Reflection Report On Experience In A Hospital

Reflection Report On Experience In A Hospital During the final term of my Diagnostic Radiography degree, I attended clinical placement for a total of 11 weeks to gain experience and practice my imaging techniques in various imaging departments. The placement module provided me with a learning experience in a hospital environment and helped to broaden my clinical skills in a variety of clinical environments. I was formally assessed by a member of the clinical staff on 2 different imaging procedures, a mobile chest x-ray and a CT head scan, as part of the degree evaluation process. I kept a reflective diary from the first day of my placement to help me record my feelings and thoughts on the examinations I was asked to perform, the varying patients I examined, the outcomes of these examinations and any problems or achievements I felt important in my time there. The most significant reflection, however, was in respect to my clinical staged assessments. I will be using this diary as a means to help me reflect on my experiences on thi s placement and on how I have developed both professionally and personally. What is reflection and why does reflection help me in my learning? Reflection is a process of gradual self-awareness, critical appraisal of the social world and how it transforms your thinking. Johns and Freshwater (2005) state that reflection is an active process that will enable me and other health care professionals to gain a deeper understanding of any experience with patients. One definition that is appropriate for student radiographers is Reflection in the context of learning is a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations (Boud et al, 1985). The use of a reflective journal during my final placement helped me with my reflective development as it would have been difficult for me to remember all the numerous thoughts and feelings I experienced over an 11 week period. Kennison (2002) sees the reflective clinical journal as a method in which a learner may write about clinical learning experiences and reflect on them. He considers this as a beneficial tool of reflection which not only improves the learners writing skills but also essentially helps to reflect on their practice, explore reactions, discover relationships and connect new meanings to past experiences. On the other hand Newell (1992) states that any reflective practice is reliant on memory and interpretation of events selective memory is a particular problem especially following a negative event. I can relate to this as I did find that a balance was required when recalling certain events, I was inclined to remember more negative situations than positive ones, these negative feelings and thoughts of particular events stayed with me longer and had a bigger impact on me. If I am to approach this account of my clinical placement reflectively I must choose an appropriate model for reflection. Johns (2002) found that there are several models have been developed to guide the process of reflection. The first model I will use to aid my analysis and to explore my feelings is the Gibbs (1988) reflective cycle. This model has 6 stopping points which are Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan. I feel this cycle allows analysis to make sense of the experience, it takes into account a sequence of feelings and emotions which play a part in a particular event and leads you to a conclusion where you can reflect upon the experience and what steps you would take if the situation happened again. This model can also be used through different levels of reflection from novice to advanced. The second model I am employing is Boud et al (1985). This model helps reflect before, during and after an action and will be ideal to explore my feeli ngs and experiences through the whole of my placement. Boud et al (1985) identify reflection as a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations. This reflective model is therefore appropriate for radiographers and other health professionals to adopt in critical reflection exercises. Boud et al, (1985) Schon, (1995) state that the development of the abilities to be reflective and critically reflective in practice can be perfected through active, repeated, guided practice. Model of reflection (Boud et al 1985 from Johns 1995) Stage 1: Return to experience Describe the experience, recollect what happened Notice what happened/ how you felt/ what you did Stage 2: Attend to feelings Acknowledge negative feelings but dont let them form a barrier Work with positive outcomes Stage 3: Re-evaluate the experience Connect ideas and feelings of the experience to those you had on reflection Consider options and choices Stage 4: Learning How do I feel about this experience? Could I have dealt with it better? What have I learnt from this experience? Starting at the beginning of the Gibbs (1988) cycle and Boud et al (1985) framework, I am asked to describe the two different clinical staged assessments that I completed and my recollection of thoughts and feelings before, during and after the process. My timetable actually dictated that I would perform my mobile chest x-ray assessment first. This was due to me spending the majority of my first few weeks on placement in the General Department where I would be performing this type of procedure regularly on ward patients. I thought it best to be assessed during the third week after I had performed the examination many times and would be feeling confident. At the start of the second week of my placement I felt confident that I would be ready for this assessment in week 3 and was looking forward to my 2 timetabled days in the Accident and Emergency (AE) Department prior to working in the General Department again. On the first morning in AE the radiographer in charge asked if I had any staged assessments to be evaluated on, I advised her that I had a mobile chest x-ray to do but I was happy to do this in the General Department the next week once I had gained more practice. Unexpectedly, the radiographer suggested that she would assess m e that morning and that I should carry out the examination on the next patient that required a chest x-ray in resuscitation. My first instinct was to put this off and decline, as in my mind I had planned to be assessed on a ward patient the following week. I also felt panicked as I did not have much practice using the mobile x-ray machine in the resuscitation area at this point and the surprise of the request took away some of my confidence. This was a test of my mental strength and as a future health care worker I would have to get used to making quick decisions and rising to challenges on a daily basis. My response was to agree, which surprised myself, I accepted that I was going to be assessed that day. I did not have my assessment sheet and criteria to hand but I managed to find another student who had the information and photocopied it. The morning passed very quickly and I was worried every time a request card was passed through to the viewing area from the AE staff as I thought it would my turn to carry out my assessment. When the request eventually arrived it was to image a 64 year old male that ha d breathing problems and a history of Chronic Obstructive Pulmonary Disorder (COPD), he was sitting upright on a trolley in the resuscitation area of Accident Emergency. A chest x-ray was required and so I checked the request card and the patients history on the hospital information system (HIS) system to check for any previous history and corresponding images, I washed my hands, collected a cassette and proceeded to take the mobile unit into the required area. The radiographer accompanied me and asked the patient for his consent and his co-operation to have a student perform the x-ray, the patient agreed. She then observed the whole procedure to evaluate my performance. The chest x-ray procedure was carried out routinely as an erect, antero-posterior view, the patient was very co-operative and aware of the situation around him which made it easier for him to understand and carry out the breathing instructions I was giving him. The resulting image showed prominence of hilar vasculature and was an acceptable diagnostic image. I received an excellent assessment mark from the radiographer and although I was relieved that it was over I still felt pleased with myself that I had carried out the mobile x-ray to a high level. I am thankful however that I kept my reflective diary on this occasion as everything happened so quickly and not to the plan that I anticipated that I benefit from reading my emotional conflicts that I experienced at a later date. This feeling is reinforced by Schà ¶n (1987) who argued that reflection is not a simple process and that practitioners need coaching and require the use of reflective diaries as tools for dealing with practic e problems. The second assessment on the other hand was not as stressful as the above experience and I feel I coped with the anticipation of this assessment better. I was timetabled for a week in the CT Department and so I knew that I would definitely be assessed then on a CT head scan. After discussion with the radiographer in charge it was agreed that we would wait until the Friday to be assessed to ensure that I had plenty practice in carrying out CT head examinations. On the day of the assessment I decided to be assessed on the first patient to attend for a CT head examination. I did not feel as nervous as the first assessment as the arrangements had been made at the start of the week and I knew when I was being assessed. I was also confident in my ability to use the CT scanner and my positioning skills. The first patient to arrive for a CT head scan was a 69 year old female who presented with a history of persistent headaches and dizziness. On checking her identification I found that the la dy was hard of hearing and I had to make sure to explain the procedure slowly, clearly and slightly louder than usual. I instantly became concerned that the patient would not hear the instructions given immediately prior to the examination, e.g. that she should remain very still and not move her head which is very important in achieving a clear and diagnostic head scan. This was a scenario that again I had not predicted. Radiographers, medical students, and nurses alike are constantly faced with unique and ambiguous problems in the clinical setting, where they are required to stop, think, and problem solve in the middle of activities or procedures they are carrying out and is a challenging part of the job. I proceeded to explain to the patient prior to positioning her in the CT scanner what the examination would entail as she would be lying in a supine position with her head resting on a head support which would further obscure her hearing. She acknowledged my instructions and I felt happy to continue with the examination. The patient was positioned head first into the scanner no intravenous contrast was necessary and the patient raised on the table so the lasers were at the level of the orbitomeatal line. I then carried out the appropriate CT head protocol on the computer system, the scout was carried out to make sure the patient was in the correct position and the x-ray beam was set at an angle along the base of the skull to prevent unnecessary radiation of the patients orbits, the slice thickness was selected between 5mm and 10 mm and the CT examination was started. Everything went smoothly and the patient was not found to have any significant pathology showing on the scan. The radi ographer in charge was pleased with my technique and anatomy knowledge and gave me a good mark for my assessment. Boud et al (1985) suggest that In reflective practice, it is necessary to gain an appropriate balance between the analysis of knowledge and thoughts, and the analysis of feelings. It is also important to focus on positive feelings as well as trying to deal with negative feelings, in order for the process to be constructive. Bulman Schutz. As I follow Gibbs (1988) cycle to explore my emotions and feelings I am aware that this step in Boud et als (1985) framework becomes appropriate. He advises to acknowledge negative feelings but also to not let them develop a barrier. I did experience negative feelings, more so in the first staged assessment. This has been an emotion that has surfaced from the start of my training and continued until this point, although the fear factor has reduced significantly. I sometimes do let my nerves get the better of me but as I have come through this degree my worrying has lessened and my confidence has grown. Wondrack (2001) acknowledges that fear and fee lings of guilt often accompany emotions which spring from a lack of confidence in how to resolve situations. On reflecting in past modules I have highlighted my nervousness and so I do not find it a barrier but a test of my determination now. With regards to my first staged assessment I was nervous and anxious as I was put on the spot and not as fully prepared mentally as I would have liked. I think I coped as well as I did due to the fact that I have been learning how to adapt to changing circumstances since my first year placement. I know that I can deal with what is thrown at me now and ask questions if I am in any doubt of my actions. My general clinical placements have all required for me to think on my feet, in the case of the patient who was hard of hearing, the main problem was communication. Schà ¶n (1993, 1987 cited Moon 2001, p. 3) focuses on reflection in professional knowledge and its development. He identified two types of reflection which are reflection in action and reflection on action.   Schà ¶n proposes that these types of reflections are used in unique situations, where the practitioner is unable to apply theories or techniques previously learnt through formal education (Moon 2001).   It would therefore seem that reflection in action and reflection on action are highly beneficial to the healthcare environment as practitioners are working with individuals who are more often than not, text book examples.   Reflection is a fundamental part of my radiography practice and future career, as all patients are unique this means that every time I image a patient I may have to approach it differently as I will need to consider the individual needs of the patient.   The outcomes of both my staged assessments were very good and a positive result did come after my initial negative feelings. Following both the reflective frameworks, I began to analyse what made me feel the way I did. As I considered the pros and cons as suggested by Gibbs (1988) I found that it was reasonable to feel the way I did and that it is all part of being a student. Every other student that I had spoken to felt nervous when both completing the staged assessments and facing new situations with patients. It was to be expected in the lead up to potentially becoming a radiographer. The cons were that I showed my weakness to the radiographer and maybe came across as less confident as I should have, the pros were that I used these feelings to push myself forward and it made me want to do my best to prove that I was capable of producing good diagnostic images. Reflection is more than just thinking about something, it should be an active process, which should result in learning, changing behaviours, perspectives or practices (Boud et al, 1985). By reflecting I have certainly changed my perspectives and behaviours on clinical placement. I am a more positive student and person due to the challenging situations and people that I have encountered. Where I previously became flustered I now take a deep breath and think through the situation and take my time. I have the knowledge to back up my skills and vice versa now so it is my application of these tools that can move me forward. Gibbs (1988) cycle concludes by asking what could I have done differently, both staged assessments were not extreme cases and I was lucky to examine co-operative patients. I would not have done anything differently in the practical aspect. Experience will help me to become more confident in my own skills and capabilities and will help me in adapting to change quickly. This is where I prefer Boud et als (1985) framework as it encourages you to reflect on how you feel about the experience and what you have learned. Gibbs (1988) is slightly more negative and asks what would you change and do differently. I was unable to turn my nerves and emotions off and on but I could learn to control them and make them work for me. From following both Boud et al (1985) and Gibbs (1988) models of reflection I have analysed the situation in detail in a logical order. These experiences have been immensely helpful in evaluating my emotional reactions and professional limitations in the clinical setting. Therefore, my diary has been an essential tool in my development. According to Maggs Biley (2000) evaluating practice through reflection can bring advantages. The challenge is to recognize and use these advantages, together with the knowledge they generate.

A Study to Determine the Prevalence of Pressure Ulcers in Spinal Cord Injury Patients and Underlying Factors (in a Governme :: Nursing Research Project

I have done a research project in fulfillment of the Bachelors of Science in nursing at Rufaida College of nursing, Hamdard University, New Delhi, India. The project was, ‘A study to determine the prevalence of pressure ulcer in spinal cord injury patients and its possible underlying factors in a selected Government hospital of New Delhi in India'. The objectives of the study were, to determine the prevalence of pressure ulcer in spinal cord injury patients and find out the possible underlying factors for the development of pressure sore in spinal cord injury patients. The conceptual framework offered for the study based on the epidemiological concept of interaction between the agent, host and environment. The research approach adopted for the study was descriptive survey method. The tools for the data collection were an observation checklist, an interview schedule and a questionnaire. The observation checklist, used to determine the prevalence of pressure ulcer in spinal injury patients. The investigators used the interview schedule for the spinal cord injury patients, and the questionnaire for nursing staff to find out the possible underlying factors. Five experts from health care profession validated the tool. Purposive sampling technique adopted to select the sample. The sample consists of 54 spinal cord injury patients and 20 nursing staff from the spinal cord injury unit of Safdarjung Hospital, New Delhi, India. The information collected over a period of two weeks. The data analyzed to find out the prevalence of pressure ulcer, their distribution by affected bony prominence and the stages of pressure sore by computing frequency and percentage. The data collected from spinal cord injury patients analyzed under host, agent and environmental factors by computing mean percentages. The significant findings of the study were as follows:- 1. There was a high prevalence (66.67%), of pressure ulcer in spinal cord injury patients. 2. The most affected bony prominence was sacrum (44.44%) and least affected area were ischial tuberosity, lateral malleolus, and toes (2.78%). 3. In most of the patients (47.22%), the pressure ulcers were in the 1st stage. 4. The key factors for the development for pressure ulcer in spinal cord injury patients were the lack of comfort devices (96%), and inadequate nurse- patient ratio (94%). 5. As reported by the nursing staff, the adequate nurse patient ratio (80%), was the dominant factor for the development for pressure ulcer in spinal cord injury patients.

The Bone People- Relationships Essay -- Essays Papers

The Bone People- Relationships Relationships surround us all though out lift. Everyone needs some type of relationship, whether it's a friendship, family, or lover. People can't last without them, no matter how different the relationships are. In the novel The Bone People, it's based on the relationships between the three main characters; Kerewin, Joe and Simon. The relationship between Kerewin and Joe was very odd. They have a type of relationship that they aren't even sure about, they like each other, but don't realize it. It's starts off with Joe asking Kerewin: "Are you afraid of kissing," and Kerewin answers "I don't like kissing." (pg: 265) It's both a strange question and answer. Then later on in the page, Joe keeps on the topic by saying: "I thought maybe someone had been bad to you in the past, and that was why you don't like people touching or holding you." "Ah damn it to hell," she bangs the lamp down on the desk and the flame jumps wildly. "I said no. I haven't been raped or jilted or abused in any fashion. There's nothing in my background to explain the way I am." She steadies her voice, taking the impatience out of it. "I'm the odd one out, the peculiarity in my family, because they're all normal and demonstrative physically." (pg: 265) Joe is Sharing with Kerewin his feelings about family, and childhood. "I've often thought that maybe what happens to you as a child determines everything about you. What you are and what you do, a...

Oppression in Jane Campion’s The Piano Essay -- Jane Campion The Piano

Oppression in Jane Campion’s â€Å"The Piano† Jane Campion’s â€Å"The Piano† relates the story of a Scottish woman who is sent to New Zealand, during the Victorian Era, for an arranged marriage with a farmer. Ada voluntarily gave up speaking at the age of 6 and communicates by either signing for her daughter, writing on a small paper tablet around her neck, or, more joyously, through playing her piano. After a long and arduous journey with the piano, Ada is forced to leave it on the beach where her boat landed. Left without her musical passion, Ada must learn to adapt in very male world. A native white man who has adopted the culture of the Maori Indians named Baines quickly discovers what the abandoned piano means to Ada. Baines secures the piano by trading 80 acres of land to the farmer and husband of Ada, Stewart. After getting the piano back to his home, he employs Ada to give him lessons, but really wants to have sex with her in exchange for the piano. Her passion for the music allows for this and an affair is born. The affair is discovered by Stewart and he goes irate eventually cutting off Ada’s forefinger in a backwards attempt to win her love. When he realizes the futility of winning her love, Stewart sends her off with Baines. On the boat to a new home and life, Ada insists of getting rid of the piano and almost commits suicide as the piano sinks to the bottom of the ocean. This movie is beautiful to watch, yet difficult. It is raw, yet the cinematography is breath...

Choruses †what is the importance of these speeches in Dr. Faustus?

Choruses – what is the importance of these speeches in Dr. Faustus? The essential function of the chorus speeches are as a commentary, an omnipotent voice which observes Faustus’s actions, clarifies his character and by foreseeing his change in fortunes, heightens the anticipation of the audience. Also, rather like dressing Mephastoples in a Friar costume, the chorus speeches are a practical device used by Marlowe to communicate aspects of the play which are simply impossible to perform on stage. Thus, they have particular significance from a 16th century perspective, as the theatre would not have had the elaborate lighting and stage sets to demonstrate a change in scenery as audiences are used to today. The chorus speeches are made at various times throughout the play, linking the dramatic scenes together. They are therefore crucial to the structure, as without them, the audience would not have the same sense of exactly how Faustus is using his powers as time passes or indeed, fully understand the progressing danger he is in. The opening chorus is essential is introducing the audience to Fausts’s character, the themes of the play and to a certain extent the morals Marlowe intended to convey. By speaking directly to the audience, the chorus brings them into the play, laying down the foundations of the essential plot. Saying this, the opening lines are not about Doctor Faustus itself but rather ironically about what the play is not going to entail. This however, has the effect of drawing in audience as the descriptions of the ‘alternative’ plays are presented as epic and intriguing in themselves: ‘Nor, in the pomp of proud audacious deeds’ The power of this line is emphasised by the alliterative... ...rue of the final, emphatic chorus, which in a way shows us that Faustus wasted his talents: ‘’Cut is the branch that might have grown full straight.’’ gives the impression that despite his ambitions, Faustus had unfulfilled his potential and could have used his skills to help others instead of for selfish reasons. Although for it’s time the essential themes of the play seem quite forward thinking yet chourus speeches were not an unheard of feature in 16th century England. They had been preciously used in Morality Plays so Marloew was arguably using a structure that had proved to be a success. However, by having a chorus directly speaking to the audience there is increased communication between the audience and the actors on stage and is simply a simple yet effective way to connect the scenes together and eliminate any confusion the audience may have. Choruses – what is the importance of these speeches in Dr. Faustus? Choruses – what is the importance of these speeches in Dr. Faustus? The essential function of the chorus speeches are as a commentary, an omnipotent voice which observes Faustus’s actions, clarifies his character and by foreseeing his change in fortunes, heightens the anticipation of the audience. Also, rather like dressing Mephastoples in a Friar costume, the chorus speeches are a practical device used by Marlowe to communicate aspects of the play which are simply impossible to perform on stage. Thus, they have particular significance from a 16th century perspective, as the theatre would not have had the elaborate lighting and stage sets to demonstrate a change in scenery as audiences are used to today. The chorus speeches are made at various times throughout the play, linking the dramatic scenes together. They are therefore crucial to the structure, as without them, the audience would not have the same sense of exactly how Faustus is using his powers as time passes or indeed, fully understand the progressing danger he is in. The opening chorus is essential is introducing the audience to Fausts’s character, the themes of the play and to a certain extent the morals Marlowe intended to convey. By speaking directly to the audience, the chorus brings them into the play, laying down the foundations of the essential plot. Saying this, the opening lines are not about Doctor Faustus itself but rather ironically about what the play is not going to entail. This however, has the effect of drawing in audience as the descriptions of the ‘alternative’ plays are presented as epic and intriguing in themselves: ‘Nor, in the pomp of proud audacious deeds’ The power of this line is emphasised by the alliterative... ...rue of the final, emphatic chorus, which in a way shows us that Faustus wasted his talents: ‘’Cut is the branch that might have grown full straight.’’ gives the impression that despite his ambitions, Faustus had unfulfilled his potential and could have used his skills to help others instead of for selfish reasons. Although for it’s time the essential themes of the play seem quite forward thinking yet chourus speeches were not an unheard of feature in 16th century England. They had been preciously used in Morality Plays so Marloew was arguably using a structure that had proved to be a success. However, by having a chorus directly speaking to the audience there is increased communication between the audience and the actors on stage and is simply a simple yet effective way to connect the scenes together and eliminate any confusion the audience may have.

Police Structure Essay

When it comes to law enforcement at the federal there are twenty one agencies that deal with issues of law enforcement. The FBI is one of these agencies, which was established in 1908. It is currently the main investigative agency of the Federal Government. The FBI is one of the agencies that is organized and run under the Department of Justice. The responsibility of the FBI is to investigate any crimes that happen across state lines as well as violation of federal criminal law. Some of the particular offenses that they investigate are civil rights violations, kidnapping, auto thefts and internal security issues. The FBI will also assist local law enforcement with their investigations as well. So when it comes to their role as it applies to the law. The law enforcement powers that the FBI as well as the other federal agencies have is to enforce any violations of current federal laws and mandates, but also have the power to enforce this over the entire United States. When it comes to state law enforcement most states have established their own state police agencies such as the Highway Patrol or State Trooper which is run under the rules of the state government. The primary purpose of establishing these state law enforcement agencies is to allow a policing agency to work throughout the entire state without the restrictions of city or county boundaries. The authority of these state police body’s are to make arrests, execute search warrants, conduct criminal investigations and enforce traffic laws on state and federal highways as well as investigate traffic accidents. Then there are the policing agencies that represent the greatest number of police officers. Throughout the United States these city police officers who work in large and medium size municipalities are the ones in charge of handling the investigation of such crimes as burglaries, robberies, assaults, and rapes as well as patrol all local streets and highways going through the cit y. The boundaries of these departments are restricted to enforcing the law within their own city limits. These local municipalities are usually run by a chief who is appointed by the city government. Outside the cities in the more rural areas there is a policing agency at the county level. These County police departments function much the same as municipal police, but are run by an elected sheriff instead of an appointed chief and the law enforcement officers who work for a sheriff’s department are typically called sheriff deputies. In the sheriff’s department the sheriff is typically elected to a two or four year term by the population of the county in which they serve. Since the sheriff is elected they usually have more degree of freedom that local city official have. When it comes to organizational theories for police officers and other agencies in law enforcement there are two different divisions the police who you see out on the streets patrolling neighborhoods and arresting criminals then there are those who work behind the scenes and whose job it is to hire and train new employees as well as making sure that communication between police and other entities is secure and not disrupted in emergency situations. They also make sure that all equipment is kept running and in good conditions so that it doesn’t fail the office when needed. These two divisions are who make up the large body of people in law enforcements. This chain of command is a very essential component in law enforcement administration, from the chief down to a patrol officer to those behind the scene the utilization of this organizational chart is what allows for clear delegation of authority in any chain of command structure. As stated in the book Police Administration: Structures, Processes, and Behavior. â€Å"The principal of hierarchical authority is a requirement that every lower level organization must be supervised by a higher level. This results not only in the use of multiple spans of control, but also in different grades of authority which increase at each successively higher level in an organization. This authority flows downward in the organization as a formal grant of power from the chief of police to those selected for leadership positions. These two different grades of authority produce the chain of command† (234, Swanson). With departments having these two very different divisions this type of management style in law enforcement is continually going to change and evolve and it will be up to the people that work in their departments to make the necessary changes by adjusting and personnel and department resources accordingly in order to continue with a working straight forward chain of command. Works Cited Swanson, Charles R, Leonard Territo, Robert W. Taylor. Police Administration: Structures, Processes, and Behavior. New Jersey: Prentice Hall, 2005

Comparison Essay Cuba & U.S. Essay

In different countries they have different economics structures. Some countries are very similiar to other economies while some are the exact opposite. For example a country could have a whealthy economy while another country could have a poor one , just like the U.S. compared to Cuba. The U.S. consitution is designed to protect the rights of the states by establishing a federal system of government. The U.S. federalist system some powers belong to the national governemnt, others share governments and still others are shared by both. The constitution wanted to protect state rights. They also wanted a national that had suffient powers to maintain order and keep the country united. The difference between the U.S. and Cuba is according to the constitution of Cuba, the country is a socialist state and a republic. Cuba is not a democratic republic, in which they people elect leaders to represent them. Cuba is actually a dictatorship controlled by Fidel Castro and communist party the highest leading force of the society and of the state the party leaded by Castro, has about 400,000 members. The top officials in Cuba is fidel Castro who continues as Cuba’s supreme patriarch and leader whos pressence helps to legitimize the regine and preserve its intual cohesion. It remains to be seen if this intual cohesion can be maintained in the event that Castro becomes incapatated or dies. Ricardo Alareor de Quesada is the president of parliament and Juan Almeida Bosque is the vice president of the council of state. In Cuba the government, the primary player in the economy, has undertaken limited reforms in recent years to stem excess liquidity, increase enterprise efficiency, and alleviate srious shortage of food, comsumer goods, and services but prioritizing of political control makes extensive reforms unlikely. Living standards foe the average Cuban, without access  dollars, remains at a depressed level compared with 1990. Income taxes and increased regulations introduced since 1996 have sharply reduced the number of legally self employeed from a high of 208,000 in January 1996. Much of Cuba’s recovery can be attributed to tourism revenues and foreign investment. Growth in 2001 should continue at the same level as the government balances the need for economic loosening against its concern for firm political control. Compared to the U.S. our economy is not stuggling as they are. From watching news recently Cuba’s from the U.S. send thier relavtives in Cuba american money because american money is worth more there. To conclude this essay Cuba is not a rich country and is struggling in there economy compared to the U.S. ,the U.S. has more organized goverment and equal economy.