A Case Study Of Social Work With Families Social Work Essay

A Case Study Of Social Work With Families Social Work Essay This was my third contact with Mrs G however my first contact with Mrs G on her own without Ps presence. The purpose of the visit was to carry out a carers assessment which focused on Mrs Gs needs separate from Ps needs. It was important that I tuned into the visit in order to work with Mrs G effectively. The process of tuning in helped me consider the legal mandate for the intervention, it helped me prepare myself for areas Mrs G may have wanted to discuss, I was able to consider relevant theories, Mrs Gs feelings, my feelings as a worker and how I would address these feelings through the use of good knowledge, skills and values. Before meeting with the family I had read through the existing case file which allowed me to gain an insight into the social work involvement of MS the transition co-ordinator to date, other professionals involved and an insight into the family background. I had previously carried out a UNOCINI assessment on P, had been on a few visits to P and Mrs G and liaised with several other professionals involved with P such as the Renal Team at the Royal Belfast Hospital for Sick Children (RBHSC), the school, Ps G.P, Clinical psychologist etc. I had already gathered relevant information and thus obtained a good insight into the family situation, particularly through liaising with the Clinical Psychologist who had done some brief family work with the family. From liaising with him, I was able to determine that there were strained relationships within the home. As my role in this instance involved assessing the needs of a carer, I read around carers in Northern Ireland, their needs and what the y often experience etc. This allowed me to tune into what Mrs Gs life may involve with regards to caring for P and consider some of the challenges carers experience on a regular basis. As I had already been involved with the family and completed a UNOCINI assessment, I gained a great insight into the familys circumstances, history/background. During this contact I wanted to obtain a greater insight into how Ps disability impacted is currently impacting on Mrs G, the primary carer of P. I prepared myself for the contact by familiarising myself with the carers assessment form however I had already decided to approach the situation by allowing Mrs G to take control and explain openly how she was coping etc. My practice teacher also discussed her expectations with me during supervision. My primary purpose in this piece of work was: The purpose of the work was to meet with Mrs G in her home. Carry out an assessment of Mrs Gs needs as a carer separate from Ps needs by allowing Mrs G to talk openly about her situation, how she was coping as a carer etc, express any concerns she had and ask her how she feels we could best support her at this time. This allowed Mrs G to take control of the discussion and identify areas to discuss. My main aims and were they achieved I contacted Mrs G prior to the visit to explain the observation so that she was aware of the situation before we arrived at the house. On arrival, I discovered that Mrs G had forgotten about the visit and planned to go into town. I asked Mrs G if she would like to reschedule but she said she would prefer to go ahead with the visit. I did not have to introduce myself at the beginning of this contact as I had clarified my role and function within the agency during the first visit with the family. I firstly introduced my practice teacher, reassuring Mrs G that she was there to assess me and my practice and that anything she would be writing would be about myself and not her. I further reassured Mrs G that anything discussed within the visit would not be discussed outside of the visit. At this stage I feel I could have explained the boundaries of confidentiality. I explained to Mrs G she was entitled to a carers assessment under the Carers and Direct Payments Act and that this would focu s on her needs as a carer as apposed to Ps needs. On reflection I do feel I could have explained to Mrs G at this stage what the assessment involved and I could have summarised what I intended to cover during the visit. Instead I just explained her entitlement to a carers assessment and that it focused on her needs. I acknowledged how difficult life has been for Mrs G and her family up until this point and asked Mrs g what it was like caring for P. Mrs G gave a very detailed account of Ps medical history and how his condition affected him. Issues arising were Ps restricted diet intake, Ps noncompliance to take medication and his personal care. On reflection, although I did attempt to probe further on these issues as an attempt to determine if and what triggers may have been contributing, looking back I do feel I could have used more effective questioning as an attempt to determine the impact this has had for Mrs G as a carer. Other issues arising were Ps lack of self-esteem and body issues which clearly contributed to his low mood. Looking back I feel I could have explored into this area more through probing more however I recall the carer at this stage having given me allot of in-depth information. I had reacted by probing further on another topic and had forgotten to go back and explore this a rea. On reflection I feel it would have been important to have explored this area further to gain a greater insight into how Mrs G coped with knowing that her son was insecure and body issues. Does she attempt to talk to P? Does this worry her, make her feel stressed etc, how does she cope seeing how Ps disability impacts upon him? Looking back another issue which Mrs G explained was the fact that P had fell out with their local Church over his diet. This was a clear issue/concern for Mrs G, however looking back, I did not probe further on this issue as once again, I recall Mrs G explaining a number of issues at once. I explored further on one issue and again I forgot to go back and explore this concern. At this point I feel I should have listed back to Mrs G the concerns that were arising and explored each of them one by one. Instead I feel I became overwhelmed by all of the information she was giving me, I consequently responded by exploring into one issue, which then led into another issue and I forgot to cover the other issues arising a the beginning. This has been a big learning curve for me as a worker. From this in particular I have learnt that I need to be more assertive and take more control of the conversation, particularly if you are with a service user who is quite talkative. In future I plan to say , ok, mrs G, youve given me quite a lot of information there. You have raised concerns about this, this and this. I would then cover each of the issues separately to ensure I have explored all areas fully that the service user has identified as being problem areas. I will also ensure to take more control of the conversation by stopping the service user if I feel she has overwhelmed me with information and pace the flow of the interaction to ensure each area is being fully explored. I recall Mrs G explaining that P had been abiding by his restricted fluid and diet intake recently as apposed to what he had done in the past. Mrs G did however express that P would still sometimes push the boundaries. I recall just reassuring Mrs G that this was very positive, however on reflection, I feel that I could have picked up on the fact that she had expressed he still pushes the boundaries at times and explored more into how they managed this, how he reacts when she reminds him the importance of his restricted diet and how Ps reactions impacted on Mrs G and other family members within the home. Mrs G went on to explain that the clinical psychologist P had been to see recently had diagnosed P as being biologically depressed and not clinically depressed. I recall probing further as an attempt to determine how Mrs G felt about this diagnosis, and asked whether P would continue to see the psychologist. However on reflection I do feel I could have explored further with regard to the possible risks this presented for P, how P was behaving, had she noticed any significant changes in his mood, behaviour etc. Looking back I feel this would have been very important and usually I feel a very obvious area to cover however I recall reminding myself of my role within that visit and that was to focus on Mrs G as a carer and how she was coping as a carer. Looking back however I do feel it was important to have explored further on this issue as there evidently could have been risks involved which could have led me to determining how Mrs G felt and coped with these. I recall Mrs G explaining about Ps argumentative nature. I did attempt to explore this area further however again at this stage I recall Mrs G giving a lot of detailed information and again I do feel it would have been beneficial to have redirected the information she had given back to how Mrs G was affected and how she was coping. I summarised by explaining to Mrs. G the main issues which we had discussed during the visit and what Mrs G was currently dealing with. I then reminded Mrs G of the main reason for the contact which was an assessment of Mrs Gs needs as a carer, how things have impacted on her and how she was coping as a carer. I summarised by asking Mrs G to once again eplain what the main concerns were for her in coping and caring for P at the minute. Mrs G once again clearly highlighted that the main concern for her as a mother was the fact that P had no opportunities at the minute to meet, socialise and interact others his own age group. She further explained that she felt this would undoubtly help to promote Ps independence while giving her and her husband a little respite. I paraphrased this back to Mrs G to have her clarify what I understood in relation to Ps needs and how this would ultimately benefit them as carers. I summarised by acknowledging and explaining to Mrs G that I understood the l evel of Ps care needs, what the family have come through in their lives to date and the impact of caring for P and other family members. At this stage I recall advising Mrs G of some support groups which may be of support to Mrs and Mrs G. Mrs G however clarified that she felt it was not them as parents who needed the support but their son, P who would benefit from some sort of social outlet. Furthermore, she did highlight she felt this would additionally benefit her and her husband as P relied quite a lot on her and her husband to take him out. Mrs G expressed she felt it would be beneficial for P if someone Ps age were to come and bring P out for a few hours. I mentioned a voluntary befrienders scheme however I was unsure as to the likeliness of getting a befriender that age within the locality thus I reassured Mrs G I would follow this up and get back to her. At this stage I recall introducing the topic of direct payments. Looking back, I feel the conversation had flowed up until this point. On reflection I had no reason to bring up the topic of direct payments as the conversation up until this stage had been centred on Mrs G, her life as a carer and how this was impacting on her. I had prepared to cover this topic solely on the basis that this was one of the topics covered within the agencys Carers Assessment forms. Looking back, I feel there was no reason to introduce this topic as there was simply no purpose in this instance. I recall asking Mrs G if she was aware of direct payments and or if she received direct paymen ts. Mrs G was not and asked if this was the same as carers allowance. At this stage I recall going completely blank. I knew it wasnt however I went completely blank and I could not think and turned to my practice teacher for reassurance and ask her if they were the same. At this stage I felt quite nervous and found it hard to refocus my mind back on the topic of conversation. I then recall trying to explain the concept of direct payments to Mrs G. I was able to explain that It focused on empowering service users through allowing them to be employers and this was a payment paid to them which would allow them to effectively employ someone if for example they wanted to pay someone to come in and care for their disabled child. I recall stumbling through this explanation as I consciously knew I wasnt communicating my understanding of direct payments effectively in a way to ensure that Mrs G understood it and furthermore I doubted what I was saying. I feel I cold have tuned in better to w hat direct payments were, whether Mrs G and P would have been eligible for this service, what the options were for them and been able to explain to them in a way that they understood and have given an example of their circumstances as apposed to a child. i.e. considering the fact that P was turning 18 in a few months. I feel if I had prepared better by doing this, there would have been more structure and purpose to introducing the topic in the first instance, Mrs G would have grasped a clear and concise understanding of what direct payments were, I would have come across as a more competent and knowledgeable worker and this would have lessened the likeliness of confusion or unrealistic hopes and expectations on Mrs Gs behalf on their eligibility and entitlement for the service. Straight away following the visit I acknowledged how my responses could have potentially have given Mrs g unrealistic hopes and expectations with regard to what they could get. I feel nervousness and lack of concise preparation significantly contributed to my inability to explain the service effectively and concisely, particularly after I was unable to explain the difference between carers allowance and direct payments initially. I finally summarised what I was going to do for Mrs G such as looking into the befriending scheme, their eligibility for direct payments, as she queried if she would be able to pay someone to come and take P out for a few hours a week etc. I then explained Mrs G that I would be in touch to arrange a time and date to talk through the assessment once I had completed it and have her sign it. Mrs G agreed. Skills I do feel I listened to Mrs G and demonstrated respect by being empathetic towards her and her situation past and present. I was very aware of the sensitivity around what Mrs G has come through in her life to date and used silence allot to allow Mrs. G to gather her thoughts before answering the questions. When she was talking I continued to use silence as a means of letting Mrs G tell her story and express her feelings. I ensured to maintain eye contact. My non verbals I hope indicated to Mrs G that I was listening to what she had to say. Although I contently listened to Mrs G and what she had to say, I do feel she overwhelmed me with information a lot of the time. Although I managed to explore further some of these issues by probing further on certain issues, I feel I failed to probe further on all the issues/concerns expressed by Mrs G. I feel I could taken control of the interaction more by stopping Mrs G at times and sensitively saying for example, ok Mrs G, you have given me quite a lot of information there. You mentioned this, this, this and this.. Can you firstly tell me a bit more about (1st issue), how does this affect you as a carer etc. I would then have gone through each issue separately and have explored each issue fully. I then would have got Mrs G to proceed. This would have ensured that I was using my probing skills more effectively and ensured I was exploring and analysing equally all areas which arose. Furthermore, I feel I did probe further on certain subjects to gain a further insight into how G fe lt about certain things although in doing this I do accept that I still may not have kept the topics focused on Mrs G as much as what I could have. I do feel however that in this instance, the needs of Mrs G was very dependent on that of meeting Ps needs first as she continually stated, if I thought that P was getting ready and looking forward to going out and meeting with others his age, I would be able to relax and when he would be away, this would act as respite for me. I truly feel this was the main issue for Mrs G and she clarified this towards the end of the visit. I was particularly ware of this as I had tuned into the fact that in a typical encounter involving two people, it is estimated that the actual spoken or verbal content is likely to carry only one third of the social meaning in any given event, whereas the non verbal forms convey roughly two thirds of the meaning (Birdwhistell, 1970). Communication is a two way process. It involves listening as well as speaking. Non- verbals used were: nodding, having an appropriate body posture, using eye contact, smiling and sitting in the SOLAR position. Allot of the time Mrs G was talking. I hope my non-verbals indicated to her that I was listening to what she had to say, respected the information she was sharing and demonstrated empathy and respect. I feel I used my interpersonal skills throughout the visit ad this contributed to a relaxed atmosphere and interaction. I do feel however I had developed a good rapport at this stage with Mrs G as I had been on a few previous home visits through carrying out the UNOCINI assessment. I feel I had a generally good structure to the contact however I do feel I could have explained at the beginning the content of what I hoped to cover with Mrs G instead of just summarising that I would be looking at her needs as a carer. I feel I demonstrated good non verbal communication through appropriate facial expressions, a good sitting position with an open posture, good eye contact and nodding my head to reassure Mrs G I acknowledged, was listening and understood what she was saying. I feel I laughed when appropriate and showed empathy when covering sensitive issues such as Ps past medical history of cancer and chemotherapy. I did ask various open questions which I had planned as a means of applyin g the exchange model and allowing Mrs G to talk openly about her life as a carer. This also allowed me to gain an insight into what Mrs Gs life was like, what her caring role entailed and how she coped with her caring responsibilities. I asked closed questions to gain more information on certain issues and clarify information. I feel my tone of voice was appropriate considering we were covering issues which were sensitive to Mrs G. Generally, I feel I effectively communicated with Mrs G. Effective communication is an essential component of traditional social work activities (Lishman, 1994, pg 1). I communicated clearly with Mrs G by explaining why I was there, introducing my practice teacher, explaining her role, reassured Mrs G my practice teacher was there to observe me and not her. I explained clearly what I hoped to cover during the contact and under ground she was entitled to a carers assessment. The process of engaging entails social workers being explicit about what we are do ing and why (Munro 1998a: 98). I feel I engaged well with Mrs G by clearing explaining my role and purpose. I paraphrased back to Mrs G what she had said at certain stages, particularly towards the end of the contact to show Mrs G that I understood what shed told me. This involved me paraphrasing or feeding back to Mrs G what theyd conveyed, in a meaningful way. This was also useful in having Mrs G clarify that this is indeed what she meant. Empowerment- Empowerment is more commonly used to describe service users being given meaningful choice and valuable options (Clark 2000: 57). I feel I provided Mrs G with choice and valuable options by providing her with information, informing her of the services available. I do feel I actively listened to G and responded by probing further on certain issues. On reflection, I feel the type of questions I asked G could have been more focused on the needs of G and Ge as apposed from having her explain about P. Initially I felt this may have given R an insight into what Gs life is like and I thought it may have been a good starting point however I feel I could have covered aspects such as how she coped when P was away to college, to dialysis. In saying this I do feel that G made it very clear particularly towards the end that the main concern for her at the minute was the fact that her son had no friends his age, was unable to get out and had nothing to look forward to. And continually expressed that this was the main issue for her and that if he had an opportunity to get out and socialise with others his age, this would positively impact on her as she would be able to relax if she felt P was happy and this would also act as a few hours respite for her as relationships in the family had been strained recently. I feel I did not communicate to Mrs G in a clear and concise manner what direct payments was and was unable to provide her with a clear distinction between that of carers allowance and direct payments. Looking back I went blank at this point and felt I could not think and panicked. As a result I looked to R for re-assurance. I do not feel I came across as a competent worker as on reflection I turned to my practice teacher when G asked me if a carers assessment was the same as a direct payment. Looking back on this I feel very silly as I knew the difference but I just recall going blank as I stumbled with how to explain the difference. I feel this was down to nervousness and as a result I panicked and turned to R for advice. I will definitely try to avoid doing this in future as it is not professional and service users expect that we as workers know what we are talking about. I feel I could have been better prepared with regard to knowledge in relation to direct payments and carers allowance etc. Although I thought I knew what they were, obviously hadnt read enough around them or had the information prepared in a way that would enable me to effectively communicate to the service user what they were. Although prior to the contact I felt I was prepared, On reflection, I feel I could have been better prepared with regard to familiarising myself better with direct payments and carers allowance etc. I should have prepared in my head how I would explain this to G in a way that was clear and concise that she would have understood. My main aims achieved were: I was successful in getting Mrs G to open up about her situation and her feelings I was successful in determining what it was she felt would best help and support her and her husband at the moment, which was providing them with respite by providing P with opportunities for social interaction. The main knowledge used and how it impacted upon my work: I had an understanding of Mrs Gs circumstances through previous visits with the family and carrying out a UNOCINI assessment and liaising with other professionals already involved with the family. I feel I tuned in thoroughly to Mrs Gs past history, current circumstances and her life and needs as a carer. I did not have a lot of knowledge about the appropriate way of completing the carers assessment form. From discussing the topic with my practice teacher and other work colleagues, I felt it was better to not bring the form in with me during the visit. I felt this may have put Mrs G of or have distracted her. I considered the sensitivity of some of the issues that Mrs G may be relaying to me and I wanted to give her my utmost attention, reassure that I was fully listening to her, engage fully with Mrs G and let her lead the interaction and speak openly about her situation. This then led me to apply the exchange model of assessment which looks upon service users as experts in their ow n lives. I tuned into the fact that no-one knew Mrs G and her life situation as well as herself and so I felt this model was ideal to apply as a method of assessment. The Life needs model is another model which informed my knowledge base prior to the visit. This is a developmental and social-ecological model and increased my knowledge base on key transitions in childrens lives. Although this model informed my knowledge base more so with regards to Ps UNOCINI assessment, it also allowed me to consider how Mrs G as a carer may be coping with Ps transition and current life stage of adolescence, as a carer and mother. Knowledge around assessment theory increased my knowledge base on what assessment is and what it involves. Erik Eriksons life stage theory increased my knowledge base around Mrs Gs life stage. Theories around loss increased my knowledge base as to how Mrs G had experienced loss as a consequence of Ps physical disability and his cancer. This was very significant as the focu s of the work was on assessing Mrs Gs needs as a carer, considering who she cares for, how that impacts on her life and how she effectively copes with her caring responsibilities. As a carer of a child who has a physical disability and who had had cancer and been treated with chemotherapy and has had two failed kidney transplants, this theory allowed me to tune into a number of losses Mrs G may has or may have had, losses in terms of lack of socialisation, independence etc. This knowledge allowed me to consider that Mrs G may have been affected psychologically, physically, emotionally and socially. One of my objectives for the visit was to discuss direct payments. I feel that I did not carry out sufficient research to allow me to explain this service clearly and concisely in a manner that Mrs G would have understood. I recognise that direct payments is a relatively new way of receiving services and other professionals are still learning about what they are and how they are used. How ever, this is an area I had planned to cover with Mrs G as it is one of the questions within the carers assessment form and thus I do feel I could have researched this area more concisely to ensure I was confident in explaining it in a way that Mrs G would have understood. I also feel I had a good grasp of the current family situation through completion of the initial UNOCINI assessment and thus I could have enquired into the familys eligibility for receiving direct payments prior to the visit. I feel I had already previously adequately researched into Ps renal condition, kidney dialysis, the effects, the importance of a restricted fluid and dietary intake and the consequences of not abiding by a restricted diet from completing Ps UNOCINI assessment. This information allowed me to further consider what life is like for Mrs G as a carer. I had already gained a great insight into the family circumstances through liaising with other professionals and completing the initial UNOCINI asse ssment. This knowledge was significant as it allowed me to consider the challenges Mrs G was facing as a mother and carer and thus I already had an insight into how she was coping with caring for P. I also done some research on carers of children who have disabilities which allowed to familiarise myself with what pressures and stresses carers are faced with on a daily basis. Throughout my work with this family I am constantly aware of overarching legislation such as the Childrens Order (NI) 1995, the Human Rights Act 1998, Disabled Persons Act (NI) 1989, and The Education (NI) Order 1996. The main piece of legislation that informed this piece of work however was the Carers and direct payments Act (NI) 1996. I must always be aware of the legal and statutory context in which I work. It is impossible to practice without coming up against the Law: it is impossible to practice effectively without an in-depth understanding of how the Law affects everyday social work practice (Johns, 2005:1). Looking back I strongly feel I could have increased my knowledge base more effectively around direct payments and familiarise myself with what the criteria is for eligibility for families. I have since spoken to other workers in the team and have read around the topic more and thus feel much more confident about the topic. The main values I used were: The NISCC Codes of Practice for Social care Workers underpins my professional value base and I felt this impacted when working with this family. I feel that I treated Mrs G and her home environment with respect by asking Mrs G prior to the visit if she would mind my practice teacher being present to observe my work. I feel I empathised with G by being understanding of her all that her and her family have come through in their lives to date. I felt I could easily empathise with her when she was referring to P and his medical history and his cancer. I considered prior to contact how devastating this particular time would have been in their lives and acknowledged the importance of showing empathy, particularly if this service user was willing to talk openly to me who she may have looked upon as a stranger, about such a sensitive area in her life. I empathised with her further when she talked openly about her older son also having been born with a renal condition and the ongoing everyday stresses and strains this had. I did not judge Mrs G. I listened openly to what she had to say and demonstrated empathy by being understanding of Mrs Gs circumstances at present and what she has come through to date. By being empathetic and understanding towards Mrs G, I feel she was more motivated to work in partnership with me. I feel I demonstrated respect by explaining the issue of confidentiality, explaining my student status, gaining consent and ensuring Mrs G was happy and content working with myself, a student, by reminding Mrs G of my student status and allowing her to clarify she was happy to proceed. Furthermore, I feel I respected Mrs G by pre arranging the appointment and turning up on time. I feel I demonstrated respect at all times throughout the visit by maintaining eye contact, listening to Mrs G, using silence when appropriate and allowing her to speak, gather her thoughts and express her feelings. I was genuinely interested in what Mrs G had to say, finding out m ore about her life and past experiences and I was honest and open which I feel contributed to an effective, positive working relationship with Mrs G. I made myself aware of any cultural/structural oppression that the service user may be experiencing, such as gender, religious issues. I also considered that Mrs G attended a Church group and that she and her family held firm religious beliefs and attended Church on a regular basis. Future learning requirements indicated by this piece of work What I hope to improve upon in the future: From looking back I can see that there are significant areas I need to develop my knowledge and experience in. For example I strongly feel I could have increased my knowledge base more effectively around direct payments and have familiarised myself with what the criteria is for eligibility for families. My lack of experience delivering direct payments is obvious here. I feel that my understanding on this topic could be improved through reading further on the topic and possibly shadowing other social workers in the team when they visit service users about direct payments. Being well prepared for what it is I want to cover during contacts is another significant area I need to work on. Looking back, I feel the contact had flowed up until the point at which I introduced the topic of direct payments. I feel, I already had an insight into the family situation through completing the initial assessment ad I knew that Mrs Gs main concern was that P did not have enough opportunities for social outlets and if I had prepared to introduce this topic, I should have previously enquired into whether this was an option for Mrs G and her family. On reflection this would have made much more sense as I would have had reasoning for introducing the topic and I would have been able to inform Mrs G of information that was clear, concise and accurate, preventing informing Mrs G of information that was inaccurate, risking false hopes and possible dis

Pulp Fiction Essay -- essays papers

Pulp Fiction The puzzle pieces are carefully fitted together as director Quentin Tarantino intermingles three different story lines in his hit movie Pulp Fiction. The movie begins in a quiet little diner as two petty robbers discuss their next mission. The mission in question involves two lovebirds (Amanda Plummer and Tim Roth) holding up unsuspecting restaurants, instead of their usual liquor stores. As their plan falls into action, time alters and we find ourselves riding down the street with Vincent and Jules John Travolta and Samuel L. Jackson), two hit men on their way to work. As the men travel to work they discuss such worldly things as gourmet food, like the "Royale with cheese", and the sexual innuendoes involved when one gives a foot massage. These two intellects do the dirty work for the infamous Marsellus Wallace (Ving Rhames). Due to Wallace's lifestyle, the movie branches off into three separate stories. The first tale begins when Wallace has some overnight business he must attend to. While gone, he leaves Vincent in charge of entertaining his beautiful wife Mia (Uma Thurman). After a surprisingly pleasant evening of dinner and dancing, Vincent must revive Mia after her abusive episode with heroin. The second adventure involves Wallace and a washed-up boxer, Butch, portrayed by Bruce Willis. Wallace gives Butch a substantial amount of money to throw a fight. After receiving the cash Butch decides to double-cross a double-crosser. The final episode revolves around Vincent's accidental murder of a young black in the back seat of Jules' car. This hilarious scene develops when Jules is forced to ask the "Wolf" (Harvey Keitel) to act as a clean-up man. As the 2 ½-hour movie unfolds, one must keep very alert and place the pieces together just right to complete the final picture. Before Tarantino begins his clip, he attempts to focus the audience by quoting two dictionary definitions of pulp. "The first one is literal: the second is the figurative usage, derived from magazines of the past that were published on cheap pulp paper and specialized in lurid fiction of several genres" (Kauffmann 26). With the making of his Cannes Film Festival winner, Tarantino changes all the rules restricting genre. "Tarantino has lifted up the dark rock of crime cliche and found a brilliantly colorful world thriving undern... ...r night out on the town with Vincent. Vincent also feels a sense of responsibility for Mia because of his relationship with Wallace. Even Wallace's enemy, Butch, goes out of his way to save Wallace from being "man-handled". Since Wallace's faith is only in those he has control over, loyalty appears to have a price. Because Tarantino's film Pulp Fiction branches off into several separate stories, one must concentrate hard to get the full affect of his work. With great talent he blends three main scenarios and several sub-plots into one full-length movie. Once completed he tosses in chaos, and ready to serve is an award winning film. Bibliography: Ansen, David. â€Å"The Redemption of Pulp.† Newsweek 124. (October 10, 1994): 71. Ansen, David and Charles Fleming. â€Å"A Tough Guy Takes Cannes.† Newsweek 123. (June 6, 1994): 79. Corliss, Richard. â€Å"A Blast to the Heart.† Time 143. (June 6, 1994): 73. Johnson, Brian D. â€Å"Making Crime Play.† Maclean’s 107. (October 24, 1994): 57-8. Kauffmann, Stanley. â€Å"Shooting Up.† The New Republic 211. (November 14, 1994): 26-7. Travers, Peter. â€Å"Movies Tarantino’s Twist.† Rolling Stone. (October 6, 1994): 79-81.

Development Of Coronary Heart Disease Health And Social Care Essay

In this essay I will debate about the relationship between high blood pressure and type 2 mellitus diabetes ( T2DM ) . Hypertension has a taking factor to play in cardiovascular diseases ; high blood pressure and diabetes affect the vascular tree. Hypertension is a long lasting status which makes the blood force per unit area rise above the normal norm, 90 % of high blood pressure is indispensable they can be classed as two different types primary and secondary, when you get high blood force per unit area because of other factors such as the kidneys or tumours this is known as secondary high blood pressure. Type 1 Diabetes is when your organic structure fails to bring forth insulin and requires insulin to be injected. Type 2 diabetes is when the organic structure is n't utilizing insulin in a correct and most efficient manner. Atherosclerosis vascular disease is besides known as coronary artery disease ; this is the thickener of the arterias and builds up of fat stuffs like cholester in. Connery bosom disease is when there is a obstruction in your Connery arterias because of fatty acids and stops the blood being pumped around the organic structure. The major factor to shots and bosom onslaughts is due because of relentless high blood pressure. From the NHS web site I can find that Connery bosom disease is the biggest slayer in the UK, at least 300,000 people dice of Connery bosom disease every twelvemonth impacting 1 in every 4 work forces and 1 in every 6 adult females. From the national UK nose count they say that the most common cause for the past 90 old ages has been Connery bosom disease, see table 1.1 ( from the tabular array you can see that in merely England and Wales disk shape disease is the most common. As age increases the opportunity of acquiring Connery bosom disease increases every bit good this is because of your immune system non working every bit good and because of the unhealthy life style being lived with non adequate exercising.Table 1.1Connery bosom disease occurs when the Connery arteries subdivision of from the chief aorta this is merely above the aortal valve, when fatty acids build up in the blood vas walls and shorten the transition manner of the blood to flux through. From the NHS web site I can find that Connery bosom disease is the UK biggest slayer, around 300,000 people have a bosom onslaught each twelvemonth there is about 1 in 6 adult females deceasing from the disease and around 1 in 4 work forces. Connery bosom dis ease when there are big sums of cholesterin in your organic structure this can besides take to atherosclerosis. In the US these figures are a batch higher the hazard of holding |CHD over 40 is 49 % for work forces and 32 % for adult females there has been a lessening in the figure of deceases from CHD for people aged 65 and under. But for people over the age of 65 there is a lessening in the figure of people deceasing from CHD but it is well more that people aged 65 and under. This is due to the life manner people have changed over the old ages. CHD decease rate as a per centum of 1980 rate among work forces and adult females aged 55-64 old ages in England and Wales ‘s clip span of 1980-1995 Type 2 diabetes can be genetically inherited non all is bad, some of them are good heritage they help forestall type 2 diabetes. A major factors for diabetes is obesity, from my statistics I can see that the national Centre for the wellness shows us that there is around 60 million corpulent people, this is because there is a higher hazard of insulin opposition because it interferes with the organic structure to utilize the insulin. The figure of kids with type 2 mellitus diabetes has besides increased. 90 % of people that have been diagnosed with type diabetes were overweight. There is excessively much fat in the organic structure and there is non adequate fiber and simple saccharides these all aid to the diagnosing of diabetes. Eating good and right can change by reversal these reactions and they can forestall type 2 diabetes. Peoples who have household diagnosed with type 2 diabetes have a greater hazard in developing it themselves. African Americans have a familial temperament tow ards type 2 diabetes. Age besides has a large part. FIG 1.2 Diabetes is when there is an addition in glucose and it rises above the normal degree, type 2 diabetes can besides be inherited genetically non wholly inherited diabetes is bad because some aids to forestall diabetes. From the national wellness statistics I can see that there is around 60 million corpulent people, fleshiness has a immense contributing factor to diabetes, the larger a individual is the higher the opportunity of the insulin being wasted and insulin opposition, type 2 diabetes increases the opportunities of a cardio vascular bosom disease this is due to your bosom working harder to get the better of the little sums of glucose being turned into glucose. If there is high degree of glucose or even if there is non plenty in your organic structure for a long period of clip this can damage the blood vass and can take to bosom onslaughts, shots and hapless circulation. Atherlersiosis is a status that hardens the arterias ; the arterias are blood vessles which carry rich O blood around your organic structure. The arterias harden due to the physique up of plaque this causes them to contract over clip and because of the arterias being narrowed there is less blood being pumped around the organic structure and to your bosom. The Plaque inside the Connery arterias is made up of fat, Ca and cholesterin, this status is known as coronary artery disease. This status causes the arterias to lose they elasticity ; this restricts the blood flow and causes high blood pressure which is addition of the blood force per unit area. This makes the arterial force per unit area to increase and causes the bosom musculus to work twice every bit difficult to pump the sum of blood a normal bosom would pump, these lending factors could take up to hold shots or even bosom onslaughts. Atherelerosis development is foremost when the fatty run is followed by the formation of plaqu e and so characterised of the increasing sum of macrophage and froth cells. Looking at FIG 1.3 you can see that A is a healthy arteria that would pump blood around the organic structure without a job, but from B you can see that there is a build up of plaque and this arteria would hold problem pumping blood about. Many people that have this status are incognizant but merely happen out after they have had a shot or a bosom onslaught, the chief intervention that is used for atherlerosis is to alter your life style, there are medical interventions and medical specialties that you can take to assist populate a healthier life style. Type 11 mellitus diabetes ; high blood pressure is linked together and all lead up to impacting the bosom. Age has a major function to play as this is an uncountable factor by acquiring one of these status e.g. high blood pressure this may take to atherlerosocis. All 3 conditions play a major function in impacting the bosom and barricading the blood vass. First if type 11 mellitus diabetes is developed and non looked after and controlled the sum of glucose will lift, as the glucose rises this puts force per unit area on the kidneys to increase their working rate to interrupt down the glucose and halt it from developing into cholesterin. When there is a build up of glucose and the is excessively much strain on the kidneys they begin to neglect and can non maintain up and this leads to cholesterol being deposited into the blood vass, as above in FIG 1.3 as cholesterin is deposited into the blood vass this leads to the physique up of plaque and eventually leads to atherolerosis. This ca uses the blood vass to halt working decently as it has restricted the blood flow, this changes the manner the blood is flowed through the arterias and leads to high blood pressure. Atherlerosis is the major cause of Hypertension. Hypertension has a prima function to play to Connery bosom disease this is the blood vass are already strained by the physique up of plaque and high blood pressure increases the strain which causes the blood vass to rupture and rend. The force per unit area builds up in the blood vass and the blood is filled in the cryings which cause coagulums and this leads to Connery bosom disease. The best manner in commanding conary bosom disease and handling it is to keep a healthy life manner. By commanding emphasis degrees will assist forestall high blood pressure, seeking to avoid emphasis and nerve-racking state of affairss and maintaining a positive head. Exerting on a regular basis helps the variety meats to work decently the NHS say at least 4-5 per hebdomad for exercising is required. To drop cholesterin degrees eating a balanced diet with at least 5 parts of fruit and vegetable and cutting back on fatso nutrients and saccharides. Eating meats in moderate parts will besides assist. Cuting back on tea, java and intoxicant can assist cut down the physique up of plaque and atherlerosis. Stevens, RJ et Al 2005 says A glass of ruddy wine daily is good for the bosom. Drug intervention for conary bosom disease is different for each person as the physicians prescribe you medication on your life style and side effects. Low doses of acetylsalicylic acid could be given as this helps to forestall blood curdling and reduces the hazard of bosom onslaughts. ACE inhibitors could be taken these aid to handle high blood force per unit area besides known as high blood pressure, this causes the blood vass to loosen up and widen and assist to take down the blood force per unit area. The drugs nitrates may besides be used this helps to forestall thorax strivings and besides widens the vass. To assist command cholesterin degrees a statin drug is used these types of drugs are merely prescribed after the non-drug interventions described as above have all been extinguished this drug helps to forestall shots and bosom onslaughts. The chief types of drugs that are used to assist handle conary bosom disease are lipid-lowering medicines and ACE inhibitors. hypertext transfer protocol: //www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx hypertext transfer protocol: //www.healthcentral.com/heart-disease/drugs.html

29 Memorable Quotes From Elf

Since it was released in 2003, the movie Elf  has become a Christmas classic. Directed by Jon Favreau and written by  David Berenbaum, the film tells the story of Buddy (Will Ferrell), an orphan who is adopted and raised by elves at the North Pole. Believing himself to be an elf, Buddy begins to encounter trouble as he gets older and becomes too large to use the toy-making machines. He eventually learns that he is human and sets out for New York City in search of his birth father. Of course, hilarity ensues as Buddys childlike innocence meets the cynicism of the big city. Elf was a box-office hit, winning praise from critics and audiences for its quotable lines and Ferrells high-energy performance. Its refreshing take on innocence, goodness, and Christmas cheer still resonates with audiences. The quotes below include Buddys most famous lines. Swirly Twirly Gumdrops Buddys journey from the North Pole to Manhattan is one of the most famous scenes in Elf.  The sequence places live-action Ferrell within the stop-motion animated world of the classic  Rankin/Bass Christmas specials. Buddys description of his trip is one of the most famous quotes in the movie: I passed through the seven levels of the candy cane forest, through the sea of swirly-twirly gum drops, and then I walked through the Lincoln Tunnel. Encountering the Human World Much of the comedy  comes from the contrast between Buddys boundless cheer and the gritty realities of New York. Buddy has no experience in the human world. All he knows are ice skating and reindeer, candy canes and toys. Hes not prepared for the Big Apple. [On seeing a sign that says  Worlds Best Cup of Coffee]  You did it! Congratulations! Worlds best cup of coffee! Great job, everybody! Its great to be here. Good news! I saw a dog today! Im a  cotton-headed ninny-muggins. [To a doctor  performing  a paternity test] Can I listen to your necklace? [To a man on the elevator] Oh, I forgot to give you a hug. Its just nice to meet another human that shares my affinity for elf culture. Francisco! Thats fun to say! Francisco.  Frannncisco.  Franciscooo. [Answering the phone] Buddy the Elf! Whats your favorite color? Have you seen these toilets? Theyre GINORMOUS! [On cabs] Watch out, the yellow ones dont stop! [On the mail room] Its just like Santas workshop! Except it smells like mushrooms...and everyone looks like they wanna hurt me. [After chasing half-brother Michael] Wow, youre fast. Im glad I caught up to you. I waited five hours for you. Why is your coat so big? So, good news — I saw a dog today. Have you seen a dog? You probably have. How was school? Was it fun? Did you get a lot of homework? Huh? Do you have any friends? Do you have a best friend? Does he have a big coat, too? [From a note on an Etch A Sketch]  Im sorry  I ruined your  lives and crammed 11 cookies into the VCR. The best way to spread Christmas  cheer is singing loud for all to hear. We elves try to stick to the four main food groups: candy, candy canes, candy  corns, and syrup. Does somebody need a hug? I just like to smile! Smilings my favorite. Son of a nutcracker! Falling in Love Elf wouldnt be a Christmas classic if it didnt have a love story. After moving to Manhattan, Buddy begins hanging around the department store Gimbels, where he meets Jovie (Zooey Deschanel), one of the stores employees. At first, Jovie doesnt know what to make of Buddy, but she soon falls in love with his Christmas spirit. First, well make snow angels for two hours, then well go ice skating, then well eat a whole roll of Tollhouse cookie-dough as fast as we can, and then well snuggle. I think youre really beautiful and I feel really warm when Im around you and my tongue swells up. I thought maybe we could make gingerbread houses, and eat cookie dough, and go ice skating, and maybe even hold hands. Fake Santa at Gimbels Buddy is a kind, good-natured man. The only time we see him get angry in the movie is when a Santa comes to Gimbels and Buddy takes him to be an imposter, loudly insulting him. Buddy doesnt treat Santas elf much better. [Seeing a sign that Santa is coming to the toy store]  Santa! Oh my god! Santas coming! I know him! I know him! [To the fake Santa]  You stink. You smell like beef and cheese! You dont smell like Santa. What about Santas cookies? I suppose parents eat those, too? You sit on a throne of lies. Im in a store and Im singing! Hes an angry elf. [After getting beaten up by a little person, played by Peter Dinklage]  He must be a South Pole elf.