God Is Great

‘God is great, God is good, now we thank him for our food. ’ This simple prayer reflects twin commitments in Christian belief to God’s greatness and God’s goodness. Yet Christian theodicies have often averred to God’s greatness to the detriment of his goodness. Let us interpret God’s greatness in a manner other than power. Indeed, let us consider God’s greatness, as the medievals understood God’s goodness, in terms of being: goodness and being are interchangeable; 1God is the most real being; hence, God is the greatest being. God is great. Let us interpret God’s goodness in a manner analogous to human goodness. I take God’s goodness as analogous primarily to the parent-child relationship; God is good, according to this analogy, as a father or mother is to his or her children. 2Caring for one’s children is a paradigm metaphor in Scripture for God’s carefor his creatures. God is good. The purpose of this essay is to explore the ramifications of these two views for the problem of evil and especially for the problem of hell. Judgements typically viewed hell as an eternal torture chamber perhaps with God himself as the torturer. I shall expound both views of divine goodness, present some arguments in their defense, and then locate them within the context of a Theodoric of human suffering. I shall argue that neither is singly adequate as an understanding of the divine nature; but, if both are maintained, a trilemma arises for the traditional doctrine of the eternal punishment of the damned. That is, I shall argue that one can hold the following three views only on pain of inconsistency: 1. God is great. 2. God is good. 3. There is a hell (an eternal torture chamber).

Nurses’ Work Hours

I have been a staff nurse in the emergency room for fourteen years. I have worked a variety of 8, 10, 12, and even 16 hour shifts. I currently am working 8 and 12-hour shifts on nights. Previously, I also worked some 12-hour day shifts. I personally have been struggling with working the 12-hour shifts. My commute to work is 1 hour one way and I have fallen asleep several times driving home from work. The last four hours of my shift I experience great fatigue and even have had trouble staying awake. I have come close to having medication errors and feel that my quality of care is less during the last four hours. When working 12-hour shifts I average around 5-6 hours of sleep before returning to do another 12-hour shift. During an interview with another colleague also working 12-hour shifts she states she also experiences feeling very tired and less alert. She actually admits to having a medication error that she feels was associated with the long hours and fatigue. With these concerns I ask, â€Å"Are nurses work hours a concern for nurses and patient safety†? Introduction As demands for flexible work hours and a balance between home and work life have increased for nurses, twelve hour shifts are more common. The nursing shortage has also contributed to nurses’ working longer hours to cover shifts. Nurses must remain alert to provide safe care and prevent errors in medications and procedures. Nurse work hours are a concern to me regarding patient safety. I am also concerned with the health risk of nurses working long hours so I decided to do a search on how long hours affect nurses and their patients. I searched evidenced based research articles available from a variety of trustworthy healthcare sites like CINHAL, ANA, and Nursing Journals. I organized this literature review in three categories. These categories are: Positive and negative effects of long hours, effects of long hours on patient safety, and if there are any health effects on the nurse working 12-hour shifts. Literature Review Positive and Negative Effects of Long Hours There are both advantages and disadvantages of working 12 hour shifts (Ede, Davis, & Sirois, Circadian, 2007). One advantage is working less days during the week, which is desirable of most nurses. It is also easier to have all the shifts covered because you do not have to hire as many nurses (Circadian, 2007). In a qualitative study by Richardson, Turnock, Harris, Finley, & Carson (2007) the purpose was to examine the impact and implications of 12-hour shifts on critical care staff. Two groups and questionnaires with critical care staff from three critical care units were reviewed. Positive effects were found with planning and prioritizing care, improved relationships with parents/relatives, good quality time off work and ease of travelling to work. Less favorable effects were with caring for patients in isolation and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested like no more than 2-3 consecutive shifts should be worked and rest periods between shifts. The survey concluded that most of the nurses that responded wanted to continue with 12-hour shifts. Systems and practices need to be developed to improve on the negative effects of working 12-hour shifts. In one of my interviews the nurse agreed that she enjoys 12-hour shifts because she has more days off during the week and feels she has more time with her family, although I personally disagree. She also states it is easier to provide day care for her children. Disadvantages of longer work hours according to Circadian (2007) included that it is harder to cover absences, limited family and social time during working days, more pay lost when a day is missed and increased percentage of night shifts. Longer work hours have also been associated with increased tiredness, less sleeping hours, driver fatigue returning home, and increased risk of errors or near errors ( Richardson et al. , 2007); (Scott, 2006); (Scott, 2010); (Chen, 2011). I have no time with my family on the days I work 12 hours. Even though I have more days off I feel I am spending at least one day recovering after working a long shift. I personally would rather have interaction with my family daily especially since the kids are in school. A colleague I interviewed also agreed that when working 12 hour shifts she had limited time with her family. Effects on Long Hours on Patient Safety As a result of nursing shortage hospital staff nurses are working longer hours with few breaks (Chen et al. 2011). In one quantitative study by Scott, Rogers, Hwang, & Zhang (2006) they randomly selected 1148 critical care nurses and sent them a demographical questionnaire to fill and return related to medical errors and the hours they worked. The objective of this article was to describe the work patterns of critical care nurses, determine if there was a relationship between the occurrence of errors and the hours worked by the nurses, and explore whether these work ho urs had adverse effects on nurses’ vigilance. The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk errors and near risk errors and decreased nurses’ vigilance. The findings supported the Institute of Medicine recommendations to minimize the use of 12 hour shifts and to limit nurses’ work hours to no more than 12 consecutive hours during a 24 hour period (IOM, 2006). Although the findings note that 12 hour shifts can have negative effects, most participants wanted to continue working them. Nurses are responsible for the safety of their patients. Nurses must remain alert to provide safe care, recognize discrete changes in patient conditions, and intercept potentially dangerous errors in medication and procedural orders (Keller, 2009). Nurses’ work hours are a concern given the expectation of their sustained vigilance to maintain the well-being of patients. The 12 hour shifts worked by many nurses are associated with reduced sleep times, difficulties staying awake, frequent overtime, and significant risk for error (Rogers, Hwang, Scott, Aiken & Dings, 2004)( Scott, Rogers, Hwang, & Zhang, 2006). Even though 12 hour shifts may be preferred by many nurses, studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long hours coupled with insufficient sleep and fatigue is even risker (Scott et al, 2010). More than two-thirds of 895 hospital staff nurses reported â€Å"struggling to stay awake on duty† at least once during a 28-day data gathering period (Rogers, Hwang, Scott, & Dinges, 2003). Nurses reported fighting sleep about once every five shifts (2,258 out of 11,218 shifts). Drowsiness was not confined to the night shift; more than half of these episodes occurred between 6 A. M. and midnight. Nurses who reported shorter sleep durations were more likely to struggle to stay awake, fall asleep, and make errors while on duty (Scott et al, 2010). Effects on Nurses Working Long Hours Studies examing the health and safety consequences of nurses themselves are beginning to shed some doubt about the wisdom of continuing to use the twelve hour work schedule. According to one study, adverse health and safety outcomes of extended work hours include increased rates of musculoskeletal disorders, needlestick injuries, motor vehicle accidents, and inadequate sleep (Greiger-Brown, & Trinkoff, 2010). All of these can be attributed to reduced vigilant attention, fatigue, and decreased neuromuscular fine motor control associated with sleep deficiency. In an interview with one colleague she states that her body, â€Å"hurts all over†, when working a twelve our shift. I have fallen asleep driving before which could of resulted in injury of myself or someone else. Lengthening of the shift duration from 8 to 12 hours significantly restricts the opportunity for sleep and produces sleep deficiency (Smith et al. , 1998). Working without adequate sleep between shifts can lead to negative chronic health effects including Cardiovascular Disease, metabolic syndrome, diabetes, obesity, decreased immune function, and increased cancer risk (IOM, 2006). In a quantitative study by Chen, Davis, Pan, & Daraiseh (2011) a total 145 nurses wore monitors for one 12-hour day shift to record heart rate (HR) and work pace(WP), which were used to calculate energy expenditure(EE). The purpose of this study was to determine whether hospital nurses are experiencing physiological strain at work by examining their physiological and behavioral response patterns over 12-hour shifts. The EE and HR data presented in the study revealed a moderate physiological strain experienced by 12-hour shift nurses, regardless of their slowed paces during the last four hours. The study noted that although work pace slowed during the last 4 hours, the nurses’ heart rate continued to be elevated, which could lead to cardiovascular disorder. Moreover, inadequate work break and sleep, family care-giving responsibility and aging presented challenges that may have prohibited nurses from full recovery and potentially exacerbated the negative impacts of the 12 –hour shifts. Overall their results relates to EE and HR suggest that nursing workload of 12-hour has a negative physiological impact on nurses. Policy Implications Although there are negative effects noted in working twelve hour shifts, I don’t think it is going anywhere due to the fact that nurses love them, and the increase in nursing shortage. Keeping this in mind instead of focusing on stopping twelve hour shifts, there needs to be interventions on how to improve the 12 hour shifts to provide safer patient care and prevent health problems in nurses. The preliminary policy implications I have discovered is the possibility of limiting how many twelve hour shifts a nurse should work in a row, mandating breaks while working twelve hour shifts, allowing the night shift to nap, regulate how many hours a nurse can volunteer to work, and allow the older nurses to have an option between 8 and 12-hour shifts. In my institution there is no limit on how many hours a nurse can voluntarily sign up for as long as it is approved if it puts the nurse in overtime. Our breaks are not mandated, if we get one great, and if not we can get paid for not getting a break. Most of the time, our breaks are interrupted. Regarding naps, physicians on the night shift are allowed to sleep if there are no patients, but there is no policy stating the nurse can sleep. Some nurses actually work 24 hour shifts, but are allowed to sleep at night if they are not busy. There are times though that they are busy the whole 24 hours. In one interview a nurse stated that if she lays her head down and naps for about 20 minutes she feels much more alert. I have also tried taking a nap at work when there were no patients in the ER, and I did feel so much more alert, especially driving home. It is therefore wise to consider limiting shift length and hours worked per week per IOM recommendations. After reviewing the literature it is clear that the main problem is nurses not getting enough sleep between shifts which causes fatigue. In a study of nurses’ sleep habits, Geiger-Brown (2010) found that 58 percent averaged only 5. 5 hours of sleep. When they work three or four 12-plus hours a day, they are also unable to easily reestablish a â€Å"consistent sleep schedule†. In one research article it noted that allowing the nurses to nap, especially the night nurses showed improvement in alertness and feeling less fatigued and ultimately showed a reduction in errors or near errors (Fallis, McMillan, Edwards, 2011). It also noted that anagement needs consider to mandating that the 12 hour plus nurses are taking full uninterrupted breaks which also improves alertness. Most nurses are not taking full breaks and stay longer than the scheduled 12 hours which reduces their sleep and recovery time between shifts (Greiger-Brown, & Trinkoff, 2010). In a recent review of studies between 1970 and 1998, 12 hour shifts nurses were fatigued in 5 of 7 studies, and of 10 studies measuring performance, 4 were negative, and 6 were neutral; none showed positive effects. In this review, laboratory studies showed deteriorated performance; but field studies found no difference between 8 and 12 hours. Recent studies with stronger designs and methods have increased the evidence that questions the safety of 12-hour shifts. More recent studies as mentioned earlier demonstrate an increase in patient care errors when nurses work 12 hour shifts compared to 8 hours. The research question that has been uncovered related to nurses’ long work hours is if the long hours affect the health of the nurse and patient safety? In my institution other colleagues have stated that they feel that when working 12 hours or longer more than two days in a row really decreases their quality of care because they are tired. I feel more studies need to be done on the impact of working hours and the nurses’ health along with more evidence regarding patient safety. One ethical implication researching effects of 12-hour shifts is that the managers do not want to take away 12-hour shifts due to nursing shortage because they do not have to hire as many nurses to cover shifts. Another issue is that most nurses enjoy the twelve hour shifts even though they know they become really tired because they enjoy having more days off during the week. Managers may fear that nurses will leave to find jobs that offer 12-hour shifts. I feel this is ethically a problem with colleagues and coalitions because they are not looking at the negative effects on the nurses and the patients. With research it has become obvious that working longer hours can effect both the health of the nurse and safety of the patients yet our facility along with many others have not come up with adequate resolutions to the problem. Conclusion Twelve hour shifts contribute to flexible patterns of work, but the effects of delivery of direct care and staff fatigue are important topics for deeper examination. More recent studies as mentioned earlier demonstrate an increase in patient care errors when nurses work 12 hour shifts compared to 8 hours. Although 12 hour shifts are popular, evidence shows us that extended working hours, and working while fatigued and sleep deprived reduce vigilance and impair physical/behavioral functioning. The result has damaging effects on patient safety, quality of care provided and the health of the nurse. I believe it is the responsibility of the nurse to recognize the risks of working longer hours to keep the patient safe and to also maintain their own health. I used the Patterns of Knowing (White, 1995) to view my topic and to gather information on this literature review. These patterns of knowing in nursing include empirics, esthetics, ethics, and personal knowing (White, 1995). I used empirics by gathering factual information regarding my topic. I discussed issues in regards to ethics on my topic that was mentioned in chapter 3. I included my personal knowledge and experience with working longer shift hours, and also looked at the esthetic form by putting it all together and acknowledging what the problem is. Doing this literature review I realize that working the longer hours does put a strain on my overall health, and also has potential to put my patients at risk. I will focus more on getting better sleep, and I have asked my manager about working only 8 hour shifts. I also really want to pursue gathering more information about night nurses being able to nap.

Music Reaction Essay

Beethoven’s Symphony No. 5, Movement, 1 and Stravinsky’s Firebird Suite are two compositions that initially sound quite similar. They are both dramatic, extremely intense, and have the ability to leave a lasting impression upon listeners. There are, however, several key differences that separate the two, including expression, timbre, and overall effect. Although the melodies and general manner of the two pieces may seem alike, Symphony No. 5 is much more grand and composed while the Firebird Suite is more erratic and less sophisticated as a whole. Symphony No.5 is arguably one of the most famous compositions in the world, and begins with a melody with which most people are familiar. Within the first four notes, it is evident that the piece was written in a minor key with a respective melody. There is a vast range of notes throughout the symphony, with the high and low pitches resulting in two different effects. In many compositions, the most dramatic part of a song will typically consist of notes in higher octaves; but in Symphony No. 5, it is the lower pitches that make up the main melody and seem to be the most dramatic. By building the song around lower pitches, Beethoven has created an air of potential energy, with light runs and scales from the string sections providing the harmonies and escalating the drama of the lower notes. One of the most noticeable characteristics of the main melody line is the rhythm and repetition of the phrase. It consists of a triplet that stays on one note, and then jumps to a lower note that is sustained. As this phrase is repeated, it also starts to create the beat of the symphony, which is extremely clear. Even as the instruments add in quicker-paced scales that go up and down in the background, there is a strong and steady pace that is maintained by the melody line. With the melody line being able to stand out amongst all the other symphony parts, it develops a very bold and brooding musical expression. It is so vivid and moody, that one can picture Beethoven himself, walking briskly through the streets of Vienna while everyone else automatically clears the way for him. Symphony No. 5 has essentially became an extension of its composer, reflecting everything he was trying to express—the various components of his own personality and outlook. Beethoven also adds variation to the song through changes in tempo and dynamics. The quicker tempos tend to serve as a way of building up each musical phrase, yet are played at a fairly piano to pianissimo level. Like the drama that the lower pitches create, the parts that are played quietly also create potential energy that makes the louder, slower, and lower parts of the song that much more impactful. In terms of texture, Symphony No. 5 is surprisingly simple considering the intricacy of the notes and the way all of the instrumental parts are pieced together. There are several pauses that add tension to the song, while also eliminating too much unnecessary sound or instrumentals. This symphony, overall, has a very dark and intense timbre. It is dramatic and moody, but at a sustainable level that is not too harsh on the listeners’ ears—that is, it is relatively easy to listen to for a lengthy period of time due to the lower pitches and pianissimo parts that allow for the audience not to be overwhelmed. Stravinsky’s Firebird, similar to Beethoven’s piece, also begins with an introduction of accented notes and lower pitches. In this song, however, it is the higher notes that are accented rather than the lower pitches. The melody is also not nearly as easy to follow, as there is significantly less repetition. Even though both compositions involve similar instruments, Firebird uses many of the higher voices as the focal point of the song rather than the lower instruments. Throughout the piece, high strings, the xylophone, and even higher octaves played by the trombone can all be heard. The Firebird harmonies are also much more muddled and not necessarily played in sync with the melody line. There seems to be several different rhythms that are being played simultaneously during the louder, more dramatic sections of the song. This makes it quite difficult to find and maintain the beat of the piece, whereas Beethoven’s symphony is easier to follow. Regardless of its lack of simplicity, Firebird is just as expressive as Symphony No. 5. The significant change in tempo and dynamics create emotion within the piece, adding depth to the song. Firebird’s dynamic changes, in fact, may be even more dramatic as it ranges from pianissimo to fortissimo; and since the higher pitches are the tones being emphasized, it is much less understated than Beethoven’s piece. It is also more complex in terms of texture. Not only does the showcasing of more instruments add to the composition, but Firebird also has more measures that serve as a relief from the otherwise frantic nature of the song. While most of the piece is intense, there are bits of it that sound light-hearted and carefree. During these sections, the tempo is not always slower but there are fewer instruments overlapping each other, resulting in less chaos. Still, it is Firebird’s timbre that makes it clear how different it is from Symphony No. 5. It is bright, brilliant, and harsh, simply because of the pairing of high pitches with a loud dynamic marking and a quick tempo. Perhaps this is a clever decision by Stravinsky, trying to mimic the calls of a wild bird—shrill, shrieking, and somewhat harsh on the ears at times. When comparing the two compositions, it is clear that Stravinsky’s Firebird is more complex; but Beethoven’s Symphony No. 5 is much more composed overall. It is not as aggressive in terms of loud, shrieking high notes, but rather understated and intense. This also evokes more emotion out of the audience, as it plays on the darkness and moodiness of Beethoven’s personality. Firebird is undoubtedly entertaining and a complicated work of art; but when it comes to which piece is easier to listen to and which makes more sense upon first impression, it is surpassed by Symphony No. 5.

Biology and Society Essay Example | Topics and Well Written Essays - 750 words

Biology and Society - Essay Example When the population of a less developed country increases, government faces the pressure of increased demand while the supply of services and facilities is limited owing to the limited budget of the country. In less developed countries, the infrastructure is poor and weak. The population of poor people with a substandard lifestyle is high. People are not much educated. Still, there is abundance of talent while the job opportunities are limited. All these factors encourage people to adopt unique ways of surviving through the hard times. Many people start informal small businesses of their own. A substantial population of people in the less developed countries renders services to foreign countries. Although the population is high, yet the pressure on the government is alleviated as hundreds of thousands of people from these less developed countries migrate to the advanced countries in search of better opportunities of education and employment and have a high standard of living in gener al. Many people from such less developed countries as India, Pakistan, and China migrate to the US, the UK, and such other developed countries every year. So the pressure of increased population is essentially shared by the advanced countries. ... Even though they are advanced economies, and have abundance of means and resources, yet there is not a substantial difference between how things are done in the less developed countries and how they are done in the advanced countries. Although there is considerable expenditure on research and development in the advanced countries, yet most of the projects are in their initial stages and are not developed enough to replace the old ways of doing things. Let’s take the hydrogen cars for example. Hydrogen car operates differently from the fuel-operated cars in that it does not use gasoline and accordingly does not cause air pollution like the fuel-operated cars do. Hydrogen cars produce steam while fuel-operated cars produce exhaust. Clearly, hydrogen cars are more environment friendly as compared to the fuel-operated cars. However, a vast majority of people even in the advanced countries drive the fuel-operated cars. Hydrogen cars are used by a minority of people since they are v ery expensive and are not produced in large numbers. As it is said, â€Å"The car of the future [the hydrogen car] is here today. Of course, you can't buy one yet† (Lampton). The bigger contributor to the reduction of environmental health and safety is growing consumption of natural resources by the advanced countries. The more the resources are consumed, the more the pollution is created. Whether it is air pollution, water pollution, noise pollution, or any kind of pollution, it is more where there is more development. In fact, the very development with the use of the natural resources is what makes the advanced economies advanced. â€Å"Even the availability of grain is affected more by rising livestock numbers and the use of biofuels – driven, again by consumption – than by human

European Union Essay Example | Topics and Well Written Essays - 500 words - 2

European Union - Essay Example The member states benefit from both internal and external aspects of single market. Examples of these aspects include free trade of goods and services among member countries, common competition law that controls non-competitive activities of companies, elimination of internal border control and harmonization of external controls. Additional aspects include citizen’s freedom to live and work in any member state, free capital movement between member states, universal external customs tariff and a universal position in negotiations involving international trade among others. Following the European Union members’ deregulation of the aviation industry, which they accomplished in 1997, they abolished all traditional national protectionism, which resulted into a great improvement in the management of air traffic. With an aim of establishing a safer and efficient flow of air traffic within Europe, they set up a new system of managing air traffic. One very significant component of this system is the single European sky legislation that the EU launched in 1999 and its institutions adopted it in 2004. This legislation involved restructuring of the European airspace, which was formally individual national airspaces that individual member states regulated, into a single area regulated by the alliance (EUROPA, 2007). The single European sky led to the simplification of procedures for controllers of air traffic and pilots as well as fewer handovers where controllers of air traffic manage wider sky expanse while Europe-wide common procedures and rules provide pilots with a flawless service. Minimizing of different areas of control enhances faster services and a structure that is far better in dealing with any eventual trouble. The single European sky has also boosted air travel in EU member countries significantly. It has directly provided airlines with quicker and safer

Business Creation and Growth Coursework Example | Topics and Well Written Essays - 2250 words

Business Creation and Growth - Coursework Example This essay â€Å"Business Creation and Growth† highlights the advantages and disadvantages of the program that is introduced and developed for assisting the entrepreneur in starting up the business and conducting of the market research. It covers various areas which include the operation, human resources, operation, finance, marketing and organization. The process and the application of Sim venture are very simple and easy to implement as well as manipulate. Therefore it is required to be applied tactically for various purposes. The Sim venture game has been introduced with the purpose of allowing the user to run the enterprise for the period of maximum 3 years. Sim venture game assists the entrepreneur in successfully expanding its business. Sim venture performs the role or the function of a business adviser in which it allows the entrepreneur to carry out its business successfully and enhance his knowledge as well as decision making skills. Sim venture is a very well known b usiness simulation game that is introduced and developed for assisting and supporting the entrepreneur for the growth and expansion of the business. This game has been introduced for developing the entrepreneurial skill. It provides an opportunity to the entrepreneur in facing the complex business environment and competing with the demands in the market. The various areas of the business that is associated with sales and marketing, finance, organization and operation has its implication in the business programme.

If saudi Arabia a person what it should be what would you like to Essay

If saudi Arabia a person what it should be what would you like to change in Saudi Arabia and why - Essay Example The person would be fond of eating and would be regular customer of world’s largest and most variant cuisines. The person would be particularly fond of dry fruits, specially dates. The person would always dress in the traditional white cloak and would preferably communicate with others in Arabic. One thing that I do not like about Saudi Arabia is the fact that the native people of Saudi Arabia show very little interest in learning a second language. A vast majority of the native people know no other language but Arabic. This makes it very difficult for the foreigners to communicate with them. Linguistic barriers are the biggest hindrance in the way of development of rapport between the native people of Saudi Arabia and the foreigners. It is very good and essential for a nation to give due importance to its own language, but government should take measures to make people learn at least one second language i.e. the international language like English so that they may also commun icate with the outer world.