5 Countries Where Spanish Is Spoken but Not Official

Fast Food Is The Reason For Obesity - 955 Words

Fast food is the reason to blame for obesity. Food made and prepared in a matter of minutes should certainly raise some flags. ---- Roberto De Vogli states in â€Å"†globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies† that â€Å" the diffusion of ‘fast food restaurants’ resulting from rapid global market integration (Hawkes 2009) and trade liberalization policies (Thow and Hawkes 2009) seems to be one of the key contributing factors behind the sharp rise in obesity†(395-396). Getting greasy foods for dirt cheap and consuming they quickly can certainly cause harm. Whereas the fast food industry is good for the economy, one can prevent obesity by using healthy eating habits given that one can avoid it by not eating fast food. Fast food plays a big part in today’s economy. Toby Parcel states in â€Å"One Firm, Two Labor Markets: The Case Of McDonalds in The Fast-Food Industry† that â€Å" the role that this industry plays in our nation’s economy is substantial and is expected to increase through the remainder of this century as the shift of our economic base from an industrial to a service orientation nears completion†(30). Most of today’s jobs have moved towards a service based economy and â€Å"the service sector is now two-thirds of the U.S. economy and of the 2.3 million new jobs created between November 1982 and February 1984, 70% were added in the retail and fast-food Industries†(Parcel 30). So without the service sectorShow MoreRelatedIs Fast Food Really The Main Reason For Childhood Obesity?907 Words   |  4 PagesIs fast food really the main reason for the rise in childhood obesity? No, it is not their fault. In fact, I believe the main reason for child hood obesity is the parents. Most parents care about their kids but yet they allow them to eat unhealthy food, watch television for long periods of time, and reward them with food. Although, the cause of childhood obesity is debated. Two of the main causes is food choices and advertisements. Exercise is critical, it is an important part in keeping your bodyRead More Fast Food Companies Are NOT Responsible For Obesity Essay1000 Words   |  4 PagesToday, many people eat fast food instead of home made food. The reason is that fast food is fast, cheap and convenient. However, at the same time, fast food is contributing to a big social problem in the U.S., which is obesity, and recently some people are beginning to sue the fast food companies for causing their obesity. Should the fast food companies have responsibility for Americans obesity? My answer for this argument is No. I think that whether people eat fast food or not is an individualRead MoreObesity Fast Food Nation Essay661 Wo rds   |  3 PagesFast Food Nation Obesity has grown into a rampant issue all over the United States, over the past few decades. Fast foods also have increased their outlets in the nation, in turn, depicting a success in the business venture. It is clear that fast foods have become quite cheap in comparison to healthy, homemade meals. Subsequently, people have turned to eat fast foods for economic reasons. Convenience is yet another reason behind people’s high indulgence in eating fast foods other than healthy,Read MoreFast Food1018 Words   |  5 PagesToday, many people eat fast food instead of home made food. The reason is that fast food is fast, cheap and convenient. However, at the same time, fast food is contributing to a big social problem in the U.S., which is obesity, and recently some people are beginning to sue the fast food companies for causing their obesity. Should the fast food companies have responsibility for Americans obesity? My answer for this argument is No. I think that whether people ea t fast food or not is an individualRead MoreHow Fitness Can Overcome Fast Food642 Words   |  3 Pages Anytime you hear the word obesity, you can almost bet the two words â€Å"fast food† will not follow too far behind. For some odd reason, people of the society seem to think eating fast food causes the large rate of obesity. At the end of the day, obesity is caused by several things and not just eating fast food. While it is true that fast food is easy to reach, good to taste, and cheap when it comes to the budget, obesity can still be lowered by simply working out and staying fit. The government hasRead MoreFood And Hospitality Investigation Questions1231 Words   |  5 PagesFood and Hospitality investigation Question 1: What are the health issues that come with fast food? Question 2: How is fast food being marketed to children? Question 3: Does fast food play a role in obesity? Introduction Fast food is food that is already cooked so there isn’t much of a waiting time. This is why fast food is so appealing instead of spending hours over an oven making a meal you don’t even need to get out of your car to get it. Fast food has been around for nearly a century now, butRead MoreThe Dangers Of Being Big1398 Words   |  6 Pagesfor the I-search paper is Obesity and the foods which cause it. The reason why I chose this topic Is because I wanted to learn more about the food which leads us to become obese, also the dangers of being over weight. Another why I chose this topic is because I think its interesting that our country isn’t doing much about this epidemic of obesity. Also I wanted to go more in depth about the food industry and what they are doing in order to sell less fattening food. Fast Food Restaurant, are they doingRead MoreChildhood Obesity And Its Effects On America1394 Words   |  6 PagesHave you ever wondered what are the major causes of obesity? The CDC (2017) states that one out of every five children in the U.S. are overweight or obese, and this number is continuing to rise. Wilson (2016) states that many children who are obese develop health complications, such as joint, gallbladder, and sleeping problems. The majority of children who are obese as kids tend to be obese as adults. Reason being, many children develop bad eating habits by learning from their surroundings. WhenRead MoreMan Vs. Food : Fast Food Can Contribute To Childhood Obesity1267 Words   |  6 Pages Man vs. Food: Fast Food Can Contribute to Childhood Obesity The United States of America has always been a safe and well-constructed country. Over the past years, it has tried to progress in numerous ways. However, America is suffering daily from obesity issues that can be prevented. America is becoming uncontrollable when it comes down to the consumption of too much fast food. When fast food was introduced to Americans, it had many advantages. These advantages have suddenly converted into disadvantagesRead MoreObesity : How Obesity Affects Your Life?938 Words   |  4 Pages How Obesity Affect Your Life? Bassam Zedan Jefferson Community and Technical College How Obesity Affect Your Life? In the United States today, obesity has become an enormous problem. In the last three decades, the number of people overweight has increased dramatically. Obesity effects the individual carrying the extra weight around, of course, but it also affects society as it is left up to the government and other health care facilities to address these issues and treat

Human Condition free essay sample

The Bible begins with the story of Adam and Eve, who are soon expelled from the Garden of Eden for eating from the tree of knowledge. Accordingly, Adam and Eve are enlightened of their humanness. This new knowledge sets them apart from other creatures of the world. After their expulsion from the Garden, Adam and Eve are forced to toil and procreate-two â€Å"labors† that characterize the Human Condition. The tale of Hester and Dimmesdale recounts that of Adam and Eve because, in both stories, sin results in expulsion and suffering. Yet it also leads to knowledge, particularly the knowledge of what it is to be human. The Scarlet Letter emphasizes the association between sin, knowledge, and the Human Condition. Hester is ushered into a sort of exile while wearing the scarlet letter, her punishment for adultery. She no longer worries as much about appeasing the desires of society. This leads to her thinking more boldly about society and herself. We will write a custom essay sample on Human Condition or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page â€Å"The scarlet letter was her passport into regions where other women dared not tread. Shame, Despair, Solitude! These had been her teachers,—stern and wild ones,—and they had made her strong, but taught her much amiss† (Hawthorne 134). Hester’s punishment leads her into a â€Å"moral wilderness† lacking rules or guidance. This is ironic in that her punishment was intended to aid in her atonement, but instead leads her even farther astray. Hester’s mind is amidst a struggle with the aftermath of her sin. Her contemplation of her sinfulness leads to feelings of affinity and an understanding of others. She begins to do public service by bringing food to the poor, nursing the sick, and becomes a source of aid in times of trouble. These actions make it appear as though Hester may be accepted regardless of her sin. However, the Puritan superiors view all sin as a threat to the community that should be punished and suppressed. Throughout the story, Hester is portrayed as intelligent and capable, but not extraordinary. By doing these services to her society, Hester has found a way to assuage her need for redemption. Reverend Dimmesdale was the counterpart in Hester’s adultery, but his sin remained hidden until his death. The knowledge of his sin is unknown to all but himself and Hester. To Dimmesdale his sin is an affliction to which he can find no rest. He attempts to find treatment in his burden by holding late-night vigils, fasting, and even scourging himself with a whip. His struggles allow him to empathize with human weakness. The hindrance of his sin gives him â€Å"sympathies so intimate with the sinful brotherhood of mankind, so that his heart vibrated in unison with theirs† (95). Dimmesdale reaches a new understanding of how sin can affect others. This new empathy draws out Dimmesdale’s most powerful and impassioned sermons. Roger Chillingworth is another character agitated by sin. When Chillingworth first arrives in the colony he deceives the townspeople and tells them he is a physician. His primary sin is that of vengeance. He vows he will find the man that Hester committed adultery with, and that he will have revenge. Completely opposite of Hester, Chillingworth’s mind is at peace with his sin. His body, however, becomes more and more deformed as time goes on, portraying that his need for vengeance is causing an outward effect. It soon become evident that his desire for revenge is boundless, I will hunt this man as I have hunted truth in books; as I have searched for gold in alchemy. There is a sympathy that will make me conscious of him. I shall see him tremble. I shall feel myself shudder, suddenly and unexpectedly. Sooner or later he will be mine (50). While sin leads to important self-discoveries for Hester and Dimmesdale, it is not as great for Chillingworth. Revenge becomes his only aspiration and he dies within a year of Dimmesdale’s death, his purpose for living gone. Chillingworth brings no good out of his sin. He simply continues his torment of Dimmesdale until the end of his life. Hester and Dimmesdale ponder their own sinfulness, attempt to learn from their sins, and try to reconcile with their lived experiences.

Women And Spirituality Essays - Womens Rights, Feminist Philosophy

Women And Spirituality What we find as an original response to existences meaning is the belief in a greater being or higher power, eg. God, that we serve and obey in the trade for a fruitful, everlasting life. This can be connected to the theory of the Earth-Mother. The female in nature was intended to represent reoccurring life. Ancient people held the belief that they would return to the body of the womb of mother earth and then be given a new life. This ancient belief is similar to our own when compared. The view of the religious world can give meaning and purpose to the lives of the people as it gives them hope. Hope that if they live their lives as God had intended for them, they will be granted entrance into heaven, an everlasting, peaceful place. It gives people meaning as to what they should do with their lives. The religious view also brings order in people's lives. Purpose in someone's life is also introduced in the world view; they can go to church and have the holy rituals which every religion practices. This may offer people a sense of purpose in their life. Religion cannot be contained by a certain definition because religion is, simplistically enough, what you want it to be. No one can write a definition of religion as it is really just personal opinion. Religion can be the way you live your life, but for someone else it may just be another word in their vocabulary. With the advent of the feminist movement, the role of women in all parts of society has come under increasing scrutiny. One area of recent controversy is the role of women in the Christian Church. Some churches whose traditions and practices are less rigidly tied to Biblical doctrines have begun placing women in leadership positions such as pastor or teacher. Other churches which interpret the Bible more literally have been slow to adopt such changes. Most Commentators agree that man and woman are both equally a reflection of God's image; the word man here is used as a synonym for humanity. Adam and Eve were also given joint dominion over creation. The role of the man is leadership, while the role of woman is as a source of strength and support. If a person wants to understand the Christian authority of a man over his wife, he must consider how Christ demonstrated his leadership as head over the Church. Primarily, he gave his life for his church, not using force or coercion for her submission. Many people would dispute the Bible's relevance to contemporary thought in general, and in particular to the role of women in worship. If the Bible were not written under divine inspiration, a person or practice is not bound by its teachings. He or she can therefore pick and choose whatever corresponds to his/her point of view. However, if the Bible is of divine inspiration, then a cautious consideration of passages relevant to a particular issue must be undertaken. Traditions and customs, that have arisen after the Bible was written, may thus be carefully scrutinized. Such practices may or may not prove sound after comparison with scripture. If women are not allowed to have a voice or some kind of input, the church could be loosing a valuable resource of wisdom. If a husband does not consider his wives thoughts and ideas as being important or valid, his family is surely incomplete, dysfunctional and doomed to failure. Therefore, as the church strives to realize Gods purpose for women, we must remember the truths of the scripture and apply them to our present day culture. This will allow men and women to present the Christian message to our world in the most powerful way. Feminist ethics has much to offer Catholicism. For one, the main issues that concern feminist ethics are basically the same ones that make up Catholic identity. That is, how women and men define themselves in society, what means are available to them for attaining their ends- in short inter personal and social relations. Second, the founding principles that guide feminist ethics are rooted in the tradition of natural law, a tradition well known to Catholicism. So,

Age, Gender Differences free essay sample

The purpose of present study was to investigate the relationship between academic performance and depression among students of University of Gujrat. It was a cross-sectional study. Convenient sampling was used to select sample of 50 males and 50 females. Depression Anxiety Stress Scale was used for the measurement. Findings of study showed that there is a positive relationship between age and academic performance with depression. Chapter I Introduction Introduction Present study was designed to investigate about age and gender differences in’ and relationship with academic performance and depression. The main purpose of this research was to investigate the relationship between gender differences ,academic performance and depression among Uog students. Gender Gender is the range of physical, mental, and behavioral characteristics pertaining to, and differentiating between, masculinity and femininity. Depending on the context, the term may refer to biological sex (i. e. the state of being male, female or intersex), sex-based social structures (including gender roles and other social roles), or gender identity. We will write a custom essay sample on Age, Gender Differences or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page According to the Publication Manual of the American Psychological Association, Gender is cultural and is the term to use when referring to women and men as social groups. Sex is biological; use it when the biological distinction is predominant. And according to the World Health Organization, Sex refers to the biological and physiological characteristics that define men and women. Gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women. Depression Depression is a mental illness in which a person has feelings of sadness, instability, loneliness, hopelessness, worthlessness, and guilt. Depression is a common mental disorder and can be successfully treated. Signs and symptoms include Persistent sad, anxious, or empty feelings Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness Irritability, restlessness Loss of interest in activities or hobbies once pleasurable, including sex Fatigue and decreased energy Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning wakefulness, or excessive sleeping Overeating, or appetite loss Thoughts of suicide, suicide attempts Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment. Gender and Depression When asked about symptoms of depression, women are more likely to admit to such features than men, a difference usually put down to women being more open and men being more likely to use denial. Similarly, women are more prepared to seek help than men for their depression. A variety of biological, social, and psychological explanations for women’s increased vulnerability to depression also has been evaluated. Research examining hormonal influences has received more attention than biological factors but both have produced inconclusive results and presently do not appear to account for the gender difference in rates (cf. reviews by McGrath et al. , 1990; Rice et al. , 1984; Kornstein, 1997). Academic performance An academic performance is how well someone does during their academics. This means, how well they did with school and all the activities that go along with it. workplace is critical for these individuals, this relationship has not been adequately investigated. Depression is a common disorder that impacts an individuals ability to perform life activities, including those required by the workplace. Academic performance can be viewed as a direct parallel to workforce performance, with students belonging to a unique set of individuals whose ability to perform can be measured on criteria applied by an observer and by self-report. While the prevalence of depression for this group is high and preparation for entry into the workplace is critical for these individuals, this relationship has not been adequately investigated. Many factors affect academic achievement. One of them is depression. Depression has a high prevalence and relationship with both memory and academic achievement. Depression indices are: persistent sadness, discouragement, loss of self-worth and interest in daily activities. True depression in teens is often difficult to diagnose because normal adolescent behavior is marked by both up and down moods. These moods may alternate over a period of hours or days. Depression has an effect on academic achievement. Research has indicated that depressed mood is negatively related to academic achievement. Objectives The objectives of the present study was to assess the relationship between age, gender and academc performance with depression among University students. Hypothesis Following hypothesis were formulated for present study: Gender and academic performance has a positive effect on depression. If depression will increases acdamic perfomance will decrease. Variables Age, Gender and Acdademic performance were independet variables and Depression was dependent variable in present study. Operational definition The World Health Organization, defines depression as: â€Å"Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. †(By Martin) Conceptual definition â€Å"In this study conceptual definition of Depression is total score on the Depression Anxiety Stress Scale. † Literature Review In the following paragraphs, there is a review of the literature pertaining to Depression, the hypothesized predictors of Depression and Academic performance ,the predicted outcomes of Depression, and the relationship between Academic performance and Depession. Robert (2008) conduct the study on the relationship between depressed mood and academic performance (measured in terms of grade point average) in U. S. middle and high schools. Utilizing data from AddHealth, the dissertation establishes Ordinary Least Squares, Two-Stage Least Squares (2SLS), and individual and sibling fixed effect regressions that attempt to control for confounding factors, including student motivation, personality characteristics, and parental inputs that are unobserved but may influence both mental health and achievement. Study findings indicate that students who report feeling depressed do not perform as well academically as non-depressed students. Additionally, the degree of GPA impact increases with the severity of reported depression. Students reporting either depressed feelings â€Å"most or all of the time† or symptoms consistent with major depression suffer GPA reductions of 0. 06 to 0. 84 grade points. In addition, middle schoolers and certain minority groups are hardest hit by depression, and persistent depression has a negative impact on grades. Dana Ahmed conducta study on Depressive Symptoms and Academic Performance of North Carolina College Students. the total number of student was 1,280 and used regression analyses were performed to examine associations between depressive symptoms and academic performance in this group. the result of this study was regression analyses were performed to examine associations between depressive symptoms and academic performance in this group. A study conduct by Alketa, Steven Clayton(2005) was on the relationship between depression and the academic performance of undergraduate students. Data regarding academics, health and productivity for students from Western Michigan University were obtained from the University’s Registrar’s Office, the campus Health Center and a survey delivered to the students. The primary outcomes of interest were the student’s grade point average (GPA), an objective, observer generated  measure of academic productivity, and the students’ self-reported academic performance. the result indicate the Diagnosed depression was associated with a 0. 49 point, or half a letter grade, decrease in student GPA, Depressed students reported a pattern of increasing interference of depression symptoms with academic performance. With respect to the study on Evaluating the Relationship between Gender, Age, Depression and Academic Performance among Adolescents by Busari, A. O. (2012) the purpose of the study was to investigate the relationship between age, depression and academic performance among adolescents. The study was carried out among 1200 students (600 male and 600 female) in the age range 15-19 years. The instrument used for data collection was the Beck depression Inventory (21 item BDI). The analysis of data used correlation coefficient and t-test. The results showed that 26. 5% of the boys and 30. 7% of the girls were depressed and that depression and academic performance were significantly correlated, r = -0. 24, p? 0. 000. Also, based on results of the present study, age and academic performance were significantly correlated (r = 0. 25, p? 0. 000). In addition there was significant difference of academic performance between male and female, (t (1) = -5. 51, p = 0. 000). Nancy, Bonnie Erin(2004) was conduct a study on Gender differences and risk factors for depression in adolescence The current study used longitudinal data (N? 1322; 648 males, 674 females) from adolescents ages 12 to 19 years (in 1994) to investigate gender differences in and risk factors for depressive symptoms and major depressive episodes (MDEs). The sample had participated in three waves of Canada’s National Population Health Survey (1994, 1996, and 1998). Results showed that although there was not a statistically significant increase in depressive symptoms in early adolescence, there was a robust gender difference in the levels of depressive symptoms and the prevalence of MDE, with girls more affected than boys. Mirowsky J Ross CE. (1992) Was conduct a study on Age and depression and the aim of this study was to find out the the relationship between age and depression is analyzed, looking for effects of maturity, decline, life-cycle stage, survival, and historical trend. The data are from a 1990 sample of 2,031 U.S. adults and a 1985 sample of 809 Illinois adults. The results show that depression reaches its lowest level in the middle aged, at about age 45. The fall of depression in early adulthood and rise in late life mostly reflects life-cycle gains and losses in marriage, employment, and economic well-being. Depression reaches its highest level in adults 80 years old or older, because physical dysfunction and low personal control add to personal and status losses. Malaise from poor health does not create a spurious rise of measured depression in late adulthood. However, some of the differences among age groups in depression reflect higher education in younger generations, and some reflect different rates of survival across demographic groups that also vary in their levels of depression. Mary Kay ONeil William J. Lancee (1985) conducted a study on Sex differences in depressed university students and in this study author select Depressed males and females from a consecutive sample of students attending a university psychiatric service (N=183) and a sample from the general student population (n=55) were compared to determine why more females (ratio 2? 1) seek help for depression. It was found that this sex difference was due neither to differential prevalence of depression nor to differences in symptom expression or social behavior, but rather to contrasting attitudes toward emotional problems and psychiatric help. Women recognize physical concomitants of depression as indicative of emotional problems and more readily accept the need for psychiatric help. Men appear not to connect physical symptoms with emotional difficulties. In this chapter, the researcher’s major purpose was to present background information on the dependent variable,Depression and to present background information on the three independent variables. The three independent variables are: age, gender and Academic performance. In varying degrees, all of the independent variables, were reported in the literature as having positive correlations with depression. Rationale of the study The purpose of this study was to find out age and gender difference in depression and academic performance with relation to  depression among students of University of Gujrat. By exploring these variables, it is hoped to add to the body of comprehension about the relationship between age, gender differences and academic performance with depression. The present study can be important addition in literature, concerning gender differences in depression. Conducting study on age, gender differences and academic performance related depression in Pakistani society can contribute in the field of basic research. Present study can be helpful in further researches . This study is also helpful for the reader to understand the relationship between age, gender differences and academic performance with relation to depression among university students. It can also support other researches and generate useful knowledge for students belonging to the discipline of psychology. There are very little research attempts to explore the relationship between age, gender differences and academic performance with relation to depression of students in Gujrat. So this study is unique because it examines the age, gender differences and academic performance relted to depression among students of University of Gujrat. Chapter II Method Method In the present study it is a multi-independent sample design . it is a independent sample design. 100 students from university of Gujrat were selected as a sample of B. S( 2nd and 8th ) semester . A standardized instrtrument was used for data collection. That is the Depression Anxiety Stress scale. Sample The present study consisted on the population from university of Gujrat. B. B. A and Sociology department were included for collection of data. Convenient sampling was used to select 100 student from university of Gujrat among them 50 were male and 50 were female. There age range from 18 to 26. There qualification was B. S(hons). Depression Anxiety Stress Scale The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The DASS was constructed not merely as another set of scales to measure conventionally defined emotional states, but to further the process of defining, understanding, and measuring the ubiquitous and clinically significant emotional states usually described as depression, anxiety and stress. The DASS should thus meet the requirements of both researchers and scientist-professional clinicians. DASS scales contains 14 items, divided into subscales of 2-5 items with similar content. The Depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia. (Lovibond, S. H. Lovibond, P. F. 1993 ). Demographic sheet Some demographic variables were included in the present research those were: Age, Gender, Department, CGPA, Semester, Father’s education and Mother’s education. Procedure First step in the present study was to select the population of students from University of Gujrat and select sample from that population.  second, researcher build rapport with students and ask them to fill the questionnaire carefully and respond to each item honestly. Some instructions were given to the respondents before questionnaire handed them over. The instructions were; the whole information will be confidential and only used for the research purpose, it was requested to show serious and careful attitude toward responding in questionnaire, and provide only required information. Researchers face some difficult in collecting data because students were showing non-serious attitude toward giving responses on questionnaire. After completed the data collection researcher thanked to all the respondents who show their cooperation to fill the questionnaire. Chapter III Results Results The aim of the present study was to explore the Age, Gender differences and Academic performance with relation to Depression among students of University of Gujrat. A standardized scale was used to measure the Depression among males and females students of University of Gujrat. Linear Regression was used for measuring Age, Gender differences and Academic performance with relation to Depression among University students.

Paragraph Length in Compositions and Reports

Paragraph Length in Compositions and Reports In composition, technical writing, and online writing, the term paragraph length refers to the number of sentences in a paragraph and the number of words in those sentences. There is no set or correct length for a paragraph. As discussed below, conventions about appropriate length vary from one form of writing to another and depend on various factors, including medium, topic, audience, and purpose. Simply put, a paragraph  should be as long or as short as it needs to be to develop a main idea.  As  Barry J. Rosenberg  says, Some paragraphs should weigh a skimpy two or three sentences, while others should weigh a robust seven or eight sentences. Both weights are equally healthy (Spring Into Technical Writing for Engineers and Scientists, 2005).   See Examples and Observations below. Also, see: The Invisible Mark of Punctuation: The Paragraph BreakCoherence and CohesionDevelopmentParagraph Break  and  ParagraphingSentence LengthUnity Examples and Observations Paragraph lengths, like sentence lengths, give an essay a kind of rhythm that readers can feel but that is hard to talk about . . .. A very short paragraph can be just the right kind of pause following a long and complex one. Or a series of paragraphs of about the same length can give the reader a very satisfying feeling of balance and proportion.(Diana Hacker and Betty Renshaw, Writing With a Voice, 2nd ed. Scott, Foresman, 1989)Paragraph Length in EssaysThere is no set rule about paragraph length. They can be long or short ..., though do note that both the shortest and the longest are rare and you should take care in their use. What works best is usually a mixture of longer and shorter paragraphs within the middle range. Aim to vary length rather than look for a set formula. . . . [A] paragraph [that] contains . . . 150 words . . . is probably about average for what would most often be used in an essay.(Jacqueline Connelly and Patrick Forsyth, Essay Writing Skills: Essential Techni ques to Gain Top Marks. Kogan Page Ltd., 2011) Dividing a Long Paragraph[S]ometimes you may discover that a particular point in your essay is so complex that your paragraph is growing far too long- well over a typed page, for instance. If this problem occurs, look for a logical place to divide your information and start a new paragraph. For example, you might see a convenient dividing point in a series of actions youre describing or a break in the chronology of a narrative or between explanations of arguments or examples. Just make sure you begin your next paragraph with some sort of transitional phrase or key words to let the reader know that you are still discussing the same point as before (Still another problem caused by the computers faulty memory circuit is . . .).(Jean Wyrick, Steps to Writing Well With Additional Readings, 8th ed. Wadsworth, 2011)Paragraph Length in Academic WritingParagraphs give readers a sense of where one unit ends and another begins, a sense of how the argument develops by moving from one topic to an other. . . . Paragraphs let the reader digest one idea at a time without becoming overwhelmed.In modern academic writing, paragraphs are usually less than a page in length. But its rare to find many short paragraphs (of, say, less than four lines) in a row. A typical paragraph is roughly ten to twenty lines in length. But there will be variety. Short paragraphs are sometimes needed for other purposes besides laying out a component of the argument. For example, a transitional paragraph might be needed at a certain point in order to sum up all thats been established so far and to hint at where the argument will go from here.And sometimes short paragraphs can simply underscore a point.(Matthew Parfitt, Writing in Response. Bedford/St. Martins 2012) Paragraph Length in Business and Technical WritingQuantifying paragraph length is difficult, but in business and technical writing, paragraphs exceeding 100 to 125 words should be rare. Most paragraphs will consist of three to six sentences. If a single-spaced paragraph goes beyond one-third of a page, it is probably too long. A double-spaced paragraph should not exceed half a page in length.The documents format should influence paragraph length. If a document has narrow columns (two to three to the page), then paragraphs should be shorter, perhaps on the average of no more than 50 words. If a document uses a full-page format (one column), then average paragraph length can reach 125 words.Length is therefore a function of appearance and visual relief.(Stephen R. Covey, Style Guide for Business and Technical Communication, 5th ed. FT Press and Pearson Education, 2012)Paragraph Length in Online WritingIf the statistics are to be believed, by the end of this sentence, I’ll have l ost most of you. Because according to some estimates, the average time spent on a webpage is 15 seconds. . .And so webmasters worldwide have launched an emergency austerity programme, pruning, paring, compacting everything possible in a frantic attempt to spare our readers a few precious seconds. . . .The most obvious casualty of this economy drive is the venerable paragraph. . . .The internet . . . has exerted further downward pressure on paragraph length. Reading on a laptop screen or phone is slower and more fatiguing, and it’s harder to keep your place; inserting regular, clear breaks (complete lines rather than indentations) is one way to create a smoother reading experience.None of this is in dispute. But consider  this recent piece on the BBC website. With two exceptions, all the paragraphs in this story consist of precisely one sentence. . . .[O]ne reason, and one reason alone, is sufficient to justify the Save the Paragraph Campaign. Time was, when you came across a paragraph of one sentence, you knew it contained powerful stuff (in the writer’s view, at least). A short paragraph, coming after many long ones, could deliver a real punch.(Andy Bodle, Breaking Point: Is the Writing on the Wall for the Paragraph?. The Guardian, May 22, 2015) One-Sentence ParagraphsOccasionally, a one-sentence paragraph is acceptable if it is used as a transition between longer paragraphs or as a one-sentence introduction or conclusion in correspondence.(Gerald J. Alred, Charles T. Brusaw, and Walter E. Oliu, The Business Writers Handbook, 10th ed. Bedford/St. Martins, 2012)Paragraph Length and ToneHow long is a paragraph?As short as that.Shorter.Or as long as it needs to be to cover a subject. . . .But there is a complication. Writing that aims to be inviting, like the writing in newspapers, popular magazines and books, uses shorter paragraphs than more ambitious and profound writing. New paragraphs are begun before a topic is exhausted.Anytime.For no reason at all.Because each new paragraph lightens the tone, encourages readers, offers a foothold down the page.When paragraphs are short, writing does seem easier. Less happily, it also seems disjointed and superficial- as though the writer cant concentrate on a subject.Thus paragraphing, like so much else, is a matter of tone. You want to have a proper paragraph length for your subject, your audience, and your degree of seriousness (or frivolity).(Bill Stott, Write to the Point. Anchor Press, 1984)

How to Combat Corruption as a Public Administrator Research Paper

How to Combat Corruption as a Public Administrator - Research Paper Example Public administrators can avoid corruption by maintaining ethical behavior as well as providing avenues such as hotlines to the members of the public and staff. In conclusion, the paper indicates that the society in countries such as Haiti and Uganda have negatively been affected by corruption that existed in the past. The US stiff regulations and empowered FBI has made the government to effectively deal with corruption. Corruption entails fraudulent conduct by the individuals who are not only in power but also by the subjects. Basically, it involves providing asking for a bribe and providing it in order for an individual to get a favor. Being a vice that has negative impact on economic, political and social development of a country, corruption is used by the government officials for illegitimate private benefits such as acquiring properties and government funds. Other forms of corruption include embezzlement, extortion, abuse of power, nepotism, favoritism and fraud. One of the major importances of combating corruption in the public service is that it ensures that the negativities that it brings about are abolished. Regardless of the economic position of a country, corruption is known to undermine sustainable development, threaten proper governance, negative impact on the democratic process, and impending economic growth. Within the public sector, corruption has implications that include underminin g people’s confidence, impeding the effectiveness of public service, increasing the cost of public transactions, and reducing tax revenues. Thus, as a public administrator one should be in a position to put adequate measures to address corruption that has emerged as one of the challenges facing the public service globally. From a public administration perspective, corruption has affected management culture in society and ethics in work

Understanding the Nature of Groups and Teams Essay

Understanding the Nature of Groups and Teams - Essay Example In most cases, individuals form groups, which later become a team. According to psychoanalytical object-relations theory (Sher, 2004), individuals, groups, and teams are not independent entities but rather are constructs that bond organizational expectations to human feelings and beliefs. Groups and teams rely on a matrix style of management (Gilley & Kerno Jr., 2010), are influenced by the existing organizational authority, and participants show commitment because of the expectations demanded by their organizations. The distinction between groups and teams is that while groups demand a lot of control, planning, and direction in its leadership, are guided by a series of well established goals and objectives, reward members depending on performance (Seat & Sundstrom, 2004), and used when executing specific functional tasks in an organization, teams demand collaborative relationships among members, are guided by a mission in fulfilling their mandate (Offermann, 2006), and can exist in or outside an organization. Therefore, teams are groups with a higher purpose in achieving goals because of creativity, mutual sharing of benefits, attributes, small member size mostly between 5-12 people, and a shared purpose. A group or team is always formed in handling different problems in an organization. Therefore, the management must be keen when determining which one to use for effective task execution and complimentary results. It is best to use groups in instances where tasks are easy, especially when results are expected within a specific timeframe in order to measure the expertise of each member on service delivery, and only if there is a well defined a guiding purpose. However, whenever the management deems there is complexity in task execution, which demands collaborative interactions, availability of enough and reliable resources, teams are given a priority (Gilley & Kerno Jr., 2010). In most occasions, organizations rely on teams

My Vision for holistic nutrition Essay Example | Topics and Well Written Essays - 750 words

My Vision for holistic nutrition - Essay Example While holistic nutrition does not make any claims that a certain food, or a vitamin or mineral contained therein, will cure any degenerative disease, for instance cancer, adequately giving the body what it needs will help the body to heal itself. In holistic nutrition every person is viewed as an individual with different nutritional needs. The Holistic community believes that many variables play a role in establishing what may be a normal nutritional requirement, resulting in a â€Å"tailored† nutritional chart for individuals based on their needs. In contrast, Allopathic medicine looks at the population as a whole; it determines the norm based on an average requirement and applies that calculation to the individual, regardless of biochemical, environmental and physical differences. Holistic nutrition, as mentioned earlier, looks at the person as a whole, keeping the differences in body systems (neurological, structural, immune, reproductive, etc.) in view, and helps deal with the various challenges facing the body for optimal nutritional functionality. For example, instead of approaching depression, skeletal pain, and fatigue as three separate issues, thus calling for three separate prescriptions, a holistic nutriti onist will look at these three different weaknesses on the whole: what do they have in common and what systemic condition could be causing it. Such an approach treats the systems of the body as being interconnected and seeks to improve the health of the person on the whole. Holistic nutrition teaches that food is the best medicine. Dietary intake and supplements are important considerations when seeking to prevent illnesses or to strengthen a body already in crisis. Prescriptions medication may quiet or silence the symptoms of illness, but may not be able to identify and correct the root cause of the illness, which, in turn, will continue to weaken the body. A holistic

Exit Voice Loyalty Neglect Model

Exit Voice Loyalty Neglect Model The Exit-Voice-Loyalty-Neglect (EVLN) analyses the consequences of job dissatisfaction, and postulates that employees will respond to job dissatisfaction in one of four ways: by exiting, by speaking out about it, through loyalty, or through job neglect (Withey Cooper 1989, 521). The model is premised upon the principle that job dissatisfaction affects individual behaviour, and has effects on the employee both intrinsically and extrinsically (Leck Saunders 2005, 219). It suggests that the consequences of job dissatisfaction can be predicted, and can be harmful to both the individual and the organisation (Naus 2007, 684). This essay will analyse the EVLN model and will reflect on its application in light of a personal work experience. It will then provide practical recommendations as to how managers can avoid the negative consequences of job dissatisfaction and in particular, the negative behaviours contemplated by the EVLN model. The EVLN model, first devised by Hirschman in 1970 and expanded upon by Rusbult, Zembrodt and Gunn in 1982 and Farrell in 1983, suggests that depending on the person and the situation, employees will respond to job dissatisfaction in any one (or a combination) of four ways, which as the name suggests, includes exit, voice, loyalty or neglect (Withey Gellarly 1998, 111). In this model, exit refers to resigning from the organisation, transferring to another work unit or office, or at the very least, attempting to make the exit (McShane 2006, 117). Voice refers to an attempt to change, rather than escape from, the situation. Voice may be constructive, particularly where employees voice their dissatisfaction and recommend ways their satisfaction levels can be improved (Luchak 2003, 116). Conversely, it can be destructive where employees begin venting to fellow employees, thereby spreading negative energy within the workplace (Turnley Feldman 1999, 897). Loyalty refers to employees who respond to job dissatisfaction by complacency, most typically by patiently waiting for the problem to resolve itself. These types of employees tend to suffer silently in anticipation of their work situation improving (McShane 2006, 118). Neglect, which broadly refers to neglecting ones work responsibilities, is perhaps the most destructive of responses to job dissatisfaction, as it involves decreasing productivity, decreased attention to quality, and increasing absenteeism and lateness (Hagedoorn 1999, 310). The responses can be independent or sequential, meaning that an employee may transition through a series of responses (Farrell Rusbult 1992, 203). For example, a dissatisfied employee may go through a period of neglect, before deciding to quit their job (Humphrey 2000, 714). Once they announce their resignation, they may speak out to their fellow employees and leave with a noisy exit (Withey Cooper 1989, 522). Loyalty and voice can be constructive where they are used to try to maintain satisfactory relationships, though they can be destructive in certain circumstances (Si, Wei Li 2008, 935). Neglect and exit are generally destructive as they occur once employees have decided that the relationship with the organisation is not worth maintaining (Si, Wei Li 2008, 936). Which response a given employee will take will generally depend upon the individual and their circumstances (McShane 2006, 117). A generally determinative factor is the availability of alternative employment. For example, where an employee has a great deal of financial freedom, they may choose to leave an aversive situation (Lee Mitchell 1994, 62). This is far less likely when they are facing financial pressures and have low employment prospects (Hagedoorn 1999, 312). Instead, they may temporarily use the neglect option until a job opportunity comes by (McShane 2006, 119). Employees who have worked at an organisation for a lengthy period of time, and who can identify with that organisation, will generally use the voice option and speak out about their dissatisfaction (McShane 2006, 118; Withey Coopers 1989, 522). This is also the case where employees cannot easily resign or transfer, or decrease their productivity without the fear of retribution (Rusbult et al. 1988, 619). Finally, where an employee feels as though they have overinvested in an organisation, they may engage in lazy or neglectful behaviours and decrease their organisational citizenship behaviour (Farrell 1983, 601). Personal Reflection In a previous workplace, I experienced serious job dissatisfaction which was followed by a series of behavioural changes. The organisation I was working for had lost a number of major clients, and had faced serious staff turnover issues, and as a result was experiencing significant financial distress. My manager had become extremely stressed and was struggling to remain calm. He would take his stress out on me on a constant basis, and his behaviour became increasingly destructive. He had a very short temper and would often shout and yell abusive words. His performance expectations of me increased unrealistically, and he began to criticise the smallest of deviations from the norm. He would confront me (and others) publically, in a way that was both demeaning and humiliating. This was followed by a pay cut of over twenty-five percent, which I felt was inequitable and unjustified. I became extremely dissatisfied and de-motivated, and whilst I would usually opt to speak out about my conc erns, I had no option to do so as my manager was self-righteous and was not interested in receiving constructive criticism or complaints. Somewhat subconsciously, I became extremely unmotivated and the energy that I put into performing my work had significantly decreased. I expressed neglectful behaviour, as my output levels had decreased, as had the general quality of my work (Farrell Rusbult 1992, 207). Furthermore, I began to speak about my problems to fellow employees, but would not confront my manager about the issues. Consistent with studies on counterproductive voice behaviour, this was a form of me using my voice in a highly destructive way (Withey Coopers 1989, 530). In line with studies on negative loyalty behaviours and the exiting response, I did not leave my job immediately as I could not find another job immediately (and I wanted have a given number of months experience on my resume), however I resigned as soon as another job became available (Rusbult et al 1998, 600 ). In hindsight, my dissatisfied work experience had a negative effect on me individually, my co-workers and on the organisation as a whole. Recommendations It is clear that employee responses to job dissatisfaction have direct implications on organisational productivity and effectiveness (Leck Saunders 2005, 219). Constructive responses such as trying to improve working conditions, improving job satisfaction and improving management approaches value-add to an organisation as they aid in decreasing job dissatisfaction on the organisational level (McShane 2006, 120; Naus 2007, 689). In contrast, destructive approaches such as resigning, absenteeism, decreased productivity, decreased quality control or psychological withdrawal can adversely affect the individual, their fellow workers, the quality of output material, and the organisation as a whole (Naus 2007, 690; Farrell Rusbult 1992, 215). Understanding employee behaviour is an all-important task for managers as it can allow them to curb those behaviours that are disruptive to the individual and the organisation, and promote constructive behaviours (Leck Saunders 2005, 221). To decrease the negative effects of job dissatisfaction, managers should be mindful of behaviours contemplated by the EVLN model and should identify them as indicators of job dissatisfaction (Humphrey 2000, 720). As the EVLN model is a typology of consequential behaviour, managers should remedy the behaviour by looking to the actual cause (McShane 2006, 121). Thus, managers should use the behaviour as an indicator of job dissatisfaction, and should immediately act upon it once identified (Si, Wei Li 2008, 940). There are a number of ways in which managers can attempt to re-instil job satisfaction in a dissatisfied employee. Research suggests that employees will be less likely to engage in destructive behaviours such as neglect, exit or negative voice when there is a possibility of improvement, a feeling of autonomy or control over the situation, foreseeable happiness, and a sense of belonging to the workplace (Withey Cooper 1989, 523; Rusbult et al. 1988, 625). Managers should focu s on these characteristics so that they promote constructive behaviour and decrease the stressors causing employees to engage in destructive behaviours. Secondly, and vitally importantly, managers should ensure that there is open communication between employees and management, so that more constructive behaviours such as using ones voice are actually an option (Naus 2007, 700). Had my former manager been more approachable and open to my feedback, I could have resolved my problems by expressing my concerns and having them dealt with. Instead, I was afraid to confront my manager, and resorted to being underproductive and speaking out to my fellow employees, therefore spreading negative energy in the workplace. This may have led to job dissatisfaction and similar consequences for other employees (McShane 2006, 123). Based on my own research and experience, I would recommend that managers be more approachable so that dissatisfied employees can opt for constructive behaviours before resorting to destructive behaviours. Conclusion The EVLN model is an important framework used to describe employee responses to job dissatisfaction. It contemplates that employees will respond to job dissatisfaction in varying ways according to their personality and their situations, and in general will respond through fight, flight, complacency or de-motivation. The framework is useful as it allows managers to identify behaviours that indicate employee job dissatisfaction, which in turn allows them address underlying stressors and concerns. In light of research and personal work experiences, it is recommended that managers be mindful of these behaviours so that they are markers of job dissatisfaction, and keep lines of communication open so that job dissatisfaction issues can be addressed constructively. References Farrell, D. 1983. Exit, voice, loyalty and neglect as responses to job dissatisfaction: a multidimensional scaling study. Academy of Management Journal 26 (4): 596-607. http://www.jstor.org.ezp01.library.qut.edu.au/stable/255909 (accessed December 2, 2009). Farrell, D. and C.E. Rusbult. 1992. Exploring the Exit, Voice, Loyalty and Neglect Typology: The Influence of Job Satisfaction, Quality of Alternatives and Investment Size. Employee Responsibilities and Rights Journal 5 (1): 201-218. http://www.springerlink.com.ezp01.library.qut.edu.au/content/gp4647hl1644p8k2/ (accessed December 1, 2009). Hagedoorn, M. 1999. Employees reactions to problematic events: a circumplex structure of five categories of responses, and the role of job satisfaction. Journal of Organisational Behaviour 20 (3): 309-321. http://www3.interscience.wiley.com/journal/120698377/issue?CRETRY=1SRETRY=0 (accessed December 1, 2009). Humphrey, R.H. 2000. Buyer-supplier alliances in the automobile industry: how exit-voice strategies influence interpersonal relationships. Journal of Organisational Behaviour 21(6): 713-730. http://www3.interscience.wiley.com/journal/72513917/issue (accessed December 4, 2009). Leck, J.D and D.M. Saunders. 2005. Hirschmans loyalty: attitude or behaviour? Employee Responsibilities and Rights Journal 5 (3): 219-230. http://www.springerlink.com/content/k18t27678h637534/ (accessed December 3, 2009). Lee, P.W. T.W. Mitchell. 1994. An alternative approach: the unfolding model of voluntary turnover. Academy of Management Review 19 (1): 51-89. http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?vid=1hid=6sid=c0a52e8f-6eec-40a4-bdf3-7e0fc6ddf452%40sessionmgr13bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyhAN=1993-97785-002 (accessed December 2, 2009). Luchak, A.A. 2003. What kind of voice do loyal employees use? British Journal of Industrial Relations 41 (1): 115-134. http://www3.interscience.wiley.com/journal/118865370/issue (accessed December 3, 2009). McShane, S.L. 2006. Organisational Behaviour on the Pacific Rim, 2nd ed, Sydney: McGraw-Hill Higher Education. Naus, F. 2007. Organisational cynicism: Extending the exit, voice, loyalty and neglect model of employees responses to adverse conditions in the workplace. Human Relations, 60 (5): 683-718. http://apps.isiknowledge.com.ezp01.library.qut.edu.au/InboundService.do?product=WOSaction=retrieveSrcApp=360UT=000247621700001SID=R2h3pp%40G%40nI%403ChJJ7jSrcAuth=SerialsSolutionsmode=FullRecordcustomersID=SerialsSolutionsDestFail=http%3A%2F%2Faccess.isiproducts.com%2Fcustom_images%2Fwok_failed_auth.html (accessed December 2, 2009). Rusbult, C.E., D. Farrell, G. Rogers and A.G. Mainous. 1988. Impact of exchange variables on exit, voice, loyalty and neglect: an integrative model of responses to declining job satisfaction. Academy of Management Journal 31 (1): 599-627. http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?vid=1hid=6sid=c0a52e8f-6eec-40a4-bdf3-7e0fc6ddf452%40sessionmgr13bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyhAN=1993-97785-002 (accessed December 1, 2009). Si, S.X., F. Wei and Y. Li. 2008. The effect of organizational psychological contract violation on managers exit, voice, loyalty and neglect in the Chinese context. International Journal of Human Resource Management 19 (5): 932-944. http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?vid=1hid=111sid=842211a4-71fd-4fd2-bb8c-f78afcf2d447%40sessionmgr112bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyhAN=2008-06433-007 (accessed December 1, 2009). Turnley, W.H. and D.C. Feldman. 1999. The Impact of Psychological Contract Violation on Exit, Voice, Loyalty and Neglect. Human Relations 52 (1): 895-922. http://www.springerlink.com.ezp01.library.qut.edu.au/content/nv179t5777237571/ (accessed December 4, 2009). Withey, M.J. and W.H. Coopers. 1989. Predicting Exit, Voice, Loyalty and Neglect. Administrative Science Quarterly 34 (1): 521-539. http://www.jstor.org.ezp01.library.qut.edu.au/stable/2393565?cookieSet=1 (accessed November 30, 2009). Withey, M.J. and I.R. Gellarly. 1998. Situational and Dispositional Determinations of Exit, Voice, Loyalty and Neglect. Proceedings of the Administrative Sciences Association of Canada 13 (4): 110-119. http://www.jstor.org.ezp01.library.qut.edu.au/stable/256461 (accessed December 3, 2009).

Explain the value that professional nursing organizations have in networking and in the legislative process. Provide a rationale for your response Essay

Professional nursing organizations range from general, such as the ANA, which represents the nursing profession and the interests of its members, to specific, which are those that represent a certain specialty, such as the American Association of Critical-Care Nurses. Professional nursing organizations can help nurses stay current in the field of study or specialty, network with other nurses, as well as many other professional and personal benefits. According to Guerrieri (2010), â€Å"Belonging to a professional nursing organization brings increased professionalism, autonomy, and self-regulation while offering additional benefits such as social interactions and peer support† (p.47). Networking is certainly one of the benefits offered by nursing organizations to its members, which may include conventions, online discussions, and forums. These social networks provide opportunities for â€Å"rapid knowledge exchange and dissemination among many people† (ANA, 2011, p.3). By connecting with other nurses, members may get a chance to hear how others are handling the same issues. Organizations can also contribute to professional growth through networking at local and national meetings. Moreover, members can serve as officers or committee chairs, which will aid in the development of leadership skills (Guerrieri, 2010). Clearly, networking opportunities offered by many professional nursing organizations are invaluable and can help in many areas such as education, career development, and even give a sense of belonging and encouragement through interactions with other nurses (Guerrieri, 2010). In addition to having a networking value, professional nursing organizations represent a public image of the nursing profession and its specialties. As such, the organization gains public’s trust in the profession and â€Å"the organization builds on this trust as it promotes awareness of public policy and advocates for patient welfare† (Guerrieri, 2010, p. 47). This also gives members opportunities to become more informed about health care policies and contribute to patient advocacy. By advocating for the nursing profession, professional organizations, along with their members, â€Å"educate the public, policy makers, healthcare administrators, and professionals on specific issues (Matthews, 2012, â€Å"Unity in advocacy†). Moreover, organizations lobby on behalf of all nurses at all levels of government on issues that directly affect its members, such as education and practice. Nursing organizations also use networking to get more people who support their views, thereby increasing the chances of success in the legislative process. Organizations also play an integral part in shaping health policy. By being members of professional nursing associations, nurses at every level have opportunities to get involved in the processes that shape nursing practice. As stated in the article written by Matthews (2012), professional organizations were â€Å"created by nurses for nurses to articulate nursing values, integrity, practice, and social policy† (Matthews, 2012, â€Å"The profession’s advocacy efforts†). References American Nurses Association. (2011). ANA’s principles for social networking and the nurse: Guidance for registered nurses . Retrieved from http://www.nursingworld.org Guerrieri, R. (2010, May). Professional growth: Learn, grow, and bloom by joining a professional association. Nursing2010, 40(5), 47-48. Retrieved from http://journals.lww.com/nursing/Fulltext/2010/05000/Learn,_grow,_and_bloom_by_joining_a_professional.14.aspx Matthews, J. H. (2012, January). Role of professional organizations in advocating for the nursing profession. Online Journal of Issues in Nursing, 17(1). http://dx.doi.org/10.3912/OJIN.Vol17No01Man03

An Inconvenient Truth Summary 3

An Inconvenient Truth In An Inconvenient Truth, Albert Gore presents us with a thought-provoking oration by employing three persuasive appeals. He utilizes the elements of ethos, logos, and pathos in order to better achieve the goal of notifying the severity of global warming as well as awakening people’s environmental consciousness. An appeal to ethos deals with credibility and what makes the author qualified to speak on a particular subject, Al Gore does this in both selections. The entire film is presented in the context of a lecture hall in a university, which gives the audience a sense of seriousness.Additionally, Gore suggests his persistency and commitment by pointing out his political career as the Vice President, worldwide travel experience and abundant research on environment which as well can substantiate his qualification to be a spokesman on the mainstream issue of global warming. Moreover, Gore calls on expert testimony for a number of times, including that of hi s Harvard professor, who first promoted measuring carbon dioxide in the earth atmosphere which effectively establishes Gore’s credibility.Albert Gore appeals to logos by piling up deliberate evidence to further convince people about the crisis of global warming. Dynamic graphs and charts, one of which indicates the rapid change in temperature associating with the escalation of carbon dioxide, are displayed with movement owning to the multi-media. Also, by using time-lapse photography, striking changes in places, such as Argentina and Grinnel Glacier, are shown in photographs to prove the scientific theory that the earth has been severely affected by global warming.Gore, in addition, mentions other effects of the global warming in an alarming tone, which comprise species lost, natural disasters, and new-found diseases; displayed footages of news about hurricanes, primarily Katrina, pictures of extinct creatures, and discoveries of viruses leading to illness, such as Avian flu, West Nile flu etc. By these methods, Gore effectively makes the audience aware of the significance of preventing global warming from being aggravated. Yet, in this seemingly pure-scientific presentation, Gore targets the audience’s emotions several times in appeal of pathos.By recalling his son’s car accident which nearly took him away from Gore, he not only provokes the listeners’ sentiment of sympathy, but also emphasizes the point that we often fail to value what is precious until we are in danger of losing it. Gore makes a profusion of projections which startle the audience with the effect of alerting them to the crisis. For instance, he employs a concerned tone by predicting the devastating future of mankind when hundreds of millions of people are killed due to global warming. On the other hand, Gore’s sense of humor alleviates the solemn atmosphere.His occasionally self-deprecating jokes (â€Å"I am Al Gore. I used to be the next President of the United States. †) and sarcastic comments ease the listeners’ mood and exert a pull on their attention. What is more, the use of comical cartoons not only gives the audience a laugh but also provides them with a more comprehensible view of global warming. By analyzing Al Gore’s well-organized steps to proving his main idea, we can ascertain that Al Gore has adroitly utilized the three above-discussed appeals, ethos, logos, and pathos when imparting his viewpoints on global warming to people.

The healthcare Law

The healthcare Law The healthcare law that was enacted this spring by the U.S. President Barrack Obama aimed at providing U.S citizens with medical cover. The law established universal medical services to all U.S. citizens and to be paid for by the federal government. The enactment of the law ends the need for private medical insurance in the country that will now provide supplementary medical coverage. Advertising We will write a custom essay sample on The healthcare Law specifically for you for only $16.05 $11/page Learn More The government would fund the national healthcare through taxation and other funds that would replace the health insurance premiums that were initially paid by the citizens. This paper examines the application of economic concepts such as law of demand supply, equilibrium and managerial decisions on this healthcare law. Managerial decision-making Every organization aims at maximizing the profit made by the organization. In order to maximize profits, the organization needs to minimize costs. According to Png and Lehman, the management of an organization has a duty to formulate policies and make decisions that would lead to the achievement of the set goals (36). Given that the business environment is dynamic, firm mangers usually rely on strategic decision making that involves making of decisions based on the strategies that would maximize the use of firm resources. Some of the strategic decisions made by an organization include decisions on cost minimization and effective utilization of firm resources. In order to minimize costs, the management ensures that the operational processes are efficient, cheap quality inputs are utilized efficiently while creating valuable products that satisfy consumer needs. Basing on the managerial decision-making, the federal government is similar to the management of organizations. It needs to ensure that all healthcare needs of U.S citizens are satisfied. Therefore, it sought to satisfy the health care needs by establishing the national healthcare act that would be funded through taxation. This decision to enact the act is optimal because the federal government would establish a healthy nation that would contribute to economic growth positively through increased production. Demand, supply and market equilibrium According to Png and Lehman, both buyers and sellers meet in a market in which there is the exchange of goods and services (121). Economic resources are usually in short supply while the needs that are to be fulfilled using the resources are usually indefinite. In addition, different people and regions are bestowed with different resources that satisfy different human needs. Advertising Looking for essay on health law? Let's see if we can help you! Get your first paper with 15% OFF Learn More Due to different endowment of resources to countries and regions, some countries have a comparative advantage in the production of a given good or service over others. In addition, the differences in resources endowment have made countries and individuals within the country to be dependent on external economies hence; they would always demand the supply of given goods and services for the fulfillment of their needs. The law of demand posits that the demands for goods and services shrink as the prices of the goods/services increases while other things are held steady. Demand is provided in terms of quantity of the goods. The quantities of goods that are demanded by clients differ from one individual to another basing on various factors that affect demand. Fluctuations in the quantity of a given good/service that is required by consumers fluctuates over time based various factors such as the level of proceeds for consumers, the price of the good and availability of substitutes among other factors. The supply of goods and services occurs in the market too. Suppliers provide goods based on the quantity of the goods that consumers require in order to meet their needs. The quantity of goods/services supplied is a function of many factors including the price of the good/service, level of income for consumers, productivity and the amount of goods/services that consumers need in order to meet their needs. The law of supply postulates that the supply of a given good/service declines as the price of the good/service decreases and vice versa with other factors being held steady (Png and Lehman 357). Equilibrium in the market is obtained at the level in which the total of goods/services demanded by clients equates the level of goods/services supplied by different sellers in the same market. At equilibrium, the price at which the sellers sell their products to customers is referred to as the equilibrium price while the equilibrium quantity is the quantity supplied by sellers and bought by clients in the market. At equilibrium, there is no incentive for the suppliers to increase the goods supplied because the price and inco me remains the same in the short term. Advertising We will write a custom essay sample on The healthcare Law specifically for you for only $16.05 $11/page Learn More Similarly, customers have no incentive to increase the amount of goods demanded in the short term. The changes in other factors in the business environment can cause the amount of goods/services supplied and demanded in the market to change. Some of the factors include changes in demographics, income and productivity among other factors (Png and Lehman 123). The economic concepts of demand and supply could also be applied to the healthcare act. The customers in include all U.S. citizens that needs medical care. The supplier is the government. The level of demand would increase if the U.S. population increased or the levels of epidemic or accidents in the country increased. The equilibrium in the provision healthcare services to the citizens would be achieved whenever the supplied services would be equal to the demanded services. Optimization techniques According to Png and Lehman, an optimizing firm should keep producing as long as the marginal costs incurred during production are less than the marginal revenue (183). During the production period, the company should always focus on minimizing processing costs to ensure that it meets its profit maximization objective. An organization should produce until the level in which the magical costs realized in the course of production are equal to the marginal revenue. This is the optimal position of the firm. Any increase in production would result in losses. The management of an organization can alter this position if long-term production capacity is created. This can only happen in new management tools such as investment in new technologies and expansion of production space and plant. The application of optimal techniques to the healthcare law would mean that the federal government should increase the provision of healthcare s ervices as long as the marginal costs incurred in healthcare service provision is less than the marginal tax collected by the government. The optimal level of healthcare service provision would be when the marginal cost of the services is equal to the marginal tax collected. New decisions to use advanced technology and increase healthcare services provision capacity should sought once the government increases service provision at the expense of healthcare costs. Consumer behavior and rational choice Organizations are involved in the production of goods and services while consumers are mainly to make consumption decisions for the produced goods. The theory of demand postulates that consumers demand goods (services) in order to meet their unlimited wants. After the goods/services are provided, the consumers consume them for satisfaction that is measured in terms of utility. Advertising Looking for essay on health law? Let's see if we can help you! Get your first paper with 15% OFF Learn More Consumers are rational in their consumption decisions because they always choose the best basket of supplied goods that would best meet their needs given the prevailing circumstances. They therefore decide the quantity of goods to purchase and the amount of money to spend on the goods. Given the rationality of consumers, the healthcare service consumers in the U.S., the U.S citizens are rational consumers too. They would make decisions on the type of healthcare services demanded. However, the amount of money to spend on the services would not be made by the citizens, but by the federal government through taxation. Demand functions Demand functions indicate the existing relationship between the levels of the good demanded and the determinants of the levels demanded by the customer. The quantity of a given good demanded by consumers is determined by various factors such as the price of the good, the level of income, the prices of other related goods such as compliments and substitute s and tastes and preferences. Given these factors, the demand function of a given good can be expressed as indicated below. D=f(P,I,PXPYT) where D- quantity demanded, P- price of the good demanded, I- Income, PX price of related good x, PY Price related good y and T- tastes and preferences. Application of demand functions in the healthcare law The demand function could also be applied to the healthcare law and the demand of healthcare in the U.S. The U.S. citizens are the consumers of healthcare services provided by the federal government under the healthcare law. The demand of healthcare services in the U.S is determined by various factors such as exposure to risk factors, levels of income, price of healthcare among other factor. The healthcare demand function can be expressed as below. H=f(R,I,P, O) where H- healthcare quantity demanded, R-exposure to risk factors, I-levels of Income, P-charge son the healthcare and O-other factors An increase in any of the causative factors coul d alter the level of healthcare services demanded by the U.S. citizens. For instance, an increase in the number of people exposed to risky environments that could affect negatively their health could increase the demand of healthcare services. An increase in healthcare taxation could reduce the demand for healthcare services because many people would opt for private services. This is similar to an increase in income for U.S citizens. Production theory Production of goods and services entails utilization of various resource inputs such as labor, power, and raw materials among other factors. The theory of production involves the determination of the levels of input factors to be used by an organization to produce a given level of out. An organization would combine different levels of factors of inputs such as labor and capital to produce a given output. However, in the course of productivity, organizations aim at minimizing the costs incurred while ensuring that the profit realized a re maximum. A firm can experience increasing returns to scale if the marginal costs incurred reduce as the produced output increases. Constant returns to scale are experienced whenever the marginal cost realized by the organization is constant as the output produced increases. On the contrary, decreasing returns to scale would be realized if the marginal costs of an organization incurred during productivity would increase as output increases. Therefore, it is advisable that the management of the organization should produce up to that level in which the marginal cost equals the marginal revenue in order to avoid reduction in scale of returns that could lead to an exit from the market (Png and Lehman 319). The application of the theory of production to the healthcare law implies that the government provides healthcare services using capital and labor. Capital used in the productivity of the services includes the buildings, latest technological equipment in public hospital vehicles a mong other capital tools. Labor on the other hand includes all healthcare professionals employed by the state to provide quality healthcare to U.S. nationals. The cost incurred in the provision of healthcare services includes the cost of capital and labor while the revenue is obtained from healthcare taxation. Increasing returns would be realized whenever the marginal cost of providing healthcare services decreases as service provision increases. On the contrary, the federal government would realize reducing returns to scale whenever the marginal costs incurred by the state in providing healthcare services increases as provision of healthcare services increases. The optimal healthcare service output would be at the position in which the level of marginal cost of healthcare service provision equals marginal revenue from taxes (Png and Lehman 170). The federal government in the healthcare sector in the long run should pursue technological change and industrial revolution. This would enable the federal government increase and improve the provision of healthcare services to U.S. citizens. However, the federal government can pursue technological change if it realizes that it is providing healthcare services under decreasing returns to scale. This change of strategy would ensure that the government minimizes costs while maximizing healthcare tax revenue. Work Cited Png, Ivan and Lehman, Dale. Managerial Economic. New York: Willey-BlackWell. 2007.

Vanilla Sky essays

Vanilla Sky essays David suffers from schizophrenia, brought on by his cut-short childhood, loneliness, the tension formed due to his questionable relationship with Julie, and eventually, his terrible disfigurement. Using Freuds definition of schizophrenia, David has escaped to an early and secure, possibly childish, state of psychological development, due to the unbearable stress and conflict that surrounds him. The id, as proposed by Freud, is the innermost core of the personality (Psychology-Frontiers and Applications). Under normal circumstances, it has no direct contact with reality, because it seeks only immediate gratification or release, regardless of rational considerations and environmental realities. In other words, What it wants, it takes! By degrading to this early stage of development, David has reduced his minds control of the release of the id, causing his perspective of the world to become wildly warped. A drunken driver killed both of Davids parents when he was very young, removing a large part of the psychological influence, which controls the development of a child. The loss of his mother, of whom he was obviously fond, must have surely been a terrible blow. However, the loss of his father may have been far greater in affecting Davids later actions and decisions. In his fathers biography, David is mentioned only once, and in passing. The relationship suggested by this oversight is one of possible rivalry, disappointment, and unfulfilled expectations. It is possible that Mr. Aames believed David unable to successfully run his company, and David has spent the majority of his life attempting to prove wrong that idea. Davids failure to resolve his emotional problems concerning his dad is a source of great anxiety and grief for David. Despite the people whom he surrounds himself with, David is unable to identify with his friends until he me ...

Week 5 discussion Questions Essay Example | Topics and Well Written Essays - 750 words

Week 5 discussion Questions - Essay Example The second weakness are of mine is economics. Economic is a very useful academic discipline that can help managers in various ways. For example managers can use economic analysis to determine the supply and demand of its products. I t can also help managers determine the optimal sales price to achieve the highest profits possible. The reason I’m weak at economic is because it economics the professor who teach these subjects seem to always incorporate graphs in their discussion. Every time I see a economic graph it becomes very hard for me to interpret to the results. Also in economics there seems to be a lot of models and concepts that are extremely difficult to understand. Since these two disciplines are important for me achieve professional goal and will put a lot of extra efforts in the future courses I may take in any of these two subject matters. The two business majors that have greatest utilize and maximum value for a corporation is managerial accounting and business research. Business research can be used in different ways to add value to a corporation. For example business research can be used to perform market research of potential expansion site in foreign territory. Researchers used either primary research or secondary research. Primary research occurs when the research perform original research, while secondary research is learning for a particular subject matter by reading and analyzing the written work in sources such as journal article, magazines, databases, and websites (Allbusines, 2009). Another research technique that can be very useful for managers is generic benchmarking. Generic benchmarking is a technique in which a company investigates business practices in other industries in order to imitate them. Managerial accounting measures and reports financial and nonfinancial information that helps managers

Vampires Research Proposal Example | Topics and Well Written Essays - 500 words

Vampires - Research Proposal Example I also participated in class debates where we discussed vampires with my classmates and tutor. I have also witnessed people who claim to be vampires. These experiences have not been able to address the origin and creation of vampires in details. As such, this research will teach me about the characteristics of real and psychic vampires as well as the origin and the process of creating a vampire. To achieve this, I am counting on my instructor and classmates’ support. Indeed, I am sure that my instructor has significant information about this topic having researched and taught this topic for a long time. Moreover, through the continued discussions about this topic, my classmates may have subtle information about vampires. Nevertheless, the information from my classmates will require undergoing verification. The topic about vampires is very general and addressing it will require huge resources and a lot of time. As such there was need to limit the research to the creation of vampires. To ensure that I use limited time on my research topic, I will seek resource materials that detail the origin and creation of vampires. I will also establish the risks that may limit the accuracy and relevance of my research. I will plan my research well and establish the relevant sources of information. I will also limit my research to real and modern vampires. I will rely on research reports from my professor, instructor, and the vampires’ museum. Ultimately, I will keep close consultations with my instructor for guidance and verification of my data. Ideally, vampires from different regions may have different characteristics. As such, I will limit my topic geographically by narrowing my research to vampires found in America. Nevertheless, various circumstances limit my research on this topic. Inde ed, it may be difficult to distinguish

Reaction paper Essay Example | Topics and Well Written Essays - 750 words - 8

Reaction paper - Essay Example ion, cell phone is a technological invention which is possessed by all .It is a known fact that, cell phone has made a prominent impact on the working behavior of employees of an organization. Cellphone has enabled increased productivity in them due to its communicative effectiveness and accessibility. The use of technological device is however a contradictory fact because it is argued by some that it can increase productivity while some argues that laptops and cellphone wear off productivity. But when we compare the business world of yesteryears with that of todays , it is obvious that commercial activities are happening on a swift basis at present. Even though these gadgets divert the concentration of employees and waste their time and man power, this can only be seen as a minor drawback. These devices does deviate employees to indulge in handling their personal lives, this is truth. But this can also have a positive effect on their mental status which could make them more vibrant to perform their official chores. In earlier times, there were no technological devices and the employees could have been more frustrated and would have been intimidated physically and mentally to perform their job. But now the quality of work is increased as most of the work happens in less time than olden times. The survey conducted in US does reveal that majority people check email while on duty and multi- tasking hurts productivity, which is true. It has been traced that many employees engage more on online activities than official work as it is human tendency to look for pleasure rather than pain. However, the responsibility factor of employees in today’s world is minor in comparison with their older counterparts. There is a lot of technological addiction among young men of today than the aged people. The technology aided social networking sites available on computer is the biggest culprit which absorbs much of productive time of employees. The technological advancement of the

Effects of Technology on Enviroment Essay Example for Free

Effects of Technology on Enviroment Essay Effects of technology on environment. Selection of topic Now a day the world relies totally on technologies. Therefore, it is important to discuss on the effect caused on environment due to these technologies. Aims and objectives To study about effects of technology on earth. To study its negative and positive impact on environment. To discuss how to decreases its ill effect. To analysis the energy consumed per year on technologies. Relevance The Negative Ecological Impacts of Technology One of the biggest problems the world faces today is the amount of energy that is consumed globally. With almost all of the worlds businesses using computer technology to operate, the energy consumption of the industrial world is constantly on the increase. Countries such as the United States where the average employee works more than 40 hours a week, as a result, the energy consumption of a typical office in the United States is likely to be higher than that of an office in a country where the average work week does not exceed 40 hours. Many offices run their computer systems on a mainframe server. This server is usually running 24 hours a day and is rarely shut down. To keep these servers from overheating, fans are installed within the hard drives. With the combined energy of the fans and the operation of the servers, the amount of energy being consumed is huge and results in a very high thermal count. According to the International Energy Agency or, IEA, around 4% of the worlds energy consumption in 2008 was due to the mass use of information communications technologies. This figure is predicted to rise to an incredible 40% by the time the year 2030 arrives. By this time, the demands on the worlds electricity sources will have also doubled globally and companies will need to have a viable solution to prevent computer technologies from being a major drain on the worlds energy resources. The  Positive Ecological Impacts of Technology Despite the claims that technology is to blame for many of the worlds ecological problems, technology has also served to improve the shape of our planet. Since the rise of technology in the workplace, numerous ICT companies have been designing greener technology to combat the detrimental effect that computers and their accompanying technology have on the environment. One of the best known organizations is the Green Grid. The Green Grid is an organization that consists of IT companies and professionals from around the world. The Green Grid is devising ways to improve the way energy is consumed by IT oriented businesses and their offices. One of the biggest achievements of the Green Grid is the Power Usage Effectiveness or, PUE, metric system. This system records data center energy consumption. How it works is by recording the energy consumption of a data center or mainframe server every 15 minutes. By recording in these 15 minute increments it helps those monitoring the data to notice if there are any energy fluctuations and if the data center systems are using an adequate amount of energy. The long term goal of the Green Grid is to introduce a standard system that allows business managers and IT operatives to compare the amount of the energy they are consuming and if necessary resolve ways to reduce it. Another technology that is having positive impacts on the environment is low carbon technology. Low carbon technology is a form of technology that has been developed in China. Largely developed because of Chinas low carbon footprint in comparison to other developing countries, the low carbon technology aims to offset the amount of emissions polluting the air by using renewable fossil fuels. Observation Improvements in the technology have antagonistic effects on the human life along with the positive effects. The growth of the technology leads to very severe problems like pollution, unemployment, effects social life of the humans etc.. First of all, the most serious problem is pollution, which is created by the technological inventions like vehicles, industries, etc.. Now-a-days the vehicles like cars, bikes are increasing which is leading to increase in pollution. The other problem is radiation caused by the increase in the mobile phones. Secondly, in most of the developing countries like  India the major problem is unemployment. This problem is mostly caused by the increase in the instruments, which are the results of improvement in the technology. Finally, in today’s world all the people are getting addicted to the internet like social sites, games and they also becoming victims of the google. For example, all the persons are getting involved in the facebook and they are not at all bothering about the surrounding world, this may leading them away from the social life and sometimes it also creates problems in the families. The other example, everyone in this world is depending on google for each and everything and they are not at all referring to the books. However, most of the people say that improvements in technology like software solutions creates employment, but that is not true because the employment created by the software field is less than the employments which is decreased by the instruments in industries. In conclusion, the negative effects of the technology is higher than the advantages from the improvements in technology. Conclusion As a result of the increase in the various forms of technology, there are many positive and negative ecological impacts on the planet. Through the rise in modern technology and increase in globalization, there is a high increase in energy consumption. This in turn has devastating effects on the planets climate and air quality. However, without modern technology there would not be the capability to improve energy management systems or to develop environmentally friendly products such as bio-fuels. To make a progressive step towards reducing the amount of damage technology does to the environment, it is necessary to find ways to manage new technology responsibly so that it can continue to have positive ecological impacts. Analysis

The Joyride :: Creative Writing Essays

The Joyride    Rain clouds began to tear themselves away from the jagged peaks of the Koolau range and rays broke through the clouds and beat down on the muddy water of Pearl Bay. Bobby glanced toward them, but his mind was elsewhere. He paced back and forth along the isolated stretch of the narrow beach. Now and then he would kick at loose pebbles along the muddy grey shoreline. For the moment, Bobby was still in his private world, consisting of little more than a strip of mud flat along one small section of the bay. But his world was about to be invaded. Chris, his best friend since kindergarten, would be showing up any minute. And Bobby knew that before this afternoon ended, their two lives, so entwined these many years, would forever be changed.    Bobby clutched a smooth black stone in his fingers. He leaned into the light breeze, preparing to skip it across the harbour waters, but stopped abruptly, remembering that the gods did not like land removed from the island. As the stone slipped from his fingers, his eyes followed the ripples that glided on and off the grey beach where he stood, then rose almost by habit to gaze once more at the Arizona Memorial stretching white and graceful, remembering painfully that this would be the last time that he would ever walk along this beautiful beach.    As his eyes watched the waves, and how they caressed the muddy shoreline, he began to think of the future. His thoughts were quickly disrupted.       â€Å"Hey bud, how's it going? What was so important that you had to talk to me about?† Chris asked.    â€Å"It's to hard. I can't go on with it.†    â€Å"What? What can't you go on with?† Chris demanded urgently.    â€Å"It's just, that, that, this will be our last weekend together†.    â€Å"Wait a minute. Slow down, your not making any sense. None at all. What do you mean that this will be our last weekend together? We have the whole entire summer planned out. Fishing next weekend, canoeing to Ford Island next month, our bike.....†    â€Å"NO STOP!!! You don't understand. My dad got transferred. We're moving.†    â€Å"But why now. School doesn't start for another two months, and colleges start even later than that!† Chris replied.    â€Å"I know, it sucks. I can't do anything about it. I've tried everything. I've even asked my parents if it would be okay to move in with my grandparents for the rest of the summer. But it's no use. They say I have to get used to the town, meet new friends,and get a job.

Organizational Systems and Quality Leadership Essay

A. Complete a root cause analysis that takes into consideration causative factors that led to the sentinel event. (This patient’s outcome) The terms failure analysis, incident investigation, and root cause analysis are used by organizations when referring to their problem solving approach. Regardless of what it’s called there are three basic questions to every investigation: 1. What’s the problem(s)? 2. Why did it happen? (the causes) 3. What specifically should be done to prevent it? (Galley, n.d., ∂ 1) In the case of Mr. J, these were multiple issues that led to and contributed to his unexpected demise after what is usually considered a routinely performed procedure in an emergency department setting. The JCHAO (Joint Commission on Accreditation of Healthcare) defines a sentinel event as â€Å"an unexpected occurrence involving death or serious physical or psychological injury†, (Frain, Murphy, Dash, & Kassai, ∂ 1) and in the case of Mr. B, his death would be considered a sentinel event which would warrant a review by a team of interdisciplinary members of the hospital. In this particular case members of the team would include one or more ED physicians, the RN in the scenario and the LPN, a respiratory therapist, a nursing supervisor, a hospital administrator, the ED nurse manager, a hospital pharmacist, and a risk manager. More staff nurses from the ER could also be involved. A credible and successful root cause analysis will identify all of the elements that contribu ted to the event, an action plan will be developed to prevent the event from reoccurring and ensure that those actions are completed. Action plans should be based on best practices and appropriate standards. (Frain et al., ∂ 10) The scenario presented starts out as what  appears to be an average afternoon shift in a small 6 bed emergency department in a rural hospital. Staffing consisted of one emergency room physician, one registered nurse (RN), on licensed practical nurse (LPN) and a secretary. Due to the size of this particular ER, there appears to be limited staffing and therefore limited resources to handle large volumes of patients and or critical patients. There are two patients already being worked up in the department at the time of Mr. B’s arrival and they are stable, have already been evaluated and they are awaiting further treatment or orders. Mr. B is brought to the ED by private vehicle complaining of left leg and hip pain after losing his balance and falling over his dog. The triage nurse noted that other than the patient displaying tachypnea, his vital signs were otherwise within norm al limits. The patient states his pain level is severe, a â€Å"ten out of ten†, and physical examination finds a shortened left lower extremity with calf swelling and ecchymosis. In triage it is noted that the patients leg is stabilized and he is subsequently moved into a patient room where the admitting RN, Nurse J, takes over and gets a more thorough history of this patient, noting impaired glucose tolerance, prostate cancer and chronic back pain. Mr. B regular medications include Atorvastatin and also Oxycodone for his chronic back pain. The doses and how often he takes these mediations is not provided. Although there is no mention of any radiology studies being performed on Mr. B after his arrival, it is assumed that this was performed before the ER physician completed his evaluation and ordered 5 mg intravenous diazepam to sedate the patient to perform a manual reduction of a dislocated hip. After waiting for 5 minutes, the physician then instructed the RN to administer 2mg of hydr omorphone, a powerful narcotic analgesic. The staff waits five more minutes, after which the physician then instructs the RN to repeat both doses of diazepam and hydromorphone because he is not satisfied with the patient’s level of sedation. It is after these medications are administered that the physician notes patient’s weight and history of opiate use. Five minutes after the last dose of medication is administered a successful reduction of the left hip takes place and the patient remains sedated. The reduction procedure, which initially began at approximately 16:05, ended at 16:30. Although Nurse J is monitoring this patient, she is alerted that EMS (Emergency Medical Services) is bringing in an elderly patient with reported acute  respiratory distress. Nurse J, an experienced critical care nurse, elects to place Mr. J on an automatic blood pressure machine with a pulse oximeter. Although not stated, it is likely that this is a portable machine and is not hooked up to any wall monitors. It does not have continuous EKG monitoring. It does not have end tidal CO2 monitoring. Nurse J then elects to leave the patient in the company of his son with a blood pressure of 110/62 and an oxygen saturation of 92% on the portable machine. The patient is breathing room air and does not have any other monitoring. The ambulance patient has arrived to the department and both the RN and LPN are involved in stabilizing this new arrival and discharging the previous patients as the lobby is now becoming congested with more patients seeking care. There is no mention of anyone suggesting that additional staff should be brought in to help with the load. During this time the pulse oximeter alarm fires off in Mr. B’s room showing at saturation of 85%. The LPN enters the room and resets the alarm and repeats a blood pressure, but there is no mention of the LPN assessing the patient’s respiratory and or mental status. At 16:43, almost forty minutes after Mr. B’s procedure had begun, the son who is at the bedside with him states the monitor is alarming. Nurse J finds a Mr. B in respiratory arrest and a stat code is called. A code team arrives and the patient is connected to a cardiac monitor for the first time. The patient is in ventricular fibrillation, CPR is begun, and according to this scenario he is intubated before he is defibrillated. After thirty minutes of interventions, this patient is resuscitated to a normal sinus rhythm with pulses, but is unable to breathe without a ventilator. He has fixed and dilated pupils and no spontaneous movements. Most likely due to the facility being a small rural hospital, they must transport this patient to a higher level of care, and he is flown out to another facility where the patient was ultimately determined to have brain death and was taken off of life support. A-1 Discuss the errors or hazards in the care in this scenario Causative factors in this scenario appear to include poor staffing to patient ratios, inadequate adherence to hospital policy for moderate sedation, and an obvious lack of communication between peers /coworkers. The human factors point to failure of staff to follow an established protocol, possible  fatigue, possible inability to focus on the task, and a lack of utilizing critical thinking skills. There did not appear to be any equipment problems other than the fact that the appropriate equipment that was available was not accessed. The environmental nature of emergency medicine lends itself to hazards in the fact that a department can go from being quiet and mellow in one moment, to being volatile and hectic the next moment. It is an environment of unpredictability and bestows care to a wider population of patients than any other department in the hospital. Common environmental issues to all emergency rooms can include poor location and accessibility of equipment, overhead paging systems that no one hears, security risks, lighting and space issues, lack of privacy due to patients being placed in hallways and other open areas not designated as patient care areas. Organizational factors may include budgeting limitations, staffing to patient ratios and contingency problems. Dealing with unexpected sick calls, inability to fill those calls, power outages and electronic documentation systems that fail, external environmental disasters, rapid influxes of unexpected patients and the media are all common factors that can disrupt hospital care. Well written policies are a must to guide staff in continuing to provide quality care while minimizing errors and hopefully avoiding sentinel events. Potential hazards and errors can be avoided by learning from the literature and past experiences of other emergency departments. Specific protocols for procedures performed in the ER are developed for this very reason. In the given scenario there is the issue of proper staffing which posed a hazard to the patient who eventually expired. Nurse to patient ratios in this scenario were inappropriate due to the fact that a patient who had received moderate sedation was not closely monitored and ideally should have received one on one nursing care for the duration of his procedure and until he met discharge criteria. This would have been possible had the RN asked for back up which was apparently available. Looking back on the scenario, it was noted that immediately after the joint reduction of Mr. B had been performed, a critically ill ambulance patient had arrived and the RN was responsible for that patient as well. In the emergency department, or any department for that matter, nurses are continually subject to frequent interruptions, the need to multi-task, and reliance on â€Å"work-arounds† because of inadequate systems  support. (Cherry & Jacob, 2011, p. 473) In the case of nurse J, she may have been fixated on completing other tasks, such as stabilizing the ambulance patient, thus distracting her from the ongoing developments with Mr. B. who appeared to be resting comfortably with his son at the bedside. Assuming the patient was safe with a family member, the RN missed the opportunity to reverse the downslide of events that unfolded. Not anticipating the need for additional help is a hazard when staff become overwhelmed but continue to proceed as if help is not needed, because they may be accustomed to being understaffed and working only with what they have. Therefore, this presents the issue of the culture of safety, or lack thereof. It did not appear that there was any organized culture of safety and the communication between staff members appeared to be minimal. Possibly there was an environment of distrust between coworkers, or an intimidating environment in which the RN was afraid to speak up to the ERMD regarding the management of the patient’s pain and sedation. Perhaps the LPN was intimidated by the RN and did not chose to inform the RN of the abnormal vital signs. It appears that inconsistent or absent communication skills among the staff present that day contributed overall to a hazardous situation. And lastly, possible poor training and education of staff creates a hazardous environment and the lack of critical thinking skills demonstrated in this scenario suggests that this is an area that needs to be examined closely at this hospital. There is no mention of what the LPN’s responsibility is in assessing the patient but it is difficult to comprehend how an experienced health care worker in an ER would not investigate a poor pulse oximetry reading further than simply resetting the monitor. Educational requirements and experience of the staff needs to be reviewed and revised by the interdisciplinary team as part of the improvement plan. Errors made in this scenario that contributed to this sentinel event include the fact that there was a specific protocol for conscious sedation and it was ignored. Although Nurse J was ACLS (advanced cardiac life support) certified, and she had completed the hospital’s training module, she did not follow the guidelines in the written protocol which more than likely would have prevented any of this event from happening. Perhaps she did not understand the protocol, perhaps she was accustomed to taking short cuts, or perhaps she was drug or alcohol  impaired. Another possibility is that the nurse was not able to find the online protocol on the hospital portal. Perhaps the portal was difficult to navigate and the policy was difficult to locate. Being under time constraint, a nurse might decide to forgo looking up the policy because it is too time consuming to look for it. Only Nurse J. would be able to provide us with this critical information. It is not clear as to why an experienced critical care nurse with no history of negligence did not follow proper procedure. Other errors include the fact that sufficient monitoring equipment was available and not utilized, including use of supplemental oxygen and possible end tidal CO2 monitoring. Furthermore, no one in the department called for any back up, such as a nursing supervisor or a respiratory therapist to help manage the patient. The ER physician who ordered the medications did not communicate with the nurse before the procedure about the risks associated with this patient, including the patient’s home use of opiates for his chronic pain. Polypharmacy, possible use of supplements, adherence issues, and the potential for adverse drug events all posed potential hazards that needed to be addressed. (Williams, 2002, ∂ 1) The RN did not question the physician about the orders and the physician in turn, did not question the nurse if she had any concerns. There was no â€Å"time-out† procedure performed by the staff, which would have given staff members the opportunity to voice concerns. The doctor also failed to notice that the patient was not being appropriately monitored, and along with the rest of the staff he did not appear to display a teamwork mentality. The key to a successful root cause analysis is to search for answers as to what system errors and failures need to be corrected, and not to pursue blame on any one individual. Individual blame centers around forgetfulness, inattention, or moral weakness. It is punitive. A systems approach examines the conditions under which health care workers work and sets up defenses to avert errors or mitigate their effects. (Cherry & Jacob, 2011, p. 473) The goal is to bring staff together to design and implement processes that provide uniform standards of treatment and care and provide safety to all involved and minimize the likelihood of harm or a sentinel event. B. Improvement Plan By requiring the staff of the emergency department to reexamine its actions on that day, a dialogue is created that hopefully will create a strong motivation to seek out better and newer ways to handle patients that require sedation and monitoring. If the participation is not there, then the motivation will not be created and change will not occur. One way of developing an improvement plan would be to apply the theories of change developed by physicist and social scientist Kurt Lewin in the 1950s. His change management model, known as Unfreeze-Change-Refreeze, refers to a three stage process of transitioning through change. Lewin believed that to begin any successful change process, one must first understand why the change must take place, and this is where the motivation for change begins. He stated that one must be helped to re-examine many cherished assumptions about oneself and one’s relations to others. This is the stage known as â€Å"unfreezing†. (Thompson, n.d., p. 1) In the case of the emergency department, the entire team needs to be compelled to change the way sedation procedures are performed, as well as how patients are handled before and after the procedure. In addition to reviewing the procedural sedation protocol, the team needs to look at overall hospital care of those receiving any medications that cause respiratory depression. This should not be too difficult to promote since the procedure performed that fateful day resulted in harm and subsequent death of a patient. Not only was the patient and his family harmed, the entire organization was harmed and is liable for this incident. The hospital and its emergency department’s community reputation is going to suffer. Knowing that the staff that day is probably emotionally traumatized and possibly fearful of the consequences, the environment is ripe for change and the unfreezing stage can begin with a review of the sedation policy and why it was not followed. Each individual there and staff that were not there that day need to be made aware and can meet one on one with the department manager to voice their concerns and questions. Barriers hopefully will be identified as to why the sedation protocol was not followed that day. The hospital already provides an electronic educational module on conscious sedation procedures which would have a required date for staff to complete. This module should be reviewed for any inconsistencies  and updated and it should be made easily accessible on the computer portal. The actual written policy should also be easily accessible on the portal as well as in print form in a binder at the nurses station, should staff not have access to the computer. An analgesic protocol could be developed in which there would be a minimum time lapse between opioid doses (for instance 10 minutes versus 5) and the use of a hospital approved sedation scoring system should be in place. Patients in addition to requiring continuous pulse-oximetry monitoring should also be on continuous end tidal CO2 monitoring as well, long considered a more effective way of measuring effective ventilatory status. A new electronic training module on the use of end tidal CO2 monitoring would be mandatory for nursing staff to complete and equipment in the ED would be upgraded to provide for this type of monitoring. A representative could come and demonstrate the use of this type of monitoring and sign off employees for a mini-education module. Although many emergency departments have upgraded their documentation to all electronic, it might be helpful for staff nurses who are continuously monitoring patients at the bedside to use paper forms to document the pre procedure requirements including consents, time-outs, intra procedure medications and response to those meds and vital signs as well as post procedure Aldrete scores and recovery notes. This would be advantageous for simply the reason that not every bed has access to a computer. Health care providers certified in Advanced Cardiac Life Support (ACLS) must be in direct attendance with the patient throughout the entire course of the sedation and until the patient is fully recovered. Their primary responsibility is to monitor the vital signs including heart rate and rhythm, blood pressures, respiratory rate and oxygen saturation, as well as the patency of the patient’s airway. The RN managing the patient should never leave the patient unattended or engage in tasks that would compromise this continuous monitoring. The RN is responsible for taking the leading role in assuring that the care provided is safe. Proper airway equipment and drug reversal agents should be at the bedside and this must be documented. In order to unfreeze the staff and help them to change their behaviors, the ED could hold mock sedation procedures to practice their skills in managing a sedated patient. Annual skills days should be held with  review of the policy and equipment used. Staff would be signed off annually on this module. Certifications for BLS(basic life support), ACLS, PALS(pediatric advanced life support) and possibly TNCC (trauma nurse core curriculum), should be up to date and the hospital should offer these courses on campus to make it easier for their employees to maintain their certifications. Staff members whose scope of practice do not require them to practice ACLS or PALS should be reeducated on what normal vital signs are, how to set parameters on the cardiac monitors, how to take vital signs on the cardiac monitor and they need to review basic BLS skills by attending their own skills day. Teaching should include basics on what normal vital signs are for different age groups, and how medications can alter these vital signs. If the hospital has the funds to open a simulation lab, all nurses and allied health personal could practice simulated scenarios on mannequins and even videotape them. This would be a huge asset for the staff of all the patient care departments. Another part of the improvement plan would include classes for staff on communication and critical conversations. Learning how to communicate as a team and voice concerns about patient safety is a skill that requires practice, confidence and no fear of retribution or intimidation. Staff members who deal in stressful and hectic environments may at times be uncertain when they see behaviors that are unsafe and therefore may elect to say nothing when they believe the care of a patient may be compromised. In the case of the LPN who turned off the SPO2 alarm, I would wonder if perhaps there was a communication barrier between her and the RN and or the MD, or was it simply a knowledge deficit. An action plan needs to be in place for a saturated emergency department in which additional staff can be called in with a less than 30 minute wait time, or perhaps float other available qualified staff from other departments, such as the critical care unit or the telemetry floor. Because critical care nurses are accustomed to working in a 1:1 environment with their patients, it would have been ideal to float a CCU nurse to the department when Nurse J realized she could not take care of the rest of the department without leaving Mr. B unattended. Of course this may not have  been feasible since we do not know the census in the CCU. Chart reviews are also an invaluable tool for improvement. The manager will assign nurse in the ED to perform a monthly audit of all sedation charts with checklists of what was done correctly and what was not. These audits are important for providing data on how the ED needs to improve its performance and safety measures. This data will be provided not only at ED staff meetings but at quality improvement meetings involving the nursing director and hospital administration. If there is a problem convincing the hospital to provide safe staffing levels, the ED must provide strong data in order to show administration that there is a need to provide additional nursing. After the uncertainty of the unfreeze stage has occurred, change then begins to take place. Staff will start to believe and act in ways that support the new growth of the department. The transition will not happen rapidly as people take time to learn and embrace new ways of doing things and for each individual the rate of change is personal. In order to accept the new change and contribute to its success, staff will need to understand how the changes will benefit them and not every person will feel this way. Most healthcare workers probably feel that if healthcare delivery is made safer and better for their patients, then they will buy in to the need for changes and produce those changes. Unfortunately some of these people may feel harmed by change, and it is possible to notice some folks not participating in meetings, outside events, or educational updates. They may voice discontent with the whole process and complain that the changes are unnecessary. They may feel the status quo is being challenged and are threatened if they are unable to adapt to the changes. They may eventually leave the department or even the hospital environment as a whole. These are the people who may require the most encouragement and handholding to get them through the transition. Time and communication are of utmost importance and as staff gains understanding of the changes, they also need to feel connectedness to the organization throughout the transition period. (Thompson, n.d., p. 3) Lewin’s third stage of change, or Refreezing, takes place when the organization has identified the barriers to sustain the changes made, and when it has identified what makes the changes work. Employees feel  confident and comfortable using new communication techniques, they participated in learning the new procedures and feel supported by their peers and leadership. There is an established feedback system for employees to participate in regarding their education and training, in which they can voice what works and what doesn’t. Changes are now used all of the time and are incorporated into the normal day to day operations in the ED. If the changes are not used regularly and not anchored in to the culture of the ED, the refreezing state cannot occur and employees may get caught in a â€Å"transition state† where each person is not sure how things should be done and there is no consistency for policies and procedures being followed. For the refreezing states to be successful, the department should celebrate its success with the change. Employees will need to have a sense of closure and management needs to help them feel appreciated for enduring an uncertain and uncomfortable time. It is important to encourage staff to believe that the contributions they have made have made the changes a success. (Thompson, n.d., p. 4) Continuing to provide support and transparency keeps employees informed and motivated to preserve the new changes in place. Allowing staff to voice their opinions and participate in how changes are rolled out is part of this process. Overall, a team approach to care is of utmost importance in the ED and each individual should be encouraged and reminded regularly how important their contributions are to the whole. Reward systems to encourage pride and enthusiasm for work well done can be included at monthly staff meetings. One or two employees might receive a gift or a trophy for hard work, these recipients would be nominated by their peers who anonymously write a nice note about someone who did something nice for a patient or a staff member or just did a particularly great job that day. Team building activities can also include an organized activity outside of the ED where employees and their family members can socialize together and relax. Nursing leaders and managers should strive to build environments that are conducive to friendships, facilitating and promoting good communication and respectful communication between nurses, physicians and administrators. (Blosky & Spegman, 2015, p. 34) Trust is the cornerstone of good communication, which was sorely lacking in the ED that day. C. Use a failure mode and effects analysis to project the likelihood that the  process improvement plan you suggest would not fail. (Identify the members of the interdisciplinary team who will be included in the RCAS and the FMEA) FMEA is a step by step process used to identify all possible failures in a design , a manufacturing or assembly process or a product or a service. FMEA was started by the US military in the 1940s, and was further developed by the aerospace and automotive industries. (American Society for Quality [ASQ], n.d., p. 1) It has been adopted by the healthcare industry successfully as a tool to identify areas of healthcare processes tat may fail, in order to prevent harm or sentinel events before they occur. â€Å"Failure modes† are the ways, or modes in which something may fail. Failures are errors or hazards, which affect the customer and in healthcare the customer is usually the patient. These errors or hazards can be actual, or potential. Effects analysis is the study of consequences of those failures. Failures are prioritized in order of how severe the consequences are, their frequency of occurrence, and their ease of detection. The purpose of the FMEA is to eliminate or reduce the percentage of failures, starting with the highest priority areas. (ASQ, n.d., p. 1) In the scenario of Mr. B, unfortunately the FMEA cannot change the outcome, but it will be a proactive method of developing a new policy and procedure for how sedation cases are handled in the emergency room setting. The FMEA will be used to evaluate the new protocol for sedation procedures as well as staffing protocols related to monitoring 1:1 patients. This evaluation will occur before the actual implementation and will be used to assess its impact on the existing protocols.(IHI, 2015, p. 1) The process that needs to be evaluated and improved specifically to the case of Mr. B, would be the moderate sedation policy and its specifics to requirements of staff during the procedure and the recovery period. Some of the failure modes that may occur or have the potential to occur would be staff resistance to change, inexperienced nurses or practitioners with lack of education, inadequate ability to staff the ED appropriately during influx of patients, sick calls, or inadequate equipment or equipment failure. (Study Mode, 2014, p. 12) The key to a successful FMEA will be the involvement of a interdisciplinary  team, which would most likely consist of the some of the same members of the RCA. An emergency room physician, preferably the director, director of respiratory therapy, the hospital pharmacist, the ED nursing director, a risk manager, a head administrator who can lead the group in decision making, one or two ACLS certified staff nurses from the ED that perform sedation procedures, head of anesthesiology, and possibly even members from other departments where moderate sedation is performed. The team will need to meet regularly and be committed to providing continuing support during the course of implementation. C1: Interventions With the unfortunate scenario of Mr.B, it is now up the the interdisciplinary team to begin testing interventions that will or may be integrated in to the new plan for management of moderate sedation patients, with the goal of improving safety and eliminating adverse events. Once the established team has focused their aim, their next step would be to test a change or a few changes in the ED. This would be done with subsequent procedural sedation procedures which are commonplace in the ED. A small but major change to test would be the mandatory presence of an ACLS certified RN in 1:1 care of the patient from the beginning of the procedure and throughout it to discharge. The goal of this change is to prevent adverse events from respiratory depression in 100% of all patients receiving sedation in the following 6 month period. Performing this test several times will enable the team to see if the staff is actually complying with the new protocol and what barriers there are to prevent it from being successful. Staff will give feedback later as to what is working and what is not, and what they think needs to be done to make the changes work. An effective way to implement testing would be to utilize a PDSA cycle. The Plan-Do-Study-Act (PDSA) cycle is known as shorthand for testing a change by planning it, trying it, observing the results, and acting on what is learned. (Institute for Healthcare Improvement [IHI], 2015, p. 1) According to the Institute for Healthcare Improvement, the reasons to teats changes are as follows: To increase ones belief that the changes will result in improvement To decide which of several proposed changes will lead to the  desired improvement To evaluate how much improvement can be expected from the change To decide whether the proposed change will work in the actual environment To decide which combinations of changes will have the desired effects on the important measures of quality To evaluate costs, social impact, and side effects from a proposed change To minimize resistance upon implementation The Institute for Health Improvement lists these steps in the PDSA cycle to include: Step 1: Plan Plan the test or observation, including a plan to collect the data State the objective of the test: â€Å"Minimize or eliminate adverse events from respiratory depression while being monitored in the ED under conscious sedation† Make predictions about what will happen and why Develop a plan to test the change (Who, what, when where? What data needs to be collected?) Step 2: Do Try out the test on a small scale: maybe only perform the test in a 3 week period, on sedation procedures performed between the busiest times of the ED, for example between noon to 6pm. In a 6 bed rural ED, this might actually be the busiest time period. Carry out the test Document problems and observations, unexpected and expected Begin analysis of the data Step 3: Study Set aside time to analyze the data and study the results, for example: a biweekly or monthly meeting of the FMEA team. Complete the analysis of the data Summarize and reflect on what was learned Step 4: Act Refine the change, based on what was learned from the test. Determine what modifications should be made. Prepare a plan for next test, probably on a larger scale. For example, test all sedations over a month , for actual 24 hour periods in the ED. In addition to performing the PDSA cycles, the ED could appoint a volunteer or volunteers from the department to form a safety committee with a leader being the liaison who would have the authority to come up with quick solutions to certain problems that are encountered in the department on a daily basis. The liaison would take care of fixing broken equipment or replacing it, ordering new equipment and providing user training, communicating with staff about safety concerns and bringing these concerns to management and the FMEA team. The safety liaison would be trained in Human Factors Engineering, the science of why people make mistakes. The staff will need to be reassured that this person is their ally and not an informant or disciplinarian. (Institute for Healthcare Improvement [IHI], 2015, ∂ 1) This is a person they should feel comfortable reporting their concerns to. This person could take an active role in the PDSA testing and collect data as which could be added to the monthly chart audits of all the conscious sedation procedures performed since that fateful day with Mr. B. C2: Presteps: Discuss the pre-steps for preparing for the FMEA. Step one in preparing for the FMEA in regards to revising the sedation protocol involves selecting a specific process to evaluate. While there were many factors that contributed overall to the sentinel event that occurred , the FMEA should be focused on a sub process. Conducting an FMEA on a combination of the sedation protocol, the staffing ratio issues, the communication problems between staff members, knowledge deficits of staff and equipment issues would be an overwhelming task, so instead we will consider individual analysis of each variant. In this case, we are going to focus on creating a better defined policy on how to safely perform conscious sedation in the emergency room setting in order to prevent further sentinel events. We want to define in the policy what licensed and certified personnel is to be present and performing the procedure, and step by step spell out what is required of those team members from the time of informed consent to the time the patient is discharged from the ED. The policy needs to be easily accessible and there needs to be a standard way of making sure staff has read the policy and understands how to follow it. The goal is to make sure that the patient has 1:1 care at all times with qualified  personnel and leaves the ED in stable, improved condition. The second pre-step is to recruit the multidisciplinary team, including everyone who is involved at any point in the process. Be clear that not all people need to be included on the team throughout the entire process, but should be part of the discussions in which they are or did participate in the process. For example, In the case o f Mr. B, radiology was probably at the bedside performing pre and post reduction films, in which the RN clearly would not have remained at the bedside unless he or she was wearing a lead apron. Pharmacy may have become involved if they had to mix any post resuscitation drips for the patient after he returned to a sinus rhythm from ventricular fibrillation. The secretary was involved in calling a rapid response team, and members of that team may be able to provide valuable insight as well. The third pre-step is to have the team meet together to create a list of all of the steps in the process. Every step should be numbered and be as detailed as possible. Note that this may take numerous meetings to complete this portion, due to all of the variables and complexities. Using flowcharts helps team members to visualize the processes more clearly and create a more understandable outline of the steps. There needs to be a group consensus that the outlined steps of the FMEA correctly show the process. By creating a step by step flow sheet the team will be able to visualize the scenario in detail and begin the process of elimination of what does and does not work and move on to pre-step 4. The team will now begin to list all of the possible failure modes. Possible failure modes include absolutely anything that could go wrong, such as the following: Staff not trained in protocol Staff not knowing how to properly use equipment Monitor not connected to patient Equipment not plugged in Medications not reconciled Communication problems between peers Assessments not completed Ancillary staff not educated IV fluids not running Patient experienced respiratory arrest These are just of the few of the possible failure modes that could be listed. For each of these failure modes, the team must list a cause. For example, in the case of Mr. B, he was never connected to a cardiac monitor until he went unresponsive, so the team must try and explain the cause of this. Prestep #5 , for each failure mode, the team will need to assign a numeric value which is called the Risk Priority Number or RPN. The RPN is a measurementof three variables: the likelihood of the failure occurring, of it being detected, and its severity. This is a scoring method that assists the team in determining what areas need the most most focus on improvement. C3 Three Steps: Once again, assigning numeric values to three separate variables assists the team in determining the issues which should be prioritized in order of importance, or the need for improvement. The three topics are as follows:( IHI, 2015, p. 4) the likelihood of occurrence: In other words, how likely is it that this failure mode will happen† A score between 1 and 10, with 1 meaning â€Å"very unlikely to occur† and 10 being â€Å"very likely to occur†. In the case of Mr. B, had a FMEA already been in place prior to his visit to the ED, the likelihood of his demise would have been much more unlikely to occur. But the system had failed him and due to all of the multiple mistakes that did occur that day, the likelihood of what happened was higher up on the numeric scale. the likelihood of detection: If this failure mode does happen, how likely is it that it will be detected? † A score between 1 and 10, with 1 meaning â€Å"very likely to be detected† and 10 being â€Å"very unlikely to be detected.† On the day of Mr. B’s demise, there were multiple opportunities for the staff to detect that there was a potential problem, but they did not. No one noted the lack of staff, communication was poor, and proper equipment was not utilized. So, this question goes back to the Root Cause Analysis and in the FMEA the team will need to determine how the staff can detect these failures before harm occurs again to someone else. the severity: If the failure mode happens, what is the likelihood that the patient will be harmed? † A score between 1 and 10, with 1 meaning â€Å"very unlikely that harm will occur† and 10 being â€Å"very likely that severe harm will occur†. According to the IHI, a score of 10 often means death. In Mr. B’s case, the consequence that resulted from the  failures in the ED that day was his untimely death. So the severity rating for that particular day would be a 10. D. Discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities: The professional nurse plays a critical role in hospital quality improvement, since nurses are the primary caregivers in the system of healthcare. They are pivotal in improving the processes in which care is provided. According to Cynthia Barnard, MBA, the role of the professional nurse in quality improvement is two-fold: to carry out interdisciplinary processes to meet organizational QI goals, as well as measuring, improving and controlling nursing sensitive indicators affecting patient outcomes specific to nursing practices. She states that all levels of nurses, from the direct care at the bedside, to the chief nursing officer (CNO), play a part in promoting QI within the healthcare provider organization. (HCpro, 2010, p. 1) Ms. Barnard lists the following levels of nursing and their professional responsibilities: The CNO: The CNO sets the tone for the nursing departments participation in QI. As an administrator, the CNO is responsible for integrating nursing practices in to the organizational goals for excellence in patient outcomes by communicating the strategic goals to all the levels of staff. The nurse manager (NM) or nursing director: The NM or director is responsible for communicating and operationalizing the organization’s QI goals and processes to the bedside nurse. The NM identifies specific nursing sensitive indicators that need improvement according to the organization’s specific patient population and coordinates QI processes to improve these at the unit level. The direct care nurse: The bedside nurse is the key to quality patient outcomes, carrying out the protocols and standards of care shown by evidence to improve patient care. Important to this provision of quality care is the fact that professional nursing leaders are the key factor in setting the tone and providing an environment in which all health care staff feel empowered to uphold these expectations. If nursing leadership and administration feel that they have less than adequate engagement of staff, it may be simply because the staff may not always understand the rationale and momentum  behind particular quality improvement initiatives. For nurses to be involved in delivering high quality care, it is imperative that leadership allows the participation of staff nurses into the design and implementation of processes by continuously educating and informing them, instead of simply telling nurses what they are supposed to do. A hospital culture that encourages quality as everyone’s responsibility is most likely to achieve sustained and noticeable improvement. Because nursing practice occurs in the context of a larger team, the impact of other departments and practitioners must be included in leadership’s efforts to improve quality. (Draper, Felland, Liebhaber, & Melichar, 2008, p. 4) By having every staff member engaged, including the other members of clinical staff, ie; physicans, respiratory therapy, even housekeeping and dietary management, accountability for patient safety and quality becomes a group effort and does not rest mainly on the shoulders of the nursing population. References American Society for Quality (n.d.). Failure Mode Effects Analysis (FMEA). Retrieved July 3, 2015, from http://asq.org/learn-about-quality/process-analysis-tools/overview/fmea.html Blosky, M. A., & Spegman, A. (2015). Communication and a healthy work environment. Nursing Management, 46(6), 32-38. Cherry, B., & Jacob, S. R. (2011). Contemporary nursing; issues, trends and management. Available from https://online.vitalsource.com/#/books/978-0-323-06953-3/pages/52165015 Draper, D. A., Felland, L. E., Liebhaber, A., & Melichar, L. (2008). The rrole of nurses in hospital quality improvement. Retrieved July 3, 2015, from http://www.hschange.org/CONTENT/972 Frain, J., Murphy, D., Dash, G., & Kassai, M. (n.d.). . Retrieved, from Galley, M. (n.d.). Basic elements of a comprehensive root cause investigation; three steps and three tools that organize and improve your problem solving capability. Retrieved June 29, 2015, from rootcauseanalysis.info HCpro (2010). Ask the expert: Understanding nur sing roles in quality improvement. Retrieved July 6, 2015, from www.hcpro.com/NRS-248978-868/Ask-the-expert-Understanding-nursing-roles-in-quality-improvment.html Institute for Healthcare Improvement (2015). Failure modes and effects analysis. Retrieved July 3, 2015, from