Work for the Dole for Policy

Questions: 1. What is the problem? 2.What presuppositions or assumptions underlie the problem? 3.How has this representation of the problem come about? 4.What is left unproblematic in this problem representation? Where are the silences? 5.What effects are produced by this representation of the problem? 6.How and where has this representation of the problem been produced, disseminated and defended? Answers: 1. As way into the broad topic of the welfare, the youth and unemployment, our practical text is on the work for Dole legislation. Back in 1997 the then minister for schools, Vocational Education and training in the Howard-led coalition government David Kemp, introduced the legislative framework for the work For Dole initiative (Bacchi, 2009). There was introduction of the social security legislation Amendment that was later amended to social security Act. The work for the Dole is an Australian state organizations system, which type a workfare. The system was initially ratified in 1998, obtaining recently been trialed in 1997. This the work seekers could gratify on their common tasks prerequisites. The intent behind the amended of the social security Act was to eliminate on the provisions that hinders a person form being forced to work for the Dole. Next, to originate a maximum variety of hours of work with the dole per fortnight. Finally was to permit all the individuals to get a su pplementary ten dollars per week to be able to handle the additional cost .We can recall that the WPR approach begin at examining what is proposed as a change and the working backwards in order to see how that could constitutes to the problem. In this case, there is removal for the provisions, which prevent an individual from being required to work for the dole in other words the unemployment benefits. Therefore, the problem is constituted to be the ability to access on the benefits of unemployment without being required to work. Note, asking question one is a clarification exercise, thus the answer to this question should be straightforward. The bill that is stipulated which is eligible to the participants will be those that are aged between the ages of 18 to 24 who have been unemployed for the last six months and those that are not in the case management or an employment-training program. The scheme initially included the scope for the older participants. The different kind of the representations in regards to this policy may conflict or even contradict on each other. The aspect of identifying the problem of the unemployment benefit has been a challenging aspect. 2. An understanding of the social relations underpins WFTD. Individuals are to be encouraged to helping themselves and become independent. The labor of some form is thus considered a necessary and a valuable part of character development. The young Australians need to be able to make valuable contribution through a worthy while work experience. The result of this will be a higher self-esteem and a work ethic. Ideally, individuals have to be given real jobs and the performance of some of the kind of work commitment remains the focus and the goal. The conception of the people that is elaborated here is similar to the one in the western Christian society where the aspect of hard work is well entrenched. The references to the governments disciplined approach to the fiscal policy align within this framework, and it suggests that the welfare policy should fit provided the fiscal imperatives. The problem that was identified was the problem and the young and their problems, the WFTD targeted the specific age categories the young individuals that were aged between 18 to 24 years (Carson, Winefield, Waters, and Kerr, 2003). It is not unusual for the policies to be age related (BaCChi, 2010). The WPR draws upon the social constructionist premises; the youth needs to be considered a social contrasted category. There is no universal meaning for the youth but rather the content of the category is determined by aspect of social, cultural and the historical context (Nevile and Nevile, 2003). The youth unemployment has been constituted as a distinct kind of the problem because of the conviction that the character is formed in these years (Bacchi, 2009). It is argued that the young people need to work for them to acquire skills that are portrayed that an person need to improve on the human capital. Nonetheless, there are some presuppositions and assumptions an example in Australia a 16 year old can drive a vehicle but cannot appear in the family court in a case over residency an d cannot make their wishes be known except through an advocate an eighteen year can marry and stand for a political office (Lombardo, Meier and Verloo, 2009). Nonetheless, under the commonwealth government the youth allowance program the same 18 year old is considered to live at home dependent on the parents until age 20. This be seen as a form of the governmental rationality, which is regarded as the though behind the government. 3.There is need to think historically in regards to the concept of unemployment. According to Walters (2001), the issue of the unemployment was more understood as an issue of overpopulation or ascribed to the exogenous elements to the market system. The history needs to be supplemented with recognition that the commitment to the social rights has been hedged with the qualifications and with the critics (Borland and Tseng, 2004). For example, in Australia in 1945 the social security legislation contained a work test, which entailed that the unemployed individuals for them to receive benefits from the government they had to actively look for work. From the history, we can see that the work from the Dole has its own antecedents even through the period it was regarded heyday of the social governance in Australia. There were other dividing practices in work especially only the Aboriginal natives were excluded unless the department was satisfied with them, based on character, intelligence and standard that are qualities that are put in the questions by their formulations as the point of exception to the standard rule (Turnbull, 2013). 4. The problem of the unemployment of youth in Australia is the problem on the concept of work for the Dole policy (Dombos, Krizsn, Verloo and Zentai, 2009). The problem to examine the contribution of the rampant unemployment to the problem of what affects the youth on a daily basis. Nonetheless, the failure to examine on the inadequacies of provision of employment in the case of Aboriginal is a great concern to the government (Edwards, 2010). The argument here is that it is not simply that there is another way to think about the issues but rather on the specific policies, which are constrained by the way, in which the problem is represented. 5. Various effects are produced by the problem of work for the Dole program; one of the effect is that the program is that it does not increase the long-term availability of the jobs. It is only when an extra job become available that individuals who are employed can move into a sustainable employment (Bessant, 2000). Secondly, the program do not provide sufficient opportunity for the skill development to make a big difference to employment prospects for the unemployed. 6. The problem has been produced due to the poor legislative mechanism by the government. The policy has been disseminated from the legislation Act back from 1991 in order to offer people employment opportunities (Bacchi, 2009). The problem exhibited on this case is in regards to the youth and unemployment. The problem that is also exhibited on the employment of the Aboriginal individuals who at the time did not employ them until certain test is accomplished. References Bacchi, C., 2009. 2 The issue of intentionality in frame theory. The Discursive Politics of Gender Equality: Stretching, Bending and Policy-Making, p.19. BaCChi, C., 2010. Gender/ing impact assessment: Can it be made to work?. Welcome to the electronic edition of Mainstreaming Poli-tics. The book opens with the bookmark panel and you will see the contents page. Click on this anytime to return to the contents. You can also add your own bookmarks., p.17. Bessant, J., 2000. Civil conscription or reciprocal obligation: The ethics of'work-for-the-dole'. The Australian Journal of Social Issues, 35(1), p.15. Borland, J. and Tseng, Y.P., 2004. Does' Work for the Dole'work? Carson, E., Winefield, A.H., Waters, L. and Kerr, L., 2003. Work for the Dole: A Pathway to Self-esteem and Employment Commitment, or the Road to Frustration? Youth Studies Australia, 22(4), p.19. Dombos, T., Krizsn, A., Verloo, M. and Zentai, V., 2009, January. Critical frame analysis: A comparative methodology for the QUING Project. In ECPR First European Conference on Politics and Gender (pp. 21-23). Edwards, K., 2010. Social inclusion: Is this a way forward for young people, and should Lombardo, E., Meier, P. and Verloo, M. eds., 2009. The discursive politics of gender equality: stretching, bending and policy-making. Routledge. Nevile, A. and Nevile, J.W., 2003. Work for the dole: Obligation or opportunity. University of New South Wales. Turnbull, N., 2013. The questioning theory of policy practice: Outline of an integrated analytical framework. Critical Policy Studies, 7(2), pp.115-131.

Using a Sample Teacher Response Essay to Practice Your English

Using a Sample Teacher Response Essay to Practice Your EnglishA sample teacher response essay is a wonderful tool for providing evidence that your writing skills are on par with others who have used the same form in the past. Here, you will learn to incorporate an English writing sample into your own copy.One of the most common uses of a teacher response essay is to create a curriculum for new teachers. This is particularly effective if you are teaching a very advanced subject. Teachers often use this kind of example in preparation for preparing their own curriculum. This can help them become familiar with this style of writing and how it works.Perhaps you have recently taken on a new, more advanced subject like Biology or Chemistry. Your grammar may be lacking, and you are desperate to improve it. Perhaps you just want to impress your students with your writing skills, so you will be able to impress future employers. Maybe you want to give yourself an extra edge in your job search.A n English composition, written by a student in this genre, is a great way to boost your confidence. When you finish your assignment, your writing will appear much more professional. You will be able to confidently read from the same paper and answer the same type of questions. Many students will see you as someone who knows how to write effectively, and you will put your homework up for evaluation.In addition, you will be able to practice your English language skills, as well as learn from the examples that are provided with your assignments. This is great for retaining and learning good English grammar and vocabulary. In fact, English is the second most common language in the world, so you can see how much importance English has, especially if you have a chance to speak with people from different countries. You will gain an enormous advantage if you begin learning to speak the language as soon as possible.A sample teacher response essay is most effective when it is used in conjunct ion with a written exam. The essay can be adapted to fit a particular course, and the exam can be adapted to fit your skills. It is important to remember that students cannot always be honest about their writing ability, so this is an excellent alternative to test taking. When your work is proofread, you will know for sure what you are working with. The same is true when you use a sample response essay.If you are English-native, this can be an excellent way to brush up on your skills. You might be surprised at the things you learn about grammar and sentence structure. However, if you have a difficult time reading and writing English, it is still possible to prepare for your own exams with a teacher response essay.Make sure that your teacher response essay is easy to read and easy to write. Try to keep it clean and not too technical.

Psychology of lying free essay sample

In order for an individual to detect that a person is telling a lie, the person needs to understand the psychology of lying to know the reason behind the act. In fact, having knowledge on the psychology of lying can help you become more observant to the different signs of lying, as well as the mentality that comes with it. This is useful in order to avoid being put in a sense of doubt or under emotional stress when you are confronted with it. The psychology of lying can be a complicated concept because people lie for a different reasons, While some people lie in an attempt to avoid punishment or to avoid hurting someone else’s feelings, others lie out of impulse or because they want to present themselves as someone they are not. Lies are common. People studying the psychology of lying will soon find that telling lies does not automatically indicate any type of mental disorder. We will write a custom essay sample on Psychology of lying or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Even if there is an instance where a person tells a lie without first considering the reasoning behind it or the consequences resulting from the lie this is not considered a symptom of psychopathology. It would only be considered a symptom if the person does this often and it has negative effects on his or her life. Lying is not simple as telling the truth versus falsifying it. It is deeper than that, it is not always about distortion or nor disclosure of facts, it may well be about creating a whole new set of truths that only the liar knows of. It appears some lie for no reason at all while many lie with great reasoning, some lie for a cause, and many build a cause to lie. It is not always about the flip side of truth, sometimes, a lie stands on its own two feet: 1upon deep explanation, you will find that lying is a complex act, a complicated aspects of ones personality. 2it is more than a habit, almost a natural human trait. You can run from the truth You can hide from the truth You can deny the truth But, you cannot destroy the truth†¦ Sometimes knowing the truth may hurt even more, yet still, in the longer run, a lie causes more damage than truth. Chapter Two REVIEW THE LITERATURE Self-esteem is one of the biggest culprits in our lying ways. â€Å"We find that as soon as people feel that their self-esteem is threaten, they immediately begin to lie at higher levels.† Many lies are simply for the purpose of maintaining social contacts by avoiding insults or discords. Small lies that avoid conflict are probably the most common sort of lie†¦ and avoiding conflict is a top motivator for deception. The farther one’s true self is from their ideal self, the more likely they are to lie to boost themselves up, in others eye or their eyes†¦ or perhaps how they perceive others to perceive them. That is hard train of thought to follow, but lying is a complex phenomenon.—Robert Feldman (psychologist) A person’s first instinct is to serve his or her own self-interest. People are more likely to lie when they can justify such lies to themselves. When under time pressure, having to make decision that could yield financial reword would make people more likely to lie and when people are not under time pressure, they are unlikely to lie there is no opportunity to rationalize their behavior. – Shaul Shalvi (psychological scientists, university of Amsterdam) Ori Eldar and Yoella Bereby-Meyer (university of the Negev Investigated)[TITLE: what factors influence dishonest behavior] To lie is to state something that one knows to be false or that one has not reasonably ascertained to be true with the intention that it be taken for the truth by oneself or someone else, then a lie is a lie big or small but since lie usually has consequences, people always want to differentiate between some of them. What the people (or court system) are actually trying to do is to weigh the effects of a lie by a liar on its victims the conceptions and outcomes of lying can be many but when a person finally make a choice to speak, write or present something knowingly to be false, that single piece there is a lie unless the liar is insane or incapable to understand what she or he is doing. – Stephanie Ericcson [TITLE: The way we lie] â€Å"Trustworthiness is a highly esteemed commodity, when one has it, one is considered valuable. When one has lost it, one may be considered worthless.† A lie is a false statement to a person or group made by another person who knows it is not the whole truth, intentionally. Lying is when a person doesn’t tell the truth. There are many reasons a person may tell a lie. Usually people lie to get themselves out of trouble. Some people actually have a disorder that makes them lie without realizing they are doing so. it is one of the most common wrong acts that we carry out. It’s an avoidable part of human nature so its worth spending time thinking about it. Most of people would say that lying is always wrong, except when there’s a good reason for it—which means that it’s not always wrong. Lying is giving some information while believing it to be untrue, intending to deceive by doing so. People have reasons for not telling the truth. Whether its to not hurt someones feelings, or to not let a parent find something out, or to even make lifes harsh reality more bearable. There are dozens of reasons that someone out there thinks is a reason to not tell the truth. Even as I write this, I still wonder. Are the people that justify their reasons for not telling the truth actually hurting themselves? The oddest thing happens if you are constantly not telling the truth. Somewhere in there, you start to forget what truth is. If someone is constantly lying to everyone around them, how in the world can they go on telling the truth to themselves. Usually people dont even know that they are doing it. After awhile, the alter reality takes over and you wont be able to tell the difference between a lie and the truth. So, in essence, you could say that one of the realities of not telling the truth is that you lose yourself, literally, but you may not even notice it. You would think that this phenomena would be something that would take a lot of big choiceslarge decisions to arrive at a point where you didnt recognize the truth. Actually, its the opposite. It takes just one tiny step at a time to lose yourself somewhere in non-truths. —unknown( What Kinds of Reasons Are There for Not Telling the Truth?Is it Okay Not to Tell the Truth? )

Understand the Philosophical Theories of Nominalism and Realism

Understand the Philosophical Theories of Nominalism and Realism Nominalism and realism are the two most distinguished positions in western metaphysics dealing with the fundamental structure of reality. According to realists, all entities can be grouped into two categories: particulars and universals. Nominalists instead argue that there are only particulars.   How Do Realists Understand Reality? Realists postulate the existence of two kinds of entities, particulars, and universals. Particulars resemble each other because they share universals; for example, each particular dog has four legs, can bark, and has a tail.  Universals can also resemble each other by sharing other universals; for example, wisdom and generosity resemble each other in that they are both virtues.  Plato and Aristotle were among the most famous realists. The intuitive plausibility of realism is evident. Realism allows us to take seriously the subject-predicate structure of discourse through which we represent the world. When we say that Socrates is wise it is because there are both Socrates (the particular) and wisdom (the universal) and the particular exemplifies the universal. Realism also can explain the use we often make of abstract reference. Sometimes qualities are subjects of our discourse, as when we  say that wisdom is a virtue or that red is a color. The realist can interpret these discourses as asserting that there is a universal (wisdom; red) that exemplifies another universal (virtue; color). How Do Nominalists Understand Reality? Nominalists offer a radical definition of reality: there are no universals, only particulars. The basic idea is that the world is made exclusively from particulars and the universals are of our own making. They stem from our representational system (the way we think about the world) or from our language (the way we speak of the world). Because of this, nominalism is clearly tied in a close manner also to epistemology  (the study of what distinguishes justified belief from opinion). If there are only particulars, then there is no virtue, apples, or genders. There are, instead, human conventions that tend to group objects or ideas into categories. Virtue exists only because we say it does: not because there is a universal abstraction of virtue. Apples only exist as a particular type of fruit because we as humans have categorized a group of particular fruits in a particular way. Maleness and femaleness, as well, exist only in human thought and language. The most distinguished nominalists include Medieval philosophers William of Ockham (1288-1348) and John Buridan (1300-1358) as well as contemporary philosopher Willard van Orman Quine. Problems for Nominalism and Realism The debate between supporters of those two opposed camps spurred some of the most puzzling problems in metaphysics, such as the puzzle of the ship of Theseus, the puzzle of the 1001 cats, and the so-called problem of exemplification (that is, the problem of how particulars and universals can be related to each other).   Its puzzles like these which render the debate regarding the fundamental categories of metaphysics so challenging and fascinating.

A background briefing memorandum for an upcoming hearing on the Assignment

A background briefing memorandum for an upcoming hearing on the proposed Safe Chemicals Act, - Assignment Example The Congress passed the (TSCA) Toxic Substances Control Act in 1976 to accredit the Environmental Protection Agency (EPA) to regiment chemicals that were potentially arbitrary risks to the environment and health of human beings. Whether or not the TSCA submits the EPA with sufficient tools to protect human health and the environment against exposure to chemical pollution is questionable. Using common sense principles and current science, the Safer Chemicals, Healthy Families coalition is working with Congress to repair our broken chemical system so that chemicals are proven safe before being added to our schools, places of work and even our homes. The 1976 (TSCA) is outdated and ineffective at protecting the public from chemicals. The chemicals may be of good use, but they are also counterproductive essentially because they have been linked to learning disabilities, reproductive problems, asthma, cancer and other serious diseases. Signaling our clear intention to protect families from toxic chemicals associated with serious health problems, Senators Frank Lautenberg, Amy Klobuchar, Charles Schumer , and I, with the support of others presented Senate Bill S.847, the "Safe Chemicals Act" to upgrade America’s out of date system for managing chemical safety. The E.U., like the U.S. has laws governing the use and production of chemicals. I will begin by looking into activities surrounding (REACH) Registration, Evaluation and Authorization of Chemicals and the (TSCA) Toxic Substances Control Act. In the recent past, the E.U has amended its policies for chemical control through legislation known as (REACH) Registration, Evaluation and Authorization of Chemicals in order to improve the identification and mitigation of risks from chemicals. The comparison of the TSCA and the recently enacted REACH approaches has the following results: Both legislations, TSCA and REACH, have accouterments to guard information rendered by chemical

The role of leadership in organisational change Essay

The role of leadership in organisational change - Essay Example This tendency is caused by companies’ desire to be successful and earn money hand over fist. Let us refer to appropriate sources in order to define the role of leadership in organizational change. Elving in conducted research (2005, pp. 129-138) claims that organizational change requires changes in communication. This study suggests that communication in organization creates a community and serves as an informative methodology. The researcher presents six propositions of communication factors which influence changes rejection. Nevertheless the author underlines that informative role of communication can positively influence readiness for changes in organization while it develops organizational commitment and give certainty to employees. Bovey (2001, pp. 534-548) explores resistance to organizational change. The author interestingly emphasizes that resistance to change is rooted not in individual, but in organization itself. He offers 5 mechanisms to resist organizational changes. Thus in case of following suggested mechanisms such as humor, anticipation etc employees and managers will easily adapt to newly introduced changes. Caldwell’s research (2003, pp. 285-293) explores change leaders as transformed managers. The author claims that change leaders are on the top of the company and they work out strategy of change and change managers translate their strategies into actions. We can correlate this study with the work by Smith C. (2002, pp. 448-460) on leading change which intrigues us with its correlation with Jungian interpretations of the book of Job. The story of Job from the Bible is considered to be the basis of current organizational life. The image of Job is a predecessor of modern leader. Transformation of Job in modern manager and change leaders as transformed managers has many traits in common. Modern world is anxious and modern leaders should have skills to react to all evoking

Nursing And Diabetes Essay Example for Free

Nursing And Diabetes Essay Patients with diabetes need to understand what diabetes is. Patients who understand what diabetes is and the complicated process associated with the disease are more likely to comply with the prescribed regimen. Diabetes Mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate (Davis, 2001). Diabetes is a chronic progressive disease that requires lifestyle changes, especially in the areas of nutrition and physical activity. The overall goal of medical and nutritional therapy is to assist persons with diabetes in making self-directed behavioral changes that will improve their overall health (Franz, 2012). Blood glucose monitoring and goals of blood glucose monitoring Testing blood glucose levels pre-meal and post-meal can help the patient with diabetes make better food choices, based on how their bodies are responding to specific foods. Patients should be taught specific directions for obtaining an adequate blood sample and what to do with the numbers that they receive. Research has found that patients who have had education on the use of their meters and how to interpret the data are more likely to perform self-blood glucose monitoring on a regular basis (Franz, 2012). There are many different glucose monitors available for patients. The patient needs to have a device that is easy for them to use and convenient. A patient’s visual acuity and dexterity skills should be assessed prior to selecting a blood glucose monitoring device. A device is usually selected to meet the patient’s needs in collaboration with a diabetic educator at a health care facility. The patient needs to be reminded to record the blood glucose values on a log sheet with the date and time and any associated signs and symptoms that he/she is experiencing at the time the specimen was obtained. This log should be shared with his/her primary care practitioner. A discussion of glycosylated hemoglobin (HbA1c) should include the reasons for doing the test, how it is performed and how the health care practitioner will interpret the data. These laboratory tests are ordered on a routine basis along with other laboratory tests that are being monitored for the patient. A simple method to describe the HbA1c is to tell the patient that the test measures the amount of sugar that attaches to the protein in the red blood cell. The test shows the average blood sugar during the last three months. The higher the blood sugar the higher the HbA1c. The high blood sugar over a long period of time causes damage to the large and small blood vessels therefore increasing the risk of complications from diabetes. Medications and Insulin The patient with diabetes needs to be reminded that the addition of medications to help manage his/her diabetes is not because they are failing at diet management. Many patients with diabetes become depressed or despondent when they have to begin taking oral hyperglycemic medications and/or insulin. The teaching session should include a review of the different types of oral diabetic agents. A review of the different types of insulins and how to mix insulins should also be discussed. Teach the patient about self-administration of insulin or oral agents as prescribed, and the importance of taking medications exactly as prescribed, in the appropriate dose (Davis, 2001). Patients should be provided with a list of signs and symptoms of hypoglycemia and hyperglycemia and actions to take in each situation. Complications from Diabetes The teaching regarding the complications encountered from diabetes should stress the effect of blood glucose control on long-term health (McGovern, 2002). The patient should be taught how to manage their diabetes when he/she has a minor illness, such as a cold, flu or gastrointestinal virus. The patient should also be taught how to watch for diabetic effects on the cardiovascular system, such as cerebrovascular incidents/stroke, coronary artery disease, and peripheral vascular disease. Patients should be taught how to be alert for signs of urinary tract, respiratory tract infections and signs of renal disease. Assessment for signs of diabetic neuropathy should also be included in the teaching plan. Diabetes is the leading cause of death by disease in the United States, it also is a contributing factor in about 50% of myocardial infarctions and about 75% of strokes as well as renal failure and peripheral vascular disease. Diabetes is also the leading cause of new blindness (McGovern, 2002). Patients with diabetes should also receive education on the importance of smoking cessation, cholesterol and lipid management, blood pressure monitoring and management and management of other disease processes. Skin and Foot Care Teach the patient to care for his feet by washing them daily, drying them carefully particularly between the toes, and inspecting for corns, calluses, redness, swelling, bruises, blisters, and breaks in the skin. The patient should be encouraged to report any changes to his/her health care provider as soon as possible. Advise the patient to wear non-constricting shoes and to avoid walking barefoot. The patient may use over-the-counter athlete’s foot remedies to cure foot fungal infections and should be encouraged to call their health care provider if the athlete’s foot doesn’t improve (McGovern, 2002). The patient should be reminded that he/she needs to treat all injuries, cuts and blisters particularly on the legs or feet carefully. Patients should be aware that foot problems are a common problem for patients with diabetes. Informing them of what to look for is an important teaching concern. The signs and symptoms of foot problems to emphasize are: feet that are cold, blue or black in color, feet that are warm and red in color, foot swelling, foot pain when resting or with activity, weak pulses in the feet, not feeling pain although there is a cut or sore on the foot, shiny smooth skin on the feet and lower legs Exercise and Diabetes A moderate weight loss of ten to twenty pounds has been known to improve hyperglycemia, dyslipidemia, and hypertension. The target goal for body weight for patients with diabetes is based on a reasonable or healthy body weight. â€Å"Reasonable body weight is the weight an individual and health care professional acknowledge as achievable and maintainable, both short-term and long-term (Franz, 2012, p.8).† More emphasis is now placed on waist circumference, rather than on actual weight. A waist circumference greater than 40 inches in men and greater than 35 inches in women indicates a risk for metabolic disease. This is now part of what is referred to as metabolic syndrome. Reducing abdominal fat improves insulin sensitivity as well as lipid profiles. The benefits from exercise result from regular, long term, and aerobic exercise. Exercise used to increase muscle strength is an important means of preserving and increasing muscular strength and endurance and is useful in helping to prevent falls and increase mobility among the elderly (Franz, 2012). Regular exercise can improve the functioning of the cardiovascular system, improve strength and flexibility, improve lipid levels, improve glycemic control, help decrease weight, and improve quality of life and self-esteem. Exercise increases the cellular glucose uptake by increasing the number of cell receptors. The following points should be considered in educating patients regarding beginning an exercise program. Exercise program must be individualized and built up slowly. Insulin is more rapidly absorbed when injected into a limb that is exercised, therefore can result in hypoglycemia (Ferri, 1999). Patients need to be informed that exercise of a high intensity can also cause blood glucose levels to be higher after exercise than before, even though blood glucose levels are in the normal range before beginning exercise. This hyperglycemia can also extend into the post-exercise state and is mediated by the counter-regulatory hormones (Franz, 2012, p. 62). The exercise program should include a five to ten minute warm-up and cool-down session. The warm-up increases core body temperature and prevents muscle injury and the cool-down session prevents blood pooling in the extremities and facilitates removal of metabolic by-products. Research studies show there are similar cardiorespiratory benefits that occur when activity is done in shorter sessions, (approximately 10 minutes) accumulated throughout the day than in activity sessions of prolonged sessions (greater than 30 minutes) (Franz, 2012). This is an important factor to emphasize with patients who don’t think they have the time and energy for exercise. Diet and Diabetes The American Diabetes Association (ADA) has established nutritional guidelines for patients with diabetes. Their focus is on achieving optimal metabolic outcomes related to glycemia, lipid profiles, and blood pressure levels. Patients with diabetes need to maintain a healthy diet consisting of multiple servings of fruits, vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry (Franz, 2012). The exchange diet of the ADA includes protein, bread, fruit, milk, and low and intermediate carbohydrate vegetables (Ferri, 1999). The food/meal plan is based on the individual’s appetite, preferred foods, and usual schedule of food intake and activities, and cultural preferences. Determination of caloric needs varies considerably among individuals, and is based on present weight and current level of energy. Required calories are about 40 kcal/kg or 20 kcal/lb per day for adults with normal activity patterns (Davis, 2001). Emphasis should also be placed on maintaining a consistent day-to-day carbohydrate intake at meals and snacks. It is the carbohydrates that have the greatest impact on glycemia. â€Å"A number of factors influence glycemic responses to foods, including the amount of carbohydrate, nature of the monosaccharide components, nature of the starch, cooking and food processing, and other food components (Franz, 2012, p.13).† Maintaining a food diary can help identify areas of weaknesses and how to prepare better menu plans. Recommendations for fiber intake are the same for patients with diabetes as for the general population. It is recommended that they increase the amount of fiber to approximately 50 grams per day in their diet. Insoluble and soluble globular fiber delay glucose absorption and attenuate the postprandial serum glucose peak, they also help to lower the elevated triglyceride levels often present in uncontrolled diabetes (Ferri, 1999). The discussion of diet management should also include a discussion of alcohol intake. Precautions regarding the use of alcohol that apply to the general public also apply to people with diabetes. Abstaining from alcohol should be advised for people with a history of alcohol abuse, during pregnancy, and for people with other medical conditions such as pancreatitis, advanced neuropathy, and elevated triglycerides. The effects of alcohol on blood glucose levels is dependent on the amount of alcohol ingested as well as the relationship to food intake. Because alcohol cannot be used as a source of glucose, hypoglycemia can result when alcohol is ingested without food. The hypoglycemia can persist from eight to twelve hours after the last drink of alcohol. When alcohol is ingested in moderation and with food, blood glucose levels are not affected by the ingestion of moderate amounts of alcohol. If the patient plans to consume alcoholic beverages they are to be included in the meal plan. The patient should be reminded that no food should be omitted because of the possibility of alcohol induced hypoglycemia (Franz, 2012). Coping with Diabetes The patient needs to understand that the diagnosis of diabetes mellitus as with any chronic illness can be unexpected and potentially devastating. Grief is the most common reaction of an individual diagnosed with diabetes. Resolution of the grief is dependent on variables such as education, economics, geography, and religious and cultural factors. The support of family and friends affects the long-term acceptance of the disease progression. Patients need to be aware that depression is common with chronic diseases such as diabetes. The depression should be recognized and treated as soon as possible since depression can affect glycemic control and complicate the management of the diabetes (Buttaro, 2008). The patient needs to understand that diabetes is a lifelong disease process that requires a lifetime commitment and lifestyle changes. The patient should be educated about empowerment – having the resources and knowing how and when to use them. The skills of empowerment that help the patient reflect on life satisfaction in the following areas: physical, mental, spiritual, family related, social, work related, financial, personal. The patient should be encouraged to establish goals which emphasize at least two of these areas in which he/she has control. In the session of coping with diabetes the patient should be assisted to develop better problem solving skills, which are necessary to manage a life-long disease such as diabetes. Coping with diabetes should also include stress management concepts. Stress management concepts should include: a definition of stress, the body’s reaction to stress, the effects of stress on diabetes management, identifying stressors, identifying methods of coping, relaxation exercises and identifying support systems to tap into. Management of the disease process should include eliminating or minimizing other cardiovascular risk factors for example blood pressure control, lipid control, and smoking cessation. Patients with diabetes should also be instructed on what to do when they become sick with a cold, flu, gastrointestinal virus, or other minor illness. They need to be aware that these minor illnesses can affect their diabetes and blood glucose levels (McGovern, 2002). Instruction on what to do when they become ill and the importance of continuing to take their diabetes medications and/or insulin and other general care should be discussed. Some basic guidelines for management during an illness or sick-day include maintain adequate hydration because of the risk of dehydration from decreased fluid intake, polyuria, vomiting, diarrhea, and evaporative losses from fever. Patient should be instructed to drink at least eight ounces of calorie free liquids every hour while they are awake. The beverages should be caffeine-free, since caffeine acts as a diuretic and can actually increase the chances of hypovolemia. If the patient is unable to tolerate fluids by mouth, antiemetic suppositories or intravenous fluids may be required. Vomiting that is persistent and intractable may require emergency room care. The patient should be encouraged to perform blood glucose monitoring more frequently while he/she is ill and to initiate urine ketone monitoring with urine dipsticks, during the illness (Franz, 2012). The patient should be instructed to continue taking his/her insulin and/or oral antidiabetic agents while ill and even when unable to eat. The omission of insulin is a common cause of ketosis and can result in a serious condition called diabetic ketoacidosis. The patient should be given a list of foods that contain fast acting carbohydrates that they can consume when they experience signs and symptoms of hypoglycemia. Patients should be encouraged to seek regular ophthalmologic examinations to detect for diabetic retinopathy. Regular dental examinations should also be encouraged to evaluate to potential areas that can become infected and possible oral lesions. Summary The teaching program for the patients with diabetes is designed to be held for six sessions. However, the sessions can be lengthened or shortened to meet the needs of the intended audience. These two to three hour sessions allow the patient to absorb the material that is being taught and to be able to ask questions. The learning needs are focused on managing their glucose levels and preventing complications of diabetes. The patient needs to be educated on the multiple disease processes associated with diabetes and the factors affecting each of these areas. The patient also needs to have the knowledge of how to manage their diabetes when they are ill and warning signs that they are hypo/hyperglycemic. Diabetic patients should be advised to contact their health care provider any time they are unsure what to do or have questions on how to manage their disease. There are many teaching handouts and pamphlets that are available free of charge from the various agencies. These handouts are available on a wide variety of subjects that can be used with the teaching plan. The evaluation criteria for the teaching plan would include an evaluation tool in which the patients could complete anonymously at the end of the program. References Buttaro, T.M., Trybulski, J., Bailey, P.P., Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice, 3rd. Edition. Philadelphia, PA: Mosby, Inc. NO Davis, A. (2001). Adult Nurse Practitioner: Certification Review. Philadelphia, PA; Mosby, Inc. Ferri, F. (2012). Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby, Inc. NO Franz, M. (Ed.) (2001). Diabetes Management Therapies: A Core Curriculum for Diabetes Education. 4th Edition. Chicago, IL: American Association of Diabetes Educators. Franz, M. (2012). American Diabetes Association Guide to Nutrition Therapy for Diabetes, 2nd Edition. Alexandria, VA: American Diabetes Association. Herfindal, E. and Gourley D. (2000). Textbook of Therapeutics: Drug and Disease Management. Seventh Edition. Philadelphia, PA: Lippincott Williams and Wilkins. NO McGovern, K., Devlin, M., Lange, E., and Mann, N. (Eds.) (2002). Disease Management for Nurse Practitioners. Springhouse, PA: Springhouse Corporation.