The Effects Of Colonialism On Gender Inequality Politics Essay

The Effects Of Colonialism On Gender Inequality Politics Essay The North/ South divide and gender inequality are intertwined and influence the lives of women in the northern hemisphere significantly different than that from women who are inhabitants of the southern hemisphere. This paper will discuss the role of globalization as a multidimensional process and how it affects the life of women in terms of economic, social, and cultural development. Globalization has led to violations of womens civil rights because of the decline of the welfare state, the increased poverty among women, the role religion plays in fundamentalist societies and in armed conflict. However, it has also caused tremendous opportunities for women to better their lives and hereby setting standards to demand equal women rights. Considering the percentage of women in the world population it is important to study the role of gender equality. Women as laborers and their contribution to their communities and national economies have a significant impact on globalization. In additi on, the emphasis on social justice and democracy as a preferred political ideology to stimulate globalization makes gender issues an important factor. Gender inequality is caused by our social institutions and organizations who suppress womens social and economic rights, often unknowingly, by placing insufficient importance on gender as a factor in decision making. Some say that inequality and economic growth are coexisting phenomena but it is no argument to allow exploitation and marginalization of selected groups. Neo-liberalist thinking promotes globalization but it also creates opportunity for avoidance of social responsibility by governments and multinational corporations. Gender inequality can most effectively be influenced by changing the political agenda. A countrys national governance on legislative, judicial and executive policies will stimulate a dialogue that leads to change. Globalization: North vs. South The term globalization has no accepted definition and therefore the interpretation depending on who uses the term, can vary from a pure economic perspective to a more liberal definition in terms of civil development. Adam Smith described in his book the Wealth of Nations, how economical growth leads to change in social behavior and eventually change in public policy. Globalization by these means is a process whereby a society acquires economic growth and sustainable human development through processes of democratization. However, these processes traditionally do not include gender in negotiation and representation. After the collapse of the Soviet Union and communism as an ideology, institutions that promoted global economies and also the spread of capitalism appeared. The divide between East and West became a divide between North and South now based on economic perspectives instead of political doctrines. Globalization is than characterized by free trade and the virtual removal of borders in order to promote exchange of goods, services and capital between nations. The countries in the northern hemisphere have experienced at least one industrial revolution and therefore have the advantage of being able to produce higher quality goods and using more advanced technology in their production methods. Countries in the Southern hemisphere are predominantly agrarian, so for the most part feudal societies instead of industrialized ones. This observable fact, lack of industrialization, is directly linked to the disadvantages that many developing countries experience, to compete with the countries of the developed world. As a result their participation in the globalization process is limited to being suppliers of raw materials. The Northerners, or developed countries, use these materials to produce high-end products for the world market including to countries who are the very same raw material supplier. The obstacle for developing countries to compete equally is often caused by the backwardness of their economic development based on their history of colonialism. Imperialism and colonialism theorized Imperialism and colonialism are factors one should consider when analyzing a countries successful participation in the global economy. Not only did these phenomena affected the colonialized countries economies by stripping their resources. Its population experienced a so called identity crisis, because they were not used to their independent status nor had they the understanding of political functions and their relationships. The inequality between developed states and developing states is discussed in the politics of modernization by Max Weber. There are three theories that are influencing developing countries. The first one, the Dependency Theory is a marxist inspired theory that entails concepts such as Core or Metropolis, (developed states) Periphery or Satellite ( developing states) and semi periphery( industrialized states that are still considered developing countries). There is a dependency between the Core and Periphery because of their interaction with each other. The core provides technology and expertise and the periphery provides the raw materials. The raw materials are offered very cheap, but in return the high end products are sold for a high price, which results in poorer countries facing a constant deficit between their export and import income. The theory assumes that core and periphery need each other to exist, but based on this interdependence some scholars of Stanfords Universities Hoover Institutions Office of Public Affairs, maintain that globalization is yet another type of imperialism. Marxist ideology as an inspiration for the Dependency Theory, claims that isolation policy provides the solution for getting rid of the unequal interdependence between rich and poor countries. Siegel et al claims that using methods such as import substitution strategy result in decline of export industry which is necessary for investment in technology to achieve advanced phases of industrialization. The theory is challenged by the lack of categorizing NICs, or new industrialized countries. An example of an NIC are oil producing countries, but calling them semi peripheral takes them out of the equation in which core and periphery are compared. To deal with crisis of nation building, state building, participation and distribution, (Almond and Powell 1966) comprehension of the Politics of Modernization is required. This pro-capitalist perspective assumes that modernization will develop similarly in the North and the South. The second theory as described by Burnell and Randall (p17), Gabriel Almonds Political Development Theory, uses a structural model for comparative analysis in which he incorporates input functions (i.e. political socialization, political recruitment, interest articulation and political communication) and output functions (i.e. rulemaking, rule implementation and rule adjudication) as a guiding principle for political development. In addition, a stable government is required to change traditional habits and principles. However, to the contrary, Burnell and Randall ( intro4) claim that developing countries, in their post- colonial phase show: authoritarian rule, political instability, internal conflict, corr uption and politics of religious or ethnic identity. The third theory of modernization, the Globalization Theory focuses on the development of communication, technology and infrastructure leading to global economic integration. According to Burnell and Randall, the Dependency- and Political Development Theory were more concerned with politics and the role of the state, which is completely opposite of the Globalization Theory which mainly focuses on development of global trade, foreign direct investment and global finance. One direct result of this focus is that the nation state loses its autonomy and eliminates one of the most primary functions, security. Protecting of ones borders, economy and inhabitants is a function that is important for very poor countries as their existence is depending on it. The controversy about the modernization theories is that they are based on ethnocentric political perspective. They are promoting an elite group of the haves and/or a capitalist class. The notion that globalization can bring everyone involved up to middle class system is ineligible. The free market system does not work for all developing countries because of the backwardness of their economy ( Burnell Randall, p3). As it took developed countries centuries to get where they are, the developing countries have to go to many stages of development to be able to compete. However, developing countries can not all be categorized in one group and to assume that all countries develop by the same principle is narrow sighted. Although, they do have a history of colonialism in common, their post -colonial development is depending on different factors. The Anglo- Saxon settler countries, United States, Australia, New Zealand and Canada took over the traditions, rules of law and property and indiv idual rights of the motherland, the United Kingdom. As they kept close ties with their previous occupiers by conducting trade and foreign investments, the transition to a developed nation was flawless. In other colonies, we see political fragmentation caused by religious and ethnic division in the countries. The economic effects of imperialism and colonialism are undeniable. The legacy is still noticeable in current world political dynamics and plays a significant role in developing countries ability to develop successful economies and achieve the same standards in civil development and human equality. GLOBALIZATION AND INEQUALITY Globalization decreases inequality! This is a common assumption for most people, but few know how inequality and economic growth are linked. For the purpose of this paper, we have to look at several forms of inequality as gender inequality is coupled with economic, social, and political inequality. Looking at economic growth in most countries, one can conclude that globalization is good for everyone as most people, even the very poor achieve prosperity. Lall et al., discusses the correlation of this viewpoint with Kuznetss hypothesis in which income inequality rises at the beginning of the industrialization process but once established it decreases again. They observed that increased technology, financial and trade globalization increased inequality, while liberalization of trade and financial markets lowered income inequality. The other outlook claims that prosperity is not shared by the whole population and that only a small group benefits from economic growth. As a matter of fact, the alleged income inequality does not advance globalization processes as the so called losers may become a burden on the welfare state. Concurrently, the machinery of globalization is obstructed and not all opportunities are exhausted. For example, proceeds are not invested in the industry but in distribution of income. Social inequality refers to differences in class and status. A good example is the cast system in India, based on religion but also on heritage. The ranking of elite groups based on descend is an inequality that is not a result of globalization. However, the status inherited came with special treatment such as education opportunity and predisposition to economic and other business dealings. In the United States, equality of men, particularly the black man has been legitimized just a few decades ago. Women, especially, the ones that live in fundamentalist religious societies are denied basic social rights and are clearly victims of social inequality. In many develop ing countries political inequality becomes evident in traditional expressions of tribal culture, the client-patron relationships, nepotism and the lack of established laws for civil and constitutional rights. GENDER INEQUALITY Gender inequality is a current world problem and is found in developed and developing countries. The Worldbank claims that in any region, any state and any social class inequality between men and women exists. A few exceptions to this rule are the Scandinavian countries. The strong democratic political structures of Sweden, Denmark, Norway and Finland and strong women organizations are believed to be the reason for this transformation in policy making. Gender Equality defined as the difference between men and women and equality in their rights perceived fair based on their biological differences. Traditionally, gender differences and roles between men and women is based on the fact that women are the bearers and caregivers of children. Men are physically stronger and therefore, the breadwinners. Each culture has their own interpretations of these gender specific roles, but with globalization socio-economic trends change as well. Inequality, weather economic, social or political have been researched and play a significant role in economic development, but also in human civil development. Gender inequality is linked to appropriate functioning of our social institutions and organizations. Suppression of womens social and economic rights often happens unknowingly because there is insufficient importance placed on gender as a factor in decision making. However, I see patriarchy as the determining factor leading to inequality in womens life. MEASURING GENDER INEQUALITY The United Nations Human Development Report measures inequality between men and women in countries. This method, GEM or Gender Empowerment Measurement, considers political participation and decision making, economic participation and decision making, and the access to economical resources. Than a calculation of each genders percentile in three areas is studied. The first measurement looks at the percentage of each gender in parliament. The second measurement focuses on the level of the position held, whether it is executive or managerial or staff. The last measurement, researches the disparity in income. Both percentage data for female and male are paired for each measurement and combined in the EDEP, (Equally Distributed Equivalent Percentage). The GEM is than calculated by averaging the EDEPs . Gender equality by regiongender_equality_index.jpg WOMENS ROLE IN THE POLITICAL PROCESS For the longest time women have not participated in the political process because of several reasons. First of all, women suffrage has not been an option in every country and was not established until the late 19th century. Most women in developing countries could not vote until the mid 50s. Governing has always been a mans job and until the networks to promote womens voices and their right to be heard were build, participating in the political process was impossible. Another obstacle is illiteracy; about two thirds of the worlds illiterates are women. Rao and Kelleher studied institutions and organizations that are involved in supporting women. They conclude that organizational structure and culture is the problem to the stagnating trend to policy change. The womens conference in Beijing in 1995 proved that women are mobilizing and that womens political activism and NGOs are increasing. The stigma that feminism creates has sometimes worked adversely for grass roots women movements a nd the resistance of a male driven government. Sikoska and Kardam infer in their study that engendering the political agenda is a slow process and requires gender advocacy on a government level. They believe that the focus on getting more women in parliamentarian seats does not warrant that women issues will be addressed. As strange as it might seem gender inequality also exists because of the lack of equality consciousness by both men and women. gender_education1.jpg INCOME AND LABOR Women earn less than men and this phenomenon arises in both developing and developed countries. This inequality has been accepted up to the 20th century as normal. Yet, the difference in pay of man and women is a form of exploitation as the employer can make additional profit based on the income inequality. Swasti Mitters claims regarding the working circumstances in the technology manufacturing industry in India , confirms my idea that in globalization the primary concern is profit. She says that in order to mobilize the employees to demand unions and healthy work environments their needs to be an opportunity for change, but as employees in this industry are so easily replaced it is hard to get support. In most developing countries women do not get paid for work on the land or any other domestic duties. They are required to take care of the children, the animals and very often they function as the head of the family. The patrimonial system, with men as the head of the families preve nt women to own land and therefore, government support for women in the agrarian sector is not available. HEALTH ISSUES Education is a first requirement for women to stimulate their personal and economic growth. Women who are educated are better in monitoring their families health (mothers make sure children get their vaccines) and providing proper nutrition. Burnell and Randall point out that the pronatalist view of developing states increases inequality as women do not have the ability to make choices over their bodies in terms of contraception and abortion. Many women die in labor and because of the restrictions on emergency contraception, local abortion practices lead to serious health issues and sometimes in death. One of the direct results of the government imposed restrictions is overpopulation, which leads to higher poverty and famine. Case studies. Engendering globalization in India India , a member of the BRIC countries because of its tremendous economic growth in the past decades is considered an example of successful globalization. The country has the largest population of one billion inhabitants, in the world. It also has one of the highest poverty levels of approximately 350- million people that are living below the poverty line. The overpopulation and illiteracy is one of the main reasons this country is so poverty stricken, with women and children as the main victims. Although the country has experienced an tremendous economic growth, the selectiveness of the industries involved in this development are not providing revenues for all areas. The middle class has experienced exponential increases in growth and wealth, but this has lead to deeper inequality. With other words, some parts are developing rapidly because of the new economic development (the urban areas) and there is the rural part that does not experience any of the growth. Actually, people in th e rural areas are getting poorer because of the commercialization of agriculture. The New Economic Policy of 1991 instigated by the IMF and the World Bank urged for human development but the policy has not been effective and at some cases it worsened inequality. Rekha Pande argues structural adjustment in particular is not gender neutral and that developmental policies affects both men and women. However, she points out that women carry the double burden of poverty and discrimination. She states that women are underpaid compared to men; they are not credit worthy to achieve loans and do not have the same access to resources as men and that these factors lead to further inequality. Women in general are not considered land owners even if statistics show that agriculture employs 85 % of all working women. The commercialization of agriculture caused many women to lose their source of income, as they could not compete with the bigger farms and landowners now hired cash workers instead of leasing their land to the landless women. CQ Researcher describes how the subsistence economy, where most of these women lived off to feed their families and make some income, providing they could sell their surplus, was now taken away and poverty deepened. Relocation to the urban areas is often the only option available for these female farmers. These displaced farmers become hired workers and are being exploited for very low wages, long working hours and no security or social benefits. Globalization does not provide the kind of richness people from the impoverished layer of the population expect. On the contrary, for many, globalization causes insecurity and inequality. Pande claims that women lose their identity and independence by giving up agriculture for a life of marginalization and pauperization. Case study: Afghanistan Afghanistan a country in South Central Asia, has a population of 28 million inhabitants consisting out of the Pashtuns, 44 % and Tajiks 25%. The remainder is divided over minorities groups. 60 % of the population is female, which is assumed happened because of the war casualties. The poverty rate is very high, in some areas over 90 %. The occupation by the Soviet Union and decades of civil war with the Mujahideen and the Taliban created an environment of economic and political chaos. They lack all essential resources, to stabilize their government but according to Huma Ahmed-Gosh this is the best period to establish a new economic polity because the country is in transf0rmation. The country had an economic growth of over 10% between 2003 and 2008 and the Afghans believe this growth can be achieved again in the very near future (World Bank 2008). USAID and the Afghan government are working together to establish economic programs that diminish poverty, provides security and stimulate t he private sector to do investments and create job opportunities. The agrarian industry is the main source of income for most Afghans. In cooperation with the World Bank a $30 million grant was approved for the Afghanistan Rural Enterprise Development Program to assist farmers in the rural areas. An additional $23 million was pledged by the UK. This pilot program targets 20 different communities and is headed by one male and one female. Savings Groups were set up to be educated in finances and provide small loans to members of the communities. Enterprise Groups were established to create community based activities and projects. For the purpose of integration of women in the economical process, this pilot can already be considered successful as after 4 months over 300 groups were established from which half of them by women. Humah-Ahmed Gosh interviewed three Afghani women in Turin at an International Conference for women about the role of their respective womens organizations and th eir criteria for establishing equal women rights. RAWA, which stands for Revolutionary Association of the Woman in Afghanistan focuses on social justice and human rights for women. HAWCA or Humanitarian Assistance for Women and Children in Afghanistan agenda is to better the lives of women and children through empowerment and support womens involvement in rebuilding Afghanistan through education. The third organization, The All Afghan Womens Union, is headed by Soraya Parlika. She claims that teaching women skills and creating jobs is the best way to change family law and give women autonomy to eventually work to estebling a democratie. Non Governmental Organisations (NGOs) are the most productive and effective means to change the political climate in Afghanistan. Globalization can change the patrilineal family structure by eliminating womens economic dependency. Conclusion Globalization and gender inequality are closely intertwined with each other. My studies of the subjects taught me that a thriving globalization process is dependent on many factors and there is significant variations in how each individual country s development is affected by these factors. First of all, the divide between North and South or rich and poor if you will, has an intricate influence on the ability of nations to fully exhaust the opportunities of globalization. That the Northerners had an advantage in the globalization race because of their role in imperialism is a fact. These nations already had gone through various stages of industrialization and achieved a higher level of civilization, resulting in higher educated employees and advanced industrialization technologies. In addition, their wealth opened opportunities for fast capital investments with tremendous gain. Most of the worlds multinational corporations were founded in the North, and that is where the profits are disbursed. The settler colonies are an exception to the rule as they were able to develop thriving economies in their post- colonial phase. Burnell and Randall analyze this phenomenon as being part of the dichotomy of the colonial elite which makes me think that Orientalism plays a significant role in the interaction between countries of the North and the South. . The role of patriarchy is rooted in society and is one of the main evils causing inequality for women. In the developed world women experience less gender inequality in the form of opportunity but more in the form of outcome. Secondly, as I mentioned processes of democratization are a vital requirement for a countrys economic growth and sustainable development. Democracy as an ideology, develops in different forms and previous colonies did not always develop into a democracy, mainly because of their pluralistic nature. However, globalization did develop in some countries with an authoritarian regime. This happened because of their resources. Good examples are the oil producing countries. In view of that, one can infer that the theories of modernization are incomplete. Some reasons are that they are eurocentric, anachronistic, uni-linear and the belief that politics in developing countries are made by domestic forces. The politics in developing countries are driven by the relationship between the state and society and depends on aspects such as finance, economy and technology. I think that countries, better said political leaders and heads of multinational corporations, are rational actors and that choices made are based on opportunities for personal gain and economic benefits. Women work hard in the development world and with globalization their numbers are increasing. Multinational corporations have transferred their manufacturing activities to developing countries because of their human capital. Globalization as a process should not have a negative effect on women in the developed world if it uses democratic processes and pursues rising the human standards of living. The controversy however, is that free trade and openness of the economic markets is not monitored by states. Transnational corporations have only one goal and that is making profits. In the developed countries regulations were in place to prevent exploitation of the factory workers through trade unions and labor laws. As most developing countries have not experienced an industrial revolution on their own, the process is expedited and some crucial steps of labor development are bypassed. Lack of education and poverty are the drivers for many women to sustain the treatment experienced in their work environments. Changing the politics and mentality is a slow process and NGOs promoting the welfare of women gain only small victories. The nation state should take control by using their sovereignty and demand changes when it comes to abuse of their inhabitants. The dominance of the richer states undermines this right, but it is apparent that countries like India and China are being listened to. Once a standard is set it can easily be globalized as a standard for all countries. I used India as an example in a case study because of my hypothesis. My choice was lead by factors such as the level of successfulness of this countries globalization, but also the adverse effect of globalization on the female population, resulting in gender inequality. Afghanistan on the other hand is an example, from which I believe that globalization can effect gender inequality positively. As shown by the humanitarian aid projects, whereby womens involvement is strong, interference by fundamentalist religion diminished. As discussed by Osborne and Gaebler, governments should steer not row. The conflict needs policies to resolve gender inequalities on a global scale as the diversity among people and the differences in cultures and tradition ask for different measures in each country. Therefore a global effort is needed by cooperation of the nation states. I researched India as an example because it fits my hypothesis that globalization can cause more inequality for women. With other dominance of the richer countries, their MNCs, foreign investmSecondlyents and transfer of resources has undermined the role of India as a nation state. ORIENTALISM AND RACIAL DOCTRINESj *Empowerment thru collective action instead of culture Women who are involved in subsistence economies and do not partake in the industrialization process. Globalization in Developing countricesk Globalization in fundamentalist societies Inequality as a tool Traditionally, men monopolize politics and Organisations The role of Democratie Engendering local and national politics References Hoover Institution: globalization versus imperialism Hoover Report February 11, 2002 Hoover Daily Report, produced by the Hoover Institution Office of Public Affairs Florence Jaumotte, Subir Lall,and Chris Papageorgiou : Rising Income Inequality Technology, or Trade and Financial Globalization?

Recovery Programme For Patients Undergoing An Anterior Resection

Recovery Programme For Patients Undergoing An Anterior Resection The topic I have chosen for my project is the Enhanced Recovery Programme (ERP) for patients undergoing elective colorectal surgery, and whether this aids with early discharge from hospital. I shall discuss traditional pre and post operative assessments alongside the one used for ERP. I will also discuss each of the seventeen modals used within ERP and how when it is used collaboratively can aid with early discharge. I will also discuss any complications that arise from ERP and traditional surgery and if there is any difference to the patient. Within the conclusion, I will discuss the findings and any way of gaining additional knowledge and skills. I will undertake a comprehensive search of literature using the cinhal, pubmed databases and reading literature that is available within the university library. I will use quantitative research to analyse my data and incorporate this and any further learning into my conclusion. During the last four years of my training, I have developed a keen interest in colorectal surgery and this is something I would like to expand on when I become a qualified nurse. I have nursed a lot of patients on the Enhanced Recovery Programme, but I have never looked into this at any great length and I wanted to see if this had any benefit to the patient or even whether it truly did mean early discharge from hospital. In the early part of the 1990s, surgery underwent a drastic change it went from using long lasting anaesthetics to shorter fast acting ones. Combining the new anaesthetics and analgesic methods together with new surgical techniques, a new surgical pathway was created and this seems to have shortened the post operative recovery period. This means that patients could be taken out of main operating theatres as they didnt need as much recovery time. Minor surgical cases were moved to smaller day stay units (Apfelbaum 2002). The term for this new pathway was called fast tracking. Recovery times for patients on the fast track programme were considerably shorter in comparison to those patients that were not. Arguments were bought up to justify the use of fast track surgery such as reduce the nurses workload, reduce hospital costs and improve patient care by getting them back to their preoperative condition more quickly (Watkins 2001). The expansion of fast track meant that more surgical pro cedures were being performed as day cases. The expansion of the fast track concept to colonic surgery was pioneered by Henrik Kehlet, a surgeon of the Hvidovre University Hospital in Denmark. He stated that of 60 patients who underwent a colostomy on the fast track programme, 59 required a hospital stay of two days. In 2001 Enhanced Recovery after surgery (ERAS) group was formed, it was their job to look into the case mix, clinical management and clinical out comes of colorectal patients. What they found was that in Denmark, the length of stay was considerably shorter than Edinburgh, Sweden and Norway who were practicing care that is more traditional. The length of stay within Denmark was 2 days and the other 4 had an average stay of between 7-9 days (Nygren 2005). With the experiences of Denmark in mind, ERAS group developed a new evidence based concept that was holistic in its approach. There are 17 key elements to the Enhanced Recovery Programme (ERP) (appendix1). The 17 elements can be divided into 3 facets Preoperative, Intraoperative and Post operative. Each one of these facets is evidence based and only when they are used collaboratively in elective surgery do they produce a paradigm shift on how we manage our patients. The concept of ERP is to increase patient satisfaction and decrease patient complications. A patient preparing for traditional open bowel surgery used to be prepared in pre-operative assessment for a stay in hospital of around 14 days (Rickard et al 2004); Enhanced recovery patients are being prepared for a stay in hospital of 5 days (Elwood 2008). What ERAS did was to discover that there is a gap between evidence and practice, one of the consistent findings in health service research was what should be done according to scientific evidence and best clinical practice (Bodenheimer 1999). Improving the quality of care increases the amount of patients that are seen each year. This is because the right things are being done in a timely and organised fashion. Preoperative The effectiveness of the Enhanced Recovery Programme (ERP) depends on changing the patients outlook on their hospital stay. Encourage patients to believe that a shorter stay in hospital is a viable option. Department of Health (2009) states that the enhanced recovery uses evidence based interventions both pre and post operative. It is well established that stress levels rise when faced with the prospect of surgery but this concept has recently been challenged by Fearon K (2005a) in which he suggests that elements of the stress response can be reduced or even eliminated with the application of modern anaesthetic, analgesic and metabolic support. The ERP relies heavily on a multi professional approach involving all members equally. Tradition was that doctors gave the pre assessment teaching. But due to time constraints on the consultants, this was often rushed due to the amount of other patients that needed to be seen and not all patients questions were answered. The introduction of nurse specialist pre assessment clinics helped alleviate some of the pressure, and the atmosphere was more relaxed and the nurses understanding of the programme made it easier for patients to follow (Crenshaw, Winslow 2002). It is essential that all patients are well prepared for the operation, not just for a check on their physical condition but also their psychological needs. Looking after the patients psychological needs is an important part of the enhanced recovery programme as it helps reduce the stress of surgery. Patients are counselled on the important parts of the enhanced recovery programme such as early mobilisation and diet resumption. Screening for malnutrition will also take place at this appointment it should include weight, height and the body mass index should be calculated and any unintentional weight loss should be calculated use of the malnutrition universal screening tool (MUST) should be used (appendix 2). It is also reasonable to discuss discharge at this point. A patient being diagnosed with any disease is hard enough to deal with but then to be told you need an operation. Obtaining consent is a vital component to the success of the programme. Gaining consent is more than signing a bit of paper (Department of health 2009). Consent must be given freely and without coercion. All the facts must be given about the treatment and any risks should be discussed. The core ethical principle according to royal college of nursing (2004) is respect for the individuals rights. Gaining consent is a legal requirement. As a nurse the NMC (2008) states that, we are accountable for our own actions so we must ensure consent is obtained before any procedure is carried out. Some patients may not wish to know all the facts if this is the case the consultant in charge of the patients care should document this in the patients medical records, and all healthcare professionals should adhere to this. Patients are encouraged to bring in their own clothes so they are not sitting around in bed all day. Patients with disabilities or who may require more help are also identified at this visit. It is explained in the pre assessment what is expected of the patient after surgery. Clarke (2005) suggest that only forty two per cent of day surgery patients in the UK are currently offered a pre-assessment visit, within my own personal experience a pre assessment appointment is well advised, as this gives the patient time to ask any questions and alleviate any last minute fears. This part of the ERP has not changed from the preoperative counselling for traditional surgery. The preoperative assessment is a critical component of ERP as it gives patients autonomy over their own care. One of the main principles of the enhanced recovery care is that bowel preparation is avoided as this can cause dehydration and electrolyte imbalance particularly in the older patient (Burch, J.2009) a point that is also raised by Holte (2004a) he also goes on to state that bowel prep can also be very stressful. The trust that I am placed only one of the consultants uses bowel preparation usually in the form of an enema as these help prevent post operative constipation and contamination of the surgical area by faeces and is only ever used if a stoma formation is not required. Bowel preparation is still used for traditional surgery with oral sodium phosphate being the most convenient method. However concerns were raised that by not giving bowel preparation this could cause problems post operatively, but these fears have not surfaced (Holte et al 2004b). A recent study by Guenaga (2005) suggested that giving oral bowel preparation can cause anastomotic leaks, and may cause wound infect ions and possibly death. Nil by mouth after midnight originated in 1946 when reports suggested that a higher risk of pulmonary aspiration existed among patients that had general anaesthesia that had not fasted. Reassessment of this tradition began in the 1980s where numerous studies failed to demonstrate that fasting ensured that the stomach would be empty (Crenshaw, Winslow 2002). Also noted was patients that had prolonged fasting would complain of headaches, dehydration, hypovalemia and hypoglycaemia. As a result, in 1999 American Society of Anaesthesiology developed guidelines that support a more liberal preoperative fasting protocol. The original belief of nil by mouth (NBM) from midnight before surgery is still widely adopted for some surgical procedures and is still applied to some elective cases (Maltby 2006).Consumption of oral fluids up to 2 hours prior to surgery is known to reduce post operative vomiting without any adverse effects, contrasting with patients that are starved normally prior to surgery (Khoyratty, Bhavik, Ravichandran 2010).There are several elements of the programme that are important, one element is the careful use of fluids, traditional surgery uses too much (Burch 2009). It is documented that hyperglycaemia increases diabetic complications, in a study by Nygren et al (1999) also found that patients that werent Diabetic had the same amount of glucose within their blood work as patients with type2 diabetes. Patients on the enhanced recovery programme are given two clear carbohydrate drinks to take: 800mls is taken the night before surgery, 400mls is to take with breakfast (Grover 2010) this reduces the preoperative thirst and hunger but it also reduces post operative insulin resistance, therefore patients are in a better anabolic state to benefit from post operative nutrition, The Carbohydrate drink consists of 12.6g of complex carbohydrate in the form of Maltodextrin Nygren et-al (2006). Having these carbohydrate drinks is the equivalent of having 2 roast dinners. A patient on a morning list must not eat after midnight but can have clear fluids until 3am. In contrast, consumption of an appropriate mixture composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Oral intake shortly before surgery does not increase gastric residual volume and was not associated with any risk of as piration. For normally nourished patients restoration of gastrointestinal (GI) function is one of the primary goals of post operative care. A recent study by Khoyratty, Bhavik, Ravichandran (2010) found that many of their patients voluntarily fasted longer than was given in the written instructions this is not advisable as this can cause post operative complications and can delay the healing process. This was also noted by others (Baril Portman 2007). Food and drink is a basic need and is needed to sustain life and aid with the healing process. A patient will routinely have a catheter inserted on the operating table and close monitoring of Urine output is vital, minimum output per hour is usually 35mls if it reduces then the team should be called because understanding fluid management is vital for the ERP to work. Intravenous fluid will have been prescribed avoiding normal saline and ideally stopping after 24hours (Billyard et al 2007). Fluid balance charts are vital as 60% of a males body weight and 55% of a females body weight is made up of water and electrolytes; one third of this fluid is extracellular (ECF) and two thirds intracellular (ICF). A reduction of 5% in total will result in thirst and thus considered to be mild dehydration (Welch 2010). Inadequate fluid intake or fluid loss can also cause dehydration. Patients who have had major abdominal surgery will have some fluid loss. With reference to preoperative and post operative patients Intravenous fluid on traditional surgical patients were given 3.5 to 5l of intravenous fluid on the day of surgery (Tambyraja et al 2004) however recent studies have found that providing no more fluid than is necessary to maintain fluid balance (for example a patients body weight), as this reduces post operative complications thus reducing a patients stay in hospital (Brandstrup et al 2006).For more traditional surgery the patient would normally be on restricted oral intake but this is not the case with ERP so monitoring intake is vitally important. Poor urine production can lead to renal failure and electrolyte imbalance. Monitoring fluid balance is important because as nurses we need to carefully monitor a patients input and output, as poor monitoring can lead to poor outcomes. The hourly catheter bag is changed to a leg bag on day 1 after the operation to make it easier for the patient to mobilise but strict fluid balance must be maintained (Burch J 2009). This should include stoma output if a patient has had a stoma. The catheter is usually removed on day 2 post operatively as long as there are no post operative complications and strict out put is still monitored. While fluid balance charts are a good and useful tool for monitoring fluid balance they are only as accurate as the data recorded on them, another good way of monitoring fluid loss or gain is to weigh a patient, as 1000mls is equivalent of 1kg any rapid weight gain can be directly related to a change in fluid status. The detrimental effects of fluid imbalance can be life threatening, therefore the importance of strict monitoring and accurate recording can not be stressed enough. Nursing staff of all levels should strive to complete fluid balance charts as fully and as accurately as possible. Traditional surgery required starving a patient the day before surgery. When a patient returned from theatre they were not allowed to eat until the Surgeon could hear normal bowel sounds and sometimes this may not happen for 4-5 days post operatively. So a patient could be starved of anything to eat and drink for as long as a week. A patient undergoing colorectal surgery may already be malnourished and the complications following surgery are greatly increased. Malnutrition can affect every tissue, muscle and organ within our bodies it can also have an affect on our psycho-social welfare (Todorovik 2003). National Institute for Clinical Excellence (2006) state in their nutritional support in adults that malnutrition is usually caused by physical factors. A recent study into nil by mouth versus early feeding found that of 837 patients that met with inclusion criteria found that early feeding reduced the risk of any type of infection although the risk of vomiting was increased (Lewis, e t al 2001). Patients on the programme are encouraged to drink and eat straightaway if they feel like it. Usually sips of water are offered and if tolerated they are offered nutritional supplements to drink, usually one about an hour after surgery, if this is tolerated then another will be given and left for the patient to drink at leisure (Fearon 2005b), Billyard (2007) contradicts this and states: the patient should drink at least 2L including three nutrition drinks on returning to the ward. Once a patient can tolerate fluids without vomiting or feeling nauseous, they can progress on to solid foods usually something light. A concern for surgeons was post operative ileus (POI). POI is a well recognised consequence of any abdominal surgery and is frequently experienced by patients, Leir (2007) states that it is not a life threatening complication but is a costly post operative complication. POI is defined as a transient impairment of intestinal motility after abdominal surgery (Han-Geurtz et al, 2007).There are many factors that have shown to increase its progression such as Local intestinal inflammation Anaesthetic Agents Over hydration Post operative analgesia(opiates) Reduced mobility. POI along with nausea and vomiting are the most common complication. POI can be minimised with the use of epidurals. Scoop et al (2006) stated: that mid-thoracic epidural is considered the pinnacle of the enhanced recovery programme. Although it is possible to use Patient Controlled Analgesia (PCA), Morphine can increase the risk of vomiting it can also cause the bowels normal peristaltic movement to temporarily paralyse. Recent research in to POI and the different approaches to treatment found by giving a patient chewing as a form of Sham feeding (making the body think it was eating) helped with gut motility. Schuster et al (2006) found that gum was an inexpensive and of some benefit after colostomy formation. Five randomised trials of chewing gum to restore the natural gut motility found that patients who were chewing gum passed flatus 24% earlier and had bowel movement 33% earlier, which shows a significant and positive conclusion of early discharge which on average 17.6% earlier than those that did not have the chewing gum (Chan and Law 2007). POI is usually diagnosed with symptoms of nausea and vomiting along with abdominal distension, pain and the failure to pass flatus or faeces. Parnaby et al (2009) found although flatus and faeces were passed earlier in patients who chewed gum it did not have any bearing on early discharge or post operative complications. If tachycardia is present then other causes should be excluded. The treatment for POI is inserting a nasogastric tube (NG) although one is inserted during the intubation process during surgery it is removed as soon as the surgeon has finished operating because there is good evidence to suggest that leaving a NGT in place can cause pneumonia (Cheatham et al 1995). Once a diagnosis of POI has been made, all oral intake should discontinue, and the patient should be removed from the programme and the traditional approach should commence. Patients are encouraged to take regular anti emetics to aid the patient with early return of oral intake the trust that I work cyclizine is the anti emetic of choice. Post operative pain is always a concern this is why Professor Kehlet designed the ERP because he believed every patient deserved to have a pain free recovery. For patients to understand pain nurses need to be able to educate the patient. Biggs (2009) states that less than 1% of university education is spent on pain and the effects of pain. It is vital that nurses have an understanding of pain physiology in order to educate our patients and in turn increase patients knowledge and reduce anxiety, increasing patient satisfaction. Regular pain assessments should be maintained at rest and on movement by a competent nurse (DH2009). It is stated by Vickers et al (2009) that pain should be classed as the Fifth Vital sign. In postoperative patients on ERP, it is vital that nurses monitor pain because pain can reduce a patients motivation for all the other parts of ERP. Concerns have arisen about the use of thoracic epidurals as the analgesia of choice due to immobility and urinary retention, but if inserted high enough in a thoracic position it is possible to mobilise safely and with fewer side effects such as constipation, this means that opiates which have an adverse effect on the bowel can be avoided and again this can facilitate to an earlier discharge. 1 gram of paracetamol is given 4 times a day and is given in conjunction with PCA or epidural, this is also part of multimodal approach. Also, the afferent nerves are blocked resulting in less stress response less gut paralysis and a decreased risk of pulmonary complications (Jorgenson et al 2000). The epidural dose is reduced 48 hours after surgery, and once epidural is running at 2mls per hour then a trial without epidural should commence and pain reassessed after 1 hour if minimal or no pain then commence co codomol 30/500 every 6 hours and oral Non Steroidal Anti Inflammatory Drug (NSAID) diclofenac 50mg every 8 hours (British National Formulary, 2009) with this in mind the consultant can prescribe a mild laxative for patents as this will avoid constipation although this is not the case where stoma formation occurs. Alternatively, at the anaesthetists request oral paracetamol 1g 6 hourly may be given also diclofenac 50mgs 8 hourly and 10-20 mgs of Oxynorm every 2-4 hourly. As a nurse I am aware of the importance of pain management within the ERP because psychologically a patient in pain will not feel like eating, or mobilising so keeping on top of pain by using trust pain charts and ensuring that pain relief is delivered on time helps reduce anxiety. In theory, there is not hing stopping nurses from giving paracetamol or co-codamol every 4 hours during the day as making the patient comfortable will aid sleep meaning that paracetamol or co-codamol will not be needed between midnight and six in the morning, it also means that extra pain relief may not be needed thus reducing post operative complications. On saying all of this post operative pain is believed to be at its worst directly after surgery and the intensity is expected to diminish over time (Buyukilmaz et-al 2010), the World Health Organisation analgesic ladder (2007) is used in reverse for surgical patients. on return from surgery patients, initial observations should be taken by the trained nurse so she has a baseline to work with. All further observations should be meticulously maintained as per any hospital policy. The use of Bair huggers during surgery has reduced the incidence if hypothermia during the operation it is important to maintain a constant core temperature as it was found that all of the anaesthetics used during operations caused hypothermia also there are several non pharmacological reasons that warrant the use of Bair huggers for example shaving the surgical site (Sessler and Akca 2002). Wound infection is a serious and costly complication. During colorectal surgery, the incidence of wound infections increases to 10%. Ikeda et al state that all incidences of wound infections occur during the first two hours of any surgical procedure. The primary connection between hypothermia and surgical site infection (SSI) is vasoconstriction because of a decrease in tissue oxygenation and if a patient is immunosuppressed which most colorectal patients are this can also cause SSI. Blood loss during surgery can increase the risk of SSI due to blood transfusions during surgery. On return to the ward from recovery the nurse in charge of the patient must ensure that the wound site is checked for bleeding and check the dressing for any sign of strike through the nurse would expect to see some excess on the dressing but it should be regularly monitored so any problems can be found early. Port sites where a patient has had laparoscopic surgery should be checked. When a stoma has been formed, the nurse should look at the site making sure it is pink/red in colour and it is warm and there is no excessive bleeding. Wound infections can delay discharge so any problems should be found early reported to the patients team and the correct antibiotics can be prescribed early and may only delay discharge by 2-3 days. Anti thrombotic prophylaxis is a must within colorectal surgery; treatment is usually commenced the evening following surgery and continued on a small maintenance dose of 40mg of enoxaprim (Dylan 2010) until the patient has regained full mobility. There are no further advantages in general surgery for extended use of enoxaprim but there are advantages for patients undergoing orthopaedic surgery. Associated use of low dose heparin and continuous use of epidural analgesia is open for discussion as there have been reported cases mainly in the United States of epidural haematomas (Tryba 1998). A patient undergoing stoma formation under ERP pathway can have their discharge delayed due to teaching, on how to care for the stoma. Although pre-operative teaching does occur, the reality often does not sink in until after the operation. The stoma nurse specialist will see the patient on the day after the operation. The patient returns with a clear see through bag so nursing staff can see when t he stoma becomes active. Teaching begins at the bedside where the patient may only want to observe the proceedings, but all of the time the stoma nurse actively encourages the patient to take note of the proceedings. Psychologically the patient may need lots of reassurance as to them this is not natural (Rust 2007). A patient with a stoma should plan for a stay in hospital between 5 -10 days and it usually takes this long for a patient to be able to manage their stoma. To become self caring with a stoma is the patients biggest psychological battle (Bekkers et-al1996). So on my understanding of the research available stoma formation does infact delay discharge by four days depending on the patient and his/her ability to manage. Patients are not always proactive recipients of care (Ellwood 2008). Early Mobilisation is important to reduce complications such as chest infections. Chest infection rates have dropped from 4% to less than 2% this is because patients are not laying in bed for days. Bed rest not only increases insulin resistance it also decreases muscle tone and in addition, there is an increased risk of thromboembolism. On the ward, the physiotherapist has a book which nurses can refer patients and patients should be seen on day 1 following surgery. Patients are encouraged to sit in the chair for two hours on the day of surgery to encourage deep breathing (Francis 2008). A care plan should be formulated with a specific mobilisation plan incorporated. It is essential that a patient should be nursed in an environment that encourages early mobilisation. Anti embolic stockings are also prescribed. The stockings facilitate venous return from the lower extremities. They also provide venous thrombosis. As nurses, we should make sure the patient is lying down as this allows the veins to relax. The stockings should be removed at least once a shift, so that the nurse can inspect the patients legs and feet for any signs of redness as the skin around the heel can break down very quickly. Encourage leg exercises every hour during the day. Muscle contractions compress the veins, preventing a clot. Contractions also promote arterial blood flow. The introduction of the enhanced recovery nurse has been invaluable not only for the patients but also for staff. The role of the ERP nurse (ERPN) is fundamental to the programme as she/he co-ordinates patient care from the beginning. The ERPN works freely within the colorectal team seeing patients in clinics. He/She helps the patient through their hospital admission reinforcing the goals and liaising with hospital ward staff. ERPN works closely within the surgical team, colorectal cancer team and stoma nurses. The biggest challenge for the ERPN was changing the practice of nursing staff on the wards repeated teaching sessions with all new nurses and doctors with regular feedback and all new updates to the programme (Elwood 2008). Unfortunately, within the trust I am placed the already busy colorectal cancer team initiate all of the teaching, ERP has become a large part of the daily schedule within the trust that a need for an ERP nurse is deemed necessary and funding for the post has become available. Although regular care pathways and protocols are in place, an integrated care pathway was drafted but due to increased pressure from our consultants the document was abandoned, and deemed unworkable but after reviewing the evidence it seems to be used within most other trusts that incorporate the ERP as part of their surgical planning. Nursing interventions within the ERP can influence the out come so it is important that the nurse looking after the patient has the most up to date knowledge and skills and able to detect when a patients condition deteriorates. Another useful tool is a patient diary so that the patient can keep a record of when they got up so the patient is aware of when they can get back into bed. On the first day of surgery, the Patient should aim for 2 hours and then 6 hours until discharge (Fearon et al 2005). Patients are encouraged to walk 60 meters from day one post operatively. To enable continuity of care nurses need to consider the clients needs for assistance within the home. Discharge planning begins even before the patient comes into hospital; the process is usually started at pre admission clinic. The nurse will take a full social history; this is obtained so nursing staff on the ward are aware of any social problems. Fearon et al (2005c) stated that patients are fit for discharge after the following criteria has been met Have good pain control with oral analgesia Are eating solid food and no Intravenous Fluids Are independent with all ADLs And willing to go home All patients should be discharged with an information leaflet including a telephone number of the ward in case they have any problems. In some of the trusts, an enhanced recovery nurse specialist post has been created and on discharge, the ERPN will telephone the patients on the programme at home to allay any fears and to check that there are no post operative complications. a telephone helpline has been set up at one London hospital so that patients can have direct contact with someone during out of hours and they are hoping that this will reduce the amount of AE admissions. The ward I worked on would refer all patients on the ERP to the district nurse with first visit being on the day of discharge, making sure that the referral form states that the patient is currently on ERP. Patients can telephone the ward if problems occur within the first 24 hours. Because patients on ERP are discharged earlier, this means that potentially serious complications can occur at home for example ana stomotic leaks (King et al 2006). Therefore, it is important that patients have a port of call once they are home and within the community setting. The need for support at discharge is also unlikely, compared to a patient who has traditional open surgery Readmission rates for patients on ERP shows that from 1998-2008 334 patients of which 99 (30%) were on ERP and 235 were not (Larsson et-al 2010). The 99 on ERP tolerated soft diet approximately 2.5 days earlier than those not on ERP and were discharged at least 2 days earlier from hospital. Recent research done by 2 Doctors searching the colorectal cancer data base for the trust found; ERP has reduced the length of stay by 3 to 5 with no change in mortality or readmission, the best results came from a gynaecology ward where the nursing staff followed the ERP care pathway in its entirety. Conclusion Traditional Perioperative procedures and prac

The Alchemist Essay -- essays research papers

"That's the principle that governs all things. In alchemy, it's called the Soul of the World. When you want something with all your heart, that's when you are closest to the Soul of the World. It's always a positive force" (80). Anything I've ever wanted to happen bad enough, there has always been a way for me to achieve that goal. Or an alternative that could be more beneficial appears. Except, I wouldn't quite call it the Soul of the World. I'd call it the will of God. Both Santiago in "The Alchemist" and the priest's son in "The Water's of Babylon" worked with the Soul of the World or the will of God. Whatever one calls it, the Soul of the World or the will of God, it is an unstoppable force. If there is a will there is a way. 	Santiago's goal was to reach the treasure at the pyramids in Egypt. From the moment he had the dream about the treasure, the world worked with him so he could realize that goal. Here, Santiago discovers some good omens for his journey: " 'In order to find the treasure, you will have to follow the omens. God has prepared a path for everyone to follow. You just have to read the omens that he left for you.' Before the boy could reply, a butterfly appeared between him and the old man. He remembered something his grandfather had once told him: that butterflies were a good omen. Like crickets, and like expectations; like lizards and four-leaf clovers." 	Even when Santiago had almost given up his j...

Oranges are Not the Only Fruit and the two letters in The Color Purple

Oranges are Not the Only Fruit and the two letters in The Color Purple The Chapter 'Joshua' in Oranges are Not the Only Fruit and the two letters in The Color Purple, where Sofia returns and later gets brutally punished for her confrontation, both explore fundamental issues that characterize a lot of the essence of both novels as a whole. At the heart of both of these two sections is the idea of fighting for the truth and facing the consequences. Although Oranges are not the Only Fruit is written in a retrospective light and The Color Purple in epistolary and consecutively in chronological order, there are similarities within the two styles, they use similar techniques in getting across certain issues. The novels use the people around Jeanette and Celie to convey oppression and hope. Janet's church people and mother have found out about her "unnatural passions" for Melanie. To them their opinion at its wrongs and sinfulness is not opinion but fact. Thus for Janet's "own benefit" they lock her up with no food or light, inflicting an exorcism on her. They believe she is demon possessed and want to rid her of the evil. In this period of confinement, Jeanette questions her sexuality and its wrongs. She states: "Can love really belong to the demon." She realizes that her feelings are not from external influences, but rather from herself. - "If they want to get at my demon they'll have to get me." She is controlled with the idea of the church, and at the same time the naturalness she feels with the feelings: "Demons are evil, aren't they?" She then goes on to say: "But in the Bible you keep getting driven out." - "Don't believe all you read." This in itself is addressing the idea of oppression from the chu... ...d this gives way to the proceedings in the novel as a whole. In The Color Purple, we are left with Celie caring for Sofia who has been so brutally to the ground. Sofia was imprisoned and left to face the circumstances for standing up for what is right. She is thus a heroine in her own right and is an example for Celie. Jeanette was imprisoned (exorcism) and came out of it knowing that she was going to put up a fight for her own truth and to face the circumstances. In Oranges are Not the Only Fruit as a whole, the "Joshua" section stands for truth and Jeanette decides to fight and this indicates the future progression of the novel. In The Color Purple, Celie sees truth being fought for and the result of this fight. These gives her determination and if can fight like that, she can at least fight against male patriarchal Oppression and her love for Slug.

The Fatal Grudge :: essays research papers fc

â€Å"For I have decided to send Ad Patres[Spanish for â€Å"to the fathers†] the feminists who have ruined my life.† -Marc Lepine, suicide note. It was the early evening of December 6, 1989; just nineteen day’s before Christmas. The students of Montreal’s Ecole Polytechnique were just finishing their classes when a stranger walked into the engineering building. Like a sadistic Santa he carried a Sturm Ruger Mini-14 automatic rifle, knives and bandoleers of ammunition. The stranger was Marc Lepine. At the end of the day he would be dead along with 14 women; leaving a suicide note blaming feminists for his actions. Marc Lepine’s brutal actions are a shocking reality check of the growing number of savage acts done by men towards women. There has always been a difference between men and women and how both treat each other. You could say the two genders secretly hold a grudge against one another. This grudge will on occasion surface and cause conflict between the two; either in a peaceful matter or violent outburst. What causes this resentment? In the women’s case many feel they do not have the same privileges that men have. On the other hand, some men say that women are now stealing the privileges which were hard enough to attain while competing with their own gender. Stevie Cameron also recognises this and states â€Å"Sharing power is not easy for anyone and men do not find it easy to share among themselves, much less with a group of equally talented, able women.† (2) This tension is then the hotbed from which these acts of violence must originate from. Women are considered by most men to be less physically inclined. Is this true? In the past men have always been the symbols of strength and fortitude, while the women represented the more gentler and timid qualities. This unfair outlook is alive and well in today’s day and age. Although it’s not nearly supported as strongly as it once was it still sits in our subconscious, dictating our actions as a society. For instance, if you took a 18 year old boy and a 18 year old girl, they have a very different set of rules to follow. These rules are set by their parents who make them based on the previous presumptions. So the girl will find it unfair that the boy, who is considered her equal, can go where he wants, when he wants.

Rebellion in Hunger Games

The Hunger Games by Suzanne Collins is written in the voice of 16-year-old Katniss Everdeen, who lives in the post-apocalyptic nation of Panem, where the countries of North America once existed. The Capitol, a highly advanced metropolis, exercises government power on the rest of the nation. The Hunger Games are an annual event in which one boy and one girl aged 12–18 from each of the twelve districts surrounding the Capitol are selected by lottery to compete in a televised battle to the death.The main idea in the book was teenage rebellion which is shown by Katniss where she and Peeta change the rules at the final moments of the Hunger Games. Peeta and Katniss decide not to fight each other to see who will win the Games, but instead to deny the Gamemakers any winner at all by eating some poisonous berries in a double suicide attempt. As Katniss said † Without a victor, the whole thing would blow up in the Gamemakers' faces. They'd have failed the Capitol. Might possibly even be executed, slowly and painfully while the cameras broadcast it to every screen in the country†.Instead of allowing the pair to kill themselves, the Gamemakers change the rules of the game once again and declare both Peeta and Katniss winners. The double suicide attempt is an act of rebellion towards the Capitol. Even after she's out of the arena, Katniss fears that the Capitol will somehow punish her subversive behavior with the power the government has over them. In reality, teenage rebellion isn't always negative and can be positive like what Katniss and Peeta have done to save their lives. Katniss also shows teenage rebellion where she sacrifices her life on a daily basis by going into the woods to provide for her family.With hunting being illegal and holds high consequences with the chance of getting caught she and Gale sacrifice their lives to hunt and to bring food for their family. Her courage to provide for her family shows that she is independent. In the movie she slips through wire fences to meet Gale becuase she feels like its her job to provide becuase she doesnt know any other way to. Covering Rue with flowers is an intense act of rebellion against the Capitol. The experience of witnessing Rue's death inspires Katniss to go on and win the Games and to prove to the Capitol that they can't strip the tributes of their humanity.By calling attention to the sacrifice that Rue made during the Hunger Games, Katniss challenges the idea that Hunger Games – and the people who play them – are mere entertainment for the audiences back in the Capitol. For Katniss, Rue isn't simply a character on a television show. She is a human being who is worthy of respect, admiration, and mourning. When she says â€Å"I want to do something, right here, right now, to shame them, to make them accountable, to show the Capitol that whatever they do or force us to do that there is a part of every tribute they can't own. That Rue was more than a piece in their Games. And so am I. â€Å"

Creative Writing – My Baby

I was walking in the thick white snow, my cheeks pale pink, and my eyes wet, from the cold, razor-sharp wind that seemed to blow across my face. My hands in my pocket, and my head down prevented me from seeing my way, so I raised my head. All of a sudden, my eyes met his across the street; he was tall, with sea blue eyes and long strawberry blond hair, which made him look ugly. But his eyes distracted me from seeing his flaws. His small white teeth showing in a smile, when he returned my stare. I was warm; my cheeks grew bright red, my eyes flooded with admiration for his looks. â€Å"Was it love or lust†? I thought as, I continued to stare at him. He was so kind, loving and caring, with a great personality that always made me smile, while I slept. He constantly made me feel good, and I loved him so much; that I could stay awake just to hear him breathing. Due to the fact that we were so young, we couldn't consummate our love for one another. I was 17, and he was 18, when we both decided that we should take our love to the next level. We wanted it to be special, so we could treasure the moment for the rest of our lives, therefore we lied to our parents about where we were going. We stayed in a cottage, which had a fire place. We made love in front of the fire place. The fire made our body, so hot, and sweaty. I smiled, keeping the pleasure from showing in my eyes. I wish could spend the rest of my life in this sweet surrender. After we made love I felt, like I have never felt before; I was far away dreaming, I was in ecstasy. The art of making love was new to me, but was exhilarating. Satisfaction drowned my body. Our body became one; and we shared deep love and feelings. I have no recollection of being this happy before, but we made one mistake. We forgot to use protection-condom. At school we were never taught sex education. Anytime I asked my mum, about sex she would make me wash my mouth out with soap, then take me to church and tell the priest he should pray for me, because I was turning to sin. I always laughed when she did it. So I did it often just to watch her reaction. Three months later I found out I was pregnant. I knew I was pregnant because I had missed my period for three months; also I got fat, and had morning sickness. I did not tell the father that I was pregnant. I didn't want to, he wouldn't have stayed anyway. But every moment I spent with him I treasured. I didn't want to have the baby, I was too young. I thought of many ways of getting rid of the baby with out killing it. I didn't know what to do, or who to tell. It was too much for me to handle. So I decided to tell my mum. Telling my mum was the worst. When I told, her normally blue-gray eyes grew green with hatred. Then her lips tightened against her reply â€Å"ok darling†. She did not shout, scream nor sob. I felt as if in her reply there was a plan. Six months later. I was ready to give birth. I preferred making the baby, than  giving birth to it, as I dreamt far away of the night it happened. It was as if my scream of pain, triggered the baby. My baby was born; he was small, and breathtaking. My breath was taken away when my mum said â€Å"you can't keep him†. There was no way I could speak; my voice had gone with shock. She took my baby away from me. I turned away so she could not see the expressions in my eyes. It took a moment for the shock-wave of pain to travel down my body, to my brain. The agony was so intense that a scream involuntarily tore its way from my throat. I hated her for what she did. My mum and I lived in silence, in a house where the love had been stolen. Although I stayed to take care of her, because she was ill with Alzheimer. Since my baby was gone I had no love to give, I had put a brick wall around my heart, which was guarded by my hatred for the world. At home in the sitting room drinking my daily caffeine shot, while watching DR PHIL, and my mum rambling incoherent words to the T.V. The phone called for me. The voice came through the telephone, echoing through a corridor 12 months long. â€Å"We have an address†, said the voice on the phone, my heart started to beat loud; it got so loud it made the voice the inaudible. 314 maple road, Leicester, could be where  my son lives.  I hesitated when I got to the door. I didn't want to ruin his happiness, in his new  life. â€Å"But my happiness has already been ruined,† I said selfishly. My finger trembled as  I rang the bell twice. A little boy answered the door. Many questions argued in my mind all at once; could he be my son? Could this be my baby? I felt happy when he spoke; â€Å"hello â€Å"said the soft voice. I could stay lost in this moment forever.