Find the equation of the tangent plane to the surface S having equation X^2y^3z^4=72 at the point (3,2,1)
(do not open the parentheses. Hint: the surface S is a level surface of the function f(x,y,z)-x^2y^3z^4)
A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?
A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?
A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of antipsychotic medication
C. Risk for injury related to a severely decreased level of consciousness
D. Risk for injury related to electrolyte disturbance
Go to the McDonalds website: www.mcdonalds.com. Explain how McDonalds uses the marketing mix (aka the 4 Ps). In your discussion: 1) list each of the 4 Ps, 2) give an example of how McDonalds uses each element of the marketing mix, 3) describe who you think their targeted customer (i.e., target market) is for each example, and 4) the strategy they employ to satisfy the needs and wants of the customer in the example you gave.
Be sure to use appropriate course concepts and terminology in your answer. Type your response in Word and submit it to the drop box prior to the deadline.
Surgical Plume PICOT
While smoking in and around most hospitals and medical facilities is prohibited, surgical smoke from electrical cautery units remains to be an inhalation health peril in the operating room. The surgical smoke, or plume, is associated with chemical, respiratory, viral, carcinogenic, particulate, mutagenic, cytotoxic, and bacterial hazards harming all surgical team members. Recent studies and increased research on surgical plume impacts show the risk can be greatly reduced using surgical smoke evacuation devices with electrosurgical and/or laser procedures (Don’t choke back the smoke, 2017). The purpose of this paper is to extensively explore the issue of surgical smoke inhalation in the operating room and present the PICOT question regarding surgical plume.
Definition
Electrosurgery is an essential tool in an orthopedic surgeon’s repertoire, being used in every total knee joint replacement surgical procedure. It is used both to cut tissue, and to control bleeding by coagulating the blood vessels. The electrocautery procedure involves administering a high-frequency electric current through the target tissue, causing its temperature to increase (Karjalainen et al., 2018)
When tissue vaporizes from using energy-generating devices, such as lasers or electrosurgery units, intracellular temperatures are raised above 100°C generating surgical smoke (York & Autry, 2018). According to Manchester (2018), “surgical plume results from the vaporization of cells through absorption heating, when energy-based devices such as lasers, diathermy and ultrasonic devices are used” (p. 30). While many regulatory agencies concur surgical smoke is dangerous, commitment to creating a firm-standard addressing the inhalation dangers related to surgical plume has been slow. Clear evidence supports the need to filter surgical smoke and help protect the estimated 500,000 health care workers in the United States being exposed to these menacing fumes
(York & Autry, 2018).
Epidemiology
Surgeons Choice Medical Center is an acute care medical facility located near Detroit, MI. The medical center’s surgery department consists of four operating rooms on the fifth floor, performing various surgical procedures 52 weeks out of the year. The surgery department works from 0700 until 1700 Monday through Friday, with total knee joint replacement surgeries being performed on Mondays, Tuesdays, and Wednesdays. Roughly 15 total knee joint replacement procedures are performed weekly, for a total of 750 surgeries yearly where surgical staff are exposed to plume created during these surgeries. The surgical staff present in the operating include the circulating registered nurse (RN), the surgical technician (ST), the certified surgical first assistant, (CSFA), the certified registered nurse anesthetist (CRNA), and the physician’s assistant (PA).
Electrosurgical cautery, known to generate surgical plume, is used during every total knee joint replacement surgery without any type of smoke evacuation device. The surgical plume produced from electrocautery usage circulates throughout the operating room air, being inhaled by all surgical team members present. Surgical smoke causes technical, physical, and occupational health problems through aerosol particles created by evaporation of tissues through electrosurgical cautery (Karjalainen et al., 2018). The major risk factor with surgical smoke inhalation is failure to utilize any type of smoke evacuator while electrocautery creates plume.
Schultz (2014) discusses the risks of inhaling surgical plume. Research studies demonstrate transmission of human papilloma virus from inhaling plume. Increased incidence of respiratory illnesses has been shown among perioperative nurses. Additionally, the presence of plume by-products, claimed by the National Institute for Occupational Safety and Health to be mutagenic and carcinogenic, are known to cause cancer.
Clinical Presentation
The heating effect of electrosurgical cautery used during total knee joint replacement procedures is controlled by the waveform of the current. A rapid increase in temperature is caused from a low-voltage, high-frequency current, where the tissue quickly evaporates, and the surgeon can expeditiously cut through the tissue. Conversely, a high-voltage, low-frequency current produces a more gradual heating effect, where denaturing of the proteins in the tissue causes coagulation and occlusion of the blood vessels.. The evaporation of the tissue from the current generates plume of smoke, referred to as surgical plume.
Research studies indicate sizeable differences in particle production from various types of tissue during electrosurgery. Tissues can be divided into three different groups depending on their particle emissions. The liver consists of high-particulate emission (PM) tissues. Medium-particulate emission (PM) tissues can be found in the renal cortex, renal pelvis, and muscle. The third group is low-particulate emission (PM) tissues found on skin, cerebral gray matter, cerebral white matter, bronchus, and subcutaneous fat. The clinical importance of these findings is translated into protective measures used by surgeons and surgical staff who extensively utilize electrosurgery, as with total knee joint replacement surgeries.
Smoke evacuation devices are advised, particularly for high-PM and medium-PM tissue surgeries (Karjalainen et al., 2018)
.
The real danger of inhaled smoke is the nanoparticles, comprising 80% of surgical smoke, as revealed by environmental health literature. Also called “ultrafine particles,” nanoparticles are less than 100 nanometers (nm) in size, with those between 20 and 80 nm not well phagocytized by alveolar macrophages when inhaled. The ultrafine particles are then capable of crossing the alveolar membranes through translocation and compromising the respiratory system (Schultz, 2014).
Complications
Surgical smoke, or plume, contains toxic vapors and gases, harmful to patients and perioperative team members, as the smoke is not suitable for humans to breathe. Identified chemical contents of plume include volatile organic compounds, polycyclic aromatic compounds, aldehydes, phenol, carbon monoxide, cresols, and hydrogen cyanide. Anemia, dermatitis, headache, hypoxia, nasopharyngeal lesions, nausea or vomiting, and eye irritation are just some of the additional negative health side-effects
(York & Autry, 2018). Manchester (2018) discusses symptoms reported by staff from inhalation of surgical plume as nausea, double vision, headaches, fatigue and numerous respiratory problems.
Diagnosis
While many regulatory agencies concur surgical smoke is dangerous, commitment to creating a firm-standard addressing the inhalation dangers related to surgical plume has been slow
.
Incorporating smoke-evacuating devices into operating rooms is a costly financial decision involving managers and surgeons, along with the entire surgical team. Based on the premise all smoke is dangerous to breathe, a commitment should be made prioritizing employee health and well-being to achieve the six standards of quality healthcare measurement supporting the patient safety movement (York & Autry, 2018). Under OSHA’s Occupational Safety and Health Act of 1970, employers must provide a safe and healthful workplace (York & Autry, 2018).
Schultz (2014) confers, “smoke capture is the ability to gather the plume produced during a surgical procedure and route it to a collection site” (p. 290). Numerous barriers exist to becoming smoke-free in the operating room. Obstacles were identified as surgeon refusal to use smoke evacuator equipment, equipment not being available or too noisy, smoke evacuator consumables not being quickly available, and staff being complacent about use of smoke evacuator equipment (Manchester, 2018).
Conclusion/ PICOT
The contents of surgical smoke are comparable to the contents of air pollution and cigarette smoke, noxious and possibly deadly. Clear evidence supports the need to filter surgical smoke and help protect the estimated 500,000 health care workers in the United States being exposed to these menacing fumes in the operating room (York & Autry, 2018). Focused foreground questions are the key to properly finding the right answers to clinical inquiries, such as surgical plume (Melnyk & Fineout-Overholt, 2015). Using the PICOT format, the question is posed; In surgical staff involved in total knee joint replacement surgeries using electrosurgical cautery in the operating room at Surgeons Choice Medical Center (P), does the use of a smoke evacuation device (I) compared to not using a smoke evacuation device (C) decrease respiratory system ailments, nausea, and headache (O) over a one-year time period (T).
References
My Health Promotion is related to educating Adults about the risk of being Obese who live in Columbus Ohio. I would like to promote dancing / aerobic classes throughout Columbus for the under privilege adults to attend.
Must use APA 6th edition format, 3 references for each topic / cited in the text. Must use scholarly nursing journals in the last 5 yrs, 250 words per topic. Please keep each topic separated.
Topic 1: Quantitative Evaluation Plan
1. Discuss quantitative data you would collect to evaluate the effectiveness of your health promotion initiative. How would this data demonstrate effectiveness and who would you share the data with?
2. Support your choices though integration of research terminology and include at least source of Evidence-Based Proposal (EBP) which used a method similar to your proposed quantitative evaluation.
Topic 2: Quantitative Evaluation Plan
1. Discuss qualitative data you would collect to evaluate the effectiveness of your health promotion initiative. How would this data demonstrate effectiveness and who would you share the findings with?
2. Support your choices though integration of research terminology and include at least source of EBP which used a method similar to your proposed qualitative evaluation.
My Health promotion initiative: See below
The information gathered should be organized into a formal research proposal. It should be communicated in an effective manner to the stakeholders, but government agencies, advocacy groups, institutions, fellow researchers, and the media should be considered as well (Houghton, Casey, Shaw, & Murphy, 2013). Communication for each should be designed and tailored according to need and the group that it is being presented to. Psychographic considerations should be made. Communication should be made in a competent, confident manner that reflects the research team’s dedication, hard work, and results. Descriptive analysis and making use of narratives and participant testimonials may be beneficial to describe the need for the proposed change. The message should be framed in different ways to capture the understanding and recognition of as many as possible. Active dissemination strategies should be implemented. Educational outreach is important and both patients and health care organizations should receive the proposed information (Bryant et al., 2010).
For my proposal, I am seeking to introduce dance aerobics to underprivileged community members in urban Columbus, Ohio who are considered obese. Reaching this demographic poses several challenges, the first of which is literacy. Utilizing radio and television time to advertise this initiative may be beneficial for community members who cannot read. Accessibility to advertisements is also an issue that should be considered. Easy to read and attractive looking flyers may be distributed at bus stops, train stations, and other places of public transportation. Flyers may also be posted on bulletin boards at local libraries. I also plan to meet at individual hospitals to discuss and plan to have these activities sponsored and housed. The use of social media should also be implemented as it has the potential to reach a large local demographic (Peate, 2013).
I will also plan meetings with my stakeholders including endocrinologists and obesity clinics to discuss plans of implementation. Communication for each should be designed and tailored according to need and the group that it is being presented to. Psychographic considerations should be made. Communication should be made in a competent, confident manner that reflects the research team’s dedication, hard work, and results (Bryant et al., 2010).
I plan to use a variety of communication techniques such as radio, television and flyers to educate the community regarding the proposed program. To communicate with key stakeholders, I will use power point presentations, lecture notes, and handouts to spread the message of my proposal. These materials will be supported with peer-reviewed articles and research studies. Continuous exposure is key to ensuring that the message is effective and reaches the targeted population (Callejo & Geer, 2012) .
References
Bryant, C. A., Courtney, A. H., McDermott, R. J., Alfonso, M. L., Baldwin, J. A., Nickelson, J., . . . Zhu, Y. (2010). Promoting physical activity among youth through community-based prevention marketing. Journal of School Health, 80(5), 214-224. doi: 10.1111/j.1746-1561.2010.00493.x
Callejo, F., & Geer, L. (2012). A community-based approach to disseminate health information on the hazards of prenatal mercury exposure in Brooklyn, NY. Journal of Community Health, 37(4), 745-753. doi: 10.1007/s10900-012-9575-7
Houghton, C., Casey, D., Shaw, D., & Murphy, K. (2013). Rigour in qualitative case-study research. Nurse Researcher, 20(4), 12-17.
Peate, I. (2013). The community nurse and the use of social media. British Journal of Community Nursing, 18(4), 180-185.
Oxidative stress is implicated in the pathogenesis of atherosclerosis and myocardial infarction. Moderate alcohol consumption has various favourable metabolic changes. In this study Malondialdehyde (MDA) levels and activities of enzymatic antioxidants namely superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) were determined in 120 non smoker healthy males with self reported daily consumption of 90ml or 120ml of whisky and rum. 30 non smoker healthy males with no history of alcohol consumption were taken as controls. The result shows significantly elevated levels of MDA (p<0.0001) in participants consuming 120ml of whisky (6.4±2.2nmol/ml) and 120ml of rum (6.7±2.0nmol/ml) compared to those consuming 90ml of whisky (3.8±2.0nmol/ml) and 90ml of rum (3.9±1.9nmol/ml). While the activities of enzymatic antioxidants were significantly increased (p<0.0001) in participants consuming 90ml of alcohol (whisky/rum) compared to those consuming 120ml of alcohol (whisky/rum). Alcohol consumption is associated with dose dependent increase in lipid peroxidation. Moderate alcohol consumption induces defensive antioxidant enzymes; this explains the increase in activities of enzymatic antioxidants in 90ml alcohol consumers. Thus study concludes that consumption of 90ml of alcohol (whisky/rum) in a regularly exercising, non smoker will increase the enzymatic antioxidants. This will lead to reduced oxidative stress which might be the reason for eventual decrease in the risk of cardiovascular disease.
Keywords: Alcohol consumption, oxidative stress and enzymatic antioxidants.
Alcohol consumption on a regular basis and at low volumes that is two standard drinks daily for men which amount to 88.8ml, will provide protection against cardiovascular disease. Whereas regular large consumption in amounts that is more than four to five standard drinks daily which amount to 177.6ml to 222ml daily and heavy episodic drinking of more than four standard drinks are associated with detrimental results.
1-6
Alcohol metabolism leads to generation of free radicals causing oxidative stress and increased lipid peroxidation (LPO), which is dependent on the dose of alcohol consumed, these free radicals generated have shown to induce enzymatic antioxidants like superoxide dismutase (SOD), glutathione peroxidase (GPx) and Catalase (CAT) in animal studies.
7,8
Thus the present study was undertaken to evaluate the effect of moderate alcohol consumption on oxidative stress.
150 non smoker participants aged 35-55 years with history of regular 30 minutes exercise per day (or equivalent) were included in the study, out of which 120 participants were consuming alcohol daily. They were divided equally into four groups depending on the type and quantity of alcohol consumed into Group I A (90ml whisky), Group I B (90ml rum), Group II A (120ml whisky), Group II B (120ml rum). 30 healthy age matched participants with no history of alcohol consumption served as controls.
Ethical clearance from the institute’s ethical committee was obtained. Informed written consent was taken from all the participants. The study was conducted in Department of Biochemistry, Belagavi Institute of Medical Sciences, Belagavi.
Exclusion criteria: Participants with history of diabetes mellitus, hypertension, tobacco smokers, tobacco chewers. Participants consuming vitamin and antioxidant supplements and subjects with acute infection and inflammatory disorders were excluded from the study.
5ml of 12 hours fasting venous blood sample was collected under aseptic precaution from the anticubital vein of all the participants. 2ml of the sample was taken in a plain bulb for estimation of MDA levels and 1ml of the sample was taken in EDTA bulb for estimation of activities of enzymatic antioxidants.
Serum MDA levels were estimated by method of Satoh K.
9
Activities of enzymatic antioxidants were measured immediately after preparation of hemolysate by using kits from randox laboratories, Ransod for SOD and Ransel for Gpx.
10,11
Catalase activity was estimated by Aebi H method.
12
The activities of SOD, GPx and Catalase were expressed as U/ml of hemolysate, U/L of hemolysate and catalase units respectively. One catalase unit is mM of H
2
O
2
decomposed /mg Hb/min.
All values are expressed as mean ± SD. Ordinary one-way ANOVA test was employed to test significance between the variables.
The consumption of alcohol was self reported by participants.
Table 1 shows comparison of estimated parameters, between controls and participants consuming alcohol and also comparison between the groups consuming alcohol. (Group IA- 90ml whisky, Group IB- 90ml rum, Group IIA- 120ml whisky and Group IIB 120ml rum).
Table 1: Showing comparison of estimated parameters in controls and participants.
|
Parameters |
Controls (n=30) |
Group IA (n=30) |
Group IB (n=30) |
Group IIA (n=30) |
Group IIB (n=30) |
|
MDA (nmol/ml) |
5.8±2.4 |
3.8±2.0 |
3.9±1.9 |
6.4±2.2 |
6.7±2.0 |
|
SOD (U/ml) |
165.2±24.3 |
199±28.9 |
197.3±27.3 |
160.5±19.5 |
157.2±16.8 |
|
GPx (U/L) |
8005±1514 |
9290±625 |
9195±764 |
7507±1087 |
7368±1012 |
|
Catalase (catalase units) |
35.3±4.6 |
49.4±8.7 |
48.6±8.6 |
34.0±5.5 |
37.9±11.0 |
*
p <0.0001,
#
p<0.001= significant, n= Number of participants, all values are expressed as Mean ± Standard deviation.
The results from the table show significantly lowered MDA levels in participants of group IA/IB when compared with control participants. No significant difference was seen between participants of group IIA/IIB and control participants. MDA levels were significantly higher in group IIA/IIB compared to group IA/IB.
Activities of enzymatic antioxidants (SOD, GPx and CAT) were found to be significantly increased (p<0.0001) in participants of group IA/IB when compared to controls. No significant difference was observed when above parameters were compared between participants of group IIA/IIB and control participants. Group IA/IB showed significantly increased (p<0.001) activities of enzymatic antioxidants compared to group IIA/IIB.
There was no significant difference in estimated parameters when compared between group IA and IB, similarly no significant difference was noted between group IIA and IIB.
Serum MDA is a widely used marker for lipid peroxidation. The mean MDA value was found to be significantly increased (p<0.0001) in both groups of participants consuming 120ml of alcohol, when compared to those consuming 90ml of alcohol (Table 1).
These findings agree with study conducted by Akkus et al (1997) reveals that LPO in the drinkers (measured in terms of MDA) was found to be significantly increased compared to that of controls and was dose dependent.
13
When moderate amount of alcohol is metabolized, it will produce free radicals, in quantity enough to induce synthesis of enzymatic antioxidants as described in different animal studies by Dinu D et al (2005), Gülçin Aykaç et al (1985) and Hurley et al (2012).
14,15,16
The findings of present study shows that in non smoking individuals consuming 90 ml of alcohol (whisky or rum) MDA is not significantly increased due to significant elevation of antioxidant enzymes. As the dose of alcohol increases LPO will increase as seen in this study where MDA levels were higher in participants consuming 120ml alcohol.
In the present study the activities of enzymatic antioxidants (SOD, GPx and Catalase) were significantly increased (p<0.0001) in both groups of participants consuming 90ml of alcohol when compared to control participants. Significant increase (p<0.0001) was noted in participants consuming 90ml of alcohol on comparison with both group of participants consuming 120ml of alcohol.
Montoliu C et al (1994) and Grasselli E et al (2014) in their study they noted significantly enhanced levelsof superoxide dismutase and catalase activities in moderate alcohol consumers compared to MDA levels.
17,18
Another study by Lecomte, et al (1994) revealed that the activities of enzymatic antioxidants were elevated in study group consuming around 59±25.7g of ethanol per day, but as the dose of alcohol (>80g of ethanol) increased the MDA levels increased and activities of enzymatic antioxidants decreased.
19
The study suggests that increase in the activities of enzymatic antioxidants in participants consuming 90ml alcohol may neutralize the free radicals thereby protecting the biomolecules from free radical injury. However, the activities of enzymatic antioxidants were not significantly increased in participants consuming 120ml of alcohol. These findings may suggest that in participants consuming 120ml alcohol the enzymatic antioxidants are used up to neutralize the substantial amount of free radicals generated. From the results it is evident that consumption of 90ml of alcohol significantly increases the activities of enzymatic antioxidants on comparison with control participants and those consuming 120ml of alcohol. Once the balance of oxidative stress is in the favor of anti oxidants, excess free radicals are neutralized preventing biomolecules from oxidative damage.
Daily consumption of 90ml alcohol (whisky/rum) in non smoker individuals will increase the activities of enzymatic antioxidants and thereby reduces oxidative stress.
Acknowledgement:
The authors would like to express their sincere thanks and gratitude to the study subjects and controls for their participation.
According to the psychological perspective and research, how can early childhood stressful experiences (e.g., neglect, abuse, or lack of a secure attachment) influence the developmental of behavioral problems?
Next, referring directly to the textbook, briefly explain all three elements of the integrated model.
Last, select one form of an anxiety disorder and explain how one of the elements of the integrated model can be used to explain the origins of that disorder. Anxiety disorders to choose from include generalized anxiety disorder, panic disorder, social anxiety phobia, specific phobia, separation anxiety disorder, selective mutism, and agoraphobia.
Student 1
Michelle Roof
Email has been sent.
7/2/2016 10:58:33 AM
Unit 5 disc, specific phobias
Professor and Class, So far in the textbook by Durand and Barlow (2013), there has been a lot focused on a person’s vulnerability along with the feeling for not being in control. How a perShow More
Professor and Class,
So far in the textbook by Durand and Barlow (2013), there has been a lot focused on a person’s vulnerability along with the feeling for not being in control. How a person deals with the uncontrollable aspects of the world can originate in their childhood. It is during our childhood that the awareness of chaos that we exist in if first understood. How a child deals with this realization and learns to cope with it comes from how they were raised, from their parents (Durand & Barlow, 2013). A child could grow up believing that they have complete control and have confidence in that belief or grow up with uncertainty that manifest when trying to figure out how they will deal with upcoming events (Durand & Barlow, 2013). It is the children who grow up in a secure environment where they are allowed to explore their world and learn to cope with unexpected situations are able to feel like they are in control (Durand & Barlow, 2013). However, if the children are overprotected and not allowed to meet adversity and bet it will not have those skills and will have anxiety later in life (Durand & Barlow, 2013). Growing up in an abusive environment may have the same effects as those who grow up overprotected. The child learns that nothing is within their control, and every situation can become dangerous.
The three elements that make up the Integrated Model are: generalized biological vulnerability, generalized psychological vulnerability, and specific psychological vulnerability (Durand & Barlow, 2013). The generalized biological theory is the vulnerability that is inherited that contributes to negative affect. Generalized psychological vulnerability is the generalized helplessness that exists within the person in every situation. The specific psychological vulnerability is the physical situation that causes weakness because of past experiences or the person was taught that certain situations are dangerous (Durand & Barlow, 2013).
Women and Other Cultures in the Workforce
After reading the text and articles about the historic struggles of women in the workforce, identify three issues that remain today for women. Then choose one group that was discussed in this week’s readings and identify the additional issues this population faces. What are some ways to reduce the impact of the issues you have identified?
Response Guidelines
Respond to at least two of your peers’ posts regarding women, including your perspective on women’s non-dominant status. Do you agree with their assessment of the issues and ways to reduce the impact?
First Peer Post
Issues today for women
Three issues that remain today for women are sexual harassment, inequality in the workplace, and then effects of gender stereotypes. Unfortunately, today women are still portrayed in ways to be objectified through the media and that culture is also introduced into the workplace resulting in many sexual harassment accusations. According to the text, more than 50% of women will experience sexual harassment in their jobs (Zunker). Women also still experience high levels of discrimination today. For many valid reasons, women continue to earn less than men. One reason can be the result of gender stereotypes where women accept roles in lower status occupations such as secretaries, teachers, and child care workers (Zunker).
Issue of the Hispanic population
Another group marginalized group to consider in the workplace is the Latino/a or Hispanic population. Of the many issues that this population face, two that I will discuss is lack of opportunities and socioeconomic status. The Hispanic community is currently the largest minority group in this country according to Zunker and youngest and fastest growing according to Zalaquett & Baez,(2012). Statistics report that Latino’s employ 15% of the United States Labor force but over represent in blue-collar, unskilled jobs which classifies them as the lowest weekly earning group when compared to other groups. There is a host of literature that discusses the lack of counseling services used in the Hispanic community, mental health and academic. These underused services reduce the amount of information made available to meet the needs of their community leaving them at a disadvantage. Strengthening education for this group may increase bilingual education, encourage higher education, job searching skills, and expose them to a host of opportunities that is sure to increase the advancement of this population (Zalaquett & Baez, 2012).
References
Zalaquett, C., Baez, J. (2012). Career counseling with Hispanics/Latinos/as. Career Planning and Adult
Development Journal, 28(1), 57-71.
Zunker, V. G. (2016). Career counseling: A holistic approach (9th ed.). Boston, MA: Cengage Learning. ISBN:
9781305087286.
Second Peer Post
Current Issues Faced by Women in the Workforce
A variety of factors continue to negatively affect women in the workforce. These factors are culturally ingrained societal beliefs that have slowly evolved over time, but continue to fall short of equality. Individual and societal views about appropriate occupations for males and females perpetuates the issue of gender stereotyping (Zunker, 2016). Social theorists point out the effects of gender socialization on women, and view its influence as partly responsible for a higher proportion of females in certain professions, i.e. teaching and nursing (Pässler, Beinicke, & Hell, 2014). Women are often expected to work and play a major role in childrearing and homemaking functions, and as a result may experience extreme fatigue and burnout. Though much progress has been made, sexual harassment and income inequality continue to prevail, negatively impacting women in the workforce.
Additional Issues Faced by Native Americans
The Native American population presents with unique issues related to their participation in the workforce. Native Americans who reside on reservations are often physically isolated in remote areas, with few local vocational opportunities. Due to years of racial oppression, many Native Americans lack confidence in their abilities, have low vocational expectations, and underestimate their skills and abilities (Flynn, Duncan, & Evenson, 2013). English as a second language could present a barrier for Native Americans whose traditional language is their primary language. Due to the importance of wakes, rituals, and celebrations in Native American culture, tribal members may place more importance in these events than in adhering to Euro-American work structure or schedule. Additionally, collectivistic family needs tend to trump other individual responsibilities, making flexibility in the work place important for Native Americans.
Strategies for Reducing the Negative Impact of These Issues
Several strategies could be incorporated to aid in the reduction of the negative impacts of culture and gender. Professionals must constantly engage in personal cultural self-awareness as a first step in providing culturally competent counseling services. Lee (2012) views this awareness as foundational, and emphasizes the importance of self-exploration and self-evaluation in growth towards positive cultural development. Counselors could help to increase client awareness of societal and cultural oppression in an effort to normalize their experiences and provide a starting place for moving forward. Both client and counselor could actively engage in different cultural activities and experiences designed to expand their awareness and perceptions. Professionals can help clients move past oppressive forces by administering assessment tools that have been appropriately normed to each unique population, thus revealing quality results that can be successfully utilized in case conceptualization and treatment planning. Pässler, Beinicke, and Hell (2014) note the inequity in certain assessment test items, and suggest eliminating those items in an effort to obtain more valid and gender neutral testing results. Finally, by adhering to the American Counseling Association Code of Ethics, counselors better ensure ethically sound and evidence based service delivery.
References
Flynn, S. V., Duncan, K. J., & Evenson, L. L. (2013). An emergent phenomenon of American Indian secondary students’ career development process. Career Development Quarterly, 61(2), 124-140. doi:10.1002/j.2161-0045.2013.00042.x
Lee, C. C. (2012). A conceptual framework for culturally competent career counseling practice. Career Planning & Adult Development Journal, 28(1), 7-14.
Pässler, K., Beinicke, A., & Hell, B. (2014). Gender-related differential validity and differential prediction in interest inventories. Journal of Career Assessment, 22(1), 138–152.
Zunker, V. G. (2016). Career counseling: A holistic approach (9th ed.). Boston, MA: Cengage Learning. ISBN 9781305087286.
Answer
Psychology homework help
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Written Assessment Two -Academic Essay
Assessment Two – Academic Essay
Word Count 3000 words including in text citations
Registered Nurses possess minimum standards of knowledge, skills, attitudes and values that are necessary for them to practice within their scope of practice.
In this assessment item you are required to write an academic essay defining and discussing scope of practice and what this means in the nursing discipline. Your discussion will be supported by analysis of contemporary literature that compares scope of practice of newly Registered Nurses to that of Registered Nurses (RN), Enrolled Nurses (EN), Student Registered Nurses (SRN) Assistants in Nursing (AIN) and other Health Care Worker (HCW) roles. You may choose to discuss this in relation to any other nursing roles you find appropriate.
You are expected to refer to Nursing and Midwifery Board of Australia (NMBA, 2006) guidelines and other legislation to support your discussion. Content must be applicable to the role of a newly registered nurse as outlined by NMBA (2006) competencies for the Registered Nurse. Some suggestions for applicable areas to begin the literature search are provided below.
1. Competency standards
2. Decision making framework for Registered Nurses
3. Guidelines for registration standards for nurses and other Health Care Workers
4. Professional Boundaries
5. Code of Professional Conduct
6. Code of Ethical practice
7. Professional Practice guidelines
8. Reporting of horizontal and lateral violence in the health workplace
9. Continuous Professional Development
10. Occupational Health and Safety responsibilities
It is expected that you will read widely around many of these topics and reference correctly in your paper. Articles used must be relevant to Australian Nursing context and ideally should be less than 5 years old for Journal articles and less than 10 years old textbooks. Seminal works are allowed. Use of websites must be from a reliable source.
Presentation Tips
Please refer to the CQ university policy on essay writing to ensure you meet minimal requirements including APA 6th edition referencing; Font Arial or Times New Roman, size 12.
Submissions to be submitted with the assessment criteria attached and in a word document (.doc or .docx). PDF files (.pdf) will not be accepted as this requires the marker to re format for marking.
More information about academic writing can be found in the links under the support tab on the left hand side of the course Moodle page.
Please attach a marking criteria
Please use a header or footer with name, student ID and page number included
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Evidence Based Practice
Evidence based practice or EBP is a problem-solving method used to make clinical decisions. Utilizing various resources related to the problem being solved, ensuring the best care is being delivered to the patient. EBP doesn’t take just one scenario and determine that to be the gold standard. Instead EBP takes many scenarios that are related to a problem and identifies techniques that were beneficial and techniques that were not advantageous. This in a way helps reinvent the wheel without completely reconfiguring it. Essentially EBP makes patient centered care more efficient and safer. EBP combines the of best investigative evidence with patient values and ultimately improve patient outcomes (Zimmerman, 2017, p.37).
Nursing Profession
Nurses make decisions everyday that affect their patient, many of these decisions are made on the premise of evidence-based practice. Nurses have access to thousands of articles and journals on evidence-based practice and utilize those resources when they decide for their patient. Nurses have the unique ability to make critical thinking decisions and alter the care of their patient if they feel it is in the best interest of their patient. For instance, oxygen therapy is typically ordered by the physician however, a nurse can independently administer a nasal cannula without an order from the physician if their patient is experiencing shortness of breath. This is a perfect example of evidence-based practice because the nurse knows the patient needs oxygen immediately based on evidence acquired related to this complication. Having the knowledge of what will happen if a complication is not addressed immediately has and will continue to save lives every day which makes EBP necessary for the nursing profession. EBP blends the aspects of science and the art of nursing so the greatest patient results are attained, the information that is obtained is analyzed and used to answer questions necessary for patient centered care (Taylor, Lillis, Lynn & Lemone, 2015, p.34).
History of EBP
EBP was not always utilized in nursing or in the medical field, it wasn’t until Florence Nightingale discovered how the environment played a role on wound healing. Florence Nightingale is considered to be the pioneer of EBP and rightfully so considering her service in the Crimean War when she cared for wounded soldiers (Mackey & Bassendowski, 2017, p.51). During this time Nightingale explored the various techniques of effective ways to clean skin. Nightingale discovered that the most efficient way to clean skin is to use hot water and soap, opposed to cleaning skin with cold water and soap (Brower & Nemec, 2017, p.14). This was only the beginning for Nightingale she went on make changes in the way we look at how the environment impacts out patients. She realized that our patients needed to have cleanliness, ventilation, temperature, light, well- balanced diet, to meet the needs of the patient involving the environment they are in (Taylor, Lillis, Lynn & LeMone, 2015, p. 29).
Application of EBP to Nursing Care
Many other theorists impacted EBP in unique ways for instance Hildegard Peplau realized in 1952 nurses must make interventions aimed towards their patients’ personality, living situation, and personal preference (Taylor, Lillis, Lynn & Lemone, 2015, p.29). In addition, Betty Newman made a new connection in 1972 regarding the way stress impacts our bodies ability to heal and made efforts to eliminate stressors for her patients, so they could rest and relax ultimately progressing the healing process. The history of EBP has shown us that with trial and error improvements can be made continuously in the way we think about caring for our patients. The founders of nursing set the stage for all nurses to follow, and with a mindful practice of nursing more advancements can be made to EBP.
EBP and Patient Outcomes
Theorist Ida Jean Orlando compiled the nursing process which is a systematic approach to care for the patient (Taylor, Lillis, Lynn & Lemone, 2015, p.29). The guidelines for the nursing process are as follows: assessment, diagnosis, outcome identification and planning, implementing, and evaluation. Nurses are always assessing their patients to correctly identify if their interventions are being therapeutic or non-therapeutic. When interventions are non-therapeutic nurse can utilize EBP for new ideas on how to care for their patient. As mentioned earlier nurses have access to thousands of online articles and journals that can be used when caring for their patients. When a new nurse begins their first shift on the floor this database helps to guide their thinking in the way they will care for their patient. In addition to Orlando’s model nurses can utilize Maslow’s Hierarchy of needs which is another EBP approach to care for our patients. Maslow’s Hierarchy describes the basic needs every person requires and the priority of each need in comparison to another. The Hierarchy explains there are five levels of needs beginning with the most basic: Level 1-Physiologic (oxygen, water, food); Level 2-Safety and Security (safe environment, clutter free, good lighting); Level 3- Love and Belonging (ability to give and receive love); Level 4- Self- Esteem (feeling good about oneself); Level 5- Self- Actualization (reaching ones fullest potential) (Taylor, Lillis, Lynn & Lemone, 2015, p.60-63). Applying the Hierarchy for the patient can help in many ways but, the most important is involving the patient in their care of plan. When patients feel like they have the right to make independent choices regarding their health care plan they tend to adhere to the medication regiments, and follow-up appointment as well as life-style choices that can increase their overall health.
EBP and Policies
EBP guides the way many policies and procedures are conducted in the health care field and in the way healthcare professionals care for their patients. EBP has helped to decrease hospital acquired illnesses and infections by placing wall hand-sanitizer stations inside and outside patients’ rooms. EBP found the connection with how germs are spread hand to surface and implemented handwashing techniques to kill the germs and limit the spread of infection. Tuberculosis precautions are also EBP, TB is an airborne sickness which is why there is a policy in place that a TB patient must be in a negative air pressure room, so the airborne bacteria doesn’t float around the hospital. In addition to the specialized room, the patient will also have to take medication for at least six months, this is an EBP related to medication administration and the effectiveness of the medication on the bacteria. In addition to the precautions and treatment for TB, a very important policy that was implemented was to use sterile technique to the application of a Foley catheter. After, many patients in various medical care settings received a Foley catheter a urinary tract infection appeared several days after the catheter had been removed. EBP showed that when a Foley catheter is not placed using sterile technique this allows for bacteria to enter the urethra and thus allows for the infection to take place. Policies were then implemented for all Foley catheters to be placed using sterile technique. These are just a few examples of how EBP has influenced facility policies. The advancements in medicine will continue to produce new policies in the healthcare field and many medical professionals will find themselves in a position to change with the times sort to speak.
EBP and Healthcare Professionals
Many healthcare professionals have already found themselves in a position to change with the times. When new policies are implemented the health care professionals are held responsible if the policy is not followed. This is crucial when discussing patient centered care, when research has been conducted and a revelation in medicine has been confirmed. It is mostly likely going to alter the way patients are cared for in the best way possible. With all the technology and the ability to link up various research efforts to find cures for Cancer, AID’s, Parkinson’s, and so forth this allows healthcare professionals to take caring for their patient to the next level.
EBP Related Quality Improvement and Patient Safety
Quality improvement in health care is aimed toward ensuring quality care for every patient regardless of financial status, race, ethnicity, education level and so forth. Quality improvement is directly related to EBP in the way that nurses and medical staff care for the patient. As mentioned earlier there have been multiple policies that have been implemented based on EBP so that falls right in to quality improvements territory. In fact, Quality and Safety Education for Nurses (QSEN) set forth the “goal to prepare nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of their health care system” (Taylor, Lillis, Lynn & Lemone, 2015, p.330). This bridges the gap between EBP, quality improvement and patient safety. When quality improvement makes a discovery, this begins a research project in a sense to see how the information is related, that turns into EBP when we have a focused assessment and evaluation of benefits and disadvantages. The research that was conducted is then put in place as EBP with patient safety at the fore front of the entire process.
EBP Benefits to Nursing
EBP can help new nurses made difficult decisions, influence facility policies, and maintain patient safety. Following the guidelines put in place by the Institute of Medicine and continuing to further personal education can help to prevent life threatening errors or procedures. Nurses have a immediate responsibility to pay attention to new EBP because this could be the difference between a good out come for their patient and a complicated outcome for their patient. In addition, following EBP can help prevent injury to the nurse, for example needle sticks can be prevented by following the policies that are put in place per facility. This simple act of knowing the policy and having the education on what needles to use for procedures can prevent this injury. Patients are in a safer environment when policies and procedures are being followed especially the policies that were put in place based on evidence-based practice.
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