Deception Point Page 64

â€Å"Holy shit!† The pilot pulled back on the stick, jolting upward. The black mountain of steel rose before them out of the waves without warning. A gargantuan unmarked submarine blew its ballast and rose on a cloud of bubbles. The pilots exchanged uneasy laughs. â€Å"Guess that's them.† As ordered, the transaction proceeded under complete radio silence. The doublewide portal on the peak of the sail opened and a seaman flashed them signals with a strobe light. The chopper then moved over the sub and dropped a three-man rescue harness, essentially three rubberized loops on a retractable cable. Within sixty seconds, the three unknown â€Å"danglers† were swinging beneath the chopper, ascending slowly against the downdraft of the rotors. When the copilot hauled them aboard-two men and a woman-the pilot flashed the sub the â€Å"all clear.† Within seconds, the enormous vessel disappeared beneath the windswept sea, leaving no trace it had ever been there. With the passengers safely aboard, the chopper pilot faced front, dipped the nose of the chopper, and accelerated south to complete his mission. The storm was closing fast, and these three strangers were to be brought safely back to Thule AFB for further jet transport. Where they were headed, the pilot had no idea. All he knew was that his orders had been from high up, and he was transporting very precious cargo. 75 When the Milne storm finally exploded, unleashing its full force on the NASA habisphere, the dome shuddered as if ready to lift off the ice and launch out to sea. The steel stabilizing cables pulled taut against their stakes, vibrating like huge guitar strings and letting out a doleful drone. The generators outside stuttered, causing the lights to flicker, threatening to plunge the huge room into total blackness. NASA administrator Lawrence Ekstrom strode across the interior of the dome. He wished he were getting the hell out of here tonight, but that was not to be. He would remain another day, giving additional on-site press conferences in the morning and overseeing preparations to transport the meteorite back to Washington. He wanted nothing more at the moment than to get some sleep; the day's unexpected problems had taken a lot out of him. Ekstrom's thoughts turned yet again to Wailee Ming, Rachel Sexton, Norah Mangor, Michael Tolland, and Corky Marlinson. Some of the NASA staff had begun noticing the civilians were missing. Relax, Ekstrom told himself. Everything is under control. He breathed deeply, reminding himself that everyone on the planet was excited about NASA and space right now. Extraterrestrial life hadn't been this exciting a topic since the famous â€Å"Roswell incident† back in 1947-the alleged crash of an alien spaceship in Roswell, New Mexico, which was now the shrine to millions of UFO-conspiracy theorists even today. During Ekstrom's years working at the Pentagon, he had learned that the Roswell incident had been nothing more than a military accident during a classified operation called Project Mogul-the flight test of a spy balloon being designed to listen in on Russian atomic tests. A prototype, while being tested, had drifted off course and crashed in the New Mexico desert. Unfortunately, a civilian found the wreckage before the military did. Unsuspecting rancher William Brazel had stumbled across a debris field of radical synthesized neoprene and lightweight metals unlike anything he'd ever seen, and he immediately called in the sheriff. Newspapers carried the story of the bizarre wreckage, and public interest grew fast. Fueled by the military's denial that the wreckage was theirs, reporters launched investigations, and the covert status of Project Mogul came into serious jeopardy. Just as it seemed the sensitive issue of a spy balloon was about to be revealed, something wonderful happened. The media drew an unexpected conclusion. They decided the scraps of futuristic substance could only have come from an extraterrestrial source-creatures more scientifically advanced than humans. The military's denial of the incident obviously had to be one thing only-a cover-up of contact with aliens! Although baffled by this new hypothesis, the air force was not about to look a gift horse in the mouth. They grabbed the alien story and ran with it; the world's suspicion that aliens were visiting New Mexico was far less a threat to national security than that of the Russians catching wind of Project Mogul. To fuel the alien cover story, the intelligence community shrouded the Roswell incident in secrecy and began orchestrating â€Å"security leaks†-quiet murmurings of alien contacts, recovered spaceships, and even a mysterious â€Å"Hangar 18† at Dayton's Wright-Patterson Air Force Base where the government was keeping alien bodies on ice. The world bought the story, and Roswell fever swept the globe. From that moment on, whenever a civilian mistakenly spotted an advanced U.S. military aircraft, the intelligence community simply dusted off the old conspiracy. That's not an aircraft, that's an alien spaceship! Ekstrom was amazed to think this simple deception was still working today. Every time the media reported a sudden flurry of UFO sightings, Ekstrom had to laugh. Chances were some lucky civilian had caught a glimpse of one of the NRO's fifty-seven fast-moving, unmanned reconnaissance aircraft known as Global Hawks-oblong, remote-controlled aircraft that looked like nothing else in the sky. Ekstrom found it pathetic that countless tourists still made pilgrimages to the New Mexico desert to scan the night skies with their video cameras. Occasionally one got lucky and captured â€Å"hard evidence† of a UFO-bright lights flitting around the sky with more maneuverability and speed than any aircraft humans had ever built. What these people failed to realize, of course, was that there existed a twelve-year lag between what the government could build and what the public knew about. These UFO-gazers were simply catching a glimpse of the next generation of U.S. aircraft being developed out at Area 51-many of which were the brainstorms of NASA engineers. Of course, intelligence officials never corrected the misconception; it was obviously preferable that the world read about another UFO sighting than to have people learn the U.S. military's true flight capabilities. But everything has changed now, Ekstrom thought. In a few hours, the extraterrestrial myth would become a confirmed reality, forever. â€Å"Administrator?† A NASA technician hurried across the ice behind him. â€Å"You have an emergency secure call in the PSC.† Ekstrom sighed, turning. What the hell could it be now? He headed for the communications trailer. The technician hurried along beside him. â€Å"The guys manning the radar in the PSC were curious, sir†¦ â€Å" â€Å"Yeah?† Ekstrom's thoughts were still far away. â€Å"The fat-body sub stationed off the coast here? We were wondering why you didn't mention it to us.† Ekstrom glanced up. â€Å"I'm sorry?† â€Å"The submarine, sir? You could have at least told the guys on radar. Additional seaboard security is understandable, but it took our radar team off guard.† Ekstrom stopped short. â€Å"What submarine?† The technician stopped now too, clearly not expecting the administrator's surprise. â€Å"She's not part of our operation?† â€Å"No! Where is it?† The technician swallowed hard. â€Å"About three miles out. We caught her on radar by chance. Only surfaced for a couple minutes. Pretty big blip. Had to be a fat-body. We figured you'd asked the navy to stand watch over this op without telling any of us.† Ekstrom stared. â€Å"I most certainly did not!† Now the technician's voice wavered. â€Å"Well, sir, then I guess I should inform you that a sub just rendezvoused with an aircraft right off the coast here. Looked like a personnel change. Actually, we were all pretty impressed anyone would attempt a wet-dry vertical in this kind of wind.†

Nursing and nutrition

IntroductionIn different healthcare institutions the question of feeding patients, particularly those who are seriously sick and expected to die soon, raises questions of moral and ethical nature thus making a decision making process very difficult for the caring staff. Such questions may include:–  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   How can decisions of giving or withholding feeding and hydration be made?–  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   What values and assumptions underlie these decisions?–  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Which courses of action are in the patient's ‘best interest', and how is this ‘interest' determined?–  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   How and when, if ever, should a decision not to feed or hydrate be made?–  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Can so basic a provision as food and water ever be considered as optional care?In most of the healthcare institutions whether they are hospitals or senior homes, the decision making lies within the practice of the nurses who are usually faced with dilemmas. While doctors are more advanced in professional knowledge they rarely find themselves in the difficult situation of making the decision of withholding nutrition or giving it. However, there is sometimes a differentiation between nutrition as part of the care given to the patient and nutrition as a biological life sustaining process:â€Å"In modern practice there is often an underlying tension between two different understandings of ‘nourishing' the patient. First, nourishing as an intrinsic part of giving care, which falls within the realm of nursing. Second, nourishing as a biological and technical process, a life-sustaining treatment under the control of the medical or nutrition team (from which the nurse may be excluded).† (Hunt, 1994)Yet the daily practice and the roles of nurses and doctors indicate that the nurses find themselves in the dilemma of making the decision more than other medical staff. In many cases where the withholding of nutrition is legally right and in the interest of the patient, the nurse still finds herself in the ethical and professional dilemma. She is not given the opportunity to discuss her opinion or given any information. As a result whatever decision she makes may be taken as wrong regardless of the fact that she was partially ignorant.The dilemma is even more difficult when considering nutrition as a basic need or a medical treatment. For a seriously sick person one may accept withholding medication or a technological device that prolongs life unnecessarily, but it is not easy to withhold nutrition which is the basic need for healthy and unhealthy persons.  Ã¢â‚¬Å"Dresser asks, ‘Ought we to regard tube and intravenous feeding as forms of medical treatment, or should we classify them with more basic sorts of care?'† (Dresser, 1985)The decision of withholding nutrition or hydration is a difficult ethical questi on that poses emotional stress on the nurses. Withholding medication or technological devices is justifiable and there is enough professional and legal guidance for healthcare staff to follow. Indeed, â€Å"Food and water are so central to an array of human emotions that it is almost impossible to consider them with the same emotional detachment that one might feel toward a respirator or a dialysis machine† (Lynn & Childress, 1983)In this research I am going to study this issue in order to confirm or rule out the possibility of establishing a professional guidance that assists the nurses in decision making. This is expected to relief them from a lot of stress and confusion that are imposed as a result of dealing with the issue on personal terms rather dealing with it objectively according to professional guidance and standards.The proposal for this research will be studied under the following headings:1.    Description of a case study2.    Literature review3.      Pro posal4.      Summary and ConclusionsDescription of a Case StudyA case study either from literature or from the records of healthcare institution is expected to illustrate the extent of the problem and its importance. In addition this will emphasise the roles of nurses, relatives and patients in the decision making process. It would also highlight the difficulties facing nurses at different stages of care giving for seriously sick persons.  At this stage of building the skeleton of this research paper very little can be said about the case study until one has been adopted.Literature ReviewThe literature generally confirms the importance of the problem and has been addressing the issues related to the problem of nutrition for sometime now. While it is suggested in the literature that in some cases of chronically ill persons the provision of nutrition is burdensome rather than beneficial, it is agreed that the interpersonal and inter-professional tensions of nurses are ignored. ( Hunt, 1994) It is also pointed out that the stressful environment in which nurses provide their professional care sometimes result in burnouts.The burnout case â€Å"evolves by a process involving three stages: (a) an imbalance between resources and demands, (b) the immediate short-term emotional response to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment† (Riordan & Saltzer, 1992). However, it is also indicated that there are personal differences here: while one may react to stressors by becoming a burnout another with personal hardiness may find the stressors only minor irritants. Riordan and Saltzer (1992) assert:  Ã¢â‚¬Å"Current literature points unanimously to a proactive approach in preventing burnout. This preserves organizational integrity by maintaining human resources and supplying cost-effective care while maintaining quality† (Riordan & Saltzer, 1992).There are a number of suggestions for reducing stress and assisting nurses to cope with the environmental difficulties, though no specific guidelines or procedures are given for dealing with the problem of nutrition and hydration.  It is also indicated in the literature that nutrition and hydration in some terminal cases may only prolong the biological life which is thought to be burdensome for some patients and their families. As Hunt (1994) asserts: â€Å"Feeding may in some circumstances prolong the process of dying and may cause avoidable suffering to the dying patient.†While generally the decision of using nutrition support for the terminally ill people is discussed as a problem facing nurses, some scholars relate the decision to dietitians.  Ã¢â‚¬Å"Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an integral role in institutional policy development concerning nutrition support at the end of lifeâ€Å" (Langdon et al, 2002)To put it in a nutshell the literature review confirms the dilemma facing healthcare professionals, particularly nurses, and families in dealing with the decision of providing nutrition and hydration or withholding it for chronically ill people whose illness is diagnosed as terminal. It is also confirmed that the decision making involves personal feelings, ethics, and sometimes legal consideration. Yet there are no clear professional guidelines that streamline the decision making in this issue in the professional practice. Rather there are observations of some acceptable practices.Sometimes the distinction between ordinary and extraordinary is used as a means of reaching decision.  Ã¢â‚¬Å"However, there appears to be an increasing opinion that artificial feeding can be viewed as a'heroic' method of treatment and is morally optional (Meyers and Grodin 1991, Hoefler and Kamoie 1994, Singer 1995, Gillick 2000).This optional treatment is referred to as ‘extraordinary' and is more likely t o be invasive, artificial or complex. Nevertheless, the Hastings Centre guidelines, cited in Meyers and Grodin (1991), stated that decisions over whether to provide artificial nutrition and hydration cannot be made solely on the distinction between ordinary and extraordinary methods of treatment. Despite this, Solomon et al (1993) demonstrated that 74 per cent of health professionals continued to use this distinction in termination of treatment decisions. It would also seem that the decision was significantly influenced by whether it was a decision to withdraw treatment or simply not initiate it in the first place. The Hastings Centre guidelines stipulate that this distinction should not be a consideration (Meyers and Grodin 1991)† (Young et al, 2002).The problem of decision making in providing or withholding nutrition and hydration in the case terminally ill people is a dilemma for nurses until some professional steps are identified to make the decision an objective one made on the basis of professional judgement   rather than being a personal one affected by personal feelings, ethics, beliefs etc.ProposalSince the aim of the study is to justify a professional basis for decision making, in this study we will attempt to investigate the possibility of establishing professional guidelines that may relief the burden on nurses. This will involve identifying criteria that make withholding nutrition more beneficial to the patient than prolonging his biological life. It should also be essential to identify professional means that enable healthcare staff to decide that a patient is not making any sense of life and advise families accordingly to participate in decision making. This should be important especially when the patient is suffering pain or given morphine regularly.In order to be able to design a professional tool or procedure that assists nurses in decision making through this study or alternatively recommend further research on this issue, the study will be a non-experimental one designed to elicit the RN’s attitudes towards nutrition of chronically ill patients using survey instrumentation.The sample will be full time RNs employed by a healthcare region in hospitals and nursing homes of the region. It is advisable to include also a sample of dietitians working in the same healthcare institutions. The RNs involved need to be well informed about the study and its aims and should be positively motivated to participate in the study.It is also important for the study to be approved by a professional body that confirms the study question and methods are ethical.  The instruments of the study should be designed in a way that they measure the attitude of the study sample towards giving or withholding nutrition and hydration for a variety of terminally ill patients. It is also important to determine the internal consistency reliability for the questionnaires and structured interviews.Summary and ConclusionsThese will follow na turally from the analysis of data and discussions and will eventually constitute a recommendation: either a draft of a guideline for assisting nurses in decision making or alternatively suggestions for further research in order to identify a suitable professional tool for relieving the burden on nurses.ReferencesI am not going to list the references now since this is just a skeleton to discuss with your supervisor; unless you deem it necessary.  The word count may not be exactly 3500, but I think what has been written here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal. Nursing and nutrition IntroductionIn different healthcare institutions the question of feeding patients, particularly those who are seriously sick and expected to die soon, raises questions of moral and ethical nature thus making a decision making process very difficult for the caring staff. Such questions may include:How can decisions of giving or withholding feeding and hydration be made?What values and assumptions underlie these decisions?Which courses of action are in the patient's ‘best interest', and how is this ‘interest' determined?How and when, if ever, should a decision not to feed or hydrate be made?Can so basic a provision as food and water ever be considered as optional care?In most of the healthcare institutions whether they are hospitals or senior homes, the decision making lies within the practice of the nurses who are usually faced with dilemmas. While doctors are more advanced in professional knowledge they rarely find themselves in the difficult situation of making the decis ion of withholding nutrition or giving it. However, there is sometimes a differentiation between nutrition as part of the care given to the patient and nutrition as a biological life sustaining process:â€Å"In modern practice there is often an underlying tension between two different understandings of ‘nourishing' the patient. First, nourishing as an intrinsic part of giving care, which falls within the realm of nursing. Second, nourishing as a biological and technical process, a life-sustaining treatment under the control of the medical or nutrition team (from which the nurse may be excluded).† (Hunt, 1994)Yet the daily practice and the roles of nurses and doctors indicate that the nurses find themselves in the dilemma of making the decision more than other medical staff. In many cases where the withholding of nutrition is legally right and in the interest of the patient, the nurse still finds herself in the ethical and professional dilemma. She is not given the oppor tunity to discuss her opinion or given any information. As a result whatever decision she makes may be taken as wrong regardless of the fact that she was partially ignorant.The dilemma is even more difficult when considering nutrition as a basic need or a medical treatment. For a seriously sick person one may accept withholding medication or a technological device that prolongs life unnecessarily, but it is not easy to withhold nutrition which is the basic need for healthy and unhealthy persons.â€Å"Dresser asks, ‘Ought we to regard tube and intravenous feeding as forms of medical treatment, or should we classify them with more basic sorts of care?'† (Dresser, 1985)The decision of withholding nutrition or hydration is a difficult ethical question that poses emotional stress on the nurses. Withholding medication or technological devices is justifiable and there is enough professional and legal guidance for healthcare staff to follow. Indeed, â€Å"Food and water are so central to an array of human emotions that it is almost impossible to consider them with the same emotional detachment that one might feel toward a respirator or a dialysis machine† (Lynn & Childress, 1983)In this research I am going to study this issue in order to confirm or rule out the possibility of establishing a professional guidance that assists the nurses in decision making. This is expected to relief them from a lot of stress and confusion that are imposed as a result of dealing with the issue on personal terms rather dealing with it objectively according to professional guidance and standards.The proposal for this research will be studied under the following headings:1. Description of a case study2.   Literature review3.   Proposal4.   Summary and ConclusionsDescription of a Case StudyA case study either from literature or from the records of healthcare institution is expected to illustrate the extent of the problem and its importance. In addition this will em phasise the roles of nurses, relatives and patients in the decision making process. It would also highlight the difficulties facing nurses at different stages of care giving for seriously sick persons.At this stage of building the skeleton of this research paper very little can be said about the case study until one has been adopted.Literature ReviewThe literature generally confirms the importance of the problem and has been addressing the issues related to the problem of nutrition for sometime now. While it is suggested in the literature that in some cases of chronically ill persons the provision of nutrition is burdensome rather than beneficial, it is agreed that the interpersonal and inter-professional tensions of nurses are ignored. (Hunt, 1994)It is also pointed out that the stressful environment in which nurses provide their professional care sometimes result in burnouts. The burnout case â€Å"evolves by a process involving three stages: (a) an imbalance between resources an d demands, (b) the immediate short-term emotional response to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment† (Riordan & Saltzer, 1992). However, it is also indicated that there are personal differences here: while one may react to stressors by becoming a burnout another with personal hardiness may find the stressors only minor irritants. Riordan and Saltzer (1992) assert:â€Å"Current literature points unanimously to a proactive approach in preventing burnout. This preserves organizational integrity by maintaining human resources and supplying cost-effective care while maintaining quality† (Riordan & Saltzer, 1992).There are a number of suggestions for reducing stress and assisting nurses to cope with the environmental difficulties, though no specific guidelines or procedures are given for dealing with the problem of nutrition and hydration.It is also indicated in the literature that nutrition and hydration in some t erminal cases may only prolong the biological life which is thought to be burdensome for some patients and their families. As Hunt (1994) asserts: â€Å"Feeding may in some circumstances prolong the process of dying and may cause avoidable suffering to the dying patient.†While generally the decision of using nutrition support for the terminally ill people is discussed as a problem facing nurses, some scholars relate the decision to dietitians.â€Å"Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an integral role in institutional policy development concerning nutrition support at the end of lifeâ€Å" (Langdon et al, 2002)To put it in a nutshell the literature review confirms the dilemma facing healthcare professionals, particularly nurses, and families in dealing with the decision of providing nutrition and hydration or withholding it for chronically ill people whose illness is diagnosed as terminal. It is also confirmed that the decision making involves personal feelings, ethics, and sometimes legal consideration. Yet there are no clear professional guidelines that streamline the decision making in this issue in the professional practice. Rather there are observations of some acceptable practices.Sometimes the distinction between ordinary and extraordinary is used as a means of reaching decision.â€Å"However, there appears to be an increasing opinion that artificial feeding can be viewed as a'heroic' method of treatment and is morally optional (Meyers and Grodin 1991, Hoefler and Kamoie 1994, Singer 1995, Gillick 2000). This optional treatment is referred to as ‘extraordinary' and is more likely to be invasive, artificial or complex. Nevertheless, the Hastings Centre guidelines, cited in Meyers and Grodin (1991), stated that decisions over whether to provide artificial nutrition and hydration cannot be made solely on the distinction between ordinary and ex traordinary methods of treatment. Despite this, Solomon et al (1993) demonstrated that 74 per cent of health professionals continued to use this distinction in termination of treatment decisions. It would also seem that the decision was significantly influenced by whether it was a decision to withdraw treatment or simply not initiate it in the first place. The Hastings Centre guidelines stipulate that this distinction should not be a consideration (Meyers and Grodin 1991)† (Young et al, 2002).The problem of decision making in providing or withholding nutrition and hydration in the case terminally ill people is a dilemma for nurses until some professional steps are identified to make the decision an objective one made on the basis of professional judgement   rather than being a personal one affected by personal feelings, ethics, beliefs etc.ProposalSince the aim of the study is to justify a professional basis for decision making, in this study we will attempt to investigate t he possibility of establishing professional guidelines that may relief the burden on nurses. This will involve identifying criteria that make withholding nutrition more beneficial to the patient than prolonging his biological life. It should also be essential to identify professional means that enable healthcare staff to decide that a patient is not making any sense of life and advise families accordingly to participate in decision making. This should be important especially when the patient is suffering pain or given morphine regularly.In order to be able to design a professional tool or procedure that assists nurses in decision making through this study or alternatively recommend further research on this issue, the study will be a non-experimental one designed to elicit the RN’s attitudes towards nutrition of chronically ill patients using survey instrumentation.The sample will be full time RNs employed by a healthcare region in hospitals and nursing homes of the region. It is advisable to include also a sample of dietitians working in the same healthcare institutions. The RNs involved need to be well informed about the study and its aims and should be positively motivated to participate in the study.It is also important for the study to be approved by a professional body that confirms the study question and methods are ethical.The instruments of the study should be designed in a way that they measure the attitude of the study sample towards giving or withholding nutrition and hydration for a variety of terminally ill patients. It is also important to determine the internal consistency reliability for the questionnaires and structured interviews.Summary and ConclusionsThese will follow naturally from the analysis of data and discussions and will eventually constitute a recommendation: either a draft of a guideline for assisting nurses in decision making or alternatively suggestions for further research in order to identify a suitable professional tool for relieving the burden on nurses.ReferencesI am not going to list the references now since this is just a skeleton to discuss with your supervisor; unless you deem it necessary.The word count may not be exactly 3500, but I think what has been written here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal.