Hospice in Rural Countries Research Paper Example | Topics and Well Written Essays - 1500 words

Hospice in Rural Countries - Research Paper Example Given the increasing statistical figures of families and patients who certainly will be facing the end-of-life crisis or issues, access to the hospice care has been a significant consideration. It has been found that the rural communities have been found to get the least access to the hospice care or a Medicare - certified hospice. In addition, the higher the number of physician found in the community shall likely to have easy access to the Medicare -certified hospice such as the urban or metropolitan. Moreover, the study shows that the number of physicians that can work in a Medicare-certified hospice can lower because of the need for the physician's certification of terminal illness. The findings show that the racial-ethnic diversity decreases from most rural places to least rural places or as the classification of the rural to urban communities progressed. The following is the table of the summary of the rural-urban, socioeconomic and physician rate variables. The computation of the median has been appropriate for this study to avoid enumeration of the numerous census data. The purpose of the calculation of the median is to approximate the middle value of every entry in the table such as the total number of the whites that resides in certain location. Table gives the reader an idea that on the average, the population of the whites living in a particular location is 84.4 or simply 84.4%. Table 1. Summary of the rate of available physician, socioeconomic, and rural-urbanclassification The above table provides the summary f the characteristics of the 3,140 counties. In 204, the census of the average county was 93,507 with the standard deviation of 304, 790. In terms of the median age of each county, on the average, was 37.3 years with the standard deviation of the 4.01. This means that the median age varies within the limits of + 4.01 and -4.01 values. The mean percentage of the population of the counties pertaining to those people who are above 65 years old was 14.76% and with the standard deviation of 4.17. On the other hand, the statistics pertaining to the people classified as under poverty line is 13.74% with the standard deviation of 5.59. The mean percentage of the minority groups such as the Hispanics and African Americans in counties were 8.76% and 6.18% respectively. The Hispanics mean percentage derives a standard deviation of 11.9 while the African Americans, 14.5% standard deviation value. Furthermore, according to the summary of characteristics of the particular counties, the physician rate reaches 12.61% with a standard deviation of 14.89. On the other hand, the mean quantity of the Medicare-certified hospice was 0.83 with standard deviation of 1.84. The significance of the values 18.99, 8.99, and 9.48 pertain to the rates of physician in the rural-urban classifications. This means that the metropolitan (most urban or least rural) has the most number of physicians qualified to work with the Medicare-certified hospice than the adjacent metro or rural areas (see figure 1). Figure 1. A comparison of MDs per 10,000 census, mean percentage of

Psychosocial Factor Depression Copd Health And Social Care Essay

Psychosocial Factor Depression Copd Health And Social Care Essay This supporting paper supports the presentation on the link between Chronic Obstructive Pulmonary Disease and the psychosocial factor depression. The supportive paper will explore, define and conclude areas of which may influence the health and well-being of patients with COPD and the psychosocial depression factor. The discussion of depression tools, guidelines, statistics and the long term use of oxygen therapy and care pathways will also be explored in this supporting paper (Cornforth, 2012 and NICE, 2009c). The supporting paper will explore COPD and depression as a separate condition and then link the impact of health and well-being. COPD is a collective term used for emphysema and bronchitis and is primarily smoking related as a consequence this leads to progressive airflow obstruction (Booker, 2003). The symptoms of COPD patients include a debilitating cough, dyspnea, excess sputum, chest tightness, fatigue and frequent chest infections. COPDs insidiously developing character means that patients often do not present these symptoms until consequential irreversible damage has happened (Britton, 2002). According to Vermiere (2002) when diagnosis is finally made healthcare professionals may chastise COPD patients for smoking, and causing a self inflicted disease. In turn not much constructive advice maybe given to help COPD patients to manage their condition and medication may not be prescribed in the mistaken belief that medication would not be beneficially (Vermiere, 2002). Healthcare p rofessionals may also unjustly chastise COPD patients, as COPD can also be caused by long term inhalation of asbestos, coal dust and pollution. The lack advice and medication given to patients with COPD may have enormous impact on a patients health and well being (Lee, 2008). According to the Department of Health the condition COPD causes nearly 25,000 deaths per year in England and Wales, and in the years 2007 until 2009 4.8% of deaths were caused by COPD being the fifth greatest killer in the United Kingdom (DH, 2011). Depression is the word used to refer to a variety of mood disorders, a collection of clinical conditions that differentiates the sense of loss and control and a subjective experience of momentous distress (Lazarou et al, 2011). Depression is a wide and heterogeneous diagnosis and can be presented in a variety of different ways. The psychological symptoms may include a continual low mood, feeling hopeless, feeling tearful, feeling irritable and anxious, having low self esteem, no motivation, self harm and suicidal thoughts and having no enjoyment out of life. The physical symptoms may include speaking or moving slowly, weight loss or gain, lack of energy, lack of interest in sexually activities, disturbed sleep and unexplained aches and pains. The social symptoms include decreased job related activities, social withdrawal from family and friends and neglecting hobbies and interest (NICE, 2009a and Elsherif and Noble, 2011). According to the National Institute for Health and Clinical E xcellence (2009b) the depression disorder is generally known as a psychological response in patients with COPD and it can be found in 20% of COPD patients. Healthcare professionals have a duty of care, therefore the recognition of depression in COPD is paramount (NICE, 2009a). Such tools have been developed to aid practitioners to diagnosis depression, for example the Health nine-item Questionnaire (PHQ9) and the Hospital Anxiety and Depression Scale (HADS), these tools are used so that the patient can be considered to see if they require drug or psychological support (Cornforth, 2012). The use of the diagnosis tools in COPD patients reduces the potential risk of an acute exacerbation. According to Jennings et al (2009) patients with COPD who suffer from depression are at a higher risk of an acute exacerbation in turn this may lead to an admission to hospital. COPD and depression may also be linked with the continual occurrences of admissions, and the extended stay in hospital (Yohanne, 2010). Furthermore depression along with COPD may reduce the desire to recover and comply with medication and medical treatment, in turn this could lead to a delay in the patients discharge from hospital (DiMatteo et al, 2004).The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines (World Health Organization, 2008a) and NICE guidelines (2009a) have highlighted the need for psychosocial factors such as depression to be diagnosis in COPD patients. The NICE care pathways are also available to help health care professionals identify, treat and manage depression in COPD patients (NICE, 2009c). The Department of Health defines health as A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (Department of Health 2010, P.7). The presence of COPD and the psychosocial depression factor is the major cause of morbidity, disability and mortality and this can have a physical, mental and social impact on patients lives (NICE, 2009b). Factors that may contribute to depression in COPD patients are weight loss, sleep deprivation and fitness levels. Weight loss is associated with COPD in particular the loss of fat as the disease progresses furthermore many patients lose weight as a consequence of decreased food intake as a result of dyspnea (Kelly 2007). In addition poor quality of sleep is frequent in COPD patients for numerous reasons. Firstly, coughing and excessive mucus may interrupt the onset of sleep, particularly since these symptoms may be worsened in the supine position. Breathlessness may also be worsened by the position and COPD patients may have numerous incidents of nocturnal dyspnea, which causes recurring awakenings (George and Bayliff, 2003). Finally COPD patients may avoid physical exercise or exc essive hard work due to the unpleasant symptoms of breathlessness, as a result the patients fitness levels may reduce and this may lead to muscle weakness which increases disability, dyspnea, loss of confidence and social isolation (Booker, 2005). According to Yohanne (2010) the chronic character of COPD and its related stigma can also lead to social isolation. COPD patients with chronic hypoxaemia rely on long term oxygen therapy (LTOT) to increase their survival rate. However the psychological effects it has on patients daily living are somewhat restricted in their capability to participate in indoor and outdoor activities, resulting in the patient suffering from depressive symptoms. Patients with chronic hypoxaemia who rely on LTOT for survival suffer from a diminishing quality of life and are susceptible to emotional lability, loneliness and social isolation in turn this may lead to clinical depression (Yohannes, 2010). The Department of Health defines wellbeing as A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment (Department of Health 2010, P.7) COPD and the psychosocial factor depression can not only affect every aspect of a sufferers life but it can have enormous impact on the sufferers family lives. The ability to cope with the loss of an active role in their family and society and the loss of intimacy and functional impairment is considered a burden to a patients state of mind (Gray et al, 2009).The British Lung Foundation (2005) carried out a survey regarding COPD patients daily activities, and the findings were 90% of patients with severe COPD were unable to do their gardening, 66% were unable to go on holiday and 33% had disabling breathlessness all factors that increase depressive symptoms. Patients with COPD who suffer from a disability can eventually become reliant on others to carry out every aspect of daily living this may include personal hygiene and grooming, functional transfers, eating and drinking, medicine management, bowel and bladder management and managing money as a result this can have a enormous impac t on a patients mental well being in turn this may result in clinical depression (Mooney and OBrien 2006 and Gray et al 2009). A patients state of mind and the ability to cope with COPD may cause the patient to experience negative thoughts and feelings such as feeling guilty, loss of independence, low self esteem and a sense of worthlessness they frequently criticise themselves for lacking in confidence, feeling irritable, impatient and frustrated all the factors may contribute to clinical depression. In some circumstances patients with depression and COPD may cause injury to themselves, experience suicidal thoughts and in extreme circumstances may attempt suicide (NICE 2009a and Gray et al 2009). This supporting paper has supported the presentation on the link between COPD and the psychosocial depression factor. The supportive paper has explored, defined and concluded areas of which influence the health and well-being of patients with COPD and the psychosocial depression factor. To conclude the main focal points, COPD is the fifth greatest killer in the United Kingdom and as a mortality rate of 25,000 per year (DH, 2011). Twenty percent of patients with COPD suffer from depression with extreme symptoms of self harm and suicide (NICE 2009a, NICE 2009b and Gray et al 2009). The symptoms of both COPD and depression have been emphasised to highlight the need for diagnosis tools, guidelines and care pathways. The main importance of this paper is the physical, mental, social, state of mind and ability to cope with COPD and depression and the impact it has on the patients lives (Cornforth 2012 and NICE 2009c). Word count 1374 References/References in text and headings and quotes 699 Total word count 2073

The Case for Torture :: Michael Levin Ethics

I seek to provide an analysis on Michael Levin's article on "The Case for Torture." This article mainly articulates that the use of torture is necessary in order to safeguard the lives of the many innocents and is justifiable. In his given example, he argues that the mass murder of millions of innocent people by a terrorist justifies the use of torture to stop such an extreme barbaric act. Indeed this is a question of moral on the action of inflicting pain. Take a look at the scenario of a war. We will never say that it is immoral to let out soldiers kill or inflict pain on the enemies in a war because we know that it is the only way to safeguard our nation's sovereignty and the lives of our people. The motives are very clear as mentioned. Thus it is justifiable to let our soldiers kill those who intended to harm the lives of our citizens. When a terrorist has clearly intended to harm the lives of millions, why is it not justified then, to inflict pain on the terrorist, with the mot ive of wanting to protect the lives of many more innocent people? Surely it is! Take a look at this argument: Constitution seeks to protect the interest of one's rights. To torture a person is to breach that protection of interest. Therefore, Torture is unconstitutional. Torturing is however, unconstitutional only when the motives behind it are deemed reasonably immoral. We should then of course not inflict pain mainly just to force the other party to confess the truth to a matter if he does not wish to. But what if the truth will then lead to the location of say, a timed-bomb, which will then be diffused in time to prevent an entire office block to collapse, bringing with it a thousand or more lives? Should the constitution then continue to protect the terrorist against such torture? The author said that millions of lives outweigh constitutionality. Surely it is not justiable for a constitution to uphold the rights of a terrorist, but at the expense of the thousands that, t oo, holds the right to live never asked to be placed in such danger. Again, the moral of one's action must be reviewed in such cases. On a personal note, I feel that to sacrifice one that is convicted, in exchanged for the many innocents, is a permissible one.

Marketing Techniques Essay

The main thing behind marketing in a business is finding the customer’s needs and produce the product/ services to satisfy their needs, this way the customer can choose what they would want included in their product/ service. A business that follows this rule is market-orientated. There is alternatives orientation for businesses, these are; The production concept: This is where the business produces in large quantities and distribute in bulk, this is so the customer/ business get the products cheaper as they will be bulk buying. A business that would do this is Walkers. They make thousands of packets and then sells them to large business such as Tesco, Tesco would be able to buy it for cheaper as they will be buying in a very large amount as they can stock allot of products. However charity shops will sell their products and with the entire surplus they send it off to the charity. An example of this is Oxfam, they will sell their products to the public and with all the surplus is sent off to the project they are currently on. The sales concept: Businesses need to know how to sell their products/ services. If they don’t know how to the business is likely to fail but if a business knows how to sell its goods/ sieves then it is likely to be successful. A type of sales technique is hard selling nor Tesco or Oxfam hard sell but businesses such as Anglian, Everest and Safestyle are usually hard sellers trying to get you to buy double glazing. As you can see some of the sales reps in these businesses have lied about the business just so they can close sales with people on the spot. The marketing Concept: Marketing concept is different to sales and production as it has to take every step with keeping customers in mind as marketing is based around customer’s needs and wishes. An example for this is Tesco they do this with their Tesco Club card every time you shop you swipe your card and the system knows what the customer purchased, so to bring back the customer they will mail you some vouchers which then makes the customer want to come back into the store and shop again. Another business that uses marketing is Curry’s when you purchase something the sales assistant take down your home address so if they have any offers which are similar to what you bought will send you letter informing you about any offers. Marketing definitions: Basic definition of marketing is meeting customer needs and wants profitably. Marketing consists of identifying, anticipating and satisfying customer requirements profitably. Objectives: Private sector The objectives for a private sector business are to maximise profits and expand all over the world. An example for a private sector business is Tesco. They have businesses in the UK and in America called Fresh & Easy. In the screen shot you can see Tesco’s objectives. Public sector The objectives for a public sector business are to provide quality service for the public. An example for this is the NHS as they provide health care for everyone. In the screenshot you can see NHS’s objectives. Voluntary sector The voluntary sector businesses objectives are to raise money for good causes. An example of this is Oxfam they aid anyone to donate any goods so they can sell them and send the money they produce from the goods they sell given to the public to projects they are currently on. As you can see this is one of Oxfam’s shops where they sell goods that have been donated by the public. Organisational objective This is a target for the whole business no matter how big it is. A good example of this is Tesco, Tesco’s objective may be to increase market share to 51%. Marketing objective This is how you are going to achieve it e.g. increase Tesco value products Tesco can produce their own products such as Ben & Jerry ice-cream they can produce a Tesco value version as some people may not be able to afford  £4 ice-cream so the people can buy the alternative which would help Tesco increase their profits. Link between organisational objectives and marketing objectives Marketing objectives shouldn’t be contradicting a business’s main objective, but should be contributing in achieving that. A business will not succeed if it’s been pulled apart in two different directions. An example of this is if Tesco want to increase their sales by a certain percentage then different functional areas have to contribute to achieve this such as advertising they may advertise products that are on offer or any seasonal products e.g. Christmas, new years or valentines. Tesco’s could also send out more offers with their Club Card meaning more customers may shop i n the business. By this way Tesco will be informing a lot more people that they have sales on which might bring more customers into the business. Market leadership This is where a business has the most market share in a given product or service, this could be measured by the amount of goods sold or the value of those goods. If a business wants to become a market leader they need to be 51% or more in sales for it to become a market leader. For example, Tesco is the leading supermarket in the supermarket market place as you can see in this screenshot (January 2012). Charity do no compete with market share as they all have similar aims and objectives but need maximum funds to stay in operation. Some charities will be more valuable then others depending on how much donations they receive. Oxfam is at the top along with cancer research UK, British Heart Foundation and many more. Brand awareness Brand awareness is making people aware of the business and what they do/ sell. Brand awareness is the NHS’s number one objective, they want all of Great Britain’s public to know what they do. Brand awareness may be an individual product or the whole business itself. Tesco may advertise their Tesco club card so people are more aware of the club card you can get when you sign up with them. Perceptions of customers A customer’s perception of a business or a brand often affects their purchasing decision. An example of this is a business might have a lot of brand awareness but their products might not be of the highest quality. This will make the customer not want to come back into the store as they are paying for a cheap quality product. Tesco has a reputation of selling goods a cheap price to everyone, if they start selling their products higher than their competitors then they are likely to lose out on customers and sales which are why they try keep their prices as low as possible. People may also decide to shop at Oxfam for clothes rather than buying clothes from the high street as they know their money goes to good use. Techniques: Growth strategies Businesses grow through their products/ services every time they put a product on the market more and more people will find out about the product. For example Tesco have been using growth strategies as they are expanding with their services, such as Tesco Money, you can now have a credit card with Tesco which people who may don’t normally do not shop at Tesco may have their Tesco credit card. Oxfam use growth strategies through advertising. Every time they advertise someone new will hear about Oxfam and how they are helping to take people out of poverty in third world countries. Survival strategies This is important for all business if they want to keep operating. The reason why Tesco are expanding into different markets is in case one market fails them they have other services which will help them keep out of making a loss for example if Tesco started making cars and sold a few thousand but then was not successful. They are likely to start making a loss but as they are successful in other markets they are unlikely that they would shut down. With Oxfam with all their stores open they can use them stores to survive. Branding Business need to have a strong brand image in order for them to survive. Providing high customer service will increase the brand image. Advertising is also a factor to increase the brand image. Tesco and Oxfam both have a very strong brand image as they are at the top of their tables Tesco is globally a very well known business and Oxfam is also globally well know as they operate in the UK and in third world countries. Relationship marketing Building a relationship with customers is very important for the business as they will think that the business cares about them. Tesco can build relationships with its customers at the tills, the cashier can communicate with the customer building a positive relationship. This is also the same with Oxfam when people buy products from the stores they are building a relationship with the business or if you support Oxfam through direct debit you will receive a welcome pack with updates every month about what the persons many is doing and how they are helping people in poverty.

Explore Joe Gargery’s role in Great Expectations Essay

In Great Expectations, Joe acts as a father figure to Pip, when he is in fact his brother-in-law, as Joe married Pip’s sister, Mrs Joe Gargery. We are introduced to Joe as a â€Å"mild, good-natured, sweet-tempered, easy-going, foolish, dear fellow†. Pip describes him as a kind and gentle man, making the reader immediately like him. â€Å"Good-natured† and â€Å"sweet-tempered† give Joe an endearing quality, so the reader is drawn to him. However, â€Å"foolish† introduces a potentially negative side to his character, like he is stupid, although this too could be considered endearing. Perhaps Dickens does this so that we can understand Joe’s actions better, or at least don’t view him too negatively when he can’t protect Pip from Mrs Joe. In contrast to his gentle personality, he is a blacksmith, and therefore a strong man. Pip thinks of him â€Å"like the steam-hammer, that can crush a man or pat an egg shell†. He is likening Joe to a machine in the forge, giving Joe a sense of power. Although, â€Å"crush† is quite a violent word, suggesting Joe to be violent, which he definitely is not. Perhaps Dickens included this detail to make us respect Joe, which is important for later on in the novel, so we don’t just view him as a â€Å"sweet-tempered† man. But there is a sense of this good natured man in the word â€Å"pat†, it could potentially have paternal connotations. Perhaps this links to the image of the egg shell as well, as it is a fragile protector of life. Furthermore Joe could almost be seen as the protector of Pip’s life, as he saves him several times. Also egg shells can be strong, but have weak sides if they are put under stress, just like Joe has a weak side  œ he can’t protect Joe from Mrs Joe Gargery. As well as this, there is the idea that Joe is in control, in the words â€Å"can† and â€Å"or†, he can choose which side of himself to be, strong or gentle. This is a very adult concept, but Joe can sometimes be very childlike. Joe can’t deal with the idea of death, despite being a strong blacksmith. When Pip asks Joe if Miss Havisham died, he eventually replies â€Å"she ain’t living†. This is a very backward way of saying it, a way we don’t normally use, showing Joe’s childish innocence. He avoids the subject of death again, when Pip asks him if he had heard of Magwitch’s death. Even though Joe never knew him personally, he avoids saying the words, instead he says he heard â€Å"something or another in a general way in that direction†. The vagueness of this statement is almost humorous, he can’t even just say â€Å"yes†. Joe is unable to confirm a person’s death, he just brushes over the subject, not fully acknowledging or possibly understanding it, like a child would. Another way Dickens portrays this childishness is through making Joe illiterate. Pip writes him a letter, and all he can read is his name: â€Å"Why, here’s three Js, and three Os, and three J-O, Joes, in it, Pip!† The exclamation mark at the end implies he is excited and proud that he has managed to read, and that he is wanting Pip to recognise his achievement, like a child would want their father too. This childishness makes Joe a lovable character, the reader wants to see him do well. Perhaps it also makes Pip’s behaviour towards him seem worse, from the reader’s perspective, as Joe is such an innocent character. Whilst Joe may not have great knowledge or academic skills, he possesses something most of the other characters don’t have, self-knowledge, he recognises he is illiterate and ‘stupid’. He tells Pip on two separate occasions that he is â€Å"most awful dull†. He is accepting of himself, he knows he is not the cleverest, in fact â€Å"awful† suggests that he thinks he is very stupid. Moreover, â€Å"dull† could imply many things, not only that he is stupid, but also that he isn’t sharp. Perhaps this is a reference to him being a black smith, that he is like one of his hammers, only good for physically things, he’s not sharp witted or clever. â€Å"Dull† could also intimate that he thinks he is boring, perhaps why he struggles to talk to, or be in the presence of people in a higher class to himself, because he considers himself boring and unworthy. But this ‘dullness’ does not stop him from being wise. Throughout the novel, Joe gives Pip many pieces of advice, for example â€Å"if you can’t get to be oncommon through going straight, you’ll never get to do it through going crooked†. Joe, even though he is perhaps the most uneducated character (shown in the wording of the sentence) he can sometimes be the most wise and honourable. Because of this he acts as a hidden role model for Pip. Not only is he honourable and wise, he understands his place: â€Å"I am wrong out of the forge† he tells Pip at their awkward reunion. Dickens suggests (through Joe) that people should stay in their class, and not aspire or try to move up; he argues for social immobility. Joe tells Pip that if he ever came back to the forge he’d â€Å"see Joe the blacksmith, there, at the old anvil, in the old burnt apron, sticking to the old work.† Joe labels himself â€Å"the blacksmith† implying that he believes it is all he is good at. The repetition of â€Å"old† makes him seem experienced, as he has been doing it a long time. There is also the idea that he clings or latches onto his work, in the word â€Å"sticking†, he fixes himself onto it so much that it has become how he defines himself. The fact that he feels himself â€Å"wrong† when not in the forge could be the reason why he can’t talk to Miss Havisham: â€Å"Joe†¦persisted in addressing me.† It is like he cannot deal with the formality of he occasion, as he feels he doesn’t belong there. Dickens humiliates Joe here, presenting him as a shy and awkward character, making the reader sympathise with him. This is another negative quality, helping to balance out the character of Joe. Joe also finds it difficult to deal with Pip when he is a ‘gentleman’. When Pip is ill, and needing Joe’s help, Joe is happy to call him Pip and treat him like he did when he was younger. But as soon as Pip starts getting better and gaining strength, Joe reverts to calling him â€Å"Sir†: â€Å"I shall be happy fur to see you able, sir†. This could show Joe’s insecurity, that when he is no longer sure if Pip needs him, he becomes very polite, and address Pip as if he is in a higher class again. However, Joe does treat everyone equally, for example when Magwitch confesses about stealing the pie, Joe says that whatever he has done, â€Å"we wouldn’t have you starved to death for it, poor miserable fellow-creature.† This shows how Joe views the world, and the people on it, that we are all of the same kind, and all have the same rights. As well as this, â€Å"creature† implies that Joe believes humans are animals, perhaps why he struggles with classes and formalities. This may relate to the fact that Joe never shows a real desire to learn to read or write, because he thinks we are animals that just do physical things, such as make things, like a blacksmith does. â€Å"Poor† also implies that Joe sympathises with the convict, despite knowing it was his own fault that he is in the position he is in, showing that Joe is very forgiving, which the reader respects him for. Joe shows this forgiveness on a number of occasions, for example, when he tells Pip about his abusive father, and how he came after him and his mother. He tells Pip it was because his â€Å"father were that good in his hart that he couldn’t abear to be without us.† One could argue that this was Joe’s innocent view on the world, and that he couldn’t accept that someone would deliberately want to hurt someone else. But, more likely, it is Joe forgiving his father for what he did. Forgiveness (or the lack of it) is a common theme throughout the novel, but Joe seems to be one of the only one who offers it readily. Not only does Joe forgive his father for abusing him, but also Mrs Joe. He tells Pip that she is a â€Å"fine figure of a woman†. This is somewhat ironic as Mrs Joe has no feminine qualities, not even a female name. It also shows Joe’s respect, if not affection, for Mrs Joe, despite her treating him so badly. For example she regularly abuses him: â€Å"she knocked his head for a little while against the wall behind him.† Joe puts up with her, although he could easily fight back. The image if almost comic, especially the phrase â€Å"for a little while†, it makes it sound like she is just casually doing it for the sake of it. It could also link to the phrase ‘knock some sense into him’, perhaps this is what Mrs Joe is trying to do? At any rate Joe is submissive, showing his selflessness, as he lets her do it so she doesn’t hurt Pip as much (as he explains later). The reader pities Joe, as he is such a kind man, married to an abusive woma n, who takes advantage of his kindness. Joe is very loyal to Pip, and is always there when he needs him. One of Joe’s ‘catch-phrases’ is â€Å"ever the best of friends†. â€Å"Ever† shows his loyalty towards Pip, and gives a sense of stability, he gives Pip something to come back to. As if to prove this loyalty, he pays of Pip’s debts. This is such a big gesture as Joe is the poorest of all men. The moral and emotional image of debt appears a lot throughout the novel, perhaps because debt was a personal issue for Dickens. His family were imprisoned for debt, therefore stopping Dickens’ education, and he bailed his father out many times. In the novel, Pip becomes Joe’s debtor, an image of ownership, like Joe owns Pip. One could argue that this was to do with Joe’s insecurity, and that he needs something solid to connect him to Pip. However, throughout the book, Joe has been completely selfless, so this act could just another example of Joe’s kindness. Ther e are also religious overtones to this, he is doing a Christian deed. There are several religious links associated with Joe, for example, Joe takes in Pip a a child â€Å"God bless the poor little child, there’s room for him at the forge.† This could be a reference to the Nativity story, when the innkeepers turn Mary away. Add this to the Christian deeds he does (like paying off Pip’s debt), give Joe an almost saint-like quality. But Dickens needs to balance the character, otherwise we may just view him as a perfect religious figure and would then find it hard to view him as a realistic role model for Pip. So Dickens makes Joe childish, innocent, illiterate and also includes some comedy moments. For example, when Joe has learned to write, he writes a letter to Biddy. Dickens writes this in a very comedic way, possibly overly so. Joe â€Å"constantly dipped his pen into space, and seemed satisfied with the result†, it is almost mocking him. As well as this, it is written like a performance for Pip, but throughout the novel Joe has been the only one who can’t act (e.g. he can’t deal with formal situations and pretend to be something he is not) or pretend. So why does Dickens include these humorous details? Possibly it could be to balance out Joe as a character, for if he was just a religious prophet, he would lose his power in the novel. Or alternatively, it could be to lighten the mood and relieve the tension between Pip and Joe. Or perhaps it is to show Joe fulfilling his mother’s expectations, of Joe being a â€Å"scholar†, to show that it can be done. This may provide hope for the reader, that Pip might be able to fulfill his own expectat ions eventually. Although that wouldn’t explain why it is so over the top. Some characters only see this side of Joe, the awkward, clown-like side. Pip says that Jaggers â€Å"recognised in Joe the village idiot and me his keeper.† Jaggers doesn’t understand Joe, he doesn’t know about Joe’s forgiving, loyal nature, he just sees an â€Å"idiot†. This could be reinforcing our first introduction to Joe, where he is described as foolish. Again this could be to balance the character of Joe, rather then make the reader view him negatively, as we know Joe is a very wise character. Jaggers believes this because Joe cries when he tells him about Pip’s expectations, and has to be comforted by Pip. Joe demonstrates many female tendencies throughout the novel, especially when he is caring for Pip at the end of the book, â€Å"Joe had actually laid his head down on the pillow at my side.† This is ironic considering his strength. Perhaps he is compensating for Mrs Joe’s lack of femininity, or he is filling in the gap left by her death, showing Joe to be a father figure for Pip. Ultimately, Joe is the only true father to Pip, he gives him â€Å"the wealth of his great nature†, which is more than Magwitch ever did. He may not have a lot of money, but he is a true gentleman in character. Ironically, the poorest of all the men is the most gentlemanly. Moreover, Pip eventually comes to realise this: â€Å"there was a simple dignity in him.† Now, whilst he is recognising Joe’s dignity, he doesn’t sound very respectful. The tone sounds quite patronising, and â€Å"simple† implies stupidity. Overall, Joe is the only constant in the book, he can’t act, he can’t pretend to be something he is not, he doesn’t change for anyone – â€Å"whoever came about me, still settled down into Joe.† Even the use of the word â€Å"settled† gives the idea of stability and constants, Joe is always there for Pip. He acts as a role model for Pip, and the other characters, even if they don’t realise it. But he does have his negative qualities, he is childish and awkward. However, this gives him more power in the book, as the reader can relate to him, and not just view him as a religious saint-like figure.