Gibbs reflective cycle

Gibbs reflective cycle Gibbs’ reflective cycle has 6 stages. They are usually given the following headings: 1. Description 2. Feelings 3. Evaluation 4. Analysis 5. Conclusion 6. Action Plan As part of my Overseas Nurse program, I am required to make a reflective essay. This essay is based on my experience in clinical placement in the Operating Theatre. The aim of this essay is to discuss my learnings about the importance of team briefing, principles of asepsis, and Surgical Handscrubbing, as well as experiences throughout my placement. I have come to select the Gibbs reflective framework for this for I feel that through this framework I can better express in a systematic manner the describe the incidents, feelings, and how I was able learn. Learning Outcome 1: Team Brief and WHO Surgical Safety Checklist In June 2008, the World Health Organization (WHO) implemented a second Global Patient Safety Challenge, ‘Safe Surgery Saves Lives’, to reduce the incidence of surgical deaths across the entire world. The initiative was developed to strengthen and improve the commitment of clinical staff to address safety issues within the surgical setting. This included improving anaesthetic safety practices, ensuring correct site surgery, avoiding surgical site infections and improving communication and teamwork within the team. The WHO Surgical Safety Checklist is a core set of safety checks, identified for improving performance at safety critical time points within the patient’s intraoperative care pathway. It is for use in any operating theatre environment, including interventional radiology with the expectation that it can be adapted to fit local practice. The three steps in the checklist (sign in, time out, sign out) are not intended as a tick box exercise, but as a tool to initiate meaningful and purposeful conversation between relevant members of the clinical team to improve the safety of surgery. According to the National Patient Safety Agency, NHS, there are five steps to safer surgeries. Namely Briefing, Sign in, Time out, Sign out and Debriefing. During my placement, I was assigned to circulate in theatre two. One of the five running theatres that our hospital has. The there was only one case. Patient Keiser (not the real name). 63 year old male consented for a Primary Total Knee replacement under general anesthesia using a Zimmer â€Å"NexGen† Knee system. I was nervous because it was a major case and I needed to be quick with my actions and be focused. I did my reading a day before so I had an idea of about the sequence of the operation. Before the patient was escorted to the theatre, the surgical team together with the anesthesia team had a team brief. In the briefing the patient details, laterality of site were confirmed as well as medication allergies, number of staff and availability of implants were all discussed. Everything went smoothly. The patient was then escorted to the anesthetic room and additional checks, verifications, and the sign in was done in the anesthetic room. The patient claimed that he had a nickel allergy and that he would get mild rashes when in contact with the metal property. The ODP (Operating Department Personnel) the person who is responsible for assisting the anesthetist and initiating the WHO Checklist was fully aware of this metal allergy as it was also reflected in the care plan and preassessment. The incident happened when the ODP and anesthetist failed to inform the scrub team about the specific allergy because they thought a nickel allergy had no significance. They were only conc erned with medication allergies. So they continued and put the patient to sleep with propofol and other anesthetic agents. The patient was then brought in the theatre with use of the trolley and placed safely on the Operating table. The scrub team on the other hand was almost done preparing the field and assembling equipment needed for the operation. When everything was ready. Being the circulating nurse, I then continued the WHO checklist and initiated the Time-out. The consent, patient verification and allergies were then reviewed but this time the ODP informed the team about the nickel allergy. The surgeon went ballistic! And ordered that the patient be woken up. There was a heated discussion between the surgeon and anesthetist and it they eventually had to wake the patient up. It was then explained to us by the surgeon that the System and implants to be used during the operation had a very small percentage of nickel present in its components which could cause a reaction if used to the patient. He was angry because it was the second time it happened to him and he did not want to go through all the paper works again. The patient was brought to recovery and woke up in a few minutes. The surgeon then explained the incident and unfortunately the operation was cancelled. The opened sterile instruments, supplies, and consumables were all put to waste. As I analyzed what happened, the mistake clearly rooted back to the team brief. There were vital information that the anesthetic team knew about the patient that was not shared to the scrub team because they did not see it as important. I personally think every allergy, be it medication, metal or objects should be taken into consideration. It was a major case and the team had to know everything relevant. I realized how important the team brief was. Often I would observe other teams not taking the team brief seriously. They would just breeze through it as if was just some unimportant routinely work. After the incident I learned a lot and the view I had on the team briefing and the importance of the WHO checklist drastically changed. It is a very important tool in ensuring a safe, effective and successful operation. I now plan to practice a thorough team brief as well as executing a proper WHO checklist. You never know, missing out on one important fact could mean a life of a patient. Learning Outcome 2: Principle of asepsis: Asepsis can be defined as the absence of pathogenic microorganisms that cause disease. It then can also be referred to as clean technique (Phillips, 2013). However, elimination of infection is the goal of asepsis, not sterility. (Ayliffe et al. 2000) suggest that there are two types of asepsis: medical and surgical asepsis. Medical or clean asepsis reduces the number of organisms and prevents their spread; surgical or sterile asepsis includes procedures to eliminatemicro-organismsfrom an area and is practised byhealth care workersand nurses in operating theaters and treatment areas. There are several principles of surgical asepsis. Although all are equally important, I have come to be more cautious and alert of specific principles more often than others. One principle I have chosen to share with is a principle stating that People who are sterile touches only sterile items or areas. (reference) It may seem as a very simple principle to follow but it could be at times difficult to imbed in our system. May it be a scrub role or circulating role this is one of the key things one should always keep in mind. I had one incident during placement relating to this. It happened during an early shift of a busy Friday. There were 52 operations to be done that morning. Everyone was on the go. For some time now I have been with an orthopedic team but this time I was assigned with my mentor to assist a list of over 6 cataract extractions with ocular lens implantation. She was to scrub and I was to assist with the circulating role. Coming into this list I had not assisted a cataract extraction in the last 4 years. My knowledge was very minimal although I knew the purpose and roughly the length of time needed to finish the procedure in general but I did not know much about the fine instruments needed, supplies and set up of the Centurion Vision. Everything was new to me and I felt much pressured to deliver and I was uncomfortable knowing I could make mistakes. As the operation began my mentor scrubbed in and she was too busy to guide me thoroughly at the moment. The surgeon and scrub started asking me to position the machine according to the surgeon’s preference. I was reprimanded for being slow and hesitant since the surgeon was ready to start. After finally connecting the plugs, foot pedals as well positioning the Centurion Machine above the patients head, the surgeon placed sterile plastic covers over each of the handles of the machine. These sterile plastic handles where used as a sterile field so that the surgeon can hold the machine. Like the principle states, only sterile people should touch sterile things and the other way around for unsterile. Already being reprimanded I was nervous that I would make another mistake and unfortunately I did. The surgeon wanted me to reposition the machine yet again to his preference but this time I unconsciously forgot my principles and touched the sterile handle and I compromised the sterility of the field. The surgeon requested for another sterile handle and the case was delayed. I felt very bad knowing that I knew the principle but still it just slipped my mind and I committed an error which compromised the operation someway. After the incident I knew what I needed to do and how to position the machine efficiently and quickly. I already knew the preferred position and supplies needed. I just needed to be more focused, less anxious and hesitant and be more confident this way I would not make mistakes of that degree. The first case finished and I was able to effectively circulate on the remaining cases with carefulness, confidence, focus and efficiency. Learning outcome 3: Surgical Hand scrubbing Microorganisms transfer from the hands of health care providers to patients; this is an Important factor with regard to health-care associated infections (i.e. nosocomial). Skin is a major source of microbial contamination in the surgical environment. Although the scrubbed members of the surgical team are wearing surgical gloves and gowns, their hands and forearms are to be cleaned preoperatively to significantly reduce the number of microorganisms (AORN 2006) According to the WHO Guidelines on Hand Hygiene in Health Care, Surgical hand scrubbing is the surgical hand preparation with antimicrobial soap and water performed preoperatively by the surgical team to eliminate transient flora and reduce resident skin flora (2009, World Health Organization). There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol (Deborah Gardener 2011). In the operating theatres there are three most probable routes of infection transmission between successive/sequential surgical patients are via the air, from instruments, or from environmental surfaces. Journal of Hospital Infection (2002) I have always felt and understood the importance of keeping our hands clean even since I was a little boy. This was a practice taught to me by my parents. As I studied nursing in my country I got to know more about it and how it was properly practised in the wards and theatre settings. During my placement I would always observe my mentor thoroughly before gowning and gloving. I knew the importance of this. She would use repetitive strokes on the hands and arms to further remove any microorganisms. She would be very meticulous and patient while stroking her hands and arms with soap and an antimicrobial agent but as Ive observed, along with most of the scrub nurses, together with my mentor did not use brushes when doing surgical hand scrubbing despite brushes being available just at the side of the scrubbing area. This made a big question mark in my head and I was really confused. I wanted to know why they didn’t bother to use the brushes. So I decided to research about it. There was a study that compared surgical hand scubbing with and without the use of brushes. Two groups were involved during this study. One group to scrub without a brush and another group to scrub with brushes. According to Life Science Journal 2014, the result showed that the group which used brushes had slightly higher bacterial counts, this could mean that brushes traumatize the skin creating an environment where bacteria thrived. Whereas using no scrub brush resulted in no skin damage and significantly lower bacterial count. (AORN journal, 2004. 79: p. 225-30). Based on this research, I was amazed on how the United Kingdom healthcare setting applied evidence based practice. I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a brush. Surgical site infections (SSIs) are the second to third most common site of health care associated infections. When providing health services, it is es sential to prevent the transmission of infections at all times. (Engender Health 2001). I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a surgical brush.

No Groove in the Gunsights by Lars Kullberg :: essays research papers

No Groove in the Gunsights Always under the thumb of his dark mistress, the speaker struggles beneath her power. Try as he may, he will never be able to break the tie of lust between the two. His threats are not threatening to her, and he knows this. His power is beneath her's, and he knows this as well. By threatening his lover in the 140th sonnet, the speaker is merely admitting to his own helplessness to which he is forever bound. This appears to be the first sonnet in which he is taking a stand. Never before has he spoken in such a threatening tone: "Be wise†¦do not press/My tongue tied patience†¦" (140. 1-2). One might think that he is now revealing for the first time his yet unheard of power. But he has no such power. He knows that his threats do not frighten her†¦ so why does he even bother? Sure, he could untie his tongue and let the world know of her habits. However, no one would care. She is a dark lady—she and others like her are meant to be that way. He would only be telling what is already known. However, what she has to tell of him is not already known. Being a married man, he is not expected to have a mistress. She is his only mistress. They both know this as well. If he were to lose her, he would have nothing left. She knows his lust for her—his need for her. She knows he lives for her darkness and for the pleasure he finds in her†¦ temporary as it may be. Temporary yet lasting. There may be times when he thinks he can live without her, but the time comes again soon when he feels the familiar lust again. It is the lack of love which makes it temporary. However, it is the abundance of lust which makes it permanent. He is only one of her many lovers. If she were to loose him, she would still have many others to satisfy her. She takes comfort in the fact that he needs her and he remains under her thumb to almost any extent. The speaker knows she has many lovers. He claims to hate her unfaithfulness, but in fact he likes it. He likes the fact that she is nothing more than an object of sex†¦of temporary pleasure. If she were really in love with him and were truly faithful, he would be less attracted to her. The passion and the lust would be gone. So the question remains—why does he bother with these empty threats?

China Essay

There were multiple changes and similarities from the time of the Warring States period to the time of the Mongols and the Yuang Dynasty. There were changes between politics and government, but also some similarities that helped China grow while also not maintaining the same structures that were successful, but did not prevail forever, because change was needed. From the Qin, Han, Sui, Tang, Song, and Yuang dynasties, many differences occurred in government and education structures while also maintaining things like Confucianism.Many people were frustrated with the differences some dynasties brought which fueled the revolts against the dynasties, and the rise and fall throughout time. The similarities are not too common between the multitude of dynasties. The Han improved their own dynasty from Qin’s Legalist principles, while making their own revisions to improve China. The Han dynasty also continued the Qin’s start of building roads and canals for trade. Lastly, the H an dynasty followed in the Qin’s footsteps by sending officers to implement policies and maintain order in administrative provinces and districts.The Sui had connections to the Qin too, imposing tight political discipline and having a very centralized government like the Qin. The Tang did not have many connections to the roots of Qin, Han, or Sui. Tang Taizong wanted to create his own separate, unique dynasty, except that they continued the successful Han educational system, Confucianism. There are multiple differences between the dynasties. The Qin got China out of the Warring States Period with Legalism, but after not too long, people started revolting against Qin due to the extremely centralized government and tightly structured rules.Liu Bang and the Han dynasty came after the Qin. Liu Bang wanted a â€Å"middle government† that was not too much like Legalism, but not too unorganized, since that would bring China back to the Warring States Period. The Han was a ver y influential dynasty that lasted for a very long time, excepting a short period of time when the government was usurped by Wang Mang. After Liu Bang came a very good leader, Han Wudi. Wudi changed the Han dynasty to a dynasty that believes in success in Confucianism. Liu Bang was never a very big supporter of Confucianism.Wudi put Confucianism in place due to the lack of education in China. While Liu Bang was in power, there were about 3,000 students. By the time Wudi was gone, there were 30,000 students. The Han improved on Qin principles because Confucianism balanced out the Han unlike the Qin, since the Qin dynasty did not believe in Confucianism. Wudi built a bureaucracy out of China, which relied on Legalist principles. The Sui dynasty was a lot like the Qin, imposing tight political discipline, which is Legalism.Yang Jian was to be in charge of Sui dynasty, and was appointed by a Turkish ruler. Emperors of the Sui dynasty placed a heavy burden on China, making it a very centr alized government. While in office, Jian constructed the Grand Canal, which served as a trading route and a communication route between many lands. The Grand Canal made China very rich, due to all the imports and exports coming in and out from trade. Still, The Grand Canal cost a lot of taxes, and forced a lot of labor on the people. Due to that, the Sui got revolted against and did not last as long as other dynasties.Sui also based their education off of the Confucianism system, which worked relentlessly for them, making the people smarter, and a more educated China. The Tang dynasty survived very long, around 300 years. The Tang was very different than all the other dynasties, and only kept the Confucian based-elections in place from the roots of other dynasties. The Tang dynasty had three main focuses, that kept them effective, powerful, and productive. Those three main focuses were maintaining a well-articulated transportations network, distributing land based on the equal-field system, and relying on bureaucracy.The Tang had fast communications and good trade, due to the high focus on the routes and communication network. Though they thought it would work, the equal-field system did end up hurting the Tang dynasty. The equal-field system stated that everyone would have equal amounts of land, based on their needs. The equal-field system did do a good job of avoiding fighting over land, which was its main focus. The third main focus was bureaucracy, which was to make sure Confucianism stayed around so that the officials elected would be intellectually smart and make the right decisions for China.Tang dynasty also had a very powerful army, taking over lands from nearly every direction. Due to the mass of land size and military successes, the Tang is one of the largest dynasties in history. Han dynasty related to the Tang dynasty because the Tang knew they had to keep strong relationships with neighboring countries, and treat each other nicely. The Song was l ike a swing in the direct opposite way. After the fall of the Tang dynasty, Song Taizu came in and made China into a very weak country.Taizu was one of the most powerful landlords which was part of the reason he got elected as emperor. Basing China on civil administration, industry, education, and the arts more than military, the Song dynasty did not have the strongest of armies. The Song did base their bureaucracy off of Confucianism, but took it overboard. Taizu gave the officials very generous pay and benefits, which eventually drained China’s economy since there was a mass incline in officials. Taizu sent many troops out to war, many of which that never came home because of the lack of military experience and knowledge.Song dynasty lost battles to nomadic people at points due to lack of military. In the long future came along the Mongols and the Yuang dynasty. The Mongols did not like the Chinese, and they were not afraid to show it. The Mongols first imposed that a Chine se person and a Mongol cannot get married. After the ban of marriage, the Mongols then imposed that a Chinese individual is not allowed to learn Mongol, as if trying very much to keep the two cultures separated. Then there were rumors that the Mongols only took China for the need of land for their horses.After all the negatives the Mongols brought to China, they put their own officials into Chinese government so they could financially drain China as a last act. China changed drastically between the Warring States Period, when landlords owned China, and there were fights based on who gets what land. From landlords to Legalism, to Confucianism and bureaucracy, there was a wide variety of similarities and differences for China throughout time. Though some dynasties were more successful than others, China made it through and is now among the biggest places in the world.

Current Developments of the European Union, Strengths and We essays

Current Developments of the European Union, Strengths and We essays In todays world, different kinds of alliances are formed between countries and nations in order to compete in a global economy. The European Union is a one of kind allegiance that has shaped many aspects of our current world. Recent developments along with the strengths and weaknesses of the European Union will be the focus of this paper. Before discussing current events, a brief overview of who and what is the European Union (EU) is vital. On May 9th, 1950, The EU was formed by the joining of six countries which were (Belgium, Germany, France, Italy, Luxembourg and the Netherlands) with the foundation of the law of democracy. The basic concept of the EU states that it is neither a new State replacing existing ones nor is it comparable to other international organizations. Its Member States delegate sovereignty to common institutions representing the interests of the Union as a whole on questions of joint interest. All decisions and procedures are derived from the basic treaties ratified by the Member States. Today, after four waves of accession (1973: Denmark, Ireland and the United Kingdom; 1981: Greece; 1986: Spain and Portugal; 1995: Austria, Finland and Sweden) the EU has 15 Member States and is preparing for the accession of 13 eastern and southern European countries. (EU at a glance) The foundation and st ructure of the EU is definitely one of its strengths. The EU has some basic principals which include establishing European citizenship. This embraces fundamental rights, freedom of movement and civil and political rights. It also wants to ensure freedom, security and justice. Like other unions, the EU definitely wants to encourage economic and social progress and finally assert Europes role in the world. Having well defined goals and showing character and conviction the EU demonstrates inner strength. The EU is governed by five institutions each having a specific function. They are the European Parli...

Definition and Examples of Verbal Placeholders

Definition and Examples of Verbal Placeholders A placeholder is a word (such as whatchamacallit) used by speakers to signal that they dont know or cant remember a more precise word for something. Also known as a  kadigan, tongue-tipper, and dummy noun. Examples and Observations You need something to sell. Now this could be anything. It could be a thingamajig. Or a whosi-whatsi. Or [pulls out a Watchamacallit candy bar from his pocket] a Whatchamacallit.(Steve Carell as Michael Scott in Business Office, The Office)Work, the whats-its-name of the thingummy and the thing-um-a-bob of the what dyou-call-it.(P.G. Wodehouse, Psmith, Journalist, 1915)I have unspiked the sliding doors at the far end of the barn, so that the greatly increased flow of visitors can move past the whatchamacallit without eddies and backwash. In one end they go, and out the other.   (Kurt Vonnegut, Bluebeard. Delacorte Press, 1987)It will do magic,Believe it or not,Bibbidi-bobbidi-boo.Now Salagadoola meansA-Menchika-boola-roo,But the thingamabobThat does the jobIs Bibbidi-bobbidi-boo.(Al Hoffman, Mack David, and Jerry Livingston, Bibbidi-Bobbidi-Boo. Cinderella, 1950) Doodad doodad n (Variations: do-dad or do-funny or doofunny or do-hickey or doohickey or do-hinky or doohinky or do-jigger or doojigger or doowhangam or do-whistle or doowhistle or do-willie or doowillie) Any unspecified or unspecifiable thing: something one does not know the name of or does not wish to name.  (Barbara Ann Kipfer and Robert L. Chapman, American Slang, 4th ed. Collins Reference, 2008) Placeholders Placeholders . . . have little or no semantic meaning and should rather be interpreted pragmatically. The placeholder words that Channell discusses... are thing, thingummy (with the variants thingummyjig and thingummybob), whatsisname, whatnot, whosit, and whatsit... Incidentally, they are all defined as slang in Cassells Dictionary of Slang (2000)... The situation where the next dialogue occurs reveals that Fanny does not know the name of the boy who was laughing with Achil and uses thingie as a placeholder: Fanny: And I walked off and like I just walked away and Achil and thingy were laughing at, you know, just not at me at how how crap [name]Kate: [Yeah.]Fanny: had been and how I had to go away.(142304: 13-215) Thingamajig occurs four times with reference to an object and twice with reference to a person. In (107) we meet 14-year-old Carola and Semantha . . . from Hackney: Carola: Can I borrow your thingamajig?Semantha: I dont know what thingamajig it is.(14078-34) Semanthas reaction shows that there is no doubt that thingamajig belongs to the category of vague words. It obviously refers to an object that Carola would like to borrow, but Semantha apparently has no idea of what she is referring to.  (Anna-Brita Stenstrà ¶m et al., Trends in Teenage Talk: Corpus Compilation, Analysis, and Findings. John Benjamins, 2002) Douglas Adams on the Placeholder in Do-Re-Mi One particularly niggling piece of Unfinished Business, it occurred to me the other day in the middle of a singing session with my five-year-old daughter, is the lyrics to ‘Do-Re-Mi,’ from The Sound of Music... Each line of the lyric takes the names of a note from the sol-fa scale, and gives it meaning: ‘Do (doe), a deer, a female deer; Re (ray), a drop of golden sun,’ etc. All well and good so far. ‘Mi (me), a name I call myself; Fa (far), a long, long way to run.’ Fine. I’m not saying this is Keats, exactly, but it’s a perfectly good conceit and it’s working consistently. And here we go into the home stretch. ‘So (sew), a needle pulling thread.’ Yes, good. ‘La, a note to follow so . . . What? Excuse me? ‘La, a note to follow so . . . What kind of lame excuse for a line is that?â€Å"Well, it’s obvious what kind of line it is. It’s a placeholder. A placeholder is what a writer puts in when he can’t think of the right line or idea just at the moment, but he’d better put in something and come back and fix it later. So, I imagine that Oscar Hammerstein just bunged in a ‘a note to follow so’ and thought he’d have another look at it in the morning.Only when he came to have another look at it in the morning, he couldn’t come up with anything better. Or the next morning. Come on, he must have thought, this is simple. Isn’t it? La . . . a something, something ... what?’...â€Å"How difficult can it be? How about this for a suggestion? ‘La, a ... a ...well, I can’t think of one at the moment, but I think that if the whole world pulls together on this, we can crack it.(Douglas Adams, Unfinished Business of the Century. The Salmon of Doubt: Hitchhiking the Galaxy One Last Time. Macmillan, 2002)

Apply for The Institutional Review Board (IRB) For My Thesis Program Essay

Apply for The Institutional Review Board (IRB) For My Thesis Program Improvement - Essay Example This usually varies basing on the PI year and if the entity is a LEA or a school. A statewide system of intensive and sustained support have been shown to help LEAs with PI schools and PI LEAs to enhance the opportunity for all students in those schools and agencies to adequately meet their academic standards. The underperforming districts and schools require policy and programmatic coherence so as to effectively address the diverse needs of the students. To assist create this coherence, some of tools developed by the state include: district assistance survey, academic program survey and the inventory of services and supports for students with disabilities. In the previous years, determining schools for program improvement was different basing on the kind of improvement program the school was operating. The study will utilize a quantitative research methodology with a descriptive design to examine. It was used due to the fact the research was aimed at answering the question like ‘what is,† ‘how’ and ‘what was’. The methods used to gather information included open-ended questions, observation, key informant interviews, collection tools, personal interviews, the use of surveys, filling of questionnaires, use of focus groups, and examination of documents. With regard to sampling, the research study will employ the random sampling technique. Vulnerable populations include minors, elderly, physically or mentally disabled, economically or educationally disadvantaged, victims, institutionalized people, or those who can easily be victimized. Will any vulnerable populations be included in your study? 6) The population sampled will include school staff (particularly those responsible for developing and administering the improvement program), board members, students, funders, and community colleagues with expertise in program’s content area. Participants will be

It is said that Mark twain in his writing tried to release human mind Essay

It is said that Mark twain in his writing tried to release human mind from moral, religious and literary standards and show the - Essay Example â€Å"There was things which he stretched, but mainly he told the truth.† (Twain 72b). Twain’s attempt to release the mind of humans from the standards that has been set for them by the society could be seen in Huckleberry’s Finn when he wrote that, â€Å"But I reckon I got to light out for the territory ahead of the rest, because Aunt Sally she’s going to adopt me and sivilize me, and I can’t stand it. I been there before.† (Twain 569). Twain used the character of Huckleberry to show an individual’s attempt to break away from the standard that the society set for him. Mark Twain used the character of Huck to show the extent at which humans tried to free themselves from what was perceived as societal norms and values. Huckleberry kicked against his adoption by Aunt Sally as he knows that Sally is someone that would likely try to instill some societal values and norms in him and he has not come to terms with this fact. The truth of life according to Mark Twain is a situation where humans can be made to enjoy life without anybody setting standards and values for them. Mark Twain believes that people should be made to do the things they feel is the best for them without being conformed to some stereotyped rules and precepts. This way, people would not have to live a hypocritical life and a life of lies and deceit.