Relationship between nurse staffing, quality of nursing care and Research Paper

Relationship between nurse staffing, quality of nursing care and outcome in intensive care unit - Research Paper Example After a comparison was done in five countries that are considered to be developed, only 40% of the nurses agreed to have enough registered nurses (Hyun Cho et al., 2009). In order for a hospital to perform well, they need to have enough registered nurses. Hospitals that have enough nurses are associated with positive patient and nurse outcomes. The paper will give a review of the relationship between nurse staffing, quality of nursing care, and outcome in the intensive care unit. Among the different nursing care units in hospitals, the intensive care unit needs to have the highest number of nurses. The intensive care unit receives patients who are seriously ill and need to be watched closely. The nurses in charge of the ICU have to provide quality services as well as safe nursing interventions without delay so as to save life. For developed countries like the United State, the ratio of nurse in the ICU to a patient is 1 – 2 patients per nurse (Hyun Cho et al., 2009). The staff ing of nurses in the ICU influences the number of patients who survive at the end of the day. Hospitals with fewer nurses assigned in the ICU are probably over worked and end up having patients admitted for long with more complications. Korea is said to have inadequate staffing in hospital. Research was carried out in Korea, which included 200 hospital showed that only a small fraction of 5%, of the hospitals met the required ratio of a patient to nurse of two patients per nurse (Hyun Cho et al., 2009). The lack of nurses has caused the family members of the offer services to their patient. In response to the shortage of nurses in Korea, the country came up with a policy meant to improve nurse staffing. According to the policy, nurse staffing is a priority and the National Health Insurance should increase inpatient nursing fee especially to hospitals with the highest number of registered nursing staffing. This policy by the Korean government was aimed at preventing hospitals from le aving a patient under the care of their family members. In addition, the policy aims at improving the quality of nursing care being offered in Korea. The policy is meant, however, for general wards, such as the medical surgical and units excluding the ICU. Various methods were used to measure nurse staffing and evaluate staffing adequacy. The common methods used are the nurse’s perceptions of staffing adequacy and the quantitative objective using empirical data, such as nurse to patient ratio. The study aims at examining the relationship between nurses staffing and the quality of nursing care, burn out, and job dissatisfaction among ICU nurses in Korea. The study in Korea involved all the nurses working in the ICU of the 22 hospitals. The hospitals in the study were general ones that provide either secondary or tertiary care. The measures in the study were composed of the nurse, ICU, and the hospital characteristics. Hospital characteristics include the level of care, its own ership, location, and the size. The ICU characteristics include the unit specialist, such medical surgery and pediatrics, the number beds in the ICU unit, and the level of nurse staffing (Hyun Cho et al., 2009). During the study, the number of nurses was compared to the number of patients they were attending. On the other hand, the nursing information included the nurses ICU specialty, sex, age, education, marital status, among other import things. The quality of service portrayed by the nurses was

Lab 4 Infectious Bacterial Identification from DNA Report

4 Infectious Bacterial Identification from DNA - Lab Report Example It is difficult to identify bacterial pathogens using the common lab processes which include morphological methods and biochemical procedures (Reece et al 2012). Bacteria that are difficult to identify yield inconsistent results when analysts use these manual procedures of bacteria identification. However, the DNA sequencing method offers a better solution of identifying different types of bacteria. This report offers the procedure of identifying Burkholderia cepacia, a bacterium that causes cold in small children. Finally, add 1 cm3 of culture to all the DNA strands from different blood samples that have undergone the above procedures to identify the Burkholderia cepacia bacterium from other similar bacteria that cause cold. Pyrosequencing becomes possible in the DNA of different bacteria that cause cold in children when culture and Carlsbad solution is added to the sample DNA strands because of some bacteria’s ability to assume different colors when these solutions used in this analysis are added to them (Luna et al 2007). Therefore, Burkholderia cepacia stands out distinctively as purple which makes it easy to identify its species when considering the various bacteria that cause cold. DNA sequencing stands out to be the most effective method of identifying the many infectious bacteria that

Raid Research Essay Example for Free

Raid Research Essay The word RAID stands for redundant ray of independent disks. Raid is usually used in environments with servers or at a business with large file servers, transaction of application servers, where data accessibility is critical, and fault tolerance is required. There are 8 types of raids, Raid 0 is technically not a raid level because it offers no fault tolerance but, it operates by providing data stripping which takes the information and spreads it out over all the disk drives. However, if one drive fails than the entire raid fails. Raid 1 is also referred to as disk mirroring; it basically takes the information from one disk and stores it on multiple disks, this is great for fault tolerance because if one disk fails the information is on another disk. The only drawback to raid 1 is data access speed and the cost because there are more disks involved. Raid 5 is considerably the most commonly used Raid level simply because it provides both stripping and parity. The parity block is distributed to all of the drives making it easier to access the information or have a balanced access load. The parity in raid 5 is used if one of the drives happens to fail, to recover that drive which makes the raid 5 the most common however the only drawback to this raid level is that it has a relatively slow write cycle. Lastly, RAID level 6 which is very similar to raid level 5 but provides two parity functions rather than just one. A minimum of four disks is required to create RAID level 6. Raid level 0, even though it offers no redundancy, is still of use mainly to those who use applications that require high bandwidth such as data streaming or video editing software. Raid level 0 is also used because it’s most simple to implement. Raid level 1 is most expensive because it requires more disks to implement. It also requires heavy software manipulation and configuration to implement Raid level 1. If I were to purchase raid it would absolutely be raid level 0 simply because its easy to implement and it would be efficient for my personal usage.

Management of Diabetic Foot Ulcers

Management of Diabetic Foot Ulcers Diabetic foot disorders are the rated as the number one cause of hospitalisation for diabetic mellitus patients in the United States and abroad. Among these disorders are, foot infection, ulcerations, cellulitis and gangrene. It is estimated that a 100 people per week lose a digit, foot or a lower limb due to diabetes mellitus8. Diabetic foot disorders and its long term complications account for direct medical budget of hundreds of millions of dollars annually, including lengthy hospital stay of patients and lengthened periods of disability. In the UK, diabetes cost the NHS over  £5 million pounds per annum and the cost of diabetic foot complications including amputations was  £252 million in 2003. Figures show that 1 in 10 foot ulcers result in the amputation of a foot or a leg. The most distinguishing foot complication of diabetes is the ulcer, which is of course a major risk factor for amputation. Mortality rates after amputation are as high as 50 percent in diabetic patients. Although the primary pathogenesis is neuropathy, immunopathy and vasculopathy (ischemia), diabetic foot ulcer is attributed to a number of other risk factors. Early detection of these risk factors as well as the foot ulcers themselves is crucial in the general management of diabetic foot ulcers and amputation prevention. Therefore, immediate and aggressive treatment of all diabetic foot ulcers can prevent worsening of the complication and the need for amputation. The objective of treatment as a result should be prompt intervention to allow good healing of the ulcer and once healed, to prevent its recurrence. However, the optimum care for foot ulcers rest upon the treatment teams understanding of the pathophysiology associated with diabetic foot ulcers, familiarity with current methods of treatment and the concept that the multidisciplinary team approach is the gold standard in preventing limb amputation. And above all, prevention of foot lesions should be ranked highest amongst all priorities. EPIDERMIOLOGY There is no concrete data illustrating the true picture of the incidence and prevalence of diabetic foot ulcers. However, majority of the information gathered about its aetiology is based upon national hospital discharge survey (NHDS) data, which does not include a vast number of patients with ulcerations treated on the outpatient basis. Cross-sectional and population-based studies help to approximate the distribution and frequency of diabetic foot ulcers, while prospective cohort studies and retrospective case-control studies are instrumental in detecting associated risk factors for the foot lesions. According to Reiber et als epidemiological review, chronic ulcers represented 2.7% of all diabetes related admissions and 46% of all admissions due to any ulcer condition. The 1983-1990 NHDS survey also revealed that the highest ulcer rates were found in individuals aged 45-64 years, with male preponderance over the female. The average length of stay (LOS) for diabetes pat ients discharged with ulcers was 59% more than in patients without ulcers, around 14 and 8 days, respectively. Numerous population-based studies record a yearly incidence of diabetic foot ulcers in the magnitude of 2% 3% in both type 1 diabetes mellitus (IDDM) and type 2 diabetes mellitus (NIDDM) patients, while the prevalence ranges between 4% and 10%. These studies also suggest a widespread trend for higher prevalence of ulcerations with increasing age and duration of diabetes. Once ulcerations have occurred, recurrence rate can get to 50% in 2 years and 70% in 5 years. Despite the fact that mortality linked with diabetic foot ulcerations has not been recorded, 70% to 80% of amputations of the lower extremity can be lead by foot ulcers. Amputation is one of the most common sequels in persons with diabetes mellitus now exceeds 100,000 per year in the United States and amputations involving the leg, foot or toe(s) are not uncommon. Approximately 15% of patients with diabetic foot u lceration will require amputations due to uncontrolled infection, gangrene or failure of the ulcers to heal. Unfortunately, there is a 3-year survival rate of 50% after the amputation of a lower limb, while the 5-year survival rate is approximately 40%. Subsequently, less than half of the patients who end up with lower extremity amputation (LEA) of one limb go on to develop a severe contralateral ulcer within a space of 2 years, thereby putting the future of the other limb at risk as well. AETIOLOGY/PATHOPHYSIOLOGY Several factors have been implicated in association with diabetic foot ulcers. These factors include the intrinsic complications of diabetes mellitus in affiliation with some extrinsic factors and together predispose the diabetic patient to the risk of developing foot lesions. The trilogy of peripheral neuropathy, peripheral arterial disease (ischemia) and susceptibility to infection (immunopathy) are the main predisposing factors for lesions on the foot. The impact of peripheral neuropathy may not be easily detectable, with little or no signs and symptoms. Notwithstanding, its pathology advances fast and the end stage of tissue necrosis quickly reached. Distal sensory neuropathy can be seen in 20% to 50% of patients with type 2 diabetes. This decreases the protective sensation in the feet, leading to abnormal spreading of foot pressure and shear stresses with subsequent callus formation. This in turn diminishes the patients ability to perceive minor trauma to the foot and this is de monstrable by vibration perception threshold (VPT) and insensitivity to a 10g monofilament, which conveys a 7-fold and 18-fold risk of foot ulceration respectively. Distal motor neuropathy precedes atrophy of the intrinsic and extrinsic musculature of the foot, with accompanying deformities of the toes and metatarsals heads on the plantar aspects of both feet and consequent bunions on the 1st and 5th metatarsal-phalangeal joints. However, these irregularities of the feet cause an increase in the foot pressures, particularly around the bony prominences, thus resulting in more calluses forming. These calluses then go on to further increase the local subcutaneous pressure, ultimately resulting into haemorrhage beneath the callus, a lesion known as the pre-ulcer is then formed. With progressive pressure mounting on the pre-ulcer, the overriding skin breaks down to produce an ulcer. In addition, distal autonomic neuropathy could as well spark a plantar ulcer directly by reducing sweating in the feet with consequent drying and cracking of the skin28.Peripheral arterial disease and impaired cutaneous circulation are also important risk factors for both ulcerations and LEA. Peripheral arterial ischemia sometimes produces ischemic ulcers, but these are rare occurrences i.e. (1% 2% incidence) than neuropathic ulcers (65%) or combined neuroischaemic ulcers (25%) 28. Transcutaneous oxygen tension (Tc pO2) levels less than 30mmHg and absence of peripheral pulses or past history of vascular surgery are strong separate predictors of ulceration. Diabetic foot infections often set in and complicate already settled foot ulcers. Although, infections play an integral part in the pathway to lower limb amputation, there is inconclusive data with regards to the position of susceptibility to infection in causing ulceration. Even though, most ulcers are caused by minor foot trauma, and in some cases the patient takes no notice of because of the sensory neuropathy. These minor injuries (i.e. extrinsic factors which include; wearing ill-fitting/brand new shoes, hot soaks occupational hazards and to a lesser extent self-induced trauma by cutting toe nails or calluses) constitute the leading cause of acute precipitant of diabetic foot ulcers. In addition, there are also a number of intrinsic factors which could predispose diabetics to developing foot ulcers and they include; longstanding diabetes, past history of ulcers or amputation, age, weight, retinopathy, nephropathy and structural deformities of the foot (i.e. Charcot foot) have al l been associated as risk factors for ulcerations. However, bad biomechanical function arising from the complications of diabetes generally leads to foot injuries in most diabetic patient. ASSESSMENT OF DIABETIC FOOT ULCERS A detailed and well organised evaluation of the lower extremities is crucial when commencing the treatment of a diabetic foot ulcer. Before carrying out the physical examination of the limbs, it is noteworthy to perform a quick inspection of the patients shoes for good fit, foreign objects and the wear and tear patterns. The clinical evaluation must include an appropriate assessment of the ulcers aetiology, its extent and depth, presence and severity of both local and systemic infection and peripheral vascular status. A comprehensive assessment of the patients general health and glycaemic control, extent of peripheral neuropathy, a careful, yet detailed dermatologic and musculoskeletal examination should also be included in the evaluation. These assessments determine the ulcers healing rate, potential progression to LEA, and the likelihood of reoccurrence. Therefore, they should be accomplished urgently in the ambulatory or hospital setting and require a multidisciplinary team approach, with possible consults to the infectious disease specialist, podiatry, vascular and orthopaedic surgeons. Bilateral lower limb pulses must be examined. When pulses are diminished or not palpable, Doppler segmental pressures to the toes or TcpO2 measurement are indicated and the vascular experts should be brought on broad. The neurological evaluation should assess the patients sensorium and deep tendon reflexes. The ankle and knee reflexes are tested with the aid of a simple neurological hammer, while the important aspects in the evaluation of the sensorium are: reduced sensation to pain, light touch, hot/cold and vibratory sensation. Pain sensation is easily assessed with a disposable needle. A piece of cotton ball, lambs wool or 10-g monofilament can be used to evaluate the light touch and a 128-Hz or 512-Hz tuning fork or biothesiometer are approved for vibratory evaluation. Cold perception is also assessed by submerging the metal arm of a neurological hammer into cold water and then placing it against the patients skin. Anatomical deformities such as hammertoes, previous foot amputation, or Charcot joints often produce high pressure areas which result in ulceration. The musculoskeletal evaluation cannot be done by visual inspection of structural findings alone, it must also include testing for muscle strength, weakness, atrophy and contracture. Assessment of joint range of movement and gait evaluation with computerised plantar pressure analysis will also be of great value in appreciating the abnormal dysfunction contributing to ulceration. Examination of the skin of both feet is also carried out with detailed attention to the quality and integrity of the skin around the interdigital areas. Changes in the colour of the skin often associated with spotted rashes and heel fissures are suggestive of a significant level of ischemia. Toenail changes and presence of subungual drainage are pointers to a proximal source of infection. Clinical assessment of the ulcer should include a detailed description of its appearance as well as the measurement of the ulcers diameter with a wound measuring guide. Outlines of the ulcer on a translucent film or plastic sheet can also promote this process. This must be documented and retraced at subsequent visits to assess the treatment process. The depth and extent of the wound should be carefully explored with a blunt sterile probe. Special care must be taken to probe for hidden sinus tracts and subcutaneous abscesses or to identify tendon, bone or muscle or joint involvement. Ulcer depth is a significant predictor of healing rate, possibility of concurrent osteomyelitis and the chances for amputation. The presence of infection is a huge cause of the need for hospitalization. Therefore, a general assessment with physical examination, laboratory investigations and radiographic studies is important in classifying infection as absent, mild, moderate or severe. This classification acts as a guide to determine or select the initial antibiotic therapy and to decide when to hospitalise the patient. Clinical signs of infection such as purulent discharge, odour, cellulitis, fever and leucocytosis must be documented. However, Leucocytosis and fever might not always be noticeable even in the presence of acute osteomyelitis. Approximately 54% of patients with diabetic foot infections had normal white blood cell count and no fever44. Bacteria cultures of anaerobes and aerobes (both gram positive and gram negative) should be obtained from the base of the ulcer, bone or blood or from all three depending on the clinical setting. This helps in clarifying the true hidden pathogens and may facilitate the decision to adjust initial antibiotic therapy. Physical examination of signs of infection in the patient centers on the presence or absence of systemic responses such as fever, tachycardia, sweats or hypotension and the appearance of the wound and adjacent tissues. Early signs of infection are evident by increased amount of exudates from the wound, base of the ulcer changes from pink granulation to yellowish- grey tissue, tenderness and induration around the ulcer. Infection should be considered severe when the patient present with systemic toxicity, signs of fascilitis or a rim of erythema around the ulcer greater than 2cm in diameter. Laboratory investigation to confirm the presence of infection should include white blood cell count and differential which could show leucocytosis or a shift to the left or both, erythrocyte sedimentation rate (ESR) which when elevated above 40mm/hr is a strong indicator of osteomyelitis28. In addition, glucose, bicarbonates and creatinine levels are tested to rule out possible hyperglycaemia, metabolic acidosis or azotemia from dehydration which strongly suggest the presence of a severe infection. Radiological evaluation should be obtained promptly to ascertain the presence of fractures, foreign objects or signs of osteomyelitis. Plain x-rays have a low sensitivity, thus they should be interpreted with caution as changes in the foot caused by Charcot foot could mirror those osteomyelitis when seen on a plain x-ray. However, a normal plain x-ray of the foot does not rule out osteomyelitis, a repeat should be requested 2 weeks later to exclude occult osteomyelitis. As indicated, other imaging modalities can aid in the diagnosis of osteomyelitis such as CT scans, magnetic resonance scan (MRI) or leukocyte scans and each having their own strengths and limitations. TREATMENT Management of the foot ulcer is mostly determined by its severity, vascularity and the presence of infection1. Recognition of its root cause will serve as a guide during the course of treatment. However, a multidisciplinary team consisting of specialist from podiatry, orthopaedic surgery, vascular surgery, the infectious disease service and diabetic education service should be involved in the management. The multidisciplinary team approach is due to the complicated nature of the disease itself as well as managing the various comorbidities associated with foot ulcers. In addition, the approach has been demonstrated in clinical trials to produce significant outcomes in terms of improvement and reduce the incidence of major amputations. The wound should be immediately relieved of all pressures, elevated and rested at first presentation. Effective local wound care must be carried out and ill- fitting footwear should be discarded and replaced with appropriate surgical or relief shoes for protection. And in cases where total nonweightbearing with crutches is impossible, a pressure felt padding or foam can be used in the surgical shoes. However, the total contact cast (TCC) is considered gold standard to protect neuropathic ulceration during ambulation due to its ability to eliminate high pressure areas under the foot. Adequate alternatives to the TCC are the Scotchcast Boot or removable walking braces. Treatment of hyperglycaemia, ketoacidosis, renal insufficiency and other comorbidities that may coincide in the ulcerated patient should be treated simultaneously with the foot lesion. Consultations to internal medicine, endocrinology and cardiology are generally frequent when managing acutely infected patient who need to be hospitalised. Such consultations are usually sought early in course of treatment to ensure good metabolic control. Diabetic foot infections are usually polymicrobial and as such initial antibiotic therapy should be broad-spectrum after obtaining good aerobics and anaerobic culture samples. Antibiotic therapy should be later modified according to the culture and sensitivity test and the patients clinical response to the initial therapy. Surgical debridement and drainage or local partial amputations are crucial adjuncts to antibiotic therapy. Underlying osteomyelitis usually present in moderate to severe infections and often requires aggressive bony resection of infected bone and joints accompanied by cultured -directed antibiotics for 4 6 weeks. Foot ulcer patients with underlying ischemia should undergo revascularization with angioplasty or vascular bypass procedure if its anatomically possible. Even with severe distal arterial obstruction, revascularization to return pulsation to the foot is a major part of the limb-salvage strategy and may be accomplished in such patients. However, where revascularization is not feasible or in cases of advanced infection or extensive necrosis, amputation at some level may be required. Wound care is also necessary after surgical or sharp debridement of all callus and necrotic tissue58. Practically, a warm, moist environment conducive for wound healing should be maintained.This can be arranged using saline wet/dry dressings or special dressings such as semipermeable films, hydrogels, calcium alginates and hydrocolloids. Tissue-engineering dermis is a more recent class of biologic dressing and has been tested to be more effective than saline dressings. There is little evidence to support the role of topical enzymes and should be avoided. Although the role of topical growth factors in the healing rate of ulcers is beneficial, however, they are expensive and should be limited to patients whose ulcers cease to improve after 4-6 weeks of adequate therapy. PREVENTION OF RECURRENCE AND AMPUTATION Prevention is regarded as a major aspect in avoiding ulcer relapse and diabetic lower limb amputation. Recurrence rate with diabetic foot ulcers and LEA are as high as 50% -70% over three years. Comprehensive intervention programs tailored to individual patients can lower these rates and can be accomplished with a multidisciplinary team approach. Control of both macrovascular and microvascular risk factors is also of great importance. Patient education and re-education plays a primary, yet active role in this program and involves instruction in foot hygiene, the need for daily inspection, proper footwear and the necessity of prompt treatment of new lesions. In addition, regular and frequent visit to a diabetic foot care program is crucial. The feet must be thoroughly inspected at every visit and should include debridement of calluses and ingrown toenails. This provides an excellent opportunity to back up self care behaviour as well as allowing early detection of new or imminent foot problems. Appropriate therapeutic footwear with pressure-relieving insoles and high toe box which protect the high risk foot are an essential element of the prevention program and have been associated with significant reductions in ulcer development. Subsequently, patients with major structural deformities may benefit from reconstructive surgery to prevent recurrent foot ulcers. Surgery may be especially suitable in patients who cannot be accommodated in therapeutic footwear. And because patients with healed ulcers are at risk for future ulceration, these preventive measures must be integrated into a long life strategy and treatment program. CONCLUSION Diabetic foot ulcerations, infections, gangrene and lower extremity amputations (LEA) are major causes of disability to patients with diabetes mellitus. And these often results in extensive periods of hospitalisation, substantial morbidity and mortality. Although not all such lesions can be prevented, it is certainly possible to reduce their incidence by proper management and prevention programs. A multidisciplinary team approach to diabetic foot disorders has been regularly proven to be the best method in achieving favorable rates of limb salvage in this high risk population. Foot care programs accentuating preventive management can reduce the incidence of foot ulceration through modification of self care practices, appropriate evaluation of risk factors and formulation of treatment protocols directed at patient education/re-education, early intervention, limb preservation and prevention of new lesions. The joint team of medical, surgical, rehabilitative and footwear specialist shou ld impart effective and coordinated services for acutely infected or ischemic inpatients as well as management for the outgoing patients. In general, the incidence and morbidity of diabetic limb amputations can be reduced if the above principles are embraced and integrated into everyday patient management protocol.

The Coach That Never Came :: essays research papers

The book, â€Å"The Coach That Never Came† was a very interesting book. In the beginning, John, Steve, Mike, and Craig were all talking about their new baseball coach that they were going to be getting that day. The boys had never heard of the man and no one in the town seemed to know who he was. The boys talk about their new coach all day while they are in school. After school was over that day, the boys went to the baseball field to prepare for their first day of baseball practice. Practice was to start at 3:30. It was 3:45 now, and their new coach hadn’t arrived yet. The boys, along with the rest of the team, waited around for awhile for their coach to come. After waiting for about an hour, they became curious and decided that they would go to Coach Anderson’s house to see why he wasn’t at practice. Craig said that he knew where the coach lived, because he had heard his mother talking on the phone about him. As the boys arrived at the house, they saw that the door was partially open, so they decided to let themselves in since no one answered the door when they knocked. As the boys entered the house, they couldn’t decide on which room they wanted to go in first. They quickly decided on that when they saw a person lying on the floor in the kitchen. The boys quickly ran out of the house and ran to Mike’s house to call the police. When the police arrived to Mr. Anderson’s house, they told the boys that their coach had a heart attack and died. The boys were very upset by this since they had never even met the man. Eventually, the story goes on and the boys get a new coach, but they never really get over what the found that day.   Ã‚  Ã‚  Ã‚  Ã‚  I feel that one of the main characters in this book would have to be Craig. He has black hair, green eyes and is of average height. Craig was just a usual guy until all of this happened to him. He received good grades in school, and was a great student. Craig’s parents were very proud of him and thought that he was the greatest son that anyone could ever have. Craig is a senior at Central High School, and was already crowned Homecoming King.

Research for a Database For a Travel Agents Essay

Introduction I have been given a task to make things easier for a travel agent called Type a Flight. Type a Flight is a travel agent which is situated in Warrington and it was established in 2005 and it also has about 500 customers. The company does all its work manually. They keep their documents in filing cabinets. So when customers call in to book flights then they have to look in the cabinets for a document. This is very time consuming and due to this problem they could loose a fantastic amount of customers because they will get tired on the phone. Filing cabinets also take up a lot of space. This is getting very difficult and time consuming as the number of customers is rising on a daily basis. One of the problems is that it takes time writing letters by hand .For this problem I have come to conclusion that I will create template letters for the company and these can be sent out to customers to tell the customers that their ticket is ready or for any reasons. The conclusion I have come to is that I am going to help the agency in every single way. My main aim is to make the agency more professional and more modern and make things easier for them. For me to do my task, I will need a computer and a few important application softwares with which I shall make a database, logo and other things. Research I had a look at a database which I was shown by my class teacher. It was called ‘Type of Flight’. In the database it had things like name, ID, gender, telephone number. Database: Type a Flight Comment: The logo is located on the centre of the switchboard. The logo is got to do with holidays and other things which the agency offers. Around the logo there are the buttons which will be needed. The database has things like name, town, address, telephone numbers, date of birth, gender postcode and other few things. The database makes things easier and quicker now. This was done by putting queries, forms and a switchboard. Tasks To do my task I have broke the task into the following five parts: 1. Getting information about the travel agency. 2. Design a logo and a slogan for the travel agency. 3. Create a database, Queries, Forms and switchboard. 4. Create a letterhead and design letter templates. 5. Writing reports at the end (User Guides). 1. Getting information about the travel agency a. I can do this task by going on the internet but I will not do it this way because on the internet it will not tell you how the agency works. b. I can also do this task by going around and asking a few people but will not use it because people might not have the correct and up to date information. c. I will do this task this by ‘Interviewing the agency manager’ because he will know the latest information and what problems there are in the agency. 1. What problems do you have in the agency? 2. How many customers does the agency have? Less than 100 100-250 250-500 More than 500 3. How are the documents of the customers stored? Filing Cabinet Other 4. What do you think of a computerized way to remove your problems? 5. Do your employees know how to use Microsoft Access? Yes No Do not know 6. Are your employees capable of using a switchboard? Yes No Do not know 7. Does the agency have letter templates? Yes No 8. Does the agency have a good logo? Yes No 9. Do the employees need a user guide? Yes No 10. What changes will the agency have if the computerized way was used? 2. Design a logo and a slogan for the travel agency a. I can do this task by using Microsoft Word but will not do it this way because it does not have many of the tools needed to make a logo but I can make the slogan on it. b. I can also do this task by using Adobe Photoshop but will not use it because the application is quite complicated for me. c. I will do this task this by using ‘Paint’ because It offers a good amount of tools which can be used to make a good logo and a slogan. 3. Create a database, Queries, Forms and switchboard a. I can do this task by using pen and paper but will not do it this way because it will be time consuming and many mistakes can be made. b. I can also do this task by using Open Office Base but will not use it because it is harder to use than Microsoft Access. c. I will do this task this by using ‘Microsoft Access’ because I can make databases, Queries, Forms and switchboards more quicker because I have used it many times before. 4. Create a letterhead and design letter templates a. I can do this task by using Microsoft Publisher but will not do it this way because it is a little hard to create a letter template but a letterhead can be produced easily. b. I can also do this task by using Paint but will not use it because it is not suitable for large amount writing. c. I will do this task this by using ‘Microsoft Word’ because this application is good for making letterheads and letter templates as it gives a step by step way of making it. 5. Writing reports at the end (User Guides) a. I can do this task by using WordPad but will not do it this way because it is not possible to put in arrows to make things clearer to people. b. I can also do this task by doing it on paper and there after scan it but will not use it because it may not be neat and professional enough. c. I will do this task this by using ‘Microsoft Word’ because I can take screen shots and then I can paste them onto the page. There after I will put in arrows and any other things if needed to label it clearly with information so that people fully understand. Input, Output, Process and Storage After my research and looking at the various tasks, I can establish what the input, output and storage of the system is. Ease of use The final product that I will make would consist of database, queries, forms and letterheads. It would be easy for the agency to use because I think the employees are more or less familiar with computers and using the applications needed. I will also supply them with a user guide. The user guide will be simple and very easy to use. It will have screenshots and clear labeling with arrows so if the employees get stuck any where then they could refer to the user guide which has clear instructions and easy step by step of using any application. After using the user guide the employees should have no doubt in using an application. Description of problem = 1 Plan of solution = 1 Methods = 1 Solution meets requirement = 1 Ease of use = 1

Current Issues in Nursing Essay Example

Current Issues in Nursing Essay Example Current Issues in Nursing Essay Current Issues in Nursing Essay Ph. D. and Ann L. Curley, Ph. D. , R. N. The challenges of operating 24/7, focusing on scheduling, training, and staffing. Despite projections that nursing is one of the top ten growth jobs for the next 15 years, our health care system is on the verge of an overwhelming nurse shortage and health care crisis. Adding to the problem is the fact that hospitals and many other health care facilities are extended hours operations that face unique challenges unknown to the 9-5 world. Hazards for nurses discussed in the book: * Health care shows the second highest turnover rate of all â€Å"extended hours† industries * Nursing is one of the ten industries with the highest levels of occupational injury or illness requiring days away from work. * The most prevalent injuries in nursing are musculoskeletal disorders and needlestick injuries. In 89% of needlesticks, the needle was contaminated. * Work related fatigue prompted nearly 20% of nurses to cite â€Å"having an accident while commuting back home† as one of the top three jobs related health and safety risks. * Nurses show high instances of sleep disorders severely affecting productivity. * High failure and short staffing severely affect quality of patient care. ?Problems With Nursing Informatics By: Heidi Cardenas Informatics is the process of advancing in a discipline with a combination of data, information and knowledge. Nursing informatics encompasses the devices, machines, resources, and methods of utilizing information, computers, and nursing science in nursing. Its a recognized specialty for registered nurses, but does present challenges that academics and medical practitioners are working to improve or eliminate. Significance * In 2007, the Healthcare Information and Management Systems Society Nursing Informatics Awareness Task Force estimated that 50 percent of a nurses time is spent on documentation. Because of explosive strides in information technology and the huge body of medical knowledge amassed, controlling medical errors and health care costs are paramount in the health care professions, including nursing. According to RN Journal, handwriting on a piece of paper has been largely replaced by reports from medical devices at the point of care, and nurses have to master electronic documentation. Function * Nursing documentation is complex and situation-dependent. With different technology and medical charting methods in use, consistent education and training on documentation is difficult to achieve, especially electronically. Considerations * There is no single device that generates a comprehensive patient record, stores it and makes it accessible to care providers in different locations. Bar codes on medicines, computerized physician order-entry, automated scheduling systems for nurse administrators, nursing student preparation for IT tools and HIPAA concerns are just a few of the problems in nursing informatics. Potential * Mobile devices, communication technologies, efficient applications, and enhanced workflow and documentation will be the norm going forward and in the future. Ideally, every nurse would learn a universal IT platform for all patient care, but that is an almost unobtainable goal with the rapid advances in research, medicine and information technology. One thing is certainnursing and information technology are integrally intertwined and will remain so in the future. ? Occupational Health and Safety Issues Among Nurses in the Philippines By: A. B. de Castro, PhD, MSN/MPH, RN, Suzanne L. Cabrera, MN, RN, Gilbert C. Gee, PhD, Kaori Fushijiro, PhD and Eularito A. Tagalog, RN, COHN Abstract * Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety. ?The National Nursing Crisis: 7 Strategic Solutions By: Jaime Z. Galvez Tan M. D. , M. P. H. Introduction At the rate we are losing monthly our highly skilled nurses to the United States, the United Kingdom, Ireland and the Netherlands, and with the Philippine government, via the Department of Health raising its hands in helplessness, offering no strategic solutions in sight, expect a worsening of the health crisis already plaguing our country. It is not only the nurses the country is losing, our medical doctors are now enrolling in nursing schools offering an abbreviated course for doctors to become nurses. ? Ethical Dilemmas in Nursing By: Jenifer Wilson-Barnett Abstract. Nurses are increasingly realizing that they can offer relevant information and participate in decision-making involving ethical issues. However, inter-professional communications are frequently inadequate, and do not permit exchange of opinions. The consequences are often frustrating and upsetting for nurses whose care is affected by others policies. ? Unemployment * The Professional Regulation Commission estimates the number of jobless Filipino nurses to hit 298,000 this year, to include the 68,000 who took the local licensure exam in December. ? RN Heals Department Order No. 2012-0184 (DO 2012-0184). * The Order speaks of the following interesting points: * RNheals nurses are not ‘employed’ but rather are intended for learning and development. Nurses under the program are not regular employees but pre-service trainees. They are given stipend/allowances not salaries. * RNheals 4 tour of duty will be from January to December 2013. Nurses will be assigned in DOH Hospitals (Hospital Setting) or Rural Health Units (Community Setting). Stipend/allowance for RN Heals 2013 is still 8,000 per month with PhilHealth and GSIS Insurance. * Nurses are to be awarded with Certificate of Completion after satisfactorily completing the RNheals program. * RN Heals 4 Recruitment and selection period will be from October 29, 2012 to November 2012. * Application forms shall be submitted directly to CHDs for community setting and DOH Hospitals for hospital setting. * ONLY NURSES WITH PRC LICENSE are eligible to apply. * Nurses who have previously engaged in RNHeals are not qualified to re-enter the project. * In case of absences, a fixed amount of Php 363. 00 per day shall be deducted. * Stipend shall be given on or before every 10th and 25th day of the month. * Eight training hours per day shall be completed by the nurse.