Abortion: the most controversial issues in America

Nina Emmrich English 1 Abortion Guy Thorvaldsen 14, April 14, 2013 Abortion, this is one of the most controversial issues in America. It’s been an issue for over 200 years. In 1973 it was protected under law. But today it isn’t. Most American’s believe that it’s a sin to have an abortion while others see it as a choice to do it. There have been many legal cases against and also for abortion. Many have won but many have lost. This issue will never end. It will always be an argument. By having an abortion the mother is killing and innocent child who has no say in it.The family and father should also have a say in it as well. A little before the 1800’s states practiced some form of the English Common Law which happened to also lack codification. Abortion and unwed pregnancy didn’t exist in this time period. Finding the history of abortion is more difficult than people can imagine because there aren’t very many records of it to go off of. Starting in the 1600’s, there was the first conviction of the intent to abort a child. This went down in the state of Maryland, and then four years later another girl was arrested for murder because she had an abortion.This also happened in Maryland, but that case was dropped after the woman married the only witness who of course refused to testify. Another case that happened was in 1710 where Virginia Law made it a capital crime to be pregnant and then be found with a dead baby. In 1719 Delaware made it that anyone who counseled abortion or even infanticide an accessory to murder. According to Olasky’s notes â€Å"infanticide was probably the most frequent way of killing unwanted, illegitimate children†. â€Å"Abortifacients were known to and used in the early America.But by using them â€Å"was like playing Russian roulette with three bullets in the chamber†. So already there are beginning to make it a crime to have abortions. (abort73. com) There are many key factors that went into the process of deciding a case. They didn’t always have specific legislation for abortion and infanticide, those who did happened to have the same problem. It was impossible to have the right evidence to convict someone, and even more so pregnancy was hard to confirm. There was never a corpse or a witness to prove it. But on the bright side there was a great deal of the ury that had sympathy for the abandoned and desperate woman. Either way there was a lot of non-legislative factors that had been working against infanticide and abortion. A major factor was that the man should â€Å"act honorably† and propose to the women if he got her pregnant before they were married. (abort73. com) To give more to the influence of the society was the religious and scientific community. They condemned abortion both for how the bible speaks of an unborn child and also for the well-known testimony of church pillars like John Calvin who forbade abortion.Fr om the 1600’s-1800’s the scientific community believed that babies actually existed before they were conceived. This was also another anti-abortion influence. The difficulty confirming pregnancy before quickening made early abortions almost impossible, and late term abortions ruined marriage prospects, and were extremely dangerous. (Abort73. com pg. 2) There’s more to the history than just the community. Lawmakers had to start dealing with abortion in the late 1800’s. It was 1821 when the first abortion legislation had passes in Connecticut.The lawmakers everywhere else tried to keep up. New York legislation changed on abortion 10 times between 1828 and 1881. (Abort73. com) Abortion should be illegal. When women have abortions they are killing innocent children. It’s a sin to do so. Of course it’s a choice of the mother but what about the family. What about the father? Don’t they have a say in what happens to their child. As America g rew and expanded, most of the support mechanisms that helped provide for women during their crisis pregnancies had begun to want.The increase in social isolation and separation through urbanization had removed the societal and familial safety net for pregnant and non-married women had to fall back on. The concealment of a women’s pregnancy alone with smothering the baby after it was born was then considered a choice. Therefore abortion was beginning to get a foothold, but it was still not considered legitimate or legal. The frequency of was increasing as more young women found alone and pregnant. Dr. John Trader of Missouri stated that â€Å"contended that men were (the ones) pushing women into abortion†.So it goes to show that the men are also part of the abortion’s happening. (abort73. com) Slowly the opposition of abortion began to lose a lot of its moral framework. In the med. Books abortion was beginning to be counseled against for the potential risks as it had been presented to many women instead of the life being destroyed. It was said that â€Å"the right to destroy† became the central belief to a women named Margaret Sanger. She began to expose it in publicity. She would celebrate the virtue of sexual promiscuity and she would attack any women’s shelter.She then would have gone on to fount Planned Parenthood which still today remains the largest abortion provider in the United States. The government funding was required to remove all religious indoctrination and professional social workers replaced the evangelically-oriented matrons. The compassion shifted from helping to do what is right to doing whatever people feel like doing. (abort73. com) The birth control issue split the pro-life community for many years and hamstrung their efforts during the crucial 1960’s. (abort73. om) In the year of 1962 there were reports of a women who died form and illegal abortion and she was then cut into pieces which had horri fied the entire nation. Sherri Finkbine became famous women for having an abortion in Sweden because she was worried that her child was going to be disabled. An average American had begun to see illegal abortion instead of abortion itself as the real problem. In the year of 1967 Colorado and California became the first states to legalize abortions for only pregnancies that resulted in rape, incest, or pregnancies that threatened the life of a women as well as a pregnancy of a severely handicapped child.Then within the next three years, Alaska, Arkansas, Delaware, Georgia, Hawaii, Kansas, Maryland, Mississippi, New Mexico, North Carolina, Oregon, South Carolina and Virginia soon followed. Then in 1970 New York became one of the first states to offer unrestricted abortion, but only during the first 24 weeks of the women’s pregnancy. Then in 1971 the Roe v. Wade case came to trial. The verdict was decided in 1973 which was that all state laws regulating abortion were strict. And the demand became the law of the land. So as you can see that abortion had a lot of history in front of it, but does it still make it right for it to be legal?Some believe that abortion should only be legal for certain reasons, such as Rape victims. While many disagree with this option there are many who do agree. A woman who was raped and is carrying the rapist baby should have the right to decide what she would like to do with the baby. It's not the court's decision it's hers. It's been a woman's right since the Roe V. Wade case that abortion is legal. This caused an outrage. There were protests out on the steps of the courthouse where people were screaming that they are allowing woman to kill innocent children.And they have a point too. Killing a child when they have no say in it is considered murder to some people. Anytime you kill a human being is murder so how is this any different. A woman in the army was 19 and was in an abusive relationship and he had gotten her pregnant. She didn’t want to tell him. She was called a whore, a tramp and embarrassment to her family. They told her to come home and discuss it as a family. Well little did she know they had made an appointment for her to get an abortion. No matter what she said it was all wrong.Her oldest brother whom she respected wouldn’t even talk to her he was so ashamed of her. Her family kept telling her to get an abortion but she was against it. The argument lasted 3 hours and finally she went to bed. But her family wouldn't leave her alone until she made a decision. She was denied food that night and when she awoke the next morning she was denied food as well. So she finally gave in and they drove her to the clinic. She had the abortion and she saw a 16 year old girl in there and she hugged her and they cried together.Her parents as well as her brothers never apologized for their actions. Her take away from this experience is that she can be compassionate to young teens that have made the horrible choice of having an abortion. She is now 47, married with 2 children and adopting a third. This story shows that there is regret to getting an abortion. She never stopped thinking of her first child. She told her now 21 year old daughter who had gotten pregnant 19 about what happened and her granddaughter is now one year old. There will always be that regret of having a child. (abort73. om) There was a case called Roe v. Wade. This was a case between a single pregnant that brought a class action challenge to the constitutionality of the Texas criminal abortion laws by procuring or attempting an abortion on medical terms for the mother. A licensed physician named Hallford who had to cases pending against him was somehow permitted to intervene. A married couple who were unable to bare a child separately attacked the laws as well based on alleged injury from the failure of contraceptives, pregnancy as well as impairment of the wife's health.Roe and Hallford were standing to sue and presented justiciable controversies. The court decided to that the abortion status void as vague as those plaintiff's Ninth and Fourteenth Amendments. The District Court granted declaratory relief to Roe and Hallford. It was then decided in 1973 that the Court's ruled that the Texas criminal abortion statures are unconstitutional. (Cornell. edu) There are places that do abortions. These are called abortion clinics. The main one that is most popular is Planned Parenthood. These places should not exist.Allowing young teens to come in and murder their child is wrong. In the case Planned Parenthood v. Casey the Supreme Court considered a Pennsylvania law that imposed the regulations on abortion. This case was not directly connected to Roe v. Wade. Although the Court didn't contend that Roe v. Wade was a correct application of reasoned judgment. In extreme arrogance the Court declared â€Å"where the performance of its judicial duties, the Court decides the case in such way a s to resolve the sort of intensely divisive controversy reflected in Roe and those rare comparable cases†¦.Contending sides of a national controversy to end their national division by accepting a common mandate rooted in the constitution. † In this case Planned Parenthood because of the case Roe v. Wade and how abortion is legal because it's a national law. (Lifenews. com) There are so many reasons as to why abortion should not be legal but we have to look at the other side of the picture. We have to look at reasons why is should be legal and the reasons behind that. The big reason is Rape victims. Why should they have to carry the rapist's baby. They should have every right to get rid of it.And with abortion being legal they can. To them it's not a sin. They are getting rid of something that was part of a horror that they went through. They have the right to decide and to them they aren’t doing the wrong thing they are doing the right thing. No one can stop them. They have the freedom to choose. Abortion is used for many different reasons. Those reasons can be that the mother was raped and didn’t want to keep the child or if they didn’t abort the mother would die. These are two serious reasons as to why some people are for abortion.It can save someone's life when it comes to the decision of life or death. Or it could be the free release from something tragic that happened to someone. Abortion isn't all bad in some ways. Those two reasons are important to some people. A mother who doesn't want to carry a rapist's baby shouldn't have to. And if the child is killing the mother and abortion is the only way to save her life then do it. There are medical reasons to do abortions. Not just personal. Not only is it the mother's decision but it should also be the father's decision as well.He should have a right to decide whether the baby lives or not. He helped create it. It's unfair to think that he will never be able to see is child be cause the mother aborted it without him knowing. It's unfair. Every father should have the right of say in what happens to his child. Then there's the issue of the family. The family should also have a say in what happens as well. They can help take care of the baby. Be there for the mother. Help her along the way. Help her, guide her. Give her and the baby love. They will be there for. The mother should want that, should have that.The families are supposed to be there for their children. Love them no matter what happens to them. They will love their grandchildren just the same. So they should have a right of say as well. They will help guide the mother through the tough times. They will be there for her and the child, no matter what. So with all that history and all that information, have you come to a conclusion as to whether you are for or against it. You should be against it. It's murder. Killing an innocent child is just wrong. Everyone has the right to do as they please but in common sense it's the worst thing you could do.There are other options like keeping the baby or giving it up for adoption. Why kill the baby when you can give it life. Give it a home, a place to eat, sleep, live and be happy. Or give it to a family whose always wanted a child but could never have one of their own. Give that baby a future. Don’t kill it. It deserves to live. Everyone deserves to live. Not die. It's wrong. So with all this information, I hope you've made the right decision as to whose side you're on. Killing an innocent child is wrong, and it needs to be stopped.

The Evolution of Citizenship essays

The Evolution of Citizenship essays As citizens living in the 21st century, we take for granted the rights and freedoms we have. We dont think about and cherish the freedoms and rights we have as citizens, which many people had to fight for. Citizenship today has changed from that almost 300 years ago. The concept of citizenship is a fairly recent invention. Being a citizen use to mean you had to do whatever the government ordered you to do, which for most people was pay outrageous taxes. This changed in the 1700s when John Locke when he had the idea that individuals should be put ahead of the government and that citizens have the right to life, liberty, and the protection of property. John Lockes ideas served as a reason for future revolutions. The next revolution that had a big impact on citizenship was the Industrial revolution (1750 1900). This led not only to the rise of organized labor, but the rights of employees. Employers were giving their employees shorter work hours, and benefits for their families. Both the Apartheid (1980s) and the Civil rights movement (1960s) helped improve the rights and freedoms for blacks all over the world. Also in 1982 we had the Constitution Act in Canada. The constitution outlined the rules of how the government (federal and provincial) should operate. The Constitution Act also included the Canadian Charter of Rights and Freedoms. For that last century we have had many rights and freedoms (the BNA Act) but for the first time in our history there are written down and protected by this constitution. The Canadian Charter of Rights and Freedoms is the ending point for the rights that we now have as a Canadian citizen. As you can see, citizenship is actually a fairly recent invention and we have many people in history to thank for the rights and freedoms we now have as Canadian citizens. ...

5 Steps to Quitting the Right Way

5 Steps to Quitting the Right Way Sometimes it’s just time to part ways from a job that is no longer working out. It’s time for you to take your job to a nice dinner, and break the news gently: â€Å"It’s not you, it’s me.† (Okay, let’s be honest: it’s always â€Å"you.†) If you’ve just plain reached the end of your patience and/or have a shiny new job waiting for you, there are ways to exit gracefully so that you can move on to the next opportunity with no regrets. Determine whether you really want to quitIf you’re angry over a particular ongoing situation, or you find that your dread and anxiety about work are dragging down the rest of your daily life, think long and hard about what quitting would mean. If you don’t yet have another job lined up, are you financially able to support yourself while you hunt for another one? It can be very tempting to bolt when things aren’t going well at work, but make sure you’ve put a lot of thought into whether this is truly quit-worthy, and that your overall well-being is served by leaving the position.Figure out whether you can fix the problem firstAgain, impulse quitting can be a very appealing option. Ask yourself questions like, â€Å"Is this situation likely to resolve soon if I don’t quit?† and â€Å"Are there any steps I can take to fix the situation without drastic measures?† If possible, talk things over with your supervisor. Let him or her know that you’re not happy with the way things are going, and you’d like to find a way to resolve that. There may be options available that you’re not aware of in the moment, when everything seems awful.Give noticeIf quitting is indeed the way to go (or you’ve got a better opportunity lined up), make sure you give an appropriate amount of notice. In most cases, that’s about two weeks. Your company may have a different policy, though, so double check with your HR depar tment if possible. If you’re breaking the news to your boss in person, make sure you follow up the conversation with a professional email that outlines your resignation and your end date.Be ready to train your replacementYour departure could leave a bit of a vacuum for your colleagues, especially if you have crucial tasks and responsibilities that affect others. Work with your soon-to-be-former boss to determine what the needs are for the post-you workplace. That could mean showing other coworkers the ropes on particular processes, or even training your replacement if your company is able to line one up before you leave.Don’t burn bridgesThe most important part of all: be gracious on your way out the door, regardless of the circumstances. This is especially true if you’re staying in the same field. You never know who’s connected on LinkedIn, or who were interns together ages ago and still meet for monthly drinks. A little graciousness lets you leave your current situation (no matter how lousy) and enter your new one without baggage- because who needs that kind of negativity? Sometimes jobs just don’t work out, and it’s not worth risking damage to your professional reputation to go all scorched-earth on your current workplace.

Managerial Applications of Technology (Virtual Workforce) 2 Assignment

Managerial Applications of Technology (Virtual Workforce) 2 - Assignment Example Technology is also the backbone of virtual working because it provides applications and appliances that enable such endeavors. Using remote workers can bring flexibility to a business organization as it will not have to depend on the state of their premises or the accessibility of their premises. Virtual employees do not need any physical office, making the financially advantageous to an organization. Due to fact that virtual employees have no geographical restriction on where they are supposed to work they sometime have higher productivity as compared to the physically available ones (Marquez, 2008). For example, virtual workers do not have to spend time travelling to the offices. The disadvantages of using virtual include the fact that monitoring them is usually a hard task. It is also hard in bringing them to be part of collective efforts by the other members of the workforce. Good strategies can help an organization in minimizing the disadvantages and maximizing the advantages of using virtual workforce. In hiring virtual workers a company should make sure that they hire self-motivated and self-disciplined individuals (Gillis, 2003). There should also be frequent and meaningful communication between an organization and their virtual employees. This will be important in monitoring their progress. Giving virtual employee targets to meet after a given duration will help in making sure that they are able to maximize their contribution to the organization. Hill, E. J., Ferris, M., & MÃ ¤rtinson, V. (2003). Does it matter where you work? A comparison of how three work venues (traditional office, virtual office, and home office) influence aspects of work and personal/family life. Journal of Vocational Behavior, 63(2),

Relationship Between ANA Test Titers Autoimmune Disease Research Paper - 9

Relationship Between ANA Test Titers Autoimmune Disease - Research Paper Example Among the patients ‘data we collected, 13 (29.5%) patients had 40 ANA test titers, 4 (9.1%) had 80 titers, 4 (9.1%) had 160 titers, 10 (22.7%) had 320 titers, 4 (9.1%) had 640 titers, 6 (13.6%) had 1280 titers, and 3 (6.8%) had 1320 titers. This is well illustrated by both table 1 below and graph 1. During the sample, analysis three groups of diagnosis of autoimmune disease were detected. Group 1 had 13 (29.5%) patients, group 2 had 19 (43.2%) patients, and group 3 had 12 (27.3%). Table 2 and figure 2 better illustrate this Among the 13 patients who were found to fall in the category of 40 titers ANA test SLE, 2 were found to fall in group 1, 6 were found to fall in group 2, and 5 were found to fall in group 3. Among the 4 patients who were found to fall in the category of 80 titers ANA test SLE, 2 were found to fall in group 1, 1 one was found to fall in group 2, and another 1 was found to fall in group 3. Among the four in the category of 160 titers ANA test SLE, 2 were found to fall in group 1, 1 in group 2, and another 1 in group 3. Among the 10 in the category of 320 titers, ANA test SLE, 3 were found to fall in group 1, 4 in group 2, and 3 in group 3. Among the 4 in the category of 640 titers ANA test SLE, 1 was found to fall in group one while the other 3 were found to fall in group 2. Among the six in the category of 1280 titers ANA test SLE, 2 were found to fall in group 1, 2 in group 2, and 2 in group 3. Among the three in the category of 1320 titers ANA test SLE, 1 was found to fall in group 1, and the other 2 in group 2. Table 3, figure 3, and figure 4 had better illustrate this. In this project, we test the null hypothesis that the ANA and diagnosis are associated. According to Hirschfield & Heathcote (2011), the ANA test is the main testing tool used for the diagnosis of autoimmune rheumatic conditions. This test makes use of antinuclear antibodies in the diagnosing of these conditions.

Comparative Analysis of Human and Chimpanzee Genome Research Paper

Comparative Analysis of Human and Chimpanzee Genome - Research Paper Example In justification of these new findings, molecular studies have been conducted and results have indeed shown that the two species exhibit some differential characteristics, mainly contributed towards genetic changes mostly on the human genomes, which have significantly contributed towards the differences in the genomes of humans and the chimpanzees. For a substantive period, scientists have always stated that there are substantive similarities between humans and chimpanzees. History has it that human beings and chimpanzees have at one time shared a common ancestor over 5 million years ago, eliciting research on the determination of the contribution factors towards such a development (Cheng et.al. 88). As science has revealed, the genome, which is the genetic material in an organism is the contributing factor towards the determination of whether an organism possesses certain similarities or differences to other. The genome is encoded in the DNA of organisms or RNA as in the case of viruses, which includes all the genes and the non-coding sequences of a DNA or RNA. From a comparison analysis of human and chimpanzee genomes, it is conclusive that despite the similarities that the two have had from sharing an ancestor, studies have ideally shown that significant changes have occurred in the genome sequences of the two species. That has indeed contributed towards the differences that are currently observed in both the human and chimpanzee genomes. Additionally, the genomic changes have also contributed towards the diverse changes in the phenotypes of the two species of organisms.

Importance of Documentation Care in Nursing

Importance of Documentation Care in Nursing This scenario presents a number of problems to the staff nurse. In relation to the sphere of practice, as a D Grade Staff Nurse I have a senior nurse present on the ward, who will be in charge during the shift. This provides me with a source of support and experiential knowledge, and also someone with whom to liaise over any issues which arise. However, as a Registered Nurse I am responsible for my own practice, accountable for all aspects of nursing practice and therefore must act on everything pertaining to practice that should arise. In an ideal situation, the E Grade will act on any information or concerns I bring to her. If she does not, then it is my responsibility to act on these concerns myself. The NMC Code of Conduct (NMC, 2004) requires that all qualified nurses act in the best interests of their patients at all times. The NMC code of conduct also states that all nurses are accountable for their own practice, and must account for their own acts or omissions (NMC, 2004). The focus of this analysis of the scenario is on documentation and the nurse. The nursing literature suggests that the completion of nursing documentation has been one of the most important functions of nurses, even from the beginning of the profesion in the time in the time of Florence Nightingale (Cheevakasemsook et al, 2006). Documentation of nursing care is an important source of reference and communication between nurses and other health care providers (Martin et al, 1999). Documentation is a fundamental component of nursing activities such as assessment and care planning, according to the various models which have been designed for these functions (Nazarko, 2007). The importance of proper documentation may also be because it serves multiple and diverse purposes for nurses, for patients, and for the health profession, because current health-care systems require that documentation ensures continuity of care, furnishes legal evidence of the process of care and promotes and facilit ates the evaluation of the quality of patient care delivery (Cheevakasemsook et al, 2006). In this instance, following handover, the first source of information to be checked will be the nursing records and care plans of each patient, as part of an individualised approach to care. The nursing records for Mrs Smith, for example, should provide the medical history and social history which will allow me to provide holistic nursing care. However, one of the problems with nursing documentation, as found in some empirical nursing studies, is that the complexity of nursing documentation does not always allow it to serve its many functions (Cheevakasemsook et al, 2006). However, the medical record is a legal document that tells the story of the patient’s encounter with the nurse and other professional caregivers, and as such should provide a complete and accurate account of his condition and the care he received (Austin, 2006). Whatever the difficulties of the documentation processes concerned here, the documentation should have been complete and correct. Documentation issues here include the improper recording of the administration of intravenious antibiotics. Given the strong nature of this medication, their specific nature and mode of action which can be tailored to the individual disease following culture and sensitivity tests, and the need to ensure they are given at the correct intervals, particularly as some such drugs can become toxic in larger doses, the proper recording of their administration is a vital part of the administration process. Bjorvell et al (2003) in a study of 377 nurses in Sweden found that nurses believed documentation to be fundamental to nursing practice, in particular, in promoting and ensuring patient safety. Protocols for the administration of intravenous medications exist, which, if followed, should promote safety. For all medications that nurses give to patients, they must know indications, contraindications, dosage parameters and adverse reactions (Austin, 2006). Nurses must always ensure that the ordered medication is appropriate for the patient, and that the prescription is clear and legible (Austin, 2006). And once a nurse has administered a drug, they must monitor the patient for signs and symptoms of drug toxicity or other adverse reactions, and these monitoring activities must be fully documented, including any actions taken on notable findings and the patient’s response to these interventions (Austin, 2006). This creates a record which demonstrates that the nurse met the prescribed standards of patient care when administering medication (Austin, 2006). Two qualified staff should have checked the drug dosage, route and timing, and the prescription against the patient identfication band, and then recorded the adminstration of the antibiotics on the chart and in the patient records . Incomplete records in this instance could be suggestive of improper procedures in the adminstration of this medication, a serious issue which could lead to legal action and professional sanction, even dismissal and loss of registration (Austin, 2006). Similarly, the issue of the blood transfusion error should be highlighted, because again patient safety is the fundamental point of nursing care. If proper procedures had been followed, this error could not have occurred. Administration of blood and blood products is subject to strict surveillance, and each Trust will have clear guidelines and protocols which govern and support this kind of activity. Checks should have been carried out on collection of the blood – the documentation should have been checked against the blood bag – patient name, number, blood group and type. The blood form, with the number of the blood bag, should have been checked properly. This should have been carried out by two qualified staff. The same checks should have been carried out at the bedside, checked against the patient notes and his identification band. Had the documentation been checked in this way, by two qualified staff, the wrong rhesus factor blood could not have been administered. T his demonstrates how correct documentation supports safe nursing practice and facilitates patient safety as well as recording nursing actions. Not only should the mistake be rectified, the doctor in charge of the patient informed and sumoned to examine the patient, and ongoing observations be carried out to ascertain if there are any side effects from the administration of the blood, but all of this should be clearly documented. Further, it should also be documented how this mistake occurred, through an examination of the documentation pertaining to the error and the actions of those who administered the blood. All medically releveant facts realted toan incident should be recorded in the medical records, according to the Trust and ward policies and protocols (Austin, 2006). A critical incident reporting from should also be completed, according to Trust policy, in order to ensure that risk management are informed and actions can be taken to prevent such occurrences in the future. Thus, such a form should also be completed for the percieved drug error. The NMC code of conduct states that nurses should act to identify and mini mise risk to the patient or client (NMC, 2004), and this applies to the action taken in the current situation and the potential protection of all clients in the future, in the avoidance of future errors of a similar nature. Another error which relates to documentation is the issue of the patient who was discharged inappropriately. It is understandable that the relative should be distressed and should be dealt with sensitively and apologetically. Liaison with management, risk management and any hospital or Trust agencies which deal with patient complaints should commence immediately. The most important issue here is to address the error, and not to question whether or not the error took place. It obviously did, because the patient arrived home in that state, and the usual discharge protocols cannot have been adhered to. If they had been, the discharge documentation should have been complete, and would have been communicated with the receiving district nursing team. The nurse plays a unique and pivotal role in discharge planning, as a key member of a multidisciplinary team (Fielo, 1998) role. If, as Bull and Roberts (2001) suggest, a proper discharge occurs in stages, and can be characterised by involveme nt of all team members within interacting circles of communication, then this discharge error should not have taken place at all. Therefore, any work done to address this error must examine where communication processes failed, and the documentation here should provide the evidence of where this failure occurred. Communication is fundamental to discharge planning, both between nurse and patient and between professionals across the divide between hospital and community services (Fielo, 1998), and so the documentation here should have been both individualised and comprehensive, functioning both as a record and as a communication tool. Effective discharge planning is also a vital link for continuity of care (Bull and Roberts, 2001), and so the failure of this process will lead to negative impact for the patient and their carers. Similarly, patient and carer participation is important in discharge planning (McLeod, 2006; Bull and Roberts, 2001). Research by Cleary et al (2003) demonstrates that consumers want information on medication, treatment, awareness of their rights and opportunities to participate in decision making. The nurse engaging in discharge planning also needs to take into account the needs and capabilities of carers (Qualey, 1997). The failure of the discharge planning process in this case therefore has a number of complex effects and may be shown to have failed in a number of key areas. It is also imperative that nurses value the social aspects of patient care and that this is seen as an integral part of the discharge process (Atwal, 2001). There are some ways in which this could be improved, and a close examination of what went wrong might highlight ways in which this could be avoided in future cases. The discharge documentation may need to be adapted to better reflect the processes and knowledge involved (Reed, 2005). This might ameliorate relationships between the acute and community sectors (McKenna and Keeney, 2000), and may prevent these errors occurring in the future. It might also be necessary, from the evidence of the available documents relating to the case, and from the ward rota, to identify who failed to properly discharge the patient so they can be engaged in education and development activities to develop their competence in this area. The documentation used should have served to enhance the ability to deal with this difficult situation (Sollins, 2007) by providing the family with the answers to their questions about what went wrong. Cheevakasemsook et al, (2006) in their study found that complexities in nursing documentation include three aspects: disruption, incompleteness and inappropriate charting. Of these, this scenario shows occurrences of incomplete documentation, whereby the documentation related to discharge planning has not been completed. Related factors that influenced documentation comprised: limited nurses competence, motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision and staff development functions (Cheevakasemsook et al, 2006). These findings suggest that complexities in nursing documentation require extensive resolution and implicitly dictate strategies for nurse managers and nurses to take part in solving these complicated problems (Cheevakasemsook et al, 2006). These are learning points to take forward into future professional development and practice. However, the more immediate needs would be to address the problems associated with these fail ures. The nurse must act to redress the balance and to minimise, for example, the potential litigation which may arise from this unfortunuate situation. The family are likely to make a formal complaint, and, depending on how this has affected the discharged patient, may even take legal action for compensation. In this instance, the incomplete discharge documentation demonstrates that the required nursing care did not take place (as there is no evidence of it in the records). Therefore, legally, the nurse taking care of this patient will be liable for the errors that have occurred. There are other issues to be considered, taking the wider view, in perhaps understanding why such errors occurred and how they can be avoided in subsequent cases. Hyde et al (2005) highlight the limitations of the forms of documentation (and the forms of communciation which characterise that documentation) within nursing practice. They suggest that this nursing documentation depicts the domination of reductionist medical models, utilising scientific rationality in linguistic and communication forms, rather than reflecting the holistic nature of nursing practice (Hyde et al, 2005). Therefore the documentation may be at odds with the autonomy of the patient, bringing up issues of control and power, where the documentation may serve to exert and maintain the power of the nurse or the medical profession rather than support the wellbeing of the patient (Hyde et al, 2005). Professional autonomy on the part of nurses demands a degree of mature clinical and ethical judgement in emergent and complex situations, and it is the documentation, if correctly completed, which should also signpost this process of judgement and decision making. But if the documentation is difficult to complete, onerous or time consuming, it may be that it detracts from the quality of patient care and the easy recording of this, rather than supporting it. Documentation provides the legal protection nurses require in modern healthcare practice (Frank-Strombourg et al, 2001). Educating nurses about the principles of documentation and the importance of implementing risk-reduction practices may help guard against liability and ultimately improve patient care (Frank-Strombourg et al, 2001). Perhaps developing better charts and records, in liaison with all staff, might also ameliorate the situation. The literature demonstrates unequivocally that nurses are the professionals that patients have the most interactions with in the hospital environment (Williams, 1997). The work and competence of the nursing staff is therefore perhaps the most significant factor in determining quality of patient care (Williams, 1997), and so it is vital to ensure that nurses record their practice accurately so that their competence can be audited, and the effectiveness of their practice evaluated. If, as suggested, evidence-based practice is now at the heart of nursing care (DOH, 2001), then documentation will also allow the implementation of evidence based practice, through care protocols and pathways, and through auditing processes and reflective practice which reviews care against the available evidence. Martin et al (1999), in their research of nursing documentation activities, found that good nursing documentation supported the implementation of evidence-based practice. This takes us back to the quality of the documentation processes, and it may be that they are under development – towards evidence-based care pathways or the like, or this kind of thing may need implementing. Utilising alternative modes of documentation may also enhance practice and recording behaviours. Lee (2006) in a study of one computerised documentation system in practice, found that nurses generally viewed the content of the computerized nursing care planning system as a reference to aid memory, a learning tool for patient care, and a vehicle for applying judgement to modify care plan content. This suggests that such tools may do more than simply streamline nurses work (Lee, 2006). It may be that using a computerized care plan system can also enhance nurses’ knowledge, experience and judgement of descriptions of patient problems and care strategies (Lee, 2006). It is my opinion that it may also serve to minimise the kinds of errors that have occurred in the assignment scenario. The nature of the documentation (ie the content and structure) may therefore need to be changed. O’Connor et al (2007) show how new, streamlined nursing charts improved planning and evaluation of care and served promote patient involvement in the care and documentation processes. In reference to the discharge planning incident in particular, this might be an area to develop within the clinical area. One innovation which supports this is that described by the NHS (2007) in The Essence of Care, which was launched in February 2001, as providing a toolkit to help practitioners to implement a structured approach to sharing and comparing practice, through principles of clinical governance, enabling them to identify the best and to develop action plans to remedy poor practice. This would appear to be a key activity in the longer term to develop from the learning points contained within this problematic scenario. These kinds of benchmarks and guidelines can provide useful guidance, in association with other activities such as evidence-based care pathways and protocols, to develop more streamlined and effective practices. Another point of action is the need to carry out specific empirical research into this area. In a systematic review of research literature to test the hypothesis that care planning and record keeping in nursing practice has no measurable effect on patient outcomes, the authors were unable to identify any robust studies for review (Moloney and Maggs, 1999). This suggests that the potential effects of documentation failures cannot be fully evaluated, anticipated or described without future research. This also underlines the need to ensure the highest possible standards of care are both implemented and fully documented throughout every stage and componenet of nursing practice. This analysis shows that documentation serves a number of purposes within nursing practice. It records care, demonstrating and communicating what procedures were carried out, when, and why. It rationalises clinical decisions and evaluates clinical and nursing actions. It also allows the direction and planning of care. It provides legal proof that nurses have followed proper protocolsand procedures for the administration of medicines and blood products, for the implementation of medical and nursing orders, and in particular supports complex activities such as discharge planning. Lack of proper documentation can indicate that proper procedures were not carried out. Poor documentation can lead to confusion and to patient compromise, whereby a patient may not receive the medication required, or may erroneously receive an overdose. Similarly, the blood error could have had significant consequences, and should not have occurred, given the nature of the procedures involved, and the clear li nks between safety and existing documentation. These errors point to either a lack of competence in basic nursing procedures, or a lack of care on the part of the staff who made them. Documentation would also have supported the D grade nurse here when dealing with the problems. The discharge planning errors could have been dealt with more effectively if the documentation had been complete. This would be their primary source of information when dealing with a patient complaint and a complaint from a district nursing colleague. The expectation on all parts that such records will be complete and will answer the questions raised by all parties places the responsibility firmly on the nurse to ensure they properly fulfill this vital part of their role. Nurses can engage in proper documentation of the errors and incidents noted so that they are appropriately and comprehensively dealt with now that the errors have been identified, and so can meet all the professional requirements of their role within this siutation (NMC, 2004). And all staff can learn from these incidents, and be included in processes of research, improvement and development to implement better documentat ion and care practices in the future. References Atwal, A.. (2002) Nurses’ perceptions of discharge planning in acute health care: a case study in one British teaching hospital. Journal of Advanced Nursing 39 (5) 450-458. Austin, S. (2006) Ladies and Gentlemen of the Jury, I present: the nursing documentation. Nursing 2006 36 (1) 56-65. Bjorvell, C., Wredling, R. and Thorell-Ekstrand, I. (2003) Prerequisites and consequences of nursing documentation in patient records as perceived by a group of Registered Nurses. Journal of Clinical Nursing 12 (2) 206–214. Bull, M.J. and Roberts, J. (2001) Components of a proper hospital discharge for elders. Journal of Advanced Nursing. 35 (4) 571-581. Cheevakasemsook, A., Chapman, Y., Francis, K., Davies, C. (2006) The study of nursing documentation complexities. International Journal of Nursing Practice 12 (6) 366–374. Cleary, M., Horsfall, J. and Hunt, G.E. (2003) Consumer feedback on nursing care and discharge planning. Journal of Advanced Nursing 42 (3) 269-277. Department of Health (2001) ‘National Service Framework for Older People’, England: HMSO. Fielo, S. B. (1998) Discharge Planning for the Elderly: A Guide for Nurses. Nursing and Health Care Perspectives Volume 19(2) 94-95. Frank-Stromborg, M., Christensen, A.and Elmhurst, D. (2001) Nurse documentation: not done or worse, done the wrong wayPart I. Oncology Nurses Forum 28 (4) 697-702. Hyde, A., Treacy, M., Scott, P.A. et al (2005) Modes of rationality in nursing documentation: biology, biography and the voice of nursing. Nursing Inquiry 12 (2) 66–77. Ting-Ting Lee, T-T. (2006) Nurses perceptions of their documentation experiences in a computerized nursing care planning system. Journal of Clinical Nursing 15 (11) 1376–1382. Macleod, A. (2006) The nursing role in preventing delay in patient discharge. Nursing Standard. 21 (1) 43-48. Martin, A. Hinds, C. and Felix, M. (1999) Documentation practices of nurses in long-term care. Journal of Clinical Nursing 8 (4) 345–352. Moloney, R. and Maggs, C. (1999) A systematic review of the relationships between written manual nursing care planning, record keeping and patient outcomes. Journal of Advanced Nursing 30 (1), 51–57. Nazarko, L. (2007) Care planning and documentation. Nursing Residential Care. 9(7). 333-6. NHS (2007) Essence of Care Available from: http://www.tin.nhs.uk/local-networks/essence-of-care/background. Accessed 10-5-07. Nursing and Midwifery Council (2004) Code of Professional Conduct Available from www. nmc-uk.org. Accessed 30-4-07. OConnor, K., Earl, T. and Hancock, P. (2007) Introducing improved nursing documentation across a trust. Nursing Times. 103(6) 32-33. Qualey TL. (1997) Assessing the patients caregiver. Nursing Management. 28(6): 43-4. Reed, J. (2005) Using action research in nursing practice with older people: democratizing knowledge. Journal of Clinical Nursing14 594-600. Sollins, H. (2007) Handling difficult family situations: practical approaches. Geriatric Nursing. 28(2) 80-2. Williams, S.A. (1997) The relationship of patients’ perceptions of holistic nurse caring to satisfaction with nursing care. Journal of Nursing Care Quality 11 (5) 15-29.