Therapeutic Engagement Is A Basic Tool For Nurses

Therapeutic Engagement Is A Basic Tool For Nurses My rationale for choosing communication and therapeutic engagement is that it occupies a central position in my experience and transition and from student nurse to an accountable practitioner. Through communication the nurse gets to know the patient and is able to form a therapeutic relationship. It is the foundation and a basic tool of the nurse -patient relationship. Without clear communication it is impossible to give care, effectively make decisions, protect clients from threats to well being and ensure their safety on the ward, co ordinate and manage clients care and offer comfort. The relevance of communication and therapeutic engagement in mental health is emphasised in the summary of the Chief Nursing Officers review of mental health nursing (DH, 2006). One of the key recommendations in improving outcome for service users is developing and sustaining positive therapeutic relationship with service users, their families and/or carers and should form the basis of all care. The N MC (2008) Code of Professional Conduct similarly emphasise that nurses must work with other members of the team and patients to promote healthcare environment that are conductive to safe, therapeutic and ethical practice. The SLAM NHS Foundation Trust document Engagement and Formal Observation Policy (SLAM, 2008) also highlight the importance of communication and engagement with patients under observation. Many patients and their family members often experience difficulty in communicating with healthcare professionals. The Audit Commission (1993) has stated that poor communication between patients and healthcare professionals is one of the main reasons for compliant and litigation in the healthcare service. The NHS Plan (DH, 2000) emphasised the importance getting the basics right by improving the quality of care and the experience of patients. One of the ways of achieving this is through effective communication between patients, carers and healthcare personnel. This is highlighted in the Department of Health document, Essence of Care (2003) (www.dh.gov.uk):Patient focused benchmark for clinical governance. In this document is a new benchmark focusing on communication between patients and/or carers and healthcare personnel which compliments that of record keeping and privacy and dignity benchmarks. The NHS Knowledge and Skills Framework (KSF) (DH, 2004) lists communication as a core dimension which is a key aspect of all jobs in the NHS and underpins all other dimension in the KSF. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) now Nursing and Midwifery Council (NMC) stated that communication is an essential part of good practice in nursing and it is the basis for building a trusting relationship that will greatly improve care and help reduce anxiety and stress for patients/ clients, their families and their carers ( UKCC, 1996). My ward is a Patient Intensive Care Unit (PICU) of a forensic setting. It has thirteen in-patients and a staff strength of twenty three nurses both qualified and unqualified. Agency staffs are frequently engaged to make up the number of staff necessary to care for patients on a particular shift. On the average there are between seven and eleven nursing staff per shift depending on the prevailing situation on the ward. It has two supervised confinements and two intensive care areas. Admissions are planned and it is based on a set of assessment criteria. Only acutely unwell patients are admitted. This essay will draw on my first working experience as a primary nurse of an acutely unwell psychiatric patient to illustrate my development with regards to communication and therapeutic engagement. Gibbs (1988) reflective cycle will be used to reflect this experience. Description I had just started work as a newly employed member of staff and was assigned primary nurse to a thirty year old patient of Afro-Caribbean origin who was transferred from another ward following a relapse in his mental state. He was under section 3 of the Mental Health Act (1983). This patient is named A for confidentiality purposes (NMC, 2008) had diagnosis of paranoid schizophrenia and had no insight into his mental illness. His carer was his mother with whom he had a luke-warm relationship. He was very suspicious of staff interventions and would not engage. Routine blood tests had revealed that he had elevated cretenine kinase (CK) levels (Cretenine Kinase enzyme, high levels of which case severe muscle damage, neuropletic malignant syndrome, myocardial infarction etc). Following this finding, his antipsychotic medication was withdrawn pending further blood tests. He refused to have a blood sample taken for further tests; he believed staff would drink his blood. As his primary nurse , I made several attempts to encourage him to have the blood tests, but he would not be persuaded. He was also diagnosed with type II diabetes and was dependent of insulin. He self managed his physical illness by carrying out blood glucose level monitoring and self administering insulin under staff supervision. Patient A fed only on pre-packed barbeque chicken purchased from the supermarket and would not eat food served on the ward. I had one to one engagement with him to discuss his dietary intake and also formulate a physical and mental healthcare plan. He was not interested and made no contributions to the discussions. I gave him copies of the care plans which he declined. He said you can keep those care plans I dont need them and I am able to take care of myself. By the end of the second week, his mental state had deteriorated so much that he was very paranoid, irritable and getting into arguments with fellow patients and staff. He was involved in incidents both verbal and physical aggression and became increasingly difficult to manage on the ward. For his safety and that of others the team made a decision to nurse Mr. A in supervised confinement based on rationalist -analytical approach, having carried out risk assessment and looked at his history as well as the trust policy. As part of this risk management plan he was transferred to the intensive care area (ICA) and nursed under enhanced observation by two nursing staff. I requested to be allocated to nurse him in the ICA as often as the trust and unity policy would allow, in order to assess his mental state and attempt to build a rapport with him. Mr. A would not talk but I persisted. He noticed that I was frequently allocated to observe him and gradually opened up. I explained to him the teams decision to nurse him in the supervised confinement and the ICA. We talked about politics, football, music etc and our relationship developed and continued till he was transferred to a rehabilitation ward. Feelings I felt very frustrated and inadequate and was very much under stress. It was obvious from his reaction that he had no confidence nor trust in me and saw me just like any other healthcare professional. Woods (2004) highlights the complex problems and needs of patients who find themselves in forensic settings and maintain that it is a common occurrence that some patients can not engage in treatment while others simply refuse to do so. Arnold and Underman-Boggs (1999) maintain that any meaningful relationship begins with trust. Trusting a nurse is particularly difficult for the mentally ill, for whom the idea of having a caring relationship is incomprehensible. As his primary nurse I saw myself as the advocate ready to work with him and seek his interest at all times. As nurses, we are called upon to play our roles as advocates, supervising and protecting clients rights and empowering them to take charge of their lives. Ironbar et al (2003) stresses that, therapeutic relationships can b e stressful. Working closely with people who are mentally unwell and under stress can be very demanding and emotionally draining experience. Consequently, nurses need to be aware of the effect that such relationships can have on them. This requires insight, self awareness and ability to cope effectively with stress. My initial perception was that Mr A was a difficult patient and considered withdrawing as his primary nurse but I felt emotionally attached. I understood that I owed Mr A. a duty of care (NMC, 2008) and simply withdrawing was not professional in my view. OCarrol et al (2007) contended that in our professional roles, nurses do not have the same option as we do in our personal life by withdrawing from difficult relationships. Rather it requires exploring the situation which may help recognise ways in which the nurse is influenced by his emotions. The authors caution that nurses must learn to manage their own emotions. Furthermore, they need to communicate their emotional r eactions to the patient, albeit in a modified form. I empathised with Mr A and it drew me closer to him, revealing to me the depth of hi mental illness. I wished I could doe something here and now to help alleviate the state f confusion, anxiety and helplessness in which he found himself. Barker (2003) reports of how in recent times empathy has been shown to enable nurses to investigate and understand the experience of persons experiencing a state of chaos as a consequence of psychiatric order. I felt uncomfortable when Mr A had to be physically restrained (PSTS techniques) and nursed in supervisory confinement, I felt that this procedure was not justifiable because the privacy, dignity and respect of this client had been compromised. As nurses we are to demonstrate respect for patients by promoting their privacy and dignity (NMC, 2008) (Essence of Care, 2003). On the other hand, I thought that his safety and that f others was paramount and this could be achieved only by nursing him separately from the rest. The NMC (2008: para 8:4) Code of Professional Conduct clearly states that when facing a professional dilemma, the first consideration must be the safety of patients. The collaborative team decision to nurse him in the supervised confinement area made me feel valued as a team member. I was actively involved in the decision making process and carried out risk assessments. I felt that I was insensitive with my sustained persistence to get him to talk. I should have understood that his moments of silence were necessary to help him calm down (SLAM, 2008). I also felt unsupported and struggled to cope with the management and care of Mr A. I was unable to access clinical supervision because my supervisor was away on holiday. Evaluation Although it seemed difficult at the beginning, but by the time Mr A was out of the ICA we had developed a good working relationship. I did not show my disappointment at his reluctance to engage when he was acutely unwell and stayed positive. Engaging with him while nursing him in the ICA offered me the opportunity to explain to him the teams decision to place him under enhanced observation. Actively listening to him and discussing with him his thoughts and feelings have helped lessen his distress. It also enabled me to give a comprehensive feedback to the team regarding his mental state. We met in one to one engagements and discussed his concerns and needs. A good and well ventilated environment was always made for our meetings. Following assessments, we discussed his care plans, participation in group activities, crisis management and other forms of therapies. He felt very much in charge, highlighting his most pressing needs. Whenever we met, there as a demonstration of mutual respect and desire for working together in a partnership. Together we identified and prioritised his goals for recovery based on his strengths and what he believes is achievable. Faulkner (1998) asserts that goals must be clearly defined so that both the professional and the patient are going in the same direction in terms of what they wish to achieve by a certain time. During our interactions, clear boundaries were set and clarified for Mr A what were acceptable behaviours. Boundaries were set as to what he was allowed to do without supervision, how he engaged with others and appropriate ways of addressing issues he felt unhappy or uncomfortable with. The plan of care was therefore service-user centred and recovery orientated approach. The recovery model has been incorporated into the principles of care delivery in the trust (SLAM, 2007). It aims to help service-users to move beyond mere survival and existence, encouraging them to move forward and carry out activities and develop relationships that give their lives meanings. Wood (2004) indicated that nursing forensic patients is not easy and requires complex treatment plans that focus fundamentally on reducing risk of harm to others. As part of his recovery, he was encouraged to self manage his diabetes under supervision. Giving his understanding of his physical illness information was provided to enable him to make informed decisions about his lifestyle. Mr A consented to giving regular blood samples. His CK level fell to normal levels and was restarted on anti psychotic medication. However, it took time for Mr A to adequately understand the situation that he was in and the effect of his illness on his lifestyles. It must also be stated that it was not always possible to meet with Mr A as planned. Scheduled meetings had to be cancelled due to being engaged with very pressing ward issues. Analysis The use of therapeutic communications in nursing, particularly empathy, is what enables therapeutic change and should not be underestimated (Norman and Ryrie, 2004). Egan (2002) argues that empathy is not just the ability to enter into and understand the world of another person but also be able to communicate this understanding to him/her. The relevance of empathetic relationships to the goals of health services are suggested by the increase in focus on patient centred care and the growth of consumerism. The client-centred focus is illustrated by the NHS patient charter which emphasises that clinicians need to collaborate with users of the health services in the prioritising of clinical needs and the setting of treatment goals (Barker, 2003). Nurses should be aware that patients who are paranoid and suspicious of staff interventions as was the case of Mr A, might not readily accept support from staff. This implies that working with such patients can be very challenging and difficult. It therefore calls for the nurse to remain impatient, calm and focused. The need to build therapeutic relationship with the patient is paramount in gaining trust and respect (Rigby and Alexander, 2008). Caring, empathy and good communication skills are needed to help patients through their illness. Therefore the use of effective interpersonal skill s facilitates the development of a positive nurse-patient relationship. McCabe (2004) argues that the use of effective interpersonal skills, a basic component of nursing, must be patient centred. Nursing Mr A in supervised confinement and subsequently in the ICA was in accordance to SLAM (2008) Engagement and Formal Observation Policy. Despite the frequent occurrence of this nursing intervention in mental health settings, for the whole of the UK there are no national standards or guidelines for practice of observation. The current situation in England and Wales is that policies are developed and implemented at a local level using SNMAC (1999) practice guidance for observation of patients at risk as a template (Harrison et al, 2006). Nursing patients in supervised confinement, though a common practice in the PICU raises a number of ethical, professional and legal issues about the role of the nurse, whether he/she is a custodian or therapist and a friend is debateable. Alland et al (2003) noted that patients view enhanced observation as uncomfortable at best, custodial and dehumanising at worst. Mr A felt that his pride and dignity had been taken away from him he was at risk an d therefore an immediate and effective risk management plan had to be implemented. This was necessary to ensure his safety and that of others even though he expressed unhappiness with this intervention. By engaging him and encouraging him to share his thoughts and feelings his anger appeared to have lessened as he joined in the discussions of politics, music, football etc. Thurgood (2004) empathised that showing your human side to clients is very important. Engaging meaningfully with patients and helping them talk about their feelings is the first step to alleviating some of their distress. The NMC (2008) Code of Professional Conduct clearly points to the rights of patients in relation to autonomy. There appeared to have been a reach to Mr As rights. The difficulty we faced as a team was finding the balance between allowing some privacy and dignity versus persevering his safety and security. Consequently, a dilemma arose for me as his primary nurse in relation to his rights, obligat ions and duties. In fact Article 5(1) e of the Human Rights Act (1998) specifies the right of the state to lawfully detain the person of unsound mind. Within the UK, that framework is provides by the Mental Health Act 1983 (DOH, 1998). One may argue then that there is no fundamental incompatibility between the Mental Health Act and the Human Rights Act. There were times that scheduled meetings with Mr A had to be cancelled because of urgent administrative duties. It meant that he lost the opportunity to meet up with me to discuss his concerns and needs. The concept of Patient Protected Time (PPT) in inpatient units is therefore valid. It allows patients to meet with a healthcare provider on one to one for a specified time when the ward is closed to administrative duties to discuss care plans, social activities, therapies and others. Such interaction according to Song and Soobratty (2007) promotes feelings of self confidence, esteem and recovery. It can also aid the patient therapeutic progress as it can help with social interaction and building relationships. However, nurses complain they already have plenty to do without an added pressure of PPT to contend with. Nurses frequently complaining of being too busy to develop therapeutic rapport with patents (Mental Health Act Commission 2008). Yawar (2008) reported that only 16% of pati ents time was spent in what can loosely be termed as therapeutic interaction. The remaining of the 84% was spent aimlessly either pacing p and down the ward or doing nothing. Nurses recognise their responsibilities to engage with patients and welcome the opportunity to do this without other demands (Edward, 2008). The Department of Health (2002) called for improvements to ensure adequate clinical support inputs to inpatient wards and to maximise the time spent by staff therapeutically engaged with patients. Therapeutic engagement, therefore involves spending quality time with patients with the aim to empower them to actively participate in their care. Conclusion Communication is without doubt the medium through which the nurse-patient relationship takes place. The skills of active listening and reflection promote better communication and encourage empathy building. My first role as a primary nurse as a good learning experience. My conduct throughout the whole experience earned me a favourable feedback from my team leader. Caring for acutely mentally unwell patients requires of the nurse sensitivity, conveying warmth and empathy. Engaging meaningfully and actively listening to patients under enhanced observation makes them perceive the practice as valuing rather than punishing, therapeutic rather then custodial. Feeling safe and secured provides a platform which can assist patients to begin to resolve some of the difficulties they may be facing in their lives. It is imperative that nurses involve patients in all aspects of their care, empowering and making decisions in partnership with the team. By developing collaborative relationship with p atients, nurses can provide prompt and focused interventions which can limit illness damage, assist in the process of symptoms management and help the process of recovery. Action plan My aim is to be proactive in the future by promptly seeking support from senior colleagues and requesting for clinical supervision. I aim to develop the skill of emotional resilience and intelligence to be able to deliver care that will promote patient welfare and aid recovery. The preceptorship experience has been a breath of fresh air. A time to look back and take stock of the transition from student nurse to an accountable practitioner. Listening and sharing in the experiences of fellow nurses was a good learning experience. The preceptors were fantastic master clinicians who were receptive to our contributions as they explored our experiences at the beginning of each teaching session. This experience has undoubtedly enhanced my critical thinking as a nurse and prepared me to move forward in my development and practice as a caring and competent nurse. I see myself as being in the right job which offers many opportunities for development and to improve upon my knowledge and skills.

Existentialism in Demian and Crime and Punishment Essay

Existentialism is fairly common in literature, despite being a relatively new school of thought, and both Demian and Crime and Punishment show existentialist traits. This gives each book not just a philosophy, but also a certain feeling and mindset. Existentialism starts that with the idea that existence precedes essence, or purpose. We come into this world without a purpose, and we simply exist. Our task is to find a purpose. The world around us is an alien chaos, a circus that we stumble through, trying to find a meaning for our life. In Demian, it is clear that Sinclair does not know his purpose. His struggle is to find out what it is. Jean-Paul Sartre says, â€Å"Life has no meaning a priori? it’s up to you to give it a meaning. † Hesse declares that â€Å"[e]ach man had only one genuine vocation? to find the way to himself?. His task was to discover his own destiny† (Hesse, 132). It is clear, then, that we come into the world with nothing, no purpose at all. The only genuine task we have is to figure out what we are going to do here. According to Existentialism, no one can find it for you, and, similarly, no doctrine or philosophy can find it for you. Sinclair learns these same lessons. Demian pulls Sinclair away from mainstream religion early in the story, saying that the division of good and evil has no real meaning. Later, Pistorius tries to teach Sinclair about myriad past religions, but Sinclair rejects him, feeling that he should try to come up with something original instead. Throughout the story, Sinclair engages in different mentor-pupil relationships (like his relationships with Demian and Pistorius) but eventually he shrugs those off, taking his friends’ wisdom with him and facing the world alone. That is what everyone must do, eventually? face the world alone. And alone is exactly how we feel, as we stumble through this circus of a world. Sinclair spends most of his time not just feeling but also being by himself, adrift. When he leaves his family and his sisters, it does not affect him much, if at all, he is so isolated. He connects only with a precious few people, and never for very long. He somehow distances himself from his peers. Even when he was partying and drinking a lot, he found a way to separate himself from them. In that case, it was the role of sex in his life. Demian is a story about one man’s journey. The reader never really learns the story of any other character, not even Demian himself, who remains something of an enigma to the very end. This puts the story in an existentialist mindset. Sinclair is drifting through a swirling, gray mass of humanity. Alone is also how we must act. Jean-Paul Sartre says, â€Å"It is only in our decisions that we are important,† and, â€Å"We must act out passions before we can feel it. † This pretty closely mirrors the sentiment presented when Pistorius says, â€Å"[Y]ou can’t consider prohibited anything that the soul desires† (Hesse, 116). It is only when we make our own decisions and act for ourselves that what we do has meaning. Hesse puts the existentialist framework to work for him by using it to highlight the need for independence and spiritual self-reliance. Dostoyevsky, on the other hand, uses the mindset to facilitate Raskolnikov’s downward mental spiral, highlight his aloofness, and pull the story along. The world of St. Petersburg is, without a doubt, a strange and hostile place for Raskolnikov. He stumbles along and things constantly happen around him. He repeatedly wakes up with people in his room. He sees things in the street, such as the drunken rape victim early in the story, or a prone Marmeladov, that cause him to lose his cool. More and more, he finds himself doing crazy things without regard for logic or even common sense. People in this world confound him. He has no idea what they are up to, and he is constantly paranoid that people are plotting against him. His guilty, delirious inner world combines with the crazy, chaotic outer world to make Raskolnikov into a raging, feverish, maniac. He is not just any raging, feverish, maniac, though. He is an aloof raging, feverish, maniac. He considers himself better than those around him, and his superior mentality drives his antisocial behavior. His antisocial behavior, in turn, gives the character and story a feeling of being alone. Not only is the world crazy, but also Raskolnikov is separated from it and everyone in it, at least until the very end of the book. He is isolated, so much so that at times he can â€Å"feel it clearly with every fiber of his being that he could never again address these people† (Dostoyevsky, 122). Finally, Dostoyevsky uses this chaotic world to drive his story along. Things are constantly happening by coincidence, and Dostoyevsky moves the plot forwards at a dizzying pace, forcing Raskolnikov to act. It is fantastic that Raskolnikov should happen upon Marmeladov soon after he is injured, and that Raskolnikov should overhear people discussing the very same murder that is on his mind, and that someone should eavesdrop on him and hear his confession. The frenzied plot makes it much easier for both Raskolnikov and the reader to slip into a mania, which is surely Dostoyevsky’s aim. The philosophy of existentialism, too, plays a part in Crime and Punishment. Sartre says that the only true goal of our lives is that which we set for ourselves. Raskolnikov, through the main portion of the story, has no clear goal. He wavers between wanting to turn himself in and trying to avoid suspicion. Sartre says, â€Å"Man can will nothing unless he has first understood that [he has] no other aim than the one he sets himself,† and it is clear that Raskolnikov’s will is pretty much useless. He can effect no real change in either himself or in his surroundings until he finally picks a goal and follows through with it. His personal development is completely halted during his entire spell of indecision. Only in the epilogue do we see him begin to change, begin to forsake his philosophy of the superman, find happiness, and fall in love. The philosophy of existentialism was around long before anyone gave a name to it, as is evidenced by Dostoyevsky’s St. Petersburg, the perfect example of an existentialist world. Both Dostoyevsky and Hesse use existentialist ideas help them express their points. Andrew Holbrook, 2006.

Top Guide of Personal Essay Samples 4th Grade

Top Guide of Personal Essay Samples 4th Grade The Ideal Strategy for Personal Essay Samples 4th Grade Whether you're aiming for a university admission or landing work at a prominent revenue statement for company, an effective personal letter provides you with a better shot in comparison to others. The aim of your sociology personal statement is to receive into the graduate school of your pick. Focus on what motivates you to work in the area of public wellbeing and the impact you wish to make in public wellness. As a way to apply to graduate school in the area of Sociology, you've got to compose a personal statement. Personal Essay Samples 4th Grade for Dummies You have just one first sentence to acquire the reader interested in YOU. It's helpful to find different folks to read your statement and offer feedback. When you haven't written one before, you should start with reading our tips about how to compose a personal statement. The personal statement isn't supposed to be a creative piece, but instead a clear, concise, professional essay indicating your interest in entering the area of dentistry and providing solid info to hold up your acceptance. Your own personal statement is restricted to only 4,000 characters to convince a university to accept your application. Keeping your own personal statement concise is particularly important on account of the limited character count. The sociology personal statement writing is not quite as easy as you might believe. With this kind of a huge name behind them, Essay Edge has lots of credibility. You'll observe a similar structure in lots of the essays. Let EssayEdge help you compose an application essay which gets noticed. These seven sample essays respond to a wide variety of thought-provoking questions. EssayEdge is the major application essay editing service on the planet. What you wish to emphasize in 1 position isn't necessarily what you wish to highlight in another. Bear in mind that a high degree of detailing is a feature of all superior narrative essay examples. Include a succinct summary of your career history. Bridget's essay is extremely strong, but there continue to be a couple little things that could be made better. A wonderful exercise to conduct before you start to collect your admission essay is to begin with a sample. Like a college essay, your private revenue statement ought to have a layout. In fact, it's difficult. The Secret to Personal Essay Samples 4th Grade There's, naturally, a limit on the variety of pages even our very best writers can produce with a pressing deadline, but generally, we figure out how to satisfy all the clients seeking urgent assistance. When you're sifting through the huge quantity of sample you'll have access to, be confident that you're looking for samples that will pertain to you and your own personal circumstance. Any numbers you are able to give to demonstrate your success could be crucial even when you're moving into a region where your expertise might seem slightly different. You should have your reasons, and our principal concern is that y ou wind up getting a great grade. While everyone needs to be different, personal statement examples can help you brainstorm ideas and provide you with somewhere to begin. Attempt to discover a topic which hasn't been examined well, or at least provokes a great deal of questions today. You should do something to set yourself apart, and the personal statement is among the few areas you experience a chance to do that. The principal relevance of a Personal Statement is to produce known your ambitions, thoughts, passions and other skills which aren't available on your resume that will cause you to stick out from the crowd. Personal statement writers feel that it could possibly be great for you while crafting your own statement. It will do just fine. Begin your private statement with a brief expert summary about yourself. Before you start, the very first thing you ought to see is that the personal statement has become the most significant part your admissions package. A personal statement provides the selection committee more info about you that isn't captured in different documents. It is not a confessional booth. A high-quality personal statement is a critical part of your UCAS application.

Definition and Examples of Decorum in Rhetoric

In classical rhetoric, decorum is the use of a style that is appropriate to a subject, situation, speaker, and audience. According to Ciceros discussion of decorum in De Oratore (see below), the grand and important theme should be treated in a dignified and noble style, the humble or trivial theme in a less exalted manner. Examples and Observations Decorum is not simply found everywhere; it is the quality whereby speech and thought, wisdom and performance, art and morality, assertion and deference, and many other elements of action intersect. The concept underwrites Ciceros alignment of the plain, middle, and elevated oratorical styles with the three main functions of informing, pleasing, and motivating an audience, which in turn extends rhetorical theory across a wide range of human affairs.  (Robert Hariman, Decorum. Encyclopedia of Rhetoric. Oxford University Press, 2001) Aristotle on Aptness of Language Your language will be appropriate if it expresses emotion and character, and if it corresponds to its subject. Correspondence to subject means that we must neither speak casually about weighty matters, nor solemnly about trivial ones; nor must we add ornamental epithets to commonplace nouns, or the effect will be comic... To express emotion, you will employ the language of anger in speaking of outrage; the language of disgust and discreet reluctance to utter a word when speaking of impiety or foulness; the language of exultation for a tale of glory, and that of humiliation for a tale of pity and so on in all other cases.This aptness of language is one thing that makes people believe in the truth of your story: their minds draw the false conclusion that you are to be trusted from the fact that others behave as you do when things are as you describe them; and therefore they take your story to be true, whether it is so or not.(Aristotle, Rhetoric) Cicero on Decorum For the same style and the same thoughts must not be used in portraying every condition in life, or every rank, position, or age, and in fact a similar distinction must be made in respect to place, time, and audience. The universal rule, in oratory as in life, is to consider propriety. This depends on the subject under discussion and the character of both the speaker and the audience...This, indeed, is the form of wisdom that the orator must especially employ--to adapt himself to occasions and persons. In my opinion, one must not speak in the same style at all times, nor before all people, nor against all opponents, not in defence of all clients, not in partnership with all advocates. He, therefore, will be eloquent who can adapt his speech to fit all conceivable circumstances.(Cicero, De Oratore) Augustinian Decorum In opposition to Cicero, whose ideal was to discuss commonplace matters simply, lofty subjects impressively, and topics ranging between in a tempered style, Saint Augustine defends the manner of the Christian gospels, which sometimes treat the smallest or most trivial matters in an urgent, demanding high style. Erich Auerbach [in Mimesis, 1946] sees in Augustines emphasis the invention of a new kind of decorum opposed to that of the classical theorists, one oriented by its lofty rhetorical purpose rather than its low or common subject matter. It is only the aim of the Christian speaker--to teach, admonish, lament--that can tell him what sort of style to employ. According to Auerbach, this admission of the most humble aspects of daily life into the precincts of Christian moral instruction has a momentous effect on literary style, generating what we now call realism.  (David Mikics, A New Handbook of Literary Terms. Yale University Press, 2007) Decorum in Elizabethan Prose From Quintilian and his English exponents (plus, it must not be forgotten, their inheritance of normal speech patterns) the Elizabethans at the end of the [16th] century learned one of their major prose styles. [Thomas] Wilson had preached the Renaissance doctrine of ​decorum: the prose must fit the subject and the level at which it is written. Words and sentence pattern must be apt and agreeable. These may vary from the condensed native maxim like Enough is as good as a feast (he recommends Heywoods proverbs which had recently appeared in print) to the elaborate or exonerated sentences adorned with all the colours of rhetoric. Exoneration opened the way--and Wilson provided full examples--for new sentence structures with egall members (the balanced antithetical sentence), gradation and progression (the paratactic cumulation of short main clauses leading to a climax), contrarietie (antithesis of opposites, as in To his friend he is churlish, to his foe he is gentle), the serie s of sentences with like endings or with repetition (like opening words), plus the verbal metaphors, the longer similitudes, and the whole gallery of tropes, schemes, and figures of speech of the last few decades of the 16th century.  (Ian A. Gordon, The Movement of English Prose. Indiana University Press, 1966)