Mobile/Tablet Devices Bringing Gaming To Everyone

Question: Discuss about theMobile/Tablet Devices Bringing Gaming To Everyone. Answer: How Are Mobile/Tablet Devices Bringing Gaming to Everyone A mobile device is an electronic device that has a small form factor, at least one wireless interface for network access, local and non-removable storage, (Wi-Fi, cellular or other), and applications (Souppaya and Scarfone, 2013). Sales of mobile devices like smartphones, tablets, and feature phones all over the world are steadily increasing (Statista, n.d.). All of the modern devices are capable of running software in the form of applications. A video game is an electronic game for the entertainment of people. In the present-day, video games are available on many platforms and range in complexity from a simple Snake game to the visually lifelike graphics, like the bouncy ponytail of the protagonist in game Tomb Raider (Stuart, 2015). Video games' platforms have been growing from consoles, personal computers to mobile devices. Consoles are specialised and usually expensive. Personal computers are generic machines capable of running any software built for the operating system the computer is running, but the computers still require a financial investment. Mobile devices, on the other hand, are general, portable, represent a relatively minor financial investment and have surpassed the usage of computers around 2014 (Chaffey, 2016). This paper looks into how the mobile devices are bringing gaming to everyone. Background The background of this research topic is video games and the players. Traditionally consoles and handheld gaming devices were the means to play video games. Then, games were developed for personal computers also. In fact, games today are released across platforms i.e. for computer, Sony PlayStation and Microsoft Xbox (Lengyel, 2000). Then mobile devices began to take hold in people's lives, and most of us might remember the classic Snake game on Nokia mobiles. With the present-day smartphones and tablets (Android from Google, iOS from Apple, and others) the software and hardware capabilities of the devices are comparable to personal computers of yesteryears, and this allows for immersive games as well. However, the comparison is not only of the base platform but also the accessibility and portability of mobile devices. We carry a mobile phone everywhere but not a gaming console. A mobile device changes the landscape of gaming for the developers as well as the players. Some industry experts argue that mobile gaming will kill console/computer gaming, while others claim that they will co-exist and mutually fuel each other's growth. After all, once a gamer, always a gamer (Science on NBC News, 2009). Additionally, mobile devices are becoming more pervasive in our lives with the advent of wearable technology like smart watches (Charara, 2016). Such technology allows for even more venues for gaming and capturing traditionally inaccessible customer demographics (Tassi, 2016). It must be noted that mobile games and the traditional (console/computer) games are complementary and do not bite into one another. Passionate gamers are more than likely to be playing on consoles as well as mobile devices, and both industries are growing (Kharpal, 2016). Also, the two venues for playing games -mobile and console/computers cannot compete with the experience they provide. As an illustration, consoles and computers give visually arresting games like Fallout 4 while its mobile version is a simple game Fallout Shelter (Tassi, 2016). Mobile devices are helping to bring gaming to everyone by enabling people who would never invest their time and money in consoles or games on computers. A mobile device, coupled with the overflowing abundance of video games allows for people to play and enjoy video games at their convenience (Scimeca, 2015). Mobile devices are also helping to bring gaming to everyone by providing a convenient and accessible venue for playing to children. The kids are moving away from the family computer and beginning to spend their leisure time as well as more of their money on mobile video games and in-app purchases (Whitney, 2015). Another trend that may be helping in creating more dedicated gamers is the movement of mobile games to computers or consoles, and vice-versa. Present-day mobile devices together with their application marketplaces (also called app stores) are helping bring gaming to everyone by making it easier to find, download and play the games. Also, the shorter time investment required to gain gratification seems to adjust well to the schedules of busy people, and this helps to expand the reach of gaming, thus bringing it to more and more people (Scimeca, 2015) like toddlers, the housewives, the elderly (Tassi, 2016). Newer, smaller and more accessible technologies like wearable technologies are providing a more new venue for gaming on opening the gaming world for more people (Falstein, 2014). This availability of such devices will allow gaming to included in more day-to-day tasks (Keating, 2015). References Chaffey, D. (2016). Mobile marketing statistics 2016. [online] Smart Insights. Available at: https://www.smartinsights.com/mobile-marketing/mobile-marketing-analytics/mobile-marketing-statistics/ [Accessed 27 Jan. 2017]. Statista. (n.d.). Global mobile phone sales by vendor 2010-2015 | Statistic. [online] Available at: https://www.statista.com/statistics/263355/global-mobile-device-sales-by-vendor-since-1st-quarter-2008/ [Accessed 27 Jan. 2017]. Charara, S. (2016). Gamer's wrist: The best smartwatch games for Apple Watch and more. [online] Wareable. Available at: https://www.wareable.com/smartwatches/best-smartwatch-games [Accessed 27 Jan. 2017]. Falstein, N. (2014). Looking to the Future (Presented by Google). [online] GDC Vault. Available at: https://www.gdcvault.com/play/1020679/Looking-to-the-Future-(Presented [Accessed 27 Jan. 2017]. Statista. (n.d.). Global mobile phone sales by vendor 2010-2015 | Statistic. [online] Available at: https://www.statista.com/statistics/263355/global-mobile-device-sales-by-vendor-since-1st-quarter-2008/ [Accessed 27 Jan. 2017]. Keating, L. (2015). Gaming On-The-Go: The Future Of Mobile Gaming vs. Consoles. [online] Tech Times. Available at: https://www.techtimes.com/articles/57048/20150604/gaming-go-future-mobile-vs-consoles.htm [Accessed 27 Jan. 2017]. Kent, S. (2001). The ultimate history of video games. 1st ed. New York: Three Rivers Press. Kharpal, A. (2016). Mobile game revenues to overtake console, PC for first time. [online] CNBC. Available at: https://www.cnbc.com/2016/04/22/mobile-game-revenue-to-pass-console-pc-for-first-time.html [Accessed 27 Jan. 2017]. Lengyel, E. (2000). Simultaneous Cross-Platform Game Development. [online] Gamasutra.com. Available at: https://www.gamasutra.com/view/feature/131830/simultaneous_crossplatform_game_.php [Accessed 27 Jan. 2017]. Science on NBC News. (2009). Once a gamer, always a gamer, experts say. [online] Available at: https://www.nbcnews.com/id/32243863/ns/technology_and_science-science/t/once-gamer-always-gamer-experts-say/ [Accessed 27 Jan. 2017]. Scimeca, D. (2015). The unstoppable rise of mobile gaming. [online] The Kernel. Available at: https://kernelmag.dailydot.com/issue-sections/headline-story/11996/rise-of-mobile-gaming/ [Accessed 27 Jan. 2017]. Souppaya, M. and Scarfone, K. (2013). Guidelines for Managing the Security of Mobile Devices in the Enterprise. [online] Available at: https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-124r1.pdf [Accessed 27 Jan. 2017]. Stuart, K. (2015). Photorealism - the future of video game visuals. [online] The Guardian. Available at: https://www.theguardian.com/technology/2015/feb/12/future-of-video-gaming-visuals-nvidia-rendering [Accessed 27 Jan. 2017]. Tassi, P. (2016). Why Haven't Video Game Consoles Died Yet?. [online] Forbes.com. Available at: https://www.forbes.com/sites/insertcoin/2016/01/31/why-havent-video-game-consoles-died-yet/ [Accessed 27 Jan. 2017]. Whitney, L. (2015). Kids pick mobile devices over PCs, consoles for gaming. [online] CNET. Available at: https://www.cnet.com/news/kids-now-pick-mobile-devices-over-pcs-consoles-for-gaming-npd-group/ [Accessed 27 Jan. 2017].

Migration Management & Mobility Pathways-Free-Samples for Students

Questions: 1.Explain in your own words what sections of the INZ Operational Instructions apply to Harpreets health assessment for a residency visa and why? 2.Will Harpreet meet the acceptable standard of health? Explain in your own words, why or why not? 3.What submissions would you make to support his Case identify any further information you might need to make these submissions? Answers: 1.According to the fact of the case, Harpeet has diagnosed with cancer and he applied for Student visa. The cost of his health care treatment will be in excess of NZ$11,000 per year. Now according to the A4.10 the acceptable standard of health provide the section for the residence visa. Under this section, the visa applicant can apply for the residence class visa. For the acceptable standard of health residential, visa applicable for a medical waiver. For the decline of the visa under the residence class visa, it may decline any person if it was not assessed. It also granted under the section A4.60 for an acceptable standard of health and a medical waiver[1]. The applicants who apply for the residence visa must provide proper information of the health diseases. It applicable for the health disease, which affects danger to public health or it may completely imposed for significant costs for a health residence services or special education services[2]. The applicant can considered under an acceptable standard of health for granting the visa for a medical waiver according to undertake the work[3]. The medical conditions, which will be applicable in this matters for the major diseases like HIV infection, Hepatitis B added with antigen positive along with abnormal liver function Hepatitis C, RNA positive, solid organ transplants Chronic renal failure or progressive renal disorders Cardiac disease Genetic or congenital disorders severe autoimmune disease Malignancies of solid organs and hematopoietic tissue Under the above medical list, the hearing loss or profound bilateral sensori-neural hearing loss, vision impairment with visual acuity and physical disability are also included. Therefore, it is necessary to meet with the requirement of the residence class visa for the applicant[4]. If the significant cost does not meet with New Zealand's health services requirement then the applicant will never get the access of the resident visa. The applicant must have the ability to pay the cost of the health services, pharmaceuticals, or residential cares, which are, required which he and someone other than the applicant[5]. 2.The medical issues are one of the important parts in the visa application for the applicant. If any delay occurs in the visa processing, then it may cancel the visa processing in a competent way. In the immigration process for the acceptable standard of health residence class visa, the applicant must follow some rules, which are essential in New Zealand. Under the terms of the visa process, it is necessary to operate the immigration process with essential two tiers which has operated by the Immigration New Zealand where individually any person can able to apply for the acceptable standard of health in a residence application[6]. It is necessary to apply under a medical condition where a medical waiver is also required in the application. The application will not acceptable if applicant is suffered under some dangerous diseases, which are: HIV infection, Hepatitis B added with antigen positive along with abnormal liver function Hepatitis C, RNA positive, solid organ transplants Chronic renal failure or progressive renal disorders Cardiac disease Genetic or congenital disorders severe autoimmune disease Nurologcal diseases which includes poorly controlled epilepsy, Cerebrovascular disease, Cerebral palsy, Poliomyelitis, progressive multiple sclerosis Malignancies of solid organs and hematopoietic tissue[7] Chronic respiratory disease Severe developmental disorders like brain injury, intellectual disability, physical disability, and Autistic spectrum disorders[8] Therefore, the medical conditions must be relevant with the health disorders of the applicant[9]. According to the case facts Harpeet has applied for Student visa ad later he found about his cancer. The cost of the treatment will be in excess of NZ$11,000 per year and his brother wants to provide the medical support to him. Now according to the health requirement for the immigration service Harpeet already cover all required area[10]. He was already applied for student visa and now suffering from a diseases. Therefore the according to the above requirement his diseases not matching with the list. The disease, which he is suffering, not creates any danger to the public. Therefore, he can apply for the residential visa in New Zealand[11]. 3.According to the act of the case Harpeet is required pay the treatment amount of NZ$11,000 per year which written by the doctor. Therefore, in the significant of the cost, he is bound to pay the medical costs in New Zealand. Now his brother will pay the amount for the medical emergency[12]. The issue about the medical costs has solved. The second issue is one of the important part in this case, which is health condition of the visa applicant[13]. The visa applicant is suffering from cancer and he need to prove that his health condition is not creating any risk for the country. The application of the visa is might not granted if the diseases are found according to the below list. The diseases are: HIV infection, Hepatitis B added with antigen positive along with abnormal liver function Hepatitis C, RNA positive, solid organ transplants Chronic renal failure or progressive renal disorders Cardiac disease Genetic or congenital disorders severe autoimmune disease Nurologcal diseases which includes poorly controlled epilepsy, Cerebrovascular disease, Cerebral palsy, Poliomyelitis, progressive multiple sclerosis Malignancies of solid organs and hematopoietic tissue Chronic respiratory disease Severe developmental disorders like brain injury, intellectual disability, physical disability, and Autistic spectrum disorders[14] Therefore, according to the facts of the case cancer is not creating any danger for the country[15]. The medical cost of him will paid by his brother according to the terms of the significant cost of New Zealand. Therefore, no issues have found in this case where Harpeet is not able to get the Acceptable Standard of Health for the residence visa. He is completely applicable for the visa according to the A4.10 the acceptable standard of health[16]. References "A4.10 Acceptable Standard Of Health (Applicants For Residence) (30/07/2012)." Immigration.Govt.Nz, 2017, https://www.immigration.govt.nz/opsmanual/44855.htm. "Operational Manual - Immigration New Zealand. Issue Date: 31 August 2017." Immigration.Govt.Nz, 2017, https://www.immigration.govt.nz/opsmanual/. "V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation." Immigration.Govt.Nz, 2017, https://www.immigration.govt.nz/opsmanual/43656.htm. Friesen, Wardlow. "Migration management and mobility pathways for Filipino migrants to New Zealand." Asia Pacific Viewpoint (2017). Joseph, Mary Geena Chakiamury. "From students to permanent residents: The role of social networks in the immigration transition of Indians in New Zealand." Asian and Pacific Migration Journal 25.2 (2016): 168-190. Spinks, Harriet, and Michael Klapdor. New Zealanders in Australia: a quick guide. Parliamentary Library, 2014. Wickramage, Kolitha, and Davide Mosca. "Can migration health assessments become a mechanism for global public health good?." International journal of environmental research and public health 11.10 (2014): 9954-9963. "A4.10 Acceptable Standard Of Health (Applicants For Residence) (30/07/2012)"). "Operational Manual - Immigration New Zealand. Issue Date: 31 August 2017"). "V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation"). ("V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation"). "A4.10 Acceptable Standard Of Health (Applicants For Residence) (30/07/2012)"). "V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation"). "Operational Manual - Immigration New Zealand. Issue Date: 31 August 2017"). "V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation"). "A4.10 Acceptable Standard Of Health (Applicants For Residence) (30/07/2012)"). "Operational Manual - Immigration New Zealand. Issue Date: 31 August 2017"). "V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation"). "A4.10 Acceptable Standard Of Health (Applicants For Residence) (30/07/2012)"). "Operational Manual - Immigration New Zealand. Issue Date: 31 August 2017"). "Operational Manual - Immigration New Zealand. Issue Date: 31 August 2017"). "V3.40 Entry To New Zealand For The Purpose Of Medical Treatment Or Consultation"). "A4.10 Acceptable Standard Of Health (Applicants For Residence) (30/07/2012)").

Convergence Of Twain Essays - United States, Canada, United Kingdom

Convergence Of Twain Thomas Hardy experienced great difficulty believing in a forgiving, Christian God because of the pain and suffering he witnessed around him. He also endured some pain, with the loss of his wife and suffering during the five years he spent in London that made him ill. As a young man, Hardy wanted to become a clergyman. This vocation was quite a turn around of what he pursued--a career as a famous agnostic writer. He lost faith in his religious, Victorian upbringing. As such, he shared a belief with many modern poets in the futility and waste of human existence. Hardy did believe in a "supreme being" or as he liked to call him "The Immanent Will," but he did not think of Him as a forgiving God like other Christians. Instead, Hardy believed Him to be portrayed as a vengeful God, which we learn from his poem, "The Convergence of the Twain: (Lines on the loss of the 'Titanic')". Thomas Hardy wrote this poem with a very noticeable chronological disruption midway through the poem. Unlike most poets who keep their poems in chronological order to maintain suspense throughout the poem, Hardy believed that the subject of the Titanic was so well known that there was not any reason to keep the readers in suspense of what impending doom awaited the Titanic. Instead, he commenced his poem with a description of the Titanic at present: "grotesque, slimed, dumb, indifferent"(st III). Then he proceeds to the "fashioning"(st VI) of the famous ship and continues to that famous April evening where the "consummation"(st XI) of the two "titanic" masses occurred--the grand ship made from human hands and the silent iceberg made by the "Immanent Will"(st VI). Hardy does not confine himself inside the walls of set syllables per verse; every stanza has a different number of syllables in each verse. In the first part of his poem the rhythm is very alluring. With proper uses of caesuras, stresses and slacks, Hardy seems to capture the solitude of the sea that he is describing with his steady, gentle sway of words, a "rhythmic tidal lyre"(st II). While reading this poem, the words seem to move persistently slowly up and down like the tide: I In a solitude of the sea Deep from human vanity, And the Pride of life that planned her, stilly couches she. (lines 1-3) Hardy also numbers all of the eleven stanzas of his poem. The numbering indicates the separation of each one of the stanzas as if to imply that we have to look at this poem as eleven different poems in one. This method gives us a chance to understand the poem more efficiently by studying one stanza at a time. A first reading of the poem would reveal five stanzas describing the "gilded gear"(st V) at the bottom of the sea and six stanzas that refer to the ship and to the iceberg converging at a point so "far and dissociate"(st VII). However, an enjambment occurs between stanza VI and stanza VII, as if these two stanzas were meant to be one: "The Immanent Will that stirs and urges everything / Prepared a sinister mate"(lines 18/19). Ironically, these two stanzas describe both the creation of the ship and the creation of the iceberg that are destined to come together later in time. Hardy takes more of an antithetical approach toward the story of the Titanic than most people think of or 'chose' to think of when they hear of the tragedy. Most people want the story to be told through a tragic, yet romantic, point of view that relates the tragedy of the men, women, and children who were lost on that gruesome night. People relate emotionally to the story of the Titanic by watching the movie that was released in the past year because it is from the point of view of the people on the ship. We see a romantic mood portrayed be the people on the ship and the tragedy suffered in the loss of their loved ones. Consequently, Hardy does not want us to share in this travesty that they have experienced. Instead of a tragic poem of the people involved in this tragic event, Hardy distances himself from the picture, far enough just to see the two grand and noble objects, a Godlike view solely focused on the two gigantic entities. Through his poem, Hardy explains to us that it is a vengeful God that planned the collision. In the section of the poem that contrasts both

Free Essays on Role Of Society In Hedda Gabler

Hedda Gabler Society and social issues play an important role in the outcome of the novel, â€Å"Hedda Gabler.† The author, Ibsen, shows how these issues affect Hedda as the main character of the play and how she ends it all with suicide, the most powerful form of her self-destruction. Ibsen, in writing the play of Hedda Gabler, showed observations on society at the time period of that setting. The characters show the reader what life was like at that time. The character of Hedda, however, is one with a destructive nature as a result of the society that she lives in. Hedda wants to satisfy her desires for life but cannot because she is detained by society and its demands on the individual. Thus, she attempts to conform instead of criticize her society on morality, and so she is in a continuous life of boredom and it results in her destructive behavior. Also, In Act 4, when Hedda discovers that Ejlert met a horrible death, she is disgusted. So, she chooses to commit suicide, thinking that it is the solution to her problem of not being able to escape her dull life, because there is no way out of her boring life. There was some foreshadowing of this act at different parts throughout the play. For example, at the end of Act 1 Hedda plays with her pistols because she is bored, showing that she needs them to provide a temporary relief from her boring life. Hedda’s suicide gives light to many aspects of the play: it is not just her tragedy that she has committed suicide. It is the tragedy that she wanted Ejlert to have a beautiful suicide, hoping that life could be beautiful and be at the same time at a particular standard. Also, the main reason why Hedda committed suicide is not only because of society’s demands on her, but also because of Brack’s use of blackmail against her. He took advantage of her and used what he knew to get him in a position where Hedda feels trapped and is deceived by him. So, both Brack a... Free Essays on Role Of Society In Hedda Gabler Free Essays on Role Of Society In Hedda Gabler Hedda Gabler Society and social issues play an important role in the outcome of the novel, â€Å"Hedda Gabler.† The author, Ibsen, shows how these issues affect Hedda as the main character of the play and how she ends it all with suicide, the most powerful form of her self-destruction. Ibsen, in writing the play of Hedda Gabler, showed observations on society at the time period of that setting. The characters show the reader what life was like at that time. The character of Hedda, however, is one with a destructive nature as a result of the society that she lives in. Hedda wants to satisfy her desires for life but cannot because she is detained by society and its demands on the individual. Thus, she attempts to conform instead of criticize her society on morality, and so she is in a continuous life of boredom and it results in her destructive behavior. Also, In Act 4, when Hedda discovers that Ejlert met a horrible death, she is disgusted. So, she chooses to commit suicide, thinking that it is the solution to her problem of not being able to escape her dull life, because there is no way out of her boring life. There was some foreshadowing of this act at different parts throughout the play. For example, at the end of Act 1 Hedda plays with her pistols because she is bored, showing that she needs them to provide a temporary relief from her boring life. Hedda’s suicide gives light to many aspects of the play: it is not just her tragedy that she has committed suicide. It is the tragedy that she wanted Ejlert to have a beautiful suicide, hoping that life could be beautiful and be at the same time at a particular standard. Also, the main reason why Hedda committed suicide is not only because of society’s demands on her, but also because of Brack’s use of blackmail against her. He took advantage of her and used what he knew to get him in a position where Hedda feels trapped and is deceived by him. So, both Brack a...

The tension between global governance and the sovereignty of the Essay

The tension between global governance and the sovereignty of the nation-state in the context of immigration - Essay Example The manner with which they should be received and treated as well as whether they should be immediately deported or given refugee status in respect to their age has sparked considerable controversy in the US. When President Obama asked for Congress to approve of $3.7 Billion budget to fund the crisis which he claims very serious, most of them were skeptical (Michael and Jeremy). They are reluctant to fund the same administration that promised to seal the Mexican border which remains porous to date. The way Obama sees it, while a humanitarian crisis, which also touches on human rights and right of children escalates in the background, congress is busy playing politics. It is evident that the president is cognizance that there is a real crisis and the American government must take action since it is taking place in their country. This issue brings to the fore numerous moral and political issues, the most predominant ones being anchored on the apparent suffering of children who are often stuck in detention centers with many of them being deported (Hill 41). The fact that the system allows children to be sent back even if they may have no family to go back to or if they are escaping violence and hunger is in contravention of everything the American republic stands for. Ultimately, the United States government must take responsibility for these children both from a moral and social political point of view. In addition, the fact that children without the aid or adults can illegally entre the United States bespeaks the lack of vigilance in boarder patrol and in a way this indirectly aids their incursion. The UN must also take some of the responsibility since they are the custodians of the human rights including children rights and the children have clearly been denied theirs both at home and in the US where they face detention and sometimes deportation

Essay convincing students of the benefits of studying abroad - 1

Convincing students of the benefits of studying abroad - Essay Example Students get to interact with the locals on a daily basis and through this they learn and experience the culture of the host society. They learn new customs, traditions, foods, social conventions, beliefs, and values, experiencing the cultures in depth. With the new experience, students learn to appreciate their culture and the new culture. Interacting with new cultures make the students break cultural barriers they had before. Being in a foreign country, offers students the chance to visit tourist attractions such as museums, landmarks and natural wonders in the host country. Studying abroad provides an opportunity to learn a foreign language. Students often learn foreign languages in classrooms while in their countries and rarely get to practice it in real life settings. Learning abroad provides the environment to improve one’s language skills. As students interact with peers, they practice and perfect their skills regarding the foreign language (McKeown 42). Written language sometimes differs from the spoken language, being immersed in the culture, they have firsthand experience even learning slang, which is not taught in the classroom. Different countries have varied styles of education. The same concepts that students study may be expressed in a new style that is different from their country of origin. When student from different backgrounds study together, they discover new ways to study and research. Ideas they share are from diverse perspectives, influenced by varied experiences and cultures. Their discussions have a global perspective, avoiding bias influenced by one way of life. Global problems influenced by differences in cultures and religions are understood and addressed with informed sensitivity Students abroad find themselves alone, often for the first time, in a foreign country. They have new found freedom and responsibility. Studying

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.