Health of Democracy

Democracy is a form of government system in which the government is chosen from the common man and it works for that common man and the representative are also selected among themselves . so it is rightly said it’s a form of government for that people , by the people from the people .. India being one of the oldest democratic country of the world has seen many changes in its democratic system but lately it has been there is an influence of certain section of society and people over the working of the government which has led to a widening gap between number of rich and poor in the country . the common man is not getting his shares of value in a democratic country which he must get . in present days it has been seen that many people such as social as social activities , reformers and political reformers are rising there voice for this in correct from of democracy in which the common man is suffering although he abites all rules and regulation . . A new party has been recently set up and also warm in one of the leading states was advocating a fact that there must be a participation of government and common people to remove this corruption and would try to change the present democratic system into a more open and transparent system in which the common man could be benefited with such a approach this is making a great impact in today political environment as people belive them to do parties are also compiled to change there way of governance . so I think that this is a good step to change the health of the democratic and increase public participation .

Graphic Novels Are They `` Real `` Literature - 916 Words

Graphic Novels: Are they â€Å"Real† Literature? Graphic novels are an up and coming new genre of literature. In any aspect, new concepts and ideas that are introduced are always put into question of how capable they are. Many people believe that graphic novels are not a type of literature that can be used in a classroom because they are not â€Å"real books† (Crawford Weiner, n.d). I believe that graphic novels should be offered and encouraged in classrooms. According to Julia Rick, many educators are hesitant to use graphic novels in the classroom. She also states that the reason behind their actions is because they are not educated in graphic novels (Rick, 2011). They do not want to teach something to their students that they are not completely familiar with. Educators also believe that, when they incorporate graphic novels into the curriculum, they are taking away the importance of traditional text. I believe there are many benefits to using Graphic novels in the classroom. Graphic novels have many different elements of literature all in one format. For instance, in Romeo and Juliet The Graphic Novel: Original Text, there are pictures, dialogue, and narratives all within the book. They allow students to make the connections needed to understand the plot. When dealing with a difficult literature such as Romeo and Juliet having those other elements helps readers understand what is happening in the scene, while trying to interpret the text. In a study conducted byShow MoreRelatedGraphic Novels : Literature? Yes, But Not All Them Can Be Classified As Literature995 Words   |  4 PagesAre graphic novels literature? Yes, but not all them can be classified as literature. Some people think that graphic novels are literature, while others disagree. A few teachers even prefer to use graphic novels as their main source. On the other hand, other teachers consider graphic novels as lack ing knowledge. Thus, the answer to this question varies from person to person depending on how they see things. Not all graphic novels are literature, but they can be. What is literature? Literature isRead MoreThe Dark Knight Returns, By Jorge Luis Borges Essay1082 Words   |  5 PagesWriter, Jorge Luis Borges says, â€Å"The things that are said in literature are always the same. What is important is the way they are said.† Literature is such a broad, all encompassing term that much is lost in translation. This is part of the reason behind the ongoing brawl: what qualifies as literature? In the case of graphic novels, they are often cast aside by critics, deemed definitively inferior and lacking intellectual merit. However, this assumption does not hold up in today’s world of literaryRead MoreGothic Realism And The Vampire Sub Cultures1512 Words   |  7 Pagesromantic and young adult literature and in celluloid. Vampire graphic narratives are finding increased popularity and have since developed into an â€Å"Iconic popular culture phenomenon drawing an obsession and fascination globally†. (Jacqueline, Ng, 2014) So what inspired this new genre of graphic narrative? Ghouls, ghosts and terrifying monsters have been around since the days of old, but the roots of horror graphic narrative begins in the late 18th century with Gothic Literature. To many the word GothicRead More Personal, Social, and Cultural Contexts Established by the Frame Story in MAUS1635 Words   |  7 PagesEstablished by the Frame Story in MAUS  Ã‚      The use of the frame story, an overarching narrative used to connect a series of loosely related stories, pervades literature. An example of a frame story on a large scale - tying together a whole book-length work, not a simple short story - can be found in Art Spiegelmans graphic novel MAUS. Each of the narratives six sections is framed with snatches of the interaction between Vladek and Art during the interview that supposedly occurred to createRead MoreAnalysis Of `` No Matter What Their Genre `` Essay1675 Words   |  7 PagesPeople have always enjoyed graphic novels for as long as they have been around. They have been used to spread around an important message, politic viewpoints, explore new ideas in literature, and expose different styles of art to people around the world. There are many genres, graphic novels can fall into, but a large majority of them will always be fiction because then the authors can expand more into their stories than they can with non-fiction. â€Å"Today, images still have the power to elicit aRead MoreThe Ideology of War Essay836 Words   |  4 Pagesenvelope for our behavior. We create ideology. We stop simply killing each other because we want to. We kill each other because of religion, patriotism, democracy, nationalism and other reasons which now justify our behavior. Marjane Satrapi in her graphic novel â€Å"Persepolis† illustrates for us how war and ideology work hand by hand on her own life example of growing in Iran during Iran-Iraq war. Her book illustrates how war and ideology can switch all value in our life when death becomes a great pleasureRead MoreUnderstanding Art Spiegelmans Maus1204 Words   |  5 PagesWhen beginning to understand Art Spiegelmans 1991 Maus, one must also remember that no literary work exists within or around a vacuous context, and that each piece of literature is ultimately influenced by the social and cultural contexts of both the author and the reader. This graphic novel is no exception. Each of the six sections within the book is framed with bits of the interactions between Vladek and Art during the interview that seemingly occurred to form the book. This framing acts as aRead MoreThe Comic Book MAUS1288 Words   |  5 PagesHolocaust but within the Jewish community pertaining to the appropriateness and representational meaning of the Holocaust in the modern literature. Many people who participate in the discussions or read the book have perceived the comic fashioning of the book as trivial, hence making the book appear as mocking, derogatory and comedic. Nevertheless, this is not the real purpose for the format employed by Art Spiegelman. The comic representation plays a critical role in ensuring that the message is atRead MoreThe Melting Pot By Harriet Jacobs874 Words   |  4 Pagesthis; we can enjoy a bounty of American Ethnic Literature. What does this mean? American Ethnic Literature are the poems, novels, and histories written by the minor ity peoples of this new world. They were the outsiders of a predominately white world and therefore had an experience like no other. African American, Native Americans and Mexican Americans have a rich deep heritage that was immortalized in writing. African American Literature began as graphic slave narratives, accounting life in bondageRead MorePersepolis : The Invisible Art Essay1369 Words   |  6 PagesPersepolis In graphic memoir Persepolis, Marjane Satrapi illustrates the eventful life of Marji, an Iranian girl’s living most of her life in Tehran, Iran during the Islamic Revolution. The author commences her story as child and creates a timeline of series of events as she enters adulthood. Marji, represents many disenfranchise women, as she faces discrimination, exile, and confusion in her own country. Uniquely, Starapi’s work can be a justification to prove Scott McCloud’s design theories in

Questions On Electronic Fiscal Devices Essay - 830 Words

2.0 Introductions This chapter summarized the studies from other researchers who have carried out their research in the same field of study. The specific areas covered are the background Electronic Fiscal devices and its challenges faced by user of EFD machines in Tanzania by drawing inference from all over the world. 2.1 Definitions of Electronic Fiscal devices Electronic fiscal device involve wide variety of technological devices that tax authorities use to monitor transactions (IMF, 2013). It is further defined as tool for efficient management controls in areas of sales analysis and stock monitoring and control (TRA, 2012). It is also defined as small machines that are used to determine the amount of Value Added Tax remitted to the government (Mapira, et al., 2000). The commonly used types of EFDs are Electronic Cash Registers, Electronic Tax Registers, Electronic Signature Devices and Electronic fiscal printers (EFPs). 2.2 Theoretical literature reviews 2.2.1 Background of electronic fiscal devices EFD was initially used by Italian authority then followed by Greek Tax Agency before spreading to other countries (Casey Castro, 2011) and the machine became popular in 2000s where a number of efforts had been done by international organizations such as IMF to promote uses of EFD machines. (IMF, 2013) The EFD purposes do not differ between the countries implementing EFD for instance Dominican Republic adopted EFD with aim of controlling local sales intended for intermediateShow MoreRelatedThe Challenges Faced By Taxpayers1026 Words   |  5 PagesZULU STUDENT NUMBER: R 154659 V ACADEMIC FACULTY: FACULTY OF COMMERCE DEPARTMENT OF ACCOUNTING MODE OF ENTRY: VISITING PROJECT PROPOSAL A qualitative case study on the challenges faced by Taxpayers in using Electronic Fiscal Devises in calculating Value Added Tax in Zimbabwe. A Case study of some selected taxpayers in KweKwe. CHAPTER ONE INTRODUCTION 1.0 Background of Study Tax evasion and avoidanceRead MoreSony Corporation Case Study1210 Words   |  5 Pagesof their business that is causing losses. Thus in summary Sony wants to narrow its focus and sell the PC to a Japanese firm who will target Japan in particular. The questions are many concerning this move that even if Sony cuts its costs what about its market share will it be reduced as it will offer fewer products? Another question related to Sony’s case is it better to diversify and have a wider range of products or specialize and focus on less products of higher quality? Article: Sony Warns ofRead MoreIntroduction Of Apple Inc. Essay1051 Words   |  5 PagesIntroduction (KS) Apple Incorporated is a multination technology company that designs, manufactures, and markets, mobile devices used for communication and multimedia purposes. The company also offers various software, services, applications, and accessories to accompany its’ devices. Based in Cupertino, California, the company was founded on April 1, 1976 by Steve Jobs, Steve Wozniak, and Ronald Wayne. The original goal of the company was to create and sell personal computers. 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They are able to perform these tasks by maintaining surveillance from covert positions and responding to electronic sensor television systems, aircraft sightings, and utilizing tracking skills. Some of the major activities used by CBP officers are basically traffic checks throughout rural areas to include city patrol and anti-smuggling activities. The HASRead MoreSony : One Of The Foremost Tech Corporations1202 Words   |  5 Pagesthis helps them to provide ground-breaking excitement and entertainment in variety of ways that only the company is able to. At the present, the company is engaged in the development, design and manufacture of various kinds of electronic equipment and instruments and devices for consumer and industrial markets. Over the years, the company has become a worldwide industry leader in technology, and has released many products along the way. One of the company’s secrets to success is they tend to createRead MoreWorkforce Diversity: Samsung Electronics1427 Words   |  6 PagesSamsung Electronics Table of Contents Chapter One 3 Introduction Chapter Two Literature Review 4 Sustainability Report 5 Forbes Insights 6 Reference 3 Chapter Three 7 Methodology Qual: Interview Qual: Survey Quant: FM Chapter Four 8 Discussion Chapter Five 10 Conclusion 11 Sources Introduction Samsung Electronics Co Ltd was founded in 1938 Seoul, Korea. The company has been around for decades, providing the world with â€Å"electronic products amp; device solutions†[9]

The Mexican Mafia And Organized Crime - 3946 Words

The Mexican Mafia, or â€Å"La Eme†, as they refer to themselves, is one of the most powerful and influential organized crime gangs in the United States. The organization has risen through the decades of mass gang wars and violence to become the power it is today. Their control is limitless and they have ventured far beyond the expectations of what was thought that gangs were capable of. They have infiltrated governments and manipulated politics. They have taken over neighborhoods and attempted to ethnically cleanse them. Innocent people have become caught up in the affairs of La Eme throughout its history and many have faced violence and death at their hands. This paper is a continual of the case analysis of the Mexican Mafia and will attempt to provide explanations for some of the crimes committed by this organization. Researching gangs and organized crime is important because of their large influence and control over many aspects of daily life. The significance of attempti ng to provide causations of their crimes can better provide the criminal justice system a clearer understanding of problems that lead to gang members committing crimes on behalf of the organization. A clearer understanding of problems can help the system to provide solutions to combat situations that inhibit crimes. *. Theories *. Social Disorganization Theory Before we provide theories in depth on the micro level, we must establish the broader concept on the macro level of the location where many of theShow MoreRelatedOrganized Crime Group Analysis1527 Words   |  7 PagesOrganized Crime Group Analysis Team A CJA 384 Organized Crime Group Analysis In this paper it was asked of us as a team to give an in-depth historical analysis of an organized crime group. With this class being about organized crime one would think to write about mobsters, but we decided to think outside the box. Even though when thinking of organized crime the first thought is The Italian Mafia and groups of that sort, one has to remember that organized crime comes in many different formsRead MoreEssay about Japanese, Russian, Chinese, and Mexican Organized Crime1042 Words   |  5 Pages Organized crime is an international issue and it exists in several different countries, such as; Italy, China, Japan, Russia and the United States of America. Although all these groups of organized crime have many things in common they tend to have different ways of doing something, or they may not do them at all. Many also commit similar types of crimes, and others commit crimes other groups would not. It is thought that the Russian Mafia has existed in Russia for several centuries. 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They are: Aryan Brotherhood, Black Guerilla Family, Mexican Mafia, La Nuestra Familia, Neta, and the Texas Syndicate (Smallagher Smykla, 2015). Why do many inmates desire to become a gang member once they are incarcerated? According to the text, â€Å"there areRead MoreOrganized Crime : Small Street Gangs Or Terrorist Groups883 Words   |  4 PagesComprised of distinct elements that assist in establishing and defining organized crime in small street gangs or terrorist groups are national or transnational criminal organizations. Organized crime groups have an organized structure. These structures include hierarchical structures or other similar structures which establish a clear chain of command. Having a structure provides knowledge of every member’s role in the organization; who gives the orders and who needs to obey and carry out the commandsRead MoreThe Fight Organized Crime Regime1692 Words   |  7 Pages21st century, organized crime has grown in complexity. With this new era, law enforcement has been made to change and improve the ways in which they try and fight organized crime. With the use of technolo gy, the new organized crime regime have used technology to its advantage and are seen as a very real threat to US law enforcement. Most members of law enforcement, anti-mafia NGOs and academic and journalistic analysts insist upon the fact that from the mid-1990’s on up, the anti-mafia fight dramaticallyRead MoreCriminology995 Words   |  4 PagesOrganized Crime By Rita Goforth July 22, 2013 CJA/384 Criminal Organizations Instructor Jack Tandy When I think about organized crime and its very definition I immediately think of is the Italian Mafia, which has been portrayed in various articles, news casts, and historical culture and let’s not forget the many movies that have been made. This alone does not define what organized crime group are though I’m sure at one time it was the primary indicator for organized crime. Yet today thisRead MoreThe Impact Of Drug Trafficking And Organized Crime1099 Words   |  5 PagesThe United States has a vast illegal drug market as well as high numbers of people indulging in organized crime. Drug law enforcement personnel face problems when protecting the United States borders to avoid any drug trafficking instances. Drug trafficking involves smuggling of illegal drugs producing states such as Mexico to the consumer markets in other regions within the United States Organized Crime, on the other hand, is the practice of the offense through threats or violence and aims to collec tRead MoreSecurity Threat Groups And Prison Gangs1665 Words   |  7 PagesSecurity threat groups and prison gangs are responsible for a lot of the crimes that occur in prison. Well-organized and highly structured prison gangs who have leaders and influences have been around decades. Gangs in prison can be described as groups whose activities pose a real threat to the safety of the institutional staff and other inmates and also to security of the correctional institution (Beth, 1991). These gangs always have strong leaders and use that leadership role to their advantageRead MorePrison Gangs2927 Words   |  12 PagesPrison Gangs Michael Dooley Aiken Tech CRJ 242.013 Prison Gangs Prison gangs are flourishing across the country. Organized, stealthy and deadly, they are reaching out from their cells to organize and control crime in Americas streets. Law enforcement personal began to systematically monitor gang activities in the 1970s. Working together, their initial attempts were to identify only gangs which had some semblance of formal structure, a constitution, bylaws, mission statement, or some identifiable

The Media Of The Oil Spill Of 2010 From China, The United...

Modern culture thrives on news media as our primary source of information, but this creates an information overload from all of the various perspectives in coverage. Media coverage is essential is our development and understanding of international affairs. Therefore, the biases in coverage can have drastic effects in our interpretation of world’s news. Countries tend to present their news in a way that favors them and their governmental responses, but coverage of other nations can be telling of their relations. The use of word choice, tone, and even selective use of quotes can have drastic effects on people’s perceptions of the information from the media. This can be observed in the media analysis of the Xingang Port oil spill of 2010 through news sources from China, the United States, and Ireland. While some nuances of American news media still portray competition between the United States and China, the portrayal of the oil spill proves that both countries are working toward improving relations with each other. The relationship between China and United States previous to the spill was pretty stable in regards to oil and energy. But the United States was feeling increasingly frustrated with the Chinese trade policy as they refused to revalue the Yuan. In 2010, China was both the second largest consumer and the second largest importer of crude oil behind the United States (Hays). China had begun collecting oil for its national oil reserve in 2004 and most of this oil isShow MoreRelatedInternational Management67196 Words   |  269 PagesCompanies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning. Some ancillaries, including electronic and print components, may not be available to customers outside the United States. This book is printed on recycled, acid-free paper containing 10% postconsumer waste. 1 2 3 4 5 6 7 8 9 0 QDB/QDB 1 0 9 8 7 6 5 4 3 2 1 ISBN 978-0-07-811257-7 MHID 0-07-811257-5 Vice President Edit or-in-Chief: Brent Gordon Vice President, EDP/CentralRead MoreLas 432 Research Paper: Gmos20901 Words   |  84 PagesMembers: Aakash Desai – D#01297308 Thomas Graf - D#01260952 Justin Greene - D#03529375 Lauren Kaminski - D#00724282 Stephanie Lopez - D#03452598 Terrance O’Connor - D#01683321 Abstract This report discusses Genetically Modified Organisms from the perspective of a pro and con standpoint. It will be up to the reader to determine what opinion or viewpoint in which they will have in regards to this subject. 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AND TOP 5 PURCHASING COUNTRIES China Poland Italy Germany Sweden 20% 18% 8% 6% 5% 16% 11% 10% 7% 7% 192 China Japan 48 12 Australia 3 ââ€"   IKEA GROUP sales totaled 21.5 billion euros. ââ€"   THE IKEA GROUP had ââ€"   IKEA fOOd SERvICES ââ€"   IKEA SUPPLIERS numbered 1,220 in 54 countries. reported sales of 1Read MoreGp Essay Mainpoints24643 Words   |  99 Pages GP NOTES 2010 (ESSAY) Content Page 1. Media a. New vs. Traditional b. New: narcissistic? c. Government Censorship d. Profit-driven Media e. Advertising f. Private life of public figures g. Celebrity as a role model h. Blame media for our problems i. Power + Responsibility of Media j. Media ethics k. New Media and Democracy 2. Science/Tech a. Science and Ethics b. Government and scientist role in science c. Rely too much on technology? d. Nuclear technologyRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. 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Acute Care Care Implementation and Evaluation. Free Essays

Acute Care: Care Implementation and Evaluation. This assignment will be based around the care that is implemented and evaluated, within a National Health Service (NHS) Foundation Trust (FT). The focus of the assignment will be to discuss two health problems that a selected patient has and has been admitted to the FT with. We will write a custom essay sample on Acute Care: Care Implementation and Evaluation. or any similar topic only for you Order Now The selected patient had been admitted into FT with breathing difficulties and also suffering from dehydration. The assignment will focus upon the goals that are set for the patient whilst in FT and the reasons why the goals are set. The patho-physiology of the two problems will also be discussed and also the care that had been implemented to achieve the goals. Throughout the assignment, the patient will be known as Terry with the permission from the patients parents, according to the Nursing and Midwifery Council (NMC, 2008) confidentiality guidelines. The assignment will also aim to discuss the role of the Health Care Professional (HCP) in planning appropriate care for the patient, in particular, using the assessment technique of goal setting by using Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique (Roper et al, 1996). The reasons for planning care can involve the HCP assisting in preventing potential health problems, for example, breathing difficulties for the patient becoming worse and to also assist in solving problems where possible. Care planning can also assist in alleviating possible health problems that cannot be solved by HCP’ s and so will need the assistance of Multi Disciplinary Team (MDT) , for example, consultant, physiotherapists to further improve an develop the care plan. Terry is a 42 year old single man, who lives with his parents, and has suffered from a number of illnesses throughout his life, for example, optical glyoma, Deep Vein Thrombosis (DVT), epilepsy, and also learning difficulties. Terry has difficulty with breathing, and this appears to have been caused by respiratory rhythmicity centre in the medulla and the pons (areas of the brain which can control breathing) and these appeared to not be working in the correct way (MacKenzie, 1996; Waugh et al 2006). Terry’s reduced neurological status was due to trauma that had been suffered in the motor pathways, and the peripheral nerves, in the brain (Iggulden, 2006). Terry was admitted to the Intensive Care Unit (ICU), within the NHS FT, suffering from numerous problems that were mainly neurological. Terry’s admission to ICU was due to the increased breathing difficulties that he was experiencing. Due to the breathing difficulties, the nursing team, and Terry’s consultant, agreed that it would be best for Terry to have a percutaneous tracheostomy inserted. Due to Terry suffering from a probable cerebellar lesion, severe learning difficulties and poor communication skills; it did appear that Terry could not understand what the nursing team were informing him of, the medication that he needed and the care that was being delivered (NMC, 2008). Due to the fact that Terry appeared not to be able to understand or communicate with the nursing team, and that his parents and family members were with him, the nursing team, and myself, ensured that the parents, and family members, were informed of what was happening regarding the care that had given to Terry. The fact that Terry could not understand the instructions given to him, due to learning difficulties, consent to insert a percutaneous tracheostomy had to be given from Terry’s parents, to the Consultant (NMC, 2008). The tracheostomy that had been inserted into Terry helped the nursing team in the ICU and on the ward, to oxygenate Terry to the optimum level of 98%. The tracheostomy, also ensured that Terry was able to maintain a breathing rate of between 35 and 50 breathes per minute (Bailey, 2008). Although Terry was able to maintain a respiration rate, the normal respiration rate for an adult is normally between 14 and 18 breathes per minute (Bailey, 2008). The nursing care that had been implemented included ensuring that oxygen was flowing through the tracheostomy and this ensured that Terry had enough oxygen in his body for his heart and lungs to function, and that the heart pumped the oxygenated blood around the body (Machin et al 1996; Roper et al, 1996; Bailey et al 2008). Due to Terry’s respiration centre not working properly, and suffering from breathing problems, this meant that gaseous exchange was impaired, and led to a risk of respiratory acidosis. Gaseous exchange is where the oxygen goes into the alveoli capillaries, and the carbon dioxide is moved out of these capillaries (Bailey, 2008). The respiration centre is made up of a group of nerve cells, which are in the reticular endothelial system of the medulla oblongata. These cells send impulses to the motor neurones, via the spinal cord, and are then sent to the intercostal muscles (Bailey, 2008). The trauma that Terry had suffered with, was a possible cerebella lesion when he was a child. When Terry was admitted, his oxygen level was 82% (Bailey, 2008). The goal for this problem was to keep Terry’s respiration and oxygenation at a level that was suitable. A suitable level of respiration for an adult is between 14 and 18 breaths per minute, and an oxygen level of around 97 to 98% (Bailey, 2008). The patho-physiology of breathing difficulties includes a lack of oxygen to the tissues of the body, including the brain, and even death (MacKenzie, 1996; Waugh et al 2006). Due to Terry haiving an oxygen saturation level of 82%, we set the goal that we would aim for and set this goal with his parents. The goal that the nurses had set with Terry’s parents, due to the fact that Terry had learning difficulties and could not set the goal with the nurses. The goal was set as the nurses aimed to have his oxygen saturation level between 95% and 98% within two hours. The goal had to fit in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique (Roper et al, 1996; Faulkner, 2000). Terry’s sitting and lying position had to be carefully planned around him, this ensured that we as a nursing team where able to ensure that his lungs would expand to their optimum and to maintain a satisfactory oxygen saturation levels within his body (Roper et al 1996; Machin et al 1996; Hackman, 2008). The normal oxygen saturation level is between 95% and 98% (Woodrow, 1999). The fact that Terry had an oxygen saturation level of just 82%, the Consultant had to prescribe oxygen for Terry. The oxygen that had been prescribed for Terry, had been increased from 24% to 40% (NMC, 2002). The consultant advised us to ensure that the oxygen was to be humidified. Due to Terry having the tracheostomy, we were able to deliver the oxygen with the use of a tracheostomy mask and what is called a T-piece circuit (Machin et al 1996; Dolan, 2008; Soady, 2008). The consultant also advised the nursing team to ensure that neurological observation’s were undertaken, especially the oxygen saturation levels, every 15 minutes until Terry’s oxygen saturation levels had risen to 96% (Machin et al 1996; Dolan, 2008; Soady, 2008) The neurological observations with regards to the goal, meant that the nurses were able to deliver oxygen, which would enable the oxygen saturation level to be maintained (Machin et al 1996; Dolan, 2008; Soady, 2008). Once the nursing team had ensured that the oxygen had been delivered to Terry at 40% and was humidified, they then ensured that 15 minute observations were maintained. The Consultant had to ensure that the 40% oxygen that he had verbally prescribed, was documented and written clearly in Terry’s medical notes and on his prescription sheet (NMC, 2002; NMC, 2004). The fact that Terry had been prescribed the higher rate of oxygen, this needed to be clearly documented within Terry’s nursing notes (NMC, 2004). The documentation was needed, so that the other nurses were aware of the change. Although the observations had been maintained every 15 minutes, with regards to Terry’s oxygen saturation levels, this ensured that the nursing team maintained Terry’s neurological observation’s (Machin et al 1996; Dolan, 2008; Soady, 2008). The goal that had been set by the nursing team and Terry’s parent’s, for his oxygenation levels did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique. The goal was specific, measurable and realistic for Terry and the nursing team caring for him, as well as being achievable in the time frame that had been set by Terry’s Consultant (Faulkner, 2000). Due to the fact that the nursing team had achieved this goal for Terry, proved that the nursing care and interventions made by the nursing team, were effective. The nursing care and interventions were effective enough, for this goal to have been met (Roper et al 1996). The goal that had been set for Terry with regards to his oxygen saturation level, had to be documented. The goal had to be documented within the nursing notes, which the nursing team had to document clearly. The nursing team were able to hand over the information about Terry, to the nursing staff that would have been caring for him on the next shift. (NMC, 2004) The second of Terry’s problem’s is that he was at risk of dehydration, this was due to the fact that Terry could not swallow as he had a reduced neurological status. The fact that Terry could not swallow was due to the motor area of cerebral cortex of his brain, did not work in the way that it should (Waugh et al 2006). The motor area of the cerebral cortex of Terry’s brain, was damaged due to the increase in epileptic seizures. Dehydration can cause the cells to deplete, due to not having enough fluids for them to replenish. The cells replenish in the sense that the fluids help the cells to regenerate, regulate the body temperature, to dilute the waste products within the body, and to maintain the level of fluids within the tissue fluid and blood (Waugh et al 2006). The patho-physiology of dehydration includes thirst, the mouth being dry, the tongue would look leathery, and fluid from within the tissues and skin would be withdrawn (Roper et al 1996; Brown, 1997; Day, 1997). Due to Terry not being able to drink fluids, he was not able to regulate his own body temperature, nor was his body able to dilute the poisonous substances in his body (Waugh et al 2006). Due to fluid being withdrawn from the body, this would mean that the body would not be able to maintain its own volume in blood (Roper et al 1996). The patho-physiology of not having enough fluids also includes the kidneys would excrete less than they normally would; a person would be lethargic; the skin would lose its elasticity and would appear to be more wrinkled (Roper et al 1996; Brown, 1997; Day, 1997). If Terry had been suffering from dehydration, his would have looked sunken and his urine output would be reduced as well as being more concentrated. If Terry had been suffering from a severe case of dehydration, his blood volume would be reduced. If the blood volume was to cause a circulation deficiency, this would cause his kidneys to fail to excrete the waste products that they normally excrete (Roper et al 1996; Brown, 1997; Day, 1997). Due to Terry not drinking the recommended two litres of fluids per day, we had to set a goal. The goal that had to be set, had to be set with Terry’s parents (Roper et al 1996). The goal for the second problem, was to prevent dehydration during Terry’s stay in hospital, through ensuring that Intravenous Saline was delivered through venous access (Dougherty et al 2008). The Intravenous Saline had to be delivered through venous access, due to the fact that this was the most effective way in which to infuse fluids. The fluids had to be infused over a period of 24 hours, due to the volume of the fluids. The Consultant prescribed two litres of Intravenous Saline, and the nursing team ensured that it was delivered (NMC, 2002; NMC, 2004; Dougherty et al 2008). Due to the fact that the fluids needed to be infused, the nursing team ensured that the fluids were delivered through the venous access, by using an infusion pump. The pump that was used by the nursing team, was the volumetric pump. The volumetric pumps allow health care professionals to administer large amounts of infusions, and this is why were used this type of pump to deliver the fluids that Terry needed over a 24 hour period (Sarpal, 2008). Due to the fact that the nursing team were delivering Intravenous Saline to Terry, it was important that this was documented by the nursing team within his nursing notes. The fact that this was documented in Terry’s notes, ensured that the information was handed over to the nursing team on the next shift (NMC, 2004). It was important hat a fluid balance chart was also documented, as this would help the nursing team to ensure that the amount of input from fluids, was similar to Terry’s urine output. The fact that the nursing team were able to monitor Terry’s fluid input and output, ensured that his body was not retaining any of those fluids within a 24 hour period (Hunt et al 2008). The goal for dehydration by providing two litres of Intravenous Saline over a 24 hour period, did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique. This was due to the fact that the goal was specific, measurable and time set. The goal was achievable and realistic, but only while Terry’s venous access was as good as it was. When Terry’s venous access for the Intravenous Saline to be delivered was poor, this meant that the nursing team had to find another route to deliver these fluids. The nursing team had to re-set the goal for delivering the Intravenous Saline. (Faulkner, 2000) Due to the fact that the nursing team could not deliver the Intravenous Saline through the venous route, had to be documented. The nursing team had to document the fact that Terry had poor venous access, and that they had asked his Consultant to review Terry (NMC, 2004). When Terry’s Consultant had been to review him, the Consultant advised the nursing team to deliver the Saline through Terry’s PEG tube. Terry’s Consultant had to document the fact, that he had advised the nursing team to deliver the Saline through Terry’s PEG tube. The Consultant also had to document that his advice was due to Terry’s poor venous access in Terry’s medical notes, and he had to document this on the prescription chart (NMC, 2004). Due to Terry having a Percutaneous Endoscopic Gastrostomy (PEG), the nursing team and Terry’s parents re-set the goal to deliver the fluids that Terry needed (Faulkner, 2000). The new goal that had been set, was to deliver one litre of Intravenous Saline through Terry’s PEG tube. The litre of Saline was delivered to Terry through his PEG tube, over an 8 hour period rather than a 24 hour period. Even though the nursing team had to deliver the fluids through the PEG tube, they had to ensure that the goal did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. This goal was specific, measurable, achievable, realistic and time set for Terry and the nursing team (Faulkner, 2000). Before the nursing team could deliver the Saline through Terry’s Percutaneous Endoscopic Gastrostomy, the Saline had to be prescribed by his Consultant. The Consultant had to document the Saline on Terry’s prescription chart, and also had to document the route that the nursing team were to deliver the Saline (NMC, 2004). The Saline that had been prescribed by Terry’s Consultant, also had to document in Terry’s medical notes, that he had prescribed this and also document the route that he had advised to the nursing team (NMC, 2002; NMC, 2004). When the nursing staff had commenced the delivery of the Saline through the Percutaneous Endoscopic Gastrostomy (PEG) tube, they themselves had to document this. The nursing team had to document the Saline running through the PEG tube, to enable the nursing notes for Terry to be up-to-date. The nursing team to document the amount of Saline that was to run through Terry’s PEG tube, and what time the Saline infusion began. The nursing team also had to document how much of the Saline was to be infused in any one hour, when the Saline was due to finish, as well as document the lot number and expiry date that were on the bag of Saline. NMC, 2002; NMC, 2004) The documentation of the infusion of the Saline running through Terry’s Percutaneous Endoscopic Gastrostomy (PEG) tube, ensured that the nursing team could hand over the information to the nursing team that were due to care for Terry on the next shift (NMC, 2004). The goal that had been re-set by the nursing team, and Ter ry’s parents, fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique (Faulkner, 2000). The fact that the goal had to be re-set, ensured that the nursing team had been able to deliver the Saline through the Percutaneous Endoscopic Grastrostomy (PEG) tube. The goal to deliver the Saline through the PEG tube, had been specific, measurable, realistic and time set for Terry and the nursing team. This goal had been achieved, due to the fact that the care that the nursing team had been able to deliver the Saline in the time that they had set with Terry’s parents (Faulkner, 2000). Due to the goal being achieved in the time frame that had been set by the nursing team, and Terry’s parents, meant that the nursing team had been able to deliver the care that had been needed to achieve this goal (Faulkner, 2000). I am now at the point in this assignment when I can reflect. For my reflection, I will be using the Gibb’s Reflective Cycle to reflect upon this assignment, which is documented within his book that was published in 1988 and entitled Learning by Doing: A Guide To Teaching and Learning Methods (Gibb’s, 1998). Due to the fact that Terry ad a number of health problems, I had a hard task of choosing which two that I would use. I did have to think long and hard about which two health problems that I would use, but I was given permission from his parents to enable me to write this assignment (NMC, 2008). The two health problems that I had chosen, were breathing difficulties and dehydration. Due to the breathing difficulties that Terry suffered with, meant that his oxygen saturation levels were low. Due to Terry’s breathing difficulties, this is why the nursing team, and his Consultant, had to gain consent from Terry’s parents, to insert a percutaneous tracheostomy. The fact that the tracheostomy was inserted soon after Terry’s admission, enabled the nursing staff within the ITU and the ward of the NHS FT, to ensure that Terry’s oxygen saturation levels were maintained. Therefore, this is the reason why a goal was set. Due to a goal being set for Terry’s oxygen saturation levels to be maintained, provides evidence to show that the nursing interventions were effective. The effectiveness of these nursing interventions, proves that goals that are set for an individual patient can also be met. The second goal that had been set for Terry by the nursing team, and his parents, had fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. Due to the fact that this goal was only partially met, did not necessarily mean that the care that had been delivered to Terry, had been ineffective. The care that had been delivered to Terry had been effective, but the goal could no longer be achieved through the venous route, due to the fact that Terry’s venous access was poor. Due to Terry’s poor venous access, this is why the nursing team had to re-set the goal with his parents. The goal that had to be re-set, fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. The goal had been re-set, and had also been achieved in the time frame that had been set with Terry’s parents. The goal that had been re-set, had been achieved in the time frame that had been set. The goal had been achieved due to the fact that, the nursing team were able to deliver the Intravenous Saline through the Percutaneous Endoscopic Gastrostomy (PEG) that Terry had in place. The fact that the nursing team could not achieve this goal when it had first been set, was not an issue that could have been anticipated. Even though nursing teams can not anticipate why the goals are not met, they can re-set the goal and in time, meet the new goal. Therefore, the nursing care and interventions that are delivered, do make nursing care effective. Documentation of all care from the nursing team was important, due to the fact that the nursing team on one shift, were able to inform the nursing team of the next shift. Documentation also ensures that if the nursing team were unsure of any test results, that they were able to look over the nursing notes to ensure they knew where we were up to with the patient. The Consultants documentation in the patients medical notes, ensured that other doctors or Consultants were also aware of the patients condition and any tests that may have been ordered. Bibliography. Bailey, M. , Crossen, S. , Holland, J. , Hollis, V. (2008) Observation’s in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 25, Pages 496-544. Oxford: Wiley-Blackwell Publishing. Brown, A. (1997) Caring for the Patient Undergoing Surgery in Walsh, M. (ed) (1997) Watson’s Clinical Nursing and Related Sciences. 5th ed. Chapter 10, Pages 232-259. Edinburgh, Bailliere Tindall. Day, S. (1997) Caring for the Patient with a Nutritional Disorder in Walsh, M. (ed) (1997) Watson’s Clinical Nursing and Related Sciences. 5th ed. Chapter 16, Pages 552-570. Edinburgh, Bailliere Tindall. Dolan, S. (2008) Respiratory Therapy in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 38, Pages 749-765. Oxford: Wiley-Blackwell Publishing. Dougherty, L. , Farley, A. , Hopwood, L. Sarpal, N. (2008) Drug Administration: General Principles in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 11, Pages 202-251. Oxford: Wiley-Blackwell Publishing. Faulkner, A. (2000) Nursing: The Reflective Approach to Adult Nursing Practice. 2nd ed. Gloucestershire: Stanley Thornes Publishers Limited. Gibb’s, G (1988) Learning by Doing: A Guide To Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechnic. Hackman, D. 2008) Positioning in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 34, Pages 668-689. Oxford: Wiley-Blackwell Publishing. Hunt, P. , Kelynack, J. Stevens, A. M. (2008) The Unconscious Patient in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 44, Pages 849-853. Oxford : Wiley-Blackwell Publishing. Iggulden, H. (2006) Care Of The Neurological Patient. Oxford: Blackwell Publishing Limited. Local NHS Trust (2004) NHS Trust – Recommended Protocol for Care of the Patient with a PEG. Liverpool: Local NHS Trust. Machin, J. , Rhys-Evans, F. (1996) Tracheostomy Care and Laryngectomy Voice Rehabilitation in Mallet, J. , Bailey, C. (eds) (1996) The Royal Marsden NHS Trust – Manual of Clinical Nursing Procedures. Chapter 41, Pages 550-565. London: Blackwell Science Limited. MacKenzie, E. (1996) Respiratory Therapy in Mallet, J. , Bailey, C. (eds) (1996) The Royal Marsden NHS Trust – Manual of Clinical Nursing Procedures. Chapter 35, Pages 474-480. London: Blackwell Science Limited. Nursing and Midwifery Council (2002) Guidelines for the Administration of Medicines. London: NMC. Nursing and Midwifery Council (2004) Guidelines for Records and Record Keeping. London: NMC. Nursing and Midwifery Council (2008) The Code – Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: Nursing and Midwifery Council. Roper, N. , Logan, W. W. , Tierney, A. J. (1996) The Elements of Nursing. 4th ed. America: Churchill Livingstone. Sarpal, N. (2008) Drug Administration: Delivery (Infusion Devices) in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 13, Pages 290-309. Oxford: Wiley-Blackwell Publishing. Soady, C. (2008) Tracheostomy Care and Laryngectomy Care in Dougherty, L Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 42, Pages 809-829. Oxford: Wiley-Blackwell Publishing. Waugh, A. , Grant, A. (2006) Ross and Wilson Anatomy and Physiology in Health and Illness. 10th ed. Philadelphia: Churchill Livingstone. Woodrow, P. (1999) Pulse Oximetry. Nursing Standard. Volume 13, Number 42. Pages 42-46. Woodrow, P. (2006) Intensive Care Nursing – A Framework for Practice. 2nd ed. Oxon: Rouledge. How to cite Acute Care: Care Implementation and Evaluation., Papers

Evaluation of Annual Influenza Vaccination Being Recommended

Question: Discuss about theEvaluation of Annual Influenza Vaccination Being Recommended. Answer: Flu or influenza affects immunity system of older adults and young children easily. Due to weak immunity response of older adults, infants, young children, they are more susceptible from the attack to the virus. Older adults over 65 years of age receiving medical treatment at the community hospital are at greater risks of getting infected from the disease. Community nurses handle a wide variety of patients, facing multiple medical conditions; flu is the most common type of virus that affects majority of patients receiving treatment at the community hospital. Community nurses having to treat so many patients have risks of bearing the disease virus themselves. Mc Elhaney (2011) in his paper explores that older adults face risks from getting infected from the disease easily when in contact with older community nurses. The scope of this analysis identifies recommendations that are given to adults over 65 years of age to get vaccinated in case they are treated by older community nurses. Flu: Influenza is commonly known as flu, is caused by a virus that causes respiratory illness. The flu virus is highly contagious in nature that spreads through infected persons cough or sneezes (Holland et. al., 2008). Flu is not a life threatening disease and adults are highly contagious for 1 to 2 days prior to getting symptoms, which might continue till 7 days of becoming ill. Symptoms associated with influenza are runny nose, high fever, muscle pain, sore throat, coughing, headache and feeling tired. The symptoms might last over a week and can include gastrointestinal symptoms as vomiting, diarrhea and nausea. The flu is usually treated by antibiotics unless the flu symptoms have aggravated into another illness that is caused by bacteria. During flu season from 71% to 85% of the older population above 65 years have experienced death and 54% to 70% had to be admitted to hospitals due to flu. Influenza is a serious issue for older adults hence they need to be vaccinated (Song, et. al., 2010). Worldwide treatment for flu is antibiotics such as antivirals oseltamivir and zanamivir. Though majority of flu cases are not considered serious but in older adults above 65 years, it can cause serious complications. Complications that are caused by influenza are dehydration, bacterial pneumonia, congestive heart failure or even asthma. There is an increasing worldwide trend in hospitalization of older adults diagnosed with flu symptoms; therefore it is better to adopt preventive measures (Medlock Galvani, 2009). Prevalence of healthcare policy that makes essential for the elderly to get vaccinated can be an effective mechanism for prevention against influenza. A healthcare policy aimed at vaccinating elderly can emerge to be an effective to overcome barriers facing primary health care professionals. In absence of policy aimed at immunization, efforts of professionals in primary healthcare along with public health agencies will remain unattended. Immunization in influe nza has to remain a government prerogative for enhancing impact on the national average rate in winter especially. Non-compliance factors to immunization schedules remains to be a major challenge arising from factors such as fear from side effects, fear from vaccinating needles, lack of confidence of immunization effectiveness and other factors conies to be barriers. Apart from immunization currently there is no other effective alternate mechanism available to protect elderly from the deadly attack of the disease that can enhance chances of comorbidity. Type of flu vaccine and requirement for annual boosters: due to the wide spread influence of influenza vaccination, it has been considered best to take vaccination of the viruses. The viruses are influenza H3N2 virus, H1N2 virus and one B virus. Post taking of the vaccination, protection begins from 2 weeks. Season based vaccination needs to begin by September and kept continued through January. Outbreak of influenza might change and be at peak during October or January month. Falsey et.al., (2009) in his article states that some individuals should not opt for the vaccination as those having allergy to chicken eggs, or who have had reaction to flu vaccination in the past, or people who had Guillain-Barre Syndrome after 3 weeks of receiving vaccine (Falsey et. al., 2009). In case an older adult had moderate fever, they need to wait prior to getting vaccinated. Older adults 65 years or more are at more risks with complications from flu symptoms, as compared to younger healthy adults. Older adults have weakened defense immune response that further weakens with age. The best tactics to deal with flu for older adults is to take a flu shot. Centers for Disease Control and Prevention suggest that people 65 years or older have to get vaccinated each season for ensuring possible immunity wanes over a year. DiazGrandoz et al. (2014) evaluated that older adults can get injectable vaccines or flu shot that are cell-based injectable vaccine flu shots (DiazGranados et.al. 2014). The high dosage vaccine is for adults over 65 years of age and it contains 4 times the amount of antigen compared to regular flu shots. It has stronger immune response post vaccination. Older adults should not get nasal spray flu vaccine, jet injector flu vaccine or the intradermal flu shot. Adjuvant flu vaccine Fluad that is produced from MF59 adjuvant can help create a better immune response in adult population. The vaccinations come with some side effects which can happen with standard-dosage of seasonal shots. Other effects include redness or swelling where injection is administered, muscle ache, headache and malaise (McElhaney, 2011). It is advisable that older adults get vaccinated with pneumococcal vaccines for prevention against pneumococcal diseases. Immunization rationale for 65 years and over population group: Influenza infection has been found associated with severe morbidity and serious outcomes. Adult population vaccination has been considered to be most effective strategy for prevention of the disease by World Health Organization. Though certain scholars argue regarding the exact magnitude of benefits from vaccination. Older adults above 65 years of age have weakened immune response system that is susceptible to the association of influenza virus response. Prevention from increased incidence of the infection can reduce morbidity and mortality significantly. Osterholm et. al. (2012), states that the flu can cause several complications with prevailing symptoms of the disease for a prolonged period (Osterholm et. al., 2012). Complications can arise in case older adults are being exposed to other older adults or older community nurses, who are bearer of the virus. Requirement to be immunized against influenza as a community nurse: Older community nurses are at greater risks of carrying the influenza virus. Older community nurses have weakened immune response system. They are exposed to multiple types of patients, which increase their risks of becoming potential virus bearers. During seasonal outbreak of the disease, community nurses need to provide professional healthcare to patients suffering from serious influenza infections. This further increase their risks of bearing the virus that have capability to get transferred to other patients in the ward. Haq and McElhaney (2014) stated importance in cases older community nurses get vaccinated, there would be a reduced incidence of influenza amongst older adults, who were not facing the disease (Haq McElhaney, 2014). This article clearly states that annual influenza vaccination of community nursing staffs greatly reduces mortality and morbidity in vulnerable patients. Older community nurses providing healthcare facilities to older adults above the age of 65 years did not visualize influenza as being a threat to their health or wellbeing. They did not perceive vaccination for influenza to be necessary and viewed it to be harming their health in a negative manner or having side effects, weakening their immunity system. Research studies conducted to evaluate threat of transmission of influenza reflected unawareness amongst older community nurses being a high-risk population as they had never fallen ill with the disease. Several researches are connected with understanding related to ways in which mortality rates or treatment of adult population, only a few researches are connected towards understanding ways in which older community nurses could reduce epidemic (Vajo, et. al.,2010). Older community nurses have often declined vaccination on the motif that they have healthy body for maintaining their decisional autonomy. Community nurses are faced with u ntrustworthy ambience that opposes them to maintain healthy body. Nurses rely on conventional health beliefs compared to evidence medication. Impact from relying on conventional health beliefs makes them decline to influenza vaccination. Community healthcare centers as well as hospitals have to design specific intervention mechanisms tailored for nurses. Older community nurses feared for side effects of vaccination, as some nurses already felt ill post taking of the vaccine. Talbot, et. al., (2011) analyses the negative effects arising from influenza vaccination made nurses feel the procedure to be unnecessary (Talbot, et. al., 2011). The negative side effects led to community nurse reluctance in getting vaccinated. Older Community Nurses felt that in case they felt ill, they had all possible right to stay back at home as they did so much work. Moreover taking influenza vaccination meant to some nurses that they had to undertake restrictive measures that could curb their autonomy. They did not trust influenza vaccination as having much effect on the virus widespread. As the vaccines composition is based on the assumption of seasons influenza virus look alike, effectiveness of the vaccination is less supposed to be less likely. Response to older adult in the community, who argued that the flu vaccine results in catching the flu: Influenza vaccine is prepared on the basis of virus type that was present in the last year. However, viruses like any other living organisms are undergoing constant genetic mutation that makes them more complex and complicated (Izurieta, et.al., 2015). Mutation of virus causes inertness to vaccination present that in turn leads to immunity from the vaccine. Meaning that probability of vaccinations effectiveness has limited potential. Moreover influenza vaccine has several side effects associated with it that ranges from fever, to headaches, flu itself and many others. Older adults often argue that flu vaccination might lead them to catch the flu itself. Influenza vaccine injected into adults helps boost their immunity defense mechanism by creation of antibodies. As earlier stated that older adults have already weaker defense immune system, getting injected from the virus antigen might lead to collapse of their defense mechanism altogether. In turn they might end up catching the flu itself. Older adults in contact with other older adults or older community nurses are at higher risk from catching infection at community health care centers. Inspite of all prevailing reasons, vaccinations remain the most effective mechanism (Lang, et. al., 2012). Older adults, who argue regarding effectiveness of the vaccination, need to provide education counseling for the vaccination. They need to be counseled regarding the various negative impacts and complexity that might arise in absence of vaccination. They need to be convinced related to their weakened immune d efense systems with which they might easily catch the flu. When older adults are receiving their treatment at community health care centers or hospitals they likely have been affected from morbidity. Additional burden of morbidity might lead to complications as bacteria might mutate to create more complicated diseases. Therefore, it is advised by health practioner as well as by Health care centers to get vaccinated to reduce impacts. Studies evaluating data pertaining to older adults facing risks from influenza while in contact with other older adults and older community nurses reflects varied evidence. All evidences support that health risks amongst older population is higher considered to other population segment. Influenza can create varied complications in older population above 65 years of age hence it becomes necessary to evaluate such outcomes and adopt measures that can prevent epidemic leading to mortality. Vaccination has been considered the most effective way in which complications can be avoided, other measures includes avoiding close contact with an infected person, covering of mouth and nose when infected, cleaning hands regularly, avoiding touching of nose, mouth or eyes and practicing overall good health habits. These habits have been shown to have a positive effect on curbing widespread of the disease. Reference Lists DiazGranados, C.A., Dunning, A.J., Kimmel, M., Kirby, D., Treanor, J., Collins, A., Pollak, R., Christoff, J., Earl, J., Landolfi, V. and Martin, E. (2014). Efficacy of high-dose versus standard-dose influenza vaccine in older adults.New England Journal of Medicine,371(7), 635-645. Falsey, A. R., Treanor, J. J., Tornieporth, N., Capellan, J., Gorse, G. J. (2009). Randomized, double-blind controlled phase 3 trial comparing the immunogenicity of high-dose and standard-dose influenza vaccine in adults 65 years of age and older.The Journal of infectious diseases,200(2), 172-180. Haq, K., McElhaney, J. E. (2014). Immunosenescence: influenza vaccination and the elderly.Current opinion in immunology,29, 38-42. Holland, D., Booy, R., De Looze, F., Eizenberg, P., McDonald, J., Karrasch, J., ... Weber, F. (2008). Intradermal influenza vaccine administered using a new microinjection system produces superior immunogenicity in elderly adults: a randomized controlled trial.The Journal of infectious diseases,198(5), 650-658. Izurieta, H. S., Thadani, N., Shay, D. K., Lu, Y., Maurer, A., Foppa, I. M., ... Worrall, C. (2015). Comparative effectiveness of high-dose versus standard-dose influenza vaccines in US residents aged 65 years and older from 2012 to 2013 using Medicare data: a retrospective cohort analysis.The Lancet Infectious diseases,15(3), 293-300. Lang, P. O., Mendes, A., Socquet, J., Assir, N., Govind, S., Aspinall, R. (2012). Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence.Clinical interventions in aging,7, 55. McElhaney, J. E. (2011). Influenza vaccine responses in older adults.Ageing research reviews,10(3), 379-388. Medlock, J., Galvani, A. P. (2009). Optimizing influenza vaccine distribution.Science,325(5948), 1705-1708. Osterholm, M. T., Kelley, N. S., Sommer, A., Belongia, E. A. (2012). Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis.The Lancet infectious diseases,12(1), 36-44. Song, J.Y., Cheong, H.J., Hwang, I.S., Choi, W.S., Jo, Y.M., Park, D.W., Cho, G.J., Hwang, T.G. and Kim, W.J.(2010). Long-term immunogenicity of influenza vaccine among the elderly: risk factors for poor immune response and persistence.Vaccine,28(23), 3929-3935. Talbot, H. K., Griffin, M. R., Chen, Q., Zhu, Y., Williams, J. V., Edwards, K. M. (2011). Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalizations in community dwelling older adults.Journal of Infectious Diseases,203(4), 500-508. Vajo, Z., Tamas, F., Sinka, L., Jankovics, I. (2010). Safety and immunogenicity of a 2009 pandemic influenza A H1N1 vaccine when administered alone or simultaneously with the seasonal influenza vaccine for the 200910 influenza season: a multicentre, randomised controlled trial.The Lancet,375(9708), 49-55.