Alcoholism 11 Free Essays

Alcoholism Alcoholism is one of the biggest medical problems in the Western world. Alcohol has been around since biblical times. The problem continues to grow every year and has a negative impact on society. We will write a custom essay sample on Alcoholism 11 or any similar topic only for you Order Now Nearly every town and city has restaurants that serve alcohol, and has stores where it can be purchased. For these reasons, the nature of alcoholism needs to be exposed. The problems that arise from this disease need to be shown. The purpose of this paper is to talk about the problem, the cause and effects, and the treatment process. Alcoholism is the habitual or compulsive consumption of alcoholic liquor to excess according to Webster’s New World Dictionary. An alcoholic has no control over drinking and continues to use alcohol even though adverse consequences occur (Hurley 71). Alcohol affects the alcoholic’s family and work, they ignore responsibilities and assignments. In nineteen fifty six alcoholism was recognized as a disease by the American Medical Association. Fishman 28) When the National Council for Education on Alcoholism (now known as the National Council on Alcohol and Drug Dependency) was formed, their first and most prominent principle was, â€Å"Alcoholism is a disease† (Nicolaus 136). The disease has serious consequences on the drinker and society as well. Even though there is much concern about drugs, next to tobacco, alcohol is the most widely used drug in the United States (Hurley 71). Alcohol impaired drivers caused thirty two percent of traffic related fatalities in two thousand eight (â€Å"Alcohol Impaired Driving†). In 1996 nearly thirty six percent of incarcerated criminals were under the influence of alcohol when committing their crime (â€Å"Alcohol and Crime†). Indeed, alcoholism has become a public concern, since it had begun to influence society as well. There are two types of alcoholism, alcohol abuse and alcohol dependency. An example of alcohol abuse is random binge drinking. A person is alcohol dependent when that person can’t stop drinking without withdrawal symptoms. â€Å"There is no known cause of alcoholism. † (Van Voorhees) Alcoholism is described as a drug addiction. There are several factors that play in its development. They are divided into two main groups, psychological and social. Psychological factors include anxiety relief, conflict in relationships, depression and low self-esteem. Some examples of social factors are the ease of getting alcohol, peer pressure, social acceptance of alcohol use, and a stressful lifestyle. (Van Voorhees) There are other factors that lead to excessive drinking. â€Å"Research suggests that certain genes may increase the risk of alcoholism, but which genes or how they work is not known. (Van Voorhees) Studies have shown that family history is a factor as well. People whose parents abused alcohol have a higher risk of alcoholism. It is a given that alcoholism leads to physical and mental problems. But how does excessive consumption of alcohol affect the daily life of alcoholics? What are the effects of alcoholism in everyday life? The organ most sensitive to alcohol is the brain. The cerebrum is affected first. It is in control of sensation, perception, speech, and judgment. The cerebellum is the second part of the brain affected. The cerebellum is responsible for coordination and balance. A person under the influence of alcohol will have slurred speech, loss of balance and uncoordinated movements. The excessive alcohol user is usually unable to judge accurately what he or she can or cannot do. Drinking alcohol increases confidence and diminishes abilities. This misplaced confidence often leads people to judge themselves competent to perform tasks that are beyond their abilities. (Fishman 37-41) An alcoholic’s job and family are also affected by alcoholism. In couples it affects communication, which in turn, increases conflict levels. It has also been proven that domestic violence increases in alcoholic families. Alcohol use affects parenting. Family life can become chaotic and have poor quality environment. The children are exposed to the parent’s increased conflict (â€Å"Alcohol and the Family†). An alcoholic’s attendance to work is affected by drinking. They are chronically late and their productivity is decreased. The effects of alcohol in everyday life can be further explained through specific examples. In terms of finances, an alcoholic would be irresponsible. The bills would not be paid on time, prompting the collection agencies to take action. An alcoholic would not be stable enough to manage his or her own money; thus, incapacity for money management is an effect of alcoholism in everyday life. In terms of employment or schooling, an alcoholic is most likely to be tardy. However, the person can altogether skip school or work to drink. Even socializing with friends is affected by alcoholism. An alcoholic usually does not like it when other people offer their opinion about his or her drinking habits. He or she is irritated by comments and critiques of their drinking. As a result, the alcoholic would soon drink in secrecy. Another effect of alcoholism in everyday life is the lapses in memory and interest. Due to the aforementioned effect on the brain, it follows that even memory is not spared from the dangers of alcohol. Alcoholics usually suffer from â€Å"blackouts† (Fishman 40). These are instances when they could not remember appointments and the like. Moreover, the activities that the person used to enjoy would cease to be enjoyable, due to the effect of alcoholism (Fishman 42). These are some of the examples of how alcoholism affects everyday life. Alcoholism is a treatable disease. There are treatments available for this condition, and several medications have made it possible for alcoholics to fully recover. In the treatment of alcoholism, there are several steps to take into account: intervention, detoxification and rehabilitation (Fishman 60). The first step is intervention. It takes someone else to point out the problem for them to realize that they need to get help. The most familiar approach in intervention is the confrontation between alcoholics and the concerned party. It was only recently when studies have shown that intervention would be more effective if it was done with â€Å"compassion and empathy† (Medline). The next step is detoxification. The objective of this step is to stop the drinking of alcoholic beverages. This phase in the treatment is tough for the alcoholic, as the intake of alcohol will suddenly be stopped. That is why detoxification usually takes place in an inpatient set-up, in which the environment is â€Å"controlled and supervised† (Van Voorhees). During the process, every medication is cautiously measured to hinder withdrawal from taking place. The moment the symptoms of withdrawal are absent, the giving of medications would be gradually stopped. The duration of detoxification usually lasts from four to seven days. These days, there is a kind of detoxification that is in the outpatient set-up, but still under the guidance of a physician. While in detoxification treatment, it is important that the patient has a balanced diet, as well as vitamin supplements. This is because there are complications that happen with alcohol withdrawal, and the patient must be as healthy as possible (Fishman 83-84). If the detoxification process stops people from consuming alcohol, the rehabilitation process guides people to fully recover by staying away from alcohol (Van Voorhees). This fourth step in the treatment is more comprehensive, as it prepares the patient for complete recovery in the long run. Not only does rehabilitation stop people from drinking, it allows them to create a network of support to encourage their continuous road to recovery. Rehabilitation programs usually involve â€Å"counseling, psychological support, therapy, education and skills training† (Fishman 85-88). There are two kinds of rehabilitation programs: the short-term and the long-term programs (Fishman 89). The former requires less than a month, while the latter could range from a month to a year or longer. There is also the outpatient counseling option, which is suitable for those who have just finished an inpatient treatment. Aside from this, there are the support groups dedicated to the endeavor of recovery of alcoholics. Examples of which include SMART Recovery, Women for Sobriety, and Alcoholics Anonymous (Van Voorhees). There are three recognized medications in treating alcoholism. The first one is Disulfiram. The medicine works by disrupting the metabolism of alcohol, causing a metabolite that would make the person sick if he drinks even a small amount of alcohol about two weeks after taking the medicine. The second drug is Acamprosate. It is believed that this drug helps people to abstain from alcohol; it also decreases the symptoms that come with abstinence (â€Å"Alcoholism†). The third drug is Naltrexone, which works on the brain to decrease alcohol cravings (Barbour 145-146). It is crucial that people are made aware of the causes, effects and treatments of alcoholism. This awareness would help prevent the problem of alcoholism. People should be reminded that alcoholism is not just the problem of an individual but also of society. Works Cited Alcohol and the Family. Aug 2004. National Institute on Alcohol Abuse and Alcoholism, Web. 15 Dec 2009. . Barbour, Scott. Alcohol. San Diego: Greenhaven Pr, 1998. 145-146. Print. Fishman, Ross. Alcohol and alcoholism. New York, NY: Chelsea House Pub, 1986. Print Hurley, Jennifer. Addiction. San Diego: Greenhaven Pr, 2000. Print. â€Å"MayoClinic. com. † Alcoholism. 08 May 2008. Mayo foundation for Medical Education and Research. Web. 15 Dec 2009 . National Highway Traffic Safety Administration. Alcohol-Impaired Driving. , 2008. Web. 28 Nov. 2009. Neufeldt, Victoria, and David Guralnik. Webster. 3rd college. New York, NY: Webster, 1989. Print. Nicolaus, Martin. Empowering Your Sober Self. 1st. San Francisco, CA: Jossy-Bass, 2009. Print. United States Department of Justice. Alcohol and Crime. , 2008. Web. 28 Nov 2009. Van Voorhees, Benjamin. â€Å"MedlinePlus. † Alcoholism. 15 Jan 2009. Web. 15 Dec 2009. . How to cite Alcoholism 11, Papers

The Laborer by diego rivera free essay sample

Diego Rivera’s artwork is very unique and is still very popular today. Diego Rivera, who is arguably one of the most important 20th Century Latin American artists, who was only eighteen years old at the time, painted â€Å"El Albanil† in 1904. This painting is only one of three or four known paintings to exist from that early period of the artist’s career. It shows his talent for a muralist style and like most well known for representing. The oil on canvas painting is signed by the artist and dated 1904. To me, this painting stood out to me because it was one of the only paintings in the exhibit where it had only one person in the painting. In my opinion, it looks like â€Å"El Albanil† which in English, means the laborer, is about to go start working. Either that, or he is taking a break from work, but he definitely looks like he is in the middle of something. We will write a custom essay sample on The Laborer by diego rivera or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page This painting looks like the man is upset about something. Maybe he believes that his heritage is being treated unfairly. After all, it is clearly obvious that this man is Mexican-American. Maybe he feels that he should be appreciated more rather than being looked at how people see him. Maybe he wants to do more with his life than just work for people. Or perhaps he is proud of the work that he does and is showing off by the stance he is in. The way Rivera made the oil on canvas look is just so magnificent. He makes it look like it’s sunny outside without anyone being able to see the sun. He does this by making the floor a bunch of different colors and by making the shovel and bucket have a shadow. It looks like its really bright on the floor and as it gets more and more to the left the colors start to change into a darker shade because the sun is not hitting that part inside. Also another thing that stood out to me was the wall. How it is dark and then becomes lighter. The way he made it look was as if the sun wasn’t hitting the inside wall but the wall that goes straight back is getting all the sun. There are many different shapes that I can point out in this picture; for example, his hat is a very strong shape as well as his bucket and shovel. The shirt he is wearing looks like a rectangular shape and the lower half of his body looks more round than is does square. The way the man is holding the shovel makes him look so masculine. Like he is in control of everything he does and doesn’t let anyone push him around or tell him what to do. It’s the way the oil defines the laborers features that makes it look so good. It’s also the way the colors look on his shirt, the way it changes from a light blue to a darker blue. It makes it look like he is standing big and tall. How his hat has a shadow can make a person tell that he is posing with his head in an upward position and usually that type of posture means that the person is very confident in themselves and not shy at all. In my opinion I find it odd that this man looks so confident in this painting because by the way he is dressed it seems like he does not come from a lot of money. Today, people who do not have a lot of money are not as confident or strong willed. However it looks like nothing is stopping this man, it seems like he does not care whether he is rich or poor, he will not let his minority classification bring down his dignity. He is proud of who he is and what he does. Like I stated before, it looks like this painting is about minority. From what I saw at the art museum, Diego Rivera focuses a lot on culture. And not just any culture, the kind of cultures that did not have a lot of money. Although these people don’t have money, they still make the best out of their lives because all they have is each other. This man looks like he is not sad, but confidant. He looks like he feels proud of himself and what he does. No one or nothing is going to stop him.

The Right To Privacy Essays - Digital Rights, Human Rights

The Right To Privacy In the United States Constitution and its subsequent amendments, there is in no place a reference to the so called ?Right to Privacy.? But in several Supreme Court Cases, the judges have ruled in favor of a certain decision by stating that people of the United States have a ?Right to Privacy.? How do these judges make the conclusion that there is a right to privacy guaranteed in the constitution, when it is not specifically written? The answer is, that they imply the power based on several of the already predefined amendments. In the Supreme Court Case, Gideons vs. Connecticut (1965), the Court ruled that the Connecticut law stating that no contraceptive may be used. The plaintiff argued that they should not be penalized for something they do in there own home. When the case reached the Supreme Court, the Court ruled in favor of the plaintiff, stating that there was a right to privacy in a man's home. In Mapp vs. Ohio, Police received an anonymous tip that there was a bomber inside the residence of a Mrs. Mapp. They came to her house, and she refused them in without a search warrant. The police came back later, handcuffed Mapp, and found several items of obscene material throughout her house. The supreme court ruled in favor the Mapp, stating the right to privacy in ones home, and the guarantees that the fourth and fourteenth amendments have. What gives the court the right to base a decision on the right to privacy? The first amendment to the constitution states that people have the rights of speech, religion, press, petition, and ?assembly.? More specifically, ?freedom to associate.? The court ruled that ?the disclosure of membership lists of a constitutionally valid association, was invalid.? It also ruled that ?we have protection in the associations that are not political in the customary sense, but pertain to the social, legal, and economic benefit of the members,? in NAACP vs. Button. Another reason why the right to privacy is implied is the fourth and fifth amendments. In Boyd vs. US, they are used as protection against invasions ?of the sanctity of a man's home and the privacies of life.? In Mapp vs. Ohio, the fourth amendment was referred to as ?a right to privacy, no less important than any other right carefully and particularly reserved to the people.? It is also referred to in Griswold vs. Connecticut case as ?the right to be left alone.? In NAACP vs. Alabama, the fourth and first amendments were used in conjunction to say ?we have the right to associate and to have privacy in one's associations.? Throughout the brief history of the Supreme Court, hundreds of cases have been held. Several of those cases have had the decision based on the ?right to privacy.? The problem is, that no where in any version or in any language does the United States Constitution specifically say we have a right to privacy. Even one of the most controversial cases in history, Roe vs. Wade, had a decision that was based at least partially on the ?right to privacy.? Whether it is written or implied by the courts, one thing is for sure, due to the ninth and fourteenth amendments, there is no way, that a state or national law will ever take away our so called ?Right to Privacy.? A Right To Privacy: Sure why not! American History

Nationalism in Europe essays

Nationalism in Europe essays Patriotism and nationalism mean essentially the same thing, only with different obvious connotations. When one thinks of patriotism in America, one thinks of the Fourth of July, fireworks, hamburger cook-outs, flags, war-heroes, and the Republican Party. When one thinks of nationalism, images are quickly brought to mind of the IRA, Al-Qaeda, Spanish Basque Countrys ETA, WWII concentration camps, nearly every war in history, and the Republican Party. It is interesting to observe how this notion is viewed in Europe as compared to the United States. In the United States, pride in ones country is regarded as a virtue. It shows honour, dignity, courage; even moral character. American pride is synonymous to the things America is founded upon: democracy, freedom, pursuits of happiness, and apple pie. It is in turn a reaction to a world in which dictators rule and terrorist groups threaten the lives and safety of innocent people. American patriotism actually becomes a reaction to foreign nationalism which these other groups are based upon, interestingly enough. There are far more flags flying over front yards in American homes than there are in Europe. In Venice, as a matter of fact, I remember seeing more PACE (peace) flags hanging out of peoples windows than I saw Italian flags or, even less, Venetian flags. Europeans seem to be a bit more sceptical of the idea of patriotism and might regard ones pride in his country as nationalistic. Bitterness toward national pride could be a reaction to the conflict between the US and Iraq, where third parties might view both sides motives as nationalistic. There are also the aforementioned examples of the separatist groups of Northern Ireland and Spain, also with which nationalism might be associated. All this makes sense in todays Europe where it almost seems like states are trying to forget their differences in order for everyon ...

Globalization And Culture Research Paper Example | Topics and Well Written Essays - 1750 words

Globalization And Culture - Research Paper Example He argues that this is because of the commercialization of culture through media, affecting civilizational, religious and cultural values. The world is thus losing its cultural diversity and is arriving at a monocultural state, which is the resultant of the homogenization of cultures through globalization. II. The Origin of Globalization and its Impact on World Culture—Varying models Globalization is a universal phenomenon resulting from commercial interactions and trade between countries. Globalization accelerated from the 1870s until the beginning of the First World War in 1914, when all countries worldwide felt the effects of an international economy (Haynes, 2010p. 134). Various routes, by both land and sea, had been developed in historical times, whose main function was to facilitate trade. However, goods were not the only entities that were being exchanged. Religious and cultural exchanges were also widespread across these routes. For instance, the influence of Buddhism, which originated in India, on Central Asia, China, Tibet, Japan and South East Asia occurred due to trade contact among these countries; and the Silk route enabled cultural exchanges between Central Asia, China and Europe (Yazdani, 2009, p. 55). The effect of globalization on culture is explained using various models described below. However, no single model is enough to relate the actual s pread of globalization. A. Vanguardist Model The Vanguardist model puts forth the notion that European culture expanded from the West to the rest of the world.

Hospitality marketing Essay Example | Topics and Well Written Essays - 1750 words

Hospitality marketing - Essay Example rms of implementing various marketing strategies especially promotional and advertising campaigns in order to communicate about their facilities and availabilities regarding foods and services to a large group of customers. They communicate about the offerings of their exceptional foods, services, designed lobbies as well as their attractive locations. Moreover, the hospitality industry also focuses to communicate about their quality and value based services for the customers (Shoemaker & Shaw 18). However, the product/service orientation approach has also certain drawbacks which might affect the performance of the companies operating in the hospitality industry. The major problem in the product/service orientation approach can be identified as the offerings of the organizations may not be adequate as per the needs and the desires of the customers (Shoemaker & Shaw 18). This orientation can potentially cause a gap between the expectations of the customers related to the offered product/service and the actual provided product/service. This orientation can positively affect word-of-mouth and customer loyalty due to reason that a satisfied customer will be willing to recommend the used service or product to his/her peers or colleagues. The operations orientation concept of an organization involves the categorization process of the operations in order to efficiently achieve the goals and objectives of the organization. The concept facilitates the organizations to design the roles and the responsibilities of the members allocated in different operational levels of the organization. The operations orientation concept aids to develop the practice in the operational divisions as per the needs and the requirements of the customers (Shoemaker & Shaw 17). However, the operations orientation concept also can impact on an organization’s efficient functioning due to an inadequate understanding of the consumer desires and needs which might create a gap between the services

Care and Management of Asthma

Care and Management of Asthma Asthma is a common incurable disease that affects the small tubes carrying air in and out of the lungs in the airways; it is more common at childhood stage but can also occur at a later age (British Lung Foundation, 2011). The major cause of asthma has not been determined but it is believed that some factors as allergies, exercise and common cold contribute to its development. In the United Kingdom, asthma is being handled primarily by a General Practitioner or nurse. Healthcare can be provided in three major means: Primary, Secondary and Tertiary. They are delivered depending on the severity of an individuals condition. General Practitioners (GPs), Pharmacists, Nurses, Dentists and Optometrists are the main classes of healthcare providers that deliver Primary care. It is the basically the first point of contact for most individuals (National Health Service Choices, 2010). Care distinctively provided in local hospitals is usually on referral from primary care health providers, such t ype of care is basically referred to as Secondary Care. The third aspect of care is the tertiary care which is provided by specialist such as neurologist and cardiologist in a majorly specialised hospital centre for long term treatment. EPIDEMIOLOGICAL OVERVIEW OF ASTHMA Major facts that make Asthma a major health issue in the UK are: In 2008, a total number of 1,204 deaths were recorded from asthma in the UK, out of which 29 were children aged 14 years and under. 1 person every 7 hours or 3 people per day die from asthma 146,000 adults and 36,000 children currently are on treatment for asthma in northern Ireland making it a sum total of 182,000 people (1 in 10)In Northern Ireland 182,000 people (1 in 10) are currently receiving treatment for asthma. This consists of 36,000 children and 146,000 adults. In Scotland 368,000 people are currently receiving treatment for asthma. This consists of 72,000 children and 296,000 adults. In Wales 314,000 people are currently receiving treatment for asthma. This consists of 59,000 children and 256,000 adults (Asthma UK, 2011). the number of adults with asthma in the UK has increased by 400,000 since the last audit of UK asthma in 2001 about 2% of adults consult their GP annually with asthma ASTHMA CARE AND MANAGEMENT AND LOCALITY STUDY OF UK Asthma exists in various forms hence; its heterogeneity has been well established by a variety of studies that have proven the disease risk from early environmental factors and susceptibility genes, inflammation and therapeutic agent response further induces accompanying diseases (Lang et al., 2011). Risk factors associated with asthma are family history of atopic disease, for example Allergic rhinitis Allergic conjunctivitis Male sex, for pre-pubertal asthma, and female sex, for persistence of asthma from childhood to adulthood Bronchiolitis in infancy Parental smoking, including passive smoking Premature birth, especially in extreme-preterm infants who required ventilatory support, with consequent chronic lung disease of prematurity (NHS Choices, 2011) In the UK, asthma is more common among children than in adults and also has an increased rate in women than men (NHS choices, 2010). A condition referred to as acute asthma exacerbation could occur and could sometimes be life-threatening but is mostly rare. Asthma patients are treated with care by GPs and nurses trained for asthma management and such treatments are specific to the symptoms portrayed by each patient. This treatment (Primary care) basically involves: A personal asthma procedural plan concurred with your GP or nurse An annual regular check ensuring proper control of the patients treatment and positive response to the treatment Proper seeking of the patients consent ensuring his/her decision is involved in decision making of his/her treatment Comprehensive detailed information about how to control and manage the patients condition; while a Secondary or Reactive care is enforced in emergency cases to regain control of more high-risk symptoms. In treating asthma, reliever inhalers are given to every patient by the GP; these inhalers serve as immediate relievers and ensure restoration of normal breathing. It functions effectively due to its composition of a short-acting beta2-agonist that works by relaxing the muscles surrounding the narrowed airways (British Medical Journal group, 2011). This further ensures the airways are opened wider, making it easier to breathe again. Salbutamol and terbutaline are common types of this inhaler. They have been proven to be generally safe except when their use is abused although they possess very few side effects. If the asthma is well controlled, then their usage will be minimal; if a patient uses the inhaler for up to three times or more weekly then it is advised that the treatment be reviewed Secondary care and management of asthma is implemented when Patients exhibit a combination of  severe asthma, behavioural and psychosocial features, they hence are at risk of developing near-fatal or fatal asthma. (BTS and SIGN, 2009). Asthma care is dependent on the age of the patients in that children have a different mode of care as compared to adults, a critical look at the adult care is elaborated below. Prior considerations are basically that the patient is registered with his GP, will have to book for an appointment with his GP before visiting (except in emergencies as acute exacerbations), confirmation with the patient of their understanding of the role of treatment, adherence to treatment, inhaler technique, and appropriate elimination of trigger factors as: exercise, drugs foods, emotional factors, weather changes, allergens etc (Shiang et al., 2009) In analyzing the delivery of care to asthma patients in the UK, data from Office for National Statistics shall be addressed. Table 1 below signifies that there was a remarkable decrease in hospital admission in 2000 for asthma; it showed a 45 percent decrease among children between ages 5 and 14 years and a 52 percent decrease among children below 5 years (Office for National Statistics, 2004). TABLE 1 The management of asthma is patient-specific and is delivered by either the GP or asthma nurse; a respiratory nurse specialist works closely with the GP and the patient serving as the best form of encouragement to the patient in the procedural management of his/her asthma condition. The respiratory nurse specialist has a critical role in the management of asthma as elaborated that he/she: Explains the need for various inhalers (ensuring the best is offered to the patient) and provides the patient with information on treatment administered Advices on triggers and how to keep off them Assists the patient in quitting smoking (if applicable) Explicates on how to monitor the condition Provides the action plan of treatment and explains it to the patient. Is always available for assistance both at home and on the phone (NHS Choices, 2006) Nurses are generally recruited into the NHS through the website www.nursebank.co.uk , the Association of Respiratory Nurse Specialists offer courses for development and training of nurses and promote clinical excellence in respiratory care delivery (Association of Respiratory Nurse Specialist, 2010). The selection of a professional nurse in a recruitment procedure is dependent on factors as Years of experience, area of expertise and personal record check. CRITIQUE ON ASTHMA CARE Asthma management involves a wide range of services including primary care, routine follow up, hospital inpatient and outpatient care, proper education and advice of patient, emergency calls and prescribed drugs; these services when combined with the intensity and level of use result to a high cost (Department of Health, 2011). In 2001, England recorded a net ingredient cost of  £442million and around  £33million for inhaled therapy Brocklebank et al (2001). In prescribing drugs, the patient is considered as whether or not to use the drug/device appropriately; the most effective and clinically proven cost effective drug is also reasonably considered. However, restrictions imposed on manufacturers make some inhalers commercially unavailable hence the use of more expensive drugs. The British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) have clinical guidelines on the use of inhalers for asthma (BTS and SIGN, 2009) however; there are inconsistencies or absence of recommendations for inhaler devices from these guidelines. Evidence-based guidelines are currently being prepared by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN). There are criticisms on the effectiveness of the inhaler which largely depends on technique of administration by patient considering experience, physical ability and education on usage (NHS centre for reviews and Dissemination, 2003) CONCLUSION The role of a nurse in quality care delivery cannot be overruled especially in a health condition as asthma which could be critical and possibly fatal. The initial primary care given to asthma patients and subsequent secondary care has been proven to be appropriate in that the health status of patients is being improved. The incorporation of a respiratory nurse specialist has been a major milestone in achieving a better health status for asthma patients in the United Kingdom. REFERENCES Association of Respiratory Nurse Specialist (2010) professional development Available at: http://www.arns.co.uk/pages/professional%20development.html (Accessed: 11 March 2011). Asthma UK (2011) For Journalists: Key facts and statistics Available at: http://www.asthma.org.uk/news_media/media_resources/for_journalists_key.html (Accessed: 5 March 2011). British Lung Foundation (2011) Asthma, Available at: http://www.lunguk.org/you-and-your-lungs/conditions-and-diseases/asthma (Accessed: 9 March 2011). British Medical Journal group (2011) Asthma in adults Available at: http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/531553.pdf (Accessed: 12 March 2011). British National Formulatory (2010) NICE Technology Appraisal. Available at: http://bnf.org/bnf/extra/current/450034.htm (Accessed: 9 March 2011). British Thoracic Society, Scottish Intercollegiate Guidelines Network (2009) British Guideline on the Management of Asthma: A national clinical guideline. Available at: http://www.sign.ac.uk/pdf/sign101.pdf (Accessed: 10 March 2011). Brocklebank, D.,  Ram, F.,  Wright, J.,  Barry, P.,  Cates, C.,  Davies, L.,  Douglas, G.,  Muers, M.,  Smith, D.,  White, J. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature Health Technology Assessment 5 (26) pp. 1-149. Pubmed [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11701099 (Accessed: 4 March 2011). Department of Health (2011) Prescription Cost Analysis 2001. Available at: http://www.doh.gov.uk/stats.pca2001.pdf (Accessed: 11 March 2011). Lang M., Erzurum S., C., Kavuru M. (2011) Asthma. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/bronchial-asthma/ (Accessed: 12 March 2011). Medicines and Healthcare Regulatory Products Agency (2007) vol (1) drug safety update. Available at: http://www.mhra.gov.uk/Publications/Safetyguidance/DrugSafetyUpdate/CON2033216 (Accessed: 12 March 2011). NHS Centre for reviews and dissemination (2003) 8 (1) Inhaler devices for the management of asthma and COPD Available at: http://www.york.ac.uk/inst/crd/EHC/ehc81.pdf (Accessed: 10 March 2011). National Health Service Choices (2010) About the NHS. Available at: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx (Accessed: 5 March, 2010). National Health Service Choices (2010) Acute asthma in adults-management in primary care. Available at: http://healthguides.mapofmedicine.com/choices/map/asthma_in_adults2.html (Accessed: 9 March 2011). National Health Service Choices (2006) The role of your Respiratory Nurse Specialist. Available at: http://www.chelwest.nhs.uk/documents/patientLeaflets/Asthma%20-%20The%20role%20of%20your%20Respiratory%20Nurse%20Specialist.pdf (Accessed: 11 March 2011). Office for National Statistics (2004) Asthma and allergies: Decrease in hospital admissions in 90s. Available at: http://www.statistics.gov.uk/CCI/nugget.asp?ID=722Pos=1ColRank=1Rank=192 (Accessed: 8 March 2011). Shiang, C., Mauad, T.,  Senhorini, A., De Araà ºjo, B., Ferreira, D., Da Silva, L ., Dolhnikoff, M., Tsokos, M.,  Rabe, K.,  Pabst, R. (2009) Pulmonary periarterial inflammation in fatal asthma Clinical and Experimental Allergy 39 (10) pp. 1499-1507 Wiley [Online]. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2009.03281.x/abstract (Accessed: 11 March 2011). LEARNING OUTCOME 2 LEADERSHIP IN NURSING AND ASSOCIATED PROFESSIONS A Leader is someone who guides or chairs a group of people or an organisation; it is common practice that a leader portrays some leadership skills to enable him/her be productive and effective. Cook (2001) describes a clinical nursing leader as someone who endlessly gets involved in direct patient care hence improving care by being of positive influence to others. All nurses (from those who provide direct care to the managers) need potent leadership skills. Mahoney (2001) emphasises that anyone (e.g. a nurse) who gives assistance to others or is responsible for other people is considered a leader; however, good leadership is reproducible superior performance targeted towards a long term benefit to everyone called for. John, (2011) has defined a manager as an individual with the sole responsibility to plan and direct the work of a group of people, ensuring proper monitoring and directives are followed. Management in nursing involves regarding leadership functions of administration and making appropriate decisions within organisations that employ nurses. SIMILARITIES BETWEEN LEADERS AND MANAGERS Leaders and managers go hand in hand, none of them tend to possess abilities that make them stand on their own, and there is no unique or particular way of managing people. Some basic similarities between managers and leaders are: People development: An effectual manager and leader have skills and abilities that tend towards the development of the people. Partnership working: the work of both a manager and a leader tend to be of a partnership level (Mather, 2009). Motivators: both leaders and managers are motivators of their subordinates DIFFERENCES BETWEEN LEADERS AND MANAGERS Thinking pattern: A major difference between a leader and manger is in their level of reasoning, Managers think incrementally, whilst leaders think radically; managers always work towards doing things rightly while leaders work in the perspective of doing the right thing (Richard, 1990). Loyalty: Subordinates are mostly subordinate to their leader than to their manager; this applies often because the leader takes credit in times of achievement and allocating merit to subordinates (John, 1990). Competencies: A nursing manager allocates resources and sets timetables while a nursing leader is someone who clarifies the big picture created by the manager and simplifies it, making the hospital/nursing homes vision more understandable to the staff and patients (Kristina R, 2009). Leadership is a very vital issue in the nursing practice because nursing requires knowledgeable, consistent and strong leaders, who inspire and boost peoples moral and support professional nursing practice. Nurses need to be both leaders and managers for some very key reasons as: An Advocate for quality care: a head nurse who serves as either a leader has to stand out in ensuring the needs of both the patients and nursing staff are adequately met, sometimes it will require a robust and bold person to stand before the board in defending these needs. An influential personality: the presence of an influential nurse handling an asthmatic patient will go a long way in guiding the patient in making informed choices; the patient becomes free and open to the nurse when she/he exhibits a high level of positive influence on the patient. CRITIQUE OF NURSING PUBLICATIONS IN RELATION TO LEADERSHIP AND MANAGEMENT IN ASTHMATIC AND GENERAL NURSING CARE A report by the Royal College of Nursing (RCN) on the support by Asthma UK on RCNs frontline campaign published on 14th January 2011 is carefully analyzed highlighting the publishers aims of writing, lessons to be learnt, consequences of the article and its impact on positive care delivery. It was rightly stated in this article that about three-quarters of asthma emergency admissions can be avoided if proper care is delivered (Royal college of Nursing, 2011). This implies that the need for proper managerial skills needs to be adapted by the healthcare leaders to manage asthma patients which will ultimately lead to the reduction of emergency care delivery for asthma patients. He went further to stress that specialist nurses are the cohesive source of support and stability for care for asthma patients; this issue is supported by the Relationship theory of leadership (also known as transformational theory) which highlights the connection between the leader and the led (Kendra, 2011). Leaders that possess this trait tend to motivate and stir their followers to ensure maximum productivity is achieved. Focus is geared towards the performance of the group members. When a leader with such trait is employed, the function of the specialist will be balanced on both as a helper of the patient and a confidant to the patient. He also said that the role of a specialist nurse has reduced hospital admissions from 22% to 6%, hence saving the National Health Service billions of pounds annually. The writer concluded by turning down the practise of relieving the specialist nurses of their jobs and employing other nurses and ward clerks to fit into their roles which he said the adverse effects were of greater negative impacts as costing the NHS more finance and damage the lives of the patients already receiving care by the specialist nurses. The lessons from this article cannot be over-emphasized in that there is an immediate need for the employment of more specialist nurses to manage asthmatic patients better and to save the lives of their patients. A similar report by Akinsanya (2009) on the Exacerbations of severe asthma; psychosocial predictors and the impact of a nurse-led clinic stated that the need for alternate management approaches is paramount in caring for people with severe asthma. He also recommended further findings on the social and psychological aspects of asthma management. Recommendations were also made on the holistic approach for long-term management of asthmatic patients (Akinsanya, 2009). This report clearly shows the application of the contingency leadership theory that postulates the influence of variables that relate to the environment on the determination of the specific leadership style fit for a situation (Kendra, 2011); it further implies the need for a paradigm shift on the care for acute asthmatic patients towards need for more nurse specialists. PERSONAL REFLECTIONS ON LEADERSHIP AND MANAGERIAL SKILLS As a major role player in healthcare delivery, nurses have inevitable functions. This Portfolio has given me an in depth understanding in various areas of my practice as: Efficiency: I have learnt that my level of efficiency has a vital impact in saving asthmatic patients lives; it will help ease the huge financial burden on Government by saving extra expenses. Leadership skills: According to the great man theory of leadership (Management Study Guide, 2011a) which denotes that some people are born with inherent leadership skills which become apparent when great needs arise. I have understood that as a nurse, I can lead rightly and manage people if I can nurture the greatness in me. In enhancing my managerial skills, I will give room for creativity in my area of work by combining both human and non-human resources (Management Study Guide, 2011b) to achieve the designed goal. Team work is also a very good point I learnt from this report in that I cannot be an effective leader if I am regarded as the only member of my team succeeding, there has to be a cohesive effort from all. Care delivery: The focus is on the nurses to serve as interlocutors between the GP and patient ensuring the patient adheres to prescriptions and that the nurse is always available for assistance by the patient. CONCLUSION The difference between a leader and manager is quite small and most leaders tend to end up as managers. Asthmatic guidelines need to be reviewed often to improve its managerial aspect of care. Nurses are relevant care deliverers and all need to develop leadership and managerial skills in order to safe guard the healthcare of the United Kingdom.