Importance Of Communication Of Nurses Nursing Essay

Importance Of Communication Of Nurses Nursing Essay Communication involves the exchange of messages and is a process which all individuals participate in. Whether it is through spoken word, written word, non-verbal means or even silence, messages are constantly being exchanged between individuals or groups of people (Bach Grant 2009). All behaviour has a message and communication is a process which individuals cannot avoid being involved with (Ellis et al 1995). In nursing practice, communication is essential, and good communication skills are paramount in the development of a therapeutic nurse/patient relationship. This aim of this essay is to discuss the importance of communication in nursing, demonstrating how effective communication facilitates a therapeutic nurse/patient relationship. This will be achieved by providing a definition of communication, making reference to models of communication and explaining how different types of communication skills can be used in practise. In order to engage in meaningful communication and develop effective communication skills, nurses must engage in the process of reflecting on how communication skills are utilised in practise. Reflection allows the nurse opportunity to gain a deeper insight into personal strengths and weaknesses and to address any areas of concern in order to improve future practise (Taylor 2001). A further aim will be to reflect on how communication skills have been utilised within nursing practise. Various models of reflection will be examined, and a reflective account of a personal experience which occurred during placement will be provided using a model. This reflective account will involve a description the incident, an analysis of thoughts and feelings and an evaluation of what has occurred. Finally, the reflective account will include an action plan for a similar situation, which may arise, in the future. Communication involves information being sent, received and decoded between two or more people (Balzer-Riley 2008) and involves the use of a number of communication skills; which in a nursing context generally focuses on listening and giving information to patients (Weller 2002). This process of sending and receiving messages has been described as both simple and complex (Rosengren 2000 in McCabe 2006, p.4). It is a process which is continually utilised by nurses to convey and receive information from the patient, co-workers, others they come into contact with and the patients family. Models of Communication. The Linear Model is the simplest form of communication and involves messages being sent and received by two or more people (McCabe 2006). Whilst this model demonstrates how communication occurs in its simplest form, it fails to consider other factors impacting on the process. Communication in nursing practice can be complicated, involving the conveyance of large amounts of information, for example, when providing patients with information relating to their care and treatment or when offering health promotion advice. In contrast, the Circular Transactional Model is a two way approach, acknowledging other factors, which influence communication such as feedback and validation (McCabe 2006). Elements of this model are also contained in Hargie and Dickinsons (2004) A Skill Model of Interpersonal Communication which suggests that successful communication is focused, purposeful and identifies the following skills; person centred context, goal, mediating process, response, feedback and perception. It also considers other aspects of the individual and the influence these may have on their approach to the process of communication (McCabe 2006). For communication to be effective it is important for the nurse to recognise key components, and intrinsic and extrinsic factors, which may affect the process (McCabe 2006). They must consider factors such as past personal experiences, personal perceptions, timing and the setting in which communication occurs. Physical, physiological, psychological and semantic noise may also influence the message, resulting in misinterpreted by the receiver (McCabe 2006). Communication skills. Communication consists of verbal and non-verbal. Verbal communication relates to the spoken word and can be conducted face-to-face or over the telephone (Docherty McCallum 2009). Nurses continually communicate with patients; verbal communication allows the nurse opportunity to give information to the patient about their care or treatment, to reassure the patient and to listen and respond to any concerns the patient may have (NMC 2008). Effective communication is beneficial to the patient in terms of their satisfaction and understanding, of care and treatment they have been given (Arnold Boggs 2007), while at the same time optimising the outcomes or care and/or treatment for the patient (Kennedy- Sheldon 2009). Questioning allows the nurse to gather further information and open or closed questions can be used. Closed questions usually require a yes or no response and are used to gather the necessary information, whereas open questions allow the patient, opportunity to play an active role and to discuss and agree options relating to their care as set out in the Healthcare Standards for Wales document (2005). Probing questions can be used to explore the patients problems further thus allowing the nurse to treat the patient as an individual and develop a care plan specific to their individual needs (NMC 2008). It is vital that the nurse communicates effectively, sharing information with the patient about their health in an understandable way to ensure the patient is fully informed about their care and treatment and that consent is gained prior to this occurring (NMC 2008). The nurse should also listen to the patient and respond to their concerns and preferences about their care and well-being (NMC 2008). In nursing, listening is an essential skill and incorporates attending and listening (Burnard Gill 2007). Attending; fully focusing on the other person and being aware of what they are trying to communicate and listening; the process of hearing what is being said by another person are the most important aspects of being a nurse (Burnard 1997). Non-verbal communication is a major factor in communication, involving exchange of messages without words. It relates to emotional states and attitudes and the conveyance of messages through body language; body language has seven elements; gesture, facial expressions, gaze, posture, body space and proximity, touch and dress (Ellis et al 1995). Each of these elements can reinforce the spoken word and add meaning to the message; it isnt about what you say or how you say it but it also relates to what your body is doing while you are speaking (Oberg 2003). Patients often read cues from the nurses non-verbal behaviour, which can indicate interest or disinterest. Attentiveness and attention to the patient can be achieved through SOLER: S sit squarely, O Open posture, L learn towards the patient, E eye contact, R relax (Egan 2002). There must be congruency between verbal and non verbal messages for effective communication to be achieved. Non-verbal communication can contradict the spoken word and the ability to recognise these non-verbal cues is vitally important in nursing practice (McCabe 2006), for example, a patient may verbally communicate that they are not in pain, but their non-verbal communication such as facial expression may indicate otherwise. It is also important for the nurse to be aware of the congruency of their verbal and non-verbal communication. Any discrepancies between the two will have a direct influence on the message they are giving to patients, and may jeopardise the nurse/patient relationship. Other factors may affect communication in a negative way, endangering the process, and nurses must be aware of internal and external barriers (Schubert 2003). Lack of interest, poor listening skills, culture and the personal attitude are internal factors, which may affect the process. External barriers such as the physical environment, temperature, the use of jargon and/or technical words can also negatively influence the process (Schubert 2003). Reflection. To fully assess the development of communication skills the nurse can make use of reflection to gain a better insight and understanding of their skills (Siviter 2008). Reflection can also be used to apply theoretical knowledge to practice, thus bridging the gap between theory and practice (Burns Bulman 2000) and allows us opportunity, to develop a better insight and awareness of our actions both conscious and unconscious in the situation. Reflecting on events that take place in practice, allows opportunity not only to think about what we do, but also to consider why we do things. This helps us to learn from the experience and improve our future nursing practice (Siviter 2008). Reflection can be described as either reflection in action; occurring during the event, or reflection on action; which happens after the event has occurred (Taylor 2001) and is guided by a model, which serves as a framework within, which the nurse is able to work. It is usually a written process, and the use o f a reflective model uses questions to provide a structure and guide for the process (Siviter 2008). Reflective Models. There are numerous reflective models that may be utilised by the nursing professional, for example, Gibbs Reflective Cycle (1988), Johns Model of Structured Reflection (1994) and Driscolls Model of Reflection (2002). Gibbs model (Appendix I) has a cyclical approach, consisting of six stages per cycle that guide the user through a series of questions, providing a structure for reflection on an experience. The first stage of the process is a descriptive account of the situation; what happened? Followed by an analysis of thoughts and feelings in the second stage; what were your thoughts and feelings? The third and fourth stages involve an evaluation of the situation, what was good and/or bad about the experience and an analysis allowing us to make sense of the situation. The last two stages are the conclusion of the situation, what else could have been done and finally an action plan to prepare for similar situations, which may arise in the future (Gibbs 1988). Similarly to Gibbs Reflective Cycle, Johns Model of Structured Reflection (Appendix II) and Driscolls (Appendix III) model of reflection promote learning through reflection. They have similar structures, which guide the user through the reflective process. Johns Model incorporates four stages; description, reflection, alternative actions and learning (Johns 1994) and Discolls model has three stages: a return to the situation, understanding the context and modifying future outcome (Discoll 2002). The three models described all have similarities in that the user is guided through the reflective process by describing the event, analysing their thoughts, feelings and actions and making plans for future practice. Considering the models of reflection described, the next component of this essay will make use of the Gibbs Reflective Cycle (1998) to provide a reflective account of a situation which I experienced during clinical placement in a community setting. Reflective Account. As part of this placement, I assisted my mentor, a health visitor, in the provision of a baby club for parents with babies and pre-school children, which takes place on a weekly basis and involves routine checks, such as baby-weighing, in addition to opportunity, for parents to socialise and opportunity for health visitors to provide information relating to the care and health of babies and children. During the second week of this placement, I was asked to assist in the delivery of a forthcoming health promotion session relating to dental health. I have chosen this event as a basis for my reflective account as I feel that health promotion is an important area to consider. It enables individuals to play a pivotal role in their own health (Webster and Finch 2002 in Scriven 2005) and is a means by which positive health can be promoted and enhanced alongside the prevention of illness (Downie et al 2000). It gives clients the knowledge to make informed decisions about their health and prevention of illness and is an area in which the nurse or healthcare professional plays a key role (WHO 1989). Description of the event. The event occurred during a weekly session at baby club that takes place in a community centre. My mentor (Health Visitor) and I were present along with a group of ten mothers and their babies. As this event took place during a group session, I will maintain confidentiality (NMC 2008) by not referring to any one individual. Consent was gained from all clients prior to the session commencing, in line with the NMC Code of Conduct (2008) and the environment was checked to ensure it was appropriate and safe for the session to take place. The aim of the session was to promote good dental health and oral hygiene amongst children and babies. Standard 1 of the Standards of Care for Health Visitors (RCN 1989) is to promote health, and the session aimed to provide clients with relevant, up-to-date information, thus allowing them to make informed choices about the future care of their childrens teeth. Chairs were set out in a semi-circle with a number of play mats and various baby toys placed in the centre. This allowed parents opportunity to interact in the session, to listen to the information and ask questions while at the same time being in close enough proximity to their children to respond to their needs. The Health Visitor and I sat at the front of the semi circle facing the group. I reintroduced myself to the group and gave a brief explanation of my role and the part I would play in the session. This was important; some of the clients were meeting me for the first time, and it is during this initial contact that jud gements are made about future interactions, and the service being provided. Positive initial interaction can provide a good foundation for a future beneficial relationship (Scriven 2005). The session was broken down into two parts: information giving, focusing on the promotion of dental health and prevention of illness in the form of tooth decay (Robotham and Frost 2005). Secondly, information relating to tooth brushing was given along with a demonstration undertaken by myself that showed the clients good oral hygiene could be achieved through effective tooth brushing. A question and answer session followed which allowed us to clarify any issues raised. Feelings and thoughts. In the week, preceding the session it was important for me to consider a systematic approach to the planning of the session. The first stage was to gather relevant, up-to-date information relating to the subject and plan how it could be incorporated in the session. The NMC Standards of Proficiency (2004a) states that nurses must engage in a continual process of learning and that evidence-based practice should be used (Bach and Grant 2009). The plan was discussed with my mentor and advice was sought about any adjustments which may be necessary. Prior to the session, I was apprehensive about delivering a health promotion session to clients (patients). I as I felt out of my depth as a first year student and my anxiety was exacerbated further as this was my first placement. However, support and encouragement from my mentor and other health visitors in the team helped me to relax. I was given the opportunity to discuss the topic with my mentor and was relieved when I was able to respond to any questions asked in an appropriate manner and that my knowledge had been increased through the research I had undertaken, thus boosting my confidence. Evaluation. Despite my initial reservation about my knowledge of the subject and apprehension at delivering a health promotion session, I feel that my mentors decision to include me in the delivery of the session benefitted me greatly in the development of my knowledge and self confidence. During the session, I feel that I communicated well verbally with clients and that my non-verbal communication was appropriate and corresponded to what I was saying. The clients were focused on the session and seemed genuinely interested, nodding when they understood and showed attentiveness by making regular eye contact. Feedback from clients after the session also allowed me to reflect on my communication; one of the clients stated afterwards that she had gained a lot from the session particularly the demonstration relating to tooth brushing and was now more aware of the importance of early oral hygiene to prevent problems later in the childs life. Analysis. Dental Health is a key Health Promotion target in Wales and is the most prevalent form of disease amongst children in Wales. Many of the participants were unaware of when and how childrens teeth should be cared for and the importance of ensuring good oral hygiene from an early age. The aim of the session was to provide information to parents as a means of promoting good oral hygiene and prevention of tooth decay in babies and young children. In order for the aim to be achieved, communication was a key element. Effective communication in a group can only be achieved if there is trust, participation, co-operation and collaboration among its members and the belief that they as a group are able to perform effectively as a group (Balzer-Riley 2008). The information was provided in a way that was easily understandable, a demonstration of how teeth should be brushed was given, and time was allowed for the clients time to ask questions. Communication and listening skills allowed us to discov er what knowledge the clients already had, and enabled us to adjust the information to meet the needs of the clients. Throughout the session, I was aware of my non-verbal communication and attempted to show attentiveness to individuals in the group, using the principles of SOLER I made the necessary adjustments. At times, this proved difficult as trying to lean towards the clients and maintain eye contact with each individual was not possible in a group situation. My anxiety about delivering the session was also an area which I had some concerns with. Nervousness can have an influence on how a message is delivered, and I was constantly aware of my verbal communication, particularly my paralanguage. I have a tendency to speak at an accelerated rate when I am nervous, and was aware that this may influence the way in which the message was being received. It is important to be aware of paralanguage in which the meaning of a word or phrase can change depending on tone, pitch or the rate at which the word(s) is spoken. Paralanguage may also include vocal sounds which may accompany speech and which can add meaning to the words being spoken (Hartley 1999). Throughout the session, I was aware of my verbal and non-verbal communication, and I tried to ensure that it corresponded to the information being given; I was also aware of non-verbal communication of the participants and made appropriate adjustments to my delivery when needed Conclusion. After the session had finished, I was given an opportunity to discuss it with my mentor. I was able to articulate what I felt had gone well, what hadnt gone quite as well and what could be improved. I noted that I was very nervous about delivering the session despite having the knowledge and understanding of the subject and felt that this may have been noticed by the participants. However, feedback from my mentor allowed me to realise that my nervousness was not apparent in my delivery. By undertaking this reflection, I have been able to question the experience and analyse my actions and behaviour, as a means of developing my knowledge for future practice Action plan. This session has helped with my learning and personal development and I now feel more confident in my ability to deliver health promotion activities in a group setting. I am, however, aware that speaking in a group setting is not an area I am very comfortable with but further practice will help alleviate this. I am confident that I will be able to use the knowledge gained on the subject of dental health in my future placements. In the future, I will repeat the process of thorough research, as it is best practice to keep knowledge up-to-date in order to provide care based on evidence (NMC 2008). Summary. In summary, communication is a complex process and an essential skill which the nurse must be aware of in every aspect, of care and treatment they give to patients. A full awareness of not only the spoken word, but also the influence non-verbal communication has on the messages being communicated, is essential in the development of a therapeutic relationship between nurse and patient. The process of reflecting upon practice is also an essential element of knowledge development. After consideration of a number of reflective frameworks, the use of Gibbs Reflective Cycle as a structure for creating a reflective account has proven to be beneficial in the exploration of personal thoughts and feelings in relation to a specified event and I recognise the importance of reflection as a learning tool that can enhance knowledge and practice.

Twilight 9. THEORY

9. THEORY â€Å"Can I ask just one more?† I pleaded as Edward accelerated much too quickly down the quiet street. He didn't seem to be paying any attention to the road. He sighed. â€Å"One,† he agreed. His lips pressed together into a cautious line. â€Å"Well†¦ you said you knew I hadn't gone into the bookstore, and that I had gone south. I was just wondering how you knew that.† He looked away, deliberating. â€Å"I thought we were past all the evasiveness,† I grumbled. He almost smiled. â€Å"Fine, then. I followed your scent.† He looked at the road, giving me time to compose my face. I couldn't think of an acceptable response to that, but I filed it carefully away for future study. I tried to refocus. I wasn't ready to let him be finished, now that he was finally explaining things. â€Å"And then you didn't answer one of my first questions†¦Ã¢â‚¬  I stalled. He looked at me with disapproval. â€Å"Which one?† â€Å"How does it work – the mind-reading thing? Can you read anybody's mind, anywhere? How do you do it? Can the rest of your family†¦ ?† I felt silly, asking for clarification on make-believe. â€Å"That's more than one,† he pointed out. I simply intertwined my fingers and gazed at him, waiting. â€Å"No, it's just me. And I can't hear anyone, anywhere. I have to be fairly close. The more familiar someone's†¦ ‘voice' is, the farther away I can hear them. But still, no more than a few miles.† He paused thoughtfully. â€Å"It's a little like being in a huge hall filled with people, everyone talking at once. It's just a hum – a buzzing of voices in the background. Until I focus on one voice, and then what they're thinking is clear. â€Å"Most of the time I tune it all out – it can be very distracting. And then it's easier to seem normal† – he frowned as he said the word – â€Å"when I'm not accidentally answering someone's thoughts rather than their words.† â€Å"Why do you think you can't hear me?† I asked curiously. He looked at me, his eyes enigmatic. â€Å"I don't know,† he murmured. â€Å"The only guess I have is that maybe your mind doesn't work the same way the rest of theirs do. Like your thoughts are on the AM frequency and I'm only getting FM.† He grinned at me, suddenly amused. â€Å"My mind doesn't work right? I'm a freak?† The words bothered me more than they should – probably because his speculation hit home. I'd always suspected as much, and it embarrassed me to have it confirmed. â€Å"I hear voices in my mind and you're worried that you're the freak,† he laughed. â€Å"Don't worry, it's just a theory†¦Ã¢â‚¬  His face tightened. â€Å"Which brings us back to you.† I sighed. How to begin? â€Å"Aren't we past all the evasions now?† he reminded me softly. I looked away from his face for the first time, trying to find words. I happened to notice the speedometer. â€Å"Holy crow!† I shouted. â€Å"Slow down!† â€Å"What's wrong?† He was startled. But the car didn't decelerate. â€Å"You're going a hundred miles an hour!† I was still shouting. I shot a panicky glance out the window, but it was too dark to see much. The road was only visible in the long patch of bluish brightness from the headlights. The forest along both sides of the road was like a black wall – as hard as a wall of steel if we veered off the road at this speed. â€Å"Relax, Bella.† He rolled his eyes, still not slowing. â€Å"Are you trying to kill us?† I demanded. â€Å"We're not going to crash.† I tried to modulate my voice. â€Å"Why are you in such a hurry?† â€Å"I always drive like this.† He turned to smile crookedly at me. â€Å"Keep your eyes on the road!† â€Å"I've never been in an accident, Bella – I've never even gotten a ticket.† He grinned and tapped his forehead. â€Å"Built-in radar detector.† â€Å"Very funny.† I fumed. â€Å"Charlie's a cop, remember? I was raised to abide by traffic laws. Besides, if you turn us into a Volvo pretzel around a tree trunk, you can probably just walk away.† â€Å"Probably,† he agreed with a short, hard laugh. â€Å"But you can't.† He sighed, and I watched with relief as the needle gradually drifted toward eighty. â€Å"Happy?† â€Å"Almost.† â€Å"I hate driving slow,† he muttered. â€Å"This is slow?† â€Å"Enough commentary on my driving,† he snapped. â€Å"I'm still waiting for your latest theory.† I bit my lip. He looked down at me, his honey eyes unexpectedly gentle. â€Å"I won't laugh,† he promised. â€Å"I'm more afraid that you'll be angry with me.† â€Å"Is it that bad?† â€Å"Pretty much, yeah.† He waited. I was looking down at my hands, so I couldn't see his expression. â€Å"Go ahead.† His voice was calm. â€Å"I don't know how to start,† I admitted. â€Å"Why don't you start at the beginning†¦ you said you didn't come up with this on your own.† â€Å"No.† â€Å"What got you started – a book? A movie?† he probed. â€Å"No – it was Saturday, at the beach.† I risked a glance up at his face. He looked puzzled. â€Å"I ran into an old family friend -Jacob Black,† I continued. â€Å"His dad and Charlie have been friends since I was a baby.† He still looked confused. â€Å"His dad is one of the Quileute elders.† I watched him carefully. His confused expression froze in place. â€Å"We went for a walk -† I edited all my scheming out of the story â€Å"- and he was telling me some old legends – trying to scare me, I think. He told me one†¦Ã¢â‚¬  I hesitated. â€Å"Go on,† he said. â€Å"About vampires.† I realized I was whispering. I couldn't look at his face now. But I saw his knuckles tighten convulsively on the wheel. â€Å"And you immediately thought of me?† Still calm. â€Å"No. He†¦ mentioned your family.† He was silent, staring at the road. I was worried suddenly, worried about protecting Jacob. â€Å"He just thought it was a silly superstition,† I said quickly. â€Å"He didn't expect me to think anything of it.† It didn't seem like enough; I had to confess. â€Å"It was my fault, I forced him to tell me.† â€Å"Why?† â€Å"Lauren said something about you – she was trying to provoke me. And an older boy from the tribe said your family didn't come to the reservation, only it sounded like he meant something different. So I got Jacob alone and I tricked it out of him,† I admitted, hanging my head. He startled me by laughing. I glared up at him. He was laughing, but his eyes were fierce, staring ahead. â€Å"Tricked him how?† he asked. â€Å"I tried to flirt – it worked better than I thought it would.† Disbelief colored my tone as I remembered. â€Å"I'd like to have seen that.† He chuckled darkly. â€Å"And you accused me of dazzling people – poor Jacob Black.† I blushed and looked out my window into the night. â€Å"What did you do then?† he asked after a minute. â€Å"I did some research on the Internet.† â€Å"And did that convince you?† His voice sounded barely interested. But his hands were clamped hard onto the steering wheel. â€Å"No. Nothing fit. Most of it was kind of silly. And then†¦Ã¢â‚¬  I stopped. â€Å"What?† â€Å"I decided it didn't matter,† I whispered. â€Å"It didn't matter?† His tone made me look up – I had finally broken through his carefully composed mask. His face was incredulous, with just a hint of the anger I'd feared. â€Å"No,† I said softly. â€Å"It doesn't matter to me what you are.† A hard, mocking edge entered his voice. â€Å"You don't care if I'm a monster? If I'm not human!† â€Å"No.† He was silent, staring straight ahead again. His face was bleak and cold. â€Å"You're angry,† I sighed. â€Å"I shouldn't have said anything.† â€Å"No,† he said, but his tone was as hard as his face. â€Å"I'd rather know what you're thinking – even if what you're thinking is insane.† â€Å"So I'm wrong again?† I challenged. â€Å"That's not what I was referring to. ‘It doesn't matter'!† he quoted, gritting his teeth together. â€Å"I'm right?† I gasped. â€Å"Does it matter?† I took a deep breath. â€Å"Not really.† I paused. â€Å"But I am curious.† My voice, at least, was composed. He was suddenly resigned. â€Å"What are you curious about?† â€Å"How old are you?† â€Å"Seventeen,† he answered promptly. â€Å"And how long have you been seventeen?† His lips twitched as he stared at the road. â€Å"A while,† he admitted at last. â€Å"Okay.† I smiled, pleased that he was still being honest with me. He stared down at me with watchful eyes, much as he had before, when he was worried I would go into shock. I smiled wider in encouragement, and he frowned. â€Å"Don't laugh – but how can you come out during the daytime?† He laughed anyway. â€Å"Myth.† â€Å"Burned by the sun?† â€Å"Myth.† â€Å"Sleeping in coffins?† â€Å"Myth.† He hesitated for a moment, and a peculiar tone entered his voice. â€Å"I can't sleep.† It took me a minute to absorb that. â€Å"At all?† â€Å"Never,† he said, his voice nearly inaudible. He turned to look at me with a wistful expression. The golden eyes held mine, and I lost my train of thought. I stared at him until he looked away. â€Å"You haven't asked me the most important question yet.† His voice was hard now, and when he looked at me again his eyes were cold. I blinked, still dazed. â€Å"Which one is that?† â€Å"You aren't concerned about my diet?† he asked sarcastically. â€Å"Oh,† I murmured, â€Å"that.† â€Å"Yes, that.† His voice was bleak. â€Å"Don't you want to know if I drink blood?† I flinched. â€Å"Well, Jacob said something about that.† â€Å"What did Jacob say?† he asked flatly. â€Å"He said you didn't†¦ hunt people. He said your family wasn't supposed to be dangerous because you only hunted animals.† â€Å"He said we weren't dangerous?† His voice was deeply skeptical. â€Å"Not exactly. He said you weren't supposed to be dangerous. But the Quileutes still didn't want you on their land, just in case.† He looked forward, but I couldn't tell if he was watching the road or not. â€Å"So was he right? About not hunting people?† I tried to keep my voice as even as possible. â€Å"The Quileutes have a long memory,† he whispered. I took it as a confirmation. â€Å"Don't let that make you complacent, though,† he warned me. â€Å"They're right to keep their distance from us. We are still dangerous.† â€Å"I don't understand.† â€Å"We try,† he explained slowly. â€Å"We're usually very good at what we do. Sometimes we make mistakes. Me, for example, allowing myself to be alone with you.† â€Å"This is a mistake?† I heard the sadness in my voice, but I didn't know if he could as well. â€Å"A very dangerous one,† he murmured. We were both silent then. I watched the headlights twist with the curves of the road. They moved too fast; it didn't look real, it looked like a video game. I was aware of the time slipping away so quickly, like the black road beneath us, and I was hideously afraid that I would never have another chance to be with him like this again – openly, the walls between us gone for once. His words hinted at an end, and I recoiled from the idea. I couldn't waste one minute I had with him. â€Å"Tell me more,† I asked desperately, not caring what he said, just so I could hear his voice again. He looked at me quickly, startled by the change in my tone. â€Å"What more do you want to know?† â€Å"Tell me why you hunt animals instead of people,† I suggested, my voice still tinged with desperation. I realized my eyes were wet, and I fought against the grief that was trying to overpower me. â€Å"I don't want to be a monster.† His voice was very low. â€Å"But animals aren't enough?† He paused. â€Å"I can't be sure, of course, but I'd compare it to living on tofu and soy milk; we call ourselves vegetarians, our little inside joke. It doesn't completely satiate the hunger – or rather thirst. But it keens us strong enough to resist. Most of the time.† His tone turned ominous. â€Å"Sometimes it's more difficult than others.† â€Å"Is it very difficult for you now?† I asked. He sighed. â€Å"Yes.† â€Å"But you're not hungry now,† I said confidently – stating, not asking. â€Å"Why do you think that?† â€Å"Your eyes. I told you I had a theory. I've noticed that people – men in particular – are crabbier when they're hungry.† He chuckled. â€Å"You are observant, aren't you?† I didn't answer; I just listened to the sound of his laugh, committing it to memory. â€Å"Were you hunting this weekend, with Emmett?† I asked when it was quiet again. â€Å"Yes.† He paused for a second, as if deciding whether or not to say something. â€Å"I didn't want to leave, but it was necessary. It's a bit easier to be around you when I'm not thirsty.† â€Å"Why didn't you want to leave?† â€Å"It makes me†¦ anxious†¦ to be away from you.† His eyes were gentle but intense, and they seemed to be making my bones turn soft. â€Å"I wasn't joking when I asked you to try not to fall in the ocean or get run over last Thursday. I was distracted all weekend, worrying about you. And after what happened tonight, I'm surprised that you did make it through a whole weekend unscathed.† He shook his head, and then seemed to remember something. â€Å"Well, not totally unscathed.† â€Å"What?† â€Å"Your hands,† he reminded me. I looked down at my palms, at the almost-healed scrapes across the heels of my hands. His eyes missed nothing. â€Å"I fell,† I sighed. â€Å"That's what I thought.† His lips curved up at the corners. â€Å"I suppose, being you, it could have been much worse – and that possibility tormented me the entire time I was away. It was a very long three days. I really got on Emmett's nerves.† He smiled ruefully at me. â€Å"Three days? Didn't you just get back today?† â€Å"No, we got back Sunday.† â€Å"Then why weren't any of you in school?† I was frustrated, almost angry as I thought of how much disappointment I had suffered because of his absence. â€Å"Well, you asked if the sun hurt me, and it doesn't. But I can't go out in the sunlight – at least, not where anyone can see.† â€Å"Why?† â€Å"I'll show you sometime,† he promised. I thought about it for a moment. â€Å"You might have called me,† I decided. He was puzzled. â€Å"But I knew you were safe.† â€Å"But I didn't know where you were. I -† I hesitated, dropping my eyes. â€Å"What?† His velvety voice was compelling. â€Å"I didn't like it. Not seeing you. It makes me anxious, too.† I blushed to be saying this out loud. He was quiet. I glanced up, apprehensive, and saw that his expression was pained. â€Å"Ah,† he groaned quietly. â€Å"This is wrong.† I couldn't understand his response. â€Å"What did I say?† â€Å"Don't you see, Bella? It's one thing for me to make myself miserable, but a wholly other thing for you to be so involved.† He turned his anguished eyes to the road, his words flowing almost too fast for me to understand. â€Å"I don't want to hear that you feel that way.† His voice was low but urgent. His words cut me. â€Å"It's wrong. It's not safe. I'm dangerous, Bella – please, grasp that.† â€Å"No.† I tried very hard not to look like a sulky child. â€Å"I'm serious,† he growled. â€Å"So am I. I told you, it doesn't matter what you are. It's too late.† His voice whipped out, low and harsh. â€Å"Never say that.† I bit my lip and was glad he couldn't know how much that hurt. I stared out at the road. We must be close now. He was driving much too fast. â€Å"What are you thinking?† he asked, his voice still raw. I just shook my head, not sure if I could speak. I could feel his gaze on my face, but I kept my eyes forward. â€Å"Are you crying?† He sounded appalled. I hadn't realized the moisture in my eyes had brimmed over. I quickly rubbed my hand across my cheek, and sure enough, traitor tears were there, betraying me. â€Å"No,† I said, but my voice cracked. I saw him reach toward me hesitantly with his right hand, but then he stopped and placed it slowly back on the steering wheel. â€Å"I'm sorry.† His voice burned with regret. I knew he wasn't just apologizing for the words that had upset me. The darkness slipped by us in silence. â€Å"Tell me something,† he asked after another minute, and I could hear him struggle to use a lighter tone. â€Å"Yes?† â€Å"What were you thinking tonight, just before I came around the corner? I couldn't understand your expression – you didn't look that scared, you looked like you were concentrating very hard on something.† â€Å"I was trying to remember how to incapacitate an attacker – you know, self-defense. I was going to smash his nose into his brain.† I thought of the dark-haired man with a surge of hate. â€Å"You were going to fight them?† This upset him. â€Å"Didn't you think about running?† â€Å"I fall down a lot when I run,† I admitted. â€Å"What about screaming for help?† â€Å"I was getting to that part.† He shook his head. â€Å"You were right – I'm definitely fighting fate trying to keep you alive.† I sighed. We were slowing, passing into the boundaries of Forks. It had taken less than twenty minutes. â€Å"Will I see you tomorrow?† I demanded. â€Å"Yes – I have a paper due, too.† He smiled. â€Å"I'll save you a seat at lunch.† It was silly, after everything we'd been through tonight, how that little promise sent flutters through my stomach, and made me unable to speak. We were in front of Charlie's house. The lights were on, my truck in its place, everything utterly normal. It was like waking from a dream. He stopped the car, but I didn't move. â€Å"Do you promise to be there tomorrow?† â€Å"I promise.† I considered that for a moment, then nodded. I pulled his jacket off, taking one last whiff. â€Å"You can keep it – you don't have a jacket for tomorrow,† he reminded me. I handed it back to him. â€Å"I don't want to have to explain to Charlie.† â€Å"Oh, right.† He grinned. I hesitated, my hand on the door handle, trying to prolong the moment. â€Å"Bella?† he asked in a different tone – serious, but hesitant. â€Å"Yes?† I turned back to him too eagerly. â€Å"Will you promise me something?† â€Å"Yes,† I said, and instantly regretted my unconditional agreement. What if he asked me to stay away from him? I couldn't keep that promise. â€Å"Don't go into the woods alone.† I stared at him in blank confusion. â€Å"Why?† He frowned, and his eyes were tight as he stared past me out the window. â€Å"I'm not always the most dangerous thing out there. Let's leave it at that.† I shuddered slightly at the sudden bleakness in his voice, but I was relieved. This, at least, was an easy promise to honor. â€Å"Whatever you say.† â€Å"I'll see you tomorrow,† he sighed, and I knew he wanted me to leave now. â€Å"Tomorrow, then.† I opened the door unwillingly. â€Å"Bella?† I turned and he was leaning toward me, his pale, glorious face just inches from mine. My heart stopped beating. â€Å"Sleep well,† he said. His breath blew in my face, stunning me. It was the same exquisite scent that clung to his jacket, but in a more concentrated form. I blinked, thoroughly dazed. He leaned away. I was unable to move until my brain had somewhat unscrambled itself. Then I stepped out of the car awkwardly, having to use the frame for support. I thought I heard him chuckle, but the sound was too quiet for me to be certain. He waited till I had stumbled to the front door, and then I heard his engine quietly rev. I turned to watch the silver car disappear around the corner. I realized it was very cold. I reached for the key mechanically, unlocked the door, and stepped inside. Charlie called from the living room. â€Å"Bella?† â€Å"Yeah, Dad, it's me.† I walked in to see him. He was watching a baseball game. â€Å"You're home early.† â€Å"Am I?† I was surprised. â€Å"It's not even eight yet,† he told me. â€Å"Did you girls have fun?† â€Å"Yeah – it was lots of fun.† My head was spinning as I tried to remember all the way back to the girls' night out I had planned. â€Å"They both found dresses.† â€Å"Are you all right?† â€Å"I'm just tired. I did a lot of walking.† â€Å"Well, maybe you should go lie down.† He sounded concerned. I wondered what my face looked like. â€Å"I'm just going to call Jessica first.† â€Å"Weren't you just with her?† he asked, surprised. â€Å"Yes – but I left my jacket in her car. I want to make sure she brings it tomorrow.† â€Å"Well, give her a chance to get home first.† â€Å"Right,† I agreed. I went to the kitchen and fell, exhausted, into a chair. I was really feeling dizzy now. I wondered if I was going to go into shock after all. Get a grip, I told myself. The phone rang suddenly, startling me. I yanked it off the hook. â€Å"Hello?† I asked breathlessly. â€Å"Bella?† â€Å"Hey, Jess, I was just going to call you.† â€Å"You made it home?† Her voice was relieved†¦ and surprised. â€Å"Yes. I left my jacket in your car – could you bring it to me tomorrow?† â€Å"Sure. But tell me what happened!† she demanded. â€Å"Um, tomorrow – in Trig, okay?† She caught on quickly. â€Å"Oh, is your dad there?† â€Å"Yes, that's right.† â€Å"Okay, I'll talk to you tomorrow, then. Bye!† I could hear the impatience in her voice. â€Å"Bye, Jess.† I walked up the stairs slowly, a heavy stupor clouding my mind. I went through the motions of getting ready for bed without paying any attention to what I was doing. It wasn't until I was in the shower – the water too hot, burning my skin – that I realized I was freezing. I shuddered violently for several minutes before the steaming spray could finally relax my rigid muscles. Then I stood in the shower, too tired to move, until the hot water began to run out. I stumbled out, wrapping myself securely in a towel, trying to hold the heat from the water in so the aching shivers wouldn't return. I dressed for bed swiftly and climbed under my quilt, curling into a ball, hugging myself to keep warm. A few small shudders trembled through me. My mind still swirled dizzily, full of images I couldn't understand, and some I fought to repress. Nothing seemed clear at first, but as I fell gradually closer to unconsciousness, a few certainties became evident. About three things I was absolutely positive. First, Edward was a vampire. Second, there was part of him – and I didn't know how potent that part might be – that thirsted for my blood. And third, I was unconditionally and irrevocably in love with him.

What Does Buy College Research Papers Online Mean?

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Lev Vygostky´s Sociocultual Theory and Deanna Kahn´s...

A present time, there are many developmental theories, which cover cognitive, socio-emotional, and physical. Among those theorists, for the purpose of this post, I will be considering two of them. First, I will be reviewing the Russian psychologist Lev Vygostsky and his sociocultural theory. Next, I will be looking at Deanna Kuhn and the Metacognitive development theory. One of the psychologists who made a significant contribution and stimulated a lot of studies in addressing the cultural impact in human development was Vygostsky. He introduced the sociocultural theory, which focused on culture transmission from one generation to another. He also theorized with social interaction, children to acquire the way of thinking and behaving†¦show more content†¦The definition of metacognition has been broadened to thoughts about thoughts and affective states, motives, intentions and the ability to consciously and deliberately monitor and regulate one’s knowledge, processes, cognitive and affective states, motives and intentions (Papaleontiou-Louca, 2008). Kuhn believes that metacognition is a high level construct, which can be conceptualized in a developmental framework. Additionally during development young children, they develop capabilities of metaknowing that many adult do not master. Therefore in early age metacognitive achievements serve as foundations of higher order thinking in adulthood, which include scientific thinking (Kuhn, 2000). She believes that knowing have to have a purpose or a goal because the simple fact of knowing what you know does not have much impact on your knowledge unless that knowledge serves a purpose. So in this developmental framework, she suggested that there are two terms: metastrategic knowing which refers to metaknowing about procedural knowing. Metastrategic knowing can be then divided into metatask knowledge about task goals and metastrategic knowledge referring to strategies a person has available to meets the goals (Kuhn, 2000). Metastrategic and metacognitive are important because they provide an explanation to as to why cognitive development occurs or fails to occur. Additionally the metacognition development has laid foundations for contemporary theories of learning