Monday, December 30, 2019

Alcoholism Is A Serious Matter - 864 Words

Many times, people young and old, will abuse the use of alcohol. It is known that when a person begins drinking alcohol at an early age, they will later develop health issues, and possibly face the risk of becoming an alcoholic. Alcoholism is a chronic disease, where a person has problems controlling the amount they are drinking. An alcoholic does not have to be someone who drinks too much, they may feel a strong urge to drink, they may become tolerant of the amount they are drinking, sometimes drinking it just like water. They also can become physical with someone and then not remember the conversation or what they did to the person the next day. Alcoholism is a serious matter, many do not fully understand what it can do to lives, and may believe that it is not an issue. This essay will explore the risk factors of alcoholism, effects of the prolonged use of alcohol, and how an alcoholic can get help. Risk factors of alcoholism are mainly because of the steady drinking over a certain period of time. Alcoholics become alcoholics when they are drinking too much on a daily basis, or binge drinking on a regular basis, and this leads to a dependence on alcohol. As mentioned before, for people who begin drinking at a younger age, they will have a higher risk of becoming dependent on alcohol. Also, it is important to notice if alcoholism runs in family history, because many times the risk is greater for people whose close relatives have an alcohol problem. Not only does alcoholShow MoreRelatedAlcoholism and Alcohol Abuse1082 Words   |  5 Pages(Chakraburtty). Alcoholism and alcohol abuse is not only damaging emotionally, physically, and mentally to the person who is doing it, but to the people around them as well. Both alcoholism and alcohol abuse are each categorized as different cases. Alcohol abuse is different from alcoholism because people who are just alcohol abusers still have the ability to stop when they need, or to have the common sense to know when they have had too much. Alcohol abuse is still a very serious case though; peopleRead MoreEssay on Dangers of Alcoholism810 Words   |  4 PagesAlcoholism Alcoholism is a very serious disease, which can cause illness, death, injuries, schooling problems, family breakups, and crime. It is a proven fact the alcohol kills more people than any other illegal drugs combined. However, alcohol courses freely through American society, from college bars to corporate lunches. In a recent journal article by The Scientist, it is stated, Technology shows alcohol abuse changes brains molecular programming and circuitry? (Scientist). ThusRead MoreAlcoholism : A Complex Disorder961 Words   |  4 PagesAlcoholism is a very complex disorder. It is believed that genetics and several other biological factors are likely involved in the materialization of alcohol dependence, along with cognitive behavior, temperament, psychological and sociocultural factors. Alcohol use patterns including alcohol abuse and alcohol dependence are â€Å"familial† in nature (cf. Heath et al., Kendlerm Heath, heath Neale, Kessler Eaves, 1992; Hesselbrock, 19 95) Alcohol abuse is a drinking pattern that results In significantRead More alcohol Essay examples805 Words   |  4 Pages Alcoholism, chronic and usually progressive illness involving the excessive inappropriate ingestion of ethyl alcohol, whether in the form of familiar alcoholic beverages or as a constituent of other substances. Alcoholism is thought to arise from a combination of a wide range of physiological, psychological, social, and genetic factors. It is characterized by an emotional and often physical dependence on alcohol, and it frequently leads to brain damage or early death. Some 10 percent of the adultRead MoreAlcoholism : Is Alcoholism A Disease?929 Words   |  4 PagesAlcoholism has raised many debates over the truth of its nature. Many scholars argue that alcoholism can be treated as a disease. Such approach to defining alcoholism means denying that alcohol abusers own a choice. In consequence, the treatment related differs and may or may not actually help alc oholics recover. A wrong diagnostic of this addiction can lead to serious health issues; therefore, it is vital to answer the following question: Is alcoholism a disease? Most experts in this field criticisesRead MoreEffects Of Alcohol On The Alcoholic Beverage1335 Words   |  6 Pageseffects of alcoholism. â€Å"Alcoholism is currently listed as the third leading cause of death in our society† (dlcas). However, because many deaths related to alcohol go unreported, some believe that alcoholism could be the number one killer in today’s world (dlcas). For example, when a person dies from the failure of an organ, the role that alcohol could have played in that failure is not taken into consideration. It is no doubt that alcohol certainly has the potential to cause serious physical harmRead MoreCauses Of Alcoholism And Alcohol Dependence885 Words   |  4 Pages Causes of Alcoholism Introduction Alcoholism or alcohol dependence is one of the most prevalent problems found among teens and adults alike. But, what exactly is alcoholism? Alcoholism is a chronic disorder marked by excessive and usually compulsive drinking of alcohol leading to [mental] and physical dependence or addiction (Merriam-Webster). However, it is still unclear to scientists as to what particularly forms this addiction. Yet, all research has led to three very distinct componentsRead MoreThe Health Care Issue And Health Problem1632 Words   |  7 Pageslegislator why it is a problem needing legislative attention. The health care issue or health issues that raise a concern is that many people are suffering from alcoholism and are in need of immediate care but cannot afford the proper care. I firmly believe that free outpatient counseling can help those individuals diagnosed with alcoholism be able to steer in a sober direction. Alcohol use across the globe is prevalent and is very harmful to the human population. According to World Health OrganizationRead MoreThe Problem Of Addiction And Addiction1387 Words   |  6 Pagesphysical addiction causes the body to adapt to the certain type of addiction, known as the tolerance of a person capability. The emotion side of an addiction is known as the addictive behavior. Experts say, â€Å"The focus of the addiction isn’t what matters; it’s the need to take action under kinds of stress† and to treat this kind of addiction it requires psychological understanding (Addiction). De Graaf, Wann, and Naylor believe,† It’s a bubbling cauldron of such traits as an anxiety, lonelinessRead MoreSubstance Abuse and Addiciton: A Very Brief History Essay example1651 Words   |  7 Pagesdrunkenness is not. Alcohol use was widely accepted since the time of first settlements. Due to Protestant reformers they discovered that drunkenness was viewed as a serious problem, often punished by putting a man in stocks for such an offense. Clearly the blame was on the sinner, not the alcohol itself. The view of alcohol as a cause of serious problems began in America soon after the American Revolution. Some people even to this day view alcohol as the devil of the demon. The first psychoactive substance

Sunday, December 22, 2019

The Rhetorical Analysis Of Aung San Suu Kyi - 885 Words

Aung San Suu Kyi is a visionary that fights for Burma, her country, believing that people should fight for democracy and freedom through non-violent movements. She had a clear knowledge of her government and the government that she wanted for her people. As Aung Dan Suu said, it is not power that corrupts but fear. Fear of losing power corrupts those who wield it and fear of the scourge of power corrupts those who are subject to it (page 682). In order to bring this matter to the reader’s attention, Aung San Suu employs several rhetorical strategies. She uses the three main rhetorical devices: ethos, pathos, and logos to provide expert opinions on the subject. Through the text â€Å"Freedom from fear†, she made her ideas clear and define for†¦show more content†¦Aung San Suu demonstrates ethos in her speech by contrasting her father with the pacifism of Gandhi by stating: â€Å"The words used by Jawaharlal Nehru to describe Mahatma Gandhi could be applied to A ung San.† (page684). She uses that allusion to show her admiration for Gandhi, whom she identifies as â€Å"Abhaya†, the absence of fear from the mind. Aung San Suu strongly supports his immense contribution to human rights, peace, and non-violent resistance to fight oppression. She uses Gandhi as an example to persuade the reader that, just like him, she is worthy of trust and respect. She wants to show them that she has the same beliefs, same ideology as Gandhi, whom with his moral and methods brought down imperialism, colonialism and dictatorships. Kyi even continues to say that â€Å"there is an inevitable sameness† when she compares Gandhi to her father. A lot of attention focused on her because she is the daughter of once an influential man, so she knows that if she talks about him they would have no problem as to follow her. When it comes to her thoughts about Burma’s governments, Kyi shows a good amount of planning and knowledge when talking about economic growth. She states that: â€Å"Public dissatisfaction with economic hardships has been seen as the chief cause of the movement in Burma, sparked off by the student demonstrations of 1988.† (page682).Show MoreRelatedOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 Pageslamentable. Taken together, the key themes and processes that have been selected as the focus for each of the eight essays provide a way to conceptualize the twentieth century as a coherent unit for teaching, as well as for written narrative and analysis. Though they do not exhaust the crucial strands of historical development that tie the century together—one could add, for example, nationalism and decolonization—they cover in depth the defining phenomena of that epoch, which, as the essays demonstrate

Saturday, December 14, 2019

The enchantress Returns Free Essays

Brave Chris Colfer’s novel The Land of Stories: The Enchantress Returns tells the story of two 12-year-old twins, Alex and Connor Bailey, who went on an adventure to save their mother, and perhaps the world, against the will of their grandmother. The Enchantress, the witch who tried to kill Sleeping Beauty, attempted to take over The Land of Stories and the Otherworld (the land where the common people live). I admired Alex for her bravery and intelligence which she showed when she was trying o save her mother and the Fairy-Tale World. We will write a custom essay sample on The enchantress Returns or any similar topic only for you Order Now Initially, I saw Alex as very foolish and immature to run away from home, but my understanding grew when I realized that from Alex’s perspective, family is the most important of all. When Alex first appeared in the story, I thought, â€Å"Really, what can a child do in a crisis? † It turns out that children can really make a difference upon further reading. We first saw that Alex was rather frustrated when her grandmother kept them hostage from going after their mom, who had been kidnapped. So, she pried information from their ‘hostage holder’ and showed incredible bravery when she ran away from home and â€Å"hijacked Mother Goose’s giant goose† ( ), which she used to fly to her grandmother’s cottage. She also showed her bravery when she was captured by Trollbella (half troll, half goblin) in the Land of Stories. She showed bravery in this situation when she â€Å"kicked the troblin in the rump† (Line ). In the ending, Alex had the audacity to go up against the Enchantress and defeated her by using her bravery. In summary, I came to see that by using her bravery and intelligence, Alex was really strong and she immensely cared about family in order to do what she did. Having to face the Enchantress, who killed many, being alone, was quite frightening. However, she pushed through and won in the end. Sometimes, we care about our families more than ourselves, and we all need that extra push to do the right thing. Alex was brave enough to sacrifice much, which in this case, was her safety, in order to save her mother. How to cite The enchantress Returns, Papers

Friday, December 6, 2019

Planning in Dementia and Palliative Care †Free Samples to Students

Question: Discuss about the Planning in Dementia and Palliative Care. Answer: Introduction: This assignment is focused on the case study representing the condition of 46 years old man named Anthony Vella who had been suffering with stage 4 of pancreatic cancer which had been diagnosed six months back after he was presented to emergency department with acute abdominal pain. Anthony had been wedded to Luisa for 20 years; and the couple are blessed with two children, both aged 16 and 19 respectively. The rest of this assignment emphasizes on the procedure of defining and curating an advanced care plan (ACP) that is generally implemented in such cases, like that of James Smith. As per the design of this assignment, the first course of action is centered on discussing how a conversation session with the patient and the respective family members about crafting an ACP can be introduced and implemented. For any strategy to be successfully implemented it is extremely important to design the strategy carefully, however the very next step that is extremely necessary is the preparation that goes behind the implementation procedure. Hence, in this case as well, the strategizing step was followed by explaining the preparation required for that discussion process. The following section after the preparation procedure discusses the members that should participate in the said ACP discussion, followed swiftly by an elucidation of the necessary informational data needed in devising such a plan. Now, ACP can be defined as the document that has the potential to change over the lifespan of a particular individual, the next requirement is periodic reviewing and amending the ACP; the next section discusses the time limit after which the ACP must be reviewed and amended. The final section of this assignment discusses the activation period of the ACP program as well. Finally, the conclusion of the essay briefly concludes the primary points presented in the entire assignment. The importance form of the impetus for the development of the ACP derives from the fact that one out of four people dies in the United States that effectively occurs in the nursing homes and also 70% cases are been encountered in the hospitals. However, little has been observed in the early 1990s, that the statistics have reported that as many as the residents of the nursing home care have been receiving the end of the care of the life that was not in the compliance to the previous patients that have expressed the wishes in the advanced form of directives. In the part that are due to these form of issues, the Institute for Healthcare Improvements that are been producing the set of the principles that have been defining the responsibility of the health care professionals providing care that are holding the ACP form of discussions with the patients. There are five principles, that are represented in Figure 1, offer a framework for designing effective inter- conversation with patients (Adams, Kabcenel, Little, Sokol-Hessner, 2015). As opined by Adams et al. (2015) in his article, the key strategy instructs the health care professionals to be engaged with the patients and their families so that they can easily determine what care components in the most necessary to them. The model associated with this process instructs the health care providers to be connected with the families of the patients more compassionately and finally connects it with the patients in a specific way that are culturally and also individually been respectful. Various studies have observed that the home residents with respect to the discussions of the ACP have been found out that too often the discussions also takes place at the time of the admissions that if it occurs at all. In a particular form of situation, there needs to be systematic form of the reviews that are needed to be formed for the four specific studies of the ACP that have focused on the residents of the nursing home and they were found admitting, the healthcare staff often realized that the patients that were incapable for having for having the discussion at the time of their admission. However, it has to be understood that when dementia occurs the cognitive functioning power of the brain is more likely to be compromised, having the ACP conversation prior rather than later had always been a vital issue to ascertain enhanced quality of life. In the case represented in the assignment of James Smith, these principles or ideologies would initially mean discovering circumstances to connect with Mr. Smith along with his family regarding his EOL care needs. As the cancer care team designated to him had indicated two weeks prior that no additional treatment, except end of life care, would be efficient, the complete newest time for this conversation should actually be at that time. However, the survival rate of stage IV pancreatic cancer is only a window of five years time (ACS) (American Cancer Society, 2016). As per the condition that the patient under consideration is in the life expectancy for the patient is not more than five years, hence the ACP talk preferably been held immediately after diagnosis, in case that Mr. Smith had not arranged an ACP or AD in advance. The early ACP discussion just after the cancer diagnosis will increase the likelihood of the patient engaging in design and implementation of a patient centered ACP (Der Schmitten, Lex, Mellert, Rothrmel, Wegscheider Marckmann, 2014; Houben, Spruit, Groenen, Wouters Janssen, 2014). Additionally, it also needs to be considered that the AD documents that are completed after a successful ACP discussion are extremely beneficial for the traetmentv plan to follow, studies suggest that thes4e documents not provides relevant data regarding the severity of the patient as compared to the data collected without a valid ACP discussion with the patient (Der Schmitten et al., 2014; Garrido, Idler, Leventhal Carr, 2012). Another fact can be considerd completing both the documentation, AD along with ACP, considerably enhances the possibility of patient preferences being valued and complied along with being tended so that that care that complies with the preferred care requirements is provided (Brin kman-Stoppelenburg, Rietjens van der Heide, 2014; Houben, Spruit, Groenen, Wouters, Janssen, 2014). Preparation for the Advanced Care Discussion Adams et al. (2015) opined an imperative assortment of different steps that can be implemented by a healthcare providing organization to arrange and carry out ACP discussions with patients along with their family members. Although, the steps are not completely characterized still, utilizing the five different principles represented in the Figure 1 the IHI that characterizes main steps in planning to carry out these discussions. As per the findings of Adams et al. (2015), the initial phase of organization is to employ the connect population to care planning procedure so that they can interpret the number of patients that have already been selected a healthcare proxy, the number that have successfully documented their what matters issues, and of those without either or both of those documents, how many of them were asked to contemplate those issues. The stewardship part of the entire preparation cycle comprises of documenting the data from healthcare proxy and what matters concerns wit hin the records of the patients (Adams et al., 2015). The concept of exemplify principles indicate at exploring the exact figure of the health care workforce that have on their own discussed about ACP with their own families, and recorded their ACP and the what matters wishes along with having a advanced healthcare proxy that is recorded (Adams et al., 2015). The majorly difficult aspect of the entire preparation procedure is crafting a strategy that can employ the spiritual, philosophical, and cultural beliefs of patients even if those beliefs are potentially quite dissimilar from healthcare staff (Adams et al., 2015). In case of Mr. Smith, there had been no data provided that discusses his spiritual or cultural setting, neither were any recorded documentation about his what matters wishes; the patient even lacked a legal healthcare proxy to take clinical decisions in behalf of him in times he was incapable of response. The ACP conversation can engage a varied amount of several healthcare givers. However, it must necessarily include the patient his family members. With respect to Mr. Smith, the ACP discussion procedure should also have included one or more individuals belonging to the cancer care team he was assigned, it is not mandatory for the oncologist to be included, but someone skilled to carry out ACP discussions (Adams et al., 2015). In case the ACP discussion have not been carried out as an element of the cancer treatment plan he was designated, as suggested by the ACS, the primary instance he had been taken to the health care facility, a specialist must have had ACP conversation with Mr. Smith and the members of his family (American Cancer Society, 2016). Given that he had been pursued by the emergency department it can be interpreted that the patient had been in a critical condition, hence, it can be concluded that having the ACP discussion with the patient much earlier would have been fa r better. Now in case none of the above healthcare professionals discussed ACP with the patient, it would be extremely necessary for initiating the discussion by the primary physician. The main difference between the ACP document and a DNR (Do Not Resuscitate) is that the information provided by ACP documents is much more inclusive than the latter. The recommendations of the IHI indicate that an ACP must initiate with recording the answer given by the patient to What matters to you? (Adams et al., 2015). The questions belonging to this genre reveal the aspects of life that are most central to the patient and put in largely to the quality of their life. Furthermore, the ACP is also known to typically include a living will that describes the types of treatment procedures the patient wishes to undergo, along with providing a strong power of attorney which nominates some other individual to take the medical decisions on behalf of the patient in times when he or she is not capable of making those decisions on his own, and documents choices for organ and tissue donation, durable healthcare power of attorney, and religion documentation, cultural, or interpersonal for proc edures like dialysis or cardiopulmonary resuscitation (CPR) (National Institute on Aging, 2016). McMahan, Knight, Fried, and Sudore (2013) researched the factors that the patient families and the patients themselves felt were most important in preparing an ACP. The suggestions from the particular study incorporated typical AD forms, but at the same time identifying and documenting the factors that were deemed as most crucial, ensuring the care proxy designated for the patient (the person particular in the durable power of attorney) understood their role in clarity, determining whether flexibility should be allowed to the surrogates in decisiveness or adhere strictly to preferences that the patient has previously expressed which helped in the family member or friends knowing the patients wishes (McMahan et al., 2013). A chief aspect in this context is to ensure ACP being safely documented in a manner that can be effortlessly understood, for the patients that are not very fluent with English or those who do not understand legal terminologies; the ACP documents ensures that everyone associated with the patient and the treatment procedure selected for him is equally involved, from family and friends of the patient to healthcare providers, everyone is clear about wants and needs of the patient. Robinson et al. (2013) distinguished that healthcare providers frequently discover ACP plans are very critical to incorporate into a clinical setting due to the concerns of complicatedness in making the legal documentation comprehensible, concerns with ambiguity in the legal background of the different documents, and concerns with differences between patient preferences eventually (Robinson et al., 2013). For Mr. Vella, his ACP comprises of a strong power for the attorney for allowing his wife and the other members of the family for making the decisions of this healthcare when he was very much incapable for doing so. Moreover, it should the core responsibility of his wife to give his proxy, should have been aware of all her responsibilities, and should know about Mr.Vellas have expressed their form of needs in the care plan. Since he had not been responding when he was admitted to the health care facility in the last event, he was also incapable to make healthcare decisions on his own regarding his conditions. Furthermore, a DNR would have potentially avoided extreme measures required otherwise to revive him, and organ and tissue donation forms serve as the means to permit his needs related to those issues are respected. According to the recent studies, the perception of the cancer patients regarding the ACP is a very dynamic one, the cancer patients often find is to be a potent device rather than being a permanent decision that is made only at one time. Michael et al. (2013) discussed the nature of response that the cancer patients have shown to ACPs over the course of their diseases. The patients who are suffering from cancer has been often found out that the ACP is a very dynamic form of the instruments rather than the fixed form of decisions that are been fixed form of decisions over the course of the disease. American patients with the incurable form of the pancreatic cancer like Mr. Velle, it has been observed in their medical reports shows only about fifteen percent of the times. Moreover, the DNR orders have also shown that the cancer patients are overpoweringly signed after the day that the patients died, either by the patients or by the proxies belonging to the healthcare systems. In one of the study by the Australian cancer patients, discovered that the extent of awareness in the public and utilization of different components of ACP (like living will, DNR orders, and more) varied extensively amongst different participants, along with the fact ACPs were tremendously changeable to cancer patients, that were unusually sought to judge various aspects of ACPs during various phases in their disease procedure. The most evocative declaration that the participants made had been that the ACP was an iterative process (Michael et al., 2013, p. 2198). With respect to the case represented by Mr. Vella, the ACP discussions it ought to be at a minimal form of level that are needed to be addressed at the time of the initial form of the diagnosis of the cancer, if it is not done before. As every stage of the protocol of his treatment was concluding, the plan has never been revisited for ensuring that Mr. Vellas desires were also with accordance to the alignment with the plan. This form of literative form of process ensures that Mr. Vella wishes were documented and updated with accordance to his physiological health and his process of the disease have also altered. The commencement procedure of ACP program is actually established on the specific situation of the patient. It has been observed that in cases when the ACP is designed and characterized by Michael et al. (2013), the commencement of the ACP plan that may take place for the over the longer period or the from time to time. For instances, to have a proxy refers to the fact that when the patient becomes incompetent and looses the capacity of making the healthcare decisions, they designated form of the proxy becomes ultimate for the patients. A circumstance where a patient is incapacitated for a short period of time which can lead to an ACP being initiated in advance until the patient can make clinical decisions on their own. Adams et al. (2015) in his article has suggested that if the entire healthcare industry propagates towards achieving the five conversation-ready principles, which are considered to be fitting stewards of the patient wishes, ACPs in most cases can be efficient and depe ndable for all kinds of patients. For Mr. Vella, the ACP was supposed to be performed at the time he was initially taken to the emergency department and had been unable to communicate his desires or preferences regarding his healthcare. Conclusion The above paper addresses the issue for the advancing care planning for the patients in the context of Mr. Anthony Vella, the cancer patient suffering with the Stage 4 of pancreatic cancer. The situation that Mr. Vella had been in highlighted the significance of preparing for the carrying out the conversation about the ACP much earlier than the disease left the patient had not been responding. The instrumental structure of elements of ACP that incorporated a living will, ADs concerning patient desires for activities to be carried out on him, choices for organ and tissue donation, durable healthcare power of attorney, and religion documentation, cultural, or interpersonal for procedures like dialysis. The ACP plans here are nothing but appropriate iterative procedures instead of being a one-time permanent set of main decisions, along with that are accurately performed earlier in the course of diagnosis and treatment, the moment a potentially severe or grave condition is diagnosed and during disease progression. Commencement of the ACP happens each time the patients situation requires major measures being contemplated. References Adams, K. M, Kabcenel, A., Little, K. Sokol-Hessner, L. (2015). Conversation ready: A framework for improving end-of-life care. IHI White Paper, Cambridge, MA: Institute for Healthcare Improvement. Available from: https://ihi.org American Cancer Society (ACS).(2016). Pancreatic survival rates, by stage.American Cancer Society.Available from https://www.cancer.org Brinkman-Stoppelenburg, A., Rietjens, J. A. C. van der Heide, A. (2014). The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine, 2014, 26 pp. DOI: 10.1177/0269216314526272 Der Schmitten, J. I., Lex, K., Mellert, C., Rothrmel, S., Wegscheider, K., Marckmann, G. (2014).Implementing an advance care planning program in German nursing home: Results of an inter-regionally controlled intervention trial.Deutschesrzteblatt International, 111(4), 50-57. DOI: 10.3238/arztebl.2014.0050 Garrido, M. M., Idler, E. L., Leventhal, H. Carr, D. (2013). Pathways from religion to advance care planning: Beliefs about control over length of life and end-of-life values. The Gerontologist, 53(5), 801-816. DOI: 10.1093/geront/gns128 Hartle, G. A., Thimons, D. G., Angelelli, J. (2014). Physician orders for life sustaining treatment in U.S. nursing homes: A case study of CRNP engagement in the care planning process. Nursing Research Practice, 2014, 7 pp. DOI: 10.1155/2014/761784 Houben, C. H. M., Spruit, M. A., Groenen, M. T. J., Wouters, E. F. M., Janssen, D. J.A. (2014). Efficacy of advance care planning: A systematic review and meta-analysis. JAMDA: The Journal of Post-Acute and Long-Term Care Medicine, 15(7), 477-489. DOI: 10.1016/j.jamda.2014.01.008 McMahan, R., Knight, S., Fried, T. R. Sudore, R. L. (2013). Advance care planning beyond advance directives: Perspectives from patients and surrogates. Journal of Pain and Symptom Management, 46(3), 355-365. DOI: 10.1016/j.jpainsymman.2012.09.006 Michael, N., OCallaghan, C., Clayton, J., Pollard, A., Stepanov, N., Spruyt, O., Michael, M., Ball, D. (2013). Understanding how cancer patients actualise, relinquih, and reject advance care planning: Implications for practice. Support Care Cancer, 21, 2195-2205. DOI: 10.1007/s00520-013-1779-6 Murray, S. A. McLoughlin.(2012). Illness trajectories and palliative care. In L. Sallnow, S. Kumar A. Kellehear, International Perspectives on Public Health and Palliative Care, pp. 30-51. London: Routledge National Institute on Aging (2016). Advance care planning. National Institute on Aging.Available from: https://www.nia.nih.gov Nicholas, L. H., Bynum, J. P. W., Weir, D. R., Iwashyna, T. J., Langa, K. M. (2014). Advance directives and nursing home stays associated with less aggressive end-of-life care for severe dementia patients. Health Affairs (Project Hope), 33(4), 667674. DOI: 10.1377/hlthaff.2013.1258 Robinson, L., Dickinson, C., Bamford, C., Clark, A., Hughes, J. Exley, C. (2013). A qualitative study: Professionals experiences of advance care planning in dementia and palliative care, a good idea in theory but Palliative Medicine, 27(5), 401-408. DOI: 10.1177/0269216312465651 Robinson, L., Dickinson, C., Rousseau, N., Beyer, F., Clark, A., Hughes, J., Howel, D. Exley, C. (2012).A systematic review of the effectiveness of advanced care planning interventions for people with cognitive impairment and dementia.Age and Ageing, 41(2), 263-269. DOI: 10.1093/ageing/afr148 Sawatzky, R., Porterfield, P., Lee, J., Dixon, D., Lounsbury, K., Pesut, B., Roberts, D., Tayler, C., Voth, J. Stajduhar, K. (2016). Conceptual foundations of a palliative approach: A knowledge synthesis. BMC Palliative Care, 15(5), 14 pp. DOI: 10.1186/s12904-016-0076-9 Van der Steen, J. T., van Soest-Poortvliet, M. C., Hallie-Heierman, M., Onwuteaka-Philipsen, B. D., Deliens, L., de Boer, M. E., Van den Block, L., van Uden, N., Hertogh, C. M. P. M. de Vet, H. C. W. (2014). Factors associated with initiation of advanced care planning in dementia: A systematic review. Journal of Alzheimers Disease, 40(2014), 743-757. DOI: 10.3233/JAD-131967 Vandervoort, A., Houttekier, D., Stichele, R. V., van der Steen, J. T. van den Block, L. (2014). Quality of dying in nursing home residents dying with dementia: Does advanced care planning matter? A nationwide postmortem study.PLOS/one, 9(3), e91130.DOI: 10.1371/journal.pone.0091130