Preventing Harm From Deterioration In Patients Nursing Essay

Preventing Harm From Deterioration In Patients Nursing Essay This study will discuss what a nurse needs to know in relation to identifying and preventing harm from deterioration in patients in a hospital ward setting. A review of current literature will be carried out in order to find the best available evidence on the subject. The key issues arising from the literature will be critically analysed to provide a balanced and objective consideration of the strengths and limitations of current practice in relation to the recognition and communication of patient deterioration. Finally the study will use the evidence to attempt to make recommendations for practice in this area and discuss the nurses role in the development of the new practices which could enhance the management of patient deterioration and ultimately ensure safer care for patients. Rationale for Subject Choice As a student nurse about to become a registered and accountable practitioner, one of my main concerns is that I have the knowledge and skills to recognise deterioration in the condition of my patients and the ability to communicate my concerns effectively to ensure they are seen promptly by a more senior clinician and any further decline is prevented. Therefore my rationale for choosing to study this topic was to try to find evidence which would support me in contributing to safer care of acutely ill patients. Background The increasing complexity of healthcare, an ageing population and shorter length of stay, means that hospital patients today need a higher level of care than ever before. Therefore, it is essential that hospital staff are equipped to recognise and manage deterioration (Department of Health 2009). Many patients who experience cardiopulmonary arrest show signs of deterioration for more than 24 hours before arrest, and it has been estimated that approximately 23,000 in-hospital cardiac arrests in the United Kingdom (UK) could be avoided each year with better care (Smith et al 2006). Furthermore, evidence has shown that delays in recognising deterioration or inappropriate management can result in late treatment, avoidable admissions to intensive care and in some cases, unnecessary deaths National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2005) National Patient Safety Agency (NPSA) (2007) (2007a). These studies highlighted the magnitude of the problem in the UK, they s howed that hospital staff do not understand the disturbances in physiology affecting the sick patient, they frequently ignore signs of clinical deterioration and lack skills in the implementation of oxygen therapy, assessment of respiration and management of fluid balance NPSA (2007) (2007a). NCEPOD (2005) reported that approximately 50% of ward based patients receive substandard care prior to Intensive Care Unit (ICU) admission, and 21-41% of ICU admissions are potentially avoidable. Analysis of 425 deaths that occurred in general acute hospitals in England showed that 64 deaths occurred as a result of patient deterioration not being recognised due to observations not being undertaken for a prolonged period leading to changes in vital signs not being detected, and delay in patients receiving medical attention even when deterioration was detected (NPSA 2007). Despite considerable economic investment there is continued evidence of suboptimal care and the Department of Health (DoH) (2 009) have acknowledged that the recognition and management of acutely ill patients need attention. They say there are many factors influencing a patients ability to receive appropriate and timely care including the failure to seek advice, poor communication between professional groups, and a lack of clinical supervision for staff in training (DoH 2009). The following literature review will attempt to find evidence of the factors which contribute to sub optimal treatment of deterioration. Literature Review A literature search was undertaken using the electronic databases CINAHL, ESCBO host, Internurse, Medline, Science Direct and Swetswise through the Liverpool John Moores University search engine, and also the British Nursing Index via Ovid using the Royal College of Nursing search engine. The keywords used were: deterioration, hospital deterioration, communication of deterioration and early warning systems. A total of thirteen articles were found to be of use, two of these were published outside the UK (Australia and Italy) however after reading them it was decided that the evidence was relevant and they were deemed appropriate for use. As the study developed a further search was performed using the terms deterioration tools, communication tools, SBAR and RSVP communication tool two articles from this subsequent search were used in this study. Additionally and as mentioned above useful references were also sought from the Department of Health, the National Patient Safety Agency, the National Confidential Enquiry into Patient Outcomes and Death, and the National Institute of Clinical Excellence. The search revealed the topic had been fairly well researched, especially in recent years and the articles seemed to have stemmed from the reports by NPSA (2007) (2007a) and NICE (2007). Smith (2010) recently proposed a Chain of Prevention to assist hospitals in structuring their care processes to prevent and detect patient deterioration and cardiac arrest. The five rings of the chain represent staff education, monitoring, recognition, the call for help and the response and it was found that the themes of education, and recognition were well documented in the literature. Nurse Education Preston and Flynn (2010) say in order to avoid unrecognised patient deterioration and therefore enhance patient safety nurses must review their knowledge and skills in measuring the physiological parameters of temperature, blood pressure, blood glucose levels, oxygen saturation levels, and neurological function, and in particular identified the respiratory rate as a particularly sensitive indicator of clinical decline. In addition nurses also need to recognise the significance of physiological compensatory mechanisms that are activated in clinical deterioration, so they can report their findings accurately and with confidence to doctors and senior staff. Steen (2010) agrees that nurses require the knowledge and skills to be able to provide critical care in the general ward setting, as accurate assessment using a systematic approach can aid timely detection and intervention and can help to stabilise the individuals condition preventing organ dysfunction, multi organ failure and furthe r deterioration, thus reducing morbidity and mortality rates and admission to ICU. However, Odell, Victor and Oliver (2009) feel that recognising deterioration of a ward patient and referring to critical care teams is a highly complex process, requiring skill, experience, and confidence. Preston and Flynn (2010) suggest that nurses can be helped to develop these skills by attending the Advanced Life Threatening Events Recognition and Treatment (ALERT) course, they considered the possibility of nurses undertaking the ALERT course whilst a student, they say this will help newly qualified nurses to promote their skills, abilities and rationale for recognizing and responding to patient deterioration. They also recommend the further development of acute illness simulation programmes in both pre and post registration courses to help nurses to become more confident and expert in responding and reporting acute illness to medical and more senior staff. They say what is needed is a closer col laboration between education and health service partners to deliver these programmes and competent clinical teaching staff to facilitate these simulated exercises in a safe environment that utilises accurate patient scenarios, equipment and charts that are currently used in practice (Preston and Flynn 2009). Monitoring Accurate monitoring of patient condition featured highly in the literature. The NPSA (2007) revealed that in 14 of the 64 incident reports they studied, no observations had been made for a prolonged period before the patient died therefore vital signs such as blood pressure, pulse and respirations were not detected. But the literature revealed the crucial importance of regular observations in the recognition of deteriorating patients. Preston and Flynn (2010) said doing the observations is crucial for detecting early signs of deterioration in acute care as closely monitoring changes in physiological observations can identify abnormalities before a serious adverse event occurs. Early identification is important to reduce mortality, morbidity, length of stay in hospital and associated healthcare costs (NICE 2007). Preston and Flynn (2010) also stipulated that close supervision of unqualified nursing staff doing the observations in acute care should be a high priority and should follow both the NICE (2007) guidelines and recommendations from the NSPA (2007) (2007a). However following an observation of care by Morris (2010) an issue was identified where observations were incomplete, with recording of respiratory rate and oxygen saturations omitted and although an early warning score chart had been used, a score had not been recorded (Morris 2010). Recognition The importance of nurses utilising an early warning system was highlighted. Cei, Bartolomei and Mumoli (2009) say using the Modified Early Warning Score (MEWS) when recording patient observations is a simple but highly useful tool to predict a worse in-hospital outcome and aid identification of patients at risk of clinical adverse events such as cardiac arrest, sepsis and raised intracranial pressure. Nonetheless a study by Donohue and Endacott (2010) revealed that participants did not look for trends in the MEWS data and few used MEWS data in the manner it was intended i.e. it was used to confirm whether the patient met the trigger criteria, rather than as a routine component of assessment, the study found that MEWS was used infrequently, used too late and not employed to communicate patient deterioration. Mohammed, Hayton, Clements, Smith, and Prytherch (2009) felt the significant advantage of an early warning or track and trigger system like MEWS was that they use a visual scale t hat gives a score if a physiological recording enters a colour zone. But they found that there are disadvantages to using these systems in practice if nurses add up the scores incorrectly. In their study (Mohammed at al 2009) found that calculating scores could be improved by using a handheld computer and this approach was more accurate, efficient and acceptable to nurses than using the traditional pen and paper methods in acute care. The Department of Health (2009) say early warning systems play a key role in the detection of deteriorating patients; however, clinicians need to be aware that in some clinical situations these systems will not reflect clinical urgency (Department of Health 2009) and effective assessment skills must be employed. Call for Help and Response The NPSA (2007) report revealed that in 30 of the 64 incident reports they audited, despite recording vital signs, the importance of the clinical deterioration had not been recognised and/or no action had been taken other than the recording of observations (NPSA 2007). This could be due to ineffective communication of the deterioration. The literature review showed that communication of deterioration was a more recently well documented subject. Steen (2010) Tait (2010) feel that a vital component of the management of the acutely ill patient is the ability to communicate clearly and precisely with all members of the multidisciplinary team to aid timely and appropriate help and intervention for the patient. Still there is much evidence of communication breakdown between disciplines, Beaumont (2008) states communication between medical and nursing staff can be problematic, nurses may not communicate clearly enough and struggle to convey information in a manner that would convince doctor s of the urgency of the situation, sometimes there is failure by doctors to perceive, understand or accept the source of nurses clinical and professional judgement, less experienced nursing staff might not feel comfortable or confident to call more senior staff because they fear doing the wrong thing or crossing occupational and hierarchical boundaries. These problems can result in conflict between professional groups as they attempt to work towards positive outcomes and may prevent patients from receiving assistance and support when required (Beaumont 2008). Endacott, Kidd, Chaboyer and Edington (2007) agree that formal divisions of labour and professional boundaries can cause gaps or discontinuities in patient care and feel communication between clinicians must improve. Donahue and Endacott (2010) say the failure of nurses to recruit senior support to deal with acutely ill patients is a contributing factor to the sub-optimal care of critically ill patient, it may be due to a lack of experience or knowledge on the part of the doctor but may equally be due to the nurses inability to articulate the seriousness of the situation. Their data identified that nurses have an awareness of the need for a succinct story but they continue to make calls for assistance with little relevant information (Donohue and Endacott 2010). As stated above suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety and the use of a structured method of communication has been suggested to improve the quality of information exchange (Marshall, Harrison and Flanagan 2009). A number of communication tools are available; some hospitals use the SBAR (situation, background, assessment, recommendation) tool to structure conversations between members of the multidisciplinary team, which uses standardised questions to prompt the conveyor of information to share the necessary details (Steen 2010). In a simulated clinical scenario Marshall et al (2009) described the positive effect of this method on students ability to communicate clear telephone referrals. However, Featherstone, Chalmers and Smith (2008) feel that SBAR is not a memorable acronym and they prefer the use of the RSVP (Reason, Story, Vital Signs, Plan) system used in the ALERT cou rse as framework for the communication of deterioration, the authors say SBAR does not easily slip off the tongue, and RSVP is much easier to remember in an emergency. They say the reason for the call can be explained in clear simple language, and the story gives a time line of important events, they feel nurses will be familiar with a narrative style of communication and are used to giving a brief summary as part of the handover process. The vital signs must be given in figures, and can include the early warning score, or summarized in words that convey the deterioration effectively and the plan for the patient should be outlined by the caller or expected from the receiver (Featherstone et al 2008). Smith (2010) says the use of standardised method of communication, such as the RSVP system will improve communication about patient decline. Recommendations for Practice Constant change within the National Health Service is essential to advance care quality and ensure the provision patient focused care that is evidenced based. Ensuring the latest and best available evidence is put into practice is a is a crucial way of ensuring that people get the treatments and services that are the most effective and will have the best health outcomes, it ensures that the public funding that supports the NHS is used wisely and that the treatments and services offered are cost effective, and both of these factors lead to the provision of clinically effective care. Everyone involved in healthcare provision must ensure quality is enhanced and must be willing to change current practices for the benefit of patients. Nurses have a professional responsibility to keep up to date with changes and developments within their field and to deliver care based on the best available evidence or best practice (Nursing and Midwifery Council 2008). Larrabees (2009) Model for Evidence Based Practice Change suggests that there are six steps towards implementing change in practice, firstly practitioners should assess need for change in practice, and this study has found evidence which clearly points to the need for changes in practice in order to reduce avoidable harm to patients. The next steps of Larabees Model (2009) are to locate the best evidence, and critically analyse the evidence, and from the evidence found in this study it is evident there are several recommendations for changes in practice which would help nurses in acute care to develop their skills in recognising and reporting deterioration. To keep the Chain of Prevention suggested by Smith (2010) strong he suggests that staff education, monitoring, recognition, the call for help and the response must all be robust in order to prevent harm from unrecognised and unassisted illness. Recommendations to enhance these areas would be to ensure that the recognition of life threatening illness is taught from an early stage in a nurses career by attending the ALERT course earlier in their training and by the teaching of patient scenarios in the clinical area and facilitated by staff who are trained in critical care. With regards to the call for help and the response rings of the Chain of Prevention (Smith 2010), it has been shown that the use of communication tools help nurses to get an earlier response when calling for assistance, so it seems sensible to implement the standard use of a communication tool in acute care when communicating deterioration. The next step in Larabees Model for Change (2009) is to design the practice change, and it is recommended that use of the RSVP communication tool (see appendix) should become hospital protocol when calling for assistance; this is because it is easy to remember and it is used as part of the ALERT course which many acute care nurses have attended. Nurses should receive training on the use of this tool and it should be displayed near the tele phone in every acute area. In order to implement and evaluate this change, which are the next steps in the Model (Lara bee 2009) a nurse should firstly let people know about it, this can be done by using various means of communication i.e. trust intranet, ward meetings, discussion with senior nursing staff and managers. They must then get people to take on the change by involving enthusiastic team members and organising a pilot test of the use of the RSVP tool. Crucially the rate in which more senior practitioners respond must be audited find out if the tool is working in practice and if not why not, is more information or training required is the tool not displayed clearly enough. The final step of the Model for Change (Larabee 2009) is to integrate and maintain the change in practice, to do this a nurse must ensure all new staff are trained to use the system and continuously evaluate its use to ensure it is working in practice. Conclusion This study has highlighted the evidence base and resources available to support nurses in contributing to safer care of acutely ill patients it has found that in order to facilitate accurate detection of changes in condition, nurses working in acute care must acknowledge the importance of observations and early warning systems in the identification of patients at risk of adverse events and ensure patients are assessed using a sound knowledge of physiological compensatory mechanisms, to enhance this knowledge they should attend an ALERT course, the evidence pointed to nurses attending these courses early in their career and that clinical scenarios could also help increase their knowledge of acute illness. It was found that communication tools help nurses when calling for senior assistance and the implementation of a standard tool within acute hospital settings could help to prevent harm from deterioration.

Criminal Evidence Essays -- essays research papers

Evidence is the key element in determining the guilt or innocence of those accused of crimes against society in a criminal court of law. Evidence can come in the form of weapons, documents, pictures, tape recordings and DNA. According to the American Heritage College dictionary, evidence is the documentary or oral statements and the material objects admissible as testimony in a court of law (476). It is shown in court as an item of proof, to impeach or rehabilitate a witness, and to determine a sentence. This paper will examine two murder cases, O.J. Simpson and Daniel Taylor. Perhaps the most famous case in the 20th century was the O. J. Simpson double murder trial. On June 12, 1994, two people were brutally killed. Those two people were Nicole Brown Simpson, O.J. Simpson's ex-wife, and Ronald Goldman. O.J. was arrested the next day and charged with their murder. O.J. pleaded innocent to murder and went to trial in criminal court. There was a load of evidences at the residence of Nicole’s to charge him with two counts of first degree murder and it seemed almost impossible for O.J. to be found innocent. There were loads of evidences found at the scene and O.J.’s home. The bodies of both Nicole Simpson and Ron Goldman, blood of the victims, shoe prints and other evidences. But, one of the main evidence was the questionable bloody glove found behind the guesthouse, which was proven by DNA testing to have O.J.'s, Nicole's and Ron's blood and hair on it. Fibers were also found on the glove that came from O.J.'s shirt and his Bronco (CNN). In addition, a bloody footprint which matched O.J.'s shoes, blood on O.J.'s Bronco door, on the console, on the interior side of the door, a bloody footprint in the Bronco, bloody socks in O.J.'s house, O.J.'s injured finger, blood found at Nicole's condo that matched O.J.'s, and so on (CNN). But, the defense claimed that the evidence had been planted. Eyewitnesses are also an important piece of evidence. Allen Wattenberg, a knife storeowner, testified during the preliminary hearing that O.J. bought a 14-inch Stiletto knife from his store. O.J.'s limo driver arrived to drive O.J. to the airport and saw a black man, with the same build as O.J. sprinting across the lawn towards O.J.'s house. When O.J. answered the door, he said he'd been napping (CNN). Simpson's houseguest stated that he saw Simpson pulled up in the white bro... ...ture on the bond slip appeared to be Taylor’s signature. Unlike O.J. there was no DNA linking him to the crime scene or the bodies. Again, all the evidences pointed favorably toward Daniel Taylor and despite the evidences presented, the jury found Taylor guilty of murder. In closing arguments, Needhand and Bishcoff sought to discredit the officers who had testified for Taylor, accusing them of covering up sloppy record keeping for fear they would be blamed for letting Taylor leave jail early to commit murders (Chicago tribune). In addition, the prosecutor used Daniel’s confession on tape to convict him. â€Å"Paperwork is not foolproof,† Bishcoff, the prosecutor, said. But I’ll tell you what is foolproof. And what is foolproof are the defendant’s own words† (Chicago tribune). REFERENCE â€Å"DNA Fingerprinting† (1997) Encarta Encylopaedia 1997 â€Å"Blood truths, Why the Police Want to Tag Your Body† Helen O’Neill, The Australian 6.12.1997 â€Å"Flaws in New DNA Database† Simon Kearny, The Sydney Telegraph 22.04.2001 â€Å"Jail For Rapist Caught by DNA† Noula Tsavdaridis, The Advertiser 21.10.2000 The American Heritage College Dictionary, 3rd edition, 1997, Houghton Mifflin Company, Boston MA, 476. Criminal Evidence Essays -- essays research papers Evidence is the key element in determining the guilt or innocence of those accused of crimes against society in a criminal court of law. Evidence can come in the form of weapons, documents, pictures, tape recordings and DNA. According to the American Heritage College dictionary, evidence is the documentary or oral statements and the material objects admissible as testimony in a court of law (476). It is shown in court as an item of proof, to impeach or rehabilitate a witness, and to determine a sentence. This paper will examine two murder cases, O.J. Simpson and Daniel Taylor. Perhaps the most famous case in the 20th century was the O. J. Simpson double murder trial. On June 12, 1994, two people were brutally killed. Those two people were Nicole Brown Simpson, O.J. Simpson's ex-wife, and Ronald Goldman. O.J. was arrested the next day and charged with their murder. O.J. pleaded innocent to murder and went to trial in criminal court. There was a load of evidences at the residence of Nicole’s to charge him with two counts of first degree murder and it seemed almost impossible for O.J. to be found innocent. There were loads of evidences found at the scene and O.J.’s home. The bodies of both Nicole Simpson and Ron Goldman, blood of the victims, shoe prints and other evidences. But, one of the main evidence was the questionable bloody glove found behind the guesthouse, which was proven by DNA testing to have O.J.'s, Nicole's and Ron's blood and hair on it. Fibers were also found on the glove that came from O.J.'s shirt and his Bronco (CNN). In addition, a bloody footprint which matched O.J.'s shoes, blood on O.J.'s Bronco door, on the console, on the interior side of the door, a bloody footprint in the Bronco, bloody socks in O.J.'s house, O.J.'s injured finger, blood found at Nicole's condo that matched O.J.'s, and so on (CNN). But, the defense claimed that the evidence had been planted. Eyewitnesses are also an important piece of evidence. Allen Wattenberg, a knife storeowner, testified during the preliminary hearing that O.J. bought a 14-inch Stiletto knife from his store. O.J.'s limo driver arrived to drive O.J. to the airport and saw a black man, with the same build as O.J. sprinting across the lawn towards O.J.'s house. When O.J. answered the door, he said he'd been napping (CNN). Simpson's houseguest stated that he saw Simpson pulled up in the white bro... ...ture on the bond slip appeared to be Taylor’s signature. Unlike O.J. there was no DNA linking him to the crime scene or the bodies. Again, all the evidences pointed favorably toward Daniel Taylor and despite the evidences presented, the jury found Taylor guilty of murder. In closing arguments, Needhand and Bishcoff sought to discredit the officers who had testified for Taylor, accusing them of covering up sloppy record keeping for fear they would be blamed for letting Taylor leave jail early to commit murders (Chicago tribune). In addition, the prosecutor used Daniel’s confession on tape to convict him. â€Å"Paperwork is not foolproof,† Bishcoff, the prosecutor, said. But I’ll tell you what is foolproof. And what is foolproof are the defendant’s own words† (Chicago tribune). REFERENCE â€Å"DNA Fingerprinting† (1997) Encarta Encylopaedia 1997 â€Å"Blood truths, Why the Police Want to Tag Your Body† Helen O’Neill, The Australian 6.12.1997 â€Å"Flaws in New DNA Database† Simon Kearny, The Sydney Telegraph 22.04.2001 â€Å"Jail For Rapist Caught by DNA† Noula Tsavdaridis, The Advertiser 21.10.2000 The American Heritage College Dictionary, 3rd edition, 1997, Houghton Mifflin Company, Boston MA, 476.

Tahiti and the French Polynesia :: essays research papers

Spread across nearly 2,000,000 square miles of the South Pacific, in an area as large as the continent of Europe, lies the Territory of French Polynesia and its principal island, Tahiti. Settlers from Southeast Asia are thought to have first arrived in the Marquesas Islands, in the northeastern part of what is today called French Polynesia, around 300 AD and in the Society Islands, including Tahiti, to the west by about 800 AD. Prior to the first European contact, the islands were ruled by a hierarchy of hereditary tribal chiefs. The first Europeans to visit the area were the English explorers Samuel Wallis in 1767 and James Cook in 1769. French explorer Louis-Antoine de Bougainville arrived in 1768 and claimed the islands for France. In the late 1700s occasional ships arrived in the islands, most notably the H.M.S. Bounty in 1788, captained by William Bligh. The first missionaries, from the London Missionary Society, arrived in the islands in 1797. By 1815, with the support of the most powerful ruling family in the islands, the Pomares, the British missionaries had secured a strong influence in much of the Society Islands, doing everything possible to eliminate traditional Polynesian culture by barring traditional dance and music as well as destroying carvings and temples associated with native religion. The French continued to hold influence over the Marquesian Archipelago and eventually were successful in expelling the British and securing influence over much of what today constitutes French Polynesia, leaving the ruling Pomare family as little more than figureheads. In 1880, King Pomare V was forced to abdicate, and a French colony was proclaimed. By 1901, the colony included the Austral Islands, the Gambier Archipelago, the Marquesas Islands, the Society Islands and the Tuamotu atolls to the southeast. The first half of the twentieth century saw periods of nationalistic protest in the colonies which were by then called the Établissements franà §ais d'Ocà ©anie (French Pacific Settlements). It was not, however, until after World War II, when Tahitians who had served France returned home, that pressure forced the French government to extend French citizenship to all islanders. The first territorial assembly was established in 1946, and by 1949 the islands obtained representation in the French Assembly. In 1957, the territory was officially renamed the Territory of French Polynesia. The Republic of France is represented in the territory by a high commissioner appointed by the Republic. Throughout the second half of the twentieth century, limited autonomy was granted to the territorial government to control socioeconomic policy but not defense, law and order, or foreign affairs.

Men and Women in Non-Traditional Sports Essay examples -- Sports Femal

Men and Women in Non-Traditional Sports The benefits of an individual entering a non-traditional sport for his or her sex can be huge – but they are usually greater for society in general than for the athlete him/herself. Being the first person to break into a non-traditional sport would obviously be trying on the athlete, who would have to face the questioning and criticisms of media, fans, and even their fellow athletes. But one athlete’s determination and persistence can open up a whole new world to both athletes and spectators. In the early 1900s, women did not participate much in figure skating competitions, partly because of the fact that they had to wear long, movement-hindering skirts. But some women did fight to participate. Eventually, when they were allowed to change certain rules (such as the one about wearing long skirts), women proved that they could compete with men. They were permitted to participate in competitions like the National Championships and the Olympics, and soon after that, women’s figure skating became an immensely popular sport. Today, it is traditionally one of the most-watched events of the Olympic games. Similarly, the NHL’s Tampa Bay Lightning invited female hockey goaltender Manon Rheaume to training camp in 1992. She played one exhibition game against St. Louis before being sent to the minors, but the publicity surrounding her stint with the National Hockey League did wonders for women in hockey. In the 1998 Olympics, women’s ice hockey was introduced as a new sport. The victory of the US Olympic team made the sport even more popular in the United States, and it is not uncommon today to see girls alongside the boys at youth hockey practices. Desegregating a sport can also add a ne... ...orts has been great in recent years. Women of the past broke barriers in sports such as track/field and figure skating, and women of recent times have broken the gender barriers in sports like basketball and hockey. Now, having women participate in sports like figure skating is not only totally natural, but a crucial part of major competitions such as the Olympics. Similarly, the sports like basketball and hockey will soon become integrated and will gain popularity among female athletes to the same degree. On the other hand, some male athletes are fighting for equality in typically female sports. As these pioneers break down gender barriers, they make way for the athletes of the future. While there are many issues that need to be resolved when barriers are broken, hopefully soon in the future all athletes will be looked at for their ability rather than their gender. Men and Women in Non-Traditional Sports Essay examples -- Sports Femal Men and Women in Non-Traditional Sports The benefits of an individual entering a non-traditional sport for his or her sex can be huge – but they are usually greater for society in general than for the athlete him/herself. Being the first person to break into a non-traditional sport would obviously be trying on the athlete, who would have to face the questioning and criticisms of media, fans, and even their fellow athletes. But one athlete’s determination and persistence can open up a whole new world to both athletes and spectators. In the early 1900s, women did not participate much in figure skating competitions, partly because of the fact that they had to wear long, movement-hindering skirts. But some women did fight to participate. Eventually, when they were allowed to change certain rules (such as the one about wearing long skirts), women proved that they could compete with men. They were permitted to participate in competitions like the National Championships and the Olympics, and soon after that, women’s figure skating became an immensely popular sport. Today, it is traditionally one of the most-watched events of the Olympic games. Similarly, the NHL’s Tampa Bay Lightning invited female hockey goaltender Manon Rheaume to training camp in 1992. She played one exhibition game against St. Louis before being sent to the minors, but the publicity surrounding her stint with the National Hockey League did wonders for women in hockey. In the 1998 Olympics, women’s ice hockey was introduced as a new sport. The victory of the US Olympic team made the sport even more popular in the United States, and it is not uncommon today to see girls alongside the boys at youth hockey practices. Desegregating a sport can also add a ne... ...orts has been great in recent years. Women of the past broke barriers in sports such as track/field and figure skating, and women of recent times have broken the gender barriers in sports like basketball and hockey. Now, having women participate in sports like figure skating is not only totally natural, but a crucial part of major competitions such as the Olympics. Similarly, the sports like basketball and hockey will soon become integrated and will gain popularity among female athletes to the same degree. On the other hand, some male athletes are fighting for equality in typically female sports. As these pioneers break down gender barriers, they make way for the athletes of the future. While there are many issues that need to be resolved when barriers are broken, hopefully soon in the future all athletes will be looked at for their ability rather than their gender.

Intelligence Essays -- essays research papers

Intelligence (what it is, and what it is not)   Ã‚  Ã‚  Ã‚  Ã‚  Today more then ever one can sit back and look out upon the world around them. One can look in the homes and see the children busy with homework. One can see the computers sorting through mass amounts of information. One can also see nature exist as it has for countless years. Over history as the Human race has developed it has taken a fascination in the world around it. It’s main query is what separates it from the rest of what can be found on this small blue green planet called Earth? One of the commonly held answers to this is intelligence; but what is intelligence? What has it and what dose not? This is what shall be covered through the duration of this paper. Intelligence- The ability to process the information found in one’s surroundings and use it to make a logical decision based on more then just environmental stimuli. The ability to store that information until it is further needed. The ability to build upon the previously known information to help to improve the conditions of that beings existence.   Ã‚  Ã‚  Ã‚  Ã‚  This definition covers all the main points in which an intelligent being should have. This said there may result some confusion as to what certain words imply, because of this the next few sentences shall be devoted to clearing such confusion. The first word is surroundings; Surroundings are the habitat or environment in which that being can be found. Logic is the...

Pharmacology; Clinical review assignment: Renal failure Essay

Renal failure is an increasing concern in Australia, with over 54 people dying every day from kidney related disease. The incidence of this pathology has been shown to be growing, with the number of people on dialysis rising by 4% from 2010 to 2011 (National Kidney Foundation, 2013). It is estimated that approximately 1.7 million Australians over the age of 25 show signs of renal failure, either chronic or acute. Indigenous Australians are also four times more likely to die from renal failure than non-indigenous Australians (Australian Bureau of Statistics, 2006). Signs of renal failure often show themselves in the form of reduced kidney function, proteinuria (protein in the urine) or haematuria (blood in the urine). Renal failure is a condition involving the failure of the kidneys, or more precisely the nephrons within the kidneys. The nephron is the functional unit of the kidney, with approximately 1.5 million working to filter blood of wastes and reabsorb water and electrolytes necessary to maintain homeostasis (U.S. Patent No. 5,092,886A, 1992). Renal failure occurs when the kidneys fail to filter blood adequately, it is often undetected until late stage failure has occurred. There are two main forms of renal failure; acute kidney disease and chronic kidney disease, both with underlying pathologies (U.S. National Library of Medicine, 2013). Treatment for renal failure involves either dialysis; filtering of the blood to remove metabolic wastes, or a kidney transplant, which is not a cure and requires permanent care and maintenance post-surgery. As of December 2012, 1080 people are waiting for a kidney transplant in Australia (Better Health Channel, 2013). It is important for paramedics to recognise and understand the underlying pathology behind renal failure as the condition results in a wide range of secondary effects & has many different presentations, with some as simple as headaches and â€Å"stomach pain†; pain in the kidney region, and more serious presentations such as metabolic acidosis (National Kidney Foundation, 2013). Pathophysiology: All 1.5 million nephrons in the kidney are working constantly to filter  blood. The kidneys receive approximately 25% of cardiac output via the afferent arteriole, into the bowman’s capsule which surrounds the glomerulus. The glomerulus is often described as a colander, as it is semi-permeable, only allowing certain things to pass through it. The kidneys main functions are to filter the blood, but they also have many other functions, such as regulating acid/base and fluid/electrolyte balances, reabsorbing water and electrolytes and excreting urine. â€Å"In addition, the kidneys excrete metabolic waste products, including urea, creatinine, and uric acid, as well as foreign chemicals† (DeRossi & Cohen, 2008). The kidneys also serve an endocrinological function, â€Å"secreting rennin, the active form of vitamin D, and erythropoietin. These hormones are important in maintaining blood pressure, calcium metabolism, and the synthesis of erythrocytes, respectively.† (DeRossi & Cohen, 2008). The progression of renal failure is often undetected, with renal function able to continue until 50% of the nephrons per kidney are destroyed. After nephrons are destroyed they never regenerate (Tilgner, n.d.). Compensatory buffer mechanisms exist in the body to counterbalance the effects of renal disease. As the kidneys are responsible for water and electrolyte balance, shifts in solute concentrations due to nephron destruction can be seen. Isosthenuria, which is excretion of urine that has not been concentrated by the kidneys and therefore has the same osmolality/gravity as plasma, is the first clinical sign of impaired renal function. Water along with sodium is flushed from the body resulting in dehydration & an electrolyte imbalance (DeRossi & Cohen, 2008). â€Å"In a healthy body, the acid-base balance is maintained via buffers, breathing, and the amounts of acid or alkaline wastes in the urine; this is because the daily load of endogenous acid is excreted into the urine with buffering compunds such as phosphates.† (DeRossi & Cohen, 2008). When the kidneys functions are impaired, a backlog of hydrogen (H+) ion occurs and the nephrons ability to excrete acid becomes inadequate. This results in ketoacidosis, a condition in which the body’s pH falls dangerously below it’s normal homeostatic range, commonly detected by the ‘fruity’ scent of a patients breath which occurs due to acetone; â€Å"a direct byproduct of the spontaneous decomposition of acetoacetic acid† (DiTomasso, Golden & Morris, 2010). Diagnostic tools; The main ways of diagnosing renal failure include serum chemistry/blood tests, urinalysis and creatinine clearance tests. Serum chemistry is the analysis of blood, when diagnosing renal failure, changes in â€Å"Sodium, chloride, blood urea nitrogen (BUN), glucose, creatinine, carbon dioxide, potassium, phosphate, and calcium levels provide a useful tool to evaluate the degree of renal impairment and disease progression.† (DeRossi & Cohen, 2008). The most important of these are creatinine and blood urea nitrogen, both of which are byproducts of protein metabolism which in healthy people is excreted in urine after filtration. In patients with renal failure the levels of createnine and BUN increase to toxic levels, indicating significant functional loss of the kidneys (â€Å"Creatinine Levels and BUN,† 2012). Urinalysis involves examining a patients urine sample, detecting protein, blood, determining osmolality and microscopic examination (Klatt & Georgia, 2013). The main indications of renal failure that urinalysis detects are hematuria and protienuria. Hematuria is defined as â€Å"†¦the presence of red blood cells in the urine. It can be characterised as either â€Å"gross† (visible to the naked eye) or â€Å"microscopic† (visible only under the microscope)† (â€Å"Blood in the urine (Hematuria)†, 2013). Hematuria is commonly benign in younger age groups, with cases of patients less than 40 years old almost always benign. In older age groups hematuria is seen as more serious, prompting medical investigation into the pathology to rule out other causes, such as infection or cancer, as many different types of cancers (bladder, kidney, prostate, urethral) also present with hematuria (American Urological Association, 2005). Proteinuria is another indication of renal failure, occurring when urine samples contain an elevated level of protein, or albumin, which is the main protein in the blood (National Institute of Health, 2010). Proteins are large molecules and should not pass through golmerular filtration. â€Å"The upper limit of normal urinary protein is 150 mg per day; patients who excrete > 3g of protein per day carry a diagnosis of nephrotic syndromeâ€Å" (DeRossi & Cohen, 2008). A creatinine clearance test is another diagnostic tool used to determine renal failure, focusing on the glomerular filtration rate to determine the level of functioning renal nephrons. Creatinine is a metabolic by-product of creatine, which remains at a constant value in the urine. It is caused by breakdown of muscle tissue, and is 100% filtered by the glomerulus. No reabsorption of creatinine should  occur in normal functioning tubules within the nephron (National Institute of Health, 2010). This diagnostic test is done via collecting a urine and blood sample within 24 hours. â€Å"In chronic renal failure and in some forms of acute disease, the GFR is decreased below the normal range of 100 to 150 mL/min. Advancing age also diminishes the GFR, by approximately 1 mL/min every year after age 30 years.† (DeRossi & Cohen, 2008). Acute vs. Chronic; Renal failure classification is broken down into two different parts; onset and location. Renal failure can be acute; occurring within a timeframe of days to weeks, or chronic; renal failure that develops slowly over years. The location of the failure is the second criteria, determining the type of destruction within the nephron (pre-renal, renal, intrinsic or post-renal) (The Renal Association, 2012). Determining the type of renal failure is important as acute renal failure is mostly curable, whereas chronic renal failure is progressive and irreversible, often leading to death. Acute renal failure is characterised by the rapid loss of kidney function, occurring over a few days to weeks, causing azotemia, a condition where a build-up of nitrogenous wastes products occurs, causing metabolic acidosis (DeRossi & Cohen, 2008). It can be broken down into sections based on where the failure is occurring within the nephron. Pre-renal failure occurs due to a reduction in blood flow/renal perfusion to the kidneys, causing loss of function. The kidney remains undamaged in this condition, with the problem being based solely on blood flow. It is the most common type of acute renal failure and can occur as a secondary illness from â€Å"almost any disease, condition or medicine that causes a decrease in the normal amount of blood and fluid in the body† (WebMD, 2013). Post-renal failure is less common, and is caused by an obstruction of the flow of urine â€Å"from the kidneys at any level of the urinary tract and that subsequently decreases the GFR† (WebMD, 2013). It is most commonly caused by prostatic enlargement or cervical cancer, usually found in older males. Intrinsic renal failure is the final type of acute renal failure, occurring from direct damage/trauma to the kidneys. The most common types of intrinsic renal failure are â€Å"acute tubular necrosis (ATN), acute glomerulonephritis (AGN) and acute interstitial nephritis (AIN)† (WebMD, 2013). Causes of the decreased blood-flow/obstruction include;  surgery, cardiovascular disease, direct trauma/impact to the kidneys, severe burns, severe muscle injury or severe physical exertion (WebMD, 2013). Chronic renal failure focuses around nephron destruction. Renal conditions such as glomerulonephritis affects the filtration rate of the glomerulus, while polycystic kidney disease involves the failure of the renal tubules. Nephrosclerosis interferes with blood perfusion, but the most common diagnosis of chronic renal failure is â€Å"diabetes mellitus, followed by hypertension, glomerulonephritis and others† (DeRossi & Cohen, 2008). Although causes vary, each condition shares the common trend of irreversible nephron destruction. Application to paramedic practice: Paramedics must be considerate of all patients with renal impairments. Prophylactic measures are often taken in renal patients, managing â€Å"diet, fluid, electrolytes and calcium-phosphate balance†, as well as dietary modifications to counterbalance the common difficulties renal patients have with hypertension, oedema and weight gain (DeRossi & Cohen, 2008). Emergency care workers should be weary to maintain a blood pressure lower than 130/85mmHg. Bleeding disorders and anaemia are common conditions patients with renal failure will suffer from. Haemorrhaging and bruising are common. â€Å"The antidiuretic hormone vasopressin has been shown to be effective int he short term management of bleeding in patients with renal failure† (DeRossi & Cohen, 2008). Renal patients on dialysis should not have their intravenous injection site compromised by any medication an ALS paramedic may administer. Blood flow through the arm must not be blocked or obstructed, and as these patients are immunocompromised, efforts to avoid sources of infection must be made (DeRossi & Cohen, 2008). Pharmacotherapeutics is a serious concern for anyone treating a renal patient, as most drugs are excreted by kidney, â€Å"and renal function affects drug bioavailability, the volume of drug distribution, drug metabolism and the rate of drug elimination.† (DeRossi & Cohen, 2008). Drug dosage schedules must be altered according to the amount of residual renal function. Drugs that would normally be safe for most patients may be toxic in patients with renal failure. â€Å"The plasma half-lives of medications that are normally eliminated in the urine are often prolonged in renal failure and are effectively reduced by dialysis. Even drugs that are metabolized by the liver can lead  to increased toxicity because the diseased kidneys fail to excrete them effectively. Theoretically, a 50% decrease in creatinine clearance corresponds to a twofold increase in the elimination half-life of any medication excreted fully by the kidneys.† (DeRossi & Cohen, 2008) Knowledge on the pharmacology on all ALS paramedic drugs must be known as certain drugs are nephrotoxic and should not be administered. The early recognition of signs of renal failure is important as mortality rates from acute renal failure (the most common type of renal failure) are high, remaining constant over the past 40 years at approximately 40-70% (Fry & Farrington, 2006). References: National Kidney Foundation. (2013). Facts on CKD in Australia. Retrieved from http://www.kidney.org.au/Kidneydisease/FastFactsonCKD/tabid/589/Default.aspx Australian Bureau of Statistics. (2008). National Aboriginal and Torres Strait Islander Health Survery Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0/ Dobos-Hardy, M. (1992). U.S Patent No. 5,092,886A. Boston, Massachusetts. Patent Buddy. U.S. National Library of Medicine. (2013). Kidney Failure. Retrieved from: http://www.nlm.nih.gov/medlineplus/kidneyfailure.html Better Health Channel. (2013). Kidney Failure. Retrieved from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Kidney_failure. National Kidney Foundation. (2013). What are the risk factors for kidney disease? Retrieved from http://www.kidney.org.au/KidneyDisease/RiskFactorsandSymptoms/tabid/819/Default.aspx DeRossi, S. & Cohen, D. (2008). Renal disease. Burket’s oral medicine, 11(2), 407- 427. Tilgner, S. (n.d.). Urinary – Kidney support. Journal for the Clinical Practitioner, 10(3), 1-13. DiTomasso, A., Golden, A. & Morri s, J. (2010). Handbook of Cognitive-Behavioural Approaches in Primary Care. New York, NY: Springer Publishing Company. DOI: 10.1037/O.0027784 Creatinine Levels and BUN. (2012). Retrieved from http://www.kidneyfailureweb.com/creatinine/ Blood in the urine (Hematuria). 2013. Retrieved from: http://www.urologyhealth.org/urology/index.cfm?article=113 Klatt, E., Georgia, S. (2013). Urinalysis. Retrieved from: http://library.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html WebMD. (2013). Prerenal Acute Renal Failure. Retrieved from: http://www.webmd.com/a-to-z-guides/prerenal-acute-renal-failure American Urological Association. (2005) Hematuria. Retrieved from www.urologyhealth.org/content/moreinfo/hematuria.pdf National Institute of Health. (2010). Proteinuria. Retrieved from http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ National Institute of Health. (2010). Creatinine Clearance. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm The Renal Association. (2012). Acute Kidney Injury. Retrieved from https:// www.clinicalkey.com/topics/nephrology/acute-kidney-injury.html Fry, A., Farrington, K. (2006). Management of acute renal failure. Postgraduate Medical Journal, 82(964), 106-116.

Conformity Paper Essay

Conformity affects one’s behavior. There are two primary reasons why individuals conform. First, people conform due to informational social influence. What this means is that people rely on others’ judgment about an ambiguous situation and use such judgment in choosing a particular course of action. The second reason is normative social influence. This refers to conforming simply to be accepted. Conformity is a big issue in most people’s lives. In my case, there has been numerous times wherein I relied on other people’s judgment to make a certain decision. The very simple example is determining what hair style would suit me best. I have consulted and asked for advice from my friends and family for this very simple matter. I could not decide for myself and I had to rely on their judgment. Another case wherein informational social influence was a factor for me was when I was deciding which course to take. To me, such decision seemed very confusing. There were too many options. Thus, I needed to consult my parents. I asked them their opinion and ended up following what it was they advised me to do. Informational social influence is very evident in society particularly in advertising. Companies use advertisements wherein they promote their product by showing surveys conducted that show their product as the preferred choice of the majority. This is meant to influence consumers to follow suit. Most people would think, â€Å"If most people choose this, then it must be the best choice.† In other words, they leave their judgment to other people. This is a very good demonstration of how informational social influence affects the decision making and behavior of individuals. In the case of the second reason for conformity, normative social influence, I have had several experiences wherein it played a factor in my behavior at the given time. This was especially true during my teenage years. When I was a teenager, I felt the need to fit in. I wanted to be among the popular kids at school. In order to be among the popular crowd, I tried to do everything that the popular ones did. I dressed as I saw them dress, I talked and acted as they did. However, I noticed that the more I tried to be like them, the more they seemed to be distant. More importantly, my real friends and my family began to question me as to why I was doing things that were unexpected of me. As I grew older and matured, I began to realize that not only were my attempts in vain, they were ridiculous and unnecessary. Nowadays, every time I look back on those days, I cannot help but to laugh. â€Å"Fitting in† is a big problem for most teenagers. That is why most teenagers get into various kinds of trouble. Some teenage girls get pregnant at a very early age simple because they thought that losing their virginity would make them more welcomed in the popular crowd. On the other hand, boys end up joining gangs as they search for a sense of belongingness. Drugs and alcohol also are common problems that teenagers face because of their wanting to fit in and be accepted by their peers. Basically, this is where the concept of peer pressure comes in. Peer pressure is simply the result of normative social influence. Teenagers feel the pressure from their friends to do certain things. They feel that if they do not do as what their peers do, they will end up being scorned and laughed at. For a teenager, humiliation is a big drawback. This is the reason why teenagers end up changing their behavior simply to be accepted by others.