Rajan

24 Januari 2011

1. Saya mempunyai seorang kawan baik

2. Kawan baik saya bernama Junaidah

3. Saya duduk di sebelahnya di dalam kelas

4. Kami murid tahun satu cemerland

5. Kawan baik saya suka membaca buku

My sister is four years older than me. She is in

Years six Her name is Kalama.

Kalama likes to play the piano

1. Good morning, father.

2. Good afternoon,Nora

3. Goodbye,Ramesh

BY

EARTH GROUP YEAR 5

2011

Binatang kesayangan saya

 Saya mempunyai seekor binatang kesayangan yang bernama Bobo.Bobo ialah seekor anjing yang berbulu putih dan berbadan kecil.

    Setiap pagi,apabila saya pergi ke sekolah,Bobo akan menamani saya sampai ke pintu pagar dan melihat saya menaiki bas.

    Apabila saya balik dari sekolah,Bobo akan menyambut saya dengan gembiranya sambil melompat ke badan saya dan mengoyangkan ekornya berkali-kali.Saya akan peluk Bobo dengan kuat dan senyuman yang manis.

    Pada waktu petang,saya selalu membawa Bobo ke padang dan bermain bola dengannya.obo pun menamani sayaberlari lari disekelilingi padang dengan gembiranya.

    Pada suatu malam,Bobo menyalak dengan berkali-kali dan kuatnya kerana dia nampak ada pencuri hendak mencuri basikal saya yang terletak di halaman rumah saya.

    Ayah saya pun membawa sebatang kayu dari biliknya dan menghalau pencuri itu.Akhirnya,pencuri itu pun lari dengan cepatnya.

    Setiap hari,saya akan memberi makanan dan minuman kepada Bobo.Saya juga akan memotong kuku Bobo dan mandikan    Bobo supaya sentiasa kelihatan shat dan bersih.

    Saya berasa sangat gembira kerana menpunyai seekor binatang yang berani.SAya sangat sayang pada Bobo

Pasar malam

        Pasar malam adalah suatu tempat yang menjual barangan keperluan harian pada

waktu malam.Pasar malam di tempat saya pula biasanya diadakan pada setiap hari Sabtu

dan bermula pada pukul 5.00 petang hingga 10.00 malam.  

        Setiap hari Sabtu,saya mengikut ibu saya pergi ke pasar malam.Ramai penjaja mula

memasang gerai masing-masing.Pada pukul 5.00 petang ditepi jalan bagai cendawan

tumbuh selepas hujan.Terdapat banyak gerai yang menjual beraneka jenis barangan

seperti sayur-sayuran yang segar-bugar, buah-buahan tempatan yang diimport,hidupan

laut yang segar,pakaian,dan alat permainan yang menarik.  

        Ramai pelangan datang berpusu-pusu bersama ahli keluarga dan membanjiri pasar

malam.Pada awalnya suasana sunyi-sepi bertukar menjadi hiruk-pikuk dengan laungan

para penjual yang ingin mrmperasikan barabgan menggunakan pembesar suara.Ada juga

peniaga memainkan lagu-lagu bagi menarik perhatian para pelangan.Lampu yang

berwarna-warni menyebabkan pasar malam terang-benderang.Para pengunjung terpaksa

berjalan berhimpit-himpit kerana penuh sesak.  

        Kebanyakan harga barangan dijual dengan berpatuan dan boleh tawar-

menawar.Saya tidak melepaskan peluang untuk menikmati pelbagai juadah yang dijual di

pasar malam.  

        Keadaan mulai reda,pada pukul 10.00 malam kerana ramai pelanggan beransur

pulang.Para peniaga pula sibuk mengemas barang masing-masing.Saya pun berjalan

pulangke rumah dengan emak saya.

மூன்றெ�ழுத்தி�ல் என் மூச்சி ருக்கும்அது முடிந்தி பி�ன்னா�லும் பேபிச்சி ருக்கும்உள்ளம் என்றெ��ரு ஊர் இருக்கும்அந்தி ஊருக்குள் எனாக்பே#�ர் பேபிர் இருக்கும்#டமை& அது #டமை&#டமை& அது #டமை&அந்தி மூன்றெ�ழுத்தி�ல் என் மூச்சி ருக்கும்அது முடிந்தி பி�ன்னா�லும் பேபிச்சி ருக்கும்உள்ளம் என்றெ��ரு ஊர் இருக்கும்அந்தி ஊருக்குள் எனாக்பே#�ர் பேபிர் இருக்கும்

பிதிவி� விரும்பேபி�து பிணி)வு விர பேவிண்டும்துணி)வும் விரபேவிண்டும் பேதி�ழா�பி�மைதி திவி��&ல் பிண்பு குமை�யா�&ல்பிழா#� விரபேவிண்டும் பேதி�ழா�பிதிவி� விரும்பேபி�து பிணி)வு விர பேவிண்டும்துணி)வும் விரபேவிண்டும் பேதி�ழா�பி�மைதி திவி��&ல் பிண்பு குமை�யா�&ல்பிழா#� விரபேவிண்டும் பேதி�ழா�அன்பேபி உன் அன்மைனாஅ� பேவி உன் திந்மைதிஉலபே# உன் பே#�வி�ல்ஒன்பே� உன் பேவிதிம்

மூன்றெ�ழுத்தி�ல் என் மூச்சி ருக்கும்அது முடிந்தி பி�ன்னா�லும் பேபிச்சி ருக்கும்

உள்ளம் என்றெ��ரு ஊர் இருக்கும்அந்தி ஊருக்குள் எனாக்பே#�ர் பேபிர் இருக்கும்#டமை& அது #டமை&#டமை& அது #டமை&

வி�மைழா &லர் பேபி�ல பூ&) மு#ம் பி�ர்க்கும்பே#�மைழா குணிம் &�ற்று பேதி�ழா�நா�மைள உயா�ர் பேபி�கும் இன்று பேபி�னா�லும்றெ#�ள்மை# நா�மை�பேவிற்று பேதி�ழா�வி�மைழா &லர் பேபி�ல பூ&) மு#ம் பி�ர்க்கும்பே#�மைழா குணிம் &�ற்று பேதி�ழா�நா�மைள உயா�ர் பேபி�கும் இன்று பேபி�னா�லும்றெ#�ள்மை# நா�மை�பேவிற்று பேதி�ழா�அன்பேபி உன் அன்மைனாஅ� பேவி உன் திந்மைதிஉலபே# உன் பே#�வி�ல்ஒன்பே� உன் பேவிதிம்

மூன்றெ�ழுத்தி�ல் என் மூச்சி ருக்கும்அது முடிந்தி பி�ன்னா�லும் பேபிச்சி ருக்கும்உள்ளம் என்றெ��ரு ஊர் இருக்கும்அந்தி ஊருக்குள் எனாக்பே#�ர் பேபிர் இருக்கும்#டமை& அது #டமை&#டமை& அது #டமை&

தி�ய் இல்ல�&ல் நா�ன் இல்மைலதி�பேனா எவிரும் பி��ந்திதி�ல்மைலஎனாக்றெ#�ரு தி�ய் இருக்#�ன்��ள்என்றும் என்மைனா #�க்#�ன்��ள்தி�ய் இல்ல�&ல் நா�ன் இல்மைலதி�பேனா எவிரும் பி��ந்திதி�ல்மைலஎனாக்றெ#�ரு தி�ய் இருக்#�ன்��ள்

என்றும் என்மைனா #�க்#�ன்��ள்தி�ய் இல்ல�&ல் நா�ன் இல்மைல

ஜீவி நாதி�யா�ய் விருவி�ள்என் தி�#ம் தீர்த்து &#�ழ்வி�ள்ஜீவி நாதி�யா�ய் விருவி�ள்என் தி�#ம் தீர்த்து &#�ழ்வி�ள்திவி� மைனா றெபி�றுப்பி�ள்திர்&த்மைதி விளர்ப்பி�ள்திரணி)யா�பேல விளம் பேசிர்த்தி�டுவி�ள் ( 2)(தி�ய் இல்ல�&ல் நா�ன் இல்மைல)

தூயா நா�ல&�ய் #�டப்பி�ள்தின் பேதி�ள)ல் என்மைனா சு&ப்பி�ள்தூயா நா�ல&�ய் #�டப்பி�ள்தின் பேதி�ள)ல் என்மைனா சு&ப்பி�ள்தின்மை&யா�ல்ல�&ல் நா�ன் &)தி�த்தி�லும்தின்மை&யா�ல்ல�&ல் நா�ன் &)தி�த்தி�லும்தி�ய்மை&யா�பேல &னாம் #னா)ந்தி�டுவி�ள்(தி�ய் இல்ல�&ல் நா�ன் இல்மைல)

பே&# வீதி�யா�ல் நாடப்பி�ள்உயா�ர் மூச்சி னா)பேல #லந்தி�ருப்பி�ள்பே&# வீதி�யா�ல் நாடப்பி�ள்உயா�ர் மூச்சி னா)பேல #லந்தி�ருப்பி�ள்&மைல முடி றெதி�டுவி�ள்&லர் &ணிம் திருவி�ள்&ங்#ல வி�ழ்வுக்கு துமைணி இருப்பி�ள்&மைல முடி றெதி�டுவி�ள்&லர் &ணிம் திருவி�ள்&ங்#ல வி�ழ்வுக்கு துமைணி இருப்பி�ள்தி�ய் இல்ல�&ல் நா�ன் இல்மைல

ஆதி� அந்திமும் அவிள் தி�ன்நாம்மை& ஆளும் நீதி�யும் அவிள் தி�ன்ஆதி� அந்திமும் அவிள் தி�ன்நாம்மை& ஆளும் நீதி�யும் அவிள் தி�ன்அ#ந்மைதிமையா அழா)ப்பி�ள் ஆற்�மைல றெ#�டுப்பி�ள்

அவிள் தி�ன் அன்மைனா &#�சிக்தி�அ#ந்மைதிமையா அழா)ப்பி�ள் ஆற்�மைல றெ#�டுப்பி�ள்அவிள் தி�ன் அன்மைனா &#�சிக்தி�

அந்தி தி�ய் இல்ல�&ல் நா�ன் இல்மைலதி�பேனா எவிரும் பி��ந்திதி�ல்மைலஎனாக்றெ#�ரு தி�ய் இருக்#�ன்��ள்என்றும் என்மைனா #�க்#�ன்��ள்தி�ய் இல்ல�&ல் நா�ன் இல்மைல

2.எத்தனை� பெ�ரிய ம�தருக்கு ...

இன்றெனா�ருவிர் பேவிதிமைனா இவிர்#ளுக்கு பேவிடிக்மை# இதியா&ற்� &னா)திருக்கு இதுறெவில்ல�ம் வி�டிக்மை#"

எத்திமைனா றெபிர)யா &னா)தினுக்கு எத்திமைனா சி � யா &னா&)ருக்கு எத்திமைனா றெபிர)யா &னா)தினுக்கு எத்திமைனா சி � யா &னா&)ருக்கு எத்திமைனா சி � யா பி�மைவிக்கு எத்திமைனா சி � யா பி�மைவிக்கு எத்திமைனா றெபிர)யா அ� வி�ருக்கு (எத்திமைனா றெபிர)யா)

உயார்ந்திவிர் என்னா தி�ழ்ந்திவிர் என்னா உடல் &ட்டுபே& #ருப்புஅவிர் உதி�ரம் என்றும் சி விப்பு உயார்ந்திவிர் என்னா தி�ழ்ந்திவிர் என்னா உடல் &ட்டுபே& #ருப்புஅவிர் உதி�ரம் என்றும் சி விப்பு ஒரு விழா) நாடந்தி�ர் உயார்ந்திவிர் ஆவி�ர் ஒரு விழா) நாடந்தி�ர் உயார்ந்திவிர் ஆவி�ர் பில விழா) #டந்தி�ர் தி�ழ்ந்திவிர் ஆவி�ர் ஹ்ம்ம்ம்.. &ஹ்ம்ம்ம்ம்.... (எத்திமைனா றெபிர)யா)

பே#�ழா)மையா பி�ரு #�மைலயா�ல் வி�ழா)க்கும்குருவி�மையா பி�ரு பேசி�ம்பிமைல பிழா)க்கும் பே#�ழா)மையா பி�ரு #�மைலயா�ல் வி�ழா)க்கும் குருவி�மையா பி�ரு பேசி�ம்பிமைல பிழா)க்கும்#�க்மை#மையா பி�ரு கூடி பி�மைழாக்கும் #�க்மை#மையா பி�ரு கூடி பி�மைழாக்கும் நாம்மை&யும் பி�ரு நா�பேட சி ர)க்கும் ஹ்ம்ம்ம்.. &ஹ்ம்ம்ம்ம்.... (எத்திமைனா றெபிர)யா)

தினாக்றெ#�ரு றெ#�ள்மை# அதிற்றெ#�ரு திமைலவின் தினாக்றெ#�ரு பி�மைதி அதிற்றெ#�ரு பியாணிம் தினாக்றெ#�ரு றெ#�ள்மை# அதிற்றெ#�ரு திமைலவின் தினாக்றெ#�ரு பி�மைதி அதிற்றெ#�ரு பியாணிம் உனாக்றெ#னா பேவிண்டும் உணிர்ந்தி�டு திம்பி� உனாக்றெ#னா பேவிண்டும் உணிர்ந்தி�டு திம்பி� உமைழாத்திதி�ட பேவிண்டும் மை##மைள நாம்பி� ஹ்ம்ம்ம்.. &ஹ்ம்ம்ம்ம்.... (எத்திமைனா றெபிர)யா)

3. கடவுள் இருக்க�ன்றா�ன்#டவுள் இருக்#�ன்��ன்

அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?#டவுள் இருக்#�ன்��ன்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?

#�ற்� ல் திவிழு#���ய்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?#�ற்� ல் திவிழு#���ய்அது உன் #ண்ணுக்கு றெதிர)#�ன்��தி�?#ண்ணுக்கு றெதிர)க்#�ன்�தி� ?#டவுள் இருக்#�ன்��ன்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி� ?இருள)ல் வி�ழா)க்#�ன்��ய்எதி�பேர இருப்பிது புர)#�ன்�தி� ?இருள)ல் வி�ழா)க்#�ன்��ய்எதி�பேர இருப்பிது புர)#�ன்�தி� ?இமைசிமையா ரசி க்#�ன்��ய்இமைசியா�ன் உருவிம் விரு#�ன்�தி�?உள்ளதி�ல் இருக்கும் உண்மை&யா�ன் விடிவிம்றெவிள)பேயா றெதிர)#�ன்�தி�றெவிள)பேயா றெதிர)#�ன்�தி� ?#டவுள் இருக்#�ன்��ன்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?#�ற்� ல் திவிழு#���ய்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?#ண்ணுக்கு றெதிர)#�ன்�தி�?புத்தின் &மை�ந்து வி�ட்ட�ன்அவின் தின் பேபி�திமைனா &மை�#�ன்�தி�?புத்தின் &மை�ந்து வி�ட்ட�ன்அவின் தின் பேபி�திமைனா &மை�#�ன்�தி�?சித்தி�யாம் பேதி�ற்�துண்ட�உல#�ல் திர்&ம் அழா)ந்திதுண்ட�?இமைதி சிர)த்தி�ரம் முழுதும் பிடித்தி பி�ன்னா�லும்சிஞ்சிலம் விரு#�ன்�தி�?சிஞ்சிலம் விரு#�ன்�தி�?#டவுள் இருக்#�ன்��ன்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?பேதிடியும் #�மைடக்#�துநீதி� றெதிருவி�னா)ல் இருக்#�து!பேதிடியும் #�மைடக்#�துநீதி� றெதிருவி�னா)ல் இருக்#�து!சி�ட்மைடக்கு அடங்#�து

நீதி� சிட்டத்தி�ல் &யாங்#�து!#�லத்தி�ல் பேதி�ன்� மை##மைள நீட்டி#�க்#வும் தியாங்#�து!#�க்#வும் தியாங்#�து!#டவுள் இருக்#�ன்��ன்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?#�ற்� ல் திவிழு#���ய்அது உன் #ண்ணுக்கு றெதிர)#�ன்�தி�?#ண்ணுக்கு றெதிர)#�ன்�தி�?#டவுள் இருக்#�ன்��ன் #டவுள் இருக்#�ன்��ன்#டவுள் இருக்#�ன்��ன்

4. ஏன் என்றா கேகள்வி�

ஏன் என்� பே#ள்வி� இங்கு பே#ட்#�&ல் வி�ழ்க்மை# இல்மைலநா�ன் என்� எண்ணிம் றெ#�ண்ட &னா)தின் வி�ழ்ந்திதி�ல்மைலபிகுத்தி� வு பி��ந்திறெதில்ல�ம் பே#ள்வி�#ள் பே#ட்டதினா�பேலபிகுத்தி� வு பி��ந்திறெதில்ல�ம் பே#ள்வி�#ள் பே#ட்டதினா�பேலஉர)மை&#மைள றெபிறுவிறெதில்ல�ம் உணிர்ச்சி #ள் உள்ளதினா�பேலஉர)மை&#மைள றெபிறுவிறெதில்ல�ம் உணிர்ச்சி #ள் உள்ளதினா�பேல

ஏன் என்� பே#ள்வி� இங்கு பே#ட்#�&ல் வி�ழ்க்மை# இல்மைலநா�ன் என்� எண்ணிம் றெ#�ண்ட &னா)தின் வி�ழ்ந்திதி�ல்மைல

#�ல� #�லத்துக்கு இப்பிடிபேயா ஒழாசி க்#�ட்பேட இருந்து

இந்தி #ன்னா) தீவு &ண்ணுபே# எரு ஆ# பேவிண்டியா�து தி�னா� ?நாம்பி றெசி�ந்தி ஊருக்கு பேபி�விது எப்பேபி� ?இளவிரசி மு#த்தி பி�ர்ப்பிது எப்பேபி� ?புள்ள குட்டி றெ&�#த்தி பி�ர்ப்பிது எப்பேபி� ?இன்னும் எத்தினா நா�மைளக்கு தி�ன் றெபி�றுமை&யா� இருப்பிது ?

ஓர் ஆயா�ரம் ஆண்டு#ள் ஆ#ட்டுபே&நாம் றெபி�றுமை&யா�ன் றெபி�ருள் &ட்டும் வி�ளங்#ட்டுபே&ஓர் ஆயா�ரம் ஆண்டு#ள் ஆ#ட்டுபே&நாம் றெபி�றுமை&யா�ன் றெபி�ருள் &ட்டும் வி�ளங்#ட்டுபே&விரும் #�லத்தி�பேல நாம் பிரம்பிமைர#ள்நா�ம் அடிமை& இல்மைல என்று முழாங்#ட்டுபே&

ஏன் என்� பே#ள்வி� இங்கு பே#ட்#�&ல் வி�ழ்க்மை# இல்மைலநா�ன் என்� எண்ணிம் றெ#�ண்ட &னா)தின் வி�ழ்ந்திதி�ல்மைல

பூங்றெ#�டி , சீக்#�ரபே& இந்தி தீவு றெசி�ர்க்# பூ&) ஆ#�வி�டும் பேபி�ல் இருக்#�ன்�துஎல்ல�ம் இந்தி அடிமை&#ள)ன் உமைழாப்பி�ல் தி�பேனா ?சிந்பேதி#ம் என்னா ?நா&க்கு வி�ய்த்தி அடிமை&#ள் &)# &)# தி��மை&சி�லி#ள்ஆனா�ல் வி�ய் தி�ன் #�து விமைர இருக்#��து

நீர் ஓமைட#ள் பே#�மைடயா�ல் #�ய்ந்தி�ருக்கும்&மைழா #�லத்தி�ல் றெவிள்ளங்#ள் பி�ய்ந்தி�ருக்கும் நீர் ஓமைட#ள் பே#�மைடயா�ல் #�ய்ந்தி�ருக்கும்&மைழா #�லத்தி�ல் றெவிள்ளங்#ள் பி�ய்ந்தி�ருக்கும் நாம் பேதி�ள் விலியா�ல் அந்தி நா�ள் விரல�ம்அன்று ஏமைழா எள)யாவிர்#ள் நாலம் றெபி�ல�ம்முன்பேனாற்�ம் என்பிறெதில்ல�ம் உமைழாப்பிவிர் உமைழாப்பிதினா�பேல#டமை&#மைள புர)விறெதில்ல�ம் வி�டுதிமைல பேவிண்டுவிதி�பேல

ஏன் என்� பே#ள்வி� இங்கு பே#ட்#�&ல் வி�ழ்க்மை# இல்மைலநா�ன் என்� எண்ணிம் றெ#�ண்ட &னா)தின் வி�ழ்ந்திதி�ல்மைலஏன் என்� பே#ள்வி�

இங்கு பே#ட்#�&ல் வி�ழ்க்மை# இல்மைலநா�ன் என்� எண்ணிம் றெ#�ண்ட &னா)தின் வி�ழ்ந்திதி�ல்மைல

5.சி�ரித்து வி�ழ கேவிண்டும்

சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி�

சி ர)த்து வி�ழா பேவிண்டும் பி��ர் சி ர)க்# வி�ழ்ந்தி�ட�பேதி சி ர)த்து வி�ழா பேவிண்டும் பி��ர் சி ர)க்# வி�ழ்ந்தி�ட�பேதி உமைழாத்து வி�ழா பேவிண்டும் பி��ர் உமைழாப்பி�ல் வி�ழ்ந்தி�ட�பேதிஉமைழாத்து வி�ழா பேவிண்டும் பி��ர் உமைழாப்பி�ல் வி�ழ்ந்தி�ட�பேதிசி ர)த்து வி�ழா பேவிண்டும் பி��ர் சி ர)க்# வி�ழ்ந்தி�ட�பேதி

அன்பி�ல் வி�ழும் இதியாம் தின்மைனாறெதிய்விம் #ண்ட�ல் விணிங்கும் எங்பே# றெசி�ல்லு விணிங்கும் அன்பி�ல் வி�ழும் இதியாம் தின்மைனாறெதிய்விம் #ண்ட�ல் விணிங்கும் ஆமைசி இல்ல� &னா)திர் தின்மைனாதுன்பிம் எங்பே# றெநாருங்கும் றெபி�ன்னா)ல் இன்பிம் பு#ழா)ல் இன்பிம்என்பே� றெநாஞ்சிம் &யாங்கும் பூமைவிப் பேபி�பேல சி ர)க்கும் உன்மைனாக்#ண்ட�ல் உண்மை& வி�ளங்கும்

சி ர)த்து வி�ழா பேவிண்டும் பி��ர் சி ர)க்# வி�ழ்ந்தி�ட�பேதி

முள்ள)ல் பேர�ஜா� &லர்ந்திதி�பேலமுள்ளுக்கு என்னா றெபிருமை&சி ப்பி�க்குள்பேள பி��ந்திதி�பேல முத்துக்கு என்னா சி றுமை& எங்பே# நான்மை& இருந்தி பேபி�தும்ஏற்றுக் றெ#�ள்ளும் உல#ம் அங்பே# விந்து திழுவி�க் றெ#�ண்டு

பேபி�ற்றும் நால்ல இதியாம்

சி ர)த்து வி�ழா பேவிண்டும் பி��ர் சி ர)க்# வி�ழ்ந்தி�ட�பேதி

சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� வி�னா)ல் நீந்தும் நா�லவி�ல் நா�மைளபிள்ள)க் கூடம் நாடக்கும் பிள்ள)க் கூடம் நாடக்கும் #�ற்� ல் ஏ� பியாணிம் றெசிய்யாபி�மைதி அங்பே# இருக்கும் பி�மைதி அங்பே# இருக்கும் எங்கும் வி�ழும் &ழாமைலச் றெசில்விம்ஒன்��ய் பேசிர்ந்து பிடிக்கும் இல்மைல ஜா�தி� &திமும் இல்மைலஎன்பே� பி�டிச் சி ர)க்கும்

சி ர)த்து வி�ழா பேவிண்டும் பி��ர் சி ர)க்# வி�ழ்ந்தி�ட�பேதி

சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி� சி க்கு &ங்கு சி க்கு &ங்கு றெசிச்சி பி�ப்பி�

நா�ன் ஆமைணியா�ட்ட�ல்...அது நாடந்து வி�ட்ட�ல்...நா�ன் ஆமைணியா�ட்ட�ல் அது நாடந்து வி�ட்ட�ல்இங்கு ஏமைழா#ள் பேவிதிமைனாப் பிட&�ட்ட�ர்உயா�ர் உள்ளவிமைர ஒரு துன்பி&)ல்மைலஅவிர் #ண்ணீர்க் #டலிபேல வி�ழா&�ட்ட�ர் (2)(நா�ன் ஆமைணியா�ட்ட�ல்)

ஒரு திவிறு றெசிய்தி�ல் அமைதித் றெதிர)ந்து றெசிய்தி�ல்அவின் பேதிவின் என்��லும் வி�ட&�ட்பேடன்உடல் உமைழாக்#ச் றெசி�ல்பேவின்அதி�ல் பி�மைழாக்#ச் றெசி�ல்பேவின்அவிர் உர)மை&ப் றெபி�ருள்#மைளத் பேதி�ட&�ட்பேடன் (2)(நா�ன் ஆமைணியா�ட்ட�ல்)

சி லர் ஆமைசிக்கும் பேதிமைவிக்கும்வி�ழ்வி�ற்கும் விசிதி�க்கும்

ஊர�ர் #�ல்பி�டிப்பி�ர்ஒரு &�னா&)ல்மைல அதி�ல் ஈனா&)ல்மைலஅவிர் எப்பேபி�தும் வி�ல்பி�டிப்பி�ர்முன்பு பேயாசு விந்தி�ர் பி�ன்பு #�ந்தி� விந்தி�ர்இந்தி &�னா)டர் தி�ருந்தி�ட பி��ந்தி�ர்இவிர் தி�ருந்திவி�ல்மைல &னாம் விருந்திவி�ல்மைலஅந்தி பே&பேல�ர் றெசி�ன்னாமைதி &�ந்தி�ர்அந்தி பே&பேல�ர் றெசி�ன்னாமைதி &�ந்தி�ர்(நா�ன் ஆமைணியா�ட்ட�ல்)

இங்கு ஊமை&#ள் ஏங்#வும் உண்மை&#ள் தூங்#வும்நா�னா� பி�ர்த்தி�ருப்பேபின்ஒரு #டவுள் உண்டு அவிர் றெ#�ள்மை# உண்டுஅமைதி எப்பேபி�தும் #�த்தி�ருப்பேபின்எதி�ர்#�லம் விரும் என் #டமை& விரும்இந்திக் கூட்டத்தி�ன் ஆட்டத்மைதி ஒழா)ப்பிபேபின்றெபி�து நீதி�யா�பேல புதுப் பி�மைதியா�பேலவிரும் நால்பேல�ர் மு#த்தி�பேல வி�ழா)ப்பேபின்விரும் நால்பேல�ர் மு#த்தி�பேல வி�ழா)ப்பேபின்(நா�ன் ஆமைணியா�ட்ட�ல்)

கடவுள் ஏன் கல்லா���ன் -&னாம் #ல்ல�ய் பேபி�னா &னா)திர்#ள�பேல (#டவுள்)

றெ#�டுமை&மையா #ண்டவின் #ண்மைணி இழாந்தி�ன் - அமைதி பே#�பி�த்து திடுத்திவின் றெசி�ல்மைல இழாந்தி�ன் இரக்#த்மைதி நா�மைனாத்திவின் றெபி�ன்மைனா இழாந்தி�ன் இரக்#த்மைதி நா�மைனாத்திவின் றெபி�ன்மைனா இழாந்தி�ன் - இங்கு எல்பேல�ர்க்கும் நால்லவின் தின்மைனா இழாந்தி�ன் எல்பேல�ர்க்கும் நால்லவின் தின்மைனா இழாந்தி�ன் (#டவுள்)

றெநாஞ்சுக்கு பேதிமைவி &னாசி�ட்சி -அது நீதி� பேதிவினா)ன் அரசி�ட்சி அத்திமைனா உண்மை&க்கும் அவின் சி�ட்சி அத்திமைனா உண்மை&க்கும் அவின் சி�ட்சி -&க்#ள் அரங்#த்தி�ல் விர�து அவின் சி�ட்சி அரங்#த்தி�ல் விர�து அவின் சி�ட்சி (#டவுள்)

சிதி� றெசியால் றெசிய்திவின் புத்தி�சி�லி -அமைதி சி#�த்துக்றெ#�ண்டிருந்திவின் குற்�வி�ள) உண்மை&மையா றெசி�ல்பிவின் சிதி�#�ரன் உண்மை&மையா றெசி�ல்பிவின் சிதி�#�ரன் -இது உல#த்தி�ல் ஆண்டவின் அதி�#�ரம் -இது உல#த்தி�ல் ஆண்டவின் அதி�#�ரம் (#டவுள்)

1.

2. விலம்

3. சிட்டம்

4. சில்லடம்

5. ரசிம்

6. பில்

7. திடம்

8. தி#ரம்

9. திர்&ம்

10. சிதிம்

11. நாட்டம்

12. நாலம்

13. நால்லவிர்

14. நா#ரம்

15. அம்&�

16. அப்பி�

17. அணி)ல்

18. அடுப்பு

19. ஆடு

20. ஆந்மைதி

21. ஆப்பி�ள்

22. ஆமை&

23. இ�கு

24. இமைல

25. இரண்டு

26. இல்லம்

27. ஈசில்

28. ஈச்சி&ரம்

29. ஈ

30. ஈட்டி

Soalan 1 - 21

Isi tempat kosong dengan jawapan yang paling sesuai.

1 “Ibu bangga mendapat anak seperti ____________ ,” kata Puan Jalilah kepada anak tunggalnya.

A dia

B kamu

C mereka

D engkau

2 “Pantang ____________ rakyat menderhaka kepada sultan,” kata Hang Tuah kepada sahabatnya.

A beta

B patik

C hamba

D tuan hamba

3 ____________ mangsa banjir telah berjaya dipindahkan ke ____________ pusat pemindahan yang berdekatan.

A Semua ..........beberapa

B Semua ..........sebahagian

C Segelintir ..........beberapa

D Segelintir ..........sebahagian

Soalan 4 berdasarkan gambar di bawah.

4 Cikgu Anis melambai tangan ____________ memanggil Ketua Darjah 6 Melur untuk memberi pesanan.

A kerana

B sambil

C apabila

D supaya

5 Dato’ Habib amat berpuas hati dengan kerja ____________ banglonya yang terletak di Taman Tasek Utama.

A ubah suai

B susun atur

C kemas kini

D tambah baik

6 Pada awal tahun, pihak sekolah akan mengadakan sesi ____________ bagi meraikan kehadiran murid-murid tahun 1.

A tegur sapa

B soal jawab

C bual bicara

D ramah mesra

Soalan 7 berdasarkan gambar di bawah

7 Ahli-ahli pengakap itu sedang berteduh di bawah sebatang pokok ____________ menunggu jurulatih mereka sampai.

A hingga

B lantaran

C sementara

D mahupun

8 Persiapan untuk menyambut Hari Kebangsaan sedang ____________ dijalankan.

A gigih

B hebat

C pantas

D rancak

Soalan 9 berdasarkan gambar di bawah.

9 Fatin ____________ ketakutan apabila melihat seekor ular keluar dari dalam semak.

A menjerit

B meraung

C melaung

D melolong

10 Puan Rohana berasa berat hati meninggalkan sekolah setelah bertahun-tahun menabur bakti sebagai guru besar di situ.

Perkataan seerti bagi bakti ialah

A jasa

B budi

C kerjaya

D khidmat

11 Api yang marak telah membakar kilang perabot itu hingga hangus dalam jangka masa yang singkat.

Perkataan berlawan bagi singkat ialah

A lama

B cepat

C ringkas

D pendek

12 Syahirah belajar membilang dengan menggunakan beberapa ____________ biji saga.

A butir

B buah

C batang

D tangkai

13 Setelah jatuh sakit, nenek tidak menjamah walaupun se____________ nasi dan se____________ air.

A biji ... titis

B buah ... titik

C butir ... teguk

D pinggan ... teguk

14 Vijay ____________ apabila diminta untuk menjawab soalan itu kerana dia sedang berkhayal.

A terkial-kial

B terkebil-kebil

C terpinga-pinga

D tersentak-sentak

Pilih jawapan yang paling sesuai bagi soalan yang diberikan.

15 Di manakah awak akan menunggu saya?

A Berdekatan dengan pejabat pos.

B Sudah lama saya menunggu awak.

C Saya akan menelefon apabila saya sampai.

D Kita akan berjumpa pada pukul 10.00 pagi.

Pilih ayat tanya yang sesuai bagi ayat di bawah.

16 Keuntungan yang diperoleh pada Hari Kantin tidak begitu memberangsangkan.

A Bilakah Hari Kantin diadakan?

B Mengapakah Hari Kantin tidak diadakan lagi?

C Berapakah keuntungan yang diperoleh pada Hari Kantin?

D Mengapakah keuntungan Hari Kantin tidak memberangsangkan?

Pilih ayat yang sama maksud dengan ayat yang diberi.

17 Gotong-royong yang diadakan itu adalah untuk mengeratkan hubungan kekeluargaan dalam kalangan penduduk taman ini.

A Hasil daripada gotong-royong itu, para penduduk taman ini bertambah erat hubungan mereka.

B Tujuan gotong-royong ini untuk mengeratkan hubungan penduduk antara kekeluargaan taman ini.

C Hubungan kekeluargaan yang bertambah erat di taman ini memudahkan program gotong-royong diadakan.

D Hubungan kekeluargaan yang erat dalam kalangan penduduk taman ini adalah matlamat projek gotong-royong diadakan.

18 “Mengapakah adik kamu menangis?” tanya cikgu kepada Farhan.

A Farhan bertanya kepada cikgu sebab adiknya menangis.

B Cikgu bertanya kepada Farhan sebab adiknya menangis.

C Cikgu bertanya kepada Farhan sebab adik kamu menangis.

D Farhan memberitahu kepada cikgu sebab adiknya menangis.

19 ____________ Sharifah Aini yang bersuara merdu itu berasal dari kampung ini.

A Biduan

B Seniman

C Seniwati

D Biduanita

20 Ayah ____________ ibu sebentuk cincin emas bertatahkan mutiara sempena ulang tahun perkahwinan mereka.

A dihadiahi

B dihadiahkan

C menghadiahi

D menghadiahkan

21 Encik Zamri bekerja siang dan malam untuk menampung ____________ sekolah anak-anaknya.

A berbelanja

B membelanja

C perbelanjaan

D membelanjakan

Soalan 22 berdasarkan gambar di bawah.

22 Pak Wan mengangkat timbunan tanah yang dicangkul dengan menggunakan ____________ .

A raga

B nyiru

C bakul

D pongkes

Pilih peribahasa yang sesuai.

23 Puan Salmah menyelesaikan pertelingkahan kedua-dua anak kembarnya seperti

A melepaskan batuk di tangga.

B menatang minyak yang penuh.

C menarik benang dalam tepung.

D menegakkan benang yang basah.

24 Perdana Menteri menyarankan agar rakyat mengamalkan konsep 1 Malaysia.

A Bagai isi dengan kuku.

B Bagai aur dengan tebing.

C Bagai duri dalam daging.

D Bagai pinang dibelah dua.

Pilih ayat yang betul.

25 A Pasu kristal itu terhempas ke lantai lalu pecah.

B Dia akan ke Pulau Pangkor di hujung minggu ini.

C Arifah lebih pintar dari kawan-kawannya yang lain.

D Kami kagum dengan kejayaan anak-anak Puan Devi itu.

26 A Wah, daif sungguh kehidupan Ah Meng sekeluarga!

B Aduhai, anak-anakku belajarlah bersungguh-sungguh!

C Cis, banyaknya ikan yang mati di kolam Pak Syahmi ini!

D Syabas, kamu terpilih untuk mewakili sekolah dalam pertandingan pidato itu!

27 I Oleh kerana cuaca panas, nenek tidur beralaskan tikar di serambi.

II Calon diberi masa satu jam suku untuk menjawab soalan Penulisan.

III Pengacara majlis mengucapkan terima kasih di atas kehadiran para tetamu.

IV Hidayah bercadang hendak melancong ke luar negara pada musim cuti nanti.

A I dan II

B I dan III

C II dan IV

D III dan IV

28 I Buku cerita yang tebal itu telah dibaca oleh saya.

II Pendingin hawa di pusat sumber sekolah kami sedang dibaiki.

III Penduduk Kampung Duyong saling tolong-menolong membersihkan kawasan sekolah.

IV Antara acara yang dipertandingkan pada hari itu ialah acara balapan dan lompat tinggi.

A I dan II

B I dan III

C II dan IV

D III dan IV

Pilih ayat yang menggunakan perkataan bergaris dengan betul

29 A Suasana di dalam stadium meregang apabila penonton mula merusuh.

B Hubungan Zuhri dan Ramesh itu meregang akibat perselisihan faham.

C Irfan meregang daun tingkap untuk membiarkan cahaya matahari masuk.

D Dawai telefon mengendur pada waktu sejuk dan meregang pada waktu panas.

30 I Buah peria katak tidak digemari kerana rasanya yang pahit.

II Roslan tidak dapat menerima pandangan pahit rakan-rakannya.

III Hatinya pahit apabila Ruzlan memalukannya di khalayak ramai.

IV Nenek asyik bercerita tentang pengalaman pahit ketika zaman

pemerintahan Jepun.

A I dan II

B I dan IV

C I, II dan III

D II, III dan IV

Soalan 31 – 35

Baca petikan e-mel di bawah, kemudian jawab soalan-soalan berikutnya.

Kepada : Mariah binti Mat

Daripada : Juliana binti Jusoh

Perkara :

Kepada sahabatku Mariah yang kini berada di Kuala Lumpur. Semoga sihat dan bahagia selalu.

Saudari,

Apa khabar saudari sekarang? Saya dan keluarga di sini berada dalam keadaan sihat

sejahtera.

Oh, ya! Lama sungguh kita tidak berjumpa. Semenjak saya berpindah ke sini, inilah

pertama kali saya menulis e-mel kepada saudari.

Buat masa ini kami sekeluarga menyewa sebuah rumah di Taman Bidara Permai. Ayah

saya telah pun membeli sebuah rumah di taman perumahan yang baru tetapi rumah itu masih

dalam pembinaan. Mungkin tahun hadapan kami akan berpindah ke rumah itu.

Kawan-kawan kita bagaimana sekarang? Saya begitu kehilangan akan mereka. Kalau

saudari berjumpa dengan Hanafi, Rogayah, Azmi dan lain-lain, sampaikanlah salam saya kepada

mereka.

Saya juga telah cuba menyesuaikan diri di tempat ini. Murid-murid di sini baik belaka.

Mereka dapat menerima diri saya dengan hati terbuka.

Setakat ini dahulu yang dapat saya tuliskan. Semoga bertemu pada masa yang lain.

Sekian, terima kasih.

Sahabatmu,

Juliana

31 Apakah tujuan e-mel ini ditulis?

A Menghubungi seorang kawan yang tinggal di luar negara.

B Menghubungi kawan yang lama tidak bertemu.

C Mengajak sahabatnya datang ke rumah.

D Meminta bantuan kewangan.

32 Di manakah Juliana tinggal?

A Di Kuala Lumpur.

B Di Taman Bidara Permai.

C Dekat dengan rumah Hanafi.

D Berhampiran Taman Bidara Permai.

33 Antara kenyataan berikut, yang manakah tidak benar?

A Juliana tidak mengenali Mariah.

B Juliana pernah tinggal di Kuala Lumpur.

C Juliana mengenali Azmi ketika di Kuala Lumpur.

D Hanafi dan Rogayah masih tinggal di Kuala Lumpur.

34 Apakah maksud ‘menyesuaikan diri’ dalam petikan e-mel di atas?

A membiasakan dengan keadaan

B menagih simpati

C membawa diri

D berhati-hati

35 Bagaimanakah keadaan murid-murid di tempat yang baru diduduki oleh Juliana?

A Cemburu atas kejayaan Juliana.

B Mengecam kedatangan Juliana di situ.

C Berpakat untuk melantik Juliana sebagai ketua.

D Menerima kehadiran Juliana dengan senang hati.

Soalan 36 - 40

Baca petikan di bawah, kemudian jawab soalan-soalan berikutnya.

Tun Abdullah bin Ahmad Badawi dilahirkan dalam keluarga yang warak di Kampung Perlis, Bayan

Lepas, Pulau Pinang. Beliau menerima pendidikan menengah di Sekolah Menengah Kebangsaan

Tinggi Bukit Mertajam dan di Penang Methodist Boys School, Pulau Pinang. Abdullah

memulakan kerjayanya sebagai guru. Selepas menerima Sarjana Muda Sastera dalam bidang

Pengajian Islam daripada Universiti Malaya pada tahun 1964, beliau menyertai sektor

perkhidmatan awam sebagai Penolong Setiausaha di Jabatan Perkhidmatan Awam.

Pada tahun 1969, Abdullah berpindah ke Majlis Gerakan Negara (MAGERAN), sebuah

badan yang berkuasa eksekutif untuk mentadbir negara yang ditubuhkan selepas rusuhan kaum

pada Mei 1969. Abdullah kemudiannya dinaikkan pangkat menjadi Ketua Pengarah Kementerian

Kebudayaan, Belia dan Sukan, sebelum menjadi Timbalan Ketua Setiausaha dalam kementerian

yang sama pada tahun 1974.

Abdullah berkahwin dengan Datin Seri Endon binti Dato' Mahmood pada tahun 1965

dan dikurniakan dua orang cahaya mata dan empat orang cucu. Pada 20 Oktober 2005, Endon

Mahmood meninggal dunia selepas bergelut dengan penyakit barah payu dara sejak 2003.

Setelah dua tahun menduda, beliau berkahwin pula dengan Jeanne Abdullah.

Beliau dikatakan mementingkan aktiviti makan malam bersama-sama keluarga dan

gemar makanan Jepun. Beliau menghargai hasil seni Malaysia dan merupakan seorang

pengumpul seni ukiran kayu serta anyaman rotan. Setiap hari selepas sembahyang Maghrib,

beliau akan mengaji Al Quran. Telah menjadi kebiasaan beliau menulis nota dalam Jawi. Selain

daripada keluarga sendiri, tokoh yang banyak mempengaruhinya serta dianggap sebagai mentor

ialah Tun Abdul Razak. Beliau juga adalah pencetus Islam Hadhari.

36 Di manakah Tun Abdullah bin Ahmad Badawi dilahirkan?

A Perlis

B Kedah

C Bukit Mertajam

D Kampung Perlis

37 Apakah jawatan yang disandang oleh Tun Abdullah bin Ahmad Badawi pada 1974?

A Pendidik

B Penolong Setiausaha

C Ketua Pengarah Kementerian Belia dan Sukan

D Timbalan Ketua Setiausaha Kementerian Belia dan Sukan

38 Bilakah beliau berkahwin dengan isteri keduanya?

A Tahun 2003

B Tahun 2005

C Tahun 2006

D Tahun 2007

39 Pilih pernyataan yang tidak benar tentang petikan di atas?

A Beliau menghargai hasil seni Malaysia.

B Beliau pernah menjadi Penolong Setiausaha.

C Beliau merupakan graduan lulusan ekonomi.

D Beliau menggemari makanan Jepun.

40 Perkataan pencetus dalam petikan sesuai digantikan dengan

A pereka

B pelopor

C pencipta

D pengilham

By

G.MAGESWARI

COHORT 9

STUDENT ID: 08035555

Word count: 10 000

1.0 Introduction

The working place of intensive care unit (ICU) is very busy and hectic with never

ended critical cases. Workload due to continuous contemporary issue such as

shortage of staff and the conflict with professional boundaries such as vertical

and horizontal substitutions . These are the factors that contributing workload

and stress in ICU. To discuss the performance hurdles experienced by intensive

care nurses in their work environment that impairs nursing care through reflective

account. To make recommendations to over come the stressful workload in ICU

in order to improve nursing quality for the clients. Intensive care nurses come

across with a lot of performance obstruction in their work environment. Reflexion

and reflexivity should be able to identify the outcome of various performance

hurdles on nursing workload, nursing quality of working life, and quality of patient

care. I would use John’s Model of structured reflection in my discussion by

reviewing my daily work to over come the stressful workload in ICU in order to

improve nursing quality for the clients by removing performance problem. The

Mechanisms of workload which I would discuss in my dissertation are

empowment, time, motivation, stress, attention, violations of work- a rounds and

impact on organization . At the same time I would approach my dissertation on

empirics, ethics, personal and aesthetic basis by using John’s Model of

Reflection (1994) .

2.3.1 Stress in ICU

Working in hospital settings can be very stressful, particularly for those

nurses and working in an ICU (DePew et al., 1999). Work pressures are

considered as part of everyday life of health professionals (McCarthy, Power and

Greiner, 2010). According to Cox, Griffiths and Rial-Ganzalez (2000) the stress

response as being mismatch between the perceived demands and the

capabilities of the individual to cope with this demands. According to Lally and

Pearce (1996) there are multiple factors which cause stress in ICU, which include

high patient mortality, the nature of death in ICU, young people dying as an

outcome of acute pathology or due to traumatic injuries as well as the fast

change in the pace of works and tasks. As a result, all of these factors result to

an environment that is full of tension and anxiety.

In addition, other studies also showed different stressors for nurses which

can be found in the ICU working environment. These include, but not limited to:

excessive workloads (Callaghan et al., 2000); conflict with the supervisors and

co-workers (Tyson et al., 2002); dealing with death and dying patients (Lambert

et al., 2004b; Mann and Cowburn, 2005); lack of support from the organization

(Tyson et al., 2002); insufficient preparation or lack of resources being issued

(Tholdy Doncevic et al., 1998); coping with emotional needs of the patients as

well as their treatment (Kalichman et al., 2000); shift rotation (Rogers, 1997);

uncertainty concerning treatment (Kalichman et al., 2000); low job control (Cheng

et al., 2000); and being moved among different patient care units (Healy and

McKay, 1999). The study of Foxall et al. (1990) showed that intensive care

nurses have to deal more with the stress of death and dying, while general

medical-surgical unit nurses have to contend more with workload and staffing

issues (cited from Burgess, Irvine and Wallymahmed, 2010).

The study of Wolfgang (1988) compared the stress level of nurses with

doctors and pharmacists. The result showed that nurses reported highly stressful

environment and jobs compare to doctors and pharmacists. This is because of

work load, needs of the patients as well as conflicts in the team. In addition, the

study of Goodfellow et al. (1997) analyzed and evaluated the occupational stress

between nurses and doctors within the ICU. The result showed that the doctors

found that some factors in their job connected to career and achievement as well

as organizational design and structure, are offering them more stressful works

than the normal working setting. On the other hand, the nursing staffs reported

different sources of stress compare to the doctors.

The negative impacts of excessive demands that the working environment

bring towards the medical staffs have been well studied and documented to offer

and cause both physical and psychological impact towards individual. Stressor

have an influence on most bodily systems, which produce quantifiable transient

impacts which questionably lead to severe, chronic or even acute physical health

problems (Mealer et al. 2007). In terms of psychological aspect, stress is

connected with the feeling of anxiety, depression, subjective fatigue, reduction of

confidence and self-esteem. All of these symptoms or signs have been showed

and studied to affect the capability of individual and group to perform and act in

different work-related tasks (Kincey et al., 2005). The study of Mealer et al.

(2007) showed that some of the traumatic events that are connected with the

PTSD in ICU nurses are quite the same to the experiences of war veterans,

which include handling of dead bodies and caring for trauma victims. With this, it

show that ICU is a very demanding environment which leave medical staffs –

particularly nurses to be anxious and depressed (Burgess et al., 2010).

My workplace has been considered as an extraordinary working environment

with different workloads. Environmental factors have been established to the

level that meets suggested standards. Currently, in my ward healthcare facilities

are experiencing overcrowding and hospital-wide waits and delays. Thus,

possible risks must be identified and alleviated by matching demand to capacity

(Hall, 2006). This is primarily because of the different changes and alterations in

ICU , which include the development of technology, innovations, the changes in

the culture and tradition of individuals and the overall organizational behavior. It

is also important to consider the different social changes found in the macro-

environment. I directly saw how patients and their families perceived about the

quality of the medical services being offered to them.

In my working place the workload demands have been changed due to the

increase in the level of patient demands and expectations. Patient’s expectations

have raised the level of working demands and perceived stress among us . At

the present time, work in the hospital is dominantly worked with a high level of

psychosocial demands and workloads. According to the results of different

epidemiological studies, the work of nurses is stressful. But, they still have to

carry out their task in agreement with professional demands and without

mistakes or error no matter how stressed and tired they are. Recently apart from

working in ICU we are been forced to work double duty and no off day for nearly

ten days in newly open dengue ward because of outbreak of dengue fever.

Actually the management side failed to declare the situation to the state

government to get man power. The working environment is consequently,

perceived as overloaded. Additionally, the cost sare fatigue, illness and sick

leaves. Nurses are in constant stress. They are worn out. Every now and then we

can talk about epidemic of burnout syndrome (Vink, Konningsveld and Dhondt,

1998). These factors are very important because it directly affect the quality of

the services they offered towards their patients, which consequently affect their

lives and health

.

As a result, the question of what decrease burnout and increases retention

and job satisfaction are widely studied in the field of health and medical working

environment. Different studies showed that empowerment and perceptions of

organizational commitment are two vital factors which are connected to job

satisfaction (Kuokkaken, 2003 cited from Hall, 2006, 103). Once during my night

duty I receive a Inferior all Myocardial Infarction patient to my ward. While I was

doing my routine work such as taking observation and preparing medication for

the gentleman. Suddenly the patient developed arrhythmia – ventricular

tachycardia so immediately I called the doctor but he is too late. And I tried to

print the electrocardiogram graph of the fatal arrhythmia unfortunately the

machine in not in good condition and can’t print for documentation purpose. But I

am sure that it is ventricular tachycardia. Because I already under gone coronary

care nursing and have advanced cardiac live support certificate moreover

working in intensive care unit for nearly ten years. While waiting for him with my

experience and knowledge I perform defibrillation with 200 joules and the graph

reverted to sinus bradycardia and I gave intravenous medication atropine. The

patient survived and the graph shows sinus tachycardia, and other observation

parameters shows normal range. I really satisfied with my reflection- in- action .

But the sad side of the story is, the doctor scolded me because I

crossed the professional boundaries and did the procedure against the code of

nursing. The only reason was I failed to print the graph and I can be charged if

anything bad or the patients’ condition deterioting or die. But I still argue with him

and said I really sure with the arrhythmia and you are late and I can’t lose the

young gentlemen. And I assume that if he is my family member I will try my best

to save him. The doctor felt guilty but he scolded there is no prove. I feel very

bad and discourage and couldn’t accept the way they treat me as a senior staff

nurse and scolded me in front of other clique who are very junior staffs, of course

they won’t respect me. And promised to myself that I won’t repeat it again but

still my feeling confront with him. The embarrassment made me depressed and I

couldn’t carry out my daily duty at that night and the following week as a mother

and a wife at home. I lost my appetite and good sleep for few week. Finally I

went to see a doctor and diagnosed as stress. Organizational commitment is

considered as the main aspect considered as in retention and job satisfaction

because it pertains on individual’s attachment, trust and involvement in the

organization (Kuokkanen et al., 2003 cited from Hall, 2006, 103).

It is important to consider that different environments have different

stressors and sources of stress may even different from individual to individual in

the same unit. For instance, the study of French et al. (2006) showed that lack or

shortage of resources help to increase levels of stress in ICU (cited from Hall,

2006). In addition, French et al. (2000) added that stress is connected on the

individual and influence perceived from situations and conditions on one’s

physical and psychological well-being, as a result, according to Tonges (1998)

workplace stress is commonly connected with workload (cited from Hall, 2006).

Stress happens based on workload when the demand exceeds the ability of an

individual to access resource or capacity.

As a result, according to French et al. (2000), it is important for hospitals

and health care organizations to develop supportive management, increasing

opportunities for positive patient interactions, and creation of a wide-spread

sense of autonomy as well as empowerment can help in order to lessen or

distribute stress (cited from Hall, 2006).

In addition,I also affected with the shortage, in my work place. As a result, the

government gets the service of foreign doctors in other countries in order to

ensure that there is sufficient number of doctors to handle the number of

patients. However, based on my observations and experiences (primarily based

on the doctors whom I worked with), they are not as professional as our local

doctors. In addition, they are also not that trained and used to speaking and

understanding our language, as a result, we, the nurses serve as translator and

interpreter in order to make the doctor and the patient to understand each other.

Recently in my ward I face a very bad situation which was contribute to very

stressful working environment. These doctors never examined the patient

properly and just accept the cases from ward. The problem I face was most of

the patient will die within hours. The sad part was immediately after I we done the

last office he will called l and order to prepare another bed for a new patient.

Even though I advice him to examine the patient use the ICU protocol to accept

the case but he never bother to listen. I also no power to reject it. Just imagine

how stress we are in this situation. Thus, this add additional burden for the nurse

and some of the doctors are not really skillful,so that t we have to assist them in

doing different procedures.

In addition, we also serve as trainer, mentor superior to the junior staffs

after most of our senior staffs move due to promotion. As a result, currently, we

are working with junior staffs with less knowledge, skills and experiences in

different procedures, tasks and responsibilities in the ICU. The performance of

our junior is on our shoulder, meaning if the junior staff did something wrong, the

management will overlook to the senior, and there are possibilities that we will be

fired.

I also have responsibilities and roles that I must do for my family – my

children and my husband. These stressors I found at work affect my relationship,

including the time that I spent with them.

1 Reflection Model

Reflective practice is considered as a learning process which encourages

self-evaluation with succeeding professional development planning. According to

(Driscoll and The, 2001) Reflection is useful strategy in nursing field because it

help to differentiate between thinking regarding daily work versus reflecting

regarding on experience, which requires intentionality and skills. Thus, reflective

practice claims the capability of an individual to evaluate situations and make

judgments pertaining to the efficiency of situational interventions and quality of

outcomes (Zuzelo, 2009).

Thus, reflective practice helps practitioners to make sense regarding the

different challenging, complicated and complex, which eventually remind

practitioners that learning is continuous, and there is a need for improving

traditional types of knowledge that are required in nursing practice, at the same

time, sustain nursing by different formal opportunities to converse with peers

regarding the practice. There are different models of reflection, which can be

used. These include: Gibbs’ model of reflection, John’s model of reflection, Kolb’s

Learning Cycle and Atkins (1995) and Murphy’s model of reflection (Zuzelo,

2009).

For this paper, John’s model of reflection will be used, for the author

believes that it is the most applicable and suitable model for the case and

scenarios being studied. Reflectivity activity is considered as an opportunity to

purposely and intentionally think regarding the practice events; analyze choices,

reactions, responses and behaviors; consider possible alternatives; develop

plans in order to improve or recognize learning needs; and to follow this action

plan in new or the same events or problems (Zuzelo, 2009).

According to John (2004) reflective practice is a holistic practice mainly

because it pertained on comprehending the vitality, importance and meaning of

the entire experience. There are different layers of reflection which progress from

a reflection on experience towards mindful practice, which are in juxtaposition

with moving from doing reflection to reflection as a way of being.

With all these, reflective practice is defined as:

Being mindful of self, either within or after experience, as if [there is] a

window through which the practitioner can view and focus self within the context

of a particular experience, in order to confront, understand and move toward

resolving contradiction between one’s vision and actual practice (Johns, 2004, 3

cited from Zuzelo, 2009)

The table below shows the cues offered by the said model in order to help

practitioners to access, make sense of and learn via experience (Ahot, n.d.).

John (1992) applied the concept of guided reflection in order to define a

structured, supported approach which will enable practitioners to learn from their

reflections on their experiences. It uses a model of structured reflective diary,

one-to-one or group supervision and keeping of a structured reflective diary. The

main advantage of this model is that it is more detailed compare with the other

models, which eventually offers advantages and disadvantages. According the

different nursing literature, nurses need to be taught on how to reflect, and the

detailed questions that the practitioners are required to ask of themselves in the

Johns model of reflection, will, no doubt, offer a comprehensive checklist for

reflection. However, the detailed structure can also offer disadvantage because it

will impose a framework that is considered as external towards the practitioner,

which will leave only little scope for inclusion of his or her own approach. In

addition, the said model is considered as complex, while the other models are

being criticized for being simple and self-evident (Davies, Finlay and Bullman,

2000). Here one of my reflection which happen in ICU that make me stress

Once during my night duty I receive a patient with Inferior all Myocardial

Infarction to my ward. While I was doing my routine work such as taking

observation and preparing medication for the gentleman who father of four

children. Suddenly the patient developed arrhythmia – ventricular tachycardia so

immediately I called the doctor but he is too late. This is a main problem in my

hospital because one doctor have to cover few wards during night time. And I

tried to print the electrocardiogram graph of the lethal arrhythmia unfortunately

the machine in not in good condition and can’t print it for documentation

purpose. But I am sure that it is ventricular tachycardia. I have to act fast within 3

minutes (Cumin, 1996) if not patient will hypoxia and vegetative. Because I

already under gone coronary care nursing and have advanced cardiac live

support certificate moreover working in intensive care unit for nearly ten years.

While waiting for him with my experience and knowledge I perform defibrillation

with 200 joules and the graph reverted to sinus bradycardia and I gave

intravenous medication atropine I mg..

The patient survived and the graph shows sinus tachycardia, and other

observation parameters shows normal range. I really satisfied with my reflection-

in- action But the sad side of the story is, the doctor scolded me because I

crossed the professional boundaries and did the procedure against the code of

nursing. The only reason was I failed to print the graph and I can be charged if

anything bad or the patients’ condition deterioting or die. But I still argue with him

and said I really sure with the arrhythmia and you are late and I can’t lose the

young gentlemen. And I assume that if he is my family member I will try my best

to save him. The doctor felt guilty but he scolded there is no prove. I feel very

bad and discourage and couldn’t accept the way they treat me as a senior staff

nurse and scolded me in front of other clique who are very junior staffs, of course

they won’t respect me. And promised to myself that I won’t repeat it again but

still my feeling confront with him. The embarrassment made me depressed and I

couldn’t carry out my daily duty at that night and the following week as a mother

and a wife at home. I lost my appetite and good sleep for few week. Finally I

went to see a doctor and diagnosed as stress

Reflection on the above incident using parts of the ‘structured reflection’

model by Johns (1992) and Carper (1978)

Aesthetics – As a art of nursing actually I’m trying to save my patient who

is having lethal arrhythmia. If I act late and still waiting for doctor I will lost the

patient. As long as I concern in this situation my action was consider according to

the ventricular tachycardia algorithm which was approved by American Heart of

Association. But then I really shocked when my doctor came and scolded me and

make me upset. After the doctor’s explanation then only I realize that even

though I had made a very best of work, on the other hand I made some inter

related job offence. In this case vertical substitution which is cross the

boundaries has taken place. I suppose to print the graph for documentation

purpose and avoid medico-legal action. This will bring some trouble to the doctor

if something happen vice versa as a result. This contradict situation make me

realize that in reality this incident thought me to be more careful prevention

measure. My knowing in an aesthetic point of view here involves the deep

appreciation of the the patients situation and calls forth inner creative resources

that transform my experience into something that would not otherwise be

possible.

Personal – In this unprecedented incident if I try to act of safe side

of professional ethic. I m sure will lost the gentleman who is father of four.

Morally my sense of sympathy and empathy was disturbed. Imagine that if the

patient is my own family member sure I will try to do the best to save him

because the doctor came late. I ‘m fully confident and have enough knowledge

to over come the crucial situation. Personal knowing here concerns the inner

experience which I have gone through . The full awareness of the self, the

moment, and the context of interaction with my patient makes me to react

meaningfully l to share my experience positively.

Ethics - Having a code of ethics helps guide nurses through tricky

situations and serves as a common reference point for everyone on the health

care team. But the primary goal of nursing ethics is to protect patients. So in

order to save my patient’s life I was tended to cross the professional

boundaries and act towards achieving the primary goal of nursing ethics. If

anything goes wrong or the patient died I can be charged under written code of

nursing ethics. Ethical knowing here involves my decision to make moment-to-

moment judgments about what ought to be done, what is good, what is right, and

what is responsible.

Empirics - In this particular nursing practice I’m came to know that my

patient is in serious condition from my experience. From my close observation

not only to the patient but from the electrocardiogram( ECG) through cardiac

monitor. I now it is a lethal arrhythmia through my experience bed side teaching

by specialist and I have gone through special course for ECG in one of the

cardiac center in my country. It really helps me to tackle this critical situation.

Empiric knowing is based on the assumption that what is known is accessible

through the physical senses, particularly seeing, touching, and hearing, and as a

pattern of knowing draws on traditional quantitative approaches to knowledge

acquisition. The Empiric knowing is expressed as scientific competence.

From the reflection on action above I learned that in this critical setting

ward I cannot fully avoid from facing stress all the way. But still there is a room to

reduce the stress by self stress management .Anyway I m very glad and

satisfied internally after I was able to recognize where the problem lies on.

2.3 Stress and Workload in ICU

Stress is considered as the most popular factors which affect performance

and productivity of nurses in the entire hospital environmental particularly in the

ICU department. It can greatly influence how the medical staffs perform, which

affect their productivity, which is directly connected to the health and condition of

the patients. On the other hand, workload is considered as one of the primary

factors which drive stress for the nurses in ICU.

Workload is considered as an important issue in my work place which

focuses on the amount of work that is placed upon the responsibility of the

nurses. When work is largely a physical activity, then the major consideration is

to ensure that the physical demands of work are not greater than the capacity

and capability of the individual in those given circumstances. On the other hand,

those works which focus on mental aspect or those involved attention or

decision-making are in need to prevent overload and under load (Di Martino and

Nigel Corlett, 1998).

ICU practices are full of high workload situations (Oates and Oates, 1996).

For me because I have to continuously entertain the demands and needs of the

patients and their family. At the same time, I also have to face with intense

emotions, such as death. This issue is important because different studies have

showed that workload is one of the important factors which affect the quality of

service and care and ICUs as well as the safety and health of the patients. The

study of Australian Incident Monitoring Study for ICUs showed that the major

causes of workload are the inappropriate staffing compare to patient load

(Beckmann et al. 1998). This result to incidents related to problems of drug

administration, documentation, not enough supervision to patients, incorrect

ventilator and other equipment and gadget setup as well as self-extubation. In

addition, the study also showed that some of the problems related to insufficient

staffs are physiological change, dissatisfaction of the patients and their

respective families and physical injury. In addition, the study of Tarnow-Mordi et

al. (2000) analyzed and evaluated the connection between mortability rates and

the workload of hospital staffs in adult ICU in the United Kingdom. The result

showed that those patients who are exposed to high ICU workload are more

expose to death than those who are in low workload. This is due to the lack or

not enough time for clinical procedures to be done in correct manner, inadequate

training or supervision, errors, overcrowding as well as the consequent

nosocomial infections, limited resources as well as premature discharge from the

ICU.

In my setting whenever patient admitted to ICU or death we really facing a big

problem in doing paper documentation. I really hate this job which restrict my

nursing care. I also have to write the report regarding the patient to matron and

the director of the hospital every day. Imagine that how much workload I have to

bear beside my routine job.

The study of Malacrida et al. (1991) using Nursing Stress Scale

(NSS) questionnaire and self-observation showed that for nurses, the most

important stressors are dealing with death of patients and high workload. This

include staffing, paper work and scheduling problems and risks, not having

enough time in order to complete the medical tasks, at the same time, support

the patients about their health. High workload may also result to poor nurse-

patient and doctor-patient communication (Llenore and Ogle, 1999) as well as

poor relationship between the nurse and physician or doctor (Baggs et al., 1999)

– which is very important in order to ensure safety and health of the patients in

ICU .There are number of problems and factors that I am facing in the ICU which

make me stress. This includes factors related to the management, leadership,

skills, roles and responsibilities and staffing.

4.1 Description of the Experience

I am experiencing high level of stress in my current work due to different

factors which involved my work itself, my position in the hospital, me as a mother

and a wife and me as a human. These similar and conflicting positions and roles

added fuel to the fire in my current stress.

Mismanagement

Based on my observation and my own experience, mismanagement is

one of the most important contributing factors to my stress and even my co-

workers at work. As have showed in the literature review, mismanagement of the

people, which include the schedule and other benefits are crucial stressors for

nurses and other medical professionals. In our case, our superiors are

manipulating their man power in inappropriate manner. They are opening wards

without first asking for the permission of higher authority, which caused us to

work double duty. In addition, we do not have annual leave, and we really need

to go for leave, we have to do night duty. We already tried to voice out our

concerns but the management threatened us that they will transfer us to another

place. Thus, it shows lack of professional management.

I would to reflect the incident that affects me due to this matter. I and my family

arranged a vacant .My husband already booked a hotel and my children were in

a very happy mood. Unfortunately my ward sister called me at home and ordered

me come to home because of epidemic of dengue fever outbreak. The whole

family was upset and out of mood. I tried to please her by explaining my

situation. But she uses her autocratic power to force me to work. Even though an

internal conflict aggravates between us, finally I agreed to follow her instruction.

The worst part was I have to do double duty

Conflict with Co-workers and Superiors

The ward sister is also very biases and would only listen and entertain

those staffs who are close to her. As a result, staff like me is always a victim

because of my race. Furthermore, she uses her power in order for her to work

double duty, which further aggravates the conflict between us and the co-

workers.

Division of Labor/Rules and Responsibilities

Aside from out daily activities and responsibilities, there are also times

when we do the responsibility and dirty work of the doctors. IN addition, we are

also crossing vertical and horizontal substitution like physiotherapy job. This

again aggravates the conflict between the doctors and the nurses.

Dealing with the Patients and Their Families

The patients and their families are other factors which add up to our

stresses. As have tackled in the literature review, the behavior of the patients and

their families, together with their conditions, their reactions, emotions, feelings

and even their gestures greatly influence the nurses’ and doctors’ feelings and

emotions. Commonly these factors bring us emotional and psychological

stresses, which also affect our physical wellbeing.

First, we have to face the rage of the families of those patients who were

dying. They sometimes blame us, and accuse us that we are not doing our job

properly. This is because of high expectations that they are giving us. More often

than not, the families considered the medical professionals as superior and all

mighty and we can do everything in order to save their dying family members. In

addition, the sufferings of the patient itself while they are at the ICU also affect us

emotionally and physically.

In addition, there are also some times when some VIPs are admitted to

the ICU. Their relatives, most often than not, do not follow the rules and

regulations of the ward. As a result, we cannot do our job properly because

people are watching us. The worst part is that they are commonly complaining

through paper that the nurses are rude and we did not do our job properly. Again,

this affects our performance in the hospital.

In addition, we, the nurses in ICU have to travel in ambulance and bring

the ventilated patient for scanning and transferring. This add up to our stress and

physical burden, because the journey is really motion sick and we always tend to

worry and take care of the safety of the patient. If things go wrong, we have to

write explanation report to the management.

4.2 Reflection

Under these experiences, I always ensure that all of these stressors will

be taken for granted in order to ensure that all of the responsibilities, to the

management, with my superiors and co-workers and to my patients and their

respective families will be met. With this, I always ensure that these stressors will

not affect my performance.

There were times were I already asked for the opinion of my co-workers,

superiors and even the management regarding the current condition of the ICU

ward, however, as have mentioned, the management has less supports to their

nurses, and they commonly threat us with actions that we can experienced upon

insisting our concerns.

However, it is important to take note that no matter how hard we try, in

spite of our effort to maintain high level of performance and services towards the

patients, due to the different stressors that are always their inside and outside the

ward, it affects our performance in direct and indirect manner.

In my case, it affects my physical, social, emotional and psychological

health. Because of the stressors, there are times, which I am not feeling well, due

to the different burdens and confusions. This further affects my responsibility and

my relationship with my family, because, most often than not, I don’t have that

much time to communicate and connect with them. For my children and my

husband, there were times that I can no longer do my responsibility for them,

including daily activities, which will show how much I care for them. There are

even times, that when I go home, I will automatically sleep because of overwork

and fatigue, which leaves my also tired husband caring for our children and

taking care of some important business in our home. On the other hand, as have

already explained, these stressors affect our relationship with our co-workers,

because of unequal or unfair treatment, at the same time, due to overwork, there

are times that we are in bad mood, and because of pressure, we commonly end

up in arguments.

During this time, it is normal that I am feeling tired, angry at some times,

and sometimes concern – concern about my job stability and security, my

patient’s health and of course, my family.

For the patients, because, they are commonly in complicated state during

their stay in the ICU, they are somewhat unaware of what is going on inside the

ward. However, if ever I am in the condition of the patient, I will feel mostly

unease because, there are times that I can already feel the emotion, behavior

and feelings of the nurses and doctors due to the challenges involved in their job,

together with those stressors, at their works.

4.3 Influencing Factors

The internal factors that are affecting my decision inside the ICU ward are

my roles and responsibilities. This pertains on the promises and preamble that I

have made upon entering my profession. This pertains on ensuring the safety

and saving the lives of the people. With this, in spite of the stressors and

difficulties of my work, I always make sure that I am at my best because I am

handling lives of the people. My co-workers, superiors and the overall

management also affect my decision. The management itself implemented its

standards and rules and regulations which influence my personal opinions and

actions about different tasks and situations in the ward. The patients and their

family also affect my decision, for their feelings, conditions, emotions and

behaviors can influence me in either direct or indirect manner.

On the other hand, the external factors which influence my decision are

my family. Like any other people, I have my responsibility to be done inside our

home. I have to take good care of my husband and my children, ensure their

safety, at the same time, and make sure that they are healthy and experiencing

good life. In my current condition, they are being affected due to my schedule as

well as my health – physical, emotional and psychological. Sometimes, it is

inevitable to bring home the feelings or emotions that I am getting inside the ICU.

With this, I have to focus on my personal experience, the knowledge that I

have learnt inside the university, at the same time, those knowledge that I have

learnt via long experience – from the doctors, from my co-nurses as well as the

patient in deciding about different matters.

4.4 Could I have dealt with the situation better?

I strongly believe that I have dealt with the situation good, because in spite

of the stressor I have experienced, I, together with the other nurses enable to do

our job properly. However, upon analyzing, it would have been better if we

pressed our concerns more towards the management. If the management will not

listen in spite of that, there can be some other organizations or agencies that can

help us solve the problem.

I know this will cause some ruckus; however, I believe that this will serve

for the betterment of the entire institution.

4.5 Learning

This experience enables to show me the different factors that affect the

performance of those nurses and medical professionals inside the ICU ward.

Thus, it poses several challenges for those individuals who are working in the

said setting, because they have to juggle different important factors – they have

to focus on their responsibilities and roles as a medical professional – ensure the

safety of their patients and to support their families and relatives, at the same

time focus on the different stressors that are related to the management, co-

workers, superiors as well as those factors that are related to the personal life.

Upon writing this reflection, I still strongly believe that there are changes

that must be done inside the ICU in order to ensure that all of the medical

professionals working their will maintain healthy physical, mental and emotional

health, which are important because it directly and indirectly influence the quality

of services that they are tending or offering towards the patients and their

families. It is important to take note that just like other people – nurses and

doctors are ordinary human being who also has their personal lives, which can

affect their performance, and which their professional or career development will

be affected. In my case, the fact that there are no annual leave available affect

my relationship with my husband and my children, for I cannot spend more time

with them, to bond, coordinate and communicate with them. In addition, because

of the stressors that I am experiencing due to mismanagement, chaos and

ruckus with the doctors, superiors and other co-workers, it influence my overall

mood, which I can bring to our home, therefore, can affect my approach towards

my husband and my children.

The setting of the ICU, itself is very stressing – seeing those people dying,

seeing the agony of their patient before their last breath, seeing the blood, flesh

and everything. At the same time, we always see the torment, hurt and pain of

their families – sometimes blaming us for their loss of their relative or love ones.

All of these negative emotions we always encountered, every day!

With this, it is important for an individual to have a sense of balance, which

can be achieved with proper support from the management – by improving the

policies, rules and regulations and ensuring that all of the staffs – from the upper

management up to the lower one about their individual rules and regulations and

their accountabilities. With this, it can help in order to lessen the burden of every

one – and ensure that everyone are working and doing their job properly,

therefore it can help to create a more cooperative and sound working

environment.

4.6 SWOT Analysis

Strengths

My strength mainly focuses on the ability to cope with the different

stressors in my working environment. Based on my credential and past

experiences, I can also say that I am much knowledgeable and skilled, which

makes me reliable and efficient at the work. In addition, I can also handle the

pressure of my work and personal life. I can also work well with different people –

with my doctors and co-nurses.

Weaknesses

I must admit that I am weak, when it comes to those aspects that are

related to emotion – I am human after all. In spite of my past experiences with

the dying patients and the reactions of their families, I can be easily affected by

their feelings and emotions, which leave me weak and stressed. Sometimes, I

can bring this feeling at home.

Opportunities

The opportunities will focus on the aspect of proper management –

division of labor, increase in staffs and the use of new technologies, which will

help us to manage our job in more efficient and faster manner. It is important to

focus on employing already-trained new staffs, in order to lessen our burden or

job. In addition, it is also important to ensure that all of the doctors to be hired are

all properly trained in terms of language and culture of the country and the

hospital setting.

Threats

The treat will remain on the aspect of decreasing number of medical

professionals in the country. In addition, the emotional and physical burden of the

nurses in the ICU-environment is another factor. With this, it is important to

ensure that there are some programs or activities to be done in order to support

the feelings, emotions and behaviors of their nurses and doctors. It is important

to ensure that they are properly rested in order to ensure good performance from

them.

5.0 Integration of Literature Review

5.1 The ICU Environment

Based on the assessment and reflection done, it had been found out that

ICU is indeed, considered as one of the busiest, if not that busiest department of

the entire hospital. It is considered as one of the most stressful department for

the employees – nurses and doctors have to handle difficult situations and cases

of the patients, considered as those emergency situations or cases.

In addition, according to the study of Angus and Kelly (2000), ICU consists

a vital percent of the entire health care system of America, which is more or less

6000 ICU in 2000 alone. In addition, according to Halpern (1994), there are more

or less 55,000 patients that are being delivered and cared for in these units. In

addition, there are different social and economic factors which influence the

growing number of patients entering the unit. First is the decrease or the

declining number of acute care hospital beds for the last 2 decades, which

increase the number of patients in ICU for more than 250%, which accounts for

more or less 10% of the entire hospital beds (Lustbader and Fein, 2000). In

addition, it is also expected to increase due to the increase in the age of the

entire population (Groeger and Strosberg , 1992). This is for the case of

American alone.

In other countries, they are experiencing shortage of nurses and doctors,

particularly in developing countries, because of most of their nurses and doctors

are going to other countries in order to acquire higher salary. On the other hand,

there are other developed countries, wherein people are not that interested in

entering the said profession. As a result, the number of people who are willing

and capable in entering the healthcare is declining, therefore, it can add up to the

problems related to stress and overload inside the ICU environment.

There are different factors inside the ICU which affect the mentality,

physical activities, feelings and emotions of the staffs – the doctors, specially the

nurses. This include those factors that are related to their working environment,

co-workers, subordinates, superiors, management, their patients and their

respective families, the facilities, etc. These factors have a vital influence on the

overall feeling, ambiance and condition of the ICU, which can greatly influence

the performance of the medical staffs, particularly the nurses, who are doing

variety of jobs. With all these work-related factors, together with the personal

factors which the nurses and doctors experienced and encountered outside the

hospital, inside their homes – with their spouses, children, families and friends,

stress is considered as inevitable.

This is important, for there are different studies which show that patient

safety and medical errors, together with the different adverse impact from those

errors are commonly found inside the ICU (Donchin and Gopher, 1995). Medical

errors are important issue in any hospital or medical institution, for it can greatly

influence the overall image of that hospital, at the same time, it has a vital

influence over the individual performance and position of medical professionals.

5.2 Workload in ICU

Based on the review and reflection, it had showed that nurses play

different roles inside the ICU. They are considered as the busiest medical

professionals inside the ICU environment, for they cater for different needs and

focus on helping other medical professionals, such as the doctors, at the same

time support the patients and their families.

According to the study of Oates and Oates (1996), ICU is filled with high

workload situations. This is because nurses have to continuously respondent to

the needs of the patients and their families, at the same time routinely connect

with the most intense emotional aspect of life. As a result, workload is considered

as one of the most, if not the most, vital determinants of safety of the patients

and the quality of services and care in ICUs (Carayon and Gurses, 2005).

In my experience as a nurse in my working environment, one of the most

common sources or reasons of over workload is the shortage of staffs. First,

some of the head nurses have been promoted in other position, as a result, we

have to focus on training and mentoring the newly hired and inexperienced

nurses, which again will add up to our burden. In addition, because the new

nurses are inexperienced and not that knowledgeable, we have to continuously

guide them, because we will be blamed for their mistakes. Therefore, we have to

cater most of the critical and difficult tasks inside the ICU. In connection, the

study of the Australian Incident Monitoring Study, showed that the shortage of

nursing staff in ICU can lead to compromised quality of care (Beckmann and

Baldwin, 1998). The two main reasons of shortage of nursing staffs are:

inappropriate staffing for current patient load and the inability of the management

to respondent in the increasing unit activity (Carayon and Gurses, 2005). These

two factors can be found in our working environment, for the management is

somewhat blind and not that open for change, in spite of the fact that they are

continuously opening new beds for the said unit.

The issue of understaff of the ICU is very important for it can cause to

different medical errors and problems, such as drug administration or

documentation problems, inadequate or insufficient patient supervision, incorrect

ventilator or equipment setup as well as self-extubation (Carayon and Gurses,

2005). Furthermore, undesirable patient outcomes connected with the

inadequate nursing staff include major physiological change, patient or relative

dissatisfaction as well as physical injury. This is because nurses will have to

handle to do different tasks of different types in short period of time.

Furthermore, the study of Tarnow-Mordi and Hau (2000) focus on the

connection of mortality rates and the workload of hospital staff in one adult ICU in

the UK. The measures of workload for a given patient’s stay include the

occupancy per shift, peak occupancy, ICU nursing requirement per shift, ICU

nursing requirement during the first shift of the patient, the ratio of the occupied

to appropriately staffed beds per shift, and the ICU nursing requirement per

occupied bed per shift. The result of the study showed that those patients who

are exposed to high ICU workload were more likely to die than those who are

exposed to low workload. The three measures of workload most strongly

connected with mortality were peak occupancy, average nursing requirement per

occupied bed per shift, and the ratio of occupied to appropriately staffed beds.

Some of the explanations for the connections between high workload and

mortality include: inadequate time for clinical procedures to be done in

appropriate manner, inadequate training or supervision, errors, overcrowding and

consequently nosocomial infections, limited availability of equipment and

premature discharge from the ICU. Some of these factors can be observed in my

current working environment. The best example is the inadequate training or

supervision given to the new nurses. This is because, we have to train them, and

at the same time do our tasks. In addition, we are also experiencing some

overcrowding, particularly when VIP patients will come, they are not following

orders regarding the visits and other important factors. As a result, we are having

difficulties in doing our jobs, particularly when there are number of people who

are watching us and asking questions while doing our jobs.

5.3 Relationship between Workload and Stress in ICU

Different studies, including Crickmore (1987), Malacrida and Bomio (1991)

and Oates and Oates (1996) showed the relationship between stress and

workload. According to their studies, workload is considered as one of the most

vital job stressors among the nurses of ICU. The practice of medicine alone is

already considered as stressful. For instance, the study of Malacrida and Bomio

(1991) studies the quality and frequencies of stressors in an ICU environment

with the use of two different data collection methods, which include Nursing

Stress Scale (NSS) questionnaire and a computer-aided self-observation method

development and improved by the authors for this study. The result of the

computer-aided self-observation method, 17 ICU nurses were asked to record

their experiences on a computer placed in the ICU, immediately after having

stressful experiences and events. These same 16 ICU nurses and other 31

nurses working at the same hospital were asked to fill out the questionnaire. The

result of both data gathering methods showed that the most vital and important

stressors for nurses, where those related to death and high workload. As a result,

staffing and scheduling problems, not having enough time in order to complete

nursing tasks and not having vital and enough time in order to offer emotional

support to patients were all connected to workload or considered as workload-

related issues or problems. Again, all of these factors can be observed and

experienced in my current working environment. The staffing and scheduling

problems due to the inconsistency and inability of the management to connect

with the nurses regarding the different changes as well as the different actions to

be implemented in the hospital, greatly influence the grievances and the roles of

the nurses inside the hospital. Having the enough or sufficient time catering the

demands and needs of the patients, together with doing the jobs inside the ICU

environment is another factor. This is because of the fact that we are

experiencing shortage of the medical professionals, particularly those related to

the experienced nurses in the environment. Even though, there are new nurses

inside the ICU environment, experience is always an important factor. This is

particularly because of the fact that ICU is different from other units of the

hospital or the medical institutions. This is because there are different emotional,

psychological and physical factors that can be faced or encountered by the

nurses, which are unavailable or cannot be encountered in other units of the

hospital, particularly those related to the deaths of the patients and grievances,

agony and pain of their families.

In addition, it is important to consider that nurses also have their lives

outside the ICU and outside the hospital. This pertains on their responsibilities

and roles inside their homes and their families, their friends, their clubs and

organizations, their religions and their society they are included in. In my case, I

have my own family, my husband and my children, to whom I have a

responsibility to be done. I have to be there in order to support my husband and

my children. Help my husband to fix his wardrobe for his work, to prepare my

family’s breakfast and dinner, at the same time, to go out with them even once a

month for bonding moment or time. However, the time that I am spending inside

the ICU and in the hospital, together with pile of tasks that I have to do inside the

ICU, most often than not I have no more energy to be spent in order to

communicate and help my husband and support my children about their work or

their studies. This commonly cause problems with my husband, because there

are times that I am bringing some of the emotional burden from ICU, particularly

related to those patients whom I have already created a certain connection.

These emotional and physical stresses affect my relationship with my family at

certain level.

Furthermore, the study of Bratt and Broome (2000) and Darvas and

Hawkins (2002), shows that in terms of working conditions and stress, there are

different evidences which shows the connections between nursing working

conditions and the job satisfactions. Behavioral consequences of job

dissatisfaction in nursing, which include low morale, absenteeism, turnover as

well as poor job performance, can potentially threaten and affect the care quality

of the patient as well as the overall effectiveness of the organization (Cavanagh,

1992). There are different nursing studies which analyzed and assessed the

results or outcomes of job satisfaction. Study of McCloskey and McCain (1987)

showed a positive connection between job satisfaction and job performance,

while the study of Tarnowski-Goodell and Van Ess Coeling (1994) showed a

positive connection between job satisfaction and patient satisfaction and quality

of care.

In addition, the study of Keijsers and Schaufeli (1995) and Aiken and

Clarke (2002) showed that high workloads is connected to sub-optimal patient

care, which can influence the decision of the care providers and nurses towards

the different medical procedures (Griffith and Wilson, 1999), which will

consequently lead to the reduced satisfaction of the patients (Anderson and

Maloney, 1998).

In addition, high workload is also expected to lead to poor nurse-patient

communication (Llenore and Ogle, 1999), impaired nurse-physician collaboration

(Braggs and Schmitt, 1999), nurse burnout and dissatisfaction to the job (Aiken

and Clarke, 2002). All of these factors can directly and indirectly influence the

individual performance of the nurses, including the quality of care that they are

tendering towards their patients, then will affect the overall image of the hospital

or medical organization or institution that they are in.

As a result, it is important to focus on the workload in order to lessen the

stress of the nurses inside the ICU. This can be done by focus on the

improvement of the working conditions, together with the improvement of the

communication, collaboration and connection between the nurse and the

physician or the doctors. This can help in order for the nurses to know their roles

and responsibilities, which will help them in order to know what are the tasks that

they must perform towards their co-workers, their subordinates, the physicians or

doctors, towards their patients and their patients’ families (Evans and Carlson,

1992).

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Appendix 1

John’s Model of Reflection (1994)

1. Description of the experience

· Phenomenon – describe the here and now experience

· Casual – what essential factors contributed to this experience?

· Context - what are the significant background factors to this

experience?

· Clarifying – what are the key processes for reflection in this

experience?

2. Reflection

· What was I trying to achieve?

· Why did I intervene as I did?

· What were the consequences of my actions for:

Myself?

The patient / family?

The people I work with?

· How did I feel about this experience when it was happening?

· How did the patient feel about it?

· How do I know how the patient felt about it?

3. Influencing factors

· What internal factors influenced my decision – making?

· What external factors influenced my decision – making?

· What sources of knowledge did / should have influenced my

decision – making?

4. Could I have dealt with the situation better?

· What other choices did I have?

· What would be the consequences of these choices?

5. Learning

· How do I now feel about this experience?

· How have I made sense of this experience in light of past

experiences and future practice?

· How has this experience changed my ways of knowing

Empirics – scientific

Ethics – moral knowledge

Personal – self awareness

Aesthetics – the art of what we do, our own experiences

Source:

(http://www.communityhealthcarebolton.co.uk/SHA/LLL/resources/reflectiv

e/JOHNS.doc)

1.4Review of Literature

Intensive Care Unit (ICU) is considered as an area of a hospital which

offer aggressive and insistent therapy, with the use of state-of-the-art and

high-end technology, together with invasive and non-invasive monitoring for

critically ill and high-risk patients. In these units, the physiological variables

and factors of the patients are reported to the practitioner on continuous and

unbroken manner, in order to offer and provide titrated care (Varon and

Acosta, 2010). With this, it shows that the main objective or purpose of ICU is

simple, but the practice and standards being implemented inside is complex.

Healthcare professionals who are working in the ICU rotate their shift in order

to offer around-the-clock intensive monitoring and treatment of patients all

throughout the week. Patients are commonly and normally admitted to an ICU

if they are expected to take advantage and be benefited from the high level of

care to be offered. Thus, it benefits those patients who are strictly and

severely ill and unstable in terms of medical and physical condition – with life-

threatening disease or illness (ENotes.com, n.d.).

According to Garland (2005) ICUs are considered as vital but troubled

component or aspect of the health-care systems (p. 2153). It is considered as the

area within the hospital which constitutes extensive and large risk of morbidity

and mortality (Berenholtz et al., 2002). In the United States alone, ICU

constitutes a vital portion of the entire health care system. According to the study

of Angus and Kelly (2000) the number of ICUs in the US is more or less 6,000.

Thus, it is considered as important aspect of the entire health care system.

Different researches and studies about ICU patient and medical staffs problems

shows that unpleasant events frequently happening in Intensive Care Unit (ICU)

(Abramson and Wald, 1980). The study of Bracco and Favre (2000) which was

conducted as a prospective observational study of consecutive patients admited

over 1 year to an 11-bed multidisciplinary ICU in a non-university teaching

hospital to know critical incidents and associated risk factors. The study included

1024 patients in 2801 days treatment in the ICU. A total of 777 incidents were

detected during the 1 year study period: 31% were human-related, 2% were

equipment-related and 67% were patient related, the study concluded that

human-related errors prolonged ICU stay by 425 patient days over 1-year period

(Carayon and Gürses, 2004). The observational study of Giraud and Dhainaut

(1993) examined the iatrogeniche connections relationship showed that

workloads of nurses are considered as one of the most important factors which

causes stress in the ICU environment. Thus, one of the major challenges for

ICUs is improving the quality and safety of nursing care. The study of Kopp et al.

(2006) shows that there was one error for every five medication doses

administered in a medical surgical ICU, therefore, it shows that medication

administration stage is very susceptible for different errors. In connection, nurses

play a vital role in the care being offered in ICUs (Rogers et al., 2008). This is

because they are responsible in the different procedures and processes related

with the medical care towards the patient. Therefore, nurses can influence the

process of healing or the other way around of the patients.