Dental Prosthetic Options

Dental Prosthetic Options S.N.: Introduction: Prosthetic options to replace a missing tooth fall into two main categories: Fixed prostheses and removable prostheses. When choosing the suitable treatment option to replace a missing upper incisor, multiple variables involving the patient wishes, expectations, dentist skills and training, cost of treatment, and clinical findings should be taken into consideration (Al-Quran et al., 2011). These factors will have a strong influence on the short and long terms success of the treatment selected. Based on the conservation of neighbouring teeth and annual failure rates, dental implants are the treatment of choice to replace a missing central maxillary incisor, followed by conventional bridges, and removal partial dentures (Pjetursson Lang, 2008). Facial growth in relation to age: Craniofacial development is a continuous process that starts intra-uterine and has shown different rates between males and females (Brahim, 2005) . Skeletal maturation in males is reported to be reached at the age of 20, while females reach the maturation phase earlier, at the age of 17-18 years (Heij et al., 2006). Therefore, it has been recommended, when selecting the prosthetic option to replace a missing tooth, to take the patient’s age into consideration. Dental Implants should be avoided until the cessation of jaw development mentioned earlier (Daftary et al., 2013) or after the end of the growth spurt (Heij et al., 2006). If dental implants are used before the vertical maturation is reached, it will not grow vertically with the alveolar bone and will be submerged at different levels depending at the patient’s age when the implants were inserted (Brahim, 2005). Dental trauma and the surrounding tissues: In most scenarios, it is rare that a single incisor will be traumatized with no damage on adjacent incisors, surrounding bone, or soft tissues. If any damage sustained to neighbouring teeth, the status and prognosis of these teeth should be assessed, as it will have a strong impact on the selection of the definitive treatment option. Traumatic avulsion of teeth, account for 0.5% 3% of all dentoalveolar trauma, and it is associated with damage to the alveolar bone, specially the buccal plate (Andreasen, 1970). After tooth extraction, reduction of the alveolar bone height and width can be as high as 50% in the first year (Schropp L, 2004) with the highest amount of bone loss within the first three months (Pietrokovski Massler, 1967). Bone loss is not even between the buccal and palatal bone plates, with more bone loss in the buccal plate (Pietrokovski Massler, 1967) and bone width than height (Van Der Weijden et al., 2009). There are several treatment options that could be used for replacing a lost maxillary central incisor: Removable Partial Denture (RPD): RPD have the advantages of minimal clinical skills required, minimal chair time, and preservation of neighbouring teeth. On the other hand, the patient satisfaction is low, with a sense of insecurity, high risk of accidental breakage, and loss. Still, RPD is the quickest, cheapest replacement option of a missing incisor, and usually used as a temporary treatment until healing is complete and bone remodelling is minimal. Resin Retained Fixed Bridges (RRB): Resin retained bridges share the advantage of removable dentures of having minimal effect on abutment teeth with no risk of pulpal injury and the reversible nature of the prostheses. It is also relatively of low cost and acceptable aesthetic result (metal frame could be masked by opaque cement on expense of translucency). The commonest failure associated with RRB is frequent debonding of 20% over 5 years (Pjetursson et al., 2008) which could cause social embarrassment to the patient. The patient could also be given an Essex Type retainer with a single tooth in the gap as an emergency prosthesis until recementation of the resin retained bridge is done. RRB could be used as a final prosthetic option but more often is used as an interim measure as it could be reversed at any time, with 87.7% 5 years prognosis (Pjetursson et al., 2008) If the prosthesis is planned to be a temporary option, Rochette type wings are made with holes to facilitate frequent removal. Conventional Bridge: This is an irreversible treatment, replacing the missing tooth with a 2 or 3 units’ conventional bridge. These offer superior retention and aesthetics over RRB by the mean of full coverage of the abutment teeth. The main drawback is the need to reduce the sound tooth structure of the abutments with 20% risk of nerve damage and higher caries risk. The reduction of tooth structure is more for porcelain fused to metal or full ceramic/Zirconia crowns than full crown which is a requirement in the anterior aesthetic zone. According to previous studies, â€Å"if the adjacent teeth are severed, or in need of being crowned, the conventional bridge is to be preferred (Annual failure rate: 1.14%)† (Pjetursson Lang, 2008). The success rate is reported to be 90 % for 10 years and 72% for 15 years (Pjetursson et al., 2008) and (Burke Lucarotti, 2012). Endosseous dental implants: When considering the success rate, dental implants are reported to have the highest documented survival rate of 94% for 5 years (Attard Zarb, 2003) and 89% over 15 years (Pjetursson et al., 2008). Dental Implants have numerous advantages over the previously mentioned treatment options. Comparing dental implants to other fixed treatment modalities, there is no danger of pulpable damage of adjacent teeth, as no abutment teeth preparation is involved. Implants also facilitate the patient’s daily oral hygiene routines around the prosthesis, since there are no connectors between the prostheses and abutment teeth, making flossing possible. Furthermore, the maintenance and regular follow ups by the dentist is easier for dental implants. Removing a conventional bridge is a challenging task compared to screw retained implant supported crowns which could be removed and re-inserted multiple times when required (not applicable to cemented crowns). For implant supported restorations in the anterior maxillary region, a detailed patient assessment, implant site assessment, and proper treatment planning is the key for a successful restoration. The planning should be derived from the restorative point of view not guided by the availability of bone. The following points should be carefully assessed: Lip position at rest and smile: The patient’s aesthetic expectations should be coupled with the upper lip position at rest and when smiling. In most cases, 2 mm of the incisal edge of the central incisors should show at rest, and it could be either 100% of all the incisors (high smile line), more than 75% visible (medium smile line), or (low smile line) showing less than 75% of the incisors. With low smile line lip position, the aesthetic challenges are lower, and the emphasis on soft tissue contouring and papilla regeneration is also lower (Tjan et al., 1984). If the patient’s expectations are high while having high smile line, patient education should take place prior to implant treatment as the implant treatment could be deemed a failure if did not meet the patient’s aesthetic requirements despite been successful in every other aspect. Attached gingiva and surrounding soft tissue: The attached gingiva could have thick, moderate, or thin architecture. Thick gingiva is more common than the thin biotype; it appears as a more stippled, flat fibrous band of attached mucosa, masking the underlying bony contours. It is associated with higher resistance to recession, better soft tissue contouring, and resistance to peri-implant disease. On the other hand, thin gingival biotypes are found in 15% of population (Tjan et al., 1984) and it is a thinner mucosal layer with the bony scalloping showing through it. This type is more prone to exposure of the implant and compromising the aesthetic result (Tjan et al., 1984). The thin biotype has been associated with long triangular teeth and more incisally positioned contact points, while the thick biotype is associated with shorter, square crowns with more apically positioned contact points (hence, more papillary regeneration). Implant size used: Implant size has a direct effect on the emergence profile of the coronal restoration and aesthetics. Natural existing teeth and available bone are helping factors when selecting the right implant diameter, while implant length should provide a safety distance to the surrounding anatomical structures. The implant diameter should allow 1.5 mm between implant and neighbouring teeth (and 3mm between adjacent implant fixtures) (Jivraj Chee, 2006). The gingival biotype also should not be overlooked when selecting the fixture diameter, for example; if wider implants are used with thin gingival biotype, the risk of recession is higher (Rodriguez Rosenstiel, 2012). Implant position: For the most aesthetic emergence profile, implants should be placed 1.5 mm – 2 mm from the adjacent tooth, 3mm – 4mm apical to CEJ (Jivraj Chee, 2006), and ideally should be placed under the proposed cingulum of the coronal restoration. A diagnostic wax up and a prefabricated surgical stent are of very important in deciding the crown and implant positions, and evaluating the amount of bony defect and the need for bone graft. Transfaring the surgical stent into the patient’s mouth will allow the visualization of the amount of incisor show and smile lines. The implant position and angulation will dictate the abutment type and the retention method used for the restoration (screw or cement retained). Available bone quality and quantity: Bone density has been classified by Lekholm and Zarb (1985) into 4 categories: Homogenous compact bone, Thick cortical bone around dense trabecular bone, Dense trabecular bone covered by thin cortical bone, Very thin cortex enclosing minimal density trabeculae. Types 3 and 4 are associated with more failure rates, and are more found in the maxilla. Therefore, under -preparation of the osteotomy site could be done to gain higher initial stability. Branemark et al 1977 defined ossteointegeration as â€Å"direct structural and functional connection between living bone and load carrying implant†. Implant fixture should be in direct contact with healthy bone in three dimensions. Therefore, the amount of available bone required around any dental implant is 1.5 mm buccally and palatally, 3 mm between adjacent implants and at least 1.5mm -2mm between implants and adjacent teeth (Misch, 2008) and (Rodriguez Rosenstiel, 2012). If buccal bone width is not sufficient, a smaller diameter implant that will be functionally and aesthetically sound could be selected. It will also allow slight palatal positioning (Rodriguez Rosenstiel, 2012). Bone grafting/augmentation procedure could be done to add the bone thickness (Esposito et al., 2009) and bone could be sourced from: Patient’s own bone (Autogenous graft): commonly could be harvested from calvarian bone, iliac crest, mandibular ramus or chin. This provides highest reported success rates (Esposito et al., 2009). Different human bone (Allograft): usually from cadaveric bone. Bone undergoes special treatment to be deproteinized and freezed (Esposito et al., 2009). Animal sources (Xenograft) usually cows or pigs. Synthetic materials (Alloplast): artificial graft material which could be used solely or in conjunction with autogenous grafts (Esposito et al., 2009). Bone regeneration membranes: these are used to act as a barrier between the superficial soft tissue and the grafted bone or material to prevent ingrowth of the fibrous tissue and allow pure bone development. These membranes could be either natural or synthetic, resorbable or non- resporbable. If block bone graft is used, it should be allowed to heal for minimum 3 months before implant placement, while bone augmentation with alloplastic materials and membranes could be done simultaneously (Esposito et al., 2009). It is worth mentioning that porcine- derived bone and membranes may not be acceptable by some patients based on their religious beliefs and a specific consent should be obtained. The bone height will also impact the papilla formation, together with the crown shape and level of contact points; the papilla regeneration is favourable is square crown, broad apical contact points, and when the distance is around 4-5 mm between bone crest and contact points (Rodriguez Rosenstiel, 2012) and (Tarnow et al., 2003). Vertical bone augmentation has been shown to be unpredictable (Esposito et al., 2009) and the patient should be aware of the black triangles (lack of papilla) if vertical bone is deficient (Tarnow et al., 2003). Conclusion: Based on the previously discussed factors and the evidence available, dental implant would be the treatment of choice if the neighbouring teeth are of good prognosis and the aesthetic results are realistic. It is safe to place an implant in 20 years old male, as the growth of the jaws is complete. A diagnostic wax up and stent could be made to evaluate the aesthetics, and available bone. A 4.5 mm buccal width is not enough to place a suitable size implant in a suitable bony envelope, so a block done graft for will be needed before the implant placement. If the source of the trauma was sports related and likely to occur again, a mouth guard should be worn to protect the implant and teeth during activity. Bibliography Abt, E.C.A.B.W.H.V., 2012. Interventions for replacing missing teeth: partially absent dentition. Cochrane database of systematic reviews (Online), (2). Al-Quran, Firas F., A.-G.R. N, A.-Z.B., 2011. Single-tooth replacement: factors affecting different prosthetic treatment modalities. BMC Oral Health, 11(1), p.34. Andreasen, J.O., 1970. Etiology and pathogenesis of traumatic dental injuries A clinical study of 1,298 cases. European Journal of Oral Sciences, 78(1-4), pp.329-42. Andreasen, J.O., 2007. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Copenhagen: Blackwell Munksgaard. Attard, N.J. Zarb, G.A., 2003. Implant prosthodontic management of partially edentulous patients missing posterior teeth: The Toronto experience. The Journal of Prosthetic Dentistry, 89(4), pp.352-59. Brahim, J.S., 2005. Dental implants in children. Oral and maxillofacial surgery clinics of North America, 17(4), pp.375-81. Burke, F.J.T. Lucarotti, P.S.K., 2012. Ten year survival of bridges placed in the General Dental Services in England And Wales. Journal of Dentistry, 40(11), pp.886-95. Daftary, F., Mahallati, R., Bahat, O. Sullivan, R.M., 2013. Lifelong craniofacial growth and the implications for osseointegrated implants. he International journal of oral maxillofacial implants, 28(1), pp.163-9. Day, P. Duggal, M., 2010. Interventions for treating traumatized permanent front teeth: avulsed (knocked out) and replanted. The Cochrane Library, (1). Eghbali, A., De Rouck, T., De Bruyn, H. Cosyn, J., 2009. The gingival biotype assessed by experienced and inexperienced clinicians. Journal of Clinical Periodontology, 36(11), pp.958-963. Esposito, M. et al., 2009. Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment (Review). The Cochrane Library, (4). Heij, D.G.O. et al., 2006. Facial development, continuous tooth eruption, and mesial drift as compromising factors for implant placement. The International journal of oral maxillofacial implants, 21(6), pp.867-78. Jivraj, S. Chee, W., 2006. Treatment planning of implants in the aesthetic zone. British Dental Journal, 201(2), p.77. Misch, C.E., 2008. Contemporary Implant Dentistry. 3rd ed. Mosby. Pietrokovski, J. Massler, M., 1967. Alveolar ridge resorption following tooth extraction. The Journal of prosthetic dentistry, 17(1), pp.21-7. Pjetursson, B.E. Lang, N.P., 2008. Prosthetic treatment planning on the basis of scientific evidence. Journal of Oral Rehabilitation, 35(1), pp.72-79. Pjetursson, B.E. et al., 2008. A systematic review of the survival and complication rates of resinà ¢Ã¢â€š ¬Ã‚ bonded bridges after an observation period of at least 5 years. Clinical Oral Implants Research, 19(2), pp.131-41. Rodriguez, A.M. Rosenstiel, S.F., 2012. Esthetic considerations related to bone and soft tissue maintenance and development around dental implants: Report of the Committee on Research in Fixed Prosthodontics of the American Academy of Fixed Prosthodontics. The Journal of Prosthetic Dentistry, 108(4), pp.259-67. S. Jivraj, W.C., 2006. Rationale for dental implants. BRITISH DENTAL JOURNAL, 200(12), pp.661-65. Schropp L, W.A.K.L.K.T., 2004. Bone healing and soft tissue contour changes following single-tooth extraction: A clinical and radiographic 12-month prospective study. The Journal of Prosthetic Dentistry, 91(1), pp.92-92. Tarnow, D. et al., 2003. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. Journal of periodontology, 74(12), pp.1785-8. Tjan, A.H.L., Miller, G.D. The, J.G.P., 1984. Some esthetic factors in a smile. The Journal of Prosthetic Dentistry, 51(1), pp.24-28. Van Der Weijden, F., Dell Acqua, F. Slot, D.E., 2009. Alveolar bone dimensional changes of postà ¢Ã¢â€š ¬Ã‚ extraction sockets in humans: a systematic review. Journal of Clinical Periodontology, 36(12), pp.1048-58.

Katherine Kolcaba’s Comfort Theory Essay

Katherine Kolcaba’s Comfort Theory fits best with my philosophy of nursing and my current work environment. As a hospice nurse comfort is the top priority. The goal of hospice care is to provide comfort and dignity at the end of life. The technical term for comfort for health care is the immediate state of being strengthened by having the needs for relief, ease, and transcendence addressed in the four context of holistic human experience: physical, psychospiritual, sociocultural, and environment. The change goal would be to implement Kolcaba’s taxonomic structure of comfort as a way for the hospice unit staff to measure comfort. Katherine Kolcaba’s Comfort Theory Kolcaba was born as Katherine Arnold on December 8th, in Cleveland, Ohio. She received her diploma in nursing from St. Luke’s Hospital School of Nursing in 1965. She graduated from the Frances Payne Bolton School of Nursing, Case Western Reserve University in 1987. She graduated with a PhD in nursing and received a certificate of authority clinical nursing specialist in 1997. She specialized in Gerontology, End of Life and Long Term Care Interventions, Comfort Studies, Instrument Development, Nursing Theory, and Nursing Research. She is currently and associate professor of nursing at the University of Akron College of Nursing. She published Comfort Theory and Practice: a Vision for Holistic Health Care and Research (Nursing Theories, 2011). Description  Comfort Theory is a middle range theory for health practice, education, and research. Comfort is viewed as an outcome of care that can promote or facilitate health-seeking behaviors. Increasing comfort can result in having negative tensions reduced and positive tensions engaged. Kolcaba (as cited in McEwin & Wills, 2011) defined comfort within nursing practice as â€Å"the satisfaction of the basic human needs for relief, ease, or transcendence arising from health care situations that are stressful† (p. 34). Purpose According to Kolcaba, (2010) â€Å"the overall purpose of Comfort Theory, was to highlight the importance of comforting patients in this high tech world. It is what they want and need from us. † Origin. To describe the origin or development of Comfort Theory, Kolcaba conducted a concept analysis of comfort that examined literature from several disciplines including nursing, medicine, psychology, psychiatry, ergonomics, and English. First, three types of comfort (relief, ease, transcendence) and four contexts of holistic human experience in differing aspects of therapeutic contexts were introduced. A taxonomic structure was developed to guide for assessment, measurement, and evaluation of patient comfort (Nursing Theories, 2011). Major concepts. Major concepts described in the Theory of Comfort include comfort, comfort care, comfort measures, comfort needs, health-seeking behaviors, institutional integrity, and intervening variables (Kolcaba, 2010). Propositions. Kolcaba (as cited in McEwin & Wills, 2011) defines eight propositions that link the defined concepts: * Nurses and members of the health care team identify comfort needs of patients and family members * Nurses design and coordinate interventions to address comfort needs * Intervening variables are considered when designing interventions * When interventions are delivered in a caring manner and are effective, the outcome of enhanced comfort is attained * Patients, nurses and other health care team members agree on desirable and realistic health-seeking behaviors * If enhanced comfort is achieved, patients, family members and/or nurses are more likely to engage in health-seeking behaviors; these further enhance comfort * When patients and family members are given comfort care and engage in health-seeking behaviors, they are more satisfied with health care and have better health-related outcomes * When patients, families, and nurses are satisfied with health care in an institution, public acknowledgement about that institution’s contributions to health care will help the institution remain viable and flourish. Evidence-based practice or policy improvements may be guided by these propositions and the theoretical framework (P. 234). Population According to the National Hospice and Palliative Care Organization, (NHPCO, 2012) in 2011, an estimated 1. 65 million patients received services from hospice and an estimated 44. 6% of all deaths in the United States were patients under hospice care. In 2001, an estimated 36. 6% of cancer patients accessed three of more days of hospice care. The median length of service in 2011 was 19. 1 days. 56. 4% of hospice patients were female and 43. 6% were male. 83. % of hospice patients were 65 years of age or older, and more than one-third of all hospice patients were 85 years of age or older. 82. 8% of hospice patients were white/Caucasian. Patients of minority (non-Caucasian) race accounted for more than one fifth of hospice patients. Today cancer diagnoses account for less than half of all hospice admissions (37. 7%). Currently less than 25% of U. S. deaths are now caused by cancer, with the majority of death due to other terminal diseases. The top four non-cancer primary diagnoses for patients admitted to hospice in 2011 were debility, dementia, heart disease, and lung disease (NHPCO, 2012). Level of care  There are four general levels of hospice care: routine home care, continuous home care, general inpatient care, and inpatient respite care. The facility where I currently work is a unit for general inpatient care. General inpatient care is care received in an inpatient facility for pain control or acute or complex symptom management which cannot be managed in other settings. In 2011, 2. 2% of hospice patients received general inpatient care. The percentage of hospice patients receiving care in a hospice inpatient facility increased from 21. 9% in 2010 to 26. 1% in 2011 (NHPCO, 2012). The main reason for a general inpatient admission is for comfort care that cannot be achieved at home or in another setting. Nursing Role  My current role at the hospice unit is one of a staff nurse. I work three, twelve hour shifts on the dayshift. My responsibilities include the day to day care of the patients that I am assigned. I provide the patients with comfort care and symptom management based on the physicians orders. I do have certain standing orders that can be put in place without making a call to the physician and using my nursing judgment alone. I report directly to the unit manager on my unit. Power I feel that I have informal power at my facility. I have been there the longest of all the nurses, including the manager. I am the person that all the nurses turn to when there is a question regarding policy and procedure. I am the person that others seek out for advice and unfortunately the person that most nurses vent to. I am always willing to pick up extra shifts without complaining. I continually hear from the other nurses, â€Å"you never complain. † I love what I do! I love providing comfort care for patients in need. Are there days when things get crazy? Are there things I wish I could change? Absolutely, but complaining doesn’t change anything and I feel that being around someone that complains all the time bring others down as well. I always try to stay positive and encourage others. The management team comes to me as well to ask me my opinion about certain changes. I feel that I could be a positive influence for change, but ultimately the decision would not be mine to make. Any decision has to go through my unit manager and then up the chain of command to the clinical director, and executive director. Comfort Theory â€Å"Best Fit† for Hospice According to Kolcaba, (2010) health is considered to be optimal functioning, as defined by the patient, group, family, or community. There are several major assumptions in Comfort Theory. Human beings have holistic responses to complex stimuli. Comfort is a desirable holistic outcome that is germaine to the discipline of nursing, human beings strive to meet, or to have met, their basic comfort needs. It is an active endeavor. When comfort needs are met, patients are strengthened (Kolcaba, 2010). The mission statement of the company that I work for includes: * Recognize that individuals and families are the true expert in their own care; * Support each other so we can put our patients and families first; * Find creative solutions which add quality to life; * Strive for excellence beyond accepted standards, and; * Increase the community’s awareness of hospice as a part of the continuum of care. I feel that the mission of my company falls in line with the assumptions of Kolcaba’s Comfort Theory. The main goal of hospice care is comfort care. Currently we assess pain using a number scale or a face/FLACC cale depending on if the patient is able to verbally respond. The majority of our patients are unable to communicate. Pain using a face or FLACC scale can vary from nurse to nurse. The FLACC scale measures pain using face, legs, activity, cry, and consolability. Kolcaba’s taxonomic structure would be an excellent way to measure comfort on a hospice unit such as the one where I work. Development. Katherine Kolcaba developed an interest in the concept of comfort during her practice as the head nurse of a dementia care unit. Her understanding that comfort lead to optimal functioning of the dementia patients, was the beginnings of her comfort theory. Kolcaba realized the relationship between behaviors such as aggression, fighting with others, refusal to cooperate, or tearing up the environment and a patient’s comfort level. Interventions to reduce these behaviors were called comfort measures (Kolcaba, 2003). Since that time, the theory has been utilized in the fields of hospice (Kolcaba, Dowd, Steiner, & Mitzel, 2004; Vendlinski & Kolcaba, 1997), orthopaedic care of adult patients (Panno, Kolcaba, & Holder, 2000), pediatrics (Kolcaba & DiMarco, 2005), and perianasthesia nursing (Kolcaba & Wilson, 2002). Kolcaba (1994) stated, â€Å"the first dimension of the theory of comfort consists of three states of comfort called relief, ease, and transcendence† (p. 1179). Relief is having a specific comfort need meet. An example would be relief from pain. Ease is the state of calm or comfort (Kolcaba, 1994). Individuals who feel ease are in a relaxed state. Ease can add to an individual’s health seeking behavior. Transcendence is each individual’s ability to rise above one’s pain or trouble (Kolcaba & Kolcaba, 1991). The second dimension of the theory consists of the contexts in which comfort occurs. This is a holistic concept. It can be examined in the physical, psychospiritual, sociocultural, and environmental perspectives. Physical comfort pertains to the body. Musculoskeletal pain, urinary discomfort, gastrointestinal upset would fall into this category. Psychospiritual comfort pertains to self-esteem, the meaning of one’s life, and one’s connection with a higher power. Sociocultural comfort pertains to family, personal relationships, and one’s cultural background. Environmental comfort pertains to the external surrounding (Kolcaba, 1994). The theory consists of three parts. Part one describes how comfort needs are assessed, appropriate nursing interventions are implemented, and the patient experiences increased comfort. The second part of the theory describes the relationship between comfort and health seeking behaviors. Kolcaba reports that patients whose comfort needs are meet are better able to participate in positive behaviors, which promote health and well-being. The third part of the theory describes the relationship between client’s health seeking behaviors and the integrity of the institution (Kolcaba, Tilton, & Drouin, 2006). Outcome measures for institutions can be improved when staff utilizes comfort measures. It is desirable that nurses caring for hospice patients are skilled in the art of comfort. Providing physical comfort such as managing pain, positioning an individual with advanced musculoskeletal problems, keeping bowel patterns regular, assisting residents in a toileting program to avoid incontinence, and protection fragile skin are skills used on a daily basis. Nurses in hospice care must address psychospiritual concerns such as depression, the loss of physical functioning, as well as the loss of loved ones and friends. Most patients in hospice care have been forced by illness and debility to give up their homes and independence. Sociocultural comfort is provided when nurses understand a person’s cultural background. Encouraging family support and understanding a resident’s background and accomplishments assist nurses in developing interventions to support comfort. The environment also plays a part in an individual’s comfort and well-being in the long-term care environment. Providing a home-like, active, and joyful environment filled with children, animals, and treasured items from home are very important. Comfort theory has been utilized as a framework for hospice nursing (Vendlinski & Kolcaba, 1997).

The Brief Wondrous Life of Oscar Wao by Junot Diaz Free Essay Example, 1750 words

Lopez holds a Phd in Romance languages which further enforces his credibility in assessing the theme of love. Egelman, Sarah Rachel. "The Brief Wondrous Life of Oscar Wao | Bookreporter. com. "Â  Bookreporter. com |. bookreporter, 6 Sept. 2007. Web. 8 Apr. 2013. . Sarah Egelman explores the theme of love by describing the layout foundations that set the mood for a novel story that is romantic in its own respect. Egelman depicts a love stricken male, a gorgeous woman with a terrible past, and a tropical island. To this end, Sarah Egelman describes Oscar as a man with no luck when it comes to love and relationships. Evidently, Oscar is a man besieged by his misfortunes in establishing a romantic relationship with any woman. Despite him being attracted to and falling in love with repeatedly, most of the women are either repelled by his advances while other only see him as a friend. We will write a custom essay sample on The Brief Wondrous Life of Oscar Wao by Junot Diaz or any topic specifically for you Only $17.96 $11.86/pageorder now The only proximity his had to love is through other females who opt to confide their own relationships with him. The author thus presents Oscar as a lonely and romantically deprived man in Junot Diaz’s novel. As far as violence is concerned, Egelman portrays the suffering under the ruthless dictator, Trujillo. Evidently, Egelman points out the suffering meted out on Abelard, who is Oscar’s grandfather. Abelard was literally tortured in prison because he did not submit his daughter to Turjillo. At this juncture, Sarah Egelman brings out the clash between denial of sexual desires of a despote leader and the violent consequence. The sadistic twist of love mixed with violence is also evident when Egelman describes the beat down given to Belicia by goons related to her gangster boyfriend. The article review of Junot Diaz’s novel by Sarah Egelman on love and violence is intriguingly fascinating. Her capability in expounding on love and violence, depicts the nature in which the two are both intertwined in a sadistic turn of events. Peterson, Latoya. "Reflections on Lola [The Brief Wondrous Life of Oscar Wao] (Part 1 of 2) | Racialicious - the intersection of race and pop culture. "Racialicious - the intersection of race and pop culture. N.p. , 25 Mar. 2009. Web. 8 Apr. 2013. . Latoya Peterson uniquely explores the theme of love by focussing on Lola’s reflections and the depiction of women.

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