their services. Maintaining & Improving Operations McDonald’s Background In 1937, Maurice and Richard McDonald created McDonald’s at a small drive-in restaurant in the east of Pasadena in California. The two brothers were able to develop assembly line and food processing techniques. In 1954, Ray Kroc (a milkshake-mixer salesperson) saw as chance and made a franchise deal with the McDonald’s which provided him with special rights to franchise McDonald’s products in America (Tassiopoulos, 2009). The business enterprise of Ray Kroc was based on the basic p rinciples of Q.S.C. &V. (Quality, Service, Cleanliness, and Value) (Svoboda, 1995). Harry Sonneborn (a business partner with Ray Kroc), introduced a method for leasing stores in 1956; the franchisees were to be sub-leased the stores at a premium of 40 percent. Finally, McDonald’s bought land for the franchisees. Eventually, McDonald’s became the world’s biggest owner of retail property. ... There are two categories of suppliers that supply food ingredients, Tier-1 and Tier-2 suppliers. Processors and growers (mainly poultry farms, potato and lettuce growers, and companies that produce coating systems that coat chicken and vegetable patties) make up Tier-2 suppliers. Tier-1 suppliers are supplied with the ingredients and process them, for example, into potato products such as potato hash browns, wedges, and French fries (McCain Foods India Pvt. Ltd does the processing), or into chicken and vegetable patties (they are processed by Vista Processed Foods Pvt. Ltd.). The effectiveness of the McDonald’s supply chain is attributed to the unique idea of outsourcing work. The supply chain of the company is 100 percent outsourced. The company believes in outsourcing everything to people who are experts in the subject matter (Cheema, 2011). A remarkable feature of McDonald’s supply chain is a network that consists of the movement of goods via a cold chain. The cold c hain is important because it maintains the integrity of the food products and it retains their nutritional value and freshness (Kulkarni and Lassar, 2009). The cold chain is made up of the suppliers and in other cases the lettuce growers. In general, the cold chain starts with the Tier-2 suppliers. It is worth noting that the cold chain has an innovative and interesting feature; this feature permits the same truck to carry products at various temperatures. These products include frozen products (temperature ranges from -18C to -25C), chilled products (temperature ranges from 1C to 4C) and dry products (carried at ambient temperatures). It is important to note that McDonald’s is the only organization that has successfully

Urbanization in ancient Greece Essay Example | Topics and Well Written Essays - 1000 words

Urbanization in ancient Greece - Essay Example One key characteristic of these settlements was lack of governmental authority beyond the boundaries of the village (Chant et al, 2000). In addition, these villages did not have any workshops or public buildings. Such egalitarian societies persevered on even after the introduction of agriculture. The egalitarian societies were stratified and turned into functionally specialized units by the formation of states and urbanization (Chant et al, 1999). This process took place independently in numerous regions of the world, probably starting from the Southwest Asian region, which was very fertile. The formative era referred to the period between the years 7000 to 5000 BC, which was characterised by urbanization and state development, which complemented each other. Upon the stratification of the egalitarian society, there emerged craftspeople, farmers, soldiers, administrators, merchants and priests, with the cities becoming the civilization focus (Chant, 1999). In the development of Greece cities, the natural environment as well as the existing technologies played a key role. These cities were built in around the eighth century by the Greeks. Distinguishing how the shape of the buildings in the cities was influenced by the natural environment or the available technologies is not easy. This is because there exists a very dynamic relationship between the natural environment and technology, with each shaping or being shaped by the other. Military technologies and needs were very important determinants in the layout and growth of Greek cities. Some of the initial cities in Greece grew as a result of pressure since the people needed to defend themselves form their enemies. As a result they were generally located on rocky positions, which were regarded as defensible. They were also positioned some distance from the harbour, with heavy fortification (Chant et al, 2000). Wall-building proved to be the most expensive and laborious task and involved very impressive engineering accomplishments in the architecture of Greece. Stone was in abundance and was used the building material, with its properties determining the style of construction. For instance, lintels and posts were frequently used in the construction of public monuments. Stone, which was the building material of choice, needed lifting technologies that utilized people as opposed to hoists (Chant et al, 1999). Cranes were not in use until much later, in 515 BC and beyond. They came into use as a result of labour shortage and not because of their capability of lifting larger blocks of stone. The unplanned growth of the earliest settlements was substituted by a bit more formal buildings, mainly after Persian attacks in the fifth century. With the advancement of technology in the military, it became necessary to adopt a defensive layout for the city streets. In the process of the reconstruction of these cities, there was development of numerous town planning theories, most of which were put into practice, with the grid plan becoming very common. Aristotle advocated for a city design of a defensive nature, which uses both the irregular and regular features. This, he argued, was aimed at reconciling the strain of moving both the equipment and troops easily, and to confuse any attackers (Chant, 2000). Natural Environment The location of earlier settlements was mainly determined by the natural

Communication Skills in Nursing | Reflection

Communication Skills in Nursing | Reflection This essay will present a reflective account of communication skills in practice whist undertaking assessment and history taking of two Intensive Care patients with a similar condition. It will endeavour to explore all aspects of non verbal and verbal communication styles and reflect upon these areas using Gibbs reflective cycle (1988). Scenario A Mrs James, 34, a passenger in a road traffic collision who was not wearing a seatbelt was thrown through the windscreen resulting in multiple facial wounds with extensive facial swelling which required her to be intubated and sedated. She currently has cervical spine immobilisation and is awaiting a secondary trauma CT. Mr James was also involved in the accident. Scenario B Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and orientated but currently breathless and requiring high oxygen concentrations. Patients who are admitted to Intensive Care are typically admitted due to serious ill health or trauma that may also have a potential to develop life threatening complications (Udwadia, 2005). These patients are usually unconscious, have limited movement and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invasive procedures for the purpose of monitoring and regulation of physiological functions. Having the ability to effectively communicate with patients, colleagues and their close relatives is a fundamental clinical skill in Intensive Care and central to a skilful nursing practice. Communication in Intensive Care is therefore of high importance (Elliot, 1999) to provide information and support to the critically ill patient in order to reduce their anxieties, stresses and preserve self identity, self esteem and reduce social isolation (Joà £o: 2009, Alasad: 2004, Newmarch:2006). Effective communic ation is the key to the collection of patient information, delivering quality of care and ensuring patient safety. Gaining a patients history is one of the most important skills in medicine and is a foundation for both the diagnosis and patient clinician relationship, and is increasingly being undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is crucial (Carr, 2005). Often the patient is transferred from a ward or department within the hospital where a comprehensive history has been taken with documentation of a full examination; investigations, working diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this admission if it was not appropriate to do so. Where available patients medical notes can provide essential information. In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective communication is restricted and obtaining a comprehensive history would be inappropriate and almost certainly unsafe (Carr, 2005). The Nursing Midwifery Council promotes the importance of keeping clear and accurate records within the Code: Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). Therefore if taking a patients history is unsafe to do so, this required to be documented. Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy person is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has often been accompanied with other injuries such as traumatic brain injury and complications such as airway obstruction. This may have been caused by further swelling, bleeding or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. Within scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for over half of the thoracic injuries from non-penetrating trauma (Middle ton, 2003). When ribs are fractured due to the nature and site of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is pain. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effectively. These combined increase the risk of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003). A key component of Intensive Care is to provide patients and relatives with effective communication at all times to ensure that a holistic nursing approach is achieved. Intensive care nurses care for patients predominantly with respiratory failure and over the years have taken on an extended role. They are expected to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a physical assessment and collect the patients history in a systemic, professional and sensitive approach. Effective communication skills are one of the many essential skills involved in this role. As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history taking process (Appendix A) and the physical assessment process. Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/Examination (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to blood cells and the oxygen cannot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid asses sment, continuity of care and the reduction of errors. Communication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, messages, opinions and thoughts are transferred by different forms. Basic communication is achieved by speaking, sign language, body language touch and eye contact, as technology has developed communication has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication: Verbal and non verbal. Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, understood and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Baron:2005, Zastrow:2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and orientated and had some ability to communicate; he was breathless due to painful fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions can allow breathless patients to communicate without exerting themselves. Closed questions such as is it painful when you breathe in? or is your breathing feeling worse? can be answered with non ver bal communication such as a shake or nod of the head. Taking a patients history in this way can be time consuming and it is essential that the clinician do not make assumptions on behalf of the patient (Ashworth, 1980). Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal communication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al:2000, Alasad:2004). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and crossed legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Alt hough Mr. James could verbally communicate, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles. A patients stay in Intensive Care can vary from days to months. Although this is a temporary situation and many patients will make a good recovery, the psychological impact may be longer lasting (MacAuley, 2010). When caring for the patient who may be unconscious or sedated and does not appear to be awake, hearing may be one of the last senses to fade when they become unconscious (Leigh, 2000). Sedation is used in Intensive Care units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony between the patient and ventilator. Poor sedation can lead to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. Over sedation can lead to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care delirium. Derlerium can be distressing for both the relatives andthe patient, who may have some recolection after the deleium epsiode (Mclafferty, 2007). Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation (Page, 2008). Within this stage of sedation or delirium it is impossible to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological status would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore im portant to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch when a patient is being moved, washed or having a dressing changed and secondly a caring touch holding Mrs James hand to explain where she was and why she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of talking to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been (Baron, 2005). If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of communication process as the Intensive Care environment in itself can cause communication barriers. Intensive Care can be noisy environment (Newmarch, 2006). Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength (Newmarch, 2006). Weakness of patients can affect the movement of hands and arms making gestures and handwriting frustration and diff icult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The University of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care. This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overall research (Alasad: 2004, Leigh: 2001, MacAuley, 2010: Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further education within Intensive Care may be requ ired to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contributions that others offer, to improve patients care and the overall patient experience. Appendix 1, The History Taking Process: The questions are the key to a good interview. You need to use a mix of open ended questions and close ended questions. Open ended questions leave the door open for the patient to tell you more. Questions like when it this problem start?, have you had any recent health problems?, and can you show me where it hurts? are open ended. The patient feels free to provide additional information. While questions like does it hurt here?, did you have this pain yesterday?, and have you had the flu in the past month? are close ended. Close ended questions seek very specific, often yes or no responses from the patient and dont encourage the patient to provide any additional information. Good interviews are a mixture of both kinds of questions. (Secrest, 2009) Basic Elements: 1. Greeting a. Introduction b. Identification of patient and self c. Assessment of the patients overall appearance and demeanor 2. Personal history a. Age b. Occupation c. Sex d. Height / Weight e. Marital / Family status i. Children 3. Chief complaint (CC) or Presenting complaint a. Why is the patient seeking care? b. What other problems concern the patient? 4. History of present illness a. Location and radiation of complaint b. Severity of complaint c. Timing of onset d. Situation (setting) of onset e. Duration of complaint f. Previous similar complaints g. Exacerbating and relieving factors h. Associated symptoms i. Patients explanation of complaint 5. Past medical history a. Systematic questioning regarding previous adult illnesses i. Neurological/Psychiatric ii. Eye, ear, nose, throat iii. Skin/Hair/Nails iv. Musculoskeletal v. Cardiovascular/Respiratory vi. Genital-urinary vii. GI tract b. Childhood illnesses c. Surgeries, injuries or hospital admissions d. OB/GYM i. Birth control ii. Pregnancies / Births iii. Menstrual periods iv. Pelvic exams / Pap smears e. Psychiatric f. Immunizations g. Screening tests h. Allergies 6. Family history a. Disease history b. Parental health c. Childrens health 7. Drug history a. Current medications i. Prescription ii. Over-the-counter b. Drug allergies 8. Lifestyle (social history) a. Alcohol b. Smoking c. Recreational drug use d. Sexual life style/orientation e. Reproductive status f. Occupational issues (Secrest,2009)