Pros And Cons Of Hybrid Cars - 1867 Words

The pros and cons of Hybrid/Alternative Fueled Vehicles: There are many factors to consider when purchasing a Hybrid or Alternative Fueled Vehicle. Most times when searching for a vehicle, consumers tend to search for amenities to help cut cost. When considering alternative fueled vehicles, consumers have to keep in mind that there are several types of hybrid vehicles with different operating abilities to choose from to satisfy the needs of the consumers. With hybrids, there are three types which are hybrid electric vehicles, plug-in hybrid electric vehicles and all electric vehicles. Since they all operate differently, it is important to be informed to ensure the consumer is happy and satisfied with their investment. Hybrid Electric†¦show more content†¦This is often referred to as the â€Å"all electric range† of the car. Most of the driving with the plug-in hybrid comes from the stored electricity. If a consumer would like to use this vehicle to do light commuting, they can plug the vehicle in at night and the next day; this vehicle will be able to be driven in all electric modes. The batteries to the plug-in electric vehicles can be charged using an outside electric power source, the internal combustion engine or by the regenerative braking. When braking, the electrical motor behaves as the generator which uses the energy to charge the battery. There are two configurations used to combine power from the electric motor and the engine which are parallel and series. Parallel connects the engine and the electric motor to the wheels through mechanical coupling. The electric motor and engine drives the wheels directly. With series, plug-in hybrids only use the electric motor to drive the wheels. All Electric Vehicles use battery packs to store the electrical energy that provides power to the motor. These types of vehicles are charged by plugging the vehicle to an electrical power source. Since this car does not produce direct exhaust or emissions, it’s been said to be a zero-emissions vehicle. The use of fuel is not needed with this vehicle so this helps reduce petroleum consumption. This type of vehicle has a short range per charge than conventional vehiclesShow MoreRelatedThe Pros and Cons of Hybrid Cars Essays852 Words   |  4 Pagesefficient while using energy. One of these inventions is hybrid cars. Though hybrid cars are a known technology, not many people know exactly what they are all about. Since many people don’t know exactly what they’re about, they then really have no interest in purchasing one. Hybrid cars are very different from gasoline cars. Gasoline cars run purely off just gasoline which pollutes the air. A hybrid car can run off gasoline and work as an electric car. Using both of these systems, gasoline powered andRead MorePriua1542 Words   |  7 Pagesdevelopment and production of a hybrid fuel-efficient vehicle to be put in the market as early as 1997. Analysis: The automotive industry is facing new challenges regarding customers being more environmentally concerned and sensitive towards fluctuations in the prices of gas. This potential market segment would be interested in a hybrid powertrain such as the one being developed by Toyota. The company has a longstanding history of producing efficient, reliable and valuable cars. Toyota Production SystemRead MoreHybrid Cars Vs. Conventional Cars869 Words   |  4 PagesBack in 1999, two of the most renowned car companies made a car with a purpose of fuel efficiency. Back then, there were only two hybrids available in the world market. Due to gas prices increasing, people find this type of car as a solution to this problem. Now, there are 71 different models available in the North American Market alone (Duffer). Because of high consumer demand, the number of production keeps on increasing. Hybrids cars are fuel efficient, and they help the environment, but theyRead MoreThe Job Title Of Automotive Technician1408 Words   |  6 Pages2012 this is a growing trade. This trade will never go down due to the fact that people will always need their cars fixed as long as cars exist. There are two types of automotive technicians, there is the specialty technicians repair only one system or component on a vehicle, such as brakes, suspension, or radiator. Then there are the service technicians who inspect, maintain, and repair cars and light trucks. Being an automotive technician is a demanding job, but, a well-paying job. As a growing tradeRead MoreThe Future Fuels For The Automotive Industry Essay1578 Words   |  7 Pagesin automotive vehicles. When considering the current market of cars, many have complaints in gas powered automobiles. There are many problems, commonly discussed, with emissions. Cars have a tendency to be harmful to the environment, and expensive to use frequently. This is where the alternatively powered cars are introduced into the conversation. There are multiple vehicles that can replace the prevalently operated, gas powered cars. However, alternatively powered vehicles must be considered inRead MoreAdjusting to the Policy of Energy Efficiency: Hybrid Cars Essays911 Words   |  4 PagesA popular invention is hybrid cars. The question is should consumers invest in buying one? Many people know about hybrid cars, but many people don’t know exactly how they work, therefore they find no interest in investing to buy one. Hybrid cars are extremely different than a gasoline car. Gasoline cars run off only gasoline, which produces more pollution that goes into the air. A gasoline-electric car, which uses both systems of gasoline powered and electric powered cars, emits less pollution intoRead MoreHybrid Vehicles And Climate Change922 Words   |  4 PagesHybrid Vehicles and Climate Change Are hybrid vehicles really that much better than normal gasoline vehicles? There are known pros and cons of having hybrid vehicles. Climate change is a huge issue in society and continues to grow as a worldwide issue. Hybrid cars use both a battery powered engine as well as a gas powered engine, it’s a very complex system for more things to go wrong in. Also, it has a special system for storing brake energy in an on board battery. Two motors in a vehicle have someRead MoreHybrid Cars And Hybrid Electric Vehicles902 Words   |  4 Pagesdaily life, there is two types of cars i.e. Gasoline vehicles and hybrid-electric vehicles, hybrid-electric cars which used quite a while but not as much as their gasoline counterparts. The difference between these two cars is mainly the Engine, tank, and the source on which the cars work. The hybrid-electric vehicle is more a computerized and electric version where it switch between running on gasoline and electricity. Other than that major changes, these cars are fundamentally the same. The bodyRead MoreA Pro Versus Con Argumentative Article Essay1347 Words   |  6 Pagestheir strong views on the topic in a pro versus con argumentative article. Blumenauer and Byrd both built up their credibility by using strong sources, including facts and statistics, and appealing to the readers’ emotions; however towards the end of the article both sides had a slight flaw which we akened their credibility. When analyzing both viewpoints of the topic, the credibility of the sources and appeals to ethos in the article are very important. The pro side of the article was written by EarlRead MoreFuel Consumption Problems and Solutions Essay1434 Words   |  6 PagesIn this essay I will attempt to solve one of the biggest problems in modern world – dependence and very large consumption of gasoline. According to the Seattle Times, Americans use over 880 million gallons of gasoline per day. With an average of 755 cars for every 1000 people, the United States of America consumes more gasoline than South America, Europe, Africa, and Asia combined (Source: Energy Information Agency) ! Modern world get well more than 80% of its energy from fossil fuels, major part of

A needs orientated approach to care Free Essays

string(46) " order to be able to build this relationship\." Introduction The aims of this assignment are to provide a needs orientated approach to care using a nursing model alongside a nursing process in order to create a framework. The nursing model for the purpose of the assignment will be Roper, Logan and Tierney (RLT). A nursing model is used to determine what is important and relevant to providing individualized care (Barrett, Wilson, Woollands 2009). We will write a custom essay sample on A needs orientated approach to care or any similar topic only for you Order Now This will be discussed in detail providing evidence of strengths and weaknesses of the model. The nursing process that will be discussed will be APIE which is assess, plan, implement and evaluate. A nursing process is a systematic approach which focuses on each patient as an individual ensuring that the patients holistic needs are taken into consideration. These include physical, social, psychological, cultural and environmental factors. . The nursing process is a problem solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). When used collaboratively the nursing model and the nursing process should provide a plan of care that considers the patient holistically rather than just focusing on their medical diagnosis (Moseby’s 2009). It will also discuss an example of a care plan done for a fictional patient and evaluate and discuss how the nursing plan and the nursing process have created a plan of care and how effec tive this was or was not. Care planning is a highly skilled process used in all healthcare settings which aims to ensure that the best possible care is given to each patient. The Nursing and Midwifery council state that care planning is only to be undertaken by qualified staff or by students under supervision. The Department of health (2009) says that â€Å"Personalized care planning is about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethinic and cultural background and circumstances† with the aim of returning the patient to their previous state before they became ill and were hospitalized considering all of these needs to provide patient centered care. It recognizes that there are other issues in addition to medical needs that can impact on a person’s total health and well being’.It provides a written record accessible to all health professionals where all nursing interventions can be d ocumented. Care planning is extremely important as it enables all staff involved in the care to have access to relevant information about the patients current medical problems and how this affecting them in relation to the 12 activities of living as well as any previous medical history. Barrett et al (2009) state that taking care of an individuals needs is a professional, legal and ethical requirement. There are many different nursing models all of which have strengths and weaknesses and its up to the nurse to choose the right one for individual patient, the model which is used will vary between different speciailties depending on which is more relevant to the patient and their illness and needs. Although a vast majority of hospitals now use pre-printed care plans it is important to remember that not all the questions on them will be relevant to all patients. An example of this would be that activity of breathing may not have any impact on a healthy young adult be would be a major f actor for an elderly man with COPD. There are four stages to the nursing process which are Assess, plan, implement and evaluate (APIE) but Barrett et al state that there should be six stages to include systematic nursing diagnosis and recheck (ASPIRE) as although they are included in the nursing process they are not separate stages and could be overlooked.(Barrett et al 2009). It is important that a nursing process is used and it is set out in a logical order, the way in that the nurse would think this helps minimize omissions or mistakes. Roper, Logan and Tierney model of nursing suggests that there are five interrelated concepts which need to be taken into consideration when planning and implementing care which are activities of living, lifespan, dependence/independence continuum, factors influencing activities of living and individuality in living (Roper, Logan and Tierney 2008). Assessment Assessment is fundamental to gaining all the information required about the patient in order to give the best possible care. â€Å"Assessment is extremely important because it provides the scientific basis for a complete nursing care plan† (Moseby’s 2009). The initial assessment untaken by nurses is to gather information regarding the patients needs but this is only the beginning of assessing as the holistic needs of the patient including physical, physiological, spiritual, social, economic and environmental needs to be taken into consideration in order to deliver appropriate individualized care (Roper, Logan and Tierney 2008). When using the 12 activities of living (ALs) for assessment it gives a list a basic information required but must not just be used as a list as the patient will respond better to questions asked in an informal manner and when just part of the general conversation. RLT (2008) state that although every AL is important some are more important than o ther and this can vary between patients. It is important for nurses to obtain appropriate information through both verbal and non-verbal conversation patients are more likely to give correct information but without jumping to conclusions or putting words into their mouths. ‘Assessment is the cornerstone on which a patients care is planned, implemented and evaluated (RLT 2008). â€Å"Poor or incomplete assessment subsequently leads to poor care planning and implementation of the care plan† (Sutcliffe 1990). Information can be gained from the patient, the patients family and friends as well as any health records (Peate I, 2010) During this process of gathering information it is important to find out what the patient can do as well as what they cant. , McCormack, Manley and Garbett (2004) state that gathering the information requires a certain kind of relationship between the nurse and the patient and nurses need to be able to communicate effectively in order to be able to build this relationship. You read "A needs orientated approach to care" in category "Essay examples" A full assessment needs to consider how the patient was before they became ill or hospitalized in relation to their medical diagnosis as well as how the patient was dealing with it, how they are now, what is the change or difference if any, do they know what is causing the change, what if anything they are doing about it, do they have any resources now or have they have in the past to deal with the problem (barrett et al). RLT (2008) state that there are 5 factors that influence the 12 activities of living which are biological, psychologic al, sociocultural, environmental and politicoeconomic, these may not all have an effect on each patient but all need to be taken into consideration.The more information gained in the assessment process the easier the other steps will follow. RLT (2008) suggest that assessing is a continuous process and that further information will be obtained through observations and within the course of nursing the patient. At the end of the initial assessment the nurse should to identify the problems that the patient has. There are limitations to using a nursing process which are the 12 als are often used as a list as part of a core care plan and are not always individualized Walsh (1998) argues that the 12 activities of living may just be used as a list which could result in vital information being missed which could be detrimental to the patient. The Nursing and Midwifery Council (NMC 2008) states a nurse is personally and professionally accountable for actions and omissions in practice and any decisions made must always be justifiable. There are many benefits to using a nursing process it is patient centered and enables individualized care for each patient. It also gives patients input into their own care and gives them a greater sense of control it is outcome focused using subjective and objective information which helps and encourages evaluation of the care given. It also minimizes any errors and omissions. When I carried out the assessing stage on mabel I did this using the 12 activities of living as suggested by Roper et al (2008) but this was used too much like a checklist. I didn’t gather enough information in order to be able to do the best plan of care possible for her although I don’t feel this could have been detrimental to the care she received it needed more information than I had. I also found it difficult deciding which information should go where so I endened up repeating information in more than one of the 12 als, Which although this wouldn’t have made a difference to the planning of the care plan there was too much irrelevant information which could mean that it wasn’t read thoroughly just skimmed over as it would take too much time. As I am inexperienced in doing this I realized when writing the care plan that there were many questions that I didn’t ask so there where many parts that could not be filled in. I also didn’t gather e nough objective data for certain parts so I didn’t have any evidence that the care had worked or how effective it had been. This is where Barrett et al (2009) state that there should be a systematic nursing diagnosis where nurses establish a nursing diagnosis rather than just a medical diagnosis. This is where the holistic needs of a patient are taken into consideration. Although nursing diagnosis differs from a medical diagnosis the two do interlink but a nursing diagnosis considers the physical, psychological and spiritual aspects of the medical diagnosis and problems that may arise from these. Another part of the systematic nursing diagnosis is to provide baselines to state where the patients are at at the present time so that a needs statement can be written in conjunction with the patient in terminology that they can understand(Barrett et al 2009). Planning The next stage of the nursing process is planning this is where all the information gained in the assessment part to plan the care of the patient. The planning stage of the process is where achievable goals need to be made through discussion with care givers and the patient or the patients representative. These goals need to contain both subjective goals and objective goals in order for them to be measurable and evaluated. The plan of care is to solve the actual problems the patient has and to prevent potential problems from becoming actual ones. It also aims to help the patient cope with their illness in a positive way and to make them as comfortable and pain free as possible (RLT 2008). Planning needs to be totally individualized and patient centered they need to feel they have a voice and part of the team. The more information gathered in assessment the easier the plan of care will be. The main objective of a nursing plan is to ‘provide the information on which systematic, i ndividualized nursing can be based and individualized nursing can be based and implemented by any nurse’ (RLT 2008). Through a detailed individualized plan of care any nurse caring for a particular patient should be able to see exactly what is required of them as all the information will be recorded in the care plan. The NMC (2008) says that nursing interventions need to be specific for that particular patient, based on best evidence, measurable and achievable. There are many different criteria for setting goals just one of these is PRODUCT which stands for, Patient centered, recordable, observable and measurable, directive, understandable and clear, credible and time related. This is just meant as a way of helping nurses to set goals (Barrett et al 2009). When planning care a great emphasis needs to be based on the dependence/independence continuum which will have been established in the assessment phase. The care to be given will encourage the patient to get back to as rea sonably possible or as close to where they were on the continuum as they were before they were admitted to hospital. Planning also needs to take into account the resources available to implement the care as they need to ensure that the care they are planning is achievable and will not be compromised by lack of resources or a shortage of nursing staff (Roper et al 2008). When I did a plan of care for mabel it quickly became evident how inexperienced I was. I didn’t gather enough information in the assessing period to be able to do an effective plan of care. I also didn’t know how achievable the goals where as I wasn’t aware of how long they would take to improve or if they where achievable or not, I also found it difficult determine which problems were interrelated and as a result tried to link anxiety in with another problem when in fact it was a problem on its own. I was able to write the needs statements effectively that were not long but on a couple of these the influencing factors were missed out which would be necessary when providing holistic care. Planning care for a patient requires a great deal of knowledge in the chosen specialty which is why it must be carried out by a qualified member of staff or a student under supervision. Implementation Implementation is the next part of the nursing process and where all the goals which were set in the planning stage are put into motion and the goals can start to be achieved through nursing and medical interventions. The main component of the implementation stage is the delivery of the care to the patient. This is done with nursing staff, the multidisciplinary team members involved in the patients care such as doctor, dieticians and physiotherapists and the patient themselves in order for the patient to be able to return to how they were previously before they were admitted to hospital. The plan of care will be specific to the particular patient and will focus on the biopsychosocial aspects of the patient (Marriner 1983).Implementation provides great emphasis on individualized care which is why it is important to establish in the previous phases where they are on the dependence/independence continuum and what they are able to do now and what they were able to do before. Individualis ed care is associated with how the patient did things before such as how the person carries out the ALs and how often they carry these out. An example of this would be when carrying out the AL of personal cleansing and dressing to individualise the care it would be necessary to have determined in the assessing stage how the patient usually did this and how often it wouldn’t be individualized if in the care plan it was stated that they got a shower every morning if at home they only did this once a week. Core care plans may be used in certain situations this can provide a greater level of care as potential problems can be foreseen if related to a certain problem on the other hand it is also important not to standardize care as patients react differently to different illnesses and treatment. (Faulkner A, 2000). The NMC (2008) state that nurses are required to ‘Make the care of people your first concern, treating them as individuals and respecting their dignity’. In order to deal with certain problems or situations people often develop coping strategies which can be either adaptive or maladaptive. Adaptive coping strategies are usually helpful to the patient whereas maladaptive ones could be detrimental to their health such as smoking or drinking, the patient may feel this helps them to deal with a present situation but it is actually causing them harm. Patients need to be discouraged from using maladaptive coping strategies this could be done by introducing them to adaptive coping strategies and encouraging them to change their maladaptive ones into adaptive ones. Diamond (2008) states that there are also legal and ethical issues when it comes to implementing care as consent needs to be gained before any care is implemented and if this is not given the care cannot be given this will obviously have an effect on how effective the care has been when evaluating the care. The Nursing and Midwifery Council (NMC) state in section 3 of the code of c onduct ‘you must obtain consent before you give any treatment or care’ (2002). During the implementation of Mabel I found that although I was able to implement the care effectively I hadn’t recognized all of the nursing interventions needed to provide holistic care and I wasn’t fully aware of timescales of the planned care. I feel I also needed to research further into Mabel’s problems in order to gain the appropriate knowledge to provide the best care available as this would ensure that are the interventions are evidence based and best practice (NMC 2008). Barrett et el (2008) state that this is where recheck should take place which would enable the health care provider to establish how effective the plan of care is before the treatment ends this would enable them to re-evaluate the plan of care while the treatment is still ongoing and adjust the goals accordingly. Evaluation Evaluation is where the care that has been given can be assessed to evaluate the care given and whether it has worked or not. Chalmers (1986) describe that it is an ongoing and continuous process and also occurs at timed points in a formal setting. Roper et al (2000) say that evaluating care also provides a basis for ongoing assessment, planning and evaluation. There are two different parts to evaluation summative evaluation and formative evaluation. Formative evaluation is done with the patient taking into account whether they feel the care given has worked when done with consideration of the dependence/independence continuum information regarding the patients previous place on the dependence/independence continuum can be obtained from the patient, their friends and relatives as well as other health care professionals in the multidisciplinary team involved in the care of the patient. Summative evaluation is when the holistic view of the patient is taken into consideration how they feel about the treatment, whether they felt that the goals were achievable. It so where all the measureable data stated in the baselines and data received after this time are analyzed to show how effective or not the treatment has been. When evaluating care consideration needs to be given to the influencing factors such as biological factors as the bodies physical ability varies according to age the physical ability of an older person is generally less efficient, therefore therefore the plan of care needs to take this into consideration so that when the evaluation takes place it its hoped to have been effective. A nurse needs to evaluate her patient’s status regularly for some patients this will be just once a day but for others it will be much more frequent depending on their illness and healthcare status. RLT (2008) says that evaluation must be individual to the specific patient and not just a standard goal that is related to a specific problem. If goals haven’t been achieved then it is up to the nursing staff to determine why. Maybe the goals set weren’t measureable or achievable. Parsley and Corrigan (1999) say that if goals haven’t been measureable or achievable then new goals need t o be set. It could also be that the nursing interventions were not successful in which case new interventions should be set. Through my evaluation of Mabel it was evident that I did not require all the information to do a comprehensive plan of care. Although I did set baselines which meant I could compare data I wasn’t experienced enough to set goals to the correct timeframe I also didn’t obtain enough measureable information in certain problems to be fully able to assess how effective or ineffective the care had been. Had I had more experience I feel that the evaluation wouldn’t be a problem. Evaluation requires checking and rechecking in order to see the effectiveness of the care delivered. It requires knowledge and expertise to be able to effectively evaluate and amend the goals and interventions set as necessary. The whole care planning process took me a long time and I still was not very good at certain aspects of it. When setting goals a lot of detailed information is required in order for the plan of care to be effective so I can now understand why it is necessary for a trained member of staff to carry out the task. Conclusion This assignment has shown that when used together the nursing process and the nursing model provide a good basis to providing care. It sets out a systematic approach to providing care. Care needs to be set out in a way that both the nurse and the patient know exactly what is happening as well as any other health care professional in the multidisciplinary team providing care for the patient. It has also shown that involving patients in their care enables them to feel they are part of the team and are more likely to help themselves with their care. Reference list Sutcliffe E 1990, Reviewing the process progress. A critical review of literature on the nursing process. Senior Nurse, 10(a), 9-13. Applying the Roper-Logan-Tierney model in practice 2008 Elsevier ltd. Roper N, Logan W, Tierney J (2008) The Roper Logan Tierney model of nursing, Churchill Livingstone:London. Dimond, B. (2008) Legal Aspects of Nursing, 4th ed. Harlow: Pearson Education. Barrett D, Wilson B, Woolands A (2009) Care planning a guide for nurses: Pearson, Essex. Faulkner A (2000) Nursing The reflective approach to adult nursing. Stanley Thornes: Cheltenham. Peate I (2010) Nursing care and the activities of living 2nd ed. Wiley-Blackwell: West Sussex. Yura H, Walsh M (1983) The nursing process: Assessment, Planning, Implementing, Evaluating. Appleton Century: Crofts Norfolk. Cook S (1995) The merits of individualized measures within routine clinical practice. . http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_093359(2009) (29/04/11 Alfaro R (2002), Applying the nursing process: Promoting collaborative care 5th ed. Lippincott: London. Moseby’s Medical Dictionary (2009), 8th ed, Elsevier. http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/[Date Accessed 11/04/2011]. McCormack B, Manley K and Garbett R (2004) Practice Development in Nursing, Blackwell Publishing, Oxford. Atkinson L Murray E, (1995), Clinical guide to care planning, McGraw, Oxford. NMC (2002), The NMC code of professional conduct, Nursing and Midwifery Council Publications How to cite A needs orientated approach to care, Essay examples

Provide Care for Babies and Toddlers

Question: Discuss about theProvide Care for Babies and Toddlers. Answer: List some of the Organizational Policies and procedures relevant to the physical, emotional and developmental needs of babies, toddlers and older children. Babies, toddlers, and the older children all are having different types of nursing categories with which they get nourished. As per the National Quality Framework, the policies and the procedures for the developmental needs of the organization are based upon few guidelines that give the basic knowledge regarding its formulation. Those are the formulated with identifying the basic needs that can provide the response to the issues of the children. Those children can be of babies, toddlers, and older children (American Diabetes Association, 2013). That is the reason the National Quality Framework has provided with the laws of National law and which gives the idea of behaving with the children. In the older children, it is mandatory to consider the self-esteem of the children. The policy and procedure say that it is mandatory to respect the privacy of the children. Therefore under the legislation, the National Quality Standard made the provision of having a particular benchmark to provid e the standard quality of services in taking care of the babies and the toddlers. In this process, the National Quality Framework goes with its principles in guiding the services to achieve the standards of the developmental needs of the babies, toddlers, and the older children (Anglin, 2014). List one of the Quality Areas and a relevant Standard and Element of the National Quality Standard which applies to the physical, emotional and developmental needs of babies, toddlers, and older children. The National Quality Standard describes the particular process which is responsible for delivering the quality amount of services for the betterment of the children. The services that are given to the babies, toddlers, and older children are assessed by the National Quality Framework which further provides the rating to the services. In this process, the regulatory body of the National Quality Standard makes the check regarding the quality areas. Out of all the quality areas of the National Quality Standard that must be applied to the physical, emotional and developmental needs of the babies, toddlers, and the older children are the relationships with children (Berry et al., 2013)n. The sources say that the children can be taken better care by the parent where they can get more opportunities for interaction. The babies and the toddlers can get special care getting close to their parents. And the older children with more and more interaction there will have the establishment of the re spectful and positive relationship in between them. Further by taking care of the relationship the older children builds up a sense of security and belongingness within them. At the same time, the babies and the toddlers very lovingly explore the environment with getting engaged in their playing and learning process (Graham, Jordan, Yeoh, 2015). As mentioned in the question during the process of early childhood education and care services must include the food safety program that will prevent the spreading of the infectious diseases. In this process, there must be followed the safety measures by the educators and the staff members during the preparation of food. It is always necessary to wash hands before the preparation of food. Also, the cuts and or the bandages must be covered with gloves by keeping the personal hygiene in concern. Along with that, it is not mandatory to have any jewellery than few of them during cooking (James, Nelson, Ashwill, 2014). Similarly, the food after eating must be kept in the refrigerator if anything left over within two hours of consumption. Also, the food that has to be kept must be kept in the refrigerator in less than 5oC, as the microorganisms usually grow in between 5oC to 60oC. Also, the food must be heated to the temperature more than 60oC to keep in microbe free. The food storage of the raw and cooled food always has different guidelines. Both the foods should be kept separately. The raw dry foods can be kept in the air tight containers on the shelves. The cooked food also to be stored in the containers in the fridge in the cold temperature by preventing spilling as it makes contamination. The raw foods are kept separately because if it is kept with the cooked food, then the juices from the raw food can get into cooked food by contaminating it. Again while preparing the bottles that must be boiled in the heat to make it bacteria-free (Janssens et al., 2013). The bottles are stood upright. The heating of the bottles depends upon the quantity of the bottle. After that, before giving it to the infant, it must be inverted finely and let to settle down, and the temperature is tested by taking few drops in hand. After that, the bottles are to be stored on the shelf in the refrigerator, not on the doors of the refrigerator. Outline an Article of the Convention on the Rights of the Child that relates to ensuring children develops physically. In the Article of Convention of Rights of Child there contain 54 articles, and out of those 54 articles, the Article no.6 describes the factor ensuring bout the physical development of the child. It is because the Article no.6 deals with the life, survival, and development. According to the Article no.6, every child has the right towards its life. Therefore as per that condition the State has the responsibility to make the obligation that can help in ensuring the childs development and survival (King, Chiarello, 2014). Using the Code of Ethics, briefly, outline an educators professional responsibility about the physical development of children. During the development of children, for the children, the parents can also be an educator who contributes to its physical development. As the childhood is a significant time that is the reason the educator must be aware of the exact situation where the child needs which type of development. The educator must be able to recognize the strengths and the capabilities of the child after which the proper learning education should be given to the child as per his or her requirement (Lindley et al., 2013). For the physical development of the child, the educator must make the child expose to the physical environment that will help in enhancing the childs dignity, learning, interaction, self-worth, and development. By this there the child will be able to understand their relationship with the outer world and the child can easily get adapted to the natural environment. Organizational standards, policies, and procedures make a list of the policies relevant to this unit of competency. The policies and the procedures are made in this context is due to the skills and the knowledge that are attained by the educators during the process of working with the children. These are formulated to make sure by ensuring the development and maintenance of the effective relationships with the child that will further help in the promotional process of positive behaviour within the child. The development of the positive relationship with the child is made through the positive communication and interaction with children and by promoting positive behaviours with the children. Along with that, the educators must do the collaborative work with the children (Mathu-Muju, Friedman, Nash, 2013). That is the reason the educator must respect the similarities and the differences of the child that can enhance their capabilities. With having these activities, the Educator can help the child in supporting them in the decision-making the process by which they can become self-dependent. The polic y helps in making the development and implementation by ensuring the parents, supervisor and the staff members with all the requirements of the child. The policy ensures the children to adequately supervise. Along with that, the policy deals with the specific group that provides the children best opportunities. The policy ensures the encouragement of the children for expressing the opinions of the children, and by this, the children maintain the dignity and their rights which provide positive guidances. EYLF or the Early Years Learning Framework is the additional tutorial that helps the educators in providing early care, education and learning to the child. The process of EYLF in children is carried through the framework of belonging, being and becoming. In this, the EYLF can be applied where the children have the strong sense of identity along with those which can get connected to the world (Marshall, Gidman, Callery, 2013). Apart from that the children those have a strong sense of well-being can have the EYLF. Again the children those are confident learners and effective communicators can get EYLF. MTOP is the process that helps the educators of school care to have the development of self-paced professionals in the school (Lindley et al., 2013). It helps the educators of the school to make the examination of the current reflective practices which can be said to be implemented in the National Quality Framework. Due to this there develop the collaborative relationships in between the schools with the school age care services. Access the UN Convention on the rights of the child and list the articles that apply to this unit of competency. As per the UN convention, there are many Articles that directly state the development of the positive relationship with of the child and match the particular competency. Those articles include the Article no. 2, 3, 5, 12, 13, 14, 27, 29 and 31 (Marshall, Gidman, Callery, 2013). These entire articles in some way or other contribute towards the enhancement of the positive and respectful relationship with the child. In this process, the educator has its major contribution which modulates the child behaviour with their concerned actions. References American Diabetes Association. (2013). Standards of medical care for patients with diabetes mellitus.Puerto Rico Health Sciences Journal,20(2). Anglin, J. P. (2014).Pain, normality, and the struggle for congruence: Reinterpreting residential care for children and youth. Routledge. Berry, J. G., Agrawal, R. K., Cohen, E., Kuo, D. Z. (2013). The landscape of medical care for children with medical complexity.Overland Park: Childrens Hospital Association. Graham, E., Jordan, L. P., Yeoh, B. S. (2015). Parental migration and the mental health of those who stay behind to care for children in South-East Asia.Social Science Medicine,132, 225-235. James, S. R., Nelson, K., Ashwill, J. (2014).Nursing care of children: Principles and practice. Elsevier Health Sciences. Janssens, A., Hayen, S., Walraven, V., Leys, M., Deboutte, D. (2013). Emergency psychiatric care for children and adolescents: a literature review.Pediatric emergency care,29(9), 1041-1050. King, G., Chiarello, L. (2014). Family-Centered Care for Children With Cerebral Palsy Conceptual and Practical Considerations to Advance Care and Practice.Journal of child neurology, 0883073814533009. Lindley, L. C., Mark, B. A., Lee, S. Y. D., Domino, M., Song, M. K., Vann, J. J. (2013). Factors associated with the provision of hospice care for children.Journal of pain and symptom management,45(4), 701-711. Mathu-Muju, K. R., Friedman, J. W., Nash, D. A. (2013). Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model.American journal of public health,103(9), e7-e13. Marshall, M., Gidman, W., Callery, P. (2013). Supporting the care of children with diabetes in school: a qualitative study of nurses in the UK.Diabetic Medicine,30(7), 871-877.

The Pearl Essay Paper Example For Students

The Pearl Essay Paper Character Analysis of Kino from The Pearl Kino, a character from the story The Pearl, is a prime example of a developing character. From the start through to the end, he develops drastically. At the beginning, he was thought out to be a good loyal husband but as time went on he became a selfish, greedy person who would do anything for money. When the story began Kino seemed to be a good husband who wanted nothing more than to be able to support his family. After a scorpion had stung Coyotito, Kino prayed that he would find a pearl not to become a rich man but so that he could pay the doctor to heal the baby, as he would not work free. After Kino had spent long hard hours searching the ocean floor, he finally found the pearl he had worked for. At first when he found it, he only wanted to pay the doctor to cure Coyotito. However as time passed he began to think of all the things that he could acquire with the money form the pearl and began to develop greed and selfishness. When people asked him what he would buy now that he was a rich man, he was quick to list several items that came to his mind. One of these items was a rifle. Kino wanted a rifle because he wanted to show power over the rest of his village. We will write a custom essay on The Pearl Paper specifically for you for only $16.38 $13.9/page Order now When Kino took the pearl to the pearl buyers to sell, he was offered one thousand pesos. Kino declined that offer claiming that his pearl was The Pearl of the World. By reacting in such a manner he yet again demonstrates his greed. It is not about saving Coyotito anymore, for he is already feeling well, it is now about the money. Although one thousand pesos was more money than Kino had ever seen he demanded that he would get fifty thousand pesos. Later in the text, Kino discovers Juana trying to destroy the pearl, causing Kino to become very angry, and resulted in him beating her. Although Juana was in very much pain she accepted the beating as if it were a punishment and stayed with Kino. A while later Kino was attacked by another man who wanted the pearl for himself and defended his pearl by killing the man. It is around this point in the story where Kino displays his greatest point of greed and selfishness. When Kino gets ready to attack the trackers Coyotito lets out a cry awakening one of the sleeping trackers. The tracker on watch described the cry as being the cry of a baby, however, the tracker who had just awaked described it as being a coyote. The tracker on guard then lifted his rifle and shot in the direction of the sound. This sparked the deadliest of fuses in Kino, which turned him from a normal man into a fearsome, uncontrollable, machinelike man killing everything in its path. When Kino returned to the village he looked at the pearl and began to realize the effect it had on him, his family, and his village, and decided to throw it back into the ocean where it came from. Kino has paid a large price to learn such a valuable lesson, that we should not let greed and our want for something to overcome us and let us lose sight of the important things in life such as family, health, and life itself.

The Real Possibilities of Cloning essays

The Real Possibilities of Cloning essays On February 22, 1999 news was announced that Dolly the lamb was the first successful animal cloned. Unlike the other cloning experiments done over the past 15 years, this was the first successful clone made with an adult cell. The cell was used to activate and program the egg from which Dolly grew. Past clones involved using the cell from a fertilized embryo in the early stages of development. As news of Ian Willmut's cloned lamb got out across the globe, many people feared what they thought could possibly never come true. With the technology to clone identical animals, can humans be cloned too? Since then topic of discussion throughout the scientific world has centered on the cloning of humans. Recently, The University of Texas lab cloned the first headless creatures, headless mice. Since then, headless tadpoles have also been born at The University of Blath. This discovery is even more chilling because it opens up the door to headless humans, for purposes such as organ banks. Headless human production could also be used as a means for testing out new treatments for diseases such as cancer. Controversy is coming up more often considering the morals and ethics of cloning. Is headless cloning opening the gate to human immortality? Is a headless clone ever a living creature? Many people are beginning to wonder if cloning will be beneficial to our country. The cloning of animals as well as human cloning could prove very beneficial to our nation. For instance, cloning research would be very beneficial to improving the vitro fertilization process. Vitro fertilization is when a woman's egg is removed from her uterus, fertilized by a sperm donation, and replaced back in the uterus. John Robertson, an authority on reproductive technology and the law at the University of Texas School of Law says, "Even if they only produced three or four embryos, it could greatly improve the odds that it will work (Robertson, 3)." This c...

Poor Teaching and Misbehaving Teachers

Poor Teaching and Misbehaving Teachers Student social media users mentioned many interesting problems they faced in school. The majority of this #StudentProblems101 are classroom problems such as difficulty in understanding lessons, humiliation, stress, and boredom. Personal problems, on the other hand, include sleep deprivation and miserable weekends and holidays due to homework. ~ Poor Teaching Poor teaching according to one study is associated with teacher’s lack of care and concern, poor social relationships, and insensitiveness to students learning requirements. In fact, student’s cognitive learning and enjoyment are highly dependent on the quality of teaching. The reason is that poor teachers decreased students’ self-confidence and motivation for learning and increase their anxiety while in the classroom. ~ Humiliation Classroom problem such as humiliation according to these social media users commonly occur when the teacher mention his or her name as an example of a bad student. For instance, â€Å"Study hard and don’t be late like Paul.† According to the result of the study conducted by Breaux and Whittaker, most participants experienced humiliation from a teacher. Offensive teachers are those who humiliate students, blame students for problems in the classroom and engage in sarcasm. They are mean and cruel, play favorites, and self-centered. ~ Stress Boredom Students with teachers who take pride in punishing students often experience stress and boredom. For instance, some teachers systematically overload students with content and impose nearly unattainable objectives, make test difficult, and punish students with low grades. Indolent teachers, on the other hand, are those who deliver boring lectures, lack basic teaching skills, arrived late, neglect to grade homework, and make their classes too easy. You will definitely enjoy these articles: College Students Developing Students Creativity and Self-Expression through Crayons Helping Autistic Students Shine in Mainstream Classroom International Students Relieving Students Scool-Related Stress There Is No Place Like Home Students are young people with natural curiosity and eagerness to learn. However, they are also outgoing people with interest other than school. Putting pressure on a young person, therefore, is counterproductive and may lead to some negative attitude towards learning. For instance, a teenager consistently deprived of sleep and missed out things such as family gets together, sport events, and so on, because of homework, may eventually hate homework and school. Young people tend to see social demands of school life extremely difficult when they spend most of their days in study tables. Study of issues in education suggests that most students seem to misbehave and hate school when they put much more time in homework. This is because young people need to play, spend time with family and friends, and do things they love. Although homework according to several studies has positive effects particularly in high school, the result of other studies suggests that it greatly affect students’ feelings and attitudes about school negatively. These include loss of interest in academic material and physical and emotional stress. In reality, homework robs students of valuable leisure and family time and time to spend on developing other interest. Moreover, excessive lesson time and homework time eventually result to burn out or students alienation from the academic material. In fact, study shows that some students left school because of homework and exacerbate the division between high and low-income families. For instance, students from more progressive backgrounds are likely to have more time and parental support than those with disadvantaged demographic backgrounds.

Interview with an Entrepreneur Assignment Example | Topics and Well Written Essays - 2500 words

Interview with an Entrepreneur - Assignment Example evealed under the heading of Interview Summary, has been scheduled to focus on eight particular issues that had been of substantial importance during one’s migration from being employed to being an independent individual with high hopes of becoming a successful entrepreneur. The interview starts with the factors that inspire a person to be self employed. Next, light has been shed on the changes that take place in his life since he had opted to be self employed and the measures adopted by him to cope with those changes. Subsequently, questions were aimed at understanding his opinions on skill requirements and other aesthetic aspects associated with entrepreneurship. The basis of this interview is to try and substantiate an individual’s decision of gauging the comparatively riskier waters of entrepreneurship by sacrificing the sense of security that employment confers. Life has turned to a new leaf since I have moved from employment to self employment. Previously job responsibilities were routine based tasks which had comparatively lower responsibilities. Self employment has imposed greater responsibilities and there is no limit with regards to the volume of work. After moving to the role of an entrepreneur I have also started devoting fewer times to my family and friends. The best part however is that I welcome this change. On the professional front entrepreneurship has provided me with lots of freedom to explore and try out new ideas which is quite different from a routine job where there is less room for exploring new ideas. Certain changes have come as a pleasant experience like added responsibilities, work pressure etc. It was difficult in the very beginning since the entire gamut of the business fell upon my shoulders. Family and personal life has of late taken a beating as I have been unable to devote time to my family. On this occasion I would sincerely thank my wife, my children and my friends who have been supporting me in my new initiative. The

Exploratory and Confirmatory Factor Analysis Essay

Exploratory and Confirmatory Factor Analysis - Essay Example The article makes use of concepts derived socio-technical theory as well as the role theory in an attempt to show the relationship between technostress and productivity. In the article, CFA and EFA approaches are applied in investigating the theoretical constructs and the factors represented in the study about the relationship between technostress and human productivity (Chilton, Hardgrave, & and Armstrong, 2005). The two approaches enhance the hypothesis that the factors used are correlated. Three hypotheses are thus developed. In hypothesis 1, stress comes out as people try to respond to various factors. Hypothesis 2 depicts stress as correlated to the roles of individuals within organizations. Hypothesis 3 also shows a correlation between technology and organization roles (Tarafdar, Nathan, & Ragu-Nathan, 2007). The two approaches are used in accessing the quality of every item used in the study. Both the CFA and the EFA are applied for both confirmatory and exploratory purposes. This aspect is seen in the three hypotheses, which address the three variables differently. While EFA and CFA are seen to have several similarities in their statistical applications, they greatly contrast in certain ways as well. The use of EFA required that a decision is made on the number of factors applied through an examination of the output from an analysis of principal component (Nygaard & Dahlstrom, 2002). For the article, a five-factor structure is first established to analyze the items. Conversely, the use of CFA requires a specification of the number of factors before the analysis. (Tarafdar, Nathan, & Ragu-Nathan, 2007) Again, the CFA involve the specification of a particular factor structure with an indication of the factor on which each item would load while in the case of EFA, all items load all the factors. In estimating factor loading, maximum likelihood is used, but

It is not possible to be a disciple of Jesus in the modern world Essay Example for Free

It is not possible to be a disciple of Jesus in the modern world Essay It is not possible to be a disciple of Jesus in the modern world I disagree with this statement, although I recognise that it is not always easy to be a disciple I believe it is possible for those who have faith. We are first called to discipleship at Baptism where the father of the child lights a candle from the Pascal candle as a sign of his responsibility to enable his son/daughter to grow in full faith. I believe that faith makes everything possible, if we have faith in God and his teaching we can achieve our hopes and dreams. If we have faith then living, as a true disciple is part of our way of life, we as Christians in todays world should try to live our lives as Jesus lived his. Without faith what meaning would life itself have for us, what would be the use in perusing life if it had no meaning to us. If we believe then we can reach goals and discipleship can bring joy and purpose to our lives we can achieve goals and targets we set for ourselves. Nothing is impossible to he who believes Faith in God is not always easy to maintain; if we pick up a newspaper what headings do we usually see? Usually something related to drugs, alcohol, kidnapping, and murder. What example is this setting to children? While there parents are teaching them about how caring we should be, and how we should love our neighbour as ourselves, these children look at the newspapers or even the news and see people who have lost arms or legs as someone has shot them. What kind of example is this of loving your neighbour? What affect is this going to have on these children in the long term? They will grow up with the opinion that this is acceptable and everybody does it why should they be different to the rest? To be a true disciple we must have immense faith in God, if we have faith nothing is impossible. But there are many difficulties which disciples of Jesus have to face when trying to carry out the work of God, one of the most difficult to deal with is peer pressure. Many people, particularly the young people, feel unable to resist the pressures put upon them by their peers and therefore behave in a way which goes against the teaching of the gospel. There are many pressures maybe to smoke, drink, vandalise others property, tell lies, use foul language, and have a sexual relationship before marriage. If enough pressure is put on these people it is very difficult to say no! And therefore they are going against the teaching of Jesus not because they want to it is because they are not strong enough to resist temptation, and they are afraid others will treat them differently. Other pressures come from the media we usually get a picture from the media of very anti-Christian values and standards. Take magazines for example they tell stories of unmarried people having a sexual relationship or young people smoking and drinking, and this is all classed as Normal and acceptable in our world. They do not present the Christian way of life as being worthwhile and Cool or up to date. We also get a lot of anti-Christian standards from the television, films, and videos. These can have a very powerful influence on the lives of many people; most soap operas and films present a non-Christian way of life. How often do you see a Christian family in a soap opera, and if there is Christian families do you ever notice that they always seem to be laughed at by the rest of the families as they are seen to be out of date and definetly not trendy. Television I believe influences many people, who is going to get up early on a Sunday morning to watch the Christian services carried out in different chapels, while they could be watching Eastenders or a popular music show! There are many ways television influences us they give us pictures of what is normal in our society such as sex before marriage, abortions are acceptable, divorce is a fact of life, the only purpose in life is to search for pleasure, and violence is acceptable and part of everyday life. Media can make Christians feel confused and unsure of their own beliefs The way of life presented by the media is often made to seem more attractive, more enjoyable, easier, and more glamorous. However we as Christians should always remember that Jesus never promised that being a disciple would be easy, in fact we must deny ourselves take up our cross and follow him. We should make up our minds whether we want to be a disciple; many people are unable or incapable to make such decisions in life because of addictions to alcohol, drugs, gambling, and solvent abuse. Becoming addicted to any of these can make people lose all sense of reality of right and wrong, of what being a Christian really means. If a person is not in total control of their life then being a Christian is almost an impossible task. The family is an extremely important unit and source of Christian discipleship in our society, it is within the family that children first learn about the love of God, right and wrong and acceptable and unacceptable modes of behaviour. Parents are the first teachers of their children and the church relies on these parents to pass on the faith to their children by what they say and through their actions. There are many broken families in todays society and many children do not receive the Christian teaching and example, which they need, such as love and understanding and therefore grow up not using the example in their life. So to be a good disciple is extremely difficult but not impossible. In todays world there are many distractions and other Gods, which can lure us away from love of the one true God. Things such as money, possessions, wealth, search for pleasure, and success, laziness, indifference, friends, and Greed. These things all tempt us in many different ways, it is as if they are trying to make us forget our first priority which is God. The easier route in life is often to give into these temptations, to become distracted by worldly and materialistic values and to become neglectful to our Christian duties. If we consider all the pressures people today face we see that it is not always an easy task to follow Jesus through thick and thin, but it is not an impossible one. When Jesus chose his first disciples he knew that it would not be easy for them, nor is it easy for us in the twentieth century. The world as we know it is becoming less and less accommodating to the Christian way of life and it is not going to get any easier, this is why we should never give up and our faith should see us through even the worse times in life. We should not become what society wants to become and is encouraging us to become we should not be lured away from God so we can fit in and act like people want us to. This is the challenge of Christian discipleship.

Tom Stoppards Arcadia Essay -- Arcadia Tom Stoppard

Throughout the text, Tom Stoppard's novel Arcadia makes a series of philosophical statements regarding the theme of determinism. These statements are developed largely through images and completely different time periods, particularly those of the Romantic and Enlightenment era ¹s. Tom Stoppard uses the theme of determinism to show how the ideas of the Romantic era and the present day have gone in a circle. And that even though we get more and more advanced everyday, Stoppard shows us that despite our constant advancement, our basic ideas have remained unchanged. Author Tom Stoppard portrays this belief of a time cycle through the image of the apple juxtaposed with the image of the garden.   Ã‚  Ã‚  Ã‚  Ã‚  In Arcadia, Tom Stoppard uses a scientific view of determinism along with a religious view on determinism in order to allow the reader to see similarities in ideas between the Romantic era and the present day. Religious determinism in Arcadia is shown to have to do with God/fate, predestination, and the future whereas the scientific view has to do with Newton, and with biological determinism. Although both stories do use both aspects of determinism, it is usually the story from 1809 using the scientific determinism whereas in the present day, they use more of the religious view of determinism.   Ã‚  Ã‚  Ã‚  Ã‚  In the first story, a scientific view of determinism is shown through Septimus and Thomasina in order to introduce to the reader the basic ideas on determinism and science.   Ã‚  Ã‚  Ã‚  ...

Profit

1. a. The total explicit cost is $793,000($970,000-$177,000). The total implicit cost is $190,000($175,000+. 15X$100,000). The total economic costs is $983,000($793,000+$190,000). b. The accounting profit in 2010 is $177,000($970,000-$793,000) c. The economic profit in 2010 is $-13,000($970,000-$793,000-$190,000). d. The owner should not leave his job because the economic profit is negative, which means he will earn less if he does his own business. 2. a.The type of agency problem that is involved here is principal-agent problem. Marriott wants to maintain a certain level of quality at all of its hotels, but in order to do that it would require capital investment by franchisees. By investing in the hotels, the franchisees are losing profits. b. I believe that Marriott needs to worry about the quality of all the hotels whether they are owned or franchised. In order to keep customers satisfied and coming back to stay at a Marriott they need to keep a good reputation. c.Marriott would t end to own its hotels in resort areas because the people will be more focused on the quality and upkeep of the hotel itself. By Marriott providing good quality in resort areas it will help them gain more business in downtown areas due to the customers’ previous experience. In downtown areas it is also more difficult to find a high quality hotel. If people do not have a good experience at a Marriott then the next time they need to stay in a hotel they will travel further down the street to a different hotel due to the poor quality of the previous Marriott stay.The reputation of the Marriott depends highly on how much business it will have. A good reputation will lead to great profits. 3. a. I would expect the price of wine to decrease as well. b. I would expect the price of wine to decrease because the quantity demanded for wine will increase. c. I would expect the price of wine to decrease as well because the quantity demanded will increase due to people having a job and maki ng more money. d. I would expect the price of wine to decrease.A rise in the price of cheese will decrease demand for cheese, which should decrease demand for wine which in turn will decrease the price for wine. e. I would expect the price of wine to increase due to the increase in prices of the wine bottles. f. I would expect the price of wine to decrease since it will be cheaper to produce. g. I would expect the price of wine to decrease. h. Since older people drink less wine, demand would be falling in this case. As a result, the price would decrease. 4. a. 5.I believe that the equilibrium price of products gaining a presence on the Internet will increase because the quantity demanded will be higher and the equilibrium output will also increase. Since it will be new to the internet the demand will increase which will make the price increase as well. 6. MC=MR 1000-10P=40P 50P=1000 P= 1000/50 P=20 units (reduction of pollution units) 7. a. MB=MC MC is w=200 and MB from hiring a sec ond worker is MB(2)=(30-20)X25=250 TB=(50-20)X25-(200X2)=750-400=350 The firm will hire two guards. b.The benefit from the first guard is: B(1)=(50-30)X25=20X25=500. The maximum payment to the first guard the firm will be willing to pay is $500. c. MC=200 MB(4)=(14-8)x50=6X50=300 TB=(50-8)X50-(4X200)=1300 Therefore the firm should hire 4 guards. 8. a. Price=MC 70=40+0. 005Q; Q=6000 The MR for each unit of output is the same at $70. b. TR=70X6000=$420,000 TC=10,000+(40X6000)+(0. 0025X(6000)^2)=$340,000 Total Profits=$420,000-$340,000=$80,000 c. MR=MC therefore providing one more unit of output will earn $70 and cost $70 so there would be no profit.

Employment and its effects on high school and college students’ grade point averages Essay

Many students, parents, and educators have been seeking the so-called Holy Grail of learning for many decades. One question that has arisen out of this learning model is that of student employment? Many wonder if working a part-time job will affect a student’s grades, and if so, how much? The answer to this seemingly simply question, however, is more complex. A variety of factors must be considered when deciding if and to what extent a student’s grades are affected by his or her employment status. In recent years, the concept of the full-time student seems to be disappearing. From about age sixteen, an overwhelming majority of students, both high school and college, work while they attend school. This average is about 85% for most college students (Bradley, 2006). However, high costs everything from apparel to tuition drives these workers into their part-time jobs which are generally retail and service related businesses for an average of fifteen hours per week (Bradley, 2006). Generally, most studies do identify some differences in academic performance and attitude, but these differences are not as great as people once may have believed. Generally, studies find very few basic differences between working and non-working students, especially in college. However, the intensity of the job and the number of hours worked did seem to affect academic performance in many students at the high school level. Generally longer hours meant more stressors on the individual and had a negative affect on their grades, which translates into about a half of a grade point average(GPA) point lower than not working students or students who work only a few hours, perhaps on the weekends (Weller et al, 2003). Oettinger (1999) also found this to be true, and noted that minority students tended to be more affected by the GPA drop than white students. He noted his drop in GPA to be about . 20 points and to be most obvious in students working more than twenty hours per week. These studies corroborates a study done nearly twelve years earlier in which the researchers found, similarly, that students who put in longer hours at their jobs suffered lower grades, higher absenteeism, and less interest in school in general which was seen in negative behaviors while in school (Perils of Part-time Work for Teens, 1991). At the college level, these differences were less noticeable. Ironically, Bradley (2006) found that the grade point averages were highest for students who did not work AND for students who worked more than twenty hours per week. This seems to contradict the research done on high school students, suggesting that maturity and attitude may also play a part in the employment/grades debate. Research has also been conducted on academic attitude and perception as they relate to grades. In high school, students who worked longer hours did not seem to have much distress about their grades as a result of the employment: â€Å"Those who had jobs displayed no advantage over the others in self-reliance, self-esteem or attitude toward work† (Perils of Part-time Work for Teens, 1991). In addition, students who worked even seemed to report less school stress, possible because they had less interest in school, as mentioned above. Moreover, researchers explain this more blase attitude toward schools by the findings that students who worked were more likely to report avoiding difficult classing, cheating on exams, and copying homework from friends (Weller et al, 2003; Perils of Part-time Work for Teens†, 1991). This was not the case for university students. In college, students who worked perceived that their employment DID affect their grades even when the researchers found little or no interest in grades between non-workers and workers at the college level. Both working and non-working college students showed a high level of interest in their grades and expressed an overall desire to achieve a high level of academic performance. Students who did not work stated that did not do so in order to focus on their studies, and they believed that their studies benefited from this extra time. Again, though, the studies showed no difference in the GPAs of working and non-working college students (Bradley, 2006). Instead many researchers ponder how college students who work so many hours are able to keep similar GPAs to those that do not work. Bradley (2006) suggests that nonworking students may be spending similar time with other activities such as sports, extracurricular clubs, or even caring for dependents at home. He also proposes that the non-working students and the working students may be approaching homework and study in different ways. He notes that non-working students â€Å"may be most likely to adopt a ‘deep’ learning style, characterized by intrinsic interest in the subject content and a desire to maximize understanding of this content† and that working students â€Å"may be more likely to adopt an ‘achieving’ style aimed at maximizing grades through the effective use of space and time. † These learned differences could certainly account for the way different students juggle the demands of work. It is certainly helpful to note when employment can be an effect socialization tool aimed at building strong character and organizational skills and when it can be a definite academic detriment. Research shows that more differences exist for high school students than for college students, and that the majority of the college differences exist only in perception, not in actuality. This gives rise to the possibility of further research which could focus on the characteristics of working students who do keep their GPAs high.

Oprah and Edison essays

Oprah and Edison essays Oprah Winfreys life was far from successful. On January, 29, 1954 Oprah Gail Winfrey was born to teenage parents who werent married. Vernita Lee her 18 year old mother was a housemaid and her father Vernon Winfrey served for armed services at the age of 20. For the first six years of her life Oprah was raised on a farm in Mississippi by her grandmother. Her grandmother taught Oprah how to read at a very young age of three. She started her public speaking at the church reciting sermons. Her grandmother believed in her and constantly said, Youre gifted. At the age of six Oprahs mother decided that she was capable of taking care of Oprah, so she moved with her mother to Milwaukee. She was raped by a cousin when she was nine and later molested by a male friend of her moms and by an uncle. Since she didnt tell anyone about this she rebelled and repeatedly ran away and got into trouble. Her mother couldnt put up with her anymore and was sent to live with her father Vernon. She became pregnant at fourteen and gave birth to a baby boy who was a still born. The death of her baby devastated her tremendously and she vowed to turn her life around. Her father was strict and made her read a book every week and have a report on it. At the age of 19 Oprah had her first job as a reporter for a radio station. Shortly after, she was accepted into Tennessee State University. She studied radio and television broadcasting which she hoped to peruse a career in. During her first year Oprah received several awards including Miss Black Nashville and Miss Tennessee. In 1976, Oprah moved to Baltimore where she hosted a show called People Are Talking. The show was a hit and Oprah stayed with it for eight years. Later after the show stopped she was recruited by a TV station in Chicago to host her own morning show, AM Chicago. The show, ...

Pteranodon Facts and Figures

Pteranodon Facts and Figures Despite what many people think, there wasnt a single species of pterosaur called a pterodactyl. The pterodactyloids were actually a large suborder of avian reptiles that included such creatures as Pteranodon, Pterodactylus and the truly enormous Quetzalcoatlus, the largest winged animal in earths history; pterodactyloids were anatomically different from the earlier, smaller rhamphorhynchoid pterosaurs that dominated the Jurassic period. Wingspan of Close to 20 Feet Still, if theres one specific pterosaur that folks have in mind when they say pterodactyl, its Pteranodon. This large, late Cretaceous pterosaur attained wingspans of close to 20 feet, though its wings were made of skin rather than feathers; its other vaguely birdlike characteristics included (possibly) webbed feet and a toothless beak. Weirdly, the prominent, foot-long crest of Pteranodon males was actually part of its skulland may have functioned as a combination rudder and mating display. Pteranodon was only distantly related to prehistoric birds, which evolved not from pterosaurs but from small, feathered dinosaurs. Primarily a Glider Paleontologists arent certain exactly how, or how often, Pteranodon moved through the air. Most researchers believe this pterosaur was primarily a glider, though its not inconceivable that it actively flapped its wings every now and then, and the prominent crest on top of its head may (or may not) have helped stabilize it during flight. Theres also the distant possibility that Pteranodon took to the air only rarely, instead of spending most of its time stalking the ground on two feet, like the contemporary raptors and tyrannosaurs of its late Cretaceous North American habitat. Males Were Much Bigger Than Females There is only one valid species of Pteranodon, P. longiceps, the males of which were much bigger than the females (this sexual dimorphism may help to account for some of the early confusion about the number of Pteranodon species). We can tell that the smaller specimens are female because of their wide pelvic canals, a clear adaption for laying eggs, while the males had much bigger and more prominent crests, as well as larger wingspans of 18 feet (compared to about 12 feet for females). The Bone Wars Amusingly, Pteranodon figured prominently in the Bone Wars, the late 19th-century feud between the eminent American paleontologists Othniel C. Marsh and Edward Drinker Cope. Marsh had the honor of excavating the first undisputed Pteranodon fossil, in Kansas in 1870, but Cope followed soon afterward with discoveries in the same locality. The problem is, Marsh initially classified his Pteranodon specimen as a species of Pterodactylus, while Cope erected the new genus Ornithochirus, accidentally leaving out an all-important e (clearly, he had meant to lump his finds in with the already-named Ornithocheirus). By the time the dust had (literally) settled, Marsh emerged as the winner, and when he corrected his error vis-a-vis Pterodactylus, his new name Pteranodon was the one that stuck in the official pterosaur record books. Name: Pteranodon (Greek for toothless wing); pronounced teh-RAN-oh-don; often called the pterodactylHabitat: Shores of North AmericaHistorical Period: Late Cretaceous (85-75 million years ago)Size and Weight: Wingspan of 18 feet and 20-30 poundsDiet: FishDistinguishing Characteristics: Large wingspan; prominent crest on males; lack of teeth

Solar Panel Battery Charger 6-12V Research Paper

Solar Panel Battery Charger 6-12V - Research Paper Example The comparator compares the voltage from the battery and acts as a switch for the voltage regulator circuit. Finally, the battery voltage checker checks the voltage of the battery (as it received from the panel) to determine if the battery needs to charge more. The circuit is designed to be simple, efficient and reliable by using easily available field replaceable parts. It uses a 12V, 5W solar panel rated from 100 milliamps to 1A and a lead acid or other rechargeable battery that is rated from 500 milliamp hours to 40 amp hours of capacity. This circuit regulates the voltage flow from the photovoltaic panel to the lead acid battery. It can produce currents up to 150mA. When external pass transistors are added to this circuit, output currents can reach up to 10A. The maximum input voltage to this circuit is 40V (LM723, 2004) with an output voltage adjustable between 2V and 37V. This circuit consists of a series regulator, LM723. ... Figure 11 and Figure 12 are the connection diagram and the datasheet circuit (Voltage regulator, 2012) as below: Figure 11: Connection Diagram Figure 12: Datasheet Circuit The basic building blocks of LM723 are: 1 The Reference Voltage Amplifier 2 The Error Amplifier 3 The Series Pass Transistor. The equivalent circuit of LM723 (LM723/LM723C Voltage Regulator, 1994) is shown in Figure 13 as below: Figure 13: Equivalent circuit of LM723. The main components used in the voltage regulator circuit are (Table 1): Table 1: Main components of the voltage regulator circuit Quantity Component Value 1 LM723 - 1 R1 4.87k ? 1 R2 7.15k ? 2 Transistor 2N3055 1 Diode 1N4007 1 VR 10k ? 1 C1 0.1?F 1 C2 500PF Calculations: Following are the calculations for design and operation of the circuit: Output voltage- Vout = Vref x ((R1+R2)/R2) Where R1= 4.87K, R2= 7.15K and Vref= 7.35V from the datasheet. Vout= 7.35 x ((4.87 + 7.15)/7.15) = 12.36V. Figure 14: Output voltage. Current- The current is establishe d from the Darlington transistor pair in the regulator circuit (Q1 and Q2 in Figure 10). Q1 and Q2 (2N3055) are silicon, Epitaxial-Base Planar NPN transistor mounted in a Jedec TO-3 metal case (Charger Circuit for 6V or 12V Car Battery, 2012) and are recommended for use in power switching circuits, series and shunt regulators, output stages and high fidelity amplifiers. Figure 15 shows the Darlington transistor pair: Figure 15: Darlington transistor pair used in voltage regulator circuit. In this circuit, a voltage of 0.7V is applied to the base (B) of the first transistor (TR1) to switch it on. A current of 300 milliamps passes through the first transistor from the collector (C) to the Emitter (E). The emitter of TR1 is connected to the second

Case Study 10.1 - Project Scheduling at Blanque Cheque Construction - 1

10.1 - Project Scheduling at Blanque Cheque Construction - Case Study Example A project manager may make use of the below approaches to estimate how long a project will last, rather than basing it on how long he is pressured to make it last. The expert opinion uses the consensus method to arrive at an estimate. The project manager will engage the services of at least three experts who have an understanding of the type of project to be undertaken or have managed similar projects before (Kerzner 6). After a briefing by the project manager on the project requirements, the experts discuss it among themselves and each submits their own separate estimates according to their understanding. Each produces a task list containing effort estimates for each task. The project manager then hands back a list of the estimates to the experts without revealing to which one of them each belongs. He asks the experts to consider the risks and estimates of the others’ results and recalculate their work. The experts then discuss the project to determine if any assumptions or issues have changed after the last discussion. After studying the combined estimates, the experts revise their estimates and submit the results independently again. If the discrepancies are still not practical, the project manager hands the results back again, or invites more experts. The aim is to make the difference between the lowest and the highest estimates as low as possible. The cycle may be repeated severally until most of the results are in or close to agreement. Once in agreement, an average of the experts’ estimates is used as the project duration. However, rather than spending much time on the estimation procedure, the project manager may use the results of several experts in the early stages. For example, if three experts determined the estimate as 2000 hours and one estimated at 4000 hours, he may need to ignore the overestimated duration but with the knowledge that he bears the risk of the duration accepted actually doubling. Past history is one of

Physician Query Essay Example | Topics and Well Written Essays - 750 words

Physician Query - Essay Example HOSPITAL COURSE AND TREATMENT: The patient was admitted and started on Lovenox and nitroglycerin paste. The patient had serial cardiac enzymes and ruled out for myocardial infarction. The patient underwent a dual isotope stress test. There was no evidence of reversible ischemia on the Cardiolite scan. The patient has been ambulated. The patient had a Holter monitor placed but the report is not available at this time. The patient has remained hemodynamically stable. Will discharge. Please review the documentation in the patient medical record on the Discharge Summary (appended as Annexure II) to ensure coding compliance and accuracy. You are requested to address the query, include the missing information and return the query (duly dated and signed). The query form will become a part of the physician’s documentation in the patient’s medical record. INTERVENTIONS: A developmentally appropriate, group-oriented therapy program was the primary treatment modality. The attending psychiatrist provided evaluation for and management of psychotropic medications. The clinical therapist facilitated individual, group, and family therapy. COURSE IN HOSPITAL: The patient was in the hospital from 06/11/09 until 07/13/09. The most prominent symptoms and behaviors while the patient was here were the following: Perceptual disturbances, strange thoughts, he was suspicious at times, at some point he was complaining of audiovisual hallucinations. He was quiet showing a flat affect, irritable, anxious and depressed moods, tearful at times, homesick, limited interaction with peers. He was attending groups, however, was showing limited participation. He was superficial, not really working too much on her issues, more focused on how soon she was going to be discharged more than working on her issues. He stated "strange feelings and sensations". The patient has shown some improvement in general. However, he is not completely stable yet, and he

Disabled American Veterans (DAV) Services

Disabled American Veterans (DAV) Services The Disabled American Veterans is an association sanctioned by the US Congress for military disabled veterans of the US Armed Forces that helps them and their families through different means. It as of now has more than 1.2 million individuals. Charity Navigator does not rate the DAV as it is a 501(c)(4) association. It does rate the Disabled American Veterans Service Charitable Trust. Debilitated veterans in the US in the result of World War I ended up truly impeded, with minimal legislative backing. A number of these veterans were deaf, blind, or rationally sick when they came back from the front lines. A surprising 204,000 Americans in uniform were injured amid the war. The thought to structure the Disabled American Veterans emerged at a Christmas party in 1920 facilitated by Robert Marx, a U.S. Armed force Captain who had been harmed in November 1918. Despite the fact that it had been utilitarian for a few months at that point, the Disabled American Veterans of the World War was authoritatively made on September 25, 1921, at its first National Caucus, in Ohio. While visiting over the U.S. as a major aspect of the election battle of James M. Cox, Judge Marx promoted the new association, which immediately extended. It held its first national tradition in Detroit, Michigan on June 27, 1921, at which time Marx was selected the first national administrator. In 1922, an auxiliary womens organization was established. The DAVWW continued working through the Great Depression to secure the welfare of disabled veterans, despite the fact that their efforts were vexed by fundraising challenges and the desire of the public to put the World War behind them. In the midst of these agitated years, DAVWW was issued by Congress federal charter, on June 17, 1932. The demands of World War II required the pressing expansion of the organization, which officially transformed its name to Disabled American Veterans to recognize the impact of the new war. In 1941, DAV propelled a direct mail campaign, distributing miniature license plates which could be joined to a key ring with instructions that lost keys should be mailed to the DAVWW, who would return them to the owners. In 1944, the DAV started offering a National Service Training Officer Program at US University in Washington, the first venture of training that finished with a two-year mentorship program. In 1945, the DAV extended the program and accumulated the assembling house, inevitably buying complete responsibility for program in 1950. The program demonstrated dependable and very effective, both in acquiring donations and utilizing veterans in production. By 1952, 350 individuals were utilized in the endeavor, which acquired over $2 million a year in donations. In the mean time, the quantity of disabled veterans had been expanded by the as yet progressing Korean War. The DAV suffered a decrease in the later 1950s and into the 1960s, with lessening funds and leadership; however it energized around the veterans of the Vietnam War furthermore concentrated intensely on living up to expectations for detainees of war and lost in action. Vietnam veterans soon filled the decreased ranks of the National Officers Service. On Veterans Day, 1966, the DAV moved its central command to Cold Spring, Kentucky. The accompanying year, the IdentoTag program was ceased for giving location marks, with an appeal for gift, when changes in license plate rehearses made proceeding with the IdentoTag program impracticable. The DAV experienced generous change in 1993, when inner contentions concerning the administration of the association prompted a watershed election that turned over the organization to new hands and the National Program was redesigned. In 1998, DAV National Wilson Arthur joined with Lois Pope and for Secretary for Veterans Affairs Jesse Brown to push for congressional approval of the American Veterans Disabled for Life Memorial. When fundraising was finished in 2010, the DAV and its offshoots had raised more than $10 million for the memorial. Dedication of the memorial is situated for October 5, 2014. This mission of DAV association is to give free proficient aid to veterans and their families in getting advantages and administration earned through military administration by the Department of Veterans Affairs (VA) and different organizations of government. It likewise gives effort concerning its program administrations to the US individuals by and large, and to disabled veterans and their families particularly. Broadening DAVs central goal of trust into groups where these veterans and their families survive a system of state-level offices and neighborhood sections; and giving a structure through which disabled veterans can express their empathy for their kindred veterans exhaustive a variety of volunteer projects. The Disabled American Veterans Organization gives administration for nothing out of pocket through an across the country system of 88 DAV National Service Offices. The Disability Assistance Transition Program administration give free help to administration individuals at Intake Site areas at military establishments by Disabled American Veterans Transition Service Officers with treatment records, recording introductory cases for VA profits and meet with the U.S. Division of Defense, the U.S. Bureaus of Veterans Affairs and U.S. Division of Labor facilitators and different members in the move process from military life to regular citizen life. Numerous outreach programs like DAVs Mobile Service Office, Veterans Information Seminars, Homeless Veterans Initiative and Disaster relief grants. The Mobile Service Office Program is designed to bring assistance for disabled veterans and their families living in geographic provincial areas on veterans benefits, documenting claims and services closer to home by taking out long trips for veterans to the National Service Offices. This outreach project is design to instruct veterans, their families and survivors who are unconscious of veterans legislature benefits and programs, counseling and claims recording assistance service by DAVs National Service Officers (NSO) at communities all through the nation. The Disabled American Veterans Homeless Veterans Initiative is supported by the DAVs Charitable Service Trust and the Columbia Trust, This activity promotes the advancement of supportive housing and necessary services to assist homeless veterans get to be gainful, self-sufficient members of society. DAV Disaster relief grants may be issued with the end goal of giving: nourishment, attire, and transitory shelter or to acquire relief from damage, illness, or personal loss resulting from regular or national disasters that are not secured by insurance or other disaster relief agencies. Since the DAV disaster relief grants program commencement in 1968, $8.7 million has been disbursed to veterans that suffered losses amid characteristic disasters. References: STEVE WILSON, Have a financial plan before transitioning, 2015 Wilborn, Thom ,Architect of Modern DAV Retires, May 2, 2013. Orkin, Lisa Emmanuel, â€Å"Disabled Veterans Memorial has DC Groundbreaking, 2010.

My Storie :: essays research papers

A Random Idiotic Story Supplying No Real Purpose Trebor observed his messy office. He needed to get out of this diminutive space. He did not know why, but something impelled him to get out of his room. As he turned the doorknob, he felt a chill that took over his body. When the door opened, Trebor realized he was in a cubicle. The bleak room gave him a languid feeling. Trevor was skeptical of what he was seeing. As he turned around to exit this incredulous room, he noticed the door was gone. Where the door had once stood was a window. Trebor heard a voice whispering to him, but could not make out what it was saying over the rasping sound, which began to escalate. The noise impaired his hearing so he put his hands over his ears. As he looked up, he saw a horde of people. Trebor observed the powerful machines. Most of the people outside were lined up in straight lines with an auxiliary force near by. As soon as he thought he was hindered in this room, a grievous man came forward. The tag on his uniform was inscribed with "Korby". He had a candid expression on his face. He rendered, "I'm Korby -agent number 4248, an envoy of our invincible government." "Invincible government? You've got to be kidding with me! This sounds like something straight out of the movies." Trebor's stolid expression Trebor Visits the New World: 3020 A.D. said it all. He is lost in this world; incredulous about his surroundings. He asked himself where he was and told himself it has got to be just a dream, but it couldn't cure his anxiety. "What year is this?" "This is 3020," replied Korby. With this Korby went into a monologue, which seemed like an eternity to listen to. It was only the preamble to the rugged history of this futuristic world. "It all fell apart", explained Korby. "Democracy and stability can only last for so long. The fate of our world looked so bleak that we became desperate. The people of this world buil t these virtually invincible machines. They were almost human-like. They were peaceful and kept order, but as time passed, a few exploited these machines. Instead of keeping the peace, they destroyed it. The diamonds, which were their power source, were being used to destroy society. Millions died at the hands of the machines and those despicable people that controlled them.

Pros And Cons Of Driverless Cars Essay

Driver-less – or ‘autonomous’ – cars are cars which can drive themselves. They operate using sensors, GPS and real-time information, so rely on the internet, and in doing so are part of ‘The Internet of Objects’. The technology used in these cars is very advanced and could be hugely beneficial, though there are many pros and cons which must first be considered. A huge benefit that will come from introduction of driver-less cars would be the massive decrease in accidents. Most car accidents are caused by human error, and with the cars carefully monitoring all possible variables (via sensors), they would be a lot less safer and less likely to crash. This would mean less damage to surroundings, less damage to the car and less injuries. However, while this would decrease the amount of money spent by the government on fixing damages and the NHS on health care for the injured, mass introduction of autonomous cars would also lead to huge job losses. A lack of necessity for drivers would mean that cab drivers, lorry drivers, valets and many more would be unemployed and in a country where unemployment is already a rising issue, many people would take issue with any further mass loss of jobs. Technology for driver-less cars would also be expensive to produce and consequently expensive to buy, rendering them only affordable to large companies. If this was the case it would mean that many of their benefits would be less applicable because less people would have them. On the other hand, people with disabilities that disallowed them to drive would be interested in buying them. Visually impaired, people with impaired use of their feet or legs, or people with mental disabilities would all ordinarily find it hard to drive and may find it difficult to access public transport, so would benefit largely from owning a car which requires no help from the driver.  With driver-less cars people would no longer face the issue of having nowhere to park, or having to park far away from their destination. The passengers could be dropped off and the car could make it’s own way to a car park further away, and then return to pick them up later on. This does, however, present the issue of letting the cars drive without any human present inside the car.

The Use of Intraosseous Vascular Access

The Use of Intraosseous Vascular Access Table of Contents Title Page†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 Body of Paper†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 Plan†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 Do†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 Check†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Act†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Research to Support Change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Change Theory†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 20 Timeline†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦. 22 Executive Summary First introduced by Drinker and colleges in 1922, intraosseous (IO) vascular access was a method used during World War II for accessing the non-collapsible venous plexuses within the bone marrow cavity to provide access to a patient’s systemic circulation. This method later fell out of use after the development of intravenous catheters.Then during the 1980s IO vascular access was again introduced as a rapid way of gaining vascular access for swift fluid infusion particularly during resuscitation attempts of pediatric patients. (Tay & Hafeez, 2011) Plan-Being by implementing a policy for the use of IO vascular access within the Emergency Department of Hays Medical Center (HMC) for critically ill patients. This would expedite critically ill and severely injured patients in receiving the intravenous fluids and medications.Currently there is no policy in place for the placement of IO devices as opposed to peripheral intravenous catheters, or central veno us catheters. However, if there was a policy in place the staff would know when it was appropriate to insert an IO device, as opposed to having to make a difficult decision based on personal judgment. Do- Create a group of physicians and nurses to write a policy outlining when it is appropriate for the placement of an IO device compared to traditional techniques for gaining venous access. Once the policy has been written implement its use within HMC’s ED.Check- Keep a careful record of when an IO device is placed, in accordance to the new policy. Monitor the outcomes of these patients. Evaluate the effectiveness of the new policy and determine if any changes need to be made. Act- Based on the information obtained during the check phase of this project, management will determine whether the policy will be continued, improved, or discontinued. The Use of Intraosseous Vascular Access in Critically Ill Patients The origin of the intraosseous cavity as an access sight to the circu latory system was originally discovered during World War II.Medical personnel during this time used an IO route to resuscitate patients suffering from hemorrhagic shock. It was first documented in medical journals by Drinker and colleges in 1922. It was later rediscovered by American pediatrician James Orlowski. During his time working in India, Orlowski observed medical personnel during a cholera epidemic using IO access to save patients in whom IV cannulation was impossible and who might have died without access. He later wrote about his experiences in a paper entitled, My Kingdom for an Intravenous Line. Wayne, 2006) Since Dr. Orlowski brought the use of IO access in pediatrics back into the medical spotlight, the implications for its use within the adult population were soon being addressed. In 2005, the American Heart Association stated in its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that â€Å"IO cannulation was appropriate to provide acc ess to the non-collapsible venous plexus found in the bone marrow space, thus enabling drug delivery similar to that achieved by central venous access. (American Heart Association) Intravenous access can mean the difference between life and death when dealing with critically ill patients. IV access means that patients can receive fluids, blood products, and life-saving medications. During situations when time is precious, and access is critical is not when nurses should be making their fifth attempt at a peripheral intravenous catherization (PIV). It also shouldn’t be when chest compressions are stopped, so that the doctor can try for a central venous line (CVL).The average time necessary for PIV catherization is reported to add up to 2. 5-13 minutes and sometimes even up to 30 minutes in patients with difficult to access peripheral veins. (Leidel, Chlodwig & Bogner, 2009) This is one of many reasons why it is imperative to have a policy in place so that the staff knows that IO access should be a go to option rather than a last resort. There are very few contraindications when it comes to the placement of an IO device. However, to untrained medical personnel the thought of having to place an IO device is very daunting.I didn’t realize until this semester that it is within the scope of practice for a RN to place an IO device, but it is absolutely is! â€Å"It is the position of the Infusion Nurses Society that a qualified RN, who is proficient in infusion therapy and who has been appropriately trained for the procedure, may insert, maintain, and remove intraosseous access devices. † (â€Å"The role of,† 2009) There is also the fact that of having to explain the procedure to the patient and the patient’s family. The fear of needles is a real one.The thought of an intramuscular injection can send certain patients into a full blown panic attack. So the thought of actually having their bone pierced with a needle is a frightening o ne. Thankfully most patients who are critically ill enough to necessitate the placement of an IO device are unconscious. In cases where patients are not unconscious, an IO device can be placed with minimal discomfort if proper anesthetic techniques are used. These techniques should be taught along with placement so that nursing staff is aware of how to place an IO with minimal discomfort to the patient.It needs to be noted that â€Å"the pain associated with insertion of the EZ-IO needle is similar to that associated with insertion of a large peripheral intravenous needle and may be alleviate with infusion of lidocaine solution. † (Luck, Haines & Mull, 2010) Unlike PIVs and CVLs, IO access can be obtained from multiple sites with less chance of being unsuccessful. The locations include: proximal tibia, distal to the tibial tuberosity, distal end of the radial bone in the upper imb, proximal metaphysis of the humerus, distal tibia, proximal to the medial malleolus, distal femu r, above the femur plateau, the sternum, and also the calcaneus (Tay & Hafeez, 2011). However, IO access is typically obtained via the proximal tibia or proximal metaphysis of the humerus. There are currently three different ways to gain IO access. The first and oldest way is a manual insertion of the IO device. In this way the device is placed using the force applied by the clinician, and is done in a rotating motion. The second technique is the use of an impact device.In this case, a spring-loaded IO device is to insert the needle into the bone using direct force. The last technique is a powered drill. The small, handheld device drills the IO needle into the bone with a high-speed rotating motion. Plan To implement a policy within the Emergency Department at Hays Medical Center that clearly outlines when the placement of an intraosseous access device should be used as opposed to more traditional techniques for gaining venous access. A committee would be assembled to look at the re search on IO placement.This committee would consist of three physicians and three nurses, and will be given three months to write a policy for the department. This committee will determine in which situations an IO should be placed. The American Heart Association guidelines for intraosseous vascular access should play a major role in this decision. Once criteria has been chosen a checklist will be created that can be hung on the walls of the trauma rooms and handed out to staff. This checklist will aide in helping the staff to be able to more quickly determine in which situations placement of an IO is within the department’s policy.The appointed committee would also be in charge of deciding on which type of IO device the department should use. They will research the availability of the device chosen and what the cost will be to stock the department which the device. Do Once the research is gathered, the assigned research committee will reassemble to compose the policy that wi ll become implemented within the Emergency Department. After the policy has been written, a mandatory unit meeting will be called to introduce the new policy and answer any questions that the staff might have.During this meeting, a demonstration will be given on the correct technique for IO placement, depending on which type of device is chosen during the planning phase. After the demonstration the staff will then be asked to practice placing IO devices using practice bones. One member of the department will then be voted upon to keep track of which patients coming through the department have IO devices placed. They will keep track of for the next six months. The data collected will include any outcomes that the patient experiences, good or bad, in regards to their IO placement.Check The member of the department will look at the data collected from the outcomes of patients who had IO devices placed within the ED in the last six months. This data will then be taken back to the origin ally assigned committee. The committee will be responsible for analyzing the data. They will look at the outcomes and determine if changes need to be made to the original policy. They will also look at the outcomes to determine if there need to be changes made in the placement technique used by the department.For example, is the rate of successful placement higher or lower when done via the humerus verses the tibia? Or is there a problem with post procedural infection? Should the technique be changed from aseptic to sterile? Etc†¦ They will also ask staff within the department to fill out a survey indicating their comfort level in placing IO devices. Act Depending upon the findings of the committee they can either be decided to leave the policy in place, as is. The committee could find that the policy needs to be altered and then reviewed in another six months’ time to see if the changes were effective.Or they could find that within the ED at Hays Medical Center IO devic es for venous access should not be used although the review of literature will prove why this outcome is highly unlikely. Research to Support Change An article published in the Journal of Emergency Medicine, collaborated by three different physicians who work in Emergency Departments in Philadelphia talks about the technical side of intraosseous access. The article states that â€Å"intraosseous vascular access is indicated in the critically ill patient of any age when rapid and timely access via the intravascular route cannot be established or has failed. The article goes on to list conditions in which this might occur, including: cardiopulmonary arrest, shock, sepsis, major traumatic injuries, extensive burns or edema, and status epilepticus. (Luck, Haines & Mull, 2010) Indications may also include obese patients on who multiple PIV attempts have failed. Because studies have shown that IO infusions have the same onset of action, as that of intravenous infusions the authors recomm end that the dose used for IV fluids and medications should remain unchanged when using the IO route.They go one to state that other studies have shown that the results of several different blood test values drawn from bone marrow aspirates are comparable to those taken from venous samples. These include blood gas analysis, blood group typing, and electrolyte, drug, and hemoglobin levels. (Luck, Haines & Mull, 2010) The authors also talk about the relatively few contraindications for IO insertion. These include a fracture to the bone that the IO device is to be placed, an extremity with a vascular injury, placement to an area with an overlying skin infection or burn.IO insertion is also contraindication in patients with certain conditions that make their bones fragile such as osteogenesis imperfect and osteoporosis. The last contraindication is a new IO insertion where another IO needle may have recently been placed. This is because the opening left by the last needle can cause flui ds to extravasate. In their research of other studies, the authors found that success rates for IO insertion vary between 75%-100%, and successful infusion achieved within 30-120 seconds in the majority of cases. Luck, Haines & Mull, 2010) The most common complication was found to be extravasation of blood, fluids, and drugs into the soft tissues surrounding the site, but this occurred less than 1% of the time. With a 0. 6% chance of incidence, the most serious adverse complication was osteomyelitis. However, this was attributed to prolonged infusion. For this reason, it is recommended that the IO need be replaced by either a PIV or a CVL once the patient has stabilized and no longer than 24 hours after IO placement. (Luck, Haines & Mull, 2010)This article concluded that the use of IO access devices is a safe, reliable, and timely way of attaining vascular access. Although vital for critically ill and injured patients, it is also a technique that can be applied in non-emergent cases where multiple attempts at peripheral and central IV access has been unsuccessful. (Luck, Haines & Mull, 2010) In a study conducted by physicians at the University of Medicine Berlin’s Department of Emergency Medicine, they looked at ten consecutive adult patients who each received an IO device and also a CVC placement during a resuscitation situation.The results showed that the success rate on first attempt was 90% for IO access versus 69% for CVC placement. They also found that the mean time required for the IO access procedure was significantly shorter, 1-3 minutes, compared to the mean CVC placement time of 4-17 minutes. While conducting this study, one IO cannulation failed â€Å"due to operator mishandling by not selecting the correct insertion site at the proximal humerus. (Leidel, Chlodwig & Bogner, 2009) The physicians of this study also noted that four CVC cannulations failed on the first attempt at insertion and had to be reattempted. The study then went on to st ate that the failed placement of one IO cannulation was the only complication regarding the IO devices placed. There was â€Å"no malposition, dislodgment, bleeding, compartment syndrome, arterial puncture, haeatothorax, pneumothorax, venous thrombosis, and vascular access related infection observed. † (Leidel, Chlodwig & Bogner, 2009)In conclusion the researchers go on to state â€Å"IO vascular access is a safe, reliable, rapid option in the acute setting of adult patients under resuscitation with inaccessible peripheral veins in the emergency department†¦ Therefore, a change in practice from CVC to immediate IO access for the initial emergency resuscitation should be strongly considered as a reasonable bridging technique to increase patient’s safety in the emergency department. † (Leidel, Chlodwig & Bogner, 2009) Another study found was performed by physicians and researchers in the Department of Emergency Medicine of Singapore General hospital.It is a l arge urban hospital that handles nearly 120,000 patients annually. 9% of these patients are priority 1 patients, or patients that need resuscitation. The inclusion criteria for this study were â€Å"patients who presented to the ED with age greater than 16 years or >40kg body weight requiring intravenous fluids or medication and in whom an intravenous line could not be established in two attempts or 90 seconds. They also had to be seriously ill or injured and meet at least one or more of the following: altered mental status, respiratory compromise, haemodynamic instability, or cardiac arrest. (Ngo, Oh, Chen, Yong & Yong, 2009) The study ran from March 1, 2006 through July 30, 2007. During this time 24 patients were met the qualifications for this study. Of all the IO cannulations, only three attempts failed on the first attempt. No failures were recorded on the second attempt. The researchers also did a comparison between junior operators and senior operators and found that there w ere no disparity regarding success rates between the groups, they both had a 100% success rate. The average insertion time for both groups was approximately five seconds. Ngo, Oh, Chen, Yong & Yong, 2009) There were only two complications regarding the insertion of an IO device with this study. The first was when an operator’s glove was caught on the need during insertion. However, this could have been prevented if the operator was holding the drill properly. The other complication noted was that of extravasation of fluid at an insertion site. This is the most common type of complication, and is seen when the need is misplaced or there is an excessive amount of movement during or after the insertion. Ngo, Oh, Chen, Yong & Yong, 2009) The results of this study concluded that â€Å"the EZ-Io is a feasible, useful and fast alternative mode of venous access especially in the resuscitation of patients with no venous access or when conventional intravenous access fails. Flow rates may be improved by the use of pressure bags. Complications encountered such as extravasation of fluid and gloves being caught in the drill device can be easily prevented. † (Ngo, Oh, Chen, Yong & Yong, 2009)The third research article was a prospective, observational study conducted by researchers in the Department of Emergency Medicine at Singapore General Hospital in Singapore. The study was conducted on a convenience sample of 25 medical students, physicians and nursing staff. They were recruited to secure intraosseous access using the EZ-IO powered drill device. Unlike the previous two studies they only need to secure access on a plastic bone model rather than a live patient. (Ong, Ngo & Wijaya, 2009)The study participants were allowed multiple attempts in placement with the aim of ensuring success in placement. Their placement times were measured by an independent observer with a stopwatch, from the time the participant placed the need set into the driver and attempted to insert the needle with the ES-IO into the plastic bone. The participants then recorded their perception on the difficulty of insertion using a visual analog scale with 0 representing very easy and 10 representing very difficult placement. (Ong, Ngo & Wijaya, 2009) The results showed 96% success rate for placement.Twenty-three of the 25 participants only required one attempt at place the IO device, and only one participant was unsuccessful at securing placement of the device. This failure was attributed to â€Å"unfamiliarity with the equipment and procedure, and hesitating beyond the allocated time given for insertion. † (Ong, Ngo & Wijaya, 2009) The results of this study also showed that the mean placement time was 13. 9 seconds. The researchers also found that 87% of their participants reported that using the EZ-IO was easier compared to intravenous cannula. Ong, Ngo & Wijaya, 2009) The researchers of this study concluded that â€Å"the I/O access device (EZ-IO) evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department. (Ong, Ngo & Wijaya, 2009) The next piece of research was a randomized trial conducted by Dr. Reades from Methodist Hospital System, in Dallas, TX, Dr. Studnek from Carolinas Medical Center and the Center for Prehospital Medicine, Charlotte, NC, S.Vandeventer from Mecklenburg EMS Agency, Charlotte, NC, and Dr. Garrett from Baylor Healthcare Systems, Department of Emergency Medicine, Baylor University Medical Center, and Dallas, TX. The purpose of this study was to determine whether the tibial or humeral placement site was more effective for intraosseous placement during out-of-hospital cardiac arrest. â€Å"All patients eligible for inclusion in this study had their first attempt at vascular access randomized to one of 3 locations: proximal tibial intraosseous, proximal humeral intraosseous or peripheral intravenous. ( Reades, Studnek, Vandeventer & Garrett, 2011) Randomized note cards were distributed to the paramedic staff at the beginning of their shifts, and told them which access site was to be initially used if they came had a patient who met the inclusion criteria. There were two outcomes that were being monitored in this study. The first was a first-attempt success at the assigned method of vascular access. This qualified in one of two ways, either as an initial success or an overall success.The second measured outcome was the â€Å"total number of attempts required for successful vascular access, time to successful vascular access, time to first ACLS medication, and total volume of fluid infused during resuscitation. † (Reades, Studnek, Vandeventer & Garrett, 2011) Overall there were 182 patients randomized to one of the 3 vascular access methods. Fifty-one patients had humeral IO placements, 67 had PIV placements, and 64 had tibial IO placements. The results showed that first-atte mpt success was greatest in patients randomized to tibial IO access at 91%, compared to both humeral IO access at 51% and PIV access at 43%.The result of the secondary outcome was also significantly shorter in patients with tibial IO access. These patients had their devices in place and ready to use in an average of 4. 6 minutes. Those assigned to the humeral IO access site averaged a 7. 0 minute placement time, which was also the same time for a PIV access site. (Reades, Studnek, Vandeventer & Garrett, 2011) This study demonstrated that there is a significant different in the frequency of first-attempt success when placing tibial IO access devices as opposed to humeral IO access devices or even PIV catheters.The researchers go on to state that the â€Å"results from this study may help stakeholders such as EMS medical directors choose the most appropriate site for first-attempt vascular access†¦Ã¢â‚¬  (Reades, Studnek, Vandeventer & Garrett, 2011) The last article was a cons ortium on intraosseous vascular access in healthcare practice, published in a journal entitled critical care nurse. It too outlined the history of IO access, dating back to World War II. It discussed the clinical considerations for the use of IO access, and the clinical situations in which IO access should be considered.It went on to talk about the types of IO devices and how they’re used. It mentioned the contraindications for IO use, and also the possible complications. All of the aforementioned material was consistent with research already discussed. This article lends credibility in support of change because it discusses the education and training needed to implement IO device use in the clinical setting. It states that â€Å"to insert and maintain an intraosseous device in a patient, the clinician must demonstrate adequate knowledge and psychomotor skill competency in the procedure. (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) The article then went on to discuss the economic considerations that must be looked at when considering implementing an IO insertion policy. It states that â€Å"the cost of intraosseous devices and needles should be compared with the cost of central catheter kits, ultrasound evaluation, and human resources required for their insertion. † (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) The authors also note that â€Å"the economic factors must be weighed along with potential complications of therapeutic strategies should be considered. (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) This article also brings to light the issue of risk management and patient safety. In this day and age where liability concerns continue to drive clinical decisions, it is important to note that delays in treatments are often cited as the cause of injury leading to malpractice claims. If there is an evidenced based option to safely and quickly provide fluid and drug resuscitation, when vascu lar access is not readily attainable, then it needs to be closely looked at.After reviewing the data the Consortium on Intraosseous Vascular Access in Healthcare Practice reached eight consensuses: 1. Intraosseous vascular access should be considered as an alternative to peripheral or central intravenous access in a variety of health care settings, including intensive care units, high acuity/progressive care units, general medical units, preprocedure surgical settings where lack of vascular access can delay surgery, and chronic care and long-term care settings, when an increase in patient morbidity or mortality is possible. . Intraosseous vascular access should be considered as part of an algorithm for patients treated by rapid response teams in whom vascular access is difficult or delayed. 3. A new algorithm that includes the intraosseous route should be developed for assessing the appropriate route of vascular access. 4. For patients not requiring placement of central catheters ei ther for long-term vascular access or hemodynamic monitoring, intraosseous access should be considered as the first alternative to failed peripheral intravenous access. 5.Techniques of intraosseous catheter placement and infusion administration should be a standard part of the medical school and nursing school curriculum. 6. In evaluating the economic implications of adopting intraosseous technology, the following should be considered: the expense of diagnostic tools to guide and confirm placement, the cost of human resources, the known and unknown risks to patient safety, and the cost of complications related to delayed treatment. 7. Organizational policies, procedures, and protocols that establish the responsibility of insertion, maintenance, and removal of intra-osseous access devices should be developed. . Further research should be conducted on, but not limited to, the safety and efficacy of use of intraosseous access in all practice settings, its economic impact on patient car e, and to support the use of intraosseous access in all health care settings. Change Theory The change theory focused upon in this paper is Gordon Lippitt’s Theory of Planned changed. According Lippitt, â€Å"Planned change or ‘neomobilistic’ change is defined as a conscious, planned effort which moves a system, an organization, or an individual in a new direction.This theory is applies because it can be applied at an individual, group, and institutional level. The basis for Lippitt’s theory of change is center around an agent for change. This agent should be a person skilled in the changed wanted to apply. It is this person who is in charge of planning for the change, initiates the change, and is credited for the accomplishment of change. Lippitt’s theory is centered around 7 phases of change. His phases are not set in stone, and there is no time frame on how long each phase should last. There should be a fluid movement back and forth between thes e seven phases.The first step is identification and diagnosis of the problem. In this case, the problem is HMC not having a firm policy in place recommending when the use of IO access devices should be implemented. The second step is the change agent assessing the client systems motivation and capacity for change. In this case, myself being the change agent, I would talk with the administrators of the ED department and determine if they agreed with my assessment for a policy to be implemented. The third step would be the initiator assesses his or her ability in helping the situation.In this case this flows back to the first step, because I saw the need for change and felt that I was equipped with the skills needed to bring about such a change. The fourth step is the change agent then chooses an appropriate role in the phase. In this case, I would choose to be part of the policy committee who is responsible for researching. The fifth step states that the change agent may be actively involved in the implementation of change, serve as an expert in fathering and providing data, or function as a liaison within the organization. I feel like in this case, I would function as a liaison within the policy making committee.The sixth step consists of maintenance of change. This involved the â€Å"Do† portion of the plan for change. This is where the decisions made by the policy are provided to the department, and the employees become responsible for implementing and maintaining the new policy. The final step is termination of the helping relationship. This step is accomplished when all parts of the PDCA plan have been completed. (Ziegler, 2005) Conclusion In a day and age where medical technology is advancing, the research about IO access devices proves that newer technologies are not always the best for a positive outcome.IO access applications have great potential in patients who are critically ill, injured, or are incapable of having PIV or CVL access. The fact that IO access is fast, reliable, and safe proves that competent placement of IO devices is a medical technique that all Emergency Departments should have in their repertoire. References (2009). The role of the registered nurse in the insertion of intraosseous access devices. Journal of infusion nursing,  32(4), 187-188. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112(24):57-66. Leidel, B. Chlodwig, K. , & Bogner, V. (2009). Is the intraosseous access route fast and efficacious compared to conventional central venous catherization in adult patients under resuscitation in the emergency department? a prospective observational pilot study. Patient safety in surgery,  3(24), doi: 10. 1186/1754-9493-3-24 Luck, R. , Haines, C. , & Mull, C. (2010). Intraosseous access. The journal of emergency medicine,  39(4), 468-475. Ngo, A. , Oh, J. , Chen, Y. , Yong, D. , & Yong, D. (2009). Intraosseous vascular access in adults using the ez-io in an emergency department. International journal of emergency medicine,2(3), 155-160. oi: 10. 1007/s12245-009-0116-9 Ong, M. , Ngo, A. , & Wijaya, R. (2009). An observational, prospective study to determine the ease of vascular access in adults using a novel intraosseous access device. Annals of the academy of medicine, singapore,  38(2), 121-124. Phillips, L. , Brown, L. , Campbell, T. , Miller, J. , Proehl, J. , & Young-berg, B. (2010). Recommendations for the use of intraosseous vascular access for emergent and no emergent situations in various health care settings: A consensus paper. Critical Care Nurse,  30(6), e1-e7. Reades, R. , Studnek, J. , Vandeventer, S. , & Garrett, J. (2011).Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial. Annals of Emergency Medicine,  58(6), 509-516. Tay, E. T. , & Hafeez, W. (2011). Intraosseous access. In R. Kulk arni (Ed. ),  Medscape reference: Drugs, disease & procedures. Retrieved from http://emedicine. medscape. com/article/80431-overview Wayne, M. (2006). Adult intraosseous access: an idea whose time has come. Israeli journal of emergency medicine,  6(2), 41-45. Ziegler, S. (2005). Theory-directed nursing practice. (2 ed. , p. 204). New York, NY: Springer Publishing Company, Inc. Timeline for Change 1/20-11/27Researched the benefits of having a policy about intraosseous access within the ED at HMC 11/28Spoke with the Director of Nursing for the ED and the Director of Emergency Medicine about my research findings 12/1A committee of three physicians and three nurses is assembled to draft a preliminary policy regarding intraosseous access 12/1-3/1The committee is given three months to compose their policy 3/2-3/10The policy is given to the Director of Nursing and Director of Emergency Medicine, who present it to the board of directors for approval 3/15A mandatory staff meeting is held outlining the new policy and answering any questions or concerns the staff has 3/16-9/16The new policy is put into effect and data is collected 9/16-10/16The original committee will analyze the data, and changes are made as needed. 10/20The final committee approved policy is present to the Director of Nursing and Director of Emergency Medicine 11/1The Director of Nursing and Director of Emergency Medicine, take the final recommendations for the policy to the hospital board of directors for approval