Nurses’ Work Hours

I have been a staff nurse in the emergency room for fourteen years. I have worked a variety of 8, 10, 12, and even 16 hour shifts. I currently am working 8 and 12-hour shifts on nights. Previously, I also worked some 12-hour day shifts. I personally have been struggling with working the 12-hour shifts. My commute to work is 1 hour one way and I have fallen asleep several times driving home from work. The last four hours of my shift I experience great fatigue and even have had trouble staying awake. I have come close to having medication errors and feel that my quality of care is less during the last four hours. When working 12-hour shifts I average around 5-6 hours of sleep before returning to do another 12-hour shift. During an interview with another colleague also working 12-hour shifts she states she also experiences feeling very tired and less alert. She actually admits to having a medication error that she feels was associated with the long hours and fatigue. With these concerns I ask, â€Å"Are nurses work hours a concern for nurses and patient safety†? Introduction As demands for flexible work hours and a balance between home and work life have increased for nurses, twelve hour shifts are more common. The nursing shortage has also contributed to nurses’ working longer hours to cover shifts. Nurses must remain alert to provide safe care and prevent errors in medications and procedures. Nurse work hours are a concern to me regarding patient safety. I am also concerned with the health risk of nurses working long hours so I decided to do a search on how long hours affect nurses and their patients. I searched evidenced based research articles available from a variety of trustworthy healthcare sites like CINHAL, ANA, and Nursing Journals. I organized this literature review in three categories. These categories are: Positive and negative effects of long hours, effects of long hours on patient safety, and if there are any health effects on the nurse working 12-hour shifts. Literature Review Positive and Negative Effects of Long Hours There are both advantages and disadvantages of working 12 hour shifts (Ede, Davis, & Sirois, Circadian, 2007). One advantage is working less days during the week, which is desirable of most nurses. It is also easier to have all the shifts covered because you do not have to hire as many nurses (Circadian, 2007). In a qualitative study by Richardson, Turnock, Harris, Finley, & Carson (2007) the purpose was to examine the impact and implications of 12-hour shifts on critical care staff. Two groups and questionnaires with critical care staff from three critical care units were reviewed. Positive effects were found with planning and prioritizing care, improved relationships with parents/relatives, good quality time off work and ease of travelling to work. Less favorable effects were with caring for patients in isolation and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested like no more than 2-3 consecutive shifts should be worked and rest periods between shifts. The survey concluded that most of the nurses that responded wanted to continue with 12-hour shifts. Systems and practices need to be developed to improve on the negative effects of working 12-hour shifts. In one of my interviews the nurse agreed that she enjoys 12-hour shifts because she has more days off during the week and feels she has more time with her family, although I personally disagree. She also states it is easier to provide day care for her children. Disadvantages of longer work hours according to Circadian (2007) included that it is harder to cover absences, limited family and social time during working days, more pay lost when a day is missed and increased percentage of night shifts. Longer work hours have also been associated with increased tiredness, less sleeping hours, driver fatigue returning home, and increased risk of errors or near errors ( Richardson et al. , 2007); (Scott, 2006); (Scott, 2010); (Chen, 2011). I have no time with my family on the days I work 12 hours. Even though I have more days off I feel I am spending at least one day recovering after working a long shift. I personally would rather have interaction with my family daily especially since the kids are in school. A colleague I interviewed also agreed that when working 12 hour shifts she had limited time with her family. Effects on Long Hours on Patient Safety As a result of nursing shortage hospital staff nurses are working longer hours with few breaks (Chen et al. 2011). In one quantitative study by Scott, Rogers, Hwang, & Zhang (2006) they randomly selected 1148 critical care nurses and sent them a demographical questionnaire to fill and return related to medical errors and the hours they worked. The objective of this article was to describe the work patterns of critical care nurses, determine if there was a relationship between the occurrence of errors and the hours worked by the nurses, and explore whether these work ho urs had adverse effects on nurses’ vigilance. The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk errors and near risk errors and decreased nurses’ vigilance. The findings supported the Institute of Medicine recommendations to minimize the use of 12 hour shifts and to limit nurses’ work hours to no more than 12 consecutive hours during a 24 hour period (IOM, 2006). Although the findings note that 12 hour shifts can have negative effects, most participants wanted to continue working them. Nurses are responsible for the safety of their patients. Nurses must remain alert to provide safe care, recognize discrete changes in patient conditions, and intercept potentially dangerous errors in medication and procedural orders (Keller, 2009). Nurses’ work hours are a concern given the expectation of their sustained vigilance to maintain the well-being of patients. The 12 hour shifts worked by many nurses are associated with reduced sleep times, difficulties staying awake, frequent overtime, and significant risk for error (Rogers, Hwang, Scott, Aiken & Dings, 2004)( Scott, Rogers, Hwang, & Zhang, 2006). Even though 12 hour shifts may be preferred by many nurses, studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors. Long hours coupled with insufficient sleep and fatigue is even risker (Scott et al, 2010). More than two-thirds of 895 hospital staff nurses reported â€Å"struggling to stay awake on duty† at least once during a 28-day data gathering period (Rogers, Hwang, Scott, & Dinges, 2003). Nurses reported fighting sleep about once every five shifts (2,258 out of 11,218 shifts). Drowsiness was not confined to the night shift; more than half of these episodes occurred between 6 A. M. and midnight. Nurses who reported shorter sleep durations were more likely to struggle to stay awake, fall asleep, and make errors while on duty (Scott et al, 2010). Effects on Nurses Working Long Hours Studies examing the health and safety consequences of nurses themselves are beginning to shed some doubt about the wisdom of continuing to use the twelve hour work schedule. According to one study, adverse health and safety outcomes of extended work hours include increased rates of musculoskeletal disorders, needlestick injuries, motor vehicle accidents, and inadequate sleep (Greiger-Brown, & Trinkoff, 2010). All of these can be attributed to reduced vigilant attention, fatigue, and decreased neuromuscular fine motor control associated with sleep deficiency. In an interview with one colleague she states that her body, â€Å"hurts all over†, when working a twelve our shift. I have fallen asleep driving before which could of resulted in injury of myself or someone else. Lengthening of the shift duration from 8 to 12 hours significantly restricts the opportunity for sleep and produces sleep deficiency (Smith et al. , 1998). Working without adequate sleep between shifts can lead to negative chronic health effects including Cardiovascular Disease, metabolic syndrome, diabetes, obesity, decreased immune function, and increased cancer risk (IOM, 2006). In a quantitative study by Chen, Davis, Pan, & Daraiseh (2011) a total 145 nurses wore monitors for one 12-hour day shift to record heart rate (HR) and work pace(WP), which were used to calculate energy expenditure(EE). The purpose of this study was to determine whether hospital nurses are experiencing physiological strain at work by examining their physiological and behavioral response patterns over 12-hour shifts. The EE and HR data presented in the study revealed a moderate physiological strain experienced by 12-hour shift nurses, regardless of their slowed paces during the last four hours. The study noted that although work pace slowed during the last 4 hours, the nurses’ heart rate continued to be elevated, which could lead to cardiovascular disorder. Moreover, inadequate work break and sleep, family care-giving responsibility and aging presented challenges that may have prohibited nurses from full recovery and potentially exacerbated the negative impacts of the 12 –hour shifts. Overall their results relates to EE and HR suggest that nursing workload of 12-hour has a negative physiological impact on nurses. Policy Implications Although there are negative effects noted in working twelve hour shifts, I don’t think it is going anywhere due to the fact that nurses love them, and the increase in nursing shortage. Keeping this in mind instead of focusing on stopping twelve hour shifts, there needs to be interventions on how to improve the 12 hour shifts to provide safer patient care and prevent health problems in nurses. The preliminary policy implications I have discovered is the possibility of limiting how many twelve hour shifts a nurse should work in a row, mandating breaks while working twelve hour shifts, allowing the night shift to nap, regulate how many hours a nurse can volunteer to work, and allow the older nurses to have an option between 8 and 12-hour shifts. In my institution there is no limit on how many hours a nurse can voluntarily sign up for as long as it is approved if it puts the nurse in overtime. Our breaks are not mandated, if we get one great, and if not we can get paid for not getting a break. Most of the time, our breaks are interrupted. Regarding naps, physicians on the night shift are allowed to sleep if there are no patients, but there is no policy stating the nurse can sleep. Some nurses actually work 24 hour shifts, but are allowed to sleep at night if they are not busy. There are times though that they are busy the whole 24 hours. In one interview a nurse stated that if she lays her head down and naps for about 20 minutes she feels much more alert. I have also tried taking a nap at work when there were no patients in the ER, and I did feel so much more alert, especially driving home. It is therefore wise to consider limiting shift length and hours worked per week per IOM recommendations. After reviewing the literature it is clear that the main problem is nurses not getting enough sleep between shifts which causes fatigue. In a study of nurses’ sleep habits, Geiger-Brown (2010) found that 58 percent averaged only 5. 5 hours of sleep. When they work three or four 12-plus hours a day, they are also unable to easily reestablish a â€Å"consistent sleep schedule†. In one research article it noted that allowing the nurses to nap, especially the night nurses showed improvement in alertness and feeling less fatigued and ultimately showed a reduction in errors or near errors (Fallis, McMillan, Edwards, 2011). It also noted that anagement needs consider to mandating that the 12 hour plus nurses are taking full uninterrupted breaks which also improves alertness. Most nurses are not taking full breaks and stay longer than the scheduled 12 hours which reduces their sleep and recovery time between shifts (Greiger-Brown, & Trinkoff, 2010). In a recent review of studies between 1970 and 1998, 12 hour shifts nurses were fatigued in 5 of 7 studies, and of 10 studies measuring performance, 4 were negative, and 6 were neutral; none showed positive effects. In this review, laboratory studies showed deteriorated performance; but field studies found no difference between 8 and 12 hours. Recent studies with stronger designs and methods have increased the evidence that questions the safety of 12-hour shifts. More recent studies as mentioned earlier demonstrate an increase in patient care errors when nurses work 12 hour shifts compared to 8 hours. The research question that has been uncovered related to nurses’ long work hours is if the long hours affect the health of the nurse and patient safety? In my institution other colleagues have stated that they feel that when working 12 hours or longer more than two days in a row really decreases their quality of care because they are tired. I feel more studies need to be done on the impact of working hours and the nurses’ health along with more evidence regarding patient safety. One ethical implication researching effects of 12-hour shifts is that the managers do not want to take away 12-hour shifts due to nursing shortage because they do not have to hire as many nurses to cover shifts. Another issue is that most nurses enjoy the twelve hour shifts even though they know they become really tired because they enjoy having more days off during the week. Managers may fear that nurses will leave to find jobs that offer 12-hour shifts. I feel this is ethically a problem with colleagues and coalitions because they are not looking at the negative effects on the nurses and the patients. With research it has become obvious that working longer hours can effect both the health of the nurse and safety of the patients yet our facility along with many others have not come up with adequate resolutions to the problem. Conclusion Twelve hour shifts contribute to flexible patterns of work, but the effects of delivery of direct care and staff fatigue are important topics for deeper examination. More recent studies as mentioned earlier demonstrate an increase in patient care errors when nurses work 12 hour shifts compared to 8 hours. Although 12 hour shifts are popular, evidence shows us that extended working hours, and working while fatigued and sleep deprived reduce vigilance and impair physical/behavioral functioning. The result has damaging effects on patient safety, quality of care provided and the health of the nurse. I believe it is the responsibility of the nurse to recognize the risks of working longer hours to keep the patient safe and to also maintain their own health. I used the Patterns of Knowing (White, 1995) to view my topic and to gather information on this literature review. These patterns of knowing in nursing include empirics, esthetics, ethics, and personal knowing (White, 1995). I used empirics by gathering factual information regarding my topic. I discussed issues in regards to ethics on my topic that was mentioned in chapter 3. I included my personal knowledge and experience with working longer shift hours, and also looked at the esthetic form by putting it all together and acknowledging what the problem is. Doing this literature review I realize that working the longer hours does put a strain on my overall health, and also has potential to put my patients at risk. I will focus more on getting better sleep, and I have asked my manager about working only 8 hour shifts. I also really want to pursue gathering more information about night nurses being able to nap.

10 Mary St

Peter Skrzynecki’s 10 Mary Street is a poem portraying a family’s process of integrating into the Australian community. The concept of belonging is explored, particularly belonging within the family and culture, and through this, Skrzynecki exemplifies the importance of establishing connections to attain the security and stability essential to people’s lives. Skrzynecki establishes the notion of belonging within the family through his portrayal of the family routine and the nurturing nature of the parents.The family’s daily routine is described as â€Å"like a well-oiled lock† and emphasised through the use of enjambment. The simile suggests a functional family comfortable and established in their nineteen-year settlement in the community. The nurturing nature of the parents is characterised by the â€Å"tended roses and camellias/ Like adopted children. This simile suggests that the garden is personified as family member and indicates the tenderne ss of the parents. The poem’s persona is rather thoughtless in his treatment of the garden, highlighted by his ravages â€Å"like a hungry bird†.The notion of cultural belonging is portrayed through the image of the house and its memories. The house symbolises the cultural identity of the family and the personification of â€Å"its china-blue coat†¦Ã¢â‚¬  suggests the family’s pride in maintaining their home, similar to caring for a family member. The memories are described as â€Å"heated discussions/ And embracing gestures/†¦Ã¢â‚¬ . This use of sensory imagery and cultural allusions â€Å"Kielbasa, salt herrings,†¦Ã¢â‚¬  suggests the cultural connections kept by the family despite immigrating to Australia.These connections are undermined by the demolition of the house, described as â€Å"inheritors of a key/ That’ll open no house/†¦Ã¢â‚¬ . This indicates the loss of cultural identity kept in their house and suggests that belo nging is an intangible and important concept. The â€Å"key† ironically represents Australian citizenship, however instead of acceptance in society, the family feels anxious and insecure as a result of their lack of belonging, indicated by the negative connotations of â€Å"pulled down†.

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The Jurisdiction of the European Court of Human Rights Case Study

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Romanticism in American Lit Essay Example for Free

Romanticism in American Lit Essay anRomanticism in American Literature brought us some of the worlds greatest writers ever to live. Writers such as Edgar Allan Poe, Nathaniel Hawthorne, Herman Melville, Ralph Waldo Emerson, and Henry David Thoreau all wrote during the Romanticism period. Without them we would not have stories such Moby Dick, Resistance to Civil Government, The American Scholar, The Scarlet Letter, and Edgar Allan Poe’s most notorious works such as The Raven and Annabel lee. The Romanticism movement started in Europe and in the late 1820’s it worked its way into America. It was aimed as a rebellion against the enlightenment movement. It was also referred to as the American Renaissance because it was the rebirth of literary values lost previously in the enlightenment era and Puritanism era. American Romanticism was in a broad sense a new attitude toward nature, humanity, and society that espoused individualism and freedom. Characteristics of romanticism writing included the power of imagination, impulse towards reform, admiration for nature, and the fascination with death and the supernatural. Romanticism literature had two very different sides to it, one being optimistic and the other is pessimistic. On the optimistic side you had writers such as Walt Whitman, Margaret Fuller, Henry David Thoreau, and Ralph Waldo Emerson. Pessimistic writers included Edgar Allen Poe, Herman Melville, and Nathaniel Hawthorne. Edgar Allan Poe was a very dark romanticist and was also a very deeply pessimistic writer, but in a philosophical kind of way. He wrote poems, novels, and essays throughout his writing career, and he even developed the style of southern gothic writing. His poems often portray a character in despair and he explores the state of the mind a lot. Another trait of Poe is he uses a lot of symbolism and imagery for example his use of darkness and light in the poem â€Å"Annabel Lee†. Poe implies that the â€Å"kingdom by the sea† is a bright, cheerful place where the sun shines on two young lovers, the narrator and Annabel Lee. Ironically, in another realm of dazzling light–heaven–the highest order of angels, the Seraphim grow dark with envy of the young couple. Under cover of night, they send a cold wind that kills Annabel Lee: The wind came out of the cloud by night, Chilling and killing my Annabel Lee. But the narrator says he remains in a realm of light, for his soul and the soul of Annabel Lee are one. In the last couple lines, Poe emphasizes this point with light imagery: â€Å"For the moon never beams without bringing me dreams, Of the beautiful Annabel Lee; And the stars never rise but I feel the bright eyes, Of the beautiful Annabel Lee† (679). Poe’s writing goes down in history for being some of the best literary works to ever come out of this period in American literature. Poe was a pessimistic writer on the other hand was Henry David Thoreau who was a very optimistic writer. One quote a found from Thoreau was just to â€Å"love your life†. In his essay â€Å"Resistance to Civil Government† he shows his rebellion in committing to governments values and ideas. Is very clearly stated at the beginning when Thoreau says â€Å"The Government is best which governs least† (829). Thoreau was a strong believer of take action for our own principles and to start thinking for ourselves and if you want change make it happen if you think it’s right. Ultimately he was jailed for his beliefs. Those including not believing for paying for stuff that didn’t benefit people and also for not supporting the Mexican American war, but Thoreau said to make changes sometimes good people have to go to jail. The romanticism period came to an end in the mid 1860’s, and In conclusion the romanticism period in America was a chance for writers to break out of the cookie cutter mold of previous era’s and a chance for writers to get their views and ideas out to the world through their literature. Romanticism writing can be broken up into eight different key ideas. Individualism is the idea that every person on earth knows God in their own way, and we will find truth for ourselves. Emerson and Melville often fall into the category of individualism. Organicism is the concept that society or the universe is comparable to a biological organism, as in development or organization, everything is connected. Unity and diversity stated that things are made up of many parts, but they all come together to make a one whole object. Dynamic change is the idea that the whole world brought us to this one moment yet the world is in a constant state of change. Imagination, originality, emotional, and finally nature.

Issues Around The Elderly And Mental Health Social Work Essay

Issues Around The Elderly And Mental Health Social Work Essay This assignment will look issues around older peoples mental health, in particular, dementia and abuse; this will include demographics of older people, statistics, the history, definitions and causes of dementia, and finally the lack of legislation to protect vulnerable people from harm and the implications for social work practice. The population surge at the end of world war 2 has gave rise to an unprecedented population explosion and to what we now call the baby boomers, these people are now in their retirement years'(Summers Et al, 2006), and our population now contains larger percentage of older people that ever. In society today elder people are becoming the fastest increasing population in the UK, National Statistics (2009) states that the population of the UK is ageing. Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1.5 million people in this age group. Due to the increase of the ageing population we are now seeing emerging health and social care issues in our society. Many older people will be active, involved within the community, and independent of others. However, as you get older it is natural to experience pain, a decline in mobility or mental awareness. Mind (2010) states that the most common mental health problems in older people are depression and dementia. There is a widespread belief that these problems are a natural part of the ageing process, but this not the case; it can start as early 40 but is more common in older people (Royal college of Psychiatrists, 2009), however, there only 20 per cent of people over 85, and 5 per cent over 65, have dementia; 10-15 per cent of people over 65 have depression (Mind, 2010). It is important to remember that the majority of older people remain in good mental health. Dementia mainly affects older people, although it can affect younger people; there are 15,000 people in the UK under the age of 65 who have dementia (Alzheimers society, 2010). However, currently 700,000 or one person in every 88 in the UK have dementia, incurring a yearly cost of  £17bn, and the London School of Economics and Institute of Psychiatry research calculated that more that 1.7 million people will have dementia b y 2051 reported by BBC news (2007). The word dementia comes from the Latin demens meaning without a mind. References to dementia can be found in Roman medical texts and in the philosophical works of Cicero. The term dementia came into common usage from the 18th Century when it had both clinical and legal connotations. Dementia implied a lack of competence and an inability to manage ones own affairs. Medical use of the term dementia evolved throughout the 19th century and was used to describe people whose mental disabilities were secondary to acquired brain damage, usually degenerative and often associated with old age (Kennard 2006). From the 20th century onwards scientific knowledge was supplemented through the examination of the brain and brain tissue which was founded and performed by a physician Alois Alzheimer (Plontz, 2010). The National service framework (Department of Health, 2001, p96) now defines dementia as a clinical syndrome characterised by a widespread loss of mental function. The term dementia is used to describe the symptoms that occur in a group of diseases that affect the normal working functions of the brain. This can lead to a decline of mental ability, affecting memory, thinking, problem solving, concentration and perception, also problems with speech and understanding (Mind, 2010). Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual. Each person is unique and will experience dementia in their own way (Alzheimers society, 2010). Symptoms of dementia include: Loss of memory, Mood changes, and Communication problems. In the later stages of dementia, the person affected will have problems carrying out everyday tasks, and will become increasingly dependent on other people, two thirds of people with dementia live in the community while one third live in a care home (Alzheimers society, 2010). There are many types of dementia, and some of the causes of dementia are rarer th an others, Alzheimers disease is the most common cause, damaged tissue builds up in the brain to form deposits called plaques and tangles, these cause the brain cells around them to die (Royal college of Psychiatrists, 2009). Other most commonly known is vascular disease, Dementia with Lewy bodies, Fronto-temporal dementia. Mostly, patients themselves do not present to the clinician with dementia, owing to gradual onset and denial of the problem. There is no cure for dementia but there is medication that will help to slow down the progression of the disease. When finding help for dementia it is usually the primary carers, caregivers, supporters, partners or family members who initiate asking help and a diagnosis (Brodaty, 1990). Depression may be misdiagnosed as dementia the difference being that people who have depression are more likely to be aware of their issues therefore are able to discuss them, whereas someone with dementia may not be able to do this due to their symptoms. Nonetheless, the Mental Capacity Act (2005) states that every person has the right to make their own decisions and must be assumed to have capacity unless otherwise proven and people should be supported to make any decisions. Under the MCA, you are required to make an assessment of capacity before carrying out any care or treatment (Office of the public guardian, 2009). The Mental capacity act is an act that protects individual rights and ensures that the persons liberty is not taken. It is based on best practice and creates a single, coherent framework for dealing with mental capacity issues and an improved system for settling disputes, dealing with personal welfare issues and the property and affairs of people who lack capacity. I t puts the individual who lacks capacity at the heart of decision making and places a strong emphasis on supporting and enabling the individual to make their own decisions (Office of the public guardian, 2009). However, even with a structure in place to protect individuals rights and liberties many people who have dementia are more vulnerable to abuse due to their lack of capacity. The University College London research revealed that a third of carers admitted significant abuse, in total 115 carers reported at least some abusive behaviour, and 74 reported more serious levels of mistreatment (Cooper et al, 2009). Caregivers can also be on the receiving end of verbal or physical abuse directed at them by parents or spouses who are confused and angry over declining mental capacities due to stroke and Alzheimers disease. In some cases, Alzheimers disease or other forms of dementia may cause the patient to be uncharacteristically aggressive (Coyne, 1996). It is only in recent years that abuse of the elderly has become more apparent, Crawford Et al (2008, p122) argues that over time it has very slowly come to the attention of people in the last 50 years that abuse does actually exist behind closed doors; in the 1950s older people lived in large families where issues were hidden, and in the 60s to 70s older people started living alone or in residential homes and it was not until the early 80s that abuse had started to be recognised and defined. Penhale and Kingston(1997) argue that over the years it has been difficult to emphasise the issues of abuse due to not finding a sound theoretical base to which an agreement of a standard definition can be made and applied. Action on elder abuse (2006) defines elder abuse as A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Abuse comes in not just physical abuse it com es also in sexual, psychological, neglect, discrimination and financial as well. Older people may be abused by a wide range of people including family members, friends, professional staff, care workers, volunteers or other service users, abuse can also be perpetrated as a result of deliberate, negligence or ignorance (Royal pharmaceutical society (RCA), 2007). Abuse can occur in a variety of circumstances and places such as, in own home, in a residential or day care setting or hospital and can by more than one person or organisation. Pritchard (2005) asserts that we will never have a true picture of the prevalence of elder abuse due to the unreported cases, and can only count ones that are known to organisations and services. Most abuse is still unreported due to victims being frightened, ashamed and embarrassed to report the abuse, not realising their rights or not being able to due to tier mental health. Summers et al (2006, p7) points out that those statutes that make abuse criminal are often ineffective due to them not being utilised by the victim, and this means that this will be the biggest challenge and barrier for change in getting people to recognise the scale of the problem and raising awareness so that the government agree to change the legislation to protect older people. Abuse of any kind should not be ignored and there should be legislation to protect adults from abuse like there is in child protection, people who recognise the extent of elder abuse argue why should adults be treated as second class to children, is their suffering and deaths any less important? The Alzheimers Society (2010) states that abuse of people with dementia should be considered in the same way as child abuse. Crawford and Walker (2008, p12) state that prejudice refers to an inflexibility of the mind and thought, to values and attitudes that stand in the way of fair and non judgmental practice. Thompson (2006, p13) defines discrimination as the process in which difference is identified and that difference is used as the basis of unfair treatment. A barrier to recognising the abuse of people with dementia and older people is that of social stigma, negative perceptions and connotations of words for mental health, such as confused or senile. Confused is something that we all experience at some time in our lives, whereas senile is a more complex word and the first recording of its usage was neutral meaning pertaining to old age, but now has negative connotations linked to mental decline due to age (Crawford and Walker, 2008). Therefore, challenging peoples perceptions needs to done to change these social constructs to enable a change in legislation and protection of vulnerable adults. In March 2010 the department of health ran a series of campaigns to address poor public understanding of dementia which included TV, radio, press and online advertising featuring real-people with dementia (Department of health, 2009). In 2009 the first ever dementia strategy was launched that hopes to transform the quality of dementia care, It sets out initiatives designed to make the lives of people with dementia, their carers and families better and more fulfilled It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive. Proposals include the introduction of a dementia specialist into every general hospital and care home and for mental health teams to assess people with dementia (Department of health, 2009). However, this is not legislation it is just a strategy for dealing with people with dementia. The government are recognising that there is little protection for vulnerable adults and that further legislation need to be put in place and stating that dementia care is a priority (BBC news, 2007). At present, there is no one specific legislation which directly protects vulnerable adults, instead the applicable duties and powers to assess and intervene are contained within a range of legislation and frameworks, such as the Mental Capacity Act 2005 and Mental Health Act 2007 and the national service framework for older people. One of the themes for national service framework (NSF) is respecting the individual which was triggered by a concern about widespread infringement of dignity and unfair discrimination in older peoples access to care. The NSF therefore leads plans to tackle age discrimination and to ensure that older people are treated with respect, according to their individual needs, specifically in standard 2 it relates to person centred care (Crawford and Walker, 2008, p8). And expectation of NSF is that there must be systems and processes put in place to enable multi agency working. In 2000 the government published No secrets which is guidance that requires local authorities to set up a multi agency framework which includes health and the police with a lead person (adult social care) to carry out procedures into the allegations of abuse whilst balancing confidentiality and information sharing (Samuel, 2008). No Secrets is only guidance and does not carry the same status as legislation, the LAs compliance is assessed through an inspection process, therefore the LA can with good reason choose to ignore the guidance (Action on elder abuse, 2006). This has concerned agencies who want to see the protection of adults given the same equivalent priorities as child protection and think that legislation is the only way to accomplish this. A review of No Secrets guidance has been carried out in 2008 and consulted with over 12000 people (Department of Health, 2009), the report found that over half (68%) of the respondents were in agreement to new safeguarding legislation and 92% wanted local safeguarding boards to be placed on a statutory footing and still there is no legislation to protect vulnerable adults (Ahmed, 2009). A recent article in community care told the failure of the government to commit to making a policy has only strengthened campaigners fight and given rise to criticism (Ahmed, 2009). The need to protect vulnerable people brought about the protection of vulnerable adults scheme (POVA) which is run by the Department of Health to regulate and monitor the employment of staff in the social care workforce, through this scheme a list of people who are unsuitable to work with vulnerable people is kept. More recently, the Safeguarding of Vulnerable Groups Act 2006 which was launched in 2008 replaced POVA with the Independent Safeguarding Authority (IDeA, 2009). The problem with this is that abusers of dementia sufferers are usually family member or informal carer that are under considerable stress and may not receiving help from within the health and social care system, therefore, an abusive situation can carry on for some time until the situation is found by an outsider. This situation may only be found when a informal carer starts asking for help, and when informed of the situation it is good practice and essential to make sure that carers are getting the help they need which can prevent the abusive situations. Under the 1995 Carers (Recognition and Services) Act carers are entitled their own assessment of need and by doing so this may allow for respite or payments to be made for their services (Parker Et al, 2003). University College London researchers who interviewed people caring for relatives with dementia in their own homes stated within their research that Giving carers access to respite, psychological support and financial security could help end mistreatment (Cooper et al,2009). When working with relatives who are carers it is important to remember who is the service user, although it is important to ascertain the wishes of the relative it should not override the wishes of the service user, this is especially true when there is a break down in the care of the service user and the carer wishes the service user to be placed in care. Many older people with dementia receive care in a residential home; this may be due to family member no longer being able to cope with the care of the person. The local authority has a duty to assess the needs of a person with dementia ensuring that their wishes are heard and adequate care is put in place. Assessment is an ongoing process, in which the client participates, the purpose of which is to understand people in relation to their environment; it is a basis for planning what needs to be done to maintain, improve or bring about change in the person, the environment or both (Anderson Et al, 2005). The trouble with placing people with dementia in care homes is there are not enough care homes specifically for people with dementia and people end up in a home that do not have trained staff to cope with individual needs of someone with dementia, therefore, people s wishes may not be heard. As part of the joint assessment process it is the social workers role to ascertain the wishes of the individual, this is done by assessing their needs in an holistic way which includes and medical and social aspects of the person. If there is doubt as to the mental capacity of the person then a mental capacity assessment will need to be acquired by asking to joint assess with community psychiatric nurses (CPN). Priestley (1998) states that the community care reforms established the principle of joint working between health and social services authorities as a priority for effective care assessment and management with social services taking the lead role. In conclusion there seem to have been many shifts in the direction of how policy and procedures framework and guidance care for people with dementia, although there is still no firm legislation to protect them. However, there seems to be more recognition of the issues that surround dementia and future goals are towards the training of people to understand those issues so that professionals are able to deal with the complex needs of a person with dementia. Word count 2969

evilmac Evil Defined in Shakespeares Macbeth and Beowulf :: comparison compare contrast essays

Evil Defined in Macbeth and Beowulf For centuries evil was defined by human preoccupation, and it was often indicated in the English literature. From Beowulf to Macbeth, people's perception on the nature of evil had matured and became more complex. In Beowulf's period, evil was simply defined based on outer appearances and actions. The author of Beowulf described the evil Grendel as a fearsome monster: "He(with sharp claws)...snatched up thirty men, smashed them." For the same reason, Grendel's mother was also considered evil although she merely wanted to revenge her son. The last evil character in the story was the Dragon. He killed the Geats and burned their homes with his breath of fire. Monster and evil certainly had the same meaning in the Pre-Christian time. As Christian was introduced, a new definition of evil that concentrated on human values and thoughts had emerged. The Christian believed that the seven deadly sins were the cause of evil. Thus in the play Macbeth, Macbeth's tragic flaws were actually the deadly sins. They were greedy and envy. Macbeth was not satisfied with his current position, "Thane of Glamis," and not even his newly gained "Thane of Cawdor" would please him. He had only one thing on his mind, the throne. When he became the king, he envied Banquo's having heirs who would be rivals for the throne. The Christian also developed the theory of the great chain of being. It basically stated that a person could not and was not allowed to change his social status. Thus in the play, everyone eventually turned against Macbeth, who had broken the great chain of being by taking the throne from the rightful king. At the end, Macbeth died as an evil being who had broken all the Christian rules. The nature of evil also became unclear as it got more complex. In Macbeth, the play began with the three witches' meeting. To a first-time reader, it would appear that these "weird sister" were the evil ones, because it was a common human perception. Who could be more evil than a witch who vowed to punish a sailor only because his wife cursed her and refused to give her some

Do not go gentle into that good night by Dylan Thomas :: Poetry

"Do not go gentle into that good night" by Dylan Thomas is a poem about death. Dylan Thomas wrote this poem during the last illness of his father's life. The author creates an image of death with the use of the sons pleading words asking his father to fight against the darkness that is taking over and leading him into the afterlife. Dylan Thomas meticulously creates an image of death through the use of cunning words and by giving each word a deeper significance than its literal connotation. The author uses the image of death in every paragraph of the poem. It is one of despair and gloom. Dylan Thomas uses the words "night (1.1)" and "dark (2.1)" to describe the certain outcome of the father. Thomas declares "Rage, rage against the dying of the light (1.3)" to generate the feeling that death is unpleasant therefore forming a grim image for the reader. The author also uses numerous literal undertones throughout the poem to produce a melancholy attitude in the reader. He speaks of "wise men (2.1)", "good men (3.1)", "wild men (4.1)" and "grave men (5.1)" all coming to their death without any hope of life continuing thus encouraging the guarantee that everyone will come to their end. The literary element of tone is also present in this poem. Thomas sets the tone by conveying his anger about death by using grim words coming together to create a poem only nineteen lines long. Thomas also repeats "Rage, rage against the dying of the light (1.3)" and "Do not go gentle into that good night (1.1)" several times, communicating a dreadful tone to the reader. By using these strategically placed words and phrases, he forms a word-repeating pattern that is often found in the tone of anger.

Childhood Is the Happiest Time of a Person’s Life Essay

I do agree the idea that the most joyful time for every person without any doubt would be their childhood. Since people are different in many areas, they may have different opinions about the reasons; however, I believe that childhood is the happiest time because first children at that age do not have any special responsibility, and second they are children and their mind and the way they think completely different from teenagers and adults. In other words, their minds are free. First, as a child you do not have to take any noticeable responsibility. You just play and enjoy your daily life. A child does not get into the troubles of for example studying, going to work or even having family duties like a father or mother. In case of everyday life, matures are dealing with a lot of chores and duties. Take the case of a mother for instance, she should have to take care of the house, do the daily chores such as cooking, ironing, cleaning and boring duties like that. Moreover, she has to look after of her child or children too. Considering that she does not have to work like her spouse outside the house. Children’s most important concern would be the size of their bicycle or the number of their toys they possess. Second, as a child your mind is largely free from many things which may cause challenge such as political or financial issues. Furthermore, in that period they tend to make friends much easier unlike teenagers. The things they are looking in a friendship are not materialistic. The purpose of make a link with their peers would not be for using them in further critical situations. They simply make friends to play with each other or to share their toys. Beside mentioned points, their needs are not much complicated. They would become easily happy by giving them a notebook and bunch of color pencils as if they are given a luxury car or a high-ranked position in a company. In conclusion, I consider the childhood time as the most memorable and happiest for everyone mostly because at that age, our expectations from life and other people around us are very simple and would not cause anyone trouble.

Hard Times: Coketown Essay

In † Hard Times: Coketown† Charles Dickens is assessing industrialization and the effect it had on the people in the towns in which they resided. Coketown seems to be portrayed as a city of work and not anything else. It is put across that the town consists of only fact and nothing else to alleviate the dullness. Charles Dickens is sharing his analysis on the social issues implicated in this town through a narrative that reflects upon the environment. He uses a lot of descriptions and similes to show the implications in which the society is inflicting. For example, the steam engine is constantly going up and down is â€Å"like the head of an elephant in a state of melancholy madness,† (1057). He also uses metaphors like â€Å"it had a black canal,† and â€Å"interminable serpents of smoke† (1057). He is portraying a point that the government in this town is not caring enough about there community so therefore he feels he needs to get the message acros s about how socially unacceptable this is. As he conveys these ideas to the reader he uses representation to give an object human life. An example when he gives an object a human life structure is; â€Å"It was a town of unnatural red and black like a painted face of a savage,†(1057). By doing this he was stressing the importance of how nothing is progressing and the politicians need to take another look at the communities whole social and living structure. He makes inferences on industrialization and the effect that it has like â€Å"the river ran purple† and â€Å"it had a black canal in it† (1057) This is just showing how much out of hand the social concern of industrialization had got to and how pollution had got to a big height. â€Å"It was a town of red brick or of red brick if that would have been red if the smoke and ashes had allowed it,† (1057). This shows how bad the living conditions were getting and he probably felt the politicians in there town were not doing anything to fix these conditions. â€Å"It was very strange to walk through the streets on a Sunday morning, and note how few of them the barbarous jangling of bells that was driving the sick and nervous mad.† (1058) Now he was stressing how the community itself didn’t even know where they fit in as a social foundation. The main problem to Dickens was that the political and social issues of this town were worsening since none was caring enough to change anything. He basically is revealing the mistreatment of industrialization in this society and is implying towards the social disgraces that have occurred. He retorts,† fact, fact fact'† (1058) just to show even more how  dull the lives of the poor became a repeating every day thing. It became the same because it seemed like every day was a desperate day to survive in this new industrialize d world. To me a major social implication made a point in this short story was of a corrupt society that the politicians were more interested in productivity than in the health and happiness of its citizens.

Fashion Essay

Fashion cannot survive without the media. Its success as both an art form and a commercial enterprise depends upon attention in the media. The media have played a vital role in shaping fashion into the complex cultural phenomenon it has become. Photography, and later film and television, have medialised fashion. Fashion has become an intrinsic part of today’s visual culture, and vice versa. Fashion magazines, glossies and women’s journals cannot exist without fashion, but fashion also cannot exist without these magazines. This chapter looks at visual culture and the ways in which fashion is ‘fashioned’ by the media. The first half of the chapter gives a theoretical background to understanding contemporary visual culture. The second half of the chapter provides an introduction to the many ways that media theory can be used to analyse and understand fashion. Visual culture Since the invention of photography, film, television, video, CD-Rom and the Internet, we have rapidly shifted from a written culture to a visual culture: ‘We live in a culture of images, a society of the spectacle, a world of semblances and simulacra’ (Mitchell 1994: 5). Contemporary visual culture is both ubiquitous and complex. The image no longer stands by itself, but is informed by multimedia; it is usually integrated with text and music. A fashion photograph comes with a caption or an accompanying text. A fashion show doesn’t work without music or a choreography of moving bodies. Apart from their multimedia aspect, images also circulate in a global media society in which all kinds of genres and media are mixed. Precisely because this visual culture is so dominant on the one hand and so complex on the other, we need theoretical tools in order to be able to understand images, including images of fashion. To do justice to the complexity of visual culture, it is necessary to pose questions on the basis of an interdisciplinary framework: questions about significance and ideology; identity and visual pleasure; technology and economy. Theoretical insight creates media literacy. We can thus acquire an attitude towards the media we use every day that has aptly been described by Laura Mulvey as ‘passionate detachment’ (1989: 26). Before supplying a number of analytical instruments in the second half of this chapter, I would first like to place visual culture within the framework of postmodernism. I Theoretical framework Postmodernity Although the term ‘postmodernism’ is often described as vague and indeterminate, there are definite ways in which it can be characterised. Here I make a distinction between a) postmodernity, b) postmodern philosophy and c) postmodernism as a movement in art and culture (Van den Braembussche 2000). First of all, postmodernity. Postmodernity refers to the age we are currently living in, particularly the information society that has arisen since the sixties. It is a question, then, of an historical period in which we live. The information society can be characterised as ‘postcolonial’: after the Second World War, the colonies in the Third World achieved independence at a fast rate. This society is also ‘postindustrial’: heavy industry has been replaced by the exchange of services. From the sixties onwards, these services have increasingly been characterised by information technology, set in motion by the advent of the computer. Science and technolo gy are indispensable and give shape to our society. While the industrial society still functioned largely around property (who has control of the means of production?), the information society is mainly about access (‘xs4all’: ‘access for all’) – access to information, that is to say, to knowledge. Postmodernity means a networked society in which everything and everyone is connected with each other via mass media such as television and the Internet. Another characteristic is globalisation. Globalisation has taken place with the media (you can watch CNN and MTV all over the world) and with capital (you can use cash machines anywhere in the world). And with fashion. Benetton’s multi-racial campaigns show the more benign face of globalisation, but, to be fair, they have also drawn attention to the more dismal effects of globalisation. Applying the characteristics of postmodernity to fashion, we get the following picture. In the past, fashion was dependent on fabrics like silk, cotton and cashmere – as well as inspiration – that the West imported from its colonies. In the seventies the Hippies came alongwith their renewed interest in non-Western clothing. With the deconstructivist fashion of Japanese designers like Yamamoto in the eighties, the first non-Western designers broke open the closed, elitist fashion world. Now they have been succeeded by other designers such as Hussein Chalayan, Xuly Bà «t and Alexander Herchovitch. With the Fashion Weeks i n India and Africa, fashion has become globalised. When we look at the  fashion industry, the picture is even clearer. Whereas the Dutch fashion industry was originally established here in Holland itself- in Enschede for example – it has now largely moved to low-wage countries in Asia or the former East Block. Look at the label in your sweater or trousers and most likely you’ll find ‘Made in Taiwan’ or something similar. Globalisation results in cheap clothing and enormous profits in the West, but also in protests against exploitation, such as against the Nikes made by small children in Pakistan. These abuses signalled the start of the No Logo and anti-globalisation movements. Postmodern philosophy Secondly, postmodern philosophy. Two notions are important here: ‘the end of the Grand Narratives’ and ‘the death of the traditional subject’. These words suggest that Western culture is going through a crisis. According to the postmodern philosopher Jean-Franà §ois Lyotard, Western culture is no longer able to tell any ‘Grand Narratives’, by which he is referring to the end of ideology. This implies that ideologies (‘isms’ like Marxism or Feminism, but also religions such as Christianity) can no longer provide modern man with a meaningful frame of reference. Ideology finds itself in a crisis of legitimatisation, no longer able to announce the truth or to proclaim a future utopia. This does not mean, of course, that everyone has given up their beliefs; on the contrary, we are actually seeing a return to ideology and religion. But, Lyotard argues, nobody can impose that belief or that ideology on others as the one and only truth. People who still try to inflict any kind of truth upon others are called fundamentalists nowadays. The end of the Grand Narratives is not just a negative process. For most people it is liberating to be freed from a one-sided, enforced truth. What’s more, it has led to a blossoming of‘small narratives’ in postmodern culture. Now that there is no one dominant truth, many people have the right and freedom to tell their stories, including those who previously had few opportunities to do so, such as women, workers, blacks, young people. You see the same development in art: there is no longer one dominant movement but a multitude of directions. And we see the same pluralism in fashion. No longer a ‘Grand Narrative’ dictated by a single fashion king, or even by just one city, but a multitude of perspectives coming from many designers, in various cities and different parts of the world. The end of the Grand Narrative also has consequences for the view of human subjectivity. The traditional notion of the individual is that he (it was almost always a he) represents an autonomous and coherent entity, endowed with reason. It was mainly psychoanalysis that put an end to this notion. According to Freud, the human being is not at all governed by his reason, but rather by his unconscious. And it was Marx who claimed that it is our class that determines who we are. We may think we are individuals, but in fact we are defined by our class, ethnicity, age, sexual preference, religion, nationality and so on – the list is endless. In fact, then, we are not really an autonomous and coherent entity. This is why postmodernism no longer refers to an ‘individual’ but to a ‘subject’. A subject, moreover, that is split, fragmented, splintered. As a piece of graffiti in Paris in the eighties put it, ‘God is dead. Marx is dead. And I don’t feel so good either†™. A more positive way of formulating this idea of fragmented subjectivity is by analogy with the network society: the subject, the self, always stands in relation to an other. Instead of being autonomous we are all incorporated in a fabric of complex and mobile relations. Our identity is to be found, as it were, on a node of communication cir cuits. The postmodern subject is thus characterised by a dynamic and a diversity that were alien to the traditional individual. This change in the position of the human being has had the same effect as the end of the Grand Narratives: many more people can now make a claim to subjectivity who were previously excluded, such as blacks, women and homosexuals. This can also be witnessed by the recognition of art and culture produced by women, people of colour, and artists from the so called ‘Third World’. This development has resulted in a much greater freedom in the formation of human identity. Just look at pop culture, where someone like Madonna assumes a different image with the regularity of a clock. Today you can play with your identity by gender bending, for example. Or by crossings with other ethnic cultures, such as Surinamese or Dutch Muslims who borrow elements from the American black hip-hop subculture. Fashion is an important component of the play with identity. I n earlier days it was your gender and your class that determined what you had to wear, and there were strict rules that were not so easy to transgress. These rules now only apply to the Queen. Everyone else stands in  front of the wardrobe each morning to determine which clothes match his or her mood: baroque, gothic, sexy, or maybe businesslike today after all? Postmodernism Thirdly, the term postmodernism as applied to art and culture. A crucial characteristic of postmodernism is the fading distinction between high and low culture. Over the course of the twentieth century the traditional notion of culture has been freed from its connection with elitist art. Scholars nowadays employ a broad notion of culture, based on Raymond Williams’s famous expression ‘culture as a whole way of life’ (1958). Here it concerns a view of culture as a practice within a social and historical context. The rigid distinction between high and low culture is no longer tenable. In any case, it was always largely based on the controversy between word and image in Western culture, where the word is seen as the expression of the superiority of the mind and the image as expressing emotion and the baser desires of the body. The shift from a textual to a visual culture means the image is no longer viewed in purely negative terms but is valued for all its positive powers and the experiences it evokes. Moreover, ‘high’ culture and ‘low’ culture cannot be unequivocally linked to particular disciplines (read: literature versus television). Every art form has its low cultural expression. Just think of the portraits of the gypsy boy with a tear running down his face or pulp romantic novels. ‘High’ is stepping off its pedestal: haute couture is influenced by street culture. ‘Low’ is upgraded and receives attention in newspaper art supplements or is exhibited in the museum. Advertising phot os from Benetton, computer art by Micha Klein and fashion photos by Inez van Lamsweerde have all been shown in Dutch museums. Dà ©mocratisation and commercialisation are also crucial to the discussion of ‘high’ and ‘low’. Increased prosperity and dissemination via the media have brought art and fashion to within almost everyone’s reach. The enormous numbers of visitors to major exhibitions testify to this, as does the ‘festivalisation’ of big cities. Culture is ‘in’ and is eagerly consumed in large quantities. Moreover, commerciality is no longer associated exclusively with low culture; it has penetrated high culture, as can be deduced from the weekly  top ten lists for literature, the piles of CDs of music by Bach and Mozart in the local supermarket, Audi’s sponsoring of the Stedelijk Museum in Amsterdam, or Karl Lagerfeld’s designs at H&M. Another postmodern feature is inter- textuality, which amounts to the idea that a text always refers to other texts. Every text is a web of quotations, borrowed words and references. This term d oes not, of course, simply represent a narrow view of text; images likewise ceaselessly refer to each other. Advertising spots refer to videoclips, which borrow from television series, which in their turn quote films, which are themselves based on a novel. And that novel refers again to a play by Shakespeare, and so on and so on. It’s an endless game. Madonna’s video clip ‘Material Girl’ refers for example to Marilyn Monroe’s song ‘Diamonds are a Girl’s Best Friend’ in the film ‘Gentlemen Prefer Blondes’. In an advertisement forEstee Lauder perfume, the model walks through a digital field of flowers that is identical to the one Madonna walks through in hervideoclip ‘Love Profusion’. Nicole Kidman, in the commercial for Chanel No. 5, does a perfect repeat of her role in ‘Moulin Rouge’. Some directors, such as Baz Luhr- man or Quentin Tarantino, have made inter- textuality their trademark. A l arge part of the visual pleasure in contemporary culture is based on recognition: the more references you can place, the more clever you feel as viewer. Some theorists, such as Frederic Jameson, call the postmodern form of intertextuality a ‘pastiche’. A pastiche is a textual or visual quotation which merely repeats; sheer quoting is the name of the game. The reference has no deeper meaning because all historical connections are abandoned. This can also be found in fashion. If you look at a John Galliano creation you can recognise myriad quotations: from other cultures (ethnic prints), from other times (nineteenth century silhouette), from street culture (‘bag lady’ with shopping cart and plastic bags) and even from the circus (clown-like make-up). Everything is thrown into a big pile while elements are wrenched from their historical time and geographical context. A term often used in this connection is ‘bricolage’, which literally means making do. We’ve become a ‘cut & paste’ culture, where everyone can tinker about and scramble together their clothes and even their identity. Postmodern culture is thus characterised by pastiche and bricolage. It’s not always an easy matter to indicate the significance of this cultural phenomenon, but it does  make fashion playful and flexible, wi thout it being compelled into an overruling ‘Grand Narrative’. A final characteristic of postmodernism that I would like to discuss is the transition from representation to simulation. We have already seen that postmodern pastiche – quoting, borrowing and referring – does not necessarily have any deeper meaning. This is because postmodern culture no longer represents, but simulates. This process is dependent upon the role of media technology. 1963 Amsterdam (NED) In 2003 the magazine American Photo put together a list of the 25 best photographers in the world. That list contained one Dutch name: Inez van Lamsweerde. Both an artist and a fashion photographer, she has ignored the dividing line between art, fashion and commercial work from the very beginning. And successfully. Her work is shown in many glossies such as The Face, Vogue and Arena Homme Plus (editorials and advertising campaigns) as well as in international museums and galleries. Her signature is clearly recognisable in both areas. Inez van Lamsweerde once said in an interview that she was obsessed with beauty. It’s always people she photographs – or recreates, to be precise. Her digitally altered creatures are alienating. Too smooth, too clone-like, too impersonal to be fully human. She often bases her work on ideal female images from the mass media and the body culture in connection with gene technology, surgery and bodybuilding, the manipulation of the body, identi ty and sex. In the series ‘Final Fantasy’ (1993) three-year-old girls posed coquettishly in satin underwear but with the mouths of adult men superimposed on their faces. The cloyingly sweet eroticised tot turns out to be a child demon. The series ‘The Forest’ V995†²) shows mWd-manneted passwe men vjWV women’s hands, and the women in ‘Thank You Thighmaster’ (1993) are really mutants who resemble mannequins, without body hair and with a neutral skin surface where nipples and genitals are supposed to be. The camera doesn’t lie? You certainly hope it does. Many models in Van Lamsweerde’s fashion photos are hyperstylised, exaggerated stereotypes, perfectly beautiful, without irregularities and without individual features. They move in a hyperrealistic setting in which the whole effect sometimes suggests the work of Guy Bourdin (for example, see the series ‘Invisible Words’ in Blvd 2,1994). But her oeuvre is more versatile than that of the old master, so it is also less likely to be  related to a certain time period. Inez van Lamsweerde graduated from Amsterdam’s Rietveld Academy in 1990. That same year she got her first photography assignment, the results of which appeared in Modus. In 1992 she received the Dutch Photography Prize as well as the European Kodak Prize (gold in the categories Fashion and People/Portraits). Since the early nineties she has been working almost entirely with her husband, Vinoodh Matadin. Today Van Lamsweerde and Matadin live and work chiefly in New York. The most recent developments in their work suggest a preference for less reconstructed photographs. In 2002 they took nine black-and-white photos of the members of the theatre group ‘Mug met de Gouden Tand’ (Mosquito with the Gold Tooth). In 2003 they produced a nude calendar for Vogue. All without digital effects. Literature: Hainley. Bruce. ‘Inez van Lamsweerde’, Art- Forum, October 2004. Inez van Lamsweerde ‘Photographs’.Deichtor- hallen Hamburg: Schirmer/Mosel. 1999. Jonkers. Gert. ‘Inez en Vinoodh’, Volkskrant Magazine, 22 February 2003. Kauw op het lijf. Rotterdam: Nederlands Foto Instituut. 1998. Schutte, Xandra. ‘Perverse onschuld’, De Groene Amsterdamer, 10 September 1997. Terreehorst. Pauline. Modus: Over mensen mode en het leven. Amsterdam: De Balie. 1990. Illustration: Inez van Lamsweerde. Devorah and Mienke. 1993 In the old conception of art, with Plato or Kant for example, a work of art refers to something deeper or higher beyond reality. Every work of art is unique and hence irreplaceable. As early as the 1930s Walter Benjamin argued that the role of the work of art was changing because of reproductive technologies. With the invention of photography and film (and later television and the Internet), any image can be reproduced infinitely. A copy of Rembrandt’s ‘The Night- watch’ always remains a copy of a famous, original painting, whereas a copy of Man Ray’s photograph of Kiki as a violin has no original. In the age of mechanical reproduction the distinction between original and copy therefore disappears, and with it what Benjamin calls art’s ‘aura’, namely that which makes a work of art unique and original. For fashion, reproductive technology initially meant an  enormous stimulus, since images of designs could be disseminated via the mediums of magazines and television. But in fashion, too, the copy has now overtaken the original design. A day after the fashion shows in Paris or Milan, the photos are already on the Internet and six weeks later H&M can sell replicas in their shops. In Pop Art, Andy Warhol played with the idea of the copy by producing silk-screened images of cans of Campbell soup or icons like Marilyn Monroe. Another example of the loss of aura is the disappointment all of us may feel when visiting Da Vinci’s ‘Mona Lisa’ or Vermeer’s ‘Girl with the Pearl Earring’ in the museum. We’ve already seen so many reproductions in books, films, on mugs, towels, with moustache and beard, or as a doll, that the original is hardly a match for these. Only if you actually succeed in experiencing the painting in the silence of the museum (but can you ever with all those tourists around you?), you may still find the original aura. In the seventies, Jean Baudrillard went a step further than Benjamin by claiming that not only art but also reality is changing under the onslaught of the media. He argues that the ubiquity of the media turns reality into a simulacrum, a copy of a copy. The simulacrum abolishes the difference between ‘being’ and ‘appearing’. Think of someone pretending to be sick – this person actually starts to display signs of sickness, so that it is no longer clear what is real and what is fake. It’s the same with postmodernism: our culture is so thoroughly ‘medialised’ that our experience is determined by the media. Media do not reflect reality, but construct it. Or to put it differently: media do not represent reality, but simulate it. We all know this phenomenon from our own experience. When we’re on holiday in Greece, for example, we exclaim that the sea is as blue as on the postcard. Our experience is determined by an image, in this case the postcard. If we’re on safari in Kenya, it seems as though we’ve landed in a National Geographic TV programme. And when we say to our beloved ‘I love you’ we can’t help feeling we’re acting in a soap. Umberto Eco therefore says that we are assuming a permanent ironic attitude in postmodern times. We can no longer innocently say ‘I love you’, because we’ve already seen and heard it a hundred thousand times on TV. The words have lost their meaning as well as their authenticity. But what we can do, according to Eco, is say it with irony: ‘As Ridge in â€Å"The Bold and the Beautiful† would say, I love you’. While reality shows on television try to simulate life as much as  possible, life itself has become one big reality show, in which being and appearance can no longer be separated. In art and in fashion we can see a longing for authenticity, as a nostalgic reaction to the culture of simulacra. People want something ‘real’ again in a postmodern culture in which the dividing line between real and unreal has become wafer-thin. The question, however, is whether such authenticity is still possible. Such is the power of the simulacrum that the media have created. Now that I have given an outline of postmodernism as a frame within which fashion functions, it is time to look more closely at instruments that can be used to analyse images. These analytical methods all come from poststructuralism, the theory underlying postmodernism. II Analysis The semiotic sign Poststructuralism was informed in the sixties by semiotics, psychoanalysis and Marxism. Poststructuralism is also referred to as ‘the linguistic turn’, since language formed the model for the development of these theories. De Saussure’s writings on semiotics helped to develop a structuralist analysis of the ‘grammar’ of any system, whether a myth, advertisement, film, fashion or novel, as in the work of the anthropologist Là ©vi-Strauss, the early Barthes or the film semiotician Metz (Sim 1998). The central idea that language is paradigmatic for meaning is followed by virtually all postmodern philosophers. According to the psychoanalytical theories of Lacan, even the unconscious is structured like a language. Although some philosophers pointed out that language and signification are fundamentally unstable, as in the deconstructionism of Derrida, or in Lyotard’s postmodern loss of ‘Grand Narratives’, text remains the central focus in poststructuralism. Everything in fact is interpreted as ‘text’, including image, music or fashion. While semiotics initially concentrated on literature, scholars soon started focussing on the field of popular culture, such as architecture, fashion, music, sport, women’s magazines or the video clip – to mention a few examples at random. Semiotics is the theory of ‘signs’ (from the Greek ‘semeion’, meaning sign). A sign is the smallest element that carries a meaning. Language is the system of signs that we are most familiar with, but traffic signs or, as Barthes has shown, fashion are also sign systems. A  sign consists of a signifier (in French, signifiant), the material carrier of meaning, and the signified (in French, signifià ©), the content to which reference is made. The letters and sound of the word ‘dress’ form the signifiers, which refer to the content of a concrete dress. Signifier and signified, form and content, together create meaning. The relationship between signifier and signified is almost always arbitrary; there is, after all, no reason why something is called a dress in English, a ‘jurk’ in Dutch, and a ‘japon’ in French. A sign always refers to something in reality. The first meaning of a sign is denotative; it is the meaningyou can look up in the dictionary. But things seldom have just one meaning; most signs have many secondary meanings. These are called connotations. In that case, the denotative sign, the signifier and the signified form a new entity, a new signifier for a new connotative sign, as in the following diag ram: SIGNIFIER| SIGNIFIED| CONNOTATION| SIGNIFIER| SIGNIFIER| DENOTATION| A well-known example is the red rose. At the denotative level it is simply a flower with leaves and thorns. In order to become a sign of love, the denotative meaning of the flower must become in its turn a signifier. The sign then forms the basis for a connotative, second meaning: love. Why? Because it is agreed upon in our culture that the rose, especially the red rose, symbolises love. An Amnesty International poster adds a third meaning to this well-known symbol by surrounding the thorns with barbed wire and placing the words ‘violence ceases where love begins’ halfway up the stem. The flower thus becomes a symbol of love and non-violence, while the thorns stand for violence. (Please read the table from the bottom up). SIGNIFIER: red rose as love| SIGNIFIED: thorns with barbed wire love| SECOND CONNOTATION: love is the reverse of violence| SIGNIFIER: red rose| SIGNIFIER: red rose| FIRSTCONNOTATION: My love for you| SIGNIFIER:rose| SIGNIFIER: Flower with thorns and lea ves| DENOTATION: Flower of the species Rosa| The multimedia image is an extremely complicated sign and can convey meaning in many ways. A still image, such as a fashion or advertising photograph, has the following signifiers: * perspective (camera position: angle, distance) * framing * photographic aspects such as exposure, rough grain, colour or black and white * composition or ‘mise-en-scene’ of what is depicted: setting, costume, make-up, attitude and actions of the model, etc. * text: caption or legend A moving image, such as film, television commercials, video clip or fashion show, has, all of the above aspects, plus even more signifiers: * movement of the models or actors; choreography * camera movement (pan, tilt, dolly, tracking) * editing * sound (dialogue, added sounds like creaking door) * music Any analysis requires us to briefly check all these elements, since they influence the meaning. Only then can you determine the denotation and the connotations. A close- up has a different effect than a long shot. Camera movements direct the viewer’s gaze. Quick editing evokes tension. Music creates atmosphere, as does lighting. This type of formal analysis soon reveals that the image is never simply a copy or a reflection of reality, even though what the camera records is real. Yet so many technological and aesthetic choices enter into the registration that reality is always moulded and constructed. The aim of analysis is to make this construction transparent. Digital images A formal analysis can be deepened even further by using the semiotics of C.S. Peirce, an American who developed his theories at the same time in the early twentieth century as De Saussure in Switzerland, without their being aware of each other. Peirce’s semiotics is used more often for analysing images because he focuses less on text than De Saussure does. Peirce argues that there are three sorts of relationships between the signifier and the signified: iconic, indexical and symbolic. An iconic relationship means that there is a similarity or resemblance between the signifier and the signified. An example of an iconic relationship is the portrait: the image (the signifier) resembles that which is portrayed (the signified). An indexical relationship presumes an actual connection between signifier and signified. A classic example is smoke as the signifier of fire, or the footprint in the sand as the signifier of the presence of a man on an ‘uninhabited’ island. The symbolic relationship corresponds to what De Saussure calls the arbitrary relation between signifier and signified: the red rose is a convention, based on an agreement. Yet this remains a moot point, because the rose has an iconic relation to the female sex organ. It is this resemblance that has probably led to the rose becoming a symbol for love. All three relationships apply to the mechanically reproducible image, like the photograph or film. An image is always iconic since that which is depicted shows a resemblance to the signifiers: every photograph is a portrait of a person or an object. Something that is photographed or filmed is also always indexical: there is a facturelationship, since the camera records reality-with the camera you prove that you’ve been somewhere (‘I was here’; the visual proof that tourists bring home as their trophy). Finally, the image, like language, has symbolic meanings, which are created through an interplay of the many audiovi sual signifiers mentioned above. Digital technology has put the indexi- cal relation under strain, because we can no longer know with certainty whether an image is analogue, and thus standing in a factual relation to reality, or digital, made in the computer without an existential relation to reality. Digital images thus create confusion. In semiotic terms: they maintain the iconic relation, for they look just like photographs and display a similarity between signifier and signified. But digital images are no longer indexical. This is what happens in Diesel’s ‘Save Yourself’ photo series. We see tiny models who look like people (iconic relation), but all the same seem unreal. Their skin is too smooth, the postures too rigid, the eyes too glassy. We suspect soon enough that the image has been digitally manipulated, which disturbs the indexical relation – these are not actual shots of real people. The tension between the iconic and the indexical relationship draws attention to the tension between real and unreal. And this creates a symbolic meaning. Together with the text, the photographs comment ironically on our culture’s obsession with remaining foreveryoung. Sometimes the digital manipulation is immediately clear, as in this picture of Kate Moss as a cyborg: a cybernetic organism. Because this is clearly an impossible image of a half human / half machine figure, we don’t get confused about the indexical status of the photograph. Its  symbolic meaning is immediately apparent, which here too represents a comment on the artificial ideal of beauty. It is typical of digital photography to create images of people that are like cyborgs, since many art and fashion photographs in today’s visual culture explore the fluid borders between man, machine and mannequin. Looking and being looked at I: the voyeuristic gaze Fashion is deeply involved with eroticism and sexuality. To analyse this we can turn to psychoanalysis, which determines how we shape our desires. The most classic model for desire is the Oedipus complex, which regulates how the child focuses its love of the parent onto the other sex and projects feelings of rivalry onto the parent of the same sex. This is more complicated for girls because they at first experience love for the mother and later have to convert this into love for the father, while the boy can continue his love for the mother without interruption. The Oedipus complex is particularly applicable in stories, in both literature and film, but in the fashion world it actually plays no crucial role, and so I won’t be going into it any further here. More relevant to fashion is the eroticism of looking. According to Freud, any desire or sexuality begins with looking, or what he calls scopophilia (literally the love of looking). The desiring gaze often leads to touch and ultimately to sexual activities. Although it has a rather dirty sound to it, scopophilia is a quite ordinary part of the sexual drive. Film theorists were quick to claim that the medium of cinema is in fact based on scopophilia: in the darkness of the movie theatre we are voyeurs permitted to look at the screen for as long as we like. There is always something erotic in watching films, in contrast to television which does not offer the same voyeuristic conditions since the light is on in the living room, the screen is much smaller and there are all sorts of distr actions. Laura Mulvey (1975) was the first theorist to draw attention to the vital role of gender in visual pleasure. The active and passive side of scopophilia (voyeurism and exhibitionism respectively) are relegated to strict roles of men and women. As John Berger, in his famous book Ways of Seeing, had already argued, ‘men act and women appear’, or rather, men look and women are looked at. According to Mulvey, this works as follows in classical cinema. The male character is watching a woman, with the camera  filming what the man sees (a so- called ‘point of view shot’). The spectator in the movie theatre thus looks at the woman through the eyes of the male character. The female body is moreover ‘cut up’ into fragments by framing and editing: a piece of leg, a breast, the buttocks or the face. The female body is thus depicted in a fragmented way. We can therefore say that there’s a threefold gaze that collapses into each other: the male charac ter, the camera and the spectator. Mulvey argues that the film spectator always adopts a structurally male position. It is important to realise that the filmic means, such as camera operation, framing, editing and often music as well, objectify the woman’s body into a spectacle. In Mulvey’s words, the woman is signified as ‘to-be-looked-at-ness’. At the same time the filmic means privilege the male character so that he can actively look, speak and act. Mulvey takes her analysis even further with the help of psychoanalysis. The voyeuristic gaze upon the female body arouses desire and therefore creates tension for both the male character and the spectator. Moreover, the woman’s body is disturbing because of its intrinsic difference from the male body. Freud would say the female body is ‘castrated’, but we can put it somewhat more neutrally: the female body is ‘different’. In a society dominated by men, women are the sign of sexual difference. In most cultures, it is (still?) the case that the woman-as-other, namely as other than man, endows sexual difference with meaning. Otherness, strangeness, difference always instils fear. The otherness of women incites fear in men at an unconscious level and this fear needs to be exorcised through culture, in film or art. According to Mulvey, this happens in cinematic stories in two ways. Firstly, through sadism where the female body is controlled and inserted into the social order. Sadism mainly accompanies a story and acquires form in the narrative structure. The erotic gaze frequently results in violence or rape. Nor is it accidental that in the classic Hollywood film the femme fatale is killed off at the end of the movie. No happy end for any woman who is sexually active. Only in the nineties is she allowed to live on at the end, like Catherine Trammell in ‘Basic Instinct’, or in television series like ‘Sex and the City’. The second way of exorcising the fear evoked by the female body is through fetishism. In that case the female star is turned into an image of perfect  beauty that diverts attention from her difference, her otherness. The camera fetishises the woman’s body by lingering endlessly on the spectacle of female beauty. At such moments the film narrativ e comes momentarily to a hold. Although Mulvey’s analysis dates from the seventies, her insights are still of considerable relevance for fashion today. The spectacle of fashion shows is almost totally constructed around looking at fetishised female bodies. Models have taken the place of film stars as the fetishised image of perfected femininity. Many fashion reportages make use in one way or another of the sexu- alised play of looking and being looked at. However, some things have changed since the time of Mulvey’s analysis. Feminist criticism has indeed counteracted women’s passivity in recent decades, and now we often see a more active and playful role for the female model. Not only is the woman less passive, but both fashion and other popular visual genres such as video clips have turned the male body into the object of the voyeuristic gaze. Now the male body too is being fragmented, objectified and eroticised. This is happening not only in fashion reportages but also on the catwalk. It may be interesting for students of fashion to take a closer look at how the male body is visualised, how passive or active the male model is, and how the gaze is supported by filmic or other means. Ethnicity also plays a role in the game of looking and being looked at. Stuart Hall (1997) and Jan Nederveen Pieterse (1992) have produced an extensive historical analysis of the way that coloured and black people are depicted in Western culture. Stereotypes are abundant, as in the image of the exotic black woman as Venus or the black man as sexually threatening. There are still very few black models in the fashion world. Again, it may be useful for students of fashion to analyse how ethnicity is visualised because of this long history of stereotyping. Does exoticising the model, for example, emphasise ethnicity? Or does it involve an actual denial of ethnic difference? This happens for example in fashion photos of Naomi Campbell with straight golden hair, or wearing blue contact lenses. Here, the black model has to conform to the white norm of ideal beauty. Looking and being looked at II: the narcissistic gaze So far I have been talking about looking at the other, but psychoanalysis also has something to say about looking at yourself. As a baby you are hardly conscious of yourself, because that self, or in psychoanalytical terminology the ego, still has to be constructed. A primary  moment in ego formation is what Jacques Lacan has called the mirror phase. A second important moment is the aforementioned Oedipus complex in which language plays a major role. The mirror phase, however, precedes language and takes place in the Imaginary, the realm of images. When you’re between six and eighteen months, and so still a baby, you’re usually held in your mother’s arms in front of the mirror. In identifying with its mirror image, the child learns to recognise itself in the mirror and to distinguish itself from the mother. This identification is important for the construction of the child’s own identity. For Lacan, it is crucial that this identification is based on the mirror image. He argues that the mirror image is always an idealisation, because the child projects an ideal image of itself. In the mirror the child sees itself as a unity, while it still experiences its own body as a formless mass with no control over its limbs. Th e recognition of the self in the mirror image is in fact a ‘misrecognition’. The child is actually identifying with the image of itself as other, namely as a more ideal self that he or she hopes to become in the future. Just check how you look at yourself in the mirror at home: in fact you always look at yourself through the eyes of the other. According to Lacan, this is in a certain sense man’s tragedy: we build our identity on an ideal image that we can never live up to. In his eyes, then, we are always doomed to failure at an existential level. We can take the mirror very literally (it is striking how often mirrors feature in films, videoclips, advertisements and fashion photos), but we can also interpret the process more metaphorically. For instance, the child sees an ideal image of itself reflected in the eyes of its adoring parents who put him or her on a pedestal: for your parents you’re always the most beautiful child in the world. And rightly so. When we’re older we see that ideal image reflected in the eyes of our beloved. We need that ideal image in order to be able to form and sustain our ego. It’s a healthy narcissistic gaze that is necessary for our identity. That ego is never ‘finished’, however; it has to be nurtured and shaped time and time again. And this is helped by internalising ideal images. The analysis of the mirror phase has been applied to many phenomena within visual culture. The film hero or heroine functions as the ideal image with which we identify ourselves. In the fashion world it’s the models. In fact you could designate visual culture as a whole in this way: pop stars, models and actors all  offer us opportunities for identifying with ideal images. Fan culture is largely based on this narcissistic identification. There’s another side to it, of course. In a culture in which youth, fitness and beauty are becoming more and more important, the ideal image becomes ever more unattainable. Many people are no longer able to recognise themselves in that prescribed ideal image and are extremely dissatisfied with their appearance. That then leads to frustration and drastic measures like plastic surgery, or to ailments like anorexia and bulimia. In that case the narcissistic gaze in the mirror falls short of expectations. Looking and being looked at III: the panoptical gaze So far we have mainly been concerned with analysing the desiring gaze: the voyeuristic look at the other (the desire to ‘possess’ the other) and the narcissistic look at oneself (the desire to ‘be’ the other). It is also possible to make a more sociological analysis of the play of looks in society. This brings us to the historian Michel Foucault, who has made a thorough analysis of how power works. Instead of seeing power as something that the one has and the other lacks, he argues that in modern culture power circulates in a continual play of negotiation, conflict and confrontation, resistance and contradictions. Changes regarding power are reflected in language. Whereas you were a victim in earlier days, now you’re an expert of experience. In this way you give yourself a certain power, namely the power of experience, even if that experience is unpleasant. One way of shaping power in our modern culture is by means of surveillance, or what Foucault calls the ‘panoptical’ gaze. He derived this from the architecture of eighteenth-century prisons which had a central tower in a circular building with cells. A central authority, out of sight within the tower, could observe every prisoner in every cell. The prisoners were also unable to see each other. The panoptical gaze means that a large group of people can be put under constant guard and scrutiny, while they cannot look back. In this way, says Foucault, they are disciplined to behave properly. Today the role of surveillance and monitoring has been taken over by cameras. Everyone knows there are security cameras ‘guarding our and your property’ in the street, in stations and supermarkets, in buses and trams and in museums. The knowledge that we are constantly and everywhere being watched by an  anonymous technology perhaps gives us a feeling of security (or the illusion of security). What is more important is that the panoptical gaze disciplines us to be orderly citizens. A large degree of discipline emanates from constant observation. Just as with Lacan’s mirror phase, we can interpret the panoptical gaze more metaphorically. It is not only security cameras that are creating a panopticum, but also the ubiquitousness of media such as television and the Inte rnet. Crime watch programmes show us images from surveillance videos in order to catch ‘villains’, while reality programmes reveal how our fellow citizens commit traffic offences. Satellites orbiting in space keep a permanent eye on us. Mobile telephones are normally equipped with GPS (Global Positioning System) and always know where we are to be found. When I was on holiday in Italy, my mobile phone sent me messages like ‘you are now in Pisa, where you can visit the Leaning Tower’ or ‘you are now in Piazza Signoria in Florence; did you know that Michelangelo’s David†¦Ã¢â‚¬â„¢ and so on. For a moment I was that little girl again who knows that God is always watching over her. But divine omnipresence has now been replaced by an anonymous, panoptical gaze. Our surfing behaviour on the Internet and our purchasing behaviour in the supermarket are registered in the same way. We can bring these three ways of seeing together. With the voyeuristic gaze we discipline the other; we all know that secret look which we use to approve or disapprove of someone at a glance. With the narcissistic gaze we discipline ourselves, through the wish to fulfil an ideal image. By internalising the panoptical gaze we discipline our social behaviour, as well as our bodies. Fashion plays an important role in this complicated play of gazes. You only have to wander around any school playground or look around you in the street to realise how fashion determines whether someone belongs or not, what the ideal images are, and how groups keep an eye on each other, disciplining each other as to ‘correct’ clothing. Through clothing I can make myself sexually attractive for the voyeuristic gaze of the other. Or I can subject the other to my voyeuristic gaze if I find their body and clothes attractive. I can use clothing to construct my own identity and emanate a particular ideal image. But fashion is more than just clothing. Fashion also dictates a specific ideal of beauty. That beauty myth determines how we discipline our bodies, for example by subjecting them to diets, fitness, beauty treatments such as waxing, depilation, bleaching and  even to plastic surgery. In short, fashion ultimately affects the body too. We see an example of that in the di gital photo series ‘Electrum corpus’ by Christophe Luxerau, which shows us how fashion is literally engraved on the skin: the logo has become our skin. Bibliography On postmodernism: Baudrillard,Jean.5/w «/ai/ow5. New York: Semiotext(e), 1983. Braembussche, A.A. van den. Denken over kunst:Een inleiding in dekunstfilosofie. 3rd, revised ed. Bussum: Coutinho, 2000. Docherty, Thomas, ed .Postmodernism: A reader. 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