July-August 2013 • Vol. 22/No. 4246 Kimberly Foisy, MSN, RN, CMSRN, is Clinical Educator/Administrative Nursing Supervisor, Orthopedic-Neurological Medical/Surgical Unit, North Shore Medical Center (NSMC), Salem Hospital, an affiliate of Partners Healthcare System Inc.; and Assistant Professor, Massachusetts College of Pharmacy and Health Sciences, School of Nursing, Boston, MA. Acknowledgment: The author gratefully acknowledges Kathy Clune, MSN, RN, Nurse Manager, Phippen 6 and 7; and Taryn Bailey, MSN, RN-BC, Executive Director, Professional Practice and Patient Education Services, for their advice and guidance in the development of this article. Thou Shalt Not Fall! Decreasing Falls In the Postoperative Orthopedic Patient with a Femoral Nerve Block N orth Shore Medical Center (NSMC), Salem Hospital, an affiliate of Partners Health - care System Inc., is a 250-bed acute care teaching hospital located in Salem, MA, near Boston. The hospital serves a diverse patient population with 12,000 inpatient admissions per year. The hospital’s 32-bed orthope- dic-neurologic inpatient unit, which is split between the 6th and 7th floors of the Phippen Building, has an average daily census of 30 patients. Unit leadership includes a nurse manager, clinical educator, unit coordinator, and one day-shift charge nurse assigned to both floors. Average daily staffing consists of three nurses, two nursing assistants, and a service associate for each 16- bed unit; staff can be assigned to either floor. Improvement Needs Decreasing patient falls is a patient safety priority for direct-care nurses. Many regulatory and govern- mental agencies, such as the Centers for Medicare & Medicaid Services (CMS), have set standards and pay- ment incentives to reduce or elimi- nate falls in the health care setting. For example, CMS (2011) no longer reimburses for hospitalization if a patient has an injury as a result of an inpatient fall. Some health care providers suggest falls cannot be avoided (Muraskin, Conrad, Zheng, Morey, & Enneking, 2007). However, staff members for the involved units at NSMC were determined to count- er this view by taking action to address a recent increase in patient falls on the unit. Phippen 6 and 7 house postoper- ative orthopedic and neurological surgical patients. Each floor has 16 private beds. A group of multidisci- plinary professionals and unlicensed staff from the two units convened to form a team under the Transitioning Care at the Bedside (TCAB) model (Rutherford, Moen, & Taylor, 2009). The team set a goal to eliminate falls on the unit and started analyzing falls data to determine the rate and cause of falls that were occurring. Data revealed as many as three falls per month associated with femoral nerve blocks (FNBs), with two patients sustaining injury from January to July 2009. The unit had a fall rate of 5.2 per 1,000 patient days, compared with a fall rate of 3.43 per 1,000 patient days for the facility. Further data anal ...

1. July-August 2013 • Vol. 22/No. 4246
Kimberly Foisy, MSN, RN, CMSRN, is Clinical
Educator/Administrative Nursing Supervisor,
Orthopedic-Neurological Medical/Surgical Unit, North Shore
Medical Center (NSMC), Salem
Hospital, an affiliate of Partners Healthcare System Inc.; and
Assistant Professor, Massachusetts
College of Pharmacy and Health Sciences, School of Nursing,
Boston, MA.
Acknowledgment: The author gratefully acknowledges Kathy
Clune, MSN, RN, Nurse Manager,
Phippen 6 and 7; and Taryn Bailey, MSN, RN-BC, Executive
Director, Professional Practice and
Patient Education Services, for their advice and guidance in the
development of this article.
Thou Shalt Not Fall! Decreasing Falls
In the Postoperative Orthopedic
Patient with a Femoral Nerve Block
N
orth Shore Medical Center
(NSMC), Salem Hospital, an
affiliate of Partners Health -
care System Inc., is a 250-bed acute
care teaching hospital located in
Salem, MA, near Boston. The hospital
serves a diverse patient population

2. with 12,000 inpatient admissions per
year. The hospital’s 32-bed orthope-
dic-neurologic inpatient unit, which
is split between the 6th and 7th
floors of the Phippen Building, has
an average daily census of 30
patients. Unit leadership includes a
nurse manager, clinical educator,
unit coordinator, and one day-shift
charge nurse assigned to both floors.
Average daily staffing consists of
three nurses, two nursing assistants,
and a service associate for each 16-
bed unit; staff can be assigned to
either floor.
Improvement Needs
Decreasing patient falls is a
patient safety priority for direct-care
nurses. Many regulatory and govern-
mental agencies, such as the Centers
for Medicare & Medicaid Services
(CMS), have set standards and pay-
ment incentives to reduce or elimi-
nate falls in the health care setting.
For example, CMS (2011) no longer
reimburses for hospitalization if a
patient has an injury as a result of an
inpatient fall. Some health care
providers suggest falls cannot be
avoided (Muraskin, Conrad, Zheng,
Morey, & Enneking, 2007). However,
staff members for the involved units
at NSMC were determined to count-
er this view by taking action to

3. address a recent increase in patient
falls on the unit.
Phippen 6 and 7 house postoper-
ative orthopedic and neurological
surgical patients. Each floor has 16
private beds. A group of multidisci-
plinary professionals and unlicensed
staff from the two units convened to
form a team under the Transitioning
Care at the Bedside (TCAB) model
(Rutherford, Moen, & Taylor, 2009).
The team set a goal to eliminate falls
on the unit and started analyzing
falls data to determine the rate and
cause of falls that were occurring.
Data revealed as many as three falls
per month associated with femoral
nerve blocks (FNBs), with two
patients sustaining injury from
January to July 2009. The unit had a
fall rate of 5.2 per 1,000 patient days,
compared with a fall rate of 3.43 per
1,000 patient days for the facility.
Further data analysis showed 5 of 30
falls reported during that time
occurred in patients with a femoral
nerve block in place following knee
arthroplasty.
A process flow analysis revealed
the nursing practice protocol recent-
ly had been replaced by a standard
computerized nursing order set that
did not include assessment parame-

4. ters for the patient or a plan of care.
Furthermore, the signs at the head of
the patients’ beds stating “Fall Risk
Femoral-Nerve Block” were being
removed as soon as the FNB was dis-
continued. A learning needs assess-
ment demonstrated nursing assis-
tants did not have adequate knowl-
edge of the definition, purpose, and
precautions needed in caring for a
patient with a current or recently
discontinued femoral nerve block. In
addition, patients and families were
not aware of the safety risks needed
during and after the use of a contin-
uous femoral nerve block.
Literature Review
Two searches of the CINAHL data-
base were performed to identify best
practices (June 2009; May 2011) for
literature of the preceding 6 years.
The terms searched included femoral
nerve block, falls, and orthopedic sur-
gery. The search revealed no pub-
lished nursing literature that demon-
strated a decrease in falls in persons
with femoral nerve blocks after an
Advanced PracticeAdvanced Practice
Kimberly Foisy
A Transforming Care at the Bedside model was used to decrease

5. falls in the femoral nerve block (FNB) patient population on a
32-
bed orthopedic/neurologic unit in a community hospital setting.
A multifaceted, strategic practice and educational bundle was
implemented, resulting in a 75% decrease in falls among
patients
with FNB.
July-August 2013 • Vol. 22/No. 4 247
educational intervention was imple-
mented to nursing staff. Results of
two medical studies are described in
the following paragraphs.
Sharman, Iorio, Specht, Davies-
Lepie, and Healy (2010) reported
patients with a FNB have a shorter
length of stay. According to these
authors, patients ambulate earlier as
a result of the comfort maintained
with the block. A large percentage of
postoperative falls among this group
of patients have quadriceps weak-
ness as a contributing factor.
Continuous FNB provides effec-
tive pain management as an anal-
gesic adjunct to other modalities for
orthopedic patients. A FNB reduces
the required doses of general anes-
thetic agents and hence their side
effects, including nausea, vomiting,
drowsiness, and respiratory depres-

6. sion. The FNB also confers superior
pain management, decreases opioid
requirements, and enables earlier
ambulation and hospital discharge
(Atkinson, 2008). The use of FNB
with general anesthesia also places
the patient at a higher risk for falls.
A continuous FNB is used as an
anesthetic. A catheter is placed just
below the skin surface, next to the
femoral nerve. The catheter coats the
nerve with anesthetic, blocking
transmission of neuronal messages
and creating a feeling of localized
numbness for the patient (Kasibhatia
& Russon, 2009). This block allows
the patient to achieve more effective
pain management. The block does
not alleviate the pain on the posteri-
or portion of the knee. An adjunct
therapy, such as patient-controlled
analgesia, often is prescribed for this
reason. Because the block causes a
weakness of the quadriceps muscle,
the patient needs assistance with
every transfer (Atkinson, 2008).
One of the cases analyzed by the
team involved a patient who was
ambulating with a nursing assistant.
The continuous femoral nerve block
had been discontinued 2 hours earli-
er. The patient’s knee buckled, and
he proceeded to fall to the floor. The
nursing assistant hit the door and

7. sustained a minor back injury. The
patient’s knee wound opened as a
result of the fall, requiring minor
suturing. Fortunately, the patient’s
length of stay did not increase as a
result of this fall.
Continuous Quality
Improvement Model
After reviewing the data, the team
developed a multifaceted plan to
educate unit staff on the safety and
care of patients with femoral nerve
block, as well as standardize the
process for patient care following
femoral nerve block. The Nerve
Block Bundle included developing
and implementing a:
1. Patient and family education
sheet to engage patients in their
care (see Figure 1).
2. Revised nursing protocol to
standardize the process for care.
3. Nursing education plan.
4. Fall prevention signage specific
to this population (see Figures 2
& 3).
5. Tip sheet for unlicensed assistive
personnel (UAP) to reinforce the

8. care and safety needs of the
patient with a FNB (see Figure 4).
The education plan and bundle
were presented at the NSMC Nursing
Professional Practice Council, ac -
cepted into practice, and imple-
mented August-October 2009.
Patient/Family Education
Sheet
Patient and family education are
vital in preventing falls (Agency for
Healthcare Research and Quality,
2010). The patient/family education
sheet (see Figure 1) includes informa-
tion related to pain management,
duration of the femoral nerve block,
sensation of the lower extremity,
and safety guidelines to reinforce the
patient’s need to call for assistance to
get out of bed.
Nursing Protocol
Sharma and co-authors (2010) rec-
ommended hospitals develop proto-
cols addressing decreased quadriceps
function as a result of a continuous
FNB. Prolonged nerve blockade can
last up to 30 hours after termination
of the continuous femoral nerve
block (Atkinson, 2008). This study
recommended the implementation

9. of a postoperative evaluation that
included proprioceptive function.
FIGURE 1.
Femoral Nerve Block Patient Information Sheet
• The femoral nerve block is a regional anesthetic technique
used in con-
junction with general anesthesia for pain relief.
• It is an effective block that provides both safe and excellent
surgical
anesthesia and postoperative pain control.
• Your leg will feel numb, but you can still move your leg
• You will have little or no pain in the front of your leg or knee.
However,
you will probably have some discomfort behind your knee. That
is
expected.
• Remember to discuss your pain plan with each nurse.
• REMEMBER: Ring your call bell for assistance.
• You MUST NOT get out of the bed or chair, or off the
commode without
assistance.
• Your therapist and/or nurse will instruct you on the safest
ways to move.
• The numbness and weakness from the block usually lasts 8-20
hours
and occasionally more than 24 hours once it is removed from
your
groin.

10. • As the block begins to wear off, you should start your pain
medicine that
was prescribed by the surgeon. REMEMBER: Ask the nurse for
your
pain medication. The nurse will be offering you pain
medication, but you
need to ask as well.
Thou Shalt Not Fall! Decreasing Falls in the Postoperative
Orthopedic Patient with a Femoral Nerve Block
July-August 2013 • Vol. 22/No. 4248
Based upon this evidence, a nurs-
ing protocol was written to include
the following:
1. Assess the sensory, motor, and
vascular condition of the
extremity every 4 hours during
and after removal of the femoral
nerve block until the patient
obtains full sensation and motor
function returns.
2. Maintain fall precautions for the
duration of the patient stay,
regardless of assessment of
FIGURE 2.
Fem Block Stop Signage
STOP

11. Do Not Get Out of Bed
Call for Help
FIGURE 3.
Fall Prevention Signage
Fem-Block
High Risk for Falls!
Patient:
Room:
Date/Time Stopped:
return of motor function and
sensory function.
3. Maintain fall risk signage for the
duration of the patient stay.
4. Place signage at the head and
foot of the bed to reinforce mes-
saging for the patient, family,
and staff (see Figures 2 & 3).
Fall Risk Signage
Patients typically have the FNB
removed on postoperative day 2 in
the early morning. Patients generally
are discharged on postoperative day
4 either to home or a rehabilitation
facility. To im prove patient safety,
the team decided signage would
remain for the entire length of stay.

12. UAP Education/Tip Sheet
Based on findings from the litera-
ture, a one-page educational sheet
was developed for all UAP (see Figure
4). The tips were developed by the
FIGURE 4.
Safety in Caring for the Patient with a Femoral Nerve Block
A femoral nerve block is a peripherally inserted catheter that
delivers a numbing
medicine to cover the femoral nerve. A TKR patient usually has
the catheter in
place for 48 hours.
Structures Seen on Ultrasound in Left Femoral Space
(viewed from foot)
The catheter is placed just below the skin surface, next to the
femoral nerve. The
catheter coats the nerve with numbing medicine; this allows for
blocking of the
painful sensations from the hip down the patient’s leg.
The medicine will numb the patient’s leg. The thigh muscle, or
quadriceps, will be
very weak.
The leg will be warm, and may be slightly warmer than the non-
affected leg.
The patient will always need two assists when getting out of bed
with this catheter
in place and for a certain period of time after removal.

13. Maintain the patient on The Falling Star Program.
After removal of the femoral nerve block, the same safety
precautions will remain
until the patient has regained complete sensation in the leg. You
need to check with
the nurse before moving the patient to determine if the patient
has feeling back in
his/her leg and identify if the patient can be transferred with
one assist.
Source: Reprinted with permission from Vander Beek, J. (2005).
Advanced Practice
July-August 2013 • Vol. 22/No. 4 249
Atkinson, H.D. (2008). Postoperative fall after
the use of the 3-in-1 femoral nerve block
for knee surgery: A report of four cases.
Journal of Orthopaedic Surgery, 16(3),
381-384.
Centers for Medicare and Medicaid Services
(CMS). (2011). Medicare fact sheet:
Proposals for improving quality of care
during inpatient stays in acute care hospi-
tals in the fiscal year 2011 notice of pro-
posed rulemaking. Retrieved from http://
www.cms.gov/Medicare/Medicare-Fee-
for-Service-Payment/AcuteInpatientPPS/
downloads/FSQ09_IPLTCH11_NPRM04
1910.pdf

14. Kasibhatia, R.D., & Russon, K. (2009).
Femoral nerve blocks. Journal of
Perioperative Practice, 19(2), 65-69.
Muraskin, S.I., Conrad, B., Zheng, N., Morey,
T.E., & Enneking, M.D. (2007). Falls
associated with lower-extremity-nerve
blocks: A pilot investigation of mecha-
nisms. Regional Anesthesia and Pain
Medicine, 32(1), 67-72.
Rutherford, P., Moen R., & Taylor, J. (2009).
TCAB: The “how” and the “what.”
American Journal of Nursing, 109(11), 5-
17.
Sharma, S., Iorio, R., Specht, L.M., Davies-
Lepie, S., & Healy, W.L. (2010). Compli -
cations of femoral nerve block for total
knee arthroplasty. Clinical Ortho paedics
and Related Research, 468(1), 135-140.
Vander Beek, J. (2005). Finding the femoral
nerve. Retrieved from http://www.neurax
iom.com/html/finding_the_femoral.php
ADDITIONAL READINGS
Schulz-Stubner, S., Henszel, A., & Hata, J.S.
(2005). A new rule for femoral nerve
blocks. Regional Anesthesia and Pain
Medicine, 30(5), 473-477.
Turjanica, M.A. (2007). Postoperative continu-
ous peripheral nerve blockade in the

15. lower extremity total joint arthroplasty
population. MEDSURG Nursing, 16(3),
151-154.
FIGURE 5.
Falls Associated with Femoral Nerve Blocks per Month
(January 2009 – September 2010)
TCAB team in collaboration with
physical therapists. This education
guide was reviewed with and sup-
plied to all UAPs, and has been
incorporated into new hire orienta-
tion for employees on these units.
The educational process consisted of
either 1:1 education or group ses-
sions. The educator continued to
contact UAPs individually to vali-
date understanding of the informa-
tion provided.
Nursing Implications
In the calendar year 2009, Phippen
6 and 7 had a reported falls rate of 5.2
per 1,000 patient days. Following
implementation of the FNB educa-
tion plan and bundle, the unit fall
rate decreased to 2.9 per 1,000 patient
days, with a facility reported rate of
3.52 per 1,000 patient days (see Figure
5). The bundle was effective in
decreasing falls among patients with
FNB, also contributing to the im -
proved overall fall rate.

16. The team has been able to sustain
the gains, in large part because of the
interdisciplinary and multifaceted
approach to analyzing the issue, pro-
viding education, and implementing
necessary practice changes. The sig-
nage has continued to have a posi-
tive influence on the fall prevention
project as it serves as a helpful visual
reminder for staff, patients, and fam-
ilies. Education, audits, and re mind -
ers to keep signs in place are ongo-
ing. Staff members now utilize the
two-person assist method with all
affected patients during the duration
of the FNB as well as after the block
is removed, until sensation and
motor function have returned as
determined by the nurse. Patients
are more aware of the need for assis-
tance now due to the signage and
education sheet. Patients and fami-
lies have identified the value of the
information. All newly hired staff
members review the bundle during
the orientation period. Fall data also
continue to be evaluated.
Conclusion
The TCAB approach engaged unit
leaders, clinicians, and patients to
improve the quality and safety of
patient care on two orthopedic-

17. neurologic units. There was only one
recorded fall in patients with FNB
after implementation of the FNB
bundle, from September 2009 to
December 2010. It is amazing what a
little bit of knowledge and education
can accomplish!
REFERENCES
Agency for Healthcare Research and Quality.
(2010). The falls management program:
A quality improvement initiative for nurs-
ing facilities. Retrieved from http://www.
ahrq.gov/research/ltc/fallspx/fallspxman
ual.htm
Jan
2009
Mar
2009
May
2009
July
2009
Sept
2009
Nov
2009
Jan

18. 2010
Mar
2010
May
2010
July
2010
Sept
2010
N
u
m
b
e
r
o
f
F
a
lls
2.5
2
1.5

19. 1
0.5
0
Date
Thou Shalt Not Fall! Decreasing Falls in the Postoperative
Orthopedic Patient with a Femoral Nerve Block
Reproduced with permission of the copyright owner. Further
reproduction prohibited without
permission.
Kobe Thomas-Joshua
ENGL 2331.701 (13669)
02/23/2022
What conception of evil does The Turn of the Screw present to
the reader?
How do we understand the problem of evil in the story if the
governess is reliable and the ghosts are real? (Be sure to anchor
your discussion in a specific passage or two-to-three narrative
details)
The governess and the narrator of the turn of the screw can be
interpreted as being both villain and heroine in the tale. The act
of expressing the ghost as real and the governess as sane makes
the governess be a heroine who succeeds in protecting her
charges and eliminates the demon from Miles and hence,
finishes the evil work of the demon. However, taking the
governess to be saner and the ghosts to be imaginary, the
governess becomes a real villain in the story. Therefore, it

20. creates unreal ghosts and makes one of her students to be sacred
and develops fear while another student also dies. While
deliberately incorporating ambiguity, James accepts and
motivates all of Governess’s interpretations. He has
incorporated a dual character. The dual character will be single
for one group and single nature for the second group. Both
groups are implemented in the prologue when Douglas
introduces the governess and tells him that he would judge
easily her character. Hence, James makes the readers understand
that they would have to determine the governess’s nature by
themselves.
How do we understand the problem of evil in the story if the
governess isn’t reliable and the ghosts are a figment of her
imagination? (Be sure to anchor your discussion in a specific
passage or two to three narrative details.)
By changing his artistic work to the turn of the screw, James
notes that the words, “the turn of the screw” blends in the tale’s
representation. It is a metaphor that provides a comparison of
the effects of the tale to its recipient to a screw being bored into
a hole. Every turn of the screw the recipients are pierced
deeper. The screws are turned several times by James to modify
his Novella’s ability to enter. He interprets the tales with an
interesting but difficult prologue that predicts the delicious
dread. The screw is turned by James when Douglas does the
same. The story introduces two children that become prey to
supernatural events. The screw turns further and we begin to
understand that governess’s children's stories are not only the
victims but participants in the ghost’s realm and may even be
plotting evil deeds by themselves. With claims that the
governess is insane and that she is a villain and not her
imaginary world, the plot becomes even more interesting.
In this paragraph, bring together your preceding discussions and
answer the overarching question. What is the relation between
the two ideas about the evil you developed in your first two
paragraphs? Don’t just assert, explain. More importantly, don’t
just summarize what you’ve already said, synthesize your

21. answers from the three preceding paragraphs by putting them
into conversation with one another. What’s further revealed
about the idea of evil in the work by juxtaposing your previous
findings? Develop a nuanced claim that answers the overarching
question. Add a final twist to your discussion by considering
why James would present this idea about evil in a text with
unlikely elements.
Towards the end, the turn of events is an important story that
highlights the struggle between good and evil. The two concepts
are removed at the end of the book. However, all the characters
also become vague, and hence, it becomes difficult to judge
them. The screw turns analyze and makes the relationship
between the innocence and youths to become difficult. The
youths and innocence are difficult to analyze and hence, the
children seem to be excellent (according to the words of the
governess) and wicked. However, at the same time, they are
depicted, to be honest, and innocent victims of a complicated
situation. The ghosts are both real and are bad. On the other
hand, the governess is portrayed as being good and heroic.
Flora’s illness and Miles’s death prove the ghost's evil effect
and lack of responsibility for the governess who died all he
could to save the children from the disaster. Ghosts are
remnants of our thoughts. There is no concrete evidence of the
existence of ghosts. If there were substantial evidence, it would
have been produced for analysis and hence, theories about
ghosts are unreal and not proven scientifically. They come as a
result of human brains and their quest to fill gaps with unproven
knowledge or insight. However, when no information is
available, they often fill their minds with all the information
they can get. The majority of the people have terrifying
experiences that might be true according to them. However,
scholars and scientists, are always seen as being illusions or
imaginations in response to fear. Ghosts are not real but are
awful. The government cannot be crazy but cannot tolerate such
cases. However, part of the children’s fate is her responsibility.
Henry James always showed an interest in the children’s private

22. lives and both mature and intelligent members of the universe
and innocent people in the universe. Henry James was sharply
drawn to the children as victims of adult affairs. On the other
hand, the children demonstrate their difficult lives in the past
with Miss Peter quint and Jessel and how they were abandoned
by almost all the people in their lives. However, it granted them
maturity and seriousness associated with the innocence of young
children. The ghost story demonstrates fantasy as a story but
also highlights the psychological and moral reality of life. The
ghosts are significant and should be analyzed according to the
governess’s reaction to them because it creates irony by the
logic of the narrative. However, neither the representatives nor
the hallucinations of a puritan asceticism or Manichean dualism,
the ghosts are a symbol of the origins of fear in human beings in
the sense of adults of sexual guilt, a sense which cannot be
avoided but passed to a child. Therefore, the governess is not
mad or abnormal but is not able to accept the innocence of the
children. The loss of innocence that James felt could be
understood as a failure of a person’s personal life that may
include the origin of sin. They are self-made and passed from
one generation to the next.
James, Henry. The Turn of the Screw. 1898. Link to Project
Gutenberg. Produced by Judith Boss and David Widger.
Accessed 23 February 2022.
Kobe Thomas-Joshua
ENGL 2331.701 (13669)
02/23/2022
What conception of evil does The Turn of the Screw present to
the reader?

23. How do we understand the problem of evil in the story if the
governess is reliable and the
ghosts are real? (Be sure to anchor your discussion in a specific
passage or two-to-three
narrative details)
The governess and the narrator of the turn of the screw can be
interpreted as being both villain and
heroine in the tale. The act of expressing the ghost as real and
the governess as sane makes the
governess be a heroine who succeeds in protecting her charges
and eliminates the demon from
Miles and hence, finishes the evil work of the demon. However,
taking the governess to be saner
and the ghosts to be imaginary, the governess becomes a real
villain in the story. Therefore, it
creates unreal ghosts and makes one of her students to be sacred
and develops fear while another
student also dies. While deliberately incorporating ambiguity,
James accepts and motivates all of
Governess’s interpretations. He has incorporated a dual
character. The dual character will be single
for one group and single nature for the second group. Both
groups are implemented in the prologue

24. when Douglas introduces the governess and tells him that he
would judge easily her character.
Hence, James makes the readers understand that they would
have to determine the governess’s
nature by themselves.
How do we understand the problem of evil in the story if the
governess isn’t reliable and the
ghosts are a figment of her imagination? (Be sure to anchor
your discussion in a specific
passage or two to three narrative details.)
Bryan Conn
90820000000007485
Bryan Conn
90820000000007485
Bryan Conn
90820000000007485
Bryan Conn
90820000000007485
You don't develop an interpretation of the story here. What idea
of evil is expressed if the ghosts are real? What kind of evil do
the ghosts symbolize?
By changing his artistic work to the turn of the screw, James
notes that the words, “the turn of the

25. screw” blends in the tale’s representation. It is a metaphor that
provides a comparison of the effects
of the tale to its recipient to a screw being bored into a hole.
Every turn of the screw the recipients
are pierced deeper. The screws are turned several times by
James to modify his Novella’s ability
to enter. He interprets the tales with an interesting but difficult
prologue that predicts the delicious
dread. The screw is turned by James when Douglas does the
same. The story introduces two
children that become prey to supernatural events. The screw
turns further and we begin to
understand that governess’s children's stories are not only the
victims but participants in the ghost’s
realm and may even be plotting evil deeds by themselves. With
claims that the governess is insane
and that she is a villain and not her imaginary world, the plot
becomes even more interesting.
In this paragraph, bring together your preceding discussions and
answer the overarching
question. What is the relation between the two ideas about the
evil you developed in your
first two paragraphs? Don’t just assert, explain. More
importantly, don’t just summarize

26. what you’ve already said, synthesize your answers from the
three preceding paragraphs by
putting them into conversation with one another. What’s further
revealed about the idea of
evil in the work by juxtaposing your previous findings? Develop
a nuanced claim that
answers the overarching question. Add a final twist to your
discussion by considering why
James would present this idea about evil in a text with unlikely
elements.
Towards the end, the turn of events is an important story that
highlights the struggle between good
and evil. The two concepts are removed at the end of the book.
However, all the characters also
become vague, and hence, it becomes difficult to judge them.
The screw turns analyze and makes
the relationship between the innocence and youths to become
difficult. The youths and innocence
are difficult to analyze and hence, the children seem to be
excellent (according to the words of the
Bryan Conn
90820000000007485
How does this answer the question that you've posed as your
heading?

27. Bryan Conn
90820000000007485
I'm not sure what you mean here...
governess) and wicked. However, at the same time, they are
depicted, to be honest, and innocent
victims of a complicated situation. The ghosts are both real and
are bad. On the other hand, the
governess is portrayed as being good and heroic. Flora’s illness
and Miles’s death prove the ghost's
evil effect and lack of responsibility for the governess who died
all he could to save the children
from the disaster. Ghosts are remnants of our thoughts. There is
no concrete evidence of the
existence of ghosts. If there were substantial evidence, it would
have been produced for analysis
and hence, theories about ghosts are unreal and not proven
scientifically. They come as a result of
human brains and their quest to fill gaps with unproven
knowledge or insight. However, when no
information is available, they often fill their minds with all the
information they can get. The
majority of the people have terrifying experiences that might be
true according to them. However,
scholars and scientists, are always seen as being illusions or

28. imaginations in response to fear.
Ghosts are not real but are awful. The government cannot be
crazy but cannot tolerate such cases.
However, part of the children’s fate is her responsibility. Henry
James always showed an interest
in the children’s private lives and both mature and intelligent
members of the universe and innocent
people in the universe. Henry James was sharply draw n to the
children as victims of adult affairs.
On the other hand, the children demonstrate their difficult lives
in the past with Miss Peter quint
and Jessel and how they were abandoned by almost all the
people in their lives. However, it granted
them maturity and seriousness associated with the innocence of
young children. The ghost story
demonstrates fantasy as a story but also highlights the
psychological and moral reality of life. The
ghosts are significant and should be analyzed according to the
governess’s reaction to them
because it creates irony by the logic of the narrative. However,
neither the representatives nor the
hallucinations of a puritan asceticism or Manichean dualism, the
ghosts are a symbol of the origins
of fear in human beings in the sense of adults of sexual guilt, a

29. sense which cannot be avoided but
Bryan Conn
90820000000007485
?
Bryan Conn
90820000000007485
Another good point
Bryan Conn
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Good!
Bryan Conn
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I agree with all of this, but it isn't relevant for an analysis of the
story.
passed to a child. Therefore, the governess is not mad or
abnormal but is not able to accept the
innocence of the children. The loss of innocence that James felt
could be understood as a failure
of a person’s personal life that may include the origin of sin.
They are self-made and passed from
one generation to the next.
James, Henry. The Turn of the Screw. 1898. Link to Project
Gutenberg. Produced by Judith Boss
and David Widger. Accessed 23 February 2022.

30. 3 paragraphs answering the questions on the story "The Turn
Screw"
Overview
The Three-Paragraph Writing Exercise asks you to respond to
an interpretive question on the idea of ethics in Henry James’s
The Turn of the Screw. The assignment has a unique structure—
it’s an exercise, not a traditional essay. Each of your first two
paragraphs will require you to respond to more specific
questions logically entailed by the broader one; you will
synthesize and build on your findings in your final paragraph.
Pay careful attention to the instructions for how to structure this
assignment!
Learning Objectives
In this writing assignment, you will be able to
· Analyze James's The Turn of the Screw for the thinking they
mobilize about ethics
· Analyze the thematization of virtue or evil in James's The
Turn of the Screw, respectively, in relation to their supernatural
and anti-mimetic elements
· Compose effective literary analyses of James's The Turn of the
Screw; to do this, you will be able to
· Select textual or narrative details that help extend your
analysis
· Demonstrate that you can effectively situate textual and/or
narrative details in your writing
· Develop close readings of textual or narrative details in order
to elaborate or further flesh out your analysis
· Provide topic sentences that conceptually frame the
subsequent discussion and, if it isn’t self-evident, make explicit
the relation between the overarching interpretive question and
the content of the paragraph
· Integrate your paragraphs using transitions and stitching
between them so that the exercise feels like a single extended
discussion

31. General Instructions
Format: Times New Roman, 12 pt. font, double spaced, default
margins
Heading: Use the overarching question that you choose to
respond to as your heading (see below for your options)
Length: three paragraphs; each paragraph should be at minimum
250-350 words
Citations: Use MLA in-text citations for textual and narrative
evidence; you do not have to include bibliographic information
if you are using the assigned version posted in Canvas.
Specific Instructions
Interpretive question options and structure instructions
Please Note:
· You should not include an introductory paragraph.
· Each of your first two paragraphs should include either a
sustained close reading of a single passage (i.e. detailed
analysis of the language of that passage) or an analysis that
braids together two-to-three narrative or textual details.
Option #1
Overarching Question
What conception of evil does The Turn of the Screw present to
the reader?
Paragraph One:
How do we understand the problem of evil in the story if the
governess is reliable and the ghosts are real? (Be sure to anchor
your discussion in a specific passage or two-to-three narrative
details.)
Paragraph Two:
How do we understand the problem of evil in the story if the
governess isn’t reliable and the ghosts are a figment of her
imagination? (Be sure to anchor your discussion in a specific
passage or two to three narrative details.)
Paragraph Three:
In this paragraph, bring together your preceding discussions and
answer the overarching question. What is the relation among the
two ideas about evil you developed in your first two

32. paragraphs? Don’t just assert, explain. More importantly, don’t
just summarize what you’ve already said, synthesize your
answers from the three preceding paragraphs by putting them
into conversation with one another. What’s further revealed
about the idea of evil in the work by juxtaposing your previous
findings? Develop a nuanced claim that answers the overarching
question. Add a final twist to your discussion by considering
why James would present this idea about evil in a text with
unlikely elements.
Kobe Thomas-Joshua
ENGL 2331.701 (13669)
02/23/2022
What conception of evil does The Turn of the Screw present to
the reader?
How do we understand the problem of evil in the story if the
governess is reliable and the ghosts are real? (Be sure to anchor
your discussion in a specific passage or two-to-three narrative
details.)
We can interpret the governess and narrator of The Turn of the
Screw as both heroine and villain of the tale. If we take the
ghosts to be real and the governess sane, then the governess
seems to be a successful heroine who protects her charges at all
costs and rids Miles of his demon, thus ending the demon’s evil
work. If we take the ghosts to be imaginary and the governess
increasingly insane, then the governess seems to be the true
villain of the story, concocting imaginary ghosts and terrifying
one of her students into a fever and the other into death. With
deliberate ambiguity, James allows for and encourages both
interpretations of the governess. He has constructed a two-sided
character who will be of one nature for one group of readers and
of another nature for a second group of readers. These two
groups of readers are established in the prologue, when Douglas
introduces the governess and singles out the anonymous narrator
by telling him “you will easily judge” her character. In this

33. way, James alerts his readers that they will have to judge the
nature of the governess for themselves.
How do we understand the problem of evil in the story if the
governess isn’t reliable and the ghosts are a figment of her
imagination? (Be sure to anchor your discussion in a speci fic
passage or two to three narrative details.)
By titling his work The Turn of the Screw, James suggests that
the phrase “the turn of the screw” is a fitting representation of
the tale. The phrase works as a metaphor that compares a tale’s
effect on its recipients to a screw boring into a hole. With each
turn of the screw, the story’s point is driven home, and its
recipients are pierced further and on a deeper level. James turns
the screw several times to amplify his novella’s ability to
penetrate. He preambles the tale with an intriguing but
ambiguous prologue that foreshadows “delicious” dread. James
turns the screw when Douglas does, with the introduction of a
story involving not one but two children falling prey to
supernatural events. The screw turns again when we understand
that the children of the governess’s tale are not merely victims
but participants in the realm of ghosts and may even be plotting
deceits and evil deeds themselves. With the suggestion that the
governess is insane and that she, not her imaginary ghost world,
is the villain, the plot thickens even more.
In this paragraph, bring together your preceding discussions and
answer the overarching question. What is the relation among the
two ideas about evil you developed in your first two
paragraphs? Don’t just assert, explain. More importantly, don’t
just summarize what you’ve already said, synthesize your
answers from the three preceding paragraphs by putting them
into conversation with one another. What’s further revealed
about the idea of evil in the work by juxtaposing your previous
findings? Develop a nuanced claim that answers the overarching
question. Add a final twist to your discussion by considering
why James would present this idea about evil in a text with
unlikely elements.
At its core, The Turn of the Screw is fundamentally a story

34. about the struggle between good and evil. "Good" and "evil" are
eventually discarded by the end of this book; the growing
ambiguity of all the characters makes it impossible to continue
to define any of them as such. The Turn of the Screw explores
and complicates the relationship between youth and innocence.
Youth and innocence are difficult to pin down in the book, the
children seem precocious and (in the governess's words)
wicked, but at the same time they are presented as innocent and
honest victims of a difficult situation. The ghosts are real and
evil; the governess is heroic and good; Miles' death and Flora's
illness are proof of the ghosts' malignant effect and no
responsibility of the governess, who did everything possible to
save the children from perdition. Ghosts are just figments of
our imaginations. There is no science or scientific evidence
behind ghosts. If there were, such evidence would have been
produced for scientific examination long before now and cannot
be scientifically verified. Ghost are caused by the need for the
human mind to fill the gaps in knowledge with “something,”
and when nothing substantial can be found, insubstantial things
are fabricated up to fill the blank spaces. Many people have
frightening personal experiences that to them are real, but to
others they can be seen as thoughts of the imagination or
illusions in response to intense fear. The ghosts are sort of real
but not really that awful; the governess isn't totally crazy but
sometimes intolerable; the children's fate is at least partially her
responsibility. Henry James was known to have had an interest
in the inner lives of children, as both intelligent and mature
members of the world, and as innocent victims of that same
world; we see how sharply Henry James has drawn the children
as innocent victims of adult concerns. At the same time, though,
the children’s victimhood their difficult pasts with Miss
Jessel and Peter Quint, their abandonment by almost all adults
in their lives grants them a kind of seriousness and maturity not
typically associated with innocently youthful children. This is a
ghost story in which the fantasy of one level of meaning
ironically reveals the moral and psychological reality of another

35. level of meaning. The symbolic significance of the ghosts
should be sought in the governess's reaction to them, as it is
ironically qualified by the logic of the narrative itself. Neither
hallucinations nor representatives of a Manichean dualism or a
Puritan asceticism, the ghosts symbolize the origins of human
fear in the adult's sense of sexual guilt a sense which is
inevitably passed on to the child. Thus, the governess is neither
mad nor abnormal, but quite tragically typical, in her inability
to accept the genuine innocence of the children. The loss of
innocence, James felt, could be understood only as a failure in
the individual's personal life failures which, like original sin,
are self-perpetuating as they are passed from generation to
generation.