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Pressure ulcers are an injury that damages skin and the layer(s) of tissue beneath, which have been exposed to pressure (NHS, 2014). They can occur in patients of varied ages; however, the most vulnerable age group who are at risk of developing pressure ulcers are patients aged 75 and above (Hope, 2014). Elderly patients tend to have co-morbidities due to the ageing process, which can sometimes leave them with limited mobility or bedridden and this then can put them at further risk of developing pressure ulcers (Jaul, 2010). Due to having a growing elderly population, it is extremely important to address the risks of pressure ulcers. There is no particular environment in which pressure ulcers occur, as they are a concern in all settings where social care is being provided, medical treatments are carried out including private homes. This paper will review the evidence regarding the risks and management of pressure ulcers. The focus of this paper will be elderly patients and the following topics will be discussed; risk assessment, patient assessment, pressure recognition and removal, non-surgical treatments/advice, complications of pressure ulcers and surgery. On recognition of a pressure ulcer or the possibility of one developing on a patient, a suitably trained health or medical professional should do a documented risk assessment (NICE, 2014). This risk assessment should cover two interlinking areas, risk factors and signs/symptoms. It is important to assess an elderly patients current health status and not just the status of their health as documented previously on records or on admittance to see a professional, as a variety of factors can affect the development of a pressure ulcer some factors more rapidly than others. Questioning into previous medical history and also looking at previous medical notes is often very informative and usually allows the professional to know of any co-morbidity which could present a further risk or act as an indirect cause of the development of a pressure ulcer. Diabetes and musculoskeletal disorders are often flagged up on assessments as a factor which can impact a pressure ulcer (Benbow, 2012). Sometimes due to the elderly patient suffering from a type of dementia, their ability to communicate or remember life events deteriorates and therefore they cannot provide the professional assessing the ulcer with key medical information. Also, some patients may be in trauma or are not conscious; this, again, makes the information gathering stage of the patients current health status difficult for the assessing professional. In such complex cases, the patients wider network such as relations or the multi-disciplinary team of health and social care professionals who have previously supported the patient may have more knowledge on the patients life history. Nursing home staff are required by the Care Quality Commission to keep records of their residents care plans and more specialist homes have routine logs written about their residents; these often can act as a good indicator of physical, mental and behavioural status and changes which have occurred with the elderly patient (CQC, 2015). Determining any other condition which an elderly patient may suffer from is important, because this needs to be considered in the patients care plan and management of the Pressure ulcer as it could have direct impact on the healing of a pressure ulcer. For example, if the elderly patient has diabetes, their wound healing process maybe prolonged ( Leik, 2013). Furthermore, as elderly individuals have thinner skin; this already puts them at greater risk of skin damage due to pressure. Musculoskeletal disease such as osteoarthritis is usually diagnosed in elderly individuals and it can limit the mobility of the patient or their ability to do specific activities (NHS, 2014). This may result in patients being in the same position for long periods of time, which may then put pressure on that area of the body, putting them at greater risk of developing a pressure ulcer. Also, elderly individuals who are less mobile are more likely to have poor circulation, which can impact on the time taken for a pressure ulcer to heal. Therefore, blood flow should also be taken into consideration when doing the risk assessment. Above are some examples of how the management of Pressure ulcers can become complex; there are more diseases such as terminal diseases and other medical conditions that need to be taken into consideration when planning the care or prevention of a pressure ulcer. Often both the lack of nutritional intake and loss of weight are two interrelated common concerns in elderly patients, unless the cause is due to a different factor such as underlying pathology of disease. Therefore, in addition to including these factors in the risk assessment, health education to encourage the patient to eat needs to be provided to the patient, their relations and health and social care staff supporting the patient. Health advice/education/guidance is important because an underweight elderly individual is more likely to have less tissue around their bones and possibly poorer blood vessel quality, hence making them more at risk of damage from pressure and also poorer healing (MNT, 2014). Also, a lack of protein in an elderly patients diet, which supports tissue growth and repair, can also cause greater damage to their skin from pressure. Low nutritional intake can also cause fatigue and frailty in elderly individuals and t his can impact an elderly individuals engagement and ability to do daily activities (Morelli and Sidani, 2011), hence impacting their psycho-social status, which may disengage them from supporting their own health, whether it be by following the guidance of a medical practitioner or by being active in their healthcare decisions generally (Morelli and Sidani, 2011). This then can make patient centred care difficult for those providing care for the elderly patient, as patient choice/preference is compromised and indication of pain, which is usually expressed verbally via description or recommended pain scales such as Braden or Waterlow, may not also be provided by the patient (Nice, 2014 and Benbow, 2012). Therefore, the patients involvement in managing the pressure ulcer is vital. Pain management is difficult in Pressure ulcer management if the elderly individual has an altered perception of pain due to a spinal cord injury or other related nerve damage injuries. This may prevent the patient from recognizing that they have an ulcer developing, hence delaying the treatment of the ulcer (MNT, 2014). Therefore, it is good practice if the elderly individual is a patient in hospital to routinely ask the patient if they have seen any abnormalities on their skin and also recommend them to change positions regularly. Alongside the detailed risk assessment, a pressure ulcer assessment/skin assessment should be done on recognition of a pressure ulcer developing. This is not only to manage the Pressure ulcer but also to be aware of those individuals who may have difficulty, as mentioned above, in detecting changes in their skin or possibly even possess a disability. Complaints of pain from the patient should be considered in the skin assessment, followed by a categorization of the ulcer as a stage 1,2,3 or 4 Pressure ulcer (NICE, 2014). This will include assessing discolouration, variations in heat, firmness and skin moisture. The categorization of the Pressure ulce r is extremely important because it allows suitable preventative measures to be put within the individuals care planning, to try to maintain the skins integrity and to support healing (NHS, 2014). The overall patient assessment will directly impact decisions on the frequency of positioning for the patient and the suitability of the support surface on which the patient is sitting or lying (Benbow, 2012). These changes are vital to pressure removal and hence, managing the development of the Pressure ulcer better because they will be included in a repositioning timetable that health and social care professionals will work to as part of the care plan. The frequency of positioning varies based on the risk, patients physical ability/state and also their acceptance to be regularly repositioned; for example, a patient in a wheelchair may need to be repositioned every 15 minutes due to the pressure of sitting in the same position for long periods of time. Elderly patients who are bedridde n should be repositioned every couple of hours, depending on the need determined in the risk assessment (NICE, 2014). A physiotherapist can often advise on repositioning that will be safe and that will also allow pressure release. Equipment can also support pressure removal. Cushions on wheelchairs not only provide comfort but they can also lessen the pressure on the hip and upper leg area of the body. However, some specialists advise that air, water or foam filled support devices are better than traditional cushions (Benbow, 2012). Small pillows/foam pads can also support areas of the body from touching each other, such as between the knees or ankles. These can also be used for comfort and support when laying in different angled positions; for example, when a patient is lying on their side, their legs may need further support (Benbow, 2012). Reclining chairs/automated chairs can also be set at different positions to support pressure removal. Patients, relatives and supporting profe ssionals need to ensure that the skin of the patient is regularly checked, as repositioning regularly can also cause skin damage due to the skin of an elderly individual being thinner. Specialised mattresses can also reduce pressure in comparison to standard mattresses. Furthermore, some specialist mattresses can be connected to an air flow system which can automatically regulate the pressure, hence making the care and management of pressure ulcers in bedridden patients easier for health professionals or carers/relatives. This may be a change that medical/health professionals recommend to elderly patients at home or even for patients in long term care/rehabilitation; however, research is still lacking on how much contribution mattress change actually has on directly lessening the risk of pressure ulcer development (Vanderwee et al, 2008 and UCSF, 2011) in comparison to other cost effective changes. Depending on the wound of the ulcer and the skin damage, often dressings and oi ntments are used to manage the pressure ulcer and to manage infection. Antibiotics may be prescribed, but not often, as usually antiseptic creams can be applied directly on the wound to prevent the spread of infection to connecting tissues. Ointments and creams may also be used to prevent or treat skin damage such as incontinence-associated dermatitis. The skin assessment should be able to identify those at risk of developing such dermatitis, as these patients often have one or more of the following conditions: incontinence, oedema or dry skin (NICE, 2014). Dressings which have been specially designed to promote wound healing and cell regrowth should be used on a pressure ulcer wound. Examples of suitable dressings include hydrocolloid dressings and aliginate dressings (NHS, 2014). These dressings also can support the regulation of skin moisture, which is important to manage the Pressure ulcer. Research and development into wound repair technology is advancing and specially designed dressings give less trauma to the patient upon removal. Therefore, the correct dressing is vital as unsuitable dressings may cause further skin breakdown. As briefly mentioned earlier in this paper, the patients diet may need altering to ensure that the elderly patient is taking nutrients which will support wound healing. Hydration is also important to maintain skin moisture and avoid flaky skin (Convatec, 2012). Hydrotherapy can also be used to keep skin clean, with possible natural removal of dead cells. In some cases, the wound healing process may be compromised due to necrotic tissue and this dead tissue will need to be removed via a debridement method. Debridement methods vary depending on the clinical situation. Larvae therapy can be used as an alternative method to debridement; this therapy consists of putting maggots on the wound for a few days via a dressing and gauze. Maggots can also promote healing due to the release of a substance that kills bacteria. Sometimes when grade 3 or 4 Pressure Ulcer wounds do not heal or they become complicated cases, surgery is needed. This is usually either surgery which directly closes the wound or flap reconstruction. To conclude, this paper has attempted to cover the overall management of pressure ulcers in elderly patients. Despite, the treatments and clinical practice carried out by medical/health professionals being similar to younger patients, the risks of pressure ulcer development and healing due to the ageing process are different. Also, co-morbidity is more identifiable in elderly patients and skin structure/composition differs due to the thinning of the skin. There are clear guidelines on managing pressure ulcers by NICE; however, further research needs to be done to optimize the management of pressure ulcers in elderly patients (Cullum, 2013). Bibliography Benbow, M. (2012) Management of Pressure ulcers. [Online] Available from: https://www.nursinginpractice.com/article/management-pressure-ulcers Care Quality Commission. (2015) Regulation 17 à ¢Ã¢â€š ¬Ã¢â‚¬Å" good governance. [Online] Available from: https://www.cqc.org.uk/content/regulation-17-good-governance Convatec. (2012) The Role of Modern Wound Dressings in Stage I Pressure Ulcers and Patients at Risk of Pressure Ulcer Formation. [Online] Available from: https://www.convatec.co.uk/media/9572137/aquacel-foam-dressing-shown-to-protect-against-ski-11546.pdf Cullum, N. (2013) Study reveals pressure ulcer research uncertainties. [Online] Available from: https://www.manchester.ac.uk/discover/news/article/?id=10016 Jaul, E. (2010) Assessment and management of pressure ulcers in the elderly: current strategies. Journal of Drugs and Aging. 27 (4). p. 311-325. Leik, M.T.C. (2013) Adult-Gerontology Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions. 2nd ed. Springer Publishing Company: New York. Medical News Today. (2014) What are bedsores (pressure ulcers)? What causes bed sores? [Online] Available from: https://www.medicalnewstoday.com/articles/173972.php Morelli, V and Sidani, M. (2011) Fatigue and Chronic Fatigue in the Elderly: Definitions, Diagnoses, and treatments. Clinics in Geriatric Medicine. 27 (4). p. 673 à ¢Ã¢â€š ¬Ã¢â‚¬Å" 686. National Health Institute. (2014) Osteoarthritis. [Online] Available from: https://www.nhs.uk/Conditions/osteoarthritis/Pages/Introduction.aspx National Health Service. (2014) Pressure ulcers à ¢Ã¢â€š ¬Ã¢â‚¬Å" Treatment. [Online] Available from: https://www.nhs.uk/Conditions/Pressure-ulcers/Pages/Treatment.aspx National Institute for Health and Care Excellence. (2014) Pressure ulcers: prevention and management of pressure ulcers. [Online] Available from: https://www.nice.org.uk/guidance/cg179/resources/guidance-pressure-ulcers-prevention-and-management-of-pressure -ulcers-pdf University of California at San Francisco. (2011) A critical analysis of Patient Safety Practices à ¢Ã¢â€š ¬Ã¢â‚¬Å" evidence report no.43. [Online] Available from: https://archive.ahrq.gov/clinic/ptsafety Vanderwee, K, Grypdonck, M, Defloor, T. (2008) Alternating pressure air mattresses as prevention for pressure ulcers: A literature review. International Journal of Nursing Studies. 45 (5). p. 784-801

Who Is The Only Source Of Knowledge Is Experience

â€Å"The only source of knowledge is experience†(Albert Einstein). This is a famous quote from Albert Einstein saying that all of our knowledge comes from experiences that we have thought out our entire life, and we learn from these experiences to shape our decisions and actions. Our actions and decisions are decided by our brain through what we have learned and experienced to chose what is right and what is wrong. The Brain is a huge networks of neurons that send signals to different parts to achieve certain actions, like the frontal lobe is used for thinking, memory, behavior, and movement. Because of out fascination of the brain and how it works sparked the field of psychology in order to find more about the brain that we did not already know. The field of psychology sparked a fire in different people to find more about the brain and its function, like Wilhelm Wundt who was the first psychologist and from him more famous psychologist came to be known. With out these famou s psychologist we would have a starting point on how the brain works and it would have stayed a mystery. We may not know it but the realm of psychology is all around us in our thoughts and behaviors, and there are examples of this all around us. Some examples of psychology are in school, public and our dreams. Example of psychology in school, When i was in psychology class i was working in group, and i noticed that i was quiet and i let my other group members do the work because they knew the material wellShow MoreRelatedEssay on Definition of Knowledge1036 Words   |  5 PagesDefinition of Knowledge Truth is the essence of all knowledge. Our Knowledge is justified true belief. Everyday people hear and experience things and then choose whether or not to believe them. It is the justification of the knowledge that we acquire that makes something believable to a person or not. 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To what extent might these vary according to age, education, and cultural background? As we grow old we will continue to learn new things in life, weather it’s how to ride a bike or learn about our heritage and certain religions. We constantly increase our knowledge in various ways to help us progress further and develop our brains more which in turn will help us develop ourselves. Of course we will learn from the media, books or from other people

U.s. Department Of Homeland Security Example For Students

U.s. Department Of Homeland Security 1. Purpose Among one of the missions of The U.S. Department of Homeland Security is to protect and preserve the security of the Cyberspace in the country. The principal objective of this Security Plan is to give instructions and direction for the Department’s workers and help the Homeland Security to create best practices and strategies in the IT security system. 2. Scope This policy needs to be applied to all users, employees, contractors, suppliers and to all IT resources such as e-mails, files, data, messages and documents controlled or administered by The Department of Homeland Security. 3. Policy Intention The Department of Homeland IT security policy must be uniform, stable, consistent, efficient, effective and compatible with best practices Information Security in the Department. It is the purpose of this security policy to create and implement the best security plans, strategies, and practices throughout the Department. Also, it is the intention of this policy to create safe and secure Cyberspace. 4. Protecting Cyberspace Building secure and safe cyberspace and Communications system in the country is the top priority of the department. In its kind the Cybersecurity Framework of the Department is the most comprehensive and efficient one. The Department of Homeland Security performing the following activities to secure the cyberspace efficiently: ïÆ' ¼ Checking and assessing organizations capacity of cyber-attacks defensive mechanisms and potentials. ïÆ' ¼ Evaluate organizations decision making and incident response strategies at the national level. ïÆ' ¼ Validate and confirm communication and information sharing methods. Create awareness about new cyber incidents and way of response, and recovery practices. ïÆ' ¼ Review the way of sharing sensitive and private information without compromising the national security interests. 5. Cybersecurity Framework The Framework is a risk-based strategy for conducting Cybersecurity peril and is comprised of three components: The Framework Core, Implementation Tiers, and Profiles. All the above Framework segment strengthens the relationship between business drivers and cybersecurity activities. ïÆ'Ëœ The Framework Core is a collection of cybersecurity activities, aspired results, and appropriate recommendations that are familiar with significant foundation areas. ïÆ'Ëœ Framework Implementation Tiers present a meaning on how The Department observes cybersecurity risk and what kind of method or processes need to follow to control and handle that risk. ïÆ'Ëœ The Framework Profile describes the consequences depend on the Department demands that already chosen and decided from the Framework segments and Sub-segments. 6. Threat Identification The following Information security risks are identified by The US Department of Homeland Security that can compromise confidentiality, availability, and integrity of the system are: ïÆ'Ëœ Administrative, Maintenance, Software and System Design and User Errors ïÆ'Ëœ Denial of service, virus, spyware, trojan, worm attacks ïÆ'Ëœ Unauthorized modification of data ïÆ'Ëœ Electronic Warfare, ïÆ'Ëœ Terrorist act such as Terrorist cyber-attack, ïÆ'Ëœ Natural disasters such as Hurricane, Lightning, Tornado, Volcano. 7. Risk Management The Department risk management includes the following processes: ïÆ'Ëœ Assessing and evaluating all types of Risks ïÆ'Ëœ Evacuating all kinds of Security Controlling Methods and procedures ïÆ'Ëœ Cost and Benefit Analysis ïÆ'Ëœ Recognize and understand Security Constraints ïÆ'Ëœ Assessing security laws, policies, and regulations 8. Risk Assessment Approach The Department risk assessment approach is used information security system analysis to find out security vulnerabilities and to determine lethal threats to the system. Also, the approach efficiently mitigates chances of risks by evaluating the existing countermeasures and by assessing providing cost effective security strategies. The Approach follows series steps to identify threats and to recommend the best security methods and practices. 9. System Vulnerabilities The primary objective of system vulnerability is to determine the weakness of the Department networking system. The system assessing communications, environmental, personal securities and evaluating significant and specific hardware, to identify the vulnerabilities of information technologies in the department. Also, the approach evaluating security controlling systems to check whether they are properly implemented or not. Drugs And Crime (3258 words) Essayï  ¶ The Department Business Systems should develop information technology and other assets security plan. ï  ¶ The Department Business Systems should develop a consistent policy that can be compatible with the organization’s objective, purpose, and structure. ï  ¶ The security policy must define and show clearly and broadly the authorization boundary of each security and controlling systems and applications. ï  ¶ The Security Policy should be able to describe the operational circumstances of the information security asset regarding its missions and business processes. ï  ¶ The Policy need to provide the different security categories and their level of impact on the information asset. ï  ¶ The vital information, assets, and technologies operational environment need to describe in the security policy. ï  ¶ There should be an indication of relationships, connections, and continuity between all information and systems in the security policy. ï  ¶ The Department security requirement and obligation systems need to be summarized and reviewed. ï  ¶ Planned and existed security control methods that are meet the safety requirements of the department need to describe and discussed. ï  ¶ Before the security plan is implemented or activated, it is crucial and necessary to be reviewed, assessed and approved by authorized officials. ï  ¶ The Department of Homeland Security information should be available to all users with their expected responsibility and the rights and limitations of asset usage. ï  ¶ The Department operating system needs to collect evaluation about information and assets risk classification and their information security status. ï  ¶ The business system of the Department needs to design and organize security associated projects that sway its information assets. 13. Plan of Action and Milestones Following the Federal Information Security Management Act of 2002 (FISMA), every information system is needed to create a Strategy of Action and Milestones (POAM) to explain any specified vulnerabilities by analyzing a memoranda and assessment. POAMs create a framework to minimize weakness, and implement suggested security measures, recognize sources and determine related expenses. The proposed safety measures in this security plan need to be incorporated in the Test_2015-01-15-1052 POAM and excited due to The US Department Homeland Security Plans of action and milestones guide requirement to mitigate the standard and the level of jeopardy that affiliated with the system.

Once You Open A Essay With A Quote Samples, You Will Discover How To Be An Excellent Writer

Once You Open A Essay With A Quote Samples, You Will Discover How To Be An Excellent WriterIf you do not have a lot of writing experience, once you open an essay with a quote samples, you can learn how to become an excellent writer. And remember, your lack of experience in this area will not stop you from writing great essays. In fact, your lack of experience can actually help you in many ways.For starters, if you are able to get online with your computer and internet access, you may be surprised at the amount of free essay writing samples. You just need to go online and type the first letter of the word 'sample' to see the vast amounts of material you can find. You will also find that these writings are very varied in length. Once you open an essay with a quote samples, you will notice that they vary in length.But even with that in mind, once you open an essay with a quote samples, you will soon discover that the writing is not always predictable. It will often surprise you. And the problem is that there are so many sources for these writings. So what will you do?With a little imagination, you will soon find yourself opening an essay with quote samples that are well thought out and informative. There are also some writers who make it a point to include a number of links as they open a quote sample, so that it helps the reader in learning more about the subject. This is why you will find that once you open an essay with a quote samples, you will find that you learn something new about the topic that you were studying earlier in the course.Another thing that you should know is that once you open an essay with a quote samples, you will often find that they are written by someone with a lot of knowledge in the field. And sometimes, the writer will be quite willing to share their knowledge with you. And what better way to learn than to learn from someone who has been in the same situation as you.In fact, once you open an essay with a quote samples, you will find th at the writer will give you advice about how to go about doing certain things that you may have overlooked. Most writers will write a general advice section, but will also include a link to another article. In fact, once you open an essay with a quote samples, you will find that most authors include a link to another article. And once you get involved with a link, the chances are good that you will pick up a great deal of knowledge about the topic that you were studying earlier in the course.And as you open an essay with a quote samples, you will find that the writer who has written it will likely give you some valuable tips about how to improve upon the basic information in the essay. And once you open an essay with a quote samples, you will find that they often include a link to another page of material, which gives you even more valuable information. And once you open an essay with a quote samples, you will find that the writer who has written it is highly professional. The tone of the writing is usually very professional, and you will realize that you will get a much better understanding of the topic after opening a quote sample.So when you open an essay with a quote samples, you will learn how to improve upon the basic writing on the topic, which is something that you might have neglected in the past. And when you open an essay with a quote samples, you will get a much better understanding of the topic, and this knowledge will lead to success in your writing.

Ielts Essay Samples Task 1 - the Story

Ielts Essay Samples Task 1 - the Story Top Ielts Essay Samples Task 1 Secrets These IELTS sample essays are categorised in a manner that makes it simple for you to observe how certain essay question types ask that you give certain responses to be sure the question is totally answered. Incidentally, the word professions is somewhat unclear. The very first explanation is that you will be in a position to demonstrate that you are able to say you're sorry in written English. This paragraph demonstrates an outstanding understanding of the necessary grammar and vocabulary. The previous letter is to a friend and has to be informal. Below is an array of useful language for you to utilize in an official letter. Ielts Essay Samples Task 1 Ideas It follows clearly from the prior paragraph that has highlighted these 2 nations. Refrigeration is likewise an important source of emission. Presently, there are more than 6000 languages utilized in 195 unique nations yet most of individuals are communicating with others from other nations in English. But after 1996 the increase of the 2 sectors was noticeably different. The Basics of Ielts Essay Samples Task 1 The action you would like to be taken. General Task 1 questions are composed of 3 unique components. In some instances this could require that you invent information. However, as is true with all kinds of education, the more you learn the more questions you've got! You played ahuge part in us getti ng together and it only makes sense that you are a part of the huge day. Unfortunately, all my yearly leave was used up. When describing trends, it's frequently a very good idea to split the period of time into various components. Finally, why it's happening and how it's affecting you or other folks. The Fight Against Ielts Essay Samples Task 1 The phrases you opt for will be contingent on the context of the question. Firstly, virtual friendships that are formed online might not be genuine. Every test-taker dreams of becoming inside info on the latest test questions. Have a peek at these sample questions. Each paragraph ought to be organised around one key idea. I hope that these sample letters and explanations offer you further comprehension of the way that it's completed. There are a couple minor spelling mistakes. IELTS Request Letter is a formal or semi-formal sort of letter in which you request some info. Included below each letter are comments so that you can understand what's good regarding the example, and, thus, understand how to best write your own letters for IELTS. You need to take care of the tone if it's format letter keep the formal tone otherwise informal tone. You want to make sure that your letter has a structure. Cooling and lighting caused the smallest amount of emissions. The very first chart below shows how energy is employed in a typical Australian household. The very first pie chart indicates the proportion of energy utilized for different purposes in an Australian residence, whereas the second one shows the quantity of greenhouse gases emitted as a consequence of energy consumption. There are two major solutions to lower the degree of obesity. The dam makes a huge reservoir and the powerhouse is the point where the electricity is generated. I would be grateful if you were able to arrange for us a plumber to come and handle the hot water system once possible. In addition to that, folks should quit taking the ready meals containing chemical ingredients, specifically, saccharin. Why Almost Everything You've Learned About Ielts Essay Samples Task 1 Is Wrong The opening paragraph has all of the crucial details about the graph but itparaphrasesthe question. Highlighting also means comparing similar or distinct things because you can see I've done in the very first paragraph. This is very vital to construct a productive software that meets customer expectations. The tone plays an important role along with other vital things that result in the band score of writing task 1. I'll provide you with a comprehensive band 9 model answer.