Improving Quality of Care Through Pain Management

Improving Quality of Care Through Pain Management Patrick Bobst A Qualitative Study Quantitative research involves testing hypotheses, making predictions, studying specific variables, collecting numbers and statistics, identifying statistical relationships, and making observations under controlled conditions (Johnson Christensen, 2008). None of the aforementioned attributes appear in chapter 17 â€Å"Improving the quality of care through pain assessment and management†. Hence. this chapter written byWells, Pasero, McCaffery, (2008) is a detailed deductive qualitative analysis which aims to increase opportunities to develop empirically supported ideas and theories with applicable relevance in the field of pain management for healthcare practitioners. Unlike inductive analysis, applied when not enough former knowledge about a phenomenon is known, deductive content analysis is used when the structure of analysis is initiated based on previous knowledge and with the intent to test a theory(Elos Helvi, 2008). The authors of chapter 17 provided qualitative resea rch by studying the issue of pain control as a whole without immersion into variables. They defined the purpose of the study by subjectively understanding and interpreting interactions with words, identifying patterns and themes, and making observations of occurrences in a natural environment(Johnson Christensen, 2008). Qualitative research is more concerned with describing social meaning and therefore provides the flexibility to follow ideas and explore processes(McGonigle Mastrian, 2012). Research Problem The level of pain a patient experiences is emerging as the fifth vital sign in health assessments statuses (Ju-Ling Wen-Chu, 2013). Pain is a common occurrence and an expectation in hospitalized patients especially during the postoperative period; yet despite the availability of analgesics along with national guidelines to manage pain a disconnect remains in in proper pain management resulting in undertreatment for about 50% of patients with moderate to severe pain(Wells et al., 2008). Inadequately managed pain can lead to an arsenal of negative adverse physical and psychological outcomes including immune system suppression resulting in infections and poor healing, sympathetic activation causing cardiac ischemia and ileus, reducing mobility resulting in deep vein thrombosis, as well as pulmonary embolus, or pneumonia(Nwachukwu, 2012). All mentioned adverse conditions carry along the potential consequence of extending a patient’s length of stay in the hospital decreasing patie nt satisfaction and increasing organizational costs(Nwachukwu, 2012). The Affordable Care Act of 2010 has established changes in the way hospitals are reimbursed for services. Value-based purchasing has come to the forefront in the healthcare industry with the centers for Medicare and Medicaid services (CMS) withholding full reimbursements for poor quality care or even nonpayment for patients readmitted within 30 days. Low patient satisfaction score indicators being tracked by CMS will not only affect an organization’s bottom line but also stand to lose its reputation(Wells et al., 2008). When pain is not managed properly through an organization’s pain management policy and procedure guideline the entire collaborative team responsible for managing a patient’s pain may be liable for legal action(Wells et al., 2008). Research Translated Into Practice The Agency for Healthcare Research and Quality (AHRQ) focuses on current issues, patient safety and quality of healthcare providing practitioners the best research for optimal patient outcomes. AHRQ is an active participant in pushing evidence forward into practice with its Translating Research Into Practice (TRIP) initiative to generate knowledge about evidence-based care and with the TRIP-II initiative the focus is on utilizing information technology to affect translational research and health policy (McGonigle Mastrian, 2012). The TRIP database is a clinical search engine designed to identify high-quality clinical evidence for clinical practice that utilizes contextual issues such as the magnitude of the health issue, economic costs of the problem, the reliability, relevance, and validity of the data along with the quality and consistency of the evidence (Glasgow Emmons, 2007). The authors in the pain assessment and pain management research study utilized the TRIP database probi ng for the terms â€Å"pain assessment† and â€Å"pain management† in the literature search, filtered only the English language and publications dated within the last 10 years, meta-analysis, practice guidelines, literature reviews, clinical trials, and random clinical trials (RCT). To use evidence in practice, the validity of research is evaluated on an evidential hierarchy that is defined and the value is assigned to the information source on a scale from 1 to 6, one being the highest evidence from a systemic review and six being the evidence from the opinion of experts(McGonigle Mastrian, 2012). The evidence table provided by the authors in the pain assessment and pain management study exhibits excellent research validity with multiple design types rating high on the evidential hierarchy scale listing. The authors utilized evidence from a meta-analysis study (Level 1), twelve RCT studies (Level 2), seven systematic literature reviews (Level 5), three literature rev iews (Level 6), and one qualitative massage study (Level 7)(Melnyk Fineout-Overholt, 2011). The RCT is considered the most reliable source of evidence in the hierarchy and the meta-analysis is the best quality evidence because it uses a multiple individual research studies to come to a consensus (McGonigle Mastrian, 2012). Practice Implications The implications of this TRIP intervention designed to increase the use of evidence-based practice (EBP) in pain assessment and management highlights scientific evidence for practitioners to augment their clinical decision-making. Recommendations for successful implementation of pain assessment and management include education, the utilization of appropriate tools in pain assessment, a multimodal analgesic approach, continuous evaluation, and an established organizational pain management guideline. Patient and family education has been a central recommendation regarding pain management prior to any surgical procedure in that comprehensive pain evaluations can uncover patient’s attitudes, beliefs, level of knowledge, and unrealistic expectations that can be addressed(Wells et al., 2008). Wells et al. (2008) found that frequent communication, shared goals, and shared knowledge in education contributed to better pain outcomes. The most critical aspect of proper pain management is assessing pain levels on a regular basis using a standard format, and in order to meet the patient’s needs pain should be reassessed after each intervention evaluating the effects and determining whether modification is needed(Wells et al., 2008). Based upon systematic reviews of pain quality improvement studies the emphasis has shifted from processes to outcomes where clinicians recognize and treat pain promptly, involve patients and families in pain management plans, adjust pain management plans as needed, and monitor processes and outcomes(Wells et al., 2008). Utilizing a multimodal approach for pain management is recommended which includes opioids, and non-opioids such as nonsteroidal anti-inflammatory drugs, and adjunct medications such as anticonvulsants can improve the safety of the therapy (Wells et al., 2008). With safety issues regarding the use of morphine, hydromorphone, and fentyal clinicians need to be educated about safe pain management to help prevent undertr eatment of pain and the resulting harmful effects. A series of systematic reviews indicate poor results and outcomes using the intramuscular route (IM) administering of an opioid analgesic (Wells et al., 2008). The IM route is painful, has an unreliable absorption time and can be dangerous since patients are often alone at the time of peak affect and can become excessively sedated, vomit, and aspiratenevertheless produces the poorest outcomes (Wells et al., 2008). Unfortunately,Wells et al. (2008) describe the evidence for nondrug techniques of pain management including relaxation, music, massage, heat and cold therapies are neither supportive nor consistent, are considered weak in reducing acute pain, and may not improve outcomes. Ample evidence revealed the appropriate use of analgesics with the proper drug at the correct interval can provide good pain relief for the majority of patients, and organizations should place their emphasis on improving assessments and administration tec hniques (Wells et al., 2008). The psychological, emotional, and financial toll of uncontrolled pain is monumental and everyone experiencing discomfort because of pain justly expects and needs to receive appropriate pain management. Research Implications The research provided supports the evidence-based treatments with analgesics in the management of pain, and appears to be effective in controlling acute pain. However, the undertreatment of acute pain remains prevalent due to the clinician’ behaviors, which includes inadequate pain knowledge, assessment skills and administration of analgesics (Wells et al., 2008). Krenzischek, Wilson, Newhouse, Mamaril, Kane (2004) also assert a lack of pain management knowledge and the reduced usage of clinical practice guidelines is a high contributor in poor pain management. Research is needed for effective strategies in changing clinician attitudes and behaviors that will result in better pain management for patients as well as non-drug therapies (Wells et al., 2008). Wells et al. (2008) asserts, â€Å"Lack of standardization of nondrug therapies is one of the drawbacks of the current literature† (p. 11). Integration of Informatics The authors of this study integrated informatics through data, information and knowledge to support clinicians and patients in their decision-making regarding the best practices in accomplishing favorable outcomes and to improve the quality of care through pain assessment and management. Wells et al. (2008) utilized the informatics infrastructure to seek and manage validated studies from various sources, capture proper demographic, treatment and outcome information, and the AHRQ to share project information, results, and insights. The informatics infrastructure is critical to EBP and promotes the use of clinical judgment and knowledge with procedures and protocols to what is scientifically proven rather than what is customary(McGonigle Mastrian, 2012). The paradigm of â€Å"this is the way I’ve done it for years â€Å"is no longer acceptable and it is upon clinicians to apply the aforementioned viable knowledge, experience, understanding, and insight derived from EBP throug h informatics to gain and synthesize the effervescent wisdom needed for high quality patient care and optimal outcomes. References Elos, S., Helvi, K. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x Glasgow, R., Emmons, K. (2007). How can we increase translation of research and to practice? Types of evidence needed. Annual Review of Public Health, 28, 413-433. http://dx.doi.org/10.1146/annurev.publhealth.28.021406.144145 Johnson, B., Christensen, L. (2008). Educational research: quantitative, qualitative, and mixed approaches. Thousand Oaks, CA: Sage Publications. Ju-Ling, H., Wen-Chu, W. (2013). Factors of accepting pain management decision support systems by nurse anesthetists. BMC Medical Informatics and Decision Making, 13(16), 1-13. http://dx.doi.org/10.1186/1472-6947-13-16 Krenzischek, D. A., Wilson, L., Newhouse, R., Mamaril, M., Kane, H. L. (2004). Clinical evaluation of the ASPAN pain and comfort clinical guideline. Journal of PeriAnesthesia Nursing, 19(3), 150-159. http://dx.doi.org/10.1016/j.jopan.2004.03.003 McGonigle, D., Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones and Bartlett. Melnyk, B. M., Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott, Williams and Wilkins. Nwachukwu, C. N. (2012). Decreasing pain and length of stay in the post anesthesia care unit (PACU) by implementing the ASPAN pain and comfort guidelines (Doctoral dissertation, The Catholic University of America). Retrieved from http://aladinrc.wrlc.org/bitstream/handle/1961/10269/Nwachukwu_cua_0043A_10311display.pdf?sequence=1 Wells, N., Pasero, C., McCaffery, M. (2008). Improving the quality of care through pain assessment and management. Rockville, MD: Agency for Healthcare Research and Quality.

Book Review of Hear My Testimony Essay -- essays research papers

Book Review of â€Å"Hear My Testimony†   Ã‚  Ã‚  Ã‚  Ã‚  This is probably one of the most moving books I have ever read in my life. It is basically a narrative story of the life of an El Salvadorian women named: Maria Teresa Tula. Maria is a wonderful storyteller and the fact the she is describing her own real life experiences greatly add to the impact of the book.   Ã‚  Ã‚  Ã‚  Ã‚  Most of the chapters in the book are just her telling about her life. She was born a very poor and sickly child, growing up with her mother and grandmother, after her mother had left her abusive husband. This was only the beginning of a very rough and trying life that she would face. She went on to describe her childhood, how other Salvadorian women were treated and the Salvadorian way of viewing women. Raised as a strict Catholic, she was taught by her grandmother at a young age to â€Å"act like a proper young women.†   Ã‚  Ã‚  Ã‚  Ã‚  From there on she continues to talk about her adolescence where she quickly learned about the threat of physical abuse and molestation towards young girls. She did not continue with school pat the age of 9 and in her small job of working in the local market she was confronted with true and absolute poverty on a daily basis. She got pregnant at age 15. At 16 she had her first fist fight with her abusive physically brother. And at 17 met the father of her other future children. While with this man, Rafael Canales, she learned first hand the hardships of poor domestic life. She also learned to assert herself even towards her own husband.   Ã‚  Ã‚  Ã‚  Ã‚  In 1978, the year I was born, Maria Teresa joined a human rights group called CO-MADRES. (The Mothers and Relatives of Political Prisoners, Disappeared and Assassind of El Salvador) Due to her husband being jailed and severely tortured after a sugar mill strike she found herself unsuspectingly thrown into a political arena. It is her work with this organization that begins to completely consume her life and is the core of the entire book.   Ã‚  Ã‚  Ã‚  Ã‚  Once aligned with this organization Maria’s eyes are opened to the bigger picture of political oppression in her country. She, along with many other women of El Salvador, watch as hundreds of their men are unjustly jailed, tortured and disappeared. She was also a witness to the inhuman... ...e. After saying all this, it is hard for me to find a weakness. The only minor weakness that I could see would be that of intense emotion. The way that this book is written is such that it is truly soaked with emotion. This being a first hand account also added the level of intimacy one feels when reading this, and for some this may translate into uncomfortable feelings. It is also clear that Maria does express her own personal opinions, on her government, on her views of women’s roles in society, and especially on the American government. Maria does use the words â€Å"they† and â€Å"them† to describe Americans sometimes and some may feel that her generalizations are unfair, especially seeing as how she did receive support from sympathetic Americans while in the US. Some may also feel that she is overly critical and excessively faulting the US for the events in El Salvador, however all I could say to people who feel this way is; it would be very difficult to not f ind American policies and actions accountable for many unthinkable tragedies all over Latin America. Personally however, I do not feel that these small weaknesses in any way, take away from the strength of the book or her story.

The Tragedy of Global Warming :: Greenhouse Effect Climate Change

The Tragedy of Global Warming The health issues of global warming are causing the human population rate to decrease over time. The health issues are caused by infectious microbes, pollution by chemical and biological wastes. Many of these diseases will cause illnesses or even death in the future. In fact, many scientists and doctors have discovered these diseases will cause human population to decrease by deaths as they are transferred from one person to the next either physical, eating animals contaminated, mosquitoes, or even blood transfusions though needles. Global warming has been discovered to be very dangerous to human health and is causing many deaths around the world. These tragic experiences in other countries are causing the health hazards to become more aware to humans and are giving the USA more time to plan cures for it before it becomes an issue for them. Global warming is affecting the health issues in today’s generation as well as the future’s generation. Global warming causes many different health issues to the human body. With the temperature’s rising, the risk of cancer is increasing. According to the U.S. National Cancer Institute between 1975 and 1991 skin cancer increased by 812 percent. â€Å"El Nino made1998 the warmest year ever recorded†(Bell 129). The warm temperature resulted in the worldwide outbreak of mosquitoes. With the warm temperatures mosquitoes were infected with different diseases such as malaria, dengue fever, yellow fever, rift valley fever and several other kinds of diseases. The World Health Organization said there were â€Å"quantitative leaps† in malaria cases around the world. â€Å"Thousands were infected with Rift Valley fever in Kenya, resulting in 200 deaths†(129). Many people around the world think that the earth is in danger because of global warming. â€Å"Rising temperatures will have enormous impact on the earth in the future†(pewtrust). With the temperatures rising this will cause the icebergs to melt and make the sea level rise. â€Å"Rising sea levels inundating coastal communities, altered crop yields and water supplies, increased floods and droughts and surge in infectious disease. The water will be tainted because of the water runoff pushing chemicals into our water supply. This will cause people to get sick or even die. With it getting hotter the carbon dioxide levels are rising. This may cause weeds to grow faster and take over the crops we need. Paul R. Epstein, a doctor from Harvard Medical School found a very interesting fact in his research that discussed how many people he estimates are going to be affected by global warming in the future.

Why Death Is Better Than Life in Prison?

Life in prison. When you look at the death penalty system in action, you realize that the only purpose it serves is retribution or revenge, it is seriously (and intrinsically) flawed in application and that there is a serious and continuing risk of executing innocent people. And, it costs much more than life in prison. Here are some facts about the death penalty system. While these refer to the system in the United States, similar things would apply to other nations as well. 130 people on death rows have been released with proof that they were wrongfully convicted. DNA, available in less than 10% of all homicides, can’t guarantee we won’t execute innocent people. If someone is convicted and later found innocent you can release him from prison, but not from the grave. The death penalty doesn't prevent others from committing murder. No reliable study shows the death penalty deters others. Homicide rates are higher in states and regions that have it than in those that don’t. Life without parole, on the books in 48 states, also prevents reoffending. It means what it says, and spending 23 of 24 hours a day locked in a tiny cell is not a picnic. Life without parole costs less than the death penalty. The death penalty is much more expensive than life in prison, mostly because of the upfront costs of legal process which is supposed to prevent executions of innocent people. (upfront=before and during the initial trial) The death penalty isn't reserved for the worst crimes, but for defendants with the worst lawyers. It doesn't apply to people with money. When is the last time a wealthy person was on death row, let alone executed? Families of murder victims are not unanimous about the death penalty. However, even families who have supported the death penalty in principal have testified that the drawn-out death penalty process is painful for them and that life without parole is an appropriate alternative. Problems with speeding up the process. Over 50 of the innocent people released from death row had already served over a decade. Speed up the process and we will execute innocent people. Sources: Death Penalty Information Center, www. deathpenaltyinfo. org, for stats on executions, reports on costs, deterrence studies, links to FBI crime stats and links to testimony (at state legislatures) of victims' family members.

The Mojito is a very well-known Cuban drink

The Mojito is a very well-known Cuban drink, but this was not always the case. There was quite a few years that passed before this drink became what it is today. The ingredients for this great tasting drink are one of a kind and though tweaked a bit over the years, are still the same ones used today. One man that really contributed to the establishment of this amazing drink was Sir Francis Drake. Another famous name that gave this drink some popularity was the writer Ernest Hemingway. This popular drink was discovered decades ago and is still thriving today. The traditional Mojito consists of 5 ingredients: sparkling water, white rum, mint, lime juice, and sugar. The recipe originally from the island of Cuba, most often consists of spearmint or Yerba Buena, a popular mint on the island. The mint and citrus is used in order to reduce the strong kick of the white rum. Due to its sweet taste, the Mojito has become a popular summer drink. When making a Mojito, the mint leaves and sugar are added first followed by the lime juice. After, the leaves must gently be mashed up, but only enough for the oils to be released. The rum is then added and the mixture is stirred in order to lift the leaves and the sugar to dissolve. Last but not least, the drink is then topped with soda water and whole ice cubes to give a better presentation. Some hotels in Havana, Cuba, add Angostura which helps to cut the sweetness the mojito presents. Angostura is a liquid made up of water and 44. 7 % alcohol. A hotel guest in Cuba may have their mojito served with fresh lime instead of lemon. This also can depend on the bartender preparing the drink. There are other ways the mojito can be made in order to give the drink a different taste. Some people say that this drink was invented by the African slaves that worked in the sugar cane fields in Cuba seeing as the name â€Å"Mojito† comes from the African word â€Å"mojo† which means to place a little spell (http://havanajournal. com/culture/entry/cuban-mojito-history-and-recipe/). There are quite a few of these rum-based drinks, but the original is the most popular. Though Cuba is said to be the Mojito’s birthplace, many would debate otherwise. The Mojito has been traced to a 19th century drink known as â€Å"El Draque†, named after Sir Francis Drake (http://iml. ou. ufl. edu/projects/fall12/araujo_J/history. html). The Draque was originally made with sugar, lime, mint, and aguardiente. Aguardiente is a clear alcoholic drink that looks like vodka, but consists of a higher alcohol percentage. It is made in Colombia, and means â€Å"sizzling or fire water†. In older times this drink was used in a medicinal way. They would place the liqu or in a bottle with a dead snake and let it set for a period of time. After some time it was used as a rubbing alcohol for muscle pains. The 1800’s was the turning point for the mojito. Thanks to the establishment of Bacardi in the 1800’s, the popularity of the Mojito sky rocketed. In 1940 Federick Villoch changed this sweet tropical drink’s name from â€Å"El Draque† to the mojito (http://www1. bacardi. com/#/us/en-us/originalmojito/history). While it was not originally called a Mojito, the ingredients used back then are still the same ones used today. One famous man who very much enjoyed this drink was the writer Ernest Hemingway. His love for this drink caused him to write â€Å"My Mojito in La Bodeguita† which translates â€Å"My Daiquiri in the Bodega†. The title of the book came from the bar La Bodeguita del Medio which Hemingway helped make famous. In the bar today you can still see his writings on the walls. The bar was opened in 1942 by Angel Martinez. It was established next to a printing shop which gave the little bar more customers who stopped by for a drink after business. The bar became the new drinking spot and in no time the place was always packed. In 1950, Martinez changed the name from â€Å"La Casa Martinez† to â€Å"La Bodequita del Medio† and has stayed that way ever since (http://bodeguita. om. ua/? page_id=6218&lang=en). The invention of the mojito was not planned, but it did produce a revolutionary product that is still to this day enjoyed worldwide. The ingredients are easy to find and the drink, though meticulous in detail, is well worth the time spent. Many people have contributed to its success, and due to this success the mojito will continue to thrive. This gives just a little hint that this w ell-made drink will continue to have success for many years to come. Works Cited http://bodeguita.com.ua/?page_id=6218&lang=en. (n.d.). http://havanajournal.com/culture/entry/cuban-mojito-history-and-recipe/. (n.d.). http://iml.jou.ufl.edu/projects/fall12/araujo_J/history.html. (n.d.). http://www1.bacardi.com/#/us/en-us/originalmojito/history. (n.d.).

Challenges of Boko Haram Insurgence on Nigeria’s Educational Sector Essay

The activities of the Islamic radical sect, Boko Haram has adversely affected Nigeria’s educational sector. This fact is not hidden as the name of the sect alone signifies a total outcry against education (western education) and schooling. Boko means â€Å"book or western learning in Hausa language and Haram means forbidden or sinful in Arabic language, thus the group’s name alone is a campaign against western education and schooling. Nigeria’s education sector at all level is suffering as a result of the current prevailing security situation in the north, a region where school enrolment has been the lowest in Nigeria. The sect’s activities have affected Nigeria’s educational sector in the following ways; †¢The sect’s activity has led to destruction of school buildings and other academic facilities †¢It has led to death of academic experts †¢It has led to exodus of academic experts and shortage of qualified teaching manpower in northern Nigeria †¢It has led to distraction and diversion of government’s attention from the educational sector †¢It has led to complete disruption of academic calendar in the region. So far this year, 15 schools have been burnt down in Maiduguri, the capital of Nigeria’s Borno State, forcing over 700 children out of formal education and pushing down enrolment rates in an already ill – educated region. The Islamic Boko Haram group is widely blamed for the attacks but the reality seems to be more complex. Both public and private schools in Maiduguri have been doused with gasoline at night and set on fire. Crude homemade bombs and soda bottles filled with gasoline have been hurled at the bare bones concrete classrooms Nigeria offers its children. The simple yellow facades have been blackened and the plain desks method to twisted pipes, leaving thousands of children without a place to learn, stranded at home and underfoot, while anxious parents plead with Nigerians authorities to come up with a contingency plan for their education. In a video posted on You Tube in February 2012, Boko Haram called on its follows to destroy schools providing western education in retaliation for the alleged targeting of Korani schools by the military. The spokes man of the sect, Abul Quqa, said the attacks were in response to what he called a targeting of the city’s (ie Maiduguri) abundant open – air Islamic schools by authorities. Since February when this call was made, many schools including private schools have been destroyed. However officials of the state have denied any of such attacks or campaign as young boys can be seen receiving lesson untroubled allover Maiduguri (the New York Times, 2012). This new dimensional shift of the sects attack has numerous adverse effects on educational development of the region and the country at large. According to Nigeria Education Data Survey 2010, school enrolment in Borno state is already low by 28 per cent than any other state in Nigeria. No doubt, the recent attack have made parents and guardians’ to withdraw their children from schools and has made it difficult for teachers and aid groups to persuade parents to let their children stay on at schools. Eric Gultscluss (a researcher in Nigeria for the Watching Human Right Organization) noted that it is not just the students at the targeted schools that end up being affected as targeting of schools can make children in neighboring schools to stay home or drop out completely for fear of further attacks. The targeting of children indirectly and destruction of schools in Maiduguri has bewildered and demoralized students, parents and teachers in a way that the daily attacks have not. Furthermore, the attacks have led to death of academic experts teaching in all levels of Nigeria’s educational system ranging from primary to secondary and beyond. On sun,29 April, 2012, members of the sect attacked Christian workshops in Bayero University Campus, Kano resulting to death of 20 students and 2 professor of the university. According to an eye witness, the attackers arrived in a car and two motorcycles and throw small homemade bombs to draw out worshippers before shooting at them as they attempt to flee. The attack led to the death of Professor Jerome Ayodele, a professor of chemistry and Professor Andrew Leo Ogbonyomi, a professor of library science with about 20 others dead and scores of others injured. (Ikhilae, 2012). Undoubtedly, this is a setback for educational development in the country. Also the persistence of insecurity in the north which has led to lose of about 700 lives so far this year (2012), has led to exodus of academic experts and shortage of qualified teaching man power in the region. It has also led to refusal of NYSC members who constitute about 50 per cent of teaching man power in the region to serve in the region. Maijawa Dawayo, Chairman, Yobe State Teaching Service Board, in an interview with Nations News Paper on 9 Feb. , 2012 has this to say, â€Å"the recent circular by the National Youth Service Corps (NYSC) that corps members who constitute 50 per cent of the board’s man power should no longer be posted to senior secondary schools in the state would have an adverse effect on the educational sector of the State. Most of the corps members are not interested in coming here again because of insecurity in the north. We are in a difficult situation and something needs to be done urgently to solve the problem. The corps members constitute 50 per cent of the manpower in our schools and the head of the scheme had issued a circular that corps members would no longer be posted to senior secondary schools (The Nation, 9 Feb, 2012). Dawoye’s fear and lamentation was later made public and a reality in July 2012 when NYSC members posted to Borno, Yobe, Kano, Kaduna, Niger, Plateau and Bauchi state refused to serve in the states and protested against their deployment to the violent prone states. Corps members and their parents took to the street to protest their deployment to the Northern States when the 2012 NYSC Bach B list came out arguing that it is senseless to post young graduate to these states. Most of the parents vowed not to allow their children to go and be killed by Boko Haram (National Mirror, 2 July, 2012). Awosuru Lola, a graduate of Ladoke Akintola University of Technology (LAUTECH), Ogbomoso in Oyo state, who was posted to plateau state said his father hard ordered him not to report at the camp â€Å"for whatever reason. † Also Badiru Tajiudeen, a graduate of quantity surveying of Obafemi Awolowo University (O. A. U), Ile – Ife, posted to Zamfara state vowed that nothing could keep him beyond the mandatory three weeks of orientation programme in the camp. He also said that his parents are even reluctant in releasing him to participate in the three weeks orientation and warned him to abort the programme if he is not transferred back to the west (National Mirror, 2 July, 2012). This development will make a devastating mark on the educational sector of the affected northern states. It will be recalled that ten young corps members lost their lives during the post – presidential election protest/violence in some northern states in April 2011, while others lost their lives in other violent clashes in the region. The case of other Southerners who are teachers in the region is not different from that of NYSC members as most of them have found the exit door from the region. Dawayo confirmed this when he said that 80 per cent of Yobe State contract teachers who are from other states have left Yobe because of the same problem of insecurity (The Nation Feb 9, 2012) In addition, insecurity in the region caused by Boko Haram has also led to complete disruption of academic calendar in the region. Most of the attacks never go without imposition of curfew by the government. The attacks have in some cases led to imposition of 24 hours curfew and when such curfew is imposed, both students and teachers are affected and this on the long run adversely affects the academic calendar which stipulates when school starts and when it ends as well as what should be done in the school and when thus drawing students in the region behind their counterparts in other peaceful states. It is important that I state it clearly at this juncture that the North is a region where education enrolment and development is the least in the country and the current security situation is bound to compound the educational woes of the North and further widen the gap between it and the South. While private higher institution are rapidly springing up in the South to complement the over – stretched public institutions, only a handful has been established in the North and the few ones have come under Boko Haram attacks. According to National University commission (NUC), 50 private universities have been licensed to operate in the country. Out of this 50, fewer than 15 are established in the north. What this implies is a bleak future for educational development of the region and a bleak future for young children in the region and this by implication is dangerous to Nigeria’s peace, unity and development. No matter how one looks at it, the attacks by the sect on schools have left many destructive marks on the future of affected children in the region and the country at large. The affected children are at home which means a bleak future for them and the country at large because the future of a country depends on the kind and quality of education it offers its children. Finally, the insurrection of Boko Haram has led to distraction and diversion of both Federal and affected State government’s attention from the educational sector. This is evident in the 2012 annual budgetary allocation of the Federal Government in which the mind – bugling chunk of 921. 91 billion was allocated to security alone, while education on which the future of the country depends got the little chunk of 400. 48 billion naira which is not up to half of what is given to security. There is no argument on the fact that both security and education are critical for the survival of a nation, but had it been there is peace in the country, the chunk given to security would have been considerately lower than what it has now. What the lean resources allocated to the educational sector means is a gloomy and difficult future for the sector. This is because there will be no resources to introduce new educational developmental program and the ones already introduced will certainly suffer of poor funding.

How does John Boyne use the character of Shmuel to show the suffering of Jewish people under the Nazis? Essay

There are many quotes in the book ‘The Boy in the Striped Pyjamas’ that show how the Jews were treated under Nazi control, through Bruno’s friend from the other side of the fence. However, the author does this in a clever and unique way; through his clothes. An example of this is found on page one hundred and six in chapter ten, where Shmuel â€Å"wore the same striped pyjamas that all the other people on that side of the fence wore, and a striped clothed cap on his head. † This tells the reader that he is not seen as an individual at the concentration camp, but as part of a group with no personal identity as he is identical to everyone else. John Boyne then goes on to say â€Å"He wasn’t wearing any shoes or socks and his feet were rather dirty. On his arm he wore an armband with a star on it. †, hinting that Shmuel is spending this period of his life in poor conditions due to the fact that he is a Jew. The reader isn’t only informed of his religion from the concentration camp, but also because he is wearing the Star of David, which identifies himfromotherfaiths. In chapter nineteen on page two hundred and five, Bruno planned to join his friend on the other side of the fence before going home to Berlin. However, before he had a chance to crawl under the fence, Shmuel â€Å"pointed at Bruno’s feet and the heavy boots he had taken from the house. â€Å"You’ll have to leave them behind too,† he said. † Although at first this simply reveals that Shmuel isn’t allowed to wear any footwear, it also shows that the Jews have no choice in what to wear, which leads the reader to believe they have no choice in anything they do at all and they are under control. This also creates an aspect of sympathy as the reader wishes to help the innocent mistreated victims when all that separates them and Bruno, who has a wonderful life, is a fence. The final most important thing that we learn about the Jews in the novel from the moment we meet Schmuel is how much their lives have changed due to their faith and how it affects them. This is shown on page one hundred and twenty seven where Bruno is told by his friend that every time him, his family and his Mother â€Å"left the house, she told us we had to wear one of these armbands. † The reader can see how big of a deal being Jewish was at the time, even before he arrived at the camp, and how the people of the religion couldn’t live a normal life like everyone else. It shows how he was forced to show who he was and wasn’t able to be seen in public without labelling himself for everyone to see, as if being different was something to be ashamed of. It also tells the story of why he has been taken to the concentration camp as we know what the armband was for, whereas Shmuel does not. When Bruno first saw Shmuel he was looking down into the dirt in total solitude and Bruno even states that he ‘had never seen a skinnier or sadder boy in his life. ’ You can also tell that he is a very ill, the quote ‘ his skin was almost the colour of grey’ tells us that the Jews receive little food from the camp explaining his needs for food later on in the book and that he may have been kept in dark,crowded areas. Grey is also known to be associated with near-death or depression adding to his negative appearance. We also learn that he is a very scared indiviual as thoughout the book he shows fear towards the soilders especially Lieutenant Kolter from quotes such as ‘there aren’t any good soliders’ and ‘if they catch me I’ll be in trouble’ showing that the Jews must be treated terribly by the soldiers even resulting in some of the bruises recived by Schmuel mentioned in the book. The one quote that I liked was the hope that Shmuel had of getting out one day. This was on page 179,chapter 16 after Bruno had said about playing or exploring, and he’s never had a friend that he hasn’t played with before. Shmuel then said â€Å"maybe someday we will, if they ever let us out† which I thought brought a sense of pity on Shmuel from a reader’s point of view, as he and the rest of the Jews, are still hoping that one day they will let him out or they’ll be able to get out. At the time this must have been really difficult to keep thinking, because of the way they treated all the people on that side of the fence. But that was maybe one of the things that helped them pass the time, thinking about being let out, and living with their family again and seeing some old friends.