Communication Skills Reflection: Patient Interaction

Communication Skills Reflection: Patient Interaction This essay will examine the interaction between myself and the mother of a child who has recently been diagnosed with diabetes mellitus (Mrs X). Before examining the interaction in specific detail I would like to consider some of the more general elements that are relevant to the topic of communication between healthcare professionals and their patients. There are many definitions of communication and Wilkinson offers one definition which describes a complex process of both sending and receiving messages in different formats (both verbal, non verbal or more commonly a mixture of both elements). This interchange typically allows for an exchange of information, feelings, needs and preferences. Typically the two protagonists in a communication exchange will encode and decode messages in a cyclic pattern. Each making an analysis and response to the preceding gambit. (Wilkinson SA et al. 1999) Bugge enlarges on this definition by putting it in a context of professional nursing and suggesting that â€Å"its purpose is generally manifold but will include the means of establishing a nurse-patient relationship, to be a tool for expressing concerns or interest in the patient’s circumstances, to elicit information relevant to the patient’s condition and to provide healthcare information.† (Bugge E et al. 2006) It is an essential part of the whole process of successful communication that both parties achieve a shared understanding of meaning. This is validated by the process of feedback interpretation which indicates if the actual meaning of the message was interpreted as it was originally intended. (Coiera E et al. 1998) In this essay I should note that communication can be considered on many different levels. In this instance we are specifically considering the mechanisms of information exchange between a healthcare professional and a client which, in the broadest sense will ultimately determine many of the parameters of treatment (and also possibly patient compliance) (Stewart M 1995). Although we are specifically considering one interaction here, this does not mean that the other elements of communication are ignored. Hogard (E et al. 2001) writes extensively on the importance of communication between healthcare professionals which can cause huge problems in terms of patient management if they are anything less than optimal. I would hope that any information that I would be able to glean from a patient could be communicated to the rest of a multidisciplinary healthcare team efficiently so that appropriate management decisions could be made. If we consider an overview of a typical communicative interchange it can generally be categorised by both type and level. In the specific context of nursing, the various levels could be considered as â€Å"Social† which is considered to be safe and non-contentious, â€Å"Structuredâ€Å", which is typically utilised for situations of teaching and patient interviews and â€Å"Therapeutic† which has the characteristic of being specifically patient focussed, purposeful and generally time limited. (DAngelica M et al. 1998) Heinmann-Knoch (et al. 2005) considers the process in greater detail. If this initial interaction is successful it can develop further characteristics such as the nurse comes to regard the patient as a unique individual and begins to understand their motivations, and the patient develops a trust in the nurse. It is within this communication context that the nurse is generally able to try to provide care and, more importantly in some instances, help patient identify, resolve, or adapt to health problems We will also briefly consider the elements of both verbal and non-verbal communication. Verbal communication requires, by definition, the conscious use of the spoken or written word. The nature, grammar and syntax and context of the words chosen are important in that they can reflect the patient’s mental age, their education, their culture and in some cases their mental state and feelings of the moment. In a clinical context inferences can be made from the way the words are delivered such as their choice, their tone or pace of delivery. The characteristics most favourable for efficient and effective communication are that the words should be â€Å"simple, brief, clear, well timed, relevant, adaptable, credible†. (Philipp R et al. 2005) Non-verbal communication by contrast, relies on the interpretation of facial expressions, hand gestures, and body language. This can be an extremely subtle means of communication and can give credence (or otherwise) to the spoken word. In the nursing context, non-verbal communication can be manipulated to the nurse’s advantage to help to elicit information that may otherwise not have been forthcoming. It has been estimated that non-verbal communication accounts for up to 85% of information transfer between communicating adults. In the professional nursing context it requires both systematic observation and careful assessment and interpretation to derive the full meaning of what the patient wishes to convey. Most importantly, the nurse should be aware of incongruity between the verbal message and the non-verbal cues. The patient who smiles while describing a terrible pain is one such example. (Musselman C et al. 1999) Specific examples If we now consider elements of communication from the transcript. Clearly there is no evidence of non-verbal communication on the transcript but I was very conscious of the mother’s initial reticence in her opening exchanges with me. She initially sat in a â€Å"closed† position and largely avoided eye contact. As the conversation unfolded she clearly became more relaxed and trusting. She adopted a more â€Å"open† and relaxed posture and started to express herself with appropriate hand gestures. (Hulsman R L et al. 1999) I particularly recall the jabbing gestures she made to emphasise a point relating to giving injections. I have to observe that the environment that was used for the interview was very contrived and I believe that this may have had an influence on both myself and the client. I think that, in a real situation I would be able to allow the conversation to be far more fluid and relaxed. I can analyse some of the techniques used to elicit or reinforce information During the interview I purposely made a point of asking open questions to try to draw out the client’s response So it sounds as if, it has obviously upset you..? It sounds as if you were almost blamed yourself for it as well..? Generally its quite a healthy family as well..? >From the terminology you’re using there is sounds as if you know what you’re talking about, you sound quite confident..? Mrs X. was clearly at ease after a while and even when closed questions were asked she would answer them Yes or No and then go onto both expand what had been said and volunteer other information. I had varying degrees of success in eliciting the information that I was after. Trying to establish whether it would be difficult to get the patient to comply with his diet I touched on the subject of diets and Mrs X clearly has a major psychological difficulty in coming to terms with her own diet. I allowed her to express her views about her obesity before trying to bring the conversation back on track. After Mrs X’s outburst about her â€Å"serious morbid obesity† I made three attempts to both empathise and sympathise with her feelings in order to gain her trust by asking supportive and non-contentious questions before returning to the point relating to injections with the question â€Å"So how did you feel with the injections, because obviously for me that was quite a scary experience, seeing someone so young giving an injection to themselves..?† Phrasing the question in this way appears to show considerable empathy for Mrs X’s situation and allows her then to offer her opinion. (Richards T 1999) There were several instances where I needed to summarise what was said in order to be sure that I had understood the thrust of Mrs X’s comments Easy to understand, em, there was no panic mongering in them and things like that. If I’d have looked on the websites, I might have found some information I didn’t want to see at this stage. So I was advised not to look and I didn’t. So would you be a bit. . So if you read something that was sort of like false information or mis-information that scared you a little bit, is that what you’re trying to say? It probably would have scared me because it’s my child, but I wouldn’t have been into histrionics about it, I would have been probably saying well that†¦Ã¢â‚¬ ¦. problems. Paraphrasing was a useful technique to ensure that I had understood what was being said. Yes, and you know, instead of buying biscuits and things for the biscuit tin in the house, I’ll be buying fruit, huge varieties of fruit, and that’ll be their options now. So you say you’re going more toward the healthy lifestyle and keeping, would you,? Direct questioning helped to elicit specific answers Prodigy websites? Off the websites, yes, they were very good because they were no nonsense. Do you mean they were easy to understand? Easy to understand, em, there was no panic mongering in them and things like that. If I’d have looked on the websites, I might have found some information I didn’t want to see at this stage. So I was advised not to look and I didn’t On occasions it was useful to reflect on the implications of Mrs X’s answers and to try to elicit further information from her So it sounds as if, it has obviously upset you..? Does that it sounds as if you were almost blamed yourself for it as well..? Empathising is a useful technique particularly when dealing with difficult issues such as the problems with diets. (Stewart M . 1995) Especially being teenagers, its all.. They eat chocolate, they eat crisps and all things that are bad for them and if they’re restricted in what they can eat it makes them want it more in a way. I know if I couldn’t have chocolate or sweets.. On reflection I believe that I made a reasonable attempt in the circumstances to get as much information from Mrs X as I could. By the end of the interview Mrs X was getting tired and losing concentration so I believe that it was correct to terminate the interview at this time. (Wilkinson S et al. 1999) I am aware that I frequently asked incomplete questions or stopped in the middle of a sentence. This may be an indication that I was not in control of the situation This whole exercise has been a useful analytical and learning experience for me. I believe that I shall have gained a great deal of experience from the episode and will use that to further inform my practice in the future. References Bugge E and I. J Higgins on (2006) Palliative care and the need for education Do we know what makes a difference? A limited systematic review. Health Education Journal, June 1, 2006 ; 65 (2) : 101 125. Coiera E and Vanessa Tombs (1998) Communication behaviours in a hospital setting: an observational study. BMJ, Feb 1998 ; 316 : 673 676. DAngelica M, Kathy Hirsch, Howard Ross, Steven Passik, and Murray F. Brennan (1998) Surgeon-Patient Communication in the Treatment of Pancreatic Cancer. Arch Surg, Sep 1998 ; 133 : 962 966. Heinmann-Knoch, Korte, Heusinger, Klunder Knoch (2005) Training of communication skills in stationary long care homesthe evaluation of a model project to develop communication skills and transfer it into practice. Z Gerontol Geriatr. 2005 Feb ; 38 (1) : 40-6. Hogard E and Roger Ellis (2006) Evaluation and Communication: Using a Communication Audit to Evaluate Organizational Communication. Eval Rev, Apr 2006 ; 30 : 171 187. Hulsman R L, Ros W J G, Winnubst J A M, et al. (1999) Teaching clinically experienced clinicians communication skills: a review of evaluation studies. Med Educ 1999 ; 33 : 655 – 68 Musselman C and C Tane Akamatsu (1999) Interpersonal communication skills of deaf adolescents and their relationship to communication history. J. Deaf Stud. Deaf Educ., Winter 1999 ; 4 : 305 320. Philipp R and P. Dodwell (2005) Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload. Occup. Med., Jan 2005 ; 55 : 40 47. Richards T. (1999) Chasms in communication. BMJ 1999 ; 301 : 1407 – 8 Stewart M . (1995) Effective physician-patient communication and health outcomes: a review. CMAJ 1995 ; 152 : 1423 – 33. Wilkinson S, Bailey, J. Aldridge, and A. Roberts (1999) longitudinal evaluation of a communication skills programme. Palliative Medicine, June 1, 1999 ; 13 (4) : 341 348. Appendix Self in blue italics Mrs X in black print How has xxxx diabetes since coming into hospital? Well it’s come as a terrible shock obviously, that he’s got diabetes, because he’s a healthy boy. It’s still a shock. I think the staff have tried to help us over it as much as they can. Do you feel as if they’ve given you enough information about diabetes..? I think we’ve been inundated with information, I think that it was good that one particular member of staff dealt with us mainly, and they listened very closely to what we had to say. We’ve had a lot of conflicting information but ultimately it all meant the same thing which caused a little bit of confusion. And did you feel as if that that was a bit of overkill? Or a bit too much information too soon? Probably, but between the bits of information that we run off the PC, off the.. Prodigy websites? Off the websites, yes, they were very good because they were no nonsense. Do you mean they were easy to understand? Easy to understand, em, there was no panic mongering in them and things like that. If I’d have looked on the websites, I might have found some information I didn’t want to see at this stage. So I was advised not to look and I didn’t. So would you be a bit. . So if you read something that was sort of like false information or mis-information that scared you a little bit, is that what you’re trying to say? It probably would have scared me because it’s my child, but I wouldn’t have been into histrionics about it, I would have been probably saying well that†¦Ã¢â‚¬ ¦. problems. Yes I had a little bit of knowledge about diabetes before this happened, but sometimes a little bit of knowledge is a more dangerous thing. Is that because of the work that you’re doing? Yes, and you know, what Ive actually learned now †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. had diabetes, so. And do you think †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ how it’s going to change your lifestyle? Definitely going to change the lifestyle. Having a big family its going to mean that.. How many people in the house sorry? In the house there’s 6. Cooking Sunday dinner yesterday, there were 11 of us for Sunday dinner yesterday.. That’s a lot of people.. Yes, and you know, instead of buying biscuits and things for the biscuit tin in the house, I’ll be buying fruit, huge varieties of fruit, and that’ll be their options now. So you say you’re going more toward the healthy lifestyle and keeping, would you, Yes, yes Would you all the bad things, would you keep them out of the house or will you still buy them in for.. I won’t be buying them because my children will need to make their own decisions about that. I don’t have small children who are going to feel deprived if they don’t have a chocolate biscuit. They’re old enough to make a conscious decision, â€Å"okay Mum’s given us that, but I fancy this so I’m going to go and buy it.† They’ve got their own resources so they can go and do it themselves. And they’re quite happy about that are they? Yes, and they’re happy, apart from one, about the healthier way of cooking things if you like and em, wasn’t a terribly bad diet in the first place. Have they all agreed to sort of, give their responses to diabetes or are they sort of laid back about it? They seem quite laid back.. They are very laid back. They’ve even, I mean it sounds absolutely terrible but they’ve even been cracking jokes about it. Three of my children have got asthma and I mean he was joking â€Å"well mine’s worse than yours† and .. So they’re all quite light hearted about it and taking it in their stride. Yes. Matthew, my eldest boy, was, because he’s a Nurse I think, he was absolutely devastated but he is better about it now. But in the first instance he was absolutely gutted. I mean xxxx he was gutted obviously.. Well this is it, he seems quite calm about it from what Ive seen and a very relaxed family in general. Yes. I mean if we were any more laid back we’d need †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. on a night to keep us going because we don’t really let things bother us. So it sounds as if, it has obviously upset you..? Yes, very much. I kicked right off. I didn’t kick off in front of him, but when I got home I kicked right off to everybody and anybody that would listen. I even had texts from friends that didn’t even know, and I was ranting to them Does that it sounds as if you were almost blamed yourself for it as well..? I did wonder, you know, initially I wondered if it was because they’ve always been allowed to have sweets. Ive never made sweets into a reward or a treat, you know, they’ve always been an everyday matter of fact, because I didn’t want them to grow with my problems, obesity problems, because they weren’t allowed sweets. I didn’t ever want them to ever think sweets were something really special. Because they’re not, they’re just another thing that, they’re a foodstuff, and they’re a bad source of.. Especially being teenagers, its all.. They eat chocolate, they eat crisps and all things that are bad for them and if they’re restricted in what they can eat it makes them want it more in a way. I know if I couldn’t have chocolate or sweets.. Well that’s just my life experience you know, being denied things and then leaving home at 16 and eating all of that stuff and becoming at one point seriously morbidly obese I don’t want that for my children. Obviously they might have a predisposition to do that. I don’t want that to happen so, let’s not make sweets and biscuits em, a reward or a treat so they never have been. So then I wondered if possibly they’d had too much. None of them are overweight, none of them are fat, none of them have got bad teeth and cavities and things. None of them has ever had a filling. Generally its quite a healthy family as well.. He hasn’t seen a doctor for 7 years. So it must be a complete shock for you that this has suddenly happened.. and changed everything that has been happening in your home. So how has the rest of the family been coping, have they been..? Very supportive, except for one.. Ah, except for one, is that the elder one or the younger one? He’s 18 just turned, and he’s got an appalling diet, all I can do is advise him. I can put his meals in front of him and if he chooses not to eat them and go and buy rubbish then, all I can do is advise him. So how did you feel with the injections, because obviously for me that was quite a scary experience, seeing someone so young giving an injection to themselves.. I knew he could do it. Of all of this, that’s the bit that doesn’t faze him. Does it faze you at all? It doesn’t faze me. Em, when I was asked to give him an injection here, and staff knew I could do it †¦Ã¢â‚¬ ¦said you might not be able to do it because he’s your son.. But its not like that is it? If he goes into a hypo and he needs me to inject him, I’m not going to start you know, â€Å"oh my god! his life depends on it, get him injected, how†¦Ã¢â‚¬ ¦..† From the terminology you’re using there is sounds as if you know what you’re talking about, you sound quite confident. Yes. I am. I mean†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.but, at the end of the day its your child and you’re not going to, going to, you wouldn’t hesitate, just get on with it, you just do it. And do you feel that that’s the attitude that you’re whole family’s going to have as well? Yes. They’re all, you know, when he’s doing his bloods they’re all there watching, hovering over him, when he’s sticking a needle in they’re â€Å"ooh, where are you going to stick it now?† you know. Nobody’s squeamish, nobody’s terribly fazed by it, I think they’re all pretty pleased because it’s not them that’s got diabetes. But at the end of the day †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.but be supportive, can’t ask any more really. Yes. Can you see yourself coming in regularly to see all the diabetes nurses? Even if he’s in complete control of his diabetes will you still come in and visit just to make sure everything’s alright? Yes, as long as he wants me to come with him, then I will come with him. I mean, when he turns 18 if he wants me to come to the diabetes clinic with him then I’ll come with him. Is he independent anyway? Very. Fiercely independent. Still like, on the phone its still like Mum †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ So when you go away today do you think you’ll feel as if you’re going to have everything that you need for the next, lets say two weeks, or week, to be happy with.. Yes I still need to ask about when I should make an appointment for †¦Ã¢â‚¬ ¦.. him to see his GP. I still need to ask little questions.. When he turns 18 is the insulin free, or does he have to pay for it like everybody else, with the prescription charges Yes †¦Ã¢â‚¬ ¦.. aren’t they? Its quite expensive as well isn’t it? Well asthmatics don’t get their inhalers free, they have to pay.. When you think about it you’ve got your insulin, your sticks you†¦. It’s the keytones as well, they haven’t been completely explained to us. They’re in the leaving pack anyway which†¦ I mean I understand what the keytones are, but†¦ What are they? Because I don’t fully understand, I know they’re a by-product .. Keytones are a waste product that your kidneys filter out of the blood and pass out in the urine. Obviously they’re in your blood for your kidneys to pull them out, filter them out, but if his blood sugars are high and remain high you should test his urine for keytones. There are sticks to test his urine. If there are a lot of keytones in his urine then he should probably do a test on his blood which is just another stick that goes in Have you got them? No. Then you would phone the ward. But we know we can phone the ward anytime. So you feel reassured at having that point of contact that you can phone up anytime†¦? Absolutely, yes. There’s still going to be stuff that comes up and â€Å"what can you do about that?† There’s going to be stuff that comes up all the time. I’m sure you’re going to have peaks and troughs a little bit where you’re unsure what’s happening and if you’re concerned he’s not controlling his diabetes properly, we’re only a phone call away. Yes. And if its not being controlled I don’t think it would be anything he’s doing deliberately wrong.. You said earlier, he knew about what his level was. I think at one point yyyy asked him â€Å"what level do you think you’re at†.. Yes, he was very close. Mm, very close And that was only on day two or three, day three maybe He’s had a couple of lows on his blood pressure as well which I think he’s realised because he’s felt the effect that it’s had on him He knew yesterday afternoon that he was low because he said look at me and he showed me and there was just ever such a slight tremor in his hands. Did that concern you or reassure you? It reassured me because he knew and I said, he said I need to test my blood and I said why and he said because I think its low and he said look and he showed me. For him it was low, it’s the lowest it’s been. Well that’s fantastic I wasn’t worried because I knew that all he had to do was have the glucose or eat something or both and em, when he goes back to school I know that he’s †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ You take home glucose tablets as well don’t you? I think you can buy them from the shops now.. Yes. You can just at the supermarket so they’re easy to carry about. Very nice sweets as well. Anyway I think that’s about enough so thank you for your time. I hope it helps. I’m sure it will. ############################################################### 17.04.07 word count 2,112 PDG

Essay --

On the Rainy River by Tim O’Brien Life can sometime bring unwanted events that individuals might not be willing to face it. This was the conflict of O’Brien in the story, â€Å"On The Rainy River†. As the author and the character O’Brien describes his experiences about the draft to the Vietnam War. He face the conflict of whether he must or must not go to the war, in this moment O’Brien thinking that he is so good for war, and that he should not be lost in that way. He also show that he disagree with the consbet of the war, how killing people will benefit the country. In addition O’Brien was terrifying of the idea of leaving his family, friends, and everything that he has done in the past years. This idea and the drafted make decide to run away from his responsibility and from his society. However, the feeling of shame embarrassed and bring crowed in the eyes of his family and friends make him go to war. After being drafted, a lot of ideas and thoughts came to his mind. O’Brien thought about what will do if he goes war and how his life will be after if he srvral. For example, â€Å"I imag...

Nutrition Self Assessment

My family often comments on how fat I am. I was diagnosed with rheumatoid arthritis in 2004. At the time I could not close either of my hands to make a fist. Opening a door was near impossible. My wife had to button up my military uniforms for me. I was eventually medically discharged. I can now make fists, but have pain as a norm. Over the past 10 years I have put on around 80 pounds. I lost around 20 over the past 2 months with eating a bit better. I was down to 226 pounds when we moved back to Utah in 2012. My food habits were great for about 2 years before moving back to Utah.I was eating good healthy portions and exercising regularly. Other than those 2 years, my exercising and eating habits have been fairly short lasting with long periods between. Have a home gym, but often find other things to do at home besides exercise. I am not a fan of the gyms because don't like waiting for the equipment and don't like other people watching me. Absolutely hate cardiac, but will play baske tball or football for hours on end. I was often in the top 5 runners in my military group when running the timed 2 mile course, but just do not enjoy going for runs.Calculations eve a Body Mass Index (IBM) of 34. 32 (height/(weight 2) x 703) which is obese for my height. I am not a believer in the IBM calculations. I almost didn't make it into the army because of how much weighed. At that time, I was 215 pounds and had a low body fat. I was lifting weights and involved in sports, but according to the IBM calculator that the army used, they had to get a doctor to look at me and decided if was too fat or not. My waist to hip ratio 46/49 = 0. 94. MY Basal Metabolic Rate (BMW) is 2,344 calories. BMW is the amount of calories needed for my body to stay alive while sitting still. Currently striving to stay under 3000 calories a day and drink a gallon of water a day. Nursing Diagnosis My nursing diagnosis would be inadequate food intake, more than body requires. This is related to the pati ent telling himself he is too busy as a student, father, business owner, and part time nurse, to work out and watch what he eats. Basically, I am tired and lazy. I attribute my obesity to most of my health problems. Know I have rheumatoid arthritis, but while I was working out and eating right before the move, I felt great. Custom Meal Plan for 7-Day PeriodI am trying to eat healthy and may start to work out again soon. Have a trip to Disney World in May with the family and want to be k with myself in a bathing suit. My diet needs some fine tuning still, but I am sure can do it. Bread Kafka For breakfast, eat oatmeal with two eggs and sometimes a banana. Also try to drink 2 glasses of water. Morning Snack For my morning snack I will eat some apples or oranges. Lunch For lunch, usually eat chicken and sweet potatoes with a cup of veggies. Sometimes I eat leftovers from the previous day. I also drink a few glasses of water.Daytime Snack For this snack, I will try to eat a protein bar or drink a protein shake. Dinner Our family usually eats dinner by 6:30. I try not to eat anything past 9:00 anymore. For this meal, I usually eat whatever my wife makes. I am going to try to eat chicken, sweet potatoes, and veggies for this meal as well. Right now, I just go for what the family eats. Want to get back to my own meals though. I was getting better results. I also usually have a glass of milk with dinner. Day by Day Journal Day 1 Today I followed my meal plan for all but dinner. I had my oatmeal and 2 eggs or breakfast with a banana.For lunch, had my chicken, veggies, and cup of veggies. Had a burrito for dinner. Feel pretty good for following most of my plan. My snacks were an apple in the morning, a protein bar during the day, and had some popcorn at night while watching a movie, because a movie must have popcorn. Did a workout found online called Scoop's beginner workout. This involves basic bodyweight movements. I did 3 sets of his ABA rotisserie, pull ups, push up s, and squats. The pull ups were very difficult, had to use my legs to help get me up. The ABA routine almost killed me.The USPS were k, but my wrists have limited range of motion, so I was in pain and doing an awkward version of a push up. I have some stretches that the physical therapist gave me, I should start to do those too. Day 2 Today I did k. I skipped breakfast. I ate more burritos for lunch. It is just so convenient to put them in the microwave. I ate my fish and veggies for dinner. Fish is what I use when chicken gets boring. Also filled my 64 ounce water jug twice today. I felt very energetic today. Today I opted out of the workout routine and just did an hour long Ate Boo video.I did a lot of walking in place. I use to be able to do the whole thing. Hope to be back to being able to do the whole thing in a week or two. Also had a strawberry protein shake for both my snacks today. I am trying to convince the wife to go for daily walks, but this cold weather is not helping . Think may try to get her to do the Ate Boo with me. Day 3 I feel like I did k again today. It was oatmeal and a banana for breakfast. I didn't have time for the eggs. Ate some chicken and veggies for lunch. Dinner was some pulled pork my wife made. I am pretty sure over ate on that meal. My water intake was good.I filled my jug twice again. My snack in the morning was an orange and my evening snack was a piece of bread with peanut butter and honey. I have been skipping the milk at dinner and going for water instead. Also have been taking a calcium supplement. Chose to do the Scoops workout again today. This time was about the same as the last time. I didn't really notice anything being easier or harder. I was a bit more out of energy afterwards this time. Hopefully sleep really well. Day 4 Today was not very good for the meal plan. Woke up feeling like a bus hit me. My head was pounding and everything hurt.I ate about 5 scrambled eggs or breakfast, had lots of left over pulled por k for lunch. For dinner, I broke down and had pizza. I also had milk with lunch and dinner. My snacks consisted of brownies, cake, chips, and some yogurt. I did not work out at all today because of how felt. Remember feeling like this for about a week last time I started to try working out and eating right. I am not so sure with school and everything else going on that can afford to feel this way for a week. Time will tell. For now am off to bed. Hopefully I don't toss and turn all night from my aching joints.Day 5 I am feeling the bad eating from yesterday. I feel kind of bloated. It must be all the salt form that yummy food or it could be the stress on my joints. Started off today with my very boring and bland oatmeal, eggs, and water. For lunch, again turned to that not so boring and bland pulled pork. I just love that stuff. I should have married a bad cook so I wasn't so tempted to eat things not on my meal plan. I also had a glass of milk. I had my chicken, cup of broccoli, an d sweet potatoes for dinner with some water. My snacks were a protein bar and a protein drink. Id the Scoops workout again. This time was really rough with my soar joints. Id notice was able to not incorporate my legs as much on the pull ups though. All in all, onto terrible day. Day 6 Today we had my daughter's birthday party. Needless to say, I had lots of cake, soda, ice cream, and chips. I had no breakfast, just a glass of water. Not the best idea. My energy level was really low and not what I wanted while swimming with the kids. I went and got the family pizza after the party, so I had about half a deep dish pizza from Little Caesar for dinner and 3 root beer sodas.My water intake was k, as the party was at the wave pool and I must have swallowed a gallon of it. I missed my workout as well, but I did swim for about 3 hours with the kids. I am going to count that since I am exhausted. I hope all that chlorine doesn't make me sick. Day 7 Today was a good day. I skipped breakfast as had to work early. I feel a bit sick from the pool yesterday. Am sure it will pass quickly. I had some tattoos for lunch along with some water. I had a healthy soup my wife made for dinner. She said it was healthy, so I believed her. I say today is good because have lost 2 pounds over this last week.I drank lots of water at work today, but I forgot to track it. Just kept filling up a water bottle multiple times. I want to use this assignment to help me focus in on my goals and be happy in my swim trunks in May. Have an app on my phone to help me track what I eat and drink called my fitness pal. Hopefully I will use it. Conclusion In conclusion, I am a 34 year old male who is obese and trying to take steps to do something about it. I tried to make some dietary changes and exercise for a week. Did k, but there is a lot of room for improvement. In the end, the result was a 2 pound loss, which is encouraging.

Positive Outome of Media Coverage of Criminal Trials in India

In India, the growing phenomenon of activist media coverage of criminal trials has seen some positive outcomes. It is even arguable that until India’s rotten criminal justice system is reformed, the judiciary must tolerate journalistic vigilantism. A journalist must not be given an absolute free reign to wantonly declare an accused person as innocent or guilty. Any institution, be it legislature, executive, judiciary or bureaucracy, is liable to be abused if it exceeds its legitimate jurisdiction and functions. But sometimes these ultra vires activities are blessing in disguise as is the case of judicial activism. Media trial is also an appreciable effort along with the innovative sting operations as it keeps a close watch over the investigations and activities of police administration and executive. But there must be a reasonable self-restriction over its arena and due emphasis should be given to the fair trial and court procedures must be respected with adequate sense of responsibility. Media should acknowledge the fact that whatever they publish has a great impact over the spectator. Therefore, it is the moral duty of media to show the truth and that too at the right time. No person charged of any crime should be judged by the media because that person is innocent until proven guilty, and it one the basic premise of criminal jurisprudence. And, no one, and this includes also the media, should be allowed to temper with the functioning of law. The rule of law as