Nutritional Value of Menu Items At a Local Fast-Food Restaurant Free Essays

In my pursuit to investigating the balancing the qualities of healthy choices of fast food restaurants were a challenging venture. During a recent visit to McDonalds, I ordered a healthy menu and then selected a very unhealthy menu. My choices included for the healthy choice a rice shrimp burger, side salad, vanilla reduced fat ice cream cone, and Dasani water. We will write a custom essay sample on Nutritional Value of Menu Items At a Local Fast-Food Restaurant or any similar topic only for you Order Now    In my selection of an unhealthy selection I chose a Big Mac, large fries, Mcfurry with Oreo cookies, and a large coca-cola drink. The assessment of my analysis provided an interesting result to the pursuit of a nutritional value meal. In my selection of my healthy selection, I discovered that McDonalds provided an easier approach to being able to select a more nutritional food selection compared to other fast food restaurants (McDonalds, 2008). The healthy selection calorie intake was less than 500 which on a world platform is a great attribute for McDonalds to develop and incorporate an excellent healthy meal. The healthy selection was tasty and fulfilling that was surprising for a fast food restaurant. However, the ingredients were not sacrificed in order to make the healthy food selection with low calories which was a good marketing decision at McDonalds. The unhealthy selection posed a greater challenge due to the higher calorie but the taste was slightly more fulfilling with a huge guilt after taste due to the 1,000 calorie meal. The difference was the feeling of self indulgence to an extreme that was both satisfying and somewhat uncomfortable. However, those feelings did not prevent the challenging temptation to stop eating the unhealthy menu selection. In the future, the fast food restaurants could create a marketing angle that ignites a strong sense of identification and acceptance depending on the social environment. For instance, on the healthy choice a marketing plan that provides an emphasis on a surprising taste of trying something new, rather than the ordinary. The imagery of the marketing ad or commercial should present a creative and alluring concept in order to entice the viewer to indulge in a new experience by making a more nutritional choice. In regards, to the marketing angle for the unhealthy selection the marketing angle can focus showcasing a back drop of self-indulgency that goes along with the sensation eating the item. In doing so, the viewer can relate the two and make a concise choice to select the unhealthy item over the healthy one. The key is the effective translation of marketing the extreme in either selection that relates to the selection – that encourages participating in enjoying the menu item. References McDonalds Inc. (2008) Official International Website. Retrieved from http://www.mcdonalds.com How to cite Nutritional Value of Menu Items At a Local Fast-Food Restaurant, Essays

Antioxidant Activity of Mangrove free essay sample

All forms of life maintain a reducing environment within their cells. This reducing environment is preserved by enzymes that maintain the reduced state through a constant input of metabolic energy. Disturbances in this normal redox state can cause toxic effects through the production of peroxides and free radicals that damage all components of the cell, including proteins,  lipids, and  DNA. Oxidative stress occurs when free radicals, which are not neutralized by antioxidants, go on create more volatile free radicals and damage cell walls, vessel walls, proteins, fats and even the nucleus of our cells. A free radical or reactive species is any chemical species capable of independent existence possessing one or more unpaired electrons. Biological free radicals are thus highly unstable molecules that have electrons available to react with various organic substrates. The reactive species generally include ROS and RNS, though reactive chlorine species also part of the reactive species. Reactive oxygen species  (ROS) are chemically reactive molecules containing oxygen. Examples include  oxygen  ions  and  peroxides. ROS form as a natural byproduct of the normal metabolism of  oxygen  and have important roles in  cell signaling  and  homeostasis. Normally, cells defend themselves against ROS damage with  enzymes  such as  alpha-1-microglobulin,  superoxide dismutase,  catalases,  lactoperoxidase, glutathione peroxidase  and  peroxiredoxins. Small molecule antioxidants such as  ascorbic acid  (vitamin C),  tocopherol  (vitamin E),  uric acid, and  glutathione also play important roles as cellular antioxidants. Reactive Nitrogen Species (RNS)  are radical nitrogen-based molecules that can act to facilitate nitrosylation reactions. Reactive Nitrogen Species (RNS) include nitrous oxide, peroxynitrate, nitrosyl cation, nitrous acid, etc. Many free radicals are the result of naturally occurring processes such as oxygen metabolism and inflammatory processes. For example, when cells use oxygen to generate energy, free radicals are created as a consequence of ATP production by the mitochondria. Exercise can increase the levels of free radicals as can environmental stimuli such as ionizing radiation (from industry, sun exposure, cosmic rays, and medical X-rays), environmental toxins, altered atmospheric conditions (e.g. , ozone and nitrous oxide (primarily from automobile exhaust). Lifestyle stressors such as cigarette smoking and excessive alcohol consumption are also known to affect levels of free radicals. Some of the important reactive species are superoxide (O2. –), shydrogen peroxide (H2O2), hydroxyl radicals (OH. ), nitric oxide (NO. ), etc. An extensive, highly effective group of protective agents and defense mechanisms referred to collectively as the  Antioxidant Defense System  (ADS), acts to regulate oxidative reactions. There are two types of antioxidant systems i. e.enzymatic and non enzymatic antioxidant system develop in plants. Enzymatic system includes superoxide dismutase, glutathione peroxidase, glutathione reductase, catalases, etc. These form the body’s endogenous defense mechanisms to help protect against free radical-induced cell damage. They require micronutrient cofactors such as  selenium, iron, copper, zinc, and manganese for their activity. Non-enzymatic system include such as  ascorbic acid  (Vitamin C), polyphenols  ,  tocopherols, etc. Vitamin C is the most important water-soluble antioxidant in extracellular fluids. Vitamin C helps to neutralize ROS in the water or aqueous phase before it can attack the lipids. Vitamin E is the most important lipid soluble antioxidant. It is important as the chain-breaking antioxidant within the cell membrane. It can protect the membrane fatty acids from lipid peroxidation. Vitamin C in addition is capable of regenerating vitamin E. Beta carotene and other carotenoids also have antioxidant properties. In human, some of the notable diseases caused due to oxidative stress include heart disease is the leading cause of death worldwide. Heart disease risk is raised by several factors including high  cholesterol  levels,  high blood pressure, cigarette smoking, and  diabetes (Sundararajan et al. , 2006; Tawaha et al. , 2007; Nanasombat and Teckchuen, 2009). These promote  atherosclerosis. Atherosclerosis refers to formation of hardened walls of the arteries that impairs blood flow to the heart and other vital organs. Cancer kills millions worldwide. Diet may be the cause for cancer in as much as 35% of all human cancers. Low antioxidant intake in diet may also be responsible. Low dietary intake of fruits and vegetables doubles the risk of most types of cancers. Pro-oxidants, or those who generate free radicals, stimulate cell division and these form the beginnings of mutagenesis and tumor formation. When a cell with a damaged DNA strand divides, it gives rise to disturbed and deformed clusters of cells that form the cancer. In addition, cigarette smoking and chronic inflammation lead to strong free radical generation that seems to be the reason for many cancers. The respiratory system is a well known target for free radical insult. This comes from endogenous factors as well as exposure to air pollutants and toxins, cigarette smoke etc. Recent studies suggest that free radicals may be involved in the development of pulmonary disorders such as  asthma. Antioxidants have been seen to reduce the development of asthmatic symptoms. Vitamin C, vitamin E, and  beta carotene supplementation has been associated with improved lung function. Free radicals can also damage nerves and the  brain. Formation of  cataracts  is believed to involve damage to lens protein by free radicals. This leads to opacity of the lens. Cataract  formation may be slowed with the regular consumption of supplemental antioxidants like vitamin E, vitamin C, and the carotenoids. Other diseases like Diabetes, Rheumatoid  arthritis  etc. are also associated with low antioxidant levels in blood. Several standard established antioxidant drugs such as butylhydroxytoluene (BHT) and rutin have been reported to be toxic to living cells (Madhavi et al, 1995, Bursal amp; Gulcin, 2011, Gocer et al, 2011). BHT drugs are known to be the most prevalent and approved antioxidant scavengers worldwide, have equally been reported to be toxic to the lungs, even at a lower concentration. As oxidative stress causes many human diseases, the use of natural antioxidants is intensively studied. Antioxidants are widely used in  dietary supplements  and have been investigated for the prevention of diseases such as cancer,  coronary heart disease  and even  altitude sickness. Plant contains a variety of phytochemical such as phenols, steroids, tannins, saponins, carbohydrates, etc having antioxidant activity that can be used for the removal of human diseases caused due to the oxidative stress. As part of their adaptation from marine life, terrestrial plants develop antioxidant system producing different phytochemicals such as  ascorbic acid  , polyphenols  and  tocopherols having antioxidant property. Mangrove plants are found to have medicinal values and have been used traditionally by local medical practitioners in worldwide. In nature, more than 65 species of mangrove plants, 18 species are found to be widely used by local medical practitioners in many countries like Africa, South East Asia, South America and Australia. These 12 species viz. Acanthus clicifolius, Aegiceras majus, Avicennia africana, A. marina, A. officinalis, Ceriops caudolleana, Exocoecaria agallocha, Kandelia rhecdi, Nypa fruticans, Rhizophora mangle, R. mcronata and Sonneratia caseolaris are used to cure some deeded diseases like leprosy, elephantiasis, tuberculosis, malaria, dysentery, ulcers and some skin diseases. Balsco et al,1976 and Banerjee and Gosh,1998 reported that 27 out of 65 species of mangrove are present in India respectively. The mangroves are the coastal tropical forest; grow in the intertidal deltaic areas, having higher salt concentration. Some species such as the Grey Mangrove can also tolerate the storage of large amounts of salt in their leaves – which are discarded when the salt load is too high. Mangroves can also restrict the opening of their stomata. This allows the mangrove to conserve its fresh water, ability vital to its survival in a saline environment. Mangroves are able to turn their leaves to reduce the surface area of the leaf exposed to the hot sun. This enables them to reduce water loss through evaporation. A distinctive feature of mangroves is their far-reaching, exposed roots. While these roots come in many different shapes and sizes, they all perform an important function – structural support in the soft soils. Some species of mangroves have pneumataphores, which are above-ground roots. These are filled with spongy tissue and peppered with small holes that offer structural support and allow oxygen to be transferred to the roots trapped below ground in the anaerobic (low oxygen) soils. The roots of many mangrove species are also adapted to stop the intake of a lot of the salt from the water before it reaches the plant. Some mangrove species have evolved to produce seeds that float. The tide acts as the method of dispersal to avoid crowding of young plants. Other mangrove species are viviparous. They retain their seeds until after it has germinated and a long, cylindrical propagule has formed. When it has matured to this stage, the parent tree drops it into the water, where it remains dormant until it finds the soil and is able to put out roots. Referring to the facts cited above the present study was designed with the following objectives. OBJECTIVES Selection of mangrove plants for antioxidant activity on the basis of their ethenomedicinal importance. 2. Preparation of mangrove plant extracts by successive extraction methods. 3. Phytochemical evaluation of the mangrove plant extracts. 4. Evaluation of antioxidant activity following in vitro assay techniques. Normally free radical formation is controlled naturally by various beneficial compounds known as antioxidants. When there is deficiency of these antioxidants damage due to free radicals can become cumulative and debilitating. Antioxidants are capable of stabilizing, or deactivating, free radicals before they attack cells. Some of the important reactive species and their biological effects are superoxide anion, hydrogen peroxide, peroxynitrite, hydroxyl radicals, etc. The free radical superoxide is generated from O2 by multiple pathways. They can be summarized into following categories, such as: i) NADPH oxidation by NADPH oxidase; ii) oxidation of xanthine or hypoxanthine by xanthine oxidase; iii) oxidation of reducing equivalents (e. g., nicotinamide adenine dinucleotide [reduced NADH], NADPH, and FADH2 [FAD reduced]) via the mitochondrial electron transport system; iv) autoxidation of monamines (e. g. , dopamine, epinephrine, and norepinephrine), flavins, and hemoglobin in the presence of trace amounts of transition metals; v) one-electron reduction of O2 by cytochrome P-450. Superoxide anion (O2-) is a reactive oxygen species that reacts quickly with nitric oxide (NO) in the vasculature. The reaction p roduces peroxynitrite and depletes the bioactivity of NO. This is important because NO is a key mediator in many important vascular functions including regulation of smooth muscle tone and blood pressure, platelet activation, and vascular cell signaling (Guzik et al, 2002). Peroxynitrite itself is a highly reactive species which can directly react with various biological targets and components of the cell including lipids, thiols, amino acid residues, DNA bases, and low-molecular weight antioxidants (ODonnell et al, 1999). Peroxynitrite can react directly with proteins that contain transition metal centers. Therefore, it can modify proteins such as hemoglobin, myoglobin, and cytochrone c by oxidizing ferrous heme into its corresponding ferric forms. Peroxynitrite may also be able to change protein structure through the reaction with various amino acids in the peptide chain. Hydrogen peroxide (H2O2) is a two-electron reduction state, formed by dismutation of †¢O2- or by direct reduction of O2. It is lipid soluble and thus able to diffuse across membranes. Hydrogen peroxide and superoxide radical (O2. –) by themselves are relatively less damaging, but they can form species such as hydroxyl radicals.

The Play Amadeus free essay sample

The Play Amadeus Is Mainly Concerned with the Destructive Nature of The play Amadeus Is Mainly Concerned With the Destructive Nature of Jealousy This passage is all too true, both in Peter Shaffer Amadeus and in life in general. However the play is also concerned with the destructive nature of ignorance and naivety. Saltier is Jealous not Just of Mozart talent, but of the fact that God gave the talent to Mozart 0 spiteful, gingering, conceited, Infantile Mozart.He is envious of he vessel of Gods laughter at the patron saint of mediocrity as he had dubbed himself. Not only did God double-cross Sellers, but he did it using this obscene child. It was this jealousy and the rage it inspired that caused Saltier to attempt to kill Mozart by starving him of work and students, and thus, money and food. If Saltier had not restricted the amount of work actually shown to the general public, then Mozart could have been wealthy, and quite possibly selected as the new Experimentalist. We will write a custom essay sample on The Play Amadeus or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Mozart doesnt understand the importance of pleasing members of the Viennese court. He has no comprehension of the value of money, for when he successfully earns any, he spends it on lavish food and clothes immediately, instead of saving it. He spends all his time churning out music in final copy, which, although beautiful, doesnt earn money as would teaching music. Mozart Is really the one who should be Jealous. As he has little In the way of money or assets, or even respect. All he has is his talent and his priceless music, but not the sense he needs to capitalist on it. It isnt the fact that someone has more talent than him, the problem is, as he sees it, that he Isnt as good as someone else after making a bargain with God, which should guarantee that he is the best In the world at least until he dies. But no, l know myself forever mediocre he cries as he realizes that the gift given to him by God only exists to allow him to recognize the greatness and incomparable beauty of the music of God. It is at this moment he resolves to condemn God in everything he does.He cancels all his appointments to help poor musicians, to break his vow of social virtue. He then seduces Katherine Cavalier to break his vow of sexual virtue. He makes the conscious decision to destroy God through Mozart In everything he does. He declares Cod, through Mozart, to be Unwelcome Teeter, the eternal enemy. HIS life Is now devoted to the destruction of God. I believe that Antonio Saltier is also Jealous of Gods ability to dole out talent as he sees fit, without Saltier being able to stand in his way.He has had enough! So he snaps, and attempts to destroy Mozart name and reputation, which wasnt that high to start with. HIS name wasnt Incredibly well known because only Saltier had the relied almost solely on the opinions of Herr Saltier, he was able to prevent Mozart music from becoming popular to a degree. He won his fight with God, but the knowledge lived in him still, he knew he would forever be, the patron saint, of mediocrity.

Penelope And Sarah Essays - Book Of Genesis, Abraham, Vayeira

Penelope And Sarah Essays - Book Of Genesis, Abraham, Vayeira Penelope And Sarah BEHIND EVERY GOOD MAN IS A GREAT WOMAN Most ancient texts were written by men. It is important to remember this. The writers made sure that men were always the heroes, the powerful ones the important ones. Women always seem to lay in the background. However, we must not blame this solely on the writers. Historically, women have not been treated as equals. One cannot help but observe that in the specific area of family life a widespread social and cultural tradition has considered women's role to be exclusively that of wife and mother. As a wife, a woman was expected to obey and serve her husband. Men saw women as, what they believed to be, the fulfillment of Gods intention: It is not good that the man should be alone; I will make him a helper as his partner (Genesis 2.18). Despite these biases, women play a central and crucial role in many historical texts. Even if the men are always the heroes, behind every good man is a great woman. Lets explore these two great women: Penelope from Homers Odyssey, and Sarah from Genesis. They are both shadowed by the greatness of their husbands. However, if we read carefully, we can make them come out of their hiding place and let their true beauty shine! Sarah is the faithful and loving wife of Abraham. God favors Abraham and makes great plans for him. God promises Abraham that he will become a numerous people (Genesis 17). However, becoming a numerous people is impossible without the aid of women. Thus, Sarah plays an important role in Gods historical purpose. Sarah plays an important role in Abrahams life too. She is a devoted wife that seems willing to do anything for her husband. When they are about to enter Egypt (Genesis 12.10) Abraham says to Sarah, I know well that you are a woman beautiful in appearance; and when the Egyptians see you, they will say, This is his wife; then they will kill me... Abraham, of course, wants to save his life. He, therefore, tells Sarah to say she is his sister. Abraham thinks only of himself. The Egyptians shower Abraham with gifts. His content with such material possessions take precedence over the well-being of his wife. However, Sarah doesnt complain. She complies with her husbands wishes. By doing this, Sarah not only brings wealth to her husband, she also saves his life. Sarahs dedication doesnt stop there. Her devotion to her husband is also seen in Genesis 16. Here, Sarah, after being barren for some time, tells Abraham to, go in to my slave-girl; it may be that I shall obtain children by her.. Sarah is not pleased with her decision. She performed this sacrifice for her husband again. We can see her frustration and disappointment when she tells Abraham, May the wrong done to me be on you! Looking at this statement, it seems that Sarah was forced to give her slave-girl to Abraham. However, it was she that made this suggestion. Was she forced by Abraham, and the author just failed to mention this? Maybe she felt forced by society. It is, after all, a womans role to please her husband. Without Sarahs faithful actions there would be no Abraham. Without Abraham there would be no numerous people. Without a numerous people millions of nations would not exist. Sarah seems pretty important now, doesnt she? Another important woman in literature is Penelope from Homers Odyssey. She, like Sarah, is extremely faithful. Her husband, Odysseus, sailed with his army in an expedition twenty years ago and hasnt returned since. In his absence, the nobleman of Ithaca and the surrounding states have converged upon his palace, hoping to win the hand of Penelope. She, ever faithful to her husbands memory, will not remarry. She goes to great lengths to keep from having to chose one of the suitors as a husband: She set up a great loom in her palace, and set to weaving a web of threads long and fine. Then she said to us [the suitors]: Young men, ...wait... until I finish this web, so that my weaving will not be useless and wasted (II, line 94). Penelope never intended to finish the web, for

Marketing project Research Paper Example | Topics and Well Written Essays - 750 words

Marketing project - Research Paper Example Also, another figure worth mentioning is the Egyptian Wael Mhgoub, who will be running a coffee branch in Dubai. It is the bargaining power of our consumers which plays a vital role in establishing our desirability from a customer point of view. UAE environment comprises of guaranteed customers for any specialty coffee industry. The ability of the consumers bargaining strength is proportional to the ability of the consumers to bring down prices and bargain for best-quality services and products. UAE customers are quite capable of being able to pit rival business firms against one another. This was one of the many considerations made before Starbucks ventured into UAE. Here at UAE, there is a vast population with the financial capability, since Starbucks products don’t come cheap (Miller, 2009). Starbucks is the most expansive and leading coffeehouse. Starbucks Corporation is a multibillion international coffeehouse chain, and it is enlisted in the New York Stock Exchange (NSE), where its shares are traded globally. This Corporation has 17,133 stores in 49 countries, 87 of these stores being based in the UAE. Starbucks headquarters are based in Seattle, Washington, USA. Starbucks is the market leader of the coffee market in the world, and in UAE, it is the leading coffee chain cafes. Starbucks is known for its exceptional high quality services and customers highly commend them, since they are happy with their excellent service. Customer feedback shows that the customers are satisfied with the quality as well as taste of the coffee. Based on customer feedback, the UAE love our coffee brands. They are impressed with the wide range of coffee brands we offer. Starbucks is in over 40 countries in the world and in UAE alone, we have 92 branches. Starbucks as a brand alone sells due to its high brand awareness and a globally known high quality coffee brand. Since it is a multibillion dollar

Procedures or Methods Research Paper Example | Topics and Well Written Essays - 750 words

Procedures or Methods - Research Paper Example The researcher requires a platform for explaining reasons behind the collected data. The researcher has to develop guidelines that help collect the reasons behind the results during the research process. This involves the formulation of causal explanations that justify the collected information. Beneficial ways of identifying and carrying out a research depend on the researcher’s intimate understanding of the issue to be studied. This is enhanced during the design process where the researcher gets some background information on the issue. The NCLB law was enacted to give children with disabilities equal education opportunities with their counterparts without disabilities (Baker, 2010). The research design process begins with identifying the aim of the research. In this case, the researcher would be interested in finding out the benefits of NCLB and how the children have benefited so far. Some scholars consider NCLB law to contradict with the initial IDEA law that protects indi viduals with disabilities (Baker, 2010). The researcher may include the effects of the two laws in protecting people with disabilities. The teachers and state education heads have developed educational interventions in order to comply with NCLB requirements and meet the required student performance. The results and failures of the strategies can be included in the aims of the research. The second step is to formulate the research questions that completely address the aims of the research (Bynner and Stribley, 2010). These questions shed light on the benefits of NCLB and the effects it has created in the education system. The research questions are: Where would Special Needs children be educationally without No Child Left Behind? What impact has NCLB created among children with disabilities? What strategies have been formulated by the education board and what effects have they introduced in the curriculum? What issues make the implementation of NCLB difficult and what are the resourc es involved in the implementation process? The third step is to design the research paradigm or theoretical framework. The framework provides a guiding structure and range of tool that will help the researcher answer the research questions. This research would require a positivistic method of collecting data like interviewing students with disabilities, parents, teachers, and curriculum developers (Mitchell and Jolley, 2012). Questionnaires would also be helpful in collecting quantitative data on the subject. The questionnaires would be distributed to various schools within the state. They would have sections to be filled by students, teachers and their parents. These would increase the sampling area by minimizing the effort used when conducting interviews. The students would provide data on the effects of NCLB on their education process. The teachers would provide information regarding the effects of the law on the curriculum and the cumulative effects on the education process for students. Parents would also provide information regarding student performance and perceived benefits introduced by the law. The curriculum developers or education officials in the state offices would provide information regarding the effects of the law on curriculum development and the challenges faced when implementing the guidelines. The questionnaires would also involve questions dealing with the benefits of NCLB on the students, the impact in the education

Reflecting On Ones Practice Nursing Essay

Reflecting On Ones Practice Nursing Essay Striving to become better at what one does entails reflecting on both the positive things that one has achieved and the mistakes committed in the process of performing ones duties and responsibilities. Reflective practice focuses on the learning that has evolved and correcting what has been done wrong. This essay assesses my professional, clinical development through an analytical reflection from a patient seen in the Emergency Care Centre (ECC), as part of the holistic health assessment module. The assessment model used in the consultation will be examined, together with theoretical and evidence based practice, and how this has helped developed my approach, linking decision-making and best practice outcomes. Following Gibbs (1988) model of reflection, I shall establish the integration between theory and practice. This model identified six stages involved in reflective practice where at each stage the I would ask myself a number of questions leading to the final stage of an action plan. It begins with selecting a critical incident to reflect upon followed by keen observing and describing of the incident, then analyzing my experience. This is followed by interpreting the experience and exploring alternatives leading up to an action plan. This is is a cyclical process which enables continual retrospective reflection. II. Reflective Practice Reflective practice has been a key underpinning of qualified nurses since the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) (1992) required them to keep a professional portfolio. As professionals, we are accountable for our ongoing learning and self development, providing the best care to our patients. To ensure this, we need to focus on our actions and skills to be able to meet the demands of patients, colleagues and professional bodies. In order to be reflective practitioners, we need to be reflective thinkers. Reflective thinking is thinking that is aware of its own assumptions and implications as well as being conscious of the reasons and evidence that support the conclusion (Lipman, 2003, p.26). John Dewey defined reflective thinking as an active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends (cited in Martin, 1995, p.167) . Reflective thinking leads one to be more self-aware so he can develop new knowledge about professional practice. Reflective practice has been recognised to be an important tool for professional development. Rowls and Swick (2000) agree and observed that practitioners who regularly reflected enabled them to develop their skills and the way they deal with patients. Schunk and Zimmerman (1998) describe how a self- reflective practice allows us to monitor, evaluate and adjust our performance during learning. Adjusting strategies based on assessment on our learning helps to achieve the goal of learning and identifying the activities well suited to our situations (Schunk Zimmerman, 1998). However, practitioners often found the process quite time consuming and there was a greater fear of becoming introspective or being critical of oneself too much in practice. It is likely that one can be too engrossed in his reflection that he gets to neglect the delivery of a great work performance. Schons theory outlines two different types of reflection that occur at different time phases: reflection on action (Schon 1983) and reflection in action (Schon 1983). Reflection in action is often referred to the colloquial phrase as thinking on your feet a term used to being able to assess ourselves within a situation, making appropriate changes and still keeping a steady flow in the process. Reflection on action is when reflection occurs after the event. This is where the practitioner makes a deliberate and conscious attempt to act and reflect upon a situation and how it should be handled in the future (Loughran 1996). This means while performing a professional task, and one keeps thinking if what he is doing is right, he is doing reflection-on-action. After the task, he gets to evaluate what he has done right or wrong, and at that point, he is engaging in reflection-in-action. I am aware that I practice both kinds in my profession. However ,Fry, Ketteridge and Marshall (2003) seem to take a balanced view and define reflection to be an integration of existing knowledge and new knowledge. This implies that as a reflective practitioner, I should always evaluate if my current knowledge is still applicable, and in updating myself, should be able to incorporate my new learning with what I already know. My Own Practice I have been an Emergency Nurse Practitioner for the past 6 years. My task was mostly seeing patients in the emergency setting with minor injuries. I took this course to gain further knowledge and revise what needs to be improved in what I previously learnt during my 15 years as a nurse. Basically, I assess patients with localized problems (i.e, sprained ankles, lacerations, painful joints, minor head injuries etc.). I found it very daunting having to deal with the person as a whole again and investigate multiple systems (respiratory, cardiac, muscular, etc). Having attended tutorials regarding the assessment of these systems using the inspection, palpation, percussion and auscultation (IPPA) methods, I was eager to practice what I have learned and felt ready to assess a patient. Reflecting on Ones Practice In the tradition of Gibbs (1988) reflective practice, the first step is concentrating on one particular example from my own work experience. One incident that is worth reflecting on was my encounter with a patient with left-sided chest pain. I immediately thought that the patient was suffering from cardiac chest pain, but upon further examination, I found out that the patient actually had a recent chest infection which was treated by a GP with antibiotics. The chest infection was resolved, but the patient was left with residual chest pain. It turns out that it was mild pleuritic chest pain after all. In this incident, I initially felt confident in my diagnosis of cardiac chest pain due to my years of experience as an emergency nurse. Such vast experience exposed me to a variety of symptoms and its diagnosed illnesses. My confidence also came from having attended enough tutorials regarding the assessment of symptoms manifested by different body systems. Upon reading the patients notes, the symptom of left-sided chest pain immediately made me conclude that it was cardiac chest pain. I know that merely reading the patients notes is not enough in coming up with conclusive diagnosis. The clinical evaluation may include the basic inspection, palpation (feeling with the hands), percussion (tapping with the fingers), and auscultation (listening) (IPPA) (The Free Dictionary, 2013); CURB 65, which is a simple well-validated tool for the assessment of severity in community acquired pneumonia (CAP) is another essential evaluative method in checking the presence of a deadly respiratory diseas e. The Ohio State University College of Medicine (2012) shares its guideline in the use of this approach. CURB is short for checking the patients confusion, blood urea nitrogen, respiratory rate, and systolic blood pressure. If the patient seems to be delirious or confused, then he is given a score of 1 on the confusion item. If his blood urea nitrogen value is greater or equal to 20 mg/dL, then it also garners a score of 1. A respiratory rate that is more or equal to 30 breaths/minute is also credited for 1 point. The same is true for the systolic blood pressure if it is less than 90 mm Hg or a diastolic blood pressure less than or equal to 60. If the patient is 65 years old and above, then it also gains 1 point. Computing all the points, if the patients score is 0 or 1, then he can safely be treated as an outpatient. However, a score of 2 may indicate that he needs closer supervision when receiving outpatient treatment, or he may be recommended for inpatient observation admission. Most of the time if the collated score of the patient is 3, 4 or 5, then this usually means the patient needs to be confined to inpatient treatment (Ohio State University College of Medicine, 2013). Clinical judgment of the professional is necessary for a decision to be made for the patient. (Karmakar Wilsher, 2010). Still another evaluative method in examining the patient is the Pulmonary Embolism rule-out Criteria (PERC) (Hugli et al., 2011). The thorough process it entails determines if there is a potentially life-threatening cause of chest pain which may include pulmonary embolus, acute coronary syndrome, aortic dissection or tension penumothorax (King et al., 2012, para.3). If the patients chest pain becomes worse when he is applied deep inspiration and recumbency, then it is likely that it is due to a pleuritic cause. With Gibbs reflection model, so far, the first three steps of identifying a critical incident, observing and describing of the incident have already been done. Now comes analyzing my experience. Triage notes stated a 57 year old female who was suffering from left sided chest pain. Observations were blood pressure ; 184/78, pulse ; 74, respiratory rate; 16, saturations on O2; 98%. I had decided to take this patient and perform an assessment on her. The immediate thoughts were of cardiac chest pain as it was stated to be left sided in nature. Since starting the health assessment module the cardiac patient was the system I was least confident in, in the assessment process. I was anxious before seeing the patient. I had concluded that she was suffering from a cardiac chest pain, and imagined her to be requiring some form of intervention from the cardiac team. However, when meeting the patient and gaining further medical history it was clear that she was in fact a stable patient with a different complaint from my first impression. She had recently been treated for a chest infection by her GP, she had undergone a course of anitbiotics, amoxicillin 500mg for 1 week, after which she had felt much better, but over the following week had been left with a residual left sided chest pain which was worse on deep inspiration. She had initially had an expectorating cough, which had now resolved to an occasional dry cough. After a thorough assessment including IPPA, baseline observations, chest x ray, bloods including D Dimer, full blood count, UEs, cardiac enzymes, and a Wells score to rule out PE, the patient was diagnosed with pleuritic chest pain or pleurisy by the Doctor. (see appendix 1) Initially, I was uncomfortable evaluating the patients condition because it was my first patient with a cardiac problem.Throughout the assessment process I felt uneasy with the knowledge that I had initially made a judgement about the patient without even meeting her. It made me revise my approach to patients as a whole and not jump to conclusions before all avenues had been investigated. I was humble enough to accept my mistake when it was confirmed that it was a mild pleuritic chest pain, garnering from the information from further examination and history taking. I felt the need to read up on cardiac chest pain and push myself into seeing patients with that particular problem so that I can overcome my apprehensions. Next in Gibbs model is the interpretation of my experience. The interpretation of the patients condition from the initial triage notes made me aware of myself making a judgement before setting eyes on the patient. This concerned me and made me question my actions. I understood that I was nervous and uneasy at the thought of assessing a patient unaccompanied, and with hindsight put too much pressure on myself regarding responsibility and duty of care. I recognised the need for me to understand that I was gaining knowledge and skills as part of the degree module that I was completing, this didnt require me to diagnose the clinical conditions of the patients, but facilitated in the learning process of assessment skills and putting into place ideas of diagnosis / differential diagnosis. It also made me reflect on my thought processes regarding making snap judgements without gaining further information. The last stage in Gibbs model entails creating an action plan. The experience I have just analyzed made me realize that the current knowledge and experience I currently have are not enough. I need to learn to be more open in my evaluation of the patients symptoms, and hold my judgment until I have completed the necessary information derived from both examination tests and consulting the medical history of the patient. The fast rate of change in the medical field necessitates health practitioners like me to constantly update myself of current trends and the latest methodologies in nursing care. I should also remind myself all the time that the patients welfare comes way before my own ego in terms of priority. Conclusion Through reflective evaluation I was able to adjust the way I assessed patients with chest pain. I relaxed considerably more and let myself enjoy the assessment process. I was able to consolidate the new skills I had learnt and put in place a methodical process of evaluating differential diagnosis. I understood that the official diagnosis was going to be made by the Doctors mentoring my practice which considerably lessened the pressure I put on myself. Through this reflective process it became evident that good and bad working practice can be monitored and evaluated. Mistakes can be avoided and good working practice can be upheld. Although the feelings initially were disheartening, support from colleagues and my own learning outcomes have helped me progress and develop my skills of assessment. As Atkins and Murphy (2003) suggest that reflection should be made in times of uncomfortable feelings and thoughts surrounding a situation.