To What Extent Did Relations Between The Usa And The Ussr...

To what extent did relations between the USA and the USSR improve during the period from 1953 to 1961? The decade of 1953 through to 1961 began with the conclusion of the Korean War and ended with the almost catastrophic Cuban Missile crisis in October of 1962. The Korean War and the Cuban missile crisis represent two of the most tense periods of 20th century history. Yet the period between has often been described as a thaw, if only a temporary one, which, brought about by the Stalin s death in 1953 permitted an improvement of international relations through various events such as Khrushchev s destalinization policy, the recognition of satellite states, conferences and treaties. However, the thaw was only partial, despite the relative success of events such as the Geneva congress of 1955, it is important to recognise that tensions still existed during this period, a fact which was demonstrated by the crisis in Berlin in 1958 and with the eventual construction of the Berlin Wall in 1961. In addition to this, the almost indifferent response to the Hungarian Uprising of 1956 from the We st did not reveal concerns which remained prominent, and events such as the Communist takeover of Cuba and the failed Bay of Pigs invasion of 1961, meant that relations during this period continued to be strained. this essay aims to portray that there was indeed a superficial degree of relaxation between the USA and the USSR, but that this was often a means of achieving underlying goalsShow MoreRelatedWeakness Of The American Foreign Policy Essay1733 Words   |  7 Pagescause to the USSR’s invasion of Afghanistan in 1979? ` The dà ©tente, a time were US and USSR were aiming to improve relations, did not prevent all diverse threats towards the USSR lead to a reaction such as their aggressive invasion of Afghanistan. In 1979, the Soviet Union made a fateful decision of invading Afghanistan. To put at risk this easing of strained relations which began in 1971 with the Soviet invasion, USSR must have had a valid enough reason. For the purpose of this essay, aggressive expansionismRead MoreThe Cuban Missile Crisis as the Turning Point in Relations Between the Superpowers2475 Words   |  10 PagesThe Cuban Missile Crisis as the Turning Point in Relations Between the Superpowers The Cuban Missile crisis is recognised by the entire world to have been one of the most dangerously fragile points in the history of conflicts between the United States of America and the Soviet Union. 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This question is about the French monarchy as an institution, not only Louis XVI, thus the first part of the question needs an analysis of the natureRead MoreHofstede’s Limitations14637 Words   |  59 Pagesseparate sets of country rankings and cultural indices for different decades. These indices are indispensable for the researchers who use archival data as they allow for the matching of the archival data with the cultural indices from the corresponding period, an important option that no other cross-cultural study offers. Improving Cultural Indices 3 Introduction Over the last several decades, cross-cultural issues have received an explosion of interest in fields ranging from psychology and educationRead MoreWhy Did Communism Fail During The Soviet Union Under Gorbachev?4960 Words   |  20 PagesEulalia Obono Nze Instructor: Lisa Goddard Poli 354 Date: 3/July/2015 Why did communism fail in the Soviet Union under Gorbachev? For many decades, Russia was isolated from other part of the world politically and geographically. During the First World War, Russia’s industrialization was progressing fairly, as they implemented an education reform program to promote literacy among people. The program would have been successful if it was continued without obstacles. They also implemented a programRead MoreGlobalisation in Russia5922 Words   |  24 PagesFifteen years ago, the Soviet Union was a socialist authoritative country, tightly isolated from capitalist countries. Nowadays, its direct heir, Russia, is one of the most quickly growing markets of the world, strongly open on the global economy. During the 1990s, Russia underwent an extraordinary transformation from a communist dictatorship to a multi-party democracy, from a centrally planned system to a market economy, and from a belligerent enemy of the West to a cooperative partner. This changeRead MoreRussian History Essay2827 Words   |  12 Pagesexpanding the middle class, which helped trade. Catherine II’s great addition to Russia was the land she gained, she was able to add more territory to Russia than had been in nearly a century before her. While nothing very important was achieved during Catherine’s rule, she acquired valuable friends that proved to be useful in the future of Russia. Alexander I. The successor of Paul I and the grandson of Catherine the Great, Alexander I spent the early part of his rule attempting to reformRead MoreModern History.Hsc.2012 Essay25799 Words   |  104 PagesMODERN HISTORY -2012 Topic one – USA 1919-1941 Topic two – conflict in the pacific Topic three – Douglas MacArthur Topic Four – World War I TOPIC ONE – USA 1919-1941 USA 1920’S * the radio age * felt like istory had turned a corner and never going back * stock market * black Thursday November 24 1929 * the jazz age * a speakeasyyyyyyy How significant were the Republican policies in causing the great depression? The significance of the republic policies

The Effects Of Smoking Cigarettes On The Health Of Smokers

Tobacco smoke attitudes are a significant risk not only to the health of smokers but to those who involuntary inhale the tobacco smoke of others. Smoking increases the risk of lung cancer and heart disease. Smoking cigarettes is a proven factor in raising the risk of having a heart attack, stroke disease, broncho-pulmonary diseases and poses risks in pregnancy to the unborn child. Tobacco smoking raises overall medical costs, decreases life expectancy and adds to loss of efficiency during the lifetime of an individual which can also lead to premature death. My target group were students from London Metropolitan University age 18 to 25, four male and six female. The majority of this age group tend to smoke to enhance enhance their personalities and for stimulation and peer pressure. Stress, depression, self-esteem, academic involvement are also factors. Advertising stood out as the main risk factors for continuing to smoke, as they were motivated by the desire to know how it feels to smoke. Smoking starts and escalates among university students. Stress associated with the change to the experiences of university life may trigger the risk of smoking among students on campus Freedom of living away from home can contribute to the choices students make and the smoking habits of their parents at home and lecturers at universities. Many students are more likely to smoke if they live in a family where at least a member of the family smoked or is likely to provide cigarettes toShow MoreRelatedSmoking Life Away: The Harmful Effects of Smoking Cigarettes1403 Words   |  6 PagesSmoking Life Away Smoke travels far. After the smoke is released, it diffuses and travels in the atmosphere reaching just about anything at a reasonable distance. When one smoker puffs out, it affects that person, somebody across from that person, and the clean air around that person. Ever wonder why warnings and disclaimers are always present with anything that concerns smoking? This is because it is dangerous, and it is harmful , and it should warn you about the lasting impact it leaves youRead MoreEffects Of Smoking Essay946 Words   |  4 PagesIntroduction Smoking has become a usual thing in our culture of recent. A person with a cigarette, E-Cigarette, Hookahs and Weed Cigarettes has become the norm in our society: we can see them on the streets, actors smoke in movies, there are also book characters who smoke, we have relatives, friends or someone we look up to who smoke. Starting as mainly as a part of a religious ritual a long time ago, smoking has become a routine thing for us in recent times, not giving thoughts to the many effects of smokingRead MoreThe Production and Sale of Cigarettes Should Be Made Illegal1494 Words   |  6 PagesThe production and sale of cigarettes should be made illegal Stanislav Philippov Writing 5 Peggy Armstrong November 18, 2011 The production and sale of cigarettes not only has negative impact on human health, it can even cause death. This is the main reason why the production and sale of cigarettes must be prohibited. It’s obviously a big issue today, some people, mostly non smokers, are against smoking altogether, while other people think that everybody has to have the right to buyRead MoreShould Smoking Be Banned Harmful Effects On Individuals And The Economy1498 Words   |  6 Pages Smoking- A Costly and Deadly Habit One of the most common problems today that are killing people all over the world is smoking. Stress, personal issues, and high blood pressure are many reasons why people start this horrible habit. One cigarette leads to another which then can lead to major addiction. When someone smokes a cigarette they are not only hurting themselves, but others around them. Smoking causes people to be exposed to hazardous fumes and chemicals in many places. The habit of smokingRead MoreIs the Cigarette Tax Enough To Prevent Smoking? Essay1337 Words   |  6 PagesSmoking cigarettes have negative effects on not only the people who smoke, but also the people around them and the environment. Smoking cigarettes lead to many diseases and negative health effects, such as lung cancer, emphysema, and heart disease. Second hand smoke can lead to the same side effects. However, the dangers of second hand smoke tend to be generally greater than that of first hand smoke, which is what the smoker inhales. Because of all the negative effects of smoking, the sale ofRead MoreShould Cigarette Smoking Be Banned? Essay1278 Words   |  6 PagesSmoking is an expensive habit. People who smoke cigarettes can spend as much as $2,500 a year on them. Smokers’ claim that it helps relax them and it releases stress but the negative aspects of smoking outweigh the positive. Smoking is a health hazard for smokers and non-smokers. Smokers should have the right to choose what to do with their own health but they should respect non-smokers. Many people believe that there are good and bad outcomes from smoking. I believe that smoking is bad and thatRead MoreEssay on Smoking Risks1748 Words   |  7 Pagesin today’s society is smoking. Yet each year, cigarette smoking kills more Americans than AIDS, alcohol, car accidents, homicides, suicides, illegal drugs and fires combined. Smoking is an extremely bad pastime, practiced for centuries, for an individual’s health and those surroun ding him/her. People start for many different reasons and get addicted to the nicotine in cigarettes. Smoking cause many fatal diseases, but help is available to those who seek it. Cigarette smoking is a disgusting and unhealthyRead MoreThe Harmful Effects Of Smoking And Smoking1380 Words   |  6 Pageswhat smokers do to themselves every time they light a smoke. Some of the harmful effects of smoking include various potentially lethal diseases to the smoker and others exposed to secondhand smoke, the sinful addiction caused by a key ingredient in cigarettes, and social issues smoking causes for smokers and their loved ones. Smoking should be prohibited completely because of the harmful physical and social effects it has on smokers and the non-smokers they associate with. First of all, smoking createsRead MoreWhy Smoking Should Be Banned884 Words   |  4 Pagespeople smoke? Is smoking really healthy for them? How much does it cost an individual to smoke? What are the costs to society when people smoke? These are all questions that can easily be taken care of by banning cigarette smoking. It is really a disgusting sight to see a woman with a cigarette hanging out of her mouth. It is equally bad to see children with smoking cigarettes. B. Cigarette smoking should be banned, not only in restaurants but everywhere. When someone smokes cigarettes it affects theRead MoreShould Cigarette Smoking Be Banned?925 Words   |  4 Pages1003 April 22, 2015 Ban smoking in the United States Tobacco use is the single largest preventable cause of diseases and premature death in the United States (U.S.), yet more than 45 million Americans still smoke cigarettes. The health threat posed by tobacco has been accepted by scientists since the 17th century. In 1928, studies linked smoking to cancer. In 1964, the first Surgeon General’s report on cigarette smoking summarized the evidence that tobacco poses serious health risks for those who use

Ethical Challenges in the Era If Health Care Reform Free Essays

string(99) " prohibited hospitals from refusing acute care to any ndividual who could not afford to pay \(CMS\." Ethics, Law, and Policy Vicki D. Lachman Ethical Challenges in the Era Of Health Care Reform n truth, the United States is at the beginning of a long overdue and a much needed health care reform. We have seen the dismal statistics about our high cost health care system and some of the less than stellar outcomes (e. We will write a custom essay sample on Ethical Challenges in the Era If Health Care Reform or any similar topic only for you Order Now g. , infant mortality) (Callahan, 2011; World Health Organization [WHO], 2011)). The purpose of this article is not to complain about the current health care system, but instead to focus on existing reform efforts — The Patient Protection and he Affordable Care Act (ACA), the ethical justifications for its creation, and ethical challenges it brings. I Key Features of the Law ACA offers new ways for consumers and providers to hold insurance companies accountable. The most important parts of the law are features described in the following discussion. Because of space limitation, I will highlight some elements of the law that are enacted through 2014 and clearly impact nursing. These selected features include insurance choices, insurance costs, rights and protection, and people age 65 and older. Insurance Choices The intention of the law is to expand health care coverage to most U. S. citizens and permanent residents by requiring most people to have or purchase health insurance (HealthCare. gov, 2012a). Citizens will have a choice of private insurance, employer-paid insurance, Medicaid, Medicare, or state-based insurance exchanges. Affordable Insurance Exchanges. Individuals and small businesses can purchase coverage through these exchanges, with premium and cost-sharing credits available to individuals and families with income between 133%-400% of the federal poverty guideline (in 2011, the overty guideline was $18,530 for a family of three) (Werhane Tieman, 2011). Businesses with 50 or more employees need to make coverage available, and businesses with less than 25 employees will qualify for tax credits to offset their cost (Kaiser Family Foundation, 2011). Consumer Operated and Oriented Plan (CO-OP). The ACA produces a new kind of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP). CO-OPs are meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. By January 1, 2014, individuals will be able to buy a CO-OP Vicki D. Lachman, PhD, APRN, MBE, FAAN, is Clinical Professor, and Director, Innovation and Intra/Entrepreneurship in Advanced Practice Nursing, Drexel University, College of Nursing and Health Professions, Philadelphia, PA. 248 health plan through the Affordable Insurance Exchanges. Pre-existing condition insurance plan. All covered benefits are available to individuals, even to treat a pre-existing condition. This program offers temporary protection for people with pre-existing conditions until 2014, when insurance companies can no longer deny individuals coverage based on their health status. Young adult coverage. Individuals can add or keep their children on their health insurance policy until they reach age 26. The law makes it easier and more affordable for young adults to get health insurance coverage. Insurance Costs ACA holds insurance companies accountable. It also helps individuals keep their costs down. Value for individual’s premium dollar. ACA requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care and efforts to improve the quality of care. Unfortunately, this does not apply to self-insured plans. Lifetime and annual limits. ACA restricts and phases out the annual dollar limits a health plan can place on most of its benefits. Furthermore, ACA eliminates these limits completely in 2014. Rate review. Insurance companies must now justify proposed rate increases for health insurance. Insurance companies cannot raise rates by 10% or more without first explaining the reasons to the state or federal rate review program. Rights and Protections The ACA puts consumers in charge of their health care, not insurance companies. The following rights and consumer protections are available. Preventive care. Individuals may not have to pay a copayment, co-insurance, or deductible to receive recommended preventive health services, such as screenings (e. g. , mammograms and colonoscopies), vaccinations (e. g. measles, polio, or meningitis), and counseling (e. g. , smoking cessation, weight loss, healthy eating). Doctor choice and ER access. Individuals can choose any available participating primary care provider and they can access out-of-network emergency rooms without prior approval. ACA prohibits health plans from requiring a referral from a primary care provider before women can seek coverage for obstetrical or ynecological (OBGYN) care. People 65 and older. ACA offers eligible elders a range of preventive services with no cost-sharing. ACA also provides discounts on drugs when older adults are in the coverage gap known as the â€Å"donut hole. † July-August 2012 †¢ Vol. 21/No. 4 Ethical Challenges in the Era of Health Care Reform TABLE 1. Views of Liberal Egalitarians vs. Libertarians and Free-Market Advocates Liberal Egalitarians Libertarians and Free-Market Advocates Health care is a fundamental good and access to this good Role of government is confined to protecting the freedom of all allows us to become full members of society. ersons to choose their own goals and means to pursue them. This right to health care must be exercised by removing all People have a right to non-interference. barriers to access. Justice, equality, and community are values. Freedom and personal responsibility are values. Health care is a right. Health care is a commodity. Single-payer system is the solution. Decentralized market mechanisms with personal payment are the solution. Preventive services. The list is significant and begins with an annual wellness visit. Other important preventive services include bone mass measurement; cervical cancer creening, including Pap smear tests and pelvic exams; colorectal, prostate, and diabetes screening; influenza, pneumonia, and h epatitis B immunizations; and many other services. There are other services and features in the ACA that could be discussed, but we will now move to discuss the ethical justifications for the ACA. The controversy it has created in the eyes of individuals with a free-market or libertarian view will be compared to those with a liberalegalitarian outlook. Ethical Justifications for the ACA Since 1986, the Emergency Treatment and Labor Act has prohibited hospitals from refusing acute care to any ndividual who could not afford to pay (CMS. You read "Ethical Challenges in the Era If Health Care Reform" in category "Papers" gov, 2012). â€Å"Consequently, $100 billion of care annually is ‘costshifted’ onto patients who can pay, almost all whom are insured. This shift raises the average annual health insurance premium roughly $1,000 for every insured family† (Crowley, 2009, p. 10). This lack of distributive justice for the insured is one reason why insurance is being man dated in ACA. It is equally unfair to mandate that all citizens have insurance if insurance is not affordable, as this could cause significant harm to individuals and families already struggling financially. Therefore, the ethical principles of beneficence and nonmaleficence are supported by the features of Affordable Insurance Exchanges and the development of Consumer Operated and Oriented Plans. Ethical reasoning for health care reform has relied primarily on distributive justice as justification for change, specifically due to lack of access to care for the underinsured and uninsured (Lachman, 2009). According to the U. S. Census Bureau, 46. 3 million people in the United States were uninsured in 2008 (ProCon. org, 2012). The United States is the only developed nation in the world hat does not guarantee health coverage. Table 1 offers a comparison of views of persons who support distributive justice, see health care as a right, and therefore want a single-payer system with those individuals who want to continue the free-market system. â€Å"To single-payer advocates, the primary goal of health policy is ensuring that everyone can obtain some minimal level July-August 2012 †¢ Vol . 21/No. 4 of health care† (Sade, 2007, p. 1429). Making access to health care widely available permits individuals to be fully functioning members of society and the moral ommunity (a group of people drawn together by a common interest in living according to a particular moral philosophy). On the other hand, Americans who are libertarians and free-market advocates mostly look beyond the natural (genetic) and social (upbringing) lottery that places some at a disadvantage and instead look to the individual’s free will and personal responsibility for actions (Callahan, 2011; Pariser, 2012; Trotter, 2011). They believe health care is one of the many options from which to choose to improve their lot in life. Their belief in personal responsibility can make them unsympathetic o people with unhealthy lifestyles for whom they would ultimately have to spend their insurance dollars. They also resent having to fund treatments they personally would not choose (e. g. , transplants, mechanical ventilation for person in persistent vegetative state). Though many wealthy individuals support health care reform out of benevolence, they do fear the loss of freedom which is central to their value system. However, two additional factors drive change for health care reform — significant cost and quality problems. In 2007, health care expenditures totaled $2. 2 trillion, 16. 2% of the U. S. economy. Health care employs more than 14 million people and is the largest industry in the United States. Of the 193 WHO member states, the United States is ranked first in per capita health care expenditures ($6,719) (ProCon. org, 2012). The present health care system is not giving the utility for the dollars spent. This cost problem is a reason that ACA has a focus on physicians counseling individuals on end-of-life options. It found that about 30 percent of Medicare dollars are spent during the last year of life, and half of that is spent during the last 60 days. In 2009 dollars, Dr. Gordon calculated, that amounts to $70 billion a year, much of it spent on futile care that prolongs suffering (Brody, 2009, para 20). Unfortunately, politics initially got in the way in 2009 with the â€Å"death panel† jargon and this counseling was dropped from ACA; however, this end-of-life options counseling was incorporated into 2011 Medicare reimbursement for health care providers (HealthCare. gov, 2012b). 249 Ethics, Law, and Policy WHO (2011) statistics also indicate the money spent is not putting us at the top of the list in quality outcomes. The infant mortality rate for the United States in 2009 was even deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia, and Iceland are all half of the United States rate. Quality is a focus of ACA in the preventive realm and with quality measurement. Two essential principles of the ACA are that: 1. Provider reimbursement for healt h services is based, in part, on the relative quality and patient experience of the care provided. 2. Information about that comparative quality and patient experience will be publicly accessible. Quality and patient satisfaction will be rewarded by ata from hospital comparison required by the Hospital Consumer Assessment of Healthcare Providers and Systems for Medicare patients. â€Å"The implications of Value-Based Purchasing (VBP) regulations for hospitals are clear — FY2013 implementation at 1% of base DRG payments, rising to 2% by FY2017† (Acton, 2012, para 2). Hospitals will have to earn it back by achieving and maintaining high quality and positive patient experiences. This consequential focus in the patient care experience supports the autonomous choice of the patient for hospitals and physicians. Ethical Challenges of ACA Legal Challenge Before discussing three key ethical challenges health care providers will face, the legal challenge before the Supreme Court needs to be addressed. This challenge determined if the ACA requirement to purchase health insurance violates Article 1, Section 8, Clause 3 of the U. S. Constitution: Congress shall have the Power To lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common Defence and the general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States†¦ (Werhane Tieman, 2011, p. 83) The argument against this mandate is that the government has never required people to buy any good or service as a condition of lawful residence in the United States. However, every working person is required to pay into Social Security and Medicare. The counter argument is that these are government-mandated and governmentrun programs. This argument ultimately could support a Supreme Court decision of only a government-run singlepayer system, an action libertarians and free-market advocates oppose. Second, there are requirements for car insurance for drivers, and flood insurance for persons ho live within authorized distance from a possible flood plain. Because all people will need health care at some point in their lives, the argument could be made that insurance should be a requirement so as not to burden the moral community with the costs of those who do pay for insurance (Hamel Nairn, 2011). 250 On June 28, 2012, the U. S. Supreme Court endorsed most of the Patient Protection an d Affordable Care Act, including the contentious individual mandate that requires most Americans to obtain health insurance. In a 5-4 decision, the court said the federal government has he power to fine Americans who do not acquire insurance because it is considered a tax (Jaslow, 2012). Electronic Medical Records The requirement for electronic records could generate a significant ethical challenge for privacy and confidentiality. Unfortunately, the $20 billion for health information technology from the American Recovery and Reinvestment Act (ARRA) did little to change the current HIPPA privacy paradigm (Crowley, 2009). Furthermore, it is likely patients will carry their personal health records in their own electronic devices or retrieve them through the Internet. A transformation in rural health care is likely through telehealth and telehomecare. These innovations will bring expertise to patients to facilitate the best choice in their treatment decisions. The challenge will be to assure informed consent and confidentiality in this expanded digital age. Chronic Disease Management Individuals with chronic illness benefit significantly from palliative care services, not just at end-of-life care but throughout the disease progression. The ACA focus on chronic disease management is best exemplified by this phrase: â€Å"An integrated care approach to managing illness hich includes screenings, check-ups, monitoring and coordinating treatment, and patient education† (HealthCare. gov, 2012b, para 1). Feministic ethics, with its focus on managing the particulars of any person’s situation, celebrates this personalized service to individuals who must manage illnesses often for many years. In her book, Caring: A Feminine Approach to Ethics and Moral Education, Nell Noddings (2003) argued that a morality based on rules is inadequate. She contended this approach loses the richness of the moral dilemmas people face, and nly situational and contextual knowledge of the individual can help resolve the moral quandaries of life. Shaping Health Care Policy According to the Code of Ethics for Nurses, provision 9 (American Nurses Association [ANA], 2001), nurses have an obligation to â€Å"work individually as citizens or collectively through political action to bring about social change† (p. 25). This responsibility to shape social (health care) policy calls for nurses to voice concerns about the meaning of the rejection of the individual mandate for society. The libertarians and free-market advocates reinforce a caricature of American individualism and weaken a sense of responsibility for oneself and fellow citizens†¦It neglects one side of the equation, forgetting that we are not only individuals with the freedom to choose, but also members of society called to uphold a common good. (Hamel Nairn, 2011, p. 94) continued on page 245 July-August 2012 †¢ Vol. 21/No. 4 Ethics, Law, and Policy REFERENCES continued from page 250 Therefore, nurses and nursing associations have the ethical challenge to stand firm for patients and ensure the long-term sustainability of our health care system. Nurses need to advocate for the people without a voice — those discriminated against because of health status and lack of insurance. Conclusion ACA has provided a forum for debate about not only health care insurance, mechanisms to maintain financial stability of its systems, and strategies to ensure access to millions of people, but also has contributed to defining American society’s values. It is easy to argue against the individual mandate impingement on choice and freedom. However, other provisions provide children, adults, and elders with coverage and services that will help keep hem healthy and support them in their management of chronic diseases, while quelling the fear of bankruptcy. The Supreme Court will decide the legal matters in ACA, but it will not resolve the ethical matters. Can Americans continue to allow the self-protective practices of insurance companies in excluding high-risk individuals (e. g. , pre-existing conditions, lifetime caps on benefits)? The principle of autonomy was never meant to abandon the moral relationships that continue to be necessary for the human good. â€Å"The nurse respects the worth, dignity and rights of all human eings irrespective of the nature of the health problem† (ANA, 2001, p. 7). July-August 2012 †¢ Vol. 21/No. 4 Acton, A. (2012). The hidden risk (or reward) of HCAHPS. Retrieved from http://blog. healthstream. com/blog/bid/103384/The-Hidden-Risk-orReward-of-HCAHPS American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretative statements. Silver Spring, MD: Author. Brody, J. E. (2009). End-of-life issues need to be addressed. Retrieved from http://www. nytimes. com/2009/08/18/health/18brod. html Callahan, D. (2011). Health care reform: Can a communitarian perspective be salvaged? Theoretical Medicine and Bioethics, 32(5), 351-362. CMS. gov. (2012). Emergency Medical Treatment Labor Act (EMTALA). Retrieved from http://www. cms. gov/Regulations-and-Guidance/ Legislation/EMTALA/index. html? redirect=/EMTALA/ Crowley, M. (2009). Connecting American values with health care reform. Garrison, NY: The Hastings Center. Hamel, R. , Nairn, T. (2011). The individual mandate: A rancorous moral matter. Health Progress, 92(4), 88-95. HealthCare. gov. (2012a). Affordable Care Act. Retrieved from http://www. healthcare. gov/law/full/ HealthCare. gov. (2012b). Chronic disease management. Retrieved from http://www. healthcare. gov/glossary/c/chronic. html Jaslow, R. (2012). Medical groups laud Supreme Court’s decision on Affordable Care Act. Retrieved from http://www. cbsnews. com/8301504763_162-57462837-10391704/medical-groups-laud-supremecourts-decision-on-affordable-care-act/ Kaiser Family Foundation. (2011). Summary of new health reform law. Retrieved from www. kff. org/healthreform/8061. cfm Lachman, V. D. (2009). Ethical challenges in healthcare: Developing your moral compass. New York, NY: Springer. Noddings, N. (2003). Caring: A feminine approach to ethics and moral education. Berkeley, CA: University of California Press. Pariser, D. M. (2012). Ethical considerations in health care reform: Pros and cons of the affordable care act. Clinics in Dermatology, 30(2), 151-155. ProCon. org. (2012). Right to healthcare: Did you know? Retrieved from http://healthcare. procon. org/ Sade, R. M. (2007). Ethical foundations of health care system reform. Annuals of Thoracic Surgery, 84(5), 1429-1431. Trotter, G. (2011). The moral basis for healthcare reform in the United States. Cambridge Quarterly of Healthcare Ethics, 20(1), 102-107. Werhane, P. , Tieman, J. 2011). Clearing the brush: Myths surround the Affordable Care Act. Health Progress, 92(4), 82-84, 86-87. World Health Organization (WHO). (2011). World health statistics 2011. Retrieved from http://www. who. int/whosis/indicators/WHS2011_ IndicatorCompendium_20110530. pdf 245 Copyright of MEDSURG Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites o r posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. How to cite Ethical Challenges in the Era If Health Care Reform, Papers

Punjabi Dance Classes In Auckland Region †Myassignmenthelp.Com

Questions: How Does The Punjabi Population Of New Zealand Still Identify Strongly With Its Ethnic Ancestral Roots? How Does The New Zealand Born Punjabi Population Define And Represent Its Indian Identity? Answers: Introduction The common features that have been observed across several societies are migrants, ethnic diversity as well as multiculturism. These arise as a result of diversity which exists within the nations and also the increasing rates of global migration. New Zealand is no exception to this rule as several ethnic groups from around the globe have been attracted to New Zealand due to the existing pro-immigration policies and the migrant history of the country. This has resulted in a society which is highly diverse and Auckland today boasts of a cultural diversity that is higher than London (Tapaleao, 2014). Asians today form New Zealands fourth largest group in terms of ethnicity. Chinese and Indians are the leading two minorities in the nation (Peacock, 2016). Among the Indian population in Auckland, the maximum strength is of the Gujarati and Punjabi communities and hence several cultural activities of these communities are known to exist in the region. The Punjabi dance classes held at seve ral institutes are among them. This dissertation will be taking into consideration the Punjabi dance classes in the Auckland region. Basic Idea of the Dissertation The basic idea of this dissertation is to find out about the Punjabi people dancing their cultural identities in a region which can be associated with several cultural identities. It is regarding the people who continue the dance practices that belong to the place of their birth and also regarding the people who continue to dance the culture which belonged to their forefathers who had migrated to Auckland region of the nation. Thus, it can be said that this thesis is related to transnationalism and migration and also to the transactional social spaces which forms a complex web which go on to construct the lived experience of people in the Auckland region. The dissertation is also regarding finding out the local which is embodied both here as well as now and also within the migrated cultural practices. The thesis will be looking at the ways in which these practices have been maintained and also at the ways in which they have changed in a new environment in a different nation, in an ur ban environment that is unique in itself and how the combination of global and local have taken place to form glocal. The dissertation deals with diversity and multi-culturalism and the ways in which people live together in a region that is made up of several cultures. It is regarding the ways in which they celebrate value and acknowledge cultures that are distinct and that have diverse practices. It is also regarding the frictions which take place between various cultures within the communities. It is regarding the reasons as to why or why not people take the decision to be a part of the dance practice classes that belong to a culture which is distinct from their own. It is also about how cultural dance occurs in a place which is multi-cultural and diverse. It is about the example which Auckland sets in the 21st century urban life. It is regarding the urban space and the ways in which people have been imbuing it with life energy as well as presence by means of Punjabi dancing. It i s regarding the ways in which the region is brought to life by the people and the ways in which they form connections within their communities by means of cultural practices. It is also about the things which make the region special, give the people a feeling that they are at home and how it makes the region feel as being their place and also make the region our place. Research Objectives It is essential to make a note of the fact that New Zealand Indian is a category that is more complex than what it was more than thirty years back. Today it consists of several religious, linguistic and regional groups along with various generations and is a representation of the various experiences of migration. The specific nature of the ways in which the Punjabi Indians born as well as raised in New Zealand actually practice and perform their ethnicity is malleable, dynamic and fluid. In addition to this, being a diasporic trans-national community, negotiation and re-negotiation of their identities take place in varied social contexts and also across the boundaries of the nation. However, the main purpose of conducting this study is to carry out an exploration of the experiences of the Indians in New Zealand in managing, accepting as well as rejecting and also negotiating their identity in their day to day lives by holding Punjabi dance classes. It tries to identify complex and at times problematic ways in which the identity of a Punjabi from New Zealand is managed or mismanaged and the means through which the shaping and reshaping of the boundaries of this particular group residing in the Auckland region takes place. Literature Review Coming of Indians to New Zealand The popular belief is that Indians are newcomers to New Zealand but this is not true. The first records of an Indian migrant to New Zealand is that of a Bengali sailor who in 1809 had jumped ship and had started to live with the local M?ori (Bandyopadhyay, Reinventing Indian identity in multicultural New Zealand, 2006). In the second half of the 19th century several Indians landed on New Zealands shores indicating the start of an Indian diaspora. However, the community of South Asia in New Zealand was established by the Punjabi as well as Gujarati families who had migrated prior to Second World War (Leckie, 2010). The influencing factors for the early migration of the Indians were sponsor patronage, kinship ties and family. This is called chain migration. In the initial stages the diaspora of Indians in the region was mostly homogeneous in economic and social terms (Bandyopadhyay, Reinventing Indian identity in multicultural New Zealand, 2006). In the latter part of the 1980s the pos t-war immigration of Indians came to New Zealand when the immigration became more skill based. The Indian communitys composition was altered by this new immigrant influx into the country (Zodgekar, 2010). The patterns of immigration led to cultural, social as well as demographic alterations in the ethnic group of Indians. Even though the classification in the census is as Indian ethnic group, homogeneity is lacking in the Indian community. This is reflected by the linguistic and religious diversity of the Indian community. The home nations diversity can be seen in the Indian ethnic groups composition in New Zealand (Peacock, 2016). This is largely varied from the original Hindu and Sikh migrants. Linguistically, the migrant Indians mostly speak English and Hindi. The other main languages spoken by them include Punjabi and Gujarati (Zodgekar, 2010). In terms of their identity the migrant Indians have been observed to be well versed in the process of articulating their identity in a w orld that is globalised which means that they are able to handle in a skilful manner and put together varied fragments of their culture (Knepper, 2006). New Zealands ethnic Indian group is able to make a shift among several cultural contexts like that of the home nation and also of the host nation. This is done relatively easily by them as the Indian societys basic composition and their familiarity in terms of negotiations between postcolonial and colonial life aspects make the people get used to living in a setting which is diverse culturally (Fuchs, Linkenback, Malik, 2010). Dance Culture of India The cultural heritage in terms of Indias classical dances originates from areas which currently form the countries of India, Bangladesh and Pakistan. Additional influences also come from the Tamil culture that exists in South India as well as Sri Lanka and other neighbouring nations like Turkey and Iran. The history of Indias classical dance is a reflection of the road taken by India to nationhood and also that of its religious and cultural traditions. Since the post-independence India which had been created by Britain is a nation which consists of diverse religious and ethnic groups it also required means of consolidation and finding of grounds that were common. In such a historical context, the function of dance was creation of an identity that is pan-India (Munsi, 2008) (Kothari, 2011). This period witnessed several dance forms such as bharata natyam and bhangra going from mainly regional origins to developing into pan-Indian (Nayar, Hocking, Giddings, 2012). Several of the Indian dances had traditions which are very long and which at times had been lost and were then again rediscovered followed by their reconstitution. In the process they also underwent changes especially the extensive developments that occurred during the period of dance revival between 1930s and 1940s. The spread of most of the dance forms took place outside the places where they originated and they went on to become national forms. However, there was a continuation of the understanding of where the origin of the dances took place. The evidence of this can be found in the Auckland region after a discussion with the dance experts as well as audience members at the performances of Indian dances (Nagel, 2009). The most prominent cultural expression for India in todays world is probably Bollywood. It has developed into a movie industry that is very huge, the Bollywood dancing style has today developed into a popular art phenomenon internationally. It originates from the Indian dance drama and incorporates several aspects of certain folklore dance forms of the country specially, bhangra the Punjabi dance form of India. Bollywoods dance choreographies today are also feeding on the American musical theatre as well as the jazz dance. A huge variation exists in terms of style exists under the umbrella of Bollywood. Punjabi Bhangra Dance of India Since the 1980s, the Punjabi Bhangra dance has turned out to be a topic of discussion in the studies related to the vernacular culture and identity of South Asia. Such information has however, been suffering due to paucity of published information on the historical and cultural context of Bhangra. As a result, discussions have mostly relied on the information which is available from the casual participants as well as the media which has been popular in recent times. Bhangra has been oversimplified by the popular narratives as deriving or being from the traditional folk dance of Punjab, often in the absence of a sense of what a folk dance is constituted of in such a context or the relationship existing between this dance and the particular form of bhangra with which one might be familiar. As a result, the picture of contemporary bhangra as a quintessential Punjabi harvest dance even in its modernised form is not seen as adequate in interpreting the acts of the audiences and performers of what happens to be many phenomena of dynamic nature. The danger lies in the characterisation of bhangra as being too-uniformly understood aspect in relation to Punjabi heritage and in reduction of its performances to merely display the identity of the Punjabis, in case the registration of the present and past aesthetic decisions, practical requirements and situations intentions of the participants is not done (Schreffler, 2013). Indian Diaspora in New Zealand Indian diaspora in New Zealand has been called as one of the major migrations in modern history. It has also been defined as being a force that is unique in terms of the world culture (Lal, 2010). The diaspora of India is vibrant and visible and estimated to be encompassing over 11 million people. The culture of India has also been capturing the Western worlds imagination for a long period of time in the form of the philosophy of peaceful resistance propagated by Gandhi, Buddhism and Hinduism, academics, yoga practices, dance and music and much more. Indians have been migrating to New Zealand mainly due to population related pressures at home, declining, lack of opportunities, poverty and small village based enterprises (Swarbrick, 2011). New Zealands Indian diaspora has also been growing fast and has also brought forth a number of prominent personalities (Bandyopadhyay, India in New Zealand. Local identities, global relations, 2010). Research Methodology The traditional culture of Indian Punjabis in the Auckland region of New Zealand will be highlighted and studied by means of an ethnographic study as to how, where as well as why they perform and what it reveals about their distinctiveness of migrating to Auckland. The research is particularly relevant to the contemporary ethnoscape of New Zealand in more ways than one. The focus is on the cultural issues in relation to immigration, nationhood and identity, the topics which are usually fore-grounded in the daily political discourse. It also attempts to explore the ways in which the Punjabi dance classes are being held and the ways in which educators are imparting teaching in a community that comprises a high immigrant density. Additionally, it identifies the ways in which the migrants are searching for an identity in New Zealand and depicts the ways in which the creative communities are making contributions to the performing arts as well as well being of a national identity that is undergoing changes as a result of the immigration of Asians, mainly the Punjabi Indians. The theoretical as well as methodological framework of this study will be drawing on the music ethnographies as well as research methods which have been featuring in a number of ethnomusicological literatures in relation to identity and diaspora. This work takes place within the diaspora ethnomusicology area and attempts to understand the phenomenon of the Punjabi dance classes conducted in an institute and also in the context of the surrounding community. As a subfield of ethnomusicology that is significant and growing and has been defined in several ways, diaspora ethnomusicology has emerged as a significant research area which is relatively new in New Zealand particularly in relation to the considerable increment in the Asian immigrants of the nation from 1980 onwards. This research has been built upon research on related topics in this field in New Zealand (Bernau, 2005). It aims to make its contribution to the field by forming an outline of and understanding a particular case st udy and at the same time work not only within but also across various disciplines such as immigration studies, music education, Asian studies and ethnomusicology. The data for the purpose of the study was collected by use of the multi-method approach in terms of field research. An etnographic study of a particular school and the Asian performance activities conducted by it were taken into consideration. The focus was primarily on the Bhangra dance, a traditional dance originating from the state of Punjab in India. It was taken as a case study for this research. Interviews of the key informants were conducted. These included the participants of the performing arts of Asia along with the teachers who played a crucial and active part in conducting and organising these dance classes on a number of occasions. The participants were of the opinion that the immigrant communities continuing and also promoting the traditions which are associated with the performing arts that belong to their home nation in the country which is their new home. Their responses also highlighted the certain remarkable ways in which the Punjabi immigrants from India or the on es having immigrant ancestry are making attempts to find a cultural identity of their own by conducting classes and performance of the Punjabi bhangra dance in Auckland. Analysis and Results The current study is an indication that Punjabi Virsa Dance and Arts Academy (PVDAA) in Auckland region of New Zealand is utilising a particular context along with the performing art in order to help in the discovery, construction and negotiation of the Punjabi cultural identity in the context of New Zealand. Even though it is not a surprising fact that the immigrant communities are continuing as well a s promoting the traditions related to performing arts belonging to their home nation in their new home, this study has highlighted certain remarkable ways in which the Punjabi immigrants from India or the ones having immigrant ancestry are making attempts to find a cultural identity of their own by conducting classes and performance of the Punjabi bhangra dance in Auckland. Certain findings of the research highlight the ways in which the context of the host country provides assistance in shaping the cultural identity particularly in rediscovering the culture of the homeland. The Auckland region has a proportionally high number of people who are immigrants of Indian ethnicity, mostly Punjabi Indians. This region is also has the one of the highest densities of people from Asia in the country. Thus, it is but natural that Punjabi Virsa Dance and Arts Academy has a very high number of students who are of Indian origin. As far as the music education is concerned, no obvious links are seen with the Indian community and the Punjabi bhangra dance has been discovered by some of the students by means of these co-curricular activities conducted by the dance school. The dance school has been instrumental in bringing together students who belong to varied Indian backgrounds and who have travelled varied routes both to as well as within Auckland. This has gone a long way in helping them in forming an identity in New Zealand on the basis of their idea of Indian cultural roots. Several of the students have not learnt the Punjabi bhagra dance previously before enrolling in this particular dance school. All the students displayed a sense of pride in what they were doing. They were relishing the fact that they had the opportunity of showcasing their culture in the co-curricular activities conducted by the school and also in the community at large. This helped the students in discovering what was perceived by them as being a component of their tradition as well as their heritage and also a component of their collective and individual cultural identity. However, such an identity was forged only once the Punjabi bhangra dance had been found by the students at this particular dance school and which was nurtured as a consequence of the performance activities of the dance group through a process which consisted of the organisation or the dance school that came together to learn and also help others in learning especially from the main community members, discovery of a dance form that was new to them by means of watching videos, conducting performances for other students and for the community at large and most of all being able to form cultural and social links with the other members who were a part of the group. This study went on to outline a number of important points in relation to the construction of cultural identity for the students of the PVDAA. The findings are an indication that the Auckland region of the country is a place which is both diverse and interesting in terms of change. It also showed that when the students of this dance school go to their respective schools, they also introduce the trading performing arts of their country to their peers and also to the public in the community at large. For the students of this school, the creation of the identity occurs mainly on the basis of what they have experience or found in the New Zealand. As a reaction to a place which is new and also to a cultural context that is new, most of them are showing a deeper interest in and in reproduction of the aspects of a cultural setting that has been left behind by them. Such identities are complex and are generally based on a number of varied factors such as nationalism and / or ethnicity. In ad dition to this, formation of multiple cultural identities can occur by means of the process of conducting performances in varied spaces as well as places and to audience of diverse nature. Conclusion The study shows that the cultural display which occurs in the form of the Punjabi bhangra dance plays a pivotal role in the relations of the school and community and also in forming the self identity of these students in New Zealand. Identity for them is performed by means of the Punjabi bhangra dance and it is formed as a consequence of the schools activities. Hybrid lives are led by the students of such schools by mixing the heritage and identities of the host country and their homeland. Additionally they also gain a sense of belonging which takes place due to coming together in the Punjabi dance school. Hence, this study has assisted in demonstrating that by means of the Punjabi bhangra dance group in this dance school of Auckland, discovery of cultural heritage has occurred and this has been performed as well as showcased to not only the other students but also to the wider community. Formation and performance of identities have occurred as a consequence of such types of confluen ces. This has turned out to be central for constructing identity of students in more ways than one. It is a display of culture which holds the intention of celebrating culture and the students sharing a common cultural bond are brought together through these dance classes. Development of school-community relations and partnerships take place and leads to the showcasing of regions creative communities which in turn makes contributions to the contemporary make-up of national identity. References Bandyopadhyay, S. (2006). Reinventing Indian identity in multicultural New Zealand. In H. Johnson, B. Moloughney (Eds.), Asia in the making of New Zealand (pp. 125146). Auckland, NZ: Auckland University Press. Bandyopadhyay, S. (2010). India in New Zealand. Local identities, global relations. Dunedin, New Zealand: Otago University Press. Bernau, S. (2005). 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