Compareable between lean and six sigma Article Example | Topics and Well Written Essays - 2000 words

Compareable between lean and six sigma - Article Example Thus this paper will identify the weaknesses and strengths of both Six Sigma and lean and the ways in which they compliment each other. Six Sigma and lean are among the two most commonly used continuous improvement tools (Mousa, 2013, p. 1137). Lean originated out of the Toyota Production System and its focus is on the elimination of waste in production which begins from the time an order is placed and ends when the order is delivered (Pojasek, 2003, p. 85). Six Sigma was introduced by the Motorola Corporation and is designed to eliminate variations in production and services and their processes so that defects are reduced and customer satisfaction is improved (Desai, 2006). In other words, lean focuses on reducing waste, while Six Sigma focuses on reducing defects. Therefore, it has been suggested that when lean and Six Sigma philosophies are combined an organization may benefit from significant improvements in a short period of time at a significantly reduced cost (Mousa, 2013, p. 1137). This paper will compare and contrast Six Sigma and Lean with a view to demonstrating their compatibility and differences for continuous improvement. The paper is divided into four parts. The first part of this paper presents a review of literature on lean and Six Sigma. The second part of this paper provides a comparison of the two philosophies. The third part of this paper will discuss the implications for practice and the final part of this paper will make suggestions for further studies. Lean is a philosophical approach to managing production and consist of facilitating a system for eliminating or reducing waste and any activity that does not add value for the end customer (Dora, Kumar, Goubergen, Molnar, & Gellynck, 2013). At its core, lean is a continuous improvement technique focused on â€Å"just-in-time (JIT), quality systems and team works† (Wong, Wong, & Ali, 2009, p.

Human Genetic Engineering Essay Example for Free

Human Genetic Engineering Essay â€Å"Human genetic engineering is the alteration of an individuals genotype with the aim of choosing the phenotype of a newborn or changing the existing phenotype of a child or adult. It holds the promise of curing genetic diseases like cystic fibrosis, and increasing the immunity of people to viruses. It is speculated that genetic engineering could be used to change physical appearance, metabolism, and even improve mental faculties like memory and intelligence†. (Wikipedia) There are many risks associated with putting genes into a human body while getting the desired results. There are genes that are carried in on viral vectors and we have altered these budgets so that they do not infect a person with a disease. There have been several deaths in gene therapy trials, such as â€Å"Jesse Gelsinger†, in 1999. Genetic engineering has attracted much controversy, pros and cons. There have been cries that scientists are â€Å"playing God† and this will lead to a two-tier society or as some would say; the haves and have- nots. This isn’t any different that the cries that were heard across the world when Louise Brown, the first child to be conceived by IVF treatment, was born. This was in the late 1970’s. Today IVF is a common but expensive fertility treatment. Genetic engineering holds the potential that parents would assemble their children genetically, to be smarter or more athletic or have a certain eye or hair color. It is this genetic engineering of humans that frighten people. They are afraid that we would somehow design the human race. But then again, people say that this could be a benefit to be able to sort out the genes that criminals have and weed it out. It is also said that a genetically engineered human could suffer from a reduced sense of individuality. A cloned child might feel that their future is worth less than a non cloned child. Critics also argue that cloning would encourage parents to value how well child can genetically meet their expectations rather than loving them for who they are. It is also said that with cloning humans, that parents and society would view their children as objects rather than a person with actually feelings. If human cloning becomes a reality and a regular social practice, parents might want to â€Å"play the lottery† and chose their child genetically. One of the saddest parts about genetic engineering is that it could end human individuality. Everyone would want to be skinny, muscular, beautiful, and intelligent and who knows what else. If your DNA could be shaped would you choose inferior traits? This could possibly end artistic expression and individuality, and make everyone predictable, identical, and boring just like a robot.

Direct Advertising of Schedule 4 Medicines to Consumers

Direct Advertising of Schedule 4 Medicines to Consumers Abduwaysi Amie Should Schedule 4 medicines be directly advertised to consumers? This essay will examine a number of arguments for and against direct advertising of Schedule 4 medicines to consumers, but it will argue that schedule 4 medicines should not be advertised directly to consumers. In the last decades advertising has grown and pharmaceutical companies are advertising directly to consumers. These days, consumers are facing the most advance and domesticated advertised about medicine. The research suggests that direct advertising to consumers is both beneficial and disadvantageous to public health in general. The TGA is the only authority that regulates direct advertising to consumers, advertisements for all therapeutic goods must comply with therapeutic good regulation act 1989. There are limits on direct advertisement product containing schedule 3,4and 8 to be advertised to consumers in Australia. Some groups of people argue the rules are too relaxed and are inadequate to enforce the Low that protects consumers ,others supporting direct advertise to consu mers (Mangin 2006), this number is evenly distributed and balanced , both side have been supporting their arguments with evidence. Currently there are a number of methods of advertising medicines to consumers. First type provides information to the consumers to seek treatment from their doctor about a particular problem without naming the drug. The second method is those which advertise their medicine directly to consumers by naming the drug, what it’s used for, how it used, how many tablets you take per days and the price of the drug. The last one is the common type of advertising, product claims such as efficacy, safety and quality of the drug. The entire drugs are subject to different TGA regulatory restriction.(Shaw March 2008) The Therapeutic Good Administration (TGA) is the branch of the Australian Department of Health and Aging, responsible for regulating therapeutic goods, prescription medicines, medical devices and non-prescription medicines including over the counter medicines in order to protect public health and safety. The TGA put in place the systems of national scheduling or classifying medicines to control medicines and chemicals that pose risks to consumers. Medicine is classified according to the level of risk. The TGA classified medicines and poison in to schedule from 1-9.† Schedule 4 (prescription only) medicines and Schedule 8 (drugs of addiction) is regulated by the Poisons Act 1964 and the Poisons Regulations 1965 State legislation). Schedule 4 medicines are Prescription only Medicine are defined by the poison act as this medicines are needed to be evaluated for safety and efficacy and for safe and appropriate use due to the complex nature of the medicine potential toxicity, compar ed with relatively safe over counter drug which do not require a prescription.(Health 2008) Under section 23(2) (e) together with substance or preparations intended for therapeutic use. The safety, quality and efficacy require further evaluation; the prescribing of certain S4 medicines is restricted to medical specialists in some cases Prescription of certain medicines to patients, who are suffering from chronic disease like skin disease and cancer. There are some drugs prescribe by dermatologist, gynaecologist that are restricted to medical practitioners.(C. Lee Ventola 2011) New Zealand and the United States of America are the only countries allowed direct advertising Schedule 4 medicines. This is not allowed by law in the most countries around the world including Australia. Direct advertisements to consumers failed to provide necessary information about the drug, instead they appeal and tend to sell and promote their products. It also contains misleading, inaccurate information.(Barbara Mintzes 2006) Today medicines are available in markets in two main forms in Australia, those required prescriptions from general practitioners and those you can buy directly without prescription(over the counter drug). Pharmaceutical companies can directly advertise to health professionals but not to the general public at all, this will affects the relationship that existed between patient and general practitioner. The health practitioners have good relation with their patients; they have also a legal responsibility in both prescribing the medicine and also informing the potential risk. In 21st t the century people attitude is changing the use of health services by accessing many range of information’s from the media. Restricting direct advertises schedule 4 medicines to consumers are justified due to safety concern. (Mangin 2006) For instance, the most recent evidences direct advertising can cause harm risk to consumer come from Vioxx. There was no enough evidence to suggest that Vioxx is more effective to treat arthritis pain and inflammation it has only benefited reduced risk of gastrointestinal effect. However the trail shows disadvantage outweighs the benefit which increases in heart attack and stroke. Many discussions have raised about the safety effects of direct advertising schedule 4 medicine to the consumer. The US cardiologist argued that the FDA has failed to stop direct advertising; Vioxx to US public, they failed to protect the public health and safety while cardiac risk grew. During those periods Merck has spent more than 500m illion for direct advertising their wonder drug to the world in its five years in the market. Vioxx case was one of the examples about the effects of direct advertising prescription medicine to the public and its potential impacts on individual patients and public health at large, based on the available evidence. Advertising schedule 4 medicine should be banned; it may expose people with serious medical problems. (Barbara Mintzes 2006)It is possible to change the law to safeguard the public from direct advertisement prescriptions medicine. The changes in policy about direct advertise prescription medicine to consumers can assist the connection between public advertising and public health. The people who are supporting direct advertising schedule 4 medicines to consumer argue that freedom of speech, commercial freedom, the right to get important information to consumers, In order to enable them to make a decision. They think direct advertising prescription medicine is very important human right, to know more information about a potential treatment for the disease they suffered from. They believe also access to their health information can be available to them with the availability of the drug, and (Assistant Professor The impact of advertising prescription medicines directly to consumers in New Zealand: lessons for Australia)information what is best for them. Defenders of direct advertise prescription medicine to consumers focused their campaign on the particular class of medicines that treat illness that symptom are already known to consumers. The defendant argues allowing direct advertise to consumers enablement and autonomy. The argument highlights the types patient who will benefit from direct advertise including the following, people those are poor who are an ability to have access health information, those who have temporary conditions, would prefer direct access information and those who have experience managing chronic pain and recurring long term conditions. In general, consumers who are adult they have capacity, entitled and right to make a decision about the products and good and services. The pharmaceutical company believes direct advertising to consumer has played important role in informing and educating the consumer about the condition that are treated by brand name drugs. Advertising schedule 4 medicines to consumers is undesirable because direct advertising does not provide necessary information about adverse effects, alternative treatments and the cost of drugs. According ED Mierzwinski, consumer program director for U.S PIRG.Direct advertising causes â€Å"over prescription of drug for condition people weren’t aware of it, has resulted in massive profit for the industry by preying on vulnerableconsumers† in addition, to discouragement doctor and patient relationship. This advertisement can give misleading information about the brand drug, exaggerate the benefits and under reporting the side effect or risk. The consumers that are exposed to direct advertising constantly think drug is the only solution to a health problem, instead of taking up healthy living, good diet and exercise. The result clearly shows, advertising new drug before fully known serious adverse effects, and current post market surveillance sometimes fails to identify adverse events that of a particular drug, which is heavily endorsed early in the process of production, which can present public health. Vioxx was such drug that mostly advertised in the U.S from 1999-2004. 4On September 30, 2004, Merck voluntarily withdrew Vioxx from the market. Before it withdrew patients requesting for Vioxx by asking the drug relying on the company advertisement they believe the Vioxx is better than other drugs treat the same conditions, not knowing that this drug can cause stroke or other heart problems. benoxaprofen (Oraflex, Eli Lilly) for arthritis, troglitazone (Rezulin, Parke-Davis) for diabetes, cisapride (Propulsid, Janssen) for gastric reflux, ceriva statin (Baycol, Bayer) for high cholesterol, and tegaserod (Zelnorm, Novartis) are other drugs that were heavily advertised to consumers, which have linked to safety risk. .(C. Lee Ventola 2011) Advertising has been the major tools of marketing to consumers for pharmaceutical companies. The profit generated by increasing spending on direct advertisement to consumer by pharmaceutical companies is the main driver of increasing prescription drug and raised the consumer expectation of drug treatment that influence both patients and doctors. The claim direct advertising can provide necessary information that could help the patients about the drug. It has been a point of discussion among patients, pharmaceutical companies and medical professionals in relation to direct advertisement to consumer.one group argues the knowledge from advertising may assist the patients in making decisions with their doctors to have a choice of treatment they need. Others argue advertising new drug to the consumer led to aggressive marketing of Vioxx the drug, which has been found unsafe and risk to consumers, such a case has put big pressure on FDA not to speed up the release of a new drug without pro per clinical trials. In recent times, more people have been calling for cessation of direct advertisement to safeguard consumers from unnecessary effects of direct advertisement and to put limits into misleading and false information. To improve access option for drug treatment, we need comprehensive, unbiased and accurate information. References Assistant Professor, DoP, Ryerson University, Toronto, Canada The impact of advertising prescription medicines directly to consumers in New Zealand: lessons for Australia, To ban or not to ban: direct-to-consumer advertising and human rights ( accessed 08/10 20140 Analysis , Australasian Medical Journal, vol. 2010,3,12, 749-766 pp. 2010,3,12, 749-766 2006, What are the Public Health Implications? ( accessed 09/10 20140 Direct- to- ConsumeAdvertising of PrescriptionDrugs in Canada, Barbara Mintzes, P, Health council of Canada. C. Lee Ventola, M 2011, Direct-to-Consumer Pharmaceutical Advertising( accessed 10/10 20140 Therapeutic or Toxic?’ U.S national library of medicine, National Institute of Health, vol. 36, no. 10 pp. 669-74, 81-84. Health, PSBDo 2008, Requirements for the prescribing , of Schedule 4 and Schedule 8( accessed 15/10 20140 Medicines in Western Australia WA Australia. Show, A March 2008, Direct-to- Consumer S Advertising (DTC) of Pharmaceuticals, Discovery Guides, 14/10/2014. ( accessed 10/10 20140

Advertisement: Greek Statue and Perfume Essay -- Ads Advertise Statues

Advertisement: Greek Statue and Perfume While flipping through the pages of a fashion magazine, my fingers stop abruptly as my eyes catch an image of a nude man holding a clothed woman. The man has a muscular body and is effortlessly supporting the woman who's body is arched backwards, her arms hang in a swan-like manner. On the ground by her left foot lays a paint palette and her right hand is grasping a paint brush. The room that they are in appears to be a studio with press board floors, brick walls, and old unfinished wooden workbenches draped in cloth. The woman is painting a canvas with the image of the nude man. The foreground consists of the artist and the model, the painting and the easel, a stool, and a table with art supplies spread out on top. In the background, to the right of the canvas, stands a life-size statue of a woman facing the wall. The statue is a generic image of Greek statues from around 400 - 200 BC. In the right bottom corner of the page, a bottle of golden perfume called Tabu is superimposed on the page. The caption written in cursive reads, "Blame it on Tabu". There are many instances in which older art works are used in contemporary situations. There is everything from cartoon characters performing in the Colosseum to government buildings modeled after the Greek Parthenon. Images from centuries ago such as those from European cave art, ancient Egypt, ancient Greece and Rome, and from medieval Europe can be seen in magazines and newspapers, television and films, architecture of buildings, etc. These images use the concepts people already have of past artworks to create a specific tone, convey messages, or sell products. The magazine ad for Tabu uses a Greek styled statue to enhance the tone of ... ...indow streaming natural light seems to be the only source of light in the room. It falls directly on the action, the man holding the woman. Their shadows then form flawlessly across the canvas and their profiles are in perfect shape. The statue, which is behind the canvas, is in complete shadows, again signifying the conservative part of the image that hides in the shadows. Why is this picture used to sell perfume? The action in the picture is meant to be something that we all desire. To get the perfume would mean that our wildest fantasies could come true. However, the Greek statue is needed to remind us that this in not always good. The beauty, passion, and classicism are all features of the overall image that are brought on by the clothes and lack of clothes, the idealness of the model's body, and the classic aura of the statue, all aspects of ancient Greece.

Boy in Striped Pyjamas: Otes and Analysis

Area of Study: Belonging Texts of your choosing: Film Title: â€Å"Boy in the striped pyjamas† Composer: Mark Herman A chilling portrayal of the power of society to define belonging, this film depicts the holocaust from the point of view of a young German boy who develops a friendship with a Jewish boy the other side of a barbed wire fence (Auschwitz). A chilling portrayal of the power of society to define belonging, this film depicts the holocaust from the point of view of a young German boy who develops a friendship with a Jewish boy the other side of a barbed wire fence (Auschwitz).Brief Outline to the text: This cautionary tale is about two boys, one the son of a commandant and the other a Jew, who come face-to-face at a barbed wire fence that separates, and eventually intertwines their lives. The novel is set during the Holocaust, Bruno is only nine-years-old when his father is transferred from Berlin to Auschwitz. The house at â€Å"Out-With,† as Bruno calls it, i s small, dark, and strange. He spends long days gazing out the window of his new bedroom, where he notices people dressed in striped pyjamas and rows of barracks surrounded by a barbed wire fence.Bored and lonely, and not really understanding the circumstance of his new existence, Bruno sets out to explore the area and discovers Shmuel, a very thin Jewish boy who lives on the other side of the fence. An unlikely friendship develops between the two boys, but when Bruno learns that his mother plans to take her children back to Berlin, he makes a last effort to explore the forbidden territory where the boy in the striped pyjamas lives.This cautionary tale is about two boys, one the son of a commandant and the other a Jew, who come face-to-face at a barbed wire fence that separates, and eventually intertwines their lives. The novel is set during the Holocaust, Bruno is only nine-years-old when his father is transferred from Berlin to Auschwitz. The house at â€Å"Out-With,† as Br uno calls it, is small, dark, and strange. He spends long days gazing out the window of his new bedroom, where he notices people dressed in striped pyjamas and rows of barracks surrounded by a barbed wire fence.Bored and lonely, and not really understanding the circumstance of his new existence, Bruno sets out to explore the area and discovers Shmuel, a very thin Jewish boy who lives on the other side of the fence. An unlikely friendship develops between the two boys, but when Bruno learns that his mother plans to take her children back to Berlin, he makes a last effort to explore the forbidden territory where the boy in the striped pyjamas lives. Explain the belonging that is represented in the text: Perceptions and ideas of belonging, or of not belonging, vary.These perceptions are shaped within personal, cultural, historical and social contexts. A sense of belonging can emerge from the connections made with people, places, groups, communities and the larger world. People may cons ider aspects of belonging in terms of experiences and notions of identity, relationships, acceptance and understanding. Through Boyne’s novel, the boy in the striped pyjamas it reveals how belonging can enrich our identity and relationships. This would subsequently portray how acceptance and understanding may be obtained through the enrichment of one’s identity.Key examples that develop belonging in the text: â€Å"A home is not a building or a street or a city or something so artificial as bricks and mortar. A home is where one’s family is†¦Ã¢â‚¬  â€Å"You're my best friend, Shmuel, My best friend for life. † â€Å"He looked the boy up and down as if he had never seen a child before and wasn’t quite sure what he was supposed to do with one: eat it, ignore it or kick it down the stairs. † â€Å"Are you allowed out? Why? What have you done†¦? â€Å"I’m a Jew† â€Å"We’re not supposed to be friends, you and me. We’re meant to be enemies. Did you know that? * clearly proves that there is a sense of the friends belonging to a relationship however there is always going to be the idea of not belonging to each other because of the cultural and moral situations they are put in, hence why they believe that they are meant to be â€Å"enemies† â€Å"He used to be a doctor once, but gave it all up to peel potatoes. † * The destruction that is caused upon a miserable man, because of the beliefs he has. There is a lack of integrity making him become their slave as he is a Jew   html http://www. enotes. om/the-boy-in-the-striped-pajamas http://www. bookrags. com/studyguide-the-boy-in-the-striped-pyjamas/ The Boy in the Striped Pyjamas is a poignant tale of events, Written by John Boyne and published in 2006 by David Fickling Books, the story was made into a major motion picture in 2008 based on the events occurred during WWII through the eyes of an eight-year-old boy. Bruno i s the bright-eyed son of a German soldier. When Bruno's father is relocated, the entire family has to move to the countryside. Although Bruno is proud that his father is a soldier, he lets his disappointment of leaving his friends show.There is a constant use of dramatic irony, through the idea that Bruno does not understand or know about the life they are entering however there is a common background understanding that all viewers will understand. This is evident when Bruno notices what he believes to be a farm with strange farmers who only wear striped pajamas. Whereas, we understand the reality of it, in which the farm is a concentration camp in which Bruno's father has been put in charge of. Fueled by curiosity, Bruno defies his mother and ends up at a corner of the fence that is not guarded.Once there, he meets Shmuel, a Jewish boy the same age as Bruno. The boys become friends quickly, even though Bruno has been told by his teacher and a frightening young Lieutenant Kotler tha t Jews are â€Å"evil. † Mark Herman, director of films such as Brassed Off and Hope Springs gives us a profound tale of innocence. The Boy in the Striped Pyjamas could be the most heartbreaking film about the holocaust since Schindler's List. Although there is no physical violence shown in the movie, outrage at the injustice of it all is still felt; the boys should be able to play with each other without fear of getting in trouble.Children should not have to go through what Shmuel does just because they are different. It is the idea that there is a visual confusion and the dramatic irony is so important in conveying the injustices. There are times when Bruno's courage fails him. When Lieutenant Kotler asks him if he gave Shmuel food, he denies the truth so he won't get in trouble. But the audience can forgive him for these mistakes just as quickly as Shmuel does. With the idea of dramatic irony again, it’s the concept in which the audience takes many journeys of the b oy’s sense of belonging to each other and to their friendship however not belonging as utcasts. Bruno's innocence is what makes The Boy in the Striped Pyjamas so Stirring. When he asks his father what is burned in the chimneys, the audience feels a sense of turmoil because they know the truth. Bruno just doesn't understand what he's seeing. It explores the beauty of a child's innocence in a time of war, the common desire we all have for friendship, and the fences—both literal and figurative—that we must all navigate and choose whether or not to break down.

The Pearl Essays - The Pearl, Literature, Film, Cinema Of Mexico

The Pearl Essays - The Pearl, Literature, Film, Cinema Of Mexico The Pearl Character Analysis of Kino from The Pearl Kino, a character from the story The Pearl, is a prime example of a developing character. From the start through to the end, he develops drastically. At the beginning, he was thought out to be a good loyal husband but as time went on he became a selfish, greedy person who would do anything for money. When the story began Kino seemed to be a good husband who wanted nothing more than to be able to support his family. After a scorpion had stung Coyotito, Kino prayed that he would find a pearl not to become a rich man but so that he could pay the doctor to heal the baby, as he would not work free. After Kino had spent long hard hours searching the ocean floor, he finally found the pearl he had worked for. At first when he found it, he only wanted to pay the doctor to cure Coyotito. However as time passed he began to think of all the things that he could acquire with the money form the pearl and began to develop greed and selfishness. When people asked him what he would buy now that he was a rich man, he was quick to list several items that came to his mind. One of these items was a rifle. Kino wanted a rifle because he wanted to show power over the rest of his village. When Kino took the pearl to the pearl buyers to sell, he was offered one thousand pesos. Kino declined that offer claiming that his pearl was The Pearl of the World. By reacting in such a manner he yet again demonstrates his greed. It is not about saving Coyotito anymore, for he is already feeling well, it is now about the money. Although one thousand pesos was more money than Kino had ever seen he demanded that he would get fifty thousand pesos. Later in the text, Kino discovers Juana trying to destroy the pearl, causing Kino to become very angry, and resulted in him beating her. Although Juana was in very much pain she accepted the beating as if it were a punishment and stayed with Kino. A while later Kino was attacked by another man who wanted the pearl for himself and defended his pearl by killing the man. It is around this point in the story where Kino displays his greatest point of greed and selfishness. When Kino gets ready to attack the trackers Coyotito lets out a cry awakening one of the sleeping trackers. The tracker on watch described the cry as being the cry of a baby, however, the tracker who had just awaked described it as being a coyote. The tracker on guard then lifted his rifle and shot in the direction of the sound. This sparked the deadliest of fuses in Kino, which turned him from a normal man into a fearsome, uncontrollable, machinelike man killing everything in it's path. When Kino returned to the village he looked at the pearl and began to realize the effect it had on him, his family, and his village, and decided to throw it back into the ocean where it came from. Kino has paid a large price to learn such a valuable lesson, that we should not let greed and our want for something to overcome us and let us lose sight of the important things in life such as family, health, and life itself.

Health care organizations essay part 2Essay Writing Service

Health care organizations essay part 2Essay Writing Service Health care organizations essay part 2 Health care organizations essay part 2Health care organizations essay part  1The growing number of patients of Veterans Health Administration New England Medical Centers naturally leads to the question of increasing the number of beds. However, at the moment, Veterans Health Administration New England Medical Centers tend to refuse from increasing the number of discharges to open additional beds because of the lack of financial resources and poor funding. In this regard, the high costs of health care services and inability of patients to cover their health care costs or insurance virtually force Veterans Health Administration New England Medical Centers to refuse from increasing the number of beds because patients will be unable to uncover the increased costs of Medical Centers.Another important issue that Veterans Health Administration New England Medical Centers are dealing with is the transfer patients to the next level of care from the emergency room. As they receive patients f or the treatment in emergency rooms they need to transfer them to another unit of care. However, Veterans Health Administration New England Medical Centers face the problem of the proper transfer of patients because of their limited inpatient capacity (Fuchs Emanuel, 2005). At the same time, this problem emerges in the result of the poor communication between units of Veterans Health Administration New England Medical Centers. As a result, they may have difficulties with the delivery of inpatients from the emergency unit to the target unit. For example, a patient may be transferred from emergency unit to another unit, where the patient is transferred to the target unit. Such extra transfer of the patient occurs because the emergency unit fails to communicate properly with the target unit.  In such a context, Veterans Health Administration New England Medical Centers face the problem of the transformation of delivery of care to improve the discharge process/patient flow. The trans formation of delivery of care to improve the discharge process is an essential step because the failure of the discharge process puts under a threat the overall effectiveness of health care services delivered to patients. In other words, the poor discharge process can deteriorate the quality of health care services, if Veterans Health Administration New England Medical Centers fail to discharge patients fast and accurately. If they lose time, while discharging patients from the emergency unit to the target unit, they may prevent other patients from obtaining urgent medical care and deteriorate the performance of other units, if patients are wrongfully discharged to a unit other but the target one.Therefore, the introduction of the change is essential to improve the performance of Veterans Health Administration New England Medical Centers and to prevent the failure of the discharge process because this problem can trigger the overall decline of the quality of health care services pro vided by Medical Centers, the decrease of the confidence of patients in the quality of health care services and professionalism of health care professionals working in Medical Center, and the deterioration of the quality of life of patients of Medical Centers. The resolution of the problem should involve the improvement of the patient flow management and discharge process (Altrichter Gstettner, 1993). In this regard, it is possible to recommend the enhancement of the patient flow management and discharge process through the improvement of the communication between emergency unit and other units. The introduction of modern information technologies and telecommunication systems along with electronic medical records for each patient may resolve the problem and enhance consistently the patient flow and discharge process management in Veterans Health Administration New England Medical Centers.The introduction of the change involves three stages: unfreeze, change, and refreeze (Lewin, 20 07). This model developed by Kurt Lewing (2007) is applicable to Veterans Health Administration New England Medical Centers, which can introduce the change aiming at the improvement of the patient flow and discharge process management through the introduction of new technologies and telecommunication systems to enhance the information sharing and communication within Medical Centers, particularly between emergency unit and other units of Medical Centers. Each step of the change is crucial and steadily leads to the successful introduction and assimilation of the change within the organization.The first step is unfreezing the change. In fact, this is the first and probably the most important step toward the change. The unfreezing stage implies the understanding of the necessity of the change by the management and staff of the organization. Therefore, managers and employees of Veterans Health Administration New England Medical Centers should become aware of the urgent change that has t o be implemented in the field of the patient flow and discharge process management. The understanding is an essential condition of the implementation and acceptance of the change by the staff of Medical Centers. In this regard, managers of Veterans Health Administration New England Medical Centers should conduct the detailed study of their organizational performance. For example, SWOT analysis conducted above reveals the persisting gap between the patient flow and discharge process management and the quality of health care services that Medical Centers can deliver to their patients (Schein, 2009). As a result, managers can become aware that the change is urgent and essential.However, the unfreezing stage implies not only the understanding of the problem by managers but also by other members of the organization (Wetherbe, 2006). Therefore, managers of Veterans Health Administration New England Medical Centers should communicate the problem to other employees working in Medical Center s and suggest a solution to the problem. For example, they can communicate to health care professionals working in Veterans Health Administration New England Medical Centers that the introduction of new information system and modern telecommunication system along with medical health records will improve consistently the quality of the patient flow and discharge process management. Managers should justify the change and emphasize key benefits of the change, including the improvement of the quality of health care services delivered to patients, the facilitation of the employees’ performance, the decrease of the risk of miscommunication between professionals working in Medical Centers and others (Miner, 2005). As managers communicate the project of the change to employees, they should receive the feedback from employees and take into consideration their suggestions and remarks concerning the change (Weber Weber, 1994). After that managers should develop the plan of the change t o prepare it to the further introduction that will take place at the second stage of the change.The change is the second stage of the implementation of the change. In fact, this stage is the implementation of the change proper. The implementation of the change should occur according to the change plan. In case of Veterans Health Administration New England Medical Centers, it is possible to recommend outsourcing the supply of the required technology and telecommunication systems required for the proposed change along with the introduction of electronic medical records for all patients. The outsourcing will facilitate the introduction of the change because Veterans Health Administration New England Medical Centers will receive a ready and working product that will allow Medical Centers to introduce it immediately (Schmitt Simonson, 2007). The training of the staff may be required to help health care professionals to use the full potential of the new information system and telecommuni cation system along with electronic medical records to enhance the patient flow and discharge process management.At the same time, the implementation of the change should be accompanied by monitoring and control from the part of control officers appointed by managers of Veterans Health Administration New England Medical Centers. Control officers will monitor and control the change to find out whether the implementation of the change matches the plan or not. Control officers will also assess the effectiveness of change and how it has influenced the performance of Veterans Health Administration New England Medical Centers and professionals working in Medical Centers. They should also measure the impact of the change on the quality of health care services and effectiveness of the patient flow and discharge process management. For example, they may use the measurement of the patient satisfaction to assess the quality of services delivered by health care professionals working in Veterans Health Administration New England Medical Centers. They can also measure the time spend on the discharge and transfer of patients from emergency unit to other units as well as they can measure cases of re-transfer of patients from units, where they were delivered from the emergency unit, to other units. In such a way, control officers will notice whether there are any improvements and what improvements exactly have occurred within Veterans Health Administration New England Medical Centers.Finally, the last stage of the change is refreezing. The refreezing stage implies that the change becomes an integral part of the organizational culture and it is not actually the change anymore but the integral part of the organizational performance (Wilkins, 2009). The refreezing stage involves the assimilation of the change into the organizational structure and operations. In case of Veterans Health Administration New England Medical Centers, the refreezing of the change means that employees wi ll use the new information system and telecommunication system along with electronic medical records on the regular basis; they will be proficient in using the new system; and the new system will have a positive impact on the organizational performance that means that the problem of the poor patient flow and discharge process management will be resolved (Mohrman, 2008). Moreover, employees of Veterans Health Administration New England Medical Centers should not take the change for the change anymore. Instead, they should take the new system for granted and they should use the new information system to manage patient flow and discharge process more effectively and succinctly.Thus, Veterans Health Administration New England Medical Centers need consistent changes to improve the quality of the patient flow and discharge process management. At the moment, Medical Centers face the problem of the low quality of the patient flow and discharge process. As a result, patients may fail to be t ransferred from the emergency unit to the target unit fast that deteriorates the quality and speed of the delivery of health care services to these patients as well as other patients, who need the urgent medical aid. The proposed solution involves the introduction of the new information system that will facilitate the communication between all units and professionals within Veterans Health Administration New England Medical Centers. Hence, they will be able to manage the patient flow and discharge process more effectively.

According to CRC- Healthcare Factbook Essays

According to CRC- Healthcare Factbook Essays According to CRC- Healthcare Factbook Paper According to CRC- Healthcare Factbook Paper Health is a state of complete physical, mental and social well being, not merely the absence of disease or infirmity.† –World Health Organization This is the most common definition of health today. But, are people really achieving the ideal heath today. According to CRC- Healthcare Factbook (1990) the health care delivery system is the totality of all policies infrastructures, facilities, equipment, products, human resources, and services that address the health needs, problems and concerns of all people. Both public and private sectors maintain their own health facilities (such as hospitals, clinics and diagnostic centers). Preventive health care is a major concern of the government-owned health centers while curative care is provided by hospitals, both government and private. The health of individuals and communities are, to a large extent, affected by combination of many factors. A person’s health is determined by his circumstances and environment. It is inappropriate therefore to blame or credit the person’s state of health to himself alone because he is unlikely able to directly control many of these factors however, knowledge of these factors is important in order to effectively promote health and prevent illness. It is also important to note that in understanding the multidimensional nature of health, the public health nurse will now be in better position to plan and implement health promoting interventions for individuals and communities.

Impacts and Contributions of the Trent Guide Term Paper

Impacts and Contributions of the Trent Guide - Term Paper Example This one-time project will remain forever since it has never been done by any other students. It will help to establish a genuine guide for the future changes within the Trent International Program. The other impact it will have is on the future international students. It will offer them a juncture to change the guide according to the real information about the Trent University and Peterborough. The impact of the project will also be on the digital technology since many students will be able to scan the guide information online before downloading it. This is an implication that online businesses such as the cybercafà © business will grow well around Peterborough. The Trent guide is useful because it is not only concerned with certain individuals but the whole society within and outside the Trent University. The Trent guide is responsible for the development of some programs, which are profitable for the international students. During the implementation and the designing processes, t he students do many types of research, as a result, they get a high level of knowledge and experience concerning the development of the project. Other new students who have an interest in developing their own projects will refer to the Trent guide project. The other contribution that this project will offer to new and other continuing students is that they will refer to it whenever they want to discover ways of developing a project.They will also learn how one handles challenges experienced in the process of the implementation and designing of the project.  

Critically explore the strengths and limitations of case study Essay

Critically explore the strengths and limitations of case study research with children and young people in exploring issues of race and ethnicity - Essay Example y looking at past works by Ince (2004) that focused on a small group of young black people leaving care as well as Maniam’s et al (2004) study on various methods that can be used in exploring issues of race and ethnicity. Research with children and young people is critical. It can advance understanding of how they develop and live, can contribute to theoretical debates, and its outcomes can impact directly and indirectly on the lives of those researched and others in similar situations. In this case, the study focuses on young people as well as children in reference to issues of race and ethnicity. The function of case study method in research becomes more outstanding when social issues such as drug abuse, racial segregation, poverty and ethnicity are considered. Prominence of case studies as a research technique gained recognition when researchers started raising more and more concerns regarding the limitations of quantitative methods. This was particularly in availing holistic and in-depth explanations for social and behavioral conditions. Superiority of case studies lies in the fact that the research approach incorporates both quantitative and qualitative data; these sets of data are utilized to elucidate both the procedure and result of a phenomenon through comprehensive observation, reconstruction and analysis of the case study under scrutiny. Ince (2004) carried out a qualitative research with a small group of black care leavers, through the research she demonstrated the young blacks’ identity problems resulting from their limited contact with their families and community. The research also brought to the forefront the impacts of racism as well as open and indirect discrimination in these children’s lives. Maniam et al (2004) seemed to favor use of case studies as he stated that bringing forth qualitative data on racism would be one way of researchers wittingly colluding with racism. He cited that to overcome inadequacies that have resulted due to a

Features of educational websites Essay Example | Topics and Well Written Essays - 1500 words

Features of educational websites - Essay Example Moodle has a sister website called www.moodle.com which is mostly used for commercial purposes and to provide other services that are necessary for the development of the organization. Moodle provides a software package that helps the teachers or educators to make learning look easy. The emphasis is more on creating right environment for the educators to understand the nuances of teaching. Moodle claims the software package helps the educators to master in creative teaching and create effective online learning communities. The home page of Moodle is user friendly. The layout structure is not bad and browsing the website is not that difficult. On the left pane of the website all the services provided by the organization can be seen and can be navigated easily. The Moodle's publish yearly newsletter that helps users who are new to the website and provides much needed information about the activities and achievements of the website. The middle pane presents briefly what the website is providing to the users. Some of the information is highlighted and when anyone clicks on the highlighted image the user will be taken to the next page related to the topic he/she clicked. One of the important features of the website is users can navigate by selecting the preferred language. The website provides community discussions in English and several other languages such as Spanish, French, German, etc. From the standpoint, overall the site gives an average look. It's not attractive and does not have any special features to pull the traffic. Though it claims to be OSI certified, who knows OSI is. Nowadays websites are certified by some organizations that no one knows. Other important aspect is the information is not well organized. It looks as if all the stuff has been put together. They should have given space to put the information at right places. www.atutor.ca ATutor copyrights are reserved by Adaptive Technology Resource Center or in short ATRC. It is an open source web based Learning Content Management System or in short LCMS. It helps tutors by providing the necessary the tools to develop the presentation style. Installing the software package can be done in minutes and the LCMS has been designed with accessibility and adaptability in mind so that when students navigate through the module can understand the topic easily. One of the important features of this software package provided by ATutor is it can be updated easily. To give Atutor a new look custom templates can be developed with ease. With ATutor quick assembling, packaging, distribution and redistribution of Web-based instructional content, retrieving, importing prepackaged content and conducting online courses is made easy. Since the whole teaching method is based on graphical user interface system and web based applications browsing the website is easier. In general when a student misses a class, he has to get the information by borrowing fellow student's notes. But with ATutor even if the student misses the class he can come to the website at any time and can view information required just like in real time environment. Thus saving the much-needed time. Overall the site is good and provides the required features for the educators and tutors. The homepage layout structure is attractive

Film review for JAWS 1975 Coursework Example | Topics and Well Written Essays - 500 words

Film review for JAWS 1975 - Coursework Example However, eventually the things go out of hand, leading to many killings and mayhem, until the man-eating shark is killed by the police chief Brody. The movie is actually a gripping sequence of exciting and nerve wrecking scenes. One of the scenes in the movie that evokes intense excitement is the one in which the police chief Brody, a shark hunter Quint and the marine biologist Hooper try to hook the man-eater shark, when suddenly an enormous great white shark emerges from behind the boat, imbuing the audience with much anticipation and fear. The other memorable scene in the movie is the climax when the trio Quint, Brody and Hooper are shown struggling helplessly against the big shark. This scene keeps the viewers hooked with an unsettling anticipation and a risky aura of expectation, when eventually Brody saves the day by his presence of mind. There are many characters in the story that sustain and maintain the tension inherent in the storyline with their specific peculiarities and character traits. Not to mention, the most important character in the story is that of the police chief Brody (Roy Scheider), who with his inherent premonition of the impending doom, keeps the audience stuck to the edge of their seats. The other interesting character is that of the marine biologist Hooper (Richard Dreyfuss), who throughout the movie, tries to balance the surrounding atmosphere of anxiety and suspense by bringing in some scientific explanation pertaining to the dark force targeting the town. It goes without saying that the immense box office success of the Jaws could be attributed to its extraordinary ability to keep the plot tout and the action enervating by its mind boggling tension, above normal levels of horrid anticipation, deep and creepy suspense, a disturbing aura of anxiety, and an intimidating sense of anticipation (Nowell-Smith, 1997, p. 515). However, the one ethical weakness of the movie is that it projects the sharks as an animal in

Psychology of Performance research about my next project Term Paper

Psychology of Performance research about my next project - Term Paper Example After long wanderings Charles returns to the coop just to learn painful truth- dead chickens were infected with bird flu and were killed by the elder and the cow to prevent contamination. Emma knew everything and also wanted to save the lives in the coop. Charles becomes involved into a process of birds â€Å"saving† by killing those which caught the flu but fails to kill his friend Marcy. Finally all chickens and hens die because of the virus and Charles finds out that he has become a main killer himself. The genre can be characterized as adult animation because the scenario is written mostly for the audience older than at least 16-18 year olds. The animation is surreal and mock with main heroes acting like people in the similar to criminal world situations. Obviously, the film incorporates a big quantity of violence and has a plot that is a bit difficult to follow for younger audience. Some details are intentionally shown with attention to injuries and aggression. The film, however, has adult sarcasm which can be understood by the auditory with good sense of humor. The animation also explores some adult social and philosophical issues with major hero dealing with the difficult choice. The audience might mostly consist of men probably because the animation does not have many female characters and any typical attractions for women such as romantic story. The only â€Å"woman† in a film also does not have a good reputation which shows that the world described is a â€Å"men`s world†. However, Emma, the only hen, is shown as brave, loyal, and decisive who can be appreciated by more women nowadays. As the animation is full of scenes of aggression and risky behaviors the film must evoke anxiety in audience first of all. However, taking into account that it is still looks a bit ironical to observe hens and chickens acting like criminals, this emotion can be mixed with amusement and irony. In some cases the

Cliffside Orchards Case Study Example | Topics and Well Written Essays - 2500 words

Cliffside Orchards - Case Study Example Cliffside Orchards generated its first profit in the year 1989. Then, the Hermans were operating as wholesalers. By the end of the year 1990, however, the Orchard recorded fewer profits as a result of a decline in crop yields. The Hermans decided to venture into farmer markets such as Sandpoint, Codalaine and Spokane. Jeff Herman stated that this â€Å"was a big change, emotionally and spiritually.† The couple states that when they began, 32 years ago, they lacked the technological advantages and technical knowhow that is enjoyed by many farmers today. Jeff, however, acknowledges Phil Unterschuetz’s publication on Organic Integrated fertility Management publication as a crucial guide that helped them through the numerous challenges that they faced over the past 32 years such as the Alar scare of 1989. The couple has witnessed firsthand the effects of unsustainable agriculture and the use of extreme chemicals in crop growth. As such, they have endeavored to adopt healthy crop growth practices for the sake of their children and the environment. The Cliffside Orchards has been a success story for farmers all over fighting for the cause of purely organic agricultural practices. Part of the couple’s objectives is to provide an example of how maintained organic practices can yield healthy and nutritious tree ripened fruit that is sweet.

Film review for JAWS 1975 Coursework Example | Topics and Well Written Essays - 500 words

Film review for JAWS 1975 - Coursework Example However, eventually the things go out of hand, leading to many killings and mayhem, until the man-eating shark is killed by the police chief Brody. The movie is actually a gripping sequence of exciting and nerve wrecking scenes. One of the scenes in the movie that evokes intense excitement is the one in which the police chief Brody, a shark hunter Quint and the marine biologist Hooper try to hook the man-eater shark, when suddenly an enormous great white shark emerges from behind the boat, imbuing the audience with much anticipation and fear. The other memorable scene in the movie is the climax when the trio Quint, Brody and Hooper are shown struggling helplessly against the big shark. This scene keeps the viewers hooked with an unsettling anticipation and a risky aura of expectation, when eventually Brody saves the day by his presence of mind. There are many characters in the story that sustain and maintain the tension inherent in the storyline with their specific peculiarities and character traits. Not to mention, the most important character in the story is that of the police chief Brody (Roy Scheider), who with his inherent premonition of the impending doom, keeps the audience stuck to the edge of their seats. The other interesting character is that of the marine biologist Hooper (Richard Dreyfuss), who throughout the movie, tries to balance the surrounding atmosphere of anxiety and suspense by bringing in some scientific explanation pertaining to the dark force targeting the town. It goes without saying that the immense box office success of the Jaws could be attributed to its extraordinary ability to keep the plot tout and the action enervating by its mind boggling tension, above normal levels of horrid anticipation, deep and creepy suspense, a disturbing aura of anxiety, and an intimidating sense of anticipation (Nowell-Smith, 1997, p. 515). However, the one ethical weakness of the movie is that it projects the sharks as an animal in

Cliffside Orchards Case Study Example | Topics and Well Written Essays - 2500 words

Cliffside Orchards - Case Study Example Cliffside Orchards generated its first profit in the year 1989. Then, the Hermans were operating as wholesalers. By the end of the year 1990, however, the Orchard recorded fewer profits as a result of a decline in crop yields. The Hermans decided to venture into farmer markets such as Sandpoint, Codalaine and Spokane. Jeff Herman stated that this â€Å"was a big change, emotionally and spiritually.† The couple states that when they began, 32 years ago, they lacked the technological advantages and technical knowhow that is enjoyed by many farmers today. Jeff, however, acknowledges Phil Unterschuetz’s publication on Organic Integrated fertility Management publication as a crucial guide that helped them through the numerous challenges that they faced over the past 32 years such as the Alar scare of 1989. The couple has witnessed firsthand the effects of unsustainable agriculture and the use of extreme chemicals in crop growth. As such, they have endeavored to adopt healthy crop growth practices for the sake of their children and the environment. The Cliffside Orchards has been a success story for farmers all over fighting for the cause of purely organic agricultural practices. Part of the couple’s objectives is to provide an example of how maintained organic practices can yield healthy and nutritious tree ripened fruit that is sweet.

Define Culture Essay Example for Free

Define Culture Essay â€Å"A person without the knowledge of their past history, origin and culture is like a tree without roots.†- Marcus Garvey. This says that a person is defined by his or her culture by the way he/she acts, thinks, and speaks. A person is defined by his or her culture by the way he or she thinks. A person see’s the world differently so the way they think and act would be distinct. They would think differently because of the different backgrounds that they have. In the story â€Å"Imagine†, it says â€Å"you may say I’m a dreamer, but I’m not the only one. I hope someday you’ll join us and the world will live as one†. John Lennon explains how people think he’s different because of what he is. He also says how people aren’t all the same but he wishes that one day we were. He wishes that one day we will all see the world the same and we would be the same. A person is defined by his or her culture by the way he or she’s history, family tree, and he or she’s way of life. A person is defined by his or her culture because it effects the way they act or speak. In the story â€Å"Where I’m From,† George States â€Å"leaf fall from the family tree† This example from the text explains that every detail, moment, or where she is from in the poem is from her family tree. It’s saying the poem are moments or cultural things that effected her or shaped her as a person. The things she shares in the poem are all from her families history or culture (family tree). Although others may argue that culture doesn’t effect your education, other people don’t always agree,because their culture has taught them everything they know.An example on how culture defines your education is that people can attend any school , but when they are being taught, they realize that it is different from what they know. In the story, â€Å"An Indian Father’s Plea,† the protagonist argues, â€Å"My son is culturally â€Å"different.† If you ask him how many months are in a year he will probably tell you 13. He will respond this way not because he doesn’t know how to count but because he was taught by our people that there are 13 full moons in a year.† This quote demonstrates that even though he is Indian, he is culturally different because his culture has taught him what he knows. Your families history, education, and your view or the way you think all contribute on how your culture defines you. It’s obvious that any person would benefit from he or she’s culture.

Skills Development for Child Nursing Course

Skills Development for Child Nursing Course Provide an in-depth reflective account that demonstrates how learning, during the three years of the child nursing course, has been achieved in relation to two areas of your practice which has informed and enhanced your development towards qualification as a Childrens Nurse. Introduction Reflection is a vital component of the development of nursing competence and reflexive nursing practice. Although reflection functions on many levels, including the personal level, in allowing student nurses to review experiences and incorporate them into their internal schema, one of the most important levels of reflection is the process of asking questions about practice, and through asking those questions learning about the self in practice, and the role of the nurse (Bowden, 2003). Reflection is an important aspect of developing competence in practice, as well as developing practice itself (Durgahee, 1998; Gustafsson and Fagerberg, 2004). Some authors view the ability of the nurse to reflect on practice and in practice as a fundamental component of providing truly holistic and client centred care (Gustafsson and Fagerberg, 2004), while others view reflection as a self-limited, flawed and biased practice which is of little or no use to developing nursing professionalism (Jones, 19 95). I believe that reflection, if properly used and structured, provides powerful insight into the self, into practice, and into the ways in which competence and practice develop over time and through experiential learning. Therefore, I have concluded that to make reflection effective and useful, it is important to use a reflective model, such as that of Gibbs (1988), which I have chosen for this essay. Although there are limitations to Gibbs’ (1988) model, particularly in applying it to the requirements of this essay, it provides clear guidance and useful questions to ask about the experiences that contribute to the reflective process. I have adapted this cycle to suit the processes and analyses of this essay, and so, while two cycles of reflection are outlined below, the conclusions are developed collectively. For the purposes of this essay, the final stage of the cycle is to be found within the Appendix (see Appendix 1), and thus the Action Plan is adapted to become the P ersonal Development Plan. The purpose of this essay is to engage in an in-depth, detailed process of reflection on two areas of practice and learning that have been important to me through my studies in the three year child nursing course. Using a reflective cycle to guide and direct the reflective process, I will explore the process of professional development, towards competence and expertise, in relation to Benner’s (1984) stages of development, examining the nature of competence in each designated area of practice. The first chosen area of practice is the skill of managing an intravenous infusion, because the use of intravenous infusions and the provision of intravenous medications is an important component of many clinical paediatric nursing scenarios, and the management of intravenous access and infusions is particularly problematic when nursing children. The other area of practice and nursing professionalism chosen is communication, with a particular focus on the development of communication skills with staff, in relation to the nursing handover within the acute hospital environment, and the development of communication skills with patients, using the example of providing health education and promotion for a patient with Type 1 diabetes. I have chosen to focus on specific examples of communication skills in practice because these relate strongly to my own experiences, and also allow for a deeper and more critical analysis of practice and my own development. This will also allow for a more co ncrete development of a personal development plan to encompass identified development needs and actions to achieve these during the first six months of practice as a Registered Children’s Nurse. The focus on critical analysis allows for the development of a skill of great value for my professional practice, deconstructing practice and reviewing it in the the light of other knowledge (Burns and Bulman, 2000). However, because of the complex nature of practice, and the reflective processes which question feelings and thoughts as well as actions, the reflective process is complex (Wilkinson, 1999). Thus, although there are two issues being reflected upon, they are drawn together in one discursive thread which signposts the learning and development, the acquisition of professional understanding, which signifies the transition from novice to competent practitioner. Discussion 1. Clinical Skill Development: Intravenous Infusion and Medication Management in Children’s Nursing Practice. Description: What Happened. During the three years of nurse training, the development of the skill of managing intravenous infusions, either of hydration solutions or of medications, was one which I developed almost from the beginning, when it was taught as a clinical skill in the university setting. The typical approach to teaching clinical skills was to provide the students with a lecture on the relevant theory, complemented by a practical skills session to apply the knowledge in a simulated environment, utilising mannequins. Every acute ward area of my clinical practice involved the care of patients with intravenous infusions, which included caring for children while the intravenous cannula was inserted, and then monitoring and care of the intravenous cannula site, and of the infusion itself. This skill was therefore not only a basic skill for nursing competence throughout my training, but also an important opportunity to promote health, prevent infection, and was fundamental to other aspects of care and tre atment. Over the three years, I first learned how to set up an intravenous infusion, safely and in a sterile manner, how to check the infusion, and how to check the infusion rate manually (ie, without the use of an infusion pump, although infusion pumps are standard best practice in children’s nursing). During clinical practice, I learned how to support a child during the cannula insertion, monitor the site, check the infusion and infusion rate, set up and check different types of infusion pumps, and how to change the IV line (which must be changed regularly). I also learned complementary skills such as drug and dosage calculations for infusions, and fluid balance calculations, both of which required numeracy skills Feelings: what were you thinking and feeling? Throughout my training, management of intravenous infusions was stressful, but in particular, the associated aspects of care were challenging. Supporting children who have intravenous infusions is problematic, particularly as the experience is often painful and distressing for them. Carrying out drug calculations was terrifying at the beginning of my training, and even by the end, despite increased competence and confidence, I would still have more than one colleague check calculations and dosage rates, and check infusion rates on pumps, to ensure I had made the correct calculations. I felt very lacking in confidence in this area. I also felt that while I focused on safety aspects of IVI use, including risk management and prevention of infection via the IV site, other colleagues did not seem to pay so much attention to this aspect of care. Evaluation: What was good and bad about the experience? It was good that I identified important aspects of this clinical skill, and the complexities of practice surrounding it. What was not so good was the lack of transparency in colleague’s practice, particularly in my earlier clinical placements. Analysis: What sense can you make of the situation? I became aware during my reflection on this element of my learning that it was very much something which became assimilated into the almost intuitive elements of nursing competence (Benner, 1984). This was because apart from the elements of the process which had been identified as distressing for the child, such as cannula insertion and removal, managing the IVI had become ‘second nature’, and checking the line, site and rate of the pump were activities that the qualified nurse carried out without any overt signifying of the action, as part of her interactions around the patient/bedside. Thus, making this overt was almost counter-intuitive. Certainly, it appeared to me that many staff did not record these observations every time they were made, and that they did not always communicate these observations to others, including me, as a student. As a student, a learner, I was required to take more time over such observations, to note their significance, and to evaluate their place within my nursing work. I was required to develop specific skills around the use of IV infusions and the management of whatever medication or fluid was being infused. This was a protracted learning process, which developed throughout the three years. I learned the importance of this for my practice. â€Å"Possible complications associated with short peripheral venous access include infiltration of infused fluids (nonvesicants) into the surrounding tissue, extravasation of vesicant medications or blood into the surrounding tissue, and phlebitis† (Hinkle and Hadaway, 2006 p 122). The clinical skill here also, therefore, included the component of determining when such complications had occurred. I also had to learn to observe for infusion reactions, which could range from mild to severe (Hinkle and Hadaway, 2006). Competency can be viewed as behaviours which are achieved or approved of in relation to the completion of a task, and competency is described in relation to that task (Gonczi, 1993). However, developing competence in IVI management is much more than simple task proficiency, and this may be true of much of professional competence in nursing (Preston and Walker, 1993). Not only does it appear that no single clinical requirement can be reduced to single task, but also, competence in that task may be affected by other contextual factors, including the presence of others, and how their contribution or lack of it can affect performance of clinical actions (Ashworth and Saxton, 1990). If we view competence as the ability to manage any situation holistically, making use of collaboration with colleagues (Meretoja et al, 2002), then even this process of reflecting on a clinical skill is very limiting, because the skill alone does not signify the whole of the learning process associated with th at area of practice throughout my training. One of the important elements of learning around this particular skill, however, was the gradual recognition of my own competence, which was signified most clearly when I no longer become ‘overt’ about assessing the IVI and monitoring it, but carried out this activity as part of my practice, almost automatically. Here, the skill had many facets, but this kind of ease was never achieved with the drug/dosage/infusion rate calculations. Numeracy competence is important for nurses, and nurses are required to demonstrate acceptable levels of numeracy in order to qualify (Bath et al, 1993). However, this was an area I struggled with, not because I had ever considered I had difficulties with numeracy, but because applying numeracy to clinical situations seemed to make drug calculations much harder. Over time, I found that if I visualised the calculations myself first, and wrote them out longhand, then checked them with a calculator, I usually reached the right conclusion, which showed that my own learning style influenced my ability to come to the right answer(Bath et al, 1993; Galligan, 2001). Hinchliff (2004) descrives Bloom’s (1972) learning domains, and this learning experience, throughout the three years, involved all three areas: cognitive, psychomotor, and affective. In relation to the cognitive domain, I learned knowledge to underpin practice, consolidated this knowledge over time. In relation to psychomotor skills, these were about the practical ability to carry out necessary procedures and actions, including running fluids through an IV line, identifying, choosing, priming and setting up the correct line for the correct infusion pump, and the skills around removal of the cannula and dressing of the cannula after insertion, along with changing an IV bag. The affective domain refers to the attitude formation, which can be seen above to be about a positive attitude but an internalisation of much of the knowledge and practice to the point that aspects of these procedures became almost innate. It became apparent that this clinical skill could not be viewed in isolation, and also incorporated a great deal of discussion with the family and the patient, and in the case of most children, informing them of the need to take care of the IV line, and educating them about infection control, thus engaging them in their own care and in their own health promotion (Long et al, 2008). Prevention of trauma to the IV cannula or site, and ensuring maintenance of patency of the cannula and line, are important in minimising the amount of times the cannula needs to be resited, which is desirable because of how distressing this procedure is for most babies and children (Thomas, 2007). I became aware of this after viewing resiting of cannulae in a number of patients, most often due to either traumatic accidental removal. 2. Professional Skill Development: Communication in Practice: The Nursing Handover. What Happened During the three years of training, communication was identified as a professional skill, and it soon became apparent that this skill formed the basis of the majority of nursing actions and roles. Because of the complexity of communication in nursing practice, during this reflection I chose to focus on one aspect, that of providing handover for a designated patient, or group of patients, under my care, to the nurse taking over care. Engaging in this activity was a significant aspect of my development. Initially, in the first clinical placements, I observed this taking place, but did not really understand all the components of the process. Over time, I was encouraged by mentors to provide the handover report myself, and I found this demanded communication and information processing skills perhaps unique to the process and to the situation. I discovered that I needed to know the terminology and abbreviations used, the format of the report, and to remember the patient information and pr ovide a comprehensive report that did not omit important elements of care. During the initial experiences of this, I did miss out elements of care, but was always supported by a mentor who could augment my limited report and ensure patient needs were communicated. However, by the end of my clinical experiences I was expected to provide reports myself, and I did so, but became increasingly aware of the limitations of this form of communication, and of how it had become ritualised in practice (Strange, 1996). Understanding the nature of this element of communication became an important element of my learning, perhaps because I had found it so difficulty initially Feelings: what were you thinking and feeling? During successive experiences of handover, I came to a growing realisation that the format and nature of the handover report was not only extremely ritualised (Strange, 1996), but also constituted a unique form of communication, with certain expected behaviours and standardised formats. However, I started to feel, quite early on, that information was not necessarily being fully communicated, and I found myself increasingly frustrated with the process, because instead of providing a comprehensive report, it was more a kind of focused tick list of tasks, which did not really relate to my concept of holistic approaches to nursing care. I found myself learning how to give a ‘proper’ handover but wishing I could give a ‘good’ handover. Evaluation: What was good and bad about the experience? The good aspects of this experience were the fact that I was able to identify what was happening, and able to realise that I was frustrated with the process of handover, and the way it had become habitual. This prompted me to explore the evidence base surrounding this important aspect of nursing communication, which then enhanced my understanding. However, to cite what was bad about the experience, I must focus on the limitations of the process, because it made me feel that the handovers were, quite often, inadequate, and very limited, reducing patients to a list of problems and actions. Having said this, it also became apparent that handovers conducted at the patient’s bedside were an entirely different entity, and that communicating at the bedside included the patient and their family in the handover, and made them much more holistic and comprehensive. But it may not be appropriate to do this in all situations. Analysis: What sense can you make of the situation? Developing professional skills is part of the complex acquisition of nursing competence, and this process can be viewed as an apprenticeship of sorts (Benner, 1984). Much of the professional competence that is assessed during nurse training is related to the standards set out by the Nursing and Midwifery Council (NMC, 2004), and are realised through a process of learning, negotiation and assessment which predominantly occurs through clinical practice. While a lot of this learning is directed and planned, development is through experiential processes, as in this case, in the development of the required verbal communication skills for providing ‘handover’ report. This emerged as a significant area of practice for me, particularly in relation to responsibility and autonomy after the transition from student nurse to staff nurse, because of the different expectations of the latter role. While in relation to performance, clinical skill and professional skill, the senior studen t nurse and the newly qualified staff nurse are similar, in relation to role and responsibility, and expectation, there is a sudden shift and competence takes on new meaning for the newly qualified nurse (Wade, 1999). Thus, I can see that my concerns about the nursing handover, and my ability to provide an appropriate, comprehensive report, were very clearly linked to this notion of responsibility, because a poor handover could impact on patient care (Sexton et al, 2004). The nursing handover report is a process which involved the communication of key information about patients on the ward, care plans, actions and imminent needs, and about the stage of their care journey (McKenna, 1997). It usually occurs as a communication between nurses at the point of shift change (McKenna, 1997), but it can also take place when a patient is transferred from one clinical area to another. According to Hopkinson (2003) the nursing handover is an important and significant activity in the hospital setting, relating to the proper management of care and the provision of continuity of care (Kerr, 2002). Although handovers have the same basic function, I have observed that they can vary from ward to ward, but that within each location, they seem to have a certain format or shape. While in some areas tape recorded handovers are used, in others, the staff provide a handover at each bedside. More commonly, handover occurs in a designated room (to ensure confidentiality), and may then in some circumstances be followed by a ward round to introduce the next shift to the patients and their family. It is important to include the family in this communication, because most sick children are accompanied by a parent or carer during their stay in hospital, for a large proportion of the time. The nurse may either hand over the care of one patient, a group of patients, or the entire ward, if they have been the nurse in charge of the ward for that shift. This requires that the nurse providing the report must have a thorough and comprehensive knowledge of the patients, their needs and diagnoses, trea tments, and any pending results or procedures. Not only is it a process of communicating this information, it is also the time when colleagues might ask questions about care, and therefore also serves to demonstrate what the nurse has achieved, or not achieved, during the preceding time period, and tests the nurse’s knowledge of the patients. Yet some evidence suggests that handovers are limited and undermined by forumulaic approaches to providing the information, by incomplete communication, use of cryptic terminology, jargon and abbreviation, and can require that nurses have ‘socialized knowledge’ in order to understand them (Payne et al, 2000). Thus, it can be difficult for the student, or even the newly qualified staff nurse, to fully understand this communication because they perhaps are not fully socialised into the clinical area. Terminology and units of language may acquire different significance in specific areas of practice (Payne et al, 2000). Another identified limitation is the tendency to prioritise biomedical and physical aspects of care, reducing the patient to their disease and its treatment (Payne et al, 2000). The handover forms the initial part of the process of care planning for the nursing staff taking over care, although this is supplemented by a thorough examination of the patient records, and discussion with the patient and family. Having observed and participated in such processes, it is understandable that this communicative act developed some significance for me in relation to professional development, particularly in relation to future practice as a qualified staff nurse. Competence takes on new meaning at this transition (Amos, 2001; Ashworth and Saxton, 1990), because it signifies the point when I have to become responsible and accountable for my own actions, with no one else to cover any inadequacies or mistakes (Gerrish, 2000). Because it is viewed as a fundamental component of good quality nursing care (Pothier et al, 2005), ‘getting it right’ is understandably important. Handover can be viewed as a communicative act from a number of perspectives. It provides a forum for discussion, debate and questioning, as well as expressing one’s views and feelings about a particular case or cases (Hopkinson, 2002), which to me suggests that it is more than simply the presenting of information, but is also a form of self-expression for the nurse. However, it’s main purpose is to provide the information that nurses will then use to formulate their plans for care and their prioritisation of their workload for that shift (Hopkinson, 2002). For example, in one handover a colleague did not inform staff that a chest X-ray had been carried out, which meant that the next shift ordered another chest-X ray with resultant delays and confusion. Providing a good quality handover may be more significant than ever in the current clinical paediatric nursing environment, where every aspect of healthcare appears to have become more complex, requiring more multiprofessional input and collaboration, and in which patients are subject to complex and multifactorial assessments (Pothier et al, 2005). There is some evidence to suggest, however, that important patient information can be lost during the shift handover (Pothier et al, 2005), which reinforces my own conclusions about this communication. This may not, however, be due to simple acts of omission, but also due to the culture of ward areas and the ways in which nurses behave and exercise power, albeit a small degree of power, over the information they possess (Hardey et al, 2000). Some research suggests that the handover process is where tensions an institutionally-derived conflicts and drivers for nurses can become evident (Parker et al, 1992). It would seem that it is more tha n a simple process of dialogic communication (Kerr, 2002), but also serves a range of other functions, including social and protective functions (Strange, 1996). To me, this knowledge and understanding of the deeper and wider aspects of communication, of what is being communicated, how and why, during this process, signifies the journey of learning and development as a student nurse. Initially, I was the novice, viewing this process as a mere interchange of key information. Gradually, however, I developed an intuitive knowledge of the handover and its communicative role, intuition based on experience and on the processing of a range of cues and sources of information (Benner, 1984), leading to a degree of awareness that the handover signified more than simply an exchange of facts. It demonstrates competence in communication, but in adherence to cultural roles and expectations, and the ability to mange the competing demands and tensions of the nursing role (Kerr, 2002). Thus it empha sises a shared valued system amongst the nurses within the given context (Lally, 1999), which in some ways can demonstrate competence and acceptance, of me by qualified colleagues, signifying I have achieved nurse status, but also which can mean an enforced compliance with local behaviours and expectations which may be at odds with my own philosophy and principles of professionalism. Therefore, I realised that the communication skills of the nursing handover are both verbal and personal, involving managing myself, managing information, and managing the work environment and my colleagues (Lathlean and Corner, 1991). Achieving competence in the effective verbal communication skills associated with the handover is problematic, because from all that I have learned through my education, and my exposure to the ideals of professional nursing, the handover should be a detailed, comprehensive communication delivered without jargon or abbreviations, and which is inclusive of the patient and their carers. However, the conventions of the handover in different areas may oppose this. This is an area of development identified as important for my personal development plan. Conclusions The first conclusion I draw from this reflection is that it is impossible to see any area of nursing competence, or any clinical skill, as a discrete entity or area of practice. Every skill and professional role is inextricably linked with others, with aspects of practice, with other skills, demonstrating the complexity of practice and of the learning and development processes which lead me towards expertise and confidence, as well as basic competence. As I have demonstrated above, managing an intravenous infusion involved a range of skills and actions, including numeracy calculations, risk management and prevention, health promotion, patient support and education, care planning, and communication. Thus, it becomes evident that what may be identified as a discrete clinical skill intersects with multiple areas of practice and competence. This perhaps reflects holistic models of nursing, because it demonstrates that the nurse cannot deconstruct practice to such an extent as to make it fully task oriented, due to these intersections and the interconnectivity of different tasks. It would appear, from my reflections, that the ideals of ‘holism’ which are expounded in relation to nursing ideologies and philosophies can be viewed on the ‘micro’ level in practice, as well as the ‘macro’ level of the nursing philosophy. Every part of clinical practice is an element of a complex, yet connected, ’whole’, and therefore, competence in every part of practice is important in order to provide optimal standards of care in every respect. This is an important realisation for me, and one which I believe to be appropriate for this stage of my development. It might be that coming to this realisation earlier on in my professional development journey would have been too overwhelming. Coming to this realisation now, when I can signpost my own learning, development and competence, is more motivating than challenging, because it underl ines my commitment to providing the best possible care that I can, which in turn must be based on ongoing professional development, diligence and a focus on the patient’s needs. The second conclusion I draw from my reflective processes is that while a reflective cycle can guide reflection, it cannot provide the answers to the questions that are raised. The value of reflection lies in the ability to take those questions, answer them honestly, and to seek out the knowledge and information required to explore those answers in relation to practice as well as in relation to the self. As with my previous point, the process of professional development has led me to understand my role as one aspect of a greater whole, a complex network of professionals and roles, where roles and activities may overlap, but where the competence of each individual contributes to the whole, and where, if one component is missing, or lacking in some way, the whole is affected. If my communication skills are insufficient, this affects the work of others, their ability to meet patients’s needs, which impacts, sometimes significantly, on patient wellbeing and the patient experience. For children, who are perhaps the most vulnerable patient group, the impact is likely to be greatest. Therefore, reflection is no mere academic exercise, it is the means by which I can remind myself of my place within this network, and value my contributions whilst also appreciating the responsibility of my future position. Again, this is a motivation to provide excellence in practice, to ensure the continued quality of the whole. While the development of nursing expertise is viewed as a foundation to professionalism (Hodkinson and Issit, 2004), I would argue that expertise is still poorly defined because in nursing it is very complex, and the intersections of various domains of practice are blurred, such that, for example, clinical skills are inseparable from other skills. Personal effectiveness in the nursing role may be more important in terms of professional development (Hodkinson and Isset, 2004). There are implications of this, however, for my role as a newly qualified staff nurse, because the change in expectations (on my own part and on others’), may lead to challenging transitions and some degree of reality shock (Evans, 2001). My reflections here have identified the fact that the socio-occupational integration into my qualified role is probably the most problematic (Evans, 2001). However, it is apparent that having engaged in a good degree of reflective practice throughout my training, I have developed the skills to be able to analyse and reflect upon experiences and situations, and to take this reflection further, by applying theory and evidence to my own practice. This requires not only a great degree of professionalism, but a commitment to ongoing professional development, preparing myself for the transition (Yonge, 2002), and continuing to view my working life as a continual process of learning and development. References Agnew, T (2005) Words of wisdom. Nursing Standard 20(6),pp24-26 Amos, D. (2001) An evaluation of staff nurse role transition. Nursing Standard 16 (3) 36-41 Andrews, M., Gidman, J. and Humphreys, A. (1998) Reflection: does it enhance professional nursing practice?. British Journal of Nursing 7(7) 413-7. Ashworth, P. and Saxton, J. (1990).On competence. Journal of Further and Higher Education, 14, 3-25. Bath, J.B., Blais, K. (1993). Learning style as a predictor of drug dosage calculation ability. Nursing Educator 18(1), 33-36. Beaney, A.M., Black, A., Dobson, C.R. et al (2005) Development and application of a ris

The Black Death Essay -- essays research papers

The Black Death   Ã‚  Ã‚  Ã‚  Ã‚  Considered one of the worst natural disasters in world history, the Black Death came through Europe in 1347 A.D. It ravaged cities and town, causing a death to the masses, and no one was considered safe. The Plague is any epidemic scourge or calamity for which remedies are difficult to find, and according to the encyclopedia, plague is a common term for a disease of rodents that occasionally cause severe human infection. Named for the black spots that appeared on the victims’ skin, the original disease originated from Oriental Rat Fleas and black rats. It first infected Mongol armies and traders in Asia, and then began moving west with them as they traveled. There was no natural immunity to the disease, and standards of public health and personal hygiene were nearly nonexistent. It is believed that if people had not fled to nearby cities in hopes of escaping the plague, it might not have ever spread like it did. In the end, it passed through Italy, France, England, Germany, Denmark, Sweden, Poland, Finland, and even up to the island of Greenland. City dwellers were hit the hardest due to the fact of crowded streets and the lack of sanitation. Up until the mid-15th century, recurrent epidemics prevented the recovery of Europe’s population to pre-plague levels. The Black Death was an important turning point for the history of Europe. This time was â€Å"the beginning of the end of the medieval period and the start of a social transformation of the continent.† The social and economic impacts of the plague were so huge, economics, politics and the European society would never be the same again.   Ã‚  Ã‚  Ã‚  Ã‚  The plague took on three different forms, each with its own unique way of killing. The most common, bubonic, was considered the mildest form, with a mortality rate of thirty to seventy-five percent. A person with this would be seen with enlarged lymph nodes in the neck, arm and groin regions, with headaches, nausea, body aches, and a high fever. The pneumonic plague was the second most commonly seen form of the Black Death. Only five percent of its victim’s survived, infecting the lungs, causing a person to cough and vomit blood. The least common form, but most deadly, with a one hundred percent death rate was the septicemic plague. Even today, if a person were to come up with this form of the... ...omes fell, resulting in the piles of accounts which survived the period of the Black Death. Many villages and hamlets were deserted and never inhabited again. Feudalism seemed to end with the coming of the Black Death, and many believe the two are directly related. Feudalism is known as the system of service in return for a grant of land, burdening the peasant with many obligations to his lord. The payments involved in feudalism were to be paid upon entering any land holdings, marriage, death, or any other occasions by which the individual lord and peasant agree. The plague seemed to speed up this process by dramatically reducing the number of peasants, and communication accelerated the matter.   Ã‚  Ã‚  Ã‚  Ã‚  Landlords tried their best to keep a cap on the rising wages and changing social ambitions of the peasants, but there was too much chaos in the system at the time. Lords and peasants were both looking for the highest wages they could possibly take. Because of this, no matter who you were before the plague hit Europe, anyone who survived the plague, additional wealth from the rise in wages and accumulated holdings of land hold by plague victims was in store.

Boeing 700 :: Essays Papers

Boeing 700 The Boeing 700’s are very capable of handling duties in the commercial and military world. The Boeing 700’s are capable of handling many tasks in the commercial and military world. With the introduction of the 707 in the late fifties to the most recent 777 in the early nineties the, 700’s have dominated the commercial world for five decades. They are a line of aircraft that are capable of handling many roles from basic civilian transport to various military needs. They are the people movers of the 20th century. Each with a large carrying capacity combined with the range of a jet aircraft they have moved more people longer distances than what was once thought possible. Boeing has truly produced some of the greatest aircraft in history. The various duties that the 700’s perform are quite extraordinary. It all started in the fifties. There was a growing demand for a commercial airliner that could move a greater number of people farther and faster. The age of the jet engine still had not reached to civilian transportation. There was still a fear of the jet because of lack of reliability, but with the advancement of technology the jet engine now had become more even reliable than the piston engine. The need for a jet engine powered plane was growing. Airlines still were looking for a plane that could cross the Atlantic Ocean without a refueling stop. The Lockheed Super Connies, a piston powered plane, were able to cross the Atlantic Ocean with out stopping on the eastbound leg, but they had to stop in Gander, Newfoundland to refuel on the westbound leg. The airlines desired a plane that could easily travel the Atlantic with out a stop. The piston engine just wasn’t going to do it, the jet engine was the answer to the question. Boeing realized this and moved to look for a design for a jet powered plane. At first Boeing was looking to modify existing aircraft with jet engines to perform the tasks. They quickly realized that they needed a whole new aircraft. The Boeing 707 was born. The first Boeing 707 was delivered to Pan America airlines in May of 1958 (Bauer, 218). Sales started out slow in fact the 707 almost died many times in it’s first couple years of existence.