Saturday, October 5, 2019
Case Study Essay Example | Topics and Well Written Essays - 500 words - 6
Case Study - Essay Example An instant EHR access also permits many doctors to be referencing the chart concurrently. Similar EHR systems provide physicians delivering enhanced quality of medical care adopting the â€Å"Intergy HER†as all measures and instructions that are recorded are capable to be checked and confirmed to be proper for the deliberated intention thus lessening the scope of mistakes. The physicians, through the implementation of same HER system are trying to reduce the healthcare costs of the patients. It has been researched that the physicians adapting Intergy EHR are much more proficient at providing medical support as repetition is possible to be minimized. The quick reference to the HER system is important in the case of diagnostic procedures like blood reports, x-rays, ultrasounds etc. that are usually re-conducted since the preceding outcomes are not available to simply â€Å"retrieved, reviewed or compared.†The EHR permits a physician to have access to all investigative results, images etc. at any point of time, as a result eliminating the scope of duplication. The EHR system also sends electronically the information recorded to the hospitals billing system enabling precise data to be recorded in the clinic’s billing system consequently dropping the instances of claim rejections by the insurance company due to missing data. The EHR solution provides physicians with the capability to record clinical information related to a patient efficiently with less errors and lapse at the point of care. Patients are capable to have access with their whole medical history obtainable to physicians and clinicians at anytime devoid of the requirement to physically locate and recover documented medical records. There is a struggle involved in maintaining the nonverbal communication, specifically eye contact and lulls in conversation while documenting the appointment in an EHR. EHR is known to be distracting. There
Friday, October 4, 2019
Popular culture-Respond to questions Essay Example | Topics and Well Written Essays - 750 words
Popular culture-Respond to questions - Essay Example As land continuously became scarce, the American frontier concept evolved the great land expanse to the frontiers such as ocean and space exploration, which were less tangible. Shames asserts that had the supply of more carried on indefinitely, expansion would could be a goal in itself. This would give rise to a value system founded on bulk rather than quality of life. Therefore, the American situation today is based on the fact that there is less to be had (Shames et al 93). According to Shames, there are connections between the history of the American frontier and consumer behaviour. The connection stems from the American culture of wanting more, which is not easily satisfied, which is synonymous to the frontier history. In this sense, the â€Å"more is better†notion that emerged during the frontier era has not changed and is still evident in consumer behaviour. He further points out that the sense of quality among American consumers has lagged behind that of scale. Therefore, both the American consumer and the frontier history are not quite about the quality of what one gets but rather, quantity. In the frontier history, people were more concerned about the acreage of land they would acquire and not its quality. In a similar manner, the modern consumer behaviour focuses more on how much the consumer can get rather than the quality of what they are purchasing (Shames et al 94). Retailers make use of spatial organisation design to affect consumers’ buying habits and their behavior. Depending on how stores use their space to arrange merchandise, they can determine how easily consumers can locate what they are shopping for. The idea of displaying the latest designs of clothes on the right hand side of the entrance to American shops was informed by the notion that people tend to walk the way they drive. On the same note, that is why fast-food outlets are
Thursday, October 3, 2019
Cleft Lip and Palate and its Effect on Speech Essay Example for Free
Cleft Lip and Palate and its Effect on Speech Essay Introduction on Speech and Phonetics            Phonetics and phonology are concerned with speech – with the ways in which human produce and hear speech. Talking and listening to each other are so much part of normal life that they often seem unremarkable. Yet, as in any scientific field, the curious investigator finds rich complexity beneath the surface. Even the simplest of conversations – an exchange of short greetings, for example – presupposes that the speaker and hearer make sense to each other and understand each other. Their ability to communicate in this way depends in turn on proper bodily functioning (of brain, lungs, larynx, ears and so on), on recognizing each other’s pronunciation a bewildering jumble of unpronounceable and unintelligible noise only underlines the extent of our organization and control of talking and listening within particular social and linguistic conventions.            Once we make a decision to start with an examination of speech, we can come up to it on a range of steps. At one step, speech is an issue of anatomy and physiology where we can examine the organs of speech such as tongue and larynx and their role in the creation of speech. Taking another perspective, we can focus on the speech sounds produced by these organs – the units that we commonly try to identify by letters such as a ‘b-sound’ or an ‘m-sound’. But speech is transmitted as sound waves themselves. Taking yet another approach, the term ‘sounds’ is a prompt that speech is proposed to be heard or supposed that it is then probable to concentrate on the manner in which a listener understands and process a sound wave (Clark, Yallop, Fletcher, 2006).            Phonetics is the study of the sounds of natural language. The use of sounds in speech involves three distinct phases: 1) the production of sounds by the speaker, 2) the transmission of sounds between the speaker and the hearer, and 3) the reception of the sounds by the hearer. Each of these phases especially 1) and 3), which clearly involve the human brain, is an extremely complicated process, each needs to be understood if we wish to have full understanding of the workings of human speech, and each requires its own methods of study. The science of phonetics thus consists of three main branches, each devoted to the study of one of the phases of speech.            Articulatory phonetics is the study of the way in which speech sounds are produced or ‘articulated’ by the speaker. It includes a description of the organs of speech, such as the vocal cords, the tongue and the palate, and how they are used to produce sounds. The description of speech in articulatory terms has a long history, going back to ancient times, and is still considered the most useful type of description for language teaching purposes. Acoustic phonetics is the study of the transmission of speech sounds through the air in the form of air waves. Precise studies of the transmission stage of speech rely heavily on electronic equipment which has only been available since the 1930s and 1940s, but in the relatively short space of time since then great strides have been made in our understanding of the transmission of speech sounds. Acoustic phonetics is not as important in pronunciation teaching as articulatory phonetics, but it can be of valuable assistance in certain areas such as the description of vowel sounds or intonations, which are not easily described in articulatory terms. Auditory phonetics, finally, studies the processes in the ear, auditory nerve and brain which lead to the perception of sounds by the hearer (Hall, 2003). Organs of Speech            The first essential for the student of Phonetics is to have a clear idea of the structure and functions of the various parts of the organs of speech. The term organs of speech is used to refer to parts of the body in the larynx and the vocal tract that are involved in the production of speech. It is a misleading term in that it suggests that we have special physical organs for speaking. This is not so: all our so-called ‘organs of speech’ have primary biological functions relating to our respiratory system and the processing of food (Gussenhoven Jacobs, 1998).            The organs of speech are all bodily structure composed of a variety of tissue types (such as bone, cartilage and skin) which are specific to their biological (rather than linguistic) function. Bodily organs are generally grouped into systems which have particular functions in the life of the organism. These include the respiratory system, the digestive system, and the reproductive system and so on. While it can be argued that the organs of speech form a system, they do not contribute to life support in the same way as other systems, and they are generally not thought of as performing their primary biological function when they are used in speech production (Clark et al., 2006). Nature of Speech Defects            Speech is a motor act that requires little concentration once it is learned. The energy source for speech is air. The diaphragm is the primary muscle of respiration and air is inhaled and exhaled through the vocal tract, the diaphragm contracts and flattens; this enlarges the thoracic cavity by displacing the abdominal contents downward and expanding the thoracic volume. The external intercostals assist the diaphragm in increasing the size of the thoracic capacity. If these movements are not coordinated, the supply and control of air may be reduced. Lack of coordination occurs during inhalation when the abdominal muscles contract simultaneously with the diaphragm and push the abdominal contents upward. This upward movement decreases the size of the thoracic cavity, which reduced the amount of air available for the production of speech. Restriction of the air supply may lead to reduced loudness, illogical breath groups, limited pitch range, decreased intelligibility and increased expiratory effort. Respiration for speech should be effortless and coordinated with phonation and resonation. Adduction of the vocal folds in a stream of air produces phonation. During quiet respiration, the vocal folds are abducted to an intermediate position by the poster cricoarytenoid muscles. Changes in the vibration pattern may result in altered voice quality, pitch, and loudness and decreased speech intelligibility Communication is a closed loop system. When individuals speak, others hear them and respond to their speech. In addition, individuals hear themselves speak and monitor their speech production. If speech production does not match the specific intention, then speech os modified. When speakers have a speech disorder, they may compensate for the impaired speech production by changing their respiration, phonation, and articulation. If this compensation is carried out in an effortful way, the compensation may be counterproductive and may worsen the symptoms (Brin, Comella, Jankovic, 2004). Speech Assessments            Speech assessments proper are established from the age of 4 years and allow objective evaluation to take place over a long period.            The articulation of phonemes is routinely evaluated during sessions of repetition as well as free speech.            The speech-language pathologist (SLP) will also evaluate the child’s speech production and some of the aspects of phonology. The SLP will ask the child to say various syllables or words and evaluate the â€Å"correctness†of what the child says. The SLP is trained to listen and compare all aspects of speech to a criterion of correct production. The SLP will comment on the child’s voice quality. Does the child’s voice sound like a typical child’s should at that age? Is it too high-pitched, strained, or too nasal? The SLP will comment on fluency, or the relative ease with which the child talks. Does the child stutter or stammer? The SLP will also perform oral-motor exam. In this exam, the SLP asks the child to do some movements incorporating his tongue, lips, teeth, cheeks, soft palate, and jaw. These movements are checked to see if the child has any weakness or coordination problems with the muscles and structures of the mouth that would influence the child’s ability to produce the speech sounds correctly. The SLP will also do an articulation test. In this test the SLP asks the child to say a group of syllables or words that contain all the sounds of English. The SLP makes a judgment about how correctly the child produced the sound. Sometimes the SLP marks whether the error was an omission (the child did not say the sound at all), a substitution (the child substituted one sound for another; for example the child said â€Å"pish†instead of â€Å"fish†), or a distortion (the child said a sound that was not the correct speech sound and did not sound like another sound). The SLP will list which sounds were produced incorrectly and make suggestions for follow-up therapy (Easterbrooks Estes, 2007). Cleft Lip and Palate            It is the term applied to a fissure in the roof of the mouth (palate) and/or the lip which is present at birth. It is found in varying degrees of severity in about 1 in 700 children. Modern plastic surgery can greatly improve the appearance of the baby and often further cosmetic surgery later will not be necessary. The parent of the child who has cleft lip and/or palate will be given detailed advice specific to his case. In general the team of specialists involved are the pediatrician, plastic surgeon, dentist or orthodontic specialist, and speech therapist (Havard, 1990).            The deficiencies associated with cleft palate depend on the location of the defect in the palate. In the normal palate, the tensor veli palatine and levator palatine muscles within the soft palate insert into an aponeurosis at the midline raphe. In the cleft palate, the muscle fibers follow the medial margin of the cleft and insert into the medial cleft edges and the posterior edge of the lateral bony hard palate. Clefts involving the alveolus can disrupt normal dental development, eruption, and retention.            The subject of normal human facial growth is extremely complex and incompletely understood; and superimposing a cleft defect complicates an already complex process. Many children with clefts will develop collapse of the alveolar arches, midface retrusion, and resultant malocclusion as they approach their teenage years. The underlying cleft deformity itself, as well as the surgical procedures performed to correct the defect, has been implicated as possible contributing causes of these developments. Currently, controversy exists regarding the relationship between surgical procedures and maxillary growth in terms of the sequencing of the surgical procedures, the timing of the cleft repair; whether or not the cleft repair itself has an effect on maxillofacial growth, and the various surgical techniques of lip and palate repair. Of interest, it is common in nonsyndromic older children whose cleft is unrepaired to have relatively normal midfacial projection and occlusion (Bailey, Johnson, Newlands, 2006). The Effects on Speech and Resonance            Dental problems in children with cleft lip and palate or craniofacial syndromes can be quite complex. These problems frequently require dental specialists to coordinate treatment with other health care providers in order to properly manage the patient. The specialists involved usually include a pediatric dentist, an orthodontist, an oral maxillofacial surgeon, and a prosthodontist. Together, they monitor and treat problems of the developing dentition, occlusion, and facial growth of the cleft lip/palate patient. As dental professionals reconstruct the oral environment, the speech pathologist leads to a more holistic management of the structural and functional effects of dental and speech abnormalities (Kumme, 2000).            Speech may be difficult to understand and have a muffled nasal quality, the greatest difficulty being in the pronunciation of consonants. This type of inadequate closure leads to the diagnosis of ‘cleft-palate’ speech, even though the palate is anatomically closed. In some cases adenoid tissue helps to close the space, so its removal by surgery or its decrease at the time of adolescence leads to further deterioration of speech. There may be associated, non-specific neurological symptoms (Baird Gordon, 1983). Cleft Palate Repair            The reasons for cleft palate repair are improved feeding, speech development and protection of the Eustachian tube, and effect on the growth of the middle third of the face. Not enough attention was paid to the hearing in cleft palate patients and, in the earlier years, the speech was also not given important consideration. All the attention was focused on the growth of the middle third of the face but if one misses the hearing and the speech, the damage is irreversible. The timing of cleft palate repair has always been governed by geographical location. In the European Centers, the repair is delayed for considerably longer, even up to six to seven years. In the English speaking countries, the repair is done around one year of age, but why leave these repairs till so late as speech usually develops by seven months? Physiologically, it is better to repair the palate before speech starts developing, so that postoperative edema and scarring settles down, it is then better to operate in the cleft palate at four months. Traditionally, the treatment of cleft lip and palate was to repair the cleft lip and anterior palate (single layer closure) between six to 12 weeks of age and repair the palate at about 18 months (Desai, 1997).            Currently, the majority of surgeons around the world who treat many of these children prefer to operate around 3 months of age for physiological and technical reasons. A 0.25mm error in alignment in a 1-day-old- child will show noticeable 1 to 2mm malalignment by age 1 year. The cleft palate is repaired best at around age 12 months. This is a compromise. Earlier repair may be an advantage for speech, but it is a disadvantage to subsequent facial growth. Late repair has an opposite effect. It is subsequently easier today to correct an underdeveloped midface in the 10% to 20% of patients in whom it may occur, rather than trying to correct bad speech in nearly all patients so treated by late palate closure. Cleft lip and palate need no longer be devastating deformity that it was 30 years ago, if untreated by an experienced team (which needs to see at least 40 new patients a year), the child should be expected to have normal speech, a symmetrical lip with a fine scar, a nose close to normal in appearance, and a full set of well-fitting teeth. To achieve this requires good patient and parent cooperation. In most cases, further surgery will be required by age 5 years to improve the nose shape. The wearing of orthodontic braces is almost inevitable but should be limited to 1 session in early adolescence. With good psychosocial support and good parenting, such children should grow into normal well-adjusted adults. However, if the quality of the surgery is bad and repeated operations are carried out, the speech and hearing are ignored and the teeth are not treated, then a very different psychological outcome will be present. Unfortunately, this still occurs even in the most advanced countries, if children are treated by either inexperienced or inadequately trained people, or without the benefits of a team approach, or where the team does not have a big enough population load to maintain its expertise (Eder, 1995). Surgical Management of the Primary Deformity            Lip Adhesion            If the child presents with a very wide cleft lip and a palate, it may be advantageous to â€Å"help†the cleft to become narrower, thereby facilitating the surgical outcome of the cleft lip repair. Most commonly, presurgical orthopedic molding of the wide cleft palate and lip can be accomplished with a process called â€Å"taping.†In taping, a strip of hypoallergenic tape is applied with tension across the cleft and secured to the child’s cheeks. The tape is worn 24 hours a day and reapplied as needed. Taping causes molding of the bony tissues by applying gentle pressure onto the protruding bony portions of the maxilla. This simple technique can be extremely effective in reducing the width of the cleft in a nonsurgical manner. When taping a ineffective or not tolerated by the infant, a lip adhesion can be considered. The goal of a lip adhesion is to surgically convert a complete cleft lip into an incomplete cleft lip, allowing the definitive lip repair to be performed with less tension. The lip adhesion also orthopedically molds and improves the alignment of the underlying maxillary segments before definitive lip repair. Lip adhesion, if indicated, is the initial procedure and it is performed at 2 to 4 weeks of age. Definitive lip repair follows the adhesion at 4-6 months of age, which allows the scar to mature. The following criteria are used to determine if lip adhesion is needed (following failure of the taping technique): Wide, unilateral complete cleft lip and palate where closure with conventional lip repair might produce excessive tension on the incision Symmetric, wide bilateral complete cleft lip with a very protruding premaxilla Introduction of symmetry to an asymmetric bilateral cleft lip A disadvantage of lip adhesion is the introduction of scar tissue, which can occasionally interfere with the definitive lip repair; although not usually a major concern, this has prompted some surgeons to limit its use. Cleft Lip Repair If no medical contraindications exist, and a lip adhesion has not been performed previously, definite lip repair is accomplished at 8 to 12 weeks of age. In the United States most surgeons follow the â€Å"rule of tens†: lip repair is performed when the infant is at least 10 weeks old, weighs 10 pounds, and has hemoglobin of 10 g. Cleft Palate Restoration Historically, the exact timing of surgical closure of the cleft palate has been controversial. The desire to facilitate velopharyngeal competence for adequate speech favors relatively early closure of the palate, whereas the possible negative influence on maxillofacial growth and occlusion favors relatively late closure. Anatomic factors to consider when evaluating the palate include the extent and width of the cleft (between both the alveolar ridge and palatal shelves); position of the maxillary segments; and, in the bilateral cleft, the size, position, and degree of protrusion of the premaxilla and prolabium. In both unilateral and bilateral complete cleft palate, collapse of the lateral maxillary segment can occur following the lip repair. In some cases, preoperative orthopedics can be used to realign the maxillary segments in a more normal position before the palate is repaired. In bilateral cleft, presurgical orthopedic treatment consists of molding the nasoalveolar process with progressively modified splints, and achieving lengthening of the deficient and short columella tissue, leading to an improved nasal appearance with a single stage procedure. Other groups favor techniques that allow for intranasal correction of the deformity and malposition during the lip repair. Although insufficient space exist to describe all the commonly used techniques, the principles of bilateral lip repair are common among them, including creation of the philtrum from the prolabium and midline tubercle from the lateral vermilion. A symmetric, bilateral complete cleft lip and palate with an adequate and moderately protruding prolabium and premaxilla are used as an example. Asymmetric, bilateral cleft lips and those with a rotated premaxilla can be treated with a one or two-stage closure (using the lip adhesion as the first stage). For children with an extremely protruding premaxilla, presurgical orthopedics may be required before definitive lip repair to move the premaxilla posteriorly, either surgically or via molding with appliances or tape (Bailey et al., 2006). Clinical Alert            Daily use of folic acid before conception decreases the risk for isolated (not associated with another genetic or congenital malformation) cleft lip or palate by up to 25%. Women of childbearing age should be encouraged to take a daily multivitamin containing folic acid until menopause or until they’re no longer fertile (Kumme, 2000).            Use of a contoured speech bulb attached to the posterior of a denture to occlude the nasopharynx helps the child develop intelligible speech when a wide horseshoe defect makes surgery impossible. Special nipples and other feeding devices are available to improve feeding patterns and promote nutrition in infants with a cleft lip or palate (Eder, 1995). Conclusion            There is no comparable series of routine cleft lip repair in newborn within 48 hours over a long period using the same technique; it is extremely difficult to fulfill such requirements as the temptation to alter the technique or timing is so great.            Every now and then, ideas about the treatment and techniques are reported in the literature or at conferences. There was considerable opposition to, and criticism of, our work at every level, nationally as well as internationally.            If one contemplates surgery in the newborn, then a proper team should be assembled. A surgeon should only undertake such a project if he feels it will help the child, not to impress other surgeons. A time will come when there will be fewer surgeons undertaking the treatment of these children in specialized centers.            It is a safe procedure in the hands of dedicated clinicians and surgeons. Pediatricians and the anesthesiologist should have a final say in the decision for surgery. It is possible to do a formal repair. The scar revision in unilateral cleft is comparable to any other series. In bilateral clefts the plan is to lengthen the columella, repair the orbicularis and narrow the philtrum at the same time at about four or five years of age. It may be worth looking at the technique of palate repair. One has to find a way to achieve repair early on in order to maintain hearing and speech results while achieving excellent maxillary alignment (Desai, 1997). References: Bailey, B. J., Johnson, J. T., Newlands, S. D. (2006). Head Neck Surgeryotolaryngology (4th ed. Vol. 1). Tokyo: Lippincott Williams Wilkins. Baird, H. W., Gordon, E. C. (1983). Neurological Evaluation of Infants and Children. London: Cambridge University Press. Brin, M. F., Comella, C. L., Jankovic, J. J. (2004). Dystonia: Etiology, Clinical Features, and Treatment. New York: Lippincott Williams Wilkins. Clark, J., Yallop, C., Fletcher, J. (2006). An Introduction to Phonetics and Phonology. Victoria, AU: Blackwell Publishing. Desai, S. N. (1997). Neonatal Surgery of the Cleft Lip and Palate. Hongkong: World Scientific. Easterbrooks, S. R., Estes, E. L. (2007). Helping Deaf and Hard of Hearing Students to Use Spoken Language. Thousand Oaks, CA: Sage Publications Inc. Eder, R. A. (1995). Craniofacial Anomalies: Psychological Perspectives. New York: Springer. Gussenhoven, C., Jacobs, H. (1998). Understanding Phonology. London: Oxford University Press US. Hall, C. (2003). Modern German Pronunciation: An Introduction for Speakers of English. New York USA: Manchester University Press. Havard, C. W. H. (1990). Blacks Medical Dictionary. Savage, Maryland: Rowman Littlefield. Kumme, A. W. (2000). Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance. San Diego, Canada: Thomson Delmar Learning.
Evidenced Based Practice In Social Care Social Work Essay
Evidenced Based Practice In Social Care Social Work Essay Evidence-based practice is a way that is followed in providing healthcare which is guided by thoughtful integration of the very best of the currently available knowledge with a clinical expertise. This approach of research in nursing practice allows the medical practitioner to have a critical assessment of the research adapt, the clinical guidelines as well as other sources of information to enhance correct identification of the clinical problem and thus application of the most high quality interventions while re-evaluating the outcome for further improvements in the future. According to Cochrane collaboration evidence based health care is a conscientious offing of the current best evidence to make decision about the care given to the patients or in the delivery process of the health and social services (Titler, Goode, 2001) The concept of evidence is used to refer to range of tangible information that is usable in identifying a problem and the necessity of responding to it forming an essential requirement for later evaluation purposes. The idea of current best evidence is information that is up to date and relevant therefore can be sued in carrying out of a valid research about various forma of health and social care, the possible harm from exposure to certain agents, accuracy of the diagnostic tests and finally the power of the predictability of the prognostic powers. This paper will offer a critical review of the evidence based practice as in concerns to the field of health and social care in nursing profession (Mason Chaffee, 2002) The term evidence based medicine was first sued in the 1980s and was used to describe the approaches that were used to in determining the best practice and was alter shifted to become evidence based practice especially after its importance in decisions making were recognized by clinicians and physicians. after that expert begun talking of the evidence based health care as process in which research evidence was used to make decisions regarding specific population or groups of patients hence assuming that the evidence was used in context of the particular group or patients preferences, desires, clinical situation and finally on the expertise of the clinicians. Experts as expect that the healthcare professionals are able to read, critique as well as synthesize the research findings to help them in interpreting the existing evidence based guideline soft e clinical practice. In recent years funding agencies have been increasing their pressure on the federal, state and local government to incase the effectiveness as well as the accountability of the preventive and intervention programs. The rising demand for increased quality of health and social programs and evidence of such quality ahs fostered for increased interest in the evidence based programs. These programs judge to be evidence based if the evaluation research indicates that the program is producing positive and expected result, and that the result can actually be attributed to the specific program but not on extraneous factor, if the evaluation is previewed by the experts while in the field and finally the programs must be endorsed by a respected research agency or federal agency which have listed it as one of their effective programs (McCarthy, 2007). The evidence based practice have been getting an increasing attention in the field of health and social care and it focuses on the perspectives of the professionals in the midwifery, physiotherapy, social acre and nursing. This new approach is seen as an optimistic approach and has had wide acceptance as it demonstrates an organization attempts to bridge the existing research practice divide which include in the process of interpretation of research outcomes as concerning the practice protocols, guidelines and standards. Nurses have often served instrumental roles in the process of ensuring as well as provision of the evidence based practice through a continuous asking of question reading the best evidence for the interventions, provisions of the best practice and finally on the possibility of achieving the highest outcome both for the patient, family and nurse. Therefore they have always been positioned to working with in collaboration with colleagues when it comes to identification of clinical problems and in the use of the exiting evidence in priding an improved practice. There are numerous opportunities that nurses can question in order to ensure that the current nursing practices use the evidence based methods to improve and make provision of health and social acre more effective. The evidence based practice research has benefited the health and social care service providers and agencies in various ways. Some of the benefits includes: helping nurses to provide patient care that is based on research and knowledge rather than on normality, intuition, traditions, myths, advice of colleague, personal experiences outdated books and hunches. Other benefits include the better and improved patient outcomes, keeps the nursing practice current and relevant, increases confidence when it comes to decision making processes, ensures that policies ad procedures in the practice are current and includes the latest research hence supporting the JCAHO -readiness and finally the integration of evidence based practice in to the practice of nursing is very important for provision of high quality patient care and achievement of the ANCC Magnet Recognition Program designation ((McCarthy, 2007). Evidence based practice in the filed of social care is defined as the conscious, explicit and judicious process of using the current best evidence in the making of decisions that regards the welfare of the service user and careers. For the past decade health and social services providers have been under pressure to increase accountability in the provision of their service especially regarding methods of measuring the effectiveness of health and social services for instance on what works the best and on the introduction of diverse range of performance indicators in the field. Some of the question that that nurses and care givers ask themselves regarding the evidence based practice in the field oh health and social care include the types of methods of evidence based that promote the best practice while ensuring that patient get the best and improved health and social services that factor in their personal preference, cultural and social differences. Effectiveness of social provision services under that children are all securely attached to careers that are capable ensuring provision of safe and effective care during the duration of their childhood and the related indicator of performance in the reduction of to no more than sixteen percent of children looked after who have two to tree annual placement (French, 2002). The concept of effectiveness in the involve the appropriateness and validity of the methods theater used by professionals in their daily work to ensuring that the basic aims of the organization and the overall abilities of the agencies in delivering services they required to while the concept of performance is concerned with the ability of n agency to achieve predetermined targets that are viewed as the determinants of both quality and quantity of the services delivered. The three Es i.e. effectiveness, efficiency and performance were the performance indicators during the 1980s. In the social and health service care the attention of the public was shifted towards the issue spreading child abuse and protection tragedies that were culminated in the enquiry of Cleveland case. This led to an increasing number of question asked concerning the effectiveness of the process of assessment sexual abuses in children and the interventions that were targeted at the victims and the perpetrators. Social service departments as well as other social acre providers are being increasing expected to be accountable for the effectiveness of the service that that are delivered both at the organizational level as well as on the specific programs used in various interventions (Gray, 1997) Therefore information technology as played a critical role when it comes to providing the means of which organizations and agencies utilize in monitoring the social service it provides and hence becoming capable of providing information that is used to achieve accountability. Focusing on the effectiveness has fostered the raising of fundamental issues regarding the nature of the research of the social work. When on considers the evidence that emerges from the National Health Service, there is a massive variations in the health service provided both for the cost between identical treatments and also in the duration and provision of the various form of treatments. Such difference can only be explained based o n the different medical or social needs as well as on the questions raised on the electiveness of such treatments. Some of the initiative designed to help in improving the services provided by health providers include the creation of national institute for clinical excellence which is intended to improve service through the use of shared knowledgebase as well as the set standards (Titler, Goode, 2001) In addition to that another impact of the effectiveness agenda in the provision of social and health service can be evident in the proliferation of the policy as well as guidance documents as well as the creation of specific initiatives intended to increaser guides in the field for instance the Centre for Evidence-Based Social Services (CEBSS). At a national level there has been development of detailed guidance as well as practice manual both for the social care staff and other professional regarding the procedures that are followed in the handling of cases of suspected child abuse but all these vary specifically on the extent in which they based on research or on other agency priorities. Finally the most concrete manifestation of the best practice in social care services is the Centre for Evidence-Based Social Services started in 1997 and based at Exeter University. The centre aims at ensuring that the decision take at every level of social service are based on trends and quality research and it conduct training on ways of achieving the stated aims. The Centre for Evidence-Based Social Services is partnership between the department of health and the social services department from corner to corner of England and at Exeter University. The organization has recently expanded to other areas and associations have various aims including the following: To help in the translation of the results of the existing research in to the service and development of the practice. Ensures that the findings derived from research are made available to the social service departments especially during the review and changing of the delivery systems To promote collaboration with other stakeholders like degree and PQ to ensuring that the training conducted in social work incorporates the available knowledge from existing research Improvement of general informational dissemination especially of research findings to the local policy makers, practitioners, managers, careers and service users Commissioning of research on areas where information gaps are identified finally is to ensure working towards level where surface user and careers are included as the valuable sources of information especially when it comes on the service effectiveness projects. Untangling the Web-The impact of internet use on the social care and the physician-patient Relationship Methods The current study lies at the intersection process and outcome study, in the process of exploring the impacts of the internet use on the social care as well as the physician-patient relations. It processes insight into the operations by which individuals access and use online social care information. It borrows much from the web based qualitative approaches. Interviews were carried out to investigate peoples meanings that are attached to their internet use, in relation to their social as well as day-day life. To ensure that the engagement of the internet user is grasped with the online medium, it was as well much significant to meet the seekers of the information in their location of activity. The initial contact and recruitment of the interviewees were hence situated online. Email Interviews With the internet users looking for social care information online, the email interview was conducted. The recruitment of the interviewees was on UK websites for lawyers for low income people, social guidance counsellors, food providers and government officials, amongst others. The reason for focusing on such like web site was because they in most cases address themselves to the public with a multiple to the public in general with multiple social issues. There are even in most cases related topics developed on the similar website. Lawyers for low income as well as food providers for instance provides various general poverty level, while general social care website becomes an important place to government and non governmental organization involvement, and also attracts various profiles of social care information seekers. These websites were identified through systematic internet research, by the use of 20 search engines as well as directories. The initial search came up with 920 websites. By the use of frequency criteria, as well as presence, 4o websites were selected. Then, they were conducted and invited for the invited to contribute to the research at hand. Amongst them, 10 websites responded positively and the research was advertised either as a web link on one of there pages, or as message in groups of discussions. The researcher posted it, after being permitted by the website administrator. Other ten were later added fin light of evidence about their appropriate content their frequent by the first interviewer. The advertisement was made to direct internet users to the website of the research where the study goals, methods and privacy were all explained. On top of responding to an online questioner, the internet users were also invited to participate in the interviews by first cond8ucting the research through email, phone or even by the use of conventional mail. As a matter of fact, only two interviewees used phone while none used conventional mails. The initial exchange of around three emails before the base was set, the basis for the undertaking full email interviews, though the participants were all given at any junction of even meeting face-to-face, or even undertake an interview through exposure. The demographic data like the respondents age, employment, gender, education, social status, health status, as well as income, were all collected to serve the purpose of statistical controls. Respondents also were asked, if they have ever worked or ever stayed in a social care related units. In addition, they were questioned about their views in non traditional social care services. Email Qualitative Research Email interview is just asynchronous online method of interviewing, based generally on several email exchange between the participants and the researcher (Bampton Cowton, 2002). Such like interviews allows greater flexibility for the interviewee, who might answer at his/her own convenience. Though it lacks the immediacy as compared to face-face interviews, once the basis has been set up, email communications helps in the attainment of conventional interviews and creates personal as well as thoughtful communications. In addition, email interviews allows repeated interactions as time goes by, this has been proved to be much significance for the deeper understanding of everyones dimension of the participants doctors relationship, (Mann Stewart, 2000). About 20-30 emails had been already exchanged between the each respondent and the researcher. The time of interview time relying on the speed that was adopted by the interviewees for replying the email. The interviewee age varied from 20 to 60 years. The respondents respondent to questions like what was their level of social help? They were also asked about the source of their social care? Another question was about their social problem that needs social care? The gender imbalance especially interviewees, especially in favour of females can be attributed to several reasons. One of them being the specificity of the mode of interview; given the gendered use as well as the social purposes of email communication; the initial email contacts might have installed an intimacy level, which in one way or the other might have locked the door out for male audience. Another reason might be the focus on social care issues like lawyers for low income individuals and the general social care websites. Though such like websites are addressed to the public in general and purpose males social problem topics, the dimension of gender of these social issues as well as their related website has to be recognized, (Saltonstall, 1993). Another reason that can explain is that, females are socially constructed as the social gatekeepers of the family, and the society as a whole. Although according to the survey knowledge, findings proving that online social information seekers are mainly females. However the gender imbalance raises the question of whether the differentiated presence as well as the gendered use of the internet regarding social information, dimensions that need to researched on din another research. The email interviews were semi-structured, such like interviewing form being characterized by its openness and its enabling the interviewer to ensure that all themes rose as well as narratives provided by interviewees. The guide of the interview focuses on the three main issues namely; the traits, context as well as the implications of the internet for social information reasons. Though initially, this method was being considered as secondary source of data collection, the relations that interviewees have with their doctors, in real sense constituted the major theme. One after the other, topics was all discussed. The process of exchanging questions, and answers having no pre-judged other than just following a style that is far much conversational style. Analysis The most appropriate application to the interview data according to, (Boyatzis, 1998, Flick, 1998) is thematic analysis. The application consists of encoding qualitative information through creation of several themes that usually organises a number of themes that have the capability of organizing qualitative observation as well as describing the data into coherent as well as meaningful ideas and constructs, which forms the foundation for the interpretation for such like data. At first, themes were organized following the interview guide before being elaborated into further subdivided themes that offers the coding foundation, under which further themes that were created inductively were also integrated, (Flick, 1998). Normally, formal informed consent is much important for all qualitative research methods in social care practices apart from participant observation, no matter the sampling method that was used in the identification of potential participants and the strategies used during their recruitment. The number of project-specific factors at ultimately upon a provably ethics committee, determines whether informed consent is written or oral. At the recruitment stage, obtaining informed consent for qualitative research involves clearly explaining the project to potential study participants. Ethical Issues for the Conduct The best protection of the subject interest and well-being is the protection of their identity. If revealing the behavior or the responds harm them then adherence to this norm is important. The two principles involved include anonymity and confidentiality. The research subject is perceived anonymous when the researcher cant associate a given data with the individual. Anonymity highlights several potential difficulties. The studies that involve field observation methods usually ensure that the research subjects are not known. Researchers might also expand access to nonpublic reports from both governmental and non-governmental organizations agencies in which the names of individuals have been uninvolved. An example is a web based survey in which no log in or other identifying data is needed. The subjects anonymously fill the questionnaires that are then tabulated. Promising anonymity makes it difficult to keep record of which sampled subjects have been interviewed. Sometimes the value of anonymity is worth paying. Other methods of information collection make it impossible to assure anonymity for the respondents. Confidentiality comes in when the researcher links the data with the individual but promises not to do so in public. In a study of self-reported drug use, the researcher is in a position to make it open the use of illegal drugs by a given subject but the subject is guaranteed that it will not happen. Research using police or court reports that contains individuals names might protect the confidentiality by not including any leading information. All names and addresses data gathering forms should be interchanged by identification numbers and master identification files made to link numbers to names to allow latter corrections missing information, (LoBiondo-Wood, Haber, 2006). Confidentiality comes in when the researcher links the data with the individual but promises not to do so in public. In a study of social care practice, the researcher is in a position to make it open so that it can be used by a given subject for the benefit of the respondent, but the subject is guaranteed that it will not happen. Research using reports that contains individuals names might protect the confidentiality by not including any leading information. All names and addresses data gathering forms should be interchanged by identification numbers and master identification files made to link numbers to names to allow latter corrections missing information. The Ability to Critique The research needs to know how to reduce the need of labeling children as for instance disabled so that they can address the learning and behavioral requirements of such like children in a social care program. Most o0f these national psychological as well as social care providers do have ethical standards that require science based practices to air some sort of problems, for instance, the American psychological association ethical standards, amongst others. There has been no agreement upon both quality as well as quantity of evidence that is necessary for the validation as well as intervention as being evidence-based practices in social care practices. Just the research methods of a single participant design are many convincing illustrations of the casual relationships. Social care practice analysis has been for a long period of time been criticized due to limited generalizability, as an effect of the small number of this taking part in the research study. In real since, there are no established standards within social care practices analysis for the validation of interventions. As an effect, there has been no single resource that decision makers can rely on to provide guidance about the best intervention to take it under practice in case of a particular problem. The identification of evidence-based interventions is much important but not enough to provide assurance that they will be implemented in practice setting. It is nevertheless important to address issues that ought to be complex which are associated with the implementation, (Joyce, et al, 1998).
Wednesday, October 2, 2019
Comparing the Role of Women in Emma and Jane Eyre Essay -- comparison
     Throughout history women have played important roles in society. Women have gone through much adversity to get where they are today. Jane Austen and Charlotte Brontà « are some the pioneers of women's literature. Each shows their different aspects of a women's role in society in their books Emma by Austen and Jane Eyre by Brontà «. In both of these books the author shows how a woman deals with societies' norms, values, and manners.       Jane Eyre is an orphaned daughter of a poor family. She is brought up by her aunt Sarah Reed. Where she is teased and tortured by the aunt and the family. She is not very pretty and is barely on the social structure. On the other hand Emma Woodhouse is a beautiful girl and is financially sound. She is raised by her maternal father.       In Emma, Emma Woodhouse is in search of finding the appropriate man for herself is the main theme. As the reader goes deeper into the text Emma slowly progresses into a self-deception. Having since childhood been obliged to manage her father, she still likes to manage things, and particularly people. She manages to manipulate everyone except Mr. George Knightley.       In Jane Eyre, Jane demonstrates a strong need to be herself, to take responsibility for her action. She is put to the test by her daily teasing and abuse from her cousins. When she is brought to a boarding school she soon distinguishes herself through her classes. Eventually ends up in Thorn... ... finds out the Bertha Mason Rochester set it on fire and jumped off the roof. Austen in a way showed this as a rebirth for Rochester and Jane Eyre.  Jane returns to Rochester even though he suffered an amputated hand and is blinded by the fire.   Eventually they marry and Rochester regains his sight in one eye and produces a son.       In both of these books the author shows how a woman deals with societies' norms, values, and manners. Jane and Emma endure harsh realities in life. Jane had to be a strong character to go through what she did. Emma not as strong but the determination in find a spouse. Even though Jane and Emma had different hardships the had similar characteristics. They both had wisdom, imagination, and character.
Tuesday, October 1, 2019
Free College Admissions Essays: The FIRST Engineering Competition :: College Admissions Essays
The FIRST Engineering Competition  It was just the second week of school, and I had mustered up all my courage to venture to the nether regions of our school known as the basement to attend the first meeting of the newly forming FIRST (For Inspiration and Recognition of Science and Technology) robotics team. When I walked into room one, the newly proclaimed FIRST headquarters, I looked around with apprehension, and I noticed that I did not recognize a single face in the room. Nervously, I took a seat, and Mr. Mothersele, the advisor for the program began describing the program. FIRST is a national engineering competition in which partnerships are formed between local businesses and high schools to design and build a robot-like machine from identical kits of parts supplied by FIRST. The team has about six weeks to build the machine which must be able to compete in a timed sporting event. As soon as I saw the video of the students working and competing with the robots, I was hooked. The program seemed tailored to my int erest in math in science and to my competitive spirit. I couldn't resist the opportunity.  As a shy and relatively inexperienced freshman, I signed up for the program as the only underclassmen on the team of ten students. I bumbled along, learning about design and how to use the machines. I made my full share of mistakes and then some, but by the end of the program, I was gaining some real experience. Although our robot did not fare very well in the competition our first year, my learning process was underway, and I knew that I had found my place.  The second year of the competition, I was only one of two returning students. I took an active role in recruiting new students, and our membership doubled. It was a complete role reversal for me because all of a sudden I was the experienced team member. We finished fifth out of forty teams at the regional competition, and at the national tournament, we placed in the top third.  This past year, was the golden year of my FIRST career. In September, I was voted team captain. It was my job to ensure that our team was well organized and that we stayed on task. Our team advanced to the semifinals, where we lost to the eventual National Champion.
International trade as opportunity for workers Essay
When is international trade an opportunity for workers? When is it a threat to workers? International trade is rewarding as it is unsatisfying when it comes to the average worker. When a new business is started for that region or area jobs are expanded merely because it is expected that it will be at a rate of lower cost production along with less expense on product materials. The more the business is in demand the more job opportunities a created or expanded. In some incidents, not so much in Mexico, but in different areas it has resulted in the local economy struggling with jobs. In some new found companies or businesses, they find that bringing in pre-trained employees (especially white collar employees) and resources fair better than working with the local nationals in that area. This very well could happen in Mexico for different types of businesses, but it is still unlikely for the mere reason of bidding for the local support. Economic prosperity is a large reason for International trade, but along with the wealth is a better chance of rules, regulations, and benefits from employees with the new found business. The laws enforced by International trade agreements tend to stress more worker related issues than that of a host nation of many second or third world countries. If the benefits and laws all improve the local’s views on the new business then a better turnout and support structure will follow for everyone involved. The best example of this is how NAFTA has implemented change and looks to have this enforced by all countries that agree to the terms with in the agreement. What are some of the major challenges confronting the international trading system? International trading has a plethora of challenges that barricade the system before any true benefits are reveled. Among these challenges are the social structure indifferences that are displayed between countries as it pertains to business plans and the split of revenue between parties. With the continuing differences between international organizations, too much red tape is casted over many prime opportunities for growth between organizations. Therefore, values that represent democratic, political and economic principles are what international organizations should be about (Moore, 1999). In addition to the government and political structures that cause challenges for international trading systems, natural resources are a key deterrent in international trade. In places like South America where the lumber and logging business is prosperous, many international trades are restrained from outside agencies coming into that region and depleting the resources more than they already have been depleted. The entire world is feeling the effects of what is considered to be the green house effect and the environmental issues that face every country range in lack of natural resources in different areas to natural disasters that alter the way the land, structures, and businesses are ran. International trade faces the constant change of supply and demand and while the world has always relied on fossil fuels for power or energy, new forms of energy are being developed that shows that international trade varies from one day to the next with its challenges. Reference: Kongsrud, P.M. and I. Wanner (2005), _†The Impact of Structural Policies on Trade-related Adjustments and the Shift to Services†_, OECD Economics Department, Working Papers, No. 427, Retrieved December 3, 2008, from http://www.oecd.org/dataoecd/49/29/20686301.HTM Moore, M. (1999, September 28). _Changes for the global trading system in the new millenium_. Retrieved December 1, 2008, from WTO News: http://www.wto.org/english/news_e/pres99_e/pr139_e.htm
Subscribe to:
Posts (Atom)