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The issues related to nursing involve a thorough examination of nursing as theory and practice. The role of the nurse practitioner especially in areas of clinical decision making and management could be studied in the contexts of obstetrics and gynaecological department or even emergency wards. The emphasis of most studies is on reflective practice using Gibbs (1988) model of treatment and reflection. The need to follow clinical guidelines as given by NICE or NHS have been emphasised in several studies especially highlighting the importance of personal cleanliness and hygiene in infection control.

The role of informed consent and clinical decision making in case of pregnancy with family history of mental health problems suggest the central role of the challenges in the decision making process (Papers4you.com, 2006). The need for counselling and holistic care of patients have been emphasised in clinical practice. The role of the nurse and the importance of proper knowledge of clinical guidelines, NHS directives and adequate medical training suggest the crucial responsibility of the nurse who plays varied roles from that of physician to hospital manager. The studies show the varied approaches to nursing as in case of a depressed patient, the emphasis is on counseling and psychological support whereas in case of treating a patient with high blood pressure or multiple injuries after accident, reflective practice on immediate measures followed would be more important, suggesting a focus on patient centered outcomes (Bowcutt, et al 2006).

Clinical management is closely related to leadership theories and it is important for the nurse to develop adequate leadership skills to effectively perform clinical duties (Booth and Davies, 1991). The differences between the role of the health visitor, nurse and midwife in general practice have been studied. Social and healthcare policy and guidelines on clinical governance suggest a multidisciplinary collaborative working approach for effective clinical management (Papers4you.com, 2006). Collaborative teamwork, holistic psychosocial treatment and proper allocation of clinical resources are some of the issues that are very important within intensive care units and for care of emergency patients. The ethical and legal responsibilities of a nurse practitioner and the medical team in general are largely guided by not just clinical guidelines set by the Department of Health but also by a team of dedicated health professionals within the clinical setting.

The issues discussed in the field of nursing include clinical governance, collaborative teamwork, the role of the clinical nurse practitioner, the importance of reflective practice, Gibbs (1988) Model, clinical management and decision making, ethical and legal issues in clinical care and holistic approach to treatment.

Bibliography

Booth J, Davies C. (1991) The management of change on a nursing development unit. Nurs Pract.;4(2):12-5.

Bowcutt M, Wall J, Goolsby MJ. (2006) The clinical nurse leader: promoting patient-centered outcomes. Nurs Adm Q. Apr-Jun;30(2):156-61.

Gibbs, G. 1988. Learning by doing: a guide to teaching and learning methods. London: Further Education Unit.

Papers For You (2006) "P/N/89. Medical nurse: characteristics, requirements, guidelines", Available from http://www.coursework4you.co.uk/sprtothers15.htm [22/06/2006]

Papers For You (2006) "C/N/42. Portfolio of the nurse. Caring for patients suffering from depression. What is the nurses responsibility?", Available from http://www.coursework4you.co.uk/sprtothers15.htm [21/06/2006]

Copyright 2006 Verena Veneeva. Professional Writer working for http://www.coursework4you.co.uk

I am very grateful to have had the opportunity to participate in such an amazing event as the Iron Man Triathlon. I truly value living in a free and democratic country that is not only war free but beautiful beyond belief. To have 5000 volunteers for 2500 athletes is phenomenal and I commend the people of Penticton for continuing to do such an outstanding job of hosting this event.

The journey to the starting line of Iron Man Canada in Penticton started about a year ago. I had completed 14 marathons and a handful of Iron Man triathlons but the Iron Man always seemed so mind boggling and apparently out of my reach.

My Iron Man game plan was to:
Hope for the Best
Plan for the Worst and
Expect the Unexpected

The biggest obstacle in my mind was the gargantuan task of running a full 26 mile marathon after swimming 2.4 miles and biking 112 miles. How did these people do it? My friend Don Henderson described the marathon in the Iron Man as a more of a pilgrimage or journey to the sacred land.

I chose to compete in the Iron Man because I knew it would be a sacred journey into the unknown. I dreamed about completing it ever since I saw Paula Newby Fraser and Mark Allen conquer the course in Kailua Kona, Hawaii in 1992.

1. Hope for the Best:

I recently researched and wrote about two people who recovered from life threatening illnesses. They learned to embrace the journey of recovery and transcended their tragic circumstances. The key for both of these people was to visualize the end result. They practiced visualization daily and saw themselves as healthy and leading happy productive lives. I followed in their foot steps and immediately started visualizing myself at the Iron Man finish line with my arms raised in victory and the crowd cheering loudly.

The obvious next step was to hire a coach and come up with a feasible training schedule.

I did not have to reinvent the wheel in preparing for the race as I hired my friend David Kazakoff a 9 time Iron Man finisher. He wisely gave me my schedule 1 month at a time so I could keep focused and not get too concerned about the rigorous training near the end. The four key components of my training were:

1. Balance --the 3 disciplines of swim, bike and run,
2. Focus --on the current workout only
3. Discovery --Enjoy all of the experiences and embrace this sacred journey
4. Fun --There is no point in doing all this training unless you enjoy the experience and have fun. I have observed many triathletes train for the Iron Man with vastly different approaches. My two 2 heroes are Leslie Riva and Lori Allin because they always looked so happy and seemed to love every minute of their training and the race itself. I wanted to be like them!

Plan for the Worst:

I was astutely instructed to prepare for something to go wrong during training sessions and on race day itself. I had my share of challenges including a fickle front derailleur, a rash of 10 flat tires and horrible cycling weather.

The most memorable training day occurred in late July. I was nicely on my way up island for my longest bike ride of the year (180km) when I got two flat tires in a row. I was only mildly annoyed and merrily on my way until I heard the dreaded thump of yet another flat tire. I was out of spare tubes, 70 kilometers away from home and it was about 34 degrees Celsius. Luckily I packed a cell phone and had memorized the local taxi companys number. However, my mouth dropped when the dispatcher said he could not pick me up for another 3 hours! I finally managed to contact my office manager Nancy who graciously saved me from walking home. Needless to say, I have a great respect and appreciation for loyal employees and cell phones.

Sunday August 27, 2006 was race day and I was ready. I was very fortunate and grateful to have the fantastic support of my girlfriend Laurie and her 12 year old son Taylor. They woke up with me at 4:30 and accompanied me to the start line for body marking and pre race preparation. Taylor supported me on my training runs by riding along side on his bike. I always wondered why he was always riding so far in front of me. Later I learned that he was embarrassed with me wearing my purple biking spanky pants. He couldnt let his friends see him with me!

When the cannon blasted to start the swim I was very excited along side the other 2500 competitors. I was going to have fun and treat this as just one long day of training. Within the first 300 meters of the swim, I was punched in the nose and kicked in the chin. I also heard a cry of, get off of me! I should have followed the swim strategy of the Iron Man triathlon author and expert Ray Fauteux and stayed totally to the left of everybody! However, I remained calm and focused and had a decent swim. As I exited the water, the announcer was boisterously calling out all our names. Before I knew it, I had my wet suit off and navigated my way to the change tent full of naked bodies and wet suits. I found my bike easily and was on the next stage of the journey. The bike ride was absolutely spectacular. The first 60 kilometers thru Oliver and Osoyoos was pretty easy and I felt very good.

I had driven the bike course 3 days ago so I knew that the challenging hills started at Richters pass and continued for another two to three hours. The view going up Richters pass was absolutely spectacular and I was actually talking to people as I rode along side them. The drafting police were very lenient as it was almost impossible to keep 4 bike lengths behind the other bikers in such a big pack. We had aid stations every 10 miles and I just loved pouring cold water on my face and body! The support of the fans along all parts of the course is totally awesome and I really appreciated Dave, Jennifer and Pheona cheering me on from their vehicle.

Aside: Even though I consumed about 5 bottles of Gatorade on the bike and the run I did not have to pee once! Apparently my body utilized all of these fluids.

The ascent up Yellow Lake reminded me of the Tour de France and I almost expected officials to let us take our helmets off. The winding downhill felt wonderful and I had tears of joy as I saw the view of Penticton and the airport. The bike portion was nearly over and I was pumped full of adrenalin and as high as a kite!

Expect the Unexpected:

I was extremely relieved to get off my bike and into my nice comfortable running shorts. I had a good transition and was fueled up and ready to go. Nothing could stop me now because the run was my strongest event.

However, a funny thing happened just after the 3 mile mark of the run.

I planned on running a mile and then walking thru each aid station. But after the 3rd aid station I could not run any more. I was exhausted, depleted and forced to walk. I had 20 miles left, struggling uphill, heading into the wind and it was 33 degrees Celsius! What was I going to do? It was at that point I heard the imaginary voice of my swim coach Malcolm telling me that I had gone out too hard on the bike and had nothing left.

But honestly, I was holding back!

I also remembered Paula Newby Fraser telling us that we better have a plan when something like this happened. My new plan was to get some different types of food inside me because I was absolutely sick and disgusted with power gel. I tried many grapes and water but that did not work. My last hope was the special needs station at the half way point. I had placed a container of apricot baby food and a spoon in my special needs bag and I hungrily devoured it; but most importantly my stomach approved. I slowly jogged to the next aid station and discovered oranges. My stomach liked them too! I was becoming stronger and in a few miles I was now able to run at a good pace for a mile at a time! My mood had drastically improved and I was no longer depleted and supercrabby.

By mile 24, I once again became very fatigued after a nasty uphill. However, I was so close to the finish line I could hear the cheering of the fans. I was going to keep running no matter what!

My legs were aching and my stride was shortened but I was magically pulled along by the cheers from the crowd and the voice of the finish line announcer! It was dark and I had difficulty seeing where I was supposed to run. Then suddenly a familiar voice yelled out my name and gave me a high five. It was Laurie! Her presence and support gave me a sudden burst of energy and it seemed as if I was sprinting to the finish line. I was so close to the finish line when the Gods played one last nasty trick on my fellow competitors and me.

We had to run past the finish line for half a mile, turn around and come back. I was so angry but even more determined not to stop. I made it to the turnaround and ran toward the finish line. The next few minutes reminded me of a near death experience. All I remember was the absolutely magnificent energy from the cheering spectators and the blinding bright lights at the finish line.

All I had to do was keep running to the bright lights and I would be home. The cheering got louder and the lights got brighter. It seemed as if everything was in slow motion as I neared the Holy Grail. Laurie snuck in front of the crowd to give me another high five as I neared the finish line. The announcer screamed out, Here is your next winner! I raised my arms in the air victoriously just as I had visualized a thousand times before and I felt the exquisite sensation of my torso pushing thru the finish line ribbon!

And then for one brief moment

Life was perfect.

Dr. Larry Smith Chiropractor and Author of:

Embrace the Journey of Recovery: From Tragedy to Triumph!

Are You Recovering From Alcohol or Drug Addiction?

If your answer is yes, then this book is for you!

Embrace the Journey of Recovery will passionately reignite your spirit and teach you how to confront, conquer and powerfully triumph over addiction, cancer or any other life threatening illness! Is addiction a genuine life threatening illness like cancer? If so, then why is it concealed behind a wall of shame and denial?

Discover the answer and experience the remarkable story of two courageous yet ordinary individuals and their astonishing recoveries from heartbreaking tragedy. Find out how a cancer survivor and an alcoholic mutually support each other and passionately embrace the journey of recovery.

Their message is simple. They transformed their lives and you can too!

To find out more about this exciting new book click here:

http://embracingthejourneybook.com/

Every horse riding exercise is based on the circle exercise. Circles help the horse to be able to bend equally in each direction, and this also helps the horse maintain straightness.

Circles are a very important part of any dressage test - a dressage test at all levels will include combinations of circles of varying sizes, at different paces and in different parts of the arena.

When a horse walks a circle he bends his body to match the curvature of the circle - this is called the correct degree of bend. It is important when asking for a circle that the rider imagines a circle drawn on the ground, and tries to follow it. The horse must not lean to the outside and make the circle too wide, or drift in, and make the circle smaller. By practicing these bends the horse becomes more supple.

Most horses find one direction of bend easier than the other. These horse riding exercises are a great way to even up the horses muscles.

The first circle exercise you will be asked to do is a 20m circle. This basically splits the 40m arena into 2, with the start of the circle at letter A or C, as below, and the mid point of the circle crossing through the imaginary letter X in the centre.

A 15m circle should take you five metres inside of X. It is a tighter circle, and will ask for more bend from your horse.

The smaller circle is the 10m, which will use up one quarter of the arena.

The circle exercises can be performed anywhere in the school - you may be asked for a 20m from A, C, E or B. 20m circles from B or E will take you from one side of the school to the other.

In beginner lessons riders will usually ride a circle as a group, or the instructor will tell you which letter to start from. In more advanced lessons riders may be working in open file, and the instructor will ask all riders to work a circle wherever they choose. In these lessons it is important to remember your school etiquette, and if you are going large (riding round the outside of the arena) you should 'give way' to the horse and rider completing a circle, and let them back onto the track in front of you.

In your first lessons you will walk or trot circle horse riding exercises. Later on you will perform canter circles. This is an excellent way of improving your balance.

Circles in the Dressage Test

At the Preliminary level of dressage (level 1) you will need to show 20m circles in trot and canter, and half 10m circles in walk. At the advanced level you will need to show an 8m circle in collected canter. For more information on the movements at each level visit the Dressage page at http://www.limebrook.com/dressage.html

Trish Haill is the Webmaster for Limebrook Farm Riding School and Livery Yard. This ever growing website is a great resource for riders and horse lovers everywhere. Check out the site at http://www.limebrook.com