Nursing Role in Elderly Person Discharge Planning

Nursing Role in Elderly Person Discharge Planning Title: Critically discuss the role of the nurse in the planning and implementation of safe discharge for the hospitalised elderly person. 1. define your understanding of discharge planning linking it to the ageing process and the reasons why older people are more susceptible to poor discharge planning. The NHS is effectively a rationed service with a finite limit on its resources. Coast points out that one of the major limiting factors which determines the overall ability of the NHS to deliver appropriate healthcare is the number of beds which are available at any given time (Coast et al. 1996) A direct consequence of this statement is the realisation that the availability of beds in the NHS as a whole is a reflection on the bed occupancy and also the efficiency with which potential patients can get into these beds. (Costain et al. 1992). It also directly follows that the efficiency with which patients can be safely discharged back into the community (or to other destinations) has a profound impact on the overall availability of beds for new patients. A patient’s discharge is ultimately dependent on an enormous number of interdependent variables, not the least of which are their physical, mental, emotional and financial state. (Gould et al. 1995). Clearly other factors such as their support networks and the availability of appropriate carers may play a critical role. If we accept that the elderly are more likely to be dependent as a demographic group, then it is clear that all of these issues must be addressed in a timely and positive fashion before a typical elderly patient can be safely discharged from hospital. If we accept that it is not ideal or practical for all of these factors to be assessed by one healthcare professional, then best practice would suggest that it is appropriate to assimilate information that is available from a number of different agencies in order to allow a proper evidence based decision to be made. (Sackett, 1996). Common clinical practice is to invoke the help of a multidisciplinary discharge team. In the context of this essay, we should note that the elderly may face a number of different discharge options and the multidisciplinary discharge team should ideally consider all of them as appropriate. We shall not discuss them all in detail here, but provide an overview of the most commonly utilised options. Victor Nazareth (et al 1994) point to the fact that multidisciplinary discharge planning may be subsumed by expediency in some cases where some immediately attractive schemes such as discharge to a nursing home may be employed as it requires only a modest investment of planning time but effectively shifts the patient sideways out of an acute hospital bed. Such options may appear to be attractive in the short term but the implications for the elderly patient and their family can be profound if they are not explored properly prior to discharge. (Stojcevic N et al. 1996) Some centres utilise the mechanism of nurse-led inpatient rehabilitation care for the elderly who no longer require medical attention, but this does not address the issue of releasing hospital beds. (Steiner 1997) The elderly, as a group, may frequently fall into a category where they are not quite well enough or independent enough to be discharged home but yet are not really ill enough to remain in hospital. (Closs et al. 1995). In these circumstances the multidisciplinary discharge team may consider the option of a Hospital at Home which acts effectively as a transition stage where help at an enhanced level can be provided in the short term which allows the elderly patient to be safely discharged from hospital thereby releasing the bed for another acutely ill patient and the original patient can recuperate in their own home until well. (Fulop et al. 1997) Martin points to the fact that, in order to be effective, a multidisciplinary discharge team needs to ensure that appropriate facilities are put in place in a timely fashion prior to patient discharge. (Martin et al 1994). Failure to do this will render the whole scheme less than optimally effective, as the patients may not get the full range of appropriate facilities, not derive appropriate benefit and this may culminate in premature or unnecessary readmission to hospital, which is effectively a waste of resources. (Pound et al. 1995) Richards (et al 1998) has provided an exemplary tour de force of the issue with a randomised controlled trial of a large cohort of patients. Their main outcome markers were, excess mortality, quality of life, cost and patient acceptability. (Coast et al. 1998) The paper is actually both long and detailed but the main findings were that all of the parameters that were measured (with one exception), showed no adverse effect of an early discharge. The differences were that there was a greater expression of patient satisfaction with the Hospital at Home scheme. (Wilson et al 1997) 2. Anatomy and physiology of the ageing process should be briefly explained. The anatomy and physiology of aging are two subjects which are specialties in themselves and we do not presume to attempt to cover them in any detail in this essay. Russell points out that older adults are not simply a more aged version of a younger adult, they have distinct metabolic and anatomical differences that alter (for example) their nutritional requirements. As humans age their variability in nutritional need becomes greater rather than narrower. (Russell R M 2000). This type of change can be demonstrated in the fact that the older adult generally maintains their ability to absorb macronutrients well into advanced years but they loose the ability to absorb a wide variety of micronutrients. (van Asselt D Z et al. 1998) Other areas where the aging adult is demonstrably different from the young adult is in the state of their DNA which undergoes progressive oxidation from free radicals throughout life. This has repercussions with regard to a number of disease processes such as diabetes mellitus and many types of cancer. (Gilchrest B A et al. 1997) There appears to be a pre-programmed reduction in mitochondria content of tissues as they age. This is manifest in a number of clinical ways. Reduced strength and energy together with muscle wasting are frequent accompaniments of advancing years and may be one of the most significant factors in the rehabilitation of the elderly person. (Navarro A et al. 2007) 3. In this assignment it is important to define and discuss your understanding of ageism and ageist attitudes in relation to appropriate discharge planning. There are many studies which explore the subject of ageism in clinical practice. They reveal a stereotypical belief that older people are â€Å"dull, disagreeable, inactive, and economically burdensome† (Spence D L et al. 1998 These attitudes are still encountered in some healthcare professionals who may categorise lives into discrete stages as a means of charting progress. The expression â€Å"Act your age† suggests that one has to comply with the cultural (rather than biological) expectations of a stage in life. These stages are commonly associated with economic power with the 40s and 50s usually being considered to be the pinnacle of life as such people tend to have good health and are most likely to have robust financial resources. (Schroots J J F 1998) Engendering positive feelings about older people will help to produce a climate of better care for the elderly. (Puckett J M et al. 1999) In terms of the multidisciplinary discharge team, one should clearly be aware of the fact that the elderly have different needs, requirements and abilities. The belief that this equates with a lesser status and a lower level of expectation should be actively challenged. There is no rational reason to expect an 80 yr old to be less entitled to dignity and a good quality of life than a 30 yr old. If we consider the Rudd study (Rudd et al 1997) we can point to a hard evidence base to support the concept that active multidisciplinary discharge planning can actually produce an improvement in the quality of life indicators for the elderly if ageist stereotypes are actively challenged. It is fair to observe that this particular study utilised a particularly wide-ranging and apparently forward thinking multidisciplinary discharge team, but the results achieved are impressive by any analysis. 4. Explore the role of the nurse in relation to multi disciplinary team working in planning safe discharge. By its very nature, the multidisciplinary discharge team is made up of members from a number of clinical disciplines. The role of the nurse is multifactorial. Very often the nurse is the lead organiser in the team. (Lindley et al 1995). In addition to this, the professional role of the nurse often will allow a special insight into the dynamics of the caring and support networks outside of the hospital environment. It is part of the professional nursing requirement that the nurse should also act as the patient advocate (in common with other clinical disciplines) and as such should speak up for the patient if she believes that a clinical or social need is being unfulfilled. (Roper et al. 1983) 5. consider the psychological psychosocial impact that appropriate discharge planning could have on the older person and their family. Because of the increased likelihood of physical frailty, secondary morbidity and financial insecurity in this demographic group, increased dependence is more likely to be found in the elderly. This dependence is almost certain to be increased in the short term in the immediate aftermath of a hospitalisation. This will inevitably have a significant impact on the psychological well-being of both the patient and their carers. Depression is commonly seen (but less commonly recognised) in the elderly as they may struggle to cope with the demands of daily living which are also likely to be more acute after as in-patient spell. (Roper et al. 1983). Anxiety is another commonly experienced entity in both the patient and their carers as, to a degree, if planning has not been adequately carried out or inadequately explained, they may be concerned about how they are going to manage. Intuitively one can suggest that both of these factors can be significantly reduced with appropriate pre-discharge planning and intervention. (Drummond et al. 1995). 6. Appraise strategies in health promotion and rehabilitation with regard to discharge planning that can assist the older person and their family. This is potentially a vast area as there are a great many papers which have looked at the efficacy of the multidisciplinary discharge team in the discharge planning process. As illustrative examples we can consider some of them. The Mahoney paper suggests that the basic minimum input for a multidisciplinary discharge team should be a nurse and an occupational therapist and that these core workers should have the ability and discretion to co-opt additional specialists such as physiotherapists, geriatricians, social workers and psychologists as they feel appropriate. (Mahoney et al 1965) Specific types of patient discharge may require specific modifications of the basic plan. Ball produced a tour de force in his paper on discharge of the elderly from a coronary care unit, (Ball et al. 2003) where patients were allowed to go home earlier than they might normally have been allowed home but with the proviso that specific teams of specialist nurses were available to reassess the patient in their own home and consider direct readmission if required. The team referred to in this study was comparatively unusual insofar as it was comprised six nursing staff but with different skills and experience and they referred the patients to other members of the team only if they felt that more expert input was required. Many papers consider the role of the occupational therapist as a specific and vital entity in the discharge planning process. Gilbertson (et al. 2000) considered the various impacts that each individual professional had on the overall effectiveness of the eventual discharge and came to the conclusion that the impact of the discharge process (as measured by the Barthel quality of life indicator) was influenced by the input of the occupational therapist more than by any other individual category of healthcare professional. In making this statement, we should note that the authors were conducting a study into the discharge of stroke patients and therefore their findings may not be completely generalsable across the entire spectrum of patient discharge. We should also note that these benefits, which were detailed at some length in the analysis section of the trial, were only demonstrable on a comparatively short term basis. Their six month follow up after discharge showed that the patients had returned to the pre-admission status of quality of life. This, in itself, should not be considered as a negative finding as ultimately, it is one of the purposes of hospital admission to try to maintain or improve a patient’s quality of life In passing, we should also note that the Logan study (Logan P A et al. 1997) produced a similar trial structure and concluded that the Social Worker had an equally important part to play in the successful discharge of the patient. 7. your discussions should address inter disciplinary practice, relevant research and government policies (including the national service framework for older people). Discussion There are a great many studies that have been consulted in preparation for this essay. An overview would suggest that it is best practice to carefully assess, consider and then implement an appropriate discharge package for each patient. This has the advantage of minimising physical, psychological and practical trauma for the patient and their carers but also, (as Hensher observes) it can reduce the incidence of readmission in the immediate post-discharge period. (Hensher N et al. 1999) The National Service Framework for the elderly makes a number of good practice recommendations together with targets and goals that have a specific impact on the whole of the discharge process. (Rouse et al. 2001). Arguably one of the most significant recommendations is the implementation of the multidisciplinary discharge team process although there is no specific recommendation as to how the team should be comprised. A number of papers have examined the impact of the various differential structures of the teams and have come to differing conclusions. We have cited some of these already but some, such as the huge STUC trial suggest that, in specific consideration of the elderly, the prime determinant of whether a patient was going to eventually cope at home or not was their ability to transfer â€Å"successfully and reliably† from chair to chair and to a large extent, this was dependent on the availability of physiotherapy input. (STUC 1997) To conclude, we should perhaps detail the structure and facilities of the â€Å"ideal† discharge team as outlined by the STUC authors. A hospital based outpatient clinic, geriatric day hospital, generic domicillary physiotherapy and speech and language therapy, hospital outpatient physiotherapy, and the usual community resources. The maximum level of home care available in the study area to all patients was three one hour visits daily by a home help for personal care, meals on wheels, and community nurse visits for specific tasks. In addition this paper also quotes details of the additional measures that were also available for the patients:- Patients randomised to the community therapy team remained in hospital until the required package of social services care could be organised and any home adaptations undertaken whereas a store of commodes, high chairs, and toilet frames was kept by the team to expedite discharge. The patients were assessed for rehabilitation needs before discharge in conjunction with the hospital based therapists to set initial objectives and to ensure continuity of care. After discharge, patients were given a planned course of domiciliary physiotherapy, occupational therapy, and speech therapy, with visits as frequently as considered appropriate (maximum one daily visit from each therapist). In addition to all this input, the paper comments that each patient was assessed by the team on a weekly basis for up to three months to ensure optimum utilisation of resources The team’s input base was detailed as:- i) Senior physiotherapist grade 1 with neurological training, ii) Senior occupational therapist grade 1, iii) Speech and language therapist, iv) Therapy aide. v) Nurse vi) Consultant physician To conclude, we can consider a very valid point made by Haines (T P et al. 2004) who suggests that if proper multidisciplinary assessments take place in admission units as well as prior to patient discharge, it is quite possible that some cases may not actually need hospital admission in the first instance. References Ball, Kirkby Williams, (20030 Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 2003 ; 327 : 1014 (1 November), Closs S J, Stewart L S P, Brand E, Currie C T. (1995) A scheme of early supported discharge for elderly trauma patients the views of patients, carers and community staff. Br J Occup Ther 1995 ; 58 : 373 376. Coast J, Inglis A, Frankel S. (1996) Alternatives to hospital care: what are they and who should decide. BMJ 1996 ; 312 : 162 166 Costain D, Warner M, eds. (1992) From hospital to home care. London : Kings Fund, 1992. Drummond A E R, Walker M F. (1995) A randomised controlled trial of leisure rehabilitation. Clin Rehab 1995 ; 9 : 283 290. Fulop N J, Hood S, Parsons S. (1997) Does the National Health Service want hospital at home? J R Soc Med 1997 ; 90 : 212 215 Gilbertson, Peter Langhorne, Andrew Walker, Ann Allen, and Gordon D Murray (2000) Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial. BMJ, Mar 2000 ; 320 : 603 606 ; Gilchrest B A and VA Bohr (1997) Aging processes, DNA damage, and repair. The FASEB Journal, Vol 11, 322 330, 1997 Gould M M, Iliffe S. (1995) Hospital at home: a case study in service development. Br J Health Care Manage 1995 ; 1 : 809 812. Haines T P, Kim L Bennell, Richard H Osborne, and Keith D Hill (2004) Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ, Mar 2004 ; 328 : 676 ; Hensher, N. Fulop, J. Coast, and E. Jefferys (1999) The hospital of the future: Better out than in? Alternatives to acute hospital care. BMJ, October 23, 1999 ; 319 (7217) : 1127 1130. Lindley R I, Amayo E O, Marshall J, Sandercock P A G, Dennis M, Warlow C P. (1995) Hospital services for patients with acute stroke in the United Kingdom: the Stroke Association survey of consultant opinion. Age Ageing 1995 ; 24 : 525 32. Logan P A, Gladman J R F, Lincoln N B. (1997) A randomised controlled trial of enhanced social service occupational therapy for stroke patients. Clin Rehab 1997 ; 11 : 107 113 Mahoney F I, Barthel D W. (1965) Functional evaluation: the Barthel index. Maryland State Med J 1965 ; 14 : 61 65. Martin F, Oyewole A, Maloney A. (1994) A randomised controlled trial of a high support hospital discharge team for elderly people. Age Ageing 1994 ; 23 : 228 34. Navarro A. Boveris A (2007) The mitochondrial energy transduction system and the aging process. Am J Physiol Cell Physiol 292 : C670 C686, 2007 Pound P, Bury M, Gompertz P, Ebrahim S. (1995) Stroke patients views on their admission to hospital. BMJ 1995 : 311 : 18 22. Puckett J M, Petty R E, Cacioppo J T, Fischer D L. (1999) The relative impact of age and attractiveness stereotypes on persuasion. J Gerontol. 1999 ; 38 : 340 343. Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow (1998) Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ, Jun 1998 ; 316 : 1796 – 1801 Roper Logan Tierney (1983) Using a model for nursing. Edinburgh : Churchill Livingstone 1983 Rouse, Jolley, and Read (2001) National service frameworks. BMJ, Dec 2001 ; 323 : 1429. Rudd, Charles D A Wolfe, Kate Tilling, and Roger Beech (1997) Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ, Oct 1997 ; 315 : 1039 – 1044 Russell R M (2000) The aging process as a modifier of metabolism. American Journal of Clinical Nutrition, Vol. 72, No. 2, 529S 532s, August 2000 Sackett, (1996). Doing the Right Thing Right: Is Evidence-Based Medicine the Answer? Ann Intern Med, Jul 1996 ; 127 : 91 94. Schroots J J F. (1998) On growing, formative change, and aging. In : Birren J E, Bengston V L, eds. Emergent Theories of Aging. New York, NY : Springer-Verlag; 1998. Spence D L, Feigenbaum E M, Fitzgerald F, Roth J. (1998) Medical student attitudes toward the geriatric patient. J Am Geriatr Soc. 1998 ;16 : 976 983. Steiner A.(1997) Intermediate care: a conceptual framework and review of the literature. London: Kings Fund, 1997. Stojcevic N, Wilkinson P, Wolfe C. (1996) Outcome measurement in stroke patients. In: Wolfe C, Rudd T, Beech R, eds. Stroke services and research. London: The Stroke Association, 1996. STUC (1997) Stroke Unit Trialists Collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997 ; 314 : 1151 8. van Asselt D Z, de Groot L C, van Staveren W A, et al. (1998) Role of cobalamin intake and atrophic gastritis in mild cobalamin deficiency in older Dutch subjects. Am J Clin Nutr 1998 ; 68 : 328 – 34. Victor C, Nazareth B, Hudson M, Fulop N.(1994) The inappropriate use of acute hospital beds in an inner London District Health Authority. Health Trends 1994 ; 25 (3) : 94 97. Wilson A, Parker H, Wynn A, Jones J, Spiers N, Jagger C, et al. (1997) Hospital at home is as safe as hospital, cheaper, and patients like it more: early results from a randomised controlled trial. Society for Social Medicine abstracts. J Epidemiol Community Health 1997 ; 51 : 593.

America Moves to the City Post-Civil War

In the decades post-Civil War, America moved to the city. The increase in population almost doubled especially with the rush of new immigrants. The drift towards the city didn’t only affect America, it affected the Western world. With new industrial jobs, immigrants and Americans had opportunities for jobs, having the United States flourish.I. The new look of cities; the urban frontier. A.1870 to 1900, the American population doubled, and the population in the cities tripled. B.Cities grew up and out, with such famed architects as Louis Sullivan working on and perfecting skyscrapers (first appearing in Chicago in 1885). 1. The city grew from a small compact one that people could walk through to get around to a huge metropolis that required commuting by electric trolleys. 2. Electricity, indoor plumbing, and telephones made city life more alluring. C.Department stores like Macy’s (in New York) and Marshall†¨Field’s (in Chicago) provided urban working-class jo bs and also†¨attracted urban middle-class shoppers. 1. Theodore Dreiser’s Sister Carrie told of woman’s escapades in the city, made cities dazzling and attractive. 2. The move to city produced lots of trash, because while farmers always reused everything or fed â€Å"trash† to animals, city dwellers, with their mail-order houses like Sears and Montgomery Ward, which made things cheap and easy to buy, could simply throw away the things that they didn’t like anymore.D.Criminals flourished, and impure water, uncollected garbage, unwashed bodies, and droppings made cities smelly and unsanitary. 1. Worst of all were the slums, which were crammed with people. 2. So-called â€Å"dumbbell tenements† (which gave a bit of fresh air down their airshaft) were the worst since they were dark, cramped, and had little sanitation or ventilation. E.To escape, the wealthy of the city-dwellers fled to suburbs.II. Immigration happens all over the nation. A.Until t he 1880s, most of the immigrants had come from the British Isles and western Europe (Germany and Scandinavia) and were quite literate and accustomed to some type of representative government. This†¨was called the â€Å"Old Immigration.† But by the 1880s and 1890s, this shifted to the Baltic and Slavic people of southeastern Europe, who were basically the opposite, â€Å"New Immigration.†1. Southeastern Europeans accounted for 19% of immigrants to the U.S. in 1880, early 1900s, were over 60%!III. Southern Europeans make their way to America. A.Many Europeans came to America because there was no room in Europe, nor was there much employment, since industrialization had eliminated many jobs. 1. America often praised to Europeans, people boasted of eating everyday/having freedom, much opportunity. 2. Profit-seeking Americans also perhaps exaggerated the benefits of America to Europeans, so that they could get cheap labor and more money. B.Many immigrants to America st ayed for a short period of time and then returned to Europe, and even those that remained (including persecuted Jews) tried very hard to retain their own culture and customs.1. However, the children of the immigrants sometimes rejected this Old World culture and plunged completely into American life.IV. Americans react to the new immigrants in their country. A.Federal government did little to help immigrants assimilate into American society, so immigrants were often controlled by powerful â€Å"bosses† (such as New York’s Boss Tweed) who provided jobs and shelter in return for political support at the polls.B.People like Walter Rauschenbusch and Washington Gladden began preaching the â€Å"Social Gospel,† insisting that churches tackle the burning social issues of the day. C.Among the people who were deeply dedicated to uplifting the urban masses was Jane Addams, who founded Hull House in 1889 to teach children and adults the skills and knowledge that they would need to survive and succeed in America.1. She eventually won the Nobel Peace Prize in 1931, but her pacifism was looked down upon by groups such as the Daughters of the American Revolution, who revoked her membership. 2. Other such settlement houses like Hull House included Lillian Wald’s Henry Street Settlement in New York, which opened its doors in 1893. 3. Settlement houses became centers for women’s activism and reform, as females such as Florence Kelley fought for protection of women workers and against child labor. 4. New cities gave women opportunities to earn money and support themselves better (mostly single women, since being both a working mother and wife was frowned upon).V. Narrowing the Welcome Mat A.The â€Å"nativism† and anti-foreignism of the 1840s and 1850s came back in the 1880s, as the Germans and western Europeans looked down upon the new Slavs and Baltics, fearing that a mixing of blood would ruin the fairer Anglo-Saxon races and create i nferior offspring.1. The â€Å"native† Americans blamed immigrants for the degradation of the urban government. These new bigots had forgotten how they had been scorned when they had arrived in America a few decades before.2. Trade unionists hated them for their willingness to work for super-low wages and for bringing in dangerous doctrines like socialism and communism into the U.S. B.Anti-foreign organizations like the American Protective Association (APA) arose to go against new immigrants, and labor leaders were quick to try to stop new immigration, immigrants were frequently used as strikebreakers.C.Finally, in 1882, Congress passed the first restrictive law against immigration, which banned paupers, criminals, and convicts from coming here. D.1885, another law was passed banning the importation of foreign workers under usually substandard contracts. E.Literacy tests for immigrants were proposed, but were resisted until they were finally passed in 1917, but the 1882 immig ration law also barred the Chinese from coming (the Chinese Exclusion Act).F.Anti-immigrant climate, the Statue of Liberty arrived from France—a gift from the French to America in 1886.VI. Churches Confront the Urban Challenge A.Since churches had mostly failed to take any stands and rally†¨against the urban poverty, plight, and suffering, many people began to†¨question the ambition of the churches, and began to worry that Satan†¨was winning the battle of good and evil.1. The emphasis on material gains worried many. B.A new generation of urban revivalists stepped in, including people like Dwight Lyman Moody, a man who proclaimed the gospel of kindness and forgiveness and adapted the old-time religion to the facts of city life.1.Moody Bible Institute was founded in Chicago in 1889 and continued working well after his 1899 death. C.Roman Catholic and Jewish faiths were also gaining many followers with the new immigration. 1. Cardinal Gibbons was popular with Roma n Catholics and Protestants, as he preached American unity. 2. 1890, Americans chose from 150 religions, including the Salvation Army, tried to help the poor. D.The Church of Christ, Scientist (Christian Science), founded by†¨Mary Baker Eddy, preached a perversion of Christianity that she claimed†¨healed sickness. 5.YMCA’s and YWCA’s also sprouted.VII. Darwin Disrupts the Churches A.1859, Charles Darwin published his On the Origin of Species, which set forth the new doctrine of evolution and attracted the ire and fury of fundamentalists. 1. â€Å"Modernists† took a step from the fundamentalists and refused to believe that the Bible was completely accurate and factual. They contended that the Bible was merely a collection of moral stories or guidelines, but not sacred scripture inspired by God.B.Colonel Robert G. Ingersoll was one who denounced creationism, as†¨he had been widely persuaded by the theory of evolution. Others blended†¨creationis m and evolution to invent their own interpretations.VIII. The Lust for Learning A.New trend began in the creation of more public schools and the provision of free textbooks funded by taxpayers. 1. By 1900, there were 6,000 high schools in America; kindergartens also multiplied. B.Catholic schools also grew in popularity and in number. C.To partially help adults who couldn’t go to school, the Chautauqua movement, a successor to the lyceums, was launched in 1874. It included public lectures to many people by famous writers and extensive at-home studies.D.Americans began to develop a faith in formal education as a solution to poverty.IX. Booker T. Washington and Education for Black People A.South, war-torn and poor, lagged far behind in education, especially for Blacks, so Booker T. Washington, an ex-slave came to help. He started by heading a black normal (teacher) and industrial school in Tuskegee, Alabama, and teaching the students useful skills and trades.1. Avoided Issue of social equality; he believed in Blacks helping themselves first before gaining more rights. B.One of Washington’s students was George Washington Carver, who later discovered hundreds of new uses for peanuts, sweet potatoes, and soybeans. C.However, W.E.B. Du Bois, the first Black to get a Ph.D. from Harvard University, demanded complete equality for Blacks and action now. He also founded the National Association for the Advancement of Colored People (NAACP) in 1910.1.DuBois’s differences with Washington reflected contrasting life experiences of southern and northern Blacks.X. The Hallowed Halls of Ivy A.Colleges/universities sprouted after the Civil War, and colleges for women, such as Vassar, were gaining ground. 1. Also, colleges for both genders grew, especially in the Midwest, and Black colleges also were established, such as Howard University in Washington D.C., Atlanta University, and Hampton Institute in Virginia.B.Morrill Act of 1862 had provided a generous gr ant of the public lands to the states for support of education and was extended by the Hatch Act of 1887, which provided federal funds for the establishment of agricultural experiment stations in connection with the land-grant colleges.C.Private donations also went toward the establishment of colleges, including Cornell, Leland Stanford Junior, and the University of Chicago, which was funded by John D. Rockefeller. D.Johns Hopkins University maintained the nation’s first high-grade graduate school.XI. The March of the Mind A.Elective system of college was gaining popularity, took off after Dr. Charles W. Eliot became president of Harvard. B.Medical schools and science were prospering after the Civil War. 1. Discoveries by Louis Pasteur and Joseph Lister (antiseptics) improved medical science and health. 2. The brilliant but sickly William James helped establish the discipline of behavioral psychology, with his books Principles of Psychology (1890), The Will to Believe (1897), and Varieties of Religious Experience (1902).a. His greatest work was Pragmatism (1907), which preached what he believed in: pragmatism (everything has a useful purpose). XII. The Appeal of the Press A.Libraries such as the Library of Congress also opened across America, bringing literature into people’s homes. B.With the invention of the Linotype in 1885, the press more than kept pace with demand, but competition sparked a new brand of journalism called â€Å"yellow journalism,† in which newspapers reported on wild and fantastic stories that often were false or quite exaggerated: sex, scandal, and other human-interest stories.C.2 Journalists emerged: Joseph Pulitzer (New York World) & William Randolph Hearst (San Francisco Examiner) Strengthening of the Associated Press, which had been established in the 1840s, helped to offset some of the questionable journalism.XIII. Apostles of Reform A.Magazines like Harper’s, the Atlantic Monthly, and Scribner’s Mo nthly partially satisfied the public appetite for†¨good reading, but perhaps the most influential of all was the New York Nation, launched in 1865 by Edwin L. Godkin, a merciless critic. These were all liberal, reform-minded publications.B.Another enduring journalist-author was Henry George, who wrote Progress and Poverty, which undertook to solve the association of poverty with progress. 1. It was he who came up with the idea of the graduated income tax—the more you make, the greater percent you pay in taxes. C.Edward Bellamy published Looking Backward in 1888, in which he criticized the social injustices of the day and pictured a utopian government that had nationalized big business serving the public good.XIV. Postwar Writing A.After the war, Americans devoured â€Å"dime-novels† which†¨depicted the wild West and other romantic and adventurous settings. 1. The king of dime novelists was Harland F. Halsey, who made 650 of these novels. 2. General Lewis Wall ace wrote Ben Hur: A Tale of the Christ, which combated the ideas and beliefs of Darwinism and reaffirmed the traditional Christian faith. B.Horatio Alger was more popular, since his rags-to-riches books told that virtue, honesty, and industry were rewarded by success, wealth, and honor. His most notable book was titled Ragged Dick.C.Walt Whitman was one of the old writers who still remained active, publishing revisions of Leaves of Grass. D.Emily Dickinson was a famed hermit of a poet whose poems were published after her death. E.Other lesser poets included Sidney Lanier, who was oppressed by poverty and ill health. XVI. The New Morality A.Victoria Woodhull proclaimed free love, and together with her sister, Tennessee Claflin, wrote Woodhull and Claflin’s Weekly, which shocked readers with exposà ©s of affairs, etc. B.Anthony Comstock waged a lifelong war on the â€Å"immoral.† C.The â€Å"new morality† reflected sexual freedom in the increase of birth control , divorces, and frank discussion of sexual topics.XVII. Families and Women in the City A.Urban life was stressful on families, who were often separated, and everyone had to work, even children. 1. While on farms, more children meant more people to harvest and help, in the cities, more children meant more mouths to feed and a greater chance of poverty. B.1898, Charlotte Perkins Gilman published Women and Economics, a classic of feminist literature, in which she called for women to abandon their dependent status and contribute to the larger life of the community through productive involvement in the economy.1. She also advocated day-care centers and centralized nurseries and kitchens. C.Feminists also rallied toward suffrage, forming the National American Woman Suffrage Association in 1890, an organization led by Elizabeth Cady Stanton (who’d organized the first women’s rights convention in 1848 at Seneca Falls, NY) and Susan B. Anthony.D.By 1900, a new generation of wom en activists were present, led by Carrie Chapman Catt, who stressed the desirability of giving women the vote if they were to continue to discharge their traditional duties as homemakers in the increasingly public world of the city.1. The Wyoming Territory was the first to offer women unrestricted suffrage in 1869. 2. The General Federation of Women’s Clubs also encouraged women’s suffrage. E.Ida B. Wells rallied toward better treatment for Blacks as well and formed the National Association of Colored Women in 1896.XVIII. Prohibition of Alcohol and Social Progress A.Concern over the popularity (and dangers) of alcohol was also present, marked by the formation of the National Prohibition Party in 1869. 1. Other organizations like the Women’s Christian Temperance Union also rallied against alcohol, calling for a national prohibition of the beverage. a. Leaders included Frances E. Willard and Carrie A. Nation who literally wielded a hatchet and hacked up bars. 2. T he Anti-Saloon League was also formed in 1893. B.American Society for the Prevention of Cruelty to Animals was formed in 1866 to discourage the mistreatment of livestock, and the American Red Cross, formed by Clara Barton, a Civil War nurse, was formed in 1881.

The Great Author Nathaniel Hawthorne Essay - 1261 Words

Nathaniel Hawthorne is an author who often uses religion, guilt, and symbolism. He usually uses a lot of descriptions and gives enough information to provide the reader with a visual picture. His mind often turned to matters associated with human judgments on mortality, with guilt and its consequences (Turner). In the novel Hawthorne’s short stories he has a series of stories that have to do with things like suffering, honor, and religion. One good novel that deals with all of these things as well is The Scarlet Letter including loneliness, revenge, shame, and betrayal. Hawthorne is also known to strongly show Puritan beliefs. Hawthorne would search out moral implications, and whether he impaled his story with its moral or allowed the†¦show more content†¦In the beginning of The Scarlet Letter the reader reads about a man returning to town after years to find a familiar looking woman with a baby on display wearing the letter A on her bosom. The letter symbolizes adult ery as well as the child throughout the whole novel. Hester refuses to tell who the father is due to the fact that Dimmesdale is the preacher for the town, and that would only make him look bad. So while Hester is going through loneliness and shame, Dimmesdale is suffering seeing her as she is and for not having what it takes to confess. The reader finds out later that the man returning in the beginning is Hesters long lost husband Mr. Chillingworth. He ends up seeking for revenge on the father of Hesters baby. Pearl often calls Chillingworth the evil man because she notices things about people and can see that he is not a good man. Once Chillingworth finds out Dimmesdale is her father he goes to him to ask questions and continues to remind him of his sin to make Dimmesdale feel worse. Once Dimmesdale confesses his sin Chillingworth says Thou hast escaped me! (Scarlet Letter 173). Pearl also symbolizes adultery and is Hesters constant reminder throughout the story. Pearl asks her m other why she wears the letter on her chest and why they do not fit in. The reader often gets the impression that Pearl is a down to earth kind of child. Hester tries to make her beautiful clothes and tries to get her to like Dimmesdale. Pearl refuses to likeShow MoreRelatedNathaniel Hawthorne and His Projected Self in the Scarlett Letter970 Words   |  4 PagesNathaniel Hawthorne Nathaniel Hawthorne was one of the most influential authors during the Romanticism time period. Hawthorne is most commonly known for his novel, The Scarlett Letter. That novel continues to still be read all over. In fact, I just read it for my history class. Not only can the novel be read for an English, but for a history class as well because of the Puritan background. Nathaniel Hawthorne wasn’t just an author that blended in within his era, he stood out. Hawthorne was uniqueRead More Hawthornes Young Goodman Brown – Poverty in the Tale and in the Life of the Author1565 Words   |  7 Pagesin the Life of the Author  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚        Ã‚   Henry Seidel Canby in â€Å"A Skeptic Incompatible with His Time and His Past† mentions of Hawthorne that â€Å"human failures and their causes were more interesting to him than prophecies of success, one might truly say than success itself. †¦He was not, I think, really interested in escape, except in moods of financial discouragement. . . . (57). Nathaniel Hawthorne’s â€Å"Young Goodman Brown† embodies traits of the modest lifestyle which the author had to subject himselfRead MoreEssay on Hawthornes Young Goodman Brown and its Author1272 Words   |  6 Pagescourse, Nathaniel Hawthorne’s literary works went unranked among those of other American and British writers. But his reputation grew gradually even among contemporary critics, until he was recognized as a â€Å"man of genius.† Edgar Allen Poe, in a review of Hawthorne’s â€Å"Young Goodman Brown,† which had been written 12 years prior, said in Godeys Ladys Book, November, 1847, no. 35, pp. 252-6: It was never the fashion (until lately) to speak of him in any summary of our best authors. . . . TheRead More Hawthornes Young Goodman Brown – Poverty in the Tale and Author’s Life1650 Words   |  7 Pagesreference to the widely-known poverty of the aspiring writer,Nathaniel Hawthorne: â€Å"True enough, Hawthorne planned more than once to write groups of tales and sketches somehow linked into a whole; but he could not get a publisher for them. When he did get a publisher in 1837, it had to be through the help of the hack-editor, Samuel Goodrich. . . .† (107) Nathaniel Hawthorne’s â€Å"Young Goodman Brown† includes traits of the modest lifestyle which the author was forced to endure in his personal life. Besides thisRead MoreEssay on Nathaniel Hawthornes Life in His Works1556 Words   |  7 Pagesto write about, how long their pieces often are, and what personal style these authors develop. While this is true of author Nathaniel Hawthorne, th ere are different elements that influence his writings. His life included many times of trials, many joys, and many ancestors that caused some turmoil within his mind. Two of his major works are influenced almost directly by his background (Werlock). Nathaniel Hawthorne threw his life into every single piece of his writing. His experiences, backgroundRead MoreA Brief Biography of Nathaniel Hawthorne856 Words   |  3 PagesNathaniel Hawthorne once said, â€Å"I do not want to be a doctor and live by men’s diseases, nor minister to live by their sins, nor a lawyer and live by men’s quarrels. So, I don’t see that there is anything left for me but to be an author† (Nathaniel). This statement describes Hawthorne’s personality and life in a way that no other quote could. Nathaniel Hawthorne was an Anti-Transcendentalist writer meaning that he had a negative view of all humans. The Anti-Transcendentalist movement was a pessimisticRead More Poverty W ithin and Without Young Goodman Brown1420 Words   |  6 Pagessimplicity within the Nathaniel Hawthorne short story, â€Å"Young Goodman Brown,† might be an expression or reflection of the utter poverty within the life of Hawthorne? It is the purpose of this essay to clarify this issue.    Hawthorne’s impoverishment probably begain with the untimely death of his father, and continuedfor most of his llife. Gloria C. Erlich in â€Å"The Divided Artist and His Uncles† states that â€Å"Robert Manning made the esential decisions in the lives of the Hawthorne children and isRead MoreAllegory and Symbolism in Nathaniel Hawthorne’s â€Å"Young Goodman Brown†1203 Words   |  5 PagesNathaniel Hawthorne’s â€Å"Young Goodman Brown† is an excellent example of the use of allegories and symbolism as a form of satire on Puritan faith. According to Frank Preston Stearns, author of The Life and Genius of Nathaniel Hawthorne, â€Å"Hawthorne may have intended this story as an exposure of the inconsistency, and consequent hypocrisy, of Puritanism† (Stearns 181). Throughout the story of â€Å"Young Goodman Brown,† Hawthorne tries to infuse as many symbols and allegories as he can to enhance the overallRead MoreBiography of Nat haniel Hawthorne 1123 Words   |  5 PagesThe tall and mysterious Nathaniel Hawthorne is a man of little understanding. We know him for being very secluded and alone much of the time. We also know he had many secrets that may have accounted for the gloomy tone in his novels. He was a writer who did not believe in the game of small talk and enjoyed losing himself to a world of this own creation. Many people might have thought that Hawthorne came off as rude and uninteresting, but they had no idea of the masterpieces that laid inside his headRead MoreThe Works of Nathaniel Hawthorne1175 Words   |  5 Pages Nathaniel Hawthorne was an American novelist and short story writer who was born in Salem, Massachusetts July fourth 1804. When Hawthorne was a young man he served as the editor of the American Magazine of Useful and Entertaining Knowledge. That job introduced him into the world of writing and at that point he decided what he wanted to do until the day he died. â€Å"I do not want to be a doctor and live by men’s diseases, nor a minister to live by their sins, nor a lawyer and live by their quarrels

About Cilmate Change and Global Warming

Climate change, specifically global warming, has captured the attention of people worldwide and has inspired more debate and action—personal, political and corporate—than perhaps any other environmental issue in history. But all of that discussion, along with the mountains of data and conflicting points of view that go with it, sometimes make it hard to really know what’s going on. This guide will help you cut through the rhetoric and confusion and get to the facts. The Nuts and Bolts of Climate Change The first step toward learning what can be done to reduce global warming, and how you can help, is to understand the problem. What Causes Global Warming?How Do Humans Contribute to Global Warming?Climate Change: Air and Land ObservationsClimate Change: Effects on the OceansClimate Change: Effects on the Frozen World Greenhouse Gases and the Greenhouse Effect The greenhouse effect is a natural phenomenon, and many greenhouse gases occur naturally, so why are they cited as problems whenever global warming is discussed? The Basics about Greenhouse Gases Current and Future Effects of Climate Change The effects of global warming are often discussed in future terms, but many of those effects are already under way and having an impact on everything from biodiversity to human health. But it’s not too late. If we act now, most scientists believe we can avoid many of the worst effects of global warming. Climate Change and Extreme WeatherClimate Change and Sea Level RiseGlobal Warming and Large Scale PhenomenaA Changing North: Climate Change in the ArcticSpring Phenology and Climate Change Climate Change and Human Health The Most Vulnerable CitiesDeer, Lyme Disease, and Climate ChangeClimate Change and Food Security Climate Change, Wildlife and Biodiversity How is Wildlife Affected by Global Warming?Bird Extinctions Occurring Faster than Previously Believed Climate Change and Natural Resources Climate Change and Maple Syrup ProductionClimate Change and SkiingGlobal Warming Puts 12 U.S. National Parks on the Endangered List Solutions Reducing global warming and mitigating its effects will require a combination of enlightened public policy, corporate commitment, and personal action. The good news is that the world’s leading climate scientists have agreed that there is still enough time to address the problem of global warming if we act now, and enough money to get the job done without undermining national economies. What Is Carbon Sequestration?The Paris Climate Change ConferenceWhat Is the IPCC? Climate Change and You As a citizen and a consumer, you can influence public policy and business decisions that effect global warming and the environment. You can also make lifestyle choices every day that reduce your contribution to global warming. Top 10 Things You Can Do to Reduce Global WarmingCut Down Your Car EmissionsSeven Ways to Your Green HomeVacation Trip? Keep Your Carbon Footprint SmallGet a Free Home Energy AuditStop Receiving Junk Mail Climate Change and Renewable Energy One of the best ways to reduce global warming is to use renewable energy that doesn’t emit greenhouse gases. The Clean Power PlanTop 7 Renewable Energy SourcesWhat is Wind Power and How Does it Work?The Pros and Cons of Solar PowerIs Ocean Power a Viable Energy Source? Transportation and Alternative Fuels Transportation accounts for 30 percent of all greenhouse gas emissions in the United States—two-thirds of that from automobiles and other vehicles—and many other developed and developing nations face similar challenges. Alternative Fuels Top 8 Alternative FuelsThe Pros and Cons of BiofuelsEthanol: Frequently Asked Questions About Ethanol On page 2, learn what governments, the business community, environmentalists, and science skeptics are saying and doing about global warming . Global warming is a complex problem that can only be solved by a worldwide effort involving individuals, businesses, and governments at all levels. Global warming affects everyone. Yet, our perspective on the issue—how we see it and how we choose to address it—may be very different from the views of people from other backgrounds, professions or communities around the world. Global Warming: Politics, Government and the CourtsGovernments play an important role in the effort to reduce global warming with public policies and tax incentives that help to promote constructive action by businesses and consumers, and through regulation that can prevent abuses that worsen the problem. U.S. Government Should the United States Ratify the Kyoto Protocol? U.S. Supreme Court Rejects Bush Policy on Vehicle Greenhouse Gas Emissions Six Ex-EPA Chiefs Urge Bush to Curb Global Warming Federal Agencies Investigate Claims that Bush Administration Muzzled Scientists Congressional Interest in Global Warming Heats Up State and Local Governments California Passes Breakthrough Bill to Help Curb Global Warming U.S. Mayors Climate Protection Agreement 500 U.S. Cities Pledge to Reduce Global Warming Governments Worldwide World Leaders Launch Initiative to Accelerate Work on Global Warming Global Warming and Business greenhouse gases U.S. Climate Action Partnership: A Coalition for Change U.S. Climate Action Partnership Doubles Membership; General Motors Signs On to Fight Global Warming Rogers and Me: An Interview with Duke Energy CEO Jim Rogers Global Warming and the Media An Inconvenient Truth Review: An Inconvenient Truth An Inconvenient Truth Wins Two Oscars Global Warming: Science and Skepticism Is Global Warming a Hoax? ExxonMobil-Funded Group Offers Scientists Cash to Attack Major New Global Warming Study Utility Pays Global Warming Skeptic-for-Hire $100,000 Scientist Denounces TV Ads for Deliberately Misleading Public on Global Warming Global Warming Elsewhere on the Web Intergovernmental Panel on Climate Change The Royal Society—Climate Change U.S. Environmental Protection Agency—Climate Change Climate Change for Kids—U.S. Environmental Protection Agency Real Climate: Climate Science from Climate Scientists National Resources Defense Council—Global Warming Sierra Club—Global Warming and Energy On page 1, learn more about the causes and effects of global warming, what is being done to solve the problem, and how you can help.