Elderly Patient on Psychotic Depression ward

Elderly Patient on Psychotic Depression ward In this assignment I will be carrying out a Critical Incident Analysis on an incident taken from my portfolio that was encountered whilst in practice placement. This type of analysis was first used to analyse flying missions by pilots, as a way of raising their performance (Flanagan, 1954), in more recent years Norman et al. (1992) and Perry (1997) described this type of analysis as being an important and valid tool for use in nurse training, as it allows the student to choose and use an incident that made an impact on them, from their practice placement that was either positive or negative, so that they can analyse, reflect on and learn from it, showing their development as a practitioner and a person whilst linking theory to practice and helping them move from novice to expert, as outlined by Benner (1984) . Model used for reflection For the purpose of this assignment I have selected the Gibbs (1988) reflective framework model which is an iterative model meaning it is cyclical in nature, the six points covered by this model are: Describe the activity or experience in objective detail. Discuss and explore any feelings you were having at the time of the experience. Evaluate the experience: What really happened? What was good about it? What was bad? What factors contributed to the event? Analyse the experience: What can you learn from it? Conclusion: What could you have done differently? Anything you wish you had done? Wish you hadnt done? Action Plan: What can you plan on doing in the future? (Bethann, 2004, p167) This is also the model I use in my portfolio as along with critical incident analysis, it centres on reflective practice, an essential skill in nursing practice allowing situations to be analysed in detail, identifying areas of potential change, Jasper (2003) and reinforcing the need for certain practices by highlighting their benefits. I also find the logical, straightforward structure of this framework allows the reflection to be written clearly, providing opportunities to look at incidents from different perspectives. The Critical Incident Stages one and two of Gibbs model of reflection are covered here, where the incident is described along with my feelings at the time of the incident. I chose this particular incident as it put me in a very challenging position where I had to think on my feet, it made me test my abilities as a communicator and a nurse under stress, whilst highlighting the importance of some of the more basic nursing techniques like non-verbal communication through touch, educating patients to help themselves, looking out for physical signs that can indicate a patient is in distress and how working closely with a patient can earn their trust whilst building up the therapeutic relationship In order to keep the patient and the practice placement confidential, as indicated in the NMC Code of Professional Conduct (2002) and the N.M.C. guide for students (2002), the practice placement is kept anonymous and the patient will be referred to as Tom. The patients consent was also obtained, as it is the patients right to choose whether or not they wish details to be written about them, highlighted by Johnston and Slowther (2003) also outlined in section 3.7 of the N.M.C Code of conduct (2002) with reference to patients who suffer from mental illness. The patient, Tom a 72 year old man, was admitted to my practice placement suffering from Psychotic depression and anxiety, my placement is at a Psychiatric admissions ward, for patients over sixty five years old. On assisting Tom with his activities of daily living (A.D.Ls), (Roper et al, 1980) after, rising one Monday morning, It became apparent when helping Tom dress that his right arm was causing him pain, in the area of his right shoulder, I relayed this to the nursing staff who explained Tom had fallen unobserved on the Friday night and had been seen by the Doctor who on examination felt no other investigations were needed. On further discussion about his arm and the fall, between myself and Tom, he eventually admitted to having also fallen on the Sunday night and had not told anyone about it, once I had explained this to the nursing staff the Doctor was again consulted and felt that Tom should have an X-ray to rule out any broken bones. I accompanied Tom as an escort to the x-ray department where he became increasingly agitated, anxious and was mumbling to himself with delusional content of speech evident, concerning the N.H.S. which had not been known about, as Tom had only recently been admitted, he felt they (the N.H.S) were going to cause him, bodily injury (a persecutory delusion Gamble Brennan, 2003) due to his doing them out of money when he was younger, I did my best to give constant reassurance that I would not let anyone harm him, but when someone holds a delusional belief it can be very firmly maintained and difficult to dissuade from, in particular when they are in a state of high anxiety like Tom, as indicated in Stuart and Laraia (2001). I was quite worried about how the situation was going and that I might be out of my depth as I did not know Tom very well and felt a little awkward trying to reassure someone who was this distressed, feeling I was doing little or no good for him. After he had his x-ray and I was assisting him to get dressed in the x-ray cubicle the Radiologist came in and told us that Toms shoulder was broken and that we would need to go round to casualty to be seen by a Doctor there. This news made Toms level of panic escalate considerably and he began to have a panic attack in the cubicle, most likely a situationally predisposed panic attack, which occurs on exposure to a situational cue or trigger (DSM-4) Tom had become quite pale and began to perspire profusely, along with his breathing becoming very shallow and rapid to the point that he was panting, I found it quite distressing to see Tom in this condition. I had never encountered someone quite as panicked as this and I felt quite concerned. I thought calling out for someone to help might only panic him more, so I decided to try some deep breathing exercises to relax and calm him down first, then if that did not work I would seek help. I knew from reading Toms notes that he did not have a heart condition or other health problem that would have been causing these symptoms and it had been recorded that Tom suffered from panic attacks, although I was still watchful for any change in his symptoms that might indicate an alternative medical reason for his condition. Initially I sat beside Tom with my arm around him, asking him to take slow deep breaths, but with his level of panic and no eye contact meant he was not concentrating on me, so I knelt down on the floor in front of him took his hands, spoke to him gently but firmly using his name and with direct eye contact got him to focus on what we were doing. I explained his symptoms were due to his panic attack and the breathing exercises we were doing would help relax him, calm him down and make him feel better. Tom started to comply and began with my instruction, breathing in slowly through his nose holding it for a moment then breathing out slowly through his mouth. In a relatively short time his breathing began returning to normal and he started to relax, enabling us to go on to the casualty department to see about his shoulder. In the casualty department Tom still required reassurance not only verbally but also with touch as he asked me to hold his hand, bringing home the importance of this simple yet significant form of non-verbal communication and despite needing another brief set of relaxation breathing in the casualty cubicle Tom was notably calmer. I felt privileged that he had put his trust in me and that we had moved on further in our therapeutic relationship, as while waiting in casualty Tom who had hardly spoken to anyone let alone myself, began discussing how scared he had been and talked about some of his delusional beliefs, which helped me empathise with how terrified he must have been. I was also able to discuss what Tom told me with the qualified nurses on return to the ward giving a deeper insight into his condition. Critical Discussion of the Incident For this section of the Critical Incident Analysis stages three and four of Gibbs reflective framework are covered, allowing me to look at what was good and bad about the incident along with contributing factors (Gibbs 1988), I am going to discuss, analyze and reflect upon three key issues: Panic attacks, the relaxation technique of Deep breathing and Touch therapy, that were encountered during the incident and that I felt were of significant importance. Panic attacks I felt this topic was important to the critical incident as it is a common condition closely linked to anxiety which a great number of mental health patients experience often along with their main diagnosis but most commonly alongside depression as in Toms case, Clayton (1990) and Merikangas et al (1996) stated that comorbidity between panic and depression is the single strongest type of anxiety-mood comorbidity found in both treatment and in the general public. Panic attacks are often talked about and appear in patient notes but this critical incident brought home for me how absolutely terrifying and totally debilitating the panic attack was for Tom and how distressing it can be to witness a patient in this condition. Anxiety is a normal healthy reaction to the stresses of everyday life as suggested by Trevor Powel (2001) and even necessary for us to perform at our best as Yerkes-Dodsons Law (1908) explains, illustrated in the graph below. Here levels of anxiety are referred to as arousal and a direct correlation to performance is demonstrated, it tells us that if we have low levels of arousal then our performance becomes decreased (distress, as introduced by Seyle (1956)), at medium levels our performance levels peak (eustress as described by Seyle (1956)) and when our arousal levels become high our performance levels and subsequent ability to function drop again (resulting in distress) as seen in Toms situation. (Yerkes Dodson 1908) Peplau (1963) defined anxiety in four levels: Mild anxiety- everyday life stress. Moderate anxiety- Immediate concerns focused on, with narrowed perceptual field, although able to function when necessary. Severe anxiety- Greatly reduced perceptual with difficulty focusing on anything except what is causing anxiety. Panic- Person feels terror, dread as is unable to reason with the threat causing anxiety blown out of all proportion, making it almost impossible to communicate or function, with little or no control over themselves causing panic attack. Toms anxiety level was clearly at the panic stage which cannot be allowed to continue indefinitely as being in a panic attack state is not compatible with living, as described by Stuart and Laraia (2001), who believe if prolonged can result in total exhaustion or in extreme cases even death. Panic attacks affect between 3 and 5 percent of the population at some point in their lives (Lynch E, 2005). The findings of an American study carried out this year showed that people suffering from panic attacks account for around 25% of those attending casualty departments or G.Ps. (Ham, P. et al, 2005) often having trouble breathing properly as found with Tom, with most people suffering from panic attacks, stating hyperventilation as being one of their main symptoms (Holt and Andrews, 1989), or with patients believing they are having a heart attack. Toms panic attack was mainly evident by the physical symptoms he displayed, described previously, physiological symptoms often being the only visible signs of a panic attack as described by Stuart and Laraia (2001). In this instance, although Toms Psychotic Depression was the likely reason for his anxiety with the resulting panic attack, I felt trying to deescalate his anxiety levels, by getting the panic attack and hyperventilation under control was my main priority, there would have been no point in me trying to deal with his delusional beliefs at this point as this takes time and experience, of which I had neither, plus Toms panic levels were so high it was difficult for him to concentrate. Therefore it seemed logical to concentrate on something which it was perhaps possible to change. I hoped that using the deep breathing technique would be successful in helping return Toms body systems to normal which would stop the hyperventilating making Tom feel a lot better and knew that breathing techniques could be very effective but did not want to put Tom at any risk by doing so, I had to make a judgment call about how I was going to handle the situation and decided I was going to try and deal with it using the breathing exercise. Relaxation Techniques Deep breathing The next topic I am going to cover is Relaxation Techniques and the technique of Deep Breathing in particular, I feel it is important to cover this topic as it was a key factor in the outcome of the incident as by guiding Tom through the breathing technique, enabled him to control his breathing resulting in his panic attack and hyperventilating coming to an end. Toms physical symptoms indicated that he was hyperventilating or overbreathing, the mental health handbook (Trevor Powell, 2001) tells us this is a normal response to threat by our bodies to bring more oxygen to the muscles, preparing us for Fight or Flight, but if the extra O2 is not needed by the muscles, i.e. the situation is only an imagined threat as in Toms case, the normal level of gases in the blood and lungs becomes out of balance, due to breathing in to much oxygen (O2) and pushing out too much carbon dioxide (CO2), this causes the blood to become alkaline which brings on many of the unpleasant symptoms Tom was suffering from. There are several ways of overcoming hyperventilation, possibly the most commonly referred to, is breathing into a paper bag to facilitate the breathing back in of the carbon dioxide being breathed out, as explained in the Nursing Times article, Facts: Panic Attacks (2003), which also acknowledges the importance of controlling the patients breathing, Stuart and Laraia (2001) also agree that relaxation techniques are an accepted therapeutic intervention in the treatment of anxiety. Since I had no paper bag with me, I decided to use the three stage deep breathing technique to retrain Toms breathing which, Risser and Murphy (2005) agree, improves panic symptoms and associated disability, this type of breathing which is commonly used in yoga helped to slow down and control Toms breathing which also stopped him hyperventilating, it is carried out by: Inhaling slowly and deeply through your nose. When youve taken in a full breath, hold it for a moment and thenà ¢Ã¢â€š ¬Ã‚ ¦ Exhale slowly through the nose or mouth, depending on your preference. This action although different to the paper bag technique brings about the same desired effect, in the case of Deep Breathing carbon dioxide is not being re-breathed but the rate it is expelled by is being slowed down along with holding it a little longer in the lungs which results in the levels of carbon dioxide in the blood rising, correcting the acid/alkaline balance in the blood, which relieved Toms unpleasant symptoms, bringing his breathing rate back to normal and making him feel calmer. At the time of the incident I really hoped that the breathing technique would be successful although I was not entirely sure whether to trust my instincts and try it out. On reflection I was very impressed at how effective such a simple procedure could be and was glad not only for Toms sake but also my own that I had decided to try it out, as it gave me more confidence in my abilities as a nurse even though at the time I was carrying it out, although outwardly calm, I had felt quite anxious. Touch Therapy The final key issue I wish to highlight from the critical incident is the benefit of touch as a therapy, which I felt was vital as a way of communicating with Tom during his panic attack along with giving him reassurance that I was there for him, empathising with his situation and helping him focus on what we were trying to do. There are several terms used to describe the different types of touch used in nursing, some of which are: necessary touch which covers task and instrumental touch that is mostly used when a procedure or task needs to be carried out on a patient as opposed to non-necessary touch which is described as spontaneous and emotional physical contact between the nurse and patient, introduced by Routasalo (1996), expressive touch comes under the non-necessary touch umbrella with the same type of nurse patient contact, described by McCann McKenna (1993) which is similar again to caring and protective touch highlighted by Estabrooks (1989) and finally therapeutic touch, which is an alternative therapy similar to reiki, discussed by Meehan (1998). Nesbitt-Blondis and Jackson (1982) agree that touch is probably the most important of all non-verbal communications that we use in nursing and can be particularly useful in cases like Toms panic attack where his ability to understand and communicate was diminished, when patients are unable to communicate verbally or understand verbal communication for reasons such as dementia, those with learning or cognitive difficulties and in panic attack situations like Toms, touch can be an excellent means of communication. Unfortunately, McCann McKenna (1993) reported that in the U.K. there is little use of expressive, non-necessary or caring touch by nurses. Many nurses see touch as just something that is used when a procedure or task needs to be carried out on a patient, but Tutton (1998) suggests that touch in nursing and the powerful expressions it conveys to patients are sadly underutilised. Routasalo (1996) also suggests that non-essential touch although not absolutely essential, can be extremely important and necessary to the patient. The benefits of this type of touch in nursing are strengthened further by Moore Gilbert (1995) who found patients interpreted the use of touch by nurses as a display of affection and attention which they greatly appreciated, with patients interviewed in Routasalo Isolas (1996) study, describing touch by nurses as extremely comforting. Davidhizar Giger (1997) whilst acknowledging the important role that touch can play in the nurse patient relationship, also points out that the value of touch is not appreciated by all health professionals or considered appropriate or desirable by some patients. Bearing this in mind as long as the correct manner of touching is employed, and there is no way it could be seen as being inappropriate with the patients personal and cultural beliefs being taken into account, it is one of our most valuable communication nursing tools. The extent of physical contact carried out in a society is governed by sets of well-defined behavioural norms for whatever circumstance we find ourselves in (Pratt Mason 1981). Jourard (1966) recognised that the incidence of touching within our Western society declines from childhood onwards but Montagu (1986) discovered that the need for touch did not reduce with age. It is felt that the level of touch common in childhood can return in situations of sickness or incapacity (Barnett 1972). This may mean that, the need for touch in illness might be more important than our ideas of proper behaviour. I felt the touch element in this incident: my taking of Toms hands to help him focus, get his attention and convey my empathy, was extremely important and was in fact the turning point in the whole incident which allowed me to gain Toms trust and initiate the breathing technique which stopped him hyperventilating. I feel that without the touch element it would have been almost impossible for me to reach Tom and the outcome of the incident would have been very different. Implications for Professional and Personal Development In this final section of the Critical Incident Analysis, the two final stages of Gibbs model of reflection (1988), five and six are covered, here we look at what was learned from the incident, what could have been carried out differently or should not have been done, along with what was missed out concluding with a plan for future action. I found in utilising the Gibbs (1998) reflection tool, the impact the incident made on my personal and professional development was made much clearer. Through carrying out this Critical Incident Analysis I have been able to see what I have learned through reflection, as the Department of Health (1999) states, reflective practice is necessary in order to further our continued personal and professional development and leads to a greater understanding of our own needs. Described as a form of self discovery by Freshwater (2004) with a deeper understanding of the needs of the patient and improved patent care highlighted by Davies (1995). From this I feel the analysis made me examine my communication skills on a deeper level for although I feel that I am a natural communicator, and have had many years experience working with people suffering from dementia, I had not fully thought about the use of touch or the great importance it has in communicating with patients . Without the use of reflective practice I would not have researched into the concept of touch so fully or really understood its relevance and consequences in my nursing practice. Or recognised the significance touch played in the successful deescalating of Toms panic attack and hyperventilating in this critical incident. This Critical Incident Analysis has definitely taught me to have more faith in my abilities as a nurse but has also taught me I have more to learn as a communicator. Similarly with the topic of panic attacks which I was obviously familiar with and had some knowledge on, having been through the incident with Tom and then carrying out the reflection on the incident, allowed me to see the field of panic and anxiety disorders with a deeper understanding and much more from the patients viewpoint. Having witnessed the real distress and levels of disability it can inflict will enable me to really empathise with patients like Tom going through this type of disorder when I come across them in my future career. The area of relaxation breathing was something which I had used myself in yoga practice and did know of its benefit in anxiety situations, but I had not expected to have to start teaching it to a patient that day in the X-Ray cubicle. I was quite shocked when Tom had began hyperventilating but on reflection I should have perhaps saw it coming with his rising levels of anxiety after our arrival at the hospital, especially after I had read only that morning that he had a history of panic attacks. Again on reflection I could have asked the nursing staff the best way to deal with it should the situation arise. I have learned from this that I could have been better prepared before escorting Tom by asking questions and having a plan of action to use if necessary. I had been worried about putting Tom at risk by trying the breathing technique with him as I stated earlier, and perhaps it was wrong of me to have tried it in the first place, but I had made a judgment in an emergency situation, and I did not make the decision lightly, being aware that help was nearby should it be needed. I did not want to distress Tom further by calling out, resulting in people rushing into the cubicle and in conclusion felt the breathing exercise was worth a try, but I would have called for help quickly if it did not appear to be working. On discussing the incident and my actions back on the ward, my mentor also felt I had made the right choice. This made me think about the fact that as a nurse there are times when it is up to you to make judgment calls regarding patient care and that it is important to remember that you are accountable for your actions. To carry this level of responsibility demands a sound knowledge of practice and an ability to think calmly and clearly even under stress. I was both relived and delighted that the breathing technique worked so well for Tom and felt honoured that he decided to put his faith in me. As stated earlier, this prompted Tom to confide some of his fears to me, which showed trust on Toms part and fostered a deeper understanding of his condition on mine. This advancement of the therapeutic relationship between Tom and I has continued during my placement where I have worked quite closely with him and where I have taught him how to practice the breathing techniques when he feels calm making it easier for him to utilise in panic situations, which he has been doing with good effect. As a follow on from this incident and after seeing the efficacy of relaxation techniques in action, at my practice placement I asked my mentor if it would be possible to carry out some relaxation groups with carefully screened groups of patients who had anxiety problems. My mentor and other nursing staff thought this would be a good idea both for the benefit of the patients and for my personal and professional development. After researching the subject and finding appropriate music along with compiling a script, the groups were initiated with great success and are now regularly used on the ward, which has given me some sense of achievement and helped build my confidence in my abilities as a nurse. Along with being very beneficial in analysing this particular incident the use of reflective analysis has definitely improved my practice in placement, and although I have used this model of reflection in my portfolio for some time now, it has made me re-examine the importance keeping and using a portfolio to further my professional and personal development. I also feel this helps me to benefit more from my placement as I fully understand the concept behind reflection and use it positively as a tool rather than a task I need to perform. When using reflection now I am able to draw more insight from my experiences on placement, while previously I had only skimmed the surface of the subjects when carrying out reflection. This has increased both my self awareness and my ability to link theory and practice together. Overall, I can see clearly how reflection is a useful tool in helping nurses to focus on their skills and behaviour which consequently enables them to provide the best care possible for patients, as discussed by Somerville (2004). Action Plan Preparing and utilising action plans is an important way of improving both our personal and professional development as nurses, whilst building on improved nursing practice. To be prepared for this kind of scenario in the future I have identified the following plan of action: Make sure I know and understand all relevant information regarding patients. Have good communication with other members of staff about patients. Have a plan of action thought out for any incidents that may arise. Remain calm and consider actions carefully. Empathise with the patient by trying to understand what it would be like to be in that situation. Where possible help the patient to help themselves, i.e. by educating them to use breathing techniques so when a panic situation arises they are in a better position to take control themselves.

Lord God forgive me! Essay

   The grenade had been thrown and it goes through it’s stages building up to the horror of the war. â€Å"(Swish swish swish BANG)! † This quote shows that there is silence at first and Sherriff shows what the grenade would do. He shows the tense of the atmosphere for example the type of smooth faint noise the grenade would make when it is in the air and then it builds up to the great noise when the grenade lands on the ground. This quote shows the tense of the atmosphere and the stages it goes through until it seems completely realistic. Sherriff uses the this example in the stage direction to show the horror’s of war through the atmosphere, through noises he is able to show the violence there is in the war, this quote can help the director create the scene and help the audience give a better understanding of the horror’s of war. R. C Sherriff uses a variety of different structures of language through the characters, he shows the audience on how the soldiers had spoken most of the time through out the war and how they might speak due to their class. For example, upper class soldiers would speak in a more posh accent and have a better use of grammar whereas the lower class soldiers would use army jargon such as â€Å"minnies† and â€Å"pineapple’s† as well as slang such as characters dropping the letters in some words, for example a soldier says e instead of he. Sherriff had created characters with this characteristic on language so he could show the rank the men are in. Osborne is from an upper class therefore he uses language in a good sense of grammar and he speaks words in a posh accent. â€Å"Osborne: Cheerio. † This quote shows that a character called Osborne is from an upper class since he uses words like â€Å"Cheerio† which is a posh word. Mason a cook who constantly speaks slang shows his characteristics to be from a lower class since he uses that sort of language and has a poor level of work in the war. â€Å"Mason: E said the leopard can’t change its spots. † This quote shows that a character called Mason is from the lower class since he speaks slang, for example he drops his h when saying he. Sherriff had initially done this because this reflects the rank the men are from so it can give a clear understanding of the characteristics to the audience. The characters Raleigh and Stanhope are significant roles in the play. Raleigh holds the characteristics of a nai ve, inexperienced and gormless person who had just joined the company. Stanhope, who is more opposite to Raleigh, he runs the company which shows that he is much more experienced. Raliegh had known Stanhope from school even though Stanhope was three years older than Raleigh. The characters mainly represent the horrors of war by talking about violence in their conversations and actually going through the process of it when coming to the points of attacking and fighting. Through out the course of the play the characters interact with each other dramatically and emotionally. Their behaviour reflects how they had survived the war, for example they would try not to talk about bad and emotional events and they would try to adapt to positive points while drinking rum. Stanhope talks about upcoming violent events. â€Å"Stanhope: We must expect this attack on Thursday morning. † This quote shows how the characters would represent the horrors of war by talking about an attack which hold the structures of violence, it makes the audience imagine a fight of some sort and injuries which reflect the horror’s of war. When the soldiers were to attend an attack six soldiers went but five came back and one had died which was Osborne. â€Å"Stanhope: Four men and Raleigh came back sir. Colonel: I’m very sorry. Poor Osborne. † This quote shows that one of the soldiers had died which shows death as a part of the horror’s of war and the men interact kindly with each other at this point because their fellow friend had just died. There are many ways the Stanhope and Raleigh had interacted with each other through out the play. At first points of the play Raleigh was more of the shy person and had seemed more scared to talk to Stanhope. â€Å"Stanhope: How did you get here? Raleigh: I was told to report to your company, Stanhope. † This quote shows how Raleigh had reacted in a more respectable manner and had called him Stanhope instead of his original name, Dennis. In addition this quote shows that Raleigh had deliberately joined Stanhope’s company which shows that he cares for Stanhope. The play shows how the soldiers were able to cope with the horrors of war since Stanhope had come back from an attack and he had started to celebrate with the other soldiers as soon as he gets back. â€Å"Mason: I thought I might tell you sir, this is the last bottle. Stanhope: The last bottle! Why damn it, we brought six. Mason: I know sir, but five of them have gone. † This quote shows that even after Osborne’s death, the soldiers are not that emotional because they face their problems to alcohol and try not to remember those emotional and heartbreaking moments. This quote shows the behaviour the soldiers had that would help them to cope with the horror’s of war. Overall this play shows the horrific effects of war and that it puts a bad example on a person, and soldiers are not treated fairly due to their personal problems. In my opinion I think that there is no reason for war, it does nothing other than create a bigger stage of conflict. It ruins many soldiers life, when they could have had a ordinary life but war can put immediate effect on it. Overall I think that R. C Sherriff had tried to outline the horrors of war, the causes of it and how it can also cause soldiers to suffer. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Miscellaneous section.

Aposiopesis in Rhetoric An Unfinished Thought

Aposiopesis is a  rhetorical term for an unfinished thought or broken sentence. Also known as  interruptio and interpellatio. In writing, aposiopesis is commonly  signaled by a dash or ellipsis points. Like paralepsis and apophasis, aposiopesis is one of the classical figures of silence. EtymologyFrom the Greek, becoming silent Examples and Observations Almira Gulch, just because you own half the county doesnt mean that you have the power to run the rest of us. For 23 years Ive been dying to tell you what I thought of you! And now--well, being a Christian woman, I cant say it!(Auntie Em in The Wizard of Oz, 1939)Sir Richard hurled a match, which for some moments he had been applying without noticeable effect to the bowl of his pipe. It remains a mystery to me, he said, his face expressing suitable if momentary mystification how the girl was murdered. Could she have been shot from outside, do you suppose, and the window--? He indicated his lack of confidence in the suggestion by resorting to aposiopesis.(Edmund Crispin, The Case of the Gilded Fly, 1944)I will have such revenges on you bothThat all the world shall--I will do things--What they are yet, I know not; but they shall beThe terrors of the earth!(William Shakespeare, King Lear)I wont sleep in the same bed with a woman who thinks Im lazy! Im going right downstairs, unfold the couch, unroll the sleeping ba--uh, goodnight.(Homer Simpson in The Simpsons)Dear Ketel One Drinker--There comes a time in everyones life when they just want to stop what theyre doing and . . .(print ad for Ketel One vodka, 2007)[Aposiopesis] can simulate the impression of a speaker so overwhelmed by emotions that he or she is unable to continue speaking. . . . It can also convey a certain pretended shyness toward obscene expressions or even an everyday casualness.(Andrea Grun-Oesterreich, Aposiopesis. Encyclopedia of Rhetoric, ed. by Thomas O. Sloane. Oxford University. Press, 2001)All quiet on Howth now. The distant hills seem. Where we. The rhododendrons. I am a fool perhaps.(James Joyce, Ulysses)She looked perplexed for a moment, and then said, not fiercely, but still loud enough for the furniture to hear:Well, I lay if I get hold of you Ill--She did not finish, for by this time she was bending down and punching under the bed with the broom . . ..(Aunt Polly in Mark Twains The Ad ventures of Tom Sawyer, 1876)And there’s Bernie layin’On the couch, drinkin’ a beerAnd chewin’--no, not chewin’--poppin’.So I said to him,I said, Bernie, you pop thatGum one more time . . .And he did.So I took the shotgun off the wallAnd I fired two warning shots . . .Into his head.(Cell Block Tango, from Chicago, 2002) Types of Aposiopesis The emotive aposiopesis is brought about by a conflict--real or represented as real--between an increasing outburst of emotion on the part of the speaker and the (material or personal) environment which does not react at all to the outburst of emotion. The speakers isolation from the concrete environment, caused by the emotion, borders on the comical. In painful awareness of this situation the speaker breaks off this outburst of emotion in mid-sentence . . ..The calculated aposiopesis is based on a conflict between the content of the omitted utterance and an opposing force which rejects the content of this utterance. . . . The utterance is therefore omitted, which is generally explicitly confirmed afterwards. . . .Audience-respecting aposiopesis . . . comprises the omission of utterances which are disagreeable to the audience and of contents which generally offend the sense of shame. . . .The transitio-aposiopesis seeks to spare the audience from having to listen to the contents of t he section of the speech that is about to end, in order to gain immediately their all the stronger interest in the new section. . . .The emphatic aposiopesis . . . exploits the avoidance of the full utterance through aposiopesis in order to represent the object as greater, more terrible, indeed inexpressible . . ..(Heinrich Lausberg, Handbook of Literary Rhetoric: A Foundation for Literary Study, 1960/1973. Trans. by Matthew T. Bliss et al.; ed. by David E. Orton and R. Dean Anderson. Brill, 1998) Variations on Aposiopesis in Films A sentence may be split between two people, with continuity no longer of timbre and pitch, but only of grammar and meaning. To Robert Dudley, seated under a river boats curtained canopy, a messenger announces, Lady Dudley was found dead . . . . . . Of a broken neck, Lord Burleigh adds, informing the queen at business in her palace (Mary Queen of Scots, television, Charles Jarrott). When Citizen Kane runs for governor, Leland is telling an audience, Kane, who entered on this campaign (and Kane, speaking from another platform, continues the sentence) with one purpose only: to point out the corruption of Boss Geddess political machine. . . . The two fragments form, and are spoken as, a grammatical whole, through the change of place, time, and person (Citizen Kane, Orson Welles).(N. Roy Clifton, The Figure in Film. Associated University Presses, 1983) Pronunciation: AP-uh-SI-uh-PEE-sis

How Physical Intimidation Influences the Way People are Bullied - Free Essay Example

Sample details Pages: 9 Words: 2831 Downloads: 2 Date added: 2019/02/15 Category Society Essay Level High school Tags: Bullying Essay Cyber Bullying Essay Did you like this example? Abstract The purpose of this study is to explore some of the different variables that influence people to become cyber bullies. The study seeks to answer the research question, How does the lack of the physical intimidation affect people’s inclination to cyber bully? The goal is to analyze the demographics of cyber bullies and determine whether or not there is a physical influence on this growing trend. Since the beginning of time people have always had to deal with bullies. Don’t waste time! Our writers will create an original "How Physical Intimidation Influences the Way People are Bullied" essay for you Create order Just like anything else, however, things tend to evolve with technology. With the evolution of social media and technology some adolescence as well as adults are simply unable to escape harassment from their peers in school and in the workplace. This social phenomenon is what has come to be known as cyberbullying. According to Willard (2004) there are eight different forms of cyberbullying, which include Flaming (online fights), Harassment (sending vulgar messages), Denigration (posting gossip), impersonation, outing (sharing peoples secrets), trickery (tricking someone into sharing secrets), exclusion, and cyberstalking. The platforms for this to occur have become countless, from well-known social media sites like Facebook, Twitter and Tumblr, to smaller sites that allow you remain anonymous such as Yik Yak and ask.com. The days are gone of having to be the biggest meanest kid in the schoolyard to hurt others. Now it doesn’t matter your size, age, gender, or social standing if you want to bully someone. People can now create their own anonymous personas or simply continue to bully others online after they have left school or work. There have been several instances in the news over the last few years of people who have taken their own lives due to the constant ridicule from their peers. Because of this researchers have started to take notice of this new social issue and have performed numerous studies analyzing different aspects of cyberbullying such as the types of people who bully, the prevalence of cyberbullying, and the effects on the victims, but one thing that hasn’t been studied is whether or not the lack of physical intimidation effects people likelihood to become cyberbullies. This study is going to include extensive research into the motivations to cyberbully as well as its influence on the aggressors and victims and the relationships between the two. We will also examine the different techniques cyberbullies employ as well as the techniques that victims use in order to cope with the harassment. Review of Literature Prevelance of Cyberbullying Cyberbullying is something that is has become a new social phenomenon in today’s society. It can often times leave students unable to escape their bullies and leave them feeling alone and helpless. Faucher, Jackson, and Cassidy(2014) performed a study on 1925 students across four Canadian universities that found 24.1 percent of students had been the victims of cyberbullying over the last twelve months. These shocking numbers show that nearly one in every four people have been the victims of this phenomenon. This statistic is interesting however because when compared to studies that were done amongst younger age students you see that the numbers are drastically different. Wegge, Vandebosch, and Eggermont(2014) found that among 1,458 13-14 year old students that considerably less students reported being cyberbullied. This is very similar to what Vanderbosch and Van Cleemput (2009) found among 2052 students in the 12-18 ranges which concluded that 11.1 percent of students had bee n victims of cyberbullying. This research concludes that cyberbullying appears to be more prevelant in students as they get older. Wegge et al. (2014) also noted that 30.8 percent had been victims of traditional bullying. This raises the question as to why it seems to be less prevalent among younger students. Is it possible that they simply don’t have as much access to the tools of cyberbullying that students at the university level have, or they possibly aren’t as technologically advances as their older peers? It continues to raise questions about the issue of cyberbullying as well as what classifies the perpetrators as well as what are their reasons for harming others. The types of people who bully. An important factor when analyzing cyberbullying is trying to understand the types of people who are the aggressors. The first thing that needs to be discussed when analyzing this is the simple matter of gender when it comes to who is generally the aggressor. Slonje and Smith (2008) found that when i t comes to cyberbullying males are more often than not the aggressors with males being reported as the cyberbully far more often than females. Slonje et al (2008) also found that 36.2 percent of students were unaware of the gender of their aggressors. This is intriguing because for one its is the same percentage as the number of males who bullied, but most importantly because it shows that over 1 in 3 students don’t actually know who is bullying them, which adds to the fear and stigma that is related to cyberbullying and not being able to escape the perpetrators. The types of people who are victims. Researchers have also conducted various studies on the types of people who are cyberbullied, or what is often referred to as â€Å"cybervictomology†. Abeele and Cock (2013) conducted a study, which concluded that the gender of victims varied greatly depending on the form of cyberbullying. Abeele et al. (2013) found that males are more likely to be on the receiving end of direct cyberbullying while females are more likely to be the victims of indirect cyberbullying such as online gossip among peers. These findings appear to remain true to social social norms where males are viewed as more confrontational and females are o ften stereotyped as gossipers. While not many studies look at the gender of the victims many studies do research things such as the characteristics of the victims. Faucher et al. (2014) found that there were numerous reasons that people felt they were the victims of cyberbullying such as their personal appearance, interpersonal problems, as well as simply having discrepancies about their views. Davis, Randall, Ambrose, and Orand (2015) also conducted a study about victims and their demographics, which looked at the reasons people, were cyberbullied. Some of the results in the Davis et al. (2015) study addressed other reasons for being bullied in which they found that 14 percent of victims had been bullied because of factors such as their sexual orientation. These are all very important because it fits the profile of the traditional bully that many people envision but it shows that it transfers over into the cyber world as well. This leads on further questions about the relationship between the two and how the cyberbullying is influencing where and how the harassment is continuing. The relationship between bully and victim. The relationship between aggressor and victim is also something that has been heavily research among professionals. Beran and Li (2007) conducted a study that involved 432 middle school students and concluded that just under half of the studnets had been victims of cyberbullying as well as traditional bullying. This is true across multiple studies. Wegge et al. (2014) also concluded that people who were bullie d in traditional manners had a much higher likelihood to become victims of cyberbullying. Another interesting relationship between bully and victim is that studies have also shown that people who are victims are likely to become aggressors in the online world. Beran et al. (2007) confirms this by stating, â€Å"students who are bullied through technology are likely to us technology to bully others†. Faucher et al. (2014) also found similar results claiming that male and female students decided to bully people online because they were bullied first. Research has also been done that looks at how the bullies find their victims. Wegge et al. (2014) studied the perpetrators preferences in victims and found that 27 percent were in the same grade, 14.2 percent were in different grades and a staggering 49.6 percent were not schoolmates of the bullies. This evidence somewhat contradicts that of the other studies that state victims are generally bullied at school and at home because it shows that nearly half of the bullies prefer to bully people they don’t go to schoo l with and possibly have do not know at all. This continues to build and add to the idea of cyberbullying in that it allows bullies to create their own personas and images in order to try and intimidate and influence others without actually providing a physical intimidation factor. Effects of Cyberbullying The first part of this literature review focused on the demographics of the bullies and their victims, but now we will focus on the lasting effects and the trauma it brings to the victims as well as the different forms of cyberbullying. While the platforms used are different the lasting effects that the bullying has on the victims are very similar. Faucher et al. (2014) concluded that one of the main effects that cyberbullies had on university students was that they were unable to accomplish some of their school assignments. While many people think of effects of bullying to be simply depression or low self esteem this study brought light to a much different more unexpected issues. Beran et al. (2007) also found similar responses from victims of cyberbullying claiming that they often didn’t achieve the same marks in school and had lower concentration. These findings indicate that the lasting impact that a cyberbully has on their victims is often more harmful than what most peop le can see on the surface. Pieschl, Porsch, Kahl, and Klockenbusch (2013) found that cybervictims generally were less distressed during the second confrontation with a cyberbully. This interesting finding indicates that victims of cyberbullies may actually become desensitized to the aggression over time lessening the effects of the bullying. Victims coping techniques. When being faced by a bully it is important that victims learn to cope and move on from their experiences in order to prevent them from suffering in their personal and professional life like some of the victims in previous studies. Davis et al. (2014) conducted a study on victim coping techniques where they broke the techniques into two distinct categories, which were behavioral and cognitive strategies. Davis et al. (2014) found that 74 percent of participants preferred behavioral strategies and of those 74 percent, 69 percent of those people found the strategies to be effective. These behavioral strategies included seeking social support, making a creative outlet, or ignoring and blocking the bully. Because of the growing trend of cyberbullying there have been people who have developed different programs to help raise awareness for cyberbullying as well as offer help to the victims. One of these programs is known as Cyberprogram 2.0. Garaigordobil and Mar tinez-Valderrey (2015) conducted a study testing the effectiveness of this program and found that it was effective in decreasing the amount of traditional as well as cyberbullying, but also and more importantly it raised empathy among classmates towards the victims of these actions. This is a big step in combatting bullying because peers are constantly influencing each other. If the general consensus among the class is that bullying is not funny and not right because they empathize with the victims than it can go a long way in changing the social norm. If the attention is not longer given to the bully by classmates and victims it could potentially cut back on the frequency of this act. With that being said it raises the question instead of trying to cope, why not just remove yourself from the situation all together and not give the bully what they desire? Arntfield (2005) discussed the risk associated with using social media and concluded that â€Å"intrinsic rewards that were not tied directly to winning as much as they were to fantasies of power, celebrity, sexuality, and elevated social status that came with participating, win or lose.†. This conclusion is one that is very accurate and relevant to the way adolescence as well as university level student s think in today’s society. The fact of the matter is in order to fit in and be considered â€Å"cool† amongst your peers you need to be on social media to understand many of the things that are talked about amongst students. Whether it be trending hashtags, viral videos, or popular memes these are all things that are commonly shared and talked about between peers. While students may run the risk of being bullied on these sites, they also run the risk of being bullied for not knowing the newest updates in our culture, it is truly a viscous cycle. Forms of cyberbullying. Cyberbullying gives the bully a much larger spectrum to choose from when it comes to how exactly they want to intimidate their victims which may be why it is often easier for them to carry out the act. Of all the different ways to cyberbully Faucher et al. (2014) found the most common platforms for cyberbullying to be social media, text messaging, and email which were used to bully students about half of the time followed up by blogs forums and chat rooms which were 25 percent. This is no surprise that social media is the most common platform for cyberbullying because it can allow for the bully to remain completely anonymous to your average victim. This allows people who may not fit the mold of your average bully to create a fake account and build their own persona in order to b ully others. Multiple studies also address a critical factor of using social media or the Internet to bully others, which is that; the photos or hurtful comments, can remain in cyberspace virtually forever. Davis et al. (2014) mentions how they received viewed several responses that talked about â€Å"how their traditional bullying experience would have been magnified if they had occurred in todays digital era†. Faucher et al. (2014) also talk about how cyberbullying has a longer â€Å"shelf life† than your average bullying. This plays such a huge role because with the aggressive material on the internet it can often be revisited and the pain can constantly be brought back to light for the victims making the experience that much more traumatic. Social media is very prevelant among cyberbullies but there is also extensive research done on cell phones and the role they play in the act of cyberbullying. Abeele et al. (2013) studied various aspects of mobile phone bullying and found that the most prevalent type was gossiping via text message, followed by gossiping over the phone, and concluded with threatening others over text message. Abeele et al. (2013) also found that girls were more often than not the perpetrators of gossiping while boys made slightly more threats via cell phone. This numbers tend lean towards the stereotype of females being more of gossipers and males generally being more aggressive and physical. This is also interesting because shows that that society’s stereotypes appear to re main true even in a cyberworld. RQ1: How does the lack of the physical intimidation effect people’s inclination to cyber bully? Method If I were to conduct this study I think the best way to do so would be by a combination of quantitative and qualitative methods. I would choose to use survey research as well as focus groups in order to study these behaviors and why they happen as opposed to traditional bullying. By using survey research I would be able to uncover whether or not people are actually inclined to cyberbully due to physical factors and the focus groups would be beneficial in trying to understand why people become cyberbullies. By using the two different types of research it also will allow for the study to be more diverse and look at different angles of cyberbullying, which will result in having a better understanding of this phenomenon. Sample Selection For my sample I would choose to use a convenience sample. The age I want to study would be 15 to 23 year olds. I would reach out to the local high schools as well as the local universities and use the students who were willing to participate in the study. Based on the number of students in Escambia county between high school and college aged students I would like to have five thousand survey responses and two thousand five hundred volunteers for focus groups. I would allow students to participate in both aspects of the study if they were interested in doing so. Procedure For my study it will be important to base a 10-15 question survey on more than simply if a student is a cyberbully or how often they bully others but rather physical aspects of the bully. The survey would be completely anonymous and would ask questions about whether they have cyberbullied someone before, followed up with questions about gender, body size, and the gender and body types of their victims. For the focus groups I would split the participants up in groups of 6-8 based on age and gender. I would focus on questions about why they may or may not be inclined to bully others online. I would then combine the data I collected and use it in order to answer my research question.