Resistance coursework Essay

My Investigation: I choose to do a nichrome wire because during my preliminary work nichrome shows more resistance compared to nickel and copper wire. This is because the electrons collide with the material of the nichrome wire. Measurements: The things I will have to measure are: the volts and amps and on each interval I take to take readings. I will have to take 5 reading of each volts and amps, so I can work out the resistance, and then I will have 5 resistance readings, from this I will work out an average resistance. Also I will be measuring the wire from 100cm down to 10cm. Diagram: This is how I will set up my circuit: There are particular factors that we have to keep the same in order not to alter the correct results.   Do not alter the positions of the devices during the experiment.   Make sure the total length of wire is exactly 1m.   Record the current and voltage accurately, using the correct units. Always place the crocodile clips on the right measurement.   Before you start the experiment, test the devices being used. If any are faulty, change them.   Leave the power pack set at the same voltage for the whole of the experiment. The surrounding room temperature must be kept, otherwise the particles in the wire will move faster (if the temperature increases). Therefore, this will have an effect on the resistance.   The wire along the metre ruler must be straight and exactly 1m long. Bends in the wire may affect the resistance. The reading of the voltage should be taken promptly after the circuit is connected. This because as soon as a current is put through the wire, it will get hotter. I want to test the nichrome wire when heat is affecting it the least. Safety: This experiment is not too dangerous but it could be if not handled with caution and care. Make sure that the electricity is off at the plug socket when connecting and altering the circuit.   Be careful of any sharp edges on the crocodile clips or on the wire cutters or on the wire once cut. If you cut your self make sure you wash the wound and see a medical nurse if needed. If a fire breaks out switch off the power and use a near by fire extinguisher that is not H2O (because of the electricity) to safely stop the fire.   Make sure the coils in the resistance wire don’t touch and short circuit because this will ruin the experiment and may heat up the wire and catch fire. Do not set the power pack voltage to more than 2V. This is a safety hazard.   If you smell burning, promptly switch off the power pack from the mains.   Make sure that when the power pack is switched on, the near by taps are switched off. If there is any water spilt near by the sockets or surrounding areas, wipe it before you start the experiment.   Make sure the power pack cable or the conducting wires aren’t frayed. Reliability and Accuracy: Reliability: I can rely on my results because I have taken 5 different readings and then taken an average. This is so if one of my results goes wrong then I have four other ones to compare it with so I know if a result is abnormal. I am using an Ammeter to get an accurate current reading and not relying on the approximate readings on the power packs variable controls. Accuracy: I will coil the wire so that there are no short circuits in the wire. I will do this by spacing out the coils and checking it regularly throughout the experiment. This is because if the wire does short-circuit then you will be measuring the resistance of the length of that short-circuited piece of wire and not the whole length of wire. I will also take the reading on the voltmeter as soon as possible so the heat does not affect the resistance. Obtaining My Evidence: During the investigation, I changed the length of the wire by 10cm to see if it affects the resistance and the amount of current I was going to use. Initially I had decided to use 2 amps but I changed it to 1 amp because I felt by using a low current I may not get a very good reading voltage and resistance. The Analysis: Explanation of results- As the length of wire increased, the current decreased. As the length of constantan wire increased, so did voltage. Resistance increased as the length of wire did. The longer the length of the wire, the higher the resistance because of the amps. The current flowing the p. d. across it providing the temperature is constant. V=Ii R or I=V/R or R=V/I From the graph which I have produces I conclude that the higher the length of the wire the higher the resistance. The thin wire in 1 amp tends to resist the movement of electrons init. We say that the wire has a certain resistance to the current. The greater the resistance the more voltage is needed to push the current through the wire. The resistance is calculated by Resistance-P. d across the wire/Current through the wire (1) I conclude that as the length of a wire doubles, the resistance also doubles (provided the thickness of the wire is kept constant0. I also conclude that as the cross-sectional area of the wire doubles; the resistance halves (provided the length of the wire stays constant. I conclude this because my graph shows that resistance is inversely proportional to 1 (thickness2) so the theories behind these conclusions are: As the length doubles the resistance doubles. Resistance is caused by electrons bumping into ions. If the length of the wire doubles, the electrons bump into the ions twice as much so the resistance will double. In my investigation I found out that as the length of the wire increased the resistance and voltage increased as well. The only thing that decreased was the current. I think this because the resistance and the voltage has no longer a distance to travel so more volts/amps are needed where as the current has a shorter distance to travel each time so as the same amount of amps are being used they are building up more. From the graph that I have done, I have found a pattern. This pattern draws me to a conclusion that the higher the length of the wire the higher the resistance. I had also stated this in my prediction, in the earlier stages of my experiment, so this means that my prediction was correct. The thin wire I (amps) a lamp tends to resist the movement of electrons in it we say that the wire has a certain amount of resistance to the current. The greater the resistance the more voltage is needed to push a current through the wire. The Ohms law calculates the resistance of a wire by: Resistance (R) = potential difference across the wire (V) Current through the wire (I) There is a resistance in a wire because the electrons bump in to each other in the nichrome wire. So the high resistance is because of the high length of the wire and because of the electrons bumping in the wire. My predictions match my results because I predicted that resistance would increase as the length of the wire increased and that is what happened. I worked it out by using my head. I started to think about this experiment then I thought that the current would have a longer distance as the length increased and that would make the resistance longer. I also found out that the resistance of one amp carries a current of one amp if there is a potential difference of one volt across it. Judging from my results, I can safely say that the majority of my prediction was right. The resistance did change in proportion to the length of wire. This is because as the length of wire increased, the electrons that made up the current had to travel through more of the fixed particles in the wire causing more collisions and therefore, a higher resistance. A thinner wire also means more resistance. Resistance is known to be inversely proportional to the cross- sectional area (diameter). I. e. if the diameter is increased, the resistance decreases. A wider wire means less chance of the free electrons having collisions into atoms and losing energy. Another point of my prediction was that as the length of wire doubles so does the resistance. This proved to be true. I can show this in my graph. The straight line indicates it. I can also see these in my results. E. g. 30cm=0. 95? and 40cm=1. 124 ?. The theories behind these conclusions are: As the length of the wire doubles, the resistance also two folds. Resistance is caused by electrons bumping in to ions. If the length of the wire doubles, the electrons bump into the ions twice as much so the resistance will double. I also want to state the fact that as the length of a wire doubles the resistance also doubles, however providing the thickness of the wire is kept constant. I conclude that, as the cross sectional area of the wire doubles the resistance halves providing the length of the wire stays constant. Evaluating my Evidence: I believe I carried out my investigation very well. I used all the equipment I was supposed to. I set the experiment correctly. Most of my results are accurate. I managed to get reading off both the volt meter and ammeter for each length five times and I used the correct safety precautions. I believe most of my results are accurate. Not all of the readings are correct as at the end the wire got very warm and gave faulty readings. After studying my results, I realise there is one anomalous result. It occurs in the voltage on the sixth voltage. It looks as if the volt meter had some interruptions such as the heat of the wire or the heat of the surrounding area. However this did not affect my predictions as I predicted the longer the wire the higher the resistance and this is what had happened but it had less resistance for that particular one than I had expected. It did not alter the increasing pattern in resistance. I believed that my investigation and the results are mainly accurate because my investigation was carried out very well. I believe that if I had to use my results as evidence I think they show that the longer the nichrome wire the more resistance and the shorter the less. I assume this because my graph shows at 10cm of nichrome wire there is 0. 592(ohms) and at 100cm of nichrome wire there is 2. 386(ohms) there is a difference of 1. 794(ohms) which proves longer the wire the more resistance. I can prove that my experiment was successful because of the graph I drew. It showed length of wire against resistance. If I had to further improve my investigation I would carry it out again and I would do it with a much longer piece of wire at a higher current. If I had to do this experiment again I will probably measure the wire every 5cm’s instead of 10cm’s to make sure it’s accurate and use a more accurate volt meter to get the best and accurate results. . I could also investigate how the diameter of a wire affects the resistance. An extra investigation I can carry out or perform to receive more proof and evidence would be to investigate and look into is the thickness of a wire and evaluate or match up with the length of the wire. Also I could examine if the specific metal materials or properties makes a change in the resistance. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Electricity and Magnetism section.

Formation of the Delian League in Ancient History

Formation of the Delian League in Ancient History Several Ionian cities joined together in the Delian League  for mutual protection against the Persians. They placed Athens at the head (as hegemon) because of her naval supremacy. This free confederation (symmachia) of autonomous cities, founded in 478 B.C., consisted of representatives, an admiral, and treasurers appointed by Athens. It was called the Delian League because its treasury was located at  Delos. History Formed in 478 B.C., the Delian League was an alliance of mainly coastal and Aegean city-states against Persia at a time when Greece feared Persia might attack again. Its goal was to make Persia pay and to free the Greeks under Persian dominion. The league morphed into the Athenian Empire that opposed the Spartan allies in the Peloponnesian War. After the Persian Wars, which included Xerxes invasion by land at the Battle of Thermopylae (the setting for the graphic novel-based movie ), the various Hellenic poleis (city-states) divided into opposing sides ranged around Athens and Sparta, and fought the Peloponnesian War. This enervating war was a major turning point in Greek history since in the following century, the city-states were no longer strong enough to stand up to the Macedonians under Philip and his son Alexander the Great. These Macedonians adopted one of the aims of the Delian League: to make Persia pay. Strength is what the poleis had been seeking when they turned to Athens to form the Delian League. Mutual Protection Following Hellenic victory at the Battle of Salamis, during the Persian Wars, Ionian cities joined together in the Delian League for mutual protection. The league was meant to be offensive as well as defensive: to have the same friends and enemies (typical terms for an alliance formed for this dual purpose [Larsen]), with secession forbidden. The member poleis placed Athens at the head (hegemon) because of her naval supremacy. Many of the Greek cities were annoyed with the tyrannical behavior of the Spartan commander Pausanias, who had been leader of the Greeks during the Persian War. Thucydides Book 1.96 on the formation of the Delian League 96. When the Athenians had thus gotten the command by the confederates own accord for the hatred they bare to Pausanias, they then set down an order which cities should contribute money for this war against the barbarians, and which galleys. For they pretended to repair the injuries they had suffered by laying waste the territories of the king. [2] And then first came up amongst the Athenians the office of treasurers of Greece, who were receivers of the tribute, for so they called this money contributed. And the first tribute that was taxed came to four hundred and sixty talents. The treasury was at Delos, and their meetings were kept there in the temple. Members of the Delian League In The Outbreak of the Peloponnesian War (1989), author-historian Donald Kagan says the members included about 20 members from the Greek islands, 36 Ionian city-states, 35 from the Hellespont, 24 from around Caria, and 33 from around Thrace, making it primarily an organization of the Aegean islands and coast. This free confederation (symmachia) of autonomous cities, consisted of representatives, an admiral, and financial officers/treasurers (hellenotamiai) appointed by Athens. It was called the Delian League because its treasury was located at Delos. An Athenian leader, Aristides, initially assessed the allies in the Delian League 460 talents, probably annually [Rhodes] (there is some question about the amount and people assessed [Larsen]), to be paid to the treasury, either in cash or warships (triremes). This assessment is referred to as phoros that which is brought or tribute. 23.5 Hence it was Aristeides who assessed the tributes of the allied states on the first occasion, two years after the naval battle of Salamis, in the archonship of Timosthenes, and who administered the oaths to the Ionians when they swore to have the same enemies and friends, ratifying their oaths by letting the lumps of iron sink to the bottom out at sea. - Aristotle Ath. Pol. 23.5 Athenian Supremacy For 10 years, the Delian League fought to rid Thrace and the Aegean of Persian strongholds and piracy. Athens, which continued to demand financial contributions or ships from its allies, even when fighting was no longer necessary, became more and more powerful as her allies became poorer and weaker. In 454, the treasury was moved to Athens. Animosity developed, but Athens would not permit the formerly free cities to secede. The enemies of Pericles were crying out how that the commonwealth of Athens had lost its reputation and was ill-spoken of abroad for removing the common treasure of the Greeks from the isle of Delos into their own custody; and how that their fairest excuse for so doing, namely, that they took it away for fear the barbarians should seize it, and on purpose to secure it in a safe place, this Pericles had made unavailable, and how that Greece cannot but resent it as an insufferable affront, and consider herself to be tyrannized over openly, when she sees the treasure, which was contributed by her upon a necessity for the war, wantonly lavished out by us upon our city, to gild her all over, and to adorn and set her forth, as it were some vain woman, hung round with precious stones and figures and temples, which cost a world of money. Pericles, on the other hand, informed the people, that they were in no way obliged to give any account of those moneys to their allies, so long as they maintained their defense, and kept off the barbarians from attacking them. - Plutarchs Life of Pericles The Peace of Callias, in 449, between Athens and Persia, put an end to the rationale for the Delian League, since there should have been peace, but Athens by then had a taste for power and the Persians started supporting the Spartans to Athens detriment [Flower]. End of the Delian League The Delian League was broken up when Sparta captured Athens in 404. This was a terrible time for many in Athens. The victors razed the great walls linking the city to her harbor city of Piraeus; Athens lose her colonies, and most of her navy, and then submitted to the reign of the Thirty Tyrants. An Athenian league was later revived in 378-7 to protect against Spartan aggression and survived until Philip II of Macedons victory at Chaeronea (in Boeotia, where Plutarch would later be born). Terms to Know hegemonia leadership.Hellenic Greek.Hellenotamiai treasurers, Athenian financial officers.Peloponnesian League modern term for the military alliance of the Lacedaemonians and their allies.symmachia a treaty where the signers agree to fight for one another. Sources Starr, Chester G. A History of the Ancient World. Oxford University Press, 1991.Kagan, Donald. The Outbreak of the Peloponnesian War. Cornell University Press, 2013.Holden, Hubert Ashton, Plutarchs Life of Perciles, Bolchazy-Carducci Publishers, 1895.Lewis, David Malcolm. The Cambridge Ancient History Volume 5: The Fifth Century BC., Boardman, John, Davies, J.K., Ostwald, M., Cambridge University Press, 1992.Larsen, J. A. O. â€Å"The Constitution and Original Purpose of the Delian League.† Harvard Studies in Classical Philology, vol. 51, 1940, p. 175.Sabin, Philip, International Relations in Greece, the Hellenistic World and the Rise of Rome, Hall, Jonathan M., Van Wees, Hans, Whitby, Michael, Cambridge University Press, 2007.Flower, Michael A. From Simonides to Isocrates: The Fifth-Century Origins of Fourth-Century Panhellenism, Classical Antiquity, Vol. 19, No. 1 (Apr. 2000), pp. 65-101.

How to Be More Punctual for School

How to Be More Punctual for School Do you seem to be late for school a lot? Do people tease you about it? Do your grades suffer because of it? Does your tardiness annoy your teacher? Being on time is so important for academic success! Learn to improve your reputation and your chances for academic success with these tips for being right on time - all the time! Tips for Punctuality Rethink the meaning of on time. People who are always on time are really people who arrive early every dayand acknowledge that things can go wrong to set them back several minutes. When things do go wrong these students arrive on time!Understand the importance of being on time. Students who are always on time are the people who earn the best grades, win scholarships, and get into great colleges. In the working world, the people who are always on time are the people who get promotions.Get enough sleep. If you have trouble getting out of bed in the morning, then make a serious effort to get to bed earlier. Sufficient sleep is essential for maximum brain function anyway, so you really dont want to ignore this aspect of your scholastic habits.Give yourself a realistic amount of time to dress and groom. You can do this with a simple exercise: Get up early one morning and time yourself (moving at a normal pace) to see how long it takes you to get ready. You may be surprised at the time it takes, especially if you find you have been trying to squeeze forty minutes worth of grooming into fifteen minutes each morning. You can try creating a time management clock. Know exactly when you need to be at your destination and subtract ten or fifteen minutes to establish your arrival time. This will give you time to go to the restroom or chat with friends. What time are you expected to be seated in your homeroom or your first class? If your class begins at 7:45, you should arrive at the school by 7:30 and be in your seat at 7:40.Be open to your teachers preferences. Does your teacher want you to be seated early? If your teacher wants you to be in class before the bell rings, then do so if its possible - even if you dont agree. Dont get angry and blame others if you arent meeting the teachers expectations. Why cause trouble for yourself?Communicate any problems. If your bus is always late or you have to take your little brother to school and it always makes you late, just explain this to your teacher.Listen to traffic news. If you depend on public transportation to get to school, always keep an eye on schedule interruptions.Have a backup plan for you r transportation. If you normally ride to school with a friend, think ahead and plan what to do if your friend gets sick. Set your clocks forward by ten minutes. This is a dirty little psychological trick that many people play on themselves. The funny thing is, it really works!

The Role of Marketing Essay Example | Topics and Well Written Essays - 4500 words

The Role of Marketing - Essay Example The intimate, and inextricable, connection between organisational success and marketing, insofar as the primary objective of the former is to ensure the latter through the creation and maximization of well-targeted demand, is a historically undeniable reality, amply supported by a wealth of empirical evidence (Church, 1999). The undeniable centrality of marketing communication to organisational success functioned as the basis for the embrace of marketing by academia and the evolution of marketing as an academic field within management sciences (Cohen, 1966). Earlier perceptions of marketing as interchangeable with advertising, with the former being defined simply as a strategy to attract consumer interest in a product, have fundamentally changed. Marketing has, ever since the mid-1960s, been recognized as a complex methodology for the fulfilment of an organization's strategic objectives, insofar as sales, the expansion of market shares, and organisational growth are concerned. As such, and within the context of the aforementioned definition for marketing, the former evolved into a science embracing methodologies for market analysis and study; strategies for the identification of the most susceptible consumer groups/target audience; and countless theories on effective communication strategies and tools f or the engendering of consumer interest and product/service demand (Cohen, 1966; Dibb and Simkin, 1994). In other words, the increasing recognition of marketing as the key to organisational success has led to its embrace by academia and its subsequent evolution into a science,' designed to articulate a set of strategies, tools and methodologies as would ensure organisational success through marketing. There is no doubt that recent technological innovations in communication sciences, bordering on the revolutionary, have significantly redefined marketing strategies and media. Marketing has not only expanded beyond the local to embrace the global but marketing media and strategies have undergone revolutionary transformations consequent to the evolution of variant forms of electronic media, from the radio to the internet (Wehner, 2001). Marketing, as a communications strategy designed to inform consumers of the availability of particular products and persuade the market of the utility of these products, has evolved into integrated marketing.'

Explain statistical power Essay Example | Topics and Well Written Essays - 250 words

Explain statistical power - Essay Example According to Ellis (71), statisticians conduct power analysis prior to experiments in order to anticipate the possibility of a study outlaying accurate results. The objective is estimating the effects of the larger sample size in relation to its significance on the study. The less the power, the higher the chances of the occurrence type II error and vice verse. The two possibilities results from the likeness of an error in data collection (Ellis 60). Consequently, statistical power is the retention of null with accuracy, hence the reason, researchers strive to attain more statistical power when conducting studies. The components that determine statistical powers in a research are the sample size, the effect size, the alpha level and the power. Sample size refers to the units available for the study. Alpha levels are the chances of possibilities. Power is the odd that will result from the treatment of the sample (Rubin 148). Lastly, effect size balances the strength of a research by eliminating errors in power analyses. Indeed, an analysis of the components prior to the collection of data is essential to facilitating accuracy in power

Public and Government Healthcare in America Research Paper

Public and Government Healthcare in America - Research Paper Example 7). There were flaws to the system which President Obama and his healthcare program were trying to correct through the Patient Protection and Affordable Care Act (PPACA) which became a law in March 23, 2010. The bill sought to provide inexpensive, but good quality health care for all the citizens of the United States. It is not only the costs of drugs and hospitalization; the entire healthcare system is being questioned. This was demonstrated in a 2007 National Health Interview Survey showing that 43 million Americans did not have an insurance coverage (Adams et al. as cited in Benson et al., 2011, p. 28). A report by Families USA (U.S. Department of Health and Human Services as cited in Benson et al., 2011) stated that most citizens below 65 had an insufficient health insurance during the period of 2007-2008. The road to a perfect healthcare system for the Obama administration and the American people is still a long way. There are many problems and challenges along the way, one of w hich is that most Americans with the insurance coverage are fearful of changing the questioned healthcare infrastructure. Why are Americans afraid of change? Change is a matter of acceptance with courage; courage is significant for accepting an improvement. Americans are afraid of changing the healthcare infrastructure for many reasons which will be discussed in this essay. The unique U.S. healthcare system allows the private sector to help the public sector or the government with providing health care. It is this kind of the system that allowed the private sector, particularly the insurance companies, to commit abuses and malpractices with ordinary citizens as the victim. It is also through this system that the Obama administration wants to incorporate changes and provide an avenue of perfect health for the American people. The healthcare system is a complicated topic involving political, cultural, and moral aspects where change could not be easily implemented as it involves many a reas. Politicians could not reach a point, while all the classes of society could not agree on the kind of change they wanted. In his first address to Congress, President Obama identified healthcare as a primary focus that required an appropriate funding regardless of the existing recession in 2009 (Obama as cited in Benson et al., 2011, p. 28). Historical Development and Current State of Health Care Delivery Before the signing of the Patient Protection and Affordable Care Act (PPACA, also known as the ObamaCare), there were several challenges, or problems, the government and the American people had to face. The PPACA was challenged by 26 state governments, but the controversy was resolved by the Supreme Court ruling in June 2012, which upheld the provision of the law that every American should have a health insurance or pay a fine. This individual mandate was a significant part of the ObamaCare, and, so, the Supreme Court ruling was a big boost and support for the law. Had the cour t ruled otherwise, the entire Affordable Care Act would have fallen (Tate, 2012, p. 4). The U.S. healthcare system allows a combination of private and public insurance agencies to provide healthcare insurance to American citizens. Many insurances of this kind were sponsored by their respective employers. Before the passage of the Affordable

Vulnerable Body Critical Discourse Of Code Blue Nursing Essay

Vulnerable Body Critical Discourse Of Code Blue Nursing Essay When words of Code Blue are announced through overhead speakers, my heart always skips a beat, and I will start my personal struggle again among professional, legal and ethic obligation: did I take the right action on a right patient and did I do a right thing? Code blue means a patient, who is in Full Code status, is suffering a event of cardio-respiratory arrest, and immediately needs a starting of full advanced cardiac life support protocol, including cardiopulmonary resuscitation (CPR), medication, and mechanical ventilation (Lewis, Heitkemper Dirksen, 2006, p.166). I have been working in an adult inpatient medicine unit for six years. I can not exactly remember how many times I initiated a code blue call and have participated with the resuscitation team. Most of the patients that I have involved in code blue have died during the resuscitation process with a huge mess of blood, airway secretion, urine, bowel movement and medication on his or her body or survived less than 24 hours. After each resuscitation action, I felt emotionally drained, depressed, guilty, helpless and frustrated with the code status decision Full Code. In this paper, by presenting a resuscitation scenario, I will conduct a discourse analysis about this clinical d ilemma from both liberal-humanist and scientific-medical perspectives. Through analysis, I understood that clinical dilemma happens all the times, and it also will happen in the future. Nurses need to seek how to explore the contradictions or tensions from different discourses and understand them to grieve over. At the end of the paper, I discuss the implication of the future nursing practice based on the knowledge acquired from this discourse analysis. Personal Story It was my first year in an adult inpatient medicine unit after my graduation from a nursing school. Mr. D was a 97 years old widower. He was admitted to the hospital for congested heart failure, shortness of breath and also found to have pneumonia. He was intubated for respiratory difficulty in the intensive care unit then eventually developed multisystem organ failure, sepsis, and meningitis. Also, he was at the end stage of liver disease, and illustrated by brain damage signs from circulating toxins, hepatic encephalopathy. Arriving at my unit, he complained of shortness of breath and dizziness. His jaundiced skin glowed bright yellow. He showed delirium, repeated the same questions in slurred voice incoherently. He presented a marginal blood pressure, lungs were full of fluid, and oozed blood from his gums and injection sites was hardly to clot. All his limbs were extremely swollen. Nasogastric feeding tube was in situ. Oxygen was supplied at 4-liter by nasal prongs with saturatio n of 88 92%. While checking orders to create a Kardex, I realized his code status was Full Code, and physicians progress notes indicated that decision of code status was discussed between health care team and family three times. Two days later, I found Mr. D was not responding to my greeting and touch during my hourly round checking at 10:00 in the morning; no breathing sound heard, and no palpable pulse. I hit the code blue button on the wall at beside and started CPR. A code blue announcement automatically was delivered through overhead speaking system. Code team arrived in one minute. Night gown was stripped off; an aged body was totally naked. Deep suction via yankauer was made in rush, a tube was inserted down his throat, and then into his lungs in a harsh manner, and a ventilator took over his breathing, blood noted in his mouth; a cardiac monitor was hooked up to his chest; chest compression was made in a powerful manner to reach the depth of 5cm, rib and sternum bones broken noise was heard; a big needle-like catheter for getting artery blood gas by a respiratory therapist was poked into to several locations, blood contaminated his right upper arm and inner thigh; venopuncturing for intravenous cannu la insertion by a nurse was re-poked four times on both extremely swollen arms and blood messed on forearms; isosource of nasogastric feeding came from his nose and mouth, foul odour smelled; epinephrine was injected two times; defibrillator was applied three times with strong electric shock. Twenty minutes later, the physician ordered to stop the resuscitation effort and give up. Mr. D was left naked in the bed, lying without moving, deadly pale on his face. Everybody was exhausted, leaving the room with disappoint on face, and huge mess on the bed and floor. Tears were running down in familys cheek, too sad to say a word. Analyzing Personal Struggle Full code is permission for a code team to insert a ventilation tube into failing lungs, apply electric shock to a fibrillating heart, and unleash a extra blood of punctures, dissections, and exsanguinations on the human body. A resuscitation based on Full Code is supposed to be performed aiming in offering the patient a benefit. However, these interventions are marginally effective (Hiberman, Kutner, Parsons Murphy, 1997; Perers, Abrahamsson, Bang, Engdahl, Lindqvist Karlson, et al, 1999), lives saved and functioning restored only for a small number (15% worldwide average) of people (McGrath, 1987; Saklayen, Liss Markert, 1995; Schneider, Nelson Brown,, 1993). Subjecting a dying person to CPR who is believed there is virtually no hope of survival is a terrible way to practise health care; it is inhumane; and it is an assault. Despite significant improvements made in training, equipment, and drugs, the overall CPR survival rate has remained almost the same over the past 30 years (Beall, 2001). Findings from 33 studies showed that about 16% of patients under age 70 and 12% of patients aged 70 and older survived CPR only (Kaye Mancini, 1996). After participating in the resuscitation for Mr. D, I have been struggling over this real scenario at: (1) what is the quality of death; (2) who can decide the code status; and (3) what can I do for advocating my patient? As a nurse, I have to deal with life-and-death decisions with each of my patients. With the participating in the resuscitation for Mr. D and witnessed his death, I am wondering: what is a quality death? What a kind of process is a quality death? Who defines it? What is the resuscitation doing? How much do patients in terminal life stage have to understand about what dying is like? How well patients dignity could be preserved and integrated into the resuscitation process? How well patients wish could be respected in the decision of code status? How does a patient want everything to be done to extend his life Full Code in hospital parlance, or a patient wants to let his/her death happen naturally without interference a Do Not Resuscitate order? Does the Full Code status really benefit the patients interest or just benefit a substitute decision makers/familys interest? As for Mr. Ds scenario, is the Full Code status his real wish? Is the dying process his real belief about dying? Is t he dying process his real value about the death? Did he image his death with broken sternum and ribs, massive blood mess and contamination? Did he image that, at the end of life, he was surrounded by the code team rather than by his family members? Unfortunately, I have no solution to seek the true answers yet; I felt the contradiction and tension between the resuscitation on behalf of a Full Code status and quality death: professionally, I have duty of care to participate in the resuscitation action and do whatever required for such a purpose, but ethically and morally, I do not want to do any harm on my patients during the resuscitation. It has become my clinical dilemma of struggle for many years. The decision of code status is a complex and controversial topic. Theoretically, it seems simple and easy to declare either patient or patients substitute decision maker will be the subject to make decision about code status. However, in the real working environment, I noted that many patients indications on code status are blank, not checked yet; and sometimes they are left as blank for a long period; also, some patients code status has been changed reversely from Do Not Resuscitate to Full Code by their family; Mr. D was one of such examples. It tells me that the decision process in not a straight-forward linear procedure; it is organic or dynamic. The confusion for me is who is the real decision maker during this organic process, the patient own, patients family/substitute decision maker or a health care provider? As a regulated professional, a health care provider is rarely taking action as such decision maker; usually, either patients or their family will be. While the patient i s capable, it is clear that the patient decides it for himself or herself. However, my wondering is that there are so many factors that will impact patients capacity when decision needed to be made on the code status, such as age, medical condition, the quality of life, religious views and overall wishes. Further more, like the perception on pain, capacity is really subjective; a sound judgement on patients capacity also is difficulty. Who can decide a patients capacity is either intact or impaired without any interest conflict? Like Mr. Ds scenario, due to his senior age and confused medical condition, his daughter was his decision maker from the admission; the reality of his condition was recorded as deteriorated daily, and he had been incapable to provide any input about his code status; the progress notes show us that his code status has been changed from Full Code to Do Not Resuscitate, and then back to Full Code again during a five-week period of hospitalization. Is there any interest conflict in the process while his daughter made decision of turning over on his code status for him, and does such change will really benefit him in relieving suffering, restoring functioning and improving his quality of life? As a member of heath care team, what I can do to advocate my patients decision is really limited so that I am feeling helpless. Being a sick people in a hospital might be very stressful; in additional to physical symptoms, people may feel anxious, depressed and helpless. Also, family members might be place under a difficult time and position during a medical crisis; family members may disagree, emotions might be high and medical information can become confusing agent. In such a stressful circumstance, any possible irrational decision could be made without considering the reality and possibility. Perhaps, we can say nurses are knowledgeable to provide information, as well as nurses know more about the patients daily condition than a physician so that a nurse really can make some good input for health care team and family in decision-making to advocate patients benefit; however, the final decision is totally depending on patients or their substitute decision-makers understanding about the context of code status; they are legally granted the power. Like Mr. Ds case, his decision-maker alternatively requested change of his code status from Do Not Resuscitate to Full Code on his behalf that resulted in futile and miserable resuscitation, even if his most responsible physician could not apply any influence on it. Health care providers are not legally granted such a power, and ethically, we also can not apply our opinions, judgement or choice on patients or their decision-makers decision. So, I have been struggling over the relationship between power and knowledge; under such circumstance, knowledge is not and does not have the power at all. What we can do is through information providing to empower our patients or their decision-maker to use their power to make a right choice on code status to avoid such futile and miserable resuscitation happened on Mr. D without any benefit, but harm. Exploring Discourse Analysis The clinical dilemma as identified in the above scenario, the contradiction and tension are mainly triaged from respecting the patients own or their decision-makers choice on code status while providing our resuscitating intervention. In order to understand the issue, I did literature review on decision making on code status choice. I chose the patients or their decision-makers decision of choice on their code status and how to empower them in making a right decision by information providing to advocate for patients benefit in quality of life at the end of life as my focus. In the following sections, I will use Mr. Ds case to analyze this clinical dilemma from both liberal-humanist discourse and scientific-medical discourse perspectives. Scientific-medical discourse: empower patients to make right choice on code status According to Grant, Giddings Beale (2005), the scientific-medical discourse is based on the biomedical mode of medical science. Its core concept is that a human body is a collection of different parts that are organically organized and form different systems that manifest as a set of symptoms (Brown Seddon, 1996, a, b). It constitutes the scientific fundamentals and becomes the root of nursing science (Grant, Giddings Beale, 2005, p.499). That is the reason I chose it as one of my discourse. Medical knowledge explicitly tells me that life maintenance must be under the control of homeostatic balance, which is maintained by normal functions of all organs; and homeostatic control mechanism can maintain only in a relative narrow constancy (Thibodeau Patton, 2005, p.16). CPR is a desperate technique that is used on the people who are might be suffering cardiac arrest in order to deliver oxygen to blood stream and maintain a cardiac circulation to keep vital organs, such as such as the brain, be oxygenized to be alive, to delay brain death, and maintain the heart to remain responsive to defibrillation; in many type of patients, it virtually never works; for a patient with an advanced age and life-threatening illness who is dying of the underlying disease, there is very limited benefit because survival is rare ( As articulated by Grant, Giddings and Beale (2005), nurses had sound technical knowledge of bodily diseases, the associated symptoms, predisposing causes, and appropriate treatment (p.499) from medical science. Under the influence of biomedical model ideology, the interventions of nursing care have been constructed as a set of tangible, specifically operate-able and measurable procedures that are implemented in a methodical manner step by step, for example, nursing process. Reflecting on Mr. Ds case, by informing them the updated condition and possible prognosis through my careful and objective assessment, I can support my patient or their decision-maker to choose a right code status to avoid a violent death that occurs during an advanced cardiac life support and artificially prolonged life maintenance. It is not to apply my opinion or choice on them. It is to empower them to make right choice in a supportive manner to preserve patients dignity and quality of life, as well as death. In such a way, my professional integrity also will be benefited in maintaining, professional contradiction and personal tension will be avoided. Liberal-humanist Discourse: Advocating Patient According Grant, Giddings Beale (2005), the liberal-humanist discourse of nursing care is a holistic approach; the patient is viewed as a whole person and a unique individual, not the collection of different parts only. Empathic nursing care does not only deal with patients biomedical issues, but also emphasize patients autonomy, rationality, emotions, understandings and dignity; it is characterized by respecting patients self-determination, free choice, and self-representation (Praeger, 2002). The ethic ideology of liberal-humanist discourse of nursing care is underpinned by two assumptions: nurses commitment to a trust therapeutic interpersonal relationship of care and having moral obligation to act (Dyson, 1997, p. 200) on behalf of patients (Grant, Giddings Beale, 2005). Such a sound holistic approach becomes the grand rationale I choose it as one of my discourses. Also, it casts and shapes my best nursing practice by providing my patients and their family holistic caring. However, it must be understand that such an universal or global ideology itself has an underlying contradiction and tension that I experienced in my patient Mr. Ds scenario, that is, under some circumstance or specific context, it is difficulty that empathetic nursing care must have commitment to trust interpersonal relationship by respecting the patients autonomy and at the same time, nurses also have moral obligation to act on behalf of the patient. As for Mr. Ds case, health care team discussed the code status choice in multiple family meetings based on informed decision principle. The whole caring process demonstrated the empathetic caring by respecting familys decision on the code status choice, taking appropriate and timely resuscitation action morally on behalf of the decision maker. However, the misery result was the violation of patients dignity and quality of death in the dying process, which is actually avoidable and it morally generates the ethic guilty and tension in health carers emotion, because health carer eventually does not have the legal authority to take action to morally prevent such an avoidable misery event to be happened. Such contradiction and tension in professional, legal and ethic principles basically contribute to my distress and confusion. Implications for Nursing Practice The discourse from either scientific-medical approach or the liberal-humanist approach, while peoples life reaches the end stage life-span, not only does the physical body, but also the person as a whole, become a vulnerable object. Being a ill person in a hospital can be terribly overwhelming with physical symptoms, anxiety, depressed and helpless, as well as invasive treatment, diagnostic interventions and a variety of information that is related to each procedure. A treatment is supposed to be of benefit if it relieves suffering, restores functioning and improves quality of life; it will become a burden if it causes pain, prolongs dying without offering a benefit or increases distress. When we emphasize that patients do have some control over what kind of treatments they do and do not want, but in how many cases patients really implement their control over the treatments? Taking Mr. Ds scenario as an example, being in his senior age and impaired cognitive status, it is impossible for him to be a host to get his treatment and care plan under the control of his wishes; his decision maker on his behalf, driven and masked by a general graceful desire that is often seen in the most of people, just wants everything has to be done to remain alive to save and prolong his physical life, even if a few more minutes, legally places not only his physical body, but also a person as a whole at the risk of vulnerable position unconsciously while choosing a Full Code status. As a nursing member of the code team, I have professional obligation to do some inhumane resuscitation actions on his vulnerable body and impair his dignity of death. So, putting myself into Mr. Ds shoes, if either my parents or I were in his age and health condition, I really need the preservation of self-determination, free choices and self-representation in decision making on code status choice choose DNR, let me go naturally without pain, suffering and inhumane resuscitating effort. Our patient-center nursing care philosophy always makes us be aware of that patients need to be supported, not blamed (Kammerer, Garry, Hartigan, Carter Erlich, 2007). From the liberal-humanist discourse of nursing care views, committed to trust interpersonal relationship with patients, empathy and communication are two core concepts. When a persons life is at the brink of death, a clear mind is a rarely existed. Often, it will be more difficulty to accept and respect a frail mind than a frail body. Terminally ill people may look differently, feel even worse and terrible, and think in another way. They need advocacy, protection and caring in humane, patient, and professional ways. Supporting their ability to get their lives under control is no less important than keeping their blood pressure under control. Communication in an empathetic passion is more conducive to doing the right thing than rigid legal documents. Nursing has moral, as well as professional, obligation to communicate our scientific-medical knowledge to support patients in determining what kind of code status they want to be and make their wishes known to their loved ones. Family is an integrated part of our clients, which are facing a difficult position during a medical crisis. Identically, we have above obligation to support patients family members in knowing what a loved one wanted that will help them get peace of mind that they are honouring the wishes of their loved one. In such a way, our professional development will be in growth, and our personal distress that is involved in the discourse tension will be released. Summary According to the learning goals of this course, discourse from scientific-medical approach and liberal-humanist approach on a real clinical situation is presented in this paper. Personal distress, frustration and confusion arisen from the clinical dilemma have been analyzed. Nursing care can be explored from different kinds of contradictory discourses. All these contradictory discourses might contribute to nurses feeling of distress, frustration or confusion when encountering different clinical situations. The liberal-humanist ideal of ethic of care focus on viewing a person as a whole and respecting patients self-determination, free choice, and self-representation, bur patients need advocates and support from scientific-medical approach in decision-making. Furthermore, for professional and personal development, nurses should learn to understand these different discourses in one situation and take effective strategies to solve the clinical dilemma. Committing to a trust therapeutic i nterpersonal relationship with patients will help nurses understand patients better, and it also helps nurses to find the meaning of the event so that effective solutions could be figured out to solve clinical dilemma.