For the Love of Water Essay Example | Topics and Well Written Essays - 1000 words

For the Love of Water - Essay Example Major bodies and political institutes have gained control over the water distribution channels of the world and are making a lot of money at the expense of the poor persons. Water has now turned into an expensive commodity that can only be afforded by the well off while the rest have to do with spring water, or even dirty ditch water. Positive and negative externalities There are positive and negative externalities as far as water supply is concerned. The positive externalities are; the suppliers of the water are making millions as the commodity is in demand since we cannot do without water. It is the big corporations that are gaining from this business. These corporations are headed by persons who are believed to be associated with the World Bank. So as the World Bank imposes regulations on countries concerning the privatization of water supply then these corporations cash in. Privatization Privatization being the transfer of the ownership or business title to the private sector has turned the water supply system into a mess. Initially as the governments would supply water through their own ministries, there was sanity in the industry. As time went by, pressures have been exerted especially on the developing countries to privatize the water supply systems. Initially, the private sectors made the people believe that they were out to help them have water supply but this was not the case. It is common sense that as these companies supply water, they are in business and would want to make an extra coin for their investors. Privatization was meant to equip the cities with portable water and sewerage which did happen but only to those people who could afford the change. A lot of people who earn very little couldn’t afford the change and thus have to do with well water or borehole water where available. In other places in the world, the private sector connected water then charged for the water supply or consumption that people use. When these people are not ab le to pay for the water, it is cut off. These people have now turned rebellious and are reconnecting the pipes themselves to get the water. Some do this in the night. Advantages of privatization. Privatization though considered a bad omen by the people especially of the developing countries has its own advantages though not many. It has created employment as these corporations set up firms in these countries to supply water. These firms also contract persons to do the piping and sewerage construction, thereby creating money making avenues for the people on the ground. With the coming of the pipe water, it is believed that the rate of people getting water borne diseases was reduced as these water supplying corporations cleaned and disinfected the water. According to FLOW (2013) bad and infected water kills more than even AIDS and other diseases. Privatization was also a God sent blessing to the water bottling companies as the rate at which people are taking bottled water is very high and it created a booming business. To the people that were able to pay, sewerage and piped water is a blessing as compared to fetching water at a river or borehole. Disadvantages of privatization With these advantages came many disadvantages. People are excluded from portable water in cities. They don’t have water nor the money to buy the basic commodity. The kind of wages that these people get cannot allow them to have all the water that they would require to live healthy lives. They have to make do with very little water and do all they need to with this. What they can do away with like bathing daily, and cleaning their clothes, they don’t do on a daily basis but just when it is really necessary. The private water suppliers have neglected them. For these suppliers it is just

Self-pity as a Dominant Emotion in Sor Juana's Reply to Sor Filotea de Research Paper

Self-pity as a Dominant Emotion in Sor Juana's Reply to Sor Filotea de la Cruz - Research Paper Example . Some of her works include This Sex Which Is Not One, Empenos De Una Casa (The Trials of a Household), Primero Sueno (first dream), Carta Atenagorica and Respuesta a Sor Filotea (response to Sor Filotea). In her response to Sor Filotea De La Cruz, Sor Juana brings out the dominant emotion, pity that reveals her feeling about the states of affairs in the society at that point in time. Sor Juana Ines de la Cruz wrote Respuesta a Sor Filotea (response to Sor Filotea) in Spain. This was a reply to Sor Filotea De La Cruz (Cruz and Rappaport 314). Throughout the reply, we find heavy groveling to the feet of the bishop with apologies that include explanations of the pains that De La Cruz goes through at that time. Sor Juana wrote the reply at a time when her society favored men to women. Women were seen as incompetent and an inferior group in the society. They were given subordinate roles and were supposed to be submissive to men. Sor Juana was motivated by the betrayal of women in the soc iety. She wrote with the intention of inspiring women not to succumb to the unfair treatments they were subjected to by the society (Cruz and Rappaport 314). One major aspect that Sor Juana used to push her idea forth was irony. Throughout the reply, she has used irony as her most important tool. Perhaps it was influenced by the place of a woman in the society. For example she states that, â€Å"†¦The first and to me the most insuperable is the question of how to respond to your immensely learned, prudent, devout, and loving letter† (De la Cruz 39). She uses this to show her feelings towards the dreadful deed that the bishop had done. She uses this ironical statement to show that despite the fact that the society thinks of women as stupid and incompetent people, they are intelligent and knowledgeable. Sor Juana decided to show her intelligence though a polite manner often apologizing and taking the submissive role just as a woman was supposed to behave (Cruz and Rappapor t 314). Women were not allowed to talk. They were to do what men told them to do. De La Cruz says, â€Å"†¦I.  .  .  was sorely tempted to take refuge in silence. But as silence is a negative thing, though it explains a great deal through the very stress of not explaining, we must assign some meaning to it that we may understand what the silence†¦Ã¢â‚¬  (De la Cruz 8). In the reply, Sor Juana tells the reader about the ways in which the society was determined to ensure that women remained helpless. The society did this by ensuring that it bound and suppressed them by maintaining a male dominant environment. The society discouraged women from attending school because they were supposed to sit at home, do home chores and take care of children. In her reply, Sor Juana shows that she had the desire to learn but the society could not support her because she was a woman. She says that, â€Å"no teacher besides books themselves.† (De la Cruz 53) She had to study bo oks on her own without the help of teachers. On the other hand boys of her age went to school and were taught be teachers. It is because of her intelligence and hard work that she managed to pursue her goals. Sor Juana shows the reader the struggle she passed through teaching herself several subjects that she lists throughout the text. (De la Cruz 53). The society did not allow women to be educated or put their ideas in writing. The society did not find anything useful that women would write. Her reply clearly shows the society’s position on the right of women to study and their courage to affirm

Why was there a considerable delay to the introduction of universal Essay

Why was there a considerable delay to the introduction of universal suffrage in France - Essay Example This section will provide detailed description about the Napoleon laws that promoted women subordination, the French political attitude towards women’s rights to vote, civil rights activists’ involvement, the role of the fight for power in the delay, and eventually, the change in French law that allowed women to vote and contend for official positions (Ringen, 2009; Reynolds, 2002). Women may have been subordinated in France before, but the Napoleon’s Civil Code of 1804 reinforced this subordination. Even after their rights were expressed in previous years, this law meant that they would still not be allowed to vote. This went on until 1890s when women’s rights activists became stronger in advocating for the women’s rights. This was when the stained political minds were heard (Boxer, 1982; Reynolds, 2002). This section will describe in detail how the above factors led to the

Concussions in the NFL, an its affect on current and retired NFL Research Paper

Concussions in the NFL, an its affect on current and retired NFL Players - Research Paper Example our game as safe as possible, to protect the health and safety of our players, and to set the best possible example for players at all levels and in all sports.† Historically, doctors were limited to post-mortem biopsies, however, thanks to new technologies such as the functional magnetic resonance imaging that allows the doctors and scientists to observe and study a living human brain, researchers are better able to understand the nature of traumatic brain injuries and the deleterious effects of repeated concussions. To limit the number and severity of future injuries, the dual-prong strategy concentrates on increasing awareness of the dangers of concussions and of their symptoms, and of using advanced medical technology to better diagnose and treat injuries, and to create and evaluate novel treatment options. The new standard states that a player who is concussed should not return to play the same day if he has memory problems, a headache or persistent dizziness. This is a change from the old standard from 2007, wherein a player should not return to play if he had lost consciousness, reflects a growing concern of fans and players on the seriousness of head injuries (Schefter 2009). Pressure on management to address the issue has meant new regulations, including suspensions and fines up to $75,000 for dangerous hits (Associated Press 2010). How widespread is the problem in the NFL? Currently, there are eleven players league-wide with reported concussions and another eight listed with head injuries (Schefter 2009). There are an average of 1  ½ to 2 concussions per game (Associated Press 2010). While the average concussion is the result of 95 g’s of acceleration to the skull, American football players experience of 103 g’s or more (Malinowski 2010). According to the Center for Disease Control, amongst the general population traumatic brain injury â€Å"is a contributing factor to one third of all injury-related deaths in the United States.† That’s roughly

Greeting Cards Research Paper Example | Topics and Well Written Essays - 1000 words

Greeting Cards - Research Paper Example Greeting cards has the potential to play a pivotal role in maintaining the goodwill of the business. The businesses use them to remind business partners of their presence. When businesses receive greeting cards on and off, they may also feel valued and important for the client. The feeling of importance may allow the business to take further interest in strengthening relationship ties with other clients. The application of greeting cards became modern just like other aspects of our lives. Nowadays, people are sending greeting cards through electronic means, but the people have lost the true taste of receiving them because human mind does not respond well towards online greeting cards in the same way. The human mind and personality internalizes stimulus in print more powerfully than electronic ones. The trend of building and forging social relations is also dying out in the modern era of the 21st century. The humans of modern times are very active on Facebook and they tend to enjoy their experience of socialization on the web. However, they are completely unaware of the fact that they might have thousands of friends on the internet. They do not have a shoulder to lean on in the times of sorrow. The modern friends remain part of one’s life during good times only, and they fly away on sighting the first sign of trouble. That is the difference between conventional friendship and modern one. In historical times, the buddy was even closer than one’s blood relatives (Fischer & Reuber, 2011). The present is witnessing breaking down of social relations that kept the community together. On the other hand, the online socialization sites are making billions by just getting people to place clicks so the humanity is dying out, and economic considerations have become very valuable during the process of selecting friends and partners. Human development and grooming occurred as a result of

Ammonia Treatment in Textile Processing Essay Example for Free

Ammonia Treatment in Textile Processing Essay Ammonia Treatment in Textile Processing BY Mrzatnqazt Ammonia Treatment in Textile Processing Before Studding Ammonia Treatment we have to know about the Pretreatments in textile processing. Why we do Pre-Treatments? Pretreatment is the heart of processing of textile. Grey cloth after weaving is quite unattractive and contains numerous natural as well as added impurities which hinder the successful carrying out of subsequent step like dyeing, printing and finishing. What are Pre-Treatments? In Pretreatment, all these impurities are removed and fabric is brought to a stage here it is more absorbent and white and can be easily processed further. In other words Pretreatment process could be defined as procedures concerning about the removal of natural and added impurities in the fabric to an optimum level that can provide good whiteness and absorbency by utilizing minimum time, energy and chemicals as well as water. Major steps involved in textile pretreatment are: De-sizing, Scouring, Bleaching and Mercerization or Ammonia Treatment In every step, different chemicals are involved which are: ? » Wetting Scoring Agents, ? » Sequestering Agents, ? » Mercerizing Agents or Liquid Ammonia, nd ? » Hydrogen Peroxide Stabilizers Pretreatment is important!!! 70% of problems during dyeing and finishing are caused by pretreatment. Now What is Mercerization? Mercerization is a method for processing cellulose fibers by alkalis. This processing makes the inside of the fibers swell to exploit new fiber properties beyond their original feel or physical properties. Sodium hydroxide (NaOH) and ammonia (NH3) are used as the alkaline chemicals for mercerization. Ammonia Mercerizing of cellulose fibers History: The use of ammonia in mercerization has been known since the 1930s and was eveloped commercially for fabric processing around 1970 in what was originally known as the Tedesco process, which was subsequently acquired by the Sanforized company and made well-known as the Sanfor-Set process. The fashion appeal of so-called flat-finish denim resulting from Japanese ammonia-finished denim that many companies substituted caustic-mercerized fabrics, often presenting them as ammonia finished. Working: By combining ammonia mercerization and Sanforizing in a single step shrinkage control is greatly improved in denim. In contrast to caustic mercerization, the fabric is ofter, semi-permanent press properties result and in the case of twill fabrics, there is less seam-puckering in garments, less leg- twist and edge-fraying. Unlike caustic mercerization, the fabric is not degraded, avoiding a harsh hand even after multiple washings. The resistances to abrasion tear and tensile is significantly improved. The original process consisted of passing the fabric though a bath of liquid ammonia with 100% pickup for approximately 10 seconds. The ammonia was removed with dry heat applied by passing over blanketed, steam heated dry cans which removed about 90% f the ammonia which was then recovered by a recovery plant consisting of large, pressurized towers and made available for recycling. The rest of the ammonia, which chemically bonded to the cellulose, was removed by light steaming. Effects ; Defects: The difference in effect as opposed to caustic mercerization is because with ammonia, there is less fiber-swelling, therefore the fibers are more pliable, which Additionally, unlike standard wet-finishing of denim, the ammonia penetrates completely into yarns and fibers, resulting in complete wetting, which is necessary for lasticizing the cotton for consistent shrinkage and elongation. In garments that are fabricated from ammonia treated-fabrics, the garment life is longer after long periods of wear and repeated washings, improving sustainability. Penetration: The much smaller molecular size of ammonia allows it to penetrate completely into every fiber of the fabric, unlike caustic which causes such rapid fiber- swelling that the caustic is blocked at the surface of yarns, preventing further penetration. The surface tension of ammonia at 26 dynes/cm is a third that of caustic (NaOH). The ower surface tension overcomes the enormous resistance of air trapped in the fabric which is a characteristic of heavy cotton fabrics. Additionally, at normal mercerization concentrations of caustic (23%/30 Baume), sodium hydroxide forms a hepta-hydrate with water (NaOH7H20), which results in a slow-moving, bulky group. Permanent- press effects: The permanent-press effects are achieved without the use of cross-linking resins, however, the commonly-used resins are soluble in ammonia and a combination resin finish and mercerizing, plus Sanforizing can be achieved if a soluble catalyst is mployed. Additionally, ammonia acts as a formaldehyde-scavenger and resin- treated fabrics that are ammonia treated will produce no free-formaldehyde. Shrinkage: As a rule, fabric shrinkage depends on the time of exposure to the ammonia, with 80% of the shrinkage occurring in the initial 6 seconds. Very close control of final shrinkage is achieved by fabric tension in the ammonia application in combination with compressive shrinkage. By 1974, the primary application of ammonia mercerization was for treatment of heavy-weight cotton fabrics such as denim and orduroy, which are difficult to properly mercerize with traditional caustic treatments. The ammonia process was intended as a replacement for conventional mercerizing for both fabrics and in mercerizing sewing threads (Petrograd process). Ammonia Recovery: The original ammonia recovery methods required a large capital investment which limited acceptance in the textile industry, however, a more recent design has adopted patented seals that totally isolates the dry and steam process sections in order to avoid ammonia from coming into contact with water and air subsequently liminating the need for an expensive distillation and recovery operation. Furthermore the seals also isolate the machine from the outside environment so that there are absolutely no ammonia odors in the room where the equipment is operating. This unit also does not employ a felt calendar, which can also transfer allowing denim to be processed on the same machine without contamination of non- denim fabrics as well as reducing the problem of back staining with denim that occurs in caustic mercerization, since no water is required for washing.. All the imited residues of non-recyclable ammonia are completely neutralized and can be safely sent to the water treatment plant, so together with the significant reduction in water usage, this newer ammonia process can actually be considered environmentally friendlier than conventional caustic mercerization. Dry-crease recovery: Ammonia- mercerization provides a higher dry-crease recovery and higher shrinkage consistency than caustic mercerization, especially with the dry-steam method of recovery. However, caustic mercerization still has an advantage with regard to luster nd improved depth of color in dyeing, although the uniformity of dyeing after mercerization is significantly improved with ammonia. Ammonia treatment results in a more rounded cotton fiber, which scatters light more, in turn resulting in a luster that is less bright. An additional advantage of ammonia mercerization is the absence of alkaline oxy-cellulose that results with caustic treatments, which is evidenced by strength-losses and dyeing variation. The lower pH of ammonia allows safe treatment of more sensitive fibers like linen (flax) or silk. With caustic treatments of fabrics like enim, the elimination of washing required in caustic mercerization avoids the problems with removing caustic. Mercerizes are not normally equipped with drum washers for removal of caustic from heavy cotton fabrics and contamination remains on the fabric at the time of drying which results in damage to cotton. The use of acetic acid to neutralize creates a problem with the formation of sodium acetate, which produces a very harsh feel. The ammonia process on denims also produces a much flatter, richer appearance and improves the performance on stretch denim improving fit. Tension control: Tension control is important in both ammonia and caustic mercerization for improved fabric tenacity and elongation. Moisture regain is improved in both if tension is applied prior to fiber swelling.

Learning Outcomes Assessment for Student Nurse

Learning Outcomes Assessment for Student Nurse Learning Outcome 1 – Pre-assessment The ultimate goal of the pre-assessment is to assure that those patients identified as suitable for day surgery are properly identified while those considered unsuitable for a selected procedure are identified early enough in the process to allow for other treatment options (National Health Services, n.d.a, p. 13). Although ultimately it is a joint decision between the surgeon and anaesthetist who make the final determination (National Health Services, n.d.b), the nurse plays a vital role in the process and should be involved in the selection criteria (Royal College of Nursing 2004, p. 1). Pre-assessments of patients scheduled for day surgery are usually performed by an outreach nurse from a day surgery centre, by telephone screening, or by questionnaire (National Health Services, n.d.a, p. 9) or via appointments with day surgery staff or in specialized pre-admission clinics (Joanna Briggs Institute 2004, p.2). Many institutions are combining pre-assessment interviews with the opportunity to work with the patient in a preoperative education status in order to decrease patient anxiety, assess the needs of the patient and/or family members and to personalise information (Joanna Briggs Institute 2004, p.2). The National Health Services (n.d.a, p. 11) states this is an effective opportunity to also discuss the surgical procedure in greater detail with the patient, note special requirements for admission, surgery and/or discharge and allow the patient to choose their own date for surgery, finalizing and/or setting the appointment. According to the Royal College of Nurses (2004, p. 3), nurses performing the pre-assessments must have the option of being able to contact the anaesthesiologist of surgeon if a problem is identified that could potentially increase the risk during anaesthetic or surgical intervention.† This is critical; otherwise, there is no apparent reason for the assessment if the nurse cannot raise her concerns. The National Health Services (n.d.a, p. 9) day surgery guidelines state pre-assessments performed as soon as possible following the surgical consultation can allow for treatment of underlying physical issues that might preclude them from the day surgery procedure, such as high blood pressure and/or arrange for home care. If this is not possible, the National Health Services (n.d.a., p. 13) recommends that patients should then complete a â€Å"health-screening questionnaire before leaving the outpatient department.† According to the National Health Services (n.d.a., p. 11), incorporating the pre-assessment step in the day surgery process has been shown to reduce surgical cancellations and increase communication across the multidisciplinary team. Based on research, it is important to note that the day surgery pre-assessment is a valuable tool that can help the patient, the perioperative and surgical nursing teams as well as surgeons and anaesthesiologists. The pre-assessment is a way of initiating a comprehensive set of documentation for the entire team. Learning Outcome 2 – Effective communication According to the Joanna Briggs Institute (2004, p. 4), caseload can determine the staffing mix required. The staffing mix for a day surgery centre, however, can vary from a group of individuals who work together on a regular basis such as the case in a specialized clinic setting to a group of individuals who rely on departmental shift staffing for perioperative nurses and surgical residents in a busy teaching hospital. No matter what the group mix is, however, the need for communication is critical to patient care in all settings, especially surgical, where according to Cowen et al. (2005) communication is especially challenging for workers in environments that are high stress and time sensitive. Vazirani et al. (2003, p. 72) states that improving the level of collaboration, not just communication, can enhance job satisfaction among medical professionals while increasing the quality of care and patient satisfaction. While traditional communication techniques such as â€Å"active listening, positive voice tone, [and] reiteration to confirm understanding† are desirable goals, in the surgical setting other barriers often compound communication problems, including status and posturing between doctors versus the communication found between doctors and nurses or nurses and nurse practitioners. Vazirani et al. (2003, p. 72) discuss the care nurse practitioners took â€Å"not to violate the autonomy of residents or interns [and] did not admit patients on their own or write orders without the consent of a resident or an intern.† Essential to a multidisciplinary team is the need for collaboration, where decision-making is a shared event for doctors and nurses and that open communication between the two professionals exists (Vazirani et al. 2003, p. 73). It is important to note that research demonstrates physicians view collaboration differently than nurses, such that physicians believe collaboration implies â€Å"cooperation with follow-through† pertaining to following orders rather than sharing in the decision making process (Vazirani et al. 2003, p. 75). Vazirani et al. (2003, p. 76) also cited nurses as not being provided timely or accurate information regarding patient information when physicians autonomously make a change in their normal protocol, stating nurses need the information most as they are the ones at the patient’s bedside. Communication is a commonly sited problem and is one that, despite all the best suggestions and recommendations, from outlining roles and responsibilities, collaborating as a team or mutual team members each afforded appropriate professional respect (Vazirani et al. 2003) to developing Integrated Care Pathways (ICPs) as outlined by Fisher and McMillan (2004) is difficult to remedy. Ultimately, human emotions and professional pride create unnecessary friction that discourages open communication for fear of reprisal. Cowen et al. (2005) emphasize the need for an accurate flow of information between various disciplines as the most critical aspect in order to assure patient safety. Learning Outcome 3 – Patient selection criteria Patient selection criteria primarily focus on three primary factors: surgical, medical and social (National Health Services, n.d.a, p.11; National Health Services, n.d.b.). Surgical criteria assess whether the procedure will leave the patient dependent on others and/or if it has a statistically significant postoperative morbidity level. The National Health Service (n.d.b.) states that the surgical procedure should take less than 1 hour, involve minimal blood loss, be unlikely to produce severe post surgical pain or nausea and be unlikely to result in a loss of physical independence. When assessing social appropriateness, according to the Association of Anaesthetists of Great Britain and Ireland (cited by Joanna Briggs Institute 2004, p. 2), the pre-screening interview is an opportunity to assess the patient’s willingness to have surgery, the certainty of adult care in the home following surgery, telephone access and taking into consideration the patient’s home situation. For example, are there several young children and toddlers or infants at home requiring constant care; is the only adult available to help the patient an elderly or frail individual, or has the patient stated they feel they are being pressured into having the surgery. These are all reasons that should be presented to the surgeon, anaesthesiologist and the rest of the multidisciplinary team as reasons the patient should be precluded from day surgery. Additionally, patients with a social history of significant levels of alcohol consumption and/or who smoke are indications of potentia l preclusion or the need for additional counselling prior to surgery (National Health Service n.d.b.). The Royal of College of Nurses (2004) also states that the patient must have the availability of an escort home following surgery and that the travel time home must be within one and a half hours; and if small children are present in the home that a caregiver is available specifically to tend to the children. Medically, it is important to assess cardiac fitness, assurance of height/weight appropriateness and if they are â€Å"physiologically under 70 years of age[1].† Exclusions are usually automatic if there is uncontrolled hypertension, recent history of cardiac failure, pregnancy, angina, asthma, diabetes or epilepsy. Additional issues that require notification of the appropriate medical personnel include prior difficulties with anaesthesia or current medications that would either preclude day surgery or require either a modification and/or temporary cessation of the pharmaceutical agent, particularly warfarin. The American Society of Anaesthesiologists’ (ASA) (cited by The Royal College of Nursing 2004) uses three classifications to assess physical status: Class 1: patient is mentally and physically fit and the surgical procedure is localized without systemic disruption, for example, removal of a uterine fibroid in an otherwise healthy female or the repair of an inguinal hernia in a healthy individual. Class 2: patient suffers from mild to moderate systemic pathology that is either caused by the pathology to be treated by the day surgery or by other pathology, for example anaemia or mild diabetes or slightly limiting organic heart disease. Class 3: patient suffers from a severe mental or physical disorder from whatever cause, such as angina pectoris, moderate to severe levels of pulmonary insufficiency, vascular complications from severe diabetes or significantly limiting heart disease. Criteria used for patient evaluation and assurance of fitness for day surgery as outlined above are focused primarily on the suitability for general anaesthesia without complication. It is essential however, to couple both the individual patient status as provided by the pre-assessment with the type of surgical intervention proposed. The medical professional cannot use the same set of pre-assessment criteria for all patients for all procedures; they must simply be a guide. For example, physiological trauma, anaesthetic requirements and post-operative pain are different for those having arthroscopy as opposed to a laparoscopic cholecystectomy or partial thyroidectomy. All three are considered day surgical procedures by the Royal College of Nurses (2004, p. 2). Patient selection criteria are important for nurses to understand from many aspects. The nurse has to understand the physician’s reason for suggesting day surgery for their patient, she needs to understand the surgeon’s belief in appropriateness and she has to understand the potential risks that are often overlooked by physicians and surgeons that now become her responsibility to ascertain. Although it is often a delicate position for the nurse to be in, it is essential that she bring to the surgeon or anaesthesiologist’s attention any patient not appropriate for day surgery. This is an issue of legal liability for all professions on the multidisciplinary team and for the clinic or hospital as well as one of ethical concerns for the patient’s overall care and wellbeing. Learning Outcome 4 – Pain management According to Lipp and Yap (2005, p. 64) prior to 2003, the responsibility for post-surgical pain was the sole responsibility of the anaesthesiologist and no routine or regular pain assessments were conducted. In 2003, pain management assessments and the nursing role in pain management in the day surgery setting became the standard. The Royal College of Anaesthetists (as cited by Lipp Yap 2005, p. 64) tell us that following a day surgical procedure, less than five percent of all patients should experience severe pain while up to 85 percent will have mild or no pain following surgery. Beauregard et al. (1998, p. 309) believes that it is not unusual for pain to persist during the entire week following surgery, but that the best predictor of significant post-surgical pain following hospital discharge was inadequate pain control during the first few hours of following surgery. Research has acknowledged that the longer an individual is experiencing pain that is not attended to or interrup ted in some way, the more sensitive to painful stimuli the patient becomes (Mukherji Rudra 2006, p. 355). Ultimately, the goal of effective post-surgical pain management is to be â€Å"safe and effective, produce minimal side effects such as nausea. It was stated that the criteria for patient selection should be individualized based on patient status and type of surgery. Similarly, Mukherji and Rudra (2006, p. 355) state that patients should be identified as potentially at risk based on â€Å"age, physical status, presence of pre-existing pain, site and extent of surgery.† Additionally, researchers believe that the amount of postoperative pain a patient experiences is also a factor of the surgeon and surgical techniques used ( Mukherji Rudra 2006, p. 356; Chung et al. cited by Beauregard et al. 1998, p. 305). Mukherji and Rudra (2006, p. 355) discuss several pain assessment tools: the visual analogue scale (VAS) where pain is rated along a continuum from â€Å"no pain at all to the worst pain imaginable† and the Oucher’s scale for children. Many patients themselves downplay post-surgical pain for reasons ranging from believing that pain is part of the natural recovery process and what they are experiencing is normal (Beauregard et al. 1998, p. 209). Post-operative pain management can take different forms, including pre-emptive analgesia and prophylactic analgesia (Mukherji Rudra 2006, p. 356). There are also pharmacologic and non-pharmacologic pain management interventions. Pharmacological interventions can be opioid or non-opioids. Opioids are centrally acting and systemic in nature whereas non-opioids are also centrally acting but have a peripheral mode of action, and include codeine, metamizol, paracetamol and non-steroidal anti-inflammatory (NSAIDS) (Mukherji Rudra 2006, p. 356). Another problem cited by the Joanna Briggs Institute (2004) is that of inadequate pain management techniques and/or follow-through by the patient place additional burdens on family caretakers and the community at large. For example, Girgis and Sanders (2004, p. 66) tell us that parents generally underestimate and under treat pain; this can be extrapolated to caregivers in the adult community as well. Home caregivers failing to recognize and/or intervene in pain management is often problematic and it is the responsibility of the nurse to assure that proper discharge information is adequately communicated to the patient and/or caregiver/escort, including proper pain management techniques and interventions. To assure there is no confusion, these should be clearly documented and reviewed with the patient and caregiver verbally. References Beauregard, L., Pomp, A. Choiniere, M., 1998. Severity and impact of pain after day surgery. Canadian Journal of Anesthesia, 45 (4), pp. 304-311. Fisher, A. McMillan, R., 2004. Integrated care pathways for day surgery patients. British Association of Day Surgery [Online]. Available from: http://www.bads.co.uk/pdf%20files/IntegratedCarePathways.pdf [cited March 17, 2007]. Girgis, M. Sanders, D. 2004. Are we giving our children the right dose? The Journal of One-Day Surgery, 14 (3), pp. 65-68. Joanna Briggs Institute, 2004. Management of the day surgery patient [Online]. Joanna Briggs Institute Best Practices. Available from: http://www.adsna.info/attachments/BPISSup.2004.pdf [cited March 17, 2007]. Lipp, A. Yap, H, 2005. Is our pain relief protocol effective? The Journal of One-Day Surgery, 15 (3), pp. 64-66. Mukherji, S. Rudra, A., 2006. Postoperative pain relief for ambulatory surgery. Indian Journal of Anaesthesia, 50 (5), pp. 355-362. National Health Services, n.d.a. Day surgery pre-assessment: A brief guide [Online]. Available from www.wise.nhs.uk/surgery/NationalGoodPractice/downloads/14/14d4.doc [cited March 17, 2007]. National Health Services, n.d.b. Day surgery: A good practice guide [Online]. Available from: http://www.wise.nhs.uk/sites/crosscutting/access/Access%20Document%20Library/1/Day%20Surgery/Day%20Surgery%20Guide.pdf [cited March 17, 2007] Royal College of Nursing, 2004. Day surgery information: Selection criteria and suitable procedures [Online]. Available from: http://rcn.org.uk/publications/pdf/daysurgery_selection.pdf [cited March 17, 2007]. Society of Critical Care Medicine, 2005. Tools for effective communication [Online]. Society of Critical Care Medicine. Available from: http://www.sccm.org/SCCM/Publications/Critical+Communications/Archive/February+2005/communicationsfeb05.htm [cited March 17, 2007]. Vazirani, S., Hays, R. D., Shapiro, M. F. Cowan, M., 2005. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. American Journal of Critical Care, 14 (1), pp. 71 – 77. 1 Footnotes [1] According to the National Health Service (n.d.b), the phrase refers to a patient who is â€Å"independent, active and compos mentis.†