Shouldice Hospital Limited Essay Example

Shouldice Hospital Limited Essay Shouldice is a private hospital founded by Dr. Earle Shouldice in Toronto in July 1945. The hospital started out as a six-room nursing home in downtown Toronto. As demand increased for hernia operations, he expanded the facilities to a capacity of 36-beds, which turned into a 89-bed facility after adding a large wing. Dr. Shouldice devised a method called the Shouldice method to increase the efficiency and the overall experience of the surgery and the post surgery recovery period. The hospital specializes on external hernia cases and will not treat internal hernia patients. The method proved to be a big success. In this case, we will analyze the process flow of the hospital, determine the bottlenecks and finally offer recommendations. Background: Dr. Earle Shouldice is a famous operator for his private method of hernia surgery. Unlike normal methods, his way allowed the patient to walk around right after the end of surgery, and move freely at the end of the day. When the number of patients he had increased, he decided to exploit this by founding his own hospital. He died in 1965, but his hospital continued to grow, and at the end of 1982, his hospital had 6850 operations per year. Analysis: Initially, the hospital sends out a medical questionnaire to figure out whether the patient has hernia. If the patient requires the operation, they were sent a confirmation card for the surgery. However, after initial examination at the hospital, some of the patients were found healthy, so they were also sent back. After the examination, an administrative personnel checks the insurance of the patient. We will write a custom essay sample on Shouldice Hospital Limited specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Shouldice Hospital Limited specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Shouldice Hospital Limited specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Then, a nurse takes blood and urine samples from the patient, and sends the patient to his room. All this is done by 5PM, after which there is an information session regarding the operation. The patients are sent to bed at 9:30PM, and waken up at 5:30AM. The operation takes 1 hour (although the recurring ones take up to 90 minutes, but theyre rare so are not included). The patient then stays in the hospital for 3 more days, but since the resource (nurse, doctor etc) requirements would be low (and are not stated in the case). Shouldice was successful because of the following strategies: 1) Unique and well defined surgical procedure (cannot be varied), 2) Operation and recovery time lower than industry average, 3) Educated, experienced, and efficient surgeons (600 surgeries per year as opposed to 25-50), 4) Lower nurse to patient ratio (reduces costs), 5) Efficient, good quality, and uniform service (dependable), 6) High demand from reputation, 7) Higher pay than union standard for employees, 8) Being selective with patients ensures speed and better outcomes The bottleneck of pre-operation is Insurance check, as shown in Exhibit 2. The second bottleneck is the number of surgeons available to perform surgery and keep patients flowing through the system. Once people have a place in the system, the next wait is for a surgeon to become available. Bottlenecks are both a burden and a blessing in this scenario. We build up a queue because people want the service but we are forced to find a way to alleviate the pressure on the bottlenecks. Recommendations: Simply adding capacity may upset the current balance that exists and lower the quality of the process. If the company would simply expand to add beds or create more hospitals, quality would eventually be lowered because you would be hiring doctors you would have eliminated for the first hospital. One possible improvement to the process would be to minimize idle time of surgeons spend doing anything other than surgeries. Since they are a bottleneck, Shouldice should make surgeons not waste time doing a job that a nurse or someone with a less important role can do. This way throughput rate is lowered because surgeons can get more operations done at the end of the day without affecting the systems balance. Another solution to improve throughput without physically expanding would be to include working on Saturday and Sunday. Shouldice can rearrange its resources to keep the hospital running weeklong. This would alleviate the burden on the bottleneck so that buildup is minimized and more patients are put through the process. One of the major limits to expansion is the number of beds available for patients. Therefore, a possible area of capacity expansion is creating an additional facility where more beds can be put for patients. But  to accommodate the increased amount of demand a bigger kitchen and a dining room would be necessary. Moreover, an additional staff should be hired as long as the amount does not exceed the current staff per patient ratio in order to keep the operational costs from increasing too much. Another limiting factor is the number of doctors. Thus, the more doctors there are, the more patient acceptance will be. However there would be a limit on the amount of additional surgeons hired since each surgeon should at least perform three surgeries a day. Additionally, having a new facility outside of Canada dealing on a different specialty is a good option for capacity in which case a careful analysis should be done to make sure that the successfulness of the additional facility is not lower then the original one. Exhibit 1: The process flow chart is attached. Exhibit 2: Examination ? 17. 5 minutes per patient X 6 ? 20. 57 Patients per Hour Insurance ? 10 minutes per patient X 2 ? 12 Patients per Hour Blood/Urine ? 7. 5 minutes per patient X 2 ? 16 Patients per Hour.

How to Say Sorry and Apologize in Japanese

How to Say Sorry and Apologize in Japanese The Japanese typically apologize far more frequently than Westerners. This probably results from cultural differences between them. Westerners seem reluctant to admit their own failure. Since apologizing means that admitting ones own failure or guilt, it may not be the best thing to do if the problem is to be resolved in a court of law. A Virtue in Japan Apologizing is considered a virtue in Japan. Apologies show that a person takes responsibility and avoids blaming others. When one apologizes and shows ones remorse, the Japanese are more willing to forgive. There are much fewer court cases in Japan compared to the States. When apologizing the Japanese often bow. The more you feel sorry, the more deeply you bow. Expressions Used to Apologize Sumimasen. 㠁™ã  ¿Ã£  ¾Ã£ â€ºÃ£â€šâ€œ It is probably the most common phrase used to apologize. Some people say it as Suimasen 㠁™ã â€žÃ£  ¾Ã£ â€ºÃ£â€šâ€œ). Since Sumimasen 㠁™ã  ¿Ã£  ¾Ã£ â€ºÃ£â€šâ€œ) can be used in several different situations (when requesting something, when thanking someone etc.), listen carefully to what the context is. If you are apologizing that something has been done, Sumimasen deshita 㠁™ã  ¿Ã£  ¾Ã£ â€ºÃ£â€šâ€œÃ£  §Ã£ â€"㠁Ÿ) can be used.Moushiwake arimasen. ç” ³Ã£ â€"è ¨ ³Ã£ â€šÃ£â€šÅ Ã£  ¾Ã£ â€ºÃ£â€šâ€œ Very formal expression. It should be used to superiors. It shows a stronger feeling than Sumimasen 㠁™ã  ¿Ã£  ¾Ã£ â€ºÃ£â€šâ€œ). If you are apologizing that something has been done, Moushiwake arimasen deshita ç” ³Ã£ â€"è ¨ ³Ã£ â€šÃ£â€šÅ Ã£  ¾Ã£ â€ºÃ£â€šâ€œÃ£  §Ã£ â€"㠁Ÿ) can be used. Like Sumimasen 㠁™ã  ¿Ã£  ¾Ã£ â€ºÃ£â€šâ€œ, Moushiwake arimasen ç” ³Ã£ â€"è ¨ ³Ã£ â€šÃ£â€šÅ Ã£  ¾ 㠁›ã‚“) is also used to express gratitude.Shitsurei shimashita. Ã¥ ¤ ±Ã§ ¤ ¼Ã£ â€"㠁 ¾Ã£ â€"㠁Ÿ Formal expression, but it doesnt show as strong a feeling as Moushiwake arimasen ç” ³Ã£ â€"è ¨ ³Ã£ â€šÃ£â€šÅ Ã£  ¾Ã£ â€ºÃ£â€šâ€œ).Gomennasai. 㠁”ã‚ Ã£â€šâ€œÃ£  ªÃ£ â€¢Ã£ â€ž Common phrase. Unlike Sumimasen 㠁™ã  ¿Ã£  ¾Ã£ â€ºÃ£â€šâ€œ), the usage is limited to apologizing. Since it is less formal and has a childish ring to it, it is not appropriate to use to superiors. Shitsurei. Ã¥ ¤ ±Ã§ ¤ ¼ Casual. It is mostly used by men. It also can be used as Excuse me.Doumo. 㠁 ©Ã£ â€ Ã£â€šâ€š Casual. It also can be used as Thanks.Gomen. 㠁”ã‚ Ã£â€šâ€œ Very casual. Adding a sentence ending particle, Gomen ne 㠁”ã‚ Ã£â€šâ€œÃ£  ­) or Gomen na (㠁”ã‚ Ã£â€šâ€œÃ£  ª, male speech) is also used. It should be only used with close friends or family members.

Top 10 Most Stressful Jobs of 2016

Top 10 Most Stressful Jobs of 2016 All jobs have aspects or components that make them stressful- even the ones that don’t seem like very high-stakes occupations. Certain scenarios or times of the year come up and it’s a mad sprint- all hands on deck. Crunch time.  Then there are the jobs that just don’t seem to ever let up. Here are the top 10 most stressful jobs of this year- based on deadlines, public scrutiny, required travel, physical risk, physical demands, environmental conditions, hazards, public interaction, and risk of one’s life. Starting to look pretty good to go into Library Science? 1. Enlisted Military PersonnelMaking less than $30k per year, and constantly risking one’s life, this is one of the most stressful jobs out there.2. FirefighterYour job is starting to look pretty cushy, when you consider that for less than $50k a year, on average, some people have to run into burning buildings on the regular. And you thought that big project was really making you stressed!3 . Airline pilotWith a median income of just over $100k per year, airline pilots are well compensated for the stress of ferrying hundreds upon hundreds of souls around the globe. That responsibility alone is incredibly stressful.4. Police officerMaking just a bit more than a firefighter, based on median income, police officers are also under a great deal of stress and risk of life.5. Event coordinatorEvent coordinators may not risk their  lives or limbs, but they are still the people  left holding the bag when anything- major or minor- goes wrong. If the hors d’oeuvres come out five minutes late- or early- or if the band has the wrong cord to connect their amp, or if there is a typo in the invitations†¦ You name it, they  gets yelled at. These aren’t life threatening stakes, but the stress is almost always at a high.6. PR ExecPublic Relations executives are responsible for the reputations and the fame-level of their clients. They don’t just have to man age logistics, they have to manage perception and public opinion. And that takes a lot of nail biting. Especially when their clients do something that requires the putting out of fires (albeit, of course, not literal fires).7. Senior Corporate ExecIf you’ve made it to the top of your company tree, it’s not all big bonuses and stock options. With every rung up the ladder comes a great deal more pressure. And with pressure comes†¦ you guessed it, stress.8. BroadcasterFor a surprisingly low annual median salary of less than $30k per year, a broadcaster is required to clearly and calmly read the news from a teleprompter often riddled with typos. She must be poised and in control at all times, as all of this happens live. You think public speaking is hard? Try doing it every day on television.9. Newspaper reporterYou won’t make a lot of money, and you’ll have to run headlong into potentially dangerous or volatile situations to get a story. And once you ge t it, you have to race to get it published first. One mistake and you’ll have lost your reputation.10. Taxi driverThis gig is perhaps the least well-paid of the top 10. Taxi drivers have to deal with rude people, drunk people, and people in a rush. Not to mention other lunatic drivers, rush hour traffic, accidents, and weather. Plus they’re stuck in a car. Imagine trying to find a parking space in NYC every time you had to pee!The 10 Most Stressful Jobs In 2016

Reading Response Assignment Example | Topics and Well Written Essays - 500 words - 2

Reading Response - Assignment Example Such is a portrayal of disregard to the innate beliefs of people that require the redrafting of the legislations that govern religion and freedom of worship in the country. Offering bodies for scientific studies is a personal decision that people make in order to foster science. However, forcing a particular group to offer their dead for scientific studies discriminative, human anatomy is similar and those compelling others should take the initiative of enhancing science by offering their own bodies. The article calls for the review of laws that govern the remittance of bodies to museums and scientific institutions in order to grow science. The conflict between science and religion requires effective management in order to ensure that each enjoys relative space for growth. In cases where religion opposes specific scientific operations people must take special deliberations including revision of existing laws in order to limit the extent of the conflicts. Science offers practical answers and solutions to the social problems while religion offers spiritual answers. Both are effective in their own way. The article therefore discusses the contention that a rises when religion and science conflict. Offering human bodies for scientific studies remains contentious to most societies. In the United States, the arguments that American Indians should offer their ancestors’ bodies for scientific studies are rising amid opposition from different quarters. I agree with the ideas in the article. Religion is an instrumental cultural component that influences the lifestyles of people. Religion influences the faith of an individual thus influencing their values. As such, religion remains an important aspect of life. The values and beliefs of people are intricate aspect of their lives that the society should respect and value. This underscores the need for changing the antiques act of 1906 and the archeological resource protection act of 1979 both of which stipulated

Business Risk Management Assignment Example | Topics and Well Written Essays - 1000 words

Business Risk Management - Assignment Example 132). The average of three hundred and fifty dollars they receive is as too low to cater for the needs and demand of their families. Working hours and salaries: Within the last ten months, all the three Apple factories operating in China exceeded both the Chinese legal limits on working hours and the fair labor association standards. The fair labor association allows a maximum of sixty working hours per week, including both standard shifts and paid overtime. According to its survey, the Apple branches in China broke this rule by subjecting its employees to more than maximum working time per week. Though the workers are forced to work over the limits allowed by both the government and the fair labor association, Apple own investigation has shown that most of its facilities located in foreign countries broke legal limits by failing to pay proper overtime wages as stipulated by the law(Sad grove, 2005, p. 338). The fair labor associations found that almost a quarter of Foxconn’s workers do not get the compensation they are owed for unscheduled overtime. Health and safety: Almost half of the employees surveyed, by the fair labor federation, said that they were either experiencing or witnessing some kind of work related accident. Before FLA investigations, Foxconn recorded only accidents that resulted to production stoppages (Pickett, 2006, p. 275). This has for a long time led to torture of many of its workers, who had no one to return to their rescue. Prevention of underage labor: In its 2006 audit, Apple Company placed some of its findings on its website. Its current reports, on breach of labor and human rights including the use of underage workers, indicated that in more than hundred of its facilities, excessive work hours were a common thing and that most of those facilities failed to pay proper overtime wages (Froeb & McCann, 2009, p. 204).

Summary of Balanced Scorecard Essay Example for Free

Summary of Balanced Scorecard Essay Robert S. Kaplan and David P. Norton introduced the balanced scorecard, which supplemented traditional financial measures with criteria that measured performance from the perspectives of customers, internal business processes, and learning and growth. The scorecard enabled companies to track financial results while monitoring progress in building the capabilities they would need for growth. Traditional management systems rely on financial measures, which bear little relation to progress in achieving long-term strategic objectives. The scorecard introduces four new processes that help companies connect long-term objectives with short-term actions. The firsttranslating the visionhelps managers build a consensus around the companys strategy and express it in terms that can guide action at the local level. The secondcommunicating and linkinglets managers communicate their strategy up and down the organization and link it to unit and individual goals. The thirdbusiness planningenables companies to integrate their business and financial plans. The fourthfeedback and learninggives companies the capacity for strategic learning, which consists of gathering feedback, testing the hypotheses on which strategy was based, and making the necessary adjustments. Many companies adopted early balanced-scorecard concepts to improve their performance measurement systems. They achieved tangible but narrow results. Adopting those concepts provided clarification, consensus, and focus on the desired improvements in performance. More recently, we have seen companies expand their use of the balanced scorecard, employing it as the foundation of an integrated and iterative strategic management system. Companies are using the scorecard to: clarify and update strategy, communicate strategy throughout the company, align unit and individual goals with the strategy, link strategic objectives to long-term targets and annual budgets, identify and align strategic initiatives, and conduct periodic performance reviews to learn about and improve strategy. The balanced scorecard enables a company to align its management processes and focuses the entire organization on implementing long-term strategy. At National Insurance, the scorecard provided the CEO and his managers with a central framework around which they could redesign each piece of the companys management system. And because of the cause-and-effect linkages inherent in the scorecard framework, changes in one component of the system reinforced earlier changes made elsewhere. Therefore, every change made over the 30-month period added to the momentum that kept the organization moving forward in the agreed-upon direction. The balanced scorecard provides a framework for managing the implementation of strategy while also allowing the strategy itself to evolve in response to changes in the companys competitive, market environments. The Balanced Scorecard: what is the score? A rhetorical analysis of the Balanced Scorecard Hanne Nà ¸rreklit Accounting, Organizations and Society 28 (2003) 591–619 This article analyses the means by which the authors of the Balanced Scorecard have created that attention. The Balanced Scorecard (BSC) is one of the latest innovations in management. It is a tool of strategic control developed by Kaplan and Norton and described in their 1996 book The Balanced Scorecard. In the business world, the balanced scorecard has engendered great interest internationally. The question of whether this is due to its substance as an innovative and practical theory or simply to its promotional rhetoric is the focus of this paper. The balanced scorecard aims to solve the problem related to the historical nature of the financial measures of accounting systems. It does so by integrating financial and nonfinancial strategic measure variables in a cause-and effect relationship which assumes the following: measures of organizational learning and growth, measures of internal business processes, measures of the customer perspective, financial measures. The assumption tha t there is a cause and- effect relationship between the suggested areas of measurements is essential because the measurements in non-financial areas make the performance measurement system a feed-forward control system, which solves the problem of the historical nature of accounting data This paper investigates whether the book entitled The Balanced Scorecard has the features characteristic of sound argumentation, i.e. whether it uses an appropriate combination of ethos, logo s and pathos when appealing to its readers; if it does not, it will be further examined which features characterize the text, which will then allow us to draw conclusions as to the genre of the text and, in turn, to tell how the BSC is promoted. All the author’s analysis shows that rhetoric is a key management tool. Management constantly requires new rhetoric. The only problem is that, if the rhetoric is combined with theory that is full of mistakes, the sources of errors are numerous. In that case, the managers cannot use the theories to analyses the problems of their companies and they will not have an instrument which actually allows them to control and direct the company. Instead, more argumentative and empirically valid theories should be combined with entertaining rhetoric. Researchers who are preoccupied with developing more cogent and realistic models possibly forget or are outright against the popularized communication of research results, which means that many managers do not ever become acquainted with the theories. Our conclusion, therefore, is that both researchers and managers have to become better at selling theories and models in a way that is persuasive yet convincing. Further research is therefore th at more rhetorical analyses should be carried out, not only of management guru texts but also of academic texts in the area, like management and accounting. The purpose is to allow identification of good as well as problematic rhetoric as part of a learning process which may offer directions for the development of theories. The balanced scorecard: the effects of feedback on performance evaluation Gerui (Grace) Kang, Amy Fredin Management Research Review, Vol. 35 No. 7, 2012, pp. 637-662 The use of a balanced scorecard (BSC) for performance evaluation is meant to help evaluators make more complete decisions, as they have a variety of financial and non-financial measures to assess. The problem is that users have difficulty taking all of the measures into consideration. The tendency to place more weight on common measures (measures that are the same across divisions) while either ignoring or placing very little weight on unique measures (measures are unique to a particular division) has become known as a â€Å"common measures bias†. The purpose of this paper is to extend a line of research that works to understand how this common measures bias might be mitigated. This study examines whether the presence of task property feedback, a form of cognitive feedback, prior to a performance evaluation task, can help evaluators overcome the tendency to rely primarily on common measures. This study used an experimental design where subjects were asked to evaluate the performance of two managers under either feedback or non-feedback conditions. In the feedback condition, subjects were provided with their supervisor’s suggestions about performance evaluation in the use of BSCs. In practice, more straight forward and simple feedback information is likely easier for companies to implement and easier for evaluators to follow. Feedback information that is too complex or that requires too much effort may frustrate evaluators, at which point they may abandon the effort. The authors’ findings also indicate that direct and clear guidance from the top manager of a business may be seen as pressure by lower-level managers. It is important for top manag ers to create such a performance evaluation environment so that all BSC measures are considered. The paper finds that when evaluators judge the performance of managers through the use of a BSC, they tend to weight common measures more heavily than they do unique measures. Where this study contributes to the literature is in the use of task property feedback, a form of cognitive feedback, to overcome this bias. Since the use of unique measures is a key attribute of BSCs as they help users capture the nuances of a specific division’s or firm’s strategy, it is crucial that performance evaluators pay careful attention to them. The findings also indicate that direct and clear guidance from the top manager of a business may be seen as pressure by lower-level managers, thereby suggesting that they (the lower-level managers) use all BSC measures in their evaluations. It is important for top managers to create such a performance evaluation environment so that all BSC measures are considered. This study is the first to examine the influence of task property feedback on perfo rmance evaluation in the context of a BSC. Going forward, it will be important to evaluate how this type of feedback, along with other forms of feedback, may influence performance evaluations over a longer time frame.

Sleep disorders Essay -- essays research papers fc

Sleep Disorders Child Sleep Disorders: Is Your Child at Risk? Recent research has proven that children just are not getting the sleep they need these days. Kids today seem to be doing poorer in school and have less attention spans. Most parents are not aware of a common problem effecting thousands of children in this country: sleep disorders. Parents often fail to follow there children's sleeping patterns which can result in some serious side effects if that child has a sleep disorder. A study done at Tulane University in New Orleans studied about 300 first graders that preformed poorly in school. They found that 18 per cent showed signs of a sleeping problem. The percentage of children with bad grades found to have sleeping problems was six to nine times higher than found in a previous study done over all of the childhood population. (The Toronto Star). Most people believe that sleep disorders only affect adults but in reality 30% of all children have some sort of sleep disorder. (Burcum). Sleep disorders are defined as a group of syndromes characterized by disturbance in the patient's amount of sleep, quality or timing of sleep, or in behaviors or physiological conditions associated with sleep. To qualify for a diagnosis of sleep disorder, the condition must be a persistent problem, cause the patient significant emotional distress, and interfere with his or her social or occupational functioning. (Frey p265). Some sleep disorders can effect children of all ages. The sleep disorder that children are subject to often depends on their age and development. Sleep disorders change most frequent in the middle-school years. Children often experience more anxiety at this time. (Burcum). The source of the certain sleep disorder cannot normally be pin pointed in every case. Many factors come in to play when dealing with the cause of a sleep disruption. Parental characteristics, personality, psychosocial influences, education, parenting skills, stress, trauma, school, culture and personal health can all bring about sleeping disorders in young to middle-aged children. Some parents find that there children sleep to much, while others don't sleep enough. Some fall asleep at the wrong times while others cant ever even get to sleep. There are about 100 different sleep disorders being researched currently. Although sleep is a basic behavior in animals as well as hu... ...nd Psychiatry. (1992). 12 Sept 2001. http://www.Ilboro.ac.uk/departments/hu/groups/sleep.com Klein, Hanne. "Troubled Nights". The Dallas Morning News. 1 March 1999. 19 Sept 2001. http://www.elibrary.com/s/edumark/getdoc.com Kryger, Meir. "Childhood Sleep Apnea". Online Posting. 24 Mar 1999. 19 Sept 2001. http://www.stanford.edu Kryger, Meir. "Children and Sleepwalking". Online Posting. 15 April 1998. 19 Sept 2001. http://www.standford.edu/slpwalking.html Kryger, Meir. "Night Terrors in Children". Online Posting. 10 Sept 1998. 12 Sept 2001. http://www.standford.edu/terrors.html "Night Terrors". The Sleep Tight Video for Sleepless Parents. Excerp. 12 Sept 2001. http://www.sleeptight.com/EncyMaster/N/night.html "Sleep Disorder Affects on Children". The Toronto Star. 11 Sept 1998. 19 Sept 2001. http://www.elibrary.com/s/edumark/getdoc.com "Sleep Problems". Online Posting care of Keep Kids Healty.com. 20 Apr 2000. 12 Sept 2001. http://www.keepkidshealty.com/schoolageproblems/sleep.html "Tipsheet: Nightmares, Night Terrors, and Sleep Walking". 1997. 12 Sept 2001. http://www.aca.ninemsn.com

English in my life Essay

In my language, English has only a small part. First of all, I speak tagalog all the time and my dominant language is tagalog. For example at home, we rarely speak English. Most of the time my family and I speak in tagalog and taglish. So, I’m really adjusting during my social interactions, most of my friends speak in English. However, I know how to speak in English but the problem is I lack practice that leads me to being inconsistent in speaking in English. Now in school, this is the place where I most often speak and practice English. The school is very helpful and encouraging for me to always speak in English at all times. In short, the school makes me realize how important English is. My English usage is very minimal. Truly, that means I’m really not that fluent in speaking in English. That’s why sometimes I tend to stutter, mispronounce and say sentences incorrectly. For me, that’s so shallow and embarrassing so instead I choose to speak in tagalog. But for me I will also consider my mistakes to be my motivation to improve my English. Addition to this is that I may be hesitant to speak in English but at least I’m trying to practice it. Therefore, I will continue practicing it so I will gain more confidence to speak more fluently in English. As we all know, English is helpful, useful and important to our future. Firstly, we are in an English-speaking country. So in order to communicate and interact with other people effectively, we should have to learn how to speak in English. Personally, it is important for me to enhance my English language for it will help me to future endeavors and in order to socialize I have to fully understand the languages that engaged in so I easily understand ones feelings. In short, I will never stop learning, improving and practicing my English language for this will help me in my profession in the near future.

Culturally Competent Nursing Care Essay

Culturally Competent Nursing Care The United States is a diverse accumulation of cultural backgrounds which can often set the stage for feelings of confusion, anger, mistrust, and a host of other emotions when dissimilar cultures disagree. Cultural competence in nursing can help eliminate these barriers and provide a platform for nursing to follow in the quest to understand a patient’s culture and background. When a nurse takes the time to learn about a given culture prior to providing care, it conveys she respects the patient’s right to their beliefs, customs, and culture. It does not necessarily mean the nurse agrees with their practices but it does show that she is willing to be open minded and deferential. It is the responsibility of the health care provider to take the time to educate themselves on the various cultures they may be exposed to in their work (Purnell & Paulanka, 2003). Evidence of Culturally Incompetent Care One act from the case study that exhibited cultural incompetence was the racial slur made by Connie when she referred to her clients as â€Å"This Mexican family†. If she would have taken the time to review the baby’s chart, she would have known that the family identified with the term Hispanic, not Mexican. Connie made a statement about the number of family members in the room and she gave the impression that the family was invading her work space unnecessarily. Connie identified that the family was speaking Spanish then stated she could not get them to understand her. Her tone indicated that the family was at fault for the lack of communication even though Connie did not bother to engage an interpreter. Connie even went so far as to label the family’s inability to understand her as noncompliance. She also proceeded to go about her task of putting in and intravenous (IV) line without establishing autonomy and getting informed consent from the mother. Connie’s action of cutting the â€Å"ragged, old red string† off the baby’s wrist without asking for permission first is proof of her cultural insensitivity. Many cultures tie strings around various parts of the body to ward off evil, aid  in healing, or as a symbol of faith. Connie knew she did something wrong because she admitted that the mother screamed at her when she cut the string. However, she did not take the time to understand why the mother was upset. She appeared to be more concerned with getting her nursing tasks done right away and with leaving for the day. Importance of Values, Beliefs, and Practices The iceberg model splits the nursing skill set into two parts; technical and behavioral. The tip of the iceberg represents what can be easily seen or the technical skills and knowledge a person has that allows them to perform their job. Examples of technical skills demonstrated by Connie were obtaining IV access and identifying the signs and symptoms of dehydration. These particular skills are considered visible to others so they correlate with the upper portion of the iceberg in the model. The lower part of the iceberg is under water or invisible and is indicative of the behavioral aspects of self that demonstrate who we are as a person. Understanding one’s own values, beliefs and practices helps when trying to understand those same characteristics in a different culture. Nurses need to understand how they view themselves and others before they can achieve cultural competence (Buffalo, 2001). The behavioral or lower portion of the iceberg is represented by social role, self-image, traits, and motives. The social role identifies with one’s image. It refers to how people want others to see them and how others actually do see them. The social role is important because it can establish how health care professionals determine what skill sets are important in their job. Self image is how people see themselves and once they understand themselves they can decide whether or not change is needed for personal growth. Another area on the hidden portion of the iceberg is traits or those characteristics and habits that determine how a person responds in a given situation. The last area of the iceberg is motives. Motives are formed early in life and are the driving forces behind personal actions. The status of the areas depicted in the lower part of the iceberg model also determine what characteristics are present on the visible portion of the model (Buffalo, 2001). Barriers to H ealthcare Communication is going to continue to be a huge barrier to healthcare for  this family. They live in Texas which is very rich in Spanish culture and the Spanish language is common. Health care workers are often bilingual so this family should not have any trouble being understood when they go in for care in their home state. The general population of Texas has been exposed to the Hispanic culture and can relate to the beliefs and practices that are followed. However, this family migrates to Northern Minnesota, an area that is mostly comprised of white, non-Hispanic, English speaking people of European descent. From a transcultural nursing standpoint, nurses from the Northern areas of Minnesota may not even know they are lacking because the degree of interaction with the Hispanic population in the healthcare setting is minimal. There will be language barriers, especially in the smaller, rural farming areas where the migrants tend to work. Many small rural hospitals do not have access to interpreters and it is common to have little to no cultural education provided to the employees. Unless there is a cultural change in this area of the country, communication will continue to be a problem. The disparity is one of population and geographic location relative to the Hispanic culture in Northern Minnesota (U.S., 2010). Cultural Sensitivity Information Additional information that could have been added to the kardex was the preferred method of communication so the nurse would know right away if an interpreter would be needed. Family demographics could have been put on there so the nurse had information regarding the cultural background. Notes could have been put on the kardex that identified the family dynamics so other nurses would understand why so many family members were present. The religious preferences would also be significant because that would give the nurse insight to the possible importance of certain charms, icons, or beliefs. Another item that could have been on the kardex was the history of the patient from the perspective of the clinic nurse. She may have passed on more information to Connie but as flustered as Connie was, that information was more than likely minimized or forgotten because it was not written down. Connie only gave the bare facts during report, then hurried out of the workplace, leaving Gina with mor e questions than answers. Provisions of Culturally Competent Care Gina recognized that she was lacking in cultural knowledge about this family and took the time to look up some information prior to interacting with them. She was respectful of the role of the elders and addressed each person accordingly, gaining some measure of respect in doing so. This helped her establish a mutually satisfying relationship with the family which in turn helped build trust. She also intervened and got an interpreter rather than allowing one of the younger teenagers to interpret. Gina also took the time to find out what interventions the family had provided and did not belittle them for their actions. Gina went from conscious incompetence to conscious competence and will more than likely advance into unconscious competence with time (Purnell & Paulanka, 2003). Transcultural Competency Model The Camphina-Bacote competence model identifies cultural competence as a process that a healthcare worker goes through to enable themselves to work in a manner that falls within the cultural context of a client. The model has five constructs: Awareness, skill, knowledge, encounters, and desire. The first construct of the model, awareness, asks healthcare workers to question their own cultural consciousness by identifying biases and prejudices they may have toward other cultures. It is an attempt to help one understand just how sensitive they may or may not be toward other cultures. The second construct focuses on whether or not the healthcare worker has the necessary skills to conduct a cultural assessment in a manner that will insure insightfulness. This is important for insuring that the assessment is properly done and that it contains information necessary to others who may rely on it. Having the skills alone is not enough; the person conducting the assessment also needs to have k nowledge of the culture. The assessor needs to research the culture to understand the worldview. There are many blanket questionnaires available to use for the assessment if one does not care about personalization. However, understanding the culture is important before the interview begins if the person conducting the interview wants to develop questions that are more in-depth and of a personal nature. The Camphina-Bacote model also recommends that the person conducting the cultural assessment determine what type of encounter they wish to use for the interaction. Some examples of encounters include face-to-face meetings, attending group cultural activities, phone interviewing, or any other type  of communication method. Some people may be more comfortable filling out a questionnaire, others may want to meet in a relaxed, public environment and still others might want the professional atmosphere of an office setting. Whatever type of encounter is chosen, it is important that the comfort of the person being interviewed is taken into consideration and a mutual setting is agreed upon. The last construct of the model is desire. If there is no desire on behalf of the professional to learn about cultural differences then the process of attempting to become culturally competent will fail. At the very best, the information gained will be inadequate and could cause more misunderstand and mistrust (Ingram, 2012). Ladder of Cultural Competency Based on the case study Gina was not being racists and was not blind to the patient and family’s needs or their culture. Purnell and Paulanka (2003) describe racism as a display of power in combination with prejudice: Gina did not exhibit either of these characteristics. She had a modest awareness and knowledge of the Hispanic culture and was sensitive to the family’s needs. Gina does not have the language proficiency yet so she would not be at the fifth step. Gina is on step four: Competence. She demonstrated her ability to provide culturally competent care for this family. Even though she did not already have all of the necessary information to care for this child, she knew where to go look for it and how to interpret it. She demonstrated that she valued the family’s cultural differences by taking the time to treat them with respect according to their beliefs. Utilization of an Interpreter Gina knew that the patient and the family had a right to have an interpreter provided. She also knew that it would be disrespectful to allow a younger person to translate for an older person. In addition, the younger teenager who offered to translate stated she spoke very good English but indicated that she only attended summer school while in Minnesota. What the teenager considered good English more than likely would not have been adequate to translate medical terminology. Gina made a very good decision when she brought in an interpreter. She also obtained a resource for herself because the interpreter could have had additional knowledge about the culture. The  Standards of Practice for Culturally Competent Nursing Care states that it â€Å"is critical that the healthcare system provides resources for interpretation when appropriate† (Douglas et al, 2009, p. 265). History of Present Illness Gina could have asked the mother or family what they felt the cause of the illness was. This would have given her insight as to whether the family believed the cause was physical or spiritual. If it was believed to be spiritual in nature, the family may have wanted to call in a Hispanic healer to perform a ceremony for the child. She asked how many days the child had diarrhea and could have asked whether the child’s diet had changed before her diarrhea started. She also could have asked if any other family members had experienced the same symptoms. Coming to Minnesota may have precipitated a change in diet for the entire family with the possibility of contaminated food. Gina could have addressed the pathophysiology of the illness by asking whether or not the child had experienced any functional changes. The family did indicate the they brought the child to the clinic after she became listless. Getting a background on other functional changes may provide clues to other factors that might be making the illness worse. For example, was the child falling down, crying a lot before she became listless, et cetera. Another area to look at would be the course of the illness. Gina could have the mother describe how the illness started and give a timeline of signs, symptoms, and interventions up to the present time. This could include the treatments the family provided along with what the expected outcomes were. Gina could ask the family whether or not they felt any of the interventions were successful, even if it was only mild success. It would also give Gina information about the remedies used so she could research and pass the information on to the health care provider. Two of the treatments supplied by the family were actually not conducive to good health. The manzanilla tea can cause diarrhea and the family was giving it to the child as a treatment for diarrhea. According to the CDC, greta is an orange powder used as a Hispanic remedy for stomach ailments. The powder contains concentrations of lead as high as 90% and contributes to lead poisoning (CDC, 2009). Getting the family’s perception on the illness is very important to increasing one’s awareness of how the family views the illness. Cultural Diversity Care Plans Cultural Preservation Practice| Nursing Diagnosis| Goal| Interventions| Gina provided care congruent with the culture via an interpreter. The family was unable to understand the plan of care for the child.| Knowledge deficit related to language barriers.| Patient will verbalize an understanding of the child’s condition and the need for the current treatment plan via an interpreter.| 1) Using an interpreter, explain the illness, causes, and treatment plan to the patient’s family.2) Have the primary care-giver demonstrate understanding by repeating back the plan of care and the potential benefits. 3) Allow for questions and answers.| Cultural Accommodation Practice| Nursing Diagnosis| Goal| Interventions| Gina attempted to put the family at ease by using an interpreter to find out what the family understands about the child’s illness and the interventions that were tried in the home environment. She discovered that the red string was on the child for good luck and to keep her safe from spirits.| Anxiety related to cultural lack of understanding of the illness and the treatment plan practices.| Collaborate with the family to identify treatments that are culturally acceptable and that can be used in conjunction with western medicine to address the child’s medical needs.| 1) Allow a spiritual advisor to place new red strings on the child and support a ceremony if need be.2) Explain the need for an IV and make sure it does not violate the family’s beliefs.3) Praise family for their efforts thus far.| Cultural Restructuring Practice| Nursing Diagnosis| Goal| Interventions| Gina found out the baby had been given manzanilla tea and greta. Neither of these remedies is a good choice. The manzanilla tea is used for constipation and the baby had diarrhea. According to the CDC, greta is high in lead content and causes lead poisoning.| Ineffective health maintenance related to lack of understanding.| Educate patient’s family on the illness and potential harm of some folk remedies and identify harmful remedies that the family needs to change.| 1) Provide family with culturally appropriate educational material in whatever configuration they require.2) Work with the family to develop a plan of action and identify alternatives to the harmful remedies.| Reflection Providing culturally competent care can be challenging at times and it requires nurses to be aware of their own limitations, strengths and beliefs. It was evident in the case study that Connie was not prepared to take on the task of developing her own cultural competence. Gina, however, showed good leadership ability and a willingness to learn about a culture different than her own in order to provide the best nursing care she could. Gina is the type of nurse that will continue to grow in her position and garner respect from her patients and co-workers. Her actions showed she was capable of doing what was in the best interest of the patient and family. Cultural competence does not just happen; nurses have to make it happen. References Buffalo State, (2001). Technical and behavioral success factors. Retrieved June 23, 2013, from The State University of New York: http://www.buffalostate.edu/offices/hr/pepds/sf/tb.asp. Centers for Disease Control and Prevention, (2009). Folk medicine. Retrieved July 17, 2013, from the National Center for Environmental Health: http://www.cdc.gov/nceh/lead/tips/folkmedicine.htm. Douglas, M., Pierce, J., Rosenkoetter, M., Callister, L., Hattar-Pollara, M., Lauderdale, J., & †¦ Pacquiao, D. (2009). Standards of practice for culturally competent nursing care: a request for comments. Journal Of Transcultural Nursing, 20(3), 257-269. Ingram, R. (2012). Using Campinha-Bacote’s process of cultural competence model to examine the relationship between health literacy and cultural competence. Journal Of Advanced Nursing, 68(3), 695-704. doi:10.1111/j.1365-2648.2011.05822.x Purnell, L., & Paulanka, B. (2003). Transcultural health care: A culturally competent approach. Philadelphia, PA : F. A. Davis Company. Sitzman, K., & Eichelberger, L. (2004). Understanding the work of nurse theorists: A creative beginning. Sudbury, MA: Jones and Bartlett Publishers. U.S. Department of Health and Human Services, (2010). Disparities. In Healthy People 2020. Retrieved June 26, 2013, from U.S. Department of Health and Human Services: http://www.healthypeople.gov/2020/about/DisparitiesAbout.aspx. Walsh, S. (2004). Formulation of a plan of care for culturally diverse patients. International Journal Of Nursing Terminologies & Classifications, 15(1), 17-26.

Andrew Jackson Hero Outline Essay Example

Andrew Jackson Hero Outline Essay Example Andrew Jackson Hero Outline Paper Andrew Jackson Hero Outline Paper   After reviewing Andrew Jackson’s positive and negative actions, it has come to a conclusion that he was in the position of a hero. In the 1800’s President Andrew Jackson showed he was a hero to the reduce in Federal debts, winning the Battle of New Orleans, and hearing the voices of the people and giving them the chance to vote for their president. Despite all his positive work, he also made many negative decisions, but none mayor and serious. Andrew Jackson made an amazing impact in our world, and without hesitation we can all say that if it wasn’t for his positive work, we would not be in the position we are in today. My first reason on why I believe President Andrew Jackson was a hero is for the fact that he vowed to pay the national debt to prevent the liberty of his country from being destroyed, and kept his word. The reducement of the national debt was lowered in 1835. Andrew Jackson had been able to decrease the national debt to only $33,733. 05, the lowest it has been since the first working year of 1791. This was a major accomplishment, and a very difficult task. Andrew Jackson was the only president in United States history to ever succeed in paying off the federal debt. This is the second reason why I believe Andrew Jackson was hero. Andrew Jackson defeated the British Army from seizing New Orleans and part of the Louisiana territory, acquired by the United States. Winning this battle made Andrew Jackson a hero because many people depended on him to keep their land safe and away from any destruction. If Andrew Jackson had not won this battle many people would have gotten ruled over by British troops. Therefore, I believe President Andrew Jackson was a president. This is the final reason why I believe Andrew Jackson was a hero. I thought he was a hero because he believed that his people should have the right to vote for their own president. This made Andrew Jackson a common man because he heard his nation’s voice. His nation did not like the fact that congress was choosing presidents, without a word from them. Andrew Jackson did many things to get him recognized as a good president towards his people. Many people believed that President Andrew Jackson was a bad person. He made bad choices, yet what these people didn’t understand was the concept of him making good choices out of these negative actions. For example, many people thought Andrew Jackson was a bad person because of the Trail of Tears, yet they know so little about it. If those people would do research they would know that there were about fifty stations, or forts, in Tennessee during the Trail of tears. Although the Trail of Tears led my president Andrew Jackson only destroyed two of the Indian tribes. After reviewing the pros and cons of Andrew Jackson’s presidency many people still believe that he was a bad president and did nothing good for the nation. I, in my point of view, believe that he was a good president, and made a lot of the year he was in The White House. President Andrew Jackson made many people happy, and many people upset. Although, when you think about it, he is the reason why our world is the way it is now. Women have the right to vote. The people choose the president depending on which one satisfies them the most. He fought way too hard for us to have the privileges we have now. He did things other presidents could never commit themselves to doing. â€Å"You must pay the price if you wish to secure the blessing. † –Andrew Jackson.

How to Introduce Your Class Rules (Grades K-6)

How to Introduce Your Class Rules (Grades K-6) Its important to introduce your class rules on the first day of school. These rules serve as a guideline for students to follow throughout the school year. The following article will give you a few tips on how to introduce your class rules, and why its best to only have a few. How to Introduce Class Rules to Students 1. Let students have a say. Many teachers choose to introduce the rules on or around the first day of school. Some teachers even give the students the opportunity to pitch in and create the rules together. The reason for this  is that when students feel they had a hand in deciding what is expected of them, they tend to follow the rules more closely. 2. Teach the rules. Once the class has created a list of acceptable rules, then its time for you to teach the rules. Teach each rule as if you are teaching a regular lesson. Provide students with an example of each rule and model if necessary. 3. Post the rules. After the rules are taught and learned, then its time to set them in stone. Post the rules somewhere in the classroom where it is easy for all students to see, and send a copy of them home for parents to review and sign off on. Why It's Best to Only Have Three to Five Rules Have you ever noticed that your social security code is written in groups of three, four, or five numbers? How about your credit card and license number? This is because people find it easier to remember numbers when they are grouped in three to five. With this in mind, its important to limit the amount of rules you set in your classroom from three to five. Try not to set more than five rules at a time. If you find it necessary to have more than five, then post them in groups of three to five.Feel free to replace a rule once it has been learned. The students must still abide by this rule, it is just now known as an unwritten rule.When writing the rules, state the rules in the positive instead of starting with Do Not. What Should My Rules Be? Every teacher should have their own set of rules. Try to refrain from using other teachers rules. Here is a list of some general rules that you can tweak to fit your personal class expectations: Sample List of Rules Come to class prepared.Listen to others.Follow Directions.Raise your hand before speaking.Respect yourself and others. Specific List of Rules Complete morning work at your seat.Wait for further directions once a task is completed.Keep your eyes on the speaker.Follow directions the first time they are given.Change tasks quietly.

Epidemiology eassy on Yellow Fever Essay Example | Topics and Well Written Essays - 3000 words

Epidemiology eassy on Yellow Fever - Essay Example The family Flaviviridae contains only one genus, Flavivirus. They are somewhat smaller than alphaviruses, being 40 nm in diameter. The name flavivirus refers to the type species, the yellow fever virus ( Flavus, L = Yellow). The yellow fever virus was first isolated in 1927 by inoculating rhesus monkeys with the blood of an African patient named Asibi. The virus was shown by Theiler (1930) to grow well following intracerebral innoculation in mice. The infected mouse brain was used as a vaccine in former French West Africa (Dakar vaccine) though this was encephalitogenic. It was later replaced by a non-neurotropic (17D) vaccine (Panicker 2007, p.527-30). Cases are classified as inapparent ( 1 week; the period of convalescence is usually short except in the more severe cases. There are no known sequele. (Beers 1999, p.1303-4). Statistics In a report by Weir and Shariqe (2004, 1909), each year about 2, 00,000 become ill with yellow fever around the world though the true incidence is likely to be much higher. This was according to estimates by the World Health Organization (WHO) in 1998. About 90% of the cases occur in Africa and 10% in South America. Epidemiology of yellow fever Approximately 2, 00,000 cases of yellow fever occur annually; 90% of them occur in Africa. A dramatic resurgence of yellow fever has occurred since the 1980s in both sub-Saharan Africa and South America. A series of epidemics and smaller outbreaks of yellow fever that occurred in West African countries were primarily responsible for the increased incidence of yellow fever in Africa, but the first epidemic reported in Kenya in>2 decades signaled that a change in the distribution of the disease was also occurring. Transmission in Africa is maintained by a high density of vector mosquito population that is in close proximity to largely unvaccinated human populations. Although some countries have incorporated programs, vaccine coverage is not optimal. In South America, the rate of transmission of yellow fever is lower than in Africa, in part because high vaccine coverage occurs primarily as part of mass immunization campaign in response to outbreaks of the disease. The largest outbreak of yellow fever in South America since the 1950s occurred in Peru in 1995, and cases were reported in Bolivia, Brazil, Colombia,