Crash Course Essay Writing - How You Can Achieve Incredible Results

<h1>Crash Course Essay Writing - How You Can Achieve Incredible Results</h1><p>In this article, I will talk about how you can accomplish some stunning outcomes by utilizing intensive lesson exposition composing. You'll see that you're ready to compose your paper similarly also and adequately as a first rate proficient in the blink of an eye at all.</p><p></p><p>It's stunning to consider, however numerous individuals experience issues composing proficient articles. In addition to the fact that it seems that they can't settle on the subject of their exposition, they additionally think that its exceptionally hard to decide the style that best suits them.</p><p></p><p>While it is difficult to compose an article in 100% lucidity, there are as yet certain rules that you should see when hoping to have a novel look. For instance, consistently consider the individual that is perusing the article. It's basic that you offer it to them in a way that causes them to feel special.</p><p></p><p>During the presentation of your paper, you ought to consistently ensure that it is written such that rules out understanding. You need to set up a decent affinity with the peruser and give them a layout that they can comprehend without being excessively tedious. This is critical to have your article perceived as being elegantly composed. There are numerous apparatuses out there that will assist you with accomplishing this end, so ensure that you exploit them.</p><p></p><p>One approach to assist you with your special composing is to attempt to keep it as brief as could be expected under the circumstances. The objective of composing an effective paper is to get the understudy to completely communicate their contemplations. You ought to have the option to utilize a base measure of words to finish your work. On the off chance that you need to, constrain yourself to around thirty to forty words in your essay.</p><p></p><p>Start your exposition with a title that recognizes what the paper is about. You would prefer not to compose something like, 'My Life As a Kid.' That sort of title could be diverting to an individual that is perusing the essay.</p><p></p><p>Although it may sound bizarre to state, having the individual that is perusing your article relate to you while you are composing will help you with your one of a kind composition. Rather than somebody seeming to be a latent member, you'll be viewed as somebody that has stepped up to the plate and build up an important relationship with the reader.</p>

Start Writing Your First College Essay With Texas Essay Samples

<h1>Start Writing Your First College Essay With Texas Essay Samples</h1><p>Applytexas Essay Samples is a remarkable asset that is really useful with regards to composing your first and most significant school exposition. The best motivation to utilize this paper tests is the way that you can adapt nearly all that you have to know from simply perusing them. That being stated, applying a touch of inventiveness can likewise be a major assistance in the zone of composing your own incredible College Essay.</p><p></p><p>The question close by is: How would you begin with utilizing Applytexas Essay Samples? Here's two or three simple approaches: You can discover by going on the web and scanning for how to utilize a program called Applytexas. There are truly many surveys out there and a ton of incredible data to help you with regards to applying this program and preparing your work for submission.</p><p></p><p>In expansion to t hat, you can likewise discover by checking with your secondary school advocate or direction advisor concerning whether you approach Applytexas Essay Samples. Regardless of whether you don't, a great deal of schools will be satisfied to check whether you do, in light of the fact that it can truly assist them with settling on whether to acknowledge your application. Most colleges will likewise need to recognize what sort of understudy you are, so they will even offer you a ton of extraordinary guidance on the best way to compose the essay.</p><p></p><p>However, on the off chance that you can't get to Applytexas Essay Samples due to get to issues, at that point your next best wager is get some example papers that different understudies are utilizing. Go on the web and look at a lot of various sites, including EzineArticles.com. You'll have the option to get some extremely extraordinary exhortation on composing school expositions, including some imaginative tips and guidance that you might not have heard before.</p><p></p><p>Once you've been given a couple of tests, investigate them and look at certain instances of how understudies are utilizing Applytexas Essay Samples. At that point, you ought to have the option to see precisely what you are searching for in a decent program.</p><p></p><p>When it comes to composing your own exposition, having the option to use Applytexas Essay Samples can truly support you. The entirety of the tips that they offer you, alongside the gigantic assistance that they offer different understudies with various types of articles, will be an incredible resource for your very own success.</p><p></p><p>As you can see, there are actually a great deal of approaches to begin with utilizing Applytexas Essay Samples, and with only a tad of innovativeness, you can locate the ideal program for your necessities. So what are you holding up for?</p>

Research Paper Topics

Research Paper TopicsIn order to research paper topics, it is necessary to select a topic that is amenable to ethical issues. It is also essential to make the selection of the topic only after taking a close look at the current ethical conditions. The ethics of a topic to determine the manner in which a topic is written and used, thereby, affecting the quality of the writing and the author's reputation.The need for ethical issues to be included in research paper topics stems from the fact that the authors or the editor should consider the psychological, social, political, cultural, social and economic aspects that influence human behavior. In other words, the reader should have a clear idea about the things that should be avoided while writing a paper.However, these ethical issues do not end with the negative effects of unethical acts. They also involve the negative effects of neutral acts. Although unethical acts have no place in a proper discussion paper, they should not be exclude d completely. For instance, there are plenty of situations where the result of an ethical issue could be ambiguous, so some ambiguity should be added to the explanation given by the author.In researching research paper topics, it is important to emphasize the importance of discussing the negative effects of certain ethical issues. It is especially important to emphasize this in the case of national development programs. This is because they are usually talked about in the context of poverty alleviation, which makes it seem as if the author supports immoral acts that are uncalled for.The first major topic that requires this kind of attention is the general level of immorality in the society. With the increase in divorce rates, gambling addiction, pornography, child sexual abuse, sex trafficking, date rape, child abuse, etc., many people are finding it difficult to remain in a relationship that is worth the trouble. Thus, if you talk about these topics in your research paper, you shou ld be careful not to imply that these problems are caused by the society as a whole. However, the impression that such subjects create is favorable to those who want to see social problems solved.In addition, research paper topics that feature in the discussion of pregnancy issues and teen pregnancy should be carefully selected. The more controversial the topic, the better. By avoiding discussion of moral issues like abortion, they can be avoided when dealing with scientific issues.Another important point to consider when writing research paper topics is what is called 'third party' effects. These are effects of another event, phenomenon or person on the society. In a word, they refer to the indirect effects that a particular issue has on the society.This is an important concern. Since the death toll of road accidents are closely related to the higher wages of the average worker, and the occurrence of deadly diseases are closely related to the increase in foreign exchange earnings, it would be a very inappropriate thing to write in the context of scientific study. By analyzing societal variables in a scientific way, we can get a clear idea of how these factors affect the society.

Sample Essay Questions For Good Writing

Sample Essay Questions For Good WritingWeak essay questions can sabotage your entire grade. Strong writing skills is required to write an effective essay and convince the professors, professors will pass your papers or grade the work with their opinion. If you have not yet enrolled for a college to advance your career, then you have to improve the writing skills and try your best in your essay. These are some of the sample questions to write your essay that will surely impress the professors.Any question that you have always heard about that, writing skills will make you forget everything that happened just before and after writing the specific questions. These questions may help you in improving your writing skills. These questions will be a help to you in improving your writing skills and convincing the professor.The next question will be on word games and answering them, you can also try asking if there are any of these words that may hurt your heart or if there are any that you h ave always heard but do not know. Writing the first paragraph of your essay is the beginning of writing your essay. The question on how you will put the first paragraph and how you will make your writing style will definitely help you in improving your writing style. It will also help you in writing in a flawless manner.Any question can be a weak essay and if you are reading a poor essay then you cannot imagine the waste of time. Most of the students get discouraged after completing one essay and writing the other essays. The next question on how you can get the information about what is bothering you and how you can think about it well and calmly is very much useful. Your essay may be biased and may be created in a negative way, so you have to overcome this flaw.Any question about how you will think about a certain topic can also be very useful to you. The question on how you can use the resources available for you is also very much helpful. This question will also make you change your idea in solving the problem. The question on how you will figure out the issue and how you will answer the problem is very much helpful. You can also talk about the importance of your issue in your life.The question about why should we pay attention to the article that has been written is also very helpful. There are many of these questions that will give you good ideas on how you can write an excellent essay. All the sample questions given are mostly for the information of the readers of the course. These questions will also help you in understanding your topic.The question on how you will start writing this particular question is very helpful. The question on how you will develop your writing style will help you in developing your writing style. These questions will definitely help you in improving your writing skills and convince the professors.

Carbon Emissions And Its Effect On The Environment

Green distribution Carbon emissions are unavoidable in distribution. However, how to reduce the emission and how to create efficiency transportation is a critical thing that enterprise needs to concern. According to HM’s annual reports, more than 50% percent of carbon emissions are from their transportation between the factories and stores, therefore, choosing more sustainable ways in transportation is one of a good resource to reduce the hurt for the environment. There are highly percentages of their shipments shipping via railway or sea, because sea transportation and train are relatively unpolluted types in transportation. Since using this way in transport, it reduced more than 5 million tons of carbon dioxide per year. On the other hand, HM asked truck drivers could not drive trucks that used more than 10 years and drivers are offered a training course from HM. Also, an intelligent transportation system built up by HM to ship products directly. Green Retailing HM believe that reduce energy consumption and energy use as well as improve energy efficiency can help to reduce the impact on the environment. There is two-thirds of energy consumption in the store, in order to reduce energy use, they reduce to build the new store as well as reduce the opportunity to rebuilt stores. In addition, more and more stores are equipped with their own meters, in order to control of their power consumption and use the energy more efficiency. HM announced that electricityShow MoreRelatedCarbon Emissions And Its Effects On The Environment1334 Words   |  6 Pagesa serious threat to the environment through acting as a catalyst for substantial climate change. Carbon Dioxide (CO2), a specific greenhouse gas, is the one that is the most prominent in our atmosphere; this being the case it is also causing the most damage. Carbon dioxide is emitted primarily through the burning of fossil fuels, such as oil and coal. These fossil fuels are burned in power plants and create large amounts of emissions that are not ideal for the environment. When faced with a problemRead MoreThe Effects Of Carbon Emissions On The Environment And The Health Of Humans931 Words   |  4 PagesInto the Future This issue of making sure life paths don’t negatively affect the environment is prevalent in everyone s life. The problem is in front of our eyes, but we aren t making changes to solve it. Carbon emissions is destroying our environment every single day. Most individuals wouldn’t think twice about their actions because the negative effects don t interfere with their present life. Our world is slowly deteriorating because of all the non-environmentally friendly actions we do, suchRead MoreThe Effect Everyones Carbon Footprint Is Having On The1344 Words   |  6 PagesThe effect everyones carbon footprint is having on the environment Carbon footprint is the measure of the amount of plant resources you use. The more your carbon footprint goes up, the more effect it has on the environment. Everyday people are doing actives that are producing greenhouse gas emissions. If one sees their greenhouse gas emission going up, that means that there will be an increase in climate change which will then lead to global warming. Your carbon footprint has a huge effect on notRead MoreEffects Of Greenhouse Emissions On The Planet s Climate1604 Words   |  7 Pagesspecifically the emission of greenhouse gasses are having drastic effects on the planet’s climate. B. In America, Industry, in general is responsible for twenty percent of all greenhouse emissions C. However, many people believe that this number can be greatly reduced by implementing cap and trade on carbon emissions. D. Some people believe that cap and trade is the most environmentally and economically sensible approach to controlling greenhouse gas emissions. The cap setsRead MoreCarbon Monoxide And Its Effects On The Environment1677 Words   |  7 Pagesextent of their effects on the environment. One of these toxins among the many is carbon monoxide. Carbon monoxide is a gaseous chemical toxin that is emitted into the air through human activity. The emission of carbon monoxide is negative one not only on the environment but to animals, plants, and humans alike. In some instances, the effects of these emissions are irreversible. In this essay, the effects of carbon monoxide, its classification, and source will be explored. These effects include the environmentalRead MoreA Brief Note On The Canadian Environmental Protection Act1180 Words   |  5 Pageseffective in reducing the level of pollution? I believe tax incentives are effective in reducing the level of pollution because everyone’s is benefiting- the people and the environment. Tax incentives are meant to improve the environment or reduce the negative impact on the environment or create a maintainable environment. Tax incentives are a kind of economic instruments to address environmental problems. It is generally believe that tax incentives will reduce environmental harm in the least costlyRead MoreThe Impact Of Globalization On Climate Change1535 Words   |  7 Pagesopportune time for the governments of the United Nations to address the impact of Industrialization on climate change. The scientific evidence is conclusive, carbon dioxide is the single most greenhouse gas made by humans and its effect range from short term problems such as floods, droughts, and crop failures to more serious long term effects such as elevated sea levels, rising global temperatures, changes in precipitation patterns, and the loss of essential animal species. James Porterba emphasizesRead MoreImpact of Carbon Taxation on Passengers of Aviation Industry1017 Words   |  4 PagesCarbon Taxation Its Impact on Passengers of Aviation Industry Introduction Introduction of Carbon taxation by European Union stirred disturbance in the aviation industry Airlines bear it or pass the effect on the customer 2 Rationale Behind Taxation Airlines use fossil fuels responsible for the emission of: Carbon compounds Green house gases (GSGs) Resulting in hazardous impact on the environment 3 Continue-2 Air transportation is the second largest with a 13% share of transport-relatedRead MoreProblems and Solutions to Catastrophic Global Warming1025 Words   |  5 Pagesbecoming a major problem for our environment. Global warming is causing the atmosphere to become warmer which causes many problems for the environment. Carbon dioxide in the atmosphere allows sunlight to pass through, but it traps heat from escaping. This causes the earth to warm which keeps the earth from becoming a ball of frozen ice, but excess carbon dioxide causes global warming, which will affect the environment. There are many solutions to slowing or stopping the effects of global warming includingRead MoreCompanies And Climate Change Case Study944 Words   |  4 Pagesand releasing carbon dioxide in large amounts will have large effects on the Earth, if companies aren’t careful. The idea of global warming has been around in the United States for many years. In fact, climate change has had effects on peop le and the environment for a while, and it may continue. The companies use fossil fuels for energy to receive the positive business effects that they give. However, companies are already starting to see consequences for releasing too much carbon dioxide. Companies

Corporate Venturing Creating New Businesses Within the Firm free essay sample

Introduction In a world which innovators are kings, interest in internal corporate ventures has grown tremendously. In my literature review, I would like to share my insights from reading the book titled â€Å"Corporate venturing: creating new businesses within the firm† by Zenas Block and Ian C. MacMillan. In this book, the authors shared their views on the importance of corporate venturing especially in this competitive global economy. Also, other aspects of venturing like the management, organisation and control of the ventures are also covered in great detail. However, much focus will be placed on the imminent need for corporate ventures and also issues like what determines the new venture success. I would also discuss the difficulties faced by managers in ventures as after all; venturing is not as simple as one would like it to be. In the later part of my review, I would also provide some evaluations in relation to this topic. What is a corporate venture? We consider a project a venture when it: †¢Involves an activity new to the organisation †¢Is initiated or conducted internally Involves significantly higher risk of failure or large losses than the organisation’s base business †¢Is characterised by greater uncertainty then the base business †¢Is undertaken for the purpose of increasing sales, profits, productivity or quality †¢Will be managed separately at some point during its life (Block Macmillan, 1993) In essence, it is a practice where a large firm takes an equity stake in a small but innovative or specialist firm, to which it may also provide management and marketing expertise. The objective of such venture is to be able to gain a specific competitive advantage. It is very important to be able to distinguish between is a corporate venture and an extension of a normal business activity as even till today, there are many misinterpretations of what entails a venture. Hence, I see the importance of being able to understand what a corporate venture is. Corporate venture: the growing phenomenon There have been a growing number of large companies creating business development organisations aimed at leveraging their IP portfolio through external licensing and/or partnerships. There are many successful examples of companies that enjoy high growth from new ventures including renowned companies like Nokia. Nokia adopted a very interesting corporate venturing approach for finding innovation. They moved beyond â€Å"not invented here† and are now embracing the idea of â€Å"finding the best ideas where ever they are†. Nokia Venturing Organisation is focused on corporate venturing activities that include identifying and developing new businesses. They introduced it as â€Å"the renewal of Nokia†. Nokia Venture Partners invest exclusively in mobile and IP related start-up businesses and they have a third group called Innovent that directly provides support and nurtures innovators in hope of creating vast future opportunities for Nokia (Docherty, 2004). It is the very fact that venture capital and opportunities is the essential tool available for companies to increase their innovativeness, quoting Wharton management professor Gary Dushnitsky and thus be able to develop a competitive edge in the economy. In another paper â€Å"When does venture capital investment create firm value,† by Dushinitsky and Lenox, they present the evidence that corporate venture capital investment is associated with the creation of firm value which goes beyond narrow financial returns and capture both the financial returns and the strategic benefits. Furthermore, in some researches, through the use of databases of hundreds of companies, the researchers compared companies that invested in venture capital and those that did not. They found that the greater the amount of corporate venture capital invested, the greater is the innovation rate of the investing company, measured by either the number of patents generated or by the citation-weighted patents output. Hence, this further presents the importance of venturing to keep up with the pace of innovation and competition in the economy. In addition it is said that corporate venture capital is one leg of a three-legged stool whose other two legs are strong internal RD capability and strong alliances with academic or government researchers. This highlights the crucial role corporate venture plays in the success of a company. Furthermore, not all firms are able to reap the full benefits of corporate ventures as results have shown that firms that invest for strategic reasons are more likely to continue to invest and in larger amounts. This is because strategically oriented firms are more likely to learn how to make good investments over time and this is not sometime that all firms are able to achieve overnight. As such, it is true that not every company can or should set up their own new ventures group due to various uncertainties or structural changes the firm might face in such circumstances. However, firms should still be focused on moving beyond the idea of â€Å"not invented here† to â€Å"finding the best ideas and technologies where ever they are†. What determines the new venture success? The strategic adaptation perspective implies that new venture success is a function of the managers or entrepreneurs ability to assess internal capabilities and environmental conditions for the purpose of developing and executing effective strategies (Andrews 1980; Porter 1980; Vesper 1980; Timmons 1982). The environment is viewed as a (major) constraint within which strategy is developed. Furthermore, environments are not immutable and are subject to negotiation and manipulation (Child 1972; Miles and Cameron 1982; MacMillan 1983). Such factor plays an important role in determining the success of the venture. Difficulties faced in venturing Reasons why companies stop venturing What we have constantly been told is the importance of venturing, the benefits that comes with it and there is a need to venture as ‘my competitors are also doing it’. However, behind the scenes, there are many circumstances that companies face which makes venturing hard and challenging and sometimes, companies are even discouraged from doing so. In order to determine why this is so, it is critical to examine the actual work of creating new businesses and distinguishing between organisational entities (such as venture companies and new venture divisions) and activities involving the development of new products, new markets and combination thereof (Block MacMillan, 1993). Much of the publicity surrounding intrapreneurship has centered on the establishment of separate organisational units within the companies. For instance, Colgate’s venture company rose and fell in three short years as well as Allied Corporation’s New Ventures operations which existed only for five years. The track record of a new venture division should not be confused or mixed with that of new venture. For organisations that put all their venturing eggs into a new venture division basket are likely to stop venturing when they disband the venturing division, only to resume as a matter of necessity after the passage of time (Block MacMillan, 1993) Another great challenge faced by organisations in their quest of venturing is that there can be extreme changes to their management teams within the company when firms engage in venturing. Such structural changes that come about with the new ventures might be a push factor for organisations considering engaging in new ventures that could potentially be of great benefits to the organisation. Furthermore, in recent years, it is frequently said that the venture industry especially in the US is facing a decline. It is thus rumoured that perhaps such venturing might not be as beneficial for the firms as it had in the past. The US venture capitalists have a depressed view of the industry mainly due to the weak IPO market and the unfavourable tax and regulatory policies present in the US domestic market. There is a shift in the amount of venture capital from the US market to the emerging market and this is a rising trend today. However, contrary to the popular belief, the venture capital industry is not a necessary condition in driving high-growth entrepreneurship, according to Right-sizing the US Venture Capital Industry, a new study by the Ewing Marion Kauffman Foundation. It is analysed that while venture capital will continue to be crucial to some forms of high growth companies, the report concluded that the sector’s size must be reduced for it to be viable. In recent years, the venture industry has been seen stagnating and declining returns coupled with rapid expansion in venture capital assets under management. It is said that the venture industry needs to shrink its way to becoming an economic force again. In various studies, it has been shown that the venture industry is profitable for many. In fact, professionals in the venture industry have gotten comfortable with the way their industry is set up in terms of size, structure and compensation. However, there is a need for venture participants to overcome their resistance to change and to get out of their comfort zone so as to be able to more effectively fund entrepreneurs and offer investors competitive returns. As such, there is a need for the venture industry to change so as to better realise the benefits it can potentially offer. Evaluation of the book This book by Block and MacMillan gave me great insight into the view of the business world and role ventures play in the economy. However, one drawback is that the context of the business world is based on that during the economic boom of the 1990s. With all the economic changes since of the following decade, some of the arguments made in the book may seem to fall flat and is less updated. Additionally, because of these new economic realities, it would be assumed venturing approached would to be reassessed with reference to the dot-com bust and the very recent global financial meltdown. Though I do not think that venturing would no longer be of importance to firms today, reassessment has to be made in the area of the risk involved, the management as well as planning due to the change in economic environment so as to ensure that firms are able to better reap the potential benefits corporate venture can offer. Conclusion The main take away from the book is that companies venture mainly to ensure growth and survival in the face of ever increasing competition. According to a number of studies and cross referencing with other academic papers, venturing is a surprisingly effective means of achieving these goals- at least for companies that create venturing programs carefully; and continually learn from their venturing experience. On a more personal note, this literature review was not an easy feat as the book includes many academic terms that I might not be clear of. However, after reading the book and other academic articles, I have to admit that this topic can indeed be interesting and it provided me with the knowledge and greater understanding of this highly debated topic. References Business dictionary. com: http://www. businessdictionary. com/definition/corporate-venturing. html Dushnitsky and Lenox, When Do Firms Undertake RD Investing in New Ventures Dushnitsky and Lenox, When Do Incumbents Learn from Entrepreneurial Ventures? Corporate Venture Capital and Investing Firm Innovation Rates Ewing Marion Kauffman Foundation (2009): US venture capital industry must shrink to be an economic force http://www. kauffman. org/newsroom/venture-capital-industry-must-shrink-to-be-a n-economic-force-kauffman-foundation-study-finds. aspx Ewing Marion Kauffman Foundation (2011): Right sizing the US venture capital industry http://www. kauffman. org/research-and-policy/right-sizing-the-venture-capital-industry. aspx Kenneth Liss (2000), Harvard business school: Corporate Venturing: Entrepreneurship on the Inside Leena Rao (2010), Study: U. S. Venture Capital Industry Expected To Shrink While Emerging Markets Grow http://techcrunch. com/2010/07/13/report-u-s-venture-capital-industry-expected-to-shrink-while-emerging-markets-grow/ Mike Docherty(2004), Innovation. net weblog:http://venture2. typepad. com/innovationnet/corporate_venturing/ Robert A. Burgelman and Liisa Valikangas (2005), Managing Internal Corporate Venturing Cycles Zenas Block Ian C. MacMillan (1995), Corporate Venturing: Creating new Businesses within the Firm

Listening Skills and Healthcare

Abstract This study uses a quantitative survey technique, and summarized data collected is used to correlate results with listening skills as its fundamental principle (Punch, 1998). A survey was sent out on the Internet and yielded results from various gender, socioeconomic backgrounds and education levels. Communication issues have been maintained by employing a number of methods.Advertising We will write a custom research paper sample on Listening Skills and Healthcare specifically for you for only $16.05 $11/page Learn More Pain faces scale training of participants and research assistants and maintaining good relationships with participants are used in our recruitment to further develop partnership between the study population and researchers and to maintain feedback. Each step undertaken to gather and analyze data, validate findings and present research outcomes in which comprehensive and accessible findings will be used to facilitative growth and c ontinued development. The purpose of this research is to develop a better understanding of listening skills and how better listening skills well as ability to recognize nonverbal expressions will assist the healthcare industry and its consumers. Introduction The merriam-webster dictionary defines pain as â€Å"suffering or distress of body or mind†. It is argued that effective communication between healthcare provider and patient is an important element in improving treatment compliance. Holmes et al, (2007) on the other hand provides that pain interferes with person’s ability to communicate by altering normal patterns of verbal and nonverbal communication. Listening skills is something that has been emphasized in the medical field for years. Professors in medical schools have been attempting to teach their students to be better listeners to their patients (Holmes at al, 2007). As we seek to integrate effective communication skills in healthcare, the best question, and yet difficult to ask, is: does listening skills, as well as purposeful nonverbal communication, while being applied, more likely to improve the relationship between healthcare providers and patients? Listening skills is something that has been emphasized in the medical field for around 2,500 years and the problem of communication challenges often leading to misdiagnosis has always been an issue. Frischenschlager and Pucher (2002) argue that describing pain to a physician falls solely on the patient. And in most cases, physicians often lack the skills to read patient’s nonverbal signs or even interpret the slang they use.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Therefore communication problems between providers and patients remain to be a major problem in the healthcare professional. The provider-patient as demonstrated by the pain scale (figure 1-Appendix) illustrates their interrelationships. The research conducted sought to answer the question, â€Å"Can pain faces be distinguished from other emotional expressions?† Literature reviews on the ability to recognize facial expressions and listening skills issues facing both patients and health care providers in social dynamics of healthcare professional will be discussed. A thorough investigation on communication of health issues affecting these communities are illustrated which provides a synthesis of the existing problems. This literature review is coined around personal and situational issues, as well as empirical research on the communication concerns with support of reviewed of population studies and themes are summarized. As the cultural context of health issues has a major influence on our communities, sociological literature on this pandemic is highlighted. To affirm this analysis, researchers linked various responses to research from the related areas and concluded with references f or future research on the health and sociological dimensions. The current literature was reviewed using Communication Mass Media Complete database and searched online article using listening skills and facial expressions in healthcare as key words using Google. The research concentrated on both young, middle and old age population as my headline and designed my research article around a pain face scales instruments to perform a thorough analysis on how participants can identify non-verbal signs to communicate their pain issues. The finding being that if a â€Å"Lay† person could do it WELL then with a little training, a Healthcare Provider could do it as well. Training that included spending more time with their patients. Our careful analysis and research will then be used to identify the validity and applicable evidences that can be used in health care practices Objective This paper seeks to explore the relationship between healthcare provider and the patient, highlighting difficulties they experience when communicating to each other about pain issues. Our analysis aims at providing evidenced-based guidelines that will provide a set of recommendations that can improve listening skills on the patient and the service provider.Advertising We will write a custom research paper sample on Listening Skills and Healthcare specifically for you for only $16.05 $11/page Learn More While much has been done to encourage physicians to improve their listening skills, research indicates that listening, as well as provider-patient interactions can improve with adequate training and follow-up. As the number of studies increases, the results, effects and outcomes of patient-provider communication, there is still a much research to be done in the field. Background Questionnaires were designed and distributed over the internet. This environment allowed participants to freely and openly rate facial expressions as much as possible. Participants were well acquainted with internet and use of facial expressions in their day to day activities. This equipped them with considerable knowledge of what was expected of them as many of the expressions such as anger, happiness, sadness, disgust, surprise, fear and pain in facial expressions related well with their personal experiences. Literature Review Analysis The most frequent complaint among patients is pain. According to Baird et al (2008), an estimation of 30 million people in the United States are suffering from chronic pain. It can not be assumed that the most prevalent pain always occur naturally. Acquiring effective communication skills requires the employment of observation and application practice of communication expressions. According to the US Bureau of the Census (1995), nearly 7% of the US population deals with chronic pain every year making it a high priority concern within the healthcare community. Evidence from the US Department of Commerce shows that pain associa ted problems costs billions of dollars in the healthcare industry. It adds that related problems such as chronic pain management and how to effectively deal with pain and cost management to be also of concern. The same studies also evidences high occurrence of opiate dependence among the mentioned group. Pain can be explained in different perspectives depending on individual experiences. Frischenschlager and Pucher (2002) provide that pain cannot be measured or quantified. Health care provider should in this case assess pain on individual perspectives. Therefore verbal and non-verbal description of their current health status depends solely on the patient.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More This simply means that the overall communication context is influenced by the dynamic exchange of the service provider and patient interaction. However, this has never been the case. As Frischenschlager and Pucher (2002) state, â€Å"problems with the communication between doctor and patient are a frequent result (p.416). Pain has often been defined as a warning sign indicating something wrong within the body. Pain is classified into two categories; acute and chronic pain. People in pain often undergo intense psychological experience. Acknowledging the importance of patients understanding how to respond to pain is important in communicating pain issues to the providers. Issues associated with patient communication process are outside the scope of medical research. In this regard, Brannigan et al (2008) quotes, â€Å"pain should be looked at as a multi-dimensional affair and not just a one a warning sign† (p.12). Thus, being able to communicate effectively and knowing which m essages to communicate are equally important. Pain Theories Frishenchlager and Pucher (2002) categorize pain theories into two groups; 1) the Frey theory and 2) the Goldscheider’s approach. Frey’s theory defines pain as special pain pathways that connect pain-specific nerve endings leading to the brain. The Goldscheider’s approach states that nerve endings are not specific to any center of the brain and that pain can only be experienced when the level of pain reaches to an intense point that can not be tolerate leading a patient to expressing their discomfort. Frishenchlager and Pucher (2002) links psychological factors such as distraction, relaxation, fear, depression, former pain experiences, family and cultural influences to be among factors that affect the way that people experience pain. In their analysis, Frishenchlager and Pucher (2002) redefine pain as,†Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦unpleasant sensory and emotional experience associated with actual o r potential tissue damage or described in terms of such damage† (p.419).Their definition gives equal weight to emotional and physical pain experience hence the rebirth of gateway theory that links emotions to physical pain, considered to be a breakthrough in theories of pain. Effects of pain and patients’ inter-personal relationships are not only becoming important topics in research, the management of chronic and acute pain are also of paramount importance. In this regard, future research should take deeper studies in defining what chronic pain is and how it effects the population (Smith, 2008; GangHeong, 2000). Pain is now being thought of as the Fifth Vital sign that offers way for physicians to assess overall health of an individual. Pain can be considered as chronic if the symptoms last up to three months. Walid et al (2008 argue that pronounced pain changes the behavior of an individual. They provide guidelines on how to determine levels of Chronic Pain as to incl ude; duration of illness; number of treatments and consulted doctors; psychological impairments such as depression, helplessness and loss of self-esteem; social impairments such as social isolation, changes in the patient’s social role and position; and Job-related impairments such as having to take days off because of being ill that can subsequently lead to dismissal. Diagnostic classification of chronic pain It presupposes: A continuous, torturing pain, which; Cannot be explained well by an organic damage; and Psychosocial problems or emotional conflicts are recognizable and can be brought into direct connection with the pain the patient experiences. Gromala and Shaw (2004) define chronic pain as pain that lasts from one month to a year. Their analysis records a statistic of 57 million people in North America with majority being the disabled people. To this we come to the conclusion that pain is indeed a difficult problem for both physicians and patients (Bennett et al, 2009). McCosker (2004) defines pain an â€Å"inner experience and others cannot truly observe its effects or share in its suffering† (p.62). Frischenschlager and Pucher (2002) links withdrawal symptoms as part of the psychological challenges a person undergoes when experiencing chronic pain. They add that when someone isolates themselves from the society to heal results to withdrawal making the pain more intense. When a person life revolves around their illness, pain becomes part of their life. Facial Action Coding System The Facial Action Coding System (FACS) dates back in to the mid 19th century (Piderit, 1858). The most influential theorist was Charles Dawn in which he argues in his book ‘The Express of Emotions in Man and Animals† that facial expression is universal and innate characteristics. He further added that facial expressions played a crucial role in the experience of emotion (Darwin (1896). FACS is defined by Ekman (1984) as â€Å"changes in the fac ial musculature comprised a large portion of emotional state† (p.319). He argues that the expressions were based on a â€Å"theoretical study designed to measure specific facial muscle movements believed to be associated with emotional expression† (p.321). Ekman and Friesen (1978) further distinguish between two different types of judgments to include message judgments that refer to specific behavior and those made about behavior. They argue that facial expressions such as anger or happiness can clearly be distinguished from pain expressions, while to accurately measure the assumptions of psychological state, inferences about that which is being measured is required. Ekman and Friesen (1978) define pain scale as a measurement that â€Å"identifies specific responses to specific stimuli, natural unfolding of specific behavior over time†¦.which segment is likely to produce the most expressive behavior† (p.322). The intensity of facial expressions are measured at four (1=low, 2=medium, 3=high and; 4=very high). The low ratings often display mild expressions such as smile with slightly raised corner of the mouth and corners of the eye without displaying the teeth. Medium rating expresses moderate expressions. This is often displayed like half smiling and half laughing, with eyebrows slightly raised and lips apart, exposing teeth. High rating emotions are displayed such cry or laugh, with an open mouth, raised eyebrows and cheeks. Very high rating, display intense expressions when crying or laughing and lips are completely apart, teeth showing and cheeks substantially raised. Nonverbal Communication There are many ways a healthcare provider can look beyond what their patients are saying to what their patient’s body is telling them. Cooper (1979) gives several suggestions for what a healthcare provider can do to read some nonverbal clues that will help them better understand their patient’s pain. Cooper (1979) suggests that man y people talk without looking at the eyes of the other person, especially physicians; and this can suggest that one is not listening at all. Some patients, especially those in pain, have trouble articulating their feelings. Some signs that Cooper (1979) gives for a healthcare provider to look out for: Facial Clues In fear and pain the eyes open wide with the lower lid tensed. The eyebrows rise in a straight line and the mouth opens with the lips tense and drawn back In sadness the eyes look downward with the lower lid raised Cooper (1979) continues on stating that a person’s attempt to control their facial expressions, their nonverbal behaviors, gives away the fact that they are in pain and not able to tell their physician everything. Use of non-Verbal Communication Clinical spectrum of typhoid is broad, ranging from diarrhea, which may be fatal in a shorter incubation period of 48 hours or longer periods of up to 3 months, with an abrupt offset of headache, diarrhea and vomiting. The symptoms are often as a result of loss of large volumes of isotonic fluid. Simple Explanation Not all people who get typhoid look equally sick. Some patients may portray minor symptoms, while others look very ill. While looking at a patient, healthcare provider should be able to identify these symptoms from facial expressions by distinguishes between judgmental facial expressions such as anger or happiness and those made about behavior. In this regard, proper training of facial coding aligned with a dimensional model of emotions should be encouraged in health professional along with spending more time with their patients to distinguish between their facial features. Some symptoms such as diarrhea may be omitted by a patient since many may regard it as routine and unnecessary to mention it to the heath provider which may lead to misdiagnosis and improper treatment regimes. Therefore purposeful nonverbal communication and asking thoughtful questions is more likely to imp rove the relationship between healthcare providers and the patients. Use of nonverbal communication such as body gestures, positions and facial expressions to convey information requires full attention and minimal distraction from the service provider, as reciprocate of showing caring and empathy to the patient. It is proven that verbal communication builds relationship and enable people stay together longer. A patient may also gain a lot of knowledge about themselves that may improve interpersonal relationships. Talking to the healthcare provider about your health concerns, how you feel about yourself and how you feel about life, helps a patient heal and accept their condition. Self disclosure puts someone in a position to see who they really are and binds people together. In addition, every person has their own beliefs, and they are able to reconcile their disagreements with a person they feel close to. Someone may feel unaccepted, your feelings may be hurt and you may feel your r elationship is threatened. To this reason, people need to make their feelings known by revealing and exposing themselves. Often, people who can not express themselves or rather shy individuals experience great anxiety in trying to express themselves. Conclusively, communication is a complex and challenging process but is still absolutely essential asset for communication and building relationships. One progressively move from being a stranger to being close friends with healthcare providers is essential in improving patient’s health. People may often feel that disclosing to much information may turn people away. They also have the perception that disclosing premature information to early, their intentions may be misread as an invasion and some may see it as an attack. Patients often relate their past experiences of telling people very sensitive issues may lead to unfavorable impressions. One patient explained that a person may use information disclosed to them against the ind ividual and we often take risks by sharing personal information with healthcare providers since information shared in a healthcare setting can not be used against them or for blackmail purposes. Therefore, while self disclosure can be useful in helping patients relieve stress, patients should be educated on the importance of disclosing all their health issues and concerns, how to express their pain using facial expressions and the ability of healthcare providers to keep this information confidential (Donabedian 1988; Mechanic, 1998). In â€Å"Healthcare and Listening: A relationship for Caring† by Brannigan et al, (2008) begin with the statement that the â€Å"optimal relationship between healthcare provider and patient is one of trust† (p.168). The authors continue on to explain that this trust relationship cannot exist without effective communication between the doctor and the patient. Research is also found to support that effective communication practices are key i n patient compliance with medical regimens, patient satisfaction, as well as decreasing malpractice lawsuits is found (Morlion et al, 2008). If the goal of healthcare is what Brannigan et al, 2008) states as one that â€Å"†¦. prevents illness and injury, and help patients and their families manage medical conditions through counseling, medicine and therapeutic interventions† (p.168). Patients must trust their healthcare providers with sensitive, possibly life-threatening or life altering, information. It is physician’s responsibility to use limited time that they have with the patient to listen and guide the conversation to get to, potentially, the most important information so that a correct diagnosis can be made. Communication becomes the most important element in the patient/doctor relationship (Eggly and Tzelepis, 2001) A providers’ nonverbal behavior may provide subtle yet powerful messages concerning their perceived efficacy of pain management (Frant sve and Kerns, 2007). They continue that patients may respond to such unintentional â€Å"demand characteristics† that physicians may show; especially those patients who are in pain. The research points out that within the last few decades the relationship between patient and physician has evolved from a parental relationship into a partnership (Eggly and Telesis, 2001). To address this shift, national medical organizations such as the â€Å"Accreditation Council for Graduate Medical Education† has put an emphasis on training physicians in more effective communication. Methodology The design for the research study uses questionnaire posted over the internet to obtain raw data about listening skills facing young, middle and old aged patients and healthcare providers. Quantitative survey technique comprising of participant observation, and quantitative methods of randomly selecting participants were utilized because they were considered appropriate to the cultural and la nguage differences that exists. This research was designed in the quantitative genre of data collection as I believe this approach will allow us to obtain a more comprehensive understanding of health issues surrounding the selected group. Our research methodology of using questionnaire helped us gain better understanding on the complexities of social, economic and cultural factors impacting on them. Quantitative approaches were believed to be appropriate as they are likely to yield more honest opinions in obtaining in-depth understanding of the meanings and events by obtaining raw data from participants. The participants were 108 comprising both male and female who ranged in age 18-60 years and were part of the large study of ability to recognize facial expressions. Target Population Target population consists of both male and female of ages 18 to 60. These samples group is aimed at educating the public, patients and healthcare providers (nurses, General practitioners and physiother apists) dealing with patients with chronic pain on how to recognize facial expressions. Participants were also selected with regards to; recent history of pain, structural deformity, thoracic pain, systematic unwell and constant progressive, non mechanical pain (chronic pain). While the focus of this study was on adults alone, a participant of below 15 years was also included to obtain a holistic view of a Lay† person could do WELL in distinguishing facial expressions. The sampling techniques were randomized sampling (Polgar Thomas, 2008), requesting participants to rate facial expressions and selecting samples to use in the study (Grove, 2007). Instrument Pain scale seems like the most appropriate instruments a physician could use to assess patient’s pain. It is performed by having patients rate their pain on a scale of 1(being no pain) to 10 (being of severe pain) as demonstrated in the graphic rating scale in Appendices A. Pain Scales Pain scale instrument is common ly used by Healthcare Providers to assess patient’s pain. Brannigan and his colleagues (2008) article on ‘Healthcare and Listening’ stated that â€Å"the optimal relationship between the healthcare provider and the patient is one of trust† (p.170). It can not be assumed that effective communication always occurs naturally. Acquiring effective interpersonal relationship between the service provider and the patient requires observation practice and interpersonal listening skills. This responsibility lies heavily on the healthcare provider. Their primary attribute to providing effective care requires being emphatic listeners as a strategy to understand patient’s nonverbal communication and take the time to observe their communication patterns. Common problems often experienced in providing effective communication to patients is lack of empathy and understanding of nonverbal signals and communication apprehension on the part of the patient (Bundy, 2001; McCroskey et al,1998). Testing and Evaluation First of all, pain face scale should be tested to check the ability of patients learn the basics of the program. For the testing, patients should be invited in the survey room where a healthcare provider explains theoretical material and track the way students accept the information from the pilot training program. Then, patients will be proposed to fulfill the assignment established by the program creators to check how they understand the facial expressions. Once the practical assignment is completed, patients should be offered to look through other options of the program. Finally, a healthcare provider should provide with other helpful ideas that might be helpful for patients when living at home. The evaluation of the results should be based on the validity and reliability verification. Project Location And Duration The project implementation will be conducted with the help of the hospital facilities for the project managers to accura tely test and evaluate the effectiveness of the pain scale instrument. More importantly, as face scale deals with exclusive evaluation of facial expressions, it has the correct training that can work out a consistent plan of publishing program implementation. The project results are planned to be delivered in three weeks, as the pain scale should be properly tested and evaluated. The operation will be defined into three stages. First, the department should study the main difficulties in handling pain scale that may appear among the patients dealing with this program. Second, the project team should conduct a research in the field and define what listening skills and technologies will fit best. This stage will take the most of the time allocated for the scheme. Finally, it is necessary to conduct pilot implementation in order to eliminate all possible drawbacks of the program. Data collection Participants were required to read the questionnaire carefully and select the picture of the facial expression such as happiness, pain, disgust, fear, anger and sadness that best described the picture provided. Below is a sample of the data collected over the internet. Respondent IP Address Response for facial Expression (Happiness, Fear, anger, sadness, surprise, pain, disgust Gender Ethnicity/Race Household Income Highest educational level Are you currently a student Specify education level Age -Happiness -Sadness -Anger Male White/Caucasian $40,000 – $59,999 Masters No 25-30 71.233.25.134 -Happiness -Sadness -anger Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 76.24.221.253 -Happiness -anger -disgust Female White/Caucasian $60,000 – $79,999 Bachelors Yes Masters 36-40 98.95.181.24 Happiness Female Asian $40,000 – $59,999 Masters Yes Masters 22-24 64.246.212.53 Happiness Sadness -Anger Female Black/African American $60,000 – $79,999 Bachelors No Masters 22-24 64.246.212.53 Happiness Sadness -Anger Female W hite/Caucasian $60,000 – $79,999 High School/GED Yes 31-35 208.139.7.64 Happiness -fear -disgust Female White/Caucasian Bachelors No Masters 22-24 75.66.190.118 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 Bachelors Yes 25-30 189.216.62.1 Happiness -anger -disgust Female White/Caucasian $60,000 – $79,999 High School/GED Yes Bachelors 18-21 75.66.190.34 Happiness -anger -disgust Female White/Caucasian Less than $20,000 High School/GED No Bachelors 25-30 98.239.42.73 Happiness -anger -disgust White/Caucasian $60,000 – $79,999 Bachelors Yes 31-35 207.191.102.215 Happiness -anger -disgust Male White/Caucasian Less than $20,000 Masters PhD 51-55 64.246.212.1 Happiness -anger -disgust Female White/Caucasian Yes 41.239.2.108 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Bachelors Yes Masters 25-30 64.246.212.1 Happiness -anger -disgust Male White/Caucasian Less than $20,000 Bachelors No Maste rs 25-30 178.25.46.77 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 High School/GED No 31-35 72.20.142.52 Happiness -anger -disgust Female White/Caucasian $40,000 – $59,999 Bachelors No 31-35 74.192.193.253 Happiness -Sadness -Anger Female White/Caucasian $20,000 – $39,999 High School/GED Yes High School/GED 22-24 76.123.128.127 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Associates No Bachelors 22-24 24.242.116.141 Happiness Female White/Caucasian $20,000 – $39,999 Bachelors Yes 25-30 125.231.225.17 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Associates Yes Bachelors 22-24 98.237.151.59 Happiness -fear -disgust Female Asian Less than $20,000 High School/GED No Bachelors 22-24 24.20.195.208 Happiness -anger -disgust Female White/Caucasian Less than $20,000 Bachelors No 22-24 115.134.253.133 Happiness -anger -disgust Female Asian $60,000 – $79,999 High School/GE D No 41-45 114.78.184.77 Happiness -anger -disgust Male Asian $40,000 – $59,999 Bachelors Yes 22-24 99.145.161.1 Happiness -fear -disgust Female White/Caucasian $100,000 or more Bachelors No PhD 25-30 137.132.234.105 Happiness -Sadness -Anger Male White/Caucasian $80,000 – $99,999 Bachelors No 25-30 65.81.247.46 Happiness -anger -disgust Female White/Caucasian $20,000 – $39,999 High School/GED No 31-35 24.18.138.184 -Happiness -fear -disgust Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 174.32.39.60 Happiness -Sadness -Anger Female White/Caucasian $40,000 – $59,999 Masters Yes 25-30 75.192.145.56 Happiness -fear -disgust Female White/Caucasian $60,000 – $79,999 Bachelors Yes Masters 36-40 Limitations of the study There are many different pain scales used; however, it is the general consensus that none of them are an adequate source of determining ones â€Å"true† pain level. When pain levels are des cribed to medical professionals they are usually assigned meaning by using verbal descriptors such as â€Å"excruciating, unbearable, etc.† At times doctors give examples and patients are asked to choose from those descriptors such as the McGill Pain Questionnaire. While there are an abundance of appropriate words to describe pain they are not words we use. Therefore it is important that patients and physician’s come to a mutual understand and achieve shared meaning when communicating about pain (Faunce et al, 2006). Although pain is the most common medical complaint most patients seeking treatment for pain are not chronic pain patients. Chronic pain patients develop a pain vocabulary that is influenced by medical specialist treatment and by exposure to repeated pain assessment measures (GangHeong, 2000). When dealing with pain it is of vital importance that the provider and patient develop a â€Å"shared meaning† of pain descriptors since the medications that a re given to deal with pain are very potent and therefore it is important to get a correct diagnosis and for the patient to have a good relationship with their health care provider (Roberts and Bucksey, 2007). According to Butler and his colleagues (2009) both the VAS and VRS (in appendices) are based on the assumption that people have a â€Å"shared† meaning or understanding of pain and its descriptors. The results of this study did not support this, as hypothesized participants were personalized in their use of pain descriptors and presumably in their understanding of the word as well. Butler et al, (2009) have shown that a valid assessment for pain cannot be developed if people in pain do not have a shared perception of the dimension. Butler et al (2009) go on to state that caution should be used when relying on the use of word to convey pain intensity. Also words meant to describe only the most acute pain have little understanding when brought together with other pain asse ssments. When attempting to clarify pain levels in a medical setting more than just relying on VAS or VRS is needed. Butler and his colleagues (2009)continues to addresses the idea that language and pain are interrelated and that pain can be better understood by the understanding of the language. Since patients and doctors use different descriptors for pain it is difficult to reconcile the descriptors. Also, since the descriptors for the illness and pain given by the doctors are at times so grave the patient’s initial reaction is not a favorable one. Also it is found that since language descriptors for pain differ from person to person, it is difficult to assign a value to each descriptor. It is understood that pain caries from person to person so the terminology differs from person to person (GangHeong, 2000; Darmohray et al, 2008; Beckett et al, 2009). Pain face scales as well as other scales are still under scrutiny for their lack of patient interaction, the scale does not take into account the fact that pain is a very personable experience and must be treated as such (Crichton, 2001). Future Research and the required Changes in Healthcare According to Roberts and Bucksey (2007), there have been two significant social changes that have helped put emphasis on the importance of effective communication for healthcare providers: The first came in 1999 when the Institute of Medicine announced that medical mistakes are not unusual or isolated, rather that they happen everywhere and often. Also they concluded that these mistakes were not minor but deadly. They went on to say that the disclosed mistakes were only a small sampling handpicked to be given to the public, while the real bulk of the incidents were never disclosed to the general public. Healthcare providers were outrage to have to admit their mistakes and patients were fearful as safety became a national priority. After panels were put together to as quoted by Brannigan et al, (2008) to â€Å"set standards, address safety issues, and review medical errors; it became apparent from the research conducted that poor communication and concealing mistakes were two significant factors that ultimately led to legal recourse† (p.170). The second problem was the public’s loss of trust, high profile scandals by individuals or groups in power caused the public to be critical to those who were in a profession that was perceived as prestigious (Brannigan et al, 2008.) In recent years various medical organizations (such as the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education) have begun to emphasize improved training and demonstration of competence in communication skills. The nursing profession is also beginning to advocate good listening and communication as a quality needed to be a good nurse; skills which one must possess to demonstrate caring to a patient. The idea that listening is important to be a well rounded medical professional is not a new concept but it is just being framed as a skill and an expectation of a skill that all medical professionals should have the basic concept of(Bundy, 2001; Bennett et al, 2009). Brannigan et al,(2008) proceeds to say that methods to improve communication and effective listening on the part of the physician have been studied since the 70’s, however the early research focused mainly on the physician’s communication skills, medical skill training communication skills and how the physician performed in clinical encounters. As studies become more recent they include the elements of empathy, time, trust, malpractice, and patient satisfaction. The patient can benefit in positive ways from a healthcare provider who is an effective communicator such as the patient’s improvement in emotional health, functional status, and a change in physiological measures, particularly in patients with chronic conditions (Morlion et al, 2008). Considering the ris ks involved for both the patient and the physician the importance of effective, thorough, and willing communication and listening goes beyond just a â€Å"courtesy† and on to an ethical obligation (Castro-Lopes et al, 2008). Listening and the sensitivity associated with communication are required by both parties: from patients to provider and from provider to patient. This is an underdeveloped area of communication, according to McCroskey et al (1998), and needs to incorporate considerations of communication and listening is required. Recommendations Communication Apprehension and Healthcare In some cases, lack of good communication relationship between the healthcare provider/patient relationships relies on the patient. The patient can experience what is called Communication Apprehension also known as â€Å"CA†. CA is â€Å"an individual’s level of fear or anxiety associated with either real or anticipated communication with another person or person’sâ €  (McCroskey et al, 1998). This is the definition that has been used to describe people who have â€Å"CA†, people who are anxious about real or upcoming communication situations. It is clear that this anxiety or â€Å"discomfort† caused by the â€Å"CA† can cause very real physical effects to the person suffering from the ‘disorder’ (McCroskey et al, 1998). There are clear indicators if a person is â€Å"high CA†. A â€Å"High CA† when presented with a situation where they have to communicate will experience the fight or flight syndrome. These are the people that would rather die than speak in public. These types of people may even have problems with their speech or they may use a high amount of vocal pauses (uum, ya know, ahhh). Others may have a negative perception of these people because of their lack of communication skills. Because â€Å"more talk† is better in the United States, someone with High CA is likely to be co nsidered as a less attractive socially and may seem less desirable to be around just because of their unwillingness to speak up. These kinds of self-crown perceptions tend to affect the patient/doctor relationships. In some cases, people with high CA may still be apprehensive to speak up when in pain or in the presence of a Healthcare Providers (McCroskey et al, 1998). When the person is having trouble speaking up they can often leave out details that are important to a potential diagnosis or frustrate the physician leading to a breakdown in communication (Bundy, 2001). McCroskey et al (1998) revealed that trait CA had a small relationship with patient question asking and information seeking. Sate CA had a strong relationship with patient question asking and information seeking. In the health care environment High CA’s are going to ask fewer questions, start fewer conversations, and avoid communicating with their physician whenever possible. Because in other contexts High CAà ¢â‚¬â„¢s should have more state anxiety when communicating with someone of elevated status such as their physician five more research questions were formed to flesh out the patients fear of communicating with the doctor and the trait and state CA. A patients fear or anxiety related to communicating with their physician is consistent with the theory that patient apprehension can seriously interfere with the physician/patient communicative relationship and be associated with negative outcomes for the patient. There are many elements which factor into communicating with the physician, such as disconfirmation communication, language usage, controlling interaction, nonverbal communication, apprehension, trust, and willingness to discuss personal issues. Butler et al, (2009) found that â€Å"individuals, who are apprehensive about communicating with a particular person, do not normally initiate interactions with that person† (p.56). So if you are uncomfortable with your doctor you would not initiate a conversation with him/her about an intimate problem (Eggly and Tzelepis, 2001). The most effective way to treat chronic pain is through an ongoing, collaborative relationship with a primary care provider or pain specialist. According to Frantsve and Kerns (2007) giving providers communication training can lead to positive outcomes, including greater satisfaction ratings by individuals with chronic pain. Most patients indicated that they believed that their relationships with providers were better when their providers spend more time with them, at least twenty minutes or more, and displayed a greater amount of interest in their life and issues (Darmohray et al, 2008). McCroskey and his colleagues (1998) article on effective physician-patient communication identified four communication relationship to include; 1) engagement 2) empathy 3) education and 4) enlisting the patient in the doctor – patient relationship. They mention communication skills required b y doctors to include: 1) active listening 2) eliciting patients’ perspective on illness 3) decoding and responding to patient emotions 4) negotiating treatment plans more effectively It is clear that communication is a necessity in a good doctor-patient relationship. The process of communication requires encouraging two way dialogue and establishing partnership between two parties; the patient and the service provider-that creates an atmosphere of caring. This bridges the social gap between the provider and the patient, effectively uses verbal and non-verbal communication and creates a friendly atmosphere that allows a patient to tell his or her story and ask questions. Pain face scales should be personalized in relation to patient’s educational level and their ability to express their pain and treatment instructions. This can first start by asking a patient to recall or to repeat instructions given to them. This is one way of ensuring effective communication by enabli ng patients understand their health conditions and available treatment options (Curtin, 1987; DiMatteo, 1994; Hal 1988; Ong, 1995). The relationship between a patient and a client is one important way of ensuring healthcare providers communicate the outcomes of the patient’s illness. Important aspects to consider when determining communication inter-relationships are educational background, sex, age and ethnicity as earlier stated by McCroskey and his colleagues (1998). Others factors such as ample time allocated to patient-provider personal contact and privacy should also be considered when identifying characteristics that can improve communication relationships between the two parties. Also, service providers should improve practices in their own settings by adopting behaviors and techniques that could result to increased patient knowledge and effective communication. It is evidenced that establishing good relationship between healthcare provider and the patient creates an atmosphere of caring and bridges the gap between them. This means that facial expression should be personalized in accordance to the patient’s educational level and ability to understand the technical information. In this regard, patients and health providers should be able to 1).establish and maintain rapport and trust (care), 2). Diagnose communication and problem solving skills to determine diagnosis and treatment (solve) and; 3).counseling and education (education) (Fallowfield, 1998; Kopp,1989; Levinson, 1995; Roter Hall, 1991). The following table provides examples of responsibilities required from both service providers and patients in exchanging factual communication. Share facts Share feelings Service provider Communicate clearly and accurately on diagnosis and help patient apply the treatment to their own life Show care by understanding and respecting them Patient’s responsibility Clearly description health condition and ask questions where needed Be honest by expressing expectations and concerns Two-Way dialogue Both speak and listen without interruption. Both ask questions, exchange information and express opinions to fully understand the other party. Both relationships should be regarded as partnerships in which both parties strive to maximize the results. The patient should also realize that both parties are responsible for the outcome and their cooperation is highly required. Disclosing all required information from a patient to determine proper diagnosis and treatment is also of paramount. The service provider on the other hand should have the required skills that will enable him interpret and analyze information received effectively to explain the condition and treatment to the patient. Bias and Confounding The problems in collecting data over the internet were summarized as follows; communication issues in the around the world have not been adequately addressed, despite best efforts of number of researchers dedicated to the health and welfare issues of these people. The quality of the data collected here can not serve as conclusive, this is because a relative small portion of the population was used, and the research used different definitions for pain. There was also a problem in assessing remote indigenous population, hence compromising the results of the study (Valance, 2001, p.1). Therefore, little data collected here can not be relied on for future research. Since communication issues in respect of listening skills such as engagement, empathy, education and enlisting the patient in the doctor care are increasing at an alarming rate, Valance (2001) suggests that studying the problem more closely with the affected people of the relevant communities is likely to address the problem adequately. Validity of the Research This research conducted sought to answer the question, â€Å"Can pain faces be distinguished from other emotional expressions-such as happiness, disgust, fear, sadness, surpris ed and anger?† This research principle is founded on two principles; Patients people have different cultural and language background—which required the researcher to develop models of inquiry Any attempt to solve problems on middle-aged population will be done in partnership with the consent of the communities surrounding them. Quantitative research methodology used in this research provided a better chance of identifying the nature of the problem because the sampling strategies are better suited in dealing with small samples. It also equipped the researcher with considerable knowledge of the population to be studied contributing to the validity of the results. Internet questionnaire were well guided, informed and driven by personal experiences. Also, the time allocated before the study commenced helped the researcher gain more understanding of health problems facing the world at large. To ensure the middle aged and the old population are able to have a say, equal opp ortunity in the research study and design was responsive to the needs of the population under study. The need for ongoing health campaigns of the communication skills should be provided and extended to the community, schools and preschools. Health related promotional activities should be encouraged to minimize occurrence of pain complains. Results The systematic reviews were identified using the internet and survey monkey database. Pain scales used the grading was simple and easy to apply and showed a large degree of consistency between the grading of the patient that of the health provider, diagnosis and treatment. Patients of ages 51 to 60 of Caucasian, Black/African American decent and Asian origins with average income mostly identified the same facial expression with regards to happiness, sadness, surprise, anger, disgust, disgust and pain. Also, participants of ages 28 to 30 with high income responded well to nonverbal communication signs compared to those of below 15 years. A set of questions were drawn in English language to guide participants and to ensure consistent information was gathered. The iquestionnaire protocol covered the key information area (facial expressions), including opinions on intervention services of the same to uncover their thoughts, perceptions and feelings. The questions were structured in a culturally sensitive manner, using their own language to obtain raw data from participants. In a research sought to measure the occurrence facial expressions on day to day activities, as a strategy to identigy the service gaps regarding health issues within the healthcare profession. Conclusion It is clear that understanding and further research in listening skills knowledge will assist in the communication of pain descriptors and putting at ease the patient in the treatment of pain. What is most needed is for all those involved in Healthcare to understand the listening process as well as having a basic understanding of how to read nonverbal signals. Having this skills along with that of empathy, will empower the healthcare provider to offer a more complete treatment plan to those who they treat and will allow them to see those that are in pain more clearly. This research has provided a set of principles that should be used in the training course to improve listening skills. The three process of communication; caring, diagnosis and problem solving and education of patient-provider provide attention to the most important aspects of healthcare. These processes combined with proficiency in providing health services and appropriate diagnosis and treatment when effectively applied results to better outcomes for the two parties. Emphasizing listening skills, nonverbal aptitude, and empathy, is not a new attitude in the healthcare setting but as seen it is one that is still lacking emphasis. It is proven that verbal communication builds relationship and enable people stay together longer and improves interpersonal relationshi ps. Patients should be educated that by talking to healthcare providers about your health concerns, how they feel about yourself and how they feel about life, helps them heal and accept their condition. Self disclosure puts someone in a position to see who they really are. Healthcare providers should on the other hand learn and understand each patient’s beliefs and cultures. As the objective of this paper strives to improve listening skills and the facial exercises, references used here will provide opportunities to accomplish these goals. Healthcare providers have their own clinical language that requires use of technical words that enable them communicate to each other which may be complex when used with patients. In some instances patients can also speak in their own dialects and slang, which makes it difficult for a health provider to comprehend. But with a little training a Healthcare Provider could be able to distinguish distinguishes between two different types of judg ments; pain expressions and emotional expressions. References Baird,J., Fanciullo,M., Sorensen,A., Washington,T. (2008). Pain Medicine. 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