Identifying factors contributing to high readmission of diabetic patients

Identifying factors contributing to high readmission of diabetic patients INTRODUCTION. Diabetes Mellitus (DM) is a chronic disease. Where the blood circulation contain of high sugar level, it can occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces (WHO). Diabetes is a progressive disease that can lead to a significant number of health complications and profoundly reduce quality of life. While many diabetic patients manage the health complication with diet and exercise and require medications to improve uncontrolled blood glucose level. Diabetes has been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Preeti (2008). Both type 1 and 2 are chronic conditions that usually cannot be cured. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyper osmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure and retinal damage. Adequate treatment of diabetes is important, to control blood pressure and healthy lifestyle such as smoking cessation and maintaining a body weight. Treatment of diabetes involves diet, exercise, education, and drugs. If people with diabetes strictly control blood sugar levels, complications are less likely to develop. The goal of diabetes treatment, therefore, is to keep blood sugar levels within the normal range as much as possible. Treatment of high blood pressure and cholesterol levels can prevent some of the complications of diabetes as well. A good health education from the medical staff in the ward can give a good condition to patient health and prevent patient from admit again to the ward. The health education in the ward should begin from day 1 patient admit to the ward until the patient discharge from the ward. This health education should not stop when the patient is discharge from the ward but it must be continued from the health community to make sure that the patient is healthy. PROBLEM STATEMENT. General Objective: To identify factors contributing to high readmission of diabetic patients post discharge. 1.2.3 Specific objective. To identify why the patient is not take their medication after discharge from the ward. To study relationship between knowledge and medication to the patient. In Malaysia, the Third National Health and Morbidity Survey showed that the prevalence of type 2 Diabetes Mellitus (DM) for adults aged 30Â  years and above was found to be 14.9% in 2006. Salwa et. al., ( 2010). Patients with diabetes should know that how importance their health after they has confirmed have diabetes. Health education to patients and families were given continuously by the nurses when these patients were admitted for stabilization of their DM, from day 1 of admission and continued until they discharged. With proper health education, the patient should be able to take care for them self until follow up in the clinic. The health education must include dietary intake and medication. The talk is given by the nutritionist and medication by clinical pharmacist. Nurses should take part in the dietary and medication talk when the patient attends the talk to ensure the compliance by the patient continuously after they discharge from the ward. In January 2011, there are 4 patient has been readmitted to the male and female medical ward within 2 weeks after discharged from the ward. To prevent from this admission, health education should be given continuously to the patients either in the ward or by the community health care provider when the patient is discharge from the hospital. CHAPTER 2 2.1 LITERATURE REVIEW. The literature review has been searched from internet. Diabetes mellitus is now a major global public health problem. The incidence and prevalence of diabetes are escalating especially developing and newly industrialized nations. In Malaysia, diabetes is a growing concern. Through the Ministry of Healths six year thematic Healthy Lifestyle Campaign which began in 1991, diabetes mellitus was the theme for the year 1995. Here, the promotion of adopting healthy lifestyle practices relating to the prevention of diabetes namely creating awareness and balance diet, maintain ideal body weight and physical activities were encouraged. The campaign emphasized on creating, awareness of the disease and its complications to the public. Rugayah ( 2007) According to Zook et.al (1980). Hospitalizations account for about half of all health care expenses, and it has been estimated that 20% of the inpatients in Malaysia and 13% in the USA use more than half of all hospital resources through repeated admissions. During past decades, hospital readmissions have been the subject of retrospective surveys and prospective trials with a view to their prevention. The objective is to review these studies and focus on the frequency of readmissions of diabetes mellitus patient, their causes and validity as a measure of quality of care, and the attempts for their prevention. The recent literature on hospital readmissions and found that most of them are believed to be caused by patient frailty and progression of chronic disease. However, from 11% to 52% of all readmissions have been judged to be preventable because they were associated with indicators of substandard care during the hospitalization, such as poor resolution of the main problem, unstable therapy at discharge, and inadequate post discharge care and advice. Furthermore, randomized prospective trials have shown that 15% to 85% of all readmissions can be prevented by patient education, pre discharge assessment, and domiciliary aftercare. However, high readmission rates of patients with diabetes mellitus may identify quality-of-care problems. A focus on the specific needs of such patients may lead to the creation of more responsive health care systems for the chronically ill. Most complications are the result of problems with blood vessels. High sugar levels over a long time cause narrowing of both the small and large blood vessels. The narrowing reduces blood flow to many parts of the body, leading to problems. There are several causes of blood vessel narrowing. Complex sugar-based substances build up in the walls of small blood vessels, causing them to thicken and leak. Poor control of blood sugar levels also tends to cause the levels of fatty substances in the blood to rise, resulting in atherosclerosis. Poor circulation to the skin can lead to ulcers and infections and causes wounds to heal slowly. People with diabetes are particularly likely to have ulcers and infections of the feet and legs. Too often, these wounds heal slowly or not at all, and amputation of the foot or part of the leg may be needed. Currently there are at least 4-5 patients will be readmission for stabilization then discharged. Upon admission of a patient, this would cause overpopulation of ward, increase expenses and uncontrolled condition of the patient in the ward. Nurse also must provide health education to the patients, their relative and refer patients to nutritionist and education unit for counseled. Browne (2000) conducted a scientific research on factor for diabetes patient on knowledge and the diabetic drugs for diabetic patients. The major purpose of the research are to identify the important factors for patient compliance in the usage of diabetic drugs, specific knowledge on the action drug, the correct dosage and adverse side effects. . From Browne (2000), noted that only 15% of the patient knows the action of the drug they are consuming, where as 62% of them consume at the right time and 23% of patients gained a proper knowledge on medication or drug that they are consuming. In summary it is concluded that the diabetes patient has the more knowledge and information on the adverse effect of the drug compared to the action of oral hypoglycaemic drugs. According to Ranjini et al,(2003) done a research on knowledge, attitude and practice from patient diabetic at Klinik Kesihatan Seri Manjung, Perak. The findings showed correlation between knowledge, attitude and practice. The finding showed that increases knowledge for patients who have education is better from the patient who does not have any education. Hospitalizations account for about half of all health care expenses, and it has been estimated that 20% of the inpatients in Malaysia and 13% in the USA use more than half of all hospital resources through repeated admissions. Zook et al (1980). For past decades, hospital readmissions have been the subject of retrospective surveys and prospective trials with a view to their prevention. The objective is to review these studies and focus on the frequency of readmissions of diabetes mellitus patient, their causes and validity as a measure of quality of care, and the attempts for their prevention. Soeken et al (1991), done a research on readmission rates according to demographic, social, and disease-related characteristics. Researcher Wray et al (1988), done a meta-analysis of 44 studies published before 1990 revealed that age, length of stay during the index hospitalization, and previous use of hospital resources were among the main independent predictors of readmissions. These findings indicate that patient-specific factors predict readmissions. A study of a national sample of patients with chronic obstructive pulmonary disease or dementia revealed that after adjusting for severity and clinical and demographic characteristics, patients discharged to nursing homes were less likely to be readmitted within 30 days after discharge than those discharged to personal homes. According to Comberg et al (1997) Finally, some studies have found an association between readmission rates and inappropriate care during the index hospitalization. A case-control study revealed that 5 criteria of inpatient care (resolution of main problem, adequacy of the post discharge destination, stability of doses of therapy, and appropriate timing of the first follow-up visit) predicted readmissions within 30 days. Ashton et al (1987) Another case-control study found that a set of disease-specific, explicit criteria of appropriateness of care predicted readmissions. It has been suggested that 1 of 7 readmissions in patients with diabetes, 1 of 5 readmissio ns in patients with heart failure, and 1 of 12 readmissions in patients with obstructive lung disease were attributable to substandard care. Absence of documentation of discharge planning, increased temperature, intravenous fluids on the day of discharge, or unaddressed abnormal test results at discharge were related to an increased subsequent mortality. Ashton et al (1997). A meta-analysis of 29 studies published from 1975 through 1993 confirmed that low-quality inpatient care during the index hospitalization increased the risk of subsequent readmissions. Wei et al (1995). At least some readmissions, therefore, are associated with modifiable factors. Readmission rates have been reported to decline after the implementation of pre-discharge reviews and improved follow-up after discharge. Bean et al (1995) However, non-experimental, before-after study designs are subject to confounding and to regression toward the mean. Confounding refers to changes beyond the planned intervention that occurred over time and that in and of themselves may have reduced readmission rates. Regression to the mean is the tendency of above-average rates to fall toward average over time. Since programs aiming to reduce readmission rates are likely to be implemented in institutions with high readmission rates, their favorable results may reflect a decline that would have occurred on subsequent determinations even without any specific interventions. The findings concerning the effect of interventions indicate that improved hospital and post discharge care are associated with fewer readmissions. Still, there is evidence that global readmission rates have a limited value as indicators of quality of care. For example, about half of the studies failed to uncover any relationship between quality of care and readmissions. Ashton et al (1997). In all clinical condition readmission rates of patients who received poor-quality care were similar to those of patients whose care was judged acceptable. Thomas (1996). Similarly, assessed risk-adjusted outcomes after renal failure, gastrointestinal tract hemorrhage, stroke, myocardial infarction, and heart failure and concluded that length of stay, death, and unplanned readmission were predicted mainly by age, severity, and co morbidity. Roe et al (1996). Hospital readmissions raise concern among health care providers, and therefore efforts for their reduction are likely to be endorsed by clinicians and administrators. CHAPTER 3 METHODOLOGY 3.1 Introduction. This is a prospective study. The data is collect from the patient who admitted to the ward. The project was conducted in the one of the district hospital at Negeri Sembilan. Data on diabetes was obtained from adult respondents through interviews by trained nurses using a questionnaires. A 2-hour-post glucose load test was conducted by the nurses to the respondents who self-professed that they were non-diabetics and have not been diagnosed by any, medical personnel. These non-diabetes were measured for their blood glucose level using glucophotometer in a dry non-wipe technique. Those who refused to be examined were classified as refused to be examined and those who could not tolerate glucose due to old age were classified as unable to be examined. For the purpose of analysis in this survey, the respondents were categorized into 3 categories. The known diabetes were the adult respondents who self-professed they were diabetics and diagnosed by medical personnel. Those non-diabetics who had undergone the 2 hour post glucose load test and whose blood glucose measurement level of 11.1 mol/1 or more were categorized as undiagnosed diabetes. Those with blood glucose measurement of 7.8 < 11.1 mmol/1 were classified as impaired glucose tolerance (IGT) The known diabetes were enquired about their treatment status, utilization pattern of health facilities and perceived complications associated with their diabetic condition. 3.2 Research design. This is prospective study. Data will be collected by reviewing medical records and completing a structured data collection sheet. Data including admission diagnosis, the type of medication that patient receive in the ward, sign and symptom of diabetic mellitus, the correct statement for people with diabetic, when the patient feel hypoglycemia, the hypoglycemia condition, and no identifiers such as medical record numbers, patients names and gender will be used on the data collection instrument. In this study it will have a graphs, charts, table and summary. 3.3 Sample size. There is 10 questionnaire was given to diabetic patient in the medical male and medical female ward at the district hospital at Negeri Sembilan. About 30 respondent involved in the interview. 3.3.1 Inclusion i. How many years the patient have diabetes. ii. The patient should understand and can read in Bahasa Melayu or Bahasa English. iii. The age of the patients above 40 years 65 years.. 3.3.2 Exclusion. i. The patient who do not understand and can read in Bahasa Melayu or Bahasa English. Ii For patient who senile or psychiatric patient which they cannot give a cooperation and understand the question during the interview. 3.4 Instrument. There is 10 questionnaire about diabetes are given to the patient in the ward. The patient should give a correct answer when answer the question. There is time frame of the project. It starts from 1st March to 31st March. 2011. There question are divided to part I and part II. There is 8 question on part I where the answer is to choose a, b, c or d. Part II has 3 question where the patient have to choose true or false in the statement. The question adopt from the: Diabetes and Hormone Center of the Pacific Ala Moana Pacific Center www.testprepreview.com/modules/diabetes.htm 3.5 Ethical Consideration. 2.5.1 Letter from Head of Department, Health Sciencs UiTM to the Hospital Director for the project. Appendic 1 Approval letter from the Hospital Director to the Health Sciences for the project. Appendic 2 2.5.3 Consent from patient, if respondent refused to be interview, the respondent should be droped from this project. Appendic 3. 3.6. Limitation. 2.6.1 Receive late approval letter from the acedemic. 2.6.2 Because this is the distric hospital the total number of admission into the ward is low. 2.6.3 If the patient refused for the interview, the respondent should be droped from the project. 2.6.4 The duration time to collect data from the patients should be finish in one month. CHAPTER 4 4.1 Result . A total number of 40 patients were admitted to the both male and female medical wards from 1st March to 31st March 2011. The gender distribution was 33.33% is female and 66.66% is male. There is 96.7% or 29 of the respondents said that they eat too much of sugar or sweat drink when they are young before they diagnose have diabetes mellitus. The patient was admitted to the ward for stabilization of sugar level. See table 1 Table 1 Frequency Percent Caused by eating too much sugar 29 96.66667 Condition which the body cannot use the food properly 1 3.333333 Total 30 100 About 80% (24) of the respondents have the common symptoms of diabetes such as frequent urination specially at bed time, where they will get up 2 to 3 times to toilet. Hunger and thirsty specially in the morning before lunch time and 20% (6) of the respondents craving for sweets. See table 2 Table 2 Frequency Percent Frequent urination, hunger, thirst 24 80 Craving for sweets 6 20 Total 30 100 70% (21) of the respondents said the following statement is correct for people with diabetes that they should have snacks between-meal. Because they feel hungry and thirsty before they had their lunch in the afternoon or in the evening. They like to had drink and eat some snacks to prevent hunger. See table 3 Table 3 Frequency Percent Everyone with diabetes should have between-meal snacks 21 70 Changes lifestyle (meal, planning, exercise, medication, stress) 4 13.33333 Travelling should avoid taking insulin 5 16.66667 Total 30 100 76.7% (21) patients who take insulin once a day said that they take the breakfast 30 minutes after the insulin injection. It show the patient understand why it is important to take breakfast after the medication to prevent from hypoglycemic attack. See table 4. Table 4 Frequency Percent About 30 minutes before breakfast 23 76.66667 I do not know 7 23.33333 Total 30 100 46.7%(14) of the patients have the symptoms of hypoglycemia attack, 20% (6) have sweating, sudden weakness, 16.7% (5) have trembling or shaking, sudden weakness, and 16.7% (5) have trembling or shaking and sweating. It showed that the symptom is different between each patient. See table 5 Table 5 Frequency Percent 1 and 2 5 16.7 2 and 3 6 20 1 and 3 5 16.7 all of the above 14 46.7 Total 30 100 What is the reaction of the patient if they get hypoglycemic attack, 73.3% (22) of the patients said that they will eat some food that has sugar or chew some sweet to prevent from severe hypoglycemia attack. They will bring along the sweets if they on exercise, working in the farm or they on vacation. See table 6 Table 6. Frequency Percent Ignore it and it will go away 5 16.66667 Eat some food that has sugar 22 73.33333 lie down and see whether it will pass 3 10 Total 30 100 50%(15) of the patients said that confusion is not an indicator of hypoglycemia. Because the patient know about the sign and symptom of the hypoglycemia and they will prevent from get this attack either in the house or out site of their house compound. They will bring some sweets along with them. See table 7. Table 7. Frequency Percent Fatigue 7 23.3 Poor Appetite 7 23.3 Tachycardia 1 3.3 Confusion 15 50 Total 30 100 73.3% (22) patients said that they are allowed to use as much sugar as they want because they use too and lack of knowledge of the diabetes symptom when they are young. All of the respondents (100%) said that they have greater change to get the complications such as hypoglycemic attack from a patient who does not have diabetes. 93.3% (28) patients said if they did not control the blood sugar level there is greater change of infection and illness. The infection will take time to heel. See table 8 Table 8 CHAPTER 5 5.1 Discussion. The World Health Organization (WHO) has estimated that in the year 2030, Malaysia would have a total of 2.48 million people with diabetes compared to 0.94 millions in 2000. In Malaysia, the First National Health and Morbidity Survey (NHMS I) conducted in 1986 reported a prevalence of diabetes of 6.3% and in the Second National Health and Morbidity Survey (NHMS II) in 1996, this had risen to 8.3%. The NHMS I and NHMS II involved subjects above 30 years. The third National Health and Morbidity Survey (NHMSIII) conducted between April to July 2006 and included the diabetes module in the survey on subjects above 18 years. Zanariah et al (2008). Diabetic is a costly, disorder. Defining the distribution of specific characteristics among diabetics can assist in the planning, implementing and evaluating diabetic programmers for primary, secondary and tertiary prevention and control of diabetes. In planning of services for diabetes control, equity policies have to be considered. In this study it show that the patients know that they prone to get diabetes because of take a sweet drinks and rich of sugar in their food. When the patient in the ward, the nurse should teach the patient how to do the insulin injection, where are the side of injection and tell the patient that he should change the site of the injection to prevent from boil. The nurse should observe the patient how he syringe out the insulin and how to inject to his body. The nurse should remind the patient about sign and symptom of hypoglycemic attack and the precaution of the disease. The health education should continuously given to the patients from day 1 they admitted until the patient discharge from the ward and continued by the health community by do a home visit to the patient if the patient cannot go to the clinic for follow up. Regarding the diet, health education from the nutritionist and the medication from the clinical pharmacist should be continued since the patient stay in the ward. 5.2 Conclusion. Diabetes prevalence rate in Malaysia has risen much faster than expected, almost double over the last decade. Prevention and control of this chronic disease should be stepped up. Diabetes is certainly a diagnosis that nobody ever wants to receive. There is no cure, but it can be managed through diet, medication and exercise. Having high blood sugar level is out of control, the result in irreparable damage to the body, particularly with the kidneys, cardiovascular and blindness. Health education to patient on how to manage the disease and how to avoid or prolong adverse effects on the body.

Shame by Dick Greogry

Trey Swearingen ENG 100 Instructor: Charley Duvaal March 7, 2013 word count: 1643 Psychological Effects of Poverty The psychological effects of poverty on children are embarrassment and public humiliations of dealing with poverty. Imagine going to school without breakfast, much sleep and clothes that may still be wet from the night before since they didn’t dry due to a lack of appropriate appliances.Many people face these hardships everyday and they learn to cope with them in the best way they can. In the short story â€Å"Shame† by Dick Gregory, he writes about him life and how he went through those same things as a kid growing up in poverty. He clearly shows that poverty brings much privation as well as a great deal of shame. However, there are still ways to gain pride and happiness. This story shows that by emulating somebody you respect, even a very poor person can derive pride from small actions, which the average person sees as insignificant. Related essay: Shame is Worth a TryThey have to deal with being put in a stereotype for â€Å"poor† or â€Å"lower income† people. The psychological effects of poverty on children are the lowering of self-esteem, being isolated, and becoming determined. So what is it exactly that creates a rift between children from low income homes and those living above the poverty line? For one, these children lack the stability that comes with a higher income home. This means not having the things that other children have, from adequate nutrition to weather appropriate clothing.In addition, less income generally means there are fewer opportunities for activities and learning experiences. Gregory tells of his shame of living in poverty, and having only one set of clothes and a jacket that welfare gave to all the poor children. Gregory writes, â€Å"There was shame in wearing the brown and orange and white plaid mackinaw the welfare gave to 3,000 boys. Why did it have to be the same for everybody so when you walked down the street the people could see you were on relief? † (194). He is expressing how inadequate he felt compared to children from higher means.He saw that they were able to afford nicer things. Children face monumental hardships in our country because of poverty or the condition of not possessing the means to afford basic human needs. Children are under a lot of pressure in today’s society to excel in everything they do: from school to sports. Being a child in poverty adds even more stress that can ultimately be detrimental to a child. Poverty causes a rift in children who live above the poverty line and those below the poverty line. In general, children from homes living under the poverty line have poorer performance in school.Emotional development is lower in poverty children than those children who live in homes whose income is above the poverty line. In the short story, â€Å"Shame†, Richard is a poor boy without a father, l iving in the ghetto. However, there is a girl at school named Helene that he is in love with. Unlike Richard, Helene is well off, wears clean clothes, and is very smart in school. Richard tries very hard to be like Helene. He melts the ice water from the grocery store so he should be able to wash his clothes for the next day of school. The only reason he goes to school is for her. Everyone else condemns his behavior.Nobody understands that the reason why he does not function like everyone else was because when he gets up in the morning he does not have breakfast. Nobody realizes that he is just another boy who wants to be recognized and seen as just a normal kid like everyone else. They do not comprehend how hard he is trying to accomplish that. While everybody else is having fun after school, he is shining shoes just to get a little change so he could get by. When the day comes that the kids pledge their fathers' money to the Community Chest, naturally Richard wants to match Helene 's pledge.However, when Richard gets up to match Helene's amount, the teacher becomes upset at Richard. She said, firstly, that the money is for â€Å"him and his kind,† and therefore, if he is able to give, he has no reason to be receiving relief. Secondly, she said that he did not even have a daddy. The story shows many different aspects in which poor people suffer, and also things that they may derive pride from that we do not understand. It also shows that the emotions that they show and actions that they do, regardless of how weird or unimportant they seem, may provide great relief and happiness to a poor person.Growing up in poverty can take a toll on anyone; not having money can affect the biggest of people, and the smallest, black or white, male or female. Many people living in poverty have to deal with the stereo-types and there are many of those. Dick Gregory writes in his essay â€Å"The teacher thought I was a troublemaker. All she saw from the front of the room was a little black boy who squirmed in his idiot’s seat and made noises and poked the kids around him. I guess she could not see a kid who made noises because he wanted someone to know he was there† (192).This excerpt from his story describes the stereo-types of stereo-types, assuming that this little boy is a bad seed because of his color and financial background. Many emotional aspects are damaged in life because of many reasons, being poor can have a damaging result on your Self- Respect. People tormenting you, teasing you, making you feel unworthy, and unwelcome, unappreciated can ruin your self- esteem, making you feel exactly what they said you are. Gregory writes about a man in his story, a wino, which was living in poverty as well.The old man was hungry, went to a restaurant and to eat, and when it was time to pay he had no money. Gregory writes â€Å"The old wino sat down at the counter and ordered twenty-six cents worth of food. He ate it like he really enjoy ed it. When the owner, Mister Williams, asked him to pay the check, the old wino didn’t lie or go through his pocket like he suddenly found a hole. He just said: â€Å"Don’t have no money. † The owner yelled: â€Å"Why in hell you come in here and eat my food if you don’t have no money? That food cost me money. Mister Williams jumped over the counter and knocked the wino off his stool and beat him over the head with a pop bottle. The he stepped back and watched the wino bleed. Then he kicked him, and kicked him again† (195). Gregory made it strongly clear that this man had lost all self respect for him self, to just let the owner rag on him, and beat him. Poverty can make you feel worthless and like you do not deserve respect from anyone. Poverty can affect anyone; I have dealt with poverty first hand. When I was in eighth grade I went on a mission trip with my church to New Orleans.It was right after hurricane Katrina had hit and everything was de stroyed. Damage estimated was in the tens of billions of dollars. At least one million people in Louisiana, Mississippi and Alabama were without electrical power, and it took weeks to fully restore service to all affected regions. Clean drinking water was scarce, and the flood waters were covering city streets that were contaminated with gas from ruptured gas lines, chemicals and human waste, raising a serious danger of infectious disease.Poverty affected almost every single person in New Orleans. It was a heartbreaking trip but I was glad to be able to help people rebuild their houses and help them start new lives. I have also dealt with shame and how it can also make you feel worthless. I personally felt sad when I read parts in â€Å"Shame† about his teacher embarrassing him. This reminded me of a time when I was in elementary school. One day, in my fourth grade class, my teacher, Miss Brooks, called on me to give the answer to a geography problem the class was working on. Although I was not afraid to speak out in class, most of the class was having problems with this particular problem, so I was not too confident I had the right answer. However, I gave the answer I had anyway, and it turned out to be wrong. At first, I was not too upset, but almost immediately, Mrs. Brooks began to laugh, and then the whole class started to laugh. I felt so sad and embarrassed that I almost fainted and fell out of my chair. I always remember that day as one of the saddest days of my life. These are just a few examples of how poor people can get pride and happiness from small actions that we do not understand.Also, we see how they can sometimes be misunderstood when they do these actions. In general, we should try to be more yielding and considerate of such people. We should see ourselves in these situations and try to understand. In conclusion, many children are in need of our attention. The best we can offer them is positive remarks and acknowledgment. Whatever we t ell them stays in their memory for a long time and would affect their thought processes. As seen in the â€Å"Shame† essay, the child felt humiliated by the teacher’s criticism. That criticism made him realize how different he really is.

Role Of African Americans In Civil War - Free Essay Example

Sample details Pages: 6 Words: 1923 Downloads: 4 Date added: 2019/05/18 Category History Essay Level High school Tags: Civil War Essay War Essay Did you like this example? Identification and Evaluation of Sources This investigation will explore the question, â€Å"To what extent did African Americans play a service role during the American Civil War?† It will focus the perspective of African Americans during the American Civil War, 1861 through 1865. Many know how greatly the American Civil War affected African Americans, but how African Americans affected the outcome of the war is often overlooked. To further understand their contribution, this investigation covers the work of African Americans in the Civil War, ranging from fighting, to farming, to stealing and spying. The first source to be evaluated in depth is a page containing multiple interviews from African American Military Laborers and Soldiers in the Civil War. During the Great Depression, the Works Progress Administration (WPA) had interviewed 2,300 formerly enslaved African Americans. This page contains only a few interviews, but specifically those who are American Civil War Veterans. The interviews allow the reader to experience a different perspective of those who partook in the Civil War. This is a value because it creates and inside view of people who not only lived during the American Civil War time but that they also were apart of it. A first-hand perspective can drastically differ from others. Although this source was very helpful in the investigation, because it was all interviews, there was an abundance of bias. Being able to sort through the information and use it without inserting bias is complicated and makes it a limitation. This may also be considered a limitation because t he interviews were taken almost 70 years after the Civil War. Don’t waste time! Our writers will create an original "Role Of African Americans In Civil War" essay for you Create order The purpose of this source is to allows to reader to understand that even though these people were encountering the same events, that each experience was still very unique. It discusses the different roles that African Americans played in the American Civil War and how each role still made a great impact. This source also displays the importance of receiving information through interview and how different perspectives can create a deeper understanding. Another source to be analyzed is a site called, â€Å"The Root.† It seems as though it is a reliable site about African American culture and history. The source was written in 2015 which allowed for the author, John Stauffer, for gain from his advantage of hindsight. Being that is a recent source, Stauffer knows and understands the post war successes and issues making the ideas more valid. Stauffer is a professor at Harvard University and has written multiple books. His scholarliness has proved him to be a just writer with verifiable information. This source may be a limitation because Stauffer shares extreme bias through his words and ideas. He often uses sarcasm to further argue his points. Stauffer also never shared any of the same experience as they took place in the 1800’s. Besides that, the article is designed to properly and fairly answer specific common questions that the reader may have. The purpose of this source is to help eliminate confusion and inform readers. Stauffer ideas are solid and easily understood. His article is very organized and has accurate information that can be fed to many people who want to understand this topic. Investigation The American Civil war resolved two fundamental questions left unresolved by the revolution: whether the United States was to be a dissolvable confederation of sovereign states or an indivisible nation with a sovereign national government; and whether this nation, born of a declaration that all men were created with an equal right to liberty, would continue to exist as the largest slaveholding country in the world. The American Civil War and it’s result still affects the United States today. The outcome of this war was impacted even more by the service role of African Americans and their efforts. Both sides, the Union and the Confederacy, had support from African American. Whether it was by force or choice, the outcome may had been altered if it weren’t for the support of African Americans. During the war, African American soldiers on the Confederate side were simply called, â€Å"Black Confederates.† While on the side of the Union, African Americans were referre d to as â€Å"Afro-Yankees.† While some still question why African Americans participated in this war, they made a great impact on the outcome. From battles to farming, African Americans played a large service role in the Civil War. African American soldiers, specifically on the Confederate side, did a lot of what could be called the â€Å"dirty work† (Stauffer). This consisted of stealing any usable objects from those who passed, killing those who are suffering, and burying many of the dead bodies. Dirty work can also be labor work, such as supporting the Confederacy as servants and teamsters to build roads, batteries and fortifications. â€Å"You see, they required all of the slave owners to send so many of us to the army to work digging the trenches and throwing up de breastworks and repairing the railroads of what the Yankees done destroyed,† said Tines Kendricks, a slave who happened to be one of the people his master sent over to war. Blacks who shouldered arms for the Confederacy numbered a rough estimate of 6,000, among the hundreds of thousands of whites who served (Stauffer). African Americans washed uniforms, shined boots, mended clothes and tents, cooked, farmed, and generally did much of the drudgery for the armed forces (Nelson). In contrast, far more Union army soldiers were tied down in such tasks, since the Union did not have many free black labor to do these non-combat duties. It was very common for African Americans to contribute to the war by cooking and or farming. A war of any sort requires enormous amounts of food which was powered by laborers, which in this case were the African Americans. and in 1862 the Confederate Congress enacted a law authorizing four black cooks per company. Some of the troops raised money to hire black cooks, they were paid fifteen dollars a month if they were free, if not, they had to have permission from their master to be able to work. African Americans also grew the crops that fed the Confederacy, as Frederick Douglass noted, blacks were â€Å"the stomach of the rebellion† (Stauffer). Black laborers numbered from 20,000 to 50,000. Many of escaped slaves followed almost every major Union army at one point or another. Legally, African Americans were not allowed to serve in the war as combat soldiers. As soon as news of the Civil War set off, a rush of free black men wanted to enlist in U.S. military. They were rejected because of a Federal law from 1792 barred African Americans from bearing arms for the U.S. army. The decision of authorizing black troops into the war sparked concern that it may prompt the border states to secede, however, the Lincoln administration still wrestled with the idea (Freeman). Congress passed the Second Confiscation and Militia Act, freeing slaves who had masters in the Confederate Army. Black leaders such as Frederick Douglass encouraged black men to become soldiers to ensure eventual full citizenship. By the end of the Civil War, roughly 179,000 black men served as soldiers in the U.S. Army, that is ten percent of the Union Army (Freeman). African American women were not permitted to be in the army by law, however many joined as nurses, spies, and scouts. One of the m ost infamous scouts in the American Civil War was Harriet Tubman. She scouted for the 2d South Carolina Volunteers. Many wonder why African Americans would even bother to participate in the war, specifically the Confederate side. There are multiple reasons to why African Americans would want to play such a role in the American Civil War. One of the first reasons being that some African Americans were forced to by their masters. â€Å"When the war started, my master sent me to work for the Confederate army. I worked most of the time for three years, hauling cannons, driving mules, hauling ammunition and provisions. When the Union army came close enough I ran away and joined the Union army,† said Bill Simms a slave who escaped but later returned to his master’s home after the war, â€Å"My master owned about four hundred acres of good land and he hired me to work for him.† Others joined the war because they were optimistic and had high hopes of the outcome. These people finally had a cause that they wanted to fight for. Often times many African Americans took advantage of the fog of war and used it as an opportunity to escape to the Union as seen in Simms case. Another man, like Simms, made a run for safety, â€Å"You know Abraham Lincoln declared freedom in ’63, first day of January. In October ’63, I ran away and went to Pine Bluff, Arkansas to get to the Yankees,† said Boston Blackwell, â€Å"When we gets to the Yankee camp all our troubles was over. We got all the contraband [food taken by the troops] we could eat.† He escaped with a young boy, and traveled for two days to reach safety. The contribution of African Americans to the American Civil War significantly altered the result. The service role of African Americans during this time period was substantial to the outcome. It is to a great extent that African Americans had played a service role in the American Civil War. Reflection The biggest challenge facing historians is uncertainty. The process of this investigation has allowed me to use a variety of research methods and experience some of the challenges that historians face. Firstly, through my use of primary sources, I came to see the difficulty of gaining accurate historical knowledge. Although primary sources are useful for bringing us closer to the past, we can’t rely just on the information being presented, for the bias may create inaccuracy. This challenge was made explicit to me through the examination of my primary resources, such as the interviews I read on the National Humanities Center website. Historians struggle with bias everyday, converting opinions into something objective is what makes their job very difficult. It is also very hard when attempting to use a story that has come from other sources for it is like a game of telephone, each time it is used, it is altered just a bit. Being a historian also requires the ability to decide what pieces of information to keep and which to leave out. They may also struggle with making all of the information, they have specifically chosen, entertaining and compelling. I found that in my research I struggled with the decision of what is important enough to be in my investigation and what is not. For example, when reviewing two similar sources that say slightly different things, could change the whole rest of my article. Many times there is very little information to go off of, like in ancient or medieval times, while other times there is too much information on. Choosing certain pieces or missing certain pieces can greatly affect the final product. Historians also have to include other effectors during that time period that could affect their research. Ideas such as culture, government, wars, gender, religion and race. Having the right background information on a topic can greatly change the concepts and the reasons behind them. Historians have to be able to understand people, for feelings can extreme the bias of a source and can justify the actions of history. There is no way to tell what is right or wrong, leading each of the historians’ ideas to differ.

The Impact of the United Kingdom Technology on the Current UK Economy Free Essay Example, 3000 words

The depression precipitated from the hidden significant imbalances. The country s overreliance on debt cash inflows and the financial sector significantly triggered the imbalances. The current leadership of the nation, United Kingdom, must resolve the high wall of imbalances to unfold a sustainable and balanced economic recovery program. In response, the government is currently putting into action a wide range of economic enhance programs that comply with environmental laws. The programs include fiscal consolidation and structural rehabilitation aimed at generating higher economic growth and enhanced balancing of the economy over time. Statistics show that the unemployment rate rose from 6.2 percent in 2008 to 7.8 percent in 2010. Likewise, the United Kingdom financial balance drastically declined from 2008 s 1 percent to 2010s -6 percent. As of 2011, the United Kingdom government s fiscal plans and economic reform programs significantly contributed to the marked reduction of fiscal risks, the government must inject further necessary improvements to the 2011 fiscal framework and reforms to make the financial sector more robust. Rick Szostak (Szostak 1995;101) reiterated This view, that technological change is the primary cause of rising incomes in the modern world, is widely held. We will write a custom essay sample on The Impact of the United Kingdom Technology on the Current UK Economy or any topic specifically for you Only $17.96 $11.86/page