Analysis Of Nabokovs Lolita And The Picture Of Dorian Gray

In Nabokov’s 1955 novel, ‘Lolita’, the fictitious foreword, presented by the equally fictitious John Ray Jr., Ph.D., describes Humbert Humbert as a ‘shining example of moral leprosy’ (Nabokov 1955). However, throughout the novel, Humbert appears to manipulate numerous characters, most of all Dolores Haze and her infatuated mother through his alluring good looks and his sophisticated British manner. Similarly, in Wilde’s 1890 novel, ‘The Picture of Dorian Gray’, Dorian, also a hideously immoral main character, successfully disguises the true horror of his sins and uses his youthful charm to continue with his upper-class life of excess and perversion. Thus, both characters possess a comparable ‘dark side’, a side which is concealed to†¦show more content†¦This results in the narrative perspective of the novel demonstrating how Humbert attempts to conceal his true nature through, in his own mind, clever ‘ad justments’ to how the story is presented and references to historical figures who shared the same desires as him- ‘Oh Lolita, you are my girl, as Vee was Poe’s and Bea Dante’s’ (Nabokov 1955), yet often reverts to a disposition in which he laments about his monstrous desires. Not only this, but the comparison to famous literary greats suggests that Humbert considers himself to be of their status and thus possesses an idolized version of himself, a self which can easily transform language into ploys to conceal his true nature. Furthermore, Humbert further provides a dishonest narrative through his creation of a ‘grotesque theatrical character’ (Courtier 1996), in order to disassociate himself from the monster he truly is. This is aided by how Nabokov uses a diary-like structure to allow Humbert to experiment with his own format, for example ‘Main character: Humbert the Hummer. Time: Sunday morning in June. Place: sunlit living room.’ (Nabokov 1955) which resembles a script that Humbert himself has created when in reality he is reciting yet another lust-filled encounter with Lolita. Throughout this passage, and the novel, Nabokov switches from third person to first person narrative which further illustrates Humbert’s confusion over his desires, and how heShow MoreRelatedWhen Art Imitates Art757 Words   |  3 Pagessoul to him because of greed, is based on the story of Doctor Faustus, a person who sells his soul to the Devil to gain unlimited knowledge and all the worldly p leasures. o â€Å"Dont Stand So Close to Me† by The Police was inspired by Vladimir Nabokov’s novel Lolita, as is clear in the lyrics: Its no use he sees her. He starts to shake and cough. Just like the old man in. That book by Nabokov. o â€Å"Samson† by Regina Spektor with lyrics such as:† Samson came to my bed. Told me that my hair was red.

Compensating Kidney Donors - 2554 Words

Organ Donation: Legalizing Human Kidney Sales The process of organ donation has existed for many years and throughout that time the system has endured controversies and changes. One of those changes occurred in the late 1960s when the development of immunosuppressive drugs made it possible for people to donate organs to patients who were not related to them (Fentiman 43). This discovery benefited many patients in need of a transplant, but also opened the door to controversies such as organ sales. The first proposal to sell organs came from Virginia physician Dr. H. Barry Jacobs in 1983. He suggested that whoever could afford to buy a kidney should be allowed to do so. As a result of Dr. Jacobs’s proposal, Congress banned the sale of†¦show more content†¦Ã¢â‚¬Å"Ailing, rich patients are buying kidneys from the poor and desperate in burgeoning black markets. Clandestine kidney-sellers get little medical follow-up, buyers often catch hepatitis or HIV, and both endure the consequences of slap-dash surgery† (â€Å"Psst, Wanna . . . † 15). This dangerous alternative provides one example of why the current organ donation system needs to be revised. Another example is that some patients pay to register with internet sites that try to help find organ donors. One site, Matchingdonors.com, charges a lifetime fee of $595 (Postrel 124). Not only do patients spend unnecessary amounts of money on these sites, many who find donors get rejected by hospitals. Hospitals fear that strangers designating a recipient may receive some sort of compensation for their donation (Postrel 124). The refusal of sick patients provides just another reason why the current organ donation system needs to be altered. A new system that provides kidney donors with compensation would correct many of the current system’s problems, and increase the donor pool. The new system would allow donors to sell their kidney at a set price. Kidneys would go to recipients in the same way they do now; through the waiting list, whether the patient is rich or poor. Compensation comes from the recipient’s insurance, such as Medicare. To insure the safety of the reciepient and donor, every donor would be medically andShow MoreRelatedPersuasive Essay On Organ Donation1371 Words   |  6 Pagesviolated to make some extra cash, which could be obtained legally if compensation for donors were legal. In 2005, about one thousand two hundred people died waiting for a kidney transplant, something that could have been prevented if only there wasn’t an organ shortage. The shortage of organs can be tied to the financial devastation that organ donors often succumb to because of medical bills, loss of work, etc. Organ donors should be reimbursed because the selling of organs on the black market would decreaseRead MoreGovernment Compensation For Organ Donation1371 Words   |  6 PagesGovernment Compensation for Organ Donation From an early age, I knew that I would be an organ donor, and when I turned sixteen I began participating in blood drives at my high school. Donating blood became routine, something that my husband and I continue to do together. The reason behind why I donate blood is because it would be quite selfish of me to deny someone, even a complete stranger the gift of life when I am fully capable of giving it. However, the sad reality is that many Americans chooseRead MoreFinancial Compensation for Organ Donation Essay1307 Words   |  6 Pagesdonation, yet only one out of four will ever receive that precious gift (Statistics Facts, n.d.). The demand for organ donation has consistently exceeded supply, and the gap between the number of recipients on the waiting list and the number of donors has increased by 110% in the last ten years (OReilly, 2009). As a result, some propose radical new ideas to meet these demands, including the selling of human organs. Financial compensation for organ s, which is illegal in the United States, isRead MoreOrgan Donation Essay915 Words   |  4 Pagesthe numerous deaths. A way to resolve this problem is to compensate organ donors. Donors should be reimbursed for their donations because it allows patients to be given their organs faster, will help end organ shortages, and the donors should receive compensation for their hospital stay, along with other expenses that the donor typically has to pay out of their pocket. This controversial topic of compensation for organ donors has been concerning more and more people, because some individuals thinkRead MoreIllegal Sale Of Human Organs1031 Words   |  5 Pagescontact with unscrupulous greedy criminals to secure themselves a kidney or any other type of human organ they may need. The idea that a person’s organ can be purchased online or through a dealer like a car is unethical and objectionable. Potential causes for the thriving black market and criminal activity is the dwindling supply of donated organs and the higher demand for organ transplants, along with the desperation of both the donor and the organ recipient. The crisis surrounding the shortages ofRead MoreSally Satels Organ for Sale.1154 Words   |  5 Pagesserves on the advisory committee of the  Center for Mental Health Services  of the  Substance Abuse and Mental Health Services Administration. After being diagnosed in 2004 with  chronic renal failure, Virginia Postrel, a friend and also a writer donated a  kidney to Satel  on March 4, 2006. Satel adopts an unbiased tone in order to appeal to the emotional feelings of the People of United States by carefully outlining reasons to back her argument most of which were personal experiences. Her argument appearedRead MoreOrgan Donation Shortage- Problem-Solution Essay2591 Words   |  11 Pagesshortage Organ donation shortage When receiving a driver’s license in the United States, there is a section on the back in which it asks if the licensed driver would like to become an organ donor. Most people overlook this option. Nothing is really pushed forth for people wanting to become organ donors. Today in the U.S, thousands of people need organ transplants. Unfortunately, there is a growing shortage of donated organs. Many people die every year because there are not enough organs readyRead MoreThe Problem Of Organ Transplants1528 Words   |  7 Pagesamongst America and countries all over the world. Thousands of people sit on waiting lists in hopes to receive a new organ never knowing if they will actually receive one before their delicate organ gives up. Although many people are willing to be donors upon the time of their own death, the shortage of organs hangs over the patients and families who deal with the reality of an organ shortage every day. One solution that has been proposed is allowing peop le to be able to sell their own organs in orderRead MoreOrgan Donation1636 Words   |  7 Pagesexpected. When this happens, families mourn the loss of the loved one. However, do people mourn the loss of another life if the individual is not an organ donor? The National Kidney Foundation believes that â€Å"legalizing payments of human organs† should continue to be opposed, as codified in the third title of the National Organ Transplant Act. (National Kidney Foundation 220). If this title is changed, then there will be multiple unexpected side effects that could corrupt the system of organ donation toRead MoreShould The Sale Of Organs Become Legalized?1494 Words   |  6 Pagesperson. However in the United States an average of twenty one people die each day waiting for transplants due to shortages of donated organs according to the Government run website Organdoner.gov. It s not as though the others will eventually get kidneys if they just wait, sustained in the meantime b y dialysis. In the next year, nearly four thousand of those patients will die waiting. At least twelve hundred others will eventually end up off the list because they develop complications that make them

Nuclear threat Free Essays

The proliferation of weapons of mass destruction (WMD) has become a metaphor for 21st-century security concerns. Although nuclear weapons have not been used since the end of World War II, their influence on international security affairs is pervasive, and possession of WMD remains an important divide in international politics today (Norris 61). The nuclear postures of the former Cold War rivals have evolved more slowly than the fast-breaking political developments of the decade or so that has elapsed since the former Soviet Union collapsed. We will write a custom essay sample on Nuclear threat or any similar topic only for you Order Now Nevertheless, some important changes have already taken place. By mutual consent, the Anti-Ballistic Missile (ABM) Treaty of 1972 was terminated by the United States and Russia, which have agreed to modify their nuclear offensive force posture significantly through a large reduction in the number of deployed delivery systems. Nuclear weapons are no longer at the center of this bilateral relationship. Although the two nations are pursuing divergent doctrines for their residual nuclear weapons posture, neither approach poses a threat to the other. The structure, but not the detailed content, of the future U.S. nuclear posture was expressed in the 2002 Nuclear Posture Review (NPR), which established a significant doctrinal shift from deterrence to a more complex approach to addressing the problem of proliferated WMD. The Russian doctrinal adaptation to the post-Cold War security environment is somewhat more opaque. The government appears to be focused on developing and fielding low-yield weapons that are more suitable for tactical use, though the current building of new missiles and warheads may be associated with new strategic nuclear payloads as well. Despite the diminished post ­Cold War role of nuclear weapons in the United States, the cumulative deterioration of Russia’s conventional military force since 1991 has actually made nuclear weapons more central to that government’s defense policy. The end of the adversarial relationship with the Soviet Union (and later, the Russian Federation) had to be taken into account in the NPR. The current nuclear posture is evolving in a manner parallel to the modernization of the U.S. non-nuclear military establishment. In stark contrast to Cold War ­era military planning, the 21st century is likely to be characterized by circumstances in which the adversary is not well known far in advance of a potential confrontation. The U.S. Department of Defense (DOD) is adjusting to these new circumstances by developing highly capable and flexible military forces that can adapt to the characteristics of adversaries as they appear. This makes the traditional path to modernization through investment in weapons systems as the threat emerges economically infeasible. Modern information technology lets the military change the characteristics of its flexible weapons and forces in much less time than it would take to develop whole new weapons systems. Thus, DOD is attempting to create a military information system: the integrated effect of command-control-communications-computation-intelligence-surveillance and reconnaissance (C4ISR). This system is inherently more flexible for adapting to changes in the threat environment. WMD and the means to deliver them are mature technologies, and knowledge of how to create such capabilities is widely distributed. Moreover, the relative cost of these capabilities declined sharply toward the end of the 20th century. Today, the poorest nations on earth (such as North Korea and Pakistan) have found WMD to be the most attractive course available to meet their security needs (Lieggi 2). Proliferation of WMD was stimulated as an unintended consequence of a U.S. failure to invest in technologies such as ballistic missile defense that could have dissuaded nations from investing in such weapons. The United States’ preoccupation with deterring the Soviet Union incorporated the erroneous assumption that success in that arena would deter proliferation elsewhere (Barnaby 7). This mistake was compounded by the perverse interaction between defense policy and arms control in the 1990s. Misplaced confidence was lodged in a network of multilateral agreements and practices to prevent proliferation that contributed to obscuring rather than illuminating what was happening. Confidence placed in the inspection provisions of the Nuclear Non-Proliferation Treaty (NPT), for example, obscured efforts to obtain knowledge of clandestine WMD programs. NPT signatories were among those nations with clandestine WMD programs. Without a modernization of defense policy, the ready availability of WMD-related technology will converge with their declining relative cost and a fatally flawed arms control structure to stimulate further proliferation in the 21st century. The process whereby WMD and ballistic missile technology has proliferated among a group of nations that otherwise share no common interests are likely to become the template for 21st-century proliferation. The scope of this problem was recognized in part as a result of a comprehensive review of intelligence data in 1997 ­1998 by the Commission to Assess the Ballistic Missile Threat to the United States (the Rumsfeld Commission). This recognition swiftly evolved into a set of significant policy initiatives that responded to changes in the international security environment. The arms control arrangements most closely identified with the adversarial relationship with the former Soviet Union were passà ©. In 1999 the Senate refused to ratify the Comprehensive Test Ban Treaty; the United States and Russia ended the 1972 ABM Treaty and agreed to jettison the START process, which kept nuclear deployments at Cold War levels in favor of much deeper reductions in offensive forces in 2002. U.S. policy began to evolve in response to these developments. The incompatibility between the Cold War legacy nuclear posture and the 21st-century security environment stimulated a search for approaches to modernize policies pertinent to nuclear weapons. In response to statutory direction, the Bush administration published the Quadrennial Defense Review, the Nuclear Posture Review, the National Defense Strategy of the United States, and the National Strategy to Combat Weapons of Mass Destruction. Taken together, these documents constitute the most profound change in U.S. policy related to nuclear weapons since the Eisenhower administration (Krepon 1).  The unique capabilities of nuclear weapons may still be required in some circumstances, but the range of alternatives to them is much greater today. The evolution of technology has created an opportunity to move from a policy that deters through the threat of massive retaliation to one that can reasonably aspire to the more demanding aim–to dissuade. If adversary WMD systems can be held at risk through a combination of precision non-nuclear strike and active defense, nuclear weapons are less necessary (Albright 2). By developing a military capability that holds a proliferators’ entire WMD posture at risk rather than relying solely on the ability to deter the threat or use of WMD after they have been developed, produced, and deployed, the prospects for reducing the role of WMD in international politics are much improved. The 21st-century proliferation problem creates a set of targets significantly different from those that existed during the Cold War. Few targets can be held at risk only by nuclear weapons, but the ones that are appropriate may require different characteristics and, in many circumstances, different designs than those currently in the nuclear stockpile. The nature of the targets and the scope of the potential threat also alter the character of the underlying scientific, engineering, and industrial infrastructure that supports the nuclear weapons posture.   This research paper will therefore seek to discuss the problem of nuclear devices or WMDs (as they are presently termed) and try to address to current policy issues surrounding the matter. RESEARCH OUTLINE: INTRODUCTION: a.)    what is the problem surrounding nuclear threats in the 21st century b.)    what are the recent developments surrounding this issue c.)    what solutions have been successful in addressing these problem BODY: a.)    who are nuclear threats b.)    what has been done to stop c.)    What can be done? d.)   What can the US do? What can the UN do? CONCLUSION: References: Robert Norris and Hans Kristensen, â€Å"Chinese Nuclear Forces, 2006,† Bulletin of the Atomic Scientists, 62. no. 3 (2006): 61. Stephanie Lieggi, Center for Nonproliferation Studies, â€Å"Going Beyond the Stir: the strategic realities of China’s No First Use policy,† Nuclear Threat Initiative, http://www.nti.org/analysis/articles/realities-chinas-no-first-use-policy/ (accessed June 30, 2006). Frank Barnaby and Shaun Barnie, Thinking the Unthinkable: Japanese nuclear power and proliferation in East Asia (Oxford, UK: Oxford Research Group and Citizens’ Nuclear Information Center, 2005): 7†³8. George Perkovich, India’s Nuclear Bomb: The Impact on Global Proliferation, (Berkeley: University of California Press, 1999.) Michael Krepon, Rodney W. Jones Ziad Haider eds., â€Å"Escalation Control the Nuclear Option in South Asia,† The Henry L. Stimson Center, September 2004, https://www.stimson.org/?id=191, (May 2005). Text of â€Å"Export Controls on Goods, Technologies, Material, and Equipment Related to Nuclear and Biological Weapons and their Delivery Systems Act, 2004,† Published in Gazette of Pakistan, 27 September 2004, Cited at, http://www.iaea.org/Publications/Documents/ Infcircs/2004/infcirc636.pdf, (May 2005). Michael Krepon and Chris Gagne eds., â€Å"The Stability-Instability Paradox: Nuclear Weapons and Nuclear Brinksmanship in South Asia,† The Henry L. Stimson Center, June 2001, https://www.stimson.org/research?ID=1, (May 2005). Feroz Hassan Khan, â€Å"The Independence-Dependence Paradox: Stability Dilemmas in South Asia,† Arms Control Association, October 2003, https://www.armscontrol.org/act/2003_10/Khan_10, (May 2005). Ashley J. Tellis, India’s Emerging Nuclear Posture: Between Recessed Deterrent and Ready Arsenal, (Santa Monica: Rand, 2001.) How to cite Nuclear threat, Essay examples

Rizal X Reaction Paper free essay sample

I was really touched and emotionally affected at how they related the chapter of Crispin and Basilio and that of Cecil to informal settlers and OFWs respectively. It made me realize that occurrences and events that Rizal wrote about more than a hundred years ago are still happening today. Rizal’s Noli Me Tangere and El Filibusterismo are still highly relevant today. There are still young Crispins and Basillions out there. Proof of this: just take a look at the street children out there selling sampaguitas and begging for alms. Notice the teenagers out already working and toiling despite being underage. Cecils also still live among us. There are still women out there who are suffering the unspeakable alone. There are still people out there that are driven mad by the plight they suffer. Our women are still relentlessly raped and abused overseas every day. Our women are still treated like animals by certain groups and people. We will write a custom essay sample on Rizal X Reaction Paper or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Then there’s Rizal’s love life. This is perhaps one of the highlights of the play. Normally when discussing the women that Rizal got involved with, people and authors tend to highlight how noble and selfless Rizal was with the sacrifices he made by leaving these women. It is usually just Rizal’s pain and heartaches that is put into the spotlight. This segment of the play provides a unique and much sadder side to the story; the point of view of the women. I have never before seen or read anything that looked at Rizal’s love life by the perspective of the women he loved. It deeply saddened me to watch this part. I just now realized that it must have really hurt for these women to endure what they did. Rizal wasn’t the only one who was making a sacrifice. These women suffered just as much as Rizal did. I berate myself for realizing this fact just now. I have gained a higher sense of respect towards Rizal’s former lovers. I believe that I might possible forget most details of this play in the future, but not this lesson. There’s also the scene at the play where the statue at Araneta actually comes alive and starts rejoicing that the problems Rizal faced have been solved. I really felt a bit depressed by this portion of the play. After a hundred years, we’re still stuck with the basic set of problems that the Filipinos faced under the Spanish Regime. There are still Padre Damasos ruling over the weak and ignorant out there. There are still the kind but naive Guevarras out there. While the Spanish are no longer in power, there are still tyrants that hold government office. Human rights and freedom are still suppressed. Portrayed next are the OFWs. The play shows how our countrymen are forced to menial and downgrading jobs in order to sustain their families. Their bravery and their sacrifice are vividly portrayed in the various scenes, especially where they slowly undress from having respectable clothes to those that are menial (From Doctor, to nurse, to Nursing Aide). The degrading of our fellow Filipinos made my heart feel deep sorrow. The plight that they encounter made me realize just how lucky my family is. Then there’s the inevitable part of every Rizal-related play – the appeal to nationalism. The actors and actresses appealed to the audience to act and change the way things are playing out. Rizal’s famous quote, â€Å"The youth is the future of our nation†, became the overall theme of the play. The Youth were encouraged to do their part and to strive to be the change our society needs. It is never too late. The change that people are desperately looking for can be achieved if Filipinos just banded together and persevered. The process of change would be slow and tedious. But if people won’t give up, then nothing is impossible. Overall, I really appreciated watching Rizal X. I’m not a huge fan of watching theatre, but with plays like these I might just change my mind. I really hope that I get to watch Filipino made plays or even films with the same quality as this.

Rizal X Reaction Paper free essay sample

I was really touched and emotionally affected at how they related the chapter of Crispin and Basilio and that of Cecil to informal settlers and OFWs respectively. It made me realize that occurrences and events that Rizal wrote about more than a hundred years ago are still happening today. Rizal’s Noli Me Tangere and El Filibusterismo are still highly relevant today. There are still young Crispins and Basillions out there. Proof of this: just take a look at the street children out there selling sampaguitas and begging for alms. Notice the teenagers out already working and toiling despite being underage. Cecils also still live among us. There are still women out there who are suffering the unspeakable alone. There are still people out there that are driven mad by the plight they suffer. Our women are still relentlessly raped and abused overseas every day. Our women are still treated like animals by certain groups and people. We will write a custom essay sample on Rizal X Reaction Paper or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Then there’s Rizal’s love life. This is perhaps one of the highlights of the play. Normally when discussing the women that Rizal got involved with, people and authors tend to highlight how noble and selfless Rizal was with the sacrifices he made by leaving these women. It is usually just Rizal’s pain and heartaches that is put into the spotlight. This segment of the play provides a unique and much sadder side to the story; the point of view of the women. I have never before seen or read anything that looked at Rizal’s love life by the perspective of the women he loved. It deeply saddened me to watch this part. I just now realized that it must have really hurt for these women to endure what they did. Rizal wasn’t the only one who was making a sacrifice. These women suffered just as much as Rizal did. I berate myself for realizing this fact just now. I have gained a higher sense of respect towards Rizal’s former lovers. I believe that I might possible forget most details of this play in the future, but not this lesson. There’s also the scene at the play where the statue at Araneta actually comes alive and starts rejoicing that the problems Rizal faced have been solved. I really felt a bit depressed by this portion of the play. After a hundred years, we’re still stuck with the basic set of problems that the Filipinos faced under the Spanish Regime. There are still Padre Damasos ruling over the weak and ignorant out there. There are still the kind but naive Guevarras out there. While the Spanish are no longer in power, there are still tyrants that hold government office. Human rights and freedom are still suppressed. Portrayed next are the OFWs. The play shows how our countrymen are forced to menial and downgrading jobs in order to sustain their families. Their bravery and their sacrifice are vividly portrayed in the various scenes, especially where they slowly undress from having respectable clothes to those that are menial (From Doctor, to nurse, to Nursing Aide). The degrading of our fellow Filipinos made my heart feel deep sorrow. The plight that they encounter made me realize just how lucky my family is. Then there’s the inevitable part of every Rizal-related play – the appeal to nationalism. The actors and actresses appealed to the audience to act and change the way things are playing out. Rizal’s famous quote, â€Å"The youth is the future of our nation†, became the overall theme of the play. The Youth were encouraged to do their part and to strive to be the change our society needs. It is never too late. The change that people are desperately looking for can be achieved if Filipinos just banded together and persevered. The process of change would be slow and tedious. But if people won’t give up, then nothing is impossible. Overall, I really appreciated watching Rizal X. I’m not a huge fan of watching theatre, but with plays like these I might just change my mind. I really hope that I get to watch Filipino made plays or even films with the same quality as this.

Listening Skills and Healthcare

Abstract This study uses a quantitative survey technique, and summarized data collected is used to correlate results with listening skills as its fundamental principle (Punch, 1998). A survey was sent out on the Internet and yielded results from various gender, socioeconomic backgrounds and education levels. Communication issues have been maintained by employing a number of methods.Advertising We will write a custom research paper sample on Listening Skills and Healthcare specifically for you for only $16.05 $11/page Learn More Pain faces scale training of participants and research assistants and maintaining good relationships with participants are used in our recruitment to further develop partnership between the study population and researchers and to maintain feedback. Each step undertaken to gather and analyze data, validate findings and present research outcomes in which comprehensive and accessible findings will be used to facilitative growth and c ontinued development. The purpose of this research is to develop a better understanding of listening skills and how better listening skills well as ability to recognize nonverbal expressions will assist the healthcare industry and its consumers. Introduction The merriam-webster dictionary defines pain as â€Å"suffering or distress of body or mind†. It is argued that effective communication between healthcare provider and patient is an important element in improving treatment compliance. Holmes et al, (2007) on the other hand provides that pain interferes with person’s ability to communicate by altering normal patterns of verbal and nonverbal communication. Listening skills is something that has been emphasized in the medical field for years. Professors in medical schools have been attempting to teach their students to be better listeners to their patients (Holmes at al, 2007). As we seek to integrate effective communication skills in healthcare, the best question, and yet difficult to ask, is: does listening skills, as well as purposeful nonverbal communication, while being applied, more likely to improve the relationship between healthcare providers and patients? Listening skills is something that has been emphasized in the medical field for around 2,500 years and the problem of communication challenges often leading to misdiagnosis has always been an issue. Frischenschlager and Pucher (2002) argue that describing pain to a physician falls solely on the patient. And in most cases, physicians often lack the skills to read patient’s nonverbal signs or even interpret the slang they use.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Therefore communication problems between providers and patients remain to be a major problem in the healthcare professional. The provider-patient as demonstrated by the pain scale (figure 1-Appendix) illustrates their interrelationships. The research conducted sought to answer the question, â€Å"Can pain faces be distinguished from other emotional expressions?† Literature reviews on the ability to recognize facial expressions and listening skills issues facing both patients and health care providers in social dynamics of healthcare professional will be discussed. A thorough investigation on communication of health issues affecting these communities are illustrated which provides a synthesis of the existing problems. This literature review is coined around personal and situational issues, as well as empirical research on the communication concerns with support of reviewed of population studies and themes are summarized. As the cultural context of health issues has a major influence on our communities, sociological literature on this pandemic is highlighted. To affirm this analysis, researchers linked various responses to research from the related areas and concluded with references f or future research on the health and sociological dimensions. The current literature was reviewed using Communication Mass Media Complete database and searched online article using listening skills and facial expressions in healthcare as key words using Google. The research concentrated on both young, middle and old age population as my headline and designed my research article around a pain face scales instruments to perform a thorough analysis on how participants can identify non-verbal signs to communicate their pain issues. The finding being that if a â€Å"Lay† person could do it WELL then with a little training, a Healthcare Provider could do it as well. Training that included spending more time with their patients. Our careful analysis and research will then be used to identify the validity and applicable evidences that can be used in health care practices Objective This paper seeks to explore the relationship between healthcare provider and the patient, highlighting difficulties they experience when communicating to each other about pain issues. Our analysis aims at providing evidenced-based guidelines that will provide a set of recommendations that can improve listening skills on the patient and the service provider.Advertising We will write a custom research paper sample on Listening Skills and Healthcare specifically for you for only $16.05 $11/page Learn More While much has been done to encourage physicians to improve their listening skills, research indicates that listening, as well as provider-patient interactions can improve with adequate training and follow-up. As the number of studies increases, the results, effects and outcomes of patient-provider communication, there is still a much research to be done in the field. Background Questionnaires were designed and distributed over the internet. This environment allowed participants to freely and openly rate facial expressions as much as possible. Participants were well acquainted with internet and use of facial expressions in their day to day activities. This equipped them with considerable knowledge of what was expected of them as many of the expressions such as anger, happiness, sadness, disgust, surprise, fear and pain in facial expressions related well with their personal experiences. Literature Review Analysis The most frequent complaint among patients is pain. According to Baird et al (2008), an estimation of 30 million people in the United States are suffering from chronic pain. It can not be assumed that the most prevalent pain always occur naturally. Acquiring effective communication skills requires the employment of observation and application practice of communication expressions. According to the US Bureau of the Census (1995), nearly 7% of the US population deals with chronic pain every year making it a high priority concern within the healthcare community. Evidence from the US Department of Commerce shows that pain associa ted problems costs billions of dollars in the healthcare industry. It adds that related problems such as chronic pain management and how to effectively deal with pain and cost management to be also of concern. The same studies also evidences high occurrence of opiate dependence among the mentioned group. Pain can be explained in different perspectives depending on individual experiences. Frischenschlager and Pucher (2002) provide that pain cannot be measured or quantified. Health care provider should in this case assess pain on individual perspectives. Therefore verbal and non-verbal description of their current health status depends solely on the patient.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More This simply means that the overall communication context is influenced by the dynamic exchange of the service provider and patient interaction. However, this has never been the case. As Frischenschlager and Pucher (2002) state, â€Å"problems with the communication between doctor and patient are a frequent result (p.416). Pain has often been defined as a warning sign indicating something wrong within the body. Pain is classified into two categories; acute and chronic pain. People in pain often undergo intense psychological experience. Acknowledging the importance of patients understanding how to respond to pain is important in communicating pain issues to the providers. Issues associated with patient communication process are outside the scope of medical research. In this regard, Brannigan et al (2008) quotes, â€Å"pain should be looked at as a multi-dimensional affair and not just a one a warning sign† (p.12). Thus, being able to communicate effectively and knowing which m essages to communicate are equally important. Pain Theories Frishenchlager and Pucher (2002) categorize pain theories into two groups; 1) the Frey theory and 2) the Goldscheider’s approach. Frey’s theory defines pain as special pain pathways that connect pain-specific nerve endings leading to the brain. The Goldscheider’s approach states that nerve endings are not specific to any center of the brain and that pain can only be experienced when the level of pain reaches to an intense point that can not be tolerate leading a patient to expressing their discomfort. Frishenchlager and Pucher (2002) links psychological factors such as distraction, relaxation, fear, depression, former pain experiences, family and cultural influences to be among factors that affect the way that people experience pain. In their analysis, Frishenchlager and Pucher (2002) redefine pain as,†Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦unpleasant sensory and emotional experience associated with actual o r potential tissue damage or described in terms of such damage† (p.419).Their definition gives equal weight to emotional and physical pain experience hence the rebirth of gateway theory that links emotions to physical pain, considered to be a breakthrough in theories of pain. Effects of pain and patients’ inter-personal relationships are not only becoming important topics in research, the management of chronic and acute pain are also of paramount importance. In this regard, future research should take deeper studies in defining what chronic pain is and how it effects the population (Smith, 2008; GangHeong, 2000). Pain is now being thought of as the Fifth Vital sign that offers way for physicians to assess overall health of an individual. Pain can be considered as chronic if the symptoms last up to three months. Walid et al (2008 argue that pronounced pain changes the behavior of an individual. They provide guidelines on how to determine levels of Chronic Pain as to incl ude; duration of illness; number of treatments and consulted doctors; psychological impairments such as depression, helplessness and loss of self-esteem; social impairments such as social isolation, changes in the patient’s social role and position; and Job-related impairments such as having to take days off because of being ill that can subsequently lead to dismissal. Diagnostic classification of chronic pain It presupposes: A continuous, torturing pain, which; Cannot be explained well by an organic damage; and Psychosocial problems or emotional conflicts are recognizable and can be brought into direct connection with the pain the patient experiences. Gromala and Shaw (2004) define chronic pain as pain that lasts from one month to a year. Their analysis records a statistic of 57 million people in North America with majority being the disabled people. To this we come to the conclusion that pain is indeed a difficult problem for both physicians and patients (Bennett et al, 2009). McCosker (2004) defines pain an â€Å"inner experience and others cannot truly observe its effects or share in its suffering† (p.62). Frischenschlager and Pucher (2002) links withdrawal symptoms as part of the psychological challenges a person undergoes when experiencing chronic pain. They add that when someone isolates themselves from the society to heal results to withdrawal making the pain more intense. When a person life revolves around their illness, pain becomes part of their life. Facial Action Coding System The Facial Action Coding System (FACS) dates back in to the mid 19th century (Piderit, 1858). The most influential theorist was Charles Dawn in which he argues in his book ‘The Express of Emotions in Man and Animals† that facial expression is universal and innate characteristics. He further added that facial expressions played a crucial role in the experience of emotion (Darwin (1896). FACS is defined by Ekman (1984) as â€Å"changes in the fac ial musculature comprised a large portion of emotional state† (p.319). He argues that the expressions were based on a â€Å"theoretical study designed to measure specific facial muscle movements believed to be associated with emotional expression† (p.321). Ekman and Friesen (1978) further distinguish between two different types of judgments to include message judgments that refer to specific behavior and those made about behavior. They argue that facial expressions such as anger or happiness can clearly be distinguished from pain expressions, while to accurately measure the assumptions of psychological state, inferences about that which is being measured is required. Ekman and Friesen (1978) define pain scale as a measurement that â€Å"identifies specific responses to specific stimuli, natural unfolding of specific behavior over time†¦.which segment is likely to produce the most expressive behavior† (p.322). The intensity of facial expressions are measured at four (1=low, 2=medium, 3=high and; 4=very high). The low ratings often display mild expressions such as smile with slightly raised corner of the mouth and corners of the eye without displaying the teeth. Medium rating expresses moderate expressions. This is often displayed like half smiling and half laughing, with eyebrows slightly raised and lips apart, exposing teeth. High rating emotions are displayed such cry or laugh, with an open mouth, raised eyebrows and cheeks. Very high rating, display intense expressions when crying or laughing and lips are completely apart, teeth showing and cheeks substantially raised. Nonverbal Communication There are many ways a healthcare provider can look beyond what their patients are saying to what their patient’s body is telling them. Cooper (1979) gives several suggestions for what a healthcare provider can do to read some nonverbal clues that will help them better understand their patient’s pain. Cooper (1979) suggests that man y people talk without looking at the eyes of the other person, especially physicians; and this can suggest that one is not listening at all. Some patients, especially those in pain, have trouble articulating their feelings. Some signs that Cooper (1979) gives for a healthcare provider to look out for: Facial Clues In fear and pain the eyes open wide with the lower lid tensed. The eyebrows rise in a straight line and the mouth opens with the lips tense and drawn back In sadness the eyes look downward with the lower lid raised Cooper (1979) continues on stating that a person’s attempt to control their facial expressions, their nonverbal behaviors, gives away the fact that they are in pain and not able to tell their physician everything. Use of non-Verbal Communication Clinical spectrum of typhoid is broad, ranging from diarrhea, which may be fatal in a shorter incubation period of 48 hours or longer periods of up to 3 months, with an abrupt offset of headache, diarrhea and vomiting. The symptoms are often as a result of loss of large volumes of isotonic fluid. Simple Explanation Not all people who get typhoid look equally sick. Some patients may portray minor symptoms, while others look very ill. While looking at a patient, healthcare provider should be able to identify these symptoms from facial expressions by distinguishes between judgmental facial expressions such as anger or happiness and those made about behavior. In this regard, proper training of facial coding aligned with a dimensional model of emotions should be encouraged in health professional along with spending more time with their patients to distinguish between their facial features. Some symptoms such as diarrhea may be omitted by a patient since many may regard it as routine and unnecessary to mention it to the heath provider which may lead to misdiagnosis and improper treatment regimes. Therefore purposeful nonverbal communication and asking thoughtful questions is more likely to imp rove the relationship between healthcare providers and the patients. Use of nonverbal communication such as body gestures, positions and facial expressions to convey information requires full attention and minimal distraction from the service provider, as reciprocate of showing caring and empathy to the patient. It is proven that verbal communication builds relationship and enable people stay together longer. A patient may also gain a lot of knowledge about themselves that may improve interpersonal relationships. Talking to the healthcare provider about your health concerns, how you feel about yourself and how you feel about life, helps a patient heal and accept their condition. Self disclosure puts someone in a position to see who they really are and binds people together. In addition, every person has their own beliefs, and they are able to reconcile their disagreements with a person they feel close to. Someone may feel unaccepted, your feelings may be hurt and you may feel your r elationship is threatened. To this reason, people need to make their feelings known by revealing and exposing themselves. Often, people who can not express themselves or rather shy individuals experience great anxiety in trying to express themselves. Conclusively, communication is a complex and challenging process but is still absolutely essential asset for communication and building relationships. One progressively move from being a stranger to being close friends with healthcare providers is essential in improving patient’s health. People may often feel that disclosing to much information may turn people away. They also have the perception that disclosing premature information to early, their intentions may be misread as an invasion and some may see it as an attack. Patients often relate their past experiences of telling people very sensitive issues may lead to unfavorable impressions. One patient explained that a person may use information disclosed to them against the ind ividual and we often take risks by sharing personal information with healthcare providers since information shared in a healthcare setting can not be used against them or for blackmail purposes. Therefore, while self disclosure can be useful in helping patients relieve stress, patients should be educated on the importance of disclosing all their health issues and concerns, how to express their pain using facial expressions and the ability of healthcare providers to keep this information confidential (Donabedian 1988; Mechanic, 1998). In â€Å"Healthcare and Listening: A relationship for Caring† by Brannigan et al, (2008) begin with the statement that the â€Å"optimal relationship between healthcare provider and patient is one of trust† (p.168). The authors continue on to explain that this trust relationship cannot exist without effective communication between the doctor and the patient. Research is also found to support that effective communication practices are key i n patient compliance with medical regimens, patient satisfaction, as well as decreasing malpractice lawsuits is found (Morlion et al, 2008). If the goal of healthcare is what Brannigan et al, 2008) states as one that â€Å"†¦. prevents illness and injury, and help patients and their families manage medical conditions through counseling, medicine and therapeutic interventions† (p.168). Patients must trust their healthcare providers with sensitive, possibly life-threatening or life altering, information. It is physician’s responsibility to use limited time that they have with the patient to listen and guide the conversation to get to, potentially, the most important information so that a correct diagnosis can be made. Communication becomes the most important element in the patient/doctor relationship (Eggly and Tzelepis, 2001) A providers’ nonverbal behavior may provide subtle yet powerful messages concerning their perceived efficacy of pain management (Frant sve and Kerns, 2007). They continue that patients may respond to such unintentional â€Å"demand characteristics† that physicians may show; especially those patients who are in pain. The research points out that within the last few decades the relationship between patient and physician has evolved from a parental relationship into a partnership (Eggly and Telesis, 2001). To address this shift, national medical organizations such as the â€Å"Accreditation Council for Graduate Medical Education† has put an emphasis on training physicians in more effective communication. Methodology The design for the research study uses questionnaire posted over the internet to obtain raw data about listening skills facing young, middle and old aged patients and healthcare providers. Quantitative survey technique comprising of participant observation, and quantitative methods of randomly selecting participants were utilized because they were considered appropriate to the cultural and la nguage differences that exists. This research was designed in the quantitative genre of data collection as I believe this approach will allow us to obtain a more comprehensive understanding of health issues surrounding the selected group. Our research methodology of using questionnaire helped us gain better understanding on the complexities of social, economic and cultural factors impacting on them. Quantitative approaches were believed to be appropriate as they are likely to yield more honest opinions in obtaining in-depth understanding of the meanings and events by obtaining raw data from participants. The participants were 108 comprising both male and female who ranged in age 18-60 years and were part of the large study of ability to recognize facial expressions. Target Population Target population consists of both male and female of ages 18 to 60. These samples group is aimed at educating the public, patients and healthcare providers (nurses, General practitioners and physiother apists) dealing with patients with chronic pain on how to recognize facial expressions. Participants were also selected with regards to; recent history of pain, structural deformity, thoracic pain, systematic unwell and constant progressive, non mechanical pain (chronic pain). While the focus of this study was on adults alone, a participant of below 15 years was also included to obtain a holistic view of a Lay† person could do WELL in distinguishing facial expressions. The sampling techniques were randomized sampling (Polgar Thomas, 2008), requesting participants to rate facial expressions and selecting samples to use in the study (Grove, 2007). Instrument Pain scale seems like the most appropriate instruments a physician could use to assess patient’s pain. It is performed by having patients rate their pain on a scale of 1(being no pain) to 10 (being of severe pain) as demonstrated in the graphic rating scale in Appendices A. Pain Scales Pain scale instrument is common ly used by Healthcare Providers to assess patient’s pain. Brannigan and his colleagues (2008) article on ‘Healthcare and Listening’ stated that â€Å"the optimal relationship between the healthcare provider and the patient is one of trust† (p.170). It can not be assumed that effective communication always occurs naturally. Acquiring effective interpersonal relationship between the service provider and the patient requires observation practice and interpersonal listening skills. This responsibility lies heavily on the healthcare provider. Their primary attribute to providing effective care requires being emphatic listeners as a strategy to understand patient’s nonverbal communication and take the time to observe their communication patterns. Common problems often experienced in providing effective communication to patients is lack of empathy and understanding of nonverbal signals and communication apprehension on the part of the patient (Bundy, 2001; McCroskey et al,1998). Testing and Evaluation First of all, pain face scale should be tested to check the ability of patients learn the basics of the program. For the testing, patients should be invited in the survey room where a healthcare provider explains theoretical material and track the way students accept the information from the pilot training program. Then, patients will be proposed to fulfill the assignment established by the program creators to check how they understand the facial expressions. Once the practical assignment is completed, patients should be offered to look through other options of the program. Finally, a healthcare provider should provide with other helpful ideas that might be helpful for patients when living at home. The evaluation of the results should be based on the validity and reliability verification. Project Location And Duration The project implementation will be conducted with the help of the hospital facilities for the project managers to accura tely test and evaluate the effectiveness of the pain scale instrument. More importantly, as face scale deals with exclusive evaluation of facial expressions, it has the correct training that can work out a consistent plan of publishing program implementation. The project results are planned to be delivered in three weeks, as the pain scale should be properly tested and evaluated. The operation will be defined into three stages. First, the department should study the main difficulties in handling pain scale that may appear among the patients dealing with this program. Second, the project team should conduct a research in the field and define what listening skills and technologies will fit best. This stage will take the most of the time allocated for the scheme. Finally, it is necessary to conduct pilot implementation in order to eliminate all possible drawbacks of the program. Data collection Participants were required to read the questionnaire carefully and select the picture of the facial expression such as happiness, pain, disgust, fear, anger and sadness that best described the picture provided. Below is a sample of the data collected over the internet. Respondent IP Address Response for facial Expression (Happiness, Fear, anger, sadness, surprise, pain, disgust Gender Ethnicity/Race Household Income Highest educational level Are you currently a student Specify education level Age -Happiness -Sadness -Anger Male White/Caucasian $40,000 – $59,999 Masters No 25-30 71.233.25.134 -Happiness -Sadness -anger Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 76.24.221.253 -Happiness -anger -disgust Female White/Caucasian $60,000 – $79,999 Bachelors Yes Masters 36-40 98.95.181.24 Happiness Female Asian $40,000 – $59,999 Masters Yes Masters 22-24 64.246.212.53 Happiness Sadness -Anger Female Black/African American $60,000 – $79,999 Bachelors No Masters 22-24 64.246.212.53 Happiness Sadness -Anger Female W hite/Caucasian $60,000 – $79,999 High School/GED Yes 31-35 208.139.7.64 Happiness -fear -disgust Female White/Caucasian Bachelors No Masters 22-24 75.66.190.118 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 Bachelors Yes 25-30 189.216.62.1 Happiness -anger -disgust Female White/Caucasian $60,000 – $79,999 High School/GED Yes Bachelors 18-21 75.66.190.34 Happiness -anger -disgust Female White/Caucasian Less than $20,000 High School/GED No Bachelors 25-30 98.239.42.73 Happiness -anger -disgust White/Caucasian $60,000 – $79,999 Bachelors Yes 31-35 207.191.102.215 Happiness -anger -disgust Male White/Caucasian Less than $20,000 Masters PhD 51-55 64.246.212.1 Happiness -anger -disgust Female White/Caucasian Yes 41.239.2.108 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Bachelors Yes Masters 25-30 64.246.212.1 Happiness -anger -disgust Male White/Caucasian Less than $20,000 Bachelors No Maste rs 25-30 178.25.46.77 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 High School/GED No 31-35 72.20.142.52 Happiness -anger -disgust Female White/Caucasian $40,000 – $59,999 Bachelors No 31-35 74.192.193.253 Happiness -Sadness -Anger Female White/Caucasian $20,000 – $39,999 High School/GED Yes High School/GED 22-24 76.123.128.127 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Associates No Bachelors 22-24 24.242.116.141 Happiness Female White/Caucasian $20,000 – $39,999 Bachelors Yes 25-30 125.231.225.17 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Associates Yes Bachelors 22-24 98.237.151.59 Happiness -fear -disgust Female Asian Less than $20,000 High School/GED No Bachelors 22-24 24.20.195.208 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Bachelors No 22-24 115.134.253.133 Happiness -anger -disgust Female Asian $60,000 – $79,999 High School/GE D No 41-45 114.78.184.77 Happiness -anger -disgust Male Asian $40,000 – $59,999 Bachelors Yes 22-24 99.145.161.1 Happiness -fear -disgust Female White/Caucasian $100,000 or more Bachelors No PhD 25-30 137.132.234.105 Happiness -Sadness -Anger Male White/Caucasian $80,000 – $99,999 Bachelors No 25-30 65.81.247.46 Happiness -anger -disgust Female White/Caucasian $20,000 – $39,999 High School/GED No 31-35 24.18.138.184 -Happiness -fear -disgust Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 174.32.39.60 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 75.192.145.56 Happiness -fear -disgust Female White/Caucasian $60,000 – $79,999 Bachelors Yes Masters 36-40 Limitations of the study There are many different pain scales used; however, it is the general consensus that none of them are an adequate source of determining ones â€Å"true† pain level. When pain levels are des cribed to medical professionals they are usually assigned meaning by using verbal descriptors such as â€Å"excruciating, unbearable, etc.† At times doctors give examples and patients are asked to choose from those descriptors such as the McGill Pain Questionnaire. While there are an abundance of appropriate words to describe pain they are not words we use. Therefore it is important that patients and physician’s come to a mutual understand and achieve shared meaning when communicating about pain (Faunce et al, 2006). Although pain is the most common medical complaint most patients seeking treatment for pain are not chronic pain patients. Chronic pain patients develop a pain vocabulary that is influenced by medical specialist treatment and by exposure to repeated pain assessment measures (GangHeong, 2000). When dealing with pain it is of vital importance that the provider and patient develop a â€Å"shared meaning† of pain descriptors since the medications that a re given to deal with pain are very potent and therefore it is important to get a correct diagnosis and for the patient to have a good relationship with their health care provider (Roberts and Bucksey, 2007). According to Butler and his colleagues (2009) both the VAS and VRS (in appendices) are based on the assumption that people have a â€Å"shared† meaning or understanding of pain and its descriptors. The results of this study did not support this, as hypothesized participants were personalized in their use of pain descriptors and presumably in their understanding of the word as well. Butler et al, (2009) have shown that a valid assessment for pain cannot be developed if people in pain do not have a shared perception of the dimension. Butler et al (2009) go on to state that caution should be used when relying on the use of word to convey pain intensity. Also words meant to describe only the most acute pain have little understanding when brought together with other pain asse ssments. When attempting to clarify pain levels in a medical setting more than just relying on VAS or VRS is needed. Butler and his colleagues (2009)continues to addresses the idea that language and pain are interrelated and that pain can be better understood by the understanding of the language. Since patients and doctors use different descriptors for pain it is difficult to reconcile the descriptors. Also, since the descriptors for the illness and pain given by the doctors are at times so grave the patient’s initial reaction is not a favorable one. Also it is found that since language descriptors for pain differ from person to person, it is difficult to assign a value to each descriptor. It is understood that pain caries from person to person so the terminology differs from person to person (GangHeong, 2000; Darmohray et al, 2008; Beckett et al, 2009). Pain face scales as well as other scales are still under scrutiny for their lack of patient interaction, the scale does not take into account the fact that pain is a very personable experience and must be treated as such (Crichton, 2001). Future Research and the required Changes in Healthcare According to Roberts and Bucksey (2007), there have been two significant social changes that have helped put emphasis on the importance of effective communication for healthcare providers: The first came in 1999 when the Institute of Medicine announced that medical mistakes are not unusual or isolated, rather that they happen everywhere and often. Also they concluded that these mistakes were not minor but deadly. They went on to say that the disclosed mistakes were only a small sampling handpicked to be given to the public, while the real bulk of the incidents were never disclosed to the general public. Healthcare providers were outrage to have to admit their mistakes and patients were fearful as safety became a national priority. After panels were put together to as quoted by Brannigan et al, (2008) to â€Å"set standards, address safety issues, and review medical errors; it became apparent from the research conducted that poor communication and concealing mistakes were two significant factors that ultimately led to legal recourse† (p.170). The second problem was the public’s loss of trust, high profile scandals by individuals or groups in power caused the public to be critical to those who were in a profession that was perceived as prestigious (Brannigan et al, 2008.) In recent years various medical organizations (such as the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education) have begun to emphasize improved training and demonstration of competence in communication skills. The nursing profession is also beginning to advocate good listening and communication as a quality needed to be a good nurse; skills which one must possess to demonstrate caring to a patient. The idea that listening is important to be a well rounded medical professional is not a new concept but it is just being framed as a skill and an expectation of a skill that all medical professionals should have the basic concept of(Bundy, 2001; Bennett et al, 2009). Brannigan et al,(2008) proceeds to say that methods to improve communication and effective listening on the part of the physician have been studied since the 70’s, however the early research focused mainly on the physician’s communication skills, medical skill training communication skills and how the physician performed in clinical encounters. As studies become more recent they include the elements of empathy, time, trust, malpractice, and patient satisfaction. The patient can benefit in positive ways from a healthcare provider who is an effective communicator such as the patient’s improvement in emotional health, functional status, and a change in physiological measures, particularly in patients with chronic conditions (Morlion et al, 2008). Considering the ris ks involved for both the patient and the physician the importance of effective, thorough, and willing communication and listening goes beyond just a â€Å"courtesy† and on to an ethical obligation (Castro-Lopes et al, 2008). Listening and the sensitivity associated with communication are required by both parties: from patients to provider and from provider to patient. This is an underdeveloped area of communication, according to McCroskey et al (1998), and needs to incorporate considerations of communication and listening is required. Recommendations Communication Apprehension and Healthcare In some cases, lack of good communication relationship between the healthcare provider/patient relationships relies on the patient. The patient can experience what is called Communication Apprehension also known as â€Å"CA†. CA is â€Å"an individual’s level of fear or anxiety associated with either real or anticipated communication with another person or person’sâ €  (McCroskey et al, 1998). This is the definition that has been used to describe people who have â€Å"CA†, people who are anxious about real or upcoming communication situations. It is clear that this anxiety or â€Å"discomfort† caused by the â€Å"CA† can cause very real physical effects to the person suffering from the ‘disorder’ (McCroskey et al, 1998). There are clear indicators if a person is â€Å"high CA†. A â€Å"High CA† when presented with a situation where they have to communicate will experience the fight or flight syndrome. These are the people that would rather die than speak in public. These types of people may even have problems with their speech or they may use a high amount of vocal pauses (uum, ya know, ahhh). Others may have a negative perception of these people because of their lack of communication skills. Because â€Å"more talk† is better in the United States, someone with High CA is likely to be co nsidered as a less attractive socially and may seem less desirable to be around just because of their unwillingness to speak up. These kinds of self-crown perceptions tend to affect the patient/doctor relationships. In some cases, people with high CA may still be apprehensive to speak up when in pain or in the presence of a Healthcare Providers (McCroskey et al, 1998). When the person is having trouble speaking up they can often leave out details that are important to a potential diagnosis or frustrate the physician leading to a breakdown in communication (Bundy, 2001). McCroskey et al (1998) revealed that trait CA had a small relationship with patient question asking and information seeking. Sate CA had a strong relationship with patient question asking and information seeking. In the health care environment High CA’s are going to ask fewer questions, start fewer conversations, and avoid communicating with their physician whenever possible. Because in other contexts High CAà ¢â‚¬â„¢s should have more state anxiety when communicating with someone of elevated status such as their physician five more research questions were formed to flesh out the patients fear of communicating with the doctor and the trait and state CA. A patients fear or anxiety related to communicating with their physician is consistent with the theory that patient apprehension can seriously interfere with the physician/patient communicative relationship and be associated with negative outcomes for the patient. There are many elements which factor into communicating with the physician, such as disconfirmation communication, language usage, controlling interaction, nonverbal communication, apprehension, trust, and willingness to discuss personal issues. Butler et al, (2009) found that â€Å"individuals, who are apprehensive about communicating with a particular person, do not normally initiate interactions with that person† (p.56). So if you are uncomfortable with your doctor you would not initiate a conversation with him/her about an intimate problem (Eggly and Tzelepis, 2001). The most effective way to treat chronic pain is through an ongoing, collaborative relationship with a primary care provider or pain specialist. According to Frantsve and Kerns (2007) giving providers communication training can lead to positive outcomes, including greater satisfaction ratings by individuals with chronic pain. Most patients indicated that they believed that their relationships with providers were better when their providers spend more time with them, at least twenty minutes or more, and displayed a greater amount of interest in their life and issues (Darmohray et al, 2008). McCroskey and his colleagues (1998) article on effective physician-patient communication identified four communication relationship to include; 1) engagement 2) empathy 3) education and 4) enlisting the patient in the doctor – patient relationship. They mention communication skills required b y doctors to include: 1) active listening 2) eliciting patients’ perspective on illness 3) decoding and responding to patient emotions 4) negotiating treatment plans more effectively It is clear that communication is a necessity in a good doctor-patient relationship. The process of communication requires encouraging two way dialogue and establishing partnership between two parties; the patient and the service provider-that creates an atmosphere of caring. This bridges the social gap between the provider and the patient, effectively uses verbal and non-verbal communication and creates a friendly atmosphere that allows a patient to tell his or her story and ask questions. Pain face scales should be personalized in relation to patient’s educational level and their ability to express their pain and treatment instructions. This can first start by asking a patient to recall or to repeat instructions given to them. This is one way of ensuring effective communication by enabli ng patients understand their health conditions and available treatment options (Curtin, 1987; DiMatteo, 1994; Hal 1988; Ong, 1995). The relationship between a patient and a client is one important way of ensuring healthcare providers communicate the outcomes of the patient’s illness. Important aspects to consider when determining communication inter-relationships are educational background, sex, age and ethnicity as earlier stated by McCroskey and his colleagues (1998). Others factors such as ample time allocated to patient-provider personal contact and privacy should also be considered when identifying characteristics that can improve communication relationships between the two parties. Also, service providers should improve practices in their own settings by adopting behaviors and techniques that could result to increased patient knowledge and effective communication. It is evidenced that establishing good relationship between healthcare provider and the patient creates an atmosphere of caring and bridges the gap between them. This means that facial expression should be personalized in accordance to the patient’s educational level and ability to understand the technical information. In this regard, patients and health providers should be able to 1).establish and maintain rapport and trust (care), 2). Diagnose communication and problem solving skills to determine diagnosis and treatment (solve) and; 3).counseling and education (education) (Fallowfield, 1998; Kopp,1989; Levinson, 1995; Roter Hall, 1991). The following table provides examples of responsibilities required from both service providers and patients in exchanging factual communication. Share facts Share feelings Service provider Communicate clearly and accurately on diagnosis and help patient apply the treatment to their own life Show care by understanding and respecting them Patient’s responsibility Clearly description health condition and ask questions where needed Be honest by expressing expectations and concerns Two-Way dialogue Both speak and listen without interruption. Both ask questions, exchange information and express opinions to fully understand the other party. Both relationships should be regarded as partnerships in which both parties strive to maximize the results. The patient should also realize that both parties are responsible for the outcome and their cooperation is highly required. Disclosing all required information from a patient to determine proper diagnosis and treatment is also of paramount. The service provider on the other hand should have the required skills that will enable him interpret and analyze information received effectively to explain the condition and treatment to the patient. Bias and Confounding The problems in collecting data over the internet were summarized as follows; communication issues in the around the world have not been adequately addressed, despite best efforts of number of researchers dedicated to the health and welfare issues of these people. The quality of the data collected here can not serve as conclusive, this is because a relative small portion of the population was used, and the research used different definitions for pain. There was also a problem in assessing remote indigenous population, hence compromising the results of the study (Valance, 2001, p.1). Therefore, little data collected here can not be relied on for future research. Since communication issues in respect of listening skills such as engagement, empathy, education and enlisting the patient in the doctor care are increasing at an alarming rate, Valance (2001) suggests that studying the problem more closely with the affected people of the relevant communities is likely to address the problem adequately. Validity of the Research This research conducted sought to answer the question, â€Å"Can pain faces be distinguished from other emotional expressions-such as happiness, disgust, fear, sadness, surpris ed and anger?† This research principle is founded on two principles; Patients people have different cultural and language background—which required the researcher to develop models of inquiry Any attempt to solve problems on middle-aged population will be done in partnership with the consent of the communities surrounding them. Quantitative research methodology used in this research provided a better chance of identifying the nature of the problem because the sampling strategies are better suited in dealing with small samples. It also equipped the researcher with considerable knowledge of the population to be studied contributing to the validity of the results. Internet questionnaire were well guided, informed and driven by personal experiences. Also, the time allocated before the study commenced helped the researcher gain more understanding of health problems facing the world at large. To ensure the middle aged and the old population are able to have a say, equal opp ortunity in the research study and design was responsive to the needs of the population under study. The need for ongoing health campaigns of the communication skills should be provided and extended to the community, schools and preschools. Health related promotional activities should be encouraged to minimize occurrence of pain complains. Results The systematic reviews were identified using the internet and survey monkey database. Pain scales used the grading was simple and easy to apply and showed a large degree of consistency between the grading of the patient that of the health provider, diagnosis and treatment. Patients of ages 51 to 60 of Caucasian, Black/African American decent and Asian origins with average income mostly identified the same facial expression with regards to happiness, sadness, surprise, anger, disgust, disgust and pain. Also, participants of ages 28 to 30 with high income responded well to nonverbal communication signs compared to those of below 15 years. A set of questions were drawn in English language to guide participants and to ensure consistent information was gathered. The iquestionnaire protocol covered the key information area (facial expressions), including opinions on intervention services of the same to uncover their thoughts, perceptions and feelings. The questions were structured in a culturally sensitive manner, using their own language to obtain raw data from participants. In a research sought to measure the occurrence facial expressions on day to day activities, as a strategy to identigy the service gaps regarding health issues within the healthcare profession. Conclusion It is clear that understanding and further research in listening skills knowledge will assist in the communication of pain descriptors and putting at ease the patient in the treatment of pain. What is most needed is for all those involved in Healthcare to understand the listening process as well as having a basic understanding of how to read nonverbal signals. Having this skills along with that of empathy, will empower the healthcare provider to offer a more complete treatment plan to those who they treat and will allow them to see those that are in pain more clearly. This research has provided a set of principles that should be used in the training course to improve listening skills. The three process of communication; caring, diagnosis and problem solving and education of patient-provider provide attention to the most important aspects of healthcare. These processes combined with proficiency in providing health services and appropriate diagnosis and treatment when effectively applied results to better outcomes for the two parties. Emphasizing listening skills, nonverbal aptitude, and empathy, is not a new attitude in the healthcare setting but as seen it is one that is still lacking emphasis. It is proven that verbal communication builds relationship and enable people stay together longer and improves interpersonal relationshi ps. Patients should be educated that by talking to healthcare providers about your health concerns, how they feel about yourself and how they feel about life, helps them heal and accept their condition. Self disclosure puts someone in a position to see who they really are. Healthcare providers should on the other hand learn and understand each patient’s beliefs and cultures. As the objective of this paper strives to improve listening skills and the facial exercises, references used here will provide opportunities to accomplish these goals. Healthcare providers have their own clinical language that requires use of technical words that enable them communicate to each other which may be complex when used with patients. In some instances patients can also speak in their own dialects and slang, which makes it difficult for a health provider to comprehend. But with a little training a Healthcare Provider could be able to distinguish distinguishes between two different types of judg ments; pain expressions and emotional expressions. References Baird,J., Fanciullo,M., Sorensen,A., Washington,T. (2008). Pain Medicine. American  Academy of Pain Medicine, 9(8), 994-1000 Beckett, M., Elliott, M., Richardson, A., Mangione-Smith, R. (2009). Outpatient satisfaction: the role of nominal versus perceived communication. Health  Services Research, 44(5 Pt 1), 1735-1749 Bennett, M., Briggs, M, Closs, S., Staples, V., Reid, I., (2009). The impact of neuropathic pain on relationships. Journal of Advanced Nursing, 65(2), 402-411. Brannigan, M., Davis, J., Foley, A., Crigger, N. (2008, August). Healthcare and Listening: A Relationship for Caring. International Journal of Listening, 22(2), 168-175 Bundy, C. (2001).When communication has gone wrong between a doctor and a patient. Diabetic Medicine, 186-7. Bundy, C. (2001).When communication has gone wrong between a doctor and a patient. Diabetic Medicine, 186-7. Butler, D., Wilson, D., Williams, M. (2009). Language and the pain experience.  Physiotherapy Research International, 14(1), 56-65. Cooper, J. (1979). Actions really do speak louder than words. Nursing, 9(4),1. Crichton, N. (2001). A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing and Health, 13, 227-236 Curtin, R. (1987). Patient-Provider Interaction: Strategies for patient compliance.  University of Wisconsin, 1, 1 Darwin, C. R. (1896). The expression of emotions in man and animals. New York: Appleton. DiMatteo, M. (1994). The physician-patient relationships: effects on the quality of healthcare. Clinical Obstetrics and Gynecology, 37(1), 149-61 Donabedian, A. (1988). The quality of care: How can it be assessed? Journal of the  American Medical Association, 260(12), 1743-48 Eggly, S., Tzelepis, A. (2001). Relational Control in Difficult Physician–Patient Encounters: Negotiating Treatment for Pain. Journal of Health Communication, 6(4), 323-333 Ekman, P. (1984). Expression and the nature of emotion. In K. R. Schere P. Ekman (Eds.), Approaches to emotions (pp. 319-343). Hillsdale, NJ: Erlbaum Ekman, P., Friesen, W. (1975). The Facial Action Coding System. Palo Alto, CA: Psychologists Press Fallowfield, L. (1998). Teaching senior oncologists communication skills: Results from Phase 1 of a comprehensive longitudinal program in the United Kingdom. Journal  of Clinical Oncology, 16(5), 1961-68 Faunce, G., Kenny, D., Trevorrow, T., Heard, R., (2006, November). Communicating pain: Do people share an understanding of the meaning of pain descriptors?  Australian Psychologist, 41(3), 213-218. Frantsve,E., Kerns, R. (2007). Patient–Provider Interactions in the Management of Chronic, Pain: Current Findings within the Context of Shared Medical Decision Making. Pain Medicine, 8(1), 25-35 Frischenschlager, O., Pucher, I. (2002). Psychological management of pain. Institute  of Medical Psychological, 24(8), 416-422 GangHeong, L. (2000). Dialogue, Narrat ive, and a Lived Body in Pain. Florida  Communication Journal, 27(1/2), 43-60. Gà ©linas, C., Fillion, L., Puntillo, K. (2009).Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. Journal of Advanced Nursing, 65(1), 203-216. Grove, S.K. (2007). Statistics for health care research: A practical workbook. Edinburgh: Elsevier Saunders. In: Chapter 10. Understanding the Sampling Section of a Research Report: Sample Criteria, Sample Size, Refusal Rate, and Mortality. Edinburgh: Elsevier Saunders Gromala, D,. Shaw, C. (2004). Expressing the Immeasurable: A Methodology for Developing a Visualization Tool for Patients’ Assessments of Pain. Cleveland  Journal of Medicine, 70(2), 1 Hall, J. (1988). Meta-analysis of correlates of provider behavior in medical encounters.  Medical Care, 26(7), 657-75 Holmes, J., Gabbard, O., Beck,J. (2007). Oxford Textbook of Psychotherapy. London: Oxford University Press Kopp, Z. (1989). Implementin g a counseling training program to enhance quality of care in family planning programs in Ecuador. American Public Health Association Presentation Levinson, W. (1995). Physicians psychosocial beliefs correlate with patient communication skills. Journal of General Internal Medicine, 10(7), 375-79 McCosker, A. (2004). East Timor and the Politics of Bodily Pain: a Problematic Complicity. Continuum. Journal of Media Cultural Studies, 18(1), 63-79. McCroskey, J., Richmond, V., Heisel, A., Smith Jr., R. (1998).The Impact of Communication Apprehension and Fear of Talking with a Physician on Perceived Medical Outcomes. Communication Research Reports, 15(4), 344-353. Mechanic, D. (1998). Public trust and initiatives for new health care partnerships.  Milbank Quarterly, 76(2), 281-302 Morlion, B., Walch, H., Yihune, G., Vielvoye-Kerkmeer, A., de Jong, Z., Castro-Lopes, (2008). The Pain Associates’ International Network Initiative: a novel practical approach to the challenge of chron ic pain management in Europe. Pain Practice, 8(6), 473-480 Ong, L. (1995). Doctor-patient communication: A review of the literature. Social Science  and Medicine, 40(7), 903-18 Piderit, T. (1858). La Mimique et al physiognomie. Paris: Alcan. Polgar, S., Thomas, S. A. (2008). Introduction to research in the health sciences. (5th edition). Sydney: Churchill Livingstone (Elsevier). Punch K. (1998). Introduction to Social Research: Quantitative and Qualitative  Approaches. London, UK: Sage. Roberts, L., Bucksey, S. (2007). Communicating With Patients: What Happens in Practice? Physical Therapy, 87(5), 586-594 Roter, D., Hall, A. (1991). Health education theory: An application to the process of patient-provider communication. Health Education Research, 6(2), 185-93 Smith, M. (2008).Pain experience and the imagined researcher. Sociology of Health   Illness, 30(7), 992-1006. US Bureau of the Census. (1995). Sixty-five plus in the United States, Economics and Statistics Administratio n. US Department of Commerce, March, 1995. Vallance R. V. Tchacos E. (2001). Research: A Cultural Bridge. Presented at Australian Association for Research in Education (AARE) Dec.2nd –6 2001 Fremantle Walid, M., Donahue, S., Darmohray, D., Hyer, L., Robinson, J (2008). The Fifth Vital Sign — what does it mean? [corrected] [published erratum appears in PAIN PRACTICE 2009 May-Jun;9(3):245]. Pain Practice, 8(6), 417-422 This research paper on Listening Skills and Healthcare was written and submitted by user Taraji Michael to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

How to Write a Comparative Essay †Be Careful. BestEssay.Education

How to Write a Comparative Essay – Be Careful. How to Write a Comparative Essay – Be Careful Remember those comparison/contrast essays you wrote in high school? Sometimes you wrote ones that only compared two things; sometimes you wrote ones that only contrasted two things; and sometimes you wrote essays that included both comparisons and contrasts. When you are assigned comparative essays in college, however, the terminology of the assignment itself is really important, because there are really two types. You need to be certain that you understand the assignment before you begin to choose a topic and produce an essay. If you are to write just a comparative essay, you will be addressing those things that two or more people, things, events, beliefs, or other ideas have in common. For example, how are the democratic systems in England and India alike? Or, how are Macbeth and Brutus, two characters from to different Shakespearian plays, alike? If you are to write a comparative analysis essay, however, the common definition of such an essay is that you will address both similarities and differences – like the comparison/contrast essay you wrote in high school Understanding the difference between these two types will be your first step in figuring out how to write a comparative essay that will meet the requirements of your instructor’s assignment. Organizing Your Essay If you are only to write an essay on the comparison of people, events, things or ideas, your organizational structure will be pretty basic. Make a list of those similarities, each of which will be addressed in a separate paragraph. If, however, your essay is a comparative analysis, things are a bit more complex, as you must address both similarities and differences. Your best bet in this case is to make two lists – similarities and differences and then to organize your essay by first assigning a paragraph to each of the similarities and then a paragraph to each of the differences. There are other format, of course, but this is really the easiest, and if you just want to get the thing done, choose this format. If, for example, you were to compare Macbeth and Brutus, you would want to address the facts that they were both highly ambitious, that they were both power-hungry to a fault, and that they were both willing to kill to obtain that power. On the other hand, there were differences. Macbeth was a military hero; Brutus was a politician; Macbeth was strongly influenced by his wife’s ambition; Brutus was driven by only his inner drive. So, your essay will have two sections – paragraphs on si milarities followed by paragraphs on differences. Write an Essay that Will Impress If you spend a good amount of time thinking about the things you are to compare and/or compare and contrast, and you prepare your lists well, you should have an easy organizational structure. The rest is in the writing. Be certain that you review and edit that rough draft so that it is really polished by the time you turn it in. Remember, a great essay grade is comprised of both what you say and how you say it.

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Law of International Carriage of Goods by Sea - Essay Example Janet’s rights and TC’s obligations will be construed by reference to the Contracts (Rights of Third Parties) Act 1999. The 1999 Act is specifically designed to protect the rights of third parties to a contract by conferring on that third party certain enforceable rights.2 The Sale of Goods Act 1979 will also apply to Janet’s case. The facts of the case for discussion reveal that Susan contracted with TC by virtue of a voyage charter for the delivery of a consignment of Russian Flagship Vodka from Russia to London. The contract incorporated the Hague-Visby Rules and contained a clause against deviation from the voyage unless it was a matter of life or death. The no-deviation clause however, did not appear in the bills of lading. In any event Susan made it clear to TC that it was imperative that the consignment of vodka arrive in London as quickly as possible since she wanted to benefit from the upcoming vodka drinking summer season. This the understanding between the parties to the contract for the shipment of Vodka from Russia to the UK. The fact that a no deviation clause does not appear on the bills of lading will not function to relieve TC of an obligation to adhere to the no deviation clause in the primary contract for the transhipment of the vodka. Article III(3) of the Hague-Visby Rules delineates the primary function of the bills of lading.3 The bills of lading will generally be useful for identifying and reconciling the goods delivered with the goods dispatched. As a result the bills of lading will describe the markings and stamps on the goods at the time of loading as well as the number of â€Å"packages, or the quantity or weight† of the goods at that particular time and the â€Å"apparent order and condition of the goods.†4 Moreover, the requirement of due diligence as contained in Article III(1) of the Hague-Visby Rules can be interpreted to include a duty of no

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Consider bauman's idea that central features of modernity underpinned the possibility and actuality of the holocaust - Essay Example Out of job, Bauman had enough spare time in his hands and completed his masters in philosophy from Warsaw University where he remained as a lecturer till 1968. With the outbreak of public protests in Poland against the ruling communist government and subsequent fanning of anti-Semitic sentiments by the government to deflect public criticism, Bauman shifted to Leeds University after briefly teaching in Tel Aviv University. Bauman faced anti-Semitic sentiments twice in his life and both were from non-Nazi state machinery. This experience led him to form an opinion that modernity, bureaucracy and social exclusion creates a situation where an extreme phobia against those social groups that cannot be neatly categorised and slotted into predetermined and well established hierarchical superstructure prevalent in the society. This in essence is the beginning of a potential holocaust that will inevitably result if this xenophobic attitude towards those social sub-groups that cannot be effectively analysed according to existing social norms is not brought under control. Such social mores can be brought under control only if the authority is aware of the potential dangers and initiates strong measures to counter such a mass phobia against so-called outsiders. History, however, has witnessed several instances of cynical exploitation of the deep seated distrust among Europeans against so-called killers of Christ by governments of several European nations, Poland and Soviet Russia being the main culprits, to further their narrow and selfish class interests. Bauman has worked extensively on these issues where he has clearly laid bare the intrinsic interconnection between modern society where people wilfully forego several facets of personal freedom (both in the realm of actions and in thoughts) and the inherent distrust of the ‘outsider’ who does not conform to the established mores of the society. His contention is

Business History Essay Example | Topics and Well Written Essays - 1500 words

Business History - Essay Example Businesses would increase their sales if there is easy transportation access to its current and prospective clients. One very successful strategy to outwit competitors is for the companies to shift to high volume and low cost productions management styles Plus, the industrialization of businesses in Britain is characterized by the popularity of the small and medium scale firms. These types of businesses were normally managed by the owners and their relatives. These small scale markets were transformed into regional markets. The established marketers would implement the business laws and political laws of the land in order to have a peaceful and harmoniously fair competitor relationship. Further, many companies decided to focus the scarce resources on the production of specialty products that satisfies the needs of a niche market. Many companies were also forced to vertically integrate like the small and medium scale industries. A few businesses were segregated by the government into districts from 1750 to 1850. Some of the businesses had to research to develop new products and processes in order to keep abreast with their wily competitors. Many of the small firms and the Zaibatsu were family owned businesses. These small and micro industries are often single proprietorships and partnerships. The family as a whole may acquire wide range of expertise in terms of diversification into other businesses. Normally these types of industries generate slow sales activities resulting to low volume sales which in turn generates correspondingly low profits. Some f the Japanese industries were characterized by merchants enveloped in the industrial world called Ukiyo or floating worlds(Whitley,66). Many of the Zaibatsu companies are bigger than the small firms. Also, many Japanese companies had to close shop because they were not able to adapt to the

The Art In Cinema Film Studies Essay

The Art In Cinema Film Studies Essay Film is considered to be an important art form, a source of popular entertainment and a powerful method for educating   or indoctrinating   citizens. Film may be combined with performance art and still be considered or referred to as a film, for instance, when there is a live musical accompaniment to a silent film. The act of making a film can, in and of itself, be considered a work of art, on a different level from the film itself.. A road movie can refer to a film put together from footage from a long road trip or vacation. Intuitively, some films qualify as artworks and others do not. All film is art, though some of it is better art or higher art. This, it turns out, is not just a question for those with a special interest in film. It has interest for aesthetic value more broadly, because film can serve as a test case for definitions of art. Some theories of art seem too restrictive, because they prevent us from classifying certain films that are aesthetic masterpieces into th e category of art. The intentions of the creators in attaining status as art. Sometimes, however, creators do not conceive of their creations as primarily belonging to the class of artworks, but viewers come to recognize that they can be fruitfully regarded in this way. This is not to say that a work becomes art when its taken up by a art-consuming audience. A theory of that kind would face the difficulty of saying which audiences had the power of conferring art status. Moreover, audiences do not transform works into art, rather they discover that a works deserves to be regarded in that way. If this intuition is right, the key to understanding what makes a film count as art is what goes on in this discovery process. India is well known for its commercial cinema, better known as Bollywood. Almost every Indian is well versed with onscreen running around the trees singing songs, the fight sequences, twins meeting each other pachchees saal baad, topped with some dose of mush and lots and lots of spice. However there are other types of movies which focus purely on story- minus the masala. This genre is sometimes referred as Pheeka or Bina namak mirch wala (bland) kind of cinema. In addition to commercial cinema, there is also Indian art cinema, known to film critics as New Indian Cinema or sometimes the Indian New Wave. A true admirers of cinema and people who consider movie-making as an art call it the Offbeat or The Art House Cinema. Many people in India plainly call such films as art films as opposed to mainstream commercial cinema. From the 1960s through the 1980s, the art film or the parallel cinema was usually government-aided cinema. Such directors could get federal or state government grants to produce non-commercial films on Indian themes. Their films were showcased at state film festivals and on the government-run TV. These films also had limited runs in art house theatres in India and overseas. The Indian Art Cinema or the New Wave sometimes called has had a humble beginning. This genre doesnt boast of foreign locales, hopelessly expensive clothes or the big star cast. The sole strength of these kind of films is the story. The Indian Art Cinema has beautifully transformed and re-invented itself. From socially relevant topics of Child Marriage, Dowry, Female Foeticide, Widow Re-marriage to a simple love story. The Art film-makers have done it all. Its amazing to see how some of the very talented film-makers have gifted their audiences with some of their magnificent work. There is Shekhar Kapoor who beautifully told the story of a man struggling to make his illegitimate son a part of his family (Masoom) and we got one of the all time masala entertainers Mr India from the same director. The person who gave us Zubeida, Ankur and Manthan came up with something as entertaining as Welcome to Sajjanpur and the very recent Well Done Abba. The Gen-X today are more intelligent and open to a wide variety of topics. At the end of the day the purpose of the film and the audience should be served. The audience wants a good story and a really good way of putting it and thats what the film makers are supposed to do. Yes masala flicks are welcome but too much of masala can cause acidity! A good mixture of masala movies and intelligent cinema is what the audience wants. Brainless comedies work, but again not always. In this new context of art-house appeal to the mainstream, of limited box-office appeal is striking, if not, perhaps, inaccurate. On the other hand, general conceptions of art house have come to describe films simply on the basis of their production outside the Bollywood system, regardless of their status as conventional dramas or slightly offbeat comedies. Surely a film with a 30-crore budget, Bollywood stars, and wide release does not fit the standard art-house profile. And yet a documentary about global warming w ith art house written all over it-complete with its charisma-challenged star, Al Gore-enjoyed sold-out screenings at huge multiplex theaters across the globe. From the very inception of this genre, there has been a difference between art and commercial cinema. However with changing times this gap has been bridged. The themes of art movies have witnessed a change. The earlier trends in Indian Art movies were more specifically related to the Indian audience, while the recent incline is towards the global concept. Quite ideally therefore the Indian Art cinema has gradually emerged itself as a reflections of the happenings in the society. Now many of these Art Movies or small films are grossing major profits and competing for space at the big multiplexes as well as finding their audiences at the small cinemas devoted to specialty fare. What will be ideal is an exclusive chain national art house cinema multiplexes to mark the new era of these specialized cinema. The audiences today look out for good films rather than the serious or popular films. Hence once a while a multi-starrer movie bombs and a small budget movie like Aamir is much appreciated by the cine goers. The need for better subjects, the desire to watch something more feasible on the screen and the boredom that has set in with the regular candy floss cinema are some of the reasons for this apparent change. If this trend continues then the day is no far when there will be no commercial cinema or art cinema, but just good cinema and bad cinema. India is full of art and that is depicted in Indian movies. But a commercial or non commercial movie, both need art. Commercial movies need art in form of background, sets, getting a shot right. Both have got distinct way of describing art through movies. There are a number of genres and styles of Indian cinema that a viewer encounters, such as, romantic comedies, gangster films, horror films, westerns, melodramas, musicals and historical films. While some of these genres are present in Indian cinema, often as a consequence of the impact of the western films, the Indian filmmakers have also created some styles of their own, that are acknowledged as their own. This is clearly discernible in the popular tradition of filmmaking in India. The knowledge of Indian cinema provides an entry into the thought-worlds and performance-worlds to the people interested in this art. Many Indian film directors, right from the pioneers such as Dadasaheb Phalke to the modern ones like Yash Chopra, have deployed their creativity along with traditional forms of dance mime, folk classical music to enhance the communicated experience. Indian popular cinema has evolved into a distinctively Indian mode of entertainment by imaginatively amalgamating music dances also and the works of veteran directors like V.Shantaram. Guru Dutt and Raj Kapoor bear a testimony to this fact. So, through Indian cinema one can also enter the larger world of Indian aesthetics. Film makers like Ketan Mehta has made a movie on the life of 19th century painter Raja Ravi Varma named it as Rang Rasiya. Its a very artistic movie showing us the reality of the society in the 19th century. He had also directed Mangal pande which was againg very artistic from the sets to costume everything gave you the feel on the 18th century. Aushitosh Gowarikars Jodha Akbar is another epic story in which art played a very important role. To add on the list is devdas Sanjay Leela Bhansali did a brilliant job with art direction. Indian cinema has presented a detailed version of India from its different historical movies to its present scenario movies. The distinct genres of films depicted by the different filmmakers have helped in the study of India from a different and distinct angle of vision. Thus, one cannot help but realize the fact that indeed it has been the old traditions and the cultures that have actually framed the Indian cinema, which have been an encouragement to uplift India and make it one of the renowned countries in the world. By seeing the cultures and traditions of the distinct societies, people can examine their own country`s culture with fresh eyes and with a special vision and approach.