“The Brief Wondrous Life Of Oscar Wao” By Junot Diaz Sample College Essay

The central character of Junot Diaz’s novel, The Brief and Wondrous Life of Oscar Wao, does not seem like a traditional hero, and his foolish choices can cause the reader to gasp or shake their head over how ill-advised they are. However, Diaz has subtly endowed Oscar’s tale with some story elements shared with quests of heroes of myth and legend. This technique lends Oscar’s journey – from geeky isolation to enduring beatings and death for love – greater stature. Other characters also follow their journeys, taking risks for those they love along the way, but can be seen as heroes in their own right, not necessarily more or less heroic (or foolish) than Oscar himself.

Young Wao’s outright unattractiveness and anti-social habits make him an unlikely protagonist of Diaz’s vivid portrayal of Dominicans living between the USA and the DR. However, in other ways this novel differs from the conventional. The most obvious unconventional feature is Diaz’s “code-switching”. The author constantly switches between English and Spanish, sometimes between one word and the next. (Casielles-Suárez 475) He also adopts several points of view and uses multiple flashbacks and flash-forwards. Perhaps, therefore, Diaz’s non-traditional hero is not so out of place.

However, Diaz’s contemporary narrative also reflects the most ancient forms of story-telling. Joseph Campbell has characterized the world’s great stories, the myths, legends, epics, and tales of adventure, as sharing common themes and elements across languages, cultures, traditions, and eras. He calls these themes the ‘Hero’s Journey’, a journey which includes certain instantly recognizable steps and characters. (Borrowing From Fiction To Turn Law Students Into Storytellers Camden Professor Employs Heroic Characters, From Harry Potter To Stephen Colbert, As Mock Clients)

In the case of Oscar Wao, like heroes of myth, he seemed different from others from early on in his life. Diaz describes him as a complete science fiction nerd, totally out of step with his contemporaries’ interests. (Diaz 22) While not stronger physically than other kids, like the young Theseus was, he is certainly more literate than most of his contemporaries. He also responds to a call to adventure, as do classic Heroes, much like the characters in the books and fantasy games he loves so much. In Oscar’s case, his adventure is his romance with Ybón, which he describes as “the start of his real-life”. (Diaz 279)

Additionally, like other heroes, he gets help from a supernatural guide that arises from “a world of magic and mystery”. This is the Golden Mongoose, which appears when Oscar is near death. (Diaz 190). He also experiences various types of personal transformation on the way to the end of his quest, including becoming nearly paralyzed with depression, trying to change his image, attempting suicide, being beaten so badly that he probably could not eat, and finally losing all the excess weight as a result of having his face and teeth bashed in. (Diaz 312)

These elements of traditional myth and legend connect Diaz’s dorky hero to long-ago figures in the earliest narratives, like Gilgamesh, Moses, Theseus, Odysseus, or even more recently, to Hamlet, Harry Potter, or Luke Skywalker. These connections lend Diaz’s awkward and unimpressive main character a kinship with these long-ago larger than life heroes, no matter how foolish his choices may seem to others.

Other elements connect to the Hero’s journey. These include the presence of a curse pursuing the hero. In classical stories, a curse from an offended deity or a fatal flaw of character sometimes prevents the hero from ever being able to succeed. Diaz tells his readers that the Dominican people suffer from “Fukú americanus”. This is the doom that Diaz describes as hanging over Oscar’s people since Christopher Columbus arrived on this continent. (Diaz 1) Another element that connects to traditional myths is that he encounters various colorful characters that help or hinder him in achieving what he set out to do. For example, Diaz calls the girls who hang out at his house his “furies”, a reference to Greek mythological beings who pursued an unlucky hero till death. (Diaz 313)

Still another subtle element that ties this very modern story to ancient tales of heroes is Oscar’s family’s connections. The narrator tells readers that “In those long-ago days…the Cabrales was numbered among the High of the Land” and were connected to the evil ruler Trujillo. (Diaz 211) This mirrors the noble birth of many traditional Heroes. Such features connect this complex and very contemporary tale to the oldest traditions of story-telling.

Meanwhile, Oscar Wao’s colleagues, rivals, persecutors, and supporters are simultaneously pursuing their heroic journeys. Their goals, or quests, reflect the specific challenges of their community. For example, both Abelard and La Inca’s heroic actions respond to the pattern of sexual exploitation and violence in the Dominican community both in the USA and in the DR, referenced constantly by Diaz. (Francis 61) Abelard, Oscar’s grandfather, for example, attempts to protect his daughters from rape and worse by taking an “enormous risk” and doing what Diaz calls a “Brave Thing”.

Abelard ends up dead, supposedly for a joke, but more likely because he objects to Trujillo’s evil. His sacrifice tragically fails, and his daughters all end up blasted by this evil, even long after his death. (Diaz 217) This could seem foolish and hopeless, but it also shows tremendous, and heroic bravery.

La Inca, Oscar’s aunt/cousin, named after an ancient, noble ruler, rescues his mother, Belicia from oppressive and abusive foster parents who objected to Beli’s scholarly ambitions. La Inca must stand up against skepticism and criticism to rescue her young relative and try to rehabilitate her. (Diaz 257) This, too, takes bravery. She rescues her once again after Belicia is beaten by her lover’s goons. This act doubtless places La Inca, herself, at risk from “the Trujillato”. (Diaz 119). It also exposes her to the disapproval of those “who had previously bagged on the girl and called her whore”. (Diaz 144). La Inca takes care of Oscar as well despite le Capitan’s power to kill and maim. (Diaz 301) These are foolish risks, especially since neither Oscar nor Beli is her child, but her actions are nonetheless heroic.

These characters, like Oscar, brave torture and death, and thus could be described as foolish in their decision-making. However, these choices do resemble the decisions of many mythic heroes. After all, if Heroes avoided foolishness, they would never stick their necks out and never leave their rooms. However, they would also not be Heroes! Whether Oscar or his family members and friends make foolish or heroic decisions may not be as important as the fact that they do not run away from what they see as their responsibilities and their ultimate fates.

Oscar Wao is certainly not classically strong, fit, physically brave, handsome, or charming in conversation. However, in many ways, his life circumstances and the events in which he participates reflect the quests and deeds of the heroes of mythology, both ancient and modern. He finds meaning and purpose for his life in doing the dangerous thing because it gives him joy. (Wood) This means that even Oscar’s foolish choices can seem heroic to the reader, as do those of La Inca and Abelard.

Works Cited

Casielles-Suárez, Eugenia. “”Radical Code-switching in The Brief Wondrous Life of Oscar Wao.Bulletin of Hispanic Studies. 2011: 475. Web.

Diaz, Junot. The Brief Wondrous Life of Oscar Wao. New York City: Penguin Publishing Group, 2007. Print.

Francis, Donette A. “Uncovered stories: politicizing sexual histories in third wave Caribbean women’s writings.Black Renaissance/Renaissance Noire 2004: 61. Web.

Miller, Jen A. “Borrowing From Fiction To Turn Law Students Into Storytellers: Camden Professor Employs Heroic Characters, From Harry Potter To Stephen Colbert, As Mock Clients.States News Service (2011): n.p. Web.

Wood, Stephanie. “Finding meaning.” Success Magazine (2014): 50. Web.

Clinical Problem: Suicide Prevention In Geriatric Patients

The clinical problem that will be considered in the proposed research consists of the challenge of suicide prevention in older patients, especially those suffering from terminal illnesses. In general, suicidal thoughts in older people can be viewed as a significant health concern; for example, in the US, over 6,000 older people commit suicide per year, and illnesses are proved to be a major predictor of such events (Conwell, 2014). Therefore, the prevention of suicide in the population is a major concern and aim of modern healthcare, and the proposed study intends to test an intervention that can assist in resolving the issue.

The proposed study is going to be community-based, which defines its settings as those of my community; the population includes the older patients with the early stages of terminal illnesses who live in the community. People are typically viewed as older adults after the age of 65 (Conwell, 2014), and this criterion can be used to determine potential participants. It is noteworthy that the population is a vulnerable one (Coburn, Marcantonio, Lazansky, Keller, & Davis, 2012), and careful consideration of the ethical implications of the study is required.

As a result, the following PICOT question is going to be explored: in gerontologic patients (P), what is the effect of a community-based intervention (I) on the occurrence of suicides (O) compared with conventional interventions (C) within the early stages of terminal illnesses (T)?

The proposed intervention is a comprehensive community-based program that should incorporate multiple non-pharmacological activities, including exercises, games, and discussions; also, it will involve counseling. A preliminary investigation shows that there is some evidence to the mentioned interventions being helpful for the resolution of the problem and the improvement of the quality of life of the population (Coburn et al., 2012; Moyle, Parker, & Bramble, 2014; Sun, 2016). Therefore, their use in the proposed study is justified.

The suggested type of research is the experimental one because the exposure of the participants to the treatment can be randomized and controlled, which enables the use of a randomized controlled trial (RCT) in the project (Burns, Grove, & Gray, 2015). The lack of exposure to the intervention does not presuppose the lack of treatment (the patients from the control group will be treated as usual), and the presence of exposure should not carry risks (due to the program being evidence-based). Therefore, no major ethical issues rule out an RCT.

PICOT

PICOT: In gerontologic patients (P), what is the effect of a community-based intervention (I) on the occurrence of suicides (O) compared with conventional interventions (C) within the early stages of terminal illnesses (T)?

The mentioned PICOT question implies that the proposed study is to test the intervention with the help of a control group, which indicates that it can be carried out as a quasi-experiment or an experiment. According to Burns et al. (2015), both approaches can help to determine the effects that treatments can have. The former type of research is easier to conduct, but the latter one is more controlled and produces more reliable results, which makes it particularly attractive. Burns et al. (2015) state that an experiment requires the randomization and control of the exposure to treatment, which is achievable in the proposed study. Thus, it is suggested to carry out a randomized controlled trial with rigorous control of the process to employ a more powerful and accurate research method.

A theoretical framework that can be proposed for the project is the Johns Hopkins Nursing Evidence-Based Practice model (The Johns Hopkins University, The Johns Hopkins Hospital, & Johns Hopkins Health System, n.d.). It contains a simple but detailed and comprehensive set of guidelines and tools that facilitate the process of the translation of evidence-based approaches into practice, which is necessary for my project because it requires the implementation of an evidence-based intervention. Thus, the three-step framework is appropriate for the proposed research, and the permission to use its tools for the project can be solicited from the Johns Hopkins University.

References

Burns, N., Grove, S., & Gray, J. (2015). Understanding nursing research (6th ed.). Amsterdam, Netherlands: Elsevier. Web.

Coburn, K. D., Marcantonio, S., Lazansky, R., Keller, M., & Davis, N. (2012). Effect of a community-based nursing intervention on mortality in chronically ill older adults: A randomized controlled trial. PLoS Medicine, 9(7), 2-17.

Conwell, Y. (2014). Suicide later in life. American Journal of Preventive Medicine, 47(3), S244-S250.

Moyle, W., Parker, D., & Bramble, M. (2014). Care of older adults: A strengths-based approach. Port Melbourne, Australia: Cambridge University Press. Web.

Sun, H. J. (2016). Suicide prevention efforts for the elderly in Korea. Perspectives in Public Health, 136(5), 269-270. Web.

The Johns Hopkins University, The Johns Hopkins Hospital, & Johns Hopkins Health System. (n.d.). Johns Hopkins Nursing Evidence-Based Practice model.

Falls Prevention Among Hospice Patients

Falls are defined as a situation when a person is inadvertently lying on the ground, floor, or any other place. Injuries related to falls could be fatal but most of these injuries are nonlethal in spite of the fact that they bring plenty of sufferings to the patient. This paper investigates falls among hospice patients in Miami, Florida and suggests some prevention solutions that are crucial for the current situation. According to the official statistics, “nearly 40percent of older adults fall at least once a year” (Yamashita, Noe, & Bailer, 2012).

Moreover, every fourth fall results in the injury. Five percent of falls end in fractures and the same percent in serious tissue injuries. Falls occupy a sixth place among the causes of death of older people in hospice (Avin et al., 2015). Among people aged 85 years, over 20 percent of deaths occur due to falls.

The consequences of falls such as a fracture of the femoral neck and the fear of falling could lead to loss of the ability of the self-service. Falls cannot be regarded as accidental and inevitable events. They should try to prevent it. The current measures that include engaging hospice patients in strengthening exercises and minimizing the use of dizziness-inducing medications offer no concrete solution to falling cases. Additionally, the weak status of the hospices makes the strengthening processes stressful thereby necessitating the introduction of more suitable strategies (Gray, 2007). Hospice patient’s safety system begins with the fact that high quality and realistic reporting explains the necessity of changes that should be done in order to reduce the incidence of falls.

Problem Identification and Significance

The majority of hospice patients are elderly people: “eighty-five percent of all hospice patients admitted were age 65 or older” (Report of Hospice Demographic and Outcome Measures, 2014, p. 18). Therefore, it seems appropriate to identify this group of patients. A person could maintain balance and move only in the case of the combined interaction of cognitive and sensory organs, the neuromuscular system, and the cardiovascular system.

They provide the ability to respond quickly to the changing environment. With age, this ability to maintain balance is weakening. The incidence of falls among the elderly living in hospices is much higher than among people living at home. It should be noted that the majority of falls end with minor injuries, bruises, minor bleeding, or mild pain.

However, there are cases of falling that might result in hip fracture, severe brain injury, and other severe consequences for elderly people over 65 years. Therefore, there is a need for mitigating the risks that lead to falls among hospice patients in Miami, Florida owing to the nature of their conditions. The plan for reducing the fall cases would embrace an evidence-based practice that would bolster the safety of patients in the hospice atmospheres. In this concern, the strategy would add value in the area due to the limited research in the fields of hospice especially regarding fall cases.

Risk Factors

It is also very important to point out the fact that risk factors of falling should be evaluated individually for each patient taking concrete measures suitable for the patient’s requirements to prevent falling. Moreover, it is significant to improve the management of patients taking into account all possible risks and developing personal recommendations for the prevention of falls. When it comes to terminally ill patients, the hospice should be the most protected and prepared place for the danger of that kind. In other words, the hospice staff should protect their patients, especially the elderly from falling.

First of all, among risk factors, there is the age of hospice patients. Age is one of the major risk factors of falls in the hospice as the majority of patients are elderly people. The risk of falls and incidences connected with it is increasing with age. For instance, in the United States, 20-30 percent of the elderly fall survivors suffer from moderate or severe injuries such as bruises, fractures of the femoral neck, or head trauma (Markey, 2007).

This risk might be partially connected with bodily, cognitive, and sensory changes occurring along with the aging process. The next risk factor is sex. In all age groups, both sexes are exposed to the risk of falling. In some cases, men are more likely to die from falls while women suffer more from non-fatal falls. As a matter of fact, women fall more often than men do, and they have a much higher likelihood of fractures as a result of falls. Other factors include the following aspects:

  • concomitant medical conditions such as neurological, cardiac, or other restrictive state functions;
  • adverse reactions to drugs, physical inactivity, and loss of balance, especially among the elderly;
  • low level of mobility, cognitive, and vision abilities;
  • unsafe environmental conditions, particularly for people with vestibular apparatus disorders and poor vision.

In addition, another high-risk group is children. Falls in childhood occur mainly because of the behavior of children, their inherent curiosity in relation to the world around them, and increasing levels of independence that accompanies intricate behavior often referred to as “risky”.

Proposed Resolution

Strategies for the prevention of falls should be widespread and diversified. They should emphasize the importance of various prevention strategies by means of assessing several types of falls risks that might appear in the hospice. What is more, they should eliminate potential hazards and raise awareness of individuals and communities of existing risk factors.

Efficient programs to prevent falls are directed at reducing the number of falls, and the rigorousness of trauma in the case of falls. With regard to the elderly, the falling prevention program might include a number of components to identify and mitigate risks such as the following:

  • clinical interventions to identify risk factors such as checking and changing health regulations, treatment of low blood pressure, the additional appointment of vitamin D and calcium, and treatment of correctable visual impairment;
  • appointment of appropriate assistive devices in the presence of physical and sensory impairments;
  • muscle strengthening and restoration of vestibular function on the requirements of health professionals;
  • group exercises at the level of individual communities, which may include the area of fall prevention training and exercises such as tai chi or training in the field of conservation and development of the dynamic equilibrium;
  • the use of special protective devices for hip among people at risk of hip fracture as a result of falls (Yamashita, Noe, & Bailer, 2012).

In the framework of falls prevention and patients care, a staff training program could be initiated. In most cases, patients who could fall were considered elderly adult patients, but this is not always true. Sometimes, there are cases of children or young people falls. Therefore, it seems important and appropriate to develop a training program to assist patients of any age with incurable diseases. Besides fostering patient’s safety and reducing the cost of providing hospice services, the study would also improve the quality of life (QOL) among the patients (Schonwetter, Kim, Kirby, Martin, & Henderson, 2010).

In all likelihood, effective fall prevention measures should be carried out in the close connection with other activities as an integral component of general programs aimed at palliative measures among hospice patients. However, the effective integration is possible only in the case when the outset is taken into account with the impact of specific measures to prevent injuries on the overall performance health of the elderly (Schonwetter, Kim, Henderson, & Martin, 2009).

Fall prevention strategy should be developed in parallel with more common strategies. It is necessary to clearly define the functions of numerous health professionals and institutions providing care for hospice patients. Successful implementation of individualized fall prevention programs is impossible without the participation of geriatricians and physical therapists who specialize in the corresponding area (Vieira et al., 2012).

Moreover, exercise is an important part of comprehensive fall prevention programs (Dyer, 2007). However, engaging professional exercise instructors is one of the conditions of the successful implementation of programs and the achievement of the long-term prophylactic effect. As a consequence, specialized training of personnel working with hospice patients is the key to safe and good practice and patients’ well-being.

Consequences of Falls among Hospice Patients

It is also worth turning one’s attention to the dissemination of information regarding the effects of falls among hospice patients. Fractures that occur because of falls are the result of the interaction of internal and external factors. It goes without saying that the majority of falls of the elderly hospice patients is not associated with loss of consciousness and is not the result of emergency external influence. In its turn, aging becomes the decisive component.

If at a younger age, people often fall in the anterior-posterior direction, the older groups most typically fall to one side. In the context of the age-related decline of the soft tissue, mass in buttocks and thighs with a dropkick to the direction of trochanter explain a significant acceleration of hip fractures of people over 75 years. If vertebral fractures could occur spontaneously and are “true osteoporotic”, then a combination of falling and reduction of bone strength cause the peripheral skeletal fractures (for example, proximal femur, humerus, and distal forearm).

This combination of mechanisms requires a comprehensive diagnostic and therapeutic approach taking into account both bone strength and the risk of falling (Sperling, Neal, Hales, Adams, & Frey, 2005). Besides, the consequences of falls for some individuals are cumulated. The basis for the successful prevention of fractures should be a strategy stratification of elderly people in terms of risk of falling.

Conclusion

In conclusion, it should be stressed that fall prevention among hospice patients in Miami, Florida is very important, as it would lead to better living conditions. In spite of the fact that exercising and review of medication do not resolve the situation, it is significant to develop falls prevention measures by means of special staff training or creating an individual plan.

References

Avin, K. G., Hanke, T. A., Kirk-Sanchez, N., Mcdonough, C. M., Shubert, T. E., Hardage, J., & Hartley, G. (2015). Management of Falls in Community-Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Physical Therapy, 95(6), 815-834. Web.

Dyer, O. (2007). Simple precautionary measures can reduce numbers of falls in hospital. BMJ, 334(7591), 447-447. Web.

Gray, J. (2007). Protecting hospice patients: A new look at falls prevention. American Journal of Hospice and Palliative Medicine, 24(3), 242-247. Web.

Markey, C. (2007). Unacceptable Risks. Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 25(3), 224. Web.

Report of Hospice Demographic and Outcome Measures. (2014). Web.

Schonwetter, R., Kim, S., Henderson,, I., & Martin, B. (2009). Prospective Study of Falls Among Hospice Patients Using Logistic Regression Modeling Technique (415-C). Journal of Pain and Symptom Management, 37(3), 503-504. Web.

Schonwetter, R. S., Kim, S., Kirby, J., Martin, B., & Henderson, I. (2010). Etiology of falls among cognitively intact hospice patients. Journal of Palliative Medicine, 13(11), 1353-1363. Web.

Sperling, S., Neal, K., Hales, K., Adams, D., & Frey, D. (2005). A Quality Improvement Project to Reduce Falls and Improve Medication Management. Home Health Care Services Quarterly, 24(1-2), 13-28. Web.

Vieira, E. R., Berean, C., Paches, D., Caveny, P., Yuen, D., Ballash, L., & Freund-Heritage, R. (2012). Reducing falls among geriatric rehabilitation patients: A controlled clinical trial. Clinical Rehabilitation, 27(4), 325-335. Web.

Yamashita, T., Noe, D. A., & Bailer, A. J. (2012). Risk Factors of Falls in Community-Dwelling Older Adults: Logistic Regression Tree Analysis. The Gerontologist, 52(6), 822-832. Web.

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