Healthcare Professional Understanding and Response to Alarms

Healthcare Professional Understanding and Response to Alarms Obstacles and Solutions for Healthcare Professionals (HP)’s understanding and response to monitor alarms: A literature Review Image(1) Abstract: The alarm systems employed in the intensive care unit (ICU) are vital for patient care and safety. They give readings for heart rate, oximetry and the cut-offs for the alarms are set by the individual or the manufacturer. There have been adverse events associated with alarms systems and recently, it has become a serious health hazard. The purpose of this paper is to review the literature for healthcare professionals’ (HP) understanding and response to monitor alarms in the hospital and any solutions proposed. Mohammad Omar Aziz 112120367 University College Cork 24/11/2014 INTRODUCTION: The alarm systems give readings of many physiological variables including heart rate, respiratory rate, oximetry and the cut-offs for the alarms are set by the individual or the manufacturer(2). These alarms can also be silenced. The machine employed in NICU in CUMH contains a Stop and Pause function(2). The Pause function silences all alarm parameters for 2 minutes, whereas the stop function silences only one particular alarm parameter for 1 minute. There is also a setting known as ‘Extreme alarm’, which alerts the HP when the particular physiological variable has gotten worse (eg oxygen saturation has been gotten less than 80% for neonates in CUMH). The reason for such functions (ie stop and pause) is that an alarm may not be deemed serious by the HP and the HP may decide to ‘wait and see’ if this is just an isolated incident. Also, alarms may not be as serious and the HP may deem it to be a ‘false positive (FP)’. This is because the alarms ar e just one input of information for the HP and he/she takes into account other inputs, such as clinical context(3). Also, the patient population itself in the ICU is to be considered. For example, it is common for neonates to have episodes of tachycardia and as such, isolated incidents would not cause the HP to be worried about patient. Rather, the alarms become worrisome if the variables are not coming back to normal limits (i.e. assessing if the alarms are continuing to sound as opposed to being an isolated incident)(2). The alarms are aimed to have a high specificity so that a true event is not missed. However, this can be burdensome. In a day in the ICU, this could translate to 187 alarms/bed, of which majority are false positive alarms(4). Another study found that for a cardiac surgery, roughly 1 alarm would go off every minute and approximately 80% of the alarms had no practical benefit (i.e. no clinical action could be taken)(5). Alarm systems can lead to adverse events and in 2010, alarm hazards was amongst the top 10 technology health hazards and in 2012, it had surpassed the others to become the leading technology health hazard(6, 7). The potential consequences of adverse events can be fatal as one of the databases for the FDA had reported that in a span of 3 years, from 2005 to 2008, there were 566 deaths related to monitor device alarms(8). In Ireland (NICU in CUMH), a neonate could have been hypoxic after a prolonged period due to misunderstanding of alarms, highlighting the global scale of such a problem(2). OBJECTIVE: This literature review was aimed to see if there are any papers dealing with HP’s understanding and response to monitor alarms in critical care setting and ways in which it is affected. Response and understanding in this paper refers to whether the staff: (i) responded/became aware of the alarm and (ii) carried out the correct response based on the alarm that sounded. These specifically are: Factors affect their response and understanding Effects of in-adequate response and understanding Solution(s) proposed to improve response and understanding Difference in understanding after stratification: between doctors and nurses, between specialties of ICU (e.g. CCU vs NICU) The conclusions drawn from the review will give insight into audits carried out in CUH regarding monitor alarms and solutions to ‘close the audit loop’. It will also allow for comparison of HP’s understanding in CUH to others hospitals. METHODS: Inclusion Criteria: Papers that dealt with the following: HP’s understanding/interaction with monitor alarms Alarms employed in Hospital (as opposed to ambulatory care) The following databases were searched: PubMed, Cochrane Collaboration. Preference was given to most recent articles as well as review articles. Abstracts were reviewed and if they met inclusion criteria, they were read. Filters applied: ‘English’, ‘Full Text available’, ‘Human’ Search terms entered included: ‘Monitor Alarms’, ‘Monitor alarms + Understanding’, ‘Monitor Alarms + Fatigue’, ‘Alarms’. Cochrane database yielded no articles with any of the search terms, except ‘alarms’( which yielded articles, but they had no relevance to topic). RESULTS: Alarm fatigue and its effect on HP’s understanding Alarms, by their nature, are in place to alert the staff that the patient needs attending to and have limits set in place such that a true event is not missed. As a result, they have a tendency to stuffer from a high false positive rate (FP) and thus, poor positive predictive value (PPV)(9). Clinically insignificant and/or FP alarms range from 80-99%(9, 10). Another study done showed the PPV to be as low as 27%(11). This contributes to staff not being aware of the alarms (desensitization), mistrust in the alarms and not responding to them(3, 9). As stated earlier, 566 alarm related deaths were reported to FDA from 2005 to 2008(8). Alarms can be induced by patient motion, which further contributes to false alarms(12). These cases can be avoided by staff silencing the alarms for a set period of time prior to moving the patient(11). Due to the high FP rate of alarms, the more reliable the alarm is (i.e. how well it predicts true alarm), the higher the response will be from staff(9). Also, the factors that determine response can be divided into: intrinsic to the alarm itself and extrinsic. Internal factors are whether alarm continues to sound or it ceases to sound soon (i.e. alarm duration). Also, the more ‘rare’ or unlikely for an alarm to go off, the more it would warrant a response. The limits set by the staff for the alarm may not be appropriate for the given patient resulting in having too many alarms that are not actionable(5). Extrinsic factors to an alarm are: work load, task complexity, patient condition. The higher the workload or task complexity, HP’s have a lower tendency to react to it. The opposite is true for the more severe the patient’s condition is(3, 9). Solutions proposed to improve response and understanding: To reduce the high FP rate, and ultimately, improve alarm response, different solutions have been proposed in the literature. Since alarms often self-correct, by adding a delay time to the alarms before they sound can reduce the number of alarms themselves(11). ‘Smart Alarms’ can be introduced that have algorithms in place that will alert only if it is a true alarm(9). These systems take trends into account as opposed to raw data itself. Increasing the ‘volume’ of alarms higher than environment was recommended (as opposed to having a fixed dB level for an alarm sound)(13). This is supported by the fact that sound may not be heard due to: room doors closed, events such as noise produced by machines that clean the floors(14). It is further supported by the fact that most hospitals have exceeded the noise levels recommended by WHO, and as such, the volume of the alarm should be customized to the environment to ensure it is heard(15). However, other literature f avours different modalities of alarms (i.e. visual or vibrating), since the noise contributes to symptoms in staff such as fatigue and concentration problems(16). Standardization of alarm sounds would decrease the number of alarm sounds the HP’s have to ‘learn’(17). Another solution proposed has been to have a central notification centre as opposed to a staff monitoring patient(s)when their alarms go off, which was reported to be advantageous. Alarm limits should be changed to levels by HP’s taking into account: if the alarm goes off, it will require some sort of clinical action, and the patient’s specific condition(s)(9). This is in contrast to when HP’s do not change limits and keep to default levels set by manufacturer, which are set to different values depending on the country (18). Customizing limits will decrease the alarm load and increase sensitivity to alarms by healthcare staff(18). Ongoing training should be provided to the staff with an aim to have the training environment as closely simulating the real clinical environment as possible(9). Training in the form of showing staff how to troubleshoot alarms should also be implemented. Alarms that have built in ‘intelligent system’ to assist in troubleshooting have shown to be beneficial. In a simulated environment, intelligent alarms helped the anaesthetists solve various breathing circuit faults 62% faster (45 sec to 17 sec)(19). DISCUSSION: Pros and Cons of Literature: There is evidence in the literature on the potential adverse events of alarms and reasons for such events and the severity of this problem. Solutions to improve understanding were also given. There was no study found that dealt with whether staff understood how to operate the alarms properly and to what extent did this problem exist. Information related to the severity of the problem only indicated a problem in understanding and response. However, there was no mention of whether any of the deaths were due to the HP’s not knowing what buttons to press once the alarm came on (eg did they silence the alarm for too long without knowing). This could be a potential barrier in improving understanding since solutions such as ongoing teaching can not be customized effectively. The review of the literature has only taken data from nurses or doctors, but not both. Therefore, comparisons in understanding between doctors and nurses could not be made. Majority of data and studies was done on nurses. However, this is expected since nurses would’ve interacted with the alarms more frequently than doctors since they are more frequently at the bedside of the patient and are the first to react to any alarms of the patient. Also, no studies have been found to compare understanding between HP’s of different specialties. It would be expected that any critical unit, regardless of specialty, would’ve had the same obstacles to monitor alarm understanding since the reasons for alarm fatigue are the same across the specialties. However, knowing of such studies would yield information about which alarm(s) specifically do the staff understand better or worse? Also, there is a possibility that the understanding diminishes when certain machine alarms are simultaneously on (e.g. ventilator machine as well as monitor alarm). As a result, training could be tailored to each specialty and emphasis placed on areas where their understanding is not sufficient. CONCLUSION: The literature review suggests that the level of monitor alarm understanding and response is not sufficient. Also, this problem of monitor alarm response and understanding is serious and not to be taken lightly. In terms of barriers in response and understanding, they include: too many alarms as well as types, low PPV of alarms, inappropriate limits. Also, no studies have been found that stratify this understanding based on staff (ie doctors or nurses) or specialty (e.g. CCU vs NICU). Moreover, the reasons identified for barriers in understanding of alarms did not appear to be different between doctors and nurses. No studies have been found that assess, specifically, whether the HP knew difference in operating the alarm system itself (ie did they press correct button to silence an alarm). The studies looked at whether they reacted to the alarms and if they did, did they carry out the correct response. Solutions proposed include: incorporating delays, having smart alarms, using different modalities for alarms as well as having continuous teaching. HP’s use alarms as one of the inputs in their decision making process. While alarms are there to alert of any physiological variable crossing a limit (in order to not miss a true event), this leads to the PPV being compromised and as such, the confidence and response to such an alarm decreases. Thus, moving forward, it is essential that strategies are aimed to increase the PPV of alarms, decrease the number of alarms themselves, and incorporate continuous teaching to ensure that the input alarms give holds more weight for the HP in the decision making process. Word Count: 1973 (Excluding abstract and methods) REFERENCES: 1.Insights A. [Online]. 2014 [Nov. 21, 2014]. Available from: http://www.anesthesiainsights.com/news/. 2.Aziz MO. Monitor Alarms (CUMH) discussion with Brian (Biomed) and Prof. C. Ryan (Neonatologist). Monitor Alarms in CUMH ed2014. 3.Bitan Y, Meyer J, Shinar D, Zmora E. Nurses’ reactions to alarms in a neonatal intensive care unit. Cogn Tech Work. 2004 2004/11/01;6(4):239-46. English. 4.Drew BJ, Harris P, Zegre-Hemsey JK, Mammone T, Schindler D, Salas-Boni R, et al. Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients. PloS one. 2014;9(10):e110274. PubMed PMID: 25338067. Pubmed Central PMCID: Pmc4206416. Epub 2014/10/23. eng. 5.Schmid F, Goepfert MS, Kuhnt D, Eichhorn V, Diedrichs S, Reichenspurner H, et al. The wolf is crying in the operating room: patient monitor and anesthesia workstation alarming patterns during cardiac surgery. Anesthesia and analgesia. 2011 Jan;112(1):78-83. PubMed PMID: 20966440. Epub 2010/10/23. eng. 6.Institute E. Health Devices: 2010 TOP 10 TECHNOLOGY HAZARDS. US. 7.Institute E. Health Devices: TOP 10 HEALTH TECHNOLOGY HAZARDS FOR 2014. US: ECRI Institute, 2013. 8.(FDA) FaDA. FDA Patient Safety News: Show #106, January 2011: Alarming Monitor Problems. January 2011. Report No. 9.Cvach M. Monitor alarm fatigue: an integrative review. Biomedical instrumentation technology / Association for the Advancement of Medical Instrumentation. 2012 Jul-Aug;46(4):268-77. PubMed PMID: 22839984. Epub 2012/07/31. eng. 10.Lawless ST. Crying wolf: false alarms in a pediatric intensive care unit. Critical care medicine. 1994 Jun;22(6):981-5. PubMed PMID: 8205831. Epub 1994/06/01. eng. 11.Gorges M, Markewitz BA, Westenskow DR. Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesthesia and analgesia. 2009 May;108(5):1546-52. PubMed PMID: 19372334. Epub 2009/04/18. eng. 12.Chambrin MC, Ravaux P, Calvelo-Aros D, Jaborska A, Chopin C, Boniface B. Multicentric study of monitoring alarms in the adult intensive care unit (ICU): a descriptive analysis. Intensive care medicine. 1999 Dec;25(12):1360-6. PubMed PMID: 10660842. Epub 2000/02/08. eng. 13.Minoru H, Eiji S, Mototake T, Kenichi K, Hirosuke K, Satoshi W. Characteristics of Auditory Alarms for Medical Equipment and Future Issues. Journal of Clinical Engineering. 2005;30(4):208-. 14.Sobieraj J, Ortega C, West I, Voepel L, Battle S, Robinson D. Audibility of patient clinical alarms to hospital nursing personnel. Military medicine. 2006 Apr;171(4):306-10. PubMed PMID: 16673744. Epub 2006/05/06. eng. 15.McLaren E, Maxwell-Armstrong C. Noise pollution on an acute surgical ward. Annals of the Royal College of Surgeons of England. 2008 Mar;90(2):136-9. PubMed PMID: 18325214. Pubmed Central PMCID: Pmc2443309. Epub 2008/03/08. eng. 16.Ryherd EE, Waye KP, Ljungkvist L. Characterizing noise and perceived work environment in a neurological intensive care unit. The Journal of the Acoustical Society of America. 2008 Feb;123(2):747-56. PubMed PMID: 18247879. Epub 2008/02/06. eng. 17.Phillips J, Barnsteiner JH. Clinical alarms: improving efficiency and effectiveness. Critical care nursing quarterly. 2005 Oct-Dec;28(4):317-23. PubMed PMID: 16239820. Epub 2005/10/22. eng. 18.Block FE, Jr., Nuutinen L, Ballast B. Optimization of alarms: a study on alarm limits, alarm sounds, and false alarms, intended to reduce annoyance. Journal of clinical monitoring and computing. 1999 Feb;15(2):75-83. PubMed PMID: 12578080. Epub 2003/02/13. eng. 19.Westenskow DR, Orr JA, Simon FH, Bender HJ, Frankenberger H. Intelligent alarms reduce anesthesiologists response time to critical faults. Anesthesiology. 1992 Dec;77(6):1074-9. PubMed PMID: 1466459. Epub 1992/12/01. eng.

Temptation In The Odyssey

This essay is about temptation in the Odyssey, more specifically temptation and its role in the book. Showing how food displays everyday temptation and how Odysseus recklessness causes his own troubled journey home. Temptation in laments terms is the desire to do something you know you shouldn’t do. This theme is something that is repeated constantly throughout the Odyssey in a multitude of ways and for many reasons. It shows on a scale how human and mortal the characters really are.At the two extremes of the scale there are those who are favored by the gods and are even sometimes called â€Å"god like† and there are those who are just mortals, no special treatment from up high. Yet all fall pray to temptation at some point in time, event he great â€Å"god like Odysseus†. You will never see a god fall victim to temptation in the odyssey, for it would ruin the message and meaning of temptation on humanity. It is meant to subtly show that we as humans are imperfec t, that no matter how high we reach and how noble we are we are still mortals and therefor susceptible to any and all mortal weaknesses.We are unable to control it because we are human, and because we are human we are unable to control it. Temptation in the odyssey does more than just hint at and reinforce our humanity in comparison to the gods, it goes much deeper and starts to talk about how as humans we should act and behave. To be fall victim to temptation shows our humanity, but to exaggerate on it and show what happens if you constantly loose to temptation you start to see the difference between a civil human being and a non-civil human. Loosing that civility puts you in a very low place in society.The Odyssey is an encoded â€Å"how to live in Greek society†. It talks about how to be goods hosts, how to treat people, how to behave and on and on the list will go. Temptation by food seems to be mentioned more than any other type of temptation. That is not to say that eve ry time a character eats bread or drinks wine that some greater force tempts him. It also serves as part of a cultural function through banquets for celebration and with the act of xenia through out the book. Food is featured a lot in a lot of the scenes and serves as more of a general statement about temptation in The Odyssey.â€Å"Of all the cities he saw, the minds he grasped, the suffering deep in his heart at sea as he struggled to survive and bring his men home but could not save them, hard as he tried- the fools- destroyed by their own recklessness when they ate the oxen of Hyperion the Sun, and that god snuffed out their day of return†1. The very first scene in the book talks about temptation and the â€Å"recklessness† of Odysseus’s crew. This scene is later depicted when Odysseus is describing his journey to the Phaeacians. Odysseus comes to the island of the Sun, a place filled with herds of immortal cattle and sheep.The island its self presents no im mediate threat the Odysseus and his crew. Odysseus has been warned by Cerci about the Sun’s herds and flocks â€Å"If you leave these unharmed and keep your mind on your journey, you might yet struggle home to Ithaca. But if you harm them, I foretell disaster for your ship and crew, and even if you escape yourself, you shall come home late and badly, having lost all your companions. †2. Odysseus does not even want to stop on the island and push through the night for fear that his crew will be reckless and give into the temptation that walks the island.His crew decides they have had enough for one day and need rest. The Island its self is a sort of temptation, a place to dock their boat and give there bodies rest, yes it would be nice to do that after rowing all day but not really necessary. It is the gods will that they are trapped on the island for a month and are tested yet again. Out of food and wine the crew becomes reckless, they have to decide whether they should forsake the sacred oath they swore to Odysseus to not touch the immortal animals or starve and pray to the gods they will be able to catch enough food to eat.Knock, Knock whose there? Temptation! This could have been the last a final test against Odysseus and his crew before they sailed home, but they were tempted by the gods to slaughter the sacred animals and eat their lives away. This event put Odysseus back quite a ways. On the verge of almost being home the greatest antagonist of all; temptation, walks up on four legs and utterly wins again. Although food is prominently the number one source for temptation but it is not the home run, the granddaddy of them all or the big kahuna of temptation.That spot is reserved for an act of recklessness that the â€Å"god like Odysseus† fell victim to. Kleos is a term used in epic poetry that speaks to the immortal fame or glory of a character. Characters earn it by doing deeds that could possible define who they are. Odysseus makes very little mistakes in the Odyssey. He is constantly praised for not only being strong and cunning physically but mentally as well. Odysseus and his crew came across the land of the Cyclopes. Odysseus was aware of these â€Å"Lawless savages who leave everything up to the gods.†3 Odysseus and his crew see an island just off the shore untouched by man and thriving with animals and nature. That is where they beach their ships in the midst of night. When morning came the crew hunted down a hundred or so goats and feasted all day, while marveling at the Cyclopes across the water from them. Being the intellectual he is Odysseus decides that it would be a good idea to take a few of his men and sail over to an island just of the shore to see â€Å"what those men are like, wild savages with no sense of right or wrong or hospitable folk who fear the gods†4.This is just the beginning of Odysseus’s brief recklessness. That scene makes Odysseus sound like he is just genuin ely interested in meeting a Cyclopes since he never has and maybe never will get this chance again. But, there is and underlying purpose that Odysseus feels is worth perusing. Since he is not sure how the Cyclopes act he is optimistically hoping that he will be treated the way that everyone else has treated him, with xenia. Odysseus is hoping to get food and gifts out of the Cyclopes. This temptation of greed is what locks Odysseus into his lengthy voyage home.If Odysseus was just wanting to look around and seeing the land that of the giants for what it was would have been ok, but Odysseus had already fallen in to the webs of temptation.. They didn’t need anything at this point, they were eating lavishly with an upwards of a hundred goats and sheep where they crew had first landed. They could have eaten and than been on there way. Heading to the high cave that was just off the shoreline Odysseus and his men take a look around and finally meet this giant Cyclopes.His size and strength intimidate Odysseus and his crew into a corner. The Cyclopes asks them who they are. Odysseus answers with a sort of arrogant response that gives you the underlying purpose for wanting to go to the cave. He tells them that they are Greeks blown of course and that he was â€Å"hoping you will be generous to us and give us the gifts that are due to strangers respect the gods, sir. †5 This arrogant response really infuriates the giant. He responds by picking up two of the crewmembers smashing them on the rocks like puppies and eating them limb-by-limb.Eventually Odysseus is able to use his canny mind to hatch a plan and stab the Cyclopes in the eye to escape to his ship. Once he gets on the ship and ready to sail off Odysseus rubs the fact that he tricked the Cyclopes and escapes in his or what ever was left of his eye. He yells â€Å" Cyclopes, if anyone, any mortal man, asks you how you got your eye put out tell him that Odysseus the maurder did it, Son of Laertes, w hose home is Ithaca. † 6 This temptation of Kleos is responsible for all of the trouble that falls upon Odysseus, his crew and even his family.There was no need to yell out your name to the Cyclopes you just blinded except for purposeless glory. Odysseus had already won him self a Kleos, â€Å"God like Odysseus†. The need for more glory blinded Odysseus and ended up being his greatest downfall. Temptation is tough to turn away from. The human world is filled with it, in fiction and the real world. The Odyssey uses temptation to show how human we really are and how easy it is to succumb to the temptation that the world offers.Homer uses food to show how easily one can be tempted as well as how much temptation there is in the world. Homer also shows that no matter how high you climb in life even if you become god like, you are still human and therefore fallible. Odysseus proved that with his reckless behavior while in the land of the giants. Through the use of food Homer is able to show how temptation is everywhere and that it is in our human nature to fall victim. Homer also shows that even the mightiest of men can slip and fall sometimes through Odysseus trials and tribulations.

The San of the Kalahari Desert

The San of the Kalahari Desert The San also known as â€Å"Bushmen† are one of the well-known foraging and hunting communities. They have made the Kalahari Desert located in Southwest Africa their home for many years. These communities are called bands that consist of multifamily groups with a size ranging from 25 to 50 people. â€Å"Family, marriage, and kinship, gender, and age are the key principles of social organizations in foraging societies† (Nowak & Laird, 2010. Section 3. 7). In this paper you will have a brief understanding of the kinship system of the San Tribe, as well as how their environment influences their behavior and interactions. The nuclear family would consist of a mother, father and their children. This family is considered the most common in the foraging societies because they are able to adapt to various conditions. Bands are made up of several multifamily groupings such as nuclear families. It is very important how these families are related because it will determine how they will act towards each other. The bands will sometime include extended family members which will be beneficial in circumstances such as cooperation and sharing amongst the community. Both men and women work together to provide for the community as a whole. Women are responsible for 80% of the san diet (Nowak & Laird, 2010). Women are the primary gathers; their diet is consisting mostly of nuts and fruit. The men are responsible for 20% of the diet. They provide meat from their hunts. The women are able to gather enough food that will last a full week in two to three days. They can enjoy each other’s company the rest of the time. The men and women work together by mentioning areas of vegetation or animals they may come across on their gathering and hunting trips. The good and services produced by the men and women are shared amongst the community. They rely on each other for the gathering and hunting of food. Everyone’s participation is very important. There is an unspoken promise on the exchange of the goods and services. This is called reciprocity, â€Å"a mutual, agreed-upon exchange of goods and services. Reciprocity works well n a society in which food items need to be consumed quickly due to spoilage† (Nowak & Laird, 2010. Section 3. 3). Foragers have to stay mobile, so there is no room for stock piles of food or goods. Everything has to be used immediately; there is no need for storage because they can always get what they need from the environment. This type of reciprocity would be generalized, there are no expectations for nothing in return, in due time everything will work it- self out. The men are not always successful in their hunts but when they are the meat is prepared and distributed throughout the community. This will also be the same for the food that comes from the gatherings that the women go on as well. This insures that everyone is fed and that both men and women do not have to look for food every day. Everyone takes their turns in providing for the entire band. These interactions promote close bonds and social ties. They are not only sharing with just their neighbors but these are also their kin, no one is an unfamiliar person in these communities. In the San Tribe no one is of more value to another. Since everyone shares everything it leaves little room for jealousy. As in our society, we do not forage, we can pretty much walk in any store and purchased pre-prepared food and goods. There is little thought put into where our food will come from or where we live. The most important thing for us would be making sure we have the funds to be able to do the things that we would like to and purchase the things that we absolutely need. We focus on the needs of our immediate family such as our partners, children and parents vs. considering our communities. I feel that in our society most people are for self only. No one is really willing to help each other no more. I believe that if we had kinship systems in placed things would be a lot better. We could all come together and be there for each other. Making sure everyone has something and no one is left without. There are services shared among my neighbors such as lawn services, babysitting and clothing. We do these things for each other never expecting anything in return. References Nowak, B. & Laird, P. (2010) Cultural Anthropology. Retrieved from https://content. ashford. edu/books/AUANT101. 10. 2/sections/sec3. 7 (EBOOK) https://content. ashford. edu/books/AUANT101. 10. 2/sections/sec3. 3 (EBOOK)

An Analysis Of Rick Moody s Boys - 1153 Words

Each story makes use of a very unique tone and form of narration yet these same qualities can be compared to some extent across these essays. The authors utilize different forms of writing to convey their intended focus to the audience. I found each story relative to one another in that they all seemed to touch of the subject of the roles of different genders in our contemporary society maybe even across different cultures. Rick Moody s short story Boys is written with a distinct style. The author uses a form of a stream of consciousness to convey the purpose at hand, which encompasses writing as if without hesitation or editing - whatever came to Moody’s thoughts, he transferred to text. There was also a substantial use of the word â€Å"boys†, placing emphasis on the central meaning of the story. The style is thoroughly descriptive and fails to leave any details of the boys lives out. This quality donates a sense of reality and creates a bond between the reader and the characters. The tone of the story comes of as particularly unbiased and serious, as if the author were just stating purely factual information. As events become more somber in the boys lives, the author approaches a more sympathetic tone. The boys were supposed to be kids, fooling around playing games and living a care-free childhood, but these boys found themselves in scenarios no boy or child should ever encompass. In the story â€Å"Boys† by Rick Moody from the book Literature To Go, The narrator writesShow MoreRelatedProject Managment Case Studies214937 Words   |  860 PagesCanada 118 Riverview Children s Hospital 124 The Evolution of Project Management at Quixtar 145 3 PROJECT MANAGEMENT CULTURES 151 Como Tool and Die (A) 153 Como Tool and Die (B) 157 Apache Metals, Inc. 160 Haller Specialty Manufacturing 162 The NF3 Project: Managing Cultural Differences 163 An International Project Manager s Day (A) 172 An International Project Manager s Day (B) (see handout provided by instructor) An International Project Manager s Day (C) (see handout provided byRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 Pagesand permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. To obtain permission(s) to use material from this work, please submit a written request to Pearson Education, Inc., Permissions Department, One Lake Street, Upper Saddle River, New Jersey 07458, or you may fax your request to 201-236-3290. Many of the designations b y manufacturers