America as a Nation of Immigrants

America will become an immigrant country, now and then immigrant country: crucible. Since the time when Amarazar's poem was engraved on the Statue of Liberty, Golden Gate saw Americans open doors and most immigrants were closed (course 4). Many people view current immigration problems as purely a modern dilemma. In fact, the United States has worked hard on solving immigration issues, including legal illegal immigration issues. A: Immigration control reform is part of a solution to build a stronger, more successful, unified country. The United States is an immigrant country, and immigrants welcome reflecting important values ​​that the country is based on: diligence, perseverance, acceptance of challenges, representation and character of individuality. In addition, immigration reform is a common problem between the two parties, and everyone can agree that an effective immigration control system will help build a stronger country - economic, social and cultural. Immigrat ion prevention experts treat immigrants as future threats and disregard the importance of immigration to the future of the United States. There are many legal issues that need to be questioned and discussed in immigration policies, but I will use this topic as a wedge issue, causing fear and uncertainty. America will become an immigrant country, now and then immigrant country: crucible. Since the time when Amarazar's poem was engraved on the Statue of Liberty, Golden Gate saw Americans open doors and most immigrants were closed (course 4). Many people view current immigration problems as purely a modern dilemma. The interests of illegal immigrants in 2012 Is immigrant immigrants or immigrants not listed in the document beneficial to the US economy? Most illegal immigrants have a positive effect on the US economy. Illegal immigrants had a positive impact on the US economy as we increased our taxes, increased social security and increased employment rates. According to statistics in 2 000, there were 8.7 million illegal immigrants living in the United States (Nick Bock

Project Managment - Team work Evaluation Assignment

Project Managment - Team work Evaluation - Assignment Example The activities that fall under these two processes are; decision on leadership through voting, this is also in line with thinking through the purpose of the group, decision on tasks for each member is a strategy to ensure fair share in the workload, all the activities that come prior to tackling of tasks are under transition processes; the plans, goal specification and planning the activities here are like decision on the backup plan as a group to avoid clashing of roles, set up on calendar et al. (Kivipelto & Yliruka, 2012). Action processes are a vital part of the taxonomy, what is entailed here is actual activities that are the sole purpose of a team or rather a group. Information and data are assembled within, members writing down their ideas and opinions, communication of venues for meetings, working on writing skills and grammar are pronounced in this process. The leader sets goals to be completed in every meeting to avoid time waste, the leader also monitors progress. Upon completion of own work, there is team monitoring, members who complete their tasks earlier help their colleagues. Evaluation of work, provision of any vital feedback, coordination and often working in pairs come in action processes. More importantly, the time for completion of work is set in this process (Kivipelto & Yliruka, 2012). Interpersonal processes come later in the taxonomy of team processes. Orchestrating conflict management techniques is employed here. Upon the rise of challenges, the crew chief would exchange tasks of the group members and work in liaison with the group to find an amicable solution. Identification of individual attributes, i.e., strengths takes place and when disagreements occur a management process would be held for instance re-evaluation of objectives and vote on decisions for the best interest of the group. Encouragement occurred during meetings, because of the positive attitude shown. Working in pairs and communication

Methodology Essay Example | Topics and Well Written Essays - 1000 words - 3

Methodology - Essay Example Qualitative research methods provide the researchers with rich data and help him to broaden his horizon during the research. Moreover, it allows the researcher to look at the data with several perspectives and conclude it with the one that seems the most feasible in terms of research question and scope. Qualitative research, as mentioned earlier, is mostly used when the researcher is not completely aware about the fact that what exactly is being looked for (McBurney & White, 2009). In this case, the same is very much true. The topic here is the effect of globalization on Saudi Arabia. However, important here to note is that the effects are unknown and hidden and only this research would be able to reveal the same. One may start this research with a narrowed perspective, a presupposition in mind that the globalization may only have affected the GDP, trade volume, services sector and employment levels. A quantitative research method would allow the researcher to check out the relation and impact on all these elements in terms of past and present number. However, what if the researcher’s assumptions are faulty and effects of globalization are widespread on other elements as well. A quantitative research would fail to overcome this problem; however, a qualitative research definitely would. Nevertheless, qualitative researchers are often very subjective (Marshall & Rossman, 2010). Despite the fact that this type of research would provide many perspectives to the researcher, but he or she would definitely pick the one that suits most of him or her, thus leading to biasness. In addition, qualitative research also makes life difficult to conclude something since there is nothing in black and white (Balnaves & Caputi, 2010). Quantitative research is the collection of hard and numerical data that provides absolute, clear picture, black and white picture of the happenings. Unlike qu alitative

Pedro Paramo by Juan Rulfo Essay Example | Topics and Well Written Essays - 1250 words

Pedro Paramo by Juan Rulfo - Essay Example Thesis statement: The close examination of the novel Pedro Paramo proves that the writer’s diction is interconnected with his aim to portray the difference between past and present, symbolism is related to the symbols like rain and fertility, usage of imagery is related to air, water and stone, and figurative language is related to the development of magical realism as a specific genre in world literature. Plot summary The novel’s plot is related to the lives of the narrator (Juan Preciado), his father Pedro Paramo, and his (the narrator’s father’s) lover, Susana San Juan. One can see that Comala, the imaginary town, is the background of the novel. In the beginning of the novel, the narrator decides to conduct an expedition to Comala to find out his father. But he did not try to stick on to his decision. Later, he was forced to start his journey to the town of Comala. Within this context, the narrator portrays the present situation in Comala. Now, the situ ation is different because most of the people who live in this town are spirits/ghosts. In the work by Rulfo, Sacabo, and Peden, the narrator made clear that â€Å"Nothing but abandoned houses, their empty doorways overgrown with weeds† (19). ... In the end, the people of Comala were forced to die by starvation. Examination: This section includes topics like diction, which portrays the difference between past and present, symbolism or the usage of symbols in the novel like rain and fertility, the usage of imagery like air, water and stone, and the usage of figurative language which represents the development of the genre of magical realism. A. Diction One can easily identify that the novelist’s ultimate aim in the novel is to make use of the story telling technique (first person and third person narrative technique) to portray the difference between past and present. For instance, the opening of the novel deals with the present condition in Comala, which is described by the narrator. On the other side, after the narrator’s untimely death, the narration suddenly shifts from first person to third person. In this way, Juan Preciado becomes unimportant in the following sections of the novel. From a different angle o f view, both the son and the father are no more and narration is handed over to the novelist. At the same time, this technique does not hinder the development of the plot because the same revolves around Pedro Paramo’s adventures. In this way, the novelist fulfils his aim to portray the difference between past and present. B. Symbolism The symbols like rain and fertility are interconnected because rain is symbolic of life/fertility. In the novel, the element of rain is made use by the novelist to portray the problems faced by the people of Comala. To be specific, the present condition in Comala is related to the lack of rain and the negative attitude of the leader (Pedro Paramo). Here, the leader is symbolic of rain which provides all to the living world. On the other

History of Medieval Welsh Law

History of Medieval Welsh Law I will first look at Roman Law as this will give me the best understanding to see if Medieval Welsh Law was built up from Roman Law, or whether the medieval law is its own unique system of law. Wales was part of the Roman Empire for over 300 years. Roman law was unlike the oral culture that Wales possessed before they arrived, as the Roman law was written enabling discipline, where everyone lived and was punished by all the same rules, so not arbitrary. The procedure of a trial differed somewhat under the Republic and under the Empire. In Republican times justice was administered in accordance with the formulary system named from the formula which was drafted by the magistrate responsible for the administration of justice in the city. Any citizen could press charges against another through a patronus acting as his advocate. The charge had to be in inscriptione (in writing), signed by both delator and subscriptores (accuser and witnesses) and delivered to the praetor (judge). Praetores were in charge of the law courts and presided over the quaestiones (jurors). The accused had to be present at the nominis delatio (making a formal charge). The delator and the subscriptores swore oaths that they would not bring false witness and penalties were given against the delator, if himself or his witnesses were later to have been found to have lied. All witnesses could be questioned and subjected to speeches attacking their credibility. Rules for permitting evidence would seem to us to have been very negligent, and the court considered the written word or spoken word as legally binding. To decide the vote, each juror in secret erased a C (Condemno) or an A (Absolvo) from a pre-marked tablet, the praetor (judge) then announced the jurys decision. Because it was easy to bring suit against another person, there were indeed many lawsuits, as people were enticed by the material rewards if a suit were won. If the accuser won his case, a praemium was given to him. But if he lost, he was deemed to have committed a calumnia (false accusation) or a praevaricatio (collusion, or conspiracy to prosecute falsely) and was fined. If a criminal was caught red-handed or confessed the deed, punishment was inflicted without trial. If he claimed innocence and was a reputable citizen, trial was held before the praetor; otherwise, he was tried in front of a triumvir. In both instances, an advisory commission (consilium) was called to determine the question of guilt. And in either case, the punishment, personally was severe. Due to the growth of the Empire trial procedures changed somewhat and a new system was created, known as cognitio. It involved â€Å"ligigation being heard and decided by the provincial governor or his nominee, the iudex pedaneurs.† Two appeals were to be allowed in every case, a principle which is still followed in civil law today and has even influenced the structure of appeals in the UK in recent centuries. (Legal history of wales book) The first step was the postulatio or application for a hearing; then, the nominis delatio, the formal charge by a delator with his subscriptores present; the consuls next summoned the senate to determine if charges should be heard as one charge or should be divided; next was the inquisitio, in which evidence was heard; debate followed and speeches were limited by a water clock then finally a vote on the verdict. The praetors and propraetors (governors) published a list of principles and formulae of their practices in the form of edicts at the beginning of each term. Although each could effectively alter the formulae, in general the list remained the same. For example â€Å"one might legally kill to defend oneself,† this is still recognised by the modern laws of today. The judge was bound to follow the opinion of the jurists where they were agreed on a point of law, but if there was disagreement, the judge was free to decide the point of law as he saw fit (book). The views of the jurists would be relied upon as legal authority Before 212AD the Britons had the status of foreigners or peregrines and lived under a separate law to the Romans. The 3 laws under the Institutes of Gaius were: Ius civile – laws for citizens Ius gentium – laws for all nations (e.g. prohibition of murder) Ius naturale – natures laws (e.g. brothers forbidden from marrying their sisters, men forbidden from marrying a cow) The year 212 AD was very significant as it enabled every free person in Britain to automatically achieve Roman citizenship. This allowed the Britons to be classed as citizens enabling to enjoy all the benefits, the right to live by Roman Law (ius civile) and acquire the protection of the law. Following 212 AD the Britons lived by Roman law within the Roman Empire for almost two hundred years, enabling a significant legal development of the native people. An example can be shown by how the welsh embraced and so faithfully maintained the Christian religion and the legal order of the church itself was grounded and remained grounded in principles derived from Roman Law. This is represented by the church saying â€Å"ecclesia vivit lege romana,† the church lives by Roman law. Roman citizenship is generally described as an combination of three private law and two public law rights. In public law, citizens had the right to vote in the legislative assemblies – suffragium, also the right to stand for certain public offernces ius honorum. In private law, the citizen had the right to trade using roman law contracts, the right of commercium, had the capacity to contract a roman law marriage, conubium, and was able to make, witness and benefit under a roman law will, testamenti factio. Sources of the Roman Law Emperors edicts Responsa prudentium – the works of the learned jurists – their writings. The jurists expressed the values of the law and decided that the law is not arbitrary and must conform with standards of justice. The jurist Ulpian wrote, â€Å"Justice is the constant and perpetual wish to give every one their due† The jurists were an important professional class who practised their skills independently of those who argued cases before the law courts as jurists concentrated on jurisprudence. Jurisprudence was to be defined by the jurist Ulpian â€Å"as the knowledge of things human and divine, the source of what was just and unjust.† Ulpian also defined justice as â€Å"the constant and perpetual wish to give to everyone their due† This definition underlies the roman practice of allowing slaves and peregrines to earn freedom and citizenship by good works. The writings of the jurists were however a source of law in their own right. â€Å"It is significant that this source of law, quite foreign to the later common law of England, was to have its counterpart in the high respect accorded to jurists in the native welsh laws.† The father as a parent was important under roman family law, as they saw the family unit a legal unit and thought it was important to protect. In roman law the family unit is greater and more powerful than the common law today. The head of the family was usually the father and was known as the paterfamilias. Roman Law was ahead of its time in terms of equality for example with Property Law, When property was inherited it was split between all children, not discriminatory like most cultures e.g. sex/race discrimination. So adopted child has the same status and right as a natural child. Concept of anybody – any country, had black generals, by your behaviour you became a roman. Shows they were ahead of their time in concept of equality. 3) For perhaps a thousand years the native law of wales has been known as the law of hywel or cyfraith hywel in welsh or lex hoeli in medieval latin – from law of hywel dda. Cyfraith Hywel, the law of Hywel, was the name by which their native law was known to the Welsh in medieval times. The law of Hywel lost its primacy after the conquest of Wales by Edward I and the passing of the Statute of Wales in 1284, but it remained an important ingredient of the law administered in Wales until the Act of Union in 1536 His reign was a peaceful one. Hywel was in a position to promote reform and uniformity in Welsh law. The law of Hywel was based on tradition rather than king-made, and is believed to have been adapted from existing laws. Some aspects probably predated his lifetime. The law did not overly stress the power of the crown, but mostly aimed to protect the people of Wales. The native laws were the recorded customs of the people, which is distinguished from Roman Law (the laws of the Emperor) and Canon Law (the laws of the Church. One advantage which Welsh law enjoyed in the political storms of the thirteenth century was that it had written form. Already in the twelfth century it was felt to be an embarrassment if law remained unwritten. Roman law was embodied in texts, and with the great legal revival of the eleventh and twelfth centuries it was felt that any law worthy of the name should be written. Hywel dda’s objectives was to examine the law, through this to validate and amend the current laws at this time, even introduce and remove laws, promoting a unified concept of Welsh law For centuries to come, living under the Law of Hywel would be one of the definitions of the Welsh people. There was a distinction between south and north wales Title/role Rome Medival welsh law Judge/presider Praetor or magistrate Elected Has consilium of three legal experts to consult In south wales, local lord would be the judge, with the advise of a lawyer, and the church would have its own courts for ecclesiastical matters. North Wales, a professional judge decided cases.. Roman influence – law reporting, use of formula Jury Quaestiones 32 to 75 jurors, depending on type of case Chosen from album judicum, list of men of senatorial or equites class Verdict decided by majority vote Usually 12 jurors Selected from a panel of citizens Individually examined, accepted, or rejected by prosecution and defense Verdict usually must be unanimous Verdict C = condemno, A = absolvo By secret ballot Result announced by praetor Guilty or not guilty By unanimous decision but each jurors vote can be polled in open court Decision read aloud by judge Prosecutor Accusator Private citizen Public official elected or appointed Defense attorney Patronus or advocatus May not accept money, although favors allowed Professional lawyer Accepts retainer or fee or works pro bono publico Defendant Reus Innocent until proven guilty Kept under house arrest or imprisoned until trial Usually in private home Innocent until proven guilty Imprisoned or free on bail or own word until trial Witnesses Subscriptores, required by magistrates subpoena Subpoena can be issued Clerks Scribae to record events Recorder/stenographer Makes word-for-word transcript of proceedings (required in event of appeal) The lawbooks do mention some practices which are confined to particular parts of wales, but we shall see that their compliers felt quite free to draw their material from any part of wales with the assurance that it was good law for any other part. –maybe from book Welsh Medieval Law contains many similarities to the Roman Law that came before it. An example of this is clearly shown with the law of marriage. Both traditions were contracted informally, without ant ceremony, the mutual intention of the couple to live together as man and wife being sufficient. Boys had to be of the age fourteen and girls twelve, but the girl could not bear children until 14 and not after 40 years of age, this is developed from the same principle as Roman Law. In roman law didn’t discriminate between married and cohabiting couples. Especially in context of children. Status of illegitimate children is still a controversial issue today. Married women held their own property (but not land) and although came under the protection of their husbands, had rights as members of their own family. The wife would be granted a dowry by her own family, her gwaddol and she would be given a share of her husbands property, her agweddi. The husband giving wife agweddi depending on how you analyse it, as looking at it from as modern day viewpoint then it appears discriminatory. But back in the period of Hywel Dda the elements of welsh law did protect women, even though it was still a male dominated world the women had a far better status than the laws of England at the time provided for them. After the consummation of the marriage, the wife’s husband would give her a gift known as the cowyll and would also pay her arglwydd an amobr, a payment for taking her virginity. The church began to increase its powers with the law making decisions, and set out prohibited degrees of marriage, and objected to marriage as far as fifth cousins. The welsh did not agree with this and so were in constant breach of this canon law. However the Romans had a different viewpoint and allowed 2nd cousins to marry which was the same line the Welsh followed. The Welsh law on marital separation was also similar To Roman Law, if the marriage was dissolved within the first seven years then the wife kept the bounty that she had received at the time of the marriage. If the marriage was dissolved after seven years, the matrimonial property split according to the rules laid out. The rights of the parties also depended on whether the repudiation was with cause. A man could repudiate his marriage if his wife was immoral after marriage, had lost her virginity before marriage, or if there was an underpayment of gwaddol by her own family. A women could do the same if her husband had committed three adulteries, was impotent, had bad breath, or if he introduced a concubine? To the family home. With regards to Roman law marriage would be terminated if either party repudiated the other (repudium) or both agreed that the marriage was at an end (divortium). The position of women under welsh law differed significantly to that of their Norman-English contempories. Women remained independent and not considered to be the property of father or husband in the same way. The welsh lawbooks have a combination of crudity and sophistication in the texts, this can be seen on the law of women. Welsh law showed its equitable and just side by not recognising any distinction between children born within wedlock and those born outside. This was important when determining liability for compensation in the event of commission of wrongs by or towards the child. I will now look at land law where the uchelwyr enjoyed land rights collectively, with the penteulu, the head of the household nominally in charge. The name for this family holding was gwely, the soms would inherit jointly in equal and individual shares for four generations. However when the father died the property was inherited by the sons only. [I think roman law was more equality based]. Land could not be taken forcibly from lawful owner which is based on roman law. With regards with property other than land, other property was inherited by all the children in accordance with the law. The wife kept half of her husbands property and the remainder of the land was split with sons taking equally and then finally daughters taking half of that which the sons received. However in certain parts of South Wales, the Roman influence ensured that daughters inherited in equal shares with the sons. With roman law once the paterfamilias died the family inherited it as a group a unit. In order to split the property between themselves as individuals they had to do so by initiating a procedure an action familiae erciscundae. Otherwise they could continue to hold the property collectively in a consortium. Water, air and land were open to all, and unoccupied land could be possessed and later owned, if it had been in uninterrupted possession for four generations or more, this also resembles roman law of setting limitation periods for the highly valued land. Childless couples can adopt children and adopted child has same rights as natural child. Even if the father then remarries and has children, then the adopted child is still the first child and the next in line of the paterfamilias. Unjust roman laws – being able to discard children who were unwanted (as in with disabilities) but they didn’t have the medical resources that we have today. Plus they thought of disabled children as living with sin. Paterfamilias could put to death his children and his slaves for any act of disobedience or disloyalty. After observing the welsh medieval law it appears to echo Roman law, however one difference I have noted is that welsh law did not recognise the roman distinction between sale and exchange. A main reason to this may do with the limited supply of minted coins in wales so unable to carry out commercial transactions, and instead carried out echange described as cyfnewid. So in this aspect Welsh Law of Hywel Dda was not as sophisticated as roman law, but Welsh law evolved in a certain way to deal with the economy. The basis of criminal law in medieval welsh law was the â€Å"three columns of the law,† which were homicide, theft and arson. In regards to homicide a killing had to be intentional for there to be punishment, and an unintentional killing would be resolved by compensation only. No compensation payable if the victim deserved to die, only due in the case of accidental killing, galanas. A physician was liable for the death of a wounded man to whom he gave treatment, particularly when he had failed to apply the skill expected of him. This is recognised in our modern laws of today as a form of professional negligence. A relict of Roman law is the ritual in confronting the thief, and gaining admission to search premises and requiring the suspect to swear as to whether the property was in possession. A judge who gave a wrong judgement could be sued, the roman equivalent to this law is known as qui litemsuam fecit. In medieval wales theft was regarded as a very serious crime and compensation and punishment was awarded. In addition to compensation for the damage caused, there was another form of compensation the sarhad. Sarhad means an insult and has to be intentional, the roman comparison is the iniuria. As can be clearly identified Welsh law differed to roman law on being a legal system that was compensation based rather than punishment. The reason this may have been the case is due to people in medieval wales saw compensation as a more just payment and solvement of the case. As the economic value in wales was very poor, more people probably would rather the money or equivalent to the money than justice served. So making amends is better than punishment being carried out. An issue to this was that those who were financially stable would be able to be above the law and commit crimes as they could afford the compensation and wouldn’t have to worry about the repercussions of their actions. As you look more in depth at the law of hywel dda as the state grew stronger, punishment was becoming more important but compensation still had priority. The payment was meant to buy off the vengence of the other group and prevent a blood feud arising. At the time of medieval Wales the law on issuing compensation rather than punishment to the welsh people probably appeared to them as sophisticated and just. However to modern eyes the Roman law model appears more equitable and just as they punished those at fault and is like our legal system of the 21st century. â€Å"The detail the law books supply with regard to the judicial process of the welsh laws go far to revealing their sophistication.† The administrative system of medieval Wales is like the roman jury system. The sophistication is provided by the roman model as this is the template that is adapted to fit in with the welsh system. â€Å"Different forms of witness were of acute concern to medieval lawyers, for in an age without police or forensic science the problem of proof was particularly difficult. Moreover, in a small-scale society, the difficulty of obtaining impartial witnesses might be severe.† The judge placed specific emphasis on quantity of witnesses, as they believed the more people you had on your side the stronger your case. Yet quantity isn’t quality, as you could have fifty witnesses who are all liars, better to have one truthful person which our modern law system is based on today. It is also equity based as the medieval welsh law followed the roman law and didn’t go back to the Celtic times of trial by ordeal and instead stayed sophisticated with a legal system put in place by the Romans. The Romans introduced a legal system which is a hallmark of their system, even though it was expensive as they had to give jobs for the legal professions, justice was above this they wanted it to prevail. A clear and distinctive identity of welsh law is the treatment of foreigners, where they provided privileges for visitors like food and shelter. This maybe due to the type of society formed as Wales was a close knit nation, needing tourism. Furthermore the Law of Hywel Dda was mainly written in Welsh furthering its distinctiveness of welsh laws. The laws of courts contain discussion of the status of the king, the members of the royal family. The queen was allotted 1/3 of the kings income for her personal use and that she is accorded a status greater than that of any of the court officers. This reflects the higher status enjoyed by women under the laws of Hywel Dda than in most contemporary legal systems. –maybe from the book. The Roman legal system is indeed different from what we follow but there are parallels in the roles of the participants, in the value of established procedure and precedent, and particularly in the many Latin terms and phrases that are still part of our legal language today. Romes continuing influence on society today is apparent in the government structure and legal system in use in much of the western world. One of the most sophisticated and practical systems of jurisprudence which the world has so far produced, and one merits of which allowed it to re-emerge in not just the medieval law but the legal system of Britain today and as the basis of the family of legal systems known as the civil law. Even the Welsh Dragon of our nations flag is actually symbol of authority by Romans. Welsh laws are officially regarded as the customs of the people. Distinguished from Roman law, laws of the emperor and medieval welsh laws are different. Enforce a law rather create law. He saw himself as a ruler/governor of Wales not as an emperor, so saw himself as enforcing things. I think that Roman law was the initial building bricks for the construction of law we know today and even though certain aspects of the law of hywell dda is unique to welsh medieval law, the main foundation is roman.

Didions Some Dreamers of the Golden Dream Essay examples -- Didion Dr

Didion's "Some Dreamers of the Golden Dream" In "Some Dreamers of the Golden Dream," the author Didion uses fiery imagery to parallel the San Bernardino Valley to hell.   It is a place where the "hills blaze up spontaneously," and "every voice seems a scream." (p.3)   Didions hellish descriptions of the geography reflect the culture of San Bernardino Valley.   It is "where the hot wind blows and the old ways do not seem relevant, where the divorce rate is double the national average." (p.4)   In this culture, the importance of   the "old ways," such as a long-lasting marriage, are devalued.   It is a society where the "dream [is] teaching the dreamers how to live," (p.17) and where reality doesnt hamper peoples obsessions and greediness.   In the essay "Some Dreamers of the Golden Dream," the San Bernardino Valleys self-indulgent culture devaluates societys morals and ethics such as religion, law, love, and life. In the San Bernardino Valley, tele-evangelism, Christian gospel spread through television, is prominent.   It is "the California where it is easy to Dial-A-Devotion, but hard to buy a book." (p.4)   It is a society where anyone with money can buy a devotion to God with the dialing of a number.   The usage of religion as a money-making business defiles the sanctity of societys most sacred and cherished belief.   However, money is made so morals and ethics are ignored.   Another example of this immorality is Edward Foley, Lucilles Millers attorney.   He sa...

AIDS Case Study Essay

Client Profile: Mr. Thomas is a 42 year old man admitted to the hospital with complaints of shortness of breath, fever, fatigue and oral thrush. The health care provider reviews the laboratory and diagnostic tests with Mr. Thomas and informs him he has pneumonia and is HIV positive. Mr. Thomas believes that he contracted HIV while involved in an affair with another woman three years ago. He is afraid to tell his wife, knowing she will be angry and that she may leave him. Case Study: The nurse assigned to care for Mr. Thomas reads in the medical record (chart) that he learned two days ago he was HIV positive. There is a note in the record that indicates that Mr. Thomas has not told his wife the diagnosis. To complete a functional health pattern assessment, the nurse asks Mr. Thomas if he may ask him a few questions. Mr. Thomas is willing and in the course of their conversation shares with the nurse that he believes that he contracted the HIV during an affair with another woman. He states, â€Å"How can I tell my wife about this? I am so ashamed. It is bad enough that I had an affair, but to have to tell her in this way – I just don’t think I can. She is not sick at all. I will just say I have pneumonia and take the medication my health care provider gave me. I do not want my wife of anyone else to know. If she begins to show signs of not feeling well, then I will tell her. I just can’t tell anyone. What will people think of me if they know I have AIDS?† 1. Briefly discuss how the HIV is transmitted and how it is not. How can Mr. Thomas prevent the transmission of HIV to his wife and others? In infected people, infectious HIV is present only in cells and in some bodily fluids. HIV can be isolated easily from blood, semen and vaginal/cervical secretions (including menstrual fluids). Blood and semen are the cells that are most likely to carry HIV. HIV has also been isolated from breast milk. With much greater difficulty, the virus has on occasion, been isolated from saliva, tears, and urine. It is has not been isolated from perspiration or feces. The current scientific view is that body fluids other than blood, semen, vaginal/cervical secretions, and breast  milk, contain so little, if any, HIV that they are not of major importance in HIV transmission between individuals. HIV is very fragile outside of the body, so transmission requires direct contact of two substances, fluid containing the HIV from an infected person and susceptible cells (usually via the blood stream) of another person. Casual contact includes all types of ordinary every day, non-sexual contact between and among people. Shaking hands, hugging, kissing, sharing eating utensils, sharing towels or napkins, using the same phone and using a toilet seat are all examples of casual contact. Because HIV is quickly inactive outside the body, it cannot survive in open air or in water. (1) Methods that Mr. Thomas can transmit HIV to his wife and others would be any type of blood transmission or intimate sexual contact. Epidemiological data points to three modes of HIV transmission from person to person: from blood, from birth, and from sex. Since Mr. Thomas is male we can cross out birth. Mr. Thomas can prevent transmission of HIV to his wife and others by only engaging in sexual activity with a condom, and even then there is a risk of the condom breaking and then being careful with any types of cuts, open wounds, and contact with others and his own blood. 2. Mr. Thomas stated, â€Å"What will people think of me if they know I have AIDS?† How can the nurse explain the difference between being HIV positive and having AIDS? The nurse can explain n that Mr. Thomas does not have AIDS. AIDs are a complication once the immune system can no longer handle fighting the HIV infection. HIV is the actual infection itself, AIDS is what happens once the immune system is compromised leading the way to other infections that may not affect a normal healthy adult or child, but become life threatening to a person with AID’s. This is caused by the weakened immune systems inability to fight off any infection. 3. Discuss the ethical dilemmas inherent in this case. HIV disclosure is defined as a ‘complex and multifaceted process of making a voluntary or involuntary decision about whom to inform about one’s status,  why, when, where and how’ . This is particularly challenging when it comes to informing patients’ sexual partners, also referred to as partner notification. The three approaches to partner notification include: i) source referral, whereby the health care provider encourages the patients to alert their partners themselves; ii) provider referral, whereby the health care provider notifies the partners with the consent of the patients while respecting the patients’ confidentiality; and iii) conditional referral, whereby the patients in agreement with the health care provider are supposed to inform their partners within a given time frame otherwise the health care provider will do so (but without revealing the patients’ identity)(2) 4. Does the health care provider have a legal obligation to tell anyone other than Mr. Thomas that he is HIV positive? If so, discuss. Legally, the nurse can’t tell anyone. â€Å"In court notifying an HIV-positive patient’s partner can be argued in terms of breaching professional ethics because ethically it is wrong to disclose your patient’s result or diagnosis to third parties without that individual’s consent.† 5. Any loss, such as loss of one’s health, results in a grief response. Describe the stages of grief according to Kubler-Ross. Denial: â€Å"This cannot happen to me!† Anger: â€Å"Why did this happen to me? Who’s to blame for this?† Bargaining: â€Å"Just let me live, and I’ll do anything† Depression: â€Å"I am too sad to do anything† Acceptance: â€Å"I’m at peace with what is coming†. 6. Discuss which stage of grief Mr. Thomas is most likely experiencing. Provide examples of Mr. Thomas’s behavior that support your decision. I believe that Mr. Thomas is experiencing both denial and anger. In denial, he recognizes that this is indeed happening to him but he does not want his wife to know and that is his refusal to accept what is going on. The anger portion comes from him blaming his affair for it happening in which sense he blames both himself and the woman he had the affair with. 7. What laboratory tests are used to confirm the diagnosis of HIV infection in an adult? HIV is most commonly diagnosed by testing your blood or saliva for the presence of antibodies to the virus. A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection. 8. Discuss the function of CD4 T cells and provide an example of how the CD4 t cell count guides the management of HIV. CD4 cells are a type of white blood cell that’s specifically targeted and destroyed by HIV. A healthy person’s CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200. (3) 9. Briefly explain the purpose of viral load blood tests in monitoring the progression of HIV. The viral load test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.(3) 10. Mr. Thomas expresses a readiness to learn more about HIV. Discuss the nurse’s initial intervention when beginning client teaching and then discuss the progression of the HIV disease, including an explanation of primary infection, A, B, and C and four main types of opportunistic infections. There are different stages of HIV infection. Primary HIV infection can show symptoms that can be confused as the flu. These symptoms can last for a couple days to a few weeks and then disappear. Stage 2 is an asymptomatic stage meaning that the patient probably shows little to no symptoms. â€Å"This stage lasts for an average of ten years and, as its name suggests, is free from major symptoms, although there may be swollen glands. The level of HIV in the peripheral blood drops to very low levels but people remain infectious and HIV antibodies are detectable in the blood, so antibody tests will show a positive result. Research has shown that HIV is not dormant  during this stage, but is very active in the lymph nodes. A test is available to measure the small amount of HIV that escapes the lymph nodes. This test which measures HIV RNA (HIV genetic material) is referred to as the viral load test, and it has an important role in the treatment of HIV infection.† (4) Stage 3 is symptomatic HIV characterized by lymph nodes and tissues becoming permanently damaged and the virus beginning to mutate to AIDs due to the inability of the body keeping up with helper T cell rebuilding as the HIV virus kills off the helper T cells. Stage 4 is progression of HIV to AIDS. AIDS is diagnosed when any condition listed in clinical stage 4 is diagnosed and/or the CD4 count is less than 200 cells/mm3 or a CD4 percentage less than 15. (4) The ABC’s of HIV are: Abstinence for youth, including the delay of sexual debut and abstinence until marriage Being tested for HIV and being faithful in marriage and monogamous relationships Correct and consistent use of condoms for those who practice high-risk behaviours (4) The CDC has listed 24 types of opportunistic infections regarding HIV. As his nurse I would make sure Mr. Thomas had the information regarding all 24, but I would clarify on the 4 main ones since he is already exhibiting symptoms of those. Four main types of opportunistic infections in regards to HIV are: â€Å"Thrush: fungal infection of the mouth, throat, or vagina. Herpes simplex virus: can cause oral herpes (cold sores) or genital herpes. This is a fairly common infection but if you have HIV, the outbreaks can be much more frequent and more severe. Mycobacterium avium complex (MAC or MAI) – a bacterial infection that can cause recurring fevers, general sick feelings, problems with digestion, and serious weight loss Pneumo cystis pneumonia (PCP) – a fungal infection that can cause a fatal pneumonia.† (6) 11. Following the nurse’s teaching, Mr. Thomas states, â€Å"How stupid I was to have that affair. Not only could it ruin my marriage, but it gave me a death sentence.† Share with Mr. Thomas what you know about long-term survivors, long-term non-progressors, and highly active antiretroviral therapy (HAART). HIV carriers can carry the virus for a decade showing little to no symptoms. There are many different types of maintenance drug therapies to alleviate symptoms, and reduce the rate of progression. Antiretroviral therapy can help stall the progression of the disease, however, discontinuation of antiretroviral therapy may result in viral rebound, immune decomposition, and clinical progression of HIV. Interruption of HAART is not recommended (7). With HAART, patients who have had a positive HIV test have gone as long as 30 years with little to no symptoms and no progression of AIDS (6). HAART is defined as a drug regimen to achieve sustained viral suppression. Simplified treatment regimens and decreasing the number of medications that patients have to take each day has proven effective in patient’s adherence to their treatment. Drug companies are constantly finding new ways to combine the inhibitors into 2-3 medications versus the extensive treatment regimens originally used. Overall adherence rates are still only 30-50% in the US, so I would recommend ex tensive follow up with Mr. Thomas and his health care providers to increase his adherence. 12. Discuss how the nurse should respond if Mr. Thomas’s wife approaches him in the hall and asks, â€Å"Did the test results come back yet? Do you know what is wrong with my husband?† The nurse must tell Mr. Thomas’s wife that she cannot discuss Mr. Thomas’s medical condition with her and that she must ask Mr. Thomas himself. Legally and ethically, the nurse cannot give Mr. Thomas’s wife any information regarding his condition and diagnosis if Mr. Thomas has specifically asked for no information to be disclosed, which he has. 13. List five possible nursing diagnoses appropriate to consider for Mr. Thomas. I chose these 5 for where Mr. Thomas is related to his disease at this time. 1. Deficient knowledge related to HIV infection, means of preventing HIV transmission, and self-care 2. Risk for infection related to immunodeficiency. 3. Activity intolerance related to weakness, fatigue, malnutrition, impaired fluid and electrolyte balance and hypoxia associated with pulmonary infections. 4. Social isolation related to stigma of disease, withdrawal of support systems, isolation procedures, and fear of infecting others. 5. Anticipatory grieving related t changes in lifestyle and roles and unfavorable prognosis References 1) Conner, Ross F., & Fan, Hung Y., & Vilarreal, Luis P. Aids, Science and Society, Sixth Edition, 2011, Jones and Bartlett Publishers, LLC 2) http://www.biomedcentral.com/1472-698X/11/6 3) www.mayoclinic.com 4) www.avert.org 5) www.cdc.org 6) www.aids.org 7) Smeltzer, Suzanne C., & Hinkle, Janice L., & Bare, Brenda G., & Cheever, Kerry H. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, (2010), Wolters Kluwer Health/Lippincott Williams & Wilkins