Monday, January 27, 2020

Reflection on Inter-professional (IP) Working

Reflection on Inter-professional (IP) Working Introduction. Professional development and up to date practice is a requirement of the nursing profession. Reflection is a vital component of this (Gustafson and Fagerberg, 2004) and allows nurses to critically and actively evaluate their practice in the light of current research and their own learning. Reflection has been defined as a process of describing experiences and then using reflection as a basis from which to ask questions about practice (Bowden, 2003). The NMC (2004) states that nurses should use professional standards of practice to self-assess performance. This essay evaluates my own learning in relation to the NMC Standards through the use of a reflective cycle by Gibbs (1998) (see Appendix). The focus of the reflection is Inter-professional (IP) working. IP is a fundamental component of education programmes for Nursing, Midwifery and Allied Health Professions (Pollard et al, 2004). The NMC (2004) states in the standards of proficiency for entry to the register that student nurses sh ould: â€Å"consult other health care professionals when individual or group needs fall outside the scope of nursing practice.† (p26). â€Å"utilise a range of effective and appropriate communication and engagement skills† (p 27). â€Å"seek specialist/expert advice as appropriate.† (p28) â€Å"establish and maintain collaborative working relationships with members of the health and social care team and others.† (p32) â€Å"participate with members of the health and social care team in decision-making concerning patients and clients.† (p32) â€Å"review and evaluate care with members of the health and social care team and others.† (p32) Description: What Happened. In providing care for clients allocated to me on the general medical ward, I engaged with the case of Mrs B, who had been admitted seven days previously from a nursing home with dehydration and confusion. Mrs B was registered blind, and required full nursing care which was delivered according to a care plan. Having been treated with IV fluids and encouraged with diet and oral fluids, she had made a good recovery and my role was to implement a discharge planning process with her, so that she could return to the nursing home. In order to assess her discharge needs, I consulted occupational therapy colleagues, dieticians, medical colleagues and social work colleagues to ensure that her needs would be met in her home environment. I also attended the ward rounds with the medical consultant and his team, to gain the expert advice needed to ensure all Mrs B’s needs were met and that she was well enough for discharge. In collaboration with other nursing colleagues and the occupational therapist, dietician and social worker, I reviewed the care plan, carried out a thorough reassessment and evaluation of Mrs B’s condition, medication and ongoing care needs, and drew up a comprehensive discharge plan, including communication to the receiving nursing home. I also discussed all of her needs with Mrs B, and her family, and ensured their input was included into the discharge plan. Feelings The sense of responsibility attached to discharge planning is considerable, and I was aware that I needed to ensure all Mrs B’s needs had been addressed. I felt uncomfortable in some of my interactions with other professionals, and frustrated at times with communication issues. Evaluation I felt confident in care planning and evaluation, having had ample opportunities to develop these skills over my training, but was also aware of the scrutiny of colleagues. This kind of scrutiny was double-edged, in that I felt uncomfortable to be the subject of scrutiny but that it also helped me to focus on the highest standards of care. It was difficult sometimes to ensure timely communication with these colleagues, and the responsibility for ensuring collaborative working and good communication was also somewhat stressful. Analysis At this stage of my training, I was very aware of requirements that I meet standards of competency related to the nursing role. This led to an initial reconsideration of what competency actually is. For example, competency has been described as being able to complete tasks (Gonczi 1993), but professional competence is much more than this. In this case, the ability to complete single tasks was evident in my ability to plan and manage care. Identifying individual nursing tasks in relation to Mrs B was a part of this process, and the process contains in-built mechanisms of evaluation which, if applied objectively, allow the nurse to ‘tick off’ tasks as achieved or in progress. But the complexity of care planning does not led itself to a simple task-based approach, and it is here that the greatest challenge to competence can be identified. The holistic approach to nursing requires the nurse work in a collaborative, inter-professional manner. In particular, it is important to take into account the context of nursing care and presence and contribution of others, including their effect on performance (Ashworth and Saxton, 1990; Field, 1991; Collins, 1991). The NSF for Older People demands the provision of care services which are based around the needs of older people and their carers (DOH, 2001). In order to meet these needs, there is a need to employ â€Å"an integrated approach to service provision†¦ regardless of professional or organisational boundaries.† (DOH, 2001, p9.) Thus IP working can be seen to be fundamental to the process of discharge planning for Mrs B. One of the challenges for my practice was to identify all the other professionals who might need to be engaged in this process. Some of these were obvious, such as the medical team, other nurses, and the dietician, who already played a fundamental role in her care management and implementation. The other professionals involved were not as obvious, and I had to consult with senior nurses to identify where other professional colleagues might be important in discharge planning. There were also other challenges in this process, in engaging with other professionals and carrying out individualised discharge planning. The NSF for Older People recognises that this has been a problem in the past, acknowledging that organisational structures have hitherto had the effect of impeding the provision of individualised care management packages (DOH, 2001.) One of the difficulties I reflected upon was the conflicting demands of such an individualised process which formed only one of my many nursing duties in a busy medical ward environment. And the sense of achievement I felt in taking such responsible role was not always reflected in the ways in which other colleagues interacted with me. Discussion with other nursing colleagues, and some exploration of the theoretical and research literature on this subject identified that this is no new experience for nurses engaged in IP working. Research seems to indicate that medical hegemony leads to the pivotal role of nurses in IP working being largely unacknowledged, which can affect the development of collaborative care practices (Coombs and Ersser, 2004). However, a new awareness of this issue made me more confident and proactive in engaging with other professionals, which led to a negotiation of sorts, during the communication process, between my role and some of their perceptions of my role and position in the institutional hierarchy. There were definite lessons to be learned from this in particular. Adapting modes of communication, paying attention to communication, and formalising communication through detailed record keeping all supported this process. I also learned how vital the nursing role is in inter-professional, client-centred working, if the highest standards of care are to be consistently achieved and maintained for every client. Some authors argue that nurses, as the primary care contact for the majority of patients, should seek to distinguish and celebrate their practice as professionally discrete from that of others because of their intimate and sustained knowledge of their clients (Price, 2006). This is a really important point, and one which allows me to take my experience forward into future practice and build on my confidence in addressing challenging situations. Conclusion I felt that I ‘matured’ through this particular care incident and my own reflections upon it, coming to terms with a sometimes uncomfortable reality of persistent hierarchies, stereotypical beliefs and defensive protection of professional role boundaries. My own competence in achieving an excellent discharge process, engaging in communication despite considerable challenges, and ensuring individualised care in an IP context were all signposts of considerable achievement in my professional journey. However, I could also have perhaps worked more collaboratively with other colleagues, qualified nursing colleagues in particular, who might have been able to give me some advance warning of these issues and perhaps identified ways in which I could overcome them. Instead, I learned the hard way. Action Plan Explore alternative strategies for inter-professional communication. Carry out further research into the challenges of IP working and its benefits. Explore ways to safely challenge rigid roles and hierarchies whilst still providing client-centred care. Seek out support from colleagues when challenging situations arise and build on this experience in future nursing practice. Carry out future cycles of reflection on similar clinical issues, and compare these to previous reflections to clearly signpost my own learning and development. References Ashworth, P. and Saxton, J. (1990).On competence. Journal of Further and Higher Education, 14, 3-25. Bowden, S.D. (2003) Enhancing your professional nursing practice through critical reflection. Abu Dhabi Nurse Summer 28-31. Collins, M. (1991). Adult education as vocation. London: Routledge. Coombs, M. Ersser, S.J. (2004) Medical hegemony in decision-making – a barrier to interdisciplinary working in intensive care? Journal of Advanced Nursing 46 (3) 245-252. Department of Health, (2001) National Service Framework for Older People. Available from www.dh.gov.uk/publications accessed 22-3-07. Field, J. (1991). Competency and pedagogy of labour. Studies in Education of Adults, 33(1), 41-52. Gonczi, A. (1993). Competence and competencies: A global perspective. Paper presented at the First National Conference on Competencies in Nursing Adelaide: Australian Nursing Federation (SA Branch) Gibbs, G. (1988) Learning by Doing. A Guide to Teaching and Learning Methods Further Education Unit, Oxford Polytechnic, Oxford Gustafsson, C. and Fagerberg, I. (2004) Reflection: the way to professional development? Journal of Clinical Nursing 13 271-280. Knight, P. (1995) Assessment for Learning in Higher Education London: Kogan Page. Neary, M. (2000) Responsive assessment of clinical competence. Nursing Standard 15 (10) 35-40. Nursing and Midwifery Council (2004) Code of Conduct Available from www.nmc-uk.org Accessed 30-4-07. Pollard, K.C., Miers, M.E. Gilchrist, M. (2004) Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health and Social Care in the Community 12 (4) 346-358. Price, B. (2006) Exploring person-centred care. Nursing Standard 20 (50) 49-56. Appendix Gibbs (1988) Cycle of Reflection http://www.nursesnetwork.co.uk/images/reflectivecycle.gif

Sunday, January 19, 2020

A Wrinkle in Time by Madeleine L’Engle Essay -- essays research paper

A Wrinkle in Time by Madeleine L’Engle Madeleine L’Engle uses a creative mixture of three different story-book motifs for building the story line in her book A Wrinkle in Time. From beginning to end Meg, Charles Wallace, and Calvin go through adventure after adventure bursting with animated fairy-tale characteristics, a model preteen coming-of-age theme, and a subtle Christian suggestion. The three are intertwined naturally, and work well within the science-fiction twist of this very believable fantasy tale. The main character Meg Murry is the perfect innocent child turned heroine. As in the typical coming-of-age theme, the beginning of the story presents 13 year old Meg as young, and terribly dependent on others. Constantly wallowing in self-pity, Meg enters the first chapter emotionally immature with a dismal self-centered â€Å"why-must-everything-happen-to-me† attitude [P.7]. Although her five year old younger brother Charles Wallace is â€Å"rumored to be not quite bright† [P.9], he is actually extremely advanced for his age and Meg’s main caretaker. â€Å"How did Charles Wallace always know about her? How could he always†¦probe (and understand) with frightening accuracy† [P.8]? The two are remarkably close, and whenever life becomes too much for Meg, Charles Wallace reaches out to comfort her. All three—Meg, Charles Wallace, and their new found friend, 14 year old Calvin O’keefe—fit the average misunderstood characteristics found in many fairy-tale and preteen stories. While both Calvin and Charles Wallace are misunderstood by most, Charles Wallace at least has the support of a loving home, with dysfunctional preoccupied parents, Calvin, on the contrary, has no one to understand and appreciate him. â€Å"The funny part of it† he says, â€Å"(is that) I love them all and they don’t give a hoot about me†¦I care, (but) nobody else does† [P.40]. All three children, each with his own special individual qualities, strive to get along in their everyday world. The boys don’t seem to care much what others think, only Meg, with her many temperamental imperfections, flounders from day to day. Mixed in with this is a hint of an orphaned-child theme. Although none of the children are actual orphans, the thought is implied first through Mr. Murry’s absents, and Meg’s constant wish of â€Å"if only father (were here)† [P.4]; and then with Calvin’s horribly neglectful family—he is, in essen... ...er to her caretaker, while she challenges It in an attempt to save her brother. In the grand finale, love concurs the incredibly evil force. Love—the one thing Meg possesses that It doesn’t†¦Ã¢â‚¬ I love you Charles Wallace† she cries, â€Å"My baby brother who always takes care of me. Come back to me†¦come away from It, come back, come home. I love you† [P.208] The message is written all through the text. God is stronger than Satan. God is love, and love is stronger than It. Once again â€Å"winning is everything† and the story finds a way of â€Å"making everything work out†[class lecture]. Charles Wallace is free, the Murry children have their father back, and Mrs. Murry has her husband back. Calvin has new friends and family with the Murrys. Meg, who has undergone her right of passage, finds friendship and self-confidence, is sure to return to daily life with a different more assertive and positive attitude. After the dark spiritual fight against It, Meg returns with a spiritual healing, and the absence of anger and resentment. Like The Lion, the Witch, and the Wardrobe the group returns at the exact moment they had departed on the quest, ready to take up where they left off—one big happy family.

Saturday, January 11, 2020

Essay On Problem Solving Techniques Used By Few Organisations

AcknowledgementAn old Chinese proverb says; When eating your bamboo sprouts, remember the man who planted them. Now that our sprouts are ready to eat, it is time for us to express our deepest gratitude to all those to have made this possible. We wish to express our sincere gratitude to our professor who guided and helped us from time to time to successfully conduct this research. We think her directions were the best thing that could happen to us and our project. We also would like to thank each other of our group members and hope you enjoy reading the report as much as we enjoyed making it.Contents Problem Solving Process & Steps Techniques used by various companies to solve their problems. 1) Nokia 2) Cadbury Dairy Milk 3) Tata Nano 4) Bisleri 5) Coca Cola 6) Allwyn photo copiersProblem Solving Process & StepsAs the owner of your own business you deal with problems on an almost daily basis. Being familiar with effective Problem Solving Techniques can dramatically affect the growth of your business. Although you find solutions to your problems, many businessmen and women are not really skilled in the methods of problem solving, and when solutions fail, they fault themselves for misjudgment. 1. Define the problemDiagnose the situation so that your focus is on the problem, not just its symptoms. Helpful techniques at this stage include using flowcharts to identify the expected steps of a process and cause-and-effect diagrams to define and analyze root causes. 2. Generate alternative solutionsPostpone the selection of one solution until several alternatives have been proposed. Having a standard with which to compare the characteristics of the final solution is not the same as defining the desired result. A standard allows us to evaluate the different intended results offered by alternatives. When you try to build toward desired results, it’s very difficult to collect good information about the process. Considering multiple alternatives can significantly en hance the value of your final solution.Once the team or individual has decided the â€Å"what should be† model, this target standard becomes the basis for developing a road map for investigating alternatives. Brainstorming and team problem-solving techniques are both useful tools in this stage of problem solving. Many alternative solutions should be generated before evaluating any of them. A common mistake in problem solving is that alternatives are evaluated as they are proposed, so the first acceptable solution is chosen, even if it’s not the best fit. If we focus on trying to get the results we want, we miss the potential for learning something new that will allow for real improvement. 3. Evaluate and select an alternativeSkilled problem solvers use a series of considerations when selecting the best alternative. They consider the extent to which: A particular alternative will solve the problem without causing other unanticipated problems. All the individuals involve d will accept the alternative.Implementation of the alternative is likely. The alternative fits within the organizational constraints. 4. Implement and follow up on the solutionLeaders may be called upon to order the solution to be implemented by others, â€Å"sell† the solution to others or facilitate the implementation by involving the efforts of others. The most effective approach, by far, has been to involve others in the implementation as a way of minimizing resistance to subsequent changes. Feedback channels must be built into the implementation of the solution, to produce continuous monitoring and testing of actual events against expectations. Problem solving, and the techniques used to derive elucidation, can only be effective in an organization if the solution remains in place and is updated to respond to future changes.Techniques used by various companies to solve their problems.1) NokiaAs we all know, Nokia had for so many years used the symbian operating system in their phones. It was working fine and Nokia had captured the Indian phone market very well. There was no competition to it from left right or centre. But in 2008 came a breathtaking technology by Google. They invented the Android OS. It became a benchmark for the mobile phone companies. Each and every phone started making their phones with the latest android technology, as android was fast, modern and the most important, user friendly. While Nokia still stuck to its old symbian os, and did not use the android technology. Slowly and gradually, Samsung took over the Indian market by storm.They had captured the Indian market which for long belonged to just Nokia. Nokia had a problem here. They did not use the android os because of some internal matters of their organization. So after a good amount of research and development later, nokia came out with a solution that would bring the brand nokia back in the market and try to regain its lost glory. They upgraded their technology and sta rted making phones with the Windows phone 8 OS. These phones gradually caught the eye of the Indian customers,  as it was something different than android. People started purchasing the Nokia Lumia series of phones and the sales of Nokia phones again where on a rise.2) Cadbury Dairy MilkIn eight outlets across Maharashtra, worms were found in some bars of Cadbury Dairy Milk, Cadbury's bread-and-butter brand selling 1 million bars a day and an icon of ‘chocolate' in India. Inquiry was instituted by the Food and Drug Administration and negative media publicity spread like wildfire. The extensively graphic media coverage led people to believe that every bar could be contaminated. Consequently, sales volume plummeted, retailer cooperation lessened and employee morale dwindled. All in all, the company's credibility suffered extensive damage. Reason behind this crisis..After a thorough investigation of the entire supply chain, it was found that the problem originated at the distri bution end.Apparently, at the retail outlets the infested bars were placed next to open unpacked items susceptible to worms. However, although the problem was not of its own making, Cadbury did take responsibility for the lack in educating retailers on storage and hygiene. The company launched a new double packaging that wrapped even the smallest 13 gm chocolate in an aluminium foil, heat-sealed for complete protection from all sides and further encased in a polyflow pack. The over-engineered pack, the first of its kind in India, cost the company a fortune, but fulfilled the company's promise to media and consumers. The new packaging was launched amidst much fanfare in a media conference.Amongst the material distributed in the conference were a comparison kit allowing evaluation of old and new packs and a video new release with packaging and factory shots for television coverage. To reinstate confidence among sales people and to motivate them, another audio-visual with a message fro m the ambassador Amitabh Bachchan was shown in a string of sales conferences.3) Tata NanoUntil the afternoon of 21 March when he took delivery of his Lunar Silver coloured Nano, 36-year-old Satish Sawant was your average citizen leading a normal life. On the Sunday of 21 March, accompanying him to collect the car  was his wife, five-year-old son and a temporary driver. It was close to 3 pm that day and they were nearing his residence. His wife pointed out that something was burning. Sawant looked out. Nothing was burning. She insisted and forced him to park. He got out—there was smoke coming out of the car’s rear. He hurriedly got his wife and son out. The smoke turned billowing black. He took the car’s papers out.The little vehicle now began to burn like you see in the movies. Tata Motors attributed the first couple of cases to the melting of localised parts caused by faulty combination switches. That is somewhat similar to sparks and smoke in your house†™s wiring caused by an electric short-circuit. There was no quality control deployed at the Tata motors production facility. So in order to bring the situation under control and solve this problem, Tata motors changed the vendors who supplied the combination switches and employed a proper quality control in their plant, by which each and every car would go through proper checks before being granted the ok status.4) BisleriIn the early 1990s, Parle Bisleri Ltd's (Parle Bisleri's) Bisleri1 had become synonymous with branded water and had a market share of 70%. In the late 1990s, Bisleri's market share began to erode with new players entering the market. The Cola majors, Pepsi and Coca-Cola and the confectionery giant, Nestle, also entered the branded water market in India. Pepsi and Coca-Cola had an established distribution network. Bisleri realized that with the new players also clambering on to the purity plank, it had to reposition itself to arrest its declining market share. In September 2000, Parle Bisleri launched its Play Safe ad campaign.The company tried to add a fun element to Bisleri to rejuvenate the brand. The ultimate aim was to increase Bisleri's turnover from Rs 4 billion2 in 2000 to Rs 10 billion by 2003. In 2001, both Kinley and Aquafina were making huge investments in bottling plants and distribution. By 2002, Coca-Cola India planned to double the number of water bottling plants to 16 and Pepsi announced that it would add seven more plants to the existing five. In contrast, Bisleri had only 15 bottling plants and three franchisees. Kinley had 500,000 outlets compared to Bisleri's 350,000.Analysts felt that Kinley and Aquafina had an edge over Bisleri because of their strong distribution network. In 2000, in the  face of competition from the new entrants, Bisleri decided to penetrate every possible segment of the market by introducing more pack sizes and to establish the brand strongly with trendy packaging. In 2000, Bisleri launched the 1. 2 litre pack. This added to the five pack sizes that Bisleri had (500 ml, one, two, five and 20 litres). The new pack was priced at Rs 12. In 2000, Bisleri also launched smaller packs like the 300 ml cup. This 300 ml cup was targeted at large gatherings like marriages and conventions. A study conducted by Bisleri showed that its one litre pack was not considered trendy enough.5) Coca ColaIn 2003, the Centre for Science and Environment (CSE), a non-governmental organisation in New Delhi, said aerated waters produced by soft drinks manufacturers in India, including multinational giants PepsiCo and Coca-Cola, contained toxins including lindane, DDT, malathion and chlorpyrifos — pesticides that can contribute to cancer and a breakdown of the immune system. Tested products included Coke, Pepsi, and several other soft drinks (7Up, Mirinda, Fanta, Thums Up, Limca, Sprite), many produced by The Coca-Cola Company.This affected the sales of cocacola to a great extent, they went crashin g down. Later on after a detailed study, the company found out that the water they used for the manufacturing was safe and free from pesticides, but the problem was in the packaging department. The bottles in which the coke is to be filled is processed and cleaned with certain chemicals so that it becomes safe and all the impurities are removed, and later on the bottle is washed with water. It was seen that after cleaning the bottles with the chemicals, they were not being washed properly, which resulted in the chemicals staying in the bottle before the coke was filled in it. The company identified this problem and resolved this by keeping a proper quality control on the bottling plant and make sure that the bottles are washed properly after being treated with chemicals.6) Allwyn photo copiersThis is a shop which is situated in Mumbai. It undertakes the work of photo copying, printing, etc. For years they have been using the old Xerox machines. The name Xerox is synonym with photo c opy in India. But as the  time changes, there is a need to adopt new technologies to keep up with the competition in the market. So the company purchased new equipments and new printers which had the latest technologies like laser beam printing, etc. But after purchasing and using the new equipments, instead of their sales going up, they started declining. This was a matter of concern for the management as the sales were declining even after they were using the new technologies.They did a proper research on this and found out that the problem was not in the machinery, but the people handling the machines were not aware of the new machines properly and thus they were not able to use it efficiently. To overcome this problem, the management decided to train the employees who handle the machines. They were trained on various aspects as to how to make full use of machiniery with minimum efforts. Training the workmen is an important part of the production process. Thus when the handlers were trained properly, they knew how to use the machines properly and this in turn increased their efficieny. This resulted in more sales and more productivity.ConclusionThus we saw the case studies of various organizations and companies and how they overcome their problems. We can take a few inputs from these cases and implement it whenever we are stuck in any problem similar to these. Quality control and problem solving techniques are extremely important for an organization , as each and every organization faces some kind of the problem. What is important is that how they overcome it.

Friday, January 3, 2020

The Pursuit Of The American Dream - 889 Words

How does a child from a low income household put an end to the vicious social reproduction cycle he/she has no control over? A higher education cannot guarantee affluence but it does provide an opportunity for growth and economic mobility. College is where people from low income families can break free the social inequality they were born into. The US is a country where people can create something out of nothing. Where people are able to give their children everything they will need to succeed and thrive in college. Which is why the US attracts people from all over the world who are in pursuit of the American Dream. The American Dream, an idea, which states that every US citizen should have an equal opportunity to achieve success and prosperity through hard work, determination and initiative. The conceptual idea behind the American dream is not what it was 80 years ago. 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