Describe a place or environment where you are perfectly content. What Personal Statement - 1

Describe a place or environment where you are perfectly content. What do you do or experience there and why is it meaningful you - Personal Statement Example Its satisfies all the five senses: It has this serenity that is exclusive, the air being inhaled is purified as there are little or no sources of pollution, the wind that blows is gentle, the sound of the animals brings a feeling that one can get from no other place, and the taste of the wild fruits provides nature’s best, as compared to the fruits that reach the markets that have be grown using chemicals. The sense of nature being around me in its purest form brings a sense of peace. Being in the woods gives me the peace that I cannot get in an environment that is characterised by the hooting of vehicles and moving machines and the threat of being mugged or knocked down by vehicle. It also takes me away from thinking about unfinished businesses and many of life’s worries. The woods present me with an opportunity to hike, making me reconnect with nature in the best way that the earth we live in provides. This is also an opportunity to go biking and feel the adrenaline as the air rushes past me and the earth moves fast behind on a a rough terrain that ignites my endurance. The wooded environment is also good for hunting, which makes me be in touch with other forms of life such as birds of different types, rodent, snakes, and lizards among other animals. Watching animals in the wild is for me one of the greatest wonders that this world presents. Seeing how the eagle preys on the rodents from the moment it targets its prey to the time it catches it is simply amazing. This makes me appreciate nature that no form of human invention can be of that complexity. Seeing how the ecosystem balances itself reminds me that there is an important part that I was created to do on earth. As every part of the ecosystem has and fulfils its purpose, so do I have a purpose that I am to fulfil. My recent visit to the Grand Canyon was an experience of a lifetime - one that I would not want to wash away from my memory. The place is such a

United States; Love us or Hate us Essay Example for Free

United States; Love us or Hate us Essay Not only is the United States one of the most culturally diverse places in the world. It is also one of the most economically viable. It continuously touts its principles of freedom and democracy as an example for all the world’s nations. It is one of the most charitable countries in the world providing private funding to millions of aid organizations in third world countries. Not only that but technological research in the United States has brought advancements to every field from medicine to space travel (Garcia, 2007). So why it is so many countries hate the United States? This topic will attempt to answer this question. The September 11th, 2001 attacks acted as an eye opening experience for the American public. The perception of American superiority in the world was challenged that day create a shock which reverberated around the world. The international reactions that followed the attacks showed the American public that anti-American sentiments did not simply come from inconsequential groups of people. There were several countries in the third world that hated the United States. One of the major criticisms leveled against the United States is their stance on foreign policy issues. The first and foremost of these is their involvement in the Arab-Israeli conflict. The Arab world believes that American support both financial and military to Israel is not only hypocritical it is also instrumental in the continued oppression of the Palestinian people. While Israel affords a status of a friend to the United States, their neighbors are constantly being bombarded by Israeli military might and being acknowledged as terrorists. The United States is also accused of pursuing this foreign policy time and time again not in the interests of world stability but rather for their own self interests. During the Bush administration Saddam Hussein was continuously demonized as an agent of Al Qaeda and acting against the interests of the United States. However what the government conveniently decided to forget is that the American government was responsible for putting Saddam Hussein in power in the first place. This is also true for in the case of Afghanistan and the Taliban during the height of their enmity with Russia. And now they blame the very governments they put in charge for terrorist attacks on their soil (Chomsky, 2001). A poll conducted in 2002 found that the population in 35 of 42 countries had a generally favorable view of the United States. The poll also showed that while citizens in many nations still find America favorable, they do not perceive it as favorably as they did 2 years ago (Roberts, 2002). Certain studies have shown that hatred of the United States is actually taught in educational institutions (Livshiz, 2001). However this does not excuse the fact the bias the United States has shown for years in dealing with international situations. While several countries such as China and Russia have several nuclear warheads, the United States imposes sanctions on countries like Iran for pursuing nuclear technology for energy purposes. While the United States invades Iraq for the sole purpose of spreading democracy, they also turn a blind eye to the genocide that is currently occurring in Darfur. It is inevitable that Anti-American sentiments will continue while the United States remains one of the most powerful and influential countries in the world. Until the United States accepts that it has to use this power responsibly, the world will continue to see its actions as a reason to hate them. References Chomsky, N. (2001, October 12). On Why Various Countries Hate the US. (R. Siegel, Interviewer) Garcia, V. F. (2007, May). Why does the world hate the USA? : A politically correct approach. Retrieved May 16, 2009, from Hispanic American Centre for Economic Research: http://www. hacer. org/pdf/Garcia00. pdf Livshiz, D. (2001, October 17). Viewpoint: Hatred of U. S. stems from hate in schools. Retrieved May 13, 2009, from The Michigan Daily : http://www. michigandaily. com/content/viewpoint-hatred-us-stems-hate-schools Roberts, J. (2002, December 4). They Love U. S. /They Hate U. S. Retrieved May 13, 2009, from CBS NEWS: http://www. cbsnews. com/stories/2002/12/04/world/main531762. shtml

Does Descartes Successfully Prove The Existence Of God Philosophy Essay

Does Descartes Successfully Prove The Existence Of God Philosophy Essay Descartes arch mission in the Meditations was to provide a theory that would help him get to the truth. Descartes book Meditations on First Philosophy consists of six meditations through which he addresses several uncertain issues in attempt to remove their uncertainties. Maybe the most essential meditation he speaks of is the third meditation in which he discusses the debatable issue of The Existence of God. Although the existence of God is an objective matter, Descartes method in proving this existence is perhaps the most efficient in removing any shadow of doubt which a person might have. This method, which will be further discussed, has its own imperfections and therefore it was fairly easy for doubters to come up with rebuttals and hence, the matter remains objective. Descartes begins his third meditation discussing the existence of himself and regards himself as a thinking thing. In addition to that, he erases any doubts having to do with his sensory experience saying that although he knows his sensory perception and imagination may not exist outside him, however, they do exist inside him and are means of thinking. This that has been said previously does help Descartes approach the truth he seeks but is still not sufficient. Furthermore he continues by saying that a person cannot exist independently; human beings were created by an infinite substance; a being that is eternal, independent and has the highest power plus intelligence. This infinite substance is the reason for the existence of human beings and everything surrounding them, this infinite substance is God. The existence of God to Descartes is a necessity and a crucial matter especially after he established that in order to exist as finite beings, an infinite substance must exist to create us. In previous meditations, Descartes talked about how doubts and desires come from an interpretation that people lack certain things and that people would not notice this lack if it werent for the existence of a more ideal presence that has the things lacked by people. Furthermore, Descartes saw that there is no reason to doubt the existence of God since his perception and understanding of God is an infinite reality and therefore is more likely to be authentic than other conceptions. Having inferred that God essentially exists, Descartes asks himself how he acquired the idea of God. That being said, he advised three types of ideas: Adventitious, factitious, and innate. Adventitious ideas are derived from knowledge that we encounter through life. Factitious ideas are ideas come from our creative imagination. Innate ideas come from within and so from this definition, Descartes considers God to exist as an idea which we were born with and which God himself placed in us. Descartes distinct and clear perception is that God exists as perfection. In order to be labeled as a betrayer, one must have defects and faults. Furthermore, since Descartes sees God as a faultless and infinite being, then God could not be a betrayer or a deceiver. Cogito, ergo sum is a Latin phrase meaning I think, therefore I am and which Descartes quotes. He then explains that as the cogito is there, so should the existence of God. Although meditation three mainly discusses the existence of God, Descartes raises the issue again in meditation five. Meditation five: The essence of material things, and the existence of God considered a second time, includes three principle matters. The first topic covers the essence of matter. The second topic discusses the ontological argument for Gods existence and the third matter involves getting to the route to perfect knowledge. In this meditation, Descartes distinguishes between two things; the essence and the existence. Before knowing of an existing thing, one must be aware of its essence. What he means by that is, knowing the essence of things is to find out whether these certain things could possibly exist and not be actually there. However, we will further see that this does not apply to God, and that God serves as an exception in this matter. Descartes was strongly against Aristotles argument of the essence. To Aristotle, one learns the essence of a triangle by observing and examining surrounding triangular objects. While Descartes says that we acquire knowledge of the essence mainly through the intellect and after that being done will we be able to observe objects in the world resembling triangles. Adding to that, Descartes continues with his argument against Aristotles belief and says that since there are no perfect triangles in the real world then how will we be able to understand them if they do not exist? He also discusses the issue of mathematically abstract equations which we have learned but have not derived from whats surrounding us in our world. He then decides to turn this argument of essence to a more important issue which is proving the existence of God a second time now. However, this second proof shows to be weaker than the one he has discussed in his third meditation. The fact that he considers he should add more proof in this meditation makes us wonder, is he not sure of his first proof? The proof he provides in the fifth meditation is a form of proof that was used amongst scholastic philosophers. We have already established that our formulated idea of God equals a perfect and infinite being. Hence, that would necessarily include existence; it would be considered ideal to exist than not to exist. According to the Descartes, the term existence is not just considered a characteristic of God but a crucial feature of Gods, so that means God cannot be created without associating existence with him. After that proof was known to people and philosophers, Kant pointed out that it contained flaws since he does not agree with the fact that existence defines and object. To Kant, existence does not accommodate a certain object as much as it accommodates the world. Therefore he concludes that existence is not a property of Gods. Although Descartes provided many explanations regarding his proofs, they still remain very objective thus raising many counter arguments presented by people and philosophers. Descartes claim that we have a clear and distinct idea of an infinite being is not a valid statement because we do not in any way have a clear idea of this infinite being. That being said, when we are able to think of an ideal being does not follow that this ideal being we are thinking of actually exists. Thinking of something does not validate its existence or make it actually exist. Furthermore, even if we have an idea of God within us, it does not necessarily mean that God put that idea in us. Our ideas are not all innate, we do possess adventitious ideas which enable us to think and imagine creatively thus creating the idea of God. In order for God to be able to create himself and exist independently, he must own the attribute of timelessness, and we cannot just assume that he does own that property; hence, we cannot say that God is the reason he exists. If we allow something to be there without a cause then we would be going against our nature, and if we do allow it, then how does that stop everything else from existing without a cause? These arguments are not denying the existence of God, they are just justifying that Descartes proofs and discussions are presented in a weak manner and do not successfully prove the existence of God. Descartes does present himself as an intelligent person with rational discussions, but has failed to provide much rational explanations with regards to the existence of God. Since the beginning of his meditations, Descartes did classify that his thoughts of God present God as a perfect infinite being and then he classified himself as an imperfect being. This poses a problem; how can an imperfect person decide and define which properties exist as being perfect and which do not? When he says that, it is as if he is saying that his judgments and explanations are as ideal as his idea of God. To conclude matters, it is possible to think of God and an imperfect being. However that does not summon the things I think of to existence. Every person can have a different thought or image of God according to his/her way of thinking. That is why, the existence of God remains a debatable issue and is very much objective regardless of the different present religions.

The Korean War And Its Origins Essay -- The Korean War, 1945-1953

Russia and the United States began their relationship as allies when Russia disregarded the non aggression pact they signed with Germany in 1939, effectively sealing Germany’s fate in World War II. Korea, like Germany, had been occupied by Soviet and United States forces at the end of World War II. Korea was split in half via the 38th parallel after the Japanese Empire fell near the end of the conflict. The soviets occupied the north side of the line and the Americans occupied the south. â€Å"By the end of the decade, two new states had formed on the peninsula. In the south, the anti- communist dictator Syngman Rhee (1875-1965) enjoyed the reluctant support of the American government; in the north, the communist dictator Kim Il Sung (1912-1994) enjoyed the slightly more enthusiastic support of the soviets.† (http://www.history.com/topics/korean-war) Many top decision makers in the US believed that the USSR was trying to spread communism throughout the world. In April 1950, a National Security Council report recommended that the U.S. use military force to â€Å"contain† communist expansionism anywhere it seemed to be occurring. â€Å"The NSC-68 called for significant peacetime military spending, in which the U.S. possessed "superior overall power" and "in dependable combination with other like-minded nations." It calls for a military capable of: Defending the Western Hemisphere and essential allied areas in order that their war-making capabilities can be developed; providing and protecting a mobilization base while the offensive forces required for victory were being built up; conducting offensive operations to destroy vital elements of the Soviet war-making capacity, and to keep... ...ut to find us the worst possible location in the world to fight this damnable war the unanimous choice would have been Korea.† (Dean Acheson, U.S. Secretary of State (1893-1971) Works Cited Evanhoe, Ed. "The Korean War." The Korean War. N.p., n.d. Web. 16 Feb. 2015. . Hickey, Michael. "BBC - History - World Wars: The Korean War: An Overview." BBC - Homepage. N.p., 21 Mar. 2011. Web. 16 Feb. 2015. . "Korean War à ¢Ã¢â€š ¬Ã¢â‚¬  History.com Articles, Video, Pictures and Facts." History.com à ¢Ã¢â€š ¬Ã¢â‚¬  History Made Every Day à ¢Ã¢â€š ¬Ã¢â‚¬  American & World History. N.p., n.d. Web. 16 Feb. 2015. . "NSC-68 - Wikipedia, the free encyclopedia." Wikipedia, the free encyclopedia. N.p., n.d. Web. 16 Feb. 2015. .

The Acquisition Team

The Acquisition Team is an information-based organization that is composed of more specialists than in the traditional command-and-control organization. Members of an acquisition team consist of multi-organizational as well as cross-functional, i. e. contractors, suppliers, acquisition professionals (Engelbeck, 2002). The focus of this paper is to present the students selection of a business opportunity offered by the Department of Energy and found at http://www. fbo. org/. This student will analyse the posting and then â€Å"reverse engineer† the notice to create the ideal agency’s acquisition team that could have prepared this solicitation. This student will also cite and summarize the FAR provisions for the formation of the acquisition team, describe the nature and specifications of the project, identify every area of expertise needed on the acquisition team, using the â€Å"Bodies of Knowledge† diagram in Engelbeck, Chapter 2, as a basis, and justify the involvement of each team member by describing his or her specific contribution to the solicitation/ request for proposal and later steps of the procurement process. Finally, the student will describe the steps to follow and ensure that the solicitation notice is complete, clear, and accurate before submitting it for posting on the FedBizOpps. gov Website. FAR Provisions for the formation of the acquisition team. The dissemination of Federal Acquisition Regulation (FAR) in 1984 replicated the Congress' intention to create a structure that was uniform for Executive Branch federal contracting. Prior to the introduction of the FAR, civilian agencies and the defence services had different and self owned set of regulations. The FAR is codified at Title 48 of the Code of Federal Regulations. It consists of regulations and rules as articulated by the United States federal government that governs the procurement processes for the government. The FAR contains the standardized procedures and policies for acquisitions by any and all federal government agencies. After the circulation of the FAR, the standardization goal was destabilized by the diverse agency-specific supplements (Vacketta, 1999). The FAR enforces the implementation of nearly every decision-making plan related to procurement. It is also within the FAR mandate to accomplish every stage of the process of acquisition. FAR 1. 102 (d) stipulates that: The function of every member of the Acquisition Team is to ensure the exercise of individual initiative and effective business decision while providing the best value product and service that meet the needs of the customers (Acquipedia, 2012). It further explains the scope and procedure of the acquisition team. This consists of the federal government team members responsible for integration tasks constraint and contracting negotiations including the requiring activity, the paying agent team, the contracting officer, financial management and others. Summary of the FAR Provisions for Acquisition Team Opportunity: Supply of Silicon Drift Detector Summary of Opportunity Opportunity is typically defined as the occasion and time that present favourable circumstance to attain precise goals. The details of opportunity identified on http://www. fbo. org/ are as presented below: a. Opportunity title / project location: Supply of Silicon Drift Detector b. Solicitation Number: RC238923 c. Agency: Department of Energy d. Office: Brookhaven National Laboratory (DOE Contractor) e. [Office] Location: Brookhaven f. URL: https://www. fbo. gov/? s=opportunity&mode=form&id=a95ff19f0cbf7a7448fbd5503527130b&tab=core&_cview=0 Nature and Specifications of the Project This is a short-term project in which a federal government body requires the supply of Silicon Drift Detectors. The Contractor is required to deliver 1 Silicon Drift Detector to the US Department of Energy. The project requires fixed pricing terms. The Silicon Drift Detector should be delivered within 180 days upon the signing of the contract at the Department of Energy office, Brookhaven National Laboratory, Brookhaven. The timings are required to be identified by the COR Feb 01, 2013 11:59 pm Eastern: Provision 333 — Machinery Manufacturing/333999 — All Other Miscellaneous General Purpose Machinery Manufacturing, many others as stipulated in AMS – Form – 010, rev. 5, should be considered for the entire process involved in the solicitation and acquisition. Technical specifications of the Hitachi Vortex Silicon Drift Detectors are that it must have a cylindrical Snout. The length of the snout should be 638 millimetres. The detector must be Ultra High Vacuum compatible with active detection area of not less than 500mm2. The unit must be usable indoor/outdoor with 12. 5 ?m window. The detector must operate with power supplies operating at 220-240 volts. Area of Expertise Required The â€Å"bodies of knowledge†, for this project consists of contracting, finance, engineering, logistics, legal, test and evaluation and cost estimates as identified by Engelbeck (2002). The areas of expertise are as outlined below: Contracting expertise will be required since it will facilitate the selection process of a contractor or vendor of Silicon Drift Detectors. The expertise includes communication skills that will enhance the process of dealing with the customer and the supplier. This will help develop trust among the acquisition team. The drafting of the contract will become easy relative to the project priorities. Risk allocation will be easily identified in managing beforehand to make the deal successful. Financial expertise will be required for the project in establishing the financing terms and budgets related to the project. This expertise will facilitate the valuation of the project for the valuable price to be considered for solicitation. Engineering expertise will be required since it will facilitate the classification of technical stipulations required for the project at hand. References for at least three successfully-manufactured, assembled, tested and delivered single-element detectors with similar complexities as the quoted product must be provided. Logistics is a central part of the project since it specifies the items and timings for the project delivery. It will also facilitate the control of the inventory and related costs to be effective in controlling extra costs. Any project under FAR should be incorporated to the law governing the situation hence Legal considerations will be critical as the terms and conditions must be aligned to FAR. Test and evaluation are as important as any other consideration because failure to create standards for the project will make it impossible to create effectiveness in the project. Evaluation is important to be considered as it will facilitate the future course of actions. Cost estimates are critical as they present the bottom-line of project. All the financials related to this project are based on cost estimates. The cost estimates are an underlying factor to the evaluation of the quality standards. Involvement of Team Members Contemporary, the integration of team members is fundamental to acquire the quoted product with the required specifications to effectively complete the processes and projects on time. The contribution of each member in the team will create synergy. Their presence during the project will act as a positive energy for team success. The involvement of each team member is based on their area of expertise: The end user is the definitive team member. In this case, the end user is the staff at the Brookhaven National Laboratory. The staffs represent the Department of Energy which offers valuable resource for the Silicon Drift Detectors being procured. The Program Manager will make sure that the ensuing agreement meets the long- and short-range requirements of the project’s mission and that the design produce the intended results. The contracting officers will make sure that all contract activities comply with relevant laws, regulations, executive orders, and other applicable measures including approvals and clearances. Financial managers will ensure the provision of information needed by the team to make decisions on the amount of money available. The legal counsel will ensure continuous provision of guidance related to legal compliance and interpretation of regulations and laws. All team members will provide necessary and continuous support throughout the project lifecycle. Steps for Solicitation Completion There are a number of steps that will be applied to make sure that the solicitation notice is clear, complete, and accurate prior to submission for posting on the FedBizOpps. gov Website. Prior to finalization of the draft solicitation, the officer in charge of contracting may issue a draft solicitation to obtain questions and comments from a group of potential (but not eligible) candidates before releasing the final solicitation. This will help to better refine the solicitation and clarify any vagueness. Posting the draft solicitation will allow exchange with industry in the form of questions, suggestions, corrections and comments that can improve the final solicitation. The contracting officer will also make a request for a review of the draft solicitation by the counsel and project officer in harmony with procedures prior to release. Upon review, the contracting officers should then seek and obtain the concluding approval from the agency leadership (Gouder, 2007).

Care at the end of life Essay

It is a fact that humans are born to die. What was once considered a natural part of life has changed to an experience that may be more painful for the patient, family, and caregivers due to the advances in medical care. New procedures have allowed life to be extended longer than ever before. The question is: has the dying experience improved? This paper will include a review of death and dying from the perspectives of the patient and caregivers. An unfortunate case will be discussed, and the organizational structure, culture, and governance that led to this situation will be reviewed. Recommendations for the changes necessary to prevent such cases in the future will be included. Ms. Smith was a 66 -year -old female with breast cancer that had metastasized to her lungs and liver. She had two adult daughters who lived in her home town and one of them had a young child. Mr. Smith was a 70- year-old retired factory worker. Ms. Smith had gone through lengthy chemotherapy and radiation treatments that had left her weak and debilitated. She developed pneumonia and experienced a respiratory arrest. She was placed on a ventilator and was weaned off the ventilator after two weeks. She remained in the Intensive Care Unit (ICU). Her family stayed with her as much as the ICU visiting hours allowed, but she was often alone and told her family that she was in pain and wanted to die. The nurses were  concerned about her pain needs, but were also worried that too much medication could cause another respiratory arrest. Ms. Smith languished in the ICU for two months until she did have another respiratory arrest and died without her family at her side. She and her family had agreed that she would not go back on the ventilator, and the physicians had written a Do Not Resuscitate (DNR) order. They had planned to move her from the ICU, but they hesitated to place her on a regular floor. Everyone involved in the case believed that it was not handled well, and a team was assembled to determine how to improve the care of the dying. A review of the literature found that this institution was not alone with their concerns that the care of the dying needed to improve. Autonomy is one of the core bioethical principles that focuses on the right of every individual to make choices regarding health care decisions. Providers and caregivers spend a great deal of time instructing and coaxing patients to take control of their own health. But these providers are often surprised and upset when patients with life-limiting illnesses express a desire to control the timing and circumstances of their end-of-life experience (Volker, Kahn, & Penticuff, 2004). In their study, they found that people with advanced cancer expressed a wide variety of preferences for personal control and comfort, and that many wanted to remain as involved as possible in their daily lives for as long as possible. Organizations can play a key role in policy changes to support the needs of these individuals. Providers are trained to see death as the enemy, and sometimes forget that death is a natural part of the human experience. Joe Cantlupe’s story in Health Leaders stated that â€Å"we don’t always deal with the issues of death and dying very well in our culture† (p. 14, 2013). The Institute of Medicine published a report that concluded that many patients die in pain, are not referred to hospice in a timely manner, and the improvements in care have not led to improvements in care at the end of life. Fortunately, there have been efforts to study the patient’s perspective of death and dying as well as the perspectives of nurses and physicians. These studies are leading to a better understanding of the experience and the methods needed to improve the quality of end of life care (Cantlupe, 2013). It may seem strange to consider quality about end of life care, but it is recognized as an ethical obligation of health care providers and organizations. Singer, Martin, and Kelner studied 126 patients on dialysis, diagnosed with AIDS, or residents of long-term care facilities, to determine their views on end-of-life issues. Their results identified five domains of quality care at the end-of-life. These were â€Å"adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones† (p. 163, 1999). The participants expressed fear of lingering or kept alive when they could no longer enjoy their lives. Many stated that they would not wish to go on life support if they were not going to improve or have a chance to live a normal life again. Several mentioned that being placed on life support was the same as being a guinea pig. There were conflicting reports on the choice of dying at home or in a hospital. Some wanted to be at home, but others felt that was a burden on the family (Singer, Martin, & Kelner, 1999). Another study by Gourdji, McVey, & Purden in 2009 interviewed palliative care patients about the meaning of quality of life at this stage of their illness, and the factors that would improve their quality of life. They found that several factors, including their approach to life, their approach to their illness, and their ideal of quality of life shaped their end-of-life experiences. These patients stressed that they most wanted to continue what they had been doing for most of their lives for as long as possible. They also wanted to help others when possible and live in a caring environment. They often mentioned the use of humor and a positive attitude in the environment. When they discussed their illnesses, they expressed frustration with their physical limitations, and hopelessness when the disease reoccurred. As providers began to understand the gap between their traditional training and the needs of patients, researchers began to evaluate the skills needed to provide a better quality of end-of-life care. Nursing had long considered the choices made about artificial nutrition or hydration, palliative treatment, or symptom control to be in the medical domain, and the nursing role was often unclear. Nursing is involved in the end-of-life care. They are with the inpatient on a 24-hour basis, they use a  patient-centered approach to care, and they have experience and expertise in caring for dying patients and their families. Case studies have found that the nurses’ involvement in end-of-life care is not only about the technical decisions in the care process, but also that the daily interactions that nurses have with patient’s vulnerabilities make them ethically sensitive to the needs of the patient and family (Gastman, 2012). The International Council of Nurses (ICN) developed a code of ethics that stated that nurses are responsible to alleviate suffering as well as promoting health and preventing illness. By expanding the scope of end-of-life care beyond the narrow medical definitions, and aligning the code of ethics with a broader definition of end-of-life care to expand beyond the hospital setting, nursing can become more involved in end-of-life care (Shigeko, Nague, Sakuai, & Imamura, 2012). The role of the primary care provider in end-of-life care has also been studied, and these studies have found that despite the continuity and comprehensiveness of primary care, few Americans die under the care of their familiar provider. Many patients have reported feeling abandoned by their primary care provider at the time of death. Care at home by primary care providers benefits many patients and the health care system overburdened by hospitalization cost (Silveira, & Forman, 2012). On the other side of the care spectrum, the role of the intensive care provider also can be improved. White and Curtis (2005) studied the need and the impact of shared decision- making on critically ill ICU patients. They found that while involving families in end-of-life decisions is a complex task that requires excellent communication skills, the more time spent with families discussing and explain the issues, the higher the family satisfaction. The hospital where Ms. Smith died was the average institution with an organizational structure that included a Chief Medical Officer and Medical Directors of each specialty area. There was a Chief Nursing Officer as well as Nursing Administrators responsible for the care of patients. They had been very focused on treating illness, and considered themselves successful. The review by the improvement team helped them to see that they needed to change their perspective and consider less paternalistic alternatives to caring for patients at the e nd-of-life. These alternatives usually save cost as well as providing better care at end-of-life. The reimbursement for palliative care programs has been slow, and this has  prompted many hospitals to team up with local hospice programs or nursing facilities to decrease cost. Palliative care has been shown to extend the life of patients, reduce cost, and be more satisfying to the patient and family. Multidisciplinary teams that include physicians, nurses, social workers, psychologists, and spiritual counselors, work together to relieve the suffering, pain, depression, and stress that is often a part of chronic illness. These teams may also include nutritionists and therapist when needed by the individual patient. These programs listen to even the simple requests of patients and families. They work with the patient to get them to the best environment for them and to allow them dignity and control at the end of life. These teams are also moving to the outpatient area to prevent or decrease hospi tal admission and improve quality of life (Cantlupe, 2013). Conclusion Ms. Smith’s hospital should implement a multidisciplinary palliative care team. They should also add education to the program so that the patients and families are better informed about the results of care decisions such as ventilation, hydration, and nutrition. The hospital personnel need to be trained about palliative care and shift their paternalistic approach to a patient-centered approach. It is doubtful that Ms. Smith would have remained in the ICU for two months if there had been a palliative care program in place. She may have been able to transfer to an inpatient hospice center where her family could stay with her, and she would not have died alone and in pain. References Cantlupe, J. (2013, September). A fresh look at end-of-life care. Health Leaders, 12-22. Gastman, C. (2012, September). Nursing ethics perspective on end-of-life care. Nursing Ethics, 19(5), 603-604. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/1041054841 Gourdji, Iris. McVey, L., & Purden, M. (2009, Spring). A quality end of life from a palliative care patient’s perspective. Journal of Palliative Care, 25(1), 40-50. Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012, September). Defining end-of-life care from perspectives of nursing ethics. Nursing Ethics, 19(5), 608-616.