Relaxation Therapy: Intervention Evaluation

Relaxation Therapy: Intervention Evaluation Part Two: Report and Discussion of Therapeutic Intervention Reflection on Feedback from Part 1 The discussion around the implementation of relaxation therapy in the chosen setting was quite detailed, because there were a number of people who raised issues which were important for managing the implementation. The first issue raised was the nature and type of the relaxation, which also related to a discussion of expertise in relation to providing relaxation of this type. Relaxation has been proven to be effective in a number of clinical scenarios (Hyman et al, 1989). However, questions were raised about the exact nature of the relaxations to be used – were these to be progressive muscle relaxations, guided visualisation, or free visualisation (Lehrer et al, 1988)? There are significant differences in the effects of different kinds of approaches to relaxation and visualisation (Galvin et al, 2006; Gerdner, 2000; Sellers, 2005). Questions were also raised about how well the intervention could be evaluated if there were different techniques being used. Therefore, one of the changes that was made was to devise a limited number of relaxation exercises and to only use these within the clinical setting. These were therefore limited to one progressive muscle relaxation exercise, and one guided visualisation, using very neutral imagery. There was no attempt at more complex therapeutic intervention. The issues raised about competence and expertise in providing these relaxation therapies were therefore addressed, and there was not need to seek out extra training or support in specific relaxation therapies. Further feedback identified a need to explore more evidence about relaxation therapies, particularly for this kind of client group, and in health interventions in particular. Therefore, a further search of the literature, extending back further chronologically as well as looking more widely, was carried out, and such literature reviewed as part of the process of evaluation of the intervention. A clear framework, rationale and evidence base for the selected therapeutic intervention Relaxation therapies have found a broad range of uses in healthcare practice. In this client group, there is evidence to suggest that relaxation therapies would be beneficial, simply because they can help the older adult retain cognitive function and memory function (Galvin et al, 2006). Galvin et al (2006) describe the relaxation response in terms of a physiologic response that can counter the bio-chemical responses to anxiety which can affect the cognitive functions of the older adult. In order to achieve this Relaxation Response, a range of therapies can be used. â€Å"Numerous techniques, including progressive muscle relaxation, meditation, guided imagery, biofeedback, the pre-suggestion phase of hypnosis, deep breathing exercises, autogenic training, tai chi, Qi gong and yoga can elicit the relaxation response† (Galvin et al, 2006 p 187). Obviously, a number of these techniques would require specialist training and specialist provision, and most likely, a private, designated and appropriate place in which to carry out the intervention. However, Gal vin et al’s (2006) research does suggest that progressive muscle relaxation and guided imagery are effective techniques for inducing the relaxation response. Improving memory function in older adults who mental illness might be particularly beneficial and might help to reduce anxiety. Conrad and Roth (2007) discuss the use of progressive muscle relaxation in providing therapy for anxiety disorders. Conrad and Roth (2007) define muscle relaxation therapy as â€Å"an abbreviated therapy based on Jacobson’s original PMR, which included in its training procedure first tensing a muscle and then releasing that tension.† (p 244). They describe progressive muscle relaxation therapy as being based on the idea that tense, stressed, and anxious people can find some symptomatic and ongoing relief from their distress and the physiological responses which accompany it, by learning to reduce muscle tension within the body (Conrad and Roth, 2007).† A modern theoretical rationale for MRT is that an important element of psychological distress is elicitation of a generalized stress activation response, comprising multiple central and peripheral physiological systems †¦ [and] learning to deactivate a single subsystem, the muscular system, will reduce activati on in many other subsystems† (Conrad and Roth, 2007 p 244). Ost (1987) echoes these findings. Conrad and Roth’s (2007) review of the literature demonstrates clear physiological responses to muscle relaxation which have a number of health benefits, in reducing the effects of anxiety on the body and brain, and controlling the body’s response. Yu et al (2007) show that relaxation therapy reduces physiologic distress in patients with cardiovascular disease, and has beneficial effects on recovery. It could be assumed, from these findings, that similar physiological responses to relaxation therapy would be beneficial to the ageing body systems as well as to the psychological state and wellbeing of the older adult. Gerdner (2000) addresses the issue of distress and agitation and confusion in the elderly patient with Alzheimer’s disease, and looks at relaxation music as a means of improving these symptoms. Gerdner (2000) found that individualised relaxation music (music of preference to the patient) was very effective in reducing agitation and confusion. It would be appropriate, therefore, to provide a range of music for the patients receiving the intervention here, and this was tailored to patient preferences over time, looking at responses from patients, and asking patients and their carers about preferences. Although this can be difficult to implement in a group setting, it was also a useful adjunct to the relaxation sessions and could be used by patients when they practised the techniques individually. Murray (2008) found that relaxation techniques were of therapeutic benefit to patients with neurogenic disorders, including Parkinson’s disease. O’Conor et al (2008) found that this kind of behavioural treatment of psychologic disturbance in dementia was effective, but in the shorter term, and so the benefits were time-limited. Staal et al (2007) also found such behavioural interventions effective in dementia patients. However, this author believes that the therapies can continue to be of benefit to patients if they can learn to apply them independently, or if they are continued as a regular part of ongoing care. Other kinds of relaxation have been found to be particularly beneficial in elderly care, including animal-assisted therapy for dementia in the older adult (Filan and Llewellyn Jones, 2006; Sellers, 2005). All such interventions require is a dedicated practitioner to implement and evaluate them, and the facilities to carry them out. However, the literature is li mited on the use of such therapeutic interventions in the kind of setting I planned to use them in. A discussion of the process of the application and an evaluation of the outcome of the intervention in the practice area. This should include objective and subjective feedback from the person(s) involved In line with the planning of this intervention, the author devised two relaxation protocols to take place in a 16 bedded functional ward for adults over the age of 65 who suffer from a range of mental health illnessess, such as bi polar disorder, shizophrenia, depression, anxiety and onset dementia. The first protocol was a progressive muscle relaxation exercise, with a duration of around 15 minutes, supported by music that was acceptable to the patients present during the intervention. The second intervention was a guided imagery relaxation exercise, in which the patients were taken through a progressive relaxation and then guided through a set sequence of visualising themselves in a comfortable place. The details of the visualisation were kept quite generic, in order to avoid, if possible, unwanted negative associations with particular imagery, such as, for example, using water in patients who are afraid of water. Therefore, the visualisation placed the patient in their favourite c hair, in their favourite location, looking out of a window onto the sky and the landscape. They are guided to see blue skies, white clouds, rays of sunlight coming through the window, and to feel warm, relaxed and comfortable. A light breeze, warm and gentle, comes through the window. The patients are encouraged to feel very relaxed and comfortable, and to enjoy the sensations they are feeling. The therapeutic relaxation was carried out with patients daily, and there was a mix of patients attending each day. The therapy was carried out in the day room, and only those patients who could mobilise to the day room were included, and obviously, those who wished to join in. The staff were informed about the intention to offer this therapy, and discussion with the lead nurses/key workers for each patient revealed their thoughts about the suitability of the intervention for their patient. Details about each patient that were relevant to the intervention were gathered from the clinical staff, and from the patients themselves and their carers/family members. Having carried out a more detailed literature review meant that I was able to provide a good rationale to staff, patients and carers, and also to discuss the measures I had taken in order to avoid any negative consequences. There were a number of issues which made the implementation of the intervention challenging. The first was the fact that I had to carry this out within the day room that is provided for the patients as no other area is available. This was not exactly appropriate as the lighting is too bright even when the lights are off and the seating is not comfortable. To achieve a good state of relaxation, comfortable seating and subdued lighting is important. Although it was possible to play music, it was not sufficient to drown out other ward noise. Also some patients tended to wander in and out of the area, which couldnt be helped, however it did disturb the group. Feedback from certain patients showed that they did enjoy the relaxation, but they found it hard to achieve deep relaxed states due to the environment in which the intervention was taking place, and due to the disturbances from patients (and staff at times) coming in and out, and from ward noises such as phones ringing. Some patient s found the uncomfortable chairs worse than anything else. What this feedback shows, however, is that given the right environment, this intervention might be somewhat more effective. Patient feedback around the effects of the intervention was mixed. Some patients said they enjoyed it, but did not feel very much different. However, these were patients who also found it difficult to carry on the intervention in their own time, and this lack of significant effect could be related to the interruptions and bad environment, and to their lack of commitment to continuing relaxation exercises on their own. Some patients found it very hard to achieve relaxation at first, but after successive sessions, were able to master the techniques. Two patients (and their carers) provided very positive feedback, stating that they were using progressive muscle relaxation regularly to manage feelings of anxiety, fear, and depression. The literature reflects this finding (Peasley Mikus and Vrana, 2000; Jorm et al, 2004; Knott et al, 1997). I found this to be a very positive result. Feedback from the staff was similarly mixed. Staff were generally positive about the potential benefits of relaxation therapy, but were vocal and quite disparaging about the available facilities and location supporting this kind of intervention. Some expressed their doubts about patients being able to sit and apply the intervention, in certain cases. However, as stated, most were not opposed to the intervention. Feedback from staff, however, did not suggest that they viewed any particular benefit to patients, except in one case, where the patient’s key worker clearly stated that the relaxation techniques had helped with anxiety and depression symptoms. However, one of the negative issues that appeared in feedback from staff, patients and carers was the lack of belief in the ongoing usefulness of such therapies for certain patients, and the difficulty for certain patients, such as those with dementia, to follow the instructions and achieve a true state of relaxation. My evaluat ion of the intervention, however, would be that limiting it to two techniques was the right thing to do. The muscle relaxation alone was effective, but some patients did not tolerate the visualisation well. However, it is difficult to determine how beneficial these interventions might have been, because in my opinion, the negative effects of the poor environment, interruptions, noise and discomfort meant that it was difficult for them to achieve true relaxation. If I had had the facilities to measure physiological markers for a state of relaxation, I could have evaluated just how deep a state was achieved. In the circumstances, I do not believe that deep relaxation was achievable. Reflection on Personal Learning Outcomes My personal learning outcomes for this experience were very much related to my skills in communication with patients, staff and carers, my ability to develop a deeper understanding of a particular approach to supportive, therapeutic intervention in a clinical area, and the ability to apply principles of experiential learning and reflection to the experience in order to prepare for future practice. In relation to the development of communication skills, implementing this intervention required a lot of different types of communication, including communicating the benefits of the interventions to different types of people, patients, some of whom had cognitive or mental health issues, carers, who were lay people without specialist knowledge, and staff, who did have specialist knowledge. This required adaptability to different levels of communication, and good listening and interaction skills to be able to answer their questions appropriately and take their opinions into account prior to the intervention. In relation to the development of a detailed knowledge of a particular intervention, this was achieved through the detailed literature review, through talking to staff, and through carrying out the intervention. I gained a deeper understanding of the practicalities of this kind of intervention, and the environment and circumstances that are most conducive to achieving a state of relaxation. I also learned a lot about the kinds of things that assist in achieving a good state of relaxation, such as making sure everyone is ready, and that they have all been to the toilet and are not hungry or thirsty, and in the case of some patients, not in pain or emotionally distressed, or due to have a dose of medication. I only learned these things through attempting to implement the intervention. In reflecting on the evaluation, the light of the feedback from staff, patients and carers, it was difficult to receive so much negative feedback, and also to understand the reasons for some of this. It was frustrating not to be able to provide an optimal environment for relaxation, and to realise that things might have been better if we could have had a better setting for the intervention. However, the fact that a small number of patients and carers, and one key worker, reported beneficial effects of the intervention, was reassuring. Ideally, for this kind of therapy to be effective, providing the appropriate setting, and support, and building the therapy into daily care activities, and care plans, is important. Providing information for patients and carers on the activity, perhaps in the form of a patient/carer leaflet, would also be useful. Overall, I do believe that the intervention was a small success, and that in the future, with better forward planning and better facilities, it could present an opportunity for significant patient benefit for certain patients. References Conrad, A. and Roth, W.T. (2007) Muscle relaxation therapy for anxiety disorders: it works, but how? Journal of Anxiety Disorders 21 243-264. Filan, S.L. and and Llewellyn-Jones, R.H. (2006). Animal-assisted therapy for dementia: a review of the literature. International Psychogeriatrics, 18 597-611. Galvin, J.A., Benson, H., Deckro, G.R. et al (2006) The relaxation response: reducing stress and improving cognition in healthy aging adults. Complementary Therapies in Clinical Practice 12 186-191. Gerdner, L.A. (2000). Effects of Individualized Versus Classical â€Å"Relaxation† Music on the Frequency of Agitation in Elderly Persons With Alzheimers Disease and Related Disorders. International Psychogeriatrics, 12 49-65 Hyman, R. B., Feldman, H. R., Harris, R. B., Levin, R. F., Malloy, G. B. (1989). The effects of relaxation training on clinical symptoms: a meta-analysis. Nursing Research, 38(4), 216–220. Jorm, A. F., Christensen, H., Griffiths, K. M., Parslow, R. A., Rodgers, B., Blewitt, K. A. (2004). Effectiveness of complementary and self-help treatments for anxiety disorders. Medical Journal of Australia, 181(7 Suppl.), S29–S46. Knott, V., Bakish, D., Lusk, S., Barkely, J. (1997). Relaxation-induced EEG alterations in panic disorder patients. Journal of Anxiety Disorders, 11(4), 365–376 Lehrer, P.M. (1978). Psychophysiological effects of progressive relaxation in anxiety neurotic patients and of progressive relaxation and alpha feedback in nonpatients. Journal of Consulting and Clinical Psychology, 46(3), 389–404. Lehrer, P. M., Batey, D. M., Woolfolk, R. L., Remde, A., Garlick, T. (1988). The effect of repeated tense-release sequences on EMG and self-report of muscle tension: an evaluation of Jacobsonian and post-Jacobsonian assumptions about progressive relaxation. Psychophysiology, 25(5), 562–569. Marks, I. M. (2002). The maturing of therapy. Some brief psychotherapies help anxiety/depressive disorders but mechanisms of action are unclear. British Journal of Psychiatry, 180, 200–204. Murray, L.L. (2008) The Application of Relaxation Training Approaches to Patients With Neurogenic Disorders and Their Caregivers. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 18 90-98. OConnor, D.W., Ames, D., Gardner, B and King, M. (2008) Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, Published online by Cambridge University Press 25 Sep 2008 Available from http://journals.cambridge.org/action/displayAbstract?aid=2324948 Accessed 8-1-09. Ost, L. G. (1987). Applied relaxation: description of a coping technique and review of controlled studies. BehaviourResearch and Therapy, 25(5), 397–409. Peasley-Miklus, C., Vrana, S. R. (2000). Effect of worrisome and relaxing thinking on fearful emotional processing. Behaviour Research and Therapy, 38(2), 129–144. Sellers, D.M. (2005) The Evaluation of an Animal Assisted Therapy Intervention for Elders with Dementia in Long-Term Care . ctivities, Adaptation Aging: 30 (1) 61 77 Staal, J.A., Sacks, A., Matheis, R. et al (2007) The Effects of Snoezelen (Multi-Sensory Behavior Therapy) and Psychiatric Care on Agitation, Apathy, and Activities of Daily Living in Dementia Patients on a Short Term Geriatric Psychiatric Inpatient Unit. The International Journal of Psychiatry in Medicine 37 (4) 357 370 Yu, D.S.F., Lee, D.T.F. and Woon, J. (2007) Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. Journal of Psychosomatic Research. 62 427-437.

Thousand Splendid Suns Comparison

It seems that War has found a home in Afghanistan. The people of Afghanistan have seen three decades of Anti-Soviet Jihad, civil war and Taliban tyranny. They have lived through unimaginable horrors and now, their incredible stories of hope and oppression are being told. In A Thousand Splendid Suns by Khaled Hosseini and The Swallows of Kabul by Yasmina Khadra, the women are oppressed by their husbands and society. Mariam is passive and compliant while Zunaira is defiant and angry, yet both suffer the same pain and isolation. Initially, their suffering increases because their anger at being oppressed and tortured is deflected towards the wrong people, people who actually care for them. Through their difficult journeys, their eyes are opened up to the power and beauty of a loving relationship. The loss or gain of such a relationship is the defining factor of whether or not each character finds peace and self-worth. The women in both novels transition from a state of being hopeful to complete desolation due to the oppression in their lives. Initially, Mariam from A Thousand Splendid Suns expresses much hope about attaining a bright future. She wants to pursue an education as she says, â€Å"I mean a real school†¦like in a classroom, like my father's other kids† (Hosseini, 17). Mariam firmly believes that she can shed her shameful status of a bastard's child, and as she gets older, she takes strides to make this vision into a reality. Moreover, Mariam is constantly inundated with her mother's pessimistic ideals about life, but she believes that â€Å"You're [Mother] are afraid that I might find the happiness you never had. And you don't want me to be happy. You don't want a good life for me† (Hosseini, 28). As a result, at first, Mariam is a strong figure with a lively spirit who is able to combat much negativity in her life and continue to dream and hope of a better future. Perhaps, her naivety fosters these hopes and dreams as well. Later, Mariam's husband, Rasheed successfully crushes her strong spirit. During one of his fierce outbursts, â€Å"he shoved two fingers into her mouth and pried it open, then forced the cold pebbles into it†¦but he kept pushing the pebbles in, his upper lip curled into a sneer† (Hosseini, 104). Mariam is tortured psychologically, physically and her lively spirit is broken. She completely isolates herself from the outside world, and quietly suffers inside her house as â€Å"†¦Mariam was afraid† (Hosseini, 98). She is passive and compliant in the abusive relationship because she abandons all hope, and tries 1 to endure everything that falls upon her. Oppression crushes Mariam's inner strength and she becomes a walking dead person, confined to her own home. Furthermore, Zunaira from The Swallows of Kabul undergoes a similar transition from a state of hopefulness to desolation. At the beginning, Zunaira is a hopeful person. Her husband, Mohsen, says, â€Å"Her zeal was unmatched, save by the praises heaped upon her. She was a brilliant girl and her beauty lifted every heart† (Khadra, 73). She is extremely passionate about empowering the women in Afghanistan, that she even pursues a career as a magistrate to set an example to rest of her countrymen. Zunaira embodies hope, and positive change in a country devastated by war. Like Mariam, Zunaira's hopeful spirit sets her up on a high pedestal to fall from. Then, Zunaira is oppressed by the Taliban. She is writhing with anger and hatred when she says, â€Å"†¦the most detestable fact of [my] existence, to the constraint with anger and hatred that even in [my] dreams [I] refuse to accept: the forfeiture of [my] rights† (Khadra, 99). Anger and hatred threatens to rip Zunaira apart because she feels that the Taliban have stripped her off her dignity and humiliated her beyond endurance. Pride is important to Zunaira. Thus, she struggles to control her anger in public when she views the bitter state of her country, how the Taliban have destroyed her pride, hopes and dreams. Unlike Mariam, Zunaira is defiant and angry. Zunaira actually attains her goal of becoming a magistrate, and thus, she experiences a greater sensation of loss. Mariam and Zunaira combat the oppression in different ways but they suffer the same pain and isolation. Oppression induces a negative change in both characters. In addition, the women have coping mechanisms to deal with the sorrow in their lives. Their ability to cope is affected by family members. Mariam remembers her mother's story, â€Å"where each snowflake was a sigh heaved by an aggrieved woman somewhere in the World. That all the sighs drifted up in the sky, gathered in the clouds, and then broke into tiny pieces†¦Ã¢â‚¬  (Hosseini, 91). Mariam is submissive in her abusive relationship because her mother has taught her by example, that Afghani women solely have to endure the pain and suffering in their lives. She makes no attempts to change her situation in her marriage because she lives by her mother's teachings. Perhaps, if Mariam were to stand up for herself or stir up chaos during one of Rasheed's beatings, Rasheed would not turn to violence against her so easily. Also, Mariam could have searched for alternatives to escape Rasheed before the Taliban implemented the harsh laws. Over the years, Mariam becomes increasingly helpless and miserable under Rasheed's rule, as she follows the model of her mother's teachings. Also, she deflects her anger and sorrow 2 towards the wrong people, people who actually care for her. Laila, Rasheed's younger wife tries to extend a friendship towards Mariam multiple times, but Mariam pushes Laila away. She screams at Laila, â€Å"†¦I have no use for your company†¦You will leave me be and I will return the favour. That's how we will get on. Those are the rules† (Hosseini, 226). As Mariam pushes Laila farther away, she only becomes a greater target of Rasheed's abuse because Rasheed tends to beat Mariam when he is angry with Laila. During a beating, Rasheed â€Å"held a belt in his hand†¦Ã¢â‚¬  and Mariam becomes absolutely petrified, but Laila tries to stand up for Mariam. United, Mariam and Laila are able to stand up to Rasheed and reduce the frequency and severity of Rasheed's beatings. By rebuffing Laila, Mariam only increases her own pain and suffering. The character's coping mechanisms seem to only destroy any remaining strands of courage and hope within them. Similarly, in The Swallows of Kabul, Zunaira tries to find a way to cope with the oppression in her life. At the beginning, she tries to forget her own pain and suffering to be strong for her husband. Mohsen, her husband, insists on taking a stroll in the streets of Kabul, and Zunaira refuses to go because she does not want to wear the Burqa. To Zunaira, the Burqa epitomizes the mistreatment and oppression of women in Afghanistan. In the end, Zunaira agrees to go with Mohsen when she says, â€Å"Let's go out. I'd rather run a thousand risks than to see you so demoralized† (Khadra, 79). Zunaira sacrifices some of her core values to make Mohsen happy, who is her only support system in this World. Though she does not want to lose Mohsen, her ability to cope with the oppression is hindered when she views firsthand the Taliban's brutality. Similarly, Zunaira's ability to cope with oppression is negatively impacted by the actions of her family members. Both women's hopes are crushed, but, Mariam becomes more compliant while a fire is ignited within Zunaira, which threatens to rip her apart. Also, Zunaira shuns her loved one out of her life. When Zunaira refuses to talk to Mohsen and remove her Burqa after the stroll in Kabul, he recounts, â€Å"her anger is so intense that her veil trembles before her agitated breathing and she says, ‘I don't ever want to see you again, Mohsen Ramat'† (Khadra, 129). At first, Zunaira uses her husband to cope, but later, she targets her fury towards him because she wants him to experience her great feeling of loss. Mohsen is a man, and Zunaira believes that a man will never allow a woman to attain her freedom. Like Mariam, she ends up deteriorating her life further because Mohsen accidentally dies during one of their fights. Thus, Zunaira loses another member of her family to the Taliban. Zunaira is angry, but her actions cause her loved ones to 3 suffer too, unlike Mariam who bottles up her fury and grieves alone. In the end, Mariam and Zunaira's coping mechanisms only accelerate their feelings of pain and isolation. Finally, the women in both novels undergo a period of self-realization by losing or gaining a loving relationship. Mariam is able to acquire a new found sense of inner strength. Laila and Mariam forge a special sisterly bond that Mariam can turn to for support and strength. Mariam says, â€Å"But, perhaps there were kinder years waiting still. A new life, a life which she would find the blessings that Nana had said a harami like her would never see† (Hosseini, 256). Her sisterly bond induces a positive change in Mariam as she starts to hope again. Mariam's spirit is rejuvenated, and she finds a newly acquired strength to defeat her oppressor, Rasheed. She frees herself off her primary oppressor for she finds the courage to kill Rasheed. She finds a state of inner peace at last. Also, Mariam finds a new purpose in life. Before Mariam is to be executed, she thinks, â€Å"A Weed. And yet she was leaving the World as a woman who had loved and been loved back†¦a person of consequence at last. No. It was not so bad†¦that she should die this way† (Hosseini, 370). Mariam is resented by her mother, father and husband, but her relationship with Laila and Aziza, Laila's daughter, redefine her outlook on life. Their love fills a hollow spot within Mariam, and it lessens the pain of living under oppression for decades. As Mariam has loved, she is finally able to shed her status of a arami and gain a new sense of selfworth. She sees the beauty in a loving relationship, and she finally does find peace and selfworth in her life. In The Swallows of Kabul, Zunaira makes an important self-discovery as well. By severing her ties to Mohsen, she attains a form of inner strength. When the Jailer, Atiq, tries to convince her to run away from the jail, she says, â €Å"I can't wait to get out of here, but not in the way you propose† (Khadra, 164). She accepts her fate and is prepared to die. With Mohsen's accidental death, Zunaira severs all ties to the physical world. She rids herself of all duties and obligations and deserts all of her hopes and dreams. She feels like a free spirit, symbolized by the removal of her Burqa. Her lightness renews her inner strength and now, she feels she can overcome any obstacle in her path, even dying. Though Zunaira attains a sense of inner peace by severing ties to loved ones, Mariam achieves this by finding the beauty in a loving relationship. Like Mariam, Zunaira is willing to die because their newly gained inner strength gives them the power to vanquish all obstacles in their path. Also, her loss of a loving relationship changes her perspective on life. She says to the Jailer, â€Å"We've already been killed, all of us, it happened so 4 long ago, we've forgotten it† (Khadra, 164). Zunaira realizes that she has lost everything to the Taliban, her family, her dignity, her hopes and dreams. When she sees that she has nothing worth living for anymore, she feels there is nothing more she can lose in this World, and thus, she thinks about life differently. The author does not elaborate about Zunaira's life after she is freed from the jail, but probably she dies in the near future because she does not have a home to return to. Similarly, Mariam and Zunaira are able to see the power and beauty of a loving relationship. Zunaira leaves behind her pride, and need to feel empowered while Mariam actually gains a new sense of self-worth. For Zunaira, leaving behind all the things attached to her relationship with Mohsen gives her peace. So, each character takes different routes to find peace and self-worth. A Thousand Splendid Suns by Khaled Hosseini and The Swallows of Kabul by Yasmina Khadra are both set in war-torn Afghanistan. The women are oppressed by their husbands and society. Then, the coping mechanisms they utilize only increase their pain and suffering. Finally, Mariam and Zunaira make an important self-discovery where they either gain or lose the power and beauty of a loving relationship to find peace and self-worth. Overall, Mariam and Zunaira seem to reverse their roles from the beginning to the end. Mariam is passive at first, but she becomes quite aggressive at the end. While, Zunaira follows the opposite path to achieve inner peace. Millions of women are oppressed around the World, and it seems that love is the critical factor to breaking the cycle of oppression.

Learning Through Play: Games and Crowdsourcing for Adult Education Essay

Games are a powerful to engage people with ideas and with each other. They are a way to learn new skills, and to interact with other people. This interaction can be with other people in the same room or with people online. Games are fun. This is obvious, but sometimes it can become forgotten about in the discussion. In research in 2011 by Bond University for the Interactive Games & Entertainment Association * pcs are in 98% of game households with 62% of game households using a pc for games. Game consoles are in 63% of game households, dedicated handheld consoles in 13%. Mobile phones are used to play games in 43% of game households, tablet computers in 13% * 43% of people aged 51 or over are garners * most garners play between half an hour and an hour at a time and most play every other day 59% play for up to an hour at one time and just 3% play for five or more hours in one sitting 57% of all gamers play either daily or every other day. * 83% of parents play video games. (1) Comparable statistics are not available for board, tabletop and card games. This is unfortunate as, from word of mouth, board games are very popular. The German, or European, style games have strong appeal for adults. Games in this category include Settlers of Catan (2) and Carcassone. (3) Board games can be used as part of an education program exploring games, game design, history, and strategy. They could also be used to introduce adults to games they did not play when they were growing up–and that is just the start of what is possible. Find the future New York Public Library received much coverage for its 2011 game Find the future (10) which ran as part of their centenary celebrations as a way for people to discover and explore the collection. The game was deliberately designed with an education focus. The first night of the game was run as an event for five hundred people. After this people could play this game at their own pace and in their own time, at the library. Changing thinking about games There is still reluctance, despite the overwhelming statistics, for many libraries to admit how many of the adults who use their collections and services probably play games. Earlier this year Heikki Holmas, the new Norwegian minister for international development, was given media coverage because of his public statements about his own playing of Dungeons and Dragons, and how skills are learned in games which have real world applications. This means that his tabletop games skills will help him in parliament. (11) Adam Grimm highlights some of the skills and attributes gained or developed by playing Dungeons and Dragons which include imagination, structure, performance and problem solving. (12) People like Heikki Holmas and Adam Grimm are using our libraries and we are rarely giving them a way to engage–or may be guilty of making judgments about them because of the games they play. The Central Arkansas Library System ran programming for adults teaching people about playing World of Warcraft. This may seem an unusual game to be part of a library education program. However, the aim of this education program was social inclusion, and it was thought that playing a game like World of Warcraft may be one way to assist in this locally. Library staff were pleased with the outcomes. (13,14) There are many opportunities in libraries using games for education Some of these can be done by showing how exciting games can be and by having people realise that the boardgames they may have played as children, or even have played with their children have developed and new possibilities target adult players. Playing Carcassonne could be used as part of an adult education program on medieval history, so people could be discussing the history they are reading, but also play a game constructing a medieval town and so apply the ideas they have learned from reading or hearing about the medieval world. Games can allow a different angle on creativity in education programming. Brian Mayer and Christopher Harris in their book Libraries got game: aligned learning through modern board games have written about this from a primary school aged perspective, but many of their ideas apply to learning through games at any age. (15) They also make the point strongly that a game has to really be a game. This sounds obvious, yet people forget this point surprisingly often. There is a lot of tools to help with boardgames. BoardGameGeek (16) is an invaluable online resource with detailed reviews about boardgames as well as walk throughs of the different games. Table Top with Wil Wheaton by Geek & Sundry (17) is an excellent video channel to learn how different table top games are played–so you can start thinking about their place in educational programming, and not simply programs about learning to play games. The Game Library for the School Library System of Genesee Valley Educational Partnership (18) has some useful resources for games targeting infants and primary aged children. Science games There are also ways to draw in the community through games. A game like Fold.it (19) a University of Washington initiative which is about folding proteins has resulted in scientific breakthroughs. (20) It was designed to trigger scientific discovery, but the game is also an experiment. Fold.it could be used as part of a series of science talks, with visiting or local scientists, at a library where the participants could join in with others who are contributing to scientific discoveries. Then people could be working in a collaborative space in the library, folding proteins together interacting with the other people also in the library space as well as others online in Fold.it. This could appeal to a wide range of ages, from students considering science careers, to adults wanting creative and puzzle solving options. It is a free, social, online game. EteRNA, (21) a collaboration between Stanford University and Carnegie Mellon University has similar concepts. This is a game about RNA molecules, and again serious science is being done through playing games. (22) This would also make for interesting library programming. These games could be part of a series about science, but equally they could be part of a series about games to help more people understand the range of options available to people who play games exploring creative problem solving, and helping to do science at the same time. Both Fold.it and EteRNA would be useful inclusions with library based science programming, and could provide a useful tie in to your library collection, including databases. The Science Museum in London has a significant collection of online games about science, which could be used to help people learn more about specific ideas, as well as to explore ideas of game design and engagement. (23) Through all this science it is important to remember the ideas of Mayer and Harris, that first and foremost the games have to be fun. Zombie Climate Apocalypse (24) run by The Edge at the State Library of Queensland may seem an unusual inclusion for science games–however the game is about survival. The players have to problem solve a vast range of survival skills (including water purification) so science is really important. A game like Zombie Apocalypse taps into many library collections (books, dvds and databases with information about the idea of zombies and survival), and can help bring a new range of clients to the library. A game like this can also be used to bring in ideas from places like the USA Centre for Disease Control and its web pages about zombie preparedness (25) which they created as a different way for people to think about disaster preparedness. If you are ready to survive zombies you are probably ready for other natural disasters as well. Science is well suited to education programs involving games, using ideas for partnerships mentioned above. Unlike Orange County Library Service we are not all going to have Otronicon in our area. Otronicon explored the science, art, technology, careers and fun behind videogames, simulation and digital media. Each year, multiple industry partners join the Orlando Science Center to celebrate how digital media technologies impact the way we live, learn, work and play. (26) Orange County Library Service has also been highlighting games as part of its services, and as part of the education program. They have classes teaching game design, but also educating people about the employment possibilities presented by games. (27) We will all have scientists in our communities, no matter how small. It just requires some creative thinking to explore partnerships, and to consider who you might invite to your library as part of a science education program including games, collections and science databases. Games design for all ages This is an area of potential partnership with universities which teach game design (if they are local to your area) or with local games groups. It is a specialist area of education. Some public libraries and museums have been running programs on game design, mainly targeting children and teenagers. There is much underexplored potential for running this kind of education program for adults. It also might be about seeing if you can create a game to help people explore the history of their area so the education elements would be around research (so that the history of the area can be explored), and games design (to see if a meaningful game can be created for the community). This is a specialist area, needing specialist trainers. Be open to the formats you are considering, as the games do not need to be made on computers or even for computers. Board games are a very popular format, as are large scale games outdoors.

Business Strategy For Hewlett Packard Company - 1444 Words

1. Introduction Among global manufacturers, offshoring, obtaining products and services from overseas, has been one of the most widely used strategies to take advantage of the arbitrage of labour cost. However, in recently years, reshoring seem to be the new trend in business as a recent survey conducted by the Boston Consulting Group found that 21 per cent of a sample of 200 executives of large manufacturers were either already relocating production to the US, or planning to do so within the next two years. A further 33 per cent said they were considering it, or would consider it in the near future. [1] Many well-known companies such as Google, General Electric, Caterpillar and Ford Motor Company are moving part of their production or adding new plants back in their country of origin.[3] In my point of view, there is a potential opportunity for Hewlett-Packard Company to reshore part of their value chain activities in its personal system division back to the US, as detailed proposal and analysis will be discussed as follow. 2ï ¼Å½Company Background Hewlett-Packard Company (HP) is an American multinational information technology corporation established in 1939. It provides personal computing devices, enterprise and industry standard servers, related storage devices, networking products, software and a diverse range of printers and other imaging products to consumers, small- and medium-sized businesses and large enterprises across 170 countries around the world. 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